Some Congressional Democrats Appear Reluctant To Enter Debate Over PEPFAR’s Abstinence Funding Requirements, Wall Street Journal Reports

Some Democratic leaders in Congress are showing "signs" that they are reluctant to enter the debate over the President's Emergency Plan for AIDS Relief's abstinence spending requirements, the Wall Street Journal reports (Phillips, Wall Street Journal, 5/21). By law, at least one-third of HIV prevention funds that focus countries receive through PEPFAR must be used for abstinence-until-marriage programs (Kaiser Daily HIV/AIDS Report, 4/2).

Some HIV/AIDS advocates are calling on Democratic lawmakers to repeal the abstinence requirement in the upcoming foreign-aid spending bill, while supporters of the requirements are lobbying against the change, the Journal reports. According to the Journal, Democratic lawmakers "seem likely to push the issue off until later this year or even next year," when Congress is scheduled to reauthorize PEPFAR. The delay could mean that "any relaxation" in HIV/AIDS funding requirements might not take effect until 2009 or 2010, the Journal reports.

Some advocates who oppose the abstinence spending requirements say that the rule diverts money from programs that promote condom use and provide access to antiretroviral drugs and HIV/AIDS care. Although "Democrats have the power to do the right thing," they "don't seem to be willing to do it," Jodi Jacobson -- executive director of the Center for Health and Gender Equity, a group that is leading efforts to repeal the spending requirements -- said, adding, "What is the point in being in the majority if you can't take action?"

Opponents of the spending requirement also have pointed to recent studies, including an Institute of Medicine report that found congressional provisions about how to spend HIV/AIDS money hinders health professionals in the field. Another study, commissioned by HHS, found that abstinence-only programs in the U.S. have not impacted young people's sexual behavior.

Supporters of the spending requirement say that without it, programs promoting abstinence until marriage and fidelity would not receive adequate resources. "Over time, we probably won't need (the provision), but for now, we still do," Ambassador Mark Dybul, who serves as the U.S. global AIDS coordinator and administers PEPFAR, said. Other supporters have cited Uganda as an example of a country that has successfully reduced its HIV/AIDS prevalence by promoting abstinence and fidelity. Stephen Colecchi -- director of the Office of International Justice and Peace at the U.S. Conference of Catholic Bishops, which supports abstinence programs -- said that in this case, "the morally right thing is also the efficacious approach."

According to the Journal, HIV/AIDS advocates have some "well-placed allies" in Congress, including Sen. Dianne Feinstein (D-Calif.) and Rep. Barbara Lee (D-Calif.), members of the Senate Appropriations Committee and House Appropriations Committee, respectively. Feinstein has said that the requirement is "squeezing out" available funding for other HIV prevention efforts, such as those aimed at preventing mother-to-child HIV transmission and maintaining a healthy blood supply. Lee also has introduced a bill that would eliminate the abstinence requirement.

An unnamed White House spokesperson declined to say whether President Bush would veto legislation that relaxes abstinence spending requirements but added that the administration would "certainly fight to maintain a balanced approach" to HIV prevention funds. Some advocates also are calling for the repeal of a U.S. policy that requires recipients of federal HIV/AIDS service grants to pledge to oppose commercial sex work, the Journal reports (Wall Street Journal, 5/21).