Tuesday, April 13, 2010

US Curbing Global HIV Drug Program

There is always plenty of federal funding to send hundreds of American bureaucrats to domestic and international AIDS conferences, UCLA's HIV modeler Sally Blower receives a steady flow of government dollars for her controversial and useless studies that are largely ignored by policymakers, and there is no cap on salaries for executive directors of AIDS nonprofits.

But programs to keep people with HIV/AIDS healthy and alive with a continuous and uninterrupted supply of medicines, seem to constantly need new funding streams or face restricting the number of PWAs receiving cocktails.

The latest threat to AIDS medicines for PWAs beyond our borders is detailed in an alarming story that recently appeared in the Boston Globe:

US officials have asked some AIDS clinics overseas to stop enrolling new patients in a US-sponsored program that provides lifesaving antiretroviral drugs, in a bid to stem the rising costs of one of the most ambitious US assistance programs, according to interviews with doctors and official correspondence.

The move, which was prompted by tighter budgets as well as a debate over how limited global health care dollars can be spent most effectively, has sparked fears among AIDS advocates that the Obama administration is curtailing its commitment to a program that provides lifesaving drugs for 2.4 million people and that many view as President Bush’s most successful foreign policy legacy. [...]

Obama administration officials say they are not capping the number of patients receiving antiretroviral drugs, but they acknowledge that they are seeking to control the ever-rising costs of the program, known as the President’s Emergency Plan for AIDS Relief, which has grown from $2.3 billion in 2004 to nearly $7 billion this year.

“People are struggling to find resources to honor the commitments we have made,’’ Ambassador Eric Goosby, US global AIDS coordinator, said in an interview. “We’re not at a cap point yet. If it gets worse, we’ll have another discussion.’’

The effects of the cost-cutting measures are beginning to be felt in parts of Africa. For patients arriving at some front-line AIDS clinics in Africa, the limits have the same effect as a cap, critics say.

“Virtually every day, we have to turn away patients who need treatment, including breast-feeding women,’’ said Dr. Peter Mugyenyi, a prominent AIDS specialist in Uganda. “We have to tell them ‘There is a freeze.’ ’’ [...]

I think many advocates would agree that the global program is a success, by a lot of criteria, especially for people living with AIDS, and now we have a problem with the Obama administration not knowing how to building on that success. Doesn't the White House understand that cutbacks to international AIDS drug efforts equals illness and early death for maybe millions of PWAs?

The Globe explains who one very important adviser is the White House on this:

Ezekiel Emanuel, a White House special adviser on health care who is also the brother of President Obama’s chief of staff, argued in an academic paper shortly before his appointment that US funds could save more lives by focusing on cheaper interventions, such as childhood vaccinations and treatments for respiratory illnesses rather than greatly increasing the budget for AIDS drugs. [...]

Sounds as if the administration is pitting diseases against one another for financing, and HIV is losing out.

In year 29 of the AIDS epidemic, it would be great if the Democratic President who promised as a candidate to be a fierce advocate for gay people, would keep that promise, and expand on it to include fiercely fighting for money to maintain and expand global access to HIV medicines.

Kudos to the Boston Globe for running this lengthy piece, and to the writer, Farah Stockman for comprehensive reporting.

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