services for approximately 4.5 million adults, orphans, and other vulnerable children; training in HIV/AIDS care and support services for well over a million people, including physicians, nurses, clinical officers, pharmacists, laboratory workers, epidemiologists, community workers, teachers, midwives, birth attendants, and traditional healers; and expansion and strengthening of clinical laboratories, supply chain management systems, blood supply systems, safe medical practices, and monitoring and evaluation systems (OGAC, 2005a, 2006a, 2007). Although data are not yet available with which to determine the quality or impact of these services, the Committee believes this substantial expansion of services represents inroads into the HIV/AIDS epidemics in the focus countries. Although data are not yet available to determine the quality or impact of these services, the Committee believes that this substantial expansion of services represents significant inroads into the HIV/AIDS epidemics in the focus countries.

Transition from Emergency to Sustainability Is Critical for Success

In 2003, when the U.S. Congress passed the landmark Leadership Act, it was widely recognized that the HIV/AIDS pandemic in developing countries had reached crisis proportions and had to be addressed urgently. According to the Leadership Act:

Congress recognizes that the alarming spread of HIV/AIDS in countries in sub-Saharan Africa, the Caribbean, and other developing countries is a major global health, national security, development, and humanitarian crisis. (p. 728)

A previous Institute of Medicine (IOM) committee that examined the issues surrounding scale-up of ART at the start of PEPFAR urged that “ART scale-up in resource-constrained settings worldwide must proceed immediately.” The committee detailed the challenges involved, but stated:

Recognizing these challenges, there remains an urgency to provide ART as rapidly as is feasible in order to extend the duration of as many lives as possible and reverse the course of social collapse in many countries heavily afflicted by HIV/AIDS. (IOM, 2005, p. 3)

In keeping with global consensus, congressional mandate, and expert opinion, OGAC characterized its strategy as an “emergency plan” and has implemented PEPFAR accordingly. A study by the Center for Strategic and International Studies issued shortly after publication of the PEPFAR strategy asserted that the ultimate success of PEPFAR would be judged in large part by the speed of its response; highlighted several “impressive, early, and accelerated steps taken to create and begin PEPFAR”; and made many recommendations for enhancing the capacity of the U.S. Global AIDS Coordinator (the Coordinator) to continue to implement the initiative rapidly and effectively (Nieburg et al., 2004, p. 3).



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