Debunking the Myths in the U.S. Global AIDS Strategy

On February 23 2004, the United States Department of State Office of the Global AIDS Coordinator released the "President's Emergency Plan for AIDS Relief: U.S. Five-Year Global AIDS Strategy", which outlines the central priorities and policy guidance for spending billions of dollars in USA global AIDS funding.

In this 30-page document, the Center for Health and Gender Equity (CHANGE) offers an evidence-based analysis of that strategy, with a focus on the assumptions that underpin it and the priorities that shape programmatic decisions based on it. (CHANGE is a USA-based international reproductive health and rights organisation that seeks to make public health and human rights principles integral to all relevant US international population and health policies and programmes).

The US strategy is premised on the idea that policies and programmes will be "evidence-based". However, according to CHANGE:

1. the prevention strategy is crafted more to cater to the ideological agenda of the Administration's "base" - the far political and evangelical right - than it is to meet the prevention needs of those at risk of infection throughout the world.
2. the treatment agenda is based more on the interests of pharmaceutical companies than on the need for access to antiretrovirals (ARVs) of those already suffering from AIDS. Thus, CHANGE claims, the strategy does not meet the test set out by the President himself when he committed to a global HIV/AIDS effort that would "create a cycle of hope and promise that will benefit millions".

Based on this analysis, CHANGE presents several recommendations, which include:

"Develop a comprehensive prevention strategy that is based on the best available public health information and on objectively evaluated best practices in the field." - CHANGE urges the Global AIDS Coordinator to make a clear public statement in support of the rights of individuals to have full access to prevention information and technologies. For example, CHANGE advocates "clear, transparent processes by which diverse constituencies within the countries in question can shape and give input into the development of country- and locale-specific strategies; mechanisms for meaningful participation in shaping objectives, indicators, and evaluation processes for the purpose of developing HIV prevention efforts in each setting; ready access to information on U.S. funding and programmatic strategies; and knowledge of and access to partner organizations receiving U.S. funding and carrying out programs". CHANGE also endorses "Support for "risk-taking" approaches that create new avenues for discussion on sex, sexuality, and power as appropriate to, and among diverse populations within specific settings."

"Increase coordination within the U.S. government agencies with oversight on related programs, and between the United States and other donor agencies on theground in all countries receiving U.S. Global AIDS funding." - CHANGE suggests that this Coordinator should, at minimum, create an interagency task force to examine the means through which US-funded global AIDS efforts can be coordinated at the country level to ensure that critical linkages are made between programmes. Furthermore, he or she should hold a high-level international summit including both US government agencies and donor representatives from other countries to create a new agenda to improve the lives of women and girls, including communication campaigns aimed at changing socialnorms around violence, stigma, and discrimination, and in other critical areas. Finally, CHANGE urges this Coordinator to develop clear mechanisms for intra-country government, donor, and civil society coordination.

"Develop a coordinated effort to increase treatment access to the greatest number of people and using mechanisms, such as the WHO 3x5 campaign, that are not tied to the needs or interests of specific political parties or to U.S. domestic interests." - CHANGE indicates that one of the priorities in this area is the participation in all stages of the process of civil society actors and others with direct experience on the ground in providing and monitoring treatment.