Kaisernetwork.org (Washington, DC)
31 July 2008
Politics and Policy
President Bush Signs PEPFAR Reauthorization Bill
[Jul 31, 2008]
President Bush on Wednesday signed into law legislation (HR 5501) that reauthorizes the President's Emergency Plan for AIDS Relief through 2013, the Washington Post reports (Eggen, Washington Post, 7/31).
The House last week approved the measure 303-115. The legislation allocates a total of $50 billion -- $48 billion of which goes to PEPFAR and $2 billion of which goes 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 bill does not mention family planning programs.
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 overturns 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 directs 10% of funding to programs for orphans and vulnerable children, as well as allocates $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 creates links between HIV/AIDS and nutrition programs and sets a target of recruiting 140,000 health care workers. In addition, the measure allocates $5 billion for malaria programs and $4 billion for TB initiatives (Kaiser Daily HIV/AIDS Report, 7/28).
Although the bill also includes a provision that eases U.S. HIV/AIDS travel restrictions, it is "unclear" whether HHS plans to address the restrictions in the near future, the Los Angeles Times reports. HHS in 1987 placed HIV on a list of diseases barring entry into the U.S., according to the Times. Although that prohibition is separate from the congressionally imposed travel restrictions eased in the PEPFAR bill, federal health officials are "no longer bound by law to keep HIV on the list," the Times reports.
An HHS spokesperson did not return a call for comment on Wednesday. CDC -- which is under the jurisdiction of HHS and would make recommendations about the travel restrictions -- also could not be reached for comment, the Times reports. However, advocates of repealing the ban are "hopeful," according to the Times (Patel, Los Angeles Times, 7/31).
Bush, White House Comments
Bush at the signing ceremony said, "Defeating HIV/AIDS once and for all will require an unprecedented investment over generations. But it is an investment that yields the best possible return -- saved lives." He added that "HIV/AIDS is still one of the world's greatest humanitarian challenges, no question about it. But it is a challenge we're meeting" (Dunham, Reuters, 7/30). Bush noted that the goal for the new funding level is to prevent 12 million new HIV cases, provide more than two million people with antiretroviral drugs, support care for 12 million people and train at least 140,000 new health care workers (Euphrat, AP/Google.com, 7/30). "We are a compassionate nation," Bush said, adding, "And that's what this bill says loud and clear" (Washington Post, 7/31).
The White House in a statement said PEPFAR is "the largest commitment by any nation to combat a single disease in human history." When Bush "launched [PEPFAR] in 2003, about 50,000 people in all of sub-Saharan Africa were receiving antiretroviral treatment," the White House said, adding, "Today, PEPFAR supports lifesaving antiretroviral treatment for nearly 1.7 million people in the region and tens of thousands more around the world, from Asia to Eastern Europe" (AFP/Google.com, 7/30).
Other Reaction
Rep. Howard Berman (D-Calif.), who sponsored the bill, said its passage is a "tribute to what we can achieve in foreign policy when the cause is right and all parties work together in goodwill" (Washington Post, 7/31). House Speaker Nancy Pelosi (D-Calif.) praised the bill for taking the global fight against AIDS, TB and malaria "from the emergency phase to the sustainability phase." The new legislation "is our compact with developing nations across the globe," Pelosi said in a statement, adding, "It says that America stands with them in this fight, that our commitment will not waver and shows them America's true face of compassion." Eric Friedman, senior global health policy adviser for Physicians for Human Rights, said the legislation is "the boldest act of any wealthy nation in ameliorating Africa's disastrous health worker shortage." He also praised the bill for lifting the HIV/AIDS-related travel restrictions but criticized the legislation for not linking HIV services with family planning. "That allows HIV to go unprevented and undetected for years, until a whole family is infected," he said (AFP/Google.com, 7/30).
UNAIDS Executive Director Peter Piot said, "The generosity of the U.S. government has helped to truly transform the global response to AIDS and the course of the epidemic" (Reuters, 7/30). Bill and Melinda Gates, co-chairs of the Bill & Melinda Gates Foundation, in a statement said, "We congratulate President Bush and leaders in Congress for their achievement in getting PEPFAR reauthorized at an unprecedented level." They added, "This bill renews and strengthens America's commitment to the global fight against AIDS, TB and malaria." They noted that they are "encouraged by the act's strong emphasis on preventing new HIV infections," as well as lifting the travel restrictions (Gates Foundation release, 7/30).
Michael Weinstein, president of the AIDS Healthcare Foundation, also praised Bush for signing the reauthorization bill. "Passage of this historic legislation is a crucial turning point in the battle to control AIDS around the world," Weinstein said. He added, "We take our hats off to everyone who helped ensure that this lifesaving global AIDS bill became a reality" (AHF release, 7/30). Pamela Barnes, president and CEO of the Elizabeth Glaser Pediatric AIDS Foundation, said the signing of the bill into law "is a beacon of hope to millions around the world living with HIV/AIDS. It is an unmistakable signal of the United States' continued commitment to preventing new HIV infections in the countries most affected by the pandemic." She added that one of the "most significant challenges for the next five years is to scale up the delivery of [the prevention of mother-to-child HIV transmission] services, and to ensure that all infected children receive urgently needed antiretroviral treatment," adding, "We are committed to achieving the target in the PEPFAR legislation of reaching 80% of these women in the next five years" (Elizabeth Glaser Pediatric AIDS Foundation release, 7/30).
Serra Sippel, executive director of the Center for Health and Gender Equity, welcomed passage of the legislation; however, she said the group will "continue to be disappointed that despite the findings and recommendations issued by U.S. government agencies, a Democratic-led Congress is continuing to impose arbitrary funding directives to encourage abstinence-only programs over effective, comprehensive prevention interventions." She added, "With the amount of work that so many prevention advocates put into the reauthorization process, it is disheartening to see global AIDS prevention policy continue to emphasize ideology in the guise of political expediency" (CHANGE release, 7/30).
Wall Street Journal Examines Role of Generic Drugs in PEPFAR
In related news, the Wall Street Journal on Thursday examined how generic drugmakers, many of which are based in India, now "dominate" PEPFAR. Generics accounted for 57% of the $131 million the U.S. spent on PEPFAR in FY 2007, according to the Office of the U.S. Global AIDS Coordinator. Generics in 2005 accounted for 11% of PEPFAR's funding. In 2005, the U.S. had approved few generic drugs for PEPFAR, so "most of the money went to buy brand-name drugs that are often more expensive," according to the Journal. Some of the largest generic contributors to PEPFAR include Aurobindo Pharma, Ranbaxy Laboratories, Cipla and Aspen Pharmacare. PEPFAR's "shift to generics" during the past two years follows a Bush administration "decision to set up a special approval" at FDA for the medicines, which cannot be marketed in the U.S. because of patent and exclusivity regulations, the Journal reports. "It's pretty clear that the system is working well, and it protects African families just like American families are protected," Ambassador Mark Dybul, the U.S. global AIDS coordinator who administers PEPFAR, said. He added, "We pretty methodically did what we said we were going to do." Ranbaxy spokesperson Chuck Caprariello said that the "key is having affordable and accessible medicines, and I think the generic industry has made a contribution in a very positive way to PEPFAR."
PEPFAR's spending on brand-name drugs totaled about $56 million in FY 2007, a decrease from the $106 million spent in 2005. Some of the largest contributors of brand-name drugs to PEFPAR are Merck, GlaxoSmithKline and Abbott Laboratories, according to the Journal (Lueck, Wall Street Journal, 7/31).
The Christian Science Monitor on Thursday examined how PEPFAR is impacting other issues, such as food security, in Ethiopia. The Lancet also recently examined issues in the PEPFAR reauthorization bill.
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Global Challenges
HIV/AIDS Advocates Protest Stigma, Discrimination Ahead of AIDS Conference
[Jul 31, 2008]
HIV/AIDS advocates in Mexico City have begun protesting the problems of stigma, discrimination and a lack of access to antiretroviral drugs in Latin America ahead of next week's XVII International AIDS Conference in Mexico City, Agence France-Presse reports (Rosenthal, Agence France-Presse, 7/29).
According to VOA News, 17 people at the conference are expected to lead discussions that address issues -- such as stigma and discrimination -- that discourage people from being tested and accessing treatment. South African Justice Edwin Cameron is scheduled to lead a plenary session about the criminalization of HIV-positive people in some countries, which is fueling stigma against people living with the virus, according to VOA News.
According to the South Africa Supreme Court of Appeals, 11 African countries -- including Kenya, Liberia, Sierra Leone and Uganda -- have laws in place to prosecute HIV-positive people who do not disclose their HIV status to their partners, even if they do not transmit the virus (Eagle, VOA News, 7/29). In addition, although most countries in Latin America have laws that prohibit HIV-associated discrimination, people who violate the laws rarely are prosecuted, Agence France-Presse reports (Agence France Presse, 7/29).
Cameron said that such laws discourage people from being tested for HIV. "The point I will make at the conference is that those statutes, apart from their very broad and vague wording, are very bad for the central issue of the epidemic, which is getting treatment to people," Cameron said.
In addition, Adeeba Kamarulzaman, president of the Malaysian AIDS Council, is expected to host a discussion on legal obstacles to fighting the spread of HIV among injection drug users. Kamarulzaman said a lack of needle-exchange programs and methadone programs, as well as criminalization of injection drug use, are fueling the spread of HIV among IDUs and discouraging them from receiving HIV tests.
Pedro Cahn -- president of the International AIDS Society, which is convening the AIDS conference -- said the conference also will address criticism that efforts to increase HIV/AIDS prevention and treatment activities have taken away from efforts to build health systems in developing countries. Cahn said some people have claimed that the international community has put "too much money into the AIDS struggle" and is "weakening health care systems." Cahn said, "African health care systems were not OK before (the AIDS epidemic) and have become better after the opening of clinics," adding that the accusations are "absolutely not true."
Cahn added that advocates attending the AIDS conference likely will call for the integration of reproductive health services and treatment for tuberculosis and sexually transmitted infections into HIV treatment programs. Advocates have said such efforts would help meet the United Nations Millennium Development Goal of providing universal access to HIV prevention and treatment by 2010 (VOA News, 7/29).
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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Kenya's HIV Prevalence Increases to 7.8% in 2007, Report Finds
[Jul 31, 2008]
HIV prevalence in Kenya increased to 7.8% in 2007, a slight increase from the 6.7% prevalence recorded in 2003, according to a survey released by the government on Tuesday, the Associated Press reports. According to the Associated Press, the increase in the percentage of the population living with HIV likely is because of wider access to antiretroviral drugs.
The survey, titled "2007 Kenya AIDS Indicator Survey," was conducted by several organizations, including CDC, the World Health Organization and the Kenya Medical and Research Institute (Associated Press, 7/29). The survey cost about 400 million Kenyan shillings, or about $6 million, Kenya's Daily Nation reports (Gathura/Okwemba, Daily Nation, 7/29). The survey is based on tests conducted among 18,000 people between ages 15 and 64 for HIV and other sexually transmitted infections from August 2007 to May 2008 (Associated Press, 7/29).
According to the survey, about 1.4 million Kenyan adults are living with HIV/AIDS. In addition, four out of every five HIV-positive Kenyans are unaware of their status, and about two-thirds of the country's 37 million people have never been tested for the virus, the survey found. Fifty-seven percent of HIV-positive people reported that they had never taken an HIV test, and 26% said they were HIV-negative but later tested positive. Ibrahim Mohammed, chief of Kenya's National AIDS and Sexually Transmitted Infection Control Program, said that 16% of those tested did not want to know their status, 14% were unaware of the HIV test or where to receive one and 5% indicated that distance to testing clinics was a "major barrier" (AFP/Google.com, 7/29). Mohammed added that three out of five HIV-positive people are women and that uncircumcised men are three to five times more likely to contract the virus, compared with circumcised men.
Prime Minister Raila Odinga said the survey's finding that 50% of Kenyans used condoms and only 20% used a condom during their last sexual encounter is "alarming," the Associated Press reports. "There are now nearly 1.5 million Kenyans living with [the virus]. ... This is nothing less than a national crisis," Odinga said. He added, "The only way to reverse this epidemic is through prevention" (Associated Press, 7/29). Kenya's Health Minister Beth Mugo said, "We have made notable progress; however, HIV/AIDS rates among our families and communities remains unacceptably high and the impact severe" (AFP/Google.com, 7/29).
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Universities in East Africa To Take Part in Study Examining Impact of HIV/AIDS on Community
[Jul 31, 2008]
A study aimed at examining the effects on HIV/AIDS on universities in East Africa is scheduled to start in October, Tanzania's The Citizen reports. According to officials at the Inter-University Council for East Africa, the project initially will target 18 universities in Kenya, Tanzania and Uganda. The project -- which will cost about $700,000 -- will involve the East African Community through the Lake Victoria Basin Commission. It is receiving funding from the Swedish International Development Agency. According to the project's manager Doreen Othero, the African Medical and Research Foundation also will be involved with the study.
Othero said that the study will run for two months and that it is aimed at examining the severity of HIV/AIDS in university communities in the region. The study will focus on the Lake Victoria basin, which has a higher HIV/AIDS prevalence compared with other parts of the region, according to The Citizen. In addition, the basin has a high population density and is home to numerous cross-border activities, according to Othero. "The survey will provide relevant contextual information, which will be used for determining intervention mechanisms for improvement of management of the problem in the university communities in terms of all aspects of the pandemic," Othero said. IUCEA Executive Secretary Chacha Nyaigotti-Chacha said there are concerns that university communities, particularly students and teachers, are highly affected by HIV/AIDS. He added that the project might be expanded to more universities in the future.
Universities currently involved in the study are the universities of Dar es Salaam, Mzumbe, Sokoine, Tumaini, St. Augustine and Muhimbili in Tanzania; the universities of Makerere, Mbarara, Gulu, Islamic, Kampala International and Nkumba in Uganda; and the Jomo Kenyatta University of Agriculture and Technology, and the universities of Nairobi, Baraton, Moi, Masinde Muliro and Maseno in Kenya (Ubwani, The Citizen, 7/28).
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Vietnam Should Prioritize HIV/AIDS Prevention Programs, Deputy Prime Minister Says
[Jul 31, 2008]
Vietnamese local governments should prioritize HIV/AIDS prevention measures, particularly education and communication programs that target injection drug use among young people, Deputy Prime Minister Truong Vinh Trong said on Tuesday at a symposium on HIV prevention and drug detoxification in Hanoi, Vietnam, the Vietnam News Agency reports.
Trong -- who also serves as chair of a committee to combat and prevent HIV/AIDS, drug addiction and sex work -- encouraged the Ministry of Health to "upgrade" the prevention of HIV/AIDS to a national target. According to Health Minister Nguyen Quoc Trieu, about 55% of HIV-positive injection drug users in Vietnam were found to have contracted the virus through needle sharing. According to the Vietnam News Agency, rates of HIV in Vietnam have declined during the last six-month period compared with the same period one year ago. Six times more men are diagnosed with HIV compared with women in Vietnam, and people between ages 20 and 39 account for 83.7% of those people with the virus, according to the Vietnam News Agency (Vietnam News Agency, 7/29).
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Opinion
Responses to PEPFAR Reauthorization
[Jul 31, 2008]
Several newspapers and a journal have published commentaries in response to legislation to reauthorize the President's Emergency Plan for AIDS Relief. Summaries appear below.
Opinion Pieces
Rep. Barbara Lee (D-Calif.), San Francisco Chronicle: The PEPFAR reauthorization bill is a "landmark achievement that will save millions of people from certain death and prevent millions of new HIV infections in the developing world," Lee writes, adding, "Sadly, our commitment to fighting AIDS globally has not extended to the fight against AIDS here at home." It is "past time our government stopped turning a blind eye to our national AIDS epidemic," according to Lee, who adds, "Far greater support is needed for community responses to the epidemic in Black America, especially through the Minority AIDS Initiative." In addition, the U.S. "must develop a national AIDS strategy and fund HIV prevention initiatives designed for African-Americans," Lee writes. She concludes that HIV/AIDS is "not just a foreign policy issue. If we wish to show real global leadership on AIDS, then we must keep our commitments abroad and take care of our epidemic here at home" (Lee, San Francisco Chronicle, 7/30).
Wafaa El-Sadr and David Hoos, New England Journal of Medicine: "Since its inception, PEPFAR has faced criticism," El-Sadr of the Mailman School of Public Health and the College of Physicians and Surgeons at Columbia University and Hoos of the Mailman School write in an NEJM perspective piece. According to the authors, PEPFAR's "most vocal critics have focused on some of its prevention strategies," but "critics have also questioned PEFPAR's focus on HIV care and treatment." In addition, the program was "criticized for creating a vertical program with disease-specific goals, as well as a single-donor driven structure and strategy," the authors write. They add that despite PEPFAR's "verticality, the program has also been reasonably well integrated with the global and national responses to the HIV epidemic." The "key challenge for PEPFAR will be to maintain its sense of urgency and its razor-sharp focus on results -- factors that have resulted in remarkable achievements in the face of enormous challenges," the authors write, concluding, "The advances have been dramatic, but much remains to be done" (El-Sadr/Hoos, NEJM, 8/7).
Michael Gerson, Washington Post: The "bipartisan expansion" of PEPFAR, as well as the President's Malaria Initiative, is "significant in a number of ways," columnist Gerson writes in a Post opinion piece. The legislation is the "congressional affirmation of a major legacy of" President Bush, Gerson writes, adding that the bill's passage "displayed the reviled Democratic Congress at its best." In addition, the legislation "served to isolate and discredit that element of American politics that refines hatred of government to a toxic purity," according to Gerson, who adds that the "largest significance of this bill, or course, is human." Without the "amazing generosity of America, the challenge faced by" many families worldwide "would be a private holocaust of abandonment, mourning and despair," Gerson writes (Gerson, Washington Post, 7/30).
Letter
Rick Santorum, Washington Times: The PEPFAR reauthorization bill "preserves the PEPFAR program's successful founding principles, and it deserves the wide support it has achieved," Santorum, senior fellow at the Ethics and Public Policy Center, writes in a Times letter to the editor in response to a recent Times editorial. According to Santorum, it is "worth noting that the bill includes new ... accountability and transparency benchmarks" for the Global Fund To Fight AIDS, Tuberculosis and Malaria (Santorum, Washington Times, 7/30).
Link to this story.
Recent Releases in HIV/AIDS
GlobalHealthFacts.org Posts Latest Global, Country-Level HIV/AIDS Data; New Latin America, Mexico HIV/AIDS Fact Sheets Available
[Jul 31, 2008]
"Latest Global and Country-Level HIV/AIDS Data Now Available on GlobalHealthFacts.org," Kaiser Family Foundation: GlobalHealthFacts.org has been updated with country-level HIV/AIDS data to reflect the latest information released in the UNAIDS 2008 Report on the Global AIDS Epidemic. The Web site includes data on people living with HIV/AIDS and AIDS-related deaths displayed in tables, charts and color-coded maps, which can be downloaded for custom analyses. In addition, GlobalHealthFacts.org's new custom data sheet tool can be used to compare data across countries. Updated regional HIV/AIDS statistics also can be found on GlobalHealthReporting.org. Several Kaiser Family Foundation fact sheets have also been updated with the new data, and the Kaiser Family Foundation has produced new fact sheets on HIV/AIDS in Latin America and Mexico in preparation for next week's XVII International AIDS Conference (KFF release, 7/30).
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