Inter Press Service - September 12, 2009

HARARE, Sep 12 (IPS) - The United States has embarked on a mission to restore Africa's trust in U.S. commitment to global AIDS relief.

During the first months of his administration, president Barack Obama has made the fight against HIV/AIDS a cornerstone of his foreign policy, using health assistance as a diplomatic tool to engage developing countries on political and economic issues.

In recent months, PEPFAR has been slammed by AIDS activists for not honouring HIV funding commitments. On a recent visit to Zimbabwe, Eric Goosby, the global AIDS coordinator for the US President's Emergency Plan for AIDS Relief (PEPFAR) reassured Southern Africans of the U.S.'s commitment.

PEPFAR contributes more than $3.7 billion to HIV prevention and care globally, but despite Obama's campaign promise of an annual increase of $1 billion, the U.S. Congress did not increase the budget this year.

IPS: Has the Obama administration made any changes to the United States President's Emergency Plan for AIDS Relief (PEPFAR)?

Eric Goosby: The strategy that was engaged before the Obama administration came in will be continued and enhanced. We believe that our ability to better understand how to fight AIDS will be improved with an increased dialogue with ministries of health in countries (in which) we run programmes and (with) civil society and non-governmental organisations.

IPS: What is your position on male circumcision as a preferred HIV/AIDS preventative measure?

EG: The research that showed that male circumcision decreases by 60 percent the likelihood of an individual getting infected was remarkable and surprising, even to those of us who have been in this field for a long time. It turns out that there are cells that uncircumcised men do not have these are specific cells that make uncircumcised men more susceptible to HIV.

But a (circumcised) individual can still get infected (with HIV). Circumcision drops the likelihood of infection, but it is not the answer. Condom use continues to be the mainstay of how men can protect themselves and others from infection.

IPS: The US has been accused of putting business interests before human lives, when buying more expensive, U.S.-manufactured antiretroviral (ARV) drugs instead of generic drugs manufactured outside of the U.S.

EG: It's legitimate criticism. The U.S. was initially worried that generic drugs were not effective. There was a worry that generic drugs had not been clearly (tested for) short- and long-term side effects. We were also worried about their generic manufacturing, their production controls, which we thought was not rigorous.

So, initially, the U.S. government was concerned that we would be creating double standards by giving patients in resource-poor settings drugs that we had not tested and that we did not give to our own population so PEPFAR initially only gave branded drugs.

But we have now switched completely to go into generic drugs, because (their lower cost) increases the number of people we can provide with drugs. I think that we had a legitimate reason not to engage with the generic drugs initially but now I don't think it's still defensible (to do so).

IPS: Do you think Southern Africa will be able to achieve universal access to treatment by 2015?

EG: I don't think it is realistic. I think it is something that PEPFAR is playing a central role in trying to move towards, but the resources that are required to respond to the large number of individuals who need to be put on ARVs by 2015 will not be met.

That's not to say that every funder and every government may stop turning their resources towards trying to develop a robust response. We need to coordinate our efforts to make sure that the resources available are used to their best and intensify our efforts to decrease the number of people affected by HIV and AIDS. PEPFAR is committed to keeping (continuous, free ARV) treatment a key part of our response.

IPS: AIDS activists say PEPFAR's funding shortfall will affect the lives of about 30 million people. What are you doing to prevent this from happening?

EG: The global economic crisis has had an impact on resource availability. President Barack Obama and secretary of state Hillary Clinton have made it very clear that (making more funding available) is the highest priority.

The new twist to the Obama administration's (foreign policy) is to use our ability to deliver health technical assistance as a diplomatic tool (when dealing with developing countries). So, (HIV funding becomes both) a humanitarian gesture and something to create dialogue with countries.

IPS: What is the U.S. doing to help improve the health infrastructure and boost human capital in Southern Africa?

EG: There is no question that you cannot deliver adequate treatment without facilities that are strong enough to support the diagnostic and monitoring needs of individuals who are on ARV therapy. The structure of the health facility, the accessibility of the hospital to patients is critical for the health provider to make proper decisions.

A significant portion of our resources must go to strengthening the medical delivery system, especially at district and village level, to support that (country's) ability to care for people over the duration of their lives.

We are committed to providing proper infrastructure to allow health workers to administer medication. We are willing to work with all parties, government and civil society, to make this (happen).

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+ AFRICA: Phoney Choice Between Life and Death (http://www.aegis.org/news/ips/2009/ip090709.html)

+ MOZAMBIQUE: Scant Progress With Paediatric HIV (http://www.aegis.org/news/ips/2009/IP090607.html)

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