Politics and Policy

Bush Receives Humanitarian Award for HIV/AIDS, Health Efforts in Africa

[Nov 14, 2008]

President Bush on Wednesday received the Bishop John T. Walker Distinguished Humanitarian Service Award in recognition of his administration's efforts to advance HIV/AIDS, health and development efforts in Africa, the AP/Washington Post reports. The award -- which is given each year to leaders who make humanitarian commitments to Africa -- was presented to Bush by the U.S.-based not-for-profit group Africare at an event in Washington, D.C. (Simmons, AP/Washington Post, 11/12).

During the event, Bush spoke about his administration's initiatives to address HIV/AIDS, malaria and other health issues. Bush said he is particularly proud of the President's Emergency Plan for AIDS Relief, which was reauthorized earlier this year (Wolfson, VOA News, 11/13). According to the White House, PEPFAR has supported HIV/AIDS care for more than 6.6 million people worldwide and has helped prevent nearly 200,000 cases of mother-to-child HIV transmission.

Bush called his administration's commitments to Africa a "labor of love," adding that "one of the most uplifting" experiences of his presidency was witnessing Africa's progress in addressing disease, education and hunger. Bush said the U.S. does "not believe in paternalism" but rather supports partnership with Africa "because we believe in the potential of the people on the continent," who have the "talent and ambition and resolve to overcome" challenges. Bush added that U.S. aid to Africa is important because "it is in our national security interest that we defeat hopelessness. It is in our economic interest that we help economies grow. And it is in our moral interest that when we find hunger and suffering, the [U.S.] responds in a robust and effective way" (AP/Washington Post, 11/12).

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Global Challenges

Chilean Lawmakers Call for Investigation of HIV/AIDS Situation

[Nov 14, 2008]

Chile's new health minister, Alvaro Erazo, on Thursday said that at least 512 people nationwide have not been informed by the public health system that they tested HIV-positive and that an additional 1,364 people have not been told by private sector services that they carry the virus, the New York Times reports. Erazo -- who was providing lawmakers with a report on the situation -- said that in about half of the cases, there was no evidence that health care workers had attempted to contact people who had tested HIV-positive. Erazo added, "There is no justification for that." According to Erazo, some of the notification problems resulted from a lack of coordination between the National AIDS Commission and the Ministry of Health. He added that epidemiological security "was not functioning" (Bonnefoy/Barrionuevo, New York Times, 11/14).

Chilean lawmakers on Wednesday called for an investigation into the growing situation in which the government has failed to notify people who tested HIV-positive, Reuters reports (Gardner, Reuters, 11/12). Chile's President Michelle Bachelet last month accepted the resignation of former Health Minister Maria Soledad Barria following an incident at a hospital in the city of Iquique in which Hospital officials did not notify people who had tested positive for the virus (Kaiser Daily HIV/AIDS Report, 10/30).

According to Cecilla Sepulveda, dean of the School of Medicine at the University of Chile, an estimated 40,000 people in the country are not aware of their HIV-positive status. The government has said that it is making a concerted effort to inform people who have tested HIV-positive of their status, and Erazo said that it will be done in as confidential a manner as possible. The Central Metropolitan Health Service in the capital of Santiago on Thursday announced that it will start an investigation into why 107 people in its jurisdiction were not notified of their HIV-positive status. According to the Times, results are expected in two weeks (New York Times, 11/14).

In reaction to the announcement, some lawmakers are urging the government to declare a health emergency. Juan Lobos, president of the health commission in the Lower House of Congress, said a "much deeper investigation into the health system" is needed. Lobos also called on all health service directors to submit resignations to Erazo.

Government Minister Francisco Vidal said Erazo is working to prevent a similar situation from occurring in the future. Vidal also said that Bachelet's administration has dismissed suggestions of a potential epidemic and is dealing with the situation.

According to Reuters, HIV/AIDS advocates have been "outraged" with the situation. Two groups -- Vivo Positivo and Asosida -- issued a joint statement that said, "Failing to adequately inform patients of the positive results of their HIV tests is not just a problem of management or human error but clearly goes against the law." The statement also said the failure to notify patients was the "worst sanitary crisis the country has faced in recent years" and a "flagrant violation of human rights and the right to life" (Reuters, 11/12).

The AP/Google.com reports that some experts blame an increase in HIV/AIDS cases in Chile on "conservative sexual mores that have prevented sexual education in Chile's schools and hindered public health campaigns," including two television networks' refusal to air advertisements in a government campaign to promote condom use (AP/Google.com, 11/13).

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Migrants in Southeast Asia Highly Vulnerable to HIV, Report Says

[Nov 14, 2008]

Millions of migrant workers in Southeast Asia are vulnerable to HIV because they do not have access to health services and legal or social protection, according to a report released Thursday by the United Nations and the Association of Southeast Asian Nations, AFP/Yahoo! Singapore News reports. According to the report, more than 1.5 million people are living with HIV in Southeast Asia, most of whom are of working age. In addition, the report found that HIV/AIDS risk behaviors are higher among migrants compared with the general population.

For the first time, the report included data on current migration patterns and HIV rates in ASEAN's 10 member countries. It found that although some countries -- such as Indonesia, Laos, the Philippines and Vietnam -- have created pre-departure HIV/AIDS training for outgoing, documented migrant workers, many of the training sessions are ineffective. "While migrants and their sexual partners are included as a vulnerable group in the national strategic plans of ASEAN countries, comprehensive programs to address their needs have yet to be developed, funded and implemented," UNAIDS Regional Director Prasada Rao said.

According to the report, HIV prevalence has been recorded at up to 9% among migrant fisherman in Thailand, while 35% and 30% of recorded HIV cases in the Philippines and Laos, respectively, occur among returning migrant workers. "Migrant workers are a vital force to national economies in Southeast Asia, yet when it comes to protecting their rights and ensuring HIV prevention and treatment, they are often among the forgotten," United Nations Development Programme Regional Director Ajay Chhibber said (AFP/Yahoo! Singapore News, 11/13).

The report is available online (.pdf).

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HIV/AIDS Advocates in Philippines Call for Passage of Reproductive Health Bill

[Nov 14, 2008]

In hopes of developing a national policy on reproductive health to help curb the spread of HIV in the Philippines, the Girls, Women and HIV/AIDS Network recently called for the passage of a reproductive health bill in the House of Representatives, the Philippine Daily Inquirer reports. During the last general assembly meeting on Oct. 26, GWHAN told lawmakers that it is their "responsibility as pioneers and leaders of the HIV advocacy to register their support for the passage of the reproductive health bill and to stand behind organized groups and networks advocating its immediate passage." The general assembly is expected to continue deliberation of the bill.

The bill would require government hospitals to include contraceptives in the supplies they purchase and make reproductive health education mandatory in schools. It also would require local governments to employ more midwives and health attendants to achieve the ratio of one midwife to 150 deliveries, the Inquirer reports. In addition, the bill would require local governments to have emergency obstetric care and maternal death reviews, as well as to provide mobile health services (Pazzibugan, Philippine Daily Inquirer, 11/12). According to the Philippine Star, the bill also would increase HIV prevention, care and support (Crisostomo, Philippine Star, 11/13).

GWHAN told lawmakers that the country is in need of a national reproductive health policy because of the increasing number of HIV cases. A national policy, according to GWHAN Chair Marlon Lacsamana, would stop people in the country who "demonize" condom use. Fifty-seven new HIV cases were reported in the Philippines in September, bringing the total to 395 new cases this year. Lacsamana in a statement said, "This alarming statistic supports the call for the immediate passage of the reproductive health bill now being deliberated in the House of the Representatives," adding, "Moreover, the widespread disinformation, misinformation and increased efforts to demonize condom use must be disproved with accurate data." According to the Inquirer, the Catholic Church in the Philippines opposes the bill (Philippine Daily Inquirer, 11/12).

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Science & Medicine

Newspapers Examine Possible HIV/AIDS Treatment Through Bone Marrow Transplant

[Nov 14, 2008]

Several newspapers recently profiled the case of an HIV-positive person who underwent a bone marrow transplant to treat leukemia and who has had undetectable HIV viral loads for almost two years. For the procedure -- performed by German hematologist Gero Hutter of Berlin's Charite Medical University on a 42-year-old American living in the city -- the patient's bone marrow cells were replaced with those from a donor with a naturally occurring gene mutation that provides immunity to almost all strains of HIV by preventing the CCR5 molecule from appearing on the surface of cells. Prior to the transplant, Hutter administered a standard regimen of drugs and radiation to kill the patient's bone marrow cells and many immune-system cells, which may have helped the treatment succeed because the procedure killed many cells that harbor HIV, according to an earlier Wall Street Journal report. Transplant specialists then ordered the patient to stop taking his antiretroviral drugs when they transfused the donor cells because they were concerned that the drugs might undermine the cells' ability to survive in their new host. Although the plan was to resume the antiretroviral regimen once HIV re-emerged in the patient's blood, more than 600 days later, standard tests have not detected HIV in his blood, or in brain and rectal tissues where the virus often hides (Kaiser Daily HIV/AIDS Report, 11/7). Summaries appear below.

New York Times: According to some U.S. researchers, the treatment has "novel medical implications" but will ultimately "be of little immediate use" in treating HIV/AIDS, the Times reports. Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, said the treatment is "very nice" and "not even surprising," but "just off the table of practicality." The Times reports that many researchers said the treatment is "unthinkable" for the millions of people living with HIV/AIDS in Africa and "impractical even for insured patients in top research hospitals." The patient had leukemia in addition to AIDS, which warranted the high risk of a blood stem cell transplant, but 10% to 30% of people who receive bone marrow transplants die. According to the Times, the odds of locating a donor who is both a good tissue match for the patient and has the CCR5 genetic mutation are "extremely small." Robert Gallo, director of the Institute of Human Virology at the University of Maryland School of Medicine, said, "Frankly, I'd rather take" antiretroviral drugs. However, the Times reports that the success reported for this patient is "evidence that a long-dreamed-of therapy for AIDS -- injecting stem cells that have been genetically reengineered with the mutation -- might work" (McNeil, New York Times, 11/14).

AP/Google.com: Although researchers and the physicians involved in the case caution that it "might be no more than a fluke, others say it may inspire a greater interest in gene therapy to fight the disease that claims two million lives each year," the AP/Google.com reports. Although the patient 20 months after the procedure has not shown signs of the virus, Andrew Badley -- director of HIV and immunology research at the Mayo Clinic in Rochester, Minn. -- said the tests that determine the patient's HIV viral loads likely have not been extensive enough. "A lot more scrutiny from a lot of different biological samples would be required to say it's not present," Badley said. Fauci said the procedure was too expensive and dangerous to use as a first-line therapy. However, he said it could inspire researchers to pursue gene therapy as a way to block or suppress HIV. "It helps prove the concept that if somehow you can block the expression of CCR5, maybe by gene therapy, you might be able to inhibit the ability of the virus to replicate," Fauci said. David Roth, a professor of epidemiology and international public health at the London School of Hygiene and Tropical Medicine, added that gene therapy as inexpensive and effective as current drug treatments is in the very early stages of development. "That's a long way down the line because there may be other negative things that go with that mutation that we don't know about," he said (McGroarty, AP/Google.com, 11/13).

Reuters: Hutter and his team said that although they have not been able to find any traces of HIV in the patient, it does not mean he has been cured. "The virus is tricky. It can always return," Hutter said. According to Reuters, the researchers said that bone marrow transplants could never become a standard HIV/AIDS treatment because the transplants are "rigorous and dangerous and require the patient to first have his or her own bone marrow completely destroyed." In addition, the procedure can be fatal because patients have no immune system until the stem cells can grow and replace theirs, leaving them susceptible to even minor infections (Reuters, 11/12).

Deutsche Welle: According to physicians at the Berlin hospital, they are continuing to monitor the patient's health and are prepared to put him back on antiretrovirals if the virus reappears. Thomas Schneider, Charite's director of infectology, said, "We cannot say with certainty that the virus won't begin replicating itself in the future," adding, "But the mere fact that it hasn't yet done so is a minor sensation" (Deutsche Welle, 11/13).

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Recent Releases in HIV/AIDS

Statehealthfacts.org Provides New Data on HIV/AIDS Funding

[Nov 14, 2008]

Updated Data on HIV/AIDS Funding, StateHealthFacts.org: The Web site has been updated to include HIV/AIDS data from the National Alliance of State and Territorial AIDS Directors for all states and the nation for the 2007 fiscal year. The data include figures for total federal funding; Housing Opportunities for Persons with AIDS funding; CDC funding for HIV/AIDS and sexually transmitted infection prevention; Substance Abuse and Mental Health Services Administration funding; and Office of Minority Health HIV/AIDS funding. In addition, the site has added new data from NASTAD on the Ryan White Program for the 2007 fiscal year (Kaiser Family Foundation release, 11/13).

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