PEPFAR, the President's Emergency Plan for AIDS Relief, was reauthorized by the Senate this past Wednesday in a dramatic 80 to 16 vote. The Bill, for a five year-$48 billion global initiative to combat HIV/AIDS, tuberculosis and malaria, also overturned a 21-year-old law that bans most foreign visitors who are HIV-positive from entering or gaining permanent residence in the United States.
The original five year-$15 billion program, created in 2003 by the Bush Administration, was due to expire September 30. President Bush originally had asked Congress for $30 billion, but the House overwhelmingly voted in April to increase the total to $50 billion. The Senate Foreign Relations Committee approved a similar version 18-3 in May. Since then, the Bill had languished in the Senate due to the opposition of conservative Republicans mainly opposed to the amount of funding.
The size of this commitment to the global fight against AIDS is indeed impressive, but under the House bill, all of whose restrictions have now been adopted by the Senate, eligibility for funds on the part of family planning services has been seriously compromised. The bill states that none of the funding can be provided to family planning clinics or groups that perform abortions or lobby for liberalizing abortion laws, even using non-U.S. funding. The original PEPFAR contained no such language, and IPPF and others have denounced this as a de-facto extension of the Global Gag Rule to HIV/AIDS funding.
These restrictions notwithstanding, the Senate additionally lost a golden opportunity to positively and proactively link HIV/AIDS treatment and prevention to family planning programs. By this critical omission, they have failed to protect both women and young people, the two most rapidly growing groups of newly-infected individuals world-wide, and those most likely to receive education, protection and treatment in family planning facilities.
This, in spite of PEPFAR's own unequivocal reports to Congress on the centrality and effectiveness of this approach:
"PEPFAR also supports linkages between HIV/AIDS and voluntary family planning programs... Along with providing linkages to family planning programs for women in HIV/AIDS treatment and care programs, PEPFAR also works to link family planning clients with HIV prevention, particularly in areas with high HIV prevalence and strong voluntary family planning systems. Voluntary family planning programs provide a key venue in which to reach women who may be at high risk for HIV infection. PEPFAR supports the provision of confidential HIV counseling and testing within family planning sites, as well as linkages with HIV care and treatment for women who test HIV-positive. Ensuring that family planning clients have an opportunity to learn their HIV status also facilitates early up-take and access to PMTCT services for those women who test HIV-positive." (Excerpt from 2008 PEPFAR Fourth Annual Report to Congress)
Another serious limitation was the failure to fully remove the earmark for so-called abstinence-only strategies to prevent the spread of HIV. The Senate bill now calls for spending at least fifty percent of prevention funds on abstinence and be-faithful programs, and PEPFAR recipients who fail to meet this requirement will have to explain why in extensive reports to Congress. While this might seem to represent a relaxation of the original PEPFAR requirement that at least one-third of prevention funds must be spent on abstinence-only education, in practice it still constitutes a harmful, unwarranted and wasteful restriction.
The anti-prostitution pledge was also untouched by the bill. In spite of the celebrated success in lowering HIV transmission rates of prevention programs targeting sex workers, the Senate upheld a provision requiring groups fighting HIV/AIDS in other countries to publicly pledge their opposition to prostitution and sex trafficking. Sex workers, a highly marginalized group with high vulnerability to HIV infection, have been stigmatized and driven further underground by the pledge, depriving them of treatment and harming the wider prevention effort.
In a step forward however, the bill provides $10 billion to the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. The Global Fund, which operates world-wide and with fewer restrictions, is under-resourced, and Republicans have long resisted attempts by Democrats to increase the U.S. contribution.
The original five year-$15 billion program, created in 2003 by the Bush Administration, was due to expire September 30. President Bush originally had asked Congress for $30 billion, but the House overwhelmingly voted in April to increase the total to $50 billion. The Senate Foreign Relations Committee approved a similar version 18-3 in May. Since then, the Bill had languished in the Senate due to the opposition of conservative Republicans mainly opposed to the amount of funding.
The size of this commitment to the global fight against AIDS is indeed impressive, but under the House bill, all of whose restrictions have now been adopted by the Senate, eligibility for funds on the part of family planning services has been seriously compromised. The bill states that none of the funding can be provided to family planning clinics or groups that perform abortions or lobby for liberalizing abortion laws, even using non-U.S. funding. The original PEPFAR contained no such language, and IPPF and others have denounced this as a de-facto extension of the Global Gag Rule to HIV/AIDS funding.
These restrictions notwithstanding, the Senate additionally lost a golden opportunity to positively and proactively link HIV/AIDS treatment and prevention to family planning programs. By this critical omission, they have failed to protect both women and young people, the two most rapidly growing groups of newly-infected individuals world-wide, and those most likely to receive education, protection and treatment in family planning facilities.
This, in spite of PEPFAR's own unequivocal reports to Congress on the centrality and effectiveness of this approach:
"PEPFAR also supports linkages between HIV/AIDS and voluntary family planning programs... Along with providing linkages to family planning programs for women in HIV/AIDS treatment and care programs, PEPFAR also works to link family planning clients with HIV prevention, particularly in areas with high HIV prevalence and strong voluntary family planning systems. Voluntary family planning programs provide a key venue in which to reach women who may be at high risk for HIV infection. PEPFAR supports the provision of confidential HIV counseling and testing within family planning sites, as well as linkages with HIV care and treatment for women who test HIV-positive. Ensuring that family planning clients have an opportunity to learn their HIV status also facilitates early up-take and access to PMTCT services for those women who test HIV-positive." (Excerpt from 2008 PEPFAR Fourth Annual Report to Congress)
Another serious limitation was the failure to fully remove the earmark for so-called abstinence-only strategies to prevent the spread of HIV. The Senate bill now calls for spending at least fifty percent of prevention funds on abstinence and be-faithful programs, and PEPFAR recipients who fail to meet this requirement will have to explain why in extensive reports to Congress. While this might seem to represent a relaxation of the original PEPFAR requirement that at least one-third of prevention funds must be spent on abstinence-only education, in practice it still constitutes a harmful, unwarranted and wasteful restriction.
The anti-prostitution pledge was also untouched by the bill. In spite of the celebrated success in lowering HIV transmission rates of prevention programs targeting sex workers, the Senate upheld a provision requiring groups fighting HIV/AIDS in other countries to publicly pledge their opposition to prostitution and sex trafficking. Sex workers, a highly marginalized group with high vulnerability to HIV infection, have been stigmatized and driven further underground by the pledge, depriving them of treatment and harming the wider prevention effort.
In a step forward however, the bill provides $10 billion to the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. The Global Fund, which operates world-wide and with fewer restrictions, is under-resourced, and Republicans have long resisted attempts by Democrats to increase the U.S. contribution.
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