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Africa: End of AIDS in Sight, 1
AfricaFocus Bulletin
Jul 27, 2012 (120727)
(Reposted from sources cited below)
Editor's Note
"Even without a vaccine or a cure, it became clear this week
that science has given us the tools we need to dramatically
change the course of the HIV/AIDS pandemic and ultimately
end AIDS. Any argument that this cannot be achieved because
we do not have evidence-based tools is no longer valid.
Science has given us the tools. Now they must be applied." -
Anthony Fauci, at the opening of this week's International
AIDS Conference
Amid the plethora of reports, commentaries, meetings, and
demonstrations this week at the International AIDS
Conference in Washington, the consensus was wider than ever
that success against the AIDS pandemic is in sight, but only
if existing knowledge is applied with sufficient resources
and commitment.
Two AfricaFocus Bulletins today select among the most
readable and informative reports and commentaries appearing
during the week.
This AfricaFocus Bulletin, sent out by e-mail today and
available on the web at http://www.africafocus.org/docs12/hiv1207a.php, contains
several other recent articles, including (1) a summary
article from PlusNews on the prospects for an "and to AIDS,"
(2) an op-ed by Anthony Fauci on the same theme, (3) an
analysis by AIDS activist Mark Harrington on the Obama
administration response to the AIDS pandemic, with proposals
for additional action.
Another AfricaFocus Bulletin, not sent out by e-mail but
available on the web at http://www.africafocus.org/docs12/hiv1207b.php, contains (1)
a report from PlusNews focused on increases in domestic
investment on AIDS in affected African countries, (2) a
commentary from Doctors without Borders on the need for
stepped-up commitment by donors, (3) a news release from
Kaiser Family Foundation and UNAIDS on trends in donor
financing, and (4) a commentary from Huffington Post on how
U.S. Trade policy is undermining the prospects for
affordable generic drugs for AIDS and other diseases.
For previous AfricaFocus Bulletins on health issues, and
additional background links, visit
http://www.africafocus.org/healthexp.php
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HIV/AIDS: "End of AIDS" in sight
July 23, 2012
This report online (including additional links):
http://www.plusnews.org/report.aspx?reportID=95932
Washington DC, 23 July 2012 (Plusnews) - There is no cure or
vaccine yet, but "the end of AIDS" was the buzzword at the
opening ceremony of the International AIDS conference in
Washington DC on 22 July.
Wishful thinking? Not for Michel Sidibé, executive director
of UNAIDS, who told over 20,000 delegates that "this time,
it is different", or for Jim Yong Kim, the new President of
the World Bank Group and the first to address an
international AIDS conference. "We can end AIDS, we must end
AIDS. The challenge we face is great, but as I look out at
all of you today, I can actually see the end of AIDS," said
Kim.
Sidibé's list of how to reach the end of AIDS is not new:
scale up treatment-as-prevention, put 15 million on people
treatment by 2015, eliminate new infections in children, and
close the funding gap.
Nonetheless there is reason for optimism. For the first time
there are more people on treatment than those who need it,
and new infections worldwide have declined by 20 percent
since 2001. In South Africa at least 300,000 people started
treatment in 2011, 150,000 started in Zimbabwe, and in China
the number of people on treatment doubled in one year.
Even scientists are hopeful and on 19 July released a road
map ahead of the conference for research toward a cure for
HIV - the first time scientists have come up with a
coordinated plan to tackle the virus.
"The science has been telling us for some time now that
achieving a cure for HIV infection could be a realistic
possibility. The time is right to take the opportunity to
try and develop an HIV cure - we might regret never having
tried," said Françoise Barré-Sinoussi, the co-discoverer of
HIV and Director of the Regulation of Retroviral Infections
Unit at the Institut Pasteur in Paris.
However, money remains a major obstacle. The new UNAIDS
report says there is still a large gap in global funding for
HIV, estimated to reach $7 billion by 2015.
"From many places in the developed world I am hearing, 'We
cannot afford to keep our promises; we have our own problems
at home.' Financial commitment from developed countries is
declining... this gap is killing people," Sidibe warned
delegates.
The last International AIDS Conference was held in the US in
1990, but restrictions on the entry of people living with
HIV into the country prohibited holding another conference
in America until now.
President Barack Obama lifted the travel ban in 2010; the
Republic of Korea announced at the conference that it had
also removed its travel restrictions on HIV-positive people.
kn/he[END]
An opportunity to end the AIDS pandemic
By Anthony S. Fauci
Washington Post, July 27, 2012
http://www.washingtonpost.com
I was honored to deliver the opening scientific plenary
lecture Monday at the 19th International AIDS Conference in
Washington. The last time the meeting took place here was 25
years ago, and the mood was entirely different. In 1987, our
scientific knowledge about this exploding epidemic was in
its infancy. What has since been accomplished emboldened the
organizers to make this yearâ€TMs conference theme “Turning the
Tide Together” - and allowed me to speak of a possible end
to the AIDS pandemic.
The medical advances discussed at this meeting result from a
30-year scientific journey characterized by incremental
progress in understanding HIV and how it causes disease, the
development of treatments and prevention tools, the testing
of these interventions in clinical trials, and
implementation of these tools in communities worldwide. What
stands out in my mind from this weekâ€TMs presentations is that
interventions previously proved to work in controlled
clinical trials are now - over and over again - proving
effective outside the research setting, in the real world,
in poor and rich communities alike. The pieces are coming
together.
More than 8 million people in low- and middle-income
countries are receiving lifesaving antiretroviral drugs.
These medications averted 840,000 deaths in 2011 alone, one
of the most extraordinary accomplishments in public health
history. Still, 9 million HIV-infected people who need
therapy are not receiving it. In the United States, more
than 1.1 million people are infected with HIV and 20 percent
are not aware of it. This group inadvertently transmits the
vast majority of the approximately 50,000 new infections
that occur annually in the United States. Researchers and
health departments are pursuing new approaches to test
people for HIV and to provide treatment and care as well as
the support that enables HIV-infected individuals to
maximize benefits from medical and social services. As
discussed at the conference, such efforts are underway here
in Washington, in other U.S. cities with high HIV infection
rates and in other countries. Lives are being saved.
Besides their lifesaving role as treatment, antiretroviral
drugs can prevent HIV infection. By significantly lowering
virus levels, they dramatically reduce the risk that
infected people will transmit HIV to sexual partners or, in
the case of pregnant women, to their infants. This concept
has been proved in rigorous clinical trials, and this week
we saw new data that the results may be even stronger than
earlier reports. We also saw evidence of real-world public
health benefits at the community, regional and national
levels: As antiretroviral coverage has been scaled up,
incidence of HIV infection has gone down. Treatment as
prevention, if properly implemented and used along with
condoms and other proven tools, will significantly slow the
trajectory of the pandemic.
Another scientifically proven prevention approach is
voluntary medical male circumcision, which reduces a
heterosexual manâ€TMs risk of acquiring HIV by 50 to 60
percent, an effect that increases over time. We are seeing
reductions in HIV incidence in settings in Africa where
adult male circumcision is being scaled up as part of a
comprehensive HIV prevention strategy.
Studies have also shown that people at high risk of HIV
infection can reduce that risk by taking an antiretroviral
pill daily - a method known as pre-exposure prophylaxis, or
PrEP. The Food and Drug Administration recently approved a
pill combining two antiretrovirals for certain high-risk
groups to use as oral PrEP together with condoms and other
prevention tools. Antiretrovirals for use at the genital
mucosa also have shown promise as PrEP and, as discussed
this week, are being tested in vaginal rings that need to be
replaced just once a month. As with many treatment and
prevention tools, the effectiveness of PrEP is directly
related to how well people adhere to the prescribed regimen,
underscoring that behavioral factors must be addressed when
rolling out any intervention. Biologically based and
behaviorally based interventions are both needed.
Major research challenges remain, notably in developing a
vaccine and a cure for HIV. But even without a vaccine or a
cure, it became clear this week that science has given us
the tools we need to dramatically change the course of the
HIV/AIDS pandemic and ultimately end AIDS. Any argument that
this cannot be achieved because we do not have evidencebased
tools is no longer valid. Science has given us the
tools. Now they must be applied.
Ending the HIV pandemic is an enormous and multifaceted
challenge, but we know it is possible. Yet it will not
happen spontaneously. It will require a global commitment of
countries, governments and communities to strengthen their
health-care systems and build the capacity to provide HIV
treatment and prevention. We need donors and partners to
continue their investments, and we need new donor
organizations and countries to step up. We must enhance what
works and eliminate what does not, overcome legal and
political barriers, and remove the stigma associated with
HIV.
The global community has a historic opportunity based on
solid scientific evidence to end the AIDS pandemic, opening
the door to an AIDS-free generation.
Africa: Obama's to-Do List Towards Ending the Aids Epidemic
25 July 2012
Health-e (Cape Town)
http://allafrica.com/stories/201207250755.html
Existing treatment and prevention techniques could prevent
millions of new HIV infections and deaths from AIDS - but
only if Obama sustains funding. By 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.
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 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.
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 pressurefrom 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 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 that these economies of scale enabled PEPFARsupported
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, 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 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 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.
Recent scientific discoveries 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:
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 in 2001, and colleagues
pointed out in their global strategic investment framework
for HIV: "[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 lifeyear
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 address, 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 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 treatmentscale-up required to end the
pandemic. Some of the steps needed to end AIDS are discussed
in a report issued this week 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, which give America the power to map out
an endgame for the epidemic around the world.
AfricaFocus Bulletin is an independent electronic
publication providing reposted commentary and analysis on
African issues, with a particular focus on U.S. and
international policies. AfricaFocus Bulletin is edited by
William Minter.
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