FW: [ACTIVIST] Fwd: What Obama needs to do to end AIDS

[Erick Otieno Owuor]

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Subject: FW: [ACTIVIST] Fwd: What Obama needs to do to end AIDS





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From: nathan...@gmail.com
To: acti...@tac.org.za, drug...@lists.hst.org.za
Sent: Tue, Jul 24, 2012 9:28 AM PDT
Subject: [ACTIVIST] Fwd: What Obama needs to do to end AIDS

Excellent article by Mark Harrington on what Obama needs to do about AIDS.

http://www.theatlantic.com/politics/archive/2012/07/only-stronger-us-leadership-can-end-the-aids-epidemic/260235/?single_page=true#

MARK HARRINGTON <http://www.theatlantic.com/mark-harrington/> - Mark
Harrington since 2002 has been the executive director of the Treatment
Action Group, which he co-founded in 1992 after four years working with the
Treatment + Data Committee of ACT UP/New York. He was awarded a MacArthur
Fellowship in 1997.

- ALL POSTS <http://www.theatlantic.com/mark-harrington>

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Only
Stronger U.S. Leadership Can End the AIDS Epidemic

JUL 24 2012, 10:00 AM ET

*Existing treatment and prevention techniques could prevent millions of new
HIV infections and deaths from AIDS -- but only if Obama sustains funding.*

[image: obamaaids]Then-Senator Obama speaks at HIV/AIDS Treatment Action
Campaign offices in Khayelitsha in Cape Town (Reuters)

Four years ago, President Obama's election generated hope for new American
leadership in the fight against AIDS here at home and around the world. On
that day, South Africa's Treatment Action Campaign -- the movement which
combined massive demonstrations with sophisticated insider legal cases and
science-based activism to force South Africa to create the world's largest
HIV treatment program -- recalledhis visit to their
offices<http://www.youtube.com/watch?v=E_YbLKguDqk> in
the township of Khayelitsha, Western Cape, in August of 2006, and how it
had urged him to run for president to have a chance to fulfill his
commitment to addressing AIDS.

"Obama took a strong position on preventing and treating HIV/AIDS," the
group recalled in 2008, "and was critical of President Mbeki and the South
African government's response to the epidemic," then expressed through a
deadly form of HIV
denialism<http://www.guardian.co.uk/world/2008/nov/26/aids-south-africa>
.

Since becoming president, Obama has continued to talk the talk, promising
last December on World AIDS Day to lead the way towards an AIDS-free
generation, and to increase U.S. support for global HIV treatment to cover
antiretroviral therapy (ART) for six million people around the world by the
end of 2013. That makes his silence this week, during the first
International AIDS Conference to be held on American soil since the 1990
gathering during the George H.W. Bush administration, all the more striking.

Obama simply hasn't walked the walk when it comes to funding for AIDS. In
fact, earlier this year, he proposed a shocking cut of $550 million to the
President's Emergency Plan for AIDS Relief (PEPFAR), the most successful
U.S.-funded global health program in history.

At first, the administration failed to provide any explanation for such
drastic cuts, which could put the lives of thousands who depend on the
United States to pay for treatment at risk. Later, in response to
pressure<http://www.treatmentactiongroup.org/policy/2012/letter-president-pepfar>from
the Treatment Action Group and its activist colleagues, administration
officials claimed that they had been so successful in reducing costs that
they could reach the target of getting medicines to 6 million during 2013
even with dramatically reduced funding.

It's true that costs have gone down. Earlier this week, the Clinton Health
Access Initiative released data showing that the cost of providing HIV care
and treatment has dramatically fallen in the past two years due to
increased use of generic medications and overall program efficiencies. The
annual cost of HIV
care<http://www.guardian.co.uk/society/2012/jul/20/aids-breakthrough-treatment-costless>
in
Ethiopia, Malawi, Rwanda, and Zambia -- including drugs, lab costs, and
health worker salaries -- is now just $200, while in more developed South
Africa it is $682. In her speech to the International AIDS Conference on
Monday, Secretary of State Hillary Clinton
indicated<http://www.state.gov/secretary/rm/2012/07/195355.htm> that
these economies of scale enabled PEPFAR-supported programs to enroll
600,000 people in the last six months, compared with 700,000 in the past
fiscal year.

With these successes in hand, the Obama administration could easily have
proposed a more rapid scale-up towards unmet HIV prevention and treatment
needs, rather than slashing PEPFAR. There are plenty of global health needs
to which the funds saved on "efficiencies" could have been applied --
expanding TB testing in mothers and children, purchasing GeneXpert TB test
kits, which can diagnose the disease and its most common drug-resistance
patterns in two hours rather than the two weeks or more traditional TB
culture takes -- as well as expanding ART treatment slots and growing
maternal and child health programs. All these would have been steps forward
towards the making administration's AIDS-free generation promise a reality.

Instead, the administration decided to pocket the savings, leaving millions
of people out in the cold.

Some people even wonder if the president's lack of enthusiasm for
PEPFAR heralds
the program's demise next
year<http://www.treatmentactiongroup.org/tagline/2012/spring/does-obama%E2%80%99s-2013-budget-herald-end-pepfar>,
when it is due to be reauthorized by Congress. PEPFAR was launched in 2003
by President George W. Bush and, along with the Global Fund to Fight AIDS,
Tuberculosis and Malaria, has channeled $39 billion in U.S.
aid<http://www.pepfar.gov/press/80064.htm> towards
HIV treatment and prevention efforts (as well as the fights against TB and
malaria) around the world, making the United States the single largest
source of dollars addressing the global HIV pandemic. Four-and-a-half
million people today are receiving life-saving HIV treatment through PEPFAR
in low and middle-income countries in Africa, Asia, the Caribbean, and
South America.

Had Obama attended the International AIDS Conference (Secretary of State
Hillary Clinton, HHS Secretary Kathleen Sebelius, PEPFAR chief Eric Goosby,
and NIH AIDS supremo Anthony Fauci and other members of the administration
have been speaking or attending in his stead), he would have heard deep
gratitude for the U.S. role in responding to the HIV epidemic around the
globe. He would have heard optimism that the world is on the cusp of being
able to do something long thought unthinkable -- actually bring about an
end to the AIDS pandemic.

But since he won't be there, here's a to do list the president should
consider if he wants to walk the walk to truly begin to make that happen:

*1. Fully fund PEPFAR and support its reauthorization in 2013.* Restore the
$546 million in proposed cuts to PEPFAR in fiscal year 2013, and begin
planning now for the program's upcoming legislative reauthorization in 2013.

*2. Restore cuts to the Centers for Disease Control and Prevention* (CDC)
tuberculosis program. TB is the leading cause of HIV related death
worldwide, yet the last budget continues a deplorable pattern of cutting
the CDC's TB control budget. As a result of the cuts, the New York City
Department of Health is being forced this week to suspend an innovative
pilot program to treat cases of latent TB infection with a three-month
course of treatment, instead of the older standard nine-month course, which
imposes much greater inconveniences on patients and health workers alike.

*3. Fully support the Global Fund to Fight AIDS, Tuberculosis and Malaria*,
and enable it to replenish depleted funding coffers for countries trying to
expand their programs for prevention, care, and treatment of the three
diseases, which often spread in tandem and occur at the highest rates in
the same countries.

*4. Reject the congressional ban on federal funding for needle exchange.* As
part of last year's budget deal, Obama conceded to congressional demands
that the ban on federal funding for needle exchange be reinstated. The
administration did this despite knowing that needle exchange programs save
lives and reduce HIV transmission -- and despite having reversed the
previous ban. Last year's decision was wrong and could lead to unnecessary
increases in HIV incidence among drug users and their sex partners.

*5. Revise and revitalize the National HIV/AIDS Strategy (NHAS)* to
incorporate new scientific findings and to more rapidly scale up HIV
prevention and treatment programs nationally. A recent
paper<http://www.ncbi.nlm.nih.gov/pubmed/22610372> by
David Holtgrave, a department chair at the Johns Hopkins Bloomberg School
of Public Health, and colleagues found that "[w]ithout expansion of
diagnostic services and of prevention services for [people living with
HIV], scaling up coverage of HIV care and treatment alone in the U.S. will
not achieve the incidence and transmission rate reduction goals of the
NHAS. However, timely expansion of testing and prevention services for
[people living with HIV] does allow for the goals to still be achieved by
2015, and does so in a highly cost-effective manner." The goals of the NHAS
include:

lowering new HIV infections by 25 percent and HIV incidence by 30 percent
increasing Americans' knowledge of their own serostatus from 79 percent to
90 percent
increasing the proportion of newly diagnosed Americans linked to clinical
care within three months from 79 percent to 90 percent
increasing the proportion of Ryan White HIV/AIDS program clients who are in
continuous care (at least two visits for routine HIV medical care in 12
months at least 3 months apart) from 73 percent to 80 percent
increasing the percentage of Ryan White HIV/AIDS program clients with
permanent housing from 82 percent to 86 percent, and
increasing the proportion of HIV-diagnosed gay and bisexual men, Blacks,
and Latinos/Latinas with undetectable viral load by 20 percent each

all by the end of 2015<http://www.whitehouse.gov/administration/eop/onap/nhas>
.

Recent scientific
discoveries<http://www.nejm.org/doi/full/10.1056/NEJMoa1105243#t=article>
have
shown that earlier initiation of antiretroviral therapy can reduce HIV
transmission by a whopping 96 percent among couples with differing HIV
status.

This led Anthony S. Fauci, director of the National Institute of Allergy
and Infectious Diseases (NIAID) at the National Institutes of Health (NIH) to
write <http://www.sciencemag.org/content/333/6038/13.summary>:

The fact that treatment of HIV-infected adults is also prevention gives us
the wherewithal, even in the absence of an effective vaccine, to begin to
control and ultimately end the AIDS pandemic....For the first time in the
history of HIV/AIDS, controlling and ending the pandemic are feasible;
however, a truly global commitment...is essential. Major investments in
implementation now will save even greater expenditures in the future; and
in the meantime, countless lives can be saved.

Revising the National AIDS Strategy to incorporate these new findings could
enable the administration to set more ambitious targets of reducing HIV
transmission and incidence by 50 percent or more -- as South Africa has
committed to doing by 2016 -- increasing linkage to care to 95 percent,
increasing Ryan White care retention to 95 percent (the program funds care
for those who cannot otherwise afford it), increasing Ryan White clients'
access to housing to 95 percent, and increasing the proportion of blacks,
Latinos and Latinas, and gay men with an undetectable viral load to at
least 90 percent.

Of course, this revised National AIDS Strategy would cost more money up
front. But as Fauci pointed out above, and as Bernhard Schwartländer of
UNAIDS, who first proposed the scale-up efforts that led to PEPFAR and the
Global Fund in a pivotal paper in *Science*
magazine<http://www.sciencemag.org/content/292/5526/2434.short> in
2001, and colleagues pointed out in their global strategic investment
framework for HIV<http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2960702-2/abstract>:
"[t]he yearly cost of achievement of universal access to HIV prevention,
treatment, care, and support by 2015 is estimated at no less than US $22
billion. Implementation of the new investment framework would avert 12.2
million new HIV infections and 7.4 million deaths from AIDS between 2011
and 2020 compared with continuation of present approaches, and result in
29.4 million life-years gained. The framework is cost effective at $1060
per life-year gained, and the additional investment proposed would be
largely offset from savings in treatment costs alone."

*6. Increase funding for the National Institutes of Health (NIH)* by 15
percent annually for the next five years. The NIH budget has been flatlined
since 2004, with the exception of two years of stimulus funding in
2010-2011. The rate at which new grant applications are funded has fallen
to 10 percent, meaning nine out of 10 applications are rejected. In his
2011 State of the Union
addres<http://www.whitehouse.gov/state-of-the-union-2011>s,
Obama committed to reinvigorating the United States' commitment to and
investment in scientific research:

This is our generation's Sputnik moment. Two years ago, I said that we
needed to reach a level of research and development we haven't seen since
the height of the Space Race. And in a few weeks, I will be sending a
budget to Congress that helps us meet that goal. We'll invest in biomedical
research, information technology, and especially clean energy technology --
an investment that will strengthen our security, protect our planet, and
create countless new jobs for our people.

This year, his proposed 2013 budget flatlines
NIH<http://www.whitehouse.gov/omb/budget> once
again. We need increased investment in biomedical research to assure the
discovery and development of the innovative tools we need to end the
epidemic, cure HIV and find a vaccine to prevent its transmission.

*7. Commit the administration to fully funding the research, prevention,
care, and treatment*scale-up required to end the pandemic. Some of the
steps needed to end AIDS are discussed in a report issued this
week<http://www.endingaids.org/> by
our colleagues at AVAC and amfAR, *An Action Agenda to End AIDS*.

President Obama has shown himself capable of the vision to create a
National HIV/AIDS Strategy and continued to ensure that the United States
is the leader in support for global HIV programs. Now is the time for him
to embrace the newest scientific
results<http://www.avert.org/hiv-treatment-as-prevention.htm>,
which give America the power to map out an endgame for the epidemic around
the world.