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Institute of Medicine Report Faults PEPFAR’s Prevention Politics: PATHWAY Act Seeks Remedy

Washington, D.C. – On Friday, the Institute of Medicine (IOM) released key findings that the “the abstinence-until marriage budget allocation in the Leadership Act hampers [prevention] efforts and thus PEPFAR’s ability to meet the [HIV prevention] target.” Under current law, 33% of all prevention funding must be spent on programs that promote abstinence as the only way to stop the spread of HIV.  The findings, released in a report titled PEPFAR Implementation: Progress and Promise, provide an in-depth analysis of the implementation of prevention, care, and treatment programs in 15 focus countries. 

According to the IOM, the earmark “has greatly limited the ability of Country Teams to develop and implement comprehensive prevention programs that are well integrated with each other.”  As a result of this earmark, PEPFAR “has supported some preventive interventions that are not firmly evidence-based.”

The report concludes that, to support and implement comprehensive interventions appropriate to each country, “congress should remove the budget allocations and replace them with more appropriate mechanisms that ensure accountability for results.”

“The findings of the IOM report strengthen our resolve to put evidence, not politics, back into the driver’s seat in our country’s HIV prevention efforts,” said William Smith, vice president for public policy at the Sexuality Information and Education Council of the United States (SIECUS).  “SIECUS’ analysis of PEPFAR’s abstinence-until-marriage earmark resulted in a similar recommendation to abandon this funding,” continued Smith.  The recommendation was included in SIECUS’ PEPFAR Country Profiles: Focusing in on Prevention and Youth, released in 2005.

The IOM findings came shortly after Representatives Barbara Lee (D-CA) and Christopher Shays (R-CT) introduced the Prevention Against Transmission of HIV to Women and Youth (PATHWAY) Act of 2007. The bill would remove the abstinence-until-marriage earmark, and require the Office of the Global AIDS Coordinator to ensure that a comprehensive and integrated HIV-prevention strategy addresses the vulnerabilities of women and girls in PEPFAR countries.

 “The report confirms the need for Congress to pass the PATHWAY Act and remove legislative funding mandates that stop PEPFAR from implementing the medically accurate, comprehensive and evidenced-based programs needed to truly fight this epidemic,” concluded Smith.