Findings

Congress makes the following findings: (1)The President's Emergency Plan for AIDS Relief (in this Act referred to as PEPFAR) is an unprecedented effort to combat the global AIDS epidemic, with $9,000,000,000 targeted for initiatives in 15 focus countries. (2)The PEPFAR prevention goal is to avert 7,000,000 HIV infections in the 15 focus countries—most in sub-Saharan Africa, where heterosexual intercourse is by far the predominant mode of HIV transmission. (3)According to the Joint United Nations Programme on HIV/AIDS, young people between the ages of 15 and 24 years old are the most threatened by AIDS and are at the centre of HIV vulnerability. Globally, young people between the ages of 10 and 24 years old account for ½ of all new HIV cases each year. About 7,000 young people in this cohort contract the virus every day. (4)A recent review funded by the United States Agency for International Development found that sex and HIV education programs that encourage abstinence but also discuss the use of condoms do not increase sexual activity as critics of sex education have long alleged. Sex education can help delay the initiation of intercourse, reduce the frequency of sex and the number of sexual partners, and also increase condom use. (5)The United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (22 U.S.C. 7601 et seq.) requires that at least 1/3 of all prevention funds be reserved for abstinence-until-marriage programs. (6)A congressionally mandated review by the Institute of Medicine of the first 3 years of PEPFAR unequivocally recommends greater flexibility in the global fight against AIDS. The March 2007 Institute of Medicine report entitled PEPFAR Implementation: Progress and Promise calls for greater emphasis on prevention than the law currently allows and says that removal of the abstinence-until-marriage earmark, among other changes, could enhance the quality, accountability, and flexibility of prevention efforts. (7)The Institute of Medicine report further found that the abstinence-until-marriage earmark has greatly limited the ability of Country Teams to develop and implement comprehensive prevention programs that are well integrated with each other and with counseling and testing, care and treatment programs and that target those populations at greatest risk. (8)The Institute of Medicine report also found that the earmark has limited PEPFAR's ability to tailor its activities in each country to the local epidemic and to coordinate with . . . the countries' national plans. (9)The Institute of Medicine report is in keeping with the conclusions of a report issued in 2006 by the Government Accountability Office. The GAO report, entitled Spending Requirement Presents Challenges for Allocating Funding under the President's Emergency Plan for AIDS Relief, found significant challenges associated with meeting the earmark for abstinence-until-marriage programs. (10)The Government Accountability Office found that a majority of country teams report that fulfilling the requirement presents challenges to their ability to respond to local epidemiology and cultural and social norms. (11)The Government Accountability Office found that, although some country teams may be exempted from the abstinence-until-marriage spending requirement, country teams that are not exempted have to spend more than the 33 percent of prevention funds on abstinence-until-marriage activities—sometimes at the expense of other programs. (12)The Government Accountability Office found that, as a result of the abstinence-until-marriage spending requirement, some countries have had to reduce planned funding for Prevention of Mother-to-Child Transmission programs, thereby limiting services for pregnant women and their children. (13)The Government Accountability Office found that the abstinence-until-marriage spending requirement limited or reduced funding for programs directed to high-risk groups, such as services for married discordant couples, sexually active youth, and commercial sex workers. (14)The Government Accountability Office found that the abstinence-until-marriage spending requirement made it difficult for countries to fund medical and blood safety activities. (15)The Government Accountability Office found that, because of the abstinence-until-marriage spending requirement, some countries would likely have to reduce funding for condom procurement and condom social marketing. (16)In addition, the Government Accountability Office found that 2/3 of focus country teams reported that the policy for implementing PEPFAR’s ABC model (defined as Abstain, Be faithful, use Condoms) is unclear and open to varying interpretations, causing confusion about which groups may be targeted and whether youth may receive the ABC message. (17)The Government Accountability Office found that the ABC guidance does not clearly delineate permissible C activities under the ABC model. Program staff reported that they feel constrained by restrictions on promoting or marketing condoms to youth. Other country teams reported confusion about whether PEPFAR funds may be used for broad condom social marketing, even to adults in a generalized epidemic. (18)Young people are our greatest hope for changing the course of the AIDS epidemic. According to the World Health Organization, [f]ocusing on young people is likely to be the most effective approach to confronting the epidemic, particularly in high prevalence countries.