Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Health Aff (Millwood). 2012 Jul;31(7):1519-28. doi: 10.1377/hlthaff.2012.0216.
The legislation reauthorizing the President's Emergency Plan for AIDS Relief (PEPFAR) in 2008 recognized the need for HIV/AIDS programs directed to most-at-risk populations, including men who have sex with men and people who inject drugs. To examine whether that goal is being met, we analyzed data from PEPFAR's Operational Plans for fiscal years 2009 and 2010. The eighteen countries in our study accounted for nearly two-thirds of overall PEPFAR financing for those fiscal years and approximately 60 percent of the total number of people living with HIV in the world in 2010. After controlling in each country for the number of people living with HIV, total population, and per capita income, we found that countries where HIV transmission occurs primarily among men who have sex with men and people who inject drugs received on average $235 million less in 2009 and 2010 than countries with widespread HIV epidemics among the general population. These findings raise questions about whether the country allocations of PEPFAR fully address needs based on the epidemiology of HIV infection in individual countries. Administrators should ensure that funding allocations directed to various countries reflect the best epidemiological data and latest science and best practices, and are devoid of bias against most-at-risk populations; they should also be more transparent about where PEPFAR's dollars go. Otherwise, it is unlikely that PEPFAR will realize its established goal of achieving an AIDS-free generation.
2008 年，授权实施总统艾滋病紧急救援计划（PEPFAR）的立法承认，需要针对高危人群，包括男男性行为者和注射毒品者，制定艾滋病毒/艾滋病方案。为了检验这一目标是否正在实现，我们分析了 PEPFAR 2009 年和 2010 年业务计划的数据。我们的研究涵盖了 18 个国家，这些国家占这两年 PEPFAR 供资总额的近三分之二，约占 2010 年全球艾滋病毒感染者总数的 60%。在每个国家，我们根据艾滋病毒感染者人数、总人口和人均收入对数据进行了调整，发现艾滋病毒主要通过男男性行为者和注射毒品者传播的国家，其 2009 年和 2010 年获得的资金平均比艾滋病毒在普通人群中广泛流行的国家少 2.35 亿美元。这些发现引发了一些疑问，即 PEPFAR 的国家分配方案是否充分考虑了各国艾滋病毒感染的流行病学情况。管理人员应确保针对各国的资金分配反映最佳的流行病学数据和最新的科学和最佳做法，避免对高危人群的偏见；他们还应更加透明地说明 PEPFAR 的资金去向。否则，PEPFAR 不太可能实现其制定的无艾滋病一代的目标。
