PEPFAR and the Power of Partnerships: Doing Good or Causing Harm?

Elisha Dunn-Georgiou

Elisha Dunn-Georgiou is the International Policy Associate at the Sexuality Information and Education Council of the United States (SIECUS).

Last week, the Office of the Global AIDS Coordinator (OGAC) released its 3rd annual report to Congress, The Power of Partnerships: The President's Emergency Plan for AIDS Relief (PEPFAR). According to the report, "Partnership is rooted in hope for and faith in people. Partnerships mean honest relationships between equals based on mutual respect, understanding and trust, with obligations and responsibilities for each partner." While this is a lovely sentiment—and hope and faith do have a place in fighting disease—OGAC should instead be talking about the power of partnerships as being rooted in collaborations that deliver the best, most effective, evidence-based public health program. This includes partnerships with institutions that have technical expertise in evidence-based HIV/AIDS prevention, treatment, and care, or expertise in poverty reduction, capacity building, reducing gender inequalities, reducing stigma and discrimination, and strengthening health systems. Truthfully, it could include forming partnerships with organizations that have expertise in any of the confounding issues that perpetuate high morbidity and mortality rates for HIV/AIDS in the 15 PEPFAR focus countries.

Elisha Dunn-Georgiou is the International Policy Associate at the Sexuality Information and Education Council of the United States (SIECUS).

Last week, the Office of the Global AIDS Coordinator (OGAC) released its 3rd annual report to Congress, The Power of Partnerships: The President's Emergency Plan for AIDS Relief (PEPFAR). According to the report, "Partnership is rooted in hope for and faith in people. Partnerships mean honest relationships between equals based on mutual respect, understanding and trust, with obligations and responsibilities for each partner." While this is a lovely sentiment—and hope and faith do have a place in fighting disease—OGAC should instead be talking about the power of partnerships as being rooted in collaborations that deliver the best, most effective, evidence-based public health program. This includes partnerships with institutions that have technical expertise in evidence-based HIV/AIDS prevention, treatment, and care, or expertise in poverty reduction, capacity building, reducing gender inequalities, reducing stigma and discrimination, and strengthening health systems. Truthfully, it could include forming partnerships with organizations that have expertise in any of the confounding issues that perpetuate high morbidity and mortality rates for HIV/AIDS in the 15 PEPFAR focus countries.

OGAC, however, can't start the report that way, because it is not selecting all of its partners based on these criteria. Instead, some of these partnerships are rooted in a desire to implement an anti-sexual and reproductive health and rights (SRHR) perspective that has become one of the hallmark ideologies of the Bush Administration. This is abundantly clear in the section on the New Partners Initiative.

Announced by President Bush in 2005, the initiative seeks to "increase the Emergency Plan's ability to reach people with needed services," and "build capacity in host nations by developing indigenous capacity to address HIV/AIDS to promote the sustainability of host nation's efforts." Theoretically, of course, this is a wonderful idea. But, a closer look at the list of new partners shows that this is not necessarily happening in practice. Fully 15 of the 22 new partners are faith-based organizations. Two of these new partners, the Natural Family Planning Center of Washington, D.C. and Geneva Global based in Pennsylvania, stand out as being particularly bad choices that meet neither goal of the initiative.

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The Natural Family Planning Center received a grant to use its hallmark abstinence-until-marriage program for HIV prevention in Nigeria and Ethiopia. The program, TeenSTAR, developed by Sister Hanna Klaus, M.D., claims to teach girls about their fertility to promote chastity. In actuality, the program, which contains separate lessons for boys and girls, reinforces gender stereotypes and preaches an anti-contraception message. In Klaus's review of the program, titled "Undergirding Abstinence within a Sexuality Education Program," she says, "contraception dichotomizes sex and procreation, thus facilitating fragmented, often solely or largely genital relationships, which do not lead to growth." Moreover, she states that understanding fertility enables girls to develop a "healthy feminine identity" and to understand the "psychosexual differences" between men and women—a key lesson of the curriculum. Klaus, a member of Physicians for Life, is a proponent of allowing medical personnel to refuse to present medical information they find morally objectionable—including information about contraception, condoms, and other sexual and reproductive health services.

Geneva Global, grounds its HIV/AIDS prevention programs in collaborations with faith-based organizations because of the "moral authority" such groups bring to combating the epidemic. Mark Forshaw, manager of Global's HIV/AIDS programming, has a long history of connecting Christian missionary work with HIV/AIDS prevention and of promoting abstinence-until-marriage and be-faithful programs to the detriment of condom promotion. Global praises Forshaw's contribution to an on-line book, The Truth About AIDS by Patrick Dixon. Dixon's chapter, "Condoms are Unsafe," explains, "The condom is the least reliable contraceptive in wide use" and "Over the next few years there will be a growing number of angry men and women who have become infected, despite their using a condom, having thought they were safe."

Ironically, the Power in Partnerships report is replete with rhetoric about the evidenced-based, country-driven focus of the program's efforts, including a whole chapter on PEPFAR's progress in responding to the critical issue of gender and HIV/AIDS. Unfortunately, OGAC's rhetoric is totally disconnected from its recruitment of new partners. How one is supposed to challenge gender norms with programs, like TeenSTAR, that teach girls that their "feminine identity" is rooted in their fertility is inconceivable. Also inconceivable is how PEPFAR can claim a balanced ABC approach while funding partners whose staff has contributed to books containing such medically inaccurate information about condoms.

Partnerships can indeed be powerful in the fight against HIV/AIDS, but only if they use evidence-based, comprehensive prevention strategies that truly address the real needs of people battling this epidemic. Otherwise, the power of these partnerships lies not in the good that they do, but only in the harm.

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