Ambassador Urges Other Nations To Step Up AIDS Relief

On November 2, Ambassador Mark Dybul, U.S. Global AIDS Coordinator, characterized the President’s Emergency Plan for AIDS Relief (PEPFAR) as an “act of compassion” that enjoys strong bipartisan support, and he said that the U.S. currently provides more than half of the total aid money contributed worldwide toward combating HIV/AIDS. “To be honest, I think the rest of the world needs to step it up,” he said.

In addition, Dybul addressed the controversy surrounding funding for abstinence education, the challenges of prevention programs promoting male circumcision and concerns about the Plan’s role in endemic health care infrastructures. The event took place at the Johns Hopkins Bloomberg School of Public Health and was co-sponsored by the Maryland Public Health Association.

The largest international effort dedicated to a single disease, PEPFAR is a $15 billion, five-year commitment made in 2003 by President George W. Bush and the U.S. to provide HIV/AIDS prevention, treatment and care in 120 countries. The bilateral HIV/AIDS programs operate with specific emphasis in 15 focus countries, which include Guyana, Haiti, Vietnam and 12 sub-Saharan African nations.

Dybul spoke of PEPFAR’s success in the achievement of the “7-2-10” goals delineated by the President: prevention of 7 million new infections, treatment for 2 million HIV-infected people and care for 10 million people, including not only those infected with HIV/AIDS, but also orphans and vulnerable children affected by the disease. Among the Plan’s successes, the ambassador pointed to support for school attendance and funding for pain medication and psychosocial services, as well as to the renovation and construction of health care facilities, creation of a previously nonexistent supply chain and support for health care workers in both HIV- and non-HIV indicators.

Dybul defended funding of abstinence programs, citing data that shows a decrease of HIV prevalence where there is a delay in sexual activity. He said that, moving forward, the Plan’s prevention agenda would expand gender programs that address male norms and violence. When questioned about PEPFAR’s efforts in family planning areas, he said, “PEPFAR is not going to be USAID,” he said. “USAID should continue to be the family planning program—but we need to integrate them.”

Dybul said that increased condom use during casual sex has decreased the prevalence of infection. He acknowledged that the Plan will need to intensify condom education programs directed at “multiple concurrent partnerships” (relationships in which one person has several long-term partners) and “discordant couples,” relationships in which one partner is infected but the other is not.

Despite a 50 percent success rate in prevention with male circumcision, and a $17 million commitment to it this year, Dybul said that there remain some cultural barriers to full implementation. PEPFAR is working closely with other agencies to promote it in countries such as Uganda, where the advocacy of male circumcision is controversial and must be handled delicately.

Recently the President called for reauthorization of PEPFAR for another five years and a doubling of the budget to $30 billion. Dybul said he would like to expand the Plan’s programs in prevention, research, public health evaluations and aggregation of data, and that he looks forward to fostering enhanced partnerships that will build a cadre of community health workers. He said that PEPFAR has brought about a “restoration of hope” to many countries, but he emphasized that the U.S. is only one piece of the infrastructure. “We can’t build the whole thing,” he said, “but with partnerships we can transform the world through health.” —Christine Grillo

To read Dean Michael J. Klag’s Spring 2006 Open Mike column about PEPFAR, click here.