Posts Tagged ‘Uganda’

Dr. Eric Goosby, US Global AIDS Coordinator

Global AIDS: `An inevitable mismatch of resources and need’

Ambassador Eric Goosby, MD, the US global AIDS coordinator who assumed his position a little more than a year ago, will be a significant presence at the International AIDS Conference in Vienna, which kicks off Sunday night. John Donnelly interviewed him Wednesday about his expectations for the conference, what was behind the Uganda problem with shortages of AIDS medicine, and whether The New York Times was right when it reported in May that the Ugandan drug shortfall was “the first example … of how the war on AIDS is falling apart.’’

Q: You just wrote an article on the State Department blog on how you traveled to Uganda in June to address drug shortages, detailing how the Global Fund suspension of funding had a spillover effect on all AIDS treatment there. Why did you feel the need to go to Uganda to sort it out?

A: The reason was that I wasn’t getting a clear picture of what the problem was and why we were finding ourselves in a situation where seven of our clinics were saturating (reaching the limit of number of patients). Attempts to work through the PEPFAR team in country resulted in explanations … patients came, we saw them, that’s what happened. It wasn’t that they were withholding their explanation of the domino-effect of the Global Fund sites. The truth was, they weren’t aware of it. So when we went we interviewed every provider, and looked at all the records, and saw an abrupt increase in enrollment that had not been budgeted for in PEPFAR. I asked the question, `Why did that occur?’ I found out that 11 Global Fund supported public clinics in the course of 18 months or so had gone from stuttering to stopping. Their Global Fund grant stopped. There was no formal closing of these clinics. They quietly closed. Patients who went to those clinics just showed up at our door.

Q: So is this an isolated problem based in one country with one large grant? Was The New York Times wrong in reporting from Uganda in May that “Uganda is the first and most obvious example of how the war on global AIDS is falling apart,’’ or was there some truth to it?



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“Missionaries of Hate,” a documentary on the role of US evangelicals in the draconian anti-gay legislation still pending in Uganda, is airling tonight at 10 pm on Current TV.  

Here is a link to the trailer. Tune in to the full show.

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Last Monday’s New York Times stories, detailing the consequences of the faltering battle against global AIDS, has triggered an outpouring of reaction.

For starters, there was this May 13 editorial by the Times itself, which noted that the war against AIDS, spearheaded by the US, had “racked up enormous successes over the past decade.” The editorial says that part of the current problem stem’s from the Obama Administration’s decision to shift its attention to improving child and maternal health and to push countries “to improve their medical delivery systems, manage their own AIDS programs and contribute more of their own funds.”

“Those are good goals,” the paper’s editorial board wrote. “But the AIDS pandemic is still spreading. And the goal of universal access to treatment remains a distant dream.”

In addition, there have been at least eight letters to the editor, representing a broad range of views about the stories and issues they raised. One notable response came from Dr. Eric Goosby, Obama’s US Global AIDS Coordinator, who defended the Administration. Goosby said the stories painted “an unjustifiably negative picture of the global AIDS fight and America’s role in it.

“…While challenges remain,” Goosby write, “we are building on and expanding our successes, not walking away from them. This is a global responsibility, and we are using this success story to invite other governments and donors to join us in meeting it.”

Here are links to all the letters.

The first four: http://www.nytimes.com/2010/05/15/opinion/l15aids.html

 Another four published on the web: http://www.nytimes.com/2010/05/16/opinion/lweb16aids.html?ref=opinion

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There is yet more reaction from Monday’s New York Times story on the unraveling of the fight against global AIDS. A very powerful, pointed post by International AIDS Society President-elect Elly Katabira gets right at the crux of the current crisis.

“Why are we now losing a battle that we had fought so hard… and won? ” he writes. “And where are the friends, including the G8 nations, that pledged to support universal access to HIV care in 2005?”

Click here to read the full post.

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Five Republican U.S. senators recently sent a pointed letter to US Global AIDS Ambassador Eric Goosby, MD, asking for a clear response to reports that patients are being denied HIV therapy in Uganda and that clinicians elsewhere are “being forced to ration lifesaving treatment.”

The letter, signed by Sens. Michael Enzi of Wyoming, Tom Coburn of Oklahoma, and others, says the lawmakers are increasing concerned “that these reports signal a troubling direction of the current PEPFAR strategy.”

“…We acknowledge that prevention efforts are an important component of the highly successful PEPFAR program, but the clear innovation of PEPFAR is its focus on treatment,” the senators write. “After all, treatment is prevention. Reductions in viral loads reduce the likelihood of individuals spreading the disease. Treatment also reduces transmission among partners, diminishes mother-to-child transmission, and keeps those with HIV in the medical system where they can receive proper counseling. The availability of treatment is integral to promoting HIV/AIDS testing and early diagnosis. After all, how can we continue to promote testing when the program is not able to provide treatment?”

Click here to read a U.S. government memo directing Ugandan implementers not to add new patients unless a treatment slot opens due to a patient’s death or loss to follow up: Memo-Oct-Halt Treatment Scaleup

The GOP senators also note that in the reauthorization of PEPFAR, Congress specifically mandated that more than half of bilateral AIDS money be spent on lifesaving medical care for HIV positive patients and said they were concerned that the Office of the Global AIDS Coordinator might not be “taking adequate steps to meet these statutory requirements.”

They ask Dr. Goosby to answer a half-dozen or questions, including the total number of people expected to receive treatment in 2010; the treatment allocation, as a percentage of PEPFAR’s budget, in FY2009; and an explanation of PEPFAR’s policy on whether savings achieved in treatment programs can be used to further expand treatment slots.

That last item is particularly worrisome among some advocates who have heard that implementers are being told any cost-efficiencies they find in their treatment programs cannot be used to add patients to the rolls.

Another letter sent this week, from HIV advocates in the U.S. and Uganda to Secretary of State Hillary Clinton, also raises these issues.

“Hundreds of people each month are already going from clinic to clinic searching for treatment,” states that missive, from a coalition of advocacy groups including Physicians for Human Rights, Health GAP, and others. “Families are being forced to choose between dangerous resistance‐inducing sharing of drugs and letting family members die. Tens of thousands waiting in line for others to die are not ‘new’ patients, per se, but were tested and put into care through PEPFAR support with the promise that treatment would be available when clinically needed. Now they are instead being turned away. We note that while some implementers are enrolling new patients the extremely limited treatment slots available are far outstripped by demand.”

To read the letter for GOP Senators, click here: PEPFAR Treatment Letter

To read the advocates letter, click here: Clinton–UGANDA CS letter

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Ruth Messinger, president of American Jewish World Service, an international development and human rights organization, just posted this passionate response to  The New York Times stories about the unfolding crisis in global AIDS funding. Ruth’s article argues that any U.S. foreign aid policy pitting disease against disease is seriously misguided and that now is the time to recommit to foreign aid funding. It also asks readers to tell their Senators to support S. 1524, the Foreign Assistance Revitalization and Accountability Act of 2009 (letter found here). Check it out!

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At a Congressional briefing today, AIDS experts expressed grave concern about a shift in the focus of the US President’s Emergency Plan for AIDS Relief, from providing HIV treatment to patients to providing technical assistance to developing country governments. The policy shift comes hand-in-hand with a pull-back from funding targets authorized in the Lantos-Hyde Act, which reauthorized PEPFAR.

These policies are leading to disturbing trends on the ground, including HIV-infected patients being denied access to lifesaving drugs in Uganda and elsewhere, emergency stock-outs of antiretroviral drugs, rising concerns about the emergence of HIV resistance,  and patients being “dumped” into the hands of ill-equipped government health facilities.

Much of the focus of the briefing, attended by key House staff members and a dozen or so HIV advocates, was on Uganda, which was featured prominently in a front-page New York Times story today about the devastating implications of stagnant funding for global AIDS programs.

“Uganda is the tip of the iceberg,” said Sharonann Lynch, of Doctors Without Borders. “You absolutely cannot ration care at this point… It’s throwing the last ten years of clinical practice out the window. What we’re seeing on the ground now is worse than six months ago. So what’s it going to be like six months for now?”

She said members of Congress need to ask the Obama Administration, including top officials at the Office of the Global AIDS Coordinator, pointed questions about their commitment to HIV treatment.

“How many new treatment slots will there be in 2010? How many new treatment slots will there be in 2011?” she asked.

Lynch noted that in several countries, such as the Democratic Republic of Congo, there are reports of PEPFAR redirecting money from treatment, i.e. purchasing ARVs, to providing training and technical assistance. That is devastating to developing country health systems, which are not equipped to take on the burden of AIDS treatment programs.

“It’s a radical shift in policy,” Lynch said. “PEPFAR had been filling the empty medicine cabinet, and technical assistance can only go so far. You can’t keep someone alive” if there are no drugs to treat their disease. She said there needs to be pressure on OGAC to get back to the business of saving lives and pursuing bold treatment targets.

Asia Russell, of Health GAP, said that OGAC officials initially told concerned activists that they could expand treatment, despite the limited funding, to more than 4 million people by finding cost savings in its current programs. But she learned on a recent trip to Uganda that implementers are being told that they cannot use any money saved through program efficiencies to add new treatment slots. She noted that creates a perverse disincentive to run efficient programs.

She said this policy seemed to be driven by the Office of Management and Budget, not OGAC. “They’re in the caboose,” she said of OGAC.

Russell said another problematic development in Uganda is that providers had once worked very closely with the public sector, sharing information and resources. But that’s not happening anymore, as treatment is being capped and patients are being steered toward ill-equipped government-run clinics.

Pearl-Alice Marsh, with the House Committee on Foreign Affairs, said she feared that the policy shift was intended to transfer programs to developing countries in a “very short period of time” and this new policy means less of a focus on bending the curve of the epidemic. But “we’re not out of the emergency phase” when it comes to AIDS.

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