The U.S. Supreme Court case Agency for International Development v. Alliance for Open Society International, Inc., 2012 revolved around the issue of whether the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act's requirement that organizations receiving funding adopt a policy explicitly opposing prostitution violated the First Amendment rights of those organizations. The act was designed to fund efforts to combat these diseases worldwide but included a provision requiring recipients to have an explicit policy against prostitution and sex trafficking. Several non-governmental organizations (NGOs), including Alliance for Open Society International, challenged this requirement on grounds it infringed upon their free speech rights by compelling them to espouse specific government viewpoints as condition of funding eligibility. The Supreme Court ruled in favor of the NGOs stating that such conditions went beyond ensuring funds were used in line with governmental objectives; they also mandated grantees' private speech aligning with government views which is unconstitutional under First Amendment protections.

In the dissenting opinion for AGENCY FOR INTERNATIONAL DEVELOPMENT, et al., v. ALLIANCE FOR OPEN SOCIETY INTERNATIONAL, INC., et al., Chief Justice Roberts argued that the policy requirement in question did not violate First Amendment rights because it was a condition of federal funding and not a direct regulation of speech. He contended that Congress has wide latitude to attach conditions to federal spending as long as they are related to the purpose of the funded program. In this case, he believed that requiring organizations receiving funds from Leadership Act grants to have policies explicitly opposing prostitution and sex trafficking is directly related to combating HIV/AIDS globally - which is what these grants were intended for. The majority's decision, according to him, undermines Congress’s ability to define the terms on which it disburses public money.