top U.S. official on HIV/AIDS says the Obama administration is committed to
fighting the disease. However,
Ambassador Eric Goosby says the economic crisis will be a factor in all funding
decisions over the next few years.
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the new U.S. Global AIDS Coordinator, Dr. Goosby oversees PEPFAR, the
President's Emergency Plan for AIDS Relief.
Created under President Bush, it began as a five-year, $15 billion
program. In 2008, Congress reauthorized
PEPFAR, approving up to $48 billion over the next five years. Besides PEPFAR, the amount would support the
Global Fund to Fight AIDS, TB and Malaria.
that was when the economy appeared healthy.
Ambassador Goosby says expanding PEPFAR and other AIDS-related programs
now must be carefully weighed.
think the problem has been the economic downturn brought us into, I think, a
reality that continues to reverberate with budgetary discussion within the
administration...and how it impacts the deficit. And those conversations have predominated in
the thinking as we move into 2010, 2011 in budget discussions," he says.
Obama administration's $6.6 billion pledge to fighting AIDS, TB and malaria in
the new fiscal year is about $165 million higher than the current fiscal year. However, the proposed increase is lower than in some years past.
Goosby says U.S. resolve is unchanged.
president and Secretary (of State) Clinton have been very clear about their
commitment to PEPFAR. Indeed, my
interest and willingness to leave everything I was engaged with and happy with
to do this work was based on my belief in that commitment," he says.
Goosby had been head of the non-profit Pangaea Global AIDS Foundation and
professor of clinical medicine at the University of California. He took part in
national treatment programs in Rwanda, South Africa, China and Ukraine.
says PEPFAR won't expand as fast as it did in the beginning.
trajectory for PEPFAR expansion in the first five years is not going to be
reflected for the immediate future. But
it does not reflect a change in commitment or emphasis," he says.
Is it possible?
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2005, at the G8 summit in Gleneagles, Scotland, leaders set a goal of near
universal access to AIDS treatment for all those who need it by 2010.
says achieving that goal is difficult for a number of reasons, including the
fact that thousands of people are newly infected every day.
continue to see new seroconversions happening.
And we continue to see them happening in groups that are generally
considered high risk and often unwilling to reveal…for fear of being stigmatized
or discriminated against," he says.
high-risk groups include intravenous drug users and men having sex with men.
there's the issue of treatment. If everyone
infected with HIV is put on anti-retrovirals even if their immune system has
not crashed, it will take a lot more money and a lot more drugs. Currently, the people who are most sick are
put on ARVs first. This is generally
determined by the number of CD4 immune cells in the blood.
says such decisions may need to be made on the country level.
don't think that the ability to move everybody into care who needs to be in
care is going to be driven by setting a new trigger for…a CD4 count. It really is still being driven…by accessing
patients who are in need of treatment.
And unfortunately we are continuing to access these patients at a very
late stage of disease," he says.
A challenge to G8 leaders
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International AIDS Society has released a new statement urging world leaders
not to mistake recent progress against HIV/AIDS for "mission
accomplished." The IAS is calling for
"sustained political leadership and financing by the G8 and other donors to
maintain recent momentum."
think that is a reasonable challenge for the International AIDS Society to call
upon world leaders to continue to acknowledge…there indeed is a collective
responsibility…by resource rich countries…around how resource rich countries relate
to resource poor countries in helping to support their response to what is an
overwhelming epidemic," he says.
U.S. Global AIDS Coordinator says PEPFAR will continue to build on past
successes. He says when the program
started, only about 50,000 people in sub-Saharan Africa were on
anti-retrovirals. He says, thanks to PEPFAR,
that number is well over two million.
More than one million others, he says, are being treated through Global
Fund and other programs.
says treatment programs have helped "stabilize people emotionally,
psychologically and economically."