| | |  Health & Beauty | August 2008 
Kaiser Daily HIV/AIDS Report [Aug 08, 2008]
 Kaisernetwork.org
go to original
Conference Addresses Universal Access to Antiretroviral Drugs, Health Systems
Although antiretroviral drugs have become "so effective" that a 20-year-old HIV-positive person in a wealthy country can now expect to live another 43 years on average - "close to a normal lifespan" - the "near-miraculous effects" of the drugs highlight the need to treat as many people as possible worldwide, advocates and researchers said on Wednesday at the XVII International AIDS Conference in Mexico City, Toronto's Globe and Mail reports.
About three million people in the developing world have access to antiretrovirals - an estimated 31% of those in need. About as many people again with HIV/AIDS are taking the drugs in wealthy nations, where treatment is virtually universal, according to the Globe and Mail. "I ran out of fingers and toes to count the inequalities," Anton Pozniak, executive director of HIV research at the Chelsea and Westminster Hospital, said.
While the United Nations' goal of achieving universal access to antiretroviral drugs by 2010 likely will not be reached, continuing to work toward the objective is essential, according to Gregg Gonsalves, program coordinator at the AIDS and Rights Alliance for Southern Africa. Speaking at the conference, Gonsalves said, "The scale-up of antiretroviral therapy is the most ambitious public health undertaking of our lifetimes."
According to Gonsalves, although the lives of millions of HIV-positive people worldwide depend on antiretrovirals, the world should understand the difficulty of providing the drugs to a vast number of people. "We've already accomplished the impossible in the last 10 years," he said, adding, "We can succeed, but our future is precarious. The technical challenges are formidable, and the political ones are brutal."
One of the most "contentious" debates at the conference this week has been over when it is best to start HIV-positive people on antiretroviral treatment (Picard, Globe and Mail, 8/8). Despite research showing the benefits of early treatment, Gonsalves cautioned that widening access to treatment in countries with weak health systems could undermine drug programs. Although Gonsalves said access to antiretrovirals during the early stages of the virus may be "clinically beneficial for individual patients," more patients in public health settings may weaken antiretroviral programs by "creating longer queues in already saturated national programs using relatively temporary facilities, where even now the sickest patients still have trouble accessing medicines."
He added that beginning antiretroviral regimens earlier "without assessing the effectiveness and indeed the feasibility of this intervention at a population level in low- and middle-income countries may end up doing more harm than good." Gonsalves called for research into when to start antiretroviral treatment in resource-limited settings and urged delegates at the conference to set firm global targets and deadlines to make sense out of "the definition of universal access" to antiretrovirals, which "is now irresponsibly vague." Gonsalves said, "Approximately 10-million people need antiretroviral therapy today. Perhaps we can't reach that goal by the next time we gather in 2010 in Vienna, but let's not leave Mexico City without attaching a firm deadline nonetheless" (Cullinan, The Star, 8/8). Gonsalves also said that well-managed HIV/AIDS programs require training of health workers and construction of clinics and laboratories (Chase, "Health Blog," Wall Street Journal, 8/7).
In related coverage, Tierramerica on Thursday included a discussion with Pedro Cahn, head of the International AIDS Society, on universal access to antiretrovirals, the conference and the worldwide fight against HIV/AIDS (Valente, Tierramerica, 8/4).
Antibodies Could Prevent HIV Transmission, Research Indicates
Antibodies that prevent some HIV-positive people from progressing to AIDS could be used to develop microbicides or a vaccine to prevent HIV-negative people from contracting the virus, according to research presented Thursday at the XVII International AIDS Conference in Mexico City, the Washington Post reports.
According to the research, conducted by researchers at the University of Texas Medical School, some long-term survivors of HIV have antibodies against an HIV protein called gp120. The antibodies, called "catalytic antibodies," attack an area on the outer shell of HIV where the virus binds to immune system cells, preventing the virus from entering the cells. According to the researchers, the antibodies are present in people with lupus, and "researchers noticed years ago that HIV infection rarely occurred in them," according to the Post. "One hypothesis is that they mount an immune response that protected them," Stephanie Planque, a student at UTMS who presented the research at the AIDS conference, said. Lupus patients' immune systems malfunction and produce a number of "unusual" antibodies, the Post reports.
HIV-positive people make separate antibodies against gp120, but they usually are not strong enough to stop or slow the progression of the virus, according to the Post. Previous research on a vaccine using the protein did not stop or slow HIV progression.
The researchers, led by Sudhir Paul at UTMS, found that gp120 is part of a 13-unit stretch of proteins located where the virus attaches to immune cells. Gp120 is hidden by the other proteins, making it more difficult for the immune system to make antibodies against it, according to the research.
Planque screened antibodies made by lupus patients to determine if any produced catalytic activity against HIV's 13-unit protein stretch, which includes gp120. She found that antibodies derived from the lupus patients killed five strains of HIV.
According to the researchers, the findings could be used to find a way to prompt the immune system to make its own supply of antibodies against gp120 before being exposed to the virus. However, the "road is long before we reach that point," Planque said. The researchers are currently researching strategies to "presen[t]" the protein stretch to the immune system that stimulates catalytic antibodies more effectively than what happens naturally. If such an approach proves successful, it could produce a useful vaccine, the Post reports.
Although drugs containing antibodies are expensive, a microbicide containing catalytic antibodies might be affordable for people in developing countries because only a small quantity would be needed to prevent HIV transmission during sexual contact, the researchers said. In addition, the protective benefit would only need to last hours, not days or weeks. According to the Post, the "broad effect" of catalytic antibodies is "important" and any microbicide or vaccine developed from the antibodies would need to prevent all HIV strains to be "useful" (Brown, Washington Post, 8/8).
About 40% of U.S. Adults Have Received HIV Tests, Study Finds
About 40% of adults in the U.S. have ever been tested for HIV, according to a study published Friday in CDC's Morbidity and Mortality Weekly Report to coincide with the XVII International AIDS Conference in Mexico City, the Los Angeles Times reports (Maugh, Los Angeles Times, 8/8). "In 2006, 40.4% (an estimated 71.5 million persons) of U.S. adults aged 18 to 64 years reported ever being tested for HIV infection," the study said, adding, "In addition, 10.4% (an estimated 17.8 million persons) reported being tested in the preceding 12 months, and 23% of persons who acknowledged having HIV risk factors reported being tested in the preceding 12 months."
The study, as well as an earlier report from CDC about annual new HIV infections in the U.S., "show that testing efforts are falling far short," with one-fourth of the approximately one million HIV-positive people in the U.S. unaware of their status, according to Reuters. "The data in this report suggest that progress in HIV testing stalled in the mid- to late-1990s and new strategies such as expanded screening in health care settings appear to be warranted," CDC said in the study.
The agency two years ago released new guidelines recommending routine HIV screening for people ages 13 to 64. Early HIV diagnosis "enables infected persons to obtain medical care that can improve the quality and length of their lives and adopt behaviors to prevent further HIV transmission," CDC said (Fox, Reuters, 8/7). An HIV-positive person who is unaware of his or her status is three times as likely to transmit HIV to others than a person who knows his or her status, according to CDC (Los Angeles Times, 8/8).
Advocacy Group at Conference Discusses Rape of Women, Girls in Zimbabwe After Recent Election
The New York Times on Friday examined AIDS-Free World's investigation into the rape of hundreds of girls and women in Zimbabwe during a two-week period of "political terror ... surrounding recent elections." At the XVII International AIDS Conference in Mexico City on Thursday, Betty Makoni of the Girl Child Network in Zimbabwe said, "Rape is being used as a weapon of political intimidation to instill fear in us, our families and communities." The latest United Nations report on HIV/AIDS stated that "widespread violence against women not only represents a global human rights crisis but also contributes to women's vulnerability to HIV" (Altman, New York Times, 8/8).
Makoni said mass rapes occurred after Zimbabwe's March 29 election. Many male members of the opposition party went into hiding, and militiamen in rural areas entered villages demanding that women identify brothers, husbands and fathers who were members of the opposition and beat, tortured or raped them to get the information (AFP/Africasia.com, 8/7). Youth militias have raped about 800 girls, Makoni said. Other rape survivors include wives, sisters, mothers and grandmothers of political opponents, many of whom were forced to say they would never support the opposition.
Makoni said many rape survivors have gone to state hospitals to seek treatment to prevent HIV and other sexually transmitted infections, as well as pregnancy, but often were denied treatment. The Times reports that physicians at the hospitals did not treat the women because of fear of repercussions (New York Times, 8/8).
According to AFP/Africasia.com, "one of the biggest worries of the rape victims was that they may have become infected" with HIV. About 15% of Zimbabwe's population is reported to be HIV-positive, and the country's HIV prevalence is one of the highest in the world.
Noah Novogrodsky, legal director at AIDS-Free World, said, "We believe members of [President Robert] Mugabe's inner circle, who turned (ruling party) ZANU-PF's youth militia into rapists and killers, are responsible for crimes against humanity."
AIDS-Free World plans to send lawyers to collect testimony for potential legal action after Mugabe leaves office, AFP/Africasia.com reports. The Girl Child Network also has collected evidence from 53 women (AFP/Africasia, 8/7). Novogrodsky said the evidence would be shared with the U.N. High Commissioner for Human Rights for possible prosecution as crimes against humanity (New York Times, 8/8).
The Economist Examines Setbacks, Progress in Fight Against HIV/AIDS
The Economist on Thursday examined promising new HIV/AIDS developments discussed at this week's XVII International AIDS Conference in Mexico City and reviewed setbacks in the fight against the disease since the XVI International AIDS Conference in 2006.
According to The Economist, some "disappointment[s]" in HIV/AIDS research since the 2006 conference have come from unsuccessful trials of potential HIV prevention strategies, including the use of microbicides, the suppression of genital herpes and the use of diaphragms. Those setbacks, as well as the failure of a promising Merck HIV vaccine last year, have led HIV/AIDS researchers to refocus on "basic science," according to The Economist.
In one example of the new strategy, research discussed at this week's conference indicates that treating patients with antiretrovirals to reduce their viral loads could be a promising new prevention method, The Economist reports. This strategy could lead in three directions: as pre-exposure prophylaxis to prevent HIV transmission; as microbicides to prevent the virus from breeding before it enters the body; and to make HIV-positive individuals less infectious. According to The Economist, Julio Montaner, the incoming president of the International AIDS Society, hopes the use of antiretrovirals to prevent HIV transmission will spur governments to "redouble" their efforts to provide the drugs.
This week's conference also highlighted promising new research that male circumcision could help reduce a man's risk of HIV, as well as the importance of behavior change and targeted outreach in curbing the spread of the disease, The Economist reports. Helene Gayle, co-chair of the Global HIV Prevention Working Group, said that no national HIV epidemic has been controlled without behavior change strategies. According to The Economist, given the broad range of prevention strategies, the "one lesson" that has come out of the conference is that "combination prevention ... is the only sensible way forward" (The Economist, 8/7).
Countries' Funding Requests in 2008 to Global Fund To Fight AIDS, Tuberculosis and Malaria Three Times Higher Than 2007 Levels
Ninety-seven countries have requested a total of $6.4 billion from the Global Fund To Fight AIDS, Tuberculosis and Malaria in its eighth round of funding proposals, the Inter Press Service reports.
At the XVII International AIDS Conference this week in Mexico City, Global Fund Executive Director Michel Kazatchkine called the requests "a historic amount, when compared with recent applications." Nearly half the funding was requested for HIV/AIDS, 30% for malaria and the rest for TB. African countries requested the most funding at approximately $4.2 billion, while Latin American and Caribbean countries applied for $600 million, three times the amount requested in 2007.
According to UNAIDS, developing nations will need $42.2 billion in funding to reach the 2010 goal of universal access to antiretroviral drugs for HIV-positive people. Many countries and several nongovernmental organizations are looking to developed nations for additional funding, especially for HIV/AIDS, according to the Inter Press Service.
Funding sustainability is a "touchy" issue, according to the Inter Press Service. "That's why we say spending must be increased, because the Fund will not be here forever," Kazatchkine said (Godoy, Inter Press Service, 8/5).
HIV/AIDS Experts at Conference Express Concern About HIV/AIDS Epidemic in Former Soviet Union States
HIV/AIDS experts at the XVII International AIDS Conference in Mexico City on Wednesday said they are concerned that former Soviet Union states are facing widespread HIV/AIDS epidemics, AFP/Yahoo! News reports. Michel Kazatchkine, executive director of the Global Fund To Fight AIDS, Tuberculosis and Malaria, said that concentrated cases of the disease among injection drug users, commercial sex workers and men who have sex with men are placing some countries "on the verge of a generalized epidemic," adding, "I am very concerned about the epidemic in the region, very concerned."
According to the UNAIDS report issued last week, the total number of people living with HIV in Eastern and Central Europe is about 1.5 million, and about 58,000 people died of HIV/AIDS-related illnesses last year. About 90% of those with HIV in the region live in either Russia or the Ukraine and most are IDUs or sex workers or partners of those individuals.
Experts at the conference said while there has been some progress in providing antiretroviral drugs to those who need them, funding and political support are lacking, AFP/Yahoo! News reports. According to UNAIDS, only one in four HIV-positive people has access to antiretrovirals in Eastern Europe and Central Asia. In addition, AFP/Yahoo! News reports that stigma and homophobia are deeply rooted in the region and that more than half of the countries have policies, legislation or regulations that have been obstacles to care, treatment and prevention.
Farida Tishkova of the Tajik Scientific and Research Institute for Prevention Medicine, said, "The fight against HIV is a new problem. It's very challenging, and it involves a lot of issues. Some of the work we do can be incompatible with the laws and practices of our countries."
Anna Koshikova of the All-Ukrainian Network of People Living With HIV/AIDS said there is more tolerance of HIV-positive people in the country's larger cities but there is a lot of stigma against HIV in rural villages. "When a village finds out that a person has HIV, life becomes very difficult, almost impossible," Koshikova said, adding, "Their children can't go to school, there could be physical violence, they may not receive medical help because they are afraid of revealing their (HIV) status. Many decide to move" (Ingham, AFP/Yahoo! News, 8/6).
Spanish, Latin American NGOs Sign Declaration Urging Governments To Prioritize Efforts To Fight HIV/AIDS
At the XVII International AIDS Conference in Mexico City on Wednesday, more than 30 nongovernmental organizations from Spain and Latin America signed a declaration calling on governments in Latin America to increase efforts to fight HIV/AIDS, Xinhua/People's Daily reports. The declaration calls on governments to prioritize HIV/AIDS in ties between Spain and Latin American countries.
Joan Tallada of the Latin America and the Caribbean Council of AIDS Services Organization said, "We ask the governments of the region to place the HIV/AIDS issue as a priority in their political agendas" (Xinhua/People's Daily, 8/7).
Kaisernetwork.org is the official webcaster of the XVII International AIDS Conference in Mexico City. Click here to sign up for your Daily Update e-mail during the conference. A webcast on Latin America is available online.
Survey Finds Number of HIV-Positive People in China Have Become Resistant to at Least One HIV Drug
More than 17% of HIV-positive patients in 28 China provinces developed resistance to at least one available HIV/AIDS drug by 2006 and 2007, Chinese government researchers announced at the XVII International AIDS Conference in Mexico City, Reuters reports. Those who developed drug resistance tended to have low or unstable incomes, government researchers said.
According to Reuters, the finding is "surprising" because very few people had access to HIV drugs before China began a program to distribute them at no cost in 2003. In addition, HIV usually does not mutate into a drug-resistant form unless people have taken the antiretrovirals for a long period of time.
"When we first started, we didn't have much experience, and patients tended to be suspicious if these medications could work. So their adherence was not good and that resulted in higher rates of drug resistance," Liao Lingjie of the Chinese Center for Disease Control and Prevention said, adding, "People who began treatment later are responding better."
According to the Chinese government, about 700,000 people were living with HIV in China in 2007. Of those, about 20,000 receive antiretrovirals at no cost, official Chinese media report, Reuters reports. The World Health Organization had estimated that about 122,000 people in China would require access to antiretrovirals by the end of 2004.
Only seven of the more than 20 HIV medications are available in China, which leaves HIV-positive people in the country with limited treatment options, Reuters reports. According to Liao, officials are following up with patients who have become resistant to medications, and some will participate in clinical trials. "A small number of people are now trying out second-line drugs to see if the medication is suitable," she said (Tan, Reuters, 8/6).
Report Released at Conference Calls for More Resources for Home-Based Care Activities in Zimbabwe
A report released on Wednesday at the XVII International AIDS Conference in Mexico City called for more attention to and funding for the role of those participating in home-based care for people with HIV/AIDS in Zimbabwe, Zimbabwe's Herald/AllAfrica.com reports.
The report was compiled by the Southern Africa HIV and AIDS Information Dissemination Service, Health and Development Networks and Irish Aid.
In a forward to the report, Zimbabwean Health and Child Welfare Minister David Parirenyatwa said home-based care activities "remain pivotal" for people living with HIV/AIDS, especially in areas with limited access to antiretroviral drugs.
He added, "HBC activities need to be adequately equipped so that timely and high-quality care is delivered to those in need. That is why it is important for the government, the private sector and funding agencies to partner with civil society and to provide significant funding to these projects."
The report calls for programs that integrate health, economic and social services, including water and sanitation facilities. The report added that many volunteers lack basic essentials, such as simple medications, soap and gloves. "As a result, the role of this vital national resource is now largely limited to providing psychological support," the study said.
Peter Power, Ireland's minister of state for overseas development, said that documentation of home-based care in Zimbabwe is a "significant step" toward improving the programs. "Reducing the impact of HIV and AIDS on communities in developing countries is a priority for Irish Aid, and documenting lessons learned is an essential component to shaping effective responses," Power added (Herald/All Africa.com, 8/7).
Experts Call for Global Sex, HIV Education Programs To Expand Beyond Discussions of Safer Sex Practices
Many sex and HIV/AIDS education programs around the world focus on the risks of unsafe sex, which can leave young people unprepared to deal with their sexuality or lead sexually fulfilling lives, experts said at a satellite session on comprehensive sex education at the XVII International AIDS Conference in Mexico City on Wednesday, IRIN News reports.
Maria Alcaldes, deputy director of the International Planned Parenthood Federation, said teachers often are not sufficiently trained to teach sex education in a way that allows children to make informed and responsible decisions. She said, "There is a need for sexuality education that goes beyond teaching the basic biology." Alcaldes noted that although Latin American countries have committed to comprehensive sex education programs, the number of teenage pregnancies in the region has increased. She said governments must work with communities to address these concerns.
Brian Ackerman, international policy manager for Advocates for Youth, criticized the U.S. global HIV/AIDS funding mechanism, the President's Emergency Plan for AIDS Relief, for limiting some HIV prevention education programs to abstinence and fidelity messages. "Society should not be afraid of young people having sex - it is a reality," Ackerman said, adding that young people need more information about condom use.
Prabha Nagarja of the Indian organization Talking about Reproductive and Sexual Health Issues, which runs an anonymous help line, said the group's efforts have shown many shortcomings in India's approach to sex education. She said, "A new national curriculum on sex education tells young people what not to do sexually, without telling them why or explaining to them the most basic things, such as how intercourse happens." She added that callers to the group's help line "have no idea how to protect themselves" from HIV/AIDS. Swedish AIDS Ambassador Lennarth Hjelmaker said, "Teaching about the risk of HIV and other sexually transmitted diseases is necessary, but it must go hand in hand with teaching about healthy sexuality and communicating with young people about their experiences" (IRIN News, 8/6).
Kaisernetwork.org Daily Video Roundup From XVII International AIDS Conference in Mexico City, Thursday, Aug. 7
Experts today at the XVII International AIDS Conference discussed the complementary nature of improving health systems in developing countries and broadening access to HIV prevention and treatment. They called for collaboration in expanding primary care as well as HIV/AIDS care. Gregg Gonsalves of the AIDS and Rights Alliance for Southern Africa gave the expansion of access to antiretroviral treatment as an example.
"ART scale up is a health systems success," said Gonsalves. "It is the most ambitious public health undertaking of my life time, and it was something that was done against the wisdom of the time. We can take that and build on what we have done with AIDS and what we can do with primary care."
"Universal access is not about HIV alone," said Kevin De Cock of the World Health Organization. "It is about viewing attainment of the health related Millennium Development Goals, including those like maternal and child health, as a global public good."
People living with HIV and AIDS can play a vital role in bolstering health care systems, according to Morolake Odetoyinbo with Positive Action for Treatment Access. She added, "Health care, health systems are everybody's business. It's not one individual, it doesn't belong the government, but to all of us."
At a session with several AIDS Ambassadors, Norway's Sigrun Mogedal called for every sector to be included in the overall battle against HIV. "We hear at this conference maybe stronger than ever before, the need for positive leadership; the need for youth leadership; the need for civil society leadership," she said. "Up until now it has been government leadership, politicians, the U.N. and scientists. We shouldn't bear that leadership; we should play a part, but not take it."
Paul Bekkers, the AIDS Ambassador from the Netherlands, spoke about the role he and his colleagues can play. "We have to make sure that countries stick to their commitments for instance on universal access," he said. "We have to tell the G8 to walk the talk, to stick to their commitments. But we also have to be willing to talk to the Vatican. We have to be vocal on issues, to have courage, to discuss sensitive issues, talk about drug use, homophobia, moral issues, gender violence."
In addition to expanding access to treatment, scientists have continued to develop new HIV drugs. Reducing toxicity and drug resistance as well as simplifying treatment regimes are all goals for improvements. So if everyone knew their status, what would an ideal, permanent course of treatment look like?
"You'd need a drug that would have a fantastic side effect profile, in other words, none," explained Anton Pozniak with the Chelsea and Westminster Hospital. "You'd need a drug that was incredibly cheap. You'd need a drug that if you missed a few doses it wouldn't matter. And you'd need a drug that if you're in any small village in any part of the world you could get access to it, but first of all you'd need access to that test. Is it a pipedream? Maybe. Could it be a reality? It possibly could."
AIDS 2008 New Studies and Development
Kaiser Daily HIV/AIDS Report Summarizes Reports, Initiatives From International AIDS Conference - Aug. 8
As part of its expanded coverage of the XVII International AIDS Conference, which is being held Aug. 3 through Aug. 8 in Mexico City, the Kaiser Daily HIV/AIDS Report will feature studies and initiatives released during the conference. Summaries of select publications and initiatives appear below.
"The Changing HIV/AIDS Landscape," World Bank: The report examines how the HIV/AIDS pandemic and environment are rapidly changing and says that a localized, evidence-based response to the disease in Africa is needed. It also looks at various issues - including transmission dynamics, economic development and the financial sustainability of HIV/AIDS interventions. The report concludes that countries, donors and communities should make efforts to understand their specific epidemics, use evidence to develop interventions and improve coordination when establishing priorities (World Bank release, 8/4).
"Highly Active Antiretroviral Therapy and Survival in HIV-Infected Injection Drug Users," Journal of the American Medical Association: Julio Montaner of the British Columbia Centre for Excellence in HIV/AIDS and colleagues conducted the study to compare survival rates among HIV-positive people initiating HAART with and without a history of injection drug use. The researchers conducted the study among 3,116 treatment-naive HIV-positive people in a treatment program in British Columbia, Canada. Of the participants, 915, or 29.4%, were IDUs; 579, or 18.6%, were women; and the median age was 39.4 years. HAART was initiated between Aug. 1, 1996, and June 30, 2006, and the researchers followed the participants up until June 30, 2007. They found that 622 participants died during the study period - 232 of whom were IDUs and 390 of whom were non-IDUs. In addition, at 84 months after the initiation of HAART, the researchers found similar mortality rates between IDUs and non-IDUs. They concluded that in the study population, injection drug use was not associated with decreased survival among HIV-positive people initiating HAART (Montaner et al., JAMA, 8/6).
"HIV Prevalence Estimates From the Demographic and Health Surveys," MEASURE DHS: The report summarizes the results of population-based HIV tests in 28 countries among more than 400,000 men and women. The MEASURE DHS project, starting in 2001, included HIV blood tests in its national surveys, leading some experts to readjust international estimates of HIV prevalence. The report also examines the international burden of HIV/AIDS with prevalence estimates ranging from less than 1% in Asia and West Africa to almost 26% in Swaziland. MEASURE DHS also has released reports on Azerbaijan, Liberia, Mali, Pakistan and Swaziland (MEASURE DHS release, 8/7).
"New Advocacy Organization for the Global Fund in Latin America Launched," Global Fund To Fight AIDS, Tuberculosis and Malaria: A new group - called Friends of the Global Fund Latin America - was launched at the AIDS conference to promote the work of the Global Fund in the region. The group will be based in Bogota, Colombia, and will work to encourage private sector involvement in the funding of programs supported by the Global Fund. The Global Fund to date has provided antiretroviral treatment to 100,000 people living with HIV/AIDS and HIV tests and counseling to 4.2 million people in the region (Global Fund release, 8/7).
"The Power of Participation: Women Leaders Speak (.pdf)," UNIFEM/Athena Network: Although there have been repeated calls for women's increased participation in HIV/AIDS efforts, the report by UNIFEM and Athena finds that women's full participation in the response to the disease still has not been realized. The study says that this is "particularly true for women who are most affected by the epidemic as for far too long, HIV-positive women have been invited only after agendas have been set or policy decisions taken." The report is based on a nine-month global review of existing documentation and interviews with stakeholders. It includes a road map for action with recommendations for advancing women's leadership in the fight against HIV/AIDS worldwide (UNIFEM release, 8/7).
Election 2008
NPR Examines Presidential Candidates' Plans To Increase Foreign Aid
NPR's "All Things Considered" on Thursday examined the plans of presumptive presidential nominees Sens. John McCain (R-Ariz.) and Barack Obama (D-Ill.) to increase U.S. foreign aid. According to "All Things Considered," the next president likely will build on some of President Bush's foreign aid programs, such as the President's Emergency Plan for AIDS Relief and the President's Malaria Initiative.
McCain has said he considers foreign aid a key factor in U.S. security. U.S. foreign aid "really needs to eliminate many of the breeding grounds for extremism, which is poverty, which is HIV/AIDS, which is all of these terrible conditions that make people totally dissatisfied and then look to extremism, particularly Islamic extremism." Although McCain has not specified how much funding he would allocate to foreign aid, he has set a goal of eradicating malaria in Africa, if elected.
Obama earlier this summer said that if elected he "will make the case to the American people that it can be our best investment in increasing the common security of the entire world and increasing our own security." Obama added that he would double U.S. foreign aid to $50 billion by 2012 if elected and use the funding increase to "support a stable future in failing states and sustainable growth in Africa, to halve global poverty and to roll back disease."
According to Steve Radelet of the Center for Global Development, the U.S. system for providing foreign assistance needs to be updated. Radelet said that several government agencies - including the State Department, Department of Treasury, Department of Agriculture and USAID - are involved in foreign aid distribution and delivery. However, he said a more independent USAID with a designated official in charge of development efforts is needed.
According to Radelet, both McCain and Obama have "hinted" that U.S. foreign aid programs need to be reorganized, but "neither has been particularly explicit as to what that reorganization might look like." He added that it is too early in the campaign to look into "specific details of what the reorganization might be" but that both McCain and Obama "have recognized the importance of making investments going forward" (Keleman, "All Things Considered," NPR, 8/7).
Public Health & Education
Canadian Health Minister Clement Criticizes WHO's Endorsement of Drug-Injection Facilities
Canadian Health Minister Tony Clement on Tuesday at the XVII International AIDS Conference in Mexico City criticized the World Health Organization's endorsement of safe drug-injection facilities like Insite in Vancouver, British Columbia, Toronto's Globe and Mail reports (Picard, Globe and Mail, 8/6).
Insite, which is funded by the British Columbia provincial government and has received research funding from the Canadian government, includes 12 booths for injection drug users to inject drugs as well as a "chill-out" room, in which users can be monitored for overdoses. Vancouver has one of the highest illegal drug use rates in North America, with as many as 12,000 IDUs in the Vancouver metropolitan area, 30% of whom are HIV-positive and 90% of whom have hepatitis C. When the facility opened in September 2003, it received a three-year exemption from the Controlled Drugs and Substances Act, which bans heroin use, to conduct a pilot study on the site's role in reducing drug use and crime in Vancouver's Downtown Eastside.
Health Canada, the country's health ministry, in October of last year announced it would extend the exemption until June 2008. An independent scientific body advised Health Canada in 2006 to recommend that funding for the project be extended and that similar programs be established in other cities. However, Clement said he could not approve the recommendations, citing inadequate research and unsound public health policy. The government later offered grants to further research the effectiveness of drug-injection sites in preventing HIV, under the condition that investigators not release their findings until after the exemption expires (Kaiser Daily HIV/AIDS Report, 5/2). According to the Globe and Mail, there are 49 safe-injection sites across Australia, Canada and Europe. Quebec provincial officials are planning a safe-injection site in Montreal.
WHO Guidelines, Clement Reaction
WHO on Tuesday at the AIDS conference released new guidelines that aim to reduce the spread of HIV among IDUs. In the guidelines, WHO said facilities such as Insite are one of the "priority interventions" countries should implement to curb the spread of HIV among IDUs. According to the guidelines, such facilities "are not a new intervention but simply a repackaging of existing WHO-recommended interventions such as needle exchanges" and "enable known, WHO-recommended harm reduction interventions to be delivered and used in a safe environment with the aim of reaching the most marginalized and vulnerable" of IDUs.
Clement criticized the guidelines, saying that "[a]llowing and/or encouraging people to inject heroin into their veins is not harm reduction ... it is a form of harm addition." He added that the Canadian government supports some harm reduction measures - such as needle-exchange programs, methadone treatment and rehabilitation programs - but opposes safe-injection sites (Globe and Mail, 8/6).
Clement during an interview at the conference said the Canadian government wants to close Insite because it has become necessary to "draw a line" determining which harm reduction measures are appropriate. "There are already people saying injection sites aren't enough, that true harm reduction is giving out heroin for free," Clement said, adding, "You have to draw the line somewhere, and we feel we're drawing the line in a place Canadians are comfortable." Clement added that it is up to each country to determine which harm reduction measures are appropriate, adding, "It's not my job to kowtow to orthodoxy."
According to Clement, preventing the spread of HIV among IDUs requires a combination of prevention, treatment and enforcement measures. Clement said he believes Canada has a good balance between enforcement and prevention measures, adding, "I believe I'm on the side of compassion and on the side of the angels" (Picard, Globe and Mail, 8/7). When asked about Clement's comments, Teguest Guerma, associate director of WHO's HIV/AIDS Department, said, "The WHO supports harm reduction." Abeeda Kamarulzaman, head professor of infectious diseases at the University of Malaya, said at the conference that safe-injection sites, needle exchanges, methadone treatment and other harm reduction measures have all been shown to curb the spread of HIV, adding, "We need to stop arguing about the merits of harm reduction and just do it" (Globe and Mail, 8/6).
Opinion
Kaiser Daily HIV/AIDS Report Highlights Editorials, Opinion Pieces Related to XVII International AIDS Conference, Other Topics
Several newspapers have published opinion pieces this week addressing the XVII International AIDS Conference, the reauthorization of the President's Emergency Plan for AIDS Relief, a CDC report updating HIV incidence in the U.S. and related issues. Summaries appear below.
Editorials
• Baltimore Sun: Baltimore health officials "monitoring the [HIV/AIDS] epidemic would be wise to become more vigilant" in addressing the issue after CDC released its report updating the number of annual new HIV infections in the U.S., a Sun editorial states. According to the editorial, Baltimore has launched several initiatives - including rapid HIV testing in emergency departments and outreach programs that seek to reduce the risk of contracting the virus and help those newly diagnosed receive treatment - that "appear to be working." However, the editorial states that the uncertainty regarding the scope of the epidemic "is troubling, and it suggests that eventually more may have to be done - and probably sooner than later." The editorial concludes, "The city must be prepared for the worst even as it continues to hope for the best" (Baltimore Sun, 8/6).
• Bergen Record: The CDC report is "chilling" because the nation's "attention had been largely focused on sub-Saharan Africa and other places where [HIV/AIDS] treatment is far less accessible and awareness of the risks of infection is supposedly lower," the Record editorial states. Meanwhile, "federal funding for domestic AIDS programs has stalled during the Bush presidency," the editorial adds, noting that the "Bush administration has been less focused on domestic AIDS needs, particularly regarding minorities." The editorial concludes, "The world, the United States and New Jersey cannot afford to underestimate the threat and the suffering caused by AIDS" (Bergen Record, 8/6).
• Boston Globe: The federal government, through its Medicare and Federal Employees Health Benefit Plan, "needs to be a part of th[e] effort" to reduce the number of new HIV/AIDS infections, according to a Globe editorial. According to the Globe, while CDC two years ago recommended routine HIV testing, neither Medicare nor FEHBP cover the cost of routine HIV/AIDS testing. The editorial concludes, "More routine testing could bring [the rate of new infections] down by alerting those who test positive that they are infectious" (Boston Globe, 8/6).
• Cox News Service/Greenville Daily Reflector: The U.S. "should divert some funding toward domestic" HIV/ADS prevention and education campaigns, "particularly those that gain traction among those most at risk of infection," a Cox/Daily Reflector editorial states. "Successful education programs and other initiatives aimed at slowing the spread of HIV/AIDS should be credited for keeping the infection rate static" in the U.S., the editorial states, adding, "But if those programs work, their expansion could help to lower the infection rate ... especially among at-risk populations" (Cox News Service/Greenville Daily Reflector, 8/6).
• Newark Star-Ledger: The U.S., which has made "major economic contributions to the fight" against HIV/AIDS worldwide, must "make attacking its own AIDS problem a priority" through a "new national AIDS initiative," a Star-Ledger editorial states. However, efforts to fight HIV/AIDS in the U.S. face a number of "obstacles," such as the "notion that those leading the national battle don't know what they are doing or are not telling the whole truth," the editorial states. It adds, "Suspicion and denial conspire to stop people from doing what is best for them - getting tested and treated and stopping risky behaviors, such as unprotected sex and sharing needles for drug use or tattoos or anything" (Newark Star-Ledger, 8/6).
Opinion Pieces
• George Katito, AllAfrica.com: "Clearly, achieving an AIDS-free generation in Africa will call for a substantial investment of financial, human and other resources," but "[m]ore importantly, it will require of African governments that they muster the political will to implement the governance reforms and foster the change in political culture needed to tackle the pandemic effectively," Katito, a researcher at the South African Institute of International Affairs, writes in an AllAfrica.com opinion piece. African legislatures need to boost oversight of government expenditures to "ensur[e] HIV/AIDS funding is put to its intended use," Katito writes (Katito, AllAfrica.com, 8/4).
• Craig Dodds, Cape Times: The world is "hopelessly short" of achieving the United Nations Millennium Development Goals of universal access to antiretrovirals by 2010, Times columnist Dodds writes in an opinion piece. "Extraordinary efforts are needed to address the shortfall," Dodds writes, adding that universal access "cannot be done without an investment in the health care systems of poorer countries, particularly in health workers." He concludes that a new campaign to curb the pandemic headed by former Botswana President Festus Mogae "should be embraced" (Dodds, Cape Times, 8/5).
• Andre Picard, Globe and Mail: "There is a realization of late that, if AIDS is ever going to be stopped, ... marginalized groups" like "girls and women in countries where they have few rights; men who have sex with men where that is taboo; sex workers; intravenous drug users; [and] members of minority groups" must "be targeted for prevention and treatment efforts," columnist Picard writes in Toronto's Globe and Mail. "Yet, for all the good intentions of the world's scientists, clinicians, community workers and activists, for all the grand statements about human rights, the largest of the marginalized groups has been callously ignored: people with disabilities," he adds. Picard writes, "In most societies, the disabled are shunned, at best hidden away and pitied," adding, "There is no reason to believe that their HIV/AIDS infection rate is any less than other groups'." He concludes, "It is time for the AIDS world to open its eyes" (Picard, Globe and Mail, 8/7).
• Helen Epstein, Los Angeles Times: "You can't fight AIDS without medicine, but you also can't fight AIDS with medicine alone," Epstein, author of "The Invisible Cure: Why We Are Losing the Fight Against AIDS in Africa," writes in a Times opinion piece. According to Epstein, HIV spreads "rapidly" in Africa "not because Africans have so many sexual partners, but because African men and women are more likely than people elsewhere to have more than one long-term partner at a time." She adds that "even small reductions in the fraction of people with multiple sexual partners can have a dramatic effect on the epidemic" (Epstein, Los Angeles Times, 8/3).
• Kyung-Wha Kang, Miami Herald: "The tenaciousness of AIDS stems in part from the fact that measures to counter it underestimate and even ignore the human rights context in which it thrives," Kang, the United Nations acting high commissioner for human rights, writes in a Herald opinion piece. According to Kang, "millions of people who experience human rights violations" - such as discrimination, gender inequality, marginalization, poverty, violence, and lack of access to education and information - "are also more vulnerable to HIV infection and more likely to die" of an AIDS-related condition. Therefore, "any approach to HIV must also respond to the human rights issues fueling the epidemic and emanating from it," Kang writes (Kang, Miami Herald, 8/6).
• Lorraine Teel, Minneapolis Star Tribune: The U.S. needs "a unified strategy and comprehensive ongoing dialogue" to curb the epidemic in the country, Teel, executive director of the Minnesota AIDS Project, writes in a Star Tribune opinion piece. "This isn't a moral issue; this isn't a political debate: this is a public health problem," Teel writes, concluding, "Now more than ever we need to call upon all segments of the community - from civic leaders, elected officials, faith-based institutions, schools, health care providers, social service agencies and, frankly, our neighbors. Let's all talk about AIDS and about how to stop it. United, we can achieve that goal" (Teel, Minneapolis Star Tribune, 8/4).
• Thompson Ayodele, New York Post: The "true obstacle" to getting HIV/AIDS treatment to people in developing countries is "local policies," including tariffs and infrastructure issues, Ayodele, executive director of Initiative for Public Policy Analysis in Nigeria, writes in a Post opinion piece. Some African countries have duties, taxes and government regulations on medicines that can "drive the costs through the roof," he writes. In addition, a lack of roads and electricity in some nations serve as obstacles to delivering medications to patients and properly storing the drugs. Ayodele concludes, "If [the XVII International AIDS Conference] is to have an impact on the growing AIDS pandemic, the participants need to get their priorities straight. Improving medical infrastructure and lowering tariffs should be their chief concern - not weakening drug patents" (Ayodele, New York Post, 8/4).
• George Curry, Philadelphia Inquirer: "There is no question that African-Americans are disproportionately represented among the ranks of those with HIV and AIDS," Curry, a columnist for the Inquirer, writes. In the column, Curry discusses a report released by the Black AIDS Institute that "paints a portrait of what black America would look like if it were a separate country." According to Curry, the report showed that there are more blacks living with HIV in the U.S. than the total HIV-positive populations in seven of the 15 nations in the President's Emergency Plan for AIDS Relief program, which provides $3 billion annually to nations most affected by the virus. Curry writes, "Some worry that not enough money is being spent at home." He says that PEPFAR spending, for example, increased by 46% in 2007 compared with a 2.5% increase for domestic HIV/AIDS spending. For 2008, global HIV/AIDS spending is expected to increase by 34%, while domestic spending will increase by 1.2%, he adds (Curry, Philadelphia Inquirer, 8/7).
• Don Bruner/Jackie Dozier, Rochester Democrat and Chronicle: The U.S. "is falling short on its commitment to curb HIV/AIDS," Bruner and Dozier, executive director and executive assistant and director, respectively, of the Women HIV/AIDS Initiatives at the Black Men Latino Men Health Crisis, write in a Democrat and Chronicle opinion piece, adding, "We still see huge racial and economic disparities in HIV infection rates." Bruner and Dozier write that CDC has been unable to "accurately estimate the annual new HIV infection rates," which has "exposed a fatal flaw in the CDC HIV/AIDS data collection and monitoring, funding allocation and prevention programs." The lack of accuracy means "state and federal funding for HIV prevention and AIDS services is less likely to reach populations who most need it," they write. They conclude that the "need for increased prevention services for women, especially women of color, has been clearly demonstrated and documented" (Bruner/Dozier, Democrat and Chronicle, 8/7).
• Henrietta Fore, Washington Times: With the reauthorization of PEPFAR, President Bush and U.S. lawmakers have kept the country "boldly at the forefront of efforts to reduce poverty and enhance the lives of people around the world for years to come," Fore, administrator for USAID, writes in a Times opinion piece. The U.S. is "not only investing in the prevention and treatment of HIV/AIDS, malaria and tuberculosis today, but we also are focusing on tomorrow by training people to manage, deliver and support the distribution of health services, which will be critical for sustained successes against infectious diseases," she continues. "Improving the health of populations and reducing the spread and impact of diseases ... result in greater productivity and economic growth, and contribute to peace and stability," Fore writes. She concludes, "We will save countless lives by expanding proven approaches and interventions until we reach all who are in need" (Fore, Washington Times, 8/5).
• Richard Elliott, Winnipeg Free Press: Ahead of the XVII International AIDS Conference, Elliott, executive director of the Canadian HIV/AIDS Legal Network, suggests three areas on which Canada should focus in the fight against HIV/AIDS. He says that Canada should address issues with the Access to Medicines Regime, which aims to help developing countries obtain access to more affordable generic medications; support health services that treat drug addictions and prevent "associated harms"; and recommit to a scaling up of funding for HIV/AIDS in the country, as well as ensure that new funding supports HIV vaccine research (Elliott, Winnipeg Free Press, 8/2).
Kaisernetwork.org is the official webcaster of the XVII International AIDS Conference in Mexico City. Click HERE to sign up for your Daily Update email during the conference. |
|
| |
Vallarta Weddings
Tell a Friend
Site Map
Print this Page
Email Us