Bush AIDS fight saved 1.1M, study says

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By Stephen Dinan

Former President George W. Bush's international AIDS-fighting campaign has reduced by 10 percent the mortality rates in 15 targeted countries, primarily in Africa, and has saved 1.1 million lives, according to a study that for the first time quantified the successes of his program.

The study by two Stanford University doctors showed the treatment part of PEPFAR, the President's Emergency Plan for AIDS Relief, which involves making drug treatment available to about 2 million people, has shown solid success while the prevention efforts under the program have not yet produced the same concrete results.

"It has averted deaths - a lot of deaths - with about a 10 percent reduction compared with neighboring African countries," said Dr. Eran Bendavid, a fellow in infectious disease and in health policy and research at Stanford who led the study. "However, we could not see a change in prevalence rates that was associated with PEPFAR."

For each life saved, $2,700 was spent on treatment, according to the study in the Annals of Internal Medicine. It looked at death and infection rates from 2004 through 2007 in countries PEPFAR focused on versus 29 other African nations. The study found HIV infection rates were about the same.

Presidential scholars have said PEPFAR is one of the best chances Mr. Bush has to rehabilitate his legacy, and the study's results are a strong showing for the still-young program.

"It's great news that even in the first three years the American people supported the saving of more than a million lives," said Mark Dybul, who ran PEPFAR as Mr. Bush's Global AIDS coordinator. He said PEPFAR, created in 2003, didn't even ramp up substantially until 2006 so the lives-saved figure is even more impressive.

Originally, PEPFAR was designed to spend half its $18.8 billion budget on treatment and 20 percent on prevention programs, with one-third of the prevention money going to abstinence. In its first five years, the government wanted to reach 2 million people with antiretroviral drug treatment, and prevent 7 million HIV infections with a special focus on 15 countries, 12 in Africa and the others in Asia, the Caribbean and South America.

The program was renewed last year with a budget of $48 billion for five years, and updated goals of treating 3 million people and preventing 12 million infections.

Some Republicans fought during the 2008 debate to keep the focus on treatment, arguing it produced concrete results compared with what they saw as vaguely defined prevention efforts. Those advocates saw Monday's report as vindication.

"It's encouraging, but we will continue to be on guard against Congress' tendency to fix what isn't broken," said John Hart, a spokesman for Sen. Tom Coburn, Oklahoma Republican and a doctor who has been active in shaping U.S. AIDS efforts.

He said treatment also ends up helping reduce transmission from mothers to their babies, and said spending money on treatment means helping families stay together.

"When you spend money on treatment, it means a household is a two-parent household rather than a one-parent household. It's the difference between a one-parent household or an orphanage," Mr. Hart said.

Health groups that want more money for prevention said it was natural that the program initially would focus on treatment, and said treatment must continue, but expanding prevention efforts are now the key.

"We're now moving from an emergency phase to a more sustainable phase," said Smita Baruah, government relations director for the Global Health Council. "As you move from emergency to sustainability, it's not going to work just to treat your way out of the infection. You now need to figure out how do we prevent new infections."

Mr. Dybul, the former World AIDS coordinator, said the prevention goals were always long term, and that it's too early to judge how well PEPFAR is meeting them.

"The plan is on track to focus on prevention, care and treatment, which is what we need to do," he said.

The renewed PEPFAR program calls for a greater focus on economic, social and behavioral factors that contribute to the spread of HIV. Lawmakers also removed the previous requirement that a third of prevention money go to abstinence programs, instead putting in a benchmark that if abstinence and fidelity spending drops below 50 percent of funding for prevention, the program would have to justify those decisions.

Serra Sippel, executive director at the Center for Health and Gender Equity, said they worry that could still be seen as encouraging local officials to do abstinence education even when it's not an effective option. She said they want to see President Obama issue clear guidelines so providers aren't confused.

That will fall to a new global AIDS coordinator. Mr. Obama asked Mr. Dybul to step down.