A reverse brain drain

A big worry among those at the summit on Friday: Finding enough health workers, especially physicians, to work on the domestic HIV epidemic.

``Clinics are at capacity, if not beyond already; the provider mix is stretched; and not a lot of new docs are going into HIV care,’’ said Dr. Michael Saag of the University of Alabama.

Dr. John Bartlett, summit co-chair and professor of medicine at the Johns Hopkins University School of Medicine, said many Johns Hopkins medical students are enrolling to become AIDS physicians, but ``they all want to go into HIV careers in Africa. It’s a brain drain in the reverse direction. We have to do something to make it more attractive’’ to work on AIDS in the United States.

Dr. Judith Feinberg, of the American Academy of HIV Medicine, said the work domestically should be framed once again as fulfilling a huge, unmet need in the country. She remembered that feeling helped motivate her to care for AIDS patients at the beginning of the US epidemic. ``It allowed us to be humane again,’’ she said.

And Dr. Laura Cheever of the HIV/AIDS Bureau in the US Health Resources and Services Administration, also reminded the group that working in AIDS domestically ``used to be a cause.’’

``There are lots of calls for a domestic PEPFAR – although I’m not sure exactly what that means,’’ she said, referring to the US government’s global AIDS program. ``But a domestic PEPFAR could make HIV a cause again.’’

She echoed Bartlett: ``Right now,’’ Cheever said, ``young idealists are going into international HIV.’’