UNAIDS Director Piot, Rep. Lowey Urge Prevention, Increased Funding, Cooperation To Fight HIV/AIDS at PEPFAR ForumUNAIDS Executive Director Peter Piot and Rep. Nita Lowey (D-N.Y.) on Thursday at a forum on the reauthorization of the President's Emergency Plan for AIDS Relief said that three themes -- prevention, increased funding and cooperation -- are necessary to fight HIV/AIDS and ensure PEPFAR funds are used efficiently, CQ HealthBeat reports. PEPFAR is scheduled to expire at the end of fiscal year 2008.
Bush in May called on Congress to double PEPFAR funding levels from its first five years to $30 billion from fiscal year 2009 to FY 2013. At the forum, Piot called for PEPFAR funding to be increased to more than $30 billion over the next five years. He said that $30 billion "is a very large sum to be sure, but more is needed." According to Piot, U.S. spending on HIV/AIDS sets the pace for funding from other sources. "We have without doubt made major, major progress" because of U.S. funding leadership, Piot said, adding that increased PEPFAR spending will encourage other donors to increase spending.
At the forum, which was sponsored by the Woodrow Wilson International Center for Scholars, Lowey said the reauthorization "must reflect a new commitment to prevention." According to Lowey and Piot, for every person who begins antiretroviral therapy, there are six new cases of HIV, underscoring the need for more prevention programs. Currently, more than 50% of PEPFAR funding is dedicated to treatment, 28% to palliative care and 22% to prevention, according to CQ HealthBeat. Lowey and Piot said funding levels for prevention efforts should be based on the nature of the epidemic in each PEPFAR country rather than on set percentages.
A UNAIDS summary of PEPFAR reauthorization principles released by Piot said the high percentage of funds dedicated to treatment has "saved many lives," but "greater investments in prevention are essential." PEPFAR "should help countries 'know and act on their epidemic' to address the principal drivers of new infections in their country and to ensure equitable access to essential services," the summary said. Lowey added that U.S. ambassadors and their deputies should lead prevention efforts in PEPFAR countries because they have a "good handle on what's happening in basic education, what's happening in health care, ... what's happening with the PEPFAR program."
According to CQ HealthBeat, President Bush also is calling for more prevention efforts. Kent Hill, a USAID official, at the forum said that prevention programs must address the issue of "concurrent multiple" sexual partners, adding that PEPFAR also should support programs that address coercion of women to have sex with HIV-positive men.
Lowey and Piot also discussed the need to coordinate prevention and treatment efforts among different donors. "We have a lot of coordination to do" with other donor governments, organizations and programs, Lowey said, adding that it is "absolutely essential" that U.S. officials "meet with other international donors on a regular basis." She added that HIV/AIDS programs need to be coordinated more efficiently with nutrition, education and safe water programs that also contribute to the fight against HIV/AIDS. According to the UNAIDS summary, PEPFAR and other efforts to fight HIV/AIDS have had their "greatest successes" when governments are "full partners and the U.S. response is fully integrated into national strategies" (Reichard, CQ HealthBeat, 9/21).
A webcast of a community forum with Piot, which occurred on Thursday and was sponsored by the Global Health Council, is available online at kaisernetwork.org. This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.