PHR in California

In 2007, 2.1 million people died of AIDS—enough to fill more than 5,000 jumbo jets. If more than 5,000 planes fell from the sky each year killing all their passengers, what would happen? The UN Security Council would call an emergency meeting. The world would stop—and everyone would try to solve this problem. Instead, with AIDS, it’s business as usual.

This is how Dr. Elioda explained the impact of HIV on the world to a group of about 80 students at Huntington Beach High School on Wednesday. The students, part of the Model UN program, invited Dr. Elioda to speak at the school about his experiences addressing the HIV epidemic in Uganda. We visited the school after first addressing a group of health professionals from UC Irvine and the Orange County Department of Health, through the AIDS Education & Training Center in Orange County. Both of these groups, though varying greatly in age and experience, demonstrated the power of voices from the field in encouraging health professionals—and future health professionals—to become advocates for health and human rights. Attendance at both events was extraordinary, with scores of participants lining up after the talks to speak to Dr. Elioda about his work and experiences.

We continue to meet amazing people and wonderful partners as we tour California. Dr. Gupta, an infectious disease specialist who runs the local AIDS Education and Training Center, was a wonderful host in Orange County. It was she who introduced us to the Model UN teacher at the Huntington Beach High School. Although Dr. Gupta was not a PHR member before, I hope she will be one of the many new health professional advocates joining the Health Action AIDS campaign as a result of this trip. More voices are needed to make sure that the US and other development partners maintain their commitment to global AIDS.

Dr. Elioda with Model UN students at Huntington Beach High School.

At the invitation of Alice Stek, MD, OB/GYN/HIV specialist and Health Action AIDS advisor, Dr. Elioda and our AIDS team toured the Maternal Child and Adolescent Center (MCA) for Infectious Disease and Virology, a model care center in Los Angeles. This unique program provides comprehensive, multidisciplinary care to women and their families, with special attention to the needs of the poor and uninsured. MCA is the largest family-centered HIV program in California, serving over 3,000  HIV+ patients and their affected family members since 1998.

The commitment of the entire staff–physicians, nurses, social workers, pharmacists, dentists–to provide “one-stop”, fully integrated, culturally sensitive, women friendly treatment, that includes strong ties to community-based organizations, has had unheard of success: 100% prevention of vertical transmission of HIV for all women who have received prenatal care at their clinic. Their goal is to establish collaborations and share their key successes.

Dr. Elioda was extremely taken with the “compassion and dedication” of the entire staff, and made note of the connection to the community that is part of their entire care process. He acknowledged how difficult this follow-up care is in Uganda because of the lack of health providers, but strongly supports efforts, being seriously considered by the Ministry of Health, to include it as a standard of care. With funding for the training of new community health workers included in the reauthorized PEPFAR, he sees this as a strong possibility and something that will make it easier to reach more women, especially those in the rural areas who have difficulty getting to healthcare facilities.

Dr. Elioda shared that the rate of vertical transmission of HIV in Uganda is “the shame of the nation”, representing 21% of new infections. One of his key priorities is to improve PMTCT access so that newborns’ rates of HIV will someday reflect those of the western world: less that .004%. “I have learned many things today that will help me think about moving forward and I promise you will hear from me about your wishes to collaborate” commented Dr. Elioda.

As we left the clinic, Dr. Elioda noted a picture of Kofi Anan on the wall taken during a recent visit to MCA. With a smile he said, “I see I am in good company.”

From left: Dr Andrea Kovacs, Director of MCA, Dr Elioda, and Dr Alice Stek.

In excess of 200 community members, doctors, nurses, students, and staff of UCLA and the Ronald Reagan UCLA Medical Center participated in a Town Hall Meeting on Thursday, Oct. 23. Sitting around a coffee table and a globe, the informal town meeting included Dr. Tom Coates, Mr. Craig Thomson, Gail Wyatt PhD, Elioda Tumwesigye, MD and Congressman Howard Berman.

Dr Tom Coates, an advisor to the Health Action AIDS Campaign and long time PHR supporter, welcomed PHR and co-organizers to the event. Dr. Thomas Rosenthal, the Chief Medical Officer of UCLA’s new hospital, also gave a few words of welcome. In his opening remarks, APLA’s Craig Thomson described the work of APLA, focusing on the lack of global and national recognition of the issues confronted by Men having Sex with Men (MSM) and the HIV/AIDS epidemic.

Dr. Gail Wyatt focused on domestic issues, noting that the US has failed to fully confront the HIV/AIDS epidemic, and said if the country adopts a “one size fits all” approach, it runs the risk of ignoring disenfranchised sections of the population which are experiencing high rates of HIV. She called upon each and every one of the participants to ask why the country is not looking beyond traditional paradigms to address the HIV/AIDS epidemic.

Dr Elioda Tumwesigye then followed, describing the impacts of HIV/AIDS on Uganda. Among Ugandans age 15 to 19 year olds, girls are nine times more likely to be infected with HIV than boys. While answering the many questions posed to him, he emphasized the need not only for anti-retrovirals, but also for the empowerment of women through income generation projects and education of girls. Primary education in Uganda has been free for some time. The government has now introduced free secondary education. It is anticipated that this will help to ensure that girls complete their secondary education and have a positive, long-term effect on the epidemic.

Congressman Howard Berman spoke next, describing the reauthorization of PEPFAR. He also identified several challenges that the next administration will face, including the difficult financial constraints that may impact funding. The Global HIV bill that was passed was an authorization, not an appropriation, so we will have to fight every year for the authorized amount. He also stated that the global gag rule must be repealed, as it excludes many organizations that are doing impactful work with women and girls from funding. Additionally, Congressman Berman highlighted the need for more programs that adequately address prevention and treatment for intravenous drug users.

Pat Daoust then took the podium, explaining PHR’s role and stressing that the global campaign to fight HIV/AIDS needs not only ARVs, but also an integrated approach. She encouraged all the participants to sign the postcards to the next President that were included in the Town Hall materials. The Health Action AIDS team will deliver these postcards to the President-elect and his transition team after World AIDS Day, Dec. 1.

We could tell that the Town Hall was an incredible success by the excellent questions that participants raised during the closing discussion. Participants queried the speakers about their advice to the next President, the future of foreign assistance, and the importance of circumcision as a prevention tool. But many questions were left unanswered by the time the meeting ended, highlighting the importance of continuing this dialogue here in Southern California and beyond.

From left to right: PHR’s CEO Frank Donaghue; HAA Campaign Director Pat Daoust; Dr. Tom Coates Director of the UCLA Program in Global Health; US Congressman Howard Berman; Honorable Dr. Elioda Tumwesigye, Member of Parliament, Chair of the Committee on HIV/AIDS and Related Matters of Uganda; Craig E. Thompson, Executive Director of AIDS Project Los Angeles; and Dr. Gail Wyatt, Associate Director, UCLA AIDS Institute. Photo credit: Jirair Ratevosian/PHR.

This past Tuesday, Dr. Elioda took a break from the PHR West Coast Advocacy Tour to fly to Washington, DC to participate in the White House Summit on International Development. As part of a distinguished panel that included Ellen Johnson Sirleaf, President of Liberia, and the Ministers of Health for both Afghanistan and Ethiopia, Dr. Elioda addressed the over 200 attendees regarding the need for increased country ownership of international development efforts.

President Bush also attended the summit, urging Congressional leaders and the next administration not to cut back assistance to developing countries regardless of the current economic crisis. As Bush stated, “America is committed, and America must stay committed, to international development for reasons that remain true regardless of the ebb and flow of the markets.” You can read more about the Summit and Bush’s remarks on the Kaiser Network Daily Update website.

At PHR, we agree with President Bush. Cutting back on the HIV/AIDS assistance promised in PEPFAR would have devastating effects on the countries whose development is already severly hampered by HIV/AIDS. Please consider taking action on this issue by signing our online petition addressed to the new administration.

On Sunday, Oct. 19, the Health Action AIDS team, joined by our guest the Honorable Elioda Tumwesigye, MD, arrived in San Francisco, the first stop on our two-week tour of California. Despite having little time to recover from his long trip from Uganda, Dr Elioda was eager to begin sharing his first-hand experiences in combating the AIDS pandemic from the perspective of a Parliamentarian, chairing the committee on HIV/AIDS, as well as a physician who continues to care for patients at a clinic in his home district of Bushenyi.

That evening, we were invited to the home of Dr. Tom Hall, a longtime supporter of PHR. Dr. Hall holds regular gatherings for faculty, students and clinicians from UCSF, Berkeley, and Stanford who have a special interest in global health issues. It was a packed house–the largest turn out ever. Dr. Elioda spoke about Uganda’s aggressive response to the AIDS epidemic in the early-to-late 90’s, which focused on open communication, strong leadership, and community outreach. This successful government campaign resulted in a drop in HIV sero-prevalance from 18.5% to 5% in ten years and today serves as a model for other African countries.

But Dr. Elioda warned of an increasing rate of new infections and stressed the need for comprehensive prevention interventions, especially for women and girls, going well beyond the conventional ABC approach. He emphasized the need for education and micro-finance programs aimed at young girls, and praised the newly authorized PEPFAR for including such initiatives.

Dr. Elioda also spoke of the significant shortage of healthcare workers in Africa and the challenge of providing quality care to those in need. In his clinic he sees close to 6,000 HIV+ patients, 1,500 of which are on anti-retroviral treatment. When he is not there, a nursing assistant is responsible for providing continuing care. “Can you imagine? It is no wonder that we lose so many doctors and nurses to other countries. The stress we feel is difficult.” He urged everyone to continue to support US efforts (through PEPFAR 2) in addressing this crisis and providing the needed leadership to other resource rich countries.

Dr Elioda’s presentation was followed by a lively discussion, which concluded with an invitation to visit Uganda, the “pearl” of Africa. He promised a wonderful experience, great hospitality, and an opportunity to work at his clinic. My guess is he will have some takers!

Dr. Elioda (right) with Dr. Tom Hall and his wife Liz.

October 23, 2008

FOR IMMEDIATE RELEASE

(Los Angeles) Earlier this year, the US approved $48 billion for global AIDS. A few weeks later, the Centers for Disease Control revealed that HIV is spreading in the United States far faster than was previously thought.

Today at UCLA, experts held a town meeting sponsored by Physicians for Human Rights (PHR), UCLA Program in Global Health, and AIDS Project Los Angeles to discuss the current state of efforts to combat the AIDS pandemic both internationally and here in the United States.

Speakers included US Representative Howard Berman (D-CA); Craig Thompson, the Executive Director of AIDS Project Los Angeles; and the Honorable Dr. Elioda Tumwesigye, a Ugandan medical doctor, Parliamentarian, and outspoken AIDS advocate who is accompanying PHR on a barnstorming tour of California.

Rep. Berman was in Africa this summer to observe how PEPFAR is being implemented on the ground. He described the successes of the reauthorized bill, which triples the allocation for the U.S. response to HIV, TB and malaria, and expands its reach beyond initial 15 focus countries. “Now, we need to integrate HIV into broader health concerns such as food security, nutrition and vaccine research,” Rep. Berman said, adding: “We also have a lot of work to do to protect women and girls.”

Gail Wyatt, professor of psychiatry and biobehavioral sciences at the Semel Institute for Neuroscience and Human Behavior at UCLA and an associate director of the UCLA AIDS Institute, noted that methods to address AIDS in the U.S., which were largely developed toward the beginning of the epidemic, have been geared primarily toward white gay males. Still needed are policies and programs geared toward other ethnic and cultural groups that are otherwise not being reached. “That’s the challenge we have in America,” she said. “For a developed country we are behind the ball, and the ball is still rolling.”

Said Dr. Tumwesigye, “There are 2.1 million people dying of AIDS every year. If instead of AIDS those people were on planes that were falling from the sky, it would be more than 5,000 planes. The UN Security Council would call an emergency meeting. The world would stop—and everyone would try to solve this problem. Instead, it’s business as usual.”

The meeting was unusual because it addressed both global AIDS and the US epidemic at the same time. PHR’s CEO Frank Donague commented, “People deserve the right to health whether they live in Soweto or South L.A. The US must live up to its commitment to fight AIDS worldwide; we must fully fund the President’s Emergency Plan for AIDS Relief. But we also need a national AIDS strategy to address the epidemic raging right here in our backyard.”

PEPFAR (The President’s Emergency Plan for AIDS Relief) was reauthorized in July, 2008 –at $48 billion–for US efforts to combat AIDS, tuberculosis, and malaria abroad.  The expanded program (known as PEPFAR 2) now includes Latin American countries; PEPFAR 1 had focused mainly on Africa.

According to UNAIDS, 75% of young adults with HIV in sub-Saharan Africa are women and girls, who are especially vulnerable to HIV infection because of their low social status. PEPFAR 2 supports the implementation of programs that enhance the status of women, potentially giving them more power in social relationships, and thus helping them avoid HIV infection.

If fully funded, PEPFAR 2 also promises to prevent 12 million HIV infections and treat three million people over five years. The reauthorized program made several key changes from PEPFAR 1, including a focus on women and AIDS—though much more must be done to protect the human rights of women.

In August, the US Centers for Disease Control and Prevention revealed that new HIV infections in the US have escalated from 40,000 annually to 56,300–with numbers in the African-American, Hispanic and gay communities skyrocketing. People of color are disproportionately affected, with rates per 100,000 persons of 83.7 among Blacks and 29.3 among Hispanics, compared with 11.5 among whites, while 53 percent of total infections are attributed to men who have sex with men (MSM). Advocates are calling on the next president to develop what the US asks of other nations it supports in combating AIDS: a national strategy to achieve improved and more equitable results.

Advocates are calling for a National AIDS Strategy to address the problem.

“In the US, the debate about where to direct scarce resources must cease, and a commitment to adequately fund all aspects of combating HIV/AIDS in impacted communities must follow,” said APLA Executive Director Craig E. Thompson.

SPEAKERS INCLUDED:

• Congressman Howard Berman (D-California), chairman of the House Committee on Foreign Affairs.
• Gail Wyatt, associate director of the UCLA AIDS Institute and professor of psychiatry and biobehavioral sciences, Semel Institute at UCLA.
• Thomas Coates, associate director of the UCLA AIDS Institute , director of the UCLA Program in Global Health and advisor to PHR’s Health AIDS Action campaign.
• Craig E. Thompson, executive director of AIDS Project Los Angeles.

PHYSICIANS FOR HUMAN RIGHTS: To follow PHR’s trip, visit PHRinCalifornia.Org

For 20 years, Physicians for Human Rights (PHR), based in Boston, MA, has advanced  health and dignity by protecting human rights. As a founding member of the International Campaign to Ban Landmines, PHR shared the 1997 Nobel Peace Prize.

UCLA PROGRAM IN GLOBAL HEALTH

The UCLA Program in Global Health partners with academic institutions in developing countries to advance prevention, policy, and clinical research for HIV/AIDS and other diseases in all regions of the world. The program works with its partners in developing countries to integrate treatment and prevention of HIV, implement innovative prevention programs, stimulate the implementation of beneficial policies and laws, address gender inequity, and train the next generation of scientists in the United States and both scientists and advocates in developing countries to continue this essential work.

AIDS PROJECT LOS ANGELES

AIDS Project Los Angeles (APLA), one of the largest non-profit AIDS service organizations in the United States, provides bilingual direct services, prevention education and leadership on HIV/AIDS-related policy and legislation. Marking 25 years of service in 2008, APLA is a community-based, volunteer-supported organization with local, national and global reach. For more information, visit www.apla.org.

Join Physicians for Human Rights and the Honorable Dr. Elioda Tumwesigye as we travel throughout California to discuss the politics and realities of global AIDS.

Between October 19 and October 28, 2008, members of PHR’s Health Action AIDS Campaign will be touring California with Honorable Dr. Elioda Tumwesigye, a medical doctor, epidemiologist, and Member of Parliament from Uganda. Dr. Tumwesigye is the chair of the HIV/AIDS Committee in the Parliament of Uganda and is a powerful advocate for people living with HIV in Uganda. He will be traveling with us and speaking to some of the social inequities and human rights violations that fuel the spread of HIV in Uganda and throughout sub-Saharan Africa.

Watch the video below to learn a bit more about Dr. Tumwesigye and his concerns about the HIV epidemic in his country.

PHR will be visiting San Francisco, Irvine, Los Angeles, and San Diego. Please visit the Events page to learn more about an event near you and check back for blog postings from Dr. Tumwesigye and our team while we are on the road.

AIDS is not over. You can help PHR fight global AIDS by attending an event or taking action.