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Issue link: https://digital.miamilivingmagazine.com/i/49177
HEALTH Social Medicine In the fall of 2011 the world found out that the U.S. Centers for Disease Control and Prevention (CDC) awarded the Harvard School of Public Health in collaboration with the Botswana Ministry of Health a four-year $20 million grant, so researchers can study the cost-effectiveness of a unique combination of HIV prevention strategies. Ambassador Eric Goosby, U.S. Global AIDS Coordinator, stated, "In light of recent research establishing the preventive effect of antiretroviral treatment, antiretroviral- based interventions will be a key component of the combination approaches studied." But to ML readers, prevention strategies are something we've become familiar with over the years. Filippo von Schloesser, ML's HIV/AIDS specialist has a lot to say on this subject. "In several issues of this magazine I have underlined that HIV treatment is prevention. Prevention for the HIV positive person is to protect him/herself from being diagnosed with AIDS. Prevention for the HIV negative person is to learn how to stay this way when contacting an HIV positive person who is taking his/her medication, while maintaining virus levels below the limits of detection in the blood," Filippo said. "But now I wish to add that new clinical studies confirmed unprecedented results that one of the drugs of the armamantarium of HIV antiretrovirals, if taken correctly, can prevent the HIV negative person to seroconvert into HIV positive if he or she does not want to use the condom and has a chance to be infected due to risky behaviors." "I specifically mention that this way of prevention is valid only for HIV and not other infectious or communicable diseases. The clinical trial HPTN 052, which has been conducted by the HIV Prevention Trials Network, a global partnership dedicated to reducing the transmission of HIV through cutting-edge biomedical, behavioral, and structural interventions, is the first randomized clinical trial developed for study on serodiscordant couples," Fillipo said. "It has shown that if the HIV positive partner is virologically suppressed and has monogamous behavior, the antiretroviral therapy as prevention is highly efficient on the serodiscordant partner. This concept makes sense as the virus in the blood stream is below detectability and the genital and rectal tract viremia is also undetectable thus exposing no risk or minor risk to the negative partner." "At the same time the medication prevents individuals from getting infected. It works like the pregnancy pill or the malaria prevention with clorochine in Africa," Filippo explained. To simplify this concept, the so-called PreP, which means pre-exposure- profilaxis: taking a drug that is mentioned by the CDC (that has already delivered appropiate interim guidelines on this subject) can be a powerful form of risk reduction. But how easy and healthy is it to take a medication that has potential side effects, especially in the kidneys and in bone density just because one wants to avoid the use of a condom? And how expensive is it for the pocket of low or medium income populations to take a drug that costs at least $500 per month? "Most likely in the near future this prevention tool will be valid for those people most at risk of contracting HIV, particularly to those who have no access to other forms of protection like condoms, clean needles and injection equipment," Filippo explained. "I wish to mention specifically the sex workers. Many HIV activists in the U.S. criticize the PreP approach to prevent HIV as they say it's a tool only wealthy homosexuals in the Western countries will access, while those more in need, living in low income countries, will have to keep the risk at a high level due to economical or social reasons. And of course, there will constantly be a risk of contracting HIV until all the population of the world has global access to PreP, as the virus does not need a passport nor a visa." Global Policy The Global Fund (http://www.theglobalfund.org) created in 2002, is an international financing institution that invests the world's money to save lives. It has provided AIDS treatment for 2.3 million people, antituberculosis treatment for 5.4 million people and has distributed 88 million insecticide-treated bednets for the prevention of malaria worldwide. It has committed US $22.4 billion in over 150 countries to support large-scale prevention, treatment, care and support programs. "Millions of lives have been saved, because of the work of the Global Fund and its partners," Filippo pointed out. "But without the financial support of the countries that committed to this global defense the struggle against these pathologies will never be eradicated." "The most shameful country is Italy, my country, yes, one of the eight most industrialized ones, where Prime Minister Mr. Silvio Berlusconi (who is currently facing four separate trials over allegations of bribery, tax fraud and hiring underage prostitutes) committed to support the Global Fund in 2009 with 130 million euros for the year, plus another 130 million euros for 2010, plus an additional amount of 30 million euros. Despite this public funding announcement, he never followed through with his intentions," Filippo commented. "The reason given by his staff: The economic crisis. But the economic crisis has existed in Italy since I was born and the world has struggled against many obstacles, including the financial mismanagement that led to bankruptcy. Or probably, he's too busy looking for a strategy to defend himself from the accusation of promoting prostitution. The money is never enough when it's the turn of fighting in favor of those who are most in need." In fact, in July 2011 Giovanni Alemanno, the Mayor of Rome, sent a letter to Berlusconi urging him to allocate promised funds as Italy has made a long-term commitment to support the Global Fund. In this letter he touches upon the fact that Italy cannot fail such an important commitment, otherwise it places the Global Funds ability to achieve strategic goals in great jeopardy. Just to sum up a small portion of what Alemanno wrote: "I'm aware of the difficult economic situation in the world as well as in Italy, and of all necessary sacrifices, but I cannot ignore the fact that thousands of men, women and children will not receive adequate treatments and therefore will die from AIDS, TB and malaria in the forthcoming months if Italy does not do its share of its long-term commitment to support the Global Fund. Abandoning everything now means risking a new spread of these infections, with negative repercussions also for more industrialized countries." An estimated $15 billion is needed each year to prevent and treat HIV/AIDS, tuberculosis and malaria around the world. The Bill and Melinda Gates Foundation, which is dedicated to bringing innovations in health, development, and learning to the global community, revealed that Italy's aid was listed in 2008 at 0.21% of its GDP, compared with the UK's 0.48%. Gates wrote that this makes Italy "uniquely stingy among European donors." The Global Fund recently received support from many celebrities, including Deepak Chopra, Jeremy Irons, Minnie Driver, Annie Lennox, Alan Cumming and Morgan Freeman, who signed an online petition expressing this support. The letter basically states, "if we don't raise widespread support, the momentum we've already built will be lost." These celebrities are encouraging people to join them by following them on Twitter @looktothestars and/or on Facebook at LookToTheStars.org. ML MIAMI LIVING 85