Wednesday, April 05, 2006

No sex, please. We're American!

That's what PEPFAR (the President's Emergency Plan for AIDS Relief) is starting to sound like. PEPFAR is, as you know, the program that provides funding for AIDS-related activities in Africa. Chris, the Clever Board Member, sent me a link to a news article about problems in PEPFAR--and I got sucked into the vortex of another GAO report.

While it's sometimes a stretch to make the connection between the workings of U.S. foreign aid and Texas concerns, stretching is good exercise. So follow along with me a bit.

The GAO report is talking about the U.S. requirement being placed on the use of its funds that ABC be the focus of prevention efforts. ABC is Abstinence, Be Faithful, Use a Condom. The problem is that at least a third of the funds used for prevention must be used for abstinence. While "abstinence" is being interpreted to mean both A and B, it still doesn't include C. That can be tough in countries where the epidemic is concentrated among sex workers and IDUs or where the average age of first sexual contact is 20. That means that millions of dollars are being spent to promote abstinence when condom promotion or cleaning up the blood supply or ensuring safe medical practices or preventing mother to child transmission is more appropriate for the local situation.

Some of the emphasis comes from congressional mandate. Some of it comes from administrative policy. All of it represents either cultural blindness or lack of concern for facts on the ground.

So here comes the stretch. You may have noticed the sad trend (flat or downward) in federal appropriations for the Ryan White CARE Act over the past few years. You may also have noticed the steady increase in appropriations for abstinence only education. How much of a stretch is it to think that these two trends will at some point converge and we will face the same problems in Texas that are being documented for Africa?

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