AIDS Alert International: U.S. officials continue to weaken UN political declaration about HIV/AIDS
AIDS Alert International
U.S. officials continue to weaken UN political declaration about HIV/AIDS
The United States wielded its power at the United Nations' high-level review meeting on HIV/AIDS in early June and weakened a political declaration by opposing the setting of clear targets and time frames for stopping the epidemic, critics say.
"Since the declaration is primarily a political document to promote accountability and government progress in fighting the AIDS epidemic, it's difficult to see how that can effectively be achieved if there are no clear targets or outcomes set," says Rachel Guglielmo, project director for the Public Health Watch of the Open Society Institute in New York, NY.
"The document failed to target the specific groups that we know 25 years into the epidemic are most vulnerable to the disease," Guglielmo adds. (See excerpt from UN declaration.)
These groups include sex workers and injection drug users, who continue to be driving forces for the transmission of HIV in many different parts of the world, she adds.
The document also doesn't mention vulnerable groups, including African Americans in the United States, Guglielmo says.
"The U.S. is a global leader in financing a response to HIV and has very special responsibility in making sure the global response is on track," says Chris Collins, consultant with Open Society Institute in Philadelphia. Guglielmo and Collins attended the review meeting from May 31, 2006 to June 2, 2006. "So it's terribly disappointing to see my own country not leading efforts in assisting vulnerable populations and insisting those are on the document," Collins says.
While the United States sets the tone for international action on the epidemic, it also ensures that little will be done by developing nations without the largest donor's approval.
"In many countries, the domestic resources are minimal," Guglielmo says. "Some receive 90% of their AIDS budget from donors, so donor policies have a disproportionate impact."
So if the President's Emergency Plan for AIDS Relief (PEPFAR) requires a significant portion of funding to be spent on abstinence-only-until-marriage education, then these types of programs will be what crop up, regardless of whether they are a particular country's preference, Guglielmo says.
The problem is the abstinence-only approach has not been shown to prevent HIV or sexually-transmitted diseases (STDs), Collins notes. So even if a developing nation believes the scientific literature would suggest a more comprehensive HIV prevention approach would be better, there's a limit to how much that nation can follow that approach, he says.
Funding restrictions tie hands
Another disconnect with how the U.S. funds other nation's prevention work occurs when the epidemic has spread through injection drug using (IDU) groups, Guglielmo says.
In Vietnam, for example, IDU is a major mode of HIV transmission, and the nation's own policy promotes harm reduction interventions, such as needle exchange, Guglielmo says. "But you can't use PEPFAR money to meet their goals," she adds.
To be successful, HIV prevention efforts should teach women how to negotiate condom use, make condoms available, make clean needles available to IDUs, and encourage abstinence, delaying sexual activity, and reducing number of sexual partners, Collins says.
The UN meeting's weakened action parallels the United States' own failure to set and meet goals and outcomes, Guglielmo notes.
"We haven't done enough to target vulnerable groups in this country, and that's worrisome," she says. "If we're dedicating funding overseas in support of policies that have not been proven effective here in the United States, then we have something to answer for when those policies are not effective internationally."
There also is a disconnect between some of the requirements put on how international HIV money is spent and what is constitutional in the United States, Guglielmo says.
For example, a recent federal court ruling said that it is unconstitutional for the federal government to require groups receiving federal funds to take a pledge opposing prostitution, but the same requirement can be made of international groups receiving U.S. funds, she says.
"The international groups don't have a constitutional basis for protesting the pledge," Guglielmo adds.
The anti-prostitution pledge ties the hands of prevention groups that intend to promote risk reduction measures with sex workers.
At the same time, the positive news is that the United States has greatly increased PEPFAR prevention funding in recent years, from $207 million to $322 million between 2004 and 2006.1
And there are some success stories in prevention work in developing nations, Collins says.
"Incidences appear to be falling in several countries that have constituted comprehensive intervention, while the epidemic is accelerating elsewhere," Collins says.
Reference:
- Global Health, spending requirement presents challenges for allocating prevention funding under the president's emergency plan for AIDS relief. United States Government Accountability Office Report to Congressional Committees. April 2006:1-47.
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