L48 Anthro 3283 Chapter Notes - Chapter 5: Heavily Indebted Poor Countries, International Monetary Fund, Global Health
RGH Ch. 5 Redefining the Possibilities
The Golden Age of Global Health
• Between 2000 and 200, the U.S. government increased funding for international AID
prevention and treatment more than tenfold
• Christian conservative leaders had a history of opposing federal funding for AIDs
treatment and research even in the 1980s and 1990s
o “AIDS is god’s punishment” for homosexuality and punishment
• PEPFAR launched during an era of Republican control over legislative and executive
branches
o Treatment programs increased from about $300 million in 2000 to $3.4 billion in
2006
o This influx of funds dramatically increased access to services in many developing
countries affected by the pandemic
• 2000, the U.S. funded antiretroviral therapy (ART) for about a few hundred patients
around the world; in 2009, PEPFAR supported treatment for 2.5 million people in 24
nations and interventions for 509, 800 HIV-positive pregnant women
o PEPFAR accredited for preventing millions of deaths
• 1994, the Bill and Melinda Gates Foundation became the largest private funder of global
health research and implementation
• in 2009, the Gates Foundation disbursed over $10 billion for global health
o focused on discovery, delivery, and policy advocacy to fight and prevent major
global health problems, including diarrheal diseases, HIV/AIDS, malaria,
pneumonia, tuberculosis, family planning, nutrition, maternal, neonatal and child
health, vaccine-preventable diseases
• 2002 – the Global Fund to Fight AIDS, Tuberculosis and Malaria was established
o 2011 – approved $22.6 billion for more than 1000 grants in 150 countries
• In 1996, the World Bank and The International Monetary Fund offered debt relief to
heavily indebted poor countries, writing more than $76 billion in debt and thereby
increasing resources available for public health in the government budgets of poor
countries
• “3 by 5” initiative launched by the WHO and the Joint UN Program on HIV/AIDS
(UNAIDS) in 2003
o set a goal of extending ART to 3 million people living with AIDS in low-and
middle-income countries by the end of 2005
o by measuring success according to the numbers of people being treated rather
than the amount of money donated, the campaign encouraged accountability
among donors
o the target was not reached until 2007, but it helped galvanize the global AIDS
effort
o at the end of 2011, 6.6 million people were receiving ART
• rise of development assistance for the health in the 2000s much greater than in the 90s
• Peter Berger and Thomas Luckman, before the 2000s the low expectations for
international health were the norm
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o Health providers became accustomed to targeting the “low-hanging fruit” of
public health – vaccines, handwashing, bed nets, condoms, and the GOBI
interventions
o Socialized for scarcity
o Accepted the high prices of lifesaving interventions, including ART and TB
treatment as fixed
From Death Sentence to Chronic Condition
• In the 1980s and the 1990s, an HIV diagnosis was a guarantee for an early death
o Physicians in both rich and poor settings lacked therapeutic tool capable for
suppressing the virus and preventing the onset of clinical symptoms; the best they
could do was treat opportunistic infections associated with HIV such as
pneumonia and herpes
• In 1987 AZT was the first drug to be found safe and effective to slow replication of HIV
o Until the introduction of didanosine in 1991, AZT monotherapy was the only
treatment option – only accessible to patients who could afford the cost of $8,000
a year
o AZT suppressed the virus for a time, but not long enough
• Mortality rates from the disease increases steadily in the U.S. between 1987 and 1995
• The Invisible People – history of the AIDS pandemic from the 1980s - early 2000s
o Behrman notes that the few activists in the U.S. understood the magnitude for the
pandemic; even fewer were willing to expand their campaigns beyond U.S.
borders
• People protested for increased AZT monotherapy, more research, more rapid FDA
approval of drugs, nondiscrimination and other measures of care and prevention
• AIDS Coalition to Unleash Power (ACT UP) (Eric Sawyer co-founder)– as of mid-
1990s, only 10% of the activist community paid attention to the global pandemic
• 1996 – turning point in the search for effective therapeutics against AIDS; 2 drugs were
approved
• David Ho, scientific director and CEO of the Aaron Diamond AIDS Research Center in
NY announced study results demonstrating that regimens containing 3 ART drugs from
at least 2 different classes of antiretrovirals → known as the Highly Active Antiretroviral
Therapy (HAART), suppressed the virus and restored patients’ immune systems
• For those who could access the drugs, it seemed possible that AIDS would become a
chronic disease rather than a certain killer
• According to the CDC, AIDS mortality rates declined; by 1998, fewer people in the U.S.
were dying of AIDS-related causes than in 1991
One World, One Hope? Different Incomes, Different Outcomes
• Vancouver Conference “One World, One Hope”
• Initially pharmaceutical companies set prices for the ART with a 3-drug cocktail at
$10,000-$15,000 a person/year – far out of reach for most people living with AIDS
• Sawyer argued that AIDS treatments should be made available to the poor everywhere, at
cost or at very minimal profit
• 2002, 2 articles from The Lancet, a medical journal, said HAART was not cost-effective
in poor countries
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Document Summary
Ny announced study results demonstrating that regimens containing 3 art drugs from at least 2 different classes of antiretrovirals known as the highly active antiretroviral. Different incomes, different outcomes: vancouver conference one world, one hope . Initially pharmaceutical companies set prices for the art with a 3-drug cocktail at. Initially, the clinton administration sided with the pharmaceutical companies: al gore expressed the u. s. government"s opposition to the medicines act, american activists called on the clinton administration to stop pressuring south. ,000-,000 in the late 1990s to in 2002 and to in 2007. University students and access to medicines, yale and d4t. In the mid-1980s, a team of researchers at yale detected the potency of d4t, an antiretroviral also known as stavudine, against hiv; yale secured a patent for the discovery. In june 2001, bms agreed not to sue and the price of d4t in south africa dropped by.
