The Hidden Costs of PEPFAR

As was evidenced by his absence at the International AIDS Conference last week, President Obama is not currying much favor with the HIV community at the moment. Despite creating the first National HIV/AIDS Strategy in our nation’s history, he hasn’t done much to combat HIV in America beyond token lip service and hoisting a giant red ribbon on the White House porch on National AIDS Day. On the flip side, HIV outreach—and global outreach in particular—has been one of the few lingering bright spots of George W. Bush’s time at 1600 Pennsylvania Ave. His creation of the President’s Emergency Plan For AIDS Relief (PEPFAR) has saved countless millions of lives in Africa and other areas of the globe with high HIV prevalence and minimal resources. PEPFAR is an odd bird in that it is, to my knowledge, the only form of humanitarian government aid that is supported more vigorously by some Congressional Republicans than by their Democratic counterparts. Republicans in the Senate and the House actually voted to exceed President Obama’s AIDS funding request for the fiscal year 2013 budget. I don’t what this says about Congressional Republicans, but it sure is damning for the Obama Administration. Whenever a homophobic, self-loathing caricature like Lindsay Graham (R-SC) can make a legitimate claim that he is doing more for the cause of HIV/AIDS awareness than a sitting Democratic President, you’ve got yourself a problem.

But, surely this outpouring of support for the global fight against HIV can’t be the brainchild of unadulterated altruism and human feeling. There has to be some fly in the ointment (not lube…never lube) of what appears to be a solid policy on HIV/AIDS globally. As per usual, the fly comes in the form of those two things that American Conservatism can’t stop trying to forcibly mate like giant pandas in a Chinese zoo: education and religion. For Bush and his ideological brethren, it’s all about the ABC’s. A is for Abstinence, B is for Be Faithful and C is for…well, we’re not going to talk about C. In theory, C is supposed to stand for condoms, but since everyone knows that condoms are clearly instruments of the devil, it is often snubbed in favor of something like C is for Character or C is for Could we not talk about this? Anyone who has ever had the misfortune to be a part of a abstinence-based sex ed class here in the states knows just how wildly effective this strategy is. Nothing curtails the spread of sexually transmitted diseases like treating teenagers as if they were preparing for the priesthood or the abbey.

Billboard in Malawi promoting the fight against HIV via “Abstinence, Abstinence & More Abstinence”. At least they have choices.

This enlightened view of human sexuality was a pre-requisite for any HIV/AIDS funding through PEPFAR during the Bush administration and many of those policies remain in place today. In order to receive funding from PEPFAR, governments had to sign an anti-prostitution pledge and are forbidden from using any PEPFAR monies on needle exchange programs. The 2008 reauthorization of PEPFAR also mandated that at least 50% of all prevention funding go towards abstinence-until-marriage and faithfulness programs. And heaven forbid anybody bring up the already socially taboo subject of homosexuality in these 3rd world nations asking for support. In fact, many media outlets1 and advocacy groups have made a convincing case that the West has actually imported homophobia into the African Continent and that Evangelical Christians have been actively cultivating anti-gay sentiment.

All of this right-wing goodness has led to the inevitable regression of the HIV/AIDS movement in areas of Sub-Saharan Africa, most specifically in Uganda. As the New York Times documents in a recent piece on the subject2, Uganda was seen as a guiding light in the fight against HIV in the developing world after they reduced their HIV prevalence from an alarmingly high 14% in 1991 to a low of 6.4% in 2005. The Ugandan campaign was so successful the Bush Administration actually based a good deal of their PEPFAR requirements on Ugandan policy. However, not included in the PEPFAR plan was anything on safe sex practices and appropriate condom usage. A large part of Uganda’s grassroots campaign in the 1990s and early 2000s was aimed at getting Ugandans to limit the number of sexual partners they had and use condoms as a “last resort” after abstinence and monogamy failed. These approaches were all but wiped away in PEPFAR-funded Uganda and after $1.7 billion in US funding from 2005 until today, the HIV prevalence has risen from 6.4% to 7.3%. Since PEPFAR intervened in Uganda, the HIV/AIDS crisis has gotten worse, not better, in spite of a staggering influx of cash.

Uganda’s claims of progress in the past 20 years have also been heavily scrutinized as the nation only measures the prevalence of HIV/AIDS and not its incidence. With their emphasis being on prevention rather than treatment, it is quite possible to have prevalence rates drop while incidence rates spike if the newly infected aren’t getting treated and are dying more quickly, thus giving the false appearance of progress. Beyond the statistical markers, the culture of ignorance and prejudice that’s being fomented in Uganda and other Sub-Saharan nations is even more troubling. Homophobia is rampant from the most rural villages to the top of government in Uganda. A Wikileak released in February of this year revealed that a bill was proposed by Ugandan representatives at a UN-sponsored meeting to make homosexuality an offense punishable by death within their nation. This type of blind hatred is characteristic of other Sub-Saharan governments as well and is a very recent phenomenon, seeming to grow from nothing other than evangelical prompting and the need for scapegoating in countries with ineffectual governance. To continue to support such governments with billions in aid is tantamount to green-lighting violent oppression and prejudice. PEPFAR saved many lives, but it was a colossal failure in more ways than it was a success. Now that the US helped create this mess, do the Obama administration and Congress have the spine to try to correct the human rights abuses growing exponentially in places like Uganda? Their silence is not encouraging.




Categories: HIV News, Social Justice

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