Global Challenges

Global Financial Crisis Could Harm HIV/AIDS Funding, Piot Says

[Oct 29, 2008]

The current global financial crisis could harm HIV/AIDS funding and increase the factors that make people vulnerable to the disease, UNAIDS Executive Director Peter Piot said on Tuesday during an event at the Center for Strategic and International Studies, CQ HealthBeat reports. According to Piot, as rising food and energy costs drive more people into poverty worldwide, the factors that drive the spread of HIV also could increase. "That must have an impact on the spread of HIV, although it's not so clear," he said, adding that it is certain that low-income countries will be more affected by and vulnerable to the financial crisis when it comes to providing HIV/AIDS treatment. For example, 100% of the cost to provide 50,000 HIV-positive people in Rwanda with antiretroviral drugs at the end of last year was paid by donors -- such as the Global Fund To Fight AIDS, Tuberculosis and Malaria and the President's Emergency Plan for AIDS Relief -- according to Piot. He added that Brazil receives no donor funding to provide similar treatment services to its HIV-positive citizens.

Countries likely will not feel the effects of the financial crisis on HIV/AIDS "in the next six or 12 months because of commitments that have been made in better times," Piot said, adding that he wonders if it will be possible to continue enrolling 700,000 to one million people in drug treatment programs over the next few years. "If not, deaths will go up again, deaths from AIDS, no doubt about it," he said, adding, "We estimate that even if (funding) continues at the same level, deaths will go up to about three million per year by 2011."

Piot also praised the Bush administration and Congress for continuing PEPFAR, which he said is an "unprecedented program that has saved millions of lives." Piot added, "It is quite rare in international development that you can count so easily, you can measure, the impact of actions, and yet this has been the case when it comes to what PEPFAR has done, and it's unprecedented in international development." In addition, Piot commended President Bush and Secretary of State Condoleezza Rice for their comments at the recent White House summit on international development about how the U.S. should not reduce aid. "I hope that the next president will follow along the same lines," Piot said.

Jennifer Kates -- vice president and director of HIV policy at the Kaiser Family Foundation -- said it is difficult to assess how the financial crisis will affect future funding levels. "How the financial crisis plays into that, we still don't know," she said.

Piot will leave his position at UNAIDS at the end of the year to head the new Institute for Global Health at Imperial College London (Vadala, CQ HealthBeat, 10/28).

A kaisernetwork.org webcast of the event is available online.

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WHO Says HIV/AIDS-Related Deaths Will Peak in Next Five Years, Then Decline

[Oct 29, 2008]

The World Health Organization on Monday in its updated Global Burden of Disease report reduced an earlier forecast of HIV/AIDS mortality rates, AFP/Yahoo! News reports. According to WHO, the number of HIV/AIDS-related deaths worldwide is expected to peak in the next five years -- from 2.2 million in 2008 to a maximum of 2.4 million in 2012 -- before declining to 1.2 million in 2030.

WHO previously had said HIV/AIDS-related deaths would rise from 2.8 million in 2002 to 6.5 million in 2030, assuming that antiretroviral drugs reached 80% of HIV-positive people worldwide by 2012. Colin Mathers, WHO coordinator for epidemiology and the burden of disease, said, "Deaths (from HIV/AIDS) will continue to increase somewhat for a few years ... by 2030 they would have declined from current levels today" (AFP/Yahoo! News, 10/27). Mathers added that the report "builds in the revisions to HIV mortality and more optimistic projections of HIV deaths that" WHO and other U.N. agencies have "produced, which suggest that the epidemic may have peaked, or will peak in the next five years or so, and then AIDS deaths will start to decline."

The study also predicts that the percentage of deaths worldwide linked to noncommunicable diseases will increase from 60% to 75% by 2030. It adds that this means people will live longer and increasingly die from cancers and heart disease rather than infectious diseases at an earlier age. According to the report, the leading causes of death worldwide are heart disease, stroke, pneumonia, chronic respiratory disease, diarrhea, HIV/AIDS and tuberculosis (Schlein, VOA News, 10/27).

The study is available online (.pdf).

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Many Zambian Citizens Concerned About Future of Fight Against HIV/AIDS After Upcoming Presidential Election, Reuters Reports

[Oct 29, 2008]

Despite progress in the fight against HIV/AIDS in Zambia, some of the country's citizens are concerned that the disease will not be a priority of the next president, who will be elected on Oct. 30, Reuters reports. According to Reuters, Zambians have said that the two main candidates -- acting President Rupiah Banda and opposition leader Michael Sata -- have not openly discussed HIV/AIDS during their campaigns.

Clementina Mumba, chair of the Treatment Advocacy and Literacy Campaign, said the candidates have remained silent on HIV/AIDS issues because of the stigma associated with the disease. Mumba said, "I am surprised not a single politician has declared he is HIV-positive, not even one minister or legislator has done that. This portrays a picture that HIV/AIDS only infects the poor." Mumba added, "During the election campaign, not a single candidate has said what they will do to tackle HIV/AIDS."

Reuters reports that more than one million of Zambia's 12 million people are HIV-positive. Ministry of Health spokesperson Cassius Banda said HIV prevalence among adults ages 14 to 49 declined to about 14% in 2007, down from 16% in the previous decade, and United Nations data reveal that nearly 56,000 people died of AIDS-related causes in 2007, down from 78,000 in 2001. However, advocates say that many more people die in their homes, unable to get treatment and unaccounted for because of the stigma attached to the disease. In addition, although the government said it has provided 170,000 people with no-cost antiretrovirals -- compared with 10,000 in 2003 -- scientific projections show that 370,000 people still are in need of the drugs. Access to treatment and a shortage of medical staff -- many of whom have migrated to the United Kingdom and other Western countries for better-paying jobs -- also pose issues to people living with HIV, and many Zambians say that they need more than no-cost antiretrovirals, Reuters reports (Shacinda, Reuters, 10/27).

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Mozambique Health Official Calls for Research Into Culture To Understand Spread of HIV

[Oct 29, 2008]

Mozambique's Deputy Health Minister, Aida Libombo, recently said that more research into the cultural habits of Mozambicans is needed to determine how these factors contribute to the spread of HIV, AIM/AllAfrica.com reports. Speaking at the National Youth Meeting in the province of Sofala, Libombo said that young women ages 15 to 24 are most at risk of HIV in the country. She added that the risk factors for HIV among women in Mozambique are poverty, an inability to negotiate the use of condoms, early initiation of sexual activity and sexual abuse. In addition, widowhood can increase a woman's risk of HIV because of the cultural tradition of a widowed woman having sex with a male relative of her late husband, Libombo said, adding that risk factors for men include excessive alcohol and drug use.

According to AIM/AllAfrica.com, participants at the meeting suggested that the government provide female condoms to all provinces. Libombo said that although female condoms are available in private pharmacies, they are expensive and not many are sold. Female condoms will be included in a shipment of 700 million condoms being sent to Mozambique in the near future and will be distributed at no cost through a government partnership with UNAIDS.

Also speaking at the meeting, Diogo Milagre -- executive secretary of the National AIDS Council -- said that men who have sex with men are at an increased risk of HIV. He also announced that a household survey will be held next year and will test people of all age groups as a way to determine HIV prevalence in the country (AIM/AllAfrica.com, 10/26).

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Across The Nation

Increased HIV Prevention, Education Efforts Needed in South Florida, Officials Say

[Oct 29, 2008]

Officials in Martin and Indian River counties in Florida are calling for increased HIV/AIDS prevention and education efforts in an attempt to encourage testing and curb the spread of the virus, the South Florida Sun-Sentinel reports. Karen Thomas, an epidemiologist at the Martin County Health Department, said that the stigma attached to HIV/AIDS could be keeping people from seeking information and being tested. "We want to know why it is that we're not being asked," she said, adding that officials are at a "fact-finding sort of stage" and "want to be out there to make sure the numbers are reflective of what's actually happening."

According to the Sun-Sentinel, Martin and Indian River counties each have reported slightly more than 100 HIV cases since 1997, but health officials say that the number of actual cases could be much higher. Statistics indicate that more than half of all HIV cases on the Treasure Coast since 1997 are transmitted through heterosexual contact. Reports of HIV/AIDS cases in Martin County show an almost even division among white, black and Hispanic populations -- a contrast with the state, regional and national trend that shows minority populations are disproportionately affected by the virus -- the Sun-Sentinel reports. Thomas said the department is working to focus prevention efforts on the migrant community in Martin County, where people often believe that if they are not showing symptoms that they do not have HIV. Regional HIV/AIDS Program Coordinator Dawn Jones said she has supported efforts by the Indian River County Health Department to establish a community outreach coalition for HIV prevention.

A lack of government funding and community-based organizations also has hindered prevention and education efforts in the two counties, according to the Sun-Sentinel. Project Response provides no-cost HIV tests in neighboring St. Lucie County -- which has recorded three times the number of HIV cases as Indian and Martin counties combined -- through a state grant, while Martin County charges $35 for an HIV test. Kay Baker -- case manager for Project Response -- said people will go for HIV tests if they do not have the money, adding that they are "just going to hope they're not positive. That's dangerous. What we need most is education" (Copsey, South Florida Sun-Sentinel, 10/27).

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Newspapers Examine Web Site Launched for Women Living With HIV/AIDS in Southern U.S.

[Oct 29, 2008]

The Raleigh News & Observer and the New Orleans Times-Picayune on Wednesday published articles about the Southern AIDS Living Quilt, which was launched last week by the Southern AIDS Coalition and Test For Life as an effort to address the HIV/AIDS epidemic among women in the Southern U.S., particularly minorities. The Southern AIDS Living Quilt initiative will feature videos about women affected by the disease and highlight the disproportionate effect of HIV/AIDS on women. The project also will provide information about testing and prevention measures (Kaiser Daily HIV/AIDS Report, 10/20). Summaries of the articles appear below.

New Orleans Times-Picayune: The Living Quilt Web site features video interviews of women living with HIV/AIDS in the South, including New Orleans, where women make up about one-third of the 3,500 people living with HIV/AIDS. Women also accounted for 67% of the new HIV cases reported last year in the city. According to the Times-Picayune, although the number of women living with HIV/AIDS in New Orleans has increased dramatically since the 1990s, there still is a stigma associated with the disease. According to the Times-Picayune, the "growing community of HIV-positive women has stayed mostly silent, a sharp contrast with the city's gay community, where being openly HIV-positive has become more accepted" (Reckdahl, New Orleans Times-Picayune, 10/29).

Raleigh News & Observer: According to the News & Observer, 80% of HIV cases diagnosed among women in North Carolina last year were recorded among blacks, Hispanics and American Indians. Although men still account for a large number of HIV/AIDS cases, an "often hidden epidemic is taking place among women," according to the News & Observer. Evelyn Foust, director of North Carolina's communicable disease branch, said that the state's rural history and pockets of poverty make it difficult to access health care and address HIV/AIDS. In addition, Foust said that the state should do more to address the stigma attached to the disease and make testing uniformly routine. Although a new state policy makes testing for women routine during pelvic exams, it has not been uniformly adopted across the state, according to the News & Observer (Avery, Raleigh News & Observer, 10/29).

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