U.S. leadership on HIV and tuberculosis "can make a profound difference" in developing countries, Diane Havlir, professor of medicine at the University of California-San Francisco, writes in a San Francisco Chronicle opinion piece. Havlir adds that global health issues, such as HIV/TB coinfection, should be a "key component of U.S. foreign policy" and that the U.S. should "double its assistance in this area by 2012."

According to Havlir, the U.S., under the Bush administration, has made "significant progress" on global health, "particularly in expanding global access to HIV/AIDS treatment." However, U.S. "success on AIDS now faces a major challenge that threatens to undermine the progress made to date, and that is the deadly rise in drug-resistant" TB, she writes. "Inadequate TB control programs" in many developing countries "jeopardize [the] success" of programs such as the President's Emergency Plan for AIDS Relief and the Global Fund To Fight AIDS, Tuberculosis and Malaria and "fail to prevent the emergence of drug-resistant TB," according to Havlir.

She says it is "vital" that the U.S. "continue to enhance its commitment to global AIDS and TB, a commitment that was renewed when Congress reauthorized the lifesaving PEPFAR program this summer." She adds that the U.S. should increase efforts to integrate TB and HIV programs because it "makes no clinical sense to consider these two infections as separate conditions, requiring separate facilities, medical personnel, budgets and treatment protocols." According to Havlir, the U.S. should "provide $2 billion to the Global Fund in 2009 and $4 billion for bilateral TB programs over five years," noting that "[s]trong leadership in Congress," particularly from House Speaker Nancy Pelosi (D-Calif.), "will be crucial in addressing the shortfall faced by the Global Fund and to fulfill the [U.S.'] bilateral funding pledges."

Although some people "would say fulfilling those commitments will be difficult, given the financial crisis," the U.S. has a "moral and public health imperative to respond to this epidemic as it is experienced by some of the poorest people in the world ... as an epidemic of HIV and TB." She adds that the inauguration of President-elect Barack Obama and confirmation of Secretary of State-nominee Sen. Hillary Rodham Clinton (D-N.Y.) "will provide an opportunity to reaffirm our leadership and put the U.S. response to global disease on a par with other foreign policy challenges" (Havlir, San Francisco Chronicle, 1/13).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

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