As PEPFAR turns 10, we’re reading about growth, lessons, goals, and perils ahead

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The 10th anniversary this week of the day Congress signed the President’s Emergency Plan For AIDS Relief into law has prompted celebration, reflection, caution, and a look at the road travelled, in What We’re Reading . . .

Ten Years of Saving Millions of Lives: “Landmark scientific advances, coupled with lessons learned from a decade of implementing programs under PEPFAR, have given us the tools, knowledge and experience needed to achieve an AIDS-free generation,” this joint post by U.S. Global AIDS Coordinator Ambassador Eric Goosby, and National Institute of Allergy and Infectious Diseases Director Anthony Fauci says. Both writers have spent their careers confronting the AIDS epidemic, and their assessment is encouraging and inspiring. The post sums up the impact of the last 10 years of investment, pointing to parents and workers, living with HIV, restored to their communities, families, and jobs, and points to the future: “Not only is progress happening,” the authors say, “but its pace is accelerating.”

What a difference a decade makes: The double byline on this commemoration of the PEPFAR anniversary is equally eyecatching and authoritative on the history of the program. Rep. Barbara Lee (D-Calif) and Republican former Senate Majority Leader Bill Frist recall working with Reps. Lantos and Hyde, the Congressional Black Caucus and other legislators from both parties to confront the fact that a treatable disease was killing millions of people across Africa. The $15 billion that President George Bush pledged was an unprecedented response to a single disease, but now, the writers note, “PEPFAR’s success isn’t just measured in dollars spent, but in lives saved and communities improved.” They are blunt about the current threat to PEPFAR and to the people whose lives depend on it: “If we back away now, the gains we’ve made will evaporate; the success we’ve had will disappear.”

After a decade of success, global AIDS program looks to the future: While Goosby and Fauci end their PEPFAR post with the thought that 10 years of the historic effort, and the change it has brought, is something to celebrate, even in the face of challenges ahead, this article suggests that the challenges ahead include a budget environment that could, very simply, deny PEPFAR the means to acheive its end. The story pulls laudatory quotes (for “reminding people in some of the poorest corners of the globe that America cares,” said President Obama) around the opening of former President Bush’s presidential library, as well as cautionary notes, from longtime global health advocates, including California Democratic Rep. Barbara Lee (“I’m worried that with any type of level-funding or cuts we’ll go backward.”) and amfAR’s Chris Collins, on the “huge mismatch” between rhetoric and funding.

PEPFAR 10 Years Later: Uniting to eliminate pediatric AIDS: Ending mother to child HIV transmission was once an “audacious goal” that now is recognized as achievable, this post by Elizabeth Glaser Pediatric AIDS Foundation CEO Charles Lyons and EGPAF Ambassador Martha Sichone-Cameron. Sichone-Cameron, who saw AIDS kill her mother and 12 cousins, according to this, knows firsthand how achievable. Diagnosed with HIV a decade ago, she survived and is the mother of two HIV-free children. PEPFAR has accomplished great things, the writers say, but has a great deal left to do.

And a trip down memory lane …

Engendering Bold Leadership: The President’s Emergency Plan For AIDS Relief: During a week celebrating PEPFAR’s support of 5.1 million people on lifesaving antiretroviral medicine, taking a look back provides additional perspective. You can find it in PEPFAR’s first report to Congress, written in 2005, which begins with a look back to December 2002, a month before State of the Union address in which President Bush spoke of an Emergency Plan For AIDS Relief, when life-saving antiretroviral medicine  had been available to people living with HIV in developed countries for more than six years. At that time, then Global AIDS Coordinator Randall Tobias wrote in the introduction to this report, the World Health Organization estimated that just 50,000 people in all of sub-Saharan Africa had access to the drugs. “We were able to support three times that number in an astonishing eight months after Congress first approved funding,” Tobias added. “Hope, which breeds further success, is following quickly.”

PEPFAR Implementation: Progress and Promise and Spending Requirement Presents Challenges for Allocating Prevention Funding under the President’s Emergency Plan For AIDS Relief: Lessons also followed quickly in PEPFAR’s first years, as reports questioned the effectiveness of the plan’s approach to prevention. “The ultimate success of the program will depend upon effective prevention,” the Institute of Medicine noted, in its first review of PEPFAR in 2007. In 2006 the Government Accountability Office found that the “ABC” approach of promoting abstinence from sex until marriage, being faithful to one partner, and correct consistent condom use in the event of A and B not working, as well as the 33-percent prevention spending requirement constrained and even confused the efforts of some country teams. Reading these now, when the value of treatment as prevention, along with medical circumcision and other approaches have bee proven, gives another chance to reflect on PEPFAR’s promise.

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