Panelists:
Varun Gauri, Senior Economist. Development Research Group, World Bank
João Biehl, Associate Professor of Anthropology, Princeton University; author of Will to Live: AIDS Therapies and the Politics of Survival (Princeton Univ. Press, forthcoming).
Cristina d’Almeida, National Agency for Research on AIDS, France
Moderator: Eduardo Gómez, Politics and Governance Group, Harvard School of Public Health; dissertation: “Contested Epidemics: Institution, Global Politics and Response in the United States and Brazil

Varun Guari, “Institutions and Identities: Explaining Gov’t Responses to HIV/AIDS in Brazil and South Africa”

• Summary of his research with Evan Lieberman
• Came out as a paper in Studies in Comparative International Development (Fall 2006). Also coming out as a chapter in “Public Health and Human Rights”
• Ethnic boundaries and fractionalization are among the most salient characteristics in explaining response levels.

João Biehl

• Most social science explanations explain HIV policies as a result of social movements. he wants to identify some of the other political and social mechanisms, obtained by broad ethnographic field research.
• AIDS policy as a marker of success of Cardozo’s model of the inter-permeability of the state and civil society. “Governmentality in action.”
• A new political economy of pharmaceuticals is one of the social and political explanations that must get attention. Trade in pharmaceuticals has increased markedly since Brazil accepted international norms on intellectual property.
• Once a government designates a disease as the “country’s disease”, a market takes shape. Thus, the preferences of the pharmaceutical industry become integral to public health policy. As drugs lose their efficacy, government will shift its preferences to new drugs developed by the pharma companies.
• PEPFAR, e.g., favors large-scale pharmaceutical intervention, but does not address health care delivery, prophylaxis, and education with the same vigor.
• Since the HIV policy is seen as the success of the previous government, the new government is seeking its own policy, and in Brazil, the preference has always been for electoral expediency over policy continuity.
• Some 80 percent of expenditures are for ARVs/drugs. This is the movement to drug monopoly.
• Sustainability of the policy has to be constantly renegotiated in the marketplace.
• The political grounds of existence become individualized and (poor) AIDS patients rarely become activists. And the patients find themselves often not having a unit of belonging, like a family.

Cristina d’Almeida, “Comparative Look at the Brazilian Response to AIDS” (crisdalmeida at gmail dot com, calmeida at seg dot univ-paris13 dot fr)

• Networks, the new trend on South-South Coop
• -Overcome IP and trade barriers
• -Local capacity/capacitation strengthening
• -national autonomy strengthening
• Descriptions of two networks: the Lacos Sul-Sul network (policy sharing), and the Technological Cooperation Network on HIV/AIDS (technical/technology experience sharing)
• Milestones of the two networks (chronologies of the meetings and some of the inter-meeting activities)
• Summary of the main achievements of the Lacos Sul-Sul network, summarized by country. Mostly the provision of HAART, health expert training, prevention education, and surveillance/data improvement.
• Achievements of the Technological Cooperation Network: ID the state of the Art in member countries, est. technological coop, elaborate joint guidelines for quality control of ARV manufacturing
• Challenges?
• -Lacos Sul-Sul: budget constraints, and diversity of the problem in member countries
• -Tech Coop Network: budget constraints, contrasting national HIV policy and industrial policy, differences in national drug procurement and price negotiation systems

Questions followed.

Technorati Tags: AIDS, HIV, politics, research, social science

Amy Nunn:

• Global context of the epidemic. In the world, only about 1.6 Million of 7 million needing HAART receive it
• Brazil was the first country to implement HAART and has the most people on it. ABout 175,000 right now.
• What social and political processes best explain the development of Brazil’s AIDS treatment institutions?
• -case study approach, 86 people in 91 interviews; 5000+ news articles, cong records, etc.; descriptive historical data. Using a historical institutionalist approach.
• 1990: Brazil’s first federal commitment to provididng drugs for AIDS treatment.
• 1996: Law 9.313 establishes foree and unversal access to drugs and treatment (Sarney’s Law)
• 1997: AIDS treatment costs rise dramatically b/c of the scale up and the new regime of respecting intellectual property laws
• Inst’ns: 1998-scale-up of ARV prod’n. 2000–Brazil’s tradition of threatening to issue compulsory license to reduce the price of patented ARVs. 2001-06: Brazil’s contributions to international health, human rights and trade institutions related to essential medicines (introduction of a number of resolutions in international fora)
• Outcomes: USTR files but later drops trade complaint; Multinat’l pharma companies drop ARV prices; Brazil negotiates ARV prices and price negotiation traditions endure
• Brazil’s costs have gone up, but it has saved about $1B through it’s pricing negotiations
• Brazil’s actions have affected the global treatment
• - Showed that resource-poor settings could have treatment
• - dramatic increases in AIDS and global health spending
• - Flexibility on intellectual prop rights and public health issues
• -1.6M on ARV today
• -never would have happened if Brazil hadn’t taken its actions
• Key Findings:
• -Brazil’s strategies were born in Brazil and the result of local initiative
• -Democ and regime change have provided instituional openings for social movements
• -Middle-income countries can and do have an enormous impact on global policies and regimes

David Martin, Undergrad H&S Harvard

• Brazilian response has three factors
• -Social mob’n via civil society mechs
• AIDS policy via int’nal mechs
• Technological developments in HIV treatment
• Response successful becuase
• -AIDS elicited a quick response
• -adaptability of AIDS policy to changing face of the epidemic
• -intro of new, effective treatment options
• AIDS and democratization
• -umbrella mov’t for previously voiceless
• -reveled the public health crisi and the social fractures within Brazilian society
• Civil soceity–what’s its role?
• -Augments the quality of the treatment program: provided some social infrastructure in geographic areas not covered and helped with the negative social manifestations of the disease(stigma, emotional support, reintegrate into society, poverty)
• Talked about an NGO in Recife as an illustration of the interaction of civil society institutions with government. Specifically, “Gestos, Soropositividade, Comunicacao, e Genero”
• Tech and Civil Society
• -Response to HIV became subject to international influence (TRIPS, compulsory licensing, etc.)
• -Increasing reliance on ARV meant a decreasing role of civil society
• Medicalization of AIDS (neglect of the social problems that stem from having AIDS)
• -ARVs only address teh physical aspects, neglecting the social dimensions of HIV, which is what the civil-society groups did.
• Sustainability of Brazilian Response?
• -Precarious balance between the social and physiological mechs of epidemic control
• -society demobilizing as HIV has become a chronic, managed disease
• -not clear what the financial sustainability of ARVs is.

Sophia Zamudio-Haas

• Presentation of the volunteer work she did for a year in Rio.

One question that the first two panelists raised that I don’t think were adequately answered was whether Brazil’s HIV policies dramatically changed global practices regarding HIV. From what I know of the global regimes, this isn’t a far-fetched notion, but I did not see any systematic evidence to support this sort of causal claim. It’s a fairly strong causal statement, and I didn’t see evidence or methods that supported the reach of that claim. In talking with Amy, she said that she’s been surprised that more people don’t know about the international dimension. Her proof is in the historical documentation that she was able to do on Brazil’s action in multilateral fora. I’m going to try to get a copy of the dissertation.

Technorati Tags: AIDS, conferences, HIV, research

In this special Web feature, Foreign Affairs has convened some of the world’s top experts — Paul Farmer, Jeffrey Sachs, Alex de Waal, Roger Bate & Kathryn Boateng, and Laurie Garrett to discuss Garrett’s essay “The Challenge of Global Health” debate how best to help the world’s poor and sick; and to debate her thesis and suggest where global public health efforts should go next.

Laurie Garrett’s article “The Challenge of Global Health” argued that the money flowing toward the world’s poor and sick might produce fewer benefits than people expect because aid is often directed at narrow, disease-specific problems rather than public health in general.

http://www.foreignaffairs.org/20070101faessay86103/laurie-garrett/the-challenge-of-global-health.html

From “Marvelous Momentum” to Health Care for All

Paul Farmer is associate chief of the Division of Social Medicine and Health Inequalities at Brigham and Women’s Hospital; Presley Professor of Medical Anthropology at Harvard Medical School; and a founding director of Partners In Health, an international charity that provides health care to and undertakes research and advocacy on behalf of the sick and poor.

“The influx of AIDS funding can indeed strangle primary care, distort public health budgets, and contribute to brain drain. But these untoward or perverse effects are not inevitable; they occur only when programs are poorly designed. When programs are properly designed to reflect patients’ needs rather than the wishes of donors, AIDS funding can strengthen primary care.” . . .http://www.foreignaffairs.org/special/global_health/farmer

Beware False Tradeoffs

Jeffrey D. Sachs is Director of the Earth Institute, Quetelet Professor of Sustainable Development, and Professor of Health Policy and Management at Columbia University.

“Foreign aid is not a whim, a matter of dole, or a matter of avoidable dependency. It is the difference between life and death. It can also be used to do exactly what Garrett rightly wants: to build an effective health system. We have just started on the road to doing this, after decades of shocking neglect. Garrett is right to call for more coherence and better strategy, but the real answer to the problems she describes is a further scaling up of aid.” . . .
http://www.foreignaffairs.org/special/global_health/sachs

Reality Check

Roger Bate is a Resident Fellow and Kathryn Boateng is a Research Assistant at the American Enterprise Institute in Washington, D.C.

“Garrett hopes to ‘witness spectacular improvements in the health of billions of people, driven by a grand public and private effort comparable to the Marshall Plan.’ But given the poor track record of foreign aid in developing countries, one can predict that unless drastic changes are made, simply sending more aid would be counterproductive.” . . .http://www.foreignaffairs.org/special/global_health/bate_boateng

Major Challenge, Minor Response

Alex de Waal, is program director at the Social Science Research Council and working group co-chair of the Joint Learning Initiative on Children and AIDS.

“Garrett is enthusiastic in pursuit of her prey: how well-intentioned and well-funded stand-alone initiatives run the risk of undermining national priorities and setting up distorted and hence unsustainable health systems. And she makes a number of telling points. But her chase is not systematic, and so she doesn’t catch her quarry.” . . .http://www.foreignaffairs.org/special/global_health/dewaal

“Stories from the Heart of a Pandemic”
A panel in recognition of World AIDS Day

Wednesday, November 29, 6:30 to 8 p.m.
World Affairs Council Auditorium
312 Sutter Street, Second Floor
San Francisco, CA 94108 [map]

In recognition of World AIDS Day, a panel of former Peace Corps volunteers and a Peace Corps country director will share stories from the front lines of the global HIV/AIDS crisis. Worldwide, Peace Corps volunteers have reached nearly 900,000 people through their work on HIV/AIDS. Come learn how you, too, can make a difference as a Peace Corps volunteer. For more information, please contact PC recruiter Sean Kennedy, 510-637-1525 or skennedy@peacecorps.gov.

MORE INFORMATION:
This panel is one of many Peace Corps events taking place nationwide in recognition of World AIDS Day. Peace Corps has become an important force in the fight against HIV/AIDS because its volunteers live and work in some of the most impacted communities in the world. Peace Corps carries out HIV-related projects in every one of its partner countries in Africa and nearly half of its partner countries in the rest of the world. Worldwide, 20 percent of Peace Corps volunteers are assigned to projects in health and HIV/AIDS. Peace Corps volunteers do not provide direct medical care; rather, they help communities build their own capacity for prevention, care, and treatment. For example, Peace Corps volunteers train youth as peer educators. They work with community leaders to develop education materials. And they provide support to children orphaned by the disease. Worldwide, Peace Corps Volunteers have reached nearly 900,000 people through their work on HIV/AIDS.

And health volunteers are not the only ones making a difference. HIV/AIDS activities are woven into all Peace Corps programs – including business, agriculture, education and the environment. In a sense, ALL Peace Corps volunteers are HIV/AIDS volunteers, because they live as members of communities. Wherever the pandemic affects a coworker, neighbor or friend, a Peace Corps volunteer is working to fight the spread and stigma of AIDS.

The 16th AIDS Conference is underway today.  It should be a fabulous, fashionable event.  Great keynotes and many famous faces.

“HIV/AIDS: Money, Bottlenecks and the Future”
With

David Andrews Assistant Director, Africa Department, International Monetary Fund