Peter Piot, head of UNAIDS, made the rounds in DC last week discussing how the global community can achieve the internationally agreed upon target of universal access to HIV prevention, treatment, care and support by 2010.   His message has been clear: Without a massive scale-up of prevention programs, we will fall far short of addressing the growing feminization of this disease.  PAI welcomes Dr. Piot and his salient message.  Now consider the future of this epidemic in countries where men and women desire to protect themselves and plan the size of their families but do not have access to services and supplies—especially condoms and contraceptives—which would make that desire a reality.

 

Take Kenya, for instance.  In a country where HIV/AIDS funding is strong and steadily growing (U.S. funding increased from $2 million to $74 million, 1995-2005), funding for family planning has fallen off (decreasing from $12 million to $9 million, 1995-2005).  With fewer financial resources for family planning services, unintended pregnancies have risen—nearly doubling in the years 1998 to 2003—and contraceptive use has declined.

 

If we’re serious about reaching universal access to HIV/AIDS prevention, we cannot turn a blind eye to the demand for voluntary family planning services and supplies—including condoms. Access to these supplies and services gives men and women the tools they need to determine the size and spacing of their families and to protect themselves from sexually transmitted infections.   Through robust voluntary family planning programs and their integration with HIV prevention programs, we can achieve universal access to HIV prevention and treatment programs. 

 

Tragically, just the opposite is happening.  Since 1995, U.S. funding for international family planning programs has fallen more than $100 million—a whopping 41% reduction when adjusted for inflation—despite the fact that the number of women of reproductive age in the developing world alone has increased by approximately 275 million women since 1995. (In Kenya, the number of women of reproductive age increased 35.9% between 1995 and 2005.)  This family planning funding shortfall is very apparent in PEPFAR's 15 focus countries, where the vast majority have seen a decrease in family planning funds in recent years. 

 

PAI urges the U.S. and the rest of the world to scale up funding for both HIV prevention and family planning/reproductive health programs.  This is the only way we can ever hope to defeat this deadly disease.

HIV/AIDS is an issue of tremendous concern to the sexual and reproductive health and rigpopact (SRHR) community. This shouldn’t be news, but it bears repeating. And therefore, SRH initiatives are key to fighting the spread of HIV/AIDS. While stemming the tide of new HIV infections, these programs also curb child and maternal mortality, prevent the spread of other sexually transmitted infections and alleviate global poverty. So, why isn’t SRHR a core component of every global initiative to fight HIV/AIDS? It should be. PAI has joined many in challenging the Global Fund to Fight AIDS, Tuberculosis and Malaria to make it so.

Many men and women already actively seek reproductive health services, whether for family planning, contraceptives, or treatment for sexually transmitted infections, including HIV. Linking these services to HIV/AIDS prevention and treatment—as well as malaria and tuberculosis programs—provides another avenue for men and women to get the supplies and services they need to prevent these deadly diseases, helping the Global Fund to reach its targets: men, women, young people, children and other vulnerable groups.

As the Global Fund’s Replenishment Conference convenes later this month in Berlin, it is critical that SRHR, through strong involvement of key civil society representation, receives the recognition of its significant role in the Global Fund’s mission: preventing HIV and meeting the health needs of those already infected. To date, the process by which the Global Fund invites proposals, the in-country work to develop these proposals, and the process by which they are approved does not adequately support the role of SRHR or sexual and reproductive health providers.

After just a few short years, the Global Fund has saved over 1.8 million lives worldwide. Just think what can be accomplished—how many more lives saved—if the Global Fund partnered with the life-saving work of sexual and reproductive health providers.

In recent years there hasn't been much good news coming out of Washington on family planning and reproductive health issues. That's probably the understatement of the year. But today there is very good news to report because of recent votes in the Senate.

Last week, despite President Bush's veto threat, the Senate passed the FY 2008 State-Foreign Operations Appropriations bill (by a vote of 81-12) that includes significant provisions overturning destructive policies on family planning and HIV/AIDS. Thanks to the leadership and commitment of Senators Patrick Leahy (D-VT) and Barbara Boxer (D-CA), the Senate bill not only includes the identical measures in the House-passed bill (H.R. 2764)—exempting contraceptives from the Global Gag Rule and repealing the abstinence-only funding restrictions for HIV prevention programs—it goes even further by repealing the Gag Rule entirely.

This repudiation of some of the most egregious and harmful aspects of U.S. international family planning and reproductive health policy marks a major—and long overdue—victory for sound public health. And to put it in historical perspective, this Senate vote is the first time since the Gag Rule has been in force—from 1984 to 1993 and again since 2001—that both the House and the Senate have passed legislation to repeal or modify the restriction. This is significant in light of the all-important showdown that looms with the White House over President Bush's threatened veto of the entire $34 billion foreign assistance bill over the Gag Rule provisions.

The Senate 53-41 vote in favor of an amendment to repeal the Gag Rule, sponsored by Senators Boxer (D-CA) and Snowe (R-ME), is a victory for the tens of millions of poor women overseas who have been victimized by the Gag Rule and lack basic reproductive health care such as contraceptives. It's a powerful recognition of the Gag Rule's devastating impact on family planning programs.

Because of the Gag Rule, dozens of family planning providers in poor, developing nations have lost U.S. funding and technical assistance, forcing them to scale back services, lay off staff, and even close their clinics altogether. Adding to this harm, contraceptive donations from the U.S. government have been stopped to 20 countries in Africa, Asia, and the Middle East since the Global Gag Rule was reinstated in 2001. Leading indigenous family planning providers in several other countries have also stopped receiving contraceptives from the U.S. Watch PAI's compelling documentary "Access Denied: U.S. Family Planning Restrictions in Zambia" for an example of the immense harm caused by the Gag Rule.

These draconian impacts come on top of major reductions in funding for international family planning and reproductive health in recent years. Since 1995, U.S. funding for these programs has fallen more than $100 million—a whopping 41 percent reduction when adjusted for inflation—despite a growing demand for reproductive health care in the developing world. It's worth noting that the number of women of reproductive age in the developing world alone has increased by approximately 275 million women since 1995. By voting to repeal the Gag Rule and rigid, ineffective abstinence HIV funding mandates, Congress has restored some desperately needed common sense to U.S. FP/RH programs. Not incidentally, they're programs that the vast majority of the American people overwhelmingly support.

So, Mr. President, let's talk about that veto threat of yours.....

It’s extremely rare for an organization to refuse funding, let alone $45 million. But that is exactly what CARE, a leading international relief organization, did last month when they refused U.S. government funding for food aid. According to a recent General Accountability Office report, the U.S. food aid program is seriously flawed. CARE agreed, finding that it hindered the development work they were trying to accomplish in the developing world. By challenging a policy they viewed as detrimental to their mission, CARE has put a spotlight on potential flaws in this U.S. policy – a spotlight that may even generate a change in policy.

The United States gives a tremendous amount of funding to U.S.-based organizations best equipped to provide aid – including food, health care and education – to people in developing countries. Like CARE, these organizations often have the best understanding of the situation on the ground and the infrastructure in place to help the most people.

But federal funding comes with a price: a laundry list of rules and regulations outlining how organizations must spend that money. While these rules and regulations are often an effective way to monitor U.S. spending, the need for U.S. funding often trumps an organization’s desire to challenge – let alone reject – funding because of flawed policies. When NGOs find that U.S. policies don’t support the work they are trying to accomplish – in this case, alleviating chronic hunger in the developing world – it’s time to speak up. In turn, the U.S. government must support an environment in which challenge is supported, rather than stifling dissent.

Sometimes the most powerful decision an organization can make is the courageous decision to say no to U.S. funding. Many family planning and reproductive health providers in the developing world have made similar decisions in recent years, declining much-needed U.S. family planning funding because of destructive restrictions such as the Global Gag Rule (Mexico City Policy). In so doing, organizations like these and CARE help draw attention to flawed and ineffective U.S. policies and lay the groundwork for urgently needed reforms.