U.S. Congress Supports PEPFAR into Its Second Decade

By Charlene Porter
Staff Writer

The U.S. Congress has made quick work of legislation that extends the life of the nation’s 10-year-old program targeting the global HIV/AIDS epidemic, the most extensive campaign a nation ever has mounted against a single disease.

Without controversy, the U.S. House and Senate on November 18–19 authorized another five-year funding period for the program, first adopted in 2003. Known as the President’s Emergency Plan for AIDS Relief, PEPFAR originated with President George W. Bush, who urged congressional approval of a $15 billion, five-year campaign targeting the epidemic in selected nations where young adults were succumbing to AIDS at a tragic rate.

The new PEPFAR Stewardship and Oversight Act received strong support from both Democratic and Republican lawmakers.

“Today, nearly 6 million people are receiving life-sustaining antiretroviral treatment” with PEPFAR support, said Representative Eliot Engel, a Democrat from New York. “Last year, more than 46 million people received HIV testing and counseling.”

With a particular focus on testing and treatment for pregnant mothers who are HIV-positive, PEPFAR has prevented mother-to-child HIV transmission and allowed the birth of 1 million HIV-free infants.

“This legislation will help reinforce those gains,” said Senator Bob Corker, a Republican from Tennessee, “as the program transitions from an emergency U.S.-led effort to one in which recipient countries increasingly sustain the program themselves.”

The 2003 passage of PEPFAR came amid a cascade of actions in the international community, where universal alarm about the severity of the HIV/AIDS crisis was rising. Today, U.S. agencies, international organizations and governments work together to contain the epidemic and build health care infrastructure to sustain a prolonged response.

The United States is “maximizing our impact,” said acting U.S. Global AIDS Coordinator Deborah von Zinkernagel, “through unprecedented coordination with the Global Fund to Fight AIDS, Tuberculosis and Malaria, partner countries, the private sector, faith-based organizations, and civil society to invest our respective resources in the most complementary and synergistic manner possible.”

The newly passed bill, awaiting President Obama’s signature, extends the funding authority for PEPFAR programs for another five years. It also adds several accountability measures, an important concern for lawmakers ever watchful of waste or abuse in government spending.

According to a summary issued by bill sponsor Senator Robert Menendez, a Democrat of New Jersey, the measure requires new reporting methods that will “reflect the program’s movement away from strictly U.S. support and toward greater partner country ownership.”

The success of PEPFAR along with other international measures to contain the epidemic and increase the number of people on drug therapy has allowed advocates to look toward the next goal: the birth of an AIDS-free generation. This goal will be achieved through completely ending any transmission of HIV from mother to child at birth and preventing HIV infection from advancing to AIDS.

PEPFAR has served as a platform for the Obama administration’s Global Health Initiative. Health care planners recognized early on that coping with HIV/AIDS required development of a broad-based system to deliver health care, counseling and preventive services at the local level. Millions of people are receiving AIDS treatment because of a vast network of community health workers and clinics developed over the last decade.

The Global Health Initiative is building on those beginnings to help other countries develop more health care services delivered more broadly. The initiative aims to improve health and quality of life everywhere. It helps create health care infrastructure and personnel capacity in developing countries to detect and prevent outbreaks of local health problems before they escalate into regional pandemics or epidemics.

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