Diary Prequel Package — page 196

i "Goosby is not bad," he said. "There are plenty of people who want Goosby -- but they'll be damned if the job is filled this way. This isn't the truth-in-advertising of the Obama campaign." Dr. Dybul's departure was both celebrated and condemned. Jodi Jacobson, a former head of the Center for Health and Gender Equity, which wants financing for all aspects of women's reproductive health, including abortion, wrote a blog post titled "Dybul Out: Thank You Hillary!!!" It argued that he had worked too closely with the far right, and she accused him of lobbying to please the Roman Catholic Church by letting its relief groups opt out of distributing condoms. Michael Gerson, a former Bush speechwriter and Washington Post columnist, shot back that "blogging extremists" like Ms. Jacobson had lied about Dr. Dybul's record and that his firing had left an important program without a leader. At the heart of the debate was the difficult bipartisan compromise behind Mr. Bush's AIDS plan. It is the darling of two groups that normally oppose each other: foreign policy liberals who want to help Africa and evangelical Christians who support mission hospitals there. Dr. Dybul was straddling some personal fences too: he was one of the Bush administration's few openly gay officials, a doctor who had treated AIDS patients in San Francisco and Africa, and he had donated to Democratic causes. His only predecessor, Randall L. Tobias, a former pharmaceutical executive, was promoted within the State Department, then ousted in the D.C. Madam scandal after acknowledging he had received escort-service massages -- a development that led to derision over the fund's abstinence policies. Mr. Tobias and Dr. Dybul surprised many with two early decisions that activists had expected fights over: Pepfar has paid for millions of condoms, and it buys cheap generic drugs from India, despite the pharmaceutical lobby's opposition. But conservatives in Congress imposed other restrictions: one-third of the money spent on prevention had to be used for teaching abstinence until marriage. Groups getting funds, including those helping prostitutes, had to sign a pledge condemning prostitution. And no money could be spent on clean needles for drug addicts. These issues were divisive not just for liberals and conservatives, but also between liberals. For example, some feminists think women needing money have a right to engage in prostitution, while others oppose it, saying it contributes to human trafficking and child rape. In separate studies, the Government Accountability Office and the Institute of Medicine both found that the abstinence earmark unnecessarily tied the hands of fund recipients, especially in countries where AIDS was concentrated among drug users and prostitutes.