PEPFAR’s Target Countries Need Sexual Health Information, Not Abstinence-Only

SIECUS today releases our
PEPFAR Country Profile Updates.  Designed to supplement the original 2005 PEPFAR Country
, these updates together track the impact and progress of
the prevention components in the President’s Emergency Plan for AIDS
Relief, or PEPFAR, in the 15 designated "focus countries" around
the world. 

There is no doubt that PEPFAR
provides assistance for care and treatment in countries most devastated
by the HIV/AIDS pandemic.  But that admission does not require
us to turn a blind eye toward its destruction of a comprehensive prevention
agenda – the third part of the emergency response – in the focus

When PEPFAR was reauthorized
earlier this year, the popular press and advocates of a "more money
whatever the cost" approach failed to recognize what our new updates
continue to show: the ideological underpinnings in PEPFAR’s prevention
portfolio stand in the way of a good program from being a great program. 

The various restrictions and
limitations in PEPFAR’s prevention portfolio are well known to many,
and include the disproportionate emphasis on Abstinence-only and "Be-faithful"
programs (AB) while downplaying the importance of correct and consistent
condom use (C).  The original law also required 1/3 of prevention
funding to go to AB programs while the reauthorized law strongly suggests
focus countries not to fall below a 50% threshold for AB. 

The impact of this particular
silliness is entirely serious on the ground.  

Tanzania is a disturbing example.  Just
over 6% of people ages 15- 49 in Tanzania are HIV-positive
and about 80% of infections occur through heterosexual sex.  The
country’s own strategy, laid out in what is known as their National
Multi-Sectoral Strategic Framework, embraces a comprehensive approach
to prevention and recognizes the key role of condoms.  (And, just
so it’s clear that they have their work cut out for them, only about
40% of males and 45% of females in Tanzania could correctly indentify
ways to prevent HIV transmission and reject misconceptions about how
the virus is spread.) 

Nonetheless, in responding
to Tanzania’s epidemic, PEPFAR prevention funding misses the mark. 
According to the country’s operational plan for 2007, a total of 25
programs received funding, but only three of these were reported to
be promoting correct and consistent condom use.  Making matters
still worse, one of these reported that it only reached 70 people (in
a country of more than 38 million people). 

A similar disconnectedness
can be observed in Botswana.  Botswana is, a country with an HIV prevalence
of nearly 24% (the second highest in the world), and while 25 organizations
received PEPFAR funding to prevent sexual transmission of HIV in 2007,
only two promoted correct and consistent condom use. 

Botswana also exemplifies the
open-door policy of PEPFAR to faith-based organizations that allows
them to withhold any information they deem contrary to faith teachings. 
So who is getting PEPFAR funding in Botswana?  True Love Waits
– a program whose central pillar is a virginity pledge that has been
disproved as an effective intervention.  Moreover, this particular
program instructs people that safe sex is wrong and that condoms have
defects in them.  This, in a country where nearly one in four people
carry the virus. True Love Waits also received PEPFAR funding in Kenya
and in South Africa. 

There is additional, disturbing
evidence about what certain faith-based grantees are doing with
U.S. tax-payer money.  For example, in South Africa, a country with about 18% HIV prevalence,
one grantee, called Scripture Union, describes its vision "to introduce
young people to Jesus" and ensure a "commitment to Jesus and also
to abstinence, whichever comes first."  To be sure, this is a
missionary organization that uses PEPFAR funding to proselytize and,
in 2007, they received nearly $1 million of U.S. money to do that. 

These are just a few of the
issues that surfaced in our extensive research and lead us to offer seven policy recommendations.  We call for: 1) an end to disproportionate
emphasis for ineffective abstinence-only programs; 2) increased transparency
of how funds are actually being used; 3) increased oversight to combat
proselytizing, to prevent faith-based organizations from exempting themselves
from discussing information on condoms/contraception, and to review
the influence of the U.S. government in the development of country plans
on prevention; 4) an end to the war on prevention efforts for sex workers;
5) increased focus on integration of HIV/AIDS and reproductive health
care services; 6) increased investment in indigenous prevention program
providers; and 7) an end to legalized discrimination in the program
that allows grantees to deny care, treatment and prevention services
to whomever they choose based on moral beliefs.  

2008 Updates
contain much useful information, but what was so striking
to us at SIECUS was one consistent theme that emerged in nearly every
country: the way in which the HIV epidemic targets the most vulnerable
members of society.  In country after country, young women, commercial
sex workers, injecting drug users, and men who have sex with men disproportionately
suffer from the HIV/AIDS.  These are the people who are most in
need of help and medical interventions, but who often slip through the
cracks.  As we face the challenges of reaching out to traditionally
underserved communities, we need PEPFAR to be more open and less blindly
moralistic in the way it distributes its resources. 

SIECUS has developed updates
for all 15 of the focus countries: Botswana, Côte d’Ivoire, Ethiopia,
Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa,
Tanzania, Uganda, Viet Nam, and Zambia. 

To see both the 2008 PEPFAR
Country Profile Updates
and the 2005 PEPFAR Country Profiles,
go to

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  • invalid-0

    thank you for being so informative. however, you seem to have a problem with sexual abstinence. abstinence is very healthy. you see with a condom you cannot guard the heart but with abstinence you do, you cannot guard the emotions with condoms( thin piece of rubber) but yet with abstinence you can. well, am not against condom use but they should be used in marriage where married couples can use them consistently and effectively, without fears or pressures. many young people cannot effectively use condoms, and so sexual abstinence till marriage should be the way to go. Condoms could perhaps prevent HIV/AIDS 90% but how a bout the 10%. what if many others fall in the 10%. and, diseases like genital herpes, chlamydia, cannot be prevented through condom use.

    What is wrong with funding faith- based organizations? they too are stakeholders in the fight against HIV/AIDS! and so should be given an opportunity to play their role, and if PEPFAR can fund them, then why not?? you see faith based organizations cannot compromise their stand-it has to be AB and if the C is added, it must be consistent condom use in marriage.Am abstaining from sex till marriage and i have no apologies for that, no emotional baggage,no regrets. Abstinence i practice, it makes sense to me….NO APOLOGIES.

  • scott-swenson

    Your numbers about condoms are not facts, but fictions; with correct and consistent use condoms work 98 percent of the time according to the Mayo Clinic, and many other reputable sources. If you don’t use them correctly, they will fail more often — so, if we teach people how to use them correctly, they will be more effective. Some people counter by saying, "but abstinence works 100 percent of the time" — except it doesn’t.  Most people who take virginity pledges and promise abstinence until marriage don’t follow through on those pledges, so the only question is given the much higher failure rate for abstinence, should we teach people how to protect themselves by using medical facts?


    It sounds like you’ve made a great decision for you, but since reality teaches us that not everyone will make that choice, and many of those who do will not live up to it, we should work with reality.  Scientific evidence and wise public health strategies can teach people to delay sexual debut, reduce partners and protect themselves and their partners. Perhaps you think it is better to just wish everyone would make the same choice as you do? There is no problem with faith-based organizations that work with reality and teach medical facts, but when programs like those cited above are actually endangering the lives of people by withholding facts, one has to wonder which faith teaches us not to use the brains God gave us to protect ourselves and others? As taxpayers we have a right — and a duty — to question how our tax dollars are being spent, and if they are not being spent in keeping with the best available medical science and public health strategies to prevent the spread of disease, then many people believe those are exactly the types of government waste, fraud and abuse that should be eliminated from our already over-burdened budget.  The problem is not that the programs are faith-based, it is that they are fraud-based.  Many faith organizations work with accepted medical science, and those programs should absolutely be encouraged as we need more people, not fewer, working to prevent disease all over the world.

    Be the change you seek,

    Scott Swenson, Editor