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Kaiser Daily HIV/AIDS Report


Wednesday, September 17, 2008

Politics and Policy

   CDC Needs Additional $4.8B To Reduce Annual Number of New Infections, Officials Say

Drug Access

   Citing Safety Concerns, FDA Bans Imports of Ranbaxy Drugs Made In Two Indian Plants, Including Antiretrovirals

Media & Society

   Survey Shows 'Grey's Anatomy' Viewers Gained HIV Knowledge

Public Health & Education

   U.S. News & World Report Examines HIV/AIDS Rate Among Black Women

Global Challenges

   Inaugural Meeting of African HIV/AIDS Campaign Examines Components of Successful Fight Against Disease

   Female Condoms Promoted Through Beauty Salon Initiative in Malawi

   Tanzanian President Kikwete Calls for Increased Efforts To Fight HIV/AIDS

Recent Releases in HIV/AIDS

   Article Examines Infectiousness of TB Patients Living With HIV




Politics and Policy
 

    CDC Needs Additional $4.8B To Reduce Annual Number of New Infections, Officials Say
    [Sep 17, 2008]

      CDC officials on Tuesday at a House Government Reform and Oversight Committee hearing said they would need an additional $4.8 billion dollars over the next five years to reduce the annual number of new HIV infections in the U.S., CQ HealthBeat reports (Stanchak, CQ HealthBeat, 9/16).

According to the Los Angeles Times, the hearing came after CDC released a study last month that found that about 56,300 new HIV infections occur annually in the U.S. (Dizikes, Los Angeles Times, 9/17).

CDC Director Julie Gerberding based on the new estimates the agency would need an additional $877 million in 2009 to reduce the number of new HIV infections. According to the Times, the fiscal year 2009 budget request for HIV prevention funding is $892 million, which includes $752.6 million requested by CDC. Waxman said that he would try to work with the House Appropriations Committee to increase funding for domestic HIV prevention efforts but added that he is "not very optimistic" the Bush administration will increase funding (Los Angeles Times, 9/17).

Gerberding; Kevin Fenton, director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; and Anthony Fauci, director of the National Institute for Allergy and Infectious Disease, told the committee that although the additional amount of money requested is high, it could reduce the HIV transmission rate by 50% over 12 years. In addition, the increased funding could help reduce the number of HIV-positive people who are unaware of their status by 50% and help reduce racial disparities.

Gerberding said that the agency would use the increased funding to expand HIV testing, research new prevention techniques and evaluate prevention programs. Fauci added that increased funding also would allow research into new areas of HIV prevention research, such as preventing coinfection with other sexually transmitted infections, providing antiretroviral drugs to HIV-negative people as a preventive measure, testing microbicides and vaccine development.

Although the $4.8 billion request is a significant amount of money, it would be more expensive not to treat HIV, Fauci said. A "professional judgment budget" (.pdf) released by the panelists noted that each HIV infection costs more than $1 million in treatment and lost productivity and that if CDC can prevent 4,800 new infections over five years, the programs established with increased funding would be "cost saving to society."

Gerberding said the request is "not just about funding, it's about needing new tools," adding, "AIDS is a social disease as well as a viral disease ... if we don't address the underpinning issues, we'll never get to where we need to be" (CQ HealthBeat, 9/16). She said that the U.S. "need[s] to do so much more than we're doing right now" to prevent new HIV infections, adding that public health workers "need to get AIDS back on the radar screen" because HIV/AIDS "is still posing a threat to college students and to young men and women across our nation's fabric."

Panelists also called for additional HIV prevention and education programs that target blacks, Hispanics and men who have sex with men. George Ayala of AIDS Project Los Angeles told committee members that only four of CDC's 49 recommended intervention programs specifically target MSM and only one targets minority MSM. He said, "Serious HIV-related health disparities, often fueled by stigma and discrimination, continue to undermine HIV prevention efforts in communities of color" (Los Angeles Times, 9/17).

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Drug Access
 

    Citing Safety Concerns, FDA Bans Imports of Ranbaxy Drugs Made In Two Indian Plants, Including Antiretrovirals
    [Sep 17, 2008]

      FDA on Tuesday announced that it has banned imports of more than 30 generic drugs, including antiretrovirals, manufactured by Indian generic drugmaker Ranbaxy, citing manufacturing deficiencies at two of the company's plants, the Wall Street Journal reports. Ranbaxy manufactures generic antiretrovirals used in U.S. and in the President's Emergency Plan for AIDS Relief, as well as other generic drugs (Mundy et al., Wall Street Journal, 9/17). According to Deborah Autor, director of FDA's compliance office, FDA inspections this year found violations at Ranbaxy factories that could lead to contamination, allergic reactions and other problems, and the company has not taken proper steps to correct them (Neergaard, AP/Google.com, 9/16).

Although the ban allows U.S. Customs inspectors to stop incoming shipments of drugs from the Ranbaxy plants in Dewas and Paonta Sahib, India, FDA officials in a statement said that Ranbaxy drugs currently in the U.S. are considered safe and will not be removed from the market because there is no direct evidence that they are harmful (Satyanarayana, Detroit Free Press, 9/16). In addition, the ban will not affect drugs made at other Ranbaxy facilities around the world or in the U.S. (Cohen, Newark Star-Ledger, 9/17). Despite the ban, FDA said it will continue to permit Ranbaxy to export the drug Ganciclovir in order to avoid a shortage (Wall Street Journal, 9/17). Ranbaxy is the only manufacturer of Ganciclovir, which is used to treat an eye infection common among HIV-positive people.

FDA told consumers of all Ranbaxy drugs to continue to use the drugs because repeated testing has found no contaminated products, just the threat of them if factory conditions do not improve (AP/Google.com, 9/17). Douglas Throckmortan, a physician with FDA's Center for Drug Evaluation and Research, said that there was "no evidence of harm to consumers" and that the import ban is "a preventive action" (Brown, Washington Post, 9/17). The agency added that it will deny new approval requests for all new Ranbaxy drugs and expects other generic manufacturers to meet any supply shortages (Detroit Free Press, 9/16). In addition, Ranbaxy will not be able to export any of the banned drugs into the U.S. until the manufacturing deficiencies are resolved (Washington Post, 9/17).

Effect on PEPFAR
A spokesperson for PEPFAR said that it is "currently working through the PEPFAR interagency process and with our technical teams to evaluate the impact of today's FDA announcement on PEPFAR drug procurement and programming." The antiretroviral AZT, however, was on the list of Ranbaxy drugs banned from importation (Washington Post, 9/17).

Ranbaxy already is under investigation by the Justice Department over whether it manufactured substandard generic drugs. Ranbaxy under a U.S. government contract was paid to provide low-cost antiretroviral drugs under PEPFAR, and investigators at the Justice Department and FDA have said that some of the drugs were substandard, impotent or unstable. In addition, court filings and lawyers close to the investigation indicate that Ranbaxy manufactured documents to cover up the poorly made drugs (Kaiser Daily HIV/AIDS Report, 8/18).

Reaction
Janet Woodcock, director of FDA's Center for Drug Evaluation and Research, said, "With this action, we are sending a clear signal that drug products intended for use by American consumers must meet our standards of safety and quality." Rep. John Dingell (D-Mich.), chair of the House Energy and Commerce Committee, said Tuesday that FDA's action was too little, too late, adding that the agency has had credible information for three years that Ranbaxy had "engaged in a pattern of fraudulent behavior regarding its generic drug applications and records pertaining to good manufacturing practices." The Energy and Commerce committee is conducting an investigation of FDA's handling of Ranbaxy. Dingell in a statement said, "Apparently, this FDA places administrative convenience over its mission to protect the public health" (Newark Star-Ledger, 9/17).

The Journal reports that a Ranbaxy executive in India said the company was not aware of any FDA action, and officials in the U.S. did not return calls. FDA officials said it had notified Ranbaxy of the import ban (Wall Street Journal, 9/17).

Online FDA's letter to Ranbaxy, a news release, a list of drugs produced by the company and other information are available online.

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Media & Society
 

    Survey Shows 'Grey's Anatomy' Viewers Gained HIV Knowledge
    [Sep 17, 2008]

      Many viewers of an episode of ABC's prime-time medical drama "Grey's Anatomy" that included a story about mother-to-child HIV transmission gained awareness of the issue, according to a survey released on Tuesday by the Kaiser Family Foundation, USA Today reports.

For the study, the Foundation worked with writers of the show to embed in the episode the story of an HIV-positive pregnant woman. According to USA Today, the woman is "distraught" before being told by her physician that with proper treatment, her child has a 98% chance of being born HIV-negative. The Foundation conducted three national random surveys of regular viewers of the show one week before, one week after and six weeks after the episode. The surveys combined had 1,505 respondents.

Victoria Rideout, vice president and director of the Foundation's program for the Study of Media and Health, said the goal of the survey was to measure the "impact of the message about mother-to-child HIV transmission" (Marcus, USA Today, 9/17). One week before the show, 15% of the viewers surveyed said that they were aware of the mother-to-child HIV transmission risk. One week after the show, 61% of viewers of the episode were aware of the risk. Six weeks after the show, 45% of viewers remembered the information correctly (Childs, ABC News, 9/17). According to the survey, the increase from 15% to 61% awareness of the risk of mother-to-child HIV transmission translates to more than eight million people learning correct information on the issue from watching the episode. The survey also found that the percentage of viewers who said it was "irresponsible for a woman who knows she is HIV-positive to have a baby" dropped from 61% to 34% after the episode aired, and then increased to 47% six weeks after the show (Kaiser Family Foundation release, 9/16). Rideout said she was "astounded" by the number of viewers who "picked up on factual health info about HIV embedded in the show, and that they remembered it weeks later."

The Foundation and the University of Southern California's Annenberg Norman Lear Center also released a second study of top-10 prime time television shows, finding that six out of 10 episodes from 2004 to 2006 included at least one health-related storyline. "People are very hungry for information about health," Linda Rosenstock, dean of the University of California-Los Angeles School of Public Health, said, adding that entertainment media do "societal good" by putting accurate health information into shows. Jay Bernhardt of CDC said that embedding information accurately into TV content could "help change behaviors about health" (USA Today, 9/17).

Online The studies, and a Kaisernetwork.org webcast of a briefing discussing them, are available online.

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Public Health & Education
 

    U.S. News & World Report Examines HIV/AIDS Rate Among Black Women
    [Sep 17, 2008]

     
U.S. News & World Report recently looked at how "black women continue to be struck particularly hard" by HIV/AIDS (Payne, U.S. News & World Report, 9/12). According to the latest available figures reported by CDC, blacks in 2006 had the highest HIV/AIDS incidence rate of any racial and ethnic group in the U.S. The research was a follow-up to a CDC study released last month that found there were about 56,300 new HIV infections in 2006, the most recent year for which data are available.

Among women, 61% of new infections occurred among blacks, 23% among whites and 16% among Hispanics. The rate of new infections among black women is almost 15 times higher than among white women; the rate among Hispanic women is nearly four times higher than white women, the study said (Kaiser Daily HIV/AIDS Report, 9/12).

In 2005, black women accounted for 64% of the more than 126,000 women living with the virus. The disease has been among the top three causes of death for black women ages 25 to 34 in the last few years, according to U.S. News.

Eighty percent of new HIV infections in women in 2006 stemmed from heterosexual sex with a high-risk partner, CDC data indicate. C. Virginia Fields, president and CEO of the National Black Leadership Commission on AIDS, said that "because of how this (disease) is spreading through heterosexual black women," it makes sense to discuss the connection to men who secretly have sex with other men, as well as to the number of black men who return from prison and are not tested for sexually transmitted infections before having sex with their girlfriends or wives. According to the CDC report, male-to-male sexual contact accounted for 63% of new HIV infections among black men. In addition, CDC estimates that HIV prevalence among those who are incarcerated is about five times higher than that of the general population, U.S. News reports.

Raymond Martins, medical director of the Whitman-Walker Clinic, said women should feel "empowered to make sure that their partner uses a condom. Especially in the black community, that doesn't seem to always be the case" (U.S. News & World Report, 9/12).

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Global Challenges
 

    Inaugural Meeting of African HIV/AIDS Campaign Examines Components of Successful Fight Against Disease
    [Sep 17, 2008]

      The most crucial elements in the fight against HIV/AIDS are the building of institutions, structures and leadership, Christopher Molomo, national coordinator of Botswana's National AIDS Coordinating Agency, said at this week's inaugural meeting of the Champions for an AIDS-Free Generation, Mmegi/AllAfrica.com reports (Ookeditse, Mmegi/AllAfrica.com, 9/15).

Champions for an AIDS-Free Generation was launched last month at the XVII International AIDS Conference in Mexico City by former leaders of Botswana, Mozambique, Tanzania and Zambia, as well as other well-known African figures. The initiative aims to put pressure on politicians whom participants believe have not done enough to fight HIV/AIDS. The initiative calls for more government actions and public education campaigns to prevent new HIV cases in countries where up to one in four people are living with HIV/AIDS (Kaiser Daily HIV/AIDS Report, 8/6).

At the inaugural meeting, Molomo said that Botswana has adopted the principles of the "three ones" in coordinating HIV/AIDS efforts. "We follow the 'three ones' principle, which is having one agreed HIV/AIDS action framework, one national AIDS authority and one agreed country level monitoring and evaluation system," Molomo said, adding that this helps coordinate responses and monitor and evaluate efforts aimed at curbing HIV/AIDS. He also said that although the National AIDS Council is in charge of monitoring the national response to HIV/AIDS, it is important to have decentralized structures fighting HIV/AIDS in district councils as well as village-level committees.

In addition, Molomo said one of the most critical institutional players in the fight against HIV/AIDS is a country's parliament. "Parliament is important at the central level," Molomo said, adding that Botswana's Parliamentary Subcommittee on AIDS ensures that HIV/AIDS issues are brought to the attention of parliament and receive advocacy. Momolo also said that leadership is an important part of HIV/AIDS efforts because lack of a willing leadership will prevent progress in the fight against the disease. "Leadership is supposed to give accountability and direction," he said (Mmegi/AllAfrica.com, 9/15).

In related news, former Zambian president Kenneth Kaunda last week at a workshop held ahead of the inaugural meeting praised former Botswana President and Chair of the Champions for an AIDS-Free Generation Festus Mogae for his work to bring African leaders together to fight HIV/AIDS, Mmegi/AllAfrica.com reports. "The deliberations were not easy," Kaunda said, adding,"[B]ut the champions rose to the challenge." Kaunda added, "Champions do what is right even when it hurts. Champions know winning is not necessarily measured by the final score. They take a stand even if they stand alone. Champions may fail, but they never quit" (Keoreng, Mmegi/AllAfrica.com, 9/16).

Editorial
Mogae "might be out of office, but he is continuing his legacy in the fight against HIV/AIDS," a Mmegi/AllAfrica.com editorial says. According to the editorial, the meeting last week was a "good initiative by Mogae and all those who are with him in the group."

During his time as president, Mogae sought to fight HIV/AIDS "at a time when many leaders were still shy to speak openly" about the disease, the editorial says, adding that Botswana consequently "stood out as an example of how a country which is badly affected by the epidemic can stem the tide. Botswana is now counted among the countries which are winning the fight against HIV/AIDS. The current initiative of Mogae and his group will go a long way in helping to address the HIV/AIDS problem in Africa and the world" (Mmegi/AllAfrica.com, 9/16).

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    Female Condoms Promoted Through Beauty Salon Initiative in Malawi
    [Sep 17, 2008]

      The United Nations Population Fund and Population Services International have introduced a program to distribute female condoms in Malawian beauty salons in an effort to encourage their use and curb the spread of HIV, VOA News reports. Pamela Msukwa, family planning and HIV technical coordinator for PSI/Malawi, said hair salons were chosen for the program because they "provide a very viable and highly targeted market" due to their popularity with women in Malawi. She added, "That's where they get to talk about issues, and there is always somebody they can discuss issues with." A team of women associated with the organization promote and distribute the condoms, and salon staff members are trained on how to talk about the products with their customers.

Although condom use and other methods of preventing pregnancy and the spread of sexually transmitted infections have been considered the "domain of males," the beauty salon initiative is attempting to change the situation, VOA News reports. A pilot project eight years ago to encourage female condom use failed in part because of a lack of information about the condoms and stigma associated with their use, according to VOA News. Msukwa said the "main goal" of the program is to reduce the rate of new HIV cases and unplanned pregnancies and "increase the adoption of safer-sex behavior through increased and consistent use of the female condom." She added that the successes of the program so far have lead PSI/Malawi to begin to consider ways of targeting men through barber shops. According to VOA News, fifteen PSI country programs distribute female condoms worldwide and more than seven million have been sold to date (Masina, VOA News, 9/15).

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    Tanzanian President Kikwete Calls for Increased Efforts To Fight HIV/AIDS
    [Sep 17, 2008]

      Tanzanian President Jakaya Kikwete on Saturday said that increased efforts to fight HIV/AIDS in the country need to be taken, the Citizen/AllAfrica.com reports. Speaking to residents of Kibaya in Tanzania's Manyara Region, Kikwete said that HIV/AIDS continues to threaten the country's development, despite efforts by the government and development partners to curb the spread of the disease. He also emphasized the need to address HIV/AIDS cases in rural areas. According to Kikwete, although it appeared in the past that most HIV-positive people were living in urban areas, rural areas now are seeing equal effects of HIV. He also asked residents to avoid unsafe sex practices, which he said are contributing to the growing number of HIV cases in the country.

The speech was part of Kitwete's first six-day visit to the Manyara region since he became president about three years ago. He also will travel to Hanang and Mbulu districts (Citizen/AllAfrica.com, 9/15).

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Recent Releases in HIV/AIDS
 

    Article Examines Infectiousness of TB Patients Living With HIV
    [Sep 17, 2008]

      "The Infectiousness of Tuberculosis Patients Coinfected With HIV," PLoS Medicine: Roderick Escombe of Imperial College London and colleagues conducted the study to examine infectiousness and airborne transmission of TB by exposing guinea pigs to air from the HIV/TB ward of a hospital in Peru. Over the 505-day study period, there were 118 ward admissions of 97 HIV-positive people with pulmonary TB. The researchers conducted monthly tuberculin skin tests, organ cultures and autopsies to detect TB among the guinea pigs. They also used DNA fingerprinting of human and animal TB strains to determine the sources of transmission. According to the study, 8.5% of the 118 ward admissions caused 98% of the 125 secondary animal TB cases. In addition, 90% of TB transmissions occurred from inadequately treated multi-drug resistant TB. The study's findings emphasize the importance of prompt TB drug susceptibility testing to ensure effective treatment and reduce the incidence of MDR-TB, the authors write (Escombe et al., PLoS Medicine, 9/16).

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