People on front lines know how to respond to AIDS
Sunday, May 25, 2008
MICHAEL SAAG
Just a few years ago, the idea of providing lifesaving drugs to men and women living with AIDS in Africa was considered implausible. From the overwhelming costs to the inconceivable logistics to the cultural challenges, there were reasons why even the experts considered the notion foolhardy.
Fortunately, they were wrong. CIDRZ, the Center for Infectious Disease Research in Zambia, and partner of UAB, stands as one of the premier examples of just how wrong the experts can be when it comes to saving lives. By this summer, CIDRZ, in full partnership with the Zambian Ministry of Health, will have enrolled 160,000 individuals into care, more than 100,000 of whom are on lifesaving treatment. They will have screened more than 500,000 pregnant mothers and intervened in time to prevent tens of thousands of babies from being born with HIV.
CIDRZ is one of the great success stories of PEPFAR, the President's Emergency Plan for AIDS Relief. But CIDRZ, along with the other programs funded by PEPFAR, is in jeopardy because of a move to stop reauthorization of the bill that would fund the effort for the next five years.
Those who oppose passage, including U.S. Sen. Jeff Sessions of Alabama, have good reasons.
Some, including Sessions, want to guarantee that 55 percent of the funds are designated for treatment. Others want a provision to guarantee prevention. And some just feel the amount of the appropriation is too large to approve without more controls on the use of funds.
Timing is wrong:
All of these positions are reasonable. But the timing is wrong.
Programs like CIDRZ are in the throes of scaling up to treat more and more people. They need to continue to make plans, hire workers, order drugs. They have proved they can do what no one thought could be done, and they have done it at a level that has defied expectations.
And even with the high level of funding, there has been an equally high level of accountability and very little accusation of waste. The government process always moves toward more accountability, more budget categories and more specific earmarks. It happens every budget cycle and within every agency.
The Office of the Global AIDS Coordinator, under the leadership of Dr. Mark Dybul, has proved itself as one of the most effective agencies, dedicated to both careful awarding of grants and consistent evaluation of progress. Meanwhile, CIDRZ and other programs have continued to evolve in order to react to the rapidly changing realities on the ground.
New research shows that cervical cancer flourishes in women being treated for AIDS, so now CIDRZ has begun to screen and treat women in a program no one would have foreseen. And with impressive rates of prevention linked to circumcision, CIDRZ is also responding with this intervention. No one would have considered budget categories for either of these important areas just a couple of years ago.
And that's the tough reality of AIDS. It is a complex pandemic, one that must be approached differently in almost every country and sometimes within the same country. It is ever-changing, meaning responses in 2008 look little like 2004 and most likely will change over the next five years.
That's why bipartisan support has favored a bill that would reauthorize PEPFAR without percentages - even ones for something that seems as sensible as requiring a specific portion for treatment. What seems reasonable is often at odds with the reality on the ground.
Reauthorizing PEPFAR is important to Africans as well as Alabamians. Too many of us have seen the horror of AIDS and have now witnessed the miracle of treatment. We can't jeopardize that treatment even with the best intentions.
Let's leave the decisions about AIDS response to the people who are on the front lines. After all, they are the ones who have already proved they are capable of defying the odds and producing miraculous results.
Come together:
There will be plenty of opportunities to hold the leadership of PEPFAR accountable for annual spending and to control the funding each year. But for now, we need to all come together and agree that the response to AIDS has been a great American success story, one in which the citizens of Birmingham have played a leading role.
Dr. Michael Saag is the Jim Straley Professor of AIDS Research, director of the Center for AIDS Research, and director of the Division of Infectious Disease and Geographic Medicine at the University of Alabama at Birmingham. E-mail: msaag@uab.edu.
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