Health Action AIDS

Problems with PEPFAR 1

PEPFAR 1 has faced extensive criticism on a number of fronts.

1. PEPFAR requires grantees to spend 33% of prevention funds ($322 million in 2006) on abstinence programs. According to a 2006 GAO report, many country teams stated that this requirement limited their efforts to design prevention programs that are integrated and responsive to local prevention needs. While 10 countries applied for and received an exemption from this requirement, the US required the other countries to then spend more than 33% of their prevention funding on abstinence programs so that the overall percentage of prevention funding spent on abstinence would be maintained. (Learn more about this issue).
2. PEPFAR requires grantees to sign a pledge opposing prostitution and sex trafficking (Learn more about PEPFAR rules and restrictions).
3. Abortion gag rule: The US will not fund clinics that provide abortion information or services.
4. PEPFAR has taken an anti-condom stance reflected in its policies and propaganda in PEPFAR countries.
5. The program is opaque; it is difficult to see or track exactly how the money is being spent. In contrast, many of the workings of Global Fund grants are available on the Global Fund website.
6. PEPFAR's prevention programs are anemic compared to its treatment programs. The effectiveness of PEFAR's prevention programs is difficult to ascertain. However, in public health research it is always more difficult to determine the number of people who avoided a disease than those who contracted it.
7. PEPFAR's treatment numbers are lower than they might be and scale-up was initially slow.
8. PEPFAR fails to adequately address the IV-drug driven epidemics currently escalating in Eastern Europe and Asia. The ban on federal funding for needles, as well lack of support for substitution therapy, are part of this problem. These prohibitions have their roots in the ideology that such interventions promote drug use.
9. PEPFAR has been criticized by the U. S. General Accounting Office for its inadequate accounting of how many people have been helped by its programs.