The outgoing administration left it up to future the Obama Presidency to change PEPFAR to begin needle exchanges or drug treatment, and Obama has been on record as being in favor for it. PREFAR currently only uses education projects for drug users. The lack of these programs is further complicated by needle exchanges being illegal in some African countries.
From this IRIN article that we found at Reuters AlertNet, we see more details about PEPFAR's preferences to combat AIDS.
Researchers have estimated that 1.2 million deaths in Africa were averted between 2004 and 2007 as a direct result of interventions funded by PEPFAR.
However, HIV activists have heavily criticised its prevention track record, including stipulations that one-third of funding be spent on programmes promoting abstinence outside of marriage, and limited funds for progammes targeting high-risk populations such as sex workers and intravenous drug users.
PEPFAR was reauthorized for an additional five years in 2008, but stayed mute on the issue of needle-exchange initiatives; media reports quoted former US Global AIDS Coordinator Mark Dybul as saying that it would be up to President Barack Obama's administration and the US Congress to decide whether to implement such programmes.
In Kenya, PEPFAR representatives were reluctant to comment on the Lancet report but said in a statement: "Our work with IDUs and non-injecting drug users is part of a balanced prevention portfolio that reflects the drivers of the epidemic in Kenya."
Although heterosexual transmission is still the main means of HIV infection, in sub-Saharan Africa there could be up to three million people who inject drugs, with more than 200,000 in Kenya and at least 250,000 in South Africa; prevalence is often higher among intravenous drug users than in the general population.
"The criminal nature of drug use in these countries means drug users are usually arrested and imprisoned, rarely ever getting treatment for their addictions," Anne Gathumbi, of the Open Society of East Africa, a think-tank based in Nairobi, the Kenyan capital. "The few treatment programmes that exist are mainly detox centres with very high rates of relapse."