Vietnam-a vibrant country of 84 million people-is experiencing rapid economic growth and unprecedented societal change ushered in by globalization. This is posing interesting possibilities and challenges for U.S. assistance and policy. In June 2004, the Bush Administration named Vietnam the fifteenth “focus” country under the President's Emergency Plan for AIDS Relief (PEPFAR). Vietnam is the sole PEPFAR focus country in Asia, with twelve in Africa and two in Latin America and the Caribbean. The HIV/AIDS epidemic here differs greatly from that of its African counterparts: HIV/AIDS prevalence is quite low and is concentrated among populations which engage in high risk behaviors.

Since 1965, Congress has appropriated money in the foreign assistance bill for population assistance to developing countries to advance the U.S. foreign policy goals of promoting sustainable development and health in these countries. This money supports family planning and related reproductive health services through programs administered by the U.S. Agency for International Development (USAID). Such programs directly benefit tens of millions of couples each year, improving both maternal and child health and contributing to slower population growth.

Whatever one's view about population as an issue, few people fervently wish the world were home to a lot more human beings than it is. Some may wonder if another Mahatma Gandhi or an Albert Einstein or a Mother Theresa missed out on being born due to the declining global birthrates of the past few decades. But most know that such a question is fundamentally unanswerable and don't stay awake at night thinking about it.

The Mexico City Policy, also known as the Global Gag Rule, was reinstated in 2001.It is a complicated policy for which explanations are rarely brief. Consequently, it is widely misunderstood and often over-interpreted. Anecdotal evidence from the field strongly suggests that the Global Gag Rule restrictions on U.S. family planning assistance are being mistakenly applied to other U.S.Agency for International Development (USAID) accounts,especially U.S. assistance for HIV/AIDS prevention, treatment and care.

On January 22, 2001 - his second day in office - President George W. Bush announced the reinstatement of the restrictions on overseas health care organizations in effect during the mid-1980s and early 1990s, commonly known as the "Mexico City Policy." The policy reversal has had serious ramifications for U.S. support for international family planning and reproductive health programs around the world.

The President's Emergency Plan for AIDS Relief is a five year, US$15 billion initiative to fight the HIV/AIDS pandemic. Unfortunately, this assistance comes with significant restrictions on how the money is spent, undermining the public health impact of the funds.

Since 2001, the U.S. Congress has encouraged the U.S. Agency for International Development – USAID, the agency that dispenses foreign development assistance – to implement family planning and related reproductive health programs in areas where biological diversity is threatened and where species are endangered. Congress has never specified a funding level for these activities, which are supported by funds appropriated for international family planning programs, amounting to more than US$400 million annually in recent years. Over the past few years the agency has allocated between $1 million and $2 million annually to fund such projects and to explore the implications of the population-environment linkage as it applies to the conservation of critical ecosystems and the biodiversity they shelter.

In 2007, more than 6,800 people became infected with HIV every day, and new HIV infections outnumbered persons receiving treatment by nearly 3 to 1. Comprehensive HIV prevention-including both condoms and contraceptives-must become a top priority in the continued fight against HIV and AIDS. Because most HIV epidemics are fueled by sexual transmission of the virus, behavior change-including condom use-is critical to stemming the number of new infections.

The international community has repeatedly agreed to meet young people's developmental needs, including those relating to sexual and reproductive health. Yet young people often have little or no access to the information and services they need to make healthy, informed decisions about their sexual and reproductive lives.