KAISER DAILY HIV/AIDS REPORT
A service of kaisernetwork.org
http://www.kaisernetwork.org/dailyreports/hiv
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Friday, March 7, 2003

PUBLIC HEALTH & EDUCATION
========================================
1. Wall Street Journal Examines San Francisco STD Director's Fight For STD
Warning, Condom Promotion Labels On Viagra

2. Pittsburgh Needle-Exchange Program May Expand Into Predominantly
African-American Community


GLOBAL CHALLENGES
========================================
3. HIV/AIDS Threatens To Undo Social, Economic Achievements in Africa, Rwandan
President Paul Kagame Says

4. UNICEF Calls for More Attention to HIV/AIDS Among Women on International
Women's Day


ACROSS THE NATION
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5. Empire State AIDS Ride Will Benefit Local and International Groups


MEDIA & SOCIETY
========================================
6. NGOs, Private Sector, Governments 'Can Join Together' To Fight AIDS,
Malaria, TB in Africa, ExxonMobil Ad Says


OPINION
========================================
7. Editorials, Opinion Piece Focus on Congressional Debate Over AIDS Funding,
Debt Relief and 'Mexico City' Policy

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PUBLIC HEALTH & EDUCATION

1. Wall Street Journal Examines San Francisco STD Director's Fight For STD
Warning, Condom Promotion Labels On Viagra

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16439

Dr. Jeffrey Klausner, the San Francisco Department of Public Health director
of sexually transmitted disease prevention and control, is fighting an "uphill
battle" to change the warning labels on Pfizer's male impotence drug Viagra to
include a statement "explicitly warn[ing]" users about STDs and promoting the
use of condoms, the Wall Street Journal reports. After seeing an empty Viagra
packet on the floor of a gay sex club during a health inspection, Klausner began
to wonder whether the drug was contributing to unsafe sexual behavior and a rise
in HIV and other diseases, according to the Journal. He has sent letters to the
FDA and Pfizer asking that the drug maker be required to send letters to
doctors, pharmacists and consumers "acknowledging the risk of disease" in Viagra
users. In addition, Klausner is calling for Pfizer to rework its advertisements
for the drug so that they mention STD risks and subsidize an education campaign
aimed at gay men, the Journal reports. Both Pfizer and the FDA say that the
current Viagra label is sufficent; the label states that the drug does not
prevent STDs, but Klausner said, "Neither does a hamburger."

Showing Cause and Effect


Harold Jaffe, director of CDC National Center for HIV, STD and TB Prevention,
said that the agency has begun examining Viagra's role in STD transmission to
help "address possible increased risk of HIV from Viagra use." Recent studies
in New York have shown that one-third of gay and bisexual men with syphilis had
used Viagra, compared with one in five of those who did not have syphilis. Dr.
Susan Blank, assistant commissioner in the New York City Department of Health
and Mental Hygiene, said, "This suggests that Viagra is in some way part of the
unsafe sex that is happening." National Coalition of STD Directors Executive
Director Theresa Raphael said, "We are concerned that there is a spike in STDs
in certain populations, and that Viagra is one of the factors contributing to
that." But Mariann Caprino, a spokesperson for Pfizer, said that there is "no
connection" between the drug and a higher incidence of STDs, according to the
Journal. She added, "We've said this is a product for men with erectile
dysfunction and have opposed recreational use from day one." Klausner points to
studies he has completed in San Francisco that show that Viagra users are two to
three times more likely to be diagnosed with an STD than men who do not use the
drug. Don Shames, director of the FDA's division of reproductive and urologic
drugs, said that there is a "big difference between association and causation,"
adding that there have been no claims that Viagra causes HIV or syphilis, the
Journal reports. He added, "I understand [Klausner's] arguments and I'm
sympathetic. But we need to have evidence to put into the label." Klausner
said, "They're suggesting public health can pick up the pieces," adding, "Hey
guys, "I'm picking up the pieces on the floor of sex clubs" in the form of empty
Viagra packets (Chase, Wall Street Journal, 3/7).

2. Pittsburgh Needle-Exchange Program May Expand Into Predominantly
African-American Community

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16440

Prevention Point Pittsburgh, which operates a needle-exchange program in
Allegheny County, Pa., is looking to expand its operations to the predominately
African-American Hill District community, the Pittsburgh Post-Gazette reports.
Prevention Point Pittsburgh distributes more than 6,500 new syringes to about
157 injection drug users each week to help stop the spread of HIV and hepatitis.
The program on Wednesday received approval from the Allegheny County Board of
Health to raise the $100,000 it needs to open its new site in the Hill District.
The health department would provide space for the needle exchange, but
Prevention Point Pittsburgh would be responsible for raising the funds to run
the program, according to the Post-Gazette. Some board members "expressed
frustration" about the lack of statistics on how many people participate in the
needle-exchange program and "raised concerns" about the possibility of people
involved in the program selling the needles to others. Prevention Point staffer
Alice Bell said that secondary distribution does occur, adding, "Our goal is
really to get many clean syringes into the drug-using community, enough so that
people can use a clean sterile syringe every time they inject." Prevention
Point is currently undergoing an internal review that will follow 75 program
participants to assess whether the program's services help participants reduce
their risky behaviors. The Hill District site could open in June if the program
receives final approve from the health department. Before the needle-exchange
program is allowed to expand, Prevention Point will have to provide the
department with its total number of participants, research on similar programs
in other cities and the proportion of syringes returned (Srikameswaran,
Pittsburgh Post-Gazette, 3/6).


GLOBAL CHALLENGES

3. HIV/AIDS Threatens To Undo Social, Economic Achievements in Africa, Rwandan
President Paul Kagame Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16441

"HIV/AIDS is the single greatest threat to welfare and development in the
developing world," and the disease "threatens to wipe out the socioeconomic
achievements ... attained over the last decades" in Africa, making the epidemic
the "biggest threat" to the continent's development, Rwandan President Paul
Kagame said on Wednesday. Kagame, speaking at a luncheon co-hosted by the
Elizabeth Glaser Pediatric AIDS Foundation and drug maker Pfizer, said that the
world faces a "grim task" in the fight against AIDS, as many countries face the
short-term challenge of caring for people living with the disease and the
long-term challenge of development. He said that there should be a
"corresponding commitment" to fight poverty in developing countries. "Investing
in poverty reduction is as indespensable as the fight against HIV/AIDS, and has
even a greater ... effect in contributing to world peace and security," Kagame
said. He added that "the role of leadership is of paramount importance" in
countries' responses, "not only in terms of mobilizing the resources required,
but also in terms of sensitizing the populations" to the disease in order to
reduce stigma and discrimination. He said that the fight against AIDS must be
"global but focused" and be a multisectoral approach, including responses from
the public and private sectors as well as civil society. However, he warned
that the establishment of numerous "mechanisms and institutions" is not the
answer to responding effectively to the epidemic. "[H]istory will not judge us
by how many of these are in place," he said, adding, "We will be judged on the
basis of whether we all acted forcefully and in time to get the desired results"
(Kagame speech text, 3/5). Kagame met with President Bush on Tuesday at the
White House to discuss bilateral relations, peace, security and development,
including HIV/AIDS. Kagame thanked Bush for the United States' continued
economic support of several development projects in Rwanda, particularly in
HIV/AIDS prevention and agricultural development. "The U.S. is very important
to Rwanda in fighting HIV/AIDS, dealing with poverty, and Rwanda will continue
to benefit from a number of initiatives created by the Bush administration,"
Kagame said on Tuesday (Department of the Presidency of Rwanda release, 3/5).

Glaser Foundation, Pfizer Active in Rwanda


Kate Carr, EGPAF president and CEO, said that the foundation funds 11 health
care delivery sites in Kigali, Rwanda, to provide treatment to HIV-positive
pregnant women to prevent mother-to-child HIV transmission. This year, the
foundation expects to reach more than 10,000 women in Kigali with voluntary HIV
testing and counseling (Carr speech text, 3/5). Paula Luff, director of
international philanthropy programs at Pfizer, said that the company's Diflucan
Partnership Programme, which provides the antifungal drug free of charge to
treat cryptococcal meningitis and esophogeal candidiasis, two AIDS-related
opportunistic infections, has provided Diflucan to 256 patients in Kigali in its
first four months. The partnership, which operates in 13 countries, also
supports training for people living with HIV/AIDS, as well as health care
workers who treat such individuals. Other attendees at the luncheon included
Deputy Assistant Secretary of State for Health and Science Jack Chow, Director
of the USAID Office of HIV/AIDS Connie Carrino, Director of the White House
Office of National HIV/AIDS Policy Joe O'Neill, Rep. Mark Kirk (R-Ill.), former
Rep. John Porter (R-Ill.) and Sandy Thurman, head of the International AIDS
Trust and a member of the EGPAF board of directors (Alyson Browett, Kaiser Daily
HIV/AIDS Report, 3/6).

4. UNICEF Calls for More Attention to HIV/AIDS Among Women on International
Women's Day

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16442

Military conflicts -- which have displaced 35 million women and children --
and "entrenched gender inequalities" are exacerbating the spread of HIV among
women, according to a UNICEF press release marking International Women's Day,
which is tomorrow. During and following wars or occupations, women and girls
"endure extreme sexual violence and abuse" that can spread the disease. For
example, 2,000 Rwandan women, many of whom were survivors of rape, were tested
for HIV during the five years following the 1994 genocide. Four out of five
tested HIV-positive, and many of the women were not sexually active before the
genocide. Women under age 25 face "especially bleak prospects," according to
UNICEF, because they are becoming infected at higher rates than men in the same
age group, and are more likely to forego school to care for a family, which
means that they may be "shut out" from HIV/AIDS prevention information taught in
schools. Carol Bellamy, executive director of UNICEF, said that "long-term,
community-based work" is needed "to undo harmful norms that perpetuate
gender-based violence" and to ensure that girls attend school (UNICEF release,
3/6).


ACROSS THE NATION

5. Empire State AIDS Ride Will Benefit Local and International Groups

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16443

The Empire State AIDS Ride will benefit HIV/AIDS groups in Rochester, N.Y., as
well as international organizations, the Rochester Democrat and Chronicle
reports. The ride, which begins Aug. 18 in Niagara Falls, N.Y., and ends in New
York City's Battery Park on Aug. 23, could raise up to $250,000 for four groups,
including AIDS Rochester, Doctors Without Borders, Health GAP and the African
Services Committee. The AIDS ride organizers say they plan to give 100% of
contributions to the groups. Other rides in California, Illinois, Alaska and
Texas have "created controversy" over the amount of money that has gone to
organizers of those races, the Democrat and Chronicle reports (Memmott,
Rochester Democrat and Chronicle, 3/2). AIDS advocacy groups in Illinois,
Wisconsin, Minnesota, California and Washington, D.C., recently announced that
they plan to sponsor cycling events this summer to raise money for HIV/AIDS
prevention and awareness efforts. Pallotta TeamWorks Inc., a group that raised
more than $15 million dollars for AIDS organizations through their Heartland
AIDS Ride from Minnesota to Chicago, last year stopped producing AIDS rides,
citing a decline in participation. Pallota had been criticized for costly
self-promotion and low returns on funds to charities. Organizers of the
upcoming rides have promised that 60% to 85% of funds raised for the rides will
go to AIDS prevention efforts; the Heartland AIDS Ride donated just 20% of funds
raised (Kaiser Daily HIV/AIDS Report, 2/11). Marty Rosen, one of the organizers
of the Empire ride, said, "[O]ne of the things I stressed with our beneficiaries
is that they be upfront with us about how they will spend the money. There
can't be any question. I don't want to find out that somebody got some nice
carpeting with the funds" (Rochester Democrat and Chronicle, 3/2).


MEDIA & SOCIETY

6. NGOs, Private Sector, Governments 'Can Join Together' To Fight AIDS,
Malaria, TB in Africa, ExxonMobil Ad Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16444

The economic impact of malaria, AIDS and tuberculosis in sub-Saharan Africa
"has been enormous," and the "health crisis in Africa is too big for the
governments there to handle by themselves," ExxonMobil writes in an opinion
piece advertisement published in the Washington Post today. The company states
that "[j]ust as there is a gathering crisis, there is a gathering response" and
lists several organizations and inititatives "dedicated to mobilizing the
resources and skills of private companies in improving public health," including
the Global Fund to Fight AIDS, Tuberculosis and Malaria; President Bush's
five-year, $15 billion initiative against AIDS; the Global Coalition on
HIV/AIDS; the Global Health Initiative Task Force of the World Economic Forum;
the World Health Organization's Roll Back Malaria initiative; and the Corporate
Council on Africa. "ExxonMobil is actively involved in their work," the company
states, adding, "Private companies benefit from healthy communities and a
healthy workforce. That is why ... we support the initiatives just mentioned."
ExxonMobil says that governments of African nations "need help -- from other
countries, from responsible NGOs and from the private sector," concluding, "All
can join together to help offer an effective response to deadly disease -- and
hope to millions" (ExxonMobil ad, Washington Post, 3/7).


OPINION

7. Editorials, Opinion Piece Focus on Congressional Debate Over AIDS Funding,
Debt Relief and 'Mexico City' Policy

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16445

Two editorials yesterday appealed to their respective senators to act on
issues currently being discussed before the Senate Foreign Relations Committee
surrounding President Bush's proposed increase in funding to fight global AIDS.
Below are summaries of the editorials:

* Indianapolis Star: Congress should fund the president's AIDS initiative and
relieve the debt of developing nations, a Star editorial says. The editorial
praises the efforts of Indiana for Africa, an organization founded after rock
star Bono visited Indianapolis on the Heart of America tour to get support for
increased AIDS funding. The group has sent petitions, letters and emails to
Indiana Sen. Richard Lugar (R), chair of the Foreign Relations Committee, where
the issue is currently being considered. The editorial concludes that Lugar
"must help push the AIDS bill through the Senate" (Indianapolis Star, 3/6).

* Minneapolis Star Tribune: Minnesota Senator and Foreign Relations Committee
member Norm Coleman (R) should "resist the move to entangle AIDS funding with
abortion policies" and should "lead his colleagues in standing up for the Global
Fund to Fight AIDS, Tuberculosis and Malaria," a Minneapolis Star Tribune
editorial says. Both of the Bush administration's "schemes" -- to cut the
amount of AIDS money going to the fund and to apply the "infamous 'global gag
rule'" to international AIDS money -- are "foolhardy and wasteful, forsaking
proven anti-AIDS efforts for unfathomable reasons," the editorial says. The
editorial asks, "Why should the U.S. government reinvent the public health wheel
when the Global Fund ... is already up and running? Why should it deny funds to
successful agencies that have integrated AIDS prevention into their broad health
programs? Why is the White House scrimping on AIDS funding after promising to
be generous?" (Minneapolis Star Tribune, 3/6).

Provide 'Factual, Non-Judgmental' AIDS Information


Bush "stirred up hopes" worldwide when he announced his plan to provide $15
billion over five years to fight HIV/AIDS in Africa and the Caribbean in
January, but it "took less than a month for the other shoe to drop," Des Moines
Register columnist Rekha Basu writes. Basu notes that the administration plans
to apply the "Mexico City" policy, which prohibits federal aid from going to
groups that fund or discuss abortion. "How does AIDS prevention get tangled in
the politics of abortion?" Basu asks, adding that the move "reflects a growing
administration bias for abstinence as the answer to everything from pregnancy
prevention to welfare reform." Basu says that "evidence of that is all around,"
stating that the administration "has signaled it doesn't want safe sex discussed
on the government's dime" by financing abstinence-only education programs and
removing references to condom use from the CDC Web site. Basu writes, "Slowly,
an agenda is emerging to inject Puritan morality into public health, welfare and
foreign-aid decisions. But at what cost? Decades of work have made inroads
toward preventing unplanned pregancies and engaging people at risk by promising
factual, non-judgmental help," concluding, "Now the administration seems to be
saying, 'Live our way or forget it.' Isn't that the sort of behavior we faulted
the Taliban for?" (Basu, Des Moines Register, 3/7).



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