The Basics on PEPFAR

by Clara Presler
Recent developments on the President's Emergency Plan for AIDS Relief (PEPFAR)
(New York City, June 12, 2007)--In 2003, President Bush introduced the President's Emergency Plan for AIDS Relief (PEPFAR), a plan that allocated $15 billion over 5 years to AIDS relief in 15 countries hardest hit by the epidemic. Last Wednesday, May 30th, Bush announced that he would reauthorize this spending and boost the amount to $30 billion over the next 5 years starting in September 2008.

While PEPFAR has been instrumental in providing treatment to some 1.1 million people since 2003, heavy controversy surrounds the myriad restrictions that are placed on the funds and the specific earmarks. Additionally, increases in the number of people on treatment are being far outstripped by those becoming infected. For example, in sub-Saharan Africa for each 1 person put on treatment in 2005, 5 became infected. This means that, while Bush has doubled the overall funds, per capita spending on HIV-positive individuals will likely remain flat or even decline.

Currently under PEPFAR, 55 percent of funds must go to treatment and 10 percent must go to programs targeting orphans. Twenty percent of the funds go towards for HIV prevention and Congress requires that 33 percent of prevention funds be spent on abstinence-until-marriage programs (the remaining 15 percent goes to palliative care). As a percentage of money spent specifically on prevention of sexual transmission, close to two-thirds is spent on abstinence-only education. This requirement has been shown to divert finds away from other methods of HIV-transmission prevention, for example prevention of maternal-to-child transmission and prevention targeting injecting drug users.

Looking ahead to the next years of PEPFAR, advocacy organizations are working to see that the restrictions on prevention programs will be lifted and replaced by programs that are evidenced-based and fulfill the right to information, and that better respond to the factors making women vulnerable to HIV infection. Such programs include prevention of mother-to-child transmission, comprehensive sex education, and programs addressing property rights and domestic violence.

Another area of advocacy relates to US government policy which does not allow funding for clean needle exchange programs. These are needed in much of Asia and Eastern/Central Europe and specifically in places like Vietnam (a PEPFAR country) where the majority of HIV-transmission occurs through injection drug use. Other groups, including HealthGap and Physicians for Human Rights are pushing for attention to increasing health personnel (training and retention). Jose DeMarco of HealthGAP said, "Fighting AIDS in Africa without addressing the health worker crisis is like treating a massive hemorrhage with a handful of bandaids. PEPFAR must spend money to train and deploy new health workers and pay the providers who are at the heart of any successful AIDS response."

One step towards these goals is the bipartisan PATHWAY Act of 2007 (Protection Against Transmission of HIV for Women and Youth Act of 2007), introduced by Congresswoman Barbara Lee and Congressman Chris Shays that is currently up for consideration. This act would strike the abstinence-only earmark and further require the President and the Office of the Global AIDS Coordinator (OGAC) to establish a comprehensive and integrated HIV prevention strategy to address the vulnerabilities of all women and girls to HIV infection.

Decisions around PEPFAR are moving quickly: just last week, the 5th of June, The House State and Foreign Operations Subcommittee marked up the appropriations bill in a manner that reflects our concerns with US foreign aid, including the recommendation that an option to waive the abstinence-until-marriage earmark be included. The next vote on this will take place this week.

MORE INFORMATION:

President Bush’s announcement of May 30th
New York Times: Bush Seeks to Double Spending for AIDS Program
Washington Post: Bush to Seek Extension of AIDS Effort

Analysis
The Government Accountability Office (GAO) April 2006 report,
The Institute of Medicine (IOM) March 2007 report
PEPFAR Watch