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Changes afoot for US global AIDS policy

Barack Obama. Wikipedia
US President-elect Barack Obama
Just three weeks into his new appointment, United States Global AIDS Coordinator Dr Eric Goosby outlined on Monday some of the changes that President Barack Obama’s administration will make to the country's global AIDS policy at the 5th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town, South Africa.

Goosby began by reassuring delegates - many of whom are implementers of programmes funded by the US President's Emergency Plan for AIDS Relief (PEPFAR) - that fighting AIDS would remain a central component of Obama's foreign policy. However, there would be a renewed focus on other priorities such as maternal and child health, and tropical diseases.

Researchers estimate that 1.2 million deaths in Africa were averted between 2004 and 2007 as a direct result of interventions funded by PEPFAR, but the initiative has also attracted widespread criticism over the extent to which conservative ideology appeared to drive policy decisions.

"Our achievements will be more durable if we lay on top of health activities, development activities," Goosby said, addressing concerns that PEPFAR programmes have been too focused on short-term goals to have an impact on the social and gender-related inequities that drive HIV/AIDS epidemics. He promised that PEPFAR would find ways to address gender inequities in particular, including by developing strategies to engage more with men.

During the Bush administration, interventions often neglected some of the populations most at risk of HIV infection: policies banned federal funding of needle exchange programmes for injecting drug users and placed restrictions on funding programmes aimed at sex workers.

Dr Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases at the US National Institutes of Health, told delegates that a bill to lift the ban on funding needle exchange programmes was working its way through Congress, and restrictions on HIV-infected people entering the US were also almost certain to be lifted in the near future. "With regard to science and policy, we will stay on the right path," he promised.

Goosby also made it clear that scientific evidence rather than moral concerns would drive intensified efforts to reach high-risk groups - men who have sex with men, injecting drug users and sex workers - with HIV prevention and care.

''The economic crisis has made countries look at what they can and can't afford with a new lens''
Addressing the criticism that PEPFAR programmes have tended to operate in isolation from, or even in conflict with, national HIV/AIDS strategies, Goosby said US interventions would promote greater government buy-in and leadership by playing more of a supporting role to national efforts. "Each government ultimately holds responsibility for the health of its citizens," he said.

An NGO-dominated strategy achieved results in a shorter time-frame, but strengthening government capacity to implement programmes was more sustainable. "The end goal is for each country to control its responses both strategically and, eventually, financially," he noted.

Goosby also promised to introduce "an element of reason" into the onerous amount of data collection and monitoring that PEPFAR currently requires from funding recipients, but touched only briefly on the issue of whether the current global economic crisis would affect US commitments to the global HIV/AIDS fight.

"The economic crisis has made countries look at what they can and can't afford with a new lens," he said. "We are trying to maximize our ability to ensure that everyone who is on ARVs [antiretrovirals] stays on them, and that we expand access to those who are not yet on them."

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