Advocates for both global AIDS and women’s health and rights are circulating two letters, each of which seeks to influence the Obama Administration’s pick for the next Global AIDS Coordinator. Though they differ on both the structure of AIDS leadership and the timing of the appointment, both groups agree on the need for new leadership for global AIDS policies.
The first letter, circulated by Results, an anti-poverty and global health organization, urges Obama to appoint a coordinator within 30 days of inauguration. This letter was submitted last week to the Obama transition team, with 20 signatories. Apart from the call for a quick appointment, another concern driving this letter is the issue of where the "base of power" for U.S. Global AIDS Policy should rest in the next Administration.
The first US global AIDS Act established the Office of the Global AIDS Coordinator (OGAC) at the Department of State and gave the new Coordinator decision-making authority over all funding for AIDS, whether it flowed through the US Agency for International Development (USAID), Health and Human Services (HHS) or the Centers for Disease Control (CDC). Talk of folding OGAC into a revamped development agency–USAID 2.0, so to speak– has these advocates concerned.
According to Matthew Kavanaugh, Global Campaigns Coordinator at Results:
There has been talk about subsuming the Global AIDS Coordinator
role under USAID or possibly of waiting for months before appointing a
permanent Global AIDS Coordinator—whomever that might be. We think
both of these would be the wrong direction to take PEPFAR. Instead we
need to build on PEPFAR’s huge successes, especially as compared to
many other aid programs, as well as prioritizing fixing the big
problems with prevention and systems—all of which requires a powerful
Global AIDS Coordinator with a direct line to and trust of
John Fawcett, Global Legislative Director of Results further notes that:
In the broader context of foreign aid reform, several prominent development groups have recommended that Obama appoint (and have the Senate confirm) a USAID Administrator, and then name that person interim Global AIDS Coordinator. While we support calls for the elevation of foreign assistance, this particular recommendation handicaps AIDS leadership at a critical moment, just when we need…bold new plans to prevent 12 million new infections, treat 4 million, care for 12 million, and fix the things that Lantos-Hyde failed to address.
The second letter, issued jointly by the International Women’s Health Coalition (IWHC) and the Sexuality Information and Education Council of the United States (SIECUS), which was submitted to the transition team on December 23rd with 49 signatories on and can now be found on Change.gov, focuses more directly on the vision and philosophy of the next AIDS Ambassador, rather than the timing of the appointment, but also is driven by concerns about the agency. According to Bill Smith, Vice President for Public Policy at SIECUS:
We are seeking to elevate the voice of advocates and implementers who believe we cannot continue under the existing leadership of the US global HIV/AIDS response. There are several key shortcomings in the PEPFAR reauthorization, particularly in the area of prevention, which require someone who can oversee the changes needed ranging from clarification of guidance to implementation of evidence-based programs. An effective response to the current global HIV/AIDS epidemic requires an understanding of the social and economic factors which drive the epidemic and a solid grounding in public health and human rights frameworks. We have learned many valuable lessons during the first five years of implementation and now is the time to act on that knowledge by appointing someone who can guide the U.S. response to the global HIV/AIDS epidemic with visionary leadership. We are therefore calling on the President-elect to appoint a Global AIDS Coordinator who can lead the transition from a disease-specific, medical model to one which embraces, and can carry out, a broader vision.
Smith also notes that a key difference in the two letters is the concern about OGAC’s "location."
The letter circulated by RESULT focuses on securing a “permanent” and independent Global AIDS Coordinator and speaks to the possibility that OGAC would be restructured to fall under the head of USAID. It addresses the concern that this shift from an independent office, with ambassador-level leadership would make it difficult to leverage cooperation from agencies/offices such as CDC, HHS etc as OGAC would no longer wield a higher political rank.
The IWHC/SIECUS effort seeks to ensure that OGAC operates within a broader development framework, with greater coordination, cooperation, and integration of programs that must simultaneously address both immediate medical and public health problems as well as the root causes of the spread of HIV infections. An example would be the more effective coordination at the country level of HIV/AIDS prevention, treatment, and care with other reproductive health and family planning services, and with programs to promote basic education, eliminate child marriage, and address gender-based violence.
The full text of each letter can be found below. Reality Check will update you on next steps.
The text of the letter being circulated by Results:
Dear President-Elect Obama:
We are writing to urge you to affirm the United States’ continued leadership on HIV/AIDS by appointing a permanent Global AIDS Coordinator within 30 days of assuming the Presidency. A strong, independent Coordinator role has been critical to providing focused leadership on the AIDS crisis and achieving tremendous results to date.
We are grateful for your support of global health while in the Senate, and for your pledge to double foreign assistance, including $50 billion for HIV/AIDS. Led by Senator Joe Biden, the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (P.L. 110-293) was a major bipartisan achievement.
While the Lantos-Hyde Act charts a path forward, now is not the time to put our global AIDS program on auto-pilot.
The Global AIDS Coordinator in the Obama administration will be immediately responsible for developing a new five-year global AIDS strategy that will shape our response to the epidemic well into the next decade. Our shared goals are ambitious: 12 million new infections prevented, with a renewed emphasis on the evidence-based approaches and the needs of women and girls; care for 12 million people affected by AIDS, including 5 million orphans and vulnerable children; four million people supported on treatment though bilateral and multilateral funding; 140,000 new health care professionals trained and retained; and improved efforts to fight co-morbidity associated with tuberculosis, malaria, and malnutrition among people living with HIV/AIDS.
The realization of these goals will require more than competent administration. It will demand vision and leadership to usher in a new era of bold U.S. action on the global AIDS epidemic.
We support calls to elevate the priority of global development within your administration. We look forward to working with you to support a strategy to reform foreign aid to make the Millennium Develop Goals truly America’s goals. However, more effective, better coordinated assistance must be pursued without diminishing focused leadership on AIDS or prematurely consolidating roles and responsibilities.
We urge you to reaffirm our commitment to the fight against HIV/AIDS by prioritizing the appointment of a Global AIDS Coordinator within the first month of your Administration. Sincerely…..
The text of the letter being circulated by IWCH and SIECUS:
Dear President-Elect Obama:
As advocates engaged in the work of ensuring the most effective and appropriate global HIV/AIDS response that the United States can offer, we call upon you to appoint a new Global AIDS Coordinator within 30 days of assuming the Presidency. We have reached a critical moment in the history of the global HIV/AIDS epidemic as this next phase of PEPFAR is set into motion through the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008 (P.L. 110-293). In order to fulfill the mission laid out therein, and to lead the response from an emergency approach to one of sustainability, new leadership is required.
From the outset, PEPFAR has been guided by a disease-specific medical model in lieu of a broader human rights framework and public health approach which is needed to more effectively address the epidemic. While excellence in medical care and services are a fundamental element in the global HIV/AIDS response, the new strategies undertaken by the Coordinator will have more impact if they are guided by a keen insight into the social complexities which drive the HIV/AIDS epidemic. We cannot treat our way out of the gender inequalities, social and economic disparities and stigma and discrimination which fuel this global pandemic. The inherent strategy steering the U.S. response to global HIV/AIDS must embrace all of these aspects– medical, social science, public health and human rights– to create and oversee PEPFAR-funded programs around the world. A new Coordinator that upholds the highest standards of prevention, care and treatment, relying on strategies and protocols that are evidence-based, to accurately respond to the needs of those who are most affected will make more headway than has been achieved in the past.
Ending the epidemic requires going beyond the medical model currently driving the U.S. global HIV/AIDS response, which means appointing a new Global AIDS Coordinator who can provide that strategic vision from the top. Sincerely,