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Will Congress Do More for HIV Prevention?

WASHINGTON, March 28 /PRNewswire-USNewswire/ -- With the full House and Senate poised to vote on the President's Emergency Plan for AIDS Relief (PEPFAR) reauthorization bill, a five-year, $50 billion initiative to combat HIV/AIDS, tuberculosis and malaria worldwide, Congress must address the critical HIV prevention shortfalls in the bill.

Progress has been made on expanding access to anti-retroviral drugs (ARVs) since PEPFAR was enacted in 2003. Today, nearly two million more people have access to anti-retroviral medication than five years ago due to U.S. government support. However, some 2.5 million women, men, and children will become newly infected with HIV this year alone--more than the total number of those put on treatment in the past five years of PEPFAR.

Sexual transmission is the single greatest cause of new infections worldwide and is responsible for 80 percent of new infections annually in sub-Saharan Africa. The highest rates of new infections are among women and youth. Ending this pandemic requires that we use every tool available to enable people to protect themselves from infection.

The funding PEPFAR provides for HIV/AIDS is the largest international initiative ever dedicated to a single disease. PEPFAR must invest in strategies that prevent as many infections as possible because it is the right thing to do, and the fiscally responsible approach: According to a 2006 analysis by Science Magazine, preventing each new infection saves a total of $4,700 in foregone treatment and care costs.

Much has been learned from evidence gathered in the first five years of PEPFAR, yet the bills now before Congress continue to reflect ideology and political expediency over proven approaches to saving lives. Ignoring those lessons wastes public resources, leaves more lives at risk and impedes development of a truly sustainable approach to HIV and AIDS. For these reasons, the following changes should be made to the reauthorization bills (HR 5501 and S 2731) currently under consideration.

-- Support proven prevention strategies that reach the largest number of people. Infections are growing most rapidly among women and adolescents. These two groups are more likely to use family planning and other reproductive health services than any other segment of the population.

* The Senate version of the bill neglects to call for HIV prevention education and testing to be linked with family planning services -- and the House bill includes new restrictions limiting which family planning service providers can partner with PEPFAR to provide HIV prevention services. This stands in the way of effective and efficient health care services.

-- Remove the bill's so-called "balanced funding" provision: Currently PEPFAR requires that 33% of all prevention funds be spent on abstinence-until marriage programs. The House and Senate bills replace this "hard" earmark with a new stipulation requiring that programs spending less than 50% of funding for prevention of sexual transmission on "behavior change" -- defined as abstinence, delay of sexual debut, monogamy and fidelity -- must justify their strategies in reports to Congress.

* Every individual needs a range of education and services to be able to protect him or herself against HIV -- arbitrary spending guidelines from Congress stand in the way of achieving this. In reviewing PEPFAR programs, the Institute of Medicine underscored this when it stated that "by requiring the country teams to isolate funding for these activities [abstinence], this budget allocation has undermined the teams' ability to integrate prevention programming." Public health experts on the ground must be able to determine the best mix of prevention programming. As it stands, their hands are tied by mandates from Washington.

-- Enact World Health Organization and USAID Recommendations to prevent mother-to-child transmission. The World Health Organization recommends that women seeking treatment to prevent maternal-to-child transmission (PMTCT) should have access to voluntary family planning information and commodities should they choose to prevent another pregnancy. Studies have revealed high rates of unintended pregnancy among HIV positive women in PMTCT clinics. In Uganda, for example, 93 percent of women seeking PMTCT services reported they were experiencing an unintended pregnancy. A similar study in South Africa revealed that 84 percent of the pregnancies in three PMTCT programs in South Africa were unintended.

* The US government itself asserts that integrating family planning services could double the effectiveness of programs that prevent the transmission of HIV from mother to infants, yet only 11 percent of pregnant women who would benefit from treatment to prevent PMTCT have access to such services. Despite this evidence, and the clear need for information and services, neither the House nor Senate bills support funding for these health care services.

-- Eliminate the prostitution pledge. The 2003 PEPFAR legislation requires groups fighting HIV/AIDS overseas to pledge their opposition to prostitution and sex trafficking before receiving U.S. money. Sex workers are among the most marginalized people in every country and often lack access to social and health support systems. Prevention programs that have reached sex workers through first building trust have yielded dramatic reductions in HIV infections among these populations. For example, a 1991 study of 1,000 sex workers in Nairobi found that a prevention program stressing condom use and education was able to prevent between 8,000 and 10,000 new cases of HIV infection per year at a very low cost.

* Congress seems to think that having organizations sign such a pledge will help contribute to ending prostitution, but in reality the opposite may be true. According to numerous reports, the pledge has led to further alienation of already-stigmatized groups and given free rein to police and resulted in further discrimination against women in sex work. Instead of reducing dependence on sex work, the policy is driving sex workers underground and away from the NGOs and health workers best poised to help them.

It is our duty to use PEPFAR funding to prevent as many infections as possible. However, large sums of money, spent unwisely, will not stem the rapid spread of HIV and will require an ever growing need for increased resources in the future. The bills fall short exactly where more was needed: full and flexible funding of prevention programs that will enable us to end the pandemic.

The fact that HIV/AIDS is primarily a sexually transmitted infection makes addressing it in the U.S. political context challenging. But true U.S. leadership in this area would enable best health practice to prevail over ideology and save countless lives.

To arrange an interview or for more information, contact:

American Jewish World Service (

Contact: Jodi Jacobson, 301 257-7897/202 408-1380 office

Artists for a New South Africa (

Contact: Sharon Gelman, 310. 204. 1748

Center for Health and Gender Equity (

Contact: Serra Sippel, 301.270.1182/ 301.768.7162

International Women's Health Coalition (

Contact: Kelly Castagnaro, 212.979.8500/646.707.1004

SOURCE American Jewish World Service
Copyright©2008 PR Newswire.
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