Between meetings at the UN General Assembly in New York and a trip to Uganda to meet with President Yoweri Museveni, Ambassador Eric Goosby took center stage at the State Department on Friday in front of more than 100 advocates, implementers and experts. With growing concern about ARV stock-outs, increasing HIV/AIDS prevalence in PEPFAR countries, and the program’s sustainability, the community welcomed the opportunity to enter into a dialogue with the U.S. global AIDS coordinator. In his opening statements Dr. Goosby recognized that there are many issues of immediate importance as well as long term goals of PEPFAR that must be focused on immediately.
It’s clear by now that it is the intention of the global AIDS coordinator to integrate maternal and child health, family planning and reproductive health programs with existing vertical HIV/AIDS programs; thus intensifying the focus on women as an access point to family-centered care. Dr. Goosby also clearly stated his intention to work with countries and communities to overcome stigma and discrimination that forces many at risk populations like injection drug users and men who have sex with men into hiding and further decreases the likelihood that they will actively seek services. Health and development will be tackled holistically through PEPFAR activities that are integrated with broader development models, such as microfinance, that work to overcome the effects that poverty has on the individual, family and community.
Although country takeover of PEPFAR programs is unlikely in the next five – or even 10 – years, Dr. Goosby emphasized the necessity for conversations with countries to begin now to solidify the long-term sustainability of PEPFAR activities. This will ensure that parallel systems interface with the ministries of health and unmet needs will be prioritized by those on the ground. Management, accountability and responsibility will be addressed by an in-country decision-making body that will identify and solve problems, and address complaints and criticism in a timely manner. Among the many tall tasks that Dr. Goosby is faced with is the mandate to increase the number of new trained health-care workers by 140,000 over the next five years. It is a task that he said must be fulfilled with a change in curriculum to one that delivers comprehensive training across skill sets and diseases.
Before taking questions, Dr. Goosby said, “We are at an exciting point in PEPFAR’s evolution,” a time to ensure that the great work that has been done to establish delivery systems and build partnerships is lasting, not just for the next five years, but 25 years. His vision of ensuring PEPFAR’s longevity for 25 years to come was further evident throughout the hour long question and answer. He expressed his feeling of “an urgent responsibility to diversify the approach to maintaining [PEPFAR] for 25 years.” In response to a question about the WHO changing the CD4 count (from 200 to 350) at which ARV treatment is initiated, Dr. Goosby said that people are proven to do better longer, but that it would put added strain on the system, doubling or even quadrupling the number of eligible patients.
Dr. Goosby stressed the need for a more efficient PEPFAR and an increased global responsibility in the fight against HIV/AIDS.