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Investigators question government's AIDS policy

The Bush administration's $15-billion global AIDS initiative is emphasizing sexual abstinence and fidelity more than Congress intended, and that focus is undermining prevention efforts in poor countries, congressional investigators said Tuesday.

U.S. teams on the ground in Africa and other poor areas told Congress' Government Accountability Office that the requirement that they spend a specific percentage of their money on abstinence is hurting some efforts to tailor prevention programs to countries' needs.

The directives are creating confusion and forcing reduction in some programs deemed necessary for pregnant women, high-risk groups like truck drivers and sex workers, married couples and sexually active youths, the GAO said.

President Bush's five-year plan touts a three-pronged approach to AIDS prevention - commonly called "ABC" - that combines abstinence, fidelity ("being faithful") and condoms in target countries.

The GAO reported there was "general consensus" among public health experts internationally that the three-pronged prevention approach "can have a positive impact in combating HIV/AIDS."

But it recommended Congress evaluate the effectiveness of the abstinence spending formulas, and the administration consider changing how it implements the law. "Lack of clarity in the ABC guidance has created challenges for a majority of focus country teams," the GAO reported.

"For example, although the guidance restricts activities promoting condom use, it does not clearly delineate the difference between condom education and condom promotion, causing uncertainty over whether certain condom-related activities are permissible," the report said.

The State Department told the GAO it will work to change the regulations to make them clearer.

The GAO also said the administration has gone beyond the abstinence requirement for a major new account Congress created to fight AIDS, mostly in 15 target countries with high rates of the disease. Congress said a third of those prevention funds must go to abstinence and fidelity programs.

The administration, however, extended the same spending formulas to other U.S. funds that fight HIV/AIDS in countries around the world, drawing sharp criticism from some Congress members and activists.

Mark Dybul, the State Department's deputy global AIDS coordinator, said the Bush administration believes all three components need to be emphasized in all 120 countries that get U.S. money for HIV/AIDS, not just the target countries.

"It's important to have guidance that shifted us from where we were, which was not a good situation," he said. "It was too much 'C' (condoms)" prior to Bush's three-year-old program, he added.

As to the GAO's finding that the approach is undermining some anti-AIDS efforts, Dybul said, "There are always challenges when you are changing things." He said U.S. teams in some countries exceeded the minimum required spending for abstinence because they found it was the most effective strategy.

[Last modified April 5, 2006, 00:38:13]