While issues such as maternal health, and male circumcision, the needs of men who have sex with men (a first at this meeting), and new research were on the table, the impact of the international financial crisis on HIV/AIDS program funding was threaded throughout the proceedings.[iv] 

 

“We cannot afford to have duplications of efforts,” said Michelle Moloney-Kitts, PEPFAR’s Assistant U.S. Global AIDS Coordinator.[v] This sentiment was echoed by other participants at the conference, who noted that ineffective or inefficient programs not only waste money but cost lives.[vi]            

 

“I don’t care whether you are talking about shoes, or coffee, you need to find ways to produce them efficiently,” said Stefano Bertozzi, executive director of the Center for Evaluation Research and Surveys at Mexico’s National Institute of Public Health. “But it turns out in HIV you can stay in business even if you don’t produce your shoes efficiently.”[vii]

 

Others worked to remind nations and donors how important it is to continue to fund HIV and AIDS related programs, despite the economic downturn. Paul De Lay, UNAIDS Deputy Executive Director, told participants in his opening remarks that “the life saving programs you are putting into place will yield dividends that last for generations.”[viii]

 

Prevention was also stressed as a potential cost-saving strategy, as new infections outpace the number of persons getting into treatment programs.[ix] Presenters discussed the importance of first identifying the nature of a region’s epidemic, including specific high-risk groups and modes of transmission, and then targeting effective “combination prevention” programming—a range of interventions that deal with behavioral, biomedical, and structural factors.[x]

Participants agreed that programs should be locally led and owned to encourage sustainability. “Communities need to decide what’s going to work for them…. And they need to…take charge of the programs. That’s the only way you’re going to ensure long-term continuity, as well as that the programs are really relevant,” Maloney-Kitts said.[xi]

 

Others saw the way forward as an opportunity. “I have to say the discussions have been sobering. Yet I sense a problem-solving spirit and determination on implementers’ part to focus on the things they can control—making programs as effective and efficient as they can possibly be,” said Tom Walsh, then-acting U.S, deputy global AIDS coordinator and PEPFAR’s chief of staff.[xii]

 

The lessons learned from the conference will certainly influence the work of incoming U.S. Global AIDS Coordinator Dr. Eric Goosby. The agency had postponed several key decisions until a permanent leader was confirmed by the Senate.[xiii] Now, many are anxious to see what direction the U.S. will take in the global fight against HIV/AIDS under Dr. Goosby’s leadership. During his confirmation hearing, he seemed optimistic about the role of the U.S. in the global war on HIV: “My mission if confirmed will be to ensure that PEPFAR continues to be a visionary program, a program that continues to exceed our expectations of what can and should be provided to people in resource-poor settings” he said.[xiv]

 

Although U.S. government representatives had hoped that Dr. Goosby’s confirmation would be fast-tracked in time for him to attend the Implementer’s Meeting, he was not confirmed until June 22, 2009—a week after the meeting concluded. “It’s a shame he’s not here,” said one veteran PEPFAR who wished to remain anonymous. “It would have saved him a year of travel just to be here to meet people and learn about the status of programs.”[xv]

 

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