UCSF's Goosby Discusses Priorities and Challenges as New Global AIDS Chief

By Robin Hindery

Eric Goosby is sworn in on June 23 as Global AIDS coordinator for the US State Department.

On June 23, Eric Goosby, MD, UCSF clinical professor of medicine, assumed the role of Global AIDS coordinator for the US State Department — a position that puts him in charge of the country’s effort to combat the disease around the world.

As ambassador at large and head of an agency with a $6.3 billion annual budget and a 78-member staff, Goosby will have considerable resources as he continues his decades-long fight against an epidemic that has infected an estimated 33 million people worldwide.

But his post will also thrust him into the center of the controversy over the prevention policy championed by President George W. Bush under his President’s Emergency Plan for AIDS Relief (PEPFAR), which emphasizes abstinence and fidelity over the use of condoms and other safer-sex methods.

Goosby comes to the State Department with an impressive résumé — including previous stints in Washington, DC — and a well-established reputation as a skilled clinician, an effective administrator and a seasoned expert when it comes to HIV/AIDS treatment and prevention.

He spoke to a UCSF reporter about what he sees as his top priorities and greatest challenges as he takes on his new role.

You were working at San Francisco General Hospital in the 1980s when AIDS first began to take its toll on the city. How have things changed since then — for better and for worse?

The landscape of HIV/AIDS has changed dramatically in the last 25 years. When I first began as a physician at San Francisco General Hospital and later at DC General Hospital, death from AIDS was a daily occurrence. Today, thankfully, HIV is no longer a death sentence. This also holds true outside of the United States, and the support from the American people through PEPFAR has been a major driving force behind the change.

I was overjoyed when PEPFAR was created, and I am still in awe of the number of lives saved as a result of the program. To date, more than 2.1 million people in sub-Saharan Africa are on treatment supported by PEPFAR, and more than 10 million individuals are receiving care. More and more mothers are receiving prevention of mother-to-child transmission services, and thousands of individuals with HIV-related opportunistic infections have been both diagnosed and treated. The situation has changed for the better. However, more change is needed if we are going to defeat this pandemic.

What are your top priorities in your new post?

My top priorities as PEPFAR moves into its next phase are intensifying the focus on HIV prevention; pursuing strong country partnerships, country ownership and coordinated, multilateral engagement; supporting the strengthening of health systems through programs and country-driven planning; and taking effective interventions to scale to achieve population-level health outcomes.

To achieve these ends, PEPFAR will build upon its strong partnerships with host governments, continue to work within existing health structures and strategies, mentor capable health care provider teams, and engage community-based peer educators to reach out and meet the needs of women, men who have sex with men, and drug users.

I believe PEPFAR is capable of achieving these goals, but we cannot do it alone. Collective action on the part of the global community is critical: It will take strong collaboration and strategic positioning of our efforts as we move forward with this fight.

What do you see as your biggest challenges?

As mentioned above, my priorities for PEPFAR as it transitions into the next phase will be HIV prevention, country ownership, supporting health systems strengthening and scaling up effective interventions to achieve population-level health outcomes. While the program has made great leaps, one of the greatest challenges will be the move from the initial emergency response to a long-term, sustainable response to the global HIV/AIDS pandemic. I believe that focusing on these four priority areas will help us to make the transition.

How can the United States best assist developing nations in slowing the spread of HIV/AIDS?

The most effective response to HIV is one tailored to the specific situation in each country. PEPFAR has worked — and will continue to work — closely with country governments to devise effective and sustainable strategies to combat HIV. Ultimately, country governments carry the long-term responsibility of responding to their respective epidemics. It is crucial that we position ourselves to transition ownership of the HIV/AIDS response to host country governments, and our focus must be to support them in building the broad range of capacity they need to do so.

Recognizing this, the US government, through PEPFAR, is working with countries to develop Partnership Frameworks, which provide a five-year, joint strategic framework for cooperation between the US government, the partner government and other partners working to combat HIV/AIDS in the country through service delivery, policy reform and coordinated financial commitments. Through this mechanism, PEPFAR plans to improve and expand its existing coordination with country and other donor activities.

To date, the US government has signed two Partnership Frameworks — one with Malawi and another with Swaziland. We look forward to adding additional countries to this list soon.

PEPFAR has been credited with markedly reducing the AIDS death rate. How would you rate the success of the program so far?

The success of PEPFAR can only be characterized as enormous. There are now many effective treatment centers throughout the African and Asian continents as a result of the program. Aggressive prevention programs initiated by PEPFAR have reduced HIV transmission and have responded directly to the needs of those most vulnerable to the disease. As I mentioned previously, PEPFAR is supporting treatment for more than 2.1 million people and care for more than 10 million people worldwide.

Now you see hope in hospitals, clinics and communities affected by HIV as a result of the support of the American people. Additionally, by using HIV treatment as a platform, PEPFAR support has strengthened and extended health systems in many areas, including human resources, infrastructure, informatics, commodities logistics and laboratory services.

PEPFAR’s prevention policies, which emphasize abstinence and fidelity, have drawn criticism, and many people are looking to you and the new administration to loosen those guidelines. Is that something you are considering?

It is important to note that there is not a single prevention intervention that can end this epidemic. We must engage in combination prevention — behavioral, biomedical and structural interventions — just as we have engaged in combination treatment. As we move into the next phase of PEPFAR, I look forward to evaluating PEPFAR’s current prevention programs and identifying areas to expand effective programming as we assemble a new, five-year strategy to drive the program.

What was your initial reaction when President Barack Obama approached you about taking on the role of US global AIDS coordinator?

I was honored to be considered for this position and deeply appreciated President Barack Obama and Secretary of State Hillary Rodham Clinton’s support for my nomination. The history of PEPFAR has demonstrated what can happen when we dare to think big. My mission as the new US Global AIDS coordinator will be to ensure that PEPFAR continues to be a visionary program — a program that continues to exceed expectations of what can and should be provided to people in resource-limited settings.

More About Eric Goosby

Goosby started his medical career as an intern at San Francisco General Hospital, and in 1987 was appointed associate medical director of the hospital’s AIDS clinic.

In 1991, he was named the first director of the federal government’s Ryan White HIV/AIDS Program, overseeing the distribution of federal funds and the planning of services in AIDS centers throughout the country.

During the Clinton administration, Goosby served as deputy director of the White House Office of National AIDS Policy and director of HIV/AIDS policy in the Department of Health and Human Services.

From 2001 until his confirmation as global AIDS coordinator in June, he served as CEO and chief medical officer of Pangaea Global AIDS Foundation, a nonprofit consulting organization that helps develop HIV/AIDS treatment and prevention programs.

In addition to his teaching position at UCSF, he has served as a primary care provider for the Men of Color Program (MOCP) at 360: The Positive Care Center, UCSF’s nonprofit AIDS clinic. The MOCP works to address the health needs of uninsured and underinsured men of color — particularly African American men — with HIV/AIDS in San Francisco.

Photo courtesy of the office of the United States President’s Emergency Plan for AIDS Relief.

Related Links:

UCSF Seeks Participants for San Francisco AIDS Walk
UCSF Today, June 29, 2009

The United States President’s Emergency Plan for AIDS Relief

360: The Positive Care Center at UCSF

Pangaea Global AIDS Foundation