In its newly released “blueprint,” the US President's Emergency Plan for AIDS Relief (PEPFAR) charts the next phase of the country’s response to the HIV epidemic. In it, the largest funder of HIV efforts globally will focus on HIV prevention, new technologies, women and girls, and the most at-risk populations (MARPs).
This year will be US Secretary of State Hilary Clinton’s final year as head of the US State Department, under which PEPFAR falls. At the International AIDS Conference in July, Clinton asked PEPFAR head Eric Goosby to create an action plan for future administrations, policymakers and implementers.
On 29 November, Goosby and his team presented the result: PEPFAR’s new five-point blueprint. The need for sound and scientific investment is an overarching theme in the 53-page document, which outlines four major aims: saving more lives, smart investments, sharing financial and programmatic responsibility, and driving results with science.
Under this plan, the agency will support medical male circumcision; targeted services aimed at MARPs such as injecting drug users and sex workers; and research into technologies such as microbicides, vaccines and point-of-care tests. In the blueprint, the US government commits to using diplomatic channels to help create enabling environments to allow MARPs to access health services. It also prioritizes using health diplomacy to promote the health and human rights of same-sex populations and women and to advance gender equality.
The need to fund new scientific innovations in the fight against HIV, and to address gender inequality, was also echoed at the launch by former South African health minister and now chairperson of the African Union Nkososana Dlamini-Zuma. After being elected chairperson in July, Dlamini-Zuma said that health would be high on her agenda.
“It is encouraging that some of our countries (within the African Union) are already putting a certain percentage of their budgets aside for innovation, not only around issues of HIV,” she said. “We will have to work hand-in-hand with partners to empower women because we can’t get to that point of an HIV-free generation without empowering women to be able to take and make the right decisions.”
The blueprint is part of the US push towards an “AIDS-free generation,” which Clinton has defined as one in which almost no children are born with the virus and in which children grow up at a reduced risk of contracting HIV later in life. Speaking at the Washington, DC, release of the blueprint, Clinton stressed that an AIDS-free generation is now within reach.
“As we continue to drive down the number of new infections and drive up the number of people on treatment, we will eventually treat more people than become infected,” she said. “That will be the tipping point when we get ahead of the epidemic and an AIDS-free generation will be in sight.”
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HIV activist Florence Ngobeni-Allen spoke of PEPFAR’s role bringing HIV treatment into South Africa. Ngobeni-Allen, who is HIV-positive, lost her first daughter and husband to AIDS-related illnesses in the mid-1990s; at the time, HIV treatment was not yet available in South Africa's public health system.
“I started working as a counsellor at Chris Hani Baragwanath hospital during the time when there were no drugs,” she said. “The worst part was hearing those screaming babies crying and looking at them and thinking, ‘they are following my daughter.’
“I couldn’t give them anything but my hope and my smile,” she added.
Now remarried and mother to two HIV-negative sons, Ngobeni-Allen says her children are part of what she hopes will be an AIDS-free generation.
Fixing the spend
The blueprint commits PEPFAR to strengthening its supply chains and business processes and to integrating programming with other donors and development partners. This may be a response to long-running criticisms from activists and global health professionals over inefficiencies in distribution and within recipients.
In April 2012, HIV activists in Kenya took to the streets after about US$500 million in unspent PEPFAR funds were discovered that had reportedly been “stuck in the pipeline.”
In the blueprint, the US also commits to funding the Global Fund to Fight AIDS, Tuberculosis and Malaria as it approaches its next replenishment meeting.