PEPFAR is history: Difference between revisions

The '''President's Emergency Plan For AIDS Relief''' ('''PEPFAR''') is a United States governmental initiative to address the global HIV epidemic and help save the lives of those suffering from the disease. Launched by U.S. President George W. Bush in 2003, PEPFAR has provided more than $80 billion in cumulative funding for HIV/AIDS treatment, prevention, and research since its inception, making it the largest global health program focused on a single disease in history.

PEPFAR has begun providing money (United States tax dollars) for male circumcision programs.<ref>{{REFweb

  |last=The White House

  |date=2010-10-01

|url=http://www.youtube.com/watch?v=60uUA0uGOkc#t=22m38s

}}</ref> Focus countries have been invited to request program funding to increase access to the procedure. According to Kent Hill (assistant administrator for [[USAID]]), funding will increase to be "an important part" of PEPFAR programs in coming years.<ref>{{REFweb

  |first=

  |date=2007-08-22

  |accessdate=2011-03-30

 

 

  |Text=I'm pleased to note that USAID will play a signifigant role, with NIH, PEPFAR, and others [...] Swaziland, where we're all working in partnership to increase circumcision [...] to more than 80% in less than one year. It's the kind of example of a rapid scale-up [...] that can really make a difference [...] we can scale them up rapidly and do that in a successful and focussed way. [...] I want to share with you my deep respect for what you do, for your work and commitment. For proving to the world, that often didn't believe you could reach such high treatment numbers, or you could acheive such  rapid scale-up of circumcision [...] We take great inspiration from that [...]

==FACT SHEET: The Beginning of the End of AIDS 2011 ==

  |Text=PEPFAR is leading the world in support for a rapid expansion of voluntary medical male circumcision. In the past few years, research has proven that this low-cost procedure reduces the risk of female-to-male transmission by more than 60 percent—and the benefit is life-long.  Approximately one million male circumcisions for HIV prevention have been done in recent years, with the United States providing the support for three-quarters of them. Building on this, over the next two years, PEPFAR will support more than 4.7 million voluntary medical male circumcisions in Eastern and Southern Africa.

Note that the 60% is a relative risk reduction (absolute risk reduction 1.31%) during 18 months - not life-long.<ref>{{BoyleGJ HillG 2011}}</ref>

 

 

|date=2011-12-01

}}</ref>  

  |quote=The Ministry of Health, supported principally by UNICEF and PEPFAR, is currently working to introduce and scale up neonatal circumcision.

Point of Interest: In recent studies, HIV transmission was found to be more prevalent in circumcised males in Swaziland. The drive to circumcise the majority of Swazi men continues none the less.<ref>{{REFjournal

  |quote=As Table 14.10 shows, the relationship between HIV prevalence and circumcision status is not in the expected direction. Circumcised men have a slightly higher HIV infection rate than men who are not circumcised (22 percent compared with 20 percent

From the PEPFAR Blueprint: Creating an AIDS-free Generation (emphasis added):<REF>{{REFweb

  |Text=Action Step: Increase the number of males who are circumcised for the prevention of HIV....

PEPFAR announced in November 2019 that it would no longer support circumcision of boys who have not reached their 15th birthday.<ref>{{REFweb

From a blog.AIDS.gov entry by Jeffrey S. Crowley, M.P.H., Director, Office of National AIDS Policy dated 26 May 2011:<ref>{{REFweb

  |Text=Last week, I wrote about my attendance at the PEPFAR annual meeting in South Africa, the country that has more people living with HIV (over 5 million) than any other country in the world.  After this meeting, I visited the neighboring country of Swaziland, which has the unwelcome distinction of having the highest HIV and TB prevalence rates in the world.

The United States Ambassador to Swaziland, the Honorable Earl Irving, was an incredible host.  I attended a large reception at the Ambassador’s residence with the Honorable Minister of Health, Benedict Xaba and other Swazi leaders working on HIV, as well as representatives from PEPFAR, Peace Corps, CDC, USAID, DoD, and private American institutions, including Columbia University’s International Center for AIDS Care and Treatment Programs (ICAP) project.   Another evening, the Ambassador hosted a dinner with leaders from the Swazi Cabinet, the Ministry of Health and the national AIDS commission. I participated in a handover ceremony where the Ambassador ceremoniously transferred nine vehicles from PEPFAR to the government of Swaziland that will support their HIV work in the field. Through this event I also had  the opportunity to meet His Excellency the Right Honorable  Prime Minister of Swaziland.

A major focus of PEPFAR’s work is to assist the Swazi government’s plan to scale up adult male circumcision.  This lowers the risk that men will acquire HIV infection and research models indicate that if the country can get up to 80% of its adult men circumcised, they could observe a substantial decline in HIV transmission.  I visited one of several mobile sites that enabled Swaziland and PEPFAR to quickly expand access to circumcision.

  |Text=Our review found that CDC did not always monitor recipients’ use of President’s Emergency Plan for AIDS Relief (PEPFAR) funds in accordance with departmental and other Federal requirements. CDC implements PEPFAR, working with ministries of health and other public health partners to combat HIV/AIDS by strengthening health systems and building sustainable HIV/AIDS programs in more than 75 countries in Africa, Asia, Central and South America, and the Caribbean. HHS receives PEPFAR funds from the Department of State through a memorandum of agreement.

  |Text=Through its Global HIV/AIDS Program, CDC implemented the President's Emergency Plan for AIDS Relief (PEPFAR), working with ministries of health and other in-country partners to combat HIV/AIDS by strengthening health systems and building sustainable HIV/AIDS programs in more than 75 countries. Through a 5-year cooperative agreement, CDC awarded PEPFAR funds totaling $20.6 million to the Republic of Namibia, Ministry of Health and Social Services (the Ministry) for the budget period September 30, 2009, through September 29, 2010.

  |Text=The President's Emergency Plan for AIDS Relief (PEPFAR) program authorized $78 billion from 2003 through 2014 in support of international programs for prevention, treatment, and care to combat HIV/AIDS, tuberculosis, and malaria. OIG examined the funds spent through this program in a 2011 report focusing on whether the Centers for Disease Control and Prevention's (CDC) oversight met departmental and Federal regulations. OIG found that while CDC performed some oversight of recipients' fund use, most of the award files did not include all required documents or evidence to demonstrate that CDC performed required monitoring. Because of these concerns, OIG expanded its audits internationally to include CDC's monitoring of PEPFAR funds by offices in other countries as well as audits of recipient organizations abroad. OIG issued two audits on Namibia, one in 2012 and another in 2013, and has an additional eight audits conducted there and in South Africa and Vietnam that are near completion." OIG is also planning seven more audits of PEPFAR grantees in Ethiopia and Zambia for FY 2013.

[[George C. Denniston]], M. D., M. P. H., the president of [[Doctors Opposing Circumcision (D.O.C.)| Doctors Opposing Circumcision]], in a letter to Ambassador Deborah L. Birx, M.D., M. P. H., (2020), the head of the President’s Emergency Plan for AIDS Relief (PEPFAR)  has called on PEPFAR to suspend the provision of male [[circumcision]] because it is ineffective and may increase the reception of HIV infection due to the loss of [[Immunological and protective function of the foreskin| immunological protections]] of the [[foreskin]], and to focus on the provision of anti-retroviral therapy and condoms.<ref name="denniston2020">{{REFdocument

  |title=World Health Organization, HIV, and male circumcision

  |publisher=Doctors Opposing Circumcision

The VMMC Experience Project published an 18-page article on 9 September 2020, that is highly critical of PEPFAR's male circumcision program. In brief, it charges:

Campaigns to circumcise millions of boys and men to reduce HIV transmission are

to properly consider the economic determinants of HIV prevalence. This critical

solution” to African HIV epidemics has more to do with cultural imperialism than with

representation within the regime.

== CircWatch ==

* [http://circwatch.org/tag/PEFPAR/ Post about PEFPAR on CircWatch]

* [[Circumcision and HIV]]