Global Health: Spending Requirement Presents Challenges for Allocating Prevention Funding under the President's Emergency Plan for AIDS Relief
GAO-06-395
Published: Apr 04, 2006. Publicly Released: Apr 04, 2006.
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Highlights
The U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 authorizes the President's Emergency Plan for AIDS Relief (PEPFAR) and promotes the ABC model (Abstain, Be faithful, or use Condoms). It recommends that 20 percent of funds appropriated pursuant to the act be spent on prevention and requires that, starting in fiscal year 2006, 33 percent of prevention funds appropriated pursuant to the act be spent on abstinence-until-marriage. The Office of the U.S. Global AIDS Coordinator (OGAC) is responsible for administering PEPFAR. GAO reviewed PEPFAR prevention funds, described PEPFAR's strategy to prevent sexual HIV transmission, and examined related challenges.
Recommendations
Matter for Congressional Consideration
| Matter | Status | Comments |
|---|---|---|
| Given the challenges that meeting the abstinence-until-marriage spending requirement presents to country teams attempting to implement locally responsive and integrated HIV/AIDS prevention programs, Congress, in its ongoing oversight of PEPFAR, may wish to use the information provided by OGAC to assess the extent to which the spending requirement supports the Leadership Act's endorsement of both the ABC model and strong abstinence-until-marriage programs. | The U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (P.L. 108-25) requires that President's Emergency Plan for AIDS Relief (PEPFAR) spend at least 33 percent of funds for the prevention of HIV/AIDS on abstinence-until-marriage programs. In April 2006, GAO reported that this spending requirement presented challenges for country teams that manage PEPFAR in the field (GAO-06-395). GAO suggested that Congress consider information from the Office of the Global AIDS Coordinator (OGAC) on the spending requirement's effect on country teams' efforts to prevent sexual transmission of HIV and use this information to assess the extent to which the spending requirement supports the Leadership Act's endorsement of the ABC model (abstain, be faithful, or use condoms) and strong abstinence-until-marriage programs. In April 2008, GAO reported that HIV/AIDS experts expressed concerns about the effects of the abstinence-until-marriage spending requirement on country-based and evidence-based programming (GAO-08-480). In the event that Congress removed PEPFAR's spending directives, GAO suggested that Congress encourage OGAC to adopt a more country-based and evidence-based approach to allocating funds. In July 2008, the President signed the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act (H.R. 5501) into law. The act reauthorizes PEPFAR for another 5 years. It removes the abstinence-until-marriage spending requirement and calls for the Global AIDS Coordinator to ensure that abstinence and fidelity programs are evidence-based and country-based. After the House of Representatives passed the original version of this bill in April 2008, a press release from the House Committee on Foreign Affairs noted that the bill removed the abstinence-until-marriage spending requirement, citing recent GAO reports about the spending requirement's negative effect on PEPFAR efforts in the field. | |
| Given the challenges that meeting the abstinence-until-marriage spending requirement presents to country teams attempting to implement locally responsive and integrated HIV/AIDS prevention programs, Congress, in its ongoing oversight of PEPFAR, may wish to review and consider the information provided by OGAC regarding the spending requirement's effect on country teams' efforts to prevent the sexual transmission of HIV. | The U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (P.L. 108-25) requires that President's Emergency Plan for AIDS Relief (PEPFAR) spend at least 33 percent of funds for the prevention of HIV/AIDS on abstinence-until-marriage programs. In April 2006, GAO reported that this spending requirement presented challenges for country teams that manage PEPFAR in the field (GAO-06-395). GAO suggested that Congress consider information from the Office of the Global AIDS Coordinator (OGAC) on the spending requirement's effect on country teams' efforts to prevent sexual transmission of HIV and use this information to assess the extent to which the spending requirement supports the Leadership Act's endorsement of the ABC model (abstain, be faithful, or use condoms) and strong abstinence-until-marriage programs. In April 2008, GAO reported that HIV/AIDS experts expressed concerns about the effects of the abstinence-until-marriage spending requirement on country-based and evidence-based programming (GAO-08-480). In the event that Congress removed PEPFAR's spending directives, GAO suggested that Congress encourage OGAC to adopt a more country-based and evidence-based approach to allocating funds. In July 2008, the President signed the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act (H.R. 5501) into law. The act reauthorizes PEPFAR for another 5 years. It removes the abstinence-until-marriage spending requirement and calls for the Global AIDS Coordinator to ensure that abstinence and fidelity programs are evidence-based and country-based. After the House of Representatives passed the original version of this bill in April 2008, a press release from the House Committee on Foreign Affairs noted that the bill removed the abstinence-until-marriage spending requirement, citing recent GAO reports about the spending requirement's negative effect on PEPFAR efforts in the field. |
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of State | Because meeting the 33 percent abstinence-until-marriage spending requirement can challenge country teams' ability to allocate prevention resources in a manner consistent with the PEPFAR sexual transmission prevention strategy, the Secretary of State should direct the U.S. Global AIDS Coordinator to collect information from the country teams each fiscal year on the spending requirement's effect on their HIV sexual transmission prevention programming and provide this information in an annual report to Congress. This information should include, for example, the justifications submitted by country teams requesting exemption from the spending requirement. The information collected should be used by the U.S. Global AIDS Coordinator to, among other things, assess whether the spending requirement should be applied solely to funds appropriated to the Global HIV/AIDS Initiative account, in line with OGAC's legal determination that the requirement applies only to these funds. |
Congressional action has rendered this recommendation moot. Specifically, in July 2008, the President signed the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act (H.R. 5501) into law, which reauthorizes PEPFAR for another 5 years. It removes the abstinence-until-marriage spending requirement and calls for the Global AIDS Coordinator to ensure that abstinence and fidelity programs are evidence-based and country-based. After the House of Representatives passed the original version of this bill in April 2008, a press release from the House Committee on Foreign Affairs noted that the bill removed the abstinence-until-marriage spending requirement, citing recent GAO reports about the spending requirement's negative effect on PEPFAR efforts in the field.
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MalariaAIDSAppropriated fundsBudget outlaysDeveloping countriesFinancial analysisHealth care programsInternational organizationsNational policiesPolicy evaluationSexually transmitted diseasesStrategic planning