By Will Dunham

WASHINGTON, March 30 (Reuters) - The U.S. program fighting AIDS globally needs to put more emphasis on prevention and helping hard-hit nations in their long-term battle against the disease, an expert panel said on Friday while also faulting congressional mandates on program spending.

The congressionally mandated report by an Institute of Medicine panel assessed the work of the President's Emergency Plan for AIDS Relief, or PEPFAR, which is three years into a five-year, $15 billion effort to combat AIDS, particularly in 15 countries mostly in Africa.

"Overall, PEPFAR is doing quite well, has a good start," the panel's chairman, Jaime Sepulveda of the University of California at San Francisco, told reporters.

PEPFAR has made important progress in hard-hit countries in part by providing AIDS drugs to more than 800,000 people, the report said.

But the report faulted congressional mandates on how PEPFAR spends its money, saying they are partially to blame for why the program does not always support the best type of prevention strategies reflecting how the disease is spread locally. It called for such restrictions to be lifted.

Congress requires that at least a third of PEPFAR's prevention funds be directed to programs promoting sexual abstinence until marriage.

"If in Vietnam the epidemic is mostly transmitted by drug injection, why put the emphasis on abstinence?" Sepulveda said.

Congress requires that 55 percent of PEPFAR funds go to treatment, 15 percent to caring for the sick and 10 percent to assist children affected by AIDS, leaving 20 percent for prevention.

"We're strongly recommending more prevention efforts and better prevention efforts," Sepulveda added. "Unless we prevent new infections ... no matter how much money is spent in treating people, the epidemic will never end."

LONG-TERM FIGHT

The report also urged PEPFAR to shift its primary focus from providing immediate, emergency assistance to building up the capacity of 15 hard-hit countries to sustain anti-AIDS efforts over future decades.

The Institute of Medicine provides advice on health issues to U.S. policymakers.

"No doubt, we can do better. We can do better on everything. And that's what we're trying to do," U.S. Global AIDS Coordinator Mark Dybul said in an interview, noting that the United States was spending as much as the rest of the developed world combined on fighting AIDS.

Dybul said the report largely endorsed what the program was doing, and said officials already were focusing on how to sustain efforts over the long term.

More than 25 million people have died of AIDS since the incurable disease was first recognized in 1981. About 40 million people now live with human immunodeficiency virus, or HIV. Most are in sub-Saharan Africa, where the virus is spread primarily through heterosexual sex.

The report urged more attention to factors making women and girls more vulnerable to HIV infection, and called for improvements in their legal, economic, educational and social status.

"We are making the overall recommendation to find ways to empower girls and women and to protect them from sexual harassment and sexual violence," Sepulveda said.

The report noted that PEPFAR has a goal of preventing at least 7 million people from becoming infected by 2010 in the 15 focus countries -- 12 in Africa, plus Vietnam, Haiti and Guyana. It said that while PEPFAR says millions of people have received various prevention services through the program, it is not clear how many infections ultimately will be prevented.

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