Praise for PEPFAR treatment goals . . . and questions.

As reported in Medical News Today, the AIDS Healthcare Foundation (AHF), a non-profit HIV/AIDS healthcare provider, has praised PEPFAR’s passage through Congress and its prioritization of treatment programs, estimating that “five to seven million people worldwide may have access to lifesaving antiretroviral treatment over the next five years via PEPFAR-backed programs.”  (See also this article on the same topic, with a chart.)

Michael Weinstein, the president of AHF, said, “Congress is to be commended for swiftly adopting and ratifying the Senate version of the bill which preserves PEPFAR’s priority on lifesaving treatment.”

Tom Myers, AHF Chief of Public Affairs, said, “AHF considers this a great achievement because it confirms that treatment is – and should be – the primary focus of PEPFAR, and is the key to controlling the epidemic.”

The prospect of millions of lives saved by HIV/AIDS treatment is undoubtedly a cause for celebration.  Yet the claim that treatment should necessarily take top priority is more debatable.

The legislation that passed the House of Representatives last week includes a stipulation that at least 55% of PEPFAR funding must be used for HIV/AIDS treatment.  This was added in the Senate as a concession to Sen. Tom Coburn and his small group of allies, who had put a hold on the bill.

Many politicians, health experts, and AIDS advocates (including many FBOs and religious groups) wanted PEPFAR to be re-authorized without the treatment earmark, arguing that the stipulation would prevent local health workers to use funding where it was needed most, would seriously dampen prevention efforts.  Ultimately, however, the 55% was agreed upon as a compromise move: it was enough to get Coburn to stand aside and support the bill.  (For a great article on this episode in PEPFAR’s tortuous history, check out this Politico.com article.  Especially helpful is the chart at the bottom of the second page, which basically outlines the positions for and against the treatment earmark.)

It’s a tragic thing that debates about AIDS efforts often amount to Treatment vs. Prevention.  And yet, in the context of limited funding and resources, the debate often arises.

This is such a hard issue.  There are no really good answers . . . the whole situation is just bad.  I don’t know how you come out of it feeling or sounding anything other than heartless.  And yet . . . the questions don’t go away.

As I often say — and as is continually the case — I’m no expert on this.  I also want to be fair to both sides.  The AHF articles give you the “Treatment is top priority” side of the argument.  I think a few things deserve to be said about the other side.

According to an AHF spokesman, treatment “is the key to controlling the epidemic.”  Yet how can this be?  Treatment can partly control the effects of the virus on an individual, but as long as there are more people in need of treatment, the epidemic isn’t under control.  As it stands, more people are getting the disease than are getting treatment.  The only way to get ahead of the virus is through prevention.  We can count how many lives are saved by treatment.  We can’t know how many are saved by prevention — we never get to the place where we have to find out.

I don’t (DON’T!) mean to downplay the goodness and importance of treatment.  I know people living with HIV, and I know what treatment has done for them.  Saved lives indeed.  But prevention shouldn’t be dismissed, or put on the back burner.  HIV/AIDS has so much potential to continue wrecking havoc.  Sometimes there is no choice but to look to the future.

I’d like to comment more on the treatment v. prevention issue in the near future, but I think I’m done for the moment.  I guess I just wanted to point out a part of the picture that AHF didn’t address.

Let me just end by saying that I am SO, SO GLAD that PEPFAR has been passed by both Houses of Congress and is on its way to the President’s Office.  Whether all the details in it are ideal or not — and, ultimately, I’m not the one to judge that — it’s certain that many, many lives will be saved, and many others will be less painful, less sorrowful than they would have been without this.  So praise God!

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~ by h.e.g. on July 27, 2008.

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