More than 40 million people are living with HIV worldwide, with 4.3 million new HIV infections in 2006 alone. Fifty percent of those new infections occurred in youth aged 15-24 years, with women disproportionately affected. By 2010, as many as 20 million children will be orphaned by the epidemic. Infection rates in some impoverished countries are greater than 33%, and the impact of AIDS poses a major humanitarian challenge to the United States. Global health diplomacy provides one key opportunity to renew our ties to the world community. Our place in history will be determined by how well we respond to this still-expanding crisis at home and abroad. The undersigned organizations and citizens urge the U.S. Members of Congress to support the following policy changes within the Presidents Emergency Plan for HIV/AIDS Relief (PEPFAR): 1. Keep the promise of universal access to prevention, care and treatment by providing a minimum of $50 billion by 2013 and at least doubling numbers on treatment for the fight against HIV/AIDS without depleting funds from core health programs; and contribute to the U.S. fair share to the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) ; 2. Invest new resources to strengthen public health workforce and systems. This includes: building infrastructure to provide HIV/AIDS care and other basic health services, training and retaining the numbers of health workers needed to achieve the World Health Organizations(WHO) minimum health workforce densities of 2.3 doctors, nurses and midwives per thousand residents in selected countries. 3. Implement comprehensive, integrated and evidence-based prevention policies: increasing the number of people reached by HIV/AIDS prevention programs from 7 million to 12 million; tailoring prevention programs to the needs of specific epidemics and populations and designing them at the country level. To achieve this: Remove the 1/3 abstinence-until-marriage earmark and fund comprehensive, integrated, and evidence-based HIV prevention programs that promote and protect the health of women, youth and vulnerable populations; Modify/expand the guidance on harm reduction from its current status that allows only for prevention interventions among HIV-positive injecting drug users to provide for all drug users; Eliminate the anti-prostitution pledge and support programs that reduce stigma against marginalized populations and promote fundamental human rights; and Expand support for research on microbicides and vaccines while ensuring that currently available prevention technologies are widely promoted, effectively programmed and accessible. 4. Support trade and licensing policies that protect and expand poor countries\' right to affordable generic drugs for important health needs and that ensure drugs developed with taxpayer resources are available in developing countries. 5. Expand Quality Treatment and Care Programs to reflect the U.S. one-third fair share of WHO treatment targets and increase access to palliative care and services, improving patient follow-up practices within PEPFAR. 6. Increase resource and programmatic coordination between PEPFAR-supported HIV Prevention, Treatment and Care services and other health and development services We urge U.S. Members of Congress to adopt the above commitments and policy changes in the reauthorization of PEPFAR.
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