In the News

Before election, President Obama pledged to continue leadership and increase investment to tackle HIV/AIDS, both worldwide—through the President's Emergency Program for AIDS Relief (PEPFAR)—and domestically. With lauded experts now appointed as director of the Office of National AIDS Policy (ONAP) and to be confirmed as Global AIDS Coordinator of PEPFAR as TLID went to press, the USA seems poised to deliver on election promises. However, concerns have been raised by activists that investment plans are not matching up to the rhetoric.a

Worldwide, eyes are on Eric Goosby, an HIV expert from the University of California at San Francisco and the Pangaea Global AIDS Foundation, who was nominated as the new head of PEPFAR and had his senate confirmation hearing on June 9.

During his hearing, he said that PEPFAR is “what can happen when we dare to think big” and promised, if confirmed, to continue “this visionary programme”. He would be guided by a set of key principles, from intensifying HIV prevention to strengthening health systems and scaling up successful interventions. But funding was not a key matter discussed.

One issue that will face Goosby is that PEPFAR is credited with reducing deaths from HIV/AIDS, but has failed to curb rising incidence of infections according to an April study in Annals of Internal Medicine. The latter might be due to restrictive policies of the previous administration on sex education and availability of information on and services for contraception and abortion from PEPFAR-funded programmes. A few days after his inauguration, Obama was widely praised for his moves to restore investment to the UN Population Fund and rescind the rule against abortion information and availability, known as the Mexico City Policy or the “global gag rule”. Goosby will play a major part in whether prevention options expand beyond abstinence and fidelity in PEPFAR-funded programmes.

PEPFAR awaits confirmation of its new head

Original funding pledges for PEPFAR of US$50 billion over 5 years have now been changed to a proposed $51 billion over 6 years, with an extra $12 billion for other global health issues such as maternal and child health, family planning, and neglected tropical diseases. The White House describes this initiative as “a more integrated approach to fighting diseases, improving health, and strengthening health systems”. A broader focus on global health has been welcomed by some, assuming that Congress will ratify the proposed funding.

However, some groups are concerned that PEPFAR funding has effectively been reduced annually, with potential impact on treatment and prevention of vertical transmission. The Global AIDS Alliance says that “Goosby has a unique opportunity to hold the Obama administration accountable for its campaign promises to increase funding for prevention and treatment of HIV/AIDS overseas”. However, Michael Weinstein, president of AIDS Healthcare Foundation, says “it is crucial that President Obama ensures that Dr Goosby has the capability and full support of the administration to effectively lead this landmark lifesaving global AIDS programme, and that we do not squander the steady progress that PEPFAR has already made in the global fight against AIDS”.

On the domestic front, Obama has charged Jeffrey Crowley, new director of ONAP, to develop a national strategy for HIV/AIDS: reducing incidence, increasing the number of people in care, and lowering disparities in care. Crowley is known for his ability to integrate public health research with political strategy to achieve policy changes. On April 7, a joint meeting between the administration, the Centers for Disease Control and Prevention (CDC), and various federal, civil, and private agencies, announced a new national 5-year campaign “Act Against AIDS” and other measures to tackle the HIV epidemic in the most-affected groups. HIV is currently the leading cause of death among black women aged 25—34 years, for example. Melody Barnes, director of the White House Domestic Policy Council, told the meeting that White House leaders are deeply concerned and deeply committed to bringing a renewed focus and urgency to the prevention of HIV/AIDS in the USA, and a strong commitment to the development and roll out of a national HIV/AIDS strategy. However, this message is at odds with the continuation in May of the federal funding ban on needle exchanges.

A multimedia public-awareness campaign was also launched, based around the fact that every 9·5 min in the USA a person is infected with HIV. Crowley says of the initiative that “this is one step to remind the country we have not yet solved the problem of HIV/AIDS”, adding that “research shows that many of those becoming infected do not recognise their risk”. However, the $45 million in new funding for the CDC-led campaign is a disappointment and “falls far short of the need to adequately address the growing domestic epidemic”, says the AIDS Healthcare Foundation.

- The Lancet Infectious Diseases

Return to In the News
Return to AHF in the Media