Tuesday, June 17, 2008


The President's Emergency Plan For AIDS Relief (PEPFAR/Emergency Plan) is a commitment of $15 billion over five years (2003–2008) by United States President George W. Bush to fight the global HIV/AIDS pandemic. As the largest international health initiative ever initiated by one nation to address a single disease, the program aimed to provide antiretroviral treatment (ART) to 2 million HIV-infected people in resource-limited settings, to prevent 7 million new infections, and to support care for 10 million people.

Sound too good to be true?

With this money came a number of caveats.

1. "Emergency Plan funds will not support needle or syringe exchange".

Many people have objected to this because needle exchange programs have been proven to help reduce the spread of blood-borne HIV by providing injecting drug users with sterile syringes, without encouraging drug use. In some areas, this may be part of a wider harm reduction strategy, whereby users are given a safe, monitored place to inject and/or pure uncontaminated drugs to reduce the risk of overdose. However, the U.S. government is opposed to such measures as it believes they make drug use seem more acceptable, and facilitate continued drug use.

2. "No funds made available to carry out this Act, or any amendment made by this Act, may be used to provide assistance to any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking."

This condition, also called the "Prostitution Loyalty Oath," led to Brazil refusing $40 million of PEPFAR funds in May 2005. The director of Brazil's HIV/AIDS program explained, "Brazil has taken this decision in order to preserve its autonomy on issues related to HIV/AIDS as well as ethical and human rights principles". The Brazilian government and many organizations believed that adopting the PEPFAR condition would be a serious barrier to helping sex workers protect themselves and their clients from HIV.

3. Congress required that 1/3 of prevention funds be spent on abstinence-until-marriage programs.

As a percentage of money spent specifically on prevention of sexual transmission, close to two-thirds is spent on abstinence-only education. This ideological requirement has been shown to divert funds away from other methods of HIV-transmission prevention, such as prevention of maternal-to-child transmission and prevention targeting injecting drug users.

Talking to people who work on HIV education, prevention and control in Africa have said that PEPFAR funding is virtually useless to them. Funding required them to sign an oath not to acknowledge the sex industry. In other words, they would not be able to distribute condoms or assist infected sex workers, unless those workers agreed on abstinence. Not only would PEPFAR funded projects have to follow this requirement, but the entire foundation would have had to adapt this oath. Fortunately, since the initiation of PEPFAR, a bill was introduced that would remove the 33 percent abstinence-until-marriage earmark from HIV prevention programs.

Elizabeth Pisani, an epidemiologist with years of experience working on HIV/AIDS, and author of the book, The Wisdom of Whores: bureaucrats, brothels, and the business of AIDS, has said she has mixed feelings about PEPFAR. On one hand, the money going into treatment has undoubtedly saved the lives of hundreds of thousands. On the other, without adequate prevention strategies, the spread of HIV will continue to grow exponentially. As the number of people living with HIV increases, so does the risk of spreading the disease.

With earmarks and other restrictions, PEPFAR really isn't doing everything it can to bring the spread of HIV/AIDS under control. It makes me kind of angry that our government would impose it's own ideological point of view when there are far greater issues at stake. I suppose I should be glad that the U.S. is at least doing something to improve the global problem of HIV/AIDS. I can only hope that in the coming years this trend will continue. Perhaps a new government will be better at listening to what needs to be done and allowing the funding to go where it needs to go.

One can hope.


Image lifted from www.avert.org


pahkcah02 said...

So what's the problem? For all of Bush's faults no President has EVER given more money to Africa or spent more on worldwide AIDS prevention than George W Bush. Check out the footage from his trip to Africa a few months ago. His commitment to the continent of Africa catapulted him to rock star status.

A few years ago South African Daniel told me a story about AIDS education he got in a country where the disease is a downright epidemic. The South African Ministry of Health sent out a pamphlet explaining that safe sex is one way to prevent the transmission of HIV and other STDs. To futher demonstrate their commitment the ministry STAPLED a condom to each of those pamphlets. This is the type of environment you're dealing with in the third world.

If the strings attached to PEPFAR dictate that you should educate people about the dangers of prostitution, pre-marital sex, and drug use then so be it. While there are a variety of other ways to spread the virus, there is no doubt that educating people about lifestyle choices is just one of many ways to prevent new AIDS cases.

I've watched two close people in my life have their lives cut short by AIDS. $15 billion is a lot of money to put towards research and prevention of this devestating disease. If that means that the US is attempting to dictate morals in order to save lives then so be it.

flutterbyblue said...

As I say above, I have no argument with the fact that PEPFAR exists. It's a huge step in the right direction, but it's just a step. There is no doubt that the billions provided by the U.S. have saved countless lives. I also do not take issue with educating people about the dangers of prostitution, pre-marital sex, and drug addiction.

The problem arises when funding can't go towards necessary preventative measures (such as clean needles for drug addicts, or condoms for prostitutes.) I think it is wrong for the U.S. to instill a moral code when it is costing the lives of populations of people most at risk for this disease.

Do I think it's wrong to do drugs or sell sex for money? Well, yes, but I also don't think people should be punished for making mistakes or being stuck in crappy life situations.

There are ways around these "moral" dilemma's other than earmarking funds. We've come a long way thanks to PEPFAR, but there's a ways to go.