Rep. Hyde Suggests More Global AIDS Funding Be Shifted To Groups Promoting Abstinence, Away From Groups Promoting Condom Use

Rep. Henry Hyde (R-Ill.) on Wednesday urged the Bush administration to direct more resources from the President's Emergency Plan for AIDS Relief to groups promoting abstinence and away from those promoting condom use as an HIV/AIDS prevention method, VOA News reports (Robinson, VOA News, 4/13). Hyde made the suggestion during a House International Relations Committee hearing on PEPFAR -- a five-year, $15 billion program that directs funding for HIV/AIDS, tuberculosis and malaria to 15 focus countries (CQ HealthBeat, 4/13). The law (HR 1298) authorizing PEPFAR endorses the "ABC" HIV prevention model, which stands for abstinence, be faithful, use condoms. The measure also specifies that one-third of the bill's HIV/AIDS prevention funding should be used for abstinence programs (Kaiser Daily HIV/AIDS Report, 4/22/04). However, Hyde said during the hearing that groups "best suited to promote A and B programs, such as faith-based and indigenous organizations, are often not the ones implementing these programs. Instead, organizations long-associated with the social marketing of condoms are given much of the funding for AB programs. This must not continue" (VOA News, 4/13). Martin Ssempa, director of Uganda's Makerere Youth Ministry and a representative of the Ugandan First Lady's AIDS Task Force, at the hearing said that the U.S. Agency for International Development and CDC are undermining the country's ABC prevention program through "what he calls a tilt toward condom distribution," according to CQ HealthBeat. Ssempa said that the social marketing of condoms "encourages sexual promiscuity," CQ HealthBeat reports (CQ HealthBeat, 4/13). "I mince no words when I address my fellow Ugandans every day, and I mince no words with you. The reason why other Africans and Ugandans are dying is because of sexual promiscuity," Ssempa said, adding, "That is what is killing us."

Sexual Coercion
Geeta Rao Gupta, president of the International Center for Research on Women, said that the ABC model alone is inadequate to address the HIV/AIDS pandemic, especially in Africa, where nearly 57% of HIV cases are among women and girls, VOA News reports. "This inexorable rise in infections among women demands special attention and immediate action, action that must go beyond the ABC approach," Rao Gupta said, adding, "That approach, while necessary to contain the AIDS epidemic, is not sufficient to address the underlying vulnerabilities that contribute to women's risk of infection" (VOA News, 4/13). Hyde suggested that a fourth component be added to the ABC model to address sexual coercion, which he said is a "vastly underreported" source of HIV transmission. Funding policies "must include a D for defending the rights of the vulnerable," Hyde said, adding, "We must expand programs to deter violence against women and children that leads to HIV transmission." Although some women might be "committed" to abstinence or monogamy, Hyde added that they are still at risk of infection because of sexual coercion or the "promiscuous sexual behavior of their husbands," according to CQ HealthBeat.

Lack of Health Care Workers
U.S. policy also must address the shortage of health care workers to administer antiretroviral therapy, Hyde said, adding that the dearth of health workers is a "far greater impediment" to treatment access than the cost of drugs, CQ HealthBeat reports (CQ HealthBeat, 4/13). According to an analysis by the Joint Learning Initiative -- a consortium of more than 100 health care leaders -- that was published in the Nov. 27, 2004, issue of the journal Lancet, approximately four million health care workers are needed in order to effectively fight diseases such as malaria, HIV/AIDS and TB in developing nations (Kaiser Daily HIV/AIDS Report, 11/29/04). Holly Burkhalter, U.S. policy director for Physicians for Human Rights, in written testimony said that Congress and the Bush administration should implement a "Global Health Workforce Initiative" to help highly affected countries hire and retain African health care workers. Hyde added that he supports shifting the PEPFAR goal of treating two million people with antiretroviral drugs by 2008 to having two million people "treated by their own citizens in their own country" by that date, according to CQ HealthBeat (CQ HealthBeat, 4/13).

Reaction
"Today women and girls represent more than half of those infected with HIV worldwide," Jodi Jacobson, executive director of the Center for Health and Gender Equity, said, adding, "Yet the Bush administration is actively dismantling effective prevention programs in the very places where women and girls are most at risk. It is time we realize that marriage is not a protective factor against HIV, ... a fact that PEPFAR ignores" (CHANGE release, 4/13). Anita Smith, president of the Children's AIDS Fund, said, "Americans don't realize what an impact our dollars are having on the ground thanks to the President's Emergency Plan. We are so used to the grinding slowness of government action in this country that we don't understand how immediate the impact can be of a program like this. ... We applaud [U.S. Ambassador Randall] Tobias and his staff in their efforts to jump start this massive program in a way that has yielded significant and tangible results" (CAF release, 4/13).

Waxman Letter
In related news, Rep. Henry Waxman (D-Calif.) on Wednesday sent a letter to the Department of Justice opposing a Bush administration policy requiring U.S. HIV/AIDS organizations seeking funding to provide services in other countries to make a pledge opposing commercial sex work (CQ HealthBeat, 4/13). Under the policy, even groups whose HIV/AIDS work in other countries has nothing to do with commercial sex workers will have to make a written pledge opposing commercial sex work or risk losing federal funding. In addition, the Bush administration might refuse to fund HIV/AIDS groups that do not accept Bush's agenda on issues such as sexual abstinence (Kaiser Daily HIV/AIDS Report, 2/28). "It would be easy to demonize anyone who complains about the administration's new policy as a 'supporter of prostitution,'" Waxman wrote, adding, "But the fact that prostitution is a dangerous practice does not make the new policy right." He added that the policy also limits constitutional free speech rights, according to CQ HealthBeat. Although the federal government has the right to limit how organizations use federal money, "what is new is the decision by the administration to require American organizations to adopt a policy explicitly opposing prostitution as a condition of receiving a grant," the letter said, adding, "Until now, the free-speech provisions of the U.S. Constitution have been understood as prohibiting the government from requiring American organizations to sign pledges to support specific government policies. Once a precedent is established, a variety of unconstitutional speech restrictions and policy requirements on U.S. organizations may follow" (CQ HealthBeat, 4/13).