12 December 2012

Experts Mixed on PEPFAR's Blueprint to End AIDS

The United States government continued its priority of realizing a world without HIV/AIDS. “Now, make no mistake about it: HIV may well be with us into the future. But the disease that it causes need not be,” said Secretary of State Clinton at a press conference marking this month’s World AIDS day. “We can reach a point where virtually no children are born with the virus, and as these children become teenagers and adults, they are at a far lower risk of becoming infected than they are today.”

At the event, Secretary Clinton unveiled the new plan from the President’s Emergency Plan for AIDS Relief (PEPFAR) that establishes a blueprint for creating an AIDS-free generation. It sets out to end new infections of aids by achieving the following five goals: 1) scaling up treatment and prevention; 2) targeting at-risk populations; 3) promoting sustainable, effective and efficient solutions that maximize every dollar spent; 4) supporting country leadership; 5) continuing efforts in science and research.

Experts weighed in on the plan offering their praise and criticisms about certain aspects of the Blueprint. UNAIDS executive director Michel SidibĂ© praised the blueprint saying, “Never in the history of the AIDS response have we been so aligned in our priorities, our mutual respect and in our shared motivation for results.” Others praised the United States for continuing its support for the Global Fund to Fight AIDS, TB and Malaria including Ann Lion of Abt and Erin Hohlfelder of the ONE Campaign.

There was general agreement about the need to support country ownership and efforts to address the challenges faced by women as well as the stigma surrounding having HIV. Greg Ramm of Save the Children commended the second goal telling Devex, “We welcome the…particular attention to women and girls. We appreciate the focus on key affected populations, and with 40% of new infections among youth, and we hope there will be sufficient emphasis on younger member of key affected populations and those living with HIV.”

Treatment as prevention, a topic that continues to engage in a healthy debate received mixed reactions. A study published on World AIDS Day found that couples where one was infected with HIV and the other was not did see declines in infection rates when the HIV-infected partner took ARVs. However, the findings by the Chinese study produce results that were not nearly as high as a previous study that found using anti-retroviral medicines were on par with using condoms.

The fact that PEPFAR is still studying the treatment as prevention strategy in South Africa, Botswana and Tanzania led CGD’s Mead Over to tell the NPR Shots blog that it may be premature to talk about achieving an AIDS-free generation.

The most pointed criticisms of the Blueprint were aimed at the issue of funding. “We had hoped that the new blueprint would focus more on the importance of narrowing the funding gap through increased donor and country level financial commitment,” said Lion. A New York Times OpEd the day after the announcement was forceful in its call for more to be done beyond promises.

“Doing better on AIDS is not a pipe dream. In fact, the combined efforts of the American program to combat AIDS abroad, a global health fund based in Geneva, private donors and national governments have substantially slowed transmission of the disease,” wrote the editors. “Middle-income countries where AIDS is prevalent have steadily increased their share of the annual total of more than $16 billion spent around the world fighting the disease, but the poorest countries still need help. Governments struggling to revive their economies will be hard pressed to increase money or resources, but this is an investment that the international community cannot put off.”

More than anything else, the Blueprint represents a commitment to ending AIDS that stems from long-standing efforts like PEPFAR and previous public declarations from Secretary Clinton. USAID Administrator Shah articulated it in his statement marking World AIDS Day, “Although HIV/AIDS remains one of the world's most serious global health challenges, we are committed to realizing a safer and healthier future, where generations of children are born free from its shadow.”