Administration wants global AIDS program's services to be routine for nations

By David Brown
Wednesday, December 9, 2009; A06

The Obama administration is trying to get the "emergency" out of the President's Emergency Plan for AIDS Relief.

In an outline of a new direction for the global program started by President George W. Bush, the administration hopes to begin handing off day-to-day management of AIDS prevention and treatment programs to the 15 countries where $19 billion has been spent since 2004. The goal is to make the services a routine part of each nation's health offerings.

The program provides AIDS drugs, HIV counseling and testing, prevention advice and condoms, palliative care for people with advanced AIDS, and support for orphaned children. The services have been delivered through a complicated tiered system that includes American universities, international nonprofit organizations, government health ministries and hundreds of charities.

Under a strategy described in documents released Monday, the countries' health ministries would assume the task of delivering services -- which many already do -- as well as managing all the programs and measuring their effect.

Most of the funding, however, would continue to come from the United States, foreign donors and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

"It is our honest belief that these programs are in a fragile period," said Eric Goosby, the U.S. global AIDS coordinator. "We need to transition them into being more embedded in the countries' infrastructure and for the countries to have true ownership of them."

Since its inception, the program -- run out of the State Department and known by its acronym, PEPFAR -- has helped provide antiretroviral treatment to 2 million people, supported the care of 10 million (including 4 million children in families affected by AIDS) and been at least partly responsible for the fact that 240,000 babies born to HIV-positive mothers did not have the infection.

The administration hopes that in the next five years, PEPFAR will help treat 4 million infected people, care for 12 million and double the number of babies born free of the virus.

In 2008, 33.4 million people were living with HIV worldwide, including 2.7 million who became infected that year, according to the joint U.N. program on AIDS. About 2 million died.

The exact amount of money to be spent through PEPFAR in the next few years is uncertain.

Last year, Bush signed the Lantos-Hyde Act, which authorized spending up to $48 billion over five years to deal with AIDS, tuberculosis and malaria. The share for AIDS was $39 billion.

The 15 countries that have received most of the PEPFAR money include 12 in sub-Saharan Africa, as well as Haiti, Guyana and Vietnam. Dozens of others have gotten less. With the exception of Rwanda and Namibia, none has "really developed the capability to oversee and manage these programs completely," Goosby said.

The transition will require teaching supply-chain management, logistics, service coordination, program evaluation and other skills while continuing to provide AIDS services to millions of people. Some of the PEPFAR partners have begun.

The new direction comes as the World Health Organization has revised its AIDS treatment guidelines in a way that will bring millions more people, especially women, into long-term antiretroviral therapy.

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