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April 2, 2008 10:56 PM   Subscribe

No-small-news-filter: House Votes to Continue and Expand President's Global Effort Against AIDS.

The House voted to drastically expand funding to the President's Emergency Plan for Aids Relief. Not everyone is happy with the details of the bill regarding AIDS prevention, but something is better than nothing. Roughly 1/5th of the funding is earmarked for tuberculosis and malaria relief / prevention as well. More info from USAID.
posted by allkindsoftime (14 comments total)

 
His legacy will be remembered for little else save the Iraq disaster, but say what you will about Bush - he's done more for epidemics in Africa, arguably, than any president in history.
posted by allkindsoftime at 10:58 PM on April 2, 2008


I am guessing that the real benefactors are the large pharmaceutical companies. Also, didn't they switch to mostly abstinence only programs that are proven to be less effective compared to protected sex education?
posted by Mr_Zero at 11:12 PM on April 2, 2008


he's done more for epidemics in Africa, arguably, than any president in history

This of course is the paraphrase of the Sir Bob Geldoff quote.
posted by humannaire at 11:17 PM on April 2, 2008





allkindsoftime writes "say what you will about Bush - he's done more for epidemics in Africa, arguably, than any president in history."

His first act in office was to withdraw funding for, among other things, distributing free condoms in Africa. See Global Gag Rule.
posted by mullingitover at 11:48 PM on April 2, 2008 [3 favorites]


Note that the house upped the amount to 50 billion and stripped the gag rule and 1/3 target towards abstinence/fidelity. The president only wanted 30 billion and his silly rules.

No house of representatives has done as much. The president as always is still ideologue and Bob Geldof is largely clueless.

It would probably be interesting to see the breakdown of voting.
posted by srboisvert at 12:35 AM on April 3, 2008 [1 favorite]


Hmmm. Good.
posted by AdamCSnider at 5:32 AM on April 3, 2008


I am guessing that the real benefactors are the large pharmaceutical companies. Also, didn't they switch to mostly abstinence only programs that are proven to be less effective compared to protected sex education?

PEPFAR is not an Abstinance-only program; the fund uses a program called ABC (Abstinence, Be Faithful, Contraception). The programs focus, more often than not, on delaying the time until sexual debut for girls, reducing the number of simultaneous partners men have, and (finally) contraception. While it's true that PEPFAR doesn't sponsor Contraception-only programs, contraception-only is not the answer. I'll break down the benefits of A and B.

Abstinence has a bad rap here in the US because people see it as a personal liberty/choice thing. Most Americans lose their virginity to someone in or near their own age cohort. Things are a bit different in Africa. Young girls are frequently coerced by older men into having sex for the first time, which creates a bad power dynamic and restricts choice. Because of the power dynamic, girls have less choice over how they have sex. This often means no condom and little foreplay (which means more chafing and greater transmission rates). Condoms might be available in these situations, but due to the power dynamic, it's entirely up to the man.

What's more, these men are more likely to have multiple simultaneous partners. Multiple partners make for faster and more widespread transmission of HIV (people are most infective around two weeks after contracting the virus, so this is a BIG problem in simultaneous sexual relationships). In a world where everyone only has one partner at a time, AIDS becomes much better contained.

Uganda is a good example of a country with a successful B program. A few years ago, they instituted a program called "No Grazing," which urged married women to keep tabs on their husbands and for husbands to be faithful to their wives. This program flourished and transmission decreased markedly.

So while I'm not thrilled that there are restrictions on condom programs, I think it's a bigger problem that PEPFAR doesn't invest in system-wide improvements to infrastructure. Including malaria and TB into the project is good, but if you're not tackling undernutrition, maternal and child mortality, poverty, and NTDs at the same time, you're not going to get anywhere. What's more, most of these programs are nigh on completely unsustainable. Further, if you're not building roads and sanitation systems, fixing corruption, and generating genuine political will, these programs will just fall to pieces the second you leave.
posted by The White Hat at 6:43 AM on April 3, 2008 [5 favorites]


His first act in office was to withdraw funding for, among other things, distributing free condoms in Africa. See Global Gag Rule.

Yeah. You kinda forgot to emphasize the "among other things" part there. The Mexico City Policy was primarily about a completely different can of worms.
posted by allkindsoftime at 7:43 AM on April 3, 2008


Voting on the bill, from AP:

The 308-116 roll call Wednesday by which the House passed a global AIDS
bill authorizing $50 billion in spending over five years.
Voting yes were 230 Democrats and 78 Republicans.
Voting no were 0 Democrats and 116 Republicans.


It now goes to to the Senate, where it faces more challenges, particularly around the abstinence issue. More perspective on the abstinence aspects.

It's true that this president has done more on global AIDS issues than any other, but he could hardly have done less. Clinton had his strong points, but global HIV was not one of them. He's trying to make up for lost time now with his foundation, which does some good work, but he missed the biggest opportunity when he was in office.

Also, the President mentions this in speeches from time to time, but the hard work on the bill is done by Congress, as it always is. They've upped the funding from his very low levels - what he was calling for initially represented no increase in funding from what's currently being provided. More.
posted by gingerbeer at 7:52 AM on April 3, 2008


allkindsoftime writes "Yeah. You kinda forgot to emphasize the 'among other things' part there. The Mexico City Policy was primarily about a completely different can of worms."

I didn't forget, and I provided a link to the explanation of the Global Gag Rule which fully lists the ramifications of his first act in office.

We're talking about Bush's AIDS relief legacy here. If we're going to do that, we should put it in context: the man doesn't just have blood on his hands, he's completely covered in it. He is not a 'great statesman' or a 'benevolent leader.' He's just scrambling to avoid having every sewage treatment plant in the country named after him for the next century.
posted by mullingitover at 10:02 AM on April 3, 2008


Abstinence has a bad rap here in the US because people see it as a personal liberty/choice thing.

Abstinence education, independent of HIV infection rates, fails miserably. This is statistically established.

On the other hand, education about birth control has been statistically demonstrated to work successfully to reduce HIV and other STD rates in Africa and SE Asia.

When you know the general outcomes of abstinence and birth control education, which of the two options would you choose to focus US$50 billion on, as a rational, thoughtful, humane human being?
posted by Blazecock Pileon at 10:17 AM on April 3, 2008 [1 favorite]


Abstinence education, independent of HIV infection rates, fails miserably. This is statistically established.

You're creating a straw man, here. PEPFAR is NOT about abstinence-only. I don't know how many different ways this can be said. Also, those articles you cited don't support your argument. Your first and fourth cited articles are only about sex workers* (whose STIs are vectored much differently from those in the general population); your second cites no statistics whatsoever. Your third supports my point about the effectiveness of ABC as an INTEGRATED approach.

*It's interesting to note that the 100% condom rule in Thai brothels is currently being eroded. Whereas they used to be operated by or under the auspices of the Thai police, the mafias are starting to establish underground brothels where tourists can once again buy unprotected sex.
posted by The White Hat at 10:47 AM on April 3, 2008


PEPFAR funding is not limited to abstinence-only, and the current House version lifts some of the requirements to fund ab-only, but it is still front and center in this bill.

Funded entities still have to provide ab-only, and cannot pay for contraception, and still have to take the counterproductive sex work pledge. This version is a little bit better than the last one, absolutely, but it still strongly pushes abstinence-only.
posted by gingerbeer at 12:33 PM on April 3, 2008


Commentary from Politico, and Feministe.
posted by gingerbeer at 1:11 PM on April 4, 2008


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