16 March 2016
Shawn Clackett

PEPFAR: Is 90-90-90 Magical Thinking?

The Lancet
By Scott Barnhart
March 2016

The world is too complicated for disease-specific approaches to health, as the ravages of Ebola in weak health systems have shown. A health-system strengthening approach will ensure that, especially in times of austerity, there are local institutions and infrastructure in place to provide care for all.

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The President’s Emergency Plan for AIDS Relief (PEPFAR) 3.0 has embarked on an important refocusing to achieve epidemic control through 90-90-90 (90% of HIV-positive individuals knowing their status, 90% of those receiving antiretroviral therapy, and 90% of those achieving viral suppression).1 and 2 Despite good intentions, the implementation is creating health-system disruption. For example, in Zimbabwe, a voluntary medical male circumcision programme will now serve ten instead of 21 districts. Ambassador Birx, referring to these programme cuts as “efficiencies”, touted that funds will be freed up “for the greatest impact.3” Although this might optimise impact in areas of the highest HIV/AIDS burden, medical sites are being triaged, with patients losing services and investments being wasted. Concentration on fewer districts also leads to poaching of health workers from already understaffed sites elsewhere.

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Pacific Friends operates as a program within the Kirby Institute at the University of New South Wales.

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Professor Janice Reid AC
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Bill Bowtell AO
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Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria is a high-level advocacy organisation which seeks to mobilise regional awareness of the serious threat posed by HIV & AIDS, tuberculosis and malaria to societies and economies in the Pacific. In pursuing its goals Pacific Friends has a specific interest in highlighting the need to protect the rights of women and children in the Pacific.

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