Newsweek examines HIV/AIDS advocates’ concerns that the Obama administration’s focus on the six-year, $63 billion Global Health Initiative (GHI) is compromising PEPFAR’s reach.

The GHI offers a “more pragmatic approach to U.S. global-health initiatives … by diversifying the U.S. global-health portfolio beyond the singular orientation of PEPFAR and teaming up with multilateral partnerships, like the Geneva-based Global Fund,” the magazine writes. “At the same time, driven by critiques of PEPFAR’s sustainability, the plan would cut costs by committing to treat the sickest patients first, shifting resources over to prevention efforts, and putting national governments on the hook for delivering services.”

“AIDS advocates are now wondering whether ‘pragmatic’ is just a euphemism for cheap,” the article continues. “In the last year, the number of HIV-positive people that PEPFAR started on treatment was the smallest it has been for four years, even while demand increases as patients live longer and the disease continues to spread unabated. … At the same time, the decision to slash $50 million from the U.S.’s commitment to the Global Fund has cast doubts on its commitment to multilateralism and partnership.”

Advocates say changes to PEPFAR could result in “long-term behavioral patterns that affect the [HIV] pandemic’s spread.” The piece also notes policymakers’ recognition of the challenges of providing treatment to the growing number of patients with HIV/AIDS in the world (Paul, 4/27).