New Goals in Global Battle

Dr. Eric Goosby, head of the President's Emergency Plan for AIDS Relief, has announced changes to the multibillion-dollar program. PEPFAR needs to address the current and future underlying health care problems in target countries, he said recently.

"We've created a very good start at what was an emergency response. We now need to move that emergency response into a sustained response," Goosby said.

Launched in 2003, PEPFAR pledged an initial $15 billion to address HIV/AIDS globally and became the Bush administration's signature foreign aid initiative. The Democratic-controlled Congress in 2008 authorized an additional $48 billion for the program in 2008, expanding it from 15 countries to some 87 -- mostly in Africa, but also including Russia and China.

Despite PEPFAR's treatment successes, many target countries still cannot handle the long-term burden of AIDS and related diseases like TB and malaria, said Goosby. The next step, he said, will be to focus on national health ministries and provincial health departments, using program funds to train and outfit health workers to increase output. Services like antiretroviral treatment, which are now often administered by non-governmental groups or provincial hospitals, must extend from national health systems to village-level clinics, he added.

"There is now a very small amount of money going from the US government to ministries of health, and that will undoubtedly increase once that transparency and accountability is in place and ensured," said Goosby.

Having saved more than 1 million lives and cut AIDS death in targeted African countries by 10%, PEPFAR is viewed as one of the most successful public health initiatives ever launched. Some critics, however, have voiced fears the new approach will undermine that success.