HIV: The forgotten pandemic

Presented by Novo Nordisk: The ideas and innovators shaping health care

Oct 12, 2022 View in browser   By Carmen Paun, Ruth Reader, Ben Leonard and Grace Scullion Presented by Novo Nordisk WORLD VIEW John Nkengasong | Veronica Davison via the Department of State From San Francisco to Asia, the number of HIV infections is rising at a speed that's alarming U.S. and global health officials. In 2021, 1.5 million people were infected with HIV, a million more than public health officials' target, according to a Joint United Nations Programme on HIV/AIDS estimate. Experts suspect the Covid-19 pandemic played a role. John Nkengasong, the leader of the biggest anti-AIDS program in the world — the U.S. President's Emergency Plan for AIDS Relief — spoke to Future Pulse about his plan to fight back. Nkengasong managed the pandemic in his previous job running the Africa Centres for Disease Control and Prevention. Last year, President Joe Biden tapped the Cameroonian American to lead PEPFAR and oversee its budget, which reached $7 billion this year. The Senate confirmed him in May. Nkengasong said he wants PEPFAR to help build health systems in the more than 50 countries it works with so they can stave off other disease outbreaks. Without that, he said, the fight against HIV/AIDS can't be won. This interview has been edited for length and clarity. How can PEPFAR work to gain back some of the ground lost to HIV due to the pandemic? Political leadership is going to be determinant. If you look at where we were 20 years ago, HIV was common, was on the streets. In sub-Saharan Africa, I remember HIV was visible. You could look across the clinic where I was working and you saw people with sunken jaws; people who were crying. Because of the remarkable success of PEPFAR and other programs like the Global Fund to Fight HIV, Tuberculosis and Malaria, we don't see that anymore. So it has lessened the visibility of HIV. It's now become a silent but dangerous pandemic. That the heads of state of the countries we are working with own that agenda, lead that agenda, is going to be critical. HIV, malaria and tuberculosis have killed more people in some African countries than Covid-19 did, yet donors wanted their money spent on the latter . Did donor countries impose the wrong priorities? No, I think we have to put the response to the Covid-19 pandemic in the right context. Covid was and continues to be very disruptive. It's impacted very heavily on economies and development. It was always clear that until you get Covid under control, it was going to be difficult to get back to the malaria fight, the TB fight and HIV fight. Stigma of LGBTQ people in some parts of the world has made the fight against HIV harder because it stops people from seeking care. How should PEPFAR address that? It is going to be a continuous engagement process, where we work with political leadership but also work with religious leaders and community leaders. And I can make a case that the sensitivities that surrounded the discussion 10 years ago are very different from what the discussion needs to be now. However, challenges remain, tremendous challenges, about discrimination and stigmatization: How do we create champions so that this dialogue continues? Recognizing that if we could not do this, it will continue to drive the problem and hide the issues where the burden of the disease is. We need to do that in partnership with the country governments that we support, be sensitive to the cultural issues that they're dealing with, but not avoid those policy discussions that need to be put in place to affect the appropriate changes.   STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president's ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.       A message from Novo Nordisk: Fixing Medicare's outdated obesity policies can reduce healthcare inequities. Obesity is a major health equity issue. Congress must act now.   WELCOME TO FUTURE PULSE This is where we explore the ideas and innovators shaping health care. A public service announcement: If you bought the newest iPhone, make sure you don't have it with you during a roller coaster ride. It may call 911 under the mistaken impression you were in a car crash while you were yelling your heart out on a steep descent. Share news, tips and feedback with Ben at bleonard@politico.com, Ruth at rreader@politico.com, Carmen at cpaun@politico.com or Grace at gscullion@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Today on our Pulse Check Podcast , Alice Miranda Ollstein shares with Krista Mahr a dispatch from her reporting in Pennsylvania and Michigan about doctors taking to the campaign trail ahead of the midterms. Plus, Dr. Katie McHugh on moving her abortion practice to other states. Listen to today's Pulse Check podcast   A message from Novo Nordisk:   DANGER ZONE As many as 500,000 newborns live in U.S. counties with little or no maternity care. | Getty Images 6.9 million The number of women in the United States estimated to live in counties with little or no access to maternity care Maternity-care deserts: Inadequate care for new mothers increases the risk of death and other health complications for both mother and baby, according to a March of Dimes report. And access is shrinking. Five percent of counties have fewer obstetricians than they did two years ago. The key data points:  2.2 million women live in counties without maternity care. Women who live in places with little or no maternity care are more likely to have asthma or high blood pressure and smoke tobacco. Since 2020, hospitals decreased obstetric services in 37 counties and added care in eight.  Only 7 percent of obstetricians practice in rural areas. Two-thirds of maternity-care deserts have a high proportion of uninsured women. Two women die every day from pregnancy complications and childbirth; two babies die every hour, according to the report. What needs to be done: The March of Dimes says Congress should expand Medicaid eligibility to include more mothers and extend postpartum care nationwide from 60 days to 12 months for those in the program. The Covid relief and economic stimulus bill Congress passed in March 2021 gave states the option to extend postpartum coverage to a year, but some states haven't done so. The March of Dimes also calls for more doula and midwife care as well as telehealth services, and it wants Congress to require insurers offering Obamacare plans to have strong maternity-care offerings.   TUNE IN TO THE PULSE CHECK PODCAST: Keep your finger on the pulse of the biggest stories in health care by listening to our daily Pulse Check podcast. POLITICO's must-listen briefing decodes healthcare policy and politics, and delivers reality checks from health professionals on the front lines. SUBSCRIBE NOW AND START LISTENING.       A message from Novo Nordisk: Fixing Medicare's outdated obesity policies can reduce healthcare inequities. Obesity is a major health equity issue. Congress must act now.   TECH MAZE Making health data available en masse is a prerequisite if artificial intelligence is to improve diagnoses and treatments. But privacy is a worry, especially as health data breaches soar. An article published in PLOS Digital Health by researchers from the Massachusetts Institute of Technology, Harvard Medical School and others, says not to fret. The study found scant evidence of any risk to privacy as long as the data sets are "de-identified," or scrubbed of links to individuals. The researchers have this advice for policymakers: Adopt regulations to penalize the use of health data for commercial purposes and re-identification of patients, in which previously anonymized data is connected to the individual it came from Developing countries should provide incentives to broaden research beyond the U.S. Engage underrepresented groups when deciding how data will be used Such outreach is crucial to prevent AI from entrenching bias in health care, the researchers wrote: "Preventing AI's progress towards precision medicine and sliding back to the 'white-size-fits-all' clinical practice dogma poses a more significant threat than contemporary concerns of potential patient re-identification."   Follow us on Twitter Ben Leonard @_BenLeonard_ Ruth Reader @RuthReader Carmen Paun @carmenpaun   Follow us

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