KAISER DAILY HIV/AIDS REPORT
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*** WEBCAST: ADAP MONITORING REPORT***
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latest National ADAP Monitoring Report,
sponsored by the Kaiser Family Foundation,
NASTAD, and the AIDS Treatment Data Network.
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Thursday, May 1, 2003

POLITICS AND POLICY
========================================
1. House Expected To Approve Global AIDS Legislation; Bill's Future
'Cloudy' in Senate


DRUG ACCESS
========================================
2. Despite Growth in National ADAP Budget, Some States Face Shortfalls in
Program Funding, Report Says


ACROSS THE NATION
========================================
3. St. Louis AIDS Agency Hires New Director After Former Director Fired
Last Year


GLOBAL CHALLENGES
========================================
4. Treatment Action Campaign Suspends Civil Disobedience Campaign in South
Africa


SCIENCE & MEDICINE
========================================
5. Magic Johnson Joins Board of California-Based Biomedical Company To
Raise Awareness of HIV Urine Test


OPINION
========================================
6. New England Journal of Medicine Features Opinion Pieces on International
AIDS Prevention, Treatment Programs

7. Kaiser Daily HIV/AIDS Report Summarizes Editorials on International AIDS
Legislation

****************************************

POLITICS AND POLICY

1. House Expected To Approve Global AIDS Legislation; Bill's Future
'Cloudy' in Senate

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=17471

The House today is expected to pass an international HIV/AIDS bill (HR
1298) that would authorize $15 billion over five years to fight AIDS in
Africa and the Caribbean, but details of the bill are "clouding the
measure's future in the closely divided Senate," the Baltimore Sun reports
(Hirschfeld Davis, Baltimore Sun, 5/1). The bill, sponsored by Rep. Henry
Hyde (R-Ill.), would authorize $3 billion a year for five years to
international HIV/AIDS programs, with up to $1 billion in fiscal year 2004
going to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Hyde's
bill endorses the "ABC" HIV prevention model -- abstinence, be faithful,
use condoms -- which has had success in lowering AIDS prevalence rates in
Uganda. The bill also allows international organizations that counsel about
abortion to receive U.S. funding on the condition that family planning and
abortion programs be financed and run separately (Kaiser Daily HIV/AIDS
Report, 4/30). Although the bill's passage in the House today is "all but
certain," an "intense" debate of the bill's provisions for funding
abstinence programs is expected, and the outcome of today's debate could
"determine how strongly Senate Republicans push the abstinence issue in
their version" of the bill, the Sun reports. Rep. Nita Lowey (D-N.Y.)
said, "Extreme conservatives would like to see us put all our eggs in the
abstinence basket." Some conservatives are concerned because they believe
Republican leaders have "sacrificed core provisions to secure enough votes
to win passage," the Sun reports. Rep. Mike Pence (R-Ind.) said, "If the
White House tells millions of pro-family voters that they're not interested
in seriously promoting our values in the formation of U.S. policy in
Africa, then that will greatly undermine the support for the White House
and for the U.S. Congress" among conservatives. He added, "I really do
believe this is a watershed vote."

Proposed Amendments


Some House Republicans are expected to support amending the bill to include
provisions that would channel funds directly to abstinence-until-marriage
counseling (Baltimore Sun, 5/1). Rep. Joseph Pitts (R-Pa.) is expected to
introduce an amendment that would specifically allocate one-third of the
bill's funding for abstinence and monogamy programs (Kaiser Daily HIV/AIDS
Report, 4/30). Another amendment, sponsored by Rep. Christopher Smith
(R-N.J.), would strengthen "conscience" language already in the bill to
"assure that religious groups are not denied funds because they object to
certain aspects of prevention programs," including condom distribution, the
AP/Augusta Chronicle reports. Hyde helped to craft the amendments so that
they would be "acceptable" to Democrats, and he said that bipartisanship
was necessary to take on "one of the great moral and physical challenges of
our time." Ken Connor, president of the Family Research Council, said,
"Those two amendments will certainly improve the bill," but he added that
the direction of money to the Global Fund remains a "glaring defect" of the
bill (Abrams, AP/Augusta Chronicle, 5/1). Senate Majority Leader Bill
Frist (R-Tenn.), who has been a "leading proponent" of the AIDS initiative,
said he hopes to debate the measure in the Senate within the next two
weeks, the Sun reports (Baltimore Sun, 5/1). Frist said on Tuesday that
his goal is to pass legislation by the end of this month (AP/Augusta
Chronicle, 5/1). Bush asked Congress to send him the measure by Memorial
Day (Kaiser Daily HIV/AIDS Report, 4/30).

Drug Maker Lobby


Some "big behind-the-scenes" support for Bush's HIV/AIDS initiative has
come from pharmaceutical companies and other firms with a "financial stake
in combating the disease," the Washington Post reports. Several
Republicans involved in the push for the bill have said that drug makers,
including Bristol-Myers Squibb and Abbott Laboratories, are giving up to
$40,000 each to join two "pro-Bush groups backed by the president and his
aides," according to the Post. Abbott CEO Miles White said that drug
makers are involved because "we recognize the magnitude of the problem" of
HIV/AIDS and it calls for a "magnitude of resources and attention that is
way beyond the ability" of one company. Terry Holt, head of the Corporate
Task Force on AIDS and former Bush campaign aide, said that Abbott,
Bristol-Myers and Pfizer each contributed $15,000 to support a "shoe
leather" lobbying campaign in support of Bush's HIV/AIDS initiative,
according to the Post. John Vandenheuvel, a Republican strategist working
for the Coalition for AIDS Relief in Africa, which focuses on "generating
support for the [president's HIV/AIDS] plan outside of Congress" and is
co-chaired by former Rep. J.C. Watts (R-Okla.), said that although
contributing to the project does make companies "look good," there "really
is a practical matter for all these companies doing business in Africa.
All the major multinational pharmaceuticals have some type of (AIDS)
program they are already using and would like to have it utilized as part
of the (Bush) plan" (VandeHei, Washington Post, 5/1).

A kaisernetwork.org HealthCast of the House floor debate will be available
online later today.

NPR's "Tavis Smiley Show" yesterday reported on Bush's HIV/AIDS proposals.
The segment includes comments from Connor and Dr. Vanessa Cullins, vice
president for medical affairs at Planned Parenthood (Keyes, "Tavis Smiley
Show," NPR, 4/30). The full segment is available online in RealPlayer.



DRUG ACCESS

2. Despite Growth in National ADAP Budget, Some States Face Shortfalls in
Program Funding, Report Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=17472

As Congress prepares to debate legislation (HR 1298) that would authorize
$15 billion over five years for AIDS prevention and treatment programs in
Africa and the Caribbean, many U.S. states are facing budget shortfalls
that are forcing them to place limits on their AIDS Drug Assistance
Programs, which are state-managed, federally funded programs that offer
antiretroviral drugs to low-income people who lack health insurance, NPR's
"Morning Edition" reports. Despite growth in the national ADAP budget over
the past six years, most of which followed the advent of highly active
antiretroviral therapy in 1996 and 1997, 16 states have had to restrict
access to their ADAPs, according to the annual National ADAP Monitoring
Report, which was released yesterday by the Kaiser Family Foundation, the
National Alliance of State and Territorial AIDS Directors and the AIDS
Treatment Data Network (Wilson, "Morning Edition," NPR, 5/1). The annual
monitoring report tracks ADAP spending and access over the past year and
examines long-term trends in the program. The 2003 report found that the
national ADAP budget, drug expenditures and the number of clients served by
ADAPs all increased between 1996 and 2002. The number of clients served by
ADAPs grew 4% last year, a rate of growth smaller than in previous years.
ADAP drug expenditures grew to more than $70 million in June 2002 -- a 12%
increase from June 2001 -- and total ADAP drug expenditures grew 370%
between 1996 and 2002. The national ADAP budget reached $878.6 million in
fiscal year 2002, rising 8% from the year before and 366% since FY 1996.
ADAP budget increases have allowed programs to expand their formularies,
with most states offering all approved antiretrovirals and 15 states
covering all drugs highly recommended for the prevention of opportunistic
infections.

Shortfalls and Solutions


Despite overall trends toward increased capacity, several states face
budget shortfalls and program restrictions, such as waiting lists and
limited formularies. Thirteen states capped or limited enrollment and/or
restricted access to antiretrovirals in at least five of the last seven
years. In addition, access to ADAPs "continues to vary greatly" by client
location. Meanwhile, uncertainty about the availability of new resources
and a changing clinical environment often make it challenging for ADAPs to
prepare for changes, such as the introduction of new and potentially
higher-priced medications. However, ADAPs are addressing fiscal pressures
and uncertainty by taking advantage of drug discount mechanisms, such as
working together to form coalitions to address drug prices (National ADAP
Monitoring Report 2003, April 2003). ADAP representatives from California,
Florida, Maryland, Massachusetts, New Jersey, New York, North Carolina and
Texas -- states that collectively account for 75% of the more than $850
million in annual ADAP drug expenditures -- for two months have been
negotiating with representatives from Roche, GlaxoSmithKline, Merck,
Pfizer, Abbott Laboratories, Boehringer-Ingelheim, Gilead Sciences and
Bristol-Myers Squibb to discuss ways of alleviating the budget shortfalls
that state ADAPs are currently facing. According to the National Alliance
of State and Territorial AIDS Directors, the ADAPs have reached agreements
with Gilead, Abbott and Merck to freeze drug prices and provide rebates on
the companies' antiretroviral drugs. Negotiations are ongoing with
Pfizer/Agouron, GlaxoSmithKline, Bristol-Myers Squibb and Boehringer
Ingelheim (Kaiser Daily HIV/AIDS Report, 4/24).

Reaction


Bill Arnold, director of the ADAP Working Group, said that ADAPs have been
underfunded for the last three years, adding, "People are piling up on
waiting lists, while Medicaid is dumping people who used to get coverage,
and private insurers, in their quiet way, are getting rid of high-cost
patients" (Russell, San Francisco Chronicle, 5/1). Jennifer Kates,
director of HIV policy for the Kaiser Family Foundation, said, "Every
single state practically is experiencing a significant crunch in their
Medicaid programs and are looking to reduce costs in that program, largely
through pharmacy controls and other mechanisms. The relationship between
Medicaid and ADAP is a very important one to understand, because ADAP fills
the gaps when Medicaid can't" ("Morning Edition," NPR, 5/1). According to
California ADAP officials, the state's program will cost about $24 million
more than was budgeted for the fiscal year beginning July 1, causing the
state to consider limiting access to medications. Michael Montgomery, chief
of the California Department of Health Services Office of AIDS, said, "We
are going to have to look at a waiting list, as well as removing some drugs
from the formulary," adding that although the state has a "robust" ADAP
program, the state is "facing a very serious budget deficit" (San Francisco
Chronicle, 5/1). Montgomery said that congressional members he met with
this week to discuss the state ADAP funding crisis did see a "potential
conflict" in coming up with billions to make medicines available overseas
through Bush's global AIDS initiative but not finding an additional $280
million so that U.S. residents also have access to HIV/AIDS treatments, NPR
reports ("Morning Edition," NPR, 5/1). Arkansas' ADAP, which was entirely
federally funded until the state Legislature allocated $661,000 for the
program in 2002, grew 72% in 2002 and eliminated a waiting list for
treatment. According to Lola Thrower, HIV services team leader for the
Arkansas Department of Health, although the increase in state and federal
funding allowed the ADAP to serve more clients, the state legislature could
still eliminate a future contribution because of possible budget cuts in
the state. However, Thrower said such a scenario would not decrease the
level of care, adding, "We have no idea what that's going to look like at
this point, and we're just kind of waiting to see what happens" (Smith,
Arkansas Democrat-Gazette, 5/1).

CBS' "Up to the Minute" today interviewed Kates about the report ("Up to
the Minute," CBS, 5/1). The full segment is available online in
RealPlayer.

The full NPR "Morning Edition" segment, which includes comments from Kates,
Montgomery and Steve Sherman, director of North Carolina's ADAP, is
available online in RealPlayer.


ACROSS THE NATION

3. St. Louis AIDS Agency Hires New Director After Former Director Fired
Last Year

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=17473

St. Louis-based Blacks Assisting Blacks Against AIDS announced on Tuesday
that it has hired a new executive director to replace Erise Williams, who
was fired in November 2002 after the organization used money to hire a gay
adult film star for an AIDS awareness event, the St. Louis Post-Dispatch
reports. BABAA chose George Cotton Sr. as its director. Cotton has served
on the school board and city council in University City, Mo., and is
leaving a job with the St. Louis Public Schools, according to the
Post-Dispatch (O'Neil, St. Louis Post-Dispatch, 4/30). The BABAA board in
November 2002 fired both Williams and James Green, BABAA senior director,
after the City of St. Louis Department of Health began investigating on
behalf of the CDC allegations that the organization had used federal money
from a $96,000 CDC grant to fight syphilis to pay Edgar Gaines, a retired
gay pornographic film actor, to strip at a sex education event (Kaiser
Daily HIV/AIDS Report, 11/11/02). Cotton said, "We have to rebuild the
enthusiasm for BABAA so the community can help in the cause," adding, "I
respect the good work that BABAA does. We need to make it the pre-eminent
source of AIDS resources and research for the African-American community."
Cotton said he will work to repair the organization's reputation and raise
private donations. A lawsuit filed by Williams and Green against BABAA
seeking back pay over their firings is scheduled for a nonjury trial on May
14 before St. Louis Circuit Judge Jack Garvey, according to the
Post-Dispatch (St. Louis Post-Dispatch, 4/30).


GLOBAL CHALLENGES

4. Treatment Action Campaign Suspends Civil Disobedience Campaign in South
Africa

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=17474

The South African AIDS advocacy group Treatment Action Campaign on Tuesday
announced the suspension of its nationwide civil disobedience campaign in
light of an upcoming meeting of the National AIDS Council scheduled to take
place on May 17, Reuters reports (Reuters, 4/29). The campaign, which
started in March, marked the first time in Africa that HIV/AIDS patients
broke the law in large numbers to demand treatment. At the start of the
campaign, the group filed charges of manslaughter against South African
Health Minister Manto Tshabalala-Msimang and Trade Minister Alec Erwin for
failing to provide sufficient treatment for HIV-positive people (Kaiser
Daily HIV/AIDS Report, 4/25). TAC said that Deputy President Jacob Zuma,
head of the National AIDS Council, agreed to discuss TAC's demands for
state-funded antiretroviral drugs at the upcoming meeting. "We are
suspending the campaign in the interest of ensuring the fullest opportunity
for government to prove its good faith," a TAC executive committee
statement said, adding, "However, should we encounter further unjustifiable
delays or deceit, we will continue with all existing campaigns." The group
is demanding that any conclusions reached at the council's meeting be sent
to the government as "urgent recommendations" and be implemented within
three weeks (Reuters, 4/29).

Health Minister Speaks at HIV/AIDS Mining Summit


In related news, Tshabalala-Msimang on Wednesday at a mining summit on
HIV/AIDS said that antiretroviral drug distribution programs should be
"done properly and not in a populist manner," the South African Press
Association reports. Tshabalala-Msimang said that while the government is
not against the provision of antiretrovirals, the necessary infrastructure,
funding and mechanisms to prevent misuse must first be in place. Proper
nutrition should be the "starting point" in boosting the immune systems of
HIV-positive people, she said, according to SAPA. Tshabalala-Msimang said
that the government could provide the drugs once the problems with
sustainable treatment are addressed (South African Press Association, 4/30).


SCIENCE & MEDICINE

5. Magic Johnson Joins Board of California-Based Biomedical Company To
Raise Awareness of HIV Urine Test

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=17475

Earvin "Magic" Johnson, the basketball legend who led the Los Angeles
Lakers to five NBA championships in the 1980s and who "shocked" the world
in 1991 when he announced he was HIV-positive, has agreed to join the board
of directors of the Alameda, Calif.-based Calypte Biomedical Corp. to raise
awareness of the company's HIV urine test, the Contra Costa Times reports.
In a statement, Johnson said that he was "amazed" that so few people were
aware of the urine test, according to the Times. "The fear of a blood test
is one of the biggest reasons why more people don't get tested," he said,
adding, "Now, with Calypte's urine test, there are no more excuses."
According to the Times, Johnson has become one of the "most prominent"
spokespersons for HIV/AIDS awareness since his 1991 announcement. Richard
Brounstein, Calypte's chief financial officer, said that Johnson's decision
to join the board "is very significant to us." He added, "When we have
been out to talk about our urine test, everybody likes the story. Our
biggest problem is a little-known company getting that story told. I can't
think of a more recognizable spokesman or figure to tell our story"
(Avalos, Contra Costa Times, 4/30).


OPINION

6. New England Journal of Medicine Features Opinion Pieces on International
AIDS Prevention, Treatment Programs

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=17476

Today's issue of the New England Journal of Medicine features three
opinion pieces on AIDS prevention and treatment strategies in resource-poor
settings. Summaries of the articles appear below:

* President Clinton, "Turning the Tide on the AIDS Pandemic": "Until we
build the human and physical infrastructure needed to deliver effective
[antiretroviral] treatment, programs will not be successful," Clinton, who
founded the William J. Clinton Presidential Foundation, which works with
Caribbean nations to procure cheaper antiretroviral drugs among other
AIDS-related activities, writes. The capacity to distribute and maintain
antiretroviral treatment must be "built into the mainstream health care
infrastructure," a move that will require "strong and sustained political
will and leadership" and "management systems," he says. The international
community must work to mobilize "human and financial resources" and to
"facilitat[e] the sharing of learning among projects" in different
countries (Clinton, NEJM, 5/1).

* Helene Gayle, "Curbing the Global AIDS Epidemic": In order for HIV
prevention programs to be successful, "multiple, complementary preventive
strategies, and investments must be made," Gayle, director of the Bill &
Melinda Gates Foundation's HIV/AIDS and tuberculosis program, writes.
These strategies must be flexible enough to "rapidly assess and overcome
logistical barriers" to the implementation of new technologies such as
microbicides and to address the "likelihood that improved [access to
antiretroviral] treatment will lead" to an increase in high-risk behavior
(Gayle, NEJM, 5/1).

* Steven Reynolds et al., "Antiretroviral Therapy Where Resources Are
Limited": "Failure to provide the resources necessary to train health care
providers, ensure reliable laboratory monitoring, and optimize treatment
guidelines may limit the public health benefit of global efforts to expand
access" to highly active antiretroviral treatment, Reynolds and colleagues
from Johns Hopkins University and NIH write. "[S]imply providing
affordable access to these drugs is insufficient"; the international
priority should be to combine access to prevention programs with increased
access to clinical care from trained providers equipped with proper
laboratory equipment and country-specific treatment guidelines, they state
(Reynolds et al., NEJM, 5/1).

7. Kaiser Daily HIV/AIDS Report Summarizes Editorials on International AIDS
Legislation

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=17477

Several newspapers across the country today published editorials
discussing the international AIDS legislation (HR 1298) that is scheduled
to be debated today in the House. The following are summaries of some of
those editorials:

* Baltimore Sun: "[A] few lawmakers who consider themselves moral, even
religious, are threatening to oppose [global AIDS] legislation" over
ideology, a Baltimore Sun editorial says. Bush has eschewed such
ideological disputes and has "taken on some of the most powerful leaders of
his conservative base" to insist on the inclusion of condom distribution as
part of a "combination approach to AIDS prevention," the Sun says. If the
measure passes, it will be a credit to both the president and bill sponsor
Rep. Henry Hyde (R-Ill.), "who has skillfully maneuvered to keep ideologues
on both the left and right at bay," the editorial concludes (Baltimore Sun,
5/1).

* Chicago Tribune: "It will be a tragedy if abortion politics is allowed
to derail" global AIDS legislation, and the House should resist any
amendments proposing to "deemphasize condom use and prohibit funding to
health and family groups that promote abortions," a Chicago Tribune
editorial says. Hyde showed "true moral backbone" in developing the
bipartisan measure, taking on the "moral imperative" of creating
legislation that will use "all tools at our disposal" to fight the
epidemic, the editorial concludes (Chicago Tribune, 5/1).

* New York Times: Bush's speech in support of swift passage of
international AIDS legislation was a "rare and encouraging" step in which
he "push[ed] beyond conservative moralizers," a New York Times editorial
says. Despite efforts by Hyde to "defuse" the abortion debate, the
bipartisan support of the measure "will be tested by antiabortion forces"
in the House, according to the editorial. Congress should accept Bush's
pledge of support for funding all "practical" AIDS strategies, the Times
concludes (New York Times, 5/1).

* St. Petersburg Times: Bush "deserves praise for standing up to" the
"obstructionism from his own party's most extreme social conservatives," a
St. Petersburg Times editorial says. "We hope pro-life obstructionists in
Congress got the message" when Bush called AIDS prevention a "right-to-life
issue," the editorials says. The Times concludes, "There should be no more
excuses for delaying the life-giving legislation," because Bush "has left
no moral ground" for conservative opponents to stand on (St. Petersburg
Times, 5/1).

* Salt Lake Tribune: The AIDS policy promoted by the president is "highly
moral, compassionate and ... deals squarely with a serious issue of
national security that many others would rather ignore," a Salt Lake
Tribune editorial says. "[T]he delay the bill has already seen is
unconscionable," the Tribune says. The editorial concludes, "We will never
know how many lives could have been saved if Congress had taken the
president's advice on AIDS as quickly and as unquestioningly as it
supported his war and homeland security measures" (Salt Lake Tribune, 5/1).


* San Francisco Chronicle: Bush "should be commended" for his support of
AIDS legislation without the hindrance of a "global gag rule," which would
prevent funding from going to groups that also promote birth control or
counsel on abortion, a San Francisco Chronicle editorial says. Congress
"should endorse the measure" without the addition of antiabortion
amendments, which have "no place in AIDS funding," the editorial concludes
(San Francisco Chronicle, 5/1).

* San Jose Mercury News: "It must be nice" for "far-right politicians
trying to bend the [AIDS] issue to suit their agendas ... to be so certain
of the correctness of [their] beliefs that it's acceptable to sign millions
of death warrants -- mostly for babies and women" -- by delaying passage of
international AIDS legislation, a San Jose Mercury News editorial says.
Bush is "dead right" in trying to inject a "sense of urgency" into the
passage of AIDS legislation, the editorial concludes (San Jose Mercury
News, 5/1).

* Springfield Republican: Congress must work to meet the "ambitious goal"
set out by Bush of passing AIDS legislation by Memorial Day, a Springfield
Republican editorial says. "It would be tragic if [partisan] bickering
slows the passage of this momentous initiative," so Congress must take
"historic action" to fight his "massive and complicated" epidemic, the
editorial concludes (Springfield Republican, 4/30).

* USA Today: "Progress [on international AIDS legislation] is being
thwarted by some social conservatives" who are "pushing burdensome
conditions that would hamstring the effectiveness" of the AIDS program, "if
not kill it altogether," a USA Today editorial says. While Bush's support
of the House legislation "has not gone over well with conservatives," his
choice to "stan[d] firm" combines "sound policy and smart politics." The
editorial concludes that by leading the battle against AIDS abroad, Bush
can win the United States "needed goodwill" and will "stea[l] part of the
'caring' issue from potential Democratic rivals in 2004" (USA Today, 5/1).

* Washington Times: Congress should "follow [Bush's] lead" in committing
money to the fight against AIDS, but it should "do so in a way that
maximizes each dollar spent," a Washington Times editorial says. Since
"[f]ar too many U.S. funds have been wasted on faulty disease prevention
programs," the AIDS initiative should have U.S. oversight, and the funding
allocated to the Global Fund to Fights AIDS, Tuberculosis and Malaria
should therefore be reduced, the editorial concludes (Washington Times,
5/1).


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