I was thrilled to have the opportunity to interview Ann Gavaghan, chief of staff at the State Department’s Office of the US Global AIDS Coordinator, about the future of the HIV/AIDS epidemic and the tremendous success of PEPFAR. Below are Gavaghan’s on-the-record responses, including a special message for ONE members.
We were thrilled to hear from UNAIDS that 6.6 million people are now on treatment globally, thanks in part to the enormous success of PEPFAR. What do you think has contributed to this success and what more needs to be done?
There are several factors that have contributed to this success -– first, the infrastructure is now in place to support treatment, so that care is more accessible for people, even at the village level. Clinics are able to provide treatment; it’s no longer just limited to the hospital level.
In addition, drug prices dropped dramatically, making care more affordable. And people in communities also are more active in seeking treatment because they have seen the impact it had on their families and friends.
However, we need to get more people tested before they get sick. We need more partners to start taking on treatment –- national governments, donors and private sector. And we need to do a better job of tying treatment into the broader health care system, so that people living with HIV can stay healthier longer.
As PEPFAR shifts from being an emergency response to taking a longer-term focus, what changes do you think we can expect to see? How will your relationship with the Global Fund evolve?
First, we’re working to emphasize our partnerships with the countries where we work. We’ve developed Partnership Frameworks -– five-year joint plans with governments where we outline the roles of the US government and our partners. We’re also placing a greater focus on health systems strengthening, to figure out how PEPFAR investments can support the entire service delivery system for communities impacted by HIV/AIDS.
Our relationship with the Global Fund has always been focused on how our programs complement each other on the ground. However, PEPFAR is increasing its engagement with the Fund. Last year, the US made its first-ever multi-year commitment to the Fund. On the program side, PEPFAR is working to ensure its country level investments are informed by and coordinated with investments from other sources, including the Global Fund and country governments.
PEPFAR is a big part of the Obama Administration’s Global Health Initiative. From your perspective as one of the GHI Deputies, how do you balance communicating the specific goals and successes of PEPFAR with the broader successes of our investments in global health?
Talking about PEPFAR’s goals and successes contributes to the conversation around the overall US government success in global health. In PEPFAR, our goal right now is to make sure we’re building upon our successes to achieve broader health outcomes. If we have contributed to a stronger clinic system, are training health workers, or are supporting a drug delivery system, how can we leverage those assets to support better health for communities that have been hardest hit by HIV? At the end of the day, we want to make sure that the woman living with HIV is able not only to get treatment when she needs it, but also access antenatal care, pediatric care, and the health services that her entire family needs. Our investments in PEPFAR are improving entire health systems and helping with better health outcomes across the board.
We heard a rumor that you’re an AIDS activist by day and a food blogger by night on your food blog Pie vs. Cake. Aside from being a really cool hobby, this reminded me of the debate around treatment vs. prevention for HIV/AIDS. At the end of the day, don’t we really need both?
Absolutely. The treatment vs. prevention debate presents us with a false choice. It’s not an either/or decision, and it’s exciting to be working on HIV/AIDS issues at a time when there’s emerging evidence regarding treatment as prevention. It’s also encouraging to see the impact that we can have through specific prevention interventions, like male circumcision.
PEPFAR is already the largest funder of HIV treatment worldwide, directly supporting more than 3.2 million people on treatment. We continue to rapidly scale up antiretroviral treatment towards the goal of directly supporting more than 4 million people. These treatment efforts complement and expand upon PEPFAR’s ongoing prevention programs, which have reached millions and saved lives.
How did you initially become involved in global health and work around HIV/AIDS?
I’ve been involved in HIV/AIDS since college, when I served as a peer educator. After college, I moved to Taiwan and was involved with the local AIDS activist community, addressing HIV in a concentrated epidemic. It was great to be working in a community setting -– doing outreach, providing safe spaces for testing, helping to establish temporary housing, and learning from people who were struggling against stigma and discrimination on multiple fronts. Since that time, I’ve been working on HIV/AIDS at a variety of levels, both for local organizations and at the national level with the federal government.
What message can you provide to the more than 2.5 million ONE members around the world who have advocated on HIV/AIDS issues for years?
First of all, thank you –- the work that you are doing has been a vital driver of strong US support for the fight against HIV/AIDS. Your efforts remind people of the lives that we are saving every day.
The fight against AIDS is not over. Treatment, care, and prevention programs have saved lives, but we’re still facing a world where 33 million people are living with HIV/AIDS, with more getting infected every day.
The good news is that we’re at a point in this epidemic where there is growing hope -– the promise of new scientific advances allows us to think of a day when this epidemic will truly be behind us. It’s going to require a lot of hard work and support to get there, and continued support from ONE members and the global health community will be essential.