Glossary of terms

Introduction

ABC: Abstinence, Be Faithful, and correct and consistent use of Condoms. ABC is part of PEPFAR’s prevention program that emphasizes abstinence for youth and unmarried persons, which includes delay of sexual initiation; mutual faithfulness in a sexual relationship and reducing the number of partners for sexually active adults; and correct and consistent use of condoms for individuals engaging in high-risk sex.

Abstinence: The “A” in ABC. Abstinence programs encourage unmarried individuals to abstain from sexual activity as the best and only certain way to protect themselves from exposure to HIV and other sexually transmitted infections.

ABY: Abstinence and behavior change in youth. Interventions targeting youth that promote sexual abstinence.

AIDS: Acquired immune deficiency syndrome. An immune disorder that renders the body more susceptible to opportunistic infections such as certain types of cancers. AIDS is caused by HIV and spread primarily through body fluids, especially blood and semen.

Anti-prostitution loyalty oath: The anti-prostitution loyalty oath is a restriction applied to all HIV/AIDS funding. The amendment that legalized the oath was proposed by Rep. Todd Akin, a Missouri Republican, in July 2004. It mandates that no money designated for HIV/AIDS programs “may be used to promote or advocate the legalization or practice of prostitution or sex trafficking.” It also requires that any organization that receives U.S. government funds to combat HIV/AIDS must explicitly state that it opposes prostitution and sex trafficking in order to receive federal funding.

ART: Antiretroviral treatment or therapy. An array of clinical support for patients of which antiretroviral drugs (ARV) represent only about 30 percent. Other facets include non-ARV medications; laboratory tests; training and support for health care personnel; physical infrastructure, including clinics, counseling rooms, laboratories, distribution and logistics systems; and monitoring and reporting systems.

ARV: Antiretrovirals are medications that hinder HIV (and other retroviruses) from making copies of themselves. Antiretrovirals have transformed HIV/AIDS from a fatal condition to a manageable illness.

At-risk group: A specific population that stands a higher chance of being exposed to HIV, including sex workers and their clients; sexually active discordant couples (one HIV-positive partner and one uninfected partner); couples who don’t know their HIV status; substance abusers (IDUs); men who have sex with men; and people living with HIV/AIDS.

Be Faithful: The “B” of ABC. Be Faithful programs encourage individuals to practice fidelity in marriage and other sexual relationships as a critical way to reduce the risk of exposure to HIV.

Behavior change: PEPFAR supports behavior change programs geared toward getting youth and members of “high-risk” groups to adopt less risky behaviors following the ABC approach.

Brand-name drug: A drug that is manufactured under a proprietary, trademarked name.

CBO: Community-Based Organization. CBOs are important PEPFAR partners because they are often among the “first responders” to community-based needs and have broad reach among hard-to-reach or underserved populations.

CDC: Centers for Disease Control and Prevention. The CDC, which comes under the Department of Health and Human Services, coordinates public health efforts “to prevent and control infectious and chronic diseases, injuries, workplace hazards, disabilities and environmental health threats.” http://www.cdc.gov/

Concentrated epidemic: For HIV purposes, an epidemic in which HIV has affected at least 5 percent of individuals in a defined population but is not well established in the general population.

Condoms and related activities: See “other prevention.”

COP: Country Operational Plan; Each of the 15 PEPFAR “focus countries” must provide a COP at the beginning of each fiscal year detailing programs and activities planned for the country. First released in redacted form through a Freedom of Information Act request to ICIJ, OGAC later posted all COPs on its Web site. They can be found at http://foia.state.gov/COP.asp.

Correct and consistent use of condoms: The “C” of ABC. Correct and consistent use of condoms programs emphasize that proper use of condoms reduces but does not eliminate the risk of contracting HIV. PEPFAR estimates their effectiveness rate to be 80 to 90 percent and provides access to condoms for those most at risk for transmitting or becoming infected with HIV.

Cross-generational sex: Sex between partners who are at least 10 years apart in age in which the girl is the younger partner; considered a high-risk activity for the transmission of HIV.

CSW: Commercial sex worker. Considered to be a high-risk group for contracting HIV, commercial sex workers are individuals who trade sex for money and/or goods.

Discordant couple: A couple consisting of one HIV-positive partner and one uninfected partner.

FBO: Faith-Based Organization. Nearly a quarter of all PEPFAR partners (both prime and sub) are faith-based organizations with religious affiliations. PEPFAR sees FBOs as a valuable resource because they can make contact with hard-to-reach and underserved populations in heavily religious countries (which many focus countries are) and are often the main providers of health services.

FDA: Food and Drug Administration. The FDA, part of the Department of Health and Human Services, must approve all pharmaceutical products before they can be made available to the public. See “generic drug.”

FGM: Female Genital Mutilation. Also called “female circumcisions,” FGM refers to procedures which partially or completely remove the external female genitalia. Such procedures are mostly done in Africa, Asia and the Middle East, though are not necessarily tied to a religion. Women who have had FGM are much more susceptible to infection, and the unsanitary conditions under which the procedure is sometimes performed can result in HIV transmission.

Focus Countries: Fifteen countries (12 in Africa, plus Haiti, Guyana and Vietnam) receiving special emphasis from PEPFAR because together they account for more than half of the world’s estimated 40 million HIV infections.

FSW: Female sex worker. A woman who trades sex for money or goods.

GNI: Gross national income. The GNI is the total value of all goods and services produced within a given country, plus income received from other countries but excluding payments made to other countries.

Generalized epidemic: For HIV purposes, an epidemic in which HIV affects more than 1 percent of the general population.

Generic drug: A drug manufactured under its chemical or “generic” name after a patent expires on the brand-name version. A generic drug is essentially the same as its formerly patented counterpart but can be sold for a much lower price because the cost of bringing it to market is not as high. Currently, 26 FDA-approved generic HIV drugs are available. PEPFAR funds can be used to purchase only FDA-approved drugs, and 14 of the 15 focus countries are now purchasing generic drugs through PEPFAR.

Global Fund to Fight AIDS, Tuberculosis and Malaria: Started in 2002, the Global Fund is an independent, multilateral organization. It receives funds from governments around the world, including the U.S., to fight AIDS. The Global Fund disburses for programs but does not implement them. The Global Fund is partnering with PEPFAR in treatment, supply chain, monitoring and evaluation and other programs in some of the focus countries. http://www.theglobalfund.org

Great Lakes Initiative on AIDS: GLIA. In 1999 six countries from the Great Lakes Region of Africa — Burundi, the Democratic Republic of the Congo, Kenya, Rwanda, Tanzania and Uganda — came together to acknowledge that in order to address the growing HIV epidemic, a broader, more regionally based response needed to be undertaken.

HAART: Highly active antiretroviral therapy. The combination of several antiretroviral medications used to slow the rate at which HIV makes copies of itself in the body.

High-risk group: See “at-risk group.”

HIV: Human immunodeficiency virus. The virus that causes AIDS, HIV kills and damages the body’s immune system cells, which hinders the body’s ability to fight off infections. HIV is spread through certain body fluids, particularly blood and semen.

Human Development Index: A composite index, compiled by the U.N. Development Program, which measures achievement in three basic dimensions of human development — a long and healthy life, literacy and a decent standard of living. http://hdr.undp.org/hdr2006/statistics/indicators/1.html

IDU: Injecting drug user, considered a “high-risk” or “at risk” group for contracting HIV.

Incidence rate: HIV incidence refers to the number of new infections over a period of time (usually one year). See “prevalence rate.”

Internally displaced persons: People who have been forced to flee their homes to escape armed conflict, generalized violence, human rights abuses or natural or man-made disasters.

Leadership Act: The Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003 authorized PEPFAR and promoted the so-called ABC approach, requiring that starting in fiscal 2006, 33 percent of prevention funds be spent on abstinence until marriage activities.

Microbicides: Substances being tested by researchers that might reduce the infectivity of HIV and other sexually transmitted infections.

MSM: Men who have sex with men; considered a high-risk group for contracting and transmitting HIV/AIDS.

New Partners Initiative: An initiative that will provide $200 million through fiscal 2008 for grants to new partners providing HIV/AIDS prevention and care services in an effort to identify potential new PEPFAR partner organizations and to increase their capacity to provide care and prevention services.

NGO: Nongovernmental organization. NGOs, which include FBOs and CBOs, make up a majority of PEPFAR partners.

OGAC: Office of the Global AIDS Coordinator, based in the State Department, which was created to coordinate and oversee the U.S. global response to the HIV/AIDS epidemic. The current coordinator is Ambassador Mark Dybul. http://www.state.gov/s/gac/

Orphans: The “O” of OVC. Children under 15 who have lost one or both parents.

Other prevention: “Other prevention” includes activities such as programs for high-risk groups to increase their awareness of HIV/AIDS prevention behaviors and their access to HIV prevention services, such as condom promotion and distribution; condom social marketing; substance abuse prevention programs; management and treatment of sexually transmitted infections; and messages or programs to reduce injection drug use and related risks. In February 2006, OGAC changed “other prevention” to “condoms and related activities.”

OVC: Orphans and Vulnerable Children, a component of PEPFAR’s “care” activities. According to OGAC, OVC services include caregiver training, access to education, legal aid, emotional and psychological care, and food and nutritional support. See “Orphans” and “Vulnerable Children.”

Palliative care: The entire spectrum of care for people living with HIV/AIDS; it differs from other palliative care in that it is broader than simply “end-of-life” care.

Partnership for Supply Chain Management: PSCM was established in fiscal 2005 to ensure that an uninterrupted supply of high-quality, low-cost medicine and supplies flows through a transparent accountable system.

PEPFAR: President’s Emergency Plan for AIDS Relief. Introduced by President Bush in his 2003 State of the Union address, PEPFAR is a five-year, $15 billion initiative to combat the spread of HIV through prevention, care and treatment programs.

PEPFAR’s 2-7-10 goals: Targets to treat 2 million infected people using ART, prevent 7 million new infections and care for 10 million infected or affected by HIV by 2008.

PLWHA: People Living with HIV/AIDS.

PMTCT: Prevention of Mother-to-Child Transmission of HIV.

Prevalence rate: The percentage of the population that is estimated to be HIV-positive. Estimates of HIV prevalence are often based on surveillance of pregnant women in prenatal clinics or population-based surveys.

Prevention: HIV/AIDS prevention activities have five components: abstinence/be faithful; “other prevention”; prevention of mother-to-child transmission; safe medical injections; blood safety.

Prime partner: An organization that receives direct PEPFAR funding.

SCMS: Supply Chain Management System. SCMS delivers medications and other HIV-related commodities to HIV/AIDS programs around the world by strengthening existing supply chains and establishing new ones. Through PEPFAR, SCMS is administered by the Partnership for Supply Chain Management.

Secondary abstinence: Returning to abstinence after having had sex.

Seroprevalence: The proportion of people in a given population who test positive for HIV (or other infections).

Sub-partner: An organization that receives PEPFAR funds through a prime partner.

Sub-Saharan Africa: The region of Africa south of the Sahara Desert. Sub-Saharan Africa, which has 11 percent of the world’s population, accounts for more than 64 percent of the global HIV-infected population.

Survival sex: Sex in exchange for items needed to survive. Similar to transactional sex. Individuals engaging in this practice are considered a “high-risk” group.

TB: Tuberculosis, an infection found mostly in the lungs whose symptoms include heavy coughing, tiredness, fever and weight loss. TB is a common infection among people with AIDS.

Transactional sex: Sex in exchange for money or favors. Transactional sex differs from prostitution because it does not imply an occupation and can take the form of long-term relationships.

UNAIDS­: Joint United Nations Program on HIV/AIDS. Launched in 1996 and based in Geneva, UNAIDS is a conglomeration of 10 U.N. system organizations responding to the HIV epidemic. UNAIDS is involved in HIV/AIDS projects in more than 75 countries. The current executive director is Belgian doctor Peter Piot. http://www.unaids.org/en/

USAID: The U.S. Agency for International Development is the principal U.S. government agency that coordinates assistance to countries “recovering from disaster, trying to escape poverty and engaging in democratic reforms.” USAID is one of the agencies involved in PEPFAR and receives the bulk of PEPFAR money. http://www.usaid.gov/

VCT: Voluntary Counseling and Testing. According to USAID, VCT serves as a link between the prevention and care components of fighting the HIV epidemic. VCT helps develop personalized programs for people to reduce risky behavior and thus the chance of spreading or contracting the disease.

Vulnerable children: The “VC” of “OVC.” Children affected by HIV through the illness of a parent or principal caregiver.

WHO: World Health Organization. The United Nations’ specialized agency for health which was founded in 1948 and has 193 member states. http://www.who.int/en/