In a second post on global health news for this week, U.S. President Barack Obama’s budget request for next year has reduced funding for neglected tropical diseases. This decrease may have wide-reaching effects on one-sixth of the world’s population. Additionally, a writer tells his story of life in a serodiscordant relationship and navigating the American health care system with a partner who is living with HIV.
U.S. Funding for Neglected Tropical Diseases May Decrease
This week, the Regional Executive Director-North America for the Drugs for Neglected Diseases Initiative (DNDi), Rachel Cohen, made an impassioned case for more funding for neglected tropical diseases from the U.S. government. President Obama’s budget request for 2013 cuts nearly 25% from USAID’s Neglected Tropical Diseases (NTD) Program, lowering funding from $89 million this year to $67 million. Ms. Cohen charges that “this isn’t trimming the fat–it’s cutting into muscle” and that the decreased funding “will have direct consequences in terms of lives lost.” She argues that the NTD Program should be given a budget of $100 million: the amount that President Obama initially requested (and was denied) for 2012. Ms. Cohen also points out that unlike for other “disease-specific programs,” the NTD Program does not fund research for new drugs, diagnostics, and other treatment tools. Furthermore the USAID program only focuses on five of the 17 WHO-identified NTDs and excludes three of the most fatal: Chagas disease, sleeping sickness, and visceral leishmaniasis (more on NTDs here).
Appearing before the House Subcommittee on State, Foreign Operations and Related Programs (within the House Appropriations Committee), Dr. Raj Shah, the USAID Administrator, testified that the Obama administration budget request “enables USAID to meet the development challenges of our time…[and] allows us to transform the way we do development.” Using language that fits into the efficiency/country ownership/tightened belts themes that we’ve seen from donors recently, Dr. Shah specifically pointed to the NTD Program in his testimony without indicating that the request would slash its budget by a quarter. Unfortunately, President Obama probably has little wiggle room, given the current American political climate, but Ms. Cohen is right: it’s time to take the “neglected” out of NTDs. One in six people on the planet has one. Without investment in research, prevention, treatment, and the development of new tools to fight NTDs, a billion people will continue to suffer from diseases that sap energy and cause disability and death.
Life in a Serodiscordant Relationship
Freelance writer John Fram wrote an article for The Atlantic this month that gives an unflinching, personal account of being half of a serodiscordant couple in the US: while Mr. Fram is negative, his partner is living with HIV. He writes of navigating the American health care system, including long waits for doctor’s visits, applying for welfare benefits, unresponsive social workers, and filling prescriptions for anti-retrovirals. Mr. Fram mentions brief feelings of stigma and discrimination, such as when Texan pharmacists seem to shy away: “I still can’t tell if the techs’ (and even some of the pharmacists’) apprehension in talking to us is based on busyness or a fear of getting something on them.” Overall, however, Mr. Fram depicts caring, supportive, no-nonsense health and social workers. He’s open about the difficulties and logistics of being in a serodiscordant relationship and the worry (and lack of worry) that comes with being at risk for infection and with caring for someone with an illness that is, luckily, becoming increasingly a chronic, as opposed to fatal, condition. Studies released in 2011 found that HIV-negative people who took antiretroviral prophylaxis reduced their risk of infection by up to 73%, and even more strikingly, that people living with HIV who adhered to their antiretroviral therapy dropped the risk of infecting a negative partner by 96%. This has led to calls in the HIV/AIDS sector to see treatment as prevention, but such findings also have obvious implications for people in monogamous, serodiscordant relationships. Mr. Fram’s story of serodiscordancy is only one of many, but he gives a glimpse into the experiences of people living with HIV and those of their partners and families. It’s well worth a read.