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Kaiser Daily Global Health Policy Report

In The News

Devex Examines Questions, Concerns Over New PEPFAR Strategy

Devex: A look at PEPFAR’s strategy: Controversies and motivations
“Last September, the United States President’s Emergency Plan for AIDS Relief announced a new strategy, one that left some AIDS experts with questions — and concerns — about what it would mean for the future of the flagship U.S. global health program and the fight against an epidemic that faces growing demographic challenges…” (Saldinger, 7/27).

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Experts At AIDS 2018 Discuss Funding Gap, Future HIV/AIDS Progress

aidsmap: Donor funding for HIV stalls, increasing pressure on high-burden countries to mobilize domestic resources
“… At a press conference, Jennifer Kates of the Kaiser Family Foundation presented data from their recent joint report with UNAIDS alongside three further studies showing that overall funding by donor governments has largely stalled, with eight out of 14 governments reducing their global spend on HIV efforts in 2017. A rise in overall funding from 2016-17 was due to changed timings in U.S. spending and not expected to be replicated in future. ‘We are in a different age of financing,’ she concluded, ‘There is no significant new funding’…” (Power, 7/25).

Newsday: Funding gaps threaten HIV, AIDS fight
“…Speaking during the opening ceremony, UNAIDS Executive Director Michel Sidibé said there was need to close the funding gaps. ‘Like you, I worry about the funding gap. There is a persistent 20 percent gap between what is needed and what is available. We know small cuts can have big consequences. A fully funded AIDS response is non-negotiable,’ he said…” (7/27).

Globe and Mail: HIV-reduction targets looking increasingly like an unattainable dream
“… ‘We are not on track to end the HIV epidemic,’ Dr. Peter Piot, director of the London School of Hygiene & Tropical Medicine, told more than 15,000 delegates to the International AIDS Conference in Amsterdam on Thursday. ‘We’ve made tremendous progress, but the discourse on ending AIDS has bred a dangerous complacency,’ he said. … ‘There’s a $6 billion gap between what’s needed and where we are,’ said Dr. Jennifer Kates, director of global health & HIV policy at the Kaiser Family Foundation. ‘It’s not clear how it will be made-up in the short-term’…” (Picard, 7/26).

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AIDS 2018 Hears About Implications Of U.S. Mexico City Policy For HIV/AIDS Efforts Worldwide

Medical Xpress: Abortion exclusion to U.S. aid threatens HIV battle: Conference hears
“Scientists and activists warned Friday that antiabortion conditions attached to U.S. aid under the Donald Trump administration threatened programs to halt the spread of HIV. … ‘Now, under the Trump administration, [the Mexico City policy] applies to almost all U.S. global health bilateral assistance, including PEPFAR,’ [International AIDS Society (IAS) President-elect Anton Pozniak] told journalists on the final day of the 22nd International AIDS Conference in Amsterdam. ‘The reach of this policy has been greatly expanded, and has the potential to roll back progress on HIV.’ … Jennifer Kates of the Kaiser Family Foundation, a health research NGO, said the altered policy ‘will likely affect hundreds of recipients’ of U.S. funding. … ‘Some of the greatest harms of the global gag rule will not be measurable … until it’s too late to reverse course,’ said Chloë Cooney of the Planned Parenthood Federation of America…” (7/27).

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People Living With HIV Continue To Face Workplace Discrimination, ILO Study Says

U.N. News: ‘Stigma and discrimination still persists’ against people living with HIV — U.N. labor agency
“Although progress in treating people living with HIV has enabled them to work, they continue to face career discrimination, says a new study launched on Thursday by the United Nations labor agency. Based on 13 country team surveys throughout the world, the International Labour Organization’s (ILO) HIV Stigma and Discrimination in the World of Work: Findings from the People Living with HIV Stigma Index, draws on interviews with more than 100,000 people living with the virus…” (7/26).

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HIV Criminalization Laws Ineffective, 20 Experts Say In Joint Statement Released At AIDS 2018

The BMJ: Criminalizing HIV transmission is counterproductive and should stop, experts say
“Twenty experts in AIDS research, epidemiology, and care have said in a joint statement that evidence does not support using laws to criminalize the transmission of HIV…” (Hurley, 7/26).

MedPage Today: HIV Criminalization Called Ineffective and Unjust
“… ‘Simply put, HIV criminalization laws are ineffective, unwarranted, and discriminatory. In many cases, these misconceived laws exacerbate the spread of HIV by driving people living with and at risk of infection into hiding and away from treatment services,’ said Linda-Gail Bekker, MBChB, of the University of Cape Town and president of the International AIDS Society…” (Susman, 7/26).

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Study Examines HIV Incidence, Population Growth Among Young People In Africa

aidsmap: Progress against HIV in young people lags behind as Africa’s youth population grows
“Africa is far off track in reducing new HIV infections among children and young people and is unlikely to reduce new infections in young people substantially before 2030 due to an anticipated doubling of the adolescent population, according to findings from a UNICEF modeling exercise presented on Thursday at the 22nd International AIDS Conference (AIDS 2018) in Amsterdam…” (Alcorn, 7/26).

MedPage Today: HIV: The Kids Aren’t All Right
“…If current trends continue, [Aleya Khalifa of UNICEF] said, the number of new infections among children ages zero through four will have dropped by 50 percent by 2030. In contrast, the number of new infections among those 15 to 19 will only drop by half in 2050. Those young people will age into older groups, sustaining the number of adults living with HIV, she said…” (Smith, 7/26).

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Media Outlets Report On Range Of HIV/AIDS-Related Issues, Developments Emerging From AIDS 2018

Canadian Press/Globe and Mail: Study finds mutated strains of HIV in Saskatchewan causing quicker illness (7/26).
The Guardian: Mutated HIV strains in Canada may cause quicker illness, study finds (Kassam, 7/27).

The Economist: A certain weariness is entering the war on AIDS. Wrongly so (7/26).

Healio: Deal gives resource-limited countries affordable access to ID testing (7/25).

MedPage Today: HIV Increases Heart Failure Risk (Smith, 7/26).

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U.S. FDA Approves New Malaria Treatment Effective In One Dose

CNBC: Gates Foundation CEO: FDA’s approval of single-dose drug to fight malaria
“Sue Desmond-Hellman, Gates Foundation CEO, talks about the importance of a new drug, Krintafel (tafenoquine) that offers hope of a radical cure for malaria. Also Desmond-Hellman shares her thought on preparing for the next pandemic threat…” (7/27).

NPR: New Drug Wipes Out Malaria In A Single Dose — But There’s One Hitch
“…On Friday, the U.S. Food and Drug Administration approved a drug to cure a type of malaria that’s been hard to stop. Called Plasmodium vivax, the parasite can hide out in a person’s liver for months and cause multiple rounds of malaria — even after being treated. … But there’s just one big hitch: To use tafenoquine, doctors and nurses need a sophisticated test that’s not available in many poor places. In certain people, tafenoquine can cause red blood cells to burst open and die. As a result, people can became anemic, and in some instances, this can be lethal…” (Doucleff, 7/26).

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Yemen Risks New Cholera Epidemic In Warmer Months, Save The Children Warns

Al Jazeera: Yemen ‘on brink of new cholera epidemic,’ charity warns
“Thousands of people in Yemen could be affected by a new wave of deadly cholera in the coming weeks, an international charity says. In a press release on Thursday, U.K.-based Save the Children warned the hot summer months are ideal conditions for cholera to spread rapidly. It added that almost 3,000 suspected cholera cases were reported in the first week of July across the country — the highest number since the start of the year…” (7/25).

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Advocates Welcome Somalia's Move To Prosecute FGM Case

The Guardian: Death of 10-year-old girl prompts first FGM prosecution in Somalia’s history
“Somalia’s attorney general has announced the nation’s first prosecution for female genital mutilation after a 10-year-old girl bled to death following a traditional cutting last week. The announcement has been described as a ‘defining moment’ in a nation where 98 percent of all women and girls undergo FGM, the highest rate anywhere in the world. … The surprise announcement has been welcomed by campaigners all over the world. FGM survivor and activist Ifrah Ahmed, 26, said the declaration ‘had taken everyone by surprise.’ ‘It shows just how quickly things can move when there is political will,’ said Ahmed…” (Hodal, 7/26).

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More News In Global Health

The Atlantic: The Deleted WeChat Post That Fueled China’s Vaccine Scandal (Zhang/Yuan, 7/25).

Devex: In Cambodia, a tobacco control campaign helped. But now what? (Ravelo, 7/27).

Devex: A simple pair of eyeglasses increases earnings and productivity for tea pickers in India (Cheney, 7/26).

Forbes: Elite U.S. Doctors Share Expertise With Developing World To Improve Global Health (Thorpe, 7/26).

The Lancet: Hepatitis C treatment in Guatemala: the struggle for access (Webster, 7/28).

Thomson Reuters Foundation: Chad health centers overwhelmed with spike in malnourished children (Peyton, 7/26).

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Editorials and Opinions

Funding, Political Will Critical To Reaching AIDS-Free Generation

CNN: The end of the AIDS epidemic is (almost) in reach
Elizabeth Radin, technical director for the Population-based HIV Impact Assessment Program at ICAP at Columbia University

“…While an end to the [HIV/AIDS] epidemic is coming into view, the battle is not yet won, and near victory could turn to renewed tragedy. … In order to expand treatment to nearly 37 million people living with HIV and reduce new infections to zero, we need to increase financial support and intensify programming. … Continued U.S. commitment to the AIDS response is critical for multiple reasons. With the U.S. contributing [nearly] eight times as much as the second leading donor, the United Kingdom, even a small percentage change in U.S. support would be deeply felt. Additionally, if the U.S. were to decrease funding significantly for the AIDS response, other countries may follow suit in a domino effect that could lead to a deadly resurgence of HIV around the world. Already, analysis by the Kaiser Family Foundation has found that eight of the 14 countries that provide international funding for AIDS decreased their support last year…” (7/26).

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New WHO 'Treat All' Guidelines, Direct-Acting Antivirals Helping To Transform Hepatitis C Treatment

The Lancet: Transforming treatment for hepatitis C
Editorial Board

“…The new [WHO guidelines for the care and treatment of people with chronic hepatitis C infection] strongly recommend offering treatment to all people aged 12 years and older (except pregnant women) who have chronic hepatitis C infection, irrespective of disease stage. Treatment regimens that can cure all six major subtypes of hepatitis C infection are recommended, including the use of direct-acting antivirals, which have become available since 2016. These new ‘treat all’ guidelines remove the need for expensive genotyping to determine the best treatment for the specific strain of the virus, simplify treatment, and enable task shifting so that non-specialized health care workers can deliver care. … The continued price reduction of direct-acting antivirals means that rolling out treatment for all can be cost effective, while also reducing deaths, preventing liver cancer development, and reducing new infection rates. It is fair to say that the development and success of direct-acting antivirals is transforming hepatitis C treatment” (7/28).

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International Research Community Can Better Support Malaria Health Workers

Nature: Pay people to fight malaria
Editorial Board

“…[T]he best way to beat malaria is to ensure that every infected person can quickly reach a health worker and be given artemisinin-based combination therapies (ACTs) … Yet health systems in many malaria-endemic nations are riddled with holes. … Malaria health workers are often unsalaried, so many leave for other jobs. Networks of researchers, technicians, and administrators support health workers, provide surveillance and inform policy. But health budgets in low-income nations are often too small to attract enough of these skilled workers. At present, too many of these crucial positions are unpaid. … The problem is complex, but there are a few ways in which the scientific community could help. Researchers can analyze the costs and value of health-system components and compare them with those of other projects, such as genetically modifying mosquitoes to wipe them out, or conducting vaccine studies. This would help donors and governments re-evaluate their priorities when funds are limited. … Public health officials attributed [Paraguay’s recent elimination of malaria] to its health system’s ability to quickly detect, treat, and track cases. Sometimes, the classic recipes are the best” (7/25).

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From the Global Health Policy Community

AIDS 2018 Official Press Release Discusses Implications Of U.S. Mexico City Policy For HIV/AIDS Efforts

AIDS 2018: New evidence shows far-reaching impact of expanded U.S. ‘global gag rule’
“Researchers shared alarming evidence at the 22nd International AIDS Conference (AIDS 2018) today of negative impacts of the U.S. Government’s ‘Mexico City Policy’, also known as the ‘global gag rule’…” (7/27).

The latest official AIDS 2018 press releases are available online.

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'Science Speaks' Discusses Research On Sex Work-Related Laws Presented At AIDS 2018

IDSA’s “Science Speaks”: AIDS 2018: Laws meant to end demand for sex work increases workers’ HIV risks, researchers say
Reporting from the 22nd International AIDS Conference in Amsterdam, Rabita Aziz, writer at “Science Speaks” and senior global health policy specialist at IDSA, discusses research presented at the conference that shows “[s]ex work criminalization laws and so-called ‘end demand’ policies — laws attempting to abolish sex work by making it a crime to pay for sex services — increase marginalization, stigmatization, discrimination, and subsequently reduce access to health services and increase risks for HIV infection” (7/26).

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Unitaid Launches 2 Grant Projects Promoting HIV Self-Testing

Unitaid: Unitaid steps up drive to revolutionize HIV diagnosis
“Unitaid stepped up its drive to revolutionize HIV diagnosis with today’s launch of two grant projects that promote self-testing as a key to turning the course of the world’s HIV epidemic. Unitaid’s investments in HIV self-testing now stand at more than US$100 million…” (7/25).

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Lancet Global Health Article, Commentary Examine Use Of NTD Service Coverage Index To Monitor Progress Toward UHC

The Lancet Global Health: Monitoring equity in universal health coverage with essential services for neglected tropical diseases: an analysis of data reported for five diseases in 123 countries over 9 years
Christopher Fitzpatrick, health economist at the WHO’s Department of Control of Neglected Tropical Diseases, and colleagues discuss the development of an NTD service coverage index to monitor progress toward universal health coverage (UHC). The authors write, “Comparing the NTD and UHC service coverage indices reveals that some countries that are performing well by the measure of the UHC service coverage index still have work to do in prioritizing services for their poorest and otherwise most marginalized communities. Our results offer hope that socioeconomic barriers to health service coverage can be overcome” (7/24).

The Lancet Global Health: Preventive chemotherapy coverage for neglected tropical diseases: does one metric fit all?
Citing the analysis done by Fitzpatrick and colleagues, Elizabeth A. Cromwell, assistant professor, and Nancy Fullman, scientific adviser, both at the University of Washington’s Institute for Health Metrics and Evaluation (IHME), discuss mass drug administration (MDA) of preventive chemotherapy for NTDs, writing, “Timely tracking of MDA program performance within broader health systems is important, particularly as countries aim to improve interventions to control and eliminate NTDs. Yet such efforts also must reflect the unique nature of MDA, which can vary between NTDs and locales — a challenge when developing one metric to fit all monitoring needs” (7/24).

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WHO Calls For Urgent Increase In Hepatitis Testing, Treatment, Releases Updated Care Guidelines

WHO: Urgent increase in hepatitis testing and treatment needed
“The World Health Organization (WHO) and partners are … calling on countries to urgently increase hepatitis testing and treatment services in order to eliminate viral hepatitis as a public health threat by 2030. The calls come in the lead-up to World Hepatitis Day 2018 on 28 July, which focuses on the theme ‘Test.Treat.Hepatitis.’ … WHO and global partners are sharing the experiences of countries such as Mongolia to promote sustained political commitment and broad-based partnerships in many other countries. Reinvigorated action and investments in viral hepatitis are necessary to achieve a world where transmission is halted and everyone living with viral hepatitis has access to safe, affordable, and effective care and treatment” (7/26).

WHO: Guidelines for the care and treatment of persons diagnosed with chronic hepatitis C virus infection
“These guidelines aim to provide evidence-based recommendations on the care and treatment of persons diagnosed with chronic HCV infection. They update the care and treatment section of the WHO Guidelines for the screening, care, and treatment of persons with hepatitis C infection issued in April 2016…” (July 2018).

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From the U.S. Government

PEPFAR Announces New Results, Commitments To Address Gaps In HIV/AIDS Response Among Men, Key Populations

U.S. Department of State: New Results and Commitments by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)
“This week at the 2018 International AIDS Conference in Amsterdam PEPFAR announced critical new progress toward reaching HIV epidemic control and strong commitments to address key gaps in the HIV/AIDS response among men and key populations. Several African countries are now on track to reach HIV epidemic control by 2020 with PEPFAR support. New data from Namibia demonstrate that PEPFAR investments have helped reduce the country’s rate of new HIV infections by 50 percent over the past five years. … PEPFAR also announced $360 million in planned investments for key populations over the next year, including $260 million, pending congressional approval, through its 2018 Country Operational Plans and nearly $100 million from its Key Populations Investment Fund…” (7/25).

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Global Scale-Up Of Chlorhexidine Can Reduce Rates Of Newborn Deaths, USAID Blog Says

USAID’s “ImpactBlog”: How One Simple Solution Has Saved Thousands of Babies
Mateo Haddad, global health communications intern, and Bethany Reyes, data science intern, both at USAID, discuss the use of the antiseptic chlorhexidine to prevent infections in surgery and childbirth in Nepal and other nations. The authors write, “In low-resource countries, [chlorhexidine] can also be used to protect the umbilical stumps of newborns to prevent life-threatening complications from infection. … As the use of chlorhexidine for preventing newborn deaths continues to grow, the global health community must keep on exploring new ways to introduce and scale-up proven life-saving interventions” (7/26).

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