The 2013 guidelines for the United States’ premiere program for addressing global HIV/AIDS contains a new provision that explicitly prevents it from funding contraceptives and other “family planning commodities.” This provision isn’t mandated by Congress; it’s a purely executive decision that hurts women’s health and rights in the developing world. So why is it there?

The provision is a part of the new Country Operational Plan Guidance for the President’s Emergency Plan for AIDS Relief (PEPFAR), a program created in 2003 to centralize America’s efforts in the fight against HIV/AIDS. The 2013 version, issued in October, says that “PEPFAR funds may not be used to purchase family planning commodities,” a phrase that did not appear in the past three versions of the same document. Moreover, the new version also threatens aid workers who violate these strictures, saying “all USG personnel should be aware of legal restrictions and program requirements relating to family planning, and should consult with relevant Agency legal counsel with any questions in this area.” The insertion of these provisions is at the discretion of PEPFAR’s administrator, the Office of the Global AIDS Coordinator (OGAC), and is not mandated by the original PEPFAR legislation nor the 2008 reauthorization of the bill.

This change isn’t heralding a new policy: PEPFAR has had a restriction on purchasing for family planning commodities for quite some time, but this report is the first time that it’s been formally codified in this fashion. The technical guidance also specifies that PEPFAR may purchase and distribute condoms, providing no formal definition of “family planning commodities” but specifying clearly that contraceptives count.

Nonetheless, the family planning restriction in PEPFAR has been devastating for women’s health. A report from the Guttmacher Institute calls contraception “an important intervention” in preventing the spread of mother-to-child AIDS in Africa, finding that “current levels of contraceptive use among HIV-positive women living in Sub-Saharan Africa may already be preventing some 173,000 HIV-positive births annually.” The report notes that, although other forms of U.S. foreign aid provide contraception (which is PEPFAR’s defense of its policy), those efforts are not enough:

[I]t is undeniable that USAID’s family planning program is currently underfunded and under attack, and unless funding is increased immediately, there will be a serious shortfall of resources to meet the growing demand. At $615 million annually, U.S. funding for family planning is only a fraction of what it should be to meet the needs of women in the developing world, of which 215 million want to avoid a pregnancy but are not using an effective method of contraception. U.S. advocates have been calling for at least $1 billion annually. A recently released report by five former directors of the Population and Reproductive Health Program at USAID goes even further, making the case that funding for USAID’s family planning budget be set at $1.2 billion—and raised to $1.5 billion by fiscal year 2014.11 But these increases are unlikely if congressional House leaders have their way. Three times in 2011 alone, the Republican House has moved to slash funding for international family planning aid.

Moreover, the Guttmacher researchers note, PEPFAR operates in some countries that do not receive other family-planning assistance from U.S. agencies. Those include the three countries with the highest rates of HIV prevalence in the world (Swaziland, Botswana, and Lesotho).

The Obama Administration has made some positive moves on increasing access to family planning abroad. It has overturned the “Mexico City Policy” that defunds all NGOs that even mention abortion and has issued a blueprint document suggesting that PEPFAR plans to improve on its contraception policy going forward. However, anti-AIDS advocates have been critical of cuts to PEPFAR proposed by the Administration.

In advance of this year’s World AIDS Day on Saturday, Secretary of State Hillary Clinton outlined a blueprint to continue advancing recent gains in HIV education and treatment, eventually leading to a future AIDS-free generation.

Clinton cited the dramatically dropping number of new infections across the globe, the growing numbers of HIV-positive individuals gaining access to treatment, and the continued advances in scientific research as reasons to be optimistic about eventually eradicating new cases of AIDS for future generations:

CLINTON: Now, make no mistake about it: HIV may well be with us into the future. But the disease that it causes need not be. We can reach a point where virtually no children are born with the virus, and as these children become teenagers and adults, they are at a far lower risk of becoming infected than they are today. And if they do acquire HIV, they have access to treatment that helps prevent them from not only from developing AIDS, but from and passing the virus on to others.

Clinton also pointed out that some communities at risk for contracting HIV — such as drug users, men who have sex with men, and sex workers — are often driven “into the shadows” by societal stigma, shame, and discrimination, and global efforts to combat the HIV/AIDS epidemic must work to correct that. Recent research has confirmed that anti-gay stigma helps maintain the HIV epidemic by hampering the effectiveness of HIV advocacy programs, and homophobia continues to impede gay men’s access to HIV services.

Public health officials maintain that early detection of the HIV virus is one of the most important methods of containing the HIV/AIDS epidemic, so treatment can begin early and the virus can hopefully be contained. Earlier this month, a government-backed health panel endorsed regular HIV screening for everyone between the ages of 15 and 65, ensuring that HIV testing will now be covered under Obamacare.

Foreign aid in the United States accounts for less than 1 percent of all federal spending. Despite that, several Republicans want to slash, if not eliminate, assistance to poorer nations. But a new report on the effectiveness of one aid program should make policymakers reconsider that broad approach.

A study released Wednesday showed that the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) averted 741,000 deaths between 2004 and 2008. Previous research found that PEPFAR, created in 2003 by President George W. Bush, had prevented AIDS-related deaths, although researchers did not know if those people were dying of other diseases instead. But this report shows that is no the case, according to Reuters:

Data for the new study came from surveys done with adult women in 27 African countries, including nine with PEPFAR programs. Women were asked about their adult siblings and recent deaths in their families. The researchers used that information to calculate approximately how many adults in each country were dying every year, for any reason.

In 2003, Bendavid and his colleagues found that between eight and nine out of every 1,000 adults died, both in PEPFAR and non-PEPFAR nations. Countries in the new report that weren’t part of the program included Madagascar, Liberia, Senegal and Zimbabwe.

Five years later, death rates had dropped to four per 1,000 in PEPFAR countries and declined more modestly to seven out of every 1,000 without the program. That worked out to a 16 percent lower chance of death in countries with PEPFAR between 2004 and 2008, once other factors such as a country’s overall HIV rate and wealth were taken into account, the researchers reported Tuesday in the Journal of the American Medical Association.

Despite the proven results, Mitt Romney would cut PEPFAR funds if elected president. At a New Hampshire town hall last October, Romney said he was “very reluctant to borrow lots more money to be able to do wonderful things, if those things can be done by people making charitable contributions or if other countries that are wealthy.” But as Bush said of PEPFAR last year, “We’re a blessed nation in the United States of America and I believe we are required to support effective programs that save lives.”

Romney is not always against spending or borrowing more money, however. From 2003 to 2008, Congress appropriated $18.8 billion to PEPFAR, or $3.76 billion a year. In contrast, Romney’s budget plan would increase the military budget by at least $210 billion a year over 10 years. Overall, the tax cuts in his budget would cost $10.7 trillion over the next decade.

-Zachary Bernstein

President George W. Bush called on “wealthy nations” — including the United States — to continue funding the President Emergency Plan for AIDS Relief (PEPFAR), a program he signed in 2003 for providing anti-retroviral (ARV) treatment to people living with HIV/AIDS around the world. Speaking at a panel discussion to commemorate World AIDS Day from Tanzania, Bush said, “I understand we’re in tight budget times,” but insisted that increasing federal funding for HIV/AIDS treatment and prevention should remain a national priority:

BUSH: There is no greater priority — and this is something our American citizens must understand and our government must understand — there is no greater priority than living out the admonition, to whom much is given, much is required. We’re a blessed nation in the United States of America and I believe we are required to support effective programs that save lives.

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According to AVERT — an international HIV and AIDS charity — funding for PEPFAR from 2009-2010, “was effectively flat-lined in contrast to the much higher previous year-on-year increases in funding, especially from 2006-2009.” “President Obama’s proposed 2011 budget included almost $7 billion for PEPFAR, representing a 1.8 percent increase on the previous year. However, according to some activists this slight increase actually represents a ‘step backwards’ due to inflation and increasing demand for treatment.” The FY2011 budget “included a 5 percent ($50 million) decrease in funding to the Global Fund compared to the previous year.”