Opportunities and challenges in the global fight against HIV / AIDS and neglected diseases

In response to the HIV / AIDS and the fight against the so-called neglected tropical diseases are the focus of the November / December 2009 Health Affairs. The articles reflect the rising point of the largest specialist global health from around the world that despite these problems vary considerably it could save millions of lives. Corresponding increase in the prevalence of HIV infection, the current global economic slowdown, suggests a drastic reduction in funding for the fight against HIV / AIDS, both in the short term and long term. By the year 2031, when the pandemic comes, is 50 years old may need financial assistance to developing countries reached 35 billion U.S. dollars per year - three times higher, according to a study by the co-author Robert Hecht. Even then, more than 1 million people are newly infected each year about 33 million people worldwide are currently infected.

"We look at the face of a major crisis," said Pike, director of outcomes Development Institute in Washington, DC "But we have an opportunity and an obligation to the crisis by political decisions difficult but necessary for now mitigation. "He and his co-authors predict that investment in prevention of high impact and effectiveness of management policies could cost the world efforts to fight against the pandemic in more than half.

Hecht's paper is part of a series of articles in this issue of Health Affairs is devoted to economic, political, scientific and ethical issues facing decision makers in the world in its response to HIV / AIDS treatment and prevention. The articles focus on the Bill & Melinda Gates Foundation to support decision makers can take steps to change the dynamics of the pandemic so that saved millions of lives, prevents infections and total costs affordable.

Other highlights include:

* Stefano M. Bertozzi, Director of the Bill against HIV & Melinda Gates Foundation, and co-authors provide a timetable for responding to the pandemic in the world and call for politicians of the urgency "or" mode in recent years to pass a series more efficient and effective initiatives today. "An emergency is an earthquake reasonable, but unnecessary and inefficient for an epidemic that is with us for over twenty-five years," they write. They require a new focus on evidence-based prevention programs, longer-term measures to change the fundamental social causes of the transfer, investment in training a new generation of health professionals and managers, and more coordinated monitoring programs of modern management practices.
* Across the board will need treatment programs HIV Re-structured to maximize benefits at the lowest possible cost, "said Anil Soni of the Clinton HIV / AIDS Initiative, and Rajat Gupta, Global Fund to fight against HIV, TB and malaria. They call for much wider use of cost-effective regimens for the treatment of patients with HIV / AIDS. They also require greater use of medical personnel available through strategies such as shifting "problem." For example, in Rwanda, trained nurses, with some medical supervision for the implementation of HIV treatment, patient consultations. Ie by reducing the demand on physicians for HIV services, the authors, a transfer of tasks reduces costs so that money can be used to improve and expand care.
* Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, and his colleague Gregory K. Folkers required a strengthening of global resources of a strong research program on everything from vaccines for the prevention of new modalities. They argue that new sources of revenue Fight against HIV / AIDS to be necessary in the world, including the country's investment income and middle rich, whose contributions have so far been limited.
* Although much attention to obstacles to scientific development of a vaccine against HIV, the accent, makes the Institute of Technology Massachusetts Jeffrey E. Harris, the economic stakes are as real to the issues raised are the lack of incentives to encourage the promotion of cooperation between private parties and legal disputes, the public good, but to take on the rights of individuals.
* Meanwhile, defenders Judith Auerbach of the AIDS Foundation of San Francisco, the focus of HIV prevention will be strengthened to change the behavior of individuals in society in terms of promotion and prevention, have a positive effect is called the HIV / AIDS needs. They cited the low cost measurement - such as the empowerment of women in poor countries, and stable housing for homeless people - who have shown good results.
* The global response to the AIDS pandemic goals of universal access to treatment and to pursue all opportunities for prevention. But to say it is, given the limited resources that Dan W. Brock, a professor at the Harvard School of Medicine, and Daniel Wikler, Harvard School of Public Health that there is a moral obligation to change the priorities of prevention, ultimately, more lives - rescue - even if such shift has slowed progress toward the goal of universal access to treatment.

It is time to eliminate neglected tropical diseases

About 1 billion people, especially in the developing world die, or a class of infectious disease, often called "neglected" tropical diseases, ill. Today, more than 30 diseases that afflict worms, protozoa, bacteria, fungi or viruses caused the poorest in the poorest countries, and lead the effort so as well as malaria and AIDS. Global Health Researchers say these conditions are treatable and can be shown that the elimination of the Euro without a large investment in height.

Another group of papers and perspectives in Health Affairs focuses on strategies and measures to fight against neglected diseases. Publication of the cluster has been supported by the Global Health Progress, an initiative of the Pharmaceutical Research and Manufacturers of America (PhRMA). In the series:

* Health Affairs Philip Musgrove, Deputy Editor and co-author Peter Hotez argue that non-drug effort - policies of mass administration of drugs - many neglected diseases could be conquered. Research, they say, is needed on four fronts: for diseases in which there is not cheap effective drugs, drugs for the backup protection against the development of resistance to vaccines, as as possible, and for a better understanding of non-organic barriers to effective delivery. "Neglected diseases are millions of lives, but can be treated or disposed at a relatively low cost," said Musgrove. "It is time for the world to act."
* So far, global efforts have left the control of tropical diseases on the mass administration of drugs. But enough of this "magic bullet" approach in most cases to stay ahead of the scalability of micro-organisms and parasites, according to Adel Mahmoud Princeton University and former National Institutes of Health Director Elias Zerhouni. They support a comprehensive approach that includes a combined set of scientific, socio-economic, educational, environmental and labor policies.
* Kenneth Gustavsen, Merck & Co. Inc. and Christy Hanson of the United States Agency for International Development, see public-private partnerships as the key to the fight against neglected diseases, including joint efforts of global products pharmaceutical and biotechnology companies and other stakeholders. The continued success of these partnerships, they say, depends on a conducive policy environment.
* Similarly, James A. Geraghty, Genzyme Corporation, also calls for expanding the commitment of the biotechnology industry to fight against neglected diseases and argues that companies have a responsibility to help the fight. Policy changes that other companies could attract such work does not include federal tax credits, as proposed in a paper by Gerard Anderson. With a low cost could help to introduce a new generation of treatments for neglected diseases.
* Scientific Sarah E. Frew, Victor Y. Liu, and Peter A. Singer of the McLaughlin-Rotman Center for Global Health (MRC), Toronto, Ontario, you need to have health biotech companies in the global South, to promote growth in these economies, develop and distribute vaccines , diagnostic and therapeutic products for local markets. These efforts should contribute to a business plan to grow and accelerate innovation for sources of affordable neglected tropical diseases, say the authors.