prevention messages compared to the coverage and reach for the amount of funding supporting individual treatment activities:

So we would rather have, it’s more sustainable to have prevention than treatment. And prevention is cheaper. Prevention is much, much cheaper than treatment. You talk about messages on TV, messages on radio [. . .] But you do that one message for $8,000, you reach the 7 million, 15 million people, I mean, 13 million people in [this country] by one message, for $1,000. But you procure ARVs for a thousand dollars that don’t reach that number of people. And they need such procurements every other time. So prevention to sustain this one is a key issue.” (934-12-CCM)

The most frequently repeated concern, across most countries by all types of stakeholders and across multiple interviews in a country, was how inadequate supply chain management could have crippling effects on all programming, but particularly on prevention programs without a continued supply of condoms, test kits, reagents, and circumcision kits (636-16-USG; 636-19-USNGO; 166-5-USG; 166-13-PCGOV; 396-12-USG; 934-45-USNGO; 934-18-PCGOV; 934-39-PCGOV; 116-18-PCNGO; 542-8-USNGO):

There are [national] condom manufacturers and with donors leaving, having a huge number of free condoms or even socially marketed condoms is just completely unsustainable. So we’re really working now towards trying to stimulate [this country’s] condom market to get them to be a lot more engaged. It turns out that there [. . .] I know there’s about 300 different brands of condoms. A lot of them—even within the price range of the socially marketed condoms available.” (396-12-USG)

The Integration of PEPFAR and Other U.S. Programs

Though the committee was not tasked with evaluating the Global Health Initiative (GHI), it is at least important to acknowledge this initiative, which was launched by President Obama in May 2009. PEPFAR is reported to serve as a central part of the GHI as the largest U.S. bilateral health program, affording a “forum for interface between PEPFAR and other U.S. programs in strengthening health systems, improving monitoring and evaluation, adopting a woman and girl-centered approach to health and gender equity, and integrating across health and development programs” (Goosby et al., 2012a, p. S53).

[OGAC] is responsible for the policy priorities of this program, but OGAC does not work in isolation and you know there’s a



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