Management of the program has been controlled by US universities and charities, now the Obama administration wants to hand off management of the program to the countries that receive the drugs. This plan is proposed despite the fact that most of these countries do not have AIDS drug programs in place or are prone to corruption.
From the Washington Post, David Brown details the proposed changes to PEPFAR.
In an outline of a new direction for the global program started by President George W. Bush, the administration hopes to begin handing off day-to-day management of AIDS prevention and treatment programs to the 15 countries where $19 billion has been spent since 2004. The goal is to make the services a routine part of each nation's health offerings.
The program provides AIDS drugs, HIV counseling and testing, prevention advice and condoms, palliative care for people with advanced AIDS, and support for orphaned children. The services have been delivered through a complicated tiered system that includes American universities, international nonprofit organizations, government health ministries and hundreds of charities.
Under a strategy described in documents released Monday, the countries' health ministries would assume the task of delivering services -- which many already do -- as well as managing all the programs and measuring their effect.
Most of the funding, however, would continue to come from the United States, foreign donors and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
"It is our honest belief that these programs are in a fragile period," said Eric Goosby, the U.S. global AIDS coordinator. "We need to transition them into being more embedded in the countries' infrastructure and for the countries to have true ownership of them."
Since its inception, the program -- run out of the State Department and known by its acronym, PEPFAR -- has helped provide antiretroviral treatment to 2 million people, supported the care of 10 million (including 4 million children in families affected by AIDS) and been at least partly responsible for the fact that 240,000 babies born to HIV-positive mothers did not have the infection.