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Lawmakers, former officials urge structured transition of PEPFAR to country ownership to protect gains and U.S. interests
Summary
Witnesses and members said PEPFAR should move toward country led programs with clear benchmarks and private‑sector involvement while guarding against chaotic withdrawals that could harm public health and U.S. diplomatic interests; China’s increasing presence in Africa was cited as a security risk if transitions fail.
Ambassador Mark Dybul, former U.S. officials and members of the subcommittee told the panel that PEPFAR’s long‑term sustainability requires carefully planned transitions to domestic financing, private‑sector engagement and stronger country ownership.
Dybul and other witnesses said domestic financing already accounts for a rising share of HIV financing—one figure cited during the hearing put domestic sources at about 59 percent of HIV‑related spending in 2023—and that many countries could begin structured transitions now. Dybul said roughly three dozen countries with substantial PEPFAR and Global Fund allocations could “successfully transition within a few years,” provided the U.S.…
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