under the direct authority of the newly established U.S. Global AIDS Coordinator, along with “other countries designated by the President.”18 The 14 countries had been previously chosen for the Mother-and-Child HIV Prevention Initiative, and these countries were among those with the highest HIV prevalence rates at the time and were home to nearly 70 percent of those living with HIV in Africa and the Caribbean (White House Office of the Press Secretary, 2003). The implementation of PEPFAR was focused on these countries as well as Vietnam, which was added subsequent to the legislation. Most of the investment was concentrated in these 15 “focus” countries, which together had HIV/AIDS burdens that accounted for more than 50 percent of global HIV prevalence (Goosby et al., 2012).

The reauthorization legislation in 2008 specified that in designating additional countries for this direct authority, priority should be given to “those countries in which there is a high prevalence of HIV or risk of significantly increasing incidence of HIV within the general population and inadequate financial means within the country.”19 Those countries with the highest levels of investment that are under the direct authority of OGAC submit COPs to OGAC. Over time the COP countries—and, in a few cases, coordinated regions—have expanded from the original focus countries. At the time of the planning of this evaluation, there were 31 individual countries submitting COPs; these countries comprise the major focus of the committee’s assessment.

To gain a more detailed understanding of the characteristics of these countries, the committee chose to examine how PEPFAR funding, as reflected in the total annual planned/approved funding reported by OGAC in the annual PEPFAR Operational Plans, is distributed using specific metrics for these 31 partner countries. As described in the sections that follow, in order to examine PEPFAR funding by the severity of the epidemic, the committee calculated summary statistics for three groups of countries based on HIV prevalence in 2009 as well as average PEPFAR funding per person living with HIV (PLHIV) from FY 2005 to FY 2011. Because low-income countries are most in need of external assistance with HIV/AIDS epidemics, the committee also looked at PEPFAR funding to countries by income level. As described previously, complete and consistent data sources across countries are not available to reflect internal resources for the HIV response in partner countries; as a result, this was not included in this analysis despite being one of the criteria for prioritization in the legislation. Chapter 9 provides a more thorough discussion of domestic financing for national HIV/AIDS responses and the implications of these data limitations.

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18Supra, note 7 at img102(a)(2), 22 U.S.C. 2651a(f)(2)(B)(ii)(VII).

19Supra, note 9 at img102(2)(E)(iii), 22 U.S.C. 2651a(f)(2)(B)(ii)(IX).



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