Kaisernetwork.org (Washington, DC)
2 October 2008
Politics and Policy
Newspapers Examine Efforts, Reaction to Easing Ban on HIV-Positive Visitors to U.S.
[Oct 02, 2008]
Some HIV/AIDS advocates are "being cautious with their optimism" regarding new immigration rules for HIV-positive visitors as well as HHS efforts to remove HIV from the list of diseases barring entry into the U.S., the San Francisco Chronicle reports (Fulbright, San Francisco Chronicle, 10/2).
A law that made foreigners living with HIV/AIDS inadmissible in the U.S. was repealed in July when President Bush signed the United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act. HHS determines which diseases are inadmissible and first placed HIV on the list in 1987. This decision was later codified by U.S. immigration law. With the statutory immigration ban now lifted, HHS is in the process of removing HIV from the inadmissibility list.
Under the new Department of Homeland Security rules, HIV-positive applicants who meet "all other normal criteria for the granting of a U.S. visa" will have the opportunity to receive a temporary, non-immigrant visa from U.S. consular offices overseas, according to a DHS statement. Under previous regulations, HIV-positive people were barred from entering the U.S. unless they received a special waiver (Kaiser Daily HIV/AIDS Report, 9/30). The new rules, like previous regulations, also require that HIV-positive visitors present proof that they are not a public health risk or that they would not create potential costs to any government agency, according to CQ Homeland Security. In addition, the new DHS rules require visitors to prove that they will have enough antiretroviral drugs and financial assets or health insurance to cover any hospitalizations during their stay. The new rules apply only to non-immigrant, 30-day visas, CQ Homeland Security reports. Homeland Security Secretary Michael Chertoff said, "This regulation significantly improves the opportunities for individuals seeking to visit the U.S. who were previously inadmissible because of an HIV infection."
According to CQ Homeland Security, HHS has not provided a timetable for the removal of HIV from the list of diseases barring entry to the U.S. (Webber, CQ Homeland Security, 10/1). However, Amy Kudwa, a DHS spokesperson, said that HHS likely will remove HIV from the list within one year, the Chronicle reports. She added that she expects the new DHS regulations to be in effect by Friday.
Reaction
"We will be very happy if they in fact get HIV completely removed from the list," Brian Moulton, associate counsel for the Human Rights Campaign, said, adding that officials "need to make the entry requirements for those with HIV the same as any other person." According to Moulton, the previous regulations were enacted at a time when people did not entirely understand how HIV is transmitted and there was hysteria surrounding the virus. "Public health officials had an understanding that it wasn't a risk to have people with HIV walking down the street, but the general public and some elected officials still had a misunderstanding," he said, adding, "Fear and ignorance drove the legislative process."
Judith Auerbach, deputy executive director for science and public policy at the San Francisco AIDS Foundation, said that the new waiver process is not what advocates want. "It is a partial solution that affects a subset of people and does not eliminate all the barriers," she said, adding, "We want all the language eliminated, the regulatory as well as the statutory. There is no grounds for it; it is a discriminatory practice" (San Francisco Chronicle, 10/2).
Victoria Neilson, legal director for Immigration Equality, said that the new visa process "continues to place a burden on HIV-positive travelers, unlike anything placed on anyone with any other disease." She added, "We're troubled that this regulation is coming out now and further codifying the HIV ban and waiver requirements just three months after Congress issued a mandate that it wants HIV removed from the list of communicable illnesses of public health significance. DHS shouldn't be focusing on fine-tuning the waiver application progress."
According to Neilson, consular officers overseas also have no method of determining during a visa interview if an antiretroviral is "medically appropriate" for an HIV-positive person or if they would engage in high-risk behavior. Joe Amon, director of the HIV and human rights program at Human Rights Watch, said the new regulations are "very indicative of the kind of stigma and discrimination that is often put against people living with HIV." He added, "People with HIV take responsibility for their behaviors all of the time, and people at-risk need to be aware and adopt protective behavior as well." According to Neilson, the new visa process would eliminate 18 days from the application process (CQ Homeland Security, 10/1).
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Science & Medicine
Researchers Find HIV Has Existed Among Human Populations for 100 Years
[Oct 02, 2008]
HIV has existed among human populations for about 100 years, decades earlier than previously believed, according to a study published Wednesday in the journal Nature, the Los Angeles Times reports (Engel, Los Angeles Times, 10/2). HIV/AIDS was not recognized formally until 1981, and scientists previously estimated its origin at around 1930. However, the new study, led by Michael Worobey of the University of Arizona, found the origin of HIV to be between 1884 and 1924, with a more focused estimate at 1908. Worobey said that the new result "is not a monumental shift, but it means the virus was circulating under our radar even longer than we knew" (Ritter, AP/Google.com, 10/1).
The research is based on lymph node tissue from an HIV-positive woman who died in the Democratic Republic of the Congo in 1960, then the Belgian Congo. The tissue specimen was one of more than 800 preserved in ice-cube-size blocks of paraffin at the University of Kinshasa. The researchers compared that sample with modern HIV strains to determine its mutation rate. They then matched that rate with the oldest sample of the virus -- from a 1959 blood sample taken from a man who also lived in the Belgian Congo -- and traced their common ancestor to between 1884 and 1924, which represents the first appearance of the virus in humans before it mutated (Los Angeles Times, 10/2). "Those old sequences helped calibrate the molecular clock, which is essentially the rate at which mutations accumulate in HIV," Worobey said, adding, "Once you have that rate, you can work backward and make a guess of when the ancestor of the whole pandemic strain of the AIDS virus originated. It is that ancestor we are dating to 1908 plus or minus about 20 years" (Steenhuysen, Reuters Africa, 10/2).
Worobey said that further research is unlikely to determine that the spread of HIV began any earlier than the late 19th century. "I think we're pretty close to where's it's going to end up. It's possible but unlikely we'd find some branch on the evolutionary tree that went deeper," he said (Innes, Arizona Daily Star, 10/2).
It has long been believed by HIV/AIDS experts that HIV descended from a chimpanzee virus. Although it is believed that the chimpanzee virus was transmitted to people in Africa when the animals were killed for bushmeat, the number of other people who contracted the virus were so few that it did not obtain a durable foothold, according to the AP/Google.com (AP/Google.com, 10/1).
According to the researchers, the spread of HIV increased as a result of urbanization during the colonial era (AFP/Yahoo! News, 10/1). "Cities are kind of ideal for a virus like HIV," Worobey said, adding that urban areas provide the virus the opportunity to spread to other people (AP/Google.com, 10/1). Steven Wolinsky, a study co-author from the Feinberg School of Medicine at Northwestern University, said that increased urbanization during the colonial era meant not only more potential hosts for HIV living closer together but also commercial sex work and other high-risk behaviors (Los Angeles Times, 10/2).
Anthony Fauci -- director of NIH's National Institute of Allergy and Infectious Diseases, which helped fund the research -- said the study is "clearly an improvement" over the previous estimate of 1930, calling the advance a "fine-tuning." The AP/Google.com reports that experts are not surprised that HIV circulated among humans for about 70 years before being recognized because an infection usually takes years to produce obvious symptoms, a lag that can mask the role of the virus and which would explain initial low levels among Africans (AP/Google.com, 10/1). Jim Moore, an anthropologist at the University of California-San Diego who was not affiliated with the study, said the fact that HIV could have spread unnoticed for decades is credible, given mortality rates in Africa during the colonial period. "The conditions then were horrendous in terms of how Africans were treated," he said, adding, "People dying of AIDS would have been part of the background" (Los Angeles Times, 10/2). The study also received funding from the David and Lucile Packard Foundation (Arizona Daily Star, 10/2).
The study is available online.
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Global Challenges
Ukraine Parliament Introduces Bill To Increase HIV Prevention, Treatment Efforts
[Oct 02, 2008]
Ukraine's Parliament recently approved a bill that would establish a national program to increase HIV/AIDS prevention and treatment efforts in the country, Ukrainian News reports. The bill -- titled "On Approving a National Program for Ensuring Prevention of HIV Infections, Treatment, Care and Support of HIV Carriers and AIDS Patients during the 2009-2013 Period" -- aims to curb the impact that the disease is having on the country's population by introducing a government policy that would increase both HIV/AIDS prevention and treatment.
Under the national program, preventive measures would include increasing the safety of blood products; providing access to large-scale primary prophylactics, especially among at-risk groups; and increasing efforts to prevent mother-to-child transmission. Improved treatment efforts would include no-cost counseling and HIV tests, access to antiretroviral and support therapy, and psychological support to those living with HIV/AIDS. The program will require about 3.7 billion Ukrainian hryvnia, or about $730 million, according to Ukrainian News.
Ukraine's adult HIV/AIDS prevalence is estimated at 1.63%, according to Ukrainian News. The bill states that more than 122,000 HIV cases were registered in Ukraine as of Jan. 1 of this year. The program attributes issues with current HIV/AIDS prevention and treatment efforts, as well as the increase in the number of new cases, to socioeconomic problems -- such as inadequate medical and social-assistance infrastructures and insufficient funding for prevention and treatment efforts -- Ukrainian News reports (Sokolovska, Ukrainian News, 9/30).
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Spiritual Healing Threatening Adherence to Antiretrovirals in Uganda, Official Says
[Oct 02, 2008]
Unverified spiritual healing promoted by some churches throughout Uganda is threatening HIV-positive patients' adherence to antiretroviral drugs, Robert Ochai, executive director of The AIDS Support Organisation, said recently during the organization's 17th annual general meeting, Uganda's Monitor reports. According to the Monitor, several Pentecostal churches in the country invite the ill, including those living with HIV/AIDS, to participate in spiritual healing. Some churches promise miracles, sometimes in exchange for the patients' valuables, according to the Monitor.
"Some clients have been misled into prematurely stopping their medication, which is extremely harmful to their health," Ochai said, adding, "While we believe in God and his ability to perform miracles, we also encourage our clients to adhere to their medications." Ochai did not provide statistics on the number of HIV-positive people abandoning their antiretroviral regimens for faith healing but said that the problem is growing and requires urgent intervention.
Robert Nakibumba, TASO public relations officer, stressed the importance of antiretroviral adherence and said that although TASO clients have a more than 95% antiretroviral adherence rate, patients under different health care providers must remain on the drugs.
Speaker of Parliament Edward Ssekandi said the government would allocate funding in the Ministry of Health's budget during the next fiscal year to address the increasing needs of HIV-positive people (Kirunda, Monitor, 9/30).
Link to this story.
Kenya Signs $15 Million Grant Agreement To Fight HIV/AIDS
[Oct 02, 2008]
The Kenyan government recently signed an agreement for a grant worth 1.1 billion shillings, or about $15 million, for the fight against HIV/AIDS, Kenya's Nation reports. According to the Nation, the funding will be shared among member countries of the Inter-Governmental Authority on Development, including Djibouti, Eritrea, Ethiopia, Sudan, Uganda and Kenya.
Acting Finance Minister John Michuki said the grant will complement contributions made by Kenya and other bilateral donors to fight the disease. In addition, IGAD Executive Mahboub Maalim said that IGAD governments will not cease in their efforts to curb HIV/AIDS, adding that the disease can be controlled through collaborative efforts.
According to the Nation, Michuki told IGAD members of Kenya's National AIDS Control Council that it will continue to support human resources, which will assist in the provision of HIV/AIDS prevention, treatment and care, as well as support and other services to internal refugees. Michuki said, "NACC will make available the necessary human resources to implement the regional activities and sub-projects in accordance with stipulated agreement," adding, "This is besides assisting in cross border collaboration on the health sector response to HIV and AIDS. The responsibility to coordinate and manage the project will be NACC, which is the key institution leading in the fight against the AIDS pandemic in the country."
The Nation also reports that the program, which will be implemented during the next four years, is expected to contribute to a decline in new HIV/AIDS cases. "It will be keenly monitored to ensure that targeted objectives are achieved," Michuki said (Kumba, Nation, 9/30).
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Public Health & Education
Canadian Program Provides Care to HIV-Positive Pregnant Women, Aims To Reduce Mother-to-Child Transmission
[Oct 02, 2008]
The CP/Yahoo! News on Tuesday examined the Positive Pregnancy Programme, a Canadian initiative created to provide HIV-positive pregnant women with care, resources and support. Jay MacGillivray, a midwife with Sages-Femmes Rouge Valley Midwives, started the program in 2005 with Mark Yudin, an ob-gyn with additional training in reproductive infectious diseases. Under the program, pregnant women living with HIV/AIDS are provided with care during pregnancy, labor and after. The women are guaranteed that they will be attended by specialists and clinicians who are used to working with HIV-positive patients.
MacGillivray said, "There are people who are up-to-speed and compassionate and wonderful and clinically terrific who are nurses, but not everybody is comfortable with HIV." She added that she arranges for the pregnant women to receive future health care for their children and additional support from HIV/AIDS service organizations. "I become the string that draws it all together. I will see her prenatally, try and normalize her pregnancy for her -- because she's thrilled to be pregnant, but she's going to find people all the way through who, if they knew she was positive, would be horrified," MacGillivray said.
According to the CP/Yahoo! News, the program does not receive any special funding and has gained international attention. Requests from places such as London, Paris, Scotland, Cameroon and Botswana have been made to MacGillivray to help launch similar initiatives. "Our hope is that eventually we can use it as a transferable model" and that organizers "can boost enough reality and enough clinical competence in enough places that we can use it as a template elsewhere."
According to the CP/Yahoo! News, pregnant women living with HIV/AIDS who receive the proper medical treatment throughout their pregnancies have a less than 1% risk of passing the virus to their infants. A lack of medical treatment can lead to a 30% risk of mother-to-child transmission. According to the Canadian Pediatric AIDS Research Group, approximately 150 to 175 infants are born to HIV-positive women annually in Canada. MacGillivray said that concerns about how they will be treated prevent many HIV-positive women from seeking medical attention, making them instead turn to high-risk home births.
Yudin, who is conducting research into physicians' attitudes toward HIV-positive people having children, said that there is a stigma associated with HIV-positive pregnant women and that more than 75% of the women he sees are immigrants from Africa. He said many of them are "middle class or better, are working, have a stable relationship, have a stable job. I think the general public might not get that" (Burgmann, CP/Yahoo! News, 9/30).
Link to this story.
Recent Releases in HIV/AIDS
GBC, Booz & Company Report Examines Corporate Engagement on HIV/AIDS, TB, Malaria
[Oct 02, 2008]
"The State of Business and AIDS, TB and Malaria," Global Business Coalition/Booz & Company: GBC and the consulting firm Booz conducted online surveys and interviews to assess levels of corporate engagement on HIV/AIDS, tuberculosis and malaria programs. Based on responses from 83 GBC members representing 15 industries, the report found that 75% of companies provide information and education on HIV testing and counseling, two-thirds provide HIV testing services for employees and 39% offer immediate information about CD4+ T cell counts. More than half of the companies reported that CEOs had communicated an HIV policy with employees, and 25% reported that CEOs had received an HIV test publicly. The report also found that businesses are moderately engaged with malaria and TB efforts, with 25% of companies reporting that malaria is considered a corporate priority and 40% of companies providing educational materials about TB to employees. One-third of businesses reported that their company was engaged in efforts to address HIV/TB coinfection efforts. The report concludes that businesses must work with the public health community, national governments, international organizations and community groups to curb the spread of HIV/AIDS, TB and malaria and reduce the social and economic impacts of the three diseases (Global Business Coalition/Booz & Company, 9/30).
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