UNAIDS Report Shows Gains in HIV Prevention

The new UNAIDS report out today—an epidemic update—highlights key strides made in HIV prevention.

New HIV infections have been reduced by 17% over the past eight years, the new UNAIDS data shows, including declines in sub-Saharan Africa, East Asia and elsewhere. The report also says that the number of AIDS-related deaths has dropped by more than 10 percent in the last five years and estimates some 2.9 million lives have been saved by global HIV treatment initiatives.

“We cannot let this momentum wane,” said Dr Margaret Chan, Director General of WHO, according to a press release accompanying the report. “Now is the time to redouble our efforts, and save many more lives.”

Despite these gains, the document says prevention efforts are lagging behind changes in the epidemic, failing to reach key populations, including sex workers and injecting drug users. Read the full report here or the press release here.

HIV/AIDS Experts Call For Bold Treatment and Prevention Targets to Combat Global AIDS

As World AIDS Day approaches, leading physician‐scientists called on the White House and Congress to continue the scale‐up of HIV prevention and treatment services in the developing world and to preserve U.S. leadership in the battle against this deadly epidemic.

The Obama Administration is expected to release its five‐year global AIDS strategy on Dec. 1—World AIDS Day. In a Global Center press release, HIV/AIDS doctors and researchers said the Administration’s new plan should set bold new treatment targets for PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief, and include robust funding levels to fulfill promises made in the landmark Lantos‐Hyde legislation, which calls for spending $48 billion over five years on global AIDS, tuberculosis and malaria.

“Less than a decade ago, some questioned the viability of providing HIV treatment to poor patients in the developing world. Today, we have extraordinary evidence of PEPFAR’s success ‐more than 2 million people in resource‐poor countries have avoided severe diseases and untimely deaths through access to antiretroviral drugs,” said Kenneth Mayer, MD, co‐chair of Global Center’s scientific advisory committee and a professor at Brown University, where he directs the AIDS Program.

But Dr. Mayer noted that the majority of people who need lifesaving antiretroviral therapy still do not have access to it. “Without continued scale up of HIV treatment, millions of people in the developing world are likely to succumb to this chronic, treatable disease—with devastating consequences for their families and their communities,” he said.

Read the full press release on the Global Center’s website.

HIV Funding Not at Fault for Health System Ills

HIV is not to blame for the ills, figuratively or literally, of developing world health systems, and funding for AIDS programs can’t take a hit in favor of other health threats.

That’s the take-home message of a statement issued last week from 87 civil society, research and other health groups from more than two dozen groups around the world. The statement condemns the notion that donor countries should siphon funding from global HIV programs to address other health problems in resource-poor countries.

“The neglect of health systems in general, and particular health challenges such as tuberculosis and diarrhea, is not a recent phenomenon and certainly cannot be attributed to one disease that is obsessively touted as the culprit-namely, HIV,” the statement reads.

The proclamation—titled “HIV is not over-funded: Health is under-funded”—rejects the notion that other health threats can or should be addressed by pitting AIDS funding against other needs, such as child and maternal health.

“This competition is completely irrational,” Paula Akugizbwe, of the AIDS and Rights Alliance for Southern Africa, said at a press conference in Cape Town last week.

“We cannot keep shuffling our scanty resources from one disease to another and expect to see lasting change,” said Akugizbwe, a key player in organizing the statement. “Health, a vital requirement for stable societies and socio-economic development, needs to be prioritized and funded appropriately. But this cannot be at the expense of HIV, which underpins so many other health challenges.”

As the statement says: “More resources for health overall are desperately needed – not only for the humanitarian and health systems benefit, but also to lessen the destabilizing impact of poor public health on socio-economic progress, particularly in low-income countries.”

It continues: “Shifting funding from HIV will not fill the yawning gaps in resources for health – this move is a cheap diversionary tactic that offers no genuine or long-lasting solutions for health systems. What is required is a shift in political will to prioritize and invest vigorously in health. Until this happens, neglect and dysfunction will continue to pervade health systems irrespective of what specific health needs we focus upon.”

 Read the full statement and see the list of endorsers by clicking below.

HIV Is Not Over-Funded Health Is Under-Funded_19 11 09

Leaders in Global Health to Obama: Keep the Promise on Global AIDS

Leading academic, scientific, and public health leaders from around the world sent a letter to President Obama last night, urging him to maintain robust scale up of AIDS services as part of his Global Health Initiative.

“It is imperative that we save lives, families and communities, as well as stabilize developing nations, through continued scale-up of HIV prevention and treatment services,” the letter says. “U.S. global health policy now has an opportunity to leverage the success of the AIDS response by using accelerated scale-up of HIV prevention and treatment as a platform on which to build broader and more sustainable healthcare capacity in low-and middle-income countries.”

The signatories on the letter include a broad array of leading medical and health experts—Jim Yong Kim, president of Dartmouth College; Martin Blaser, chair of the Department of Medicine at New York University, David M. Serwadda, dean of the School of Public Health at Makerere University, and Paul Farmer, chair of the Department of Global Health and Social Medicine at Harvard University, to name a few.

The missive to Obama comes as the Administration hones a new approach to global health. Top government officials are putting the finishing touches on a new global AIDS strategy, which is set to be released on Dec. 1—World AIDS Day. But right now, signals from the White House indicate lukewarm support for the US global AIDS program. Dr. Eric Goosby, Obama’s global AIDS coordinator, recently said the Administration would flat-fund PEPFAR for at least the next two years, possibly longer

The White House is also crafting details of its all-important Global Health Initiative, which could come out in the next few months. And there’s the nomination—finally—of Dr. Rajiv Shah to head USAID.

Given all that activity, the focus on AIDS could not come at a more crucial moment, particularly as the Administration appears to be shifting its attention to other health problems, such as child and maternal health, without an apparent acknowledgement of the link between AIDS and the health of mothers and children.

As the letter notes, HIV/AIDS is the No. 1 cause of death among women aged 15-44, the virus remains a leading cause of maternal mortality in sub-Saharan Africa. “Globally, only one-third of pregnant women have access to antiretroviral drugs that can virtually eliminate the risk of perinatal transmission,” the signers note. “Twelve million children have lost one or both parents to AIDS and the number of orphans continues to rise.”

The letter argues we cannot effectively address other health threats by pitting AIDS funding against other health needs, as some in Washington seem to be advocating.

“Today, some argue that we cannot increase the so-called “treatment mortgage” or that HIV resources should be shifted to other health care priorities,” the letter says. “We reject the notion that urgent health conditions should be pitted against one another. Narrow conceptions of cost–effectiveness, or the cost of a given intervention in isolation, cannot become the litmus test to compare interventions for different diseases or to prioritize U.S. global health funding.”

Click here to read the full text and see a complete list of signatories or below for a PDF.

Final_Letter to President on AIDS scale up 11 18 09 (2)

Sen. Brown Tells White House Not to Neglect TB

Sen. Sherrod Brown, D-Ohio, has asked the White House to make tuberculosis a focal point of its Global Health Initiative.

As the Obama Administration works to flesh out the all-important details of its six-year $63 billion GHI plan, Brown sent a letter to the White House saying it is “imperative” that TB be part of the strategy to combat diseases around the world.

“TB kills nearly 2 million people each year and is the leading killer of people with HIV/AIDS,” Brown wrote in the Nov. 17 missive. “In many cases, AIDS patients receiving drugs thanks to American aid die for lack of TB treatment.”

Brown also pointed out the role an aggressive U.S. TB strategy could have in shoring up key American allies and in strengthening maternal health, a cornerstone of the GHI.

“Global aids for TB control and prevention will also advance women’s rights, which I know is a priority for your administration,” Brown says. “TB is the leading curable infectious killer of women, claiming even more women’s lives than maternal mortality.”

The Administration first announced its Global Health Initiative in May, but crucial details have yet to be released. The White House is reportedly crafting those detals now but it’s unclear when the full plan will be released publicly.

Here is a link to Brown’s letter.

111709 TB Letter to the President

New Publication Details “Advances and Challenges” in HIV Clinical Care

The latest HIV clinical care information is now available in a compendium of the year’s HIV-related articles from Clinical Infectious Diseases and The Journal of Infectious Diseases.

The publication, 2009 Clinical Issues in HIV Medicine: Recent Advances & Challenges, was edited by Kenneth Mayer, MD, Miriam Hospital, Brown University and Daniel Kuritzkes, MD, Brigham and Women’s Hospital, Harvard Medical School. It includes a wide range of HIV-related articles, including a piece on when to start HIV therapy, race and sex differences in ART use and mortality among HIV-positive persons, and the NIAID’s research agenda on drug-resistant TB.

Click here to see this important publication put out by the HIV Medicine Association.

NIAID’s Fauci on Tuberculosis: “We have much catching up to do”

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, delivered a forceful message on the need for a “storm” of attention and resources devoted to developing new TB treatment and prevention efforts.

“It is imperative that we transform the way we diagnose, treat, prevent, and control TB — through biomedical research and public health measures — to the same extent that we have done and will continue to do with HIV/AIDS,” Fauci writes in this commentary on MSNBC’s website today. “We are beginning to see the winds of change, but what we really need is a storm.”

In an echo of the speech he delivered this summer at the Pacific Health Summit in Seattle, Fauci, a powerful leader in infectious disease research, outlined the need for a robust new TB research agenda. “The TB research effort will require a sustained and long-term commitment from government, academia, industry and philanthropy.”

Click here to read the whole piece and here to read our earlier post on Fauci’s remarks in Seattle.

IDSA Joins the Stop TB Partnership’s TB/HIV Working Group

The Stop TB Partnership has made the Infectious Diseases Society of America an organizational member of its TB/HIV working group, a reflection of IDSA’s increasingly visible work on these twin global health threats.

Housed within the World Health Organization, the Stop TB Partnership was formed more than a decade ago as a network of international organizations, donors, governmental and non-governmental groups—all committed to eliminating the deadly scourge of TB. The Partnership has seven working groups to focus energy and attention on specific challenges in fighting TB, including drug-resistant TB, new TB drugs, and DOTS expansion.

IDSA’s membership in the TB/HIV working group will provide a new mechanism to advocate for improvements in policies and programs designed to combat these two epidemics, which have formed a deadly synergy that threatens to unravel gains in treating HIV. Christine Lubinski, IDSA’s vice president for global health, will serve as IDSA’s representative on the TB/HIV working group.

In ratifying a proposal to accept IDSA, the Partnership took note of IDSA’s recent work on co-infection through its Center for Global Health Policy. In particular, the Partnership drew attention to the Global Center’s call for a Presidential Initiative on TB and for a comprehensive strategy to combat HIV/TB co-infection, as detailed in “Deadly Duo: The Synergy Between HIV/AIDS & Tuberculosis.”

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.