While reading this week’s assignments, I noticed that the President’s Emergency Plan for Aids Relief (PEPFAR) is a significant part of the newly developed Global Health Initiative. PEPFAR has saved many lives and impacted the global response to HIV/AIDS by funding anti-retroviral treatments and counseling for millions of people. Nonetheless, the policy troubles me. The denial of medical care based on moral and religious grounds is discriminatory and undermines the best practices for fighting HIV/AIDS. As long as global health funding is based on ideologies that are undercutting prevention and treatment efforts, PEPFAR will never measure up to its potential.
In 2003, Congress passed the United States Global AIDS Act, which prohibits the use of federal funds to “promote, support, or advocate for the legalization or practice of prostitution.” In 2008, the reauthorization of PEPFAR included the Global AIDS Act by extending “the conscience clause” mandating organizations to sign Anti-Prostitution Loyalty Oaths (APLO) in order to receive PEPFAR funding. The pledge requirement states:
“No funds . . . may be used to provide assistance to any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking.”
The Global AIDS Act operates under the false assumption that providing prostitutes with medical care will encourage them to remain sex workers. APLO perpetuates the discrimination associated with HIV/AIDS. Preventing HIV/AIDS among sex workers is incredibly challenging due to negative stigmas associated with prostitution. By discouraging organizations from discussing the practice of safe sex for fear of “promoting prostitution” and losing PEPFAR funding, NGOs are unable to effectively educate and prevent the spread of the disease.
Sex workers are at high risk for contracting and spreading HIV/AIDS. In order to prevent transmission, health organizations must be allowed to use empowerment programs and reach out to vulnerable groups that are most likely to be impacted by the disease. Studies have shown that the most effective anti-AIDS strategies build trust and credibility among marginalized populations. PEPFAR’s “conscience clause” drives sex workers away from organizations that can provide them with counseling, protection, and testing.
Medical treatment contingent on religious principles is discriminatory and undermines the best practices for preventing the disease. The assumption that health treatment must be earned on the basis of belief systems, rather than considered a human right, can have fatal consequences for HIV/AIDS patients. If the goal of PEPFAR is to save as many lives as possible from HIV/AIDS, then a step in the right direction is to abolish Anti-Prostitution Loyalty Oaths from PEPFAR. The fight against HIV/AIDS is too important to moralize global health policies.