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TRANSPARENCY SCORE
The transparency grade represents the expectation that the federal government should make data about U.S. global health assistance available, accessible, and informative. To see the transparency grade, toggle below.

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TRANSPARENCY SCORE
The transparency grade represents the expectation that the federal government should make data about U.S. global health assistance available, accessible, and informative. To see the transparency grade, toggle below.

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B

This is an average of the three domain scores below.

YEAR 2019

HIV & AIDS

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.

B
B+

White House

 

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.

The CHANGE data index grades government agencies on policies and funding impacting family planning, maternal and child health, and HIV & AIDS foreign assistance.

Selecting a document will download the file
2019_Global Health Innovation Act of 2017 (H.R.1660)
This law signed by the President instituted a new requirement for the Administrator of USAID to report to Congress about USAID’s investment in and development of novel global health technologies. The passage of this bill indicated White House and Congressional interest in global health technologies and implemented a mechanism to hold USAID accountable to continuous innovation of such technologies. HIV and AIDS technologies, unlike family planning technologies, were explicitly mentioned in the Act which provided an accountability mechanism for these specific technologies. The Act did not reference human rights principles or the need for more women and girl-centered technologies, such as multi-purpose prevention technologies that prevent both pregnancy and HIV acquisition. This law was responsive to need and evidence-based, as it emphasized the importance of global health technologies and innovation in achieving global health goals. Overall, this law promoted SRHR within the HIV and AIDS domain because it encouraged the development of technologies to support HIV and AIDS programming.
2019_United States Government Global Health Security Strategy
This document was a cross-agency Strategy to improve global health security both in the U.S. and globally. The Strategy discussed the importance of disease prevention and treatment and outlined the role of the U.S. and other funders invested in strengthening health systems in countries that may not currently have the capacity to respond to outbreaks. This Strategy was high-level and did not specifically discuss relevant global health issues, including HIV and AIDS. The annex of the Strategy mentioned the role of the President's Emergency Plan For AIDS Relief (PEPFAR) in ending the HIV and AIDS epidemic, however the discussion about HIV and AIDS should have been more consistent throughout the Strategy given the importance of this health issue to global health security. This Strategy was responsive to need and evidence-based, as it referenced global standards regarding global health security and data proving the need for strengthening of health systems throughout the Strategy. The Strategy was neither gender transformative nor based in international human rights norms, as it did not discuss the role of gender norms in global health security or specifically reference human rights principles that frame global health security efforts. Overall, this Strategy’s silence on HIV and AIDS did not harm SRHR but it also did not promote SRHR. Future strategies should provide specific details about relevant programs that contribute to global health security, including HIV and AIDS.
2019_United States Strategy on Women, Peace, and Security
The U.S. Strategy on Women, Peace, and Security is the operationalization of the Women, Peace, and Security Act of 2017 and is intended to "increase women’s meaningful leadership in political and civic life by helping to ensure they are empowered to lead and contribute, equipped with the necessary skills and support to succeed, and supported to participate through access to opportunities and resources." However, the Strategy dismissed the important role of health in the wellbeing and participation of women and girls in decision-making processes and institutions both during times of conflict and peace. Given that the Department of State and USAID were named as relevant actors in this Strategy, the lack of discussion of health—specifically of HIV and AIDS treatment and prevention—was an obvious gap in the Strategy. The absence of health was further glaring given the documented impact of the breakdown of health systems on people living with HIV (PLHIV) in conflict and humanitarian settings. The Strategy also did not address the risk of sexual transmission of HIV due to gender-based violence (GBV) in conflict and crisis settings. This Strategy was responsive to need as it addressed the lack of representation of women in conflict resolution and peacebuilding processes. However, the Strategy is not grounded in evidence as evidence shows the key role of health—particularly HIV and AIDS prevention, care, and treatment—in achieving country stability. The Strategy was not grounded in human rights, as the document cited "the United States Government’s interpretation of the laws of armed conflict and International Human Rights Law'' which may have implied that human rights principles were not being followed as written. Lastly, this Strategy was not gender transformative because it recognized but did not take steps to address the root causes of gender inequity within conflict and post-conflict settings, nor did it advocate strongly for the inclusion of all populations in these efforts. It is possible that this Strategy, once implemented, could create avenues for significant gender transformation but this Strategy is narrow in a way that ultimately harms women and girls.
2018_Asia Reassurance Initiative Act of 2018 (S. 2736)
The Asia Reassurance Initiative Act discussed U.S. efforts to improve relations with countries in Asia and promote democracy and human rights within the region. These efforts were responsive to need and based in human rights principles, particularly related to reducing poverty and violations of human rights that have occurred within the region. However, the law was not gender transformative or strongly evidence-based in HIV and AIDS prevention and treatment efforts. It mentions "reducing the HIV and AIDS infection rate” through the Lower Mekong Initiative (LMI), but provided no programmatic guidance on how to accomplish this. The LMI was launched in 2009 and is a multinational partnership among Cambodia, Laos, Myanmar, Thailand, Vietnam, and the U.S. to create integrated sub-regional cooperation among the five Lower Mekong countries. The LMI could serve as a promising platform for HIV and AIDS prevention and treatment efforts, but this could only be implemented if additional policy and technical guidance are released. The law also briefly mentioned supporting women’s equality, but did not discuss the importance of addressing gender-based violence (GBV) and sexual and reproductive health and rights (SRHR) in promoting democracy and human rights. Given the prevalence of GBV against ethnic and religious minorities in the region, this was a missed opportunity by the White House to address this issue. For these reasons, this law will likely only have minimal direct effect on the ability of U.S. global health assistance to support HIV and AIDS programs in the region.
2018_PEPFAR Extension Act of 2018 (H.R. 6651)
The PEPFAR Extension Act amended the PEPFAR Stewardship and Oversight Act of 2013 by extending the authorization of PEPFAR through FY 2023. The law allowed PEPFAR to continue its programming, which is largely evidence-based, responsive to need, and based in human rights norms. However, this law also maintained previous authorization language that is not gender transformative and continued clauses that cause harm to key populations, such as the Anti-Prostitution Loyalty Oath and the refusal clause. With the reauthorization, the White House had the opportunity to revise these harmful aspects of the authorization of PEPFAR and chose not to do so. As a result, this law moderately promoted the ability of U.S. global health assistance to support HIV and AIDS programs that are evidence-informed, responsive to need, consistent with human rights principles, and gender transformative.
2017_Presidential Memorandum of January 23, 2017_The Mexico City Policy (Expanded Global Gag Rule)
President Trump reinstated and expanded the Mexico City Policy, often known as the Global Gag Rule, and renamed it the Protecting Life in Global Health Assistance (PLGHA) policy. When in place under previous administrations, the policy applied only to international family planning assistance, whereas Trump’s version of the policy "extend(s) the requirements... to global health assistance furnished by all departments or agencies." Research has documented the harms of this policy in previous administrations when the policy was in effect, and the expansion of this policy via this 2017 Presidential Memorandum demonstrated a disregard for evidence and international human rights norms. This policy spurred a chain of events that significantly reduced community and government engagement in HIV prevention, care, and treatment programs and prohibits beneficiaries from accessing key services in many countries that receive U.S. global health assistance. The expansion of the PLGHA policy was against evidence, need, and human rights principles and was not gender transformative; this policy was gender blind, as it did not discuss the role of gender norms on the promotion of SRHR through U.S. global health assistance programs.
2016_The United States National Action Plan on Women, Peace, and Security
The United States National Action Plan on Women, Peace, and Security described what the U.S. continues to do to empower women as equal partners in preventing conflict and building peace in countries threatened and affected by war, violence, and insecurity. The Plan moderately promoted SRHR by calling for better access to "clinical care and reproductive health services such as family planning, HIV testing, counseling, and treatment…" though HIV testing, counseling, and care was not discussed in further detail. The Plan did not explain the impact of access to HIV and AIDS prevention and treatment services on conflict prevention and country stability nor did it acknowledge the relationship between gender-based violence (GBV) in conflict and the prevalence of HIV and AIDS among women and girls. In fact, there was little discussion on any structural, cultural, and safety barriers that prevented women in conflict-ridden areas from accessing the HIV and AIDS care they wanted and needed. However, the Plan did discuss the intersections of HIV and AIDS with other sexual and reproductive health (SRH) issues, such as maternal mortality. Additionally, this plan is moderately gender transformative as it called for more gender equality and inclusivity in all initiatives, especially regarding “members of marginalized groups, including youth, ethnic, racial or religious minorities, persons with disabilities, displaced persons and indigenous peoples, lesbian, gay, bisexual, transgender, and intersex (LGBTI) individuals, and people from all socioeconomic strata.” The Plan also discussed the distinct needs of ex-combatants and former violent extremists who are female, specifically stating that these women have a difficult time adhering to traditional gender norms upon their return from combat. However, it did not explicitly mention the disproportionate impact of HIV and AIDS on former combatant populations or other key populations such as female sex workers or people who inject drugs (PWID). This National Action Plan supported the U.S. government's ability to promote SRHR with regard to HIV and AIDS programs and funding.
A+
A+

Congress

 

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 CHANGE data index grades government agencies on policies and funding impacting family planning, maternal and child health, and HIV & AIDS foreign assistance.

Selecting a document will download the file
2019_Global Health Innovation Act of 2017 (H.R.1660)
This law instituted a new requirement for the Administrator of USAID to issue a report to Congress about USAID’s investment in and development of global health technologies. The passage of this bill indicated Congressional interest in global health technologies and implemented a mechanism to hold USAID accountable to continuous innovation of such technologies. HIV and AIDS technologies, unlike family planning technologies, were explicitly mentioned in the Act which provided an accountability mechanism for these specific technologies. This law was responsive to need and evidence-based, as it emphasized the importance of global health technologies and innovation in achieving global health goals. The Act did not reference human rights principles or the need for more women and girl-centered technologies, such as multi-purpose prevention. Overall, this law promoted SRHR within the HIV and AIDS domain because it encouraged the development of technologies to support HIV and AIDS programming.
2018_Asia Reassurance Initiative Act of 2018 (S. 2736)
The Asia Reassurance Initiative Act discussed U.S. efforts to improve relations with countries in Asia and promote democracy and human rights within the region. These efforts were responsive to need and based in human rights principles, particularly related to reducing poverty and violations of human rights that have occurred within the region. However, the legislation was not gender transformative or strongly evidence-based in HIV and AIDS prevention and treatment efforts. It mentioned "reducing the HIV and AIDS infection rate” through the Lower Mekong Initiative (LMI), but provided no programmatic guidance on how to accomplish this. The LMI was launched in 2009 and is a multinational partnership among Cambodia, Laos, Myanmar, Thailand, Vietnam, and the U.S. to create integrated sub-regional cooperation among the five Lower Mekong countries. The LMI could serve as a promising platform for HIV and AIDS prevention and treatment efforts, but this could only be implemented if additional policy and technical guidance are released. The legislation also briefly mentioned supporting women’s equality, but did not discuss the importance of addressing gender-based violence (GBV) and sexual and reproductive health and rights (SRHR) in promoting democracy and human rights. Given the prevalence of GBV against ethnic and religious minorities in the region, this was a missed opportunity by Congress to address this issue. For these reasons, this legislation will likely only have minimal direct effect on the ability of U.S. global health assistance to support comprehensive HIV and AIDS programs in the region.
2018_PEPFAR Extension Act of 2018 (H.R. 6651)
The PEPFAR Extension Act amended the PEPFAR Stewardship and Oversight Act of 2013 by extending the authorization of PEPFAR through FY 2023. The legislation allows PEPFAR to continue its programming, which is largely evidence-based, responsive to need, and based in human rights norms. However, it also maintained previous authorization language that is not gender transformative and continued clauses that cause harm to key populations, such as the Anti-Prostitution Loyalty Oath and the refusal clause. With the reauthorization, Congress had the opportunity to revise these harmful aspects of the authorization of PEPFAR and chose not to do so. As a result, this legislation moderately promoted the ability of U.S. global health assistance to support HIV and AIDS programs that are evidence-informed, responsive to need, consistent with human rights principles, and gender transformative.
A
A+

Department of State

 

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.

The CHANGE data index grades government agencies on policies and funding impacting family planning, maternal and child health, and HIV & AIDS foreign assistance.

Selecting a document will download the file
2019_PEPFAR 2019 Annual Report to Congress
The President's Emergency Plan For AIDS Relief (PEPFAR) Annual Report to Congress provided an overview of PEPFAR’s accomplishments to date and discussed the program’s future directions. This report largely summarized high-level information that was known about PEPFAR programs. The report was responsive to need and based in evidence, as it referenced data that demonstrated the need for and efficacy of PEPFAR programs. The report did not mention human rights principles and was not gender transformative but demonstrated awareness of gender norms in the discussion of layered packages in DREAMS programming.
2019_PEPFAR 2019 Country Operational Plan Guidance for all PEPFAR Countries
Released annually by the Office of the Global AIDS Coordinator, the Country Operational Plan (COP) Guidance outlines the plan for the global HIV and AIDS activities funded by the President's Emergency Plan For AIDS Relief (PEPFAR) and provides the basis for the approval of annual bilateral HIV and AIDS funding for partner countries. The 2019 COP Guidance was based in evidence and responsive to need. The document provided comprehensive guidance on the implementation of PEPFAR programs for all populations and, within this domain, discussed the importance of integrating cervical cancer screenings into care for women living with HIV as well as into layered DREAMS programming for adolescent girls and young women. However, much of this language could have been stronger and made mandatory. Depending on the program area, the Guidance was based in human rights norms, as it addressed PEPFAR’s role in protecting the human rights of populations that are criminalized or face stigma, such as the LGBTQI+ community. However, in other areas, the COP Guidance was not based in human rights norms, particularly the high targets for index testing within PEPFAR programs, which create an environment where human rights may be violated by grantees in pursuit of high target numbers and to avoid negative performance evaluations. It is critical that the PEPFAR COP Guidance be more specific about the subservience of targets to voluntarism and informed consent, ensure that this human rights mandate reaches the clinic level, and set more realistic targets to avoid harmful outcomes that will ultimately undermine PEPFAR’s goals. Lastly, the guidance was not gender transformative but demonstrated some gender awareness, as it used “clients” and other gender-neutral language and discussed the impact of gender norms on numerous program areas, including DREAMS, stigma reduction activities, and programs to reach undiagnosed men. Overall, the COP Guidance moderately promoted SRHR through HIV and AIDS programs.
2019_PEPFAR Monitoring, Evaluation, and Reporting Indicator Reference Guide_MER 2.0 (Version 2.4)
The President's Emergency Plan For AIDS Relief (PEPFAR) Monitoring, Evaluation, and Reporting (MER) guidance included the indicators used to monitor and evaluate PEPFAR. All PEPFAR programs were evaluated according to their performance within these indicators and metrics, and this guide helped country teams and PEPFAR implementing partners understand the monitoring and evaluation process. In 2019, some of the MER indicators were updated, but it remains unclear what prompted these changes. The document included many HIV indicators, including indicators that focused on key population (KP) programming and programming for adolescent girls and young women. The updates to the indicators and addition of new indicators provided more detail and definitions about data to be collected, which demonstrated the guide’s responsiveness to need and basis in evidence. The indicators were mostly based in human rights principles, but it is important to note that there is no way to assure that the indicators were implemented in accordance with these norms. For example, all KP-relevant indicators included the "do no harm" mandate, but there was no explicit guidance beyond that. This limitation of the MER Indicators was particularly relevant with the Index testing indicator which reinforced the primacy of testing yield with no measurement for fidelity to human rights. Lastly, the guide was not gender transformative but was gender aware, as it included a vague consideration of structural factors, such as “living and family situation,” that impact HIV and AIDS treatment and prevention. Measures of gender equity were not included as a required reporting element across relevant indicators.
2019_Protecting Life in Global Health Assistance Frequently Asked Questions and Answers_September 2019
The Protecting Life in Global Health Assistance (PLGHA) FAQ document was updated in September 2019 to provide clarity on the implementation of the May 2019 expansion of PLGHA as well as address questions and confusion from the 2018 Department of State’s PLGHA Six Month Review. The text of this document was similar to the 2018 FAQ document but included additional questions and answers (see questions 33-37). The document did not meaningfully discuss the impacts of the May 2019 expansion on HIV and AIDS. Similar to the 2018 FAQs, this document aimed to provide clarity on the implementation of the policy but left many questions unanswered. This document was somewhat responsive to need as it did include additional questions and answers based on confusion expressed by recipients of U.S. global health assistance, specifically regarding the definition of “financial assistance” and the applicability of the policy to technical assistance. The document was not evidence-based, was not grounded in international human rights, and was not gender transformative, as it was based on the PLGHA policy which has been shown to be harmful globally, particularly to women and girls. PLGHA has also been shown to decrease access to HIV and AIDS services. Overall, this document provided a substantial hindrance to SRHR.
2019_State and USAID Agency Priority Goal Action Plan_HIV/AIDS
The Agency Priority Goals (APGs) for HIV and AIDS were released by both the Department of State and USAID to hold the President's Emergency Plan For AIDS Relief (PEPFAR) accountable through quarterly reporting that included details around the goals, strategies, milestones, indicators, and progress made towards controlling the HIV epidemic in FY 2019. The 2019 APGs set goals to scale up antiretroviral therapy (ART) services, voluntary medical male circumcision (VMMC) services, and access to HIV and AIDS services for priority and key populations, including men who have sex with men (MSM), sex workers, transgender people, and adolescent girls and young women (AGYW). This plan was responsive to need and based in evidence but did not explicitly mention human rights principles. The APGs were not gender transformative as gender norms were not discussed. Overall, the document moderately promoted SRHR within this domain.
2019_State and USAID FY 2018 Annual Performance Report_FY 2020 Annual Performance Plan
This document shared the goals and timelines for FY 2020 as well as evaluated and summarized the progress of State and USAID in achieving various strategic goals in FY 2018. These goals included global health and gender-related programs across all three domains. The FY 2020 Performance Plan elements were included throughout the report along with reporting on standard indicators for each Performance Goal under the 4 Strategic Objectives. The Report discussed the joint efforts by the Department of State and USAID to achieve HIV and AIDS epidemic control within the third goal. However, there was very little discussion of the evidence used to inform the President's Emergency Plan For AIDS Relief (PEPFAR) programming or the human rights foundation for such programmatic decisions. The document did not provide a recommendation or detailed plan for the continuation of the success of HIV and AIDS prevention and treatment programming to date. This document was responsive to need but lacked a description of the evidence and human rights frameworks that guided PEPFAR programming. The Plan mentioned the disadvantages of a “gender-blind system” within Strategic Goal 2 but perpetuated such a system by not including a gendered lens throughout the document. As such, this report had little effect on the ability of the Department of State to implement HIV and AIDS programs that promoted SRHR.
2018_DREAMS Report: Dreaming of an AIDS-Free Future
The annual DREAMS report highlights the strengths, challenges, and future directions of the DREAMS program. The report was evidence-based and responsive to need, but lacked a clear gender transformative stance. The DREAMS program does have concrete gender transformative components, but they were not reflected in this report in a clear and substantial way. The report described harmful gender norms that affected HIV and AIDS prevention and treatment programs for adolescent girls and young women (AGYW), but did not mention how to address these barriers in a manner informed by human rights principles.
2018_PEPFAR 2018 Annual Report to Congress
The PEPFAR Annual Report to Congress provides an overview of the PEPFAR program to date and discusses future directions. The report was evidence-based, responsive to need, and included a description of how the Department of State will deliver on the mission of PEPFAR moving forward. The report also discussed factors that made HIV prevention and treatment complex for AGYW and for key populations; however, these programmatic concerns were framed within current constructed gender norms. The programming discussed in this report did not include gender transformative components as a means to provide comprehensive HIV and AIDS services.
2018_PEPFAR 2018 Country Operational Plan Guidance for Standard Process Countries
Released annually by the Office of the Global AIDS Coordinator, the Country Operational Plan (COP) Guidance outlines the plan for PEPFAR-funded global HIV and AIDS activities and provides the basis for the approval of annual bilateral HIV and AIDS funding for partner countries. The 2018 COP guidance was comprehensive and provided updates that were evidence-informed, responsive to need, and based in human rights principles. The 2018 COP Guidance took a holistic approach to PEPFAR programs and discussed intersecting issues, such as: gender-based violence, post-abortion care, contraceptive access, and comprehensive HIV prevention programs. The COP Guidance illustrated gender as a cross-cutting issue within PEPFAR but should have included specific guidance to increase gender transformative programming across PEPFAR countries.
2018_PEPFAR 2018 Progress Report
The PEPFAR Progress Report is issued annually to provide an overview of programs and illustrate PEPFAR priorities in the future. The report shared a program plan that was responsive to need and based in evidence and human rights principles. However, the document did not discuss gender norms or include a commitment to increase gender transformative programming.
2018_PEPFAR Statement on Potential Safety Issue Affecting Women Living with HIV Using Dolutegravir at the Time of Conception
This press release contains PEPFAR's policy and technical guidance in response to data from a study in Botswana indicating a potential association between women of childbearing potential taking dolutegravir (DTG), an antiretroviral, at the time of conception and the risk of neural tube defects. The statement provided a nuanced overview of the data and concluded by issuing the guidance that all PEPFAR programs continue transitioning to a DTG-based regimen. The release recommended that "HIV-infected women who desire to become pregnant" should remain on efavirenz-based regimens until further data are available. The issuance of this statement was timely and provided an accurate explanation of the Botswana study preliminary findings; however, the Department of State's recommendation took away the choice of treatment from a population based solely on their ability or desire to become pregnant. This was in conflict with a human rights, individual-centered framework. It is also unclear from the press release if PEPFAR consulted with civil society or other relevant stakeholders before issuing this statement.
2018_Protecting Life in Global Health Assistance FAQs_September 2018
The PLGHA FAQs provided detailed guidance on the implementation of the expanded Global Gag Rule for implementing partners as of September 2018. The document was responsive to need in that it clarified areas of the policy that partners had expressed are vague or unclear, but the FAQs were not evidence-based or based in human rights principles. The FAQs included a PEPFAR-specific section that provided detailed guidance on the implementation and monitoring of the impact of PLGHA on PEPFAR programs, specifically within DREAMS. However, this discussion of PEPFAR, aside from the mention of DREAMS, did not discuss gender norms or include gender transformative language. This section emphasized the importance of minimizing disruption of HIV and AIDS care and treatment and therefore received a higher score within this domain compared to the other two domains, Family Planning and Maternal and Child Health.
2018_Protecting Life in Global Health Assistance Six Month Review
The PLGHA Six Month Review summarized the PLGHA policy and identified solutions to challenges that had arisen in the process of PLGHA implementation. The review was responsive to need in that it addressed concerns expressed by partners who are required to implement the policy, but it was not evidence-based, based in human rights principles, or gender transformative. The Six Month Review received a higher grade within the HIV and AIDS domain because it discussed the importance of addressing the impact of PLGHA on HIV and AIDS programs and assured that efforts are being made to track the impact of this policy through PEPFAR programming. Still, the Six Month Review substantially hindered the Department of State's ability to support comprehensive HIV and AIDS programs.
2018_State and USAID Agency Priority Goal Action Plan_HIV/AIDS
The Agency Priority Goals (APGs) for HIV and AIDS hold PEPFAR accountable through quarterly reporting that includes details around the goals, strategies, milestones, indicators, and progress made towards controlling the HIV epidemic. Released by both the Department of State and USAID, these reports are useful for government transparency and are responsive to need, and based in evidence and human rights. The 2018 APGs reported on challenges faced by HIV and AIDS programs, but did not provide clear strategies to address them. One such challenge was high HIV and AIDS rates among AGYW and key populations. The APGs mentioned the importance of promoting layered core packages of services for AGYW through the DREAMS program and increasing access to HIV and AIDS services for key populations. However, the APGs did not include indicators specific to either population or data disaggregated by gender as a means to highlight progress made in these areas. As a result, the APGs moderately promoted the ability of the Department of State to support comprehensive HIV and AIDS programs.
2017_PEPFAR Country/Regional Operational Plan (COP/ROP) Guidance 2017
The Country Operational Plan (COP) Guidance is an annual document released by the Office of the Global AIDS Coordinator. It outlines the plan for global HIV and AIDS activities funded by PEPFAR and provides the basis for the approval of annual bilateral HIV and AIDS funding for partner countries. The 2017 COP Guidance was evidence-informed and ensured continued community and government engagement in PEPFAR programs. It also discussed the intersection of gender-based violence with HIV and AIDS and the importance of including contraception and counseling into HIV and AIDS programs. This guidance moderately promoted SRHR because it was responsive to need and addressed the disproportionate impact of HIV and AIDS on adolescent girls and young women, men who have sex with men (MSM), female sex workers, and transgender individuals. The plan was gender accommodating, as it did not seek to dismantle existing gender differences and inequalities. Such guidance should instead outline how to change inequitable gender norms and dynamics and promote gender equity.
2017_PEPFAR Evaluation Standards of Practice (Version 3.0)
The PEPFAR Evaluation Standards of Practice was released to increase the quality of evaluations conducted by all PEPFAR implementing agencies. These standards emphasized the importance of evidence-informed evaluation planning and provided a detailed explanation of the ethics and human rights principles that should be incorporated in all PEPFAR-funded evaluations, particularly for "children, prisoners, pregnant women, and other vulnerable groups." Additionally, these standards laid the groundwork for adaptive programming and the continued commitment of all key stakeholders, including community members and government personnel, in PEPFAR programs. Although the Standards of Practice acknowledged that evaluations should be “context-sensitive” and “culturally relevant,” they did not include a gender transformative component. There was no mention of the gendered power dynamics and cultural barriers that may prevent people living with HIV, sex workers, or lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) persons from participating in evaluations. Despite this, the Standards of Practice were responsive to need and were based in evidence. The Standards moderately supported the ability of PEPFAR programs to promote SRHR.
2017_PEPFAR Monitoring, Evaluation, and Reporting Indicator Reference Guide_MER 2.0 (Version 2.1)
The 2017 PEPFAR Monitoring, Evaluation, and Reporting (MER) Indicator Reference Guide provided guidance for monitoring and evaluating PEPFAR’s HIV and AIDS programs. The indicators were evidence-informed, based on human rights principles, and detailed the importance of sustained “district and community” engagement. The document included an extensive list of indicators for HIV and AIDS program evaluation, including the number of key and priority populations reached with specifically tailored HIV prevention programs, and the percentage of pregnant women living with HIV that receive antiretroviral therapy (ART) to reduce mother-to-child transmission. Though the Reference Guide listed sex workers, MSM, and transgender individuals as key populations, it did not address their distinctive needs when discussing how to evaluate interventions that were tailored for these populations. This lack of clarity can be harmful as evaluators may not understand how to meaningfully engage with these key populations during the evaluation, monitoring, and reporting processes. The indicators were somewhat gender transformative, as they included a limited discussion of gender norms and related stigma, though this element should be standardized throughout the Reference Guide. The updates within this version of the MER Reference Guide were responsive to need and based in human rights norms and evidence, including WHO and UNAIDS indicators.
2016_Department of State Implementation Plan for the U.S. Adolescent Girls Strategy
The Department of State Implementation Plan for the U.S. Adolescent Girls Strategy was launched in partnership with three other U.S. implementing agencies as part of the first U.S. Global Strategy to Empower Adolescent Girls in 2015. This Plan moderately promotes sexual and reproductive rights (SRHR) because it discussed the importance of incorporating HIV prevention in all adolescent girls' empowerment programs, especially those that address girls’ political, civic, and economic participation and programs that increase peace and security. This Plan specifically acknowledged the relationship between girls who have undergone female genital cutting (FGC) and their increased risk of acquiring HIV. The Plan also mentioned HIV as a barrier to girls’ education and provided examples of existing Department of State programs that are responsive to need and grounded in human rights, including the President’s Emergency Plan for Aids Relief (PEPFAR). However, this Plan did not disclose how to support the needs of adolescent girls and young women (AGYW) who are living with HIV. It only discussed preventing HIV transmission to AGYW. The Plan is gender accommodating, not gender transformative because it relied on existing gender norms and references unequal gender and age dynamics that put AGYW at a higher risk of HIV incidence.
2016_PEPFAR Country/Regional Operational Plan (COP/ROP) 2016 Guidance
The Country Operational Plan (COP) Guidance is an annual plan that outlines global HIV and AIDS activities funded by PEPFAR and provides the basis for the approval of annual bilateral HIV and AIDS funding for partner countries. The fiscal year (FY) 2016 COP Guidance was responsive to need and addressed the disproportionate impact of HIV and AIDS on AGYW and other key populations such as men who have sex with men (MSM), female sex workers, pregnant women and infants living with HIV, and transgender individuals. The programming was evidence-informed and promoted community and government engagement. Although the Guidance discussed the intersection of gender-based violence (GBV) and HIV and AIDS, it failed to strongly incorporate the positive impact that comprehensive and integrated sexual and reproductive health (SRH) services can have on reducing HIV transmission amongst key populations.
B
B+

US Agency for International Development

 

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.

The CHANGE data index grades government agencies on policies and funding impacting family planning, maternal and child health, and HIV & AIDS foreign assistance.

Selecting a document will download the file
2019_Acting on the Call
Acting on the Call is USAID's annual flagship report for reproductive, maternal, newborn, and child health services. As in the 2018 report, the 2019 report mentioned child mortality caused by HIV and AIDS in the country-level analyses, but the inclusion of HIV and AIDS programming was not included in a standardized way across all countries. For example, the country-specific section for Tanzania mentioned the following: “Integrated voluntary family planning within existing HIV care in 5,600 facilities and care delivery points, which increased the availability of voluntary family planning by 300 percent.” This was a unique case where HIV and AIDS programming was mentioned at the country level, so more country-level data is needed to document the intersections between maternal and child health and HIV and AIDS programs across the board. There was no mention of HIV as a leading cause of maternal death, nor any emphasis on the integration of HIV testing and treatment into antenatal care (ANC) services. Prevention of mother-to-child transmission (PMTCT) services and programs for orphans and vulnerable children (OVC) were not discussed, both of which directly contribute to maternal and child health outcomes. Overall, this report was responsive to need, but was not based in evidence or human rights principles, nor was not gender transformative. It substantially hindered SRHR because it did not address HIV and AIDS as a primary cause of maternal mortality globally. The exclusion of HIV and AIDS within this report reinforced the fragmented and siloed nature of U.S. global health programs across program and budget areas.
2019_Additions to the Answers to FAQs Related to the Revised Standard Provision for Grants and Cooperative Agreements to Implement the PLGHA Policy_June 2019
These additional Frequently Asked Questions (FAQs) were released in June 2019 after the assurance by Secretary Pompeo in March 2019 that the language surrounding financial assistance in the guidance on the implementation of the Protecting Life in Global Health (PLGHA) would not change. This additional document asserted that the definition of financial assistance will remain unchanged and that organizations who sub-grant will be required to ensure their subgrantee’s compliance with the policy. Similar to the original FAQ document, there was no discussion of the impacts of this policy or its expansion on HIV and AIDS. This document was somewhat responsive to need as it included additional questions and answers based on confusion expressed by recipients of U.S. global health assistance. The document was not evidence-based, based in international human rights, or gender transformative as it was based on the PLGHA policy which has been shown to be harmful globally, particularly to women and girls. The PLGHA policy has also been shown to decrease access to HIV and AIDS services. Overall, this document provided a substantial hindrance to SRHR.
2019_ADS Chapter 212_Breastfeeding and Infant and Young Child Nutrition Promotion, Protection, and Support
This Automated Directive System (ADS) chapter was updated in its entirety for the first time since 2012 and addressed USAID’s priorities and positions related to breastfeeding and child nutrition. The update expanded the chapter’s guidance regarding infant and young child nutrition as well as incorporated new language on the donation of breastmilk in humanitarian crises. The chapter also included language regarding breastfeeding and HIV, and referenced the WHO guidance on this subject that was released in 2016. The update also included a shift away from the stigmatizing “HIV-infected” language and instead used the accepted language of “people living with HIV” (PLHIV). This document was responsive to need and based in human rights and evidence. However, the document was not gender transformative. Though it discussed the importance of policies on paid family leave or workplace breastfeeding, it did not take steps to ensure these policies were put in place (which could be achieved through the requirement for partners to report on the implementation of this guidance in their programs through mandatory performance reports). The guidance was gender blind because it ignored gender inequalities and stereotypes that could have influenced a person’s ability to adhere to this guidance, such as a pregnant person who is transgender. Overall, this chapter moderately promoted SRHR with regard to guidance for pregnant and breastfeeding women (PBFW) who are living with HIV.
2019_ADS Chapter 303_Grants and Cooperative Agreements to Non-Governmental Organizations and Standard Provisions
This chapter of the Automated Directive System (ADS) governs the grants and cooperative agreements between USAID and NGOs and included three reference documents that were updated in 2019: the ADS 303maa, 303mab, and 303mat. The ADS 303maa was the Standard Provisions that specified the expectations of U.S.-based NGOs that receive funding from USAID through grants and cooperative agreements. The ADS 303mab was the Standard Provisions for foreign NGOs, and the ADS 303mat was the Standard Provisions for fixed amount awards to NGOs. These provisions were updated in 2019 to incorporate the newly expanded Protecting Life in Global Health (PLGHA) policy, including additional guidance regarding the consequences of violation of the PLGHA policy and a new requirement for prime partners to ensure compliance with PLGHA among all sub-partners, regardless of donor. With regard to violations of the policy, the updated ADS allowed for USAID to determine “consistent with 2 CFR 200.338, that other corrective action is warranted” while the previous version only listed termination of the USAID award and repayment of funds as a consequence of a PLGHA violation. Given that USAID was required to implement the PLGHA policy, the agency was only graded for their implementation of the policy and not for the existence of the policy. All of the ADS 303 updates were responsive to need, as it was clear that USAID attempted to address some of the confusion surrounding the policy, particularly amongst grantees and sub-grantees. However, this chapter of the ADS was still not based in evidence nor human rights and was not gender transformative, so therefore may or may not have impacted USAID’s ability to implement HIV and AIDS programs that promoted SRHR.
2019_ADS Chapter 308_Agreements with Public International Organizations and Standard Provisions
This chapter of the Automated Directive System (ADS) governed the agreements between USAID and Public International Organizations (PIOs) (such as UNAIDS, UNICEF, WHO, etc.) and included one reference document that was updated in 2018 and 2019: the ADS 308mab. The ADS 308mab was the Standard Provisions for Cost-Type Agreements with Public International Organizations and specified the mandatory policies and guidelines that must be followed by PIOs who receive funding from USAID. The provisions were updated in August 2018 to require abortion-related restrictions to be included in all health awards. In previous iterations of the ADS 308mab, these restrictions were only required to be included in awards that funded family planning activities. As such, the 2018 update of the ADS 308mab constituted an expansion of the implementation of pre-existing statutory requirements regarding abortion and involuntary sterilization. This updated language expanded the PIO programs to which these pre-existing statutory requirements apply. The 2018 update also added a new requirement that the PIO that received U.S. funds “must insert this provision in all subsequent subawards and contracts” whereas this was not required in prior versions of the ADS 308mab. The 2018 updates to the ADS 308mab substantially hindered SRHR. The updates released in November 2019 were not related to SRHR. The references to voluntarism and the prohibition of involuntary sterilization in this chapter were based in evidence and human rights, however the expansion of the implementation of abortion restrictions and the expansion of these restrictions to all health awards was not based in evidence or human rights, was not responsive to need, nor was gender transformative. Note: The 308mab was updated in August 2018 but CHANGE has been unable to confirm that this version was ever uploaded onto USAID’s website as required by law. Instead, the 2014 version of the document was replaced in 2019 with the 2019 version of the document with the 2018 edits included but not highlighted as new. For this reason, USAID was significantly docked in the transparency grade, as this lack of transparency by USAID hindered the ability of grantees, sub-grantees, partners and civil society to access and respond to the ADS accordingly.
2019_Agency Financial Report_Fiscal Year 2019
This document was in response to congressionally mandated reporting on the spending of USAID. The report highlighted HIV and AIDS programming within the context of reducing child transmission and included a testimony of a woman living with HIV in Tanzania to demonstrate the importance of USAID’s programming. However, the report did not discuss HIV and AIDS in a meaningful way. This report was responsive to need, as expressed by Congress, and based in evidence however there was no mention of human rights principles or gender norms. Overall, this document neither harmed nor promoted SRHR.
2019_Protecting Life in Global Health Assistance Frequently Asked Questions and Answers_September 2019
The Protecting Life in Global Health Assistance (PLGHA) FAQ document was updated in September 2019 to provide clarity on the implementation of the May 2019 expansion of PLGHA as well as address questions and concerns from the 2018 Department of State’s Six Month Review. The text of this document was similar to the 2018 FAQ document, though also included additional questions and answers (see questions 33-37). The document did not meaningfully discuss the impacts of the May 2019 expansion on HIV and AIDS prevention and treatment. Similar to the 2018 FAQs, this document aimed to provide clarity on the policy but left many questions unanswered. This document was somewhat responsive to need as it included additional questions and answers based on confusion expressed by recipients of U.S. global health assistance, specifically regarding the definition of “financial assistance” and the applicability of the policy to technical assistance. The document was not evidence-based, was not grounded in international human rights, and was not gender transformative as it was based on the PLGHA policy which has been shown to be harmful globally, particularly to women and girls. The PLGHA policy has also been shown to decrease access to HIV and AIDS services. Overall, this document provided a substantial hindrance to SRHR.
2019_State and USAID Agency Priority Goal Action Plan_HIV/AIDS
The Agency Priority Goals (APGs) for HIV and AIDS were released by both the Department of State and USAID to hold the President's Emergency Plan For AIDS Relief (PEPFAR) accountable via quarterly reporting that included details around the goals, strategies, milestones, indicators, and progress made towards controlling the HIV epidemic in FY 2019. The 2019 APGs set goals to scale up antiretroviral therapy (ART) services, voluntary medical male circumcision (VMMC) services, and access to HIV and AIDS services for priority and key populations, including men who have sex with men (MSM), sex workers, transgender people, and adolescent girls and young women (AGYW). As a result, this plan was responsive to need and based in evidence and human rights. The APGs were not gender transformative as gender norms were not discussed. Overall, the APGs moderately promoted SRHR.
2019_State and USAID FY 2018 Annual Performance Report_FY 2020 Annual Performance Plan
This document shared the goals and timelines for FY 2020 as well as evaluated and summarized the progress of State and USAID in achieving various strategic goals in FY 2018. Goals included global health and gender programs across all three domains. The FY 2020 Performance Plan elements were included throughout the report along with reporting on standard indicators for each Performance Goal under the 4 Strategic Objectives. The report discussed the joint efforts by the Department of State and USAID to achieve HIV and AIDS epidemic control within the third goal. However, there is very little discussion of the data that was used to inform President's Emergency Plan For AIDS Relief (PEPFAR) programming or the human rights foundation for such programmatic decisions. The document did not provide a recommendation or detailed plan for the continuation of the success of HIV and AIDS prevention and treatment programming. This document was responsive to need but was not evidence based, based in human rights nor gender transformative. The Plan mentioned the disadvantages of a “gender-blind system” within Strategic Goal Two but perpetuated such a system by not including a gendered lens throughout the document.
2019_USAID Policy Framework: Ending the Need for Foreign Assistance
This document discussed USAID's new policy framework to achieve self-reliance through a three-step approach. The document was general and did not discuss any particular aspect of assistance, such as HIV and AIDS. There was one mention of HIV and AIDS as a foreign assistance success, but it was without a discussion of President's Emergency Plan For AIDS Relief (PEPFAR) as the main mechanism by which USAID has carried out these programs. This policy was responsive to need in that it reflected conversations about democratizing foreign assistance and creating more sustainable systems, however the framework did not mention the evidence or international human rights norms that should be the foundation of such programs. This policy framework was also not gender transformative, as it contained very little about the role of gender in a country's "Journey to Self-Reliance." USAID’s Policy Framework moderately hindered the ability of USAID to support HIV and AIDS programs that promote SRHR.
2018_Acting on the Call
Acting on the Call is USAID's annual flagship report for reproductive, maternal, newborn, and child health services. Within the 2018 report, HIV and AIDS was discussed strictly in the context of child mortality despite the fact that HIV is a leading contributor of maternal mortality worldwide. Evidence suggests that HIV and AIDS are key factors in maternal mortality and wellness and in child health through the prevention of maternal to child transmission (PMTCT). By leaving out HIV and AIDS data herein, the framework of this report reinforced the silos between maternal and child health, family planning, and HIV and AIDS programming that challenged USAID's ability to support integrated SRHR programs in 2018.
2018_Acquisition and Assistance Strategy
As USAID’s first-ever Acquisition and Assistance (A&A) Strategy, this guidance document increased the accountability and transparency of USAID's procurement, partnering, and project management processes across the Agency. The goal of this Strategy was to streamline "approaches to design and procurement" and develop "new and innovative methods of collaboration" to advance USAID's Journey to Self-Reliance mandate. The Strategy was responsive to need and evidence-based because it cited the current make-up of USAID foreign assistance funding recipients and set specific goals to diversify this partner base. Many of the strategies and shifts put forward in the report incorporated feedback received from smaller and/or local partners. The Strategy also demonstrated a commitment to human rights norms, specifically to the right of self determination, by actively incorporating local partners in the design, procurement, and implementation of USAID's programming. Though the Strategy referenced the importance of "diverse" partners, it did not define who these partners were except for a specific mention of faith-based organizations. Women's rights and human rights groups should also be explicitly mentioned as underutilized partners because of their important role in advancing SRHR for all populations. This Strategy indicated a meaningful effort by USAID to ensure that local partners and recipient countries are included and supported throughout the Journey to Self-Reliance. However, this effort by USAID seemed to be in direct conflict with the Trump Administration's strategy of decreasing appropriated funds as a means to ‘motivate’ self-reliance and haphazardly decrease U.S. involvement in foreign assistance. It is unclear in this Strategy how USAID aims to reconcile this conflict.
2018_ADS Chapter 312sae_Condoms and Pharmaceuticals
The Automated Directives System (ADS) contains the operational policies that guide USAID's programs and operations. The Condoms and Pharmaceuticals ADS Help Document is an addendum to ADS Chapter 312 that was revised in 2018 to guide the procurement of condoms and pharmaceuticals by USAID’s Bureau for Global Health. The updated directive required that the procurement of all condoms (internal and external) be managed by the Office of HIV/AIDS. While this directive was detailed and informative and included the procurement of female (internal) condoms, it is unclear what prompted this update. As a result, it was challenging to gauge whether the guidance was responsive to need, evidence-based, human rights-based, or gender transformative. It was also unclear how the consolidation of procurement of all condoms under the Office of HIV/AIDS will impact USAID's HIV and AIDS programming and, therefore, SRHR overall, given that condoms are an important intervention in both family planning and maternal and child health.
2018_Protecting Life in Global Health Assistance FAQs_September 2018
The PLGHA FAQs provided detailed guidance on the implementation of Trump's expanded Global Gag Rule for implementing partners as of September 2018. The FAQs were responsive to need in that they clarified areas of the policy that partners had expressed were vague or unclear. The FAQs were neither based in human rights principles nor evidence. The FAQs were also not gender transformative and substantially hindered USAID's ability to implement comprehensive HIV and AIDS programs that were evidence-informed, responsive to need, consistent with internationally-recognized human rights principles, and gender transformative.
2018_State and USAID Agency Priority Goal Action Plan_HIV/AIDS
The Agency Priority Goals (APGs) for HIV and AIDS hold the President’s Emergency Plan for Aids Relief (PEPFAR) accountable through quarterly reporting that includes details around the goals, strategies, milestones, indicators, and progress made towards controlling the HIV epidemic. Released by both the Department of State and USAID, these reports are useful for government transparency and are responsive to need and based in evidence and human rights. However, the APGs did not explain the role of USAID, specifically, in HIV and AIDS programming and only discussed PEPFAR-level successes and challenges. As a result, the APGs did not hinder or promote USAID's ability to support comprehensive HIV and AIDS programs, so the APGs did not increase or decrease USAID's score in this domain in 2018.
2016_USAID Adolescent Girl Strategy Implementation Plan
The USAID Adolescent Girl Strategy Implementation Plan was launched in partnership with three other U.S. implementing agencies as part of the first U.S. Global Strategy to Empower Adolescent Girls in 2015. The Plan moderately promoted SRHR, noting the importance of using USAID’s “whole-of-girl” approach (which “encompasses the interconnected events that resonate across a girl’s life from birth to adulthood”) to reduce gender disparities and gender-based violence (GBV) and increase capacity of women and girls through USAID’s programs. Though it did not explicitly mention USAID’s HIV and AIDS programs through the President’s Emergency Plan for Aids Relief (PEPFAR), this Plan provided a high-level overview of the programs, best practices, and indicators that were used to measure USAID’s progress in implementing the Adolescent Girl Strategy across programs, including HIV and AIDS. The Plan was responsive to need and based in evidence. The Plan referenced USAID’s ongoing work on gender (e.g., implementing USAID’s 2012 Gender Equality and Female Empowerment Policy) and directly acknowledged the importance of incorporating activities that foster gender equity in all USAID programs. This plan supported the ability of USAID to implement HIV and AIDS programs that moderately promoted SRHR.
D-
D+

Department of Health and Human Services

 

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 CHANGE data index grades government agencies on policies and funding impacting family planning, maternal and child health, and HIV & AIDS foreign assistance.

Selecting a document will download the file
2019_CDC Global Health Strategy_2019-2021
The CDC Global Health Strategy, 2019-2021 presented data to document the CDC’s progress to date with regard to HIV and AIDS activities. It provided evidence to support continued investment in CDC’s programs across the spectrum of HIV and AIDS prevention, care, and treatment through the President’s Emergency Plan for AIDS Relief (PEPFAR). This Strategy was based on programmatic and global evidence but did not include an international human rights component. The Strategy also did not include a gender transformative approach to the CDC’s HIV and AIDS programs. In fact, the word "gender" was not mentioned in the entire document, despite gender being a vital factor in HIV and AIDS programming. However, the Strategy advocated for the continued support of evidence-based HIV and AIDS programs carried out by the CDC and therefore moderately promoted SRHR.
2019_Joint Statement on the Nairobi Summit on the ICPD25
This Statement by the U.S. Secretary of Health and Human Services Alex Azar only affirmed the specific elements of the International Conference on Population and Development (ICPD) Programme of Action that aligned with the Trump Administration’s ideology. It asserted that any outcomes of the Nairobi Summit—including any discussions or decisions related to SRHR—were not to be considered reflective of Member State consensus. Though this Statement might not immediately impact the implementation of global health programs related to SRHR, including HIV and AIDS efforts, it reflects the U.S. government’s stance on SRHR generally and amplifies and emboldens anti-SRHR ideals globally. This Statement operated within traditional gender norms and was based on ideology, not evidence or international human rights norms. Furthermore, the Statement conflicts with comprehensive sexuality education "that fails to adequately engage parents" and mentioned the importance of "giving young people the skills to avoid sexual risk" which suggested support for abstinence-only programs. The language did not promote autonomy and agency of all people to engage in sexual experiences free of shame, coercion, and violence and substantially hindered SRHR.
2019_Joint Statement_Item 12.8: Global Strategy for Womens, Childrens, Adolescents Health (2016-2030)
This Statement denounced "ambiguous" terms such as "the right to sexual and reproductive health (and its derivatives)" at a World Health Assembly meeting to discuss the WHO Global Strategy for Women’s, Children’s, and Adolescents’ Health. This Statement highlighted the role of the family over the rights of the individual and omitted inclusive language regarding gender or the specific health needs of key populations. This Statement did not mention HIV and AIDS as a health issue that is relevant for women, adolescents, and children. This Statement was not based in evidence or international human rights norms and substantially hindered SRHR.
2019_U.S. Commitment Statement to the Nairobi Summit on ICPD25
This Commitment Statement undermined international human rights norms related to SRHR and their supporting processes, including the U.S. government’s own commitments under the International Conference on Population and Development Programme of Action. This Commitment Statement sought to excuse the U.S. government from its commitments to comprehensive SRHR included in the ICPD Programme of Action under the guise of protecting "the inherent value of every human life -- both born and unborn" and the role of "caring fathers" and faith-based organizations (FBOs) in supporting women and girls access to healthcare. This Statement included an account of some relevant U.S. global health or development initiatives that contributed to ICPD, including the HIV and AIDS programming administered by PEPFAR. This statement moderately hindered SRHR because it was not based in evidence or international human rights norms and was not gender transformative.
2019_U.S. Government Statement at the U.N. High Level Meeting on Universal Health Coverage
This Statement emphasized the U.S. government’s commitment to universal health coverage (UHC) but condemned the inclusion of SRHR language and sexual education that "diminishes the protective role of the family in improving health." This Statement also rejected that there is an international right to abortion. Though language included was possibly more immediately related to domestic U.S. health policy, it directly translates to the ideology being used to shape U.S. global health assistance through the Protecting Life in Global Health Assistance (PLGHA) policy and other mechanisms. This Statement substantially hindered SRHR because it did not discuss HIV and AIDS as a vital health issue, was not based in evidence or international human rights norms, and was not gender transformative.
2018_HHS Strategic Plan_Strategic Goal 2: Protect the Health of Americans Where They Live, Learn, Work, and Play
The HHS Strategic Plan provides an overview of the Agency's domestic and global strategy that is based on evidence and human rights norms. Strategic Objective 2.2 within the Strategic Plan states that the Centers for Disease Control and Prevention (CDC) will implement HIV programs "including prevention, testing, treatment, and retention interventions, provide technical assistance, and conduct research in support of PEPFAR." The Strategic Plan did not include any other specific information, so was determined to have little effect on the ability of HHS to implement HIV and AIDS programs that are evidence-based, responsive to need, consistent with internationally-recognized human rights principles, and gender transformative .
2018_Protecting Life in Global Health Assistance FAQs_August 2018
The Protecting Life in Global Health Assistance (PLGHA) FAQs provided detailed guidance on the implementation of the expanded Global Gag Rule for implementing partners as of September 2018. HHS was graded based on the "HHS Specific Information" section on page 17 that outlined how HHS administered grants according to the Code of Federal Regulations (CFR). The information offered in this section did not have an effect on the ability of HHS to implement HIV and AIDS programs that were evidence-based, responsive to need, consistent with internationally-recognized human rights principles, and gender transformative .
C-
B-

Department of Defense

 

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.

The CHANGE data index grades government agencies on policies and funding impacting family planning, maternal and child health, and HIV & AIDS foreign assistance.

Selecting a document will download the file
2018_Department of Defense Directive_DoD HIV/AIDS Prevention Program to Support Foreign Militaries
This directive discussed the DoD HIV and AIDS Prevention Program and its efforts to protect foreign armed forces from the threat of HIV and AIDS. The program provided funding for the development of programs and interventions to protect foreign nation armed forces from HIV and AIDS. This directive was originally written in 2013 and was revised in 2018 to extend it indefinitely. By doing so, this directive allows the DoD to continue minimizing the threat of HIV and AIDS among the U.S. and foreign militaries. This directive was responsive to need, evidence-based, and human rights based; however, it did not discuss gender norms which are particularly relevant in the armed forces.