In a clear disavowal of Bush-era rules that prevented cooperation between government-funded HIV/AIDS programs and broader sexual health and gender work in developing countries, the Obama administration has signaled to agencies abroad that the walls are coming down and that experts on the spot will have new freedom of action.
Under Bush, people in the field working to implement the United States President’s Emergency Plan for AIDS Relief, known as Pepfar, were subject to micromanagement under ideologically inspired guidance that, among other requirements, demanded that 50 percent of AIDS prevention funds in countries with generalized epidemics be devoted to abstinence and “faithfulness” campaigns. That provision, born of provincial ignorance about the world, would be a joke if it weren’t so cruel to millions.
The old guidelines also barred links between AIDS efforts and family planning, at a time when AIDS was becoming a woman’s disease in many places and women had no power to resist unwanted or risky sex.
In new guidelines for 2010, the Obama Pepfar team opened the way to linking AIDS work with strengthening of health systems generally, taking into account the development of human resources, maternal and child health, family planning and access to it for women, gender equality, malaria and tuberculosis, food and nutrition, education and local economies. While Pepfar money may not be involved directly, the program’s door will be open for cooperation. It is, in short, a holistic and realistic policy. It will matter because the United States is the world’s largest contributor to HIV/AIDS relief, and Bush restrictions have had a deadening effect on many international programs.
“This is a big one,” said Wendy Turnbull, senior policy research analyst at Population Action International in Washington, which acquired a copy of the internal government Country Operational Plan Guidance for 2010 (dated June 29) in July, digested it and sent a heads-up summary to health workers in government and nongovernment agencies abroad. “We all think this is significant.”
The relaxed guidelines, from the office of the recently installed global AIDS coordinator, Eric Goosby, former CEO of Pangaea Global AIDS Foundation and professor of clinical medicine at the University of California, San Francisco, follow a series of steps taken by Obama to increase American support for global family planning and the health of women and children.
The trend began early in the year with the reversal of the global gag rule that banned US aid to any organization dealing in any way with the issue of abortion. Then came the resumption of US contributions to the United Nations Population Fund (UNFPA). Bush had stiffed the agency since 2002, citing ideologically motivated, untrue accusations that the UNFPA abetted abortion in China.