Background

The United States has responded to the challenge of combating the global HIV/AIDS pandemic with the President’s Emergency Plan for AIDS Relief, the largest financial commitment ever, by any nation, for a major international health initiative dedicated to a single disease. The President’s Emergency Plan for AIDS Relief is the single umbrella program for all existing and new USG international HIV/AIDS assistance, including:

• Existing HIV/AIDS programs of all USG agencies and departments in
  approximately 123 countries
• Enhanced bilateral programs of all USG agencies and departments in the 15 nations designated as focus countries
• USG international HIV/AIDS research activities
• USG policies and oversight pertaining to the Global Fund
• USG relationships with all other multilateral HIV/AIDS organizations
• USG bilateral relationships with HIV/AIDS donor nations
• All other USG international HIV/AIDS activities and partnerships

The Emergency Plan targets $10 billion over five years to dramatically ramp up HIV/AIDS services in 15 of the most affected countries in the world (the “focus countries”), representing nearly 50 percent of HIV infections worldwide, with the goals of (1) supporting the treatment of two million people infected with HIV; (2) supporting the prevention of seven million new HIV infections; and (3) supporting care for 10 million people infected and affected by HIV/AIDS, including orphans and vulnerable children. The Emergency Plan also targets $5 billion over five years to support HIV/AIDS programs in an additional 108 countries, international research, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (“Global Fund”).

In addition to the massive dedication of resources, the Emergency Plan represents an important change in how USG HIV/AIDS international assistance is planned, managed, and implemented. Priorities include coordinating all of the USG Agencies working in HIV/AIDS to create one unified USG response at the headquarters and country levels; a focus on accountability and achievement of results; and the strengthening of indigenous responses, organizations and systems to combat the pandemic and ensure sustainability.

The position of U.S. Global AIDS Coordinator and the Office of the U.S. Global AIDS Coordinator (OGAC) have been established to lead the integrated planning and implementation of the President’s Emergency Plan for AIDS Relief. The U.S. Global AIDS Coordinator, who is the President’s representative on international HIV/AIDS issues, has “primary responsibility for the oversight and coordination of all resources and international activities of the United States Government to combat the HIV/AIDS pandemic” [U.S. Leadership Against AIDS, Tuberculosis, and Malaria Act of 2003, Section 102]. Consistent with these responsibilities, the Coordinator will:

• Establish all USG policies relating to combating HIV/AIDS internationally
• Develop a global HIV/AIDS strategy for USG international HIV/AIDS assistance and partnerships
• Direct the use of all international HIV/AIDS funds
• Establish policy, program, and implementation consistency across all USG agencies and departments and nongovernmental organizations for all international HIV/AIDS activities
• Determine standards and procedures across agencies for planning, implementing, and monitoring all USG international HIV/AIDS assistance
• Coordinate all USG international HIV/AIDS activities with other countries and international organizations
• Monitor progress toward meeting the Emergency Plan’s goals
• Ensure program accountability within the Emergency Plan, and take corrective action when required

In its first year, the Office of the Global AIDS Coordinator established a Five-Year
Global AIDS Strategy for achieving the President's goals; since then, programs, systems, and structures have operationalized the strategy in the focus countries. Similar communication, coordinated strategic planning, resource allocation and evaluation mechanisms are now being extended to the other bilateral HIV/AIDS programs to ensure that programs are in keeping with and contributing to the goals identified in the Five-Year Global Strategy. While U.S. missions in all countries with a USG presence are expected to play a leadership role in the fight against HIV/AIDS [cable: UNCLAS STATE 168905], it is important to explicitly address the approach, including coordination of activities and policies, of U.S. missions in countries of strategic importance that have significant USG HIV/AIDS bilateral funding and that are implementing programs.

U.S. Government Country Programs:

This document pertains to any USG bilateral programs that currently receive HIV/AIDS funds through any of the USG implementing agencies, including the US Agency for International Development (USAID), the Department of Health and Human Services and the Centers for Disease Control (HHS/CDC), the Peace Corps and the Department of Defense. FY 05 funding levels were used as the basis for this analysis. In FY 05, 123 country programs received funding for HIV/AIDS programs from various USG implementing agencies.¹ Among the programs receiving bilateral HIV/AIDS resources outside of the 15 focus countries, 90 received less than $5 million. Eighteen USG programs received over $5 million, including new funds from the Global HIV/AIDS Initiative (GHAI) account, and have more than one USG agency providing assistance.


Five of these USG country programs received more than $10 million. A list of countries receiving more than $1 million according to FY 05 funding levels is included in Appendix 1. A list of all countries is included as Appendix 2.

This guidance addresses all USG programs providing HIV/AIDS resources on a country level. Although both USAID and HHS/CDC have provided support and GHAI funds to regional programs, because of their unique position, the diversity of program mix and models, and the difficulty in measuring their performance against service delivery results, these will be addressed at a later time. Policy articulated in this document does, however, apply to countries where the regional platforms are essentially serving as a funding vehicle for service delivery programs because there is not a USG implementing agency presence in-country, for example in Swaziland, Lesotho and Burma.

Expectations relative to the President’s Emergency Plan:

When considering the responsibilities of bilateral programs under the Emergency Plan, several aspects are considered, including:
1. Adherence to Emergency Plan policy
2. Collaboration with the Global Fund for Aids, Tuberculosis and Malaria
3. Coordinated programming across USG Agencies
4. Relationship to host country strategies
5. Comprehensive HIV/AIDS technical interventions
6. Accountability and focus on results
7. Reporting and documentation
8. Communication and support strategy
9. Timeline

1 Please see Appendix 2 for a full listing of the 123 countries.

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