UNIVERSITY COALITIONS for GLOBAL HEALTH

Last year Malgorzata Malak participated in a 3-month internship in a local Mozambican organization, Kindlimuka in August – November.  During the internship, together with her tandem partner, Verena Allinger, they made a documentary about HIV/AIDS issue in Mozambique.

The film is called “Vida Positiva” and is an outline of the situation including reasons for HIV spread, national combat strategies, projects run by NGOs, ways of treating the disease and personal stories of HIV positive people and their relatives.

The film is available at: http://mlume.com/vida

PEPFAR is probably not a term most people in the United States hear every day, but around the world, PEPFAR has become one of our nation’s most successful ambassadors. The initials stand for the President’s Emergency Plan for AIDS Relief. People in developing countries, particularly in Africa, know it means life-saving help. In the 15 countries that PEPFAR serves, U.S. approval ratings are among the highest anywhere in the world.

Congress is considering reauthorization of the U.S. PEPFAR for another five years, yet, sadly, the bill has stalled in the Senate. It is urgent that the Senate move this forward, not only for the sake of the millions of people in need of lifesaving AIDS medication, or the millions of orphans the AIDS pandemic has left in its wake, but also because of the value PEPFAR has to the U.S. in shaping and improving the way the rest of the world sees us. The children of today will not forget that PEPFAR saved their mothers with antiretroviral medicine or helped provide skills training for their transformation into adulthood when there were no other options. The $50 billion price tag is clearly worth the money in lives saved, and the goodwill PEPFAR brings to the U.S. in the eyes of other nations has a value that should not be underestimated.

What will become of the children orphaned by AIDS if PEPFAR is not fully funded? In communities across the globe heavily impacted by AIDS and poverty children face challenges every day that no child should ever have to consider. Too many must ask: Should I go to school, or, instead, stay at home to find food and care for my family? Orphans and vulnerable children are far more susceptible to a host of dangers than children with healthy parents and stable communities to care for them. These dangers include being forcibly recruited into a rebel army, a child sex trafficking ring, or child labor. So, we must realize that if we invest in the future of these children now we make everyone’s future a better, safer place.

While 10 percent of PEPFAR funding is dedicated to assisting orphans and vulnerable children, the bill will also help keep children from being orphaned in the first place. PEPFAR is, in effect, “orphan prevention.” PEPFAR improves the future for the world’s children and is an effective use of taxpayer dollars.

Some may say that foreign aid is a waste of money, but tell that to the 1.4 million people receiving life-saving antiretroviral medicine through the U.S. program, enabling parents to care for their children and pass down important lessons and traditions. PEPFAR provides care to millions of aunts, uncles and neighbors allowing them to go to the office, till the fields and be productive, contributing members of society. It has built health-care infrastructure increasing the number of doctors and nurses to keep communities healthy. It creates lasting, widespread goodwill towards the U.S. among the nations and the people it helps. Helping children means keeping parents alive, communities thriving and holding the social fabric of societies together. Children everywhere have a better shot at life and make better choices when they have parents to guide them, healthy communities and stable nations to grow up in.

A great deal is at stake as the Senate is considering the reauthorization of PEPFAR. It is a moment when the support of Sen. Tom Coburn, R-Okla., and leadership of Sen. Harry Reid, D-Nev., is critical. They and the rest of the Senate should pass this bill and do so quickly for President Bush to use it to leverage other countries to also give more in effective aid when the G-8 meets in Japan this July. The $50 billion for PEPFAR might be seen as an investment in developing countries; however, it is actually a key investment in the future for the United States and the rest of the world. by Jennifer Deleny

Hi folks– a much needed PEPFAR update from Pete at Physicians for Human Rights! Read below for the full scope or check out Pete’s blog.

As you may know, the House of Representatives has already passed their version of the PEPFAR program. The next step in the process for the bill to become law (think schoolhouse rock) is for the Senate to pass their version of the bill. Any differences between the two bills will be sorted out in a conference committee, made up of key stakeholders from the House and Senate, which then sends the bill to the President to sign into law.

We still have a big fight ahead of us to get the best possible bill signed into law. Unfortunately, a group of fiscal conservatives in the Senate, led by Tom Coburn (R-OK), are using a procedural hold to stop the bill from going to the floor of the Senate. Michael Gerson has written a great op-ed in the Washington Post, which explains:

The seven, led by Coburn, complain that the reauthorization is too costly. They object to “mission creep”—the funding of “food, water, treatment of other infectious diseases, gender empowerment programs, poverty alleviation programs”—as though people surviving on AIDS treatment do not need to eat, work or get their TB treated. And the senators are concerned that AIDS funds might be used for things such as abortion referrals and needle distribution, though the legislation doesn’t mention these possibilities. So they are pushing for the extension of a superfluous spending mandate requiring that at least 55 percent of PEPFAR resources be used for treatment, on the theory that this will starve “feckless or morally dubious” prevention programs.

Gerson emphasizes that there is no way to control the epidemic with treatment alone.

Given that there are about 2.5 new HIV infections for every person starting on AIDS drugs, there is no way to control the pandemic through treatment alone. And because treatment is less expensive than it used to be, PEPFAR is meeting its treatment goal for less money. The 55 percent treatment floor would force the program to waste money in pursuit of an arbitrary, nonsensical spending target— the worst kind of congressional earmark.

The implementation of PEPFAR has shattered the old conceptions that it is simply too expensive to treat people with AIDS. We’ve also learned over the last 5 years that ABC only prevention strategies tie the hands of implementers on the ground and do not work, especially not for women who now comprise 60% of those living with AIDS in sub-Saharan Africa.

As I’ve noted before, the current versions of the House and Senate bills are based on series of compromises—some of which are good and some of which are not so good. One area we are fighting for improvement on is the integration of family planning services with HIV/AIDS services as a crucial way to give women access to care. In partnership with other AIDS advocacy organizations, we are working on several fronts to ensure that PEPFAR incorporate evidence- and human rights-based prevention and treatment programs.

Watch your in boxes for some new opportunities to help PHR’s Health Action AIDS Campaign in these efforts by contacting your Senators.

Update 5/16:

Senator Coburn (R-OK), one of the leaders of the current opposition to the speedy passage of PEPFAR, has posted a response to Gerson’s article.

Jordan Sloshower, Research Coordinator in Family Medicine at the University of Manitoba, Canada, tells us about his university’s involvement in the UCGH Week of Action. He also reflects on the reasons for the increasing interest in global health -Stephanie

During the week of March 24, 2008, the University of Manitoba played host to a lecture series on topics related to “Global Health”. This event was part of a larger “Global Health Week of Action” organized by Universities Coalitions for Global Health (UCGH)-a network of international health-focused organizations and individuals with a university presence.

The overarching goal of this international campaign was to bring together medical, graduate and undergraduate students to advocate for the right to health for populations that are underserved by drawing attention to a host of pressing issues, including gender inequality, HIV/AIDS, access to clean water, sanitation and essential medicines, and the global healthcare worker shortage.

Here at the University of Manitoba, lecturers spoke about their groundbreaking work in the field of infectious disease, about HIV/AIDS advocacy and activism, and about the relationship between health, politics and culture. In the lecture series’ keynote address, Professor Emeritus Dr Alan Ronald outlined his experience with the university’s global health initiatives in Kenya, Uganda and India and provided advice for students in health disciplines who wish to “change the world” through their life’s work. As this lecture series coincidentally overlapped with the launch of The University of Manitoba’s Alan Klass Memorial Program for Health Equity and the publication of a two-day report in The Winnipeg Free Press on HIV/AIDS prevention programs in India set up by Manitoba-based researchers and physicians, (1) the question arises, why there is so much interest and activity in the field of global health and health equity?

Part of the answer to this question surely lies in the fact that the search for solutions to global health problems presents unique challenges (and funding opportunities) to researchers who attempt to apply science and technology to the improvement of the human condition. However, an equally significant reason for the recent surge of interest amongst the public and academics worldwide is that achieving global health equity, or fairness in basic health care measures for rich and poor alike, is not just a scientific problem, but also a cultural, political and economic problem deeply rooted in rapidly changing social structures. In other words, the issues raised by the field of global health probe deeper into human consciousness, as they call into question the way we organize our affairs in society and raise ethical questions about our actions in an increasingly interconnected world.

The aforementioned report in the Winnipeg Free Press is illustrative of this point. Rather than focusing on Dr Stephen Moses’ groundbreaking scientific research on the effectiveness of male circumcision in preventing the spread of HIV, the report assumed a more humanistic perspective. By examining the sex-trade in India, the report outlined how underlying social structures and cultural norms on gender roles become embodied as disease in female sex-workers. In so doing, this article effectively conveyed the anthropological observation that “AIDS is a socio-cultural and political-economic phenomenon with biological manifestations.” (2) As a result, preventing HIV/AIDS is not just a problem for medical doctors, but is a complex initiative requiring collaboration between health workers, politicians, development workers, community leaders and ordinary people. The need for such an interdisciplinary approach speaks to the underlying reality that the problems afflicting the health of populations worldwide are symptoms of a web of social, political and economic pathologies that constitute social injustice. Hopefully, the growing interest in global health reflects the realization that assaults against human dignity should not only attract the interest of inquisitive scientists and researchers but should compel all constituents of global civil society into concerted pragmatic action. Jordan Sloshower: sloshowe@cc.umanitoba.ca

References

(1) Skeritt J. Where HIV flourishes:India’s culture makes AIDS campaign an uphill battle. The Winnipeg Free Press 2008 Mar 22. Available from:URL: http://www.winnipegfreepress.com/special/aidsindia/story/4147383p-4737039c.html

(2) Marshall W. AIDS, race and the limits of science. Soc Sci Med 2005;60(11):2515-2525.

Hey UCGH!

This morning, the Senate Foreign Relations Committee marked up and approved the Lantos/Hyde Leadership Against AIDS, TB, Malaria Act of 2008 by a vote of 18-3. Though we have not seen the final bill that passed through committee, we understand that the bill is still a $50 billion bill, including $9 billion for TB and malaria. Thank you to all of you who were able call your Senator yesterday and ask them to retain the $50 billion-you’re voices were heard today at the Committee mark up!

Because of all of your amazing efforts we now have a U.S. Global AIDS Bill that has passed committee in both the House and the Senate! But we still need your help, especially as Congress gets ready to go on recess from March 15-30. This is a great time for all to go out and do in district lobby visits to make sure that when the bill hits the Senate and House floor for a vote after March 30th that your Congressional Member will vote in favor of this awesome bill! Please get out there and help us pass this bill-we’re almost there!

To learn more about in district lobby visits check out http://www.ucgh.org/resources/toolkit-center/ucgh-action-guide/contacting-politicians/

The only amendment offered today in the Senate mark up was a managers’ amendment. Though most of the provisions relate to the HIV/AIDS section of the bill there is one provision related to malaria (see #9).

The provisions of the managers’ amendment are as follows:

1. Technical amendments to Section 101(f) on Inspectors General (Biden)

2. Alter conscience clause on page 90 to conform to the House bill (Biden/Lugar)

3. Changing “healthcare workers and professionals” to “healthcare paraprofessionals and professionals” in Section 301, changing goal to target, and adding definition of paraprofessionals; elimination of “behavior change” phrase in several places in the bill to conform with House compromise; adjustments to pediatric treatment provisions (Biden)

4. Global Fund — retain current law on timing of measuring Fund contributions for purposes of U.S. limitation of 33 percent (DeMint)

5. Define “structural prevention” (Biden)

6. Create panel on reviewing PMTCT (Dodd)

7. Promote vaccine development (Kerry)

8. Promote microbicide development (Obama)

9. Malaria/ensure CDC surveillance doesn’t duplicate WHO (DeMint)

10. Highlight Caribbean as potential partner for regional approaches to AIDS (Nelson)

11. Sense of the Senate, adding new section 401(b) on the scale-up of the spending over the course of the five fiscal years (Biden/Lugar)

12. Promote pre-service training for health capacity (Cardin)

13. Technical change to insert section 307 (missing by mistake from original bill), and renumbering rest of Title III accordingly (Biden/Lugar)

To learn more about the U.S. Global AIDS Plan visit www.pepfar2.org