Browsing Category: Policy/Advocacy

PEPFAR, Prostitution Policy, and the First Amendment

By Sarah E. Fay, J.D,
Zamora Fellow 2009

This spring, the Supreme Court of the United States (SCOTUS) will decide whether the government can condition PEPFAR funds on the adoption of an explicit anti-prostitution policy.

On January 11 2013, SCOTUS granted a petition for writ of certiorari in the matter of United States Agency for International Development, et al. v. Alliance for Open Society International, Inc., et al(1)

Specifically, the Court will determine whether a federal conditional spending statute predicated on adoption of a policy explicitly opposing prostitution and sex trafficking violates the First Amendment. The outcome of this case will have far reaching effects throughout the HIV/AIDS community, as two of the respondents collectively include most of the organizations receiving Leadership Act funding in the U.S.

The U.S. Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003 (” Leadership Act“) is at the heart of this debate, and it is the primary vehicle for distributing funds for the President’s Emergency Plan for AIDS Relief (“PEPFAR”). The Leadership Act requires organizations receiving funds to have policies affirmatively opposing prostitution and sex trafficking:

No funds made available to carry out this chapter, or any amendment made by this chapter, may be used to provide assistance to any group or organization
that does not have a policy explicitly opposing prostitution and sex trafficking, except that this subsection shall not apply to the Global Fund to Fight
AIDS, Tuberculosis and Malaria, the World Health Organization, the International AIDS Vaccine Initiative or to any United Nations agency. 22 U.S.C. §

The Alliance for Open Society International (“AOSI”) claims that the Leadership Act’s Policy Requirement violates First Amendment guarantees by requiring grantee organizations to adopt as their own the government’s viewpoint on prostitution. Moreover, grantees’ First Amendment rights are further offended by the Policy Requirement’s application to grantees’ alternatively funded, private speech. With regard to the substance of anti-prostitution policies, AOSI states that the Policy Requirement impedes its ability to work to fight HIV/AIDS by prohibiting from discussing its work and research at “public health conferences, in publications, and on websites.”(2)

USAID asserts that congressional Spending Power permits Congress to use federal funding to further a government purpose. Here, Congress intended for the Leadership Act to include efforts to prevent the spread of HIV and alter high-risk behaviors associated with spreading the disease. Congressional findings linking prostitution and the spread of HIV serves as a strong foundation for the Policy Requirement’s focus on deterring behavior associated with prostitution. USAID claims that enlisting NGOs to spread a message aimed at preventative measures falls within the purview of SCOTUS precedent and is constitutional. Additionally, USAID notes that organizations are not required to accept the funding if they do not wish to adopt an explicit anti-prostitution policy. In the alternative, the Department of Health and Human Services and USAID, the two agencies tasked with disbursement of Leadership Act funds, have issued nearly identical guidelines allowing grantees to create or work with non-recipient organizations to engage in activities contrary to the Policy Requirement. In its petition, USAID states that this dual structure approach for affiliates “cabin[s] the effects of a restriction on speech,” thereby “cur[ing] any constitutional difficulty” relating to alternatively-funded, private speech.(3)

Aside of First Amendment implications, what is clear here is that organizations focused on HIV/AIDS issues need to be empowered to meet the needs of their communities. The sooner those organizations are able to carry out their work uninhibited, the better.

For a full discussion of the additional issues addressed in this case, please see SCOTUSblog.

The petition was made on appeal of a United State Federal Court of Appeals Second Circuit decision that affirmed
the SDNY District Court’s decision to grant a preliminary injunction against
enforcement of the Leadership Act’s pledge requirement. The case is likely to be heard during the upcoming April sitting of SCOTUS.

Brief in Opposition, p7. The Policy Requirement’s exemption of specific international organizations – such as WHO and UN – that have made statements in direct
opposition to the anti-prostitution approach underscores AOSI’s assertion.

Reflections on World AIDS Day in D.C.

By Melissa Donze, Zamora Fellow

On the evening before World AIDS Day, I took a walk down to the White House after work. As a recent transplant to D.C., the sight of the White House, the Washington Monument, and the Capitol still make me smile like a tourist. But this time, as I turned the corner and crossed through Lafayette Square, the sight of the White House took my breath away.

Draped across the North Portico was a big, red ribbon. It stood out so vividly against the white backdrop, and for a moment I stood there, frozen, completely entranced. It was an incredibly beautiful sight.

It’s been seven years since I first became actively involved in the fight against HIV/AIDS; seven years since I first started informing my high school peers about HIV; seven years since I found out that most people in my small hometown didn’t want to talk about sex or drugs or race or poverty because HIV “didn’t affect them.”

Admittedly, I was one of those people. I thought I was invincible, untouchable, unaffected. That all changed at the age of eleven, when I was diagnosed with Latent Tuberculosis. Nine months of medication, blood tests and doctor’s visits later, I stand here at the age of 22, happier and healthier than ever. I knew that the reason for my good health was the medicine I was taking, and despite financial struggles, there was never any question about affording my medication. I knew that in some way, I wanted to help those who weren’t given the chance to live, a chance I had been given without restriction or hesitation. It was a few years later on World AIDS Day 2005 that I learned about HIV through an amazing documentary, and it struck me like no other issue has struck me before; it is so incredibly preventable, yet there are still 30 million people living with HIV/AIDS today, over 1 million of which are in the United States.

Despite the fact that I had been commemorating World AIDS Day for years, this time felt different. It felt exhilarating. As I stood in front of the White House that night and gathered with strangers for a candlelight vigil the next day, I felt empowered in a way I had never felt before. There I was, standing in our nation’s capital, witnessing a fight that has always been so personal converging with the work I do daily in an incredibly powerful way. I am grateful every single day that I work at AIDS United as the Zamora Fellow, an opportunity that allows me to channel my truest passion into real, tangible progress and policy.

Just in the seven years that I have been involved in this fight, I have witnessed enormous progress. I have seen the advent of new science provide breakthrough methods of treatment and prevention. I have seen declines in transmission rates in many countries around the world. I have seen community-based organizations take innovative approaches to encourage testing and disseminate awareness about HIV-related issues. I have seen President Obama release the first ever National HIV/AIDS Strategy, which aims to reduce new HIV infections, increase access to care, reduce health inequities and HIV-related disparities, and coordinate a more effective response to the national epidemic.

At the same time, however, I see that incidence rates in the United States remain at around 50,000 new infections per year despite an abundance of information and resources to actually reduce the number of new infections. I see a huge disconnect in the number of people diagnosed with HIV and the number of people who have regular access to care and treatment. I see certain groups, especially young, African-American men who have sex with men (MSM), disproportionately affected by HIV. I see outdated policies and misguided notions perpetuate stigma and discrimination. I see newspaper columnists and government officials talk about the “global AIDS epidemic,” yet fail to consider HIV in the United States as part of this epidemic. I see an increasingly disillusioned population, in particular the youth, who do not care about HIV, who believe HIV doesn’t impact their lives in any way.

To them, I ask: Do you have sex? Do you have friends who have sex? If the answer is yes, then HIV has an impact on your life. Are you between the ages of 13-24? If the answer is yes, you are a part of the population that accounts for 25% of new HIV infections. HIV has an impact on your life. Do you live in an urban area or in the South, areas in which rates of HIV tend to be higher? If the answer is yes, HIV has an impact on your life. Do you have friends who have been tested for HIV? Have you yourself been tested for HIV? Regardless of your answer, HIV has an impact on your life.

This World AIDS Day, I remembered those we have lost, celebrated those still with us and reflected on the great strides we have made. In the face of the many challenges that confront us, I renewed my commitment to end this epidemic. We have come so far, and our success should be recognized. But we can’t let our past success preclude us from taking action today. We are at a crossroads in history; we have the science, political momentum and expertise to actually see the end of AIDS, but it requires us to take aggressive and coordinated action now.

I truly believe I will see the end of AIDS in my lifetime. Today, more than anything else, I have hope. And it is this hope that keeps me fighting every day.

AIDS United Field Team Hosts Medicaid Advocacy Training in South Carolina

By Charles Stephens, Regional Organizer

One of the more optimal paths to achieving an end to the HIV/AIDS epidemic as we know it is through the full implementation of the Affordable Care Act in this country. We are presented with a critical opportunity, particularly through the expansion of Medicaid, to increase access to HIV prevention, care and treatment. The evidence suggests this will reduce the number of new HIV infections and improve health outcomes for those living with HIV. This approach would also move the needle in creating greater parity in healthcare access, and improve the overall health outcomes for people living with HIV. In the U.S. South this change would quite literally save lives. Unfortunately, the southern region far too often lags behind the rest of the country on healthcare issues and certainly in HIV/AIDS treatment and care.  Click here

To assist our grantees and partners in their advocacy efforts for Medicaid expansion, the AIDS United Field Organizing team is hosting a series of trainings. I led the first of these events in South Carolina with the South Carolina HIV/AIDS Care Crisis Task Force (SCHACCTF). SCHACCTF is a statewide coalition of individuals, organizations, and other stakeholders committed to HIV/AIDS advocacy in South Carolina.  The goal of the training was skills building among our stakeholders on how to educate their constituency and plan their advocacy efforts in the state.

The training began with a general overview of the Affordable Care Act and how it would impact the HIV/AIDS community in South Carolina. I shared with the group how the majority of HIV/AIDS care and treatment funding is currently through Medicaid. We talked about the relationship between the Ryan White CARE Act (RWCA) and Medicaid.  I explained the RWCA is scheduled to be reauthorized before September 30, 2013. We discussed how implementation of the Affordable Care Act, especially Medicaid expansion, would impact the RWCA reauthorization potentially helping reduce the strain on RWCA funding. Whereas, the Ryan White CARE Act has to be reauthorized every 3 – 5 years, the benefit of Medicaid expansion, if fully implemented, is a permanent solution. This would create a more sustainable solution for access to healthcare for people with HIV.

We discussed the potential if Medicaid expansion is fully implemented we could end the HIV/AIDS epidemic in the United States. Greater access to HIV care and treatment would reduce the number of new infections each year and create better health outcomes for people living with HIV. Ensuring HIV positive people receive an early diagnosis, get linked to care, have access to drugs and receive assistance in managing adherence and sustaining their health and the health of their partners will lead to an AIDS free generation.

I also provided an overview of the Essential Health Benefits component of the Affordable Care Act.  States will have wide latitude in choosing 10 Essential Health Benefits categories so the minimum benefits provided from state to state will look different. Thus, the minimum benefits in California might look different than the minimum benefits in Georgia.

Developing an educational public message was an important part of the training. Participants worked together in small groups and developed messages related to Medicaid expansion advocacy. The cost effectiveness of Medicaid expansion both in terms of the federal resources that would be used to support implementation and cost effectiveness of keeping people healthier resonated most with the group. Several participants volunteered to share their messaging with the group.

Moving forward with advocacy in the state, the South Carolina HIV/AIDS Care/Crisis Task Force is hosting an Advocacy Day breakfast early next year. The group will continue advocating elected officials and key figures on the expansion of Medicaid in South Carolina. The AIDS United Field Team will continue hosting Medicaid expansion trainings over the next year. In December we are hosting events in Louisiana and Virginia.

So Many Issues, So Little Time for Lame Duck Session

by Donna Crews, Director of Government Affairs

On Tuesday, November 13 the House and Senate will convene for the “lame duck” session of the 112th Congress, which will run through the end of December. The list of legislative priorities far outweighs the six-week timeframe that Members of Congress have to address those issues. The timeframe offers less than 20 possible legislative days working 4 day weeks each week except Thanksgiving and Christmas week.

The issues that must be addressed prior to New Year’s are:

  1. Sequestration with a January 2 start date without change in legislation.
  2. Expiration of the Bush era tax cuts December 31 without an extension
  3. Expiration of long-term unemployment insurance benefits December 31
  4. Expiration of payroll and alternative minimum tax credits (AMT) December 31
  5. Decrease in the payment amount to doctors who care for Medicare patients (SGR)
  6. Emergency appropriations package for FEMA in light of Hurricane Sandy
  7. Various reauthorizations including the Farm Bill (which expired 9/30/12). This bill includes the Supplemental Nutrition Assistance Program

Other issues that will need resolution include:

  1. Possible increase in the debt limit by February
  2. Completion of Fiscal Year 2013 appropriations prior to March 27, 2013

Each one of these issues could take the complete lame duck session to debate and pass. It is expected that the Congress will come up with a legislative fix to delay or punt the first year of the $1.2 trillion sequestration plan and stop the 8.2 % cuts to non-defense discretionary. Neither Democrats nor Republicans want sequestration. When passed into law as part of the Budget Control Act in 2011, sequestration was never intended to take effect. It was included as an enforcement mechanism to encourage the bipartisan Joint Committee to come to agreement a year ago. Since that did not occur Congress and the White House must determine a way to avert the devastating impact of these possible cuts. Thus far the only budget savings have been $1.5 trillion in cuts to discretionary programs.

Now that the election is over Members of Congress may be able to debate and discuss a balanced compromise to this situation that includes revenue in addition to cuts. Thus far, Republican Members have been adamant about only including cuts to programs and the Democrats and the President have explained another deal will not be on the table without a balanced approach that includes revenue.

It is expected that President Obama will unveil his “Grand Bargain” plan to address sequestration next week. His plan likely will be based closely on his FY 2013 budget proposal, which adverted sequestration with revenue increases as well as defense and non-defense discretionary cuts. The President will give a preview of his thinking in a speech scheduled for 1 p.m. EST today (Friday, November 9). It has been reported that the bipartisan Senate “Gang of Eight,” the group of Senators charged with creating a deficit-reduction deal, has been meeting for some time but does not yet have a viable plan to avert sequestration.

AIDS United believes the most likely way forward will be a date change to the sequester of six months to a year that includes instructions for relevant committees to make changes in the tax code and determine spending cut targets. On Wednesday, November 7th, Speaker John Boehner held a press conference where he stated that Republicans are willing to discuss revenue and they await the President’s “leadership” on the fiscal concerns facing the nation.

It is not clear how much more of the lame duck issues will be resolved prior to adjournment. Those issues not addressed will have to be addressed by the 113th Congress, which convenes January 3, 2013.

The Results Are In! Congressional and State Election Breakdown

by Melissa Donze, Zamora Fellow

What an election! Tuesday saw victories across the board that could signify a change in the tide of HIV/AIDS in the United States. However, the fight to ensure the best quality of life for people living with HIV/AIDS won’t be without struggle. Here’s a breakdown of some of the major victories and challenges we can expect as a result of Tuesday’s election:


The Democrats gained two seats and will maintain control of the Senate with a likely 55 seat majority (Independents Bernie Sanders (VT) and Angus King (ME) are likely to caucus with Democrats), while the Republicans lost two seats and will hold 45 seats in the new Congress. This election saw multiple contentious tossup races go to Democrats. Here are some of the key Democratic victories from that night:

  1. In Indiana, Joe Donnelly (D) beat Richard Mourdock (R), who (along with multiple other Republican candidates) was firmly against implementation of the Affordable Care Act (ACA).
  2. Missouri saw Claire McCaskill (D) defeat Todd Akin (R), another Republican who voted against the Affordable Care Act. He also claimed it is impossible for women to become infected with HIV.
  3. In Montana, Jon Tester (D) won against Denny Rehberg (R), who as chair of the House Labor, Health and Human Services Appropriation Subcommittee has consistently sought to cut health care funding and in 2011 introduced a bill to cut HIV prevention funding and advocated to restore federal funds for abstinence-only prevention programs and revived the federal ban on syringe exchange funding.
  4. In Wisconsin, Tammy Baldwin defeated Tommy Thompson, who also advocated for abstinence-only HIV prevention programs and in 2012 suggested eliminating Medicaid. Tammy Baldwin is the first openly gay person elected to the U.S. Senate!

House of Representatives

All 435 seats in the House were up for grabs Tuesday night, and Republicans will maintain control into the next Congress. In the election, Democrats gained four seats for a total of 194, while Republicans lost three seats for a total of 233 but will maintain a majority. Eight seats are currently still undecided. In the current Congress, Republicans have a majority of 240 seats, Democrats currently have 190 seats and there are five vacancies. It takes at least 218 seats to make up a majority.

One truly historical outcome is that, the majority of Democrats in the House will not be white men. Instead, come January, the Democrats in the House will be comprised mostly of women and minorities. AIDS United hopes this change will lead to more allies in the House, as HIV/AIDS in the United States disproportionally affects young men and women of color.

State Legislatures

The importance of the state elections this year cannot be stressed enough. With President Obama’s reelection, implementation of the Affordable Care Act will move forward, and the states will play a large role in Medicaid expansion and the creation of health insurance exchanges in 2014. Six Democrats and four Republicans won their races for governor, and Democrats took control of eight state legislative chambers.

“Interestingly, the two parties will share legislative control (i.e. one Republican chamber and one Democratic chamber) in only three states. Therefore, bipartisan agreements regarding Medicaid expansion and health insurance exchanges will be difficult.” Furthermore, this election saw all state legislatures in the South turn Republican, while state legislatures in the Northeast and the West Coast are now almost purely Democratic. Many Republicans have voiced their opposition to the Affordable Care Act, meaning that achieving Medicaid expansion and establishing health insurance exchanges in the South could be extremely difficult given the new political makeup. However, the South continues to see a concentration of HIV/AIDS and rising infection rates! It is imperative that all states, especially those in the South, achieve some sort of compromise on these issues in order to provide the best possible care to
people living with HIV/AIDS.

President Obama Reelected! No Post-Election Honeymoon Expected

by Ronald Johnson, Vice President, Policy and Advocacy

At the end of what seemed to be an endless campaign, President Obama and Vice President Biden were elected to a second term Tuesday night. The President won with 332 Electoral College votes to Mitt Romney’s 206 (including unofficial votes from Florida). The President’s share of the popular vote stands at 50.4%.

Nearly all HIV/AIDS organizations are non-partisan and thus did not endorse either candidate in the elections. At the same time many HIV/AIDS organizations including AIDS United had very serious policy concerns and there was some relief throughout the HIV community that the election results signaled that current policies would continue in most ways. The Obama Administration’s record of accomplishments in addressing the domestic HIV epidemic and overall health care were in clear contrast to Romney’s silence and relatively short state record on HIV/AIDS. Romney’s oft repeated pledge to repeal “Obamacare.” The Medicaid and Medicare proposals of his running mate, Rep. Paul Ryan (R-WI), were also a significant source of concern. Finally, it has to be said that the media was not helpful – that the still raging HIV epidemic here in the U.S. was not mentioned during the debates and the campaign was extremely disturbing.

The President’s prompt return to Washington, D.C. with his family Wednesday evening was a hoped-for sign that with the election behind him, he is back to work. A lame duck session of Congress that will begin next week must act to avoid additional deep spending cuts to nearly all domestic programs that are scheduled to kick in on Jan. 2, 2013. The President will need to be engaged actively in putting forth and fighting for a plan to replace the automatic spending cuts, “sequestration,” with a balanced approach to reducing the federal deficit that preserves essential programs of health care and the safety net for low-income and other vulnerable populations. The election results have made the Affordable Care Act (ACA) much safer from repeal, however full implementation of health care reform needs to move forward and the President still will need to oppose efforts to defund or otherwise weaken the ACA. Vigorous implementation of the National HIV/AIDS Strategy is another important agenda item for the reelected President and his Administration.

AIDS United heartily congratulates President Obama and Vice President Biden on being elected for a second term. We look forward to continuing a sound partnership with the President and the Administration to bring an end to the HIV epidemic here in the U.S. and around the world. We will advocate in the lame duck session and with the new, 113th Congress for federal policies and funding levels that keep ending the epidemic a reality. And as always, we will keep you informed and fully engaged.