International Groups Press for Changes to President’s AIDS Program

As Congress prepares this year to extend President Bush’s multibillion-dollar global HIV/AIDS program, international aid groups are asking lawmakers to scrap several provisions of the program that they say hinder their work.

The five-year, $15-billion program — known as the President’s Emergency Plan for AIDS Relief, or Pepfar — has been praised for significantly increasing U.S. government spending on the HIV epidemic overseas. But two requirements of the program have sparked particular criticism from some AIDS practitioners.

A stipulation that one-third of money for prevention programs be spent on teaching abstinence, even in areas where the disease is spread primarily by drug users or by people who have multiple sexual partners, has drawn fire.

Charities say there should be more flexibility on how money can be spent. “We think the evidence points to getting rid of the earmark and allowing folks on the ground to determine how to allocate funds,” said Jennie Quick, governmental affairs manager with Population Services International.

Abstinence may be an appropriate message for youth, she said, but people who are already having sex might benefit more from learning about condom use or fidelity.

Aid groups are also seeking to eliminate a pledge disavowing prostitution that they must sign to receive government grants. The pledge, charities say, has had a chilling effect on HIV/AIDS work.

“It has led to groups censoring themselves,” said Jodi Jacobson, director of advocacy with American Jewish World Service. “They aren’t doing the kinds of work they might otherwise be doing because they’re afraid they’ll be de-funded.”

Ms. Jacobson cited a case in Bangladesh where 20 “drop-in centers” that provide job training, child care, and other services to sex workers were closed when a grant maker — an intermediary agency that regranted money to these drop-in centers — withdrew support out of fear that it would lose U.S. government funds.

The anti-prostitution pledge has been challenged in court by charities on at least two occasions since it was introduced in 2003.

Last year, DKT International, in Washington, lost a bid to eliminate the provision after a federal appeals court decided that compelling charities to sign the pledge did not violate First Amendment rights. A second case, involving Open Society Institute, is still pending in a New York court.

Legislation to reauthorize Pepfar is expected to be introduced in the House of Representatives next month. In addition to pushing for specific changes in the legislation, charities are hopeful that they’ll see an overall increase in spending.

Congress is expected to commit at least $30-billion over the next five years to the program. But many nonprofit groups say that $50-billion is needed to effectively fight the disease.

They are also hopeful that areas such as prevention and family planning will receive additional support.

But perhaps most important, they say, is that legislators use data, rather than ideology, to shape the program.

“If we’re going to be spending $50-billion in trying to fight an epidemic, we ought to be doing so in ways that are evidence-based and are shown to be highly effective,” said Ms. Jacobson.