Revamping AIDS strategy at home, Obama looks to what worked for Bush worldwide

Obama looks to Bush’s worldwide strategy on AIDS

JOHANNESBURG — President Barack Obama is trying to bring home some of the much-lauded strategies his predecessor used to fight AIDS around the world.

The national strategy for combatting HIV and AIDS the Obama administration released Tuesday credits the Bush-era international campaign against AIDS for setting clear targets and ensuring a variety of agencies and groups worked together smoothly to achieve them.

George W. Bush launched the President’s Emergency Plan for AIDS Relief, or PEPFAR in 2003 in 15 countries, 12 of them African, that bear most of the world’s AIDS burden. It has helped to treat more than 2 million Africans and supported 10 million more.

“The people here are so incredibly grateful for the impact it has had,” said Kate Bistline, an official with Right to Care, a South African AIDS group that receives PEPFAR funds.

Bistline said a key to PEPFAR’s success has been having simple, compelling goals — preventing new HIV infections, treating people with AIDS and caring for orphans and others affected by AIDS.

“It’s there, it’s clear, and it’s something you can grab onto,” she said. “PEPFAR’s been quite good about communicating what its overall goal is, and … making everybody feel we’re working toward the same goal. And that’s not always the case with a big international donor.”

Bistline also praised PEPFAR for encouraging government agencies, aid groups and private companies to work together. Her own group, for example, might extend training and other services to a private clinic. There, doctors also would see poor patients who pay little or nothing, and rely on government testing labs.

“All of us working together can make sure that HIV services are available in very remote areas that any of us alone would be unable to serve,” Bistline said.

An alphabet soup of U.S. agencies works on PEPFAR around the world. The CDC, the Centers for Disease Control and Prevention. HRSA, the Health Resources and Services Administration. USAID, the U.S. Agency for International Development.

The U.S. agencies work with South African and other governments, the World Bank, the Global Fund. It could be a recipe for confusion. But Ruth Stark, who directs programs in South Africa for Catholic Relief Services, said that since she started receiving PEPFAR funds in 2003, “it has been very well coordinated.

“You didn’t have to worry that one agency would be saying things different from another, and another,” she said.

She also praised PEPFAR for eliminating unnecessary paperwork, allowing doctors and nurses to concentrate on helping patients, not filling out forms.

“Obviously we have to account,” she said. “But what I can say is that I’ve seen over the years them really trying to get down to what’s the essential they need to know.”

Catherine Connor, a top official with the Elizabeth Glaser Pediatric AIDS Foundation said that while the U.S. was able to create systems overseas, the challenge at home has been integrating existing private, public, regional, state and local approaches to combating AIDS and providing health care.

“We didn’t have a coordinated strategy,” added Dr. Stephen Lee, head of prevention, care and treatment services for the Glaser foundation. “It took us awhile, but we are there.”

Stark, of Catholic Relief Services, was pleased to hear PEPFAR was a model.

“It’s very nice to see the world learning from Africa,” she said.