This post is by Center Director Christine Lubinski, who is attending the 2009 IAS conference in Cape Town.
There was no shortage of hot-button questions for Dr. Eric Goosby, the new US Global AIDS Coordinator, and Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, at the International AIDS Conference today.
*What new directions might the new Administration take regarding injecting drug users and sex workers? (Read do we still have to live with a ban on funding for syringe exchange and the prostitution pledge?)
*How can the AIDS response achieve better outcomes and improve programming for maternal/child health and family planning with same level of resources?
*How will the U.S. response work to ensure that treatment advances (presumably less toxic regimens and earlier access) reach the developing world?
Those were just the initial queries, thrown out by Michel Kazatchkine, director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, at a special session of the IAS conference entitled “US Global HIV Policy, Research and Implementation under the New Administration.” Kazatchkine moderated the session with Goosby and Fauci, two of the US’s leading HIV/AIDS physicians-scientists, who together offered some significant hints, if not concrete answers, about positive changes to come, and soon, in the US approach to fighting global AIDS, at least when it comes to evidence-based policies.
Neither Drs. Fauci nor Goosby took on the resource question, although Goosby responded later to a query from the audience about access to treatment at a CD4 level of 350. He said the issue was under discussion and that the scientific evidence for earlier treatment would be evaluated in the context of resource constraints. Click here to read an Aidsmap story, reported from Cape Town, on the CD4 count issue.
Both Drs. Fauci and Goosby signaled a new day for U.S. policy on prevention interventions. Dr. Fauci noted that the Obama Administration was on the side of the evidence on needle exchange and presented a slide highlighting the recent action in the House Appropriations Committee eliminating the federal funding ban on needle exchange programs, albeit with numerous troubling restrictions (read our earlier post for more on the committee’s needle exchange provision). His presentation also included a slide on evidence-based prevention strategies that did not include abstinence programs but did include needle exchange, which won him plaudits from attendees.
When Dr. Goosby was queried by the audience about the status of new guidance from the Office of the Global AIDS Coordinator to allow US funding for needle exchange programs in international settings, he told the questioner to give him a few more weeks. Dr. Goosby assured the audience that global AIDS was a central piece of the global health agenda for President Obama and Secretary of State Hillary Clinton, as well as an expanded program to address health issues easily accessed from the PEPFAR platform—maternal and child health, family planning and neglected tropical diseases. He spoke about increasing the durability of the response by integrating development activities with health programs. New partnerships that will promote government buy-in and leadership—which will ultimately lead to country-led efforts to plan, implement and finance programs—will be a hallmark of the new approach.
Dr. Goosby also acknowledged that is was not possible for most high-burden countries to assume complete responsibility for these programs, especially financially, now or in the near future. US support would include resources for strengthening health systems, including workforce, he said.
Many advocates were no doubt pleased to hear him highlight at-risk, vulnerable populations that required special targeted human-rights-based strategies, including MSM, transgender persons, injection drug users, and sex workers. Another bit of news that was warmly received: an acknowledgement that the end to the US policy barring HIV-infected visitors and would-be immigrants from the US was near.