A World Without AIDS, Still Worlds Away

via the New York Times, by Lawrence K. Altman

WASHINGTON — Is the world on the verge of ending the AIDS epidemic and creating an AIDS-free generation, even though a cure and a vaccine are still distant hopes?

Yes, roared enthusiasts among the nearly 24,000 participants at the 19th International AIDS Conference here last week. Their hopes are based on the extraordinary scientific gains made since the conference was last held in the United States, 22 years ago, when an AIDS diagnosis was a sure death sentence.

Among those gains: antiretroviral drug combinations for women to prevent infection of their newborns; drugs to treat and prevent infection with H.I.V., the virus that causes AIDS, among adults; and evidence that voluntary male circumcision can reduce the risk of female-to-male transmission by 50 to 60 percent.

Today, H.I.V. has become a chronic disease that, if treated appropriately, can be held at bay in a newly infected young adult for decades — if the patient adheres to the rigid daily drug regimen.

Michel Sidibé, the executive director of the United Nations AIDS agency, said that the opportunity to end AIDS will “evaporate” if governments do not show greater political will and increase investments to make gains available to millions more people.

“All that can stop us now is indecision and lack of courage,” he said.

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HIV and the Law

via the Global Commission on HIV and the Law

The end of the global AIDS epidemic is within our reach. This will only be possible if science and action are accompanied by a tangible commitment to respecting human dignity and ending injustice.

Law prohibits or permits specific behaviours, and in so doing, it shapes politics, economics and society. The law can be a human good that makes a material diff erence in people’s lives. It is therefore not surprising that law has the power to bridge the gap between vulnerability and resilience to HIV.

We came together as a group of individuals from diverse backgrounds, experiences and continents to examine the role of the law in eff ective HIV responses. What we share is our abiding commitment to public health and social justice. We have listened with humility to hundreds of accounts describing the eff ects of law on HIV. In many instances, we have been overwhelmed by how archaic, insensitive laws are violating human rights, challenging rational public health responses and eroding social fabric. At other times, we have been moved by those who demonstrate courage and conviction to protect those most vulnerable in
our societies.

Many would say that the law can be complex and challenging and is best left alone. Our experience during this Commission has shown us a very different perspective. We have been encouraged by how frank and constructive dialogue on controversial issues can sometimes quickly lead to progressive law reform, the eff ective defence of legislation or better enforcement of existing laws. Even in environments where formal legal change is a slow and arduous process, we have witnessed countries taking action to strengthen access to justice and challenge stigma and discrimination.

Click here for the full report.


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UNAIDS: TRIPS and the potential impact of free trade agreements

via UNAIDS.org

For long-time HIV activist and Coordinator of the Asia Pacific Network of People Living with HIV (APN+) Shiba Phurailatpam, the importance of sustained access to affordable AIDS medicines is more than a trade, legal or logistical issue: “It is literally a matter of life and death for people living with HIV,” Phurailatpam says. “More than 60% of people in need of HIV treatment in Asia-Pacific still don’t have it.

Across the world, millions of people need access to HIV treatment, today, to keep them alive.

Antiretroviral drugs have changed the way in which HIV is viewed—from a death sentence to a chronic illness. That achievement was propelled by a surge in donor funding and by the drastic reduction of the cost of first-line antiretroviral regimens from around US$ 10 000 to under US$ 100 per person per year over the past decade, due in part to the increased availability of low-cost generic medicines.

Over the past decade, more than 6.6 million people have received antiretroviral therapy in developing countries across the world.  At the UN General Assembly High Level Meeting on AIDS in New York in June 2011, governments from around the world made a bold pledge to get all people eligible—an additional nine million people living with HIV—on treatment by 2015.

But at this time of opportunity, the sustainable future of HIV treatment programmes remains of serious concern. Countries are facing mounting challenges to produce or procure affordable HIV treatment, including cutbacks in AIDS funding and a proliferation of increasingly restrictive intellectual property measures in free trade agreements.

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UNAIDS Prevention Advocate Michel Sidibé's Approach to the Fight Against AIDS

viaNew York Times, by Donald G. McNeil Jr.

Shortly after Michel Sidibé became executive director of the United Nations’ AIDS prevention agency, a court in Senegal sentenced nine gay men, all AIDS educators, to eight years in prison for “unnatural acts.” In one of his first moves as the new chief of U.N.AIDS, Mr. Sidibe flew to Senegal to ask its aging president, Abdoulaye Wade, to pardon the men.
Mr. Sidibé, the son of a Muslim politician from Mali and a white French Catholic, asked the president — who is married to a white Frenchwoman — if he had ever suffered discrimination.
“Oh, Sidibé, you have no idea,” came the reply. “And for not marrying a Muslim.”

“Then, Uncle,” Mr. Sidibé said, using the African way to politely address an older man, “why do you accept that men here are put in jail for eight years just for being gay?”

Mr. Wade thought about it and promised to call his justice minister. Shortly afterward, the charges were dropped.

Asked if his predecessor — Dr. Peter Piot, a Belgian and one of the discoverers of the Ebola virus — could have gotten the same results, Mr. Sidibé said, “Without doubt, it would have been more difficult. It would be very automatically perceived as ‘the white people moralizing to us again.’ Since I’m African, I can raise it in a way that is less confrontational.”

Asked about that, Dr. Piot laughed and agreed, saying he sometimes thought his African missions, like those of the U2 singer Bono, “felt like a junior Tanzanian economist and Hugh Masekela coming to Washington to scold Congress for its budget deficit” — with Congress having to grin and bear it because it needed Tanzania’s cash.
Mr. Sidibé, 59, is a former relief worker, rather than a physician, and, along with English and French, he speaks West African Mandingo, the Tamashek of the Tuaregs and other languages.

With a combination of bonhomie and persistence, he has delivered difficult messages to African presidents very persuasively in his three years in office: Convince your men to get circumcised. Tell your teenage girls not to sleep with older men for money. Shelve your squeamishness and talk about condoms. Help prostitutes instead of jailing them. Ask your preachers to stop railing against homosexuals and order your police forces to stop beating them. Let Western scientists test new drugs and vaccines, despite the inevitable rumors that Africans are being used as guinea pigs.

“You can’t say ‘no’ to Michel,” said Dr. Piot, who hired him away from Unicef. “I was at a conference in Ethiopia in December, and for the first time, I felt I was hearing ‘ownership’ of AIDS by African countries. They weren’t talking so much about the donors, but about it as their own problem. I think he had a lot to do with that.”

Thanks, in part, to Mr. Sidibé’s intensive lobbying, South Africa and China are rapidly revising their approaches to the epidemic, and he hopes Russia and India soon will too. And the notoriously conservative African Union has created a committee to help populations it previously ignored: homosexuals, prostitutes and drug abusers.

Mr. Sidibé is from so deep in Africa that his professional career actually began in Timbuktu, helping Tuareg nomads. (His grandfather, he said, was a Fulani nomad in the same desert.)
He has the African shtick down. He calls anyone younger than him “my brother” or “my sister.” He seems to remember, and hug, everyone he has met before, from drivers to senators to journalists. He regales guests at cocktail parties with long parables about chameleons that he learned as a teenager in circumcision school (a bonding ritual that many African men remember with a mix of fondness and terror — a cross between boot camp and a bar mitzvah, but ending with a collective bris, sometimes done with a spear blade.)

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Mapping Pathways at ICASA: Generating interest, creating buzz

 Original content from our Mapping Pathways blog team

Two Mapping Pathways team members – Molly Morgan Jones from RAND Europe and Jim Pickett from the AIDS Foundation of Chicago – recently presented two project posters at the 16th International Conference on HIV/AIDS and Sexually Transmitted Infections in Africa (ICASA) held in Addis Ababa from December 4-8. This was the first time preliminary project findings from the literature review, online survey, stakeholder interviews, and ExpertLens were officially shared with the wider HIV prevention community on such a large scale. The semi-annual ICASA is Africa’s largest gathering on HIV/AIDS. This year it brought together approximately 7,000 delegates from more than 103 countries. Check out the two Mapping Pathways poster presentations here. The daily poster exhibition showcased posters on research findings, best practices, and innovative strategies in the response to HIV/AIDS in Africa.

“Molly and I had a lot of fun,” says Jim Pickett. “In general, the focus of the conference wasn’t so much about new prevention technologies, so it was important for us to get out there and get the word out. We stood in front of the posters and had some really great discussions – people were  not only interested in the science behind some of these ARV-based prevention strategies, but also understanding the various viewpoints from stakeholders ‘on the ground.’ I think Mapping Pathways generated a real buzz.”

At this year’s ICASA, concerns about funding took center stage. According to a conference write-up, “Underlying the encouraging atmosphere, participants, presenters and conference organizers shared concerns about recent announcements regarding cuts in much needed life-saving funding for HIV, AIDS, tuberculosis and malaria. The financial blow of the Global Fund, which suspended normal disbursements until 2014, comes at the worst moment – when the use of antiretroviral drugs for treatment and prevention has dramatically reduced mortality from the virus and reduce transmission of AIDS.” Read the rest of this synopsis on the conference here: ICASA 2011 Closes with a Call for a Sustainable HIV Response

Apart from discussions on funding, other conference presentations included promoting gender equality (a high-level task force “Women, Girls, Gender Equality and HIV for Eastern and Southern Africa” was launched); strengthening health systems and showcasing the additional benefits the AIDS response has had for the broader health and development; and committing to the elimination of new HIV infections in young children. Pickett co-chaired a session on HIV and LGBT issues in the African context as well, which was standing room only.

On the last day of the conference, delegates gathered together to discuss how to deliver on the 2011 United Nations Political Declaration on HIV/AIDS for Africa, which was unanimously adopted this June. The declaration calls for universal access by 2015. Read more here.

Check out the Mapping Pathways posters here. And let us know what you think. You may leave a comment here, or send us an email at: mappingpathways@gmail.com

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

AIDS Battle Risks Being Derailed by Global Financial Crisis

via Nature, by Meredith Wadman

Thirty years after AIDS was first recognized as a human scourge, major recent gains in treatment and prevention risk being derailed by the global financial crisis.

On 23 November, the Global Fund to Fight AIDS, Tuberculosis and Malaria announced that it will not fund new grants for prevention and treatment until 2014, owing to “substantial budget challenges in some donor countries”. The fund's HIV activities run the gamut from counselling and testing pregnant women in India to providing medications to infected children in Kenya.

And on 7 December, a report from Policy Cures in Sydney, Australia, a group that monitors global research and development for neglected diseases, showed that public and private funders last year cut their commitments to HIV/AIDS research targeted at the developing world by US$67.5 million, or 5.9%. The decline was due entirely to cutbacks by wealthy nations, which slashed spending by $72.6 million; poorer countries actually increased funding by $5.1 million. Where research is concerned, “AIDS had a bigger drop in dollar terms than any other disease”, says Mary Moran, the executive director of Policy Cures and the lead author on the report.

The threat comes even as US President Barack Obama last week promised that the United States will step up its worldwide attack on AIDS. Breaking the White House's past reticence on the issue, he urged nations to honour their unmet pledges to the Global Fund.

“Countries that have committed to the Global Fund need to give the money that they promised,” he said on 1 December, World AIDS Day. “Countries that haven't made a pledge, they need to do so,” he added, singling out emerging nations such as China that are recipients of funds “but now are in a position to step up as major donors”.

The United States has given $6.1 billion to the Global Fund since 2004, and last year pledged to contribute $4 billion between 2011 and 2013. Congress approved $1.05 billion in 2011, meaning that allotments must increase substantially in 2012 and 2013 to honour the pledge. Obama has asked Congress to provide $1.3 billion in 2012, but Senate lawmakers have so far resisted the increase.

Obama pledged to increase by 50% — to 6 million — the number of people receiving antiretroviral therapy (ART) worldwide by 2013 through the President's Emergency Plan for AIDS Relief (PEPFAR), the nation's major global treatment and prevention programme. He also said PEPFAR would aim to provide ART to an additional 1.5 million pregnant women with HIV in the next two years. The international promises came with no new money immediately attached. But Obama has asked Congress to provide nearly $7.2 billion — a 6% increase — for PEPFAR in 2012, part of the unfinished budget bills still being debated.

Advocates said that his speech marked a significant turning point. “This is the first time he's signalled that he's going to champion global HIV in this way,” says Jennifer Cohn, an assistant professor of infectious diseases at the University of Pennsylvania in Philadelphia, and a policy adviser in Nairobi for Médecins Sans Frontières (MSF; also known as Doctors Without Borders). “Whether or not this gets translated into the president's 2013 budget request, or what Congress chooses to protect during the 2012 budget negotiations — that's what I'm waiting to hear.”

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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Global Fund to Fight AIDS, TB and Malaria Cancels Funding

via The Guardian, by Sarah Boseley

"If we lose the ground we have gained, we will be back to square one – all that effort and investment, lost. The decisions you make here today will determine the outcome."

In what must be seen as a serious setback in the progress made against the major infectious diseases in poor countries, a board meeting of the Global Fund to Fight Aids, TB and Malaria in Accra, Ghana, has effectively cancelled its next round of grant-making.

The fund has been staring at a financial black hole ever since its big replenishment meeting in New York a year ago failed to deliver the sums it hoped for. It wanted $20bn. It got $11.7bn. That was in spite of exhortations to donors to pledge money from the UN secretary general, Ban Ki-moon, who warned that the stakes were high and that lives would be lost if pressure on the big killer diseases was not maintained.

It once seemed unthinkable that the money would not continue to stream into programmes to treat people with Aids, TB and malaria and to prevent others becoming infected. But that is what is happening. There is no doubt that people who could have been spared will instead fall ill and die as a result of the drying up of funds. There is also a Damoclean sword hanging over the heads of people who are alive and well thanks to drug treatment for their HIV infection. The Global Fund – together with Pepfar (the President's Emergency Plan for Aids Relief) – has been the main source of money to pay for drugs. Those who start the combination treatments to prevent HIV causing Aids must stay on the drugs for life. If they stop, there is a danger the virus will become resistant to the drugs they are on.

The Global Fund's board is buying time by telling governments not to put in new applications for funding for round 11, which is supposed to provide money for 2011 to 2013. It is offering a "transitional funding mechanism", which will allow countries to ask for money to cover essential needs. In recognition of the danger of stopping HIV treatment, this should allow countries to continue to supply drugs to people who are already taking them.

But, as Secretary of State Hillary Clinton said in her recent address, the need now is to step up the fight against HIV by providing more drugs – not less. Scientific studies showed this year that treatment makes people with HIV less infectious. Failure to keep rolling out the drugs to more and more people will waste an opportunity to deliver what she and others have hopefully termed "an Aids-free generation".

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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Bureaucracy in Nepal Leads to HIV Deaths

via World Policy Blog, by Kyle Knight

Bureaucratic deadlock is starting to kill people in Nepal. The country’s NGO sector working with populations deemed high-risk for contracting HIV-AIDS are in desperate need of $10 million of donor funds currently held by the cash-strapped government. While stories of stagnant bureaucracy in Nepal’s fledgling democratic government are not new, the consequences this time will put those increasingly dependent on NGO support at great risk. The failures of Nepal’s ineffective—even Kafkaesque—bureaucracy have obstructed even the most basic services, leaving NGOs to care for the country’s population.

Working with the most at-risk groups in the country such as intravenous drug users (IDUs), men who have sex with men (MSMs), and Nepal’s sizable transgender (TG) population, these organizations are unable to help treat or prevent HIV from spreading, because of the government’s embarrassing financial disorganization. NGOs working with IDUs have already reported preventable deaths linked to the funding gap, and organizations working with MSMs and TGs have not been able to hand out condoms for nearly three months. “It’s not that we don’t know how to treat people, or that we don’t have the capacity—it’s that we don’t have the money, ” explains an activist working for an IDU NGO. “Basic infections are going un-treated. Staff are looking for jobs elsewhere. These are unnecessary deaths.”

This is nothing new for donor-dependent Nepal. Sadly, the country is used to funding crises, especially in its HIV-AIDS programs. A recent impending shortage of pediatric ARV (anti-retro viral) was averted, thanks to the intervention of the United Nations.

The UN action has been a lifeline for the medical community and Nepali children living with HIV-AIDS. But it is far from enough. The HIV prevalence rate in Nepal is believed to be below 1 percent of the adult population, but infection rates vary considerably, and are substantially higher in most at-risk populations. In 2009, the government announced that the prevalence rates were decreasing across the country. The blocked $10 million will surely and unnecessarily boost the number of people infected by the virus and erase any gains made in recent years. While the impassive government receives warnings from international organizations, the risk of a new wave of infection is reaching a critical point.

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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

An end to AIDS is within our reach

via The Washington Post, by Desmond Tutu

A study published in the New England Journal of Medicine last month has demonstrated that antiretroviral treatment can prevent the spread of HIV, in addition to saving those infected from sickness and death.

Armed with this new data, President Obama should lead the world in a massive effort to expand access to treatment and rid humanity of AIDS — the most devastating disease of our time.

But just as the end of AIDS has finally come within reach, we are witnessing an unprecedented drop in financial and political support for the cause.

The Joint United Nations Programme on HIV/AIDS and the Kaiser Family Foundation reported in August that donor funding for HIV/AIDS leveled in 2009 and then declined — 10 percent — in 2010 for the first time ever. The United States, which accounts for more than half of global contributions to fight the disease, disbursed $700 million less in 2010 than in 2009. And projected U.S. funding in 2011 is roughly $28 million less than in 2010.

This is a great shame, as millions of people receiving treatment worldwide depend on these funds to stay alive.

Our support should be increasing. AIDS remains the leading cause of orphanhood and of death among women of reproductive age. It is a major driver of opportunistic infections — particularly tuberculosis — and keeps tens of millions of Africans mired in poverty.

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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

National Institutes of Health (NIH) Launches $140M Project to Predict Drug Toxicity

via Science Magazine, by Jocelyn Kaiser

National Institutes of Health (NIH) Director Francis Collins's controversial plan to launch a new center for translational biomedical research got a boost today in a White House announcement on science initiatives. NIH also rolled out an early project for the planned center, promising up to $140 million over 5 years to develop a chip for predicting drug toxicity.

The drug chip will be developed in a partnership to include NIH, the Food and Drug Administration (FDA), and DARPA--the Defense Advanced Research Projects Agency--which is known for funding risky research. Collins says the first-ever collaboration of this kind will try to combine human cell types, such as liver and kidney cells, that can represent physiological systems and "talk to each other" on a chip that will be used to predict whether a drug will be safe. Researchers will try to grow cells in three dimensions rather than as a flat layer because that's a better way to model how a drug will act in human tissues. The project "is really ambitious," Collins says.

DARPA this week began soliciting proposals for its piece, which will focus on engineering. NIH's half of the funding, which may involve both intramural and extramural researchers, will come from the director's Common Fund.

The drug chip will be a project of the National Center for Advancing Translational Sciences (NCATS), which got a mention when President Barack Obama signed a new patent bill. The White house also touted a new low-cost licensing agreement to help startup companies license inventions from NIH and FDA intramural research.

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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Obama Pushes More Competition on Biologic Drugs

via The New York Times, by Andrew Pollack

President Obama is not giving up when it comes to trying to introduce competition to expensive drugs made by biotechnology.

Tucked into the president’s deficit reduction plan released on Monday was a proposal to reduce the market exclusivity offered to brand-name biologic drugs to seven years, down from the 12 incorporated in the 2010 federal health care legislation.

That would allow so-called generic versions of such drugs to reach the market sooner, saving an estimated $3.5 billion in federal health spending over 10 years, or a little over one-tenth of 1 percent of the $3 trillion the president’s deficit reduction plan is supposed to save in a decade.

Biologic drugs are proteins made in living cells, like Avastin and Herceptin for cancer and Enbrel and Humira for rheumatoid arthritis. Such drugs can cost tens of thousands of dollars a year and are not subject to the same rapid onset of generic competition as drugs made in chemical factories, like Lipitor and Prozac.
The issue was a thorny one during the debate in Congress over the health care legislation.

The biotechnology industry argued it needed 12 years of freedom from lower priced competition to recoup research and development costs. Any less, it argued, would retard innovation. The generic industry, as well as many insurers and employers who pay health care bills, said a much shorter period would suffice.

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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

How Much Would it Cost to End AIDS?

via Bloomberg, by Simeon Bennet

Michel Kazatchkine and Eric Goosby may be able to halt the spread of HIV. They just need the money.

The two men control the funds that buy drugs for most of the world’s AIDS patients. Studies in July provided the strongest evidence yet that medicines used since 1994 to treat HIV can almost eliminate the chance an infected person will pass the virus to a sex partner. Given to healthy people, the treatments can also protect against infection, offering the potential to end a pandemic that has killed 30 million people in 30 years.

Governments are now planning projects to assess whether those findings can be replicated in the real world, and what that might cost. Getting the drugs just to those patients who should be treated under existing guidelines would cost another $6 billion a year, according to the United Nations. Treating all those infected, in some of the world’s poorest countries, would cost tens of billions more.

Finding more money will be difficult with economic growth stalling and nations including the U.S., the biggest donor to the AIDS fight worldwide, trying to curtail overall spending to rein in debt. Funding for AIDS in poorer nations fell 10 percent to $6.9 billion in 2010 from 2009 levels, according to the UN.

“We may well be able to overcome AIDS,” Kazatchkine, the director of the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria, said in an interview. Still, “the gap between what the science is telling us we can achieve and what we would be able to achieve is at risk of increasing.”

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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

India says EU deal won't hit AIDS drugs supply

Via Reuters, by Nita Bhalla.

India has promised not to link a proposed trade deal with the European Union with limiting its production of generic HIV/AIDS drugs, the United Nations said on Thursday, giving hope to millions of infected patients but underlining the hurdles for the controversial pact.

The EU and India began negotiations in 2007 on a free-trade agreement which could generate two-way trade annually worth about $134 billion. But campaigners, including the U.N., have voiced concerns over how it could block India's ability to produce anti-retroviral (ARV) drugs and prevent the world's poor from accessing cheaper treatment.

"The Government of India reaffirms its full commitment to ensure that quality generic medicines, including anti-retroviral drugs, are seamlessly available, and to make them available to all countries," India's Commerce Minister Anand Sharma was quoted as saying in a statement issued by the Joint United Nations Programme on HIV/AIDS (UNAIDS).

"India will also use the flexibilities allowed under (the copyright pact) TRIPS, including the use of compulsory licensing, to ensure that people living with HIV have access to all life-saving medicines."

Sharma made the comments in a meeting with UNAIDS Executive Director Michel Sidibe, who on Tuesday told Reuters in an interview that millions of people around the world would die if the deal blocked India from producing generic medicines.

An estimated 15 million people are eligible for ARVs in low-and middle-income countries, yet currently only about 6.6 million people have access to treatment. India's pharmaceutical industry produces about 86 percent of the first-line cheap generic drugs, most of whom live in Africa.

Generic ARVs cost about $137 per person per year, a fraction of the price of patented ARVs used to treat the human immunodeficiency virus (HIV) that causes AIDS, and are sold by western pharmaceutical firms, say experts

Read more here.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]