The Global Pulse Journal Blog

The World Bank and USAID are hosting a series of debates exploring emerging issues in global responses to HIV/AIDS and worldwide evolving approaches to development aid, .  The debates attempt to lay out the best evidence and information available to assist world governments, civil society organizations, and other development organizations in interpreting and responding to the shifting dynamics of the epidemic and our collective responses to the challenges it presents.

This global discussion series began this past May with a debate entitled “Test and Treat: Can We Treat Our Way Out of the HIV Epidemic?” which looked at testing and treating strategies with a focus on their role in Africa.

In June, a debate on “Behavior Change in HIV Prevention” took place looking at dynamics involved in behavior change approaches and their past ineffectiveness.

Check out these past debates and the ones still to come including theis week’s August 26th debate on “Discordant Couples and HIV Transmission” and continue to follow this debate series for future conversations.

Recently members of several major corporations including Nike, EBay and the Modernizing Foreign Assistance Network (MFAN) presented an open letter calling on the US government and President Obama to take an innovative approach to carrying out the goals and visions committed to at the recent G8 summit and to develop a US global development strategy. They call on US leaders and Congress to develop a rewritten US development Act to replace the outdated 1961 Foreign Assistance Act. They discuss an approach to modernize foreign assistance in the global arena.

A recently released working paper by Joel Cohen of Rockefeller University reviews important demographic trends expected to occur between 2010 and 2050. In this report, based on a lecture that was part of CGD’s Demographics and Development in the 21st Century initiative, the author explores the role of population in development and indicates some of their implications for economic and global development. Additionally, he suggests some possible policies to respond to these trends and their implications.

With the highest recorded global population growth rate and the most enormous demographic shift ever between the more developed and less developed regions, the century from 1950 to 2050 saw dramatic changes in global development. It is still unforeseen whether this pattern of human development will remain sustainable. This paper explores the ways in which policy could respond to unmet human needs, many of which have arisen from human choices rather than biophysical necessities.

Today’s post continues to explore the debate over U.S. contribution to funding for combating global AIDS. It features contributions by Anand Reddi, author of the article highlighted earlier (United States global health policy: HIV/AIDS, maternal and child health, and The President’s Emergency Plan for AIDS Relief).  A former Fulbright Scholar, Anand serves on the board of directors of the AIDS Healthcare Foundation, and is a student at the University of Colorado School of Medicine.

In a recent article on Huffington Post, Dr. Ezekiel J. Emanuel, special advisor for health policy in the OMB, defends the Obama Administration’s decision to shift some of the funding away from successful AIDS treatment efforts:

This comprehensive and integrated approach is what the President’s Global Health Initiative is all about. It recognizes that we can’t treat our way out of the HIV-AIDS epidemic. The key to ending it is to reduce the number of those who become HIV-positive in the long-term – and that takes improving their overall health and the health systems around them. After all, patients don’t come to doctors with one disease or condition, and our response shouldn’t focus on one as well.

Dr. Emanuel writes in response to widespread criticism of the Obama Administration during the International AIDS Conference in Vienna, as well as to the July 20^th New York Times op-ed by Archbishop Desmond Tutu, who writes:

During my life, I’ve witnessed amazing advances in medical science. New treatments turn H.I.V. infection from a death sentence to a manageable illness. The cost of treating it is a small fraction of what it was 10 years ago. Meanwhile, more and more African nations have invested in the public health infrastructure needed to distribute AIDS drugs. I appreciate that tough financial times require the United States government to cut spending. But scaling back America’s financial commitments to AIDS programs could wipe away decades of progress in Africa.

Anand Reddi responds on Huffington Post and specifically counters the argument that “we can’t treat our way out” of the epidemic:

Results by Dr. Julio Montaner published in The Lancet demonstrated that provision of antiretroviral therapy in British Columbia halved the rate of new infections. The Economist writes the study by Montaner is “the strongest confirmation yet that treatment and prevention are two sides of the same coin.”  Treating our way out is indeed possible.  In our recent article in AIDS, Sarah Leeper and I demonstrated the unique dynamic-reciprocal relationship that HIV/AIDS, TB, and Malaria have on maternal and child health and vice-versa in the resource limited setting. I salute Dr. Emanuel for forwarding the dialogue on global health and advocating for comprehensive, integrated, cost-effective models of care that advance not just HIV/AIDS but other important health priorities including maternal and child health. Given that the provision of antiretroviral treatment can actually lead to prevention, eradication of new HIV infections is possible if the world community remains fully committed to funding cost-effective antiretroviral treatment initiatives.

Further reading:

• Anand Reddi’s previous article about AIDS funding on Huffington Post.
• The CID journal article by Rochelle Walensky and Daniel Kuritzkes, from the Center for AIDS Research at Harvard Medical School, that Archbishop Tutu references in his letter.

Is funding for global HIV/AIDS programs too “vertical”?  Faced with funding shortfalls, should donor countries put the brakes on AIDS funding in favor of other  initiatives, ones that propose to address a broader range of health problems?  This proposal has drawn the anger of AIDS activists the world over, and is now the subject of passionate debate in Vienna. Back home, two medical students examine the Obama Administration’s plan to let PEPFAR funding flatline while promoting a new Maternal and Child Health (MCH) initiative.  In a commentary published in AIDS, Sarah C. Leeper (Warren Alpert Medical School of Brown University) and Anand Reddi (University of Colorado School of Medicine) take on the claim one argument at a time:

The architects of the Obama administration’s Global Health Initiative recommend funding the Mother and Child Campaign at the expense of future funding increases for PEPFAR. The idea that differing global health initiativesmust compete with each other lacks not only ethical legitimacy but also scientific merit. Confronting illness in isolation – whether by funding PEPFAR at the expense of programs that targetMCH or vice versa – cannot be our way forward. Policies that de-emphasize PEPFAR threaten to undermine,rather than support, MCH in countries with high HIV/AIDS prevalence [PubMed; full-text].

The strongest scientific-journal rebuttal yet to the Obama Administration’s proposal to shift resources to maternal and child health at the expense of HIV/AIDS treatment scale up comes from two medical students, who in a commentary just published in AIDS make a clear and convincing case that such a move would actually undermine the health of women and children around the globe, not improve it.

UNAIDS estimates that the cost needed to continue global HIV treatment in 2009 will be about US$9 billion.

Related reading:

• Denny CC and Emanuel EJ. “US Health Aid Beyond PEPFAR: The Mother & Child Campaign.” (JAMA,  11/2008.)
• “At Front Lines, AIDS War Is Falling Apart” (NYTimes, 05/05/2010)
• “Donor AIDS” (The Lancet Student, 05/14/2010)
• Jennifer Weinberg’s post on the Administration’s effort to address global maternal, newborn, and child health needs (GP Blog, 06/17/2010)
• “Obama ‘hurt’ by AIDS funding criticism” (The Guardian, 06/21/2010)

A recent article in the Christian Science Monitor by the SEVEN Fund’s Michael Fairbanks explores a potential approach to addressing Haiti’s need for long-term economic support. While several different groups have contributed to relief efforts after the devastating January 12th earthquake, many are looking to develop a more long-term solution. A challenge to building private-sector support is the atmosphere in a country where the elite and wealthy have often supported business initiatives which favor big business and are not developed to lend support to those most in need.

In order to create prosperity for the average Haitian citizen, innovative solutions are needed to develop “attractive export market segments to serve with unique products, building new distribution systems, lowering energy costs, and providing skills to Haitian citizens who will be compensated for the high value they create” according to Pierre Marie Boisson, a Harvard-educated, Haitian international banker.

Despite being one of the world’s poorest nations, Rwanda has had national health insurance, know as health mutual, for the past 11 years. With two dollar a year premiums, an overwhelming 92 percent of the nation’s 9.7 million people are currently covered. While the coverage is not extravagant, it covers the major causes of illness and death in the region including diarrhea, malaria, pneumonia, malnutrition and infected wounds. Further, this basic health insurance provides access to local health centers which usually have all the medicines on the World Health Organization’s list of essential drugs as well as laboratories providing routine blood and urine analyses, in addition to tuberculosis and malaria tests. This access to health care has had a measurable impact on average life expectancy, which has risen from 48 to 52 years of age since the introduction of health mutual despite a continuing AIDS epidemic.

In order to achieve such coverage for only two dollars a year, the government of Rwanda must receive supplemental help from outside organizations such as Partners in Health, The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the US government. Additionally, the plan requires co-pays which can be cost prohibitive for many patients. For example, a Caesarean section requires a five dollar co-pay which many patients cannot afford.

For more on this issue check out the New York Time’s recent article, this info sheet from the World Bank and this article in the bulletin of the World Health Organization.

For a look at the US government’s role in improving global maternal, newborn, and child health check out the Kaiser Family Foundation’s recently released report entitled “The U.S. Government’s Efforts to Address Global Maternal, Newborn, and Child Health: The Global Health Initiative and Beyond.” The report discusses US efforts towards improving child and maternal health including the recently heightened focus placed on these issues by the Administration’s Global Health Initiative. It provides a detailed overview of the U.S. government’s response thus far, looks at U.S. funding trends for maternal and child health, examines international and domestic agencies’ activities related to maternal and child health, explores U.S. participation in international multilateral efforts and identifies key policy issues surrounding the future of the U.S. involvement in such health issues.

A related webcast and fact sheets on maternal and child health and family planning are also available.

According to the World Health Organization, non-communicable diseases such as heart disease, cancer and diabetes, account for 60% of deaths worldwide, claiming more than 35 million lives per year. In all regions of the world except Africa, mortality rates among men and women age 15 to 59 are higher for non-communicable diseases than for communicable diseases. Further, The World Economic Forum recently highlighted the economic costs of non-communicable diseases, naming this health threat as one of the three most likely and severe risks to the global economy alongside fiscal crises and asset bubbles, a form of inflation. Yet despite this significant impact, non-communicable diseases tend to be overlooked and underfunded. For example, a Center for Global Development report estimates that less than 1% of public and private health funding is allocated to the prevention and control of non-communicable diseases in low- and middle-income countries. In response to this need for a greater focus on non-communicable diseases globally, a recent United Nations resolution has been introduced calling for a summit on non-communicable diseases “in order to develop strategic responses to these diseases and their repercussions.”

The CEOs of the American Heart Association, the American Cancer Society, and the American Diabetes Association comment on this issue in a recent (5/13) CNN opinion article.