Considering the current status of legislation to reauthorize the President's Emergency Plan for AIDS Relief (PEPFAR), it seems as though Washington lawmakers didn't get it. While lawmakers should be applauded for increasing funding for HIV/AIDS prevention, treatment, and care globally, they missed a crucial opportunity to address the unique vulnerabilities of women and girls. They don't get the fact that more than four-fifths of new HIV infections in women result from sex with their husbands or primary partners (UNFPA, The Promise of Equality 2005). And, they definitely don't get the fact that 74% of the young people (aged 15-24) living with HIV and AIDS in sub-Saharan Africa are female (UNAIDS, Global Facts and Figures 2006).

Did Washington lawmakers ignore the evidence that points to the fact that the AIDS pandemic is crippling the livelihoods of women and girls? Did they not hear the countless arguments of courageous global AIDS prevention advocates fighting for real change to impact those at greatest risk for HIV infection in regions like sub-Saharan Africa and Southeast Asia? HIV and AIDS is pressing itself upon women and seeping its way into their lives through vectors like gender-based violence, sexual coercion, and even marriage.

How did it come to this? Both the House (H.R. 5501) and Senate (S. 2731) versions of the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 continue the legacy of the extremely harmful abstinence-until-marriage funding directive by imposing a confusing reporting requirement on countries that spend less than 50 percent of sexual transmission funds on abstinence and faithfulness prevention programs. The bills also fail to strike the anti-prostitution loyalty oath, discounting one of the most vulnerable populations at-risk for HIV infection and in need of prevention services.

Regarding the integration of services that women use the most, H.R. 5501 would grant HIV and AIDS funding to family planning programs wishing to also provide women with HIV testing, counseling, and education services. Yet these family planning programs must already receive U.S. funding for population services and therefore must be compliant with the Mexico City Policy. S. 2731 totally neglected the issue of integrated services for women by failing to mention family planning in the context of HIV and AIDS altogether.

While conducting those "secret" conversations and compromises in the eleventh hour, it seems as though Washington lawmakers forgot about the women and girls who are virtually voiceless when it comes to their sexual and reproductive health. They forgot that abstinence, fidelity, and faithfulness messages in HIV prevention neglect to consider the life circumstances of those most vulnerable to HIV infection. They forgot that the integration of sexual and reproductive health/family planning and HIV and AIDS services is one of the most cost-effective and efficient ways to get ahead of the HIV epidemic among women and girls. In the end, political expediency was the most important objective — not the promotion of evidence — based prevention for populations vulnerable to HIV infection, especially women and girls.

The purpose of the Caucus for Evidence-Based Prevention is to highlight and defend the importance of evidence and science in determining what works best to prevent HIV infection. Watch out for the next blog from the Caucus! Coming soon, SIECUS's Bill Smith will introduce the Caucus, comprised of many of the United State's major organizations leading the fight against HIV/AIDS.

The opinions of the author do not necessarily represent those of The Caucus for Evidence-Based Prevention.

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