What global health needs is more (value for) money | 

There’s been a lot of hoo-hah this week in and around the UN General Assembly meeting in New York City focused on maintaining the world’s progress against poverty, especially diseases of poverty – aka global health.

GlobalFundLogoNothing perhaps inspires more hoo-hah in the global health arena than the Global Fund to Fight AIDS, Tuberculosis and Malaria – and for good reason. The Global Fund has saved millions of lives by getting life-saving drugs to people with HIV, TB and malaria, by getting tens of millions of bed nets out to prevent malaria and by literally bringing back to life many of the poorest, most ravaged communities on Earth. It now pays for most TB and malaria care worldwide, and one-fifth of the world’s response to HIV-AIDS.

It’s easy to forget how hopeless we all felt little more than a decade ago regarding the deadly threat of these major killers. It’s easy to forget how crazy ambitious it was to launch the Global Fund. AIDS was burning a wide swath through Africa, which the Economist magazine notoriously dubbed “The Hopeless Continent.” Hardly anyone even thought much about the millions dying from TB and malaria.

The Global Fund was, and is, one of the most hopeful, compassionate and impressive things the international community has done in a long time. That’s why it’s being celebrated in and around the grand UN confab this week. That’s why everyone cheered at the stunning statistics of lives saved, as well as when Britain announced this week it would give another $1.6 billion to the Global Fund, and it’s also why some are clamoring for even more funds – since many millions more are still not reached.

But like most things we humans do when we rush in to fix something, the Global Fund was also seriously flawed.

And it’s high time we deal with the flaws. Or so says Amanda Glassman, a global health expert and author of a new report called More Health for the Money. Here’s the video version:

What? There are 200 different kind of bed nets to prevent malaria? How can that be? Continue reading

Visualizing progress on 3 Millennium Development Goals (MDGs) | 

Guest post by Katie Leach-Kemon, a policy translation specialist from the University of Washington’s Institute for Health Metrics and Evaluation.

MDGsProgress toward the current Millennium Development Goals (MDGs) and establishing new goals after 2015 are a hot topic of discussion this week at the UN General Assembly in New York City.

In today’s post, we’ll use Global Burden of Disease Study 2010 (GBD 2010) data to explore how much progress countries have made in three key health MDGs, 4, 5 and 6, the first two focused on reducing child mortality and maternal mortality while the latter is on halting the spread of diseases such as HIV/AIDS and malaria.

MDG 6 is arguably the highest-profile goal and one that’s seen tremendous progress – halting or reversing the spread of HIV/AIDS, tuberculosis, and malaria. By 2010, antiretroviral therapy financed by country governments and donors had succeeded in reversing the rise in HIV/AIDS deaths at the global level.

Below is a figure showing donor funding (also known at IHME as development assistance for health, or DAH) for HIV/AIDs from IHME’s report Financing Global Health 2012: The End of the Golden Age?

Funding HIV AIDS

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Viz Info: Progress in the fight against HIV/AIDS | 

Guest post by Katrina F Ortblad, a global burden of disease specialist from the University of Washington’s Institute for Health Metrics and Evaluation.

The massive scale-up of antiretroviral drugs (ARTs) and prevention programs over the past decade has resulted in incredible progress in disease reduction around the world, yet HIV/AIDS still kills around 1.5 million people every year.  These findings were recently reported in a new study by the Institute for Health Metrics and Evaluation (IHME).

The rate of HIV/AIDS remains high in many countries, especially in sub-Saharan Africa.  The screen grab below shows rates of premature death and disability, also known as healthy years lost, due to HIV/AIDS across the world in 2010.

These rates adjust for differences in population growth and ages across countries and can offer insight into how well each country is performing in the fight against this disease. Globally, Swaziland, Lesotho, South Africa, Zimbabwe, and Mozambique had some of the highest rates of healthy years lost from HIV/AIDS.

Ortblad IHME

Why do Rwanda and Botswana have lower rates of HIV/AIDS than South Africa and Zimbabwe, and are there ways that lower-performing countries could learn from higher performing countries? Continue reading

Gates Foundation wants to make safe sex more fun | 

Happy Condoms
Flickr, bnilsen

The Bill & Melinda Gates Foundation thinks safe sex isn’t as much fun as it should be.

At least, that seems to be the gist of one request for a grant application from the world’s largest philanthropy as part of its Grand Challenges Explorations program. One of the goals for this round is to develop a better condom – and by better they basically mean a condom that doesn’t suck.

“It is a bit unusual,” said Stephen Ward, the program officer with the Gates Foundation administering the project.

In its request for proposals, the foundation opens with a detailed description of the global production of condoms (15 billion units per year), usage (750 million) and a ‘steadily growing market.’ When used properly, the Gates Foundation notes, condoms can protect females from pregnancy and both partners from sexually transmitted infections like HIV. They are cheap, ubiquitous and a great example of a ‘multi-purpose prevention technology.’

“The one major drawback to more universal use of male condoms is the lack of perceived incentive for consistent use.”

Yeah, they suck. They’re no fun. Continue reading

Obama Continues Path to AIDS-Free Generation in State of Union speech | 

Ten years ago, President Bush used the State of the Union to unveil the President’s Emergency Plan for AIDS Relief (PEPFAR). The program is a lasting legacy of the administration that has won praise from both sides of the aisle.

An initiative of this scale and ambition — the largest effort to fight a single disease in history — was utterly unexpected. Bush’s strongest political supporters had not demanded it. His strongest critics, at least for a time, remained suspicious. The President’s Emergency Plan for AIDS Relief (PEPFAR) existed entirely because of a willing leader, a creative policy team, a smattering of activists and a vast, bleeding need, wrote Michael Gerson in remembering the occasion.

Because of the success of PEPFAR, there have been expectations in development circles that President Obama may too seek to leave his mark in a similar manner. The ten year anniversary, to some, may have been the right moment to make a surprise announcement. What happened was a speech that leaned heavily on rebuilding the American economy, improving education, immigration reform, national security and passing  a gun bill.


The President did manage to squeeze in a few lines about international development. In them, he gave quick mention to existing programs and put his support to accomplishing an AIDS-free generation. Continue reading

Without more money, it’s the end of the beginning of the end of AIDS | 

Tomorrow is World AIDS Day and most organizations that had something to say about this have already said it.

Most said: “We can end AIDS.”

Flickr, by Roger H. Goun

Secretary of State Hillary Clinton

Secretary of State Hillary Clinton called for creating an “AIDS-free generation” and on Thursday released the Obama Administration’s blueprint aimed at describing how we can achieve this. Unfortunately, as the Washington Post noted:

The document, however, contains no specific targets or a schedule for achieving them. It also doesn’t estimate how much more money it would cost to reach the “tipping point” in high-prevalence countries, or where the money would come from.

Michele Sidibé, head of UNAIDS (the UN’s program on HIV/AIDS), also released a report and a suggested game plan for ending the AIDS pandemic.

The UNAIDS report celebrated major gains in reducing new HIV infections in many countries, some of them in sub-Saharan Africa, and called for “Getting to Zero” in terms of new HIV infections worldwide. Most of these gains have been in preventing mother-to-child transmission of HIV in newborns.


Michel Sidibé

“It is becoming evident that achieving zero new HIV infections in children is possible,” said Sidibé. “I am excited that far fewer babies are being born with HIV. We are moving from despair to hope.”

Others celebrated some of the scientific gains such as more conclusive evidence that getting people on anti-HIV treatment also prevents the spread of disease by significantly reducing viral loads in HIV-infected persons.

And though a vaccine still seems a distant hope, researchers have made progress and are making headway on the basic immunology in ways that have recently also moved the vaccine community from despair to hope.


A Positive Trend, new HIV infections vs people getting treatment to prevent AIDS

We can end AIDS. It’s true.

It is also true to say we can end hunger and extreme poverty, if only we put enough resources, talent and political will into those efforts. But we don’t.

And until we put in the effort needed to truly suppress HIV/AIDS, calling for an end to the global AIDS pandemic will be, despite some amazing progress made in the past decade, wishful thinking. Continue reading

Seattle AIDS vaccine scientists celebrate new clues – and uncertainty | 

Jim Kublin provides an overview of AIDS vaccine science at Seattle HVTN meeting

Seattle is home to the world’s largest HIV vaccine research network and, as a scientitic meeting here this week indicated, they’re quite comfortable with not knowing where they’re heading.

“We actually don’t know what the agenda is,” said Dr. Jim Kublin, executive director of the HIV Vaccine Trials Network (HVTN) based at Seattle’s Fred Hutchinson Cancer Research Center.

That drew a lot of laughs from the audience, since Kublin’s lecture title for the day was ‘Scientific Agenda, the Next Seven Years.’

“That’s the way science is,” Kublin told me after his talk. “Good science is based on uncertainty, on having an open mind and dealing with the unknown.”

But what makes it easier to laugh about not knowing where you’re going, he added, is that researchers today have a lot more tantalizing clues – beginning with the ground-breaking Thai vaccine trial known to this bunch as RV 144. Continue reading

Rhetoric versus reality on Obama Administration’s AIDS policies overseas | 

Jessica Mack

This is a guest post by Jessica Mack

Jessica Mack is a global gender specialist and freelance writer. She is currently based in Bangkok, Thailand where she works on issues of violence against women and girls in the Asia Pacific region. More at You can also follow her on Twitter @fleetwoodjmack

The Obama Administration talks a lot about integrating and coordinating our various global health projects, and also about how important it is to empower women. That’s the rhetoric. Here’s one womens health advocate’s view of the reality.


Preventing the spread of HIV and AIDS has a lot to do with promoting safe sex.

That may sound obvious, but it seems to remain a mystery to those in the U.S. Government who set our AIDS prevention policies overseas. Stemming the spread of HIV has as much to do with family planning and enabling safe sex as it does with ensuring access to affordable drugs, accurate education, or changing norms and mindsets at the community level.

So it would make a hell of a lot of sense if all money for HIV/AIDS prevention efforts also included money for family planning. But alas.

Though the US President’s Emergency Plan for AIDS Relief (PEPFAR) has been touted as one of our nation’s most successful initiatives in global health (and certainly one of President George W. Bush’s most positive legacies) it continues to miss the mark on this important point.

Oddly, PEPFAR will allow funds to be used for condoms — but only if they are promoted for protection against HIV as opposed to pregnancy.

PEPFAR recently released its 2013 country operational plan (COP), the framework for how its funding should be used by developing countries. This included what activities should and should not be supported – with one big bolded addition.

Under the section titled “Family Planning” – which extolls the importance of family planning as an effective means for reducing HIV/AIDS – is added this sentence: “PEPFAR funds may not be used to purchase family planning commodities.”

Um, come again?

This bizarre prohibition has had and will continue to have the effect of systematically cleaving contraceptive services from HIV/AIDS treatment and prevention services, oftentimes quite literally into different clinic sites and distinct service providers.

It doesn’t make sense, and it’s dangerous.

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