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Kaiser Daily HIV/AIDS Report
Thai Government Failing To Prevent, Treat HIV/AIDS Among Injection Drug Users, Report Says
Public Health & Education
Number of Annual New HIV Cases in U.S. Might Be Higher Than Previously Thought
New York Gov. Spitzer Considers Imposing Mandatory Managed Care Enrollment Among HIV-Positive Medicaid Beneficiaries
HIV Vaccine Trial Participation Might Lead to Negative Social Consequences, Study Says
Editorials, Opinion Pieces Respond to World AIDS Day
Statehealthfacts.org Adds Updated Data About Needle-Exchange Programs
Global Challenges
President Bush Announces Plans To Travel to Africa Next Year To Review Progress of PEPFAR Programs
[Dec 03, 2007]
President Bush on Friday in recognition of World AIDS Day on Dec. 1 announced that he plans to travel to Africa next year to review the progress of programs funded by the President's Emergency Plan for AIDS Relief, the Baltimore Sun reports (Nitkin/Gencer, Baltimore Sun, 12/1). President Bush and first lady Laura Bush on Friday met with faith-based HIV/AIDS advocacy groups in Mount Airy, Md., to discuss PEPFAR, White House spokesperson Alex Conant said. The administration chose Calvary United Methodist Church to host the event because of its support for Children of Zion Village, a group home and school in Namibia for AIDS orphans, according to Conant. The orphanage is located in northeastern Namibia and was opened in 2003 by missionaries (Kaiser Daily HIV/AIDS Report, 11/30).
"Americans expect results," the president said after meeting with the groups, adding, "I look forward to seeing the results of America's generosity." He said that U.S. assistance over the past five years has "pioneered a new model for public health," adding that PEPFAR includes "specific, measurable targets for progress" that demand "honesty and accountability for all those involved" and "puts local partners in the lead" (Ward, Washington Times, 12/1).
Bush also called on Congress to increase funding for PEPFAR to $30 billion during the next reauthorization process, the Los Angeles Times reports (Gerstenzang, Los Angeles Times, 12/1). PEPFAR's original mandate is scheduled to expire in September 2008. Bush in May called on Congress to double current funding levels to $30 billion over five years (Kaiser Daily HIV/AIDS Report, 11/15). According to Bush, the number of people with access to antiretroviral drugs has increased from 50,000 to 1.4 million under PEPFAR. Ambassador Mark Dybul, the U.S. Global AIDS Coordinator who administers PEPFAR, said that the program is providing care to 6.7 million people (Washington Times, 12/1). In addition, PEPFAR is helping provide care to 2.7 million orphans and other children, according to Dybul.
The "time has come for Congress to act again," Bush said. He added that "tens of millions have received ... prevention messages based on the proven principles of ABC" -- which stands for abstinence, be faithful and use condoms -- as a result of the program (Los Angeles Times, 12/1). "Some call this a remarkable success," Bush said, adding, "I call it a good start." He added, "It lifts our spirits and souls to help neighbors in need, whether it's a neighbor across the street or a neighbor in the global community" (Abramowitz, Washington Post, 12/1). Some HIV/AIDS advocates have criticized Bush for "focusing too heavily" on abstinence, the Los Angeles Times reports. About 40 people were arrested on Friday for protesting outside the White House against PEPFAR rules that require at least one-third of HIV prevention funds that focus countries receive through the program to be used for abstinence-until-marriage programs (Los Angeles Times, 12/1). Lawmakers Pledge To Reauthorize PEPFAR
House and Senate leaders on Friday pledged to reauthorize PEPFAR at levels higher than Bush's request and committed to considering reauthorization early next year, CQ HealthBeat reports. Senate Foreign Relations Committee Chair Joseph Biden (D-Del.) on Friday called on Bush and Congress to pledge $50 billion over the next five years for global HIV/AIDS, tuberculosis and malaria programs. He said that the U.S. "cannot keep up with the current pace of the epidemic through treatment programs alone," adding that prevention programs are "critical to beating" HIV/AIDS. Biden also called for the elimination of "barriers" that set specific percentages for the amount that can be spent on HIV/AIDS care, treatment and prevention.
House Foreign Affairs Committee Chair Tom Lantos (D-Calif.) said the committee will consider PEPFAR reauthorization as its "first major order of business in 2008." Lantos also said in a statement Friday that he intends to increase funding for HIV/AIDS programs "dramatically over current levels" (Gensheimer, CQ HealthBeat, 11/30).
Rep. Barbara Lee (D-Calif.) on Friday criticized Bush for not seeking a $50 billion appropriation for PEPFAR, saying that "$30 billion does not meet the need and simply maintains the status quo" (Los Angeles Times, 12/1). House Speaker Nancy Pelosi (D-Calif.) said that reauthorizing PEPFAR "is an opportunity to show that America stands with developing nations as they fight this deadly disease" (Washington Times, 12/1). Asked on Friday whether the U.S. is working hard enough to control HIV/AIDS domestically, White House Press Secretary Dana Perino said the administration is "putting resources and money towards" HIV/AIDS in the U.S. Perino added that there is a "need here in America, but there is also a need in other countries, including Africa, Latin America and Asia" (Washington Post, 12/1).
 A fact sheet about PEPFAR is available online. Additional Comments
Former South African President Nelson Mandela on Saturday at the fifth "46664" HIV/AIDS awareness concert in Johannesburg, South Africa, said, "If we are to stop the AIDS epidemic from expanding, we need to break the cycle of new HIV infections." Mandela hosted the concert -- which drew about 15,000 people -- to coincide with World AIDS Day. "All of us working together with government, communities and civil society can make the difference that is needed," he said, adding, "Together, we have the power to change the course of destiny" (Jacobson, AP/Yahoo! News, 12/1). United Nations Secretary-General Ban Ki-moon on Saturday said, "We have made tangible and remarkable progress on all these fronts. But we must do more" (AFP/Google.com, 12/1). Reports, Initiatives
Several groups released studies and launched initiatives to mark World AIDS Day. Summaries appear below.
- The Global Fund To Fight AIDS, Tuberculosis and Malaria: The organization on Friday announced that more than 1.4 million HIV-positive people worldwide have received access to antiretroviral drugs through Global Fund-supported programs -- almost twice the number reported last year. The organization also announced that more than 3.3 million people with TB received drug access through Global Fund-supported programs. TB is the leading cause of death among HIV-positive people worldwide. The Global Fund earlier last week announced that the number of insecticide-treated nets distributed by programs supported by the organization has increased to 46 million so far this year -- a 155% increase from the 18 million families that received ITNs in 2006 (Global Fund release, 11/30).
- Lancet: The journal on Saturday released a special issue in recognition of World AIDS Day. The issue includes editorials, reports, research and other resources (Lancet, 12/1).
- PLoS Medicine: The journal on Saturday released a special collection of articles, commentaries and editorials. The articles include research on men who have sex with men in developing countries; pregnant women and when they disclose their HIV status around childbirth; a mutation in HIV that can cause drug resistance; how confirmatory HIV tests can help estimate recent cases; how CMV retinitis can cause blindness among young HIV-positive people in developing countries; and developments and future directions for antibody-based HIV vaccines (PLoS Medicine release, 11/26).
Broadcast Coverage
Several broadcast programs reported on issues related to World AIDS Day. Summaries appear below.
- CNN's "World Report": The program on Sunday included three segments examining issues related to HIV/AIDS, including reports on AIDS orphans, stigma toward HIV/AIDS in China and medical research ("World Report," CNN, 12/2). Video of the segment is available online.
- C-SPAN's "Washington Journal": The program on Saturday included a discussion with Ronald Johnson of the AIDS Action Council about U.S. efforts to combat HIV/AIDS ("Washington Journal," C-SPAN, 12/1). Video of the segment is available online.
- NBC's "Nightly News": The program on Friday profiled Austin Gutwein, a 13-year-old Arizona resident who founded Hoops of Hope to raise money for AIDS orphans in Zambia (Larson, "Nightly News," NBC, 11/30). Video of the segment is available online.
- NPR's "News & Notes": The program on Friday included a discussion with Shannon Hader, director of Washington, D.C.'s HIV/AIDS Administration, about the number of HIV/AIDS infections in the district (Chideya [1], "News & Notes," NPR, 11/30). Audio of the segment is available online. Friday's program also included a discussion with a woman who has AIDS and her daughter about living with the disease (Chideya [2], "News & Notes," NPR, 11/30). Audio of the segment is available online. In addition, the program included a discussion with psychologist Dorothy Holmes about coping with issues related to family members who have HIV/AIDS (Chideya [3], "News & Notes," NPR, 11/30). Audio of the segment is available online.
- PBS' "NewsHour with Jim Lehrer": The program on Friday included the third in a three-part series on the impact of PEPFAR in Africa. The segment includes comments from Dybul; Tracy Carson, coordinator of the U.S. Global AIDS program in Tanzania; Dennett Fimbo of the Tanzania National AIDS Control Program; Peter Masika, head of the Tanzania Youth Alliance; Chip Health, a professor at the Stanford Graduate School of Business; and Tanzania residents (Dentzer, "NewsHour with Jim Lehrer," PBS, 11/30). Audio and a transcript of the segment are available online.
Thai Government Failing To Prevent, Treat HIV/AIDS Among Injection Drug Users, Report Says
[Dec 03, 2007]
The Thai government's failure to effectively address HIV/AIDS among injection drug users in the country is undermining its position as a leader in the fight against the disease, according to a report released Thursday by Human Rights Watch and the Thai AIDS Treatment Action Group, the AP/International Herald Tribune reports. According to the groups, IDUs were the first group in Thailand to be affected by HIV, and HIV prevalence among IDUs has been between 40% and 60% during the last 20 years (Streib, AP/International Herald Tribune, 11/29). Report
The 57-page report -- titled "Deadly Denial: Barriers to HIV/AIDS Treatment for People Who Use Drugs in Thailand" -- found that routine police harassment and arrest "keeps drug users from receiving lifesaving HIV information and services that Thailand has pledged to provide," according to a HRW release (HRW release, 11/29). The government between 2003 and 2004 launched a campaign against the illegal drug trade that led to the deaths of thousands of alleged dealers in the country, the AP/Herald Tribune reports.
The report also found that antiretroviral treatment often is denied to HIV-positive people based on their status as drug users. It noted that HIV treatment programs sometimes presume that IDUs are incapable of following through with their antiretroviral regimens and refuse to refer them for treatment. In addition, the report said that the Thai government has failed to effectively promote harm-reduction techniques -- such as the provision of no-cost, clean needles to IDUs -- to help reduce the spread of HIV. About 1% of IDUs received harm-reduction services, according to a July 2006 USAID study. Under Thai law, sale and possession of clean syringes is legal, but authorities in some cases have considered their possession as a basis for drug charges, the report said (AP/International Herald Tribune, 11/29).
"Thailand wants to be seen as a success story in the fight against AIDS, yet it is failing to address the epidemic among the population hit hardest by HIV," Rebecca Schleifer, an advocate with the HIV/AIDS and Human Rights Program at HRW, said. Paisan Suwannawong, director of ThaiTAG, added that Thailand "must stop discrimination against drug users seeking health care services, or it will never meet its promise to ensure access to AIDS treatment to all who need it" (HRW release, 11/29).
The report is available online.
Public Health & Education
Number of Annual New HIV Cases in U.S. Might Be Higher Than Previously Thought
[Dec 03, 2007]
The number of new annual HIV cases in the U.S. could be as much as 50% higher than previous estimates, according to U.S. health officials, who are expected to release new data next year, the Wall Street Journal reports.
Researchers and public health officials who have been briefed on the new data have said CDC next year likely will release figures indicating that in 2005, new HIV cases were 20% to 50% higher than previously thought -- translating to a total of up to 60,000 new cases annually. The final number is pending peer review by a scientific journal, the Journal reports (Chase/McKay, Wall Street Journal, 12/1).
CDC for more than 10 years reported that 40,000 new HIV cases occur annually in the U.S. and said that the HIV epidemic in the U.S. is stable (Brown, Washington Post, 12/1). According to the Journal, CDC in recent years has developed new testing technology and has updated its methodology to yield more accurate data. The new estimate was derived using state data and new antibody testing technology that can distinguish infections that occurred in the past 160 days from older infections, the Journal reports (Wall Street Journal, 12/1). Nineteen states and cities are performing the new antibody test along with an older test to calculate the number of new cases, the New York Times reports.
According to the Times, the Washington Blade on Nov. 14 reported that the new estimate showed that between 58,000 to 63,000 people became HIV-positive during the most recent 12-month period. An unnamed federal official said the new estimate was higher than the old one but not as high as reported in the Blade. Tom Skinner, a CDC spokesperson, said that the agency is "not in a position to say one way or another whether the numbers will actually be up from current estimates" until the peer review is completed.
It is unclear to what extent more people were becoming HIV-positive or if the new numbers are a better estimate than the old ones, the Times reports (Harris, New York Times, 12/2). It will take additional years using the new methodology to determine whether HIV cases are increasing or have been underreported, the Post reports (Washington Post, 12/1). Reaction
Kevin Fenton -- director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention -- emphasized that the "new estimates are not yet final," adding that the "new system will provide the clearest picture to date of new HIV infections" in the U.S. (Reuters, 12/2).
David Holtgrave, an epidemiologist with the Johns Hopkins Bloomberg School of Public Health, said it has been clear for at least one year that the old estimate would increase. He added that from 2001 to 2005, there were 37,000 cases annually in two-thirds of the country. "With just a little simple math, you get more than 40,000 new cases," Holtgrave said. According to Julie Davids, executive director of the Community HIV/AIDS Mobilization Project, the new estimate "shows that prevention efforts are insufficient" (New York Times, 12/2).
Across The Nation
New York Gov. Spitzer Considers Imposing Mandatory Managed Care Enrollment Among HIV-Positive Medicaid Beneficiaries
[Dec 03, 2007]
New York Gov. Eliot Spitzer (D) is considering imposing mandatory managed care enrollment among Medicaid beneficiaries who are living with HIV/AIDS, the New York Sun reports. Since the late 1990s, the state's 65,000 people living with HIV/AIDS who are enrolled in New York's Medicaid have been exempt from a statewide enrollment drive to place beneficiaries into managed care plans, the Sun reports. About 10,000 HIV-positive beneficiaries are enrolled in Medicaid managed care plans.
Spitzer officials said the plan to mandate managed care enrollment among HIV-positive Medicaid beneficiaries is in its beginning stages and might offer a better value for Medicaid spending. "One reason we want to start a discussion is because the data we have, across the board for Medicaid managed care, shows that enrollees are getting better care than in fee-for-service" plans, Deborah Bachrach, the state's Medicaid director, said. She added, "We can't make a decision without looking at cost savings. ... We can't just look at cost. What is the care we're buying?" According to the Sun, a "central question" to mandatory enrollment is whether people living with HIV/AIDS would need to enroll in existing Medicaid managed care plans, known as HIV Special Needs Plans.
Michael Kink -- legislative counsel for Housing Works, an HIV/AIDS service and advocacy group -- said, "Simple mandatory enrollment in Medicaid HMOs is not any kind of magic bullet," adding that mandatory enrollment has "the potential for large-scale disruption of the HIV care system." Some HIV/AIDS advocates questioned if HMOs could handle the unique needs of people living with the disease and if there are enough physicians specializing in HIV/AIDS. They also questioned whether the state's three HIV Special Needs Plans -- which currently have 2,500 members and are available only in New York City -- could absorb the influx of members. Doug Wirth -- president and CEO of New York City-based VidaCare, which offers an HIV Special Needs Program -- said the company's "special needs program would definitely need to expand its provider network in order to be responsive to large numbers of people who would choose" the company (Solomont, New York Sun, 11/30).
Science & Medicine
HIV Vaccine Trial Participation Might Lead to Negative Social Consequences, Study Says
[Dec 03, 2007]
HIV vaccine trial volunteers could experience negative social consequences because of their participation in the trials, according to a study published in the Nov. 1 issue of the Journal of Acquired Immune Deficiency Syndromes, Reuters Health reports.
For the study, Jonathan Fuchs of the San Francisco Department of Public Health and colleagues evaluated the negative social effects reported by 5,417 people who participated in HIV vaccine clinical trials. Nearly 1,000 volunteers reported negative social events -- including negative reactions from friends, family and partners -- during a 36-month follow-up period, the study found. The study authors attributed the negative reaction to a misunderstanding of the volunteers' HIV status or risk of contracting the virus, Reuters Health reports.
Less than 1% of the participants reported problems with disability or life insurance, employment, medical or dental care, insurance, government agencies or housing, according to the study. The study also found that 12 of the 368 participants who contracted HIV after the trial reported at least one negative social event, mostly involving family or friends who believed the experimental vaccine caused the trial participant to become HIV-positive or more susceptible to the virus. Twenty-nine volunteers reported negative social events related to HIV antibodies, although the researchers attributed the events to vaccine-induced antibody results.
Fuchs said that health care providers should ask whether patients "have participated in an HIV vaccine trial before they perform HIV testing, to avoid potential misinterpretation of antibody results and possible social harm." In an effort to minimize negative social effects, the researchers recommended that trial sites "continue their educational efforts with both study participants and with local communities" and emphasize that people cannot contract HIV "from the vaccine itself and that these trials seek HIV-negative individuals" (Boggs, Reuters Health, 11/29).
An abstract of the study is available online.
Opinion
Editorials, Opinion Pieces Respond to World AIDS Day
[Dec 03, 2007]
Several newspapers have published editorials and opinion pieces in response to World AIDS Day. Summaries appear below. Editorials
- Chicago Tribune: Although "significant sums are needed to arrest the AIDS epidemic," the revised global estimates recently released by UNAIDS and the World Health Organization suggest that "AIDS funding can be better focused that it has been," a Tribune editorial says. The United Nations has "harmed the cause of AIDS prevention by not acknowledging sooner that it had inflated the number" of people living with HIV/AIDS worldwide, the editorial says, concluding, "But AIDS has hardly disappeared: 33.2 million people still takes your breath away" (Chicago Tribune, 12/1).
- Honolulu Advertiser: The world should "put the numbers aside and think instead about the faces -- the mothers, the fathers, the brothers, the sisters and the children -- who are fighting AIDS," an Advertiser editorial says, adding that for "them and for the 2.5 million people expected to be infected each year, it's time to renew the passion and resources in the fight against AIDS" (Honolulu Advertiser, 12/1).
- Houston Chronicle: Because of recent setbacks in HIV vaccine research, other "sound strategies must continue to be the centerpiece of efforts to prevent the spread of HIV/AIDS," a Chronicle editorial says. Such strategies include education programs that teach safer sex methods, condom distribution, drugs to prevent mother-to-child HIV transmission and male circumcision, according to the editorial (Houston Chronicle, 11/30).
- Newark Star-Ledger: There are "many new challenges ahead" in the fight against HIV/AIDS, a Star-Ledger editorial says. These challenges include the extended survival of HIV-positive people because of antiretrovirals, which will "test the medical care system and current funding strategies," the editorial says, adding that the "perception that AIDS is not a death threat will test prevention efforts" (Newark Star-Ledger, 12/1).
- News-Press: The global community should "fight the notion that because treatment now allows people to live with HIV and AIDS," the disease is "not a serious illness," a News-Press editorial says. HIV testing efforts also should be expanded, the editorial says, adding that the "campaign to fight HIV/AIDS needs to be re-energized, not neglected" (New-Press, 12/1).
- Tulsa World: HIV/AIDS "may never be completely defeated, but it can be battled to a standstill," a World editorial says. "It is of crucial importance, for both humanitarian and practical reasons, to keep up the good fight," the editorial concludes (Tulsa World, 12/1).
- Washington Post: The HIV/AIDS pandemic has "required an unprecedented response," a Post editorial says, adding that governments, "private organizations and millions of individuals have had to tackle a chronic disease that is incurable but that can be treated through a relatively complex set of medical interventions." Funding for HIV/AIDS "must, of course, take its place among many needs in the American foreign aid budget," the editorial says, concluding, "But this is no time for complacency or 'donor fatigue.' HIV/AIDS is still a medical Mount Everest; perhaps, though, the peak is at last in sight" (Washington Post, 12/1).
Opinion Pieces
- Sandra Thurman, Atlanta Journal-Constitution: Needle-exchange programs effectively prevent the spread of HIV among injection drug users, Thurman, president of the International AIDS Trust, writes in a Journal-Constitution opinion piece. However, a lack of federal funding for needle-exchange programs, as well as local support to implement them when possible, are contributing to the spread of HIV among "thousands" of IDUs, "their sexual partners and their children," she adds (Thurman, Atlanta Journal-Constitution, 12/3).
- Sen. John Kerry, Boston Herald: World AIDS Day is an opportunity to "stand up against all that still holds us back from fulfilling our moral responsibility" in the fight against HIV/AIDS, Sen. Kerry (D-Mass.) writes in a Herald opinion piece. He writes that fighting HIV/AIDS should be a "first-tier priority" of U.S. foreign policy and an "ultimate measurement of our values" (Kerry, Boston Herald, 12/1).
- Elizabeth Pisani, London's Guardian: Despite the recent reduction in global HIV/AIDS estimates from UNAIDS and WHO, the "bad news is that in many parts of the world we are still doing all the wrong things," Pisani, an epidemiologist who works on HIV/AIDS in developing countries, writes in a Guardian opinion piece. Although education, earning opportunities and increased equality within couples "are wonderful goals," the world "can't wait for equality to prevent HIV," Pisani writes (Pisani, Guardian, 12/1).
- Susan Blumenthal and Melissa Shive, Newsweek: It is "troubling" that few U.S. presidential candidates have released "proposals for how they would lead in the fight against the HIV/AIDS epidemic in the U.S. and globally," Blumenthal -- a health and medicine adviser at the Center for the Study of the Presidency -- and Shive, a Fulbright scholar, write in a Newsweek opinion piece. They add that presidential candidates should release "details of their plans for eradicating this disease" and that the next president must "move quickly to strengthen efforts of" the Office of National AIDS Policy, "appoint a director and expand its activities" (Blumenthal/Shive, Newsweek, 11/29).
- Pamela Barnes, Ocean County Observer: If antiretroviral drugs do not reach people living with HIV/AIDS, "lives are lost prematurely and needlessly," Barnes, president and CEO of the Elizabeth Glaser Pediatric AIDS Foundation, writes in an Observer opinion piece. She adds that mother-to-child HIV transmission can be curbed when the "infrastructure necessary to deliver life-saving care to everyone who needs it" is built (Barnes, Ocean County Observer, 12/1).
- Laura Bush, Washington Post: World AIDS Day is a "reminder to all Americans that the AIDS epidemic" in the U.S. and abroad "is far from over," U.S. first lady Bush writes in a Post opinion piece. "Practice safe sex," Bush writes, adding, "Let's take a cue from our African counterparts and follow the ABC method of prevention: Abstinence, Be Faithful, and the Correct and Consistent Use of Condoms. That means not just occasionally, but every time" (Bush, Washington Post, 12/1).
Recent Releases
Statehealthfacts.org Adds Updated Data About Needle-Exchange Programs
[Dec 03, 2007]
Statehealthfacts.org: The Web site recently added 2005 information from CDC about needle-exchange programs for all states and nationwide (Kaiser Family Foundation release, 11/29).
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