Lawrence Altman, former senior medical correspondent for the New York Times, writes in an opinion analysis in the newspaper that while there was much discussion about “ending the AIDS epidemic” and an “AIDS-free generation” at the XIX International AIDS Conference (AIDS 2012) last week in Washington, D.C., “[o]ne obstacle is a failure to clearly define the epidemic or what it means to have an AIDS-free generation.” He continues, “Definitions of terms like these may help determine how many billions of dollars the world devotes to the battle against AIDS and how many millions of lives will be extended. A failure to meet ill-defined goals could lead to public misunderstandings that limit investments and the number of people who have access to the lifesaving antiretroviral drugs in the future.”
Inter Press Service reports on HIV/AIDS in the Caribbean, a region with “the second highest incidence of HIV/AIDS after sub-Saharan Africa.” The news service highlights a report titled “Together We Will End AIDS,” released by UNAIDS ahead of the XIX International AIDS Conference (AIDS 2012) in Washington, D.C. last week, which “noted that AIDS-related deaths in the Caribbean have declined by almost 50 percent in 10 years.” The news service highlights progress made in various countries in the region and quotes a number of experts and officials who spoke at or before the conference.
IRIN reports on HIV prevention efforts aimed at injecting drug users (IDUs) in Thailand, noting HIV prevalence among Thai IDUs is “among the highest in the Southeast Asia region, according to the Global AIDS Response progress report by” UNAIDS. “Providing free clean needles and syringes has proven to be the safest and most effective way to prevent new infections among injecting drug users,” but “the Council of State, Thailand’s central legal advisory body, has interpreted any needle distribution program as promoting drug use, Petsri Siriniran, director of the National AIDS Management Centre in the Public Health Ministry’s Department of Disease Control, told IRIN,” the news service writes. However, “the ministry is collaborating on a pilot project, run by PSI since 2009, in which counseling and sterile syringes are provided through drop-in centers and outreach services in 19 of Thailand’s 76 provinces,” according to IRIN.
Bloomberg Businessweek reports that “[c]ircumcision is in the spotlight again after a German court ruling has pitted those who support it for religious and health reasons against those who say boys should have the right to decide for themselves” and discusses how the procedure’s role in “helping prevent the spread of AIDS in Africa” is “[l]ost in the debate.” According to the news service, “Circumcision is picking up in Africa as a pragmatic health measure to ward off disease,” including HIV, herpes, and human papillomavirus (HPV). “Some mild adverse effects may occur, especially when circumcision is done when the patient is older or when the practitioner hasn’t been properly trained, according to a review of more than 50 studies published in 2010,” which also found severe complications are uncommon, the news service writes. Bloomberg examines circumcision policies and laws of the WHO and several countries (Wainer/Bennett, 7/29).
GlobalPost’s “Global Pulse” blog examines questions surrounding the use of the antiretroviral Truvada for pre-exposure prophylaxis (PrEP) to reduce the risk of HIV infection among people at high risk, as studies released and panel discussions held last week at the XIX International AIDS Conference (AIDS 2012) “raised concerns about the drug’s effect on the future of the AIDS fight.” According to the blog, “Leaders in the fight against AIDS are trying to work through these issues and figure out the best way to make use of Truvada as prevention.” The blog notes that the WHO last week “released a set of guidelines for how to use PrEP in demonstration projects” and quotes AVAC Director Mitchell Warren, AIDS Healthcare Foundation President Michael Weinstein, amfAR Vice President and Director of Public Policy Chris Collins, and Black AIDS Institute President and CEO Phill Wilson (Judem, 7/27).
Some members of Congress “are advocating deep cuts to funding for domestic programs such as [the Ryan White CARE Act] and international programs such as the Global Fund [to Fight AIDS, Tuberculosis and Malaria] and PEPFAR,” but “[w]hat these critics fail to realize is that though we have won a multitude of battles, we are still losing the war in many communities,” Rep. Michael Honda (D-Calif.) writes in a U.S. News & World Report opinion piece. “We must continue to find innovative, targeted solutions in the fight against this dreaded disease,” he continues, adding, “There are many of us in Congress who recognize this important fact, chief among those are my dear friend Rep. Barbara Lee [D-Calif.], whose upcoming ‘Ending the HIV/AIDS Epidemic Act of 2012’ targets at-risk populations both domestically and internationally.” Honda concludes, “From legislative action on the federal level to grassroots efforts in state communities, we need to make targeting these communities a top priority in order to move forward. This requires advocacy, this requires commitment, and most importantly, it requires more investment” (7/27).
In this post in the Human Rights and HIV/AIDS “Now More Than Ever” blog, Michel Kazatchkine, the former executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria and newly-appointed special envoy to U.N. Secretary-General Ban Ki-moon for HIV/AIDS in Eastern Europe and Central Asia, examines why human rights are “so central to the AIDS response.” He writes, “An urgent mobilization is needed to respond to the epidemic in Eastern Europe and Central Asia, including much greater attention to, and involvement of marginalized and criminalized populations, particularly people who use drugs, sex workers, and gay men and other men who have sex with men,” adding, “As Special Envoy, I will continue to speak out loudly and clearly about the need to devote much greater attention to human rights. And I pledge to listen to the voices of those who too often are excluded” (7/26).
Noting “the total clinic-level cost of providing a year’s worth of antiretroviral drugs … ha[s] dropped” in some countries, Charles Kenny, a fellow at the Center for Global Development and the New America Foundation, discusses “disagreement over the effectiveness of the global AIDS response” in this Bloomberg Businessweek opinion piece. Kenny highlights a debate that took place last week on the sidelines of the XIX International AIDS Conference (AIDS 2012) that “focused on the question: should we use resources for antiretrovirals at a cost (including overhead) of perhaps $350 per patient per life year saved if we could use those resources to provide a course of drugs to cure victims of tuberculosis at a cost of $5 to $50 per life year, or of extending childhood immunizations at the cost of $2 to $20 per life year?” He writes, “Simply, millions of people are dying unnecessarily, for lack of $350 a year or less. It may be those who don’t get AIDS treatment, or those that don’t get other treatments because the available money is being used to buy antiretrovirals.” He continues, “If anything could open treasury accounts in the rich world to provide a larger flow of resources to global health, perhaps it is to get policymakers in those countries to think through these gut wrenching decisions that limited funding (and lack of funding flexibility) forces doctors and ministers and activists alike to make every day” (7/27).
Laurie Garrett, senior fellow for global health at the Council on Foreign Relations, published three new blog posts last week examining issues discussed at the XIX International AIDS Conference (AIDS 2012). The mood at the conference was “strangely optimistic,” as scientists, politicians, and advocates discussed the “end of AIDS,” she writes in one, adding, “The pandemic will not be over until the number of new infections hits zero, and the annual death toll plummets to insignificant levels.” In another, she states, “The newfound optimism that imbues this gathering of some 25,000 people in Washington, DC, is based on a few genuinely important breakthroughs. But while these insights offer hope of saving millions of lives and limiting a tidal wave of human suffering, they do not add up to the much-vaunted ‘end of AIDS.'” In a third, Garrett examines funding for the HIV/AIDS response and describes a debate that took place among experts and economists at the World Bank (7/27).
“Charged by Secretary of State Hillary Clinton with developing a blueprint for the next phase of the [U.S. government’s] involvement in the fight against HIV and AIDS, [U.S. Global AIDS Coordinator Ambassador Eric Goosby] … will lead an interagency effort to give clearer meaning to the term, ‘AIDS-free generation,’ and provide a basis for programming,” Sharon Stash, a senior fellow at the Center for Strategic & International Studies’ (CSIS) Global Health Policy Center, writes in the CSIS “Smart Global Health” blog. “Clearly the notion of an ‘AIDS-free generation’ within our reach is a powerful one,” she writes, and asks, “Is the meaning it inspires powerful enough to attract and keep the attention of national policymakers, already burdened with competing priorities in a tight economic environment?” (7/29).