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Kaisernetwork.org (Washington, DC)

Africa: Daily HIV/Aids Report

27 November 2007

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Election 2008

Clinton To Release HIV/AIDS Policy

[Nov 27, 2007]

Sen. Hillary Rodham Clinton (N.Y.), who is running for the Democratic presidential nomination, on Tuesday while campaigning in South Carolina is expected to announce a plan to fight HIV/AIDS domestically and abroad, the New York Times reports. Clinton's "two main rivals" for the Democratic nomination -- Sen. Barack Obama (Ill.) and former Sen. John Edwards (N.C.) -- already have released HIV/AIDS plans, the Times reports. The three plans are "similar in terms of spending, goals and differences with President Bush's AIDS policy," according to the Times.

Clinton's plan, like Edwards' and Obama's, will propose spending at least $50 billion by 2013 on initiatives to fight HIV/AIDS worldwide. The Bush administration has allocated $30 billion for the same time period. Clinton's plan also will propose doubling funding for HIV/AIDS research at NIH to $5.2 billion annually. Edwards' plan, which was released in September, pledges to "strengthen" spending for such research, while Obama, who released parts of his plan at different times throughout the year, said he would "expand" research funding.

According to the Times, the three plans would not focus HIV prevention strategies on abstinence-only education. A paper provided by Clinton's campaign that outlines her plan says that she supports providing young people with "age-appropriate information about HIV/AIDS and how to protect themselves against it." Clinton, Edwards and Obama also all support federal funding for needle-exchange programs.

In addition, the paper outlining Clinton's plan says that she would work to "significantly" reduce the number of new HIV cases in the U.S. each year, as well as to establish measureable targets and timelines for expanding prevention and treatment services. Obama's plan for reducing new cases is "almost identical to what [Clinton] proposes," the Times reports. Edwards has said that his plan for reducing new cases includes holding his HHS secretary "accountable" for releasing an annual HIV/AIDS report that demonstrates progress toward Edwards' targets. Edwards also has said that he would appoint a "strong" director for the White House Office of National AIDS Policy.

Clinton, Edwards and Obama all pledge to provide HIV-positive people with improved medical care, primarily through health insurance programs that the three candidates have proposed this year. According to Clinton campaign advisers, she thinks that the current federal plan to combat HIV/AIDS is "diffuse and uncoordinated," according to the Times.

Although HIV/AIDS plans have not been a primary topic among the leading Republican presidential candidates, some have spoken about how increased efforts are needed, according to the Times. Former New York City Mayor Rudy Giuliani, who is running for the Republican presidential nomination, has said that he would increase funding for Bush's HIV/AIDS programs in Africa. He added that he would provide aid to fight malaria in Africa, as well as aim to bolster trade between the U.S. and the continent (Healy/Altman, New York Times, 11/27).

Link to this story.

Across The Nation

Washington, D.C., Mayor Fenty Pledges Increased HIV Testing, No-Cost Condom Distribution in Response to Report

[Nov 27, 2007]

Washington, D.C., Mayor Adrian Fenty's administration on Monday pledged to triple within one year the number of no-cost condoms distributed by the city, as well as to work with hospitals to increase HIV testing in emergency departments, in an effort to curb the spread of the virus, the Washington Post reports (Nakamura, Washington Post, 11/27).

The announcement follows the release of a report that called HIV/AIDS a "modern epidemic" in the district with "complexities and challenges that continue to threaten the lives and well-being of far too many residents." According to the report, almost 12,500 district residents were known to be living with HIV/AIDS in 2006. Thirty-seven percent of HIV cases were transmitted through heterosexual contact, compared with 25% that were transmitted among men who have sex with men.

The number of HIV cases in the district began declining in 2003, but the decrease likely is the result of underreporting or delayed reporting, the report said. One in 20 district residents is HIV-positive and one in 50 is living with AIDS, according to Shannon Hader, head of the city's HIV/AIDS Administration. The city's cumulative number of AIDS cases is more than 17,400.

More than two-thirds of AIDS cases in the district during the past 10 years were among people who progressed to AIDS within one year of being diagnosed with HIV, compared with 39% of AIDS cases nationwide, the report found. The report also found that more people ages 40 to 49 were being diagnosed with HIV than any other age group. In addition, all of the 36 children in the district who tested positive for HIV since 2002 contracted the virus during birth (Kaiser Daily HIV/AIDS Report, 11/26).

Hader said the HIV/AIDS Administration plans to scale up several initiatives that began before she started at the administration in October, the Post reports. Hader also said that she hopes to increase the number of no-cost condoms distributed by the city to three million by 2009 to help prevent the spread of HIV. She added that she wants to "challenge" all hospital EDs to offer "rapid HIV testing" to help diagnose the virus in earlier stages. George Washington University Medical Center and Howard University Hospital have the only EDs that currently offer HIV testing, Hader said. In addition, Hader said she plans to collaborate with the city's seven birthing centers to draft guidelines and set up outreach and testing sites to help prevent mother-to-child HIV transmission.

"These things have already been started, but we want to use the report to build on them," Hader said, adding, "We're using all the tools in the tool kit, and we're also looking at all of our tool kits, figuring out where there are gaps." Hader said she does not plan to request more HIV/AIDS funding in the coming year but added that if early testing and treatment rates are increased, the programs could become more costly (Washington Post, 11/27).

Related Editorial

The figures in the report are "harrowing," but "with a new director of HIV/AIDS administration, plenty of funding and, now, data, the district stands a chance of beating back this killer that has no cure," a Post editorial says. According to the editorial, doctors and hospitals need to routinely test pregnant women for HIV, and prevention and treatment efforts "must be accelerated." The Post adds that Fenty and Hader have committed themselves to this goal, but "their efforts will be useless if people think they are somehow immune to the epidemic." The editorial concludes that "AIDS is an equal-opportunity killer" (Washington Post, 11/27).

NPR's "The Bryant Park Project" on Tuesday included a discussion with Larry Bryant, an outreach and advocacy worker in the district, about the report ("Bryant Park Project," NPR, 11/27). Audio of the segment is available online.

In addition, WAMU's "The Diane Rehm Show" on Tuesday is scheduled to include a discussion with Anthony Fauci, director of the National Institute of Allergy and Infectious Disease at NIH, about the report and other issues related to HIV/AIDS ("The Diane Rehm Show" Web site, 11/27). A broadcast schedule and additional details about the segment are available on the program's Web site. Audio of the segment will be available online about one hour after the broadcast.

Link to this story.

Palm Beach Post Examines HIV/AIDS in Florida

[Nov 27, 2007]

The Palm Beach Post on Sunday examined HIV/AIDS in Florida, which has the third-highest caseload nationwide. More than 105,000 people have been diagnosed with AIDS since the start of the epidemic in the U.S., and the rate of HIV/AIDS among children in the state is second only to New York, according to the Post. In addition, about 80% of pediatric HIV/AIDS cases occur among black children. Palm Beach and St. Lucie counties have recorded the highest HIV/AIDS rates among black residents statewide, the Post reports. Black residents, who make up 15% of Palm Beach county's population, comprise 65% of people living with HIV/AIDS in the area.

Leaders in Florida have not responded to HIV/AIDS as a sexually transmitted epidemic, Palm Beach County Health Director Jean Malecki said, adding that sex education programs in the state do not provide students with information about how to prevent HIV. In addition, the federal government has not supported local prevention efforts in Florida and during the past two years has reduced HIV/AIDS funding for Palm Beach County and the Treasure Coast, according to Malecki.

Although religious leaders in the state have not spoken out about the disease, an exception has been Bishop Lewis White, who has run HIV/AIDS education, prevention and care programs in the county, Malecki said. "Other pastors have said I'm promoting sex when I hand out condoms," White said, adding, "I'm sorry to tell them that is not true. People are having sex with or without condoms. I'm promoting life. I'm here for a purpose: not to judge you on who you have sex with, but to judge how careful you are when you have sex." According to White, poverty, unemployment and homelessness are contributing to the spread of HIV in communities where conditions have deteriorated during the past few years (Barton, Palm Beach Post, 11/25).

The recent series of HIV/AIDS articles in the Post was supported by the Pulitzer Center on Crisis Reporting. Additional resources are available online.

Link to this story.

Global Challenges

Queen Elizabeth Visits Uganda HIV/AIDS Clinic, Praises Country's Efforts To Combat Disease

[Nov 27, 2007]

Ahead of the Commonwealth Heads of Government Meeting, which opened on Friday, Queen Elizabeth II on Thursday praised efforts of health organizations and the Ugandan government to combat the spread of HIV in the country, AFP/Yahoo! News reports (AFP/Yahoo! News, 11/22). Queen Elizabeth also visited a clinic and children's hospital run by U.K.-based charity Mildmay.

Queen Elizabeth in a speech to members of Uganda's parliament and President Yoweri Museveni said the "scourge of HIV infection and AIDS has touched the lives of so many of Uganda's people," adding, "Yet there are growing numbers of people and organizations whose work gives cause for real hope." The role of centers such as the Mildmay-run clinic will be "central to achieving our common aim of controlling" HIV/AIDS, Queen Elizabeth said. Museveni in a speech praised Uganda's partnership with the United Kingdom, adding that the country is "ready to work with Britain on a range of global issues" (Jones, Press Association, 11/22).

Commonwealth Countries Should Take Action Against HIV/AIDS, Group Says

In related news, Para 55, also known as the Commonwealth Action Group on HIV and AIDS, on Saturday called on countries in the Commonwealth of Nations to take action against HIV/AIDS and provide universal access to antiretroviral drugs, Xinhua News Agency reports. According to statistics, Commonwealth countries account for 60% of the global HIV/AIDS burden and are home to the majority of AIDS orphans.

The group urged Commonwealth leaders in their final document to be released following the Heads of Government Meeting, which ended on Nov. 25, to "make a bold commitment to work together and take action to deliver on improved health for all and keep the promise" to achieve "all health-related Millennium Development Goals by 2015." The group also called on member states to fully utilize World Trade Organization provisions that secure access to affordable drugs, Xinhua News Agency reports.

Anton Kerr, deputy chair of Para 55, said, "Greater collaboration among Commonwealth member states is needed to overcome key barriers, including appropriate levels of financing, to realize the promise to provide universal access to HIV prevention, treatment, care and support by 2010." Richard Matikanya of Para 55 said, "It is only through a determined, comprehensive and collective response by Commonwealth member states that we can significantly turn the tide against HIV and deliver the promise of universal access" (Xinhua News Agency, 11/24).

Link to this story.

Public Health & Education

Los Angeles Times Examines Efforts To Prevent Spread of HIV/AIDS Among U.S. Adults Ages 50, Older

[Nov 27, 2007]

The Los Angeles Times on Monday examined the "national push" to increase HIV/AIDS prevention efforts among adults ages 50 and older in the U.S. As people begin to live longer than previous generations and experience extended sex lives because of hormone replacement therapy and erectile dysfunction drugs, there is a "growing concern that the baby boom generation -- and their elders -- don't understand that getting older doesn't make one immune" to HIV/AIDS, according to the Times. That concern is fueling efforts by public health officials and educators for scaled up prevention efforts aimed at "aging baby boomers and those who are firmly in their golden years," the Times reports.

Most medical experts agree that the older U.S. population often is among the "most overlooked" and, therefore, "one of the more vulnerable" populations to HIV/AIDS, the Times reports. Experts note that the majority of funding for HIV/AIDS prevention education during the last 20 years has been aimed at teenagers, urban residents and men who have sex with men. In addition, older people often are reluctant to talk about sex with their doctors, according to AARP. A study published earlier this year in the New England Journal of Medicine reported that a majority of 3,005 surveyed U.S. adults ages 57 to 85 have sex two to three times monthly. However, only 38% of the men and 22% of the women surveyed had discussed sex with a doctor since they turned 50, according to the report. The report also found that doctors are uncomfortable with discussing the risks of sexually transmitted infections with older patients, the Times reports.

Spencer Lieb, senior epidemiologist at the Bureau of HIV/AIDS at the Florida Department of Health, said that part of the problem with determining what risks older U.S. residents face comes from a lack of testing data. Lieb said some of the increase in the number of people ages 50 and older living with HIV/AIDS can be attributed to people who are living longer with the disease. Researchers "don't really know what the true prevalence" of STI infection is in "this group," Lieb said, adding, "There's reason to think, at least anecdotally, this is a combustible situation that is being overlooked" (Huffstutter, Los Angeles Times, 11/26).

Link to this story.

Opinion

Editorials, Opinion Pieces, Letter Respond to UNAIDS, WHO Report on Global HIV/AIDS Estimates

[Nov 27, 2007]

Several newspapers recently published editorials, opinion pieces and letters to the editor in response to UNAIDS and the World Health Organization's annual report on HIV/AIDS, which was released last week. The organizations in the report lowered their estimates of how many people are living with HIV/AIDS worldwide. According to the report, about 33 million people worldwide are living with HIV/AIDS, compared with an estimate of nearly 40 million in 2006. The U.N. bodies said that better methods of data collection and increased data availability from countries show that HIV/AIDS is not quite as widespread as previously thought (Kaiser Daily HIV/AIDS Report, 11/21).

Editorials

Economist: Although the decrease in the estimated number of people living with HIV/AIDS "should be cause for rejoicing," the "fall is not a real fall," but a "change in the way the size of the epidemic is estimated," an Economist editorial says. The editorial adds that the "best news of all" is that the "epidemic has peaked," meaning that the "goal of treatment for all who need it will be easier and cheaper to achieve" (Economist, 11/22).

New York Times: The "AIDS epidemic remains one of the world's greatest scourges," despite the "revised estimates," a Times editorial says. The editorial adds that although there are "glimmers of hope that the epidemic is beginning to wane," the "revised numbers cannot be used as an excuse to relax the campaign against AIDS" (New York Times, 11/23).

Los Angeles Times: Although the report indicates that HIV/AIDS is not "as prevalent as previously thought," that is "no reason to be complacent," a Times editorial says. "Even using the lowered estimate, AIDS is one of mankind's deadliest afflictions," the Times says. Even if the United Nations "had been intentionally overstating the problem -- which is unlikely -- the PR effort didn't work," the editorial says, adding, "The world still isn't giving enough money" (Los Angeles Times, 11/27).

Opinion Pieces

Helen Epstein, Mail & Guardian: The "key to fighting AIDS lies" in something "best described as a sense of solidarity, compassion and mutual aid that is impossible to quantify or measure," Epstein -- author of "The Invisible Cure: Africa, the West and the Fight Against AIDS" -- writes in a Mail & Guardian opinion piece in response to the new data. Because "sexuality is shaped by society and because sex itself involves more than one person, behavior change is a collective act, not one of individuals acting alone," Epstein writes, adding, "That's the reason why social mobilization is so important. And that's also why HIV prevention is so difficult. But sometimes it works" (Epstein, Mail & Guardian, 11/26).

Donald McNeil, New York Times: The new estimates "mean the vision" that HIV/AIDS will be "viewed as a chronic problem" is "now possible" on a global scale, Times reporter McNeil writes in an opinion piece. It also is possible that in the "very distant future," it might be "actually affordable" for the global health community to contain the pandemic, McNeil adds (McNeil, New York Times, 11/25).

Margaret Wente, Toronto's Globe and Mail: Researchers at UNAIDS and WHO were "finally forced to admit that their numbers had been wildly overstated," Wente, a columnist for the Globe and Mail, writes in an opinion piece. She concludes that "fudging the facts doesn't help anyone -- least of all the victims of this tragic, dreadful plague" (Wente, Globe and Mail, 11/24).

Letter to the Editor

Adrienne Germain, New York Times: The revised data is "pointless" because the "pandemic and number of new infections are still horrific," Germain, president of the International Women's Health Coalition, writes in a Times letter to the editor. Germain adds that the global health community "must make better progress on prevention and treatment for all" (Germain, New York Times, 11/27).

Germain, Washington Post: The report "must not detract from the world's effort to stem the HIV/AIDS pandemic," Germain writes in a Post letter to the editor, adding that the global health community "must ensure access to prevention and treatment for all" (Germain, Washington Post, 11/23).

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