This posting is being written over a long weekend in Canada. It will only be posted on the website in early July. The reason is that I am one of the contributing authors to a paper being published in the journal Health Affairs and the article was released on Monday. That means we could put a link up, but not until 4 PM Eastern time on 1st July. Eastern time refers, of course, to the time in New York and Washington, not Moscow. The writing was led by Steven Forsythe, someone I have known for many years, and who did his Ph.D. at the Liverpool School of Tropical Medicine. Apart from him there are another seven named co-authors. The title is Twenty Years Of Antiretroviral Therapy For People Living With HIV: Global Costs, Health Achievements, Economic Benefits. It will go on the reading list for my students.
The other activity I have been extensively engaged in over the past couple of weeks is editing The African Journal of AIDS Research. I am the Editor-in-Chief. This means that I read every article that gets through the review process to approve it for publication. We are now getting about 260 articles submitted every year, we only publish 40 (and these I read), and so there is quite a lot of work involved. On the other hand it is does give me a forum to express views in editorials, should I wish, and keeps me up to date on current writing. Hopefully the last issue of 2019 will comprise papers presented at the International AIDS Economics Network meeting just ahead of the International AIDS Conference in 2018. To some extent this will be a ‘development’ issue as some of the authors have not published before. Steven is one of the two guest editors for the issue.
I am teaching two courses this term and am increasingly aware of the importance of equity in health. It is quite clear that, in the near future, a number of countries will not be able to afford to have their citizens on antiretroviral therapy. Donors are paying for it and may step back. This will raise a series of moral questions and it will be deeply interesting and concerning to see how they are addressed. My belief is that donor agencies will agree to continue funding people who are on treatment, but they probably won’t initiate new patients.
The big news from Waterloo is that the light rail service is finally in operation. This means that there are spanking new two-car trains running from a mall to the north of Waterloo to one to the south of Kitchener. I find it quite telling that the endpoints are shopping emporia. The train has been free of charge for the first 10 days of operation, giving the local citizens the opportunity to try it. In general I believe large infrastructure projects are critical for long term development, although it may not seem so at the time.
The second edition of HIV and AIDS: A Very Short Introduction, by Alan Whiteside, has just been published by Oxford University Press.
HIV/AIDS: A Very Short Introduction provides an introduction to AIDS—the most serious human epidemic in centuries—tackling the science, politics, demographics, and devastating consequences of the disease. The first case was identified in 1981; by 2004 approximately forty million people were living with the disease, and about twenty million had died. The outlook today is a little brighter. Although HIV/AIDS continues to be a pressing public health issue, the epidemic has stabilized. The worst affected regions are Southern and Eastern Africa. Elsewhere, HIV is found in specific, often marginalized populations. Although there remains no cure for HIV, there have been unprecedented breakthroughs in understanding the disease and developing drugs
You can find out more on the Oxford University Press website.
I wish I knew a more productive way of writing than my current style. At the moment it seems that I allow deadlines to creep up on me, and then there is a period of frenetic activity before the article, blog, book or whatever is submitted. I never feel completely satisfied. This is hypocritical, given that the advice I give my students is: “done is good enough”. One thing that became clear over the last few weeks is that I do my best work with other people. I was very fortunate last month in that Gemma Oberth, whose Ph.D. I examined some years ago, and who now lives and works in Cape Town, asked if she could come and spend a period of time writing with me. She was visiting her parents in Toronto and so it was a simple matter for her to travel up to Waterloo. (Having said that though, travelling from Toronto to Waterloo is never a simple matter, the traffic can be horrendous.) This was absolutely great. We were able to settle down, plan out an article, do the research, and actually get close to a final draft. We then exchanged versions over email and submitted it to a journal within a week of her departure. It now goes out to peer review and I will be interested to see what the reviewers think of it. Personally I found this method of writing to be easier than most.
Every academic establishment goes through the rewarding period of convocations when degrees are conferred on successful students. Wilfrid Laurier is no different, though here in Canada, there is a tendency for shorter ceremonies over a longer period. For about a week, there are two ceremonies a day, one in the morning and one in the afternoon. I was pleased to be invited to give the convocation address at one of the events. It is reproduced below. I spent a great deal of thought over it, trying to work out the pitch of the presentation, what was really important, and what the students might even recall. The addresses come before they have to walk across the stage and receive their degrees so I suspect most are not paying close attention. I hope you find it interesting. I was complimented by a couple of the students and their parents afterwards so at least I must have reached five or six people.
There are sparrows living in the terminal building at National Airport in Washington. Clearly they have found an ecological niche and are making the most of it. I don’t know if they spend all their time in there or if they manage to get in and out. This is the sort of question that I would ‘Google’, but I was unable to connect with the internet. I was too tired to do battle with the technology, especially since I had just 40 minutes before boarding my flight to Toronto. Instead I sat in the boarding area and contemplated. There was an elderly gentleman sitting in there playing snatches of music on a French horn. This was designed to keep the waiting passengers amused I think. Unfortunately he was not very good and did not play any piece for long enough. One of the gate staff walked over, plonked himself in an empty wheelchair next to me, and gently rolled himself back and forth in time to the music while texting furiously. These are the vignettes of the departure gate.
There are many places in Ontario named after English towns. Not far from Waterloo, there is a Norwich and down the road, the small town of Stratford hosts, perhaps predictably, an excellent Shakespeare festival. The other day I told a colleague I needed to leave the meeting we were at: I was travelling to London.
“Oh”, she responded, “So am I”.
The difference was she had to drive for an hour while my journey was to Pearson Airport, Amsterdam, and a connection to Heathrow.
Commentary: Global Fund Observer
There are just two years remaining on the clock for developing nations to achieve the Millennium Development Goals, including Goal Six, targeting the global fight against AIDS, TB and malaria. While some progress in some parts of the world has been made, it looks increasingly clear that the goal – of halting and reversing the spread of HIV; of achieving universal access to treatment by 2010; and of halting and reversing the incidence of malaria and other major non-communicable diseases – will not be met. Click here for the complete article.
It’s been a few months of intense traveling and presenting research for HEARD staff. I participated in various conferences commemorating the 30th anniversary since HIV and AIDS was first discovered. Below are some of the event highlights and information on forthcoming conferences I will be attending.
2011 Caribbean HIV Conference
The 2011 Caribbean HIV Conference was held in the Bahamas from 18 – 21 November. The focus this year was given to sharpening the focus on HIV in the Caribbean, the region with the world’s second highest adult HIV prevalence. As a panelist at event, I presented What is Realistic ‘Sustainability’ within the Context of a Multi-country Regional HIV Response?: A Perspective from southern Africa. This conference presentation was prepared with the support of HEARD research intern Natashya Pillay and was well received. The key points were that the Caribbean has succeeded in controlling their epidemic and should be commended for this, the price of success is continued vigilance. There is diversity between the countries. One key lesson both ways is to build on regional organisations.
Focal points of the presentation:
- An epidemiological comparison of hyper-epidemic countries in the Caribbean and sub-Saharan Africa.
- Sustainability; regional versus multi-country efforts; prevention, treatment and impact mitigation.
- Results/Good Practices
- In particular, lessons can be learnt from Swaziland, the sub-Saharan country with the highest adult HIV prevalence rate.
- Efforts need to be concretized and regional integration is a way to achieve this. It will allow HIV and AIDS efforts to be mainstreamed.
Economic Reference Group Meeting (ERG) in Washington
HEARD organised the World Bank and UNAIDS ERG in Washington on 29 and 30 November. This meeting was attended by HEARD researcher Ilaria Regondi and Professor Whiteside. The meeting looked at financing of the AIDS response and the results of the RethinkHIV project.
Guest of the School of Public Health at the University of Alberta
In late November I travelled to Edmonto and was hosted by David Zakus, who is a Professor and the Director of Global Health in the Division of Community and Occupational Medicine Engagement of the Department of Medicine at the University of Alberta.I gave four presentations consisting of two lectures presented to a class of students: Aid for AIDS and Making Hard Choices: Prevention in the Global Crisis; and two public lectures Economics and HIV in Africa: Costs and Consequences and A Safe Sex/No Sex Month: Could it work? Innovative Responses for Preventing HIV Transmission.
AIDS @30 Symposium at the Harvard School of Medical Health- 1 and 2 December
I was also invited as a participant together with other international health leaders, elected officials, scientists, artists and activists. The meeting was convened to reflect on what we have learned from AIDS and how to apply those lessons towards ending the epidemic. There were presentations from among others, Julio Frenk the former Mexican Minister of Health and currently Dean of the Harvard School of Public Health and Anthony Fauci who is the Director of the US National Institute of Allergy and Infectious Diseases. Durban academics were well represented at the event.
Health Systems Workshop at the Wellcome Trust London
This workshop will take place on the 13 and 14 December 2011. This is the UK health funders workshop on health systems research in low and middle income countries.