PEPFAR Aims To Build Alliance With Global Fund, Works To Help Countries Maintain Programs

The President's Emergency Plan for AIDS Relief is working with the Global Fund To Fight AIDS, Tuberculosis and Malaria to better fight HIV/AIDS in countries receiving money from the fund, officials said this week at the second annual meeting of field workers for PEPFAR in Addis Ababa, Ethiopia, the Boston Globe reports (Donnelly, Boston Globe, 5/25). PEPFAR is a five-year, $15 billion program that directs funding for HIV/AIDS, TB and malaria primarily to 15 focus countries and provides funding to the Global Fund (Kaiser Daily HIV/AIDS Report, 5/13). As part of the coordination effort, PEPFAR will offer technical and organizational assistance to countries that are having difficulty spending their Global Fund aid money, which puts them at risk of losing the money. Officials cited Tanzania and Kenya as examples of countries where coordination between the agencies would be useful because governments of both countries have spent little of the millions of dollars in HIV/AIDS money they have received from the Global Fund. U.S. officials said they are unsure of how the coordination would work, according to the Globe.

Program Successes, Challenges
During the meeting this week, participants examined Global Fund programs experiencing difficulty and reviewed the performance of PEPFAR prevention and treatment programs. U.S. representatives noted several successes in their PEPFAR programs, including a 300% increase in the number of HIV/AIDS patients receiving treatment in Kenya in 2004 and a 94% acceptance rate for a door-to-door HIV testing program in Uganda. However, participants also described challenges, including poor coordination among donors, according to the Globe. Officials said a main concern is the lack of an international purchasing plan for HIV/AIDS drugs and supplies, which could save money and ensure delivery of the medicines to avoid drug shortages.

Concerns, Comments
U.S. HIV/AIDS workers are concerned that if Global Fund programs in developing countries fail, the fight against the pandemic could slow in those areas. However, there also are "doubts and confusion" about how a partnership would work, according to the Globe. "If some Global Fund programs are failing, it would be disastrous for everyone," Kevin DeCock, director of CDC's Kenya office, said, adding, "But we have no influence over the Global Fund or over the groups that receive their money. One of the reasons that PEPFAR is working on the ground is coordination of activities." Deputy U.S. Global AIDS Coordinator Mark Dybul said the United States has an interest in ensuring the success of Global Fund programs because the organization is "so important in fighting AIDS around the world." Dybul also said that the Global Fund "unquestionably needs more money," but he added that the primary concern is supporting existing programs.
Despite early concerns that PEPFAR might detract from the Global Fund, especially in terms of U.S. donations, Brad Herbert, the Global Fund's chief of operations, said "the opposite was true," adding, "The relationship has changed dramatically. It's been a learning curve for everybody" (Boston Globe, 5/25).

Cooperation Background
The cooperation among global HIV/AIDS players originated in the "Three Ones" agreement signed in April 2004 during a meeting in Washington, D.C. Donor nations and developing countries agreed to three principles, known as the "Three Ones," that are aimed at streamlining HIV/AIDS programs in developing nations so that the money can be spent more efficiently and effectively. The principles include: one HIV/AIDS action framework to coordinate the work of all involved parties, one national AIDS authority with a broad-based multisector mandate, and one country-level system to monitor and evaluate programs. The United States, Britain, Australia, Belgium, Canada, Denmark, Finland, France, Germany, Ireland, Italy, Japan, Luxembourg, the Netherlands, Norway and Sweden signed the agreement (Kaiser Daily HIV/AIDS Report, 4/26/04).