Kaisernetwork.org (Washington, DC)
11 November 2008
Politics and Policy
Obama Likely To Reverse Some Bush Administration HIV/AIDS Prevention, Family Planning Policies, Adviser Says
[Nov 11, 2008]
President-elect Barack Obama likely will undo U.S. family planning and HIV/AIDS prevention efforts that long linked funding to antiabortion and abstinence-only policies, Susan Wood -- co-chair of Obama's advisory committee for women's health and a professor at George Washington University's School of Public Health and Health Services -- said recently, Bloomberg reports. Wood said that although President Bush's global health programs -- such as the President's Emergency Plan for AIDS Relief -- have brought more HIV/AIDS treatment to developing countries than under any other president, spending requirements for abstinence-only education have hampered family planning and the prevention of sexually transmitted infections worldwide.
"We have been going in the wrong direction, and we need to turn it around and be promoting prevention and family planning services and strengthening public health," Wood said. She added that Obama "is committed to looking at all this and changing the policies so that family planning services -- both in the U.S. and the developing world -- reflect what works, what helps prevent unintended pregnancy, reduce maternal and infant mortality, prevent the spread of disease."
According to Bloomberg, one of Bush's policies that has been cited for hindering STI and HIV/AIDS prevention efforts is restrictions on condom education. Gill Greer, director-general of the International Planned Pregnancy Federation, said CDC has pulled some condom information from its Web site. Greer said, "The U.S. administration has certainly succeeded in demonizing condoms rather than showing that they can be part of prevention of both unplanned pregnancy and sexually transmitted infections."
Valerie Huber, executive director of the National Abstinence Education Association, said the Bush administration's emphasis on abstinence and fidelity "been shown to have demonstrable success in Africa," adding, "It would be more than unfortunate if that policy was changed." According to Huber, both Republicans and Democrats have cited support for PEPFAR's focus on abstinence and education, which has reduced the spread of HIV in countries such as Uganda. "If the president-elect wants to be science-based in foreign sex education policies, it would be wisest to continue this way because it's shown to be effective," Huber added.
Wendy Turnbull, a senior policy analyst with Population Action International, said that because of the "Mexico City" policy -- which restricts U.S. international foreign aid to family planning programs abroad using their own funds to provide abortion services or lobby their governments regarding abortion rights -- many family planning associations that rejected the terms of the rule "lost funding ... lost technical assistance and ... lost contraceptives." Under the basis of the policy, Bush also halted support for the United Nations Population Fund in 2002, saying it supported "coercive" abortion programs in China, an allegation the agency has denied, Bloomberg reports (Gale/Lauerman, Bloomberg, 11/10). The Los Angeles Times "Top of the Ticket" blog reports that the Mexico City policy is likely to be "quickly rescinded" after Obama takes office (Hoffecker, "Top of the Ticket," Los Angeles Times, 11/10).
According to Wood, the U.S. government in recent years has influenced and "tightly vetted" international organizations to reflect its own policies. She added that Obama will bring "back a sense of balance and perspective and the use of good science and good medicine in these positions, and not just this narrow, political ideology"(Bloomberg, 11/10).
USA Today Examines Future of HIV/AIDS Efforts in Africa Under Obama
USA Today on Monday examined the future of efforts to address HIV/AIDS and other issues in Africa under Obama's administration. According to USA Today, Obama's commitment to fighting HIV/AIDS and addressing other issues might be hindered by the global economic crisis and large U.S. military commitment overseas.
Although expectations "have been high" in Africa since Obama traveled to the continent as a senator in 2006, some African leaders "have tried to tamp down their own peoples' hopes" because they are "[a]ware of the limitations now that Obama is president-elect," according to USA Today. Senegalese President Abdoulaye Wade said, "Africans must not ask extraordinary things from [Obama], must not expect ... that through the miracle of his election, America will drain money on Africa to change our continent." John Norris, executive director of the Enough Project, said that issues such as HIV/AIDS in Africa are "clearly issues that [Obama] is passionate about and serious about," adding, "There's a lot of goodwill and a sense of optimism. But that new approach is being tempered by a lot of realism about the magnitude of the problems that he has to deal with."
According to USA Today, HIV/AIDS is an "issue where the money crunch could be particularly acute." Laurie Garrett, a senior fellow at the Council on Foreign Relations, said that even though Congress passed legislation that increases PEPFAR's funding to $48 billion over five years, the economic crisis could force cuts in funding for other critical foreign aid programs. Garrett said, "If they cut the rest of foreign assistance by 50% or more, we're going to be funding a U.S. foreign assistance that is just basically three things: Iraq, Afghanistan and AIDS."
Peter Piot, executive director of UNAIDS, last month said that even if U.S. foreign aid remains at current levels, AIDS-related deaths worldwide could reach three million annually by 2011, an increase from two million in 2007. In addition, providing treatment to HIV-positive people under PEPFAR is becoming more expensive as many people develop resistance to first-line drugs and require more expensive second-line therapies. "The dollar has declined so much in value," Garrett said, adding, "There is the food crisis, the economic crisis and energy crisis, and when you put it together, the cost of doing anything is far greater today than it was a year ago" (Alsop, USA Today, 11/10).
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Across The Nation
Late Testing, Treatment Leads to Increased HIV/AIDS Prevalence Among Hispanics in Los Angeles County
[Nov 11, 2008]
Hispanics in Los Angeles County are waiting about twice as long to seek HIV testing and treatment as whites, leading to increased HIV prevalence among Hispanics, the San Gabriel Valley Tribune reports. According to the Tribune, 60% of HIV cases among Hispanics in the county are detected "very late," compared with 33% among whites.
Hispanics accounted for 50% of new AIDS cases in 2007 but represented 47% of the county's population, Paulina Zamudio, program supervisor for prevention services at Los Angeles County's Office of AIDS Programs and Policy, said. Zamudio said, "One of our biggest concerns is that Latinos aren't getting tested early enough." Rey Reyes, an HIV-positive Hispanic man who conducts HIV/AIDS outreach, said denial is a major barrier to testing among Hispanics, adding, "if we don't talk about it, it's not happening to us."
Although HIV/AIDS programs often target injection drug users and men who have sex with men as high-risk populations, some experts say that HIV/AIDS cases among Hispanic migrant workers as a group are increasing. According to a study of 450 migrant workers conducted by Bienestar -- an organization that provides social services for HIV-positive Hispanics -- 26% reported having sex with female commercial sex workers and 5.5% reported having sex with men in exchange for money. Victor Martinez, director of programs and services at Bienestar, said that a lack of health insurance or proper documentation often prevents Hispanics from seeking regular, preventive health care. "Health is a luxury," he said, adding that some Hispanics cannot afford to take time off work to visit a clinic. However, some organizations in the county are working to provide low-cost care to uninsured and undocumented patients, including those with HIV/AIDS. One such organization, East Valley Community Health Center, takes mobile units to bars, night clubs and drug rehabilitation centers to offer HIV tests to high-risk populations (Kimitch, San Gabriel Valley Tribune, 11/10).
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Global Challenges
Global Fund Grants Nearly $3B for HIV/AIDS Efforts
[Nov 11, 2008]
The Global Fund To Fight AIDS, Tuberculosis and Malaria on Monday announced it has approved nearly $3 billion in Round 8 funding to improve access to HIV treatment and prevention and help reduce deaths from TB and malaria by 50% by 2015, AFP/Yahoo! News reports (AFP/Yahoo! News, 11/10). The Global Fund's board approved 94 grants worth $2.75 billion, representing the group's largest funding round to date (Global Fund release, 11/10).
Rajat Gupta, chair of the Global Fund's board, said the grants represent "the highest amount of new financing approved by the Global Fund ever," adding that 38% of the resources will be used for HIV/AIDS programs, 11% for TB programs and 51% for malaria programs. Gupta said that 90% of the approved grants will be distributed to low-income countries, 77% of which are in Africa and the Middle East. The remaining funds will be dispersed to countries in Asia, Central Asia, Eastern Europe, Western Pacific, the Caribbean and Latin America (AP/International Herald Tribune, 11/11). The funding brings the total amount of aid awarded by the Global Fund to $14.4 billion.
Michel Kazatchkine, executive director of the Global Fund, said the "increased demand" for funding "requires a renewed resource mobilization effort." He added that the Global Fund has a "fantastic message to bring back to the rich nations of the world: programs to fight these three diseases save lives, reduce disease burdens and strengthen health systems" (Global Fund release, 11/10).
Link to this story.
Group Leads Efforts To Document Politically Driven Rapes In Zimbabwe
[Nov 11, 2008]
Toronto's Globe and Mail on Monday examined efforts by the advocacy group AIDS-Free World to address politically driven, widespread rapes in Zimbabwe that followed the country's first round of presidential elections in March.
In August, AIDS-Free World launched an investigation into a two-week period of rapes following the election and is continuing those efforts. Stephen Lewis -- former United Nations Ambassador for AIDS in Africa and head of AIDS-Free World -- is leading a team of international human rights lawyers that is collecting testimonials from women who were raped, tortured or beaten. The Globe and Mail reports that the group is working with other women's organizations in the country to identify rape survivors and provide them with HIV tests and medical care. Over the past week, eight women have provided testimony to the human-rights lawyers and said that their attackers openly identified themselves as members of President Robert Mugabe's ZANU-PF party. The women also reported that their attackers said they were being raped because of their support for opposition party, the Movement for Democratic Change. Lewis said, "The affidavits bear out that these attacks were directed at the political opposition in a very methodical way -- the women chosen were chosen because they were part of the political opposition and the links made to ZANU-PF are unassailable."
The evidence has allowed the women to find support through one another and form a Zimbabwe Rape Survivor's Network to speak out about their attacks, according to Betty Makoni of the Girl Child Network in Zimbabwe (Nolen, Globe and Mail, 11/10).
Link to this story.
Science & Medicine
Studies Examine Use of Modified CD4+ T Cells, Vaccine To Fight HIV/AIDS
[Nov 11, 2008]
A new therapy that involves engineering an HIV-positive individual's own immune system to fight the virus more effectively has been developed by researchers at Adaptimmune in Oxford, England, London's Guardian reports (Randerson, Guardian, 11/10). The therapy involves genetically engineering CD4+ T cells, called "assassin" cells by the researchers, which were able to recognize other cells infected with HIV and slow the spread of the virus. According to Reuters, if the therapy -- which worked in laboratory tests -- is effective in humans, it could provide a new method of treating HIV (Fox, Reuters, 11/9). The therapy was detailed in a study published on Sunday in Nature Medicine.
According to the Guardian, researchers began to pursue a different approach to a traditional HIV vaccine after investigating a patient who had "resisted his HIV infection particularly effectively." Researcher Bent Jakobsen said, "When we tested the T cells from this patient, it looked as if he was responding to a number of those variants that normally escape the immune system." In developing the therapy, the Guardian reports that the researchers first isolated the T cell receptor protein, which can recognize HIV antigens, and then improved its ability to recognize HIV further by randomly mutating it. The therapy will involve taking blood samples and adding an engineered virus that contains genes for the improved T cell receptor. A patient's T cells then take up the genes and are thus equipped with the improved receptor. These cells are then injected back in the patient (Guardian, 11/10).
James Riley, a University of Pennsylvania researcher involved in the study, said that not only could the engineered T cells see HIV strains that had escaped detection by natural T cells, "but the engineered T cells responded in a much more vigorous fashion so that far fewer T cells were required to control infection." Researcher Andy Sewell of Cardiff University said, "In the face of our engineered assassin cells, the virus will either die or be forced to change its disguises again, weakening itself along the way" (Reuters, 11/9). The Guardian reports that a clinical trial of the therapy will take place next summer among 35 participants at the University of Pennsylvania (Guardian, 11/10).
In related news, a second, unrelated report by researchers testing Crucell's experimental HIV/AIDS vaccine that is based on T cells said it was effective among six rhesus monkeys. For the study, published in the journal Nature, the monkeys were injected with a lethal dose of SIV, the simian version of HIV. When injected, they were able to stop replication of the virus and remained healthy for more than 500 days after infection (AFP/Google.com, 11/9).
According to Dan Barouch of Beth Israel Deaconess Medical Center and Harvard Medical School, the study shows there is still hope for developing an effective HIV/AIDS vaccine (Reuters, 11/9). Barouch added, "Despite the disappointing setbacks in HIV-1 vaccine development this past year, our findings suggest that we're not at the end of the road when it comes to T cell vaccines" (AFP/Google.com, 11/9).
The Nature Medicine study is available online. The Nature study is also available online.
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Opinion
New Orleans Health Officials Should Examine 'Ways To Speed Up Process' of Distributing Ryan White Funding, Editorial Says
[Nov 11, 2008]
"Six months is a long time to wait if you're fighting a disease like HIV/AIDS or if you are an agency that works to help those patients," a New Orleans Times-Picayune editorial says in response to the recent announcement that the distribution of $7 million in Ryan White Program funding to city HIV/AIDS agencies has been delayed by six months (New Orleans Times-Picayune, 11/10). Fran Lawless, director of Mayor Ray Nagin's Office of Health Care Policy, made the announcement at a city council meeting on Oct. 30. According to Lawless, who testified before the council's Housing and Human Needs Committee, the city received the money March 1 but did not send out grant award notices to medical case management agencies until June and did not finalize contracts, which are required for funding to be spent, until October. In explaining the reasons for the delay, Lawless said some agencies were slow to file spending invoices and blamed "implementation problems" for the long contracting process, saying that funding "will flow better from now on."
Although the "Nagin administration did better than the Morial administration," the "long wait this year hurt agencies at a time when cases are on the increase," according to David Munroe of In This Together, the editorial says. In addition, none of the reasons for the delay provided by Lawless at the city council meeting "explains why it took [her] office four months to begin contract negotiations," the editorial says, adding, "The office has seven staffers, and Councilwoman Stacy Head pointed out that departments with much larger budgets operate with only two or three people." In addition, although Lawless "said that the contracting process will flow better in the future," when "council members suggested that her office review applications before the funding is announced each March, she was noncommittal," according to the editorial. That is "no way to improve," the editorial says, concluding, "This office should be looking at ways to speed up the process. As Councilman Arnie Fielkow pointed out, 'We're not dealing with a pothole here. We're dealing with life'" (New Orleans Times-Picayune, 11/10).
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