The AP/Washington Post on Sunday examined the impact of the President's Emergency Plan for AIDS Relief on the burden of HIV/AIDS in African countries. According to the AP/Post, "countless Africans ... will always be grateful to [President] Bush for his war on AIDS."

PEPFAR initiatives have increased the number of Africans receiving antiretroviral treatment fortyfold over the past five years by working through grass-roots organizations as well as "higher-profile charities and big state clinics," the AP/Post reports. Still of the 1.5 million Africans who died from AIDS-related causes in 2007, less than one-third had access to antiretroviral treatment. The number of new HIV cases also continues to exceed the number of people receiving treatment. In addition, the current economic downturn has caused concern about whether the five-year, $48 billion in PEPFAR funding passed last year will be delivered.

Although numerous programs cite successes achieved as a result of PEPFAR funding, several advocates disagree about how the initiative has impacted HIV/AIDS in Africa. According to the AP/Post, some advocates have suggested that the initiative overemphasizes abstinence and faith-based programs. Helen Epstein, an HIV/AIDS expert and consultant for the United Nations and the World Bank, said PEPFAR's focus on abstinence has hindered prevention efforts by failing to address certain African cultural practices involving simultaneous long-term relationships. According to Epstein, PEPFAR could achieve a greater impact if funding were directed at strengthening health care systems rather than addressing a single disease. Johanna Hanefeld, researcher at the London School of Hygiene and Tropical Medicine, added that the Global Fund To Fight AIDS, Tuberculosis and Malaria more effectively utilized HIV/AIDS programs for improving health care and training because it did not distribute funding among many different groups.

However, many experts and advocates disagree with PEPFAR's critics and believe that the initiative will have a lasting impact on the HIV/AIDS in Africa. Mark Dybul, U.S. Global AIDS Coordinator who administers PEPFAR, said, "In Africa, you can't tackle development goals unless you tackle HIV/AIDS." According to Dybul, the initiative also is a major supplier of condoms to several African countries, demonstrating that PEPFAR does not emphasize abstinence exclusively. "It's the largest international health initiative in history for a single disease," Dybul said. Francois Venter, who heads a PEPFAR-funded program at the University of the Witwatersrand in South Africa says, "PEPFAR is different" because of its emphasis on measurable targets. Josh Ruxin, assistant professor of public health at Columbia University, said President Bush and his administration "deserve a lot more credit than they received" for launching PEPFAR. "[I]t is impossible to deny the results and achievements of PEPFAR," Ruxin said, adding that he hopes President-elect Barack Obama will continue the initiative while shifting its focus away from abstinence and providing funding for programs involving commercial sex workers and abortion.

According to the AP/Post, supporters and critics alike "agree that prevention is the weakest link" among global HIV/AIDS programs and will need more emphasis in the future (Nullis, AP/Washington Post, 1/11).