|
Partnerships for Comprehensive Programming
As was discussed above, the vision for PEPFAR was remarkable not only for its size, but also for its scope — combining prevention, treatment and care in a comprehensive response. The President and a bipartisan Congress integrated prevention, treatment and care in a comprehensive program, in order to reflect basic public health realities:
Without treatment, people are not motivated to be tested and learn their HIV status.
Without testing, we cannot identify HIV-positive persons and so we cannot teach them safe behavior, and they cannot protect others.
Without care and treatment programs, we do not have regular access to HIV-positive persons to constantly reinforce safe behaviors — a key component of prevention.
Without testing and treatment, we have no hope of identifying discordant couples, and women have no possibility of getting their partners tested so they can protect themselves.
Without testing and treatment, we cannot “medicalize” the disease, which is essential to reducing stigma and discrimination—which, in turn, is essential for effective prevention and compassionate care for those infected and affected by HIV.
Without care for HIV-positive persons who do not yet require treatment, we cannot follow them to determine when it is optimal to initiate therapy and thereby increase the chance of a successful outcome.
Without compassionate care for children orphaned or made vulnerable by AIDS, the social fabric of entire communities is being torn and we fail in our humanitarian duty.
And, of course, without prevention, we cannot keep up with the ever-growing pool of people who need care and treatment.
As we scale up comprehensive programs, it is essential to remember that PEPFAR is one piece — albeit a very large piece—of a complex puzzle of partners engaged in combating HIV/AIDS. The other pieces include: the contributions of the countries themselves, including remarkable efforts by PLWHA, families, communities, and national leaders, and which can include substantial financial contributions in countries such as South Africa, Botswana, Namibia and others; the Global Fund — for which the American people provide roughly 30 percent of the budget and which is an important piece of our overall global strategy — and other multilateral organizations; other nations’ bilateral programs; private foundations; and many others. PEPFAR constantly adapts the shape of our bilateral programming piece to fill its place in this puzzle, and to ensure that at the country level, the needs for prevention, treatment and care are being addressed in a comprehensive way. | 
