Politics and Policy

House Rules Committee Takes Action on PEPFAR Reauthorization Bill Ahead of Floor Consideration

[Apr 02, 2008]

The House Rules Committee on Tuesday took action on a bill (HR 5501) that would reauthorize the President's Emergency Plan for AIDS Relief ahead of floor consideration of the measure, which is scheduled for Wednesday, CQ Today reports (Graham-Silverman, CQ Today, 4/1). 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 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, 3/31).

The Rules Committee on Tuesday approved by voice vote a structured rule (HR 1065) for floor consideration of the bill. During the Rules Committee consideration, Reps. John Campbell (R-Calif.) and Dave Weldon (R-Fla.) attempted to decrease the $50 billion funding amount allocated in the bill to $15 billion and $38 billion, respectively. The committee ruled the representatives' amendments out of order. Any changes to funding levels would "unravel" compromises, Foreign Affairs Committee Chair Howard Berman (D-Calif.) said, adding, "Part of the balance that was achieved with this bill was the funding level."

Rep. Betty McCollum (D-Minn.) attempted to gain Rules Committee approval to offer an amendment during floor consideration to eliminate a phrase in the bill that some advocates say could remove funding for family planning groups that currently receive PEPFAR money. According to CQ Today, 45 HIV/AIDS groups last week sent a letter to lawmakers in support of such efforts. "The effect of the language as it is could be interpreted to actually restrict access to those services," Jennie Quick -- the government affairs manager at Population Services International, one of the groups that signed the letter -- said. The Rules Committee did not allow the amendment, CQ Today reports.

The Rules Committee also rejected an amendment that would have changed a reference to "health care professionals and workers" to "health care professionals." The committee did approve four amendments to:

• Add Lesotho, Malawi and Swaziland as PEPFAR focus countries;
• Include clean water programs in the program;
• Encourage countries to work with historically black colleges to improve their health infrastructures; and
• Expand inspector general authority.

The White House in a policy statement said that it supports the PEPFAR reauthorization bill but hopes to resolve some concerns about provisions in the bill that it says would limit the president's authority to conduct foreign policy (CQ Today, 4/1).

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Science & Medicine

Examination of Antiretrovirals Abacavir, Didanosine's Potential Link to Increased Risk of Heart Attack Continues

[Apr 02, 2008]

GlaxoSmithKline's antiretroviral drug abacavir could nearly double the risk of heart attack, according to a study released at a meeting in February and published on Tuesday in the online version of the Lancet, the San Francisco Chronicle reports (Russell, San Francisco Chronicle, 4/2).The study also found that Bristol-Myers Squibb's antiretroviral didanosine might be associated with a 50% increased risk of heart attack, the AP/International Herald Tribune reports (AP/International Herald Tribune, 4/2). According to the researchers, the increased risk of heart attack could be the result of a cardiovascular inflammatory response to the drugs, but they added that more research is needed. GSK in a letter published alongside the study said its own analysis of 54 pooled studies did not suggest an increased risk of heart attack associated with abacavir (Berton, Dow Jones/CNNMoney.com, 4/1).

For the study, Jens Lundgren of the University of Copenhagen and colleagues examined more than 33,000 HIV-positive people who had been followed from 1999 to 2005 at clinics in Australia, Europe and North America. The researchers looked for heart issues that occurred until February 2007 (AP/International Herald Tribune, 4/2). The researchers analyzed the risk of heart attack among those who had used or were using abacavir, didanosine and lamivudine. The researchers found that an increased risk of heart attack was only found in participants currently receiving abacavir and didanosine. Abacavir was associated with a 90% increased risk of heart attack, and didanosine use was associated with a 49% increased risk, the study found. An increased risk was not found among past users of the drugs. According to the study authors, the findings suggest that the risk of heart attack associated with the two drugs is reversible if use is stopped (Kaiser Daily HIV/AIDS Report, 2/6). The study found that the people most likely to experience heart problems with abacavir were those with underlying medical conditions, such as high blood pressure and diabetes, that also place them at an increased risk of heart attack (San Francisco Chronicle, 4/2). The company said that an analysis of its database of about 14,600 HIV-positive people did not support the conclusions of the Lancet study.

Reaction, Comments

"We were unable to show any increased risk in heart attacks," Gwenan White, a GSK spokesperson, said, adding that the Lancet study results are "inconclusive" (AP/International Herald Tribune, 4/2). In a linked comment to both the study and GSK's response, James Stein of the University of Wisconsin School of Medicine and Public Health and Judith Currier of the University of California-Los Angeles David Geffen School of Medicine disagreed with GSK's analysis. They wrote that although findings from observational studies should not lead to changes in clinical practices, the increased risk of heart attack cannot be ignored. "Alternatives to abacavir and didanosine in high-risk patients should be considered," they said (Dow Jones/CNNMoney.com, 4/1).

Steven Deeks, a professor at the University of California-San Francisco, said the study was thorough and large-scale but not definitive. He added that although the study shows an increased risk of heart attack, it does not show why. "The concerns it raises are legitimate," he said, adding that until a plausible biological explanation can be ascertained and the findings are confirmed, he would be reluctant to recommend that patients switch to another antiretroviral. John Pottage, vice president for GSK, said the company is taking the results seriously. He added that although the risk of heart attack appears to double with abacavir, such risk is relatively low to begin with. "Obviously, the study is provocative, and people are trying to dig into it and understand it," Pottage said (San Francisco Chronicle, 4/2).

According to the AP/Herald Tribune, the study's findings could affect how people living with HIV/AIDS are treated worldwide. Charlie Gilks, director of AIDS treatment and prevention at the World Health Organization, said, "These antiretrovirals are wonderful and lifesaving, but they do have toxicity problems." He added, "It may be that we can continue to use them, but we need to be aware of their long-term problems." According to Gilks, physicians in wealthy nations have "24 different antiretrovirals to choose from if one isn't appropriate. But if that happens in resource-poor countries, it's not so simple." He added that WHO will "have to review what the likely implications of using these drugs is on a large scale and if we should consider alternatives." Lundgren said, "No drug is risk-free." He added, "For all patients, it's a matter of finding the right balance" (AP/International Herald Tribune, 4/2).

The European Medicines Agency on Wednesday said it is seeking further information about abacavir's safety. The announcement follows a similar one from FDA last week. "At present, no changes to the prescribing information for abacavir-containing medicines are required, but further information is needed to determine the risk of" heart attack with the drugs, the agency said (Reuters, 4/2).

The study is available online.

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Public Health & Education

Online Survey Looks at Women, HIV in U.S.

[Apr 02, 2008]

HIV-positive women in the U.S. face stigma associated with the virus, according to the results of an online survey released Monday by the American Foundation for AIDS Research, CNS/Atlanta Journal-Constitution reports (Krouse, CNS/Atlanta Journal-Constitution, 3/31).

The survey was conducted online between March 22 and April 17, 2007, by Harris Interactive among 4,831 U.S. residents ages 18 to 44 who were willing to disclose their race. According to an amfAR release, one-fifth of the respondents said they would be somewhat or not at all comfortable having a close friend who is HIV-positive, and 59% said they would be somewhat or not at all comfortable with an HIV-positive woman caring for their children. Among the respondents, 68% and 57%, respectively, said they would be somewhat or not at all comfortable having an HIV-positive female dentist or physician. Only 14% of respondents said they believe HIV-positive women should have children, despite antiretroviral drugs that can prevent mother-to-child HIV transmission.

Black and Hispanic respondents were more likely to have an HIV-positive family member at 34% and 32%, respectively, compared with 13% of white respondents. About 40% of the respondents said they were sure they had not been tested for HIV. Eighty percent of these respondents said it was unnecessary for them to receive an HIV test because they "knew" they were not HIV-positive or did not believe they should be tested.

Most respondents supported expanded HIV testing, with 65% saying HIV testing should be part of routine health care. Sixty-seven percent of respondents incorrectly assumed they are screened for HIV during screenings for other sexually transmitted infections, and half of respondents believed pregnant women are automatically tested for the virus as a part of prenatal care.

The survey was funded by Broadway Cares/Equity Fights AIDS and the MAC AIDS Fund (amfAR release, 3/31).

Reaction, Recommendations

Fears associated with contracting HIV, the belief that HIV is the result of promiscuity or moral failures and the severity of the disease all contribute to the associated stigma, according to participants at a conference on Monday in Washington, D.C., to release the survey (CNS/Atlanta Journal-Constitution, 3/31). Susan Blumenthal, senior policy and medical adviser for amfAR, said that "[c]omplacency has obscured the changing face of" HIV and the "dramatic" increase in HIV infections among women in the past 25 years (amfAR release, 3/31).

A panel of HIV/AIDS advocates and experts at the conference said policymakers should increase efforts to improve HIV/AIDS education in an effort to reduce stigma (CNS/Atlanta Journal-Constitution, 3/31). The survey's results "should serve as a wake-up call for action across all sectors of society," Blumenthal said, adding, "We need to intensify efforts for science-based education and policy to shatter the stigma that has surrounded this disease for all too long" (amfAR release, 3/31).

Regan Hofmann, editor-in-chief of POZ Magazine, said the government should increase comprehensive sex education to ensure people understand how HIV is transmitted and how to prevent the spread of the virus. Hofmann also discussed the importance of promoting safer-sex practices and discussing HIV with future partners. "Women are the ones living in secret," Hofmann said, adding, "Women are terrified, women of all colors, of all socio-economic statuses" (CNS/Atlanta Journal-Constitution, 3/31).

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Across The Nation

Florida Advocacy Group Launches HIV/AIDS Education, Testing Campaign Aimed at MSM

[Apr 02, 2008]

COMPASS, a Palm Beach County, Fla.-based gay and lesbian advocacy group, last week launched an HIV/AIDS education and testing campaign aimed at men who have sex with men, the Palm Beach Post reports. The campaign encourages MSM to sign cards pledging to promote HIV testing to 10 other people.

According to the Post, the "impetus" for the campaign was a report released last year that documented the impact of HIV on MSM in the state (Barton, Palm Beach Post, 3/30). The report, conducted by the state Department of Health, found that an estimated one in 22 MSM in Florida is HIV-positive. The report also found one in 12 black MSM in the state is HIV-positive, compared with one in 18 Hispanic MSM and one in 29 white MSM. Some advocates argued that the state might be underestimating the incidence of HIV/AIDS among MSM, adding that many MSM do not practice safer sex for a number of reasons (Kaiser Daily HIV/AIDS Report, 11/15/07).

Chris Lacharite, a prevention coordinator at COMPASS, said that because the data are based on an estimate more likely to be true in dense urban areas, such as Miami and Fort Lauderdale, the estimates do not represent the reality in Palm Beach County, the Post reports. He added that the number of HIV-positive MSM probably represents a higher percentage of the total number of HIV-positive people in the county. In addition, it is possible that as many as one in seven black MSM in Palm Beach County is HIV-positive, Lacharite said.

Lorenzo Robertson, the county regional AIDS coordinator, said many of these men are not getting tested. "Stigma and denial still play a large part in why black and Hispanic [MSM] are disproportionately affected by the epidemic," Robertson said, adding that the facts about HIV/AIDS continue to be widely misunderstood. Rob Scott, an early intervention specialist at the county health department, said that if people who are living with the disease do not think they are exposed to the virus, routine testing is all the more important (Palm Beach Post, 3/30).

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Stigma, Funding Among Challenges HIV/AIDS Advocates in Rochester, N.Y., Face

[Apr 02, 2008]

Advocates who seek to raise HIV/AIDS awareness in black communities in Rochester, N.Y., are faced with a number of challenges, including determining how to "combat an epidemic that carries so many stigmas, without indicting a race of people," the Rochester Democrat and Chronicle reports.

In Monroe County, N.Y., roughly 14% or the county's population is black, and 56% of men and 65% of women diagnosed with HIV in 2006 were black, according to data from the Monroe County Health Department. Don Bruner of Rochester, N.Y.-based Black Men Latino Men Health Crisis said the black community has not yet "embraced the severity" of HIV/AIDS, adding, "We are 20 years behind. Everybody in Rochester knows somebody who knows somebody ... affected by AIDS. But how do we break the silence?"

Some advocates contend that prevention efforts should be tailored to minority communities and focus on increasing attention on the issue. Others contend that targeted efforts could stigmatize the black community and "create a misconception that the disease can only come to poor, black people," according to the Democrat and Chronicle. "I know it's affecting us more. But I don't want to make it a black issue," LaDawn Williams, a volunteer for the AIDS Community Health Center, said. Williams added, "There are so many people in this community that are infected that could be instrumental in speaking out, but because of fear of being stigmatized, they won't."

Funding is another issue advocates face. Efforts to address HIV/AIDS rates in Rochester's black communities are "mostly fragmented," and funding is "hardly reliable" despite an increase in money available for HIV/AIDS programs, according to the Democrat and Chronicle. Advocates "tug at whatever remains after money is directed toward medical care, housing assistance, research and international programs," the Democrat and Chronicle reports. In addition, guidelines to apply for federal HIV/AIDS grants have become more onerous, and those targeting minorities are limited, according to the Democrat and Chronicle. Paula Silvestone, executive director of AIDS Rochester, said, "We need people on the streets, mass media campaigns, black leaders, black ministers who step up to the plate and talk about this. But it oftentimes boils down to money" (Wang, Rochester Democrat and Chronicle, 3/31).

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Global Challenges

New Zealand Group Launches Fund To Provide HIV-Positive People With Assistance for Health, Travel Costs

[Apr 02, 2008]

The New Zealand AIDS Foundation this week launched a fund to provide HIV-positive people in the country with financial assistance for health and travel costs, the NZPA/New Zealand Herald reports. The Wellness Fund is a needs-based service that was established after the foundation conducted nationwide consultations with HIV/AIDS-affected people. According to Eamonn Smythe, the foundation's national positive health manager, the primary focus of the fund is to cover health-related costs for which alternative funding is not available. "Despite substantial improvements made over the last decade in the treatment of HIV, New Zealanders living with the virus continue to face significant and diverse challenges in maintaining their health and well-being," Smythe said.

The fund will provide annual grants of up to 750 New Zealand dollars, or about $592, for low-income people. "These can be used to reimburse fees incurred by" general practitioners, "massage, podiatry, physiotherapy, osteopath, acupuncture, naturopathy, nutritionists, dieticians or other health-related needs," Smythe said. Special grants of up to 3,000 New Zealand dollars -- or about $2,370 -- will be available for health care services that are not publicly funded. In addition, a third grant of up to 500 New Zealand dollars, or about $395, will be used for travel costs, according to Smythe. The fund will be sustained entirely through donations and other gifts (NZPA/New Zealand Herald, 4/1).

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Malawi Launches Program Aimed at Preventing HIV, Improving Sexual Health Among Young People

[Apr 02, 2008]

Malawi's Ministry of Youth Development and Sports last week launched a National Plan of Action for Young People aimed at preventing the spread of HIV, as well as improving sexual and reproductive health, among young people ages 10 to 24, Malawi's Daily Times reports.

Simon Vuwa Kaunda, youth development and sports minister, during the program's launch in Lilongwe, Malawi, said the country will not achieve the United Nations Millennium Development Goals by 2015 if it does not follow the new program. Finance Minister Goodall Gondwe at the launch said the Ministry of Finance and Economic Planning will ensure that funds are available to implement the program.

The program has six strategic objectives:

• Improving HIV programs, as well as sexual and reproductive health programs, for young people;
• Teaching young people how to adopt safer-sex practices;
• Increasing youths' utilization of health services;
• Increasing access to integrated sexual and reproductive health, and livelihood skills programs;
• Strengthening coordination between HIV prevention programs and sexual health programs; and
• Strengthening capacity to sustain evidence-based prevention programs.

Kaunda said the country's biggest problem in fighting HIV has been a lack of coordination among different groups that aim to prevent and treat the disease. "Each one of us now is working as an island," Kaunda said, adding, "If this goes on, we'll not achieve what we want, and young people will continue suffering while millions of dollars are being spent on HIV/AIDS programs" (Nyangulu-Chipofya, Daily Times, 4/1).

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