The US Government Accountability Office (GAO) today released a long-awaited report analyzing the effects of the abstinence-until-marriage earmark in the US Global Leadership on HIV, Tuberculosis, and Malaria Act of 2003, also known as the President's Emergency Plan for AIDS Relief, or PEPFAR. In theory, the law supports a comprehensive approach often described as ABC or Abstain, Be Faithful, Use Condoms, and argues that prevention programs should be designed to meet local needs and realities. In practice, the law requires that, as of FY 2006, at least 33 percent of prevention funding be set aside for so-called "abstinence-until-marriage" programs. "Key findings in the GAO report confirm what we have argued for over two years," stated Jodi L. Jacobson, Executive Director of the Center for Health and Gender Equity. "The earmark effectively requires that prevention programs be designed to respond to the ideological agenda of the Bush Administration and Congress, rather than the local prevention needs of individuals and populations at immediate risk of HIV infection," stated Jacobson. "Indeed, the earmark and the restrictive interpretations of the law by OGAC together contradict the law's stated intention that programs respond to local epidemiological needs and cultural realities and that prevention efforts be integrated." Key findings in the GAO report included the following: · OGAC is applying the abstinence-until-marriage earmark to a larger pot of money than required by law, further reducing the flexibility of program managers in the field. · Funding streams and program efforts for "A," "B," and "C" are "disaggregated," rather than treated as an integrated whole and as a result deny individuals at risk access to life-saving information, skills, and technologies. · Spending requirements and ambiguities in program guidance have created confusion about how to implement the "ABC" model under PEPFAR in many countries. · Exemptions from the earmark received by one recipient country mean that another country has to make up the difference by spending more on abstinence-until-marriage programs, leading to cuts in comprehensive ABC approaches designed to meet the needs of populations at immediate risk of contracting HIV. The end result is that sexually active adolescents and adults, sero-discordant couples and others at immediate risk of HIV infection are left in the breach while Congress and the Administration fight a political and ideological battle over safer sex. "In effect, we are wasting hundreds of millions of US taxpayer dollars and precious time that could be better used to prevent the spread of a deadly infection and to save billions in treatment costs down the line," stated Jacobson. "This is no way to respond to an epidemic in which there are 5 million new infections every year." "President Bush has stated, and Congress has agreed, that saving lives by preventing the spread of HIV is a primary goal of the United States," noted Jacobson. "Rather than dictating agendas from Washington, we need to let public health professionals and human rights advocates do what is needed: ensure that all persons have access to all the tools necessary to protect their own, their partners', and their families' health." To do so, stated Jacobson, "Congress should strike the earmark for abstinence-until-marriage programs and encourage the development of comprehensive programs that best meet local needs."