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NY Times says prevention failed and now treatment is too

By Sarah Arnquist | 11 May, 2010 Last edited by Sarah Arnquist on 11 May 2010

If you haven't seen the New York Times piece on global AIDS response from this week, you should check it out.

It sparked a debate in our office about why the Times wrote the piece now, why it chose to focus on Uganda, and what the overall point was. McNeil gave no voice to a call to action or a description of a plan to deal with the problem.

As a former reporter, I think the timing was likely a result of when the reporter had a chance to finish it and the paper had space to run it. Most reporters have notepads filled with stories they’d like to write and there is no science to when they can actually scratch one off the list.

McNeil is a great guy and an experienced correspondent, having done stints in South Africa and Paris (someone has to do it). Why Uganda? There were earlier reports from clinics there that took a similar tone, and for the same reasons Uganda has so many Mzungus: It’s a relatively easy place to visit and work. People speak English, the weather is nice, and it’s mostly peaceful. Furthermore, the concentration of NGOs, aid programs and universities running programs helps a reporter out.

People tend to imagine there is much more deliberation that goes into what appears in the newspaper, when the reality is it’s often

It’s not McNeil or any reporter’s job to write a “call to action.” That’s the job of the advocates in response, in my humble opinion. I also appreciated that he didn’t quote a bunch of “experts” waxing on about potential solutions. The reality is that right now, there is no long-term plan to maintain funding for HIV treatment, but before PEPFAR and the Global Fund financed treatment expansions, we all knew treatment was for life.

One article can’t be all things but if I were to write a follow-up, I’d want to further exploration of:
• The host country’s responsibility in delivery HIV prevention and treatment.
• The PEPFAR transition ongoing to transfer treatment responsibility to the host countries.
• Are there any new prevention strategies that seem to be working?

Many diseases and public health problems compete for scare resources. The trade-offs between them are real. HIV isn’t the top killer in many of the countries, but it receives by far the most funding. The battle against one disease might be weakening, but maybe that’s the wrong lens to see things through. Maybe we need to measure our progress against trends in the total burden of disease?



Maria May Replied at 4:57 PM, 17 May 2010

Several letters, from head of PEPFAR Eric Goosby and others were posted here:
It's worth noting that most of the letters take a strong biomedical emphasis, with comments about hope for a cure or the battle for universal access to treatment. Would be great if dialog stemming from the New York Times' articles served as a moment to reflect on current investments in prevention AND treatment and how to optimize these.

Claire Cole Replied at 6:05 PM, 20 May 2010

Hi all-- I am cross-posting as this discussion has also been picked up in the Adherence & Retention community:

Chilunga Puta Replied at 1:54 AM, 21 May 2010

HIV/AIDS management is an issue that is likely to be with us for a longtime to come and I think it is a fallacy to believe that time bound donor funding is going to be a long term solution. My own view is that every government should take responsibility for its citizens. Granted countries are poor but can we honestly say we are cost-efficient in the way we do things? We in poor countries, especially those who have the capacity to take action must take up the challenge now to devise long term strategies to treat and support those affected by HIV/AIDS and even more importantly to prevent new cases.

Sarah Arnquist Replied at 10:35 AM, 21 May 2010

Chilunga, I completely agree that there are many opportunities to improve efficiencies in delivery, but this is where I think "ownership" of the program becomes particularly important. An outside donor can try to enforce efficiencies through things like results-based financing, but does true system transformation have to be internally driven?

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