Researchers Eran Bendavid, MD, and Jayanta Bhattacharya, MD, PhD, from Stanford University recently released findings from their study on the effectiveness of PEPFAR's programs in the article "The President's Emergency Plan for AIDS Relief in Africa: An Evaluation of Outcomes." The report, released in the Annals of Internal Medicine, found that the U.S. effort to curb the global HIV/AIDS epidemic has been a mixed bag. The study found that significant progress has been made in the areas of care and treatment, a laudable accomplishment of the first phase of implementation. But the report also confirmed what too many of us had seen coming - we have not made any significant progress in curbing new infections because our prevention efforts have failed. And while the oft quoted truism that we cannot treat our way out of this epidemic is spot on, we must also now couple this with an equally true mantra: politically- and ideologically-based prevention will not work.
SIECUS has long been critical
of the prevention paradigm in the Bush Administration's global HIV/AIDS
efforts and at the end of this month, will release Making Prevention
Work: Lessons from Zambia on Reshaping
the U.S. Response to the Global HIV/AIDS Epidemic.
This report is based on interviews and on-the-ground research by SIECUS
staff that traveled to Zambia one of the countries hardest hit by
the HIV/AIDS epidemic in Sub-Saharan Africa and, therefore, the world.
For those of us who closely follow the global HIV/AIDS epidemic, the numbers of new infections coming out of Zambia confirms in real life, the findings of the Stanford report: without the right policies and adequate resources, the HIV/AIDS epidemic continues to wreak havoc. No single government or organization, international or otherwise, is solely responsible for the current situation in Zambia. Rather, it is the result of a failure to integrate sound, responsible policies at the international level while prioritizing effective execution of strategies on the ground. In other words, where none are to blame, all are to blame.
Making Prevention Work
will not only shine a spotlight on, and give a better understanding
of, the realities faced by those struggling against the HIV/AIDS epidemic,
but also provide sound, evidence-based policy recommendations designed
to improve the response. While those of us in the U.S. can never
presume to put ourselves in the shoes of the dedicated workers and volunteers
who are doing their best in Zambia every day, we can take care of business
on our side - strengthening the largest source of money on earth to
fight HIV/AIDS, the President's Emergency Plan for AIDS Relief (PEPFAR).
While PEPFAR does a great deal of good now, particularly in the areas
of treatment and care, the prevention portfolio must be reshaped
and fine-tuned into a tool to turn the tide in this global conflict
against HIV/AIDS. This is the focus of our recommendations.
For those of us who focus on domestic issues, the numbers and crisis facing Zambia and Sub-Saharan Africa can seem daunting and almost incomprehensible. For example, the HIV prevalence rate in Zambia is 15.2%. But what does that look like? What does that number represent? Think about it this way: imagine if the entire population of the state of Oregon were HIV positive. Think of the national outcry and response of the federal government to what would obviously be an enormous national crisis. Now, see if you can handle this. In fact, 15.2% of the U.S. population would not only constitute the population of Oregon, but also add to this the equivalent of every man, woman, and child in Oklahoma, Connecticut, Iowa, Mississippi, Arkansas, Kansas, Utah, Nevada, New Mexico, West Virginia, Nebraska, Idaho, Maine, New Hampshire, Hawaii, Rhode Island, Montana, Delaware, South Dakota, Alaska, North Dakota, Vermont, Washington, D.C., and Wyoming.
That is the scale of the crisis Zambia is facing.
Not all is lost, however. During the last 20 or so years, our knowledge about HIV/AIDS treatment and prevention has come light years, and there is no reason why we cannot lower rates of transmission and ensure access to treatment if we finally take the steps that are necessary to show that we are serious in our fight.
With new leadership at the helm, now is the time to take a close and introspective look at our global HIV/AIDS efforts and make an informed and deliberate choice about how to proceed. Zambia is a case study on our nation's success and failures in helping this amazing country deal with the moral crisis of our time. We here at SIECUS hope the report will be received in that spirit and it will make seven concrete recommendations for moving forward. Until then, our previous postings on lessons from Zambia can be found here:
Prostitution Pledge or Zambia's Women and Girls
The Future of PEPFAR: What Zambia Teaches Us
