The Global Fund over the past four years has gone from launch to $3.6 billion in grant agreements. It has been a remarkable demonstration of speed and finesse. Richard Feachem, who on Friday announced he will be leaving his position as Executive Director, deserves respectful thanks for his impressive efforts in this enterprise.

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.

Kudos to HBO Films for making an important (and entertaining) romantic comedy about -- the Millennium Development Goals (yes, that's correct). Screenwriter Richard Curtis (Four Weddings and a Funeral, Love Actually, Notting Hill) wanting to address a more weighty topic, penned a screenplay of serendipitous romance against the backdrop of a G8 conference debating poverty strategy. I saw last night the premier of "The Girl in the Cafe" at the French Embassy in Washington DC -- it is a fine film. The movie debuts Saturday June 25th at 8pm on HBO and will be replayed subsequently.

Kudos to the New York Times for being a consistent voice in calling for increased US assistance for global AIDS and for African relief. Today's editorial "Crumbs for Africa" criticizes the Bush Administration for its miserly African aid offer of $674 million of funds already allocated by Congress.

The United States currently gives just 0.16 percent of its national income to help poor countries, despite signing a United Nations declaration three years ago in which rich countries agreed to increase their aid to 0.7 percent by 2015. Since then, Britain, France and Germany have all announced plans for how to get to 0.7 percent; America has not. The piddling amount Mr. Bush announced yesterday is not even 0.007 percent.

What is 0.7 percent of the American economy? About $80 billion. That is about the amount the Senate just approved for additional military spending, mostly in Iraq. It's not remotely close to the $140 billion corporate tax cut last year.

There is little enthusiasm in the Executive Branch for more generous assistance to Africa. Congress is somewhat better, but still ineffectual. Even the American public is divided: in today's CNN web poll "Is the United States doing enough to help Africa?", of the first 100,000 respondents, 51% answered "yes".

Most Americans believe we spend much more on assistance than we do. In reality we're at the bottom of the list of rich countries in terms of aid as a percent of GDP. As Jeff Sachs says, the notion that there is a flood of American aid going to Africa "is one of our great national myths." It unfortunately doesn't appear to be a myth that will be rectified soon.

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.

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.

We are well-familiar with the impressive AIDS philanthropic work of one high-tech entrepreneur, but there is another entrepreneur less lionized, but worthy of acknowledgement. Ed Scott, co-founder of BEA Systems, is the co-founder and principal funder of the Center for Global Development, a well-regarded policy institute with considerable focus on HIV/AIDS. He also co-funds DATA, a global AIDS advocacy organization, and most recently provided financial support to launch Friends of the Global Fight, which advocates on behalf of the Global Fund. Ed's background is atypical for a software entrepreneur, including 17 years of work for the US government. He apparently keeps a low profile (a quick Google search demonstrates that), but his efforts are impressive and meritorious.

When Jim Kim, Senior Advisor to the Director General of the World Health Organization. spoke in Bangkok about AIDS, he touched on many familiar refrains: challenges, goals, progress and needs. He also touched on one refrain new to my ear: opportunity. AIDS, in all of its devastation, offers an opportunity to address many issues in healthcare that have been neglected for decades. Because of AIDS, health centers are being built, health providers are being trained, healthcare finance is being restructured -- it's a long, long list reflected in the many diverse topics discussed at Bangkok. Jim speaks not only with credible credentials (Harvard training, co-founder of Partners in Health, recent MacArthur Grant winner), but with the experience of tackling TB for years in many difficult environments. He has seen that seemingly intractable problems can be addressed with new resolve, and AIDS is providing exactly that resolve to the international community, and as such, an impressive new opportunity.

The Global Fund has made remarkable progress in thirty months. While many people deserve credit, much of the success is certainly due to Richard Feachem. He brings experience, stature, and communications skills few can match. Most impressively, he strikes a persuasive posture of inclusiveness, listening to others, reacting to advice, and structuring the organization in a way that is far more responsive to country needs than any other donor. His staff reflects this culture of inclusiveness, carrying an intelligent humility in every Global Fund presentation I've seen. Congratulations.

Today we launched a "Global Dialogue" interview which I conducted recently with Dr. Paul Farmer, director of the Clinique Bon Sauveur in Cange, Haiti (and Harvard professor in his free time). In it he discusses successes and failures of AIDS efforts in Haiti, and how lessons might apply elsewhere. He is particularly passionate about the necessity of integrating prevention and care efforts.

Paul, for those of you not familiar with him, represents astounding scholarship and indefatigable efforts on behalf of the poor, all nicely catalogued in the recent bestseller "Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World". His successes in Cange make it impossible for policymakers to say "it can't be done". Even as a med student (where, incidentally, we were classmates -- although he spent much of his time in Haiti!), he already was proving what progress on health was possible in the most difficult of environments. He probably needs to clone a few more of himself to stay intact (or at least share more of his experiences online...).

With the launch of the latest study of the Global HIV Prevention Working Group, the issue of "prevention vs. treatment" has been resurrected. Helene Gayle, Director, HIV, TB and Reproductive Health programs at the Bill & Melinda Gates Foundation, has emerged with an unambiguous call for more attention on prevention. The Wall Street Journal reported yesterday:

"World-wide, prevention expenditures fall below $2 billion. Dr. Gayle urged that spending on prevention be tripled to roughly $6 billion by 2005. If prevention funding isn't increased, she warned that all the world's drug programs will never keep pace with the spread of HIV."

The "prevention vs. treatment" debate came to a head several ago (in great part due to falling drug prices), but then was replaced by calls to "integrate treatment and prevention", suggesting there was no longer tension. Of course treatment and prevention need to be closely integrated (as the report says clearly), but unfortunately health officials still face difficult budget and program decisions everyday. Congratulations to Helene Gayle for promoting a point of view that is both out of vogue and vital.

When Bernard Rivers founded AidSpan, he had no organizational backing, no obvious source of funding, but a conviction that an independent Global Fund watchdog and resource would be significant. Since then he has served as a font of useful information (and happily has attracted initial financial support from the Soros Foundation and others). Just this week Aidspan released a new, terrific report, "An Updated Analysis of the Equitable Contributions Framework regarding the Global Fund" Bernard combines sectoral knowledge, technical skills, personal diplomacy and unbridled passion in an impressive and impactful mix.

As I meet with professionals involved with HIV/AIDS, I periodically ask "whom do you admire in the field?" One name I hear frequently: John Stover of the Futures Group. John seems to prefer a low profile, but seemingly every major policy or research document on AIDS includes citations to his work. (Some of his papers can be read on the IAEN.) We're impressed.