Why is Politics Determining U.S. Health Policy?

April 25, 2006—Tried-and-true methods of HIV prevention are under attack by U.S. government policies that place ideology ahead of scientific consensus, said Dr. Judith Auerbach, amfAR’s vice president of public policy and program development, during a guest lecture at the University of Washington, March 1.

The University of Washington’s Allen Edward Psychology Lecture Series brings together faculty from the University’s psychology department and international experts to share research on a variety of today’s most pressing health topics. Dr. Jane Simoni, associate professor at the University of Washington, joined Dr. Auerbach to discuss the ways in which politics is increasingly undermining evidence-based HIV prevention policy.

Dr. Simoni described her experience as a co-principal investigator of an NIH-funded study that was subject to congressional vote for de-funding. Among its goals, the study of gay, lesbian, bisexual, transgender, and two-spirit Native Americans in six urban centers in the United States, aimed to develop culturally appropriate measures to address this group’s disproportionate risk of contracting HIV/AIDS.

Deciding on appropriate HIV prevention interventions depends on a variety of factors, none more important than whether there is solid evidence that the intervention is, in fact, effective, said Dr. Auerbach. Unfortunately, in recent years, evidence-based approaches have been replaced by policies that reflect the ideological and political agendas of the U.S. government and its allies in Congress, Dr. Auerbach said.

Two clear examples of this are:

• The promotion of abstinence-only-until-marriage programs for HIV prevention, in spite of a lack of evidence that this approach is effective. On the contrary, systematic reviews have found that comprehensive sex education programs those that include an abstinence message and provide information about contraception and sexual risk reduction, including condom use are actually more effective in delaying sexual initiation and increasing condom use once sex begins.
• The disavowal of evidence demonstrating that, when used correctly and consistently, male latex condoms are the most effective HIV prevention technology available. U.S. government policy requires that references to condoms in its HIV prevention information emphasize their failure rates, even though condoms are between 80 and 95 percent effective in preventing the sexual transmission of HIV.

“The promotion of non-evidence-based abstinence-only-until marriage programs, and the suppression and distortion of information about the effectiveness of condoms represents the triumph of social ideology—specifically the belief that no one should have sex outside of heterosexual marriage—over public health science,” said Dr. Auerbach. “This has deleterious effects, particularly for young people, who, as the data indicate, might end up engaging in higher HIV-risk behavior.”

Another way to undermine the integrity of science in policy-making is to ignore the advice of scientific experts. One of the best-known examples of this is the issue of harm reduction, specifically syringe exchange programs, for preventing HIV infection among drug users, she said.

The sharing of contaminated needles accounts for about a quarter of all AIDS cases diagnosed in the United States. Scientific evidence repeatedly has shown that improving access to sterile syringes reduces the risk of HIV transmission and other blood-borne diseases among drug users, their partners, and their families without increasing drug use. But the U.S. Congress and several Administrations have ignored this scientific advice and continue to ban federal funding of syringe exchange programs.

“The argument is that, regardless of their disease prevention potential, making condoms and sterile syringes available will encourage wrong behaviors, and therefore, it is better to withhold them from people,” said Dr. Auerbach.

This erosion of evidence-based public policy will have a chilling effect on public health policy, public trust, and scientific research, she said.

Safeguarding fundamental scientific principles is not only crucial to assuring continued advances, it is also “central to preserving two core principles on which America was founded: representative democracy and separation of church and state,” Dr. Auerbach said. “Both of these are intended to ensure governance for the greater good and freedom from tyranny.”