On April 13, the House International Relations Committee heard testimony concerning the global HIV/AIDS crisis and implementation of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (P.L. 108-25).
U.S. Global AIDS Coordinator Randall Tobias stated that since January 2004, the President’s Emergency Plan for AIDS Relief (PEPFAR) “has worked throughout the world, with a special focus on 15 severely burdened nations, including 12 in sub-Saharan Africa, two in the Caribbean, and one in Asia,” adding, “We believe that dramatic success in these nations, many of them among the world’s poorest, will enable us to demonstrate to the entire world what intensive leadership and commitment of resources can do in this fight.” He explained that the FY2006 budget request of $3.2 billion for HIV/AIDS would keep the United States “on track to fulfill our commitment of $15 billion over 5 years, and to reach our goals of preventing 7 million new infections, supporting treatment for 2 million people, and caring for 10 million people, including orphans and vulnerable children.” Highlighting achievements in the fight against HIV/AIDS, Ambassador Tobias said that 1.2 million women had received services to prevent mother-to-child transmission. In addition, he noted that the United States “has provided technical assistance for appropriate policy development, including policies protecting women and girls, and for strengthening local institutions and organizations, including organizations of persons living with HIV/AIDS.”
Geeta Rao Gupta, president of the International Center for Research on Women, focused her comments on the impact the HIV/AIDS epidemic has had on women and girls. Citing statistics provided by UNAIDS, she stated that since 2002, “the number of women living with HIV has risen in every region of the world. In sub-Saharan Africa, out of every 10 infected persons nearly 6 are women…In Kenya, for example, for every 20 young men with HIV (15-24 years of age), there are 45 young women with the virus more than double.” Dr. Gupta argued that the ABC method: “A” for abstinence, “B” for being faithful, and “C” for condoms, “while necessary to contain the AIDS epidemic, is not sufficient to address the underlying vulnerabilities that contribute to women’s risk of infection.” She went on to explain that for married women the ABC method “is not a realistic strategy for prevention because abstinence within marriage is not a viable option; their husband is typically their only sexual partner; and the use of a condom is dependent on their husband’s cooperation and is often stymied by the need to have a child.” Dr. Gupta noted that in many countries, women are married before the age of 18, stating, “Research…shows that it is poverty, lack of education and a lack of viable economic alternatives for young women that makes child marriage so prevalent not culture.” She recommended that the United States invest in female-controlled methods of HIV prevention, such as female condoms or microbicides, and urge other nations to adopt laws increasing the legal age for marriage.
Dr. Gupta noted that violence against women increases the risk of HIV/AIDS, stating, “Forced or coercive sex presents a direct risk of HIV infection for women that cannot be prevented through any strategies currently promoted…And fear of violence and the threat of abandonment poses significant risks as well because they significantly limit women’s ability to negotiate protection, leave a risky relationship, discuss fidelity, or access testing or treatment services.” She encouraged the administration to include in PEPFAR a provision of “post-exposure prophylaxis” for rape victims, communication programs aimed at preventing violence against women, and a coordinated health sector response to the incidence of violence against women. Finally, Dr. Gupta explained that “women’s economic vulnerability underlies must of their vulnerability in the AIDS epidemic because without economic leverage women cannot insist on protection against infection or fidelity in their marriage or other relationships, nor can they leave a relationship they know to be risky.” She urged the Bush administration to support legal literacy programs for women and invest in paralegal services that would help families affected by HIV/AIDS write wills and other legal documentation.
Director of the Makerere Youth Ministry in Uganda Martin Ssempe highlighted the success of the ABC method in Uganda: “The health ministry, the local health agencies, the schools, the churches and other faith-based organizations, the newspapers and the radio all were involved. And the program worked. HIV/AIDS incidence rates fell in the late 1980s and the HIV/AIDS prevalence rate fell from 21% in 1992 to around 6% in 2002. I know of no other country which has cut its HIV/AIDS prevalence rate by two-thirds.” Expressing his concern that the U.S. Agency for International Development (USAID) and the Centers for Disease Control and Prevention have turned away from the ABC method, Mr. Ssempe stated, “Today the abstinence messages are gone. Gone are the ‘AIDS Kills’ ads warning teenagers to abstain. Gone are the signs that once warned truck drivers to ‘drive home to their wives.’ The abstinence billboards have been replaced with new billboards advertising condoms with slogans like ‘So Strong. So Smooth.’ And the HIV/AIDS rate has begun to tick upwards. In the Rakai district where condom promotion overshadows the promotion of abstinence and marital fidelity, USAID has increased the level of condom use only to find that the rate of new infections, which had been declining, is now back on an upward trend.”
Testifying on behalf of the Friends of the Global Fight Against AIDS, and Tuberculosis and Malaria, President Jack Valenti pointed out that there are a number of challenges confronting PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria, mainly a shortage of medical professionals and a lack of funding. He further stated, “Our battle plan must also focus on those who are bearing the brunt of this onslaught, women. A broad range of tactics must be deployed to help all women, from young school girls to married mothers, protect themselves from these diseases. The Global Fund is attuned to this need. It has many programs around the globe employing those critical tactics. In Kenya, for example, a remarkable group of women from the Kenyan Network of Women Living with HIV/AIDS are spreading compassion and empowerment to women throughout the country with the help of the Global Fund.” Mr. Valenti urged Congress to provide $800 million for the Global Fund in FY2006, explaining that without these funds, “the Fund may surely have to discontinue effective life-saving programs and the life-extending medications of AIDS patients would be in jeopardy.”
Holly Burkhalter, policy advisor for Physicians for Human Rights, addressed the shortage of health care professionals in regions affected by HIV/AIDS: “Funding for public health in Africa by national governments has been largely stagnant for decades, and ‘brain drain’ of doctors and nurses who migrate to the West has in some countries approached the number of new health worker graduates. Today, Africa faces one of the greatest threats to health and survival in human history the HIV/AIDS pandemic but it is in a poor position to confront it. Adding new duties such as AIDS counseling, testing, and treatment to an overburdened health workforce without a commitment to dramatically enlarge their numbers will not only undermine new AIDS treatment initiatives, it has the potential to weaken fragile public health systems and erode other primary health activities.” She further noted that the HIV/AIDS crisis “has also been a key factor in other health emergencies, including the continent’s tragically high rate of maternal mortality. In sub-Saharan Africa, a woman’s lifetime risk of maternal death is 1 in 16, compared to 1 in 2,800 in rich countries. According to the World Health Report 2005 Make Every Child and Mother Count, ‘Putting in place the health workforce needed for scaling up maternal, newborn and child health services toward universal access is the first and most pressing task.’” Ms. Burkhalter urged the United States to provide technical assistance to countries to assess the shortage; fund strategies aimed at improving the health care workforce in HIV/AIDS-affected regions; and support the World Health Organization’s efforts to recruit, retain, and deploy experienced health care professionals.
