The President's Emergency Plan For AIDS Relief
) was a commitment of $15 billion over five years (2003–2008) from United States President
The President of the United States of America is the head of state and head of government of the United States. The president leads the executive branch of the federal government and is the commander-in-chief of the United States Armed Forces....
George W. Bush
George Walker Bush is an American politician who served as the 43rd President of the United States, from 2001 to 2009. Before that, he was the 46th Governor of Texas, having served from 1995 to 2000....
to fight the global HIV/AIDS pandemic. The program initially aimed to provide antiretroviral treatment (ART) to 2 million HIV-infected people in resource-limited settings, to prevent 7 million new infections, and to support care for 10 million people (the "2–7–10 goals") by 2010. PEPFAR increased the number of Africans receiving ART from 50,000 at the start of the initiative in 2004 to at least 1.2 million in early 2008. PEPFAR has been called the largest health initiative ever initiated by one country to address a disease. The budget presented by President Bush for the fiscal year 2008 included a request for $5.4 billion for PEPFAR.
The U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (or the Global AIDS Act) established the State Department Office of the Global AIDS Coordinator to oversee all international AIDS funding and programming. In July 2008, PEPFAR was renewed, revised and expanded as the "Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008". The expansion more than triples the initiative's funds, to $48 billion through 2013. On June 23, 2009, Ambasssador Eric Goosby
Ambassador Eric Goosby currently serves as the United States Global AIDS Coordinator. In this position Goosby directs the U.S. strategy for addressing HIV around the world and leads President Obama's implementation of the President's Emergency Plan for AIDS Relief . Goosby was sworn in on June 23,...
was sworn in as the United States Global AIDS Coordinator
The Global AIDS Coordinator at the U.S. State Department is the official responsible for overseeing U.S.-sponsored humanitarian aid programs to combat the AIDS epidemic in Africa and Asia. The office was previously held by Ambassador Mark R. Dybul, , until June 23, 2009 when Ambassador Eric Goosby...
The massive funding increases have made anti-retrovirals widely available, saving millions of lives. Critics contend that spending a portion of funding on abstinence-until-marriage programs is unjust while others feel that foreign aid is generally inefficient. According to a 2009 study published in Annals of Internal Medicine, the program had averted about 1.1 million deaths in Africa and reduced the death rate due to AIDS in the countries involved by 10%.
PEPFAR prioritizes resource-limited countries with high HIV/AIDS prevalence rates. The 15 current "focus countries" are Botswana
Botswana, officially the Republic of Botswana , is a landlocked country located in Southern Africa. The citizens are referred to as "Batswana" . Formerly the British protectorate of Bechuanaland, Botswana adopted its new name after becoming independent within the Commonwealth on 30 September 1966...
, Côte d'Ivoire
The Republic of Côte d'Ivoire or Ivory Coast is a country in West Africa. It has an area of , and borders the countries Liberia, Guinea, Mali, Burkina Faso and Ghana; its southern boundary is along the Gulf of Guinea. The country's population was 15,366,672 in 1998 and was estimated to be...
Ethiopia , officially known as the Federal Democratic Republic of Ethiopia, is a country located in the Horn of Africa. It is the second-most populous nation in Africa, with over 82 million inhabitants, and the tenth-largest by area, occupying 1,100,000 km2...
Guyana , officially the Co-operative Republic of Guyana, previously the colony of British Guiana, is a sovereign state on the northern coast of South America that is culturally part of the Anglophone Caribbean. Guyana was a former colony of the Dutch and of the British...
Haiti , officially the Republic of Haiti , is a Caribbean country. It occupies the western, smaller portion of the island of Hispaniola, in the Greater Antillean archipelago, which it shares with the Dominican Republic. Ayiti was the indigenous Taíno or Amerindian name for the island...
Kenya , officially known as the Republic of Kenya, is a country in East Africa that lies on the equator, with the Indian Ocean to its south-east...
Mozambique, officially the Republic of Mozambique , is a country in southeastern Africa bordered by the Indian Ocean to the east, Tanzania to the north, Malawi and Zambia to the northwest, Zimbabwe to the west and Swaziland and South Africa to the southwest...
Namibia, officially the Republic of Namibia , is a country in southern Africa whose western border is the Atlantic Ocean. It shares land borders with Angola and Zambia to the north, Botswana to the east and South Africa to the south and east. It gained independence from South Africa on 21 March...
Nigeria , officially the Federal Republic of Nigeria, is a federal constitutional republic comprising 36 states and its Federal Capital Territory, Abuja. The country is located in West Africa and shares land borders with the Republic of Benin in the west, Chad and Cameroon in the east, and Niger in...
Rwanda or , officially the Republic of Rwanda , is a country in central and eastern Africa with a population of approximately 11.4 million . Rwanda is located a few degrees south of the Equator, and is bordered by Uganda, Tanzania, Burundi and the Democratic Republic of the Congo...
, South Africa
The Republic of South Africa is a country in southern Africa. Located at the southern tip of Africa, it is divided into nine provinces, with of coastline on the Atlantic and Indian oceans...
The United Republic of Tanzania is a country in East Africa bordered by Kenya and Uganda to the north, Rwanda, Burundi, and the Democratic Republic of the Congo to the west, and Zambia, Malawi, and Mozambique to the south. The country's eastern borders lie on the Indian Ocean.Tanzania is a state...
Uganda , officially the Republic of Uganda, is a landlocked country in East Africa. Uganda is also known as the "Pearl of Africa". It is bordered on the east by Kenya, on the north by South Sudan, on the west by the Democratic Republic of the Congo, on the southwest by Rwanda, and on the south by...
Vietnam – sometimes spelled Viet Nam , officially the Socialist Republic of Vietnam – is the easternmost country on the Indochina Peninsula in Southeast Asia. It is bordered by China to the north, Laos to the northwest, Cambodia to the southwest, and the South China Sea –...
, and Zambia
Zambia , officially the Republic of Zambia, is a landlocked country in Southern Africa. The neighbouring countries are the Democratic Republic of the Congo to the north, Tanzania to the north-east, Malawi to the east, Mozambique, Zimbabwe, Botswana and Namibia to the south, and Angola to the west....
. While most of the $15 billion for this program will be spent on these focus countries, $4 billion is allocated for programs elsewhere, and for HIV/AIDS research. (The other $1 billion is contributed to the Global Fund, see below.) See the PEPFAR World Wide Activities Map
To slow the spread of the epidemic, PEPFAR supports a variety of prevention programs: the ABC approach
e faithful, and correct and consistent use of C
ondoms); prevention of mother to child transmission (PMTCT)
interventions; and programs focusing on blood safety, injection safety, secondary prevention ("prevention with positives"), counseling and education.
Initially, a recommended 20% of the PEPFAR budget was to be spent on prevention, with the remaining 80% going to care and treatment, laboratory support, antiretroviral drugs, TB/HIV services, support for orphans and vulnerable children (OVC), infrastructure, training, and other related services. Of the 20% spent on prevention, one third, or 6.7% of the total, was to be spent on abstinence-until-marriage programs in fiscal years 2006 through 2008, a controversial requirement (see below). The other two thirds was allotted for the widespread array of prevention interventions described above, including counseling, education, injection safety, blood safety and condoms.
The 2008 reauthorization of PEPFAR eliminated the 20% recommendation for prevention efforts, including the requirement for abstinence programs.
In addition to providing antiretroviral therapy (ART), PEPFAR supports prevention and treatment of opportunistic infections, as well as services to prevent and treat malaria, tuberculosis, waterborne illness, and other acute infections. PEPFAR supports training and salaries for personnel (including clinicians, laboratorians, pharmacists, counselors, medical records staff, outreach workers, peer educators, etc.), renovation and refurbishment of health care facilities, updated laboratory equipment and distribution systems, logistics and management for drugs and other commodities. This is intended to ensure the sustainability of PEPFAR services in host countries, enabling long-term management of HIV/AIDS.
PEPFAR-supported care and treatment services are implemented by a wide array of U.S.-based and international groups and agencies. Among the largest "Track 1.0" (treatment) partners are Harvard University, Columbia University's International Center for AIDS Care & Treatment Programs (ICAP), the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), and the AIDSRelief consortium of Catholic Relief Services.
For those who have already been infected with HIV/AIDS, PEPFAR provides HIV counseling, resources for maintaining financial stability, etc. Special care is given to orphans and vulnerable children (OVCs) and services are provided that meet the unique needs of women and girls, including victims of sex trafficking, rape, abuse, and exploitation (see fact sheet on Gender and HIV/AIDS
). Finally, the Emergency Plan works closely with country leaders, military groups, faith-based organizations, etc. in an attempt to eliminate stigma
Social stigma is the severe disapproval of or discontent with a person on the grounds of characteristics that distinguish them from other members of a society.Almost all stigma is based on a person differing from social or cultural norms...
PEPFAR establishes bilateral programs in host countries and also works closely with multilateral partners, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the United Nations program on AIDS (UNAIDS)
, as well as the Peace Corps
The Peace Corps is an American volunteer program run by the United States Government, as well as a government agency of the same name. The mission of the Peace Corps includes three goals: providing technical assistance, helping people outside the United States to understand US culture, and helping...
and local Faith-Based OrganizationsPEPFAR_Inter-faith_New_Partners_Initiative
. PEPFAR also endorses the international principles of the "Three Ones"
: — one national plan, one national coordinating authority, and one national monitoring and evaluation system in each of the host countries in which organizations work.
PEPFAR reports to Congress on an annual basis, providing programmatic and financial data as required by law. The Second Annual Report to Congress on the President's Emergency Plan for AIDS Relief is available on the official PEPFAR website, as are more specific reports, financial information and other information.
PEPFAR was exempt from the Mexico City Policy
The Mexico City Policy, also known by critics as the Mexico City Gag Rule and the Global Gag Rule, was an intermittent United States government policy that required all non-governmental organizations that receive federal funding to refrain from performing or promoting abortion services, as a...
Funding data was obtained by the Center for Public Integrity
The Center for Public Integrity is a nonprofit organization dedicated to producing original, responsible investigative journalism on issues of public concern. The Center is non-partisan and non-advocacy and committed to transparent and comprehensive reporting both in the United States and around...
from PEPFAR's own information system COPRS. The data were obtained after CPI sued the U.S. State Department to gain access to the data. The data were shared on the CPI site
as well as analyzed by the HIV/AIDS Monitor team
at the Center for Global Development
The Center for Global Development is a non-profit think tank based in Washington, D.C. that focuses on international development. It was founded in November 2001 by former senior U.S. official Edward W. Scott, director of the Peterson Institute for International Economics, C. Fred Bergsten, and...
, who also share the full dataset.
Some critics of PEPFAR feel that American political and social groups with moral rather than public health agendas are behind several requirements of PEPFAR, pointing to the mandates that one-third of prevention spending in 2006–2008 be directed towards abstinence
Abstinence is a voluntary restraint from indulging in bodily activities that are widely experienced as giving pleasure. Most frequently, the term refers to sexual abstinence, or abstention from alcohol or food. The practice can arise from religious prohibitions or practical...
-until-marriage programs and that all funded organizations sign an anti-prostitution pledge
The U.S. federal government requires non-governmental organizations that receive federal anti-HIV/AIDS or anti-trafficking funds to adopt an organization-wide policy opposing prostitution and sex-trafficking. This requirement, known as the anti-prostitution pledge, has been in place since 2003...
. PEPFAR also does not fund needle exchange programs, which are widely regarded as effective in preventing the spread of HIV. The requirement for prevention spending was lifted with the PEPFAR reauthorization in 2008, but some critics worry that some funds could still be spent on abstinence programs. The Center for Health and Gender Equity and Health GAP outline their criticism of PEPFAR on a website known as PEPFAR Watch
. The previous 33% earmark has since been replaced by a requirement that if more than 50% of PEPFAR funds are allocated to non-abstinence promotion measures, the US Global AIDS Coordinator must report to Congress.
Randall L. Tobias
Critics of PEPFAR found fault with President George W. Bush's selection of former Eli Lilly and Company
Eli Lilly and Company is a global pharmaceutical company. Eli Lilly's global headquarters is located in Indianapolis, Indiana, in the United States...
chief executive Randall L. Tobias
Randall L. Tobias is a former chief executive officer of Eli Lilly and Company who became the first United States Director of Foreign Assistance, and served concurrently as the Administrator of the U.S. Agency for International Development , with the rank of Ambassador...
as the first Global AIDS Coordinator in charge of PEPFAR, a position in which Tobias served from 2003 until 2006.
Paul Zeitz, executive director of the Global AIDS Alliance, stated that the naming of Tobias raised "serious questions of conflict of interest and the priorities of the White House", while Kate Krauss of the AIDS Policy Project called Tobias "the fox in charge of the henhouse". Ambassador Mark Dybul
Ambassador Mark R. Dybul served as the United States Global AIDS Coordinator, leading the implementation of the President's Emergency Plan for AIDS Relief during the presidency of George W. Bush.-Biography:...
replaced Tobias as U.S. Global AIDS Coordinator on August 11, 2006.
PEPFAR was criticized for initially funding only branded antiretroviral drug
Antiretroviral drugs are medications for the treatment of infection by retroviruses, primarily HIV. When several such drugs, typically three or four, are taken in combination, the approach is known as Highly Active Antiretroviral Therapy, or HAART...
s instead of cheaper generic
A generic drug is a drug defined as "a drug product that is comparable to brand/reference listed drug product in dosage form, strength, route of administration, quality and performance characteristics, and intended use." It has also been defined as a term referring to any drug marketed under its...
versions, but distribution of generic drugs began in late 2005.
Many have argued that PEPFAR's emphasis on direct funding from the United States to African governments (bilateral programs) have been at the expense of full commitments to multilateral programs such as the Global Fund. Reasons given for this vary, but a major criticism has been that this enables the U.S. "to maximize its leverage with other countries through the funds available for distribution" since the "Global Fund and other multilateral venues do not possess the same top-down leverage as does the United States in demanding fundamental national-level reforms".
Lack of funding
While the Bush administration had promised to increase funding for PEPFAR, January 2010's Obama administration budget proposes to 'flatline' its funding. This could cause a drought in medicines to people who need them to survive. UNAIDS Executive Director, Michel Sidibé has said that the world is likely to witness ‘our worst nightmare’ if funding for HIV/AIDS medicines falls short of sustaining those already on anti-retroviral medicines.
Though Obama had pledged $1.05 billion per year for the Global Fund to Fight AIDS, TB, and Malaria for 2010 and 2011, the actual % contributed were 75% and 60% respectively. Overall funding has decreased by 22.5% between fiscal years 2008 and 2011.
Harm reduction refers to a range of public health policies designed to reduce the harmful consequences associated with recreational drug use and other high risk activities...
Advocates for harm reduction believe that better results would be achieved globally if PEPFAR revamped their approach to reducing
the spread of HIV rather than trying to prevent it all together. They believe that PEPFAR does not thoroughly take into account the prevalence of challenges against effective harm prevention. Although it is ideal, it is impossible to completely prevent drug use, prostitution and rape from occurring globally. By "reducing" the high-risks associated with HIV transmission, advocates believe their approach provides to be more effective in terms of results than harm prevention.http://www.aids.org/topics/harm-reduction-and-hiv/
Faith-Based Organizations (FBOs) | Ideology vs. Science
FBOs and their missions of faith being intertwined within PEPFARs AIDS relief has been a sore spot for many. Opposition lies within the fact that many of the places where HIV/AIDS is prevalent do not adhere to the same religious doctrines as the FBOs are providing. http://digital.graphcompubs.com/publication/?i=54869&p=15
Investigation by the Department of Health and Human Services Office of Inspector General (OIG)
On the 15 June 2011, the OIG published a report critical of the Centers for Disease Control and Prevention’s (CDC's) failure to oversee recipients’ use of PEPFAR funds. The report read in part:
- "Lectures For The Dying" by Max and the Marginalized (Song and Music Video about PEPFAR and Abstinence-Only Education)
- PEPFAR and the Global AIDS Response Video and summary for event held at the Woodrow Wilson Center in September 2007.
- PEPFAR Watch
- AVERT's PEPFAR Information Site
- AIDSPortal PEPFAR page with reports, events and factsheets
- Mozambique faces HIV cash dilemma, BBC News
BBC News is the department of the British Broadcasting Corporation responsible for the gathering and broadcasting of news and current affairs. The department is the world's largest broadcast news organisation and generates about 120 hours of radio and television output each day, as well as online...
, 1 December 2004 (note: graphic images)
- CSIS Events — ABC Guidance Roundtable — Global AIDS Coordinator Mark Dybul, M.D., addressing controversies over the ABC approach to prevention, misinformation, etc. (December 15, 2005)
- Religious Groups Get Chunk of AIDS Money, ABC News
ABC News is the news gathering and broadcasting division of American broadcast television network ABC, a subsidiary of The Walt Disney Company...
, 30 January 2006
- Bush's Foreign Sex Policy, CounterPunch.org, 22 December 2006
- George Bush is an HIV/AIDS relief revolutionary at Jewcy.com
- Twice As Many Die: Bush's Duplicitous New AIDS Plan in Dollars & Sense
Dollars & Sense is a magazine dedicated to providing left-wing perspectives on economics.Published six times a year since 1974, it is edited by a collective of economists, journalists, and activists committed to the ideals of social justice and economic democracy.It was initially sponsored by the...
magazine, July/August 2007
- The Flawed ABCs of PEPFAR Michael Stulman, Foreign Policy in Focus, August 21, 2007