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
Global Challenges
Global Fund To Review India Programs After World Bank Report Uncovers Fraud in Bank-Sponsored Health Projects, Official Says
World Bank President Zoellick Voices Concern About Mozambique's HIV/AIDS Epidemic
Human Rights Watch Calls for Increased Police Protection for MSM, WSW in Jamaica
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).
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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).
Celum said that despite the study's "disappointing" findings, she will continue another study currently under way that aims to determine whether herpes treatments block HIV among couples in which one partner is HIV-positive. That study is expected to end in June, and results are expected in about one year, the Chronicle reports (San Francisco Chronicle, 2/5).
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Global Challenges
Global Fund To Review India Programs After World Bank Report Uncovers Fraud in Bank-Sponsored Health Projects, Official Says
[Feb 05, 2008]
The Global Fund To Fight AIDS, Tuberculosis and Malaria plans to review its programs in India after the World Bank announced it had uncovered fraud in its programs in the country, Taufiqur Rahman, Global Fund head of grants for South and West Asia, said on Friday, Reuters India reports (Allen, Reuters India, 2/1).
The World Bank last month announced that it has uncovered serious incidents of fraud and corruption in five bank-funded health projects worth about $570 million. A detailed internal review, launched in 2006 by the bank's Department of Institutional Integrity with support from the Indian government, found illegal activity in projects, including those focused on curbing malaria, HIV/AIDS and TB, which dates as far back as 1997. The review found that some of the HIV test kits for the $194 million HIV/AIDS Control Project "often performed poorly by producing erroneous or invalid results, potentially resulting in the further spread of disease." In addition, the report found inadequate facilities and evidence that the bank repeatedly ignored that the corruption was occurring (Kaiser Daily HIV/AIDS Report, 1/14).
The Global Fund said it does not have evidence of fraud occurring in any of its programs in the country, which are worth about $170 million. Rahman said the review is necessary to ensure Global Fund's "investments are protected." Rahman added that the only complaints he has heard about Global Fund programs in India involve a delay in receiving funds.
Rahman said the review is a "priority" for the Global Fund, adding that the organization will "come down very hard" if there is "any hint of corruption." When asked whether he expects the review to find fraud, Rahman said the Global Fund does not "want to get into a situation where we're making assumptions" regarding fraud, adding that it is "not fair to the country." Rahman said he hopes the review, which will be conducted by PriceWaterhouseCoopers, will begin this week.
The Indian government is examining the World Bank report and has said it will punish people who have committed fraud. The World Bank report was the fourth report since 2005 to find signs of fraud in the country, Reuters India reports (Reuters India, 2/1).
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World Bank President Zoellick Voices Concern About Mozambique's HIV/AIDS Epidemic
[Feb 05, 2008]
World Bank President Robert Zoellick on Monday in Maputo, Mozambique, said he is concerned that the number of HIV/AIDS cases in the country could increase as new transport routes are developed to meet economic demands, Reuters reports. Zoellick was speaking at a meeting with government officials, donors and not-for-profit groups during the final stop of his four-nation African tour through Ethiopia, Liberia, Mauritania and Mozambique.
"I've grown increasingly concerned about the HIV/AIDS issue" in Mozambique, Zoellick said, adding, "I am concerned that Mozambique could be at a real tipping point either way. With the deeper economic integration and some of the infrastructure projects that would interconnect Mozambique as a country and with its neighbors, I suspect the movement of people will increase the likelihood for HIV/AIDS." Zoellick said that Mozambique's business sector has begun to expand its role in addressing HIV/AIDS. "How do you get the message out? For some it's billboards, for some it's the private sector, for some it's the public sector, so I think this will be a critical issue because the irony is that economic integration here can create some other challenges," he said. Zoellick also said that tuberculosis and malnutrition should be taken into consideration when addressing the country's HIV/AIDS epidemic.
Mozambique's Health Minister Paulo Garrido said the government considers HIV/AIDS an "exceptional situation" and has drafted a plan to fight the disease. He noted that the government is working to incorporate HIV/AIDS testing into routine medical exams. According to Garrido, 90,000 people living with HIV/AIDS were receiving antiretroviral treatment in 2007, compared with 5,000 in 2004. However, Garrido added that Mozambique's poor health care infrastructure and medical worker shortage undermine efforts to provide increased treatment access. Government data show that new HIV cases in Mozambique are expected to increase by 135,000 annually unless steps are taken to address the virus. The data also indicate that there were about 1.5 million people living with HIV/AIDS in Mozambique in 2004 and that 60% and 40% of cases occurred among women and men, respectively (Wroughton, Reuters, 2/4).
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Human Rights Watch Calls for Increased Police Protection for MSM, WSW in Jamaica
[Feb 05, 2008]
HIV/AIDS advocates at Human Rights Watch on Friday called on Jamaican authorities to scale up their efforts to protect men who have sex with men, as well as women who have sex with women, the AP/International Herald Tribune reports. The announcement comes after a group of about 20 people attacked several men at their home in Mandeville, Jamaica, on Jan. 29, leaving one man severely injured and another missing. "While Jamaican police have begun to reach out to gay and lesbian communities, this change hasn't reached many police stations, where protection remains an illusion," HRW HIV/AIDS advocate Rebecca Schleifer said in a statement (AP/International Herald Tribune, 2/1).
During the recent attack, a group approached the house and demanded that the four men leave the community, according to human rights advocates who spoke with the survivors. The men called the police twice before the group attacked the house. The police arrived about 90 minutes after the men first called for help and 30 minutes after the group broke into the house, according to the statement. HRW said the incident is the most recent in a series of "homophobic mob violence" in the country during the last year (HRW statement, 2/1).
Police spokesperson Camika Parker said that MSM and WSW receive the same level of police protection as the rest of the population (AP/International Herald Tribune, 2/1).
HIV-positive people and MSM are discriminated against heavily in Jamaica. Many MSM in Jamaica have been reluctant to disclose their HIV-positive status because they fear discrimination if their sexual orientation or HIV status becomes known. Some HIV/AIDS advocates in the country have been increasing HIV education in an effort to reduce the violence and discrimination (Kaiser Daily HIV/AIDS Report, 8/22/07).
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Lack of HIV/AIDS Awareness Widespread in Singapore Despite Awareness Campaigns, Survey Finds
[Feb 05, 2008]
A lack of basic knowledge about HIV/AIDS is widespread in Singapore despite public awareness campaigns about the disease, according to a recent survey conducted by World Vision, the Straits Times/EarthTimes.org reports. The survey was initiated on World AIDS Day on Dec. 1, 2007, the Straits Times/EarthTimes.org reports.
According to the survey, one-third of the 705 survey respondents said they believe HIV can be transmitted through mosquito bites and kissing. More than half of the survey respondents also said they did not know HIV can be transmitted through breastmilk. In addition, half of the respondents said they would be uncomfortable around a person living with HIV/AIDS. Although most respondents said they knew the virus cannot be spread by sharing food, more than 50% said they would be reluctant to eat with someone who was HIV-positive, the survey found. The survey also found that one in 11 people said he or she would not take an HIV test even if being HIV-positive was a possibility. More than 80% of the respondents said they knew condoms can prevent HIV transmission, the survey found. Elaine Tan, executive director of World Vision Singapore, said that the survey results "show there is a need to sensitize people to HIV/AIDS before it becomes a silent pandemic" (Tan, Straits Times/EarthTimes.org, 2/2).
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