SIECUS today releases our 2008 PEPFAR Country Profile Updates.  Designed to supplement the original 2005 PEPFAR Country Profiles, these updates together track the impact and progress of the prevention components in the President's Emergency Plan for AIDS Relief, or PEPFAR, in the 15 designated "focus countries" around the world. 

There is no doubt that PEPFAR provides assistance for care and treatment in countries most devastated by the HIV/AIDS pandemic.  But that admission does not require us to turn a blind eye toward its destruction of a comprehensive prevention agenda - the third part of the emergency response - in the focus countries.  

When PEPFAR was reauthorized earlier this year, the popular press and advocates of a "more money whatever the cost" approach failed to recognize what our new updates continue to show: the ideological underpinnings in PEPFAR's prevention portfolio stand in the way of a good program from being a great program. 

The various restrictions and limitations in PEPFAR's prevention portfolio are well known to many, and include the disproportionate emphasis on Abstinence-only and "Be-faithful" programs (AB) while downplaying the importance of correct and consistent condom use (C).  The original law also required 1/3 of prevention funding to go to AB programs while the reauthorized law strongly suggests focus countries not to fall below a 50% threshold for AB. 

The impact of this particular silliness is entirely serious on the ground.  

Tanzania is a disturbing example.  Just over 6% of people ages 15- 49 in Tanzania are HIV-positive and about 80% of infections occur through heterosexual sex.  The country's own strategy, laid out in what is known as their National Multi-Sectoral Strategic Framework, embraces a comprehensive approach to prevention and recognizes the key role of condoms.  (And, just so it's clear that they have their work cut out for them, only about 40% of males and 45% of females in Tanzania could correctly indentify ways to prevent HIV transmission and reject misconceptions about how the virus is spread.) 

Nonetheless, in responding to Tanzania's epidemic, PEPFAR prevention funding misses the mark.  According to the country's operational plan for 2007, a total of 25 programs received funding, but only three of these were reported to be promoting correct and consistent condom use.  Making matters still worse, one of these reported that it only reached 70 people (in a country of more than 38 million people). 

A similar disconnectedness can be observed in Botswana.  Botswana is, a country with an HIV prevalence of nearly 24% (the second highest in the world), and while 25 organizations received PEPFAR funding to prevent sexual transmission of HIV in 2007, only two promoted correct and consistent condom use. 

Botswana also exemplifies the open-door policy of PEPFAR to faith-based organizations that allows them to withhold any information they deem contrary to faith teachings.  So who is getting PEPFAR funding in Botswana?  True Love Waits - a program whose central pillar is a virginity pledge that has been disproved as an effective intervention.  Moreover, this particular program instructs people that safe sex is wrong and that condoms have defects in them.  This, in a country where nearly one in four people carry the virus. True Love Waits also received PEPFAR funding in Kenya and in South Africa. 

There is additional, disturbing evidence about what certain faith-based grantees are doing with U.S. tax-payer money.  For example, in South Africa, a country with about 18% HIV prevalence, one grantee, called Scripture Union, describes its vision "to introduce young people to Jesus" and ensure a "commitment to Jesus and also to abstinence, whichever comes first."  To be sure, this is a missionary organization that uses PEPFAR funding to proselytize and, in 2007, they received nearly $1 million of U.S. money to do that. 

These are just a few of the issues that surfaced in our extensive research and lead us to offer seven policy recommendations.  We call for: 1) an end to disproportionate emphasis for ineffective abstinence-only programs; 2) increased transparency of how funds are actually being used; 3) increased oversight to combat proselytizing, to prevent faith-based organizations from exempting themselves from discussing information on condoms/contraception, and to review the influence of the U.S. government in the development of country plans on prevention; 4) an end to the war on prevention efforts for sex workers; 5) increased focus on integration of HIV/AIDS and reproductive health care services; 6) increased investment in indigenous prevention program providers; and 7) an end to legalized discrimination in the program that allows grantees to deny care, treatment and prevention services to whomever they choose based on moral beliefs.  

The 2008 Updates contain much useful information, but what was so striking to us at SIECUS was one consistent theme that emerged in nearly every country: the way in which the HIV epidemic targets the most vulnerable members of society.  In country after country, young women, commercial sex workers, injecting drug users, and men who have sex with men disproportionately suffer from the HIV/AIDS.  These are the people who are most in need of help and medical interventions, but who often slip through the cracks.  As we face the challenges of reaching out to traditionally underserved communities, we need PEPFAR to be more open and less blindly moralistic in the way it distributes its resources. 

SIECUS has developed updates for all 15 of the focus countries: Botswana, Côte d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Viet Nam, and Zambia. 

To see both the 2008 PEPFAR Country Profile Updates and the 2005 PEPFAR Country Profiles, go to www.siecus.org/countryprofiles.