Population Action International


The Road to Toronto – PAI Questions U.S. Abstinence Earmark Awaits GAO Report

Washington, DC -

Responding to requests from various House and Senate members, the Government Accountability Office (GAO) is expected to release a report Tuesday examining the implementation of HIV prevention programs under the President's Emergency Plan for AIDS Relief (PEPFAR). Of particular interest to many, including PAI, will be GAO's findings on the earmark that designates one-third of all prevention funds for "abstinence-until-marriage" programs.

Since the program’s inception, policymakers and HIV prevention experts have questioned the reasoning behind mandating that one-third of all bilateral prevention funds be spent on abstinence-until-marriage programs:

  • Is the earmark based on best practices for HIV prevention and based on the nature of the epidemic in developing countries?
  • Or, is it an arbitrary number with no scientific backing that actually hinders countries’ attempts at stemming the spread of HIV/AIDS?

In practice, requiring countries to spend one-third of their PEPFAR funding on programs that teach abstinence-until-marriage leaves them unable to address the specialized needs of communities within their borders – even if, for example, the epidemic is raging disproportionately among married women or sex workers.

According to the Office of the Global AIDS Coordinator (OGAC), 10 countries have received waivers from this requirement because they cannot effectively reach their highest-risk populations through the normally-required earmark. This raises an interesting question: Is the earmark truly necessary if OGAC already grants exceptions to some countries wanting to address the nature of their specific epidemic? Shouldn't all countries be afforded this opportunity?

Furthermore, while the waivers are a welcome relief for many countries, they do not relieve OGAC of its responsibility to meet the overall abstinence earmark. When Dr. Mark Dybul, Deputy Director of OGAC, testified before the House Appropriations Subcommittee on Foreign Operations, Representative Mark Kirk (R-IL) asked about the effect that these waivers may have on non-waiver-receiving countries. Dr. Dybul's response was vague, merely citing an overall increase in PEPFAR funding and noting that the 2006 earmarks are "absolute."

The GAO report is expected to address this issue in further detail. In the interest of promoting U.S. policy that benefits women and their families worldwide, PAI hopes the report will clarify the many remaining questions about the wisdom and effectiveness of this provision.Responding to requests from various House and Senate members, the Government Accountability Office (GAO) is expected to release a report Tuesday examining the implementation of HIV prevention programs under the President's Emergency Plan for AIDS Relief (PEPFAR). Of particular interest to many, including PAI, will be GAO's findings on the earmark that designates one-third of all prevention funds for "abstinence-until-marriage" programs.

Since the program’s inception, policymakers and HIV prevention experts have questioned the reasoning behind mandating that one-third of all bilateral prevention funds be spent on abstinence-until-marriage programs:

  • Is the earmark based on best practices for HIV prevention and based on the nature of the epidemic in developing countries?
  • Or, is it an arbitrary number with no scientific backing that actually hinders countries’ attempts at stemming the spread of HIV/AIDS?

In practice, requiring countries to spend one-third of their PEPFAR funding on programs that teach abstinence-until-marriage leaves them unable to address the specialized needs of communities within their borders – even if, for example, the epidemic is raging disproportionately among married women or sex workers.

Population Action International (PAI) works to improve individual well-being and preserve global resources by mobilizing political and financial support for population, family planning and reproductive health policies and programs.