“Increased country engagement, or so-called country ownership, in HIV and health programming is central to achieve adequate scale in service delivery, improve the acceptability of interventions, increase domestic investments in health, and advance integration of HIV programming with national health goals and systems,” Chris Collins, vice president and director of public policy for amfAR, The Foundation for AIDS Research, and Chris Beyrer, director of the Johns Hopkins Fogarty AIDS International Training and Research Program and Center for Public Health & Human Rights, write in a Lancet opinion piece. “Increased country ownership is fundamental to long-term progress in global health, but too rapid a transition runs the very real risk of undercutting access to services and squandering the potential to accelerate progress in HIV/AIDS,” they write, adding, “Four areas raise particular concern and deserve close attention.”

“First, rapid transitions could decelerate scale-up of effective HIV services, including antiretroviral treatment, prevention of mother-to-child transmission services, and voluntary medical male circumcision,” Collins and Beyrer write. “Second, in many settings, country ownership could undermine the nascent response to HIV in many of the most vulnerable populations, including marginalized groups such as men who have sex with men, transgender people, people who inject drugs, and sex workers,” they state, adding, “Third, the transition to increased country ownership will require attention to the participation of various stakeholders in health decision making.” They continue, “Finally, adequate financing remains a crucial challenge as countries assume a greater role in their AIDS responses.” Collins and Beyrer describe three tiers of transitioning to country ownership, using the Avahan program in India as an example of success. They conclude, “At this pivotal point in tackling the epidemic, we need to advance nationally owned decision making while acting decisively on the evidence of what works to accelerate the end of AIDS” (10/17).