December 14, 2009
Some AIDS advocates accuse the Obama administration of turning its back on global HIV treatment in its attempt to focus more on HIV prevention and on the less costly treatment of other diseases in poor countries.
On Dec. 7, the administration released more information about its five-year strategy for the President's Emergency Plan for AIDS Relief (PEPFAR), including treatment objectives. From 2010 to 2014, the goal is to increase the number of patients receiving antiretroviral (ARV) therapy in target countries to 4 million. The 2010-14 plan for 320,000 new patients on treatment per year is slower than PEPFAR's previous pace of almost 500,000 per year since 2004.
PEPFAR's head, Dr. Eric Goosby, denied the administration is backtracking on its promise to fight AIDS overseas. "We're honoring our commitment," said Goosby, noting that more people will receive antiretroviral therapy each year.
Some global health advocates expressed sympathy but said the administration is being pragmatic in shifting funds for cheaper interventions that save even more lives. It is an approach advocated in a November 2008 paper in the Journal of the American Medical Association by Dr. Ezekiel J. Emanuel, a bioethicist at the National Institutes of Health, an Office of Management and Budget advisor and brother of the president's chief of staff, Rahm Emanuel.
Fighting "simple but more deadly diseases, such as respiratory and diarrheal illnesses, the US government could save more lives -- especially young lives -- at substantially lower cost," Dr. Emanuel wrote. Since then, he has denied having an influence on the administration's management of PEPFAR. "This is the president's policy and the way he wants to approach it, and no individual counselor stands in his way," he said.
Fearing PEPFAR cutbacks, a number of presidents and deans of schools of medicine and public health submitted an open letter on Nov. 18 urging Obama to continue expanding ARV access.