Kaisernetwork.org (Washington, DC)
5 February 2008
Politics and Policy
Bush Releases FY 2009 Budget With Funding for Global, Domestic HIV/AIDS Programs
Science & Medicine
Studies Examine Reducing Risk of Vertical HIV Transmission While Breastfeeding, Effect of Herpes Treatments on Transmission
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World Bank President Zoellick Voices Concern About Mozambique's HIV/AIDS Epidemic
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Lack of HIV/AIDS Awareness Widespread in Singapore Despite Awareness Campaigns, Survey Finds
Politics and Policy
Bush Releases FY 2009 Budget With Funding for Global, Domestic HIV/AIDS Programs
[Feb 05, 2008]
President Bush on Monday released his $3.1 trillion fiscal year 2009 budget proposal, which allocates funding for global and domestic HIV/AIDS programs, the AP/Google.com reports (Taylor, AP/Google.com, 2/5). Under Bush's budget proposal, $4.8 billion would be allocated for the Global HIV/AIDS Initiative, which forms the bulk of funding for the President's Emergency Plan for AIDS Relief. Bush's total request for PEPFAR funding is $6 billion in FY 2009. In addition, the budget would allocate $1.6 billion for child survival and health programs.
The budget proposal would allocate $200 million for the Global Fund To Fight AIDS, Tuberculosis and Malaria within the Global HIV/AIDS Initiative account. The Global Fund also would receive $300 million within the National Institute of Allergy and Infectious Diseases account. The budget proposal would provide $300 million for the President's Malaria Initiative and ongoing malaria programs worldwide. Bush also requested $2.2 billion for the Millennium Challenge Corporation, a program meant to encourage economic and political reforms in developing countries (President's FY 2009 budget, 2/4).
Domestic Programs
Under Bush's budget proposal, funding for the Health Resources and Services Administration -- which administers the Ryan White Program -- would be reduced by about $1 billion from FY 2008 levels to $5.8 billion. HRSA HIV/AIDS programs would receive "small increases in spending," according to CQ Today (Wayne, CQ Today, 2/4). According to a HRSA release, the budget proposal would provide an overall $1.1 million increase for Ryan White and a $6 million increase for AIDS Drug Assistance Programs (HRSA release, 2/4).
In addition, Bush requested $300 million for Housing Opportunities for Persons With AIDS to support stable housing, improved access to health care and supportive services for low-income people living with HIV/AIDS (Department of Housing and Urban Development release, 2/4). The administration also called for renewing a ban on city funding for needle-exchange programs in Washington, D.C. (Sheridan/Fahrenthold, Washington Post, 2/5).
Reaction
Michael Weinstein, president of the AIDS Healthcare Foundation said, "This budget shows an irresponsible neglect of our burgeoning domestic epidemic" (AHF release, 2/4). Gene Copello, executive director of the AIDS Institute, said, "While the President's FY 2009 budget carries good news for addressing the global pandemic, it is terribly inadequate to address the epidemic in our own backyard. Following a trend now for several years, this budget will only further destabilize the prevention of HIV and the care and treatment of people living with HIV/AIDS in our own country" (AIDS Institute release, 2/4).
Link to this story.
Science & Medicine
Studies Examine Reducing Risk of Vertical HIV Transmission While Breastfeeding, Effect of Herpes Treatments on Transmission
[Feb 05, 2008]
HIV-positive women who are breastfeeding can reduce the risk of vertical HIV transmission if they take the antiretroviral drug nevirapine for up to six months after giving birth, according to five CDC- and NIH-funded studies conducted in Africa and India and presented Monday at the 15th Conference on Retroviruses and Opportunistic Infections in Boston, the New York Times reports.
In one of the five studies, HIV-positive women in Kenya took a combination of antiretrovirals beginning in their 34th week of pregnancy until they had been breastfeeding for six months. Their infants received the standard single dose of nevirapine after birth to prevent vertical transmission. Of the 497 infants in the Kenyan study, 12, or 2.4%, were HIV-positive one week after birth. Fifteen infants, or 3%, contracted the virus from breastfeeding eight days to 12 months after birth, the study found.
In a similar study conducted in Malawi, more than 3,000 infants received one of three treatment regimens during the first 14 weeks following birth. The study found that after nine months, HIV incidence was lowest at 3.1% among infants who received nevirapine for 14 weeks, compared with 10% in the control group, which received the standard single dose of nevirapine at birth followed by one week of treatment with another antiretroviral (Altman, New York Times, 2/5).
In the other studies -- conducted by Brooks Jackson of Johns Hopkins University and colleagues in Ethiopia, India and Uganda between 2001 and 2007-- 2,000 infants received either nevirapine or a placebo for six weeks. After six months, the risk of HIV or death was one-third less among the infants who received nevirapine than among the other infants, the study found (Reuters Health, 2/4).
According to the Times, the studies' findings "open the way" for new strategies to prevent vertical transmission in developing countries, where HIV-positive women often must breastfeed because of a lack of access to formula or clean water, strong cultural traditions of breastfeeding or fear of stigmatization for not breastfeeding. Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, said the studies "could serve as the basis of a new standard of care," adding that the next step is to "determine the optimal time for treating mothers and infants" (New York Times, 2/5).
Herpes Treatments
In related news, another study presented Monday at the conference found that treating genital herpes with the drug acyclovir does not prevent or reduce the risk of HIV transmission, the San Francisco Chronicle reports. According to the Chronicle, many researchers believed that treating herpes would reduce susceptibility to HIV because numerous studies in the past 20 years have found that herpes increases the risk of HIV by creating lesions that serve as points of entry into the body for the virus.
The study was conducted among 3,000 men who have sex with men in New York, Peru, San Francisco and Seattle, as well as women in Africa (Russell, San Francisco Chronicle, 2/4). Half of the participants took acyclovir and half took a placebo. The study found that people who took acyclovir to treat herpes contracted HIV at the same rate as those who took a placebo (Fox, Reuters Health, 2/4). The study also found that acyclovir reduced herpes lesions by different percentages in different groups: 32% among African women, 41% among MSM in Peru and 50% among MSM in the U.S.
According to the Chronicle, one possible reason the herpes treatment did not prevent HIV is that it does not eradicate herpes, meaning that people who take acyclovir continue to have occasional genital ulcers, which increase the risk of HIV. A possible solution would be to increase the number of acyclovir pills beyond two daily, the Chronicle reports. According to Connie Celum, a researcher at the University of Washington who led the study, previous studies have shown no significant improvement in herpes suppression with higher doses (San Francisco Chronicle, 2/5). In addition, Rowena Johnston, vice president of research for the American Foundation for AIDS Research, said it is possible that herpes causes immune cells to circulate actively in the body, increasing the risk of HIV (Reuters Health, 2/4).
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