PEPFAR´s Power of Partnerships boosts global health recovery
Surya B. Prasai
March 15, 2008
On December 1, 2007, many Americans were impressed to see in front of the White House lawns a Big Red Ribbon, which extended to faraway capitals of the world such as Gaborone in Botswana, Dar e-Salaam in Tanzania, and Bangkok in Thailand. The 2007 U.S. government theme for World AIDS Day commemoration was "The Power of Partnerships" to highlight the successes and future promise of partnerships in the fight against HIV/AIDS. It highlighted the importance of working together, the American people with the rest of the world to achieve better and far reaching results in the fight against HIV/AIDS.
Through the President´s Emergency Plan for AIDS Relief (PEPFAR) and the United States´ broader development agenda, the American people have engaged in one of the great humanitarian efforts in this century. It is an effort that makes many Americans proud to see their President well known abroad as a crusader against HIV and AIDS. The foundation of this success has been true partnership, and the rejection of the donor-recipient mentality that often bogs down meaningful foreign assistance. For those who want to better understand the critical role of PEPFAR in defeating AIDS globally and extending AIDS benefits to millions of global citizens, it is another proud moment under U.S. leadership to know the good results, help further to erase stigma and discrimination against HIV/AIDS, find treatment, and provide moral support, counseling and encouragement to the millions of families affected globally.
According to UNAIDS, in 2008 the number of funding and implementing partners in HIV/AIDS prevention have dramatically increased with more principal global philanthropies such as the Ford Foundation, Merck Company, and Bill and Melinda Gates Foundation involved in a more aggressive manner in dispensing money to where it should belong, the highly impoverished countries where AIDS thrives. Add to it, President Bush´s recent five nation tour to Africa which was another eye awakener on the generosity of U.S. foreign assistance to help fight one of the world´s most infectious diseases that poses a major threat still to global progress, prosperity and good health, particularly the 15 highly affected countries and another 100 more countries that are receiving assistance under the UN Global Fund, some of the money which is U.S. funded.
President Bush stated on World AIDS Day 2007, "The pandemic of HIV/AIDS can be defeated. ... By working together, we can give hope and comfort to millions." According to the 2007 December revised estimates from UNAIDS, there are an estimated 33.2 million people living with HIV where by there are 6,800 new infections and over 5,700 people die of AIDS.
President Bush´s valiant personal crusade as a global leader and a responsible G-8 'voice' in highlighting global AIDS awareness through PEPFAR must be lauded as an extraordinary commitment of the United States to serve the deprived populations in the developing countries fighting one of the deadliest infectious diseases. Thus, PEPFAR´s new funding at US$ 50 billon from the U.S. House has made it talkable, walkable and doable for American and global experts to forge a more dynamic and intensive alliance, including making stronger public-private partnerships work to prevent AIDS in the target countries. The generous American assistance has also made it possible for millions of those infected with the virus to receive accessible services within their community and to know how prevention, care and treatment can change the battle against AIDS.
PEPFAR has lobbied for some time on these partnerships in the 15 focus countries in sub-Saharan Africa, Asia and the Caribbean, founded in the profound sense of dignity and worth of every human life, and in trust and mutual respect between peoples. According to PEPFAR, the benefit has been giving great hope, and are transforming individuals, communities, nations, and -- in the case of sub-Saharan Africa -- much of a sub-continent.
The results that PEPFAR has revealed in January 2008 on its website are quite impressive. PEPFAR, it appears, is right on target to achieve its ambitious goals of supporting treatment for two million people, prevention of seven million new infections, and care for 10 million people infected and affected by HIV/AIDS, including orphans and vulnerable children. Globally, it has managed to support life-saving antiretroviral treatment for approximately 1,445,500 men, women and children through September 30, 2007. Of the people receiving antiretroviral treatment through direct U.S. government support among focus countries, nearly 86,000 are children aged 14 and under; a 77 percent increase over the number of children on PEPFAR-supported treatment in 2006. In the focus countries, 62% of the individuals on antiretroviral treatment are women and girls. In the period, PEPFAR has been able to do more work by working with local health experts. For instance, it has been able to provide prevention of mother-to-child HIV transmission services for women during more than 10 million pregnancies, antiretroviral prophylaxis for women in over 827,000 pregnancies, prevention of an estimated 157,000 infant infections, care for more than 6.6 million, including care for more than 2.7 million orphans and vulnerable children, and over 33 million counseling and testing sessions for men, women and children. Some of the countries such as Botswana, Nigeria, Rwanda, South Africa, Tanzania and Zambia have been able to make real achievements in their upstream uptake in antiretroviral treatment. Most PEPFAR results data have consistently proven reliable and in consonance with targets set.
Why does PEPFAR work so well? The answer might be, under PEPFAR, all U.S. Government bilateral HIV/AIDS programs are developed and implemented within the context of multi-sectoral national HIV/AIDS strategies under the host country´s own national authority and governance. Programs usually reflect the comparative advantage of PEPFAR involvement in the national strategy extending to other partnerships with international and private-sector resources.
However, according to UNAIDS in 2008, there is still urgent need to deal with the risk of program duplication, overlap and fragmentation of response due to heavy involvement of international donors. While PEPFAR´s global role is quite clear because it has a set of easily verifiable indicators and results outputs, other country donor partnerships focus more on the political and foreign policy returns of AIDS investment. Often, this makes the capacity to co-ordinate at regional and country levels weak and inflexible. This is why PEPFAR has solely been credited by many developing countries leaders, thanks to the leadership of President Bush, in helping them develop a nationally owned and led AIDS response keeping in consonance with UN universal human rights principles in guaranteeing every citizen of the world political, economic and social rights, which also includes the right to lead healthy and productive lives(particularly those infected with the virus).
While in 2008, it appears that HIV prevalence has somewhat leveled off in Africa, including peak epidemic countries such as Botswana and Southern Africa, PEPFAR´s fight is not over. The prevalence rates are only slowly declining in sub-Saharan Africa, threats still exist in South Asia and the CIS states. More concentric focus is needed in these regions. The achievements of PEPFAR must also be taken as a tribute to the serious nature of G-8 investments in making sure that AIDS does not become an unknown enemy that drastically kills millions of human beings each year with no known treatment. AIDS deaths and their prolonged social, economic and demographic negative effect in lessening global productivity and growth are well known to the global community. But the power of partnerships to reduce the numbers must be emphasized in dealing with the global AIDS crises in future. Thus, the scope and complexities of the global AIDS epidemic demands total dedication, competence and capabilities in helping the communities affected. As PEPFAR has shown through its global interventions, it requires that the national technical and health institutions be fully aware of the problem and be able to help everyone who needs information, or has come for AIDS treatment. In countries with full-blown AIDS epidemic, what is required still is moral and social resilience in leadership at the highest level to be able to accept the vulnerability of the large number of deaths as a result of AIDS, and also to find out the local determinants to roll it back. Don´t forget, AIDS is today the world´s sixth largest killer disease in human history and a major challenge to global health experts.
Through the President´s Emergency Plan for AIDS Relief (PEPFAR) and the United States´ broader development agenda, the American people have engaged in one of the great humanitarian efforts in this century. It is an effort that makes many Americans proud to see their President well known abroad as a crusader against HIV and AIDS. The foundation of this success has been true partnership, and the rejection of the donor-recipient mentality that often bogs down meaningful foreign assistance. For those who want to better understand the critical role of PEPFAR in defeating AIDS globally and extending AIDS benefits to millions of global citizens, it is another proud moment under U.S. leadership to know the good results, help further to erase stigma and discrimination against HIV/AIDS, find treatment, and provide moral support, counseling and encouragement to the millions of families affected globally.
According to UNAIDS, in 2008 the number of funding and implementing partners in HIV/AIDS prevention have dramatically increased with more principal global philanthropies such as the Ford Foundation, Merck Company, and Bill and Melinda Gates Foundation involved in a more aggressive manner in dispensing money to where it should belong, the highly impoverished countries where AIDS thrives. Add to it, President Bush´s recent five nation tour to Africa which was another eye awakener on the generosity of U.S. foreign assistance to help fight one of the world´s most infectious diseases that poses a major threat still to global progress, prosperity and good health, particularly the 15 highly affected countries and another 100 more countries that are receiving assistance under the UN Global Fund, some of the money which is U.S. funded.
President Bush stated on World AIDS Day 2007, "The pandemic of HIV/AIDS can be defeated. ... By working together, we can give hope and comfort to millions." According to the 2007 December revised estimates from UNAIDS, there are an estimated 33.2 million people living with HIV where by there are 6,800 new infections and over 5,700 people die of AIDS.
President Bush´s valiant personal crusade as a global leader and a responsible G-8 'voice' in highlighting global AIDS awareness through PEPFAR must be lauded as an extraordinary commitment of the United States to serve the deprived populations in the developing countries fighting one of the deadliest infectious diseases. Thus, PEPFAR´s new funding at US$ 50 billon from the U.S. House has made it talkable, walkable and doable for American and global experts to forge a more dynamic and intensive alliance, including making stronger public-private partnerships work to prevent AIDS in the target countries. The generous American assistance has also made it possible for millions of those infected with the virus to receive accessible services within their community and to know how prevention, care and treatment can change the battle against AIDS.
PEPFAR has lobbied for some time on these partnerships in the 15 focus countries in sub-Saharan Africa, Asia and the Caribbean, founded in the profound sense of dignity and worth of every human life, and in trust and mutual respect between peoples. According to PEPFAR, the benefit has been giving great hope, and are transforming individuals, communities, nations, and -- in the case of sub-Saharan Africa -- much of a sub-continent.
The results that PEPFAR has revealed in January 2008 on its website are quite impressive. PEPFAR, it appears, is right on target to achieve its ambitious goals of supporting treatment for two million people, prevention of seven million new infections, and care for 10 million people infected and affected by HIV/AIDS, including orphans and vulnerable children. Globally, it has managed to support life-saving antiretroviral treatment for approximately 1,445,500 men, women and children through September 30, 2007. Of the people receiving antiretroviral treatment through direct U.S. government support among focus countries, nearly 86,000 are children aged 14 and under; a 77 percent increase over the number of children on PEPFAR-supported treatment in 2006. In the focus countries, 62% of the individuals on antiretroviral treatment are women and girls. In the period, PEPFAR has been able to do more work by working with local health experts. For instance, it has been able to provide prevention of mother-to-child HIV transmission services for women during more than 10 million pregnancies, antiretroviral prophylaxis for women in over 827,000 pregnancies, prevention of an estimated 157,000 infant infections, care for more than 6.6 million, including care for more than 2.7 million orphans and vulnerable children, and over 33 million counseling and testing sessions for men, women and children. Some of the countries such as Botswana, Nigeria, Rwanda, South Africa, Tanzania and Zambia have been able to make real achievements in their upstream uptake in antiretroviral treatment. Most PEPFAR results data have consistently proven reliable and in consonance with targets set.
Why does PEPFAR work so well? The answer might be, under PEPFAR, all U.S. Government bilateral HIV/AIDS programs are developed and implemented within the context of multi-sectoral national HIV/AIDS strategies under the host country´s own national authority and governance. Programs usually reflect the comparative advantage of PEPFAR involvement in the national strategy extending to other partnerships with international and private-sector resources.
However, according to UNAIDS in 2008, there is still urgent need to deal with the risk of program duplication, overlap and fragmentation of response due to heavy involvement of international donors. While PEPFAR´s global role is quite clear because it has a set of easily verifiable indicators and results outputs, other country donor partnerships focus more on the political and foreign policy returns of AIDS investment. Often, this makes the capacity to co-ordinate at regional and country levels weak and inflexible. This is why PEPFAR has solely been credited by many developing countries leaders, thanks to the leadership of President Bush, in helping them develop a nationally owned and led AIDS response keeping in consonance with UN universal human rights principles in guaranteeing every citizen of the world political, economic and social rights, which also includes the right to lead healthy and productive lives(particularly those infected with the virus).
While in 2008, it appears that HIV prevalence has somewhat leveled off in Africa, including peak epidemic countries such as Botswana and Southern Africa, PEPFAR´s fight is not over. The prevalence rates are only slowly declining in sub-Saharan Africa, threats still exist in South Asia and the CIS states. More concentric focus is needed in these regions. The achievements of PEPFAR must also be taken as a tribute to the serious nature of G-8 investments in making sure that AIDS does not become an unknown enemy that drastically kills millions of human beings each year with no known treatment. AIDS deaths and their prolonged social, economic and demographic negative effect in lessening global productivity and growth are well known to the global community. But the power of partnerships to reduce the numbers must be emphasized in dealing with the global AIDS crises in future. Thus, the scope and complexities of the global AIDS epidemic demands total dedication, competence and capabilities in helping the communities affected. As PEPFAR has shown through its global interventions, it requires that the national technical and health institutions be fully aware of the problem and be able to help everyone who needs information, or has come for AIDS treatment. In countries with full-blown AIDS epidemic, what is required still is moral and social resilience in leadership at the highest level to be able to accept the vulnerability of the large number of deaths as a result of AIDS, and also to find out the local determinants to roll it back. Don´t forget, AIDS is today the world´s sixth largest killer disease in human history and a major challenge to global health experts.
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