Kaisernetwork.org (Washington, DC)
31 August 2007
Global Challenges
Books Accuse UNAIDS of Inflating HIV Prevalence Estimates To Increase Donor Funding
[Aug 31, 2007]
UNAIDS in two recently published books has "come under stinging attack" and been accused of "allowing politics to trump science in its efforts to combat" HIV/AIDS, AFP/Yahoo! News reports. According to AFP/Yahoo! News, the books have "sparked a wide-ranging debate" among HIV/AIDS advocates about how to fight the spread of the disease and "raised questions about UNAIDS' leadership."
U.S. epidemiologist James Chin in his book, "The AIDS Pandemic," accused UNAIDS of inflating HIV prevalence estimates to "dramatize the epidemic" and increase donor funding. Chin "appeared vindicated" earlier this year, when India reduced its HIV/AIDS caseload estimate to 2 million to 3.1 million people, AFP/Yahoo! News reports. UNAIDS previously estimated that the country had about 5.7 million people living with HIV/AIDS. In addition, the organization estimated that 1.6% of adults in Cambodia were HIV-positive, but the estimate later was reduced to 0.6% of adults, AFP/Yahoo! News reports.
Prasada Rao, UNAIDS regional director for Asia, said that the higher estimates were based on data from clinics, which experts used to estimate the number of people in the general population living with the virus. Rao added that the lower estimates were based on improved, random surveys among households, which provided a better analysis of the general population. "I don't see any motive on the part of UNAIDS to inflate numbers," Rao said, adding that he does not "think there is any axe to grind in this case."
Most experts agree that HIV/AIDS caseload estimates "remain a guess best used to show trends in each country," according to AFP/Yahoo! News. "There is a fine line between deliberately lying with the numbers or using the upper range of estimates that are based on slim assumptions and unrepresentative data," Chin said in an e-mail to Agence France Press. Both Chin and Rao agreed that the debate should focus more on how to spend resources than on the number of people living with HIV/AIDS.
In another recently published book, "The Invisible Cure," Helen Epstein, who studied HIV/AIDS in Africa, wrote that UNAIDS either misunderstood or ignored data in the mid-1990s that showed the practice of having multiple, long-term sexual partners was common in Eastern and Southern Africa and allowed HIV to spread quickly through the region. According to Epstein, rather than encouraging people to be faithful to one partner, UNAIDS focused on condom use and abstinence, which she says was less effective but more politically appealing.
Epstein added that the organization "overblew the prospects" for an HIV epidemic in Asia, where the virus is spread mainly through high-risk groups, whereas in Africa it is spread among the general population. "They got it almost perfectly wrong in some places," she said. Epstein added that UNAIDS previously focused more on potential HIV/AIDS outbreaks in other parts of the world rather than on addressing the disease in the most affected African countries.
Rao said he is concerned that if advocates believe UNAIDS is manipulating data, the agency's reputation and efforts to eradicate the disease could be damaged. "UNAIDS is not saying the data is wrong. It is accepting the data and trying to harmonize the facts," Rao said, adding, "That shows the openness that the organization has got on this issue. And it is prepared to correct its data (and) revise its data based on other sources of information" (Shea, AFP/Yahoo! News, 8/29).
Link to this story.
Science & Medicine
Hospitalizations Among HIV-Positive Infants, Young Children in U.S. Decreasing Because of HAART, Study Says
[Aug 31, 2007]
Hospitalizations among HIV-positive infants and children younger than age five are decreasing because of the introduction and widespread use of highly active antiretroviral therapy, according to a study published in the August issue of Pediatrics, Reuters Health reports. Athena Kourtis of CDC and colleagues used the National Inpatient Sample database to examine trends in hospital visits among HIV-positive children and adolescents during the 10 years between 1994, before HAART was introduced, and 2003, after HAART was in widespread use. The researchers found that there were an estimated 3,420 hospitalizations among HIV-positive children ages 18 or younger in 2003, compared with 11,785 in 1994 -- a decrease of 71%.
The decrease in hospitalizations was more apparent among infants and preschool-aged children, as the researchers recorded a 94% decrease among boys and a 92% decrease among girls in this age group, according to Reuters Health. The researchers recorded a 47% decrease in hospitalizations among boys ages 15 to 18 and an increase of 23% among girls in this age group. The inpatient fatality rates among HIV-positive children also decreased from 5% in 1994 to 1.8% in 2003, according to the study.
In addition, the researchers found that hospitalizations for several HIV-associated conditions became less common after HAART was introduced and came into widespread use. These conditions include bacterial pneumonia caused by Pneumocystis jiroveci, general bacterial infections, sepsis, systemic infections, fungal infections, brain infections and failure to thrive. The researchers did not observe any significant changes in the number of hospitalizations for Pneumococcus or cytomegalorvirus infections.
The researchers wrote that they hope the study's findings will be used to examine the health needs of specific HIV-positive populations, including adolescents, as well as specific HIV-associated complications. They said that they also hope the study will help "define future policies in an era of competing health care priorities" (Reuters Health, 8/29).
The study is available online.
Link to this story.
Opinion
Access to High-Quality, Low-Cost Antiretrovirals in Developing Countries Major Challenge in Fight Against HIV/AIDS, Opinion Piece Says
[Aug 31, 2007]
A "little-noticed milestone was reached in the fight to save lives from AIDS with high-quality antiretroviral treatment" last week when FDA "granted its 50th and 51st priority approvals for HIV/AIDS medications, making them eligible for purchase" by the President's Emergency Plan for AIDS Relief, Ambassador Mark Dybul, who serves as the U.S. global AIDS coordinator and administers PEPFAR, and FDA Commissioner Andrew von Eschenbach write in a Washington Times opinion piece. "One of the many needs that had to be met" in the fight against HIV/AIDS when President Bush announced PEPFAR was for a "supply of inexpensive, high-quality" antiretrovirals, Dybul and von Eschenbach write, adding that in 2004, FDA and HHS "adapted and expedited its review process for generic antiretroviral drugs products" to meet this need. Under the process, "products undergo the same rigorous scientific quality review that would make them eligible for use in the U.S. once patents expire," according to the authors.
The "benefits" of the expedited review process are not "limited to programs supported by PEPFAR," Dybul and von Eschenbach write, adding that through PEPFAR's Supply Chain Management System, the "lowest-priced products are now available for other programs serving the developing world as well." The expedited review process also has "made three generic drugs originally approved under PEPFAR now available" in the U.S. "because their patents expired," according to the authors. They add that in "short, the process has benefited both Africans and Americans."
Although "much progress has been made" in the fight against HIV/AIDS, "many challenges remain," Dybul and von Eschenbach write. "Because there is no cure or highly effective vaccine in sight, the need for HIV/AIDS treatment likely will be with us for generations," the authors write, adding that a "continuous stream of new, high-quality products to overcome the inevitable development of drug resistance" also will be needed. The U.S. approach "balances current and future needs for high-quality drugs that are affordable in resource-poor settings," according to Dybul and von Eschenbach. They conclude that this "effort plays a vital part in the American people's long-term commitment and leadership in the global fight against HIV/AIDS -- and it is something to celebrate" (Dybul/von Eschenbach, Washington Times, 8/31).
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