Gay men have long subscribed to an AIDS prevention strategy that can be summed up in a single word: condoms. But now one of President Bush's top AIDS advisers, conservative Oklahoma physician and former U.S. representative Tom Coburn, says he would like to change that strategy--both inside and outside the gay community.
"I do believe in condoms for HIV prevention," Coburn tells The Advocate. "But I also believe in informed consent about the effectiveness of condoms. Ask any expert you want, and they will tell you that condoms are not always effective, and people have a right to know this."
During his tenure in Congress, Coburn, who in January was tapped to cochair the Presidential Advisory Council on HIV and AIDS (along with former Health and Human Services secretary Louis Sullivan), called for warning labels on condom packages stating that they do not prevent the spread of some sexually transmitted diseases. In 2001, Coburn demanded the resignation of the director of the federal Centers for Disease Control and Prevention, Jeffrey Koplan, who he charged had kept from the "American people the truth of condom ineffectiveness."
Coburn's position is a fundamental break with mainstream public health thinking. And even in the Bush administration, he hardly represents the majority view. Scott Evertz, the president's openly gay director of the Office of National AIDS Policy, is a proponent of education that includes instructions about the proper use of condoms. Nevertheless, since Bush tapped Richard Carmona--a man many expect will focus on bioterrorism-related health concerns--as U.S. surgeon general in March, activists believe Coburn will become the president's go-to guy when it comes to HIV and AIDS.
Coming at a time when HIV infection rates are climbing among sexually active gay men--some of whom are eschewing prophylaxis altogether--Coburn's new role is yet another major challenge, AIDS educators say.
"In our years of following the epidemic, we've never seen such a triumph of conservative ideology over sound concern about public health from someone who is in such a position of power," says Bill Smith, director of public policy for the Sexuality Information and Education Council of the United States. "Time and time again, we learn in focus groups with young people that they are being taught that condoms don't work, that HIV can get through holes in them. So they don't even bother using them. While it is true that condoms are not effective 100% of the time, we know for a fact that they are effective against the transmission of HIV."
Coburn, who peppers his remarks with references to exposure rates for a long list of STDs, says that instead of safer sex, he advocates abstinence or, in the case of gay men, monogamy.
Traditionally, advocates of abstinence-until-marriage education have ignored the situation of gay men and lesbians, who of course are denied the right to marry. Coburn, who opposes same-sex marriage, has obviously given this conundrum some thought. "If you asked if all gay men were monogamous, would there be fewer HIV infections, the answer is yes," he says. "The consequences of nonmonogamy are terrible. It tears up relationships and can make people vulnerable to STDs."
In addition, Coburn seeks to emphasize what he calls "responsibility" in HIV-education campaigns. …