INTE 398 Lecture Notes - Lecture 12: Danaya, Firstline, Global Governance
5 May 2018
School
Department
Course
Professor
Ffar 291/Inte 398 – Intro HIV Class
Lesson 12
12.1 Intro Video
-gonna talk about the cost of HIV
-there has also been a shift of thinking, not related to HIV but things happened simultaneously
-question of who pays for public health, where is the responsibility in the public and
private sectors when needs emerge and when things go wrong, how do we manage the
high cost
-generally those that most econ insecure - deal w devastation of HIV that true on
ind lvl and to some extent on national lvl too
-if not financially viable in terms of resources and pop needs, how do we fit in the
skyrocketing costs for that country's pop
-Is public health a public responsibility?
-many of the hardest hit communities devastated by HIV are socially and economically
marginalize, w poverty often contributing to potential vulnerabilities
-here we explore who is paying for the resources, services and treatment needed to
limit the impact of HIV/AIDS
12.2 The Cost of Treatment Lecture
The Cost of Treatment
-treatment is a complicated issue - involves lots of elements that go into the cost of a drug
when it hits the market
-May 2000 - when the cocktail was available, there was in fact available, standardized, quite
effective treatment available for HIV+ people
-were costing a bit over 10k US$ per person
-around this time, Brazil decided to make treatment available to everyone that needed that
(provided by the state)
-produced generic versions of these medications much more cheaply
-huge reduction of cost in Summer 2000 - how quickly the cheaper version
induced the brand name producers to lower the price
-even as brand producers were lowering costs to be able to maintain some sort of
control over international markets, those producing generic products dropping
their products overtime
-in just a few months, the cost of annual treatment for someone living w HIV went
from over 10k$ to 300$ - HUGE diff
Numbers of People Receiving ARVs
-if look at number of ppl receiving meds, number of ppl has grown exponentially
-ability to get those cheaper meds to those who need it, a lot of those meds allocated to
Afria sie gts theseles do’t hae the resoures to pa treatet for its pop ulike
Brazil that was able to do so
find more resources at oneclass.com
find more resources at oneclass.com
Recommended ARV Treatment Initiation Threshold Among PLW HIV Per Ministry of Health
Guidelines, mid-2016
-over the last little while, the recommendation to start treatment has been moved overtime
-initially, when have AIDS and CD4 cell count when under 200 and that was when first started
giving treatment
-now, when starting treatment earlier so before AIDS were more able to maintain standard lvl
of health and earlier can manage the replication of HIV and the neg impact that HIV has on
their health (so start at CD4 cell count when 350)
-the quicker they are put on treatment, the better they can manage their health
Increased Need
-while overall prevalence rates have stabilized, the growing number of ppl on treatment,
growing rates of resistance to first-line meds, growing pops and a continuing failure to reduce
transmission mean that the response must expand just to stand still
-in past 15-20 years, treatments more accessible, less expensive, more available
-concentrated effort to ensure that ppl who need treatment in regions where high prevalence
of HIV like Sub-saharian Africa
-growing demands for treatment as more countries dev policies that treatment starts earlier
-treatment costs went steadily up even if less expensive to treat ppl per person
-even if incidence went up a bit, prevalence hasn't changed bc ppl not dying w HIV but they
are living longer w HIV so 10 ppl is now 15 ppl
-practically doubled the number of ppl needing treatment in a period of time
-always growing number of ppl getting infected and more ppl need treatment so need more
resources to treat those ppl
-need to keep expanding the response
Combined Impact - Sub-Saharan Africa
-initial costs of ARVs meant many African countries in particular were encouraged by the
World Bank to concentrate on prevention rather than treatment
-it was less expensive to prevent rather than treat
-in 2003, fewer than 100 000 ppl in sub-Saharan Africa had access to such treatment
-a decade later, that figure had increased over 90-fold to 9.1 million in 2013 (number
multiplied by 90)
12.3 Framing AIDS in Times of Global Crisis Reading
-After some hope from the mid-2000s onwards, when unprecedented resources were
mobilized to provide life-saving treatment to the millions dying from HIV/AIDS in the global
South, donors are reneging on their promises, bowing to the imperative of austerity of a self-
inflicted economic crisis.
-Draig o Galtug’s tpolog of strutural ad ultural iolee, this artile eaies ho
the rules and norms of global governance have shaped the context of policy responses to the
pandemic in sub-Saharan Africa, and how these material struggles are intimately bound up
with struggles over the frames through which the disease is portrayed and perceived by key
policy actors and the public.
-First, we argue that the strikingly differential global distribution of the disease is, at least
partiall, attriutale to the strutural iolee of Afria’s eouter ith eolieral
capitalism. Second, we focus on two dominant frames—behavioral and philanthrocapitalist—
find more resources at oneclass.com
find more resources at oneclass.com
and examine how they contributed to a depoliticization of the AIDS crisis, negating the
counter-framing work of transnational AIDS activism.
-The latter, which has done so much to unmask our shared responsibility for the unequal
distribution of vulnerability and death, is critical to countering the threat the economic crisis
poses to the global HIV/AIDS response
12.4 Neoliberalism and Funding Lecture
Building on Past Achievements: Funds Invested in AIDS Programs in Low and Middle-Income
Countries, 1986-2013
-increasing move on part of private enterprise and foundations to try to raise the funds
needed to pay for meds in place where gvts can't or won't take on that responsibility
-clear recognition that global north has far more resources than the global south
-since the 2000s when med was available and beginning to become affordable, a growing
number of either private foundations (Bill and Melinda Gates Foundation for ex) or combined-
gvt resources (either combined btwn gvts or combined btwn gvts and private enterprises)
-ex Global Fund to Fight AIDS, Tuberculosis and Malaria = partnership btwn corporate
and gvt interests
-PEPFAR: The United States President's Emergency Plan for AIDS Relief
-in last few decades, variety of diff bodies created to help increase the funds available to fight
HIV around the world
Scarcity/Austerity
-after some hope from the mid-2000s onwards northern countries are reneging on their
promises to fight the global pandemic, bowing to the ostensibly unassailable imperative of
fiscal austerity due to a self-inflicted economic crisis
-began to double back on their promises to fight the epidemic
-for a uer of reasos, gt ould proise fuds ad ould’t delier or gae feer
funds
-w certain gvts being unable to raise the funds necessary to deal w their own pops, others
proisig fuds that the ould’t delier - ongoing stress to find the resources necessary
Global Funding
-in 2013, funding from donor gvts actually fell to 8.07 billion $ - so a 3% drop on 2012
-this drop was primarily the result of declining annual commitments by the US gvt - the
world's largest HIV donor
-in 2012, 47% of all HIV spending was in Sub-Saharan Africa followed by Latin America (17%)
-Meanwhile
-over the last 2 decades, the private sector (commerces, busn) has emerged as the
world's top source of financing and leadership in the fight vs deadly diseases
-in 1970, these private contributions constituted a quarter of the WHO budget. By 2008,
they constituted nearly 80%
-philanthropies provided 636 million $ for global HIV and AIDS programs in 2012, the
majority of which comes from US-based ones (467 million $), followed by EU-based
ones (147 million $) and 38 million $ comes from philanthropies elsewhere
-public sector moving out and private sector moving on
The World Bank
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
There has also been a shift of thinking, not related to hiv but things happened simultaneously. Question of who pays for public health, where is the responsibility in the public and private sectors when needs emerge and when things go wrong, how do we manage the high cost. Generally those that most econ insecure - deal w devastation of hiv that true on ind lvl and to some extent on national lvl too. If not financially viable in terms of resources and pop needs, how do we fit in the skyrocketing costs for that country"s pop. Many of the hardest hit communities devastated by hiv are socially and economically marginalize, w poverty often contributing to potential vulnerabilities. Here we explore who is paying for the resources, services and treatment needed to limit the impact of hiv/aids. Treatment is a complicated issue - involves lots of elements that go into the cost of a drug when it hits the market.
