By Lydia Gensheimer

In advance of World AIDS Day on Dec. 1, HIV/AIDS experts and activists on Thursday called for a revised, holistic approach to combat the HIV/AIDS epidemic.

Congress is set to reauthorize the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2008 and advocates and policy experts are weighing in on the direction the five-year reauthorization should take.

When PEPFAR was launched in 2004, the program set the goal of treating two million people with anti-retroviral therapy, preventing 7 million new infections and supporting the care of 10 million people in the program’s 15 recipient countries.

At the program’s inception, President Bush pledged $15 billion over five years to fight the global HIV/AIDS pandemic. He has called on Congress to double that amount to $30 billion over fiscal 2009-2013.

Experts, though, say $30 billion may not be enough to fight the epidemic in the next five years. And many are demanding a more comprehensive approach to combat the epidemic.

“The problem with HIV is this is a very deep bucket,” said J.P. Heath, co-founder of ANERELA+ (African Network of Religious Leaders Living with or Personally Affected by HIV and AIDS). “And it’s going to take an even bigger response than what we currently see pledged. We are going to have to do so much more.”

Heath said the wide range of factors that contribute to HIV — from migrant labor to poverty to women’s issues to domestic violence — necessitate a holistic response to the epidemic.

Bernice Heloo, president of the Society for Women and AIDS in Africa, who spoke to reporters from Ghana on Thursday, called on Congress to address women’s vulnerabilities when drafting the PEPFAR reauthorization.

“To reduce the feminization of HIV on the continent, we need fully-funded programs that are truly comprehensive and holistic in nature,” Heloo said. “We call for programs that would promote the reproductive health of women and girls.”

Chairman of the House Foreign Affairs Committee Tom Lantos , D-Calif., has said PEPFAR’s reauthorization must represent a shift from emergency efforts to a sustainable approach to combating HIV/AIDS. But the committee’s ranking Republican, Ileana Ros-Lehtinen of Florida, in remarks before a PEPFAR hearing in September, cautioned against directing PEPFAR money to nutritional or health care systems deficits.

“If PEPFAR is directed to take on the universe of problems that plague the Focus Countries, we risk reducing it to a program that is a mile wide and an inch deep,” Ros-Lehtinen said in September.

Abstinence-Only Earmark

Experts Thursday also voiced concern with a provision in the 2003 PEPFAR legislation (PL 108-25) that requires one-third of all money spent on HIV prevention go to abstinence-until-marriage programming.

“We add our voice to demand the removal of the one-third abstinence earmark and also ask for a track out of the anti-prostitution pledge which is really discriminatory,” Heloo said.

Under the 2003 PEPFAR law, an organization must have a policy explicitly opposing prostitution and sex trafficking before it is eligible to receive HIV funds.

Lawmakers have taken aim at the so-called abstinence earmark, and as members prepare to reauthorize PEPFAR, opponents of the abstinence earmark may be able to eliminate it when PEPFAR is reauthorized. Bills introduced in the House (HR 1713) and the Senate (S 1553) by California Democrats Rep. Barbara Lee and Sen. Dianne Feinstein respectively, would strike the earmark.

Serra Sippel, executive director of the Center for Health and Gender Equity (CHANGE) called the Lee and Feinstein bills “promising efforts.”

“I think given the leadership within Congress now, we are hopeful that these changes will be incorporated,” Sippel said.

She emphasized, though, that removal of the abstinence-until-marriage provision would not eliminate PEPFAR’s focus on abstinence; rather, it would lend flexibility when determining how to divvy up aid.

“Given the conservative stance of this administration . . . an important message in all this is that eliminating the earmark does not eliminate abstinence form a prevention approach,” Sippel said. “Abstinence is part of a comprehensive approach.”

Krystle Corpuz, a member of the International Youth Leadership Council, Advocates for Youth, stressed that abstinence-until-marriage programming is often ineffective for women who have little or no control over who they have sex with or at what age.

“We need to increase access to HIV prevention and not limit it to abstinence-until-marriage programs,” Corpuz said.

Because HIV does not discriminate, Corpuz said, “its prevention should not categorize who should and who should not receive information.”

Heath said aid efforts need to steer away from the current PEPFAR ABC approach: abstinence, be faithful, and correct and consistent condom use.

“The challenge with the ABC approach to HIV prevention is that the only thing we’re talking about is sex,” Heath said. “The focus on sex makes HIV a moral issue. HIV is a virus, not a moral condition. So when we deal with HIV, we have to deal with it holistically, not just focusing on one aspect of prevention.”

“There Is Not a Moment to Lose”

HIV/AIDS policy advocates and experts on Thursday appealed to Congress to make improvements in HIV prevention policy sooner rather than later. Paul Zeitz, executive director of the Global AIDS Alliance Fund, said it is an important time in global efforts to fight HIV/AIDS.

Not only is Congress going through the PEPFAR reauthorization process, Zeitz said, but Democratic presidential candidates are “making the issue known.”

Illinois Sen. Barack Obama , New York Sen. Hillary Rodham Clinton , and John Edwards , a former North Carolina senator, have all pledged to provide $50 billion by 2013 to fight HIV/AIDS.

Joanne Carter, associate executive director of RESULTS/RESULTS Educational Fund (REF), said it is imperative for the Senate to pass a bill authorizing over $800 million to fight tuberculosis, which is the leading cause of death among those who are HIV-positive. The Senate Foreign Relations Committee approved the bill (S 968) Sept. 11, but the legislation has yet to make its way to the Senate floor.

The House passed its version of the bill ( H.R. 1567) Nov. 5, 2007.

“TB has been grossly under financed, almost to the point of negligence,” Carter said. “We need to scale up resources for TB treatment and prevention.”

Nearly a third of all people with AIDS are infected with TB, Carter said. Screening those with AIDS for TB is one of the best ways to reduce mortality rates, she said.

The PEPFAR reauthorization, Carter said, must include a “major TB scale up.”

Two days before World AIDS Day, activists said the time is ripe for lawmakers to work to make changes to the United States’ HIV/AIDS policy.

William G. Sinkord, a minister and president of the Unitarian Universalist Association, said there were 2.8 million new HIV infections in sub-Saharan Africa last year. Sinkord said that according to UNAIDS, the Joint United Nations Programme on HIV/AIDS, prevention efforts are reaching fewer than 20 percent of those in need.

“We must work together to stop the spread of HIV,” Sinkord said. “Right now. Today. There is not a minute to lose.”