Ebola – Why is Ebola one of the top 10 stories in HIV and TB globally? Because the current crisis in West Africa echoes the history of those epidemics, highlights weaknesses that will continue to dog ongoing work to conquer those epidemics, and has once again shown that neglecting infectious disease anywhere poses a threat everywhere. The tragedy that began at the end of last year continued to be internationally ignored for five months after Médecins Sans Frontières, one of the few responding organizations then, warned at the end of March that the outbreak would be “unprecedented” in its spread and its toll. Like responses to the beginnings of the HIV epidemic, and sentiments that linger still, reactions to Ebola in West Africa continued to follow those of the stages of grief — from denial, evidenced by months of neglect, to anger and bargaining demonstrated in stigmatizing and self defeating policies that penalized both victims and those who would help them. The acceptance phase came quicker this time, bringing accelerated research and responses in the field, in months, rather than years, but once again the price of the first three stages has been high.
90-90-90 – UNAIDS offered a vision this year of 90 percent of all of those living with HIV being diagnosed, 90 percent of those individuals accessing treatment, and the treatment of 90 percent of them being effective enough to keep levels of the virus in their systems undetectable within the next five years. If that vision became reality, it could end HIV as a global threat before the middle of this century. But while the vision illustrated how far the global response to HIV has come, it also highlighted how far it has to go. This year, the world finally reached the “tipping point” when the numbers of people starting treatment for HIV surpassed the numbers of people becoming infected. But many countries have yet to get there, and many countries, including the United States, are still seeing a minority of those who should be on treatment accessing it, maintaining it, and only a relative handful even having a means to know if they are virally suppressed.
Promising drugs developed but remain out of reach – In the last year, TB treatment advocates continued to press for affordable widespread access to new anti-tuberculosis drugs that, developed in the last two years, remain available to a fraction of a percent of those who need them. In the meantime, the U.S. Food and Drug Administration’s approval at the end of last year of Gilead’s sofosbuvir, a “game-changing” hepatitis C cure, was followed by the jaw-dropping price tag of roughly $90,000 for a round of treatment in the U.S., and an equally unaffordable $3000 in middle-income countries and $1000 in low-income countries. This month, The New York Times reported that the U.S. Food and Drug Administration’s approval of Viekira Pak, a new hepatitis C treatment regimen from AbbVie raised hopes that the competition it posed would drive Gilead’s price down. But, the article added, at a wholesale price of $83,319 for a course of treatment, relief is not expected to be immediate or significant.
HIVR4P – In October, the first international conference dedicated to biomedical HIV prevention technologies highlighted a vision of success that will rely not on one breakthrough, but on many that will stem from responsive research and collaboration. Featuring gains and setbacks in AIDS vaccine research, microbicide research and the promise of pre-exposure preventive use of antiretroviral treatment to protect against acquisition of HIV, as well as the impacts of treatment for the virus in preventing transmission, the meeting merged explications of laboratory science with examinations of realities on the ground.
The Mississippi baby – The story of the “Mississippi Baby” born with HIV, treated early and aggressively, lost to treatment at 18 months only to return to care with no signs of virus, inspired a closer examination of what medicine could do to stem the tide of HIV, and spare children born with the virus from a lifetime of antiretroviral treatment. News that the child’s virus had rebounded “felt very much like a punch in the gut,” the doctor who had cared for the child from the beginning said. But the length of time the virus was documented to be suppressed in the child without medicine remains unprecedented, and research spurred by the child’s case continues.
The crash of MH17 – Among the 298 lives lost when Malaysia Airlines flight 17 was shot down over Ukraine were six people, headed for Sydney, Australia whose work to save lives put them on that plane. The deaths of Joep Lange, Jacqueline van Tongeren, Glenn Thomas, Lucie van Mens, Martine de Schutter, and Pim deKuijer on their way to AIDS 2014 brought devastating grief to a meeting in July that reflected their legacies.
Ambassador Deborah Birx ushers in transparency – The U.S. President’s Emergency Plan for AIDS Relief has produced and publicized a series of success stories over the last decade. But particulars on how they came to pass, and more importantly, on failures, has been hard enough to come by to make the answers of how the world’s largest health response targeting a single disease works one of the biggest secrets in global aid work. With tightening budgets and a proven need to accelerate treatment access to more people than ever before, Dr. Deborah Birx took leadership of PEPFAR in April stressing “impact, accountability and transparency.” In the months since, PEPFAR’s updated “dashboards” of information on planned funding, impact, and expenditure analysis have provided access to data that can shed light on needs and gaps.
Homophobia, anti-gay laws continue to undermine HIV fight – After raising hopes at the end of last year that he would not approve an Anti-Homosexuality Law that threatened gay people with life in prison and criminalized health services provided to them, Uganda President Yoweri Museveni signed the law and celebrated it. He joined Nigeria that year in escalating aggressive homophobic policies that dealt devastating blows to HIV responses, including halting significant treatment and prevention efforts, in those countries. Neither international outrage, which included U.S. sanctions, nor the Ugandan High Court’s ruling overturning the law on a technicality discouraged Museveni, who encouraged his Parliament to come up with new legislation against “homosexual recruitment.” Parliament members responded with a new bill that also targets HIV responses, but have yet to vote on it. In the meantime, Gambia passed its own anti-gay law modeled on Uganda’s.
Criminalization, and the prosecution of Rosemary Namubiru – The workplace accident in which an overworked nurse may have used a needle that had pierced her own skin when administering intravenous fluids to a struggling and feverish child could have passed with little notice beyond her supervisors. But it happened when Uganda politicians were in the midst of pushing legislation criminalizing HIV transmission. As it was she was arrested, humiliated, vilified, jailed during her trial and sentenced to three years in prison. All the while international and local journalists neglected their own due diligence, ignoring the facts of the case and pandering to sensationalism. Namubiru was freed this month after 10 months in jail by an appeals court judge who decided she had suffered enough. But in the meantime the Ugandan Parliament passed, and President Museveni signed an “HIV Prevention and Control Act” which not only criminalizes “attempted” and “intentional” HIV transmission, but mandates HIV testing of pregnant women and their partners, as well as victims of sexual assault and anyone else who “unreasonably” withholds consent to be tested. And this time, as the United States weighed in against the law, its stance was compromised by legislation on the books of at least 33 of its states criminalizing HIV transmission.
Global Health Abides in funding for FY2015 – Which, in a way, brings us full circle. With the Ebola crisis in West Africa having heightened awareness of global health needs, Congress ended the year with a spending bill that for all its gaps and appendages, funded efforts to fight HIV, tuberculosis — and Ebola — at, and in many cases, above current levels. But without attention to positive policies ensuring resources go to where and when they are needed most, the impact of the funding will continue to be compromised.