AIDS Alert International: Group of journalists say PEPFAR is too inefficient and political
AIDS Alert International
Group of journalists say PEPFAR is too inefficient and political
Money goes to favored religious organizations
The President's Emergency Plan for AIDS Relief (PEPFAR) has resulted in $15 billion to be spent in 15 focus countries, with smaller amounts going to more than 100 other countries. While widely lauded as a compassionate governmental response to the global epidemic, a public interest watchdog group charges that the money has been funneled to organizations and nations based on politics — not need — and that it's been spent inefficiently.
The Center for Public Integrity of Washington, DC, claims that PEPFAR restricts, rather than empower, local governments, and that it sends millions of dollars to Christian faith-based organizations that support President Bush's ideology and form his political base.
The Center for Public Integrity consists of more than 100 journalists in 50 different countries. They are on the ground reporting and talking with HIV patients, nurses, and doctors, says Marina Walker Guevara, a writer/researcher for the Center.
"We follow money and politics," Guevara says. "Fifteen billion dollars is a lot of money, so that's why we decided to look into the programs and follow the money to see who was getting it."
More importantly, the journalists looked at how the PEPFAR funds were perceived by people who worked with HIV patients around the globe, she adds.
One of the chief restrictions PEPFAR places on recipient countries is what's called the Anti-prostitution Loyalty Oath, which asks organizations requesting funding to document that they will oppose the prostitution industry, says Sheetal Doshi, a writer/researcher for the Center.
"This creates problems for organizations that work directly with that group of people," Doshi says.
For example, an organization called SANGRAM in India works hard at HIV prevention among sex workers. SANGRAM distributes information about the disease, holding clinics for their clients in which a doctor will give the men a physical exam and prescribe any necessary medication to treat a sexually-transmitted disease, Doshi explains.
Also, the group provides prevention information to truck drivers and other clients of sex workers, encouraging them to use condoms so they won't become infected and then transmit HIV to their wives, Doshi says.
However, because of the group's direct involvement with sex workers, including the use of sex workers as peer counselors, it is unable to receive PEPFAR funding, which would greatly enhance its ability to spread prevention messages, Doshi says.
On the other hand, the Catholic Relief Services receives a large portion of PEPFAR funding in India, and that organization uses the money to provide programs in high schools that promote abstinence and being faithful policies to teen-age girls, Doshi says.
According to the 2006 AIDS epidemic update by the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS), a large proportion of women with HIV were infected by their regular sexual partners, who had been infected by sex workers. About half of the sex workers in Mumbai and Pune, India, are HIV-positive, so the likelihood of their transmitting the virus to truck drivers and other single or married men who purchase their services is high.1
The WHO/UNAIDS report also notes that HIV prevention work that targets sex workers has proven to be effective, particularly those that are run by sex workers.1
Logic would dictate that prevention money be spent where it has the potential to stop HIV transmission, such as among sex workers and their clients, but PEPFAR funding doesn't support these more effective programs, Doshi says.
"By not providing funding for these groups, which can stop the spread of HIV, we're unable to effectively treat the epidemic," Doshi says.
"There's a high risk population that needs to be dealt with in India, and PEPFAR is unable to provide funding for them because PEPFAR is against what they do."
When Doshi asked the Catholic Relief Services country director whether they were targeting any prevention programs at sex workers, the response was that this organization is not meant to deal with certain populations.
"This is a population that has every ability to create change and by denying them funding, we're weakening the fight against HIV by ignoring this target population," Doshi says.
Several United States non-governmental organizations (NGOs) challenged the Anti-prostitution Loyalty Oath in court and in the district courts of New York and Washington, DC, it was found to be in violation of the first amendment, Doshi notes.
"Due to this ruling, directly-funded U.S. groups receiving PEPFAR funding do not have to abide to the restriction," Doshi says. "However, any foreign groups they subcontract are still required to."
The Center's journalists also found that many groups receiving PEPFAR funding use the much-touted ABC prevention method, but they are subtly encouraged to focus more on A for abstinence and B for be faithful, leaving a small amount of funding for C for condom use.
"Some groups told me in Africa that 'We are answering questions about condoms if they arise, but our message is abstinence and fidelity,'" Guevara says. "When you take choice away from people, it's dangerous — they don't have the tools they need to protect themselves."
Some of the groups receiving PEPFAR funds are long-time abstinence promoters and have been assessed as lacking the necessary expertise to provide effective HIV prevention information, according to the Center's report, written by Wendell Rawls, Jr.
Also, the Center's reporters found it difficult to learn why the 15 favored countries achieved that status. It wasn't based on infection rates, as some of the nations with the highest prevalence rates, including Swaziland, Lesotho, and Zimbabwe, are not on the list.
Although India and China have the largest populations and the greatest potential for an explosion of the HIV epidemic in Southeastern Asia, they also are not on the list, which only includes Viet Nam from that region.
"No one could tell us why these 15 countries were selected," says Victoria Kreha, a writer/ researcher for the Center.
"The ones in Africa have high prevalence rates, but not higher than those that were not selected," Kreha says. "In Viet Nam, I was told it was a country where they could make a difference because the country did not have a generalized epidemic, and when compared with India and China, the population is not overwhelming."
But there also are political reasons for the selection of Viet Nam, Kreha says.
"Viet Nam and the U.S. are repairing their relationship, so this is a way to repair a special friendship," Kreha says.
The Center for Public Integrity highlights potential problems with government spending and other issues, but it doesn't take a stand or advocate, Kreha says.
"We don't make recommendations for policies, so while we hope government officials will read our pieces, we don't attach any recommendations to them," she adds. "Our work speaks for itself."
PEPFAR will be up for reauthorization in 2007.
Reference:
- AIDS epidemic update, December 2006. Report from the Joint United Nations Programme on HIV/AIDS and the World Health Organization: 1-96.
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