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Africa: AIDS Updates & Analysis
AfricaFocus Bulletin
Aug 2, 2008 (080802)
(Reposted from sources cited below)
Editor's Note
"The scale up of antiretroviral therapy in the developing world is
the most ambitious public health undertaking of our lifetimes,
...We were told it couldn't be done, and shouldn't be done, but we
persevered, set ambitious goals and targets, and now 3 million
people are on antiretroviral treatment." - Gregg Gonsalves,
International Treatment Preparedness Coalition (ITPC)
As the XVII International AIDS Conference gets under way this
coming week in Mexico City (http://www.aids2008.org), a report by
ITPC is one of many addressing still unresolved debates in the
fight against AIDS. ITPC's report, based on detailed case studies
in Argentina, Brazil, Dominican Republic, Uganda, Zambia, and
Zimbabwe, argues, in contrast to some commentators, that the
expansion of the fight against AIDS can help spur improvements in
the wider healthcare system, towards the goal of universal care.
Activists are also celebrating the re-authorization of President's
Emergency Program for AIDS Relief (PEPFAR), which many observers
see as one of few accomplishments that can be claimed for the two
terms of President George W. Bush. The program was first passed in
2003, after several years of mobilization by activists in Africa,
the United States, and worldwide, that also led to the founding of
the Global Fund to Fight Aids, Malaria, and TB, in 2002.
In 2001, USAID administrator Andrew Natsios that antiretroviral
treatment programs for Africans were impractical, because Africans
"couldn't tell time" (http://www.africaaction.org/docs01/nat0106.htm). His statement,
while extreme in its wording, reflected common assumptions. There
is no doubt that the effect of AIDS activism has been enormous in
the last decade, particularly following the AIDS conference in
Durban in 2000, in changing assumptions about the need to act and
mobilizing resources.
Yet debates continue about the relative balance between treatment
and prevention, between disease-specific programs and broader
approaches to healthcare, and about the effectiveness of current
programs and the difficulty of adapting them to specific national
contexts. These debates - and the fact that the gains in both
treatment and prevention still fall far short of reversing the
death toll and new infections - are an indication that in fact the
fight against AIDS is still only beginning. Despite greatly
increased awareness and investment over the last decade, The scale
of the response is still too small, and scientific knowledge about
the complex virus, the social paths of its transmission, and
effective strategies to combat it are far from adequate.
This AfricaFocus Bulletin contains press releases from ITPC and
from Health GAP, Also included are links to recent books on AIDS &
Africa, and to other reports released recently.
Another AfricaFocus Bulletin sent out today contains the executive
summary of the a report from the Black Aids Institute, "Left
Behind! Black America: A Neglected Priority in the Global AIDS
Epidemic."
For previous AfricaFocus Bulletins on health issues, visit
http://www.africafocus.org/healthexp.php
++++++++++++++++++++++end editor's note+++++++++++++++++++++++
@@@@@@@@@@@New in AfricaFocus Bookshop@@@@@@@@@@@
Several recent books explore different aspects of the complexity of
AIDS and unresolved issues in the fight against it.
* Toronto Globe & Mail Africa bureau chief Stephanie Nolen in "28:
Stories of AIDS in Africa" approaches AIDS through the stories of
28 individuals. One reviewer noted: "Nolen's book stands out for
her insightful descriptions of the human costs as well as the its
fluid integration into the stories of aspects of socio-economic
conditions and up-to-date science research surrounding the
pandemic."
Order from
Powell's Books - http://tinyurl.com/5zy36p
Amazon USA - http://tinyurl.com/5pz3mh
Amazon UK - http://tinyurl.com/6zogwq
* Researcher and journalist Helen Epstein, in "The Invisible Cure:
Africa, the West, and the Fight Against AIDS," is scathing about
simplistic assumptions and faulty policies of the international
AIDS establishment, including both multilateral programs and the
U.S. PEPFAR. The title is explained by a quote from Beatrice Ware
of Uganda. "As a woman living with HIV, I am often asked whether
there will ever be a cure for HIV/AIDS, and my answer is that there
is already a cure. It lies in the strength of women, families and
communities who support and empower each other to break the silence
around AIDS and take control of their sexual lives."
Order from:
Powell's Books http://tinyurl.com/6gh7gs
Amazon USA http://tinyurl.com/6s7rmx
Amazon UK http://tinyurl.com/6xxspv
* Researcher David Gisselquist in "Points to Consider: Responses to
HIV/AIDS in Africa, Asia, and the Caribbean," sharply criticizes
the failure of the international AIDS establishment to pay
sufficient attention to the risks of transmission of AIDS through
the medical system itself, in the context of generalized epidemics
and inadequate health systems. He is particularly critical of the
lack of sufficient research to provide reliable estimates of the
proportion of cases coming from unsafe injections with reusable
needles.
Order from
Powell's Books http://tinyurl.com/5kd5lq,
Amazon USA - http://tinyurl.com/5n5blp or
Amazon UK - http://tinyurl.com/6mbkgf
For a selection of more new books on AIDS in Africa, published in
2007 and 2008, visit the AfricaFocus Bookshop at
http://www.africafocus.org/books/themes.php#aids1 or
http://www.africafocus.org/books/themes_uk.php#aids1
@@@@@@@@@@@New in AfricaFocus Bookshop@@@@@@@@@@@
New "From-the-Ground" Report Reformulates Simplistic Argument About
HIV/ AIDS and Health Care Systems In A Fundamental Way
International Treatment Preparedness Coalition
http://www.aidstreatmentaccess.org
29 July 2008
Contact: Chris Collins: +1 845 701 0158; ChrisCSF@aol.com
Gregg Gonsalves: +27-78-456-3848; gregg.gonsalves@gmail.com
Kay Marshall: +1 347-249-6375; nkmarshall@gmail.com
Dr. Jim Kim of Harvard School of Public Health joins International
Treatment Preparedness Coalition to release new report and call for
broad, systematic approach to HIV/AIDS and health care scale up
New York, Harare, Boston and S o Paulo, 29 July 2008. The
International Treatment Preparedness Coalition (ITPC), a group of
1,000+ treatment advocates from more than 125 countries, issued its
sixth report on delivery of AIDS treatment today. "issing the
Target #6: The HIV/AIDS Response and Health Systems: Building on
success to achieve health care for all.: The report is available at
http://www.aidstreatmentaccess.org.
The new report, launched during a teleconference with Dr. Jim Yong
Kim, Director of the Fran‡ois- Xavier Bagnoud Center for Health and
Human Rights (FXB) at Harvard University and advocates from around
the world, provides some of the first from-the-ground research to
inform the debate on HIV treatment scale up and its interaction
with health systems. It includes reports from six countries:
Argentina, Brazil, the Dominican Republic, Uganda, Zambia and
Zimbabwe. Dr. Kim praised the report and noted that it is both
welcome and timely to set the stage for the next phase of research
and investigation for AIDS services and health care systems scale
up in developing countries.
"The report shows that each country situation is complex. Every
country has made thousands of decisions, good and bad. What we are
seeing now is that funding for HIV is, for the first time in
history, directed at chronic care for a chronic condition. We have
the opportunity to think hard about what it will take to keep a
large population of people healthy over their entire lives. What we
know is that it takes more than just antiretrovirals. This report
takes us to the point of reformulating in a fundamental way the
argument over HIV and health systems," Dr. Kim said. Matilda Moyo,
a co-author of the report's Zimbabwe chapter said, "What we found
was that HIV/AIDS services, particularly provision of
antiretrivirals, have become a lifeline for the health care system
in Zimbabwe. In the midst of the economic and political crises, a
consistent focus on HIV health services has been an oasis in a
whole desert of the collapsing health delivery system."
Problems in Zimbabwe include extreme shortages of healthcare
workers, with one doctor often responsible for providing services
for 8,000 patients, frequent drug stock outs and a crumbling
healthcare infrastructure. "Some donors such as the Global Fund
have come together to provide much needed financial resources for
Zimbabwe," added Moyo. "For example, efforts have been made to
invest in infrastructure through HIV programs which has boosted the
general health delivery system."
Alessandra Nilo, a co-author of the report's Brazil chapter, said,
"In Brazil, HIV/AIDS services have been scaled-up in conjunction
with the expansion of general public health. The scale up of AIDS
services has also had positive impacts on human rights, education
and sexuality in Brazil." Brazil has been cited as a great success
story for developing strong HIV treatment and prevention programs
as well as general public health programs. Nilo added, "Despite the
success of integrating HIV and general health systems, we still
identified clear and distinct benefits for maintaining dedicated
HIV-related services."
"The AIDS response in Zimbabwe, Brazil and other countries shows
that new investments in health can have dramatic impact. But a
simple reshuffling of health resources toward more generalized
health functions at the expense of effective disease-specific
programs, such as HIV/AIDS, would jeopardize the remarkable
advances that have been made and leave the more than six million
people who urgently need AIDS treatment without this care," said
Chris Collins, a co-coordinator of the report.
"The scale up of antiretroviral therapy in the developing world is
the most ambitious public health undertaking of our lifetimes,"
said Gregg Gonsalves, a co-coordinator of the project. "We were
told it couldn't be done, and shouldn't be done, but we persevered,
set ambitious goals and targets, and now 3 million people are on
antiretroviral treatment."
"AIDS is a disease of primary health care, and we need to
strengthen health systems to provide for the future of AIDS
treatment," Gonsalves added. "We are the heirs of Alma Ata. We will
make comprehensive primary care -- health for all -- a reality.
We'll be told again that it is impossible. Well, we've done the
impossible and will do it again. What ITPC is about is finding out
what people need and what is happening on the ground, and then
pushing to make the changes that will save people's lives."
"If the UN's health-related Millennium Development Goals (MDGs) are
to have and chance of being realized, we need to do for health
systems what we've done for AIDS, while increasing the momentum of
the response to AIDS," added Collins.
Key findings from the report include:
- The HIV/AIDS response to date has had sizeable positive impacts
on health care in many settings: building infrastructure and
systems, raising the bar on quality, extending the reach of health
care to socially marginalized groups, and engaging consumers.
- But new investments in HIV/AIDS services have also exposed
existing fragilities in health systems. In some cases expanding
demand has stretched already overextended human resources and
placed increasing burdens on infrastructure.
- The engagement of health consumers and advocates in AIDS scale
up has forced global and national leaders toward a more vigorous
sense of accountability and urgency, both critical elements in the
success of AIDS programming.
# # #
About the International Treatment Preparedness Coalition
The International Treatment Preparedness Coalition (ITPC) was born
out of the International Treatment Preparedness Summit that took
place in Cape Town, South Africa in March 2003. That meeting
brought together for the first time community-based HIV treatment
activists and educators from over 60 countries. Since the Summit,
ITPC has grown to include more than 1,000 activists from over 125
countries and has emerged as a leading civil society coalition on
treatment preparedness and access issues. On the web at
http://www.itpcglobal.org
President Signs Landmark $48 Bn Global Health Bill
Activists say the bill is a major step forward, but critical
changes are still needed
Health GAP (Global Access Project) http://www.healthgap.org,
http://www.pepfar2.org
July 30, 2008
Contact: Kaytee Riek, +1 267-334-6984, kaytee@healthgap.org
Washington, DC - After a year of negotiations, today President Bush
signed into law a $48 billion bill that continues US programs aimed
at addressing global AIDS, tuberculosis and malaria. The bill,
named after the late Congressmen Tom Lantos and Henry Hyde, passed
both the House and Senate by overwhelming majorities.
Health GAP with many allies worked over the last 12 months, in
African countries and across the U.S., to help develop and support
the passage of this landmark legislation. "Many said it could not
be done, but the bill is now law, " said Paul Davis, Health GAP s
Director of US Government Affairs. "However, there are still US
policies that stand as serious barriers to AIDS prevention and
sexual and reproductive health, and we will continue to challenge
these harmful policies. But the passage of this bill is a huge step
forward for people with AIDS worldwide.
This groundbreaking global health bill begins to address critical
lessons of the past five years of global AIDS programs. Health GAP
activists in particular applauded the bill s new support for the
efforts to correct the shortage of health workers that has
frustrated efforts to scale up access to care and treatment. The
bill calls for supporting poor countries efforts to achieve 2.3
doctors, nurses and midwives per thousand country residents, with
direct support to train and retain 140,000 new health workers. The
bill also places an emphasis on training and retention of new
doctors and nurses.
"Millions of people living with or at risk for AIDS, tuberculosis
and malaria can look forward to new hope and support thanks to the
leadership and staff of Rep. Lantos and Berman, as well as Senators
Biden and Lugar for pushing this bill through Congress, despite
significant hurdles, " said Davis. "These leaders would not have
been successful without the strong support they got from
Representative Lee, Payne, and Waxman as well as Senators Reid,
Feingold, Kennedy, Kerry and Coleman, Hagel, Specter, along with
others. And at the 11th hour when things look grim, Senators McCain
and Obama weighed in with others to "unstick" the bill.
The legislation also overturns the HIV travel and immigration ban
that has been in place since 1992. The ban denied entry, either as
a tourist, student or resident, to any non-US citizen living with
HIV or AIDS. "This much-derided ban has no place in public policy,
and only reinforces the stigma associated with HIV infection, "
said Health GAP Board member Amanda Lugg of New York City.
"Finally the US has joined almost every other nation in removing
discriminatory barriers against the travel and immigration rights
of people living with HIV."
Just a few weeks ago, passage of the AIDS, TB and malaria bill
seemed uncertain. Seven Senators led by Tom Coburn had placed a
"hold " on the legislation, in spite of broad bipartisan support
ranging from President Bush to both presidential candidates.
"Groups from across the political spectrum raised a ruckus in their
respective ways, and Senator Reid stepped up and made it a priority
to pass this legislation," said Health GAP board member Jose
DeMarco from Philadelphia.
Activists, while grateful for passage of the legislation, said that
changes were still needed to make sure the programs are fully
effective. "Lifesaving provisions on treatment, prevention and care
were stripped from the bill as a result of compromises," said
Health GAP s grassroots organizer Kaytee Riek. "This bill is a
major step forward, but critical changes are still needed."
Activists detailed five major areas of concern with the
legislation:
- Treatment: The bill does not set a specific target for the number
of people to receive treatment, but instead relies on a "formula"
for determining the number of people set to receive treatment,
which would fluctuate based on annual appropriations. Without clear
targets, it is very difficult to program for the future. In fact,
the formula creates an economic incentive against treatment
scale-up. This extremely problematic feature of the formula has
been confirmed as intentional by Senator Coburn s staff.
- Funding: Congress authorized spending $48 billion over five years
on AIDS, TB and malaria. But the legislation calls for programming
that will cost at least $59 billion over five years. House and
Senate appropriators need to commit to the major increases in
spending required to fulfill the expanded program in the bill.
- Abstinence-only funding: The Hyde/Lantos bill does overturn a
previous requirement that 1/3 of prevention funding be directed
towards abstinence-only programs. This has been replaced with a
"reporting requirement" which mandates that the Office of the
Global AIDS Coordinator submit a report to Congress if a country
with a generalized epidemic spends less than 50% of sexual
prevention funding on programs promoting abstinence and
faithfulness.
- Health Care Workers: During negotiations, Congress dropped two
provisions that would require recipient programs to provide
urgently needed health care for health care workers, as well as a
provision that would have instructed the US Treasury to oppose the
International Monetary Fund s policies that seek to limit poor
country spending on health and education.
- Sex Worker 'Loyalty Oath': The bill does not address a current
US policy that requires recipients of US foreign assistance funds
to certify that they oppose prostitution. This"pledge" increases
stigma for hard to reach populations and can lead to fewer sex
workers having access to HIV prevention and treatment programs.
- Sexual and Reproductive Health: US policies that limit the
ability of recipients to provide family planning services are
harmful and must be overturned by a future Congress or President.
The bill is silent on integration of family planning programs with
AIDS programs. US policies create increased fragmentation on the
ground and deny resources to organizations providing family
planning services/organizations that must choose between sexual and
reproductive health and care for AIDS, TB and malaria. Effectively,
US policy limits availability of health care to sick patients.
Other Recent Reports and Commentaries relevant to AIDS in Africa
UNAIDS
Annual Report on the Global AIDS Epidemic
http://www.unaids.org
ActionAid
Politics of Prevention - A Global Crisis in AIDS and Education
http://www.actionaid.org/main.aspx?PageID=1128
Center for Health and Gender Equity
Another 5 Years of Flawed Prevention Policy?
http://www.genderhealth.org
Global AIDS Alliance
Scaling Up for Zero Tolerance: Civil Society Leadership in
Eliminating Violence Against Women and Girls in Ghana, Rwanda, and
South Africa
http://www.globalaidsalliance.org/index.php/1003
Nigeria Health Watch Blog
"Another International AIDS Conference"
by Chikwe Iheweazu and Ike Anya
http://nigeriahealthwatch.blogspot.com
or
http://tinyurl.com/6ptsld
AfricaFocus Bulletin is an independent electronic publication
providing reposted commentary and analysis on African issues, with
a particular focus on U.S. and international policies. AfricaFocus
Bulletin is edited by William Minter.
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