Kaisernetwork.org (Washington, DC)
25 August 2008
Politics and Policy
Eight States, Puerto Rico Will Not Receive CDC Funding for Advanced HIV Monitoring System
[Aug 25, 2008]
CDC on Friday announced that it will no longer fund an advanced HIV/AIDS monitoring system in eight states and Puerto Rico, the New York Times reports. The eight states are Georgia, Illinois, Maryland, Missouri, Ohio, Oklahoma, Pennsylvania and Tennessee. According to the Times, the system uses a new test that distinguishes recent HIV infections from old ones, which helps "epidemiologists track [infections] in something much closer to real time than was previously possible."
Data from the advanced system were used in a recent report on new HIV infections in the U.S. based on 22 of the 34 states using the test, Terry Butler -- spokesperson at the National Center for HIV, STD and TB Prevention -- said. Butler added that future monitoring will include data from all 25 jurisdictions. The change in CDC funding will reduce the number of states using the advanced system from 34 to 25. Total funding for the advanced testing method will remain the same but the 25 states will receive a larger portion of funding, Butler said.
Butler added that the 25 states that will continue using the advanced test have the most reliable systems and could help CDC produce the most accurate estimate of HIV infections in the U.S. Julie Scofield, executive director of the National Alliance of State and Territorial AIDS Directors, said that more extrapolations would be necessary to estimate HIV infections nationwide if fewer states use the advanced test.
Scofield added that federal funding for HIV surveillance has decreased and that many states are struggling to meet CDC standards for HIV monitoring. She estimated that the eight states and Puerto Rico lost about $3 million in CDC funding with the announcement. "Surveillance funding is starving at the CDC," Scofield said, adding, "Their ability to say that they're going to have ongoing reliable reports of [HIV] incidence is somewhat questionable unless you have funding for that." NASTAD has called for a $35 million increase in funding for HIV surveillance efforts, the Times reports (Dewan, New York Times, 8/22).
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Public Health & Education
HIV/AIDS Groups Express Concern About Potential for New Antiretroviral Advertising To 'Scare Off' Patients
[Aug 25, 2008]
The Wall Street Journal on Monday examined a new trend for drugmakers marketing HIV/AIDS treatments to release ads that "tak[e] aim at rival HIV drugs, hinting at side effects and other drawbacks." Drug companies have "traditionally sold" antiretrovirals "with images of hope and by explaining the benefits of their treatments" and the "tough new tack has some patient groups unsettled, saying it could scare off patients," according to the Journal.
A recent GlaxoSmithKline ad shows shark-infested waters with the message: "Don't take a chance -- stick with the HIV medicine that's working for you." According to the Journal, another GSK ad in the monthly magazine Poz promotes the drugmaker's protease inhibitor Lexiva and advises patients to ask their physicians, "Will the HIV medicine make my skin or eyes turn yellow?" Other protease inhibitors have been associated with such a side effect, the Journal reports.
The AIDS Healthcare Foundation sent a letter to HHS last month expressing concerns about GSK's ads. The organization said it has not yet received a response, but a spokesperson for HHS said it has not received the letter. In addition, Bob Huff, antiretroviral project director at Treatment Action Group, said he complained to GSK about the shark-themed ad. Huff said the ad is offensive and intended to create fear among HIV-positive people.
According to GSK, the ads are "educational" and appropriate. Marc Meachem, a spokesperson for the company, said in a statement, "While we acknowledge that some people may find the headline and imagery of the materials to be provocative, GSK stands firmly behind the ads and their underlying message: Patients considering changing HIV therapy ought to consult closely with their physician to fully understand the near and potential long-term health implications of such changes."
Meachem said the ads are "just as likely to encourage a patient to stay with another medicine as it is one of our own, assuming that the medicine is working for a patient and is well-tolerated." Meachem said that he is aware of the concerns regarding the ads, adding that the shark-themed campaign "ends this September, and, as always, we will take all the community feedback we have received into consideration for future campaigns."
A recent print ad from Bristol-Myers Squibb shows an image of a toilet and says, "Ask your doctor if there are HIV medications with a low risk of diarrhea." Diarrhea is a side effect associated with Abbott Laboratories' Kaletra, but not BMS' Reyataz.
BMS spokesperson Brian Henry said the ad is appropriate. Abbott spokesperson Melissa Brotz said, "Kaletra has a well-established side-effect profile and profound and sustained effectiveness in combating HIV."
According to the Journal, part of the push behind the new "sharp-elbows advertising" is that the "market for HIV medicines has grown crowded and companies want to protect their market share." While GSK is one of the world's biggest sellers of antiretrovirals, its medicines are older and its share of the $11 billion global antiretroviral market has dropped from 39% in 2004 to 25% currently.
Regan Hoffman, editor of Poz, said, "Treatments have become so comparable, so [companies] are really trying to split hairs to have a marketing advantage" (Whalen/Wang, Wall Street Journal, 8/25).
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Global Challenges
Namibia To Launch Program That Will Address HIV/AIDS Among Workers at Sea
[Aug 25, 2008]
A program that will provide employees in Namibia who work at sea with information on HIV/AIDS and focus on antiretroviral treatment is in an advanced stage of development, the New Era/AllAfrica.com reports. According to the New Era/AllAfrica.com, the program is needed to address this group's vulnerability to HIV/AIDS because of a lack of information and to ensure that HIV-positive employees do not miss scheduled doses of antiretrovirals. Representatives from the Ministry of Health and Social Services, fishing companies and other HIV/AIDS service providers met last week to create a committee that will oversee the program's implementation.
According to assessments, the extended period of absence at sea can disrupt the antiretroviral regimens of employees living with HIV/AIDS because they often are unable to take the drugs at sea. Although the health ministry does make arrangements for HIV-positive employees to receive treatment, most employees are unaware of such arrangements, the New Era/AllAfrica.com reports.
Immanuel Mwilima of the Walvis Bay Multi-Purpose Centre Trust, which will lead the program, said the initiative could be effective in addressing the vulnerability of sea-going employees to HIV/AIDS. "Such a program will cater for the very basic needs in form of information and education for seafarers when it comes to HIV/AIDS," Mwilima said, adding, "These people are very vulnerable, as most information does not reach them due to their extended length of stay at sea."
Mwilima added that Namibia will pilot the program and that if successful, it could be rolled out to other countries. "We have very high expectations for this program and will do everything possible to make sure that it succeeds. If successful, Namibia could be used as a model for other countries facing the same scenario worldwide," Mwilima said (Tjatindi, New Era/AllAfrica.com, 8/21).
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HIV/AIDS Awareness Efforts Face Difficulties in Northern Kenya, Health Workers, Advocates Say
[Aug 25, 2008]
Some health workers and advocates in Kenya's North Eastern Province recently said that HIV/AIDS awareness campaigns face difficulties in the region because of its remote location and culture, IRIN/PlusNews reports. Ijara, a district in Kenya's North Eastern Province, has recorded the lowest number of people living with HIV in the province at 130. However, the "stigma associated with HIV/AIDS is very, very strong here," Mohamed Abdikadir Sheikh, Ijara's medical officer, said. According to Sheikh, HIV/AIDS still is associated with magic, witchcraft and evil spirits by many people in the region, leading them to seek ritualistic instead of medical treatment. The voluntary HIV counseling and testing center in Ijara "remains idle because the local community believe they cannot contract the disease," Sheikh said, adding, "We need an aggressive awareness campaign in these remote areas."
According to IRIN/PlusNews, the remoteness of the area, cultural taboos and the transient nature of the population create difficulties for groups already working to create HIV/AIDS awareness. The group Isiolo Youths Against AIDS and Poverty said it is limited in its abilities to spread awareness in the region because of a lack of resources and ethnic conflicts. Ali Boru, an IYAP official, said open discussions of sex and sexuality are discouraged by the largely Muslim population, adding, "We have no picture or poster of a condom here -- we cannot take the risk." According to IYAP official Amina Abdullahi, the young age of the group's educators also hinders awareness efforts because the "culture does not allow me to advise or discuss any sexual matter with a woman who is older than me" (IRIN/PlusNews, 8/21).
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HIV-Positive Women in Swaziland Protest Royal Family's Use of Funds
[Aug 25, 2008]
More than 1,500 mostly HIV-positive women on Thursday protested against a foreign shopping trip taken by eight of King Mswati's 13 wives in what appeared to be the first demonstration in the country by HIV-positive people questioning how money should be spent, AFP/Khaleej Times reports. Swaziland, which has an HIV/AIDS prevalence of close to 40%, is facing shortages of medicines, including antiretroviral drugs. The wives and their children and staff left Swaziland last week to shop for celebrations to mark Mswati's birthday and the country's independence from Great Britain in 1968 (AFP/Khaleej Times, 8/21).
The protest was organized by Positive Living, a nongovernmental organization that aims to help women living with HIV. Participants chanted slogans such as, "We need to keep that money for" antiretrovirals, and, "We can't afford a shopping trip when a quarter of the nation lives on food aid" (BBC News, 8/21). Siphiwe Hlophe, a spokesperson for the Women's Coalition of Swaziland and Positive Living, said, "With this march, we want to drive home the point that we people living with HIV are not happy with the way our money is being used." According to AFP/Khaleej Times, per capita income in Swaziland is about $1,000 -- the lowest in Southern Africa.
Government spokesperson Percy Simelane said, "Poverty has been with us for many years. We cannot then sit by the roadside and weep just because the country is faced with poverty." He added that Swaziland has "made great strides as a country that gives us pleasure in celebrating the 40 years of independence and the king's birthday" (AFP/Khaleej Times, 8/21).
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Recent Releases in HIV/AIDS
Lancet Publishes Article About Behavioral HIV Prevention Strategies
[Aug 25, 2008]
"Behavioral Strategies To Reduce HIV Transmission: How To Make Them Work Better," Lancet: Thomas Coates of the University of California-Los Angeles and colleagues make five points in the paper about behavioral HIV prevention strategies. First, they write that the "aggregate effect of radical and sustained behavioral changes in a sufficient number of individuals potentially at risk" for HIV is "needed for successful reductions" in transmission of the virus. Second, "combination prevention is essential" because HIV prevention is "neither simple nor simplistic," according to the authors. Third, prevention programs "can do better" by "aiming for many goals ... that are achieved by use of multilevel approaches" with both HIV-positive and HIV-negative populations, the authors write. Fourth, "prevention science can do better," the authors write, adding that interventions "derived from behavioral science have a role in overall HIV prevention efforts, but they are insufficient when used by themselves to produce substantial and lasting reductions in HIV transmission between individuals or entire communities." Lastly, the researchers write that "we need to get the simple things right," adding, "The fundamentals of HIV prevention need to be agreed upon, funded, implemented, measured and achieved." They conclude, "That, presently, is not the case" (Coates et al., Lancet, 8/23).
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