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Our Concerns About the Presidential HIV/AIDS Council Getting the Boot. 2/1/2018

Published by POZ

AIDS United questions the timing and approach of the PACHA dismissals.

AIDS United expressed concern over reports that the Trump Administration had sent letters dismissing all remaining members of the Presidential Advisory Council on HIV/AIDS (PACHA) — six members had previously resigned already, citing a lack of action by the administration to combat the global HIV/AIDS epidemic. For more than two decades, this body has provided advice, information, and recommendations to the President and the Secretary of Health and Human Services regarding programs, policies, and research to promote effective treatment, prevention and research to end the HIV/AIDS epidemic.

While AIDS United recognizes that it is within the Trump administration’s purview to appoint PACHA members, and previous new Administrations also asked for the resignations of entire council memberships, we are very concerned about the timing and lack of transparency surrounding today’s dismissals. Most new administrations appoint their own Councils early in their terms, not after almost a year in office. Additionally, it is quite unusual to take such action between Christmas and New Year’s, when much of Washington is closed and their PACHA members are home celebrating the holidays with loved ones. AIDS United is especially bewildered by the administration’s dismissal of members whose terms had expired this year, and whose appointments the administration itself had extended.

What’s more, this timing negatively and directly affects current PACHA members’ ability to reapply for the position by January 2nd (the deadline provided by a recent Federal Register notice) as some have been encouraged to do. This timing also suggests an intent to avoid public scrutiny about the decision. More importantly, there is a strong value in having an independent and evidence-based council that can provide the Administration with the best advice on ending the HIV epidemic, something that is only now realistic thanks to the dedication of, among many others, previous and current PACHA members.

PACHA should represent the community and have members who fully reflect the breadth of individuals living with and affected by HIV. As such, it should contain a diversity of opinions as well as racial, gender and LGBTQ representation. AIDS United will be watching the appointments and will work to hold the new PACHA and this Administration to account to ensure that it does not become a rubberstamp for policies or partisan strategies that will harm previously bipartisan efforts to end the epidemic.

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Trump Fires All Members of HIV/AIDS Advisory Council. 29/12/2017

Published by POZ

The termination by FedEx letter happens after six other PACHA members resigned in protest in June.

The White House fired the remaining 16 members of the Presidential Advisory Council on HIV/AIDS (PACHA), reports The Washington Blade. They received word of their termination on Wednesday via a FedEx letter, though no explanation was given.

In June, six other members of PACHA resigned in protest over the way President Trump was dealing with the epidemic, citing in particular his attempt to repeal the Affordable Care Act (ACA, or Obamacare).

It is not unusual for an incoming administration to terminate PACHA members and appoint new ones. The Obama administration did exactly that when it took charge after George W. Bush’s presidency.

It is odd, however, that Trump has done this a year after taking office and after some PACHA members whose terms ended earlier in the year were sworn back in, said Gabriel Maldonado, CEO of LGBT and HIV group TruEvolution and one of the remaining members of PACHA let go this week. He told the Blade that he could only guess as to why the Trump administration cleaned house. One reason, he said, could be ideological and philosophical differences. “Like any administration, they want their own people there. Many of us were Obama appointees.”

Maldonado references the recent reports that the Centers for Disease Control and Prevention (CDC) had banned words such as diversity,science-based and transgender from budget documents.

Scott Schoettes, a senior attorney for Lambda Legal and one of the PACHA members who resigned in June, tweeted December 28 that it is “Dangerous that #Trump and Co. (Pence esp.) are eliminating few remaining people willing to push back against harmful policies, like abstinence-only sex ed.”

 

 

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Pharma Funds Planned Parenthood HIV Program. 5/11/2017

Published by MEDSCAPE

Planned Parenthood is in the crosshairs of federal plans to defund it, but the nonprofit has new partners and plans to expand care.

A grant from Gilead Sciences will help fund HIV prevention efforts, including awareness about pre-exposure prophylaxis. The company manufactures Truvada, the prominent PrEP combination of tenofovir disoproxil fumarate and emtricitabine.

This is the first significant corporate grant of its kind for Planned Parenthood.

It will fund a multiphase pilot program to expand HIV prevention and education efforts at 11 Planned Parenthood affiliates over 18 months, said Raegan McDonald-Mosley, MD, chief medical officer of Planned Parenthood.

"The bottom line is that we have the tools to get rid of HIV, but we have to continue to fight and hold the line," Dr McDonald-Mosley said during a plenary talk here at the Association of Nurses in AIDS Care (ANAC) 2017 meeting.

"Black women are more than 20 times more likely to acquire HIV in their lifetime than white women in the United States, and Hispanic women are more than four times more likely," she reported.

Women at Risk

"However, many programs that focus on HIV prevention are not addressing the needs of women. We aim to fill some of this gap," she explained.

 

"The Planned Parenthood affiliate covering Minnesota, North Dakota, and South Dakota entered the project providing no PrEP services at all. But in just 3 months, PrEP was rolled out at 19 of the health centers across three states," she reported.

"Their staff was very surprised by the unmet need for PrEP that they are now seeing," Dr McDonald-Mosley noted.

As part of the initiative, Planned Parenthood is also partnering with the Black AIDS Institute to expand resources in black communities that have been hit hardest by the HIV/AIDS epidemic. A report on the mobilization of the initiative and the outcomes will ultimately be published.

Another change underway is a notable addition to Planned Parenthood's patient population — men.

Growing Patient Demographic of Men

"The patient demographic that is growing the most rapidly right now in our health centers is men, making up more than 10% of our patient base," said Dr McDonald-Mosley.

Transgender individuals are also an increasing segment of the patient population, because they can seek health services that might not otherwise be available.

In 2015, Planned Parenthood centers saw 2.4 million patients, provided more than 4.2 million tests for sexually transmitted infection, including HIV screenings, provided more than 320,000 breast exams and 295,000 Pap tests, and provided birth control to nearly 2.0 million women, Dr McDonald-Mosley reported.

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Strategy for Accelerating HIV/AIDS Epidemic Control (2017-2020). 19/9/2017

Published by PEPFAR

Setting a Bold Course for Epidemic Control

We are at a historic moment in the global HIV/AIDS response. For the first time in modern history, we have the opportunity to change the very course of the HIV pandemic, by actually controlling it without a vaccine or a cure.  For the first time, the end of the epidemic as a public health threat is in sight. 

The United States, through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is the largest bilateral donor to the global HIV/AIDS response. Together, with host countries, the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and other partners we are beginning to demonstrate the ability to control a pandemic for which there is neither a vaccine nor a cure. This is being done by supporting HIV treatment and prevention services using data and analytics to improve performance, find efficiencies, and increase impact, saving more lives and decreasing the number of new HIV infections.  From driving scientific discovery and program innovation to demanding accountability, efficiency, and impact, the U.S. government has helped transform the way that development is done.

The Trump Administration’s leadership and commitment to international efforts to control the HIV/AIDS epidemic are a direct reflection of the goodwill, compassion, and generosity of the American people. This investment not only improves people’s lives but also supports communities all over the world.  We also care about ensuring accountability for each U.S. dollar spent – through PEPFAR we can track every single dollar to the site where it is supporting prevention and treatment interventions among the people we serve. Building on our tremendous progress, we are now poised to accelerate progress toward reaching epidemic control, something that was unimaginable just a decade ago. 

This PEPFAR Strategy for Accelerating HIV/AIDS Epidemic Control (2017-2020) (“Epidemic Control Strategy”) sets a bold course for achieving control of the HIV/AIDS epidemic in 10 high-burdened countries by the end of 2020 through a particular focus on 13 priority high-burdened countries¹. This will be accomplished in partnership with and through attainment of the UNAIDS 90-90-90 framework – 90 percent of people living with HIV know their status, 90 percent of people who know their status are accessing treatment, and 90 percent of people on treatment have suppressed viral loads - and an expansion of HIV prevention. This bold course toward epidemic control is only possible with continued aggressive focus, quarterly analysis, and partner alignment for maximum impact.  Beyond saving an untold number of lives, this will reduce the future costs required to sustain the HIV/AIDS response. In less than two decades of commitment and funding since PEPFAR’s launch by President George W. Bush in 2003, the pandemic will have progressed from tragedy to control.

According to recent data from PEPFAR’s Population-based HIV Impact Assessments (PHIAs), five high-burdened African countries are approaching control of their HIV/AIDS epidemics, demonstrating the remarkable impact of the U.S. government’s efforts together with partner countries (Figure 1). With support from the U.S. government, seven additional high-burdened countries will complete PHIAs on a rolling basis through 2017-2019, providing the latest data to chart and validate their progress toward reaching epidemic control by 2020.

This Epidemic Control Strategy both seizes the unique opportunity presented in these 13 high-burdened countries leading the way to epidemic control and also reaffirms our ongoing commitment to HIV/AIDS investments and efforts in over 50 countries.  Wherever PEPFAR works, we will maintain life-saving antiretroviral treatment (ART) for all of the people we support, provide even more services for orphans and vulnerable children, and ensure that the most vulnerable and key populations have access to essential services for preventing and treating HIV.

The U.S. government remains the world’s leader in responding to HIV/AIDS.  This Epidemic Control Strategy once again demonstrates both the courage of our convictions and the boldness of our ambitions.  But we cannot do this alone.  All partners – from governments, the private sector, philanthropy, multilateral institutions, civil society, the faith community, and others – must step up their efforts if we, as a global community, are to control, and ultimately end, this pandemic.

You can access the resource here

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Secretary Tillerson Launches PEPFAR Strategy for Accelerating HIV/AIDS Epidemic Control. 19/9/2017

Published by PEPFAR

Today, Secretary of State Rex Tillerson released the new U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) Strategy for Accelerating HIV/AIDS Epidemic Control (2017-2020), which reaffirms U.S. support for HIV/AIDS efforts in more than 50 countries, ensuring access to services by all populations, including the most vulnerable and at-risk groups.

The Strategy also outlines plans to accelerate implementation in a subset of 13 high-burden countries that have the potential to achieve HIV/AIDS epidemic control by 2020, working in collaboration with host governments; the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund); the Joint United Nations Programme on HIV/AIDS; and other partners.

The latest PEPFAR data show that, largely through the U.S. government’s support, the HIV/AIDS epidemic is coming under control in five of these 13 countries: Lesotho, Malawi, Swaziland, Zambia, and Zimbabwe. These data also indicate that the previously expanding HIV epidemic in Uganda has now stabilized.

The United States remains the largest bilateral donor to the global HIV/AIDS response, support which is made possible through the goodwill, compassion, and generosity of the American people. Today’s announcements demonstrate the remarkable impact of these investments over the past fourteen years. 

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Trump Doesn’t Care About HIV. We’re Outta Here. 6/6/2017

Published by NEWSWEEK

Five of my colleagues and I resigned this week from the Presidential Advisory Council on HIV/AIDS (PACHA).

As advocates for people living with HIV, we have dedicated our lives to combating this disease and no longer feel we can do so effectively within the confines of an advisory body to a president who simply does not care.

The Trump Administration has no strategy to address the on-going HIV/AIDS epidemic, seeks zero input from experts to formulate HIV policy, and—most concerning—pushes legislation that will harm people living with HIV and halt or reverse important gains made in the fight against this disease.

Created in 1995, PACHA provides advice, information, and recommendations to the Secretary of Health and Human Services regarding programs, policies, and research to promote effective treatment, prevention, and an eventual cure for HIV.

Members, appointed by the President, currently include public health officials, researchers, health care providers, faith leaders, HIV advocates, and people living with HIV. PACHA also monitors and provides recommendations to effectively implement the National HIV/AIDS Strategy, which was created by the White House Office of National AIDS Policy in 2010 and revised in 2015.

 

GettyImages-499435366 A red ribbon is displayed on the North Portico of the White House to recognize World AIDS Day, December 1, 2015 in Washington, DC. Mark Wilson/Getty

The decision to resign from government service is not one that any of us take lightly. However, we cannot ignore the many signs that the Trump Administration does not take the on-going epidemic or the needs of people living with HIV seriously.

While many members of the public are unaware of the significant impact that HIV/AIDS continues to have in many communities— or that only 40 percent of people living with HIV in the United States are able to access the life-saving medications that have been available for more than 20 years—it is not acceptable for the U.S. President to be unaware of these realities, to set up a government that deprioritizes fighting the epidemic and its causes, or to implement policies and support legislation that will reverse the gains made in recent years.

Signs of President Trump’s lack of understanding and concern regarding this important public health issue were apparent when he was a candidate. While Secretary Clinton and Senator Sanders both met with HIV advocates during the primaries, candidate Trump refused. Whatever the politics of that decision, Mr. Trump missed an opportunity to learn—from the experts—about the contours of today’s epidemic and the most pressing issues currently affecting people living with HIV.

In keeping with candidate Trump’s lack of regard for this community, President Trump took down the Office of National AIDS Policy website the day he took office and there has been no replacement for this website 132 days into his administration.

More important, President Trump has not appointed anyone to lead the White House Office of National AIDS Policy, a post that held a seat on the Domestic Policy Council under President Obama. This means no one is tasked with regularly bringing salient issues regarding this ongoing public health crisis to the attention of the President and his closest advisers.

 

GettyImages-499471446 Harvey Milk's name is seen among the engraved names of AIDS victims during a World AIDS Day commemoration event at the National AIDS Memorial Grove on December 1, 2015 in San Francisco, California. Justin Sullivan/Getty

By comparison, President Obama appointed a director to this office just 36 days into his administration. Within 18 months, that new director and his staff crafted the first comprehensive U.S. HIV/AIDS strategy. By contrast, President Trump appears to have no plan at all.

We believe he should embrace the important work accomplished by the National HIV/AIDS Strategy. Public health is not a partisan issue, and this important document could easily be ratified by the Trump Administration. If the President is not going to engage on the subject of HIV/AIDS, he should at least continue policies that support people living with and at higher risk for HIV and have begun to curtail the epidemic.

While these actions and others are gravely worrisome to us as HIV advocates, the final straw for us—more like a two-by-four than a straw—is President Trump’s handling of health care reform.

It is indisputable that the Affordable Care Act has benefitted people living with HIV and supported efforts to combat the HIV/AIDS epidemic. Gains in the percentage of people with HIV who know their status, the percentage engaged in care, the percentage receiving successful treatment, and a decrease in new cases of HIV were seen in Massachusetts under Romneycare. We are beginning to see similar effects on a national level under Obamacare.

People living with HIV know how broken the pre-ACA system was. Those without employer-based insurance were priced out of the market because of pre-existing condition exclusions. And “high risk pools” simply segregated people living with HIV and other health conditions into expensive plans with inferior coverage and underfunded subsidies—subsidies advocates had to fight for tooth-and-nail in every budgetary session.

Because more than 40 percent of people with HIV receive care through Medicaid, proposed cuts to that program would be extremely harmful. Prior to Medicaid expansion under ACA, a person had to be both very low income and disabled to be eligible for Medicaid.

For people living with HIV, that usually meant an AIDS diagnosis—making the disease more difficult and expensive to bring under control—before becoming eligible.

Between reinstating that paradox by defunding Medicaid expansion, imposing per-person caps on benefits, and/or block granting the program, the changes to Medicaid contemplated by the American Health Care Act would be particularly devastating for people living with HIV.

And we know who the biggest losers will be if states are given the option of eliminating essential health benefits or allowing insurers to charge people with HIV substantially more than others.

It will be people—many of them people of color—across the South and in rural and underserved areas across the country, the regions and communities now at the epicenter of the U.S. HIV/AIDS epidemic.

It will be young gay and bisexual men; it will be women of color; it will be transgender women; it will be low-income people.  

It will be people who become newly infected in an uncontrolled epidemic, new cases that could be prevented by appropriate care for those already living with the disease.

While we are in agreement that the ACA needs to be strengthened to lower premiums, improve competition, and increase access to care, it makes no sense to dismiss gains made under the ACA just to score political points.

Experts with real facts, grounded in science, must be in the room when healthcare policy decisions are made. Those decisions affect real people and real lives. If we do not ensure that U.S. leadership at the executive and legislative levels are informed by experience and expertise, real people will be hurt and some will even die.

Because we do not believe the Trump Administration is listening to—or cares—about the communities we serve as members of PACHA, we have decided it is time to step down.

We will be more effective from the outside, advocating for change and protesting policies that will hurt the health of the communities we serve and the country as a whole if this administration continues down the current path.

We hope the members of Congress who have the power to affect healthcare reform will engage with us and other advocates in a way that the Trump Administration apparently will not.

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AIDS Activists Push PEPFAR Plans Toward Higher Impact. 9/5/2017

Published by HEALTHGAP

Civil society groups recently capped a busy few months of advocacy around the President’s Emergency Plan for AIDS Relief (PEPFAR) that succeeded in moving many millions of dollars toward key community priorities to improve the AIDS response. Health GAP has been part of a collaborative advocacy effort with allies in a dozen countries and global networks to use the PEPFAR Country Operational Planning (COPs) process to push U.S. AIDS funding into high-impact, evidence-based programming that meets the real needs and demands of affected communities.

The PEPFAR COP reviews just took place in Johannesburg, South Africa — three rounds of intense three-day meetings where U.S. government staff based in PEPFAR countries and at PEPFAR’s Washington, D.C. headquarters were joined by representatives from civil society, national governments, UNAIDS, WHO, and the Global Fund. The 2017 COPs direct how over four billion dollars for HIV treatment and prevention will be spent in fiscal year 2018, with detailed plans for each country approved after negotiations at these reviews.

We worked alongside a set of amazing leaders from networks of PLHIV, key populations groups, and other activist organizations in East and Southern African countries before the reviews to generate demands about how PEPFAR funding could be better used and have greater impact. And we advocated for their inclusion in the COPs with allies from global organizations like AVAC, AmFAR, MSMGF, International AIDS Alliance, Sister Love, ICW, GNP+, CHANGE, and others.

You can read some of the critical demands led by groups from Kenya, Malawi, Uganda, and Zimbabwe here.

This year’s PEPFAR COP process benefited from the most participation and effective advocacy we’ve ever seen. In this 3rd year of PEPFAR’s new open reviews, a coalition of groups has increasingly worked to build capacity and knowledge for engaging PEPFAR. As it becomes evident that we can make real, substantive changes that matter for communities, more groups are coming on board. Meanwhile, with PEPFAR making its data transparent, advocates are increasingly able to bring the data together with deep community knowledge to inform specific, actionable demands for improving how PEPFAR funds are spent. This year, Health GAP, AmFAR and AVAC collaborated with local CSOs in Malawi, Zimbabwe, and Kenya to host “Using Data for Advocacy” trainings that we all put to use in our COP advocacy. As a result, PEPFAR teams were more responsive than in previous years, with many of civil society groups’ inputs incorporated into the draft COPs as they were being written in the first quarter of this year.

FullSizeRender_(2).jpgEven with this improved process, PEPFAR engagement has a long way to go -- the 2017 timeline was incredibly compressed and we will need to keep pushing in many countries for more time, information, and deeper engagement to make the most of this process.

Despite the challenges, civil society leaders arrived with a clear set of priorities that had not yet been taken up and, over the course of three days, many of the COPs shifted further — incorporating new ideas to improve retention and HIV treatment program quality, shifting funds into improved evidence-backed testing strategies, committing to reach more men who have sex with men (MSM) with better programming, and more.

We expect the final COPs will be posted soon, but you can read some of the highlights from Kenya, Malawi, Mozambique, Uganda and Zimbabwe here. These reflect just a few of the improvements made in PEPFAR programming this year.

Key civil society wins include:

  • Better testing strategies: Mozambique, Zimbabwe, and Kenya will each roll out new community-based HIV testing strategies based on the SEARCH trial, which showed that multi-disease testing and community-census could reach 97% of people living with HIV (PLHIV), including men and young people, and effectively link them to care.
  • Expanded MSM prevention programming: The goals for men who have sex with men reached with effective HIV services was increased or will be re-considered in the coming months in Kenya, Zimbabwe, and Uganda; in Kenya the combined PEPFAR and Global Fund goal will reach 52,000 MSM in 2018!
  • More health workers: In Malawi, PEPFAR will more than double the number of front-line clinical health workers it directly supports in 2018 and in South Africa investment in community health workers will both see significant expansion and a new strategy for coordination and regularization.
  • Increased investment in differentiated models of HIV care and treatment literacy in several countries: Mozambique has a plan to expand the use of community-based Activistas to build capacity for community-based ART and increase treatment literacy; Malawi will be funding pharmacy techs and new strategies to roll out “fast-track” pharmacy ART refills across the most congested clinics; Zimbabwe had committed to expanding funding for Community Adolescent Treatment Supporters (CATS) and Community ART Groups (CARGs).
  • Expanded access to Pre-Exposure Prophylaxis (PrEP): In Malawi, the new PrEP strategy will begin roll out with PEPFAR funds after an agreement was reached during the review between activists, the Ministry of Health, and PEPFAR.
  • Funding for communities and PLHIV to monitor program performance: In Zimbabwe, PEPFAR will fund a bold new effort to enable communities to monitor, report on, and advocate around HIV program quality to improve treatment scale up and retention.
  • More investment in direct service delivery as opposed to technical assistance, over and above the shift started in COP 2016: In Zimbabwe, where PEPFAR has traditionally not invested in direct service delivery, PEPFAR continued its shift towards increased investment in direct service delivery as opposed to technical assistance. In fiscal year 2018, PEPFAR Zimbabwe will allocate 64% of its budget to purchasing medicines and other commodities and paying the salaries of health care workers, better positioning the program to halt the epidemic.
  • Plus much more, including programming for people who inject drugs and new voluntary medical male circumcision strategies.

We left Johannesburg inspired -- which is really saying something for a bureaucratic process of global health policymaking. But we are seeing the power of informed demands and smart evidence-driven advocacy to shift donor funds toward greater impact. And now that the plans are done we can start building toward monitoring to ensure the impact is really happening.

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PEPFAR is on Track to Deliver Yet More Results. 4/5/2017

Published by UNAIDS

Since its establishment in 2003, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) has saved millions of lives. In 2016, around 11.5 million people living with HIV had access to antiretroviral treatment through PEPFAR-funded programmes, including 1.1 million children. Nearly 2 million babies born to women living with HIV were born HIV-free, and 6.2 million orphans and other vulnerable children received care and support.

In addition, PEPFAR funding supported more than 11.7 million voluntary medical male circumcision procedures to help prevent HIV acquisition and one million adolescent girls and young women were reached through the DREAMS initiative in 10 countries in sub-Saharan Africa.

And PEPFAR is on track to continue to deliver yet more results. Through a series of consultations over the past three months, PEPFAR has completed planning for its 2017 funding cycle to support more than 30 countries through Country Operational Plans.

The final regional review meeting in the process—which involved around 250 partners, including senior government officials in implementing countries, civil society representatives and multilateral organizations—concluded on 29 April in Johannesburg, South Africa. UNAIDS Executive Director Michel Sidibé addressed the opening plenary meeting, underscoring the vital role of PEPFAR in accelerating country efforts to control their epidemics and advance towards the goal of ending AIDS by 2030.

PEPFAR’s investments in countries supports UNAIDS’ efforts to Fast-Track the response to HIV. The Fast-Track approach focuses on accelerating scale-up of HIV prevention, treatment, care and support for the populations and locations most affected by the epidemic. The development and review of PEPFAR’s Country Operational Plans is a model for transparency, inclusion and country ownership, with senior government officials and people living with and affected by HIV involved in the process.

UNAIDS is a key partner, working closely with countries to leverage PEPFAR investments and accelerate progress towards prevention and treatment targets. Bringing together the diverse technical resources of the United Nations system, UNAIDS helps countries to strengthen data systems, focus national strategic plans, overcome bottlenecks to scale-up, and put in place an enabling policy and social environment for access to services, including by eliminating stigma and discrimination.   

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Trump Sends Chilling Proposal to Congress With Deadly Proposition: Cap HIV Treatment Expansion Immediately. 4/4/2017

Published by THEBODY

President Donald Trump included a chilling proposal last week in his request for the as yet unresolved 2017 federal budget: slash funding for the wildly successful and bipartisan-backed President's Emergency Plan for AIDS Relief (PEPFAR) by $300 million and "begin slowing the rate of new patients on treatment in FY 17." While many policymakers are dismissing the possibility that this proposed budget will pass through Congress, advocates nevertheless have every reason to be deeply concerned. This dangerous proposal is likely a harbinger of more grave harm to come. What could be a worse strategy for combatting the world's leading infectious disease killer than slowing the expansion of treatment that not only saves lives but also prevents HIV transmission?

After the White House "skinny budget" for Fiscal Year (FY) 2018 appeared to spare global AIDS programs, this bait-and-switch sends a strong signal: PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria are far from safe from Trump's attacks. Nevertheless, despite the mixed message the White House is sending to lawmakers, funding levels are ultimately decided by Congress, and AIDS advocates must demand they publicly reject this deadly policy shift.

This mirrors one of the biggest mistakes of the early Obama administration, when officials started talking about HIV treatment as a "mortgage" that needed to be curtailed. As we documented at the time, the administration pulled back from investing in HIV treatment and we lost significant ground -- leading not only to many avoidable deaths, but to many new infections. In 2009, PEPFAR directed service providers in Uganda, for example, to cap new HIV treatment enrollment, resulting in treatment wait lists and catalyzing a crisis in the AIDS response. This came even as evidence increasingly showed that HIV treatment is among the most effective methods of preventing HIV transmission -- as effective as using condoms. This failed policy contributed to a stalling of the response and, for the first time in several years, new infections globally did not decrease at all. After strong protests by AIDS activists, students, and clinicians in the U.S. and Uganda, a year later the deadly policy was reversed.

Now Trump is proposing to repeat these mistakes. The global AIDS response is finally within sight of halting the disease, with new infectious dropping in large part because of the increasing portion of people living with HIV who are on effective antiretroviral treatment, which halts HIV transmission. Trump's proposal to slash PEPFAR's current year budget signals a dangerous diversion in the global AIDS response that will come at a great cost -- in lives and in dollars. In May, the White House will issue its full budget proposal for the 2018 budget, and the language in its "skinny budget" proposal that PEPFAR should be funded to "maintain the current treatment levels" points to a surely significant slash in PEPFAR funding for the needed continued expansion of people in HIV treatment.

Not only would denying lifesaving treatment for people with HIV be immoral, it would also be fiscally irresponsible. A $300 million cut would translates to roughly 600,000 fewer people getting into treatment this year alone and the epidemic would continue to rise, just we can end it within 15 years with a modest scale-up. In South Africa alone, according to projections by Dr. Rochelle Walensky, Professor of Medicine at Harvard Medical School, a $300 million or 7.5% cut would translate to 900,000 additional deaths and 500,000 new HIV infections. This approach is completely paradoxical to the strategy required to save both lives and money.

Instead, we need to implement UNAIDS' globally endorsed strategy to ensure 90% of people living with HIV are diagnosed, 90% have treatment, and 90% achieve viral suppression. In Malawi, Zimbabwe, and Zambia, for example, new evidence shows this approach is working--with lower rates of HIV than expected due to high HIV treatment coverage. To achieve this strategy, we need to close a global funding gap of $6 billion per year, and continue our historic leadership by providing one-third of the necessary increase -- an increase of $2 billion per year by 2020. In South Africa alone, this investment would result in 2 million fewer HIV transmissions, and 2.5 million fewer deaths relative to current funding rates.

The choice is clear: we can end the HIV epidemic by 2030, or we can forever keep underfunding the effort, costing millions more human lives and billions of dollars.

Once again, as we have in the past, AIDS activists need to come together to push Congress to vocally reject both the FY 17 White House request now, and any future treatment caps from the full 2018 White House request expected in May. This is a key moment to show our power as a movement. Congress will take a two week recess from April 10-21. We need to show up at local offices and demand that they follow through on the U.S. commitment to end the epidemic. To lead or join a district level contingent demanding a meeting and a promise to fully fund PEPFAR, please sign up here. We cannot stand by and let people die when we have the tools, the science, and the resources to end AIDS.

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President’s Budget Blueprint Threatens Research Essential to End the Epidemics of HIV/AIDS, Tuberculosis, and Hepatitis C Virus. 20/3/2017

Published by TREATMENTACTIONGROUP

Treatment Action Group (TAG) releases this statement in strong opposition to the President’s 2018 budget blueprint. The blueprint threatens research essential to ending the epidemics of HIV/AIDS, tuberculosis (TB), and hepatitis C virus (HCV) in the United States and globally by cutting funding and eliminating programs. Massive and disruptive cuts to the National Institutes of Health’s (NIH) research budget and the Food and Drug Administration’s (FDA) regulatory capacity will set back years of investment in public health and scientific research in the effort to eliminate these diseases.

Ending these epidemics starts with science. With an unprecedented projected 20% cut to NIH funding, this budget could cripple the research strategy that has brought groundbreaking treatment and prevention to millions affected by HIV/AIDS, TB, and HCV. Without a robust, well-funded NIH, we set back progress in science made across disease areas, including promising vaccine and cure research. The proposed $6 billion cut to the NIH and blueprint language calling for the reorganization of the agency’s centers pits research needs against each other in an increasingly resource-scarce environment. By proposing to eliminate the Fogarty International Center entirely, the administration has shown how little it values or understands research on global threats like HIV/AIDS, TB, and neglected diseases that also affect health and the economy in the United States.

These proposed cuts to NIH funding will reverse the research funding boost promised through the passage of the 21st Century Cures Act late last year. Instead, as research funding drops, efforts to deregulate product development at the FDA will complicate access to safe drugs and devices. Vague budget blueprint language calls for regulatory efficiency through a “package” of administrative actions. We reject any actions that weaken the review process of the FDA, and we call for a lifting of the federal hiring freeze to strengthen the capacity of the agency to continue its transparent, timely, world-leading drug and device approval process.

We stand with our partners at Health GAP in acknowledging the administration’s continued commitments to PEPFAR, the Global Fund, and the Gavi Alliance, and echo the call for additional funding for these programs to support expanded access to treatment and prevention for the 19 million people still in need of treatment. The budget blueprint’s language on PEPFAR and the Global Fund omits mention of essential prevention programs. Multilateral and bilateral programs are needed to sustain valuable in-country public health infrastructures, which have been crucial in responding to infectious threats like Zika, Ebola, and drug-resistant TB.

We call on Congress to reject these cuts to critical NIH research and any reprogramming and reorganization that takes already limited funding away from HIV/AIDS, TB, HCV, and other neglected diseases, and compromises the role of the United States in leading the world in scientific research. We call for opposition to any weakening of the authority of the FDA. We urge critical community action to pressure policymakers to commit to ending the epidemics by:

  • Contacting your legislator by calling the Capitol switchboard (202-224-3121) to urge them to reject the President’s budget proposal for the NIH and FDA in FY 2018 and replace it with a budget that:
     
  • Monitoring for updates on the President’s prospective budget. The fully detailed FY 2018 budget is expected in May 2017, and will provide further insight into proposed cuts and actions.
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Dear President Trump: A Letter from the Congressional HIV/AIDS Caucus. 14/3/2017

Published by POZ

U.S. Representatives Barbara Lee and Ileana Ros-Lehtinen urge the Trump administration to continue the U.S. commitment to fighting HIV/AIDS.

The Honorable Donald J. Trump

The White House

1600 Pennsylvania Ave, NW

Washington, DC 20502

Dear President Trump,

As co-chairs of the bipartisan and bi-cameral Congressional HIV/AIDS Caucus, we write to encourage you to continue the longstanding American commitment to the fight against HIV/AIDS, both here at home and abroad. We’d also like to express our eagerness to work with your administration on this important issue. According to the Centers for Disease Control and Prevention (CDC) there were 1.2 million individuals living with HIV and nearly 40,000 people diagnosed in the United States in 2015. Globally for the same year, nearly 37 million people were living with HIV and an estimated 2.1. million individuals had become newly infected.

Over the last two decades, because of strong bipartisan support in Congress, strong leadership from the executive branch, and the tireless work of advocates we have made tremendous progress towards our ultimate goal of ending AIDS once and for all. In the last five years, the number of people on lifesaving antiretroviral treatment worldwide has doubled to 18.2 million — nearly 11.5 million due to the President’s Emergency Plan for AIDS Relief (PEPFAR). Because of PEPFAR’s commitment to reach pregnant women with HIV, more than 2 million new infections have been averted in children born to infected mothers.

The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) has also played a significant role in reducing the number of deaths due to AIDS by 45 percent in the countries where it has a presence since the peak of the crisis in 2005. Additionally, as of mid 2016, Global Fund programs provided important care and treatments to 3.8 million HIV-positive pregnant women as part of efforts to prevent mother-to-child transmission. Furthermore, the partnership between PEPFAR and the Global Fund goes far beyond ending HIV in the countries where they work, it has also significantly improved the health systems and economies of these nations.

Significant advances in science and treatment have transformed HIV from a fatal epidemic to a treatable chronic disease. A February 2017 CDC report showed an 18 percent decline in the number of HIV infections between 2008 and 2014 in the United States. The estimated number of new HIV infections also fell from 45,700 in 2008 to 37,600 in 2014. These encouraging numbers are due to the ability of caretakers, including those in the Ryan White program, to achieve viral suppression in patients. Viral suppression allows people to live longer, healthier lives, and lowers the risk of transmission of HIV to near zero. By ensuring all people living with HIV achieve viral suppression, we could end the epidemic and reduce health care costs by billions of dollars. We know that this is not an unobtainable dream, as in 2015 the Ryan White program successfully achieved viral suppression among 83 percent of its clients versus 55 percent of people diagnosed with HIV nationwide.

However, despite the considerable scientific and epidemiological advances we have achieved, there is still more work to be done. We still face significant risk of surpassing the infamous mark of a cumulative 100 million HIV infections by 2030. Every week, 40,000 people around the world are infected with HIV. While HIV incidence in sub-Saharan Africa has declined by 50 percent since its peak, the population has increased by 340 million during the same period. And each day, another 1,900 young people ages 15 to 24 become infected. In the United States alone, an estimated 55 percent of those living with HIV are virally suppressed, but 13 percent of those infected are not aware of their status. Given these trends, we need your assistance to keep and expand our progress.

We urge you to ensure that HIV/AIDS remains a critical public health priority during your administration, as it has been for many presidents before you. We hope you will consider the following actions:

  • Support critical and timely investments in global health programs, in particular the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund)
    • PEPFAR and the Global Fund work hand in hand to ensure those infected and affected by HIV have access to critical and oftentimes lifesaving services. Without these investments progress stalls, and worse still previous gains could be lost.
  • Support continued and robust funding for HIV/AIDS research, prevention and treatment programs, including for the Ryan White HIV/AIDS Program
    • The Ryan White HIV/AIDS Program has provided critical funding to cities, states, clinics, and local community-based organizations for more than 25 years. The program serves more than 500,000 people and guarantees that more than 50 percent of people living with HIV in the United States are in ongoing care.
  • Continue the implementation of the National HIV/AIDS Strategy (NHAS)
    • Initially developed in 2010, the NHAS is a clear roadmap for harnessing public and private sector resources to combat HIV in the United States. The National HIV/AIDS Strategy: Updated to 2020 includes key goals with quantifiable targets developed with input from multiple stakeholders to measure progress.
  • Maintain the Office of National AIDS Policy (ONAP) and the Presidential Advisory Council on HIV/AIDS (PACHA)
    • The White House Office of National AIDS Policy (ONAP), within the Domestic Policy Council, is tasked with coordinating governmental efforts to reduce the number of HIV infections across the United States. ONAP has been instrumental in ensuring accountability, continuity and consistency between all sectors of government and the NHAS goals.
    • The Presidential Advisory Council on HIV/AIDS (PACHA) — which has been in existence since 1995 — provides critical expert advice, information and recommendations to the secretary of health and human services regarding programs, policies and research to promote effective treatment, prevention and cure of HIV/AIDS.

Because of these indispensable federal programs and advancements in treatment and prevention, we are on track to significantly reduce the number of new infections and eventually end the HIV epidemic. However, our progress is dependent on continued federal support and coordination that we can continue caring for patients and preventing new infections. We cannot afford to take a step back.

Under your presidency, we could end AIDS in the United States and around the world. We look forward to working with your administration to achieve these goals.

Sincerely,

Rep. Barbara Lee (D–Calif.)

Rep. Ileana Ros-Lehtinen (R–Fla.)

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New HIV Infections Down by 18% in The United States of America. 16/2/2017

Published by UNAIDS

The state of Georgia, the home to the Ponce de Leon Center in Atlanta, saw a 6% annual decline in new HIV infections between 2008 and 2014. The clinic treats more than 6000 people living with HIV. Marianne Swanson, a nurse at the clinic who is also living with HIV, told UNAIDS about the antiretroviral therapy that she and her clients take to stay healthy and to ensure that their loved ones stay HIV-free. Treatment for HIV is playing a major role in HIV prevention. New evidence released shows that annual new HIV infections in the United States of America fell by 18% between 2008 and 2014, but that not all groups are benefitting equally.

https://twitter.com/MichelSidibe/status/829461954863456256/photo/1

The estimates were released by the United States Centers for Disease Control and Prevention (CDC) at the Conference on Retroviruses and Opportunistic Infections, taking place in Seattle, United States of America, from 13 to 16 February.

The CDC’s estimates show that while the number of new HIV infections among people who inject drugs fell by 56% from 2008 to 2014, there was no decline among men who have sex with men in the same period. The number of white and young men who have sex with men acquiring HIV dropped in the six-year timespan, but increases among other groups—most notably 25- to 34-year-old men who have sex with men, with a 35% increase—were responsible for the general flatlining of new infections among men who have sex with men in the country.

The drop in new HIV infections also varied by location, with states and districts showing drops of up to 10% annually, for example Washington, DC, while others experienced lower declines—for example Texas, with a 2% annual drop—or remained stable. No states showed increases in new HIV infections, however.

The CDC attributes the 18% decline from 2008 to 2014 in large part to the increased number of people living with HIV knowing their HIV status, accessing treatment and becoming virally suppressed—including the clients of the Ponce Center—as well as the success of past programmes for people who inject drugs and the increasing use of pre-exposure prophylaxis (PrEP). This shows the importance of the Fast-Track approach and its 90–90–90 targets for 2020 towards ending AIDS by 2030, whereby 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads.

While the 18% reduction in new infections between 2008 and 2014 is very encouraging, additional tailored programmes are needed to achieve a 75% reduction by 2020, as set out in the 2016 Political Declaration on Ending AIDS.  

The variance in the decline in new HIV infections among different groups of people and in different states shows the importance of a location and population approach, in which programmes are focused on the people and places that will deliver the greatest impact. CDC’s High-Impact Prevention approach plans to scale-up prevention programmes through such a location and population response.

By scaling up prevention programmes and ensuring that more people stay HIV-free, the hope is that the need of clinics like the Ponce Center, and the thousands like it worldwide, to provide HIV treatment to people living with HIV will be much less in the future.

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Bill Frist: The Case for Keeping America’s AIDS Relief Plan. 9/2/2017

Published by THENEWYORKTIMES

Among global public health advocates, there is a growing concern that President Trump may cut back, or even eliminate, programs that have played a critical role in fighting diseases worldwide. While every administration should strongly review our nation’s overseas commitments, and there are undoubtedly programs that we should cut, I hope he recognizes the success and importance of one in particular: the President’s Emergency Plan for AIDS Relief.

I have been treating patients in Africa and Haiti for 20 years. When I was Senate majority leader in 2003, I led the Senate’s passage of the plan, called Pepfar, on an overwhelming voice vote. It has since been reauthorized twice. President Trump, like his predecessors, will have the chance to put his own stamp on this winning program.

Pepfar was created in a moment of crisis: In the late 1990s, H.I.V.-AIDS was the No. 4 killer worldwide, and No. 1 in Africa. The program aimed to bring reliable, proven measures like antiretroviral drugs, counseling and prevention services to underserved communities around the world — and it worked. Today, Pepfar reaches 11.5 million people with antiretroviral drugs, a 50 percent increase since just 2014. Two million babies with infected mothers have been born H.I.V.-free thanks to Pepfar interventions, and 6.2 million orphans and vulnerable children receive care from the program.

The program has been able to expand, without a significant change in its budget, because it leverages the latest scientific innovations and reductions in drug prices. As a result, the rate of new H.I.V. infections in Malawi, for example, has dropped 76 percent in just three years. But the work is far from over. One million people worldwide died of AIDS last year, and only about half of those afflicted with the disease are getting proper treatment.

Pepfar’s success is no secret to the new administration. In his confirmation hearing as secretary of state last month, Rex Tillerson called it “a model for us to look to as we’re thinking about other ways in which to project America’s values, project our compassion” to “solve these threats.”

A few days later, though, The New York Times reported that the Trump transition team was asking questions about the value of humanitarian aid in general and Pepfar in particular. For example, transition officials asked, “Is Pepfar worth the massive investment when there are so many security concerns in Africa?”

It’s a fair question, and the answer is yes — in large part because it is such a cost-effective way of addressing those security concerns. After the Sept. 11 attacks originated from a country unable to govern its own territory, buttressing weak states became a key element of America’s national security strategy. The military and intelligence communities were saying that the AIDS epidemic made Africa particularly vulnerable.

Pepfar has helped stabilize much of Africa. In 2015 my former Senate colleague Tom Daschle and I wrote an extensive report for the Bipartisan Policy Center, “The Case for Strategy Health Diplomacy: A Study of Pepfar.” Our researchers compared countries that received Pepfar assistance and, as a control, similar countries that did not.

The findings were dramatic. From 2004 to 2013, political instability and violence fell by 40 percent in countries that received Pepfar assistance versus just 3 percent in similar countries that did not. Measurements of the strength of the rule of law increased 31 percent versus just 7 percent.

And it has paid dividends for America’s image abroad. In 2007, just as Pepfar was taking hold, both Pepfar and non-Pepfar countries in Africa gave the United States approval ratings of about 40 percent, but by 2011 the rating in Pepfar countries had risen to about 80 percent, while in non-Pepfar nations it had risen only to around 50 percent.

Some people are concerned, however, that rhetoric emanating from the White House about foreign aid could spell doom for programs like Pepfar. Others have interpreted Mr. Trump’s executive order reinstating and expanding the “Mexico City policy” gag rule on abortion counseling to mean shuttering Pepfar, though there’s no concrete evidence of that.

Indeed, President Trump seems to favor Pepfar: During the campaign, he was asked in New Hampshire if he would help double the number of people receiving treatment under the program. “Yes,” he said. “I believe so strongly in that, and we’re going to lead the way.”

Vice President Mike Pence is also an avid supporter. In a news release in 2008, he said, “If not addressed, this plague will continue to undermine the stability of nations throughout the third world.” He added, “I believe the United States has a moral obligation to lead the world in confronting the pandemic of H.I.V.-AIDS.”

By embracing and expanding Pepfar, President Trump could make the world’s next generation AIDS-free. He and his administration should render Pepfar not only more efficient but also more strategic by aligning it with clear national security goals. For example, while continuing to focus on eradicating AIDS in Africa, President Trump could deploy additional health dollars to fight diseases and win hearts and minds in countries where traditional diplomacy isn’t an easy option.

 

Pepfar is the greatest humanitarian effort undertaken by the United States in more than 60 years. But it also makes us safer by making afflicted countries stronger, more stable and more grateful to us. And it can prevent the disease from re-emerging at home in a more virulent form. President Trump has the chance to make America even greater by making the world AIDS-free.

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TAG Expands Its End the Epidemic Campaign to Include Southern States Heavily Impacted by HIV. 30/1/2017

Pubished by THEBODY

New initiative is under way to strengthen community leadership and mobilization toward ambitious HIV prevention and treatment goals against the backdrop of anticipated shifts in federal support and resources for critical programs.

Treatment Action Group (TAG) is pleased to announce the expansion of its Ending the Epidemic campaign to foster the development of bold epidemic-ending initiatives in some of the most heavily impacted regions of the United States. In close collaboration with its national and regional partners, TAG aims to strengthen partnerships in three southern states to substantially reduce HIV incidence and maximize health outcomes, and to support the community mobilization efforts required to foster the federal and regional political support necessary to meet established goals.
 
“This initiative seeks to expand the monumental community mobilization that ultimately led to the development and implementation of the blueprint to end HIV as an epidemic in New York State,” said Mark Harrington, TAG’s executive director. “Ambitious regional HIV incidence and survival outcomes require significant community coordination and unflinching support from state and other jurisdictional lawmakers. This demands robust community leadership and engagement every step of the way, particularly in regions where resources and political support are currently in short supply and there are significant concerns about federal commitments under the new White House administration and 115th Congress.”
 
The initiative will begin with a consultation of community stakeholders in southern states in April 2017, with additional TAG-sponsored meetings later in the year in the three jurisdictions to be selected by TAG and its partners. “What does it mean to end HIV as an epidemic? How do we translate the robust science and prevention and care toolboxes into strategies that will save lives and support health? How do we mobilize to protect, strengthen, and coordinate programs and services to meet epidemic-ending goals in the face of uncertainties regarding the future of the Affordable Care Act, Medicaid expansion, and other federal health programs? These are just some of the questions we need to be considering, particularly if we want all regions of the United States to meet and exceed the goals of the National HIV/AIDS Strategy,” explained Tim Horn, Deputy Executive Director of HIV and HCV Programs.
 
“As the director of an STD/HIV program in the Deep South, I could not be more thrilled to see this initiative expand,” said NASTAD (National Alliance of State & Territorial AIDS Directors) board chair, Dr. DeAnn Gruber, STD/HIV Program Director for the Louisiana Department of Health. “This initiative aligns well with NASTAD’s longstanding work and the ‘Ready to End the HIV and Viral Hepatitis Epidemics’ Chair’s Challenge that calls on U.S. health departments to accelerate the end of HIV and viral hepatitis in the United States. We are working with health departments to ensure the program and policy building blocks are in place to support impactful prevention and care programs. I challenge all of my colleagues in both states and cities to join us in this unique opportunity at this moment in history to change the trajectory of HIV and hepatitis forever.”
 
The initiative will be coordinated through close collaboration with TAG’s national and regional partner organizations—notably AIDS Alabama, NASTAD, the Southern AIDS Coalition, the Southern HIV/AIDS Strategy Initiative, and SisterLove—and in the three selected jurisdictions. “The high level of knowledge, determination, and community engagement work by our southern colleagues has long been exemplary, particularly in the context of political indifference to the needs of people living with and vulnerable to HIV infection,” said Kenyon Farrow, TAG’s U.S. and Global Health Policy Director. “The goals of substantially lowering HIV incidence and improving health outcomes through increased viral load suppression rates, pre-exposure prophylaxis access and utilization, and the expansion of support services are very much shared by our southern state partners. Despite the considerable federal challenges on the horizon, we remain steadfast in our belief that we can still end HIV as an epidemic in all regions heavily impacted by HIV. TAG looks forward to supporting efforts to develop and implement ambitious, feasible, and cost-effective strategies.”
 
Southern states are disproportionately affected by HIV. Deep South states (Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Texas) are home to 28% of the U.S. population, yet they account for an estimated 40% of new HIV diagnoses, 43% of new AIDS diagnoses, 43% of all HIV-related deaths, and 34% of all people living with HIV in the United States.[1],[2] Black, gay, bisexual, and other black men who have sex with men (MSM) face an especially heavy burden, accounting for 59% of all HIV diagnoses among African Americans in the South. In fact, of all black MSM diagnosed with HIV nationally in 2014, more than 60% were living in southern states. Black women face an equally disproportionate burden of the disease, accounting for 69% of all HIV diagnoses among women in the South.[3]

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PEPFAR Is Saving Lives and Changing the Course of the Epidemic. 1/12/2016

Published by PEPFAR

New PEPFAR data show for the first time that the AIDS epidemic is becoming controlled in older adults and babies in three key African countries – Malawi, Zambia, and Zimbabwe – where the program has significantly invested. New pediatric HIV infections globally have declined by nearly 70 percent since 2000, and there are significant validated declines in adult HIV incidence across Malawi (76 percent), Zambia (51 percent), and Zimbabwe (67 percent) since 2003.

The results of these surveys and program data have allowed PEPFAR to expand results and impact in a budget-neutral environment. They also demonstrate the urgency of redoubling global resolve toward ending the epidemic by 2030 and delivering the first AIDS-free generation in over three decades.

Ambassador Deborah L. Birx, M.D., U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy, said, “PEPFAR’s success is measured in saving lives and changing the course of the pandemic. The fact that the epidemic is becoming controlled in several key African countries demonstrates the remarkable impact of PEPFAR’s investments, which have long received strong bipartisan support.”

These three African countries have achieved an average of 65 percent community viral load suppression among HIV positive adults, approaching the 73 percent target of the UNAIDS 90/90/90 goals. This means they are nearing a point at which HIV transmission would effectively be controlled. However, the data also point to an urgent need for HIV prevention and treatment for young people. Among adolescents and young people in these same countries, the average community viral load suppression is only 42 percent. This is particularly concerning as this young population in sub-Saharan Africa is doubling in size by 2020.

These new data emerge from critical surveys that are funded by PEPFAR and conducted by the U.S. Centers for Disease Control and Prevention and ICAP at Columbia University, as well as local governmental and non-governmental partners.

“It is heartening to see the impressive decrease in HIV incidence and gains in viral suppression,” said Dr. Wafaa El-Sadr, ICAP director. “ICAP is honored to partner with ministries of health, PEPFAR, and CDC to implement these groundbreaking surveys.”

Today, PEPFAR also announced it has surpassed global targets set by President Obama in 2015. PEPFAR now reaches nearly 11.5 million people with life-saving antiretroviral treatment and has provided more than 11.7 million voluntary medical male circumcision procedures. Nearly 2 million babies have been born HIV-free with PEPFAR support.

PEPFAR also announced that it is providing life-saving treatment for nearly 1.1 million children globally, which represents a 97 percent increase since 2014, and reached over 1 million adolescent girls and young women with critical comprehensive HIV prevention interventions through its DREAMS partnership.

There is much more work to be done, especially for adolescent girls. In sub-Saharan Africa, young women and adolescent girls are up to 14 times more likely to get HIV/AIDS than young men. To reduce this elevated risk, PEPFAR launched the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) public-private partnership and the complementary DREAMS Innovation Challenge to develop and drive pioneering solutions, which are often found closest to communities. DREAMS is a $385 million comprehensive, multi-sectoral program focused on addressing the key factors that put young women at increased risk for HIV in 10 sub-Saharan African countries.

Dr. Tom Frieden, CDC Director, noted, “The ground-breaking population-based HIV impact assessments show that, as a result of close collaboration with partner government ministries of health, HIV programs are decreasing the spread of HIV. Malawi, Zambia, and Zimbabwe have made remarkable progress helping people learn their HIV status, get life-saving HIV treatment, and suppress the virus completely. This means that more than half of the HIV infected people in these countries can live full, healthy lives – and not spread HIV to others. More importantly, these surveys give us a clear picture of what to do next and where to focus our resources. To further reduce spread of HIV in this new era of Test and Start, we need to reach more men and more young women to provide testing and immediate start of HIV treatment.”

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PEPFAR Latest Global Results: The Epidemic is Becoming Controlled in key African Countries. 12/2016

Published by PEPFAR

PEPFAR Latest Global Results. 2016. The epidemic is becoming controlled in several key African countries 

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Teleconference Panellists Address the Future of the U.S. Global AIDS Response in the Era of Trump. 18/11/2016

Published by GNP+

Earlier this week, GNP+ hosted an informational teleconference, with over 200 HIV advocates and civil society representatives from around the world to discuss the outcome of the U.S. election as well as the future direction of PEPFAR, the Global Fund and other key population-focused health and human rights initiatives heavily funded by the U.S. Government.

The U.S. is the largest external funder for HIV and other global health programmes around the world. Over 6 million people living with HIV are recipients of lifesaving treatment, care and prevention services directly supported by The United States President’s Emergency Plan for AIDS Relief (PEPFAR) bilateral funding programme. Further, millions more around the globe depend on U.S. contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) – a multilateral financing mechanism that supports not only essential treatment, care and prevention programs, but also lifesaving harm reduction and civil society support services as well.

Key populations affected by HIV – sex workers, drug users, gay and bisexual and other men who have sex with men and transgender people – feel particularly threatened by the campaign rhetoric espoused by some conservative politicians whose followers now feel emboldened by the election results. This is understandably so, as even the President-elect’s campaign was characterized by statements that fuel the kinds of stigma and discrimination that drives the HIV pandemic as well as policy proposals that would undermine dramatically healthcare access for millions of Americans. Yet despite these threats, activists remain optimistic that a strong movement can stop, or at least blunt, these policy moves and keep the fight against AIDS on track.

During the call, speakers articulated the critical role the U.S. has played over the last two decades in the domestic and global fight against HIV and how that support has been garnered in bipartisan ways from the Bush administration onwards. As panellist Matt Kavanagh, Senior Policy Analyst at Health GAP noted in his remarks, “HIV activists have reason to worry that what was proposed in this campaign could undermine progress against AIDS. But we also have been very effective in mobilizing bipartisan allies to push back against discriminatory policies and convince members of Congress to take seriously their commitments to the AIDS fight, the Global Fund and PEPFAR’’ he added that the President-Elect “did not campaign on promises of cutting foreign aid. However, the House Budget resolution and plans by the Republican right have done so, so we need to act urgently as a movement to fight for increases not cuts.” 

Echoing Matt, panellist Cecilia C. Chung, member of IRGT: A Global Network of Trans Women and HIV, said “we still have our champions in Congress, so the question for advocates is, how do we continue to build more champions and reframe some of the [rights and justice based] language that we are currently using to reach more Republican members.’’ Additionally, panellist Kenyon Farrow, U.S. and Global Health Policy Director at Treatment Action Group noted that “in order to make a reliable prediction about what direction the new Administration is going with its global and domestic AIDS policy we need to know who our U.S. Secretary of State will be and who will lead the U.S. Health and Human Services.”

As panellist Laurel Sprague, Research Fellow in HIV, Gender, and Justice, HIV Justice Network, summarized “as AIDS activists in the States…we were not a strong enough presence on the campaign trail…now we need to go to every Congressional office, Democrat and Republican, to let our legislators know that HIV matters.  For activists outside of the U.S. this is the moment to push your own Governments as much as you can to lead by example and to step up pledges to UNAIDS, the Global Fund, and other multilateral aid programs wherever they are able to do it.’’

In sum, the panellist agreed that the U.S. election results create many uncertainties and provide a sobering moment for the global and domestic HIV/AIDS movements.  Now more than ever, the domestic and global AIDS community and our colleagues in the intersectional women’s rights, racial and economic justice, immigrant rights, harm reduction, sex worker, drug user, and LGBTQ movements – must stand together in solidarity with each other to ensure that our voices are heard, our gains protected and our principles are not compromised.

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Senior United States Officials, Members of Congress and Partners Recommit to Ending AIDS Among Children, Adolescents and Young Women. 16/9/2016

Published by UNAIDS

UNAIDS and the Elizabeth Glaser Pediatric AIDS Foundation hosted a high-level Congressional briefing in the United States Senate to increase momentum around an ambitious Super-Fast-Track framework—Start Free, Stay Free, AIDS Free. The initiative, which was launched by UNAIDS, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and partners in June 2016, outlines a set of time-bound targets to reach in order to stop new HIV infections among children, prevent new HIV infections among adolescents and young women and ensure access to antiretroviral treatment.

The Start Free, Stay Free, AIDS Free initiative builds on the progress made under the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive (Global Plan). The Global Plan made a major contribution to a 60% reduction in new HIV infections among children since 2009 in the 21 countries in sub-Saharan Africa most affected by the epidemic. Speakers highlighted the need to keep up the momentum, warning that complacency could reverse the important gains that have been made.

Michel Sidibé, Executive Director of UNAIDS, brought attention to the need to increase access to treatment for children. He said that despite the treatment scale-up for children, which has grown twofold in the past five years and resulted in a 44% reduction in AIDS-related deaths among children, one in two children living with HIV still does not have access. Without immediate access to treatment, about 50% of children infected at birth will die by age 2.

Senators Edward Markey and Benjamin Cardin, honorary co-hosts of the briefing, and Congressman James Himes referred to the commitment of the American people through PEPFAR, and the important results that have been achieved through the strong partnerships with the countries most affected by the epidemic. Monica Geingos, First Lady of Namibia, expressed appreciation for the support of PEPFAR and UNAIDS in Namibia, and emphasized the need for continued engagement to address challenges related to HIV prevention, inequality and harmful gender norms. Namibia is a leader in the response to HIV and one of six countries—together with Botswana, Mozambique, South Africa, Swaziland and Uganda—that have reached 90% or more of pregnant women living with HIV with life-saving antiretroviral medicines.

Deborah Birx, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy, presented data illustrating dramatic recent achievements in stopping new HIV infections among children, and described evolving epidemic dynamics that demand new approaches so that the next phase of the response is successful in addressing the needs of the largest generation of young people the world has ever seen.

Director of the National Institute of Allergy and Infectious Diseases, Anthony Fauci, shared an overview of the science behind each pillar of Start Free, Stay Free, AIDS Free, showing that the world has the tools required to achieve the targets. Further innovations in treatment and prevention science hold the promise of accelerating the response by making commodities and services easier to access and use, and overall more effective.

Speaking in his capacity as a board member of the Elizabeth Glaser Pediatric AIDS Foundation, former Senator Christopher Dodd reflected on the bipartisan political commitment behind PEPFAR and the courage demonstrated by a number of elected officials at a time when AIDS was considered to be a difficult and controversial issue. He emphasized that this commitment must be constantly reinforced until the vision of an AIDS-free generation is achieved.

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Statement by the President on the 35th Anniversary of HIV/AIDS in America. 5/6/2016

Published by WHITEHOUSE

On June 5, 1981, the Centers for Disease Control and Prevention published a report on what would later be understood as the first documented cases of AIDS.  The past 35 years tell a story that bends from uncertainty, fear, and loss toward resilience, innovation, and hope.

We've learned that stigma and silence don't just fuel ignorance, they foster transmission and give life to a plague.  We've seen that testing, treatment, education, and acceptance can not only save and extend lives, but fight the discrimination that halted progress for too long.  And we've reaffirmed that most American of ideas - that ordinary citizens can speak out, band ourselves together like a breathtaking quilt, and change the course of our communities and our nation for the better.

Over these 35 years, American ingenuity and leadership has shaped the world's response to this crisis.  From the Ryan White HIV/AIDS Program to the President's Emergency Plan for AIDS Relief (PEPFAR), we've saved millions of lives at home and around the world.  My administration implemented our nation's first comprehensive National HIV/AIDS Strategy, and we've updated it through 2020.

We've invested in research and evidence-based practices that have given us revolutionary tools like treatment as prevention and pre-exposure prophylaxis.  We've made critical investments to help eliminate waiting lists for the AIDS Drug Assistance Program.  We’ve continued efforts to support the promise of a vaccine.  And the Affordable Care Act has resulted in millions of individuals gaining affordable, high-quality health coverage – all without denial for pre-existing conditions like HIV.

While there is more work to do – the economically disadvantaged; gay and bisexual men, especially those who are young and Black; women of color; and transgender women all continue to face huge disparities – I’m confident that if we build upon the steps we’ve taken, we can finish the job.

Nearly five years ago, I said that an AIDS-free generation is within reach, and today, the global community is committed to ending this epidemic by 2030.  This will take American leadership, smart investments, and a commitment to ensure that all communities are heard and included as we move forward.

 

So today, let's call the names.  Let's remember those we lost too soon.  And let's rededicate ourselves to ending this epidemic once and for all.

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HIV Surveillance Report. Special Report Number 13. 24/08/2015

Published at Centres for Disease Control and Prevention

August 2015


This report summarizes findings from cycle 3 of NHBS data collection among heterosexuals at increased risk of HIV infection, which was conducted in 2013. Heterosexual sex among adult and adolescent males and females continues to be a common route of HIV transmission in the United States, accounting for a quarter of the estimated new HIV diagnoses in 2013.

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More Focus on Populations and Places Most in Need as United States Updates Its National HIV/AIDS Strategy. 12/08/2015

Published at UNAIDS
05 August 2015


The United States of America (US) released an updated AIDS strategy on 30 July which sets the course for its domestic response to HIV over the next five years. The National HIV/AIDS Strategy: Updated to 2020 sets ambitious targets which put particular focus on the people and places most in need.

The US strategy mirrors many of the goals of UNAIDS Fast-Track approach. It calls for 90% of people living with HIV to be aware of their status, aims to increase the percentage of people living with HIV who are retained in medical care to at least 90% and to ensure that 80% of all people diagnosed with HIV have a suppressed viral load which reduces the likelihood of transmitting the virus by around 96%.

Commenting on the new strategy President Obama said that it seized upon rapid shifts in science and policy as more had been learned about the disease. He also said it focused on making sure that every American could get access to life-extending care, no matter who they were, where they lived or how much money they had.

The strategy recommends that efforts be concentrated on people who are being left behind in the response to HIV, namely, gay men and other men who have sex with men, especially African American men, heterosexual African American men and women, young people, people who inject drugs and transgender women. It calls for full access to comprehensive pre-exposure prophylaxis (PrEP) services for those for whom they are appropriate and desired. The strategy also prioritizes certain geographic areas where HIV incidence is high and linkage to, and retention in care is low, including the southern US and specific major metropolitan areas, like Washington, DC.         

“I commend President Obama on the bold, new goals set in the updated US strategy which align with the UNAIDS ‘Fast-Track’ approach. The United States joins other nations in pursuit of key prevention, testing and treatment targets that, if met by 2020, put the world on course to end AIDS as a public health threat by 2030,” said Michel Sidibé, Executive Director of UNAIDS.          

According to the latest data available from the Centers for Disease Control and Prevention (CDC), there are an estimated 1.2 million people living with HIV in the US, of whom 1 in 8 are unaware of their HIV status. CDC also estimates that 50% of Americans who are diagnosed with HIV are not retained in medical care and that only 37% are accessing life-saving HIV treatment.

At the event to launch the revised strategy, which was held in Atlanta, Georgia, it was also announced that Mayor Kasim Reed had signed the Paris Declaration—Fast-track cities: Ending the AIDS epidemic. In signing the declaration, the mayor has committed to putting Atlanta on the Fast-Track to ending the AIDS epidemic through a set of commitments. Those commitments include achieving the UNAIDS 90–90–90 targets, which will result in 90% of people living with HIV knowing their HIV status, 90% of people who know their HIV-positive status on antiretroviral treatment and 90% of people on treatment with suppressed viral loads, keeping them healthy and reducing the risk of HIV transmission.

The Fast-Track Cities Initiative is supported by its core partners, namely, the City of Paris, the International Association of Providers of AIDS Care (IAPAC), UNAIDS and the United Nations Human Settlements Programme (UN-Habitat).

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Nation's Capital Sees 'Remarkable' Drop in New HIV Cases. 6/7/2015

Poz.com

Washington DC HIV 
Newly diagnosed HIV cases declined 40 percent from 2009 to 2013.
Source: DC Department of Health.

By most measures, Washington, DC, is making major progress in its fight against HIV, according to new data released by the city and reported in the Washington Post. From 2012 to 2013, the latest date available, newly diagnosed cases per year dropped from 678 to 553. 

This represents a 40 percent decline from 2009, which saw 916 new cases. In 2009, officials had claimed the city had rates that were “higher than West Africa.”

HIV-related deaths in 2013 decreased by 44 percent from the previous years, and no children were born with the virus. What’s more, new HIV rates in 2013 declined among whites, Latinos and African Americans. Despite this good news, the city still has a high prevalence of HIV: 2.5 percent of the population was HIV positive as of December 2013. This translates to 16,423 residents, an increase from 16,044 in 2012.

Mayor Muriel E. Bowser presented the new data at Whitman-Walker Health, a nonprofit that caters to DC’s LGBT and HIV communities. The mayor, according to the newspaper, also announced a series of goals for the city to achieve by 2020: “for 90 percent of residents with HIV to know their status; for 90 percent of those infected to be in treatment; for 90 percent of those infected to achieve viral load suppression; and for the District to see a 50 percent decrease in new cases.” 

“The precipitous drop in new HIV cases in recent years has been nothing short of remarkable, said Don Blanchon, the executive director of Whitman-Walker Health, in a statement. “We’ve also made tremendous progress in keeping people who test positive engaged in care. These hard-won victories are a tribute to government and the community working hand-in-hand to address the epidemic.”

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Revitalizing the HIV prevention response in eastern and southern Africa. 24/08/2015

Published at UNAIDS

10 August 2015


 

In recent years, considerable progress has been made in eastern and southern Africa to reduce the number of new HIV infections, which decreased by 21% between 2010 and 2014. The region has also made a significant contribution to achieving the global target of having 15 million people on life-saving antiretroviral medicines by the end of 2015, which was met nine months ahead of schedule in March this year. Despite these advances, however, the region still accounts for over half of all new HIV infections worldwide.

New HIV infections among young women and girls aged between 15 and 24 are especially high, with 3700 new HIV infections per week among young women and adolescent girls across eastern and southern Africa. New HIV infections occur five to seven years earlier in young women and adolescent girls compared with young men and boys of the same age. This means that sexual partners of young women and adolescent girls—who are often much older—are themselves a priority population for HIV prevention and treatment programmes.

Another challenge for the region is reaching key populations at higher risk of HIV infection, such as men who have sex with men, people who use drugs and sex workers. These groups are often marginalized due to legal barriers to accessing services or because of stigma and discrimination. In addition, a lack of strategic information or insufficient resources leads to many high impact HIV prevention programmes not being implemented to the necessary standard or scale.            

At a recent meeting in Johannesburg, South Africa, experts from UNAIDS, the United Nations Population Fund (UNFPA) and the World Bank came together to discuss these challenges. Participants agreed that the way forward included customizing UNAIDS global Fast-Track targets to the regional level and re-positioning HIV prevention strategies based on existing evidence.

UNAIDS Fast-Track targets for 2020 include 90% of people living with HIV knowing their HIV status, 90% of people who know their HIV-positive status on antiretroviral treatment and 90% of people on treatment with suppressed viral loads, keeping them healthy and reducing the risk of HIV transmission. Other targets include reducing the number of new HIV infections to fewer than 500 000 and reaching zero discrimination.

Those taking part in the Johannesburg meeting also concluded that upcoming forums such as ICASA 2015 (International Conference on AIDS and STIs in Africa) and the 21st International AIDS Conference 2016 in Durban, South Africa, will be crucial in persuading the international community to invest sufficient resources in HIV prevention programmes.

 

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In HIV-riddled town, addiction 'the lifestyle'. 4/5/2015

Published at The Courier-Journal
Written by Chris Kenning
28 April 2015


AUSTIN, Ind. –Two miles from a new HIV testing clinic and needle exchange, a 26-year-old woman in dark sunglasses sat in a city park next to a neighborhood of dilapidated homes with peeling paint and boarded-up windows.

Long addicted to crushing and shooting up pain pills — and sometimes trading sex for drugs — she said last week that she'd recently been diagnosed with HIV, part of an epidemic in Scott County that has reached 142 cases.

But she doesn't plan to stop using drugs, she said, flicking a cigarette into the grass with pink-painted fingernails and climbing into an SUV. There, she mixed powdered heroin and water in the bottom of an energy drink can, drawing the brownish liquid into a well-used needle and injecting it into a hand pocked by drug use.

"Anything bad that can happen has already happened. So why stop now?" she said.

To spend time with drug users and those with HIV in this isolated, impoverished town of 4,200, including the 26-year-old who asked not to be named, is to understand the depth of the problem as Austin battles a drug-fueled HIV epidemic unprecedented in rural America in recent years.

Inside Austin's community of drug abuse — concentrated in neighborhoods dotted by sagging wood-frame houses, tiny Pentecostal churches, no trespassing signs and a few Confederate flags — addiction is "just the lifestyle," the woman said.

"It's normal. In such a small town, there's nothing else to do," she said. "All your friends do it. Everybody here does it. I mean, you probably can go to three houses in a row and one of those houses has people getting high in it."

Despite an influx of aid from the Centers for Disease Control, Indiana's Department of Health and groups such as the California-based AIDS Healthcare Foundation, —which has brought new testing, treatment and outreach — officials know it won't be easy reversing underlying conditions of poverty, drug abuse and lack of resources that formed the tinder to HIV's match.

"We saw this coming, for sure," said Dr. William Cooke, Austin's only physician. "But I never expected it to be like this. It's spreading and it's going to spread. It's a demonstration of what happens when we ignore a demographic group."

'Recipe for disaster'

Austin sits a half-hour's drive north of Louisville on Interstate 65, past farm fields and woods, just north of the county seat of Scottsburg. Founded in 1853 as a rail stop between Louisville and Indianapolis, it later became home to large food canneries.

Older residents say the Austin they grew up in was a small, close-knit community — a place of modest homes and neat lawns, with several manufacturing plants and restaurants dotting a tiny downtown strip. But over time, Austin increasingly fell on hard times. It lost some businesses, restaurants and jobs, and property values dipped. On some streets, yards became dotted with old cars, broken furniture and trash.

In 2004, when Cooke opened Family Foundations in Medicine to become the town's only doctor, he found a pervasive lack of opportunity, generational poverty and a severe lack of access to health care and substance-abuse treatment.

State figures show about one in five Scott County adults live in poverty, have not completed high school or are on disability. It has disproportionately high teen birth rates, and more than twice the state's rate of cases of child abuse and neglect. It ranks at the bottom of 92 Indiana counties on most health indicators, according to the Robert Wood Johnson Foundation national health rankings.

Cooke said abuse of opiate painkillers such as Oxycontin, made accessible from traffickers moving along I-65 and from doctors outside town, added to the mix. Around 2010, Cooke began to see intravenous use, and "from there it has just gotten worse." Drug overdoses and hepatitis C also began to increase.

Cooke said it was "a recipe for disaster," and he "repeatedly asked for help," including trying to get grants and added services and to organize behavioral health coalitions that never materialized.

"Everybody would agree it's a problem, everybody would agree something needed to be done, but everybody was busy with other priorities," he said, noting that he grew so frustrated he almost left town nearly five years ago.

In the meantime, used needles were turning up in parks and gutters and on ballfields. Austin police Chief Don Spicer has said police did what they could to crack down with a seven-man force, but the problems persisted.

On the town's north side, 67-year-old Don Estep, who has lived there for five decades doing small engine repair, said he has watched prostitutes walk the street, often looking for a single dose of drugs, as he sat on his front porch. "It's unreal," he said. "At one time we had 20 prostitutes walking the street."

Chris Albertson, a Scott County council member, said "a lot has to do with quality of life. There's not a lot of opportunity in Scott County. The poverty, lack of education, jobs — it all ties together. A lot of people think they're sort of stuck here. They feel hopeless."

He also believes some in the city "sort of turned a blind eye to" the community's problems as they built.

All that came to a head this year when the first cases of HIV began mounting with alarming speed. In a county that saw only three new HIV cases between 2009 and 2013, Scott has recorded 142 new cases through April 24 in the recent outbreak, though HIV cases related to intravenous drug use have declined nationally in recent years.

"It's not like it's happened overnight," said David Reed, 34, adding that he has watched as many as 15 people share the same needle. "Drugs have been in this town for years. They just let things go too far. And now the HIV outbreak is here."

Drugs take toll

Not far from Austin's high school, across from a house with rotten siding and a wheelchair sitting out front, Bobbie Jo Spencer sat on her porch near an old mattress. She said she was "trying to get better" from Opana pain pill withdrawal by looking for a dose.

Rubbing the needle tracks on her arms, she had just finished talking with two visibly intoxicated neighbors as they argued about whether they would learn they had both recently tested positive for HIV.

Spencer, 30, tested negative at the new clinic, where she got clean needles. But she was worried, she said. She'd shared needles with a HIV-positive couple, and some who initially tested negative for HIV later were found to be positive.

Story continues below this video "A Voice of an Addict"

Bobbi Joe Spencer says her addiction is the result of personal tragedy in her life. Matt Stone, The Courier-Journal

With a boyfriend on disability, she said she earns up to $200 a week on odd house-cleaning and yard-cutting jobs, which she spends mostly on pills, purchasing a quarter of an Opana — a powerful painkiller — for $30. With a handful of friends killed as a result of drugs, she said the HIV outbreak renewed her desire — but not her ability — to quit.

"I do it to escape from my reality. I don't like my reality," she said. "I've been wanting to get off this crap. But rehab is so expensive. I wish I had my life back. I wish it was normal. I hate getting up and wondering where I'm going to get my next pill so my body can function right."

While heroin is surging in Kentucky amid a crackdown on pain pills, Austin's drug of choice is oxymorphone, or Opana, which can be crushed up and mixed with water to take advantage of its time-release properties. While a crush-resistant formulation was developed in 2011, it can still be ground up. Traffickers often cut them in quarters to sell.

Jeanni McCarty, a nurse who works for Cooke and has lost five relatives to drug abuse, said along with traffickers, pills are also coming from valid prescriptions filled in Louisville and Indianapolis for often legitimate ailments. But in some cases, "the amount of medication they're being prescribed, it's insane," she said.

Spicer said while there is some heroin in Austin, "due to the poverty levels, more people can get prescriptions (paid for by Medicaid) ... They may make $1,000 a month. Someone says 'Hey, you can get $130 a pill.' And the wheels start turning."

Because the high from a pill doesn't last long, four to 10 injections a day are common, which increases needle sharing, officials said. And the pills don't dissolve as well as heroin, requiring wider-gauge needles — which could spread more HIV during each injection. One drug abuser said there is a home in Austin in which there is a bucket of used, dirty needles for visiting users.

"Many family members will use drugs together," Joan Duwve, chief medical consultant to the Indiana Department of Health, said last week. "There are children, parents and grandparents who live in the same house, who are injecting drugs together, sort of as a community activity."

Yet for years, treatment and testing have been scarce around Austin. There were no drug treatment facilities in the city and no inpatient drug-treatment facilities in Scott County. And many could not make the trips to the Louisville area for methadone clinics or treatment programs, according to Cooke and others.

"There has been so many people who have wanted help for so long," Reed said. "But it was like nobody had time to help them, or couldn't help them because they didn't have insurance."

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The Best Way to Beat AIDS Isn't Drug Treatment. It's a Living Wage. 14/01/2015

Published by New Republic
Written by Alejandro Varela
7 December 2014


In a report marking World Aids Day on Dec. 1, the advocacy organization ONE announced that we are reaching “the beginning of the end” of the disease: For the first time, “the world added more people last year to life-saving AIDS treatment than the number of people who became newly infected with HIV in the same year.”

But of the 1.2 million Americans living with HIV only 37 percent are taking medications, and 1 in 7 are unaware that they are HIV positive, according to the Centers for Disease Control. With new infections in the U.S. hovering around 50,000 per year, the end is still a long ways off.

To get there, some policymakers are turning to a pill: New York Governor Andrew Cuomo is betting that the recently introduced pre-exposure prophylaxis (PrEP), Truvada, will help to drastically reduce HIV by 2020. The drug’s effectiveness (it’s been shown to successfully thwart virus replication in HIV negative people) and its accessibility (the governor rightfully negotiated down its cost with the pharmaceutical companies that corner the anti-HIV drug market) make it the linchpin of New York’s newest HIV initiative. Cuomo hopes PrEP will, within five years, help to reduce the annual number of new HIV cases below the number of annual deaths caused by AIDS.

But treatment can also lead to complacency and, ultimately, more pills. Cuomo’s laudable plan, the first in the nation to set the stage for HIV eradication, risks failure, if it doesn’t also address HIV’s most virulent precursor, catalyst, and enabler: Poverty.

As it happens, the maps of poverty in the United Stateswhere officially 14.5 percent of the population is poor and another 5 percent are nearly pooroverlay quite seamlessly onto the maps of HIV. That should come as no surprise to anyone who studies or treats chronic conditions, most of whichdiabetes, heart disease, kidney disease, etc.correlate with poverty.

Not only does poverty prevent us from accessing the stuff of life that buffers us from poor health, it also creates hospitable environments for disease. People living at or near poverty have greater levels of stress hormones, like cortisol, running through their bodies. And stress has a direct effect on each of the ten leading causes of death in the United States.

This isn’t the “good” stress that saves us from dangerous situations (“fight or flight”) or even the “medium” stress that causes panic before public speaking, as a work deadline looms, or on the way to the birth of your first child. The stress of poverty is a chronic stress that kills by hastening the wear and tear of processes and organs that are necessary for our survival. In fact, chronic stress is akin to untreated HIV: it assaults the immune system and quickens the transition to AIDS.


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Poverty doesn’t only manifest internally. People struggling to make ends meet are more likely to be perpetrators of violence and to be its victims. They are more likely to drown their sorrows and to inject drugs. They are more likely to fall into homelessness. They are less likely to have healthy nutrition options. And they are also less likely to access and adhere to prevention or treatment regimens for all of their ailments, not just HIV.

The situation may get worse before it gets better. Research recently found that countries in recession and with growing income inequality experienced jumps in HIV incidence. It isn’t only our elevated poverty levels that put us at risk. A comparison of 141 countries ranks the United States 100th in income equality. Lesotho, which has an adult HIV prevalence of 23 percent, is in last place. The country with the most equal distribution of income is Sweden; its HIV prevalence is 0.2 percent.

Being poor is a more accurate predictor of HIV than being male, female, Black or Hispanic is. A 2010 study of poor urban areas found that race and gender were not significant predictors of HIV prevalence. Why then are our proposed solutions for a problem with economic roots overwhelmingly clinical?

Cuomo and our other leaders would do well to focus on progressive fiscal policies such as a living wage, universal health care, and a basic income. These measures would lift Americans out of poverty, save money on health costs, and, most importantly, save lives.

It won’t be easy. Even with popular support, these economic policies continue to be controversial in the halls of power. But this World AIDS Day is as good a time as any to remember that controversial interventionscondoms, disclosure, and needle exchangehave been some of the most successful in the battle against HIV.

It’s because we discriminate that HIV doesn’t have to. It just picks off the poor, disenfranchised, disempowered, and otherwise oppressed members of our society. Reducing poverty will give millions of people more room to breathe, to arrive at informed conclusions, and to make the decisions that will ultimately eradicate HIV and, in the process, ease the entire disease burden on society.

The alternative is the status quo: a long road paved with well-intentioned but inefficient, piecemeal plans and initiatives.

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PEPFAR Pumps US$ 210 Million in Africa. 14/01/2015

Published at SafAIDS
13 January 2015


LUSAKA, 13 January 2015 (Times of Zambia) - The United States through its President's Emergency Plan For AIDS Relief (PEPFAR) has set aside US $210 million for the Accelerated Children's HIV/AIDS Treatment (ACT) for children living with HIV in Sub-Saharan Africa.

Speaking from Washington D.C. via a telephone conference call with African journalists from the Sub-Saharan Region, PEPFAR Ambassador Deborah Birx said an additional 300,000 children will be helped over the next two years through that investment.

Ambassador Birx said PEPFAR has created expanded partnerships with the private sector for the innovation of new ideas to combat the HIV/AIDS pandemic.

She said out of the approximated 3.2 million children across the globe living with HIV, only a quarter of them have access to treatment.

"And it was that data that was very compelling to us to really work with countries to accelerate access to treatment by young children."

"Much of this has to do with finding their mothers while they are pregnant, ensuring the mothers receive life-saving treatment, but also to ensure that when we are not successful in finding the mother, that the children are diagnosed early," she said.

She said according to data obtained from the Gap Report, it has been established that about half of the children living with HIV die before the age of two years if they don't access treatment early.

"One of the purposes of this programme is not only to treat children, but to find their mothers to ensure the mothers have life-saving treatment, to find the positive young children, and to get them on treatment."

"The other thing that is in the Gap Report is it shows that the adolescents, particularly adolescent young women, are also particularly susceptible to dying from HIV/AIDS because of their lack of access to treatment. And so this has also been an important piece for us, because among adolescents, 10 to 19, AIDS-related deaths are the primary cause of death in that age group," Ambassador Birx added.

She explained that the ACT initiative is aimed at is committed to doubling the number of children who are receiving life-saving ART and life-saving treatment.

"It is a 200 million dollar initiative, and we believe we will be able to reach nearly 300 thousand additional children. The countries that we will be working with are Cameroon, the Democratic Republic of Congo, Kenya, Lesotho, Malawi, Mozambique, Tanzania, Zambia, and Zimbabwe," she said.

This is a partnership between PEPFAR, the Nike Foundation, and the Bill &Melinda Gates Foundation, 210 million dollars specifically targeted, and these are new funds, specifically targeted to reduce new infections among adolescent girls and young women.

Statistics indicate that nearly seven thousand young women are infected every week, between the age group of 15 and 24, and that is nearly 400,000 adolescent girls and young women, every single year.

About 80 per cent of these new infections occur in girls, and that boys of the same age group do not have the same exposure and risk to HIV as young girls.

"So this program is very much focused on ensuring that young women have the ability to remain, and have the skill sets to remain, HIV free," Ambassador Birx said.

Since its inception in 2004, PEPFAR Zambia has received over 1.7 billion U.S. dollars.

She said through the partnerships PEPFAR has made tremendous progress by utilizing national strategies, and utilizing and improving information and data, and using those to respond to this epidemic.

She explained that about 3,600 children die on a weekly basis, with about 25,000 adults dying of HIV related infection.

"While we have been going around our daily business 4,600 new babies were infected, and 36,000 adults were infected, 7,000 of them young women, just this week."

"So we have to stem this epidemic now before these numbers increase to a level where we don't have the fiscal resources globally to make the impact that we know we need to make," she said.

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HIV 2020. 26/6/2017

Published by POZ

Gazing into the crystal ball at the epidemic's future reveals many exciting advancements. Lower infection rates is just the beginning.

In the eyes of the mainstream press, the most recent edition of the annual Conference on Retroviruses and Opportunistic Infections (CROI), held in February in Seattle, wasn’t a watershed event. This was quite an oversight, however, considering that the findings of one particular study reported at this important HIV-focused scientific gathering were reason for considerable excitement.

According to a recent Centers for Disease Control and Prevention (CDC) analysis presented at CROI, the estimated number of new annual HIV infections, or HIV incidence, in the United States fell 18 percent between 2008 and 2014. This promising downward shift followed two decades of frustrating stagnation.

“That’s really tremendous progress,” John T. Brooks, MD, a senior medical adviser with the CDC’s Division of HIV/AIDS Prevention, tells POZ. Anticipating that the drop is the beginning of a long-term trend, he continues: “We may actually have HIV be a disease that we’re controlling rather than reacting to over the next decade.”

The dawning of the 2020s will bring HIV into its fifth decade—the first reports of what became the AIDS crisis emerged in 1981. Crystal balls are by their nature hazy, and the current political climate raises many worrisome questions about how shifting federal priorities may affect people living with and at risk for HIV. Nevertheless, thanks to recent promising strides in HIV research and public health efforts to tackle the virus from all sides, leaders in the field are increasingly optimistic about what the next decade of the epidemic will look like.

Anthony S. Fauci, MD, the director of the National Institute of Allergy and Infectious Diseases (NIAID), embraces cautious optimism, saying the 2020s will see “substantial advances, over and above where we are now.” He foresees “a great improvement in the ability to manage people who are HIV-infected—either by 1) having them take less toxic and more user-friendly drugs; or 2) getting a proportion of them off therapy” and in a state of what scientists often call viral remission.

According to Fauci, the 202s will see “substantial advances, over and above where we are now.”

Two key concepts have dominated the public health discourse about HIV during the 2010s. The first is biomedical prevention. This refers to the awesome power of antiretrovirals (ARVs) to prevent transmission, either as treatment as prevention (TasP), whereby HIV is fully suppressed, rendering it virtually impossible to transmit, or in the form of Truvada (tenofovir disoproxil fumarate/emtricitabine) as pre-exposure prophylaxis (PrEP), which grants protection to those at risk for HIV in case of exposure to the virus. The second major concept is the HIV care continuum, which refers to the series of steps required for an HIV-positive person to achieve an undetectable viral load: diagnosis, being linked to and retained in medical care for the virus, receiving ARVs and, finally, full viral suppression.

Gloom and doom has been the name of the game where U.S. care continuum statistics have been concerned, with a mere 30 percent of the national HIV population virally suppressed. However, recent evidence suggests not only that this figure, which was based on 2011 data, was an underestimate to begin with but also that concerted efforts around the country to improve measures of the continuum are beginning to bear fruit. In fact, the CDC pointed to a rising viral suppression rate as a likely driver of the recent decline in new HIV infections. In addition, the CDC says that PrEP, which began gaining popularity in late 2013, may have contributed to the decline in HIV incidence seen in 2014.

Crucial for continued progress in care continuum statistics and PrEP use alike is health care access. On both fronts, the Affordable Care Act (ACA, or Obamacare) has apparently provided a pivotal boost. A recent Kaiser Family Foundation analysis found that between 2012 and 2014, the first year that Obamacare’s key provisions were implemented, the uninsured rate among people in medical care for HIV fell from 13 percent to 7 percent in states that expanded their Medicaid programs under the legislation.

Jennifer Kates, PhD, the director of global health and HIV policy at Kaiser, believes that “in almost every way,” overall indicators of progress in combatting the U.S. epidemic are “moving in the right direction.” However, she says, “This progress could be at risk if current proposals to replace the ACA are enacted and if there are any funding cuts to key federal HIV programs.”

Specifically, future federal budget cuts could compromise efforts of the CDC, the Ryan White CARE Act and the National Institutes of Health (NIH) to prevent, treat and research HIV. And after the U.S. House of Representatives passed the American Health Care Act in May—the Republicans’ first salvo in the party’s ongoing efforts to repeal and replace the ACA—all eyes are now on the Republican-dominated Senate, which is tasked with adapting the bill to its own tastes.

Given the swirl of scandal increasingly consuming the White House, the future of the entire Republican legislative agenda lies in question, including the health care bill. Ideally for the fight against HIV, any legislation that does ultimately pass will preserve support for Medicaid, as well as Obamacare’s protections ensuring that individuals with preexisting conditions, like HIV, can access affordable, quality health care.

Reassuringly, at the end of the day, all public health is local—or so the saying goes. While the CDC may contribute vital federal funds to local efforts, the true fire behind the most impressive recent battles against the epidemic have come at the municipal level. New York City, San Francisco and Seattle are the standard bearers on this front, having masterminded their own highly tailored, full-on assaults against HIV, with increasing indications of success.

According to Kates, these cities “show that it’s possible—through collective public, private and community action—to actually implement the right tools at the right scale to the right people and to drive down new infections, increase access to care and reduce disparities.”

The question remains, though, whether other cities will follow suit, especially those in the hard-hit South, where local public health responses to HIV tend to remain woefully inadequate. Demetre Daskalakis, MD, MPH, the energetic acting deputy commissioner of New York City’s Division of Disease Control, is hopeful for such a sea change and notes that his counterparts in other cities are “looking at what we’re doing and sampling our menu.”

PrEP, which has seen soaring rates of new users during the past four years, is a key factor in the strategies of the three lead cities and will likely play an increasingly pivotal role in driving down U.S. HIV rates during the 2020s. However, thus far, PrEP’s use has largely been limited to white men who have sex with men (MSM) over the age of 25 in major urban areas. This lopsided uptake has raised concerns that Truvada may lead to a collapse in HIV rates among a population that has long enjoyed a declining infection rate, while leaving behind the demographic hardest hit by the epidemic: African-American MSM.

“A world with PrEP is better than a world without PrEP,” stresses Eli Rosenberg, PhD, an assistant professor of public health at Emory University, whose research led to the shocking estimate that 11 percent of 18- to 24-year-old Black MSM in Atlanta contract HIV annually. “But racial disparities in infection rates may grow, as the access is uneven.”

***

In the current one-pill-once-a-day era of HIV treatment, there are so many highly effective and tolerable ARV regimens that future progress in developing first-line therapies (those offered to people with HIV who haven’t taken ARVs before) will probably focus more narrowly on simplifying treatments, as with ViiV Healthcare’s recent efforts to develop a two-drug regimen.

Tim Horn, deputy executive director of HIV and hepatitis C programs at Treatment Action Group, predicts that Gilead Sciences’ investigational integrase inhibitor bictegravir, which recently showed promise in a head-to-head with Tivicay (dolutegravir), will likely bring to an end efforts to improve the effectiveness of triple-drug first-line treatments.

On the other hand, those who have failed multiple ARV regimens will probably more broadly benefit from the expansion of treatment options going forward. In a recent trial of the long-acting antibody treatment ibalizumab, which was given in biweekly infusions as an adjunct to daily ARVs, the treatment helped suppress the virus among those with multidrug resistance who were on otherwise failing HIV regimens. Ibalizumab is now up for FDA approval.

Long-acting injectable ARVs are also poised to give people with HIV the option of ditching daily drugs, with the regimen of long-acting cabotegravir and Edurant (rilpivirine) given every eight weeks currently in a Phase III trial.

Researchers are also fast at work identifying what are known as broadly neutralizing antibodies that, especially when used in combination, appear highly effective at suppressing HIV. Daily oral ARVs may become a thing of the past for at least some people with HIV as scientists figure out how to treat—as well as prevent—the virus with intermittent infusions of such antibodies.

Fauci is enthusiastic about the possibility that the interval between such infusions could become quite wide and says, “If you could get it to six months and have somebody come in twice a year for an injection—wow!”

In the meantime, the particulars of intellectual property law will likely instigate a considerable shift in what people with HIV keep in their medicine cabinets. In the coming years, an increasing number of ARVs will lose patent protection, including those used as first-line therapies, such as the all-important Viread (tenofovir disoproxil fumarate), a component of numerous combination-ARV tablets.

Horn anticipates that insurers, seeking to cut the high costs of HIV treatment, will likely begin to pressure people with HIV to take cheaper generic equivalents of brand-name drugs. This may mean pushing people off single-tablet regimens and toward multi-tablet equivalents, especially if research doesn’t demonstrate a clear safety advantage to the brand-name alternative.

“That’s where the showdown is,” Horn says.

The prospects for PrEP, meanwhile, likely include an array of choices that will better fit the needs and lifestyles of at-risk individuals. Two major trials in this field are under way: One is examining a long-acting injectable form of PrEP given every eight weeks, and the other is testing daily oral Descovy (emtricitabine/tenofovir alafenamide), which research has shown is safer for bones and kidneys than Truvada, currently the only approved form of PrEP. Much further back in the PrEP research pipeline are a subdermal implant that could last for six months, a microbicidal enema and long-lasting antibody infusions.

And then there are the efforts to find a cure for HIV. Given the byzantine complexity of attacking the HIV reservoir—the amorphous collection of cells in which the virus hides even in the face of successful ARV treatment—experts typically believe that the 2020s won’t see a widely replicable so-called sterilizing cure that would totally rid the body of the virus.

However, recent research advances are raising hopes for what scientists call a functional cure, or a state of extended viral remission, meaning that although a treatment wouldn’t totally eliminate HIV from the body, the virus wouldn’t replicate significantly. We’ve already seen a handful of cases with this type of remission, including the famous Mississippi Baby, who was aggressively treated for HIV starting at birth and later spent 28 months off ARVs before her virus rebounded at age 4.

“We’re going to have a certain percentage of people who are going to go prolonged periods of time without requiring therapy,” Fauci says of the next decade.

Recent research suggests that the smaller the viral reservoir, the greater the likelihood individuals may achieve such extended viral remission. Consequently, treating HIV as early and as consistently as possible—both efforts likely yield smaller and more unstable reservoirs—is probably a fundamental prerequisite to increasing the chances of such an outcome.

In the near future, efforts used to shrink the reservoir—researchers are investigating numerous avenues, including genetic treatments—may not fully cure the virus. But as scientists reach for that ultimate goal, they may succeed in finding ways to diminish the harmful chronic inflammatory state to which even well treated HIV gives rise and which is believed to raise the risk of many aging-related health problems.

“We're going to have a percentage of people who will go prolonged periods of time without requiring therapy.”

“The future of HIV is gray hair,” predicts New York City’s Daskalakis.

Indeed, with an overall life expectancy approaching normal and new membership to their club falling, the HIV population is steadily marching toward its senior years. At the beginning of the 2010s, only a bit more than one third of HIV-positive U.S. residents were 50 or older. That proportion is projected to reach one half by 2020. By 2030, more than a fifth will likely be older than 65.

Unfortunately, living longer with HIV comes with a higher risk of various aging-related conditions, such as diabetes, high cholesterol, cardiovascular disease, high blood pressure, cognitive decline and bone loss.

But there’s no need to push the panic button just yet. Bear in mind that these are largely manageable conditions. Eleanor E. Friedman, PhD, a fellow at the Oak Ridge Institute for Science and Education who conducted one of the first studies to look at the health challenges of seniors living with HIV, stresses that this group is largely well poised to weather such additional challenges, owing to these individuals’ wealth of experience in managing HIV itself.

“If you have spent so many years practicing good self-care,” Friedman says, “I mean emotional self-care, and dietary self-care, and medication self-care, then this shouldn’t throw you off your stride.”

It may be that a simple way to allay various age-related conditions in older people with HIV is already readily available. A major, highly important trial called REPRIEVE is currently looking at whether cholesterol-lowering statins may improve the health of people with HIV on numerous fronts, including the risk of heart disease and death, possibly by lessening chronic inflammation (see sidebar below).

At present, liver disease poses a major threat to the overall HIV population, largely because approximately one fifth of those living with HIV are coinfected with hepatitis C virus (HCV), which attacks the organ. HIV itself accelerates such HCV-related liver damage. But for those with HIV and HCV, cirrhosis and liver cancer are hardly inevitable, considering how easily hep C can be cured now, thanks to new, highly effective medications. And while the sky-high cost of these drugs has led insurers to limit who can receive coverage for them, current hep C treatment guidelines move HIV/HCV-coinfected individuals toward the front of the line.

“We have the opportunity to really eliminate this disease in HIV infection,” says the CDC’s John Brooks of the benefits of modern HCV treatment. “The value in terms of the illness and death that’s averted by getting rid of this coinfection could be enormous.”

In the end, the holy grail in the quest to end the HIV pandemic is a vaccine. Fauci says the world is unlikely to see a highly effective vaccine this side of 2030. However, he remains cautiously optimistic about the advanced vaccine trial launched in sub-Saharan Africa in late 2016. The study is testing a retooled version of the vaccine that showed moderate success in a previous trial in Thailand. According to Fauci, it may yield a vaccine that cuts HIV risk by 50 to 60 percent.

If the vaccine proves that powerful, Fauci says it would be a go. In fact, a recent paper projected that a vaccine that cut HIV risk in half could eliminate more than 6 million cases worldwide by 2035.

Just imagine what decade six of the epidemic might look like.

The Heart of the Matter

First, the worrisome news. Even when taking successful antiretroviral (ARV) treatment, people living with HIV face up to double the risk of heart disease of HIV-negative individuals. And as the HIV population ages, the virus’s apparent contribution to health events such as heart attack and stroke looms ever larger.

And now for the promising news. A simple solution to this increased health risk may already be at hand. Research suggests that cholesterol-lowering statins reduce harmful chronic inflammation, which even well-treated HIV may fuel and which scientists believe contributes to increased rates of aging-related diseases, including heart disease.

Seeking gold-standard proof that statins lower the risk of heart disease as well as death among people with HIV, in April 2015, the National Institute of Allergy and Infectious Diseases and the National Heart, Lung, and Blood Institute launched a mammoth global trial called REPRIEVE. The study is geared to enroll 6,500 HIV-positive participants at 100 research sites around the world, including in the United States, who will be randomized to receive a placebo or the statin Livalo (pitavastatin) in addition to their standard ARVs.

The first results from REPRIEVE are expected in 2020 but may come earlier if a clear benefit to taking a statin emerges particularly quickly.

The study’s investigators are hoping to gain a wealth of knowledge from the trial, including information about the complex mechanisms involved in HIV’s contribution to heart disease and whether statins lower rates of other health conditions, such as kidney disease and cancer. They’ve also set their sights on developing a heart-disease risk calculator that is specific to people living with HIV.

REPRIEVE’s ultimate goal is to maintain the more than two decades of scientific progress that have steadily found effective ways to make HIV a more manageable and less harmful infection.

In short, success in the trial would be great news for the next decade of the epidemic.

For more information on REPRIEVE, including how to participate, visit reprievetrial.org. Women, who are strongly encouraged to join the trial, can check out followyourheart.reprievetrial.org.

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Sec. Clinton: “Creating an AIDS-free generation has never been a priority of the U.S. government until today…” 18/11/2011

The community responds to Clinton’s momentous speech.

Science Speaks: HIV & TB News

18/11/2011

The U.S. Secretary of State Hilary Clinton made a bold announcement Tuesday – that an AIDS free generation is possible and the U.S. will be working toward that goal. Aiming to reinvigorate the fight against global AIDS, she emphasized the leadership role the U.S. must play but, as administration folks have reiterated for several months, the U.S. cannot do it alone.

Secretary of State Hilary Clinton speaks to a packed audience Tuesday at the National Institutes of Health.

Achieving an AIDS free generation, she said, requires ensuring that no children are born with the virus; that as these children mature they are at a far lower risk of becoming infected; and if they do acquire HIV, that they have access to treatment that keeps them from developing AIDS and passing the virus on to others.

“Creating an AIDS free generation has never been a priority of the U.S. government until today – because this goal would have been unimaginable just a few years ago,” she said, referring to new groundbreaking evidence that utilizing a combination of prevention interventions can make a significant impact on the devastating toll of this disease. The key interventions needed, she said, are prevention of mother-to-child transmission (PMTCT), voluntary medical male circumcision and antiretroviral therapy (ART) to prevent transmission among discordant couples — where one partner is HIV infected and the other is not.

“She spoke emphatically about the importance of using scientifically proven tools to prevent the spread of HIV infection,” said Dan Kuritzkes, MD, director of AIDS Research at Brigham and Women’s Hospital in Boston, noting that the three tools she highlighted have each proven effective through prospective, randomized clinical trials funded by the National Institute of Allergy and Infectious Diseases with other donors and funders. “Her call to change the course of the AIDS epidemic by applying these science-based approaches, including condom use and counseling and testing, emphasizes the need to use combination-based prevention strategies.”

Citing a recently published scientific paper, Clinton said, “Mathematical models show that scaling up combination prevention to realistic levels in high-prevalence countries would drive down the worldwide rate of new infections by at least 40 to 60 percent. That’s on top of the 25 percent drop we’ve already seen in the past decade.” Clinton also noted that the President’s Emergency Plan for AIDS Relief (PEPFAR) program costs for treating patients – including medication and services – have dropped by 24 percent in just the last year.

To further assess the benefits of combination prevention, Clinton announced a new $60 million investment by PEPFAR in four countries in sub-Saharan Africa, to rapidly scale up these interventions and “rigorously” measure their impact. The U.S. recently gave grants totaling $50 million to three institutions to develop rigorous studies to test what combinations of interventions work in various settings.

The Secretary also took a moment to speak in defense of the Global Fund to Fight AIDS, Tuberculosis and Malaria – a multilateral donor organization that has taken heat recently as internal investigations have turned up the mismanagement and misspending of some grant money. “…Let’s remember, uncovering problems is exactly what transparency is supposed to do. It means the process is working,” she said. Giving an example of one of the many achievements of the Fund, Clinton said, “In 2004, virtually none of the people in Malawi who were eligible to receive treatment actually received it. As of last year, with significant help from the Global Fund, nearly half did.” She then urged donor nations to step up and continue to fund the organization and not penalize them for taking steps to uncover internal fraud.

Community Response
Her speech to a packed audience of policymakers, global AIDS advocates and scientists at the National Institutes of Health in Bethesda, Maryland, drew varied yet positive reactions from the community, as well as some unanswered questions. Like, what next? And what about funding?

“Sec. Clinton laid out a vision for beginning to end this epidemic,” said Chris Collins from the Foundation for AIDS Research (amfAR). “Her leadership, and the startling scientific results of the last year, raise our hopes, and also our expectations for what comes next in terms of policy implementation from the White House.”

“What I hope would come from this speech is a continued, long-term commitment by the U.S. to the fight against HIV – A concerted effort to focus on what we know works and to take that to action and scale,” said Wafaa el-Sadr, MD, MPH, founding director of ICAP at the Columbia Mailman School of Public Health and a professor of epidemiology and medicine at Columbia University “Now is the time to move from aspiration to action.”

“She made it clear that the United States is not walking away from treating and caring for those living with HIV and helping to prevent the spread of new infections,” said Smita Baruah of the Global Health Council. “Collectively we all must help the U.S. keep up its commitments.  Congress must also not back away from efforts to fight against HIV/AID and other global health issues.  Funding is a critical component to ensuring an AIDS-free generation.”

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Trump’s HIV Aid Cuts Could Cost 9 Million Life Years Lost in SA, I Coast. 29/8/2017

Published by EWN

Donald Trump’s proposed budget for 2018, made public in May, envisions cuts to the President’s Emergency Plan for Aids Relief programme.                                         

US President Donald Trump’s plan to cut foreign aid supporting HIV/Aids treatment could cost 9 million years of lost life in South Africa and Ivory Coast, according to a global study released on Monday.

In the first study to measure the impact of cuts in global investment in HIV care in terms of health and costs, scientists found sky-rocketing deaths in the African nations would far outweigh savings.

South Africa has the highest prevalence of HIV worldwide, with 19% of its adult population carrying the virus in 2015, according to UNAIDS, with a total of 7 million HIV-infected people.

Ivory Coast counted 460,000 HIV-infected people in that same year.

Trump’s proposed budget for 2018, made public in May, envisions cuts to the President’s Emergency Plan for Aids Relief (PEPFAR) programme, a cornerstone of US global health assistance, which supports HIV/Aids treatment, testing and counselling for millions of people worldwide.

Under Trump’s budget, which pursues his “America First” world view, PEPFAR funding would be $5 billion per year compared to about $6 billion annually now, the US State Department has said. No patient currently receiving antiretroviral therapy, a treatment for HIV, through PEPFAR funds will lose that treatment, officials have said.

Should the cuts keep South Africans and Ivorians from receiving antiretroviral drugs, an additional 1.8 million HIV-infected people would die over the next 10 years, 11 researchers in America, Europe and Africa concluded, using mathematical models.

The combined deaths amount to nearly 9 million years of life lost, the scientists calculated, in what they said was the first effort to put figures on the proposed cuts.

The researchers measured expected savings over the next decade, whose small scale they said raised efficacy and ethical questions. In South Africa, it would amount to some $900 per year of life lost, compared to $600 to $900 in Ivory Coast.

“We leave it to readers to draw their own conclusions about whether imposing such trade-offs on vulnerable populations accurately reflects how donor countries value life in recipient nations,” the researchers wrote in Annals of Internal Medicine.

Savings would eventually dry up over the decade, they found, due to higher costs tied to the spread of HIV amid scaled back screening and care.

“Would the relatively small savings realised by currently proposed budget reductions be worth these large humanitarian costs?” said lead author Rochelle Walensky, a professor of medicine at Harvard Medical School.

“Over the past decade and a half we’ve spent considerable money to save lives in these and other African nations.”

Some 90% of Ivory Coast’s funding for HIV care and prevention depends on international aid, while South Africa self-finances most of its HIV expenditures, according to US government figures.

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U.S. Seeks to Cut Costs in Sustained War Against HIV/AIDS. 11/2/11

Campaign has become "sustainability" -- rather than "emergency" -- and the key is reaching more people while reducing costs.

AllAfrica

By Philip Kurata
11 February 2011
The U.S. government is preparing for a sustained war against HIV/AIDS.

At a gathering of international health experts in Washington February 10, the Obama administration official in charge of the anti-HIV/AIDS campaign, Dr. Eric Goosby, said the watchword in the campaign has become "sustainability" -- rather than "emergency" -- and the key is reaching more people while reducing costs.

Since PEPFAR (the President's Emergency Plan for AIDS Relief) was launched in 2003, the cost of administering anti-retroviral drugs (ARVs) to one patient has fallen from $1,400 per year a few years ago to an average of $435 per patient per year now, Goosby said. The former medical director of the AIDS clinic of the San Francisco General Hospital now heads the global AIDS office at the U.S. State Department.

In the first five years of PEPFAR, ARVs reached 1.7 million people as funding shot upward from $2.3 billion in 2003 to $6 billion in 2008, Goosby said. But because of budgetary constraints that have come with the global recession, funding increases to combat the disease have flattened out. In 2009, the Obama administration spent $6.7 billion and in 2010, $6.8 billion for PEPFAR. Nevertheless, the number of people receiving ARVs has mushroomed from 1.7 million in 2008 to 3.3 million through the end of 2010.

Goosby said that PEPFAR has a special focus on children.

"In the last year alone, we have been able to prevent 114,000 transmissions to children during pregnancy of HIV-positive mothers," he said, adding that 3.8 million vulnerable children are cared for by PEPFAR programs. "From birth until they are 18 years old, we feed them, clothe them, house them, educate them, train them for jobs and turn them loose, and we have a case management relationship with them as they go into young adulthood. This is a remarkable example of the American people's tax dollars having a high impact to stabilize lives and save lives, stabilize communities and stabilize countries."

"Despite funding constraints, the number of people receiving treatment is increasing rapidly," said Dr. Charles Holmes, PEPFAR's chief medical officer.

As the United States prepares for a long-term campaign against the disease that destroys the body's immune system, Goosby said making health management systems more efficient is the core theme. "It's not flashy or sexy, but it has a huge monetary impact. We want to have one manager for 20 clinics, not 20 managers for 20 clinics. We want to have one procurement system for 20 clinics, not one procurement system for each clinic," he said.

Goosby said the international community needs to do more to support the anti-AIDS struggle, and said he hopes to see greater contributions from European countries, China and Saudi Arabia, among others. PEPFAR, he said, is engaging faith-based charities operating in AIDS-stricken countries as another measure to broaden its partnerships and cut costs.

"When the PEPFAR efforts move out of cities into rural areas, medical facilities thin out and people are more dependent on nonprofit groups. We have taken full advantage of that, especially with faith-based organizations," Goosby said.

The end goal of PEPFAR is to enable health ministries in AIDS-affected countries to take control of the efforts to counter the epidemic.

"The unifying thread is having a ministry of health that is strong enough to take the reins so that they are able to plan effectively, define and prioritize unmet needs, then move to implement the program," he said. "We are making a permanent system of care embedded in the existing ministries of health that will be there long after PEPFAR is gone."

Dr. Ndwapi Ndwapi of Botswana said he is taking many ideas from the conference to make his country's anti-AIDS programs more effective.

"The emphasis on cost control, knowing how much things cost, going into the details, looking at those areas that are most costly and finding interventions, such as the procurement of ARV drugs, a strategy that South Africa is undertaking. I look at them with great interest," Ndwapi said.

Ndwapi said it is urgent for the Botswana Health Ministry to bring down costs and develop a self-sustaining program because international donors are beginning to send their anti-AIDS funds to other countries deemed to be in greater need.

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Nation, America Building On Success in Fighting AIDS. 5/12/10

It is in their honour that we work to provide HIV prevention, treatment and care to millions of people and to make progress against this epidemic.

AllAfrica

By Jerry Lanier
5 December 2010

WEDNESDAY December 1 was World AIDS Day. The World AIDS Day is both a day of remembrance and a day of celebration. We must all remember those who have lost their lives to AIDS.

It is in their honour that we work to provide HIV prevention, treatment and care to millions of people and to make progress against this epidemic.

Yet, it is also a day to celebrate those whose lives have been improved and saved in Uganda and throughout the world, thanks to the global fight against this devastating disease.

On World AIDS Day, it is important to remember that we have a shared responsibility to build on the success achieved to date by making smart investments that will ultimately save more lives.

There is much success to build on: In Uganda, the US, through the President's Emergency Plan for AIDS Relief (PEPFAR), has directly supported life-saving anti-retroviral treatment for over 207,000 men, women and children. PEPFAR is also directly supporting 845,000 people in Uganda with care and support programmes, including 250,000 orphans and other vulnerable children.

US support continues to grow. PEPFAR is not ending. Instead, building on the success of PEPFAR and other global health programmes, President Barack Obama has put forward an ambitious Global Health Initiative, which will support coordinated programmes aimed at reducing lives lost from HIV/AIDS and other health challenges.

And through US investments in the Global Fund to fight AIDS, tuberculosis and malaria, more people will benefit from prevention, care and treatment.

Our commitment to combating the HIV/AIDS epidemic in Uganda has not wavered. We will continue to support those currently receiving treatment from PEPFAR. We are already looking at ways of improving programme efficiencies and effectiveness, making smarter investments and increasing our value for money.

Thanks to increased support from Washington, we will have additional resources for treatment services. This started with an infusion of anti-retroviral drugs to the National Medical Stores in September, enabling the Ministry of Health to continue treatment while waiting for the next tranche of Global Fund drugs.

An increase in funding in the short and medium-term will enable us to reach 36,000 additional patients with direct treatment support this year and next year.

But the US Government is obviously not - and should not be - the sole supporter of prevention, care and treatment, either globally or in any particular country. Therefore, we are committed to continuing our intense engagement in support of the national multi-sectoral response led by the Uganda AIDS Commission, the Ministry of Health and other ministries.

We are also committed to helping Uganda improve the functioning of the Global Fund and identify additional bilateral and multilateral funding. We were pleased by the continued commitment of Government funds to purchase anti-retroviral drugs and encourage the Government to increase its support to HIV/AIDS and health in general in the years ahead.

To meet the need, Uganda's national Government must resume the central role in leading the national response on health in general and HIV/AIDS in particular.

This will require increased investment in leadership and coordination at all levels of the national response.

We will continue to work with the Government, civil society and the private sector, laying out a shared strategic vision and joint responsibilities. In this way, we can develop a road map towards joint strategic framework for cooperation, linked to the National HIV/AIDS Strategic Plan and the new National Health Sector Strategic and Investment Plan.

On this World AIDS Day, we honour the lives lost and celebrate the lives saved. Working together, we must remain dedicated to building on success by making smart investments to save even more lives.

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US Pledges K1.2 Trillion towards HIV/AIDS Fight. 25/11/10

US6 million to Zambia’s national HIV and AIDS response for the 2011 fiscal year.

The Post Online

By Namatama Mundia
25 November 2010

The US government has pledged a total of K1.2 trillion US6 million to Zambia’s national HIV and AIDS response for the 2011 fiscal year.

Ambassador Mark Storella said the funds were meant to strengthen the prevention and treatment activities.

He observed that HIV and AIDS continued to be one of the greatest threats to sustainable human development in Zambia.

“HIV and AIDS are undermining national capacity to build sustainable productivity while at the same time, threatening and destroying household livelihoods,” said Ambassador Storella during the signing of the Partnership Framework for HIV and AIDS between the US and Zambian governments.

However, Ambassador Storella acknowledged that enormous strides had been made to strengthen the prevention of HIV infection and ensure access to quality treatment, care and support.

“The US government will partner with the Zambian government and others to support health systems development, foster greater country ownership of HIV and AIDS programming and identify means to institutionalise and sustain country led responses,” Ambassador Storella said.

And finance minister Dr Situmbeko Musokotwane observed that the country still had a lot to do to further reduce the HIV infection rate.

He said although significant progress had been achieved, Zambia remained a hyper endemic country, with thousands of people dying of AIDS related illnesses each year.

“The devastating effects of HIV and AIDS run across all economic and social sectors, implying that this is not only a health problem. Deaths due to HIV and AIDS have continued to escalate, affecting the labour force across all economic activities,” said Dr Musokotwane.

Zambia is ranked seventh highest globally among countries with hyper endemic HIV and AIDS levels.

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Condoms Used by Teens, not Adults. 5/10/10

Most teens don't have sex, but when they do, condom use has become normative

5 October 2010

Americans enjoy sex well into old age, but are more responsible about it - at least in terms of condom use - when they are teens, says the biggest survey in decades on US sexual behaviour.

Most teens don't have sex, but when they do, condom use has become "normative" behavior, found the study, published in a special edition of the Journal of Sexual Health.

Teenage boys reported using a condom use 79% of the time during the last 10 times they had intercourse with a girl, while teen girls reported using a condom 58% of those encounters, the study found.

But condom use declines with age, and by the time people reach 50, only one in five men and one in four women uses a condom, the study found.

The study

The data was compiled by researchers at the University of Indiana, who documented the sexual experiences and condom use - or not - of 5,865 Americans aged 14 to 94.

The drop in condom use is not due to a lack of sexual activity among older Americans, because Americans are sexually active "well into old age (80+)", according to the study, which was funded by a condom maker.

"But freed from concerns about contraception by virtue of age, they remain unclear or unaware about the need to continue protecting themselves and their partners from STIs," or sexually transmitted infections, it said.

Study followed a 60-year-old survey

The study followed a ground-breaking survey published 60 years ago by Dr Alfred Kinsey, also of the University of Indiana, and another study with nationwide reach which was published in 1994.

"This survey is one of the most expansive nationally representative studies of sexual behavior and condom use ever conducted, given the 80-year span of ages," said Michael Reece, director of the Center for Sexual Health Promotion, and one of the authors of the new research.

"These data about sexual behaviors and condom use in contemporary America are critically needed by medical and public health professionals who are on the frontline, addressing issues such as HIV, sexually transmissible infections and unintended pregnancy," he said. (Sapa/ October 2010)

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Obama Does the Right Thing on Global AIDS, Says AHF. 5/10/10

AIDS Healthcare Foundation Today Welcomed President Obama’s Announcement that He Will Seek $4 Billion for the Global Fund Over the Next Three Years, Challenging Other G8 Nations to Step-Up Contributions

5 October 2010

AIDS Healthcare Foundation (AHF) today lauded the Obama administration’s announcement that it will seek $4 billion for the Global Fund to Fight HIV/AIDS, Malaria and Tuberculosis over the next three years—a 38% increase over what has been provided in the previous three-year period. The U.S. also urged better management of grants by participating countries, as well as increased accountability and efficiency by the Global Fund

“We applaud the Obama administration for reasserting U.S. leadership and for challenging the rest of the world—particularly the other G8 nations—to step up contributions to fight the global AIDS scourge,” said Michael Weinstein, President of AIDS Healthcare Foundation. “AHF has been championing reform of the Global Fund for some time. It is our hope that with this funding—as well as a U.S. commitment to bringing down the cost of care through increased accountability and efficiency—the number of people receiving lifesaving AIDS treatment worldwide can be doubled and a new era of hope will dawn.”

Today’s announcement was made during theGlobal Fund’s Third Voluntary Replenishment and pledging conference taking place in New York October 4th and 5th. The U.S. is by far the largest donor, having contributed over $4.3 billion to the Global Fund. This accounts for 28% of all donations and is less than .038% of the U.S. GDP.

“Now that the U.S. is beginning to resume its role as the global leader in AIDS control, other countries will have no excuse not to contribute more,” said Jorge Saavedra, AHF’s Chief of Global Affairs. “Of course, in these tough economic times, it is the responsibility of all funding bodies to spend money in the most efficient possible ways, in order to save the maximum number of lives through testing and treating and thereby breaking the chain of infection. We are pleased at this latest development and hope that the result will be more lives saved.”

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President Obama's Pledge to the Global Fund Falls Far Short Even of Austerity Forecasts? 5/10/10

Health GAP expressed profound disappointment today with the $4 billion, 3-year pledge by President Obama

5 October 2010

Health GAP expressed profound disappointment today with the $4 billion, 3-year pledge by President Obama to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).

We are alarmed that this contribution fails to meet even the U.S. share of the ?austerity? scenario projected by the Global Fund. The President had the opportunity to lead the world toward sufficient funding for AIDS and failed to do so. Heroes in Congress have fought hard to increase the U.S. pledge to sufficient levels?with 101 members of the President?s own party asking him to make a $6 billion pledge. It is unfortunate this President?the winner of the Nobel Peace Prize?failed to respond to their call to support multilateralism.

The Global Fund is the largest multilateral funder for the three diseases, and has supported programs have already saved nearly 6 million lives. We are gravely concerned that this pledge?unless increased with $1 billion in additional funding?will mean that the Global Fund will have to virtually halt scale up in the fight against the three diseases, and turn away high quality proposals for life saving HIV treatment and prevention scale up.

This failure to adequately contribute to the Global Fund will harm and could reverse extraordinary progress made in fighting the AIDS pandemic. Despite the pledge by world leaders to provide universal access to treatment by 2010, only one third (5.25 million) of the 15 million people in urgent clinical need of life saving HIV treatment currently have access.

Over the past 10 years, the US has helped lead impressive progress in scaling up HIV prevention and treatment, and we can now say with confidence that it is possible to win the fight against AIDS. We know now that with adequate funding, millions of lives could be saved with HIV treatment, and tens of millions of new infections could be prevented. Mother-to-child transmission of HIV could be virtually eliminated.

Investing now means saving billions of dollars later?because of averted infections, and the ability to start HIV positive people on less toxic regimens, earlier, when treatment is more likely to have a long lasting effect. Treatment allows people to live full lives, to hold jobs and care for their children. Research proves that HIV treatment significantly reduces the risk of HIV transmission?with one study of African couples showing a 92% reduction in transmission among HIV positive people who were taking HIV treatment.

We demand that President Obama to live up to his campaign promises by pledging $50 billion for 5 years to fight global AIDS, including contributing the U.S. fair share to the Global Fund?which means an additional $1 billion over the period of the replenishment (2011-2013). This will also leverage commitments from other donor countries, since historically every dollar contributed by the US to the Global Fund has leveraged three additional dollars from other donors.

In addition to fully funding the Global Fund, we call on President Obama to support a Financial Transaction Tax (FTT) for health, which is already widely supported by other governments, including Germany and France. For example, a minor 0.005% tax on wholesale currency transactions and could raise $33 billion a year for global health and climate change. Even in this time of economic crisis, President Obama has found billions to bail out Wall Street and to continue wars?we urge him to find a way to do the same to save lives around the world.

We do not want Mr. Obama to be the president who chose not to defeat AIDS when it was possible?we want him to be the president who put us on track to defeat AIDS.

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1 in 5 gay men in US cities HIV+. 24/9/10

"We can't allow HIV to continue its devastating toll among gay and bisexual men, and in particular, among young black men."

24 September

Chicago - Nearly one in five gay and bisexual men in 21 major US cities are infected with HIV, and nearly half of them do not know it, US health officials said on Thursday.

Young men, and especially young black men, are least likely to know if they are infected with HIV, according to a study by the US Centres for Disease Control and Prevention (CDC).

"We need to re-invigorate our response to preventing HIV among gay and bisexual men," Dr Jonathan Mermin, director of the CDC's Division of HIV/Aids Prevention, said in a telephone interview.

"We can't allow HIV to continue its devastating toll among gay and bisexual men, and in particular, among young black men."

Mermin's comments echoed an Aids policy rolled out in July by the White House, that asked states and federal agencies to find ways to cut new HIV infections by 25%.

Prevalence and awareness

Researchers at the CDC studied 8 153 men who have sex with men in 21 US cities. The men were taking part in the 2008 National HIV Behavioural Surveillance System, which looked at prevalence and awareness of the human immunodeficiency virus or HIV, the virus that causes Aids.

Overall, they found that 19% of gay men were infected with HIV.

The study found that 28% of gay black men were infected with HIV, compared to 18% of Hispanic men and 16% of white men.

Black men in the study were also least likely to be aware of their infection, with 59% unaware of their infection, compared to 46% of Hispanic men and 26% of white men.

Age also plays a role. Among 18 to 29-year-old men, 63% did not know they were infected with HIV, compared to 37% of men aged 30 and older, the team reported in the CDC's weekly report on death and disease.

Risk

The CDC recommends that gay and bisexual men of all ages get an HIV test each year, and men at highest risk - those who have multiple sex partners or use drugs during sex - get tested every three to six months.

"This alarming new data provides further evidence that prevention efforts for gay men have not been adequate to meet the growing epidemic and should be dramatically scaled up," said Carl Schmid of the non-profit Aids Institute.

"The severity of the impact of HIV in the gay community is nothing new. What has been missing is an appropriate response by our government, at the federal, state and local levels, and the gay community itself," he said in a statement.

Mermin said some studies had shown that there was less urgency and fear associated with HIV infections than in the past, which may be due to the effectiveness of Aids treatment.

While not a cure, drug cocktails can keep patients healthy and can reduce the risk that they will infect other people.

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AIDS Waiting Lists Grow Amid Economic Woes. 7/7/10

"Over the last several months in the latter part of this recession, we have been averaging over 350 patients a month coming forward for assistance"

NPR

By Brenda Wilson
7 July 2010

It's a veritable pileup — a convergence of factors that's led to a long line of HIV/AIDS patients waiting for assistance to pay for the medicines that have helped them live longer and healthier lives.

Now, many people with HIV are losing jobs, along with insurance, or discovering that they are infected at a time when the AIDS Drug Assistance Program — ADAP — they depend on is being overwhelmed by demands being made on it. Federal and state budgets aren't meeting the challenge.

As of July 1, Georgia was the latest state to set up a waiting list for people applying for coverage. In June, Florida was forced to do the same. It now has more than 500 people waiting for help with paying for medications. Tom Liberti, the state's chief of the bureau of HIV/AIDS, tried to stave off the inevitable.

"Over the last several months in the latter part of this recession, we have been averaging over 350 patients a month coming forward for assistance," Liberti says.

Demand Increasing, But Not Funding

There are more than 1.4 million people unemployed in Florida, in addition to a population of 3.5 million uninsured. At the same time, the federal government has been expanding testing programs, pushing states to test millions of people for HIV and get people into treatment early.

"So, if you saw a picture of this, you would see that the demand and the number of patients coming forward has gone up dramatically, but the funding that pays for the pharmaceuticals and the drugs did not,” Liberti says.

ADAP provides assistance for nearly 170,000 people nationwide who can't afford the expensive AIDS drugs — and a lot of people can't on a working person's salary. The drugs mean that people with HIV can not only survive many years but also lead productive lives.

Federal and state ADAP budgets are determined on a year-to-year basis, and there have been minimal or no changes every fiscal year. In fact, states, facing budget shortfalls, are cutting back. More than 2,000 people in 12 states are now on waiting lists, and just as many states are tightening requirements for clients and limiting the list of drugs they will cover.

Struggling To Get Medication

These events were not on 46-year-old Mike Demory's mind in December when he moved to Victor, Mont., from Portland, Ore. In Oregon his medicines and part of his insurance premium were paid for by the state's ADAP.

"I moved here for my mother," Demory says, "My mother has a lot of health problems and I didn't do much investigating as far as what they had ... as plans for medications."

First, there was a monthlong wait to see a doctor. By that time, he says, "I had been without my medication for a month and a half, which is bad for a person [with] HIV."

During that time, the virus started coming back, but he had to get in line behind 18 people who were on Montana's list. He has slowly — month by month — been working his way to the top of it, even as it continues to grow.

Luckily, Demory still had a one-month refill back at a pharmacy in Oregon that was sent to him by mail. A case manager in Montana helped him apply for free drugs from pharmaceutical companies through the patient assistance programs that most companies have, which means that he has to apply to three different companies because each of the medications he relies on are manufactured by different pharmaceutical companies. Every 90 days, he will have to apply again for assistance to each of these companies.

People Living Longer

Waiting lists for ADAP aren't new. The program has been running over budget since a decade after its inception, but never have the lines been this long. Murray Penner of the National Association of State and Territorial AIDS Directors says it's not just the economy.

"The other factor driving that is just more people living longer, which is the obvious, and that's a good thing over time," Penner says. "It is something that has been coming over a long period of time since all of the new treatments have come into play."

In the past, federal and state governments would appropriate money for emergency assistance. Not this time. Penner says Congress has failed to respond to an appeal from the states for $126 million.

"Everybody is supportive. We've got letters with lots of sign-ons from representatives and senators saying we want more money, but no one is willing to stick their neck out and put more money towards the issue," Penner says.

So, state AIDS directors like Florida's Liberti say they're just hanging on until the next fiscal year.

"We don't want people to panic. We don't want people to make wrong decisions about getting tested or coming forward," he says. "I do believe that if the economy gets better and some additional federal resources come through, we can get by this. It's just unclear how long."

Under the new health care law, people who are not on ADAP and don't qualify for Medicaid would be eligible for subsidies for health care coverage, but that won't kick in until 2014.

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Africa: Bill Clinton Delivers Keynote Speech at AIDS Conference. 19/7/10

Offering his own thoughts on Barack Obama's criticised funding plan against Aids, Clinton defended the president's decision

19 July 2010

Bill Clinton made his voice heard Monday, delivering a keynote speech at the at the 18th International Aids Conference in Vienna. The former US president and veteran campaigner has attended every International Aids Conference since 2002.

In a reflective speech Clinton divulged his dreams for the future, which include climbing Kilimanjaro before the snow melts, running a marathon, as well as living long enough to see the birth of his grandchildren.

Poignantly he added his wish to "live to know that all the grandchildren of the world will have the chance in the not too distant future to live their own dreams and not die before their time."

Offering his own thoughts on Barack Obama's criticised funding plan against Aids, Clinton defended the president's decision, pinning the blame on the US congress for the perceived financial cut backs.

At the opening of the conference on Sunday, protesters chanted "Obama lies -- people die," accusing the president of backtracking on a campaign promise to spend some 50 billion dollars on Aids by 2013.

In an ultimatum Clinton stated:

"You have two options here, you can demonstrate and call the president names or we can go get some more votes in Congress to get some more money. There is no way the White House will veto an increase in funding for Aids."

On Monday the UN announced that Anti-HIV drugs reached a further 1.2 million more people last year.

Figures released on Sunday however, showed that rich countries in the grip of the recession in 2009 caused funding to dip.

In a video message at the opening ceremony UN Secretary General Ban Ki-moon warned that the "significant progress" in the 29-year war on Aids could be reversed if countries reigned in their funding efforts.

Whether Clinton's message will pack a punch only time will tell. On his position as ex-president and campaigner Clinton remarked "that's the great thing about not being president anymore, I can say whatever I want," before swiftly adding "of course, nobody cares what I say anymore, but I can say it!"

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Clinton to Activists: Get more Votes in Congress for AIDS Funding. 19/7/10

"You can demonstrate and call the president names, or we can go get some more votes in Congress to get some more money"

Science Speaks

By Donnely Globe
19 July 2010

“This is only the end of the beginning,” former President Bill Clinton said at the Monday morning plenary session of the International AIDS Conference in Vienna. “We have to transition now from what has essentially been a ‘make-it-up-as-you-go’ initial response to a calculated, long-term response.“

Part of that response, he said, is recruiting more well-trained health care workers. “Specifically, we need people who can do good work at a lower cost over a wider geographic range than doctors can do alone in poor countries, or that doctors and nurses can do alone.” Clinton also spoke about fighting the idea that there is a dichotomy between investing in HIV/AIDS treatment and prevention and investing in health care systems. Part of that involves showing that we are spending the money we do have effectively and wisely.

A few other recommendations he mentioned: challenging African nations to spend more on health, educating as well as advocating on the economic benefits of HIV treatment and prevention, cutting the cost of service delivery, and spending a higher percentage of donor aid on in-country services managed by local government or nongovernmental organizations.

At the Sunday evening opening ceremony, protesters marched into the session room and onto the stage with posters, flags and horns, chanting about keeping promises for AIDS funding. This was in response to recent budget proposals for FY2011 that indicate a retreat from the Obama administration’s promise to fund global AIDS at $50 billion over the next five years.

In response to the protesters, Clinton offered this advice, “You have two options here. You can demonstrate and call the president names, or we can go get some more votes in Congress to get some more money. My experience is that the second choice is the far better one and more likely to pay off,” Clinton said, adding, “There is no way the White House will veto an increase in spending for AIDS.”

 

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Obama's AIDS Strategy a Test of Will. 14/7/10

This country has a better record on fighting AIDS overseas than it does at home.

14 July 2010

This country has a better record on fighting AIDS overseas than it does at home. In 2003, Washington launched a $15 billion overseas effort to stem the outbreak in 15 hard-hit countries, but it neglected to focus on the plague here.

President Obama wants to change this disparity with his own domestic AIDS plan. It keys on testing, sending federal money where it's needed most, and setting a goal to cut infection rates by 25 percent.

It's gotten mixed reviews. Several AIDS groups, bothered that the epidemic has dropped from public view, are grateful for the White House emphasis. Others are angry that plan isn't calling for more spending.

On balance, the strategy is thrifty and targeted. Washington politics won't welcome another big-ticket health care item, worthy as this one may be. The Obama plan intends to work within the $19 billion worth of AIDS spending already on the books.

The package aspires to make a significant dent in the troubling fact that AIDS cases haven't dropped in years. About 56,000 - chiefly gay males, Latinos and African Americans - are infected each year by the virus that causes AIDS.

By insisting on widespread testing, the new policy tries to make more people aware of their condition as a way to cut new infections and provide treatment. Currently, 79 percent of those infected know their condition. The plan wants to raise the number to 90 percent.

The package also wants to put more people into clinical programs sooner. Life-extending drugs have blunted a condition once regarded as death sentence.

The new thinking was revealed a week in advance of an international AIDS gathering in Vienna. Also, the White House wants to improve relations with gay groups upset at its go-slow pace of ending discrimination in the military.

The plan sticks with the basics - testing and access to care - and avoids a divisive battle over new money. Those are the right ingredients for the next phase in the AIDS fight.

 

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HIV in the United States: An Overview. 6/10

Creating an overview of the HIV epidemic in the United States requires combining different indicators of the epidemic, such as prevalence, incidence, transmission rates, and deaths

6 June 2010

To download this article in PDF, click HERE (PDF, 194.09 KB, 4pg)

Creating an overview of the HIV epidemic in the United States requires combining different indicators of the epidemic, such as prevalence, incidence, transmission rates, and deaths. Therefore, this document uses multiple sources to provide a comprehensive picture of HIV in this country.

The number of people living with HIV infection in the United States (HIV prevalence) is higher than ever before.  CDC has estimated that more than 1 million (1,106,400) adults and adolescents were living with HIV infection in the United States at the end of 2006, the most recent year for which national prevalence estimates are available. This represents an increase of approximately 11% from the previous estimate in 2003 . The increase may be due to:

a higher proportion of people living with HIV infection knowing their status, and seeking care and antiretroviral treatment that can increase survival;

a higher number of people becoming infected with HIV than the number of people who die each year with HIV or AIDS.

Despite increases in the total number of people living with HIV infection, the annual number of new HIV infections (HIV incidence) has remained relatively stable in recent years.  According to the most recent incidence estimates, approximately 56,000 persons have been infected with HIV annually during the past decade. This estimate has been relatively stable since the late 1990s - despite more people living with HIV infection every year and, thus, increased opportunities for transmission to occur. CDC expects to release the next incidence estimates later in 2010.

The great majority of persons with HIV infection do not transmit HIV to others. CDC estimates that there were 5 transmissions per 100 persons living with HIV infection in the United States in 2006. This means that at least 95% of those living with HIV infection did not transmit the virus to others that year – an 89% decline in the estimated rate of HIV transmission since the peak level of new infections in the mid-1980s. The decline in transmission is likely due to effective prevention efforts and the availability of improved testing and treatments for HIV.  The lower transmission rate is what has enabled HIV incidence to remain stable despite increasing prevalence.

Estimated number of new HIV infections and persons living with HIV, 1977-2006.

Despite continued increases in the number of people living with HIV infection over time, HIV prevention efforts have helped to keep the number of new infections stable.

More people in the United States with HIV know of their HIV infection. The estimated proportion of persons in the United States with HIV who know they are infected increased from 75% in 2003 to 79% in 2006. This is a sign of progress for HIV prevention because research shows that most individuals reduce behaviors that could transmit HIV when they know they are infected.

Diagnoses of HIV infection reported to CDC have increased in recent years. In 2008, 41,269 persons were diagnosed with HIV infection in the 37 states with long term, confidential, name-based HIV infection reporting - an increase of 8% overall since 2005. The overall increase in diagnoses reported to CDC may be due to a number of reasons:

increases in HIV testing;

uncertainty inherent in statistical estimates;

an increase in incidence could account for at least some of the increase in diagnoses of HIV infection. However, available incidence estimates do not suggest an overall increase in new HIV infections in recent years.

The HIV diagnosis rate has remained stable in recent years. From 2005-2008, the annual estimated rate of diagnoses of HIV infection (the number of new HIV diagnoses per 100,000 persons) remained relatively stable, which is a result of increases in diagnoses of HIV infection and increases in the size of the US population during this period.

HIV disproportionately affects certain populations. Men who have sex with men (MSM), blacks/African Americans, and Hispanic/Latinos are the groups most affected by HIV infection.

MSM represent approximately 2% of the US population. However, MSM have an HIV diagnosis rate more than 44 times that of other men, and more than 40 times that of women.

MSM account for more than half of all new HIV infections in the United States and nearly 30,000 MSM are newly infected with HIV each year.

MSM is the only risk group with increasing annual numbers of new HIV infections.

From 2005-2008, estimated diagnoses of HIV increased approximately 17% among MSM. This increase may be due to a combination of factors: increased incidence, increased testing, and diagnosis earlier in the course of infection. These increases may also be affected by the degree of uncertainty inherent in statistical estimates.

Blacks/African Americans are the racial/ethnic group most affected by HIV. Blacks/African Americans represent approximately 12% of the US population, but account for almost half of all new HIV infections.

At some point in their life, 1 in 16 black/African American men will receive a diagnosis of HIV, as will one in 30 black women.

The rate of new HIV infection for black/African American men is six times as high as that of white men, nearly three times that of Hispanic/Latino men, and more than twice that of black/African American women.

The rate of new HIV infection for black/African American women is nearly 15 times as high as that of white women, and nearly four times that of Hispanic women.

From 2005-2008, estimated HIV diagnoses increased approximately 12% in blacks/African Americans. This may be due to increased testing or diagnosis earlier in the course of HIV infection; it may also be due to uncertainty inherent in statistical estimates.

From 2005-2008, the rate of HIV diagnoses among blacks/African Americans increased from 68/100,000 persons to 74/100,000.

Hispanics/Latinos represent 13% of the population, but account for an estimated 17% of new infections.

The rate of new HIV infection among Hispanic/Latino men is more than double that of white men.

The rate of new HIV infection among Hispanic/Latina women is nearly four times that of white women.

From 2005-2008, estimated HIV diagnoses increased approximately 5% among Hispanics/Latinos. However, this increase is within the boundaries of normal fluctuations and may be due to uncertainties inherent in statistical estimates.

The rate of HIV diagnoses among Hispanic/Latinos decreased, most likely reflecting the growing population of Hispanics/Latinos in the United States.

Despite many prevention and treatment successes, people are still dying from AIDS. HIV remains a significant cause of death for some populations. For example, in 2006, HIV was  the third leading cause of death for black males and black females aged 35-44 and the fourth leading cause of death for Hispanic/Latino males and females in the same age range. Further, MSM are strongly affected by HIV and represent the majority of persons with an HIV diagnosis who have died in the United States.

Overall, more than 576,000 persons with an AIDS diagnosis in the United States have died since the beginning of the epidemic through 2007 (the most recent year that death data are available) [6].   From 2005 through 2007, deaths of persons with a diagnosis of HIV infection have increased 17% and the estimated rate of deaths increased 14%. Interpreting data regarding deaths of persons with a diagnosis of HIV can be difficult because many factors can affect the data. For example

the increases may be influenced by significant efforts that have been made to improve death reporting by state HIV surveillance programs;

the number of people living with HIV infection has increased over time, so the number of deaths would also be expected to increase;

the group of persons living with HIV infection is aging, which may result in an increased number of deaths from any cause, including those unrelated to HIV infection.

there are uncertainties inherent in statistical estimates.

Too many people are diagnosed with HIV late in the course of infection. Despite an increase in persons getting diagnosed with HIV earlier in the course of their infection [9], far too many continue to be diagnosed late. In 2008, about one-third (32%) of individuals with an HIV diagnosis reported to CDC received a diagnosis of AIDS within 12 months of their initial HIV diagnosis . These late diagnoses represent missed opportunities for treatment and prevention.

AIDS disproportionately affects different parts of the country. HIV and AIDS have had a severe impact on all regions of the country. It remains mostly an urban disease, with the majority of individuals diagnosed with AIDS in 2008 residing in areas with more than 500,000 people. Areas hardest hit (by ranking of AIDS cases per 100,000 people) include Miami and Jacksonville, Florida; New Orleans and Baton Rouge, Louisiana; Baltimore, Maryland; and Washington DC. However, due to differences in population sizes, rates do not always highlight the large number of people diagnosed with AIDS in certain metropolitan areas, such as New York City or San Francisco.

Currently, only 37 states have collected HIV diagnosis data from name-based HIV reporting systems for a sufficient length of time (defined as being submitted to CDC since at least January 2005) to be included in CDC’s HIV surveillance estimates. However, CDC’s AIDS data are representative of all 50 states and the District of Columbia. The 2008 HIV Surveillance report contains HIV and AIDS tables that include 50 states, Washington DC, and 5 US territories (American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and the US Virgin Islands). National prevalence estimates (number of persons living with HIV infection) are also for the 50 states and DC, as are estimates for incidence (the number of new HIV infections) and transmission rate (the number of HIV transmissions per 100 people).

Key References that Explain the HIV Epidemic in the United States

Following are some of the key indicators of HIV disease in the United States and the references that best explain them.
HIV incidence in the United States: Hall HI, Song R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA 2008;300(5):520-529.

HIV incidence in the United States by subpopulation estimates: CDC. Subpopulation estimates from the HIV Incidence Surveillance System—United States, 2006. MMWR 2008. 57(36);985-989.

HIV prevalence in the United States: CDC. HIV prevalence estimates—United States, 2006. MMWR. 2008;57(39):1073-1076.
Estimate of undiagnosed persons with HIV in the United States: Campsmith, ML, Rhodes PH, Hall HI et al. Undiagnosed HIV prevalence among adults and adolescents in the United States at the end of 2006. J Acquir Immune Defic Syndr. 2010;53(5):619-624.
HIV transmission rates: Holtgrave DR, Hall HI, Rhodes PH, et al. Updated annual HIV transmission rates in the United States, 1977-2006. J Acquir Immune Defic Syndr 2009;50(2):236-238.
Lifetime risk of HIV infection: Hall, HI, An Q, Hutchinson A, et al. Estimating the lifetime risk of a diagnosis of the HIV infection in 33 states, 2004-2005,Link to non-CDC web site J Acquir Immune Defic Syndr 2008;49(3):294-297.

Deaths from HIV:

NCHS. Deaths: Final data for 2006. Statistics Reports 2009;57(14).
Estimate of number of MSM in the United States and MSM’s rates of HIV and syphilis: Purcell DW, Johnson C, Lansky A, et al.  Presented at 2010 National STD Prevention Conference; Atlanta, GA. abstract #22896.

The following indicators can be found in the CDC’s HIV Surveillance Report (CDC. HIV Surveillance Report, 2008; vol 20.)

Diagnoses of HIV infection in the United States (37 states and 5 US dependent areas)
Persons living with a diagnosis of HIV infection (37 states and 5 US dependent areas)
AIDS diagnoses in the United States and 5 US dependent areas
Persons living with an AIDS diagnosis in the United States and 5 US dependent areas
Deaths of persons with a diagnosis of HIV infection or AIDS
Time to AIDS diagnosis after a diagnosis of HIV infection (late HIV diagnoses)
Survival time after diagnosis of HIV infection or AIDS
Geographic information (United States) on distribution of diagnoses of HIV infection or AIDS

References

CDC. HIV prevalence estimates—United States, 2006. MMWR. 2008;57(39):1073-1076.
Hall HI, Song R, Rhodes P, et al. Estimation of HIV incidence in the United States. JAMA 2008;300(5):520-529.
Holtgrave DR, Hall HI, Rhodes PH, et al. Updated annual HIV transmission rates in the United States, 1977-2006. J Acquir Immune Defic Syndr 2009;50(2):236-238.
Campsmith, ML, Rhodes PH, Hall HI et al. Undiagnosed HIV prevalence among adults and adolescents in the United States at the end of 2006. J Acquir Immune Defic Syndr. 2010 Apr;53(5):619-24.
Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr 2005;39:446-453.
New diagnoses are not the same as new infections (incidence). A person can be infected with HIV for years before being diagnosed.
CDC. National Health Interview Survey, 2008: Early Release of Selected Estimates. Tables 10.1, 10.2, 10.3. Accessed 19 May 2010.
Purcell DW, Johnson C, Lansky A, et al. Presented at 2010 National STD Prevention Conference; Atlanta, GA. abstract #22896. Accessed May 4, 2010.
The MSM rates were calculated using the methodology described in reference #9, which is different than the methodology used to calculate the other rates in this fact sheet, which are based on population estimates from the US Census Bureau.
CDC. Late HIV testing—34 states, 1996–2005. MMWR 2009;58:661-665.
MSM accounts for a higher proportion of testing for acute (newly acquired) infection relative to other risk groups.
Hall, I, An Q, Hutchinson A, et al. Estimating the Lifetime Risk of a Diagnosis of the HIV Infection in 33 States, 2004–2005.Link to non-CDC web site  J Acquir Immune Defic Syndr. 2008;49(3):294-297.
Deaths of persons with a diagnosis of HIV or AIDS may be due to any cause, not necessarily HIV disease.
 

 

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USA: CDC Releases 2008 HIV Surveillance Report. 14/6/10

Today, the Centers for Disease Control and Prevention (CDC) released its HIV Surveillance Report, 2008 Vol. 20. This report presents data for cases of HIV infection and AIDS reported to CDC through June 2009.

14 June 2010

CDC’s 2008 HIV Surveillance Report is intended for use by epidemiologists, researchers, public health practitioners, and others as one source of information to help guide program planning, evaluation, and resource allocation.

To put the surveillance report’s findings in context, as well as to explain some of the changes to this year’s surveillance report, CDC also is releasing two fact sheets: HIV in the United States: An Overview, which draws on multiple sources to provide an overall picture of the HIV epidemic in the United States; and Summary of Changes to the National HIV Surveillance Report, which describes and explains changes to the surveillance report.

CDC’s 2008 HIV Surveillance Report and both fact sheets are posted on the web site of the Division of HIV/ AIDS Prevention.

In addition to new data, CDC’s2008 HIV Surveillance Report has some new elements. Based on feedback from partners and issues such as the 2008 changes to the HIV case definition, the report has undergone some structural changes from previous years’ reports.

There are now 42 areas (37 states and 5 dependent areas) that have been reporting confidential, name-based HIV infection data to CDC long enough (defined as being submitted to CDC by at least January 2005) to apply statistical adjustments to the data and be included in CDC’s estimates in this report. According to the number of reported AIDS cases, these 37 states represent approximately 68% of the epidemic in the 50 states and the District of Columbia.

Advancing technologies and effectiveness of highly active antiretroviral therapy (HAART) is changing the epidemic of HIV infection so people are living longer and healthier lives. Therefore, to accurately track the epidemic, growing emphasis needs to be placed on HIV surveillance more than on AIDS surveillance, a gradual process that is reflected in changes to the report, such as renaming the report the HIV Surveillance Report.

Most data analyses are presented in two formats: one that includes data from the dependent areas (American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands) and one that is presented without the data from the dependent areas. This change makes better use of data from the dependent areas, which previously were not included in breakouts by age, race/ethnicity, transmission category or sex.

Other changes are outlined in the Summary of Changes to the National HIV Surveillance Report fact sheet.

Almost 30 years after the first case of AIDS was reported, HIV remains a significant cause of illness and death. Through our collective work, we have made great progress in slowing the epidemic. But within the overall epidemic, some groups and areas are more affected than others. Therefore, we must remain vigilant and focus our resources where they will make the biggest difference.

We hope this report will be useful to you as we continue to work together to reduce this unacceptable burden of HIV/AIDS. Thank you for your continued commitment to HIV/AIDS prevention.

Please visit this site to access CDC’s 2008 HIV Surveillance Report, and the fact sheets HIV in the United States: An Overview and Summary of Changes to the National HIV Surveillance Report.

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HIV Still Plagues the U.S.: Some Areas Have Higher Rates Than Africa. 26/2/10

More than 1 in 30 adults in Washington, D.C., are HIV-infected—a prevalence higher than that reported in Ethiopia, Nigeria, or Rwanda.

Newsweek

By Jaime Cunningham
26 February 2010

In December, NEWSWEEK argued that new signs of life were showing in the AIDS activism movement. Let's hope so. Recent research published in The New England Journal of Medicine shows that within certain populations in America, the prevalence of HIV-infected people is higher than in certain parts of Africa:

More than 1 in 30 adults in Washington, D.C., are HIV-infected—a prevalence higher than that reported in Ethiopia, Nigeria, or Rwanda. Certain U.S. subpopulations are particularly hard hit. In New York City, 1 in 40 blacks, 1 in 10 men who have sex with men, and 1 in 8 injection-drug users are HIV-infected, as are 1 in 16 black men in Washington, D.C. In several U.S. urban areas, the HIV prevalence among men who have sex with men is as high as 30%—as compared with a general-population prevalence of 7.8% in Kenya and 16.9% in South Africa.

What’s interesting is that the research shows that a person’s sexual network, more than just his or her lifestyle choices, defines the risk of getting HIV in America. So, black and Hispanic women are at increased risk due to the instability of their sexual relationships —which is attributed to the high rate of incarceration of men in their networks—and their vulnerable or dependent economic situation, which may cause them to be fearful of suggesting safer-sex options to their companions. And black men who have sex with men are at high risk because of the likelihood of their choosing to engage in sexual activity with someone who is racially similar, and because of the prevalence of HIV within their sexual networks.

America’s epidemic most strongly affects the urban regions of the Northeast and West Coast, and small towns and cities in the South. Part of this is because these local populations have unprotected sex within “relatively insular social-sexual networks.” Lower-income black Americans with poor education and unstable housing are disproportionally affected, and black or Hispanic women make up more than 25 percent of new HIV infections in the U.S.

More than 20 percent of the estimated 1 million HIV-positive Americans are unaware of their status. Additional behavioral studies, better communication, and preventive education need to be directed toward the identified at-risk communities. It’s time to admit that HIV is still a major threat to Americans.

 

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US Puts Locals in Charge of AIDS Spending. 4/2/10

U.S. and South African AIDS workers say putting more of the decision-making in local hands can help stretch donor money, amid concerns international giving will be limited because of the global recession.

Times Live

4 February 2010
By DONNA BRYSON, Sapa-AP

U.S. and South African AIDS workers say putting more of the decision-making in local hands can help stretch donor money, amid concerns international giving will be limited because of the global recession.

Since 2004, the U.S. government has funded a project for AIDS patients in rural South Africa through Catholic Relief Services, the charity arm of the Catholic Church in the United States.

In a significant shift made official this week, the U.S. will now directly pay South Africans with whom the U.S. Catholics have been working.

What may seem like a small bureaucratic step is significant, said Ruth Stark, head of CRS in South Africa. She said that instead of channeling U.S. funds to South Africans, CRS would now serve as a partner for monitoring, clinical and other services, and would now be paid by the South Africans.

"The person in charge, who is the local partner now, they decide what they need and they pay for it," Stark said in an interview Thursday.

Stark said she has already seen savings as officials prepared for the hand-over. Local instead of international experts were tapped for some jobs, for example.

"The cost difference is huge," Stark said.

In the future, the overhead costs of an international organization's branch office - salaries at international level, housing and education benefits - would be saved.

South Africa, a nation of about 50 million, has an estimated 5.7 million people infected with HIV, the virus that causes AIDS, more than any other country. It is the largest recipient of funds from the President's Emergency Plan for AIDS Relief, PEPFAR, the main U.S. program for international AIDS programs.

After years of foot-dragging on AIDS, South Africa last year set a target of getting 80 percent of those who need AIDS drugs on them by 2011. The government also has called for earlier and expanded treatment for HIV-positive South Africans, and pledged to step up testing for HIV.

The CRS project has reached 73,000 people since 2004, of whom 35,000 have received AIDS drugs, Stark said. Other services include support for children orphaned by AIDS.

The South African groups who have been working with CRS are in some of the poorest and hardest to reach areas of the country. They include the AIDS office of the Southern African Catholic Bishops' Conference, the Institute of Youth Development of South Africa, which operates in southeastern South Africa, and St. Mary's Hospital in KwaZulu-Natal, the South African province hardest hit by AIDS.

These groups received more than $25 million PEPFAR funds last year channeled through CRS, and will get about the same directly this year, Stark said.

Connie Kganyaka, chief director of the AIDS office of the South African government's social development office, said the possibility of foreign funding dropping was "a big concern for South Africa."

She told The Associated Press that the South African government has thus increased their funding to AIDS organizations. Money to help children orphaned by AIDS had increased from 7 million rand when she first joined her department in 2004 to almost 1 billion rand (about $130,000) today.

She said South Africa also was looking for sources beyond the U.S., including its own entrepreneurs in a country seen as the continent's economic hub.

"We think our private sector has the capacity," she said. But she added the day when South Africa could do without foreign funding was a long way off.

At the hand-over ceremony in Johannesburg Wednesday, Alison Munro, a nun who directs the Southern African Catholic Bishops' Conference AIDS office, said the partnership between donors and groups like hers was crucial.

"We have the people," Munro said. "They have the money."

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Strategy Shifts on Global Health. 1/2/10

HIV/AIDS Remains Priority, but New Emphasis Is Planned for Tropical Diseases and Efficient Care

1 February 2010
By Betsy Mckay

The Obama administration is expected to propose in its fiscal 2011 budget Monday new funding to combat preventable and tropical diseases, malnutrition and other conditions afflicting the world's poor, as part of a strategy to broaden its approach to global health.

The new policy, details of which the administration plans to release along with the budget, retains HIV/AIDS as the administration's top funding priority, but will devote new funding to reducing deaths from complications related to pregnancy or childbirth, poor nutrition and common treatable illnesses that kill millions every year, particularly women and children, according to people familiar with the new plan.

The strategy also seeks to work more closely with individual countries to help strengthen their own health-care systems, and to integrate programs that are now focused on individual diseases. The hope is to make care more efficient and easy, so that, for example, a woman doesn't have to go to one clinic for AIDS treatment, another for prenatal care, and still another for her young child's care, people familiar with the plan say.

Improving health systems has taken on new urgency in the aftermath of the earthquake in Haiti, where thousands may have died because of a lack of adequate hospital care, and women and children are now at particular risk of disease, global health experts say.

The details of the new plan will fill in a pledge by President Barack Obama in May to request $63 billion between 2009 and 2014, including $51 billion to combat HIV/AIDS and malaria, and $12 billion for other priorities, including maternal and child health.

While the bulk of funding will go toward HIV/AIDS, AIDS advocates are concerned the administration is scaling back an aggressive initiative launched by President George W. Bush in 2003. Funding for HIV/AIDS programs is still rising, but the increase has slowed. Mr. Obama's fiscal 2010 budget requested a $165 million increase in funding for the President's Emergency Plan for AIDS Relief, or Pepfar, the program established by Mr. Bush. The government committed nearly $19 billion for the program between 2004 and 2008, and it had enrolled about 2.4 million people into drug therapy by the end of last year.

Advocates said they would be watching closely on Monday for details of the new plan. A broader global health strategy is "great, but not at the expense of AIDS spending," said Paul Zeitz, executive director of the Global AIDS Alliance.

Administration officials declined to discuss specific funding requests before Monday's release of the proposed budget. But they stressed that HIV/AIDS remained the cornerstone of the administration's global health strategy, and said the new plan wasn't meant to trade one priority off against another. Further reducing deaths from AIDS, malaria and tuberculosis will require strengthening health systems in individual countries, they say, giving them greater capacity to fight these killer diseases.

"This isn't a trade-off; this is a holistic view of health," said a senior administration official, calling it "absolutely consistent with building and strengthening the Pepfar program."

Preventing mother-to-child transmission of HIV will be an important part of the new policy's focus on maternal and child health, for example; approximately 60% of those infected with HIV in sub-Saharan Africa are women, the official noted.

Some global health experts praised the new attention the U.S. is devoting to maternal and child health. Focusing on the health needs of mothers and children will improve health systems overall, they say. "It's not something you can do on a campaign basis, like polio," said Nils Daulaire, professor of global health at the University of Washington, who was president and chief executive of the Global Health Council and a senior official in the Clinton administration. "You've got to have an operating, capable health system open 24 hours a day, seven days a week."

Among initiatives targeted for increased funding are family planning, to prevent some of the 52 million unintended pregnancies each year, and the reduction or elimination of tropical diseases such as lymphatic filariasis, a parasitic disease that affects more than 120 million people world-wide, and onchocerciasis, or river blindness.

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HIV/AIDS among Older Americans. 23/7/09

Examiner

The world has this idea that only the young can get HIV/AIDS, but the truth is NO ONE is immune to this disease. One big factor is that older Americans have less knowledge about sexually transmitted diseases than their younger counterparts. They are less likely to talk about their sex lives among their peers or to health care professionals. Another shocker is that health care professionals rarely  talk about HIV/AIDS, offer testing, or provide education on what exactly HIV/AIDS is to the older population. Whether we want to believe it or not...they have sex!!!  Women who have been though menopause, getting pregnant is no longer a worry and the use of condoms become a non issue for her. Or you may have the older man who is recently divorced looking for a younger woman to spice up his life. This last example goes for women as well. Seniors are not protecting themselves, and this leaves them extremely vulnerable.
According to the National Prevention Information Network (NPIN), 19% of people with HIV/AIDS are over the age of 50. Now this may very well be because of the new advancements in the types of drugs that many people that are living with HIV/AIDS have available to them. But it is uncertain as to how many of that 19% have recently been infected with this disease. With age the immune system becomes weakened and when you add HIV/AIDS to the picture it makes for a more compromised immune system. HIV/AIDS commonly goes undetected in the older population because they are misdiagnosed by health care professionals. A lot of the symptoms may be brushed off as common signs of aging.

It truly is difficult to get through the day without reading, seeing or hearing about sex, be it on TV, the radio and of course the World Wide Web. It has become the norm in our society. It is promoted as if it were fireworks on the 4th of July. But with that ,comes a great responsibility of education. According to Avert in 2007, in New York State there were 46,390 reported cases of people living with HIV and 75,253 reported cases of people living with AIDS. In the Buffalo-Niagara Falls Area there were 2,598 people living with AIDS. Now imagine all the people who haven't been tested that are HIV positive having unprotected sex and are over the age of 50...Very scary! There are places that offer free anonymous testing like AIDS Community Services located at 206 South Elmwood Ave Buffalo, NY. You can also go to ECMC where they provide testing as well. Both of these places will also provide education and counseling if needed.

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Obama Lifts 'Mexico City' Policy, Could Affect HIV/AIDS Efforts. 26/01/09

[Jan 26, 2009]
 

 President Obama on Friday issued an executive order repealing the "Mexico City" Policy, which banned U.S. funding for international health groups that use their own funds to perform abortions, lobby their governments in favor of abortion rights or provide counseling about terminating pregnancies, the Washington Post reports. Obama also said that he would work with Congress to restore funding to the United Nations Population Fund to prevent HIV/AIDS, reduce poverty, and improve health care access for women and children in 154 countries. The Post reports that Obama's decision was praised by women's health advocates, family planning groups and others for allowing USAID to fund programs that offer HIV prevention and care, birth control and medical services (Stein/Shear, Washington Post, 1/24).

According to Reuters, critics of the "Mexico City" Policy say that the restrictions have resulted in large reductions in funding for organizations worldwide that provide family planning services and basic health care. For example, the Center for Reproductive Rights reports that in Ethiopia and Lesotho, some nongovernmental organizations are not able to offer comprehensive and integrated health services to people living with HIV/AIDS (Mason/Charles, Reuters, 1/23).In a related San Francisco Chronicle opinion piece, Shalini Nataraj of the Global Fund for Women writes of one operation in Ghana that lost funding because it refused to adhere to the "Mexico City" Policy, resulting in an estimated 600,000 people losing access to HIV/AIDS prevention education, counseling and family planning services.

The effects of the policy have been "compounded" by a requirement in the President's Emergency Plan for AIDS Relief that organizations receiving funding must oppose commercial sex work, Nataraj writes, adding that the "reasoning behind this pledge is that by denying services or outreach to those who work as" commercial sex workers, such work "will be abolished and HIV/AIDS will be reduced." She writes that the "reality is otherwise, because women enter sex work for a variety of deeply entrenched sociocultural and economic reasons that must be addressed before [commercial sex work] can be reduced. This means that organizations that work with sex workers are threatened with a loss of funding for serving those most in need of information and protection from HIV/AIDS" (Nataraj, San Francisco Chronicle, 1/26).

Reprinted from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv . The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

 

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Obama Administration Requests Dybul To Resign as PEPFAR Administrator. 26/01/2008

Jan 26, 2009

 The Obama administration has requested that Mark Dybul immediately resign from his position as U.S. Global AIDS Coordinator and administrator of the President's Emergency Plan for AIDS Relief, CQ HealthBeat reports. An e-mail sent Thursday to U.S. foreign aid officials said that Dybul is "no longer serving" as PEPFAR administrator and that the Office of the Global AIDS Coordinator "will continue to function under the leadership of career staff until a successor is confirmed."
Dybul has overseen PEPFAR, which Congress reauthorized in July 2008 for an additional five years, since 2006. Dybul in an e-mail to his staff earlier this month said he would continue to serve as PEPFAR administrator, at least temporarily, "beyond the inauguration" of President Obama. According to CQ HealthBeat, many global health advocates were disappointed by the earlier announcement that Dybul would continue to serve as the U.S. Global AIDS Coordinator (Semnani, CQ HealthBeat, 1/23).

Reprinted from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv . The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

 

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PEPfAR

In 2003, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) was launched to combat global HIV/AIDS - the largest commitment by any nation to combat a single disease in history.

PEPFAR plans to work in partnership with host nations until 2013 to support:

  • Treatment for at least 3 million people
  • Prevention of 12 million new infections
  • Care for 12 million people, including 5 million orphans and vulnerable children
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US AIDS Program in Africa: ‘Massive Entitlement’ or Biggest Success of 50 Years? 23/1/2017

Published by CSMONITOR

The Trump Administration has expressed divergent views about the program, leaving beneficiaries across the continent uncertain about its future at a crucial junction in the global fight against HIV.

Fifteen years ago, there was no shortage of ways to measure the growing scale of the HIV crisis here. It was visible in the country’s spiraling death toll and its overburdened hospitals, in the sputtering proclamations from the country’s president and health minister claiming that HIV drugs were “poison,” and in their recommendations of a treatment of rest and good diet.

But for David Clark, a South African doctor and HIV researcher, there was perhaps no starker measure of the epidemic’s destructive path than the rapid growth of the massive cemetery hugging one of Johannesburg’s major highways, where he watched new graves shoot up like wildflowers and the soil become pockmarked with dozens of gaping holes – a queue of newly dug graves waiting be filled.  

“The weekly advance of that cemetery in those years was absolutely tangible,” says Mr. Clark, now CEO for southern Africa at the Aurum Institute, which works on HIV treatment and prevention in the region. “You could see the march of those gravestones visibly every time you passed.”

A decade and a half later, however, South Africa, once ground zero for the disease, has become one of the world’s great HIV success stories. The disease now accounts for less than one-third of all deaths in the country, down from half in 2005, and life expectancy has climbed by nearly a decade. In a brisk turnaround from its denialist days, the country also now has by far the largest public antiretroviral treatment program in the world, serving more than 3 million people.

And the country owes those successes at least in part to a massive George W. Bush-era aid program known the President’s Emergency Plan for AIDS Relief (PEPFAR), which since 2003 has funneled more than $72 billion into the fight against HIV globally, and nearly $5 billion into South Africa alone. 

Although PEPFAR has attracted significant criticism over the years – much of it around the moralizing bent of some of its early funding provisions  – it is nearly universally regarded, even by detractors, as a turning point in the AIDS epidemic here.

“It’s not every day in global health where a program gets to essentially say they’ve turned the tide on an epidemic, and that’s what PEPFAR has done,” says Sharonann Lynch, HIV and TB policy adviser for Doctors Without Borders' access campaign. “When PEPFAR was announced, you didn’t have anyone talking about ending AIDS – and now that’s exactly what the US and other governments have committed to. They can see it in sight.”

It is, says Clark, “the single most important health care intervention in the world in the past 50 years.”

Provocative questions

But the Trump Administration has expressed divergent views about the program, leaving beneficiaries across the continent uncertain about its future at a crucial junction in the global fight against HIV.

During Rex Tillerson’s confirmation hearing for secretary of State, for instance, he called PEPFAR “one of the most extraordinarily successful programs in Africa.” But in a questionnaire about US-Africa policy distributed by Trump’s transition team to the State Department earlier this month and later obtained by The New York Times, Trump officials appeared to express concern over the size and scope of PEPFAR going forward.

“Is PEPFAR worth the massive investment when there are so many security concerns in Africa?” the questionnaire asked. “Is PEPFAR becoming a massive, international entitlement program?”

For the Trump team, the provocative framing of those questions may simply have been an attempt to boldly challenge assumptions about the utility of America’s aid programs in Africa.

But for many living and working in the epidemic’s heart, the queries felt simplistic – at times, even condescending. If PEPFAR was saving millions of lives, what did it mean, they wondered, to ask if the investment was “worth” it?

“We have made incredible progress, but now we must be very careful not to reverse it,” says Linda-Gail Bekker, president of the International AIDS Society and a professor of medicine at the University of Cape Town in South Africa. “If we turn our backs now, we’re going to look back in 15 years and ask how, just when we were beginning to claw our away out of this tragedy, we let it slip away.”

Casting PEPFAR as an entitlement program, meanwhile, struck many here as far too narrow.

“This disease knows no borders, so to look at PEPFAR as an entitlement program that only benefits Africans [and other direct PEPFAR beneficiaries] would be a huge mistake,” says Olive Shisana, a South African scientist who has directed several HIV research organizations and projects. “We live in an integrated world. Bringing an end to HIV benefits the health of the US as well.”

That perspective, she adds, obscures the work that African activists, researchers, and governments have done over the past decade to push PEPFAR to become more collaborative, responsive not just to the interests of politicians in Washington, but also those living in the eye of the storm.

In the early days of the program, for instance, PEPFAR often seemed to approach AIDS as “a moral issue as much as a public health issue,” says Kikonyogo Kivumbi, executive director of the Uganda Health and Science Press Association, a network of LGBT health activists.

In line with the social conservatism of George W. Bush Administration, early PEPFAR regulations stipulated that one-third of all PEPFAR money spent on HIV prevention efforts must go to teaching abstinence, and forced recipient organizations to sign an anti-prostitution pledge.

“You were telling people how they had to behave if they wanted to live,” Mr. Kivumbi says.

But over time, activists in both the US and Africa pushed back against the stipulations, with the restrictions eventually ending. “We fought a long fight to contest those kinds of exclusions,” he says, adding that the program is better for it. (Recent research has shown that the $1.4 billion spent by PEPFAR on abstinence education, for instance, almost universally failed to reduce HIV prevalence. PEPFAR’s most recent description of its work, meanwhile, claims “we will work to leave no population at greatest risk behind.”)

In recent years PEPFAR has largely pivoted toward bulking up local health systems in AIDS-affected countries and training local personnel. 

Sisonke Msimang, a South African writer and activist who previously ran the HIV and AIDS program at the Open Society Foundation for Southern Africa, says the Trump Administration’s views on PEPFAR "aren’t entirely wrong … the development paradigm is broken," and needs rethinking, in part because of the imbalance in power relationships that aid may foster.

African governments must ask themselves difficult questions, she says, about how they can grow more self-sufficient in funding and developing HIV treatments and prevention strategies. That’s a process that will require both “better and bolder activism from above – from African and US governments – and from below, from African people,” she says.

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Harnessing the Data Revolution for an AIDS-Free Generation. 14/4/2016

Published by HUFFPOST IMPACT

2016-04-13-1460554347-2335010-SmilingChildrenatPEPFARevent.jpg

A data revolution is underway at the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). We’re using data in transformational ways to prevent more HIV infections and save more lives, ensuring our investments have the greatest impact by targeting lifesaving interventions to the populations and places with the highest HIV/AIDS burden. By collecting local-level granular data, more frequently, and analyzing it through innovative approaches, we’re accelerating progress toward reaching the bold HIV prevention and treatment targets set by President Obama last September and, ultimately, achieving our globally agreed goal: end the AIDS epidemic by 2030.

Transparency is one of the critical factors for data to be truly useable and actionable. That’s why we are committed to opening as much of our data that we can, while protecting individual and community confidentiality. We’ve taken great strides to increase transparency, as evidenced by the recently released 2016 Aid Transparency Index, on which PEPFAR’s score has risen by more than 40 points since 2013. And we’re far from finished. We’re continuing to challenge ourselves to open even more data to the public, leading by example to drive greater impact, transparency, and accountability.

Earlier this year, in our quest to provide more granular data, we published 2015 PEPFAR’s annual program results (APR) at the subnational level by country. These data display results by district/county across program indicators and through the use of country maps, enabling our partners and stakeholders to view, download, and utilize PEPFAR data in more accessible ways. We’re also making data more visually-accessible through geospatial modeling and mapping.

Equally important, to be impactful, data must be timely. That’s why this summer PEPFAR will release subnational data that reflect current program implementation. As part of the PEPFAR Oversight and Accountability Review Team (POART) process, we’re prioritizing the frequency of data sharing by releasing preliminary data at quarterly intervals instead of waiting for the end of fiscal year final results. In addition, future versions of the PEPFAR Dashboards will go beyond national level data to include state and provincial level data, with quarterly updates that allow for program adjustments in real time. We want our partners and stakeholders to use this data to interrogate and improve their work - and ours.

Building on our data-driven approach, PEPFAR is working with partner country government, civil society, multilateral, and private sector partners through theGlobal Partnership for Sustainable Development Data to fill critical data gaps and invest in capacity building for data collection and analysis in support of the Sustainable Development Goals (SDGs). Through the Global Partnership, PEPFAR is collaborating with innovators to fuel data-driven decision making, including to drive forward, SDG 3 (improving good health and well-being) and SDG 5 (promoting gender equality). PEPFAR is also working closely with the Millennium Challenge Corporation toward establishing Data Collaboratives for Local Impact in several sub-Saharan African countries. Finally, PEPFAR is joining the recently launched Health Data Collaborative that will address key global health data gaps and challenges. All of these collaborative efforts will use data on HIV/AIDS, global health, gender equality, and economic growth to improve programs and policies

Over the past two years, we’ve made considerable progress in leveraging data to prevent more new HIV infections and save more lives. But we’re not satisfied. PEPFAR remains deeply committed to data-driven decision-making, mutual accountability, transparency, and ensuring our programs have clear and deliberate impact. And amidst the statistics and spreadsheets, we must always remember that each data point represents one of the millions of men, women, and children that we serve. At the end of the day, that’s what harnessing the data revolution is all about.

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Statement By National Security Advisor Susan E Rice on New Pepfar Targets. 29/09/2015

Published at Aids.Gov

26 September 2015


 

We are at a pivotal moment in the global fight against HIV/AIDS. Globally, both new HIV infections and AIDS related deaths are down by more than 40 percent since their peak. This Administration has invested nearly $50 billion through the President’s Emergency Plan for AIDS Relief (PEPFAR) to achieve an AIDS-free generation, building on the initiative and $15 billion provided by President Bush. Working with partner countries around the globe, we are now supporting life-saving antiretroviral treatment for 7.7 million men, women, and children worldwide; enabled more than one million babies to be born HIV-free; and tested and counseled more than 14 million pregnant women last year alone.

Today, we are setting a bold, new course by announcing ambitious PEPFAR prevention and treatment targets for 2016 and 2017.

The United States is committing resources to ensure PEPFAR will by the end of 2017 support 12.9 million people on life-saving anti-retroviral treatment, provide 13 million male circumcisions for HIV prevention, and reduce HIV incidence by 40 percent among adolescent girls and young women within the highest burdened areas of 10 sub-Saharan African countries.

No greater action is needed right now than empowering adolescent girls and young women to defeat HIV/AIDS. Every year, 380,000 adolescent girls and young women are infected with HIV—7,300 every week, over 1,000 every day. This must change.

Today, we are announcing that PEPFAR is now investing nearly half a billion dollars to support an AIDS-free future for adolescent girls and young women.

Over the last 15 years, we have seen remarkable results as we have worked together toward achieving the Millennium Development Goals. PEPFAR’s new targets and investments come at a critical time as we transition from the Millennium Development Goals to meet the challenge before us in the new Sustainable Development Goals: to end the AIDS epidemic by 2030.

We believe if we all – governments, the private sector, civil society, including faith-based organizations – bring our collective will and energy together we can achieve an AIDS-free generation and bring this epidemic to a halt.

- See more at: https://blog.aids.gov/2015/09/statement-by-national-security-advisor-sus...

We are at a pivotal moment in the global fight against HIV/AIDS. Globally, both new HIV infections and AIDS related deaths are down by more than 40 percent since their peak. This Administration has invested nearly $50 billion through the President’s Emergency Plan for AIDS Relief (PEPFAR) to achieve an AIDS-free generation, building on the initiative and $15 billion provided by President Bush. Working with partner countries around the globe, we are now supporting life-saving antiretroviral treatment for 7.7 million men, women, and children worldwide; enabled more than one million babies to be born HIV-free; and tested and counseled more than 14 million pregnant women last year alone.

Today, we are setting a bold, new course by announcing ambitious PEPFAR prevention and treatment targets for 2016 and 2017.

The United States is committing resources to ensure PEPFAR will by the end of 2017 support 12.9 million people on life-saving anti-retroviral treatment, provide 13 million male circumcisions for HIV prevention, and reduce HIV incidence by 40 percent among adolescent girls and young women within the highest burdened areas of 10 sub-Saharan African countries.

No greater action is needed right now than empowering adolescent girls and young women to defeat HIV/AIDS. Every year, 380,000 adolescent girls and young women are infected with HIV—7,300 every week, over 1,000 every day. This must change.

Today, we are announcing that PEPFAR is now investing nearly half a billion dollars to support an AIDS-free future for adolescent girls and young women.

Over the last 15 years, we have seen remarkable results as we have worked together toward achieving the Millennium Development Goals. PEPFAR’s new targets and investments come at a critical time as we transition from the Millennium Development Goals to meet the challenge before us in the new Sustainable Development Goals: to end the AIDS epidemic by 2030.

We believe if we all – governments, the private sector, civil society, including faith-based organizations – bring our collective will and energy together we can achieve an AIDS-free generation and bring this epidemic to a halt.

- See more at: https://blog.aids.gov/2015/09/statement-by-national-security-advisor-sus...

We are at a pivotal moment in the global fight against HIV/AIDS. Globally, both new HIV infections and AIDS related deaths are down by more than 40 percent since their peak. This Administration has invested nearly $50 billion through the President’s Emergency Plan for AIDS Relief (PEPFAR) to achieve an AIDS-free generation, building on the initiative and $15 billion provided by President Bush. Working with partner countries around the globe, we are now supporting life-saving antiretroviral treatment for 7.7 million men, women, and children worldwide; enabled more than one million babies to be born HIV-free; and tested and counseled more than 14 million pregnant women last year alone.

Today, we are setting a bold, new course by announcing ambitious PEPFAR prevention and treatment targets for 2016 and 2017.

The United States is committing resources to ensure PEPFAR will by the end of 2017 support 12.9 million people on life-saving anti-retroviral treatment, provide 13 million male circumcisions for HIV prevention, and reduce HIV incidence by 40 percent among adolescent girls and young women within the highest burdened areas of 10 sub-Saharan African countries.

No greater action is needed right now than empowering adolescent girls and young women to defeat HIV/AIDS. Every year, 380,000 adolescent girls and young women are infected with HIV—7,300 every week, over 1,000 every day. This must change.

Today, we are announcing that PEPFAR is now investing nearly half a billion dollars to support an AIDS-free future for adolescent girls and young women.

Over the last 15 years, we have seen remarkable results as we have worked together toward achieving the Millennium Development Goals. PEPFAR’s new targets and investments come at a critical time as we transition from the Millennium Development Goals to meet the challenge before us in the new Sustainable Development Goals: to end the AIDS epidemic by 2030.

We believe if we all – governments, the private sector, civil society, including faith-based organizations – bring our collective will and energy together we can achieve an AIDS-free generation and bring this epidemic to a halt.

- See more at: https://blog.aids.gov/2015/09/statement-by-national-security-advisor-sus...


We are at a pivotal moment in the global fight against HIV/AIDS. Globally, both new HIV infections and AIDS related deaths are down by more than 40 percent since their peak. This Administration has invested nearly $50 billion through the President’s Emergency Plan for AIDS Relief (PEPFAR) to achieve an AIDS-free generation, building on the initiative and $15 billion provided by President Bush. Working with partner countries around the globe, we are now supporting life-saving antiretroviral treatment for 7.7 million men, women, and children worldwide; enabled more than one million babies to be born HIV-free; and tested and counseled more than 14 million pregnant women last year alone.

Today, we are setting a bold, new course by announcing ambitious PEPFAR prevention and treatment targets for 2016 and 2017.

The United States is committing resources to ensure PEPFAR will by the end of 2017 support 12.9 million people on life-saving anti-retroviral treatment, provide 13 million male circumcisions for HIV prevention, and reduce HIV incidence by 40 percent among adolescent girls and young women within the highest burdened areas of 10 sub-Saharan African countries.

No greater action is needed right now than empowering adolescent girls and young women to defeat HIV/AIDS. Every year, 380,000 adolescent girls and young women are infected with HIV—7,300 every week, over 1,000 every day. This must change.

Today, we are announcing that PEPFAR is now investing nearly half a billion dollars to support an AIDS-free future for adolescent girls and young women.

Over the last 15 years, we have seen remarkable results as we have worked together toward achieving the Millennium Development Goals. PEPFAR’s new targets and investments come at a critical time as we transition from the Millennium Development Goals to meet the challenge before us in the new Sustainable Development Goals: to end the AIDS epidemic by 2030.

We believe if we all – governments, the private sector, civil society, including faith-based organizations – bring our collective will and energy together we can achieve an AIDS-free generation and bring this epidemic to a halt

- See more at: https://blog.aids.gov/2015/09/statement-by-national-security-advisor-sus...

 

We are at a pivotal moment in the global fight against HIV/AIDS. Globally, both new HIV infections and AIDS related deaths are down by more than 40 percent since their peak. This Administration has invested nearly $50 billion through the President’s Emergency Plan for AIDS Relief (PEPFAR) to achieve an AIDS-free generation, building on the initiative and $15 billion provided by President Bush. Working with partner countries around the globe, we are now supporting life-saving antiretroviral treatment for 7.7 million men, women, and children worldwide; enabled more than one million babies to be born HIV-free; and tested and counseled more than 14 million pregnant women last year alone.

Today, we are setting a bold, new course by announcing ambitious PEPFAR prevention and treatment targets for 2016 and 2017.

The United States is committing resources to ensure PEPFAR will by the end of 2017 support 12.9 million people on life-saving anti-retroviral treatment, provide 13 million male circumcisions for HIV prevention, and reduce HIV incidence by 40 percent among adolescent girls and young women within the highest burdened areas of 10 sub-Saharan African countries.

No greater action is needed right now than empowering adolescent girls and young women to defeat HIV/AIDS. Every year, 380,000 adolescent girls and young women are infected with HIV—7,300 every week, over 1,000 every day. This must change.

Today, we are announcing that PEPFAR is now investing nearly half a billion dollars to support an AIDS-free future for adolescent girls and young women.

Over the last 15 years, we have seen remarkable results as we have worked together toward achieving the Millennium Development Goals. PEPFAR’s new targets and investments come at a critical time as we transition from the Millennium Development Goals to meet the challenge before us in the new Sustainable Development Goals: to end the AIDS epidemic by 2030.

We believe if we all – governments, the private sector, civil society, including faith-based organizations – bring our collective will and energy together we can achieve an AIDS-free generation and bring this epidemic to a halt.

- See more at: https://blog.aids.gov/2015/09/statement-by-national-security-advisor-sus...

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Coburn Introduces the HIV/AIDS Save Lives First Act

“This important piece of legislation will make crucial improvements in our approach to bilateral global AIDS efforts."

PA Positvely Aware

On July 21, Senate Republican Tom Coburn of Oklahoma introduced Senate bill 3627 (S.3627), legislation that would ensure that United States global HIV/AIDS assistance prioritizes saving lives by focusing on access to treatment.

In his statement to the Senate, Coburn said, “This important piece of legislation will make crucial improvements in our approach to bilateral global AIDS efforts. As a practicing physician and former co-chair of President Bush's Advisory Council on HIV/AIDS, I have introduced this bill to ensure that our global AIDS efforts continue to prioritize life-saving medical treatment and reduce the transmission of the disease from mother to child.”

Senator Coburn noted that the President’s Emergency Plan for AIDS Relief (PEPFAR) has been successful in providing two and a half million HIV/AIDS patients from 30 different countries access to lifesaving treatment and that it has been estimated that “from 2004-2007 as many as 1.2 million lives had been saved because of the program.”

In 2008, Congress, in what has become an extremely rare case of bipartisanship, passed the United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act to continue the important life-saving work of the PEPFAR program. Said Coburn, “It is of grave concern, then, that our fight against AIDS is now at risk of failure. A recent New York Times article, ‘At Front Lines, AIDS War Is Falling Apart,’ details how hundreds of thousands of patients are being denied promised care in countries such as Uganda.”

Former UNAIDS chief Dr. Peter Piot remarked about past success and doubts about the future. “Then, we were at a tipping point in the right direction,'' he explained. “Now I'm afraid we're at a tipping point in the wrong direction.''

Coburn, also a co-sponsor of the Access ADAP Act (S.3401), went on to explain to his colleagues the facts about the costs of prevention and early treatment as opposed to the costs, financial and otherwise, of neither an aggressive testing policy nor a way to ensure access to treatment.

In his statement, Coburn said, “By emphasizing providing life-saving treatment under the PEPFAR program, we can continue the enormous success we have had in saving lives and preventing the spread of this terrible disease. It is my sincere hope that my colleagues adopt these common sense policy changes that will significantly reduce human suffering, keep families together, and save millions of lives.”

The bill now goes to the Committee on Foreign Relations.

 

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Goosby Gives Straight Talk on PEPFAR. 10/8/10

“The President has every intention of keeping up with the $63 billion over six years,”

Science Speaks

By Meredith Mazotta
10 August 2010

“The President has every intention of keeping up with the $63 billion over six years,” that was promised for the Global Health Initiative (GHI) and the President’s Emergency Plan for AIDS Relief (PEPFAR), said Ambassador Eric Goosby, MD – the U.S. Global AIDS Coordinator, on Tuesday.

Goosby sat down with Global Health Council President and CEO Jeffrey Sturchio, MD, for a live webcast discussion specifically about PEPFAR.

Although over the course of the past two years we’ve only seen small increases in PEPFAR funding, Goosby said, “We’ve been able to drop the cost of care about two-thirds in the past 18 months, freeing up resources.” And those resources can be redirected back into the care, treatment and prevention services PEPFAR provides. He also said the President’s cross-government freeze on hiring or expansion of programs not related to security is causing administrators to look at areas of synergy and efficiency, where money can be spent more wisely and go further.

“That’s not to say that there won’t be situations where resources are temporarily saturated or there are queues [for receiving antiretrovirals], but those are rational queues and only used when they have to be,” Goosby said. “It really is the exception in the PEPFAR family of countries.”

When asked about marginalized populations, Goosby agreed with Sturchio that that often stigma and ignorance prevent these hard-to-reach populations from accessing treatment and care. As for how these populations are treated in PEPFAR programs, Goosby said, “When governments are not willing to engage, we go through NGOs to bypass that, creating opportunities for marginalized communities to access care,” he said.

Sturchio also asked Goosby to comment on health systems integration. “Since PEPFAR supports some 67,000 service sites, this isn’t an easy task,” Sturchio said. But Goosby maintained that “As HIV care providers, we see a host of other issues… We have felt, to date, impaired in our ability to respond to the patient sitting in front of us,” who has HIV/AIDS but is now presenting with these other diseases. But integration of services helps in that regard and also creates economies of scale, he said. “When women come in for ARVs they can also get information on family planning and reproductive help. By integrating those two services, the money that PEPFAR is giving for HIV/AIDS is being extended for family planning. In the same clinic they can be screened for cervical cancer. Now a range of services are being offered. Multiply that by the tens of thousands of sites where people are coming for treatment, prevention, etcetera, and then you can see the power of that approach,” Goosby said.

The session was the fifth in a new video series at the State Department entitled “Conversations with America.” Cheryl Benton, deputy assistant secretary of state for the bureau of public affairs, moderated the live webcast, which streamed on DipNote, the State Department’s official blog. To watch the recording, click here

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Less Aid for AIDS? 16/2/10

Groups fear impact of Obama administration's PEPFAR stance.

Christianity Today

Bobby Ross Jr.
16 February 2010

Leaders of Christian organizations that fight AIDS in Africa are expressing fears that the U.S. government is slowing its fight against the disease. The Obama administration is shifting its global health emphasis from putting more people on AIDS drugs to combating less-costly diseases.

"There seems to be an AIDS funding fatigue developing on many levels," said Nelis du Toit, director of the Christian AIDS Bureau for Southern Africa.

The 2010 federal budget allocates $5.7 billion for programs like the President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. That represents a 3.6 percent, or $200 million, increase over 2009.

"Technically, it is not flatlining, but given the very considerable growth over the past five years, the AIDS advocates are considering this flatlining," said Ray Martin, executive director of Christian Connections for International Health.

The World Health Organization estimates that faith-based organizations deliver 30 to 70 percent of health care in developing countries. They account for roughly a quarter of groups that have received PEPFAR grants.

"If antiretroviral medicines become unavailable due to funding shortfalls, then the children who depend on them will die. It is that simple," said immunologist Scott Todd, senior ministry adviser at Compassion International. (The ministry doesn't accept federal grants but supports 1,600 HIV-positive children who benefit from PEPFAR.) "The U.S. government acted honorably and compassionately through PEPFAR, and many lives have been saved. But in saving them, we took up a moral obligation not to end their lives when the wind changes in Washington."

Kay Warren, founder of the HIV/AIDS Initiative at Saddleback Church in Lake Forest, California, is urging Obama and Congress to keep funding increases high. But she said churches "are in this for the long haul," regardless of the federal budget. "Our responsibility to the sick isn't tied to congressional funding."

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PEPFAR makes U-Turn in Uganda. 4/8/10

U.S. global AIDS program, PEPFAR, has reversed severe restrictions that capped enrollment of new HIV patients on life saving treatment in Uganda.

4 August

Advocacy organisations in the US and Uganda have welcomed the announcement that the U.S. global AIDS program, PEPFAR, has reversed severe restrictions that capped enrollment of new HIV patients on life saving treatment in Uganda.

Following Pressure, White House Announces it is Lifting AIDS Treatment Caps in Uganda. Similar Treatment Access Crises Loom Unless the Obama Administration Keeps its AIDS Funding Promises.

(Kampala and Washington DC) Today advocacy organizations in the US and Uganda welcomed the announcement that the U.S. global AIDS program, PEPFAR, has reversed severe restrictions that capped enrollment of new HIV patients on life saving treatment in Uganda, following criticism and outcry from people with HIV, clinicians, advocates, and public health experts in the US, Uganda and around the world.

In a statement by Ambassador Eric Goosby, the Coordinator of PEPFAR, the U.S. government committed to increasing investments of additional resources for HIV treatment in Uganda (see this). Specifically, the White House has pledged to return to the rate of new patient enrollment taking place before treatment caps were put in place--approximately 3,000 new patients each month until 2013. Advocates fear that the treatment caps, in place for almost one year, have already set back the country response to HIV, as a result of HIV treatment waiting lists expanding to crisis levels. This situation followed an instruction by PEPFAR to AIDS treatment providers to cap new HIV treatment enrollment (See October 29, 2009 USG communication to PEPFAR Implementing Partners). 

"The White House has responded to criticism and grave concern from people with HIV, activists and other experts," said Asia Russell of Health GAP. "Now partners are picking up the pieces, reconstructing efforts to scale up to reach HIV treatment access for all. There is no time to waste." Advocates urged PEPFAR to implement this new policy as quickly as possible, with minimal bureaucratic delay and with clear guidance to providers about how they can restart new patient recruitment. 

Because the White House has recommended virtually no increased funding for PEPFAR for two consecutive years, advocates point out that the crisis in Uganda will be duplicated in multiple additional countries unless the Obama Administration increases its investment of additional funds in PEPFAR. "This announcement means the waiting lists in Uganda will ease—for now," said Matthew Kavanagh of Health GAP. "But Uganda is just the tip of the iceberg—Ambassador Goosby also said that he was worried there would be  'Kampala situations' in other countries soon. President Obama and Congress must prevent that, by keeping their AIDS funding promises." 

As a Senator and Presidential candidate, President Obama promised publicly and in writing to spend at least $50 billion fighting AIDS over 5 years, as the U.S. 'fair share' response to the pandemic. Instead, U.S. AIDS funding has been virtually flat-lined by the Obama White House and Congress.    

Advocates also challenged the Government of Uganda to significantly scale up its investments in HIV treatment. "Our government should commit to its own target of treating an increasing number of HIV positive Ugandans," said Lillian Mworeko, of the International Community of Women Living with HIV East Africa. "Our country could mobilize the resources—but we need the political will from our leaders." In 2009, Uganda budgeted 60 billion Ugandan Shillings ($30 million) for antiretroviral and anti-malarial medicines procured from the local manufacturing company Quality Chemicals Limited. But advocates expressed concern at the lack of transparency in the procurement, and higher prices charged by Quality Chemicals relative to other suppliers. "While we appreciate that investment, $30 million is also not enough," Mworeko continued. "We need a commitment from our President to a permanent budgetary allocation for HIV treatment that increases over time."    

The advocates called on the White House and Congress to commit to progressive scale up in HIV treatment to reach one third of those people in clinical need—as it has already pledged to do—even while leveraging increased commitments from national governments and other donors. "Shifting away from HIV treatment scale up misses the opportunity to save lives," said Dorcas Amoding of Community Health and Information Network Uganda. 

"Stepping back from treatment scale up will result in substantial numbers of new infections as evidence shows significant prevention benefits associated with universal HIV treatment coverage," added Agnes Apea of the National Community of Women Living with HIV/AIDS (NACWOLA) Uganda.  "Moreover it will simply postpone—and likely increase—ballooning treatment costs, because people will present later, when they are seriously ill and already requiring complex care. An urgent course correction is needed—so that communities benefit fully from the direct and indirect benefits of HIV treatment, contributing to reduced rates of new HIV infections, declining HIV prevalence, and—potentially—an eventual end to the pandemic.”

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Pepfar Showing Greater Effectiveness, Efficiency Against HIV/AIDS. 10/11/10

United States has committed approximately $32 billion to fight HIV/AIDS

AllAfrica

By Stephen Kaufman
10 November 2010

Nearly seven years after the President's Emergency Plan for AIDS Relief (PEPFAR) was announced, the program is having an "extraordinary impact" on the prevention and treatment of HIV/AIDS, with data showing that more than 2.5 million people have been directly supported by its treatments through 2009, according to U.S. Global AIDS Coordinator and PEPFAR Administrator Dr. Eric Goosby.

Through PEPFAR and contributions to the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, the United States has committed approximately $32 billion to fight HIV/AIDS.

Goosby spoke with reporters in Washington November 10, saying "PEPFAR has shown that indeed one disease responded to with significant resource infusion can have outcomes that have changed the way we think about global health."

The program, now operating in more than 30 countries, is showing increased efficiency and effectiveness, with more than 60,000 patients receiving anti-retroviral medication every month, and expansions in prevention and care programs.

Each partner country is looking more closely at who is being affected by HIV and how the disease is moving through its populations, and that information is helping PEPFAR decide where to position its prevention programs as well as any special care and treatment services that might be needed.

"We're learning how to do this better than we did in the first couple or three years of PEPFAR. Each month brings in new insights that we are better and better positioned to realize, to see, to document and then to reintegrate that learned advantage or system change into our larger systems of care in each country," Goosby said.

The United States accounts for almost 60 percent of international funding commitments to prevent and fight HIV/AIDS, and Goosby said more nations need to step up their support.

"We alone are not going to be successful ... without really soliciting the help of all countries on the planet, including the countries we are working in," he said. Other nations need to join the United States by contributing to the effort, and to do so explicitly and continuously. "We are ready to be the voice to put that challenge out," he said.

Reducing HIV/AIDS contributes to a country's overall security and stability. Individuals aged 15 to 50 are disproportionally targeted by the disease, and they also represent the prime years of a country's working force. It also "hits individuals who have money, who are mobile and often educated," including doctors, lawyers and teachers, he said.

"The lack of that layer in society is ... a huge destabilizing force and kind of lends fertile fodder to the development of armed and terrorist activity," Goosby said.

In its fight against HIV/AIDS, PEPFAR is now looking to transition toward "a more stable, sustained response," from its initial emergency focus. "We're lean and clean in our ability to deliver more with fewer people and for less money," he said.

For example, Goosby said, new research has demonstrated the effectiveness of male circumcision, which has been shown to reduce the rate of HIV infection by 64 percent. The operation removes a layer of cells that are highly susceptible to infection, he explained, and PEPFAR's data has projected that 4.2 million HIV infections can be averted through 2025 with an increase in the number of circumcised men between ages 15 and 50, as well as having programs in place to circumcise newborn males.

Circumcised males are still at risk of infection, he said, but the reduced rate "will look like a vaccine has entered" the population because of the drop in the number of infections.

PEPFAR is also planning to accelerate its prevention of mother-to-child transmission by providing 80 percent coverage of disease testing at the national level and 85 percent coverage of prophylaxis and treatment for infected pregnant women by the year 2014, he said.

The increased availability of generic drugs has also helped to lower the average treatment cost per patient to about $435, and Goosby said he expects the figure to drop even further, thanks to increased procurement pooling with the Global Fund to Fight AIDS, Tuberculosis and Malaria, reduced transportation costs, new drugs that require fewer doses, and other innovations.

PEPFAR will also be expanding its services through the U.S. Global Health Initiative to provide treatment and prevention against other infectious diseases, as well as supporting maternal and child health and clean water. He said this will help increase the effectiveness and efficiency of overall U.S. health assistance.

PEPFAR is "often the strongest delivery system that's up and running," he said. For example, when Haiti was devastated by a January 12 earthquake, "our clinic system and our providers in these clinics were the first responders and the primary responders for the first 10 days or so. Our resources also fed into a lot of that first response effort."

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Protest at HIV Funds Cuts. 15/6/10

More than 5000 people are expected to march to the US consulate tomorrow to protest about cuts in HIV funding, march organisers said in Johannesburg yesterday.

15 June 2010

"We have been receiving bouncing cheques from [US President Barack Obama's] administration and the G8 [group of developed nations]," World Aids Campaign co-ordinator Linda Mafu said at Cosatu House, in Braamfontein.

Mafu was referring to Obama's President's Emergency Plan for Aids Relief, which recently reduced its support for antiretroviral treatments in sub-Saharan Africa and froze its funding for HIV/Aids.

This meant that many of those infected by the disease who were receiving treatment funded by the Obama plan would no longer receive it and would die, she said.

"They started it [funding] so they must complete it," said Treatment Action Campaign general secretary Vuyiseka Dubula.

Other donors, such as Unitaid and the World Bank, have also announced plans to reduce their funding for ARV drugs in Malawi, Zimbabwe, Mozambique, Uganda, and the DR Congo.

As a result, the World Aids Campaign, the largest funding institution in the fight against HIV/Aids, faced a huge funding shortfall.

Dubula said the US was being targeted because it contributed to saving the most number of lives.

"The recession has been used as a scapegoat. [The US] is one of the most powerful economies and has resources to scale up services. If wars can be funded, then so can [HIV/Aids programmes]."

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The Power of PEPFAR. 21/10/10

“It’s quite impressive that we can see this level of impact"

21 October 2010

AIDS mortality in South Africa has seen an observed decrease at the population level from 2006-09 — the first time since the epidemic began, according to Jeffrey Klausner, MD, of the Centers for Disease Control and Prevention (CDC) in Pretoria. He presented on the impact of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in South Africa at the 48th Annual Meeting of the Infectious Diseases Society of America in Vancouver Thursday.

“It’s quite impressive that we can see this level of impact and we expect to see this improvement in life expectancy to continue,” Klausner said. This was just one example Klausner gave of the “Power of PEPFAR,” as he moderated and presented at a session by that name. Klausner said the implementation of PEPFAR in South Africa has been associated with significant increases in HIV treatment and services, reduced mortality and increased life expectancy.

High-functioning prevention of mother to child transmission (PMTCT) programs are preventing a substantial number of HIV infected babies in the country. Dr. Klausner reported that from April to June 2010, 92 percent of women reporting for prenatal services agreed to be tested for HIV, with 28 percent of those testing HIV-positive. Ninety-five percent of those women were initiated on antiretroviral prophylaxis. It is estimated that through the effective use of PMTCT, more than 61,000 infants per year in South Africa are protected from HIV infection.

While the strides have been significant, much more needs to be done, Klausner said. Accelerated prevention programs in other areas, including male circumcision, are needed to help curb the epidemic. Trials show that initiation of highly active antiretroviral therapy (HAART) at higher CD4 counts and switching to tenofovir-based treatment regimens improve survival rates significantly. But the resources needed to start antiretroviral therapy (ART) earlier are not there, and there is still no fixed-dose combination therapy available in South Africa, Klausner said.

Despite the World Health Organization recommendation that ART for HIV-infected people begin at CD4 counts of 350, the majority of HIV-infected people in South Africa are starting therapy at CD4 counts of 200. “Less than 40 percent of those in need as defined by the WHO are on treatment,” Klausner said. Current treatment guidelines in South Africa provide for initiation of ART for pregnant mothers and patients with TB at CD4 cell counts of 350 or fewer.

Today there are 1.1 million PEPFAR-supported patients on ART in South Africa, the South African government currently predicts they are treating 70 percent of those with CD4 counts less than 200; the goal is to expand that to at least 80 percent by the end of 2011.  

Cotrimoxazole saves lives

Jonathan Kaplan with the Division of Global AIDS at the CDC presented about HIV-related opportunistic infections in the African context.  He highlighted cotrimoxazole (CTX) as a lifesaving prophylaxis antibiotic, which offers substantial protection against a variety of bacterial infections, pneumonia, malaria, diarrhea and sinusitis.  Studies have demonstrated that CTX provides a benefit even to patients on ART, and reduces the risk of malaria by 90 percent with the benefit increasing even further by providing patients with ART and insecticide-treated bed nets.  Research has also indicated that patients on CTX also have reduced rates of CD4 cell decline. And in a study in Zambia reported in the Lancet in 2004, CTX reduced hospitalization by 23 percent and death by 43 percent in children.

The leading cause of death for persons with HIV is tuberculosis.  Isoniazid preventive therapy (IPT) has been demonstrated to reduce the risk of TB disease by as much as 62 percent.  Despite the fact that WHO has been recommending IPT for more than a decade, coverage rates remain extraordinarily low.  There are some outstanding questions about the length of time patients should be on isoniazid (INH) – especially in TB endemic areas.  A Botswana study found a strong protective benefit when INH was continued for 36 months.  Current WHO guidelines recommend a 6-month course.

Kaplan identified cryptoccocal meningitis as a serious opportunistic infection with high mortality that should be prioritized for further research related to screening and treatment.

The current PEPFAR preventative care package includes cotrimoxazole prophylaxis, safe water, insecticide- treated bed nets, TB screening and a nutritional assessment.  Important goals in the arena of HIV care include increasing coverage and adherence to CTX, completion of IPT and the retention of pre-ART patients in care.

NIAID and PEPFAR Partner on Research Priorities 

Emily Erbelding, Deputy Director of the Division of AIDS at the National Institute of AIDS and Infectious Diseases (NIAID) highlighted some PEPFAR-related research priorities.  She identified tuberculosis as the highest PEPFAR-related clinical research priority since the “full benefits of ART rollout cannot be achieved without improvements in TB diagnosis and treatment, and TB control will not be successful without widespread and successful HIV treatment.”  In fact Erbelding called tuberculosis the “highest clinical trial priority in the Division of AIDS.”

Erbelding highlighted the need for a range of new diagnostic tools for resource poor settings such as diagnostics to measure HIV RNA, CD4 cells, HIV drug resistance as well as new TB and malaria diagnostics and a test to measure HIV seroincidence—so that the impact of new prevention interventions can be calculated.

Erbelding also noted that implementation science to address the gap between science and practice was critically important and posed a number of research questions in this arena.

-How can nutritional packages improve HIV prevention, care and treatment outcomes?
-How can we eliminate bottlenecks in PMTCT services?
-How can we best bring male circumcision to scale?
-What behavioral prevention approaches are components of effective combination packages?
-What innovative strategies strengthen health systems to improve HIV outcomes?

National Institutes of Health/PEPFAR implementation science initiatives under consideration are available online

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U.S. Seeking To Hand Off Oversight Of AIDS Program. 9/12/09

Administration wants services to become routine for nations

By David Brown
Wednesday, December 9, 2009

The Obama administration is trying to get the "emergency" out of the President's Emergency Plan for AIDS Relief.

In an outline of a new direction for the global program started by President George W. Bush, the administration hopes to begin handing off day-to-day management of AIDS prevention and treatment programs to the 15 countries where $19 billion has been spent since 2004. The goal is to make the services a routine part of each nation's health offerings.

The program provides AIDS drugs, HIV counseling and testing, prevention advice and condoms, palliative care for people with advanced AIDS, and support for orphaned children. The services have been delivered through a complicated tiered system that includes American universities, international nonprofit organizations, government health ministries and hundreds of charities.

Under a strategy described in documents released Monday, the countries' health ministries would assume the task of delivering services -- which many already do -- as well as managing all the programs and measuring their effect.

Most of the funding, however, would continue to come from the United States, foreign donors and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

"It is our honest belief that these programs are in a fragile period," said Eric Goosby, the U.S. global AIDS coordinator. "We need to transition them into being more embedded in the countries' infrastructure and for the countries to have true ownership of them."

Since its inception, the program -- run out of the State Department and known by its acronym, PEPFAR -- has helped provide antiretroviral treatment to 2 million people, supported the care of 10 million (including 4 million children in families affected by AIDS) and been at least partly responsible for the fact that 240,000 babies born to HIV-positive mothers did not have the infection.

The administration hopes that in the next five years, PEPFAR will help treat 4 million infected people, care for 12 million and double the number of babies born free of the virus.

In 2008, 33.4 million people were living with HIV worldwide, including 2.7 million who became infected that year, according to the joint U.N. program on AIDS. About 2 million died.

The exact amount of money to be spent through PEPFAR in the next few years is uncertain.

Last year, Bush signed the Lantos-Hyde Act, which authorized spending up to $48 billion over five years to deal with AIDS, tuberculosis and malaria. The share for AIDS was $39 billion.

The 15 countries that have received most of the PEPFAR money include 12 in sub-Saharan Africa, as well as Haiti, Guyana and Vietnam. Dozens of others have gotten less. With the exception of Rwanda and Namibia, none has "really developed the capability to oversee and manage these programs completely," Goosby said.

The transition will require teaching supply-chain management, logistics, service coordination, program evaluation and other skills while continuing to provide AIDS services to millions of people. Some of the PEPFAR partners have begun.

The new direction comes as the World Health Organization has revised its AIDS treatment guidelines in a way that will bring millions more people, especially women, into long-term antiretroviral therapy.

 

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PEPFAR Unveils New Strategy But More Funds Needed. 4/12/09

"transitioning from an emergency response to a sustainable one through greater engagement with and capacity building of governments"

NAIROBI, 4 December (PLUSNEWS) - A shift from an emergency response to sustainable, country-driven HIV programming is at the heart of a new five-year strategy recently announced by the US President's Emergency Plan for AIDS Relief (PEPFAR).

 "We're going to begin transitioning from an emergency response to a sustainable one through greater engagement with and capacity building of governments," Ambassador Eric Goosby, US Global AIDS Coordinator, said as he unveiled the plan in Washington DC on 1 December.

 "We need to do more, especially around supporting the creation of mid-level government capacity to oversee, manage and eventually finance these programmes."

 In 2003, former President George Bush launched PEPFAR, which has provided more than US$18 billion in HIV/AIDS funding - the largest international health initiative dedicated to a single disease.

 In 2008, Congress approved the extension of PEPFAR for another five years and increased its funding to $48 billion.

 Between 2010 and 2014, PEPFAR intends to support the prevention of more than 12 million new HIV infections, double the number of at-risk babies born HIV-free, provide direct support for more than four million people on treatment and provide all youth in PEPFAR prevention programmes with knowledge of HIV transmission and prevention.

 In addition, the strategy details plans to provide care to more than 12 million people - including five million orphans and vulnerable children - and supports the training and retention of more than 140,000 new healthcare workers.

 PEPFAR's support for treatment has been widely praised, and researchers have estimated that 1.2 million deaths in Africa were averted between 2004 and 2007 as a direct result of interventions funded by PEPFAR.

 However, a new "report card" by a coalition of AIDS organizations gives US President Barack Obama a D+ for his performance during his first year and warns that unless US funding increases, putting more people on treatment will not be possible.

 Critics have accused Obama of backtracking on promises to provide at least $50 billion by 2013 for the global fight against AIDS, to double the number of people on AIDS treatment and increase the number of health workers by at least one million.

 "Can do better"

 "Funding for PEPFAR has essentially been flat-lined, which means that there will not be enough money to fulfil the goals of the new strategy," Paul Davis, director of global campaigns for Health Global Access Project, a group of US-based AIDS and human rights activists, told IRIN/PlusNews. "In many PEPFAR countries, enrolment in treatment programmes has already been halted, so how can they hope to increase treatment numbers?"

 Davis noted that while PEPFAR under Bush was criticized for placing ideology above science in its emphasis on abstinence-only prevention programmes, Obama also failed to recognize that putting more people on treatment was the best way to prevent new HIV infections and AIDS-related deaths.

 "The evidence we have now is that putting more people on treatment would go a long way in reducing the number of HIV infections occurring, so treatment is where more money should go," he added. "Otherwise, there is little chance that universal access to treatment targets will be achieved."

 "President Obama could earn an 'A' if he seizes this opportunity and if he crafts a budget request for FY [financial year] 2011 that puts US investments in global AIDS back on track and includes prominent support for a bold HIV treatment target to be achieved by 2013," the report card said.

 

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Summary from CCIH on PEPFAR’s New Five-Year Strategy 2/12/09

The U.S. global AIDS program, PEPFAR, released its new five-year strategy today, World AIDS Day. A few highlights are copied below. The complete document can be accessed online at http://www.pepfar.gov/documents/organization/133035.pdf
 
 It mentions that it "draws upon the knowledge, access, and talents of local community- and faith-based organizations."  Three new directions are cited:
  • Sustainable programs must be country-owned and country-driven.
  • Sustainable programs must address HIV/AIDS within a broader health and development context.
  • Sustainable programs must build upon our strengths and increase efficiencies.
 
PEPFAR’s Goals:
·         Transition from an emergency response to promotion of sustainable country programs.
·         Strengthen partner government capacity to lead the response to this epidemic and other health demands.
·         Expand prevention, care, and treatment in both concentrated and generalized epidemics.
·         Integrate and coordinate HIV/AIDS programs with broader global health and development programs to maximize impact on health systems.
·         Invest in innovation and operations research to evaluate impact, improve service delivery and maximize outcomes.
Programmatic Strategy
In this second phase of PEPFAR, a new program strategy is underway that supports the Administration’s overall emphasis on improving health outcomes, increasing program sustainability and integration, and strengthening health systems.
 
Prevention
 Prevention remains the paramount challenge of the HIV epidemic, and the major priority for the next five years of PEPFAR. Successful prevention programs require a combination of evidence-based, mutually reinforcing biomedical, behavioral, and structural interventions. PEPFAR is expanding its prevention activities with an emphasis on the following:
  • Working with countries to track and reassess the epidemiology of the epidemic, in order to fashion a prevention response based on best available and most recent data;
  • Emphasizing prevention strategies that have been proven effective and targeting interventions to most at-risk populations with high incidence rates; and
  • Increasing emphasis on supporting and evaluating innovative and promising prevention methods.
 
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Learning From Criticism, U.S. Committed to Aids Fight. 17/9/09

The United States has embarked on a mission to restore Africa's trust in U.S. commitment to global AIDS relief.

Stanley Kwenda

13 September 2009

AllAfrica.com

Harare — The United States has embarked on a mission to restore Africa's trust in U.S. commitment to global AIDS relief.

During the first months of his administration, president Barack Obama has made the fight against HIV/AIDS a cornerstone of his foreign policy, using health assistance as a diplomatic tool to engage developing countries on political and economic issues.

In recent months, PEPFAR has been slammed by AIDS activists for not honouring HIV funding commitments. On a recent visit to Zimbabwe, Eric Goosby, the global AIDS coordinator for the US President's Emergency Plan for AIDS Relief (PEPFAR) reassured Southern Africans of the U.S.'s commitment.

PEPFAR contributes more than $3.7 billion to HIV prevention and care globally, but despite Obama's campaign promise of an annual increase of $1 billion, the U.S. Congress did not increase the budget this year.

Has the Obama administration made any changes to the United States President's Emergency Plan for AIDS Relief (PEPFAR)?

The strategy that was engaged before the Obama administration came in will be continued and enhanced. We believe that our ability to better understand how to fight AIDS will be improved with an increased dialogue with ministries of health in countries (in which) we run programmes and (with) civil society and non-governmental organisations.

What is your position on male circumcision as a preferred HIV/AIDS preventative measure?

The research that showed that male circumcision decreases by 60 percent the likelihood of an individual getting infected was remarkable and surprising, even to those of us who have been in this field for a long time. It turns out that there are cells that uncircumcised men do not have - these are specific cells that make uncircumcised men more susceptible to HIV.

But a (circumcised) individual can still get infected (with HIV). Circumcision drops the likelihood of infection, but it is not the answer. Condom use continues to be the mainstay of how men can protect themselves and others from infection.

The US has been accused of putting business interests before human lives, when buying more expensive, U.S.-manufactured antiretroviral (ARV) drugs instead of generic drugs manufactured outside of the U.S.

It's legitimate criticism. The U.S. was initially worried that generic drugs were not effective. There was a worry that generic drugs had not been clearly (tested for) short- and long-term side effects. We were also worried about their generic manufacturing, their production controls, which we thought was not rigorous.

So, initially, the U.S. government was concerned that we would be creating double standards by giving patients in resource-poor settings drugs that we had not tested and that we did not give to our own population so PEPFAR initially only gave branded drugs.

But we have now switched completely to go into generic drugs, because (their lower cost) increases the number of people we can provide with drugs. I think that we had a legitimate reason not to engage with the generic drugs initially but now I don't think it's still defensible (to do so).

Do you think Southern Africa will be able to achieve universal access to treatment by 2015?

I don't think it is realistic. I think it is something that PEPFAR is playing a central role in trying to move towards, but the resources that are required to respond to the large number of individuals who need to be put on ARVs by 2015 will not be met.

That's not to say that every funder and every government may stop turning their resources towards trying to develop a robust response. We need to coordinate our efforts to make sure that the resources available are used to their best and intensify our efforts to decrease the number of people affected by HIV and AIDS. PEPFAR is committed to keeping (continuous, free ARV) treatment a key part of our response.

AIDS activists say PEPFAR's funding shortfall will affect the lives of about 30 million people. What are you doing to prevent this from happening?

The global economic crisis has had an impact on resource availability. President Barack Obama and secretary of state Hillary Clinton have made it very clear that (making more funding available) is the highest priority.

The new twist to the Obama administration's (foreign policy) is to use our ability to deliver health technical assistance as a diplomatic tool (when dealing with developing countries). So, (HIV funding becomes both) a humanitarian gesture and something to create dialogue with countries.

What is the U.S. doing to help improve the health infrastructure and boost human capital in Southern Africa?

There is no question that you cannot deliver adequate treatment without facilities that are strong enough to support the diagnostic and monitoring needs of individuals who are on ARV therapy. The structure of the health facility, the accessibility of the hospital to patients is critical for the health provider to make proper decisions.

A significant portion of our resources must go to strengthening the medical delivery system, especially at district and village level, to support that (country's) ability to care for people over the duration of their lives.

We are committed to providing proper infrastructure to allow health workers to administer medication. We are willing to work with all parties, government and civil society, to make this (happen).

Copyright © 2009 Inter Press Service. All rights reserved. Distributed by AllAfrica Global Media (allAfrica.com). To contact the copyright holder directly for corrections — or for permission to republish or make other authorized use of

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Lessons Learned From PEPFAR. 10/09

Dybul, Mark MD

 Abstract
The United States President's Emergency Plan for AIDS Relief (PEPFAR), launched by President Bush with strong bipartisan support, was a historic moment in development both in size and scope. With $18.8 billion across its first 5 years, it is the largest international health initiative in history for a specific disease. In scope, it is the first global initiative to tackle a chronic disease and was based in a new philosophical foundation centered in country ownership, a results-based accountable approach, the engagement of all sectors, and good governance. With resources and a strong intellectual base, PEPFAR saved lives and provided lessons learned for effective development.
The Lancet recently called the United States President's Emergency Plan for AIDS Relief (PEPFAR) the largest and most successful bilateral HIV/AIDS program worldwide.1 With an initial commitment of $18.8 billion over 5 years, the program set ambitious prevention, care, and treatment goals-to support treatment for 2 million persons, the prevention of 7 million new infections, and care for 10 million, including orphans and vulnerable children. On World AIDS Day 2008, then-president Bush announced that the treatment and care goals he had set had been met ahead of schedule and that the 2010 prevention goal was on track. In July 2008, with strong bipartisan support-including from then-senators Obama, Biden, and Clinton-the law authorizing PEPFAR was renewed at a staggering level of $48 billion for HIV/AIDS, tuberculosis, and malaria, with $39 billion for HIV/AIDS. The funding for what was already the largest international health initiative in history for a single disease more than doubled.
Looking forward, it is important to consider the components of the success of PEPFAR's first 5 years. Many details contributed, among them bureaucratic processes that will not be addressed here, where the focus will be on the underlying conceptual framework that promoted success. PEPFAR's innovative programmatic approach was rooted in a historic global commitment on development, the Monterrey Consensus,2 and the fundamental principles it articulated. The first and defining principle is country ownership, and effective country ownership requires good governance, a results-based approach with accountability, and the engagement of all sectors. These principles were further refined and delineated in the Paris Declaration3 and the Accra Accord.4
Country ownership begins with a belief in the dignity and worth of every human life and respect for, and trust in, the people of every country to design and implement successful programs. These truths would seem to be self-evident. But much of development had been based in concepts of donors and recipients and a paternalistic approach that those from the north and west were coming to help poor uneducated people. There was even a prevalent belief that it was not possible for Africans to develop the comprehensive chronic care programs needed for HIV prevention, treatment, and care. PEPFAR created what the New York Times called a philosophical revolution by definitively shattering the notion that developing countries could not effectively lead and implement complex chronic care programs.5
Nearly 90% of PEPFAR's implementing partners are local organizations, and PEPFAR's success is, in the end, the success of the people in the countries whom the American people are privileged to support. President Paul Kagame of Rwanda put it well when he discussed the fundamental difference in this approach to development-for the first time, countries were being held to high standards, and leaders and countries responded to that respect and trust by achieving goals early and on budget.
Those high standards included a focus on results, with strong accountability measures and an expectation of good governance. When PEPFAR began, there was actually criticism that there were preestablished goals and that development efforts could not be reduced to numeric targets. But the goals and focus on results were fundamental to the success of the program. They kept individuals and programs focused and drove an on-the-ground response to achieve them. The goals themselves had important ripple effects, including the establishment of monitoring and evaluation systems required for reporting. It was at the HIV clinic at McCord Hospital in Durban, South Africa, that the first computerized monitoring system was established to report on results. Noticing that nonpregnant women with an elevated mean body mass who were receiving stavudine were developing lactic acidosis, clinicians were able to identify every woman at risk in the clinic, and after their treatment was modified, the phenomenon disappeared. The HIV clinic's monitoring system was so clinically useful that the entire hospital adopted it.
However, there is always room for improvement. The ultimate goal of antiretroviral therapy is to decrease morbidity and mortality. The number of persons receiving therapy is an output that predicts to some degree these ultimate outcomes, but an evaluation of the morbidity and mortality is needed. Early independent analysis shows 1 million lives saved in just 3 years by treatment alone, but ongoing study is needed.7 Although infections averted is an outcome measure, evaluating changes in gender norms is important for assessing the overall impact of prevention programs. The past several years saw the beginning of a process to establish a continuum of indicators from planning to outputs to outcomes and impact. But there is no doubt that a results base with strong accountability was a key factor in the success of PEPFAR, not only in addressing issues relating to HIV but also in strengthening the monitoring and evaluation of health systems and, therefore, in facilitating development overall.
The final principle is an essential component of country ownership-the engagement of all sectors. A country cannot be reduced to its government. Government engagement and leadership are essential, and only governments can set national guidance and norms. But the private sector and nongovernmental organizations, including faith-based and community-based organizations, also have important roles. No health program can be successful unless the community and its leaders are engaged, particularly when behavior change is required. Available data indicate that health outputs improve when the community is involved: Utilization of services increases and loss to follow-up decreases.6 When the private sector contributes its expertise, innovative solutions to problems emerge. In PEPFAR, 80% of partners are nongovernmental organizations and 23% are faith-based organizations. PEPFAR was a leader in public-private partnerships, including perhaps the most significant new effort in prevention in decades-the Partnership for an HIV-Free Generation-which injects the unparalleled expertise of the private sector in reaching youth and promoting behavior change. In the end, the heart of PEPFAR was supporting the people of a country to tackle their problems-not just the government but people from all sectors. And the empowerment of all sectors was at the heart of PEPFAR's success.
The fundamental principles of PEPFAR's success are the fundamental principles of a new era in development. As we look to the next 5 years, it is important to draw on these successes and acknowledge the countless opportunities for improvement. If we maintain the focus on country ownership, a results-based approach and accountability, good governance, and the engagement of all sectors, and if the resource commitments are met, everything is possible.
Author Information
From the O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC.
Data presented: Not applicable.
Sources of support: None.
Correspondence to: Mark Dybul, MD, O'Neill Institute for National and Global Health Law, Georgetown University Law Center, 1340 Wallach Place, NW, Washington, DC 20009 (e-mail: mrd54@law.georgetown.edu).
 
REFERENCES
1. Appointment of PEPFAR head should be merit based [editorial]. Lancet. 2009;373:354. doi:10.1016/s0140-6736(09)60112-4.
2. The Monterrey Consensus of the International Conference on Financing for Development: The Final Text of Agreements and Commitments Adopted at the International Conference on Financing for Development, Monterrey Mexico, 18-22 March 2002. New York, NY: United Nations; 2003. Available at: http://www.un.org/esa/ffd/monterrey/MonterreyConsensus.pdf. Accessed May 16, 2009.
3. Paris Declaration on Aid Effectiveness: Ownership, Harmonization, Alignment, Results, and Mutual Accountability. Presented at: The High-Level Forum on Aid Effectiveness; February 28-March 2, 2005; Paris, France. Available at: http://www1.worldbank.org/harmonization/paris/finalparisdeclaration.pdf. Accessed May 16, 2009.
4. United Nations Conference on Trade and Development. Accra Accord. Resolutions of UNCTAD XII. Accra, Ghana: United Nations; 2008. Available at: http://www.unctad.org/en/docs//tdxii_accra_accord_en.pdf. Accessed May 16, 2009.
5. Stolberg SG. In global battle on AIDS, Bush creates legacy. New York Times. January 5, 2008. Available at: http://www.nytimes.com/2008/01/05/washington/05aids.html?fta=y. Accessed May 16, 2009.
6. World Health Organization Maximizing Positive Synergies Collaborative Group. An assessment of interactions between global health initiatives and country health systems. Lancet. 2009;373:2137-2169. doi:10.1016/S0140-6736(09)60919-3.
7. Bendavid E, Bhattacharya J. The President's Emergency Plan for AIDS Relief in Africa: evaluation of outcomes. Ann Intern Med. 2009;688-695.

© 2009 Lipp

 

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PEPFAR Programme Evaluated. 07/04/09

Lyn's Comment: Much has been said and written about the US President's Emergency Plan for AIDS Relief (PEPFAR).  Many programmes in Southern Africa benefitted from, and were also challenged by the demands of PEPfAR.  A recent report evaluated the success of the programme:

 
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How Much Bang for the PEPFAR Buck? 07/04/09

Your daily selection of IRIN PlusNews reports, 4/7/2009

JOHANNESBURG, 7 April (PLUSNEWS) - Researchers have estimated that 1.2 million deaths in Africa were averted between 2004 and 2007 as a direct result of interventions funded by the US President's Emergency Plan for AIDS Relief (PEPFAR).

Since former President George Bush launched the programme in 2003, it has been widely praised as the largest and most ambitious health initiative dedicated to combating a single disease, but until recently the outcomes of this multibillion-dollar effort had never been measured.

Using figures from UNAIDS, researchers from Stanford University in the US compared HIV-related deaths, the number of people living with HIV, and HIV prevalence in 12 "focus" countries, selected by PEPFAR to receive funding, with 29 other countries in sub-Saharan Africa that are also experiencing generalised HIV epidemics.

They found that in the four years after PEPFAR's activities started, the annual number of HIV-related deaths in the focus countries was 10.5 percent lower.

In an article published on the website of the Annals of Internal Medicine, the authors of the study noted that nearly half of PEPFAR's expenditures went to providing antiretroviral (ARV) treatment, and that better ARV treatment coverage in the focus countries probably accounted for the lower death rates.

Based on the more than US$6 billion that PEPFAR had spent in the 12 countries by the end of 2007, the researchers estimated the cost of each death averted at $2,450.

In the focus countries, a slightly steeper increase in the number of HIV-positive people might also have been because those on ARV treatment were living longer.

However, the researchers found no evidence that PEPFAR's activities had affected prevalence rates. About one-fifth of PEPFAR's resources were spent on prevention programmes during the study period, of which one-third were earmarked for abstinence-only programmes.

The authors raised the concern that, as the number of people receiving life-long ARV treatment in the focus countries increased, the cost of treatment would become unsustainable unless the number of new HIV infections could be substantially reduced.

"Striking the right balance between treatment and prevention, with insufficient resources for the burden of the epidemic, is a major challenge for comprehensive care programmes such as PEPFAR," said the authors, who recommended ongoing evaluation.

In July 2008 the US Senate extended PEPFAR for another five years, with an increased budget of $48 billion. "The commitment of funds by the US government is commendable," the authors noted, "but it is crucial to ascertain that PEPFAR is effective, and that the investment in this programme is cost-effective."

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PEPfAR Helped Prevent More than 1M AIDS-Related Deaths in Africa, Study Says. 07/04/09

Kaiser Daily HIV/AIDS Report - Tuesday, April 7, 2009

The President's Emergency Plan for AIDS Relief has helped prevent more than one million AIDS-related deaths and reduced AIDS-related mortality by an average of 10.5% annually in 12 African focus countries as more people gained access to antiretroviral drugs, according to a study published online Tuesday in the Annals of Internal Medicine, Bloomberg reports. According to the study, the program did not have any effect on overall HIV prevalence. The Agency for Healthcare Research and Quality provided funding for the study.

Eran Bendavid, an infectious diseases and health policy fellow at Stanford University, and Jayanta Bhattacharya, associate professor of medicine at Stanford, used data compiled by UNAIDS to examine HIV/AIDS data in sub-Saharan Africa (Chase, Bloomberg, 4/6). They examined the period prior to PEPFAR's launch -- 1997 to 2002 -- and the period during PEPFAR's implementation -- from 2004 to 2007. The researchers compared HIV/AIDS-related mortality and prevalence among residents of 12 PEPFAR focus countries with residents of 29 other sub-Saharan African countries that did not receive PEPFAR funds (Steenhuysen, Reuters, 4/6). The PEPFAR countries examined were Botswana, Cote d'Ivoire, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia. The researchers did not include Guyana, Haiti and Vietnam -- three non-African countries receiving PEPFAR funds -- in their analysis (Bloomberg, 4/6).

According to the study, both the countries receiving and those not receiving PEPFAR funding had similar HIV/AIDS-related mortality rates during the period prior to PEPFAR's launch. After the target countries began receiving PEPFAR funds, the researchers found that mortality rates decreased by about 10.5% in the PEPFAR countries, compared with the non-focus countries. The researchers also estimated that the program helped prevent about 1.1 million AIDS-related deaths (Reuters, 4/6). According to the New York Times, antiretroviral treatment provision accounts for about half of PEPFAR funding (McNeil, New York Times, 4/6). The study also found that PEPFAR's cost per death averted was $2,450 between 2004 and 2007.

According to Bendavid, the study demonstrates that PEPFAR has allocated "a lot on treatment and treatment has worked" (Bloomberg, 4/6). Mark Dybul, former U.S. Global AIDS Coordinator and PEPFAR administrator, said that it is "great news that even in the first three years [of PEPFAR], the American people supported the saving of more than a million lives" (Dinan, Washington Times, 4/7). Peter Piot, former executive director of UNAIDS, added that the program "is changing the course of the AIDS epidemic." Piot said, "People are not dying. That is spectacular." However, he added, "The irony -- and it is a positive irony -- is that the more people are staying alive, the higher the percentage" of people living with HIV will be. According to Bendavid, any increase in HIV prevalence "probably reflects the decreasing death rate and may have several public health spillover benefits." For example, HIV-positive adults who live longer lives "may be able to support their children and dependent elderly family members, reducing the burden of orphans and elderly care" (Bloomberg, 4/6).

Despite the study's promising findings, challenges remain for reducing HIV/AIDS prevalence in high-burden countries, the researchers said. For example, as increased treatment distribution allows more HIV-positive people to live longer, the cost of providing treatment to the affected population will increase. According to the study authors, "The gap between the available funds and those needed will continue to increase unless the incidence of HIV in Africa is substantially reduced" by "striking the right balance between treatment and prevention."

According to the authors, about 20% of PEPFAR funding was allocated to prevention under the Bush administration, with about one-third earmarked for abstinence-only efforts (Reuters, 4/6). When Congress reauthorized the program in 2008, the abstinence provision was removed. Bendavid said that the challenge will be to make prevention a "serious component of the program in the next five years" (Bloomberg, 4/6). Smita Baruah, government relations director for the Global Health Council, said that although PEPFAR initially focused on treatment, it should now expand its focus to prevention. She said, "As you move from emergency to sustainability, it's not going to work just to treat your way out of the infection. You now need to figure out how do we prevent new infections" (Washington Times, 4/7). According to Bendavid, "You need to reduce the number of new people infected by at least as many as the number of people you're keeping alive" (Bloomberg, 4/6).

The study is available online.

Reprinted from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv . The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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US AIDS Programme Saves Lives. 07/04/09

07/04/2009 14:51 - (SA)
- Reuters
Chicago - A US programme launched during the Bush administration has cut Aids deaths by 10% in targeted African nations compared to their neighbours and saved more than a million lives, US researchers said on Monday.

The study tracked Aids deaths and HIV infections in 12 African countries getting aid under the President's Emergency Plan for Aids Relief, or PEPFAR, during the four years after it was launched in 2003 as a five-year, $15bn effort.

The programme has made a major impact in saving lives but has done little to reduce the number of people infected with the human immunodeficiency virus, or HIV, which causes Aids, the researchers found.

"It has averted deaths - a lot of deaths - with about a 10% reduction compared with neighbouring African countries," Dr Eran Bendavid of Stanford University School of Medicine in California, whose study appears in the journal Annals of Internal Medicine, said in a statement.

"However, we could not see a change in prevalence rates that was associated with PEPFAR," Bendavid said. Bendavid said the 10% decline translates to about 1.1 to 1.2 million deaths that have been prevented.

Bright spot in Bush tenure

PEPFAR is the largest US foreign aid programme devoted to a single disease and has been lauded as a bright spot of former President George W Bush's tenure. It pays for drug treatment for people infected with HIV as well as other steps such as prevention efforts.

Last July, the US Congress voted to spend $48bn to expand PEPFAR for five years to treat and prevent Aids, tuberculosis and malaria in sub-Saharan Africa and elsewhere.

About 33 million people are infected with HIV and 2 million die of Aids each year, according to the World Health Organisation.

Bendavid said in a telephone interview his study is one of the first to look at whether PEPFAR has helped change the course of the Aids epidemic. It offers concrete evidence that foreign aid programmes can bring about positive change, he said.

"It is making a palpable and discernible impact," he said.

The researchers gathered data on 12 countries targeted by the programme, and compared this to 29 other African nations. They looked at the five years leading up to the start of the programme in 2003, and then from 2004 to 2007 after it began.

Programme has since expanded

The African countries receiving PEPFAR aid that were tracked in the study were: Botswana, Ivory Coast, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia.

PEPFAR initially provided aid in those 12 African countries and three others elsewhere, and has since been expanded.

The researchers found that in the years leading up the start of the programme, death rates rose in all of the countries studied. But as PEPFAR funding became available, the death toll declined by more than 10% in the focus countries compared to countries not participating in the programme.

PEPFAR spent about $2 450 on treatment for each life saved, the study found. "This is not a trivial cost, and PEPFAR will need to make the available resources go a long way to continue changing the course of the epidemic," Bendavid said.

Bendavid said the programme is reducing the death toll from HIV, allowing people to work and support their families and local economies. "There has to be a very strong focus on prevention, especially when the number of people infected is still staggeringly high," Bendavid said.

- Reuters

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Global Health Advocates Respond to Obama's FY 2010 Budget Proposal. 03/03/09

Kaiser Daily HIV/AIDS Report  - Tuesday, March 3, 2009

Although many global health advocates have expressed optimism about the proposed 10% increase in foreign spending in President Obama's $3.55 trillion budget proposal for fiscal year 2010, others have expressed concern that a deceleration in global health funding could hinder U.S. efforts to combat disease overseas, CQ Today reports. Obama's proposal calls for $51.7 billion in foreign spending, including about $4.5 billion in new spending compared with 2009. The president also will request $7.1 billion in supplemental FY 2009 spending for the State Department and foreign affairs this spring, CQ Today reports. According to CQ Today, administration initiatives such as expanding the Foreign Service and providing aid to Afghanistan and Pakistan could compete with U.S. global health investment.

Many of former President George W. Bush's programs -- such as the President's Emergency Plan for AIDS Relief, the President's Malaria Initiative and the Millennium Challenge Corporation -- contributed to a significant increase in foreign aid over the past eight years; however, the 2010 budget could present challenges for maintaining those commitments, CQ Today reports. According to CQ Today, the Global Fund To Fight AIDS, Tuberculosis and Malaria has requested $2.7 billion in U.S. funding for 2010, which is three times greater than the $900 million proposed in the FY 2009 omnibus bill. The Global Fund also has asked for an additional $350 million for projects approved in 2009 that lack sufficient funding. In addition, Congress likely will receive pressure to maintain the $48 billion authorized for PEPFAR for FY 2009 to 2014. Although the FY 2009 omnibus appropriations bill (H.R. 1105) would bring funding for HIV/AIDS, TB, and malaria to $6.8 billion for the year, this increase is less than in previous years, leading some HIV/AIDS advocates to express concern that funding eventually will stagnate, according to CQ Today.

According to some advocates, the U.S. will need to make progress with programs such as PEPFAR to meet the $48 billion target. Larry Nowels, a budget expert with the Modernizing Foreign Assistance Network, said, "The longer they wait to ramp it up in a meaningful way, the harder it's going to be to achieve it, or it's going to crowd our programs in 2012, 2013, 2014." Natasha Bilimoria, executive director of the Friends of the Global Fight, said, "If the funding doesn't continue, we are at risk of backsliding." Bilimoria added that stakeholders "want to ensure that the investments that we've made in the past are able to continue to grow and that people's lives are saved." Paul Zeitz, executive director of the Global AIDS Alliance, said there has been "evidence of a diminishing commitment" to the Global Fund. "There are so many pressures on the budget, the pie had to expand more dramatically," he said, adding that Obama's "intention of restoring America's credibility in the world is what is in jeopardy."

However, some advocates said that they are hopeful about the proposed increases in global health spending for both the omnibus and 2010 proposals. Smita Baruah, director of government relations at the Global Health Council, said "We were prepared for flat funding, and we feel optimistic" about the administration's intentions to continue funding global health initiatives. Laura Barnitz, director of policy communications at GHC, said she believes it has "become very apparent" to U.S. leaders that investment in global health programs, even though it takes a long time to see results, is nothing but beneficial to our national security interests and our diplomatic initiatives." According to CQ Today, some congressional leaders agree with the need to maintain and increase global health spending. Sen. Judd Gregg (N.H.), the ranking Republican on the Senate State-Foreign Operations Appropriations Subcommittee, said it is "probably necessary" to double foreign aid because of U.S. commitments to fight terrorism and disease overseas (Graham-Silverman, CQ Today, 3/2). 

 

Reprinted from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv . The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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Obama's FY 2010 Budget Emphasizes Commitment to PEPFAR. 27/02/09

Kaiser Daily HIV/AIDS Report - Friday, February 27, 2009

President Obama on Thursday released his $3.55 trillion budget proposal for fiscal year 2010, the San Francisco Chronicle reports. According to the Chronicle, the proposal emphasizes the commitment to the President's Emergency Plan for AIDS Relief and other global health programs (Coile, San Francisco Chronicle, 2/27).

According to the New York Times, the $51.7 billion allocated in the budget for the State Department and foreign assistance is "purposely vague" because the administration is working to "figure out its overseas spending priorities during an economic crisis at home," some experts said. Obama's proposal for the department and foreign assistance is an almost 10% increase over the FY 2009 budget of $47.2 billion, which the White House says places the U.S. "on a path to double foreign assistance," although the budget does not provide a timeframe. The Times reports that the Obama administration might be "rethinking" some international issues, such as global health. According to Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies, this could include PEPFAR. According to Morrison, he expects the Obama administration will continue to provide antiretroviral drugs to those already receiving them from the U.S. "on ethical and moral grounds." However, he added that Obama might shift funding to other infectious diseases, such as malaria and tuberculosis, or other health issues such as family planning or clean water. Morrison added that promoting foreign aid in the U.S. could be difficult because of the current economic situation. "There's going to have to be a strong case made," he said, adding that "these investments have concrete, verifiable impacts on people's lives" (Gay Stolberg, New York Times, 2/27).

The AP/Google.com reports that Obama's budget proposal pledges to increase resources to domestic HIV/AIDS prevention and treatment, although a specific amount was not included (AP/Google.com, 2/26). The budget also notes the increased resources for domestic HIV/AIDS efforts will have a particular focus on underserved populations (FY 2010 budget, 2/26).

Reprinted from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv . The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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Obama Names Head of AIDS Policy Office. 26/02/09

The Associated Press: Thursday, February 26, 2009 

WASHINGTON -- President Barack Obama has selected a senior researcher from Georgetown University to direct his Office of National AIDS Policy, the White House announced Thursday. 

Jeffrey S. Crowley will lead an office tasked with coordinating government efforts to reduce HIV infection in the U.S. and leading treatment of Americans with HIV/AIDS.

Crowley, who holds a master's degree in public health from Johns Hopkins University, has worked since 2000 as senior research scholar at Georgetown University's health policy institute. 

"Jeffrey Crowley brings the experience and expertise that will help our nation address the ongoing HIV/AIDS crisis and help my administration develop policies that will serve Americans with disabilities," Obama said in a statement. "In both of these key areas, we continue to face serious challenges and we must take bold steps to meet them." 

The Centers for Disease Control and Prevention reported last summer that it had been underestimating new HIV cases in the U.S. and that a better blood test and new statistical methods showed roughly 56,300 new HIV infections in 2006 - about a 40 percent increase from the 40,000 annual estimate used for the past dozen years. 

Obama's 2010 budget proposal released Thursday pledged increased resources to domestic HIV/AIDS prevention and treatment, though no dollar figure was specified. 

Crowley previously worked at the National Association of People with AIDS. His areas of expertise include Medicaid policy. 

Rep. Barbara Lee, D-Calif., who chairs the Congressional Black Caucus, welcomed Crowley's appointment in a statement. "We need a national AIDS strategy to better coordinate and guide our response to this devastating disease," she said.

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Obama Administration Fumbled in Asking for Dybul's Resignation. 30/01/09

Kaiser Daily HIV/AIDS Report 30/01/2009

"President Obama is all about sound science and a fresh global image," a San Francisco Chronicle editorial says, adding, "On these points, he has no better opportunity than building on" the President's Emergency Plan for AIDS Relief. However, the administration "fumbled the first step with summary firing" of Mark Dybul as U.S. Global AIDS Coordinator and PEPFAR administrator, the editorial says, adding, "It was unexpected, unceremonious and undeserved." 

Although it is a "president's prerogative to name his own team" and "Obama insiders and Dybul had agreed on a waiting period before a successor was lined up," that "orderly timetable was shredded after politics entered the picture," according to the Chronicle. Dybul was "scapegoated for the marginal portions" of PEPFAR, such as an "emphasis on sexual abstinence and a ban on aiding" commercial sex workers, the editorial says, adding, "These stances, while objectionable, never stood at the heart of far-larger goals of prevention, research and medical treatment that has enrolled two million worldwide." According to the editorial, Dybul critics believed that he did not "object loudly enough and had to go." 

If Obama is not "careful, the AIDS fight may return to the bad old days with factions fighting over the latest trend or more perfect answer," according to the editorial. It adds, "It's a special worry as Congress is asked to follow through on its vote last year to increase spending to $48 billion in future years, a pledge that looks iffy as economic conditions tighten." Obama should "mend his mistake by finding a replacement who matches Dybul's experience and competence," the editorial says, concluding, "That task could be a challenge given shabby handling of this praiseworthy public official" (San Francisco Chronicle, 1/30). 

Reprinted from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, and sign up for email delivery. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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Opinion Piece Respond to Dybul's Resignation as PEPFAR Administrator. 28/01/09

KAISER Daily HIV/AIDS Report

Wednesday, January 28, 2009 

Michael Gerson, Washington Post:

Although some of the "stumbles" of the Obama administration have "resulted from incompetent vetting," the requested resignation of Dybul "was made from malice" and "calls into question the depth and duration of President Obama's 'new politics,'" columnist Gerson writes in a Post opinion piece. Dybul was the "main architect" of PEPFAR and "one of its guiding visionaries," Gerson writes, adding that Dybul helped to organize the "most staggeringly successful foreign assistance effort since the Marshall Plan -- eventually helping support lifesaving AIDS therapy for more than two million people." 

However, a "few radical 'reproductive rights' groups -- the fringe of the fringe -- accused Dybul of advocating 'abstinence only' programs in AIDS prevention," according to Gerson, who adds, "It was always a lie" because Dybul "consistently supported comprehensive prevention efforts that include abstinence, faithfulness and condom use." 

It is "difficult to imagine what vision of public service could cause any Obama official to celebrate a victory by sabotaging a good man and a good cause," Gerson writes, adding that Dybul has been recognized as a "great humanitarian physician -- a man of faith and conscience -- almost universally respected among legislators, AIDS activists, foreign leaders and health experts." According to Gerson, the global AIDS coordinator position is a "massive emergency operation to provide lifesaving drugs, through complex logistics, to some of the most distant places on Earth. And now that operation may be months without effective leadership -- undermining morale, complicating interagency cooperation, delaying new prevention initiatives and postponing budget decisions" (Gerson, Washington Post, 1/28). 

Reprinted from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv . The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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Appointment of PEPFAR Head Should be Merit Based. 26/01/09

The Lancet Editorial

Published OnlineJanuary 26, 2009

DOI:10.1016/S0140-6736(09)60112-4

Last week saw the sudden departure of Mark Dybul as the US Global AIDS Coordinator, in charge of the Presidentfs Emergency Plan for AIDS Relief (PEPFAR). PEPFAR is the largest and most successful bilateral HIV/AIDS pro-gramme worldwide and considered one of President Bushfs greatest achievements. The reauthorisation of this US$50 billion initiative to support HIV/AIDS, tuberculosis, and malaria over the next 5 years makes the position of coordinator one of the most important jobs in global health.

The three candidates thought to be under consideration are: Jim Yong Kim, former Director of the WHO HIV/AIDS department, Chair of the Department of Global Health and Social Medicine at Harvard Medical School, and Chief of the Division of Global Health Equity at the Brigham and Womenfs Hospital; Eric Goosby, former Director of the Office of HIV/AIDS Policy of the US Department of Health and Human Services, and current CEO and chief medical officer of the Pangaea Global AIDS Foundation; and Nils Daulaire, former President and CEO of the Global Health Council.

The incoming Coordinator should be chosen based on his experience and ability to do the job. Essential credentials for the position include: bold and visionary leadership and expertise in global health at the scientific, policy, and implementation levels; high-level global management experience in collaboration with political, technical, and civil society groups and those living with HIV/AIDS; a commitment to increase coordination with other HIV/AIDS donors, the private sector, and foundations thereby reducing duplication and increasing efficiency; a proven track record of making ambitious decisions independent of political or special interest considerations; and a commitment to do more to integrate disease-specific responses with health systems strengthening.

The new appointee will have an enormous effect on the lives of millions of people worldwide, which is why it is imperative that the move to fill this position is not made in haste. We urge the new administration to pursue a competitive merit-based selection process for the new Coordinator, one that involves input from all stakeholders comprising representatives including scientists and civil society. Not to do so would go against the spirit of transparency and inclusiveness that President Obama has signalled is the hallmark of his administration.

The Lancet

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Obama Administration Requests Dybul To Resign as PEPFAR Administrator. 26/01/09

[Jan 26, 2009]

The Obama administration has requested that Mark Dybul immediately resign from his position as U.S. Global AIDS Coordinator and administrator of the President's Emergency Plan for AIDS Relief, CQ HealthBeat reports. An e-mail sent Thursday to U.S. foreign aid officials said that Dybul is "no longer serving" as PEPFAR administrator and that the Office of the Global AIDS Coordinator "will continue to function under the leadership of career staff until a successor is confirmed."

Dybul has overseen PEPFAR, which Congress reauthorized in July 2008 for an additional five years, since 2006. Dybul in an e-mail to his staff earlier this month said he would continue to serve as PEPFAR administrator, at least temporarily, "beyond the inauguration" of President Obama. According to CQ HealthBeat, many global health advocates were disappointed by the earlier announcement that Dybul would continue to serve as the U.S. Global AIDS Coordinator (Semnani, CQ HealthBeat, 1/23).

Reprinted from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv . The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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Obama Lifts 'Mexico City' Policy, Could Affect HIV/AIDS Efforts. 26/01/08

[Jan 26, 2009]

President Obama on Friday issued an executive order repealing the "Mexico City" Policy, which banned U.S. funding for international health groups that use their own funds to perform abortions, lobby their governments in favor of abortion rights or provide counseling about terminating pregnancies, the Washington Post reports. Obama also said that he would work with Congress to restore funding to the United Nations Population Fund to prevent HIV/AIDS, reduce poverty, and improve health care access for women and children in 154 countries. The Post reports that Obama's decision was praised by women's health advocates, family planning groups and others for allowing USAID to fund programs that offer HIV prevention and care, birth control and medical services (Stein/Shear, Washington Post, 1/24).

According to Reuters, critics of the "Mexico City" Policy say that the restrictions have resulted in large reductions in funding for organizations worldwide that provide family planning services and basic health care. For example, the Center for Reproductive Rights reports that in Ethiopia and Lesotho, some nongovernmental organizations are not able to offer comprehensive and integrated health services to people living with HIV/AIDS (Mason/Charles, Reuters, 1/23).

In a related San Francisco Chronicle opinion piece, Shalini Nataraj of the Global Fund for Women writes of one operation in Ghana that lost funding because it refused to adhere to the "Mexico City" Policy, resulting in an estimated 600,000 people losing access to HIV/AIDS prevention education, counseling and family planning services.

The effects of the policy have been "compounded" by a requirement in the President's Emergency Plan for AIDS Relief that organizations receiving funding must oppose commercial sex work, Nataraj writes, adding that the "reasoning behind this pledge is that by denying services or outreach to those who work as" commercial sex workers, such work "will be abolished and HIV/AIDS will be reduced." She writes that the "reality is otherwise, because women enter sex work for a variety of deeply entrenched sociocultural and economic reasons that must be addressed before [commercial sex work] can be reduced. This means that organizations that work with sex workers are threatened with a loss of funding for serving those most in need of information and protection from HIV/AIDS" (Nataraj, San Francisco Chronicle, 1/26).

Reprinted from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv . The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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A New and Improved PEPFAR under Obama? 21/01/09

JOHANNESBURG, 21 January 2009 (PlusNews) - Hopes are high that the change promised by incoming US President Barack Obama will extend to his foreign policy, but for more than two million people living with HIV, mainly in Africa, the changing of the guard at the White House may elicit mixed feelings.

For them, outgoing President George Bush's term in office has meant nothing less than an extension of life. In 2003 he launched the US President's Emergency Plan for AIDS Relief (PEPFAR), which has provided US$18.8 billion in HIV/AIDS funding - the largest international health initiative dedicated to a single disease.

The money has helped provide life-prolonging antiretroviral (ARV) drugs to more than 2.1 million people, most of them living in 15 focus countries, according to the programme's 2009 annual report to the US Congress.

It has also contributed to the care of more than four million orphans and vulnerable children, provided HIV counselling and testing to nearly 57 million people, and made prevention of mother-to-child HIV transmission services available to nearly 1.2 million pregnant HIV-positive women.

Although PEPFAR has generated its share of controversy, the decision to extend it for another five years and increase funding to US$48 billion received bi-partisan support in the US Congress in July 2008.

The question then, is not whether PEPFAR will continue under Obama's administration, but whether it will continue in the same form.

Criticisms
The programme's achievements in providing treatment and care are on fairly solid ground. Although there have been questions about precisely how it counts its beneficiaries, there is no question that it has saved lives.

"Several 100,000 people in South Africa are alive, thanks to the PEPFAR programme," said Dr Francois Venter, president of the Southern African HIV Clinicians Society. "They've patched up gaps in provision to groups like illegal immigrants and refugees. I think there's fairly universal acknowledgement it's been a successful programme."

Among the early criticisms of PEPFAR was the Bush administration's decision to take a bilateral approach rather than increasing funding to multilateral organisations like the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Its focus on one disease was also seen as unlikely to strengthen weak health systems in the target countries.

Today, it is generally accepted that the bilateral approach was necessary. "I think it was the right decision in terms of bringing [HIV/AIDS] services to people," said Michael Bennish, a senior associate with the Bloomberg School of Public Health at Johns Hopkins University in Baltimore, and executive director of Mpilonhle, a PEPFAR recipient in South Africa.

"I think there were inefficiencies in the Global Fund programme in terms of reaching out to NGOs like ourselves," he said.

The issue of whether PEPFAR has strengthened health systems by investing in equipment, infrastructure and staff, or weakened them by creating vertical programmes that have drawn manpower and resources away from dealing with other health problems is still up for debate.

"The health system [in South Africa] is weak, not because of PEPFAR, but because of the health ministry," Venter commented. "Arguing for donors to fit in with local agendas is terribly politically correct, but under Manto's leadership [former South African health minister Manto Tshabalala-Msimang], it wasn't a good idea."

Science instead of ideology
It is in the area of HIV prevention that PEPFAR has most irked AIDS activists. They have maintained that requirements such as that a third of prevention funding be spent on programmes promoting abstinence outside of marriage were influenced by religious conservatives in the Bush administration, and have no scientific basis.

Current policies also prohibit funding for organisations that target sex workers with HIV prevention, or for needle exchange programmes to prevent the spread of HIV among injecting drug users.

In the new mandate authorised by Congress in July 2008, the abstinence requirement was removed, but a new reporting rule requires recipients who spend less than 50 percent of prevention funds on abstinence programmes to justify their decision.

"We don't know the impact [of the new reporting requirement] yet, but implementers on the ground suggest it pushes a bias towards abstinence interventions," said Serra Sippel, executive director of the Centre for Health and Gender Equity, a US-based non-governmental organisation focused on the effects of US international policies on women's health.
The policy regarding sex-workers remains in force and, according to Sippel, would require a lengthy process of legislative reform to revise. "We feel we might be able to accomplish more by trying to change the way the programmes are implemented," she told IRIN/PlusNews.

Changing the policy would require action from President Obama, who has already indicated that he plans to overturn a policy banning funding to international organisations that perform or promote abortion. Activists have long argued that the 'global gag rule', as the policy is unofficially called, is detrimental to family planning efforts and to maternal and reproductive health.

Obama disappointed many in the HIV/AIDS sector when it emerged recently that he would not be immediately replacing Ambassador Mark Dybul as the Global AIDS Coordinator. Dybul is strongly associated with PEPFAR's ideologically driven approach to HIV prevention.

"It's a problem, Dybul's being kept on," commented Sippel. "He's been implementing these policies that aren't evidence-based. We're hoping he'll be given explicit guidance from the Obama administration."

Several organisations that receive PEPFAR funding, while full of praise for the programme's achievements, told IRIN/PlusNews that they would also like to see Obama make some changes in the way it is implemented.

"I think the evidence is overwhelming that abstinence programmes aren't effective, that they don't reflect the reality of the world we live in," said Bennish, adding that his organisation struggled with a PEPFAR ban on the use of its funding to distribute condoms at schools, a rule that clashes with national policy in South Africa, which states that any child over the age of 12 can consent to reproductive health services.

"There's no sense preaching the gospel of condoms and then not having them available," he said. "Under Obama, I'd hope that they will look at the science of things and base decisions on facts and not beliefs."

Bennish and other recipients also expressed the hope that under Obama, PEPFAR would relax some of its more onerous reporting and record-keeping requirements, and demonstrate greater flexibility in adapting to local realities.

"We feel much more can be done if we're prepared to take into consideration communities' cultures and own ways of viewing things," said Alfred Mikosi, executive director of Lifeline Southern Africa, a PEPFAR beneficiary organisation that provides HIV/AIDS counselling, education and training.

Meeting expectations
During their election campaign, Obama and his deputy president, Joe Biden, released a plan to combat global HIV and AIDS in which they pledged that "best practice, not ideology" would drive US funding for HIV/AIDS programmes.

They said they would "support the rights of sovereign nations to access quality-assured low-cost generic medication to meet their pressing public health needs". This will mean going up against the big pharmaceutical companies and pushing through licensing policies to make the latest ARV drugs available to people in developing countries.

They also promised to "dramatically increase" HIV/AIDS funding, not only to PEPFAR but also to the Global Fund, a goal the new administration may be forced to re-evaluate in light of the international financial crisis and the many priorities competing for US government spending.

"We have to keep the pressure on them to uphold their promise to increase [HIV/AIDS] funding," said Sippel. "We're trying to make the case that it's the poor and most vulnerable that are going to be hurt the most by this [financial] crisis, so we [the US] need to make sure we step up to the plate and provide the funding we've committed to."

John Prendergast and John Norris of Enough, a US-based project to end genocide and crimes against humanity, took a different view in a recent strategy paper: "While responding to the HIV/AIDS pandemic is a crucial priority, if US development assistance becomes skewed too far in this direction, it will become very difficult to make long-term investments in state-building, the rule of law, basic education, and economic growth."

To what extent Obama's campaign promises regarding HIV and AIDS will translate into policy remains to be seen, but expectations are high.

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AP/Washington Post Examines PEPfAR's Impact on HIV/AIDS in Africa. 12/01/09

[Jan 12, 2009]

The AP/Washington Post on Sunday examined the impact of the President's Emergency Plan for AIDS Relief on the burden of HIV/AIDS in African countries. According to the AP/Post,"countless Africans ... will always be grateful to [President] Bush for his war on AIDS."

PEPFAR initiatives have increased the number of Africans receiving antiretroviral treatment fortyfold over the past five years by working through grass-roots organizations as well as "higher-profile charities and big state clinics," the AP/Post reports. Still of the 1.5 millionAfricans who died from AIDS-related causes in 2007, less than one-third had access to antiretroviral treatment. The number of new HIV cases also continues to exceed the number of people receiving treatment. In addition, the current economic downturn has caused concern about whether the five-year, $48 billion in PEPFAR funding passed last year will be delivered.

Although numerous programs cite successes achieved as a result of PEPFAR funding, several advocates disagree about how the initiative has impacted HIV/AIDS in Africa. According to the AP/Post, some advocates have suggested that the initiative overemphasizes abstinence and faith-based programs. Helen Epstein, an HIV/AIDS expert and consultant for the United Nations and the World Bank, said PEPFAR's focus on abstinence has hindered prevention efforts by failing to address certain African cultural practices involving simultaneous long-term relationships. According to Epstein, PEPFAR could achieve a greater impact if funding were directed at strengthening health care systems rather than addressing a single disease. Johanna Hanefeld, researcher at the London School of Hygiene and Tropical Medicine, added that the Global Fund To Fight AIDS, Tuberculosis and Malaria more effectively utilized HIV/AIDS programs for improving health care and training because it did not distribute funding among many different groups.

However, many experts and advocates disagree with PEPFAR's critics and believe that the initiative will have a lasting impact on the HIV/AIDS in Africa. Mark Dybul, U.S. Global AIDS Coordinator who administers PEPFAR, said, "In Africa, you can't tackle development goals unless you tackle HIV/AIDS." According to Dybul, the initiative also is a major supplier of condoms to several African countries, demonstrating that PEPFAR does not emphasize abstinence exclusively. "It's the largest international health initiative in history for a single disease," Dybul said. Francois Venter, who heads a PEPFAR-funded program at the University of the Witwatersrand in South Africa says, "PEPFAR is different" because of its emphasis on measurable targets. Josh Ruxin, assistant professor of public health at Columbia University, said President Bush and his administration "deserve a lot more credit than they received" for launching PEPFAR. "[I]t is impossible to deny the results and achievements of PEPFAR," Ruxin said, adding that he hopes President-elect Barack Obama will continue the initiative while shifting its focus away from abstinence and providing funding for programs involving commercial sex workers and abortion.

According to the AP/Post, supporters and critics alike "agree that prevention is the weakest link" among global HIV/AIDS programs and will need more emphasis in the future (Nullis, AP/Washington Post, 1/11).

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PEPfAR Funding Threatened: What Does This Mean for HIV Treatment and Prevention Programmes? 10/02/09

US Discussions may lead to decresed funding
 TAC Press Statement
10 February 2010

American leaders are currently discussing the future of the President's Emergency Plan for AIDS Relief, PEPFAR. Global health activists and experts have warned that these discussions could lead to reduced funding for, and threaten the autonomy of, PEPFAR in a period of declining donor interest in HIV/AIDS.

In order for South Africa and many other countries to reach universal access, a commitment endorsed by the United States, PEPFAR will need to continue to expand funding for HIV.

In its first five years, PEPFAR funding reached $18.8 billion (R141 billion). From 2003 – 2009 PEPFAR treatment support is estimated to have saved 3.28 million adult lives. South Africa, the epicenter of the epidemic, receives a substantial amount of its HIV funding from PEPFAR. In fiscal year 2008, South Africa received nearly $590.9 million (R4.43 billion).

South Africa is moving into a new era in its AIDS response. The new government has demonstrated political commitment to meeting the treatment and prevention targets of the National Strategic Plan (2007-2011) (NSP). Targets include providing treatment to 80% of people in need and reducing new infections by 50% by 2011. It would be a great pity if this new era of local political commitment to tackle HIV was undermined by a decline in the international funder commitment.

South Africa will need to double the number of people receiving antiretroviral treatment to meet its NSP targets. The government will be further expanding access to treatment through implementing the changes to the treatment guidelines announced by President Zuma on World AIDS Day and implementing provider initiated testing.

In South Africa a funding cut will mean the government will face an increase in costs with the rapid need for scale up in spending of HIV and at the same time replacing donor funds.

Moreover, other Sub-Saharan African countries with large HIV epidemics are much more dependent on donor funds than South Africa. Unlike South Africa, countries like Malawi, Namibia and Zambia have little prospect of finding alternative finance if PEPFAR funds decline and any contraction of PEPFAR would mean less money for HIV treatment and prevention programmes. This will mean more infections and more deaths.

Unfortunately, several very vocal economists and public health officials, with little understanding of the crisis HIV presents for Sub-Saharan Africa, have been calling for reduced funding for AIDS because, they argue, donor money should rather be directed towards building health systems. This argument fails to consider:

  • the massive negative impact of the HIV epidemic on life-expectancy and the economic potential of young adults in Sub-Saharan Africa;
  • the benefits to programmes fighting TB and malaria (the two other largest causes of infectious disease deaths in the world) of increased AIDS spending;
  • the improvements to health systems that are occurring because of AIDS programmes, in part because of the unprecedented community involvement in the HIV epidemic in Sub-Saharan Africa compared to other diseases; and
  • the positive changes to patient-health worker relations in many poorer countries that the global response to health that HIV has caused.
We urge the United States not to turn its back on universal access to HIV treatment at this vital time.
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USA Travel Restrictions

You can read more about travel restrictions in general here

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AIDS Activists Laud Lifting Of US HIV Travel Ban. 2/11/09

NAIROBI, 2 November (PLUSNEWS) - A 22-year-old ban on people infected with HIV entering the US was officially lifted on 2 November, with the new rules taking effect in 60 days. AIDS activists have hailed the move as a major coup in the fight against stigma.
 "This comes as very good news for us," Michael Angaga, regional coordinator for the Network of African People Living with HIV/AIDS (NAP+), told IRIN/PlusNews.
 "For so long HIV-positive people have felt isolated by one of the greatest nations in the world, which should be spearheading human rights." Angaga said he looked forward to seeing the new rules rapidly implemented in US embassies around the world.
 In 1987 HIV was added to the list of communicable diseases that could prevent infected immigrants, students and tourists from obtaining visas to enter the US without special permission. President Barack Obama's announcement on 30 October marked the end of a process started in 2008 by then US President George W. Bush, who signed a law repealing these restrictions.
 "We lead the world when it comes to helping stem the AIDS pandemic, yet we are one of only a dozen countries that still bar people from HIV from entering our own country. If we want to be the global leader in combating HIV/AIDS, we need to act like it," Obama was reported as saying.
 Samuel Kibanga, national coordinator of the National Forum of People living with HIV/AIDS Networks in Uganda, commented: "This shows that America can now see the reality that people living with HIV are just like any other people, deserving of the right to free movement - the travel ban was discrimination of the highest calibre."
 The UNAIDS International Guidelines on HIV/AIDS and Human Rights state that any restriction on liberty of movement or choice of residence based on suspected or real HIV status alone, including HIV screening of international travellers, is discriminatory.
 Governments usually give two main reasons for imposing travel restrictions on HIV-positive people: to help control the spread of HIV, and save host countries the cost of HIV-related treatment, but Kibanga said these regulations merely drove the problem of HIV underground.
 "People fear to reveal their status when travelling. It is better to be with someone who feels free to be open about their status than one who is hiding it," he said. "That way we can all fight AIDS as partners."
 A June 2009 report  by watchdog organization Human Rights Watch, found that immigration laws and stringent requirements for accessing free health care often created insurmountable barriers to treatment and care for migrants living with HIV.
 Kibanga said he hoped the US's move would serve as an example to other nations. According to UNAIDS, 59 countries impose some form of travel restrictions on people living with HIV.
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Obama Announces Lifting of HIV/AIDS Travel Ban. 30/10/09

October 30, 2009
FoxNews.com
 President Obama overturned a decades-old policy Friday that he said was "rooted in fear rather than fact," when he announced the lifting of a rule barring HIV-positive people from entering the US.
"Now, we talk about reducing the stigma of this disease -- yet we've treated a visitor living with it as a threat," the President said.
"[W]e are one of only a dozen countries that still bar people [with] HIV from entering our own country. If we want to be the global leader in combating HIV/AIDS, we need to act like it."
 Mr. Obama touted the move just before signing the Ryan White HIV/AIDS Treatment Extension Act Of 2009, a bill that provides treatment and support to low-income people affected by the disease.
 It was named after 13-year-old Ryan White, who was stigmatized by his Indiana community after he contracted the disease in 1984 from a blood transfusion. He died in 1990. Ryan's mother, Jeanne White-Ginder, attended the bill signing.
 In 1987, the Senate unanimously passed a ban on visitors or immigrants who have HIV or AIDS from entering the US.
 But just last year, the Senate voted to overturn that ban and President George W. Bush signed it into law.  
 The publication of the rule Monday is the final step in the process. There will then be a 60-day waiting period before the ban is implemented.
 
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People Living With HIV Celebrate United States Lifting HIV Travel And Immigration Ban. 30/10/09

The Deutsche AIDS-Hilfe, European AIDS Treatment Group (EATG) and the Global Network of People living with HIV (GNP+) congratulate the United States Government.

Download the common press-release : 20091031 US lift HIV travel and immigration ban.pdf (313.37 kB)
Amsterdam, Berlin, Brussels, October 30, 2009
The United States Government today announced the lifting of HIV related entry, stay and residency restrictions. The ruling confirmed that HIV infection will be officially removed from the definition of communicable diseases of public health significance as of January 1st, 2010. The Deutsche AIDS-Hilfe (DAH), European AIDS Treatment Group (EATG) and the Global Network of People living with HIV (GNP+) congratulate the United States Government on fulfilling its promise and completing the legal procedure that was started by former President Bush on World AIDS Day 2007.
“This is a great victory for the fight against the worldwide discrimination of people living with HIV”, says Peter Wiessner from the Deutsche AIDS-Hilfe: “I remember times where we never thought that this would happen. This is an emotional moment and it feels a bit like the fall of the Berlin wall.”
DAH, EATG and GNP+ have long argued that HIV specific restrictions on entry, stay and residence are not only stigmatizing and discriminatory, but are also ineffective for public health protection and prevention purposes.
“Lifting the ban is a great step forward in the battle against stigma and discrimination against people living with HIV,” stated Kevin Moody, International Coordinator and CEO of GNP+.
“This groundbreaking move is the result of joint advocacy efforts by countless activists in the United States and around the globe over many years,” reported David Haerry of the EATG. “It is a strong message to other countries maintaining stigmatizing restrictions today, such as Russia, China, Australia and Canada.”
DAH, EATG and GNP+ commend the United States Government for its commitment to lead diplomatic efforts to lift HIV specific entry, stay and residency restrictions in other countries. There are multiple countries that could be spurred to deliver on their commitments: For example, China never delivered on the promises made in 2007 to the Global Fund to Fight AIDS, TB and Malaria to lift immigration restrictionsi and both Namibia and South Korea have not yet fulfilled their promise to review their restrictive legislationsii.
“Let’s not forget that even after the United States decision, we count more than 60 countries having stigmatizing entry or residency restrictions, including some in Western and Eastern Europe,” Peter Wiessner said: “27 countries deport people on the grounds of having an HIV infection.”
While the lifting of the United States entry ban is an important decision, there remain many loose ends. According to DAH, EATG and GNP+, the United States government should direct its immigration services to protect privacy and erase all information with regards to the HIV status of people from its immigration databases.
In addition, it is hoped that the United States criminal justice system is paying close attention. Kevin Moody: “We hope realistic information on the ways HIV gets transmitted will also filter through to United States criminal justice system, where saliva of a person living with HIV is still regarded as a deadly weapon, often resulting in ridiculously long prison sentences for spitting or biting.” iii
DAH, EATG and GNP+ want to recognize the enormous efforts by activists and diplomats inside the United States as well as outside to change these legislations. Precious support was provided by Congress woman Barbara Lee (California) and Senator Kerry. Special mention should be made of the Government of Norway and UNAIDS , that jointly led the International Task Team on HIV-related Travel Restrictions.
For more information contact:
Deutsche AIDS Hilfe: Peter Wiessner, +49-221-80 14 96 36 (German, English)
European AIDS Treatment Group: David Hans U. Haerry, +41-31-352 3210, david@eatg.org (French, English, German, Spanish)
Global Network of People living with HIV: Martin Stolk, Communications Officer, +31-6-1991 2406, mstolk@gnpplus.net (Dutch, English)
The Deutsche AIDS Hilfe and EATG collaborate with the International AIDS Society IAS on the Global Database of HIV-specific Travel Restrictions www.hivtravel.org
DAH, EATG and GNP+ have been regular partners advocating against HIV related discriminatory measures such as travel restrictions.
i DAH, EATG (2009). Peoples Republic of China: Unmet promises to the Global Fund. http://www.aidshilfe.de/media/de/DAH-EATG-letter-China.pdf
ii GNP+ (2009). Namibia will lift Travel Restrictions for PLHIV. http://www.gnpplus.net/content/view/1492/34/

iii On October 27, 2009, a woman living with HIV in Pennsylvania got sentenced for up to ten years imprisonment for spitting at another person. Last year a person living with HIV got sentenced to thirty years imprisonment for the same offence. More cases can be found at: http://criminalhivtransmission.blogs

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CDC Hears Loud and Clear: HIV Travel Ban Should Go 20/8/09

Majority of 20,000 Comments to CDC Support Lifting Travel Ban; Activists Rally at Canadian/U.S. border.

In Surrey, British Columbia and Niagara, New York last Sunday dozens of Canadians and Americans joined in solidarity to support lifting the U.S. ban on travel and immigration by people living with HIV. The views of the ralliers were buttressed by the incredible volume of comments made to the CDC in favor of its proposal to lift the ban: By the comment period deadline on Monday, the CDC had received 20,000 comments, the vast majority in support of ending the despicable policy -- though some health departments pushed for mandatory testing of immigrants.
"We were all incredibly energized around eliminating this policy that creates so much stigma," said Doulton Wiltshire of AIDS Niagara, the Canadian AIDS organization that helped organize the rally in Niagara. Wiltshire collected 300 signatures of people supporting lifting the ban on a giant petition, which was submitted to the CDC. At both the rally in Niagara and in Surrey, speakers talked about how the ban is discriminatory.
"If the U.S. wants to be a leader in the fight against AIDS, it has to start by eliminating any type of restriction on people with HIV status," Housing Works President and CEO Charles King said at the Niagara rally.
Mandatory HIV Testing
While the end to the ban will certainly face bureaucratic obstacles, the good news is that the comment period yielded comments overwhelmingly in favor of fully lifting the ban (The Human Rights Campaign helped corral 17,663 of the 20,000 comments through national action alerts to their lists). According to an analysis by Immigration Equality, no organizations or government entities suggested keeping the ban in place (though some individual commenters issued terse statements such as "NO HIV Immigrants!").
However, there were a few comments from state and municipal governments that suggested retaining mandatory HIV testing from immigrants. These comments, which came from the California Department of Social Services, Colorado Department of Public Health and Environment and Multnomah County, Oregon were responding to CDC's statement in the resolution that "although the approach of removing HIV from the definition of communicable disease of public health significance but maintaining the mandatory testing component of the medical examination was not selected for this proposal, HHS/CDC welcomes public comment on the advantages and disadvantages of this or alternative approaches, such as (non-mandatory) testing ( i.e., opt out/opt in approach)."
Experts agree that mandatory testing would be disastrous -- and possibly illegal.
"Obviously everyone supports the goal that people with HIV should know they're positive, but the immigration system is so ripe with stress, abuse and sensitivity. It is not the proper venue for testing," said Immigration Equality Legal Director Victoria Neilson. "In addition, if the ban is lifted, it's legally shaky ground if the U.S. even has the authority to test for HIV."
Nancy Ordover, founder of the Lift the Ban Coalition, agreed that mandatory testing would create new problems. "If the CDC removes HIV from its definition of 'communicable disease of public health significance' but maintains mandatory testing for people trying to immigrate/adjust their residency status, HIV will be the only nonexcludable health condition with a mandatory test."
Is This Really the End?
While the end of the ban looks promising, immigrants with HIV trying to get green cards, and travelers from throughout the world who just want to visit the U.S. should know that nothing is a done deal.
What is the next step now that the comment period is over? The CDC will develop responses to the comments and a final regulation will be drafted and submitted to the Office of Management and Budget for up to 90 days for a second review before the CDC publishes the final review. If the ban is then lifted, there will be many bureaucratic hurdles ahead, particularly the process of reviewing greencard requests for the backlog of HIV-positive immigrants living in the United States.
This isn't the first time the CDC submitted comments to lift the ban. In the early 1990s, the CDC solicited comments but when the ban looked like it might be lifted, Sen. Jesse Helms championed a 1993 law preventing HIV-positive people from entering the U.S. The 1993 law was repealed in July 2008 by Congress and President Bush as part of the President's Emergency Plan for AIDS Relief (PEPFAR).
"We've reached this threshold before. A lot of people are feeling like it's a done deal. What I did find gratifying was that the rule that the CDC put out, I think is good," Ordover said. "But I won't say I'm optimistic until the ban's lifted."
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Faith Groups Applaud Proposed US Rule To Lift HIV Travel Ban 17/8/09

EAA Press Release


Introduction

Fifty-four churches and Christian organizations, networks of people living with HIV and individuals have sent a letter to the United States’ Department of Health and Human Services welcoming a proposed revision to current US regulations that ban people living with HIV from entering or transiting through its borders without a special waiver.

The US currently is one of 13 countries that essentially bar people living with HIV from entering their borders. In July 2008, the US Congress requested that the Department of Health and Human Services remove HIV from an official list of communicable diseases that disqualify foreigners from entering the country. Public comment on the proposed revision closes today.

Explaining their support for the proposed change, the church organizations emphasize that the current ban “serves no justifiable public health purpose” and rather “entrenches discriminatory practices against people living with HIV who wish to travel to the US”.

Linda Hartke, coordinator of the Ecumenical Advocacy Alliance (EAA), noted that civil society organizations, including the EAA and its members, have campaigned vigorously for two years for countries to remove travel restrictions against people living with HIV. There are still about 60 countries worldwide with such restrictions.

“These restrictions should be a relic of our past irrational fears about the spread of HIV,” Hartke states. “Preventing people living with HIV to travel for work, visit family, or enjoy a holiday has no impact on public health or the provision of health care, “ she emphasizes, “but it does have a huge personal toll and contribute to people hiding their status or going off their treatment for fear of discrimination.”

The EAA letter also notes that “the ban has been a significant barrier to churches, mosques, temples and people in the U.S. having the privilege to engage directly in dialogue and action with people living with HIV from other countries.”

In the US, the Evangelical Lutheran Church in America took the lead in submitting a letter signed by 21 faith-based organizations.

“The fear that once surrounded the spread of HIV that paralyzed the response of the international community, including many faith organizations, has been replaced by facts,” states the ELCA letter. “Informed by our work both domestically and internationally in the fight against AIDS, we believe that eliminating the HIV-specific grounds for inadmissibility to the United States will help reduce stigma and discrimination against HIV-positive persons, enhance U.S. leadership in the global fight against AIDS and allow our ministries to more effectively partner with those most severely affected by HIV and AIDS in the world.”

For the full text of the letter and list of signatures, contact Sara Speicher, +44 7821 860 723 (mobile), sspeicher@e-alliance.ch
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Ban on Travelers with HIV to US Is Partly Lifted. 31/07/08

Streamlined Process Announced for Otherwise Eligible HIV-Positive Individuals to Enter the United States

Release Date: September 29, 2008
Office of the Press Secretary
Contact: 202-282-8010
The U.S. Department of Homeland Security (DHS) has issued the Human Immunodeficiency Virus (HIV) Waiver Final Rule, a regulation that will streamline the issuance of certain short-term non-immigrant visas for non-U.S. citizens who are HIV-positive.
Streamlining the Process
  • Under the new regulation, U.S. Department of State consular officers overseas will now have the authority to grant non-immigrant visas to otherwise eligible HIV-positive people who meet certain requirements, instead of waiting for a special waiver from DHS.
  • In fiscal year 2007, the average processing time for DHS to make decisions on such consular recommendations (for the issuance of non-immigrant visas and authorization for temporary admission) was 18 days. The final rule streamlines this process, and will make visa authorization and issuance available to many otherwise eligible HIV-positive travelers on the same day as their interview with a U.S. Consular officer.
  • The final rule applies only to foreigners who are HIV-positive and seek to enter the United States as visitors for up to 30 days; these individuals still must meet all of the other normal criteria for the granting of a U.S. visa. The issuance of visas under the rule will also be subject to certain criteria designed to ensure an HIV-positive person’s activities while in the United States do not present a risk to the public health.
  • Visas issued under this final rule will not publicly identify any traveler as HIV-positive.
Previously, the U.S. Department of State had to make individual recommendations on HIV-positive travelers to DHS, which then conducted a case-by-case evaluation to determine an applicants temporary admission to the United States. The State Department would occasionally recommend, and DHS approve, group waivers for events at the United Nations or other international gatherings in the United States.
Alternative Procedure
  • The HIV Waiver Final Rule will speed up the application process by making it easier for those HIV-positive individuals who meet the requirements to get a short-term, non-immigrant visa.
  • However, those who do not meet the specific requirements of the rule, or who choose not to use the streamlined process, may elect the existing procedure for a case-by-case determination of their eligibility for a visa and admission authorization.
Background
  • Since 1952, U.S. law and regulation have made persons “who were afflicted with any dangerous contagious disease” ineligible to receive a visa to enter the United States. People infected with HIV have been inadmissible to the United States since 1987, when Congress directed the U.S. Department of Health and Human Services (HHS) to add HIV to its list of diseases of public health significance.
  • Accordingly, foreigners infected with HIV have been ineligible to receive U.S. visas without a waiver by the U.S. Government.
  • The United States Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008, which President Bush signed on July 30, 2008, removed the statutory requirement that mandated the inclusion of HIV on the list of diseases of public health significance that made any person infected with those conditions ineligible for admission to the United States. The legislation did not, however, automatically change the existing regulations, administered by HHS, that continue to list HIV as a “communicable disease of public-health significance.” HHS is currently beginning the rulemaking process to remove HIV from the list.
  • In the meantime, the DHS HIV Waiver Final Rule fulfills the President’s promise to create a streamlined process for otherwise eligible HIV-positive individuals to gain temporary admission to the United States. On Dec. 1, 2006, President Bush directed the Secretaries of State and Homeland Security to initiate a rulemaking that proposed a categorical waiver for otherwise eligible foreigners who are HIV-positive and who seek to enter the United States on short-term visas.
  • DHS published a notice of proposed rulemaking on Nov. 6, 2007, and welcomed public comments for 30 days thereafter. The final rule adopts the proposed amendments to the regulations, and simplifies the process for the authorization of admission, with some modifications, in light of the public comments received.
For more information on the HIV Waiver Final Rule, including the published regulation, please visit http://www.dhs.gov/xprevprot/laws/.
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Barring None: Overturning HIV Related Travel and Immigration Restrictions 20/7/09

Global Health Magazine

Lyndel Urbano and Nathan Schaefer reflect on the implications of travel and immigration restrictions for HIV positive people
Twelve countries around the world, including the United States, have HIV related travel restrictions in place that ban or make it extremely difficult for HIV-infected people to travel, even for a short time, to these countries. They are: Armenia, Brunei, Iraq, Libya, Moldova, Oman, Qatar, the Russian Federation, Saudi Arabia, South Korea, Sudan, and the United States. Sixty-seven countries make it impossible for HIV positive people to change immigration status.
Depending on the country, the restrictions target individuals who plan to come to the country as tourists, for business, to visit family, or other short-term personal reasons. In some cases, they target HIV-positive people seeking longer stays for educational purposes, employment or those seeking to become permanent residents or citizens of the countries. These restrictions have been found to harm public health and economic efforts and have grave implications for the human rights of people living with HIV/AIDS.

The United States travel and immigration ban disallows the entry of HIV-positive non-citizens into the country and prohibits HIV positive non-citizens from becoming permanent legal residents. Implemented in 1987 at a time when discrimination drove public health policy, the bar actually leads to more cases of HIV among immigrants. The ban also serves as a disincentive for immigrants to test for HIV, as a positive result could mean deportation.
People living with HIV/AIDS should have full enjoyment of their human rights, including the right to privacy, confidentiality and protection from stigma and discrimination. HIV-related travel restrictions infringe upon these and other human rights in multiple ways. The U.S. Immigration and Naturalization Service currently conducts the largest mandatory HIV-testing program in the world. Every applicant for permanent residence over the age of 15 undergoes HIV testing, and largely without informed consent. In many instances, these mandatory tests are done without appropriate pre- and post-test counseling, or safeguards of confidentiality.

The United Nations International Guidelines on HIV/AIDS and Human Rights note that:
There is no public health rationale for restricting liberty of movement or choice of residence on the grounds of HIV status...Therefore, any restrictions on these rights based on suspected or real HIV status alone, including HIV screening of international travelers, are discriminatory and cannot be justified by public health concerns.
The personal impact of HIV-related travel restrictions can be devastating. The candidate immigrant, refugee, student or other traveler may simultaneously learn that he or she is infected with HIV, that he or she may not be allowed to travel, and possibly that his or her status has become known to government officials, or to family, a community, and employer, thus exposing the individual to possibly serious discrimination and stigma.
The HIV travel and immigration ban stymies HIV prevention efforts by perpetuating the myth of the HIV-infected immigrant. However, studies based on experiences of people with HIV traveling to the U.S. under current policy have shown that laws restricting entry on the basis of HIV status have not been effective in keeping people with HIV out. Instead they have been counterproductive by pushing the issue underground, as many choose to lie about their status rather than risk being turned away. The fear of being caught at the border with HIV medication in their luggage may also lead people with HIV to discontinue use of their medication while traveling. Such interruptions of treatment increase the chances of developing new or further viral mutations, which can lead to drug resistant strains of HIV, with risks of possible treatment failure. A community health survey conducted by the New York City Department of Health and Mental Hygiene (DOHMH) in 2006 found that foreign-born New Yorkers were less likely than U.S. born New Yorkers to be tested for HIV (29 percent vs. 32 percent). Foreign born New Yorkers also find out their HIV status later since they are much more likely to be dually diagnosed with HIV and AIDS than U.S. born New Yorkers (32 percent vs. 24 percent).
The restrictions also have negative economic consequences for the countries implementing them. Since 1993, the International AIDS Society (IAS), which convenes the International AIDS Conference, has refused to hold its biennial meetings in the United States. In July 2007, the its governing council adopted this additional restriction to its previous policy: "The IAS will not hold its conferences in countries that restrict short-term entry of people living with HIV/AIDS, and/or require prospective HIV-positive visitors to declare their HIV status on visa application forms or other documentation required for entry into the country." Therefore, the U.S. fails to profit from such a large gathering.
After 22 years of implementing this discriminatory policy, the United States has finally taken steps to remove its travel and immigration ban. In 2008, then President George W. Bush signed into law reauthorization of the President's Emergency Plan for AIDS Relief that included language to repeal the HIV entry ban. This action removed the statutory ban from the Immigration and Naturalization Act and opened the door for the Department of Health and Human Services (HHS) to determine whether HIV should remain on a list of "communicable diseases of public health significance." On July 2, 2009, HHS issued a long overdue proposed regulatory change to remove HIV from a list of communicable diseases for which people are barred from traveling or immigrating to the United States.
This proposed rule does not change the underlying requirements for legal entry into the United States. Instead it makes in optional for HIV-positive people to apply. If implemented, mandatory testing for HIV infection would no longer be required and HIV-positive people might be able to adjust permanent resident status as long as they meet all other conditions for admissibility. All immigrants will still be required to complete the complicated and arduous application process to change permanent legal residence.
In proposing the change, HHS maintains that "HIV/AIDS should not be considered a condition that poses a threat to public health in relation to travel because, although infectious, the virus cannot be transmitted by the mere presence of a person with HIV in a country or by casual contact."
Individuals and organizations have until Aug. 17, 2009 to submit public comments in support of the proposed regulatory change. The rule can be accessed on the CDC website. Supportive public comments will ensure the prompt implementation of the long overdue reversal of the U.S. HIV travel and immigration ban.
Read more about the public health and human rights implications of the travel and immigration ban.

Lyndel Urbano is the manager of government relations and Nathan Schaefer is the director of public policy at the Gay Men's Health Crisis

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America To Remove HIV Visa Ban After Briton's Protest 5/7/09

Campaigner persuades Washington to alter laws that forced travellers to lie on entry forms

A law that has in effect banned people with HIV from visiting America for two decades is to be overturned after a Briton with the virus accused the US of hypocrisy and discrimination during a major health conference.
Paul Thorn should have spoken at the Pacific health summit in Seattle last month, but was refused entry to the country after admitting hisHIV status on his visa-waiver application.
He sent a powerful statement to be read out in his place. The message accused the US of having an HIV policy rooted in fear and said it had no right to call itself a world leader in the fight against the disease.
In the days after the conference Thorn's case was taken up by politicians including US congressman Jim McDermott. He wrote a letter to the Obama administration citing what had happened to Thorn and another case where people were turned back at the Canadian border. "Now is the time to repair our nation's standing as the leader in the treatment of the Aids epidemic," wrote McDermott.
Last week - less than a fortnight later - the US government decided to bring the ban to an end. Its proposal, "to remove HIV as a 'communicable disease of public health significance'," is likely to be in place by the end of the year.
"A lot of people have worked on this but it seems this was the straw that broke the camel's back," said Thorn, 38, a writer and adviser on TB and HIV issues from Brighton, who described the policy as grotesque. "I have lied in the past on the visa-waiver form, but this time I wanted to make a stand."
His statement read: "The US government gives people who have HIV one of two choices. The first is to actually be dishonest on the visa application or visa-waiver form, commit a felony by lying to US immigration, and become a criminal. The second choice is to be honest, and have a visa rejected because you are considered an undesirable person, and unfit to enter the US. To my mind either being a criminal or an undesirable isn't much of a choice. I don't want to be either."
Michael Birt, executive director of the summit, said he had been "saddened" by the news that Thorn was unable to attend. "However, his absence made an even greater statement about the challenges we still face to addressHIV policy. And the impact, it seems, is that real change is under way so that perhaps others will not face a similar predicament in the future."
McDermott, a Democratic party representative for Washington state, acknowledged that George Bush had begun the process of repealing the law while president, but said the changes had never been implemented. "I am very pleased with this decision because it enables the United States to fully assume its proper leadership role in combating the scourge of HIV/Aids," he told the Observer, praising the work of the Bill and Melinda Gates Foundation and the Clinton Foundation.
Thorn, who campaigns for HIV and TB sufferers to gain access to treatment, said that he was amazed how quickly things had moved: "I am an advocate and I am used to advocacy being a very long process." He said he had written the statement in anger: "I tried to keep it as unemotional as possible, but it is quite barbed in places and it was clearly designed to cause embarrassment."
As someone who has been HIV positive since 1988, Thorn said he found the policy undermining: "I want this legislation to be in its grave for good." He pointed out that the question asking whether he wasHIV positive on the visa-waiver form was alongside those asking if he was a terrorist or Nazi.
Rowan Harvey, parliamentary and campaigns manager at the Terrence Higgins Trust, said the law was unfair. "Imagine if you're HIV positive and you've not told your employer and you are then required to travel for work purposes," she said. She described one case in which a group of activists who wereHIV positive were even banned from changing flights in the US.
Harvey said no other western countries imposed such a ban. However, China, Iraq, Sudan and Yemen were among a handful of countries that discriminated. "The idea that the ban might go within a couple of months is absolutely fantastic," she said.
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U.S. to (Finally) Begin Removal of Ban on HIV-Positive Visitors 1/7/09

The Body

Could the U.S. finally be on the verge of eliminating its ban on HIV-positive visitors? The U.S. government has formally begun the process of removing HIV from an official list of communicable diseases that you're not allowed to have if you want to enter the U.S., whether it's as a visitor or an immigrant.
It's still likely to be months before the so-called "HIV travel ban" is completely off the books. However, it looks like the sun has finally begun to set on a rule that many in the HIV community feel is an embarrassment."
The U.S. HIV travel ban has been on the books since 1987, but has been strongly opposed for many years. The issue was brought back to forefront on World AIDS Day in 2006 when former U.S. President George W. Bush promised to issue an executive order removing a requirement that HIV-positive people from other countries apply for a special waiver before they could receive short-term visas. Unfortunately, that executive order never actually happened. But in July 2008, Bush did sign a law that lifted some HIV-related travel restrictions.
Arguably, those changes only fueled the dissatisfaction of HIV advocates who felt that any restrictions on travel by HIV-positive people were silly, if not downright discriminatory.
Which brings us to the latest developments in this story. The U.S. Office of Management and Budget (OMB) recently told the U.S. Department of Health and Human Services (DHHS) that it was OK to move forward with proposing the removal of HIV from a list of "communicable disease[s] of public health significance" that make non-citizens of the U.S. ineligible for entry into the country.
If you think that sentence was confusing to read, welcome to the dizzying rules of U.S. government lawmaking. Here is the sequence of events that now has to unfold, as reported by Advocate.com:
  • The OMB says it's OK for DHHS to change the rule. (This is done.)
  • The DHHS has to formally propose changing the rule. (This should happen soon.)
  • Once the rule change has been posted, the U.S. voting public then gets 45 days to offer comments on it. (We'll let you know when this comment period begins!)
  • Once 45 days have passed, the DHHS makes additional changes to the rule based on those public comments.
  • Once those final changes are made, the DHHS sends the revised rule back to the OMB for final approval.
  • Once the OMB approves the final rule, it goes back to the DHHS for entry into the Federal Register, which is the official home for all U.S. agency rules.
  • Once it's in the Federal Register, another review period (of a month or two) goes by where people can offer new comments or Congress can try to block the rule change from going into effect.
  • After that review period is over, the new rule becomes law.
Piece of cake, right? One immigration activist -- Steve Ralls, the communications director for Immigration Equality -- was quoted as saying he hopes the new rule will take effect by the end of the year. That may or may not be in time for the International AIDS Society (IAS) to decide whether the U.S. should play host to an International AIDS Conference, the world's largest meeting of HIV researchers and activists, for the first time in two decades. (Just last month, IAS suggested it would hold its 2012 conference in Washington, D.C., provided the ban were lifted.)
Although it will take some time for the gears of government to grind out the rule change, advocates and activist groups have expressed happiness that it's in the works. "We are thrilled to hear that these proposed rules will be published," said Scott Schoettes, the HIV Project Staff Attorney as Lambda Legal, in a statement. The new rule would "once and for all eliminate the regulation that has prevented people living with HIV from visiting and immigrating to this country," he said.
The Human Rights Campaign echoed the sentiment: "This regulation is unnecessary, ineffective and lacks any public health justification," said the organization's president, Joe Solmonese. "We are confident that this sad chapter in our nation's treatment of people with HIV and AIDS will soon be closed."
In the meantime, however, we can perhaps expect to see more of the events that happened this spring. In May, as many as 60 HIV-positive Canadians were refused U.S. entry for an HIV housing summit unless they completed a long, rigorous and expensive visa approval process. (They ended up not completing the process after they determined there was no way they could carry out all of the requirements before the summit took place.)
And in June, HIV-positive British activist Paul Thorn, a project director of the Tuberculosis Survival Project, was scheduled to speak at the Pacific Health Summit in Seattle, Wash. Thorn said he was denied a U.S. visa because he revealed that he is HIV positive.
When the rule change is complete, only eight countries will remain in the world that ban visits by HIV-positive foreigners. Brunei, China, Oman, Qatar, South Korea, Sudan, United Arab Emirates and Yemen currently stand alongside the U.S. on that list, according to the International AIDS Society.
This article was provided by The Body. You can find this article online by typing this address into your Web browser:
http://www.thebody.com/content/art52524.html
General Disclaimer: The Body is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through The Body should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, consult your health care provider.
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An End to the US Ban on HIV-positive Visitors? 30/6/09

Sciencespeaks

The Obama administration is poised to lift a two-decades-old ban on travel and immigration to the US by HIV-positive foreigners, which has long been criticized as unnecessary and discriminatory.
When Congress reauthorized the PEPFAR program last summer, lawmakers included a provision overturning the ban that barred HIV-positive visitors from the US. But the prohibition remained in effect because HIV was still on a list of “communicable diseases of public health significance,” allowing US officials to bar entry into the country.
Tomorrow, the administration is expected to publish a proposed regulation that would remove HIV from that list of diseases, a move hailed by leading HIV/AIDS advocates who say the ban perpetuated the stigma and discrimination surrounding HIV. Among other effects, the ban has meant the US was unable to host the International AIDS Conference despite its leading role in combating the deadly epidemic.

Once the administration’s proposed regulation is published, there will be a 45-day open comment period before the Department of Health and Human Services can make it final.

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HHS To Propose Removal Of HIV From List Preventing Foreigners U.S. Entry 30/6/09

Kaiser Daily U.S. HIV/AIDS Report

HHS this week will issue proposed regulations that would remove HIV from the list of "communicable diseases of public health significance," effectively lifting the ban on HIV-positive foreign residents from entering the country, the Long Island Newsday reports (Reddy, Long Island Newsday, 6/29). In 2008, former President George W. Bush signed into law a bill that removed the statutory ban on foreign travelers and immigrants with HIV from entering the U.S. HHS then needed to remove HIV from the list of inadmissible conditions. The proposed rule will be published in the Federal Register this week and then undergo a 45-day comment period before it can become final (Hsu, Washington Post's blog "44," 6/29)

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SA: Disease Experts Applaud Move to Overturn HIV Entry Ban 30/6/09

AIDSPortal

Discriminatory Rule Has No Medical or Scientific Basis
The Infectious Diseases Society of America, the HIV Medicine Association (HIVMA), and the Center for Global Health Policy strongly support the Obama administration’s move to lift the two-decades-old ban on travel and immigration to the U.S. by HIV-positive individuals.
“This rule is unnecessary and discriminatory,” said HIVMA Chair-elect Michael Saag, MD, FIDSA, professor and chair of the Division of Infectious Diseases at the University of Alabama at Birmingham. “There is no scientific or public health rationale for excluding people with HIV infection from the U.S. HIV infection is a manageable condition not transmitted through casual contact. The travel ban actually serves to undermine public health by discouraging people from determining or disclosing their HIV status.”
Overturning the ban would simply put HIV-positive people on a level playing field with any other foreigner wanting to visit or immigrate to the U.S. This long-overdue move would bring the U.S. in line with current science and international standards of public health practice and diminish the stigma and discrimination suffered by HIV-positive people.
At issue is a prohibition on travel and immigration to the U.S. by people with HIV, put in place in the late 1980s. Congress overturned this law last summer, in legislation signed by President George W. Bush that also reauthorized the President’s Emergency Plan for AIDS Relief. Despite that move, the ban has remained in place because HIV is still classified by the Centers for Disease Control and Prevention as a “communicable disease of public health significance.”
In the coming days, the Obama administration is expected to publish a new regulation that would remove HIV from that list of diseases. The CDC supports the move, saying that HIV does not pose a risk to the general population and that removing it from the disease list reflects “public health best practices.”
“These changes reflect current scientific knowledge and public health best practices and will have the benefit of removing stigmatization of and discrimination against people who are HIV infected,” the CDC states. “While HIV infection is a serious health condition, it does not represent a communicable disease that is a significant threat for introduction, transmission, and spread to the United States population through casual contact. An arriving alien with HIV infection does not pose a public health risk to the general population through casual contact.”
For more information on this topic or to arrange an interview with an HIV/AIDS expert, please contact Deirdre Shesgreen at 703-740-4954 or dshesgreen@idsociety.org.
The Infectious Diseases Society of America (IDSA) is a professional society representing more than 8,600 infectious diseases physicians and scientists devoted to patient care, education, research, prevention, and public health. The HIV Medicine Association (HIVMA) is the professional home for more than 3,600 physicians, scientists and other health care professionals dedicated to the field of HIV/AIDS. Nested within IDSA, HIVMA promotes quality in HIV care and advocates policies that ensure a comprehensive and humane response to the AIDS pandemic informed by science and social justice.
The Center for Global Health Policy is an organization of physicians and scientists dedicated to promoting the effective use of U.S. funding for addressing the global HIV/AIDS and TB epidemics by providing scientific and policy information to policymakers, federal agencies, non-governmental organizations, and the media. The Center is a project of IDSA and HIVMA. All three organizations are based in Arlington, Va.
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Obama Takes Steps to End the HIV Travel Ban 29/6/09

Poz.com

The federal Office of Management and Budget posted a notice on its website June 26 saying that the Department of Health and Human Services (HHS) could take steps to remove a travel regulation that prohibits HIV-positive travelers from entering the United States, The Advocate reports. Specifics about the regulatory change will be available in the next few days.
“We won’t know all of the details until the HHS regulation is posted,” said Steve Ralls, communications director for Immigration Equality. “Congress’s intent was clear that this should be a clean lift of the ban—our hope is that will be reflected in the HHS regulation.”
Former President George W. Bush signed into law a measure to remove the HIV travel ban last summer, but HHS has yet to put the new policy into effect. After a substantial public comment and approval phase, the new travel regulation could go into effect in the fall.
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Removal Of US Entry Ban For People With HIV Moves A Step Closer 29/6/09

Aidsmap

Hopes that restrictions on entry to the US for people with HIV will finally be removed were raised when the US government indicated that it had completed a review of the removal of HIV from the list of communicable diseases that prevent entry to the US.
Once the regulations have been removed, HIV will no longer be a bar for entry to the US for visitors or migrants.
There will now be two periods of consultation, which could see the ban finally removed by late 2009.
“We are only one important step closer to finally ending this discriminatory ban once and for all”, said Joe Solmonese of Human Rights Campaign, a New York-based advocacy organisation.
Almost a year ago, legislation that bans HIV-positive non-US citizens from entering the United States in all but exceptional circumstances was repealed. However, separate regulations dating from 1987 remained in place.
This meant that HIV-positive individuals could not enter the US even for travel without first obtaining a visa. The process for obtaining a visa was recently streamlined, but there have been numreous reports of visas being refused and people with HIV being refused entry to the US if they travelled without the correct documentation.
Earlier this month British TB activist Paul Thorn, who is HIV-positive, revealed that he had been refused a visa after an invitation to speak at the Pacific Health Summit in Seattle.
It now looks likely that the regulations prohibiting entry to the US for HIV-positive travellers and migrants will removed. On June 26th the Office of Management and Budget said that the Department of Health and Human Services (HHS) could move forward with the revision of the regulations.
These revised regulations have not yet been published. Once they are, there is a lengthy and complex period of consultation and review. Firstly they will be open for public consultation for 45 days. The regulations can be amended by the Department of Health and Human Services to reflect comments. The revised regulations will then have to be returned to the Office of Management and Budget for approval. A further period of review lasting between 30 and 60 days will then follow, after which the revised regulation will come into effect.

Until this process is complete, individuals with HIV will still need to obtain a visa to legally enter the US.

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HIV Entry Ban Undermines Public Health. 18/03/09

GMHC Report Claims Immigrants Diagnosed With HIV Later Than Native-Born

March 18, 2009

New York, N.Y. -- Today Gay Men's Health Crisis (GMHC) released a new report, Undermining Public Health and Human Rights: The United States HIV Travel and Immigration Ban. The report details the history of the U.S. HIV travel and immigration ban, including its public health, human rights, and economic tolls. The report also highlights new research that analyzes HIV-related disparities experienced by immigrants.

According to New York City Department of Health and Mental Hygiene data, immigrants are more likely (32%) to be diagnosed with both HIV and AIDS than their native born counterparts (24%), a marker of both late diagnosis and poor access to healthcare. HIV incidence among foreign-born New Yorkers steadily increased from 2001-2006. In 2001, they accounted for 15% of new HIV diagnoses in New York City versus 24% in 2007.

Although the HIV entry ban was adopted in 1987 to ostensibly keep HIV out of the country, research shows that, in fact, most immigrants contract HIV after entering the U.S. This research is presented in the GMHC report.

"Our report documents the devastating impact of the discriminatory U.S. travel and immigration ban that has for decades contributed to HIV-related stigma and the proliferation of HIV in immigrant communities," said Marjorie J. Hill, Ph.D., Chief Executive Officer of GMHC. "We call on the Obama administration to expeditiously repeal the HIV travel and immigration ban."

Congress and President Bush repealed the statutory HIV ban in July 2008. However, the Department of Health and Human Services must now remove HIV from a list of communicable diseases in order to completely repeal this discriminatory policy.

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HIV Entry Ban Undermines Public Health. 18/3/09

GMHC Report Claims Immigrants Diagnosed With HIV Later Than Native-Born

March 18, 2009

New York, N.Y. -- Today Gay Men's Health Crisis (GMHC) released a new report, Undermining Public Health and Human Rights: The United States HIV Travel and Immigration Ban. The report details the history of the U.S. HIV travel and immigration ban, including its public health, human rights, and economic tolls. The report also highlights new research that analyzes HIV-related disparities experienced by immigrants.

According to New York City Department of Health and Mental Hygiene data, immigrants are more likely (32%) to be diagnosed with both HIV and AIDS than their native born counterparts (24%), a marker of both late diagnosis and poor access to healthcare. HIV incidence among foreign-born New Yorkers steadily increased from 2001-2006. In 2001, they accounted for 15% of new HIV diagnoses in New York City versus 24% in 2007.

Although the HIV entry ban was adopted in 1987 to ostensibly keep HIV out of the country, research shows that, in fact, most immigrants contract HIV after entering the U.S. This research is presented in the GMHC report.

"Our report documents the devastating impact of the discriminatory U.S. travel and immigration ban that has for decades contributed to HIV-related stigma and the proliferation of HIV in immigrant communities," said Marjorie J. Hill, Ph.D., Chief Executive Officer of GMHC. "We call on the Obama administration to expeditiously repeal the HIV travel and immigration ban."

Congress and President Bush repealed the statutory HIV ban in July 2008. However, the Department of Health and Human Services must now remove HIV from a list of communicable diseases in order to completely repeal this discriminatory policy.

 

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US Relaxes Visa Rules for HIV+ Travellers. 01/10/08

Washington - United States immigration officials on Monday announced moves to ease and speed up visa-processing for HIV-positive visitors to the United States, months after a 21-year entry ban on people with the virus was lifted.

Under the new rules, US consular offices overseas will have the authority to grant temporary, non-immigrant visas to HIV-positive applicants who meet "all of the other normal criteria for the granting of a US visa", the Department of Homeland Security (DHS) said in a statement.

Previously, people with HIV were banned from entering the United States unless they obtained a special waiver.

"We're also accelerating the process by providing an additional avenue for temporary admission while maintaining a high level of security at our borders," Homeland Security Secretary Michael Chertoff said in the statement.

Visas issued under the new rules will "be subject to certain criteria designed to ensure an HIV-positive person's activities while in the United States do not present a risk to the public health," the statement said, without going into detail.

President George Bush signed legislation in July which removed HIV from a list of diseases "of public health significance" that effectively barred any person infected with the virus that causes Aids from entering the United States.

The ban on HIV-positive foreigners entering the United States had been in place since 1987. – AFP

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US Lifts Travel Ban on HIV-Positive People. 21/07/2008

Ban on Travelers with HIV to US Is Partly Lifted.

Los Angeles Times (07.31.08)::Vimal Patel

On Wednesday, President Bush signed into law a measure that provides $48 billion to combat HIV/AIDS and other diseases globally, and ends a longstanding policy banning HIV-positive people from travelling to the United States. However, the repeal of the 1993 travel ban does not remove all impediments for HIV-positive foreign visitors and immigrants.

Since 1987, the Department of Health and Human Services (HHS) has had HIV on a list of diseases barring entry into the United States, a prohibition that is separate from the congressionally imposed ban. But now that legislators have repealed the overarching travel ban, federal health officials are no longer legally bound to keep HIV on the list, which also includes tuberculosis, gonorrhea, and leprosy.

In 1991, HHS proposed removing HIV from its list but the move drew outrage from religious conservatives and the effort was derailed, said Victoria Neilson, legal director for Immigration Equality, a New York-based group. A similar public comment period would be likely if HHS revisited the proposal.

Attitudes about HIV/AIDS have changed, and the debate may be different today, said Neilson. "People understand it's a virus, not a black plague or something. There's no reason for a disease that isn't airborne to be on the list," she said.

Waivers are available. A short-term waiver permits visitors to enter the United States temporarily if they can show they do not have HIV symptoms, do not pose a threat to public health, and can pay for their medical care, if necessary.

 

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Senate Repeals HIV Travel Ban. 17/07/08

Bay Area Reporter (07.17.08: Bob Roehr)

AIDS advocates applauded the Senate's 80-16 vote on July 16 to repeal the longstanding ban on travel and immigration by non-US residents with HIV. The provision overturning the 20-year ban, sponsored by Sens. John Kerry (D-Mass.) and Gordon Smith (R-Ore.), was included as an amendment to the President's Emergency Plan for AIDS Relief. A bid by Sen. Jeff Sessions (R-Ala.) to reinstate the ban never materialized; he accepted a substitute amendment instead. 

The Congressional Budget Office estimated the cost of lifting the restrictions would amount to $83 million in additional medical costs over the next 10 years. To offset the cost, visa application fees were raised by $1 and immigration application fees by $2. 

"For those of us who have long dreamed of becoming Americans, and have been prevented by the 1993 law from ever being able to enter or leave the US without waivers or fear of humiliation, this is a massive burden lifted," said Andrew Sullivan, a conservative gay commentator. 

"It is gratifying to know that my HIV-positive colleagues from other countries will finally be allowed to come to the United States to share their expertise," said Michael Saag, vice chair of the HIV Medical Association. 

"We applaud the Senate for rejecting this unjust and sweeping policy that deems HIV-positive individuals inadmissible to the United States," said Joe Solmonese, president of the Human Rights Campaign, which lobbied to lift the ban. 

The restrictions originated in 1987 and were codified by Congress in 1993. 

Immigration law excludes non-citizens with any "communicable disease of public health significance" from entering the United States. However, only HIV is explicitly named in the statute.

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Momentum Builds to Eliminate Travel Restrictions Against People Living with HIV. 30/3/08

Bulletin no. 01/2008
Keep the Promise, HIV AIDS AND CAMPAIGN

When the HIV and AIDS epidemic was identified in the early 80s, countries began establishing travel restrictions in an effort to prevent the virus from entering their borders. Such measures include mandatory HIV testing for persons seeking entry to the country and that would-be entrants declare themselves to be uninfected. 

Based on these mandatory tests and declarations, a number of countries have excluded from entry people living with HIV or people suspected of being infected. Restrictions have been imposed upon people wishing to enter the country for short-term stays such as for business or personal visits or tourism, or for longer periods such as for study, employment, refugee resettlement or immigration. 

Despite the medical advances that have made HIV a more manageable disease, most countries still impose travel restrictions on people living with HIV and cite two main reasons – to protect the national public health and to avoid the economic costs of providing health care and social assistance to people affected by HIV and AIDS. Over the years, many international organizations, including United Nations agencies and programs, the International AIDS Society and the Global Fund to Fight AIDS, Tuberculosis and Malaria, have strongly opposed the use of HIV and AIDS-related travel restrictions, noting that there is no public health rationale for such restrictions and that the practices are discriminatory, increase stigma, and prevent people from seeking available treatment and support. 

A briefing paper on travel restrictions will soon be available (Stories are needed! See below). There are also a number of recent steps being taken to address the restrictions. 

To search a country by country database of HIV-related travel restrictions visit:

http://www.eatg.org/hivtravel/ 

International Task Team on HIV-related Travel Restrictions convened 

UNAIDS has set up an international task team to work toward the elimination of HIV-related travel restrictions towards people living with HIV. The group includes representatives of governments, inter-governmental organizations, civil society groups, the private sector and networks of people living with HIV. It held its first meeting in Geneva at the end of February, co-chaired by UNAIDS and the

Norwegian Government. 

The Ecumenical Advocacy Alliance is represented on the task team by Peter Prove, of The Lutheran World Federation, who is a lawyer specializing in human rights (he is also a member of the EAA Global Trade Strategy Group). 

“Travel restrictions based on HIV status again highlight the exceptionality of AIDS, especially short-term restrictions,” said Dr. Peter Piot, Executive Director of UNAIDS. “No other condition prevents people from entering countries for business, tourism, or to attend meetings. No other condition has people afraid of having their baggage searched for medication at the border, with the result that they are denied entry or worse, detained and then deported back to their country”, he added Recent studies indicate that 104 countries have some form of HIV-specific travel restrictions, including 12 which ban people living with HIV from entering for any reason or length of time.

Most of the restrictions require people to indicate their HIV status before entering or remaining in a country, with some countries requiring them to undergo mandatory HIV testing, without privacy safeguards. 

“Addressing the issue of travel restrictions related to HIV status helps us to confront the larger issue of systemic discrimination towards people living with HIV and AIDS”, said Peter Prove. “In the case of travel restrictions, the policy of discrimination is often shockingly explicit”. 

The next meeting of the task team will be 31 March to 2 April in Geneva.

For more information, see:

http://www.unaids.org/en/KnowledgeCentre/Resources/FeatureStories/archive/2008/20080304_HIVrelated_travel_restrictions.asp

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