Kaisernetwork.org (Washington, DC)
22 January 2008
Public Health & Education
Groups Respond to Research That Links Drug-Resistant MRSA Strain to MSM Communities in Boston, San Francisco
[Jan 22, 2008]
Gay rights advocates and opponents recently responded to research that links a drug-resistant strain of methicillin-resistant staphylococcus aureus, or MRSA, to men who have sex with men in Boston and San Francisco, the New York Times reports. The study was published online recently in the journal Annals of Internal Medicine, the Times reports (McKinley, New York Times, 1/20).
For the study, Binh Diep, a researcher at the University of California-San Francisco, and colleagues reviewed the charts of 183 people treated for MRSA at San Francisco General Hospital's Positive Health Program, an outpatient program for HIV-positive people. They also reviewed the charts of an additional 130 people at Fenway Community Health clinic in Boston. The review found that MSM ages 18 to 35 were the most likely to have the infection. According to a statistical analysis based on ZIP codes, one in 588 people in San Francisco's Castro neighborhood, which has the highest number of MSM residents nationwide, is living with MRSA, compared with one in 3,800 people across San Francisco. The study also found that MSM in San Francisco were 13 times more likely than other city residents to contract MRSA.
The study found MRSA spreads most often through anal intercourse but also can be spread through casual skin-to-skin contact or by touching contaminated surfaces. MRSA can cause abscesses and skin ulcers and can produce necrotizing facsiitis, or flesh-eating bacteria. The infection also can cause pneumonia, heart damage and blood infections. Among MSM in the study, MRSA was spread through skin-to-skin contact and caused abscesses and infection in the buttocks and genitals. The most effective way to prevent skin-to-skin transmission of MRSA is to wash with soap and water, particularly after sex, the researchers said (Kaiser Daily HIV/AIDS Report, 1/15).
According to the Times, the study "seemed to cast an unfair, and all too familiar, stigma" on MSM and "inadvertently offered ammunition" for gay rights opponents, including Concerned Women for America and Americans for Truth About Homosexuality. CWA on Wednesday issued a release that said the "sexual deviancy" of MSM has led to HIV/AIDS, syphilis and gonorrhea. The group added that the "medical community has known for years that homosexual conduct, especially among males, creates a breeding ground for often deadly diseases." National gay rights groups in response labeled the reaction as "hysteria," and the study's authors on Friday issued an apology that said their press release "contained some information that could be interpreted as misleading."
Henry Chambers, one of the study's authors and a professor of medicine at UCSF, said, "We deplore negative targeting of specific populations in association with MRSA infections or other public health concerns." He added that the researchers were "looking at this from a scientific point of view and not projecting any political impact." Diep on Friday said he regrets not being more thorough in communicating the study's findings to reporters, adding that the term "general population" used in the study did not translate well. "It's really meant to be used to mean all inclusive, including the MSM population," he said.
CDC on Wednesday in a statement said that MRSA is not sexually transmitted or limited to a certain population. According to the statement, MRSA is transmitted by skin-to-skin contact and is widespread in hospitals and among hospital workers (New York Times, 1/20).
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Global Challenges
Chevron Pledges $30M to Global Fund as Part of Corporate Initiative
[Jan 22, 2008]
U.S. energy group Chevron on Monday pledged a $30 million, three-year grant to the Global Fund To Fight AIDS, Tuberculosis and Malaria in an effort to provide corporate support to global health programs, the Financial Times reports. Chevron employees also will provide local assistance to Global Fund-supported programs in six countries in Africa and Asia, according to the Times (Jack, Financial Times, 1/21).
The Chevron grant was announced in conjunction with the launch of the Global Fund Corporate Champions program, which aims to provide global companies with an opportunity to invest in the fight against HIV/AIDS, TB and malaria. Under the program, participating businesses will make contributions to Global Fund programs in countries where they operate, as well as use their employees and other assets to improve health programs (Global Fund release, 1/21).
"This is the biggest single commitment we've made," Chevron Vice-Chair Peter Robertson said, adding, "The Global Fund has got a pretty good record of governance, and this is an opportunity to leverage what we bring with what they bring." According to Global Fund Board Chair Rajat Gupta, who also serves as chair of McKinsey & Company, the organization is in talks with five other corporations. The Global Fund Board this spring also plans to reconsider a ban on in-kind contributions from pharmaceutical companies for drugs and other products.
The Chevron grant was announced ahead of a discussion at the World Economic Forum in Davos, Switzerland, about corporate responsibility, according to the Times (Financial Times. 1/21).
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Writers Participate in Gates Foundation Initiative Aimed at Promoting Dialogue About HIV/AIDS in India
[Jan 22, 2008]
A group of Indian writers is participating in an initiative funded by the Bill & Melinda Gates Foundation that aims to promote public dialogue about HIV/AIDS in the country and abroad, the Hindustan Times reports. According to the Times, 15 writers will visit communities and families affected by the disease to explore different aspects of India's epidemic.
Parmeshwar Godrej, who is closely involved with the project, said the authors' works will be similar to news magazine articles and compiled together. The anthology will be published in August with a foreword by Indian writer Amartya Sen. Authors participating in the project are Salman Rushdie, William Dalrymple, Nalini Jones, Vikram Seth, Kiran Desai, Amit Chaudhuri, Siddhartha Deb, Nikita Lalwani, Sonia Faleiro, Shobhaa De, Jaspreet Singh, Siddharth Dhanvant Shangvi, C.S. Lakshmi, Sunil Ganguly and Mukul Kesavan, the Times reports. The Gates Foundation said it hopes the initiative will humanize the epidemic, according to the Times (Bhayana, Hindustan Times, 1/19). According to estimates released earlier this year, about 2.5 million people in India were living with HIV/AIDS in 2006 (Kaiser Daily HIV/AIDS Report, 12/21/07).
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Provider-Initiated HIV Testing Programs in Zimbabwe Increasing Number of Pregnant Women Seeking Testing, Counseling, Health Minister Says
[Jan 22, 2008]
An increasing number of women in Zimbabwe are receiving HIV tests and counseling as a result of the country's provider-initiated testing and counseling programs, Minister of Health and Child Welfare David Parirenyatwa said recently, The Herald reports.
About 541,000 pregnant women as of September 2007 have received HIV counseling through the country's Prevention of Mother-to-Child HIV Transmission program, Parirenyatwa said, adding that more than 432,000 of the women were screened for HIV. He said that nearly 38,000 women and their infants received nevirapine prophylaxis as a result of the provider-initiated approach. According to Parirenyatwa, the national PMTCT program, which started as a pilot project in 1999, has expanded to reach all the 1,560 public health facilities that offer prenatal care in the country. Health practitioners offer HIV testing to pregnant women, but the women have the right to opt out of testing.
"We must applaud the service providers for contributing significantly to this important milestone," he said. Parirenyatwa also called on health officials to encourage families to learn about the PMTCT program. "We should commit ourselves to the success of the program to enable people to know their status in order to take appropriate and positive action to relieve the pain and suffering that comes with" HIV/AIDS, Parirenyatwa said. He added that collaboration from several groups has helped make positive achievements and improvements in the services offered by the programs (The Herald, 1/18).
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Cameroon Scientists Call for Improvements to HIV/AIDS Communication Strategy
[Jan 22, 2008]
The Cameroon Association of Young Scientists, or CAMAYS, recently called on the country's National AIDS Control Committee to strengthen its communication strategy to help curb the spread of the disease in the country, The Post reports. Speaking at a recent meeting in Yaounde, Cameroon, the group said NACC's HIV/AIDS messages have weaknesses that hinder efforts aimed at encouraging behavioral change.
Shifu Ngalla, an expert in communication and media policy, said there is a "missing link" in NACC's communication strategy. According to Ngalla, the messages do not target specific populations or cultures. The messages also do not consider the population's level of illiteracy, language, or accessibility to radio and television, Ngalla said, adding that they also overlook the fact that people in the country, who mostly are poor, identify little with the messages.
"Messages are conceived, designed and transmitted all over the country as standardized products," Ngalla said, adding that target groups are "considered as a uniform entity." He added, "Meanwhile, issues like gender composition, age, social identity groups like school children, drinking communities and cultural landscapes for receivers to identify with are ignored or not adequately carried."
According to another CAMAYS presenter, the HIV/AIDS prevalence in the country has increased from 0.5% in 1987 to about 5.5% in 2004 in a population of about 18 million people. He said Cameroon's unemployment rate, denial, stigma, poverty, high transmission among youth, lack of sex education and polygamy are fueling the increase in prevalence. Those most at risk of contracting HIV in the country include commercial sex workers, truck drivers, mobile populations, military personnel, young people, agricultural and industrial workers, and workers in the mining sector, the presenter said (Njechu, The Post, 1/17).
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Drug Access
Ethiopia Launches Multisectoral HIV/AIDS Plan
[Jan 22, 2008]
Ethiopia has launched a multisectoral HIV/AIDS plan that aims to provide universal access to no-cost antiretroviral drugs by 2010, Meskele Lera, deputy director of the country's HIV/AIDS Prevention and Control Office, said on Thursday, AFP/Inquirer.net reports. According to Lera, additional measures -- including the promotion of condom use, and increased testing and awareness -- also will be included in the plan. "One hundred percent of the people in need will have free access to treatment by 2010," Lera said, adding, "It is an ambitious target, but a necessary one. The Ethiopian government is committed to ensure universal and free access to treatment to all in need." Although antiretrovirals have been available at no cost in Ethiopia since 2005, not all people who need the drugs have been able to access them, according to AFP/Inquirer.net. The number of people with access to antiretrovirals under the plan will increase from 140,000 at the end of 2007 to 397,000 in 2010.
Lera also said that a primary goal of the plan is to prevent new HIV cases, which will require "deep social transformations." Under the plan, the HIV/AIDS office aims to increase condom use among people ages 15 to 49 from 10% in 2007 to 60% by 2010. The plan also has an HIV testing and counseling target of 9.27 million people by 2010. About 80% of HIV-positive pregnant women under the plan will receive services to prevent mother-to-child transmission by 2010. In addition, the country aims to establish an increased number of HIV/AIDS care and support centers, as well as local awareness programs with centers in all schools. Efforts to provide universal access to basic health care will begin this year, according to the plan.
The government estimates that about 1.5 million people in Ethiopia are living with HIV, but the World Health Organization's figure is about 2.8 million people (AFP/Inquirer.net, 1/17).
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Thai HIV/AIDS Advocates To Ask Administrative Court for Review of Ruling That Found Abbott Did Not Violate Trade Laws
[Jan 22, 2008]
HIV/AIDS advocates in Thailand plan to ask the country's Administrative Court to evaluate an Internal Trade Department's decision to not file suit against Abbott Laboratories for allegedly violating trade laws when the company canceled the registration of its antiretroviral Aluvia with the country's Food and Drug Administration, the Bangkok Post reports (Apiradee, Bangkok Post, 1/18).
The Thai government in January 2007 issued a compulsory license to produce a lower-cost version of Abbott's antiretroviral Kaletra. The drug company in May 2007 offered to sell Aluvia, an updated version of Kaletra, at a reduced price in Thailand on the condition that the country agree not to allow generic versions of the drug into the market, Siriwat Thiptaradol, secretary-general of the Thai FDA, said. The Thai Ministry of Public Health in June 2007 confirmed that it would continue with its plan to issue a compulsory license for the drug after Abbott and the health ministry could not reach a price agreement during negotiations. Thailand's FDA in October 2007 completed the registration of a generic version of Aluvia for use under the country's compulsory licensing program. The generic version is manufactured by the Indian generic pharmaceutical company Matrix Laboratories (Kaiser Daily HIV/AIDS Report, 10/17/07).
According to HIV/AIDS advocates, Abbott canceled registration of Aluvia in Thailand after the government issued a compulsory license for the drug. Advocates have said the move violated section 25 of the country's Trade Competition Act, which stipulates restrictions against a product being dominant in the market. In addition, the advocates said that the canceled registration violated section 28 of the trade act, which places controls on parent companies' influence on subsidiaries' decisions, the Post reports.
Advocates later petitioned a trade competition panel at the Ministry of Commerce to look into the matter. The panel in late December 2007 ruled that Abbott's withdrawal of Aluvia's registration did not violate trade regulations. Panel secretary Yanyong Phuangrach said the body determined the market value of Aluvia was too small to dominant the market and thus did not violate trade law.
Saree Ongsomwang -- manager of the Foundation for Consumers, which petitioned the ministry panel to examine the issue -- said advocates would ask the Administrative Court to review the panel's decision. Nimit Tienudom, chair of the AIDS Access Foundation, petitioned the panel to reveal additional details about its decision. He also proposed that a new panel of neutral academics be convened to examine the issue. Saree said she was "surprised by the panel's decision," adding, "They should have prioritized health problems caused by HIV/AIDS and consider essential lifesaving drugs as a special case rather than protecting the benefits of big pharmaceutical business" (Bangkok Post, 1/18).
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