Bush Touts HIV/AIDS Program in Africa; House Committee on Foreign Affairs Set to Consider Strong PEPFAR Bill; Minority Threatens to Derail Bill over Opposition to Family Planning

Washington, DC… President Bush is traveling around Africa this week, where he has been touting his HIV/AIDS program. While the President’s Emergency Plan for AIDS Relief (PEPFAR) is a historic effort to combat HIV, there are critical flaws in the program that Congress is poised to address. The arbitrary funding mandate on abstinence and be-faithful programs are tying the hands of programs on the ground and HIV-positive women are in need of the contraceptives that will allow them to plan the timing and spacing of their children.

The House Committee on Foreign Affairs will mark-up a bill to reauthorize PEPFAR Wednesday, February 27. The bill, authored by the late and highly revered Chairman Lantos and widely supported by the community, would strengthen U.S. HIV/AIDS assistance by taking a big step forward in meeting the needs of the population most at risk for HIV infection – women and girls.

What the Bill Does:

Provides greater access to contraceptives for HIV-positive women who desire to space and plan their births or who choose not to get pregnant.

Provides greater effectiveness and flexibility in the fight against HIV/AIDS by striking the restriction under PEPFAR that mandates at least one-third of U.S. HIV/AIDS prevention funding be limited to abstinence-only programs.

Why Contraceptives Are Important:

Many people living with HIV want contraception: At various points in their lives, HIV-positive men and women want to have a child or another child or want to prevent a pregnancy, either to time and space their childbearing or to avoid it entirely. Those living with HIV often desire to prevent pregnancy because of the risk of transmitting the virus to their newborn or because of concerns that they will be leaving behind children, HIV-positive or not, as orphans.

Unmet need for contraception: High rates of unintended pregnancy occur throughout Sub-Saharan Africa, including among women living with HIV. The Centers for Disease Control and Prevention (CDC) reported in 2006 that among pregnant women receiving antiretroviral treatment in Uganda, 92% said their pregnancies were unintended.

Contraception as HIV Prevention: Research suggests that in the absence of contraceptive use in Sub-Saharan Africa, the number of HIV-positive births would be 31% higher than it is now. There would be an additional 153,000 infants born HIV-positive each year—and all of these births would be unplanned.

Contraception Enhances PMTCT Programs: USAID has projected that adding contraceptive services to PMTCT (Preventing Mother to Child Transmission) programs to make it easier for women to avoid an unintended pregnancy can prevent almost twice the number of child HIV infections and three times the number of child deaths as can PMTCT programs alone.

Linking HIV and Contraceptive Services is Cost-effective: Family Health International calculated in 2006 that for the same cost, contraceptive services can avert nearly 30% more HIV-positive births (by preventing unwanted pregnancies) than identifying HIV-positive women during pregnancy and administering nevirapine.

*The law makes clear that no PEPFAR funds may be used for abortion. That is because the Helms amendment to the Foreign Assistance Act applies to PEPFAR as it does to all foreign aid. Nothing in the PEPFAR reauthorization bill would alter the Helms amendment in any way.

Quote from Amy Coen, President of Population Action International:

"I want to live to see the day that victory is declared on the dreaded and deadly HIV/AIDS virus. Until then we have to do all we can to stop it, slow it, and save lives. Declaring victory against HIV/AIDS requires us to pool all effective resources and to put aside our ideological differences to save precious lives. It is only by standing together that we will ensure PEPFAR's legacy."

Why Strike the Abstinence-Only Requirement:

In 2006, there were 4.3 million new HIV infections. According to the WHO, unprotected heterosexual sex is the leading cause of HIV infections worldwide, representing 80 percent of new infections in sub-Saharan Africa.

For every person put on treatment for AIDS, seven new people become infected.

Yet currently, one-third of US HIV prevention funding (and two-thirds of funding that addresses the prevention of sexual transmission of HIV) is spent on abstinence-until-marriage programs.

Marriage is not a protective factor from contracting HIV/AIDS. Over the next ten years, more than 100 million girls in developing countries will be married before their 18th birthday – mostly to older men and often against their will. These girls have significantly higher rates of HIV infection than their sexually active, unmarried peers.

According to UNAIDS, women and adolescent girls account for about half of all HIV infections worldwide. In sub-Saharan Africa, women and girls make up 60 percent of all infections and 76 percent of infections among those aged 15-24.

40% of new HIV infections are in youth aged 15-24; the majority of youth are already sexually active.

According to two congressionally mandated reviews from the Government Accountability Office (GAO) and the Institute of Medicine (IOM), and countless experts in the field, the abstinence restriction is detrimental to the overall effort and should be eliminated.

From the IOM:

"The earmark has greatly limited the ability of Country Teams to develop and implement comprehensive prevention programs that are well integrated with each other and with counseling and testing, care and treatment programs and that target those populations at greatest risk."

The earmark has "limited PEPFAR’s ability to tailor its activities in each country to the local epidemic and to coordinate with…the countries’ national plans."

The IOM was "unable to find evidence for the position that abstinence can stand alone or that 33 percent is the appropriate allocation for such activities even within integrated programs."

From the GAO:

The abstinence-until-marriage requirement "can undermine the integration of prevention programs by forcing [country teams] to isolate funding for AB activities." This "limited some country teams’ ability to shift program focus to meet changing prevention needs."

"17 of 20 PEPFAR teams…reported that the spending requirement presents challenges [in responding] to local epidemiology and cultural and social norms."

IMPORTANT: In the FY2008 Appropriations bill, the House and Senate voted in favor of removing this onerous earmark and the President signed the bill. The House, Senate AND President have already spoken in favor of removing this earmark.

For more information or to arrange an interview with a PAI spokesperson, please contact Tyler LePard at 202.557.3422.
 
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Population Action International works to improve individual well-being and preserve global resources by mobilizing political and financial support for population, family planning and reproductive health policies and programs.