Brazil last week cancelled the remaining $40 million of a five year $48 million dollar USAID grant because of a refusal to pledge to oppose commercial sex work. Brazil has also cited concerns about agreeing to US government principles concerning sexual abstinence and drug use. The policies stem from two 2003 US laws, one involving HIV/AIDS funding and another regarding sex trafficking. Pedro Chequer, Director of Brazil's AIDS program, explains:

We can't control (the disease) with principles that are Manichean, theological, fundamentalist and Shiite.

He goes on to describe US policies as:

Interference that harms the Brazilian policy regarding diversity, ethical principles and human rights.

Further coverage in today's Wall Street Journal and also on the Kaiser Network.

The International AIDS Society has launched an online consultation program in connection with the 2006 Toronto conference. The Future Directions Project seeks participant input regarding priorities and changes for future international AIDS conferences.

The Project is commendable for two reasons. First, few public sector organizations seek input through online forums of this nature, although there are many reasons to do so. Second, the IAS' web efforts in Bangkok were not impressive, in part due to lack of interactivity. The use of online forums now signals that the IAS is bringing more sophistication to its efforts.

The President's Emergency Response to AIDS Relief (PEPFAR) recently released its first Annual Report to Congress. The 123 page document (available in PDF | 2.6 meg) is the most detailed public view yet of the accomplishments and ambitions of the world's largest AIDS program.

The report is laden with statistics demonstrating accomplishments in care, prevention, training, and other services. It also does a reasonable job outlining program priorities and directions. The report doesn't, however, provide a usable compilation of the most important question: where is the money going? (Appendix II lists six uses of funding with no breakout detail.) There is also limited mention of grant recipients and contractors who do much of the PEPFAR program implementation.

The Annual Report is a welcome step forward for PEPFAR communications. Overall, however, PEPFAR still has a long ways to go in its stated goal of communications "transparency". Two years out there is still no reasonable program web site. Only one site worldwide links to the Annual Report (USAID). A Google search on "PEPFAR" brings up discussion of PEPFAR in AIDS Matters as the fourth entry (in contrast, a Google search on "Global Fund" doesn't return AIDS Matters in the top 200 results). PEPFAR certainly has a lot of information to share with the global AIDS policy community. The Annual Report is a good start.

We commented in September on the hours and effort required to establish a policy blog such as AIDS Matters. At that stage we had about 800 monthly visitors from 40 countries. At this point those numbers have grown to approximately 4500 monthly visitors from 80 countries. Linking web sites have grown from 16 ot 75. The site still requires several hours per week of attention.

Based on these numbers, are policy blogs worth it? Assuming AIDS Matters indeed reaches thousands of people, and assuming it continues to grow, it seems hard to argue against the investment.

For groups considering policy blogs, I'd again point to the excellent vaccine blog maintained by Owen Barder at the Center for Global Development as a good example. Also feel free to contact us about policy blogs if you are considering one for your organization.

In his recent Time Magazine cover story on poverty (pdf version), Jeff Sachs describes the plight of the "bottom billion", the poorest members of the planet that exist on less than one dollar a day. He describes how two centuries ago, essentially everybody on the planet was comparably poor. Since then, however, economic growth has been distributed very unevenly due to many factors (geography, climate -- even luck). These days wealthy countries have left the "bottom billion" far behind.

This raises a central challenge in combatting poverty: If the rich never come in contact with the very poor, how can one expect them to have sufficient empathy? I have no doubt that if you dropped any American or European into, say, rural Kenya, they would immediate react with "wait, this just isn't right -- with a little money we can help these people help themselves". Unfortunately very few outsiders ever see rural Kenya.

I don't have the answer on how to increase the contact, and therefore the empathy, with the bottom billion. Photo essays and news reports aren't doing their job. Tours? Reality TV? Webcams? We clearly need a way to better empathize with the daily struggles of the poorest on our planet.

The Kaiser Family Foundation has launched a new information resource addressing AIDS, TB and Malaria. GlobalHealthReporting.org aggregates Kaiser newsfeeds, research, interviews and other resources into a web site targeting "journalists and others". It provides a particularly good array of background materials for the three diseases, a hallmark of Kaiser publications.

The Center for Global Development recently launched a new professional blog called "Vaccines for Development", which addresses the need for better vaccines targeting developing countries, and reviews strategies for promoting vaccine development. The blog is a nice example of a topic-related offering (I played a role in its launch so I'm biased), and I hope there will be many similar professional blogs addressing AIDS and development in the future. The main person behind the blog, Owen Barder, has significant experience with the topic and is sure to turn this into a useful resource.

Scientists at the Africa Genome Education Institute Conference report that an effective AIDS vaccine is at least 15 years away. As more research is conducted on vaccines, the time estimate for an effective AIDS vaccine continues to recede. In 1984, Margaret Heckler, Secretary of Health and Human Services, predicted an AIDS vaccine would be available in 1986. In 1997, President Clinton called for an AIDS vaccine by 2007. Now the date has been pushed to 2020 at the earliest -- 40 years following the discovery of HIV.

The importance of the receding AIDS vaccine is that even if one is found to be effective -- and eventually we'll succeed -- the vaccine will have no impact on the approximately 80 million new infections foreseen by UNAIDS by 2025. Since there are no current prospects for medical cures for AIDS, the only remaining strategy for slowing the next 80 million infections is through prevention efforts.

The US Senate yesterday passed a budget resolution which included an amendment for funding of $800 million for the Global Fund in the next fiscal year (as opposed to $300 million requested by the White House). The amendment, sponsored by Senators Rick Santorum and Dick Durbin, would raise the US contribution to levels necessary to sustain current Global Fund commitments (adding new commitments would require approximately $1.5 billion in US funding). In their "Dear Colleague" letter, Senators Santorum and Durbin emphasize that US contributions would continue to not exceed 33% of total contributions to the Global Fund, as stipulated by US law. While it certainly is aggrevating for Global Fund officials to try to plan in the face of enormous funding uncertainty, at least there are signs of sufficient support to meet current commitments.

Peter Piot, head of UNAIDS, gave an important speech February 8th at the London School of Economics which didn't appear to receive sufficient attention. Entitled "Why AIDS is Exceptional" (pdf), the presentation outlined Dr. Piot's arguments on why AIDS needs to be considered in a category all to itself -- akin to nuclear weapons or global warming -- and receive an unprecedented global response.

Is the AIDS pandemic so exceptional a threat that it is in a league altogether different to other infectious diseases or causes of ill health? Is the pandemic so exceptional a threat that its control should not be just one of many Millennium Development Goals but rather an overarching priority, a prerequisite to achieving the MDGs? Is the threat so exceptional that it demands a binding first call on the attention of political leaders as well as on finances? So exceptional that it demands that we undertake fundamental changes on many fronts if we are to succeed? Ladies and gentlemen: AIDS is exceptional. The response to AIDS needs to be equally exceptional.

Dr. Piot concludes by calling for unprecedented attention to advocacy efforts, financing, and implementation.

UNAIDS published this week AIDS in Africa: Three scenarios to 2025, a study involving over 150 participants from UNAIDS, the African Union, African Development Bank, UNDP, World Bank, Royal Dutch / Shell Group, and others. The conclusion (taken from figure 2, page 23):

Scenario / Cumulative Deaths / Cumulative New Infections / Infections Averted / Cost

1 / 83m / 89m / 0 / $70b
2 / 75m / 65m / 24m / $98b
3 / 67m / 46m / 43m / $195b

Seen first at The Marginal Revolution.

The White House Council of Economic Advisors last week published the 2005 Economic Report of the President, a 300 page tome discussing the principal economic challenges facing the US. Chapter 7 (of eight chapters) is dedicated exclusively to global HIV / AIDS. It provides a concise portrait of the global epidemic, its economic consequences, and strategies towards prevention and care. While it breaks little new ground, the Report does emphasize new market approaches to encouraging vaccine development, an idea that is receiving increased attention.

While there is full agreement that an AIDS vaccine will be vital in combatting AIDS in the future, there appears to be a shift in approach to vaccine development. Current funding for vaccine research is tightening, while simultaneously many advocates are calling for new "market incentives" to encourage private sector involvement. The United Kingdom, currently heading the G8, has said that advance purchase commitments would be on the agenda in June's meeting in Gleneagles. As background on this issue, the Center for Global Development has published an excellent primer on Advance Markets for Vaccines in two forms: a consultation draft (which will be followed by a full book) and a 3 page brief.

Kudos to the British charity Avert for providing excellent information resouces on global HIV/AIDS. While the web site covers many topics that are well-discussed elsewhere online, it also includes informative sections on US Government programs that are not well-presented on other sites. The PEPFAR page is more detailed than anything provided by PEPFAR itself; it even includes reference to the SCMS program (remember that -- the world's largest AIDS program nobody has ever heard of?). The PEPFAR page also includes an excellent bibliography at the end.

If one searches on "SCMS" on the USAID web site, there are zero citations. Thanks to Avert for helping fill the gaps.