Kaisernetwork.org (Washington, DC)
24 July 2008
Politics and Policy
House Expected To Send PEPFAR Reauthorization Legislation to Bush Thursday
[Jul 24, 2008]
The House on Thursday is expected to approve a bill (HR 5501) to reauthorize the President's Emergency Plan for AIDS Relief that was passed by the Senate last week, CQ Today reports. President Bush likely will sign the bill, which would authorize $48 billion for the program. "The bill before you is truly a compromise in the best sense of the word," Rep. Barbara Lee (D-Calif.) said. Rep. Ileana Ros-Lehtinen (R-Fla.) said, "The challenges have been great ... but the urgency of the HIV/AIDS pandemic has moved us toward this bicameral, bipartisan consensus" (Graham-Silverman, CQ Today, 7/23).
The legislation allocates a total of $50 billion -- $48 billion of which would go to PEPFAR and $2 billion of which would go to American Indian issues. The bill also includes 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. The measure also includes a provision that would ease U.S. HIV/AIDS travel restrictions.
One primary difference between the original House version of the legislation and the version passed by the Senate last week is that the House version would have allowed groups to use PEPFAR funding for HIV testing and education in family planning clinics but not for contraception or abortion services. The Senate bill passed last week does not mention family planning programs.
The measure approved by the Senate last week also includes a provision that more than half of the program's aid go toward HIV/AIDS treatment and care. In addition, it 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. The bill also would direct 10% of funding to programs for orphans and vulnerable children, as well as allocate $2 billion for the Global Fund in fiscal year 2009. The legislation contains an existing requirement that organizations receiving PEPFAR aid have a policy that opposes commercial sex work. The bill would create links between HIV/AIDS and nutrition programs and set a target of recruiting 140,000 health care workers. In addition, the measure would allocate $5 billion for malaria programs and $4 billion for tuberculosis initiatives (Kaiser Daily HIV/AIDS Report, 7/18).
According to CQ Today, lawmakers "must now follow through on the funding boost" outlined in the legislation. Congress provided about $6 billion for HIV/AIDS in FY 2008, but the Senate's FY 2009 foreign operations spending bill would provide $5.1 billion. The House's draft version would allocate $5.5 billion (CQ Today, 7/23).
Related Opinions
Editorial
Washington Post: The PEPFAR legislation has "dodged multiple challenges from Republican lawmakers and is set to become one of the Bush administration's finest accomplishments," a Post editorial says, adding that "one of PEPFAR's most significant provisions" is the easing of HIV/AIDS-related travel restrictions. However, the provision to ease such restrictions might "not take effect even if the legislation passes" because the "bill leaves to [HHS] the decision as to whether HIV-positive visitors may enter the country," according to the editorial. It adds that "HHS officials have previously expressed a willingness to remove the ban but may delay a decision until the next administration takes office." Bush has "an impressive legacy of combating HIV/AIDS," the editorial says, adding that if the PEPFAR bill passes, Bush "could further burnish that legacy by urging [HHS] to end the ban on U.S. admission for would-be visitors and immigrants who are HIV-positive" (Washington Post, 7/24).
Opinion Piece
Mike King, Atlanta Journal-Constitution: Although "Democrats and Republicans disagree over the Bush administration's foreign policy, they do agree that under President Bush, the U.S. has taken a decisive role in saving hundreds of thousands of lives in the global battle against AIDS and other infectious diseases," columnist King writes in a Journal-Constitution opinion piece. He adds that the PEPFAR reauthorization legislation "marks a rare, bipartisan agreement between Congress and the administration and shows the world this country's compassion toward those threatened by poverty and disease" (King, Atlanta Journal-Constitution, 7/23).
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Public Health & Education
FDA To Recommend That Doctors Conduct Genetic Screening Before Prescribing Antiretroviral Abacavir To Reduce Allergic Reactions
[Jul 24, 2008]
FDA on Thursday is expected to issue an advisory that urges physicians to conduct genetic testing before prescribing GlaxoSmithKline's antiretroviral drug abacavir to reduce allergic reactions in people taking the drug, the New York Times reports. The recommendation to conduct genetic screenings will be included in a black box warning on the drug's label.
HIV-positive people who have a certain variation in an immune system gene should not take abacavir because they have a higher risk of a severe allergic reaction to the drug, according to FDA. A GSK-sponsored study, published in the New England Journal of Medicine in February, found that genetic screening prior to prescribing abacavir could reduce the incidence of suspected hypersensitivity reactions from 7.8% to 3.4%. Symptoms of the reaction include fever, rash, nausea and breathing difficulties. Based on the data, it was estimated that about 61% of people with the genetic variant could experience a severe allergic reaction to abacavir, compared with 4% of people without the variant.
In addition, abacavir's revised label will mention a study that found an increased incidence of heart attacks among people taking the drug, the Times reports. The label also will mention that GSK conducted its own review by pooling the results of numerous clinical trials and found no increased risk of heart attack. The new label will say that although the data on the increased risk of heart attack is "inconclusive," doctors still should be cautious in prescribing the drug (Pollack, New York Times, 7/24).
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Many U.K. Physicians Missing Early Signs of HIV, Group Says
[Jul 24, 2008]
As many as 50% of early-stage HIV cases are being missed by physicians in the United Kingdom, largely because they overlook symptoms that are flu-like in nature, the National AIDS Trust said recently, BBC News reports. According to NAT, people who visit their physicians complaining of flu-like symptoms often are told that the cause is a minor viral infection and that they should return if their conditions do not improve.
According to BBC News, there are approximately 7,000 new cases of HIV in the United Kingdom each year, and as many as half are estimated to be transmitted by people who are in the early stages of the virus. During the early stages of HIV, there are large amounts of HIV in the blood and, in most cases, the heightened levels cause sore throats, fever and rashes. An HIV-positive person is most likely to transmit the virus at this point. However, after six weeks, the symptoms generally recede and the individual returns to feeling normal, BBC News reports.
Deborah Jack, NAT's chief executive, said, "It is very worrying that" physicians "and other health care professionals are often missing the signs and symptoms of HIV infection." Jack added, "This can mean they become seriously ill in the longer term and respond less well to treatment. It also means they are likely to be putting partners at risk of infection as they may live undiagnosed for a number of years." According to NAT, spotting flu-like symptoms and carrying out an HIV test could help prevent further HIV cases.
Martin Fisher, a consultant in HIV medicine, said the early stage of the virus is a "golden opportunity" to discover new cases. Fisher said, "HIV testing needs to be more widespread and routine. It's reasonable to expect doctors to be able to make this diagnosis." However, Christian Jessen, a physician specializing in sexual health medicine, said that doctors still are influenced by the stereotypical notion of the "gay man with HIV." Jessen said, "I have seen so many cases come to me which have been missed, and people with HIV are not just gay men, they are heterosexual men and women as well. Doctors need to always be alive to the possibility that the person in front of them may have HIV" (BBC News, 7/22).
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Global Challenges
TB Prevention, Treatment Should Be Integrated Into HIV Treatment Programs, JAMA Study Says
[Jul 24, 2008]
Tuberculosis prevention and treatment activities should be integrated into HIV treatment programs in resource-limited settings where TB mortality is widespread and where multi-drug resistant TB is emerging to reduce deaths among people living with HIV/TB coinfection, according to a study published Wednesday in the Journal of the American Medical Association, Xinhuanet reports.
The study proposes that increased efforts should be made to identify TB cases in HIV clinics. HIV-positive people and those living with them should regularly be screened for TB, the study says. The study authors also recommend that all HIV-positive people who do not have TB receive the antibiotic isoniazid to help prevent TB infection. Physicians also should consider administering antiretroviral drugs to HIV-positive people at earlier stages of the disease to reduce damage to the immune system and reduce the risk of TB.
The study's authors emphasized that TB control measures should be implemented in HIV clinics and that all TB cases among HIV-positive people should be recorded and reported to national agencies. "HIV programs have no option but to address TB vigorously to save patient lives, safeguard the massive investment in HIV treatment and to curb the global TB burden," Diane Havlir, lead author of the study and an HIV/AIDS expert at the University of California--San Francisco, said (Xinhuanet, 7/22).
An abstract of the study is available online.
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Support for, Access to Condoms, Contraceptives in Developing Countries Not Meeting Needs, Report Says
[Jul 24, 2008]
HIV prevention remains a top priority in reducing the spread of the disease, but donor support for and access to condoms in developing countries remain dormant and are not meeting projected needs, according to highlights of a report released Tuesday by Population Action International, VOA News reports. The report will be formally presented at the XVII International AIDS Conference in Mexico City next month.
Karen Hardee, co-author of the report, on Tuesday said that in recent years, the use of condoms has been de-emphasized in favor of abstinence. "An assessment was done a few years ago that showed that fewer than half of the people who wanted to use a condom during a sex act could obtain one. That's inexcusable 20 years into the HIV epidemic," Hardee said. She added that "despite the fact that there are 2.5 million new HIV infections [annually], overall donor support in developing countries for condoms has remained largely unchanged over the past few years." She noted that of the "estimated 18 billion condoms that were needed in 2006, ... donors provided just 2.3 billion."
Amy Coen, president and CEO of PAI, said that abstinence does not align with human nature and therefore is not a reliable prevention method. "Sexual activity is a strong human drive," Coen said, adding, "It's a very good part ... of all marriages and most relationships. Asking people to stop having sex may sound good but has never worked any time in history. And it isn't working now." Coen said that HIV prevention efforts should include condoms and other contraceptives, which can prevent unplanned pregnancies and mother-to-child HIV transmission. "We really, really have to scale up and integrate condoms and contraceptives into HIV prevention," she said, adding, "I don't think people realize that contraceptives are indeed a prevention strategy" (De Capua, VOA News, 7/22).
Kaisernetwork.org is the official webcaster of the XVII International AIDS Conference in Mexico City. Click here to sign up for your Daily Update e-mail during the conference.
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IFRC Launches $21M Appeal for HIV/AIDS Program in Five African Countries
[Jul 24, 2008]
The International Federation of Red Cross and Red Crescent Societies on Tuesday launched an appeal for a $21 million, three-year HIV/AIDS program in Burkina Faso, the Central African Republic, the Democratic Republic of Congo, Guinea and Nigeria, AFP/Google.com reports.
The community-based program, which will operate between 2008 and 2010, aims to expand IFRC's HIV/AIDS work in the five countries through home-based care, anti-discrimination efforts and prevention initiatives. According to an IFRC statement, the program hopes to reach 950,000 vulnerable people in the countries, including 49,000 people living with HIV, 13,000 commercial sex workers and 10,000 orphans. Based on UNAIDS statistics, IFRC estimates that approximately 4.5 million people are living with HIV in these countries, including about 400,000 children younger than age 14. In 2006, about 350,000 people died of AIDS-related causes and 1.9 million children have been orphaned by the disease in the five countries that will be targeted with the IFRC program, AFP/Google.com reports.
Abdourahmane Ndiaye, IFRC's HIV Program Officer for the region, said that West and Central Africa are struggling to deal with the effects of HIV. He added that HIV/AIDS is "a major obstacle to development," because the disease affects all key sectors of society, including the economy, health, education and food security (AFP/Google.com, 7/22).
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Science & Medicine
Parasitic Worm Infection Can Increase Susceptibility to HIV, Study Finds
[Jul 24, 2008]
People infected with parasitic worms that cause schistosomiasis might be more susceptible to HIV and more likely to transmit the virus, according to a study published Tuesday in PLoS Neglected Tropical Diseases, Reuters reports. According to Reuters, the findings might help explain why HIV particularly has affected regions like sub-Saharan Africa.
Schistosomiasis -- which affects 200 million people worldwide but is seen primarily in developing countries -- is caused by flatworms that live in snail-infested freshwater such as lakes and rivers. When people wade, swim or bathe in contaminated water, the worms bore through the skin and enter the blood -- which can cause anemia, diarrhea, internal bleeding, organ damage and death -- Reuters reports.
For the study, Ruth Ruprecht of Harvard Medical School and colleagues conducted experiments on rhesus monkeys, some of which were infected with the Schistosoma mansoni parasitic worm and some that were free of the parasite and healthy. The researchers then exposed the monkeys to a hybrid virus that was genetically engineered to combine elements of HIV and simian immunodeficiency virus, or SIV. The study found that the monkeys with the parasite needed much lower amounts of the virus -- about 17 times lower -- to cause infection, compared with the parasite-free monkeys. Having the worms made the monkeys more susceptible to infection, Ruprecht said, adding that once infected, the monkeys with worms had far higher concentrations of the virus in their blood, making them more likely to transmit the virus. Study co-author Evan Secor of CDC said that the parasitic worm infection might hinder the immune system's ability to fight HIV and make it easier for HIV to enter white blood cells.
"The presence of the worm is like adding fuel to the fire -- it creates more fertile ground for the virus to take hold," Ruprecht said. Secor noted that the findings likely apply to people as well and might confirm theories that parasitic worm infections -- some of which are common in sub-Saharan Africa with unsanitary water supplies -- make people more vulnerable to HIV. "Sub-Saharan Africa has only like 10% of the world's population but almost two-thirds of the world's HIV/AIDS," Secor said. He added, "So there's an apparent disproportionate amount of HIV/AIDS there, and it's very severe. So the hypothesis is that one of the things that may contribute to the more intense nature of HIV/AIDS in sub-Saharan Africa is the presence of these parasitic worms." Ruprecht said the findings emphasize the need for public health measures to control parasitic worm infections in regions where HIV infection is common. According to Reuters, a drug called praziquantel is available to treat schistosomiasis (Dunham, Reuters, 7/22).
The study is available online.
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Recent Releases in HIV/AIDS
Kaiser Family Foundation Releases New, Updated Resources on HIV/AIDS Reporting; Journal AIDS Releases Special Issue
[Jul 24, 2008]
The Kaiser Family Foundation has released new and updated resources on HIV/AIDS reporting. Summaries and links appear below.
Reporting on HIV/AIDS: Lessons From the Field: This new video features interviews with reporters who share their views on the unique challenges of reporting on HIV/AIDS. Four reporters and Jennifer Kates, Kaiser Family Foundation vice president and director of HIV policy, offer guidance about issues ranging from understanding data to considering the sensitivities of reporting on someone who is HIV-positive. Webcasts, podcasts and transcripts of each of the five video chapters are available.
HIV/AIDS Reporting Guide: The guide is a tool to help journalists meet the challenges of covering HIV/AIDS. The material in this new and expanded edition covers a broad range of subjects, including treatment and prevention strategies, the status of vaccine research, key figures in the struggle against HIV/AIDS and global efforts to finance the campaign against the disease. A special section covers issues relevant to the epidemic in Latin America. In addition, a Spanish-language version of the guide for journalists covering the epidemic in Latin America and the Caribbean is available, and the guide for covering the epidemic in India has been updated.
Broadcast-Quality Daily Highlight Videos on International AIDS Conference Available for Media: The Kaiser Family Foundation will provide broadcast-quality videos from the XVII International AIDS Conference, scheduled for Aug. 3 to Aug. 8 in Mexico City. Kaisernetwork.org is the official webcaster of the conference and in partnership with the International AIDS Society will provide complete online coverage, including webcasts, podcasts and transcripts of conference sessions and press briefings as well as interviews with newsmakers. Members of the media will be able to download a daily highlight video of conference developments. Broadcasters in Africa, Asia, Latin America and the Caribbean also can access a daily satellite feed of region-specific conference highlights, relevant b-roll and newsmaker interviews -- all available rights-free for broadcast use (Kaiser Family Foundation release, 7/23).
Journal AIDS Releases Special Issue
Special Issue, Journal AIDS: The August 2008 issue of AIDS features articles examining universal access to HIV/AIDS treatment, prevention, global policies over the next five years, gender issues and human rights. In the forward article for the journal, Jacob Gayle of the Ford Foundation writes, "I trust the details that are found within this publication might help us all to begin to think about not only the latest in the art and science of HIV action, but also allow us to reflect upon the kind of world we hope to engender, with the values and actions that promote the efforts we know are necessary for reinforcing the human rights and dignities afforded to us all" (AIDS, August 2008).
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