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A counselor at the PEPFAR-supported Binh Thanh Out-Patient Clinic in Vietnam shows a patient how to use a pill box. (USAID photo)
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03 April 2007
U.S. AIDS Relief Program Has Made “Good Start,” Evaluators Say, April 3, 2007(Emergency plan has been major factor in increasing global response)
By Cheryl Pellerin
USINFO Staff Writer
Washington -- Two years into the five-year U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), an evaluation committee at the Institute of Medicine (IOM) concludes that the program has made a good start toward meeting its ambitious targets and establishing the program to make further progress.
The five-year worldwide targets include supporting the prevention of 7 million HIV infections, providing anti-retroviral therapy to 2 million people with HIV/AIDS and caring for 10 million people affected by HIV/AIDS, including orphans and other vulnerable children.
The IOM Committee for the Evaluation of the PEPFAR Implementation, chaired by Jaime Sepulveda, University of California-San Francisco presidential chair and visiting professor, released its report -- PEPFAR Implementation: Progress and Promise -- March 30.
The committee “did a great service in the report,” said Ambassador Mark Dybul, a physician and U.S. global AIDS coordinator, at an April 3 policy discussion at George Washington University. “There isn’t an area we’re working in where we couldn’t do better.” (See related article.)
A GOOD START
In 2003, Congress passed the U.S. Leadership Against HIV/AIDS, Tuberculosis and Malaria Act, which established the five-year, $15 billion PEPFAR initiative to help countries around the world respond to their AIDS epidemics. The act required that the IOM give Congress a three-year evaluation of the initiative’s progress.
To produce its report, the IOM committee examined the initiative and made visits to most of the 15 PEPFAR focus countries -- Botswana, Côte d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Nigeria, Namibia, Rwanda, South Africa, Tanzania, Uganda, Vietnam and Zambia.
“Though the programs evaluated are still young,” Sepulveda wrote in the report’s preface, “it was clear that millions of people are being served and life-saving medical care is being delivered on a large scale in some of the world’s most challenging settings.”
He added, “I strongly believe that the American people, acting through PEPFAR, are to be complimented for supporting this remarkable humanitarian undertaking.”
Since its beginnings, the PEPFAR program has supported anti-retroviral therapy for more than 800,000 adults and children; HIV testing and counseling for nearly 19 million people; and services to prevent mother-to-child transmission of HIV to more than 6 million women, including preventive anti-retroviral drugs for more than half a million HIV-positive women.
PEPFAR also has reported funding education and information campaigns that have reached an estimated 140 million adults and children; care and support services for 4.5 million adults, orphans and other vulnerable children; and training in HIV/AIDS care and support services for more than 1 million people.
Dybul said PEPFAR is part of a “broad and bold development agenda” based on a radical philosophy outlined in the Monterrey Consensus -- the outcome of the 2002 United Nations International Conference on Financing for Development -- that rejects the donor-recipient approach and embraces the power of partnership.
The principles include country ownership of programs and processes, good governance, performance-based development and engagement of all sectors, not just governments.
RECOMMENDATIONS
To respond to the “enduring need for U.S. leadership in the effort to respond to the HIV/AIDS pandemic,” the committee said, PEPFAR should modify its approach, including the following:
• Transition from its focus on emergency relief to an emphasis on long-term strategic planning and capacity building for a sustainable response.
• Address long-term factors underlying the epidemics in each country (accumulate better data, emphasize and enhance prevention, empower women and girls, build work force capacity and expand the knowledge base).
• Improve coordination with partner governments and other donors and support the World Health Organization prequalification process (a faster process than approval through the U.S. Food and Drug Administration) for medications obtained through PEPFAR.
• Expand, improve and integrate prevention, treatment and care for orphans and vulnerable children services and increase attention to marginalized populations.
“The United States has taken a critical leadership role in responding to the HIV/AIDS pandemic,” Sepulveda wrote, “but since it cannot provide all the necessary resources, the lessons learned from PEPFAR will be critical leverage to motivate other donor nations to follow its lead with deeper investments.”
“The United States cannot solve the world’s HIV/AIDS problems, or tuberculosis or malaria or development problems,” Dybul said. “These are global epidemics that require a global response. Currently, the American people are providing as many resources as the rest of the world combined for HIV/AIDS. As long as that is happening, there will be gaps.”
The United States has expanded its HIV/AIDS funding dramatically, he added, “and we need the rest of the world to do the same or we’re not going to solve this problem.”
More information about PEPFAR is available on a Web site of the U.S. global AIDS coordinator.
The full text of The Power of Partnerships: The President’s Emergency Plan for AIDS Relief Third Annual Report to Congress is available on the PEPFAR Web site.
For more information on U.S. policy, see President Bush's HIV/AIDS Initiatives.
