On Wednesday, February 8, the Office of the Global AIDS Coordinator released its second annual report on the President’s Emergency Plan for AIDS Relief (PEPFAR), entitled Action Today, A Foundation for Tomorrow: the President’s Emergency Plan for AIDS Relief . Action Today reports the latest numbers of people reached with PEPFAR-funded programs, but, like previous reports, fails to reveal the substantive details of programming. The report also offers new interpretations of policy guidance that clarify restrictions on HIV-prevention funding. Overall, this report paints a picture of HIV prevention that leaves many experts concerned that young people and women are still being left without the information, skills, and social environments they need to pursue healthy sexual relationships.

PEPFAR Funding for the Prevention of Sexual Transmission of HIV

Number of individuals reached with community outreach HIV/AIDS prevention activities that promote abstinence and/or being faithful	24,862,000
Number of individuals reached with community outreach HIV/AIDS prevention activities that have abstinence as their primary behavioral objective	8,000,000
Number of individuals reached with community outreach HIV/AIDS prevention activities that promote condoms and related services	17,941,100
Fiscal year 2005 funding for abstinence and/or faithfulness promotion activities	$76,000,000
Percentage of spending on the prevention of sexual transmission of HIV that goes towards abstinence and faithfulness promotion	53%
Fiscal year 2005 funding for condoms and related prevention strategies	$66,000,000
Percentage of spending on the prevention of sexual transmission of HIV that goes towards condoms and related prevention strategies	46%

The numbers in the chart above illustrate the level of funding for programs aimed to prevent the sexual transmission of HIV, the most prevalent means of transmission in all but one (Viet Nam) of the 15 focus countries that are receiving increased funding under PEPFAR. The United States government is also funding related mass media campaigns, but the scope and content of these campaigns were not reported in this document.1

Such high numbers do not necessarily translate to success, however, and this report has renewed debate among policymakers as to the wisdom of the Administration’s approach. Despite claims of maintaining a comprehensive and evidence-based program relying on the ‘ABC’ (Abstain, Be faithful, and use Condoms) model, the Office of the Global AIDS Coordinator is still supporting abstinence-until-marriage programming as the primary HIV-prevention intervention for the vast majority of young people and adults. Representative Barbara Lee (D-CA) responded, “I remain strongly concerned about the Administration’s emphasis on abstinence-only-until-marriage programs as the primary method of HIV-prevention. In many countries with large sexually active populations, widespread testing is unavailable. In such an environment promoting a strict abstinence-only message without providing information about risk reduction activities such as condom use is irresponsible.”2

Mark Dybul, U.S. Deputy Global AIDS Coordinator, defended the Administration’s approach on National Public Radio, “you need all three components. And here it’s a good thing were concentrating on Africa, because the data, the evidence from Africa is crystal clear… You need all three components.”3

The policy analysis offered in Action Today , however, clearly shows that on-the ground, individuals in touch with U.S.-funded programs are not learning their ABCs. The report states, “the PEPFAR-supported ABC approach employs population-specific interventions that emphasize abstinence for youth and other unmarried persons, including delay of sexual debut; mutual faithfulness and partner reduction for sexually active adults; and correct and consistent use of condoms by those whose behavior places them at risk for transmitting or becoming infected with HIV. PEPFAR-supported programs may include all three of the ABC messages, or a subset of them, as appropriate.”4 More simply put, “marketing campaigns that target youth and encourage condom use as the primary intervention are not appropriate for youth, and the Emergency Plan will not fund them.”5 The report explains that PEPFAR funds may support ‘AB’-only campaigns for young people ages 10-14 and age-appropriate ‘ABC’ information for young people over age 14, but that condom promotion and dispensing of condoms in school-based settings is prohibited.6

“The report shows a striking disconnect between reality and programming,” said William Smith , vice president for public policy at SIECUS. “For example, the report announces that in many countries hardest hit by HIV/AIDS, sexual activity begins early and prior to marriage. Yet, the Administration abandons unmarried sexually active young people, leaving them without information on condoms that could save their lives. It is a shame that even when this Administration acknowledges the circumstances on-the-ground, it fails to support programs that address this reality.”

Following the first report on PEPFAR to Congress, SIECUS released the SIECUS PEPFAR Country Profiles: Focusing in on Prevention and Youth and posed 6 recommendations to U.S. policy makers. Action Today , the second PEPFAR report, has shown little progress in meeting these proposals, which include rescinding the mandated funding for abstinence-until-marriage programming as well as increasing transparency and on-the-ground monitoring of programs.

 

To download the entire PEPFAR report, please visit
http://www.state.gov/documents/organization/60841.pdf

References

1. Action Today, A Foundation for Tomorrow: The President’s Emergency Plan for AIDS Relief, (Washington , DC : Office of the Global AIDS Coordinator, 2006), 25-26, accessed 27 February 200, <http://www.state.gov/documents/organization/60841.pdf>.
2. “Barbara Lee Responds to President’s Global AIDS Plan Report,” Press Release published 8 February 2006, accessed 27 February 2006, <http://lee.house.gov/index.cfm?ContentID=674
   &ParentID=0&SectionID=4&SectionTree=4&lnk=b&ItemID=669>.
3. “News & Notes with Ed Gordon,” National Public Radio, 24 February 2006.
4. Action Today, A Foundation for Tomorrow.
5. Ibid., 22
6. Ibid., 22-23.

---