A post by our internal co-president, Cindy Sui, on HIV/AIDS research and recent sequestration. Follow the links in her post to support global health outreach and let your voice be heard.
What does the HIV/AIDS baby mean for the future of global health?
I think it’s amazing that a baby has been certifiably cured of HIV/AIDS. It’s a true tale of medical innovation – a little risk-taking, a dash of courage to break with convention, a little luck. Dr. Hannah B. Gay from the University of Mississippi Medical Center put this baby (whose name and gender are still both unknown) on HIV drug therapy only 30 hours after birth, even before tests had confirmed their HIV-positive status. Whether it was the promptness of the intervention or the specific drug regimen that birthed this remarkable cure, or both, it’s clear that we wouldn’t have found out if Dr. Gay hadn’t abandoned the conventional protocols for treatment. And as for the place of luck – a trick of circumstance is the reason scientists were able to discover that this has the potential to be a permanent cure. After 18 months of drug therapy, the baby left the care of the hospital and his or her mother stopped adhering to the treatment regimen, which should have caused a relapse in disease. But they came back to the hospital five months later and Dr. Gay ran more tests, she discovered something astounding: the baby was still completely healthy. The intermittent treatment had stuck.
Scientists are debating and will continue to debate the veracity and importance of this “cure.” They are asking questions like: was the baby actually infected in the first place? Will the baby stay “cured” in the next year, the next ten years, the next fifty? How reproducible is this treatment in adults, or in patients with latent reservoirs of HIV? All of these questions are worthy of discussion and research. And the fact that this study from Mississippi has sparked off these new questions and investigations counts it as a win. This is an entirely new paradigm and hope for the HIV field.
But while this discovery is undoubtedly a step forward for the field, I shy away from celebrating too soon. The US government recently passed a mandate on the 2013 sequestration cuts (yes, the ones they punted on at the end of December), which – among other things – cuts funding to the National Institutes of Health (NIH) by $1.6 billion, and funding to global health programs at the State Department and USAID by over $432 million, according to a report from the Democratic members of the House Appropriations Committee. Since current research grants from the NIH are locked-in and must be fully funded until the end, these budget cuts will disproportionately affect the funding of new research, such as studies exploring the complexities of this baby’s recovery from HIV/AIDS. These NIH cuts are especially dangerous to the future of global health because the US government is the largest funder of global health research & development in the world, and NIH accounted for nearly 90% of US government spending on global health R&D. Furthermore, HIV/AIDS is a global pandemic, and as the US government is responsible for amajority of international AIDS assistance, this decrease in USAID & State Department funding has the potential to severely limit the spread and impact of a new treatment if one is discovered in the future. In the more immediate term, sequestration budget cuts of $293.8 million to the President’s Emergency Plan for AIDS Relief (PEPFAR) and $138.6 million to the Global Fund to Fight AIDS, TB and Malaria are predicted to lead to 39,200 more AIDS-related deaths and 77,200 more children orphaned by AIDS-related deaths.
Yes, there is much hope for the future – proof that a permanent cure for HIV/AIDS could result from a year of treatment instead of a lifetime would revolutionize the economics of HIV programs all around the world. And yes, this discovery out of the University of Mississippi could spur non-profits and foundations to support more HIV research and global health programs than ever before, perhaps making up for the US government’s withdrawal. But the road ahead is still uncertain. And if in ten, twenty, fifty years, there is still no permanent cure to HIV/AIDS, or there are still millions of deaths in sub-Saharan Africa or Central Asia despite the existence of a cure, we must have the courage to face reality and understand that we are partly responsible for this failure, because of the (in)actions of our government and the (in)actions of ourselves, as citizens in influencing our government and as citizens who can independently build organizations and infrastructure in civil society.
There is still some hope for change on these blunt, across-the-board sequestration cuts. Although the mandate for these budget cuts was passed on March 1st, advocacy organizations such as Save the Children and ONE are gearing up for a fight in Washington DC. They’re mobilizing grassroots support to demand legislation to reverse these cuts by March 27th, because NIH & global health budget cuts actually do very little to decrease our federal deficit – they account for $2 billion out of an $85 billion sequestration, or only 2.35% – but these cuts would have immense human costs.
Here are three organizations mobilizing around the cuts to global health & international development funding:
But let’s also take a step back and consider the probable outcome that these sequestration cuts are here to stay. There is a bigger lesson to be learned here about the problematic reality of global health, which is that technology is not enough. Scientific advancement is not enough. If we want to keep our eye on the ball until there is a permanent cure to AIDS, and until every single human on Earth has access to such a cure, we need to build a social movement in the US around global health equity that can influence all sectors of society, whether government, non-profit or for-profit. Only this kind of cross-sector social movement will ensure that we do not shoot ourselves in the foot in one sector while hope blooms anew in another.
Knowledge and awareness is the beginning of such a movement, and informed dialogue is the beginning of change. So if you believe that we should end the suffering caused by HIV/AIDS, if you think the coincidence of this possible cure with the sequestration budget cuts is darkly ironic and should not pass unseen, here’s one more thing you can do right now – forward this story to your friends and family, to your entire social network. Spread this knowledge in tandem with the hope that has gone viral after the discovery from the University of Mississippi, and ask those in your network not only to celebrate this triumph but to face up to the context in which it exists. Perhaps even ask everyone in your network to perform one or more advocacy actions against the sequestration cuts – which, by the way, also greatly affect domestic growth & social programs (see the first reference below). So even if your friends and family don’t care about global health, they will still care about the effects of sequestration. Make sure they know about it. Start that conversation. Act now, and let’s move together towards a better, more knowledgeable, AIDS-free world.
Good references on the effects of sequestration:
- All effects of the sequestration bill: http://www.ghtcoalition.org/files/Sequestrationfullreport.pdf
- Specifically on global health programs: http://www.amfar.org/uploadedFiles/_amfarorg/In_The_Community/SequestrationJuly2012.pdf
- Specifically on international global health NGOs: http://blog.psiimpact.com/2013/03/7-potential-impacts-of-sequestration-on-international-global-health-ngos/
- The US government’s role in global health research & development: