PEPFAR: Are Abstinence Requirements Really Gone?

Liz Bayer

While prevention restrictions under US Global AIDS Policy were made looser in last year's reauthorization bill, the new law includes worrisome reporting requirements for prevention programs.

This article was originally published at Amplify, the online publication of Advocates for Youth, one of the leading organizations on sexual and reproductive health for youth.

In mid-September, I was lucky enough to be a part of a group of young
people from Advocates for Youth, comprised of students and activists
from the US, Jamaica, Nigeria, and Ethiopia, that met with the Office
of the Global AIDS Coordinator (OGAC).  OGAC is responsible for
administering and overseeing the President’s Emergency Plan for AIDS
Relief, which was reauthorized in 2008.  We met with OGAC to talk with
them about how new funding regulations and policies would affect young
people in PEPFAR countries.

With the first PEPFAR authorization in 2003, the authorizing
legislation required that a third of all HIV prevention funding (20
percent of the total PEPFAR funds) be used for
abstinence-until-marriage programs, or the “A” part of the ABC approach
to prevention.  For young people, the B (be faithful), and C
(consistent and correct condom use) approaches were emphasized less
than abstinence and were stressed mainly as interventions for married
couples, commercial sex workers, and “high risk” groups. Fortunately,
the reauthorized PEPFAR does not include the earmark for
abstinence-until-marriage funding. 

However, the new law does include a new reporting requirement that
requires OGAC to submit an explanation to Congress whenever countries
with generalized epidemics utilize less than 50 percent of their funds
allocated to prevention of sexual transmission on programs containing
abstinence, delay of sexual initiation, fidelity, monogamy, and partner
reduction components.

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While this may not seem like a problem, it’s still a worrisome regulation. 
In this vein, it was not clear whether OGAC’s current legislative
interpretation means that a comprehensive program that teaches the
values and benefits of abstinence, while also teaching faithfulness and
condom use, would count towards the 50 percent requirement, or if the
inclusion of condom instruction would render it a “C” program in the
eyes of PEPFAR and congressional stipulations. It’s important OGAC
employs a prevention model for young people that is centered on
comprehensive prevention education, because when it comes to HIV
prevention, we need to make sure that young people have all the
information that they need to prevent HIV.  There is no evidence that
abstinence only programs work, whereas comprehensive programs have been
shown to delay sexual initiation and increase correct and consistent
condom use among sexually active youth.  We need comprehensive
education, which is by definition inclusive of abstinence, to count
towards soft quota for “AB” programs.

Because the HIV pandemic affects a vast number of young people, it’s
important that they be included in the conversations about
implementation of PEPFAR and also that they be a major focus group for
PEPFAR funding and programming.  Youth activists from Ethiopia,
Nigeria, and Jamaica were able to share with OGAC the major success
that they have had in influencing policy in their countries.  They have
also been able to reach out to their peers through the schools and
through extension workers to educate other young people about sexual
and reproductive health, including HIV prevention.   In particular,
there has been a focus on incorporating the voices of young people who
are HIV-positive in crafting strategies to help them live longer and
better lives.  But there also needs to be an increased focus on getting
feedback from young people who are at risk of infection about how to
best reach them, help them, and get them the information and education
that they need to prevent HIV infection.

We were all very grateful that OGAC took the time to meet with us and
hear from youth activists.  We’re hopeful about the direction that
PEPFAR is heading, and we’re encouraged that abstinence-only
restrictions have been relaxed, but it’s important to ensure that
comprehensive education, which includes “A,” “B,” and “C” is readily
available in PEPFAR countries and fits within the “AB” reporting
requirements.   We also want to ensure that young people, who
constitute 45 percent of all new HIV infections, are included in the
planning, implementation, and monitoring and evaluation of prevention
efforts.  We’ve seen that young people can make a difference in
designing and implementing policy and reaching out to other
adolescents.  In the fight against HIV, it’s vital that our voices be

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