New AIDS chief

WASHINGTON-After three months without a leader, the State Department's Global AIDS Office has a newly named head from the Clinton administration, Eric Goosby, who awaits Senate confirmation.

The nomination comes after a poorly handled dismissal of the Bush administration AIDS coordinator, Mark Dybul, who spearheaded what many consider President Bush's most successful program. The President's Emergency Plan for AIDS Relief (PEPFAR) has provided antiretroviral treatment to over 2.1 million HIV/AIDS victims-only 50,000 were receiving treatment before-cutting AIDS deaths by 10 percent over five years. The program relies on prevention methods heavily, too, like abstinence education and condom distribution, often provided by faith-based organizations.

The Obama administration had asked Dybul to remain in charge during the transition period, then abruptly demanded his resignation after inauguration, leaving raw feelings among some staff, nervousness among some faith-based organizations, and celebration among some more liberal-leaning groups who found Dybul's approach too centered on abstinence.

Goosby faces pressure to alter the program-groups like International Women's Health Coalition say abstinence education is ineffective, and condoms should be the main weapon against the virus. Meanwhile, Obama's White House has been almost entirely silent on the issue.

"Eric Goosby has significant challenges coming into this position," said Shepherd Smith, president of International Youth Development and a onetime delegate to the United Nations on HIV/AIDS. "Where in the past the White House had a keen interest, it doesn't appear that this administration has such a keen interest in this program."

Goosby doesn't have a strong record of supporting abstinence education, like Dybul did. In response to a vote in the House of Representatives in 2003 requiring one-third of PEPFAR funding to be used for abstinence programs, Goosby wrote, "It is disappointing that the House added amendments to the bill that would siphon funds to HIV prevention programs that exclusively focus on abstinence and ignore the benefits of condoms for those who are sexually active." The amendments, he wrote, are "unnecessary and harmful."

Some AIDS experts said privately that Goosby's position on prevention is to be expected for someone from a Democratic administration-in fact, his rhetoric on abstinence and prevention is more mellow than some other candidates for the post, and his career shows few talismans of controversy.

Just last year on World AIDS Day, he gave some indication of support for education in prevention, saying, "It is clearer than ever that we cannot treat AIDS in a vacuum, and that successful, sustainable programs must increasingly address HIV at the societal level." But his vague statements still have some experts nervous about the changes he could make in the program, returning to methods of pre-Bush days.

"I am worried that just at a time when the AIDS establishment is waking up to the need to address multiple and concurrent sexual partnerships, we might revert to the old condoms-drugs-testing formula known not to prevent HIV infection in Africa's 'hyper-epidemics,'" said Edward Green, director of the AIDS Prevention Research Project at Harvard University.

Goosby is currently the CEO of the Pangaea Global AIDS Foundation, which has partnered with the Clinton Foundation on certain projects in Russia and Ukraine. He began his career addressing AIDS 25 years ago in San Francisco, his hometown, when the domestic crisis began to break out. During President Clinton's administration, he worked at the Department of Health and Human Services and directed the White House HIV/AIDS office.

Pangaea's website reports that he supports the delivery of antiretroviral treatment through "existing healthcare systems." World Relief's HIV/AIDS Director Esther Gwan, who has worked in PEPFAR programs in Rwanda, had expressed concerns after Dybul's resignation that the new head, whomever he was, would direct PEPFAR funds to governments instead of organizations on the ground, which she said are more effective in helping people fight the epidemic long-term.

In June 2008, Goosby penned an op-ed in Politico applauding the reauthorization of PEPFAR, which put more control of AIDS funding in the hands of "countries themselves," and criticizing past legislation "specifying the amount that needed to be spent on abstinence."

Last year, PEPFAR distributed nearly $5 billion to participating organizations, while Congress increased funding for the program, which works with over 8 million individuals infected and affected by HIV/AIDS each year.