Politics and Policy

Obama Administration Requests Dybul To Resign as PEPFAR Administrator

[Jan 26, 2009]

The Obama administration has requested that Mark Dybul immediately resign from his position as U.S. Global AIDS Coordinator and administrator of the President's Emergency Plan for AIDS Relief, CQ HealthBeat reports. An e-mail sent Thursday to U.S. foreign aid officials said that Dybul is "no longer serving" as PEPFAR administrator and that the Office of the Global AIDS Coordinator "will continue to function under the leadership of career staff until a successor is confirmed."

Dybul has overseen PEPFAR, which Congress reauthorized in July 2008 for an additional five years, since 2006. Dybul in an e-mail to his staff earlier this month said he would continue to serve as PEPFAR administrator, at least temporarily, "beyond the inauguration" of President Obama. According to CQ HealthBeat, many global health advocates were disappointed by the earlier announcement that Dybul would continue to serve as the U.S. Global AIDS Coordinator (Semnani, CQ HealthBeat, 1/23).

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Obama Lifts 'Mexico City' Policy, Could Affect HIV/AIDS Efforts

[Jan 26, 2009]

President Obama on Friday issued an executive order repealing the "Mexico City" Policy, which banned U.S. funding for international health groups that use their own funds to perform abortions, lobby their governments in favor of abortion rights or provide counseling about terminating pregnancies, the Washington Post reports. Obama also said that he would work with Congress to restore funding to the United Nations Population Fund to prevent HIV/AIDS, reduce poverty, and improve health care access for women and children in 154 countries. The Post reports that Obama's decision was praised by women's health advocates, family planning groups and others for allowing USAID to fund programs that offer HIV prevention and care, birth control and medical services (Stein/Shear, Washington Post, 1/24).

According to Reuters, critics of the "Mexico City" Policy say that the restrictions have resulted in large reductions in funding for organizations worldwide that provide family planning services and basic health care. For example, the Center for Reproductive Rights reports that in Ethiopia and Lesotho, some nongovernmental organizations are not able to offer comprehensive and integrated health services to people living with HIV/AIDS (Mason/Charles, Reuters, 1/23).

In a related San Francisco Chronicle opinion piece, Shalini Nataraj of the Global Fund for Women writes of one operation in Ghana that lost funding because it refused to adhere to the "Mexico City" Policy, resulting in an estimated 600,000 people losing access to HIV/AIDS prevention education, counseling and family planning services.

The effects of the policy have been "compounded" by a requirement in the President's Emergency Plan for AIDS Relief that organizations receiving funding must oppose commercial sex work, Nataraj writes, adding that the "reasoning behind this pledge is that by denying services or outreach to those who work as" commercial sex workers, such work "will be abolished and HIV/AIDS will be reduced." She writes that the "reality is otherwise, because women enter sex work for a variety of deeply entrenched sociocultural and economic reasons that must be addressed before [commercial sex work] can be reduced. This means that organizations that work with sex workers are threatened with a loss of funding for serving those most in need of information and protection from HIV/AIDS" (Nataraj, San Francisco Chronicle, 1/26).

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Public Health & Education

New York Times Examines Cell Phone Soap Opera Campaign To Promote HIV Awareness

[Jan 26, 2009]

The New York Times on Sunday examined a campaign that aims to provide women with messages about HIV awareness, safer sex and condom use through a series of soap opera episodes that can be viewed on a cell phone. Rachel Jones, assistant professor at Rutgers University's College of Nursing, developed the project after working as a nurse practitioner and interacting with young women who were aware of the risks of unprotected sex but still did not use condoms.

According to Jones, the soap operas will target black and Hispanic women. According to the Times, about one-third of the 35,300 HIV-positive people in New Jersey are black or Hispanic women. In addition, about eight out of 10 new infections will affect women in these two groups, the state Department of Health and Senior Services reports. To create the dialogue and storyline for the films, Jones held focus group discussions with young women from these ethnic groups and generated ideas from their experiences. Jones said the "soap opera format provides an opportunity to identify with the heroine and make more powerful choices after they see her make more powerful choices." In addition, cell phones allow women to have privacy when viewing the episodes and enable them to watch them repeatedly, Jones said. Martinique Moore, an assistant director of the project, said safer-sex messages need to reach beyond pamphlets and billboards. Moore added, "A lot of young people get their cues from music videos."

The Healthcare Foundation of New Jersey provided $154,400 for the project, and NIH recently granted $2 million for a study assessing the effectiveness of the campaign. According to Michael Castlen -- executive director of PCI-Media Impact, an organization that has broadcast more than 240 radio and television dramas with social messages in 27 countries -- "[p]ublic service announcements are very effective in getting people aware of an issue." However, "they are not intended to actually change behavior," he said (Hughes, New York Times, 1/25).

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Across The Nation

Palm Springs, Calif., Sees Increase in HIV-Positive Test Results; Advocacy Group Seeks Additional Funding

[Jan 26, 2009]

An increase in HIV-positive test results is leading the Palm Springs, Calif.-based Desert AIDS Project to request additional funding from the Riverside County Department of Public Health for more testing resources, the Palm Springs Desert Sun reports. According to the Sun, positive test results were at their highest at 15% one month in 2008. According to the group, the average rate in the area is about 5%. Officials with DAP said they have spent almost all of the $25,000 earmarked from the county for HIV testing this fiscal year. A response for additional funding could be given as early as next week, HIV/AIDS Program Chief for Riverside County Victoria Jauregui Burns said.

David Brinkman, executive director of DAP, said that there is "no cure on the horizon" for HIV/AIDS and that an increase in HIV/AIDS cases "will be dramatic" if the group is unable to receive additional funding for testing for the next six months. According to DAP, two-thirds of people living with HIV do not know their status. Brinkman said, "We know that people change their behavior once they know that they are carrying the virus and go into treatment. The great way to prevent the spread of the virus is to get everybody tested. We're a huge part of the solution" (Brambila, Palm Springs Desert Sun, 1/23).

According to the Sun, DAP -- which provides medical care and social services to people living with HIV/AIDS -- in 2008 tested more than 1,800 people in the Palm Springs area, which has one of the largest populations of men who have sex with men in the U.S. Burns said DAP "reach[es] the population that we need to reach." She added that the increase in positive test results is "something that we are defiantly concerned about" but that it is "not surprising" because "we know that their service area is greatly impacted by HIV" (Brambila, Palm Springs Desert Sun, 1/22).

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Nebraska Bill Would Criminalize Intentional Transmission of HIV/AIDS, Other Diseases

[Jan 26, 2009]

Nebraska State Sen. Pete Pirsch (R) on Wednesday introduced a bill (LB 625) that would make having sex with the intent of transmitting HIV a felony, the AP/KPTMNews.com reports. The bill also would make it illegal to donate or sell organs and bodily fluids, including blood and semen, or share a needle with the intention of spreading HIV/AIDS and other diseases. People who violate the law would be committing a Class 1B felony, which carries a minimum 20-year prison sentence and a maximum sentence of life in prison, the AP/KPTMNews.com reports (AP/KPTMNews.com, 1/21).

12 Nebraska Residents on ADAP Waiting List

In related news, about 12 Nebraska residents are on the state's AIDS Drug Assistance Program waiting list, the University of Nebraska Medical Center said Thursday, the Omaha World-Herald reports. Susan Swindells, medical director of the center's HIV clinic, said the "federal support is vital because these drugs are expensive, and many of our patients do not have the means of paying for this medicine otherwise" (Ruggles, Omaha World-Herald, 1/22).

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Virginia's Eastern Region Has One of State's Highest HIV Rates, Experts Say; Blacks Mostly Affected

[Jan 26, 2009]

In 2008, the Virginia Health Department's Eastern Region had a rate of 19 new HIV infections reported for every 100,000 residents, which is nearly twice the rate in Northern Virginia and higher than the state rate of 12 infections for every 100,000 residents, Newport News Daily Press reports. That same year, there were 332 new HIV infections reported in the region, which includes Hampton Roads, the Middle Peninsula and the Eastern Shore.

One in three of all HIV infections reported in Virginia is in Hampton Roads, which has a large black population, according to Edward Oldfield, director of Eastern Virginia Medical School's Center for the Comprehensive Care of Immune Deficiency. Between 2005 and 2007, the number of new HIV cases on the Peninsula increased by 10%, Oldfield said. The number of new cases in Norfolk increased by 50% during the same period.

Experts say that drug use and other high-risk behaviors are contributing to the spread of HIV in the area's black community. The region historically has had higher rates of sexually transmitted infections such as chlamydia, gonorrhea and syphilis, the Daily Press reports. High STI rates indicate that people are more likely engaging in activities that increase their risk for contracting HIV, Irma Hinkle, program director for AIDS Care Center for Education and Support Services, said.

"The population that is most at risk [is] the socioeconomically disadvantaged African-Americans," Robert Johnson, director of outbreak response with the state Health Department, said, adding, "We know from years of research that poverty leads to less access to health care, and it leads to less care about care."

Health care workers and HIV advocates in Hampton Roads are encouraging residents to speak openly about HIV, be tested and disclose their status. "The area is so deeply embedded in denial, both on the individual and the community level," Donald Walker, the HIV Early Intervention Services prevention supervisor for the Hampton-Newport News Community Services Board, said. "It's those secrets that perpetuate the virus in this community," he said (Finneran, Newport News Daily Press, 1/23).

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Global Challenges

IRIN News Examines Challenges of HIV-Positive Women in Liberia

[Jan 26, 2009]

IRIN News on Thursday examined the challenges of HIV-positive women in Liberia, including unemployment, gender discrimination and violence. According to a 2008 government report, although women account for about half of the 100,000 HIV-positive people in Liberia, women and girls are "doubly disadvantaged" by HIV/AIDS because they often serve as caregivers as well as patients. The report noted that "little is known about how HIV is affecting vulnerable populations" in Liberia, including women, young people, rural residents and children. In addition, violence against women "continues to permeate society and rape is among the most frequently reported crimes," the report said.

According to David Logan, grant coordinator for the Global Fund To Fight AIDS, Tuberculosis and Malaria, since 2007 more than 1,000 women living with or affected by HIV/AIDS have participated in job training activities such as basket weaving, fabric dyeing and fish preservation. He added that it is difficult to track whether these women found vocations as a result of the training because "[m]ost beneficiaries use these skills to start small businesses in the informal economy." According to Logan, the Global Fund also has provided funding to establish an Internet cafe that will be operated and managed by HIV-positive employees. The cafe is scheduled to open in the coming weeks, Logan said. He added that the Global Fund plans to use a $78 million grant, allocated for 2009 to 2013, to "expand activities to fight gender inequity, sexual and gender-based violence and unemployment faced by HIV-positive persons." These issues are "all related," Logan said (IRIN News, 1/22).

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