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PEPFAR Programs Should Focus On Sustainable HIV Prevention Model

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PEPFAR Programs Should Focus On Sustainable HIV Prevention Model

A panel of public health experts on Tuesday at a House Foreign Affairs Committee hearing on the reauthorization of the President's Emergency Plan for AIDS Reliefsaid the program should emphasize HIV prevention that can be sustainedin the long term rather than implementing emergency programs, CQ HealthBeat reports (Gensheimer, CQ HealthBeat, 9/26).

PEPFARdirects an authorized $15 billion over five years for HIV/AIDS andtuberculosis primarily to 15 focus countries and provides funding tothe Global Fund To Fight AIDS, Tuberculosis and Malaria.PEPFAR's original mandate is scheduled to expire in September 2008.President Bush in May called on Congress to double current fundinglevels to $30 billion for five years (Kaiser Daily HIV/AIDS Report, 5/31). Joia Stapleton Mukherjee, medical director of Partners in Health,at the hearing said that the $30 billion proposed by Bush is not enoughand recommended that the committee authorize $50 billion over fiveyears for the program. Rep. Nita Lowey (D-N.Y.) last week at a forumon PEPFAR's reauthorization said she is aiming to increase the $30billion funding level over the next five years. "With these smalltargets, we are not building," Mukherjee said, adding, "We are simplysustaining work that is less than half done."

Potential Changes to PEPFAR Focus

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Foreign Affairs Committee Chair Tom Lantos (D-Calif.) at the hearingsaid that the "task for the next five years is not only to solidify"the progress PEPFAR has made in its 15 focus countries, "but toreorient the program so that our efforts to combat HIV/AIDS will besustainable for generations to come." Helene Gayle -- president and CEOof the international development and relief organization CARE,which operates in 11 of PEPFAR's 15 focus countries -- said PEPFARshould work toward creating a sustainable model for HIV prevention. Shecited an Institute of Medicine report releasedin March that recommended PEPFAR transition from focusing on emergencyrelief to "long-term strategic planning and capacity building." Gayleadded that "[a]ddressing HIV/AIDS solely as a medical challenge is liketreating the symptoms but not really the cause of the disease."

Accordingto Lantos, PEPFAR should work with focus countries to strengthen healthcare delivery systems and food security programs. Gayle and NilsDaulaire, president and CEO of the Global Health Council,added that prevention programs would not be fully effective unlessfunds also support health care systems. Mukherjee added that people indeveloping countries likely would not travel to clinics to receive anHIV test if the country's health care system is unable to providetreatment.

Rep. Donald Payne (D-N.J.), who chairs the Africa and Global Health Subcommittee,said he believes there is a relationship between PEPFAR's success infocus countries and a concentration on providing adequate nutrition incountries with high HIV prevalence. However, Rep. Ileana Ros-Lehtinen(R-Fla.), the ranking member on the committee, expressed caution aboutusing PEPFAR funds to improve health care systems and establish foodsecurity for HIV-positive people. "If PEPFAR is directed to take on theuniverse of problems that plague the focus countries, we risk reducingit to a program that is a mile wide and an inch deep," Ros-Lehtinensaid.

Gayle also recommended that PEPFAR adopt an "ABC-plus"prevention model that incorporates factors not addressed by theprogram's current ABC model. The ABC model stands for abstinence, befaithful and use condoms. Gayle said that the current ABC model isineffective for many women in developing countries who are unable tonegotiate sex or condom use, adding that the program also shouldaddress social, cultural and economic factors that affect girls'vulnerability to HIV.

Some panel members also expressedconcern that condom distribution programs have not been effective inthe fight against HIV/AIDS. "No generalized HIV epidemic has ever beenrolled back by a prevention strategy based primarily on condoms,"Norman Hearst, professor of medicine at the University of California-San Francisco,said, adding that successful HIV prevention programs "were achieved notthrough condoms but by getting people to change their sexual behavior."According to CQ HealthBeat, some of the panelists saidthat experts have moved beyond the issue of whether one component ofABC is essential for HIV prevention. Daulaire said that successfulprograms need to focus on "changing social behavior" (CQ HealthBeat, 9/26).

Reprinted with permission from kaisernetwork.org. You can view theentire Kaiser DailyHIV/AIDS Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . TheKaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service ofThe Henry J. Kaiser Family Foundation.