Debunking the Myths in the U.S. Global AIDS Strategy: An Evidence-based Analysis

On February 23, 2004, the United States Department of State Office of the GlobalAIDS 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 United States global AIDS funding. The Center for Health and Gender Equity (CHANGE) has conducted an evidence-based analysis of the United States Strategy, including the assumptions that underpin the Strategy and the priorities on which programmatic decisions are being made.

The United States Strategy asserts that policies and programmes will be "evidence-based." The author's review of the Strategy arrives at two basic conclusions. One is that 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 urgent prevention needs of the millions of people now at risk of infection throughout the world. The second is that the treatment agenda is based far more on the interests of pharmaceutical companies than on the urgent needs for access to ARVS of the millions already suffering from AIDS. Thus, 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."

In this analysis, the authors aim to review the Strategy in relation to available evidence. For example, the Strategy emphasises that policy decisions will be evidence-based, by declaring that:

"We will make policy decisions that are evidence-based. We will build on the best practices established in the fight against HIV/AIDS and bring the resources of sound science to bear in selecting and developing interventions that achieve real results." (p. 8)

The author's objectives in analysing United States Global AIDS strategies are to evaluate the degree to which the Administration's Strategy fulfills its own stated objectives and to identify existing gaps in efforts to address those at risk of infection and those living with HIV/AIDS. We do so by asking the following questions:

• What is the United States Global HIV/AIDS Strategy as articulated by the Five-Year Plan released by the Global AIDS Coordinator?
• Are the strategies proposed for prevention and treatment based on the best available evidence? Do they indeed provide clear and objective strategic direction for the what of programmes, and allow local conditions and needs to determine the how?
• Do the approaches outlined in the document address the needs of those most vulnerable, including women and girls and other vulnerable populations? Do they promote equitable access to information, technologies, and life-saving drugs?

Throughout this analysis, the authors aim to review the core assumptions made in the Strategy document, focusing for now on the sections addressing prevention, treatment, and funding mechanisms. Data and evidence used in the critique by CHANGE are referenced throughout and draw from a range of scientific and public health literature, including scientific journals and evidence collected and disseminated by the Centers for Disease Control, UNAIDS, the Demographic and Health Surveys, and elsewhere.

Click here to download this analysis paper in PDF format [435 KB].

Click here to download the "President's Emergency Plan for AIDS Relief: U.S. Five-Year Global AIDS Strategy" in PDF format [1.9 MB].