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United States' AIDS Relief Plan at Crossroads

Despite dramatic advances, HIV/AIDS emergency far from over

THURSDAY, July 31 (HealthDay News) -- The President's Emergency Plan for AIDS Relief (PEPFAR) has achieved dramatic results so far, thanks to a strong results-oriented focus and sense of urgency, but as Congress reauthorizes funding for the program, it must consider where it goes from here, according to an article published online July 30 in the New England Journal of Medicine.

Wafaa M. El-Sadr, M.D., and David Hoos, M.D., of Columbia University in New York City, write that the plan has been heavily criticized, notably for including ideologically driven prevention programs, expanding use of antiretroviral therapy in resource-poor settings and raising the specter of drug-resistant HIV strains.

However, the plan has also been applauded for getting antiretroviral therapy to 1.7 million people, revitalizing local AIDS responses through collaboration at a national level and expanding health care networks that benefit broad patient populations, not just those with HIV.

"The key choice for PEPFAR at this crossroads is between a 'pull' strategy and a 'push' strategy: Will a continued singular focus on HIV 'pull' other components of national health care systems forward, so that they become more responsive to other health threats?" the authors write. "Or will a 'push' strategy that is focused primarily on strengthening health care systems and tackling fundamental issues that define societal vulnerabilities to disease be more effective in achieving both HIV-specific and broader health and social goals?"

El-Sadr and Hoos report receiving grant support from PEPFAR.

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