Across The Nation

Southern U.S. Not Receiving Adequate Federal Funding To Provide HIV/AIDS Prevention, Support, Report Says

[Jul 21, 2008]

The Southern U.S. is not receiving enough federal funding to provide adequate HIV prevention, treatment and support programs, according to a report scheduled to be released on Monday by the Southern AIDS Coalition, the Birmingham News reports.

An increasing number of new HIV cases in the South -- combined with "inadequate funding, resources and infrastructure" -- have "resulted in a catastrophic situation in our public health care systems in the South," the report says. The report added that public health workers should "act to correct funding and treatment disparities" to slow the spread of the virus in "isolated communities" in the region. Kathie Hiers, CEO of AIDS Alabama and a co-author of the report, said that HIV/AIDS is increasingly affecting remote areas of the South populated by blacks, who are at greatest risk of the disease. "The ruralness of the epidemic is what's becoming painfully clear," she said.

Although health officials for years knew that HIV was increasingly affecting the South, they believed the increase in new HIV cases was coming from large cities in Florida, according to Hiers. However, experts concentrated on the Deep South -- Alabama, Georgia, Louisiana, Mississippi, North Carolina and South Carolina -- and found HIV cases spreading in rural areas with large black populations with financial, health and social issues. "You don't think of the rural areas as driving the epidemic in the South, but that's clearly what's happening," Hiers said.

Federal Funding

According to the report, the distribution of federal funding does not reflect the path of the HIV epidemic nationwide, with the South receiving less funding for treatment, education and support despite a higher number of new HIV cases and an increasing number of AIDS-related deaths. Total deaths from AIDS-related causes increased to 190,000 in the South in 2001 through 2005, while the number of such deaths decreased in the rest of the nation during that time period, the report says.

According to the News, much of the funding issue "revolves around funding formulas devised early in the HIV/AIDS epidemic." These initial funding formulas were based on cumulative AIDS cases as opposed to HIV cases, giving "an advantage to large metropolitan areas where the epidemic started," according to the News. Last year, authorities adjusted Ryan White Program funding formulas, and the changes have helped, the News reports. However, the South still ranks No. 1 nationwide in the number of new HIV cases but ranks last out of four regions nationwide in overall federal funding. The federal government distributes about $6,565 annually for each person living with AIDS in the South, compared with $6,963 per person in the North, which has a higher percentage of AIDS cases, the News reports. "We're driving the epidemic, but we're still getting the least money," Hiers said.

Gary Puckrein, president and CEO of the National Minority Quality Forum, said that "one of the big misconceptions is it is big cities on the West Coast and East Coast that are really driving the disease," adding that the epidemic has "moved both in terms of geography and demography." Puckrein added, "It's really important for people in Southern states to know that because they're not getting their fair share of [federal] support."

Another report, released in May by Funders Concerned About AIDS, found that the South also receives less private funding to fight HIV/AIDS, the News reports. The report found that the South received only 19% of U.S. donations for HIV/AIDS in 2006 (Parks, Birmingham News, 7/20).

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Global Challenges

Russia Considers Ending Mandatory HIV Testing for Foreigners Entering Country

[Jul 21, 2008]

Following U.S. Senate approval of legislation to reauthorize the President's Emergency Plan for AIDS Relief that includes a provision to ease HIV/AIDS-related travel restrictions, Russian government officials have said they are considering replicating the U.S. measure, "an indication that Russia may end mandatory HIV tests for foreign residents," the Moscow Times reports. According to the Times, European Union countries and some former Soviet republics, such as Azerbaijan, do not have entry restrictions for HIV-positive people. Russia remains one of a dozen countries -- including Libya, Saudi Arabia and Sudan -- that bar long-term stays and immigration to people living with HIV/AIDS.

Top HIV/AIDS officials for the Russian government have said it is "high time" that the country's restrictions be lifted. A spokesperson for the Health and Social Development Ministry said there are no current plans to rescind a 1995 law that requires foreign nationals to pass an HIV test to receive a visa to stay in Russia for more than three months. However, the Times reports that ministry officials are closely watching the PEPFAR legislation. An official said the ministry is waiting to see the details of the final U.S. bill before considering its own steps. "It is not clear yet whether the ban will be rescinded completely or the legislation will be changed through a number of amendments," an official said. Vadim Pokrovsky, head of the Federal AIDS Center and the country's top HIV/AIDS official, said, "If they will do it in the States, then it is very likely that it can happen in Russia, too." Pokrovsky said that the restrictions are a "violation of human rights because it limits the freedom of movement."

Konstantin Poltoranin, a spokesperson for the Federal Migration Service, said HIV testing is not required for visits of up to three months and for those who enter the country with tourist visas. "If an HIV test done in Russia reveals that a person has HIV, the law says we have to deport [that] person, for example, a student, from the country," Poltoranin said. However, Valery Zubov, a State Duma deputy and a member of a government working group on HIV/AIDS, said there is no public health rationale for the restrictions.

Avet Khachaturyan, director of the Transatlantic Partners Against AIDS in Russia and Ukraine, said that Russia's restrictions were adopted during a time of ignorance and fear about HIV in the country. "To address the problem, the state should create a policy of openness and go forward by spreading proper information regarding the ways the disease is transmitted," Khachaturyan said, adding, "We should understand that bans do not work but urge some people to hide their HIV status." Corinna Reinicke, coordinator of the World Health Organization's HIV/AIDS program in Russia, said restrictions have a stigmatizing rather than preventive effect. "The International AIDS Society condemns such a ban as discriminatory," Reinicke said, adding that when HIV/AIDS-related stigma and discrimination are part of government policies or legislation, they are "one of the major obstacles to an effective response to HIV."

Nevertheless, Zubov said legislation to lift the restrictions would be difficult to implement. "It is not popular to lobby for the interests of HIV/AIDS people in the Duma, but bans and barriers that create the illusion that the problem is being tackled are easy to introduce," Zubov said. According to the Times, government officials did not say whether lifting the ban would lead to an end of tests for diseases such as HIV, tuberculosis, syphilis and leprosy, which foreigners are required to take to obtain work permits (Osadchuk, Moscow Times, 7/18).

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PBS' 'News Hour' Examines Efforts of Baylor's Pediatric AIDS Corps To Fight HIV/AIDS in Africa

[Jul 21, 2008]

PBS' "News Hour with Jim Lehrer" on Thursday examined efforts from the Baylor College of Medicine's Pediatric AIDS Corps to fight HIV/AIDS among children in Malawi. About 83,000 children in Malawi are living with HIV/AIDS, according to physician Peter Kazembe, and until recently, only two pediatricians in the country provided treatment for them.

The program aims to implement "long-term solutions" to "encourage African doctors to remain in Africa and to bring back African doctors who have emigrated" to developed countries because of better opportunities, according to Mark Kline, a physician at BCM who launched the program. "But while those fixes are being put in place, we can't afford to lose a generation of children to this epidemic," Kline said. Participating physicians receive medical equipment and drugs, including antiretrovirals, that are not readily available in many areas on the continent. The program, which receives funding from pharmaceutical company Bristol-Myers Squibb, has placed about 60 physicians in 11 African countries since 2005. The mission of the program is not only to treat patients but also to train local providers.

Kline said he believes many physicians participate in the program because they "feel that AIDS in Africa is the challenge of this generation." He added that PAC physicians are "a very highly idealistic group of young physicians" who "want to do something very meaningful" and have an "immediate impact." The story also includes comments from Fitzhugh Mullan, a physician at George Washington University Hospital, and several physicians who have participated in the program (Lazaro, "News Hour with Jim Lehrer," PBS, 7/17).

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Public Health & Education

16% of New HIV Cases in Canada in 2005 Linked to Immigrants, Report Says

[Jul 21, 2008]

About 16% of all new HIV cases reported in Canada in 2005 were linked to immigrants from countries where HIV is prevalent, according to a report recently released by the British Columbia Centre for Disease Control, the CP/Toronto Star reports. According to the study, immigrants make up 1.5% of Canada's population. The figures mean the HIV incidence among immigrants from HIV-endemic countries, or people connected with them, was almost 13 times higher in 2005 than for Canadians, according to the CP/Star.

In response to the study, Citizenship and Immigration Canada is considering making HIV a "reportable" disease, which will designate it a public health risk and mandate all health care professionals to immediately report any cases of the virus. As a reportable disease, the source of every case would be investigated to prevent transmission to others. Citizenship and Immigration Canada currently designates HIV as a "notifiable" disease, which means there is no mandatory conditions for follow-up among immigrants who test HIV-positive. However, every province and territory lists HIV as a reportable disease, the CP/Star reports.

Mark Gilbert, co-author of the report, said the goal of making HIV a reportable disease would be to connect with new immigrants who might not know that treatment assistance is available. He added, "From a public health perspective, if HIV were treated as a reportable infection through Citizenship and Immigration Canada, that would be one way of improving the timeliness of connecting with these folks when they come to Canada." However, some critics said making HIV a reportable disease is an unnecessary intrusion on privacy.

Karen Shadd, a spokesperson for the immigration department, said officials have read the report. She added, "It is under consideration, but we're in discussions on the issues that were raised in the report." Since 2002, the immigration department has required a medical exam for immigrants and certain visitors, including an HIV test for those ages 15 and older. Between 2002 and 2006, there were 2,567 immigrant applicants who tested HIV-positive among the 1.2 million immigrants to Canada accepted during the same time. Of the HIV-positive applicants, 89% were determined to be medically admissible to Canada, the CP/Star reports (Theodore, CP/Toronto Star, 7/18).

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Opinion

Newspapers Respond to PEPFAR Reauthorization Legislation

[Jul 21, 2008]

Several newspapers recently responded to the reauthorization of the President's Emergency Plan for AIDS Relief, as well as other issues. Summaries appear below.

Editorials

Las Vegas Sun: "It is rare to find President Bush and the Democratic-controlled Congress on the same page, especially in an election year," which is why it is "refreshing" that both sides "have agreed to join forces in the battle against the spread of AIDS, malaria and tuberculosis in Africa," a Sun editorial says. According to the Sun, "Our hope now is that the rest of the world takes America's generosity to heart and steps up funding to help eradicate diseases that have claimed the lives of tens of millions of Africans. As humanitarian efforts go, this should top the list" (Las Vegas Sun, 7/21).

Oklahoman: Bush "deserves credit for a visionary idea, one where the wealth of America could be brought to bear on a global crisis," an Oklahoman editorial says. The editorial adds, "That the program has avoided many of the problems usually associated with big-government initiatives is a bonus and another reason to believe taxpayer dollars can make a difference across the world" (Oklahoman, 7/21).

Seattle Times: "Cool heads prevailed in the U.S. Senate" and put the reauthorization of PEPFAR "back on track," a Times editorial says. PEPFAR "offers the strongest and most compassionate response of developed nations to the battle against AIDS, malaria and tuberculosis," the editorial says, adding that it "also represents bipartisanship at its best." According to the editorial, although the legislation "spent months tied up in ideological wrangling," two "key portions" of the bill "survived," including the end of restrictions on HIV-positive visitors to the U.S. and an initiative to hire and train 140,000 new health care professionals (Seattle Times, 7/18).

Washington Times: Although PEPFAR is a "good human-rights program that attempts to protect innocent life," the "Senate-passed bill constitutes good intentions gone haywire" -- including excessive spending, lifting of HIV travel restrictions and potentially allowing funds directed at wealthier countries like China, India and Russia -- a Times editorial says. The editorial claims that U.S. funding for the Global Fund To Fight AIDS, Tuberculosis and Malaria could end up going for "coercive sterilizations and abortion" through Global Fund grants the Times says have been given to the Chinese organization that implements that country's one-child policy (Washington Times, 7/21).

Letters to the Editor

Christoph Benn, Washington Times: A recent Times editorial about the PEPFAR legislation "wrongly accuse[d] the Global Fund To Fight AIDS, Tuberculosis and Malaria of paying for 'coercive sterilizations and abortion,'" Benn, director of external relations for the Global Fund, writes in a Times letter to the editor. The Global Fund "does not support any activities that are not designed to contribute to the reduction of the three diseases, ... and such activities have never been financed through any Global Fund grants," Benn writes. He adds that audits conducted by the Global Fund, as well as biannual audits by the Government Accountability Office, "have never reported any links between the Global Fund and abortion or coercive sterilization services" (Benn, Washington Times, 7/18).

David Bryden, Washington Times: The Times editorial "makes it sound as if large amounts of funding will flow to China as a result" of the PEPFAR reauthorization measure, Bryden, communications director for the Global AIDS Alliance, writes, adding that less than 1% of U.S. annual AIDS funding is used in China and that "none of this funding will be used ... for 'coercive sterilizations and abortions.'" PEPFAR funding "is a small price to pay for programs that will save millions of lives and foster good will around the world," according to Bryden (Bryden, Washington Times, 7/21).

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