Backlash from civil society as PEPFAR announces three-year strategy

16 October 2017

The President’s Emergency Plan for AIDS Relief (PEPFAR) is to accelerate efforts in just 13 countries under its news strategy. But critics say this narrowed focus could lead to a resurgence of the HIV epidemic.

Women see the doctor in Zambia

PEPFAR's new three-year strategy, which was announced at the UN General Assembly in September, focuses efforts on 13 countries with high HIV prevalence that are nearing epidemic control – the point at which there are more annual AIDS-related deaths than there are new HIV infections.

Under PEPFAR’s 2017-2021 strategy, Botswana, Côte d’Ivoire, Haiti, Kenya, Lesotho, Malawi, Namibia, Rwanda, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe will see PEPFAR-funded programmes renewed and expanded. National surveys suggest five of these target countries – Lesotho, Swaziland, Malawi, Zambia and Zimbabwe – are already nearing epidemic control.

PEPFAR currently funds HIV testing and treatment for millions of people in more than 50 countries. Although PEPFAR’s new strategy includes plans to continue working in all countries in which it has a presence, critics have linked the new focus with proposals to cut PEPFAR’s budget by 17%, from US $4.6 billion to US $3.8 billion. This proposed cut, which was included in President Trump’s budget in May, has so far been rejected by Congress.
The International HIV/AIDS Alliance said: “…we remain concerned about the ever-narrowing focus of resources on a dwindling subset of countries and locations. Primarily, we worry about the impact the new strategy will have on the lives of people living with or affected by HIV outside of the 13 selected PEPFAR countries. For example, in Ukraine new HIV infections have been rising and a cut in funding now could see a resurgence in the epidemic.

“This new strategic direction, given that it comes from the single largest donor to global HIV, risks undermining decades of critical prevention and treatment efforts. We must be very careful about not declaring mission accomplished on the global AIDS response. There are still close to 2 million new infections every year, and we are still 'only' half way to securing treatment for everyone.”

Asia Russell, Executive Director at Health GAP, described PEPFAR’s new strategy as “the kind of global AIDS response policymakers craft when they have one hand tied behind their backs.”

Health GAP criticised the plan for failing to address human rights and offer an “aggressive strategy” for reaching key populations, as well as “failing to highlight the dangerous impact of expanding the Global Gag Rule”, which blocks US funds to any organisation involved in abortion advice and care overseas.

Ms Russell added: “An ambitious strategy wouldn't limit efforts toward epidemic control in just 13 of PEPFAR's more than 50 countries, but would aggressively map out a plan for ending AIDS as an epidemic in all countries, including those with the highest burden and greatest need such as Mozambique, South Sudan, the Democratic Republic of Congo and other parts of West Africa.

"This strategy makes the right moves in too few places, at the expense of saving lives everywhere else. PEPFAR leadership should sound the alarm about the risks of committing too few resources to the global AIDS response and the dangers of using scarce resources for anything other than evidence-based strategies."

Written by Hester Phillips