The U.S. governmental program to fight HIV/AIDS is formally known as the President’s Emergency Plan For AIDS Relief (PEPFAR). From the outset, PEPFAR has been run out of the Department of State’s Office of U.S. Global AIDS Coordinator (OGAC). The project works through many other U.S. government agencies (US AID, etc). PEPFAR, according to its own reports, has given anti-retroviral drugs –according to 2013 GAO report to 5.1 million people, more than half of these in low or middle income countries, many of them in Africa. In recent years PEPFAR has shifted emphasis to training in-country specialists to take over the programs.
Sounds good but at best, the results have been mixed. A great deal of money has been spent on the program since its inception with questionable, limited – often exaggerated results and few serious follow up studies. From the outset the program has been plagued with criticisms. PEPFAR there is a typical `top down’ bureaucratic affair with very little interaction with “folks on the ground”, similar in many ways to many World Bank/IMF structural adjustment programs.The program is not run out of the United Nations nor organizations like the World Health Organization, but is run bilaterally between the United States and the target nations involved.
When Bush was in office, PEPFAR was little more than yet another boom for U.S. pharmaceuticals as the program required that the drugs be purchased from the pharmaceuticals holding patents, It was the shift to generics, encouraged according to some sources by Bill Clinton, has led to a significant extension of the program and $1 billion savings over a five year period. As a result, the cost per patient has gone dropped some 400% from 2005-2011 and many more people have been treated.
At the heart of the program is what is referred to as the ABC approach, an acronym for `abstention, be faithful, use a condom’ – a touching, Christian fundamentalist inspired, but almost entirely irrelevant way of treating AIDS. As the ABC approach glaringly suggests, PEPFAR is infused with Christian fundamentalist values. In line with their skewed thinking, the program promotes `abstention’, prostitutes and homosexuals are excluded from treatment. Emphasizing abstention tends to focus on individual behavior modification for prevention, – as opposed to structural change, or some kind of hybrid approach or an approach which focuses on prevention. PEPFAR has resulted in a number of unintended consequences: the marginalization of groups at high risk for HIV/AIDS (LGBT, prostitutes, IV drug users, etc.); the promulgation of misunderstandings about HIV transmission, prevention and safe sex (condoms); the promulgation of misunderstandings about the causes of HIV/AIDS epidemic
By excluding those more likely to be affected by HIV/AIDS, PEPFAR is shooting itself in the foot. The results have been – almost predictably – uneven. If HIV/AIDS levels in Uganda did dip in the early years of the program, their levels are once again on the rise. While some groups see (significantly) falling rates of HIV/AIDS prevalence, other groups see rates rising or unchanged (e.g. married women, LGBT community). In a similar vein, there is no real evidence that the credit for declining HIV prevalence where it exists, is as a result of the Bush program.
Taken from this article by Rob Prince