October/November #175 : R.I.P. HIV - by Regan Hofmann

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Table of Contents
 

Features

R.I.P. HIV

From the Editor

Retiring the Ribbon

Feedback

Letters- October/November 2011

The POZ Q+A

High-Impact Prevention

What You Need to Know

Health Care Should Be a Human Right—for All

Too Few Pharma Companies in the Patent Pool

Legislation Proposed to End Criminal HIV Laws

AIDS Is Not an "Automatic Death Sentence"

Geckos Don’t Cure AIDS

We Hear You

The PrEP Debate

What Matters to You

Getting HIV Care Without Getting Deported

Treatment News

A Peek Into the Pipeline

Savvy Survival Strategy

Going Norvir-Free?

Cure Watch

Listen Up

Oh Baby!

Make Some Bones About It

Comfort Zone

Waiting to Inhale

POZ Heroes

Defying Gravity

   
Most Popular Lessons

The HIV Life Cycle

Shingles

Herpes Simplex Virus

Syphilis & Neurosyphilis

Treatments for Opportunistic Infections (OIs)

What is AIDS & HIV?

Hepatitis & HIV


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October / November 2011

R.I.P. HIV

by Regan Hofmann



1. POLITICAL WILL

We need to ask the president to step up his game on HIV/AIDS. President Barack Obama took a leadership position on HIV/AIDS when he made the development of a National HIV/AIDS Strategy for the United States a campaign promise. He delivered on that promise, reinvigorating the Office of National AIDS Policy, re-upping the President’s Advisory Council on HIV/AIDS (PACHA) and ushering the National HIV/AIDS Strategy to life. It exists. Now we ask: Will its implementation get funded, or will it remain merely a promise on paper?

Barack ObamaIf President Obama can encourage Congress to secure the money to fight AIDS abroad and at home at levels capable of changing the course of the pandemic (which in today’s grim economy may equate to defending current spending levels or at least, minimizing cuts), he will do something no president has done before: jump-start the end of AIDS. PEPFAR is already ahead of its pledge to put more than 4 million people on meds by 2014. We’d like to see President Obama ratchet it up and officially pledge to put 6 million in care by 2013 as a “down payment” toward achieving the United Nations’ goal of 15 million in care by 2015.

Linking millions more with HIV to ARVs, coupled with being the first president to reform health care, would secure President Obama’s place in the humanitarian history books.

It would also make him a wildly popular guy at the International AIDS Conference, scheduled for next July in Washington, DC. And being popular is a very good thing for a man looking to get re-elected several months later.

We need to request that the first lady publicly state that HIV/AIDS is the No. 1 cause of death for women of childbearing age worldwide. Michelle Obama’s main platform is fighting obesity. While it is a critical issue that needs resolving, nothing kills more women ages 15 to 44 than HIV. Nothing.

The Obama administration launched the U.S. government’s Global Health Initiative (GHI); and GHI took PEPFAR under its umbrella. Since one of the GHI’s underlying principles is to “implement a women- and girl-centered approach” to health, and considering how profoundly HIV undermines the health of women and girls, HIV should remain at the top of the list of GHI’s concerns. The first lady could help ensure that happens. While we’re asking, we’d also love to see the first lady and her daughters Sasha and Malia help unfold the AIDS Quilt on the Mall in July 2012 at the start of the International AIDS Conference—a conference that the president and Congress helped bring home by lifting the ban on people with HIV traveling into the United States.

The president and first lady were publicly tested for HIV when visiting Kenya in 2006, and on her recent trip to South Africa in 2011, Michelle Obama said, “You can be the generation that ends HIV/AIDS in our time—the generation that fights not just the disease, but the stigma of the disease, the generation that teaches the world that HIV is fully preventable and treatable and should never be a source of shame.”

If there was ever a first couple that could embrace the end of AIDS as part of their legacy, the Obamas are it.

We need to encourage conservative Democrats and Republicans (yes, even Tea Partiers) to support AIDS spending stateside—and overseas. Fighting AIDS has historically been a bipartisan effort. Both sides of the aisle have seen the value of America launching a global humanitarian relief effort focused on AIDS via PEPFAR. The program built relationships between our government and foreign governments, elevated health literacy around the world and developed health infrastructure with and in other nations. In turn, those accomplishments served as sound foreign policy and were good for U.S. national security.

Regardless of what anyone thinks of the rest of his record, President George W. Bush’s decision to start PEPFAR (and Congress’s approval to fund it) saved millions of lives and made America many new friends around the world. Bush II believed that because America could help end the suffering of people with HIV/AIDS globally, it was our moral imperative to do so. Was PEPFAR perfect under Bush II’s oversight? No. Did it have questionable constrictions around certain populations like sex workers and injection drug users? Yes. Does it happen to align with some of the nations on which we are dependent for natural resources (like oil)? Yes. Did it give the religious right a direct line into vulnerable people in need of “conversion” in the developing world? Yes. But it also proved that we could get lifesaving medications to people in developing nations who need them and that they will take them as prescribed, then get healthy, survive, parent their children and contribute to the world’s economy.

I’d like to think that the current crop of Republicans could be similarly moved to see the value of fighting HIV/AIDS both abroad—and at home (because while Bush II set out to save the world from AIDS, he forgot that the United States was part of the world). However, bearing witness to Tea Party Republicans’ attitudes toward all disenfranchised people, it’s reasonable to be deeply skeptical that Tea Party leadership would be 
benevolent to people with HIV.

We must help them see the light. The argument for finding the money to end AIDS exists. We just have to make it compelling to everyone.

We need to support the HIV/AIDS Caucus within Congress. As we go to print, the HIV/AIDS Congressional Caucus has been strengthened. As founding co-chair of the caucus, Barbara Lee (D–Calif.) is leading the charge to keep Congress abreast of HIV/AIDS issues. To date, there are 50 members in the caucus, including: caucus co-chairs Trent Franks (R–Ariz.) and Jim McDermott (D–Wash.), as well as notable newcomer Jim Himes (D–Conn.) and AIDS heroine Nancy Pelosi (D–Calif.). Currently, two new pieces of AIDS legislation are on the Congressional table. They include: H.R. 1462, the National Black Clergy for the Elimination of HIV/AIDS Act of 2011, re-introduced by Charles Rangel (D–NY) and Senator Kirsten Gillibrand (D–NY); and H.R. 2704, the Justice for the Unprotected against Sexually Transmitted Infections among the Confined and Exposed (JUSTICE) Act (introduced by Lee). Another bill, the Repeal HIV Discrimination Act, is scheduled to be introduced by Lee in September. With the help of this bipartisan caucus, we have a better shot at educating more members about why these bills are essential and must be passed. Not to mention that the caucus will be critical as we struggle to protect AIDS funding.

We need to start an AIDS PAC. Washington, DC, is a transactional town. If we expect members of the House of Representatives and Senate to go to bat for us, we need to ensure they get re-elected. “PAC” stands for political action committee and refers to a private group of people who organize to elect political candidates or to advance certain issues and/or legislation. A political committee is so named when the organization receives donations, or makes them, in excess of $1,000 for the purpose of influencing a federal election. In short, an AIDS PAC allows us to put our money where our mouths are. We can ask, but money really talks.

2. MONEY


We need to secure the money we have and raise more soon to avoid needing a whole lot more later. Almighty greenbacks, euros, yen, pesos, rands or rupees. Call your dinero anything you want—we must defend our earmarks and find more funding if we can. This is challenging during an economic crisis. However, if we’ve learned anything from our current state of economic affairs, it’s that ignoring problems in the short term ensures they can reach catastrophic dimensions down the road.

As Anthony Fauci said at a meeting of the U.S. Mission to the United Nations this summer, “Either you are going to pay a lot now [to end AIDS] or an awful lot later on.” The piper will be paid one way or another. We can either pay with cold, hard currency or with tens of millions of lives.

Modeling conducted by Bernhard Schwartlander, MD, UNAIDS director for evidence, strategy and results, shows that if we invest and maintain the $46.5 billion needed over the next 10 years to make the United Nations’ universal access goal a reality, new HIV infections would be reduced by 12.2 million between 2011 and 2020, a cumulative 7.4 million deaths from AIDS would be averted during that time and 29.4 million life years would be gained. The $46.5 billion investment would pay for itself with savings incurred from averted infections and their associated cost of treatment.

The more quickly we act, the better our long-term outcomes and the more money we’ll save to apply to other problems at home and around the world.

We need to encourage the U.S. government to remain a leader in global funding for HIV—in order to encourage other countries to pony up. It was never the United States’ intention to pick up the tab for ending AIDS. PEPFAR was designed so that the countries we helped could eventually sustain their own AIDS relief efforts. Our long-term strategy needs to shift the monkey of paying almost entirely for AIDS off the backs of the U.S. government and American tax payers and spread the enormous cost among all those who will benefit from the demise of AIDS.

This isn’t happening. The Global Fund to Fight AIDS, Tuberculosis and Malaria is essentially flat funded. Some nations are refusing to meet their pledges (Italy, for example, is $192 million in arrears); some have reduced their pledges; and some are paying far too little given their relative wealth and dependency on the fund.

More of the G8 and G20 countries must be convinced to get some skin in the AIDS game. The world needs to find a way to hold donor nations accountable to their Global Fund commitments, and we must see an increased investment in bilateral and multi-lateral aid. Affected countries with big GNPs should be required (and pressured by in-country advocacy efforts led by people with and affected by HIV) to dedicate more resources to their own epidemics. The Global Fund’s policy review process needs to be refined; we need to get more strategic about HIV-related granting. All donors and affected countries should reallocate their HIV portfolios to maximize impact and to ensure investment in what we know works in any particular area or nation (for example, male circumcision or prevention of mother-to-child transmission in certain African nations).

We should encourage the United States to demonstrate it is prepared to do what it expects other nations to do: find the funds to provide health care for their citizens with HIV. About 950,000 of the estimated 1.2 million Americans living with HIV are not on antiretroviral medicines (ARVs) for a variety of reasons. A good way to inspire other nations to contribute to the global AIDS fight would certainly be providing care for our citizens. By doing so, we could also show that when enough people are on ARVs consistently and that when this expanded access is coupled with awareness, testing and prevention efforts, AIDS can be wiped out.

The Affordable Care Act, a.k.a. health care reform, should address much of the gap in access to care in the United States, but reform doesn’t fully kick in until 2014, and even then, it won’t solve all of the health care concerns of people living with the virus domestically.

So far, the president and Congress have released emergency funding to meet the growing need of the AIDS Drug Assistance Program (ADAP). And the pharmaceutical companies that manufacture the drugs have dropped prices and increased funding for their Patient Drug Assistance Programs. But the recent waves of emergency funding are not a long-term solution. As we wait for health care reform, we must ask the president and Congress to continue to preserve AIDS funding. We need to ensure states are pulling their load and that they are using their funds most efficiently. And we need to ask our community to make some difficult choices and to make the money we already have work harder.

The depth and breadth of the president’s commitment to HIV/AIDS will be challenged as recommendations for discretionary and entitlement budget cuts land on his desk. The U.S. political system is not structured to reward long-term planning and decision making on the part of politicians. Many politicians have no choice but to cater to their largest donors short term to secure re-election. This is true, even for the president of the United States. And the Supreme Court’s ruling that private corporations could give unlimited funds to politicians made it more challenging for elected officials to support what’s good for the public, the nation and the world, as opposed to what’s good for the special interests of their biggest backers. That’s not conspiracy, that’s the way the system currently operates.

This means the president is in a pickle. If he fails to get re-elected, it is possible (and likely) that Republicans will   abolish his legacy of health care reform. That means people with HIV will be in deep trouble since the majority of us rely on entitlement programs like Medicaid, Medicare and the Ryan White CARE Act for meds. But in order to get re-elected, the president may have to make some budget cuts that could prove disastrous short- (and possibly long-) term for many disenfranchised people—including many people living with HIV/AIDS. We need to help him understand that this short-term thinking will kill people, cost more money long-term—and backfire when it comes to Election Day.

We need to engage the private sector to help raise new money for HIV/AIDS. Corporations could play a hugely important role in bringing in-kind services and resources to the fight against HIV/AIDS. There are myriad ways multi-national corporations can leverage the reach, resources and the power of their brands to capture people’s attention and link them to lifesaving care. Corporations can deliver information or tools for health, leverage connections and media platforms or underwrite micro-lending programs to help people with HIV secure jobs, incomes and health insurance.

We also need innovative financing solutions that allow the general public to make micro-contributions to the AIDS cause. A prime example is “Massive Good”—a program launched by the Millennium Foundation for Innovative Finance for Health. Massive Good utilizes a global network of travel agencies to allow travelers to add two dollars to hotel or flight reservations. The money is passed to UNITAID, which buys AIDS drugs 
in bulk and helps get them to those in need. Another example is AIDS United’s recently launched “Make It Grow” campaign that also solicits micro-donations from individuals—donations that are matched dollar-for-dollar by Social Innovation Fund federal government grants. That program also supports access to AIDS meds for those who can’t afford them.

We need to broaden our fund-raising appeals beyond the usual suspects when it comes to targeting philanthropic foundations. The Bill & Melinda Gates Foundation, the Elton John AIDS Foundation, the Ford Foundation, the MAC AIDS Fund and others have contributed gigantic amounts of cash to the AIDS fight. But we must solicit new philanthropists and charitable foundations, directing our pitches at foundations beyond those that focus on funding health care. We need help with policy, advocacy, media, technology and education. And, our message should be that those who invest today in the fight against AIDS have a chance to end suffering on a biblical scale. And who doesn’t want to be a hero of epic proportion?

We need to whip up Wall Street. We should re-engage the investment community and convince the big money crowd that substantial investments in AIDS research science now could not only make investors richer but also secure them a legendary place in history for fast-tracking the cure and a vaccine. There is no longer a rationale for the existence of the “Valley of Death” (as the gap between funds needed to develop basic science and funds needed to bring drugs to market is known). Indeed, eliminating the Valley of Death is likely to save tens of millions of lives—while potentially generating billions of dollars.
 
We need to address the pricing issue of AIDS drugs to allow more people access to lifesaving care. The 27.3 million people not in care represent a potentially huge global expansion market for HIV drugs—a market that could bring billions to the for-profit drug companies, even if they reduced their prices. The trouble so far is that no one has been able to guarantee a payer for that market. We need to find a way to make it more profitable for pharmaceutical companies to get the drugs to more people—people who can’t pay for them themselves. It’s a conundrum.

If the cost burden for universal access to care falls solely onto governments (particularly the U.S. government) and the for-profit companies that manufacture the pills, then these entities don’t have a significant economic incentive to encourage more global expansion to care.

We need a more sophisticated strategy for asking pharmaceutical companies to reduce their drug costs. Just because their products happen to provide humanitarian relief does not, apparently, mean that pharma is obligated to manufacture or distribute them at lower prices. There needs to be a financial incentive. We need innovative financing solutions that tap fresh sources of money, and we need more support from the G8 and G20 countries, the private sector and citizens of the world. If we could gather a pool of cash in order to make universal access feasible, we could go to the table with pharmaceutical companies and negotiate for more compassionate pricing.

Advocates for the AIDS Drug Assistance Program (ADAP) have shown that a model exists for lowering drug costs in order to get more pills to more people and grow profits. The Clinton Health Access Initiative and the work being done to engage pharmaceutical companies in international patent pools will prove key to ending AIDS.

Pages: 1 | 2 | 3 | 4

Search: Washington DC, Thomas Frieden, U.S. Centers for Disease Control and Prevention, CDC, HPTN 052, PEP, PrEP, pre-exposure prophylaxis, post-exposure prophylaxis, Bill Gates, Anthony Fauci, National Institutes of Health, National Institute of Allergy and Infectious Diseases, United Nations, Medicaid, Medicare, stigma, discrimination, homophobia, criminalization, deportation, President?s Emergency Plan for AIDS Relief, PEPFAR, Barack Obama, Office of National AIDS Policy, President's Advisory Council on HIV/AIDS, PACHA, Michelle Obama, Global Health Initiative, GHI, UNAIDS, Affordable Care Act, AIDS Drug Assistance Program, ADAP, Ryan White CARE Act


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  comments 30 - 31 (of 31 total)     << < previous

Betsy Yung, Burbank, CA, 2011-09-26 12:17:25
I can't help but wonder if a shift in thinking might ultimately occur if all HIV positive people would decide to come out of the shadows and disclose... particularly those who are public figures. I know it's just a wild dream... if only we could just feel normalized and not stigmatized... if everyone would test and get treated. I imagine that with all the weapons we currently have... AIDS could die with my generation. Sadly, a cure for me, in my lifetime, is unlikely.

carol durante, fredericksburg, va, 2011-09-26 08:56:59
This is wonderful news and I feel a sense of obligation to move this forward. I hope everyone feels a sense of responsibility to do whatever is needed to end AIDS.

comments 30 - 31 (of 31 total)     << < previous

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