A poster juxtaposes the faces of Presidents George W. Bush and Barack Obama, the caption asking "Who is better for AIDS?" And, a sticker worn by a man standing nearby has a deli number distributor, its caption saying "Obama's AIDS plan. Take a Number, Wait to Die."
These are a sample of messages from HIV/AIDS activists gathered at the 18th biennial International AIDS Society (IAS) conference in Vienna, Austria. For more than a year, the HIV/AIDS community has been criticizing the Obama administration for decreasing or flat lining the global HIV/AIDS budget, claiming we are literally killing millions of people by not funding ARV drugs to treat HIV infection. To accentuate this point, the IAS conference began with activists staging a "Die In." Just today, Archbishop Desmond Tutu published an op-ed in the New York Times, echoing these criticisms, and in Huffington Post, Anand Reddi repeats these claims. As the conference comes to a close in Vienna and the baton is passed to Washington, D.C. to host the 2012 gathering, it is time to change the tenor of this global debate.
First, we need to get the facts straight.
A few days ago UNAIDS in conjunction with the Kaiser Family Foundation released a report showing that in 2009, the United States provided 58 percent of all funds worldwide to fight HIV/AIDS in developing countries. Furthermore, while numerous developed countries were actually reducing their support for HIV/AIDS between 2008 and 2009, the United States actually increased its funding by more than 10 percent.
The president recognizes that funding global health is good for national security, domestic health and global diplomacy. Consequently, President Obama has steadily increased funding for the President's Emergency Plan for AIDS Relief, or PEPFAR, which was created by President Bush and has strong bipartisan support. The President's 2011 budget proposed an 8 percent increase in global health funding. This included a historic $7 billion request for PEPFAR the largest-ever request for PEPFAR, accounting for 73 percent of the total proposed global health budget.
At the IAS conference, many activists chanted that the "U.S. government counts pennies, Africa counts lives." But it is precisely the activists who have been measuring success in the global fight against HIV/AIDS in terms of dollars and pennies. Their focus seems to be only on the budget. But what counts are not dollars spent or drugs bought, but lives saved.
That's why as part of the President's $63 billion Global Health Initiative, the Obama Administration is emphasizing the need to shift the focus from funding levels to substantive health outcomes -- reductions in AIDS-related deaths, improvements in morbidity and quality of life, and the prevention of new HIV cases. These results -- not dollars budgeted or spent -- are what we ultimately care about, and what the activists should care about as well.
Part of the reason to shift the focus is that there is not a one-to-one relationship between the input of dollars spent and the output of improved health or lives saved. Recent studies have shown that the costs of HIV screening, counseling and testing, medical male circumcisions, and ARV treatment and monitoring vary tremendously both within countries and in regions. Some programs are efficient; other programs are ineffective. We need to figure out which programs and approaches are failing, end them, and shift funds to those programs that are working. And, even within programs that are working, we need to do things more effectively.
Contrary to what Dr. Reddi argues, neither I nor the Obama Administration sees an "either-or" trade-off between PEPFAR and other global health priorities such as improving maternal-child health. What it takes to save lives of those with HIV and those most at risk to contract it is a comprehensive approach that recognizes the roles of other diseases (many inexpensively preventable), child and maternal health, and strong health systems play in saving lives and solidifying health gains in developing nations.
This comprehensive and integrated approach is what the President's Global Health Initiative is all about. It recognizes that we can't treat our way out of the HIV-AIDS epidemic. The key to ending it is to reduce the number of those who become HIV-positive in the long-term - and that takes improving their overall health and the health systems around them. After all, patients don't come to doctors with one disease or condition, and our response shouldn't focus on one as well.
Indeed, in addressing the International AIDS Society conference Kgalema Motlanthe, South Africa's Deputy President, discussed the country's plan for mass screening and care, noting that rather than focusing just on HIV, South Africa will include screening and care for TB, hypertension, high cholesterol, diabetes, as well as other diseases. The integrated care that is the heart of the GHI is the wave of the future.
Over the years, activists have exhibited tremendous creativity, passion, and energy in the global fight against HIV/AIDS. Let's re-direct that energy into making programs work better and pinpointing effective interventions that serve all the population -- persons living with HIV as well as mothers, children, people with malaria, TB, neglected tropical diseases. Working together to improve the health of the bottom billion should be our legacy.
Peter Hotez, M.D, Ph.D.: The London Declaration: A Tipping Point For The World's Poor
I know men who say they are monogamous, but are having sex on the side. I know others who have HIV/AIDS or some other type of STD (Herpes, Hepatitis, Syphilis) who are not wearing condoms (by their own omission). I think many of the gay men who acquired this disease are guilty for being reckless and greedy about their sexcapades. I often wonder how they reconcile this in their minds. Do you ever think about your contribution to the pandemic and the challenges it brings? I know there are men out there who feel guilt, but I know too many who are passive.
Do the DL (downlow) guys think about the future, or always act in haste for simple pleasure? Yes, I know promiscuity exists within straight culture too, but gay culture is who I am, and I am often perplexed by many a gay man’s perspective, morals (lack of), and especially their inability to take a good hard look in the mirror to see what they need to change.
All of us fail to realize that our actions impact the world at large. One small slipup can have a rippling affect, creating catastrophe for years to come. I wish we all would think twice before taking that plunge into the point of no return.
http://paulkilmon.blogspot.com/2010/07/what-can-i-say.html
needs to link to the LIVING section all the MDs practicing integrative medicine
as an amature i've made myself a nuisance advocating solution and prevention namely integrating alternative modalities and protocols into the endeavors against AIDS
alternative medicine is a minority among doctors it would need to be focused on some clinics
starting with Maharishi Ayur Veda PANCHAKARMA treatments [ use Lancaster, Mass. MAV clinic, Bad Ems MAV clinic in Germany , some in India ]
i had advocated funding 7 antiAIDS clinics in africa , each using a major modality of alternative [ what WHO calls traditional medicine TM }
including mind/body medicine i.e. Transcendental Meditation(TM) :
Ayur Veda { AYUSH } ; TCM ; Naturopathy and Master Herbalism ; local healers ; intravenous high dose Vitamin C [ DR Klenner's ]
China has 3300 TCM hospitals India has about 100 Ayur Veda colleges , 400 000 Vaidyas so test it there keeping in mind that Maharishi Ayur Veda is th e most authentic Ayur Veda ( 64 treatment modalities )
IT would be nice to advocate this without making accusatory and true statements about the stubborness of orthodox medicine to see the wisdom of time tested knowledge and use it
the debate must be about using Maharishi Vedic Hospitals which exist at this time only on green paper at mum.edu ; as with the 7 clinics , this will be actual treatment and scientific proof of effectiveness
major baby steps
I went from a T-cell count of under 60 and viral of estimated 3-5million ppb to T-cell of 1000+ and undetected in under 3 years and am now stronger at 45 (and a father) than I have ever been in my life.
Remember Garlic is good on a pizza, not as medicine!
First - I agree - let's get the facts straight. While the the $7B request for PEPFAR is the largest ever, let's put it into context. It is only a $154M increase over last year's enacted budget. You fail to mention that the US reduced its contribution to the GFATM by $50M. To infer that this is somehow laudable in the context of the epidemic is disingenuous.
Second, I agree that there are good and bad programmes - some efficient/effective and others not. We must systematically change those that enable corruption and have bloated administrative costs and redirect that money to effectively treat and prevent new infections.
Third, Indeed, we must work together. Maternal/childhood health and AIDS are inextricably bound. Women who come in for prenetal care receive pre-and post-natal counseling and can prevent vertical transmission. Encouraging health seeking behaviours for women of child bearing years and mothers is a common goal on which AIDS and MCRH activists and programmes must unite.
You are incorrect to say that activists only count dollars, not lives. This is an affront to thousands of health workers and programme managers who work on the front lines who are also activists.
Finally, by saying that "patients don't come to doctors with one disease or condition" is naive and out of touch with reality. In much of Africa and "poor America", patients seek care ONLY when desperately ill.
I agree we must work together - I would appreciate an invitation to do so.
"The key to ending it is to reduce the number of those who become HIV-positive in the long-term - and that takes improving their overall health and the health systems around them. After all, patients don't come to doctors with one disease or condition, and our response shouldn't focus on one as well.
So we can't end the epidemic with treatment (as though anyone had suggested that), but "the key" is improving overall health systems? No. Improving overall health is obviously a good thing, but it will have little direct effect on the AIDS epidemic. After all, we have a substantial health system in the US, and HIV infections continue apace. But there are fewer AIDS deaths here because of access to effective treatment.
It makes no sense. Bush put lots of money toward public health with positive results (that's hard enough to wrap one's mind around), and Obama and Emanuel are arguing that the way to treat HIV is to treat everything but HIV. And if there must be money for HIV treatment, it must be given in cowardly Democratic fashion, for the benefit only of women and children. (Sorry, guys.) The explanation has to be something irrational and political because the official story makes no sense.
You can spin it any way you'd like to but according to the Kaiser Family Foundation's Global Health Tracker, the Administration asked for a 2.3% increase for PEPFAR for this year (which doesn't keep pace with inflation in many PEPFAR countries) and a 4.8% cut in its contribution to the Global Fund. While you tout overall spending figures on AIDS, it is a little more than disingenuous to claim credit for the previous Administration's investment in AIDS as your own.
Your comments move from the disingenuous to the outright repulsive when you claim that activists measure success in dollars spent not in lives saved. AIDS activists have been the fiercest watchdogs of health programs around the world, sometimes putting our lives on the line to criticize our governments. Many of us are HIV+ and thus we don't have to be told what fighting this epidemic is about.
Lastly--in the Journal of the American Medical Association in 2009, you made an explicit case for new investments in global health to go towards cheap interventions for maternal and child health and not towards further scale-up of AIDS treatment. So sir, you are simply lying when you say neither you nor the President wants to pit AIDS against MCH.
We know a comprehensive plan for global health is what is needed--but you are pitting diseases against diseases, shortchanging global health overall, and that is what history will remember.
The root problem internationally in HIV/AIDS is poverty. In the U.S., an expanded social safety net would have profoundly positive effects in reducing transmission. In developing countries the proven effect of distributing small amounts of money to impoverished women at risk could be expanded through microcredit programs allowing these women to prepare themselves for a greater degree of financial independence. It can be demonstrated that women who are no longer surpressed by poverty will substantially decrease risky sexual behavior. Microcredit has been clearly been shown to be financially self sustaining.
As an aside, the growing focus on male circumcision is based on very suspect research, and may have little or no effect.
http://www.doctorsopposingcircumcision.org/info/HIVStatement.html
As of Dec 2009 (last year), After two decades, Congress has voted to lift a ban on federal funding of needle exchange programs. AIDS activists are cheering the move, saying it legitimizes needle exchange in the nationwide fight against HIV/AIDS.
Mode of transmission: MSM = 53% of cases in 2007, IDU = 12% (http://www.cdc.gov/hiv/topics/surveillance/resources/slides/general/slides/general_7.pdf).