By Scott Blaine Swenson
Americans need look no farther than the reauthorization of the President’s Emergency Plan for AIDS Relief (PEPFAR) to understand why fundamental change is needed in Washington. The good intentions of American taxpayers extending a helping hand to Africans ravaged by AIDS are caught between Republican ideologues and complicit Democrats avoiding a fight on issues at the center of efforts to combat AIDS; sexual and reproductive health.
PEPFAR’s mission was compromised by the House Foreign Affairs Committee because they cannot honestly discuss sexual reproductive health. Once Republican ideologues invoke abortion, which has nothing to do with PEPFAR, problem solving is lost to politics.
For 25 years social conservatives ignored AIDS, using it to marginalize people and allowing the disease to run rampant. Now rigid ideology prevents them from allowing public health experts to use proven scientific methods to educate, prevent and treat. Democrats who compromise are politically complicit.
Ignoring objective analyses and recommendations based on PEPFAR’s first five years from the Institute of Medicine, General Accounting Office, Center for Public Integrity and others, the current proposal fails to ensure the increased funds are spent wisely. Congress will spend more without listening to proven public health strategies.
The good news is the White House has agreed to Congress’ request for $50 billion, over five-years, up from $30 billion President Bush requested. More money is good, but more money spent wisely, based on reality is better.
The new proposal includes efforts to address unique circumstances that women, girls and youth face, including efforts to confront violence against women, promoting property and inheritance rights, expanding economic opportunity to promote financial independence, and efforts to work with men and boys to reinforce positive attitudes and the rights of women. Women in Africa have less ability to negotiate sex, are often married young, and exposed to HIV often through marriage.
Other positive changes include increased training of health care professionals and support for nutrition programs.
Now for the bad news:
Republicans continue to push abstinence-only policies that major studies on PEPFAR indicate impede program effectiveness. An earmark insisting 33 percent of funds be spent on abstinence is gone. But in its place is a requirement that 50 percent of funds for preventing sexual transmission be spent on “behavior change,” defined as abstinence, delay of sexual debut, monogamy and fidelity. The tone of the new requirement suggests that abstinence-only programming is preferred. The proposal requires local public health officials to report noncompliance. Congressional micro-management like this perpetuates failed abstinence-only policies and politicizes a program that should be based on scientific evidence, not ideology.