June 30, 2007
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.
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.
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."
June 21, 2007
Take Your Pick, Again
The Washington Post says that, despite availability of medicine, controlling HIV in Africa remains a distant hope.
June 20, 2007
Abstinence-Only Education: A Billion-Dollar Industry?
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.
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.
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.)
June 10, 2007
More reaction from AIDS leaders to the G8's pledges out of their summit. Sounds like people are not happy.
June 09, 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."
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.
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.
June 08, 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.
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.
June 07, 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.
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.
June 04, 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."
June 01, 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.
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.