While announcements from the President’s Emergency Plan for AIDS Relief often highlight the program’s success stories, PEPFAR supplied depressing data along with its release Saturday of new targets for treatment enrollment, additional prevention interventions, and infections to be prevented, over the coming two years. That’s because the targets “for the first time ever” (as the release puts it) include specific goals to reduce HIV infections in young women, who continue to be infected at a rate of one thousand a day, accounting for 71 percent of HIV incidence among teenagers in sub-Saharan Africa.
The targets announced over the weekend include lowering HIV incidence 25 percent among young women and girls in 10 southern African countries by the end of next year, and by 40 percent by the end of 2017. Other targeted achievements give some concrete examples of how that could happen, with goals to have provided cumulative totals of 11 million medical circumcisions by the end of 2016, and 13 million by the end of 2017, as well as goals — listed separately under treatment — of:
- PEPFAR-supported antiretroviral treatment for a total of 11.4 million people — 7.2 million directly through PEPFAR funding, 4.2 million through technical assistance — by the end of 2016;
- PEPFAR-supported antiretroviral treatment for a total of 12.9 million people — 8.5 million directly through PEPFAR funding, 4.4 million through technical assistance — by the end of 2017;
- A total of 18.5 million people on antiretroviral treatment supported by PEPFAR, the Global Fund to Fight AIDS, Tuberculosis and Malaria and by countries where PEPFAR works by the end of 2017.
U.S. Global AIDS Coordinator Ambassador Deborah Birx spoke recently of the role that treatment upon diagnosis could play in preventing infections to young women by immediately linking their current or potential male partners to care in greater numbers, adding that she was looking forward to the release of World Health Organization guidelines in December that would add impetus to treatment expansion. On Sunday the global treatment access advocacy organization Health GAP called on the U.S. government to ensure sufficient funding to deliver the treatment specified in the goals, and called on Congress and the White House to increase funding for PEPFAR by $300 million in 2016. The group noted that PEPFAR has been operating without specific treatment targets for the last two years, and hoped that the targets announced Saturday indicated a renewed emphasis on treatment.
Saturday’s PEPFAR announcement, though, was accompanied by a description of “a core package that combines evidence-based interventions that go beyond the health sector . . .” delivered through the DREAMS initiative, a public private partnership launched last year. The initiative, set in the 10 sub-Saharan African countries that PEPFAR says account for nearly half of all incidence among young women globally (Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanznia, Uganda, Zambia, and Zimbabwe) sets as its goal “to help girls develop into Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe Women. PEPFAR’s announcement includes that $300 million in “additional prevention investments” will support PEPFAR-led DREAMS and related efforts.