The original PEPFAR law contains a provision that enables organizations receiving U.S. funding to elect which prevention and treatment services they wish to provide. This clause allows organizations receiving public funding to carry out prevention programs based on their own philosophy, even if it is in conflict with human rights and evidence-based interventions. For example, millions of dollars go to organizations to provide HIV prevention services, even if they refuse to discuss safe sex options like male or female condoms or other contraceptives in preventing the spread of HIV.
The 2008 PEPFAR reauthorization law exacerbates this policy by extending the so-called “conscience clause” to organizations that provide care and support to people living with HIV/AIDS, their families, and their communities. This enables organizations that receive U.S. funds to choose those groups and individuals to whom they are “morally” comfortable providing care, thereby permitting the denial of services to those whose behavior, identity, religion, or other attributes may be deemed unacceptable. During the nearly three decades of the HIV/ AIDS epidemic, efforts to reduce and eliminate stigmatization of those infected and those at risk have been a critical factor in successful approaches to prevention. Yet, the conscience clause actually codifies the acceptance of stigmatization and discrimination and allows the use of U.S. taxpayer funds to perpetuate such discrimination. This is a part of U.S. law, and can only be altered by U.S. Congress.
Evidence and human rights, not religion or ideology, should guide the spending of public health funding. Conscience clauses have no place in the provision of health care funded by taxpayer dollars. If a group or organization cannot, due to its own ideology, implement programs or provide care based on the best available public health evidence, it should not be eligible for public funding for such programs.
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