The Center for Global Development has launched a nice online competition to vote for the "individual or organization from the rich world who has made a significant contribution to changing attitudes and policies towards the developing world". Nominees include a number of individuals and organizations that have focused on global AIDS, including Bill Clinton, Bono, Jim Kolbe, and the Gates Foundation. Voting is open through April.

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.

Is it time to change the name of PEPFAR? First, since PEPFAR isn't really the "President's" program -- but a program of the American people -- the first letter is confusing (note that the Global AIDS Coordinator's Office frequently refers to the program not only as the "President's Emergency Plan for AIDS Relief", but as "President Bush's Emergency Plan for AIDS Relief", such as three times in Monday's press release about treatment). Second, calling the effort an "emergency" program suggests a short time horizon which is the opposite of the desired impression.

Why not rename the effort APFAR -- "American Program for AIDS Relief"? I'm sure that http://www.apfar.gov is still available.

The Global Fund has announced it is directing a new advertising campaign in England, Italy and Germany in order to raise public awareness and support for global AIDS programs. While such a program is laudable, it seems questionable that the Global Fund itself would direct the effort (particularly since past advertising campaigns supported by the Global Fund have lingered, such as the "Investing in our Future" effort with VH1). The Global Fund, whose motto is "Raise it, Spend it, Prove it", has assiduously focused on core competencies in the past. It isn't obvious that ad campaigns represent a core competency.

Advertising and lobbying groups are experts in campaigns of this sort. Today's Washington Post story by Stephen Weissman describes a notional campaign for Darfur -- a model which lends itself comfortably to global AIDS as well.

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.

How can one help a struggling village in a developing country without actually visiting in person? A new service called Nabuur.com provides a venue in which individual villages list principal needs, and then volunteers from around the globe can organize work groups to assist. A search on "AIDS" lists many needs: a home for AIDS orphans in Kwandengezi, South Africa; education programs for street children in Pune, India; and AIDS refugee issues in Kigoma, Tanzania. Despite the site's sizable ambitions, it does a good job through photos, descriptions and profiles of feeling local and accessible. As the service grows larger, it also offers the potential for significant donor coordination, consistent monitoring & evaluation, and other issues which challenge traditional development efforts.

I've listed in the past core principles for confronting the AIDS crisis. Here is an expanded approach of how a simple mind might consider AIDS:

• AIDS is the biggest problem facing the planet today (or so says the Copenhagen Consensus);


• A vaccine is probably 15 years away at best (or so estimates Paul Farmer and many others), so it won't play a role in the next 100+ million infections;


• Drug treatments will greatly lag behind need for many years. Drugs might lessen the rate of growth of AIDS if tied to prevention, but will increase infection rates if programs are implemented poorly;


• The only hope of containing AIDS is through prevention. Societies need to be "immunized" against AIDS through education.


• While the mass media and training programs can be helpful in prevention education, there is no better way to spread important messages than by word of mouth through family and friends.


• There is no better way to motivate people to tell their friends and family about AIDS than to pay them money to do so.

My conclusion is that the best way to confront the planet's biggest problem is to pay people to tell their friends and families about AIDS

I'm not sure what this means.  I'm not aware of social marketing programs that rely on payments, especially in some sort of "multi-level marketing" format.  I've heard no discussion of payments in AIDS education.  I understand that there are myriad political, financial and social obstacles to paid prevention programs. 

I also know, however, that paid programs are highly effective in many diverse contexts, the amount of money necessary to motivate action is relatively inconsequential (I won't run numbers here -- but think ten cents per referral), and that paid programs can be highly controversial (which isn't necessarily bad in education programs).  I expect the next step in designing smart efforts would be to offer a competition to policymakers around the world to design an effective AIDS education campaign that included payments as incentives -- and see what the most knowledgeable people on the front lines had to say.

One clear gap in the "information infrastructure" supporting global AIDS professionals is the lack of any widely-used online gathering place to share professional information. This Spring's information resources survey by the IAEN indicated diverse information resources in many areas, but few interactive offerings. There is no good online community site for global AIDS professionals.

Many professions have active online community sites. If I were a cardiothoracic surgeon, every day I'd be visiting CTSNet to interact with colleagues. If I were a particle physicist, every day I'd be visiting ArXiv (which has grown to 3500 research article submissions per month as shown in this impressive graph). But where do I turn as an AIDS professional? The closest model is probably the IAEN, but it hasn't had the funding base to grow to prominence.

What is necessary is a new online community site for global AIDS professionals, probably associated with UNAIDS (but not strictly part of the site) to allow debate across multiple topics. Ideally such a community site would help narrow the gap between policymakers in Geneva, New York and Washington, D.C., and those AIDS professionals battling the pandemic around the world.

In coming years there will be billions of dollars spent on AIDS medicines, most on generic drugs. The future of the AIDS response pivots on these purchases: they are the biggest line item in most AIDS programs, and programs and individuals will become totally dependent on continued future funding by "fickle" donors.

Unfortunately, there is relatively little good information online focusing on drug purchases. The Global Fund will be launching a drug price database (a big help), but other donors have not disclosed budgets or pricing information, and additional systems of surveillance of black market pricing or other data are not in place.

One step that would help greatly would be for interested donors to establish an "AIDS Drug Watch" Web site that would:

• Explain current issues with drug purchases (including contrasting perspectives of donors, Pharma, and countries);


• Aggregate drug budget information from different donors;


• Aggregate price data (as best possible) from different countries;


• Highlight areas requiring improvement.

Good recent examples exist of "transparency" efforts such as this, including the excellent "Oil Revenue Watch" sites of the Open Society Institute.

A "AIDS Drug Watch" site, to run well, would cost low to mid six figures per year, not a middling sum. It could play a key role, however, in performance and accountability of a principal element in our battle against global AIDS.

It has now been over a month since the Copenhagen Consensus concluded that AIDS should be at the top of the world's list in prioritizing development resources. Interestingly, there has been very little discussion of this stunning result within the AIDS community itself. I heard no mention of it in dozens of meetings in Bangkok last week. I find scant mention of it on Web sites for UNAIDS, the Global Fund, or WHO. I haven't yet heard anyone talk about doing a similar initiative focusing on AIDS.

Doesn't it make sense to do an "AIDS Consensus" exercise to recommend how the notional $27 billion for AIDS should be spent? There are two dozen principal interventions for AIDS, a half dozen key epidemiologic regions -- where should we put resources? Would it be possible to find scholars to write a couple dozen key cost-benefit analyses to be judged by a neutral, credible panel? It's impossible to answer resource allocation questions with precision, but certainly we can do better than we are doing now (trusting fate?).

One of the most remarkable information resources online is Wikipedia, a volunteer-driven online encyclopedia which combines impressive scope (over 300,000 articles) with admirable quality (see, for example, the entry on AIDS). A number of additional "wiki" projects have spun off -- dictionary, textbooks, quotes resource -- all also demonstrating impressive dynamism.

I could imagine a team of motivated volunteers (ok, some foundation stipends might help) doing something similar for AIDS, building "AIDSpedia.org" (I have the domain in case anyone wants to take the lead :) ). Right now an online search on topics of interest to global AIDS professionals, such as MTCT, surveillance, or monitoring and evaluation, provide a jumble of results. An AIDSpedia effort could simplify a lot of our lives by pulling together best resources on topics of interest. A good place to start would be to convert each of the 100 main session topics at the Bangkok conference as outlined in the conference wiki into a full AIDSpedia home page including definitions, news, key resources, background data, and individuals of note. This could grow to be an impressive free-standing resource, or possibly rolled back into Wikipedia in the future if that made sense.

In preparation for the Bangkok conference, my colleagues and I were setting up a wiki site for one of the conference sub-topics. Seeing that the conference organizers haven't set up a wiki site for the overall conference (at least we can't find one), we decided to broaden the site to include all conference topics in case any attendees find this a convenient way to post notes and share ideas. The site can be found at http://www.aids2004wiki.org. Please feel free to post to this wiki or write me with any questions.

A wiki, for those of you not familiar with the term, is a simple Web site which allows any user to post and edit content. While this sounds like a recipe for chaos, in many cases they are very effective. The best example of a wiki I've seen is Wikipedia, a public encyclopedia site. Feel free to contact me if you'd like to participate.

One tool which has yet to appear for global AIDS professionals is a "knowledge base": a question and answer area in which visitors post and respond to questions, and all text is captured in a searchable database. The only application I've seen that approaches this is the Q&A area of the IAEN -- an application that is currently promising but neglected (due to funding limitations). The best examples of knowledge bases -- and there are many of them -- come not from public policy but from the commercial sector. Nearly every user support area of technology or consumer information firms rely heavily on them, such as offerings by Dell (including knowledge base, online community discussions, feedback opportunities, and other community applications). Ah, if we only treated the AIDS epidemic with the same attention as our laptops.

Developing countries will soon be seeing billions of dollars of new AIDS medicines. There will be a complex system in place to procure, ship and distribute these drugs. Tracking whether or not drugs will be reaching health centers in expected volumes will be extremely difficult.

One idea would be to establish a network of volunteers (or perhaps paid staff) who monitor the black market price of ARVs in cities throughout the world. A network of, say, 200 people in 50 countries monitoring 1000 sites monthly could provide prompt and useful feedback to policymakers pushing ARVs into the pipeline. Such a network could be created out of an existing global network (for example, the IAEN has 9000 economists and policymakers representing nearly every country -- I'm sure many would volunteer) or created afresh. I'm certain a small financial commitment from the Global Fund or WHO could set this idea in motiion.

In the coming five years, billions of dollars of new funds will join the fight against global AIDS. These funds will be allocated by a relatively small and identifiable group of AIDS professionals around the world. One important component of allocation decisions will be experience to date: which interventions are and are not working in different regions of the world?

Unfortunately, there currently is no cogent compilation of global AIDS research by intervention type or region. Policymakers are left to base funding decisions on anecdote and extrapolation. What is needed is a new research initiative, the Global Research Map. The initiative will combine a comprehensive literature categorization with supplemental surveys to produce a topography of global AIDS research.