Kaisernetwork.org (Washington, DC)
1 October 2008
Across The Nation
California Gov. Schwarzenegger Signs Bill Requiring Insurers To Pay for HIV Testing
[Oct 01, 2008]
California Gov. Arnold Schwarzenegger (R) on Tuesday signed a bill (AB 1894) into law that requires health care plans operating in the state to pay for routine HIV testing, the Los Angeles Times reports (Rau/McGreevy, Los Angeles Times, 10/1).
According to the California Office of AIDS, about 40,000 Californians are HIV-positive but are not aware of their status. CDC figures show that about 40% of the U.S. population has ever received an HIV test (Kaiser Daily HIV/AIDS Report, 9/18).
In a statement, the AIDS Healthcare Foundation, which sponsored the bill by Assembly member Paul Krekorian (D), praised Schwarzenegger for signing the measure. AHF President Michael Weinstein said, "Nearly 40,000 Californians do not know they are HIV-positive, and they are unwittingly causing between 2,500 and 5,000 new infections in California each year."
According to AHF, "opt-out" HIV testing as part of routine care in all health care settings for people between ages 13 and 65 was recommended by CDC in 2006; however, the recommendation has not been implemented widely in California or throughout the rest of the country largely because of issues over who should pay for the tests. AHF said the bill will help California implement the guidelines (AHF release, 9/30).
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Science & Medicine
Scripps Research Institute Receives IAVI Grant To Develop HIV Vaccine, Create HIV Vaccine Research Center
[Oct 01, 2008]
The Scripps Research Institute on Monday received a $30 million, five-year grant from the International AIDS Vaccine Initiative to develop an HIV vaccine, the South Florida Sun-Sentinel reports.
The grant will finance a team of scientists who will work to develop an HIV/AIDS vaccine that would stimulate the body to produce antibodies to kill the virus, SRI spokesperson Keith McKeown said. The grant also will fund a research center that will be connected to other vaccine research efforts and projects worldwide. The center will be led by SRI researcher Dennis Burton (LaMendola, South Florida Sun-Sentinel, 9/30). The center will open in California, and no date has been announced for its opening, according to Reuters Africa (Reuters Africa, 9/30).
The center, called the HIV Neutralizing Antibody Center, will bring together scientists from several disciplines, including biology, virology, chemistry and immunology. "Collaboration is essential to making things happen so the more we bring people together to promote scientific interaction, the more rapid our progress will be toward the creation of an effective AIDS vaccine," Burton said. SRI President Richard Lerner added that SRI is "confident" the center "will facilitate more productive exchanges among researchers and stimulate new ideas that will help to accelerate AIDS vaccine science" (IAVI release, 9/30). "This reinvigorated approach will also make it easier for us t recruit and mentor the young scientists who represent the future of HIV/AIDS vaccine research," Burton said (Reuters Africa, 9/30).
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Global Challenges
Developing Countries Face Shortage of Medical Workers Trained To Treat HIV/AIDS, Malaria, TB, Reuters Reports
[Oct 01, 2008]
Many developing countries are facing a shortage of medical workers -- leaving health care gaps in nations with high HIV/AIDS, malaria and tuberculosis burdens -- Reuters reports.
Although Africa has 25% of the world's disease burden, it has only 3% of the world's health care workers, Reuters reports, adding that the continent also is most affected by medical brain drain worldwide. In addition, the continent's high HIV/AIDS prevalence has led to an even greater shortage of medical workers who have died from the disease. HIV/AIDS patients in Africa often use clinics staffed by a single nurse and a few untrained assistants, with a physician visiting once every few weeks, Reuters reports. "A nurse taking care of 400 patients is paid $3 a day in Malawi," a situation that leads many medical workers in the country to migrate abroad or work for private companies, Moses Massaquoi, a physician with Medecins Sans Frontieres in Malawi, said. According to Reuters, some international disease experts earlier this year called the recruiting of African health care workers by Western nations an international crime.
In India, which has the world's third highest HIV/AIDS caseload, people often sleep outside of health clinics while waiting for medications and tests, HIV/AIDS advocate Loon Gangte said. Gangte added that the challenge of obtaining care leads some patients to abandon treatment. According to Reuters, India has a significant shortage of medical workers, with one nurse for every 1,000 patients, compared with 11 nurses for every 1,000 patients in Europe. "Demand is greater than the supply," Sunita Maheshwari, a pediatric cardiologist in Bangalore, said.
Ezekiel Nukuro, an official with the World Health Organization, said that many developing countries are facing an increase in deaths from preventable diseases and a decrease in life expectancy. He added that the health systems in these countries are "on the brink of collapse due to the lack of skilled personnel." According to Reuters, some experts say the situation has worsened because of new immigration regulations in Western nations that allow medical workers from developing countries to migrate abroad for work. Some aid organizations have expressed concern that a proposed European Union "blue card" scheme, which in September received initial backing from ministers, would lead to a further migration of health care workers from developing countries.
Experts have said there "is no easy solution" to address brain drain, but retention strategies may reduce the problem, Reuters reports. "It would be impossible to solve or stop migration of health workers," Nukuro said, adding that "strong political and international commitment, innovative strategies ... partnerships and alliances and long-term investments" are crucial in retaining health care workers. WHO in a July report recommended that international aid to Africa should go towards increasing physician salaries and improving recruitment and training of medical workers. The report also suggested the use of "telemedicine" to connect African hospitals with laboratories and experts abroad through the Internet and telephones. In India, efforts have been made to reduce the burden on physicians by training housewives to provide medical advice and administer fever medicine, oral rehydration tablets and rapid diagnostic kits for malaria and pregnancy. Naresh Dayal, India's secretary of health, said this strategy is a "small intervention but it will have a big impact on reducing maternal mortality rates and infant mortality rates." Similar programs are being implemented in some African countries, especially in rural areas, according to Reuters (Chandran/Tan, Reuters, 9/30).
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Indian Health Minister Calls on Country To Legalize Homosexuality To Improve Fight Against HIV/AIDS
[Oct 01, 2008]
Following his recent efforts to legalize homosexuality in India, Health Minister Anbumani Ramadoss said the country should recognize the increasing acceptance of homosexuality worldwide because such tolerance would ensure "an effective fight against AIDS," IANS/Thaindian News reports (IANS/Thaindian News, 9/29).
Under Section 377 of the Indian Penal Code -- which was established under British rule in 1860 -- homosexuality is a crime that carries a punishment of life in prison. The Delhi High Court had been holding daily hearings on a petition that sought to legalize homosexuality, which was supported by the Ministry of Health and Family Welfare but opposed by the Ministry of Home Affairs. According to the Centre Party, legalizing homosexuality would have adverse health effects, and the party asked the court to ignore Ramadoss' position on legalizing homosexuality. The health ministry wants to make homosexuality nonpunishable particularly because of the latest figures from the National AIDS Control Organisation that estimate there are 22 million men who have sex with men in the country.
According to NDTV.com, the court questioned the Centre Party's views against homosexuality and called them outdated. Advocates have said that Section 377 goes against fundamental rights, adding that considering the British government repealed the law in 1967, it is time that the Indian government did the same. Sumit Baudh, an advocate for Voices Against 377, said, "I think this fight is about human rights. This fight is about privacy, dignity and equality" (Khanna, NDTV.com, 9/30).
Ramadoss said that he recognizes the social opposition to his call to decriminalize homosexuality but that it is "a very serious issue from the AIDS-control point of view." According to Ramadoss, the National AIDS Control Programme, which is in its third phase from 2007-2012, is being "adversely impacted because it is difficult to reach out to the gay population of the country." He added that 86% of HIV cases in the country are transmitted sexually, a figure that includes MSM and transgender people.
According to Ramadoss, Section 377 also effectively makes it illegal for a physician to treat MSM, as well as for a health care worker to advise MSM about HIV. Ramadoss said, "Imagine the problem this means when it comes to our fight to contain HIV infection" (IANS/Thaindian News, 9/29).
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Zimbabwean HIV/AIDS Advocates Express Hope About New Government
[Oct 01, 2008]
A power sharing deal signed on Sept. 15 by Zimbabwe's three political parties has made some HIV/AIDS advocates optimistic for increased access to medications and services at state hospitals, IRIN/PlusNews reports. Benjamin Mazhindu, chair of the Zimbabwe National Network of People Living with HIV and AIDS, said, "In previous years, there has been serious under-funding of key ministries, such as health and social welfare, with ministries such as defense being given priority." He added that budget decisions in an "all-inclusive government" would not be made by just one party that holds a majority. In addition, the network's "hope ... rests on the fact that budget proposals will [now] be heavily debated in parliament," Mazhindu said.
The new power sharing agreement -- between the ZANU-PF party and the two factions of the majority Movement for Democratic Change -- has contributed to the end of a period of political violence, IRIN/PlusNews reports. An estimated 320,000 HIV-positive people in Zimbabwe are in need of antiretroviral treatment but only about 100,000 are accessing the drugs at public health facilities, according to IRIN/PlusNews. A ban by the Social Welfare Ministry that hindered nongovernmental organizations' HIV/AIDS relief efforts was lifted, but "in reality," only groups running antiretroviral treatment programs were permitted to resume their work, IRIN/PlusNews reports. According to IRIN/PlusNews, the political crisis also led to a funding deficit for HIV/AIDS programs because international donors have been pulling out of the country. Some NGOs in Zimbabwe said they hope that the new government will allow them to continue their work without restriction or interference, according to IRIN/PlusNews.
President of the Zimbabwe HIV and AIDS Activist Union Bernard Nyathi said that the "welfare of HIV-positive Zimbabweans has, for too long, been ignored," and that the parliament under the new administration would not be the "rubber stamp" it had been for the past two decades. He said that members of parliament "could help improve the lives of us people living with HIV. We have no doubt about that and we are very optimistic" (IRIN/PlusNews, 9/29).
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Kenyan Program Distributes No-Cost ITNs, Condoms, Water Filters to People Who Receive HIV Tests
[Oct 01, 2008]
A new HIV testing program in Kenya's Lurambi district is providing an insecticide-treated net to prevent malaria, no-cost condoms and a water filter to everyone who receives a test, DPA/Bangkok Post reports. The campaign -- which aims to administer HIV tests to 43,000 sexually active people ages 15 to 49 in the district -- is a joint project of Vestergaard Frandsen, the Kenyan Ministry of Health and nongovernmental organizations.
Peter Cleary -- communications director of Vestergaard Frandsen, which is providing the HIV tests and the no-cost items -- said the campaign has received an "overwhelming" response, with more than 10,000 people arriving for an HIV test on the first day of the program and nearly the same turnout on the second day. Some health officials, including Louis da Gama of Global Health Advocates, attributed the strong turnout to a high demand for the no-cost items, particularly the ITNs. According to DPA/Post, 52% of children and 37% of pregnant women in Kenya sleep under an ITN.
Of the 650 people tested in Eshisuru village during the first two days of the campaign, 40 tested positive for HIV, a rate slightly lower than Kenya's estimated national HIV prevalence. Eight of the 40 people who were found to be HIV-positive immediately began antiretroviral treatment, which the health ministry provided to the program in advance. The program also provides counseling for people who test positive for HIV, many of whom "come expecting to be negative because they don't feel sick and are still able to work," but who "are distraught when they find out" they are HIV-positive, Beatrice Awino, manager of the testing site in Eshisiru, said. In addition, the campaign aims to reduce HIV-associated stigma by holding the testing sites in central locations.
Vestergaard Frandsen plans to fund the first 43,000 HIV tests, but the success of the program could lead Kenya to expand the campaign, with an aim of reaching the national target of having 80% of all adults know their HIV status by 2010. According to DPA/Post, less than 20% of Kenyans know their HIV status, and an estimated 1.2 million HIV-positive Kenyans do not know their HIV status (Logan, DPA/Bangkok Post, 9/30).
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