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Challenges on the Road to Universal Access

At a satellite session on Sunday, a striking statistic was reported by the humanitarian organization Medecins Sans Frontieres: in one of its ARV treatment programs, 60 percent of project costs are going toward the treatment of 10 percent of patients. Why? After several years on standard ARV treatment regminens, many patients will inevitably develop resistance to the drugs and require newer ones.

Should We Expect More from Middle Income Countries?

The MCC is in final negotiations with El Salvador, one of two lower middle income countries (LMICs) deemed eligible in FY2006. Over the last year, we've heard bits and pieces of feedback from NGOs on the ground. Together with a review of the actual proposed compact (pdf), here's what I think is worth watching and discussing:

Act Up!

International AIDS Conferences are known for their dramatic protests. Tommy Thompson was booed off the stage in Barcelona. Randall Tobias, then head of PEPFAR, silently fumed at the podium for 45 minutes in Barcelona before protesters quieted enough for him to speak. The Prime Minister of Thailand was embarrassed at the Bangkok opening ceremony. AIDS activists, following the tradition of ACT UP! are known for their vocal presence -- and for pushing for real dialogue and action.

Is this "Performance-Based" Funding?

Today's Washington Post highlights several AIDS prevention programs in Africa which are using the ABC approach without much success. Programs in both Botswana and Kenya failed to change participants' behavior while another program in Nigeria increased condom use but not fidelity or abstinence rates. The lack of results would make you think that funders would be hesitant to expand ABC programs, wouldn't it? Unfortunately, the opposite may be true.

What's the buzz in Toronto?

It's both energizing and exhausting to be at this largest ever AIDS Conference in Toronto. With 25,000+ delegates and an impressive line-up of global, national and community leaders attending this conference, the message is very clear: it isn't just time to deliver, but rather it is Time to Deliver NOW! With 25 years behind us, billions of dollars spent, millions of deaths and millions more being infected there is no time and money to waste.

To Test or Not to Test?

That was the question at the International AIDS Conference session on "HIV Testing the Era of Treatment Scale Up." As ARVs become more widely available, more people need to take HIV tests to get started in treatment programs. But should Voluntary Counseling and Testing (VCT) be replaced by "Routine Offer" or "Routine Testing" programs? Routine Offer refers to testing programs where all clinic visitors, or those meeting certain risk guidelines, are offered a test.

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