The second in a series of interviews with staff members of the Office of the U.S. Global AIDS Coordinator (OGAC), responsible for the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program, Science Speaks sat down with Winnie Roberts, PhD. As director of multilateral diplomacy, Roberts manages OGAC’s engagement with the Global Fund to Fight AIDS, Tuberculosis (TB) and Malaria and is a trained ecologist. She has served the office since 2008, before which she worked at the Bureau of International Organization Affairs, coordinating U.S. engagement with a range of United Nations technical agencies including the Joint UN Programme on HIV/AIDS (UNAIDS), the World Meteorological Organization, and the UN Office on Drugs and Crime.
In this interview, Roberts explains what motivated her to join OGAC, how PEPFAR is working with the Global Fund to coordinate services, and what is coming down the pike at both organizations.
How did you get involved in AIDS?
Working at the State Department in the Bureau of International Organization Affairs, I had the privilege of representing the U.S. government at a range of technical agencies. They all provide essential services from weather forecasting to setting health policies and endemic flu preparedness.
One of the organizations I worked with in that role was UNAIDS and it really brought home for me the impact that the U.S. government was having in peoples’ daily lives. The international response to HIV, from the very beginning, brought in civil society – the people who are really impacted by HIV. It was a really exciting opportunity to work much more directly with the people you support and with the U.S. government leadership in its effort of financial and political support. It was such a great experience.
I left that job that I loved and came to work here at OGAC and it has been a fantastic experience.
What do you consider the most important aspect(s) of your job?
This is going to sound goofy, but working at the State Department is such a tremendous opportunity and I feel like with my work here at OGAC I have the opportunity to help millions around the world. The most important aspects are to make sure that the U.S. government’s investments in HIV are being spent as wisely as possible – in order to save the most lives, and in coordination with the various shared responsibilities of other donors and civil society to really do this together, to make it a sustainable effort.
Right now the U.S. government has about $1 billion a year going into the Global Fund to Fight AIDS, Tuberculosis and Malaria and additional investments going to the World Health Organization (WHO) and UNAIDS for work they’re doing. So my job is to put in place the policies and procedures that will allow that money to be spent well and reach the people in need. I help develop policy and standards, and the programs that will be put in place through the Global Fund.
Do you feel like you’re making a difference?
I do. Having the opportunity in this job to go to some of the countries we are supporting and meet the people we are supporting, “we” meaning PEPFAR and the Global Fund, you see people that would not be alive today without our support – who wouldn’t have been able to live to adulthood, marry or have children born HIV free. It is the strength of those individuals, augmented by the services we’re providing, that is making a difference. It’s really amazing.
Tell me about the negotiation process at the United Nations (UN) High Level Meeting (HLM) and what the impact of your work there has been?
With the UN, it’s really an opportunity to bring the world together around the fight against HIV. The world obviously has a lot of things we’re dealing with – security issues, famines, development challenges, etc. And the HLM was an opportunity to reenergize the fight against HIV and to really work with other countries to rally around the importance of human rights and services for the most at risk populations. I feel like we were really able to advance the key issues and make sure that donor countries and donor entities alike remain committed to the fight.
It is also a process in which about 191 countries, coming from different cultural and economic contexts, are working together, which is challenging. But it’s an opportunity to pause and set some hopeful goals and standards and say – what ought we be trying to achieve? What goals can we set?
It was challenging but I think ultimately it gave us a good outcome. We will continue to support treatment, care and prevention services through our investments in bilateral programs as well as the Global Fund – we will continue encouraging other donors and donor countries to step up their response as well. Not just in the provision of services, but also helping governments and donors to set up systems of services so they can run the response in the long run.
How does the UN declaration help advance the fight against AIDS?
A political document like the UN General Assembly (UNGASS) declaration provides civil society in some of these countries with some leverage they can use with their own governments. They can say, “You committed to these standards, you committed to these human rights policies, and we are going to hold you accountable.” This is not something we as the U.S. government can do, and the UNGASS declaration is something that really helps civil society in that effort.
Any specific challenges to the UN process?
It was a very intense process on a very short timeline so I think it always is challenging to get that many countries in agreement. All of the countries that we engaged with approached this in a good faith manner and with a shared goal of supporting global health. There are always differences of opinion and moving forward with what we’re trying to achieve takes work.
What work are you doing with the Global Fund in key countries to ensure coordination of services and avoid redundancy? Which countries? Where do you start? What are the challenges in the PEPFAR/GF relationship?
We’re looking at all countries we have investments in – we don’t want duplication of services or gaps in any of the countries we are co-invested with the Global Fund. We approach this through a variety of ways. Centrally, we’re in direct contact with the Global Fund Secretariat and we have funding to perform that coordination – helping support staff focus on Global Fund grants, mapping exercises, technical support, a whole range of activities.
The biggest way we’re fostering that coordination is with direct engagement with governments with country coordinating mechanisms (CCMs). The way the GF model works is a CCM develops a Global Fund proposal and maps out the way forward so what we need to do is work with the country as a convener of that discussion and work with the CCM to see what the country is supporting, what PEPFAR is supporting, what does the Global Fund support, and how do we coordinate that. The real action is at the country level. We’ve already started this process.
This is an intensification of what we’ve been doing all along. Ever since we’ve been investing in the Global Fund we’ve wanted our resources to work together effectively. It’s always been in our interest. It’s really now that the Global Fund has become such a big actor that this coordination has increased in importance. It’s more like a scale up of efforts already in place, in sync with PEPFAR’s emphasis on building a sustainable response and country ownership.
What should people know about that’s coming down the pike at OGAC?
First, at the Global Fund, there are a number of things that are coming down the pike. There is a high-level panel report looking at the Global Fund structures and ways to strengthen them. There’s also a big reform agenda that’s underway focused on how do we safeguard our resources, and most effectively reach people that are most in need. It has been an ongoing process for the past 18 months, launched really when the U.S. made its three-year funding commitment to the Global Fund and made simultaneous calls for reform. This panel report is due out in the middle of September.
Here at PEPFAR, we continue to work to ensure that we’re increasing the impact of the resources we have, of reaching more people with high quality services more efficiently, and taking advantage of developments in the science.
The big push is starting to plan for World AIDS Day and laying the groundwork for that and obviously the International AIDS Conference here in 2012 is absolutely a big focus. Working with the PEPFAR scientific advisory committee to develop a strong scientific program, and working with logistical arrangements for the meeting – it’s something like 40,000 people coming here to DC next summer – it’s a really big effort.
I am not central to that process but given that this is an organization that’s bringing together all sorts of actors from the international arena – UNAIDS, the Global Fund, all of the standard stetting organizations such as the WHO – I am helping facilitate those discussions and working with our counterparts at UNAIDS to make sure people can get here, submit and develop abstracts, and make sure we have the right mix of science at the conference.