PEPFAR Is Still Without a Leader. H.I.V. Activists Want to Know Why.
The Biden administration has yet to appoint a leader for the Presidential Emergency Plan for AIDS Relief, a $ 7 billion program that sets priorities for the fight against AIDS around the world, leaving countries that receive program funds without counseling during a particularly severe pandemic for those with HIV
PEPFAR is headed by a Global AIDS Coordinator, a cabinet-level position that was last filled by Dr Deborah Birx. Dr Birx served from April 2014 until February 2020, when she left to join the White House Coronavirus Task Force. Dr Angeli Achrekar, an MP, has served as PEPFAR’s interim leader since President Biden took office.
Global health experts have sharply criticized the delay in appointing a permanent chief. “Can’t we think about and act on two pandemics at the same time? asked Gregg Gonsalves, longtime HIV activist and epidemiologist at the Yale School of Public Health.
PEPFAR was launched in 2003 by President George W. Bush and has enjoyed bipartisan support ever since. Funds distributed by PEPFAR are used to support prevention and treatment programs, including voluntary male circumcision, as well as HIV testing and provision of antiretroviral therapy to people of all ages.
It is widely regarded as the most successful global health program. Since its inception, the U.S. government has invested more than $ 85 billion in more than 60 countries, saving an estimated 20 million lives.
“PEPFAR is an example of what can be done when you combine diplomacy and global health,” said Dr Carlos del Rio, infectious disease expert at Emory University in Atlanta and chair of the PEPFAR Science Advisory Board. “All over Africa, they love and respect the United States because of PEPFAR. “
Last week, a group of more than 50 advocacy organizations sent a letter to Biden, urging him to “immediately appoint a bold, creative and qualified leader” for PEPFAR. “This is unacceptable, especially at a time of dueling HIV and Covid-19 pandemics,” they wrote.
The White House did not respond to a request for comment.
The coronavirus pandemic has disrupted access to HIV prevention, diagnosis and treatment, as well as supply chains for condoms, lubricants and antiretroviral drugs, according to a recent UNAIDS report.
And the pandemic has reversed hard-won progress in ending HIV, including a 23% annual drop in new infections since 2010.
Inertia in appointing a leader is particularly damaging “when more leadership, ambition and governance are badly needed to guide global efforts to catch up on the HIV response,” said Suraj Madoori, director of the Treatment Action Group, an advocacy organization. based in New York.
A new study published last week showed that people living with HIV have an increased risk of serious illness and death from Covid-19. The coronavirus pandemic could also benefit from the health care infrastructure put in place to provide services for HIV, experts noted.
“There are a lot of things that can happen now, using the PEPFAR structure to take on Covid in these countries,” Dr del Rio said.
“Not taking advantage of the PEPFAR infrastructure – I think it’s crazy, it’s a huge missed opportunity,” he added. “This administration has been in existence for six months. Why haven’t we named them?
Dr del Rio said the head of PEPFAR has been conspicuously absent from global conversations, including a recent UN resolution to end AIDS by 2030, and efforts to enable PEPFAR sites to respond to the call. coronavirus pandemic. It is also important for the head of PEPFAR to defend the program when budget budgets are allocated, added Dr del Rio: “I almost feel that the program is basically at a standstill.
The lack of an American voice is also having a ripple effect on many issues in African countries, said Richard Lusimbo, program director at Pan Africa ILGA in Uganda. Basic programs for key populations like LGBTQ people have been cut in several countries since the start of the Biden administration. In Côte d’Ivoire, for example, the budget for services to key populations has been halved.
In Kenya, a dispute between his government and the US Agency for International Development has resulted in a shortage of antiretroviral drugs. A permanent PEPFAR leader with political power could have resolved this dispute, said Lusimbo.
Mr. Biden appointed Samantha Power as head of USAID on January 13, even before taking office. And last week, the White House announced candidates for seven more positions.
For weeks, the HIV community learned that the administration was planning to lead PEPFAR to five global health experts: Shannon Hader, Charles Holmes, Chris Beyrer, Vanessa Kerry and Paul Farmer. But no candidate has emerged as a favorite.
“Unfortunately, we are seeing the lack of global support for the Covid-19 response in Africa, the AIDS response is weakening and it is not clear who the head of the US government is on this,” Lusimbo said. . “Does the administration not understand that, for our communities, the response to AIDS and the response to Covid-19 are closely linked?
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