Recommendations Discussed in This Chapter

Recommendation 3-1: To support country leadership, the U.S. Global AIDS Coordinator should seek to identify and remove barriers to coordination with partner governments and other donors, with a particular focus on promoting transparency and participation throughout the annual planning process.

Recommendation 3-2: The commitment of the U.S. Global AIDS Initiative to work toward reducing stigma and discrimination against people living with HIV/AIDS requires that marginalized and difficult-to-reach groups receive prevention, treatment, and care services. These groups include sex workers, prisoners, those who use injecting drugs, and men who have sex with men—groups that not only are characterized by their high-risk behavior, but also tend to be stigmatized and subject to discrimination. The U.S. Global AIDS Coordinator should document how these groups are included in the program planning, implementation, and evaluation of PEPFAR activities.

Recommendation 3-3: Although they may have been helpful initially in ensuring a balance of attention to activities within the four categories of prevention, treatment, care, and orphans and vulnerable children, the Committee concludes that rigid congressional budget allocations among categories, and even more so within categories, have also limited PEPFAR’s ability to tailor its activities in each country to the local epidemic and to coordinate with the level of activities in the countries’ national plans. Congress should remove the budget allocations and replace them with more appropriate mechanisms that ensure accountability for results from Country Teams to the U.S. Global AIDS Coordinator and to Congress. These mechanisms should also ensure that spending is directly linked to and commensurate with necessary efforts to achieve both country and overall performance targets for prevention, treatment, care, and orphans and other vulnerable children.