On October 6, SIECUS released updates to our 2005 Country Profiles which painted an in-depth picture of HIV prevention efforts under the President’s Emergency Plan for AIDS Relief (PEPFAR). The updates are designed as a supplement to the original publication and look at each of the 15 nations designated as “focus countries” by the Bush administration: Botswana, Cote d’Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Vietnam, and Zambia. SIECUS’ 2008 PEPFAR Country Profile Updates provide the most recent and comprehensive information on the status of the PEPFAR program in these targeted countries, as well as tools and recommendations for international policy makers and advocates who are hoping to improve the beneficial impact of PEPFAR.

While it is widely felt that PEPFAR has been successful in increasing HIV/AIDS treatment and care services around the world, it has consistently lacked a comprehensive approach to HIV/AIDS prevention since its passage in 2004. The various restrictions and limitations in PEPFAR’s prevention portfolio are well known to many, and include the disproportionate emphasis on Abstinence-only and ”Be-faithful“ programs (AB) while downplaying the importance of correct and consistent condom use (C). The original law also required 1/3 of prevention funding to go to AB programs while the reauthorized law strongly suggests focus countries not fall below a 50% threshold for AB.

The new Country Profiles illustrate just how serious the impact of this particular silliness is on the ground. Tanzania is a disturbing example. Just over 6% of people ages 15–49 in Tanzania are HIV-positive and about 80% of infections occur through heterosexual sex.[1] The country’s own strategy, laid out in what is known as its National Multi-Sectoral Strategic Framework, embraces a comprehensive approach to prevention and recognizes the key role of condoms.

A similar disconnectedness can be observed in Botswana. Botswana is a country with an HIV prevalence of nearly 24% (the second highest in the world), and while 25 organizations received PEPFAR funding to prevent sexual transmission of HIV in 2007, only two promoted correct and consistent condom use.[2]

Botswana also exemplifies the PEPFAR policy that allows faith-based organizations to withhold any information they deem contrary to faith teachings. One of the programs in Botswana supported by PEPFAR is True Love Waits, a virginity pledge program the central strategy of which has been disproved as an effective intervention. Moreover, this particular program instructs people that safe sex is wrong and that condoms have defects in them.[3] This, in a country where nearly one in four people carry the virus.[4] True Love Waits also received PEPFAR funding in Kenya and in South Africa.

Our new Country Profiles uncover additional, disturbing evidence about what certain faith-based grantees are doing with U.S. tax-payer money. For example, in South Africa, a country with about 18% HIV prevalence, one grantee, called Scripture Union, claims its vision is ”to introduce young people to Jesus“ and ensure a ”commitment to Jesus and also to abstinence, whichever comes first.”[5] To be sure, this is a missionary organization that uses PEPFAR funding to proselytize and, in 2007, it received nearly $1 million of U.S. money to do that.

These are just a few of the issues that surfaced in our extensive research, and lead us to offer seven policy recommendations. We call for: 1) an end to disproportionate emphasis for ineffective abstinence-only programs; 2) increased transparency of how funds are actually being used; 3) increased oversight to combat proselytizing, to prevent faith-based organizations from exempting themselves from discussing information on condoms/contraception, and to review the influence of the U.S. government in the development of country plans on prevention; 4) an end to the war on prevention efforts for sex workers; 5) increased focus on integration of HIV/AIDS and reproductive health care services; 6) increased investment in indigenous prevention program providers; and 7) an end to legalized discrimination in the program that allows grantees to deny care, treatment and prevention services to whomever they choose based on moral beliefs.

“The 2008 Updates contain much useful information, but what was so striking to us at SIECUS was one consistent theme that emerged in nearly every country: the way in which the HIV epidemic targets the most vulnerable members of society,” said Joseph DiNorcia, president of SIECUS. “In country after country, young women, commercial sex workers, injecting drug users, and men who have sex with men disproportionately suffer from the HIV/AIDS. These are the people who are most in need of help and medical interventions, but who often slip through the cracks. As we face the challenges of reaching out to traditionally underserved communities, we need PEPFAR to be more open and less blindly moralistic in the way it distributes its resources.”

SIECUS has developed updates for all 15 of the focus countries: Botswana, Côte d’Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Viet Nam, and Zambia.

1 2008 Report on the Global AIDS Epidemic Annex 1: HIV and AIDS Estimates and Data, 2007 and 2001,UNAIDS, (New York, NY), accessed 31 July 2008, http://data.unaids.org 217
2 Botswana FY 2007 Country Operational Plan (COP), Office of U.S. Global AIDS Coordinator and the Bureau of Public Affairs, U.S. State Department, (Washington, DC), accessed 8 August 2008,
http://www.pepfar.gov/documents/organization/103927.pdf
3 Frequently Asked Questions. True Love Waits SA 2004. Accessed 27 August 2008, http://www.truelovewaits.org.za/page_faq.html
4 2008 Report on the Global AIDS Epidemic Annex 1: HIV and AIDS estimates and data, 2007 and 2001, UNAIDS, (New York, NY) accessed 19 August 2008, http://data.unaids.org 215
5 Scripture Union South Africa: Vision, accessed 29 August 2008, http://www.su.org.za/vision.htm; http://www.su.org.za/reach.htm