An AIDS mission renewed

Sunday, December 13, 2009

THE FIRST five years of the President's Emergency Plan for AIDS Relief (PEPFAR) have been a success. More than 2 million people in poor foreign countries are now on antiretroviral medications through the program created by President George W. Bush in 2003. A study released in March showed that PEPFAR averted "about 1.2 million deaths." But with five people becoming infected for every two who get treatment through PEPFAR, the program is unsustainable without a change in strategy. The new five-year plan issued last week by Eric Goosby, the U.S. global AIDS coordinator, seems to be a sensible approach.

President Obama started the expansion of PEPFAR's mission last May. The budget went from $48 billion over five years to $51 billion over six years. Many organizations, including Doctors Without Borders, continue to worry that Mr. Obama is "flat-lining" funding for the vital program. But this ignores Mr. Obama's move to make PEPFAR the center of a larger $63 billion global health initiative to develop more comprehensive and integrated approaches to care.

To that end, PEPFAR 2 has three pillars: prevention, integration and improved health-care systems in the 15 participating countries, which include Haiti, Vietnam, Guyana and 12 sub-Saharan nations. While getting people into treatment has been relatively easy, preventing them from becoming HIV-positive has been the harder nut to crack. Under the new strategy, women and mothers will be the focus of prevention efforts, with a particular emphasis on preventing mother-to-child transmission of HIV. To foster a more integrated approach to care, PEPFAR patients will also be treated for tuberculosis, malaria and previously untreated tropical diseases. The administration believes that with its effort to beef up medical personnel and assist governments to manage epidemics, overall health systems will improve.

Ultimately, the goal is to shift to a partnership, with the PEPFAR country taking ownership of the program's oversight. And the targets for PEPFAR 2 are ambitious. By 2014, more than 4 million people should be in treatment, more than 12 million HIV infections should be prevented and the number of at-risk babies born without HIV should double from the 240,000 negative babies born to positive mothers over the previous five years. The financial resources are there to do it. What's needed is the active participation and leadership of PEPFAR countries to make it happen.

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