1. The U.S. President’s Emergency Plan for AIDS Relief HIV/AIDS and the U.S. Government’s Response: The Power of Partnerships

2. Adults and Children Estimated to Be Living with HIV in 2006 Source: UNAIDS, 2006

3. Effects of HIV/AIDS on Economic Development and Security HIV/AIDS is reversing developing nations’ progress towards welfare and stability. The serious threat it poses to global development and security is one reason why the President and PEPFAR host nations have made addressing it such a priority. High HIV prevalence among people in the most productive years of their lives presents a long-term adverse strain on the socio-economic structure of these nations. Businesses in the developing world are faced with absenteeism, declines in skilled workers, high rates of turnover, expenses to train new workers, reduced revenue, and increased health care costs.

4. Effects of HIV/AIDS on Economic Development Among those of working age, 11.7 million more people who are engaged in some form of productive activity are now living with the virus. Many of these people are women who work in the home. This number is in addition to the 24.6 million labor force participants living with HIV. Between 1992 and 2004, 43 countries heavily affected by HIV/AIDS lost a yearly average of 0.5 percent in their rate of economic growth due to the epidemic. And, as a result of this decline, they forfeited 0.3 percent per year in employment growth.

5. HIV/AIDS Impact on National Security Many nations suffer from high HIV prevalence among defense forces, losing their soldiers—and their leadership—to AIDS. For example, deaths due to HIV/AIDS are estimated to have reduced the size of Malawi’s armed forces by 40 percent. In Uganda, more soldiers are believed to have died from AIDS than from the nation’s 20-year insurgency.

6. The Transformational Power of Partnerships The Emergency Plan is part of a broader renaissance in partnerships for international development. The United States is changing the paradigm for development, rejecting the flawed “donor-recipient” mentality and replacing it with an ethic of true partnership. There is a growing consensus that the world’s response to global HIV/AIDS has undergone a transformation in recent years—and the new U.S. partnerships with hard-hit nations have been the catalyst.

7. U.S. Government Commitment on Global HIV/AIDS PEPFAR is a $15 billion, five-year, comprehensive approach to combating HIV/AIDS around the world. The Emergency Plan is on track to exceed its original commitment of $15 billion over five years. By the end of fiscal year 2008, the American people will have invested $18.3 billion in the global fight against HIV/AIDS. On May 30, 2007, President George W. Bush announced his desire to double America’s commitment to fight global HIV/AIDS. He will work with Congress to reauthorize The United States Leadership Against HIV/AIDS, Tuberculosis, And Malaria Act Of 2003, which established the Emergency Plan.

8. Recent USG Spending on Global HIV/AIDS

9. International HIV/AIDS Commitments, by Donor, 2005

10. The Focus Countries PEPFAR works predominately in 15 focus countries. These countries are home to approximately half of all the world’s HIV infections. These countries were picked because, with U.S. support, they should be able to achieve national scale-up of HIV/AIDS prevention, treatment and care by 2009. PEPFAR’s 2-7-10 goals are to support: Prevention of 7 million new HIV infections Treatment of 2 million HIV-infected people Care for 10 million infected with and affected by HIV/AIDS, including orphans/vulnerable children

11. PEPFAR Worldwide Activities

12. The Power of Partnerships: Impact of Prevention The most recent UNAIDS report indicates that there were approximately 4.3 million new HIV infections in 2006. If this number continues to rise, it will soon overwhelm the world’s ability to respond and sustain that response. The Emergency Plan supports the most comprehensive, evidence-based prevention program in the world, targeting interventions based on the epidemiology of HIV infection in each country.

13. Prevention of Sexual Transmission PEPFAR supports the “ABC” approach to behavior change (Abstain, Be faithful, and the correct and consistent use of Condoms where appropriate). New data, from time periods that pre-date PEPFAR scale-up, link adoption of all three of the ABC behaviors to reductions in prevalence. In addition to earlier dramatic declines in HIV infection in Uganda, there is growing evidence of similar trends in other nations, including Botswana, Ethiopia, Haiti, Kenya, Tanzania, Zambia, and Zimbabwe.

14. Prevention of Sexual Transmission In focus countries during fiscal year 2006, approximately 61.5 million people were reached by community outreach programs promoting ABC and other related prevention strategies. The U.S. Government has supplied 1.3 billion condoms worldwide from 2004 to 2006, lending support to comprehensive ABC approaches based on the epidemiology of each country. When new prevention strategies, such as male circumcision, are identified by normative agencies as effective prevention interventions, PEPFAR will support them as part of a comprehensive prevention strategy.

15. Prevention of Mother-to-Child Transmission As of September 30, 2006, PEPFAR has supported antiretroviral prophylaxis for HIV-positive women during 533,700 pregnancies. This has prevented an estimated 101,500 infant infections. In total, since the program’s inception, PEPFAR has supported PMTCT services for women during more than 6 million pregnancies. By promoting the routine, voluntary offer of HIV testing—so that women receive testing unless they elect not to receive it—host nations have increased the rate of uptake among pregnant women from low levels to around 90 percent at many sites.

16. Estimated Coverage of PMTCT with USG Support in FY2004 and FY2006* *Source: PEPFAR Third Annual Report to Congress, 2007 (Page 14)

17. Addressing Gender Issues PEPFAR recognizes the critical need to address the inequalities between women and men that influence sexual behavior and put women at higher risk of infection. Many HIV prevention programs also address issues related to gender. Five priority gender strategies are monitored annually during the Country Operational Plan review process. In fiscal year 2006, a total of $442 million supported over 830 interventions that included one or more of these gender activities. Number of Activities per Gender Strategic Focus Area in FY2006* *Source: PEPFAR Third Annual Report to Congress, 2007 (Page 15)

18. The Power of Partnerships: Impact of Treatment As of March 31, 2007, the Emergency Plan has supported antiretroviral treatment for approximately 1,101,000 people in the 15 focus countries. When we compare this to the number of people estimated to be on treatment pre-PEPFAR — only 50,000 in sub-Saharan Africa — the benefits of our partnerships are clear.

19. Number of Individuals Receiving Antiretroviral Treatment in the 15 Focus Countries Number of Individuals Receiving Antiretroviral Treatment Total of both upstream and downstream USG-supported interventions As of March 31, 2007

20. Progress in PEPFAR Support for Treatment Coverage in Select Focus Countries, FY2004-FY2006 2004 2005 2006

21. National Treatment Coverage Supported by All Sources* *Source: PEPFAR Third Annual Report to Congress, 2007 (Page 18)

22. Access to Generic Antiretroviral Drugs The Food and Drug Administration (FDA) within U.S. Department of Health and Human Services (HHS) introduced an expedited “tentative approval” process whereby ARVs from anywhere in the world, produced by any manufacturer, could be rapidly reviewed to assess quality standards and subsequently cleared for purchase under PEPFAR. As of September 2007, 51 generic ARV formulations have been approved or tentatively approved by the HHS/FDA. *Chart reflects generic ARV approvals as of September 2007 Cumulative HHS/FDA Approvals/Tentative Approvals of Generic ARVs*

23. The Power of Partnerships: Impact of Care HIV/AIDS and associated opportunistic infections cause severe pain and debilitating symptoms in advanced stages. Millions of orphans growing up without the support of their parents face increased vulnerability to violence and coercion — and to HIV.

24. Number of Individuals Receiving Care in the 15 Focus Countries* *Source: PEPFAR Third Annual Report to Congress, 2007 (Page 22)

25. The Power of Partnerships: Building Capacity At least one-quarter of PEPFAR resources in fiscal year 2006 were devoted to capacity-building in the public and private health sectors – physical infrastructure, training, and support for workforce. And 83 percent of partners were local organizations, which support more than 15,000 project sites for prevention, treatment and care. The U.S. Government and other international partners can play a vital role, but outside resources for HIV/AIDS and other development efforts must be focused on transformational initiatives that are owned by host nations.

26. The Power of Partnerships: Creating a Culture of Accountability PEPFAR’s support for capacity-building has important spillover effects that support nations’ broader efforts for sustainable development. Expanded health system capacity improves responses for diseases other than HIV/AIDS. Supply chain management capacity-building improves procurement for general health commodities. Improving the capacity to report on results fosters quality/systems improvement, and the resulting accountability helps to develop good governance and democracy. A growing number of nations are investing in fighting HIV/AIDS on a scale commensurate with their financial capacity.

27. Beyond 2008: The Next Phase of PEPFAR The American people must and will continue to stand with our global sisters and brothers as they take control of the pandemic and their lives and restore hope to individuals, families, communities and nations. Assuming Congress meets the President’s request for Fiscal Year 2008, and with the new $30 billion proposal, the American people have committed $48.3 billion across 10 years to fight HIV/AIDS. The next phase of PEPFAR will continue to expand life-saving treatment, comprehensive prevention programs and care for those in need, including orphans and vulnerable children, to support: Treatment for 2.5 million people Prevention of more than 12 million new infections Care for more than 12 million people, including 5 million orphans and vulnerable children.

28. Beyond 2008: The Next Phase of PEPFAR The New Plan Emphasizes Continuation And Expansion Continuation – HIV/AIDS treatment, prevention and care are life-long needs, and the American people will continue to support those served during PEPFAR’s first 5 years. Expansion –PEPFAR will further expand efforts to strengthen health systems, and to leverage programs that address malaria, tuberculosis, child and maternal health, clean water, food and nutrition, education and other needs. The Plan will emphasize transitioning from an emergency to a sustainable response for treatment, prevention and care.