Dr. Eric Goosby is President Obama's choice to fill the vacancy left by the departure of AIDS Relief Chief Dr. Mark Dybul, an openly gay man, in January.

Goosby, 56, is an HIV/AIDS specialist who began his work in treating AIDS patients at San Francisco General Hospital during the early years of the pandemic. He served as deputy director of the White House Office of National AIDS policy and director of the Office of HIV/AIDS Policy at the Department of Health and Human Services during the Clinton administration. Goosby has served as CEO and chief medical officer of the San Francisco-based Pangaea Global AIDS Foundation since 2001.

Goosby will helm the President's Emergency Plan for AIDS Relief, PEPFAR. An appointment which carries the status of ambassador. The position was created by President George W. Bush in 2003.

PEPFAR remains a political hot potato. Conservatives and evangelicals like to call the program Bush's greatest success, but HIV prevention experts have long disagreed. Several say the program has actually increased the number of HIV cases worldwide.

The program has distributed life-saving antiretroviral drugs to more than 2.1 million men, women and children in fifteen focus countries decimated by the AIDS pandemic, twelve of which are in Africa. Critics, however, say the money – Congress just pledged $48 billion – was not well spent. They point out that only 20% of the budget is used for prevention and of that one-third to one-half (the figure varied between authorizations) must be used for abstinence-only programs lauded by social conservatives. It funds neither clean needle exchange programs for IV drug users, nor AIDS prevention programs targeted at sex workers, two of the largest at-risk groups.

Condom distribution is shunned in favor of abstinence programs by many of the organizations on the ground receiving PEPFAR support.

PEPFAR's political fire is not confined to how the money is spent, but also who's influencing those decisions. Rev. Rick Warren, the evangelical pastor who found himself at odds with the gay and lesbian community after he likened gay marriage to an incestuous relationship and supported a gay marriage ban in California, had worked closely with Bush administration officials on AIDS prevention in Africa. And ardent anti-gay former Senator Jesse Helms was on board with the goals of PEPFAR.

AIDS itself remains greatly stigmatized, even more so in Africa where conservative lawmakers have used the AIDS pandemic to rationalize dogmatic legislation aimed at marginalizing gays, despite a glut of research that proves heterosexual sex remains the major conduit for HIV transmission on the continent. Lawmakers supporting a bill in the Nigerian Assembly that would criminalize a gay or lesbian couple living together say it is necessary to break the links between “sodomy” and AIDS.

Social conservative groups had praised Dybul and called his firing – one of President Obama's first tasks in office – a “scapegoating.” They now worry what the change in leadership will mean to their faith-based approach to AIDS relief.

“Right now, agencies like Catholic Relief Services can opt out of programs that provide for condom distribution,” Catholic League President Bill Donohue said in a statement. “But under Goosby, this may change. He will be under enormous pressure by radical feminists, gay activists and assorted sexologists to force faith-based organization to get on board or get out.”

Both the International Association of Physicians in AIDS Care (IAPAC) and AIDS Action applauded Goosby's nomination.