Global HIV / AIDS — The Politics of Prevention Issue Summary

Introduction

The U.S. response to the global HIV/AIDS pandemic has gained momentum in recent years. During his January 2003 State of the Union Address, President Bush announced his intention to create a new U.S. initiative to fight the global AIDS pandemic (White House, 2003). Several months later, Congress passed the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003, also referred to as the President's Emergency Plan for AIDS Relief (PEPFAR) (United States Department of State, 2004; The White House, 2005). Unfortunately, this momentum has been accompanied by ideologically motivated restrictions.

The Global HIV/AIDS Pandemic — Women and Young People Are at Its Center

The global HIV/AIDS pandemic has taken the lives of more than 25 million people, and today an estimated 40.3 million people are living with HIV/AIDS (UNAIDS, 2005a). What is more, the rate of new infections continues to rise every year. In 2005 alone, an additional 4.9 million people were infected (UNAIDS, 2005a).

For a variety of biological, cultural, and social reasons, women and girls are increasingly vulnerable to HIV/AIDS infection. Marriage offers little protection against HIV/AIDS. In many developing countries, married adolescent girls have higher rates of HIV infection than their sexually active unmarried peers (Engender Health, 2005).

Young people, too, are increasingly vulnerable to HIV/AIDS. Approximately half of new adult HIV infections are among young people ages 15-24, and the majority of these young people are women (KFF, 2005). In sub-Saharan Africa approximately 76 percent of all young people living with HIV/AIDS are women (UNAIDS, 2005b).

PEPFAR Limits Spending on HIV/AIDS Prevention Programs

Prior to the introduction of PEPFAR, prevention efforts constituted the largest proportion of U.S. global HIV/AIDS activities (Boonstra, 2003). PEPFAR, however, reorients U.S. priorities. As of 2006, not less than 55 percent of total PEPFAR funds must be used to support treatment efforts, 15 percent of funds must be used to support palliative care, and 10 percent is recommended for programs supporting orphans and vulnerable children. The remaining funds — about 20 percent of all PEPFAR funds — may be allocated for prevention efforts around the world (P.L. 108-025).

PEPFAR and the Politics of Prevention

With the introduction of PEPFAR, and the five-year, $15 billion commitment to fight the global HIV/AIDS pandemic, the Bush administration made global HIV/AIDS a significant focus of its foreign policy and development assistance efforts. At the behest of social conservatives, though, PEPFAR funding is attached to a number of criteria and restrictions that have little to do with sound, epidemiologically informed public health.

Paramount to the agenda of ultraconservatives is a focus on abstinence-promotion in U.S.-funded programs to prevent the spread of HIV/AIDS. Citing Uganda's success in reducing prevalence rates of HIV/AIDS, they adapted Uganda's ABC approach (Abstinence, Be faithful, and use Condoms) to primarily emphasize abstinence programs (The Guttmacher Institute, 2004). PEPFAR requires that at least 33 percent of prevention funds be used for abstinence-until-marriage programs (P.L. 108-025). Other examples of ideology trumping science in the United States' approach to combating HIV/AIDS are

• De-emphasis of condom use. Although correct and consistent condom use is the most effective HIV/AIDS prevention tool for sexually active individuals (WHO, UNAIDS, and United Nations Population Fund, 2004), PEPFAR limits their appropriateness to "high-risk" groups, such as "prostitutes, sexually active discordant couples, and substance abusers" (United States Department of State, 2004).

• Ideological litmus test. Until it was recently ruled unconstitutional, the Bush administration required that groups receiving PEPFAR funds explicitly oppose prostitution (Cohen, 2006). Among many other issues, the policy forced groups to denounce the same people they were seeking to help.

• Funding for poorly qualified faith-based organizations. PEPFAR prioritizes funding for faith-based organizations (Office of the United States Global AIDS Coordinator, 2005; United States Department of State, 2005), including those with little or no relevant international development experience (Sealey, 2005). Moreover, organizations cannot be required to support prevention methods (such as condoms) to which they have religious or moral objections (P.L. 108-025).

Conclusion

Passage of the global AIDS bill signals the Bush administration's recognition of the moral imperative of the world's wealthiest country to take significant action against the HIV/AIDS pandemic. This pandemic is cutting short lives, devastating families, disrupting communities, and threatening global security. If the United States is truly serious undertaking an unprecedented "work of mercy," as President Bush declared in his 2003 State of the Union Address, then U.S.-funded efforts must be based in sound, proven strategies free of political and ideological motivations (White House, 2003).

This document is a condensed version of Global HIV/AIDS, The Politics of Prevention. www.plannedparenthood.org

Cited References

Boonstra, Heather. (2003). "U.S. AIDS Policy: Priority On Treatment, Conservatives' Approach to Prevention." The Guttmacher Report on Public Policy, 6(3), 1-3. [Online]. http://www.guttmacher.org/pubs/tgr/06/3/gr060301.pdf.

Cohen, Susan A. (2006, May). Guttmacher Policy Review, Federal Judges: US HIV/AIDS Groups Cannot Be Forced to Sign Pledge Against Prostitution. [Online]. http://www.guttmacher.org/pubs/gpr/09/2/gpr090220.html.

Engender Health. (2005, accessed 2005, September 8). Women's Health in Jeopardy: Women and HIV. [Online]. http://www.engenderhealth.org/ia/swh/pwomenandhiv.html.

_____. (2004, November 26, accessed 2005, November 2). The U.S. Government and the ABCs of HIV/AIDS Prevention. [Online]. http://www.guttmacher.org/medi/inthenews/2004/11/26/index.html.

The Office of the United States Global AIDS Coordinator. (2005, September). The President's Emergency Plan for AIDS Relief: Community and Faith-based Organizations. [Online]. http://www.state.gov/documents/organization/54420.pdf.

P.L. 108-025, 108th Congress. (2003). United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act.

Sealey, Geraldine. (2005, June 2, accessed 2005, September 7). "An epidemic failure." Salon.com. [Online]. http://archive.salon.com/news/feature/2005/06/02/aids/print.html.

UNAIDS. (2005a, accessed 2005, December 1). AIDS Epidemic Update, 2005. [Online]. http://www.npr.org/documents/2005/nov/unaids/2005_update_full.pdf.

_____. (2005b, April 6, accessed 2005, November 11). "Integration of the Human Rights of Women and the Gender Perspective." Sixty-First Session of the United Nations Commission on Human Rights. [Online]. http://www.unchr.info/61st/docs/0407-Item12-UNAIDS.pdf.

United States Department of State. (2004, accessed 2005, November 15). The President's Emergency Plan for AIDS Relief: U.S. Five Year Global AIDS Strategy. [Online]. http://www.state.gov/documents/organization/29831.pdf.

_____. (2005, November, accessed 2006, January 25). PEPFAR: Community and Faith-Based Organizations (September 2005). [Online]. http://www.state.gov/s/gac/rl/more/2005/fbo/54316.htm.

The White House. (2003, accessed 2005, November 11). The State of the Union. [Online]. http://www.whitehouse.gov/news/releases/2003/01/print/20030128-19.html.

_____. (2005, March, accessed 2005, November 1). Engendering Bold Leadership: The President's Emergency Plan for AIDS Relief First Annual Report to Congress. [Online]. http://www.state.gov/s/gac/rl/43846.htm.

WHO, UNAIDS, and United Nations Population Fund. (2004, July, accessed 2005, November 11). "Position Statement on Condoms and HIV Prevention." [Online]. http://www.unfpa.org/upload/lib_pub_file/343_filename_Condom_statement.pdf.

Published: 09.29.06 | Updated: 09.29.06

Published by International Division, Planned Parenthood^® Federation of America

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