Do or Dybul

Was Bush’s AIDS czar a pragmatic dissenter, a tool of the religious right, or both?

On January 9, Ambassador Mark Dybul circulated a memo to his staff informing them that President-Elect Barack Obama’s transition team had asked him to stay on, at least temporarily, as the U.S. Global AIDS Coordinator, a position to which he had been appointed by President Bush in 2006. The backlash from AIDS activists was swift. William Smith, vice president for policy of the Sexuality Information and Education Council of the United States, blamed Dybul for continuing the Bush administration’s policies of abstinence education, downplaying condom usage, and failing to shape effective prevention policies for gays and prostitutes, groups at particularly high risk of contracting HIV. Dybul’s continuation of these policies, favored by the religious right, “made him a very good civil servant in the Bush administration,” Smith says. “He contributed to the destruction of a comprehensive approach to prevention.”
By all accounts, Dybul was passionately devoted to the cause of AIDS prevention and research; an openly gay medical doctor, he worked for years treating AIDS patients in San Francisco and Africa before migrating to the National Institutes of Health, where he conducted research on the disease. Since his appointment as Global AIDS Coordinator, the budget for the program he administered, the President’s Emergency Plan for AIDS Relief (PEPFAR), had more thantripled, extending countless lives through its disbursement of anti-retroviral drugs. Dybul had become the public face of a Bush administration program that many, liberals included, considered a success story.
On January 22, a day after Hillary Clinton was sworn-in as secretary of state, Dybul’s staff was promptly informed that their boss had been asked to tender his resignation. Since his firing, he has been criticized by many as a willing tool of the religious right. But far from a diehard standard-bearer of Bush’s misguided AIDS policies, Dybul was a pragmatic dissenter who eventually made too many sacrifices in his quest to get important work done in a relentlessly politicized office.

The story of Scott Evertz illustrates the confines within which Dybul operated. From 2001 to 2002, Evertz was director of the Office of National AIDS Policy, a position created prior to PEPFAR’s establishment in 2003. He seemed like an ideal Bush administration bureaucrat: Before taking a job in the administration, Evertz had served as president of the Wisconsin chapter of the Log Cabin Republicans (a gay GOP organization), and was a member of the“Austin 12,” a group of prominent gay Republicans with whom then-candidate George W. Bush met during the 2000 presidential election. At the time of his appointment, Evertz, who describes himself as a “conservative Republican,” was the only openly gay senior official in the White House.
But in April of 2001, two days after Evertz’s appointment was announced but before he was set to take office, he gave an interview to USA Today in which he departed from the conservative orthodoxy on a whole host of issues related to HIV/AIDS–endorsing, for instance, needle exchange programs and supporting safe-sex education for teenagers. After the interview was published, Evertz received a phone call from Bush’s chief of domestic policy, Margaret LaMontagne (who would later marry, change her last name to “Spellings,” and become secretary of education). “What’s up with this USA Today piece?” he recalls her asking him. “I hope the president doesn’t see it.”
In his new role, Evertz recommended Rose Brownridge, an African-American medical doctor who had served as chief of the HIV/STD Program in the Texas Department of State Health Services, to be director of the President’s Advisory Council on HIV/AIDS (PACHA). But she was passed over in favor of Patricia Funderburk Ware, a former actress and education director of a conservative religious organization called Americans for a Sound AIDS/HIV Policy, now called the Children’s AIDS Fund, which was one of the earliest proponents of abstinence-only education. Bush also appointed ultra-conservative Oklahoma Senator Tom Coburn as co-chairman of the council. Even though Evertz “did not object” to either of these appointments, he says, “as I thought this may even help me with the base to be seen as cooperative,” he wasforced out of his job at the White House in July of 2002 and given a new post at the Department of Health and Human Services. He blames his short tenure on the fact that he wasn’t initially vetted by the religious right.
He wouldn’t be the only senior-level public health official to lose his job because of politics. Anne Peterson, an assistant administrator for global health in the U.S. Agency for International Development and an evangelical who had worked with Christian aid groups in Africa, incurred the wrath of Focus on the Family founder James Dobson during a 2004 meeting at his Colorado Springs headquarters. There, Dobson asked Peterson for her position on condoms, to which she replied that they were an essential feature in HIV prevention alongside the encouragement of abstinence and monogamy. Soon after, Focus on the Family issued a paper criticizing her, and she eventually resigned under pressure. Peterson was replaced by Kent Hill, an evangelical Christian activist with neither a medical degree nor public health experience, who is currently the acting administrator of USAID.
According to Evertz, promoting scientifically sound HIV prevention policies in the Bush administration was a constant struggle. “If you’re me and you want to survive,” Evertz says, recalling his torturous years in government, “the policy that you articulate is the opinion of the religious right.”

The first time Scott Evertz met Mark Dybul was in 2001 at a luncheon meeting of the National Association of State and Territorial AIDS Directors. Dybul, Evertz recalls, “said he had little taste for Republicans, and had little faith in the Bush administration doing anything significant on AIDS.” But Dybul seemed to have learned from the experience of Evertz and Peterson, as it wasn’t long before he developed a close relationship with evangelical leader and AIDS activist Rick Warren, at whose Saddleback Church he spoke. A former White House official recalls Dybul bragging to him that “even James Dobson likes me.” Unlike Evertz and Peterson, Dybul voiced little concern in public over the Bush administration’s policies on HIV prevention, which paid little heed to the health needs of gays, prostitutes, or intravenous drug users.
Under Dybul’s directorship, PEPFAR supported a series of African figures (such as Ugandan Pastor Martin Ssempa) who oppose the use of condoms and support discriminatory, and at times violent, policies against gays. Ssempa, for instance, whose church has received PEPFAR money, recently declared that “homosexuals should absolutely not be included in Uganda’s HIV/AIDS framework. It is a crime, and when you are trying to stamp out a crime you don’t include it in your programs.” Under the Bush administration, the United States made little effort to confront the way these figures dealt with homosexuality (other than through token gestures like continuing to document anti-gay policies in their countries in annual State Department reports). And if Dybul, who had a significant role in controlling PEPFAR funding, made an effort to influence the policies of grantee governments, he was unsuccessful. “If you’re not addressing the epidemic in pockets like that, you’re never going to eradicate it or bring prevalence rates down,” says Cary Alan Johnson, Executive Director of the International Gay and Lesbian Human Rights Commission (IGLHRC).
Despite repeated requests for a meeting to discuss the United States government’s aiding and abetting brutal homophobia, Johnson says IGLHRC never received a reply from Dybul. Charles Francis, one of the Austin 12 and a PACHA member from 2002 to 2003, recalls asking Dybul why he didn’t pressure the Bush administration to cut its ties to extremist voices in Africa. “There’s extremists on both sides, Charles,” he recalls Dybul telling him. (Dybul did not return calls seeking comment for this article.)

The troubles with PEPFAR were hardly the fault of Mark Dybul. The program was founded in part to bypass the UN-affiliated Global Fund to Fight AIDS, Tuberculosis, and Malaria, in favor of more conservative faith-based initiatives. As explained in a recent article for Commentaryby Bush deputy domestic policy advisor Jay Lefkowitz. “Although we should continue contributing to the [Global] Fund [to Fight AIDS], developing and administering our own programs seemed to [Bush] by far the more effective approach.” Circumventing the Global Fund allowed the administration to funnel U.S. largesse towards the kinds of faith-based organizations beholden to religious conservatives at odds with family planning, condom distribution, or homosexuality.
The problems with PEPFAR were inherent in the 2003 legislation establishing the program, which catered to the religious-right base that the Bush administration was so frequently trying to please. PEPFAR requires that at least 33 percent of funds allocated for prevention efforts be devoted to abstinence-until-marriage programs. (Meanwhile, according to Johnson, of the $3 billion assigned to prevention in PEPFAR’s initial outlay, most of which went to Africa, his organization was able to locate just one program on the continent–receiving than less than $100,000–that addressed men who have sex with men.) Additionally, no federal funds may go towards needle exchange schemes–dirty needles are a leading cause of HIV transmission in Asia and Eastern Europe–nor to any entity that does not explicitly oppose prostitution. The consequences of these prohibitions have been costly. In 2005, for example, the government of Brazil, which has dramatically cut HIV transmission rates by educating sex workers about safer sex techniques, chose to forgo $48 million in U.S. funding rather than agree to the anti-prostitution clause.
Many organizations combating HIV–whether groups that worked with prostitutes, gays, or intravenous drug users–have been either neglected or explicitly prohibited from receiving U.S. money, while evangelical Christian organizations have had little problem accessing funds. In this way, while PEPFAR distributed drugs to millions of people living with the disease, the program undermined the global fight against HIV transmission. “How do you teach abstinence to a sex worker?” asks Kevin Robert Frost, the CEO of the American Foundation for AIDS Research.
It’s not difficult to see how Dybul rationalized his desire to stamp out HIV and care for its victims with the policies he propagated during the Bush administration. “In his mind, someone cut a deal with the devil, and in the end, he was delivering the drugs that were saving lots of lives,” one gay activist says. “I know [Dybul’s] philosophy is much closer to mine than the ones he had to go out and give space to,” the leader of a prominent AIDS organization told me. “But ultimately he chose to work for the previous administration and not speak truth to power and he chose not to push the issues that most people in the AIDS community believed needed to be challenged.”
What’s ironic about the Bush administration’s legacy on AIDS is that Evertz, its first “AIDS czar,” was a conservative who got the ax because of his association with liberals, while Mark Dybul, initially a skeptic of the Bush administration and “the furthest thing from a Republican or a conservative,” in the words of a former colleague, was forced out for going too far to mollify the religious right. Days after Dybul’s departure, former Bush speechwriter Michael Gerson attacked the Obama administration officials who orchestrated his ousting in The Washington Post, writing that “this type of captivity to extreme interests is precisely what has discredited Democrats so often in the past.” This was a hypocritical allegation coming from one of the chief architects and nurturers of the alliance between the Bush administration and the Christian right. But it was also an unwitting epitaph for the career of Mark Dybul, who, whatever his benign intentions, remained captive to extremists throughout his tenure in the Bush administration.