PEPFAR Programs Should Focus On Sustainable HIV Prevention Model, Experts Say At Reauthorization Hearing

Main Category: HIV / AIDS
Article Date: 01 Oct 2007 - 5:00 PDT

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A panel of public health experts on Tuesday at a House Foreign Affairs Committee hearing on the reauthorization of the President's Emergency Plan for AIDS Relief said the program should emphasize HIV prevention that can be sustained in the long term rather than implementing emergency programs, CQ HealthBeat reports (Gensheimer, CQ HealthBeat, 9/26).

PEPFAR directs an authorized $15 billion over five years for HIV/AIDS and tuberculosis primarily to 15 focus countries and provides funding to the Global Fund To Fight AIDS, Tuberculosis and Malaria. 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 for five years (Kaiser Daily HIV/AIDS Report, 5/31). Joia Stapleton Mukherjee, medical director of Partners in Health, at the hearing said that the $30 billion proposed by Bush is not enough and recommended that the committee authorize $50 billion over five years for the program. Rep. Nita Lowey (D-N.Y.) last week at a forum on PEPFAR's reauthorization said she is aiming to increase the $30 billion funding level over the next five years. "With these small targets, we are not building," Mukherjee said, adding, "We are simply sustaining work that is less than half done."

Potential Changes to PEPFAR Focus
Foreign Affairs Committee Chair Tom Lantos (D-Calif.) at the hearing said that the "task for the next five years is not only to solidify" the progress PEPFAR has made in its 15 focus countries, "but to reorient the program so that our efforts to combat HIV/AIDS will be sustainable for generations to come." Helene Gayle -- president and CEO of the international development and relief organization CARE, which operates in 11 of PEPFAR's 15 focus countries -- said PEPFAR should work toward creating a sustainable model for HIV prevention. She cited an Institute of Medicine report released in March that recommended PEPFAR transition from focusing on emergency relief to "long-term strategic planning and capacity building." Gayle added that "[a]ddressing HIV/AIDS solely as a medical challenge is like treating the symptoms but not really the cause of the disease."

According to Lantos, PEPFAR should work with focus countries to strengthen health care delivery systems and food security programs. Gayle and Nils Daulaire, president and CEO of the Global Health Council, added that prevention programs would not be fully effective unless funds also support health care systems. Mukherjee added that people in developing countries likely would not travel to clinics to receive an HIV test if the country's health care system is unable to provide treatment.

Rep. Donald Payne (D-N.J.), who chairs the Africa and Global Health Subcommittee, said he believes there is a relationship between PEPFAR's success in focus countries and a concentration on providing adequate nutrition in countries with high HIV prevalence. However, Rep. Ileana Ros-Lehtinen (R-Fla.), the ranking member on the committee, expressed caution about using PEPFAR funds to improve health care systems and establish food security for HIV-positive people. "If PEPFAR is directed to take on the universe of problems that plague the focus countries, we risk reducing it to a program that is a mile wide and an inch deep," Ros-Lehtinen said.

Gayle also recommended that PEPFAR adopt an "ABC-plus" prevention model that incorporates factors not addressed by the program's current ABC model. The ABC model stands for abstinence, be faithful and use condoms. Gayle said that the current ABC model is ineffective for many women in developing countries who are unable to negotiate sex or condom use, adding that the program also should address social, cultural and economic factors that affect girls' vulnerability to HIV.

Some panel members also expressed concern that condom distribution programs have not been effective in the fight against HIV/AIDS. "No generalized HIV epidemic has ever been rolled back by a prevention strategy based primarily on condoms," Norman Hearst, professor of medicine at the University of California-San Francisco, said, adding that successful HIV prevention programs "were achieved not through condoms but by getting people to change their sexual behavior." According to CQ HealthBeat, some of the panelists said that experts have moved beyond the issue of whether one component of ABC is essential for HIV prevention. Daulaire said that successful programs need to focus on "changing social behavior" (CQ HealthBeat, 9/26).

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.

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