Notes on Public Health - Live and Let Live

Progress on South Africa's New Stance on AIDS? Ten years ago, former South African president Thabo Mbeki told the National Council of Provinces that it would be "irresponsible" for the state to endorse antiretroviral drugs, noting a "large volume of scientific literature" attesting to the toxicity of ARV medicines. We've written about South Africa's HIV/AIDS denialism and obfuscation over years, when, despite international and national pressure on behalf of millions dying from AIDS, Mbeki's health policies never budged and the African National Congress (ANC) leadership failed.

Now, President Jacob Zuma has eased concerns about his intentions for controlling the pandemic by articulating a new path for the country. He recently told the National Council of Provinces that he would fight the AIDS crisis, and warned that the "real danger that the number of deaths will soon overtake the number of births." Treatment Action Committee (TAC), hailed the new administration's stance.

Acronym Required previously wrote about South Africa's new health minister and her stance on AIDS treatment in "New Minister of Health For South Africa. Change Afoot?"; and AIDS in South Africa in "Mbeki's AIDS Legacy and Ours", Public Health, AIDS, Mbeki, and the Media, "South Africa: Peddling Beetroot, Courting AIDS", ""Not in Paradise Anymore - AIDS in Africa - Reason for Optimism?", Zuma Dodges Corruption Charges", and others.

When Opposition is de Rigeur: In 2004, after the publication of "Mountains Upon Mountains", Partners in Health founder Jim Yong Kim moved to the World Health Organization to lead the HIV-AIDS program, where he initiated the 3 by 5 HIV/AIDS treatment plan with a goal to treat 3 million people by 2005.

From the time that antiretrovirals became available in the 1990's, people in Western countries like the US and countries like Brazil, that endorsed universal public health, increasingly had access to retrovirals, which made an AIDS diagnosis for those people more manageable and less often lethal.

But there was huge opposition to treating large scale AIDS pandemics in places like sub-Saharan Africa. The various reasons people gave for not treating ranged from logistical (transport over inhospitable terrain), to patient non-compliance, to high rates of fraud, to fear of Western drugs. South Africa's example was publicized and shocking but not isolated. However, by 2004 drug prices had dropped and the tone of objectors had softened, if only slightly. Here's Kim in 2004, urging the world respond to the AIDS epidemic quickly "at its own pace", that is, at a pace comparable to the rapidly advancing viral pandemic. The 3 by 5 plan allowed 1 million people to be on treatment by 2005, and today, more than 4 million are being treated.

"For the activists, you must hold all of our collective feet to the hottest possible fire because large organizations and the powerful have a way of finding reasons to not take action. If you don't continue to push us, we will falter."

A good message. Jim Yong Kim is now the president of Dartmouth College.

Problems in National Health: 17,000 kids in the U.S. Die each Year Because They Lack Insurance: John Hopkins Children's Center researchers studied data from more than 23 million children's hospitalizations in 37 states from 1988 to 2005. Compared with insured children, uninsured children faced a 60 percent increased risk of dying, the researchers found. The analysis attributed 16,787 of some 38,649 children's deaths nationwide during the period analyzed to lack of insurance.

Polls, Spin, Memos, and the Public Option: We previously wrote about Frank Luntz, whose healthcare memo urged defeat of the public option via specific spin doctoring and tested rhetoric last July. Well, of course with Congress chewing over healthcare, Luntz has been at it again. Luntz purports to have talked to some Americans who told him they want still worse healthcare with no public option -- the "massively expensive" option he opines with false, if resonant authority. The new memo reiterates much of the old one and it contains all the same language aimed at preserving the healthcare status quo. When invited to talk shows, he says that his polling shows that Americans are "mad as hell". And Luntz isn't the only one lobbying against healthcare reform.

Evidence Based Policy - Abstinence Funding Halted Decades After Proving Ineffective (Sometimes Time Wins): The Obama administration cut abstinence-only funding, after multiple studies showed that it doesn't work -- abstinence doesn't change sexual behavior, pregnancy, STD rates, or age of first sexual activity. Furthermore, studies showed that abstinence programs routinely dole out incorrect or incomplete information about condoms and contraception, causing confusion and misperceptions among the very vulnerable populations the programs claim to protect. (Abstinence-only doesn't work in HIV/AIDS programs either.)

A recent Newsweek article focuses on the sudden funding decrease affecting those organizations which burgeoned during the last couple of decades because of the federal money. According to Newsweek's article, some U.S. programs like Kids Eagerly Endorsing Purity (K.E.E.P), in the South still manage to get lots of private funding, whereas other programs are at "in a race against time to keep these people in business."