March 6, 2013
The Institute of Medicine (IOM) recently released an independent evaluation of the President's Emergency Program for AIDS Relief (PEPFAR), in which IOM praised PEPFAR's achievements, verifying that large-scale HIV services can be provided successfully. However, the report, resulting from a 4-year study mandated by Congress in 2008, also recommended several changes to the program to ensure that the HIV/AIDS response is sustainable. The IOM report stated that PEPFAR's work is unfinished and recommended change in the following four broad categories: scaling existing programs, helping countries strengthen their systems to improve HIV/AIDS response, transitioning to a country-owned response, and improving knowledge management.
PEPFAR, in existence since 2003, is widely perceived as having successfully decreased HIV/AIDS prevalence throughout the world. A UNAIDS December 2012 report found that HIV incidence in 25 countries declined by more than 50 percent and decreased by 20 percent worldwide between 2001 and 2011. The number of AIDS-related deaths has declined by almost one-third since 2005.
IOM's PEPFAR report recommends that the program must change from being an emergency response provider to being in an advisory role so that PEPFAR will be sustainable. The report recommends that other countries must begin to take ownership of their HIV/AIDS responses.
The IOM report states, "PEPFAR will gradually cede control, as partner countries take on more central roles in accountability and setting strategic priorities for investment in their HIV response. The pace of transition will vary by nation, but such an evolution in PEPFAR's mission is vital." David Haroz, State Department special assistant to the principal deputy US global AIDS coordinator, declared that PEPFAR has long been planning for this transition, and notes that in some countries, such as South Africa, the change has already begun.
The AIDS Healthcare Foundation (AHF) is concerned that PEPFAR will be unable to transition to countries without sacrificing the progress that it has made. Omonigho Ufomata, AHF's director of Global Policy and Advocacy, explained in an e-mail interview that AHF does not want to see a transition to country ownership if that means patients have a more difficult time accessing care. "We want all that the United States can do along with all that the South African government can do. So long as there are still people dying of this disease and we witness overflowing waiting rooms, we don't want to see transitions."