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Which HIV prevention programs are truly saving lives in Africa?

In 2003, President Bush asked Congress for $15 billion to establish the PEPFAR plan to fight AIDS in Africa. A contentious debate ensued. The Democrats were seeking condom-centered prevention, and Republicans were demanding abstinence-only programs. In the midst of it all, Uganda’s first lady, Janet Museveni, came to Washington and made a compelling case for abstinence-based programs. (In the end, Congress voted to earmark $1billion of PEPFAR for abstinence-only-until-marriage efforts.

Towards the end of Bush’s second term, almost everyone could agree that the drug portion (distribution of antiretrovirals) of PEPFAR was extremely successful, even eliciting support from the likes of Bono and Bob Geldof. But there was still controversy over what made for successful HIV prevention.

During Obama’s run for the presidency he made it clear he would continue the good work that had been started with PEPFAR. However, he indicated his desire to “rewrite much of the bill to allow best practices – not ideology – to drive funding for HIV/AIDS programs” (i.e., return to condom-centered efforts), and in late 2008, Congress stripped PEPFAR of its abstinence-only earmark. It appears that Obama will continue the long legacy of HIV prevention utilizing technical approaches such as HIV testing and condom distribution. His administration has also stated their intention to reintegrate HIV prevention with other reproductive health programs that include abortion and contraceptive services.

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