On Wednesday, March 18, I attended a
presentation entitled "It’s not Over: Global AIDS Funding in an Era of
Uncertainty," sponsored by Physicians for Human Rights (PHR) and
Georgetown University. The speaker, Dr. Peter Mugyenyi, Executive
Director of Uganda’s Joint Clinical Research Center, pioneered the
administration of anti-retroviral (ARV) therapy on the continent of
During his introduction of Dr.
Mugyenyi, former U.S. Global AIDS Coordinator, Ambassador Mark Dybul
and current co-Director of the O’Neill Institute for National and
Global Health Law at Georgetown University, cited Dr. Mugyenyi’s ARV
treatment and care delivery strategy as the model for the President’s
Emergency Plan for AIDS Relief (PEPFAR).
Dr. Mugyenyi expressed gratitude to
both Ambassador Dybul and the American people in the opening sections
of his speech. He also noted that PEPFAR’s immense successes,
particularly in terms of treatment access, had made an enormous
difference. He stressed that the difference between people accessing
life-saving interventions and not, was really a question of political
will and not simply one of resource availability.
But it was his statement about
prevention that really gave me goosebumps. He called for a redesigned
prevention strategy that would address the realities of the epidemic in
2009. Mugyenyi noted that women are at a higher risk of infection, not
just for biological reasons, but particularly because of the social and
political marginalization that they face caused by a system of gender
inequality. "The epidemic has changed," Mugyenyi said.
"Many people say that reproductive health is a dirty word. It becomes
even dirtier when you call it ‘family planning.’ But it is not a dirty
word. It is a clean word. And integration of reproductive health
services with HIV testing and care services is critical for women’s
Let’s take a moment to reflect! The
doctor whose program was the basis for the President’s Emergency Plan
for AIDS Relief (at least according to former U.S. GAC Dybul), said
that "reproductive health is a clean word," and that the "integration
of reproductive health services with HIV" programming should be a
priority for the future of PEPFAR’s implementation.
Feels good, doesn’t it? Having spent
the last two years fighting for improvements to PEPFAR’s prevention
policies toward young people and women, Dr. Mugyenyi’s statements
really made my day.
There was just one down side – while
Dr. Mugyenyi focused on the specific vulnerabilities of very young
children and women to infection, he did not elaborate on the particular
needs of adolescents. According to UNAIDS, young people under the age
of 25 comprise 45 percent of all new infections. Young people must be
at the core of any new strategy. The stigma of sex blocks the
information and resources critical to the prevention of transmission
among youth. Dr. Mugyenyi’s point, that reproductive health care must
be integrated with HIV testing and care services, would not only serve
women, but also young people. Adequate sexual and reproductive health
care resources for young people would serve to help normalize sexual
health among adolescents and young adults, thus weakening the power of
stigma to fuel new infections transmitted through unprotected sex.
As Dr. Mugyenyi is a pediatrician, I
am sure that he is aware of the epidemic among youth. But we must all
ensure that the realities of HIV among adolescents are never an
afterthought when we discuss prevention strategies.
Fifteen years after the International
Conference on Population and Development (ICPD) in Cairo, Egypt, where
participating country delegations established that young people have
the right to medically accurate information and evidence-based care for
their sexual and reproductive health, the inclusion of adolescents and
young adults in HIV prevention strategies should be a given. Well, here
we are fifteen years later and we are still fighting for inclusion.
Let’s take full advantage of this
political springtime – this new beginning – in the United States by
demanding a change in U.S. global AIDS policies.
Just as we knew that ARVs saved lives
and used our "political will" to make the impossible possible (their
delivery in low-resource settings), we can garner that same "political
will" to ensure that comprehensive, medically accurate information
about the prevention of HIV – especially for young people – also be
In a closing anecdote, Dr. Mugyenyi
noted that, before PEPFAR was a household acronym, he sat in a meeting
of public health officials in Uganda. The group collectively stated
that anti-retroviral delivery could never take place in Uganda on the
same scale and with the same efficacy as it had in the United
States. Dr. Mugyenyi said he got up and left the meeting, never to
return. He had decided not to waste his time with the naysayers, but to
invest in making antiretroviral therapy a reality in his country.
Today, Dr. Mugyenyi proudly noted, anti-retroviral delivery and
adherence to treatment in Uganda is "just as good" and in some cases
"better" than in the United States.
This is a strategy I have not yet
employed in my fight to have U.S. global HIV prevention policy reflect
the realities of young people’s lives, but it sounds like it’s a tactic
waiting for the moment. Next time policy makers smugly tell me that
young people cannot handle comprehensive HIV prevention education, or
do not need access to sexual and reproductive health services, I’ll be
sure not to let the door hit me on the way out.
This post first appeared at Amplify.