Kaisernetwork.org (Washington, DC)
17 July 2008
Politics and Policy
Senate Passes PEPFAR Reauthorization Legislation
[Jul 17, 2008]
The Senate on Wednesday voted 80-16 to approve legislation that would reauthorize the President's Emergency Plan for AIDS Relief at almost $50 billion over the next five years, "rejecting efforts to pare down the bill's" spending levels, the Washington Post reports (Kane, Washington Post, 7/17). The measure would replace and expand the current program, which was passed by Congress in 2003 at $15 billion and will expire at the end of September (Abrams, AP/Google.com, 7/17).
According to the Los Angeles Times, although passage of the measure had stalled in recent weeks over objections from some Republicans concerning its cost, how the money would be spent and the role of abstinence education, most Senate Republicans joined Democrats in backing the measure, which the Bush administration also supports. Sen. Richard Lugar (R-Ind.) said, "It's one of the strongest ways the U.S. has made an impact on a number of countries where our diplomacy hasn't been effective in the past," adding that one of the bill's goals is "the alleviation of extraordinary suffering on Earth" (Patel, Los Angeles Times, 7/17). Sen. Joseph Biden (D-Del.), chair of the Senate Foreign Relations Committee, praised Bush's "bold" support for AIDS funding, calling it his greatest achievement as president. "We've made tremendous strides, but our work is not nearly finished," Biden said, adding, "Two million people died last year of HIV/AIDS. Over two and a half million people died of malaria" and tuberculosis. According to the Post, Sen. Tom Coburn (R-Okla.), who is a "staunch opponent of most government spending," said PEPFAR "is by far the only true foreign policy program that's working. The dollars are actually making a difference" (Washington Post, 7/17). In a statement, Bush said, "With passage of today's bill, we are one step closer to ensuring that this excellent program continues to help those in need. I encourage the full Congress to move quickly to send me final legislation that I can sign" (Cowan, Reuters, 7/16).
Leading opponents of the measure earlier on Wednesday continued to express concern about the bill's price tag. Sen. Jim DeMint (R-S.C.), whose amendment to reduce the program's funding to $35 billion was rejected by a 32-63 vote, said, "Why, at a time when our country is in debt as far as we can see, why would we as a country create the biggest foreign aid bill in history and borrow more money, $50 billion, and send it all around the world?" (Graham-Silverman, CQ Today, 7/16). Sen. John Cornyn (R-Texas) said the funding should have been reduced to $35 billion over five years. "There should be a limit," he said, adding, "It's one thing to say you'll support it at $15 billion; it's another thing to say you'll support it at $35 billion. To me, it's entirely another thing to support it at $50 billion" (Washington Post, 7/17).
According to CQ Today, the only "sizeable change" adopted by the Senate was to trim the original $50 billion authorization to $48 billion and to include $2 billion for American Indian issues. The chamber also adopted an amendment intended to increase oversight of the Global Fund To Fight AIDS, Tuberculosis and Malaria and encourage cost-sharing and transition strategies as part of agreements with countries that receive PEPFAR aid (CQ Today, 7/16). Although some Republicans objected to a provision in the bill that would ease U.S. HIV/AIDS travel restrictions, Sen. Jeff Sessions (R-Ala.) dropped his amendment to challenge the provision (Reuters, 7/16). The Senate also defeated an amendment by Cornyn to establish a "sunset" commission to propose legislation that would abolish any global HIV/AIDS program Congress did not explicitly reauthorize. In addition, an amendment by Sen. Judd Gregg (R-N.H.) to set up an inspector general for the program, and another by Sen. Jon Kyl (R-Ariz.) that would have limited spending in the program's final year to $10 billion, also were rejected (CQ Today, 7/16).
The House version of the legislation, which would allocate $50 billion for PEPFAR, passed in April (Kaiser Daily HIV/AIDS Report, 7/16). According to Biden, there are small differences between the two versions of the legislation. The Post reports that one "key" difference between the House and Senate versions is that the House bill would permit funding for family planning programs in developing countries (Washington Post, 7/17). The House version would allow groups to use PEPFAR funding for HIV testing and education in family planning clinics but not for contraception or abortion services (Kaiser Daily HIV/AIDS Report, 4/3). In addition, the House version includes some spending mandates that are not in the Senate bill, including a requirement that 20% of PEPFAR funding be allocated to prevention. The Senate version includes a provision that more than half of the program's aid go toward HIV/AIDS treatment and care. Both versions would overturn an existing law that requires one-third of prevention funds be spent on abstinence and fidelity programs, instead requiring a report to Congress if countries do not spend half of prevention money on such programs (CQ Today, 7/16). Biden said that he has been working with House leaders and that he is confident they can come up with a final version "within a matter of days" (AP/Google.com, 7/17).
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Science & Medicine
Gene Mutation That Protects Against Virtually Extinct Form of Malaria Makes Blacks More Susceptible to HIV, Study Says
[Jul 17, 2008]
A gene mutation that likely protected people living in sub-Saharan Africa from a form of malaria seldom found in the region now could make blacks more susceptible to HIV, according to a study published Wednesday in the journal Cell Host & Microbe, the New York Times reports. The researchers say if their results are confirmed by other research, important insights into HIV's biology could be gleaned (Wade, New York Times, 7/17). The researchers estimate that the gene mutation could account for about 11% of, or 2.7 million, HIV cases in sub-Saharan Africa (Russell, San Francisco Chronicle, 7/17).
According to the researchers, there are no immediate practical implications of the study's findings. However, the findings "in theory" could be used to develop a "susceptibility test" that can identify the mutation. In addition, HIV vaccine researchers could use the findings to tailor vaccine candidates to groups most likely to benefit from such vaccines, the Wall Street Journal reports (Naik, Wall Street Journal, 7/17).
For the study, researchers compared blood samples of 814 black U.S. military personnel who were HIV-negative with samples from 470 personnel who were HIV-positive. The researchers examined the samples for a protein known as the "Duffy antigen," which enables some malaria parasites to enter red blood cells (San Francisco Chronicle, 7/17). People with a genetic mutation that disables the Duffy antigen are protected against the Plasmodium vivax malaria parasite, a form of which was common in Africa thousands of years ago (Dunham, Reuters, 7/16).
About 90% of blacks living in Africa and 60% of U.S. blacks have a disabled Duffy antigen, according to the researchers. However, the Duffy antigen absorbs HIV, preventing the virus from entering white blood cells. Those with a disabled Duffy gene therefore are more susceptible to HIV, according to the study. The researchers found a 40% higher risk of HIV among the military personnel whose genes disabled the Duffy antigen (San Francisco Chronicle, 7/17).
In addition, the researchers found that HIV-positive people with a disabled Duffy antigen had a slower progression to AIDS and likely survived about two years longer than those without the variant (Wall Street Journal, 7/17). Although researchers are unsure why the absence of the antigen both increased susceptibility to HIV and slowed progression of the virus, it is possible that people without the antigen have lower levels of infection-fighting chemokines in their blood, which make infection more likely but limit damage to the body if infection occurs (Kaplan/Maugh, Los Angeles Times, 7/17).
Comments
Robin Weiss, a virologist at University College London and study co-author, said that the study "helps in part to explain why HIV is so prevalent in Africa," but added that additional research is needed among a larger group on the continent "to see if [the finding] really applies to Africa" (Wall Street Journal, 7/17).
Phill Wilson, chief executive of the Black AIDS Institute, said the study seems to confirm a theory that HIV risk is not connected solely to behavior. Wilson said that the behavior of black men who have sex with men "is no more risky" than among white MSM but vulnerability to HIV "is so much greater" among black MSM. Sunil Ahuja, lead study author from the South Texas Veterans Health Care System, said that social factors -- such as poverty, lack of access to health care and sexual behavior -- likely are more important indicators of a person's HIV risk than the gene mutation (Los Angeles Times, 7/17).
Cheryl Winkler, head of the Laboratory of Genomic Diversity at the National Cancer Institute, said she is "a little skeptical about" the study. Winkler added that the difference in HIV prevalence among participants who had the mutation and those who did not was barely statistically significant. The study researchers "don't have enough evidence," Winkler said, adding that the findings "definitely require[e] more study and replication of results before you can make these assumptions" (San Francisco Chronicle, 7/17).
The study is available online.
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Study Examines Interaction Between HIV, Antibody That Helps Fight Infections
[Jul 17, 2008]
HIV gradually depletes the number of functioning B cells, an antibody that fights infections, according to a recent study published in the Journal of Experimental Medicine that reveals another method used by HIV to affect the immune system, IANS/Thaindian News reports.
According to researchers from NIH's National Institute of Allergy and Infectious Diseases, B cells initially coat HIV particles to prevent them from infecting other cells, but the B cells tend to become exhausted and unable to fight off the infection. The study found that although HIV-positive people with high viral loads started with high levels of B cells, the cells failed to replicate normally or to produce high-quality antibodies needed to fight HIV. The researchers found that when B cells are overworked or fatigued, they tend to produce a protein called FCRL4, which inhibits the cells' ability to respond to infection (IANS/Thaindian News, 7/15). It is unknown how HIV triggers the production of FCRL4, the researchers noted (ANI/Thaindian News, 7/15).
According to an NIAID release, the institute's HIV vaccine research program aims to increase the understanding of B cells to help develop an effective vaccine. The researchers said that the design of a therapeutic vaccine aimed at slowing HIV progression will need to overcome or circumvent the challenges created by the failure of certain B cells to make high-quality antibodies (NIAID release, 7/14).
An abstract of the study is available online.
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Global Challenges
Developing Countries Should Pass HIV/AIDS Policies That Respect Human Rights, Encourage HIV Testing, Treatment, Australian Judge Says
[Jul 17, 2008]
Developing countries should pass HIV/AIDS policies that respect human rights and encourage people at risk of HIV to be tested for the virus and receive treatment if necessary, Australian High Court Judge Michael Kirby said Tuesday at the International Criminal Law Reform Conference in Dublin, Ireland, the Canberra Times reports.
According to Kirby, governments that have focused their HIV/AIDS policies on education rather than on treating the disease as a crime have been more successful in slowing the spread of the virus. "Those countries that have adopted a human rights-respecting approach to the HIV/AIDS epidemic have been far more successful in containing the spread of HIV than those countries that have adopted punitive, moralistic, denialist strategies, including those relying on the criminal law as a sanction," Kirby said (Violante, Canberra Times, 7/16).
Kirby also addressed the increased pressure to criminalize some instances of HIV transmission in developing countries, saying that such policies are counterproductive and a violation of human rights (Australian Broadcasting Corporation, 7/16). Kirby said laws introduced in several African countries -- including Benin, Guinea, Guinea-Bissau, Mali, Niger, Togo and Sierra Leone -- infringe on the human rights of people living with HIV/AIDS.
In addition, Kirby cited a law that criminalizes the "willful transmission" of HIV "through any means by a person with full knowledge of his or her HIV status to another person." He added that the law potentially "imposes criminal liability," even if an HIV-positive person practices safer sex or takes steps to reduce mother-to-child HIV transmission.
Kirby called on governments to implement laws and policies that have been proven effective in fighting the virus, even if such policies are unpopular. "Taking the effective measures is not always popular," Kirby said, adding, "Yet taking punitive measures, depending on their terms and enforcement, is ... unlikely to succeed in the environment where there is no effective vaccine" or cure for HIV/AIDS (Canberra Times, 7/16).
Link to this story.
Congo To Provide No-Cost Malaria Drugs, HIV Tests to Children, Pregnant Women, Official Says
[Jul 17, 2008]
The Democratic Republic of Congo will begin providing no-cost malaria drugs to children younger than age 15 and pregnant women, Health Minister Emilienne Raoul announced Tuesday, BBC News reports. The country also will provide no-cost HIV tests to children through the campaign, Raoul said (BBC News, 7/16).
Raoul at the campaign's launch said that although the drugs and tests will be available at no cost, the "medicines are for the sick and must not end up on the streets and in neighboring countries." According to AFP/Google.com, the theft and resale of medicines on the black market by hospital staff is a "major problem" in the country.
According to AFP/Google.com, HIV/AIDS, TB and malaria are the leading causes of death in the country. About 21,000 children younger than age five die from malaria annually in the country, according to UNICEF. The country already provides no-cost treatment for tuberculosis, AFP/Google.com reports (AFP/Google.com, 7/15).
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Across The Nation
Arkansas HIV/AIDS Task Force Considers Recommending That Insurers Be Required To Cover People Living With Disease
[Jul 17, 2008]
The Arkansas HIV/AIDS Minority Task Force on Monday considered recommending to state lawmakers that insurers be required to provide coverage for people living with the disease, the Arkansas Democrat-Gazette reports (Frago, Arkansas Democrat-Gazette, 7/15).
The 19-member task force was formed in January by Gov. Mike Beebe (R) to examine HIV/AIDS among the state's minority populations and ways to strengthen HIV/AIDS prevention and treatment among blacks, Hispanics and other minorities in the state. The task force will hold a series of meetings in the state's four congressional districts to hear public comment on the issue, as well as to discuss HIV/AIDS incidence among minorities and the efficacy of current programs. The committee will be responsible for submitting a report of its findings and recommendations to Beebe, leadership in the state House and Senate, and Arkansas' Department of Health by Nov. 1 (Kaiser Daily HIV/AIDS Report, 6/12).
Task force chair Rick Collins said that the insurance recommendation is a "good idea" but that it is "something we'll have to discuss more." Wallace Thomas, associate medical director at Arkansas Blue Cross Blue Shield, said that it is surprising that there is no state mandate requiring insurers to provide coverage for people living with HIV/AIDS. "I was, quite frankly, shocked that it was not (mandated)," Thomas said, adding that state law requires insurance carriers to cover FDA-approved cancer drugs. Although all insurers operating in Arkansas voluntarily provide HIV/AIDS coverage in their policies, uninsured people living with the disease would have difficulties obtaining insurance when they seek coverage, Thomas said. He added, "I won't say it's impossible, but it's remote." In addition, companies with less than 50 employees might establish conditions of coverage, such as not covering medical expenses associated with HIV/AIDS during the first year of employment, according to Thomas.
Michelle Smith, a physician who attended the task force meeting, asked why it should not be mandatory for carriers to treat existing HIV/AIDS patients. "Since they're already doing it voluntarily, it would basically be symbolic," she said. Thomas replied that he would "have no problem with that."
In addition to the meeting held on Monday, the task force held a forum in Little Rock last month, and another is planned for Thursday. In addition, forums are scheduled in August and September (Arkansas Democrat-Gazette, 7/15).
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