United States global health policy: HIV/AIDS, maternal and child health, and The President's Emergency Plan for AIDS Relief (PEPFAR)

Abstract

The Obama administration has unveiled a new 6-year, $63 billion Global Health Initiative. In addition to the reauthorization of the President's Emergency Plan for AIDS Relief (PEPFAR) to fund HIV/AIDS, tuberculosis, and malaria, the plan also supports maternal and child health (MCH) initiatives that are rooted in a proposal known as the Mother and Child Campaign. The architects of the Obama administration's Global Health Initiative recommend funding the Mother and Child Campaign at the expense of future funding increases for PEPFAR. The idea that differing global health initiatives must compete with each other lacks not only ethical legitimacy but also scientific merit. We believe that MCH need not to be framed in opposition to PEPFAR. Confronting illness in isolation - whether by funding PEPFAR at the expense of programs that target MCH or vice versa - cannot be our way forward. Given the intimate connection between HIV/AIDS and MCH, we affirm supporting PEPFAR and MCH programs together. We argue that policies that de-emphasize PEPFAR threaten to undermine, rather than support, MCH in countries with high HIV/AIDS prevalence. PEPFAR has directly and indirectly supported the care and treatment of other milieu specific diseases, including those afflicting mothers and children, bringing about broad benefits to the primary healthcare systems of recipient countries. We advocate the vertical integration of MCH initiatives into PEPFAR in order to create a comprehensive approach to addressing MCH against the global backdrop of HIV/AIDS.

Prevention of mother-to-child HIV transmission within the continuum of maternal, newborn, and child health services

“…While integrated health systems may streamline service provision, reduce stigma, and broaden coverage, in most settings such models cannot address existing gaps in health infrastructure such as staffing shortages and physical space (22). Integrated health approaches themselves require investment, perhaps leveraged through existing resources for HIV care (23, 24), to realize their full potential.…”

Linking Global HIV/AIDS Treatments with National Programs for the Control and Elimination of the Neglected Tropical Diseases

“…Embracing the control of the NTDs, the most common infections of girls and women in developing countries [5], is also consistent with recent calls to expand PEPFAR's mandate to include maternal and child health initiatives [35]. In the meantime, there is a need for studies to confirm the cost-effectiveness of linking NTDs with HIV/AIDS.…”

Infections and inequalities: anemia in AIDS, the disadvantages of poverty

“…Other aspects should be taken into account, too: 1) the biological plausibility of the observed association is a meaningful relationship; 2) regarding the biological gradient of the observed association, there is a relationship between the extremes (> poverty and < educational level = > risk of anemia); and 3) the consistency of our research findings with which is known about the natural history of the disease. In fact, poverty produces not only direct effects but also non financial costs, such as hunger, undernourishment and malnutrition, which contribute to arise feelings of deprivation and frustration, apart from pain, suffering and reduced life quality [4] . Impoverishment, life conditions on the borders of survival and social inequality have a high negative impact on the health of AIDS patients and increase their vulnerability to anemia [5] .…”

“…In fact, the effectiveness of health programs in ensuring the access of the poor to the best possible health care in AIDS has never been assessed. It is clear that the government must control that costs and effects of state interventions are closely watched so that the costefficiency ratio may be increased [4] .…”