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On World AIDS Day, Strategy for Future of PEPFAR Released

BY Talea Miller  December 1, 2009 at 7:05 PM EST

White House on World AIDS Day 2009; Flickr user Troy Holden

Ambassador Eric Goosby, the U.S. global AIDS coordinator, said: “We’re going to begin transitioning from an emergency response to a sustainable one through greater engagement with and capacity-building of governments.”

The road map set out for the future of former President George Bush’s well-regarded U.S. President’s Emergency Plan for AIDS Relief would provide 4 million people with treatment by financial year 2014, an increase from the current treatment levels of about 2.4 million.

But new World Health Organization guidelines released Monday advised doctors to start giving patients AIDS drugs a year or two earlier than previously recommended, instantly adding another 3 to 5 million patients that qualify for treatment to the 5 million already waiting for AIDS drugs.

Goosby acknowledged the challenges of trying to treat an ever-growing epidemic Tuesday and said that is why new emphasis will be placed on prevention strategies.

“For every two people we’ve put on treatment, five more have become infected,” he said. Nearly 2.7 million new infections occur annually.

Paul Zeitz, head of the Global AIDS Alliance, said the new plan will not come close to meeting the global need for AIDS medications.

“The demand for treatment is escalating according to the [WHO] evidence,” he said. “The PEPFAR strategy mentions the new guidelines but doesn’t address them.”

Christine Lubinski, director of the Center for Global Health Policy called the treatment target disappointing and not aggressive enough.

“It literally will translate into lives lost and it raises lots of questions,” she said.

Goosby said PEPFAR’s commitment to universal coverage continues, and that PEPFAR will remain central to that effort.

Family affected by HIV; Flickr user daveblume“What we also realize is that the resources that are going to be needed for that need to converge at the country level to support the full realization of universal coverage,” he said. “A bilateral program alone will not do that. But we are committed to work with our country partners to engage in that dialogue.”

Since its launch in 2003, PEPFAR has been a game-changer in the provision of HIV care around the world, providing health services for more than 10 million people.

But many in the health field and the current administration say PEPFAR needs to be better integrated with other health services and needs to be paired with improvements in health systems to make lasting gains, a theme President Obama reinforced in May when he proposed his Global Health Initiative, which would build from PEPFAR but also include maternal and child health, as well as nutrition.

Under the new strategy “PEPFAR will be carefully and purposefully integrated with other health and development programs,” the report stated and “will now emphasize the incorporation of health systems strengthening goals.”

Zeitz agreed that type of collaboration is a “no-brainer” as long as it doesn’t take away support from people in need of life saving AIDS medications.

“When you are distributing life saving AIDS medicines you also need to be delivering life savings malaria medicines, or bed nets,” he said. “The same systems that PEPFAR has been developing needs to be extended to those other priorities.”

Pairing prenatal and maternal services with HIV services is another area that could be expanded under this new mandate said Lubinski, because the two can be more effective when located in the same facility.

The issue of integration links closely with sustainability, something PEPFAR has faced criticism for in the past because of the ever-growing number of infections and because HIV treatment needs to be provided for life.

A 2008 Center for Global Development study found that as U.S.-funded AIDS treatment around the world is extended to more people and sustained for those already on it, the pricetag, which stands at about $2 billion per year now, could grow to as much as $12 billion a year by 2016, taking up about half of the U.S. foreign aid budget

The five-year strategy released Tuesday does not include a budget, much to the frustration of groups waiting to here how the president plans to fund the new goals.

A report card released this week by Health GAP, Africa Action, Treatment Action Group and the Global AIDS Alliance gave President Obama’s HIV/AIDS efforts during his administration’s first year a “D+” primarily because of funding. The report highlighted that the president’s first budget request to Congress for the 2010 fiscal year basically flat-lined funding at the previous year’s levels, and they are concerned the same will be true next year.

“This is a pattern in this administration, good words and good rhetoric but there is no money to follow through,” said Zeitz. “If you’re not putting the money up how could you implement the strategy… it’s designed to fail.”

Lubinski worries that without continued strong financial leadership from the United States, some countries may cut services to some of the populations that need help the most, such as sex-workers and drug users.

“Sustainability–I think that is absolutely critical,” said Lubinksi. “The worry is that that should not become code for a significant decrease in U.S. support.”

When asked about the flat-lined funding of PEPFAR at the press conference Tuesday, Goosby did not directly answer the question but said the U.S. commitment remains strong.

“Our strategy is to intensify the technical assistance that we give to countries to take over the role of both understanding…their epidemic and responding to it,” he said.
“It is not a turning away from our conviction and commitment to the burden of disease that HIV/AIDS has presented to the planet.”