Across The Nation

House Subcommittee To Hear Washington, D.C., Appropriations Bill That Restricts City Funding for Needle-Exchange Programs

[Jun 05, 2007]

The House Appropriations Subcommittee on Financial Services and General Government on Tuesday will consider a Washington, D.C., appropriations bill that includes language preventing the city from financing needle-exchange programs, the Washington Post reports. According to the Post, some health advocates are hopeful that the language will be removed from the bill because of the "changed balance of power on Capitol Hill" (Levine, Washington Post, 6/5). The ban was first imposed under a federal law signed by former President Clinton in 1998 that prohibits the district government from using local tax money to fund any organization that operates a needle-exchange program (Kaiser Daily HIV/AIDS Report, 5/29). According to the Post, the House has added the ban each year to the district's appropriations bill (Washington Post, 6/5).

Rep. Jose Serrano (D-N.Y.), chair of the subcommittee, recently said he will make it a priority to push for the removal of the language. District Mayor Adrian Fenty has said that he will provide funds for needle-exchange programs as soon as Congress removes the language.

Injection drug use is the second most common mode of HIV transmission among men in the district and the most common mode among women in the city. Prevention Works!, the district's only needle-exchange program, is financed through private donations and reaches about one-third of the estimated 9,700 injection drug users in the city (Kaiser Daily HIV/AIDS Report, 5/29). Walter Smith, executive director of the DC Appleseed Center for Law and Justice, said that there is a connection between the high number of HIV/AIDS cases in the district and lack of a city-funded needle-exchange program, adding that it's "time to uncouple" the connection.

Serrano said that although it is unclear whether the ban will be lifted, he is ready to push the issue. Del. Eleanor Holmes Norton (D-D.C.) called the ban "abuse of the city," adding that "countless deaths have occurred" because the city lacks a government-funded needle-exchange program. More than two dozen medical, public health, social service and philanthropic organizations last month sent a letter to Sen. Richard Durbin (D-Ill.), chair of the subcommittee that initially handles the district's budget, urging that the restriction be lifted, the Post reports. Chuck Knapp -- a spokesperson for Rep. Todd Tiahrt (R-Kan.), the original author of the ban -- said that Tiahrt likely will try to continue the ban but added that "it's a different political environment" than when it originally passed (Washington Post, 6/5).

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Drug Access

Merck Offers To Reduce Price of Antiretroviral Efavirenz in Thailand, Provide No-Cost Efavirenz, Testing, Treatment Access to Children

[Jun 05, 2007]

Merck has offered to reduce the price of its antiretroviral drug Efavirenz in Thailand, Vichai Chokewiwat, chair of the Government Pharmaceutical Organization and the Ministry of Public Health's Committee on Compulsory Licensing, said on Saturday, Thailand's Nation reports (Nation, 6/3). The Thai government in November 2006 issued a compulsory license to produce a lower-cost version of Efavirenz. Since then, the government and Merck have continued negotiations. Thai Health Minister Mongkol Na Songkhla last month announced the government was considering revoking its compulsory license for Efavirenz following recent talks with Merck (Kaiser Daily HIV/AIDS Report, 5/24).

According to Vichai, Merck's subsidiary in Thailand, MSD Thailand, has agreed to sell Efavirenz for 767 baht, or about $23, per patient monthly, about half of the original price of 1,400 baht, or about $43, per patient monthly (Nation, 6/3). Merck previously had offered to reduce the price of Efavirenz to $23 per bottle, but the government can purchase a generic version of the drug from India-based drug makers for about $20 per bottle (Kaiser Daily HIV/AIDS Report, 4/16). In addition, Merck offered to provide a liquid version of Efavirenz at no cost to 2,500 HIV-positive children in Thailand and to sponsor HIV testing and treatment programs for children. The new price was "offered verbally" to Siriwat Thiptaradol, GPO secretary-general, according to Vichai. Merck has until June 12 to submit the offer in writing to the health ministry, Vichai added.

Reaction

Merck's offer was welcomed by HIV/AIDS advocates, according to the Nation. Vichai said that the offer is about 5% higher than generic versions of Efavirenz but added that the ministry likely will accept the offer because the inclusion of no-cost Efavirenz and treatment for children made the package "interesting" (Nation, 6/3). Siriwat, who also serves as secretary-general of Thailand's Food and Drug Administration, said he will discuss Merck's offer to provide treatment access to HIV-positive children with Thai medical experts (Kultida, Bangkok Post, 6/2). Jiraporn Limpananont, a lecturer at Chulalongkorn University's Faculty of Pharmacy, said Merck's new offer proves that the "original drug price does not reflect the real cost of drug development and investment" (Nation, 6/3).

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Global Challenges

Hundreds of People Living With HIV/AIDS in Puerto Rico Not Receiving Medical Care, Doctors, Advocates Say

[Jun 05, 2007]

Hundreds of people living with HIV/AIDS in Puerto Rico are not receiving needed medical care, some local doctors and advocacy groups have said recently, the New York Times reports. According to the Times, the situation "reflects a stew of problems" on the island, including an overstretched health care budget and contention between the commonwealth and San Juan city governments, which run separate HIV/AIDS programs. Federal officials and some local doctors say that the "main culprit" is the island's mismanagement of funding from the Ryan White Program, the Times reports (Eckholm, New York Times, 6/5).

Puerto Rico receives about $58 million annually under Ryan White. Some clinics in San Juan in March began rationing drugs for hundreds of HIV-positive people after they stopped receiving reimbursements from the program. Ryan White invoices from Puerto Rican health agencies have received extra scrutiny since 2005 because of previous management issues. In addition, FBI agents in December 2006 raided four San Juan government health offices that manage Puerto Rico's Ryan White funds as part of a broader fraud investigation.

According to Maria del Carmen Munoz, director of federal affairs for San Juan, FBI agents conducting the fraud investigation seized documents in the December raid that were needed by the local government to obtain Ryan White reimbursements for the clinics -- a claim that the FBI has denied. Munoz said that Puerto Rican health officials have had to request new invoices from the island's clinics and verify their authenticity. Some patient advocates have said that San Juan city government officials and other agencies are at fault for the funding suspension, saying it is a result of mismanagement and longtime corruption in the program (Kaiser Daily HIV/AIDS Report, 3/9).

The Health Resources and Services Administration, which administers Ryan White funding, repeatedly has called for streamlining Puerto Rico's health care system and sent advisers to the island, Laura Cheever, HRSA deputy associate administrator, said. Local physicians say that it takes months to obtain approval from the island's central government to switch a patient to a new antiretroviral regimen, adding that the new drugs often are not available, the Times reports. The commonwealth health department also often makes errors in antiretroviral distribution, some doctors say. In addition, the commonwealth has not shared the $22 million it receives in AIDS Drug Assistance Program funding, according to Hector Sorentini Mendez, San Juan's health director.

"Antiquated equipment and poor communications" also have contributed to issues associated with the provision of antiretrovirals, the Times reports. An audit by the comptroller of Puerto Rico published in November 2006 found that health department records of drug stocks and deliveries to clinics were significantly deficient. Another report found that four of the eight main HIV/AIDS clinics on the island lacked functioning bathrooms or computers, the Times reports.

Puerto Rico officials say the waiting list for the island's ADAP has decreased from 130 in the fall to 36 and soon will be eliminated. Puerto Rican and mainland groups, including the Congressional Hispanic Caucus, during the past year have called on federal authorities to take an increased role in the situation. Administration officials have said that they proposed transferring San Juan's Ryan White funds to a separate agency that would manage them, adding that Puerto Rico's Mayor Jorge Santini Padilla refused, the Times reports. "In the end," it is "up to them to do the planning, allocations and administration, and what we can do in terms of sanctions is very limited by legislation," Cheever said (New York Times, 6/5).

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HIV/AIDS Threatening Democracy, Governance in Southern African Countries, Study Says

[Jun 05, 2007]

HIV/AIDS is threatening democracy and governance in Southern African countries because of the large number of elected officials who have died of AIDS-related illnesses, according to a study recently released by the Institute for Democracy in South Africa, Reuters reports.

For the study, Kondwani Chirambo, head of the Governance and AIDS Program at IDASA, and colleagues examined mortality patterns in Malawi, Namibia, Senegal, South Africa, Tanzania and Zambia. The study found that HIV/AIDS is responsible for shifts in political power and extra strains on countries' treasuries, which have to organize special elections when elected officials die.

"Our findings have shown there has been a sharp rise in the number of elected leaders that have died prematurely of illness," Chirambo said. He added, "If you compare the trends before the onset of the pandemic and after, we do see that patterns of death mimic the mortality pattern of the general population." According to Chirambo, a recent study found that between 1994 and 2006, 42 of Malawi's Members of Parliament died. According to an official statement released in 2000 by the speaker of the country's National Assembly, 28 of the deaths were AIDS-related, Chirambo said.

In Zambia, between 1985 -- the year after the first AIDS case was reported in the country -- and 2003, 102 special elections have been held, compared with 14 between 1964 and 1984. Thirty-nine of the 102 elections were the result of officials dying while in office, Reuters reports. Between 1994 and 2006, 23 vacancies in South Africa's parliament have been recorded as a result of death.

Alan Whiteside, director of health economics and the HIV/AIDS research division at the University of KwaZulu Natal, said that the study's findings indicate the HIV/AIDS pandemic is having a cumulative impact on Africa's institutions and that most African countries are not equipped to deal with it. "HIV/AIDS is having an impact not just on electoral institutions but also on government and governance, and we have underestimated this impact," Whiteside said (Felix, Reuters, 6/4).

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Uganda Female Condom-Distribution Program Halted Over Complaints That Condoms Were Not User Friendly, Official Says

[Jun 05, 2007]

A Ugandan program that distributes female condoms has been halted until further research is conducted because many women complained about the condoms, James Kigozi, spokesperson for the Uganda AIDS Commission, said on Thursday, Uganda's Monitor reports.

The AIDS commission had been conducting a trial of female condom use in the country. Kigozi -- speaking to journalists at the National AIDS Research Stakeholders' Workshop in Kampala, Uganda -- said that the commission was "forced to halt their distribution because the women who were using them said they were not user friendly." He added that the women "said their husbands used to complain that they make a lot of noise during sexual intercourse and that they are smelly."

According to the Monitor, many women have said the condoms were painful and difficult to insert in the vagina prior to sexual intercourse. In addition, Kigozi said that empowerment among women also affected use of the condoms because men often instructed their partners to remove the condoms after they had been inserted.

The condoms were being distributed to prevent transmission of HIV and other sexually transmitted infections, as well as to prevent unintended pregnancies, the Monitor reports. The commission has asked condom manufacturers to ensure that newer versions of the condom are easy to use before introducing them in Uganda, Kigozi said (Nafula, Monitor, 6/2).

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Reuters UK Examines Program That Aims To Involve Traditional Healers in HIV/AIDS Care

[Jun 05, 2007]

Reuters UK on Monday examined a program run by the African Medical and Research Foundation in South Africa that aims to involve traditional healers in HIV/AIDS treatment and care. According to AMREF, more than two-thirds of people in rural parts of Africa consult traditional healers before visiting clinics. Traditional healers also are "revered and trusted in rural communities and play multiple roles as spiritual guide, healer and counselor," according to Reuters UK. The AMREF program aims to encourage traditional healers to continue providing spiritual advice and basic health care, as well as to use their "influence and authority to promote HIV testing and modern medicine in areas where many people are distrustful of hospitals, clinics" and antiretroviral drugs, Reuters UK reports.

"Obviously, there is not a traditional healer who can cure AIDS, but they can help treat the symptoms and help support patients by giving them what they want to believe," Tryphina Ngwenya, a traditional healer involved in the AMREF program, said. Ngwenya added that more needs to be done to involve traditional healers in HIV/AIDS treatment and care. About 200,000 healers practice in South Africa, and organizations like AMREF have "trained just a handful," according to Reuters UK (Harrison, Reuters UK, 6/4).

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