July 18, 2008
It’s Broke, But They Won’t Fix It: The Senate Authorizes a Global AIDS Relief Package that Comes Up Short
Washington, D.C. – On Wednesday, the Senate voted 80 to 16 to reauthorize the President’s Emergency Plan for AIDS Relief (PEPFAR), a five-year, $48 billion global initiative to combat HIV/AIDS, tuberculosis and malaria.
The Senate missed a golden opportunity to epitomize the generosity of the American people by making U.S. global HIV/AIDS relief more effective, compassionate and fiscally responsible. As a result, millions of people are at greater risk of HIV infection.
Under pressure to act quickly, policymakers failed to address critical shortfalls in the bill that would have ensured effective use of scarce public funds and a sustainable response to the pandemic. Much has been learned since PEPFAR was enacted in 2003. However, rather than heeding to the evidence collected by our own government agencies, the bill passed by the Senate compromises sound public health practice for ideology and political expediency.
Arbitrary funding guidelines
One key change that should have been made in the PEPFAR bill was the abolishment of arbitrary funding guidelines that determine how money can be distributed on the ground. The Senate bill calls for spending at least fifty percent of prevention funds designed to halt the sexual transmission of HIV, in countries with generalized epidemics, only on abstinence and faithfulness programs. PEPFAR recipients that do not meet this requirement must justify their programmatic decisions through an onerous reporting requirement to Congress, potentially facing defunding.
This provision was left in the bill despite a 2007 report from The Institute of Medicine, which recommended the removal of PEPFAR’s then-requirement that one-third of prevention funds be spent on abstinence-only-until-marriage programs. The Senate’s decision to leave these de facto restrictions in the bill means that those fighting the HIV epidemic on the front lines will be deprived of the vital discretion they need in determining how funds are best spent.
Protection for women and young people
The PEPFAR bill passed by the Senate also failed to fully increase protection for women and young people, two groups increasingly vulnerable to new infections in nearly every region of the world. Women and young people are most likely to use family planning and other reproductive health services, and would benefit greatly from a strategy that integrated HIV prevention and treatment with family planning. Recent studies suggest that upwards of 90 percent of HIV-positive pregnant women in countries such as Uganda and South Africa have unmet need for integrated family planning and HIV services.
However, the bill passed by the Senate fails to call for, or even acknowledge, the need to strengthen critical linkages between family planning and reproductive health services and HIV prevention efforts.
"Conscience clause"
The 2003 PEPFAR legislation contains a provision that enables organizations receiving U.S. funding to pick and choose the prevention and treatment services they wish to provide. Millions of dollars go to organizations to provide prevention services, even though they refuse to discuss the potential of condoms or other contraceptives in preventing the spread of HIV. As abstinence and partner reduction programs have outpaced programs that enable individuals to have all the information they need to prevent HIV, the law stands in the way of the effective use of resources.
The Senate has taken this bad policy and made it worse by extending the so-called “conscience clause”,or refusal clause, to organizations that provide care and support to people living with HIV/AIDS, their families and their communities. This provision paves the way for taxpayer-funded discrimination based on “moral” and religious grounds, allowing PEPFAR funding recipients to refuse to provide care for someone based on their religion, how they got infected or any other basis. The refusal clause is yet another damaging provision that flies in the face of good public health practice.
Anti-prostitution pledge
Lastly, the Senate upheld the requirement that groups fighting HIV/AIDS overseas publicly pledge their opposition to prostitution and sex trafficking before receiving U.S. money. Prevention programs that have reached sex workers, a group that is marginalized and exceedingly vulnerable to HIV infection, have yielded dramatic reductions in HIV transmission. According to numerous reports, the pledge has led to further alienation and discrimination of already-stigmatized groups. This policy drives sex workers underground and away from the non-governmental organizations and health workers best poised to provide them with services they need to protect themselves from infection.
It is our moral obligation and fiscal responsibility to use PEPFAR funding to prevent as many infections as possible. However, large sums of money, spent unwisely, will not save lives and will require an ever growing need for increased resources in the future. The bill fell short exactly where more was needed: full and flexible funding of prevention programs that would enable us to make a difference in the lives of millions.
It’s Broke, But They Won’t Fix It: The Senate Authorizes a Global AIDS Relief Package that Comes Up Short
Washington, D.C. – On Wednesday, the Senate voted 80 to 16 to reauthorize the President’s Emergency Plan for AIDS Relief (PEPFAR), a five-year, $48 billion global initiative to combat HIV/AIDS, tuberculosis and malaria.
The Senate missed a golden opportunity to epitomize the generosity of the American people by making U.S. global HIV/AIDS relief more effective, compassionate and fiscally responsible. As a result, millions of people are at greater risk of HIV infection.
Under pressure to act quickly, policymakers failed to address critical shortfalls in the bill that would have ensured effective use of scarce public funds and a sustainable response to the pandemic. Much has been learned since PEPFAR was enacted in 2003. However, rather than heeding to the evidence collected by our own government agencies, the bill passed by the Senate compromises sound public health practice for ideology and political expediency.
Arbitrary funding guidelines
One key change that should have been made in the PEPFAR bill was the abolishment of arbitrary funding guidelines that determine how money can be distributed on the ground. The Senate bill calls for spending at least fifty percent of prevention funds designed to halt the sexual transmission of HIV, in countries with generalized epidemics, only on abstinence and faithfulness programs. PEPFAR recipients that do not meet this requirement must justify their programmatic decisions through an onerous reporting requirement to Congress, potentially facing defunding.
This provision was left in the bill despite a 2007 report from The Institute of Medicine, which recommended the removal of PEPFAR’s then-requirement that one-third of prevention funds be spent on abstinence-only-until-marriage programs. The Senate’s decision to leave these de facto restrictions in the bill means that those fighting the HIV epidemic on the front lines will be deprived of the vital discretion they need in determining how funds are best spent.
Protection for women and young people
The PEPFAR bill passed by the Senate also failed to fully increase protection for women and young people, two groups increasingly vulnerable to new infections in nearly every region of the world. Women and young people are most likely to use family planning and other reproductive health services, and would benefit greatly from a strategy that integrated HIV prevention and treatment with family planning. Recent studies suggest that upwards of 90 percent of HIV-positive pregnant women in countries such as Uganda and South Africa have unmet need for integrated family planning and HIV services.
However, the bill passed by the Senate fails to call for, or even acknowledge, the need to strengthen critical linkages between family planning and reproductive health services and HIV prevention efforts.
"Conscience clause"
The 2003 PEPFAR legislation contains a provision that enables organizations receiving U.S. funding to pick and choose the prevention and treatment services they wish to provide. Millions of dollars go to organizations to provide prevention services, even though they refuse to discuss the potential of condoms or other contraceptives in preventing the spread of HIV. As abstinence and partner reduction programs have outpaced programs that enable individuals to have all the information they need to prevent HIV, the law stands in the way of the effective use of resources.
The Senate has taken this bad policy and made it worse by extending the so-called “conscience clause”,or refusal clause, to organizations that provide care and support to people living with HIV/AIDS, their families and their communities. This provision paves the way for taxpayer-funded discrimination based on “moral” and religious grounds, allowing PEPFAR funding recipients to refuse to provide care for someone based on their religion, how they got infected or any other basis. The refusal clause is yet another damaging provision that flies in the face of good public health practice.
Anti-prostitution pledge
Lastly, the Senate upheld the requirement that groups fighting HIV/AIDS overseas publicly pledge their opposition to prostitution and sex trafficking before receiving U.S. money. Prevention programs that have reached sex workers, a group that is marginalized and exceedingly vulnerable to HIV infection, have yielded dramatic reductions in HIV transmission. According to numerous reports, the pledge has led to further alienation and discrimination of already-stigmatized groups. This policy drives sex workers underground and away from the non-governmental organizations and health workers best poised to provide them with services they need to protect themselves from infection.
It is our moral obligation and fiscal responsibility to use PEPFAR funding to prevent as many infections as possible. However, large sums of money, spent unwisely, will not save lives and will require an ever growing need for increased resources in the future. The bill fell short exactly where more was needed: full and flexible funding of prevention programs that would enable us to make a difference in the lives of millions.
To arrange an interview or for more information, contact:
Advocates for Youth
Contact: Marcela Howell
202.419.3420, marcela@advocatesforyouth.org
American Jewish World Service
Contact: Jodi Jacobson
301.257.7897, 202.408.1380, jjacobson@ajws.org
Center for Heath and Gender Equity
Contact: Serra Sippel
301.270.1182, 301.768.7162, ssippel@genderhealth.org
International Women’s Health Coalition
Contact: Kelly Castagnaro
212.979.8500 x.266, 646.707.1004, kcastagnaro@iwhc.org
National Council of Jewish Women
Contact: Emily Alfano
202. 296. 2588 x.5, emily@ncjwdc.org
SIECUS
Contact: Patrick Malone
212.819.9770 x.316, pmalone@siecus.org
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