LA TIMES: "Unintended Victims of Gates Foundation Generosity"

If you read just one piece in the mainstream media this week about global health, make sure its "Unintented Victims of Gates Foundation Generosity," by Charles Piller and Doug Smith in the Los Angeles Times.

This may be exactly the wrong season to find out about what happens when charity backfires--then again, depending on how your holiday shopping is going, you may be in exactly the right mood.

"Unintended Victims of Gates Foundation Generosity" looks at the unintended consequences of putting most of your donor dollars in the AIDS basket--something that is troubling more and more public health practitioners on the ground these days. The LA Times is one of the few media organizations that has taken a consistently critical look--both pro and con--at what Bill and Melinda Gates are doing in global health.

Here's an excerpt to whet your appetite. But definitely read the whole thing:

(from the LA Times) . . . Botswana offers an example of how a special Gates initiative, narrowly applied to a specific disease, may have disrupted other healthcare.

In 2000, the Gates Foundation joined with the drug firm Merck & Co. and chose Botswana as a test case for a $100-million effort to prove that mass AIDS treatment and prevention could succeed in Africa.

Botswana is a well-governed, stable democracy with a small population and a relatively high living standard, but one of the highest HIV infection rates in the world.

By 2005, health expenditures per capita in Botswana, boosted by the Gates donations, were six times the average for Africa and 21 times the amount spent in Rwanda.

Deaths from AIDS fell sharply.

But AIDS prevention largely failed. HIV continued to spread at an alarming pace. A quarter of all adults were infected in 2003, and the rate was still that high in 2005, according to the U.N. Program on HIV/AIDS. In a 2005 survey, just one in 10 adults could say how to prevent sexual transmission of HIV, despite education programs.

Meanwhile, the rate of pregnancy-related maternal deaths nearly quadrupled and the child mortality rate rose dramatically. Despite improvements in AIDS treatment, life expectancy in Botswana rose just marginally, from 41.1 years in 2000 to 41.5 years in 2005.

Dean Jamison, a health economist who was editor of Disease Control Priorities in Developing Countries, a Gates Foundation-funded reference book, blamed the pressing needs of Botswana's AIDS patients. But he added that the Gates Foundation effort, with its tight focus on the epidemic, may have contributed to the broader health crisis by drawing the nation's top clinicians away from primary care and child health.

"They have an opportunity to double or triple their salaries by working on AIDS," Jamison said. "Maybe the health ministry replaces them, maybe not."But if so, it is usually with less competent people." . . .

Connecting the Dots on Moms, Roads and Plumpy'Nut

Most people I run across in the public health world still view blogs suspiciously as the source of a lot of heat and not very illuminating. But with a little judicious filtering (both mental and electronic), I find blogs incredibly useful in my research and reporting.

Recently, in response to my post on Peanut Butter and Patents, someone with the handle "RUTF blogger" posted a tip about the production of peanut-based nutritional supplements in Malawi for a story I'm following on the patenting of Plumpy'Nut. Obviously, the information needs to be checked out but at least I have some names and an idea of where to look.

And last Friday, I received an e-mail reply to a question I posted at The INFO Project Blog, the brainchild of the Center for Communication Programs at the Johns Hopkins School of Public Health. While researching the link between paved roads and improved maternal health, I found a blog post that related to maternal health from the folks at JHU. I asked my question and a very nice person named Rose replied both by e-mail and on the blog.

In both cases, I am learning and assessing what I need--but because the q and a are publicly available, others may benefit as well.

Monique and the Mango Rains is a Must Read

I sometimes think public health experts have doctor-envy because they come up with such cerebral, unemotional terms--like maternal mortality--to talk about issues of life and death.

They would do better just to encourage everyone to read a book like Monique and the Mango Rains by Kris Hollowell. It's about the friendship that develops between a Peace Corps volunteer and a midwife in Mali. A quick read, very engaging, full of joy and sorrow. Makes you want to get out and do something!

From Maternal Health to Web2ForDev

It's all about the links. The little snippet I wrote earlier this fall about whether Richard Cash ever considered patenting oral rehydration therapy got picked up by a class on maternal and child health at Columbia University's Mailman School of Public Health. From there I learned about a conference on using Web2.0 ideas and technology for promoting development in the poorest countries of the world.

The meeting has already happened but at least there's video from some of the sessions. Why it's Explorer-only is beyond me. Wouldn't you expect a group promoting Web2.0 to be platform agnostic? at least choose Firefox?

Meanwhile, back in the real world, I spoke with Henry Jenkins of MIT this afternoon after a panel discussion on our Totally Wired Kids. He mentioned the Center for Collective Intelligence as another possible contact for my project on promoting greater coverage of global health issues.

Huckabee No Longer Believes in AIDS quarantines

What a difference a few days make. On Dec. 9, GOP Presidential hopeful Mike Huckabee told the Associated Press that he would not back off of statements he made in 1992 in favor of isolating AIDS patients. After Ryan White's mom called him on that stance, Huckabee is backpedaling as fast as he can--not always convincingly.

AIDS Mom Slams Huckabee

Now that Gov. Mike Huckabee's campaign for the GOP Presidential nomination is surging, he's getting more scrutiny on his previous remarks about AIDS. From the folks at the Human Rights Campaign:

Subj: RELEASE: Letter Urges Gov. Huckabee to Repudiate AIDS Remarks, Meet with Ryan White's Mother
Date: Tue Dec 11, 2007 10:22 am

Letter Urges Gov. Huckabee to Repudiate AIDS Remarks, Meet with Ryan White's Mother. Human Rights Campaign and The AIDS Institute sign letter to Gov. Huckabee asking for meeting with Jeanne White-Ginder

WASHINGTON – The Human Rights Campaign and The AIDS Institute sent a letter to Republican presidential candidate Governor Mike Huckabee today asking that he personally meet with Jeanne White-Ginder, the mother of Ryan White, who was diagnosed with AIDS on December 17, 1984, and captivated the attention of millions as he battled the disease and ultimately succumbed to it. As reported by the Associated Press, "Huckabee once advocated isolating AIDS patients from the general public, opposed increased federal funding in the search for a cure and said homosexuality could 'pose a dangerous public health risk.'" In a FOX News interview on Sunday, December 9, Huckabee stood by his remarks and said he still believes today that people living with HIV and AIDS should have been "isolated" even after it was determined the virus was not spread through casual contact.

"Have we not learned the difficult lesson of how devastating these statements based in ignorance and fear can be to American families? Has it been so long ago that we have forgotten how our neighbors had the backs of entire communities turned on them?" the letter, signed by the Human Rights Campaign and AIDS Institute, said. "Governor Huckabee, those dark moments in American history are the direct result of ignorant views that stifle discussion, hinder resources and delay action. We have a moral obligation as a nation to never allow ourselves to repeat the shameful mistakes of the past. And we cannot sit idly by when a candidate for President of the United States tries to lead us back down that path of ignorance and fear."

As a candidate for a U.S. Senate seat in 1992, Huckabee answered 229 questions submitted to him by The Associated Press. The Senate candidate wrote: "It is difficult to understand the public policy towards AIDS. It is the first time in the history of civilization in which the carriers of a genuine plague have not been isolated from the general population, and in which this deadly disease for which there is no cure is being treated as a civil rights issue instead of the true health crisis it represents."

As the Associated Press recently reported, "When Huckabee wrote his answers in 1992, it was common knowledge that AIDS could not be spread by casual contact."(Associated Press, December 8, 2007)

In the same election year that Gov. Huckabee answered the questionnaire, Mary Fisher, an HIV-positive former aide to President Gerald R. Ford and founder of the Family AIDS Network, addressed the 1992 Republican National Convention. In her groundbreaking speech, "A Whisper of AIDS," Fisher sought compassion for and understanding of people living with HIV and AIDS and received a standing ovation from a crowd that included the President and Mrs. Ford. To view her 1992 speech visit: http://www.youtube.com/watch?v=0vTKDFcRDLY

To view the FOX News interview from Sunday visit: http://youtube.com/watch?v=2cT6n-VJ1Xg

The complete letter to the governor follows:

December 10th, 2007

Dear Governor Huckabee: In 1984, a young boy living in Indiana was diagnosed with AIDS. At the time, that boy, thirteen-year-old Ryan White, had no idea that his life would become a testament of courage and bravery responsible for opening the hearts and minds of millions of people throughout our country and around the world. Six years later, in 1990, Ryan's life ended -- a dear, precious life cut short. But Ryan's death wasn't the only tragedy in this well-known story in our country's history. Ryan and his family's battle with HIV/AIDS was also a stark reminder of what happens in our country when fear and ignorance go unchecked. Governor Huckabee, the Ryan White family was ridiculed, shunned and ostracized by people who thought the answer was to "isolate" them far away from the rest of society. In 1984, this belief was purely based on ignorance. But these same beliefs, which you espoused in 1992 and have refused to recant today, as a candidate for President of the United States, a
re completely beyond comprehension. When you answered the Associated Press questionnaire in 1992, we, in fact, knew a great deal about how HIV was transmitted. Four years earlier, in 1988, the Reagan Administration's Department of Health and Human Services issued a brochure assuring the American public that "you won't get the AIDS virus through every day contact with the people around you in school, in the workplace, at parties, child care centers, or stores." To call for such an oppressive and severe policy like "isolation," when the scientific community and federal government were certain about how HIV is transmitted was then, and remains today, irresponsible. Such statements should be completely repudiated, not simply dismissed as needing to be slightly reworded.

This was not and is not an issue of "political correctness," as you state. Rather, this is an issue of valuing science-based evidence over unfounded fear or prejudice. Have we not learned the difficult lesson of how devastating these statements based in ignorance and fear can be to American families? Has it been so long ago that we have forgotten how our neighbors had the backs of entire communities turned on them? Governor Huckabee, those dark moments in American history are the direct result of ignorant views that stifle discussion, hinder resources and delay action. We have a moral obligation as a nation to never allow ourselves to repeat the shameful mistakes of the past. And we cannot sit idly by when a candidate for President of the United States tries to lead us back down that path of ignorance and fear. Governor Huckabee, if you need a reminder of how calls for "isolation" can shatter a Mother's heart, you only need to turn to Jeanne White-Ginder. Today, we respectfully as
k you to sit down with her and allow her to share with you Ryan's story. Ms. White-Ginder continues to be active in AIDS advocacy as a member of the board of The AIDS Institute. We hope that, even in 2007, Ryan's story can continue to open hearts and minds. We would be happy to facilitate a meeting between Ms. White-Ginder and yourself, or a member of your staff. Please feel free to contact Brad Luna, Communications Director for the Human Rights Campaign, at (202) 216-1514 at your convenience.

Sincerely,

Joe Solmonese
President
Human Rights Campaign

A. Gene Copello
Executive Director
The AIDS Institute

The Human Rights Campaign is America's largest civil rights organization working to achieve gay, lesbian, bisexual and transgender equality. By inspiring and engaging all Americans, HRC strives to end discrimination against GLBT citizens and realize a nation that achieves fundamental fairness and equality for all.

And Just How Did You Get Those Numbers?

First there was a movement for transparency in government. But the need for transparency in data is growing stronger by the day. And by transparency in data, I mean more than just the free and easy access to authenticated figures and official statistics--transparency in data must also include publishing the methods used to derive those numbers.

Mixed messages. Late last month the UN released new statistics, saying that 33 million people worldwide are infected with HIV instead of 40 million. More recently, the CDC reported that the number of new HIV infections in the U.S. each year is probably closer to 60,000 people rather than the long-cited stat of 40,000.

The CDC says it will release its methodology very soon. But so far, we haven't heard anything from the UN about how they came by their new numbers. That's a bit of a puzzle since some epidemiologists and demographers have been very public in their criticisms of the UN's approach to counting HIV infections.

To give just one example, check out James Chin's The AIDS Pandemic: The Collision of Epidemiology with Political Correctness. Chin used to be director of the World Health Organization's Global Program on AIDS and so should know what he's talking about.

Alas, a few folks in the blogosphere have latched on to Chin's critiques as further justification for their own AIDS denialism. Their histrionics are obscuring the real story behind the numbers.