Kaisernetwork.org (Washington, DC)
22 July 2008
Election 2008
Presidential Candidates McCain, Obama To Attend Forum at Saddleback Church
[Jul 22, 2008]
Presumptive presidential nominees Sens. John McCain (R-Ariz.) and Barack Obama (D-Ill.) have agreed to attend a forum at Saddleback Church in Lake Forest, Calif., on Aug. 16, the New York Times reports. According to the Times, the candidates will appear together for the first time since presidential campaign efforts began. The Rev. Rick Warren, who called the candidates personally to invite them to the forum, said that the event will focus on how they make decisions and on some of Warren's main focus areas, such as HIV/AIDS, poverty and the environment (Rutenberg, New York Times, 7/21).
Warren said that at the request of McCain and Obama, the forum will be held in a nondebate format and open to all media, although only Warren will ask questions. The candidates will appear briefly together before each one takes questions from Warren for an hour, according to the AP/Contra Costa Times. "While I know both men as friends, and they recognize I will be frank, but fair, they also know I will be raising questions in ... four areas beyond what political reporters typically ask," Warren said, adding, "This includes pressing issues that are bridging divides in our nation, such as poverty, HIV/AIDS, climate and human rights" (AP/Contra Costa Times, 7/21). According to Warren, he will develop his questions with feedback from the Muslim, Jewish and Christian leaders associated with the group (New York Times, 7/21).
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Global Challenges
Use of Methadone To Curb Rising Injection Drug Use, Spread of HIV in Russia Examined at Conference
[Jul 22, 2008]
Faced with a "steady increase" in injection drug use that is cited as the leading cause of the spread of HIV/AIDS in Russia, a meeting of physicians and specialists was held in the country in February to discuss the use of methadone in treating injection drug users, which number between three million and six million in Russia, the New York Times reports. Although injection drug use is "widely linked" to the country's HIV/AIDS epidemic, "the issue of methadone treatment is all but taboo" in Russia, according to the Times.
Injection drug use in Russia accounted for about 66% of new HIV/AIDS cases in 2006, and the numbers continue to grow, though not as quickly as in the past, according to UNAIDS. The Russian government estimated that as of 2007, more than 400,000 people in the country were HIV-positive, out of a population of about 142 million. The United Nations' estimated in 2005 that 940,000 were living with HIV in the country. The Times reports that although methadone is central to a therapy endorsed by the United Nations and 55 other countries to treat IDUs, there is considerable opposition to the treatment in Russia. Some opponents argue that methadone keeps patients in lifelong addiction, while others say that Western countries push the treatment on Russia for commercial profit. There also are fears that methadone could enter the black market, because there is a considerable amount of corruption at many clinics throughout the country, according to the Times.
At the conference, Gennady Onishchenko, Russia's chief sanitary physician, said health officials "are not convinced" that methadone "is effective," adding, "There is little optimism for legalizing methadone therapy in the near future." Nikolai Ivanets -- the country's top narcotics specialist, who criticized the professional credentials of some conference participants -- said, "Everyone has become so annoyed with methadone, with the exception of a few groups of people who call themselves specialists." Ivanets added, "This is a group of dissenters." Vladimir Mendelevich -- director of the Institute for Research Into Psychological Health and organizer of the conference who supports methadone use -- said, "There is no possibility to have a normal discussion about this issue."
According to the Times, some Russian specialists, along with current and former IDUs, "have begun to challenge the official line." Evgeny Krupitsky, head of a laboratory that conducts research on drug addiction at St. Petersburg State Pavlov Medical University, said, "Scientific arguments, evidence-based data, are not convincing" opponents of methadone. Russian methodology regarding opiate addiction "is not evidence-based," but relies on "subjective opinions of major leaders in the field," Krupitsky added. Although not all IDUs would benefit from methadone treatment, more than 60% in Russia would, Krupitsky said. The Times reports that many researchers on both sides of the methadone debate agree that only a small fraction of heroin users in Russia seek treatment at detoxification centers and that most who do -- some say more than 90% -- relapse into drug use shortly after leaving.
At the clinics, physicians encourage immediate abstinence from drug use rather than the gradual process that methadone substitution therapy entails. Patients also receive sedatives and painkillers to cope with withdrawal symptoms. Many are allowed to leave after one or two months with the expectation that they will remain drug-free; however, few do so, the Times reports.
Consequently, methadone supporters or other opiate substitution therapies say that if properly administered by medical professionals, the treatment can end IDUs' dependence on drugs, acting as a surrogate to ease withdrawal symptoms while decreasing the risk of overdose (Schwirtz, New York Times, 7/22).
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Human Rights Watch Urges Iran To Release or Charge Two HIV/AIDS Advocates
[Jul 22, 2008]
Human Rights Watch on Monday said that Iranian authorities have not disclosed why two physicians known for their work on HIV/AIDS prevention and treatment were detained last month or where they are being held, BBC News reports. The physicians, brothers Arash Alaei and Kamyar Alaei, are credited with encouraging Iranian authorities to tackle the stigma of HIV/AIDS "in a country where sex, drug abuse and the disease itself are taboo subjects," BBC News reports. HRW called on Iran to immediately release or charge the physicians, whom the group says have not had legal representation.
Joe Amon, HRW's HIV/AIDS program director, said that Iran's work to combat the disease is internationally acclaimed, largely because of the work of the brothers, who established educational campaigns among injection drug users and commercial sex workers. They also introduced harm-reduction programs in prisons, working closely with Iran's government and religious leaders (BBC News, 7/22). Amon added, "The detention without charges of the Alaei brothers has a chilling effect on all of those efforts" (HRW release, 7/21). The brothers, who have traveled widely outside of Iran to take part in HIV/AIDS conferences, planned to attend the XVII International AIDS Conference in Mexico City next month. Arash Alaei was scheduled to present in Mexico about Iran's innovative HIV programs, according to HRW (BBC News, 7/22).
According to the Albany Times Union, Kamyar Alaei is enrolled in the University at Albany's doctorate of public health program. Philip Nasca, the university's dean, said, "We are obviously very concerned. We're kind of in the dark like everybody else is." Kamyar Alaei had returned home to Iran for the summer and was expected back in Albany for the fall semester, the Times Union reports.
Neither brother is known to be involved in politics, the Times reports. They have spoken about the health situation in Iran during professional visits to the U.S. (Parry, Albany Times Union, 7/22). According to BBC News, Iran in recent years has arrested a number of academics with ties to the U.S. (BBC News, 7/22).
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Antiretroviral Treatment Programs Should Take Poverty, Hunger Into Account, Report Says
[Jul 22, 2008]
Programs that provide access to no-cost antiretroviral drugs have had a significant impact on people living with HIV/AIDS, but they also should take into account the effects of poverty and hunger, according to a report recently released by the Catholic Agency for Overseas Development, PlusNews reports. According to CAFOD, the "long-term sustainability" of people living with HIV/AIDS who need treatment is "threatened by the continuing lack of food and economic independence."
The report, which includes interviews with several organizations, found challenges in two aspects of sustainability: the need and desire of clients of antiretroviral programs to become self-reliant, and the programs' need for clients to become self-reliant for the programs' own sustainability. Jo Maher, author of the CAFOD report, said that antiretroviral programs "need to take into account the fact that people on treatment still need to eat and still need an income." He added that programs providing antiretrovirals should determine what form the income should take based on individual capacities. "HIV-specific organizations, for instance, should decide whether to retain their HIV focus and partner with organizations with better skills in income generation, or expand their activities to include income generation," Maher said, adding, "Sometimes they may not have the skills or manpower to take on the task themselves."
James Kamau, coordinator of the Kenya Treatment Access Movement, said antiretroviral programs need to include food as part of their support to HIV-positive people. Most antiretroviral programs "started with the basic aim of keeping people alive, but drugs alone cannot keep [an HIV-positive person] alive," Kamau said, adding, "If you don't feed people, they can't regain enough strength to work and earn a living." Kamau noted that in Kenya, poverty is a "huge problem." He added, "Women in particular suffer because they are responsible for caring for and feeding people in the home, and when they have no means to do this the whole household suffers." Kamau said that although antiretroviral programs need to provide food as part of a complete treatment program, they should not provide income-generating projects. "Those who get better should be able to find work for themselves, and if they fail, it is the responsibility of the government to look after their needs," Kamau said, adding, "If the government spent a decent amount of the national budget on health, people would get their drugs and would be well enough to work, thereby improving the economy and creating enough work for everyone" (PlusNews, 7/18).
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Singapore Ministry of Health Calls on More Physicians To Offer Anonymous Rapid HIV Tests
[Jul 22, 2008]
Singapore's Ministry of Health recently called on more private general practitioners in the country to provide anonymous rapid HIV tests, which currently are available only at two clinics, the Straits Times reports.
According to the health ministry, it has invited 70 physicians to provide anonymous rapid tests in order to expand its network of clinics offering anonymous testing and encourage people at risk of the virus to undergo testing. The two clinics currently offering anonymous rapid tests have reported that they have seen 2.5 times more people come in for the test recently. According to the clinics, 1,723 people underwent anonymous rapid testing between July 2007 and June 2008, compared with 678 who did so between July 2006 and June 2007. Sixteen of the 1,723 people who were tested were diagnosed with HIV (Tan, Straits Times, 7/19).
According to Singapore's Today, the increase in testing could be attributed to HIV/AIDS awareness generated by the local media. About 60% of respondents to a survey by the biomedical company Rockeby, which distributes the test, said they learned of it from newspapers. More nonprofessionals also are coming forward to be tested, Today reports. Tan Sze Wee, Rockeby managing director and chief executive, said, "It's not just the educated who are going for the tests, but the message has gone down to the [less]-educated." In addition, the number of nonmarried individuals and women undergoing testing has increased. One-third of all patients said they went for testing because it was both anonymous and fast, and the percentage of people receiving the test for the first time increased from 65% to 74% (Leng, Today, 7/18).
Wong Tien Hua, a physician at Mutual Healthcare Medical Clinic in Anchorvale who received the health ministry's invitation to provide the test, said making anonymous tests more widely available could remove barriers associated with people finding out about their HIV status, especially for populations involved in high-risk activities. Joyce Liang of Anteh Dispensary, which is one of the two clinics that currently offers the test, said, "It is usually the stress of the wait for results that kills them, figuratively speaking. Here, they had to wait for only 20 minutes. Of course, they have to be counseled post-test."
According to the Times, 422 people in Singapore were diagnosed with HIV last year, up from 357 in 2006. Numbers for this year as of June indicated that 236 people have been diagnosed as HIV-positive (Straits Times, 7/19).
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Across The Nation
Short-Film Features Oklahoma Prison Program That Teaches Women How To Prevent HIV
[Jul 22, 2008]
The Tulsa World on Sunday examined a short documentary film about incarcerated women in Oklahoma and a peer education program that teaches them about HIV prevention and other social issues. The Tulsa Community AIDS Partnership recently hosted an event featuring the film and a panel discussion about HIV among the state's female prison population.
The film, titled "Empowering the Yard" and filmed at the Eddie Warrior Correction Center in Taft, features the 15-year-old peer education program. Under the program, which won a Robert Wood Johnson Community Health Leadership Program Award in 2002, college professors teach the women, who receive college credit, about HIV/AIDS and other issues. After completing the curriculum about women's theory and HIV prevention, the women teach others in the prison, according to Melanie Spector, health education researcher for the state's Department of Corrections, who founded the program. "It's a whole cadre of women's developmental theory and women's developmental issues that can all lead to HIV transmission," Spector said.
Janice Nicklas, director of TCAP, said Oklahoma incarcerates more women per capita than any other state, adding, "It's just a situation we really need to focus a lot of attention on and go a different direction in." Nicklas added that the film and following panel discussion should demonstrate that the state needs to do more to help women with mental health and substance use problems, instead of only sending them to prison. "We want to bring all parties into the discussion and see if we can do something about it," she said (Muchmore, Tulsa World, 7/20).
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Opinion
Column Discusses HIV/AIDS Risks for Black Women
[Jul 22, 2008]
If the popular television series "Sex and the City" "chronicl[ed] the sexually liberated adventures of four black women" instead of white women, "one of the lead characters could credibly have tested positive for" HIV, Johnathon Briggs, director of communications at the AIDS Foundation of Chicago, writes in a Chicago Tribune opinion piece. According to federal health data, black women are nearly 23 times more likely to be diagnosed with AIDS than white women, Briggs writes.
Briggs says research has found that even though black women "engage in risky sex no more often than their white counterparts," they still are more susceptible to HIV/AIDS, which further underscores the "notion that behavior is not the sole contributing factor driving HIV transmission." While the public service message on HIV has been, "It's not who you are, it's what you do," that message is only partly true for black women, Briggs says.
He notes a recent study that found gene mutation is possibly what makes black people more susceptible to HIV/AIDS. Further, members of communities with high rates of poverty and incarceration have higher risks of HIV, Briggs writes. He quotes the Community HIV/AIDS Mobilization Project, which has said, "We have seen that social factors like lack of housing, less access to health care and being in a tough financial situation also can make people vulnerable to HIV/AIDS." Briggs continues, "In short, who you are, and where you live and, consequently, the sexual partners you choose, matters when it comes to HIV prevention."
He adds, "Though it is true that nearly every major character on 'Sex and the City' had [a sexually transmitted infection] scare, the most severe disease any of the four white Manhattan women ever got was chlamydia," which can be treated with antibiotics. He concludes that the "reality of sex in the inner city requires more than medicine. It also demands effective prevention programs and tools to change the environments that lead to disparities in disease," which is "far more worthy of our attention" than the "hard-candy gloss and glimmer of its pop-culture counterpart" (Briggs, Chicago Tribune, 7/20).
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