Disraeli, AIDS, etc.

DISRAELI'S CONSERVATISM

David Gelernter's article on Benjamin Disraeli ("The Inventor of Modern Conservatism," Feb. 7) is superb. His understanding of the historical memory that infuses conservatism is exactly right. Likewise his grasp of Disraeli's enormous contribution in blending memory (the Burkean wing) with progress (in some ways a 19th-century innovation) and democratic populism (the inclusion of the whole nation and the concern for the whole nation--Tory Democracy) into one strong system of behavior. Gelernter's closing paragraphs capture what I describe as "patriotic education" in my new book, Winning the Future.

Years ago I spent time with former president Richard Nixon discussing Disraeli's contribution to modern thought. I think Gelernter captured it well.

Newt Gingrich
Washington, DC

David Gelernter's excellent article on Disraeli correctly contrasts him with Friedrich Nietzsche, but also overlooks the close intellectual and spiritual kinship between the two men. In one of Nietzsche's first English publications ( Thoughts out of Season, 1909), editor Oscar Levy pointed out that the only author whose work could prepare the English-speaking public for Nietzsche was "a man whose politics you used to consider and whose writings you even now consider as fantastic, but who, like another fantast of his race, may possess the wonderful gift of resurrection, and come again to life amongst you . . . Benjamin Disraeli."

Both Nietzsche and Disraeli recognized the disastrous cloud of nihilism looming over Europe and fought against it. Disraeli's last, unfinished novel (available as an appendix in Monypenny and Buckle's Disraeli biography) prophetically describes a political movement whose only real function is to exterminate as many human beings as possible--an idea as fantastic to the Victorians as it is familiar to the survivors of the 20th century. But Disraeli's foresight does not stop there. The villains of this novel construct a social circle that is eerily indistinguishable from today's postmodern academic and political establishment.

Robert A. Harman
Kingston, NJ

Since Benjamin Disraeli has long been one of my favorite modern European historical figures, I have been disturbed by the lack of serious scholarship on his life and ideas. Perhaps David Gelernter's fine article will trigger a renewed academic interest in Lord Beaconsfield.

My only quibble is with Gelernter's characterization of Disraeli and religion. Gelernter presents Disraeli's strong embrace of Christianity as being a mistake. This is far too simplistic a view of a man so enthralled by the traditions of Christianity as Disraeli, a man who counted St. Ignatius Loyola as one of his literary heroes. It also glosses over Disraeli's firm belief that Christianity was the natural and organic extension of Judaism.

As Disraeli biographer André Maurois writes in Disraeli: A Picture of the Victorian Age, "[Disraeli] did not understand how a Jew could not be a Christian; in his eyes that was to stop half-way and to renounce the glory of that race, which was that it had given the world a God."

Nevertheless, Gelernter's was an extremely insightful article on an oft-neglected individual.

Eric D. Thorner
Little Neck, NY

David Gelernter writes with admiration for Benjamin Disraeli. No doubt Disraeli was admirable in many ways. But his consistent opposition to repeal of the Corn Laws, which he saw as a means of preserving "the preponderance of the landed interest," likely increased the level of suffering and starvation in the Irish potato famine. (The potato famine began in 1845, the year before the Corn Laws were finally repealed.)

Disraeli clearly thought the landed gentry, in their paternalism, did a better job of caring for members of the laboring classes than workers, given the opportunity, could have done for themselves. But as economic history has shown, competition increases wealth and leads to more efficient use of resources. And as recent U.S. welfare reforms have demonstrated, treating the poor as adults can help lead them out of poverty.

Indeed, to believe that even people with few advantages can and will seize opportunities for self-improvement and wealth-building is a bedrock belief of American conservatism. To extol as an icon for modern conservatives someone who lacked insight into this aspect of human nature seems both strange and counterproductive.

Emily Rudd
Boulder, CO

How to Beat HIV/AIDS

Edward C. Green raised serious concerns about how committed the U.S. Agency for International Development is to the "A" and "B" components of the "ABC" (Abstain, Be faithful, or use a Condom) approach to AIDS prevention ("AIDS in Africa--a Betrayal," Jan. 31).

Over the last several years, USAID has conducted or sponsored much of the research that has documented the effectiveness of the ABC method. We at USAID have funded research by Green and others that played a key role in producing the international consensus that the ABC approach is essential to the prevention of HIV transmission in countries experiencing a generalized epidemic. In fact, Green was a major source for the seminal USAID publication "What Happened in Uganda?" This told the story of the decline of Ugandan HIV/AIDS prevalence from 15 percent in 1991 to 5 percent in 2001 due to the practice of ABC, and particularly the role of "A" and "B" in that success. As a result of the success in Uganda, President Bush's Emergency Plan for AIDS Relief adopted ABC as the foundation of our own strategy. America is now spearheading this prevention strategy worldwide in collaboration with host governments.

The Ugandan government is very much committed to implementing an ABC approach, and USAID is supporting these efforts. Currently, USAID is working with First Lady Janet Museveni and the Ugandan Ministry of Education to implement abstinence education programs for youth. In 2004, USAID dispersed approximately $7.2 million in Uganda for interventions that promote abstinence and faithfulness, including a major initiative in schools that promotes abstinence and is championed by President Museveni. By comparison, USAID dispersed $4.8 million for programs that target condom promotion to high-risk groups and diagnose and treat sexually transmitted infections. USAID is also moving to bring in new partners to the war on HIV/AIDS, particularly in A and B behavior-change programs.

In the past four years, USAID has moved from a strategy that emphasized broad-based marketing of condoms to a more balanced approach that significantly strengthens and recognizes the special importance of A and B. Under the Emergency Plan for AIDS Relief, USAID and other U.S. agencies have been able to increase funding for programs that promote abstinence and faithfulness, with particular emphasis on abstinence for youth.

Recently, for instance, USAID announced 14 new, centrally funded grants for A and B programs totaling approximately $125 million over five years. Still, during this period of transition to a strong focus on A and B, there have been challenges and problems in fully implementing the change to a more balanced policy.

As the newly appointed acting assistant administrator for USAID's Bureau for Global Health, I am fully committed to promoting effective ABC programs in Uganda and elsewhere. I look forward to meeting with Green and other critics of our policy or its implementation. In February I traveled to Central Asia. In March I will travel to Africa (Uganda and Ethiopia) to assess how we are doing and to consider ways in which we can best implement a balanced ABC approach to HIV prevention.

The bottom line is, we share Green's deep commitment to Uganda's ABC strategy, and to using it worldwide.

Kent R. Hill
USAID Bureau for Global Health
Washington, DC

Long after most public health experts agreed that all three prongs of the "ABC" approach to HIV prevention are critical to success, Edward C. Green continues his anti-condom crusade.

Green insists that condom use has only a minor role to play in HIV prevention, and that promoting abstinence and fidelity are by themselves adequate strategies for those not already infected or in "high-risk" groups (such as prostitutes). But the data he cites belie his assertions. Green points to surveys suggesting that "more than half of African males and females between the ages of 15 and 19 are abstaining from premarital sex."

In other words, nearly half of unmarried African teenagers are not abstaining. To ignore the "C" in ABC is to withhold a critical weapon in the fight against HIV/AIDS from citizens of all ages, including young married couples who may wish to delay childbearing in addition to protecting themselves from sexually transmitted infections.

Along with Green and more than 140 leaders from around the world, I signed the consensus statement on HIV/AIDS published in the Lancet. Contrary to Green's characterization, the statement does not endorse the primacy of abstinence and monogamy in HIV prevention. Indeed, it recognizes that even as we promote "A" and "B," we must expand and improve condom use among those who are sexually active.

The AIDS epidemic must be faced head-on and addressed comprehensively. It's time to stop denigrating any of the three elements of the ABC strategy.

Sharon L. Camp
Alan Guttmacher Institute
Washington, DC

While we do not agree with Edward C. Green that the United States is overemphasizing the use of condoms in preventing the spread of HIV/AIDS, we share his concern about uneven implementation of the so-called ABC approach, which in itself is too narrow to effectively fight the pandemic.

Surprising as it may be to people like Green, international women's health organizations such as ours are deeply concerned that the Bush administration uses ABC as a mantra for its AIDS prevention efforts, but employs nothing more than rhetoric to promote fidelity. As the AIDS pandemic feminizes rapidly, women are at grave risk.

Neither abstinence nor condoms can protect women from unfaithful husbands, sexual coercion, or violence. Changing individual behavior and promoting faithfulness are fundamental to achieving the administration's goal of preventing 7 million new HIV infections. Correctly implemented, "B" programs can lead to individuals' valuing and respecting their partners--and faithfulness grows from that. Properly undertaken, efforts to encourage fewer sexual partners and the rejection of sexual violence and coercion will help slow the spread of HIV. In addition, parents learning to be faithful to their young daughters' rights--for example, keeping them in school and not marrying them off to much older men (who often have HIV)--should be part of the equation.

Adrienne Germain
International Women's Health Coalition
New York, NY

It is a difficult task to challenge the many assertions made by Edward C. Green. Difficult not because he makes his case convincingly, but because paragraph after paragraph is constructed upon red herrings that almost make one think he has spent too much time in his Harvard ivory tower. Green presents viewpoints as facts, excludes the findings of others who have examined the Ugandan HIV/AIDS model, and assumes--in direct conflict with the research--that teaching abstinence along with other methods of disease prevention is incompatible.

For example, Green begins by outlining how Uganda's AIDS policy is founded on the now ubiquitous "ABC" approach, which Green contends means the "promotion of sexual abstinence and fidelity, with condoms promoted only quietly, to high-risk groups and those already infected." Let's be clear: The coining of ABC was and is a notion devised by Western researchers who set out to determine why Uganda was successful in stemming the spread of HIV. It was then, and remains now, a dumbed-down, after-the-fact formula that fails to capture the complex and vast response from every sector of Ugandan society.

Green also asserts that Uganda's AIDS program relegated condoms to the fringes of society. This simply is not true, but since Green insists that this was "an open secret" known by a select few--including Green himself--why don't we get all the secrets out on the table. Uganda's president and his erstwhile spouse (who is now a regular on the abstinence-until-marriage lecture circuit) only began parroting Green's--and President Bush's--slanted interpretation of ABC when it was clear that the Bush administration would look favorably upon such a stance. As Green says, Western donors like the United States "pay the bills" and "have a great deal of influence on national strategy," including HIV/AIDS.

We have an opportunity here. It is an opportunity for the billions of dollars spent by the U.S. government to make a real difference in the lives of millions of people. I'd like to believe Green feels similarly. But demonizing the good people working on behalf of our country in difficult circumstances overseas is not productive. Nor are the contrived and offensive assertions Green makes about the "hypersexed African that Western AIDS experts have been selling since the beginning of the AIDS pandemic."

Our good and moral response to the global HIV/AIDS pandemic deserves a more sophisticated level of debate.

William Smith
Sexuality Information and Education Council of the United States
Washington, DC

Edward C. Green responds: I am especially pleased to see Kent R. Hill's letter, and in fact I have already met with him. I am pleased to see his commitment to ensuring the full implementation of our government's "ABC" policy. I have worked in association with USAID for 25 years and have evaluated many of its programs. I could say a great deal about many of the good things they do, and the positive impact they've had. AIDS prevention has been problematic, however, and not just at USAID but almost everywhere, due to the model of prevention we were all working with.

I am a little suspicious of the statistics suggesting that more funds are now going to faithfulness-abstinence programs than to condom programs. There are many different ways to make these estimates. The actual cost of condoms is a very small part of programs that promote and distribute condoms. Moreover, there is condom promotion in programs officially classified as "voluntary counseling and testing," among others. But I don't wish to quibble with Hill. Instead, I am delighted with the offer to move forward to solve the problem, whatever its magnitude, and to keep lines of communication open with critics.

For the other writers, who think I am crusading against condoms, let me say that I understand your feelings. For many years I held your viewpoint (we have to defend condoms against all those crazy religious conservatives!). But let me put out a simple challenge: Can you find any study published in a peer-reviewed journal that suggests an increase in condom promotion has led to lower HIV infection rates anywhere in Africa? (I'm talking at the population level, not just among a high-risk subgroup such as those in commercial sex.)

This is a reasonable request, because condoms have represented the first line of defense for all Africans, not just those at high risk, such as those famously targeted in Bangkok. If you cannot produce a single study, then maybe Uganda's original approach of promoting fidelity and abstinence to most of the population, while targeting condoms to high-risk groups, is not such a crazy idea. It's hard to argue with success.