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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 2018

HIV & AIDS

The U.S. Government received an 86 (B) with transparency and a 90 (A-) without transparency for HIV and AIDS across all actors. This grade reflects the negative impact of the PLGHA FAQ and Six Month Review and the gender accommodating nature of issued guidance. This domain also had a low funding transparency score for some actors which led to a decrease in its grade. However, in spite of these negative actions, the domain grade for HIV and AIDS-related government work remains higher than the grades of the other domains.

A-
A

Department of State

 

The Department of State received a 90 (A-) with transparency and 93 (A) without transparency for HIV and AIDS based on eight relevant guidance documents released in 2018. Aside from the guidance documents related to the implementation of PLGHA, the State Department issued guidance documents and reports that were responsive to need, evidence-based, and grounded in human rights principles regarding HIV and AIDS. The Department of State released detailed technical guidance documents that guide country-level PEPFAR programs. The Department of State also released annual reports that document programmatic progress and demonstrate areas for improvement. Overall, the guidance documents and annual reports do not include gender transformative language. The Department of State’s commitment to comprehensive HIV and AIDS programming is demonstrated in the disbursement of funds for HIV and AIDS programming according to country-level 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
2018_Protecting Life in Global Health Assistance Six Month Review
The Protecting Life in Global Health Assistance (PLGHA) Six Month Review summarizes the PLGHA policy and identifies solutions to challenges that have arisen in the process of PLGHA implementation. The review is responsive to need in that it addresses concerns expressed by partners who are required to implement the policy, but it is 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 discusses the importance of addressing the impact of PLGHA on HIV and AIDS programs and assures that efforts are being made to track the impact of this policy through PEPFAR programming. Still, the Six Month Review substantially hinders the Department of State's ability to support comprehensive HIV and AIDS programs.
2018_Protecting Life in Global Health Assistance FAQs
The Protecting Life in Global Health Assistance (PLGHA) FAQ provides detailed guidance on the implementation of the expanded Global Gag Rule policy for implementing partners. The document is responsive to need in that it clarifies areas of the policy that partners have expressed are vague or unclear, but it is not evidence-based or based in human rights principles. The FAQ includes a PEPFAR-specific section that provides 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, does not discuss gender norms or include gender transformative language. This section emphasizes the importance of minimizing disruption of HIV and AIDS care and treatment and therefore receives a higher score within this domain compared to the other two domains, FP and MCH.
2018_HIV/AIDS Agency Priority Goals
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 APGs report on challenges faced by HIV and AIDS programs, but do not provide clear strategies to address them. One such challenge is that of increased HIV and AIDS among adolescent girls and young women (AGYW) and key populations. The APGs mention 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 do not include indicators specific to either population or data aggregated by gender as a means to highlight progress made in these areas. As a result, the APGs moderately promote the ability of the Department of State to support comprehensive HIV and AIDS programs.
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 is comprehensive and provides updates that are evidence-informed, responsive to need, and based in human rights principles. The 2018 COP Guidance takes a holistic approach to PEPFAR programs and discusses intersecting issues, such as: gender-based violence, post-abortion care, contraceptive access, and comprehensive HIV prevention programs. The COP Guidance illustrates gender as a cross-cutting issue within PEPFAR but should include specific guidance to increase gender transformative programming across PEPFAR countries.
2018_PEPFAR Progress Report
The PEPFAR Progress Report is issued annually to provide an overview of programs and illustrate PEPFAR priorities in the future. The report shares a program plan that is responsive to need and based in evidence and human rights principles. However, the document does not discuss gender norms or include a commitment to increase gender transformative programming.
2018_PEPFAR 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 is evidence-based, responsive to need, and includes a description of how the State Department will deliver on the mission of PEPFAR moving forward. The report also discusses factors that make HIV prevention and treatment complex for adolescent girls and young women and for key populations; however, these programmatic concerns are framed within current constructed gender norms. The programming discussed in this report does not include gender transformative components as a means to provide comprehensive HIV and AIDS services.
2018_DREAMS Report
The annual DREAMS report highlights the strengths, challenges, and future directions of the DREAMS program. The report is evidence-based and responsive to need, but lacks a clear gender transformative stance. The DREAMS program does have concrete gender transformative components, but they are not reflected in this report in a clear and substantial way. The report describes harmful gender norms that affect HIV and AIDS prevention and treatment programs for adolescent girls and young women, but does not mention how to address these barriers in a manner informed by human rights principles.
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 provides a nuanced overview of the data and concludes by issuing the guidance that all PEPFAR programs continue transitioning to a DTG-based regimen. The release recommends that "HIV-infected women who desire to become pregnant" should remain on efavirenz-based regiments until further data are available. The issuance of this statement was timely and provides an accurate explanation of the Botswana study preliminary findings; however, the State Department's recommendation took away the choice of treatment from a population based solely on their ability or desire to become pregnant. This is 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.
B
B

US Agency for International Development

 

USAID received a 84 (B) with transparency and an 86 (B) without transparency for HIV and AIDS based on four HIV and AIDS-related documents issued in 2018. These documents ranged from significantly hindering to moderately promoting SRHR within the HIV and AIDS sector and all four documents issued neglected to discuss the role of gender norms in the implementation of relevant programming. USAID’s grade decreased in this domain since last year primarily due to the lack of HIV and AIDS-specific information in the 2018 Acting on the Call Report. USAID received a high budget score because disbursed funds were responsive to demonstrated HIV and AIDS programming needs. USAID’s commitment to HIV and AIDS programming is demonstrated in the disbursement of funds for HIV and AIDS programming according to country-level 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
2018_Acting on the Call Report
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 is 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 reinforces the siloes between MCH, FP, and HIV and AIDS programming that challenges USAID's ability to support integrated SRHR programs.
2018_Condoms and Pharmaceuticals ADS Help Document
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 that was revised in 2018 to guide the procurement of condoms and pharmaceuticals by the Bureau for Global Health. The updated directive requires that the procurement of all condoms (internal and external) be managed by the Office of HIV/AIDS. While this directive is detailed and informative and includes the procurement of female (internal) condoms, it is unclear what prompted this update. As a result, it is challenging to gauge whether the guidance is responsive to need, evidence-based, human rights-based or gender transformative. It is 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_HIV/AIDS Agency Priority Goals
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. However, the APGs do not explain the role of USAID, specifically, in HIV and AIDS programming and only discusses PEPFAR-level successes and challenges. As a result, the APGs do not hinder or promote USAID's ability to support comprehensive HIV and AIDS programs, so the APGs do not increase or decrease USAID's score in this domain.
2018_Protecting Life in Global Health Assistance FAQs
The Protecting Life in Global Health Assistance (PLGHA) FAQ provides detailed guidance on the implementation of Trump's expanded GGR for implementing partners. The FAQ document is responsive to need in that it clarifies areas of the policy that partners have expressed are vague or unclear. The FAQs are neither based in human rights principles nor evidence. The FAQs are also not gender transformative and substantially hinder USAID's ability to implement comprehensive HIV and AIDS programs that are evidence-informed, responsive to need, consistent with internationally-recognized human rights principles and gender transformative.
2018_Acquisition and Assistance Strategy
As USAID’s first-ever Acquisition and Assistance (A&A) Strategy, this guidance document increases the accountability and transparency of USAID's procurement, partnering, and project management processes across the Agency. The goal of this Strategy is 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 is responsive to need and evidence-based because it cites the current make-up of USAID foreign assistance funding recipients and sets specific goals to diversify this partner base. Many of the strategies and shifts put forward in the report incorporate feedback received from smaller and/or local partners. The Strategy also demonstrates a commitment to human rights norms, specifically to the rights of self determination, by actively incorporating local partners in the design, procurement, and implementation of USAID's programming. Though the Strategy references the importance of ""diverse"" partners, it does not define who these partners are 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 indicates 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 seems 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.
D+
C-

Department of Health and Human Services

 

HHS received a 67 (D+) with transparency and a 71 (C-) without transparency for Family Planning based on the release of two relevant documents in 2018. The disbursed funds for HIV and AIDS programs through HHS are not publicly available, which contributed to this actor’s 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
2018_Protecting Life in Global Health Assistance FAQs (HHS)
The Protecting Life in Global Health Assistance (PLGHA) FAQ provides detailed guidance on the implementation of the expanded Global Gag Rule for implementing partners. HHS was graded based on the "HHS Specific Information" section on page 17 that outlines how HHS awarding agencies administer grants according to the Code of Federal Regulations (CFR). The information offered in this section does not have an 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_HHS Strategic Plan
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 does 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.
C-
B-

Department of Defense

 

The Department of Defense received a 72 (C-) with transparency and a 81 (B-) without transparency based on one directive that signifies progress within this domain. The directive allows DoD to continue incorporating HIV and AIDS treatment and prevention into their work with foreign militaries. It is unclear whether the implementation of this directive is efficacious, but it is specific and nuanced. The disbursed funds for HIV and AIDS programs through DoD are not publicly available, which contributed to this actor’s low transparency grade.

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

Congress

 

Congress received a 93 (A) with transparency and 95 (A) without transparency for HIV and AIDS because it passed two pieces of legislation related to HIV and AIDS in 2018. Neither piece of legislation hinders the ability of U.S. global health assistance to support comprehensive HIV and AIDS programs globally that are based in evidence and human rights principles. However, both legislation had the potential to include gender transformative language, but did not. The Congressional budget within this domain received a high score because the budget request included adequate funding for PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Transparency for this domain was also high for both legislation and funding information.

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_Asia Reassurance Initiative Act of 2018 (S. 2736)
The Asia Reassurance Initiative Act discusses U.S. efforts to improve relations with countries in Asia and promote democracy and human rights within the region. These efforts are 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 is 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 provides 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 mentions supporting women’s equality, but does not discuss the importance of addressing GBV and SRHR in promoting democracy and human rights. Given the prevalence of GBV against ethnic and religious minorities in the region, this is 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 amends 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 maintains previous authorization language that is not gender transformative and continues clauses that cause harm to key populations, such as the Anti-Prostitution Loyalty Oath and the "conscience 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 promotes the ability of U.S. global health assistance to promote HIV and AIDS programs that are evidence-informed, responsive to need, consistent with human rights principles, and gender transformative.
B+
A-

White House

 

The White House received a 87 (B+) with transparency and an 92 (A-) without transparency for HIV and AIDS because it signed into law two HIV and AIDS-related pieces of legislation in 2018. Neither policy hinders the ability of U.S. global health assistance to support comprehensive HIV and AIDS programs globally that are based in evidence and human rights principles. However, both policies had the potential to include gender transformative language, but did not. The White House budget within this domain received a high score because the budget request included adequate funding for PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Similar to other domains, the transparency score for the White House under HIV and AIDS is low due to difficulty accessing budgetary information and the inability to search White House policies by criteria that have been previously available.

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_Asia Reassurance Initiative Act of 2018 (S. 2736)
The Asia Reassurance Initiative Act discusses U.S. efforts to improve relations with countries in Asia and promote democracy and human rights within the region. These efforts are 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 is 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 provides 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 mentions supporting women’s equality, but does not discuss the importance of addressing GBV and SRHR in promoting democracy and human rights. Given the prevalence of GBV against ethnic and religious minorities in the region, this is 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 amends the PEPFAR Stewardship and Oversight Act of 2013 by extending the authorization of PEPFAR through FY 2023. The law allows PEPFAR to continue its programming, which is largely evidence-based, responsive to need, and based in human rights norms. However, this law also maintains previous authorization language that is not gender transformative and continues clauses that cause harm to key populations, such as the Anti-Prostitution Loyalty Oath and the "conscience 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 promotes the ability of U.S. global health assistance to promote HIV and AIDS programs that are evidence-informed, responsive to need, consistent with human rights principles, and gender transformative.