Sex, lies, and contradictions: This could have been the subtitle of Wednesday's Congressional hearing on the President's Emergency Plan for AIDS Relief (PEPFAR). The hearing, chaired by Congressman Chris Shays (R-Conn), was called to review mounting evidence that one of the key restrictions under PEPFAR-a requirement (also known as an earmark) that one third of prevention funding go to abstinence-until-marriage programs-is undermining effective prevention programs on the ground because it is, in most cases, an "abstinence-only" program.

But at a hearing where the word evidence was used so many times it could give a scientist a headache, the most contentious, confusing and contradictory statements on evidence, ideology and program strategy came from Administration officials.

Some examples:

Sex: Don't have it. According to the Office of the Global AIDS Coordinator, a perfect world is one in which people abstain…..they simply don't have sex…and if they do have sex, it is only after they are married. If they must have sex, if they can't control themselves (note the little stigmatizing factor here….) then please use condoms to protect the innocent.

Never mind the evidence that marriage is not a protective factor for women. Never mind the evidence from country after country, including our own, that the majority of people become sexually active before they are married. Never mind the evidence from throughout the United States that federal programs promoting abstinence-only education are failing miserably at protecting older adolescents and young adults from infection or pregnancy. And never mind the mounting evidence that it is a combination of delaying sexual debut among adolescents and promoting a wide array of changes in behavior geared toward healthy safe, consensual sex–including safer sex practices such as reductions in the number of lifetime sexual partners, and correct and consistent use of condoms-that has contributed to declines in sexually transmitted infections in many countries.

Condoms: "The U.S. relied too heavily on condoms in the past." "The U.S. is de-emphasizing condoms under PEPFAR now because abstinence is a better strategy." "The U.S. sends abroad more condoms than any other country in the world." "The U.S. is sending more condoms abroad under PEPFAR than ever before." "Countries are relieved that the U.S. is not focused on condoms because everyone else is…"

Confused? So was I. But here are the facts: Today, with 5 million new infections each year, the U.S. is sending fewer condoms abroad than in 1990. Claims by OGAC that we've doubled condom procurement and distribution under PEPFAR are not true, as we are basically sending the same amount we did in 2001, before a strike in the main plant from which condoms are procured by the USG cut procurement in half in one year. Moreover, OGAC counts as "distributed by the US" all condoms from other sources that are sold by social marketing organizations supported by US dollars….a little double-counting never hurts, I guess, to make yourself look better. But in the end, it really doesn't matter how many condoms we sent abroad in 1996, because the people having sex now likely didn't stockpile them back then and there's still on average only about 4 condoms per sexually active male in most countries of Africa. And it really doesn't matter how many we are sending abroad today, if half or more of funding for prevention of sexual transmission is going to groups in countries such as Zambia that microwave condoms and then pour milk through them in public demonstrations proving that "condoms don't work." What does count is that U.S.-funded programs are re-stigmatizing condom use and safer sex practices as part of "fear-based" prevention strategies based on ideology, not evidence." And in places where the U.S. did provide the bulk of condom supplies in the past, such as in Tanzania, other donors are not able to make up the difference in the long run because their funds are tied up in other areas. The end result, as testimony by Dr. Lucy Nkya of Tanzania stated, is a shortage of condoms and a proliferation of new infections.

ABC: It's what countries want, stated Dybul, Hill, and Greene, over and over and over again. And our programs are locally led, says OGAC, so we are just doing what the countries themselves want to do. Yet, when asked by Congresswoman Barbara Lee, lead author of the PATHWAY Act of 2006, why, if this is true, we need an earmark to require certain spending patterns, both Dybul and Greene contradicted themselves by

by suggesting if we did not control the way the funds were spent, governments might actually just revert to the condom-crazed promoters of the past. So much for "local leadership" by our "partners." And, despite extolling the virtues of locally led initiatives, Dybul, Hill, and a raft of USAID and State Department staffers simply left the hearing room rather than stay for testimony by either Helene Gayle of CARE or Dr. Lucy Nkya on the ways in which the abstinence earmark is undermining effective prevention programs on the ground.

Evidence: OGAC and its supporters such as Ted Greene are all over the map on the evidence thing. Dybul started out extolling all the evidence that ABC as practiced by the U.S.—that's A, B ….(c…if you can't control yourself…)-and claiming credit for recent declines in prevalence in Kenya, for example, despite the fact that he later claimed that "we don't really know what works," and "behavior change takes a long time…"….so how is it that PEPFAR funding for prevention, which first started rolling out in Kenya only in late 2003, is responsible for declines in prevalence in that country?

What is more, Greene appears to make up his own evidence when it suits him. He claims that the majority of people in Africa are "abstinent" (so how is it that 80 percent of new infections in sub-Saharan Africa are sexually transmitted?) and that condoms are only 80 to 85 percent effective in preventing HIV transmission, when in fact research shows that correct and consistent use of condoms is at least 95 percent effective in reducing transmission of HIV and other sexually transmitted infections.

The only clear thing out of this hearing is that we have a bad law and a bad policy. And it needs to change. That message appears to be gaining ground, because as of today, the PATHWAY Act has the bipartisan support of 80 cosponsors, with more coming on board each week.