Deaths from AIDS were peaking in Zambia in 1998, when Robert Clay arrived there. The epidemic there had been recorded for more than a decade, but the antiretroviral treatment that was saving livesfor the last two years in affluent countries, remained unavailable to Zambians.
The house where Clay lived was on the road to the capital’s main cemetery, and daily he watched funeral processions go by. He watched his secretary wasted away from AIDS, and carry the secret of what was killing her, unspoken to her grave. The stigma surrounding a disease for which there was no hope was only another burden. And as the cemetery filled, orphanages grew crowded too.
He and his colleagues wrote home to Washington. A major storm is sweeping across Africa, they wrote, and no one is watching.
Clay, who as the director of USAID’s Population, Health and Nutrition Office in Zambia led the development of an HIV program there, recently returned to Zambia, a place now where estimates now show that more than 70 percent of people needing antiretroviral treatment are getting it.
“People with HIV are working. Their families are still intact,” Clay said.
Now the deputy assistant administrator in USAID’s Bureau for Global Health, Clay told this story Monday morning to an audience attending the launch of Global Health: Investing in Our Future, a briefing book presenting the progress and goals surrounding responses to infectious illnesses, neglected tropical diseases, noncommunicable health conditions, malnutrition, sanitation, family planning, and more. Directed to the 113th Congress, it is a book put together by international nonprofits focusing as much on what is yet to be done as what has been done.
What has been done was the subject of a quiz at the start of the event: How many people receiving HIV treatment as a result of U.S.-funded efforts? How many mosquito nets distributed? How many children’s lives saved? By how great a percentage has polio been reduced worldwide? The audience largely scored well on the multiple choice test — hint: the highest number generally was the right answer — but the point of neither the event or the book was to bask in success. Rather, the progress highlights unprecedented opportunities, Clay said, “to think about bold endgames.”
The book also highlights enormous remaining challenges, including:
- The millions of HIV-infected people still going without needed treatment services, including 72 percent of HIV-infected children whose condition requires treatment;
- Shortages of medicine and failures in treatment efforts that continue to feed multi drug-resistant, and extensively drug-resistant strains of tuberculosis, while protection remains inadequate for healthcare workers who face two-to-three times the risks of the general population of getting tuberculosis;
- A rapidly increasing burden of noncommunicable diseases in low-and-middle-income countries, including heart disease, cancer, diabetes and lung diseases killing young people in their most productive years.
The book calls on the administration to maintain support for global health programs, ensure their priorities are aligned with those of developing nations receiving support, reduce inequities in access to quality care, continue to build partnerships with private sector donors and civil society groups and ensure that crisis responses lay foundations for lasting change. It calls on Congress to maintain appropriate funding levels, continue to invest in research and evaluation, encourage agencies efficient use of resources, provide adequate funding for health workforce training.
“The money doesn’t just go into a black box,” Clay said. “It’s actually creating a world where this kind of assistance won’t be needed, as it is now.”