Kaisernetwork.org (Washington, DC)
19 July 2007
Drug Access
Governments, Donors Falling Short of Goal To Provide No-Cost Antiretroviral Access, Report Says
[Jul 19, 2007]
Governments and international donors are falling short of their goal to provide no-cost antiretroviral drug access to the HIV-positive people in developing countries who need them, according to a report released on Wednesday by the International Treatment Preparedness Coalition, Reuters reports.
The Group of Eight industrialized nations at the close of its summit in Heiligendamm, Germany, in June pledged to provide five million HIV-positive people worldwide with drug access by 2010, but current trends indicate that the world will miss that goal, the report said (Perry, Reuters, 7/18). The report analyzed HIV/AIDS treatment access in 17 countries, nine of which are in Africa (Maphosa, VOA News, 7/18).
Gregg Gonsalves of ITPC in a statement said, "Free treatment is not truly free in most countries surveyed." He added, "Charges for diagnostic tests, medical care and other services are putting lifesaving care out of the reach of many thousands of people."
The report also said there are challenges associated with providing drug access to marginalized groups, children and rural populations. It also found that there are drug access issues related to transportation, HIV/AIDS-related stigma and the high cost of antiretrovirals, Reuters reports. "Tripling the annual growth rate of treatment access from today's 700,000 to two million new people on treatment each year is both possible and necessary to meet the G8 commitment of coming close to universal access by 2010," according to the report.
Cambodia, which has about 134,000 HIV-positive residents, is a "success story" in increasing treatment access, the report said. Antiretrovirals became available in the country in 2004, and there now are 40 centers providing treatment to about 21,900 HIV-positive people, the report found. However, the report added that there still is a "large but silent minority" of marginalized people in Cambodia who do not receive treatment access, including commercial sex workers, Vietnamese citizens and people living in remote areas and slums. Other countries -- including China, India and South Africa -- have treatment programs in place but face obstacles to meet the goal of universal access, according to the report (Reuters, 7/18).
The report called on UNAIDS and the World Health Organization to be more vocal when treatment targets are not met, national programs are mismanaged or vulnerable populations are neglected, VOA News reports. It also urged the agencies to develop plans to provide testing technology, eliminate antiretroviral shortages and integrate HIV prevention and tuberculosis services (VOA News, 7/18).
The report is available online. Note: You need Adobe Acrobat to view this report.
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Across The Nation
Puerto Rico's HIV/AIDS Treatment Program Will Be Overhauled To Ensure Drug Access, Gov. Vila Says
[Jul 19, 2007]
Puerto Rico's HIV/AIDS treatment program will be overhauled to ensure that people living with the disease have access to drugs without delays, Gov. Anibal Acevedo Vila (D) announced on Tuesday, the AP/Fox News reports. According to Vila, about $78 million in federal and local territorial funds will be allocated to streamline the treatment program. Some of the funds also will be used to hire 23 additional employees -- including Jorge Delgado, an HIV-positive physician from California who will serve as the program's new director -- Vila said (Coto, AP/Fox News, 7/17).
According to some local doctors and advocacy groups, hundreds of people living with HIV/AIDS in Puerto Rico are not receiving needed medical care. The situation reflects a number 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 primary cause is the island's mismanagement of funding from the Ryan White Program.
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.
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, has 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 commonwealth health department also often makes errors in antiretroviral distribution, some doctors say (Kaiser Daily HIV/AIDS Report, 6/5).
Health officials are reviewing existing HIV/AIDS cases so they can improve services, Vila said, adding that a system to oversee the management of federal and state funds also will be created. The New York-based Latino Commission on AIDS praised the planned overhaul of the program (AP/Fox News, 7/17).
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Global Challenges
Former President Clinton Visits Dominican Republic as Part of Tour of Foundation-Funded HIV/AIDS Projects
[Jul 19, 2007]
Former President Clinton on Tuesday visited a hospital in the Dominican Republic that provides treatment to HIV-positive children as part of an eight-day global tour of projects funded by the Clinton Foundation, the AP/Houston Chronicle reports. Clinton toured a playroom and the pediatric HIV/AIDS ward at the Robert Reid Cabral Children's Hospital in Santo Domingo, which an administrator said provides care to about 610 HIV-positive children and teenagers. About one-fourth of the children receive antiretroviral treatment. "It's an impressive facility," Clinton said, adding, "They do important work here."
The foundation aims to more than double the number of Dominican children who have access to antiretroviral drugs, open rural clinics and train doctors in the country, as well as in Jamaica and Trinidad and Tobago, the AP/Chronicle reports. Clinton was scheduled to go to South Africa after meeting with Dominican President Leonel Fernandez. His tour also will include stops in Malawi, Zambia and Tanzania. According to the AP/Chronicle, the trip follows a $1.25 million grant from Estee Lauder-owned MAC Cosmetics to the Clinton Foundation for HIV/AIDS programs in the Caribbean (Katz, AP/Houston Chronicle, 7/18).
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Number of Orphans in Zimbabwe Increasing Primarily Because of HIV/AIDS, Survey Says
[Jul 19, 2007]
Almost one-quarter of all children in Zimbabwe are orphans, primarily because of the country's HIV/AIDS epidemic, according to a recent survey conducted by Zimbabwe's Central Statistics Office in collaboration with Maryland-based ORC Macro, the Boston Globe reports. According to the survey, which was conducted in 2006, nearly 22% of all children under age 18 in the country have lost one or both parents, compared with 9% in 1994 and 14% in 1999. Zimbabwe has an adult HIV prevalence of 18%, the survey found.
According to some HIV/AIDS specialists, the number of orphans in the country is linked to its long economic and health crises, which began in the 1990s and were driven by polices implemented by President Robert Mugabe. In addition, the country's health care infrastructure has "disintegrated" -- a situation that is reflected in Zimbabwe's declining childhood immunization rates and increasing rates of stunted growth among children -- according to the Globe. "The numbers on immunization reflect the broader economic decline and the consequent meltdown in the public health care sector," outgoing U.S. Ambassador to Zimbabwe Christopher Dell said, adding, "Thousands and thousands of health care workers have left the country."
According to Zanele Sibanda-Knight, advocacy coordinator for the Firelight Foundation, the rate of AIDS-related deaths is higher in Zimbabwe than surrounding countries because fewer people have access to antiretroviral drugs in the country. Vinod Mishra, director of research at ORC Macro, said that increasing access to antiretrovirals likely would decrease the number of orphans in Zimbabwe.
According to some analysts, the number of orphans in Zimbabwe likely is similar to the number in other Southern African countries. Jennifer Delaney, executive director of Global Action for Children, said that the survey's findings reveal the need to expand HIV/AIDS programs throughout the continent (Donnelly, Boston Globe, 7/18).
Germany, New Zealand, Sweden and the United Kingdom in February pledged $70 million to Zimbabwe to help the country address the growing number of children who have lost one or both parents to AIDS-related illnesses. The funding will be administered jointly by UNICEF, nongovernmental organizations and the government to ensure that AIDS orphans have access to services such as education and health care. The $70 million will go toward a five-year, $250 million program aimed at AIDS orphans in Zimbabwe (Kaiser Daily HIV/AIDS Report, 2/20).
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Inter Press Service Examines HIV/Malaria Coinfection
[Jul 19, 2007]
Inter Press Service on Tuesday examined issues surrounding HIV/malaria coinfection, particularly in Mozambique. Research during the past five years has suggested that severe malaria can further suppress the immune system of an HIV-positive person, according to Albert Kilian, a senior technical adviser for Malaria Consortium. "Patients suffer more often and more severely from malaria once their immune system starts to decline, and they will respond less quickly to treatment," he said. A pregnant HIV-positive woman who also has malaria is "likely to have more severe malaria symptoms and runs the risk of developing life-threatening anemia," Kilian said, adding that malaria adds to the risk of having a low-birthweight infant. Although there is "no solid evidence yet," some researchers believe that malaria also might increase HIV viral loads and the risk of mother-to-child HIV transmission, Kilian said. He added that anemia, which is common among children who have malaria more than once, also has been associated with increased mortality among HIV-positive children. It is possible for people living with HIV to minimize their vulnerability to malaria, Kilian said, adding that they should take prophylactic treatment using co-trimoxazol and antiretroviral drugs, if appropriate.
There are significant challenges to controlling the spread of HIV and malaria in Mozambique. According to Inter Press Service, Mozambique has an adult HIV prevalence of 16.6%, and malaria is endemic and transmitted throughout the year. Cases of the disease peak toward the end of the rainy season, which usually starts in September and ends by May. Addressing HIV/malaria coinfection is an additional challenge, primarily because of widespread poverty and a lack of access to basic health service. "Many people living with HIV/AIDS die of malaria, especially in the rural areas," Cesar Mufanequico, national director of the Mozambican Treatment Access Movement, said. Although the government distributes no-cost insecticde-treated nets to pregnant women and children younger than age five, Mufanequico said he wants the distribution of no-cost ITNs to HIV-positive people increased as well. "Many people living with HIV/AIDS die of malaria, especially in the rural areas," he said, adding, "Most do not have nets. We talk about fighting HIV/AIDS together with malaria and tuberculosis, but in practice, we often treat them separately" (Ayisi, Inter Press Service, 7/17).
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Opinion
Surgeon General Nominee Holsinger's Views on MSM Unclear, Editorial Says
[Jul 19, 2007]
Although President Bush's nominee for surgeon general, James Holsinger, is "nearly perfect" on "paper," a 1991 document he wrote on the health of men who have sex with men has "gummed up his effort to become the nation's top" physician, a Washington Post editorial says (Washington Post, 7/19). Bush nominated Holsinger on May 24 to succeed former Surgeon General Richard Carmona, who ended his term last year with no replacement.
The HIV Medicine Association and other groups -- including the American Public Health Association and some gay and lesbian organizations -- announced their opposition to Holsinger ahead of his Senate confirmation hearing, which was held last week. HIVMA, APHA, the Human Rights Campaign, the National Gay and Lesbian Task Force and other groups in their opposition to Holsinger cite in part a document he wrote in 1991 called the "Pathophysiology of Male Homosexuality." The document was written to a United Methodist Church panel studying homosexuality. In the document, which focuses on anatomy and the reproductive system, Holsinger wrote that the "varied sexual practices of homosexual men have resulted in a diverse and expanded concept of sexually transmitted disease and associated trauma." Holsinger also called anal sex unnatural and gave an anatomical explanation. Holsinger during the the (Senate Health, Education, Labor and Pensions Committee hearing said that his views have changed and that the issues he raised in the paper are not relevant to current public health discussions (Kaiser Daily HIV/AIDS Report, 7/13).
The "hope" was that Holsinger's confirmation hearing last week would "bring some clarity" to his views on MSM, the editorial says, adding that there was no "such luck." Although Holsinger's comments during the hearing are "excellent," they do not "answer the question" about his views, according to the Post. The editorial concludes that the "question remains: Does Dr. Holsinger still believe that homosexuality is unnatural and unhealthy? If the answer is yes, he should not be confirmed" (Washington Post, 7/19).
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