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New Battle Brewing Over HIV Prevention

Top conservatives say Democrat rewrite of PEPFAR will "destroy" Bush program that treats and prevents HIV/AIDS.

In Washington this week, conservatives held a press conference on Thursday to call public attention to efforts in Congress to "radically" rewrite PEPFAR, President Bush's signature program to fight HIV/AIDS globally.

In their press statement, these conservatives said:

In his 2008 State of the Union, President Bush said:

"Our Emergency Plan for AIDS Relief is treating 1.4 million people. We can bring healing and hope to many more. So I ask you to maintain the principles that have changed behavior and made this program a success." Instead, the Democrats have decided to radically change or abandon the principles of this widely successful program. Their radical rewrite will pour billions into the hands of abortion providers with little or no regard for the pro-life, pro-family cultures of recipient countries. It also strips provisions that ensure priority funding for the highly effective abstinence and fidelity programs, which have reduced HIV rates in African nations that have implemented it. The Democrat proposal also strips the provision that forbids grants to groups that do not have a policy explicitly opposing prostitution and sex trafficking–a provision designed to combat exploitation of women in recipient countries.

In addition to members of Congress, Saddleback church's senior pastor Rick Warren and author Chuck Colson attended the press event. A transcript of remarks are not available. But most if not all of these conservatives will speak out in favor of the controversial program designations that:

* 33 percent of prevention funding go toward programming that promotes sexual abstinence before marriage and sexual fidelity within marriage; and,

* The grant ban should be maintained on groups that do not have a policy statement opposing sex trafficking and prostitution.

The 33 percent represents tens of millions of dollars available for such programs, which liberals and others brand as basically a waste of money.

Critics of PEPFAR's existing prevention programs are turning up the heat rhetorically. Pamela Barnes, head of the Elizabeth Glaser Pediatric AIDS foundation said on Thursday:

Proposals to maintain partisan, ideologically-driven mandates that constrain countries' abilities to respond to their own epidemics threaten the continued success of the President's Emergency Plan for AIDS Relief (PEPFAR).

One sympathetic blogger notes:

The bottom line is that not providing people with what they need to protect themselves is a sin. The abstinence earmark skews the programs and gives short shrift to all the other prevention efforts that need to be undertaken as well.

Somewhat caught in the middle are organizations such as Physicians for Human Rights, which has laudably held out hope that a strong consensus can emerge involving evangelicals, health groups, and liberals for reauthorization for PEPFAR.

And, they are aiming for $50 billion, not the $30 billion that the Bush administration has asked for. This afternoon, PHR media coordinator/AIDS Campaign Katie Krauss released an exclusive statement to CT via email, which in part says:

We were surprised to see a great deal of controversy regarding PEPFAR reauthorization recently, and wanted to explain what we are after. We want PEPFAR to be a bigger program so that it can save more lives. It's already started at least a million people on HIV treatment.


African women are especially vulnerable to HIV–more than 60% of adults in subSaharan Africa are women, and as many as 75% of young people with HIV there are women and girls. We want PEPFAR to really go after this problem and develop science-based programs (with local authorities and local NGOs that understand the culture) to solve it.

Integrating AIDS Services with Reproductive Health Services and basic health care

There is some money now to treat AIDS in parts of Africa, but no money for basic health care or for reproductive health services (NOT including abortion; it's illegal to use US tax dollars for abortion). So now there are clinics where women are dying in childbirth, when right next door women with AIDS get much better medical care. Our field nurses and doctors have seen this first hand and find it very frustrating. What is needed is one place where women can get regular health care and AIDS care - integrated health care. This would also help the many women who are too embarrassed to walk into an AIDS clinic, fearful they will be abandoned by their families if people find out they are HIV-positive.

Programs that prevent mother-to-child transmission and treat both mom and dad for HIV after baby is born. These are called Prevention of Mother-to-Child Transmission Plus programs. They keep both mom and dad alive (instead of just baby, as regular prevention of mother-to-child transmission programs inadvertently do), stabilize communities, and prevent untold misery.

Africa's health worker shortage

There is also a desperate need for more health workers - according to the World Health Organization at least a million more are needed. Many clinics operate with one or two health workers, who may be on call around the clock, every day and see 100 patients per day. Or there may be no health care at all because of the shortage. We want PEPFAR to train and retain at least 140,000 more health workers, and help build long-lasting solutions to this crisis.


In prevention, as always, we've supported lifting the abstinence earmark because the overwhelming evidence is that abstinence-only programs (for adults) don't work; see the 2006 report from the General Accounting Office that showed that they impeded effective AIDS prevention. Of course we support abstinence for kids.

For adults, we support a comprehensive approach where education about condoms, abstinence, communication, fidelity, etc. is available. In other words, provide all the information, and let the adult decide what will work best for them. [Much more research is needed to better understand what is driving the very high infection rates in subSaharan Africa.]

Saving lives by keeping up with the epidemic. If funded at $30 billion over five years, the US would be treating only 100,000 new patients per year, when millions of people will die without treatment. We want more money to expand HIV treatment (and prevention) to keep up with the pandemic.

The PEPFAR reauthorization is under active consideration at the committee level in the House and Senate. Billions of aid dollars and many lives hang in the balance within this bill – which is likely to be among the few major pieces of legislation to move through Congress in this election year.


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Related Topics:Africa; Aids and HIV
Posted:February 8, 2008 at 4:08PM
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