Dec 14, 2009
week on the Global Prosperity Wonkcast, I'm joined by
Nandini Oomman, director of the Center's HIV/AIDS
Monitor. Our conversation focuses on the
new 5-year strategy laid out earlier this month by Ambassador
Eric Goosby, the new U.S. global AIDS coordinator and head of
PEPFAR (the President's Emergency Plan for AIDS Relief).
Nandini praises the evidence-based framework PEPFAR has laid out
and its move towards much greater openness and transparency. She
stresses that the challenge ahead will be in designing concrete
plans that implement the strategy effectively and measure its
Nandini brings to the table a wealth of experience, dating back
to the late 1980s, when she worked on the front lines of the battle
against HIV/AIDS in India. On the Wonkcast, she tells me how she
moved from educating sex workers in Mumbai about HIV to studying
global HIV/AIDS policy. That journey started when her organization
hosted a US Congressman, who wanted to see the realities of AIDS
& sex work in India up close.
"I felt there was such a distance between the woman we were
addressing and this wonderful Congressman, and I wanted to travel
that distance to find out what decisions were made at the top that
allowed money to flow down and prevention programs for health to
Money earmarked specifically for HIV/AIDS represents a
significant chunk of total foreign assistance (roughly 5-10% of the
$125 billion official development assistance in recent years), and
the United States provides around two-thirds of the AIDS money,
around $5 billion in 2007 alone.
Nandini explains that four out of every five dollars the United
States spends internationally on AIDS is channeled through U.S.
bilateral agreements, while the remainder goes through multilateral
organizations such as the World Bank and the Global Fund for AIDS,
Tuberculosis, and Malaria.
PEPFAR is the main channel for U.S. bilateral spending on the
disease, and Nandini gives listeners a brief history of PEPFAR and
its approach. She says the program has always strived for clear
results. "When PEPFAR was established, the administration thought
very strategically about how they could demonstrate success... and
I think they realized that to make this a success, they had to have
very strong metrics."
In the first five years of its existence, PEPFAR exceeded its
target of getting 2 million people with HIV on treatment. The
challenge now, Nandini explains, is making PEPFAR's work
sustainable, in particular by stepping up prevention efforts, since
for every two people who are placed on treatment, five people
become newly infected.
"The difficulty in defining success in prevention is great,
because how do you count something that didn't happen?" she tells
For those who are interested, this is an area where CGD has been
doing some pioneering work: senior fellow
Mead Over is investigating the possibility of designing a
Delivery program that would offer clear incentives for
governments to prevent new HIV infections. I'll be interviewing
Mead in an upcoming Wonkcast.
Listen to the Wonkcast to hear the interview. Have something to add to our discussion? Ideas for future interviews? Post a comment below. If you use iTunes, you can subscribe to get new episodes delivered straight to your computer every week.