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Report: Bush’s Program to Combat HIV Abroad Fails Countries Struggling with the Pandemic

StoryDecember 04, 2006
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A new report released by the Center for Public Integrity is the first of its kind to examine the policies, politics and goals of the President’s Emergency Plan for AIDS Relief, known as PEPFAR. The report finds that PEPFAR’s faith-based ideology—including promotion of abstinence—often trumps science. The report states that PEPFAR is “failing to help lead the world to stop this deadly disease. Instead of empowering people we are restricting them.” [includes rush transcript]

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This is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: A new report released by the Center for Public Integrity finds President Bush’s $15 billion initiative to combat HIV abroad has failed countries struggling with the pandemic. The report is called “Divine Intervention.” It was released as countries across the globe observed World AIDS Day Friday. It’s the result of a year-long investigation. It’s the first of its kind to examine the policies and politics and goals of the President’s Emergency Plan for AIDS Relief, known as PEPFAR. The center worked with reporters in eight countries who found PEPFAR’s faith-based ideology—including promotion of abstinence—often trumps science. The report states, quote, ”PEPFAR is failing to stop the global spread of AIDS and failing to help lead the world to stop this deadly disease. Instead of empowering people we are restricting them. We have a flawed framework with flawed policies.”

Marina Walker Guevara and Sarah Fort join us in Washington, D.C., investigative reporters with the Center for Public Integrity. Marina traveled to Ethiopia, and Sarah to Haiti, to report on the local effects of the Bush administration policies.

Marina, let’s begin with you. Give us a broad picture of this report and what you have found around the world.

MARINA WALKER GUEVARA: Yes, the President’s Emergency Plan for AIDS Relief has a series of very strict rules and funding restrictions that, we found, are very disconnected with the reality that those rules are supposed to serve in the field in the countries abroad, restrictions such as the type of work that you can do with commercial sex workers, restrictions around who can get information about condoms and who cannot get information about condoms, restrictions about how much money must be spent in abstinence-only programs. So all of these programs are disconnected or in some cases do not seem to fit the reality, the reality where very young girls get married in many areas in Africa, in Haiti, a reality where commercial sex work is a widespread profession in many countries, and in most cases, because these women do not have economic alternatives, do not have education opportunities and they must resort to this type of work.

AMY GOODMAN: One of the things in the report, in South Africa, almost one of every three pregnant women attending prenatal clinics in 2004 was infected with AIDS.

MARINA WALKER GUEVARA: Exactly, so South Africa continues to be the epicenter of the epidemic around the world. It’s a very difficult situation. They have had their own internal problems to come to terms with the disease, to finally address it, to work on it. And now, as I said before, these restrictions and these roles put another stone in the way, another difficulty, to really address the disease as it should be addressed.

AMY GOODMAN: As we travel through Africa, in Uganda, the report says, in the two years since the new U.S. emphasis on youth abstinence began, the rate of new HIV infections has almost doubled. Since the arrival of PEPFAR money, the student and teacher materials in schools now stress abstinence. One student handbook advises, young people do not need condoms, they need skills for abstaining from premarital sex.

MARINA WALKER GUEVARA: Exactly. And one interesting thing is that a lot of the condoms information that used to be included in the students’ books was required by the Inter-Religious Council of Uganda to be — they required that that information be excised from the books. Well, the Inter-Religious Council of Uganda has been awarded a $15 million PEPFAR grant very recently to run prevention, treatment and cure programs, which tells you which are the priorities of the U.S. government at the time.

AMY GOODMAN: PEPFAR requires its partners to emphasize condom failure rates?

MARINA WALKER GUEVARA: They do require that partners in the field emphasize failure rates of up to 20 percent. They say most groups are saying these days, especially the faith-based groups, I should say, that condoms are effective between 80 to 85 percent. And other studies have found that they’re a much higher rate of effectiveness. And people in the field, what they say is that in countries where condom use is still taboo, it’s very, very dangerous to be emphasizing these type of very high failure rates.

AMY GOODMAN: Marina Walker Guevara is an investigative reporter with the Center for Public Integrity. I want to ask her about Ethiopia, but before we do, I want to go to Sarah Fort, who is another of these reporters who worked on this report for the Center for Public Integrity. You spent time, Sarah, in Haiti. What did you find?

SARAH FORT: While I was in Haiti, I found that one of the most serious issues that wasn’t being addressed by the president’s emergency relief plan was that of gang rape. There is a very serious issue of rape right now, especially in Port-au-Prince, and it’s something that is not being addressed by any of the prevention programs that I observed.

AMY GOODMAN: Explain further.

SARAH FORT: So, for example, what I understood is that in particularly low-income areas of Port-au-Prince, gang rape is a serious problem for many women, women who are trying to, for example, go get water or go buy food at the market. They’re quite fearful of leaving areas that they feel safe. And there aren’t programs that are addressing women’s insecurity or fear or economic vulnerability in these areas. And several women that I spoke to, several organizations that I spoke to said that they wish that there were more funding dedicated to these causes.

AMY GOODMAN: Recently, in August, we did a report on the Lancet study, the prestigious medical journal, that said 8,000 murders, 35,000 rapes and sexual assaults in Haiti during the time of the U.S.-backed coup regime, after the Aristide ouster. A Wayne State University student and professor led this study. And then, in the last few days, BBC just came out with a big report. In both cases, they talked about the role of U.N. peacekeepers involved in preying on kids in Haiti.

SARAH FORT: That’s correct. I did hear of cases where U.N. peacekeepers were involved, but in general it seemed that most of the cases were resulting from gang violence. That’s what I understood from the women at the Rape Crisis Center, where I spent some time.

AMY GOODMAN: And how did you see the PEPFAR policies, in particular, playing out, the president’s initiative on emergency funding for AIDS, in Haiti?

SARAH FORT: Well, Haiti is a little bit more complicated than some of the other countries, because of the insecurity, so many of the programs that had begun in other countries had not actually yet begun in Haiti and are only just now beginning, in particular, prevention programs. There are some exceptions — treatment programs have continued — and some exceptional organizations — Partners in Health being one of them — have been able to continue to provide treatment. It’s the prevention programs that we are spending some more time looking at, and many of them had not begun. Many people, American workers, employees, American staff, USAID staff, were actually evacuated to Miami several times and were unable to continue with some of the prevention programs while I was there.

AMY GOODMAN: According to U.N. data, women and girls in the Caribbean, 15 to 24 years old, are up to six times as likely as men to contract HIV, often as a result of sexual violence. In Haiti, you report says, the money being spent by the U.S. government on HIV prevention has not yet seriously addressed the issue of violence against women. How would it do that?

SARAH FORT: I think there are many ways that it could. I think recognizing women’s vulnerability and insecurity is one way, perhaps trying to make sure that there are more economic opportunities for women and girls, perhaps having more programs that target boys or men to recognize the disparity between men and women. Again, I’m a reporter and not an advocate or a policy person, so it’s harder for me to say what exactly should be done. I’m only able to say what I observed while I was there.

AMY GOODMAN: We’re talking to Sarah Fort. She spent time in Haiti and is one of the reporters who put together this report looking at PEPFAR, the president’s emergency initiative for AIDS around the world, emergency funding for AIDS. Marina Walker Guevara, also with us, who spent time in Ethiopia. Can you describe the situation there, Marina?

MARINA WALKER GUEVARA: Yes. In Ethiopia, one of the things that I found most interesting and sad, at the same time, is that, as we know, because of the terrible economic situation that most women go through in Ethiopia, commercial sex work is widespread, yet very, very few PEPFAR programs are targeting this group. There is one major area for commercial sex works, that is the Djibouti corridor, which is the main route to the sea, Ethiopia to the sea. And in this area of the program that we investigated, a PEPFAR program that is operating there, more than 80 percent of its funding is directed toward fidelity and abstinence activities, which people doing work in the field say they feel that does not fit the environment, does not respond to the needs of these women.

I talked to women, to sex workers. They also had been trying to get some PEPFAR funding to start small business opportunities, anything that can get them away from the life that they are having now, and they were denied that funding. So there’s a lot of frustration. There’s a lot of concern as to whether these programs are really going to change anything in that area.

The other thing is that there’s a lot of money going to the Ethiopian Orthodox Church and also to the Muslim community. This is right, in a way, because these two groups really, really have a huge influence in Ethiopia, so not acknowledging them would be probably not the smartest thing to do, but the problem with these two groups is that neither of them address condoms in their programs. They have explicit policies that they do not — they don’t talk against condoms, so at least that’s good. But they don’t address them, either. So again, it’s like policies that — how effective can they be? And people that get these programs in rural areas, areas where they don’t get radio programs or TV programs or any other information, supplemental information about condoms, then they just get the abstinence message. And what happens when they can’t or they don’t abstain anymore?

AMY GOODMAN: I mean, the numbers are quite astounding. When condom use enforced on sex workers in the brothels, the number of annual new HIV infections fell from 143,000 in 1991 to about 20,000 by 2003.

MARINA WALKER GUEVARA: Exactly. Exactly. So that shows you how important it is to have comprehensive programs. What most people are saying in the field is that all three components — abstinence, being faithful and condom use — should be taught. The choice should be there for people to choose what best fits their situation and that there also should be programs addressing violence, gender inequality, economic empowerment and all these other situations that are unfortunately part of the landscape in many developing countries.

AMY GOODMAN: Marina, why did you call the report “Divine Intervention”?

MARINA WALKER GUEVARA: We call it, because we think that — I think that many elements in PEPFAR do cater to faith-based interests. And in some cases, the policies seem to be built more around some faith-based concepts, rather than science.

AMY GOODMAN: And we didn’t talk much about Asia, but you do in the report that the Center for Public Integrity has put out.

MARINA WALKER GUEVARA: Yes, we sent reporters, and we work with reporters in Thailand and in India, and those are countries that we need to watch. Thailand was a huge success story in the '90s, and now its own government is cutting funding on prevention. And that's very scary. PEPFAR did not choose Thailand as a focus country. There’s relatively little money spent there. And if you add all the restrictions and all the policies, specifically the policies that have to do with commercial sex workers — as you may know, there’s the anti-prostitution loyalty oath that organizations doing HIV work must sign, saying that they oppose prostitution. Well, many organizations working with sex workers, they cannot say that. Otherwise, they should, like, shut down their operations. So they just refuse to get funding, and in consequence, women are not served.

AMY GOODMAN: How difficult was it to get information, Marina? You filed lawsuits?

MARINA WALKER GUEVARA: Yes, we filed three lawsuits against the State Department, Human Services and the U.S. Agency for International Development. It was very difficult to get information. We filed more than two dozen Freedom of Information Act requests during the year that the investigation lasted, and in the end we got some information, because of the lawsuits, basically, which is scary because this is information that is public, that should be available. It’s information that has nothing to do with national security or with any other topic that may concern the government. And basically, if you don’t have the money to file a lawsuit, you don’t get information. And we didn’t get the funding information that we were expecting. The government released some sort of database that contained errors, and they acknowledged that they still don’t have a good database, that they are improving, that they are trying. So this also raised concerns about the accountability of the project, of the PEPFAR program.

AMY GOODMAN: They’re blacking out financial information. This is public funding. This is funding using taxpayer dollars.

MARINA WALKER GUEVARA: Exactly. They have, you know, excuses as to why they do that. Fortunately, we were able to get some financial information from the groups that are receiving money.

AMY GOODMAN: Well, we’re going to have to leave it there. Marina Walker Guevara and Sarah Fort, I want to thank you both for being with us, investigative reporters with the Center for Public Integrity. The new report is called “Divine Intervention.”

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