On World AIDS Day, the Obama Admin­is­tra­tion hinted at some changes to the PEPFAR AIDS pro­gram. The President’s Emer­gency Plan for AIDS Relief has pro­vided drugs to hun­dreds of thou­sands of HIV-positive peo­ple in the under-developed world.

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.

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