Learning From Our Global HIV/AIDS Programs

Last week, I was in Johannesburg, South Africa, where I attended the annual meeting of the President’s Emergency Plan for AIDS Relief.  Known as PEPFAR, this is the United States global HIV/AIDS program that was established by President Bush.  PEPFAR has been continued and strongly supported by President Obama.  The focus of this Administration has been to move the program from an emergency response to a sustainable, long-term effort that builds the capacity of host countries to take the lead in responding their HIV epidemics.  Indeed, in 2009, President Obama announced his Global Health Initiative (GHI) that acknowledges the enormous success of PEPFAR and seeks to build on this effort by strengthening health systems to tackle other health problems.

It is humbling and exciting to be with this group of committed Americans and host country partners.  The American people should be proud of the fact that we are leading the response to the global pandemic and our work is literally saving the lives of millions of people around the world.  A couple of statistics caught my ear.  Through PEPFAR, 385,000 infants have been born HIV-free who otherwise would have been born with the virus. More than 100,000 of these births have been in the last year alone.  The PEPFAR program is currently supporting more than 3.2 million people on anti-retroviral therapy, an amazing achievement for a program that is only 7 years old.  What an enormous achievement!  I could cite facts and figures for days, but the most meaningful way to see the impact of our efforts is to visit the clinics and programs that the US government is supporting.  With CDC Director Dr. Tom Frieden, I visited a local clinic and a hospital in Tembisa, a community outside of Johannesburg that is home to two million people.  I also visited Helen Joseph Hospital in Johannesburg, a research hospital and one of the largest HIV treating hospitals in South Africa, as well as Nazareth House, a Catholic institution that cares for children orphaned by HIV.  It is hard to describe the feeling of seeing hundreds and hundreds of people living with HIV, many of whom are on HIV treatment, and to hear them thank PEPFAR and the American people for helping to keep them alive.

I came here hoping to learn lessons from Africa and other parts of the world to apply to the domestic epidemic.  There are lots of lessons as we work to implement the National HIV/AIDS Strategy.  What I found is that PEPFAR is grappling with so many of the same issues.  There has been a lot of talk about combination prevention.  As with domestic HIV programs, there is concern here about the challenging fiscal environment—and this is leading everyone to ask if they are prioritizing the right programs and interventions to save as many lives as possible.  Interestingly, there has been a lot of discussion about coordination among PEPFAR’s implementing agencies—State, CDC, USAID, Peace Corps, Department of Defense—and working with the host countries and their health systems.  This mirrors the challenges and opportunities of coordinating CDC, CMS, HRSA, and HUD, as well as the challenges and opportunities working with state and local governments.  I am not walking away with any magic solutions, but this meeting has given me a lot to think about… We definitely need to do more to integrate our domestic and global efforts.

As I left this meeting, I was energized by the committed people I met who are working so hard to achieve the vision similar to the U.S. National HIV/AIDS Strategy, but on a global scale.

Jeffrey S. Crowley is the Director of the Office of National AIDS Policy