VII. Strengthening Bilateral HIV/AIDS Programs

“By the legislation I will sign today, the United States of America will take the side of individuals and groups and governments fighting HIV/AIDS in Africa and other parts of the world. We’ll provide unprecedented resources to the effort. And we will keep our commitment until we have turned the tide against AIDS.” President George W . Bush, May 27, 2003

In keeping with the United States’ position as the global leader in the fight against HIV/AIDS, President Bush’s Administration provides over 50 percent of bilateral international HIV/AIDS assistance. Through various agencies and departments, the United States has bilateral programs to combat AIDS in over 100 countries, including the focus countries, and is active through diplomatic and public diplomacy channels in dozens more.

Outside of the Emergency Plan’s focus countries, the profile of HIV/AIDS varies widely among nations. Some countries have a high disease burden; others have low incidence of HIV but are witnessing emerging epidemics through rapid increases in infections; and others have low HIV incidence rates but need to remain vigilant. Unfortunately, no country is unaffected by the problem.

These countries have diverse drivers of HIV/AIDS, including epidemics led and compounded by such factors as high-risk sexual behavior, injection drug use, unsafe medical practices, gender inequality, prostitution, and poverty. All have challenges in implementing integrated and effective prevention, treatment, and care strategies. Stigma and denial remain widespread challenges, as does the lack of correct and consistent information about HIV/AIDS. Testing is underutilized, and appropriate protocols and enabling policies are often lacking. The U.S. Government has collected many “lessons learned” over two decades of worldwide HIV/AIDS activity, and it is on the strength of best practices that we embark on an intensified effort in our bilateral HIV/AIDS programs to ensure coordination, effectiveness, and accountability.

The President’s Emergency Plan offers a fresh opportunity to develop and implement consistent HIV/AIDS policies and programs across our bilateral prevention, treatment, and care initiatives, drawing on the U.S. Government’s strong field presence and technical expertise. Our bilateral programs worldwide will be an integral part of the President’s Emergency Plan for AIDS Relief and will be harmonized in policy and management to create the momentum that will truly turn the tide against HIV/AIDS.

Bilateral Program Objective:
Apply best practices in prevention, treatment, and care, and improve coordination, management, and accountability across all U.S. Government (USG) bilateral HIV/AIDS programs

Bilateral Program Strategies:

1. Strengthen quality and capacity of prevention, treatment, and care programs

2. Advance policy initiatives that support effective bilateral programs

3. Strengthen coordination, management, and accountability of programs, and ensure their consistency with the principles of the Emergency Plan

1. Strengthen quality and capacity of prevention, care, and treatment programs

Integrated prevention, care, and treatment programs are an established best practice. Integrated programs combat stigma, encourage behavior change and testing, and mitigate the consequences of HIV/AIDS. Countries are at different stages of HIV/AIDS response, but all HIV/AIDS programs of the U.S. Government should be working toward establishing a continuum of prevention, treatment, and care programs in proportions appropriate for the host country. Thus, USG efforts will be focused toward increasing the availability of high-quality, sustainable prevention, treatment, and care programs by:

Promoting evidence-based risk elimination and reduction programs
Successful strategies, such as the ABC approach and tailored interventions for high-risk groups like injection drug users, are helping to prevent new HIV infections. These strategies will be promoted across all USG bilateral HIV/AIDS programs.

Promoting strategies to increase testing
Worldwide, it has been estimated that some 95 percent of HIV-infected individuals do not know their status and thus do not have vital information to protect themselves and others. Testing is a crucial behavior change strategy, and new methods for increasing testing will be explored and promoted, including routine testing in health care settings.

Promoting strategies to combat stigma and denial
Stigma and denial remain primary barriers to addressing HIV/AIDS effectively. Programs will address stigma and denial by increasing the involvement of people living with HIV/AIDS, emphasizing the role of leadership, and providing consistent and correct HIV/AIDS information.

Offering technical assistance for the development of appropriate prevention, treatment, and care protocols.
Many countries lack appropriate prevention, treatment, and care protocols, contributing to ineffective and inconsistent program implementation. The U.S. Government will capitalize on its expertise and established best practices to promote and assist with the development of comprehensive national prevention, treatment, and care protocols to guide program development across all governmental and nongovernmental sectors.

Offering technical assistance and training of providers
Limited technical capacity is a barrier to increasing and strengthening prevention, treatment, and care interventions, and to ensuring compliance with established protocols. The focus of the U.S. Government’s HIV/AIDS programs, and a necessary tool for ensuring sustainability, is building the capacity of local providers to implement effective programs. USG efforts will have as a priority capacity building of health care workers and CBOs to strengthen the quality and expand the reach of effective HIV/AIDS interventions.

Identifying and developing the capacity of new partners
Worldwide, efforts against HIV/AIDS are amplified through approaches that reach individuals where they live, learn, work, and pray. New partners can expand the reach of programs, fill gaps in service delivery, and contribute additional necessary resources to the fight against HIV/AIDS.

Coordinating with host governments and a wide range of organizations active in country
To be fully effective, USG programs should be coordinated with and complementary to existing programs and the host government’s national AIDS strategy. The U.S. Government will work closely with the host government, the private sector, NGOs, FBOs, multilateral institutions, other bilateral donors, and others active in country.

2. Advance policy initiatives that support effective bilateral programs

The ability of programs and populations to address HIV/AIDS and mitigate its consequences are enormously impacted by policies related to the importation, regulation, and registration of essential medicines and supplies; the provision of basic social services such as health and education; and the allocation of resources. The President’s Emergency Plan will promote policies reflecting best practices through:

Active diplomacy to advocate for the adoption of supportive policies
Through the U.S. Chief of Mission and U.S. Government representatives in sectors such as education, health, defense, and trade, the U.S. Government will engage with its leadership counterparts in host countries to advocate for the adoption of supportive HIV/AIDS prevention, treatment, and care policies.

Technical assistance for policy development
Drawing on its expertise and worldwide experience, the U.S. Government, through its representatives in the field, will provide technical assistance for the development and application of policies supportive of effective action against HIV/AIDS and its consequences.

3. Strengthen coordination, management, and accountability of programs, and ensure their consistency with the principles of the Emergency Plan

President Bush has placed a strong emphasis on increased accountability for program activities. The USG programs worldwide are currently implemented by a multitude of U.S. Government agencies and departments, each with different management and accountability processes. Programs can be uncoordinated, both with other U.S. Government agency programs and with host governments and other donors, leaving gaps in service delivery and needs unmet. The lack of uniform accountability methods, including program evaluation methodologies, poses difficulties in comparing program impact and ensuring effective and efficient allocation of resources.

President Bush’s Emergency Plan will:

Coordinate leadership of U.S. Government bilateral HIV/AIDS programs through the leadership of U.S. Chiefs of Mission
The benefits of coordinated leadership, as demonstrated by the U.S. Global AIDS Coordinator and the U.S. Chief of Mission-led in-country USG teams in the focus countries, should be applied across USG bilateral programs. Government agencies will work as a united team under the leadership of the Chief of Mission, ensuring that programs are working toward shared goals.

Coordinate with host governments and other donors to eliminate duplication and ensure that needs are met
Coordination with host governments and donors will be strengthened. This will allow for more effective communication and evaluation of country-specific needs and circumstances, facilitate the effective and efficient use of funds, and determine and fill gaps in service provision.

Implement uniform standards for strategic information and evaluation
As a unified team implementing a coordinated country plan, all U.S. Government agency activities will be evaluated on their progress toward meeting established goals according to shared indicators that will facilitate the comparison of programs.

Hold U.S. Government programs accountable for results
U.S. Government programs will be funded accordingto their ability to indicate evidence-based success against specified goals. Improved accountability, in addition to uniform evaluation standards, will facilitate the identification of successful programs for scaleup and poorly performing programs for elimination.

Assist countries in developing their own strategic plans
Following from the coordination of leadership described above, U.S. Government departments and agencies will work with host-country governments to develop coordinated country plans that will identify opportunites to capitalize on the strengths of individual USG agencies and eliminate duplication in program services.

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