Nearly a year ago, Obama lifted the “global gag rule,” which prohibited the US from funding any organizations that provide or “promote” abortions. This move, combined with Obama’s appointment of Eric Goosby to the position of Global AIDS Coordinator and Ambassador-at-Large, signaled that the US government was becoming less conservative in its approach to fighting the AIDS pandemic. These changes gave many hope that the government might soon eliminate its “ABC Policy” and “anti-prostitution pledge” funding requirement. Unfortunately, neither has been eliminated.
The Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (which was approved in March 2008, long before Obama’s election, and which provides funding through the 2013 Fiscal Year) amended the original 2003 PEPFAR law, which required that at least 33% of all funds being put towards prevention efforts be spent on abstinence-until-marriage programs.[i] The 2008 law instead required that the Global AIDS Coordinator send an explanatory report to Congress within 30 days should less than 50% of US prevention funds be spent on “activities promoting abstinence, delay of sexual debut, monogamy, fidelity, and partner reduction.”[ii]
Though Goosby, in his executive summary of Obama’s five-year PEPFAR strategy, indicated that only evidence-based programs would be implemented going forward, the ABC approach to prevention is still considered the standard. According to the PEPFAR website: “PEPFAR supports the most comprehensive, evidence-based prevention program in the world, targeting interventions based on the epidemiology of HIV infection in each country. These include reducing sexual transmission with the ABC Strategy (Abstain, Be Faithful, correct and consistent use of Condoms), the prevention of mother-to-child transmission, the transmission of HIV through unsafe blood and medial injections, and male circumcision.”[iii]
As of December 8, 2009, Goosby had not given any definitive answers about the extent to which abstinence would be emphasized in practice or how condoms would be distributed to patients in religious hospitals that refuse to distribute them [iv]. The 2008 PEPFAR law states that “an organization, including a faith-based organization, that is otherwise eligible to receive assistance…shall not be required, as a condition of receiving such assistance—(A) to endorse or utilize a multisectoral or comprehensive approach to combating HIV/AIDS; or (B) to endorse, utilize, make a referral to, become integrated with, or otherwise participate in any program or activity to which the organization has a religious or moral objection.” [iii]
Goosby has, however, suggested that the ABC model may eventually be reworked and that the Obama Administration may be more flexible than the Bush Administration when it comes to funding non-abstinence-only/abstinence-first programs. At a December 4, 2009 town hall discussion with the Kaiser Family Foundation, Goosby was asked about how abstinence-first/abstinence-only policies would be better communicated to people working in the field. He responded: “We’re about to go into a dialogue with the field around the entire framework and through that very quickly, we will identify the need for specific guidance. Clearly this will be an area that we’ll need specific guidance, yeah.'” [v]
To summarize, the Obama administration has signaled its intention to move towards a more evidence-based approach to fighting HIV/AIDS, and this is certainly a positive change. However, both the ABC approach to prevention and the anti-prostitution pledge funding limitation remain on the books. To truly emphasize condom distribution, Goosby will be required to submit a report justifying any decisions to spend less than 50% of prevention funds on “AB” programs (which it is not clear he will). To eliminate the anti-prostitution pledge requirement, the law itself will need to be changed. There is no indication that this will happen any time soon.
[ii] http://www.pepfar.gov/documents/organization/108294.pdf
[iii] http://www.pepfar.gov/about/c19387.htm
[iv] http://www.nytimes.com/2009/12/09/health/policy/09aids.html
[v] http://globalhealth.kff.org/~/media/Images/KGH%20Home/120409_TownHall_Transcript.pdf
