New WHO Report Documents Toll of HIV/AIDS on Women

A new World Health Organization’s report on women’s health highlights the increasing toll HIV/AIDS has taken on women in the developing world. HIV/AIDS is “by far the leading cause of death among adult women in Africa,” the report says. It is also the leading cause of death globally among women of reproductive age.

“Of the 30.8 million adults liv­ing with HIV in 2007, 15.5 million were women,” according to the report, “Women and Health: Today’s Evidence, Tomorrow’s Agenda.” “The prevalence of HIV infection in women has increased since the early 1990s and is most marked in sub-Saharan Africa.”

The report details how women’s vulnerability to HIV infection “stems from a combination of biological factors and gender inequality.” Biological differences are “compounded” by cultural/societal restrictions that limit women’s power to have safe sex and to access to information about avoiding HIV infection.  

The WHO study also notes the heavy toll tuberculosis takes on women, as the second leading cause of death in the Eastern Mediterranean and South-East Asia regions and the fifth leading cause of death of women aged 20 to 59. The three leading causes of death in low-income countries are HIV/AIDS, maternal conditions and tuberculosis, which together account for one in every two deaths. This year, the report says, “a mil­lion women will die from HIV/AIDS, half a million from tuberculosis, and another half a mil­lion from complications related to pregnancy and childbirth.”

Click here to read the full report and associated documents.

Doctor, Ag Official Tapped to Head USAID

The White House has finally moved to fill the top slot at USAID—with a doctor no less—ending months of angst and speculation about who would take that long-vacant post.

Media reports indicate that President Obama will tap Rajiv Shah, MD, currently a senior official at the Department of Agriculture whose portfolio includes food security, to oversee the U.S. foreign-assistance agency. Besides the MD after his name, Shah has another good item on his resume, at least from the global health perspective; he was formerly with the Bill & Melinda Gates Foundation, where he helped launch a global development program and worked on the foundation’s global health program. Other top items on his CV include a reference to his work for the Global Alliance for Vaccines and Immunization and the Global Fund for AIDS, Tuberculosis and Malaria.

The appointment, subject to Senate confirmation, comes as Congress looks at foreign assistance overhaul and the White House drafts a new Global Health Initiative, both critical efforts that could significantly alter the landscape for US global health policy. Click here to read Politico’s account of the nomination and here to see Shah’s full resume, as posted by Politico.

New Goosby Interview Highlights Challenges, Next Steps in Global AIDS

President Obama’s US Global AIDS Coordinator, Eric Goobsy, MD, discusses health system strengthening, PEPFAR’s tight budget, the Administration’s Global Health Initiative, and other subjects in this interview posted on the Global Health Council’s blog. It’s definitely worth reading for the latest insights into the Administration’s plans for battling global AIDS.

WHO Official: “Prevention and Treatment Are Two Faces of the Same Coin”

The idea of HIV treatment as prevention got a major boost yesterday in the wake of a WHO meeting in Geneva on the use of antiretroviral therapy as a way to curb new HIV infections.

“In the past, there has been a false dichotomy between prevention and treatment,” Teguest Guerma, interim director of the WHO’s AIDS department, told Bloomberg news, according to this story, as the WHO meeting wrapped up. “That is really what has been corrected. Prevention and treatment are two faces of the same coin.” Guerma said providing wider access to ARV drugs “will achieve a significant transmission benefit.”

His comments are likely to bring fresh attention to the debate over scale up of HIV programs. They come at the same time the WHO is considering changing in its HIV treatment guidelines to support earlier initiation of antiretroviral therapy, reflecting scientific evidence that such a move significantly enhances survival. With evidence mounting that wider access to ARVs would have benefits for everything from HIV prevention to AIDS mortality to tuberculosis control, the chasm between the need for ARVs and the funding for treatment seems to be getting wider by the minute. Let us know what you think about Guerma’s statement and these related issues.

Ramifications of a Retreat on HIV/AIDS

A new report out today from Doctors Without Borders (Medecins Sans Frontieres) highlights concerns that donor countries’ commitment to combating the deadly HIV/AIDS epidemic is wavering.

“MSF teams working to treat HIV/AIDS are witnessing worrying signs of waning international support to combat HIV/AIDS,” the report says. “In some high-burden countries, patients are being turned away from clinics, and clinicians are once again being forced into the unacceptable position of rationing life-saving treatment. At the same time, more robust and better-tolerated treatments – widely prescribed in wealthy countries – are not reaching patients.”

The report, called “Punishing Success: Early Signs of a Retreat from Commitment to HIV/AIDS Care and Treatment,” says that the Global Fund to Fight AIDS, Tuberculosis and Malaria Board is considering a move to cancel Round 10 funding for 2010, which would mean no new grant proposals could be considered until 2011. The document also says that the Obama Administration plans to provide only level funding for the US President’s Emergency Plan for AIDS Relief (PEPFAR) for the next two years.

Both these moves would have dire consequences, the report says, putting at risk the gains made in HIV/AIDS treatment and prevention. Click here to read the full document, which calls on the donor community to provide robust funding for AIDS, among other recommendations.

No Rosy Scenarios for AIDS in 2031

What will the HIV/AIDS epidemic look like in 2031, on its 50th anniversary? A provocative article in Health Affairs, online here, tries to answer that question, and the picture is not pretty.

Without a “gamer changer” in prevention, the AIDS epidemic will still be raging when we reach that milestone, write Robert Hecht, managing director of the Results for Development Institute, and his co-authors in the lead article.

“Without a change in approach, a major pandemic will still be with us in 2031,” Hecht et al declare. “Modeling carried out for the AIDS 2031 project suggests that funding required for developing countries to address the pandemic could reach $35 billion annually by 2031—three times the current level. Even then, more than a million people will still be newly infected each year.”

They argue that smart policy decisions and more efficient treatment strategies, among other steps, could cut costs and lead to better results. But the findings signal a major funding shortfall in global AIDS programs in the coming decade, not to mention the here and now.

“We are staring at the face of a huge crisis,” Hecht said in a news release highlighting the Health Affairs article.

Hecht’s piece is just one in a series of articles in this issue of Health Affairs devoted to current challenges in HIV/AIDS prevention and treatment. The November/December issue also includes an article by Stefano Bertozzi, of the Bill & Melinda Gates Foundation, on the need to shift away from the emergency response mode in AIDS to a more sustainable effort, and a piece by Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, and Gregory Folkers, who call for increased global funding for AIDS prevention research. Click here to check out this issue.

Global TB & HIV–The Promise and Perils Ahead

Physicians on the front lines of the global tuberculosis epidemic have faced an uphill battle against this deadly scourge, especially with the rise of virulent new drug-resistant strands of this ancient germ and outmoded drugs and diagnostics.

But the medical landscape for TB could change dramatically in the coming years—with new tests and better drugs paving an easier path for TB treatment and care. That upbeat assessment comes from William Burman, MD, an TB specialist and associate professor of medicine at the University of Colorado, speaking at a global health news conference during the Infectious Diseases Society of America’s 47^th Annual Meeting last weekend.

“We could have new TB drugs approved by 2011,” said Dr. Burman, who is also a member of the Global Center’s Scientific Advisory Committee. Two drugs currently in the pipeline look particularly promising, he said, because they work in new ways and appear to be very potent.

Those drugs and others in development, along with exciting new tests that could make tuberculosis diagnosis faster and easier, have the potential to “revolutionize the treatment of tuberculosis,” Dr. Burman said. “We can start to see the outlines of major improvement for TB treatment for patients,” with shorter therapy and possibly safer therapy too.

Dr. Burman said he sensed a renewed commitment in the US and other countries to TB research and treatment, a much-needed shift for this often-neglected forgotten disease. But he noted that the scope of the threat is still grave, with 9 million new TB cases a year and more than 1 million deaths, including an estimated 100,000 children who die from TB annually. Drug-resistant TB is of particularly concern, since it is extremely hard to diagnose and treat with the medical weapons currently available.

“The message is that this is a time of great need,” he said. And “it’s also a time of great opportunity.”

There was no similar talk of turning the corner in the battle against global HIV/AIDS at the news conference. Instead, two HIV/AIDS physician-experts said the gains made in the last decade against this deadly epidemic are tenuous, and developing countries could all too easily lose ground if leadership and resources wane.

Obama Lifts HIV Travel Ban

In a widely hailed move, President Obama announced an end to the two-decades-old ban on travel and immigration to the U.S. by HIV-positive individuals Friday.

Obama said the ban was rooted in “fear rather than fact,” and disease experts agreed, saying the prohibition had no basis in public health or science and only served to deepen the stigma and discrimination suffered by HIV-positive individuals.

“Good riddance to this discriminatory rule that had no basis in public health or sound science,” said HIVMA Outgoing Chair Arlene Bardeguez, MD, MPH, in a news release issued by HIVMA and the Center for Global Health Policy. “This long-overdue move brings the U.S. in line with current scientific and international standards of public health and will lessen the painful stigma and discrimination suffered by HIV-positive people.”

The travel ban served to undermine public health by discouraging people from determining or disclosing their HIV status. It also highlighted a troubling paradox in US policy. Even as Washington took a leading role in combating the AIDS epidemic globally, the US kept in place a policy that prevented international HIV/AIDS activists and researchers from coming to here. Indeed, no major international AIDS conference has been held in the US in nearly two decades because of the ban.

“If we want to be the global leader in combating H.I.V./AIDS, we need to act like it,” Mr. Obama said at the White House on Friday, during a signing ceremony for the Ryan White H.I.V./AIDS Treatment Extension Act.

Overturning the ban puts HIV-positive people on a level playing field with any other foreigner wanting to visit or immigrate to the U.S.

“This move brings common sense to US policy and means that people from developing countries who  receive US funded-HIV treatment will finally be welcome here,” said Kenneth Mayer, Co-Chair of the Global Center’s Scientific Advisory Committee and professor at Brown University, where he directs the AIDS Program.

New Coalition Urges White House to Think Big, Boldly on Global Health

 A diverse coalition of more than two dozen organizations outlined a bold, comprehensive approach to global health at a Capitol Hill briefing today. The briefing comes as White House officials work behind closed doors to flesh out the details of a much-anticipated new US strategy on fighting disease and improving health across the globe.

Today’s event brought together, for the first time, experts and advocates who work on HIV/AIDS, malaria, tuberculosis, child and maternal health, and other health issues, with a unified message: President Obama’s proposal for a new Global Health Initiative  (GHI) offers a significant opportunity for the US to take a transformative role in global health, but the new plan will fall far short if the US does not provide the leadership and resources to back up its promises of more comprehensive, integrated care. If given short-shrift, advocates warned, the GHI could force false choices between diseases and threaten key gains made in combating global AIDS and other epidemics.

“We are massively excited about the possibilities, but we are massively worried” that the funding will not match the rhetoric, said Matthew Kavanagh, director of US advocacy for Health GAP, who moderated today’s Congressional briefing.

Kavanagh said the President’s proposed price tag for the GHI—$63 billion over six years—is simply not sufficient to achieve the goals his plan has identified. The GHI, which the White House first sketched out in May and is expected to detail more fully later this year, listed six target health areas: HIV/AIDS; malaria; tuberculosis; reproductive, maternal, newborn and child health; health systems and health workforce; and neglected tropical diseases.

To truly address those global health issues, the White House and Congress will need to spend about $95 billion over that time period, according to a new report, “The Future of Global Health: Ingredients for a Bold & Effective U.S. Initiative,” released in conjunction with today’s briefing.

Living Proof Project Launched in Washington

Last night Bill and Melinda Gates launched their Living Proof Project, which eloquently shows how US investments in global health are something of which every American should be proud.  

The main event was at a packed auditorium in downtown Washington, where the Gates’ took turns speaking about global health and their personal commitment to these issues.  They also responded directly to several objections frequently heard to the idea that US global health spending should be increased.

The evening included some very impressive use of audiovisuals, using a large backdrop screen – be sure to look at some of the amazing short videos online, which are some of the best I have ever seen.  The video they showed about malaria and children in Tanzania still reverberates in my mind. 

There was also a brief performance by a Namibian singing group called Vocal Motion which had won the Namibian equivalent of American Idol – and they were indeed terrific.

Bill Gates said that it was part of the American spirit that everyone have an equal chance to pursue and develop their talents, and that global health investments are a part of realizing this vision for the world.  He pointed out that US gobal health spending is only a tiny fraction of the US budget — .22% to be exact — but has already accomplished a great deal.

The Gates’ called themselves impatient optimists – “optimists” because, as they clearly demonstrated, there has been much progress in improving global health and there are important innovations coming along that will help even more, and yet also “impatient” because there is so much more that must be done to quickly deliver life-saving services. 

He said he and Melinda were committed “for their entire lives” to global health and that they would continue spending the majority of their foundation’s resources on it.  Yet they also emphasized that the US government needs to do even more to invest its resources. Bill Gates pointed out that the US investment in global health has led other countries, such as in Europe, to scale up their own investment in global health progress. 

Bill Gates began with what he said was his favorite picture, which turned out to be a chart showing the decline in child deaths from in recent years.

Vaccines have been an enormous payoff, which Bill Gates called the “miracle of our lifetimes.” He noted the tremendous success of smallpox elimination, which cost only $130 million over ten years but which has led to savings of $17 billion. He asked the developer of the successful rotavirus vaccine, Dr. Paul Offit, who was in the audience, to stand and be recognized for his 26-year long effort.

Melinda Gates spoke movingly about HIV/AIDS and the need to scale up prevention.  She discussed the price decline that has done so much to make access to antiretroviral medications possible.  She showed a beautiful short video of a seven-year-old girl in South Africa who was dying of HIV/AIDS when access to treatment saved her life. 

“We are hopeful about HIV/AIDS,” said Melinda Gates.  She noted a number of recent innovations that are boosting prevention, such as male circumcision, plus innovations are expected to come in the next few years, such as pre-exposure prophylaxis of HIV.  She also emphasized the recent HIV vaccine clinical trial in Thailand showed partial protection and represented “an important advance.” 

The Gates’ proactively addressed a number of “objections from skeptics.”  To the charge that global health money will be lost to corrupt dictators they said that in fact it is possible to measure results and independently verify the proper use of resources.

To the charge that global health funding is creating dependency, they noted that a number of countries were receiving aid in the 1960s, such as Brazil and Thailand, but which are now no longer in need of outside help.

To the charge that better global health will lead to a population explosion, Melinda Gates responded that she and Bill Gates themselves considered this a serious concern until they learned that better health is leading to better life-expectancy, which has in turn led to women to preferring smaller families.

The Gates emphasized that there was not all good news, however.  They pointed out there has been “little progress” on maternal health issues and on the issue of the health of newborns. 

Melinda Gates pointed out that every year 4 million babies die in the first 33 days of life, many of them in rural Africa, particularly from hypothermia, and millions of women die in childbirth, particularly from hemorrhaging. She showed a very moving video of a man in Ethiopia who had lost his wife in childbirth.

But she also stated that here too there were relatively simple solutions available that could save millions of lives, from ensuring babies are not immediately washed, and instead kept wrapped and warm, to providing expecting mothers with medication that will help prevent hemorrhaging.

“These solutions don’t mean anything unless we deliver them to the people who need them,” Melinda Gates reminded the audience.  Bill Gates concluded with the message that, while the foundation would continue its work, the role of the US government is “absolutely central.” 

The Gates’ called on audience mmembers to help share with friends and neighbors the good news of the postiive impact of US tax dollars in helping improve global health.

See the living proof yourself – with special sections on both HIV and TB – at the Living Proof Project.