• The first question touched on the Ambassador’s recent statement that “achieving universal access to ARVs [antiretroviral drugs for HIV treatment] in South Africa by 2015 was not realistic.”[iii] In response, Ambassador Goosby reiterated that running a sustainable PEPFAR program required a more holistic focus—a balance must be struck between delivering HIV/AIDS specific care and “broader development models, such as microfinance.”[iv]

• Another question addressed the recent considerations to start treatment sooner, when CD4 counts are higher.[v] Ambassador Goosby explained that while research supports this change, it is unclear how it will affect the ability of PEPFAR to deliver care. Further, if treatment does begin earlier, “we expect the number of eligible patients will rise up to two to four times…and will give us another stress on the system for cost and meeting those needs…Countries will decide if they’re going to embrace it and if so, how they will find the resources.”[vi] He added that PEPFAR is currently working to engage multilateral and country conversations to resolve the issue.

• Ambassador Goosby also responded to a question concerned with “new program directives that reflect more evidence-based prevention policies.”[vii] He explained that PEPFAR will present a “menu of options” and allow countries to decide which are most appropriate for their local populations, instead of being overly prescriptive as U.S. program directives have been in the past.[viii] Ambassador Goosby specifically referenced needle exchange programs as fundamental elements of such a tool box, although it is unclear what other strategies would also be incorporated. In addition, the Ambassador emphasized that the State Department is committed to working “with countries and communities to overcome stigma and discrimination that forces many at risk populations like injection drug users and men who have sex with men into hiding and further decreases the likelihood that they will actively seek services.”[ix]

• One advocate asked about a possible timeline for issuing new prevention policy guidance, to which Ambassador Goosby responded that no specific timeline existed and that the Office of the Global AIDS coordinator was wary of being “overly proscriptive” about how countries should approach HIV prevention interventions. “While we are thrilled at the new administration’s commitment to evidence-based prevention strategies, it is imperative that the Office of the Global AIDS Coordinator issue clear interpretations of PEPFAR’s mandates to prevent any confusion on the ground,” responded William A. Smith, vice president for public policy with the Sexuality Information and Education Council of the United States.

• Finally, the Ambassador discussed implications of the administration’s new Global Health Initiative, which stressed HIV/AIDS relief as an elemental component, as well as intense focus on delivering services to women. He explained that PEPFAR will be adjusted to incorporate this focus. For example, Ambassador Goosby stated that “a woman who seeks care at a PEPFAR clinic might also get reproductive health care services, with PEPFAR resources, if those would not be otherwise available to her. [Secretary Clinton] has set priorities with an eye on women, and to me, that’s a no-brainer,” [x]

The Forum highlighted the shift in the new administration toward sustainability but also toward a more comprehensive approach to HIV/AIDS-related services. It will be up to all stakeholders involved to continue mounting pressure to ensure the Office of the Global AIDS Coordinator follows through with these commitments.