Kaisernetwork.org (Washington, DC)
3 December 2008
Global Challenges
Advocates Urge Obama, Sarkozy To Fulfill HIV/AIDS Commitments Ahead of ICASA Conference in Senegal
[Dec 03, 2008]
Several hundred African HIV/AIDS advocates on Tuesday marched in Senegal's capital of Dakar to urge U.S. President-elect Barack Obama and French President Nicolas Sarkozy to fulfill funding commitments for HIV/AIDS efforts, Reuters reports. The advocates demonstrated ahead of the 15th International Conference on AIDS and STIs in Africa, which will take place from Dec. 3 to Dec. 7 in Dakar. The advocates, who dressed primarily in white, carried large puppets representing Obama and Sarkozy, a large red and yellow spiked ball representing HIV and banners with messages such as, "African children are watching you."
According to the advocates, the march aimed to remind French and U.S. leaders to sustain funding commitments to HIV/AIDS programs. Velephi Riba, a spokesperson for Save the Children, said Obama and Sarkozy "have to walk the talk," adding that pledges to support HIV/AIDS programs "must be fulfilled." Save the Children, which helped organize the march, said world leaders should not go back on commitments to provide support for people living with HIV despite the current global financial crisis. Ame David, another spokesperson for the organization, said that African children affected by HIV/AIDS, "who have never heard of Wall Street, should not pay the price for the global economic decline." According to Save the Children, Obama has pledged to provide at least $50 billion for international development. In addition, France has been a leading contributor to HIV/AIDS efforts in Africa, spending about $458 million annually. Riba said the two world leaders "must not drop from these pledges by a single dollar or euro" (Fletcher, Reuters, 12/2).
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U.N. Report Says Increased HIV Testing, Treatment Can Increase Survival Rates of Infants Living With Virus
[Dec 03, 2008]
Early treatment for HIV-positive infants can significantly increase their chances of survival, according to a report released Monday by UNICEF, the World Health Organization, UNAIDS and the United Nations Population Fund, the AP/Baltimore Sun reports (AP/Baltimore Sun, 12/1). The report also said that many children younger than age one are dying of AIDS-related illnesses before they are even tested for HIV and that pregnant women are not receiving sufficient counseling and other services necessary to teach them about contraception and safer infant feeding (Charbonneau, Reuters, 12/1). Consequently, the report called for increased HIV testing so appropriate treatments can begin as early as possible.
"Without appropriate treatment, half of children with HIV will die from an HIV-related cause by their second birthday," Ann Veneman, executive director of UNICEF, said, adding, "Survival rates are up to 75% higher for HIV-positive newborns who are diagnosed and begin treatment within their first 12 weeks." WHO Director-General Margaret Chan said in a statement, "Today, no infants should have to die of AIDS. We know how to prevent these tragic deaths, but now we need to focus on strengthening our health care systems to ensure that all mothers and children receive treatment as early as possible" (AP/Baltimore Sun, 12/1). Outgoing UNAIDS Executive Director Peter Piot added that he remains optimistic about the prevention of MTCT, which he called a "human right" (AFP/Google.com, 12/1).
The report found that only 18% of pregnant women in low-income and middle-income countries were given HIV tests and that of those who tested positive, only 12% were further screened to determine how advanced the virus was and the type of treatment required (AP/Baltimore Sun, 12/1). The report recommended that tests to determine the immune functions of HIV-positive women be made more widely available to determine virus progression and reduce the chance of MTCT (Reuters, 12/1). In addition, less than 10% of infants with HIV-positive mothers were tested for the virus, according to the report. Nevertheless, the report forecasted progress in some of the most affected countries where early screening is increasing, including Kenya, Malawi, Mozambique, Rwanda, South Africa, Swaziland and Zambia (AFP/Google.com, 12/1).
The report is available online (.pdf).
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Lack of Funding Contributing to AIDS-Related Deaths in Myanmar, Group Says
[Dec 03, 2008]
Thousands of HIV-positive people in Myanmar are dying because not enough funding is being allocated by the government for treatment, Medecins Sans Frontieres said last week, the New York Times reports. MSF said that about 240,000 people in Myanmar are living with HIV and that of the 76,000 who need antiretroviral treatment, only about 15,000 are receiving it with MSF paying for 11,000. Officials with MSF said they are only able to work in some parts of the country and are having to turn away new patients. Joe Belliveau, MSF's operations manager for Myanmar, said, "It is unacceptable that a single [nongovernmental organization] is treating the vast majority of HIV patients in a crisis of this magnitude."
According to MSF officials, the government spends about 70 cents per citizen for health care annually and most people cannot afford the cheapest antiretroviral regimen from private physicians, which costs about $30 monthly. According to the Times, funding for HIV/AIDS drugs is available through the Global Fund To Fight AIDS, Tuberculosis and Malaria, but only governments can apply for it. Governments also must prove that the funding will not be used inappropriately or corruptly. The Times reports that the military government of Myanmar "has a long record of watching indifferently as its citizens die" (McNeil, New York Times, 12/2).
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Across The Nation
Loss of Funding, Increase in Participants Likely To Cause Kentucky ADAP To Implement Waiting List
[Dec 03, 2008]
Kentucky's AIDS Drug Assistance Program -- which provides medications to low-income, uninsured and underinsured HIV-positive people -- has lost a significant portion of its federal and state funding over the past three years and may be forced to reinstate a waiting list by April, state health officials said Monday, the Lexington Herald-Leader reports.
According to Sigga Jagne, branch manager for the program with the state Cabinet for Health and Family Services, an increase in the number of patients who have applied for assistance has coincided with the drop in funding. Jagne said, "We are seeing 50 new patients a month," which is up from monthly figures of 35 in 2007 and 23 in 2006. However, federal funding decreased from $4.6 million in 2005 to $4.3 million in 2008; antiretrovirals can cost between $2,000 and $10,000 a month. Deborah Wade, program director for the WINGS Clinic at the University of Louisville, said that in 2005, "Kentucky had the longest waiting list of all states for the drug program," adding that 30% of her 1,100 clients do not have insurance and are in need of the program's assistance.
According to the Herald-Leader, a waiting list was eliminated in 2006 as the program became more efficient and the state Legislature appropriated money to the program, beginning in 2004. However, no money for the program was appropriated for this fiscal year. Jagne said Kentucky already is preparing a waiting list and that social workers who work with HIV-positive people are getting ready to fill out applications for individual drug companies' no-cost or reduced-cost programs until additional funding can be found. Kraig Humbaugh, director of the Division of Epidemiology and Health Planning for CHFS, said the agency is looking at all options but, with a state facing a deficit of more than $450 million, it has to be pragmatic.
Humbaugh said that two other states already have implemented waiting lists and that six others have put some type of cap on antiretrovirals covered or the number of people who can receive services. The Herald-Leader reports that HIV/AIDS advocates argue it is more cost-effective for states and the federal government to pay for antiretrovirals than to wait until someone becomes seriously ill. Wade said, "People who don't get their medicines get really, really sick. That means that they are admitted to the emergency rooms and eventually moved to intensive care. They stay longer. They can't work ... and taxpayers are going to have to pay for that." According to advocates, life expectancy for HIV-positive people nationwide and in Kentucky has greatly improved, largely because of access to antiretrovirals (Musgrave, Lexington Herald-Leader, 12/2).
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Washington Post Examines Local Shelter For Homeless People Living With HIV/AIDS
[Dec 03, 2008]
The Washington Post on Tuesday examined the Washington, D.C.-based homeless care center Joseph's House, which provides nursing services and support to homeless people living with HIV/AIDS. Physician David Hilfiker in 1990 opened Joseph's House in response to the increasing number of HIV/AIDS diagnoses in the city. The house provides nursing and hospice care for patients living with the disease but also welcomes, if space allows, people who are not HIV-positive. Around half of the funding for the house comes from federal and local government support, and the remaining funding comes from grants and private donations, the Post reports.
Hilfiker said that his "vision" for the house was "really community, not a hospice." The Post reports that as the house has retained its sense of community, "the frailty of its residents has increased." While medications have made it possible for people living with HIV/AIDS to live longer, "many residents [of Joseph's House] have not consistently taken those drugs, facing barriers such as addictions, mental illnesses or a shelter life inconsistent with medicine that must be taken regularly," according to the Post.
The D.C. Department of Health's HIV/AIDS Administration reports that there were at least 400 people known to be homeless and living with HIV/AIDS in the city as of December 2007; 75% were men and 83% were black. According to the Post, the district has one of the largest homeless populations in the country and a high HIV/AIDS burden, but "it is impossible to know how many people live at the intersection of those two statistics." Nationwide, 3% to 10% of homeless people are HIV-positive -- about 10 times greater than the general population -- and the HIV/AIDS mortality rate among homeless people is seven to nine times higher than the general population, according to Nancy Bernstein, executive director of the National AIDS Housing Coalition. Priscilla Norris, a nurse at Joseph's House, said that a lack of drug access often does not pose the biggest problem for people who come to the house but rather "out of control" lives that did not allow them to take advantage of medication until coming to the shelter. The article also profiled several people living at the shelter (Vargas, Washington Post, 12/2).
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Opinion
Absence of 'Frank Talk' About HIV/AIDS Hurts Black Women in Washington, D.C., Opinion Piece Says
[Dec 03, 2008]
"If ever there was a case for unvarnished sex education in public schools, the ongoing AIDS epidemic in black America ought to be it," columnist Courtland Milloy writes in a Washington Post opinion piece, adding, "[H]ow can we teach [HIV prevention] if we can't talk frankly?" Milloy writes that he is "focusing on women and AIDS ... because it's up to women to save their own lives" and that "too many men are not trying to protect" women from sexually transmitted infections. "Most of the time, they are just trying to have sex," he writes, adding, "Quite frankly, you would have thought more women would have caught on by now."
According to Milloy, "In the district, the number of women living with AIDS increased by more than 76 percent in six years -- nine out of 10 of them black women." He adds that AIDS-related illnesses are the fourth leading cause of death among black women ages 45 to 54, and 9% of all pediatric HIV/AIDS cases in the U.S. occur in the district. "Blame the man all you want, but it's the mother and child who suffer most," he writes. "There's certainly no shortage of public service announcements aimed at reducing infection rates among African-Americans," Milloy writes, adding, "But most consist of preachy platitude, politically correct and 'culturally sensitive' pablum ... The results should not be surprising." He concludes that "in the absence of frank talk, we could at least help young girls ... by getting them to serve a few weeks at an AIDS hospice. Careless sex would likely lose its sheen once they realize that their lovers could be the Grim Reaper in disguise" (Milloy, Washington Post, 12/3).
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Opinion Pieces Examine Male Circumcision for HIV Prevention
[Dec 03, 2008]
The Los Angeles Times and the Journal of the American Medical Association recently published opinion pieces about male circumcision as a method of HIV prevention. Summaries appear below.
Los Angeles Times: As circumcision "gain[s] a hold in communities where historically it has not been practiced" in sub-Saharan Africa, policies surrounding the procedure "must be supported with appropriate resources, and government and health leaders must work with practitioners on the ground to make sure that the procedure is wholly beneficial and in no way harmful," Paul Perchal -- director of the HIV/STI Program for EngenderHealth -- writes in a Times opinion piece. According to Perchal, "Support is needed in regions where health systems are weak so that health professionals are properly trained to perform circumcisions and always use sterile instruments." To be effective, Perchal writes that circumcision "must be offered as part of an overall HIV prevention strategy, not as a stand alone service." He writes that proper information about circumcision is "essential" for men to "understand that circumcision won't make them immune to HIV or other sexually transmitted infections, and that condom use is still crucial." Without this information, women could be harmed by an increase in male circumcision because "men who are circumcised may believe that they do not need to use condoms," Perchal writes, adding that funding for HIV prevention methods that "involve and benefit both women and men may be shifted disproportionately" to circumcision -- which "serves only men." Recognizing that "what works in one community may not be appropriate in another," governments must "remai[n] respectful of existing traditions while ensuring safety" for all who undergo the procedure. He concludes that "having full information" and "high-quality care" are "two factors that should never be compromised for anyone, anywhere" (Perchal, Los Angeles Times, 12/3).
JAMA: Lawrence Gostin of the O'Neill Institute for National and Global Health Law at Georgetown University and Catherine Hankins of UNAIDS write that "male circumcision can have deep symbolic meaning that could pose barriers to implementation." They add that because "the procedure may be viewed with suspicion, particularly if outsiders propose it," implementation planning "should involve all sectors of society, including government, health professionals, persons living with HIV, the media, nongovernmental organizations, traditional health practitioners, as well as men, women and youth." The authors continue that in order to make the procedure "available and affordable to all who seek it, human resources, training, infrastructure, logistics, funding, ... quality assurance, monitoring and evaluation" are necessary. They write, "All sectors of society should be able to access accurate information about the benefits and risks of male circumcision," adding that "health professionals should communicate with patients and their sexual partners or parents in a culturally and linguistically appropriate and effective way." Confidentiality of a person's HIV and circumcision status is "essential for the dignity of the person," the authors write. Lastly, they add that it is "important that male circumcision services do not diminish the resources and attention devoted to prevention, treatment and empowerment of women" and "sexual partners should be involved in the decision-making process." They add that "governments should take strong measures to ensure that male circumcision is not used as an excuse to tolerate female genital circumcision, which has no health benefits and is harmful to the health and well being of girls and women." The authors conclude, "To be fully effective, male circumcision services -- whether for adults, adolescents or infants -- need to be scaled up to achieve coverage levels adequate for population effect" (Gostin/Hankins, JAMA, 12/3).
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