US on target with AIDS goals, top official says

WASHINGTON, DC—One month before the International AIDS Conference, the top US official overseeing the global AIDS fight today said that the Obama administration was on target for meeting goals for putting people on treatment, reducing the number of babies infected with HIV, and expanding male circumcisions – but he acknowledged that the circumcision effort was tough going.

Last December, President Obama set goals for US support to increase the number of people on AIDS treatment to 6 million by 2013, from 4 million at the end of 2011; to give antiretroviral drugs to 1.5 million more HIV-positive pregnant woman; and to increase the number of male circumcisions to 4.7 million men, up from 1 million at the end of 2011.

“We believe we are on track to achieve all of those goals,” said Ambassador Eric Goosby, the US global AIDS coordinator. “Since 2009, we have expanded all portfolio areas of care, prevention and treatment.”

Still, Goosby told an audience at Brookings Institute, scaling up male circumcision is a “slower process. We’ve learned this by direct experience. Having political buy-in is difficult to get.”

Goosby said US efforts have sometimes emphasized supply over demand, when creating demand for circumcisions should have been the top priority. He called it “putting the cart before the horse,” and said of the three priority goals, circumcision is “going to be the most challenging to achieve, but we are positioned to achieve it.”

More from GlobalPost: A Q&A with US global AIDS coordinator Eric Goosby

In preventing HIV infection of newborns, Goosby said the administration is working with UNAIDS, UNICEF, the World Health Organization, and other partners to map out areas of greatest need. Roughly 390,000 babies are born with HIV every year; the US has set a goal of zero infections by 2015. The HIV infections, Goosby said, largely occur in 30 countries, and 22 of them are in sub-Saharan Africa. He said country PEPFAR plans have identified problem areas and “I am confident with our current plan … we will be moving aggressively toward an AIDS-free generation.”

Still, doubts linger with advocates about all of the administration’s goals, especially given concerns about whether the United States, other donors, and developing countries can increase funding or find major savings in order to meet scaled-up demand for these services.

Goosby said that in order for countries to move toward an AIDS-free generation, and to greatly improve health services overall, they need to start owning the process. This country-ownership movement, which formed the crux of his address, has been one of the key changes in global health over the past few years, he said.

For instance, he said that PEPFAR – the President’s Emergency Plan for AIDS Relief – has signed 22 partnership framework agreements with developing countries since 2009. These agreements lay out responsibilities of all parties, and give countries more say and better coordination over the funding of health projects.

Goosby called it “a new era of collaborative planning.” He was set to leave Monday night for Haiti, in order to to sign a new partnership agreement with officials there.

One short-term irony is that the framework agreements — while in the long run hoping to establish more effective delivery of health services — have significantly delayed US spending in many countries. The PEPFAR program has identified a backlog of nearly $1.5 billion in unspent AIDS funding dating at least 18 months from Congress’ appropriation, and one of the reasons is that the frameworks have taken months, or years, putting some projects on hold.

More from GlobalPost: US reveals nearly $1.5 billion in unspent AIDS money