Kaisernetwork.org (Washington, DC)
2 December 2008
Global Challenges
Bush, Obama Mark World AIDS Day, Discuss HIV/AIDS Fight
[Dec 02, 2008]
President Bush on Monday in honor of World AIDS Day highlighted "his dramatic and widely praised overhaul of U.S. efforts to combat the deadly disease, particularly in Africa," AFP/Google.com reports. President-elect Barack Obama on Monday also praised the Bush administration for its involvement in global HIV/AIDS efforts and pledged to continue the fight against the disease once he takes office in January (AFP/Google.com, 12/1). According to Bush, the President's Emergency Plan for AIDS Relief has reached its goal of providing antiretroviral drugs to two million people over five years (Feller, AP/USA Today, 12/1). Bush said, "When you have somebody say there's a pandemic, that you can help, and you do nothing about it, then you have, frankly, disgraced the office" (AFP/Google.com, 12/1).
Bush on Monday also participated in the Rev. Rick Warren's first Civil Forum on Global Health to discuss his work in the fight against HIV/AIDS. Warren said, "No world leader has done more for global health than President George Bush," adding, "We need to recognize that." Warren also presented Bush with the first International Medal of PEACE for his efforts associated with PEPFAR (Ritchie, Orange County Register, 12/1).
In videotaped remarks played at the forum, Obama said, "I salute President Bush for his leadership in crafting a plan for AIDS relief in Africa and backing it up with funding dedicated to saving lives and preventing the spread of the disease," adding, "And my administration will continue this critical work to address the crisis around the world" (Sanner, AP/Yahoo! News, 12/1). In addition, Obama said that because of the work of PEPFAR, "women in Kenya who were widowed by the disease, and once shunned by society, have banded together to support and empower each other. Scientists around the world are discovering and engineering new medicines to give people with HIV/AIDS another chance at life. NGOs and faith-based institutions are marshaling the best of the human spirit to help those affected. And world governments are coming together to address the humanitarian crisis the pandemic has left in its wake" (Rhee, "Political Intelligence," Boston Globe, 12/1). In addition, Obama said that the U.S. "must also recommit ourselves to addressing the AIDS crisis here in the United States with a strong national strategy of education, prevention and treatment, focusing on those communities at greatest risk." He added, "This strategy must be based on the best available science and built on the foundation of a strong health care system." According to Obama, "in the end, this epidemic can't be stopped by government alone, and money alone is not the answer either" (AFP/Google.com,[2] 12/1).
Other political figures who praised Bush's work on HIV/AIDS included former President Clinton, who, in a message that was read to the gathering, said, "I think as time passes, people will look back on this as one of your most remarkable contributions, Mr. President." Irish musician and HIV/AIDS advocate Bono also called Bush "a hero" for his work on the disease (Ward/Dinan, Washington Times, 12/2).
Broadcast Coverage
The following highlights broadcast coverage of World AIDS Day.
ABC's "World News Webcast": The segment includes comments from five ABC digital reporters who discuss HIV/AIDS in India, Indonesia, Iran, Kenya and South Korea (Gibson, "World News Tonight," ABC, 12/1). Video of the segment is available online.
CBS' "Early Show": The segment includes comments from Marvelyn Brown, author of the book "The Naked Truth: Young, Beautiful and HIV-Positive" and several HIV-positive people (Rodriguez, "Early Show," CBS, 12/1). Video of the segment is available online.
NBC's "Today Show": The segment features musician John Legend, who discusses (RED)WIRE, an online music magazine that donates a portion of subscription fees to HIV/AIDS efforts (Robach/Rocker, "Today Show," NBC, 12/1). Video of the segment is available online.
NPR's "Talk of the Nation": The segment includes comments from HIV/AIDS researcher Robert Gallo (Conan, "Talk of the Nation," NPR, 12/1). Audio of the segment is available online.
PRI's "The World": The segment includes comments from Mark Dybul, U.S. Global AIDS Coordinator who administers PEPFAR; Craig Usswald, manager of PEPFAR's drug supply system; and Jyoti Schlesinger, former PEPFAR head in Cote d'Ivoire (Baron, "The World," PRI, 12/1). Audio of the segment is available online. A transcript of the segment and expanded coverage are available online.
PRI's "The World": The segment includes comments from HIV policy expert and epidemiologist Elizabeth Pisani (Mullins, "The World," PRI, 12/1). Audio of the segment is available online.
WBUR's "Here and Now": The segment includes comments from Negar Akhavi, editor of the book "AIDS Sutra: Untold Stories from India"; and Nalini Jones, an author who wrote an essay for the book (Young, "Here and Now," WBUR, 12/1). Audio of the segment is available online.
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Michel Sidibe Appointed Next Executive Director of UNAIDS
[Dec 02, 2008]
Michel Sidibe will succeed Peter Piot as the next executive director of UNAIDS on Jan. 1, 2009, United Nations Secretary General Ban Ki-moon announced Monday to coincide with World AIDS Day, Bloomberg reports (Varner, Bloomberg, 12/1). Ban made the announcement at the International Conference on Financing for Development in Doha, Qatar (AFP/Google.com, 12/1).
According to Ban, Sidibe "brings a wealth of experience together with a firm commitment to human rights and to greater involvement of people living with or affected by HIV/AIDS." Sidibe, who is from Mali, has served as deputy executive director of UNAIDS for the past two years and began working for the organization in 2001 as a director of country and regional support. According to the United Nations, Sidibe "transformed UNAIDS into a more focused, efficient and effective joint program for delivering country-level results" when he joined the agency. During his tenure as deputy executive director, Sidibe managed more than 70% of UNAIDS's budget and personnel, seven regional support teams and 81 country offices, according to the United Nations (Bloomberg, 12/1). Before joining UNAIDS, Sidibe for 14 years worked at UNICEF, where he managed an immunization program for 30 million people in the Democratic Republic of the Congo and also worked in Burundi, Swaziland and Uganda.
Sidibe in January will succeed Piot, who has led the agency since its inception in 1995. Piot in April announced his intention to resign his post at the end of the year. Ban in June said that Piot is a "tireless leader who has been at the vanguard of the response to AIDS since the earliest days of the epidemic" (Reuters, 12/1).
Piot said, "The leadership of UNAIDS is in very capable hands. UNAIDS has a vital role to play in sustaining the progress made in the global response on AIDS." Sidibe said that the "AIDS epidemic is not over in any part of the world. We have to ensure that there is strong and long term leadership and financial commitment to respond to AIDS that is grounded in evidence and human rights" (UNAIDS release, 12/1).
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AP/International Herald Tribune Examines Progress In Reducing Number of African Infants Born With HIV
[Dec 02, 2008]
The AP/International Herald Tribune on Sunday examined how "after years of despair, Africa is making progress in protecting unborn [infants] from AIDS -- and in prolonging the life of the parents." According to a United Nations report titled "Children and AIDS" and published for World AIDS Day, the number of pregnant women receiving antiretrovirals in low- and middle-income countries has tripled in the past three years. In addition, increased donor interest and funding has made such gains even more impressive in some countries. Outgoing UNAIDS Executive Director Peter Piot, said, "The prevention of mother-to-child transmission of HIV is not only effective, but also a human right. We are seeing good progress in many countries, especially in parts of Africa, but we need to significantly scale up HIV testing and treatment for pregnant women."
The Cape Fertility Clinic in South Africa is the first such facility in Africa to open a laboratory for HIV-positive parents, enabling them to conceive and give birth to HIV-negative infants through procedures such as in vitro fertilization. Approximately five or six couples, with either one or both partners living with HIV/AIDS, visit the clinic every month, the AP/Herald Tribune reports. However, it adds that the clinic "is only for the favored few with enough money to pay for fertility treatment and is a drop in the ocean compared to the huge numbers of infected people."
Klaus Wiswedel, one of the clinic's directors, said, "HIV is no longer seen as a death sentence but a chronic disease. And people with chronic diseases are entitled to have fertility treatment. We can safely deliver an HIV-negative child and, with the right treatment, the parent can live a long life." According to Wiswedel, if the woman is HIV-positive and her husband is not, artificial insemination is used; if the man is HIV-positive, the sperm is cleansed of the virus. Once pregnant, the HIV-positive woman has to be followed by an HIV specialist and gives birth via caesarean section to reduce the chance of mother-to-child transmission (Nullis, AP/International Herald Tribune, 11/30).
The U.N. report is available online (.pdf).
Christian Science Monitor Examines HIV Prevention in Africa
In related news, the Christian Science Monitor on Monday examined a "revolutionary new generation of AIDS prevention campaigns that reflect a growing recognition that condoms aren't enough and that slowing the epidemic will require widespread cultural change." According to the Monitor, the campaigns are "based on new research about the driving forces of the epidemic -- specifically the common practice in many hard-hit African countries of having multiple, long-term sexual partners at the same time." However, the new messages "are also blurring the often-rancorous divide between largely secular advocates of condom-based messages and religious organizations that emphasize abstinence and fidelity," the Monitor reports. According to the Monitor, these efforts are "boosting enthusiasm for HIV/AIDS prevention efforts" (Itano, Christian Science Monitor, 12/1).
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HIV Risk Factors, Misconceptions Could Lead to 'Rapid Spread' of Virus in Egypt, Daily News Reports
[Dec 02, 2008]
Although Egypt has a low HIV prevalence at 0.02%, numerous risk factors and misconceptions about the virus could lead to a "rapid spread" of the disease, Egypt's Daily News reports.
According to the News, factors such as overpopulation among people ages 15 to 24, who account for 50% of HIV cases in Egypt; poverty; illiteracy, especially among women; and a weak health system create an "ideal environment" for the spread of HIV. Vulnerable groups -- including commercial sex workers, injection drug users, men who have sex with men, refugees, homeless children and prison inmates -- are at risk of HIV and could transmit the virus to the general population because "none of these are closed groups," Wessam El Beih, UNAIDS country officer in Egypt, said.
In addition, misconceptions about HIV are prevalent in the region and lead to HIV-associated stigma and discrimination, which discourages people from seeking HIV testing or treatment. El Beih noted that some people in the country believe all HIV cases in Egypt were contracted outside the country but that 80% of HIV-positive women contracted the virus from their husbands.
According to Jeffrey O'Malley, director of the HIV/AIDS group at the United Nations Development Programme, the "most important aspect [of HIV/AIDS] Egypt has to work on" is prevention. Although Egypt has a multi-sector approach for addressing HIV that includes collaboration with religious leaders and action at the community level, O'Malley said that "many African countries, such as Botswana, are far more advanced than Egypt when it comes to HIV." The country's HIV strategy also includes efforts to increase education about HIV/AIDS among medical students, Ahmed Khamis, UNAIDS program officer in Egypt, said (Abdoun, Daily News, 11/30).
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India's Hijra Community Promotes Safer Sex, HIV Awareness
[Dec 02, 2008]
Members of India's community of hijras -- pre- and post-operative transsexuals and cross-dressers -- who work as commercial sex workers are helping to promote awareness about safer sex and sexually transmitted infections, including HIV, AFP/Google.com reports. According to AFP/Google.com, hijra sex workers often refuse to engage in sex unless the client uses a condom. The hijra communities provide information about HIV risks and protection in India, where discussion about sex is generally taboo and formal sex education is largely absent from schools.
Organizations such as the Bhoruka Charitable Trust, which is supported by the Bill & Melinda Gates Foundation, provide educational programs promoting HIV awareness among India's long-distance truck drivers, who are more than three times as likely to have HIV as the general population, the Transport Corporation of India Foundation reports. Bhoruka holds discussion groups about safer sex, performs daily street plays in truck stops and installs vending machines selling condoms for five rupees each, or about 10 cents. Truck drivers also can seek HIV testing at Bhoruka's medical center on the highway or receive prescriptions and counseling at the organization's traveling ambulance. According to AFP/Google.com, India's National AIDS Control Organization soon will oversee all of the HIV/AIDS programs operating among the country's transportation sector (Hazlewood, AFP/Google.com [1], 11/29).
India's HIV/AIDS Organizations Require More Funding, Advocates Say
In related news, although local HIV/AIDS facilities are "at the heart" of India's five-year plan to reduce the HIV incidence, several advocates say their organizations need greater funding support to provide services, AFP/Google.com reports. Sunny Joseph, administrator at the community HIV/AIDS care center Snehadaan, said his organization "need[s] more money," particularly for antiretroviral drugs. Snehadaan receives $1,350 per month from the Global Fund To Fight AIDS, Tuberculosis and Malaria and the Karnataka Health Promotion Trust and receives $1,200 per month from the USAID-sponsored Samarth Project. Snehadaan spends about $1,800 to $2,000 on medication each month and the remaining funding goes toward wages and operating costs. This level of funding is "not enough," Joseph said.
Nalini Mehta, India's national program manager for UNAIDS, said India has a wide-ranging and well-regarded policy for HIV/AIDS and has increased budget allocations for the disease in recent years. Although some HIV/AIDS organizations might claim "there is not enough (money)" for their programs, India's government understands there is "scope for a lot more," and is in the process of "upscaling" HIV/AIDS efforts, Mehta said. UNAIDS also has expressed concern that second-line antiretroviral drugs, which cost $280 for a two-month supply, and pediatric treatment are "inaccessible" in many Indian states. According to AFP/Google.com, between two million and 3.1 million people in India are estimated to be HIV-positive (Hazlewood, AFP/Google.com [2], 11/29).
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Public Health & Education
American College of Physicians Releases Guidelines on Routine HIV Screening
[Dec 02, 2008]
The American College of Physicians on Tuesday released guidelines urging physicians to begin routine HIV screening among patients at age 13, regardless of whether they engage in risky behaviors, the New York Times reports. Amir Qaseem, senior medical associate with ACP, said an upper age limit was not included in the recommendations because 20% of people living with HIV are older than age 50. He added that repeat screening should be determined by physicians on a case-by-case assessment. Qaseem said that about 24% to 27 % of the estimated one million to 1.2 million people currently living with HIV in the U.S. are unaware of their status and that ACP is "recommending clinicians just adopt routine screening in their patients."
According to the Times, ACP's guidelines differ from the U.S. Preventive Services Task Force's, which urge routine screening only for patients at high risk of the virus. However, many patients do not inform their physicians about their risky behaviors, Qaseem said. The American College of Obstetricians and Gynecologists also recommends routine HIV screening for all women between ages 19 and 64, regardless of their risk factors, the Times reports.
The Times also reports that the ACP guidelines differ from CDC's guidelines on routine HIV testing, which recommend routine screening until age 64 unless the HIV prevalence in the patient population is known to be less than 0.1%. According to Qaseem, it is difficult for physicians to know what the HIV prevalence rate is among certain patient populations.
According to the Times, hospitals and clinics have been slow to implement CDC recommendations on routine HIV screening. Richard Rothman, associate professor of emergency medicine at Johns Hopkins School of Medicine, said that a lack of funding has prevented the implementation and that only 50 to 100 of the country's 5,000 emergency departments routinely test for HIV. Rothman said, "The CDC's view was that you would get an HIV test just like you would have a complete blood count or any other test as part of your care. But right now in many states there is no mechanism for reimbursement, so emergency [departments] that try to do it have to foot the bill themselves or find creative ways of paying for it" (Rabin, New York Times, 12/2).
The ACP guidelines are available online.
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Across The Nation
MSM Most Affected by HIV/AIDS in Massachusetts, Report Says
[Dec 02, 2008]
Men who have sex with men are the most affected by HIV/AIDS in Massachusetts, according to a report released by the state Department of Public Health ahead of World AIDS Day, the AP/Worcester Telegram reports. According to the report, although Massachusetts has seen success in curbing the spread of HIV/AIDS among injection drug users and heterosexual men and women, it has had less success among MSM. "The message of prevention is missing too many men in Massachusetts," Kevin Cranston, director of the health department's HIV/AIDS Bureau, said.
The report found that more than half of HIV cases between 2004 and 2006 occurred among MSM. Four to nine percent of men in Massachusetts report having sex with other men in annual surveys, according to the AP/Telegram. It also found that 56% of MSM who participated in a 2005-2006 health survey reported regular condom use -- an increase compared with 36% in 2000.
In addition, the report said that 17,295 people in Massachusetts were living with HIV/AIDS as of May 2008, and male-to-male sexual contact is the primary mode of HIV transmission in the state. The proportion of MSM living with HIV/AIDS was 25 times greater than men who reported sex with only female partners, according to the report. Sixty-eight percent of white men reported exposure to HIV through same-sex contact, compared with 25% of black men and 25% of Hispanic men.
To improve the fight against HIV/AIDS in the state, the health department plans to merge its HIV/AIDS Bureau with its Communicable Disease Control Bureau. In addition, the report recommends that Massachusetts increase its efforts to promote condom use, including "widespread free condom availability" to MSM, including high-school students. "Condoms save lives, so it is a good sign that we are seeing an increase in condom use," health department Commissioner John Auerbach said, adding, "However, it is clear given the data in this report that more needs to be done with respect to reaching men who have sex with men with important HIV prevention messages."
The report also calls for increased access to rapid HIV tests and routine screening in hospital emergency departments, community health centers and private practices. It also recommends increasing HIV/AIDS prevention resources directed at MSM; expanding HIV testing efforts that target MSM; making prevention messages available at public, private and commercial venues, including the Internet; and preserving the availability of treatment (LeBlanc, AP/Worcester Telegram, 11/30).
The report is available online (.pdf).
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