policy paper outline: PEPFAR

Policy issue and background
• Since the first cases of AIDS in the 1980s, more than 25 million people have died from related symptoms.
• Estimates put worldwide infection today at approximately 35 million. Every year, 2-3 million people lose their lives to AIDS; one third of those people are in sub-Saharan Africa.
• The most common methods of transmission of HIV are sexual contact, exposure to bodily fluids, and mother-to-child transmission.

Current U.S. policy
• President Bush announced the PEPFAR (President’s Emergency Plan for AIDS Relief) in 2003. It is a five-year, $15 billion initiative to combat the AIDS pandemic.
• Fifteen focus countries will receive $10 billion in aid; dozens of smaller nations will receive a total of $4 billion dollars.
• The three main goals are prevention, treatment, and care. Most of the funding is spent on treatment.
• One-third of the prevention budget is for abstinence-only programs; emphasis is on the ABC approach (Abstain, Be faithful, or use a Condom).
• The goal is to support prevention of 7 million infections, antiretroviral treatment for 2 million HIV-infected individuals, and care of 10 million people infected and affected by HIV/AIDS, including orphans and vulnerable children, by October 2008.

Strengths and weaknesses of current U.S. policy
• According to the official PEPFAR website, through 2006 the U.S. is well on its way to meeting the set goals.
• PEPFAR is well-intentioned, and is the self-proclaimed largest initiative by a single country for a single disease. However, in FY 2006 alone, the U.S. budget included $21 billion for treating and preventing domestic HIV/AIDS.
• There is a good deal of controversy over the ABC approach—it is seen as the U.S. trying to push its conservative religious values on victims of a disease. The ABC approach often focuses more on ideology than what is most effective for the patients, and stigmatizes condom use.
• For the first several years of PEPFAR, the U.S. refused to use generic ARV drugs because they were not FDA-approved. Twice as many patients could have been treated by not limiting prescriptions to name-brand pharmaceuticals; generic drugs cost as little as 10% of the name-brand drug price. The FDA was slow in approving drugs even though they had been approved by the WHO. Generic drugs have been, from early-on, 3-in-1 pills that need only be taken once a day, whereas name-brand drugs required taking several pills several times a day. Missing doses decreased the efficacy of the prescription.
• U.S. pharmaceutical companies are working on developing second-line regimens for AIDS victims who are resistant to first-line prescriptions.
• Despite the “Three Ones”—one national plan, one national coordinating authority, and one national monitoring evaluation system—PEPFAR is often considered a unilateral approach to the AIDS problem, pushing its own agenda on the focus countries and has sometimes disregarded the programs each nation has developed that were in some cases more effective than PEPFAR has proven.
• Teaching women to abstain until marriage and be faithful to their partner does little good if men continue to seek out prostitutes, particularly without using condoms. Additionally, cultural degradation of women means that for many girls and young women, their first sexual encounter is forced, and they have little power to negotiate condom use or whether they wish to have intercourse at all. Without changing societal views of women, there is little point in teaching women about being faithful.

Policy recommendations
• The PEPFAR website gives very ambiguous numbers when citing the current progress. For example, it states the U.S. has “supported community outreach activities to nearly 61.5 million people to prevent sexual transmission,” “supported prevention of mother-to-child HIV transmission services for women during more than 6 million pregnancies,” and “supported antiretroviral prophylaxis for HIV-positive women during 533,700 pregnancies, averting an estimated 101,500 infant HIV infections.” When looking at the goal of preventing 7 million infections by 2010, how does the U.S. determine how close it is to reaching that goal?
• Although $15 billion is indeed a substantial sum of money to be spending outside the U.S., it is very little compared to what the U.S. budget includes for domestic HIV/AIDS research and treatment. Since Americans are concerned very little with the AIDS problem in comparison to how much most Africans are concerned with the AIDS problem, the U.S. should reexamine its funding policies. At the very least, the American public should be made more aware of the PEPFAR program. Regardless of how small a percentage of the yearly budget $3 billion is ($15 billion over three years), it is so much more than many Americans will ever see that they deserve to know what the government is spending money on.
• The ABC approach has medical evidence to support its effectiveness, but it carries a lot of Western-centric ideology and conservative moral values that may not be in line with the cultures the U.S. is trying to aid. We should avoid making condom use a last resort, or refusing to make them available on the grounds that they will be used in “immoral” situations. Funding stipulations that require 1/3 of the prevention budget to be directed to programs which advocate abstinence-until-marriage should be removed. Numerous organizations are helping to reduce the number of HIV infections around the globe; funding should not be denied them simply because they are willing to distribute condoms, which have proven to be a very effective prevention method.
• The U.S. should continue to develop cheap, 3-in-1 ART drugs that will reduce the cost of treating individuals, allow more individuals to receive treatment, and make life easier for those who live with AIDS. The FDA should work with the WHO in expediting the drug approval process. Pharmaceuticals need to find effective second-line prescriptions for patients who are resistant to first-line prescriptions, and find inexpensive ways of producing those second-line drugs.
• Deference should be given to national governments and organizations that already have programs in place for combating AIDS, if those programs have proven effective. PEPFAR should work alongside existing systems rather than creating extra levels of bureaucracy.
• Part of the prevention section of PEPFAR should be a goal to increase respect for women through classes, workshops, and activities. Until the social status of women is raised in many of the focus countries, little progress can be made. It has been proven that there is a negative correlation between a woman’s level of education and her likelihood of contracting HIV. Therefore, it would be in the best interest of both the U.S. and the focus countries to provide more opportunities for girls and young women to complete at least a basic elementary school education.

Howl's Moving Castle

by Diana Wynne Jones

I rented the movie version of Howl’s Moving Castle a few months ago, and it was a bit confusing but still quite fun. The book possibly makes less sense than the movie, which I didn’t think was really possible – how could anime come out as a logical story? But, it sort of happened.

At any rate, while some things were explained more clearly in the book, I didn’t really understand the last bit at all. Maybe someday when I’m not sitting in Jarom’s history class trying to ignore the professor talking about ancient geography, I’ll try reading the book again. Until then, I’m just a little too confused to really know if I liked it much or not. Although I think I did.

colorful food

a few weeks ago we bought some red snapper at smith’s, because it was too good a deal to pass up. we ate half and put the rest in the freezer.

since then, jarom has been requesting “black & red fish.” we finally got the recipe from his mom last night, and I discovered it is, in fact, called blackened red snapper.

if you say it quickly, it does sound like “black & red” fish…

suffice it to say I feel rather silly.

a beautiful cardboard box

I’ll just say briefly that whether you like the new look or not, it’s going away. it was fun for a day though, no?

we found a place to live! it is a fantastic apartment. about 3 blocks from besta and 2 blocks from quimberlee; pleasant nice-weather walking distance from campus; far enough away to have a feeling of quietness and escape from the crazed singles byu life. we love how spacious the place is, and it has tons of storage, a really large kitchen, only a few neighbors, plus a deck outside with reinforced hammock hooks. it’s well within our budget, pets are allowed, any repairs you do (including lightbulb replacements) can be deducted from the rent, and shoveling the walk in the winter gets an extra $25 off the rent as well. we filled out the application as soon as we got back from our “tour” and are trying to get it pushed through this morning.

so I am crossing my fingers as cross as they’ll go. with any luck we can sign the papers by the end of the week and have our official first apartment ready to go!


today’s weather is gorgeous. I’m walking around in a short-sleeved shirt. me, of all people. and yet I pity myself…who’d have guessed that a california girl would ever think 43°F is warm?

and now, off to the weekly lunch meeting…I am crossing my fingers that someone has brought a list of people who need invitations…

and some insomnia

blarg I hate not being able to sleep. so here I am, pretending to be cool.

see how cool I am? I wrote this in october 2003. at the time I called it “experiences: a thought meander.” I do miss writing…

Have you ever been in a friendship that you knew was coming to an end? You can feel things winding down, drifting apart, slowly dying. Did you try to fight it? ignore it? or just make the most out of those last days?

To me, autumn always feels like a fading friendship. There’s a wistful enjoyment in watching the leaves change color. Their beauty is made all the more exquisite knowing that they’ll soon be fallen, leaving the trees bare. Maybe that awareness of the limited time frame is what makes autumn more appreciated. Maybe this season is a metaphor for life, and the reason we can find so much fulfillment is because we try to make the most out of those “last days.”

Imagine if this life went on indefinitely. Would each new morning matter? The first snowfall of the year could hardly fill you with excitement. There would be a hundred more to come, a thousand more already past. The fact that we can only experience a finite number of snowfalls makes each of them a glorious wonder.

There are so many things we pay little attention to because we see them so often, yet they, too, are limited. How many times have you seen the moon come up over the mountains? How many of those times did you stop for a moment, captivated by its breathtaking grandeur? What about storm clouds in the distance, stretching down to earth with their mists of rain? I love the colors of a summer sunset, the sky glowing with lavenders and golds you have to experience to believe. That’s what life is about—experiences. Get yours while you can, before the last leaf of autumn falls.

the screwtape letters

this past sunday we went up to jarom’s grandma’s house for dinner. on the way up we started reading the screwtape letters together. I’ve read it before, and wanted jarom to share. last year I read the great divorce to him, and I think this one is maybe a little bit more fun, though they’re both excellent books.

two of my favorite quotes:

“Indeed the safest road to Hell is the gradual one–the gentle slope, soft underfoot, without sudden turnings, without milestones, without signposts.”

“The more often [a man] feels without acting, the less he will ever be able to act, and, in the long run, the less he will be able to feel.”

on an unrelated note (I love those), today in my social problems class we talked more about race and ethnicity. mostly our teacher shared some personal stories with us. his daughter married a tongan man in the late 70s, and they decided for their reception they would just have an informal get-together with extended family on sunday after church. when our teacher arrived at the provo park they decided to meet at, there were about a dozen members of the tongan ward, still in church clothes, setting up tables and carrying casseroles, etc. there were also 3 police cars with lights flashing. mr. teacher went to talk to the officers and see what was up – they were responding to a “threatening situation” of what appeared to be an “ominous gathering.” our teacher was furious. he said you could recreate that situation a thousand times with white people (and yes, our teacher is white) and no one would ever dream of calling it an “ominous gathering” or “threatening situation.” people in church clothes, carrying casseroles on a sunday afternoon? the officers finally agreed to leave, if mr. teacher was sure he could “control these people.”

I thought, initially, that my small contribution to saving the world would be through fighting hunger. and that is a huge issue. but maybe problems with prejudice are just as bad, or greater. it isn’t limited to the u.s., not by any stretch of the imagination. today I read up on my yugoslav war history (I knew relatively nothing about it before this morning) – a lot of the conflict was over who was ethnically serbian and who was not. only a tiny fraction of the 30,000 genes in our genomes have anything to do with skin color. why have we decided that differences in skin color and heritage are so important, when in reality we are all so similar?

I know I need to choose a focus if I am going to save the world. (it’s better than the first advice my sociology teacher gave me when I told him I wanted to save the world – “give up now.”) but there are so many major issues. and bigger than them all, for the moment, is a policy paper I have to write! I guess saving the world will have to wait…