Prevention Against Transmission of HIV to Women and Youth (PATHWAY) Act of 2007 Introduced

On March 28, 2007, Representatives Barbara Lee (D-CA) and Christopher Shays (R-CT) introduced the Prevention Against Transmission of HIV to Women and Youth (PATHWAY) Act 2007 (H.R. 1713).  The bill was introduced in response to flaws in the President’s Emergency Plan for AIDS Relief (PEPFAR) that limit the implementation of comprehensive HIV prevention programs.

PEPFAR, a five year program with a budget of 15 billion dollars, provides HIV prevention, care, and treatment services in over 120 countries, including 15 focus countries.1  PEPFAR has several mandates indicating how funds need to be allocated including a requirement that 33% of all prevention funding must be spent on programs that promote abstinence as the only way to stop the spread of HIV.  The PATHWAY Act would strike this abstinence-until-marriage funding earmark.

A 2006 U.S. Government Accountability Office report found that the abstinence-earmark required by PEPFAR interferes with efforts to develop comprehensive and effective HIV- intervention programs and contributes to the marginalization of condoms as a way to prevent transmission of HIV.2  A similar report by the Joint United Nations Program on HIV/AIDS (UNAIDS) compiled results of surveys in the hardest hit African, Asian, and Caribbean countries, including the 15 PEPFAR focus countries, and revealed that a lack of sexuality education, a lack of comprehensive knowledge of HIV, as well as a lack of knowledge about condoms and low condom usage are all contributing to an increase in HIV infections.3

In addition to removing the abstinence-until-marriage earmark, PATHWAY would also require the Office of the Global AIDS Coordinator, the U.S. agency that directs PEPFAR, to ensure that a comprehensive and integrated HIV-prevention strategy addresses the vulnerabilities of women and girls in PEPFAR countries.  Since women and girls now account for more than half of all infections, concentrating on the root causes of gender disparities in the focus countries is crucial to curbing the epidemic.  Thus far, PEPFAR has made few strides in tackling the problems of gender inequity, poverty, and violence against women all of which increase women’s vulnerability to HIV.4 

“PATHWAY requires a true integrated approach to HIV prevention,” said William Smith, vice president for public policy at SIECUS. “Removing the abstinence-until-marriage earmark will go a long way to ensuring that women and youth get the comprehensive, medically accurate information they need to lead safe and healthy lives.  SIECUS applauds Representatives Lee and Shays for introducing this important piece of legislation.”

For more information about PEPFAR, see our PEPFAR Country Profiles at


  1. The 15 focus countries are Botswana, Cote d’Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Zambia and Vietnam.
  2. Global Health: Spending Requirement Presents Challenges for Allocating Prevention Funding Under the President's Emergency Plan for AIDS Relief, (Washington D.C.: Government Accounting Office, April 2006), accessed 27 March 2007, < >.
  3. December 06: AIDS Epidemic Update, (New York: UNAIDS, 2006), accessed 22 November 2006, <>.
  4. See SIECUS’ previous policy update Office of Global AIDS Coordinator Releases Report on PEPFAR Activities on Gender Based Violence.

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