Monday, August 24, 2009

Markets have a role in malaria treatment

By sheer serendipity, I happened to pick up a copy of The Guardian (link text), my favorite British newspaper, in London last Thursday and saw an interesting piece on the challenges in providing malaria treatment by Sarah Boseley, the Guardian health editor. I thought Sarah captured very well the dire lack of Coartem malaria treatment in most of the country. But I was dismayed by the way she suddenly turned against the role of the market in providing such treatment at the very end of her story, even after admitting the failure of the public sector to do so and praising the ability of companies like Coca-Cola to make their products widely available.

So I felt compelled to challenge her dissing of the potential for markets to contribute to health care in developing countries, and today my letter was published in The Guardian.

And here is the story of my own encounter with malaria treatment in Uganda based on my trip to Uganda in 2008, and which I cited in my letter. 

Saturday, August 8, 2009

AIDS prevention must be more of a priority

Everyone working in HIV/AIDS -- as I have been for 17 years since I founded Society for Family Health, the leading HIV prevention organization in Zambia in 1992 -- has heard the aphorism "We can't treat our way out of this epidemic" and everyone knows that for every person that goes on treatment, there are several more new infections.

Both Randall Tobias and Mark Dybul, the first two PEPFAR coordinators, always said that HIV prevention was a priority. But in reality, prevention was never a priority with PEPFAR and could never be a priority since the law that created PEPFAR hamstrung prevention efforts by limiting them to 20% of the budget. And the bitter political battles swirling around HIV prevention during the eight Bush years prevented an evidence-based formula for measuring the number of HIV infections from being implemented. Instead, PEPFAR was reduced to measuring prevention with process indicators such as messages transmitted and campaigns conducted.

I thought of all of this today when reading the press accounts of the visit of Secretary of State Hilary Clinton to HIV/AIDS programs supported by the U.S. government in South Africa. Treatment dominated Secretary Clinton's visit and understandably so, given the fact that South Africa has more HIV-positive people than any other country in the world. But where is prevention in all of this? After all, even South Africa, with its vastly greater resources as compared to any other sub-Saharan African country, cannot treat its way out of its epidemic.

That is why I was so pleased to see, hidden at the end of today's Washington Post account of Secretary Clinton's visit to South Africa, the following paragraph:

"U.S. Rep. Nita M. Lowey (D-NY), the head of the House Appropriations subcommittee that funds foreign aid programs, said at the ceremony that she hopes to see more assistance going toward prevention, rather than just treatment."

Bless the heart of Rep. Lowey for reminding us of this simple fact: We will never get ahead of the AIDS pandemic until we focus more on prevention, which continues to be grossly neglected. It is so much easier -- although much, much less cost-effective -- to treat people after they have been infected than to prevent the infection in the first place.

And it is awfully messy -- not to mention politically perilous -- to protect injecting drug users, sex workers and the men who patronize them, and even more controversial when we direct efforts at adolescents who most adults would prefer to pretend will be celibate until marriage.

Thanks to Rep. Lowey for reminding us of the importance of prevention, and let's hope Eric Goosby, the incoming PEPFAR coordinator, hears her plea, and directs more PEPFAR resources into prevention, finally. The future of the pandemic depends on it.