As President Obama and his staff worked to fill key roles in his administration, rumors emerged that Mark Dybul, a political appointee under President Bush, would continue in the position of Global AIDS Coordinator indefinitely. This, however, proved not to be the case. In late January of this year, shortly after Hillary Clinton was confirmed as Secretary of State, Dybul’s immediate resignation was requested.
Former-Ambassador Dybul began serving as the Global AIDS Coordinator in 2006, overseeing the President’s Emergency Plan for AIDS Relief (PEPFAR) which had been created through the United States Leadership Against Global HIV/AIDS, Tuberculosis and Malaria Act of 2003. There he coordinated the efforts of disparate agencies such as the Centers for Disease Control and Prevention and the United States Agency for International Development, and guided the vision for meeting the prevention, care, and treatment needs of those living with and affected by HIV/AIDS primarily in the 15 focus countries within PEPFAR’s purview.
“Many of PEPFAR’s successes in advancing care and treatment efforts can be attributed to Dr. Dybul’s leadership, however, despite these accomplishments, we cannot ignore the politicization of prevention under his tenure, which has nearly destroyed a comprehensive approach to prevention in the focus countries,” remarked William Smith, vice president for public policy of the Sexuality Information and Education Council of the Unites States.
While it is not beyond the realm of possibility that a political appointee might survive the transition from one administration to the next, former-Ambassador Dybul’s track record did not bode well for this prospect. A flurry of op-eds defending Dybul appeared such outlets as the Washington Post, San Francisco Chronicle, and Boston Globe over the last month over, claiming among other things that he was simply following orders from higher up. However, it was his unconditional adherence to the Bush administration’s ideology which caused him to lose the confidence of many HIV/AIDS advocates and program implementers. He guided PEPFAR’s HIV-prevention toward abstinence-only and be-faithful approaches, instead of more comprehensive approaches, and this has been the downfall of prevention in the U.S. response to the global HIV/AIDS epidemic.
In an epidemic where six new infections occur for every one person receiving treatment, prevention of HIV-transmission, particularly in the 15 PEPFAR focus countries, must rise to the same level of importance as care and treatment for those already living with or affected by HIV and AIDS. We have reached a critical moment in the history of the global HIV/AIDS epidemic, and the next phase of PEPFAR is set into motion through the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, and Dybul’s departure in February has created the opportunity for new leadership.
Over the past month several names have come forward as front runners for the position including, Former President and CEO of the Global Health Council, Nils Daulaire; Chair of the Department of Global Health and Social Medicine at Harvard Medical School, Jim Yong Kim; and CEO and Chief Medical Officer of Pangaea Global AIDS Foundation ,Eric Goosby. Still, there is no clear consensus among the global HIV/AIDS advocacy community behind a candidate for the role of Global AIDS Coordinator and it is not clear whether the Obama administration has a strong inclination as of yet.
“Whoever is chosen, the new Coordinator will be charged with navigating a monumental transition from an emergency-based response, to one oriented towards sustainability and long-term goals. Medical care and services remain fundamental to the global HIV/AIDS response; however, the new GAC must also bring an awareness of the social complexities which drive the HIV/AIDS epidemic,” continued Smith. “We cannot treat our way out of the gender inequalities, social and economic disparities, and stigma and discrimination that continue to fuel the HIV pandemic. The vision and strategies that the new Coordinator stands behind must embrace all medicine, social science, public health, and human rights.”