Politics and Policy

Sen. Coburn Says He Might Block PEPFAR Reauthorization Bills

[Apr 04, 2008]

Sen. Tom Coburn (R-Okla.) has said in a letter that is circulating among senators that he might block attempts to pass both House and Senate bills (HR 5501, S 2731) that would reauthorize the President's Emergency Plan for AIDS Relief, CQ Today reports. Coburn plans to send the letter, which asks for support from other senators, to Senate Minority Leader Mitch McConnell (R-Ky.).

Coburn in the letter wrote that the PEPFAR reauthorization bills "contain dramatic policy reversals coupled with irresponsible spending levels," adding that the "combination prevents our support for reauthorization of the program that, until now, has been a rare model of foreign aid success." Coburn added that he wants to preserve a requirement in the existing law that 55% of PEPFAR funding be spent on treatment for HIV/AIDS and prevention of mother-to-child transmission. He has introduced a bill (S 2749) that would maintain the requirement and expand HIV testing.

Sen. Jim DeMint (R-S.C.), who signed the letter, said he believes the PEPFAR reauthorization measures represent the "height of irresponsibility in the middle of a war and surging debts" because they "dramatically increas[e] the cost and scope of the program." Coburn's spokesperson John Hart emphasized that Coburn is committed to reauthorizing the program but "wants to ensure that they money is directed to people that need the assistance." Hart added that the new versions would "take the focus off of widows and orphans and put it on consultants and program officers."

An unnamed congressional aide added that the senators who are supporting Coburn's letter are more concerned about a lack of accountability and "mission creep" in the new versions than the spending levels. The aide said the letter's support is not driven by a "knee-jerk opposition to foreign aid" (Graham-Silverman, CQ Today, 4/3).

House, Senate Bills

The Senate version of the bill passed the Foreign Relations Committee last month and is awaiting floor consideration. The House version was approved 308 to 116 earlier this week (Kaiser Daily HIV/AIDS Report, 4/3). Both the Senate and House versions of the bill would reauthorize PEPFAR at $50 billion over five years. President Bush had called on Congress to reauthorize the program at $30 billion over five years.

Both bills 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. They also would retain the requirement that PEPFAR recipients pledge opposition to commercial sex work. Both versions would require a report to Congress if abstinence and fidelity programs account for less than 50% of prevention spending in each PEPFAR focus country.

In addition, the Senate version includes a requirement that 10% of funds be allocated for services aimed at AIDS orphans and other vulnerable children. It also includes a provision that would lift some U.S. HIV/AIDS-related travel restrictions. Included in the $50 billion allocated by the Senate version are $4 billion for tuberculosis programs and $5 billion for malaria efforts worldwide. The House 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 Senate version does not mention family planning (Kaiser Daily HIV/AIDS Report, 3/14). The House version would add Lesotho, Malawi and Swaziland as PEPFAR focus countries; include clean water programs; encourage countries to work with historically black colleges to improve their health infrastructures; and expand inspector general authority. In addition, the bill would add 14 Caribbean countries to the program and include $9 billion for TB and malaria efforts. 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. Of the $41 billion specifically allocated for HIV/AIDS under the House measure, up to $2 billion would be included annually for the Global Fund To Fight AIDS, Tuberculosis and Malaria. The bill limits U.S. contributions to the Global Fund to one-third of total contributions (Kaiser Daily HIV/AIDS Report, 4/3).

Related Editorial

Bush's "leadership in fighting disease and poverty" in Africa "culminated" Wednesday when the House passed its version of the PEPFAR reauthorization bill, a Los Angeles Times editorial says. The House's approval "marks a dramatic shift in the United States' attitude toward foreign aid," the editorial says.

According to the Times, the U.S. has "supported big international disease-eradication in the past," but "never with such an enormous financial commitment." Although there are a "few flaws" in the bill, it "gives Americans a good reason to be deeply proud of their country, a feeling" many U.S. citizens have not "experienced in a while," the editorial concludes (Los Angeles Times, 4/4).

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Rep. Farr Requests That Policy Barring MSM From Donating Blood Be Re-Evaluated

[Apr 04, 2008]

Rep. Sam Farr (D-Calif.) on Wednesday requested that the fiscal year 2009 agriculture spending bill include language to require FDA to re-evaluate its policy preventing men who have sex with men from donating blood, Farr spokesperson Tom Mentzer said, CQ Today reports (Sternstein, CQ Today, 4/2). According to the FDA policy, which has been in effect since the early 1980s, MSM are barred from donating blood regardless of sexual activity, safer-sex practices or HIV status. Potential blood donors are asked to fill out a questionnaire before donating, and MSM, injection drug users, people who received a tattoo within the previous 12 months and pregnant women are prohibited from donating (Kaiser Daily HIV/AIDS Report, 2/28).

Farr on Wednesday during a House Appropriations Committee Subcommittee on Agriculture hearing said the policy is "discriminatory" and outdated. "The science doesn't seem to support" the policy, Farr said. He added that testing for donated blood has improved since the policy was implemented and that women who have sex with women or heterosexuals who have had sexually transmitted infections are not banned from donating.

Jesse Goodman, director of FDA's Center for Biologics Evaluation and Research, at the hearing said the policy is supported by science and that allowing MSM to donate blood would result in a "real risk" of increased HIV and hepatitis cases. Goodman added that the policy is a "safety issue" and is "not discriminatory." According to Goodman, several other groups are banned from donating blood. The blood donation policy is not a "perfect system, but it's built on risk rates in those groups," Goodman said (CQ Today, 4/2).

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Across The Nation

AIDS Project New Haven Launches Program To Educate Older Women About HIV

[Apr 04, 2008]

AIDS Project New Haven in Connecticut has launched an initiative aimed at educating postmenopausal women about HIV/AIDS in an effort to prevent the spread of the virus among older women, the New Haven Register reports. The Center for Interdisciplinary Studies on AIDS at Yale University is partnering with APNH on the initiative, called Wise Women Win.

Six women older than age 50 recently received training to participate in the program as mentors and educators to other women ages 50 and older, APNH program coordinator Nick Boshnack said. These women then recruit other women to join a group in which they provide education about HIV/AIDS and safer-sex practices and help spread the messages among seniors. Senior centers, residential developments and retail stores have participated in the program.

According to the Register, many older women have little knowledge about HIV/AIDS but engage in unprotected sex because they are not concerned about pregnancy. Although some people consider seniors to be at low risk of HIV, many are still sexually active and at risk of contracting the virus. "There are women who are sexually active after divorce or after they are widowed," Boshnack said, adding that older women are not familiar with HIV prevention because the virus "wasn't around" when they first began having sex.

HIV is rising rapidly in women older than age 50, according to a report from the AIDS Research Institute at the University of California-San Francisco. In 2005, people older than age 50 accounted for 19% of new HIV/AIDS diagnoses, 29% of people living with HIV/AIDS and 36% of deaths from AIDS-related causes, according to CDC (Garriga, New Haven Register, 4/2).

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Global Challenges

Ethiopia Launches HIV/AIDS Workplace Policy

[Apr 04, 2008]

Ethiopia recently launched a policy that provides a framework for addressing HIV/AIDS in the workplace, the Daily Monitor/AllAfrica.com reports. According to the Monitor/AllAfrica.com, the policy was developed during a three-year project, called "HIV and AIDS Workplace Policy Project for NGOs in Ethiopia," which was hosted by the Jerusalem Children and Community Development under the slogan Stop AIDS Now!, or SAN!

The campaign emphasizes building the capacities of more than 35 local and international nongovernmental organizations in the country to create, implement and manage the impact of HIV/AIDS workplace policies. The campaign also addresses the high rate of new HIV cases projected for 2008, projections that the majority of cases will occur among people ages 15 to 45 and the virus' effect on Ethiopia's working population. Speaking at the launch of the project on Saturday, Dereje Alemayehu, steering committee member of SAN! Ethiopia, said the campaign was designed to address the realization by organizations in the country that a response to HIV/AIDS is needed in the workplace. He added that the project will address some of the major difficulties that organizations in Ethiopia face by providing support to implement the policies. The project also aims to increase awareness and knowledge of how to effectively address the disease in the workplace by using various tools and techniques, Alemayehu said. According to the Monitor/AllAfrica.com, SAN! has implemented similar workplace policies in India and Uganda (Tesfaye, Daily Monitor/AllAfrica.com, 4/2).

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IRIN/PlusNews Examines Global Campaign Aimed at Reducing HIV/AIDS-Related Stigma Among Youth

[Apr 04, 2008]

IRIN/PlusNews on Wednesday examined a global campaign, called "Does HIV Look Like Me?", that aims to reduce HIV/AIDS-related stigma and discrimination among youth. The campaign is organized by the U.S.-based organization Hope's Voice International, which partners with groups in other countries such as Cambodia, South Africa and Swaziland. The campaign operates in six countries and uses posters that feature the pictures of young people with the campaign slogan in an effort to reduce stigma associated with the disease. Adam Garner of the International Planned Parenthood Federation, which works with Hope's Voice on the campaign, said that a key component of the campaign is that local partners adapt the project to specific cultural contexts. "The epidemic is very different in all countries in the world in the way stigma manifests itself and in the way the virus is predominantly transmitted," he said. Sedumedi Soke, an ambassador for the campaign from South Africa, said that when he became aware of his HIV-positive status, it was "very difficult because of the environment I am in. There's more than the virus -- there are hate crimes, discrimination, stigma, people being labeled like they were the virus itself." He added that since becoming an ambassador, he "found that for the first time, I was looking at myself in the mirror and speaking openly to a broad group of people. It helped me get back the confidence, hope and self-esteem I had lost" (IRIN/PlusNews, 4/2).

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Opinion

Use of Antiretrovirals as 'Alternative' to HIV/AIDS Vaccine 'Goes Unchampioned,' Opinion Piece Says

[Apr 04, 2008]

The HIV/AIDS vaccine "establishment continues its taxpayer-funded, repeatedly unsuccessful search for a preventive AIDS vaccine while an alternative many have seen work on multiple levels -- successful antiretroviral treatment as both treatment and prevention -- goes unchampioned," AIDS Healthcare Foundation President Michael Weinstein writes in a Los Angles Times opinion piece in response to a recent Times editorial. The Times editorial "took issue" with AHF's position "without fully understanding it," Weinstein writes. He adds that the group's position is that in "light of over 20 years of failed AIDS vaccine research on which billions of dollars of U.S. taxpayer money have been spent, [AHF believes] it is simply unconscionable for the U.S. government to continue such wasteful funding while millions worldwide die for want of access to the AIDS research breakthrough that occurred more than 10 years ago -- lifesaving antiretroviral treatment."

While "AIDS vaccine candidates repeatedly fail," a "consensus continues to build that successful antiretroviral treatment offers a vaccine-like effect -- rendering most HIV-positive people noninfectious," Weinstein writes, adding, "This treatment offers a far more enduring benefit than anything that AIDS vaccine research has or will offer." More than 33 million "people worldwide continue to live with and die from HIV/AIDS," Weinstein writes, adding that about two million people "in the developing world have access to the treatment that we know works to save lives" and "reduces the likelihood of transmission." Antiretroviral treatment costs "as little as $300 per patient per year in Africa and elsewhere in the developing world," according to Weinstein, who adds that the "$700 million or so the U.S. currently spends annually on fruitless AIDS vaccine research could save an additional 2.3 million lives around the world each year."

AHF "believes it is time to pull the plug on U.S. taxpayer financing of the search for a vaccine and leave it to private donors to back what has been and continues to appear to be a fruitless goal," Weinstein writes. He concludes that to "continue to invest hundreds of millions of dollars in a government-funded search for an AIDS vaccine in the vain hope of success someday while millions worldwide suffer and die is simply unacceptable when other currently available strategies offer practical and effective alternatives" (Weinstein, Los Angeles Times, 4/4).

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