In mid-September, I was lucky enough to be a part of a group of young people from Advocates for Youth, comprised of students and activists from the US, Jamaica, Nigeria, and Ethiopia, that met with the Office of the Global AIDS Coordinator (OGAC).  OGAC is responsible for administering and overseeing the President’s Emergency Plan for AIDS Relief, which was reauthorized in 2008.  We met with OGAC to talk with them about how new funding regulations and policies would affect young people in PEPFAR countries.

With the first PEPFAR authorization in 2003, the authorizing legislation required that a third of all HIV prevention funding (20 percent of the total PEPFAR funds) be used for abstinence-until-marriage programs, or the “A” part of the ABC approach to prevention.  For young people, the B (be faithful), and C (consistent and correct condom use) approaches were emphasized less than abstinence and were stressed mainly as interventions for married couples, commercial sex workers, and “high risk” groups. Fortunately, the reauthorized PEPFAR does not include the earmark for abstinence-until-marriage funding. 

However, the new law does include a new reporting requirement that requires OGAC to submit an explanation to Congress whenever countries with generalized epidemics utilize less than 50 percent of their funds allocated to prevention of sexual transmission on programs containing abstinence, delay of sexual initiation, fidelity, monogamy, and partner reduction components.

While this may not seem like a problem, it’s still a worrisome regulation. 
In this vein, it was not clear whether OGAC’s current legislative interpretation means that a comprehensive program that teaches the values and benefits of abstinence, while also teaching faithfulness and condom use, would count towards the 50 percent requirement, or if the inclusion of condom instruction would render it a “C” program in the eyes of PEPFAR and congressional stipulations. It’s important OGAC employs a prevention model for young people that is centered on comprehensive prevention education, because when it comes to HIV prevention, we need to make sure that young people have all the information that they need to prevent HIV.  There is no evidence that abstinence only programs work, whereas comprehensive programs have been shown to delay sexual initiation and increase correct and consistent condom use among sexually active youth.  We need comprehensive education, which is by definition inclusive of abstinence, to count towards soft quota for “AB” programs.

Because the HIV pandemic affects a vast number of young people, it’s important that they be included in the conversations about implementation of PEPFAR and also that they be a major focus group for PEPFAR funding and programming.  Youth activists from Ethiopia, Nigeria, and Jamaica were able to share with OGAC the major success that they have had in influencing policy in their countries.  They have also been able to reach out to their peers through the schools and through extension workers to educate other young people about sexual and reproductive health, including HIV prevention.   In particular, there has been a focus on incorporating the voices of young people who are HIV-positive in crafting strategies to help them live longer and better lives.  But there also needs to be an increased focus on getting feedback from young people who are at risk of infection about how to best reach them, help them, and get them the information and education that they need to prevent HIV infection.

We were all very grateful that OGAC took the time to meet with us and hear from youth activists.  We’re hopeful about the direction that PEPFAR is heading, and we’re encouraged that abstinence-only restrictions have been relaxed, but it’s important to ensure that comprehensive education, which includes “A,” “B,” and “C” is readily available in PEPFAR countries and fits within the “AB” reporting requirements.   We also want to ensure that young people, who constitute 45 percent of all new HIV infections, are included in the planning, implementation, and monitoring and evaluation of prevention efforts.  We’ve seen that young people can make a difference in designing and implementing policy and reaching out to other adolescents.  In the fight against HIV, it’s vital that our voices be heard.