U.S. Commitment to Saving Lives in the Developing World

Posted by Eric Goosby
May 28, 2010
Nurse Takes Blood Sample for Testing in Pretoria

About the Author: Ambassador Eric Goosby serves as U.S. Global AIDS Coordinator.

Over the last two weeks, I've had the opportunity to visit programs supported by the United States through PEPFAR in three African countries -- Tanzania, Mali, and Nigeria.

I have visited multiple PEPFAR-supported economic empowerment groups and groups of people living with HIV. The common denominator was this: from the bottom of their hearts, people thanked the American people for our support and noted that if we stopped, they do not know what they would do.

They remember how different things were just a few years ago, when there was little hope and hospitals were overcrowded with people dying from AIDS. And they get that the U.S. has been at the forefront of this transformation.

In public discussion of PEPFAR, it is important to accurately reflect the impact the U.S. is making -- and has committed to continue to make. If people are given a misleading impression that our investments are not saving lives, they may be tempted to give up on this effort. That would be a tragedy.

The United States is committed to saving lives in the developing world. The Obama Administration believes that it is in keeping with America's values and in service of the security of our nation and our common security to take the lead in helping to save lives and relieve suffering, especially among the world's poorest people.

That is why President Obama has undertaken a comprehensive Global Health Initiative (GHI) -- investing $63 billion over six years to help partner countries improve the health of their people through an integrated approach.

There is no doubt that there is ongoing, unmet need for HIV prevention, treatment and care. That's why, as part of the GHI, we are increasing funding for PEPFAR, and doing so in a very tight fiscal environment. The President requested increases for PEPFAR in both his FY 2010 and FY 2011 budgets. In fact, the FY 2011 request is the largest request to date in a President's Budget, and the program is slated to increase in the years ahead.

But the metric for success is not dollars spent, but actual lives saved. Some critics have mistakenly alleged reduced or flat-lined funding under PEPFAR, translating that into a reduction in the number of people getting antiretroviral therapy (ART). Yet the number of people PEPFAR directly supports on ART has continued to increase dramatically each year -- in FY 2009 alone, from approximately 1.6 million to nearly 2.5 million. Without ART, very few of those people would be alive -- that's why lives saved, rather than dollars spent, is most meaningful.

What's more, PEPFAR will continue to increase the numbers treated in coming years toward our ambitious goal under the GHI of treatment for more than 4 million. That's a commitment we've made publicly.

Critics have alleged a negative impact in South Africa due to "flat-lined" PEPFAR budgets in the country. But in 2009, PEPFAR announced plans to add $120 million to our already very large budget there to support the South African Government's effort to rapidly scale up treatment. That is not a flat-line.

Treatment is indispensable, but we need to do more than simply expand access to treatment to change the course of the HIV epidemic. Ending this epidemic also requires reducing the number of those who become HIV-positive. This means access to an array of evidence-based HIV prevention interventions, as well as HIV counseling and testing, and it requires improving the health systems at every level.

The comprehensive approach we are pursuing through the GHI, which includes a focus on maternal/child health, on strengthening health systems, going after neglected tropical diseases, and -- yes -- providing more funding for ART and other HIV programs, will have a significant and swift impact on the longevity and quality of life of millions of people now suffering from preventable and treatable diseases. Also important is maintaining the gains we do make which can be done by strengthening health systems, improving nutrition, and other aspects of this approach. Lives saved, diseases prevented and even eradicated, health systems and nations strengthened -- these are the goals by which global health efforts should be measured. And we are confident that by those measures, our efforts under the GHI will prove to be a success.

A lasting solution to HIV and other global health needs must also involve participation from partner governments and other donors around meeting this shared global responsibility. A key focus of the GHI is to strengthen and leverage key multilateral organizations, global health partnerships, and private sector efforts. In addition to our bilateral programs, the U.S. is also by far the largest donor to the Global Fund to Fight AIDS, Tuberculosis and Malaria, a key multilateral vehicle for countries and the private sector to contribute to the fight.

As we focus on the challenges of the future, let's not lose sight of the remarkable things that have already been accomplished. I wish that everyone reading this had the opportunity I have had to visit the people we work with in the field, to be inspired by them. If the global community can come together to support those people, in a spirit of partnership, I know we can meet the challenges ahead.



United States
May 28, 2010

O.C. in USA writes:

When people see dramatic changes to their everyday life like medical services, clean water, education and innovation it endears them to the USA. This is what we should be doing the world over on a massive scale. Americans have the knowledge, ability and will and like to help others in need. We should be exporting this ability on a grand scale so we can live in peace and harmony with others who aren't as violence oriented. It seems like 100 years of past foreign policy has brought us a lot of enemies trying to destroy us. Showing the world our goodness through great deeds wins friendship and understanding. The "Aloha" style to foreign policy. Obama should be very familiar with that one.

Julian L.
Vermont, USA
June 25, 2010

Julian L. in Vermont writes:

Suppression of the availability of immunostimulation is an abomination, an atrocity, and a crime against humanity.


In 1980, Dr. Louis Shenkman showed that lithium has potent immunostimulating properties, and the ability to prevent recurrences of bacterial skin infections. In 1981, I published he first of nine review articles on the immunostimulating and antimicrobial properties of lithium and antidepressants. Evidence to date reveals that lithium has immunostimulating, antiviral, and antibacterial properties, antidepressants immunostimulating, antiviral, antibacterial, antiparasite, and fungicidal properties.
A recent study showed that antidepressants frequently reduce HIV viral load to undetectable..

A therapeutic claim is reinforced when the mechanism is known. In this case, minute molecules known as prostaglandins, when produced excessively, depress every component of immune function, and induce microbial replication. In the early nineteen seventies, my late colleague Dr. David Horrobin and others showed that antidepressants and lithium inhibit prostaglandins.

With the threats posed by resistant T.B and HIV, and the emerging resistance of the malaria parasite to artemisin, the availability of immunostimulation becomes all the more crucial. Government and private laboratories are pursuing immunostimulation in the context of infection and cancer; they are unlikely to succeed. In a review published in 1983, I proposed that to stimulate immune function, an agent must have mood elevating properties. Over the past quarter of a century, I appealed to innumerable individuals or institutions to support the advance, none of which consented. For almost thirty years innumerable vested interests have suppressed the availability of immunostimulation, with catastrophic worldwide repercussions.

A complete bibliography is available in “Stimulating immune function to kill viruses.” (2009) Amazon

These comments are intended for education only. All treatment decisions should e made with a physician.

I m a semi-retired, former Yale medical school psychiatry professor, and author or coauthor of forty- eight articles and eleven books.


July 2, 2010

Rev. Jerad M.A. in Kenya writes:


DipNote B.
July 2, 2010

DipNote Bloggers write:

And we would love to oblige! We’ll work on bringing you more features about the great things PEPFAR is accomplishing. In the meantime, you can read more about PEPFAR here.

United States
July 2, 2010

O.C. in the U.S.A. writes:

I wrote to Obama about preparing a civilian corps of American workers or a massive development team that could be employed working on these problems on a grand scale and organising systems of medical care, education, transportation etc. When are these civilian teams going to be deployed? What is taking so long? Their first assignment should be on the Gulf Coast.


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