In a 90 minute meeting with HIV advocates and implementers today, Ann Gavaghan spent almost as much time explaining what PEPFAR’s new five-year strategy does not mean as what it does mean.
The term “increased efficiencies” is not some code for budget cuts, Gavaghan promised, but rather a mandate to maximize the impact of PEPFAR programs. The phrases “country-led” and “country-driven” do not mean all PEPFAR funding will now flow to country governments and that “everyone else gets shut out,” she said. And the call for PEPFAR programs to address HIV/AIDS within a broader health and development context “does not mean HIV programs will be subsumed into development.”
Gavaghan is a top policy official with the Office of the US Global AIDS Coordinator, and her remarks came at a meeting of the Global AIDS Roundtable in Washington. The room was jammed with more than 50 advocates looking for translation and elaboration of the strategy documents OGAC released last month on World AIDS Day. Those documents spell out, in broad brush, a vision for transitioning PEPFAR over the next five years from an emergency response to a more durable, integrated initiative, but they’ve sparked a wave of questions about PEPFAR’s focus and its commitment to continued treatment scale-up.
On the latter point, Gavaghan was adamant in rebutting the notion that PEPFAR is pulling back on treatment. “We are continuing to support scale up of treatment,” she said. ”Let me repeat that.” And she did.
In the five-year plan, PEPFAR set a treatment target of reaching more than 4 million people with antiretroviral drugs. Advocates say this is a low-ball figure; the program already serves more than 2.4 million, so the new figure suggests that expansion of AIDS treatment over the next five years will be only about 1.6 million people, a significant slowing of the initiative’s growth and far short of the need. Disease experts and advocates have said that PEPFAR can and should reach 7 million people with ARVs by 2014.
Gavaghan stressed that PEPFAR’s target is more than 4 million, although she didn’t give any additional specifics. When asked how PEPFAR would achieve that with flat funding, she said PEPFAR would continue to expand, without offering details. And she added: “If you hear specific examples where PEPFAR programs are flatlining or cutting funding, let us know … We want to be able to track that down.”
Smita Baruah, of the Global Health Council, and others said they had heard of specific examples, particularly with implementers being forced to choose between treatment scale up and prevention. “It’s become an either or game,” Baruah commented.
Gavaghan demurred on other questions as well, including when the Administration might issue new evidence-based guidance for implementers on needle-exchange and abstinence-only policies. “I don’t have a timeline for you,” Gavaghan said. But she noted that guidance is not the only way PEPFAR communicates with implementers in the field and that in speeches and other public statements, Ambassador Eric Goosby has been very clear about his desire for swift change on issues like the needle-exchange funding ban and increased focus on outreach to marginalized populations.
On another salient concern—the release of the Obama Administration’s Global Health Initiative—Gavaghan said she could not provide details about content or timing. But she tried to tamp down concerns that the GHI would adversely impact US commitment to global AIDS, saying the goals of the GHI “are very much the goals of PEPFAR.”
“ … It shouldn’t be seen as a directive of a hammer,” she added. “It’s going to help us do our programs in a better way.”
Gavaghan said that Goosby and other PEPFAR officials were working hard to make OGAC more open and responsive to civil society. In that vein, she said they’ve tapped Jenny Peterson, the communications officer, as a key liaison to the advocacy community and a conduit for questions and input as PEPFAR seeks to take the five-year strategy off the drawing board and into the field.