Chip Lyons Responds with a call to PEPFAR:

In a recent Los Angeles Times piece, Siobhan O’Grady explored how West and Central Africa lag painfully far behind the rest of the continent in combatting HIV/AIDS, particularly when it comes to children and adolescents. O’Grady paints a bleak picture of pernicious stigma and cites a slew of grim figures, including that 80% of HIV-positive children in the region are not receiving antiretroviral therapy. For context, I’d add that even 57%, the proportion of children worldwide not on treatment, is considered intolerably high by those of us working in pediatric AIDS.

O’Grady is correctly heartened that Congress refused to cut $800 million from the President’s Emergency Plan for Emergency AIDS Relief (PEPFAR), the popular U.S.-funded global program that has provided HIV prevention and care to millions of people in Africa and beyond. Yet the problems O’Grady details, including regional disparities in progress and the crisis for children and teens, are ones on which PEPFAR can and should say more. In September, PEPFAR released a strategy for controlling the epidemic in 13 countries, only one of which is in West or Central Africa. The strategy did not address adolescent infection and death rates, or paltry treatment coverage for children.

Epidemic control is a laudable goal that PEPFAR is right to pursue in the countries where it is imminently possible. But by highlighting the circumstances in regions outside PEPFAR’s list of priority countries, O’Grady reminds us that epidemic control should not be pursued at the expense of other prongs of our global HIV/AIDS strategy. It is incumbent upon us to remember and keep fighting for the populations that are most vulnerable—and in the countries which are farthest behind.