Saturday is World AIDS Day, and we Americans should be proud of what our country has achieved in the fight against AIDS. But we also should be improving our efforts.
The President's Emergency Plan for AIDS Relief (PEPFAR), a $15 billion program, has supported the care of 2.4 million people with AIDS, saving them from certain death. President Bush's initiative and the American people's generosity should be commended. Having met South Africans and Ugandans who are alive because of the program, I have seen firsthand the difference PEPFAR is making.
Almost five years into its lifesaving mission in sub-Saharan Africa, PEPFAR is due for reauthorization by Congress. This presents a great opportunity to increase PEPFAR's strengths and move the program beyond its initial triage approach and into a second phase that builds for the future.
Where does PEPFAR fall short? First, it is not creating a public health or clinical care infrastructure. If the program ends, its staff will pack up and go home. The United States needs to do a better job of leveraging PEPFAR to create health care systems that will improve the health of Africans, regardless of their HIV status. Upon its demise, PEPFAR should leave countries better equipped than when it started.
Second, PEPFAR is not spending taxpayer dollars wisely. About 7 percent of PEPFAR funding goes to abstinence-based programs. According to the Institute of Medicine, there is no evidence that abstinence-based interventions prevent transmission of HIV. If the American people are going to donate billions of dollars to save lives in Africa, they - and the Africans whom PEPFAR is charged to help - deserve a program that is as efficient and effective as possible.
Third, it does not support research. PEPFAR is the equivalent of an emergency relief airdrop. That's important when you have an immediate crisis, when people are dying. But HIV/AIDS is not a short-term challenge. We must start thinking about the long term. We need to know that the drugs are getting to the right places, that the treatment protocols are not leading to drug resistance, that optimal drug distribution methods are being employed, and so on.
