Global Challenges

Russia Should Increase HIV Prevention Efforts Targeted at IDUs, UNAIDS Executive Director Piot Says

Group Launches Program To Expand Role of People Living With HIV/AIDS in Uganda

'60 Minutes' Profiles Partners in Health Co-Founder Paul Farmer

Across The Nation

Texas AG Abbott Issues Opinion Allowing Prosecution of People Involved in Bexar County Needle-Exchange Program

Opinion

HIV/AIDS Should Not Be 'Barrier' to Peace Corps Service, Editorial Says

PEPFAR Reauthorization Bills Should Address Increased Risk of HIV Among Women in Africa, Editorial Says

Global Challenges

Russia Should Increase HIV Prevention Efforts Targeted at IDUs, UNAIDS Executive Director Piot Says

[May 06, 2008]

Russia should increase efforts to address HIV/AIDS among injection drug users to slow the spread of the disease, UNAIDS Executive Director Peter Piot said on Saturday during a conference on HIV/AIDS in the former Soviet Union, Reuters reports. According to Reuters, the former Soviet Union has the third-highest number of people living with HIV/AIDS worldwide.

IDUs account for about 80% of people living with HIV/AIDS in the region, and about one-third of IDUs in Uzbekistan are HIV-positive, Reuters reports. The region has "ploughed millions of dollars" into HIV prevention and treatment programs, and the number of new annual HIV cases decreased from 210,000 in 2001 to 150,000 in 2007. However, there has been a 150% increase since 2001 in the number of people living with the virus in the region to about 1.6 million.

Russia has not invested in methadone clinics or needle-exchange programs to help slow the spread of HIV among IDUs, according to Reuters. In addition, HIV-associated stigma is still widespread in the country. Piot said that the "big difference" between HIV epidemics in the former Soviet Union and other regions is that injection drug use is "so widespread" in former Soviet countries "compared to other countries in the world." Piot added that although the region is "on the right path, the right trajectory," it "is at a critical point," and "some difficult decisions have to be made."

At the conference, Piot also noted an increase in the number of women living with HIV/AIDS who are not IDUs or commercial sex workers -- a group previously considered less vulnerable to HIV. Women accounted for about 40% of new cases in Russia and Ukraine in 2007, nearly double the percentage in 2000, Piot said. "The question for me is: Is this the beginning of the generalization of HIV, is HIV getting out of the classic high-risk groups?" Piot asked (Kilner, Reuters, 5/3).

Russia Not Prepared To Implement Drug-Substitution Programs, Health Official Says

In related news, Gennady Onishchenko, Russia's chief public health officer, on Monday said that the country is "not ready" to implement some HIV-prevention measures related to drug use. According to Onishchenko, regulations are not sufficient enough for some initiatives, such as methadone replacement therapy for heroin users, to run properly. He added that he is "not convinced" about the efficacy of substitution therapy, which is illegal in Russia under current regulations. Even if such programs were effective, the clinics would "turn into shops for drugs" because of inadequate law enforcement, Onishchenko said.

However, Craig McClure, executive director of the International AIDS Society, said that there is much scientific evidence that supports the effectiveness of substitution programs. He added that such programs "could have a dramatic impact if implemented properly." In addition, Michel Kazatchkine -- executive director of the Global Fund To Fight AIDS, Tuberculosis and Malaria -- said that substitution therapy is a serious matter and should not become a political issue. "You have countries that are moving in the right direction ... and others that do not move," he said, adding, "Russia is like an isolated island. Where [injection] drug use drives over 60% of the epidemic, you cannot afford not to have a comprehensive approach."

Some advocates also said that Onishchenko's comments reflect the attitudes of the Russian government and overall population. According to Kazatchkine, few members of the country's national legislature or dominant political party support substitution programs. He added that the Moscow government is conservative in its methods of addressing HIV/AIDS. "There is a basic lack of political support," Kazatchkine said. In addition, there is widespread stigma and discrimination against IDUs, according to Onishchenko.

However, some advocates and officials say there has been some progress in Russia. Myths about HIV/AIDS are being addressed through measures such as television advertisements, McClure said. In addition, Russia has pledged about 9.3 billion rubles, or $392 million, for HIV/AIDS efforts in 2009 -- more than 20 times the amount spent in 2005. "The money is enough," Kazatchkine said, adding that the "question is whether the money is spent on the right things" (Nowak, AP/Google.com, 5/5).

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Group Launches Program To Expand Role of People Living With HIV/AIDS in Uganda

[May 06, 2008]

The International HIV/AIDS Alliance recently launched a three-year program in Uganda to expand the role of networks of HIV-positive people in an effort to improve the delivery of services and reduce stigma, Uganda's Monitor reports.

The program, called the Community Action Against the HIV/AIDS Scourge, will be launched in 27 districts in the country. With funding from USAID, IHAA will train people living with the disease to become network support agents to improve the delivery of HIV/AIDS services. Asaph Ivan Byamukama, IHAA financial and grants manager, said the program will connect service providers with HIV-positive people in order to increase utilization of the services. IHAA has purchased nine motorcycles and 37 bicycles -- as well as provided over 40 million Ugandan shillings, or about $24,000 -- to nine networks in the Jinja and Iganga districts.

Jinja District Health Officer Sarah Byakika said that a lack of strong networks is contributing to the expiration of pediatric antiretroviral drugs at health centers in the district. She added that nongovernmental organizations and the networks should be responsible for disseminating information about HIV/AIDS services to the community.

According to Byamukama, the major challenges faced by local communities are the failure of the Ministry of Health to provide antiretroviral treatment at all health units and a lack of community resources to allow HIV-positive people to receive services. In addition, community leadership is lacking, Byamukama said. Building the capacity of networks of HIV-positive people to address awareness, counseling and coordination is very important at this stage in the fight against the disease, Byamukama said. He added that there is "evidence that stigma is reduced when people living with the disease come together" (Mazige, Monitor, 5/3).

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'60 Minutes' Profiles Partners in Health Co-Founder Paul Farmer

[May 06, 2008]

CBS' "60 Minutes" on Sunday profiled Paul Farmer, co-founder of Partners in Health, which provides no-cost medical care for people with HIV/AIDS, tuberculosis, malaria and other conditions in Haiti and eight other countries worldwide. The group's work focuses on increasing access to medical care by lowering treatment costs and training local residents to provide care.

Jim Kim, professor at Harvard Medical School and a co-founder of Partners in Health, said that when Farmer "stared treating people in 1998 in Haiti, everyone said he was absolutely nuts," adding, "And here we are, you know, not even a decade later, where the goal is to treat every single human on the planet who needs HIV treatment with the right drugs."

According to "60 Minutes," Kim and Farmer also have worked to lower prices for drugs to treat multi-drug resistant TB by improving access to generics. In addition, the organization trains community health workers to visit HIV/AIDS and TB patients at home to ensure they adhere to their treatment regimens (Pitts, "60 Minutes," CBS, 5/4).

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Across The Nation

Texas AG Abbott Issues Opinion Allowing Prosecution of People Involved in Bexar County Needle-Exchange Program

[May 06, 2008]

Texas Attorney General Greg Abbott (R) on Monday issued an opinion saying that three advocates involved in an effort to launch a needle-exchange program in Bexar County, Texas, "appear to be subject to prosecution" for possession of drug paraphernalia, the Austin American-Statesman reports (MacLaggan, Austin American-Statesman, 5/6). The opinion means that Bexar County officials will not move forward with the planned needle-exchange program, which would have been the first in Texas, the San Antonio Express-News reports (Allen/Finley, San Antonio Express-News, 5/6).

The Texas House in May 2007 voted 71-60 to approve a provision in a Medicaid bill (SB 10) that would have established the needle-exchange program in Bexar County, which includes San Antonio. State Rep. Ruth McClendon (D), who sponsored the provision, initially tried to add an amendment that would have created a statewide program. However, the program was limited to the San Antonio area after the broader program failed to gain support in the House.

The Bexar County Commissioners Court in August 2007 unanimously voted to move forward with a pilot initiative to establish the program. The court voted to approve spending $60,000 for a staff position and planning costs for the program. Following the vote from the County Commissioner's Court, Bexar County District Attorney Susan Reed said that the law authorizing the exchange program was faulty and that she would not hesitate to prosecute anyone who distributes needles before the program is approved by county health officials (Kaiser Daily HIV/AIDS Report, 1/29).

Three people with the Bexar Area Harm Reduction Coalition were charged in February for possession of drug paraphernalia, and Abbott's opinion allows prosecutors to move forward in the case (Austin American-Statesman, 5/6). Abbott in the opinion left the prosecution of the three people up to Reed's discretion. "Participants in the program may, in the discretion of the prosecutor, be prosecuted under the Texas Controlled Substances Act," the opinion said (White, AP/Google.com, 5/5). Police have refiled the charges as a Class A misdemeanor, which carries a punishment of up to one year in jail and a $4,000 fine (San Antonio Express-News, 5/6).

Texas is the only state nationwide that does not allow needle-exchange programs, according to state Sen. Bob Deuell (R), who co-sponsored the original provision with McClendon. Deuell and McClendon both have said that they plan to reintroduce the legislation in 2009 (Austin American-Statesman, 5/6).

Aurora Sanchez -- Bexar County executive director of community and development programs, who supervised the exchange program -- said the county will continue to provide educational materials to injection drug users to prevent the spread of HIV and other bloodborne diseases (San Antonio Express-News, 5/6).

Reaction

Neel Lane, an attorney representing the coalition, said Abbott "reached an absurd conclusion ... that the Legislature somehow may have intended to criminalize the conduct of the people who carried out" the needle-exchange program (AP/Google.com, 5/5). He added that the "practical effect" of the opinion is that Reed "has the discretion to veto laws passed by the Legislature" and signed by the governor.

Cliff Herberg, first assistant district attorney for Bexar County, said the legislation "was faulty from the beginning" and "left open the possibility that needles would be distributed to underage kids." Herberg added that the Legislature "clearly didn't intend to create this program."

Sanchez said, "We were hoping the attorney general would see the value of operating the sterile needle exchange in toto, which included the distribution of sterile needles." She added, "But since it doesn't do that, it appears to me we have to wait until the legislation is changed in 2009" (San Antonio Express-News, 5/6).

State Sen. Jeff Wentworth (R), who asked the attorney general's office for its opinion, said that it is not the Legislature's intent for participants to be prosecuted and that lawmakers should address any problems with the legislation. "We're not in the business of passing bills that if people follow them, they would be charged with a crime," he said (AP/Google.com, 5/5).

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Opinion

HIV/AIDS Should Not Be 'Barrier' to Peace Corps Service, Editorial Says

[May 06, 2008]

HIV/AIDS should not be a "barrier" to serving in the Peace Corps, a Washington Post editorial says in response to a recent article by Post columnist Stephen Barr about the organization's policy regarding HIV-positive volunteers (Washington Post, 5/6).

According to Barr, Jeremiah Johnson, a former volunteer in Ukraine, recently was discharged by the agency after he was diagnosed as HIV-positive. Johnson discovered that he is HIV-positive in January during a scheduled medical exam that took place in Ukraine's capital of Kiev. Johnson said that a few days after the test results came back positive, the Peace Corps' Ukraine country director told him to return to Washington, D.C., because Ukrainian law prevents HIV-positive people from working in the country.

After returning to the district, Johnson in February had another medical exam and was given a "medical separation" from the Peace Corps, according to Barr. The agency on the separation notice said that it had determined the "resolution of [Johnson's] condition(s) will take longer than the maximum-allowable 45 days" and that Johnson "would be medically unable to perform [his] volunteer assignment."

According to Johnson, the Peace Corps' decision to end his assignment violates federal anti-discrimination laws. He was referred to the American Civil Liberties Union, which recently wrote to the agency's director, Ronald Tschetter. Peace Corps Press Director Amanda Beck said that Tschetter plans to respond to ACLU (Kaiser Daily HIV/AIDS Report, 4/29).

Although Beck has said that the Peace Corps does not have a policy of "automatically excluding people with HIV," the "fact remains" that Johnson was "booted from the Peace Corps because of his diagnosis," the editorial says. In addition, while Ukraine's policies regarding HIV-positive workers are "misguided and discriminatory, they cannot excuse the U.S. government," according to the Post. HIV "should not be a barrier to public service," the editorial says, adding, "Making it so, as in Mr. Johnson's case, is a waste of talent and goodwill." The editorial concludes that with all of the Peace Corps' "work in dealing with HIV/AIDS around the world, the agency should know that" (Washington Post, 5/6).

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PEPFAR Reauthorization Bills Should Address Increased Risk of HIV Among Women in Africa, Editorial Says

[May 06, 2008]

When reauthorizing the President's Emergency Plan for AIDS Relief, Congress should address the "cultural tragedy" that married women in Africa are at an increased risk of HIV, a Kansas City Star editorial says. According to the Star, women and young girls make up more than 60% of those living with HIV in Africa and as many as 75% of HIV-positive young people in sub-Saharan Africa. It adds that these figures in part are "due to women's lack of rights, including the inability to request that their husbands use condoms, or even their ability to refuse sex."

According to the editorial, the most effective way to reach women is during routine prenatal visits, when health professionals are more likely to discuss HIV/AIDS with women before they contract the virus or at least during the early stages of the disease. Therefore, PEPFAR funding should be made available in "family health clinics, where women can access HIV testing and treatment services early as they see doctors for their pregnancies," the editorial says. However, some PEPFAR funds are "being held hostage by unsubstantiated fears that the money would support doctors who perform abortions," the editorial says, adding that the "truth is that abortion is illegal" throughout most of the continent. "Integrating HIV prevention and treatment with women's other health care would save hundreds of thousands of lives," the editorial says, adding, "Current restrictions segregate HIV/AIDS assistance, in separate clinics. As a result, many women are not seen until they have AIDS, when it is too late for medicines to help" (Kansas City Star, 5/4).

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The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.