Written by Daniella Choi
On June 28th, the Global Health Policy Center at CSIS hosted Ambassador Eric Goosby for a conversation on “HIV/AIDS in 2011: The Global Outlook and America’s Role.” As the U.S. Global AIDS Coordinator and a pioneer in the HIV/AIDS response, few can speak as clearly about the U.S. involvement in HIV/AIDS as Ambassador Goosby.
“We can see the light at the end of the tunnel,” Goosby said. Goosby cited useful and practical tools such as high impact preventive interventions and new breakthroughs in using treatment as prevention to curtail the epidemic. Goosby argued that the unanimous approval of the U.N. Security Council Resolution 1983(2011) as well as the U.N. Political Declaration at this month’s High Level Meeting on AIDS confirmed the world’s political will to end the epidemic.
Goosby focused on four key steps to bring us closer to this goal: making smart investments to increase efficiency, encouraging others to play their part, establishing country ownership to create self-correcting mechanisms, and linking the public health response with human rights to ensure safe spaces for high-risk groups.
Today’s fiscal environment, argued Goosby, requires us to do more with less. Ambassador Goosby outlined PEPFAR’s Smart Investment strategy, which aims to reduce duplication, support evidence-based interventions, and make managerial changes to cut operation costs. The President’s Global Health Initiative, which builds on the PEPFAR platform, may help PEPFAR coordinate efforts with other U.S. agencies and maximize benefit. Goosby also projected significant savings in coordinating with the Global Fund to Fight AIDS, TB, and Malaria. “We need the Global Fund. PEPFAR’s ability to be successful is directly dependent on the Global Fund continuing. Together we will continue to do better. Without it, our ability to do this is markedly diminished,” Goosby remarked.
In addition to the Global Fund, other actors such as the G8 and G20 must step up and commit to the shared responsibility of combating AIDS, Goosby said. The United States remains the largest contributor to the HIV/AIDS work globally by a dramatic margin, even though the disease is a shared burden. Altogether, donors contributed $7.6 billion dollars in 2009. That is $100 million less than the 2008 contribution and is significantly below what is needed to move towards the universal coverage from the High Level Meeting. Goosby called for new contributors as well as unwavering commitment from the existing donors to put forth a durable and sustained response to the disease.
PEPFAR uses a country-by-country approach and relies on partner governments to take ownership of their public health programs. Ambassador Goosby made it clear that the United States cannot and will not be the Ministry of Health for others. PEPFAR seeks to be “traceable in decision-making” while remaining in a supporting role. Goosby believes that Ministries of Health in target countries, in combination with civil society, can create self-correcting mechanisms that can adapt to the country’s needs. Country ownership must be the central pivot in this dialogue.
For too long, high risk populations have been ignored and marginalized. These groups include men who have sex with men (MSM), injecting drug users (IDU), and female sex workers (FSW). PEPFAR’s goal is to understand the impact of HIV in high risk populations and to create a safe environment. The U.N. High Level Meeting used bold and clear language to address the specific needs of these populations by appealing to human rights imperatives. PEPFAR also engages in diplomatic dialogues to discourage criminalization and target stigmatization. However, long-term solutions will require civil society to mobilize, oversee, criticize, and challenge discriminatory practices.
Goosby’s speech and the lively Q&A that followed identified concrete steps to achieve the ambitious goals signed at the U.N. High Level Meeting but many challenges lie ahead-supply chain management, understanding the implications of new discoveries, better integrating HIV/AIDS with other global health agendas, and others. There is no single formula for success. From Ambassador Goosby’s perspective, we must creatively define and redefine the most effective strategies at our disposal to win the fight against the HIV/AIDS epidemic.