a luta continua

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

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.

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.

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."

Bill summary here.

Take Your Pick, Again

The Washington Post says that, despite availability of medicine, controlling HIV in Africa remains a distant hope.

Abstinence-Only Education: A Billion-Dollar Industry?

Judge for yourself.

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.

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.

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.)

Update Update

More reaction from AIDS leaders to the G8's pledges out of their summit. Sounds like people are not happy.

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.

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.

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.

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.