“The old concept of concentrated, mixed, and generalized epidemics is making way for a new approach that requires analysing, understanding, and responding to subnational and local diversity of the AIDS epidemic, including knowing which populations are most affected within local epidemics.” PEPFAR Country/Regional Operational Plan 2015 Guidance
Citing this year’s UNAIDS 90-90-90 recommendations to end AIDS as a global pandemic by 2030, and its own 2012 Blueprint: Creating an AIDS-free Generation, the President’s Emergency Plan for AIDS Relief released its 2015 guidelines for country and regional PEPFAR-funded programs Thursday, with an unprecedented formal requirement to use input from in-country civil society.
With an emphasis on reaching populations with the highest rates of HIV and the least access to prevention and treatment services, the PEPFAR Country/Regional Operational Plan 2015 Guidance spells out a shift in the decade-old global program’s approach, that has in the past been criticized for failing to respond to realities on the ground. It comes at a time when diminishing funding, and confirmation that antiretroviral treatment for HIV reduces risks of transmission of the virus as well as of illness and death, have called for re-evaluations of how the program allocates its resources.
Since taking the role of U.S. Global AIDS Coordinator in April, Ambassador Deborah Birx has summed up the more targeted approach as “doing the right things, in the right places at the right times.” That, she has said, means shifting resources — funding, people, commodities — from geographical regions where HIV prevalence is low, and where HIV testing programs have turned up few positive diagnoses, to geographical areas where HIV prevalence and incidence remain high and programs have been inadequate to needs. It also has meant seeking to ensure that resources reach populations that include men who have sex with men, transgender women, sex workers, and people who inject drugs, who, in spite of high risks, have been denied services by discriminatory practices, laws and policies. The new guidelines note that local civil society involvement is needed to inform and sustain effective outreach to neglected populations, and the guidelines establish procedures to ensure that involvement is sought and put to use.
Activist groups representing affected populations, including sexual minorities and people who inject drugs are encompassed in the guidelines definition of civil society. Engagement with civil society groups also is delineated, with a minimum of four formal steps: preparing a plan to engage the groups, convening quarterly formal meetings with the groups, soliciting their written feedback and, in turn, informing the groups in writing of the outcomes of their participation in establishing program planning.
The requirements build on a directive sent by the State Department to PEPFAR country leaders in June 2013, under previous U.S. Global AIDS Coordinator Ambassador Eric Goosby. The change since the cable is quantifiable; while guidelines issued in 2012 for 2013 PEPFAR country and regional plans made eight references to “civil society,” the guidelines released Thursday include 104 references to civil society.
PEPFAR’s Country/Regional Operational Guidances, issued each year set a tone, as well as requirements under which PEPFAR programs carry out their missions. Underscoring strides in making information about the program more open and accessible, that Amb. Birx has called essential to achieving its goals, and that earned the program “a most improved” rating in the 2014 AID Transparency Index, this year’s guidance was posted for public perusal within a few weeks of its distribution to country PEPFAR leaders.