Simple Steps to Effective Prevention: Groups Call on Obama Administration to Revise Global AIDS Policies

A coalition of leading reproductive and sexual health advocacy groups and U.S. government-funded program implementers has drafted recommendations on effective strategies for preventing HIV infection worldwide and submitted these to the Obama transition team.

The recommendations focus on the full range of concerns within HIV prevention and include specific steps that can be taken early in the Obama Administration to fix persistent and literally fatal flaws in U.S. global AIDS policy.  In addition, the recommendations, part of a broader document also endorsed by many treatment access groups, call for changes in policies that undermine primary sexual and reproductive health care overall, such as an executive order rescinding the global gag rule.  Not yet posted to the change.gov website, the full range of prevention recommendations are now on RH Reality Check.

Earlier this year, Congress passed the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008.  The bill--which authorizes spending of $50 billion on global AIDS programs through 2013--resulted in several important steps forward on prevention of HIV transmission, including explicit support for programs to reduce HIV transmission among men who have sex with men and dramatically increased funding for prevention of maternal-to-child transmission.  At the same time, however, restrictions found in earlier global AIDS legislation stayed put.  These include minimum funding requirements for abstinence-until-marriage programs, the “prostitution pledge,” and de facto policies limiting U.S. support of proven strategies for reducing transmission among intravenous drug users.   These restrictions have been widely criticized: Both the Government Accountability Office and the Institutes of Medicine, for example, found that ab-only programs were undermining comprehensive approaches to prevention of sexual transmission.  After the new bill passed, the Office of the Global AIDS Coordinator took another step and published guidance prohibiting the purchase of contraceptives with global AIDS funding, even for HIV positive women who wanted to avoid unintended pregnancy, despite calls by the World Health Organization and other bodies to increase access to family planning as an integral part of HIV prevention.

Obama can take immediate steps to counter these restrictions without waiting for changes in law by allowing funds to be spent on integration of HIV prevention with other sexual and reproductive health services, providing more flexible interpretation of the restrictions on comprehensive programs and limiting the scope of the prostitution pledge.

In short, while the law should be changed, the new Administration can and must take immediate steps to strengthen HIV prevention worldwide by interpreting policies to promote both public health and human rights.  Given the amount of money at stake, and the political opposition to comprehensive, rights-based approaches, advocates must be vigilant in making sure these changes are carried out…and can start by commenting here!

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