Bush advocates $30B for PEPFAR

Bush advocates $30B for PEPFAR

Yesterday, President Bush implored Congress to extend PEPFAR, the President’s Emergency Plan for AIDS Relief, for an additional 5 years and allocate an additional $30 billion to the program. Initially proposed in the President’s 2003 State of the Union address, PEPFAR targets HIV/AIDS treatment in 15 countries with high HIV/AIDS burdens.

As President Bush noted, the $15 billion allocated to PEPFAR thus far has resulted in antiretroviral drugs for 1.1 million people in these resource limited countries and the increased funding could result in treatment for as many as 2.5 million people. This drug therapy, obviously, will extend and improve the lives of these lucky individuals. Arguably, then, PEPFAR is changing the HIV/AIDS landscape.

The plan cannot, however, be considered an unqualified success. Approximately 30 million people in sub-Saharan Africa alone are HIV positive. Providing treatment to 2.5 million of them is not enough. Until all people, in all countries, have access to the life-saving antiretroviral drugs, we can not be satisfied with any existing plan.

More importantly, we need to examine the restrictions associated with PEPFAR funds. One third of allocated funds must be spent on abstinence programs, despite the clear evidence that condoms are the most effective means of preventing the sexual spread of HIV. No funds can be spent on clean needle exchange programs, despite the clear evidence that needle exchange programs prevent the transmission of HIV and do not lead to increased injection drug use. The $15 billion currently allocated to PEPFAR has made a difference. And the additional $30 billion proposed by President Bush will make an even greater impact on the pandemic. President Bush should be commended for this initiative and his leadership. But President Bush also should be admonished for ignoring the scientific evidence. When it comes to the AIDS pandemic, decisions need to be based on evidence, not one person’s faith-based morality.

WHAT ACTIVITIES ARE MOST RISKY?

WHAT ACTIVITIES ARE MOST RISKY?

The highest risk of becoming infected with HIV is from sharing needles to inject drugs with someone who is infected with HIV. When you share needles, there is a very high probability that someone else’s blood will be injected into your bloodstream. Hepatitis virus can also be transmitted by sharing needles.

The next greatest risk for HIV infection is from unprotected sexual intercourse (without a condom). Receptive anal intercourse carries the highest risk. The lining of the rectum is very thin. It is damaged very easily during sexual activity. This makes it easier for HIV to enter the body. The "top" or active partner in anal intercourse seems to run a much lower risk. However, the risk still seems higher than for the active partner in insertive vaginal intercourse.

Receptive vaginal intercourse has the next highest risk. The lining of the vagina is stronger than in the rectum, but is vulnerable to infection. Also, it can be damaged by sexual activity. All it takes is a tiny scrape that can be too small to see. The risk of infection is increased if there is any inflammation or infection in the vagina.

The risk is higher for the receptive partner. However, there is some risk for the active partner in anal or vaginal sex. It’s possible for HIV to enter the penis through any open sores, through the moist lining of the opening of the penis, or through the cells in the mucous membrane in the foreskin or the head of the penis.