July 11, 2007
I'm Going to a Town That Has Already Been Burned Down
Dear devoted readers:
I have accepted a new job covering foreign policy for my old friends at Congressional Quarterly. This means a move back to DC and, what with the assumption of a heavy load of new duties, a hiatus for this blog.
Yrs,
AGS
Posted by Adam Graham-Silverman at 2:39 AM | Comments (0)
June 30, 2007
Old Friends
Laura Bush's trip to Africa doesn't generate a whole heck of a lot of coverage, though Joe Schatz tells us that she stopped in Zambia to talk about faith-based organizations battling AIDS. Reuters also checks in from Senegal, and the AP from Mozambique.
Our other acquaintance in the news, Andy Taylor, reports that the Senate is making headway on its bill to authorize foreign aid programs, including PEPFAR. Don't get bogged down in the numbers: The upshot is that PEPFAR, and the Global Fund in particular, would get a big boost. And: "The Senate's foreign aid bill, like the House's, faces a veto because it would ease restrictions on overseas groups that perform or promote abortion by allowing them to receive U.S.-donated contraceptives. A ban on direct monetary aid would remain in place."
Old friend update, July 2: Laurie Garrett offers some context on all these spending bills and their impact on global health.
Posted by Adam Graham-Silverman at 3:06 PM | Comments (0)
June 26, 2007
Ryan White Flip Side: Some States Get More Money, and Spend it Too
NASTAD's new ADAP Watch for June says that 12 states are putting the extra Ryan White money that came about because of the new formula enacted last year to use, eliminating waiting lists and expanding formularies. Nonetheless, 529 people remain on ADAP waiting lists for medication -- most of them, 470, in South Carolina.
Posted by Adam Graham-Silverman at 8:07 PM | Comments (0)
June 23, 2007
House Advances Foreign-Aid Money, Easy on the Riders
The House passed its fiscal 2008 spending bill funding the State Department and other foreign operations, including PEPFAR. The bill includes a waiver of funding requirements for abstinence-only education in PEPFAR, as well as a provision that would allow the U.S. to provide condoms to organizations that may also provide abortions. As CQ's Budget Tracker puts it: "Lawmakers ignored a Bush veto threat regarding language allowing the use of federal funds for the donation of contraceptives to certain family planning groups, rejecting (205-218) a Chris Smith-Bart Stupak amendment to strike the language and adopting (223-201) a Nita Lowey 'clarifying' amendment specifying it could be used only for the donation of contraceptives in developing nations. Lawmakers adopted several amendments to shift money around (including for democracy assistance to Cuba), but rejected a series of GOP amendments that would have cut various accounts. Also rejected, 205-219, was a Frank Wolf amendment to provide $158 million for Iraq reconstruction; the bill provides no funds for that purpose."
Posted by Adam Graham-Silverman at 12:16 AM | Comments (0)
June 21, 2007
Take Your Pick, Again
The Washington Post says that, despite availability of medicine, controlling HIV in Africa remains a distant hope.
Posted by Adam Graham-Silverman at 4:33 PM | Comments (0)
June 20, 2007
Abstinence-Only Education: A Billion-Dollar Industry?
Posted by Adam Graham-Silverman at 9:33 PM | Comments (0)
Take-Your-Pick Department
A new World Bank report says that ARVs and condoms, among other things, are in fact slowing the spread of HIV in Africa. Or perhaps the opposite.
Posted by Adam Graham-Silverman at 9:28 PM | Comments (0)
June 15, 2007
Deck Chairs, Titanic?
One interpretation of name-brand drug companies' aggressive response to countries that issue licenses to produce generic drugs is that the companies are seeking to preserve an economic worldview that no longer exists. The intellectual property regime that allows companies set high prices in order to recoup costs, which works for artists and high-tech companies, can't work for life-saving drugs. High prices are not an acceptable response in the face of AIDS, malaria or even heart disease.
So drug companies' attempts to curtail these licenses that threaten their bottom line is just rearranging deck chairs on a sinking ship. A new report that suggests the current model is not sustainable supports this view. Slipping sales and reliance on the success of a few blockbusters does not help the situation. The report has some suggestions for change, though they do not mention the profit-sharing or research prize ideas popular among many economists.
Posted by Adam Graham-Silverman at 9:51 PM | Comments (0)
June 13, 2007
Scene of the Crime
"Federal guidelines calling for the routine testing of all Americans ages 13 to 64 for the AIDS virus might not be the best way to identify people who are infected but don't know it," says the Baltimore Sun.
CDC's decision to recommend routine, opt-out testing initially angered advocates who said it would cut out essential pre-test counseling and consent. Now a report in PLoS Medicine from a respected epidemiologist says it's not cost-effective either.
Instead, clinicians can find more infections -- and at lower cost -- by targeting groups like drug addicts, men in prison and people in high-prevalence neighborhoods. It's worth mentioning that no matter what the plan, some people would fall through the cracks.
Posted by Adam Graham-Silverman at 10:46 PM | Comments (0)
AIDS and the President
Bono's One Campaign is investing $30 million in trying to get the 2008 presidential candidates talking about global poverty and disease. (Good luck.) Are these the same folks whose marketing expenses may outweigh their philanthropic efforts? Turns out $22 million comes from the Gates Foundation. (Good luck.)
Posted by Adam Graham-Silverman at 3:55 AM | Comments (0)
June 10, 2007
Update Update
More reaction from AIDS leaders to the G8's pledges out of their summit. Sounds like people are not happy.
Posted by Adam Graham-Silverman at 3:50 AM | Comments (0)
June 9, 2007
Update from G8
While the outside world focuses on climate change and Russia, one of the main agenda items at last week's G8 summit was Africa. Activists gathered in Heiligendamm, Germany to try to hold leaders to the promises of universal access to AIDS treatment by 2010, along with significant financial commitment made to Africa at 2005's Gleneagles summit. (background)
A report from the Financial Times that claimed the G8 leaders were planning to abandon their promises sent these folks into a minor state of panic. The FT story says that the leaders were planning to commit to provide treatment for 5 million AIDS patients, rather than the earlier call for 10 million, by 2010. The cost of universal treatment is not small; nor is the cost of inaction. And then there is this sentence: "The lowered goal in the G8 draft communique was inserted at the insistence of the US delegation, according to several officials close to G8 delegations."
The World AIDS Campaign responded with alarm: "These directions will spell nothing less than death to millions of people in need of life-saving treatment now and in the next three years."
In the end, the G8 agreed to provide $60 billion over an unspecified time frame to fight AIDS. It refers to treating 5 million, not 10. About half of that counts on PEPFAR being renewed at double its original funding level. The money includes $6 billion to $8 billion for the Global Fund.
As with many such announcements, the dollar total does not represent new money. And the amount indicates only an intent to donate, not a promise or commitment of funds. Activist groups like the Global AIDS Alliance attacked the amount as only a third of what the United Nations says is needed to stay abreast of the epidemic.
The G8 also took steps to strengthen intellectual property and patent rights for developing nations, according to IP-Watch, which also prompted a rebuke from access-to-medicine advocates like Doctors Without Borders. Posters to the IP-Health forum called it "industry language" and "the U.S. position," undiluted.
For some background information on the needs and funding for universal access and the demands on the G8 nations, see this report. It reviews country-by-country donations up to this point.
Posted by Adam Graham-Silverman at 2:52 PM | Comments (0)
Trade and Patent Update
The Economist weighs in on Thailand vs. big pharma, pointing out the implications for the generic industry. India's robust generic industry has gone from ignoring patents to seeking to honor them as the companies develop their own drugs and methods of production. That would seem to give some credence to the argument that patents, wherever they may be enforced, are key to innovation.
Also, some discussion of the Bush-Democratic trade deal.
Posted by Adam Graham-Silverman at 6:06 AM | Comments (0)
June 8, 2007
New Survey Puts India Behind South Africa
In the race for the not-hotly-contested title of country home to the most HIV infections, India has apparently fallen behind South Africa. India had earned this honor, which it has been trying to shake, about a year ago. But more accurate surveying suggests that India's infection rate is far lower than previously thought. South Africa, which has a longer history of surveys spread throughout the country, has about 5.5 million infected people.
Posted by Adam Graham-Silverman at 5:35 PM | Comments (0)
Faith-Based Opportunities
A WHO official charged with building community partnerships offers a note reminding us of the value of faith-based groups in providing care and treatment in the developing world.
In light of the ongoing health worker shortage, The Rev. Canon Ted Karpf offers religious workers as a way to fill the gaps. Faith-based work is overlooked, he says, and argues that these groups and government offices should be better connected and coordinated.
Posted by Adam Graham-Silverman at 3:53 PM | Comments (0)
June 7, 2007
A Democratic Congress Acts
A House subcommittee approved the spending bill that provides for PEPFAR, and took a few shots at the social-policy riders that go along with the legislation. The bill includes a provision that would allow the president to waive the requirement that a third of PEPFAR prevention funding be spent on abstinence programs. President Bush could ignore the opportunity, so this is largely symbolic. But another provision, which would repeal the Mexico City rule prohibiting funding to groups that perform or promote abortion, could draw a veto threat.
In The Hill, Rep. Barbara Lee, D-Calif., a leading voice on global AIDS policy, responds to President Bush's call last week to double PEPFAR funding. She notes that Bush leaves out the Global Fund from his plans.
Elsewhere in the Capitol, AIDS activists are criticizing Democrats for increasing funding for abstinence-only education. "The move appears to be a ploy by the Democratic majority designed to win enough Republican votes to make the spending bill veto-proof," writes Housing Works' Michael Kink.
Posted by Adam Graham-Silverman at 3:43 PM | Comments (0)
New Infections > Treated Infections
Bad news from sub-Saharan Africa in The New York Times: For each person who was placed on anti-AIDS drugs last year, experts say, five more were newly infected. The data comes from a report to be released by the Gates- and Kaiser-funded Global HIV Prevention Working Group.
Posted by Adam Graham-Silverman at 12:31 AM | Comments (0)
June 4, 2007
Challenge to Anti-Prostitution Pledge
One of the strings attached to PEPFAR funds that activists and aid workers complain about is the requirement that organizations have an explicit policy opposing prostitution. When fighting HIV transmission requires working with sex workers, who are a major source of transmission in many countries, organizations worry about running afoul of the rule. In Brazil, where prostitution is legal, sex workers are the first line of defense. The country refused some $40 million from the United States because it didn't want to go along with the rules. In other countries, women turn to transactional sex -- which some say isn't prostitution -- for food, clothing or school fees, putting them at risk. These circumstances thus call for help, not persecution.
So several groups have challenged the law, and two lower courts split on whether it unconstitutionally restricts free speech. Last Friday the 2nd Circuit Court of Appeals heard one of the cases. And AP writes: "Assistant U.S. Attorney Sean Lane, representing the government, conceded that the health groups had legitimate constitutional concerns."
Posted by Adam Graham-Silverman at 10:55 PM | Comments (0)
June 1, 2007
A Step Backward
Australia's health and immigration ministers are urging the country to require HIV-positive migrants to report to local authorities or risk losing their visas.
At this point, even the United States is trying to ease its ban on HIV-positive foreigners. The ban dates from a time when HIV was less understood, and treatment nonexistent. It was also used to stigmatize the infected, particularly gays and drug users who were first hit by the disease. So now, with treatment and prevention options widely available, advocates are wondering why a developed country like Australia would seek a ban. The head of the International AIDS Society blames ongoing prejudice and says a ban would be a "blatant violation of basic human rights" directed at people who have done more than most to push treatment and research.
Posted by Adam Graham-Silverman at 5:13 PM | Comments (0)
G8 Plans Its Own AIDS Funding
In advance of next week's G8 summit, member countries are discussing what the group's role should be in fighting AIDS in the developed world. President Bush's goal to double PEPFAR funding is "interesting," according to Germany. PEPFAR seems to be having its intended effect of keeping AIDS on the agenda and spurring countries to keep up with the United States, but each grop will offer its own plan.
Global warming is sucking up the oxygen right now, but many government officials say that AIDS and Africa will be the focus of the summit. Activists are pushing some big-league changes.
ActionAid says the G8 should triple its funding, and has a list of where one might spend all that money.
Posted by Adam Graham-Silverman at 5:04 PM | Comments (0)
May 31, 2007
Here's a Good Idea
Southern African nations are organizing to launch a joint effort to produce antiretrovirals. In the wake of several countries offering compulsory licenses to produce generic versions of AIDS drugs, this step would be another way that the developing world can take some control over the way it treats AIDS. It also could do more to disrupt the current drug distribution and patent hegemony.
Posted by Adam Graham-Silverman at 5:08 PM | Comments (0)
May 30, 2007
Ryan White Redux
Housing Works has some details on the impact of Ryan White restructuring on New York City. Though the city's HIV services groups planned for a shortfall, they were apparently not expecting it to hit $20 million. They are appealing to the city for help, but it remains to be seen whether the backlash is strong enough to prompt a response. Whether federal money could be made available on an emergency basis is also not clear.
In other news, this year's NYC AIDS Walk was the most successful ever, raising $6.9 million for AIDS organizations here. Not that it fills the gap, but perhaps there is appetite for private fundraising.
Posted by Adam Graham-Silverman at 4:41 PM | Comments (0)
PEPFAR Redux
In a Rose Garden press conference, President Bush has announced he'd ask Congress to "double" the budget for his global AIDS plan over the next five years. That would be $30 billion from 2008 to 2013. But if you're keeping track at home, you've noticed that PEPFAR won't be reauthorized until next year. And since budgets are made on an annual basis, it's hard to make sense of a request of $30 billion over five years, just as it was hard to make sense of his original $15 billion request for PEPFAR's first five years. (Congress will have provided about $18 billion.)
Bush, of course, will be out of office in 2009, 2010, 2011, 2012 and 2013, and presumably he won't be hanging around lobbying Congress come budget season in each of those years. Also, he didn't say where Congress should come up with the money. And as with any budget request, Congress could ignore Bush and chart their own course.
So why the press conference? The Washington Post says: "But administration officials said he wants to make the announcement in advance of next week's [G8] summit, during which Bush is likely to take criticism for his administration's positions on climate change. Also, [Robert] Zoellick's appointment is expected to stir opposition among nations weary of U.S. leadership of the World Bank." As John Donnelly puts it: Bush is looking at his legacy.
Many AIDS groups criticized the request as being too paltry to keep up with the spread of HIV. The New York Times says: "Administration officials concede that point and say the White House is hoping Mr. Bush's announcement will prod other Group of 8 countries, as well as nations that have growing economies, to make spending commitments of their own." Perhaps this will be one of PEPFAR's lasting effects, to normalize high spending on HIV overseas.
It's worth noting that you can't go from zero to 60 instantaneously. Even if money suddenly became available to pay for every request under the sun, countries couldn't absorb it or spend it efficiently.
Posted by Adam Graham-Silverman at 4:18 PM | Comments (0)
Guidelines for Expanded Testing
The World Health Organization now advises making an HIV test a part of routine care in parts of the world hardest hit by AIDS. Evidence suggests that making tests more regular goes a long way to cutting down the vast majority of infected people who do not know it. "Those who do not know they are infected are more likely to infect others and less likely to seek early treatment, experts said. That means it costs more and takes more effort to save them with antiretroviral drugs," writes Sharon LaFraniere in the New York Times.
"Still, some human rights advocates have argued that because of the stigma of AIDS, no one should be pushed to take a test that could lead to the loss of their employment or abandonment by their families," she writes. Others argue that normalizing testing will go a long way to normalizing HIV.
The real rub is here, however: "... the new policy would likely depend on hiring and training more low-level health care workers because there are far too few doctors or nurses in low-income countries to handle the task."
Posted by Adam Graham-Silverman at 11:46 AM | Comments (0)
Drug Access = Drug Profits?
Turns out that the lobbying push for better access to HIV medicines in Canada perhaps had a profit motive. If your national health care system will pay buy the drugs you make, it gives you a regular revenue stream. This is not unheard of and it's probably going to crop up in a lot of places. Last year I covered a Abbott Labs-sponsored buffet dinner for poor AIDS patients in New York, and I couldn't figure out why the company was wining and dining them. Then it hits me: New York has a very comprehensive health care system for the poor -- which would cover the new version of Abbott's Kaletra, the drug that was the subject of the dinner's PowerPoint presentations and postprandial entertainment.
Posted by Adam Graham-Silverman at 12:36 AM | Comments (0)
A Helpful Reminder
Doctors Without Borders has a new report setting down in painful detail the lack of health care workers in southern Africa, and its effect on medical treatment there, especially around AIDS. The health-worker crisis is pushing its way onto the global AIDS community's radar, albeit slowly. Last year at the International AIDS Conference in Toronto, protesters interrupted one of Bill Clinton's speeches to call for more doctors and nurses. Clinton said something to the effect of "Actually, I agree with them."
Now that drugs are more widely available, the barriers to access are increasingly about infrastructure and personnel. Malawi, the report says, has two doctors for every 100,000 people -- that's 260 for the entire country of 13 million.
There are a few causes here. The New York Times recently pointed out the problems with Africa's crumbling universities. Students I met in both Mozambique and Ghana were good-naturedly waiting out strikes and political strife to return to class. But Google "brain drain Africa" to see what happens when countries produce highly skilled workers like doctors. If they are trained abroad, they tend not to come back -- at least in particular in the medical fields.
Posted by Adam Graham-Silverman at 12:20 AM | Comments (0)
May 29, 2007
DC IDU HIV
The New York Times reviews the way in which the federal government uses Washington DC as a social-policy laboratory by way of the ban on needle exchange programs. The degree to which that ban worsens DC's HIV epidemic -- growing 10 times as fast as the national average -- is not clear, but it cannot be helping. Now that Democrats control Congress, however, some influential members are saying they'll get rid of it. A moral battle will no doubt ensue.
Posted by Adam Graham-Silverman at 11:31 PM | Comments (0)
May 25, 2007
Innocent Until Tested?
The New York Times explains a fight over a state bill to require anyone indicted for rape to undergo an HIV test. The rationale behind the bill: If someone who is raped is at risk for exposure, he or she should know. If exposed, the victim could take a prophylactic course of ARVs, a treatment that often keeps the virus from taking hold. The current law requiring a test only on conviction of rape does not allow the victim to start the drugs fast enough. There are a couple of sides to this one:
Why not give ARVs to any rape victim, just to be safe? That would alleviate the concerns of those who point out that tests can sometimes show up falsely negative if the rapist had only recently been infected. Well, the bill's backers say, ARV treatment is quite toxic and not without side effects. Best not to put people through that unless it's necessary.
The civil-liberties types say that it sets a disturbing precedent to test someone who is merely accused of a crime, particularly if the results become public. But given the huge number of infected people who don't know their status, any excuse to test seems like a good one, especially set against the many other indignities the accused suffer regardless of whether they are ultimately convicted.
The bill touches on a broader debate about testing: Because of the stigma that remains around AIDS, even some patient advocates argue for limits on testing. And most say that testing must be accompanied by proper counseling, education and referrals. Still, no one argues against more people getting tested and knowing their HIV status.
Posted by Adam Graham-Silverman at 11:25 PM | Comments (0)
May 24, 2007
Set the Bar Lower
The CDC's new target for reducing HIV infections is 10 percent -- a number some advocates call too low to inspire the necessary response, according to Poz. The old target had been 50 percent, which was perhaps unrealistic in the other direction. Take your pick.
Posted by Adam Graham-Silverman at 9:56 PM | Comments (0)
Ryan White Cuts Still Raw
The San Francisco Chronicle reports on millions in cuts the Bay Area faces as a result of last year's Ryan White law reauthorization. The changes prompted Speaker Nancy Pelosi to write to HHS seeking an explanation.
As the Chronicle notes: "Among the programs bracing for cuts are meal deliveries, emergency housing, legal assistance, benefits counseling and emergency financial aid. The council voted to maintain Ryan White funding for core services such as primary medical care, mental health and substance abuse, home health care and case management."
The new law was meant to spread the money better between historically hard-hit areas and others getting big HIV populations for the first time. One might argue that a cutback in secondary services in San Francisco might mean more primary services for the rural South, but it's a debate we'll see across the country as states get their Ryan White money.
Posted by Adam Graham-Silverman at 7:47 PM | Comments (0)
