Background on the President's Emergency Plan for AIDS Relief (PEPFAR)

In his 2003 State of the Union address, President Bush launched the Emergency Plan for AIDS Relief (PEPFAR), pledging a groundbreaking $15 billion over five years to combat HIV/AIDS in 14 countries in Africa and the Caribbean (Vietnam was added as a 15th country in 2004). PEPFAR was heralded by the international health community, AIDS activists, the American public, and many African leaders as an unprecedented U.S. government investment in the health and security of the developing world.

Undermining Prevention Efforts
Congress responded to the President Bush’s request, and passed legislation to treat 2 million people, prevent 7 million new HIV infections, and provide palliative care for 10 million people. Congress added a number of damaging amendments to the PEPFAR legislation as it moved to turn the Bush proposal into law. These amendments threaten to undermine PEPFAR's effectiveness on the ground, especially as they fail to take into account the realities women and young people face in the countries designated to receive funds. For example:

• The Pitts Amendment. Disregarding the key forces driving the spread of HIV, urged on by Rep. Joe Pitts (R-PA), Congress earmarked 33 percent of prevention funds for unproven "abstinence-until-marriage" programs. For an adolescent girl already married to an HIV-positive man twice her age—a situation in which many young women living in the countries designated for PEPFAR funding currently find themselves—abstinence is not an option, and as a result, programs that offer abstinence as the only strategy for avoiding HIV are of little value to these young women. Further, the earmark reduces funding for effective comprehensive prevention efforts that include the provision of accurate information about reproduction, contraception, and condom use and reliability.

• The Smith Amendment. An amendment offered by Rep. Chris Smith (R-NJ) allows "faith-based" groups that receive U.S. funds to refuse to provide information about proven methods of protection against HIV/AIDS or to make referrals to clinics or organizations that offer critical prevention services. Even though condoms are credited with helping to reduce the spread of AIDS, U.S.-funded groups are now allowed to denigrate the benefits of condom use.

• The Litmus Test. Another Smith amendment requires organizations receiving HIV/AIDS funding to certify that they oppose the legalization of prostitution. The provision will severely hamper treatment and prevention services for sex workers—a population that is proven to be of critical importance in any credible effort to stem the spread of HIV/AIDS —because the local, community-based organizations that are best positioned to reach those in the sex trade may be active in efforts to de-stigmatize sex workers. Such a stance, which builds trust and allows for better health interventions, has been twisted by critics as promoting prostitution.

Denying the Connection to Reproductive and Sexual Health
In the 15 PEPFAR countries, the Administration has consistently failed to invest in reproductive health services already in place—services ideally positioned to deliver lifesaving information on HIV/AIDS to women and their families. The majority of Americans believe that information and education on how to prevent HIV/AIDS should be provided through reproductive health programs. But instead, the Administration's policies, priorities, and approach have fostered an artificial division between HIV/AIDS and sexual and reproductive health, failing to acknowledge and address the social and behavioral factors fueling the epidemic's spread.