Kaisernetwork.org (Washington, DC)
18 December 2007
(Page 2 of 2)
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Madagascar's Response to HIV/AIDS One of 'Most Aggressive' in Africa, AP/ABC News Reports
[Dec 18, 2007]
Madagascar's response to HIV/AIDS has been one of the "most aggressive" in Africa and should serve as a model for how to prevent the transmission of the virus and improve overall health care, the AP/ABC News reports. Although less than 1% of Madagascar's population is living with HIV/AIDS, an influx of foreign workers, as well as a high rate of other sexually transmitted infections, has led the country to implement aggressive HIV prevention campaigns, the AP/News reports.
According to the AP/News, the government has established more than 100 testing clinics, increased access to condoms and has begun training teachers how to relay HIV prevention messages to their students. In addition, the country in August passed the first law in Africa that imposes fines for discriminating against people living with the disease or disclosing their status. The country also plans to distribute 400,000 HIV test kits by the end of 2007 and to provide 90% of HIV-positive people with antiretroviral drugs within five years, the AP/News reports.
Fanjaniaina Rajoelisolo, head of the country's national AIDS office, said the country's campaign against HIV/AIDS is a "personal initiative" of Madagascan President Marc Ravalomanana, adding that the president negotiates with international donors. According to Rajoelisolo, the country also ensures that precise records of every procedure and consultation are kept to provide donors with detailed accounting of how funds are being spent. "Donors see exactly what their money is doing and are willing to contribute more," Rajoelisolo said, adding, "We compare ourselves with other countries" and "then analyze all of [the information] and plan a strategy that will fit us." Hugo Templeman, an expert in South Africa who advises Ravalomanana on HIV/AIDS, said, "On HIV and AIDS, Madagascar is the only country in Africa that is getting it right" (Leonard, AP/ABC News, 12/16).
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Opinion
Vaccine Needed To Eliminate HIV/AIDS, Opinion Piece Says
[Dec 18, 2007]
Although campaigns to prevent the spread of HIV are "critical and need more attention," a vaccine is needed to effectively "protect society as a whole and eliminate" HIV/AIDS, Seth Berkley, president and CEO of the International AIDS Vaccine Initiative, writes in a Washington Post opinion piece.
According to Berkley, prevention campaigns -- including those that promote abstinence, faithfulness to one partner, circumcision, condom use and the provision of clean needles -- are necessary, but "given human nature and the cultural and economic realities in the societies hit hardest by AIDS, these programs can do only so much." Berkley writes that to eliminate HIV/AIDS, "we need a much more powerful weapon" -- a vaccine -- because no "major viral epidemic has been defeated without one." He adds that a vaccine "holds the hope of eliminating, and not just curbing," the HIV/AIDS pandemic.
Although there were "high hopes" for Merck's experimental HIV vaccine, the trials ultimately were canceled, Berkley writes, adding that "more study is needed to find out why it failed and what implications that may have for the 30 or so experimental AIDS vaccines in trials." According to Berkley, researchers also should "build on ... insights" -- such as why a small number of HIV-positive people never progress to AIDS or why vaccines can protect nonhuman primates from infection with SIV -- adding, "We can't afford the alternative, in financial or human terms." Financing HIV/AIDS research is a "minimal investment, but it is one that will ultimately prove cost-effective," Berkley writes, concluding that a "preventive vaccine is the only intervention that could ultimately eliminate the need for all others" (Berkley, Washington Post, 12/18).
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Low Insurance Reimbursement 'Biggest Impediment' to Routine HIV Testing, Letter to Editor Says
[Dec 18, 2007]
The "biggest impediment" to routine HIV testing is not "state restrictions" or "insufficient funding," but rather "government health insurance, Medicare and managed care insurance companies," Gary Blick -- an HIV/AIDS specialist in Norwalk, Conn. -- writes in a Washington Times letter to the editor in response to a recent Times opinion piece. According to Blick, Medicare reimburses $12.14 for the $17.50 HIV test, and United Healthcare, which covers 70 million U.S. residents, reimburses $6.04 for the test, "making it impossible to routinely test anyone."
It is "ironic" that CDC recommends routine HIV testing because Medicare prevents it by reimbursing 30% below cost for the test, Blick writes. Meanwhile, the number of new HIV cases is increasing, and President Bush has "significantly" reduced "funding for HIV prevention and testing," he adds.
Blick also writes that FDA in 2004 approved the drug Sculptra for correction of facial lipoatrophy, a "serious, disfiguring and stigmatizing complication" that occurs among people living with HIV/AIDS. The disease, also called facial fat wasting, "causes severe depression" and can lead "people to divulge their HIV status to others." However, Medicare and managed-care companies "routinely deny" Sculptra for HIV/AIDS patients as a "cosmetic procedure without it having a cosmetic indication," Blick writes. According to Blick, it also is "ironic" that FDA has approved a treatment that would help "reverse stigma" so that "Medicare can deny it for irrelevant, cost-saving reasons" (Blick, Washington Times, 12/15).
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