On Tuesday, November 28, the International Initiative Human Well-being Working Group hosted a documentary film viewing and a scholarly panel discussion on "Endangered Childhood: Disease, Conflict, and Displacement." The film, Their Brothers' Keepers: Orphaned by AIDS, opened the session to provide insight into the plight of children orphaned by AIDS. Moderator Paul Wise and the other panelists spoke on the impact of conflict and displacement, the psychological effects on child health and development, and work done to assist children affected by AIDS. The session concluded with a Q&A session.

A proposal to assess the societal and security implications of the female deficit in China, a study of the impact of higher education's rapid expansion in large developing economies, and incentives for provision of health care services for one billion people in rural China were among the new projects funded by Stanford's Presidential Fund for Innovation in International Studies (PFIIS) in mid-February. Planning grants for an international health and society initiative in the Indian subcontinent and psychosocial treatment for children orphaned by the tsunami in Indonesia were also awarded.

"These projects show great potential to advance human knowledge, help devise sustainable solutions, and build a better, more secure future for millions around the world," said Stanford President John Hennessy. "In launching The Stanford Challenge, we committed to marshal university resources to address some of the 21st century's great challenges in human health, international peace and security, and the environment."

The $3 million, intellectual venture capital fund was established by the Office of the President and the Stanford International Initiative in 2005 to encourage new cross-campus, interdisciplinary research and teaching among all seven schools at Stanford on three overarching global challenges: pursuing peace and security, improving governance, and advancing human well-being. The first $1 million was awarded in February 2006 to eight interdisciplinary faculty teams examining such issues as the HIV/AIDS treatment revolution in sub-Saharan Africa, why Latin America has been left behind in recent gains by developing countries, and food security and the environment.

"It's impressive to see the committed, collaborative, and innovative ways Stanford faculty are joining together in new interdisciplinary research and teaching to generate new understanding of the linkages among complex problems and train a new generation of leaders to address them effectively," said Freeman Spogli Institute Director Coit D. Blacker, chair of the International Initiative Executive Committee.

New projects qualifying for funding and their principal investigators are:

• Female Deficit and Social Stability in China: Implications for International Security. Melissa Brown, anthropological sciences; Marcus Feldman, biological sciences, and Matthew Sommer, history. As the number of surplus, marriage-age men in China approaches 47 million in 2050, this project will study factors that predict men's inability to marry before 30, the availability of social welfare to men and their families, their contribution to the floating population of rural-to- urban migrants, the labor-related migration of unmarried women, and the impact of this migration for domestic stability and international security.
• Potential Economic and Social Impacts of Rapid Higher Education Expansion in the World's Largest Developing Economies. Martin Carnoy, education; Amos Nur, geophysics; and Krishna Saraswat, electrical engineering. The development of higher education systems in Brazil, Russia, India, and China (BRIC) will have a major impact on their ability to transition to large, developed, knowledge-based economies. Is the way nation states expand and reform higher education in response to global pressures an important indicator of societal capacity to achieve sustained economic growth? This project will examine differing approaches of BRIC governments to higher-education growth and reform, and ask whether these reflect differing levels of state capacity to expand the knowledge base for economic and social development and whether differing approaches result in significant changes in formation of analytical skills in university graduates, particularly scientists and engineers.
• Health Care for One Billion: Experimenting with Incentives for the Supply of Health Care in Rural China. Scott Atlas, radiology; Scott Rozelle, the Walter H. Shorenstein Asia-Pacific Research Center, FSI. This project examines the effects of existing health policies and institutions in rural areas of China - including rural health insurance, privatization of rural clinics, and investment in township hospitals - and introduces a new experiment to study and realign incentives to address a serious flaw in China's health care system, the practice in which doctors both prescribe and derive significant profits from drugs.

Two planning grants were also awarded, as follows:

• Stanford International Health and Society Initiative: Proposal to Plan for an Initial Program in the Indian Subcontinent. Vinod K. Bhutani, pediatrics; Nihar Nayak, obstetrics and gynecology. This project seeks to improve unacceptably high maternal and childhood morbidity and mortality rates in the Indian subcontinent by devising innovative strategies to bridge existing social and access barriers in the micro- and macro- health environment. Includes leadership training and cooperative work on practice and policy strategies with experts from Stanford and the subcontinent.
• Psychosocial Treatment of Children Orphaned by the Asian Tsunami in Indonesia. Hugh Solvason, psychiatry; Donald Barr, sociology. This project's goal is to develop and implement changes to reduce the sense of dislocation, anxiety, and behavioral problems among tsunami orphans at the As-Syafi`iyah Orphanage in Jakarta. By arranging the children into more cohesive groups that can operate like "families" rather than their current state of random associations typically found in orphanages, the project will create a new and ordered social system. In addition, Solvason and Barr plan to develop a system of counseling interventions for the most severely symptomatic children (supervised by Stanford Psychiatry faculty). Translated measures of depression, anxiety, and PTSD will be used to assess the success of the intervention.

The projects will produce new field research, conferences, research papers, books, symposia, and courses for Stanford students.

A third round of project awards will be made in February 2008. A formal request for proposals will be issued in the fall of 2007, with proposals due by December 14, 2007. Priority is given to teams of faculty who do not typically work together, represent multiple disciplines, and address issues that fall broadly within the three primary research areas of the International Initiative. Projects are to be based on collaborative research and teaching involving faculty from two or more disciplines, and where possible, from two or more of Stanford's seven schools.

For additional information, contact Catharine Kristian, ckristian@stanford.edu.

In late September, the federal Centers for Disease Control and Prevention announced new guidelines recommending that all Americans ages 13 to 64 be voluntarily screened for HIV infection. That's a significant change from the previous guidelines, which recommended testing only for high-risk individuals, such as injection drug users or those with multiple sex partners.

The new guidelines were influenced by a study published last year in the New England Journal of Medicine, led by Douglas K. Owens, a CHP/PCOR core faculty member and an investigator at the VA Palo Alto. Owens and his colleagues -- including CHP/PCOR researchers Gillian D. Sanders, Vandana Sundaram, Kristof Neukermans and Laura Lazzeroni -- found that expanding HIV screening would be a cost-effective way to increase life expectancy and decrease the transmission of HIV. Below, Owens discusses the research and the CDC's new screening guidelines.

Q. Why does this new policy matter, and whom will it help?

Owens: The policy is a profound change because it advises that all individuals ages 13 to 64 be screened for HIV. It matters because it will identify people who have HIV but don't know it. These people will benefit because they'll have access to life-prolonging drugs that they otherwise might not have received until very late in the course of HIV disease. The rest of the community will also benefit, through reduced transmission of HIV.

Q. How did your findings contribute to the CDC adopting the new guidelines?

Owens: First, we found that widespread screening provides a substantial health benefit to HIV-positive people who are identified through screening and receive anti-retroviral treatment earlier than they would have otherwise. Early treatment added about a year and a half of life expectancy for these people. Second, we found a substantial potential benefit to the community because of reduced transmission of HIV. Transmission is reduced because many people cut down on risky behaviors (such as having unprotected sex) when they're identified as having HIV, and because anti-retroviral treatment makes a person less infectious. Our key finding was that routine screening is cost-effective even if only 1 in 2,000 people who are screened have HIV. This means HIV screening is cost-effective in a much broader group than recognized previously.

Q. How and why did the CDC revise its previous guidelines? What role did you and your colleagues play in the decision-making?

Owens: CDC officials made this change because they saw mounting evidence that the prior approach to screening -- focusing on those with identifiable risk factors -- simply wasn't working. If you test people based on risk behavior, you miss many people who have HIV. Even among people who had easily identified risk behaviors, many of them weren't being tested. We also know that most people who have HIV are diagnosed very late in the disease, when they can't get the full benefit from anti-retroviral therapy.

Our involvement in the decision-making was to help assess the prevalence of HIV at which routine screening would be recommended. Through several conference calls with CDC officials, we presented our work and explained the issues related to cost-effectiveness and prevalence. Based on those results and the results of a similar study from Yale, the agency went in the direction of lowering the threshold for screening quite substantially -- to 1 in 1,000 from a prior threshold of 1 percent.

Q. Will most physicians follow the new guidelines? What can be done to make sure they do?

Owens: That's the big question. The CDC's previous screening guidelines were not widely adopted. The new recommendations are much easier to adopt, because they don't depend on clinicians determining the prevalence of HIV in their patient population. Still, it will take a lot of follow-up to make sure physicians implement the guidelines. One key obstacle will be getting payers to reimburse for HIV testing. That's a critical issue, which the CDC is well aware of.

Q. Some HIV/AIDS advocates object to the new guidelines because they recommend removing two requirements that some states now have: mandatory signed consent forms and counseling before testing. Does removing these requirements pose a big problem?

Owens: It's important to emphasize that the new guidelines say people should always be informed before testing and should be able to decline. Informed consent and pretest counseling had become significant barriers that were preventing people from being tested who should have been tested. Everyone agrees that no one should be tested without their knowledge, but that doesn't mean you need a separate consent form. Of course, the confidentiality of the test results should continue to be carefully protected. I would point out that some states have laws requiring informed consent, but whether they will now change those laws isn't clear.