CARE Reacts to Institute of Medicine Report on President's Emergency Plan for AIDS Relief

ATLANTA (April 2, 2007) - Dr. Helene D. Gayle, president and CEO of CARE, reacted today to the Institute of Medicine's report entitled PEPFAR Implementation: Progress and Promise. "The findings are largely consistent with CARE's experience as an implementer of PEPFAR," she said. "IOM is absolutely right that prevention has to be a higher priority."

"The best way to ensure that funding is invested wisely is to gather the scientific evidence about the nature of each country's epidemic and to target our work to fight HIV and AIDS without arbitrary limits. In part, this means removing the earmark that requires 66 percent of funds for preventing sexual transmission of HIV to be spent on abstinence and faithfulness programs. In addition, evidence-based HIV prevention should be a higher priority within PEPFAR programming in the months and years ahead. More efforts should also be devoted to reducing the stigma and discrimination surrounding HIV and AIDS," Dr. Gayle urged.

Dr. Gayle said that CARE concurs with the IOM report's recommendation for more effective outreach to particularly marginalized and stigmatized groups – for example, sex workers, injecting drug users, prisoners and men who have sex with men.

"Engaging stigmatized and highly vulnerable populations without judgment and with approaches that are supported by evidence and best practice is critical to success in the fight against HIV and AIDS. In most countries, these populations live on the margins of society, and their isolation and stigmatization drives their vulnerability to HIV infection," Dr. Gayle stressed.

An increased focus on HIV prevention also entails addressing the underlying factors that put women and girls at disproportionate risk, Dr. Gayle advised. "If this is not done, even the best-funded efforts will not make a long-term impact in the protracted fight against HIV and AIDS. Long-term focus and support of enhancements of women's legal, economic, educational and social status is critical. In addition to the 'ABC' approach, which focuses on abstinence, fidelity and condoms, we must address the reasons why women are vulnerable in the first place," she said.

"Effective AIDS responses must be based on the realities of people living with HIV, including poverty and vulnerability. A malnourished woman or child without access to clean water is less likely to thrive, even with access to AIDS treatment and care. As PEPFAR transitions from an emergency program to a more sustainable, long-term approach, it needs to deal with the whole person, the whole family and the whole village. Only a comprehensive approach will fully address the crisis of HIV and AIDS around the world."