US HIV/AIDS policy under fire

Posted: 21 November 2005

The announcement, in 2003, that the US Adminstration under President Bush was to give $15 billion (£9 billion) to help the fight against AIDS in Africa and the Caribbean was welcomed by campaigner Sir Bob Geldof, and others, as a major breakthrough. But, critics argue, it has become increasingly clear that the Bush policy is, in many ways, proving more damaging that helpful, as this Editorial Comment from the Baltimore Sun reveals.

AIDS has hit Africa hard. But non-governmental organizations confronting the epidemic have been hit even harder by the Bush administration's ideologically based edicts.

Last month, the UN special envoy for HIV/AIDS in Africa, Stephen Lewis, and others declared that the administration's policy of emphasizing abstinence-only programmes and cutting federal funding for condoms has undermined Uganda's HIV/AIDS effort. Sadly, Uganda is not alone.

In Kenya, health professionals are despairing, not because of HIV/AIDS, which has infected 7 per cent to 9 per cent of Kenyans, but of numerous US funding restrictions.

The first was the global gag rule, reinstituted by President Bush immediately after he assumed office in 2001. It mandates that no foreign agencies may receive US assistance if they provide abortion services, including counseling or referrals, or lobby to make or keep abortion legal.

Since abortion is largely illegal in Kenya, one would expect the gag rule to have had little impact. But because organizations such as International Planned Parenthood Federation refused to buckle, they experienced major cuts, which they had to pass along to their developing-country affiliates.

Hence, the Family Planning Association of Kenya's budget was halved, and many clinics offering birth control and other vital services were closed. This significantly reduced Kenyans' access to contraceptives and, ironically, probably increased unsafe abortions. Dr Solomon Orero, a Nairobi obstetrician, estimates that more than 200 maternal deaths in Kenya can be attributed to the gag rule.

The second was the President's Emergency Plan for AIDS Relief (PEPFAR). This five year, $9 billion programme supports AIDS treatment, care and prevention activities in 15 countries, including Kenya. Health professionals have been dismayed by the regulations governing disbursements.

One-third of PEPFAR prevention funds must be spent on "abstinence/be faithful" youth programmes, even though Kenya's AIDS Control Programme promotes abstain, be faithful, or use condoms (ABC) messages.

Last year, 11 faith-based organizations, some with no prior youth health experience, were awarded about $1 million each to engage in abstinence-only campaigns in Kenya. One recipient was World Vision, which requires that its employees call Jesus their saviour.

A spokesman, Samson Radeny, said that World Vision's activities will include Christian "transformative education" and encourage "abstinence peer models" in schools. For the estimated three in five youths who are sexually active, the organization will promote "teen faithfulness" but will not provide any contraceptive information. Apparently, unprotected "faithful" sex is preferable to safer sex.

The final action was the Bush administration's decree in June that any non-governmental organization receiving US government funding must explicitly oppose sex work and sex trafficking. This caused consternation among NGOs, which train sex workers to serve as health educators and condom distributors.

Refusing to adhere to this new requirement, the Brazilian government returned $40 million to the US Treasury. Unfortunately, NGOs in Kenya are not in a position to reject money. Instead, they are quietly ending their prevention programmes for sex workers, even though experts believe these activities are vital for reducing HIV/AIDS prevalence.

At a public health conference last year, an American public health professional declared:

"At least under Reagan we could still do our jobs." Regrettably, the Bush administration's policies are reducing the effectiveness of our foreign aid, squandering our reputation and alienating our scientifically minded public health allies in Africa.

Policy reversal

In a separate policy reversal, the Bush administration has imposed its global gag rule on groups seeking funding for a large project to curb the spread of HIV/AIDS in Africa. The Center for Health and Gender Equity (CHANGE), a Washington-based health policy advocacy group, said it spotted the change in a request for applications (RFA) issued on November 18 by the US Agency for International Development for $193 million in grants for five years of programmes in Kenya. The administration has broken its own written commitment not to subject global AIDS funds to these onerous restrictions, said CHANGE Executive Director Jodi Jacobson. "This shift in policy goes beyond hypocrisy to sheer irresponsibility and complete disregard for the lives and welfare of women and girls worldwide" she said. The global gag rule, also called the Mexico City policy, already bars international family planning organizations from providing abortion referrals, counseling or services in their facilities or from discussing abortion laws in public, on pain of losing US. funding. In early 2003, President Bush sought to extend the rule to all State Department programmes, but was so heavily criticized that he issued an executive order exempting AIDS funding from the rule. On Nov. 18, however, the new RFA twice included eligibility criteria requiring grant recipients to agree to abide by the Mexico City Policy, the Tiahrt Amendment and all U.S. AID policies and regulations. The Tiahrt Amendment, sponsored in 2001 by Rep. Todd Tiahrt (R-KS), requires parental notification and consent for all information and medical care supplied to minors. Jacobson noted that the theme of World AIDS Day on December 1 is Keep the Promise, referring to the lag between world leaders pledges against the AIDS pandemic and the reality of insufficient contributions. "What we are doing with this policy is taking an already sub-par effort and making it worse" she said.

Source: Baltimore Sun reported in Push Journal on 19 October, 2005 and Planetwire, 23 November 2005.

Related link

Geldof praises US AIDS plan