2010/01/11 00:00:00
By Tom Philpott
The dark image of the U.S. painted by murderous fanatics is contradicted in many ways by the generosity of Americans, including leadership in programs to fight world hunger and disease.
One initiative, by President George W. Bush — that even his harshest political critics acknowledge is praiseworthy — was the creation of the President’s Emergency Plan for AIDS Relief (PEPFAR), the largest commitment ever made by a nation to combat a single disease.
The initial commitment was $15 billion to combat global HIV and AIDS. In 2008, Bush pledged another $48 billion, to be spent from 2009 through 2013, to fight AIDS as well as tuberculosis and malaria around the globe.
To date, officials estimate the program has helped more than two million additional AIDS victims receive treatment and averted more than 10 million new infections.
And a small part of PEPFAR dollars — $80 million a year — finances a little-known effort by the U.S. military to lower the incidence of HIV and AIDS in militaries of developing countries. The program provides medical information and assistance to help not only foreign-partner soldiers but also their families.
Dr. Rick Shaffer, executive director of the DoD HIV/AIDS Prevention Program (DHAPP), says $80 million delivers “a big bang for the buck” with militaries in 80 countries having been guided to establish their own policies and programs for diagnosing, treating, and preventing HIV and AIDS.
AIDS remains one of the world’s most deadly infectious diseases. It’s the leading cause of death in sub-Saharan Africa, where 22 million people currently are infected. About 1.7 million people in the region die of AIDS each year, accounting for three of every four AIDS deaths globally.
DHAPP, headquartered in San Diego, actually was started in 2001, two years before Bush ordered PEPFAR’s launch. Shaffer has been in charge from the beginning, first as a Navy physician and now as a federal civilian employee.
“When we first started this program, the majority of militaries around the world did not have a policy to ensure their prevention activities were widespread or [even to know] what to do if one of their military members became HIV positive,” says Shaffer.
“Now the majority of militaries have policies for HIV, and a lot of that is because the U.S. military continued to talk to them, to provide assistance, and to say, ‘You really need to address this from a leadership point of view.’ ”
The U.S. military’s contribution in the battle against AIDS goes well beyond DHAPP into groundbreaking medical research. In September 2009, for example, Lt. Gen. Eric Schoomaker, Army surgeon general, announced an investigational HIV vaccine regimen had been proven safe and “modestly effective” in preventing HIV infection. That vaccine was tested on more than 16,000 adult volunteers in Thailand in a program the Army sponsored. The vaccine lowered the HIV infection rate by 31 percent, compared to those given a placebo.
“This is the first HIV vaccine candidate to successfully reduce the risk of HIV infection in humans,” says Schoomaker.
Inside the U.S. military, every branch of service has its own HIV- and AIDS-prevention program. But it was a decade ago that DoD set out to assist other militaries in combating the disease, coordinating with NGOs as well as universities.
“We will approach a military through our embassy or our defense folks in a country and ask if they’d like our assistance with their HIV program,” says Shaffer. “We then have a very large program that can help them with all aspects of prevention, care, and treatment for HIV.”
DHAPP will arrange for foreign military medical personnel to visit San Diego for up to four weeks of classes, or it will arrange visits for U.S. infectious disease physicians, laboratory experts, epidemiologists, psychologists, prevention experts, and logisticians to visit with foreign militaries to build disease-fighting capabilities and regimens. The effort focuses on training, but equipment and resources can be provided. Coordination occurs with NGOs that also fight HIV.
Most of the money for DHAPP comes from the President’s Emergency Plan for Aids Relief. DoD will set aside additional monies for militaries of countries not among those covered by PEPFAR dollars.
Most countries helped are in Africa, but others are in Central Asia, South America, Central America, and along the Pacific Rim. Two former adversaries — Vietnam and Russia — are among the nations to accept help with HIV and AIDS programs. “As with anything in medicine and science, we always are interested in collaborating with others having the same challenges,” Shaffer says. “What we did with the Russian military was help them have prevention discussions. … When we came in and said, ‘You know, militaries ought to talk about HIV,’ it gave the Russian military an opportunity to say internally, ‘Even the U.S. military needs to talk about this. So let’s talk about this.’ ”
DHAPP also helped the Russian military establish a reference laboratory for HIV diagnostics and expand its prevention activities.
With Russia, as with most militaries, he added, the approach was to “not tell them what they ought to do but help them with process development. We didn’t say, ‘You should adopt the U.S. military policy.’ We said, ‘You should adopt a policy and here’s how you should go about doing it.’ So we had a very productive relationship … for about four years.”
In July 2008, DHAPP staff and U.S. Pacific Command personnel traveled to Hanoi, Vietnam, to discuss AIDS-prevention strategies and programs and interagency cooperation with its ministry of defense. About 850 Vietnamese received training on HIV-related policy, on building of treatment capacity, and on reducing the stigma and discrimination associated with HIV and AIDS.
DHAPP has a staff of only 17 in San Diego, with a few additional people in select embassies around the world.
“But we use a lot of partner military resources and … university and [NGOs’] expertise. In any given year, the U.S. military will provide 35 or so military HIV experts for a week at a time. … We leverage a lot of existing U.S. military activities and a lot of partners.”
Shaffer has visited 29 different countries to help establish military-related HIV programs. The rate of infection within partner militaries typically reflects that found in a nation’s general population.
Thanks to DHAPP, he says, “many militaries now are able to not only identify those who are HIV positive but identify those who need treatment and get them on treatment.”
Thanks in large part to PEPFAR, medicine for treatment and condoms for prevention widely are available in most developing countries. DHAPP doesn’t need to serve those supply chains. But it advocates for militaries with their own ministries of health to ensure they receive treatment, have appropriate laboratory equipment and facilities, and have the ability to care for families, says Shaffer.
“Certainly from the military perspective we consider this to be a very big success, both in getting our partner militaries the added capability in health care and in keeping our partner militaries functioning.”
The effort is such a “good fit” for DoD, says Shaffer, because “we don’t take assets away from the U.S. military for this program. All of this is on top of what we already do.”
The personal satisfaction for Shaffer and his small staff is inestimable, he says. Despite all the travel, he says, “I love it.”
About the author: Tom Philpott is a freelance writer and syndicated news columnist. His column, "Military Update," appears in 48 daily newspapers throughout the United States and overseas.
Copyright Tom Philpott and Military Officers Association of America. All rights reserved.
