The battle, taking place largely out of public view, has intensified as some conservatives have attempted to gain greater control of the process through which U.S. aid groups working overseas get federal money.

Even groups that say they explicitly oppose prostitution appear to be losing federal support over their dealings with sex workers. Population Services International, which operates in brothels and bars in Central America, has recently seen its bid for a contract renewal go from the fast track to doubtful as the process was altered to favor a faith-based approach.

The antiprostitution push is the latest in a string of health policy moves made on ideological grounds. In 2003, when President Bush announced his $15 billion global AIDS plan, he earmarked a portion for "faith-based" organizations. This year, just more than $82 million - nearly a tenth of federal AIDS funding - went to such groups, double the amount in the previous year, according to the Office of the U.S. Global AIDS Coordinator.

On one side of the latest clash are mainstream public-health advocates, who say that to reduce AIDS, sex workers must be educated about condoms and other practices that lower risk.

'Aggressive agenda'

"Instead of getting on with the basics of treating and preventing AIDS, these religious conservatives have gone in with a very aggressive ideological agenda," said Paul Zeitz, director of the Global AIDS Alliance, a nonprofit group.

On the other side are those who say working with prostitutes perpetuates an evil practice.

"Giving money to groups that turn a blind eye to prostitution is unacceptable. If you're turning a blind eye to it, then you're supporting it," said Pia de Sollenni, director of women's issues at the Family Research Council, a conservative group.

The organization is one of dozens that signed an Aug. 4 letter to Bush, urging that political appointees in federal agencies scrutinize groups that receive federal funds to make sure their "actual field practices" do not condone prostitution.

Two years ago, in passing Bush's global AIDS initiative, Congress voted to deny funds to "any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking." The administration had required the pledge of international recipients, then extended it last spring to U.S.-based groups.

The move has triggered widespread objections. On May 18, more than 200 U.S. groups wrote the White House, contending that the policy was "undermining promising interventions" to fight AIDS.

Funding cuts fought

A U.S.-based HIV prevention group, DKT International, lost $60,000 in funding for work in Vietnam after refusing the pledge and has filed suit on free-speech grounds.

Conservative lawmakers have moved to beef up the policy. On July 20, the House passed a bill sponsored by Rep. Steve King (R., Iowa), that would require each group to give details of dealings with prostitutes. And a House subcommittee wants agencies to furnish a list of groups working with prostitutes. Meanwhile, two senators have written Bush attacking several federally funded groups. In a May 31 letter, Sen. Rick Santorum (R., Pa.), accused CARE and several other groups of having a "solid record of anti-abstinence, pro-prostitution, and anti-American activities."

The letter was addressed to Bush and to Andrew S. Natsios, the head of U.S. Agency for International Development, which handles about half of federal AIDS funding.

CARE denies the accusation.

"We do not promote prostitution or sex trafficking in any way," spokeswoman Beatrice Spadacini said.

An observer familiar with public health policy said HIV prevention groups were alarmed.

"This is a McCarthyite environment," said Jodi Jacobson, executive director of the Center for Health and Gender Equity, a nonprofit watchdog organization.

PSI, the organization whose contract appears in jeopardy, was criticized in May by Sen. Tom Coburn (R., Okla.). In a letter to Bush, he accused PSI of encouraging the work of prostitutes by throwing parties for them.

"There is something seriously askew at USAID when the agency's response to a dehumanizing and abusive practice that exploits women and young girls is parties and games," he wrote.

White House spokesman Ken Lisaius said Coburn's letter had been "referred to USAID for response." A spokeswoman for USAID declined requests for interviews with Natsios and other agency officials. Coburn was not available to comment.

PSI spokesman David Olson said Coburn grossly misrepresented the work. In Central America, the program holds events for prostitutes in places such as Guatemala City, including educational bingo games that focus on reducing risk.

Central America's HIV rate is about 1 percent, far less than in many other parts of the world. But among prostitutes it is as high as 20 percent. Last year, PSI's program made contact with 422,000 people in high-risk groups and sold 14 million condoms in the region. In parts of Guatemala, where PSI has significantly expanded its work, HIV infections among prostitutes have fallen by a third.

By David Kohn, Baltimore Sun, published in Philadelphia Inquirer, Oct 2, 2005

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