KAISER DAILY HIV/AIDS REPORT
A service of kaisernetwork.org
http://www.kaisernetwork.org/dailyreports/hiv
________________________________________



Tuesday, March 4, 2003

POLITICS AND POLICY
========================================
1. USAID To Review Population Services International Contracts After Realizing
Board Member Operates Sexual Products Company

2. Baltimore City Council To Consider Establishing AIDS Commission To
Coordinate Prevention Efforts

3. South Dakota Senate Committee Approves Bill Allowing Health Department To
Release Confidential HIV Records


GLOBAL CHALLENGES
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4. High HIV Rates Among Sub-Saharan African Militaries Could Become Security
Threat


SCIENCE & MEDICINE
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5. Scientists Considering Risks of Using Hepatitis C-Related Virus To Treat HIV


OPINION
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6. Opinion Pieces Criticize Media Coverage of VaxGen AIDS Vaccine Trial Results

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POLITICS AND POLICY

1. USAID To Review Population Services International Contracts After Realizing
Board Member Operates Sexual Products Company

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http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16359

A spokesperson for the U.S. Agency for International Development has said that
the agency "was not aware" that the founder of Population Services
International, a not-for-profit organization that manages sexually transmitted
disease prevention and international family planning programs, also founded and
operates a sexual products mail-order distribution company Adam and Eve and that
USAID Administrator Andrew Natsios has "ordered an immediate review of the PSI
contract," the Washington Times reports. USAID has awarded $170 million in
contracts to PSI to manage health programs. Philip Harvey, who currently sits
on PSI's board of directors, originally founded the Adam and Eve company in 1974
as the country's first mail-order condom distributor, but he has since expanded
its products to include X-rated videos, lingerie and sex toys. Although Harvey
founded PSI in 1971 and served as its chief executive until 1978, he currently
has no management responsibilities, according to current PSI President Richard
Frank. Harvey said, "I don't see any conceivable conflict in being a
businessman with serving nonprofit organizations. Indeed, the confluence of
interests seems to have worked well over the last thirty years." Frank added
that PSI has "nothing to do with what [Harvey] does in his private life ... and
his private life ... has zero to do with [PSI]." Harvey also is a founder and
board member of DKT International, a social marketing organization that manages
programs in nine countries, mainly involving condom distribution (Seper/Taylor,
Washington Times, 3/3).

2. Baltimore City Council To Consider Establishing AIDS Commission To
Coordinate Prevention Efforts

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http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16360

The Baltimore City Council's Judiciary and Legislative Investigations
Committee tomorrow is scheduled to consider whether to create a commission to
coordinate city-wide HIV/AIDS prevention efforts, the Baltimore Sun reports.
City Council President Sheila Dixon, who two years ago formed an AIDS advisory
group that last year recommended that AIDS be declared a public health
emergency, is sponsoring the bill to establish the commission. The hearing is
scheduled for 5 p.m. on Wednesday at City Hall (Baltimore Sun, 3/3).

3. South Dakota Senate Committee Approves Bill Allowing Health Department To
Release Confidential HIV Records

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http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16361

The South Dakota Senate Judiciary Committee on Friday voted 5-2 to approve a
bill (HB 1019) that would allow the state Department of Health to release
otherwise confidential HIV records to prosecutors if ordered to do so by a
judge, the Associated Press reports. The bill would also allow health officials
to contact the attorney general if they believed an HIV-positive individual was
intentionally exposing others to the virus without informing them (Associated
Press, 2/28). Under current state law, doctors must report all cases of
contagious diseases to the health department, but it is not permitted to make
public the identities of those people (Kaiser Daily HIV/AIDS Report, 2/26).
Sen. Gene Abdallah (R) said that the bill is necessary and is being supported by
several health and legal organizations, according to the Associated Press.
"It's got to be here for the protection of the public and for the people of the
state," Abdallah said. However, Sen. Gil Koetzle (D) said that he believed that
part of the bill "circumvents judicial processes," the Associated Press reports.
The bill now moves to the full Senate for consideration (Associated Press,
2/28).


GLOBAL CHALLENGES

4. High HIV Rates Among Sub-Saharan African Militaries Could Become Security
Threat

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http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16362

Approximately 10% to 60% of military personnel in sub-Saharan Africa are
HIV-positive, which could become a security threat to developing countries,
according to an article in the March/April issue of the Worldwatch Institute's
World Watch magazine, the Washington Post reports. Countries such as South
Africa, Angola and the Democratic Republic of the Congo, where more than 40% of
the military is HIV-positive, are facing a "significantly higher" incidence of
HIV/AIDS among military personnel than among the general public (Morin/Deane,
Washington Post, 3/4). In addition, 15% of United Nations peacekeeping soldiers
returning after three-year tours of duty are HIV-positive, compared with 7%
returning following a one-year shift. The increases could be due in part to the
higher incidence of rape during wartime and an "explosion of commercial sex
work" in proximity to peacekeeping installations. According to the article,
responses to the epidemic from the United Nations and national militaries "vary
widely" (Worldwatch Institute release, 2/27). For example, Nigerian officials
have made HIV prevention education a "major part" of military training, and they
also distribute condoms and offer treatment to soldiers, the Post reports.
Similar efforts have proven successful in other countries, such as Uganda, where
HIV infection rates among military personnel have dropped from more than 10% in
1990 to less than 7% today (Washington Post, 3/4). Radhika Sarin, the author of
the article, said that "[s]enior military officials and national defense
ministers are finally beginning to recognize this emerging threat, but there are
considerable differences in how militaries are approaching such issues as HIV
testing among soldiers." The magazine also includes an interview with Sandra
Thurman, former head of the White House Office of National AIDS Policy
(Worldwatch Institute release, 2/27).

Ethiopian Military


The United States and Ethiopia on Saturday signed a "tripartite" five-year
agreement to provide HIV/AIDS assistance for the Ethiopian military, the
Ethiopian News Agency reports. The CDC will provide approximately $330,000
annually for HIV/AIDS and other disease prevention programs -- including
voluntary counseling and testing in military hospitals in Harer and Mekele --
for military personnel, their families and other civilians. The agreement also
calls for a "behavioral change communication strategy" to fight the spread of
the disease along the country's border with Djbouti, the Ethiopian News Agency
reports. The agreement was signed by U.S. Ambassador to Ethiopia Aurelia
Brazeal, CDC Country Director Dr. Tadese Wuhib and Head of Administration and
Finance of the Ethiopian Ministry of Defense Major General Haile Tilahun
(Ethiopian News Agency, 3/4).


SCIENCE & MEDICINE

5. Scientists Considering Risks of Using Hepatitis C-Related Virus To Treat HIV

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http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16363

The "harmless and fairly common" virus GBV-C, which is closely related to
hepatitis C, could help prevent HIV-positive individuals from developing AIDS by
stopping HIV from entering cells, but scientists are concerned that injecting
HIV patients with GBV-C could result in less protection against HIV if an
individual's immune system clears the virus, the Milwaukee Journal Sentinel
reports. Carolyn Williams, an epidemiologist at the National Institute of
Allergy and Infectious Diseases, and Jack Stapleton, director of the AIDS
program at the University of Iowa, examined the effects of GBV-C in 271 gay men
who participated in the Multicenter AIDS Cohort Study, which has periodically
tested and examined HIV-positive gay men over the past 20 years (Marchione,
Milwaukee Journal Sentinel, 3/2). All participants had recently been infected
with HIV, and 40% had GBV-C present in their samples, while 50% had antibodies
for GBV-C, meaning that they had once been infected but had cleared the
infection. Researchers found that 79% of the men carrying GBV-C were still
alive after 10 years, compared with 36% of the men who tested negative for
GBV-C, and only 16% of men who had cleared the virus survived at least 10 years.
So far, eight clinical studies have found a "beneficial association" between
GBV-C and HIV (Kaiser Daily HIV/AIDS Report, 2/14). "This is the strongest
analysis to date supporting the protecting role" of GBV-C in delaying HIV
disease progression, the researchers said. According to Stapleton, GBV-C
increases the production of chemokines, chemicals that occupy the same docking
sites on blood cells that HIV uses to enter cells. In addition, GBV-C decreases
the amount of CCR5, another receptor on the surface of blood cells, decreasing
the opportunity for HIV to locate an opening. "[T]here is not a way for HIV to
get in the cells -- the doors are gone," Williams said.

Weighing Risks, Benefits


Despite the evidence that GBV-C has a protective value against HIV, scientists
are hesitant to inject patients with the virus because of the negative effects
that could result if the virus is cleared. "It makes me nervous to infect
someone with something that may give them a benefit" but that could be harmful
if they clear the virus, Williams said, adding, "A lot more work will be done"
on GBV-C in the next few years. Stapleton said that it might be ethical to
treat HIV patients with GBV-C if all other treatment options have failed.
Richard Olds, chair of medicine at the Medical College of Wisconsin, said that
he did not know of another example of a virus being used as a treatment for a
completely unrelated virus. "There's no exact parallel. This is a unique thing
to try," he said, adding, "Obviously, we need to do the study" (Milwaukee
Journal Sentinel, 3/2).


OPINION

6. Opinion Pieces Criticize Media Coverage of VaxGen AIDS Vaccine Trial Results

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http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16364

Three newspapers over the last few days have published opinion pieces
criticizing the media's portrayal of VaxGen's AIDS vaccine clinical trial
results. VaxGen last week announced that its experimental AIDS vaccine AIDSVAX
reduced the rate of new HIV infections by only 3.8% among people who received
the vaccine, compared with clinical trial participants who received a placebo
injection. However, the company said that the vaccine was effective among
African Americans, Asians and other non-white, non-Hispanic volunteers (Kaiser
Daily Reproductive Health Report, 2/27). The opinion pieces are summarized
below:

* Cleveland Plain Dealer: "Anyone who scanned [the headlines about the vaccine
results] would have missed the real news. ... The vaccine did work. It just
didn't work on white people," columnist Sam Fulwood writes in a Plain Dealer
opinion piece. Fulwood says that "as with most medical studies," the AIDSVAX
study had too few black volunteers to yield conclusive results. The company
will have to conduct additional tests, for which "investors should be lining
up," Fulwood states. However, "NIH remains on the sidelines," and the negative
media coverage surrounding the vaccine may have "scare[d] away public support
for HIV/AIDS clinical testing and driv[en] off [the] venture capitalists who are
the ones putting up most of the money," Fulwood concludes (Fulwood, Cleveland
Plain Dealer, 3/1).

* San Francisco Chronicle: Last week's coverage of the VaxGen trials "exposed
weaknesses in the media's ability to explain complex science and statistics,"
Chronicle reporter Tom Abate writes. Abate calls his own article on the subject
"a failure to communicate" and goes on to clarify areas that he did not cover in
his article, including an explanation of how the company may verify the
vaccine's efficacy and why the vaccine may have different effects on different
racial groups. While Peggy Johnston, assistant director of vaccine research at
NIH, said that the study was "of the highest standards," Abate states that "the
same can't be said ... for how the media explained this data to a public that
included African Americans who have cause to be deeply suspicious of medical
research," considering the legacy of mistrust engendered by the unethical
Tuskegee syphilis experiments. Abate concludes, "This is only the first chapter
in the AIDS vaccine. As we write future installments, we'll have to do better"
(Abate, San Francisco Chronicle, 3/3).

* San Jose Mercury News: In a Mercury News opinion piece, columnist Loretta
Green writes that while the trial was a failure in the eyes of VaxGen because it
did not hit the 30% effectiveness mark needed to gain FDA approval, she was
"annoyed" by media claims that the vaccine was "useless" and an overall
"failure." She states, "Certainly" the fact that the vaccine proved helpful to
some minority groups makes it "worthy of scrutiny for future testing and
research." Green concludes that the trial results should "inspire a mandate
about broad representation in AIDS studies and drug trials," as well as a fairer
"presentation and perspective" of trial statistics in the media (Green, San Jose
Mercury News, 3/1).


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