Stepping Up US Global HIV Prevention

Kimberly Whipkey and Healy Thompson

World AIDS Day offers an opportunity to raise awareness about changes that PEPFAR desperately needs -- like reforming the ABC approach, the anti-prostitution pledge, and the one-third earmark for abstinence-until-marriage programs.

This World AIDS Day (December 1), we're marching toward a historic moment in the course of U.S. global HIV prevention policy and its impact on the lives of women and youth worldwide. The President's Emergency Plan for AIDS Relief (PEPFAR) — the U.S. initiative intended to prevent 7 million new infections, treat 2 million people living with AIDS related illnesses, and provide care and support for 10 million people living with AIDS — is headed into its fifth year and final months before Congress reauthorizes the initiative in 2008.

While the U.S. is a leading source of funding for HIV/AIDS programs worldwide, after four years of PEPFAR, we've seen a lot of missteps in making HIV prevention strategies work for women and youth, including a misguided "ABC" (Abstain, Be Faithful, Use Condoms) approach to HIV prevention and ideologically-driven funding restrictions like the one-third abstinence-until-marriage earmark and anti-prostitution pledge. World AIDS Day offers an opportunity to raise awareness about necessary reforms to PEPFAR prevention policy and to call upon Congress to step up and stand up for the lives of women and youth worldwide.

Consider the abstinence-until-marriage earmark. When Congress authorized $15 billion for PEPFAR, it mandated that at least thirty-three percent of HIV prevention funds be spent on abstinence-until-marriage programs. Not surprisingly, this funding restriction has harmed women and youth by failing to address the varied realities of their lives. The vast majority of youth in PEPFAR's fifteen focus countries are sexually active by the time they are twenty, and half of all new HIV infections occur in youth aged 15-24. Counter to what the abstinence-until-marriage policy suggests, marriage is not a safe haven from infection. Eighty percent of HIV infections among women worldwide result from sex with their husbands or primary partners.

In the vein of funding restrictions and missteps, there is also the anti-prostitution pledge — the requirement that nongovernmental organizations adopt a policy explicitly opposing prostitution in order to receive PEPFAR funding for HIV/AIDS programming. Women and men who engage in sex work are among the most marginalized persons in any society and are at increased risk of HIV infection. Yet organizations that advocate for the health and human rights of commercial sex workers face a difficult decision: sign the pledge and further stigmatize and marginalize those most in need of comprehensive HIV/AIDS prevention, treatment and care or renounce the pledge and risk closure due to lack of funds.

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Reproductive health and HIV/AIDS services are generally operated separately — a burdensome arrangement for women and girls in resource-poor countries who must often visit one provider for family planning or prenatal care and another for HIV testing or treatment. To improve access to life-saving health care, PEPFAR must take steps toward integrating sexual and reproductive health services with HIV/AIDS services and programs. This makes sense because for women who have sex with men, unprotected sex may result in pregnancy and/or HIV infection. Integrated service sites staffed by trained and sensitive practitioners would also help ensure that U.S. global AIDS policy respects the childbearing decisions of HIV positive individuals and people living with AIDS.

As the U.S. prepares to usher in the next phase of PEPFAR, we must step away from ideological funding restrictions and centralize effective, integrated prevention programs and policies for those most vulnerable to infection.

That's why for World AIDS Day 2007, organizations and advocates across the nation are participating in the "STEPS" to Effective U.S. Global HIV Prevention Policy for Women and Youth campaign. STEPS stands for "Start Taking Effective Prevention Seriously" — which is our message to Congress as members deliberate over changes to PEPFAR. We're encouraging supporters to join the campaign by taking literal steps, like organizing and participating in marches, and figurative steps, like making the case for reform to policy makers and the media. Around the country, people will call or write their Representatives and Senators to co-sponsor the PATHWAY Act or the HIV Prevention Act (both bills would remove the 1/3 abstinence-until-marriage funding earmark), write letters-to-the-editor about effective U.S. global HIV prevention policy, or even get tested for HIV. Nationally, our goal is that 4 million steps be taken, representing the approximate number of new HIV infections each year.

As part of the STEPS campaign, we're calling on Congress to take three major steps for PEPFAR reauthorization:

  • Remove the 1/3 abstinence-until-marriage earmark and fund comprehensive, integrated, and evidence-based HIV prevention programs.
  • Expand access to HIV/AIDS and reproductive health services by integrating these programs to help prevent and reduce HIV infections among women and girls, avert HIV transmission from mother-to-child, and support HIV-positive women's reproductive rights and fertility choices.
  • Strike the anti-prostitution pledge and support programs that advance effective HIV prevention interventions, promote fundamental human rights and free speech, and reduce stigma and discrimination against marginalized populations.

These global HIV prevention demands will be shouted loud and clear at a World AIDS Day "STEPS" march in Washington, D.C. on Friday, November 30. Advocates will be marching from the Office of the Global AIDS Coordinator (OGAC — the U.S. agency that oversees the implementation of PEPFAR), where they will be calling on OGAC to support our calls to Congress. We will then join with a larger rally that brings together local, national, and global anti-AIDS activists in Lafayette Park at 1:00 p.m. To learn more about the STEPS World AIDS Day campaign and the D.C. march and rally, please visit For those looking to take STEPS toward effective domestic HIV prevention policy, we recommend joining the Prevention Justice Mobilization, which can easily be integrated with a global STEPS message.

Together, our STEPS can go a long way!

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