While Bush’s AIDS initiative undoubtedly made great strides in the 12 African target countries, PEPFAR did not come without stipulations.
The foundation of PEPFAR’s prevention programs is ABC—Abstain, Be faithful, and use Condoms. Of the 20% of PEPFAR funds allocated for prevention programs, one third of the money must be spent on abstinence until marriage programs. However, some say that for every dollar that was spent on condom programs, two were spent on abstinence and faithfulness programs. It is often thought that ABC was the order of importance assigned, with abstinence given the most funding and condoms the least.
Furthermore, organizations that receive PEPFAR funds are forced to sign documents saying that they will oppose sex workers and abortion. While this ideal is ethically steadfast, this causes organizations to turn their backs on those who need the most outreach and support. It is for this reason that Brazil refused funds marked with this clause.
The abstinence strategy has been widely criticized by those who say that PEPFAR is far too determined by ideology, rather than driven by strategies that are proven to produce the most success. Republican leaders promote abstinence, having claimed that condom distribution endorses premarital sex. Yet a 2006 study by the World Health Organization found “little evidence of the effectiveness of abstinence-only programs in developing countries.”
One health expert has said, “The directives made in the United States look ridiculous to the world. It was like, ‘There they go again—being generous on the one hand and then earmarking dictates on the other.’”
While no initiative will be perfect, it is important that future policymakers focus on what is the best for the people they are trying to help, rather than simply pushing their own ideologies and making PEPFAR less effective.
Click here for a slideshow showing AIDS prevention efforts.