20 July 2009

U.S. Leaders Address HIV Policies Under Obama

U.S. Ambassador at Large and Global AIDS Coordinator Eric Goosby and National Institute of Allergy and Infectious Diseases (NIAID) Director Anthony Fauci today addressed U.S. global HIV policy, research and implementation under the Obama Administration in a special session. Addressing the current debate over when to initiate antiretroviral therapy, Dr. Goosby noted that the science clearly shows starting treatment at CD4 cell counts of 350 is better than starting at counts of 200. He assured delegates that this science will inform discussion of whether the World Health Organization's HIV treatment guidelines should be revised, but also noted that fiscal realities of what countries can afford will be a consideration. Dr. Goosby also said that PEPFAR is committed to mainstreaming responses to gender inequality in its activities and the programmes it supports. "We know we must place a special emphasis on women and girls to address gender inequity," he said.

[Update: A webcast of the session is now available.]

Dr. Fauci reviewed the current state of HIV science and U.S. health policy, noting the benefit and cost-effectiveness of beginning treatment earlier. He cited research showing that the annual cost of caring for someone who starts treatment late in the course of disease (with a CD4 cell count of less than 50) is twice as high as the cost of care for someone who began treatment earlier. Dr. Fauci also said that he is confident the U.S. entry ban on people living with HIV will be lifted, as will the ban on federal funding of needle exchange programmes operating in the U.S. Both issues are under active consideration in the U.S. at present.

The special session was chaired by
Global Fund Executive Director Michel Kazatchkine.

Additional notable quotes from the session included:

Michel Kazatchkine:

"I hope that Obama's stated commitment to restoring science to its rightful place applies to all the responses to HIV."

"Many of us are hoping for change in US policies on abstinence, needle exchange and addressing populations most at risk."

Anthony Fauci:

"Every bit of data we accumulate, we move to the realization of starting HAART earlier."

"Everything points to earlier HIV therapy."

"With regard to the science and the policy, we will stay on the right path."

Eric Goosby:

To the delegates, "You've permanently changed the landscape of global health."

"PEPFAR is committed to mainstreaming responses to gender inequality in its activities and the programmes it supports."

"The end goal is for each country to be in a position to control its response to HIV."

Update: the Center for Global Health Policy also blogged about this session on Science Speaks.

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