Politics and Policy

Senate Passes $463B Spending Bill That Would Allocate $1.3B Increase To Fund International HIV/AIDS, TB Programs

The Senate on Wednesday voted 81-15 to approve a $463.5 billion spending resolution (HJ Res 20) for fiscal year 2007 that includes a $1.3 billion increase for international HIV/AIDS and tuberculosis programs, Reuters reports (Cowan, Reuters, 2/14). The resolution would bring the total for the President's Emergency Plan for AIDS Relief to $4.5 billion. The $4.5 billion for PEPFAR includes $3.2 billion for the State Department's Global HIV/AIDS Initiative, $712 million for USAID's Child Survival and Health Program, and $494 million for CDC and HHS global HIV/AIDS activities. Of these amounts, $724 million from PEPFAR would be allocated for the U.S. contribution to the Global Fund To Fight AIDS, Tuberculosis and Malaria, with $625 million coming from the State Department and USAID and $99 million from HHS. In addition to the PEPFAR funding, $248 million would be allocated to expand programs under the President's Malaria Initiative, an increase of $149 million. The resolution also allocates an additional $75.8 million in funding for the Ryan White CARE Act, which provides care and services to people living with HIV/AIDS in the U.S., to bring its funding to $1.2 billion. The House on Jan. 31 passed the resolution (Kaiser Daily HIV/AIDS Report, 2/1). The bill now goes to President Bush, who has indicated he will sign it, the AP/Washington Post reports (Taylor, AP/Washington Post, 2/14).

Drug Access

Countries Should Find Balance Between Affordable Drugs, Development Incentives, WHO Director-General Says in Letter to Thai Health Minister

World Health Organization Director-General Margaret Chan in a letter to Thai Health Minister Mongkol na Songkhla said that although the Thai government was fully within its rights to issue a compulsory license for Abbott Laboratories antiretroviral drug Kaletra, countries should find the "right balance" between providing affordable medicines and incentives for drug companies to develop new treatments, Reuters reports (Reuters, 1/13). Mongkol last month signed the compulsory license, which allows Thailand to produce a lower-cost version of Kaletra, into law. World Trade Organization regulations allow governments to declare a "national emergency" and issue compulsory licenses without consulting the foreign patent owner. Thailand, which has 580,000 people living with HIV/AIDS, has won international recognition for its quick launch of a national drug program that treats more than 82,000 HIV-positive people. However, the government's commitment to providing universal access to care is facing increasingly high drug costs. The compulsory license could save the country as much as $24 million annually. According to a joint statement released earlier this month by the health ministry and Abbott, the two sides agreed in principle to reduce the price of Kaletra in Thailand to increase access to the drug among HIV-positive people who have developed resistance to other antiretrovirals. The lower price will apply only to Thailand's public health programs and will not apply to private hospitals, people with high incomes or foreign patients. Abbott offered to lower Kaletra's cost to $167 per patient monthly, although representatives from the health ministry said that was still too high. Abbott and the ministry agreed to meet for further negotiations in one month (Kaiser Daily HIV/AIDS Report, 2/9).

Chan's Letter, Reaction

In the letter, Chan said the Thai government was fully within its rights under WTO regulations to issue compulsory licenses. However, she added that she "firmly believe[s] that the pharmaceutical industry -- generic manufacturers and research and development companies -- are part of the solution." Countries are not required to negotiate with patent holders before issuing a license, but "prior negotiations with industry is a pragmatic approach that may ensure countries have access to high quality medicines and at affordable prices," Chan said. According to Reuters, Chan's letter in part was a response to some HIV/AIDS advocates who have criticized her for not supporting Thailand's decision during her visit to the country two weeks ago. "We expected that [Chan] would have congratulated Thailand for its efforts ... to increase public health and access to medicines for its people," a coalition of more than 400 AIDS advocates and groups wrote in a letter to Chan last week (Reuters, 2/13). In addition, Mongkol on Monday said that a Ministry of Health panel is examining drugs, including HIV/AIDS medications, that the country needs and could make or buy generic versions of while completing negotiations with pharmaceutical companies. He added that if the pharmaceutical companies reduce the cost of their drugs to a level the country is "satisfied" with, Thailand will not enforce the compulsory license. "We don't call this a threat but a negotiation for the country's benefit," he said (Wong-Anan, Reuters, 2/12). Thailand's Pharmaceutical Research and Manufacturers' Association on Thursday said it believes the government is planning to issue compulsory licenses for an additional 11 drugs, including antiretrovirals. The decision to issue compulsory licenses is "major and regrettable," the association said in a statement, adding that the health ministry's "actions risks limiting development of next-generation treatments and could lead to the proliferation of low-quality medicines." A senior health ministry official would not confirm if the government is planning to issue the licenses for the additional drugs (AFP/Nation, 2/15).

Global Challenges

Faith-Based Organizations Major Contributors to Fight Against HIV/AIDS in Sub-Saharan Africa, Report Says

Faith-based organizations are playing a major role in the fight against HIV/AIDS in sub-Saharan Africa, according to a World Health Organization report released this week, IRIN/AllAfrica.com reports. According to the report -- titled "Appreciating Assets: Mapping, Understanding, Translating and Engaging Religious Health Assets in Zambia and Lesotho" -- Christian hospitals and health centers provide about 40% of HIV/AIDS medical care in Lesotho and manage nearly one-third of treatment facilities in Zambia. The report found that faith-based organizations seldom are credited for their efforts to increase access to antiretroviral treatment and provide care to those living with HIV/AIDS on the continent, IRIN/AllAfrica.com reports. According to WHO, faith-based organizations make up 30% to 70% of the health infrastructure in sub-Saharan Africa. Patrick Purtill, director of new partner outreach in the Office of the U.S. Global AIDS Coordinator, said failing to recognize that faith-based organizations "possess an extensive geographic reach and a well-developed infrastructure in the developing world" could hinder efforts to fight HIV/AIDS. Francois Venter, director of the Southern African HIV Clinicians Society, said that churches and faith-based organizations are "uniquely positioned to help realize the goal of universal access to HIV prevention, treatment, care and support in Africa as a result of their stature in the communities." Ted Karpf, partnerships officer in WHO's HIV/AIDS Department, in a statement said, "This data demands that we continue to explore and expand the field," adding that the report is the "first serious study of FBO engagement in HIV/AIDS, but it cannot be the last" (IRIN/AllAfrica.com, 2/13).

Zanzibar Officials Call for Targeted Response To Combat Spread of HIV

A targeted response is needed to combat the spread of HIV in Zanzibar, Chief Minister Shamsi Nahodha said at the recent launch of an HIV/AIDS awareness campaign targeting young people on the island, PlusNews reports. According to government statistics, HIV prevalence on Zanzibar has increased from 0.6% in 2002 to 0.9% in 2006. "This is a shocking figure in such a small population," Nahodha said, adding, "Unfortunately, the most affected group is youths aged between 20 and 49 years." According to Nahodha, most workshops and seminars about HIV/AIDS in Zanzibar occur in urban areas and target political leaders rather than the youth and the island's general population. "It seems the ongoing strategies to control the spread of HIV have not been productive. [W]e need to review our strategies," Nahodha said. Asha Abdalla, director of the Zanzibar AIDS Commission, said that the government statistics were based on prenatal records and that the commission is planning to conduct a study later this year to determine HIV prevalence in the general population. USAID, Family Health International and the Zanzibar government are supporting the five-year campaign, which will be coordinated by Africare (PlusNews, 2/13).

Nigeria Commits $10M to Friends of the Global Fund Africa

Nigerian President Olusegun Obasanjo on Monday announced a $10 million donation to the Friends of the Global Fund Africa to help combat HIV/AIDS, tuberculosis and malaria on the continent, Nigeria's This Day reports. Speaking in Kigali, Rwanda, at the inauguration of the Friends Africa board, Obasanjo said that although the government has launched initiatives to reduce HIV prevalence in Nigeria, more efforts are needed to combat the three diseases (Ogbonnaya, This Day, 2/13). Obasanjo also said that if the spread of the diseases is not brought under control, they "have the potential to damage our social fabric; diminish agricultural and industrial production; undermine political, social and economic stability; and contribute to national, regional and global insecurity." He also called on the Global Fund To Fight AIDS, Tuberculosis and Malaria and other aid agencies to "intensify" their "already commendable level of assistance to fight against these diseases, which threaten to circumscribe our progress and prosperity" (Nigeria First, 2/13).

Editorials, Opinion Pieces Respond to Impact of HIV/AIDS on U.S. Blacks

Newspapers recently have published editorials and opinion pieces on the impact of HIV/AIDS on blacks in the U.S. Feb. 7 marked the seventh annual National Black HIV/AIDS Awareness Day, which aimed to encourage blacks to get tested for HIV, become educated about the virus and receive treatment if necessary. According to CDC data from 33 states published in November 2005 in the Morbidity and Mortality Weekly Report, the rate of new HIV cases among blacks has decreased an average of 5% annually since 2001, declining from 88.7 cases per 100,000 people in 2001 to 76.3 cases per 100,000 in 2004. However, blacks in 2004 were 8.4 times more likely than whites to be newly diagnosed with HIV. Blacks -- who make up about 12.3% of the U.S. population -- in 2004 accounted for about 49% of the estimated number of reported AIDS cases nationwide. In addition, HIV/AIDS in 2002 was the leading cause of death for black women ages 25 to 34; was among the top three causes of death for black men ages 25 to 54; and was among the top four causes of death for black women ages 25 to 54. National Black HIV/AIDS Awareness Day is sponsored by the Community Capacity Building Coalition, a consortium of national minority-focused groups supported by CDC's Division of HIV/AIDS Prevention (Kaiser Daily HIV/AIDS Report, 1/7). Summaries appear below.

Editorial

Palm Beach Post: Although 30 years of "research have given people diagnosed with HIV/AIDS a greater chance at survival," the "lack of a cure, the enduring stigma, the side effects of prescription-drug cocktails, and the racial and economic disparities in access to medical care tend to temper optimism about treatment advances," a Post editorial says. It adds that a recent study in CDC's Morbidity and Mortality Weekly Report found a decrease in HIV incidence among blacks in Florida, which "offers a rare chance to celebrate" (Palm Beach Post, 2/11).

Opinion Pieces

Judith Lightfoot, Philadelphia Inquirer: HIV/AIDS has "become a disease that hits African-Americans with particular force," Lightfoot -- an infectious disease specialist at Garden State Infectious Disease Associates and head of the American College of Osteopathic Internists' Task Force on Minority Health and Cultural Competency -- writes in an Inquirer opinion piece. HIV/AIDS is "not a disease that anyone has to get," and the black community has the "power to stop its spread," Lightfoot writes, adding, "If we are not proactive in adapting our strategies against the epidemic, ignorance, denial and fear will become a lethal combination" (Lightfoot, Philadelphia Inquirer, 2/14).

Bill Maxwell, St. Petersburg Times: Only a "handful" of black churches in the U.S., "primarily in major cities, are actively involved" in the fight against HIV/AIDS, columnist Maxwell writes in a Times opinion piece. Other churches have "descended into denial, ignorance and homophobia," Maxwell writes, adding that the church has to "do more to help reverse this cycle of illness and death" (Maxwell, St. Petersburg Times, 2/11).

James Ragland, Dallas Morning News: "Silence is more than devastating when it comes to AIDS," columnist Ragland writes in a Morning News opinion piece, adding, "It's deadly." According to Ragland, HIV/AIDS "continues to take a toll on the black community," which can "no longer afford to be silent" about the disease (Ragland, Dallas Morning News, 2/7).

Rochelle Riley, Detroit Free Press: The awareness day is a "one-day effort to raise awareness" about HIV/AIDS that "actually reminds us how far we have to go," columnist Riley writes in a Free Press opinion piece. The "conversation" about the disease "has to last for more than one day," Riley writes, adding that the black community should "speak out" because if HIV/AIDS "continues to win anywhere, it is an enemy to us everywhere" (Riley, Detroit Free Press, 2/14).