UNAIDS last week released their most recent AIDS Epidemic Update, an excellent resource for for AIDS policy professionals. The document is a 94 page tour de force, cogently presenting the many faces of the AIDS epidemic around the globe.

The stark graphs and figures continue to tell a devastating story: 5 million new infections in 2004, 3 million deaths, and rapid growth in the epidemic in many regions. The report also emphasized two key themes:

• Women are particularly vulnerable: We know that AIDS moves from "at risk" populations (sex workers, drug users, men who have sex with men) to the general population. What is increasingly clear that once in the general population, in most countries AIDS disproportionately targets poor women. There are many societal reasons for this, none easy to reverse. The report offers suggestions for stemming this problem -- such as the empowerment of women through education and legal means -- but the lack of concrete recommendations reflects the intractability of the problem.


• The Epidemic is extremely heterogenous: It is simplistic to refer to the "AIDS Epidemic" in the singular: its dynamic varies widely from region to region. Unfortunately, surveillance capabilities are still far too nascent to adequately track and understand the many "epidemics" which exist. In areas where we do have better data, policies are often poorly refined to respond to local conditions.

Overall the document does an excellent job presenting global statistics, describing the dynamics of AIDS by region, and offering a long list of background resources. While it doesn't take an aggressive "prescriptive" role, it does offer the data and insights necessary for smart policy formulation.

Kudos to author Hein Marais and many UNAIDS colleagues responsible for this document.

Amidst the frustrations of combating global AIDS, it is important to remember other major global health battles that have been fought in the past -- and won. The Center for Global Development has just published "Millions Saved", an excellent compendium of 17 case studies of major global health successes, ranging from the eradication of smallpox to success against onchocerciasis. The compendium includes a review of HIV prevention efforts in Thailand.

A group of economists and organizations, spurred by Professor Alan Whitesite, has launched the "Free by 5" initiative calling for the free provision of ARVs to any patient that can't afford to pay. Making their arguments on both humanitarian and pragmatic grounds, the economists urge both policymakers and funders to recast the current "3 by 5" program to a free variant. A description of the initiative is downloadable as a PDF document. Fuller details and a petition are available at the University of Kwazulu-Natal.

The World Bank today announced the launch of the AIDS Media Center, an information resource for media professionals worldwide that cover the AIDS epidemic. The site is a collaborative effort involving the World Bank, UNAIDS, Kaiser Family Foundation, PANOS, and other partners. Journalists play an enormous role in combating AIDS. The AIDS Media Center will make their work easier and more effective.

While global AIDS remains the principal health crisis of our era, its coverage in mainstream media is less than is warranted. This may be slowly changing. A recent documentary, "A Closer Walk", offers an informed and moving portrait of the toll of AIDS in many countries. Director Robert Bilheimer interviews well-known figures (Kofi Annan, Dalai Lama) as well as people from all walks of life in many countries to draw the troubling portrait of AIDS. His efforts have led to a number of other initiatives elucidated on the film's web site.

Information technology plays a huge role in targeting education and treatment for HIV-positive people. Unfortunately, only a minority of those people has access to medical professionals that can provide case-specific advice. There may be an important intermediary, however, that can facilitate communications: the cell phone.

Cell phone usage in developing countries is growing quickly. 90% of South Africa, for example, has sufficient coverage, with a quickly growing subscriber base. Individuals or health professionals with cell phones can interact, via text messaging, with sophisticated databases that can guide treatment, prompt compliance, or provide surveillance capabilities. One "open source" effort in South Africa is described in Wired News. Other commercial efforts are also underway, such as those by Voxiva. It is easy to imagine a future when the most important communications technologies combatting AIDS are effected via the cell phone.

A current New York Times Magazine article on Jeffrey Sachs, "Spend $150 Billion per Year to Cure World Poverty, reflects why Sachs' role in combating AIDS and poverty is so important: he argues for an entirely new pardigm. It isn't sufficient to improve programs at the margins -- we need a major new commitment for global assistance. Fortunately, he has the energy, intelligence and clout to be taken as seriously in the pursuit of this new paradigm as anyone could be.

He spends a great deal of time debunking conventional wisdom. For example, from the magazine:

The idea that African failure is due to African poor governance is one of the great myths of our time,'' Sachs began, addressing a packed hall. ''They can't get out of the hole on their own. If we don't take a different approach, we will not only see certain collapse; we will see a catastrophic downward spiral of violence."

While Sachs' calls for increased resources often sound quaintly unrealistic, it is noteworthy that he is calling for no more than donor countries have already established as spending targets: .7% of GNP (including as recently as 2002 at the Monterrey Consensus). Five European countries currently meet that goal. The US falls short at .2% GNP, lowest of donor countries.

PEPFAR has previously announced a drug procurement and distribution program worth up to $7 billion. While proposals were initially scheduled to be submitted October 15th, the due date was changed to "indefinite" (amendment 2) -- with no further news as to when or if the program will proceed.

It is not surprising that a large contract faces delays. What is surprising is that, despite USAID officials' interest in transparency, there is little to be learned in the news or online about the program. This is after all the world's largest AIDS program to date. It has significant implications for AIDS programs and planning everywhere. PEPFAR could assist by providing more information about all of its efforts.

The World Bank today posted a request for proposals for Indian research organizations interested in modeling the long-term economic impact of AIDS in India. The RFP is significant for two reasons. First, most models addressing the economic impact of AIDS look simply at current productivity losses. The World Bank, on the other hand, seeks a more sophisticated approach based on overlapping generations (OLG) models that consider human capital accumulations (translation for the rest of us: when parents die, their immediate productivity disappears, but there are also many other negative repercussions for the next generation). The second significant feature of this research program is that the Bank seeks to have Indian research institutes lead the process (rather than Bank economists), which should increase the quality, relevance and acceptance of results.