Trangendered Confusion

Senator Tom Coburn’s conflicted relationship with the global battle against HIV and AIDS took another turn Tuesday when he released a statement denouncing US government expenditure on the AIDS 2008 conference.

Credit where it’s due, Coburn supports funding the fight against HIV and AIDS, despite his self-declared and very public battle against anything he regards as unnecessary and wasteful government spending. He regards PEPFAR as “America's most significant foreign policy accomplishment since the Marshall Plan” and when he was in the House, he supported a law that sought to limit mother-to-child transmission of HIV as well as the reauthorization of the Ryan-White CARE Act. So far, so good.

It’s also true, however, that while the PEPFAR legislation is flawed (criticism of many of its flaws has appeared in previous editions of this newsletter), Coburn was on the wrong side of most if not all of those flaws. Conscience clause? He supported its expansion. Clean needle-exchange programs? Against. De-stigmatizing sex workers and men who have sex with men? Against, with bells on. Funding for abstinence-only education? Decoupling family planning assistance? Big thumbs up from Senator Tom. As I said, in every battle, Tom was on the wrong (if sadly, triumphant) side.

However, Coburn’s condemnation of the $450,000+ the US government spending is way off base. In whose world is it wasteful to send representatives of the National Institutes for Health (NIH), Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), U.S. Agency for International Development (USAID) and Office of the U.S. Global AIDS Coordinator (OGAC) to the world’s largest conference on AIDS? Welcome to Senator Tom Land. (And, truth be told, the $9,500 that the government spent on its prime-location, four-square, stand-alone booth was a steal, given the amount that booths were going for.)

Sure, we all have ideas to make these events better. And putting 25,000 people in one space is a sure-fire recipe for a few missteps, though the ones Coburn picked out were a mite strange. Specifically, he highlighted a ‘Sex Workers Mini Film Festival,’ (darn, missed it) and a session by another group of sex workers who have the temerity to be “proud” of their work. A workshop on sex after a positive HIV diagnosis also came under fire, as did, mystifyingly, a session titled “Good Catholics Use Condoms: How to Answer the Tough Questions Surrounding HIV/AIDS Prevention and Religion.” (Full disclosure: I was part of the team that presented at that workshop.) His spies though, were clearly overcome by the event, or perhaps merely over-sensitive to the potential presence of transgendered people. They saw a woman moderating that one, when everybody present could clearly see that Jon O’Brien is a man. As we all know, silly mistakes like that take away from whatever message we seek to get across.

His sign-off, “Talk or treatment? Conference or care?” presents a dichotomy that simply does not exist. These conferences provide so many rich opportunities to network with and learn from our colleagues that we simply cannot afford to let them pass without taking full advantage. As a doctor, Tom should know that. As the self-styled guardian of American’s tax dollars, there are many, many better targets than AIDS 2008. Give me a call, Tom, I have a list ready.

David Nolan