Taking American Values out of HIV/AIDS Legislation

This past winter break, I traveled with an American Jewish World Service group to Gbi Atabu, a small village in the Volta region of Ghana. Over the course of a week spent working with and learning from our group’s host community, we witnessed the paradox of a people bustling with warmth and congeniality amid the challenges of systemic poverty and a public health crisis.

One of the region’s two doctors spoke to us of treating two or three cases of HIV/AIDS per day and witnessing as many deaths from the disease every week. These numbers are staggering and disheartening, but sadly they represent only a tiny portion of the estimated 33.5 million people worldwide currently infected with HIV/AIDS.

So why am I telling you about my experiences in Gbi Atabu? Because although President George W. Bush has addressed the global pandemic of HIV and AIDS by appropriating an estimated $30 billion in AIDS relief, which demonstrates his attention to the magnitude of the issue, this legislation fails to address the reality of the people’s lives it is intended to help. Speaking to people on the ground in sub-Saharan Africa, I have gained an understanding of how this legislation can be changed to maximize our money’s efficacy in saving lives.

The President’s Emergency Plan for AIDS Relief (PEPFAR), which he called for in his January 2003 State of the Union speech, is scheduled for a “mark up” on Feb. 7, 2008 and will be discussed in Congress thereafter. The goals of the legislation are to treat two million people, to prevent seven million new infections, and to provide care and support for 10 million people infected with HIV/AIDS.

HIV/AIDS relief is undeniably crucial to many African countries. However, the fundamental problem with the legislation as currently written is that money distribution is contingent upon international aid recipients’ adherence to the president’s sexual mores—specifically abstinence until marriage and non-promotion of prostitution.
PEPFAR currently requires that 33 percent of all funding for HIV/AIDS prevention activities be spent on abstinence-until-marriage programs. Organizations receiving U.S. international assistance must also sign a pledge stating they will not “promote the legalization or practice of prostitution.” Philosophically, the legislation does not seek to step into the social and cultural realities on the ground in the effort to help the utmost number of individuals, but rather it asserts our president’s a priori values. Because of this contentious aspect of the legislation, many organizations either rejected the proposal or lost funding despite involvement in cutting-edge and internationally recognized work on human rights and public health.

In a meeting with Pro-Link, an NGO for sustainable development in Hohoe, a native Ghanian explained that Pro-Link’s HIV/AIDS prevention curriculum would be completely ineffective if they had to focus on abstinence-only education. Pro-Link works in a society in which children as young as 15 have sex before marriage, often with multiple partners, and do not speak openly about these activities. Traditional gender roles limit women from suggesting condom use, and men are often too embarrassed to go to the store to buy condoms. Comprehensive educational programs that address the root of these issues are essential in HIV/AIDS prevention—abstinence education is not enough.

Another contentious piece of the PEPFAR legislation is that it forces organizations receiving U.S. international aid to pledge not to “promote the legalization or practice of prostitution.” As part of the trip, my group visited a Liberian refugee camp where sex work is the only income-generating activity for many women. In a choice between starvation and prostitution, these women engage in sex work to support themselves and their families. Their engagement in this industry is a sad reality that also leaves them at a high risk for contracting and spreading HIV/AIDS, and as it stands, the legislation denies them access to any funding generated from PEPFAR. Who are we to turn our backs on saving the lives of individuals who have no other means to put food on the table?

Our country should be mature enough to assess problems from multiple perspectives, and accept that what we see as ideal might not be the most effective way of dealing with HIV/AIDS issues.

Finally, the PEPFAR legislation also fails to maximize the efficacy of our dollars because it imposes the primary use of branded drugs in an effort to appease U.S. drug manufacturers. Branded drugs generally cost four times more than generic drugs, meaning four times as many people could have been treated and saved at the same cost. Striking this aspect of the legislation could make a significant difference in the number of lives saved in the developing world.

We make our donations and wear red clothing in solidarity with those suffering from HIV and AIDS. While this is admirable and important, we cannot sit idly by as our government imposes some of our values onto others at the cost of human life. As most of us do not have $30 billion to distribute as we please, let us take the next step together by contacting our congressional representatives to ensure that the money our government has already appropriated for AIDS relief is used in the most effective ways. It is in our hands and within our power to make a significant difference in alleviating the global pandemic of HIV and AIDS.

The author is a member of the Columbia College class of 2007.