Every nation, large or small, developed or developing, is vulnerable to the threat of HIV/AIDS. No nation is protected by geography or political boundaries. With the knowledge that turning the tide against global AIDS requires a global fight, the President's Emergency Plan for AIDS Relief (PEPFAR/Emergency Plan)) encompasses HIV/AIDS programs in 96 countries in addition to the 15 focus countries. The Emergency Plan targets $4 billion over five years to support HIV/AIDS programs in these countries, including international research. Recognizing that an effective global strategy to combat the pandemic must respond to the diversity of the global HIV/AIDS challenge, the Emergency Plan is committed to strengthening U.S. Government-supported HIV/AIDS programs and promoting strong leadership in all of the countries in which it works.
The Emergency Plan committed significant resources -$437 million in fiscal year 2004 - to sustain and expand ongoing U.S. assistance to HIV/AIDS programs in these 96 additional countries. The Office of the U.S. Global AIDS Coordinator (OGAC) has promoted consistent HIV/AIDS policies and programs across our continuing bilateral prevention, care, and treatment initiatives with the aim of harmonizing bilateral programs with the principles and intent of the Emergency Plan. To date, strategic planning and budgeting for U.S. Government programs outside of the focus countries have remained the responsibility of the implementing agencies, which do so within the framework of the U.S. Global AIDS Strategy and under OGAC leadership.
Bilateral programs are making significant progress. The Emergency Plan seeks to develop lessons learned from the rapid scale-up of national integrated prevention, treatment, and care programs in the focus countries, and from U.S. interagency coordination, to strengthen prevention, care, and treatment interventions worldwide. Several features of the Emergency Plan in focus countries have taken hold in other bilateral programs. Interagency teams have been formed to undertake joint planning and programming, especially in countries with significant HIV/AIDS prevalence. OGAC has begun to collect data from these countries using the same measures and indicators used in the focus countries. While the data collection systems in the countries outside of the 15 focus countries do not yet produce the optimum level of information, improving these systems will be a key focus of ongoing strategic information activities. Moreover, as best practices are identified across programs, they will be shared with other programs facing similar challenges.
Through its bilateral programs, the U.S. Government supports programs and builds capacity for countries to prevent the spread of HIV. Such programs include addressing medically and sexually transmitted HIV, preventing mother-to-child transmission, and promoting the ABC approach. Stigma and discrimination remain challenges worldwide, greatly impacting the quality of life of those infected and affected by HIV/AIDS. Access to needed support mechanisms, education, treatment for HIV-related illnesses, prevention of violence against women, and the ability to seek and maintain employment are all affected by stigma and discrimination in a society.
As in the Emergency Plan's focus countries, other bilateral HIV/AIDS programs are challenged in their ability to provide treatment to people with HIV/AIDS. In addition to the focus countries, there are 10 countries in Africa, Asia, and the Caribbean that have launched U.S. Government-financed treatment programs since the beginning of the President's Emergency Plan, including a significant program in China. More than 135 service outlets in these countries are providing treatment.
Care for orphans and vulnerable children is a key component of a compassionate response to HIV/AIDS throughout the world. The Emergency Plan's bilateral programs outside of the focus countries have included 240 programs targeted to orphans and vulnerable children. As described in chapter 3 of this report, programs seek to strengthen the ability of families and communities to care for orphans and vulnerable children and to ensure that these children receive basic nutrition, education, and housing.
Even in countries where the epidemic is not widespread in the general population, it is important that care be made available to those who are affected. Chapter 3 also describes how the Emergency Plan supports the continuum of care from the time of diagnosis with HIV infection until death, including counseling and testing to make the diagnosis of HIV infection.
Collecting information on best practices in providing quality care to orphans and vulnerable children and people living with HIV/AIDS received much attention in fiscal year 2004 and will continue to receive attention. These practices include assessing optimal packages of services, home- and community-based care programs, training for providers, and many others. Lessons learned from the scale-up of care programs in the focus countries are being applied in other bilateral programs of the Emergency Plan.
The President's Emergency Plan for AIDS Relief is committed to improving and amplifying the HIV/AIDS response worldwide. The U.S. Government supports appropriate policy development and system strengthening for host-country HIV/AIDS responses across the globe, capitalizing on its expertise in technical assistance and capacity building for quality improvement and sustainability of programs. In countries where the U.S. Government provides assistance, public and private sector institutions across all categories of HIV/AIDS response receive technical assistance for policy development, including policies aimed at reducing stigma and discrimination and other capacity-building activities. \
In fiscal year 2004, the U.S. Government trained people to prevent the medical transmission of HIV, provide PMTCT services to pregnant women and their infants, deliver HIV-related palliative care, conduct HIV counseling and testing, and perform necessary laboratory tests. In addition, the U.S. Government took a leadership role in training country staff in monitoring and evaluation, surveillance, and health management information systems, as well as policy, capacity building, and stigma and discrimination reduction programs. The investment in capacity building through bilateral programs reflects the United States' commitment to helping nations increase their ability to respond to both current and future HIV/AIDS challenges and establish programs that are sustainable in the long term.
Increased Financial Commitments
In addition to the 15 focus countries targeted for dramatically scaled-up resources (home to nearly half of the world's HIV-positive people), the Emergency Plan continues to track and respond to rising needs in countries with the potential for explosive epidemics, such as China, India, and Russia, as well as countries like Angola, Swaziland, and Lesotho, all struggling to contain their epidemics.
In fiscal year 2004, acting on the recommendation of an interagency team of experts, the U.S. Global AIDS Coordinator provided an additional $25.5 million to seven countries, including India, Russia, Cambodia, Swaziland, and Lesotho, and to five regional programs covering an additional 20 countries.In India, the U.S. Government increased its commitment to fighting HIV/AIDS by nearly 25 percent from fiscal year 2003 to fiscal year 2004. India has the largest HIV/AIDS program ($36 million, including research, in fiscal year 2004) supported by the U.S. Government outside the 15 focus countries.
HIV/AIDS-related stigma. Since 2003, the Department of State has programmed more than $2 million for HIV/AIDS vaccine research, including identification of a novel vaccine platform technology, in conjunction with Russia's former Weapons of Mass Destruction Institutes.
The U.S. Government's commitment of $37 million in fiscal year 2004 for bilateral health assistance to China for HIV/AIDS and other diseases has had an impressive impact on U.S.-Chinese health cooperation. The Chinese government is actively engaging U.S. officials and medical professionals for help in designing and improving the nation's health care infrastructure.
Sub-Saharan Africa remains by far the most affected region, and the Emergency Plan's commitment there also extends beyond the focus countries. Emergency Plan budgets for several countries in this region increased, with budgets for Lesotho and Swaziland increasing by as much as 150 percent between fiscal years 2003 and 2004.
Finally, the United States remains by far the largest contributor to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which is now active in 130 countries. In 2004, the United States' contribution made up one-third of all contributed Global Fund resources; thus, roughly one-third of the $352 million the Global Fund has approved in two-year projects for China, India, and Russia -- or approximately $117 million -- is attributable to U.S. contributions.
Strengthening Coordination, Management, and Accountability: Ensuring Consistency with Emergency Plan Principles
The President's Emergency Plan offers a fresh opportunity to implement consistent HIV/AIDS policies and ensure a coordinated U.S. Government approach across all of our bilateral prevention, care, and treatment initiatives. The Global AIDS Coordinator has provided program and policy guidance to all U.S. missions with HIV/AIDS programs, urging them to adopt integrated interagency strategies wherever U.S. resources are used. Strategies may include prevention, treatment, care, and technical assistance, as well as U.S. leadership and advocacy to reduce stigma and diplomacy to increase host government engagement.Specific guidance included:
In addition, as part of the significantly enhanced accountability of HIV/AIDS programs introduced by the Emergency Plan, interagency strategic information teams worked this past year to identify strategies and indicators to better track and monitor activities in bilateral HIV/AIDS programs outside of the focus countries.
Based on the indicators developed for the focus countries, implementation of this coordinated monitoring and evaluation effort will greatly improve program planning and accountability.