Kaisernetwork.org (Washington, DC)
25 February 2008
Global Challenges
Recruitment of Health Workers in Sub-Saharan Africa Weakening Health Systems, Inhibiting Efforts To Fight HIV/AIDS, Article Says
[Feb 25, 2008]
The practice of recruiting trained health personnel from sub-Saharan Africa to work in developed nations is weakening health infrastructures and undermining efforts to fight HIV/AIDS in the region, according to an article published in the Feb. 23 issue of the Lancet, Reuters reports. The article was authored by Edward Mills of the British Columbia Centre for Excellence in HIV/AIDS and colleagues from Uganda, South Africa, Ireland and Argentina (Fox, Reuters, 2/21).
"Although active recruitment of health personnel in Africa may lack the heinous intent of other crimes covered under international law, the resulting dilapidation of health infrastructure contributes to a measurable and foreseeable public health crisis," the authors wrote, adding, "The practice should therefore be viewed as an international crime."
According to the article, more than 13,000 health workers trained in sub-Saharan African countries now practice in Australia, Britain, Canada and the U.S., AFP/Google.com reports. Recruiting agencies use workshops, advertisements, e-mails and Web sites to attract health workers, according to the article (AFP/Google.com, 2/21). The agencies generally offer to pay higher salaries, cover moving expenses and provide assistance navigating the visa and citizenship process, Toronto's Globe & Mail reports (Branswell, Globe & Mail, 2/22).
The authors cite Ghana as an example of the effects of health personnel recruitment, Reuters reports. According to the researchers, Ghana spent $70 million training health professionals who then left to work in the United Kingdom. In comparison, the United Kingdom saved about 65 million pounds, or about $130 million, in training health care costs between 1998 and 2002 by recruiting Ghanaian doctors, the authors write, adding that the country's contribution to service provision is estimated at around 39 million pounds, or $80 million, annually.
Implications on HIV/AIDS
The recruitment practices could have a significant impact on the fight against HIV/AIDS in sub-Saharan Africa, according to the authors. They project that between 2006 and 2012 "there could be an almost three-fold increase in the number of patients per physician" -- from about 9,000 to 26,000 -- and an "overall decrease in the number of physicians treating patients with HIV from 21,000 to about 10,000." The doctor-to-patient ratio in the U.S. is about 2,000 patients annually to each doctor, they note.
Developing countries "are systematically seeing their recruits being enticed away," Mills said, adding, "What we are saying is that if one of these countries that is being systematically poached were to pursue it as a crime, contributing to unrest ... then they would have some leg to stand on" (Reuters, 2/21).
Amir Attaran, a professor at the University of Ottawa Institute of Population Health, said he understands the argument but disagrees with the position that such recruitment is an international crime. "I don't have any difficulty saying that it would be lovely and I would prefer to live in a world where it were criminal," Attaran said, adding, "But their argument is that already customary international law tells us that this recruitment should stop ... That is an incorrect understanding of what customary international law is" (Globe & Mail, 2/22).
Mills and colleagues said developed countries that benefit from recruits should "make amends" by offering to train, build and staff new health schools, and provide ways for health workers to remain in their home countries (Reuters, 2/21).
The article is available online.
PRI's "The World" on Friday included a discussion with Mills about the article (Werman, "The World," PRI, 2/22). Audio of the segment is available online.
Link to this story.
In The Courts
AIDS Healthcare Foundation Sues City of Los Angeles To Stop Foreclosure of Former AIDS Hospice
[Feb 25, 2008]
AIDS Healthcare Foundation has filed a lawsuit in Los Angeles Superior Court against the city of Los Angeles to stop it from foreclosing a former AIDS hospice that now serves as an office for the organization's case managers, the Los Angeles Times reports.
AHF opened the hospice, called the Linn House, in 1995 on donated property near West Hollywood, Calif. The city granted AHF a $1.1 million, 40-year loan to build the hospice. In 1999, as antiretroviral drugs changed the course of the epidemic, AHF converted the building into offices for staff and meeting rooms for support groups.
According to the Times, the city now says that AHF is violating the terms of the loan contract by using the building for offices and not housing. AHF in its lawsuit filed earlier this month argues that Los Angeles waived its right to enforce the terms of the loan because the city had been aware of the facility's new use since 2000. The two groups conceded that they have failed to reach a compromise in their negotiations during the last year, the Times reports.
When AHF "conceived the [Linn House] and built it, people were dying within 30 months of being diagnosed with AIDS," AHF President Michael Weinstein said, adding, "We should be celebrating that this change took place, not punishing the organization that came to the rescue."
Mercedes Marquez, general manager of the city Housing Department, said the "law very clearly requires that the money that was lent to the foundation be used for housing." Marquez noted that AHF could convert the building into a nursing facility or transitional housing and remain eligible for the housing loan. Weinstein said that without county funding, the state's Medicaid care program, Medi-Cal, pays too little to keep such a facility in operation.
This is the second time AHF has challenged the city of Los Angeles over an AIDS hospice, the Times reports. The foundation closed the Carl Bean House in 2006 after the Los Angeles County Board of Supervisors reduced funding for patient care. The county said that AHF was overcharging for the care of indigent patients. The foundation argued that the facility was needed to provide skilled nursing services.
According to a study released in December 2007, 46% of the Los Angeles County nursing homes surveyed refused to accept a person living with HIV/AIDS. Brad Sears, University of California-Los Angeles law professor and director of a think tank on sexual orientation law, and two law students conducted the study. The law students posed as hospital discharge planners and called 131 Los Angeles County nursing homes. They found that 36% of the nursing homes responded with an unqualified yes to the question about accepting HIV-positive patients (Engel, Los Angeles Times, 2/24).
Link to this story.
Drug Access
New Mexico Adds Three Antiretrovirals to AIDS Drug Assistance Program
[Feb 25, 2008]
New Mexico's Department of Health recently added three antiretroviral drugs to its AIDS Drug Assistance Program, the AP/Las Cruces Sun-News reports. The health department now provides 77 medications to 426 people through its ADAP, which has been in operation for at least 12 years, according to health officials. All of the three new antiretrovirals have been approved by FDA during the past six months. The drugs will be used primarily by people who have developed resistance to first-line drugs or who experience side effects from first-line medications, the AP/Sun-News reports.
To qualify for New Mexico's ADAP, individuals must earn less than 400% of the federal poverty level, according to the AP/Sun-News. The average cost of medications for people enrolled in the ADAP is $10,680 annually, the health department said. The health department adds new medications to its ADAP based on recommendations from a medical advisory committee comprised of department staff, community physicians and other HIV/AIDS treatment experts.
"In the short term, these medications represent a very significant advance in our ability to treat HIV, particularly among people who have developed drug resistance," Steve Jenison, medical director of the health department's Infectious Disease Bureau, said, adding, "In the long term,
these medications get us one step closer to being able to control HIV by interfering with each stage of its life cycle. That is key to someday finding a cure for HIV" (AP/Las Cruces Sun-News, 2/21).
Link to this story.
South Africa To Spend $274M To Increase Treatment Access, Finance Minister Says
[Feb 25, 2008]
South African Finance Minister Trevor Manuel on Wednesday in his fiscal year 2008 budget speech announced that the government will spend an additional $274 million by 2011 to almost double the number of people with antiretroviral drug access, the AP/Google.com reports.
Manuel said the funding increase will provide an additional 500,000 HIV-positive people with drug access, bringing the total to about 900,000. Mark Heywood of the AIDS Law Project welcomed the new spending plan. According to Heywood, even with the additional funding, about 500,000 people in need of treatment by 2011 will not receive it. There are about 5.5 million people in South Africa living with HIV/AIDS, the AP/Google.com reports (Nullis, AP/Google.com, 2/20).
Text of the budget speech is available online (.pdf). Video of Manuel's budget speech also is available online.
Link to this story.
Opinion
Congress Must Allow States, Washington, D.C., To Fund Needle-Exchange Programs, Editorial Says
[Feb 25, 2008]
Congress "must insist" that Washington, D.C., is allowed to fund needle-exchange programs to prevent the spread of HIV and must pass measures that allow states and health organizations to use federal funds for such programs, a New York Times editorial says (New York Times, 2/23). President Bush earlier this month released his $3.1 trillion fiscal year 2009 budget proposal, which attempts to reinstate a ban on city funding for needle-exchange programs in the district (Kaiser Daily HIV/AIDS Report, 2/5). The ban was effectively lifted when Bush signed the FY 2008 omnibus spending bill (HR 2764).
The district plans to invest $650,000 in needle-exchange programs to help prevent the spread of HIV among injection drug users in the city, officials announced last month. Since 1999 the district had been the only U.S. city barred by federal law from using local funds for needle-exchange programs. A report released in November 2007 by district health officials found that injection drug use was the second most common cause of HIV transmission in the city (Kaiser Daily HIV/AIDS Report, 1/3).
"Needle-exchange programs save lives" by reducing the spread of HIV, the editorial says, adding, "Yet when it comes to supporting these programs, it seems that the political cowardice never ends." The editorial says, "Now that Washington has a chance to fight back, the White House must not be allowed to hobble that effort" (New York Times, 2/23).
Link to this story.
Massachusetts Should Increase Funding for HIV/AIDS Prevention, Outreach Services, Editorial Says
[Feb 25, 2008]
Massachusetts as "recently as 2001" was "spending $51 million a year to prevent HIV/AIDS and provide services to those suffering from the disease," a Boston Globe editorial says. However, HIV/AIDS spending "plummeted" during the "budget crisis in the early years of this decade," and Gov. Deval Patrick (D) is "asking for only $37.1 million in his new budget -- just $200,000 more than is being spent this year," the editorial adds. To reduce the spread of HIV, particularly in the "minority communities where it is taking its greatest toll," the state Legislature should "add substantially to the state's HIV/AIDS programs," according to the Globe.
Increased HIV prevention and outreach efforts could reduce the almost 1,000 new HIV cases recorded annually in Massachusetts, the editorial says. It adds that efforts aimed at preventing new cases are "complicated by the fact that of the 22,000 people believed to be HIV-positive, an estimated 5,000 to 7,000 don't know their status."
HIV prevention efforts should focus on "black and Hispanic communities, which are increasingly bearing the brunt of the disease," according to the Globe. "Each group is just 6% of the state population, but more than 28% of people living with HIV/AIDS are black, and 25% are Hispanic," the editorial says. It adds that among men who have sex with men between ages 13 and 24 who were diagnosed with HIV from 2004 to 2006, 53% were black or Hispanic.
The Department of Public Health's HIV/AIDS Bureau in December 2007 released a "well-documented report on the heavy impact of HIV/AIDS on communities of color," the editorial says, concluding that the Legislature should "ensure the bureau has the resources it needs to reduce the disparity and prevent further transmission of the disease" (Boston Globe, 2/22).
Link to this story.
Be the first to Write a Comment!
Copyright © 2008 Kaisernetwork.org. All rights reserved. Distributed by AllAfrica Global Media (allAfrica.com). To contact the copyright holder directly for corrections — or for permission to republish or make other authorized use of this material, click here.
AllAfrica aggregates and indexes content from over 125 African news organizations, plus more than 200 other sources, who are responsible for their own reporting and views. Articles and commentaries that identify allAfrica.com as the publisher are produced or commissioned by AllAfrica.
