Ambassador-at-Large Deborah Birx giving a speech from a podium with an American flag and PEPFAR banner in the background

One of the Biggest Public Health Initiatives in History: PEPFAR and HIV

By Daniel Aaron

In October, the Petrie-Flom Center hosted a conference of world-leading experts in HIV/AIDS to discuss one of the biggest public health successes in history: PEPFAR, the President’s Emergency Plan for AIDS Relief. PEPFAR was launched in 2003 in response to a burgeoning global epidemic of HIV. The program offered $2 billion annually, rising to about $7 billion in 2019, to surveil, diagnose, treat, and reduce transmission of HIV around the world.

PEPFAR prevented what could have become an exponentially growing epidemic. It is estimated to have saved more than 17 million lives and avoided millions of new HIV infections. As a result, the speakers at the conference were quick to extol the virtues of the program. Professor Ashish Jha called it an “unmitigated success”; Professor Marc C. Elliott named it a “historic effort”; Dr. Ingrid Katz described PEPFAR as “nothing short of miraculous.”

However, several undercurrents within the conference, as well as more explicit points made by several panelists, suggested the importance of enlarging the discussion beyond PEPFAR itself to include other policies that impact HIV and AIDS, and even other diseases.

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Flag of Malawi blowing in the wind in front of a clear blue sky

A 15-year review of the PEPFAR support to Malawi: How Has it Succeeded?

Monday, October 7, the Petrie-Flom Center is co-sponsoring “15+ Years of PEPFAR: How U.S. Action on HIV/AIDS Has Changed Global Health,” from 8:30 AM to 6:00 PM. The event is free and open to the public, but registration is required. This event is cosponsored by the Harvard Global Health Institute, the Harvard University Center for AIDS Research, the Center for Health Law Policy and Innovation at Harvard Law School, and the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School.

By Maureen Luba

Malawi was listed as one of the six locations that have made remarkable progress towards ending the AIDS epidemic in a recent report produced by AmfAR, AVAC, and Friends of the Global Fight. Being one of the poorest countries on the list, Malawi has proven that ending the epidemic is possible anywhere.

But one would want to know what has contributed to this success!

Well, there are many factors. And funding from donors is one of them. The HIV/AIDS response in Malawi is largely funded by the Global Fund and PEPFAR. But for the sake of this blog I will focus on PEPFAR, a U.S. government program launched in 2003 by then President George W. Bush. In 15 years of support, PEPFAR has led the world in funding the global HIV response.

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Illustration of a red AIDS awareness ribbon. The right end of the ribbon is the Nigerian flag.

PEPFAR and Health Systems Transformation in Nigeria

Monday, October 7, the Petrie-Flom Center is co-sponsoring “15+ Years of PEPFAR: How U.S. Action on HIV/AIDS Has Changed Global Health,” from 8:30 AM to 6:00 PM. The event is free and open to the public, but registration is required. This event is cosponsored by the Harvard Global Health Institute, the Harvard University Center for AIDS Research, the Center for Health Law Policy and Innovation at Harvard Law School, and the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School.

By Prosper Okonkwo

HIV diagnosis in Sub Saharan Africa in the nineties and early 2000s was literally a death sentence. This was either due to one or a combination of ignorance, denial, and weak health systems.

A few focusing events and the return to democratic rule in 1999, acted as fillip, jump-starting the national response, albeit modestly. In 2001, 10,000 adults and 5,000 children were placed on antiretrovirals (ARVs) at the cost of $7 a month. This was at a time when sourcing these drugs privately cost about $350 monthly in a country with a GDP per capita of less than $750, less than 5% health insurance coverage, and with about 80% of health expenditure paid out of pocket.

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3-D rendering of an HIV virus

Not Another Scott County?

By Emily Beukema, Aila Hoss, and Nicolas Terry

In November 2014, Scott County, Indiana was the site of a now infamous HIV outbreak linked to intravenous drug use. Syringe service programs (SSP) would not only have curbed that outbreak but also could have prevented it from occurring in the first place. Later analysis found that then Governor Pence of Indiana failed to declare a state of emergency until two months after the peak infection rate and that, even after that declaration, disagreements among stakeholders later delayed the implementation of a temporary SSP. Absent those delays the number of infections could have been dramatically decreased.

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Photograph of memorial to victims of the El Paso, TX mass shooting

Pervasive Health Effects of Anti-Immigrant Rhetoric at the U.S.-Mexican Border

By Lilo Blank

The current xenophobic, racist, and anti-immigrant climate in the United States and its detrimental impact on immigrant communities and their health cannot be ignored. This month, gunmen have executed a series of mass shootings, including one specifically in El Paso, Texas, in which the gunman killed 22 people. The FBI is currently investigating the shooting as a suspected hate crime against immigrants. Terroristic acts of violence such as this are enough to incite fear in anyone, but especially in Hispanic communities on the border, who are facing additional forms of structural violence.

“Stigma is fundamentally about alienation and exclusion,” said stigma expert Dr. Daniel Goldberg, Associate Professor at the University of Colorado Anschutz Medical Campus’s Center for Bioethics and Humanities, in a recent interview. “Even when you control for access, people who are stigmatized get sicker and die quicker. And of course, we are social creatures. If stigma exists persistently and longitudinally, the more likely you are to be socially isolated, and social isolation is one of the most powerful predictors of mortality.”

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3D illustration of anatomically correct HIV Virus floating in the bloodstream

HIV Treatment: Functional Cures are Just One Aspect of Newsworthy Progress

Major news networks around the globe this week broke the story that a second HIV-positive patient appears to have been “functionally cured” of HIV.

In a welcome piece of good news, the world learned that an anonymous individual, known simply as “the London patient” has experienced a year and a half of sustained remission of the HIV virus without medication. The patient entered into remission after receiving a bone marrow transplant from someone naturally resistant to HIV infection. This is the second functional cure of HIV of its kind. The first such case occurred in 2007.

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Image of a man spurting out water from his mouth

Spitting at Science: The Unjustified Criminalization of Spitting While HIV-Positive

Saliva doesn’t transmit HIV. And no one has ever become HIV-positive because an HIV-positive person spit on them.

Yet a number of states, including Louisiana, Mississippi, Missouri, Nebraska, Ohio, Oklahoma, Pennsylvania, and Texas, either have laws that explicitly criminalize the act of spitting specifically if one is HIV-positive or in recent years have used the criminal law to prosecute and convict the act of spitting by an HIV-positive person. Read More

Senator Scott Wiener talking into a mic

Successful HIV Criminalization Reform in California: Q and A with Sen. Scott Wiener

The majority of states have laws that criminalize activities by HIV-positive people that are not criminalized when the rest of the population engages in them.

Many of these laws improperly single out HIV over other infectious diseases and reflect a lack of understanding of both how HIV spreads and how it can be treated.

In 2017, California passed legislation which modernized and improved California’s HIV criminalization law. One of the authors of the law was State Senator Scott Wiener. I recently had a chance to ask Sen. Wiener some questions about that process.

His responses are given here in hopes of supplying useful information for legislators, lobbyists, and activists in other states who are interested in starting the reform process in their own states or other jurisdictions around the world. This interview has been edited for clarity.

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EVENT: Punishing Disease: HIV and the Criminalization of Sickness

Punishing Disease: HIV and the Criminalization of Sickness
January 29, 2018, 12:00 PM
Wasserstein Hall, Room 3007
1585 Massachusetts Ave., Cambridge, MA

Please join us for a talk with Trevor Hoppe on his book, Punishing Disease: HIV and the Criminalization of Sickness. The book examines how and why US policymakers and public health systems have adopted coercive and punitive responses to stop the spread of HIV/AIDS. It also looks at how others diseases have been punished throughout history, and cautions against the extension of criminalization to diseases such as hepatitis and meningitis.

Trevor Hoppe is Assistant Professor of Sociology at the University at Albany, SUNY. He was previously a postdoctoral fellow in the Criminology, Law andSocietyDepartment at the University of California at Irvine. Hoppe’s research examines how punishment came to be a legitimate response to controlling HIV and disease more generally. In 2017, Hoppe published The War on Sex, a collection of essays co-edited with David Halperin analyzing the criminalization of sex, and Punishing Disease a monograph explaining the rise of punitive responses to HIV and other infectious diseases.

This talk is part of the Human Rights Program’s year-long speaker series examining the criminalization of human rights concerning gender, sexuality, and reproduction. It is co-sponsored by the Petrie-Flom Center for Health Law, Policy, Biotechnology and Bioethics, the Criminal Justice Policy Program, and the Center for Health Law Policy Innovation at Harvard Law School. 

 

NEW EVENT (1/29)! Punishing Disease: HIV and the Criminalization of Sickness

Punishing Disease: HIV and the Criminalization of Sickness
January 29, 2018, 12:00 PM
Wasserstein Hall, Room 3007
1585 Massachusetts Ave., Cambridge, MA

Please join us for a talk with Trevor Hoppe on his book, Punishing Disease: HIV and the Criminalization of Sickness. The book examines how and why US policymakers and public health systems have adopted coercive and punitive responses to stop the spread of HIV/AIDS. It also looks at how others diseases have been punished throughout history, and cautions against the extension of criminalization to diseases such as hepatitis and meningitis.

Trevor Hoppe is Assistant Professor of Sociology at the University at Albany, SUNY. He was previously a postdoctoral fellow in the Criminology, Law andSocietyDepartment at the University of California at Irvine. Hoppe’s research examines how punishment came to be a legitimate response to controlling HIV and disease more generally. In 2017, Hoppe published The War on Sex, a collection of essays co-edited with David Halperin analyzing the criminalization of sex, and Punishing Disease a monograph explaining the rise of punitive responses to HIV and other infectious diseases.

This talk is part of the Human Rights Program’s year-long speaker series examining the criminalization of human rights concerning gender, sexuality, and reproduction. It is co-sponsored by the Petrie-Flom Center for Health Law, Policy, Biotechnology and Bioethics, the Criminal Justice Policy Program, and the Center for Health Law Policy Innovation at Harvard Law School. 

Sponsored by the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School with support from the Oswald DeN. Cammann Fund and Ropes & Gray LLP.