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Probing U.S. Global AIDS Policy

Prepared by: Carin Zissis
December 26, 2006

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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.

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