In May 2003, Congress approved and President Bush signed into law, the "United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003" This legislation approved expenditure of up to $15 billion over 5 years.The program known as the President's Emergency Plan for AIDS Relief (PEPFAR) spent $18.5 billion over those five years to prevent HIV infection, treat people with AIDS, and provide care to orphans and vulnerable children. PEPFAR is "the largest commitment by any nation to combat a single disease in human history."
Moving Forward
On July 30th , 2008 the U.S. Government reauthorized the President's Emergency Plan for AIDS Relief (PEPFAR) allocating $48 billion to developing countries for their struggle against AIDS, tuberculosis and malaria. The bulk of this money, $39 billion, is for HIV/AIDS, with $4 billion going towards tuberculosis, and $5 billion for tackling malaria. The act also doubles the US contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria to $2 billion yearly.
The 2008 reauthorization act provided the following guidelines:
- Over half of the funds are to be spent on treatment programmes, including antiretroviral treatment, care for associated opportunistic infections and nutritional support for people living with HIV/AIDS.
- In countries with generalised HIV epidemics, at least half of all money directed towards preventing sexual HIV transmission should be for ‘activities promoting abstinence, delay of sexual debut, monogamy, fidelity, and partner reduction’. If this is not complied with then the Global AIDS Coordinator must report to Congress within 30 days on the reasons behind the shortfall.
- 10% of the funds are directed towards helping orphans and vulnerable children.
The U.S. is saving the lives of millions of people in the poorest places on the planet through this effort. The number of AIDS deaths worldwide dropped 10% in 2007 due to increasing access to treatment, as did the number of new infections in children. “In a surprisingly short period of time, there has been a tripling of prevention efforts in some countries,” said Dr. Paul De Lay, director of evaluation for UNAIDS.
PEPFAR reauthorization was the result of months of work by Democratic and Republican congressional leaders, advocacy organizations, foreign policy experts and medical professionals who worked together to pass historic new funding levels to fight AIDS, TB and malaria.
Bipartisan Support: McCain and Obama were co-sponsors on the the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008. (headed by Sen. Biden and Lugar and others)
PEPFAR II rescinded the United States HIV/AIDS travel and immigration ban, which as one consequence had prevented the US from ever hosting HIV/AIDS conferences, and even worse discouraged HIV-positive immigrants, many of whom acquired the disease in the US, from taking an AIDS test or accessing medical services.
"America’s global AIDS plan has proved to be a smart investment, paying dividends in lives saved, communities stabilized and America’s reputation in the world growing a little bit brighter. This stuff works and leaders from left and right — leaders like Senators Biden and Lugar, Representatives Berman and Ros-Lehtinen, President Bush, Speaker Pelosi and Senator Reid - put aside their differences and agreed to do more." Bono- co-founder of the One organization. 7/31/08
CONS
PEPFAR continues to require beneficiary countries to emphasize abstinence-only in their prevention efforts, a methodology supported by religious ideology, not scientific evidence.
At times this means countries have had to use essential funds in ineffective ways.
PEPFAR has a "conscience clause" allowing HIV/AIDS workers to deny services to anyone they deem "immoral." This U.S. foreign policy often promotes both stigma and discrimination against homosexuals, intravenous drug users and sex workers ironically, among those most at risk of HIV/AIDS.
A recent study in six U.S. urban centers revealed an astounding HIV prevalence of 46 percent among black gay men. In addition, the U.S. Centers for Disease Control and Prevention released its revised estimate for annual new HIV infections in the United States, a 40 percent increase, from 40,000 a year to more than 56,000. It seems possible that we have grossly underestimated the scope of the national U.S. epidemic in the past decade.
PEPFAR requires beneficiary nations to develop a national AIDS strategy, while the Bush administration has refused to create one of its own. However, Congress has just allocated $1.4 million to launch a national strategy.
Rwanda has been ahead of the curve in meeting treatment goals, but they and many of the other focus countries struggle with the following challenges:
- coordination difficulties amongst both U.S. and non U.S. agencies
- U.S. government policy constraints
- shortages of qualified focus country health workers
- focus country government restraints
- weak infrastructure, including data collection and reporting systems, and drug supply systems.
For more information: A report from the Kaiser Family Foundation compares PEPFAR I with PEPFAR II here.
