The United States is failing to fulfill its promise of universal access to HIV/AIDS medication, says advocate and professor Peter Mugyenyi.
Mugyenyi, director and founder of Uganda’s first HIV/AIDS research center, spoke at the Yale Law School on Monday about the great success of PEPFAR, the President’s Emergency Plan for AIDS Relief, and the way the program had been undermined by the financial crisis and Congress’s recent decision to cut foreign aid. In front of an audience of about 40 students and faculty, Mugyenyi criticized the G8 group of “resource-endowed countries” for failing to fulfill its 2005 promise of universal access to HIV anti-retroviral treatment.
“[There exists] a conspiracy of silence about the [failed] commitment to universal access that was made by world leaders,” Mugyenyi said. “Have you heard it being talked about? I haven’t.”
The Western world risked abandoning millions of Africans to die if they cut off funding for AIDS relief, Mugyenyi said. Money for AIDS needs to be a long-term commitment because of the lifetime nature of the disease, he said.
Mugyenyi, who is also the chancellor of Mbarara University of Science and Technology in Uganda, mentioned a protest that occurred during White House advisor Ezekiel Emanuel’s November visit to the Law School, in which students held up signs and chanted slogans that blamed PEPFAR cuts for killing children. He said the students were correct in their criticism of the flatlining of PEPFAR spending.
“Activism is at an all-time low,” Mugyenyi said, adding that he is on a tour of four college campuses, hoping to find idealistic young people to join the ranks of activists like those who protested Emanuel’s talk.
AIDS activism is particularly important now, Mugyenyi said, because the cuts to PEPFAR funding threatens to return HIV-positive Africa to the desperate times of the 1980s and early 1990s, when HIV treatment was scarce.
Anti-retroviral treatment, the most commonly used type of treatment for HIV/AIDS, was developed and introduced in the Western world in the mid-1990s. Before the medication became popular the morbidity rates for HIV-positive patients in the West roughly mirrored those of the developing world, but after the introduction of anti-retroviral treatment patients in developed nations began to live longer, Mugyenyi said.
“The turning point for resource-constrained countries,” Mugyenyi said, “was the establishment of the Global AIDS Fund and PEPFAR programs in 2003 and 2004.”
Before this point, the lack of health care infrastructure in developing nations was viewed by many activists as an insurmountable obstacle, Mugyenyi said. But the introduction of PEPFAR funding, and the resulting stabilization of the African epidemic, proved Africa could sucessfully fight HIV/AIDS, he said.
“PEPFAR is the U.S.’s greatest humanitarian mission to Africa ever,” Mugyenyi said. “Adherence and treatment outcome in some cases surpassed levels in North America and Europe.”
About one-third of PEPFAR funding has gone to anti-retroviral drugs, which Ezekiel Emanuel has criticized as being more expensive than preventing new infections. But Mugyenyi emphasized that treatment can play a role in prevention, if it is accompanied by preventative techniques such as circumcision. In one study of couples in which one partner is HIV-positive and the other is HIV-negative, there was a 100 percent reduction in transmission if the infected partner used antiretrovirals.
The higher the CD4 cell count — a type of cell important in the immune system — the lower the HIV transmission rate was in the study, while the lower a person’s CD4 cell count, the higher the transmission rate was.
“[Antiretroviral treatment] breaks the back of the epidemic,” Mugyenyi said.
Chris Gentry NUR ’13 said he enjoyed Mugyenyi’s talk but wished Mugyenyi spoke more about the larger issue of foreign aid.
“It’s an unsustainable model that is in place right now,” Gentry said.
Yael Shavit LAW ’13 said there were not enough public health speakers at the Law School, so she appreciated the chance to see Mugyenyi.
After speaking at Yale, Mugyenyi will travel to Harvard and then Duke University, before returning to Uganda on April 3.