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).
Link to this story.
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."
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