White House's global anti-AIDS program has roadblocks, report says

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4/5/2006

The Bush administration's emphasis on AIDS programs that advocate saying no to sex until marriage represents a stumbling block to the global AIDS response, congressional investigators reported Tuesday.
Though advocates praise the five-year, $15 billion President's Emergency Plan for AIDS Relief for allowing them to attack the disease "head on," the report says rules for how the money is spent sometimes make it hard for AIDS workers to meet local needs.

How the money is spent isn't just a matter of political debate. Each day, more than 13,000 people worldwide are infected with HIV, the report says. During the past two decades, more than 20 million people have died.

The U.S. government plans to spend $332 million on HIV prevention in 2006, up from $207 million in 2004, in 15 countries in Africa, Asia and the Caribbean. One-third must be spent on programs that promote abstinence, approaches that some public health experts say haven't been proven effective.

"Some countries have had to cut programs that prevent mother-to-infant HIV transmission to meet the abstinence-only provisions. That's shocking because mother-to-infant prevention programs work," says Rep. Henry Waxman, D-Calif., one of several legislators who requested the investigation by Congress' non-partisan watchdog agency, the General Accounting Office.

The Bush administration's approach is officially called ABC: Abstinence before marriage, Be faithful in marriage and Condoms for high-risk groups. But the administration has placed restrictions on how money is spent, and the guidance that lays out those restrictions is confusing, the report says.

The rules limit spending for efforts to promote condom use among young people, who account for an increasing share of new HIV infections. The money can be used only to promote condoms to high-risk groups, including sex workers, drug users and couples in which one partner is HIV-positive.

Heather Boonstra of the Guttmacher Institute, a reproductive rights advocacy group, says the Bush plan gives health workers "an opportunity to fight this epidemic," but "the rules that have been superimposed on this (program) by social conservatives give the U.S. government less flexibility to respond to public health needs."

Sen. Dianne Feinstein, D-Calif., said in a statement that she plans to introduce a bill that, if it passed, would ensure that countries receiving U.S. money to fight AIDS would get more flexibility.

James Wagoner of Advocates for Youth says, "I don't think a reasonable person can stand on the sideline any longer and say abstinence-only policies allow us to deploy every tool we have for HIV prevention."

The report drew an angry response from Rep. Mark Souder, R-Ind., chairman of the House subcommittee that oversees public health. He called it "incompetent" and "possibly biased."

Mark Dybul, deputy director of the Office of the Global AIDS Coordinator, which administers the plan, counters that the report endorses the administration's emphasis on the ABC approach.

He says the complaints in the GAO report stem mostly from spending shortfalls resulting from Congress' decision to supply $527 million less than the president requested for his 15 focus countries.

"There's no science backing the 33% abstinence quota," Waxman counters. "We should leave funding decisions to officials working in these countries."



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