Effects of HIV/AIDS on Economic Development and Security

2. Effects of HIV/AIDS on Economic Development and Security • HIV/AIDS is reversing developing nations’ progress towards welfare and stability. The serious threat it poses to global development and security is one reason why the President and PEPFAR host nations have made addressing it such a priority. • High HIV prevalence among people in the most productive years of their lives presents a long-term adverse strain on the socio-economic structure of these nations. • Businesses in the developing world are faced with absenteeism, declines in skilled workers, high rates of turnover, expenses to train new workers, reduced revenue, and increased health care costs.

3. Effects of HIV/AIDS on Economic Development • Among those of working age, 11.7 million more people who are engaged in some form of productive activity are now living with the virus. Many of these people are women who work in the home. • This number is in addition to the 24.6 million labor force participants living with HIV. • Between 1992 and 2004, 43 countries heavily affected by HIV/AIDS lost a yearly average of 0.5 percent in their rate of economic growth due to the epidemic. • And, as a result of this decline, they forfeited 0.3 percent per year in employment growth.

4. HIV/AIDS Impact on National Security • Many nations suffer from high HIV prevalence among defense forces, losing their soldiers—and their leadership—to AIDS. • For example, deaths due to HIV/AIDS are estimated to have reduced the size of Malawi’s armed forces by 40 percent. In Uganda, more soldiers are believed to have died from AIDS than from the nation’s 20-year insurgency.

5. The Transformational Power of Partnerships • PEPFAR is part of a broader renaissance in partnerships for international development. • The United States is changing the paradigm for development, rejecting the flawed “donor-recipient” mentality and replacing it with an ethic of true partnership. • There is a growing consensus that the world’s response to global HIV/AIDS has undergone a transformation in recent years—and the new U.S. partnerships with hard-hit nations have been the catalyst.

6. New Way of Doing Business • One integrated USG bilateral program: Department of State, Department of Defense, Department of Commerce, Department of Labor, Department of Health and Human Services [Including CDC, FDA, NIH, and Health Resources and Services Administration (HRSA). Substance Abuse and Mental Health Administration (SAMHSA)], Peace Corps, U.S. Agency for International Development – and others • Results oriented: links performance and funding with strong strategic information element • Network model: links prevention, treatment and care • Three Ones is the guiding principle: success depends on building in-country ownership, capacity and leveraging all sectors of society • Sustainability/New Partners

7. New Leadership Model:US Global AIDS Coordinator • Lead USG international HIV/AIDS efforts • Ensure USG program and policy coordination • Pursue coordination with other countries and international organizations • Resolve policy, program and funding issues among USG agencies • Directly approve all USG HIV/AIDS activities • Promote accountability and monitor progress toward meeting Emergency Plan goals

8. What supports interagency collaboration? • Deliverables: • PHASE I: 5 Year Strategies, Annual Country Operational Plans • PHASE II: Partnership Compact Agreements, Annual Country Operational Plans • Final funding approval by Global AIDS Coordinator • MOAs signed by Coordinator with Agencies • Structures: • HQ: Principles, Deputy Principles, Core Teams, TWGs, PAWG • Field: In-country cross-agency structure lead by Ambassador • Processes: • HQ: interagency reviews COP, compacts, joint TA to field • Field: Joint planning, portfolio reviews, site visits, Staffing for Results

9. PEPFAR Washington Structure - OGAC • Coordinator • Policy Advisor • Program Services • Management and Budget • Strategic Information • Multilateral Diplomacy • Public Affairs • Congressional Relations • New Partner Outreach • Public Private Partnerships • Management Services

10. HQ Interagency Leadership Structures • Policy Group/Principals • Deputy Principals • Core Teams • Technical Working Groups • Scientific Steering Committee • PHE Subcommittee • Care and Treatment Coordinating Committee (CC), Prevention CC, and Strategic Information CC • Ad hoc task forces (e.g. gender, male circ, etc.)

11. In-Country Team • Led by the U.S. Ambassador • Multiple U.S. agency representation in-country • One program, one reporting system • Collaboration with country leadership and other donors/partners, support for “Three Ones”

12. Overall Coordination Host Government In-Country Partners International Partners Implementing partners Other stakeholders • USG Team • U.S. Ambassador • PEPFAR Coordinator • Embassy Staff • USAID • Peace Corps • HHS • DoD • DoL • DoC Headquarters Global AIDS Coordinator Principals Deputy Principals Core Teams Technical Working Groups Agency Support

13. Recent USG Spending on Global HIV/AIDS Under PEPFAR, the U.S. Government has committed $18.8 billion to the fight against global HIV/AIDS, exceeding its original commitment of $15 billion over five years.

14. PEPFAR Funding Flow

15. International HIV/AIDS Commitments, by Donor, 2007 • In 2007, the United States was the largest donor in the world, accounting for approximately 55% of commitments by governments. • Among resources available in 2007 for the fight against AIDS in low-and middle- income countries from all sources (domestic and international), the U.S. accounted for 20%, the largest share. *Source: http://www.pepfar.gov/documents/organization/107828.pdf

16. The Focus Countries • Under the first phase of PEPFAR, the program has been working around the world, with a special emphasis on 15 focus countries. These countries are home to approximately half of all the world’s HIV infections. • These countries were picked because, with U.S. support, they should be able to achieve national scale-up of HIV/AIDS prevention, treatment and care by 2009.

17. PEPFAR Worldwide Activities

18. FY 2008 Spending for Prevention, Treatment and Care in Focus Countries

19. Progress in PEPFAR Support for Treatment Coverage in Select Focus Countries, FY2004-FY2007 2004 2005 2006 2007

24. Latest Program Results PEPFAR has supported in the 15 focus countries Through March 31, 2008: • Prevention of mother-to-child HIV transmission services for women during nearly 12.7 million pregnancies • Antiretroviral prophylaxis for women in more than 1 million pregnancies • Prevention of an estimated 194,000 infant infections • Antiretroviral treatment for more than 1.64 million people Through September 30, 2007: • Care for more than 6.6 million, including care for more than 2.7 million orphans and vulnerable children • Over 33 million counseling and testing sessions for men, women and children

25. Beyond 2008: The Next Phase of PEPFAR • The American people will continue to stand with our global sisters and brothers as they take control of the pandemic and their lives and restore hope to individuals, families, communities and nations. • This legislation will increase the U.S. financial commitment to the fight against global HIV/AIDS, tuberculosis, and malaria, authorizing up to $48 billion to combat the three diseases, including: • $39 billion for: • PEPFAR bilateral HIV/AIDS programs • U.S. contributions to the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria • $5 billion to: • The President’s Malaria Initiative to fight malaria through bilateral programs around the world • $4 billion for: • Bilateral programs to fight tuberculosis, which is the leading killer of Africans living with HIV

26. Beyond 2008: 10-Year Program Goals Working in partnership with host nations, PEPFAR will support: • Treatment for at least 3 million people • Prevention of 12 million new infections • Care for 12 million people, including 5 million orphans and vulnerable children • To meet these goals, PEPFAR will support training of at least 140,000 new health care workers in HIV/AIDS prevention, treatment and care.

27. Beyond 2008: Emphasizing Continuation and Expansion • Continuation: HIV/AIDS treatment, prevention and care are life-long needs, and the American people will continue to support those served during PEPFAR’s first five years. • Expansion: PEPFAR will further expand efforts to strengthen health systems and to collaborate with programs that address malaria, tuberculosis, child and maternal health, clean water, food and nutrition, education, and other needs.

28. Beyond 2008: Bilateral Partnership Compacts • PEPFAR resources and other commitments will increase in partnership with countries dedicated to fighting their HIV epidemics. • Through these compacts, host nations will strengthen their collaboration with the U.S. Government by: • Increasing their own resources, according to economic ability, for HIV/AIDS and health systems so that the combined resources can achieve clear goals. • Implementing policies and practices to optimize effectiveness of resources in key areas

29. Beyond 2008: Multilateral Partnerships • The U.S. Government, through PEPFAR, will help to bolster multilateral efforts by continuing to engage international organizations as partners and to put accessibility, quality and sustainability at the center of all HIV/AIDS work. • This complex effort requires close cooperation with the Global Fund to Fight AIDS, Tuberculosis and Malaria; the Joint United Nations Programme on HIV/AIDS (UNAIDS); and other international partners. • The U.S. is the first and largest contributor to the Global Fund to Fight AIDS, Tuberculosis and Malaria. To date, the U.S. has contributed more than $2.5 billion to the Global Fund.

30. Inspiring a Global Response • Responding to President Bush’s call for PEPFAR reauthorization, in June 2007 the United States and other G8 nations set ambitious goals to collectively support: • Treatment for a total of 5 million HIV-infected individuals • Prevention of 24 million new infections, and • Care for 24 million people, including 10 million orphans and vulnerable children

31. Thank you For further information, please visit: www.PEPFAR.gov