Funding with moral strings attached

In his 2003 State of the Union Address, US President Bush announced the President's Emergency Plan for AIDS Relief, often known as PEPFAR, a five year $15 billion global initiative to combat the HIV/AIDS epidemic. PEPFAR programs have proven effective in many areas, particularly in the scale-up of AIDS treatment in its 15 target countries. PEPFAR has also been dogged by controversy, particularly the amount of its funding allocated to abstinence HIV prevention programs, and the pledges that non-profit AIDS groups must sign before being eligible to recieve PEPFAR funds, i.e. pledges opposing prostitution or pledges that one will not give clients information about or referrals to reproductive services that also offer abortions.

As for the money alloted to abstinence programs, it is written into the 'United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003', and it is unlikely to be removed. The pledges, on the other hand, may be more negotiable. Last May, DKT International Inc. sued USAID, the agency in charge of PEPFAR, claiming that forcing them to sign a pledge opposing prostitution was a violation of the right to free speech. A US District Court judge sided with DKT, but this week the Justice Department has appealed the decision. According to the press report, the Justice Department claims that the pledge was "highly germane" to the overall goal of fighting the spread of AIDS and HIV, because:

Congress could reasonably determine that the government's efforts to stamp out prostitution and sex trafficking would be most successful if HIV/AIDS services are provided by organizations that affirmatively oppose two underlying causes of the disease.

But it is a very strange line of reasoning. There is no empirical evidence of the efficacy of signing these pieces of paper in the struggle against HIV/AIDS, and it is not as if organizations working with sex workers are 'in favor' of the trade. Nor are prostitution and sex trafficking 'two underlying causes of the disease'. They are ways that HIV/AIDS gets spread, but if you want to find underlying causes, it might be more wise to look at why women (and men) in developing countries enter into prostitution in the first place. DKT would surely sign a pledge against poverty, but the current US government seems more interested in using pledges to moralize about sexual behavior.