According to a new report issued by the U.S. Government Accountability Office (GAO), the U.S. approach to AIDS prevention is essentially unworkable.
At present the State Department deems that two-thirds of funding devoted to preventing sexual transmission of AIDS must be spent on programs that encourage abstinence and fidelity.
The report says that in order to comply with that requirement, agencies in Africa and the Caribbean have been forced to reduce funding for programs that meet the needs of sexually active youth, truckers, sex workers, and couples in which one partner is negative and the other is positive.
The GAO conducted a full survey of the seventeen country teams in charge of implementing the U.S. program in Africa and other regions.
Ten of these teams found that satisfying the requirement would force cutting back on essential programs, including Prevention of Mother to Child Transmission (PMTCT).
These teams requested, and received, exemptions.
The remaining seven country programs also cited potential cuts in PMTCT and other services, but they did not qualify for exemptions.
As a result, says the report, the State Department effectively required these seven teams to spend more than 33% of their prevention funds on abstinence and fidelity programs and spending on other kinds of programs declined.
Many have expressed concern about the level of information on condom use presented within programs that promote abstinence and fidelity and say they found the policy "ambiguous and confusing".
The GAO report states that eight of the seventeen country programs have found that the policy "compromises the integration of their programs", and recommends that Congress "assess the extent to which the spending requirement supports both the Leadership Act's endorsement of the ABC model programs -- abstain, be faithful or use a condom and abstinence-until-marriage programs".
Dr. Paul Zeitz, Executive Director of the Global AIDS Alliance, says the report confirms what has been said all along and echoes the deep concern expressed about with the policy from the European Union, UN officials, African experts, religious organizations and others.
Zeitz says lives are in the balance, and Congress must amend the policy.
In October 2003, the Senate considered an amendment that would have made the requirement more flexible, by allowing programs that simply place a "priority emphasis" on refraining from sexual activity before marriage to receive funds, but pressure from Randall Tobias, then the U.S. Global AIDS Coordinator and now the head of USAID, ensured the amendment was narrowly rejected.
Zeitz says messages promoting abstinence and fidelity have a place in a comprehensive strategy, and condoms are not the only solution to AIDS, but, the current U.S. approach is far from the 'balanced, effective' policy promised by President Bush.
The Bush policy on AIDS prevention he says is unworkable and is essentially doing more harm than good.
President Bush, encouraged by Senator Jesse Helms, first launched an AIDS initiative in 2002, when he proposed new funding for programs to stop transmission of the virus from mother to child (PMTCT).
Ironically, the GAO report shows that progress in this area is being sacrificed to meet the U.S. demand for spending on abstinence and fidelity.
The United Nations estimates the global HIV/AIDS pandemic infects more than 30 million people in Africa.
The disease has killed at least 20 million worldwide.
The reduction in funding for the programs other than abstinence and fidelity programs took place even as overall funding for the U.S. bilateral AIDS program was being massively increased.
For the period the GAO studied, Congress approved 95% of the funding the President had requested for U.S. bilateral AIDS programs.
The Report is posted online at: http://www.globalaidsalliance.org/docs/GAO_Report_April_2006.pdf