Kaisernetwork.org (Washington, DC)
27 June 2008
Politics and Policy
Senate Attempts To Pass PEPFAR Measure, Faces Continued Block Over Cost; PEPFAR Issues Annual Report
[Jun 27, 2008]
Senators on Thursday attempted to pass measures (HR 5501, S 2731) that would reauthorize the President's Emergency Plan for AIDS Relief, but Republican opponents of the legislation vowed to continue to block it because of its cost, Reuters reports. Wesley Denton, a spokesperson for Sen. Jim DeMint (R-S.C.) said, "Senator DeMint objects to a huge increase in deficit spending and the lack of real oversight to ensure funds are going for medical purposes to help those in need."
On Wednesday, "progress toward passing the bill in the Senate" came after negotiators reached an agreement on funding allocation (Cowan, Reuters, 6/26). Under the agreement, "more than half" of PEPFAR funding would go to treatment. The agreement also requires that antiretrovirals used in PEPFAR programs be approved by FDA or another approved regulator agency. In addition, the agreement prevents PEPFAR funding for wealthier developing nations, such as China and Russia (Kaiser Daily HIV/AIDS Report, 6/26).
The bill's supporters sought to pass the legislation before President Bush leaves for the Group of Eight industrialized nations summit, which begins July 7 in Japan. The House passed its version of PEPFAR reauthorization in April (Reuters, 6/26). Bush has said he would like it to pass in Congress so he can use it at the summit to call for increased contributions from other countries (Kaiser Daily HIV/AIDS Report, 6/26).
PEPFAR Report
In related news, PEPFAR on Thursday released a report that found the program is helping to supply antiretroviral drugs to 1.73 million people worldwide, mostly in sub-Saharan Africa, up from 50,000 in the region when the program began in 2003 (Reuters, 6/26). "Only a few years ago, many doubted whether prevention, treatment and care could ever successfully be provided in resource-limited settings, where HIV was a death sentence," Ambassador Mark Dybul, who administers PEPFAR, said. He added, "Today, while much remains to be done, the skeptics have been proven wrong. Millions of people are on life-saving antiretroviral treatment in developing countries, and many millions more have benefited from prevention and care programs ." Since the program's inception, PEPFAR has supported prevention of mother-to child-transmission for women during more than 12.7 million pregnancies. For pregnant women found to be HIV-positive, it has provided antiretroviral prophylaxis in more than one million pregnancies, preventing transmission of HIV to an estimated 194,000 infants. (PEPFAR release, 6/26).
The report is available online (.pdf).
Related Editorial
"It will be irresponsible if PEPFAR isn't reauthorized, and successful life-saving health programs and treatments are disrupted, before the current legislation expires," a Contra Costa Times editorial says. "We urge the Senate to approve" the legislation "before its July 4 break or Aug. 11 recess," the editorial says (Contra Costa Times, 6/26).
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Public Health & Education
Communities Nationwide Recognize National HIV Testing Day; U.S. First Lady Addresses Importance of Testing
[Jun 27, 2008]
Communities nationwide on Friday will promote and offer no-cost HIV screenings to mark National HIV Testing Day, the South Florida Sun-Sentinel reports (Torbati, South Florida Sun-Sentinel, 6/26). According to HHS, an estimated 250,000 people in the U.S. are HIV-positive and are not aware of their status. HIV/AIDS is severely impacting the black and Hispanic communities, as well as men who have sex with men in all groups, Kevin Fenton -- director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention -- said (Coley, Charleston Post and Courier, 6/26). CDC in 2006 recommended that written consent and pretest counseling requirements be dropped; however, many physicians and health care facilities have not "embraced" the approach, according to the Sun-Sentinel. In addition, evidence suggests that people who are unaware of their HIV-positive status do not get tested for the virus, even after visiting emergency departments or physicians multiple times, according to Marlene LaLota, HIV prevention director for the Florida Department of Health (South Florida Sun-Sentinel, 6/26).
A Charlotte Observer Q&A with first lady Laura Bush is available online. In addition, a survey from Test for Life about attitudes toward HIV/AIDS, testing and other issues is available online.
Link to this story.
HIV Diagnoses Among MSM Ages 13-24 Increased by 12% Annually From 2001 to 2006, CDC Report Says
[Jun 27, 2008]
The number of new HIV diagnoses recorded between 2001 and 2006 among men who have sex with men ages 13 to 24 increased by 12.4% annually, according to a study published Thursday in CDC's Morbidity and Mortality Weekly Report, the New York Times reports. Some experts said the findings are an "ominous ... indicator" that the HIV/AIDS epidemic continues to flourish among MSM, the Times reports.
For the study, CDC analyzed data from 33 states but did not include statistics from states with large minority and MSM populations, including California, Illinois and Georgia (Tuller, New York Times, 6/27). The study found that of the 214,379 HIV diagnoses recorded during the study period, 46% were among MSM. Although the rate of new diagnoses increased for MSM, it declined in all other transmission categories, including injection drug use and high-risk heterosexual contact, Reuters reports. Among all MSM, the estimated annual percentage change was 1.5%, according to the study (Reuters, 6/26). Among MSM ages 25 to 44, the rate of new diagnoses declined by 1%. In addition, among MSM ages 45 and older, the rate increased by 3%, the study found. Among MSM ages 13 to 24, the annual increase was 8% among Hispanics, 9% among whites and 15% among blacks. According to the Washington Post, the increase among young MSM is about 10 times higher than the overall MSM community.
Previous studies have found that black MSM on average have fewer sexual partners, are less likely to use drugs and are no more likely to have unprotected sex than white MSM. The higher rate recorded among black MSM, therefore, does not seem to stem from riskier behavior but rather the higher prevalence of HIV and other sexually transmitted infections that can increase a person's likelihood of contracting the virus (Brown, Washington Post, 6/27).
"To reduce transmission of HIV among MSM of all races/ethnicities, prevention strategies should be strengthened, improved and implemented more broadly," the report said. The report added that HIV testing is important because "after persons become aware that they are HIV-positive, most reduce their high-risk sexual behavior" (Reuters, 6/26). According to the report, some of the increase could be because of higher rates of HIV testing among MSM. However, it added that "available data suggest that these increases cannot be explained by increases in testing alone" (New York Times, 6/27).
Comments
Richard Wolitski, acting chief of prevention research in CDC's Divisions of HIV/AIDS Prevention, said that MSM ages 13 to 24 "represent a new generation that has not been personally affected by AIDS in the same way that their older peers were." Ron Simmons, president of Us Helping Us, said the revolution in antiretroviral therapy during the last 10 years appears to have lessened the fear of HIV transmission. "I can remember going to a funeral every four or five days," Simmons said, adding, "Now, if you talk to some of these young men, they say, 'If I do get infected, I will simply take the blue pill or the pink pill, like my friend.'"
Phill Wilson, head of the Black AIDS Institute, said, "When you see a 15% yearly increase, that is an epidemic that is out of control." He added, "And yet we don't see a response that recognizes it is an epidemic out of control" (Washington Post, 6/27). "It's a grim report," Ronald Stall, an epidemiologist and professor of public health at the University of Pittsburgh, said, adding, "It means roughly speaking that about half of the American AIDS epidemic is occurring among a few percent of the adult population. And the terrible trends we're seeing among white gay men are even amplified further among minority men."
Jennifer Hecht, education director at the Stop AIDS Project, said that lack of access to information is a key factor in the increase of new diagnoses. "In a lot of ways, this is connected to the administration's policy of emphasizing abstinence-only education," Hecht said, adding, "And the high rates we see among black men and other minorities indicate that it's very much connected to larger issues, like poverty and racism" (New York Times, 6/27).
The study is available online.
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Many People Who Know, Trust Sex Partners Assume Low Risk of HIV, Other STIs, Study Finds
[Jun 27, 2008]
Many people who know their sexual partners well consider themselves to be at a low risk of sexually transmitted infections, including HIV, according to a study published in the June issue of Sexually Transmitted Diseases, Reuters reports.
For the study, Cindy Masaro of the University of British Columbia and colleagues distributed questionnaires to 317 men and women who were attending an STI clinic for the first time and had not yet been diagnosed with an STI. The questionnaire asked whether people could be "pretty sure" a sex partner was "safe" in certain circumstances, such as if they knew the partner well, knew the partner's friends or believed they could trust the partner.
The study found that people often considered subjective measures in determining whether a sex partner would put them at increased risk for HIV and other STIs. Many people determined their partner's "safety" based on how long they had known the partner or on how intelligent or well-educated the partner was. In addition, 70% of participants said they probably would consider a partner "safe" if the partner generally was trustworthy.
According to the researchers, earlier studies have found that although many people are "confident in their assessments of their partner's character," their knowledge of their partner's STI risk often is inaccurate. The researchers said that interventions that "target assumptions of safety and dispel incorrect beliefs about the selection of safe partners [are] needed to promote safer-sexual behavior" and reduce the risk of STI transmission (Reuters, 6/25).
An abstract of the study is available online.
Link to this story.
Global Challenges
HIV/AIDS Epidemic in Sub-Saharan Africa Should Be Classified as Disaster, Red Cross Report Says
[Jun 27, 2008]
The HIV/AIDS epidemic in sub-Saharan Africa is so severe that it should be classified as a disaster comparable to famine or floods, according to a report released Thursday by the International Federation of Red Cross and Red Crescent Societies, AFP/Google.com reports. In its annual report, titled "World Disasters Report 2008," IFRC said there is "no doubt" that HIV/AIDS matches the United Nations' definition of a disaster.
According to AFP/Google.com, the U.N. Office for the Coordination of Humanitarian Affairs defines a disaster as a "serious disruption of the functioning of a society, causing widespread human, material or environmental losses which exceed the ability of a society to cope using only its own resources." IFRC said that such a situation exists in sub-Saharan Africa, where about two-thirds of the world's people with HIV live. The report noted that at least one in 10 people is HIV-positive in countries such as Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. In addition, the social tension and economic strain related to the disease are felt by everyone in a country and not just those living with the disease.
"Reflecting on the lives of most people living in sub-Saharan Africa raises more alarm than hope," the report said, adding that HIV/AIDS "is directly responsible for restraining and reducing human and resource capacities across societies because HIV infections and AIDS[-related] deaths are common among workers of all qualifications and expertise, and in all industries." The report noted that along with the "high costs of caring for people living with HIV, those capacity constraints lead to withered health and education systems, declining food security, skilled labor shortages and an increasingly ramshakled infrastructure" (AFP/Google.com, 6/25).
IFRC said that ignoring HIV/AIDS as a disaster exposes people to unnecessary risks. According to the report, relief workers should do more to prevent unsafe blood donations, protect women and children from rape and minimize disruptions in HIV treatment. In addition, low-cost measures and better planning should be implemented to minimize the risk of spreading the disease in a disaster zone (AP/International Herald Tribune, 6/26). The report also called on governments and humanitarian agencies to pay more attention to HIV/AIDS in their response to armed conflicts, as well as the growing rate of transmission among vulnerable groups, including injection drug users, commercial sex workers and men who have sex with men (Evans, Reuters, 6/25).
Mukesh Kapila, IFRC's special representative for HIV/AIDS, said, "It's a question of adding HIV as a dimension in planning a response to disasters." He added, "Let's not forget that the HIV disaster takes place invisibly. A few [cases] here, a few hundred there, if you add up the numbers, it's a major disaster for many communities" (AP/International Herald Tribune, 6/26).
The report is available online.
Link to this story.
Across The Nation
South Carolina Legislature Upholds Governor's Veto of HIV Notification Bill
[Jun 27, 2008]
South Carolina legislators on Wednesday during a special session upheld Gov. Mark Sanford's (R) veto of a bill that would modify regulations concerning HIV-positive students in the state, the AP/Augusta Chronicle reports. The House upheld the veto, which means that the Department of Health and Environmental Control will continue to inform nurses and superintendents when they have HIV-positive students at their schools (Adcox, AP/Augusta Chronicle, 6/25).
The bill, which Sanford vetoed earlier this month, would have required school nurses to inform the DHEC 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 also would have been required to 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 have continued to inform DHEC of positive test results under the bill, which would have stipulated that the names of students living with the diseases be known only to DHEC (Kaiser Daily HIV/AIDS Report, 6/16).
Sen. Brad Hutto (D), the bill's sponsor, said that the measure was the only one taken up Wednesday that could save lives (Smith, Columbia State, 6/26). "Right now, these kids are not getting tested," Hutto said, adding, "They're just going out and spreading whatever they have. They're afraid somebody at school's going to find out, and everybody's going to find out."
Hutto added that school officials should assume that injured students are HIV-positive and use gloves as a precaution; however, other lawmakers said school nurses should know students' HIV status (AP/Augusta Chronicle, 6/25).
Link to this story.
Science & Medicine
Australia Launches New Center To Focus on HIV Prevention, Treatment Research
[Jun 27, 2008]
A new HIV/AIDS research center in Sydney, Australia -- called the National Institute of Virology -- will bring together 300 of the country's top scientists to conduct research in the fight against the disease, New South Wales Premier Morris Iemma said recently, the AAP/The Age reports.
The New South Wales government has committed 20 million Australian dollars, or about $19 million, toward the center, which has a total cost of 120 million Australian dollars, or about $115 million. The center will be located at St. Vincent's Hospital in Darlinghurst, and a chief scientist and scientific engineer for the state have been appointed. Iemma said that "NSW researchers are at the forefront of work in HIV treatment, prevention and vaccination" and that the "investment will expand the international role of our state's researchers in both the prevention of HIV and their role in emerging public health issues, such as prevention of hepatitis C" (AAP/The Age, 6/25).
University of New South Wales Vice-Chancellor Fred Hilmer said the center will allow the state's scientists to remain at the forefront of HIV treatment and prevention research. "We are really delighted that what we will see is a $120 million project, funded a third by the government and two-thirds by the university and philanthropy, and the hospital providing the land on which the facility will be built." Hilmer added that the center will work to "capitalize on strength for the benefit not just of NSW, not just of Australia, but really the very many people in the world who suffer from the ailments that hopefully the research here will help alleviate" (Australian Broadcasting Corporation, 6/26).
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