What You Need to Know About the Presidents Emergency Plan for AIDS Relief
February 1, 2007The President’s Emergency Plan for AIDS Relief, commonly known as PEPFAR, is the largest commitment to HIV/AIDS prevention, care and treatment by any government or private entity in history. While U.S. assistance for HIV/AIDS prevention activities is urgently needed, it comes with significant restrictions on how the money is spent. These restrictions have seriously undermined the public health impact of U.S.-funded efforts to help stop the spread of infection and will continue to do so unless they are repealed.
What is the President's Emergency Plan?
PEPFAR, authorized in 2003 and funded in 2004, is a five-year, US$15
billion initiative to fight the HIV/AIDS pandemic in 15 of the most affected
countries in Africa, the Caribbean and Asia. Nearly half of all HIV infections
worldwide have occurred in these regions. PEPFAR aims to treat at least 2
million HIV-infected people with anti-retroviral therapy, prevent 7 million new
infections and care for 10 million people infected and affected by HIV/AIDS,
including orphans and vulnerable children.
Legislation and policies governing U.S. HIV/AIDS programs
Legislation that authorized and established the President’s Emergency Plan was passed by Congress and signed by President Bush in May 2003. Between 2004 and 2006, PEPFAR has spent $5.6 billion on prevention, care and treatment of HIV/AIDS, a five-fold increase from what it was spending in 2003. The U.S. in on track to exceed the $15 billion authorized by law.
A biased approach to prevention of sexually transmitted HIV/AIDS
The principal U.S. government prevention strategy is the “ABC” model—
Abstain, Be faithful, and correct and consistent use of Condoms. In practice, this model places a rigid
programmatic emphasis on “A” for youth, “B” for married couples, and condoms
only for those “who practice high-risk behaviors.”
“Abstinence until marriage” earmarked for funding
U.S. authorizing legislation further reinforces the preference for abstinence-only prevention programs, as it mandates a funding floor of not less than one-third of bilateral prevention funds—20 percent of the $2 billion authorized annually —for undefined “abstinence until marriage” programs.
“Conscience clause” for faith-based groups
U.S. authorizing legislation also includes a “conscience clause” allowing the provision of funds to groups that are unwilling to discuss the full range of HIV/AIDS prevention options. This legislation stipulates that an organization is “not required, as a condition of receiving assistance… to endorse, utilize, or participate in a prevention method or treatment program to which the organization has a religious or moral objection.”
Accurate information on condoms is required
The law, however, includes an important legal requirement that condom information provided in U.S.-funded programs “be medically accurate and shall include the public health benefits and failure rates of such use.” The provision does not require organizations that may have a moral objection to the promotion of condoms as part of a comprehensive HIV/AIDS prevention strategy to provide information on condoms, but it is intended to prevent those same organizations from disparaging condoms as a means of promoting an abstinence-only approach.
U.S. PRESIDENT’S EMERGENCY PLAN FOR AIDS RELIEF
(PEPFAR) WORLDWIDE ACTIVITIES – JULY 2006
This map includes all HIV/AIDS activities funded through the following USG agencies: Department of State, U.S. Agency for International Development, Department of Defense, Department of Commerce, Department of Labor, Department of Health and Human Services, and Peace Corps. This does not include activities funded through the U.S. Department of Agriculture. Source: Office of the Global AIDS Coordinator, Humanitarian Information Unit |
Opposition to prostitution and sex trafficking is required
U.S. authorizing legislation includes a ban on the use of U.S. funds to promote or advocate the legalization of prostitution or sex trafficking. However, the legislation stipulates that nothing should interfere with the provision of HIV/AIDS prevention, treatment and care to individuals, including access to condoms and microbicides. More significantly, a requirement is imposed that U.S. and foreign organizations receiving HIV/AIDS assistance have an official policy opposing prostitution and sex trafficking as a condition of eligibility for funds, potentially limiting the ability of organizations to address the health needs of these highly vulnerable women. The Global Fund and UN organizations are exempt from this requirement.
Global Gag Rule does not apply
Foreign organizations receiving U.S. funding for HIV/AIDS activities are specifically exempt from the requirement to certify compliance with the Mexico City Policy. Known by its opponents as the Global Gag Rule, this policy renders organizations ineligible for U.S. family planning assistance if they use non-U.S. funds to provide legal abortion, counsel or refer for abortion, or lobby for the legalization of abortion in their own country. However, those organizations receiving only HIV/AIDS assistance are not required to comply with the gag rule’s terms.
PEPFAR PREVENTION PROGRAM AREAS |
