Opinions: Obama's Global Fund pledge; harm reduction in Iran; HIV prevention; African development

Congress Must Honor Obama's Global Fund Commitment

"There are some encouraging signs in the epic battle against AIDS and HIV infections. ... But those bright spots dim considerably in the face of the fact that about 7,100 people a day become infected. And that's why the WHO continues to mark the advances and all the need every December. Now in its 22nd year, Worlds AIDS Day, which will be observed tomorrow, draws attention to the continuing worldwide scourge," according to a Times of Trenton editorial.

"The U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria has helped dramatically increase resources to fight three of the world's most devastating diseases in countries of greatest need," the editorial notes, adding that the U.S. has a "moral responsibility to continue leading the fight against AIDS and its attendant diseases." The newspaper notes President Barack Obama's recent $4 billion pledge over three years to the Global Fund. "It's up to Congress to honor that commitment. We urge it to do so," the editorial concludes (11/30).

Praise For Iran's Harm Reduction Program

In a post on the New York Times' "Opinionator" blog, author Tina Rosenberg highlights how needle exchange programs can reduce the spread of HIV/AIDS and specifically applauds Iran's harm reduction program. In 2005, "harm reduction had become official policy in Iran. ... Even prisons in Iran now have widespread methadone, and there have been pilot projects in prisons for needle exchange ─ something not yet found in prisons in the United States, Canada or Australia. In 2007, 95 percent of drug injectors surveyed in Iran said they had used safe equipment when they last injected," Rosenberg writes. "The rate of new HIV infections in Iran rose until 2005, and has dropped ever since," she notes, adding that Iranian drug control official Saeed Sefatian "said in 2008 that 18 percent of injecting drug users were HIV-positive, but estimated that if it weren't for harm reduction, that number would have been 40 percent."

"By pointing out the success of this program, I do not mean to endorse Iran's prisons, where political dissidents are being tortured. Nor does Iran's modern approach to harm reduction redeem the government's stone-age approach to just about everything else. ... The important point here is that even a theocracy as repressive and rigid as Iran ─ the anti-Amsterdam ─ managed to create policies that have likely saved the country from an AIDS and drug disaster," Rosenberg argues (11/29).

Donor Governments, Developing Countries Must Invest More In HIV Prevention

"Increasingly ... both donor and recipient governments are questioning the sustainability of foreign funding for antiretroviral treatment. ... It has become clear that treatment for HIV, though still crucially important, can't solve the problem. That will only happen through preventing transmission of the virus in the first place," Seth Berkley, CEO of the International AIDS Vaccine Initiative, writes in a Los Angeles Times opinion piece. Berkley highlights some of the current promising prevention options, including the use of the drug Truvada for pre-exposure prophylaxis and the HIV vaccine candidate tested in Thailand that showed the "first proof of efficacy - albeit modest efficacy."

"Though the science for these new tools is promising, the funding base is flat, despite large investments of stimulus dollars by the United States government," Berkley notes, praising the U.S. "for financing the lion's share of both HIV treatment in Africa and HIV prevention research internationally." He continues: "Other donor countries that are contributing to HIV treatment globally should also make simultaneous and significant investments in new prevention methods to ensure that their HIV costs won't rise indefinitely. Governments of developing countries can also play their part, first by instituting proven HIV prevention efforts while being accountable for results as measured by reductions in new infections. Second, they can demand the development of new HIV prevention tools as passionately as they have demanded universal access to HIV treatment" (11/29).

Wall Street Journal Essays Examine Differing Views On African Development

In a Wall Street Journal essay exploring various ideas presented in the book, "The Rational Optimist: How Prosperity Evolves," by science writer Matt Ridley, Bill Gates, co-chair of the Bill & Melinda Gates Foundation, writes: "Development in Africa is difficult to achieve, but I am optimistic that it will accelerate. Science will come up with vaccines for AIDS and malaria, and the 'top-down' approach to aid criticized by Mr. Ridley (and by the economist William Easterly) will fund the delivery of these life-saving drugs. What Mr. Ridley fails to see is that worrying about the worst case - being pessimistic, to a degree - can actually help to drive a solution" (11/27).

In a response to Gates also published in the Wall Street Journal, Ridley writes: "I think that we agree on the most important point, namely, that Africa can have a good future. ... Far from saying that aid 'doesn't work, hasn't worked and won't work,' I actually say this in my book: 'Some of the most urgent needs of Africa can surely be met by increased aid from the rich world. Aid can save lives, reduce hunger, deliver a medicine, a mosquito net, a meal or a metalled road.'" Ridley goes on to write: "Now here I admit that Mr. Gates does have a point. Unintentionally, I have given him and perhaps other readers the impression that, in my view, combating malaria or AIDS does not pay economic dividends. It does. What I do take issue with is economic aid designed to stimulate economic growth" (11/27).