JAMA Commentaries Examine PEPFAR

Main Category: HIV / AIDS
Article Date: 06 Nov 2008 - 8:00 PDT

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The Journal of the American Medical Association in its Nov. 5 issue published two commentaries about the President's Emergency Plan for AIDS Relief. Summaries appear below.

• "President's Emergency Plan for AIDS Relief: Health Development at the Crossroads": The commentary, by Lawrence Gostin of Georgetown University's O'Neill Institute for National and Global Health Law, examines how U.S. health assistance to the developing world, particularly through PEPFAR, is at a "crossroad." According to Gostin, HIV/AIDS treatment is a "humanitarian triumph ... but from a population perspective it does little to stem the tide of the pandemic." Rather, Gostin writes that the role of the U.S. in the fight against HIV/AIDS "would be more effective if PEPFAR focused on comprehensive behavioral strategies, condoms, male circumcision and structural approaches such as social, economic, political and environmental factors that have an evidence base for preventing infections." Gostin also discusses the "ideological aspects inherent in PEPFAR" that "tarnish its reputation" -- including abstinence and faithfulness program requirements and funding restrictions surrounding family planning programs, commercial sex work and sex trafficking. However, Gostin writes that "PEPFAR represents a milestone in development assistance" and has "instilled a sense of hope in poor African communities ravaged by AIDS that is heartening and palpable on the ground." He adds that PEPFAR "can remain a vertical program of exceptional value that will cease when political will subsides. Alternatively, rich countries can build on PEPFAR by making a historic commitment to international development assistance for health that is scalable and sustainable and that attacks the root causes of poverty, inequality and early death" (Gostin, JAMA, 11/5).
  
  
• "U.S. Health AIDS Beyond PEPFAR: The Mother & Child Campaign," JAMA: According to Colleen Denny and Ezekiel Emanuel of NIH, while PEPFAR represents one of the "biggest successes" of President Bush, "doubling or tripling PEPFAR's funding is not the best use of international health funding." They add that in "focusing so heavily on HIV/AIDS treatments, the United States misses huge opportunities. By extending funds to simple but more deadly diseases, such as respiratory and diarrheal illnesses, the U.S. government could save more lives -- especially young lives -- at substantially lower cost." Denny and Emanuel write that PEPFAR funding could be used to launch a new proposal program called the Mother & Child Campaign, which would focus on the health needs of those "hit hardest by simple but deadly diseases: young children and their mothers." Such efforts would include the distribution of insecticide-treated nets in malaria-endemic areas, nutritional supplements for anemic pregnant women and community-based care for neonatal pneumonia. "It would be unethical and impractical to abandon or decrease programs developed under PEPFAR given fiduciary relationships, the threat of drug-resistant HIV/AIDS and the devastation the disease wreaks on societal infrastructure," the authors write, adding, "But the choices are not 'double or nothing.'" Pledges for increased government funding of PEPFAR "create new options for international health aid. By allotting these newly pledged billions to the Mother & Child Campaign, the United States could continue PEPFAR programs at their current high level while using the newly committed funding to launch a more cost-effective program targeting basic health problems," according to Denny and Emanuel. They add, "This would respect the continuing need for HIV/AIDS work while acting upon the moral, economic and practical advantages of devoting funding to diseases afflicting mothers and children in the developing world" (Denny/Emanuel, JAMA, 11/5).

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