WASHINGTON, 30 March: A 15 billion US dollar fund that is the major source of US global AIDS giving should abandon its system of earmarking funding – especially for abstinence-based programs (programmer baseret på seksuel afholdenhed) – according to a new report from the Institutes of Medicine.
– We are recommending Congress to remove budget allocations, said Jaime Sepulveda, chairman of the report committee, Friday, adding: – Having a one-size-fits-all kind of approach is not helping countries to tackle (their) local epidemic.
In 2003, at president Bushs request, Congress established the Presidents Emergency Plan for AIDS Relief (PEPFAR) to distribute 15 billion dollar over five years to 15 of the neediest countries affected by the epidemic.
The authorization requires that 55 percent of funds be spent on treatment, 15 percent on palliative (lindrende) care and 10 percent on children affected by the epidemic. The remaining 20 percent was earmarked for prevention programs, and of those funds, a third must be spent on abstinence-based programs.
The model used for such programs, called ABC, advises individuals to be abstinent until marriage, be faithful to a sex partner, and failing those approaches, use a condom.
While PEPFAR has had many successes, the report says, the budget formula limits countries ability to apply resources where they are most needed, in line with their own anti-AIDS plans.
In some countries, for example, most new AIDS cases are the result of intravenous drug use, while in other countries the most common route of infection is heterosexual sex, said Sepulveda, adding – The same budget allocation format for 15 countries with very different epidemics is not useful.
At the briefing, committee members declined to criticize the abstinence-based funding requirement outright, but they did say that a comprehensive, evidence-based response to the problems faced by individual countries is best.
– In the spectrum of prevention efforts, I think it is advisable to try to cover every angle that an infection can be prevented. The ABC approach is a necessary component, but certainly insufficient in an overall prevention program, Sepulveda noted.
Focus should be put not on types of intervention, but the overall strategy that is best for a country, said James Curran, dean of the Emory University school of public health, and chair of the reports prevention subcommittee. That way, funding is spent “where it can be most effective.”
The report to Congress, mandated by the law that established the fund, came after another report by the Government Accountability Office that found the abstinence-based program requirement limited flexibility in countries receiving funds.
But Mark Dybul, the US global AIDS coordinator, dismissed the notion that the spending rules are hurting anti-AIDS efforts. – Spending directives help direct programs at things that are important. That is how we have used them and interpreted them, he said.
The overall guidelines apply to total PEPFAR spending, not relative spending in individual countries, he said, which means countries are free to determine their own spending ratios as long as their decisions are offset elsewhere.
Calling ABC programs abstinence-only is also a mischaracterization, Dybul said. – “There is no abstinence-only provision. I wish people would stop calling it that. It is abstinence until marriage, noted he.
Others, however, reject the Bush administrations assertion that the spending rules are not interfering with country-level efforts.
– “The prohibition (forbud) on condom education for young people and unilateral emphasis on abstinence has been a major barrier to AIDS prevention, said James Wagoner, president of Advocates for Youth, a group that operates HIV peer-education programs in more than a dozen countries.
– On the ground, it absolutely intimidates grantees around condom use, noted he.
– There are 19 million sexually active young people in the 15 PEPFAR countries and they deserve complete information about all the methods of reducing the risk of HIV infection – including condoms, Wagoner said, adding: – It is a public health disgrace when we are creating a climate of fear around the most effective prevention tool for sexually active young people.
The overall budgetary constraints are also counterproductive, he added, because they complicate groups efforts to get help to those who need it.
– This is not some benevolent theoretical column for money in Washington. This is a barrier on the ground that is doing real harm to real people in real time, he stressed.
The controversy obscured the reports other major recommendation that the fund move from an emergency relief fund to a long-term prevention strategy.
Kilde: The Push Journal
