Requirements In Global AIDS Initiative Cost Lives


This morning, the Religious Coalition for Reproductive Choice called on Congress to remove “language restricting the participation of family planning organizations” from the President’s Emergency Plan for Aids Relief or PEPFAR, an international health initiative dedicated to combating HIV/AIDS around the world:

The Religious Coalition for Reproductive Choice and our partners in the interfaith community are urging the Senate to hear the voices of people of faith…we want PEPFAR to be reauthorized and we welcome the increased funds — but we want language restricting the participation of family planning organizations to be removed.

Competing House and Senate versions of the bill to expand PEPFAR both seek to boost funding to $50 billion over the next five years. While the House version allows “groups to use PEPFAR funding for HIV testing and education in family planning clinics,” the bill expands the global gag rule, and does not extend PEPFAR funding “for contraception.”

Under the House legislation, family-planning services that accept funding through PEPFAR would be restricted in two ways. First, PEPFAR funding would impose a gag-rule to prohibit family planning initiatives from using their own funds for performing or promoting abortion. Secondly, PEPFAR-funded programs would not be allowed to use PEPFAR funds on family planning services.

Both versions also replace the current earmark requiring 33% of prevention funds to be spent on abstinence only programs with a provision that obliges “the Global AIDS Coordinator [to] report to Congress if less than 50% of funding to prevent sexual transmission of HIV is spent on abstinence and fidelity programs.”

Both versions place unnecessary obstacles in the path of effective prevention policies:

– The gag rule interferes with the ability of family planning organizations to reach the most vulnerable populations and provide them with needed services.

– The ban against “contraception or abortion services”in the House bill would prevent a PEPFAR-funded clinic which funds anti-retroviral treatment for positive women from providing these women with contraception, even though contraception may be what they want and need to protect their own health.

– The 50 percent provision — while more progressive than the current requirement — still hampers the ability of governments and NGOs to tailor their programs to local needs.

In fact, two studies by the Government Accountability Office and the Institute of Medicine have already concluded that abstinence-only requirements, like the global gag rule, are “undermining global efforts to prevent 7 million new HIV infections by 2008”:

– “Although several teams indicated that they value the ABC [Abstinence, Be faithful, use a Condom] model and noted the importance of AB messages, some teams also reported that the spending requirement can limit their ability to design programs that are integrated and responsive to local prevention needs…to meet the abstinence-until-marriage spending requirement, teams have in some cases reduced or cut funding for certain prevention programs, such as those to deliver comprehensive messages to certain populations. OGAC’s decision to apply the spending requirement to all PEPFAR prevention funds may further challenge country teams’ ability to address local prevention needs. [GAO, 9/06/2006]

– “The earmark has greatly limited the ability of Country Teams to develop and implement comprehensive prevention programs that are well integrated with each other and with counseling and testing, care, and treatment programs and that target those populations at greatest risk…[the earmark has] limited PEPFAR’s ability to tailor its activities in each country to the local epidemic and to coordinate with…the countries’ national plans.” [IOM, 3/30/2007]

As the Center for Health and Gender Equity argues, “restrictions and reporting requirements like those in the House and Senate bills hinder access to life-saving information and services, such as male and female condoms, and must be eliminated.”

Indeed, the rise of HIV infections in girls and women in Africa is largely attributable not to women’s individual choices and behavior, but to gender inequities and sexual violence, including the widespread practice and acceptance of child marriage of young girls to older men, forced marriage and polygamy, male promiscuity, “marital rape, domestic violence, wife inheritance, widow cleansing, and female genital mutilation.” According to Thoraya Obaid, executive director of the United Nations Population Fund (UNFPA):

Women and girls are vulnerable to AIDS not because of their individual behavior, but because of the discrimination and violence they face, the unequal power relations. Even being married is a risk factor for women.

Rather than stigmatizing condom use and family planning programs, the American government should adopt an evidence-based approach to the AIDS pandemic, providing developing nations with a wide range of prevention options and empowering AIDS-stricken populations to take control of their sexual health.