Once again it is World AIDS Day, a time to honor the many citizens, activists, scientists, medical professionals, NGOs and others around the world who are fighting against this terrible disease. It is too bad, then, that so many of them must fight with one hand tied behind their backs thanks to the rigid ideology promoted by the U.S. government.
For instance, the amount of funding going to abstinence-only programs continues to rise, both in the U.S., where it has more than doubled since 2001, and overseas, especially within the President’s Emergency Plan for AIDS Relief (PEPFAR). Much of the new funding is going to support unqualified “faith-based” supporters of the Bush administration, who actively undermine condom use and take money away from more effective comprehensive programs. Since its inception, a portion of PEPFAR funding has been earmarked for "faith-based" organizations, and according to the Office of the U.S. Global AIDS Coordinator, over $82 million – nearly a tenth of federal AIDS funding – went to such groups this year.
Career staff at USAID have come under extreme pressure to advance the Administration’s ideological agenda, and political appointees are now overruling career staff and public health experts in order to direct grants to political supporters and withhold them from those who don’t adhere to an abstinence-only agenda. For instance, Population Services International (PSI) is a long-time recipient of USAID funds that specializes in social marketing of public health tools, especially condoms. PSI has operated an innovative and effective USAID-funded program to provide HIV prevention outreach and education in brothels and bars in Central America. This year, when the project came up for contract renewal, PSI’s proposal was removed from standard consideration by career public health professionals and given instead to higher-level political appointees who, not surprisingly, have yet to act on the contract.
The political pressures on and within USAID have combined with broader policies to do real harm at the country level. For example, thanks in large part to pressure from the Bush administration, Uganda’s successful “ABC” (Abstinence, Be Faithful, Use a Condom) approach to HIV/AIDS prevention has shifted to an A – abstinence-only – strategy. In fact, according to the Center for Health and Gender Equity (CHANGE), the U.S. government is now spending 56 percent of its funding for the prevention of sexual transmission of AIDS in Uganda on abstinence-only programs that prohibit the dissemination of condom information and supplies to young people, ages 15-24; this in a country where 66 percent of 15-24 year olds are sexually active. A portion of the remaining 44 percent of funding is available for more comprehensive programs that promote condom use, but this funding is limited to projects that focus on outreach to “high risk” groups, defined as sex workers, truck drivers, and people in bars. Young women, the fastest growing group of people with HIV, are not defined as high risk and are not receiving comprehensive services.
Meanwhile, the Bush administration has decided to require U.S.-based recipients of PEPFAR funding to adopt a policy “explicitly opposing prostitution and sex trafficking.” This “loyalty oath,” which had already been applied to overseas recipients of PEPFAR funding, has drawn widespread opposition from public health professionals and advocates who see it as an unconstitutional imposition on free speech and as an unnecessary obstacle to working with sex workers, one of the most vulnerable and critical populations they are trying to serve.
As if the loyalty oath weren’t enough, the Administration is now also trying to apply the “Global Gag Rule” (aka the “Mexico City Policy”) to PEPFAR funding, despite previous promises not to do so. On November 18th, USAID issued a five-year $193 million request for applications (RFA) for HIV/AIDS prevention, treatment and care in Kenya. The RFA explicitly states that funding will only go to organizations that “agree to abide by the Mexico City Policy,” which prohibits recipients of U.S. family planning assistance from providing abortion counseling, referrals or services or from advocating for safer abortion policies – even with their non-U.S. funding. On November 28th, in response to public pressure, the RFA was withdrawn under the guise that it was a "mistake." Nonetheless, a lack of clear guidance on whether and how the Gag Rule is applied to HIV funding is wreaking havoc at the field level in countries like Kenya and Uganda, where family planning organizations are being told they are ineligible for HIV prevention funds.
This year alone, roughly five million people around the world became newly infected with HIV and more than three million died from the disease. Since it was first recognized in 1981, AIDS has killed more than 25 million people worldwide, making it one of the most devastating epidemics in recorded history. Policies that promote abstinence as the only solution to AIDS, limit access to life-saving devices like condoms, prevent NGOs from addressing critical public health problems like unsafe abortion, and condemn the very people we most need to help are not only short-sighted, they are immoral and dangerous. Let’s celebrate World AIDS Day by lifting these restrictions so that all of us – citizens, activists, scientists, medical professionals, NGOs and others around the world – can fight the battle against AIDS with both hands until we win.
Shira Saperstein is a Senior Fellow at the Center for American Progress and Deputy Director of the Moriah Fund.