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The '''President's Emergency Plan for AIDS Relief''' (PEPFAR) has begun providing money (United States tax dollars) for male circumcision programs.<ref>{{REFweb
| last=The White House | first= | yeardate=2010-10-01 | title=World AIDS Day at the White House | url=http://www.youtube.com/watch?v=60uUA0uGOkc#t=22m38s | accessdate=2011-04-10
}}</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 name='Medical%2525252525252520News%2525252525252520TODAY%25252525252525202007-08-22'>{{REFweb
| last=Medical News TODAY | first= | yeardate=2007-08-22 | title=PEPFAR To Begin Providing Funds For Male Circumcision Programs In Some African Countries, Officials Say | url=http://www.medicalnewstoday.com/articles/80219.php | accessdate=2011-03-30
}}</ref>
{{Citation
| Title=PEPFAR Press Conference | 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 [...] | Author= | Source=The White House | ref=<ref>[http://www.youtube.com/watch?v=60uUA0uGOkc#t=22m38s ''World AIDS day at the White House.'' (2010)]</ref>
}}
{{Citation
| Title=PEPFAR Press Conference | Text=Here's some concrete things I think we need to do. Anything that happens to black men affects black women. <small><small>[...]</small></small> Circumcision. We need to make sure circumcision is paid for. We clearly need to reimburse circumcision of male infants. About 3/4 of black men in the U.S. are already circumcised, I mean, this is clearly an issue. | Author= | Source=The White House | ref=<ref>[http://www.youtube.com/watch?v=60uUA0uGOkc#t=48m48s ''World AIDS day at the White House.'' (2010)]</ref>
}}
{{Citation
| 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. | Author= | Source=The White House | ref=<ref>[http://www.whitehouse.gov/the-press-office/2011/12/01/fact-sheet-beginning-end-aids FACT SHEET: The Beginning of the End of AIDS 2011]</ref>
}}
Note that the 60% is a relative risk reduction (absolute risk reduction 1.31%) during 18 months - not life-long.<ref>{{REFweb
| last= | first= | yeardate=2011 | title=Boyle, GJ and Hill, G. Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns | url=http://www.salem-news.com/fms/pdf/2011-12_JLM-Boyle-Hill.pdf | accessdate=2012-12-29
}}</ref>
President Obama commemorated World AIDS Day by stepping up America’s commitment to the fight against AIDS, both domestically and internationally. In addition to his broad rhetoric on the importance — and feasibility — of ending AIDS, he made a number of specific commitments. The US will (among other commitments) provide support for more than 4.7 million voluntary medical male circumcisions in Eastern and Southern Africa over the next two years.<REF>{{REFweb
| last= | first= | yeardate=2011-12-01 | title=President Obama announces bold new AIDS commitments | url=http://www.one.org/us/2011/12/01/president-obama-announces-bold-new-aids-commitments/ | accessdate=2012-12-29
}}</ref>
== Swaziland ==
PEPFAR is helping fund the "Accelerated Saturation Initiative", a program to circumcise 80% of the men ages 18 to 49 within the year 2011.<ref>{{REFnews
| last=Mazzotta | first=Meredith | coauthors= | url=http://sciencespeaksblog.org/2011/03/04/swaziland-embarks-on-ambitious-plan-to-circumcise-80-percent-of-men-18-to-49-this-year/ | title=Swaziland embarks on ambitious plan to circumcise 80 percent of men 18 to 49 this year | date=2011-03-04 | publisher=Science Speaks: HIV & TB News | quote=Much attention has been paid to the launch of an aggressive medical male circumcision (MC) campaign in Swaziland that starts this month, a program aiming to circumcise 80 percent of the small nation’s men aged 18-49 by the year’s end with significant support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program. | accessdate=2011-05-06
}}</ref> Additionally, it is working with the Swaziland Ministry of Health to introduce and scale up neonatal circumcision.<ref>{{REFnews
| last=Mazzotta | first=Meredith | coauthors= | url=http://sciencespeaksblog.org/2011/03/04/swaziland-embarks-on-ambitious-plan-to-circumcise-80-percent-of-men-18-to-49-this-year/ | title=Swaziland embarks on ambitious plan to circumcise 80 percent of men 18 to 49 this year | 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. | accessdate=2011-05-06
}}</ref>
"Typically, USAID’s policy is to circumcise males between the ages of 15 to 49, as one part of a comprehensive HIV/AIDS program. However, with encouragement from PEPFAR, the Raleigh Fitkin Memorial Hospital in Manzini, has led the way on infant circumcision, circumcising all male children born at the hospital since 2009 unless the parents opt out. This is a health facility delivering 8,000 babies a year where half of the women are HIV-positive). Prevention of mother to child transmission is now complemented with infant circumcision."<REF>{{REFweb
| last= | first= | yeardate=2011-11-14 | title=The PEFPAR ripple effect | url=http://www.one.org/us/2011/11/14/the-pepfar-ripple-effect/ | accessdate=2012-12-29
}}</ref>
From the PEPFAR Swaziland Operational Plan Report FY 2011 (emphasis added):<REF>{{REFweb
| last= | first= | yeardate=2012-10-03 | title=PEPFAR Swaziland Operational Plan Report FY 2011 | url=http://www.pepfar.gov/documents/organization/199708.pdf | accessdate=2012-11-19
}}</ref>
{{Citation
| Text=4. Women and girl-centered Approach: ...'''Neonatal circumcision''' counseling for women who give birth to baby boys will be included in the nationwide campaign. | Author= | Source=
}}
From the PEPFAR Blueprint: Creating an AIDS-free Generation (emphasis added):<REF>{{REFweb
| last= | first= | yeardate=2012-11-30 | title=PEPFAR Blueprint: Creating an AIDS-free Generation | url=http://www.pepfar.gov/documents/organization/201386.pdf | accessdate=2012-12-30
}}</ref>
{{Citation
| Text=Action Step: Increase the number of males who are circumcised for the prevention of HIV....
10. Build the capacity of partner governments to begin planning for and financing an integrated, long-term '''early infant male circumcision (EIMC)''' program as the adult V[oluntary ]M[edical ]M[ale ]C[ircumcision] program is being scaled-up. PEPFAR’s financial support is prioritized to the adult VMMC program. However, '''once the adult program has progressed sufficiently, PEPFAR funds may be used to support EIMC activities'''.
| Author= | Source=
}}
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
| last= | first= | yeardate=May 2011 | title=My Visit to Swaziland: The Country with the World’s Highest HIV Prevalence Rate | url=http://blog.aids.gov/2011/05/my-visit-to-swaziland-the-country-with-the-world%E2%80%99s-highest-hiv-prevalence-rate.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+aids%2Fgov+%28Blog.AIDS.gov%29 | accessdate=2011-10-17
}}</ref>
{{Citation
| 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.
...
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.
| Author= | Source=
}}
On the 15 June 2011, the OIG published a report critical of the Centers for Disease Control and Prevention's (CDC's) failure to oversee recipients’ use of PEPFAR funds.<ref>{{REFweb
| last= | first= | yeardate=June 2011 | title=Review of the Centers for Disease Control and Prevention’s Oversight of the President’s Emergency Plan for AIDS Relief Funds for Fiscal Years 2007 Through 2009 (A-04-10-04006) | url=http://oig.hhs.gov/oas/reports/region4/41004006.pdf | accessdate=2011-06-25
}}</ref> The report read in part:
{{Citation
| 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.
There was evidence that CDC performed some monitoring of recipients’ use of PEPFAR funds. However, most of the award files did not include all required documents or evidence to demonstrate that CDC performed required monitoring on all cooperative agreements. Of the 30 cooperative agreements in our sample, the award file for only 1 agreement contained all required documents. The remaining 29 award files were incomplete. In addition, 14 of 21 files were missing audit reports. (A report was not yet due for 9 of the 30 cooperative agreements.) The lack of required documentation demonstrates that CDC has not exercised proper stewardship over Federal PEPFAR funds because it did not consistently follow departmental and other Federal requirements in monitoring PEPFAR recipients.
| Author= | Source=
}}
On the 19 November 2012, the OIG published a report critical of the CDC Namibia Office's failure to properly monitor recipients' use of PEPFAR funds <ref>{{REFweb
| last= | first= | yeardate=November 2012 | title=The Centers for Disease Control and Prevention's Namibia Office Did Not Always Properly Monitor Recipients' Use of the President's Emergency Plan for AIDS Relief Funds (A-04-12-04020) | url=https://oig.hhs.gov/oas/reports/region4/41204020.pdf | accessdate=2012-12-07
}}</ref>. The report read in part:
{{Citation
| Text=CDC's office in Windhoek, Namibia (CDC Namibia), is responsible for PEPFAR funds awarded to government agencies and for-profit and nonprofit organizations (recipients) in Namibia.
Our audit found that CDC Namibia did not always monitor recipients' use of PEPFAR funds in accordance with HHS and other Federal requirements. There was evidence that CDC Namibia performed some monitoring of recipients' use of PEPFAR funds. However, most of the recipient cooperative agreement files did not include required documents or evidence that CDC Namibia had monitored all cooperative agreements. CDC Namibia did not consistently monitor the cooperative agreements in accordance with HHS and other Federal requirements because it did not have written policies and procedures for the monitoring process. As a result, CDC Namibia did not have assurance that PEPFAR funds were used as intended by law.
| Author= | Source=
}}
On the 4 February 2013, the OIG published a report critical of Namibia's Ministry of Health and Social Services failure to manage PEPFAR funds and meet program goals in accordance with award requirements <ref>{{REFweb
| last= | first= | yeardate=February 2013 | title=The Republic of Namibia, Ministry of Health and Social Services, Did Not Always Manage the President’s Emergency Plan for AIDS Relief Funds or Meet Program Goals in Accordance With Award Requirements (Audit A-04-12-04019 | url=https://oig.hhs.gov/oas/reports/region4/41204019.pdf | accessdate=2013-02-04
}}</ref>. The report read in part:
{{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.
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.
(3) Obtained an annual financial audit and submitted the report as required by Federal regulations.
| Author= | Source=
}}
On the 12 February 2013, the OIG published a report critical of the CDC South Africa Office's failure to properly monitor recipients' use of PEPFAR funds <ref>{{REFweb
| last= | first= | yeardate=February 2013 | title=The Centers for Disease Control and Prevention's South Africa Office Did Not Always Properly Monitor Recipients' Use of the President's Emergency Plan for AIDS Relief Funds (Audit A-04-12-04022) | url=http://oig.hhs.gov/oas/reports/region4/41204022.pdf | accessdate=2013-02-27
}}</ref>. The report read in part:
{{Citation
| Title= | Text=Our audit found that CDC South Africa did not always monitor recipients' use of PEPFAR funds in accordance with HHS and other Federal requirements. There was evidence that CDC South Africa performed some monitoring of recipients' use of PEPFAR funds. However, most of the recipient cooperative agreement files did not include required documents or evidence that CDC South Africa had monitored all cooperative agreements.
CDC South Africa did not have written policies and procedures to help ensure that it consistently monitored the cooperative agreements for recipients in accordance with HHS and other Federal requirements. As a result, CDC South Africa did not have assurance that PEPFAR funds were used as intended by law.
| Author= | Source=
}}
From "Spotlight on... Grants Management and Oversight" published by the OIG on 4 February 2013:<ref>{{REFweb
| last= | first= | yeardate=February 2013 | title=Spotlight on... Grants Management and Oversight | url=https://oig.hhs.gov/newsroom/spotlight/2013/grants.asp | accessdate=2013-02-04
}}</ref>
{{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. | Author= | Source=
}}