Commentary  Obama must push AIDS reform


The Inauguration is just two days behind us and the next four years are stretched in front of us with all of their hopeful promise still in tact. Everyone is looking to Obama to fix a slew of problems left after a retrospectively dark eight years under the Bush administration. But with the economy teetering on the edge of unparalleled crisis – not to mention the ongoing wars in Afghanistan and Iraq, the new year’s Israeli-Palestinian crisis, the $10-trillion U.S. debt, and the onslaught of climate change – it would be easy to see how so many of those promises of change which were the main rhetoric of Obama’s presidential run, could fall by the wayside. I, however, would like to focus on an issue which seems to be left out of the mainstream dialogue: the ongoing international fight against HIV/AIDS.

It may come as a surprise to many, but the role of the U.S. in funding the global HIV/AIDS battle has been hailed as one of the few shining lights of the Bush years, by no less than the New York Times, among others. With the authorization of the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, the U.S. committed an unprecedented US $15-billion over five years to fight the HIV/AIDS pandemic internationally. It has been hailed as the largest health initiative directed at a single disease to be initiated by one country – ever.

The successes of PEPFAR are many; the program more than doubled the number of people receiving anti-retroviral treatment (ART) in the most hard-hit countries from 2004 to 2008. Yet, it has also faced its fair share of problems and criticisms.

PEPFAR has most prominently been accused of being largely morally motivated. Of the US $15-billion allotted in 2003, 20 per cent was outlined to be spent on prevention efforts, one-third of which was earmarked to go toward non-scientifically based “abstinence only” education programs. These sorts of programs have been largely dismissed as unconstructive both in the U.S. and abroad, as they provide a narrow educational lens and leave participants more vulnerable when they do choose to engage in sexual relations at a later time. PEPFAR’s ideological policing of funding has also required agencies to sign an anti-prostitution pledge – requiring an explicit opposition to sex work – before being eligible for funding, leaving one of the most stigmatized and at-risk groups out of a constructive dialogue of prevention and care. PEPFAR has also turned a blind eye to another marginalized community – intravenous drug-users – by not supporting clean-needle-exchange programs.

Other criticisms levied against PEPFAR include its initial refusal to use generic drugs, instead requiring FDA-regulated, name-brands despite the high costs associated with them. However, this clause has been reformed to an extent since 2005, making generic ARTs at least partially available.

Due to the ideological short-sightedness implicit in PEPFAR’s requirements for gaining program funding, many organizations and governments have chosen to turn their backs to this considerable tool in the fight against HIV/AIDS. For instance, the BBC media outreach program in Tanzania and the Brazilian government, both at odds with the anti-prostitution pledge, have refused PEPFAR sponsored funds.

While the Bush administration showed positive initiative in its bipartisan and globally oriented proposal of PEPFAR, the mire of moral baggage that comes along with funding only weighs down the full potential such an initiative could offer. PEPFAR funding can no longer be tied to ideology and unproven science. While steps have been taken to remove some specifications from the 2008 PEPFAR reauthorization – such as the exact percentages of money allotted for prevention and abstinence programs – the general atmosphere of moral stringency associated with the Bush administration’s agenda remains.

With administration change, however, comes a new opportunity to set PEPFAR funding free from previous moral constraints. Obama’s pledge to “ensure that best practices – not ideology – [sic] drive funding for HIV/AIDS programs,” is certainly a firm step in that direction. But now, upon officially entering office, Obama must work toward the structural changes that can provide a more comprehensive and wide-reaching access to anti-HIV/AIDS funding from the U.S. for all of those countries in need.

Now is the time to act on AIDS worldwide; now that gains are already being made, we cannot sit idly by and feel as if our part of the work is finished. Instead, Bush’s initiative must be set for a more expansive course. In hard economic times, it may be easy to say that a reformation of PEPFAR may not be at the top of the agenda, but millions of lives literally depend upon such reforms. Global as well as domestic expansion of anti-HIV/AIDS funding and reforms of existing legislation should be a top priority for the new administration.

For a full outline of the Obama administration’s HIV/AIDS initiative pledges, visit Nadja Popovich is The Daily’s Mind&Body editor. Send your used condoms to