Bush's announcement last week to double the funding for the President's Emergency Plan for AIDS Relief (PEPFAR) to $30 billion was nothing less than political brilliance on his part. I mean that genuinely. It was a preemptive strike to once again claim empathetic superiority in an area once reserved for well-meaning progressives. Yes, it was also timed to provide cover for Bush's anti-environmentalism in advance of the G8 Summit, but here at home, it had the added utility of once again using an abundance of funding to disguise underlying policy flaws—deliberate and favored—that are hampering a good program from being a great one.
Already, some rumblings suggest that Democrats might be throwing up their hands in the face of Bush's suggestion of fiscal largess. If that happens, prevention policies will continue to undermine attempts to curb HIV transmission via commercial sex work by retaining the anti-prostitution pledge, and countries like Uganda will continue to see early successes unravel as comprehensive programs disappear in favor of abstinence and marriage promotion. But, more importantly, the same Bush ideological kin will continue to reap huge windfalls that in the long run serve only to undermine sexual and reproductive health and rights globally.
The debate on PEPFAR's future, at present on but a slow simmer, is likely to hit the front burner after the summer months. While Bush throws cash to distract, our goal as advocates must be continued vigilance in shining a light on PEPFAR's policies that are undermining prevention.
To this end, today SIECUS has released a special report on PEPFAR prevention policies and how they are affecting efforts in Vietnam (PDF), one of the 15 PEPFAR focus countries and the only one in Asia. In 2006, SIECUS and colleagues from Population Action International (PAI) conducted an investigative research trip to Vietnam. (PAI's own earlier report can be found here.) SIECUS' report is particularly focused on the impact of PEPFAR's prevention efforts on youth in Vietnam.
In 1992, Vietnam had no reported cases of HIV among youth. Less than ten years later, young people under age 19 made up 10% of all cases. Greater emphasis on testing accounts for part of this, but given that more than half of Vietnam's 84 million people are under age 24, this trend nonetheless presents a particular challenge.
PEPFAR is the largest HIV/AIDS donor in Vietnam, providing $17 million in Fiscal Year 2004 and an additional $25 million in Fiscal Year 2005. For Fiscal Year 2006, Vietnam applied for and received a waiver from the requirement that 1/3 of all prevention funding go to abstinence-until-marriage programs. This makes good sense given that commercial sex work and injection drug use are the main culprits behind Vietnam's epidemic. Yet, despite the waiver on paper, the U.S. Office of the Global AIDS Coordinator (OGAC) has continued to ask Vietnam to focus on abstinence and marriage promotion/faithfulness programming. This pressure from Vietnam's largest HIV/AIDS donor continues to result in a ramping up of abstinence-until-marriage programming. The funding for these types of programs has nearly doubled from $1.2 million in 2005 to $2 million allocated for 2006.
Additionally, the majority of PEPFAR's prevention funding for condom promotion in Vietnam is reserved for MARPS, or most-at-risk populations, and exclude youth more generally. To address the inability to use U.S. funds to educate youth about things other than abstinence and marriage promotion, Vietnam has secured two additional donors, the European Union and the Asia Development Bank to fund more comprehensive programs that give youth the full and complete information they need to protect themselves from HIV.
PEPFAR's splintering policies impede collaboration and the resulting lack of coordination with other donors in Vietnam is wasting both human and fiscal resources. This was documented in a 2006 report by the Center for Strategic & International Studies and corroborated in our in-country interviews with key players.
Moving forward, our report views Vietnam as yet another example of why PEPFAR's ideological shenanigans—namely the anti-prostitution pledge and the abstinence-until-marriage earmark—must be abandoned. Our research also shows that the lack of coordination by OGAC continues to be a major flaw. This lack of coordination applies both within the PEPFAR triad of treatment, care, and prevention itself, but also in how it interacts with the many other donors in the country. Bush's press to double funding before the kinks are worked out should give Congress even greater emphasis to force OGAC to solve the coordination conundrum that has become a hallmark of PEPFAR.
Will Congress heed the lessons of PEPFAR before it is reauthorized? We should be hopeful, but at the same time, recognize that it is our additional duty to leave as little wiggle room as possible. Then the Democrats can claim to have made a good program a great one and Bush's cynical support for nonsense can once again occupy the maniacal rantings of Focus on the Family instead of official U.S. international development policy.