Kaisernetwork.org (Washington, DC)
14 May 2008
Politics and Policy
Republican Senators Advocate Legislation That Would Specify Treatment Goals for PEPFAR
Global Challenges
Microsoft Official Named New Head of Gates Foundation
Jamaica Program Aims To Help Older Family Members Provide Care for HIV-Positive Children
London's Guardian Profiles HIV/AIDS Advocate, Author Pisani
Public Health & Education
Increased Evidence Finds Exercise Beneficial to HIV-Positive People, Sacramento Bee Reports
Opinion
U.S. Should Repeal HIV/AIDS-Related Travel Restrictions, Opinion Piece Says
Politics and Policy
Republican Senators Advocate Legislation That Would Specify Treatment Goals for PEPFAR
[May 14, 2008]
A group of Republican senators at a press conference on Tuesday advocated for legislation that would set specific treatment goals for the President's Emergency Plan for AIDS Relief, CQ HealthBeat reports.
The lawmakers said the Save Lives First Act (S 2749) would do more to address mortality and illness rates among people living with HIV/AIDS than the current PEPFAR reauthorization bills (HR 5501, S 2731).
At the press conference, Sen. Tom Coburn (R-Okla.), the bill's sponsor, presented a comparison of the number of people in need of antiretroviral treatment over the next five years under his bill with the number under the current PEPFAR reauthorization bills. Coburn's data showed that the number of people who need antiretroviral therapy or who have a life expectancy of less than three years would level off under his legislation, according to CQ HealthBeat.
In April, Coburn said that he might block attempts to pass the House and Senate bills that would reauthorize PEPFAR. He said that the current bills have "irresponsible spending levels," adding that he wanted to expand HIV testing and preserve a requirement in the existing law that 55% of PEPFAR funding be spent on treatment and prevention of mother-to-child transmission. The reauthorization bills do not contain treatment formulas, CQ HealthBeat reports.
However, Coburn noted at the press conference on Tuesday that he supports funding levels in the reauthorization measures and that his current goal is to restore a treatment target. "Any HIV/AIDS bill that moves through the Congress must prioritize saving lives," Coburn said in a release.
Michael Weinstein -- president of the AIDS Healthcare Foundation, which sponsored the press conference -- said the current reauthorization legislation would nearly triple funding but only raise treatment levels by 50%, from two million to three million, CQ HealthBeat reports.
"Critics of our proposal say you cannot treat your way out of AIDS, but their proposal is to die your way out," Weinstein said (Cooley, CQ HealthBeat, 5/13).
Related Editorial
It is the "nature of the Senate that the smallest of minorities can impede the work of the majority," Washington Post columnist Michael Gerson writes in an opinion piece, adding, "But it takes a conscious choice -- an act of tremendous will and pride -- for members to employ these powers against" PEPFAR reauthorization legislation, which has "overwhelming bipartisan support."
The seven Republicans -- Sens. Jim Bunning (Ky.), Richard Burr (N.C.), Saxby Chambliss (Ga.), Tom Coburn (Okla.), Jim DeMint (S.C.), Jeff Sessions (Ala.) and David Vitter (La.) -- who have signed a letter to delay action on PEPFAR reauthorization legislation "complain that the reauthorization is too costly," Gerson writes. He adds that for all of conservatism's "evident virtues, it can have one furtive, seedy vice: A justified suspicion of government can degenerate into an anti-government ideology -- rigid, stingy and indifferent to human suffering."
Concerns from some conservatives about "family planning and abstinence in the PEPFAR reauthorization are not imaginary, but they could be resolved through good-faith negotiations," Gerson writes, adding, "A generalized hostility toward AIDS prevention, however, is destructive." In addition, the 55% funding target for treatment "would force the program to waste money in pursuit of an arbitrary, nonsensical spending target," according to Gerson.
In addition, Sen. Majority Leader Harry Reid (D-Nev.) "supports the legislation but seems uninterested in scheduling floor time without assurances from Republicans that the debate will be short and the number of amendments limited," Gerson writes. He adds that if the legislation passes, President Bush "will get much of the credit." According to Gerson, the "political calculation must be tempting: Why not allow seven white Republicans to discredit their party by blocking a lifesaving bill for Africa?"
Gerson writes that each of the seven senators "counts himself pro-life," adding, "If a bill came to the Senate floor that would save millions of unborn children, one assumes that pro-life members would push to improve it." He concludes, "It is difficult to imagine why pro-life legislation involving millions of Africans should be viewed differently" (Gerson, Washington Post, 5/14).
Link to this story.
Global Challenges
Microsoft Official Named New Head of Gates Foundation
[May 14, 2008]
Microsoft executive Jeffrey Raikes on Monday was named the new CEO of the Bill & Melinda Gates Foundation, the New York Times reports. Raikes will replace Patty Stonesifer, who in February announced that she will step down from her position (Strom, New York Times, 5/13). Raikes joined Microsoft in 1981 and most recently served as president of the company's business software division (Rucker, Washington Post, 5/13). He will start at the Gates Foundation on Sept. 2, a day after he retires from Microsoft (New York Times, 5/13).
As head of the Gates Foundation, Raikes will manage a $37 billion endowment, $3 billion annually in grants and "ambitious goals," such as developing an HIV/AIDS vaccine and eradicating malaria, the Seattle Times reports (Heim, Seattle Times, 5/12). According to the New York Times, the Gates Foundation is growing quickly, "in part to satisfy the terms set by the billionaire investor Warren Buffett when he committed the bulk of his fortune to it." The terms of Buffett's gift require the Gates Foundation to spend the full amount of his annual donation within one year, over and above what foundations must spend under U.S. law (New York Times, 5/13).
Raikes "brings more than 25 years of experience in the private sector and has earned a reputation as a trusted and respected leader," Melinda Gates said in a statement, adding, "Equally important, he shares our passion for these issues and for continuing [Stonesifer's] work to build a great culture at the foundation. [Raikes] is the right CEO to lead the strategies we have in place to help reduce inequities we have in the Untied States and around the world."
Raikes said that "joining the Gates Foundation is an honor and a once-in-a-lifetime opportunity to focus on improving the lives of others." He added, "I am thrilled to join Bill and Melinda and this team, because I'm convinced that through strong partnerships, ambitious goals and a commitment to impact, we can transform people's lives"
Bill Gates said that Raikes is a "smart, independent thinker who's passionate about using innovation to help people change their lives" (Seattle Times, 5/12).
A Wall Street Journal interview with Raikes is available online.
NPR's "All Things Considered" on Monday included a discussion with the Gateses about Raikes and the foundation (Norris, "All Things Considered," NPR, 5/12).
Link to this story.
Jamaica Program Aims To Help Older Family Members Provide Care for HIV-Positive Children
[May 14, 2008]
The Jamaica Gleaner on Monday profiled a program in the western part of the country aimed at improving the treatment outcomes of HIV-positive children. According to the Gleaner, "the burden of care" for many children living with and affected by HIV/AIDS has fallen on older female family members -- such as aunts, grandmothers and great-grandmothers -- in part because HIV-positive mothers are dying young, often in their early 20s.
The program is run by the Cornwall Regional Hospital pediatric clinic to improve treatment outcomes and provide a support network for 63 HIV-positive children in western Jamaica. The program includes grandmothers, great-grandmothers, fathers, aunts, uncles and other relatives. In addition, nine grandmothers and great-grandmothers assist pediatrician Tracy Evans-Gilbert in ensuring the children they care for adhere to treatment regimens. Of the 54 children who are part of the treatment adherence program, the five who have undetectable HIV viral loads are taken care of by either a grandmother or great-grandmother. "Children whose caregivers miss doses or don't give it to them on time don't do well," Evans-Gilbert said, adding that "children whose caregivers are vigilant have undetectable levels of HIV and get healthy."
Despite the success of the program, there are still physical and medical challenges for older caregivers, the Gleaner reports. Evans-Gilbert said that children whose grandparents or great-grandparents are unable to administer treatment properly because of health or other challenges are not placed on antiretroviral regimens. In addition, such caregivers often face difficulties finding money to feed the children and to pay for transportation to take them to clinics and collect their medication. About 45% of Jamaican households are headed by women, who are more likely to face economic hardship because of high female unemployment levels and jobs that offer unskilled women irregular hours and low wages (Jamaica Gleaner, 5/12).
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London's Guardian Profiles HIV/AIDS Advocate, Author Pisani
[May 14, 2008]
London's Guardian on Tuesday profiled HIV/AIDS advocate and author Elizabeth Pisani. Pisani, an epidemiologist and medical demographer, spent 10 years working on HIV/AIDS issues for UNAIDS and a nongovernmental organization in Indonesia before leaving the field to write her new book, called "The Wisdom of Whores."
According to Pisani, there are two separate HIV/AIDS epidemics -- one in Africa, and one in the rest of the world -- the Guardian reports. In Africa, HIV is primarily spread by heterosexual, noncommercial sex. In other parts of the world, data show that injection drug users, sex workers and men who have sex with men are the most at risk of the virus, Pisani said.
In her book, Pisani says that current HIV/AIDS efforts have become more centered on poverty, gender, development, vulnerability and leadership issues -- or what she calls "sacred cows." According to Pisani, condom use and needle-exchange programs would be more effective at curbing the spread of the virus outside of Africa. "We have to stop this nonsense now," she said, adding, "Talking about 'vulnerability' will not stop people" from contracting HIV/AIDS.
"We could knock this epidemic in the rest of the world on the head -- just like we've knocked so many things on the head in the rest of the world -- but we're not doing it, largely because of the paradigm that we're developing in Africa," Pisani said, adding, "The AIDS industry has become an island unto itself, in a sea of common sense. That's the tragedy of it. It's unsayable" (Aitkenhead, Guardian, 5/13).
Link to this story.
Public Health & Education
Increased Evidence Finds Exercise Beneficial to HIV-Positive People, Sacramento Bee Reports
[May 14, 2008]
An increasing amount of evidence is finding that exercise can improve the health of HIV-positive people and reduce the risk of AIDS-related illnesses by increasing muscle mass and improving heart and lung endurance, the Sacramento Bee reports. Many people living with HIV/AIDS have begun or resumed exercise regimens since the development of antiretroviral drugs in the 1990s, according to the Bee.
Archana Maniar, an infectious disease specialist and assistant professor at the University of California-Davis, said that HIV-positive people need regular exercise just like HIV-negative people. HIV-positive people are living longer and developing diseases such as diabetes, hypertension, cardiovascular disease and strokes, Maniar said. "From that standpoint, exercise promotes their general wellness and increases their chances of avoiding those things," Maniar added.
A 2006 Massachusetts General Hospital study found that exercise helps manage the symptoms of metabolic syndrome, which some studies indicate as many as 45% of HIV-positive people have. Metabolic syndrome increases the risk of heart disease and diabetes. In addition, a 2005 Columbia University study found that moderate exercise in combination with antiretroviral treatment leads to improved nervous system function and circulation among people living with HIV/AIDS. Many HIV-positive people also say they exercise for psychological benefits. "For me, the effects are more psychological than biochemical," Bob Katz -- a member of the Positive Pedalers, a cycling group with HIV-positive members in California -- said, adding, "Having a sense of self-worth, feeling comfortable in your body, is something exercising will do" (McManis, Sacramento Bee, 5/13).
Link to this story.
Opinion
U.S. Should Repeal HIV/AIDS-Related Travel Restrictions, Opinion Piece Says
[May 14, 2008]
It "seems unthinkable" that the U.S. -- the "country that has been the most generous in helping people with HIV" -- would "legally ban all non-Americans who are HIV-positive," Andrew Sullivan, a senior editor of Atlantic magazine, writes in a Washington Post opinion piece. However, the "leading center of public and private HIV research discriminates against those with HIV," he adds (Sullivan, Washington Post, 5/14).
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.
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.
The Senate Foreign Relations Committee in March 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 (Kaiser Daily HIV/AIDS Report, 3/25).
Sullivan, who is HIV-positive, writes that with "great lawyers, a rare" type of visa, a "government-granted HIV waiver and thousands of dollars in legal fees," he has "managed to stay in" the U.S. However, because he his HIV-positive, he is "not eligible to become a permanent resident," according to Sullivan.
HIV is "the only medical condition permanently designated" in the Immigration and Nationality Act "as grounds for inadmissibility" to the U.S., Sullivan writes, adding that the restrictions "can be traced to the panic that dominated discussion" of the virus "two decades ago." Many non-Americans with HIV "live in fear of being exposed" and "have to hide their medications when entering the country for fear of being discovered by customs or immigration," according to Sullivan. He adds, "Couples have been split up and torn apart," and international HIV/AIDS conferences "have long avoided meeting in the United States because of the ban, which violates [United Nations] standards for member states."
The travel restrictions have "lasted so long because no domestic constituency lobbies" for their repeal, Sullivan writes, adding that immigrants or visitors "with HIV are often too afraid to speak up" and that the restrictions are "largely unenforceable." The "result is not any actual prevention of HIV coming into the United States but discrimination against otherwise legal immigrants who are HIV-positive," according to Sullivan.
"In the end, though, removing the ban is not about money," Sullivan writes, adding, "It's a statement that the United States does not discriminate against people with HIV and does not retain the phobias of the past." In addition, it is "worth remembering that we are talking about legal immigrants and visitors, people who go through the process and seek to participate and contribute to this country," according to Sullivan. "People with HIV are no less worthy of being citizens of the United States than anyone else," Sullivan writes, concluding, "All we ask is to be able to visit, live and work in America and, for some of us, to realize our dream of becoming Americans -- whether we are HIV-positive or not" (Washington Post, 5/14).
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