The U.S. Supreme Court case, U.S. Agency for International Development v. Alliance for Open Society International (2019), revolved around the issue of whether a policy requirement imposed by Congress on funding recipients violated their First Amendment rights to free speech. The Leadership Act was enacted in 2003 to combat HIV/AIDS globally and required organizations receiving funds under this act to have a clear policy opposing prostitution and sex trafficking. However, two non-governmental organizations (NGOs) - Alliance for Open Society International and Pathfinder International - argued that this provision infringed upon their freedom of speech as it compelled them to adopt the government's viewpoint on these issues against their will or risk losing federal funding. In its ruling, the Supreme Court sided with the NGOs stating that while Congress has broad powers over spending public money, it cannot attach conditions that violate constitutional protections such as freedom of speech. This decision upheld an earlier ruling from 2013 where similar restrictions were deemed unconstitutional when applied domestically but left open questions about foreign affiliates which were addressed in this case.

The dissenting opinion in the case of U.S. Agency for Int'l Development v. Alliance for Open Society Int'l, 2019 argued that the majority's decision was a departure from established First Amendment principles and could potentially undermine other government programs requiring recipients to adopt or reject specific positions as conditions of funding. The dissenters contended that the policy requirement did not violate any constitutional rights because it only applied to an organization’s official statements, not its private speech. They also pointed out that organizations were free to establish affiliates with different views without losing federal funds, thus maintaining their freedom of speech while still complying with program requirements.