She's Married, She's Faithful, She's Dying: Politicizing the President's Emergency Plan for AIDS Relief

Conservative Christians played a significant role in pioneering the United States’ groundbreaking anti-HIV funding initiative, the President's Emergency Plan for AIDS Relief (PEPFAR). Consequently, PEPFAR is widely regarded as George W. Bush's crowning achievement. The same political forces that ushered in PEPFAR under President Bush were also the architects of strict ideological restraints around the otherwise straightforward public health goal of curbing the spread of HIV/AIDS. In recent years, some of these restrictions have been rolled back or struck down by the U.S. Supreme Court, and PEPFAR has continued to serve a crucial role in global health and security. PEPFAR's future success in achieving its health mandate (to create an AIDS-free generation) will be influenced by lessons from its past. This article illuminates how, in its first decade, PEPFAR was directed toward the fulfillment of socially conservative goals that ran counter to its official agenda. This was accomplished in large part through two controversial provisions: the “anti-prostitution pledge” (2003–2013) and the “conscience clause” (2003–present). Working in tandem, these policies sought to secure funding for organizations that favored abstinence and fidelity rather than a multisectoral approach to AIDS prevention.

Cameroon: Peer education and youth-friendly media reduce risky sexual behavior

Cameroonian researchers at the Institute of Behavioral Studies and Research (IRESCO), with support from FRONTIERS, conducted an operations research project between 2000 and 2002 to assess strategies to encourage abstinence, increase contraceptive use, and reduce sexually transmitted infection (STI) rates among sexually active youth. The intervention combined peer-education strategies with media campaigns to promote healthy behavior among youth in the Mokolo neighborhood of Yaoundé. IRESCO trained 49 peer educators aged 19–25 in reproductive health (RH) communication strategies. The team coordinated educational talks, counseling sessions, conferences, and cultural and athletic events; produced comic books and brochures; and sold French and English editions of Among Youth magazine, featuring celebrity interviews and information on RH, unwanted pregnancy, and STI transmission. IRESCO evaluated the intervention’s impact through baseline and endline surveys of 2,500 youth in Mokolo and the control site, New Bell, in Douala. This brief concludes that urban youth in Cameroon are knowledgeable about HIV/AIDS and the risks of early pregnancy, but their behavior often fails to reflect their knowledge. Peer-education programs targeting youth through one-on-one counseling, theatrical performances, youth magazines, and sporting events increases abstinence and fidelity and improves consistent and correct condom use.