Matt Fisher and Alisha Kramer
Research Assistants, Global Health Policy Center
In advance of the XIX International AIDS Conference -- AIDS 2012 -- CSIS celebrated the release of the special supplement of the Journal of AIDS focused on PEPFAR. Organized in cooperation with the Office of the Global AIDS Coordinator (OGAC), the event featured contributing authors and guest editors who are leading figures in PEPFAR and the international HIV/AIDS community. The roundtables engaged in wide-ranging discussions of the successes and challenges of PEPFAR, from its inception to its future.
Panel 1: Does PEPFAR Promote U.S. National Interests?
Panelists: Ambassador Mark Dybul, former U.S. Global AIDS Coordinator; Ambassador Eric Goosby, U.S. Global AIDS Coordinator; and Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases. Moderator: Dr. J. Stephen Morrison, Director of the CSIS Global Health Policy Center and guest editor of the special supplement of JAIDS.
In the view of the panelists, PEPFAR was created primarily out of a moral compulsion to provide humanitarian assistance to developing nations grappling with a worsening global AIDS crisis. In making the case to Congress and the American people, the Bush administration and other advocates buttressed "soft" humanitarian imperatives with "hard" security arguments. By focusing on saving lives, PEPFAR contributed to economic and political stability in focal countries and improved international perceptions of the U.S., thereby promoting U.S. national interests. Despite its successes, sustaining PEPFAR will nevertheless be difficult in the current climate of constricting budgets, partisan gridlock, and growing fatigue on the part of Congress and the American people.
Panel 2: What PEPFAR Has Taught Us, for Good and Bad?
Participants in this panel discussed the lessons learned from PEPFAR I and II. Panelists included:
Dr. Wafaa El-Sadr, Director of International Center for AIDS Care and Treatment Programs, Dr. Alex Muganzi, Infectious Disease Institute, Uganda, and Dr. Jeff Stringer, Director of the Centre for Infectious Disease Research in Zambia.
The panelists stressed the need for more active participation by African civil society, a greater push toward country ownership, and the integration of ART treatment into a primary health care platform. PEPFAR, Dr. El-Sadr explained, has allowed space for innovation. Despite its expansion and evolution, PEPFAR has maintained clear targets and goals. All panelists agreed PEPFAR should be used as a platform for advancing other health priorities, specifically strengthening health and procurement systems; training health care workers and integrating services. In closing, Dr. Stringer shared the primary lesson that PEPFAR has taught him: big things are possible.
Panel 3: What Should PEPFAR Look Like in Five Years?
Participants in this panel discussed the future of PEPFAR. Panelists included:
Dr. Chris Beyrer, Professor, Johns Hopkins Bloomberg School of Public Health, Dr. Kevin De Cock, Director of the Center for Global Health at the Centers for Diseases Control and Prevention, and Dr. David Serwadda, Makerere University School of Public Health, Uganda.
Reminding us to remain realistic about the constraints of continued progress, the panelists presented a cautiously optimistic picture with several prescriptions for how to strengthen the PEPFAR platform. Dr. Beyrer pointed out that we can expect to see prevalence rise as increasing numbers of HIV positive individuals are kept alive by ARV treatment. New infections will continue into the foreseeable future, and we can expect ongoing epidemics in select hotspots. According to Dr. de Cock, we want our goals to be “aspirational but achievable, ambitious but realistic. We can’t make the mistake of overpromising.” Most importantly, we need to plan for the long term, Dr. Serwadda stressed, by engaging African countries in decision-making, generating incentives to reach clearly defined goals for donors and host countries, and increasing African financial contributions to combat their own epidemics. Ending on an optimistic note, the panelists agreed that: we can see the beginning of the end of epidemic transmission. We can start to begin to see real decline in infection rates and the next generation will experience a reduced burden of disease. PEPFAR is a starting point to address HIV/AIDS, and it serves as a platform for the broader access to health services and continuous care. Panelists emphasized the continued need for dedicating resources to PEPFAR, while remaining aware of the acute financial challenges faced by the U.S. government.