New Policy Report from Advocates for Youth
Last December, I traveled to South Africa and Kenya to get a handle on what programs funded by the President's Emergency Plan for AIDS Relief (PEPFAR) looked like on the ground. Specifically, I wanted to talk to youth themselves to get their perception of PEPFAR and to examine program responses to young people's needs.
Overwhelmingly, I learned that the common sentiment on the ground was that PEPFAR has, so far, largely ignored the realities of young people's lives and the state of the epidemic among youth. It's no surprise, considering the policies that strangle an effective response like the ideological abstinence-until-marriage earmark and the un-scientifically based guidance from the Office of the Global AIDS Coordinator (OGAC).
One Kenyan PEPFAR implementing partner told me, "PEPFAR requires you to present everything about condoms very negatively. You … shoot yourself in the foot before you start."
There was common agreement that PEPFAR HIV prevention programs for youth also lacked sufficient links to reproductive health care. One recipient stated that PEPFAR's current youth prevention policy has resulted in "an absence of condoms and aggressive inattention to STI education and clinical services [for youth] … this inattention is unethical and disgusting."
I also found a widespread belief that PEPFAR's one-size-fits-all approach to youth HIV prevention ignores the social and cultural factors that contribute to the spread of HIV. One South African PEPFAR implementing partner said,
"PEPFAR prevention programs that target youth ignore the context. At home, a teenage girl is hearing from her mother and aunty that she has to have a baby to prove she is a woman. … Post-apartheid democratization has created tensions for youth. They have their family and cultural obligations on the one hand, and on the other, they see the opportunity for a different world. Basically, they are stuck between two worlds. Society and the family expect different things of the young person."
Another PEPFAR implementing partner told me to be successful in positive behavior change for an individual, "You have to target the community to change attitudes. A young person may want to change behavior, but the environment might not allow them to." I even found some research funded by USAID in Namibia that found that most youth did not understand the concepts of abstinence or faithfulness for HIV prevention. Namibian youth believed that "abstinence" meant "to be absent" and "faithfulness" meant faith in religion; 75 percent of the study population had never heard the word "monogamy."
The findings from my travels to South Africa and Kenya along with several months of research are documented in a new Advocates for Youth publication, Improving U.S. Global AIDS Policy for Young People: Assessing the President's Emergency Plan for AIDS Relief. The report makes a number of recommendations to Congress, including the immediate repeal of the abstinence-until-marriage earmark from PEPFAR and an increase in appropriations for international family planning.
The report also critiques PEPFAR's response to HIV-positive youth which will be featured in a new blog tomorrow.