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Partnerships for Comprehensive Programming
As previously discussed, the vision for PEPFAR was remarkable for both its size and scope - integrating prevention, treatment and care in a comprehensive response. President Bush and a bipartisan Congress got it right. A comprehensive program that includes prevention, treatment and care reflects 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 comprehensive programs are scaled up, it is essential to remember that PEPFAR is only 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 countries themselves, including the PLWHA, families, communities, and national leaders (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 nearly 30 percent of the budget and which is an important piece of our overall global strategy); 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.
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