During his upcoming trip to Africa, Bush will visit Tanzania and Rwanda, two target countries of the President’s Emergency Plan for AIDS Relief (PEPFAR). Later this month, the House Foreign Affairs Committee will debate reauthorization of this US$15 billion global anti-HIV program.

The record of the first PEPFAR program was decidedly mixed, Human Rights Watch said. The United States has demonstrated global leadership in scaling up access to HIV treatment, but it undermined HIV prevention through the adoption of ideologically driven approaches that emphasized abstinence until marriage and hindered programs targeting sex workers by requiring organizations to sign a so-called “prostitution pledge” opposing prostitution.

“The US could be a global leader in the fight against AIDS,” said Joe Amon, HIV/AIDS Program director at Human Rights Watch. “But if Congress allows ideological views about sexuality to trump evidence-based programs and human rights protections, US efforts against HIV/AIDS in Africa will continue to fall short.”

Congressionally mandated evaluations of PEPFAR programs by the Institute of Medicine and the US Government Accountability Office have criticized the rigid abstinence-until-marriage funding requirement. They have recommended that the funding restriction be eliminated because it undermines prevention efforts and hampers the capacity to develop and implement comprehensive prevention programs that are well-integrated with each other and with HIV testing, care, and treatment programs.

In Uganda, another PEPFAR target country in Africa, Human Rights Watch documented the ways in which the US abstinence-only policy resulted in censored or distorted information about condoms, and denied young people information about any method of HIV prevention other than sexual abstinence until marriage .

“PEPFAR could be a positive legacy of the Bush administration” said Amon. “But only if the new legislation does not repeat the mistakes and limitations of the current program.”