PEPFAR is history: Difference between revisions

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[[Image:PEPFAR.png|right|thumb|PEPFAR]]

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 $85 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.

The '''President's Emergency Plan For AIDS Relief''' ('''PEPFAR''') was 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 on the advice of [[Anthony Fauci]], PEPFAR has provided more than $85 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. <b>PEPFAR was a failure and has now been terminated by the United States Government that eliminated the United States Agency for International Development (USAID) in 2025 in accordance with the recommendation of the [[Department of Government Efficiency (DOGE)]].</b>

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

PEPFAR (2025) has scrapped its ineffective and harmful "voluntary male medical circumcision" (VMMC) program after 15 years and at least 27,000,000 harmful and useless [[foreskin]] amputations.<ref name="gwarisa2025">{{REFnews

|last=~~The White House~~

|title=New PEPFAR Waiver Scraps Voluntary Medical Male Circumcision Program

|first=

|url=https://healthtimes.co.zw/2025/02/07/new-pepfar-waiver-scraps-voluntary-medical-male-circumcision-program/

|~~date~~=~~2010~~-~~10-01~~

|last=Gwarisa

|~~title~~=~~World AIDS Day at the White House~~

|first=Michael

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

|init=

|accessdate=~~2011~~-04-10

|author-link=

}}</ref> ~~Focus countries~~ have ~~been invited to request program funding to increase access to the procedure~~.

|publisher=Healthtimes

|website=

|date=2025-02-07

|accessdate=2025-02-15

|format=

|quote=

}}</ref> Numerous studies have demonstrated that [[adult circumcision]] is not effective in preventing [[HIV]] [[infection]].

PEPFAR ignominiously ended the provision of non-therapeutic circumcision of boys under age 15 in November 2019 due to significant abuses ~~and complications~~.

PEPFAR ignominiously ended the provision of non-therapeutic [[circumcision]] of boys under age 15 in November 2019 due to significant, [[Complication| complications]], injuries, and other abuses.

==Reimagining PEPFAR's Strategic Direction==

This document, ''Reimagining PEPFAR's Strategic Direction'', published in September 2022, provides new directions for PEPFAR's fight against the ''HIV'' pandemic. The document is entirely silent on male and female circumcision, although male circumcision was the cornerstone of the previous effort to prevent HIV infection and PEPFAR formerly proudly trumpeted the 32,000,000+ circumcisions (AKA genital mutilations) in Africa that it had sponsored. It is unclear if PEPFAR will continue to promote circumcision, which has been demonstrated to be ineffective.<ref name="reimagining2022">{{REFdocument

|title=Reimagining PEPFAR's Strategic Directio

|url=https://www.state.gov/wp-content/uploads/2022/09/PEPFAR-Strategic-Direction_FINAL.pdf

|contribution=

|last=

|first=

|publisher=U.S. Department of State

|format=PDF

|date=2022-09

|accessdate=2022-11-28

}}</ref>

<!--

== World AIDS Day (2010) Announcements ==

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

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

{{Citation

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}}

Note that the 60% is a relative risk reduction (absolute risk reduction 1.31%) during 18 months - not life-long.<ref name="boyle2011">{{BoyleGJ HillG 2011}}</ref>

Note that the 60% is a relative risk reduction (absolute risk reduction 1.31%) during 18 months - not life-long.<ref name="boyle2011">{{BoyleGJ HillG 2011}}</ref>-->

== Swaziland ==

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|date=2011-03-04

|publisher=Science Speaks: HIV & TB News

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

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

|accessdate=2011-05-06

}}</ref>

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

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

|last=

|first=

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}}

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

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

|last=

|first=

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== PEPFAR's African Safaris ==

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

From a blog.AIDS.gov entry by Jeffrey S. Crowley, {{MPH}}, Director, Office of National [[AIDS]] Policy dated 26 May 2011:<ref>{{REFweb

|last=

|first=

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...

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.

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.

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==RCTs shown to be erroneous==

Boyle & Hill (2011) established conclusively that the randomized controlled trials had disabling methodological and statistical flaws that invalidated their findings,<ref name="boyle2011" /> therefore the PEPFAR VMMC program is based on false information. [[Robert S. Van Howe|Van Howe]] & Storms (2011) correctly forecast that institution of a circumcision program would increase the number of [[HIV]] infections.<ref>{{REFjournal

Boyle & Hill (2011) established conclusively that the randomized controlled trials had disabling methodological and statistical flaws that invalidated their findings,<ref name="boyle2011">{{BoyleGJ HillG 2011}}</ref> therefore the PEPFAR VMMC program is based on false information. [[Robert S. Van Howe|Van Howe]] & Storms (2011) correctly forecast that institution of a circumcision program would increase the number of [[HIV]] infections.<ref>{{REFjournal

|last=Van Howe

|first=Robert S.

|init=

|init=RS

|author-link=Robert S. Van Howe

|last2=Storms

|first2=Michelle

|init2=

|init2=M

|author2-link=

|etal=no

|title=How the circumcision solution in Africa will increase HIV infections

~~|trans-title=~~

~~|language=~~

|journal=Journal of Public Health in Africa

|location=

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|DOI=10.4081/jphia.2011.e4

|accessdate=2021-02-16

}}</ref> PEPFAR, however, paid no attention to these warnings and continued to promote the harmful VMMC program.

}}</ref> [[Robert S. Van Howe|Van Howe]] & Boyle (2018) added further critical comment and suggested the possibility of fraud.<ref name="vanhowe2018">{{REFjournal

|last=Van Howe

|first=

|init=RS

|author-link=Robert S. Van Howe

|last2=Boyle

|first2=

|init2=GJ

|author2-link=Gregory J. Boyle

|etal=no

|title=Meta-analysis of HIV-acquisition studies incomplete and unstable

|journal=BJU Int

|date=2018-10-31

|url=https://www.bjuinternational.com/letters/meta-analysis-circumcision-incomplete-unstable/

|quote=Given the effectiveness of condoms, the lack of consistent findings on national levels, the methodologically flawed RCTs, the lack of translational research, and the impressive potential uptake and effectiveness of pre-exposure prophylaxis, circumcision as an intervention to prevent HIV infection should be treated with greater scepticism.

|pubmedID=

|pubmedCID=

|DOI=

|accessdate=2022-01-01

}}</ref>

PEPFAR, however, paid no attention to these warnings and continued to promote the harmful VMMC program.

== Investigations by the Office of Inspector General (OIG) ==

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{{Citation

|Title=

|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=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.

Our audit found that the Ministry did not always manage PEPFAR funds or meet program goals in accordance with award requirements. With respect to financial management, specifically financial transaction testing, we found that $3.7 million of the $4 million reviewed was allowable, but $243,000 was not. Additionally, the Ministry used PEPFAR funds to pay $565,000 of potentially unallowable value-added taxes (VAT) on purchases, did not accurately report PEPFAR expenditures for this cooperative agreement on its financial status report (FSR) submitted to CDC, and did not obtain an annual financial audit as required by Federal regulations.

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{{Citation

|Title=President's Emergency Plan for AIDS Relief Funds

|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.

|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.

|Author=

|Source=

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==Recent developments==

Garenne & Matthews (2019) reported that there is little difference in the incidence of [[HIV]] infection between circumcised men and intact men in Zambia. The authors stated that the "effectiveness of VMMC could therefore be seriously questioned."<ref name="garrenne2019">{{REFjournal

[[Michel Garenne|Garenne]] & Matthews (2019) reported that there is little difference in the incidence of [[HIV]] infection between [[circumcised]] men and [[intact]] men in Zambia. The authors stated that the "effectiveness of VMMC could therefore be seriously questioned."<ref name="garrenne2019">{{REFjournal

|last=Garenne

|first=Michel

|init=

|init=M

|author-link=

|author-link=Michel Garenne

|last2=Matthews

|first2=Alan

|init2=

|init2=A

|author2-link=

|etal=no

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</center>

<br>

[[George C. Denniston]], {{MD}}, {{MPH}}, the president of [[Doctors Opposing Circumcision (D.O.C.)~~| Doctors Opposing Circumcision~~]], in a letter to Ambassador Deborah L. Birx, {{MD}}, {{MPH}}, dated 29 June 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

[[George C. Denniston]], {{MD}}, {{MPH}}, the president of [[Doctors Opposing Circumcision (D.O.C.)]], in a letter to Ambassador Deborah L. Birx, {{MD}}, {{MPH}}, dated 29 June 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=Letter to Deborah L. Birx, M.D.

|url=https://pool.intactiwiki.org/images/2020-06-15b_LettertoPEPFAR.pdf

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|last=Denniston

|first=George C.

|publisher=Doctors Opposing Circumcision

|publisher=[[Doctors Opposing Circumcision (D.O.C.)]]

|format=

|date=2020-06-29

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|last=Gisselquist

|first=David

|init=D

|year=2021

|title= Stopping Bloodborne HIV: investigating unexplained infections

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}}</ref></blockquote>

[[George Hill]], CFI, ATR, acting for Doctors Opposing Circumcision, wrote to Deborah L. Birx on 28 January 2021 regarding her lack of action and to transmit a copy of the article by Fish et al. (2020).<ref name="hill2021">{{REFdocument

[[George Hill]], CFI, ATR, acting for [[Doctors Opposing Circumcision (D.O.C.)]], wrote to Deborah L. Birx on 28 January 2021 regarding her lack of action and to transmit a copy of the article by Fish et al. (2020).<ref name="hill2021">{{REFdocument

|title=Letter to Deborah L. Birx

|url=https://pool.intactiwiki.org/w/images/2021-01-28A_LetterBirx_516.pdf

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|last=Hill

|first=George

|publisher=Doctors Opposing Circumcision

|publisher=[[Doctors Opposing Circumcision (D.O.C.)]]

|format=PDF

|date=2021-01-28

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}}</ref>

== Population-based studies ==

==Two African surveys==

The previously reported studies were from developed Western nations. Now we have information from Sub_Saharan Africa.

French scientist [[Michel Garenne]], Ph.D. has published two reports in 2022 comparing the incidence of HIV infection in [[circumcised]] and [[intact]] men.

In his first report, Garenne presented the findings from a study in Lesotho, the enclave in South Africa. He reported:

In couple studies, the effect of circumcision and VMMC on HIV was not significant, with similar transmission from female to male and male to female. The study questions the amount of effort and money spent on VMMC in Lesotho.<ref name="garenne2022A">{{REFjournal

|last=Garenne

|first=Michel

|init=M

|author-link=Michel Garenne

|title=Changing relationships between HIV prevalence and circumcision in Lesotho

|url=https://pubmed.ncbi.nlm.nih.gov/35373731/

|date=2022-04-04

|journal=J Biosoc Sci

|volume=online ahead of print

|pages=1-16

|DOI=10.1017/S0021932022000153

|pubmedID=35373731

|accessdate=2022-11-04

}}</ref>

</blockquote>

In his second report, Garenne (2022) presented information from six Sub-Saharan African nations (Eswatini, Lesotho, Malawi, Namibia, Zambia, Zimbabwe). He reported:

"Results matched earlier observations made in South Africa that [[circumcised]] and [[intact]] men had similar levels of HIV infection."<ref name="garenne2022B">{{REFjournal

|last=Garenne

|first=Michael

|init=M

|author-link=

|etal=no

|title=Age-incidence and prevalence of HIV among intact and circumcised men: an analysis of PHIA surveys in Southern Africa

|trans-title=

|language=

|journal=J Biosoc Sci

|location=

|date=2022-10-26

|season=

|volume=

|issue=

|article=

|page=

|pages=1-13

|url=https://www.cambridge.org/core/journals/journal-of-biosocial-science/article/abs/ageincidence-and-prevalence-of-hiv-among-intact-and-circumcised-men-an-analysis-of-phia-surveys-in-southern-africa/CAA7E7BD5A9844F41C6B7CC3573B9E50

|archived=

|quote=

|pubmedID=36286328

|pubmedCID=

|DOI=10.1017/S0021932022000414

|accessdate=2022-11-04

}}</ref></blockquote>

* [[Centers for Disease Control|CDC]]

* [[Circumcision and HIV]]

* [[National Institutes of Health|NIH]]

* [[Stop the Cut]]

* [[World Health Organization]]

* [[USAID]]

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|url=https://foregen.webflow.io/commentarium-articles/international-contractors-are-profiteering-from-new-circumcision-devices

|title=International Contractors are Profiteering from New Circumcision Devices

|last=Foregen Staff

|last=[[Foregen]] Staff

|first=

|author-link=

|publisher=Foregen

|publisher=[[Foregen]]

|date=2021-03-08

|accessdate=2021-03-08

}}

* {{URLwebsite|https://www.state.gov/pepfar/|2021-12-31}}

~~[[Category:Programs]]~~

[[Category:Circumcision in Africa]]

[[Category:Fund]]

[[Category:Program]]

[[Category:Scandal]]

[[Category:From CircLeaks]]

@@ Line 1: / Line 1: @@
 [[Image:PEPFAR.png|right|thumb|PEPFAR]]
-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 $85 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.
+The '''President's Emergency Plan For AIDS Relief''' ('''PEPFAR''') was 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 on the advice of [[Anthony Fauci]], PEPFAR has provided more than $85 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. <b>PEPFAR was a failure and has now been terminated by the United States Government that eliminated the United States Agency for International Development (USAID) in 2025 in accordance with the recommendation of the [[Department of Government Efficiency (DOGE)]].</b>
-PEPFAR has begun providing money (United States tax dollars) for male circumcision programs.<ref>{{REFweb
+PEPFAR (2025) has scrapped its ineffective and harmful "voluntary male  medical circumcision" (VMMC) program after 15 years and at least 27,000,000 harmful and useless [[foreskin]] amputations.<ref name="gwarisa2025">{{REFnews
-  |last=The White House
+ |title=New PEPFAR Waiver Scraps Voluntary Medical Male Circumcision Program
-  |first=
+ |url=https://healthtimes.co.zw/2025/02/07/new-pepfar-waiver-scraps-voluntary-medical-male-circumcision-program/
-  |date=2010-10-01
+  |last=Gwarisa
-  |title=World AIDS Day at the White House
+  |first=Michael
-  |url=http://www.youtube.com/watch?v=60uUA0uGOkc#t=22m38s
+  |init=
-  |accessdate=2011-04-10
+ |author-link=
-}}</ref> Focus countries have been invited to request program funding to increase access to the procedure.
+  |publisher=Healthtimes
+  |website=
+ |date=2025-02-07
+  |accessdate=2025-02-15
+ |format=
+ |quote=
+}}</ref> Numerous studies have demonstrated that [[adult circumcision]] is not effective in preventing [[HIV]] [[infection]].
-PEPFAR ignominiously ended the provision of non-therapeutic circumcision of boys under age 15 in November 2019 due to significant abuses and complications.
+PEPFAR ignominiously ended the provision of non-therapeutic [[circumcision]] of boys under age 15 in November 2019 due to significant, [[Complication| complications]], injuries, and other abuses.
+==Reimagining PEPFAR's Strategic Direction==
+This document, ''Reimagining PEPFAR's Strategic Direction'', published in September 2022, provides new directions for PEPFAR's fight against the ''HIV'' pandemic. The document is entirely silent on male and female circumcision, although male circumcision was the cornerstone of the previous effort to prevent HIV infection and PEPFAR formerly proudly trumpeted the 32,000,000+ circumcisions (AKA genital mutilations) in Africa that it had sponsored. It is unclear if PEPFAR will continue to promote circumcision, which has been demonstrated to be ineffective.<ref name="reimagining2022">{{REFdocument
+ |title=Reimagining PEPFAR's Strategic Directio
+ |url=https://www.state.gov/wp-content/uploads/2022/09/PEPFAR-Strategic-Direction_FINAL.pdf
+ |contribution=
+ |last=
+ |first=
+ |publisher=U.S. Department of State
+ |format=PDF
+ |date=2022-09
+ |accessdate=2022-11-28
+}}</ref>
+<!--
 == World AIDS Day (2010) Announcements ==
@@ Line 33: / Line 52: @@
 }}
-==FACT SHEET: The Beginning of the End of AIDS 2011 ==
+== FACT SHEET: The Beginning of the End of AIDS 2011 ==
 {{Citation
@@ Line 42: / Line 61: @@
 }}
-Note that the 60% is a relative risk reduction (absolute risk reduction 1.31%) during 18 months - not life-long.<ref name="boyle2011">{{BoyleGJ HillG 2011}}</ref>
+Note that the 60% is a relative risk reduction (absolute risk reduction 1.31%) during 18 months - not life-long.<ref name="boyle2011">{{BoyleGJ HillG 2011}}</ref>-->
 == Swaziland ==
@@ Line 61: / Line 80: @@
   |date=2011-03-04
   |publisher=Science Speaks: HIV & TB News
-  |quote=The Ministry of Health, supported principally by UNICEF and PEPFAR, is currently working to introduce and scale up neonatal circumcision.
+  |quote=The Ministry of Health, supported principally by [[UNICEF]] and [[PEPFAR]], is currently working to introduce and scale up neonatal circumcision.
   |accessdate=2011-05-06
 }}</ref>
-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
+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
   |last=
   |first=
@@ Line 94: / Line 113: @@
 }}
-From the PEPFAR Blueprint: Creating an AIDS-free Generation (emphasis added):<REF>{{REFweb
+From the PEPFAR Blueprint: Creating an [[AIDS]]-free Generation (emphasis added):<REF>{{REFweb
   |last=
   |first=
@@ Line 130: / Line 149: @@
 == PEPFAR's African Safaris ==
-From a blog.AIDS.gov entry by Jeffrey S. Crowley, {{MPH}}, Director, Office of National AIDS Policy dated 26 May 2011:<ref>{{REFweb
+From a blog.AIDS.gov entry by Jeffrey S. Crowley, {{MPH}}, Director, Office of National [[AIDS]] Policy dated 26 May 2011:<ref>{{REFweb
   |last=
   |first=
@@ Line 144: / Line 163: @@
 ...
-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.
+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.
@@ Line 153: / Line 172: @@
 ==RCTs shown to be erroneous==
-Boyle & Hill (2011) established conclusively that the randomized controlled trials had disabling methodological and statistical flaws that invalidated their findings,<ref name="boyle2011" /> therefore the PEPFAR VMMC program is based on false information. [[Robert S. Van Howe|Van Howe]] & Storms (2011) correctly forecast that institution of a circumcision program would increase the number of [[HIV]] infections.<ref>{{REFjournal
+Boyle & Hill (2011) established conclusively that the randomized controlled trials had disabling methodological and statistical flaws that invalidated their findings,<ref name="boyle2011">{{BoyleGJ HillG 2011}}</ref> therefore the PEPFAR VMMC program is based on false information. [[Robert S. Van Howe|Van Howe]] & Storms (2011) correctly forecast that institution of a circumcision program would increase the number of [[HIV]] infections.<ref>{{REFjournal
   |last=Van Howe
   |first=Robert S.
-  |init=
+  |init=RS
   |author-link=Robert S. Van Howe
   |last2=Storms
   |first2=Michelle
-  |init2=
+  |init2=M
   |author2-link=
   |etal=no
   |title=How the circumcision solution in Africa will increase HIV infections
- |trans-title=
- |language=
   |journal=Journal of Public Health in Africa
   |location=
@@ Line 181: / Line 198: @@
   |DOI=10.4081/jphia.2011.e4
   |accessdate=2021-02-16
-}}</ref> PEPFAR, however, paid no attention to these warnings and continued to promote the harmful VMMC program.
+}}</ref> [[Robert S. Van Howe|Van Howe]] & Boyle (2018) added further critical comment and suggested the possibility of fraud.<ref name="vanhowe2018">{{REFjournal
+ |last=Van Howe
+ |first=
+ |init=RS
+ |author-link=Robert S. Van Howe
+ |last2=Boyle
+ |first2=
+ |init2=GJ
+ |author2-link=Gregory J. Boyle
+ |etal=no
+ |title=Meta-analysis of HIV-acquisition studies incomplete and unstable
+ |journal=BJU Int
+ |date=2018-10-31
+ |url=https://www.bjuinternational.com/letters/meta-analysis-circumcision-incomplete-unstable/
+ |quote=Given the effectiveness of condoms, the lack of consistent findings on national levels, the methodologically flawed RCTs, the lack of translational research, and the impressive potential uptake and effectiveness of pre-exposure prophylaxis, circumcision as an intervention to prevent HIV infection should be treated with greater scepticism.
+ |pubmedID=
+ |pubmedCID=
+ |DOI=
+ |accessdate=2022-01-01
+}}</ref>
+PEPFAR, however, paid no attention to these warnings and continued to promote the harmful VMMC program.
 == Investigations by the Office of Inspector General (OIG) ==
@@ Line 230: / Line 268: @@
 {{Citation
   |Title=
-  |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=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.
 Our audit found that the Ministry did not always manage PEPFAR funds or meet program goals in accordance with award requirements. With respect to financial management, specifically financial transaction testing, we found that $3.7 million of the $4 million reviewed was allowable, but $243,000 was not. Additionally, the Ministry used PEPFAR funds to pay $565,000 of potentially unallowable value-added taxes (VAT) on purchases, did not accurately report PEPFAR expenditures for this cooperative agreement on its financial status report (FSR) submitted to CDC, and did not obtain an annual financial audit as required by Federal regulations.
@@ Line 278: / Line 316: @@
 {{Citation
   |Title=President's Emergency Plan for AIDS Relief Funds
-  |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.
+  |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.
   |Author=
   |Source=
@@ Line 285: / Line 323: @@
 ==Recent developments==
-Garenne & Matthews (2019) reported that there is little difference in the incidence of [[HIV]] infection between circumcised men and intact men in Zambia. The authors stated that the "effectiveness of VMMC could therefore be seriously questioned."<ref name="garrenne2019">{{REFjournal
+[[Michel Garenne|Garenne]] & Matthews (2019) reported that there is little difference in the incidence of [[HIV]] infection between [[circumcised]] men and [[intact]] men in Zambia. The authors stated that the "effectiveness of VMMC could therefore be seriously questioned."<ref name="garrenne2019">{{REFjournal
   |last=Garenne
   |first=Michel
-  |init=
+  |init=M
-  |author-link=
+  |author-link=Michel Garenne
   |last2=Matthews
   |first2=Alan
-  |init2=
+  |init2=A
   |author2-link=
   |etal=no
@@ Line 343: / Line 381: @@
 </center>
 <br>
-[[George C. Denniston]], {{MD}}, {{MPH}}, the president of [[Doctors Opposing Circumcision (D.O.C.)| Doctors Opposing Circumcision]], in a letter to Ambassador Deborah L. Birx, {{MD}}, {{MPH}}, dated 29 June 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
+[[George C. Denniston]], {{MD}}, {{MPH}}, the president of [[Doctors Opposing Circumcision (D.O.C.)]], in a letter to Ambassador Deborah L. Birx, {{MD}}, {{MPH}}, dated 29 June 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=Letter to Deborah L. Birx, M.D.
   |url=https://pool.intactiwiki.org/images/2020-06-15b_LettertoPEPFAR.pdf
@@ Line 349: / Line 387: @@
   |last=Denniston
   |first=George C.
-  |publisher=Doctors Opposing Circumcision
+  |publisher=[[Doctors Opposing Circumcision (D.O.C.)]]
   |format=
   |date=2020-06-29
@@ Line 425: / Line 463: @@
   |last=Gisselquist
   |first=David
+ |init=D
   |year=2021
   |title= Stopping Bloodborne HIV: investigating unexplained infections
@@ Line 433: / Line 472: @@
   }}</ref></blockquote>
-[[George Hill]], CFI, ATR, acting for Doctors Opposing Circumcision, wrote to Deborah L. Birx on 28 January 2021 regarding her lack of action and to transmit a copy of the article by Fish et al. (2020).<ref name="hill2021">{{REFdocument
+[[George Hill]], CFI, ATR, acting for [[Doctors Opposing Circumcision (D.O.C.)]], wrote to Deborah L. Birx on 28 January 2021 regarding her lack of action and to transmit a copy of the article by Fish et al. (2020).<ref name="hill2021">{{REFdocument
   |title=Letter to Deborah L. Birx
   |url=https://pool.intactiwiki.org/w/images/2021-01-28A_LetterBirx_516.pdf
@@ Line 439: / Line 478: @@
   |last=Hill
   |first=George
-  |publisher=Doctors Opposing Circumcision
+  |publisher=[[Doctors Opposing Circumcision (D.O.C.)]]
   |format=PDF
   |date=2021-01-28
@@ Line 454: / Line 493: @@
 }}</ref>
+== Population-based studies ==
+{{Population-based studies}}
+==Two African surveys==
+The previously reported studies were from developed Western nations. Now we have information from Sub_Saharan Africa.
+French scientist [[Michel Garenne]], Ph.D. has published two reports in 2022 comparing the incidence of HIV infection in [[circumcised]] and [[intact]] men.
+In his first report, Garenne presented the findings from a study in Lesotho, the enclave in South Africa. He reported:
+<blockquote>
+In couple studies, the effect of circumcision and VMMC on HIV was not significant, with similar transmission from female to male and male to female. The study questions the amount of effort and money spent on VMMC in Lesotho.<ref name="garenne2022A">{{REFjournal
+ |last=Garenne
+ |first=Michel
+ |init=M
+ |author-link=Michel Garenne
+ |title=Changing relationships between HIV prevalence and circumcision in Lesotho
+ |url=https://pubmed.ncbi.nlm.nih.gov/35373731/
+ |date=2022-04-04
+ |journal=J Biosoc Sci
+ |volume=online ahead of print
+ |pages=1-16
+ |DOI=10.1017/S0021932022000153
+ |pubmedID=35373731
+ |accessdate=2022-11-04
+}}</ref>
+</blockquote>
+In his second report, Garenne (2022) presented information from six Sub-Saharan African nations (Eswatini, Lesotho, Malawi, Namibia, Zambia, Zimbabwe). He reported:
+<blockquote>
+ "Results matched earlier observations made in South Africa that [[circumcised]] and [[intact]] men had similar levels of HIV infection."<ref name="garenne2022B">{{REFjournal
+ |last=Garenne
+ |first=Michael
+ |init=M
+ |author-link=
+ |etal=no
+ |title=Age-incidence and prevalence of HIV among intact and circumcised men: an analysis of PHIA surveys in Southern Africa
+ |trans-title=
+ |language=
+ |journal=J Biosoc Sci
+ |location=
+ |date=2022-10-26
+ |season=
+ |volume=
+ |issue=
+ |article=
+ |page=
+ |pages=1-13
+ |url=https://www.cambridge.org/core/journals/journal-of-biosocial-science/article/abs/ageincidence-and-prevalence-of-hiv-among-intact-and-circumcised-men-an-analysis-of-phia-surveys-in-southern-africa/CAA7E7BD5A9844F41C6B7CC3573B9E50
+ |archived=
+ |quote=
+ |pubmedID=36286328
+ |pubmedCID=
+ |DOI=10.1017/S0021932022000414
+ |accessdate=2022-11-04
+}}</ref></blockquote>
 {{SEEALSO}}
 * [[Centers for Disease Control|CDC]]
 * [[Circumcision and HIV]]
 * [[National Institutes of Health|NIH]]
+* [[Stop the Cut]]
 * [[World Health Organization]]
 * [[USAID]]
@@ Line 473: / Line 567: @@
   |url=https://foregen.webflow.io/commentarium-articles/international-contractors-are-profiteering-from-new-circumcision-devices
   |title=International Contractors are Profiteering from New Circumcision Devices
-  |last=Foregen Staff
+  |last=[[Foregen]] Staff
   |first=
   |author-link=
-  |publisher=Foregen
+  |publisher=[[Foregen]]
   |date=2021-03-08
   |accessdate=2021-03-08
 }}
+* {{URLwebsite|https://www.state.gov/pepfar/|2021-12-31}}
 {{ABBR}}
 {{REF}}
-[[Category:Programs]]
 [[Category:Circumcision in Africa]]
+[[Category:Fund]]
+[[Category:Program]]
+[[Category:Scandal]]
 [[Category:From CircLeaks]]