February 1st, 2009

Whither PEPFAR?

Mark Dybul will no longer be running the President’s Emergency Plan for AIDS Relief, or PEPFAR, the multi-billion dollar international program for HIV treatment program started by Bush in 2003.

Some are happy.  Others are not.

(Note the exquisite use of euphemism — he was “required to submit his resignation“, not “fired.”)

Experts on global HIV treatment can debate the pros and cons of this move, but can anyone truly be surprised?  In this most highly politicized of diseases, how could we expect otherwise?

Right from the start, I viewed PEPFAR as kind of like a lifesaving medication that had a few side effects that you wished weren’t present, but was, well, lifesaving — so you dealt with it.  Sure, critics might (and did) carp at the abstinence education requirement, the restrictions on treatment for “sex workers” (some say this isn’t the preferred term now, if not help me with this), and the fact that PEPFAR was set up independently from other already established treatment programs.  And what about the 40+ million Americans without insurance?  Why no PEPFAR-equivalent for them?

But it’s hard to argue with the results — In some of the world’s poorest nations, millions got HIV treatment who previously could not.

So say what you will about the politics of this recent move, PEPFAR was a groundbreaking piece of legislation by Bush, and Dybul was its on-the-ground leader.  And given the past track record of some Repubicans on this disease, for these accomplishments they must get some credit.

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HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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