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House Approves Bill That Would Allow for Waiver of PEPFAR’s Abstinence Spending Requirements

On June 22, the U.S. House of Representatives passed the $34.2 billion Fiscal Year 2008 State-Foreign Operations appropriations bill with a vote of 241 to 178.  The bill included $5.08 billion for HIV/AIDS efforts, an increase of $1.25 billion over 2007 funding levels. In addition to funding allocations for global health programs, the FY 2008 State-Foreign Operations appropriations bill includes critical provisions that could expand the availability of contraceptives and comprehensive HIV-prevention strategies.1 

The contraceptives provision would expand access to contraceptives in impoverished nations by providing a partial exemption from the Global Gag Rule, also known as the Mexico City policy. The Global Gag Rule denies U.S. family planning aid to foreign health care providers who offer legal abortions, provide counseling or referrals for legal abortion, or publicly support legal abortion within their own countries even if these activities are conducted with other sources—including their own governments. The Global Gag Rule forces providers to choose between receiving desperately needed funds or maintaining the ability to provide patients with full and complete information and services.

As it stands, the provision would allow organizations that had been banned from receiving U.S. aid because they provided or promoted abortion to receive donations of condoms and other contraceptives from the United States Agency for International Development (USAID).

The bill also makes progress in providing access to comprehensive HIV-prevention strategies worldwide by allowing the U.S. President to waive the abstinence-until-marriage earmark under the President’s Emergency Plan for AIDS Relief (PEPFAR). PEPFAR is a 5-year, $15 billion initiative to combat global AIDS, Malaria and Tuberculosis.  The abstinence-only earmark, put in place by congress in 2003, mandates that at least 1/3 of HIV-prevention funding under PEPFAR be spent on abstinence-only-until-marriage programs. This requirement exists despite the stark lack of evidence that abstinence-until-marriage programs are effective in halting the spread of HIV/AIDS.  In fact, several organizations have found that the earmark hinders PEPFAR’s implementation of comprehensive prevention programs that would best serve the needs of those most affected by HIV/AIDS. 

The new provision could allow U.S.-funded programs to better respond to the differing features of the HIV/AIDS epidemic in each country. Although it seems unlikely that the current President will waive the earmark, advocates feel that this positions the next President to do so.2

The House bill passed with these provisions despite amendments offered by right-wing politicians Representatives Joseph Pitts (R-PA) and Chris Smith (R-NJ).  Pitts, who was responsible for the very amendment that created the earmark, proposed an amendment to remove the provision that would allow USAID to distribute contraceptives.3  Smith offered an amendment to remove the provision regarding the waiver for the abstinence-only earmark as part of prevention funding, which was defeated by a vote of 218 to 205.4 

“This is a real step forward for advocates who have long recognized the detrimental health effects of the administration’s policies on sexual health and reproductive issues,” said William Smith, vice president for public policy at SIECUS.  “We are excited to see that the new Congress realizes the importance of allowing countries to respond to the AIDS epidemic based on science and not ideology.”

Despite these victories, President Bush has threatened to veto any bill that contains an expansion of sexual and reproductive health and rights.


  1. Elizabeth Williamson, “Democrats Pass Provision for Contraceptives in House Foreign Aid Bill,” Washington Post, 22 June 2007, accessed 25 June 2007 <>.
  2. The AIDS Institute, “The AIDS Institute Praises the House of Representatives for Passing the State-Foreign Operations Appropriations Bill,” Press Release published 22 June 2007.
  3. Ibid.
  4. Williamson.