ABC .... easy as 123?

Last week - I attended the PEPFAR (President's Emergency Plan for AIDS Relief) annual conference (in Durban - so - sadly no sexy international business trip for me) .... an event showcasing the achievements so far in fighting the AIDS pandemic in the 16 recipient countries.

PEPFAR (as many of you already know) is the US initiative established by President George Bush in 2003 .... pledging $15 billion over 5 years to a global crusade against HIV/AIDS ..... in essence the largest amount ever pledged by a single country to combat a single disease .... thereby making it one of the most influential programmes in international health today .... (as well as funding my own current employment - thank you Uncle George) .... for more background info - check - http://www.avert.org/pepfar.htm

There are of course a myriad of reasons why President Bush would choose not to put this huge bolus of cash into a multilateral organisation such as the Global Fund - not least the ability to stipulate branded drugs and accommodate the interests of Big Pharma .... and it certainly allows him to state that the American People have put 560,000 people on ARV treatment within 3 years and enabled testing for many millions more .... as well as helping to prevent mother-to-child transmission of HIV to four million women .... which no one can deny is a monumentous achievement .....

But perhaps the most controversial reason is the ideological motivation behind the ruling that PEPFAR funds must be divided as follows:

1. 55% for the treatment of individuals with HIV/AIDS
   
2. 15% for the palliative care of individuals with HIV/AIDS
3. 20% for HIV/AIDS prevention (of which at least 33% is to be spent on abstinence until marriage programs)
4. 10% for helping orphans and vulnerable children

Now most of us have heard of the ABC approach to preventing HIV (Abstinence/delay having sex, Be faithful and Condomise) ....

But PEPFAR has developed its own definitions for ABC ..... namely Abstinence for youths until marriage, Be faithful in marriage/monogamous relationship and Condoms for those who practise high risk sex ..... (and all this on a background of the global gag rule and the prostitution loyalty oath)

And so - many PEPFAR-funded prevention programmes are limited to providing condoms only for "high risk groups" .... and the only message available for young people is that of abstinence until marriage .... and this in countries where the reality is that kids start having sex in their early teens because there is little else to do .... where early sex is often violent .... and where young girls have little choice or decision-making capacity over what happens to their own bodies ....

In addition - whilst the guidelines insist that a third of all the prevention money is spent solely on promoting A and B .... the reporting system for ALL the PEPFAR prevention programmes (well - in South Africa at least) requires them to submit stats only on their A/B achievements (but not C) .... so even if you do distribute/preach condoms .... you're not given any credit for it ..... and there's no incentive to really make an effort to provide them .... given that A/B targets are the only results that will get you refunded ....

The EU on World AIDS Day 2005 openly distanced themselves from this policy .... advocating instead for a comprehensive approach to prevention and treatment ..... and the GAO reported earlier this year .... that some countries receiving PEPFAR money had needed to divert resources from efforts to prevent mother's transmitting the virus to their children and for ensuring clean blood banks .... in order to meet such A/B targets set for them .......

The Lancet published an editorial accusing PEPFAR of being " ill-informed and ideologically driven" .... noting that almost a quarter of such US funding was being chanelled through faith-based organisations .... and concluded that "Many more lives will be saved if condom use is heavily promoted alongside messages to abstain and be faithful".

And yet .... some organisations still believe that PEPFAR's efforts to influence the HIV world are not profound enough ..... "Casting the first stone: the US Christian right’s war on the Global Fund"

So obviously ..... this has formed the basis of many a wine-fuelled-late-night-indignant discussion here ..... but surrounded as i am by liberal heart-bleeding ngo types .... i was taken aback when asked by a friend that ..... given this current american administration was elected not once but twice - then why can't the US spend its dollars in a manner that its citizens would approve of, advocate for and most importantly vote for?

Indeed at the end of the day .... if we ignore the prevention agenda .... PEPFAR has proved incredibly successful in rapidly putting people on treatment .... often in creative and innovative ways .... and so ..... whilst it calls into question the motivations behind such donor aid (should the US be allowed decide who can use a condom or not - even if sex is the major cause of HIV spreading?) .... realistically this is the nature of development ..... and we will have to weigh up how nefarious it really is to use such bilateral aid agreements to ensure the success of our own pharma companies or religious organisations ..... as long as the job gets done - especially when no one else is putting up the cash ....

Lets just be thankful that Bill Gates thinks that religion isn't time efficient ....