In a feature analysis, Devex examines the history of PEPFAR, the program’s sustainability, its use of public-private partnerships, and the potential impact of the closure earlier this month of the Global Health Initiative (GHI) office. Noting that next year marks the 10-year anniversary of PEPFAR, Devex concludes, “The Obama administration’s apparent about-face on components of GHI is but one reminder that in Washington — especially as administrations come and go — ideas, initiatives, and funding often fade away all too quickly. The U.S. foreign aid industry is no exception. If PEPFAR can continue its commitment to innovation and partnership, however, visitors to the U.S. capital this week [for the International AIDS Conference] can still be hopeful over America’s leadership role in the fight against HIV/AIDS” (Troilo/Piccio, 7/23).
Bill Gates Stresses Importance Of Investment In Both HIV Treatment And Research For Vaccines, Microbicides
In a symposium session on Monday at the XIX International AIDS Conference in Washington, D.C., politicians and public health experts joined Bill & Melinda Gates Foundation Co-Chair Bill Gates for a discussion about improving effectiveness and efficiency in the HIV/AIDS response, the Washington Post reports (Brown/Botelho, 7/23). “Gates … reiterated the importance for nations and donors to support research, but also expressed support for ongoing treatment initiatives in the meantime,” according to Agence France-Presse. “No one should think that we have got the tools yet. We will get the tools but only if we stay the course in terms of the scientific investments,” Gates said, AFP notes (Sheridan, 7/23). The Washington Post adds that “[t]he main one lacking is a vaccine, but also important and missing are woman-controlled means to prevent infection, such as a vaginal microbicide” (7/23).
RECENT RELEASE: CSIS Blog Posts Highlight Panel Discussions On PEPFAR, Examine Challenges To Administering Treatment-As-Prevention
“In advance of the XIX International AIDS Conference — AIDS 2012 — CSIS celebrated the release of the special supplement of the Journal of AIDS focused on PEPFAR” with an event organized in cooperation with the Office of the Global AIDS Coordinator (OGAC),” the Center for Strategic & International Studies’ (CSIS) “Smart Global Health” blog reports. According to the blog, the event “featured contributing authors and guest editors who are leading figures in PEPFAR and the international HIV/AIDS community” participating “in wide-ranging discussions of the successes and challenges of PEPFAR, from its inception to its future” (Fisher/Kramer, 7/23). In a related post in the blog, Phillip Nieburg, a senior associate at the CSIS Global Health Policy Center, examines the challenges of adopting treatment-as-prevention as a strategy to achieve an “AIDS-free generation” (7/23).
Secretary Clinton Reaffirms U.S. Commitment To 'AIDS-Free Generation,' Pledges More Than $150M For Global Efforts
In a speech delivered at the XIX International AIDS Conference in Washington, D.C. on Monday, U.S. Secretary of State Hillary Clinton “underscored the United States’ commitment to achieving an ‘AIDS-free generation’ and announced more than $150 million in additional funding,” Politico reports (Norman, 7/23). “‘Iâ€™ve heard a few voices from people raising questions about America’s commitment,’ she said, adding, ‘We will not back off. We will not back down,'” according to The Hill’s “Healthwatch” (Viebeck, 7/23). Of the $150 million pledged, “$80 million will be dedicated towards preventing mother-to-child transmission abroad, with the goal of eliminating it by the year 2015”; “[a]nother $40 million is allotted for voluntary male circumcision in Africa to decrease risk of transmission of the virus”; “an additional $15 million [will] fund research on interventions”; “$20 million [is] to bolster country-led efforts to expand HIV-related services”; and “$2 million [will go] towards civil society groups to reach key populations affected by HIV,” ABC News writes (Duwell, 7/23). “Clinton said she had commissioned [U.S. Global AIDS Coordinator Ambassador Eric Goosby] to produce a blueprint for the way ahead,” the Guardian notes (Boseley, 7/23). “Goosbyâ€™s deadline is the upcoming World AIDS Day, Dec. 1,” Inter Press Service adds (Biron, 7/23).
Michael Merson, director of the Duke Global Health Institute, writes in The Hill’s “Congress Blog” that much of the progress in the fight against HIV/AIDS “has been made — and the lives of millions of people saved — because of PEPFAR, … [t]he largest ever global investment in health by the United States government.” With PEPFAR’s “aggressive new goals” — to provide antiretroviral drugs to six million people in low- and middle-income countries, “fund 4.7 million male circumcisions and provide antiretroviral therapy to 1.5 million HIV-infected pregnant women by 2013” — “[w]e need to ask: Are we setting ambitious goals that we’re not prepared to fund or meet? Are we setting up one of our country’s greatest successes for failure?” Merson asks. He notes that “PEPFAR funding has flatlined despite these new targets and is not nearly enough to maintain progress and continue reducing new HIV/AIDS cases and deaths” and that “uncertainty” surrounds the “commitment by Congress” and the outcome of the presidential election. Saying that “PEPFAR itself also needs to continue to adjust its priorities,” Merson states that “treatment, prevention, care, health system capacity and scientific research to develop an HIV vaccine require financial commitment, strong political will and investment in resources from all stakeholders. Let us not fall behind now and bring back the suffering of the past” (7/20).
“[F]olks in Kansas City, Memphis, Selma, El Paso and all across America need to know that you are, indeed, keeping nearly six million men, women and children alive with your tax dollars,” Laurie Garrett, senior fellow for global health at the Council on Foreign Relations, writes in the Huffington Post “Impact” blog, adding, “Actually, the total is much larger than that, America, because six million is just the number of people that are every single day taking anti-HIV medicines that they receive through programs that you fund.” She notes that American tax money pays for HIV prevention campaigns worldwide and medical research on antiretroviral drugs, diagnostic tests and other advances. “Though other countries and private donors contribute to the prevention and treatment of AIDS, none can match the sheer scale of what America is doing,” Garrett writes, adding, “A mere $6.6 billion this fiscal year — out of a total U.S. budget of $3.8 trillion — is the cost of our modern day, life-giving packages.” She concludes, “That’s 0.16 percent of the federal budget, to save millions of lives. What a bargain” (7/20).
Noting the successes of PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria, former President George W. Bush writes in a Washington Post opinion piece that “[a]n important byproduct of this massive effort on HIV/AIDS has been the improvement of African health systems,” which “has raised an exciting prospect: to extend the gains on AIDS to other diseases.” Bush also discusses his work with the Pink Ribbon Red Ribbon, a public-private partnership initiative spearheaded by the Bush Institute to save women from breast and cervical cancer. Over the past decade a “global effort” has saved millions of lives, he says, adding, “It would be a sad and terrible thing if the world chose this moment to lose its focus and will.” Bush concludes, “Other countries and local governments in Africa can do more in providing resources and increasing funding … [b]ut to continue the momentum in the fight against AIDS, America must continue to lead” (7/22).
The Associated Press on Saturday examined the HIV/AIDS epidemic in Uganda, where “[a] new government report says the prevalence of HIV in this East African nation increased from 6.4 percent in 2004 to 7.3 percent in 2011, a shocking statistic for a country once praised for its global leadership in controlling AIDS.” The news service highlights PEPFAR’s contributions to fighting the epidemic in Uganda, noting that “[a]t least half of the 600,000 Ugandans in need of AIDS treatment are able to access the drugs, mostly through PEPFAR.” According to the AP, “U.S. government officials have been pressing Uganda to devote more resources to AIDS and issues such as maternal health, saying dependency on foreign support is unsustainable in the long term.” On a recent trip to the country, Rep. Barbara Lee (D-Calif.) said meeting patients benefitting from PEPFAR-funded treatment “was confirmation of the fact that United States foreign aid works,” the AP writes (Muhumuza, 7/21).
“Lack of money can no longer be considered a reason — or an excuse — for failing to treat all those with HIV who need drugs to stay alive, following game-changing work about to be published by the Clinton Foundation that shows the real cost is four times less than previously thought,” the Guardian reports. “The striking findings of a substantial study carried out in five countries of sub-Saharan Africa are hugely important and will set a new hopeful tone for the International Aids Conference in Washington, which open[ed] on Sunday,” the news service writes.
The XIX International AIDS Conference opened in Washington, D.C., on Sunday and “is expected to draw 25,000 people, including politicians, scientists and activists, as well as some of the estimated 34 million people living with HIV who will tell their stories,” Agence France-Presse reports (Sheridan, 7/22). “Researchers, doctors and patients attending the world’s largest AIDS conference are urging the world’s governments not to cut back on the fight against the epidemic when it is at a turning point,” the Associated Press writes, adding, “There is no cure or vaccine yet, but scientists say they have the tools to finally stem the spread of this intractable virus — largely by using treatment not just to save patients but to make them less infectious, too” (Neergaard, 7/22). “New breakthroughs in research will be announced, as will new efforts by governments and organizations to reduce the spread of HIV, to treat those who have it, and to work, eventually, toward a vaccine and a cure,” the Seattle Times writes (Tate, 7/22). According to the Washington Post’s “Blog Post,” three remaining challenges to be addressed at the conference include: “More research into treatment and prevention, and more ways to deliver treatments”; reaching marginalized populations, such as men who have sex with men and sex workers; and “[i]ncreasing funding for PEPFAR and other anti-AIDS programs” (Khazan, 7/20).