On April 2, the U.S. House of Representatives voted to reauthorize and expand the President’s Emergency Plan for AIDS Relief (PEPFAR).  More than tripling the funds previously allocated to the programme in the last five years – from $15 billion to $50 billion over 5 years. The plan still needs to pass through the Senate where it is set to face opposition from both fiscal conservatives alarmed by the marked increase in funding, as well as Democrats opposed to channeling money through faith-based groups. The White House has issued a statement “strongly” supporting the bill’s passage, however, so it looks likely that it will be approved.

Announced during the 2003 State of Union address, and passed later that year, PEPFAR initially allocated $10 billion for AIDS prevention, treatment and care for those people living in the 15 most severely affected countries around the world.  It also provided $4 billion to other countries for similar purposes as well as research, and another $1 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria.   

Almost 85% of the next $50 billion (about $41 billion) would be solely for the prevention and treatment of AIDS around the world.  Of that amount, up to $2 billion would be given to the Global Fund. The further 15% would be spent on addressing wider health issues, in an attempt to shift PEPFAR from an emergency response programme toward a long-term, sustainable plan. It would provide training for 140,000 new health care workers, target vulnerable groups such as women and girls, and add nutrition and other secondary services to PEPFAR, including spending $9 billion on tackling tuberculosis and malaria.

At first glance, the new PEPFAR appears to have won a victory for comprehensive, evidence-based prevention, as the previous stipulation that one third of all funds be allocated toward the promotion of abstinence only prevention programmes, has been taken out.  However, on further reading it becomes apparent that despite this earmarking having been removed, new conditions mean that more money, not less could be channeled into abstinence only programmes! Reports to Congress are required for countries spending less than 50% of HIV prevention funds on these programmes. In addition organizations receiving funds must sign a clause opposing sex work.

Many organizations working in the field of HIV and AIDS are outraged by this illogical and moralistic clause. VSO’s work in China, Mozambique and Vietnam, for example, has shown that working with people who sell sex is essential to halting HIV transmission.

Despite consistent evidence that abstinence and faithfulness programmes alone are not effective, the new bill still embraces them. Unless this changes, the effectiveness of the money continues to be undermined by clauses that are based on conservative moral considerations rather than hard facts about how to prevent HIV infections.

The AIDS Healthcare Foundation has also raised concerns over the lack of ambition in terms of treatment targets.  The previous bill had a requirement that 55% of funds had to be spent on treatment.  This has now been removed and the new PEPFAR only increases the treatment goals by one million people in the next five years.  Well below the US’s fair share of the Universal Access promise.  Penninah Iutung, a Medical Director with the AIDS Healthcare Foundation/Uganda CARES described this as “a move that will only create despair and hopelessness where so much hope has been raised.”

So is the reauthorization of an expanded PEPFAR a good thing? It has undoubtedly achieved a lot, particularly in relation to treatment. It has provided over 1.4 million people with Antiretroviral therapy since 2003.  But the overall success of the initiative is slightly marred by concerns such as that from the European Union “about the resurgence of partial or incomplete messages on HIV prevention which are not grounded in evidence and have limited effectiveness.”

One thing is certain though, with the US giving $50 billion in aid to tackling AIDS in the developing world, the British Government should see this as a strong signal that AIDS is still an issue that needs addressing, and progress can only come with sufficient funding.  Surely the Government can spare its fair share of £2.5 billion over the next three years?

If the US reauthorizes PEPFAR without addressing the need to provide comprehensive, evidence-based prevention and scale up treatment to reach Universal Access, the UK must rise to the challenge and bridge this crucial gap.

For more information go to http://www.pepfar.gov/.

PEPFAR in Numbers

 1,445,500 The number of men, women and children given access to ARV treatment through September 2007.

2.7 million  The number of orphans and vulnerable children given care through September 2007.

10 million  The number of pregnancies supported during which HIV transmissions were prevented through September 2007.

33 million The number of counseling and testing sessions provided to men, women and children through September 2007.

5-year Goals Support the prevention of 7 million infections in the 15 core countries. 

Support ARV treatment of 2 million people.

Support care for 10 million people.

Sources: avert.org, The New York Times, The Washington Post, The Associated Press, pepfar.gov

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