Kaisernetwork.org (Washington, DC)
12 August 2008
Politics and Policy
Washington Post Examines Treatment of MSM, WSW In Mexico, Latin America, Ability To Access HIV Treatment, Seek Asylum in U.S.
[Aug 12, 2008]
Asylum applicants, U.S. lawyers and Hispanic advocates say it has become increasingly difficult for men who have sex with men and women who have sex with women from Mexico and other Latin American countries to obtain asylum in the U.S. because of the countries' improved treatment of homosexuality, liberalized laws and expanded HIV/AIDS treatment, according to the Washington Post. Arthur Leonard, a professor at New York Law School, said, "For a time, it seemed like it was a slam-dunk if you were gay, from Mexico and filed for asylum in the United States," adding, "But there's been a turning point. The gay rights movement has started to make progress in Mexico, and it's a little harder to show" that asylum is warranted.
Leaders throughout the region who consider asylum as way to access better treatment of people with HIV say the "subtle, unofficial shift in immigration policy" has significant public health implications, the Post reports. Although advocates praise the progress on rights for MSM and WSW in Latin America -- where it has been argued that the culture of "machismo" places them in danger -- they say that it may take decades to reverse "deeply ingrained" attitudes toward homosexuality, which some believe are linked with the spread of HIV in the region, according to the Post. According to the Post, there are no official figures for the number of such cases that have been granted asylum in the U.S. because the Department of Homeland Security does not track asylum cases by categories such as sexual orientation. DHS officials said that there has been no change in policy regarding asylum for MSM and WSW.
Jorge Saavedra -- director of Censida, the National Center for the Control of HIV/AIDS in Mexico -- said that MSM in Mexico have been most affected by HIV/AIDS and that homophobia has been the main cause of the epidemic. "People think the homophobia is under control, which is not true," Saavedra said, adding, 'Homophobia in Mexico is really high." According to Saavedra, although Mexico has a relatively low overall HIV/AIDS prevalence of 0.3% of the general population, routine medication shortages and discrimination and violence against MSM and WSW still necessitate some HIV-positive people's need for asylum.
The Post also reports that stigma and a lack of education have complicated prevention efforts and that some hospital patients and employees are routinely screened for HIV without permission. Martin Martinez Sanchez, who works at a private hospital in Mexico City where this practice takes place, said, "If they test positive, they are not admitted." The story profiles several experiences, including that of Arturo Lopez, an HIV-positive MSM, who has been trying to get asylum into the U.S. (Connolly, Washington Post, 8/12). The article was supported by a Kaiser Family Foundation mini reporting fellowship.
Link to this story.
HHS Secretary Leavitt To Visit HIV/AIDS Projects in Cote d'Ivoire
[Aug 12, 2008]
HHS Secretary Mike Leavitt on Wednesday is scheduled to arrive in Cote d'Ivoire, where he will visit projects aimed at fighting HIV/AIDS, malaria and other diseases, AFP/Google.com reports. Leavitt will spend two days in the country, which receives funding from the President's Emergency Plan for AIDS Relief. PEPFAR has allocated $120 million for Cote d'Ivoire's HIV/AIDS efforts from April 2008 to March 2009, according to the U.S. embassy in Abidjan. The $120 million represents a 43% increase in funding compared with the previous year, AFP/Google.com reports. According to the embassy, a second five-year HIV/AIDS project likely will be approved by the government this year (AFP/Google.com, 8/11).
CDC Director Julie Gerberding and coordinator of the President's Malaria Initiative Tim Ziemer are traveling with Leavitt, and they also will visit Ethiopia and Mali. The officials will meet with government representatives in the three countries; visit hospitals, research centers and clinics; and travel to rural communities. They also will meet with religious leaders and look at the role of faith-based organizations in health care (HHS release, 8/8).
Link to this story.
Global Challenges
About 1% of HIV-Positive People Worldwide Have Been Tested for TB, Report Says
[Aug 12, 2008]
Only 1% of people living with HIV/AIDS worldwide have been screened for tuberculosis, according to a report recently released by the coalition Advocacy To Control TB Internationally, or ACTION, Reuters reports. The report, which is based on World Health Organization statistics, was released Thursday at the XVII International AIDS Conference in Mexico City.
According to the report, of the 33 million HIV-positive people worldwide, only 314,394 have been tested for TB, and of those screened, more than one in four were found to have active TB (Shankar, Reuters, 8/8). People living with HIV are 50 times more likely than HIV-negative people to develop TB, and without proper treatment, 90% typically will die within months, according to WHO data. None of the world's three largest HIV/AIDS donors -- the Global Fund To Fight AIDS, Tuberculosis and Malaria; the President's Emergency Plan for AIDS Relief; and the World Bank -- requires mandatory TB testing for HIV-positive individuals (IRIN/PlusNews, 8/8).
Researchers from ACTION at the AIDS conference said the low TB screening rate is "unacceptable." The group recommended universal TB screening for HIV-positive individuals, along with access to the three "I"s: intensified TB case detection, infection control and isoniazid preventive therapy. According to Jim Yong Kim, chief of the Division of Social Medicine and Health Inequalities at Harvard Medical School, screening tests for TB are inexpensive compared with the cost of antiretroviral drugs. Kim added that an integrated approach is necessary to address HIV/TB coinfection (Reuters, 8/8). Advocates at the AIDS conference also called on global leaders to commit to universal access to high quality HIV/TB care by 2015 (ACTION release, 8/7).
According to Kim, the initial pressure to deal with HIV/AIDS led to HIV services developing separately from TB services. "But now the focus needs breadth," Kim said, adding that people living with HIV need a "full range of public health services, including TB care." Kim noted that TB diagnosis tools may be outdated but that HIV programs could perform better even with existing TB diagnostic technology. "TB is a very curable disease," Kim said, adding that even extensively drug-resistant TB can be treated, according to a study conducted in Peru. "It is a crime for people with access to [antiretrovirals] to continue to die from TB," Kim said. Vuyiseka Dubula, secretary general of South Africa's Treatment Action Campaign, added that "[i]gnoring TB screening and care undermines all the gains made in HIV treatment," (IRIN/PlusNews, 8/8). According to Michel Sidibe, assistant secretary general and deputy executive director of UNAIDS, TB is a "preventable plague inside a devastating epidemic" (Reuters, 8/8).
In an effort to address HIV/TB coinfection, several HIV/AIDS and TB advocacy groups at the AIDS conference collected more than 10,000 postcards signed by people affected by HIV/AIDS and TB. The postcards will be sent to heads of the Global Fund, PEPFAR and the World Bank, as well as to the ministers of health in four countries -- Botswana, Kenya, Nigeria and South Africa -- with high HIV and TB burdens (ACTION release, 8/7).
The report is available online (.pdf).
Kaisernetwork.org was the official webcaster of the XVII International AIDS Conference in Mexico City.
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Poverty, Population Movement Contributing to Spread of HIV in Sudan, U.N., Health Officials Say
[Aug 12, 2008]
Poverty and the movement of people displaced by war have contributed to an increase in the number of HIV/AIDS cases in Sudan, United Nations and Sudanese health officials said on Sunday, adding that a lack of data is hindering efforts to get an accurate picture of the disease in the country, the AP/International Herald Tribune reports. According to the officials, an estimated 1.6% of Sudan's 37 million people are living with HIV. However, the actual prevalence of HIV/AIDS likely is higher and improved surveillance would help determine that number, they added.
The movement of large populations -- including people fleeing Darfur and those returning from areas with higher prevalence rates following the separate north-south conflict -- is in particular contributing to the spread of HIV. Although a peace deal in 2005 ended conflict in the south, the war in Darfur continues and so far has resulted in up to 300,000 deaths and the displacement of about 2.5 million people, according to the AP/Herald Tribune. The number of HIV/AIDS cases in Sudan based on available data is estimated to be between 350,000 and 600,000, and less than 2,000 HIV-positive people in need of treatment are receiving it, according to the officials. In addition, the 1.6% prevalence is based on outdated data from surveys conducted in a limited number of clinics rather than nationwide surveillance, they added.
According to Abdel Kareem Gibreel Algoni, a Sudanese public health consultant, the spread of HIV is influenced by poverty and illiteracy, both of which are widespread in Sudan. Sudan now is like how South Africa was in the 1990s, he said, adding, "The virus is not that clever. We can overcome but it works on our ignorance, both political ignorance, economic ignorance and personal ignorance." Although a U.N. survey has indicated that certain regions in Sudan have prevalences of between 1% of 3%, Algoni said that in Abyei, about 18% of the population has been seeking treatment for sexually transmitted infections at mobile clinics he has established. "Most probably, they will also have HIV," he added.
Zahir Babikr, an infectious disease specialist, said that some physicians in the capital of Khartoum and surrounding areas are reporting an average of three to five newly diagnosed HIV cases daily. "We need to do something about it," Babikr said.
A nationwide HIV/AIDS survey has not yet been conducted, the officials said, adding that conducting one without a reliable, updated census would be difficult. A national survey expected this year has been delayed until next year because of low funding, the AP/Herald Tribune reports. Musa Bungudu, the head of UNAIDS in Sudan, said that a serious response to HIV/AIDS in the country began about two years ago and that the country's religious leaders only recently condoned condom use. According to UNAIDS, HIV primarily is spread through sex, not drug use, in Sudan. In addition, stigma continues to pose challenges, and the country does not have a national condom campaign, according to the AP/Herald Tribune. HIV/AIDS centers primarily are located in large hospitals in cities, and most of the population does not have access to such services. Mohamed Abdel Hafeez, manager for Sudan's national HIV/AIDS program, said that training for physicians, efforts to combat stigma surrounding the disease and resources in remote areas are still lacking (El Deeb, AP/International Herald Tribune, 8/10).
Link to this story.
Public Health & Education
AP/Google.com Examines Efforts To Reduce Spread of HIV Among MSM
[Aug 12, 2008]
The AP/Google.com on Friday examined new approaches to curbing the spread of HIV among men who have sex with men. A program in North Carolina that showed "promising signs" enlisted local MSM opinion leaders to urge their peers to practice safer sex in an effort to curb the spread of HIV, the AP/Google.com reports. In return for promoting condom use, regular HIV testing and other actions, the leaders were given $25 gift coupons and marketing materials. According to the AP/Google.com, the idea "may sound frivolous, but little else has proven effective for the men most affected by the epidemic." A study of the program, published in June in the American Journal of Public Health, found that more MSM were practicing safer sex. The study was based on repeated surveys over time of about 300 men and found a 32% reduction in unprotected anal intercourse during 2005, as well as a 40% reduction in the number of sex partners.
Although funding for the program ran out and the effort ended in North Carolina, its success led CDC to begin expanding it on a broader scale to more than 200 community groups nationwide at a two-year budget of $1.5 million. CDC also said it has committed $5 million to a five-year social marketing campaign to promote HIV testing among young black MSM. CDC is "committed to ensuring that its resources are going to the populations hardest hit by the epidemic," Richard Wolitski, acting director of CDC's Division of HIV/AIDS Prevention, said.
The article also examines issues surrounding funding for CDC's HIV prevention efforts. According to the AP/Google.com, CDC's prevention budget has remained at about $700 million since 2001 while costs have risen. In addition, prevention programs that target MSM are "scattershot," the AP/Google.com reports, adding that some experts say even in progressive cities, prevention efforts aimed at the population consist of little more than HIV testing and distribution of no-cost condoms. According to the Division of HIV/AIDS Prevention, about 42%, or $280 million, of its fiscal year 2007 budget was directed at MSM. However, with 53% of new HIV cases occurring among MSM, some experts have said the funding is not enough. "At a minimum, we need to be matching percentages to where the epidemic is," David Holtgrave of Johns Hopkins University said. Leroy Blea, a health official and past president of the National Association of County and City Health Officials, said that the MSM community is not "a very easy population to fund. It's often more politically viable to fund programs for women and children and youth" (Stobbe, AP/Google.com, 8/8).
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Across The Nation
Dallas Morning News Examines HIV/AIDS Among Texas Hispanics
[Aug 12, 2008]
HIV is being detected in Texas Hispanics at later stages than in other ethnic groups in the state, which increases their risk of spreading the virus and delaying treatment, the Dallas Morning News reports. There are more than 8,000 Hispanics living with AIDS in Texas, which has the largest recent influx of new Hispanic immigrants in the nation.
Thirty-two percent of HIV-positive Hispanics in the state are diagnosed with AIDS within 30 days after testing positive for HIV, compared with 24% of both HIV-positive blacks and whites. "This is a pretty significant difference," Sharon Melville, manager of the Texas HIV/STD Epidemiology and Surveillance Branch, said. "It's troubling. They are getting into care late and not getting diagnosed as early and we need to pay attention to that," she added.
According to the Morning News, there are a number of challenges in addressing HIV/AIDS among Hispanics in the U.S., including language barriers, limited access to health care, legal issues and cultural differences. Guillermo Chacon, vice president of the Latino Commission on AIDS, said a culture of silence, particularly among men who have sex with men, coupled with the failure of government agencies to address the issue, contributes to the growing number of cases among the group. AIDS activists contend that a cultural emphasis on masculinity and privacy doubles the stigma against MSM.
Chacon called for more bilingual outreach efforts and services for the Hispanic community. His agency recently released policy recommendations that seek to improve HIV/AIDS treatment access and raise awareness (Meyers, Dallas Morning News, 8/8).
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