Some global health advocates on Tuesday expressed concern following news that Mark Dybul will continue to serve in his position as U.S. Global AIDS Coordinator and administrator of the President's Emergency Plan for AIDS Relief following the inauguration of President-elect Barack Obama, CQ HealthBeat reports. Dybul in a recent e-mail to his staff indicated that he will continue his role "beyond the inauguration" of Obama, at least temporarily.
Since 2006, Dybul has overseen PEPFAR, which Congress reauthorized in July 2008 for an additional five years. Although many people have praised the program's success, others say it has overemphasized abstinence at the expensive of more inclusive prevention strategies, according to CQ HealthBeat. Many of these advocates anticipated that Obama's administration would shift PEPFAR's focus, but news of Dybul's continuation has led some to express concern that such changes might not occur. Serra Sippel, executive director of the Center for Health and Gender Equity, said that there is "legitimate concern that keeping Dybul in place will mean a continuation of the Bush administration's one-size-fits-all approach" to HIV/AIDS prevention programs, rather than a more tailored approach to meet the needs of individual countries. However, replacing Dybul with a less-qualified candidate "could be disastrous," Sippel said.
Beth Frederick, spokesperson for the International Women's Health Coalition, said Dybul has spoken about a number of issues "but not about women and not about prevention." Dybul in November 2008 during a talk at the Center for Strategic and International Studies acknowledged that PEPFAR has "not progressed in prevention" but added that he hoped to address this issue by providing funds to train 140,000 health workers and focus on country-specific prevention strategies. Kaytee Reik, a grassroots organizer with Health GAP, said officials should guarantee the allocation of training funds, adding that other comprehensive prevention strategies -- such as needle-exchange programs -- should receive funding during the next phase of PEPFAR. Dybul in November 2008 said that although PEPFAR's reauthorization was "silent" on needle-exchange initiatives, it will be "up to the new administration and the Congress" to decide whether to implement such programs. Officials in the next administration and new Congress have "the opportunity to take this where they would like," Dybul said. According to Sippel, "Dybul has displayed he will follow the orders of his boss," and therefore global health advocates should focus on Obama and the policies that he will pursue in office (Semnani, CQ HealthBeat, 1/13).
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