A Critical Analysis of the President's Emergency Plan for Aids Relief (PEPFAR) and Its Emphasis on Abstinence-Only Prevention

The President's Emergency Plan for AIDS Relief (PEPFAR) is the most recent in a series of policies aimed at promoting abstinence-only education over comprehensive sex education- those that combine information on abstinence, monogamy, and contraceptive use. United States policies promoting abstinence as the sole option for youth are as old as the AIDS pandemic itself- originating in 1981 with the Adolescent Family Life Act. PEPFAR represents the first exporting of abstinence-only education to developing nations besieged by HIV/AIDS. Numerous. evaluations have been conducted on the relative effectiveness of abstinence-only education and comprehensive sex education programs. These studies overwhelming illustrate the failure of abstinence-only programs to achieve their goals, while demonstrating the effectiveness of comprehensive sex education in delaying sex, reducing partners, and increasing contraceptive use. In support of this extensive evidence, several health organizations and associations - including the American Public Health Association, the Society for Adolescent Medicine, and the American Academy of Pediatricians - have generated policy statements supporting comprehensive sex education for youth. Despite the evidence, PEPFAR requires that two-thirds of funds available for prevention of the sexual transmission of HIV/AIDS be restricted to abstinence-only education interventions. PEPFAR and its supporters claim that abstinence-only education is an African solution to HIV/AIDS, citing Uganda's success in lowering its prevalence using what has come to be known as the ABC Model- Abstain, Be faithful, use Condoms. However, PEPFAR has significantly altered - some would say distorted - the Ugandan model. PEPFAR requires that donor recipients separate AB from C and remove information on contraception and condom use from their schools - in effect, transforming a model of comprehensive sex education for all into one that is essentially abstinence-only for youth. There has been an international outcry against PEPFAR and its feared impact on the HIV/AIDS pandemic. Meanwhile, Uganda - which receives more PEPFAR funds than any other country - reported in 2005 that the decline in the country's HIV prevalence rate has stagnated and even increased over the past three years, rising from 6.2 percent in 2002 to 7.1 percent in 2005 (UAC, 2005). Several U.S. policymakers have reexamined PEPFAR and legislation has been introduced in the House of Representatives to amend PEPFAR. It is critical that the PEPFAR's abstinence-only funding requirements be repealed, and that the ban on condom education for youth be lifted. On a larger scale, PEPFAR stands as a glaring example of ideology trumping evidence-based best practice. Clearly, we cannot assume that U.S. policymakers will support evidence-based best practices in IDV prevention. Therefore, health legislation with its potential for life or death consequences must be subject to review and approval by an independent panel of health experts.Master of Public Healt