This is an average of the three domain scores below.
The U.S. Government received an 88 (B+) with transparency and a 92 (A-) without transparency in the HIV and AIDS domain across all actors in 2021. This grade reflected the continued commitment of the U.S. government (USG) to support the President’s Emergency Plan for AIDS Relief (PEPFAR) to implement programs that were based in evidence, consistent with international human rights norms, and responsive to need. However, the majority of PEPFAR actions graded across actors in 2020 were gender accommodating and not gender transformative. Global HIV and AIDS efforts were largely excluded from the Strengthening Health Security Across the Globe Report, which was graded across all actors except the U.S. Congress. All actors except the U.S. Congress had low transparency for most actions graded in the HIV and AIDS domain. Budget scores were relatively high across actors where budget data were available, and transparency of funding information was high for all actors except the Department of Health and Human Services (HHS) and the Department of Defense (DoD). Consistent with previous years, the domain grade for HIV and AIDS was higher than the Maternal and Child Health and Family Planning domains across actors in 2021.
The White House received a 90 (A-) with transparency and a 94 (A) without transparency in the HIV and AIDS domain in 2021. The White House requested full funding for global HIV and AIDS programs through the Global Fund to Fight AIDS, Tuberculosis and Malaria as well as the President’s Emergency Plan for AIDS Relief (PEPFAR). Generally, actions graded in this domain meaningfully prioritized global HIV and AIDS programs, which supported the ability of U.S. global health assistance to promote SRHR in the HIV and AIDS domain. The White House demonstrated moderate levels of transparency across actions and funding information in this domain. As in previous years, HIV and AIDS was the White House’s highest scoring domain in 2021.
Congress received a 97 (A+) with transparency and a 99 (A+) without transparency in the HIV and AIDS domain in 2021. Congress appropriated full funding for the President’s Emergency Plan for AIDS Relief (PEPFAR) and The Global Fund to Fight AIDS, Tuberculosis and Malaria. Passing the American Rescue Plan Act (H.R.1319) moderately increased Congress’ grade in this domain because it appropriated additional funds for the Department of State to support HIV and AIDS prevention, care, and treatment programs as well as mentioned the need to mitigate the impact of COVID-19 on such programs. Congress demonstrated high levels of policy and funding transparency related to HIV and AIDS globally in 2021.
The Department of State received a 94 (A) with transparency and a 98 (A+) without transparency in the HIV and AIDS domain in 2021. This domain grade was raised by the PEPFAR Core Program and Policy Priorities, as well as the updated DREAMS Guidance from March 2021, which were both responsive to need, based in evidence, aligned with human rights norms, and were gender transformative. The February 2021 COP/ROP Guidance and other COP/ROP-related materials did not promote SRHR because they did not include adequate information for partners to understand the revocation of PLGHA and adapt their programs accordingly. Overall, actions graded in this domain were largely gender accommodating, and could have included more gender transformative elements. In the budget evaluation, the Department of State allocated HIV and AIDS funds in accordance with country-level HIV incidence, which significantly promoted SRHR. Transparency was relatively high across actions and budget data in the HIV and AIDS domain.
USAID received an 86 (B) with transparency and a 90 (A-) without transparency in the HIV and AIDS domain in 2021. This domain grade was raised by actions outlining the Agency’s response to the COVID-19 pandemic in a manner that promoted SRHR, such as the USAID Implementation Plan for the U.S. COVID-19 Global Response and Recovery Framework and Issues and Recommendations on Gender-Based Violence Prevention and Response in COVID-19 Programming. The decision to remove the PLGHA section in ADS Chapter 303 without offering additional information or guidance for partners about how to adapt their programs significantly hindered SRHR. Overall, transparency was low for many actions graded in this domain because USAID did not indicate which content had been updated in 2021 from previous versions. USAID had a high level of transparency for funding data and disbursed HIV and AIDS funding in a manner that was highly responsive to need, which increased this actor’s grade in this domain in 2021.
HHS received a 62 (D-) with transparency and a 71 (C-) without transparency in the HIV and AIDS domain in 2021. This domain grade was raised by the action: “CDC Virtual Training Prepares Mentors and Peer Educators to Respond to Disclosures of Violence” because it was based in evidence, consistent with human rights, and responsive to need. Several of the Additional Requirements (ARs) and the General Terms and Conditions for Research and Non-Research neither promoted nor hindered sexual and reproductive health and rights (SRHR) because it was unclear whether these actions were relevant to the HHS’ global HIV and AIDS programs. AR 35 noted that the PLGHA policy had been revoked, but did not provide additional guidance or directives for implementing partners to adapt their programs to align with the policy change, which moderately hindered SRHR. Funding data for global HIV and AIDS efforts implemented by HHS were not publicly available at the time of grading, which contributed to the low transparency grade in the HIV and AIDS domain in 2021
DoD received a 65 (D) with transparency and a 74 (C) without transparency in the HIV and AIDS domain in 2021. Both graded actions lacked specific information about the contributions of the DoD’s global HIV and AIDS programs to global health security efforts and the implementation of the Women, Peace, and Security (WPS) Agenda. The lack of detail in the actions along with the unavailability of budget information contributed to the low transparency score for both actions and budgetary data in the HIV and AIDS domain in 2021.