Kaisernetwork.org (Washington, DC)
28 April 2008
Politics and Policy
PEPFAR Reauthorization Bill To Benefit Malaria Efforts, Experts Say
[Apr 28, 2008]
New funding and provisions included in a bill (HR 5501) to reauthorize the President's Emergency Plan for AIDS Relief would significantly benefit efforts to fight malaria worldwide, experts said last week at a forum in Washington, D.C., CQ HealthBeat reports.
The panel discussion -- hosted by the Christian Children's Fund and the Johns Hopkins Center for Communication Programs -- was one of several events held to mark World Malaria Day on Friday, April 25. During the discussion, a number of directors of nongovernmental organizations working to address malaria discussed experiences and effective strategies for future work to eradicate the disease, CQ HealthBeat reports.
The PEPFAR reauthorization bill authorizes $5 billion over five years for malaria treatment and prevention efforts and codifies the creation of a five-year plan to control the disease. Specific appropriations for malaria were not included in prior PEPFAR legislation, according to CQ HealthBeat.
The majority of NGOs' work on malaria includes community-level efforts to provide education about prevention methods, distribute insecticide-treated nets and develop awareness campaigns. According to some experts, the programs have been effective in reducing malaria cases, while others say they have had little success because the programs are new.
Maurice Middleberg, vice president of public policy for the Global Health Council, noted that House passage of the reauthorization bill is vital to fighting malaria worldwide. Middleberg said that although "funding for malaria efforts doesn't necessarily have to come from PEPFAR ... the size of this appropriation and its malaria-specific strategy is significant."
Tim McCully -- vice president for international programming at Lutheran World Relief, a faith-based organization working to combat malaria with a USAID grant in Tanzania -- said, "When I look at strategies and operation for PEPFAR" and the President's Malaria Initiative, "they have gone out of the way to attract and make funds accessible to smaller organizations with the broader range of programs, but competition for funds is still steep." McCully also discussed the importance of addressing HIV/AIDS and malaria together. According to CQ HealthBeat, some global HIV/AIDS advocates say the PEPFAR reauthorization bill has "strayed too far from its original intent" of addressing the spread of HIV/AIDS by appropriating funds specifically for malaria (CQ HealthBeat, 4/25).
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In The Courts
Appeals Court Decision Restores More Than $1M in HIV/AIDS Funds to New York Counties
[Apr 28, 2008]
The U.S. Second Circuit Court of Appeals on Friday ruled that HHS should restore more than $1 million in Ryan White Program funding to Nassau and Suffolk counties in New York state, the Long Island Newsday reports. The ruling overturns a previous decision by the U.S. District Court, which agreed with the federal government that the counties no longer qualified for the annual amount of Ryan White funding they had received since 1990 (Maloney, Long Island Newsday, 4/28).
Nassau and Suffolk counties in February 2007 filed a lawsuit against HHS to prevent the funding cuts, which were included in a Ryan White Reauthorization Bill (HR 6143). Under previous Ryan White allocations, the counties received $6.1 million annually in funding for services for people living with HIV/AIDS. Under the reauthorization bill, which was signed into law by President Bush in December 2006, Nassau and Suffolk counties and 33 other communities nationwide were placed into one category that share $145 million in funding, down from $458 million under previous CARE Act allocations, because they were no longer considered eligible metropolitan areas. The suit sought to restore Nassau and Suffolk counties' eligible metropolitan status. It also aimed to procure for the counties a waiver for a provision of the bill that states 75% of funding be spent on core medical services (Kaiser Daily HIV/AIDS Report, 3/1/07).
Federal appeals court Judge John Walker in Friday's decision wrote that although the counties did not record enough new HIV/AIDS cases during the past five years to be considered eligible metropolitan areas, an amendment passed by Congress in 1996 that protected future funding for all regions that met the metropolitan definition in that year allows Nassau and Suffolk counties to retain their funding levels. The counties recorded 1,505 new cases during the past five years, and eligible metropolitan areas generally are defined as recording more than 2,000 new cases, according to the Newsday.
Several agencies that receive HIV/AIDS funding -- including the Long Island Minority AIDS Coalition, Federation Employment and Guidance Service, and Thursday's Child -- joined Nassau and Suffolk counties in the suit. Jennifer Kim, a spokesperson for Nassau County Executive Thomas Suozzi, said that officials are "very pleased with the outcome, and we'll know in the near future how much aid we'll be getting." U.S. attorney's office spokesperson Robert Nardoza declined to comment (Long Island Newsday, 4/28).
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Global Challenges
Second Conference About HIV/AIDS in Eastern Europe, Central Asia Scheduled for May in Moscow
[Apr 28, 2008]
The second Eastern European and Central Asian AIDS Conference is scheduled for May 3 to May 5 in Moscow, UzReport.com reports. The conference -- which is being organized by the Russian government, UNAIDS and the International AIDS Society -- aims to address the HIV/AIDS situation in the region by sharing best practices and evidence, as well as mobilizing action.
The conference will focus on accelerating universal access to HIV prevention, treatment and care by 2010. It also will provide an opportunity to increase dialogue and interaction among political and community leaders, researchers, people living with HIV/AIDS and representatives from civil society. Delegates are expected to discuss ways to balance treatment programs with prevention efforts targeted at high-risk groups, such as injection drug users, commercial sex workers and men who have sex with men. More than 2,000 delegates from 50 countries are expected to attend the conference.
According to UzReport.com, HIV/AIDS in Eastern Europe and Central Asia is threatening to affect work forces and national security in the region and is burdening the health sector. The first EECAAC was held in May 2006 in Moscow, UzReport.com reports (UzReport.com, 4/25).
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Christian Science Monitor Examines Peace Corps' Efforts To Attract Experienced Volunteers for Work Related to HIV/AIDS, Other Issues
[Apr 28, 2008]
The Christian Science Monitor on Friday examined how the Peace Corps is attempting to attract skilled volunteers as it begins to address "more complex issues," such as HIV/AIDS, and "professionalize" the agency.
Peter Parr, the agency's country director in Ethiopia, last year approached Ethiopian officials about the possibility of increasing Peace Corps volunteers' work on the HIV epidemic in the country. However, the officials said that such an approach would require more skilled volunteers rather than recent college graduates with little work experience.
In Ethiopia, the Peace Corps operates with funding from the President's Emergency Plan for AIDS Relief, making volunteers' work on the disease an "increasingly prominent part of its portfolio," the Monitor reports. However many volunteers lack the "commitment and capacity" to handle such work, Meskele Lera, deputy director of the Ethiopian agency that oversees HIV/AIDS activities, said.
The Peace Corps is increasing its efforts to attract retirees with professional experience by reducing the necessary medical screenings and by recruiting volunteers from groups such as AARP and the retired teachers' association. According to Peace Corps spokesperson Joellen Duckett, applications from people older than age 50 have increased by 60% since September 2007, when the agency began actively recruiting retirees.
Kevin Quigley, president of the National Peace Corps Association for returned volunteers, is advocating for more "drastic" reforms to the agency by reducing volunteers' 27-month service commitment. Quigley, who served as a Peace Corps volunteer in Thailand, said he and many other former volunteers would like to volunteer again but are unable to take such a long absence from work.
Quigley has suggested reforms that would allow older volunteers to travel to focus countries intermittently over several years and provide guidance to local partners via e-mail and phone. There is growing support among lawmakers for significant reforms to allow such changes by the Peace Corps' 50th anniversary in 2011, Quigley said.
According to the Monitor, efforts to reform the Peace Corps are coming after similar Japanese and British agencies reformed their programs to make "measurable contributions" to developing countries. The Japanese program about 10 years ago was incorporated into an international aid agency through which volunteers and professionals work together in focus countries. The British Volunteer Service Overseas program considers applicants based on their work experience and professional credentials. The average age of VSO volunteers is 41, compared with 26 for Peace Corps volunteers, the Monitor reports.
"You can't replace [work] experience," Peace Corps Director Ronald Tschetter said, adding that retirees have the "same kind of passion" as recent college graduates but "have 30 years of experience to bring along with it." Quigley added that it is "absolutely" a "historic moment" for the agency (Benequista, Christian Science Monitor, 4/25).
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UNICEF Peer Education Program Increasing HIV/AIDS Awareness in Yemen, Official Says
[Apr 28, 2008]
A UNICEF training program that provides teenagers in Yemen with information about HIV/AIDS has helped increase awareness about the disease, Nasim ur-Rehman, a UNICEF communication officer, said recently, IRIN/PlusNews reports. According to ur-Rehman, the program has "blossomed" into a "truly national effort," which has initiated a "national debate and openness" about HIV/AIDS.
The program teaches youth about HIV transmission, prevention and care -- as well as the rights of people living with the disease -- in an effort to address denial, stigma and discrimination. The program was launched in the southern province of Aden in 2005 and has since been established in Sanaa, Taiz and al-Hudeidah, IRIN/PlusNews reports. Mulhem Saif, a consultant for the program, said there are 44,788 peer educators in targeted areas, including secondary schools, and that the focus has shifted to marginalized groups, such as refugees. According to Saif, more than 6,000 people were provided with HIV/AIDS education in military camps in Aden during the first three months of this year. He added that peer educators also target young people in social care centers, prisons and orphanages (IRIN/PlusNews, 4/24).
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Science & Medicine
Survival Rates Among HIV-Positive People Who Receive Lab Tests Similar To People Who Do Not Receive Tests, Study Finds
[Apr 28, 2008]
Survival rates among HIV-positive people who undergo routine viral load and CD4+ T cell counts were nearly the same as those who do not receive the tests, according to a study published on Friday in the journal Lancet, the CP/Google.com reports (CP/Google.com, 4/24). In some wealthy countries, HIV-positive people undergo routine laboratory screening -- which can cost about $20 to $60 -- about every six months. In many developing countries, HIV-positive people usually are monitored by a physician or nurse for clinical signs of disease progression (Cheng, Associated Press, 4/24).
For the study, Andrew Phillips from the Royal Free and University College Medical School and Charles Gilks -- head of treatment, prevention and scale-up at the World Health Organization's HIV/AIDS Programme -- used a computer model that simulated patient details based on HIV progression in real people living with the virus, Reuters reports. The researchers projected survival rates for up to 20 years. The study found that after five years, 83% of the simulated HIV-positive people who were monitored with the viral load tests survived, compared with 82% for those who received CD4+ monitoring and 82% for those who were received clinical monitoring. Over two decades, the projected survival rates were 67%, 64% and 64%, respectively, the study found (Nebehay, Reuters, 4/24).
"The results of this study should reassure clinicians in Africa and Asia, who are treating literally millions of people without these laboratory tests, that they are not compromising patient safety," Gilks said. He added, "In fact, the outcome of their treatment is almost as good as those patients in the [U.S.] and Europe, where laboratory-guided treatment is the norm" (AFP/Channel NewsAsia, 4/25). As antiretroviral drugs have been distributed in developing countries, some doctors worry that without lab monitoring, HIV-positive people will die earlier or develop drug resistance faster, the CP/Google.com reports. However, based on the evidence to date, that has not happened (CP/Google.com, 4/24).
Phillips said, "Laboratory monitoring shouldn't be the priority while we've got less than half of people who need treatment still waiting for it" (Associated Press, 4/24). "Waiting for the perfect lab infrastructure to be ready before rolling out antiretroviral therapy means that millions of people will die," Jennifer Kates, vice president and director of HIV policy for the Kaiser Family Foundation, said, adding, "This study says we shouldn't wait" (CP/Google.com, 4/24). Gilks said that the tests "obviously do help, but if you don't have tests available, the priority remains to get drugs there in the first instance." He added that antiretrovirals are the "most important thing because without them, people die, it is as simple as that" (Reuters, 4/24).
According to the Associated Press, although the study results still have to be verified, they could affect how HIV-positive people "across Africa and Asia are treated." The original computer model was developed by Phillips with funding from Pfizer (Associated Press, 4/24).
The study is available online.
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