In Foreign Policy’s “Passport” blog, Associate Editor Uri Friedman reflects on former President George W. Bush’s efforts against AIDS, highlighting PEPFAR, which he “established in 2003 and which now supports antiretroviral treatment for 4.5 million people around the world.” Friedman quotes former President Bill Clinton, who, speaking at the Democratic National Convention on Wednesday, said, “I have to be grateful, and you should be too, that President George W. Bush supported PEPFAR. It saved the lives of millions of people in poor countries.” Friedman continues, “[W]hat’s particularly notable about the reference is that, during a convention season designed to draw sharp distinctions between Republicans and Democrats, the two parties have found common ground on at least one point: the success of Bush’s efforts to fight AIDS.”
Access to Health Services
Ugandan Parliamentarians Threaten To Hold Up National Budget Unless More Funding Committed To Health Care
In Uganda, where “there are fewer than two health workers for every 1,000 people — a level the World Health Organization defines as a severe shortage” — the nation’s parliamentary “social services committee, which has initial oversight of the country’s health budget, pushed a resolution through parliament last week threatening to hold up approval of the entire budget unless funding to recruit and retain new health workers is increased,” VOA News reports. “Committee members, with support from the Women’s Parliamentary Association, called for a specific increase of at least $103 million to the sector,” the news service notes. “In addition to the funding increase, the parliamentarians are calling for an end to a wage freeze for current employees and a ban on recruiting new health workers,” as well as “demanding a supplementary pool of money to improve health care in communities that are particularly short staffed,” according to the news service.
In a 200th anniversary article for the New England Journal of Medicine, Salmaan Keshavjee of the Department of Global Health and Social Medicine at Harvard Medical School and Paul Farmer of Partners in Health “seek to elucidate the reasons for the anemic response to drug-resistant tuberculosis [TB] by examining the recent history of tuberculosis policy,” they write. The authors outline the history of TB drug development and how the disease became resistant to myriad drugs, and write that by the 1970s, “[t]uberculosis, whether caused by drug-susceptible or drug-resistant strains, rarely made even medical headlines, in part because its importance as a cause of death continued to decline in areas in which headlines are written. They continue, “In the United States, federal funding for tuberculosis research was cut; consequently, drug discovery, development of diagnostics, and vaccine research ground almost to a halt.”
“Kenya has launched an investigation after researchers claimed HIV-positive women were being routinely sterilized without their consent in government hospitals,” the Guardian reports. The African Gender and Media Initiative issued a report “based on interviews with 40 women, suggest[ing] the practice was widespread and ongoing,” according to the newspaper. “The report also includes examples of coercive tactics used by medical staff to obtain consent — for instance, threatening to withhold antiretroviral medication or baby milk if the woman did not agree to the procedure,” the newspaper writes. “‘These allegations are very serious and the Kenya Medical Practitioners and Dentists Board is going to investigate them before appropriate action is taken,’ Shariff Shahnaz, the director of public health, told the Daily Nation newspaper,” the Guardian reports (Mojtehedzadeh, 9/4).
“Despite pledges from governments across Eastern Europe and Central Asia to fight HIV/AIDS — one of the eight Millennium Development Goals — the region has the world’s fastest-growing HIV epidemic,” Inter Press Service reports in an article examining challenges to stemming the spread of the disease, particularly among injection drug users. “Punitive drug policies, discrimination and problems with access to medicines and important therapy are all driving an epidemic which is unlikely to be contained, world experts say, until governments in countries with the worst problems change key policies and approaches to the disease,” the news service writes. According to experts and activists, a lack of opiate-substitution therapy (OST) and needle-exchange programs, as well as discrimination against and “active persecution” of drug users who try to access therapy programs, contributes to the spread of HIV, IPS notes (Stracansky, 9/3).
Researchers from South Africa and South Korea are developing a smartphone-based device and application able to “photograph and analyze blood samples in areas far from laboratories to diagnose HIV and even measure the health of [patients’] immune systems,” Agence France-Presse reports. The device, called Smartscope, is a small microscope that clips over a phone’s camera and holds a standard chip with a blood sample, the news service notes, adding the camera then photographs the sample and the application analyzes the photo to produce a CD4 cell count. “The team hopes that trials in clinics may start next year,” according to AFP (8/31).
“More than 4,000 delegates — including government officials, health experts, community leaders, scientists, indigenous populations, youth and people living with HIV — convened from 28-31 August in Sao Paulo, Brazil, for the 6th Latin American and Caribbean Forum on HIV/AIDS and Sexually Transmitted Infections (STIs),” UNAIDS reports in a feature story. “[T]he forum provided an opportunity to take stock of progress, challenges and lessons learned in HIV responses across the region,” according to UNAIDS, which adds, “Participants engaged on a range of issues, from AIDS financing and new HIV prevention technologies to strategies for closing treatment access gaps.” The article expands on several of these issues (8/31).
“Government assurances that the scaling back of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program in South Africa (SA) will be carefully managed to protect patients are welcome, but … [t]he reality is that the Department of Health is struggling to cope with severe medical staff shortages, financial resources that never seem to stretch far enough, inadequate infrastructure and maintenance programs, and administrative bottlenecks,” a Business Day editorial states. Though the reworking of PEPFAR funding will take place over five years “and does not entail the complete loss” of funding, “the shortfall will have to come from somewhere,” the editorial says, adding, “It will be tragic if, just as we are starting to see light at the end of the long, dark tunnel of the HIV/AIDS epidemic in SA, the gains of the past few years were to be reversed due to the loss of critical foreign funding and the government’s lack of capacity to plug the gap.”
“Abortions are just as safe when performed by trained nurse practitioners, midwives and physician assistants as when doctors do them, a new review of the evidence suggests,” Reuters reports. “Researchers analyzed five studies that compared first-trimester abortion complications and side effects based on who performed the procedures in close to 9,000 women — and typically found no differences,” the news service writes. The review is published in BJOG: An International Journal of Obstetrics and Gynaecology, according to the news service.
Brazil is expanding its national HIV/AIDS treatment program to include about 35,000 additional people, the Associated Press/Seattle Times reports. “Ronaldo Hallal of the [health] ministry’s Sexually Transmitted Disease Department said people with 500 or fewer CD4 cells per cubic millimeter will receive antiretroviral HIV treatment,” increasing the cutoff from 350 or less CD4 cells per cubic millimeter prior to the expansion, the news service writes. The Ministry of Health noted on its website that the expansion will require spending an additional 120 million reals, or $60,000, annually, according to the news service, which adds, “Hallal said Brazil already spends 1.2 billion reals ($600 million) each year in its free anti-AIDS program that is currently treating 223,000 people.” The AP notes Health Minister Alexandre Padilla said in a statement, “Brazil will be the only large country in the world to offer this kind of treatment that will reduce the risk of opportunistic infections like tuberculosis” (8/29).