Popping the Pepfar bubble

A Times article neglected to mention key criticisms of the president’s AIDS program.

By Paul Clement

» Discuss Article (8 Comments)

With nary a mention of the multitude of criticisms aimed at the President's Emergency Plan for AIDS Relief, or Pepfar, Edmund Sanders' article, "New life for African AIDS patients," sounds more like a presidential news release than an objective analysis.

The criticisms of Pepfar are numerous. For the first two years of the program, Bush blocked the procurement of most low-cost, generic fixed-dose combinations of antiretrovirals in favor of brand-name, multi-drug regimens that cost twice as much — thus lining the pockets of U.S. pharmaceutical companies instead of saving lives. Even though a generic antiretroviral was approved by the FDA in 2005 and made available for purchase through Pepfar, only 27% of the antiretrovirals purchased by Pepfar in the 2006 fiscal year were generic. In addition, the U.S. has attempted to block access to quality generics on the global market.

Pepfar requires that 33% of all prevention monies (including prevention of nonsexual transmission) and two-thirds of sexual-transmission funds be spent on abstinence and fidelity programs. Many of these programs are administered by "faith-based" organizations, typically evangelical Christian groups that promote "abstinence before marriage" and "being faithful" and downplay the use of condoms. This, combined with the Bush administration's go-it-alone approach and refusal to integrate with national AIDS prevention programs already in place, has essentially destroyed years of AIDS prevention work in several countries. Nowhere is this more apparent than in Uganda, where a highly successful AIDS prevention program that stressed the used of condoms had been in place since 1990. After Uganda accepted Pepfar funding in 2003, faith-based organizations undermined the country's condom program. As a result, millions of condoms sat in warehouses because they were not wanted. According to Dr. Kihumuro Apuuli, the director general of the Uganda AIDS Commission, since it adopted the program, the rate of new HIV infections almost doubled, from 70,000 in 2003 to 130,000 in 2005.

This is only a taste of the many criticisms of Pepfar. Not to mention any of them in the article is negligent. Pepfar has done much good, but it has accomplished only a fraction of its potential. Pepfar should not be used as platform for Christian groups to proselytize and attempt to impose their own view of morality on different cultures. It should not be used to transfer taxpayers' dollars to the pockets of pharmaceutical companies. We must cut the many strings attached to the program that hobble its effectiveness and bring the focus back to saving lives, not playing politics.

Paul Clement is a high school science teacher and edits a newsletter for parents of children with hemophilia.

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1. PEPFAR is up for reauthorization. Now is the time to improve PEPFAR and remove these restrictions and save the lives of tens of thousands of individuals. I urge everyone to call their congressman to support the “Lantos Bill” (officially known as the Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, or PEPFAR 2.), which will be introduced to the House of Representatives tomorrow, February 27th (and a different version in the Senate in a few months).
Submitted by: Paul Clement
10:17 PM PST, Feb 26, 2008

2. Continued... Restrictive PEPFAR rules ignore the reality on the ground. We advise married women to “be faithful”, ignoring the fact that in Uganda, 81% of the HIV positive women are infected by their husbands. (They need birth control and HIV prevention information, not preaching.) We prevent counselors from distributing any information about birth control and condoms to girls younger than 15, ignoring the fact that in Uganda, 51% of the girls are married before they reach the age to 18.
Submitted by: Paul Clement
10:16 PM PST, Feb 26, 2008

3. continued Our refusal to use any of the high quality, low cost, generic 3-in-1 antiretroviral drugs for the first two years of the PEPFAR program and our continued insistence on using primarily brand name multi-drug cocktails costing twice as much as the generic drugs reduces the availability of the treatments to tens of thousands—who will die without them. (Of course, President Bush’s decision to appoint former drug giant Eli Lilly CEO Randall Tobias to run PEPFAR has no influence on our insistence on lining the pockets of US pharmaceutical companies at the expense of lives.)
Submitted by: Paul Clement
10:14 PM PST, Feb 26, 2008

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