Kaisernetwork.org (Washington, DC)
21 May 2007
Politics and Policy
Some Congressional Democrats Appear Reluctant To Enter Debate Over PEPFAR's Abstinence Funding Requirements, Wall Street Journal Reports
[May 21, 2007]
Some Democratic leaders in Congress are showing "signs" that they are reluctant to enter the debate over the President's Emergency Plan for AIDS Relief's abstinence spending requirements, the Wall Street Journal reports (Phillips, Wall Street Journal, 5/21). By law, at least one-third of HIV prevention funds that focus countries receive through PEPFAR must be used for abstinence-until-marriage programs (Kaiser Daily HIV/AIDS Report, 4/2).
Some HIV/AIDS advocates are calling on Democratic lawmakers to repeal the abstinence requirement in the upcoming foreign-aid spending bill, while supporters of the requirements are lobbying against the change, the Journal reports. According to the Journal, Democratic lawmakers "seem likely to push the issue off until later this year or even next year," when Congress is scheduled to reauthorize PEPFAR. The delay could mean that "any relaxation" in HIV/AIDS funding requirements might not take effect until 2009 or 2010, the Journal reports.
Some advocates who oppose the abstinence spending requirements say that the rule diverts money from programs that promote condom use and provide access to antiretroviral drugs and HIV/AIDS care. Although "Democrats have the power to do the right thing," they "don't seem to be willing to do it," Jodi Jacobson -- executive director of the Center for Health and Gender Equity, a group that is leading efforts to repeal the spending requirements -- said, adding, "What is the point in being in the majority if you can't take action?"
Opponents of the spending requirement also have pointed to recent studies, including an Institute of Medicine report that found congressional provisions about how to spend HIV/AIDS money hinders health professionals in the field. Another study, commissioned by HHS, found that abstinence-only programs in the U.S. have not impacted young people's sexual behavior.
Supporters of the spending requirement say that without it, programs promoting abstinence until marriage and fidelity would not receive adequate resources. "Over time, we probably won't need (the provision), but for now, we still do," Ambassador Mark Dybul, who serves as the U.S. global AIDS coordinator and administers PEPFAR, said. Other supporters have cited Uganda as an example of a country that has successfully reduced its HIV/AIDS prevalence by promoting abstinence and fidelity. Stephen Colecchi -- director of the Office of International Justice and Peace at the U.S. Conference of Catholic Bishops, which supports abstinence programs -- said that in this case, "the morally right thing is also the efficacious approach."
According to the Journal, HIV/AIDS advocates have some "well-placed allies" in Congress, including Sen. Dianne Feinstein (D-Calif.) and Rep. Barbara Lee (D-Calif.), members of the Senate Appropriations Committee and House Appropriations Committee, respectively. Feinstein has said that the requirement is "squeezing out" available funding for other HIV prevention efforts, such as those aimed at preventing mother-to-child HIV transmission and maintaining a healthy blood supply. Lee also has introduced a bill that would eliminate the abstinence requirement.
An unnamed White House spokesperson declined to say whether President Bush would veto legislation that relaxes abstinence spending requirements but added that the administration would "certainly fight to maintain a balanced approach" to HIV prevention funds. Some advocates also are calling for the repeal of a U.S. policy that requires recipients of federal HIV/AIDS service grants to pledge to oppose commercial sex work, the Journal reports (Wall Street Journal, 5/21).
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Across The Nation
Georgia Gov. Perdue Signs Bill That Would Require Doctors To Offer Pregnant Women HIV Tests
[May 21, 2007]
Georgia Gov. Sonny Perdue (R) on Thursday signed into law a bill (HB 429) that would require doctors in the state to offer pregnant women HIV tests, the Atlanta Journal-Constitution reports (Atlanta Journal-Constitution, 5/18). The bill, sponsored by state Rep. Sharon Cooper (R), also would require doctors to refer HIV-positive pregnant women to counseling and treatment services. Women would be able to opt out of the test, but their refusals would be included in their medical records.
Almost one-quarter of pregnant women in Georgia are not tested for HIV because their physicians do not think they are at high risk of transmission, according to Cooper. She added that between 20 and 30 infants in the state are born HIV-positive annually, according to statistics from the Department of Human Resources Division of Public Health. Treatment costs about $600,000 per infant, according to the public health division. Several physician groups -- including the Georgia chapter of the American Academy of Pediatrics and the Georgia Obstetrical & Gynecological Society -- have voiced their support for the bill (Kaiser Daily HIV/AIDS Report, 3/21).
Greg Cook -- an Augusta, Ga.-based ob-gyn -- said, "The whole purpose of this [law] is we really want more women to get tested for HIV, and if they're pregnant, not only can we refer the mother to infectious disease and treatment, but it's very important for the baby." He added that cases of mother-to-child HIV transmission can be reduced to 1% to 3% if the virus is detected during pregnancy and treatment is administered (Eckenrode, Morris News Service/Augusta Chronicle, 5/18). The law will take effect on July 1 (Atlanta Journal-Constitution, 5/18).
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Global Challenges
Swedish Agency Provides Zimbabwe With $7.6M for HIV/AIDS Projects
[May 21, 2007]
The Swedish International Development Cooperation Agency on Thursday announced it will provide the Zimbabwean government with $7.6 million to fund HIV/AIDS projects in the country, Xinhua News Agency reports.
The Swedish Cooperative Center will receive $1 million for the Food Security and HIV/AIDS Affected Households project, which supports farming for households affected by HIV/AIDS, in Zimbabwe's Kwekwe and Gweru districts. The program will be implemented jointly with the Midlands AIDS Service Organization, according to Xinhua News Agency. The remaining $6.6 million will be used for the Expanded Support Program, a collaborative effort between Zimbabwe's National AIDS Council and the United Nations aimed at expanding access to HIV prevention, care and treatment services.
Goran Engstrand, head of the Swedish Embassy's development cooperation, on Wednesday at a signing ceremony said that HIV/AIDS is a major threat to Zimbabwe's development. He added that Sweden will continue to support efforts aimed at helping families affected by HIV/AIDS in the country. "Sweden also hopes that the support will go a long way to strengthen the mitigation of the effects of HIV and AIDS on the agriculture sector," Engstrand said (Xinhua News Agency, 5/17).
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Low Levels of HIV/AIDS Awareness, Stigma Contributing to Spread of Disease in Pakistan
[May 21, 2007]
Low levels of awareness about HIV/AIDS and the social stigma associated with the disease are contributing to its spread in Pakistan, IRIN News reports. Pakistan's HIV prevalence is 0.1%, but cases of the disease are increasing among high-risk groups -- such as the country's 150,000 injection drug users and men who have sex with men -- according to new data. In addition, the stigma associated with these populations has kept most people from reporting their HIV-positive status. About 3,700 HIV/AIDS cases have been registered officially in the country since 1986, but the World Health Organization and UNAIDS say there are about 200,000 cases. The World Bank also says that limited surveillance and voluntary HIV/AIDS counseling and testing services, combined with a lack of education among health professionals and the general population, are contributing to the spread of the disease.
A survey released in April by the Punjab AIDS Control Programme found that 87% of people in Punjab province's eight districts had heard of HIV. Twenty-six percent of respondents said they were aware that HIV can be transmitted through risky sexual behavior; 23% said they knew that HIV can be transmitted by reusing needles; 6% said they knew that blood transfusions pose a risk; and 4% said they knew that condoms help prevent HIV. Some advocates have launched media campaigns and lobbied government officials in the country to help promote HIV/AIDS awareness. The government has adopted new awareness targets that seek to reach 25% of the population in each high-risk group -- including commercial sex workers, MSM and transgendered people -- by the end of 2007, with an ultimate target of 60% by 2010.
Akbar Babar, a private consultant who carried out the Punjab study, said that increased resources are needed to conduct an HIV/AIDS awareness campaign in the country. "We all know awareness campaigns are expensive, electronic media is expensive, but extremely poor levels of awareness about HIV and its transmission routes should convince policymakers that we need to allocate a lot more (resources) so that the media reports can be more intense," he said, calling for a significant boost in funds, particularly for television (IRIN News, 5/16).
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