Kaisernetwork.org (Washington, DC)
26 February 2008
Politics and Policy
Clinton Reiterates Commitment To Invest $50B To Fight Global HIV/AIDS
[Feb 26, 2008]
Sen. Hillary Rodham Clinton (D-N.Y.), who is running for the Democratic presidential nomination, on Monday during a speech at George Washington University in Washington, D.C., reiterated her commitment to address the global HIV/AIDS epidemic, the Cleveland Plain Dealer reports (Kleinerman, Cleveland Plain Dealer, 2/26).
Clinton in her speech Monday said she "was proud" to sign a pledge to invest $50 billion by 2013 to combat HIV/AIDS, adding that the U.S. "will lead the world in combating AIDS." She also said she has seen how diseases such as HIV/AIDS, tuberculosis and malaria "undermine progress across" Africa. "I'm very hopeful that we will make progress in Africa dealing with the multiplicity of challenges that the continent faces," including HIV/AIDS, Clinton said, adding that the U.S. needs a "consistent coherent strategy in dealing with Africa and that is something that I will promote" (Speech transcript, 2/25).
In a plan released in November 2007, Clinton also proposed doubling funding for HIV/AIDS research at NIH to $5.2 billion annually, as well as doubling the number of people worldwide who receive HIV/AIDS treatment through U.S. funding. In addition, Clinton said that if elected president, she would try to eradicate malaria deaths in Africa within eight years. She also said that she would commit $1 billion annually for global malaria control efforts (Kaiser Daily HIV/AIDS Report, 11/30/07).
A Kaiser Family Foundation issue spotlight, available at health08.org, summarizes each presidential candidate's position on HIV/AIDS and global health, along with a selection of quotes and links to additional resources.
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Global Challenges
Reported HIV/AIDS Cases in China Increase 45% From 2006 to 2007, Health Ministry Report Says
[Feb 26, 2008]
The number of HIV/AIDS cases reported in China in 2007 was 45% higher than the number reported in 2006, according to a report released Friday by the country's Ministry of Health, Xinhua/Shanghai Daily reports. The government in November 2007 estimated that about 700,000 HIV-positive people were living in China in 2007, compared with an earlier estimate of 650,000. According to Xinhua/Daily, 223,501 HIV/AIDS cases had been officially reported at the end of 2007 (Xinhua/Shanghai Daily, 2/25).
The health ministry's report did not include exact figures or give the increase in reported cases (Reuters Health, 2/22). Gao Qi, a project manager with the China HIV/AIDS Information Network, said the report "doesn't mean the HIV/AIDS situation is getting worse," adding, "The increase might be due to more screening tests" (Juan, China Daily, 2/23).
The number of sexually transmitted infection cases increased by nearly 7% in 2007, while the number of bloodborne diseases increased by 3.55%, according to the report, Xinhuanet reports. The report noted that the number of hepatitis C cases increased by 30% and that syphilis cases increased by 24% in 2007. More than 4.7 million cases of infectious diseases were reported in China last year, an increase of nearly 3% from 2006, according to the report. There were 13,037 deaths due to infectious diseases in 2007, 2,311 more than in 2006 (Xinhuanet, 2/23).
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Rwanda To Launch Campaign Aimed at Addressing Circumcision Myths, Encouraging Procedure in Effort To Prevent HIV
[Feb 26, 2008]
Health authorities in Rwanda are planning to launch a nationwide campaign this year aimed at addressing myths about male circumcision and encouraging men to be circumcised in an effort to prevent the spread of HIV, McClatchy/Miami Herald reports (Bengali, McClatchy/Miami Herald, 2/24).
Rwanda announced plans to launch the campaign in September 2007. According to final data from two NIH-funded studies -- conducted in Uganda and Kenya and published last year in the journal Lancet -- routine male circumcision could reduce a man's risk of HIV infection through heterosexual sex by 65%. The results of the Uganda and Kenya studies mirrored similar results of a study conducted in South Africa in 2005. In response to the findings, the World Health Organization and UNAIDS in March 2007 recommended the procedure as a way to help reduce transmission of the virus through heterosexual sex (Kaiser Daily HIV/AIDS Report, 1/24).
The campaign will initially target the army, police officers and university students, Innocent Nyaruhirira, the country's health minister, said. The campaign will aim to reduce the cost of the procedure, which can be as much as $55 at private hospitals, as well as ensure it is covered by basic health insurance policies.
According to McClatchy/Herald, many men in the country have already received the procedure. Justin Gatete -- a nurse at a clinic in Kigali, Rwanda's capital -- said he performed more than 1,000 circumcisions last year.
"We're not going to wake up one morning and have all men be circumcised," Anita Asiimwe, director of Rwanda's Treatment and Research AIDS Center, said, adding, "We need to see how best to implement this."
Health experts from the U.S. are helping Rwandan officials develop the campaign. The Bush administration has said it would allocate funds in the President's Emergency Plan for AIDS Relief to make circumcision more accessible in Africa. Kenya, Swaziland and Zambia have announced plans to make the procedure available in public clinics, McClatchy/Herald reports (McClatchy/Miami Herald, 2/24).
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Science & Medicine
Experimental Microbicide Tenofovir Safe for Women To Use Daily, Study Finds
[Feb 26, 2008]
The experimental microbicide tenofovir is safe for women to use daily, according to results from clinical trials funded by NIH and conducted in three locations in the U.S. and India, though it is too early to tell if it actually prevents HIV infection, Reuters reports (Fox, Reuters, 2/25). Microbicides include a range of products -- such as gels, films and sponges -- that could help prevent the sexual transmission of HIV and other infections (Kaiser Daily HIV/AIDS Report, 2/6). A study released last week showed that the microbicide candidate Carraguard, though safe, was ineffective in preventing HIV transmission. Other candidates, including nonoxynol-9 and Ushercell, have been found to increase women's risk of HIV infection, according to Reuters (Reuters, 2/25).
The study -- presented at Microbicides 2008, the biannual international conference that began on Sunday in New Delhi, India -- was conducted from August 2006 to September 2007 at the National AIDS Research Institute in Pune, India; the Bronx-Lebanon Hospital Center; and at the University of Alabama-Birmingham, the Times of India reports. Tenofovir gel is a HIV-specific microbicide that is designed to prevent HIV from replicating when it comes in contact with uninfected T-cells (Sinha, Times of India, 2/23). The study involved 200 HIV-negative women of reproductive age who were asked to apply the gel either daily or before sexual intercourse for about six months. The women were asked to use condoms as well as the gel, AFP/Yahoo! News reports.
The study found no disruption of blood, liver or kidney function and found that women were willing to follow the treatment guidelines. According to the study, more than 90% of the participants said they would consider using the gel to prevent HIV transmission if it were approved. More than 80% of the participants followed the experimental regimen, the study found.
Sharon Hillier, lead investigator and director of reproductive infectious diseases at the University of Pittsburgh School of Medicine, said, "Based on what we have learned, we can proceed with greater confidence on a path that will answer whether tenofovir gel and other gels with HIV-specific compounds will be able to prevent sexual transmission of HIV in women when other approaches have failed to do so" (AFP/Yahoo! News, 2/25). Craig Hoesley of UAB said a "key message" of the results is that the "gel is safe to use and well-tolerated by HIV-negative women," adding, "This sets the stage for larger studies to see if tenofovir can prevent HIV infection" (Reuters, 2/25). According to the Times of India, a Phase II trial is under way among 1,000 women in South Africa to test the microbicide's effectiveness at preventing HIV transmission (Times of India, 2/23).
Development of Microbicides Top Priority for India, Health Minister Says
In related news, India's Health Minister Anbumani Ramadoss at the conference said the development of microbicides is a priority for India, the Press Trust of India reports. "At the moment, 50 experimental substances as possible vaginal microbicides are being examined and about a quarter of these agents are at various stages of human testing and four of these are in advanced states of clinical trials," Ramadoss said. He added that "women need a product that they can control and even use without their partners' consent or knowledge." Effective microbicides would offer an alternative method of protection for women, Ramadoss said (Press Trust of India, 2/24).
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Across The Nation
Needle-Exchange Pilot Program in New Jersey Is 'Struggling' To Enroll IDUs, AP/Long Island Newsday Reports
[Feb 26, 2008]
New Jersey's pilot needle-exchange program is "struggling" to enroll injection drug users in part because of a lack of funding, the AP/Long Island Newsday reports (Mulvihill, AP/Long Island Newsday, 2/23). The pilot programs were recently launched in Camden and Paterson, N.J. Another program has been in effect in Atlantic City since November 2007, and a program in Newark is also scheduled to start, according to Roseanne Scotti, director of the Drug Policy Alliance of New Jersey.
The New Jersey Department of Health and Senior Services in August 2007 approved the establishment of three-year needle-exchange programs in the four cities. Gov. Jon Corzine (D) in December 2006 signed into law a bill that allows six cities to establish needle-exchange programs and provides $10 million to drug treatment programs in the state. The state health commissioner must report to the governor and state Legislature on whether the needle-exchange programs are effective. In addition, people who participate in and run the programs are required to carry identification cards that protect them from being arrested for possessing drug paraphernalia. No state funding will be allocated to the cities for operating needle-exchange programs.
To be eligible for a program, a city must have at least 300 HIV/AIDS cases attributed to injection drug use per 100,000 residents and at least 350 confirmed HIV/AIDS cases overall. Each program will be required to report data on the number of people participating in the programs and referred to drug treatment, the status of their treatment and the number of syringes exchanged. According to state Health Commissioner Fred Jacobs, the data will be used to promote the expansion of the programs and will remain anonymous (Kaiser Daily HIV/AIDS Report, 1/31).
While the state government allocated $10 million toward drug treatment, it did not fund the needle-exchange programs, which is making it difficult to reach IDUs, the AP/Newsday reports. According to a 2005 report by the Kaiser Family Foundation, at least 43% of the state's 48,000 reported HIV/AIDS cases were transmitted through needles. While it is believed that the state has tens of thousands of IDUs, there are only 200 people enrolled in the three pilot programs so far.
"All the programs in New Jersey are operating on a shoestring," Scotti said, adding that despite the program's modest start, the needle-exchanges are promising. Kim McCargo, who oversees the exchange at the Camden Area Health Education Center, said it would take $500,000 annually to run a program that could distribute clean needles three days weekly at more than one location. She added that the Camden program is running on about $85,000 in grants, which is enough to provide clean needles once a week.
Jerome King, director of Well of Hope Drop-in Center in Paterson, N.J., said, "People are still getting over the stigmas and some of the fears, not knowing if [the needle-exchange center is] a police trap." He added, "Once people feel safe, it will pick up" (AP/Long Island Newsday, 2/23).
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Media & Society
New York Times Profiles Documentary Aimed To Help Parents Discuss Sex, HIV/AIDS With Their Kids
[Feb 26, 2008]
New York Times reporter Donald McNeil on Tuesday profiled the new documentary "Please Talk to Kids About AIDS," which aims to help parents talk about sex and HIV/AIDS with their children. The film features two sisters -- Vineeta and Sevilla Hennessey, ages six and four -- as they accompany their parents, who are the filmmakers, to the XVI International AIDS Conference in Toronto in 2006. The documentary has been shown to schools of public health and at film festivals.
According to McNeil, a stop at the Condom Project's booth at the conference prompted the filmmakers, Brian Hennessey and Radia Daoussi, to center the film on their daughters. The sisters interview top HIV/AIDS experts and advocates -- including Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, International AIDS Society Director Craig McClure and conference co-chair Mark Wainberg. The girls also talk to condom distributors, a sex toy salesperson, a cross-dresser and an Indian transgender hijra.
According to McNeil, the sisters ask questions such as "How does AIDS get into your body?" and "How come they want to have sex with each other?" Fauci in response to one question said, "You know ... when a man and a woman have sexual relationships they get infected. And also from injecting from a needle that is contaminated with the virus." McNeil said the girls get "straightforward answers about bodies conjoining" from McClure, as well as about commercial sex work from a sex worker-rights advocate.
According to McNeil, the film is "not really for children" in its present form. "For a parent, however, watching someone else's very young child ... grapple with the topic is a powerful exhortation to begin thinking about how to talk to one's own," McNeil writes. Daoussi said that there is no right age to talk to kids about sex and HIV/AIDS. "It's when they're ready," Daoussi said, adding, "It's our own discomfort that's the problem, not theirs. Kids don't have taboos" (McNeil, New York Times, 2/26).
The film is available online.
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