A joint conference of:

The 2nd annual University of Michigan Sujal Parikh Memorial Symposium for Health & Social Justice

and

The Physicians for Human Rights National Conference

March 24^th to 25^th, 2012 in Ann Arbor, Michigan

Featuring keynote speakers Drs. Arash and Kamiar Alaei, Iranian physicians and brothers imprisoned for over two years for their work on fighting HIV/AIDS. Learn more at http://iranfreethedocs.org/.

Program and confirmed speakers available here.

Sustainable Connections & Collaborations:

Sujal Parikh was a University of Michigan medical student and NIH Fogarty Scholar who held leadership positions on the Physicians for Human Rights (PHR) Student Advisory Board, as well as in AMSA, GHEC, UAEM, UM Center for Global Health, and UVP.  A passionate believer in the collective power of committed individuals to advance health and social justice, Sujal leveraged his networks within these organizations to make each of them stronger.  Sujal’s unique gift for bringing people together in pursuit of common goals inspired the theme for this year’s joint conference.  Learn more about Sujal here.

The Sujal Parikh Memorial Symposium:

The Sujal Parikh Memorial Symposium on Health and Social Justice began as a collaborative effort among friends, colleagues, and representatives of the numerous global health organizations to which Sujal contributed. The 2011 symposium, The Social (Justice) Network, brought together diverse students and professionals to learn from one another, create lasting connections, and generate new ideas for the advancement of health and social justice. Together, we established a community committed to carrying on Sujal’s work and ensuring that his spirit continues to inspire a better world. More information on the 2011 symposium is available here.

The Physicians for Human Rights National Conference:

PHR is an independent organization that uses the integrity of medicine and science to stop mass atrocities and severe human rights violations against individuals.  The organization was founded in 1986 on the idea that health professionals, with their specialized skills, ethical duties, and credible voices, are uniquely positioned to protect human rights.  PHR uses its investigations and expertise to advocate for the:

• Prevention of individual or small scale acts of violence from becoming mass atrocities
• Protection of internationally-guaranteed rights of individuals and civilian populations
• Prosecution of those who violate human rights

PHR’s National Student Program provides health professional students with opportunities to learn about, advocate for, and develop leadership in the field of human rights.  Information about PHR’s 2011 National Conference is available here.

We are honored to be sponsored and hosted by the University of Michigan Center for Global Health, the U of M Medical School, the U of M Gerald R. Ford School of Public Policy, the U of M School of Public Health, and Global REACH, and to be supported by the Michigan Student Assembly.

These neglected tropical diseases include:

• lymphatic filariasis
• blinding trachoma
• sleeping sickness
• leprosy
• soil-transmitted helminthes
• schistosomiasis
• river blindness
• Chagas disease
• visceral leishmaniasis
• guinea worm

Check out the related webcast and infographic

According to the Executive Director of the Global Fund Michel Kazatchkine:

“The story about the Global Fund is a story about how the world could actually come together and turn a hopeless situation into one of promise. This amazing film tells that story through the words of some of the people who were crucial in making this dramatic turnaround. It is fantastic to be reminded of how terrible the future looked for global health ten years ago, and how far we have come.”

The Bill & Melinda Gates Foundation recently renewed its commitment to the Global Fund to Fight AIDS, Tuberculosis and Malaria, giving $750 million through a promissory note. This innovative funding method gives the Global Fund the flexibility and authority to distribute funds efficiently based on immediate needs, leading to greater impact.

SUSTAINABLE CONNECTIONS & COLLABORATIONS FOR HEALTH & HUMAN RIGHTS

A joint conference of:
The 2nd Annual University of Michigan Sujal Parikh Memorial Symposium for Health & Social Justice
and
The Physicians for Human Rights National Conference

This conference serves as an opportunity to connect students, researchers, and professionals in a variety of fields, ranging from law, health professional, business, to public policy and beyond. The goal is to bring together a diverse audience to share, learn, and foster lasting collaborations among the variety of sectors that are working to further the health of populations globally and locally through the defense of equity and human rights.

Featuring keynote speakers:

Drs. Arash and Kamiar Alaei

Iranian doctors, and brothers, imprisoned for over two years for their work on fighting HIV/AIDS.

Additional presentation topics include:

Climate Change and Health

Youth Violence

Human Trafficking

Global Health Supply Chain Management

Social Entrepreneurship

and more…

March 24-25th, 2012
Gerald R. Ford School of Public Policy
University of Michigan School of Public Health
Ann Arbor, Michigan

For Information, participant registration, and abstract submission: www.sujalsymposium.org

For more information about the keynote speakers: www.iranfreethedocs.org

ABSTRACTS DUE FEBRUARY 15TH, 2012

Themes of interested for abstracts include:

Global health and/or human rights education initiatives

Innovative programs to promote equity

Health of vulnerable/underserved populations

Effective advocacy campaigns targeted at promoting health as a human right

Interdisciplinary models of collaboration to promote social justice

Please contact Lesley Everett (lesleyae@med.umich.edu) with any questions or for further information about the event.

3 strategic objectives are incorporated in USAID’s strategy:

1. Enhance the transition to low emission development via investments in clean energy and sustainable landscapes for climate change mitigation;
2. Grow resilience of people, places, and livelihoods through investments in climate change adaptation; and
3. Strengthen development outcomes through the integration of climate change in USAID programming, learning, policy dialogues, and operations.

“…the threat from climate change is serious, it is urgent, and it is growing. Our generation’s response to this challenge will be judged by history, for if we fail to meet it—boldly, swiftly, and together—we risk consigning future generations to an irreversible catastrophe.”

President Obama, United Nations Summit on Climate Change, September 22, 2009

Supporting similar goals, the Center for a Livable Future at Johns Hopkins also encourages means to support a growing population’s needs while protecting the environment, biodiversity and the earth’s finite resources.

Check out TEDxManhattan’s “Changing the Way We Eat” held today to explore the current food system and the ongoing efforts to create a more sustainable way of farming and eating, including a talk from the Center for Livable Future’s director Dr. Robert Lawrence, MD.

If you missed the live stream of this event, check out last year’s recorded videos of the talks and look out for the recordings from this year’s event as well.

What are your thoughts on framing international health issues in terms of fairness and equity?

In what ways do you think that investments in females can have an impact?

The following question and answer session was originally posted on the Bill and Melinda Gates Foundation’s Blog Impatient Optimists January 9. 2011 as part of an ongoing and upcoming commitment to family planning and contraception for women in developing countries. Stay tuned for Part 2 of the conversation coming soon!

Melinda Gates and Nick Kristof Answer Your Questions

MELINDA FRENCH GATES

Melinda recently returned from a three-day trip to Bangladesh. She, along with Nick Kristof, agreed to answer readers’ questions about development issues focusing on that part of the world. Here is the first installment of the Q&A session reposted from Kristof’s  New York Times blog “On the Ground.”

Q. How can a “small” person without a lot of financial resources help the women of the world? What can each of us do to reach out to the women in Africa, Haiti, South America and the Far East? I feel so helpless and it really hurts. –JEANIE, New York City

A. MELINDA: That’s a great question, Jeanie. I believe that each of us can do important and meaningful work to make the world a better place. It’s not about the money. It’s about using whatever resources you have at your fingertips to try to improve the world.

A group of Bangladeshi women learning about childhood health and nutrition at a clinic that they visit five days a week for five months, as part of an initiative sponsored by the Bill & Melinda Gates Foundation.

I think that real giving starts with caring about others and wanting to learn more. I encourage everyone to become a student of the causes they care about. And if you are interested in learning about what you can do to help women in developing countries lead healthy and productive lives, you can go to the websites of organizations such as UNICEF, UN Women, CARE, and Save the Children that support programs focused on women. At Nothing But Nets you can purchase a bed net for just $10 to protect a mother and her children from getting malaria.

One thing that touches me the most when I travel is the fact that so many of the women I meet don’t have a voice—not in their government, often not even in their own household. They want to be able to deliver their babies in a clinic or get their children immunized, but there is no place for them to be heard. They go to incredible lengths to take care of their children, like the group of women I met with today who were at the clinic learning about health and nutrition. This is something they will do for five days a week for five months, to make sure their children are properly fed, thanks to a program put together by the Foundation.

By supporting programs like this, we in the developed world can use our voices to demand that those women have the same basic health services we do.

This is the reason why I’ve started using Twitter and Facebook to share stories and communicate with people who are making a difference—as well as those who are eager to make a difference. I’m a big believer in the power of social networks, whether they are local networks of women working together to improve newborn health in rural Bangladesh, or online networks. Use your own network to spread the word about challenges that these women face or successful organizations that you learn about so others can also become engaged.

A. NICK: Two suggestions for Jeanie’s good question. First, you don’t have to be wealthy to make a difference. Even modest donations do make a difference. For less than $1 a day, for example, you can sponsor a child through PLAN USA (I have a PLAN child in Dominican Republic, whom I visited a few years ago). Or you can browse Kiva.org or GlobalGiving.org and probably find a better use for $25 than you could find at the mall.

But even if you don’t have $25 to spare, there are other steps you can take – such as lobbying for good programs, or for change in bad ones. The CARE action network, for example, suggests who to send emails or letters to on humanitarian causes. Many other organizations have similar online campaigns. You can even introduce your child to freerice.com and, through educational game play there, support food donations. So sure it helps to be a billionaire, and Jeanie is unlikely to affect as many people as Melinda. But I’ll bet that Jeanie or anyone else can affect one or two people or more in ways that are transformative. If you see a girl who can go to school, for example, because someone has paid her school fees through Camfed, and who as a result now has an entirely different future – well, that’s the most gratifying feeling in the world.

Q. I’d like to thank the Gates, and I would like to ask how they factor in the unintended consequences which may result from their work. For example, earlier efforts to use vaccinations and other means to reduce child mortality were extremely successful in the Third World, but the consequence was very rapid and substantial population growth. I’m not suggesting that saving lives is bad; it is the most noble act a person can perform. My question is how does the Gates Foundation estimate the results of their programs, and do you plan additional efforts to ensure that the results of your work, such as population growth, are effectively managed as well? Thank you. –MARSHALL GOLDBERG

A. MELINDA: This is a question that we think a lot about. The foundation is data-driven in everything we do, from making grants to estimating and evaluating their impact. For example, here in Bangladesh, we are funding several research studies to better understand which viruses and bacteria cause the most cases of pneumonia. Only by generating solid data will we be able to make well-informed decisions. And, of course, we need to know if our work is having impact. Measurement and evaluation is built into every single grant so we can analyze the results of programs that we fund.

I want to share with you something that surprised Bill and me when we first started learning about global health. Like many people, we thought that if you made advancements in global health, rapid population growth would result. But, in fact, the opposite is true. When the health of a population improves, family size starts to decrease and population goes down. If a mother knows that her children are going to make it through to adulthood, she will have fewer children. She will have an easier time feeding those children and sending them to school. Life for her family starts to get better by every measure.

I encourage everyone to become a student of the causes they care about.Melinda Gates

But in order for this to happen, family planning is critical. More than 215 million women want to use modern contraceptives but don’t have access. That’s a crime. We need to make sure that every woman is able to choose how many children she wants to have and when she wants to have them.

A. NICK: People often push back at me when I talk about saving lives and say, in effect: There’s no point. Those people who are saved will just have more children until everyone is starving again. That’s a canard. In fact, it’s increasingly understood that one reason people have large families is because they expect some children to die. If they can be assured that their children will live, they’ll have fewer kids (after a lag). That’s why birth rates are already dropping in poor countries. Indians, for example, now have just 2.6 babies – down from almost 6 in 1950. Bangladeshis average just 2.3 babies.

The bottom line is this: the way to deal with population pressures is to support family planning, not to let children die of disease.

Q. I attended a talk once with the British economist Benny Dembitzer. He thinks that too much money is spent on the fight against malaria and other diseases, believing that a child may be saved from malaria today but could die from diptheria tomorrow. Instead, he’d rather see that money spend on primary education. As a molecular biologist, I think that the fight against insect transmitted diseases can be won, but I can understand the argument. Do you think that a point might be reached at which we have to say: Enough’s enough. Let’s give everyone bed nets and we can fight malaria through bringing people out of poverty? –ROBERT JONES

A. MELINDA: I hear that question a lot, and I don’t think it is either or. We have to do both. It is incredibly important not only to invest in health, but also to invest in efforts that stimulate economic growth, expand access to opportunity, and help the poor raise themselves out of poverty. Take agriculture, for example. We invest in agriculture because we believe that if smallholder farmers, the majority of whom are women, had access to better information and higher yielding and more resilient crops, they could better feed their families, earn higher incomes, and become self-sufficient.

On the health front, we’ve learned that in addition to causing some children to die, infectious diseases take a massive toll on those who get sick but survive. For instance, some studies have shown that children who suffer from cerebral malaria have more trouble paying attention and remembering information. The same holds for children suffering from diarrhea and for those who are undernourished, especially newborns and infants. Over 80 percent of calories in the first year of a baby’s life goes towards brain development. If that energy is used instead to fight malaria or diarrhea, the brain may not develop properly. And then children can’t live up to their full potential, no matter how good a primary education they receive. Good health is fundamental to breaking the cycle of poverty.

Just this morning, I met a beautiful little girl named Shrabonti in Mirpur, a slum in the Northwest of Dhaka, while visiting a study site exploring the link between intestinal infections, nutrition, and cognitive development. Shrabonti, who shares her name with the rainy season, looked fairly normal, until I realized that she was already 20 months old.

Melinda Gates met a 20 month-old and her mother in Mirpur, a slum in the Northwest of Dhaka, Bangladesh.

She only weighed 19lbs, the size and weight of a healthy nine-month-old. Shrabonti had already been sick 27 times in her short life, including seven bouts of diarrhea. I was left thinking—life shouldn’t be so hard for her. How do we make sure that all children like Shrabonti have the greatest chance of living up to their full potential?

A. NICK: Should American presidents focus on the economy or on national security? Obviously, the answer is both. We have many priorities and we’re fated to juggle them all. In the same way, combating malaria is important not only to save lives but also to promote economic development – but education is also critically important to build skills and transform economies and societies. So I agree with Melinda that we don’t have the luxury of picking and choosing a single target; to make a difference, we have to be jugglers.

That said, I think Robert is right that we have to scrutinize the challenges and figure out where we can be more cost-effective. One of the things that the development community has gotten better at doing is introducing metrics and rigor to see what kinds of interventions get the most bang for the buck. I do think that the evidence is pretty good that work in both education and public health tend to be highly cost-effective, and also are mutually supportive. Deworm kids and give them bed nets, and they’ll miss less school. And as they become better educated, they’ll become more concerned with their own health and will have fewer children whose health they’ll take better care of. We’re already seeing this virtuous cycle in action right now, which is why Africa is economically the fastest growing part of the world today.

For example, JHPIEGO is working to protect women and girls with strategies like HPV vaccination and improved screening.

Researchers at the University of Pennsylvania, lead by Dr. Carrie Kovarik, are using innovative techniques like mobile phone based telemedicine to improve screening for cervical cancer in resource-challenged countries.

The Global Initiative against HPV and Cervical Cancer also has several programs to fight against cervical cancer including education, strengthening HPV vaccination programs and improving screening and treatment programs for cervical cancer.

What other innovative programs are you aware of to fight this deadly disease? What approaches do you think will be most successful at eradicating cervical cancer globally?

• Gender-Based Violence: From Commitment to Action by  Daniela P. Ligiero, PhD
• Sanctions and Sanctuary: Reducing Violence-Related Health Inequities for Women and Children by Jacquelyn C. Campbell, PhD, RN, FAAN

Check out the Johns Hopkins Center for Clinical Global Education for more webcasts and resources. ]]> http://www.globalpulsejournal.com/blog/index.php/2011/12/27/confronting-gender-based-violence/feed/ 0 http://www.globalpulsejournal.com/blog/index.php/2011/12/27/exploring-hhs-role-in-global-health/ http://www.globalpulsejournal.com/blog/index.php/2011/12/27/exploring-hhs-role-in-global-health/#comments Tue, 27 Dec 2011 20:51:10 +0000 Jennifer Weinberg http://www.globalpulsejournal.com/blog/?p=1612 Kaiser Family Foundation and the U.S. Department of Health and Human Services is holding a briefing on Thursday, January 5, 2012 at 9:30am at the Barbara Jordan Conference Center in Washington, D.C. to explore HHS’ role in global health and the emerging global health strategy. The event will explore the goals of the new strategy and the ways in which it fits with other U.S. global health objectives. If you are in the Washington, D.C. area, register online to attend.

The Pap smear is the most widely known method of screening cervical cancer, but pathologists are needed to diagnose precancerous cells from the smear samples. Many low-income countries lack the resources to interpret the results of the smear and have to outsource this test, leading to delays in making a diagnosis.  These delays are problematic for women who must travel from distant areas to get screened.

This newly approved procedure avoids the delay found with Pap smears and uses supplies that are readily available.  Another added bonus is that it can be performed by trained nurses and it requires only one office visit.

The Global Pulse’s Fall Issue features one medical student’s experience in implementing a cervical cancer screening program in Haiti.  To read her account, click here.

http://www.slate.com/articles/business/ft/2011/12/melinda_gates_discusses_fighting_poverty_in_the_developing_world_.html

Below are some ways to reflect on recent developments and the the burden of HIV in the world:

• Take this quiz
• A successful recent mouse HIV vaccine study
• Johns Hopkins School of Public Health’s World AIDS Day Getting to Zero Slide Show
• Greater Than AIDS partnerships and collaborative efforts with leading media and other corporate allies, community organizations, and state and local health departments to increase knowledge and understanding about HIV/AIDS in America.
• HIV facts and statistics at WorldAIDSDAy.org
• Impatient Optimist’s blogs about people impacting HIV/AIDS
• Hear from people living with HIV
• Find an HIV/AIDS prevention and testing center
• Add a panel to the 2015 Quilt fighting for an AIDS-free generation by 2015
• 
  

The panel was moderated by Susan Dentzer, Editor-in-Chief of Health Affairs, and included representatives from USAID and several global health R&D partners from the public and private sectors (representing Product Development Partnerships – or PDPs).

• Hugh Chang, Director of Special Initiatives, PATH
• Rick King, PhD, Vice President, Vaccine Design, IAVI
• Emily Moore, Vice President for Business Development, Temptime Corp.
• Wendy Taylor, Senior Advisor for Innovative Finance and Public Private Partnerships, Bureau of Global Health, USA

Currently, over 215 million women worldwide want but do not have access to family planning tools. “We’ve made a lot of progress in putting maternal health on the global agenda; now we must call on leaders to put family planning on their to-do list. Every individual deserves this – women, men, and young people,” said Jill Sheffield, President and Founder of Women Deliver.

These speakers reinforced the importance of the demographic dividend – the concept that health and social development, enabled by full access to contraception, are inextricably linked with strong economic growth. They provide examples of success in Asia, where declining fertility, spurred by rising contraceptive use, have led to increased education, improved health, and market-driven economic policies which have allowed for significant income growth.  With an expanded world population of over seven billion, “Now is the time to prioritize family planning – as a strategy to reduce maternal mortality, to improve the lives of women and their families, and ultimately, to enable broad and enduring economic development,” said Dr. Amy Tsui, Director of the Gates Institute for Population and Reproductive Health, Professor at Johns Hopkins Bloomberg School of Public Health, and a lead conference organizer.

To proceed into the future, investments must be made in the health sector maintaining adequate numbers of midwives, OB/GYNs, facilities, etc. and examining past successes around the globe. As Hon. Stephen O’Brien stated, “having a child should bring joy” not dying in childbirth and women must be able to plan for the future. Family planning is smart and cost-effective. As Dr. Osotimehin stated, we must empower young people to take control of their futures along with the future of their countries and make sure that economic and social justice drives this process. Issues of family planning are issues of human rights.

According to Judy Manning from USAID, their priorities include: 1) Improve existing methods to make them more acceptable, easier to use and more affordable like injectable forms of contraceptives. 2) Develop new contraceptives to fill gaps such as duration of effectiveness between 3 month injectables and 5 year inserted rings. 3) Develop technologies that simultaneously prevent pregnancy, HIV & other STDs like the silk diaphragm which delivers tenofovir.

Clearly there is an immense need for family planning access, affordability, and effectiveness. Fortunately, there are also attainable solutions. Meetings such as ICFP brings together a wealth of scientific knowledge, family planning experience, and critical discussions to help ensure that universal access to family planning becomes a reality.

World AIDS Day is a time to renew our commitment to the 34 million people living with HIV/AIDS worldwide and the recent developments revolving around HIV, including several scientific breakthroughs in HIV prevention research and Secretary Clinton’s recent remarks declaring that it is possible to reach an AIDS-free generation, make this an especially exciting time to reflect on the epidemic.

According to Dr. Bertozzi, the strategy of the Bill & Melinda Gates Foundation includes both decreasing new infections and improving quality of life of those currently infected. A large focus of this strategy is on the delivery of current strategies in large part through the Global Fund as well as smaller national programs.

Despite the proven effectiveness of existing prevention approaches, there are limitations. For example, many women are not in a position to insist that their partners wear condoms and daily adherence to prophylactic treatments is difficult. The development of a vaccine and other new prevention options is critical for successfully fighting the epidemic, especially in developing countries. The largest investment in newer technologies is currently in trying to develop a HIV vaccine. As such, a focus is on the success of the RV144 HIV vaccine trial, which recently showed encouraging results in Thailand and advancing that to the next generation of the vaccine with hopes of increased efficacy.

They are also investing heavily on products that can be used by individuals to protect themselves either topically in the vagina or systemically. While daily use of vaginal microbicides has shown mixed results, many reasons may contribute to this, especially lack of adherence which is a common problem with daily use products. To address these challenges, they are working on products which are less dependent on adherence such as a vaginal ring which slowly releases the antiretroviral compound dapivirine and can be left in for up to a month.

Another strategy is systemic daily antiretroviral prophylaxis which has also had mixed results and faces problems with adherence, but looks promising. They are focusing on injectables which can be injected every 1 to 3 months, decreasing the need for adherance. The Gates Foundation is currently supporting clinical trials to evaluate the effectiveness of Pre-exposure prophylaxis (PrEP) such as this for HIV prevention.

Images from the Bill & Melinda Gates Foundation

Additional efforts are on enhancing the delivery of male circumcision and scaling up these programs with fewer resources. Despite three clinical trials demonstrating the protective benefit of the procedure, donors and countries have been slow to invest in voluntary male circumcision for HIV prevention. The foundation is investing in advocacy efforts to encourage more rapid scale-up of male circumcision for HIV prevention and funding research on new technologies and methods for performing male circumcision safely and less expensively. This strategy is so cost effective that it costs more money to NOT implement such programs due to the future treatment savings.

The Gates Foundation is also working towards improving the delivery and effectiveness of current programs. With decreasing funding in a faltering global economy, scale up of treatment has continued at the same pace by improving efficiency of programs. Fortunately this has been happening in HIV treatment. Continuing efforts to reduce the cost of drugs, design and implement more efficient delivery systems and further task shifting and sharing among health providers is needed without compromising care and can even lead to improved quality of care.

On Monday, Nov. 21^st 9:30am EST, Research!America will be webcasting a briefing on USAID and the agency’s impact on global health research and development.  The panel will be moderated by Susan Dentzer, Editor-in-Chief of Health Affairs, and will include representatives from USAID and several global health R&D partners from the public and private sectors (representing Product Development Partnerships – or PDPs).  Panelists include:

• Hugh Chang, Director of Special Initiatives, PATH
• Rick King, PhD, Vice President, Vaccine Design, IAVI
• Emily Moore, Vice President for Business Development, Temptime Corp.
• Wendy Taylor, Senior Advisor for Innovative Finance and Public Private Partnerships, Bureau of Global Health, USAI

The U.S. Agency for International Development (USAID) is marking its 50th anniversary as the main U.S. humanitarian relief and international development agency. This conversation regarding USAID and its global partenrs will shed insight into instrumental partnerships in global health work.

This important event will be webcast live at http://bit.ly/vWwx9o where you can also submit questions. You can also join the conversation on Twitter under the hashtag #GHPDP.

As students immersed in the study of biological sciences, and as future physicians anxious to provide care and improve lives, we can be frustrated when public health policy seems based on interests neither scientific nor beneficent. United States programs that fight global AIDS have accomplished tremendous good over the past eight years; however, recent stewardship by President Obama has been disappointing both scientifically and morally. Last fall, many of us at Harvard Medical School protested President Obama because we believed his failure to keep his promises to scale-up the fight against HIV/AIDS was proof that he was ignoring the science and neglecting his ethical obligation to save millions of lives around the world. However, on Tuesday, Secretary of State Hillary Clinton delivered an inspiring address that is at once evidence-based and morally laudable.

When we began our protests last fall, there was a growing body of research indicating that treating HIV also prevents its spread. Evidence from a localized study South Africa indicated that when people with HIV received antiretroviral treatment (ART), their partners were 92% less likely to contract the virus. [1] Initial modeling used this information to theorize that, with universal access to treatment, infections could plummet within 10 years. [2] With this growing evidence (as well as other studies), the phrase “treatment as prevention”—long used by health professionals working at the front lines of AIDS care—resonated in scientific communities. Not only does treatment save lives, but these recent studies show that treatment could dramatically reduce new infections, slowing or even halting the epidemic in the future. It was not until this year, however, that this could be said with such certainty. A multi-site, large-N, randomized control trial showed that ART reduces new infections by 96%. [3]

We have also been encouraged by the growing literature showing that investments in HIV treatment programs improve health systems and eases delivery of other life-saving interventions.[4,5]  Dr. Paul Farmer, co-founder of Partners In Health, described HIV treatment as the “battle horse” to drive the necessary expansion in infrastructure and political will for addressing other global health priorities.

The evidence is clear: now, more than ever, we know that investing in AIDS treatment will save millions of lives and reduce new infections. Yet in the first years of his administration, President Obama fell dreadfully short on campaign promises to significantly improve resources for AIDS funding.  Many fellow classmates from Harvard Medical School, as well as from colleges and medical schools across the east coast, joined in protests encouraging the administration to uphold its promises.  It is impossible to forget the numbers—a year of AIDS treatment costs less than $100, and the treatment program makes up far less than 0.2% of the federal budget.  Yet while hundreds of billions of dollars went to bank bailouts, no new money was found for the meager $1 billion dollar annual rise that was promised during the election cycle.

Secretary Clinton’s speech on November 8^th, therefore, was encouraging.  She declared that for the first time, it will be United States government policy to create “an AIDS-free generation.”  She emphasized prioritizing high impact interventions—prevention of mother-to-child transmission, circumcision, and treatment.  And she lauded the vital role of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has been an innovative and transparent engine for delivering resources where they are needed most.  Secretary Clinton’s speech had much of what is needed, except for the numbers.

To transform the Secretary’s vision into a reality, we will need bold treatment targets and solid commitments to increase funding.  Six million patients on treatment by the end of 2013 would be an appropriate goal for the United States government, which is on track to have four million on treatment by the end of this year.  Congress and the administration have responsibility for the 2012 budget, while the Super Committee debates 2013 and beyond.  We eagerly await President Obama’s address on World AIDS Day (December 1^st).  Lawmakers have the opportunity to transform one of the greatest human scourges of our generation, or to be held accountable for inaction by patients, activists and history books.  As medical students, we have the ability to hold lawmakers accountable by calling and writing our elected officials, and communicating publically the cost of inaction.

-Matthew Basilico, Nworah Ayogu, Arjun Suri; Harvard Medical School

References

1. Deborah Donnell, Jared M Baeten, James Kiarie, Katherine K Thomas, Wendy Stevens, Craig R Cohen, James McIntyre, Jairam R Lingappa, Connie Celum, “Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis,” The Lancet 2010;375:2092-2098.

2. Reuben Granich, Siobhan Crowley, Marco Vitoria, Ying-Ru Lo, Yves Souteyrand, Christopher Dye, Charlie Gilks, Teguest Guerma, Kevin M De Cock, and Brian Williams “Highly active antiretroviral treatment for the prevention of HIV transmission,” Journal of International AIDS Society 2010; 13:1

3. Cohen MS, Chen YQ, McCauley M, et al. “Prevention of HIV-1 infection with early antiretroviral therapy.” New England Journal of Medicine 2011;365:493-505.

4. David Walton, Paul Farmer, Wesler Lambert, F. Léandre, Serena Koenig and Joia Mukherjee, “Integrated HIV Prevention and Care Strengthens Primary Health Care: Lessons from Rural Haiti,” Journal of Public Health Policy 2004:137-158.

5. World Health Organization, “An Assessment of Interactions Between Global Health Initiatives and Country Health Systems,” Lancet 2009;393:2137-2169.

Amie Batson on Why Americans Should Care about Global Health Research:

FDA Commissioner, Margaret Hamburg:

Representative Ed Markey (D-Mass):

Whoopi Goldberg:

Stay tuned to Global Pulse Blog for more views on this monumental speech and its implications.

Yesterday, Secretary of State Hillary Rodham Clinton declared the U.S. government’s intent to create an “AIDS-free generation.” Secretary Clinton outlined a bold plan to reduce new HIV-infections, globally, including the eradication of pediatric HIV by 2015. This new strategy builds upon the success of the President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. program that addresses HIV/AIDS in resource-limited settings.

A notable feature of Secretary Clinton’s “AIDS-free generation” initiative is to strengthen healthcare systems in sub-Saharan Africa. Clinton stated:

“We know we can’t create an AIDS-free generation by dictating solutions from Washington. Our in-country partners — including governments, NGOs, and faith-based organizations — need to own and lead their nation’s response. So we are working with ministries of health and local organizations to strengthen their health systems so they can take on an even broader range of health problems.”

Strengthening African healthcare systems is a view echoed by many eminent voices in the global health community. Last year, the Institute of Medicine (IOM) of the National Academy of Sciences authored a report entitled: “Preparing for the Future of HIV/AIDS in Africa: A Shared Responsibility.” The IOM report recommended the urgent need to increase African healthcare workforce capacity to address the HIV epidemic.

I offer Secretary Clinton a solution to assist African healthcare workforces and ensure the success of the “AIDS-free generation” initiative. Last year, in an editorial in The New England Journal of Medicine, Vanessa Kerry, Sara Auld, and Paul Farmer reintroduced the idea of enacting a Global Health Service Corp (GHSC). The GHSC, compromised of U.S. healthcare professionals, would provide medical education and technical assistance to enhance the healthcare workforces in low-income countries. The GHSC’s goal would “go beyond that of filling a human resource void to focus on infrastructure development, knowledge transfer, and capacity building.” The GHSC could also offer partial student loan forgiveness for U.S. corps members who engage in service abroad for a specified time period similar to the loan forgiveness offered by the National Health Service Corp.

To address the African healthcare workforce shortage, I encourage Secretary Clinton to adopt the principles of the GHSC. The success of the “AIDS-free generation” initiative depends on the availability of skilled healthcare workers in African resource limited settings. Additionally, the eventual transition from a U.S. to African led HIV/AIDS response requires the U.S. to teach and train healthcare personnel in recipient countries through collaborative partnerships that eventually lead to African ownership of their domestic healthcare needs.

Some may argue that enacting the GHSC, especially in the era of U.S. government austerity measures, is not prudent. However, the funding for the GHSC already exists. In addition to HIV/AIDS prevention and treatment, PEPFAR’s congressional mandate requires the program to “strengthen partner government [healthcare] capacity to lead the response to this epidemic and other health demands.” Last year alone, PEPFAR committed over $734 million in healthcare capacity building initiatives.

Global health is the moral litmus test of our time. As Secretary Clinton asserted: “An AIDS-free generation would be one of the greatest gifts the United States could give to our collective future.” The U.S. should enact the GHSC to ensure the success and sustainability of the “AIDS-free generation” initiative.

-Anand Reddi, The Huffington Post

If you are interested in supporting the Global Health Service Corp please sign the petition to show your support. http://www.globalhealthservicecorps.org/index.php/petition/

Additionally, the Medical Student Section of the American Medical Association is considering a resolution endorsing the GHSC at its 2011 Interim Meeting in New Orleans, Louisiana.

Some of the most incredible health research is taking place in Kenya right now. Because of this work, we are on the cusp of the most exciting new tools in global public health in recent years—the first ever malaria vaccine, gels women can use to protect themselves from HIV, new drugs for neglected diseases that affect the poorest of the poor. Kenya is also rolling out an array of lifesaving new health products that research has already made available, like HIV/AIDS drugs, vaccines to protect children from pneumonia, and insecticide-treated wallpaper that prevents malaria inside people’s homes.

During the GHTC’s recent trip to Kenya, I was fortunate to visit several of these global health research projects, most of them run by our dedicated coalition members like the Drugs for Neglected Diseases initiative (DNDi), PATH, the International Partnership for Microbicides (IPM), Aeras, and the International AIDS Vaccine Initiative (IAVI).

We also saw firsthand how the US is making a huge impact in health research in the country, through the work of agencies like the US Agency for International Development (USAID), Centers for Disease Control and Prevention (CDC), and the Department of Defense (DoD).

3935 – Siaya, Kenya – Kayla Laserson is the Director of the KEMRI/CDC Field Research Station . Photo: Evelyn Hockstain/PATH.

Although we visited a range of projects, I was left with the lasting impression that much of this research is so close to producing new health tools that can lead to amazing innovations in public health. “We are on the verge of breakthroughs in malaria and in TB and in other diseases,” Kayla Laserson, director of the CDC/KEMRI Field Research Station in Kisian, said. “What we really need is continued support so we can get the job done, we can finish it, we can show the impact, we can save hundreds of thousands of lives here and globally.”

We also saw how past commitments to research are already saving lives. For example, research that led to the development of antiretroviral drugs is one of global public health’s biggest success stories.  Rister Kageha, a woman living with HIV close to the town of Kakamega, told us how these drugs had not only saved her life, but also prevented her daughter Sylvia from contracting HIV. Because of these drugs, “I expect to live long,” Rister said, adding that she also hopes for a long life for Sylvia due to the drugs that kept her daughter HIV-negative.

Rister Kageha says antiretroviral drugs saved her life. Photo: Evelyn Hockstein/PATH.

And while past research has led to some health tools already in use, and current research is producing breakthroughs we could see in next five years, other innovations aren’t as far along down the research pipeline. This is why continued US support is critical to sustain the momentum around these new tools, from discovery to delivery. US support for microbicides, for example, has been vital to recent research successes, and must continue while the research continues over the next several years.

A microbicide “is one of the tools that gives us the opportunity that we could actually end the epidemic,” Elizabeth Bukusi, deputy director at the Kenya Medical Research Institute (KEMRI) who works with IPM, said. “I think we can move towards a complete AIDS-free generation that will completely stop the epidemic in its track using microbicides as part of the armament.” She added that the “US has been a critical partner in providing catalystic funds and also in funding a large number of the trials that have looked at microbicides. So US funding is absolutely critical to moving this agenda forward.”

The same can be said of US support for all global health tools, not just microbicides. Fortunately, if Kenya is any indication, the US has a long history of supporting research for health products like vaccines and drugs.This long history should not end anytime soon. It’s imperative that this historical leadership continues, so the groundbreaking research the GHTC saw in Kenya can produce the next generation of lifesaving health tools.

-Kim Lufkin, GHTC