PEPFAR

Intro
Funding initially committed was $15bn - ended up nearer $19bn, and in the next five year cycle will be up to about $30bn. Mixed success, and while there has been a scale up in treatment, rates of infection continue to rise.

Lack of access to medical services has inhibited efficacy of roll out of ARV. Monitoring of immune and HIV status is a key service. Vital to deploy modern techniques to test for TB, and other laboratory testing in order to accurately inform treatment planning.

First threshold was getting ARV prices down, the next threshold is scaling up other medical services and systems to support therapy.

Warner Bros.
have created a 2 minute thirty second video trail to explain PEPFAR.

Have also created a video game to teach teenagers an HIV prevention message, and will be distributed through PEPFAR target countries. It will be acculturated and localised for each nation, will be linked in to a mentorship programme.

PEPFAR has also been working with MTV on an anti-trafficking campaign, also working on multimedia prevention campaigns with John Hopkins, and a values based programme in South Africa.

Pangaea Global AIDS Foundation
Understanding the demographics of communities, and how to reach and target them effectively is key.

Testing to identify early treatment failure will be critical to minimise risks of multi drug resistance.

Faith Based Groups
Not clearly separate from other sectors - people of faith in secular bodies, and secular bodies work with secular. PEPFAR has acknowledged vital role of faith based groups in care, prevention and advocacy.

Shepherd Smith
PEPFAR contributions can be so large that they can exceed the whole annual health budget for some recipient nations - this means that a sudden withdraw would be disastrous - in fact long term sustainability of interventions. It is taking health professionals from other sectors, so in the process of scaling up HIV services can be in danger of damaging other aspects of healthcare delivery. So local and sensitive solutions, not going in thinking we have all the answers. PEPFAR is leaning more about how to do this. It is also integrating faith based responses in to the whole.

Treatment is also becoming a potential enemy to prevention - people are not as concerned as they once were because effective therapy is available.

Revd. Herb Lusk; Philadelphia
You need to serve at home and abroad. Has been working for some years with OVC in several African countries. But we cannot rely just on government engagement and funding, there needs to engagement through and within communities, and faith communities are key networks for responding to crises.

Comments from the Floor
Transparency is needed about how PEPFAR money is being used by recipient govts.

Need to build capacity, and the best way to do this will be to get in to a good working relationship with orgs that have capacity.

Kent Hill expressed a strong hope that the PEPFAR Bill will get through congress, hopefully it will mean $41bn for HIV/AIDS and $9bn for TB & Malaria over the next five years. Culture wars have been an issue, with left unhappy with AB programmes and right unhappy with C - but seeing a growing consensus appearing from both sides. Furthermore, PEPFAR have a "big tent" approach, get all groups from all sectors and perspectives to have as wide an approach as possible to care and prevention.