Pass PEPFAR 2008 Now - Build Capacity for Prevention and Treatment
a shorter version of this op-ed was posted on politico.com on June 21, 2008
As Congress considers the five year/$50 billion legislation extending and strengthening the President’s Emergency Plan for AIDS Relief (PEPFAR), lawmakers have a critical opportunity to capitalize on what we have learned so that U.S. dollars have maximum impact in the global fight against HIV.
After hammering out a new PEPFAR bill earlier this year with the support of the White House and both sides of the aisle in Congress, this lifesaving legislation is being held up by a small group of Republican senators who are trying to put restrictions on the way the money is spent, undermining the ability of the African countries hardest hit by AIDS to mount a successful response.
The urgency to reauthorizing PEPFAR is not academic; delay has real implications for programs on the ground. At the 2008 HIV Implementers Meeting in Kampala, Uganda earlier this month, concerns were rife about firing employees whose contracts expire, only to scramble to rehire this talent when legislation is finally approved. Administrative delays cost lives and waste money. President Bush will be heading to the G8 meeting in July, where world leaders meet to define priorities for investment and action. By coming in with a $50 billion commitment, the US can encourage other donors to increase their financial support in combating this global plague.
The original PEPFAR legislation prescribed how countries could use the money, specifying proportions for treatment, prevention, care and support – and even specifying the amount that needed to be spent on abstinence. In 2008 we believe that it is time to move away from overly prescriptive U.S. government-directed programs. Instead, PEPFAR should support accountable country-driven decision-making processes that allow national governments to have a guiding voice in determining how to most effectively fight the AIDS epidemic in their countries based on prioritization of unmet need and coordination of all available resources.
There is no danger that African countries that have benefited so much from PEPFAR in the establishment of successful AIDS treatment programs will turn their back on treatment. Mandating a treatment goal that squeezes out prevention misses the point that treatment offers one of the best places from which to stage prevention programs.
The math for prevention is clear – for every person we that gains access to treatment, more than 2 people become newly infected. Investments in prevention as well as treatment are imperative. It is also vitally important that we allow our African colleagues to leverage AIDS programs to increase their human resource capacity and improve their overall healthcare systems, which will be the keys to long term sustainability and success.
It’s time to put aside politics and pass the PEPFAR legislation that has been hammered out in successful bipartisan negotiations over the last year.
Eric Goosby, MD, CEO and Chief Medical Officer
Ambassador Theogene Rudasingwa, MD, Vice President for Global Affairs