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.
Link to this story.
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.
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