Mark Dybul – Obama’s Global AIDS Coordinator, Too?

Will President-Elect Obama keep Mark Dybul on as Global AIDS Coordinator, when Dybul has supported ideological restrictions on prevention funding?

Sexual and reproductive health advocates in Washington are hearing rumors they’re not pleased about: that Mark Dybul, US Global AIDS Coordinator, may stay on into the Obama administration – for the first year of President-Elect Obama’s term, or indefinitely.  While there is not total consensus among HIV advocacy and sexual health groups in opposition to his re-appointment, the majority say it’s time for new leadership.  Why?

Dybul is responsible for implementation of the President’s Emergency Plan for AIDS Relief, or PEPFAR, a program that has made an unprecedented financial investment in fighting HIV/AIDS in 15 focus countries worldwide.  Yet PEPFAR is widely-regarded as fundamentally compromised by a host of ideological restrictions that Dybul has supported, interpreting policy as narrowly as possible.

"PEPFAR has made progress in providing more people with access to anti-retroviral medication, but the approach has not been far-sighted in terms of prevention," says Kelly Castagnaro of the International Women’s Health Coalition. "The failure on the prevention side can’t continue if we are going to see progress in stemming the pandemic."  Dybul, a medical doctor, has been criticized for focusing exclusively on a medical and behavior-change response to the global AIDS pandemic, rather than building into PEPFAR mechanisms that take into account public health realities and promote human rights.  "Dybul has a medical background, and the next appointment should be someone who has experience in gender equality and human rights to ensure a more comprehensive response that addresses the vulnerability of women and girls," Castagnaro continues.  "Provisions in current PEPFAR, such as the current prostitution pledge, ignore human rights.  It ignores that sex workers can be powerful agents for change when it comes to HIV/AIDS." Jodi Jacobson, who chaired the Prevention Working Group of the Global AIDS Roundtable, has outlined a PEPFAR that promotes human rights on Rewire.

Health GAP’s Kaytee Riek draws attention to the fact that "not enough progress has been made to address the lack of health care workers.  Considering that this is what we need to make PEPFAR sustainable in the long run, hopefully a new doctor would take the need to train new doctors and nurses seriously."

Would keeping Dybul on represent a change in course for the President-Elect?  While Obama has not specifically disavowed PEPFAR’s ideological restrictions, his global AIDS plan, laid out during the campaign, is uncompromising on the need to put science before ideology, and to make certain the US is not funding ineffective programs. The "Barack Obama-Joe Biden: Fighting AIDS Worldwide" plan states, "The U.S. has dramatically increased funding for global HIV and AIDS programs through the President’s Emergency Program for AIDS Relief (PEPFAR), but the program has faced controversy.  Barack Obama believes that our first priority should be to implement the recently signed President’s Emergency Plan for AIDS Relief (PEPFAR), legislation Barack Obama long-supported, to ensure that best practices – not ideology –  drive funding for HIV/AIDS programs."  "Obama has made some very bold commitments around global AIDS, and it’s going to need to be a priority for him to implement the plans that he laid out during on the campaign," says Riek.