Stepping Up US Global HIV Prevention

This World AIDS Day (December 1), we're marching toward a historic moment in the course of U.S. global HIV prevention policy and its impact on the lives of women and youth worldwide. The President's Emergency Plan for AIDS Relief (PEPFAR) — the U.S. initiative intended to prevent 7 million new infections, treat 2 million people living with AIDS related illnesses, and provide care and support for 10 million people living with AIDS — is headed into its fifth year and final months before Congress reauthorizes the initiative in 2008.

While the U.S. is a leading source of funding for HIV/AIDS programs worldwide, after four years of PEPFAR, we've seen a lot of missteps in making HIV prevention strategies work for women and youth, including a misguided "ABC" (Abstain, Be Faithful, Use Condoms) approach to HIV prevention and ideologically-driven funding restrictions like the one-third abstinence-until-marriage earmark and anti-prostitution pledge. World AIDS Day offers an opportunity to raise awareness about necessary reforms to PEPFAR prevention policy and to call upon Congress to step up and stand up for the lives of women and youth worldwide.

Consider the abstinence-until-marriage earmark. When Congress authorized $15 billion for PEPFAR, it mandated that at least thirty-three percent of HIV prevention funds be spent on abstinence-until-marriage programs. Not surprisingly, this funding restriction has harmed women and youth by failing to address the varied realities of their lives. The vast majority of youth in PEPFAR's fifteen focus countries are sexually active by the time they are twenty, and half of all new HIV infections occur in youth aged 15-24. Counter to what the abstinence-until-marriage policy suggests, marriage is not a safe haven from infection. Eighty percent of HIV infections among women worldwide result from sex with their husbands or primary partners.

In the vein of funding restrictions and missteps, there is also the anti-prostitution pledge — the requirement that nongovernmental organizations adopt a policy explicitly opposing prostitution in order to receive PEPFAR funding for HIV/AIDS programming. Women and men who engage in sex work are among the most marginalized persons in any society and are at increased risk of HIV infection. Yet organizations that advocate for the health and human rights of commercial sex workers face a difficult decision: sign the pledge and further stigmatize and marginalize those most in need of comprehensive HIV/AIDS prevention, treatment and care or renounce the pledge and risk closure due to lack of funds.

Reproductive health and HIV/AIDS services are generally operated separately — a burdensome arrangement for women and girls in resource-poor countries who must often visit one provider for family planning or prenatal care and another for HIV testing or treatment. To improve access to life-saving health care, PEPFAR must take steps toward integrating sexual and reproductive health services with HIV/AIDS services and programs. This makes sense because for women who have sex with men, unprotected sex may result in pregnancy and/or HIV infection. Integrated service sites staffed by trained and sensitive practitioners would also help ensure that U.S. global AIDS policy respects the childbearing decisions of HIV positive individuals and people living with AIDS.

As the U.S. prepares to usher in the next phase of PEPFAR, we must step away from ideological funding restrictions and centralize effective, integrated prevention programs and policies for those most vulnerable to infection.

That's why for World AIDS Day 2007, organizations and advocates across the nation are participating in the "STEPS" to Effective U.S. Global HIV Prevention Policy for Women and Youth campaign. STEPS stands for "Start Taking Effective Prevention Seriously" — which is our message to Congress as members deliberate over changes to PEPFAR. We're encouraging supporters to join the campaign by taking literal steps, like organizing and participating in marches, and figurative steps, like making the case for reform to policy makers and the media. Around the country, people will call or write their Representatives and Senators to co-sponsor the PATHWAY Act or the HIV Prevention Act (both bills would remove the 1/3 abstinence-until-marriage funding earmark), write letters-to-the-editor about effective U.S. global HIV prevention policy, or even get tested for HIV. Nationally, our goal is that 4 million steps be taken, representing the approximate number of new HIV infections each year.

As part of the STEPS campaign, we're calling on Congress to take three major steps for PEPFAR reauthorization:

  • Remove the 1/3 abstinence-until-marriage earmark and fund comprehensive, integrated, and evidence-based HIV prevention programs.
  • Expand access to HIV/AIDS and reproductive health services by integrating these programs to help prevent and reduce HIV infections among women and girls, avert HIV transmission from mother-to-child, and support HIV-positive women's reproductive rights and fertility choices.
  • Strike the anti-prostitution pledge and support programs that advance effective HIV prevention interventions, promote fundamental human rights and free speech, and reduce stigma and discrimination against marginalized populations.

These global HIV prevention demands will be shouted loud and clear at a World AIDS Day "STEPS" march in Washington, D.C. on Friday, November 30. Advocates will be marching from the Office of the Global AIDS Coordinator (OGAC — the U.S. agency that oversees the implementation of PEPFAR), where they will be calling on OGAC to support our calls to Congress. We will then join with a larger rally that brings together local, national, and global anti-AIDS activists in Lafayette Park at 1:00 p.m. To learn more about the STEPS World AIDS Day campaign and the D.C. march and rally, please visit For those looking to take STEPS toward effective domestic HIV prevention policy, we recommend joining the Prevention Justice Mobilization, which can easily be integrated with a global STEPS message.

Together, our STEPS can go a long way!

Like this story? Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

For more information or to schedule an interview with contact

  • invalid-0

    AIDS WAR: We (youths) should NOT die like dogs

    The preparing of children for school and coordination of scarves suits preoccupied most minds of those filing out of Kenyan homes on Thursday morning. On the lapels of but a few, was a plash color, in the form of a red ribbon, symbolic for AIDS awareness. Stigma, discrimination and/or the fear of being ostracized coiled up support: A random activist and lone sufferer made their statement.

    In New York, thousands of miles away from my homeland of Kenya, a small group of about 30 or so gathered to solemnly watch “We will not Die like Dogs”, a defiant documentary directed by film maker Lisa Russell.

    “Do you know what your government’s HIV/AIDS policies are?” Russell challenged, “And do you monitor them?” The IMPORTANCE of the questions would unravel with the film – a feature on four African AIDS activists combating the pandemic from the grassroots. “Africa is dying”, Russell noted; “Enough said”.

    While little remains unknown about how the virus spreads, much talk – and many questions seem to be centering on the United Nations General Assembly Declaration of Commitment signed in June 2001. It promised the reduction of HIV prevalence by 25 percent (among those aged 15-24 years) and an increased annual spending on HIV/AIDS to the tune of $7-10 billion in low and middle income countries, experiencing, or at risk of experiencing rapid expansion of the HIV epidemic.

    The commitment also covered countries in sub-Saharan Africa, where it pledged to, “ensure that 90 percent of young people have access to the information, education and services necessary to develop the life – skills required to reduce their vulnerability to HIV infection”. A far cry from reality! Are our (youth) strategies wrong? As has always been the case, plenty of attention remains focused on the ABC’s of HIV/AIDS – the “Abstinence, Be faithful and use Condoms” approach. But does this solve, in any measure, the catastrophe that Africa faces with its alarming orphan rate; and should interventions, efforts and policies NOT focus more on the youth and building their capacities?

    Minors, it should be noted, comprise about half of the sub-Saharan population. It is they, and NOT older counterparts, that national priorities should point to. How else can we incept our poverty cycle when so many orphans are illiterate?

    My country, which I happen to adore and love dearly, Kenya, has made some effort in this regard by providing free primary education; but problems linger. About four million AIDS orphans in sub-Saharan Africa are currently not attending school. In Kenya, a majority of those orphaned by HIV/ADS experience difficulty with attendance, owing to household responsibilities, stigma, discrimination and the inability to purchase school uniforms, among others.

    It is not entirely hopeless. Collaboration, like the GYCA, and closer home, such as that launched by the Kenyan government; Pathfinder International and UNFPA, which focus on adolescent reproductive health and development policy, are a good start to encouraging,

    “Youth to become actors in their own health and development, and ensuring that this critical segment of the country remains in good health, it thereby paves way for the future social and economic achievements”.

    Yet the challenge remains if these efforts are implemented without tackling the underlying problems of poverty, illiteracy and disease – the items that render them vulnerable. Few have taken this to heart like Kenyan Dr. Olubayi Olubayi. He is the founder and chair of the Global literacy Project, which has placed public libraries across Machakos, Teso and Bungoma Districts. More recently, the project poured books into South Africa’s Caroll Shaw Memorial Centre, which caters to AIDS orphans and recovering drug addicts.

    Dr. Olubayi, a lecturer at the Rutgers University in the US, sees this as our government – in black and white: “Literacy is a tool for self empowerment and poverty eradication”, he asserts, “and we know that HIV/AIDS and other infectious diseases succeed most where there is entrenched poverty. Why not, as our project is doing, fight the pandemic through literacy? It is logical and we are showing success”.

    I wore my red ribbon on World AIDS Day, but I know little will come from it unless our government realizes that funds are a commendable start. Youth play a pivotal role against this disease, and this may be a commendable start, but NOT ENOUGH! Hungry children cannot read. Uniforms are NOT free, and what happens after high/secondary school? These are the government’s responsibility, and something which can be addressed with increased political goodwill, as well as the reprioritization of resources. We MUST address the future because ALL sentiment aside, much is at stake. It is time, as activist Janet Feldman says, “to pray for the dead and fight like hell for the living”.

    This was world AIDS day last year!I may be African and in Africa,but at the end of the day to me what really really matters is: A- Am I- I D- Doing S- Something?
    We all have a part to play and we have to understand that this virus know No tribe,Culuture,Boundaries,colour,religion,Money,Status,SEX,Race,and any others that u may think of.Lets make a differnce!
    Even though i am NOT observing the World Aids Day i the United States this yeari will be back home in Kenya and with you in spirit!