PEPFAR's challenge: Reducing the rates of HIV infection.

Thursday, May 7, 2009

PRESIDENT OBAMA'S push to reenergize the fight against the AIDS epidemic in the United States led to concern that he was going to allow U.S. global leadership in fighting the disease to languish. Those fears ought to be calmed after Mr. Obama's announcement Tuesday of an initiative that will sustain the President's Emergency Plan for AIDS Relief program.

PEPFAR was created in 2003 by President George W. Bush to make HIV testing, counseling and treatment available in Vietnam, Haiti, Guyana and 12 sub-Saharan countries. Just how successful this groundbreaking program has been in Africa was revealed in a study by the Annals of Internal Medicine (AIM) released in March, which showed a 10.5 percent reduction in the AIDS death rate in 12 PEPFAR countries in Africa compared with neighboring nations. The researchers said that PEPFAR activities averted "about 1.2 million deaths."

Between 2003 and 2008, $18.8 billion was spent. Last year, Congress and the Bush White House authorized an additional $48 billion over the next five years. Mr. Obama wants to boost the funding to $63 billion over six years. PEPFAR would receive the bulk of the funding ($51 billion). The rest would be aimed at averting unintended pregnancies and eliminating some tropical diseases. "[W]e will not be successful in our efforts to end deaths from AIDS, malaria, and tuberculosis unless we do more to improve health systems around the world," Mr. Obama said in a written statement.

And this brings us to one failing of PEPFAR. According to the AIM study, the rate at which people were becoming infected with HIV remained unchanged. Efforts to end deaths from AIDS will continue to fail until ways are found to slow and eventually halt the number of HIV infections. This task will fall to Dr. Eric Goosby, the highly regarded chief medical officer at Pangaea Global AIDS Foundation in San Francisco who was nominated last month to head PEPFAR as global AIDS coordinator.

For more than 25 years, Dr. Goosby has fought the epidemic. He has helped develop and implement major treatment programs in South Africa, Rwanda, China and Ukraine. Given this vast experience, Mr. Goosby must make it a priority to find ways to bring down the rates of HIV infection.

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