A brief background of PEPFAR

By request, here's some more information about what exactly I'm doing for work in Zambia. I’ll give you a warning that I can’t talk in too many specifics due to the fact this is a public blog. A lot of the work I do deals with sensitive information, however if you have a question, please ask. I’ll go into greater detail if I can.

Let’s give some background: The bulk of the funding and programming for CDC’s international work is geared toward The President’s Emergency Plan for AIDS Relief (PEPFAR). PEPFAR started a little more than five years ago as a coordinated international effort between the Department of State (DOS), United States Agency for International Development (USAID), Department of Health and Human Services (HHS), and the Department of Defense (DOD). CDC is part of HHS. While we get most of the money given to HHS there are a few lines of PEPFAR funding that go through the National Institute of Health (NIH) and Health Resources and Services Administration (HRSA), which are also part of HHS. Peace Corps volunteers in many countries are also PEPFAR funded. (Confused with all the acronyms yet?)

PEPFAR originally started with 14 focus countries, but quickly spread to work in over 100 nations world wide. CDC did not have a large international presence before PEPFAR, so the offices in the field are fairly new. In contrast, USAID has been on the ground working in some of these countries for 50 years.

There are 19 different program areas in PEPFAR which include things like prevention, patient care, treatment, counseling, testing, prevention of mother to child transmission, and TB/HIV co-infection programs. In the international community, AIDS, TB and malaria are often fought using the same programs as so many people have more than one of these diseases at a time. AIDS is not what generally kills a person, but rather another infectious disease caught because the body's immune system is suppressed. Although transmitted in different ways, both tuberculosis and malaria have a high prevalency in most of the countries that we work. So programs reach a greater population by educating, testing and treating patients for multiple problems.

One of the main focuses of PEPFAR is to increase the local capacity for health care. Understand that in most of these countries there are very few hospitals and even fewer clinics from which to obtain health care. People wait for hours in line just to be seen by someone and those are the people that can afford the cost. Although the cost maybe only $1, in a place where most people live in extreme poverty, this could be a week's worth of wages. So now there is a choice: Do you buy food for your family or seek medical care? Moreover, a person might have to walk 5k to even get to the clinic itself. Imagine walking a 5k when you don't feel good, let alone when you have something as bad a TB or malaria. Thankfully, PEPFAR and many other international programs are addressing these issues to make health care more accessible and affordable.

Through mainly grants, we teach local organizations and the ministry of health a lot of basic skills like how to screen blood samples for HIV and how to handle samples and needles safely. We train more people to become health care professionals, we provide access to essential medicines and Anti-Retro Viral (ARV) therapy. (This is the cocktail of drugs that has keeps the infection to HIV level and drastically prolongs life.) There are also a lot of programs that educate what HIV is and how it is transmitted and to get rid of the stigma of getting tested. This includes dispelling myths like: "having sex with a virgin gets rid of HIV," or "If my partner doesn't have HIV, neither do I." The point is not only to provide increased services, but to create a health care system within the country so that it can be self-sustaining. We don't intend to stay here forever. The best thing that we can hope for is that we work ourselves out of a job, that these countries can handle health problems on their own and that some of these epidemics are no longer a problem.

Obviously, I could write a masters thesis on the problem of AIDS in Africa and how we are addressing it, so please accept this watered down version. If you're interested more in Zambia and how it's doing with health and development, I invite you to read the World Bank profile on Zambia. If you have question, let me know. I'm happy to translate jargon. :)