Internal Criticism Voiced on U.S. Plan for AIDS Relief

Last week, more than 1,000 U.S. officials and AIDS specialists gathered in South Africa to discuss the successes and failures of the President's Emergency Plan for AIDS Relief (PEPFAR).

Though the global program has received praise in many quarters, particularly in Africa, huge challenges remain, said U.S. officials working in the PEPFAR-targeted countries. In two sessions called "Good Ideas That Worked and Good Ideas That Didn't," U.S. ambassadors outlined some of the hurdles. In Ghana, which has a 2.7 percent national HIV prevalence rate, U.S. Ambassador Pamela Bridgewater said that transmissions among men who have sex with men are a significant component of the epidemic, yet MSM "are stigmatized even by health workers." "Many of these men are married and could be a bridge to spreading HIV to the general population," she said.

Bridgewater said the embassy recently created a program that brought in MSM to sensitize health workers about their needs. The effort appears to be working, she said. Last month, Ghana health workers referred 250 men for various services, up from just 50 four months ago.

In Uganda, which has one of the highest fertility rates in the world, U.S. Ambassador Steven Browning reported on a worrying unintended consequence of AIDS treatment for HIV-positive women. To the surprise of some women who had stopped menstruating, antiretroviral treatment allowed them to become fertile again. A study revealed that 90 percent of HIV-positive Ugandan women who became pregnant did not want to have the child. Browning said the U.S. program must develop better communication strategies to encourage use of contraception to avoid unwanted pregnancies.

Dr. Mark Dybul, PEPFAR's acting coordinator, said hearing such criticisms helps to correct problems. "If we don't face challenges square-on, we're never going to get to national coverage" against AIDS. "If you can't improve on what you've done, you can't save as many lives," noted Dybul.

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