home > by publication type > daily analysis > Probing U.S. Global AIDS Policy
Email
| Prepared by: | Carin Zissis |
|---|
PEPFAR's pro-abstinence approach will face Congressional scrutiny in 2007.
Four years after President Bush launched an ambitious plan to address the global HIV/AIDS crisis, the program’s policies will now face ideological scrutiny. The five-year, $15 billion President’s Emergency Plan for AIDS Relief (PEPFAR), supports prevention, treatment, and care for the dying and for orphans. The plan requires spending at least a third of prevention funds on abstinence-until-marriage programs—a stipulation that set off a policy debate (PBS). But November’s Democratic congressional victory could spell changes in PEPFAR’s abstinence-until-marriage policy by elevating the chances for passage of the Pathway Bill, sponsored by Rep. Barbara Lee (D-CA). The bill would revise current practice by focusing more on preventing the spread of AIDS among women and girls, and would remove the abstinence-only spending limitations (BosGlobe). AVERT, an international AIDS prevention agency, offers this statistical analysis of PEPFAR policies.
Currently, the Bush administration’s funding packages go to fifteen countries, most of them African. Over one hundred other countries receive smaller quantities of aid. Through September 2006, PEPFAR supported antiretroviral treatment for more than 820,000 people with HIV/AIDS and counseling and testing for nearly nineteen million people in focus countries. In Kenya, considered one of the more successful programs (AP), the number of people receiving treatment through the U.S. plan rose from fewer than 350 in 2003 to some seventy thousand.
Although the program has shown signs of success, critics say its ABC approach—“Abstain, Be faithful, or use Condoms”—plus its funding stipulations undermine its goals. An April 2006 analysis by the U.S. Government Accountability Office found that PEPFAR’s abstinence-only spending requirement “presents challenges to [the program's] ability to respond to local prevention needs.” In a recent in-depth assessment of PEPFAR, the Center for Public Integrity harshly criticized Bush’s AIDS initiative for offering “too little choice, too much ideology” by channeling funds to Christian organizations and promoting abstinence and fidelity rather than condom use. Uganda, which significantly reduced its AIDS transmission rates during the 1990s, has begun shifting its prevention strategy away from “scientifically proven and effective strategies toward ideologically driven programs” that promote abstinence and are “orchestrated” by the U.S. government, according to a Human Rights Watch report. Uganda has witnessed a moderate rise in HIV prevalence, from 5 percent in 2001 to 6.7 percent in 2005.
Even as the debate over U.S.funding for overseas AIDS programs continues, the disease continues its deadly spread in the developing world. The number of people living with HIV reached 39.5 million in 2006, with 4.3 million new infections this year. AIDS is Africa’s leading cause of death and the world’s fourth. Thus far the virus has claimed 25 million lives.
CFR Senior Fellow Laurie Garrett says that recent years’ stepped-up spending by the United States and the global community still represents insufficient funds—not to mention political action—to stop the spread of the virus. Says Garrett: “We do need much more money to battle this pandemic. But money isn't enough; it must be carefully managed and properly used.” Writing in Foreign Affairs, she looks at how the HIV/AIDS crisis galvanized the world to ramp up spending on public health programs for the world’s poor, yet the narrow disease-specific approaches of such programs and the brain drain they precipitate threaten to upend public health efforts in the developing world.
Weigh in on this issue by emailing CFR.org.
To order Task Force reports, Council Special Reports, and Critical Policy Choices, please call, fax, or order online from our distributor, the Brookings Institution Press: phone +1.800.537.5487, fax +1.410.516.6998.
For information on other reports that are not for sale, or for general publications information, please call +1.212.434.9516 or email publications@cfr.org.
Start-Up Nation addresses the trillion-dollar question: How is it that Israel—a country of 7.1 million, only sixty years old, surrounded by enemies— produces more start-up companies than large, peaceful, and stable nations like Japan, China, India, Korea, Canada, and the UK? With the insights of geopolitical experts and investors, the authors examine this nation’s adversity-driven culture to answer this question and offer prescriptions for a global economy on the rebound.
In Forces of Fortune, Vali Nasr presents a paradigm-changing revelation that will transform the understanding of the Muslim world at large. He reveals that there is a vital but unseen rising force in the Islamic world—a new business-minded middle class—that is building a vibrant new Muslim world economy and that holds the key to winning the cold war against Iran and extremists.
In Cuba: What Everyone Needs to Know, Julia E. Sweig presents a remarkably accessible portrait of Cuba's unique place on the world stage over the past fifty years, including its internal politics, its often fraught relationship with the United States, and its shifting relationship with the global community.
Complete list of CFR Books
The report of this bipartisan Task Force of distinguished leaders and experts represents a strong consensus on the importance of repairing America's immigration policy. It makes the case that maintaining America's political and economic leadership depends on attracting talented and hard-working immigrants, and on securing the country's borders in a smart, effective, and humane way.
This report finds that nuclear weapons will remain a fundamental element of U.S. national security in the near term, and makes recommendations on how to ensure the safety, security, and reliability of the U.S. deterrent nuclear force, prevent nuclear terrorism, and strengthen the nuclear nonproliferation regime.
About Independent Task Forces at CFR
Complete list of Task Force reports
Identifying international threats and acting on them may be the most difficult job for U.S. policymakers. This report
provides an actionable road map for managing international threats before they erupt into crises and makes a strong case that preventive action is not a luxury but a necessity.
For more than a decade, the United States has mostly watched from the sidelines as Asian countries organize themselves into an alphabet soup of new multilateral groups. In this report, the authors review the relationship between pan-Asian and trans-Pacific institutions and suggest policy guidelines for a new U.S. approach to this new Asian landscape.
Complete list of Council Special Reports
To request permission to reprint or reuse CFR material, please fill out this permissions request form (PDF), referring to the instructions on page 1.
Copyright 2009 by the Council on Foreign Relations. All Rights Reserved.