In January 2003, President George W Bush launched PEPFAR, which hopes to secure US$15 billion in funding between 2004 and 2008, to combat HIV/AIDS in some of the poorest parts of the world. One of the aims of the Plan is to prevent 7 million new HIV infections by 2010. The cornerstone of this prevention strategy is the ABC approach – Abstain, Be faithful, use Condoms – with a strong emphasis on A and B, over C, in most settings.
The legislation that underpins PEPFAR requires that a third of all the money that goes towards preventing new cases of HIV ($108 million of $322 million in 2006) must be spent on programmes that promote sexual abstinence and faithfulness and cannot be spent on promoting condoms. However, last week a report by the US Government Accountability Office (GAO) (http://www.gao.gov/new.items/d06395.pdf) revealed that this ideologically driven strategy is causing problems for health workers on the ground. The Office of the Global AIDS Coordinator (OGAC), which oversees the PEPFAR programme, has produced guidelines for the country teams to help them meet their legal requirements. However, these guidelines are often ambiguous and some of the OGAC's implementing partners are confused about which population groups can be targeted with information about condoms. This ambiguity has led to ridiculous situations, outlined in the GAO report, where workers are unsure whether they will lose funding if they answer young peoples' legitimate questions about condom use.
The Lancet comments: "Rigorous implementation of the "C" part of ABC is crucial if PEPFAR is to reach its target of preventing 7 million new infections by 2010…The GAO report should prompt Congress to ask whether the $600 million ear-marked for prevention programmes based on abstinence and faithfulness is an effective use of US tax-payers' money. Many more lives will be saved if condom use is heavily promoted alongside messages to abstain and be faithful."
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Journal
The Lancet