Your Tax Dollars Hard at Work

Mar 27, 2011 No Comments

An Interview with Art Reingold, HIV/AIDS Research Expert

by Zoe Kornberg

Zoe Kornberg: What is PEPFAR?

Art Reingold: PEPFAR fundamentally stands for the President’s Emergency Program for AIDS Relief, and it was started under George Bush. It provides a substantial amount of money, in the billions of dollars per year, with the primary purpose of antiretroviral treatment for HIV-infected individuals in a variety of poor countries in Sub-Saharan Africa (and in other locations, as well). Also, it provides antiretroviral drugs to prevent mother to child transmission, and other types of treatments for HIV/AIDS. It can be used for a variety of purposes relating to prevention of HIV. It’s one of the most important and largest sources of funding for treatment and prevention of HIV/AIDS in poor countries of the world. There are other sources, like the Global Fund, but [PEPFAR] is a very important source of money for this purpose.

ZK: Would you say that it has worked?

AR: Oh, the evidence is very clear that it has worked in the sense that it is helping put enormous numbers of people on antiretroviral drugs who otherwise would not have had access to those drugs. I don’t have the numbers in front of me, but the numbers are certainly in the millions, who otherwise would have died of HIV/AIDS.

ZK: You mentioned prevention earlier. Could you talk a little about how the Bush administration addressed prevention with condom use and sex education?

AR: It’s complicated because fundamentally, a lot of it varies by country, but in essence, there has been a lot of the money given to prevention. While the people with some political and cultural and religious views have been unenthusiastic about condoms and anything that might be seen as promoting sexual behavior, the reality is the funds have been used for a variety of prevention activities, including sexual education, targeted at young people—and to the general population—in terms of trying to get people to delay initiation of sexual activity, reduce the number of sexual partners, and things of that kind. In addition, in many countries, condoms have been provided in order to help people have sex and to stay safe from HIV/AIDS. I can’t tell you in terms of the PEPFAR budget how much money has been spent on prevention and condoms, but it’s certainly the case that some of the PEPFAR money from Congress has gone to these methods of prevention.

ZK: Do you know what Cal’s role has been? What do you do in your own work?

AR: I can’t speak for everyone on the campus, but I in particular have a large training grant from the National Institutes of Health (NIH), called the AIDS International Research Training Program, which we’ve had for twenty-two years. It trains people from countries with large AIDS problems in order to make them better researchers and better able to do in-country research. That is our main priority. In addition to the money from NIH, which is primarily for research training, we have received supplemental funds from PEPFAR to train people to improve the capacity for monitoring and evaluation of PEPFAR programs. So in these countries where our funds are being spent, it’s important to monitor the impact: how many people are put on treatment, how effective is the treatment in prevention, etc… We get through our AIDS training program supplemental PEPFAR money for Vietnam, Ivory Coast, and Uganda. These funds allow us to do additional training in support of PEPFAR activities in those countries. That’s what I know I can tell you about, because that’s my program. I’ve been running this large program in collaboration with UCSF, but it is based at Berkeley. We’ve spent that last twenty years training several hundred people, primarily here in the US, either at Berkeley, or at UCSF in everything from virology to immunology to behavioral science to epidemiology or any host of different disciplines. They’ve come for Master’s degrees, PhDs, laboratory training, medical science training. I’ve had students go on and do very important work. I actually help individual students with their research, both students from these countries, and from the US. My contribution has been in the training. I don’t have my own large, independent research grants on HIV/AIDS.

ZK: How has the program changed under Obama?

AR: Well, I don’t know if the program has changed under Obama to be perfectly candid. I think people have been concerned going forward that because there are many, many other important needs, in what we euphemistically call “Global Health,” that even if the budget for global health remains the same, if there’s a shift in emphasis, like towards infant mortality or diarrheal disease or respiratory infections or other priority areas, that might mean that funding for AIDS prevention and the other programs in PEPFAR will go down, in order to make room for the other high priority causes. That’s been a contentious issue, and I think that AIDS activists have been concerned that the AIDS budget will go down. I don’t think that it has. Obviously there are limited funds available for Global Health, and there are lots of important priorities—there is a lot of infant mortality in these countries, so what’s the most fair and equitable distribution? You have lots of well-intentioned people with different points of view.

ZK: What can a potential reader of the magazine, an undergraduate student at Cal do to help?

AR: The first thing to say is that undergraduates who are interested in a future career, or maybe they’re interested in working on these types of issues, and of course there are many, undergraduates at Cal or elsewhere have potential opportunities in terms of summer internship grants. We have a couple at Berkeley, called the Minority Health Research Training, where we send people overseas. There are others, too. So it’s possible for some Cal undergraduates to actually get research opportunities. The key message would be, if this is the area you want to work in, you need to get a skill set. Whether that’s graduate school, medical school, whatever, that ultimately, you need to get a skill set in one or more areas, so that you have something to contribute in service provision or research or training. People as undergraduates need to be thinking in longer terms. Do they want graduate school training? Do they want to go to medical school? Nursing school? They need to be thinking about getting that skill set. In the short term, there are some research opportunities to get to work in the lab working on HIV or things like that.

Spring 2011 For. Pol. Issue

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