10 November 2010
By Stephen Kaufman
Washington — Nearly seven years after the President’s Emergency Plan for AIDS Relief (PEPFAR) was announced, the program is having an “extraordinary impact” on the prevention and treatment of HIV/AIDS, with data showing that more than 2.5 million people have been directly supported by its treatments through 2009, according to U.S. Global AIDS Coordinator and PEPFAR Administrator Dr. Eric Goosby.
Through PEPFAR and contributions to the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, the United States has committed approximately $32 billion to fight HIV/AIDS.
Goosby spoke with reporters in Washington November 10, saying “PEPFAR has shown that indeed one disease responded to with significant resource infusion can have outcomes that have changed the way we think about global health.”
The program, now operating in more than 30 countries, is showing increased efficiency and effectiveness, with more than 60,000 patients receiving anti-retroviral medication every month, and expansions in prevention and care programs.
Each partner country is looking more closely at who is being affected by HIV and how the disease is moving through its populations, and that information is helping PEPFAR decide where to position its prevention programs as well as any special care and treatment services that might be needed.
“We’re learning how to do this better than we did in the first couple or three years of PEPFAR. Each month brings in new insights that we are better and better positioned to realize, to see, to document and then to reintegrate that learned advantage or system change into our larger systems of care in each country,” Goosby said.
The United States accounts for almost 60 percent of international funding commitments to prevent and fight HIV/AIDS, and Goosby said more nations need to step up their support.
“We alone are not going to be successful … without really soliciting the help of all countries on the planet, including the countries we are working in,” he said. Other nations need to join the United States by contributing to the effort, and to do so explicitly and continuously. “We are ready to be the voice to put that challenge out,” he said.
Reducing HIV/AIDS contributes to a country’s overall security and stability. Individuals aged 15 to 50 are disproportionally targeted by the disease, and they also represent the prime years of a country’s working force. It also “hits individuals who have money, who are mobile and often educated,” including doctors, lawyers and teachers, he said.
“The lack of that layer in society is … a huge destabilizing force and kind of lends fertile fodder to the development of armed and terrorist activity,” Goosby said.
In its fight against HIV/AIDS, PEPFAR is now looking to transition toward “a more stable, sustained response,” from its initial emergency focus. “We’re lean and clean in our ability to deliver more with fewer people and for less money,” he said.
For example, Goosby said, new research has demonstrated the effectiveness of male circumcision, which has been shown to reduce the rate of HIV infection by 64 percent. The operation removes a layer of cells that are highly susceptible to infection, he explained, and PEPFAR’s data has projected that 4.2 million HIV infections can be averted through 2025 with an increase in the number of circumcised men between ages 15 and 50, as well as having programs in place to circumcise newborn males.
Circumcised males are still at risk of infection, he said, but the reduced rate “will look like a vaccine has entered” the population because of the drop in the number of infections.
PEPFAR is also planning to accelerate its prevention of mother-to-child transmission by providing 80 percent coverage of disease testing at the national level and 85 percent coverage of prophylaxis and treatment for infected pregnant women by the year 2014, he said.
The increased availability of generic drugs has also helped to lower the average treatment cost per patient to about $435, and Goosby said he expects the figure to drop even further, thanks to increased procurement pooling with the Global Fund to Fight AIDS, Tuberculosis and Malaria, reduced transportation costs, new drugs that require fewer doses, and other innovations.
PEPFAR will also be expanding its services through the U.S. Global Health Initiative to provide treatment and prevention against other infectious diseases, as well as supporting maternal and child health and clean water. He said this will help increase the effectiveness and efficiency of overall U.S. health assistance.
PEPFAR is “often the strongest delivery system that’s up and running,” he said. For example, when Haiti was devastated by a January 12 earthquake, “our clinic system and our providers in these clinics were the first responders and the primary responders for the first 10 days or so. Our resources also fed into a lot of that first response effort.”