Good Money After Bad (Ideas)

In recent years the strong ideologically conservative and religious climate in the United States has resulted in increased political and financial support for abstinence-only-until-marriage education programs. Under the Bush Administration, federal support for abstinence-only education has expanded rapidly. In fact, of the billion dollars spent on abstinence education since 1982, more than half has been spent under the current administration. This fact is alarming because of the mounting evidence that abstinence-only programs do not work. A recent report, published in the British Medical Journal, concluded that there is no evidence that abstinence-only sex education programs reduce risky sexual behaviors, incidence of sexually transmitted infections, or pregnancy in high-income countries.

Although federal support for abstinence-only programs has been available since the early years of the Reagan Administration, they have become progressively more common in the U.S. over the last decade, largely as a result of enhanced government funding initiatives. Funding was significantly increased in 1996, when a provision was attached to welfare reform law which added Title V, Section 510(b) of the Social Security Act. Commonly referred to as Title V, this provision established a new funding stream which has allowed the U.S. government to direct more than $1.4 billion dollars to abstinence-only education programs.

Despite the lack of evidence that abstinence-only programs work to reduce HIV infections in the U.S., they are the core of the administration's plan for U.S. involvement in HIV/AIDS prevention globally. The President's Emergency Plan for AIDS Relief: U.S. Five-Year Global HIV/AIDS Strategy committed the U.S. to provide $15 billion over five years towards AIDS relief in 15 countries in Africa, the Caribbean, and in Vietnam, with about 20 percent of the funding—or $3 billion over five years—allocated for prevention. PEPFAR requires that one-third of that prevention funding be earmarked specifically for abstinence- only programs. Global AIDS prevention advocates are critical of the funding restriction, and a 2006 report by the U.S. Government Accountability Office also criticizes the earmark, outlining the challenges that the funding restrictions pose to countries hardest hit by the AIDS epidemic, and urges Congress to reconsider how this funding is spent.

Fortunately, for opponents to the policy, the political climate in the United States is changing, as evidenced by the shift in control of Congress. The Responsible Education About Life (REAL) Act of 2007, sponsored by Representatives Barbara Lee (D-CA) and Christopher Shays (R-CT) and introduced as H.R. 1653, provides federal money to support responsible sex education in schools. This education must include science-based, medically accurate, and age- appropriate public health information about both abstinence and contraception. Representatives Lee and Shays have also introduced the Prevention Against Transmission of HIV for Women and Youth (PATHWAY) Act of 2007, introduced in the U.S. House of Representatives as H.R. 1713. This legislation would require an HIV prevention strategy be developed addressing the vulnerabilities of women and girls around the world. It would also strike the earmark requiring that one-third of all HIV prevention funding be spent on abstinence- only programs.

The San Francisco AIDS Foundation is committed to evidence- based prevention programs and supports efforts to increase access to comprehensive sex education, both domestically and internationally, based on evidence which shows that these programs reduce HIV-risk behavior. OUTReach readers interested in this topic are encouraged to visit: www.sfaf.org/policy/ for more information, as well as to enroll in our HIV Advocacy Network to receive action and information alerts on this and other HIV/AIDS policy issues.