Abstinence & Fidelity


Funding Restrictions

Based on Uganda’s success in bringing down their HIV infection rate with its “ABC” campaign (Abstinence, Be Faithful, use Condoms consistently and correctly), the Bush administration and Congressional allies adopted ABC as PEPFAR’s original HIV prevention approach, although emphasizing the “A” and “B” sometimes to the exclusion of “C.” 

There is convincing evidence that this approach to prevention was a failure.  While PEPFAR was very successful in getting treatment to millions of people, according to a study published in the Annals of Medicine, the pace of new infections in PEPFAR focus countries continued to grow.

The original 2003 PEPFAR law contained a requirement that 33 percent of all funding for prevention activities be spent on abstinence-until-marriage and faithfulness programs.  With the 2008 reauthorization of PEPFAR, this earmark was removed from the legislation.  However, it was replaced with a requirement that the Global AIDS Coordinator report to Congress if less than 50 percent of funding to prevent sexual transmission of HIV is spent on abstinence and fidelity programs in countries with generalized epidemics.

The new reporting requirement continues to emphasize abstinence and fidelity to the exclusion of comprehensive approaches, such as those that include education about male and female condoms. This can cause a chilling effect for organizations receiving PEPFAR funding, who may censor their prevention activities and fall short of providing comprehensive HIV prevention services to women, men and young people.

By creating preferences for programs that do not include safe sex information, this policy by definition undermines comprehensive, rights-based approaches to sexual and reproductive health.

Recent Policy Developments

PEPFAR’s five-year strategy does not include any language about abstinence and states that PEPFAR's prevention programs will focus on scaling up high-impact, evidence-based, combination prevention approaches. Unfortunately, new guidance on condom promotion has not been issued and condom distribution is still restricted to individuals 15 years of age and older. CHANGE’s research indicates that restricting condom distribution to older teens keeps life saving tools from younger at-risk youth.

Why Comprehensive?

Globally, the majority of HIV infections occur through sexual contact between men and women.  People have a human right to full information about safe sex.  Comprehensive prevention strategies are needed to ensure that women, men and adolescents are equipped with the knowledge, tools and skills necessary to prevent HIV infection and practice safe sex. Funding restrictions like the abstinence and fidelity reporting requirement hinder access to life-saving information and services and must be eliminated.

Congressionally-mandated reports from the Institute of Medicine and Government Accountability Office found that the abstinence-until-marriage earmark was hindering prevention efforts on the ground.  While the earmark is no longer part of U.S. law, the analysis included in these reports is still relevant when assessing the abstinence and fidelity reporting requirement.

PODCAST: The Future of PEPFAR: What Should Funders Know?
In February 2013, the Institute of Medicine released a 10-year evaluation of PEPFAR. What do the findings show us about the effects of advocacy on PEPFAR, and what will it mean for future advocacy? Listen to CHANGE President Serra Sippel discuss CHANGE's advocacy work around PEPFAR's abstinence-focused earmark and guidance, and why advocacy is still critical to shaping rights-based PEPFAR policies.

IOM Report - PEPFAR Implementation: Progress and Promise, March 30, 2007.

GAO Report - Global Health: Spending Requirement Presents Challenges for Allocating Prevention Funding Under PEPFAR, April 4, 2006.

Abstaining from Reality: U.S. Restrictions on HIV Prevention, via Population Action International


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