A year after he admitted "you've stumped me" when asked whether contraceptives help stop the spread of HIV, John McCain once again finds himself in the AIDS spotlight. On Wednesday, Americans learned that arch-conservative Tom Coburn (R-OK) is blocking Senate action on a proposed tripling of President Bush's global AIDS program. That would be the same Tom Coburn John McCain extolled in March 2007 as "the guy I really respect" when it comes to policy for AIDS and contraceptives.
As Politico detailed, Coburn and a group of six other socially conservative GOP Senators have placed a hold on the reauthorization of one of President Bush's few popular initiatives, the Emergency Plan for AIDS Relief (PEPFAR). Enjoying broad bipartisan in Congress, the Senate has proposed boosting funding to $50 billion over five years. But the Senate bill would do away with the previous requirements "that 55 percent of the HIV/AIDS appropriation be spent on treatment and drugs and that about 30 percent of prevention funds be allocated to abstinence education."
Which is what raised the ire of John McCain's AIDS mentor Tom Coburn. Rather than see American aid dollars flowing to the "C" in the U.S. "ABC" strategy against AIDS ("abstinence, be faithful, condoms"), the physician Senator and his group of 7 socially conservative colleagues are demanding that treatment receive the lion's share of the expanded PEPFAR funding. Otherwise, Coburn insists:

"The vast majority of the money is going to get consumed by those wanting to help people with HIV, rather than [by] people with HIV."

The overwhelming consensus in both the Senate and the public health community, of course, holds just the reverse:

"Most experts agree that treatment is only one small part of the prevention agenda," said Denis Nash, director of monitoring, evaluation and research at the International Center for AIDS Care and Treatment Programs at Columbia University.
"The prevention effect of treatment is not likely to be anywhere near the magnitude of prevention through prevention," including safe-sex education and condom distribution, said Mead Over, senior fellow at the Center for Global Development.

Which is why John McCain found himself in hot water at a town hall meeting in Pennsylvania on Wednesday. The first question came from health care activist Kaytee Riek, who asked whether McCain would work to advance the bill in the Senate now being blocked by Coburn. Despite his grand December 1, 2007 proclamation recognizing World AIDS Day ("Today is a call to action to roll-back the scourge of HIV and save lives"), McCain on Wednesday was caught off guard and in the dark:

"I'll be glad to assist. I'm sorry to tell you I'm not that familiar with the process of this legislation."

That McCain was asked to "look into talking to his Senate buddy Tom Coburn" about the PEPFAR reauthorization should have come as no surprise to the supposed maverick. After all, during an even more uncomfortable March 2007 ride with reporters on his campaign bus in Iowa, McCain identified Dr. Coburn as the man with the plan when it came to HIV/AIDS and abstinence.
That infamous exchange, so bizarre and so unsettling, requires to be seen in its entirety to fully appreciate John McCain's ignorance and confusion when it comes to HIV/AIDS:

Reporter: "Should U.S. taxpayer money go to places like Africa to fund contraception to prevent AIDS?"
Mr. McCain: "Well I think it's a combination. The guy I really respect on this is Dr. Coburn. He believes - and I was just reading the thing he wrote - that you should do what you can to encourage abstinence where there is going to be sexual activity. Where that doesn't succeed, than he thinks that we should employ contraceptives as well. But I agree with him that the first priority is on abstinence. I look to people like Dr. Coburn. I'm not very wise on it."
(Mr. McCain turns to take a question on Iraq, but a moment later looks back to the reporter who asked him about AIDS.)
Mr. McCain: "I haven't thought about it. Before I give you an answer, let me think about. Let me think about it a little bit because I never got a question about it before. I don't know if I would use taxpayers' money for it."
Q: "What about grants for sex education in the United States? Should they include instructions about using contraceptives? Or should it be Bush's policy, which is just abstinence?"
Mr. McCain: (Long pause) "Ahhh. I think I support the president's policy."
Q: "So no contraception, no counseling on contraception. Just abstinence. Do you think contraceptives help stop the spread of HIV?"
Mr. McCain: (Long pause) "You've stumped me."
Q: "I mean, I think you'd probably agree it probably does help stop it?"
Mr. McCain: (Laughs) "Are we on the Straight Talk express? I'm not informed enough on it. Let me find out. You know, I'm sure I've taken a position on it on the past. I have to find out what my position was. Brian, would you find out what my position is on contraception - I'm sure I'm opposed to government spending on it, I'm sure I support the president's policies on it."
Q: "But you would agree that condoms do stop the spread of sexually transmitted diseases. Would you say: 'No, we're not going to distribute them,' knowing that?"
Mr. McCain: (Twelve-second pause) "Get me Coburn's thing, ask Weaver to get me Coburn's paper that he just gave me in the last couple of days. I've never gotten into these issues before."

Just as disturbing as McCain's incomprehensible response to a simple question on American global AIDS policy is his reliance on Tom Coburn as the authority on the topic. The anti-earmark crusader blocked funding for breast cancer and ALS (Lou Gehrig's Disease) research. Coburn, an obstetrician, has said he favors the death penalty for abortion providers and called his home state legislators "a bunch of crapheads." The good doctor, who called his 2004 race against Brad Carson a choice between "good and evil", also has been accused of Medicaid fraud and sterilizing a woman without her permission. And during his 2004 Senate campaign, the Oklahoman famously alerted his fellow Sooners to the threat of lesbians run amok in the their high schools:

"Lesbianism is so rampant in some of the schools in southeast Oklahoma that they'll only let one girl go to the bathroom. Now think about it. Think about that issue. How is it that that's happened to us?"

For the American people, the pressing question is, how did Tom Coburn come to have any influence at all on public health policy in general and on AIDS in particular? And how can Americans take a presidential candidate like John McCain seriously when he cites Tom Coburn as the source of his own knowledge on HIV/AIDS?