HIV :: IOM’s concerns about President Bush’s HIV Prevention Strategy

A new report released by the Institute of Medicine (IOM) shows that the fight against AIDS is being undermined by the requirement that most US funding to address sexual transmission of HIV go to abstinence-until-marriage programs.

The report states that the requirement greatly limits the ability of countries to respond to local needs.

To fix this dangerous flaw in the US approach to global AIDS, a bill was introduced this week in Congress that would lift the funding restriction.

The PATHWAY Act, introduced by Rep. Barbara Lee (D-CA) and Rep. Chris Shays (R-CT), would eliminate the abstinence-until-marriage funding requirement, fulfilling a primary recommendation of the IOM report. The bill would also require a comprehensive strategy for responding to the particular vulnerabilities of women and girls to HIV infection. This vulnerability was also highlighted in the IOM report, which stated that the US global AIDS program must increase its emphasis on interventions that this population.

“This is a must-pass bill for the new Congress,” said Dr. Paul Zeitz. “We have to ensure that US AIDS policy is grounded in scientific evidence, and is doing what we know works. The Institute of Medicine’s report showed that this funding requirement is undermining the success of the whole AIDS program. That’s why this bill is so critically important.”

The HIV virus is primarily spread through sexual activity. The US approach in this area is thus crucial to success in the fight against the pandemic. While most US funding to address AIDS is financing treatment, a significant portion is going toward sexual prevention programs. The funding requirement results in two-thirds of the budget for sexual prevention going toward abstinence-until-marriage programs, even though these programs have not been shown to be effective.

In addition, the funding requirement does not reflect the reality that women and girls are increasing infected with HIV, and yet frequently do not have full control of their sexual choices. The IOM report demonstrates that, if the US government is to meet its HIV/AIDS prevention and treatment targets, women and girls must be given more support in AIDS programs and countries must have greater flexibility in designing programs to meet their needs.

“This funding requirement distorts not only the US response to AIDS,” said Zeitz. “Because of the tremendous influence of US policy in this area, it also leads governments to modify their own programs in order to show they are in sync with US wishes. It has given a green light to religious conservatives to push policies that stigmatize sexuality and deprive people at risk of the information, training, and products, such as condoms, that they need to survive. The PATHWAY Act does not say abstinence and faithfulness will never be promoted, only that US-supported country programs will have the flexibility they need to implement the most successful strategy.”

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