UNAIDS this week released its Epidemic Update 2005. As in the past, the document is professionally presented, meticulously dispassionate, and very nearly devoid of good news. Another five million people have contracted the virus worldwide. Three million more have died. Forty million people carry the virus worldwide. Twenty five million people have died since 1981. Some countries show modest signs of progress, while many others show worrisome decline. Many countries appear on the brink of pronounced epidemics. The disease shows few signs of slowing its devastation.

If there is good news to be distilled from the document, it is that there is ample evidence on the right set of policies required to combat AIDS. Unfortunately there remain many obstacles to these policies. It is hard to conclude anything from this Update other than we're still losing the battle against AIDS.

The Kaiser Family Foundation will be screening on November 16th in Washington, DC the new documentary "Ending AIDS: The Search for a Vaccine". Other screenings are offered around the US and other countries, leading to the wide television broadcast of the documentary on World AIDS Day December 1.

The documentary is an excellent synopsis of the breakthroughs and challenges of combatting AIDS, but concludes that we are still years away from a vaccine -- although important and promising work is clearly underway.

Readers of this blog know that I comment periodically on PEPFAR, the world's largest AIDS program which is all but invisible online. In August of 2004 I listed six suggestions for PEPFAR's communications strategy (none of which has been implemented). In December of 2004, PEPFAR led the list of ten information resources requiring improvement.

Perhaps the most amazing fact about PEPFAR online is that the main PEPFAR page, the Office of the U.S. Global AIDS Coordinator, is almost impossible to find through the search engines. It doesn't appear in the top 300 listings for a Google search on "PEPFAR". There are two reasons for its invisibility. First, relatively few other sites link to it (Google shows only 138 linking domains, compared to 208 to this little blog site, or over 1200 for the Global Fund). Second, and more consequential, the "PEPFAR home page" doesn't mention the word "PEPFAR" -- only the "President's Emergency Program for AIDS Relief". Thus anyone searching on "PEPFAR" won't find it.

It is hard to imagine PEPFAR being programmatically or politically successful without a better online strategy. The good news is that the information problems which plague PEPFAR are relatively easy to fix. Once there is a will, there is clearly a way.

Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa, doesn't mince words. In articulate and piercing tones, he consistently calls for more global attention to the AIDS pandemic. In a new series of lectures in Canada, he articulates his current views about the looming devastation many countries will face in coming decades:

It's simply impossible to tear the productive generations out of the heart of a country without facing an incomparable crisis.

In fighting against AIDS, Lewis at some point will exhaust patience (his own or others'). Nonetheless, the greatest ally of AIDS in developing countries is indifference, and Stephen Lewis does his best to eschew global indifference.

More information in KaiserNetwork Daily Report.

Does AIDS crowd out funding for other global infectious diseases? The current issue of PloS Medicine has an article which discusses "rapid impact interventions", a strategy which combines effective treatments for seven common infectious diseases in Africa. Because costs are low ($0.40 per year per patient, vs. nearly $1,000 for ARV -- see graph at left) and the treatments are proven, the authors argue that funding for these interventions is a highly effective strategy in combatting poverty.

Owen Barder offers an excellent review of progress and missed opportunity in international development in 2005, the "Year of Development". He notes a number of significant accomplishments, including debt relief and support for immunizations for developing countries. He also catalogs a frustrating list of squandered opportunities, including shortcomings on MDG targets and failure of donors to meet HIV/AIDS 3x5 obligations.

Kudos to President Clinton and the Clinton Global Initiative for completing earlier this month a series of meetings culminating in $1.25 billion dollars of commitments from governments, non-commercial groups and businesses to combat poverty. The Initiative takes the excellent step of requiring participants to make written pledges that will be reviewed in one year.

It is puzzling that the Initiative apparently doesn't make these commitments public. While press releases trumpet the $1.25 billion figure, the Initiative web site lists only a small number of commitments to date. With transparency comes accountability. The hope is that the Initiative will become more transparent soon around these commendable commitments.

We have commented previously on PEPFAR's requirement that all recipient groups sign a pledge opposing prostitution. Unfortunately, PEPFAR doesn't make the language of their restrictions readily available (we have posted some language here). As far as we know, PEPFAR also has yet to issue additional guidance concerning this policy.

PEPFAR may now need to address the issue directly. This week the Open Society Institute announced a lawsuit against USAID, claiming the policy to be unconstitutional. As the lawsuit moves forward, USAID will by necessity be required to explain and defend its policies.

The new McKinsey Quarterly (free registration required) includes two good overview articles of interest to AIDS professionals. The first, "Vaccines Where They Are Needed", provides a nice review of the challenges of vaccines for development. The second, "Battling AIDS in India", discusses the challenge of gaining the attention and commitment of the Indian private sector in the fight against AIDS.

The global AIDS epidemic is incessant and predictably horrible -- which is to say it isn't very newsworthy. Media (and political) attention focuses on the new, and unfortunately global AIDS is an old story. Keyword searches on Google News illustrate the challenge:

• "Katrina": 404,000 entries
• "Iraq": 165,000 entries
• "Gaza": 62,000 entries
• "Roberts": 50,000 entries
• "HIV": 10,000 entries

In a competition of just these five terms, "HIV" gets slightly over 1% of current press attention.

Unfortunately, it is difficult to push global AIDS higher in the mainstream media or political agendas, despite characterizing it as a "Katrina every day" or "tsunami every week". The best hope for providing ongoing emphasis on global AIDS may be through the web and blogosphere, where large numbers of dedicated posters can keep the issue prominent for journalists, politicians, and the public.

The Global Fund makes many grants (over 300 to date representing $3.5 billion). Some don't perform. Global Fund staff monitor grant progress, and if things don't proceed, they stop the grant.

The most recent high-profile example is this week's termination of a $36 million package of grants to Myanmar. In canceling the grants, the Global Fund issued both a press release and a detailed five-page factsheet describing the situation.

There is a maxim in grant programs that if some grants don't go bad, you're not doing your job. The Global Fund, to its credit, publicizes failed grants along with successful ones, allowing other donors and grant recipients to learn from their circumstances.

The July 28th issue of the Economist has a number of excellent articles discussing global AIDS, including a review of the IAS pathogenesis and treatment conference in Rio de Janeiro.

The most significant article, however, addresses the success Brazil has had in AIDS prevention efforts (available here for subscribers). Four principles underpin this success:

• Don't let morality get in the way: distribute condoms, distribute needles, and treat sex workers;
• Treat freely: provide screening and treatment at no cost;
• Encourage NGO participation: NGOs are more effective overall than government agencies;
• Account for cost savings: "If you think action is expensive, try inaction".

As sensible as this list is, it unfortunately characterizes the programs of only a small number of countries (or aid agencies) worldwide.

The Kaiser Family Foundation has issued a new review of global financing for HIV/AIDS. The report, "Financing the Response to HIV/AIDS in Low and Middle Income Countries", provides current data and graphs describing the financial commitments of G7 countries. The report, along with an associated chartpack, was presented at a Kaiser-sponsored event "The Long-term Financing Implications of the HIV/AIDS Pandemic" July 21st (webcast available).

The Global Fund announced the selection of Richard Burzynski of ICASO to serve as the Developed Country NGO Communication Focal Point (read announcement here). This follows a call for applicants in May which outlined requirements for the position.

While the job is no more important than many other important roles at the Global Fund, it is noteworthy nonetheless the effort the Global Fund makes in genuinely engaging with the NGO community in policy and administrative issues. The Global Fund is unique among donors in its efforts at networking -- a laudable example others should emulate.

Alan Whiteside and Sabrina Lee have published an article in the August issue of PLoS Medicine entitled "The “Free by 5” Campaign for Universal, Free Antiretroviral Therapy". While we've commented previously on the initiative, this article provides updated information and rationale for providing free ARV therapy.

The August issue also includes many other articles relevant to global AIDS.