Kaisernetwork.org (Washington, DC)
6 December 2007
New regulations for HIV-positive people visiting the U.S. are more restrictive than the old rules , which prohibited issuance of visas to people living with HIV, critics of the rules said recently, the San Francisco Chronicle reports.
Under the old restrictions, HIV-positive people could visit the U.S. by applying for a waiver to the rules. According to the Chronicle, the waiver process was "cumbersome," and some critics said it was "slow, arbitrary and unfair." President Bush in December 2006 requested the waiver process be streamlined with new administrative rules. Federal authorities occasionally have granted some short-term exceptions to the rules, such as allowing HIV-positive researchers to attend scientific conferences in the U.S., according to the Chronicle.
The new rules were proposed by the Department of Homeland Security and took 11 months to draft. According to some critics, the new rules would require that visitors prove they are bringing with them to the U.S. an "adequate supply of antiretroviral medicines." However, Veronica Nur Valdes, a DHS spokesperson, said the current waiver rules already require that HIV-positive visitors "must be traveling with an adequate supply of drugs." Applicants for a waiver also would have to agree to not extend their visit to the country, and visits would be limited to two 30-day stays annually, according to Victoria Neilson, legal director for Immigration Equality. HIV-positive people who are found to be violating the rules could be permanently banned from entering the U.S. According to the Chronicle, in an effort to cut red tape, the new rules would remove a requirement that applications for a waiver be reviewed by the U.S. Citizenship and Immigration Services and instead would leave waiver decisions to U.S. consular offices worldwide. A public comment period on the new rules is scheduled to expire Thursday.
Reaction
According to the Chronicle, opponents of the new rules are using the deadline for public comment to criticize the rules, as well as the policy that HIV-positive people require special visas to enter the U.S.
Paul Volberding, chief of medicine at the VA Medical Center in San Francisco and an adviser to Physicians for Human Rights, said the new rules are more discriminatory than the old ones. U.S. citizens "travel to other countries for pleasure and business without restrictions," Volberding said, adding that the U.S. places "barriers against those from other countries for a chronic, treatable disease that is not casually spread." He added that requiring local consular offices to make decisions on waiver applications could fuel discrimination because applicants would have to disclose their HIV status to officials in their communities.
Susannah Sirkin, deputy director of PHR, said that only 13 nations worldwide impose similar restrictions on HIV-positive visitors. "These policies are totally counterproductive to our own country's programs to address the global AIDS crisis," she said, adding, "To put possibly more restrictive policies on the table does not serve any public health interest." Nur Valdes said the new rules will improve the process, adding that local consular offices will determine whether waiver applicants have a "controlled state of HIV infection" (Russell, San Francisco Chronicle, 12/6).
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Global Challenges
India Should Target HIV Prevention Efforts at High-Risk Groups, Commentary Says
[Dec 06, 2007]
India should focus its HIV prevention efforts at high-risk groups in light of recent data that found the number of people estimated to be living with HIV/AIDS in the country is half of previous estimates, Lalit Dandona and Rakhi Dandona of the Administrative Staff College of India wrote in a commentary published in the Dec. 1 issue of the Lancet, ANI/Cheers News reports (ANI/Cheers News, 12/4).
Indian Health Minister Anbumani Ramadoss in July announced that the number of people estimated to be living with HIV/AIDS in the country is about 2.47 million, or half of previous estimates, according to United Nations-backed government estimates. The new estimate decreases India's HIV prevalence from 0.9% to 0.36%, Ramadoss said. The new estimate was calculated with the assistance of international agencies, such as the United Nations and USAID. The earlier estimate was based on blood samples taken from pregnant women and high-risk groups, such as injection drug users and commercial sex workers. The new estimate was based on a population-based survey that took blood samples from 102,000 people to determine HIV prevalence among the general population (Kaiser Daily HIV/AIDS Report, 9/5).
According to the authors, in light of the new estimate, India should target its HIV prevention efforts toward high-risk groups -- including commercial sex workers, injection drug users, mobile populations, people with other sexually transmitted infections and men who have sex with men. Other areas of focus should include counseling, testing, blood transfusion safety and preventing mother-to-child transmission of the virus, the authors wrote.
They also said that it is vital for the public health approach to HIV control in the country to become more scientific. "The establishment of a reliable estimate of HIV burden in India is only an initial step," the authors wrote, adding that what is "needed now is more scientific effort to understand the dynamics of HIV spread in India and the impact of interventions on HIV control" (ANI/Cheers News, 12/4).
The commentary is available online.
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Ukrainian President Yushchenko Says Government Has Inadequately Addressed HIV/AIDS
[Dec 06, 2007]
Ukrainian President Victor Yushchenko on Tuesday in a meeting with Cabinet ministers and the Ministry of Health said that the government's work in fighting HIV/AIDS in the country has been inadequate, UNIAN News Agency reports. There are more than 119,000 HIV-positive people and more than 21,000 people living with AIDS in Ukraine, he said.
According to Yushchenko, the government's purchases of antiretroviral drugs lack transparency, which has led to an inconsistency in the supply of medications and compromises in quality. He urged the Office of the Prosecutor General to conduct an investigation of all purchases made by the health ministry. He also highlighted issues with financing HIV/AIDS programs. Although budget growth provided financing for HIV/AIDS programs in 2007, only 50% of the available 98 million hryvnyas, or about $19 million, have been used to fight HIV/AIDS during the past 10 months, according to Yushchenko.
In addition, Yushchenko emphasized that the 112 million hryvnyas, or about $22 million, provided in the draft budget for 2008 is insufficient for treatment, prevention and the purchase of necessary medical equipment. Yushchenko called for all corresponding expenses to be included in the draft budget, saying that he will not sign a budget law that does not include expected expenses from the health ministry (UNAIN News Agency, 12/4).
"I can express a clear assessment of what the government, particularly the health ministry and the relevant subordinate organs, are doing," Yushchenko said. He added, "Unfortunately, it seems to me that there is no work in the system of government that has failed more than the fight against HIV/AIDS." The World Bank estimates that the number of HIV-positive people in Ukraine will increase to 820,000 by 2014 and that people ages 20 to 34 will account for 75% of all new cases by the same year (Ukrainian News, 12/4).
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HIV/AIDS, Gender-Based Violence Interlinked, Zambian National Assembly Speaker Mwanamwambwa Says
[Dec 06, 2007]
Amusaa Mwanamwambwa, speaker of the Zambian National Assembly, recently said that gender-based violence and HIV/AIDS are interlinked and that increased efforts should be made to address the relationship, the Times of Zambia/AllAfrica.com reports.
Mwanamwambwa was speaking to National Assembly members to commemorate World AIDS Day and the 16 days of advocacy against gender violence (Times of Zambia/AllAfrica.com, 12/4). The 16 days of advocacy against gender violence were launched Nov. 25 during the International Day for the Elimination of Violence Against Women in Lusaka, Zambia (Kaiser Daily HIV/AIDS Report, 11/28).
Mwanamwambwa said that social and cultural factors leave women unable to protect themselves from risky sexual behaviors and HIV transmission, adding that laws against gender violence should be strengthened and that access to reproductive health should be increased in an effort to eliminate gender-based violence. He added that businesses should implement HIV/AIDS policies and voluntary counseling and testing programs (Times of Zambia/AllAfrica.com, 12/4).
United Nations Special Envoy for HIV/AIDS in Africa Elizabeth Mataka at the IDEVAW launch called on women to openly discuss and increase awareness of how gender-based violence is contributing to the spread of HIV among women (Kaiser Daily HIV/AIDS Report, 11/28).
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Opinion
Editorials, Opinion Pieces Respond to World AIDS Day
[Dec 06, 2007]
Several newspapers have published editorials and opinion pieces in response to World AIDS Day. Summaries appear below.
Editorials
Boston Globe: Although "promising evidence" suggests that the number of new HIV cases worldwide has "declined in recent years," the "trend will only reverse if broader access to HIV drugs makes the infection appear to be a risk worth taking," a Globe editorial says. "Defeating AIDS requires the best drugs and the best prevention strategies, buttressed by the best research on what is working and what is not," the editorial says, adding that paying for these efforts will "continue to require generous support" for the Global Fund To Fight AIDS, Malaria and Tuberculosis and the President's Emergency Plan for AIDS Relief. The new HIV/AIDS figures "must prove to be not just a statistical blip, but a long-term trend to greater survival," the editorial concludes (Boston Globe, 12/1).
Calgary Herald: Canada has made "enormous progress" to "contain" the "tragic consequences" of HIV/AIDS, a Herald opinion piece says. It adds that despite "medical breakthroughs and educational programs," the "disease continues to exact a terrible toll." Although it is "encouraging that new medicines are helping to slow the progression of HIV into AIDS, the stark fact remains that there is still no cure for the disease," the editorial says. It adds, "As public health agencies continue to emphasize, the only way to remain safe is not to become infected" with the virus (Calgary Herald, 12/3).
Charlotte Observer: It is "good" that President Bush is calling for increases in global funding for HIV/AIDS, but "more resources and attention are needed in the U.S. too," an Observer editorial says. "Tackling the AIDS epidemic requires renewed efforts and stronger commitment of the public and public officials," the editorial says, adding that those "efforts and that commitment are needed at home and abroad" (Charlotte Observer, 12/4).
Korea Herald: People living with HIV/AIDS in Korea still are "burdened" by discrimination and stigma associated with the disease because "crucial facts ... have yet to become common knowledge," a Herald editorial says. It adds that "acute social stigmatization and alienation" will "continue until people finally recognize that AIDS is one of many chronic illnesses which have to be fought scientifically and with compassion" (Korea Herald, 12/4).
Uganda's New Vision: Uganda is at the "forefront" of the fight against HIV/AIDS, but the increase of discordant couples -- where one partner is HIV-positive and the other partner is HIV-negative -- is a "new phenomenon" that needs "close attention," a New Vision editorial says. "This calls for renewed vigilance in the fight against the disease because this discovery is likely to compromise the country's achievements," the editorial says, concluding, "It is vital ... to encourage married people to establish their HIV status so that they do not pass on the virus if they are found to be discordant" (New Vision, 12/5).
Opinion Pieces
Max Essex and Loretta McLaughlin, Boston Globe: "AIDS is no longer the death sentence it once was" because of increased access to antiretroviral drugs, Essex -- professor of health sciences and chair of the Harvard School of Public Health AIDS Initiative -- and McLaughlin -- senior fellow at the Harvard AIDS Initiative -- write in a Globe opinion piece. They add that although "success with treatment is now reality, prevention of AIDS through vaccines and microbicides will follow as long as we remain committed" (Essex/McLaughlin, Boston Globe, 12/1).
Janet Museveni, Uganda's Daily Monitor: "If an AIDS vaccine is to become a reality in the near future, there is a need to significantly expand political support for AIDS vaccine research globally," Uganda first lady Museveni writes in a Monitor opinion piece. "Heavily affected countries should support vaccine trials and can invest in their own research capacity, for instance, by committing to train the next generation of researchers," Museveni writes, adding that countries with "established research capacity should increase and sustain their funding for research to combat HIV" and other diseases. Countries also should "explore incentives to stimulate greater private sector engagement," according to Museveni, who adds that wealthy "nations should help ensure adequate support for AIDS vaccine research and development. Without better prevention, the costs of treating AIDS will only continue to soar" (Museveni, Daily Monitor, 11/23).
Kofi Annan and Rajat Gupta, Seattle Times: "Fighting HIV/AIDS is a business problem that demands businesslike solutions with measurable targets and results-based funding," Annan -- former United Nations secretary-general -- and Gupta -- board chair of the Global Fund To Fight AIDS, Tuberculosis and Malaria -- write in a Times opinion piece. They add that failure to "act today will leave the next generation with a deadly and impossible burden" (Annan/Gupta, Seattle Times, 12/1).
Elizabeth Mataka, Zimbabwe Standard: Mataka, U.N. special envoy for HIV/AIDS in Africa, in a Standard opinion piece writes that as the special envoy, she will "work tirelessly towards ensuring" that all Africans have "access to HIV prevention, treatment, care and support." She adds that individuals also can "make a promise" to stop AIDS by knowing their HIV status, changing risky sexual behavior, protecting against HIV transmission and by not "discriminating against people living with HIV" (Mataka, Zimbabwe Standard, 12/2).
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