Congressman Tom Lantos died before completing work to improve PEPFAR. Some of his last words chided GOP ideologues, and could apply to some AIDS advocates who are running from a fight Lantos was eager to engage.

The nation mourns Congressman Tom Lantos (D-CA), a Holocaust survivor who served in the House of Representatives for 28 years and who died Monday. Lantos never caved in to forces of ideology, throughout his entire life, that suggested we should accept the politics of a few trying to claim power over many. His life is a triumph of courage, personal and political, over ideology for the sake of raw power.

Lantos also understood bipartisanship meant working across party lines to achieve real and genuine compromise, as he did with Rep. Henry Hyde, the Chairman of Foreign Affairs when the President's Emergency Plan for AIDS Relief (PEPFAR) was originally authorized and Lantos was in the minority. When PEPFAR was passed, the "E" in it standing for "Emergency," compromise was important. But even then Lantos did not compromise principle, working to balance competing ideas to address an urgent situation.

The reauthorization of PEPFAR this year, while every bit as important, need not be seen as an "emergency" and should not fall victim to political "expedience." Democrats won a majority, in part, because voters are fed up with social conservative ideologues. As such, the goal for PEPFAR reauthorization must be sustainable, workable programs that apply lessons from the first five years moving forward. The final bill should honor the convictions of Chairman Tom Lantos.

In a press release four days before he died, Lantos chided ideological Republicans on the committee, including Rep. Chris Smith, Rep. Steve Chabot, and Rep. Mike Pence, saying,

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Henry [Hyde], God rest his soul, joined me and many of our colleagues five years ago in ensuring that a bipartisan bill became law by creating a $15 billion program that has saved countless lives in some of the poorest countries in the world. That legislation included compromises on issues important to those of us who were then in the minority. It is a shame that the current minority is failing to honor this spirit of compromise and is willing to endanger a valuable U.S. foreign policy program addressing one of the most serious health care challenges that humanity faces today.

But it is not only social conservative ideologues on the House Foreign Affairs Committee that should be called out. It's not just Wendy Wright from Concerned Women for America, or Pastor Rick Warren trying to be an Evangelical moderate but never far from conservative ideologues. Some AIDS advocates seem too willing to appease, even though they know the scientific data, see the problems created by ideological politicians first-hand, and hear what public health experts around the world say:

PEPFAR's 33 percent abstinence-only earmarks prevent wider success and should be eliminated;

Failure to integrate reproductive health and HIV prevention endangers women and girls, failing to meet them where they receive health services, where the most could be done to prevent HIV. This is especially true in macho cultures where females cannot negotiate sex or access contraception to protect themselves from disease;

Local implementation of public health strategies, prevention and education efforts should not be dictated by politics, rather guided by people on the ground who know how to reach the most vulnerable populations;

Family planning and contraceptive services, according to the World Health Organization, should be available through other health interventions to prevent mother-to-child transmission.

Despite gathering and promoting much of this data and working to promote better understanding of the AIDS pandemic, Bono's Debt AIDS Trade Africa and the Global AIDS Alliance are suggesting that Democrats on the Foreign Affairs Committee give in to ideological demands of the far-right. The bill is not even marked up or out of committee where less ideological Republicans can work with Democrats to strengthen the bill.

Tom Lantos' last efforts before he died called for bipartisanship that can achieve real results, not appeasement.

Noting the mountains of evidence the World Health Organization and Institutes of Medicine have gathered in the first five years of PEPFAR, all encouraging a shift to longer term sustainability and emphasizing the importance of local implementation, Lantos said,

Facts are driving the reauthorization of the Global HIV/AIDS program, not ideology. The draft global HIV/AIDS reauthorization bill actually supports and increases the number or references to abstinence and faithfulness education as part of the integrated ‘ABC’ prevention approach. Yes, it removes the 1/3 abstinence-only earmark, which was included in the 2003 law over strong Democratic objections, because that restriction has proven to be hampering the effectiveness of programs in the field.

Bipartisanship is not an end we should seek for political expedience, but a means to improving public health policy and making certain that PEPFAR experience, public health data, and science prevail so that good money doesn't follow bad. Continuing to support failed abstinence-only programs with 33 percent earmarks that tie the hands of cultures vastly different than ours, binding them to narrow social ideologies that even the vast majority of Americans don't support, makes no sense.

Tom Lantos understood that, and so should Bono, DATA, the One Campaign and the Global AIDS Alliance. This is the moment to fight for what's right against ideologues who contributed to the spread of the AIDS pandemic for the first 25 years, and continue to stigmatize many.

Efforts by Democrats in Congress to improve PEPFAR based on proven scientific and public health methods, collected during the first five years of the program, should be strongly supported — especially by AIDS advocates — over the efforts of Republican ideologues that are trying to weaken the Lantos Bill.

More money on bad policies is not the way to confront this epidemic. There is no reason to cave to ideologues like Chris Smith, Mike Pence and Steve Chabot in the name of bipartisanship – especially when it flies in the face of sound public health policies.

If the Democrats, working with moderate Republicans who will not ignore scientific and public health data, cannot produce a dramatically improved bill, it may be better to wait for the new President and Congress, and raise awareness of the failures of conservative ideologues between now and the November election. PEPFAR money will continue to flow, and the chance for a better bill that can address problems on the ground will be vastly improved with a strong mandate for reality over ideology in the 2008 election.

Let the people who stand in the way of improving PEPFAR answer these questions:

1. Why shouldn’t Congress act on the recommendation by the Institutes of Medicine and the Government Accountability Office to remove the requirement that at least 33% of prevention funds be spent on abstinence-until marriage programs?

2. Under the current PEPFAR, countries have already asked to not have the abstinence earmark apply to them because it does not work. Why not listen to local public health experts?

3. While there are a range of ways to prevent HIV, we know that in practicality none of them on their own are always effective, so isn’t there a moral obligation to make all the tools available to people?

4. Given the savings – in lives and in money – for full scale up of prevention efforts, wouldn’t it be prudent to promote every prevention tool and behavior change available in a way that meets a country’s needs?

5. Who should be deciding what public health strategies work best in any country?

6. Do you believe people should be able to choose to use contraceptives?

7. Can you imagine that an HIV positive person may actually want to choose to not become pregnant and may live in a culture where women and girls cannot negotiate sex?

8. Should PEPFAR money be targeted to the most vulnerable populations to stem the spread of AIDS, and should local public health officials be able to determine who is most vulnerable in their communities?

9. Some Members of Congress have had sex with people other than their spouses – should their spouses have the information and services to protect themselves from HIV and other sexually transmitted infections?

10. Shouldn't reality trump ideology when it comes to preventing disease?

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