February 29, 2008
RIGHT ON THE MONEY, WRONG ON PREVENTION
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PEPFAR reauthorization not all smiles |
In a bipartisan compromise the House Foreign Services committee approved a draft bill (H.R. 5501) for the reauthorization of the President's Emergency Plan for AIDS Relief (PEPFAR) Wednesday that expands global AIDS funding to $50 billion—the U.S.'s fair share in the fight against HIV/AIDS in Africa—as well as $9 billion to fight tuberculosis and malaria.
Though the bill vastly improves the 2003 initiative, like all compromises, no one's totally happy—particularly reproductive health advocates, who are angered by the bill's ambiguous language regarding HIV prevention, the reinsertion of the heinous "prostitution pledge" and the lack of funding for family planning, and basic health care for women that is an essential part of ending the AIDS epidemic.
"The bill is 100 steps ahead of what the president proposed but 100 steps behind what we need," said Kaytee Riek of Health GAP. "The bill left out evidence-based prevention, and took out anything that could get right-wing extremists angry, and that's not how to make policy."
Although "PEPFAR 2" as the reauthorization is referred to, removes the infamous earmark that one-third of prevention dollars must go to abstinence-only-until-marriage prevention programs—which in actuality had been 56 percent of all sexual prevention dollars — it still has a preference for such programs. It includes unclear language that half of all sexual prevention funding must go to "behavioral change" programs unless the host country issues a report explaining why.
Examples of behavioral change in the bill are "abstinence, delay of sexual debut, monogamy, fidelity, and partner reduction" with no mention of condoms. Women's health advocates say that "behavioral change" is just code for proven-ineffective ab-only prevention and decry the lack of funding for contraceptives and other family planning for women and girls. Reproductive health advocates are working to clarify what this ambiguous language actually means, and what these reports entail.
As with the original incarnation of PEPFAR, funds recipients must also pledge opposition to commercial sex work. The requirement was removed in the bill drafted by Rep. Tom Lantos, who died earlier this month, but was reinserted. "The Congress and the administration conflate prostitution and sex work into sex-trafficking," said Serra Sippel, executive director of Center for Health and Gender Equity (CHANGE). "The political challenge is to get members of Congress to say they support the rights of sex workers without saying they support prostitution and sex trafficking."
"Some unnecessary compromise"
"It's a travesty that some members of Congress are letting women and girls continue to get infected just to make their ideological point," said Adrienne Germain, president of the International Women's Health Coalition. "For every person who goes on treatment, six more people get infected. Drugs may extend life, but basically it is an early death sentence. It is unconscionable for our country not to take every option possible to end this epidemic." Germain said the fight is not over and reproductive health advocates plan to work to improve the Senate version of the bill.
Sippel said there was some unnecessary compromising with the bill, but that reproductive health advocates were fighting on a variety of fronts. "Everybody could have done more, but what happened was the reproductive health language has been diluted. I was very disappointed with the level of compromise," she said. "I wouldn't finger-point in the sense that I think there's only so much all of us can do. There are so many different opinions within the family planning and HIV/AIDS lobby and the Catholic relief services. And then we're up against the Bishop's lobby, and they're strong. But I thought there was going to be more of a fight."
The new PEPFAR appropriation adds 14 Caribbean countries to the 15 African countries already participating, and the bill's goals include, by 2013, preventing 12 million new infections; providing antiretroviral treatment for 3 million people (including 450,000 children); medical and nonmedical care for 12 million (including 5 million orphans); and training at least 140,000 new health-care workers.
Riek says she and others are working to ensure that the health-care workers funded by PEPFAR are trained doctors and nurses, as opposed to community health workers. Another concern is that one-third of the demonstrated treatment need that is promised is actually 4 million people, not 3 million. But ultimately, she said, advocates can push, but in the end it is Congress that has the final say.
"This bill is not perfect, but no compromise ever is," said Howard L. Berman (D-CA), who became acting chairman of the House Foreign Affairs Committee upon the death this month of Tom Lantos (D-CA). The measure is named in honor of Lantos and the late Henry J. Hyde (R-Ill.), who as committee chairman in 2003 helped push the original legislation. The bill is scheduled for a full House vote next week.