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AIDS 2010 Recent Releases

Editor’s note: Excerpts from journals, press releases and blogs focusing on the AIDS conference in Vienna appear below. Other notable global health items will be included in next week’s comprehensive edition of Recent Releases.

Blog: HIV/AIDS Community Needs Cooperation

In response to criticism from advocates at AIDS 2010 that the U.S. is retreating from funding HIV/AIDS, a blog post on the Huffington Post writes that “President Obama has steadily increased funding for the President’s Emergency Plan for AIDS Relief, or PEPFAR, which was created by President Bush and has strong bipartisan support. The president’s 2011 budget proposed an 8 percent increase in global health funding. This included a historic $7 billion request for PEPFAR the largest-ever request for PEPFAR, accounting for 73 percent of the total proposed global health budget.”

The post continues that “[a]t the IAS conference, many activists chanted that the ‘U.S. government counts pennies, Africa counts lives.’ But it is precisely the activists who have been measuring success in the global fight against HIV/AIDS in terms of dollars and pennies. Their focus seems to be only on the budget. But what counts are not dollars spent or drugs bought, but lives saved.” The post concludes that the HIV/AIDS community has “exhibited tremendous creativity, passion and energy” and should now “re-direct that energy into making programs work better and pinpointing effective interventions that serve all populations” (Emanuel, 7/21).

Blog: Legal Obstacles, Civil Society Role In Latin America’s HIV/AIDS Response

A post on the Center for Strategic and International Studies’ “Smart Global Health” blog examines an AIDS 2010 session on Latin America, including comments by the panel’s four featured speakers: Pedro Cahn, former co-chair and past International AIDS Society (IAS) president;, Mario Bronfman, former co-chair of the scientific program in Mexico City; Lilian Abracinskas of Uruguay; and Gloria Carreza of Mexico. “Several panelists focused on the legal obstacles to improved response to the HIV/AIDS pandemic. Bronfman … signaled the persistence of legislation that criminalizes vulnerable populations, such as MSM, CSW and IDU; the lack of sexual education, and the efforts of the Catholic Church, evangelical groups, and conservative political parties to prevent the implementation of meaningful sexual education; and the uneven implementation of human rights and anti-discrimination legislation, as important challenges.”

The post also cites a study on the links of gender based violence and HIV status and discusses the role of Latin American civil society groups in fighting HIV/AIDS, which “came up several times during the question and answer period.” The blog also features posts from Vienna on changing standards of HIV treatment and sex workers’ rights (Bliss, 7/21).

Release: Senator Tom Coburn Introduces Bill To ‘Make Better Use’ Of PEPFAR Funds

Senator Tom Coburn (R-Okla.) has introduced a the HIV/AIDS Saves Lives First Act of 2010, which “seeks to save lives by making better use of existing resources for PEPFAR,” according to a press release from the AIDS Healthcare Foundation. The bill would focus on “making delivery of lifesaving AIDS treatment the #1 priority of the program by increasing the treatment allocation to 75% of all funding; requiring more efficiency with a treatment allocation of $500 annually per patient; and, ensuring that the money goes to patients by limiting administrative overhead to 10% of total expenditures per grantee” (7/21). The bill also “sets a target of eliminating baby AIDS … in all PEPFAR countries by 2013,” according to a statement on the senator’s website (7/21).

Blog: GHI Has Strengths, Handicaps In Guaranteeing Sexual And Reproductive Rights

Part of Global Health Magazine‘s blog series on AIDS 2010 discusses whether the Global Health Initiative (GHI) will “guarantee the sexual and reproductive rights of women and girls,” writing that one of GHI’s strengths is addressing the “realities and concerns of women and their reproductive health needs.” However, the author writes, it “remains handicapped by discriminatory funding and policy restrictions,” noting that the “U.S. continues to support abstinence and be faithful-only programs” which are “not required to include such information” on male and female condoms. The post also states that “the GHI must address unsafe abortion, a major cause of maternal death” and address the “anti-prostitution loyalty oath, which requires organizations receiving U.S. funding to adopt a policy opposing prostitution” (Sippel, 7/21).

Blog: Obama Administration Committed To The Fight Against HIV/AIDS

A post on the White House Blog addresses the questions “many people have raised … about the Obama Administration’s commitment to the fight against HIV/AIDS” in light of AIDS 2010. The author writes that President Barack Obama has made a “significant investment” in HIV/AIDS by requesting increases in PEPFAR in “both his FY 2010 and FY 2011 budgets … In fact, the FY 2011 request is the largest request to date in a President’s Budget.” The post goes on to say “[the] amount of money spent on HIV/AIDS cannot be the measure of success. The right measures are lives saved and lengthened … [a] comprehensive approach is what the President’s [Global Health Initiative] is all about” (Smith, 7/21).

Blog: Harm Reduction’s ‘Underlying Similarities’ With Integration

“Harm reduction strategies have been found to be an effective way to prevent HIV transmission as well as reduce risky behaviors. But what exactly does harm reduction mean?  Harm reduction is making potentially risky behaviors or situations safer, instead of stigmatizing those behaviors or making them illegal, which is a goal of the Vienna Declaration and a subject here in Vienna,” according to a post on the K4Health blog, which discusses the “underlying similarities” between harm reduction and the integration of HIV/AIDS and sexual and reproductive health services. It also summarizes a session that “discussed the issue of protecting the reproductive rights of [people living with HIV/AIDS] and how provider stigma prevents women and couples from getting the care they need which often results in riskier situations.” The post is part of a series of updates on the blog from the conference (Mickish, 7/20).

Blog: ARV Drugs For Prevention Not A ‘Panacea’

Referring to the results of the CAPRISA 004 trial presented at AIDS 2010, a post on “Science Speaks” states, “[T]he use of [antiretroviral] ARV drugs for prevention cannot be perceived as a panacea. There are significant costs, the potential for side effects, the need for careful clinical monitoring and concerns about risk compensation. Yet drugs offer the best opportunity to slow the epidemic by earlier treatment of infected people and by careful use of chemoprophylaxis for specific populations of at-risk individuals.” The author calls the trial result a “critical finding,” and writes that “there will be a need for careful discourse among affected communities, advocates, clinicians, public health officials and funders in order to decide how to determine the best mix of the use of ARVs for both treatment and prevention” (Mayer, 7/20).

PLoS Medicine Policy Forum Looks At Expansion Of PMTCT Programs

A PLoS Medicine Policy Forum article discusses the expansion of prevention to mother-to-child transmission (PMTCT) programs in resource-limited settings, which “remains a challenge.” The authors write that infants not diagnosed at birth are “rarely diagnosed until symptomatic with HIV, resulting in increased morbidity and mortality,” and that “infant and pediatric testing programs are needed until PMTCT challenges are overcome or universal treatment of HIV-infected pregnant women becomes the norm.” The piece also addresses the cost of initiating pediatric ARV treatment in resource-limited settings and new investments required for implementing “tried and evaluated” strategies “in a coordinated fashion” (Kellerman/Essajee, 7/20).

PLoS Medicine Looks At South African Circumcision Project As A Model

An article published in PLoS Medicine discusses South Africa’s “Bophelo Pele” project as “a model for the roll-out of comprehensive adult male circumcision [AMC] services in African low-income settings of high HIV incidence.” The study “demonstrates that a quality AMC roll-out adapted to African low-income settings is feasible and can be implemented quickly and safely according to international guidelines.” The project, implemented in 2008, offered “free medicalized AMC” to male residents 15-years-old and older. By November 2009, “14,011 men had been circumcised … and 27.5% agreed to be tested for HIV (Lissouba, et al., 7/20).”

Conference Generates Attention, Does Little For Accountability

Noting the conference theme of “Rights Here, Right Now,” a blog post on the Huffington Post asserts that “[t]hose who bemoan that [AIDS 2010] is not more narrowly devoted to the latest from virology labs are missing the point: there are other more scientifically focused conferences on HIV/AIDS, and raising global attention to the on-going AIDS crisis requires some spectacle.” The post discusses recent positive news of declining prevalence rates in Kenya and also “many continuing problems,” such as the use of criminal law to “target groups at high risk of HIV infection.” The author also writes that while the conference is a good opportunity to “generate attention,” holding governments accountable to their promises “is another thing altogether” (Amon, 7/19).

Hope And Despair In AIDS

“[H]ope and despair are tightly bound in AIDS,” according to a blog post on the Huffington Post. “Despite the longer life for the millions of adults now using antiretrovirals in rich and poor countries alike – and despite the unexpected bonus that … current antiretroviral treatment has a major, major impact on prevention … the conference has already seen international officials and donors increasingly declare the ‘antiretroviral route’ is ‘unsustainable,’” she writes. She calls “unsustainable,” the “new code word for things that governments either can’t or won’t pay for any longer.” She writes that AIDS “needs a radical reorganization” because it is “top heavy” with too much spent on studies and reports and that “we must look with new eyes” at how ideas can “arise through this top heavy structure” (Norwood, 7/19).

Blog: Opening Ceremony Should Have Been More Positive, Direct

A post on the Center for Global Development’s “Global Health Policy” blog called the opening of AIDS 2010 “uninspiring” and “not as large or energizing as previous AIDS conferences.” Though there is much to be “thankful to the AIDS movement for,” according to the author, “the organizers of the conference didn’t effectively encompass this positive messaging into the opening ceremony, both in terms of content and form.” Because the audience includes “thousands of people from all walks of life” the messages at opening ceremony and the conference “need to be punchy, direct and evidenced based” (Oomman, 7/19).

Blog: Universal Treatment, Inability To Change Behavior Among HIV/AIDS Misconceptions

“While future possibilities, such as the gel, and rhetoric in Vienna [at AIDS 2010] are well-intentioned, some of the assertions about AIDS are quite flawed,” according to a post on Reuters’ “The Great Debate” blog. The author outlines four “major misconceptions about the global HIV/AIDS epidemic” which are: “providing medications to everyone is the best prevention method,” behavior change is not possible, “magic bullets” don’t exist and HIV/AIDS is “different from all other epidemics,” writing that “AIDS is not the overriding health problem in most countries, where more mundane problems such as lack of access to clean water overshadow it” (Halperin, 7/19).

Blog: Universal Access Laudable But Costly

The expansion of HIV treatment to five million people in low- and middle-income countries is “an amazing achievement by the international community,” but “this increase has simultaneously spurred an enormous increase in cost,” writes the author of a post on Center for Global Development’s “Global Health Policy” blog. “Clearly dramatic reductions in treatment costs would help,” the author continues, noting the WHO “proposing a new model of treatment, dubbed ‘Treatment 2.0,’ to deliver better quality of care at a much lower cost.  But it’s not here yet and it might not work.” He concludes that there “is only one way” to show that universal access is achievable: presenting evidence that “the number of new infections is trending lower, on a path towards becoming smaller than the annual number of deaths,” what the author dubs the “AIDS Transition” (Over, 7/19).

Blog: Ezekiel Emanuel Responds To PEPFAR Funding Critics

Science Speaks” posted a Q&A with Ezekiel Emanuel, one of the “architects” of the Obama administration’s Global Health Initiative. In response to a question about AIDS activists criticizing the Obama administration for “smaller increases in the global AIDS budgets,” he responds “[t]he fact is funding for HIV and our work on PEPFAR is going up … You may not like the allocation we have made, or not like the pot we are putting it in but (saying we are) cutting the budget is wrong.” He also said a big part of GHI is “built on the foundation of PEPFAR. We want to broaden it.” Emanuel also discussed the need to identify cost effective or inefficient programs, the GHI budget and protesters at the conference (Donnelly, 7/17).