PEPFAR support for abstinence-based education

The US Leadership against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 which set up the President's Emergency Plan for AIDS Relief (PEPFAR) recommended that 20% of funds designated to fulfilling the act be designated to prevention. Of that 20%, the act mandated that 33% should be dedicated to abstinence-until-marriage programmes.

In April 2006, the US Government Accountability Office released a report1 reviewing how the Office of the US Global AIDS Co-ordinator (OGAC) administered funds for HIV prevention through PEPFAR. The GAO report found that ten of the 15 PEPFAR-focus countries had requested exemptions from fulfilling the abstinence requirement between September 2005 and January 2006, citing the following problems with abstinence programmes:

  • reduced spending for preventing mother-to-child transmission (PMTCT)

  • limited funding to deliver appropriate prevention messaging to high-risk groups

  • lack of responsiveness to cultural and social norms

  • cuts in medical and blood safety activities

  • elimination of care programmes.

It found that the lack of clarity from OGAC on how to implement ABC programmes had caused major confusion and challenges for US government staff and partners implementing programmes in PEPFAR countries.

A lack of clarity about what was permitted in regard to 'C' (condom activities) had created a culture of fear amongst PEPFAR implementing partners who were concerned about "crossing the line between providing information about condoms and promoting or marketing condoms". One PEPFAR partner non-governmental organisation said that "although the organisation views condom demonstrations as appropriate in some settings it believes that condom demonstrations, even to adults, are prohibited under PEPFAR".

Seventeen of the 20 PEPFAR country teams interviewed reported that the abstinence requirement "presents challenges to their ability to respond to local epidemiology and cultural and social norms".

During the campaign for the 2008 presidency, candidates Hillary Clinton and Barack Obama committed themselves to reforming PEPFAR.

The original clause requiring that one-third of all prevention funding be spent on abstinence (as was the case during the first five years of PEPFAR) was in fact removed by the George W Bush administration during the 2008 reauthorisation of the law enacting PEPFAR. However, in its place is a new requirement with complicated language. In short, it says that, in countries with generalised HIV epidemics, strategies to prevent the sexual transmission of HIV must allocate at least 50% of funding for “activities promoting abstinence, delay of sexual debut, monogamy, fidelity and partner reduction”, and that PEPFAR must report to Congress if this target is missed. It does, however, add that such activities should be “implemented and funded in a meaningful and equitable way in the strategy for each host country”.2

It’s unclear how this has actually played out on the ground, though under the Obama administration, with Eric Goosby at the helm of PEPFAR, there has been renewed emphasis on tailoring PEPFAR programming to evidence-based information on the state of each local epidemic.

References

  1. Government Accountability Office Spending Requirement Presents Challenges for Allocating Prevention Funding under the President’s Emergency Plan for AIDS Relief. GAO report, April 2006
  2. Kaiser Family Foundation Reauthorization of PEPFAR, the United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act: A Side-by-Side Comparison to Current Law. Kaiser Family Foundation, 2008
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We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

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