Tuesday, May 01, 2007

New and exciting forms of abstinence

Tobias Randall, head of the $15 billion President's Emergency Plan for AIDS Relief (PEPFAR) and administrator of the US Agency of International Development (USAID), resigned last week after he admitted having used a Washington escort service for massage. Randall stated firmly that he did not pay for, or receive, sexual favors. His plea of innocence -- made while handing in his resignation -- will help the cause of Deborah Jeanne Palfrey, the boss of the escort service, who claims that her business is legal because it involves only the use of costumes, massages, lascivious conversation, and (for example) young women playing Monopoly in the nude.

The irony, of course, is that Mr. Randall was a strong proponent of 'abstinence only' programs to prevent HIV transmission worldwide, and was also the chief enforcer of the 'Anti-Prostitution pledge', which requires USAID grantees to state their opposition to prostitution in writing and strongly discourages programs that distribute condoms to sex workers. In other words, Randall seems to have very much enjoyed the company of women who, in his professional role, he didn't mind exposing to risks of HIV infection worldwide. And if things were not bad enough, Mr. Randall is quoted in his ABC interview as saying that he 'invited gals to come over to the condo' to give him a massage, stating a special preference for 'Central American gals.' Did he really say 'gals'? Mr. Randall is one step away from being the Don Inus of global health.

On the other hand, according to his own account, Mr. Randall did abstain after all. You might even say that the former 'AIDS Czar' was taking abstinence to a new erotic level, showing the rest of us that abstinence could be very very sexy, albeit without the sex, a way of having your cake and not eating it too. Perhaps it was an exercise in policy experimentation, a bold personal journey beyond the ABC approach to a place where you are not really faithful, not really abstinent, not really using a condom, not really at risk for HIV and not really having sex. (Such behavior may not be for everyone, so he wanted to try it out first.) Then again, maybe it was simply a case of an repressed hypocrite, who was riding his moral high horse last week, and whose name does not even register on the USAID or US Department of State websites this week.

What lessons are to be drawn from this? One possibility is to acknowledge, rather than deny, the pervasive sway that sexuality has over humanity, and try to translate that acknowledgement into science-based and psychologically realistic policies dealing with sexually transmitted diseases around the world. Given the number of lives in the balance in the fight again HIV/AIDS, winning that acknowledgement is far more important than explaining Mr. Randall's puzzling failure to find a registered massage therapist in the nation's capital.


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