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
PEPFAR Country Profile Updates.  Designed to supplement the original 2005 PEPFAR Country
, 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

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.  

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

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