President's Emergency Plan For AIDS Relief

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The President's Emergency Plan For AIDS Relief (PEPFAR/Emergency Plan) is President Bush's pledge of $15 billion over five years (2003-2008) to fight the HIV/AIDS pandemic. As the largest international health initiative ever initiated by one nation to address a single disease, the program hopes to provide antiretroviral treatment (ART) to 2 million HIV-infected people in resource-limited settings, to prevent 7 million new infections, and to support care for 10 million people (the "2-7-10 goals").

The U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (or the Global AIDS Act) established the State Department Office of the Global AIDS Coordinator to oversee all international AIDS funding and programming. Ambassador Mark R. Dybul has been the U.S. Global AIDS Coordinator since July 2006.

As of September 2006, the program estimates that it has supported the provision of ART to approximately 892,000 people. See the official PEPFAR website [1], the Five Year Strategy Fact Sheet, the Funding Fact Sheet,and Funding Information for FY2006. NB that critics have questioned the accuracy of PEPFAR reporting.

1 Focus Countries
2 Prevention
3 Treatment
4 Care
5 Programs
6 Accountability
7 Criticism
8 External links
- 8.1 Official
- 8.2 Others

[edit] Focus Countries

PEPFAR prioritizes resource-limited countries with high HIV/AIDS prevalence rates. The 15 current "focus countries" include Botswana, Cote d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Vietnam, and Zambia. While most of the $15 billion for this program will be spent on these focus countries, $4 billion is allocated for programs elsewhere, and for HIV/AIDS research. (The other $1 billion is contributed to the Global Fund, see below). See the PEPFAR World Wide Activities Map

[edit] Prevention

To slow the spread of the epidemic, PEPFAR supports a variety of prevention programs: the ABC approach (Abstain, Be faithful, and correct and consistent use of Condoms); prevention of mother to child transmission (PMTCT) interventions; and programs focusing on blood safety, injection safety, secondary prevention ("prevention with positives"), counseling and education.

[edit] Treatment

In addition to providing antiretroviral therapy (ART), PEPFAR supports prevention and treatment of opportunistic infections, as well as services to prevent and treat malaria, tuberculosis, waterborne illness, and other acute infections. PEPFAR supports training and salaries for personnel (including clinicians, laboratorians, pharmacists, counselors, medical records staff, outreach workers, peer educators, etc), renovation and refurbishment of health care facilities, updated laboratory equipment and distribution systems, logistics and management for drugs and other commodities. This is intended to ensure the sustainability of PEPFAR services in host countries, enabling long-term management of HIV/AIDS.

[edit] Care

For those who have already been infected with HIV/AIDS, PEPFAR provides HIV counseling, resources for maintaining financial stability, etc. Special care is given to orphans and vulnerable children (OVCs) and services are provided that meet the unique needs of women and girls, including victims of sex trafficking, rape, abuse, and exploitation (see fact sheet on Gender and HIV/AIDS). Finally, the Emergency Plan works closely with country leaders, military groups, faith-based organizations, etc. in an attempt to eliminate stigma.

[edit] Programs

PEPFAR establishes bilateral programs in host countries and also works closely with multilateral partners, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the World Health Organization (WHO), as well as local Faith-Based Organizations. PEPFAR also endorses the international principles of the "Three Ones": - one national plan, one national coordinating authority, and one national monitoring and evaluation system in each of the host countries in which organizations work.

[edit] Accountability

PEPFAR reports to Congress on an annual basis, providing programmatic and financial data as required by law. The Second Annual Report to Congress on the President's Emergency Plan for AIDS Relief is available on the official PEPFAR website [2], as are more specific reports, financial information and other information.

PEPFAR is exempt from the Mexico City Policy, also known as the "global gag rule." [3]

[edit] Criticism

Public health experts and non-profit organizations have questioned the tactics and effectiveness of PEPFAR programs, including requirements mandating that one-third of prevention spending be directed towards abstinence-only programs.

According to its critics, PEPFAR is influenced too heavily by American political and social groups with "moral" rather than public health agendas. PEPFAR Watch, a website run by the Center for Health and Gender Equity and Health GAP, notes that the legislation behind PEPFAR “contains several restrictions, including those on funding for prevention activities and on organizations working with commercial sex workers.” [4] PEPFAR has also refused to fund effective yet “taboo” safe needle exchange programs to prevent HIV transmission among drug users. [5]

An early criticism was that PEPFAR initially supported only branded antiretroviral drugs instead of cheaper generic versions; this has become less of an issue since distribution of generic drugs began in late 2005. [6]

As above, the accuracy of PEPFAR reporting has also been questioned, and internal audits have identified areas where improvement in monitoring and evaluation - particularly of prevention services - is needed.