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The Future of PEPFAR: What Zambia Teaches Us

Earlier this month, Population Action International (PAI) and the Sexuality Information and Education Council of the United States (SIECUS) teamed up to conduct a joint policy research trip to Zambia. Zambia is one of the 15 focus countries prioritized to receive global U.S. HIV/AIDS assistance. Zambia was also one of the first countries where PAI documented, in 2003, the destructive impact of the Global Gag Rule (also known as the Mexico City policy) on family planning and reproductive health care services. Other criteria, however, also made Zambia an ideal country through which to answer many questions about the effects of U.S. policy and funding. Long before PEPFAR’s arrival, a conservative religious environment defined Zambian society, within which the promotion of abstinence and marriage were already strong currents in everyday life. First, what would the effect be after four years of the U.S. putting nearly $577 million into the country under policies that disproportionately emphasize these strategies over a more comprehensive HIV- prevention approach that included condom education and distribution? Second, how are PEPFAR policies interpreted and implemented in this environment? And have they exacerbated the dire sexual and reproductive health and rights situation in Zambia, where rural family planning and reproductive health outreach collapsed after the country’s leading SRHR provider refused the terms of the Global Gag Rule? Third, has U.S. assistance harmonized with other donors and what has the Zambian government’s role been in the midst of this? And finally, and perhaps most importantly, what are the needs of the health care workers on the ground and the Zambian people themselves in attempting to stem the generalized HIV epidemic in the country?…(read more)