Posts Tagged 'PEPFAR'

What We Need From the Next Head of PEPFAR

President’s Emergency Plan on AIDS ReliefDr. Eric Goosby stepped down from his role as U.S. Global AIDS Coordinator this month. As the White House and the State Department consider Dr. Goosby’s replacement, the Council believes there are some qualities that are essential in his successor.

The Council and its member organizations strongly support the President’s Emergency Plan on AIDS Relief (PEPFAR) – not only for health policy reasons, but for the broader reflection of fundamental U.S. values that PEPFAR offers. In that respect, we believe it crucial that PEPFAR programs be fully inclusive of most-at-risk populations, including men who have sex with men (MSM). We are grateful that  the Obama Administration has embraced that principle by expanding PEPFAR programming to include MSM – a legacy that, in turn, is elevating the importance of enabling legal environments for MSM prevention and treatment programs.

The nominee for Dr. Goosby’s replacement obviously must reflect experience in, and knowledge of, HIV/AIDS policy. Given the cross-agency nature of our tools to fight HIV/AIDS, however, we believe it critically important that he or she also demonstrate proven abilities to lead a complex and multi-tiered interagency health policy team.

Moreover, the new Coordinator will carry important leadership responsibilities in ensuring the consistency and integrity of PEPFAR programs. This must include clear commitment to meeting the needs of most-at-risk populations, including LGBT individuals, in each country served by PEPFAR. It equally must include persistence in seeking host country understanding of, and shared commitment to, this goal.

The Council remains concerned at indications that some PEPFAR implementers may have inappropriately blurred the distinction between their personal views on homosexuality and their responsibility, as an implementing organization of U.S. policy, not to undercut broad U.S. government policy goals that support both sound HIV/AIDS prevention and LGBT rights. We wish to see a Coordinator who will prioritize the integrity and effectiveness of our programs in this respect, even while respecting First Amendment rights. We, in turn, will join in holding the new Coordinator publicly accountable for effective oversight in investigating and responding to any alleged abuse.

Finally, the person selected as Coordinator has an essential role in communicating to foreign leaders, and indeed to American and foreign publics, the critical importance of PEPFAR’s life-saving programs, and the need for those programs to embrace all populations.

The new Global AIDS Coordinator can anchor a strong legacy not only of humanitarian attention to a critical health challenge, but also to insistence that our global health policies be fully inclusive, in reflection of American values. The Council for Global Equality is hopeful that there will be a speedy announcement of Dr. Goosby’s replacement, and that that announcement will reflect these inclusive values that are critical to the direction in which our PEPFAR programs must go.

Scope of Interagency Influence and Authority

The Council for Global Equality - Scope of Interagency Influence and AuthorityOver the past three days, we’ve laid out a number of key issues to be grappled with as the U.S. government meshes its foreign assistance programs with the goals laid out in the President’s December 6 memorandum and in Secretary Clinton’s speech the same day. These issues will require more than energy and thought: they will require clear and determined support from department and agency leaders, which we trust will be given.

As referenced earlier, USAID’s development assistance programs represent, in fact, only part of a larger set of assistance programs scattered across the U.S. government. The President’s memorandum references a baker’s dozen agencies that have such programs. Apart from USAID, two of our largest assistance programs were established under the Bush Administration: the Millennium Challenge Corporation (MCC), which we mentioned in yesterday’s blog, was established as a government corporation under the direction of a public/private board; PEPFAR, which operates under the Secretary of State’s oversight, oversees our international HIV/AIDS prevention and treatment programs. Smaller grass-roots development assistance programs are managed by the Inter-American Foundation and the African Development Foundation. Even the Pentagon carries discretionary funding that can buttress our overseas development assistance efforts. Continue reading ‘Scope of Interagency Influence and Authority’

U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) releases MSM technical guidance

PEPFAR, President’s Emergency Plan for AIDS Relief May 19, Washington – Today the office of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) released a technical guidance note to assist PEPFAR administrators in developing health interventions that respond to the unique needs of men who have sex with men (MSM).  The guide finds that MSM are on average 19 times more likely to have HIV than the general population in low and middle-income countries, and that dedicated MSM programming is essential to reach this severely at-risk population. Download the guidance here.

The Council is pleased that the guidance reviews best practices in identifying and serving MSM communities.  The guidance also calls for PEPFAR support to develop legal environments that allow MSM to access HIV prevention, care and treatment in an affirming and nondiscriminatory manner that respects their human rights.  To accomplish this, the guidance explains that PEPFAR resources may be used “to establish laws, regulations and policies that support HIV prevention efforts for MSM.”  In simple terms, the guidance recognizes that laws criminalizing homosexual relations and relationships undermine our country’s large international investments, and that PEPFAR resources should also be used to support legal reform. It calls on PEPFAR implementers to offer nondiscriminatory programs and for government leaders to make legislative changes, recognizing that “country leadership . . . is needed to develop and implement, at all levels, any necessary supportive legislation, policies, and regulations.” Continue reading ‘U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) releases MSM technical guidance’

The Council supports the global community on MSM field guidance

Amb. Eric Goosby

On February 1, 2011, the global community urged the U.S. Global AIDS Coordinator, Ambassador Goosby, to issue a PEPFAR Field Guidance on Men who have Sex with Men (MSM).  The Council for Global Equality is one of the many signatories urging the release, and the broad international response is indicative of the wide support that exists for this effort.

As noted in the letter, by releasing the MSM guidance the United States will demonstrate “that the U.S. government prioritizes an evidence-based response that aligns with the global HIV epidemic, one that seeks to stem the tide of new infections among most-at-risk populations.”

Read the full letter here.

The Council for Global Equality releases a study on the impact of PEPFAR on LGBT communities

CFGE and CAP Pepfar ReportThe President’s Emergency Plan for AIDS Relief has saved many lives and profoundly shaped the global response to HIV. But like the proverbial Trojan Horse, it has been let into the gates with a belly full of hidden contradictions—insufficient attention to marginalized communities, earmarks for unscientific programming, and forced “pledges” that both undermine sound reproductive rights programming and challenge basic rights to freedom of expression.

In this report, Washington insider Scott Evertz takes a serious look at the politics of one of our country’s signature foreign assistance programs. Scott is the former director of President George W. Bush’s Office of National AIDS Policy and an openly gay Republican, and his analysis reflects a degree of experience and honesty that is too often obscured by the rigid ideology and partisan policymaking that have—up until now—been the cornerstones of PEPFAR and the Bush administration’s bilateral funding strategy.

Read the complete report here.

How Ideology Trumped Science: Why PEPFAR has Failed to Meet its Potential

Next week, the Center for American Progress will publish a scathing critique of how PEPFAR – the Bush Administration’s signature initiative to combat the spread and impact of HIV and AIDS in Africa – ignored by design the HIV prevention needs of LGBT communities.

“How Ideology Trumped Science: Why PEPFAR has Failed to Meet its Potential” is written by Scott Evertz, a Bush Administration appointee. The Council for Global Equality sponsored Evertz’ refreshingly honest research, the thrust of which is to advocate a more inclusive, science-based program that ultimately will make more effective use of taxpayer dollars.

PEPFAR is rightly praised for having provided anti-retroviral medicines to some 2.1 million people who otherwise may have lacked recourse to them. It has made HIV testing and counseling available to millions more, while providing care to orphans and others with little means to provide for themselves. But PEPFAR’s assistance pipelines largely have bypassed LGBT communities, leaving gaping holes in the logic of efforts to stem the disease.

At a pre-holiday preview of his report, Evertz demurred on whether PEPFAR’s exclusion of LGBT needs was a deliberate reflection of anti-gay bias. But PEPFAR’s emphasis of abstinence until marriage amounts to a built-in exclusion of gays and lesbians, for whom marriage isn’t presently an option. Indeed, only negligible funding has been targeted at prevention outreach to men who have sex with men – a population that remains, at least partly of consequence, highly vulnerable to HIV infection.

Dogma-over-science has undermined PEPFAR’s effectiveness in other ways as well. PEPFAR grantees must explicitly oppose prostitution – thereby undercutting outreach to commercial sex workers, a major avenue of HIV infection. Averting needle exchange programs for injecting drug users has torn another hole in PEPFAR’s impact. And by giving overriding primacy to “abstinence” and “be faithful” messages, with little attention to correct condom usage, PEPFAR programs have reduced sex education to an asterisk.

The most detailed and disturbing portions of Evertz’ report relate to how PEPFAR may have contributed inadvertently to the unraveling of Uganda’s previously successful fight against HIV/AIDS. The Ugandan Government readily adopted PEPFAR’s de-emphasis of condoms and related sex education as effective means of HIV prevention. Evertz also reveals tell-tale signs that some faith-based PEPFAR sub-grantees may have helped nurture the anti-gay climate in Uganda that has spawned a horribly homophobic draft law that may be put to a vote in the coming days. Those of us of the Christian faith should be first to speak out against this subversion of religion to justify state-sponsored homophobic hate, imprisonment, and even death.

Larger questions fleetingly emerge, without answer, from Evertz’ work. For example, how could the UN Security Council not have recognized until the year 2000 – almost 20 years into this health crisis – the global security repercussions of the spread of HIV/AIDS? But the most disturbing question is this: how were those who ran PEPFAR allowed to break the wall of public policy separation our Founding Fathers rightly erected between church and state – thereby infusing a ground-breaking public health program, and indeed America’s national foreign policy interests, with sectarian dogma?

This is less a question for historians to dissect, or even for the previous Administration to defend, than one that public policy experts must ensure can never rightly be asked again.

View the panel discussion about this report held on December 15, 2009 at the Center for American Progress:


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