	Background

		President’s Global Health Initiative

In May 2009, the President announced the creation of a new Global Health  Initiative (GHI) and proposed $63 billion in funding for all global health  programs, including HIV/AIDS, malaria, tuberculosis, and maternal and  child health, through 2014. Global AIDS  Coordinator (OGAC). Although PEPFAR initially targeted 15 countries, known as focus  countries, since its establishment PEPFAR has made significant  investments in 31 partner countries and 3 regions. From 2001 through 2003, U.S. bilateral  spending on global HIV/AIDS rose, while spending on other global health  programs dropped slightly. As would be expected given PEPFAR’s  significant investment, from fiscal years 2004 through 2008, U.S. bilateral  HIV/AIDS spending showed the greatest increase in PEPFAR focus  countries, relative to nonfocus countries and regions with PEPFAR  operational plans and other countries receiving HIV/AIDS assistance. In  addition, our analysis determined that U.S. spending for other health- related health assistance also increased most for PEPFAR focus countries. Spending on HIV/AIDS and Other Health Programs Grew Overall, Despite Decreases in Other Health Foreign Assistance Spending

Overall, U.S. bilateral foreign assistance spending on both global HIV/AIDS  and other health programs increased in fiscal years 2001 through 2008. U.S. spending on other health-related programs decreased  from 2001 to 2003. 2004-2008. Spending Levels and Growth Rates Varied among Three Key Regions

In fiscal years 2001 through 2008, the majority of U.S. bilateral HIV/AIDS  program spending was in sub-Saharan Africa, Asia, and Latin America and  the Caribbean—three regions where the 15 PEPFAR focus countries and  14 of the 16 nonfocus countries with PEPFAR operational plans are  located—with the greatest U.S. spending on global HIV/AIDS foreign  assistance programs in sub-Saharan Africa. Three Key HIV Treatment Costing Models Used to Inform Policy and Program Decisions

To inform policy and program decisions related, in part, to expanding  efforts to provide ART in developing countries, OGAC, USAID, and  UNAIDS have adopted three different models for ART cost analyses. The report also provides information  on models used to estimate HIV treatment costs. To examine trends in U.S. bilateral spending on global HIV/AIDS- and  other health-related foreign assistance programs, we analyzed data from  the Foreign Assistance Database (FADB) provided by the U.S. Agency for  International Development (USAID), interviewed State Department,  USAID, and Health and Human Services (HHS) officials in Washington,  D.C., and Centers for Disease Control and Prevention (CDC) officials in  Atlanta. The specific analyses presented in this report examine disbursement levels  and growth trends from fiscal years 2001 to 2008 for bilateral HIV/AIDS  and other health-related foreign assistance programs by time period (pre- PEPFAR and first 5 years of PEPFAR for all countries); PEPFAR country  status (focus countries with PEPFAR operational plans, nonfocus  countries with PEPFAR country or regional operational plans, and other  nonfocus countries receiving HIV/AIDS-related foreign assistance from  2001 to 2008); and region (sub-Saharan Africa, Latin America and the  Caribbean, and Asia, which received the majority of U.S. spending on  bilateral HIV/AIDS-related foreign assistance). Global Health: Spending Requirement Presents Challenges for Allocating  Prevention Funding under the President’s Emergency Plan for AIDS  Relief.
Why GAO Did This Study

U.S. funding for global HIV/AIDS and other health-related programs rose significantly from 2001 to 2008. The President's Emergency Plan for AIDS Relief (PEPFAR), reauthorized in 2008 at $48 billion through 2013, has made significant investments in support of prevention of HIV/AIDS as well as care and treatment for those affected by the disease in 31 partner countries and 3 regions. In May 2009, the President proposed spending $63 billion through 2014 on global health programs, including HIV/AIDS, under a new Global Health Initiative. The Office of the U.S. Global AIDS Coordinator (OGAC), at the Department of State (State), coordinates PEPFAR implementation. The Centers for Disease Control and Prevention (CDC) and the U.S. Agency for International Development (USAID), among other agencies, implement PEPFAR as well as other global health-related assistance programs, such as maternal and child health, infectious disease prevention, and malaria control, among others. Responding to legislative directives, this report examines U.S. disbursements (referred to as spending) for global HIV/AIDS- and other health-related bilateral foreign assistance programs (including basic health and population and reproductive health programs) in fiscal years 2001-2008. The report also provides information on models used to estimate HIV treatment costs. GAO analyzed U.S. foreign assistance data, reviewed HIV treatment costing models and reports, and interviewed U.S. and UNAIDS officials.

What GAO Found

In fiscal years 2001-2008, bilateral U.S. spending for HIV/AIDS and other health-related programs increased overall, most significantly for HIV/AIDS. From 2001 to 2003--before the establishment of PEPFAR--U.S. spending on global HIV/AIDS programs rose while spending on other health programs dropped slightly. From fiscal years 2004 to 2008, HIV/AIDS spending grew steadily; other health-related spending also rose overall, despite declines in 2006 and 2007. As would be expected, U.S. bilateral HIV/AIDS spending showed the most increase in 15 countries--known as PEPFAR focus countries--relative to other countries receiving bilateral HIV/AIDS assistance from fiscal years 2004 through 2008. In addition, GAO's analysis showed that U.S. spending on other health-related bilateral foreign assistance also increased most for PEPFAR focus countries. Spending growth rates varied among three key regions--sub-Saharan Africa, Asia, and Latin America and the Caribbean--as did these regions' shares of HIV/AIDS and other health foreign assistance spending following establishment of PEPFAR. OGAC, USAID, and UNAIDS have adopted three different models to estimate and project antiretroviral therapy (ART) costs. The three models--respectively known as the PEPFAR ART Costing Project Model, the HIV/AIDS Program Sustainability Analysis Tool, and Spectrum--are intended to inform policy and program decisions related, in part, to expanding efforts to provide ART in developing countries.