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



Wednesday, March 5, 2003

POLITICS AND POLICY
========================================
1. USAID To Review Study Claims That Unsafe Medical Practices Is Main Cause of
HIV Transmission in Africa

2. Health Professionals Send Letter of Opposition To Bush Over Plans To Extend
'Mexico City' Policy To AIDS Funding

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

4. California County Supervisors Reject Plan to Keep Needle-Exchange Program
Operating

5. Orange County, Fla., Officials Deny Federal Funds for Not-For-Profit AIDS
Resource Alliance


GLOBAL CHALLENGES
========================================
6. War in Cote d'Ivoire Exacerbates Spread of HIV/AIDS

7. PRI's 'Marketplace' Reports on South African Businesses Benefiting From
AIDS-Related Deaths


SCIENCE & MEDICINE
========================================
8. Roche CEO Responds To Questions Regarding Pricing for Fuzeon


OPINION
========================================
9. Editorials, Opinion Pieces Discuss Bush AIDS Initiative, Application of
'Mexico City' Policy To Funding

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POLITICS AND POLICY

1. USAID To Review Study Claims That Unsafe Medical Practices Is Main Cause of
HIV Transmission in Africa

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http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16375

The U.S. Agency for International Development yesterday said that it plans
this week to begin a review of research published in the International Journal
of STD & AIDS that claims that unsafe medical practices, not heterosexual sex,
is the main cause of HIV transmission in Africa, the Washington Times reports
(Carter, Washington Times, 3/5). While most AIDS organizations contend that
heterosexual contact has accounted for 90% of HIV cases in Africa, the studies
state that only one-third of HIV cases have been transmitted in this manner,
while unsafe medical practices, such as injections and blood transfusions using
unsterile needles, have proved to be a much greater risk (Kaiser Daily HIV/AIDS
Report, 2/21). "It is possible that we have underestimated" the number of
people infected through unsafe medical practices, Dr. Anne Peterson, head of the
USAID bureau of global health, said, adding, "We plan to take a pretty hard look
at this." The World Health Organization and UNAIDS have scheduled a meeting in
Geneva for March 17 to discuss the research and its potential impact on HIV
prevention programs. Peterson said that USAID would send a representative to
the meeting. Peterson said that it was her "goal to designate AIDS prevention
funds to the areas that scientific data indicates would be the most effective,"
according to the Times. She added that the agency has "always been concerned
about needles as a route of transmission," citing the agency's research on
disposable and "autodestruct" needles (Washington Times, 3/5).

2. Health Professionals Send Letter of Opposition To Bush Over Plans To Extend
'Mexico City' Policy To AIDS Funding

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Health and human rights organization Physicians for Human Rights yesterday
sent a letter to President Bush asking him to abandon plans to make
organizations that wish to receive federal AIDS funding comply with the
so-called "Mexico City" policy, which prohibits federal aid from going to groups
that fund or promote abortion, according to a PHR release. PHR said that it has
learned that a White House Executive Order on the policy is expected to be
released "soon" (PHR release, 3/4). The policy -- which was originally
implemented by President Reagan at a population conference in Mexico City in
1984, removed by President Clinton and reinstated by President Bush on the first
day of his presidency -- "bars U.S. money from international groups that support
abortion, even with their own money, through direct services, counseling or
lobbying activities." Under the new policy, outlined by a senior Bush
administration official in a Feb. 11 memo to the State Department, social
services groups that deal with abortion services would have to "administer AIDS
programs separately from family planning" in order to receive funds from the
administration's new AIDS initiative (Kaiser Daily HIV/AIDS Report, 3/3).

Letter Content


"As health professionals with experience in prevention, care and treatment of
HIV/AIDS, we strongly advise against placing such a bureaucratic burden on
foreign nongovernmental organizations," the letter said, adding, "Requiring
groups that offer significant HIV/AIDS prevention services who may also be using
non-U.S. government funds to provide legal abortions or information about them,
to duplicate their staff, facilities or administration is a potentially wasteful
and burdensome requirement." The letter says that because health services are
often scarce and difficult for poor women to access, "people should be
encouraged to obtain prevention education and supplies wherever they are
available." Furthermore, because of the intense stigma associated with
HIV/AIDS, "prevention programs ... must be integrated into services that people
are accustomed to accessing, including family planning and maternal health
services." The letter concludes that the Mexico City policy "run[s] counter to
best practice in HIV/AIDS prevention and general public health" (Letter text,
3/4). The letter is signed by more than 15 leading health care professionals,
including Holly Atkinson, president of PHR; James Curran, dean of the Rollins
School of Public Health at Emory University; Allan Rosenfield, dean of the
Mailman School of Public Health at Columbia University; Linda Rosenstock, dean
of the University of California-Los Angeles School of Public Health; and Peter
Lamptey, senior vice president of Family Health International (PHR release,
3/4).

PRI's "The World" yesterday reported on the administration's intentions of
applying the Mexico City policy to international AIDS funding. The segment
includes comments from Julia Ernst of the Center for Reproductive Rights,
National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci
and Global AIDS Alliance Executive Director Paul Zeitz (McCleskey, "The World,"
PRI, 3/4). The full segment is available in RealPlayer online.

3. South Dakota Senate 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=16377

The South Dakota Senate yesterday approved 32-2 a bill (HB 1019) that would
allow the state Department of Health to release otherwise confidential HIV
records to prosecutors who are investigating people for intentionally exposing
others to HIV if ordered to do so by a judge, the Associated Press reports
(Associated Press, 3/4). 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. 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, 3/4). "This is really a public health
issue, allowing the secretary of health to work with the attorney general and
law enforcement in certain emergency circumstances when people are being put at
grave peril through the risk of HIV," Sen. David Knudson (R) said. Under South
Dakota law, exposing someone to HIV is punishable by up to 15 years in prison.
The bill, which the House has already passed, now moves to the governor for
consideration (Associated Press, 3/4).

4. California County Supervisors Reject Plan to Keep Needle-Exchange Program
Operating

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http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16378

Contra Costa County, Calif., supervisors on Monday rejected a plan that could
have saved the county's needle-exchange program by cutting services and dropping
the private agency that administers the program, the Contra Costa Times reports
(Felsenfeld, Contra Costa Times, 3/4). The program was established four years
ago and provides more than 35,000 clean needles to an estimated 700 injection
drug users in the area each year. Community Health Empowerment/Exchange Works
currently administers the program with $262,000 in funding from grants and
foundations, and the county health department contributes $25,000 for syringes.
Last month, Christine Leivermann, director of the county's AIDS program, said
that the county Health Services Department had already spent this year's
allotted funds, and that it did not have the available funds to save the program
(Kaiser Daily HIV/AIDS Report, 2/13). The program would need $186,240 from the
county's general fund to continue operating at current service levels, but
Public Health Director Wendel Brunner said that the funds would have to come
from another "deserving program" due to the county's budget woes. "It's simply
a matter of priorities, and to give that kind of money would mean laying off
staff somewhere else," Brunner said.

Proposal Details


Brunner proposed eliminating the program's services in East County and offering
a "scaled-back version" of the program in West County through Contra Costa's
Health on Wheels van. Under the plan, the health department would increase its
funding to $40,000. However, Supervisor Federal Glover said that many injection
drug users in his district would not be able to travel to use the program in
West County. "It is absolutely not an option to shut East County down," he
said, adding, "We need to look for some more creative solutions." In addition,
Bobby Bowens, executive director of Community Health Empowerment/Exchange Works,
said that the health department would not be successful in taking over the
program because clients have "developed trust" with existing program staff that
would be difficult to duplicate, according to the Times. "The Health Department
in no shape, fashion or form can do what we do. People just won't show up, and
that means the spread of HIV and hepatitis in our communities," Bowens said.
Supervisors asked Brunner to present to the full board alternate funding
strategies in two weeks, the Times reports. In the meantime, the program
continues to operate with needles provided by the county as an "interim
measure," Bowens said (Contra Costa Times, 3/4).

5. Orange County, Fla., Officials Deny Federal Funds for Not-For-Profit AIDS
Resource Alliance

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http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16379

Orange County, Fla., officials on Monday rejected a "last-ditch" effort by
Orlando-based AIDS Resource Alliance to gain federal Ryan White CARE Act
funding, the Orlando Sentinel reports. The not-for-profit group, which offers
health care and counseling, as well as assistance with rent, utilities and
transportation, to HIV-positive patients, was appealing the county's February
decision to deny its grant request, but the county's three-member review panel
said that the group's "financial footing is too wobbly," according to the
Sentinel. The panel also said that it based its decision on recent leadership
changes and "financial clouds." The group has had four directors in the past
year, and Medicaid officials in 2002 told the group it had overbilled the
federal government by at least $400,000, the Sentinel reports. Although the
state attorney general's office said it would settle the issue for about
$63,000, Marc D'Aoust, executive director of AIDS Resource Alliance, said that
the group faced up to $1.4 million in fines. The group was seeking around
$300,000 in funds from the county, which will distribute a total of about $2.4
million in federal funds to other agencies that provide services for HIV/AIDS
patients. Without the funds, the group might have to lay off half of its 25
full-time employees, according to D'Aoust. He said, "I'm devastated. We've got
to make some drastic changes." Syd McCallister, a senior contract coordinator
on the panel, said, "I think they are dramatically short of being a financially
viable agency. I feel like, again, we are grasping at straws" (Damron, Orlando
Sentinel, 3/4). In March 2001, AIDS Resource Alliance also faced controversy
over grant applications. The group, one of the largest providers of AIDS
services in Orlando, was denied federal funds for turning in its application 59
seconds late. Several other agencies were also denied funding for submitting
late proposals (Kaiser Daily HIV/AIDS Report, 3/28/01).


GLOBAL CHALLENGES

6. War in Cote d'Ivoire Exacerbates Spread of HIV/AIDS

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http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16380

The war in Cote d'Ivoire has impeded efforts to curb the spread of HIV/AIDS in
the country and the city of Bouake and "threatens to encourage" the spread of
the disease, exacerbating the AIDS crisis in a "part of the worst-affected
continent that has so far gotten off fairly lightly," compared with Southern or
East Africa, Reuters reports. There have been reports of rapes by combatants on
both sides of the war in the western part of the country, and more than one
million people have been displaced from their homes, which could help spread the
disease outside of Cote d'Ivoire's borders to Ghana, Mali and Burkina Faso,
Reuters reports. Pierre Mpele, head of UNAIDS for West and Central Africa,
said, "Ivory Coast was already the country with the highest rate of infection in
this region. Crisis situations help to spread HIV/AIDS and if it continues any
longer then we fear that we will start to see an impact in the region because of
the movements of people." Mpele also said that the Cote d'Ivoire situation
makes "the young and women particularly vulnerable" to infection, adding, "The
health infrastructure is gone in some areas, there is violence, there is an
increased likelihood of rape and the behavior of young people has changed
because of the war and has put them at greater risk." Penda Toure, who runs an
HIV/AIDS program in Bouake, said, "There are no condoms in town even if people
want to use them and people cannot hold on forever. There is no money for
campaigns to persuade people of the dangers," adding, "We have the impression
here that we are not going back to zero [when the war is over], but well below
zero" (Tostevin, Reuters, 3/3).

7. PRI's 'Marketplace' Reports on South African Businesses Benefiting From
AIDS-Related Deaths

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http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16381

PRI's "Marketplace" yesterday began a two-part series on the "growing number
of people who are actually benefiting from the rising death toll" from
AIDS-related causes in South Africa. The first segment examines how businesses
in the funeral industry, such as crematoriums, funeral parlors, memorial parks,
coffin makers and grave diggers, are "getting rich as more people begin to die."
PRI reports that South Africa's death rate from AIDS-related causes -- which is
expected to climb by 20% each year and total six million deaths by the end of
the decade -- has made funeral homes a "guaranteed growth industry." In two
years, the number of undertakers in South Africa has almost tripled, from 1,500
to 4,000. The second segment in the series, which will air today, will examine
how the "overwhelming cost" of burying the dead is having a "sobering economic
impact" on families and communities (Costello, "Marketplace," PRI, 3/4). The
full segment is available in RealPlayer online. In addition, a slideshow of
images related to the story is available online.


SCIENCE & MEDICINE

8. Roche CEO Responds To Questions Regarding Pricing for Fuzeon

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http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16382

The Newark Star-Ledger today features an interview with Roche CEO Franz Humer
regarding the controversy surrounding the company's pricing of its
antiretroviral drug Fuzeon (Silverman, Newark Star-Ledger, 3/5). Last week,
Roche announced that the drug, which is designed for HIV patients who have
failed to respond to other medications, will cost $20,385 per year in Europe,
more than double the price of the most expensive AIDS treatments on the market.
Roche said that a complex manufacturing process, which requires 106 chemical
reactions, more than 10 times the number for most other antiretroviral drugs,
accounts for the "unusually high" cost of producing the drug. The company is
not expected to announce the U.S. market price until the drug receives FDA
approval, which is expected to come next month (Kaiser Daily HIV/AIDS Report,
2/24). The interview is available online.


OPINION

9. Editorials, Opinion Pieces Discuss Bush AIDS Initiative, Application of
'Mexico City' Policy To Funding

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16383

Several editorials and opinion pieces this week have discussed President
Bush's proposed AIDS initiative, including his decision to apply the "Mexico
City" policy to the funding. Bush in his State of the Union address on Jan. 28
proposed the plan, which includes $10 billion in new money for HIV/AIDS
prevention and treatment programs in Africa and the Caribbean (Kaiser Daily
HIV/AIDS Report, 2/26). In a memo to the State Department last week, a senior
administartion official outlined the president's decision to apply the Mexico
City policy to the distribution of the AIDS funds. The policy -- which was
originally implemented by President Reagan at a population conference in Mexico
City in 1984, removed by President Clinton and reinstated by Bush on the first
day of his presidency -- "bars U.S. money from international groups that support
abortion, even with their own money, through direct services, counseling or
lobbying activities" (Kaiser Daily Reproductive Health Report, 3/3). The
following are summaries of the editorials and opinion pieces, listed in
alphabetical order by the newspaper's name:

* Boston Globe: The Bush administration's decision to apply the Mexico City
policy to organizations receiving AIDS funding attaches "antiabortion paranoia
to every single dollar, ... force-feed[s] religion to the poor on a global
scale," and ignores the fact that "[t]he pandemic has a woman's face," Frances
Kissling, president of Catholics for a Free Choice, writes in a opinion piece in
the Globe. The administration "tried to portray this move as somehow a
'compromise' that merely requires family planning groups to separate their work
fighting HIV/AIDS from everything else they do. But the two are inseparable,"
Kissling states. She says that applying the Mexico City policy would force
people living with HIV/AIDS, who can currently avoid stigma by seeking treatment
at general family planning clinics, to "either go public or go without
assistance." Application of the policy would also force "perennially
short-funded nongovernmental groups," which are often "the only health care
providers within miles," to set up separate facilities, bookkeeping systems and
to double their staff and equipment, which Kissling says "simply will not
happen." Kissling concludes by urging Bush to "reconsider this latest assault
on women" (Kissling, Boston Globe, 3/4).

* Christian Science Monitor: "Without profound and massive changes in culture
and behavior," the money and drugs to be provided through Bush's AIDS initiative
"will be of limited benefit," Amitai Etzioni, a sociologist and author of the
book "The Spirit of the Community," writes in a Monitor opinion piece. The Bush
approach to prevention, which relies on a network of medical centers that will
provide testing, counseling and medication, "medicaliz[es] prevention" and will
not serve "young teenagers, as they develop their sexual habits," Etzioni says,
adding that prevention funds aimed at "behavioral modification" should be
shifted to "educators, community leaders and faith-based institutions." Etzioni
concludes that the United States should "risk unpopularity" and "reiterate that
unless people stop unsafe practices, no one can help them" (Etzioni, Christian
Science Monitor, 3/4).

* Greensboro News & Record: "Less publicized maneuvers" surrounding the
president's AIDS initiative "toss cold water on what should be well-earned
accolades," a News & Record editorial states. Advocates say that the actual
amount of new money earmarked for fighting AIDS included in Bush's proposed 2004
fiscal year budget is "inflated by including millions for other diseases and
money for prior unfulfilled promises," which "actually cuts in half what
Congress contemplated for 2003," the editorial says. The News & Record also
criticizes the administration for insisting on working "unilaterally" instead of
the working with the Global Fund to Fight AIDS, Tuberculosis and Malaria;
"undercut[ting]" WTO talks about generic drug access; and "clinging to
prevention education that preaches abstinence only." The editorial concludes
that Bush's domestic and international AIDS programs "must match rhetoric with
strong, swift action, or the disease ... will win" (Greensboro News & Record,
3/3).

* Indianapolis Star: "If the Middle East seems volatile today, imagine what an
entire continent devastated by AIDS and famine would look like 10 years from
now," a Star editorial says. "Slowing the spread" of the disease will "avert
far more desperate policy problems down the road in troubled Third World
nations," according to the Star. The editorial concludes that Bush's AIDS
initiative is a "pre-emptive strike of the best kind that deserves citizens'
support" (Indianapolis Star, 3/4).



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