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Posts Tagged ‘global health initiative’

A crucial milestone was passed this week in the effort to get increased funding levels approved for global health programs, including PEPFAR, USAID and the Global Fund. The State and Foreign Operations Subcommittee of the House Appropriations Committee, led by Rep. Nita Lowey (D-NY), approved some increases for these programs relative to FY 2010, despite having less money overall to work with.

The Subcommittee divides up an overall amount of money that is only about 1.4% of the total US budget.   But, this total was $4 billion less than what President Obama requested, due to a cut imposed by the Chair of the Appropriations Committee, Rep. David Obey.  In fact, it was the international affairs account that bore the brunt of the cuts to the President’s budget proposal.

All of the global health programs in this bill were increased over FY 10 enacted levels.  Tuberculosis, family planning, and the Global Fund received increases above the President’s request.  Advocates had requested specific, higher levels and have sent a letter to both the House and Senate raising concern about HIV/AIDS funding.

These are the amounts approved for a few areas of interest, drawing on info from the Global Health Council:

The Global Fund — the Subcommittee rejected the Obama proposal to cut the US contribution below the FY 2010 level.  Instead, the Subcommittee approved $825 m,  a boost of  $75 million for the Fund above FY 2010. (President’s Request: $700 m; FY10: $750 m).  However, it remains to be seen whether the portion of the US contribution that comes through the Labor Health and Human Services budget will be provided in full.

Bilateral HIV/AIDS — the Subcommittee provided a boost of $91 million over the FY 2010 level, approving $5.050 b (President’s Request: $5.150 b; FY 10: $4.959b).  This is about half of what President Obama had requested.  Obama had proposed using half of his requested increase for PEPFAR to help finance technical and management assistance for the GHI Plus Countries, and we hear that the report language accompanying allows this.  That means  that about $50 m of the boost for PEPFAR will go to this purpose and only $41 m will be available to expand access to direct services, such as prevention, care and treatment.

USAID’s TB program —  The Subcommittee gave this program a boost of $15 m over the FY 2010 level, approving a total of $240 m (President’s request was $230 m; FY 10: $225 m)

In other decisions, the Subcommittee provided the full amount requested for the Peace Corps, giving it a boost of $46 m over 2010.  And it approved a $71 m increase for Embassy Security, Construction and Maintenance, $114m above the Obama request.

The panel considered an amendment offered by Rep. Rehberg that would have reduced most of the bill’s spending levels by 7.27 percent and reduced multilateral assistance by 31.85 percent.  But, this was voted down along party lines.

There are still many hurdles yet before the funding levels are finalized.  The Senate’s State and Foreign Operations Subcommittee is expected to consider the International Affairs budget sometime in July.  Then a conference committee would have to iron out any differences. Finally, the bill would have to be approved by the full Congress, which could be significantly delayed by the fall elections.

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Last week, the Center for Strategic and International Studies (CSIS) brought together a number of panelists from various administration agencies and NGOs at an event called “Linkages between Gender, AIDS, and Development – Implications for U.S. Policy.”  Panelists discussed the importance of placing women’s and girl’s health at the forefront of the Obama Administration’s global health efforts, and how policymakers and implementers can integrate programming that has already been proven to be effective, into the new Global Health Initiative. 

Ambassador Eric Goosby, the U.S. Global AIDS Coordinator, opened up the event by stating that women and girls are disproportionately impacted by the HIV/AIDS epidemic, and focusing on women and girls when implementing programs to fight HIV/AIDS will yield positive results for not only women and girls but entire communities. 

According to Goosby, 62 percent of individuals on PEPFAR-supported treatment are women.  PEPFAR will start new women-focused programs next year, such as a new gender-based violence initiative, and the PEPFAR Gender Challenge Fund, which makes an additional $8 million available for strengthening gender-based programs.

Ambassador Goosby explained that the Obama Administration’s new Global Health Initiative will build off existing programs to ensure that the necessary linkages are made to integrate family planning, reproductive health, and HIV/AIDS services.  He explained that women and girls should have access to a ‘one-stop-shop’ for services.  In addition to making more services available, Goosby underlined the importance of engaging in diplomatic dialogue with leaders to encourage them to address discriminatory laws and practices against women.

The resounding message of the day was the importance of integrating reproductive health services, family planning services, maternal and child health services, and HIV/AIDS services all in one synergistic package to ensure that women and girls in developing countries have all the tools they need to protect their wellbeing. 

Dr. Marsden Solomon of Family Health International (FHI) in Kenya explained the necessity of integrating such services by citing that 60 percent of their HIV/AIDS patients have unmet family planning needs.  He went on to explain that integrating HIV/AIDS and family planning services reduces unintended pregnancies, prevents vertical transmission, and improves maternal and child health overall.  FHI began integrating their HIV/AIDS and family planning services in 2001.  Their services include ARV and PMTCT treatment, STI treatment, pre and post-natal care, cervical cancer screening, and post-rape care, among others.

Amie Batson, Deputy Assistant Administrator for Global Health of the USAID, argued that women’s health should be promoted not just in health-related programs, but in economic growth programs, education initiatives, and in governance as well.  Health service accessibility should be expanded as well: commodities should be available at more locations, such as at kiosks or beauty salons.

A number of panelists emphasized the importance of integrating HIV/AIDS services and prevention techniques into economic development programs as a way to address both economic and health disparities.  Lufono Muvhango and Julia Kim described their successes in battling both HIV/AIDS and economic underdevelopment with the Image Program in South Africa.  The program not only provides microfinance loans to women in villages, but also implements gender training programs which aim to empower women to have the confidence needed to fight against sexual violence. 

In South Africa, it is estimated  that a quarter of women are living in abusive relationships.  Women involved in abusive relationships are 50 percent more likely to be infected with HIV/AIDS, compared to women who do not fall victim to intimate partner violence.  After reaching out to 12,000 women in 160 villages in South Africa, the Image Program has not only seen a significant increase in HIV/AIDS awareness, but has seen a 55 percent reduction in the risk of physical and sexual violence.

Pearl-Alice Marsh, the majority professional staff member for the House Committee on Foreign Affairs, stated that there are two major issues blocking progress in women’s health and HIV/AIDS concerns.  The first is funding: Marsh stressed that advocates must continue to pressure Congress to maintain their financial commitments, as well as help African nations get a handle on their budgeting so they can contribute more to the fight against HIV/AIDS and increase their ownership.  The second issue deals with global women’s health being a proxy for anti-abortion advocacy.  Marsh explained that letting ideology and politics get in the way of women’s health amounts to femicide, and more should be done to ensure that such rhetoric does not hinder progress in global women’s health.

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Lydia Mungherera knows better than most people what’s at stake in the unfolding crisis over global AIDS funding. She is a medical doctor, an activist, and woman living with AIDS, and she’s growing increasingly concerned about the ramifications of flat-funding for the President’s Emergency Plan for AIDS Relief, a cornerstone of the international response to HIV/AIDS.

Dr. Mungherera sees the battle from those three fronts, as her native country of Uganda faces drug stock-outs and treatment slot shortages. Some clinics in Uganda are beginning to turn patients away, she said, and others, hampered by drug shortages, are giving out only 2 of the three drugs in the HIV regimen, which is a recipe for drug-resistance and treatment failure. 

“The hopelessness we had in the 1980s, when we had no treatment, is what we are going back to now,” Dr. Mungherera said at a community meeting in Washington on Monday. “The basic issue of right to life is being disrupted.”

Uganda had a very successful family-based approach to HIV testing and treatment, but that is starting to fall apart, she said. “You can’t treat the father and not treat the child or the mother,” she said, referring to increasing scarcity of new openings for treatment.

She said testing programs are also being undermined, because people don’t want to get tested if there’s no treatment available. “Seventy percent of Ugandans don’t know their status,” she noted, “but what are we going to tell those people who come for testing? I’m sorry, there’s no treatment?”

 Dr. Mungherera, who has worked with The AIDS Support Organization (TASO) since 1999 and is the founder of Uganda Cares, the first treatment centre to give free antiretroviral drugs in the Masaka District, said she was particularly worried about the Obama Administration’s Global Health Initiative. The GHI calls for a more integrated approach to global health and a new focus on health systems and child and maternal health. But the $63 billion, six-year formulation of the GHI seems to ensure that some funding will have to taken from PEPFAR to make the other pieces of the program work. And undermining PEPFAR will hinder all the other goals of the GHI, a consequence the some top U.S. officials do not seem to understand or acknowledge.

Dr. Mungherera said, for example, that integration of mother and child health services is a great idea, “but you can’t start integrating services when people are dying.”

Dr. Mungherera has particular expertise on the impact of HIV on women and girls in sub-Saharan Africa. She created Mama’s Club, a community-based psychosocial support group for HIV-positive mothers and their children. In this video below, she talks more about the links between HIV and child and maternal health, in the context of the  GHI’s “women and girl-centered approach” to global health.

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At the start of a forum today on the Obama Administration’s Global Health Initiative, Jen Kates, the Kaiser Family Foundation’s director of global health policy and HIV, laid out eight major questions about the proposal—queries that will go a long way toward determining whether the initiative is a success or not.

After a 90-minute discussion, most of those key questions—such as how much funding the GHI will get, how the money will be divvied up, and how its goals will be measured—remained unanswered. But we did learn a few things from the U.S. government panelists who are developing and overseeing the implementation of the GHI, the White House’s controversial initiative calling for a more integrated, comprehensive approach to funding global health.

Amie Batson, the deputy assistant administrator for global health at USAID, had the most news to share. On governance of the GHI, she said a “strategic council” had been established, and it would serve as a forum for pulling together all the government agencies that have expertise in achieving the GHI’s goals. The group has partners from a gamut of federal agencies—from the departments of the Treasury and Defense to NIH and CDC.

At the more operational level, she said, there was a “trifecta” of leaders– USAID Administrator Rajiv Shah, CDC director Thomas Frieden, and Global AIDS Coordinator Eric Goosby—charged with developing and executing the GHI. “They are tasked with defining a shared or joint operational plan,” she said, and each of them has a deputy charged with delivering on that plan.

Batson also said the Administration would release a final GHI plan by early summer. And by the end of this month, officials would announce the first ten “GHI Plus” countries; those countries will then get additional technical, management, and financial resources to implement integrated programs and make investments across health conditions. (The list of GHI Plus countries will be expanded to 20 in later years.)

“We’re now engaging very actively with the countries,” she said. The GHI Plus countries will offer a sort of field test “where we have an intensified learning effort.”

Today’s forum, hosted by the Kaiser Family Foundation and available online here, was the most extensive public discussion yet of the GHI, a $63 billion six-year plan announced by President Obama nearly one year ago.  It has been the subject of much debate because, while the plan includes many lofty and significant goals, some advocates fear it will not be adequately funded and that it may shift focus away from critical programs, such as PEPFAR. Key officials crafting the plan say the U.S. needs to turn its attention to other health problems, such as child and maternal health, but they do not seem to fully grasp or acknowledge the links between specific diseases, such as HIV and TB, and women’s health.

The shift could have serious repercussions on the ground in the developing world. For example, the GHI’s goals on TB represent a significant step back from more aggressive targets laid out in the Lantos-Hyde Act that reauthorized PEPFAR, even though TB claims 1.8 million lives a year.

At today’s forum, Ann Gavaghan, chief of staff in the Office of the U.S. Global AIDS Coordinator, said the GHI should be viewed as an opportunity to build on the stunning successes achieved in fighting global AIDS and other diseases over the last decade, not as a step back from those efforts. “The GHI is not designed to take away from any of those successes but to say let’s recognize what’s been done … and let’s figure out a way to really build those best practices,” she said.

But wide-ranging questions from the audience signaled there is still deep concern about the initiative and how it will be implemented and funded. Several attendees asked about why TB, for example, appeared to be getting short shrift in funding and focus. Gavaghan and Deborah Birx, director of CDC’s Global AIDS Program, both tried to assure advocates that the Administration was committed to combating TB and understood how much of a threat it presents, but neither one specifically addressed the underfunding or weak targets.

Another advocate asked about the apparent contradiction between the Administration’s rhetoric about wanting more international collaboration and its proposed cut to the U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Gavaghan said the White House had made a robust request for the Global Fund and remained fully committed to its success, including active U.S. participation on the organization’s board and in country-level coordination.

Several attendees asked about how the GHI would deal with the severe health care workforce shortage in the developing world, noting that the GHI blueprint issued in February did not offer very many details about that critical piece of health system strengthening.

Batson said that’s because the solution to that problem is country-specific and will have to be dealt with in a focused way in each place. “Many of the governments have put this as No. 1 on their lists, so I think you will see a lot of innovation,” she said.

To learn more about the GHI, read our earlier blog posts here and here analyzing the GHI’s consultation document. In addition, Kaiser has this nice analysis/overview—including the 8 outstanding questions—of the GHI.

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There were plenty of frightening statistics and unsettling trends highlighted at today’s World TB Day briefing on Capitol Hill. But one photo captured the true scope of the problem in scaling up diagnosis and treatment of the global TB epidemic.

Celine Gounder, MD, an IDSA member and TB/HIV specialist at Johns Hopkins University, described a recent trip to Malawi, where she saw shopkeepers volunteering to collect sputum samples from customers with chronic coughs. The accompanying photo: a man transporting the sputum samples to a laboratory in a small wooden box balanced on the back of his bicycle.

Dr. Celine Gounder discusses the TB epidemic at a Senate briefing

As Dr. Gounder noted, this small community had overcome one of the hurdles in getting suspected TB patients access to proper care. But many others remain. For starters, those specimens so carefully balanced on the bike would be examined using sputum smear microscopy, the only widely available diagnostic test for TB in Malawi. But Malawi has one of the highest HIV prevalence rates in the world, and the vast majority of HIV-related TB cases will be missed by sputum smear microscopy. A more accurate TB test, culture, is not available in the country because of lack of funding. So many of the patients will get false negative results, and continue to transmit the TB bug.

Her presentation provided compelling evidence of the need for more resources devoted to increased laboratory capacity and better diagnostics for TB. But she noted the gap between rhetoric and reality when it comes to TB funding. See Dr. Gounder’s power point here: CGounder_US Senate Briefing_20100324 and below is a video of her presentation.

“Despite the clear need for a heightened response to the global TB problem, funding that has been appropriated for these activities falls short of what was authorized by the Lantos-Hyde Act and what is needed to make decisive progress,” she said. “USAID, which is the primary US agency conducting global TB activities, received only $225 million in FY 2010 of the $650 million dollars authorized.”

She noted in particular that the White House’s Global Health Initiative includes TB treatment targets that are much lower than those set out in the Lantos-Hyde Act, which reauthorized PEPFAR. And she said HIV/TB co-infection was getting particularly short-shrift.

“Little more than lip service has been paid to delivery of TB-related interventions by HIV programs,” Gounder said.  “Only 16% of all TB patients were tested for HIV in 2007. Only 2.2% of HIV patients were screened for TB. And only 30,000 of HIV patients, 2% of the target, received isoniazid preventive therapy, which has been proven to reduce the risk of TB and mortality by one-third to two-thirds.”

Gounder’s remarks came at a Senate briefing on the global TB epidemic, which included a special focus on drug-resistant TB. The event, entitled “Bringing Methods to Scale: New Perspectives in the Changing World of TB,” also featured a presentation by Ernesto Jaramillo, team leader for MDR-TB for the World Health Organization’s Stop TB Department, who detailed the WHO’s newest data on drug-resistant TB. (more…)

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The Center for Strategic and International Studies yesterday unveiled  a new “must-read” report for global health advocates, “Smart Global Health Policy.” While a panel at the Congressionally-chartered Institute of Medicine, made up primarily of scientists, issued recommendations on US global health policy last year, the CSIS panel is the first to involve high-level business leaders and sitting members of Congress.

The report drew on observations made during a study trip to Kenya, but it is unclear if consultation in developing countries went beyond that, for instance to include global representatives of affected communities and of developing country civil society, such as those on the boards of UNITAID and the Global Fund.

The report and the webcast of the launch event are available online.  Here are a few highlights:

The report makes a strong case that it is in the interest of the United States to continue and increase  our investment in global health and that the issue should matter to all Americans. It calls for keeping funding for AIDS, TB and malaria on a “consistent trajectory,” doubling spending on maternal and child health to $2 billion a year, forging a collaborative response to emerging heath threats, establishing strong coordination of global health policy across US agencies, and increasing support for multilateral efforts.

In 2009 there was a massive drop off in the expansion of treatment by US programs, and the report notes that AIDS advocates are “particularly anxious” at the slowing growth rate, a stalling that could also impact health systems.  The report suggests that funding is a concern for treatment advocates, yet, in fact, HIV prevention advocates have also been quite alarmed at the essentially flatline funding picture.

Despite World TB Day (March 24) being just a few days away, no mention is made in the report of immediate tuberculosis funding concerns, lowered TB targets in the 6-year Global Health Initiative or USAID’s role in responding to TB.  Instead, the report includes TB within a much longer timeframe, stating that “we can accomplish great things in the next 15 years:  We can cut the rate of new HIV infections by two thirds, end the threat of drug-resistant tuberculosis, and eliminate malaria deaths.”

In terms of overall funding, the report calls for less spending in the near term than either the IOM panel or the Global Health Initiative coalition did; instead, the CSIS document endorses the President’s proposed funding of $63 billion by 2014.  While the IOM called for specific increased funding levels on AIDS, TB and malaria consistent with Lantos-Hyde, the CSIS report does not delve into specific funding levels, with the exception of maternal and child health.  Instead, taking the long view, it calls for $25 billion in annual spending by 2025.

One exciting aspect of the CSIS report is that it endorses innovative financing as a means of raising funds for global health.  The report does not touch on the concept of innovative taxation for health, recently championed by maternal health advocates at Family Care International and many other groups. However, it identifies some specific mechanisms, such as borrowing the money needed through an international finance facility, and it urges the US National Security Council to review the most promising ideas on innovative financing and develop a US position.

Admiral William J. Fallon kicked off the launch event, stating that global health is a “bipartisan enterprise… which can unite US citizens in collective action.”  He stated the importance of maintaining forward momentum, noting that “we do not want to coast or slide backward.”  Helene Gayle said that global health efforts are showcasing the American spirit of generosity and said “we need forward momentum even in a period of constrained resources.”

Jack Lew, the top State Department official developing the US Global Health Initiative, spoke about the Administration’s goals in developing the new strategy. He said that the Administration’s aim was to “challenge a way of doing business by moving beyond a primary focus on disease treatment.”  He said the goal was “not to do harm to existing programs.”

Advocates for effective HIV prevention have felt stymied in recent weeks by the lack of specific HIV/AIDS guidances from the Administration to the field and have noted that Kenya’s Partnership Framework with the US even appears to rule out family planning integration.  Family planning came up at the event when Dr. Michael Merson, of Duke University, criticized the Canadian government’s rejection of the inclusion of family planning as a part of its maternal health initiative.

But Lew’s presentation did not delve into details — and there was no opportunity at the event for questions from the floor.  He stated that program integration was crucial to meet the needs of women, and he commented on the importance of having family planning and HIV/AIDS services in one location.

The report is particularly noteworthy for the very strong focus on measurement for accountability in delivering services. Business leaders at the event decried the reporting burden on health programs and, along with Dr. Merson, called for a common set of impact indicators.

Rajeev Venkayya, Director of Global Health Delivery at the Bill and Gates Melinda Foundation, said that measurement matters because it allows us to maximize efficiency and stretch dollars while identifying what works and what doesn’t.  In addition, measurement allows us to hold accountable institutions, organizations, and even individuals, which in turn allows for greater project improvement.  Exxon Mobil Chairman and CEO Rex Tillerson agreed, and cited a Lancet article which said that evaluation must be a top priority for global health.

Robert Rubin, former US Treasury Secretary and former head of Citigroup and Goldman Sachs, told the audience that global health leaders “face wrenching choices” as a result of US fiscal problems.  He asked two members of Congress, Rep. Keith Ellison and Senator Jeanne Shaheen, whether global health is an issue that can “break through the mire” on Capitol Hill.

Senator Shaheen said that the issue can succeed, but it is crucial to explain to Americans that international affairs spending is only a tiny fraction of the US budget, much less than people realize.   She said it was cheaper to spend on global health than on war, noting Bill Clinton’s recent statement about the appreciation of PEPFAR expressed by Muslim residents of Tanzania.  She also said the current committee structure in Congress is an impediment and endorsed the recommendation included in the report for a consultative body that would work across committees.

Congressman Ellison also voiced strong support for greater US action on global health, stating that “infectious diseases know no borders.”  He said that while in Kenya, he made good progress in persuading Kenyan leaders of the necessity of stepping up their own contributions.  He suggested that by reducing US spending on outmoded weapons systems the US could improve its budget outlook and make global health spending easier.

Gayle Smith, the NSC official leading the development of the US Global health Initiative, was the concluding speaker at the event. She said global health was a bipartisan issue and that in fact President Obama specifically directed that the achievements of the previous Republican Administration be recognized.  She praised the CSIS report, and said that its ideas were remarkably congruent with those of the Administration.

She said the Administration’s commitment to fighting global HIV/AIDS was “absolute” and, she added, “this will grow over the life of the initiative.” She said the Administration’s plans for the Global Health Initiative “include an ambitions set of targets in terms of outcomes.”

She did not respond to concerns submitted to the Administration by the Global Center, TAG, the Global Health Council, and the GHI Working Group that the Administration’s targets regarding tuberculosis contradict a directive from Congress approved in 2008 as a part of Lantos-Hyde.  In fact, it was surprising that the event unfolded without  reference  to the consultative process which numerous NGOs have engaged in regarding the US Global Health Initiative or to the detailed analyses these groups have submitted to the Administration.

There were a range of reactions from health NGOs to the event.  Eric Friedman at Physicians for Human Rights noted the “surprisingly little attention in the report to human resources for health and health systems, and no mention of including civil society in the development of country compacts.” He praised the report for “proposing that the Administration develop a long-term, 15-year framework for making progress in and committing the United States to improving global health, a good idea so long as it does not set the stage for underambition, and is flexible to respond to changes in the years ahead. ” He also would have liked to see “a recommendation that the United States should deliberately integrate a right to health approach throughout U.S. global health programs, including the consistent focus on equality, accountability, and participation that this entails.”

Matt Kavanagh at Health GAP praised what he heard from the report, which included an emphasis on keeping up the fight against HIV/AIDS, especially important for the health of African women. But he noted with concern that “some of the Administration comments that seemed to favor prioritizing ‘cheap’ interventions that do not work in the long term, such as single dose nevirapine instead of treatment for HIV positive mothers, an approach abandoned long ago as ineffective in wealthy nations.”

The American Medical Students Association’s Farheen A. Qurashi said that the report “takes a bold, but necessary, approach to U.S. global health planning by insisting upon a 15-year comprehensive plan.”  She said, “Unfortunately, the Commission’s report does not appear to specify the need for scaling-up of PEPFAR investments versus the dangers of flat-funding, and instead uses language that suggests that a continuation of current levels of funding without annual growth is sufficient.”

On health systems, she said that “though integration and health systems strengthening is mentioned in general terms, and the need for training and retention of health care workers is noted, there is no detailed analysis of the measures, funding, and support necessary to establish and retain adequate numbers of health professionals and other health care workers.”

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Just as HIV experts are beginning to see new hope in beating the AIDS epidemic, a funding crisis threatens to throw us back a decade or more in the effort to combat this deadly virus. Dr. Peter Mugyenyi and other HIV experts delivered this forceful message to U.S. lawmakers today at a hearing before the House Foreign Affairs Subcommittee on Africa and Global Health.

Dr. Mugyenyi, director of Uganda’s Joint Clinical Research Center, was one of several witnesses who urged Congress to keep its promise on global AIDS by fully funding PEPFAR, instead of approving the near flat budget proposed by the White House for FY 2011.

Dr. Peter Mugyenyi testifies before a House Foreign Affairs subcommittee

Dr. Mugyenyi said that already, last year’s flat-funding has rippled across his home country of Uganda, forcing him and other health care providers to turn away sick patients who were promised treatment. Dr. Mugyenyi described having to turn away as many as 15 to 20 patients a day, including pregnant and breastfeeding women.

“Recently, an HIV-infected woman who was breastfeeding her HIV-negative child because she could not afford formula milk came to our clinic, having been turned away from three other clinics in Kampala because they had no slots. She knew that every day she breast fed her baby without being on treatment greatly increased the chances of her child getting infected, but she had no alternative,” he said.

The situation, he said, jeopardizes the incredible gains PEPFAR has achieved in its first five years. “PEPFAR has saved millions of lives in Africa,” he said. “These people—and their mothers, husbands, wives and children—got a chance to live” because of PEPFAR. The program has “helped ease the carnage that I and my fellow health care providers used to witness on a daily basis.”

Dr. Mugyenyi pointed to recent studies showing that treatment with antiretroviral drugs can also help prevent new infections. Research released at CROI last month documented a 90 percent reduction in HIV transmission among so-called “discordant couples,” in which one partner is HIV-infected and the other is not.

“This gives credence to recent modeling by the World Health Organization that shows some of the first good news on prevention in several years: that we could truly end the AIDS crisis within a generation,” he said. “However, a funding crisis threatens to reverse these highly positive changes and we could miss the opportunity to defeat the epidemic.”

Rep. Donald Payne, D-N.Y., chairman of the subcommittee, said he was “deeply concerned about the reports that the fight against HIV/AIDS is faltering and that continued rapid roll out of AIDS treatment is endangered in Africa. We must make sure we don’t start a decline.”

The panelists and lawmakers alike commended President Obama’s proposed Global Health Initiative, with its call to spend $63 billion over six years and its promise of an integrated approach to foreign health assistance. But experts testified that the GHI would only work if it was adequately funded

And so far, said Joanne Carter, executive director of the RESULTS Educational Fund, there’s a gap between rhetoric and reality on US global health funding. The White House’s budget request for FY 2011 “essentially flat funds our global AIDS programs,” she said, noting it’s more than $2 billion short of what was promised in the Lantos-Hyde Act that reauthorized PEPFAR.

The White House budget also calls for a $50 million cut to the US contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria. And she noted that the GHI’s treatment targets for TB were significantly lower than mandated in Lantos-Hyde.

PEPFAR has been “nothing short of transformative,” Carter said. “We’ve made remarkable progress, and we can’t stop now.” (more…)

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