How Ideology Trumped Science: Why PEPFAR Has Failed to Meet its Potential

A report by Evertz S H sponsored by the Council for Global Equality. Evertz was the director of the Office of National AIDS Policy during U.S. President George W. Bush's first term.

The report looks at PEPFAR’s development and considers how its flawed, ideologically driven framework hindered, rather than supported, preventive efforts to stem the spread of HIV/AIDS.

The report covers the PEPFAR policy requirement that recipients of funding adopt a policy explicitly stating their opposition to prostitution and sex trafficking - this is often known as the 'Prostitution Pledge'.

The report concludes that,

"The antiprostitution loyalty oath has done nothing to reduce the numbers of women and men who, for economic or other reasons, engage in commercial sex work. It has, however, impeded access to vital HIV prevention services among commercial sex workers and has had a chilling effect on organizations that work with them. In fact, some organizations have foregone PEPFAR grant monies rather than sign the oath.

Sexual activities remain the main route of HIV transmission, and commercial sex workers and their clients continue to be at increased risk for contracting HIV. Requiring those engaged in outreach to these risk groups to adhere to the loyalty oath does nothing to stem the spread of HIV and it does not, as has been written, slow the growth of the business of prostitution. As long as the oath is in place, the Office of the U.S. Global AIDS Coordinator should issue policy guidance to make clear to countries receiving PEPFAR funds that those who do sign the oath, while being forced to denounce prostitution, are not prohibited from conducting campaigns of prevention, care, and treatment to commercial sex workers. Congress should consider introducing an amendment during the next PEPFAR appropriations process to eliminate the anti-prostitution loyalty oath entirely."