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Trimming treatment for AIDS patients

I read the New York Times account of the president’s new AIDS plan, and all that came to mind were the images of people I met in Africa who were dying of the disease because they had no access to antiretroviral drugs. People like Susan Andukais, who was in the last throes of AIDS when I met her and was gone within weeks, leaving four children behind. Or those who were able to live - people like Joseph Mbsa, who is able to care for his HIV-positive son because both were able to get medications through U.S.-funded nonprofits.

I wonder where the new plan would leave these folks now. The program, officially known as the President’s Emergency Plan for AIDS Relief (PEPFAR) is getting wide criticism today because it cuts back on treatment initiatives. Instead of keeping up with its standard of putting 500,000 people on treatment each year, it will provide life-giving therapy for only 320,000 each year, according to the Times account. Instead, more funds will go to other medical therapies, such as oral rehydration packets for diarrhea, or generic antibiotics, that are cheaper and save lives as well.

I understand this logic in the context of limited resources. But it feels like a betrayal, as so much more was promised when former President George W. Bush (yes, Bush) created this ambitious and highly successful program. An estimated nine million people in poor countries now are in need of antiretroviral drugs, and every year 3 million more become infected with HIV, according to the Times report. So prevention, too, is important, to change this equation. The question is how to strike a balance.

“I would say that devoting resources to both HIV prevention and treatment is essential, because we get further behind each year in providing treatment to those who need it if we can’t slow the pace of new infections,” notes Douglas Owens, MD, a health policy and HIV researcher here at Stanford. “And it’s important to remember that in HIV, treatment is prevention, because antiretroviral therapy reduces transmission,” meaning fewer people would get infected if there were more access to drugs.

I think many people had great expectations when Obama was elected president that he would continue the momentum of this valuable program. Ironically, AIDS activists now are pining for the days of President Bush, when there was no question about U.S. loyalty to AIDS patients in the developing world.

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