Tuesday, July 18, 2006

Sustaining US Global Leadership on HIV/AIDS

July 13, 2006 11:30 AM- 6:00 PM

Welcome: Dr. J. Stephen Morrison, Executive Director, CSIS Task Force on HIV/AIDSCo-chair Address: Senator Bill Frist (R-TN) and Senator Russell Feingold (D-WI)

The CSIS Task Force on HIV/AIDS is co-chaired by Senators Frist and Feingold and funded by the Bill and Melinda Gates Foundation. The task force outlines choices for the US in fighting the HIV/AIDS pandemic. The task force works with US leaders to strengthen country-level capacities to enhance completion, care, and treatment of HIV/AIDS. It its third phase, the task force is focusing on improving US support and effectiveness for global prevention efforts, as well as examining the leadership of the US for future sustainability of the HIV/AIDS programs in place.

In the opening address, Senator Frist emphasized sustainability as the single greatest health challenge of our time. Therefore, it is essential for continued commitment within the US in funding and developing the HIV/AIDS programs. As a country, we have a moral obligation to continue to focus on alleviating the HIV/AIDS crisis and working towards an elimination of the disease. Unity and global health synergy will be vital in the future in slowing the epidemic. One key issue he addressed was the need for clean and safe drinking water worldwide as a necessary part of the health solution. Lack of clean water is the leading cause of preventable death. Water is a foundation for stability that will exponentially improve the health of people around the world and can decrease the effects of AIDS.

Senator Feingold addressed the upcoming challenged in the HIV/AIDS epidemic. The four main challenges are:
1. Prevention: There were 4 million new infections in 2005. The US must expand and reach out to hotspots. Drug use as well as sexual intercourse needs to be of focus. The ABC plan (abstinence, be faithful, condom use) needs to be balanced in spreading the message of correct prevention.
2. Gender: On a global scale, women lack power. When they are less empowered, they have less access to economic opportunities. This is a cause of trafficking which is now one of the main causes of the spread of HIV in particular countries. Rape is also a huge cause of the spread, and the stigma of HIV/AIDS worldwide decreases communication about the consequences and prevention techniques of the disease. The US must institute reproductive health services where PEPFAR is operating, making the program more comprehensive and cost effective.
3. Sustainability of financing: The US must not lose focus and must avoid erosion of finances. The US should mobilize international partners to alleviate costs and increase synergy.
4. Healthcare workforce shortages: In sub-Saharan Africa alone 4 million workers are needed to fill the gap in the healthcare field. This is essential for progress in alleviating the HIV/AIDS epidemic.

Meeting Steep Future Financial Demands
Moderator: Princeton Lyman, Ralph Bunche Senior Fellow for Africa Policy Studies, Council on Foreign Relations
Presenters: Congressman Jim Kolbe (R-AZ)
Congresswoman Betty McCollum (D-MN)
H.E. Ivo Garrido, Mozambican Minister of Health
Jennifer Kates, Director, HIV/AIDS Policy, and Vice President, Henry J. Kaiser Family Foundation
Anil Soni, Director of Pharmaceutical Service, HIV/AIDS Initiative, William j. Clinton Foundation
Discussant: Dr. Michel Kazatchkine, Ambassador on HIV/AIDS and Transmissible Diseases, Government of France

This portion of the conference focused on the financial aspects related to HIV/AIDS.

Congressman Jim Kolbe first spoke, stating that this year 3.4 billion dollars were spent on HIV/AIDS, tuberculosis, and malaria, and in 2007 4 billion dollars will be spent. The global fund for HIV/AIDS has separate funding from the US, the House and Senate will combined be setting aside over 1 billion dollars this year for the fund. The foreign assistance budget continues to grow as well, over the last six years it has doubled. Development is a moral obligation, but the US has to consider the implications of putting funds into foreign assistance when there are domestic priorities.

H.E. Ivo Garrido then gave his input, stating that the fight against HIV/AIDS is complex. Quick results are difficult to achieve. Globally, as the world grows, it is harder to meet goals. Less than 30% of people are reached by prevention programs and less than 25% of people are receiving treatment. Less than 10% of pregnant women are reached. There is not a clear roadmap for the future. The US needs to exercise leadership. There needs to be a focus on moral aspects, increasing development aid, and a focus on prevention, since it goes hand in hand with treatment.

Congresswoman McCollum reiterated the moral obligation the US has to continue sustainability of HIV/AIDS funding. Right now there is a ‘brain drain’ in which nurses from affected areas are drawn to the US for a better life, leaving behind those suffering in their country. The US needs to address this vitally important issue. The job of the US is not to ‘plant flags’ but rather to work in collaboration with the international community.

Jennifer Kates explained how health commitments have risen and donors have changed in the past few years. Now, Europe and the US are equal in health funding. The US needs to look at what money is going into the field and how quickly, and be aware that there are many different financing vehicles, for example UNAIDS and the Global Fund. In 2005, there was 8.3 billion available, but 11.6 billion needed.

Anil Soni first spoke about antiretroviral drug treatments, stating that the cost of treatment for AIDS has gone up, even though the cost of antiretroviral drug treatments has gone down. This is because many people now are moving towards a second line of defense which is accounting a doubling of price increase. To solve this, the US must act early and innovatively, work with industry to understand cost components, and focus also on diseases other than HIV/AIDS.

Michel Kazatckine praises US leadership in the global fight against HIV/AIDS. However, the US should still be focused on increasing ODA (Official Development Aid). The US should also use innovative methods to spend their money and focus on partnerships.

Health Systems Challenges: Workforce & Infrastructure
Moderator: Todd Summers, Senior Policy Officer fro Global Health, Bill and Melinda Gates Foundation
Presenters: Senator Richard Durbin (D-IL)
Dr. Timothy Evans, Assistant Director-General, Evidence and Information for Policy Cluster, WHO
Discussants: Ambassador Jimmy Kolker, Assistant Coordinator, and Director of Diplomatic Outreach, U.S. Global AIDS Coordinator
Brenda Collatrella, Merck & Company

This section focused on some of the problems due to healthcare infrastructure and healthcare worker scarcity.

Senator Durbin addressed some of the persistent healthcare challenges. In the Congo, a main concern is obstetric fistula in young girls, and the ever-present need for nurses. There is a dilemma in the US over focusing on international vs. national healthcare issues, and the correct way to respond to both, alleviating HIV/AIDS and other health problems abroad, while still concerning themselves with the current national health issues.

Dr. Tim Evan spoke of the health workforce. Currently there are 57 crisis countries with a minimum density of workers. Some of this is a result of the young age of retirement. To improve human resources, the US should realize this is an outcomes-based-development era, create leadership for training healthcare workers, and improve technological facilitation.

Jimmy Kolker thought that an innovative way to change the healthcare industry would be to look at the private sector for a cross referral of policies. The US should especially focus of the procedures and guidelines for retired healthcare professionals in tapping resources for training new healthcare leaders.

Brenda Collatrella discussed the HIV/AIDS epidemic in Botswana. There is very little access to treatment; less than 2 million people have been tapped in the past six years. This country needs support financing for a treatment program.

Dr. Mark Dybul gave the keynote address for the conference. He recommended the policy of ‘save and sustain’ by developing capacity and forming partnerships. He focused on country ownerships, the multi-sectoral nature of countries (including governments, private groups, and faith based organizations), good governance, and results. He encouraged reporting and accountability, and response on all levels of society. He recommended task shifting, especially on HIV tests abroad. This could alleviate the healthcare workers scarcity, and make HIV testing more efficient. Using a case study, Dybul gave an example of the positive changes that because of US funding. In Kenya, the prevalence of HIV has dropped by 30% because of increased male faithfulness, a delayed sexual start, and primary and secondary abstinence.

Expanding the Prevention Agenda
Moderator: Jennifer Kates, Director, HIV/AIDS Policy, and Vice President, Kaiser Family Foundation
Presenters: Dr. Nguyen Van Kinh, Head of AIDS Care and Treatment Department, Vietnam Administration of HIV/AIDS Control, Ministry of Health, Vietnam
Dr. Le Truong Giang, deputy Director of the Health Department, Ho Chi Minh City, Vietnam
Janet Fleishchman, Chair, Gender Committee of the CSIS HIV/AIDS Task ForceAllen Moore, Senior Associate, CSIS and Senior Fellow, Global Health Council

This portion of the conference focused on the prevention agenda abroad, using Vietnam as a case study.

Dr. Nguyen Van Kinh overviewed the current status of Vietnam in regards to the HIV/AIDS epidemic. The first AIDS case was reported in 1990, and since then, there have been over 10,000 deaths. Many cases have gone unreported. The greatest occurrence of HIV/AIDS is in young adults aged 20-39, where 75% of cases occur. The biggest cause of the transmission of HIV is through drug injections. 1n 1987 a programs was set up as a preventative measure against HIV under the recommendations set forth by UNAIDS, however that program has since been overwhelmed by the rapid spread of the disease.

Dr. Le Truong Giang gave an expanded overview of the situation in Vietnam, as well as challenges and recommendations. In 1993, the first wave of HIV hit Vietnam, primarily because of sharing needles for opium drug usage. The government responded and there was a decrease. However, since 1996, HIV has been on the rise, with the second wave much more deadly than the first. The wave has hit the younger generation, who are using heroin. The addictive nature of the drug has made it harder for peer-education programs and rehab programs to be effective. Now, the third wave has hit Ho Chi Minh since those participating in the large rehab program have had unsuccessful re-integration into society and drug relapse. A more comprehensive program is needed that covers the city as well as the provinces. PEPFAR should be extended another five years to develop Vietnam’s programs.

Janet Fleischman was the final speaker; she discussed the importance of reproductive health and family planning as a tool to combat HIV/AIDS. These programs can be entry points that will expand communication to women and girls. In Africa, adolescent girls are 5 to 7 times more likely to contract the HIV virus. Mother to child transmission is high, and antenatal care, postnatal care, and family planning are necessary.

Allen Moore briefly discussed PEPFAR and the need for evidence based responses. Aggressive recommendations are needed to increase effectiveness of PEPFAR. The US needs to consider if they are spending too much foreign assistance in the health field. They should also consider if the donor community within the health field is spending too much of its budget on HIV/AIDS instead of other equally important dangerous health viruses.

by Rebecca Bonardi

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