Tomorrow, on World AIDS Day, let's talk about sex.  80% of new HIV infections are sexually transmitted; let’s stop pretending that sex isn’t happening and start making it safer.

This World AIDS Day—and every day after—we need to talk openly and honestly about how to stop the spread of HIV.  We need to ensure that all women have the ability to make choices about their own sexual and reproductive health.  Both men and women need to have access to the contraceptive supplies they need to protect themselves.  Men, women and couples of all ages must be educated about how HIV is transmitted and how to best protect themselves: reducing the number of sexual partners, using a condom every time they have sex, and being aware of their HIV status.  We need to encourage men to be involved in their own sexual health and that of their partners.  And, HIV positive women need to have access to the tools they need to be sexually healthy and make choices about if and when to have children.

When a deadly disease such as HIV/AIDS is transmitted largely through sex, we can't afford to be shy.  We have let ideology and fear curb a global conversation about the reality of how this epidemic continues to spread, and history will judge us harshly for it.   Let’s stop this deadly trend and make sex safer for men and women around the world.  It’s World AIDS Day; let’s talk about sex.

Question: What do you do with a $100 million U.S. government program that isn’t working?  The answer; you fix it.  Abstinence and be-faithful programs for youth in the President’s Emergency Plan for AIDS Relief (PEPFAR) are not meeting the needs of sexually active and at-risk youth, according to a government-commissioned evaluation that took place in March.  Eight months later, no plan has been put into place to address these flaws—endangering the millions of young people these programs are supposed to help protect. 

 

In July, the Chairman of the House Oversight and Government Reform Committee, Henry Waxman; Chairman of the House Foreign Affairs Committee, Tom Lantos; and member of the exclusive House Appropriations Committee, Congresswoman Barbara Lee—all champions of evidence-based HIV prevention—sent a letter to Mark Dybul, US Global AIDS Coordinator at the Department of State, asking how PEPFAR planned to respond to the serious concerns raised in this report.  Dybul’s response gave no indication of a plan to address the gaps the evaluation found and offered no evidence of the effectiveness of these abstinence and be-faithful programs.  Last month, Reps. Waxman, Lantos and Lee wrote to Mark Dybul again, reiterating the need for a plan to address the shortfalls in PEPFAR’s youth programming. How many letters have to be written when people's lives and wellbeing are at stake? 

 

For every person who gains access to HIV treatment, six more become infected with this deadly disease. PEPFAR cannot afford to support anything less than sound, evidence-based prevention programs if we truly intend  to stop this epidemic.  There simply isn’t enough funding to spend $100 million on a program with harmful flaws.  While PEPFAR’s administrators write letters, young people are at risk of contracting HIV because they don’t have access to the education and supplies that they can use to protect themselves.

 

Through programs funded by PEPFAR, the U.S. has made a historic commitment to the prevention, care and treatment of HIV/AIDS.  But this financial commitment is dwarfed in size by the global need for these services.  PEPFAR has a responsibility to ensure that all their programs, including abstinence/be-faithful programs, are addressing the needs of their target audience— youth, including those who are sexually active.  If programs cannot meet this basic requirement, it’s time to find a more effective investment for U.S. dollars.

Women are dying from preventable causes and the U.S. is contributing to the problem. This was the grave truth repeated at last Wednesday’s hearing before the House Committee on Foreign Affairs on the Global Gag Rule (Mexico City policy)—the first hearing of its kind in the last decade. Women are dying because the U.S. Global Gag Rule is preventing them from getting the reproductive health care and supplies they desperately need to prevent unwanted pregnancies. For the first time since President Bush took office, both houses of Congress have passed legislation to right this wrong.

This hearing was a long-overdue opportunity for Congress to better understand the real-life, destructive consequences of the Gag Rule on women and children. Members of the committee heard first-hand how this restriction's cut-off of family planning services is increasing unwanted pregnancies, abortions and maternal mortality. Witnesses testifying at the heavily attended hearing included Duff Gillespie, PhD,former Senior Deputy Assistant Administrator for the Global Health Bureau at USAID and current PAI Board member; Ejike Oji, MD, Country Director for Ipas-Nigeria; and Joana Nerquaye-Tetteh, PhD,former Executive Director, Planned Parenthood Association of Ghana.

“The Global Gag Rule exacerbates the situation in Nigeria whereby women have no choice about how to manage their own lives. That is what makes me so angry, because at the end of the day it is our women—our wives, daughters, and sisters—who are dying,” Dr. Oji testified. The Global Gag Rule prevents USAID from working with organizations that can most effectively increase the use of family planning—largely through rural distribution. This is an incredibly dangerous gamble in Nigeria where nearly one-third of women say they have had an unwanted pregnancy and half of those have attempted an abortion.

Ghana has also been hit hard by the Global Gag Rule. According to Dr. Nerquaye-Tetteh, as a result of this U.S. policy, access to family planning was significantly reduced and the number of unintended pregnancies and new sexually transmitted infections both increased. Immediately following the imposition of the Gag Rule, and PPAG’s refusal to sign the policy, they saw a 50% increase in the number of women seeking post-abortion services.

While some supporters of the policy tried to make the case that family planning is not harmed by the Global Gag Rule, this is simply false. As Chairman Lantos stated in his opening remarks, “While the Global Gag Rule is being promoted as anti-abortion, it remains at its core anti-family planning.” By preventing funding from going to the organizations where they can be most effective on the ground, the Gag Rule is the roadblock keeping life-saving reproductive health care and supplies from women in need.

"It is clear that the Mexico City Policy is in fact thwarting our efforts to prevent unintended pregnancies, abortions and the spread of HIV/AIDS," said Representative Nita Lowey, chair of the House Appropriations Committee on State-Foreign Operations. The Global Gag Rule "is unconstitutional, immoral, unsubstantiated and dangerous."

The hearing was especially well-timed as President Bush threatens to make good on his promise to veto the entire Fiscal Year 2008 foreign assistance spending bill over a provision that exempts contraceptives from the Gag Rule's restrictions. We urge the President to stop playing politics with women’s lives and repeal the Gag Rule.