President's Emergency Plan for AIDS Relief

The President's Emergency Plan For AIDS Relief (PEPFAR/Emergency Plan) is a commitment of $15 billion over five years (2003–2008) from United States President George W. Bush to fight the global HIV/AIDS pandemic. As the largest international health initiative ever initiated by one nation to address a single disease, the program hopes to provide antiretroviral treatment (ART) to 2 million HIV-infected people in resource-limited settings, to prevent 7 million new infections, and to support care for 10 million people (the "2-7-10 goals").

The U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (or the Global AIDS Act) established the State Department Office of the Global AIDS Coordinator to oversee all international AIDS funding and programming. Ambassador Mark R. Dybul has been the U.S. Global AIDS Coordinator since July 2006.

As of March 2007, the program estimates that it has supported the provision of ART to approximately 1,101,000 people. See the official PEPFAR website [1], the Five Year Strategy Fact Sheet, the Funding Fact Sheet,and Funding Information for FY2006. NB that critics have questioned the accuracy of PEPFAR reporting (see below).

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Focus Countries

PEPFAR prioritizes resource-limited countries with high HIV/AIDS prevalence rates. The 15 current "focus countries" include Botswana, Cote d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Vietnam, and Zambia. While most of the $15 billion for this program will be spent on these focus countries, $4 billion is allocated for programs elsewhere, and for HIV/AIDS research. (The other $1 billion is contributed to the Global Fund, see below). See the PEPFAR World Wide Activities Map

Prevention

To slow the spread of the epidemic, PEPFAR supports a variety of prevention programs: the ABC approach (Abstain, Be faithful, and correct and consistent use of Condoms); prevention of mother to child transmission (PMTCT) interventions; and programs focusing on blood safety, injection safety, secondary prevention ("prevention with positives"), counseling and education.

20% of the PEPFAR budget is spent on prevention, with the remaining 80% going to care and treatment, laboratory support, antiretroviral drugs, TB/HIV services, support for orphans and vulnerable children (OVC), infrastructure, training, and other related services. Of the 20% spent on prevention, one third of the budget must be spent on abstinence-only campaigns, a controversial requirement (see below). The other two thirds is alloted for the widespread array of prevention interventions described above, including counseling, education, injection safety, blood safety and condoms.

Treatment

In addition to providing antiretroviral therapy (ART), PEPFAR supports prevention and treatment of opportunistic infections, as well as services to prevent and treat malaria, tuberculosis, waterborne illness, and other acute infections. PEPFAR supports training and salaries for personnel (including clinicians, laboratorians, pharmacists, counselors, medical records staff, outreach workers, peer educators, etc), renovation and refurbishment of health care facilities, updated laboratory equipment and distribution systems, logistics and management for drugs and other commodities. This is intended to ensure the sustainability of PEPFAR services in host countries, enabling long-term management of HIV/AIDS.

PEPFAR-supported care and treatment services are implemented by a wide array of US-based and international groups and agencies. Among the largest "Track 1.0" (treatment) partners are Harvard University [2], Columbia University's International Center for AIDS Care & Treatment Programs (ICAP) [3], the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) [4], and the AIDSRelief consortium of Catholic Relief Services [5].

Care

For those who have already been infected with HIV/AIDS, PEPFAR provides HIV counseling, resources for maintaining financial stability, etc. Special care is given to orphans and vulnerable children (OVCs) and services are provided that meet the unique needs of women and girls, including victims of sex trafficking, rape, abuse, and exploitation (see fact sheet on Gender and HIV/AIDS). Finally, the Emergency Plan works closely with country leaders, military groups, faith-based organizations, etc. in an attempt to eliminate stigma.

Programs

PEPFAR establishes bilateral programs in host countries and also works closely with multilateral partners, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the United Nations program on AIDS (UNAIDS), as well as local Faith-Based Organizations. PEPFAR also endorses the international principles of the "Three Ones": — one national plan, one national coordinating authority, and one national monitoring and evaluation system in each of the host countries in which organizations work.

Accountability

PEPFAR reports to Congress on an annual basis, providing programmatic and financial data as required by law. The Second Annual Report to Congress on the President's Emergency Plan for AIDS Relief is available on the official PEPFAR website [6], as are more specific reports, financial information and other information.

PEPFAR is exempt from the Mexico City Policy, also known as the "global gag rule." [7]

Criticism

Public health experts and nonprofit organizations have questioned the tactics and effectiveness of PEPFAR programs, including requirements mandating that one-third of prevention spending be directed towards abstinence-only programs.

According to its critics, PEPFAR is influenced too heavily by American political and social groups with "moral" rather than public health agendas. PEPFAR Watch [8], a website run by the Center for Health and Gender Equity and Health GAP, notes that the legislation behind PEPFAR “contains several restrictions, including those on funding for prevention activities and on organizations working with commercial sex workers.” [9] PEPFAR has also refused to fund effective yet “taboo” safe needle exchange programs to prevent HIV transmission among drug users. [10]

On July 2, 2003, President George W. Bush selected former Eli Lilly and Company chief executive Randall L. Tobias as the Global AIDS Coordinator in charge of PEPFAR.

"This decision is another deeply disturbing sign that the president may not be prepared to fulfill his pledge to take emergency action on AIDS," noted Paul Zeitz, executive director of the Global AIDS Alliance. "It raises serious questions of conflict of interest and the priorities of the White House."^[1]Several said they feared that Tobias would be "the fox in charge of the henhouse," as Kate Krauss of the AIDS Policy Project put it. Ambassador Mark Dybul replaced Tobias as U.S. Global AIDS Coordinator on August 11, 2006.

Bush's AIDS project under Tobias has been called "extremely flawed" by critics.^[2] Tobias later become the Administrator of the United States Agency for International Development (USAID), where he held the rank of Ambassador. Tobias, a proponent of abstinence as Global AIDS Coordinator, ironically resigned from the United States Department of State over a pay for sex scandal in April 2007.^[3]

Another early criticism was that PEPFAR initially supported only branded antiretroviral drugs instead of cheaper generic versions; this has become less of an issue since distribution of generic drugs began in late 2005. [11]

See also

• Office of National AIDS Policy
• Presidential Advisory Council on HIV/AIDS

References

1. ^ Asia Times, Bush's 'surreal' choice for AIDS czar. July 4, 2003
2. ^ Rita Beamish, Associated Press. "Poor records plague Bush AIDS effort" Dec 26, 2006
3. ^ Rice Deputy Quits After Query Over Escort Service. Washington Post (2007-04-28).

Others

• "Lectures For The Dying" by Max and the Marginalized (Song and Music Video about PEPFAR and Abstinence-Only Education)
• PEPFAR and the Global AIDS Response Video and summary for event held at the Woodrow Wilson Center in September 2007.
• PEPFAR Watch
• AVERT's PEPFAR Information Site
• AIDSPortal PEPFAR page with reports, events and factsheets
• Mozambique faces HIV cash dilemma, BBC News, 1 December 2004 (note: graphic images)
• CSIS Events — ABC Guidance Roundtable — Global AIDS Coordinator Mark Dybul, M.D., addressing controversies over the ABC approach to prevention, misinformation, etc. (December 15th, 2005)
• Religious Groups Get Chunk of AIDS Money, ABC News, 30 January 2006
• Bush's Foreign Sex Policy, CounterPunch.org, 22 December 2006
• George Bush is an HIV/AIDS relief revolutionary at Jewcy.com
• Twice As Many Die: Bush's Duplicitous New AIDS Plan in Dollars & Sense magazine, July/August 2007
• The Flawed ABCs of PEPFAR Michael Stulman, Foreign Policy in Focus, August 21, 2007