Kaisernetwork.org (Washington, DC)
28 July 2008
Politics and Policy
President Bush Says He Will Sign PEPFAR Reauthorization Bill
[Jul 28, 2008]
President Bush on Saturday during his weekly radio address said he is eager to sign legislation (HR 5501) that would reauthorize the President's Emergency Plan for AIDS Relief through 2013, the AP/Google.com reports (Reichmann, AP/Google.com, 7/26).
The House on Thursday approved the measure 303-115. 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. The bill passed on Thursday does not mention family planning programs.
The final version of the measure 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 TB initiatives (Kaiser Daily HIV/AIDS Report, 7/25).
Bush praised Congress for "working" with the administration to pass the legislation, adding that he "will be honored to sign it into law" this week (AP/Google.com, 7/26). Bush added the legislation will enable the U.S. to "expand access to lifesaving antiretroviral drugs" and "help prevent millions of new HIV infections from occurring." He added that the legislation will help the U.S. "bolster our efforts to help developing nations combat other devastating diseases like malaria and tuberculosis" (Blake, The Hill, 7/26).
In related news, the Washington Post on Saturday examined the implications of PEPFAR's commitment to provide HIV/AIDS services in developing countries "for an indefinite period of time." The reauthorization bill "extends an implicit pledge that has little precedent in the history of U.S. foreign assistance: to continue purchasing lifesaving drugs for millions of individual people in developing countries for an indefinite period of time," according to the Post. Health care assistance traditionally has been used to construct buildings, purchase equipment and train workers, the Post reports. Direct medical care for "individuals was limited to one-time interventions such as vaccinations, emergency treatment after natural disasters, and curative treatments of limited duration for diseases such as tuberculosis or leprosy," according to the Post. PEPFAR is different and has purchased large quantities of antiretrovirals and supported medical care of more than 1/4 million people. "It is the first time I can think of where we have foreign aid treating a chronic disease," Michael Merson, director of Duke University's Global Health Institute and a former head of the World Health Organization's AIDS office, said, adding, "It's a challenge to take this on. I think the questions it raises are going to be important ones for the future."
It is unlikely that PEPFAR focus countries would be able to provide HIV prevention, treatment and support services without assistance, and it would be "immoral" for PEPFAR to withdraw funding unless another group replaces it, according to some experts. In addition, some experts are concerned that foreign aid for other programs will decrease as PEPFAR commitments grow (Brown, Washington Post, 7/26).
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Science & Medicine
HIV Vaccine Research Requires Innovative Ideas, New Scientists, More Funding, Researchers Say
[Jul 28, 2008]
New researchers and innovative ideas are needed to further research on developing an HIV/AIDS vaccine, U.S. scientists wrote in Friday's edition of Science magazine, the AP/Google.com reports. The researchers, including an NIH official, wrote that research should focus on developing a vaccine rather than on clinical trials for medicines that may not be effective. "Design of a vaccine that blocks HIV infection will require enormous intellectual leaps beyond present day knowledge," the researchers wrote.
NIH is looking for "fresh ideas" about developing an HIV/AIDS vaccine and is emphasizing laboratory research to fill knowledge gaps, according to the AP/Google.com. Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, in a Science podcast said that the failure of a Merck vaccine candidate illustrated that researchers "were maybe on the wrong track a bit." He added, "We will be turning the knob, as I like to say, more preferentially toward answering some of the fundamental questions that have gone unanswered." Increased research in chimpanzees will be a priority, although NIAID will continue to support studies in people under raised standards for federal funding, the AP/Google.com reports.
The need for increased resources aimed at vaccine research comes at a time when NIH's budget remains flat, the researchers wrote. They added that if the agency's budget increases in future years, "one of the highest priorities will be to target those additional resources to HIV vaccine programs, particularly vaccine discovery research" (Freking, AP/Google.com, 7/24).
The researchers' comments in Science follow a summit held by NIAID in March, which was held to re-evaluate vaccine research after the failure of the Merck HIV vaccine candidate in September 2007 (Kaiser Daily HIV/AIDS Report, 3/26).
The issue of Science is available online.
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Study Finds Improved Life Expectancy for HIV-Positive People Receiving Treatment
[Jul 28, 2008]
HIV-positive people in wealthy countries using highly active antiretroviral therapy increased between 1996 and 2005, but a large disparity in life expectancy remains between HIV-positive people on HAART and the general population, according to a study published Friday in the journal Lancet, Reuters reports.
For the study, Robert Hogg of the British Columbia Centre for Excellence in HIV/AIDS and colleagues examined 14 ongoing studies of 43,000 people in the U.S., Canada and several European countries who use HAART. The study found that between 1996 and 1999 and 2003 and 2005, there was an approximately 13-year increase in life expectancy for HIV-positive people who used HAART at age 20. Similar gains were recorded for people age 35 living with the virus and taking HAART, the study found (Fox, Reuters, 7/24). The study also found that people who contracted HIV through injection drug use had a shorter life expectancy at an additional 32.6 years, compared with those from other groups who had on average an additional 44.7 years. Women had a slightly longer life expectancy than men -- 44.2 additional years compared with 42.8 additional years for men -- which might be because women on average tend to start their treatment earlier, the study found (PA/Google.com, 7/24).
According to the study, despite the overall increase in survival chances, a large gap in life expectancy remained between people on HAART and the general population. In developed countries, an HIV-positive person who begins treatment at age 20 will on average live another 43 years, while an HIV-negative person will survive to around age 80. The researchers noted that the mortality figures in the study are not detailed enough to explain the discrepancy. Given that most HIV-positive people are younger than age 50, there is no data to compare survival rates among older HIV-positive people with HIV-negative people, the researchers added (AFP/Google.com, 7/24).
Jonathan Sterne -- a professor at Bristol University's Department of Social Medicine and co-author of the study -- said, "These advances have transformed HIV from being a fatal disease, which was the reality for patients before the advent of combination treatment, into a long-term chronic condition." He added that the development is a "testament" to the success of antiretroviral drugs.
Marc Thompson, deputy head of health promotion at the Terrence Higgins Trust, said, "HIV medication has become much more effective since the early days." He added, "There has been great progress, but research needs to continue, especially for those who have developed resistance to some drugs and are running out of options." Thompson noted that the study also highlighted the need for early diagnosis. Deborah Jack of the National AIDS Trust said, "Hopefully, this study will encourage more people to come forward for testing but we need to better educate doctors about the signs and symptoms to look for." She added, "Society also needs to catch up with the fact that HIV is a long-term condition that thousands of people in the U.K. are living with every day. HIV is not deserved of the fear or stigma that still surrounds it" (BBC News, 7/24).
An abstract of the study is available online.
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New HIV Cases Could Quadruple Over 10 Years if Discordant Couples Discontinue Condom Use, Study Says
[Jul 28, 2008]
New HIV cases could quadruple over the next 10 years if couples in which one person is HIV-negative and the other is HIV-positive discontinue condom use based on factors such as suppressed viral loads, according to a study published Friday in the journal Lancet, Reuters reports (Tan, Reuters, 7/25).
For the study, David Wilson, an epidemiologist at the University of New South Wales, and colleagues used a mathematical model to estimate the risk of HIV transmission in discordant couples (AFP/Google.com, 7/24). The researchers based their calculations on 10,000 discordant couples each having 100 unprotected sexual encounters over 10 years.
The researchers found there would be an additional 215 female-to-male HIV transmissions, 425 male-to-female transmissions and 3,524 male-to-male transmissions if discordant couples became more complacent about condom use (Reuters, 7/25). The study found that an HIV-negative man would have a 0.22% annual risk of contracting HIV from an HIV-positive female partner, while an HIV-negative woman would have a 0.43% annual risk of contracting HIV from an HIV-positive male partner. HIV-negative men who have sex with men would have an annual 4.3% risk of contracting HIV from an HIV-positive partner, the study found (AFP/Google.com, 7/24). According to the researchers, the findings represent "an increase in incidence of four times compared with incidence under current rates of condom use" (Reuters, 7/25).
The study was conducted in response to a Swiss AIDS Commission statement released earlier this year that said HIV-positive people in discordant relationships who adhere to their treatment regimens, have suppressed viral loads and do not have other sexually transmitted infections likely would not transmit the virus through sexual contact. "If the Swiss commission's conclusions were adopted at a community level and resulted in reduced condom use, it would be likely to lead to substantial increases in infection," Wilson said.
Wilson added that although the "individual risk of HIV transmission per act is fairly small for people on antiretrovirals, the risk of transmission over large numbers of acts could be substantial." Jonathan Anderson, president of the Australasian Society for HIV Medicine, said that reduced HIV viral loads in blood -- the basis of the Swiss statement -- does not mean viral loads also are reduced in semen or vaginal and anal fluids (Medew, Age, 7/25).
If the Swiss "claim of non-infectiousness in effectively treated patients was widely accepted, and condom use subsequently declined, then there is the potential for substantial increases in HIV incidence," the study said (AFP/Google.com, 7/24). Anderson, who did not participate in the study, added that antiretrovirals "can complement consistent condom use, but replacing condom use with medications may end in disaster" (Reuters, 7/25).
An abstract of the study is available online.
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Opinion
Report on HIV/AIDS in Southern U.S. Should 'Serve' as 'Call to Action,' Editorial Says
[Jul 28, 2008]
A recent report from the Southern AIDS Coalition should "serve as a call to action," a Columbia State editorial says, adding, "While many rightfully call on state and federal officials to provide more funding to pay for drugs, education and other resources to deal with this public health crisis, the epidemic won't be overcome by government funding and influence alone." According to the editorial, churches, communities and "individuals must help defeat this disease. People who engage in high-risk activities, including unprotected sex and [injection] drug use, must not only get tested but change their behavior." It also is "important for communities to combat the stigma attached to the disease so more people will feel free to seek help," the editorial adds.
HIV/AIDS "exacts a particularly high toll on the South because of high rates of poverty, unemployment and a lack of insurance," the editorial says, adding, "To help, the AIDS coalition advocates for more funding for prevention, testing, improving health care and addressing homelessness, mental illness and substance abuse." Individuals in "every community -- regardless of age, gender, race or socioeconomic status -- must do their part, whether it's getting tested or helping educate others, if this disease is to be brought to heel," the editorial concludes (Columbia State, 7/25).
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Washington Post Mischaracterized HIV/AIDS Among Hispanics, Letter to Editor Says
[Jul 28, 2008]
A recent Washington Post story about HIV/AIDS and Hispanics in the U.S. "mistakenly characterized" the disease among the population as a "simmering public health crisis," Jane Delgado, president and CEO of the National Alliance for Hispanic Health, writes in a Post letter to the editor. She adds that "since the first days of the epidemic, Hispanics have been overrepresented among AIDS cases." In addition, the article was "wrong to focus almost exclusively on immigrants, as most Hispanics with AIDS are U.S.-born," according to Delgado. "Moreover, Hispanic leaders responded to the AIDS crisis from the very beginning," Delgado writes, adding, "Our own efforts at the National Alliance for Hispanic Health and those of community agencies attest to a history of commitment and care." The "real story is decades of inadequate response from" CDC and the "U.S. health system to HIV/AIDS in the Hispanic community," Delgado writes, concluding that this response has "allowed almost 100,000 Hispanics to die and new cases to continue to appear" (Delgado, Washington Post, 7/28).
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Recent Releases in HIV/AIDS
Lancet Publishes Opinions, Profiles Pieces About HIV/AIDS in Latin America, U.S. Blacks
[Jul 28, 2008]
The Lancet on Saturday published an editorial, profile piece and viewpoint about HIV/AIDS in Latin America, the Caribbean and U.S. blacks. Summaries appear below.
"HIV/AIDS in Latin America and the Caribbean": Approximately "20,000 people are expected to attend" the XVII International AIDS Conference in Mexico City next week, a Lancet editorial says, adding that the conference "should provide a unique opportunity to focus attention on a region that often gets sidelined in the global response to HIV/AIDS." Almost two million people are estimated to be HIV-positive in Latin American and the Caribbean -- more than in the U.S., "Canada, Western Europe, Australia and Japan combined" -- the editorial says. There is "still an enormous amount to do to bring about the large reductions in HIV prevalence in the high-risk groups" in the region, and the "global health architecture needs to put Latin America in their plans," according to the editorial. It adds that not doing so "is unfair and shortsighted because there are likely to be good returns on investment." During the conference, "people from Latin America and the Caribbean will have the chance to show the world the reality of the different epidemics the region is confronting, the responses in place and the obstacles to overcome," the editorial says, concluding, "Garnering the world's attention for five days must have a lasting impact and re-energize the HIV community in the region" (Lancet, 7/26).
"Jorge Saavedra: Committed Campaigner on HIV/AIDS in Mexico": The Lancet profiled Saavedra, director of Mexico's National Centre for the Prevention and Control of HIV/AIDS, or CENSIDA. Saavedra is an "articulate and openly gay physician who lives with HIV in a predominantly Catholic country, where homophobia and the machismo culture continue to be the societal drivers of HIV transmission," according to the Lancet. Saavedra also "helped secure Mexico as the host city" for the AIDS conference, the Lancet reports. "The epidemic in Africa is huge and should be a priority, but that focus overlooks the fact that HIV continues to take its toll in other regions," Saavedra said (Das, Lancet, 7/26).
"Understanding and Responding to Disparities in HIV and Other Sexually Transmitted Infections in African-Americans": Sevgi Aral, Adaora Adimora and Kevin Fenton of CDC in this viewpoint piece examine how rates of "infection with HIV and some other sexually transmitted infections are higher among African-Americans than among European Americans." According to the authors, growing "evidence indicates that disease epidemics and, consequently, disparities in morbidity rates, are outcomes of the functioning of systems." They add, "Populations function as complex systems, and disease rates might result from the characteristics of individuals in the population, the interactions and interdependencies between individuals, the effects of population-level factors on individual-level health outcomes, and the interplay between individual-level and population-level factors." To address this issue, the "African-American HIV and STI prevention research agenda needs to be more deliberately placed within a social determinants and social justice framework," the authors write, adding, "Persistent stigma and silence surround HIV and STIs among African-Americas, but community mobilization efforts can help mitigate their effect." In addition, "committed leadership at the highest levels in the African-American community and in governments across the country is essential," the authors write. They conclude, "Without efforts to fundamentally improve population health and well-being by addressing the root causes of these epidemics, African-Americans will continue to be severely affected and disadvantaged" (Aral et al., Lancet, 7/26).
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I appeal to scientists who get involved to AIDS prevention to conduct further research on the relationship between AIDS and ultraviolet radiation (UV). Please think more deeply to the recent research about Genetic Mutation / Duffy antigen, the hight rate HIV infection in Africa sub-Sahara, and the hight rate HIV infection in black men than white men. In my view, its all are connection with the principles of radiation.