HIV/AIDS Treatment Programs Will Not Keep Pace Unless Number Of New Cases Decreases, Experts Say At PEPFAR Reauthorization Hearing

Main Category: HIV / AIDS
Article Date: 13 Dec 2007 - 9:00 PDT

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HIV/AIDS treatment programs in Africa will not be able to keep pace unless the number of new cases significantly decreases, experts said Tuesday at a Senate Health, Education, Labor and Pensions Committee hearing to reauthorize the President's Emergency Plan for AIDS Relief, the Boston Globe reports (Donnelly, Boston Globe, 12/12). PEPFAR's original mandate is scheduled to expire in September 2008. President Bush in May called on Congress to double current funding levels to $30 billion over five years (Kaiser Daily HIV/AIDS Report, 12/3).

Experts at the hearing testified that the "most important battle" in curbing HIV/AIDS is stopping HIV transmission but disagreed on how to stop the spread of the virus, the Globe reports. Some witnesses at the hearing debated the effectiveness of a PEPFAR requirement that one-third of HIV prevention funds focus countries receive through the program be used for abstinence-until-marriage and fidelity programs (Boston Globe, 12/12).

Norman Hearst, a professor at the University of California-San Francisco School of Medicine, said that encouraging married men to be faithful to their wives and delaying the onset of sexual intercourse are the two main ways to stop the spread of HIV in Africa (Walker, CQ HealthBeat, 12/11). Hearst added that Congress should set target abstinence and fidelity rates for countries receiving PEPFAR aid because prevention programs in such countries are designed by "Western consultants," who promote condom use as the primary way to prevent HIV. According to Hearst, programs that focus on promoting condom use have "never worked" in areas where HIV is generalized (Boston Globe, 12/12). "It's easier to change sexual behavior than getting the people to use an imported sexual device all of the time," Hearst said (CQ HealthBeat, 12/11).

Helen Smits, co-chair of a recent Institute of Medicine PEPFAR report, said that spending requirements should be dropped so that PEPFAR focus countries can direct programs on their needs. "If a country discovers it has a big problem with needle-sharing (spreading HIV), they could devote all their money in one year to stamp it out," she said. Sen. Edward Kennedy (D-Mass.), chair of the committee, also said he supports a comprehensive approach that would allow focus countries flexibility in spending money for prevention programs (Boston Globe, 12/12). Sen. Richard Lugar (R-Ind.) has introduced a measure (S 1966) that would remove PEPFAR's abstinence and fidelity requirement and instead allocate 50% of prevention funding for comprehensive prevention programs, including abstinence and condom use, CQ HealthBeat reports. The measure also would pledge $30 billion through fiscal year 2013 for PEPFAR (CQ HealthBeat, 12/11).

Mark Dybul, U.S. Global AIDS coordinator who administers PEPFAR, said he favors Lugar's proposal because evidence supports abstinence and monogamy as ways to prevent the spread of HIV. Dybul added that this prevention strategy could change because he is not "sure 50% (of the budget) will be needed in five years."

Other HIV prevention strategies discussed during the hearing include programs to prevent mother-to-child HIV transmission and expansion of male circumcision, the Globe reports (Boston Globe, 12/12). The witnesses at the hearing also discussed the importance of PEPFAR programs that increase laboratory capacity and improve access to antiretroviral drugs, diagnostic testing for infants and nutrition for people living with HIV/AIDS (CQ HealthBeat, 12/11).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.