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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