September 18, 2013, Vol 310, No. 11
PEPFAR’s Antiprostitution PledgeSpending Power and Free Speech in Tension
Lawrence O. Gostin, JD1
Excerpt (per Jama convention)
The United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003, which established the President’s Emergency Plan for AIDS Relief (PEPFAR), exemplifies the nation’s extraordinary compassion and generosity—granting $48 billion over the current 5-year period (2009-2013). PEPFAR, however, has mired successive administrations in controversy for politicizing public health. PEPFAR must report to Congress if a country fails to spend at least one-half of its prevention funding to promote “abstinence, delay of sexual début, monogamy, fidelity, and partner reduction.” PEPFAR’s “conscience clause” allows organizations to withhold particular services (eg, condoms) or deny individuals care (eg, based on sexual orientation) if the organization has a moral or religious objection.