5 November 2017

Africa: PEPFAR's new strategy has implications for the Global Fund

PEPFAR will focus its resources in 13 priority countries

The (U.S.) President’s Emergency Plan for AIDS Relief (PEPFAR) will “concentrate its resources” in 13 countries with high levels of HIV that have the best chance of controlling their epidemics by 2020, under a new strategy announced on 19 September by U.S. Secretary of State Rex Tillerson. However, people currently receiving treatment will still receive it, the State Department said, and PEPFAR will continue to operate programs in more than 50 countries.

The 13 countries are Kenya, Zambia, Tanzania, Uganda, Zimbabwe, Malawi, Lesotho, Côte d’Ivoire, Botswana, Namibia, Swaziland, Haiti and Rwanda. The State Department defines “controlling their epidemics” as “the point where there are more deaths each year from AIDS than there are new HIV infections.”

According to an article in Reuters, five of the target countries – Lesotho, Swaziland, Malawi, Zambia and Zimbabwe – are already nearing control of their HIV epidemics. This assessment is based on national surveys from the Centers for Disease Control and Prevention, Columbia University and local governmental and non-governmental partners.

The strategy covers the period 2017-2020, but it is likely to kick in at the start of the U.S. 2018 fiscal year, which runs from 1 October 2017 to 30 September 2018.

The new strategy comes at a time where there is uncertainty over the size of the PEPFAR budget. The administration of President Donald Trump had proposed that the program’s approximately $6 billion annual budget be cut by $1 billion. However, the Senate Appropriations Committee voted recently to maintain the budget at $6 billion. (See separate article in this issue.)

The 12-page strategy document was short on specifics. It does not explain, for example, how much of PEPFAR’s budget will be devoted to the 13 priority countries, or by how much the budget for other PEPFAR countries will be reduced.

The U.S. NGO Health GAP was critical of the new strategy. “The plan includes a greater push toward epidemic control in 13 target countries, but takes the foot off the gas for more than 37 countries PEPFAR does not designate as ‘priority,’ leaving behind millions of people living with HIV due to a lack of resources and a waning commitment to evidence-based strategies,” Health GAP said in a news release.

“The strategy announced today is the kind of global AIDS response policymakers craft when they have one hand tied behind their backs,” said Asia Russell, Health GAP’s executive director. “An ambitious strategy … 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.”

The Global Fund invests in all of the countries where PEPFAR operates. All 50 PEPFAR countries have already been notified of their Global Fund allocations for 2017-2019. Of PEPFAR’s 13 priority countries, all but one (Botswana) have already submitted their funding requests. Most of the other 37 countries have also already sent in their proposals

PEPFAR and the Global Fund work together to ensure that their respective investments complement each other. The Fund’s Head of Communications, Seth Faison, told Aidspan that the Secretariat is already working on how to best coordinate efforts with PEPFAR’s new strategy, “which we support.”

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