It’s the treatment, stupid . . . We’re reading why medicine is the best medicine for infectious diseases

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NewWWRWhy Africa’s HIV crisis continues . . . – This opinion piece by Washington Post columnist Michael Gerson is troubling both in its assumptions and its glaring omissions. As a key Bush Administration advocate for the U.S. President’s Emergency Plan for AIDS Relief, Gerson is familiar with the conditions and challenges that have fueled the pandemic. And inequities facing young girls and women living in poverty in countries where HIV prevalence is high are certainly among them. But his description of the thoughtful behavior of a Zambian man  for his wife described in the story followed by the unquestioning conclusion that “someone, at some point, reached [him]” is outstandingly patronizing and presumptuous in its implication that kindness and decency in sub-Saharan Africa must be imported by aid workers. At the same time, Gerson manages to leave out something more young men do need to be reached with, and that does currently continue to depend on donor input — antiretroviral treatment. The importance of greatly increased access to treatment for men of all ages is not touched on here, although U.S. Global AIDS Coordinator Ambassador Deborah Birx has included it among the aims of the PEPFAR initiative that Gerson is writing about. The bonus? Not only does treating HIV among men help prevent sexual transmission of HIV to women and young girls (and other men), it also fulfills the moral imperative of preventing deaths from a treatable illness.

Community-Based Antiretroviral Therapy Delivery – UNAIDS and Médecins Sans Frontières in this set of case studies examine answers to the challenge of more than doubling the current numbers of people accessing antiretroviral treatment for HIV. They look at community-based strategies that serve the triple purpose of extending the reach of treatment to areas where clinical staff and services are inadequate or out of reach, developing more effective, efficient and economical models of HIV service delivery, and structuring roles for people who are confronting the impacts of HIV in their communities. The ones described here include adherence clubs, which we had the opportunity to see the benefits of in Mozambique, community antiretroviral therapy distribution points, and appointment spacing. The document is part of a series, so we can look forward to more answers developed and presented in collaboration with those living with the impacts of effective strategies, including, we hope, a look at the impact paying a living wage to community-based providers would have on treatment access and economic inequities.

Obama Dreams of an AIDS-free Generation . . . – But funding cuts, and failures to make the case for resources necessary to ensure everyone who needs treatment for HIV gets it, are threatening the achievement of that goal, and instead offer a nightmarish vision of a return to a shameful time of acceptance that some people simply aren’t in the right place to save their lives. This Foreign Policy piece tells the story of PEPFAR’s ambition and impact in Mozambique, one of Africa’s highest burden and lowest health-resourced countries, and a look at the stakes of funding and maintaining its vision.

 

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