This is an average of the three domain scores below.
The U.S. Government received an 86 (B) with transparency and an 89 (B+) without transparency for HIV and AIDS across all actors in 2019. This grade reflected the continued commitment of the President’s Emergency Plan for AIDS Relief (PEPFAR) to implement programs that are evidence-based, responsive to need, and gender accommodating and Congress’s commitment to appropriating adequate funding for HIV and AIDS. Similar to past years, the implementation of the PLGHA policy by relevant actors harmed SRHR within this domain. Furthermore, HIV and AIDS continued to be omitted from key reporting documents across actors, including USAID’s annual Acting on the Call report. Low transparency of policy documents from USAID in this domain also contributed to the overall lower grade. In spite of these negative actions, however, the domain grade for HIV and AIDS-related funding and policies remained higher than the grades of the other domains across actors.
The White House received an 84 (B) with transparency and an 87 (B+) without transparency for HIV and AIDS. The White House proposed adequate—but less than ideal—funding for the Global Fund and for the Department of State’s HIV and AIDS programs but zeroed out funding for USAID’s HIV and AIDS programs. This grade was harmed by the lack of inclusion of HIV and AIDS in a meaningful manner in the United States Strategy on Women, Peace, and Security and the Global Health Security Strategy. The transparency grade was low for HIV and AIDS due to the White House website no longer using filters or criteria to navigate the policies listed online. Similar to 2018, HIV and AIDS continued to be the White House’s highest scoring domain.
Congress received a 97 (A+) with transparency and a 97 (A+) without transparency due to Congress appropriating high levels of funding for the Global Fund and President’s Emergency Plan for AIDS Relief (PEPFAR) and high levels of transparency within policy and funding. This grade was further raised by the passage of the Global Health Innovation Act which instituted a Congressional reporting requirement regarding HIV and AIDS-related global health technologies by USAID.
The Department of State received a 94 (A) with transparency and 98 (A+) without transparency for HIV and AIDS in 2019. The grade within this domain was raised by the Department of State and USAID Agency Priority Goals for HIV and AIDS, 2019 PEPFAR COP Guidance, and the updated version of the PEPFAR MER Indicator Reference Guide. Overall, these documents were based in evidence and responsive to need but did not include gender transformative language and were not grounded in international human rights norms. In particular, the PEPFAR COP Guidance included index testing guidance and targets that ignored evidence, international human rights norms, and input from civil society that advised against these targets. This grade was lowered by the implementation of the PLGHA policy through the 2019 PLGHA FAQs, which was responsive to need but not based in evidence or international human rights norms. In the budget evaluation, the Department of State largely disbursed HIV and AIDS funds in accordance with country-level HIV incidence.
USAID received an 85 (B) with transparency and an 88 (B+) without transparency for the HIV and AIDS domain in 2019. USAID was graded based on a number of Agency-level guidance documents, Agency Priority Goals for HIV/AIDS, ADS Chapters, and two PLGHA FAQs. Though these documents were responsive to need, none of them included a gender transformative component and few were based on international human rights norms. The two PLGHA FAQs as well as the updated ADS Chapter 308 significantly reduced the Agency’s grade in this domain because they substantially hindered USAID’s ability to implement HIV and AIDS programming that promoted SRHR. USAID’s grade in this domain was again reduced due to the lack of HIV and AIDS-specific information in the 2019 Acting on the Call Report, which was noted in 2018 as well. Within this domain, USAID received a high budget score because USAID disbursed funds for HIV and AIDS programming according to country-level HIV incidence.
HHS received a 60 (D-) with transparency and a 68 (D+) without transparency for HIV and AIDS in 2019. The four statements related to the U.S. government’s regressive stance on SRHR (including HIV and AIDS) shared by Alex Azar, the U.S. Secretary of Health and Human Services, significantly decreased the HHS’s grade in this domain. The amount of disbursed funds for HIV and AIDS programs through HHS was not publicly available which also contributed to the low transparency grade in this domain.
The DoD received a 71 (C-) with transparency and an 81 (B-) without transparency due to the unavailability of budget information and low transparency in 2019. The DoD also did not release any policy or technical guidance related to HIV and AIDS in 2019.