Wednesday, July 21, 2010

Nobel Peace Prize Winner vs. Nobel Peace Prize Winner

In an opinion piece in today's New York Times, Desmond Tutu took President Obama to task for his administration's funding cuts to the President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Malaria, and Tuberculosis. As you may know, PEPFAR was perhaps the best legacy of the second Bush administration (as much as it galls me to give the man any credit), a United States government (USG) program that funded HIV/AIDS interventions, including getting millions of people living with HIV/AIDS on life-saving antiretroviral drugs (ARVs). Like the Global Fund, it has been instrumental in the great strides taken in the fight against the HIV/AIDS epidemic.

There have been rumblings over the past six months or so about changes in the funding and implementing sectors of public health. That USG would shift its focus to less expensive health interventions and force people needing ARVs onto waiting lists. That funders are looking to shift money from "vertical" interventions--ie, focusing on one aspect of healthcare--in favor of an "integrated" approach. That funding from government and multilateral sources (such as the UN or the World Bank) would be funneled through the local Ministries of Health in nations needing development aid, effectively cutting off direct funding to non-governmental organizations (NGOs), which would encourage even more corruption and slow, or even stop, the progress made in public health, especially in HIV/AIDS prevention and treatment. I wrote a bit about it here, though I didn't know much when I wrote it (I'm certainly no expert now, but I had to research all of this for work).

Now, it's hard to know what's true and what's not, what's rumor or a sensationalist media taking a story and running with it. I haven't seen ARV stock-outs or waiting lists for treatment firsthand. But I hear they're coming. And I know that they've happened already. There is a shift of some kind happening, that's accepted by almost everyone, but no one knows what form it will take.

The Obama administration has insisted over and over that it is not abandoning the fight against HIV/AIDS. I understand that the administration is under huge pressures--the bail out, the healthcare bill, the oil spill, etc--but essentially flat lining funding for PEPFAR and decreasing funding for the Global Fund, which are certain and established facts, is not going to help make progress to achieve universal access to ARVs (we're still well short, and growing, since the WHO has recently upped the threshold for when people living with HIV should begin on the drugs) or to achieve full coverage of prevention of mother-to-child transmission (PMTCT). In these uncertain economic times, which have affected people across the globe, robust support for HIV/AIDS treatment and prevention is even more vital.

There's been some hopeful news recently: for example, scientists may have finally found a microbicide that women can apply before sex to decrease the likelihood of being infected, though it won't be available for years, and preliminary findings are putting prevention at 54%, hardly a grand slam. And all this squawking over USG cuts and the public health shift and the Global Fund not being able to get enough money this year means that there are people out there watching, and there are people out there who care. This week, the International AIDS Society is holding its annual conference in Vienna. It's the top conference for those who work in the HIV/AIDS field, from researchers to implementers to funders. It's also why there's been so much press this week about HIV/AIDS. Yes, a lot of it is about back-patting and bragging. And yes, a lot of it is about setting up meetings and not always about concrete action. But it's also a time to gather together and remind ourselves of why we are working to turn back HIV/AIDS, why we need to do so, and how we can hope that within my lifetime, we can see an end to this epidemic. On top of that, you learn about the discoveries being made in the field and how you can improve the response to the virus (a bunch of m2m-ers are there this week to present and to learn).

So, to President Obama, I'd say: don't give up now. Even though the $1Billion for PEPFAR was just a campaign pledge, people are still going to see a promise as a promise--be true to your word. And when Desmond Tutu chastises you for something, you're probably doing it wrong.

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