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Reuters: “Americans enrolled in the U.S. government-run AIDS will be covered for Medicare beneficiaries who are at increased risk for the infection, including pregnant women, CMS said, but it added that Medicare participants of any age who voluntarily request the service will also be covered” (Berkrot, 12/8).

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The Obama administration last week released a 74-page outline of its new President’s Emergency Plan for AIDS Relief implementation strategy, which includes slowing expansion of antiretroviral drug distribution in favor of prevention and fighting other deadly diseases, the New York Times reports. The strategy emphasizes prevention, curtailing mother-to-child transmission and focusing on treatment of the sickest people, pregnant women and individuals with tuberculosis. In addition to HIV/AIDS, funding would be used to battle diseases that cost less to fight, including diarrhea, fatal birth complications, malaria and pneumonia. Since its 2004 inception under President George W. Bush, PEPFAR has provided antiretroviral access to a total of 2.4 million people, with an average of nearly 500,000 new people beginning to take the drugs annually. The new strategy aims to increase the number of individuals receiving antiretrovirals by about 320,000 each year for the next five years, bringing total recipients to four million people by 2014, according to the Times.

According to the Times, the strategy “is nearly silent” on controversial issues like abstinence and distribution of condoms through missionary hospitals that oppose their use. The proposal also does not specify whether funding would be cut off for groups that support abortion rights, groups that work with sex workers but do not condone prostitution or countries that criminalize homosexual sex (McNeil, New York Times, 12/9).

In addition, more of the day-to-day management of the program will be shifted to the 15 countries that have received the bulk of PEPFAR funding to date. According to the Washington Post, the goal is to make prevention and treatments services — such as the provision of antiretroviral drugs, HIV counseling and testing, prevention advice and condoms, and palliative care for people at advanced stages of the disease — a routine part of those countries’ health offerings.

Over the next five years, the Obama administration’s goal is for PEPFAR to provide care for 12 million people and double the number of infants born without HIV. While the U.S. will continue to contribute most of the funding, additional money would come from foreign donors and the Global Fund To Fight AIDS, Tuberculosis and Malaria. According to the Post, the exact amount of money slated to be spent through the program is unclear (Brown, Washington Post, 12/8). The Times reports that President Obama, during the presidential campaign, pledged to increase PEPFAR’s budget by $1 billion annually, though his first budget proposal included a $165 million increase (New York Times, 12/8).

On Monday, administrators of the program also released three supplements that describe how nations’ health ministers would take on the tasks of delivering services — as many already do — managing the programs and gauging their effects, the Post reports. Eric Goosby, the Obama administration’s global AIDS coordinator and chief administrator of PEPFAR, said, “It is our honest belief that these programs are in a fragile period,” adding, “We need to transition them into being more embedded in the countries’ infrastructure and for the countries to have true ownership of them” (Washington Post, 12/8).

The Obama administration has drawn the criticism of some HIV/AIDS advocates who believe that the administration is trying to save money by shifting emphasis from providing antiretrovirals to encouraging preventive measures, according to the Times. Gregg Gonsalves — a longtime HIV/AIDS campaigner — said, “I’m holding my nose as I say this, but I miss George W. Bush,” adding, “On AIDS, he really stepped up. He did a tremendous thing. Now, to have this happen under Obama is really depressing.”

Goosby stressed that more people would be given the treatments each year. “We’re honoring our commitment, we’re increasing our commitment, we will not veer from that commitment,” he said. Ezekiel Emanuel — a bioethicist at the National Institutes of Health and a health care adviser to the White House Office of Management and Budget, who also is the brother of White House Chief of Staff Rahm Emanuel — rejected rumors that he and Goosby have sparred over the number of people that should be treated. “This is [Obama's] policy and the way he wants to approach it, and no individual counselor stands in his way” (New York Times, 12/8).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

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The fiscal year 2010 State and Foreign Operations Appropriations bill, which includes funding for global health-related measures, “is moving on the Hill as part of a mammoth catch-all spending bill that’s expected to move through both chambers this month,” Foreign Policy’s blog, “The Cable,” reports. “It’s been more than a month since the new fiscal year started and several federal agencies are operating under a stop-gap funding measure called a ‘continuing resolution’ that keeps the government humming but doesn’t allow for new funding initiatives to begin. That expires on Dec. 18, giving a semi-firm deadline for Congress to pass the real funding bills,” the blog notes (Rogin, 12/9).

A Committees on Appropriations summary document (.pdf) from the House and Senate chairs highlights some funding allocations in the consolidated bill. The items related to global health and food security are:

“Global Health and Child Survival: $7.779 billion, $440 million above 2009 and $184 million above the request, to strengthen global public health infrastructure and surveillance to save lives overseas and protect the health of Americans from infectious diseases. It is estimated that U.S. investment in bilateral HIV/AIDS programs has provided life-saving treatment for 2.4 million people and the Global Fund to Fight AIDS, Tuberculosis, and Malaria has saved millions more. Specific investments include:

• HIV/AIDS: $5.709 billion (including $350 million for AUSAID HIV/AIDS programs), $200 million above 2009 and $100 million above the request, for international HIV/AIDS prevention, treatment and care programs including $750 million for multilateral programs through the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria.
• USAID Global Health and Child Survival Programs: $2.42 billion to USAID, including for HIV/AIDS, which when combined with $50 million for global pandemic programs in the FY 2009 supplemental is $134 million above the request and $440 million above 2009, for other global health programs. This includes increases of nearly $54 million for maternal and child health programs, $202.5 million to fight malaria, $62 million to fight tuberculosis, and $103 million for international family planning.”

“Development Assistance: $2.520 billion, $720 million above 2009 and $214 million below the request, including for agricultural development, climate change, micro-credit, democracy and governance, and education in countries that face a complex range of long-term development challenges.”

“Agriculture and Food Security Programs: $1.170 billion, $698 million above 2009 and $193 million below the request, to provide agricultural assistance and improve food security. More than one billion people suffer from chronic hunger.”

“Improving Access to Safe Drinking Water: $315 million, $15 million above 2009 and $160 million above the request, for safe water programs, including increasing access to safe drinking water (such as pumps and wells); building water systems; and expanding safe hygiene programs. Over a billion people around the globe lack access to safe drinking water and two and a half billion lack access to basic sanitation.”

“Humanitarian Assistance:

• Refugee Assistance: $1.730 billion, $19 million above 2009 and $175 million above the request, to help displaced people around the world with food, water, shelter and other basic needs. According to the UN High Commissioner for Refugees, as of early 2009, there are approximately 10.5 million refugees of concern worldwide, and many more internally displaced persons.
• Disaster Assistance: $845 million, $25 million above 2009 and $35 million below the request, to avert famines and provide life-saving assistance during natural disasters and for internally displaced people in Africa, Afghanistan, Pakistan, Iraq and elsewhere around the world.”

“Millennium Challenge Corporation (MCC): $1.105 billion, $230 million above 2009 and $320 million below the request, for bilateral assistance to developing nations. MCC compacts have supported agriculture, transportation, education, health, and financial development projects” (Committees On Appropriations, 12/8).

This information was reprinted from globalhealth.kff.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Global Health Policy Report, search the archives and sign up for email delivery at globalhealth.kff.org.

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