Two recent studies have illuminated an alarming trend in Uganda: HIV policies that do not link or integrate family planning and reproductive health programs are missing the mark and putting more people at risk of contracting HIV. The first, conducted by the Uganda AIDS Commission, shows that married couples now account for the highest proportion (42%) of new HIV infections in Uganda. The second, a recent Guttmacher study, found that 40% of births in Uganda are unintended. The evidence is mounting: The current approach to family planning and HIV prevention is not working. As the global leader in both, the U.S. must shape its policies and funding to respond to the reality Ugandans—and women around the world—are facing.

According to the Uganda AIDS Commission, lack of knowledge of HIV status, engaging in sex with multiple partners, and lack of condom use are among the reasons for the high infection rate among married couples. Currently, PEPFAR-funded HIV/AIDS prevention programs overemphasize abstinence—an inappropriate message for married couples. This is further evidence that PEPFAR’s requirements do not always make good use of limited funds. Countries receiving PEPFAR and other reproductive health assistance must be able to determine for themselves the most appropriate approach for addressing critical health issues—without misguided policy and funding prescriptions that hamper individual countries’ efforts.

In addition to ill-suited policies, the neglect of funding for family planning programs has very real consequences for Ugandan women and their families. The unmet need for contraception is 35%, the lifetime risk of maternal mortality is 1 in 13, and it is projected that one million people living in Uganda will become HIV-positive in the next five years. According to former U.S. Ambassador to Uganda Steven Browning, 90% of pregnant HIV-positive women do not wish to have more children.

These statistics illuminate a dangerous and deadly future for this country if current policy and funding trends continue. This closer look at Uganda reveals many of the holes in the current U.S. prescription to address high and growing rates of HIV and unintended pregnancies. PAI urges the U.S. to set aside the policy restrictions that keep countries from designing integrated HIV and reproductive health and family planning programs that meet the needs of their populations.

As the 109th Congress adjourns, its inability to pass appropriations bills ranks among the top failures that have rightly earned it the moniker the “do-nothing Congress.” Among the 9 of 11 mandatory spending bills that will not get final approval is foreign assistance, which includes funding for international family planning.

Funding for international family planning stands at $436 million. This is significantly below the amount passed by the Senate Appropriations Committee ($465 million), just slightly over what the House passed ($432 million), much better than President Bush’s extremely low request of $357 million, and a fraction of what we’re spending on related health issues. Congress passed a “continuing resolution” to maintain current funding through mid-February—perhaps to be extended for all of FY2007—unless the incoming new Congress can clean up the fiscal mess that has been left for them.

Adding to the list of unknowns is the Administration’s effort to restructure U.S. foreign assistance programs. In addition to questions surrounding the 2007 budget, it remains unclear whether foreign assistance will continue as we know it. Until greater clarity is given, U.S. agencies that disperse funding to overseas programs are in a virtual holding pattern.

Because the State Department and USAID have been consumed by questions surrounding restructuring, they are struggling to come up with both a FY 2008 budget request and a reworking of the FY 2007 operating year budget. Bureaucratic uncertainty and increased workload on staff have led to a de facto moratorium on new approval of reproductive health projects. In addition, little of the previously-approved funding is being disbursed to organizations and field programs. Combined with the lack of an enacted FY 2007 appropriations bill, these delays mean that overseas programs may not receive a new infusion of funds until April or May of next year.

We urge the new Congress to take a more proactive role in ensuring that international family planning funding goes where it’s supposed to—rather than get mired in a bureaucratic no man’s land, which is where it stands now.

 

The world took a giant step towards developing a viable, safe and effective microbicide against HIV with commitments from several governments to significant microbicide development. Canada pledged US$13.2 million, and the Netherlands committed to $15.7 million over four years, to the International Partnership for Microbicides. Belgium ($4 million) and Sweden ($2.17 million) also increased their support for microbicides research. PAI hails these commitments and urges other governments to follow suit in order to bring this innovative and life-saving technology to the women around the globe who desperately need it.

Microbicides are designed to reduce or prevent the transmission of HIV—and potentially other sexually transmitted infections (STIs) as well—when used during sexual intercourse. They would also provide women with a defense against HIV that they can initiate without the consent of their partner—a crucial innovation that does not currently exist. In parts of the world where the status of women makes it difficult for them to negotiate condom use, microbicides would empower women to protect themselves. Some microbicides even have the potential to allow pregnancy while still offering protection from STIs including HIV.

Funding for this exciting new technology now stands at $168 million total worldwide, with the U.S. providing over $100 million. Sadly, this still lags far behind the estimated $280 million needed annually over the next five years in order to accelerate the development of this life-saving tool. A number of HIV/AIDS congressional champions, led by Congressman Chris Shays (R-CT), have sponsored the Microbicide Development Act (HR 3854) which would prioritize funding and support for the development of microbicides. It should be reintroduced in the 110th Congress, passed and fully funded.

With HIV/AIDS affecting a disproportionate number of women, having safe and effective microbicides available could go a long way towards stemming the infection rate worldwide. PAI is encouraged by recent governmental pledges, but total public—and private—financial commitments must be increased to meet realistic cost estimates of this vital research and product development.