Members of Congress head back to their districts this month with the threat of a Presidential veto of the 2008 Foreign Operations Appropriations Bill casting a dark cloud over the good work they’ve done. Why a possible veto? It’s all because of a provision that exempts U.S.-donated contraceptives and condoms from the restrictions of the Global Gag Rule. Who would have thought that helping life-saving contraceptives and condoms get to the people who want and need them most would be reason to veto $34.5 billion in foreign assistance?

Keeping this language in the 2008 foreign assistance budget is critical - and much will need to happen in the coming months. First, the U.S. Senate, which is expected to vote on their own version of the foreign spending bill when they return to Washington, must take a stand for women’s lives and keep this language in the bill. After that, the House and Senate must gear up to overturn the promised Presidential veto.

We at PAI wonder if anyone in the Bush Administration has really even read this language carefully. It’s hard to fathom that the President would veto the entire foreign operations budget in order to prevent these supplies from reaching the women and couples around the world who desperately want and need them. Since the Global Gag Rule was reinstated by President Bush in 2001, shipments of U.S.-donated contraceptives have been stopped to 20 developing countries in Africa, Asia and the Middle East. Filling the unmet need for contraceptives would avert 52 million unwanted pregnancies each year, preventing an estimated 29 million abortions, 142,000 pregnancy-related deaths and 505,000 children from losing their mothers. How could the President possibly disagree with provisions that have the potential to save so many lives?

Just because Congress isn’t in session this month doesn’t mean that they take a break from their responsibilities on the Hill. While your Senators and Representatives are in your district, ask them to support this bill and vote to overturn a Presidential veto.

In the meantime, we have a little homework assignment for the Bush administration: Take a moment to read this language. We think you’ll realize that all it does is save lives.

“For every person who began antiretroviral therapy in 2006, six people were newly infected,” according to a new report from the Global HIV Prevention Working Group.Without a major scale-up of HIV prevention programs, using existing prevention tools, 60 million more HIV infections are projected to occur by 2015.  The best of the best have confirmed what many knew to be true: Only by significantly ramping up HIV prevention programs can we curb the scourge of HIV/AIDS. If the world does not listen, and new HIV infections continue to grow as they are, we'll have no one to blame but ourselves.  The members of this group  are the most knowledgeable experts on HIV prevention in the world and they have rung an alarm bell that world leaders must heed in order to put an end to the HIV/AIDS epidemic. 

 

Countries such as Haiti and Kenya have seen early success from a scale up of their HIV prevention programs, as reported by the Prevention Working Group. Haiti has seen a drop in HIV prevalence among pregnant women (from 6% to 3.4% between 1998 and 2004). In Kenya, HIV prevalence among adults fell dramatically, from 10% in the late 1990s to 6.1% in 2005.  But, with the populations of Haiti and Kenya projected to double in 43 and 27 years, respectively, how can this progress possibly continue?

 

HIV prevention and family planning should go hand in hand. Voluntary, non-coercive family planning programs, including access to contraceptives, help HIV positive women avert unintended pregnancies, while programs that promote condom use not only reduce unintended pregnancies, they also prevent the spread of HIV and other sexually transmitted infections between sexual partners.

Tragically, however, family planning has played a diminishing role in the U.S. response to this epidemic. President Bush’s fiscal year 2008 budget request slashed international family planning assistance to Kenya and Haiti (as well as to six other PEPFAR focus countries) in half.  Meanwhile, populations are growing rapidly, HIV/AIDS continues to spread, and demand for family planning and HIV prevention and treatment programs continues to rise.

 

Ultimately, the success of our global effort to eradicate HIV/AIDS is two fold: we must scale-up prevention programs while simultaneously increasing access to family planning programs. While a stronger commitment to preventing new infections is paramount —and PAI joins the Prevention Working Group in calling for this—we will never get ahead of the race to end this deadly disease if people don’t have the tools to determine their own fertility.

 

PAI urges the U.S. and other nations to rapidly step up funding for HIV prevention and family planning programs. Ideology must be set aside in favor of heeding the warnings and advice from the experts.

Too often, it is women who make—and disproportionately bear the brunt of— reproductive health decisions on behalf of a couple.  Women are the ones who risk dying from complications in pregnancy and childbirth.  And if a mother dies, her daughters—not her sons—tend to be the ones who leave school to care for their families. Sadly, men more often hold the power in decision making, both at a personal and at a political level. PAI urges men to be the strongest allies in improving the health and well-being of women— whether as partners or politicians—by engaging in the fight to save the lives of their wives, sisters, daughters, mothers and other women in their community.

 

This year, World Population Day focused on the role of men in maternal health—emphasizing reproductive health as a goal that both men and women want and need. The role of men is crucial according to Amy Coen, President and CEO of PAI, who stated, “Women cannot win this war—a war in which they suffer poor health at the hands of inequality— without the help of their partners, husbands, and fathers.”

 

By promoting sound policy, increasing funding for reproductive health programs and making sure that these programs address the needs of both men and women, policymakers have the ability to save tens of thousands of lives and improve the quality of life for countless more women and children—and in turn, the men in their lives.

 

The involvement of men at all levels of society is critical to saving women’s lives and achieving gender equity.  Reproductive health programs must reach out to men, as well as women, if they are to be effective.  In addition, these programs must be made accessible and attractive to men and be combined with strong programs that engage men in broader issues, like preventing gender-based violence and eliminating the practice of female genital mutilation.  Reproductive health isn’t just a “woman’s issue.”  It affects the health and prosperity of every man, woman and child in the world. 

 

With further Senate action on the appropriations bill exempting contraceptives from the Global Gag Rule not likely until September, this is the perfect moment to highlight the importance of increasing access to contraceptives, which is crucial to global development and the fight against poverty.

Next year, for the first time in history, over half of the world’s population will live in urban areas, according to the U.N. report, State of World Population 2007. It is imperative that we not allow this increase in urbanization – most of which will occur in developing countries – to result in a dramatic increase in urban slums and the number of people living in poverty.

Since most of the growth in urban population is due to increased fertility, it is essential to better provide reproductive health services and to empower women through education and economic opportunity.  Janice Banaag, an eighteen-year-old mother who lives with her husband and newborn under a bridge in Manila, doesn't want to have another child until she and her husband can save more money. Tragically, planning one’s family is extremely difficult to do in Manila, where the mayor has banned contraceptives in public hospitals and health centers – making it nearly impossible for women like Janice to protect themselves from HIV/AIDS and to plan the timing of their children.

Currently, over 200 million women in the developing world wish to prevent or delay pregnancy, but lack access to modern contraceptives. If these women – many of whom live in urban slums – had the access they desire and need, they could prevent unwanted pregnancy, curb child and maternal mortality and remain free from sexually transmitted infections like HIV/AIDS, leading to longer, healthier lives. 

Passage of the Senate appropriations bill can help provide access to these life-saving supplies by exempting donated contraceptives from the Global Gag Rule. Since the reinstatement of the Global Gag Rule in 2001, shipments of contraceptives have been stopped to over 20 developing countries in Asia, Africa and the Middle East – the same areas that are now facing this increased urbanization.

Access to reproductive health programs and services is not only a fundamental right, it is key to eradicating poverty. PAI urges the Senate to pass the appropriations bill in its current form, providing the tools necessary for millions to rise out of poverty.

  “When you are married, you do not have the right to say ‘no’”  -- Skytt Nzambu

 

These are the words of Skytt Nzambu, a Kenyan woman who was infected with HIV by her unfaithful husband.  Tragically, Skytt is only one of an increasing number of HIV infections that are occurring within married couples, according to information reported at last week’s HIV/AIDS Implementers’ Meeting  in Rwanda.  This information highligpopact yet again the urgent need to continuously re-evaluate prevention programs as new evidence emerges in order to accurately address the needs of a constantly evolving epidemic. PEPFAR’s (the President’s Emergency Plan for AIDS Relief) ABC model, which emphasizes abstinence and provides condoms only for those “who practice high-risk behaviors,” doesn’t do a good enough job with “B” (Be faithful) to provide protection for what is increasingly becoming a “high-risk behavior” for women: sex between a husband and wife.

 

Dr. David Apuuli, director-general of the Uganda AIDS Commission, indicated that marital sex accounts for 42% of new infections in Uganda. According to Apuuli, “Studies show that a significant number of new infections through marital sex are because, over the past four years, men have increased their number of sexual partners, be it wives or girlfriends.” Sadly, it is these wives and girlfriends who are paying the ultimate price: HIV infection.

 

Vinod Mishra, director of research at Macro International, warned the attendees not to ignore these findings, saying, “It’s not about laying blame, it’s about saving lives; it’s about preventing future infections within marriage, and marriage is… the primary route of the epidemic, and the primary source of new infections in many of these countries now.” It is clear that prevention strategies that focus on abstinence and faithfulness in lieu of comprehensive, evidence-based prevention programs are not adequate to protect a woman whose husband is unfaithful.

 

The House of Representatives has taken the first step toward eradicating these flawed prevention strategies by passing H.R. 2764 , the appropriations bill that provides greater effectiveness and flexibility in the fight against HIV/AIDS by allowing the President to waive the restriction under PEPFAR that mandates at least one-third of U.S. HIV/AIDS prevention funding be limited to abstinence-until-marriage programs.  During House debate of this bill, Congressman Walberg (R-MI) mentioned that he'd met a young woman "with three children who has HIV as a result of behavior issues related specifically to a husband who was unfaithful in many, many ways.” Congresswoman McCollum (D-MN) followed up on that point and said:  "I thought it was very compelling to hear the story that was just shared on the floor by my Republican colleague about how a wife had become infected, not because of her behavior, but because of her husband's behavior."

 

Now, the Senate has their opportunity to support responsible, evidence-based HIV/AIDS prevention as they debate their own version of the appropriations bill. The language passed by the Senate Appropriations Committee contains a similar provision, which we urge the Senate to maintain to show their commitment to preventing the spread of HIV/AIDS. In addition, it also contains the provision exempting contraceptive donations from the Global Gag Rule . These two provisions will help reduce HIV infections and unintended pregnancies, including among HIV-positive women, strengthening U.S. foreign assistance and improving its ability to save the lives of women and men around the world who don’t currently have the services and supplies they need to protect themselves.