The Red Cross: A Question of Competence
The AIDS Manual
In early 1995 the special team went so far as to intervene in previous Red Cross public health policy in the interests of Elizabeth Dole's private political agenda. That spring, less than a year from the first presidential primary in New Hampshire, the American Red Cross was readying an updated version of what was nicknamed its "AIDS 101" course, which features a lengthy manual, posters, leaflets and a video used by instructors who teach people how to protect themselves from H.I.V. Funded by a $5 million grant from the Centers for Disease Control and Prevention, the H.I.V./AIDS education program sends Red Cross-trained instructors into schools, churches and to civic and medical groups around the country. The largest AIDS education program in the United States, it reaches more than 2 million people every year, and nearly half of those presentations are made to youth.
Early last year, when Bob Dole was courting the Christian right, and religious conservatives in North Carolina, Texas, Mississippi and Oklahoma had recently passed laws that muted the discussion of sex education, Red Cross chapters and AIDS clinics across the country were on hold awaiting the arrival of their new AIDS manual.
"We always had a balanced approach," explained one Red Cross official who participated in production of the manual. "We would teach how to negotiate abstinence and how to negotiate condom use." While the young people would be informed that sexual abstinence is the only way to guarantee against exposure to the disease through sexual contact, they were also told that if they did have sex, they must use condoms and use them properly. The materials also warned about the dangers of contracting H.I.V. through contaminated needles used for intravenous drugs.
The Red Cross professionals had one public health goal in mind: fighting the spread of the fatal virus. They knew from conclusive studies that presenting straightforward, nonjudgmental information is the best way to convey life-saving lessons to young people who come from many cultures and hold diverse attitudes about sex. In spring 1995 the AIDS office put the finishing touches on its new training material, which had already been approved by a volunteer panel outside the Red Cross comprising AIDS experts, university professors and other professionals.
Enter the special team: When Shepherd Smith (no relation to Sharon Ritter Smith), the president of a group called Americans for a Sound AIDS/H.I.V. Policy (A.S.A.P.), which has close ties to the conservative Christian movement, objected to the Red Cross AIDS material, Mrs. Dole consulted with her team and halted publication. She then took the unusual step of asking the Red Cross board of governors to review the manual with an eye toward toning down the language and illustrations. Jennifer Dorn, a member of the special team who shares Mrs. Dole's deeply felt religious views (they first met years ago at a Monday night Bible group), made specific suggestions. The employees in the H.I.V./AIDS program were stunned--never before had there been such high-level interference in what was normally a midlevel bureaucratic function.
The documents, which were made available by Red Cross officials, show that the revisions place a greater emphasis on "individual responsibility"--the politically salable euphemism often used by the extreme right in discussions ranging from welfare to teen pregnancy. The revisions emphasize the difference between prevention of AIDS and risk reduction, downplaying the use of condoms and instead stressing abstinence.
"We got word that the [AIDS training] program cannot be released without approval from on high," a Red Cross official told The Nation from her house in the Washington area. More than a year after the dispute began, the soft-spoken woman still had a quaver of nervousness in her voice when discussing the fight over the manual. "The manual was sent to [Mrs.] Dole's office. It got pretty much a line-by-line review."
"The Red Cross will not teach individuals how to engage in behavior which is against the law, but will assist people in finding help to stop engaging in such behavior in order to prevent or reduce their risk of getting HIV/AIDS," read the board of governors' policy statement. In addition, the Red Cross governors ordered restraint in language and pictures. "The Red Cross will not utilize profane language or graphics in its teaching materials, nor encourage the use of such language or materials by Red Cross instructors in classes," said the policy statement.
As the editing progressed, the AIDS professional staff felt under siege. "Dole personally blamed the office," said the Red Cross official, who discussed the internal struggle only on condition that she not be identified. "This was very frightening to people. The Red Cross was crashing and burning its own safety services division."
Sharon Ritter Smith, the senior vice president who oversees the Red Cross health and safety programs, "tried desperately to keep these changes from happening, but she was overruled by Jenna Dorn," adds a former Red Cross AIDS official.
Mrs. Dole and her team paid particular attention to the remarks of A.S.A.P. president Shepherd Smith. He had submitted a scathing attack on the material on the ground that teaching condom use encourages sexual activity among youngsters. He argued that the Red Cross should instead use its influence to promote monogamy. "Not acknowledging such basic tenets of American life undermines the credibility of your message," he wrote in a letter obtained by The Nation. "Values, attitudes and beliefs that are fundamental to character development should--no, must be retained," he continued.
According to the Red Cross employee involved in the bitter negotiations, the complaints against the AIDS teaching materials were "no longer based on biology or science. They were starting to come from religious points of view."
Last September, when chapter executives began to complain to the press that Dole's decisions seemed to be informed by political motives, Red Cross officials quickly fired off an Orwellian, agency-wide "alert" to employees to explain how they should defend the handling of the program. The memorandum, obtained by The Nation, sets forth the official line: "Mrs. Dole asked the Board to become involved in order to ensure there would be no false perception that politics had entered into the issue." At the time, Bob Dole defended his wife for carefully avoiding potential conflicts between her job and his campaign. "Elizabeth has been very scrupulous in trying to keep the Red Cross out of it," he said.
But Red Cross chapter executives were not placated. At a time when AIDS has been a significant cause of death among 15-to-24-year-olds, they were angry that their new program materials were held up for months because of political considerations, and that the contents of the AIDS manual were watered down. The revisions not only cost the Red Cross financially, they cost it professionally. "Anytime you have a delay like this you lose a little credibility," said one state coordinator for the AIDS program. Unfortunately, this wasn't the first time that public health considerations at the Red Cross had lost out to political exigencies.