Politics and Policy

HIV/AIDS Advocates Petition Sen. Reid To Override Sen. Coburn's Block on PEPFAR Reauthorization Bills

[Jun 16, 2008]

In a petition generated by MoveOn.org recently presented to Senate Majority Leader Harry Reid (D-Nev.), advocates asked him to override seven Republican senators, led by Sen. Tom Coburn (R-Okla.), who are blocking a vote on measures (HR 5501, S 2731) aimed at reauthorizing the President's Emergency Plan for AIDS Relief, CQ Today reports. More than 15,000 people have signed the petition, according to CQ Today (Graham-Silverman, CQ Today, 6/13).

The Senate version of the PEPFAR reauthorization bill passed the Foreign Relations Committee in March, and the House version was approved 308-116 in April. Both the Senate and House versions of the bill would reauthorize PEPFAR at $50 billion over five years (Kaiser Daily HIV/AIDS Report, 4/4).

Coburn and six other Republican senators are blocking the legislation because they are opposed to the legislation's cost and "mission creep" into health and development efforts, CQ Today reports. In addition, they want language inserted into the measure that would guarantee that 55% of PEPFAR funding goes toward treatment, including antiretroviral drugs. Some advocates have said that they would agree to the treatment language but that efforts to compromise with Coburn have been ineffective. Coburn declined to comment on the negotiations.

According to CQ Today, it is unclear whether the legislation will reach the Senate floor this year. Supporters of the measure had hoped it would pass the Senate ahead of the Group of Eight industrialized nations summit in July. However, Reid's aides said there is nothing he can do in response to the petition. In addition, Senate Democrats have been unwilling to bring the measure to a floor vote because it would "give [President] Bush an item for his legacy on his way out of office," according to some advocates. "There's no political win for (Reid) if it passes," one advocate said.

Some other Republican senators also have expressed concern about the bill and an interest in offering amendments. In addition, Republicans are likely to criticize the $50 billion funding amount in the bill. Reid spokesperson Jim Manley said that the measure is a "priority" for Reid but that the bill "not only faces holds but also a ton of amendments."

Some international reproductive health groups, which are upset that the legislation does not link family planning programs and HIV prevention, have said it would be better to pass PEPFAR reauthorization legislation next year when there is a new administration. However, supporters have said the bipartisan support for the bill might not continue next year because of concerns over the U.S. economy.

In an effort to pass the measure ahead of the G8 summit and July 4 recess, supporters are launching an effort that will include a sit-in as early as this week in the Senate, as well as a protest march on June 26, CQ Today reports. Advocates also are encouraging the White House to increase pressure to pass the legislation. Mark Dybul, U.S. Global AIDS coordinator who administers PEPFAR, declined to comment on the negotiations but said they are ongoing. "Everyone's trying really hard right now," Dybul said (CQ Today, 6/13).

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G8 Nations Should Increase Aid to Africa To Meet 2010 Targets, Report Says

[Jun 16, 2008]

The Group of Eight industrialized nations should increase assistance to Africa in order to meet pledges to double aid to the continent by 2010, according to a report released on Monday in London by the Africa Progress Panel, the Washington Post reports. The report says that G8 progress toward meeting aid targets, which were set at annual summits in recent years, is a "mixed picture." Although wealthy nations have eliminated many debts owed by African countries, they have not done well on direct aid to the continent, according to the report. Unless major aid increases are made, most wealthy nations will be "well below" the collective target of $130 billion in aid by 2010, the report says. It adds, "We are in a situation where it is increasingly clear that traditional budgetary resources are too overstretched to meet aid pledges, unless innovative financing mechanisms are promptly put in place."

The report was released ahead of the G8 summit scheduled for July in Hokkaido, Japan. The Africa Progress Panel report "echoes criticism from President Bush, who has complained that other G8 countries have not fulfilled promises aimed at stemming AIDS and malaria," the Post reports. Bush during his weekly radio address on Saturday said, "To achieve this noble goal, all nations must keep their promises to deliver this urgent aid." White House officials have said that they expect Bush to make Africa a primary focus during the summit and that the U.S. is on target to double aid to Africa to $8.7 billion by 2010.

The Africa Progress Panel was created by former British Prime Minister Tony Blair and includes former United Nations Secretary-General Kofi Annan, former U.S. Treasury Secretary Robert Rubin, singer and advocate Bob Geldof, Nobel Peace Laureate Muhammad Yunus and former Nigerian President Olusegun Obasanjo. Annan in an interview praised Bush for his efforts for Africa but said that the U.S. should increase the percentage of its economy allocated to development assistance. Annan added that France and Japan should increase aid to Africa.

The report released on Monday is the first from the panel and focuses on increasing food prices, according to the Post. According to the report, food prices are threatening to reverse gains made in addressing HIV/AIDS, reducing poverty and boosting economic growth. "Unless some way can be found to halt and reverse the current trend in food prices, there will be a significant increase in hunger, malnutrition, and infant and child mortality," the report says. It adds, "Many countries are already experiencing the reversal of decades of economic progress, and 100 million people are being pushed back into absolute poverty."

The report makes a variety of recommendations, including increasing emergency assistance to the U.N. World Food Programme, eliminating food tariffs and pledging new investments to bolster agricultural productivity. According to Annan, the focus of the July G8 summit should be to fulfill commitments already made to Africa. Speaking about recent economic gains, Annan said, "All this could be rolled back by the food crisis, a lack of follow-through of promises made. ... What we really ask of the G8 is not to make new promises but to meet the promises that have already been made" (Abramowitz, Washington Post, 6/16).

The report is available online.

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Across The Nation

More Than Half of AIDS-Related Deaths in Washington, D.C., Not Reported, Analysis Finds

[Jun 16, 2008]

More than half of the AIDS-related deaths that occurred in Washington, D.C., from 2000 to 2005 were missed by the city's system for reporting such deaths, according to an analysis by the district's Department of Health and CDC that was published recently in CDC's Morbidity and Mortality Weekly Report, the Washington Post reports. The underreporting of AIDS-related deaths suggests that the epidemic "may be taking a far greater toll" on the district than health officials had originally thought, according to the Post.

For the analysis, city health officials worked with CDC to review all death certificates from 2000 to 2005 in an effort to identify deaths that appeared to be AIDS-related. They compared that number with the deaths that had been reported and discovered the discrepancy, the Post reports. According to the analysis, of the 2,460 deaths from AIDS-related illnesses that occurred between 2000 and 2005, 1,337 had not been reported because the city's system for tracking them was "inadequate," the Post reports. Officials launched the investigation because of health officials' increasing concern that they were undercounting the number of district residents living with HIV and those dying of AIDS-related causes, in part because they discovered boxes of unexamined paper records. Shannon Hader, senior deputy of the health department's HIV/AIDS Administration, said the analysis "tells us our surveillance system wasn't complete enough," adding, "We're clearly underreporting."

According to the Post, at least 12,500 district residents have developed AIDS -- one of the highest rates in the country -- and officials estimate that between 3% and 5% of people living in the city are HIV-positive. Hader said that in order to curb the spread of HIV in the district and ensure that HIV-positive people receive appropriate care, the department needs an "accurate count." In addition, the amount of federal HIV/AIDS funding the district receives is based on such estimates, Hader said, adding, "We want everything they owe us."

In response to the findings, Hader said the district has initiated several efforts to improve its reporting system, including a mass mailing in January to about 4,000 physicians and laboratories to try to increase the number of reported diagnoses. Officials also have begun routinely reviewing death records and have launched a campaign to try to identify more people for treatment.

"What we need to do is get more people who don't know they have HIV diagnosed and into care and treatment," Hader said, adding, "Every time you go into a health care provider, they should be offering to test you for HIV. We want to drive down the number of people living with HIV and [who] don't know about it" (Stein, Washington Post, 6/14).

The analysis is available online.

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Sponsors of South Carolina Bill That Would Modify Regulations Concerning HIV-Positive Students Will Attempt To Override Veto

[Jun 16, 2008]

The sponsors of a South Carolina bill that would modify regulations concerning HIV-positive students in the state have said that they will attempt to override a recent veto by Gov. Mark Sanford (R) when the General Assembly meets later this month, the Columbia State reports (Smith, Columbia State, 6/13).

Sanford last week vetoed the bill, which was approved by the state House last month. The bill would require school nurses to inform the Department of Health and Environmental Control when any student in grades kindergarten through 12 has contact with another person's blood in order to determine if the student was exposed to bloodborne diseases such as HIV. Under the bill, DHEC would notify school nurses if a student involved in incidents such as fights or sports injuries had HIV, hepatitis or any other bloodborne disease and would advise about medical treatment. Clinics and doctors' offices would continue to inform DHEC of positive test results under the bill, which would stipulate that the names of students living with the diseases be known only to DHEC. Under current state law, school nurses and superintendants are notified by DHEC when they have HIV-positive students at their schools (Kaiser Daily HIV/AIDS Report, 6/12).

"In the interest of health and safety for all children, DHEC should continue to notify the proper school officials if a child has" HIV/AIDS, Sanford wrote in his veto message. He added, "If anything, we would take this law a step further by adding two other highly contagious bloodborne diseases -- hepatitis B as well as hepatitis C."

Rep. Bakari Sellers (D), who drafted the bill with Sen. Brad Hutto (D) and Rep. Kris Crawford (R), said that federal law prevents school nurses from sharing information about HIV-positive students with other staff, parents or students. "They can't do anything with the information," Sellers said, adding that the current notification system is useless. Sanford in his veto message acknowledged that the federal law prevents the information from being shared. "But I see no reason that state law should codify this misguided principle that is now, indeed, codified at the federal level of law."

Supporters of the measure have said that South Carolina's current law could discourage students from receiving HIV tests. HIV is "ravaging our communities, particularly African-American communities," Sellers said, adding, "We don't need barriers that prevent people from getting tested. We need to break down all the barriers we can." Bambi Gaddist, executive director of the South Carolina HIV/AIDS Council, said, "What we're talking about is violating someone's right to medical privacy based on their age and based on one health condition." She added, "The question is why do (school officials) need access to this information?" (Columbia State, 6/13).

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Global Challenges

HIV/AIDS Hinders Children's Access to Education, UNDP Official Says

[Jun 16, 2008]

Children who lose one or both parents to HIV/AIDS are unlikely to remain in school and finish their education, Robert Greener, senior economic adviser at the United Nations Development Programme, said at the World Bank's Annual Bank Conference on Development Economics in South Africa recently, the Inter Press Service reports.

According to Greener, HIV/AIDS hinders "knowledge and skills transmission from one generation to the next, which, over time, results in the loss of human capital." He said, "This also has an impact on economic growth. Economies need educated and skilled people." Children who live in communities with an HIV prevalence of more than 10% go to school for a half a year less than children in other communities, according to Inter Press Service. Natalia Trofimenko of the Kiel Institute for the World Economy said that children who live in female-headed households are more likely to remain in and complete school. Trofimenko said, "In African households, it is usually the father who decides whether a child goes to school or not. However, it is the mother who decides how long the child will enjoy an education."

According to Aparnaa Somanathan, a World Bank health economist, HIV/AIDS more negatively affects the education of girls than boys because the eldest female child is usually pulled out of school, especially after the death of a mother. Samwel Otieno of Kenya's Ministry of Agriculture also said that girls' education is likely to end when they are married at an early age. Trofimenko added that financial constraints related to HIV/AIDS treatment can prevent children from completing school. However, she added that it is vital to provide HIV-positive adults with antiretroviral drugs. "Postponing the death of parents is crucial," Trofimenko said, adding, "When extending the life of the parents, you not only improve the child's overall quality of life but you also increase his or her chance to complete school. This has a positive impact on a child's life later on."

According to U.N. figures, the number of AIDS orphans worldwide has increased from 8.5 million in 2000 to 14 million in 2006. About 80% of them live in Africa (Mannak, Inter Press Service, 6/12).

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Unsafe Blood Transfusions, Medical Practices in Central Asia Contributing to Spread of Infectious Diseases, Including HIV, World Bank Report Says

[Jun 16, 2008]

Unsafe blood transfusion services and medical practices in Central Asian countries are contributing to the spread of HIV and other infectious diseases in the region, according to a report recently released by the World Bank, Kazakhstan Today/Gazeta.kz reports. According to the report, of all the people living with HIV worldwide, 5% to 10% contracted the virus through contaminated blood transfusions (Kazakhstan Today/Gazeta.kz, 6/13).

For the report, the World Bank -- in collaboration with CDC, the World Health Organization Regional Office for Europe and Ministries of Health in the region -- re-tested 7,500 blood donor samples from Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan. The test included an ALT test, which detects liver injuries that are caused by all types of hepatitis. The re-testing identified the prevalence of some infectious diseases in the blood samples, including 0.2% for HIV, 2.7% for hepatitis B, 3% for hepatitis C and 3.6% for syphilis. The results indicate that current screening methods for donated blood in the countries studied might not be fully effective, according to the report. The report also found that some health facilities in the countries did not test blood donations at all.

The report recommends that countries in Central Asia implement measures to improve blood services, including establishing nationally coordinated blood transfusion systems and universal unpaid blood donor systems, as well as optimizing laws, regulations and donor promotion campaigns. Attention also must be placed on effective donor screening strategies, training of medical personnel, and promoting the use of blood and blood products. In addition, international support is critical to assisting the countries to restructure their health systems and to prevent disease transmission, the report noted.

"Numerous parts of these countries' blood transfusion systems are in serious need of restructuring, of new investments and of increased budgetary support for operation and maintenance," Patricio Marquez, lead health specialist at the World Bank and author of the report, said. He added, "These findings underscore the need to strengthen screening of blood donors for each donation and strengthen other prevention and control measures to guarantee the safety of the blood supply in the health systems of the Central Asia countries. Such improvements would reduce the potential risk of involuntary infection to the unsuspecting population" (AKIpress, 6/13).

The report is available online (.pdf).

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Drug Access

NPR Program Examines Brazil's Antiretroviral Program, Efforts To Collaborate With Other Countries To Fight HIV

[Jun 16, 2008]

NPR's "Tell Me More" on Thursday included a discussion with Brazil's HIV/AIDS program director Mariangela Simao. Simao discussed progress in Brazil's no-cost antiretroviral program and the country's efforts to collaborate with Portuguese-speaking countries in Africa on HIV prevention.

According to Simao, 180,000 Brazilians are receiving no-cost antiretroviral treatment, one of the highest numbers among developing countries. An additional 15,000 to 17,000 people annually enroll in the treatment program, Simao said. Brazil aims to achieve universal access to HIV treatment and to make the country's antiretroviral program sustainable in the long term, Simao added.

Simao also discussed Brazil's efforts to provide materials on HIV/AIDS and collaborate on prevention activities with Portuguese-language speaking countries in Africa. According to Simao, the United Nations, Brazilian government, and health and women's affairs ministries from Portuguese-speaking countries met in Brazil last month to discuss ways to address HIV/AIDS and gender issues (Corley, "Tell Me More," NPR, 6/12).

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