The White House and Congress reached a compromise on the PEPFAR (the President's Emergency Plan for AIDS Relief) renewal legislation. I wrote about the controversies in this program last week. House Democrats have been wrangling with the Administration for the next 5-year AIDS relief program.
The Democrats (and most of the NGOs and HIV policy community) wanted to drop two PEPFAR requirements: that 1/3 of all the program's prevention funds be spent on abstinence-only messges and that PEPFAR recipients pledge opposition to prostitution. They also wanted to be allowed to use PEPFAR money to support general reproductive health services.
Congress got some of what it was after. The 1/3 abstinence requirement is gone (although PEPFAR will have to report if non-abstinence or fidelity programming acounts for more than 1/2 of prevention funds.) That rule was always too cumbersome and illogical to use, and I’m personally glad that it is gone. What I’m worried about is that from what I can tell the ABC (Abstinence, Being Faithful, Condom use as appropriate) policy seems to have been further entrenched in US policy.
The PEPFAR policies have to be followed by all US-funded HIV projects (PEPFAR itself only goes to a small number of focus countries, USAID and other sources work to address the pandemic in a lot of other places). ABC sounds fine, and probably would be fine if it was used as a guidline within the US government reporting and project planning system.
But fear of getting on the wrong side of the more conservative members of congress makes the assistance managers responsible for HIV programming overly cautious, and too often the prevention materials our government pays for go to ridiculous lengths to push ABC. I don't think anybody wants a copy of a condom use promotion leaflet to find its way to Washington without the protective words “Abstinence” and “Faithfulness”. That leads to sloppy prevention activities, and undermines the point of our assistance. We would all be better off if people on both sides of this issue could just take a deep breath and trust each other to be reasonable.
As for the other issues:
PEPFAR will now be able to take an approach to prevention that is tailored to each country. The funds can also now be used for “HIV testing and education in family planning clinics but not for contraception or abortion services“.
The prostitution rule will stay as is.
The final bill fund PEPFAR at $50 billion over 5 years (the President asked for $30 billion, and the first PEPFAR package was for $15 billion).
