PEPFAR’s Target Countries Need Sexual Health Information, Not Abstinence-Only

Ariana Childs Graham

While PEPFAR funds abstinence-only programs, SIECUS finds the program's target countries desperately need basic sexual health information.

SIECUS today releases our
2008
PEPFAR Country Profile Updates.  Designed to supplement the original 2005 PEPFAR Country
Profiles
, these updates together track the impact and progress of
the prevention components in the President’s Emergency Plan for AIDS
Relief, or PEPFAR, in the 15 designated "focus countries" around
the world. 

There is no doubt that PEPFAR
provides assistance for care and treatment in countries most devastated
by the HIV/AIDS pandemic.  But that admission does not require
us to turn a blind eye toward its destruction of a comprehensive prevention
agenda – the third part of the emergency response – in the focus
countries.  

When PEPFAR was reauthorized
earlier this year, the popular press and advocates of a "more money
whatever the cost" approach failed to recognize what our new updates
continue to show: the ideological underpinnings in PEPFAR’s prevention
portfolio stand in the way of a good program from being a great program. 

The various restrictions and
limitations in PEPFAR’s prevention portfolio are well known to many,
and include the disproportionate emphasis on Abstinence-only and "Be-faithful"
programs (AB) while downplaying the importance of correct and consistent
condom use (C).  The original law also required 1/3 of prevention
funding to go to AB programs while the reauthorized law strongly suggests
focus countries not to fall below a 50% threshold for AB. 

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The impact of this particular
silliness is entirely serious on the ground.  

Tanzania is a disturbing example.  Just
over 6% of people ages 15- 49 in Tanzania are HIV-positive
and about 80% of infections occur through heterosexual sex.  The
country’s own strategy, laid out in what is known as their National
Multi-Sectoral Strategic Framework, embraces a comprehensive approach
to prevention and recognizes the key role of condoms.  (And, just
so it’s clear that they have their work cut out for them, only about
40% of males and 45% of females in Tanzania could correctly indentify
ways to prevent HIV transmission and reject misconceptions about how
the virus is spread.) 

Nonetheless, in responding
to Tanzania’s epidemic, PEPFAR prevention funding misses the mark. 
According to the country’s operational plan for 2007, a total of 25
programs received funding, but only three of these were reported to
be promoting correct and consistent condom use.  Making matters
still worse, one of these reported that it only reached 70 people (in
a country of more than 38 million people). 

A similar disconnectedness
can be observed in Botswana.  Botswana is, a country with an HIV prevalence
of nearly 24% (the second highest in the world), and while 25 organizations
received PEPFAR funding to prevent sexual transmission of HIV in 2007,
only two promoted correct and consistent condom use. 

Botswana also exemplifies the
open-door policy of PEPFAR to faith-based organizations that allows
them to withhold any information they deem contrary to faith teachings. 
So who is getting PEPFAR funding in Botswana?  True Love Waits
– a program whose central pillar is a virginity pledge that has been
disproved as an effective intervention.  Moreover, this particular
program instructs people that safe sex is wrong and that condoms have
defects in them.  This, in a country where nearly one in four people
carry the virus. True Love Waits also received PEPFAR funding in Kenya
and in South Africa. 

There is additional, disturbing
evidence about what certain faith-based grantees are doing with
U.S. tax-payer money.  For example, in South Africa, a country with about 18% HIV prevalence,
one grantee, called Scripture Union, describes its vision "to introduce
young people to Jesus" and ensure a "commitment to Jesus and also
to abstinence, whichever comes first."  To be sure, this is a
missionary organization that uses PEPFAR funding to proselytize and,
in 2007, they received nearly $1 million of U.S. money to do that. 

These are just a few of the
issues that surfaced in our extensive research and lead us to offer seven policy recommendations.  We call for: 1) an end to disproportionate
emphasis for ineffective abstinence-only programs; 2) increased transparency
of how funds are actually being used; 3) increased oversight to combat
proselytizing, to prevent faith-based organizations from exempting themselves
from discussing information on condoms/contraception, and to review
the influence of the U.S. government in the development of country plans
on prevention; 4) an end to the war on prevention efforts for sex workers;
5) increased focus on integration of HIV/AIDS and reproductive health
care services; 6) increased investment in indigenous prevention program
providers; and 7) an end to legalized discrimination in the program
that allows grantees to deny care, treatment and prevention services
to whomever they choose based on moral beliefs.  

The
2008 Updates
contain much useful information, but what was so striking
to us at SIECUS was one consistent theme that emerged in nearly every
country: the way in which the HIV epidemic targets the most vulnerable
members of society.  In country after country, young women, commercial
sex workers, injecting drug users, and men who have sex with men disproportionately
suffer from the HIV/AIDS.  These are the people who are most in
need of help and medical interventions, but who often slip through the
cracks.  As we face the challenges of reaching out to traditionally
underserved communities, we need PEPFAR to be more open and less blindly
moralistic in the way it distributes its resources. 

SIECUS has developed updates
for all 15 of the focus countries: Botswana, Côte d’Ivoire, Ethiopia,
Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa,
Tanzania, Uganda, Viet Nam, and Zambia. 

To see both the 2008 PEPFAR
Country Profile Updates
and the 2005 PEPFAR Country Profiles,
go to www.siecus.org/countryprofiles.

News Family Planning

Judge Thwarts Ohio GOP’s Attack on Planned Parenthood Funding

Michelle D. Anderson

“This law would have been especially burdensome to communities of color and people with low income who already often have the least access to care—this law would have made a bad situation worse,” said Iris E. Harvey, president and CEO of Planned Parenthood of Greater Ohio.

An effort to defund Ohio Planned Parenthood affiliates by Gov. John Kasich (R) and the Republican-held legislature has come to an end.

Judge Michael R. Barrett of the U.S. District Court of the Southern District of Ohio on Friday ruled in Planned Parenthood’s favor, granting a permanent injunction on an anti-choice state law.

The court ruling will keep Richard Hodges, the Ohio Department of Health director, from enforcing HB 294.

The 2015 law, sponsored by Rep. Bill Patmon (D-Cleveland) and Rep. Margaret Conditt (R-Butler County), would have redirected $1.3 million in state and federal taxpayer funds from Planned Parenthood’s 28 clinics in Ohio.

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The law would have required the state department to keep federal funds and materials that the health department receives from being distributed to entities that perform or promote non-therapeutic abortions, or maintain affiliation with any entity that does.

Funding that would’ve been cut off from the state health department went to the Violence Against Women and Breast and Cervical Cancer Mortality Prevention acts, the Infertility Prevention Project, Minority HIV/AIDS and Infant Mortality Reduction initiatives, and the Personal Responsibility Education Program.

Planned Parenthood in a lawsuit argued that the Republican legislation violated the First Amendment and the Due Process Clause and Equal Protection Clause of the 14th Amendment.

Barrett had temporarily blocked the law after Planned Parenthood affiliates filed the lawsuit and requested a preliminary injunction. The judge had issued an opinion contending that some legislators passed the law to make it difficult for people to access abortion care, as Rewire reported.

Iris E. Harvey, president and CEO of Planned Parenthood of Greater Ohio, praised the judge’s temporary order.

“This law would have been especially burdensome to communities of color and people with low income who already often have the least access to care—this law would have made a bad situation worse,” Harvey said in a statement.

Kellie Copeland, NARAL Pro Choice Ohio’s executive director, said in a statement that the Ohio legislature passed the anti-choice measure in an effort to appeal to conservative voters in early primary states during Kasich’s presidential campaign.

Copeland said that while the legislation made no effort to reduce the number of abortions performed, “it actively blocked critical health care for low-income women and families.”

Planned Parenthood said those services included 70,000 free STD screenings, thousands of HIV tests for at-risk community residents, and the largest infant mortality prevention program in the state.

In the 23-page court order and opinion, Barrett, an appointee of President George W. Bush, acknowledged that the law would have deterred “patients from seeking these potentially life-saving services.”

Planned Parenthood noted that the recent ruling in Ohio makes it among the ten states where courts have blocked anti-choice laws following June’s landmark Whole Woman’s Health v. Hellerstedt U.S. Supreme Court ruling.

Analysis Politics

Experts: Trump’s Proposal on Child Care Is Not a ‘Solution That Deals With the Problem’

Ally Boguhn

“A simple tax deduction is not going to deal with the larger affordability problem in child care for low- and moderate-income individuals," Hunter Blair, a tax and budget analyst at the Economic Policy Institute told Rewire.

In a recent speech, GOP presidential nominee Donald Trump suggested he now supports policies to made child care more affordable, a policy position more regularly associated with the Democratic Party. The costs of child care, which have almost doubled in the last 25 years, are a growing burden on low- and middle-income families, and quality options are often scarce.

“No one will gain more from these proposals than low- and middle-income Americans,” claimed Trump in a speech outlining his economic platform before the Detroit Economic Club on Monday. He continued, “My plan will also help reduce the cost of childcare by allowing parents to fully deduct the average cost of childcare spending from their taxes.” But economic experts question whether Trump’s proposed solution would truly help alleviate the financial burdens faced by low- and middleincome earners.

Details of most of Trump’s plan are still unclear, but seemingly rest on addressing child care costs by allowing families to make a tax deduction based on the “average cost” of care. He failed to clarify further how this might work, simply asserting that his proposal would “reduce cost in child care” and offer “much-needed relief to American families,” vowing to tell the public more with time. “I will unveil my plan on this in the coming weeks that I have been working on with my daughter Ivanka … and an incredible team of experts,” promised Trump.

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An adviser to the Trump campaign noted during an interview with the Associated Press Monday that the candidate had yet to nail down the details of his proposal, such as what the income caps would be, but said that the deductions would only amount to the average cost of child care in the state a taxpayer resided in:

Stephen Moore, a conservative economist advising Trump, said the candidate is still working out specifics and hasn’t yet settled on the details of the plan. But he said households reporting between $30,000 and $100,000, or perhaps $150,000 a year in income, would qualify for the deduction.

“I don’t think that Britney Spears needs a child care credit,” Moore said. “What we want to do is to help financially stressed middle-class families have some relief from child-care expenses.”

The deduction would also likely apply to expensive care like live-in nannies. But exemptions would be limited to the average cost of child care in a taxpayer’s state, so parents wouldn’t be able to claim the full cost of such a high-price child care option.

Experts immediately pointed out that while the details of Trump’s plan are sparse, his promise to make average child care costs fully tax deductible wouldn’t do much for the people who need access to affordable child care most.

Trump’s plan “would actually be pretty poorly targeted for middle-class and low-income families,” Hunter Blair, a tax and budget analyst at the Economic Policy Institute (EPI), told Rewire on Monday.

That’s because his tax breaks would presumably not benefit those who don’t make enough money to owe the federal government income taxes—about 44 percent of households, according to Blair. “They won’t get any benefit from this.”

As the Associated Press further explained, for those who don’t owe taxes to the government, “No matter how much they reduce their income for tax purposes by deducting expenses, they still owe nothing.”

Many people still may not benefit from such a deduction because they file standard instead of itemized deductions—meaning they accept a fixed amount instead of listing out each qualifying deduction. “Most [lower-income households] don’t choose to file a tax return with itemized deductions,” Helen Blank, director of child care and early learning at the National Women’s Law Center (NWLC), told Rewire Tuesday. That means the deduction proposed by Trump “favors higher income families because it’s related to your tax bracket, so the higher your tax bracket the more you benefit from [it],” added Blank.

A 2014 analysis conducted by the Congressional Research Service confirms this. According to its study, just 32 percent of tax filers itemized their deductions instead of claiming the standard deduction in 2011. While 94 to 98 percent of those with incomes above $200,000 chose to itemize their deductions, just 6 percent of tax filers with an adjusted gross income below $20,000 per year did so.

“Trump’s plan is also not really a solution that deals with the problem,” said Blair. “A simple tax deduction is not going to deal with the larger affordability problem in child care for low- and moderate-income individuals.”

Those costs are increasingly an issue for many in the United States. A report released last year by Child Care Aware® of America, which advocates for “high quality, affordable child care,” found that child care for an infant can cost up to an average $17,062 annually, while care for a 4-year-old can cost up to an average of $12,781.

“The cost of child care is especially difficult for families living at or below the federal poverty level,” the organization explained in a press release announcing those findings. “For these families, full-time, center-based care for an infant ranges from 24 percent of family income in Mississippi, to 85 percent of family income in Massachusetts. For single parents the costs can be overwhelming—in every state annual costs of center-based infant care averaged over 40 percent of the state median income for single mothers.”

“Child care now costs more than college in most states in our nation, and it is an actual true national emergency,” Kristin Rowe-Finkbeiner, CEO and executive director of MomsRising, told Rewire in a Tuesday interview. “Donald Trump’s new proposed child care tax deduction plan falls far short of a solution because it’s great for the wealthy but it doesn’t fix the child care crisis for the majority of parents in America.”

Rowe-Finkbeiner, whose organization advocates for family economic security, said that in addition to the tax deduction being inaccessible to those who do not itemize their taxes and those with low incomes who may not pay federal income taxes, Trump’s proposal could also force those least able to afford it “to pay up-front child care costs beyond their family budget.”

“We have a crisis … and Donald Trump’s proposal doesn’t improve access, doesn’t improve quality, doesn’t lift child care workers, and only improves affordability for the wealthy,” she continued.

Trump’s campaign, however, further claimed in a statement to CNN Tuesday that “the plan also allows parents to exclude child care expenses from half of their payroll taxes—increasing their paycheck income each week.”

“The working poor do face payroll taxes for Social Security and Medicare, so a payroll tax break could help them out,” reported CNN. “But experts say it would be hard to administer.”

Meanwhile, Democratic presidential nominee Hillary Clinton released her own child care agenda in May, promising to use the federal government to cap child care costs at 10 percent of a family’s income. 

A cap like this, Blank said, “would provide more help to low- and middle-income families.” She continued, “For example, if you had a family with two children earning $70,000, if you capped child care at 10 percent they could probably save … $10,000 a year.”

Clinton’s plan includes a promise to implement a program to address the low wages many who work in the child care industry face, which she calls the “Respect And Increased Salaries for Early Childhood Educators” program, or the RAISE Initiative. The program would raise pay and provide training for child-care workers.

Such policies could make a major difference to child-care workers—the overwhelming majority of which are women and workers of color—who often make poverty-level wages. A 2015 study by the EPI found that the median wage for these workers is just $10.31 an hour, and few receive employer benefits. Those poor conditions make it difficult to attract and retain workers, and improve the quality of care for children around the country. 

Addressing the low wages of workers in the field may be expensive, but according to Rowe-Finkbeiner, it is an investment worth making. “Real investments in child care bring for an average child an eight-to-one return on investment,” she explained. “And that’s because when we invest in quality access and affordability, but particularly a focus on quality … which means paying child-care workers fairly and giving child-care workers professional development opportunities …. When that happens, then we have lower later grade repetition, we have less future interactions with the criminal justice system, and we also have a lower need for government programs in the future for those children and families.

Affordable child care has also been a component of other aspects of Clinton’s campaign platform. The “Military Families Agenda,” for example, released by the Clinton campaign in June to support military personnel and their families, also included a child care component. The former secretary of state’s plan proposed offering these services “both on- and off-base, including options for drop-in services, part-time child care, and the provision of extended-hours care, especially at Child Development Centers, while streamlining the process for re-registering children following a permanent change of station (PCS).” 

“Service members should be able to focus on critical jobs without worrying about the availability and cost of childcare,” said Clinton’s proposal.

Though it may be tempting to laud the simple fact that both major party candidates have proposed a child care plan at all, to Rowe-Finkbeiner, having both nominees take up the cause is a “no-brainer.”

“Any candidate who wants to win needs to take up family economic security policies, including child care,” she said. “Democrats and Republicans alike know that there is a child care crisis in America. Having a baby right now costs over $200,000 to raise from zero to age 18, not including college …. Parents of all political persuasions are talking about this.”

Coming up with the right way to address those issues, however, may take some work.

“We need a bold plan because child care is so important, because it helps families work, and it helps them support their children,” the NWLC’s Blank said. “We don’t have a safety net for families to fall back on anymore. It’s really critical to help families earn the income their children need and child care gives children a strong start.” She pointed to the need for programs that offer families aid “on a regular basis, not at the end of the year, because families don’t have the extra cash to pay for child care during the year,” as well as updates to the current child care tax credits offered by the government.

“There is absolutely a solution, but the comprehensive package needs to look at making sure that children have high-quality child care and early education, and that there’s also access to that high-quality care,” Rowe-Finkbeiner told Rewire. 

“It’s a complicated problem, but it’s not out of our grasp to fix,” she said. “It’s going to take an investment in order to make sure that our littlest learners can thrive and that parents can go to work.”

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