Politics and Policy

IRIN/Plus News Examines PEPFAR Under Obama Administration

[Jan 23, 2009]

The extent to which President Obama's campaign promises regarding HIV/AIDS will turn into policy "remains to be seen, but expectations are high," and the question is "not whether" the President's Emergency Plan for AIDS Relief will "continue" under Obama, but "whether it will continue in the same form," IRIN/Plus News reports. Obama's plan to combat global HIV and AIDS released during the campaign "pledged that 'best practice, not ideology' would drive U.S. funding for HIV/AIDS programs," according to IRIN/Plus News.

According to IRIN/Plus News, it is PEPFAR's HIV prevention efforts that have "most irked" many advocates, like policies that favor abstinence, require organizations receiving funding to oppose commercial sex work and a ban on money for needle exchange programs. Some advocates said that they were disappointed with Obama's decision to not immediately replace Ambassador Mark Dybul as the Global AIDS Coordinator, IRIN/Plus News reports, because of Dybul's association with an "ideologically driven approach to HIV prevention."

Serra Sippel, executive director of the Center for Health and Gender Equality, said that reversing some current PEPFAR policies would require a lengthy legislative process and action from Obama but that she believes "we might be able to accomplish more by trying to change the way the programs are implemented." Michael Bennish -- executive director of PEPFAR-recipient Mpilonhle in South Africa and a senior associate with Johns Hopkins University's Bloomberg School of Public Health -- said that he hopes PEPFAR under Obama "will look at the science of things and base decisions on facts and not beliefs." In addition, Sippel said advocates "must keep the pressure on" Obama and Vice President Joe Biden to "uphold their promise to increase (HIV/AIDS) funding" despite the current economic crisis.

IRIN/Plus News reports that PEPFAR's achievements in areas such as providing treatment and care are "on fairly solid ground" and that there is "no question that it has saved lives." Francois Venter, president of the South African HIV Clinicians Society, said that PEPFAR "patched up gaps in provision to groups like illegal immigrants and refugees," adding that he "think[s] there's fairly universal acknowledgement it's been a successful program" (IRIN/Plus News, 1/21).

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Global Challenges

Solomon Islands Reports Condom Shortage; Officials Express Concerns About Effect on Spread of HIV

[Jan 23, 2009]

Several hospitals, clinics and health centers in the Solomon Islands have reported that their condom stocks have run out since last year, and some health authorities are concerned that the situation could contribute to the spread of HIV, the Solomon Star News reports. The island's primary condom suppliers -- the National Medical Store, Save the Children Australia and the Solomon Islands Planned Parenthood Association -- announced earlier this week that their condom stocks are gone. In addition, some provincial hospitals, such as those in Kilufi'i in Malaita and Gizo in the Western province, are reporting outages.

"We have no condoms in our stock since last year, and it is becoming an issue we really need to address seriously," Save the Children's HIV/AIDS program manager Casper Supa said. According to SIPPA program officer George Pitakoe, the organization has been out of stock since October 2008. He added that SIPPA's provincial centers in Gizo, Auki and Taro are out of stock and that although the shortage might indicate that more people are using condoms, the shortage is a serious concern. "We might see it as a good thing people are taking precautions, but the question is what happens if our stocks don't arrive in time as expected? We can't wait that long."

According to the Star News, the International Planned Parenthood Federation supplies condoms to SIPPA, but the group has to wait until June for the next shipment to arrive. Pitakoe added that when SIPPA's condom supply ran out in the past, the group would receive new supplies from the Medical Store; however, the Medical Store, which also supplies condoms to hospitals and clinics nationwide, has run out. An unnamed Medical Store employee said, "We have received orders from hospitals and clinics all over the country for new stocks of condoms since last year. But we cannot do anything because we are out of stock."

In an earlier interview, the Director of Pharmacy Wale Tobata said that the government has allocated 2.5 million Solomon Island dollars -- or about $350,000 -- for new supplies. According to the Star News, it is unclear if condoms are included in the order. An unnamed nurse called on the government to address the situation, adding, "We cannot live without condoms for too long because if we do, who knows -- a lot of people might not be using them and our HIV/AIDS cases in the country might increase" (Marau, Solomon Star News, 1/21).

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Indonesia's HIV-Positive Transgendered Population Faces Discrimination, Jakarta Post Reports

[Jan 23, 2009]

Some transgendered people living with HIV in Indonesia face discrimination and experience stigma when accessing health care, the Indonesian Transvestites Communication Forum said recently, the Jakarta Post reports. The group spoke about the status of transgendered and gay people in the country -- particularly those living with HIV/AIDS -- at a hearing held Thursday with members of the House of Representatives' Commission IX, which handles citizenship, health, labor and transmigration affairs. Yulianus Rettoblaut, head of the forum, said that the group came to the meeting "with high hopes that legislators will articulate the grievances" of transgendered people in the country, "whose social, economic and health rights are neglected."

The group cited a report issued by the Health Ministry in 2007 that found one in three transgendered people in Jakarta is HIV-positive. According to the forum, the high rate of HIV/AIDS among the population in large part is because of inadequate health care. The rate of sexually transmitted infections among transgendered people was higher in the West Java capital of Bandung, where half of the population was living with an STI, the group reported.

After hearing from the group, Commission IX member Rudianto Chen said that no new information was reported since the issue had been discussed last year at a similar hearing. However, he added that the commission failed to uphold its pledge to monitor reports of discrimination. "This is partly [the commission's] fault. ... That's why we plan to facilitate another meeting between ministry officials and [transgendered] groups," Chen said. He added that a new system would be implemented in which the health ministry would conduct oversight of all reports of discrimination and suggested that reports be filed promptly, "so [the commission] can do something about it" (Christanto, Jakarta Post, 1/23).

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Drug Access

Togo Resumes No-Cost Antiretroviral Treatment Program

[Jan 23, 2009]

People living with HIV/AIDS in Togo will be able to resume or begin no-cost antiretroviral treatment as a result of a restocked government program, which had not been able to supply the drugs since November 2007, IRIN News reports. The National AIDS Control Program estimates that an additional 4,000 people will be able to access the drugs. According to Takouda Pelei -- deputy director of the state medical purchasing agency, CAMEG -- there are enough antriretrovirals to treat people already enrolled in the program, as well as an additional 4,000 people, until August 2009. The country also was approved to receive an additional $94 million in funding from the Global Fund To Fight AIDS, Tuberculosis and Malaria over the next five years. Of the $94 million, $25 million will go toward stocking antiretrovirals and other drugs to treat opportunistic infections.

In 2006, the Global Fund suspended part of a grant to Togo and then turned down the government's request for funding in 2007 because of "irregularities" in oversight. From June 2007 to November 2007, new patients were denied access to antiretrovirals, and patients already receiving the drugs were told they would not receive treatment for three months. More than 3,000 people who did not receive subsides had monthly antiretroviral costs of either $9 or $47, depending on the medication. According to the World Bank, the average monthly income in the country in 2007 was $30. Protests resulted as thousands of HIV-positive people, unable to access or pay for antiretrovirals, used antibiotics or halted treatment entirely, IRIN News reports. In order to address interruptions in therapy, the government purchased $365,000 worth of supplies and support from the French Network for Therapeutic Solidarity in Hospitals and borrowed stocks of antiretrovirals from Burkina Faso and Benin.

Pelei said that it is critical to avoid another shortage of antiretrovirals, adding that treatment cannot be turned "on and off without risking the patient's life." HIV/AIDS groups and the government report that an additional 18,000 people still are in need of antiretroviral treatment. The most up-to-date report of the number of people on antiretroviral treatment estimates that 11,490 had access to the drugs at the end of 2007 (IRIN News, 1/21).

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Across The Nation

Iowa Health Department Reports Decreasing Number of Newly Recorded HIV Cases, AIDS-Related Deaths

[Jan 23, 2009]

The Iowa Department of Public Health recently reported that 10 fewer HIV cases were newly recorded in the first half of 2008 than in the same period in 2007, the Associated Press reports (Associated Press, 1/20). In addition, the number of Iowans dying from AIDS-related causes is decreasing, the AP/Sioux City Journal reports. According to the AP/Journal, 49 new HIV cases were reported in the first half of 2008 -- the latest reporting period -- and 59 were reported during the same period in 2007. A total of 127 newly recorded cases occurred in 2007, an increase from the two previous years. Health department estimates show that an additional 566 people are unknowingly living with HIV in the state.

Randy Mayer, a public health spokesperson, said there is a decline in the number of AIDS-related deaths in Iowa, with 32 in 2008 compared with 102 in 1995. Mayer said that improved medications are helping people with HIV/AIDS live longer and that the virus is beginning to be viewed as "more of a chronic disease." He added, "With good treatment and early diagnosis, we wouldn't expect [HIV/AIDS] to significantly change your life expectancy."

According to the health department, 1,567 Iowans were living with HIV/AIDS in 2008. Mayer said that unprotected sex is the primary mode of transmission and that most people living with AIDS are men (AP/Sioux City Journal, 1/20).

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