PEPFAR, Youth, and the AIDS Epidemic: A Call for Real Leadership on Prevention


The global HIV and AIDS strategy is at a turning point. We have witnessed dramatic scientific advances in the fight against the pandemic, spurring renewed hope that the end of AIDS is in sight. President Obama and Secretary Clinton recently delivered major speeches announcing new targets and goals for achieving an “AIDS-free generation.” Yet globally, young people continue to account for four in ten new infections and those directing the U.S. effort to combat the epidemic are not taking the bold steps necessary to match the inspiring vision outlined by the President and the Secretary of State.

But rather than building a firewall of prevention around the largest youth generation in the world’s history, the Office of the Global AIDS Coordinator (OGAC) is pursuing a limited, politically-safe approach–based largely on a biomedical approach to prevention–that downplays the sexual health needs and rights of youth throughout the world.

In a newly-released report, Advocates for Youth analyzes youth policies within the President’s Emergency Plan for AIDS Relief (PEPFAR), including its legislative authority, most recent five-year strategy, relevant guidance documents, and all twenty-one currently available PEPFAR country Partnership Frameworks. Our analysis outlines a series of policy recommendations that could help the agency address the real challenges at hand. This first-of-its kind, in-depth analysis assesses PEPFAR policy and programming according to nine youth indicators, including:

  • Requirements that comprehensive sex education, which includes information about abstinence and condoms, be provided for all youth;
  • Emphasis on the meaningful inclusion of youth in the development, implementation and/or evaluation of youth HIV prevention and care strategies;
  • Clear support for the integration of youth-friendly HIV/AIDS and family planning/reproductive health services;
  • Emphasis on specific prevention strategies for young people living with HIV or AIDS;
  • Recommendations for the compilation and reporting of age disaggregated data and statistics;
  • Explicit inclusion of programs and strategies targeting young men who have sex with men, young commercial sex workers and young intravenous drug users;
  • Language that identifies youth as a Most-At-Risk Population;
  • Policies and programs designed to reach at-risk and out-of-school youth; and
  • Policy reforms that improve youth access to sexual health services, including condom availability.

The report finds that the while there are promising advances for youth sexual and reproductive health in PEPFAR’s second phase, progress is being significantly hampered by a siloed, segmented approach to prevention that fails to address the holistic needs of youth or to engage young people themselves as partners in prevention. In addition, the report notes a tepid commitment within OGAC to the rights of young people to the information and education they need to protect their health and lives in the era of AIDS. The report concludes with a set of recommendations for the U.S. Congress, OGAC, and Partner Country governments, to design and implement the bold policy needed to support youth sexual and reproductive health and rights, including promotion of comprehensive sexuality education and youth-friendly, integrated, HIV and family planning services.

While “combination prevention” approaches may be all the rage in Washington these days, a key piece of the prevention puzzle is missing—the health and rights of young people. We all understand that prevention of mother-to-child transmission (PMTCT), male circumcision, and treatment as prevention are critical interventions in the global HIV prevention arsenal. However, they represent only a partial picture of prevention—one that focuses entirely on biomedical approaches at the expense of behavioral and structural interventions. We simply cannot afford to take the path of least resistance and promote politically easy biomedical approaches while minimizing attention to more comprehensive strategies that recognize the realities of young people’s sexual lives. The 2,500 young people who are newly-infected with HIV every single day serve witness to the inadequacy of our current approach.

We have to recognize that young people have the right to accurate and complete sexual health information and services; that young people deserve our respect; and that as a leader in the global HIV fight, the U.S. has a responsibility to require that those receiving U.S. funds provide young people with all of the tools they need to safeguard their sexual and reproductive health. Yet, all too often, young people are ignored or caught in the crosshairs of controversy and politics. One of the many costs of this fallout: only 34 percent of young people in low- and middle-income countries (24 percent of young women and 36 percent of young men) can correctly answer the five basic questions about HIV and how to prevent it.

We’ve got to do better than this.

As the host of the International AIDS Conference this July, the United States and Washington, DC, in particular, will be in the spotlight. And thousands of young people will be at the forefront, thanks to efforts of Youth Force, expecting their leaders to not just listen, but to take action to address the health and rights of young people. We must seize this opportunity to promote a truly science-based, holistic, HIV-prevention strategy for young people in the U.S. and abroad. In the end, it is young people who hold the key to ending this epidemic. That’s why they should be at the center, not the periphery, of our programs and policies. The ultimate challenge we face is not money or technology—it’s leadership. And the time to exercise it is now.

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  • james-wagoner

    Finally, OGAC is being held accountable for its diminimous attempts to place young people where they belong- at the center of prevention strategy. While a bio-medical approach certainly has its merits, it is too often used as a way to circumvent the perceived controversy around sexual health prevention. Well, you don’t conquer stigma by failing to address it- that much we know. Deb hauser is right. Time for leadership!