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FOR IMMEDIATE RELEASE
March 27, 2008
Will Congress Do More for HIV Prevention?
March 27, 2008 - With the full House and Senate poised to vote on the President's
Emergency Plan for AIDS Relief (PEPFAR) reauthorization bill, a
five-year, $50 billion initiative to combat HIV/AIDS, tuberculosis and
malaria worldwide, Congress must address the critical HIV prevention
shortfalls in the bill.
Progress has been made on expanding access to anti-retroviral drugs
(ARVs) since PEPFAR was enacted in 2003. Today, nearly two million
more people have access to anti-retroviral medication than five years
ago due to U.S. government support. However, some 2.5 million
women, men, and children will become newly infected with HIV this year
alone-more than the total number of those put on treatment in the past
five years of PEPFAR.
Sexual transmission is the single greatest cause of new infections
worldwide and is responsible for 80 percent of new infections annually
in sub-Saharan Africa. The highest rates of new infections are among
women and youth. Ending this pandemic requires that we use every tool
available to enable people to protect themselves from infection.
The funding PEPFAR provides for HIV/AIDS is the largest
international initiative ever dedicated to a single disease. PEPFAR
must invest in strategies that prevent as many infections as possible
because it is the right thing to do, and the fiscally responsible
approach: According to a 2006 analysis by Science Magazine, preventing
each new infection saves a total of $4,700 in foregone treatment and
care costs.
Much has been learned from evidence gathered in the first five years
of PEPFAR, yet the bills now before Congress continue to reflect
ideology and political expediency over proven approaches to saving
lives. Ignoring those lessons wastes public resources, leaves more
lives at risk and impedes development of a truly sustainable approach
to HIV and AIDS. For these reasons, the following changes should be
made to the reauthorization bills (HR 5501 and S 2731) currently under
consideration.
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Support proven prevention strategies that reach the largest number of people.
Infections are growing most rapidly among women and adolescents. These
two groups are more likely to use family planning and other
reproductive health services than any other segment of the population.
The Senate version of the bill neglects to call for HIV prevention
education and testing to be linked with family planning services—and
the House bill includes new restrictions limiting which family planning
service providers can partner with PEPFAR to provide HIV prevention
services. This stands in the way of effective and efficient health care
services.
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Remove the bill's so-called "balanced funding" provision:
Currently PEPFAR requires that 33% of all prevention funds be spent on
abstinence-until marriage programs. The House and Senate bills replace
this "hard" earmark with a new stipulation requiring that programs
spending less than 50% of funding for prevention of sexual transmission
on "behavior change"—defined as abstinence, delay of sexual debut,
monogamy and fidelity—must justify their strategies in reports to
Congress.
Every individual needs a range of education and services to be able to
protect him or herself against HIV—arbitrary spending guidelines from
Congress stand in the way of achieving this. In reviewing PEPFAR
programs, the Institute of Medicine underscored this when it stated
that "by requiring the country teams to isolate funding for these
activities [abstinence], this budget allocation has undermined the
teams' ability to integrate prevention programming." Public health
experts on the ground must be able to determine the best mix of
prevention programming. As it stands, their hands are tied by mandates
from Washington.
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Enact World Health Organization and USAID Recommendations to prevent mother-to-child transmission. The
World Health Organization recommends that women seeking treatment to
prevent maternal-to-child transmission (PMTCT) should have access to
voluntary family planning information and commodities should they
choose to prevent another pregnancy. Studies have revealed high rates
of unintended pregnancy among HIV positive women in PMTCT clinics. In
Uganda, for example, 93 percent of women seeking PMTCT services
reported they were experiencing an unintended pregnancy. A similar
study in South Africa revealed that 84 percent of the pregnancies in
three PMTCT programs in South Africa were unintended.
The US government itself asserts that integrating family planning
services could double the effectiveness of programs that prevent the
transmission of HIV from mother to infants, yet only 11 percent of
pregnant women who would benefit from treatment to prevent PMTCT have
access to such services. Despite this evidence, and the clear need for
information and services, neither the House nor Senate bills support
funding for these health care services.
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Eliminate the prostitution pledge. The 2003
PEPFAR legislation requires groups fighting HIV/AIDS overseas to pledge
their opposition to prostitution and sex trafficking before receiving
U.S. money. Sex workers are among the most marginalized people in every
country and often lack access to social and health support systems.
Prevention programs that have reached sex workers through first
building trust have yielded dramatic reductions in HIV infections among
these populations. For example, a 1991 study of 1,000 sex workers in
Nairobi found that a prevention program stressing condom use and
education was able to prevent between 8,000 and 10,000 new cases of HIV
infection per year at a very low cost.
Congress seems to think that having organizations sign such a pledge
will help contribute to ending prostitution, but in reality the
opposite may be true. According to numerous reports, the pledge has
led to further alienation of already-stigmatized groups and given free
rein to police and resulted in further discrimination against women in
sex work. Instead of reducing dependence on sex work, the policy is
driving sex workers under ground and away from the NGOs and health
workers best poised to help them.
It is our duty to use PEPFAR funding to prevent as many infections
as possible. However, large sums of money, spent unwisely, will not
stem the rapid spread of HIV and will require an ever growing need for
increased resources in the future. The bills fall short exactly where
more was needed: full and flexible funding of prevention programs that
will enable us to end the pandemic.
The fact that HIV/AIDS is primarily a sexually transmitted infection
makes addressing it in the U.S. political context challenging. But
true U.S. leadership in this area would enable best health practice to
prevail over ideology and save countless lives.
To arrange an interview or for more information, contact:
American Jewish World Service (www.ajws.org)
Contact: Joshua Berkman, 212.792.2893
Artists for a New South Africa (www.ansafrica.org)
Contact: Sharon Gelman, 310.204.1748
Center for Heath and Gender Equity (www.genderhealth.org)
Contact: Serra Sippel, 301.270.1182/301.768.7162
International Women's Health Coalition (www.iwhc.org)
Contact: Kelly Castagnaro, 212.979.8500/646.707.1004
Physicians for Human Rights (www.phrusa.org)
Contact: Kate Krauss, 617.395.4198/215.939.7852
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