# Presentation: 436480

## The President’sEmergency Plan for AIDS ReliefPresident’s Advisory Council on HIV/AIDSMarch 17, 2006

**William R. Steiger, Ph.D.**
- Special Assistant to the Secretary for International Affairs
- Director,
- Office of Global Health Affairs
- Department of Health and Human Services

## The President’s Emergency Plan

- Five-year, $15 billion initiative to provide prevention, care and treatment for HIV/AIDS
- “2-7-10” targets in 15 focus countries
- Expansion of policies past 15 focus countries
- Bilateral and multilateral components
- Select policy issues
- Upcoming work

**Notes:**
In the 2003 State of the Union Address, President Bush declared that the nation would meet the severe and urgent crisis abroad and would lead the world in turning the tide against HIV/AIDS

## The Focus Countries

- Focus on 15 most heavily impacted countries in the world with approximately 50% of all HIV infections worldwide

- The U.S. goals include support for:

-  Treatment of _2 million_ HIV-infected people

- Care for _10 million_ people infected with and affected by HIV/AIDS, including orphans and vulnerable children

-  Prevention of _7 million_ new infections

## PEPFAR Worldwide Activities

## Recent USG Spending on International HIV/AIDS

- FY 2001 - $844 million
- FY 2002 - $1.2 billion
- FY 2003 - $1.6 billion
- FY 2004 - $2.4 billion (first Emergency Plan year)
- FY 2005 - $2.8 billion
- FY 2006 - $3.3 billion
- FY 2007 - $4.0 billion *(Requested)*

## New Way of Doing Business

- One integrated USG bilateral program:
- 	Department of State, Department of Defense, Department of Commerce, Department of Labor, Department of Health and Human Services [Including CDC, FDA, NIH, and Health Resources and Services Administration (HRSA)], U.S. Agency for International Development, Peace Corps
- Results oriented
- Network Model
- 	Promotes linkages between prevention, treatment and care
- Guiding principle that success is dependant on building local capacity and leveraging all sectors of society

## Global AIDS Coordinator: New leadership model

- Lead USG international HIV/AIDS efforts
- Ensure USG program and policy coordination
- Pursue coordination with other countries and international organizations
- Resolve policy, program and funding issues among USG agencies
- Directly approve all USG focus country HIV/AIDS activities
- Promote accountability and monitor progress toward meeting Emergency Plan goals
- Divisions:
- Program Services, Strategic Information, Congressional Affairs, Diplomatic Liaison, Public Private Partnerships and Public Affairs

## Overall Coordination

_**In-Country Partners**_
- 	Donors
- 	Implementing partners
- 	Other stakeholders

- 	_**USG Team**_
*U.S. Ambassador*
- Embassy staff
- HHS
- USAID
- DoD
- DoL
- DoC
- Peace Corps

_**Headquarters**_
- 	*Ambassador Tobias*
- 	Principals
- 	Deputy Principals
- 	Core teams
- 	Technical Working  Groups
- 	Agency Support

- Host Government

## In-Country Team

- Led by the U.S. Ambassador
- All U.S. agencies in-country represented
- Frequently works with a host government steering committee
- One program, one reporting system
- Supported by a headquarters core team
- Collaboration with country leadership and other donors/partners, support for “Three Ones”

## Interagency TWGs

- Care and Treatment
- PMTCT/Pediatric AIDS
- TB/HIV
- Palliative Care
- Adult Treatment
- Prevention
- ABC (including youth)
- Populations at increased Risk
- Medical Transmission
- Counseling and Testing
- IDUs

- Orphans and Vulnerable Children
- Human Capacity Development
- Strategic Information
- Management and Staffing
- Faith Based Organizations
- Procurement
- Food
- Gender

## 2005 Spending for Prevention, Treatmentand Care in Focus Countries

- 2005 Spending for Prevention, Treatmentand Care in Focus Countries

## Total Amount Requested per Implementing Agency, FY2005 & FY2006

- Total requested: $1,032,386,758

- Total requested: $1,225,709,100

- Does not include headquarters funding

## HHS in the Emergency Plan 

- Centers for Disease Control and Prevention
- Health Resources and Services Administration
- National Institutes of Health
- Food and Drug Administration
- Substance Abuse and Mental Health Services Administration
- Office of Global Health Affairs

## Program Results To Date

** **Treatment for 471,000 people
-  PMTCT services for over 1.9 million women
-  Community outreach activities to over 42 million people to prevent sexual transmission of HIV
-  Care for over 1.2 million orphans and vulnerable children
-  Care for over 1.7 million people living with HIV/AIDS, including over 368,000 who received care and treatment for tuberculosis

- From:  Second Annual Report to Congress, February 8, 2006

**Notes:**
These results are from the Second Annual Report to Congress, released February 8, 2006 (yesterday).

## Bilateral Projects in Over 120 Nations

- The U.S. is devoting $15 billion over five years to ongoing bilateral programs in more than 120 countries:
- 10 billion in focus countries
-  4 billion in other PEPFAR countries
-  1 billion for Global Fund
- Changes to bilateral programs outside the 15 focus:
- Five countries over $10 million
- One USG team
- Strategy and modified “COP”
- India, Russia, Cambodia, Malawi & Zimbabwe
- Six countries receiving between $5 million and $10 million
- One USG team
- Strategy
- Lesotho, Swaziland, Senegal, Dominican Republic, China, Democratic Republic of Congo

## Increasing Linkage BetweenBilateral and Multilateral Aid 

- The U.S. is the largest contributor to the Global Fund
- Five percent of FY05 contribution (about $12 million) may be used for technical assistance to Global Fund grantees
- U.S. participation in Global Fund CCMs is increasing
- U.S. is chair of the Global Fund Policy Sub-Committee

## Select Policy Issues 

- Prostitution and Sex Trafficking
- “ABC”/Condoms
- Male Circumcision

## The US Leadership Against HIV/TB and Malaria Act of 2003 mandates that ‘no funds made available to carry out this Act...may be used to promote or advocate the legalization or practice of prostitution or sex trafficking. ‘ 

Immediately thereafter, the law clarifies that “nothing in the preceding sentence shall be construed to preclude the provision to individuals of palliative care, treatment, or post-exposure prophylaxis, and necessary pharmaceuticals and commodities, including test kits, condoms, and when proven effective, microbicides”

- Immediately thereafter, the law clarifies that *“nothing in the preceding sentence shall be construed to preclude the provision to individuals of palliative care, treatment, or post-exposure prophylaxis, and necessary pharmaceuticals and commodities, including test kits, condoms, and when proven effective, microbicides*”

- Prostitution and Sex Trafficking

## ABC and the President’s Emergency Plan

- ABC and the President’s Emergency Plan

- Earmark: Prevention _<_ 20% of country budget, with 50% of that on sexual prevention, and 66% of sexual prevention on AB/Y interventions
- Increased role for the B, along with both A or C
- Condoms remain a part of prevention strategy
- Allows support for national strategies of host nations

## USG Total Condoms Shippedto Focus Countries, 2001 & 2005

**Notes:**
This slide counters the common misconception that USG support for condoms has decreased.

## Male Circumcision and HIV, Africa

**High (>80%) male circumcision**

**Low (<20%) male circumcision**

## Male Circumcision and HIV, Asia

**0**

**1**

**2**

**3**

**Cambodia**

**Thailand**

**Burma**

**India**

**PNG**

**Vietnam**

**China**

**Fiji**

**Indonesia**

**Philippines**

**Pakistan**

**Bangladesh**

**Low (<20%) male circumcision**

**High (>80%) male circumcision**

**2.6**

**0**

**1.5**

**1.2**

**0.91**

**0.60**

**0.30**

**0.1**

**0.1**

**0.1**

**0**

## Male CircumcisionRandomized, Controlled Trials

- 			            _South Africa_	  _Uganda_	_Kenya_
- Trial setting        	Semi-urban	   Rural 		Urban
- Study sites		3 Clinics	 Community     1 Clinic
- Circumcision (%)   	 ~20%		   16%		 <10%
- Enrollment		3,520	  	  5,000		2,784
- Surgeons		General 	Surgeons	Medical					practitioners			officers
- Result			0.85 inf/100py	Completion	Completion				versus		in 2007		in 2007
- 				2.1 inf/100py
- 				(60% protection)

## Upcoming Work

- Continued emphasis on “Three Ones”
- Focus on quality
- Work toward greater interagency collaboration and efficiency
- These and other issues to be discussed at annual implementers meeting in Durban, SA, June 11-15
**For annual report and further information, please visit:**
- _[www.](http://www.pepfar.gov/)__[pepfar](http://www.pepfar.gov/)__[.](http://www.pepfar.gov/)__[gov](http://www.pepfar.gov/)_
**For FDA ARV approvals:**
**http://www.fda.gov/oia/pepfar.htm**