Kaisernetwork.org (Washington, DC)
19 March 2008
Global Challenges
British Government To Provide $28M for HIV/AIDS Initiatives in Sub-Saharan Africa
[Mar 19, 2008]
The British government on Tuesday announced that it will provide 225 million rand, or about $28 million, over the next four years to fight HIV/AIDS in sub-Saharan Africa, SAPA/iAfrica.com reports. According to Russ Dixon, a spokesperson for the British High Commission, the funding is a continuation of the government's support for Soul City initiatives.
Soul City is a radio and television program that deals with HIV/AIDS and other issues -- including teenage pregnancy, poverty and intolerance -- in Southern African countries. "Soul City indicated to us that they wanted to expand to the sub-Saharan region as a whole in all forms of the media," Dixon said. He added that it is important for the British government to continue its support because of the high HIV/AIDS rates in the region. The British government has spent more than 200 million rand, or about $24 million, on the program during the past 13 years, SAPA/iAfrica.com reports.
British Minister for International Development Gillian Merron, who made the funding announcement during a two-day visit to South Africa, said the government is proud to be associated with Soul City. She added, "Young people deserve to have access to information that can save their lives, and Soul City's approach does just that." John Molefe, spokesperson for Soul City, said effective communication is key to controlling the spread of HIV (SAPA/iAfrica.com, 3/19).
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Progress in Global Fight To Stop TB Slowing, WHO Report Says
[Mar 19, 2008]
The pace of progress in detecting new tuberculosis cases worldwide is slowing, according to the 12th annual report on TB control released Monday by the World Health Organization, the New York Times reports. According to the report -- titled "Global Tuberculosis Control 2008 -- Surveillance, Planning, Financing"-- the rate of increase in detecting new TB cases was 3% from 2005 to 2006, compared with the previous average of 6% recorded from 2001 to 2005 (Altman, New York Times, 3/18).. The report found that out of the total 14.4 million people living with TB in 2006, the last year for which statistics are available, 9.2 million were new cases. Global deaths from the disease decreased by 2.6% in 2006 to 1.7 million people when compared with 2005 figures, the report found (Dunham, Reuters, 3/17). TB incidence worldwide decreased by 0.6% in 2006, but the decrease was so modest compared with 2005 that the increase in the world's population meant there were actually more TB cases, the report noted (Reuters, 3/17). Health officials said that they ideally want to see TB incidence decline by 5% to 7% annually (Cheng, AP/Google.com, 3/17).
About 700,000 of the TB cases and 200,000 deaths occurred among people who are HIV-positive, WHO reported. WHO's Africa, Southeast Asia and Western Pacific regions accounted for 83% of the total cases reported. The African region has 363 cases per 100,000 people, which is the world's highest incidence rate per capita, the report said. It found that China, India, Indonesia, Nigeria and South Africa topped the list in terms of absolute numbers of TB cases. The information is based on data provided by 202 countries and territories (New York Times, 3/18). WHO estimated that 61% of all TB cases worldwide are registered (AFP/Google.com, 3/17).
About 30 million people, or 84.7% of reported TB cases, have successfully completed treatment, according to the report. That figure is close to WHO's target of 85%. However, the report found that WHO's treatment programs have "not yet had a major impact on TB transmission and incidence around the world." In addition, the report found that TB rates had fallen in some regions, stabilized in Europe and increased at least fivefold in Africa since the 1990s (AP/Google.com, 3/17).
The report identified multi-drug resistant TB and HIV/TB coinfection as two factors that could further slow progress toward controlling TB, according to a WHO release. Countries predict they will treat only about 10% of people with MDR-TB in 2008 because of limited laboratory and treatment capacities, according to the report. Funding also is a concern, the report said. Despite increases in resources from the Global Fund To Fight AIDS, Tuberculosis and Malaria and some middle-income countries, TB budgets likely will not increase in 2008 in nearly all of the countries most heavily burdened by the disease, the report said. Ninety countries in which 91% of the world's TB cases are recorded provided complete financial data for the report. These 90 countries need about $1 billion to meet the 2008 targets of the Global Plan to Stop TB, 2006-2015, the report said (WHO release, 3/17). In addition, WHO said that there is a funding shortfall of $2.5 billion of the $4.8 billion needed in 2008 for overall TB control in low- and middle-income countries (New York Times, 3/18).
Reaction
Margaret Chan, WHO director-general, said the slowing progress documented in the report "comes at a time when numbers are still way too high" (AFP/Google.com, 3/17). Mario Raviglione, director of WHO's Stop TB Department, said, "We're really in a very uncertain situation, so I don't feel happy at all, actually, that it is really getting controlled" (Reuters, 3/17). He added that data are worrisome because the "more cases that are detected early interrupt transmission and provide a better chance of cure, and that ultimately has a greater impact on the incidence of the disease (New York Times, 3/18).
Joanne Carter of RESULTS said the data should "serve as a warning to the global community that we must do more and be more aggressive in supporting TB programs or face a continued erosion of progress." She added that "on top of last month's data on high rates of drug resistance, we should take this very seriously and act with urgency" (Reuters, 3/17).
The report "clearly demonstrates how closely TB and HIV are" related, UNAIDS Executive Director Peter Piot said, adding that TB is the "single most important cause of death for people living with HIV" (AFP/Google.com, 3/17).
Some experts criticized WHO for not taking into account people living with TB who have not been diagnosed, the AP/Google.com reports. Critics also said the statistics were gathered from governments without being verified independently. "This is a compilation of what the countries want to show ... Some of these data are too good to be true," Francis Varaine, coordinator of Medecins Sans Frontieres' Tuberculosis Working Group, said (AP/Google.com, 3/17).
Raviglione said that countries should either create facilities to detect more cases or "depend more and more on the private sector" because "more and more we are realizing that nongovernmental agencies and faith-based organizations that contribute to caring for AIDS cases now have an increased role" in TB (New York Times, 3/18).
The report is available online.
Updated TB information from the 2008 WHO report is now available at the Kaiser Family Foundation's GlobalHealthReporting.org and GlobalHealthFacts.org.
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Group of Transgender People Spread HIV Prevention Messages Among MSM in Cuba
[Mar 19, 2008]
A group of male-to-female transgender people in the western Cuban province Pinar del Rio recently have begun to educate local men who have sex with men about HIV prevention, Inter Press Service reports.
The group last week participated in a cultural festival that aimed to promote HIV prevention through artwork. The group's HIV prevention messages reached about 500 people, according to Inter Press Service. Nelson Simon, a poet who participated in the festival, said the art aims to educate people about responsible sexual behavior, adding that the prevention messages are "important and timely."
Since the first festival last year, 18 transgender people have participated in training workshops to become health promoters and participate in HIV prevention activities. As part of the program, the Pinar del Rio Centre for Prevention of Sexually Transmitted Diseases and HIV/AIDS has helped transgender people find jobs and enroll in training programs. The program is part of a larger strategy aimed at addressing the needs of transgender people.
Cuba had recorded 9,039 HIV/AIDS cases by late 2007, with men accounting for 81% of all cases, according to Inter Press Service. Among the HIV-positive men, 86.1% have reported engaging in sex with other men, according to the Ministry of Public Health. In Pinar del Rio, 68.7% of HIV-positive men report having sex with other men. Geidy Diaz of the provincial HIV prevention center said health workers in the region should begin to target HIV prevention messages at heterosexual men, as well as MSM (Acosta, Inter Press Service, 3/17).
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Across The Nation
AP/Montgomery Advertiser Examines Debate Over Segregating HIV-Positive Inmates From General Prison Population
[Mar 19, 2008]
The AP/Montgomery Advertiser on Monday examined issues surrounding the segregation of HIV-positive inmates from the general prison population. Regulations in two prisons in Alabama previously restricted HIV-positive inmates from participating in some activities -- such as eating, worshiping and visiting family members -- with other inmates. Prison officials in November 2007 announced that they planned to eliminate some of the restrictions.
However, space issues at one of the prisons have kept some of the regulations in place, according to Margaret Winter, associate director of the American Civil Liberties Union's National Prison Project. Winter said that inmates living with HIV/AIDS must visit with their families in a separate visiting area and sit in separate pews during chapel services. Alabama Prisons Commissioner Richard Allen said the segregation is a "security issue," adding, "One thing we don't want to do is put the [HIV-positive inmates] in a situation where other inmates want to retaliate against them."
Integration of HIV-positive people into the general prison population has "gone much more smoothly" at the second prison, according to the AP/Advertiser. In addition, Allen said the Department of Corrections has started classes to help educate prisoners about HIV/AIDS, as well as to address related stigma and misconceptions about the disease. Winter said ACLU is recommending that the department offer 90 days of "intensive HIV education," adding, "I think we feel strongly that without that, it could be another 20 years" of inmate segregation. ACLU is advocating for HIV-positive inmates in Alabama to be allowed to participate in work release programs. "It's going to take some time," Allen said, adding, "It may take several sessions. We're committed to getting the attitudes changed" (Hunter, AP/Montgomery Advertiser, 3/17).
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Science & Medicine
Researchers Discover Genetic Circuit in HIV That Controls Whether Virus Activates, Remains Dormant
[Mar 19, 2008]
Researchers from the University of California-San Diego and Oak Ridge National Laboratory have discovered the genetic circuit in HIV that controls whether the virus is activated or remains dormant, according to a study published in the March 16 issue of the journal Nature Genetics, Xinhuanet reports (Xinhuanet, 3/18).
For the study, Leor Weinberger, professor of chemistry and biochemistry at UCSD, and colleagues examined HIV's genetic master circuit, called the Tat circuit, by building upon previous research by Weinberger, IANS/Sify reports. The previous research found that the circuit is driven by "cellular noise," or random events, which activate the circuit for a limited amount of time before it shuts off, according to IANS/Sify (IANS/Sify, 3/17). In the current study, the researchers used the noise in the Tat circuit to measure how long HIV remained activated in cells. The researchers found that the time the virus spent in the active state determined if it destroyed a cell or not. The researchers then increased the levels of the cellular gene SirT1 -- a gene associated with aging -- to reduce the lifespan of HIV, which forced cells infected with the virus to become dormant, the Press Trust of India reports (Shourie, Press Trust of India, 3/17).
According to Weinberger, the findings are significant because "many researchers are interested in determining which cellular processes generate biological noise." He added that the researchers "asked if the cellular noise could tell us anything about HIV and the cell -- and it did. What it told us is how a developmental decision is made by HIV." Weinberger said the findings do not indicate "how developmental decisions are made at the single-cell level" and "whether noise can drive this decision." He added, "Surprisingly, viruses appear to be good models for understanding this type of cellular decision-making." Weinberger and colleagues are conducting further studies on the feasibility of using this approach for HIV treatment, Xinhuanet reports (Xinhuanet, 3/18).
An abstract of the study is available online.
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Opinion
'More Vigorous' Leadership by Black Public Officials Needed To Fight HIV/AIDS Within Black Community, Opinion Piece Says
[Mar 19, 2008]
Although the HIV/AIDS epidemic has "taken hold in black America," the disease "can be prevented and sent packing," Del. Eleanor Holmes Norton (D-D.C.) writes in a Louisiana Weekly opinion piece. According to Norton, blacks comprise 12% of the U.S. population but account for 50% of HIV/AIDS cases. The "myths and stereotypes" that surround HIV "have fed the virus," she writes, adding that people "have allowed it to thrive in the shadows, with too little open discussion and leadership to conquer it."
For this reason, Norton dedicated last year to "breaking through the silence" on HIV/AIDS with a series of meetings in Washington, D.C., she writes. The meetings were "no-holds-barred" discussions, led by "well-known, popular" figures, according to Norton. She adds that the meetings highlighted the importance of practicing safer sex and "knowing your partner," as well as universal HIV testing.
HIV/AIDS has "gone mainstream" among blacks in the U.S., and the disease "can no longer be marginalized," Norton writes. She adds that the virus is a "human tragedy we can turn around." However, "it will take far more vigorous and visible leadership from African-American public officials and other leaders, and more candor, courage and care for one another by us all," she concludes (Norton, Louisiana Weekly, 3/17).
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