Panel discusses future of US global HIV/AIDS policy

Experts addressed the future of US efforts to tackle HIV/AIDS abroad at a panel discussion earlier this week in Washington, DC. 

Convened by the Kaiser Family Foundation (KFF) and the Center for Strategic and International Studies’ (CSIS) Global Health Policy Center, the event focused on the policy implications of a recent Institute of Medicine (IOM) evaluation of the US’ largest global health program, the President’s Emergency Plan for AIDS Relief (PEPFAR). 

The Policy Implications of the Institute of Medicine’s Evaluation of PEPFAR

The congressionally mandated IOM report, published in February, heralded PEPFAR as “globally transformative” and made several recommendations to continue the program’s progress on preventing and treating HIV/AIDS. Chief among these recommendations is for the US to help partner countries assume management of their own programs. 

Panelists discussed priorities for PEPFAR in the coming years, including the need to improve metrics and data, better address the needs of at-risk populations, and ensure sustained program funding.

The successful transition of programs to partner countries – one of the IOM’s most important takeaways – was another key subject of concern for the panelists. “We’re grappling very seriously with the word ‘transition’” and what that means for the countries themselves, said Julia Martin, deputy global AIDS coordinator.

The insufficiency of data measuring health outcomes and the impact of interventions is not new. J. Stephen Morrison, director of CSIS’s Global Health Policy Center, who moderated the panel, mentioned that data problems were also present in 2007, when the IOM published its first evaluation of PEPFAR. “It’s really the challenge of our field” to get data, said another panelist, Jennifer Kates, vice president and director of global health and HIV policy, who was on the IOM report committee. 

Panelist Chris Collins, vice president and director of public policy at the HIV/AIDS research and advocacy group amfAR, expressed concern about serving key populations, including sex workers, and scaling up interventions such as condoms. “There’s enormous unmet need” in these populations, Collins said. 

He also said there was a “huge mismatch” between the country's rhetoric around ending HIV/AIDS and what the science says is doable on the one hand, and proposed budget cuts to PEPFAR on the other. 

In his 2013 State of the Union address, President Obama reiterated his administration’s commitment to achieving an “AIDS-free generation.” But the PEPFAR budget has been cut 12 percent since 2010, Collins said, and the lauded efficiencies in the program are “no excuse to be cutting the program.” 

IOM’s Senior Program Officer Kimberly Scott, who co-directed the report study, also participated as a panelist in the discussion. 

PEPFAR is the US’ largest global health program by far, comprising around 75 percent of the country’s Global Health Initiative funding in fiscal year 2013, according to KFF. It was created under the George W. Bush administration in 2003 with broad bipartisan support to address HIV/AIDS, tuberculosis, and malaria – legislation that was reauthorized by Congress in 2008 through 2013 with up to $39 billion in funding.

Panelists acknowledged that the legislation’s reauthorization in 2013 is uncertain, but said that either way, the IOM report provides a path for future global work on HIV/AIDS and related global health issues.

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