On September 6, 2006, the U.S. House of Representatives Committee on Government Reform held a hearing, led by Representative Christopher Shays (R-CT), on the appropriateness of the President's Emergency Plan for AIDS Relief's (PEPFAR) abstinence-until-marriage funding requirement.1 Although PEPFAR purports to promote a balanced ABC approach (abstinence only-until-marriage, be faithful, and correct and consistent condom use), the program requires that all countries spend a minimum of 1/3 of all prevention funding on abstinence only-until–marriage programs. A recent Government Accounting Office (GAO) report found that this funding requirement, along with PEPFARs preference for an abstinence-only-until-marriage and be faithful (AB) approach, has hindered promotion of a comprehensive prevention campaign and has impeded staff working within PEPFAR countries to respond to specific epidemiologic, social and cultural needs.2
Kent Hill, Assistant Administrator for United States Agency for International Development's (USAID) Bureau for Global Health, and Mark Dybul, U.S. Global AIDS Coordinator from the U.S. Department of State, steadfastly defended and praised the abstinence-until-marriage funding requirement in their testimony before the committee.3 According to Kent Hill, one of the main benefits of PEPFARs AB programming is its potential to increase gender equity. Hill stated, “after all, many of the problems associated with the spread of HIV are intimately connected with the absence of gender equality, the presence of gender-based-violence and coercion typical of transactional and transgenerational sex. For all too many young girls, abstinence is not being morally conservative but about having the ‘right' to abstain. The double standards of men who are not faithful while their wives are is a gender equity issue. In short, AB interventions must be seen as fundamentally linked to gender inequality issues.”4 Mark Dybul echoed Hill's sentiments about gender and also stated in defense of the funding requirement that “PEPFAR support for AB is needed… because other international partners support primarily C interventions.”5
Unfortunately, the rosy picture Dybul and Hill painted about PEPFAR is not supported by evidence from the field. As Helene Gayle, President and Chief Executive Officer of CARE USA pointed out in her testimony, field staff reported that, “despite the importance of gender as a critical determinant of vulnerability for people at risk of contracting HIV and AIDS, gender inequity is still not a sufficient focus of PEPFAR nor an area that PEPFAR is especially effective at addressing. Too many women and girls are becoming infected with HIV and dying of AIDS. We have to do better.”6
Hill and Dybul's statements regarding the need for an AB-only focus were further contradicted by the testimony of Dr. Lucy Nkya, Member of the Tanzanian Parliament and Director of the Faraja Trust Fund. Dr. Nkya indicated that despite Tanzania's desire to promote a comprehensive HIV prevention campaign that includes condom use, free condoms were no longer available for distribution due to lack of donor funds for such programs.7 Dr. Nkya also stressed that many in-country youth are confused by PEPFAR's focus on AB and not ABC. In particular, Dr. Nkya noted that many Tanzanian youth expressed concern that PEPFAR's “moralistic approach” does not take into account the needs of sexually active or HIV+ youth. Moreover, Tanzanian youth are concerned that PEPFAR does little to address the social and economic issues of poverty that put many youth at risk for unsafe sexual encounters.
“Rep. Shays' hearing illustrates one thing clearly: the current U.S. Administration and its policies are in total disconnect from what is happening on the ground in countries most in need of our help,” said William Smith, Vice-President for Public Policy at the Sexuality Information and Education Council of the United States (SIECUS). “The testimony of Drs. Gayle and Nkya illustrates that PEPFARs ideological approach to HIV prevention is not working in the field. Evidence from the experiences of both country program staff and in-country youth indicate that the abstinence-until-marriage funding requirement is hindering rather than enhancing HIV prevention.”
For more information on PEPFAR and SIECUS' recommendations for improving it, see our PEPFAR Country Profiles.
- Representatives present at the hearing, “HIV Prevention: How Effective is The President's Emergency
Plan for Aids Relief (PEPFAR)?” were: Rep. Christopher Shays (CT), Rep. Henry Waxman (CA), Rep. John Duncan, JR. (TN), and Rep. Barbara Lee (CA).
- “Global Health: Spending Requirement Presents Challenges for Allocating Prevention Funding Under the President's Emergency Plan for AIDS Relief,” Government Accounting Office, April 2006 GAO-06-395
- Panel 1: The Honorable Mark R. Dybul, U.S. Global AIDS Coordinator, U.S. Department of State; The Honorable Kent Hill , Assistant Administrator , Bureau for Global Health , U.S. Agency for International Development; Panel 2: Dr. David Gootnick, Director, International Affairs and Trade, Government Accountability Office; Dr. Helene Gayle, President and Chief Executive Officer
CARE USA; Dr. Lucy Sawere Nkya, Member of Tanzanian Parliament (MP, Women Special Seats),
Director, Faraja Trust Fund; Dr. Edward C. Green, Senior Research Scientist, Harvard Center for Population and Development Studies
- Testimony of the Honorable Kent R. Hill, Assistant Administrator, Bureau of Global Health, United States Agency for International Development, 06 September 2006, accessed 18 September 2006, <http://reform.house.gov/UploadedFiles/Updated%20Hill%20Testimony%20Sept%206.pdf >.
- Testimony of Ambassador Mark R. Dybul, U.S. Global AIDS Coordinator, U.S. Department of State, 06 September 2006, accessed 18 September 2006, <http://reform.house.gov/UploadedFiles/2006-
- Testimony of Dr. Helene Gayle, President and Chief Executive Officer, CARE USA, 06 September 2006, accessed 18 September 2006, <http://reform.house.gov/UploadedFiles/HELENE%20GAYLE%20-%20Written%20Statement%20-
- Testimony of Dr. Lucy Sawere Nkya, Member of Tanzanian Parliament, Director of the Faraja Trust Fund, 06 September 2006, accessed 18 September 2006, <http://reform.house.gov/UploadedFiles/NKYA%20Testimony.pdf>