Global AIDS Processing
Dybul and Condi in 2006; Who should be next?
Moments after Mark Dybul’s dismissal from his post as U.S. Global AIDS Coordinator (OGAC) last week, major drama began on various federal AIDS advocacy listservs. Although most agreed (at least publicly) that getting someone new to oversee PEPFAR was a good thing—particularly someone who supports evidence-based HIV prevention policies—the particulars were up for debate. Passionate views emerged regarding one of the perceived frontrunners, Eric Goosby.
Insiders who have spoken to people at the State Department say Drs. Eric Goosby, CEO of Pangaea Global AIDS Foundation; Jim Kim, co-founder with Paul Farmer of Partners in Health and Nils Daulaire, CEO of the Global Health Council and Senior International Health Advisor for the U.S. Agency for International are the top picks being considered by Secretary of State Hillary Clinton and her crew.
As the Update reported earlier this month, some activists rallied around Kim for his progressive ideas and some opposed Daulaire for a perceived coziness with Big Pharma but Goosby hadn’t received much attention. But this week, with Dybul out for sure, some listserv posters cited Goosby’s inability to stand up to the Clinton administration over its stance on syringe exchange as a deal breaker.
The criticism flushed out Goosby defenders, who have worked with him on global AIDS. Goosby was an early AIDS doctor and helped get the Minority AIDS Initiative passed. He started the Pangaea Foundation which has worked to provide care to people with AIDS throughout the world.
“I know firsthand he was very forward-thinking. He has an incredible international global AIDS foundation. He’s been working very well. He knows about the effectiveness of needle exchange. I felt he wasn’t getting a fair shake,” said Pat Daoust, Health Action AIDS Campaign Director of the Physicians for Human Rights. Daost said she has also worked with Kim and Daulaire and said, “All three of them are incredibly committed leaders. Everyone has their strengths and weaknesses. I understand why those three names have been brought out.”
But longtime AIDS activist Gregg Gonsalves said that a person with “strengths and weaknesses” isn’t good enough when dealing with appropriating $50 billion for global AIDS.
“It’s not like anyone jumps out among those being mentioned. I just don’t want us to settle because someone paid their dues,” Gonsalves said. “Global AIDS is under threat right now. We really need a visionary, a once-in-a-lifetime leader. We need a Barack Obama for global AIDS.”
Take a letter
Gonsalves agrees with the Lancet and 93 groups that signed a letter to Secretary of State Hillary Clinton—calling for “a multi-stakeholder committee comprising U.S. government representatives, implementers and civil society, to identify top candidates for the position. This selection committee could consider a range of critical qualifications, for example, experience implementing HIV prevention and treatment programs and a demonstrated commitment to involving affected communities, including people with HIV, at all levels of program activity.”
Gonsalves said a similar process was employed during the NIH reauthorization process last decade, and it brought in out-of-the-box applicants.
But that process was for a non-appointed position, and no Obama appointments have been filled in the manner called for by the letter.
Longtime AIDS and reproductive rights advocate Jodi Jacobson said those calling for a process aren’t being realistic. “I just don’t see it happening,” she said. “We don’t have a process. You elect a president, and they choose. The State Department is asking for community input. That’s the process. To do it another way sort of smacks of AIDS exceptionalism.”
Others worry that a “process” is an excuse to hold up particular candidates. “I do not believe that a stakeholder process such as that suggested in the sign-on letter will necessarily result in the most competent person being selected, and I strongly oppose such a letter being developed as a mechanism to derail any candidacy,” Housing Works President and CEO Charles King wrote in a message to various listservs debating this issue. “If people object to a particular candidate or favor a candidate, they should come out and say so and say why.”
Director of Adolescent AIDS Program at the Montefiore Medical Center Dr. Donna Futterman agreed that a community process wouldn’t necessarily produce the best results and was worried about who the self-appointed “community” is. “I happen to occasionally be part of the advocacy community, but it’s not my usual scene. I see very few medical providers involved,” she said. “The role of OGAC is to administer PEPFAR. The provider community is a big part of PEPFAR. If there is a community process, it needs to be more inclusive.”
Futterman receives a grant from PEPFAR for a program that provides testing and linkage to care for HIV-positive youth in South Africa and said she’s excited to see how a new appointment will change the work on the ground. “I’m thrilled we have a new political context,” Futterman said. “The abstinence-only requirements were extremely destructive. Eric Goosby and some of the other candidates will be such an improvement.”
Posted on January 29, 2009 at 11:22 pm
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