Kaisernetwork.org (Washington, DC)
31 March 2008
Politics and Policy
House To Consider PEPFAR Reauthorization Bill Wednesday
[Mar 31, 2008]
The House on Wednesday is scheduled to consider a bill (HR 5501) that would reauthorize the President's Emergency Plan for AIDS Relief, CQ Today reports (Vadala/Ethridge, CQ Today, 3/27).
The measure, which was approved in February by the House Foreign Affairs Committee, would allocate $50 billion for PEPFAR over the next five years. President Bush had called on Congress to authorize a $30 billion, five-year extension of PEPFAR. The bill also would remove a requirement that at least one-third of HIV prevention funds that focus countries receive through PEPFAR be used for abstinence-until-marriage programs. It also would require "balanced funding" for abstinence, fidelity and condom programs based on evidence in each PEPFAR focus country. In addition, the bill would retain the requirement that PEPFAR recipients pledge opposition to commercial sex work.
The bill would allow groups to use PEPFAR funding for HIV testing and education in family planning clinics but not for contraception or abortion services. The bill also would require reports to Congress if abstinence and fidelity programs compose less than half of country-level spending on programs aimed at preventing sexual transmission of the virus. In addition, the bill would allocate about $9 billion to fight tuberculosis and malaria, which often affect HIV-positive people in Africa. That amount also would underwrite food supplements for people living with HIV/AIDS. The bill would provide loans to women widowed by the disease or ostracized because of their HIV-positive status (Kaiser Daily HIV/AIDS Report, 2/29).
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Across The Nation
CDC Releases Surveillance Report on U.S. 2006 HIV/AIDS Cases
[Mar 31, 2008]
CDC last week released its annual HIV/AIDS surveillance report, which found that the number of reported HIV cases in 2006 was higher compared with previous years, the Wall Street Journal reports. According to the Journal, the higher number of reported HIV cases reflects CDC's "improved surveillance system rather than a rise in the epidemic" (Wall Street Journal, 3/31).
According to the report, the number of reported HIV cases based on data from 45 states and five dependent territories with confidential name-based reporting was 52,878 in 2006. Five states -- Hawaii, Maryland, Massachusetts, Montana and Vermont -- were not included in the data. The 2006 data for the first time included the seven states -- California, Delaware, Illinois, Maine, Oregon, Rhode Island and Washington -- which have now implemented confidential, name-based reporting. The comparable number of HIV cases reported in 2005 was 35,537 based on data from 38 states and five territories (CDC release, 3/27). The number of HIV/AIDS cases in the 33 states and five areas with long-standing reporting has remained stable from 2003 to 2006, according to the report (Wall Street Journal, 3/31).
"No matter how the CDC tries to spin these numbers, the fact remains that the numbers they've been reporting for years have been inaccurate and have incorrectly portrayed the U.S. epidemic as static at roughly 40,000 new infections per year," Whitney Engeran, director of the AIDS Healthcare Foundation's Public Health Division, said, adding, "We missed a crucial opportunity to work with Congress to adjust the budget to better reflect the needs of the populations affected because of the CDC's delay in reporting these numbers" (AHF release, 3/27). Robert Janssen, director of CDC's Division of HIV/AIDS Prevention, said that the report does not "show an increase in HIV/AIDS diagnoses." He added, "The higher number of reported HIV diagnoses in 2006 ... is due to the fact that this table includes data from states that have newly implemented confidential name-based HIV reporting as of 2006, including highly populous states like California, Illinois and Washington" (CDC release, 2/28).
The report is available online (.pdf).
A Kaiser Family Foundation fact sheet with the 2006 data is available online. Several state indicators also have been updated on statehealthfacts.org.
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Report Finds That HIV Cases in Baltimore Increasing Among People Ages 20-29, Calls on City To Do More To Fight Spread of Virus
[Mar 31, 2008]
The number of HIV cases recorded in Baltimore among people ages 20-29 increased by 10% annually between 2000 and 2006, and blacks account for 90% of new cases in the city, according to a report released Thursday by the Baltimore City Commission on HIV/AIDS Prevention and Treatment, the Baltimore Sun reports.
According to the Maryland AIDS Administration, almost 16,000 city residents were living with HIV/AIDS as of September 2006, the last date for which data are available. Although the rate of new cases has been declining by about 2% annually, the decline has not been as fast as other U.S. cities, the administration found. Baltimore has the second-highest rate of new AIDS cases in the nation, according to a federal report. The commission's report called on the city to begin measuring results of its prevention efforts to ensure that people who test HIV-positive receive treatment access. The report also said that Baltimore should increase HIV/AIDS education in the city's public school system. In addition, it recommended a citywide advertising campaign to increase awareness about the disease and programs to provide homeless people living with HIV/AIDS with housing and treatment.
"Baltimore as a whole is not doing well," William Blattner, head of the commission, said, adding, "We need to have a strategic plan so we can move ourselves out of the top 10 in a coordinated way." Blattner said he is disturbed by the increase of HIV cases among people in their 20s, adding that it is a trend that the school system could address through "age-appropriate" classes starting in grade school.
City health commissioner Joshua Sharfstein said his top priority is to develop a "coherent prevention plan." He added the city still lacks an inventory of what public and not-for-profit groups are doing and what they have accomplished. "There's no public accounting," Sharfstein said, adding that one problem is the assortment of public and private agencies making grants. "If there were a single funding agency, it would be easier," Sharfstein said. The Health Department is creating a program, called "HIV stat," that will ask agencies to report their activities on a quarterly basis, the Sun reports. Sharfstein said the health department also is planning new methods to fight the spread of the disease among people who engage in commercial sex work to support their drug habits (Bor, Baltimore Sun, 3/28).
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Global Challenges
Ugandan Vice President Bukenya Calls for Research on Country's HIV Prevention Strategies
[Mar 31, 2008]
At Uganda's fifth National AIDS Conference last week, Ugandan Vice President Gilbert Bukenya called for research into the country's primary HIV/AIDS prevention strategies to understand why prevalence of the disease has increased in the country, Uganda's Monitor reports.
Bukenya said that research is needed to "establish what has worked and what has not worked." Although the ABC approach -- which stands for abstinence, be faithful and use condoms -- has been credited with curbing the spread of HIV in Uganda in the past, HIV prevalence in the country has increased in recent years, according to the Monitor. "Researchers should be able to carry out operational research to know why there is an increase in infections, yet we still have in place this policy that has worked very well," Bukenya said.
Alex Coutinho, executive director of the country's Infectious Diseases Institute, said that Uganda has conducted research that could help slow the spread of the virus but has not used the research in designing new policies. "Uganda has research that is really important," Coutinho said, adding that other countries have taken Ugandan research and are "making good use of it." He said the country tends to "stagnate when it comes to putting into practice most of this research that promotes prevention."
Coutinho added that Uganda participated in a study that found male circumcision reduced the risk of HIV by 60% among men but has not implemented policy aimed at increasing circumcision rates in the country. However, Rwanda and other African countries have "taken [the research] on with full force" and have introduced campaigns to increase male circumcision, he said.
HIV prevalence in Uganda decreased from 18% in the early 1990s to 5% earlier this decade but has increased to about 6.4%. The country records a minimum of 132,000 new HIV/AIDS cases annually, the Monitor reports. The biennial conference was organized by the Uganda AIDS Commission (Kirunda/Natabaalo, Monitor, 3/27).
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61% of New HIV Cases in Nigeria Occur Among Girls, Women, Official Says
[Mar 31, 2008]
An estimated 61% of new HIV cases in Nigeria occur among girls and women, Babatunde Oshotimehin, director-general of the National Agency for the Control of AIDS, said recently at a one-day conference, the Vanguard/AllAfrica.com reports.
According to Oshotimehin, women are disproportionately affected by HIV/AIDS because of their inability to speak out against some sexual practices that put them at risk of the disease. He added that the "gender distance" between men and women in Nigeria makes it difficult for women to protect themselves from contracting the virus. Oshotimehin said that the spread of HIV could be "easily tamed" if women were empowered to negotiate safer sex with their partners. He called on women in the country to fight the spread of HIV/AIDS, as well as gender inequality.
"Today, the burden of the disease in terms of care and support of those living with the virus is the responsibility of the women across our continent," Oshotimehin said, adding, "So when you look at the statistics, and you look at how the disease affects our women, it is important that we put women at the center of the control of this virus."
Ramatu Bala Usman, president of the National Council of Women Societies, at the conference said the involvement of women in the fight against HIV/AIDS will help reduce the spread of the disease. "It is in [women's] collective interest to fight the spread of HIV/AIDS because we are the most infected and affected." She added that NCWS is affiliated with 250 groups that can "carry the campaign to the grassroots." NCWS is "not just composed of educated elites but ... also include the uneducated women in the rural areas," Usman said, adding, "It is easier for us to penetrate the rural areas because we speak their language and they understand us more" (Shaibu, Vanguard/AllAfrica.com, 3/27).
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Opinion
Editorials Respond to Call for Increase in Basic Research, New Strategies for HIV/AIDS Vaccine
[Mar 31, 2008]
Two newspapers recently published editorials in response to a call last week from HIV/AIDS researchers for an increase in basic research on the virus and new strategies for research into a vaccine during an NIH AIDS Vaccine Summit. The summit was held to discuss the future of HIV vaccine research following the recent failure of a Merck vaccine candidate. Experts at the meeting said that NIH's National Institute of Allergy and Infectious Diseases should support basic research into HIV prevention, testing and treatment strategies. In addition, researchers said NIAID should support efforts to develop animal models of HIV, and they also called for cooperation between scientists developing such models and those developing vaccine candidates. Several researchers at the meeting -- which drew about 300 scientists from around the world -- said NIAID should fund new, innovative research proposals and support younger scientists who might abandon HIV vaccine research for less challenging fields (Kaiser Daily HIV/AIDS Report, 3/26).
Summaries of the editorials appear below.
Akron Beacon Journal: HIV/AIDS vaccine researchers have "made the call, wisely, not to chase shadows" and "refocus attention on basic research and direct more of the available resources to developing approaches that improve current prevention and treatment alternatives," a Beacon Journal editorial says. "Disappointing as the development is, the failure of the vaccine route does not mean it is a permanent dead-end," the editorial says, adding, "Scientific breakthroughs rarely follow a deliberate timetable." Curbing the spread of HIV/AIDS "goes well beyond a disappointing quest for a vaccine," the editorial notes, concluding that the Merck "failure emphasizes again that for the foreseeable future, global success in controlling the viral infection will depend on applying precautions research has taught in 25 years, the simplest of which is to avoid complacence about risky behavior" (Akron Beacon Journal, 3/31).
New York Times: Health officials are "rightly determined" to increase support for "basic laboratory research" into HIV/AIDS because "giving up on a vaccine and shifting the money to testing, treatment and prevention ... is too defeatist," a Times editorial says. After 25 years of "toil and struggle," the effort to develop an HIV/AIDS vaccine has "crashed in failure," and no one "yet knows whether a vaccine to prevent the disease will ever be possible," the editorial says. However, NIH is right to increase funding for basic research, "curtail big clinical trials of existing vaccine candidates and funnel money to researchers with novel ideas," the editorial notes, concluding that there is "little doubt that a vaccine would be the most effective and cheapest way to shrink the AIDS epidemic" (New York Times, 3/30).
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Efforts To Loosen U.S. HIV/AIDS-Related Travel Restrictions 'Long Overdue,' Editorial Says
[Mar 31, 2008]
The recent effort to loosen "discriminatory and anachronistic" U.S. HIV/AIDS-related travel restrictions for visitors and immigrants is a "long-overdue development," according to an editorial in Toronto's Globe and Mail. According to the editorial, the restrictions from the "outset" had "more to do with politics than any serious medical concern." Although HHS in the early 1990s "sought to ease the restrictions," Congress "enshrin[ed] the ban in the Immigration and Nationality Act" following a "conservative outcry" (Globe and Mail, 3/28). A regulation included in a 1993 amendment to the Immigration and Nationality Act only permits HIV-positive foreigners to obtain visas to enter the U.S. under limited circumstances. The regulation also requires HIV-positive foreigners to obtain waivers from the Department of Homeland Security before they can receive visas.
The Senate Foreign Relations Committee earlier this month approved a President's Emergency Plan for AIDS Relief reauthorization bill (S 2731), which includes a provision that would lift some of the travel restrictions. Rep. Barbara Lee (D-Calif.) has sponsored a House version of the amendment. The U.S. is one of 13 countries -- including Armenia, Iraq and Qatar -- that has such restrictions. Draft rules proposed by the Homeland Security Department that would change U.S. HIV-related travel rules have not been finalized. Some advocates and Democrats have objected to the proposed rules, saying that the rules do not improve the situation (Kaiser Daily HIV/AIDS Report, 3/25).
U.S. "lawmakers seem to be prepared to stop ignoring the available medical evidence and cease treating HIV so disproportionately, compared to most other medical conditions," the editorial says. It adds that with "apparent congressional support" for the PEPFAR reauthorization bill and "no indication" that President Bush will veto the bill, the "repeal appears likely to go through." HIV/AIDS is "no longer the mysterious super-disease that terrified the Western world in the 1980s," and people living with the disease "should not be treated as pariahs," the editorial says, adding that it is "about time" for the travel restrictions to be loosened because U.S. "politicians have taken two decades longer than everyone else to recognize this" (Globe and Mail, 3/28).
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