From PEPFAR to PEPFAR-plus
by Peter Luckow on November 15, 2008
Over the past two decades, the global AIDS pandemic has wreaked havoc in developing countries around the world. More than 25 million people have already died of AIDS, a treatable and preventable infectious disease. Children have been orphaned, economies have suffered, and the health workforce in the hardest hit countries has been weakened.
The past decade has seen a major surge in funding for global health, much of it being dedicated to combat the AIDS pandemic. On May 27, 2003, President Bush authorized the US President's Emergency Plan for AIDS Relief (PEPFAR), committing $15 billion from 2003-2008 for global AIDS relief for prevention, care, and treatment. Just this past July, President Bush reauthorized PEPFAR, pledging $50 billion for the next five years. Many say that PEPFAR will be Dubya's greatest (positive) legacy, despite some ideological shortcomings attached to the funding.
While PEPFAR has brought important strides in the fight against AIDS, its narrowly-focused prevention and treatment efforts have not gotten to the root causes of the pandemic. In Structural Violence, Poverty, and the AIDS Pandemic, Joia Mukherjee provides invaluable insight into the root causes of the global AIDS crisis - poverty, gender inequality, lack of access to education, neoliberal economic reforms, and exhorbitantly priced medicines. According to Mukherjee, these root causes are representative of the structural violence that is being inflicted on the poor throughout the world. She defines structural violence and its relationship to AIDS:
Structural violence, defined as the physical and psychological harm that results from exploitive and unjust social, political and economic systems, is the shadow in which the AIDS virus lurks.
The $50 billion pledged through PEPFAR to fight the AIDS pandemic will be a huge boost to advance further prevention, care, and treatment. However, a worthy fight against AIDS must include a broader sense of prevention and treatment that goes beyond preaching abstinence and distributing ARVs, to preventing and treating the devastaingly powerful effects of structural violence.
Ankur says on November 22, 2008 at 12:28am:
One question I have is how can those government officials who are responsible for legislation like PEPFAR, better understand the need for a comprehensive approach to HIV/AIDS? While many organizations have been able to use PEPFAR funds as a way of also strengthening health systems, I wonder what will happen if public imagination about HIV/AIDS runs out (and how government representatives would be persuaded to fund 'comprehensive' health systems)?Rachel says on November 22, 2008 at 2:19am:
I had an additional question... In the description of the 5-year strategy for PEPFAR (http://www.state.gov/s/gac/plan/c11652.htm), the importance of working with political leadership in participating countries is highlighted. In the actual strategies document (http://www.state.gov/documents/organization/29831.pdf), the focus of leader engagement is on declaration of HIV/AIDS as a problem, raising appropriate resources, and encouraging multisectoral involvement. In order to incorporate a structural approach, this description would need to be altered and at times condoning the structural circumstances which leaders may have had a hand in creating (or at least not addressing directly). How could PEPFAR, as an entity of the U.S. Government, shift its approach towards participating countries to incorporate significant structural factors which increase incidence and risk of HIV/AIDS? And, to play devil's advocate a bit, what might be the challenges or even costs of such a shift?