PEPFAR is ten years old so it is time for an evaluation. You can download the evaluation report.
Warning - This report is ten megabytes. http://www.iom.edu/Reports/2013/Evaluation-of-PEPFAR.aspx
Prevention was clearly recognised by the evaluation team as a weakness. And it was not measured well.
It is interesting that counselling and testing have been included under a prevention category for PEPFAR budgeting and reporting for the last three years. Though they have little or no impact in preventing HIV acquisition. The evaluators missed the latest evidence review. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001224.pub4/abstract This practice also inflates the prevention budget so that it appears that more funding is going into prevention.
A few 'clips' are below.
[him] moderator
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"One critical need is to improve ... prevention services aimed at reducing HIV transmission."
"Targeting the specific populations that are vulnerable to HIV infection and transmission, which differ by country, is critical for prevention. Notwithstanding some restrictive U.S. and partner country policy and legal environments, PEPFAR has made progress in this area through its support for data collection in specific populations and for prevention and harm reduction programming; these efforts have resulted in positive effects for populations at elevated risk, including men who have sex with men, people who engage in sex work, people who inject drugs, and other populations identified as vulnerable. Populations at elevated risk remain an important focus for prevention programming, and they also continue to struggle with barriers to accessing care and treatment services."
"To contribute to the sustainable management of the HIV epidemic in partner countries, PEPFAR should support a stronger emphasis on prevention. The prevention response should prioritize the reduction of sexual transmission, which is the primary driver of most HIV infections, while maintaining support for interventions targeted at other modes of transmission. The response should incorporate an approach balanced among biomedical, behavioral, and structural interventions that is informed by epidemiological
data and intervention effectiveness evidence. PEPFAR should support advances in prevention science to expand the availability of effective interventions where knowledge is lacking."
"Today, the potential impact of counseling and testing on directly reducing HIV incidence is unclear, with studies showing both decreases and increases in sexual risk behavior following counseling and testing and the knowledge of one’s serostatus (Corbett et al., 2007; OGAC, 2011d; Sherr et al., 2007; Sweat et al., 2000; The Voluntary HIV-1 Counseling and Testing Efficacy Study Group, 2000; Weinhardt et al., 1999).
From the start of PEPFAR through FY 2008, the budget for counseling and testing activities was captured as a part of the larger technical area of HIV Care (OGAC, 2005b, 2006c, 2007c, 2008c). In FY 2009 the budget code was relocated to the technical area of Prevention, and as a result, funding for counseling and testing has since been included by PEPFAR in overall spending on HIV prevention efforts"
“I think one of the great challenges for PEPFAR has been on the one hand, professing to be evidence driven and interested in best practice and standards for HIV prevention treatment and care and at the same time, being constrained by the very real political realities of the US where both sex work and injection drug use have beenidentified as things that the US should not be funding.”
(NCV-24-USNGO)
