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



Wednesday, May 7, 2003

POLITICS AND POLICY
========================================
1. Global Fund Making Progress But Lacking Resources, GAO Report Says

2. U.S. Ambassador to Malawi Says Peace Corps Volunteers Can Help Fight
AIDS by Dispelling Myths


ACROSS THE NATION
========================================
3. Number of Reported Cases of Chlamydia, Gonorrhea, Syphilis in Minnesota
Rose From 2001 to 2002


DRUG ACCESS
========================================
4. 'Radical' Antiretroviral Drug Program in Botswana Becomes 'Test Case'
for AIDS Treatment in Region


GLOBAL CHALLENGES
========================================
5. Unsafe Medical Practices Primary Mode of HIV Transmission Among South
African Children, Study Says

6. Life Expectancy in Zambia Falls to 33 Years Due to AIDS


SCIENCE & MEDICINE
========================================
7. Thai Government Bans Manufacture, Distribution of Reported 'AIDS Cure'
V-1 Immunitor


OPINION
========================================
8. San Francisco Officials Should Address Crystal Meth Use, HIV Risk Among
Gay, Bisexual Men as 'Public Health Crisis,' Editorial Says

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POLITICS AND POLICY

1. Global Fund Making Progress But Lacking Resources, GAO Report Says

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http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=17573

The Global Fund to Fight AIDS, Tuberculosis and Malaria has made
"noteworthy progress" since its inception but could face difficulty
approving and subsidizing grants due to a lack of resources, according to a
General Accounting Office draft report being circulated for comment, the
Boston Globe reports. The 51-page report, requested by Rep. Jim Kolbe
(R-Ariz.), found that the fund's "most glaring problem" was a lack of
resources. The Global Fund has already disbursed two rounds of grants, but
it does not have the estimated $1.4 billion needed this year or $3.3
billion needed next year to finance the third round of grants, which are
scheduled for October (Donnelly, Boston Globe, 5/7). The report states,
"Pledges made for this year are insufficient to cover more than a small
number of additional grants" and "without significant new pledges" the
Global Fund -- which so far has awarded grants to 160 projects in 92
countries -- would not be able to complete projects it has already begun.
Thus far, the United States has pledged $1.65 billion of the total $3.4
billion pledged to the fund through 2008 (Phillips, Wall Street Journal,
5/7).

More Money


President Bush's original plan for an international AIDS initiative
announced during his State of the Union address in January proposed a total
of $1 billion to go to the fund over a five-year period (Boston Globe,
5/7). However, last week, the House approved 375-41 an international AIDS
bill (HR 1298), sponsored by Rep. Henry Hyde (R-Ill.), that would authorize
$3 billion a year for five years to go to HIV/AIDS programs in Africa and
the Caribbean, with up to $1 billion in fiscal year 2004 going to the
Global Fund (Kaiser Daily HIV/AIDS Report, 5/5). The bill is still up for
debate in the Senate, and then must go through the appropriations process,
the Journal reports. Some observers are projecting that the fund could
receive approximately $350 million from the United States for FY 2004.
Global Fund Chair and HHS Secretary Tommy Thompson is expected to visit
several European countries to urge officials there to increase their
contributions to the fund. In addition, officials from some "wealthy"
countries could use the G8 summit in June -- or a donors' meeting scheduled
for July -- to lobby for more pledges, the Journal reports (Wall Street
Journal, 5/7).

Reaction


Global Fund Executive Director Richard Feachem said that the GAO report's
findings are "constructive" and that they reflect the "growing pains" of
any new organization. In a seven-page written statement, Feachem said that
raising money is the Global Fund's "single most important challenge,"
adding, "To date, the United States has led the way in giving, acting as a
beacon for others" (Boston Globe, 5/7). He said, "We can't afford to
squabble when there are six million people a year dying from the three
diseases we're working on" (Wall Street Journal Europe, 5/7). Paul Zeitz,
executive director of Global AIDS Alliance, said that Bush's proposal for
$1 billion over five years for the Global Fund would "doom the fund just as
it starts showing potential," according to the Globe. Zeitz, who recently
returned from a trip to Zambia and Kenya, added, "Our feedback from groups
in Africa is that this is working; it is creating new momentum. It is not
business as usual on the ground in Africa. That is exciting. But the Global
Fund's ability to continue the effort, and refine on these initial phases,
is compromised by the lack of support from President Bush" (Boston Globe,
5/7).

The House Appropriations Subcommittee on Foreign Operations is scheduled to
hold a hearing today on global AIDS, at which Thompson, Feachem and Dr.
David Gootnick, director of international affairs and trade at the GAO, are
scheduled to testify. A kaisernetwork.org HealthCast of the hearing will
be available online by noon ET tomorrow.

2. U.S. Ambassador to Malawi Says Peace Corps Volunteers Can Help Fight
AIDS by Dispelling Myths

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http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=17574

U.S. Ambassador to Malawi Roger Meece on Friday during the swearing-in
ceremony of 15 Peace Corps volunteers in Lilongwe, Malawi, said that the
volunteers could "greatly contribute" to curbing the spread of HIV/AIDS by
helping to dispel misconceptions about the disease, Chronicle/AllAfrica.com
reports. Meece said that HIV/AIDS is "killing too many Malawians," adding
that "it is critical to bring down the infection rate and get this problem
under control. It can be done." He added, "To control HIV/AIDS, it is
important for people to overcome stigma, to understand how the disease is
spread, the critical importance of abstinence and faithfulness in a
relationship and the use of condoms." Meece called on the Peace Corps
volunteers to be "role models" in the Malawian communities where they will
serve, adding, "[Y]our influence on your friends to practice safe behavior
can help keep them HIV-negative and that's a very important role for you
all to play." Peace Corps volunteers have been placed in Malawi since 1963
(Jimu, Chronicle/AllAfrica.com, 5/5).


ACROSS THE NATION

3. Number of Reported Cases of Chlamydia, Gonorrhea, Syphilis in Minnesota
Rose From 2001 to 2002

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http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=17575

The number of reported cases of sexually transmitted diseases in Minnesota
increased 19% from 2001 to 2002, according to statistics released on Monday
by the state Department of Health, the St. Paul Pioneer Press reports. The
number of reported chlamydia cases increased 21% from 8,323 in 2001 to
10,107 in 2002. In addition, reported gonorrhea cases increased 13%, from
2,701 in 2001 to 3,049 last year. According to the data, the highest
chlamydia and gonorrhea rates were among teens and young adults ages 15 to
24. Reported cases of syphilis in all stages increased 10% over the same
period, from 134 cases to 148 cases, with reported early-stage syphilis
cases increasing 67%, from 49 cases in 2001 to 82 cases in 2002. In
addition, 56 of the 82 reported cases of early-stage syphilis occurred
among men who have sex with men, compared with only five such cases among
MSM in 2001. According to the Pioneer Press, the state's data on the
growing number of STD cases reflects a national trend among MSM (Majeski,
St. Paul Pioneer Press, 5/6). In 2001, the number of new syphilis cases in
the United States rose for the first time in 11 years, with large increases
occurring among MSM. The increase is a setback for the CDC's goal of
eliminating syphilis in 90% of U.S. counties by 2005, but it also signals
that many MSM are no longer practicing safe sex, which could lead to an
increase in HIV and other STDs (Kaiser Daily HIV/AIDS Report, 4/22).
According to the Pioneer Press, the increase in risky behavior could stem
from a perception that HIV/AIDS is a treatable disease and is no longer a
"death sentence." In addition to MSM, minority populations are
disproportionately represented among newly diagnosed cases of STDs, with
African Americans, American Indians and Latinos having STD rates two to 40
times higher than whites, depending on the group and the disease, according
to the Pioneer Press. Nicoline Tablan, the health department's STD
surveillance coordinator, said that the number of reported STD cases still
"underrepresents the true incidence" of STDs, adding, "It's called the
hidden epidemic for a reason." Tablan emphasized the importance of STD
testing for at-risk individuals and treatment with antibiotics for those
already infected (St. Paul Pioneer Press, 5/6).


DRUG ACCESS

4. 'Radical' Antiretroviral Drug Program in Botswana Becomes 'Test Case'
for AIDS Treatment in Region

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=17576

The success of the Botswana's "radical" antiretroviral drug program has
made the country a "test case" for AIDS treatment in sub-Saharan Africa,
the Christian Science Monitor reports (Itano, Christian Science Monitor,
5/7). Botswana, which has the world's highest HIV prevalence rate -- 38.5%
of people between the ages of 14 and 49 are estimated to be HIV-positive --
began offering treatment last year through a partnership with drug maker
Merck and the Bill & Melinda Gates Foundation (Kaiser Daily HIV/AIDS
Report, 9/12/2002). There are currently four clinics around the country
that provide antiretrovirals and counseling for 6,000 HIV-positive people,
and the government hopes to have 13 clinics open by the end of the year.
The antiretroviral drugs alone cost the country between $1,200 and $3,000 a
year per patient, but since the program is still in its nascent stages, the
additional cost of new clinic buildings and equipment has put the price of
the program at between $7,000 and $10,000 a year per patient, according to
Ernest Darkoh, operations director of the 15-month-old program. The total
cost for the first year of the program was $30 million (Christian Science
Monitor, 5/7). Merck has agreed to provide $50 million over five years to
help finance the project and has also agreed to "undertak[e]" the provision
of free antiretroviral drugs, according to the Associated Press. The
program is "beginning to make headway" in treating HIV-positive people in
the country, reducing HIV prevalence among pregnant women from 36.2% in
2001 to 35.4% last year, which is a small change but an "encouraging sign,"
the Associated Press reports (Motseta, Associated Press, 5/6). In
addition, patients in the program have 90% to 100% drug regimen adherence
rates, which is as much as 20% higher than adherence rates in the most
successful programs in Western countries. Doctors attribute this success
to the intensive counseling given to patients as part of the program and to
the effectiveness of the drugs (Christian Science Monitor, 5/7).

'No Room for Mistakes'


Botswana is the first country in Africa to commit to the widespread
distribution of antiretroviral drugs through its public health system
(Associated Press, 5/6). The government therefore recognizes that there is
"no room for mistakes," because the success or failure of the program could
"affect future AIDS treatment" throughout Africa, according to the Monitor.
Many other African countries have said that Botswana's diamond wealth has
made the program possible and that the Botswana program's "steep price tag"
makes it impossible for them to afford similar programs. Regardless, the
success of the program has "invigorated" Botswana's medical community and
made it an international center for AIDS research, as scientists are coming
to the country to conduct HIV research and young scientists are receiving
training in a new $3 million research laboratory, according to the Monitor
(Christian Science Monitor, 5/7). The government has said that it will try
to eradicate new HIV infections by 2016 (Associated Press, 5/6).


GLOBAL CHALLENGES

5. Unsafe Medical Practices Primary Mode of HIV Transmission Among South
African Children, Study Says

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http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=17577

Unsafe medical practices are the primary mode of HIV transmission among
children in South Africa, according to a study published in the British
Journal of Obstetrics and Gynaecology, BBC News reports (BBC News, 5/6).
The study was conducted by Stuart Brody of the University of Tubingen in
Germany and anthropologist David Gisselquist, John Potterat and Ernest
Drucker of the Albert Einstein College of Medicine in New York (Brody et
al., British Journal of Obstetrics and Gynecology, 5/6). A team of eight
researchers from the United States and Germany led by Gisselquist in March
published in the International Journal of STD & AIDS three studies
supporting a theory that unsafe medical practices and blood transfusions
have been primarily responsible for the spread of HIV in sub-Saharan
Africa. The researchers said that despite the consensus among AIDS
organizations that heterosexual contact has accounted for 90% of HIV cases
in Africa, only one-third of the total cases have been transmitted in this
manner; the researchers concluded that unsafe medical practices held a
"much greater risk" for HIV transmission. The researchers stated that
previous studies conducted on HIV transmission, which they reexamined for
their studies, failed to account for the fact that HIV transmission in
Africa did not follow the same pattern of other sexually transmitted
diseases and that high rates of HIV/AIDS can be attributed to contaminated
blood transfusions, the reuse of dirty needles in the administration of
vaccinations and injections and the use of improperly cleaned surgical
instruments (Kaiser Daily HIV/AIDS Report, 4/17).

Infection Rates Do Not Match Mother-To-Child Transmission Rates


For the BJOG study, the researchers examined statistics from a study
conducted last year by the Human Sciences Research Council of South Africa.
The HSRC study found that 5.6%, or 670,000, of South African children
between the ages of two and 14 are HIV-positive (BBC News, 5/6). Data from
the same study showed that the HIV prevalence among white children was 11%,
while the prevalence among white adults was 5.7%. The researchers said
this discrepancy pointed to another method of HIV transmission among
children other than vertical transmission (Woodman, Reuters Health, 5/6).
The researchers also rejected suggestions that the children could have
contracted the disease through unsafe sex or as a result of sexual abuse,
BBC News reports. "For hundreds of thousands of South African children to
have acquired HIV sexually, inordinately high levels of childhood sexual
exposure would be required, a phenomenon unlikely to have been overlooked
by pediatricians," the study says, according to BBC News. The researchers
predicted that the children became infected through "parenteral exposures
in health care settings," such as injections with unsterilized needles and
transfusions of unscreened blood. They concluded that urgent action must
be taken to improve conditions in South African clinics, adding that the
research could be applied to countries with "similar epidemiological
characteristics" in order to "protect patients from their own medical care
system." Both the South African government and the United Nations have
rejected such findings. "I believe the matter needs to be much more
closely interrogated before we form conclusions about the cause" of HIV
transmission, Dr. Nono Simelela, head of the South African health
department's HIV/AIDS program, said (BBC News, 5/6). A UNAIDS/WHO expert
group in March said that unsafe sex, not unsafe medical practices, is the
primary mode of HIV transmission in sub-Saharan Africa (Kaiser Daily
HIV/AIDS Report, 3/17). In addition, researchers from the University of
Oxford last month published a study in Nature supporting the theory that
unsafe sex was the primary transmission route for HIV infection in Africa
(Kaiser Daily HIV/AIDS Report, 4/17).

6. Life Expectancy in Zambia Falls to 33 Years Due to AIDS

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=17578

Zambians' life expectancy at birth has fallen from 44 years to 33 years
over the last 10 years due to AIDS, according to the country's Central
Statistical Office, Reuters reports. "The adult mortality rate has
increased in the last decade," CSO Director Buleti Nsemukila said on
Monday, adding that "an adult has lost about 11 years of survival due to
the AIDS problem." The HIV/AIDS epidemic is a "huge" development problem
in Zambia, which has a population of 9.8 million, Reuters reports.
According to the government, 20% of Zambian adults are HIV-positive, 200
Zambians die each day due to AIDS-related illnesses and 500 people are
infected with the virus daily (Reuters, 5/5).


SCIENCE & MEDICINE

7. Thai Government Bans Manufacture, Distribution of Reported 'AIDS Cure'
V-1 Immunitor

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=17579

The Thai government has banned the manufacture and distribution of V-1
Immunitor, a food supplement that was being promoted by its inventors as an
"AIDS cure," the Boston Globe reports. Although the supplement has never
been shown to be effective in treating HIV/AIDS, thousands of Thais who
cannot afford standard antiretroviral treatment have taken the pill (Boston
Globe, 5/4). The Salang Bunnag Foundation in Bangkok in August 2002
stopped distributing the pill after the organization conducted research
that found V-1 to be useless in treating HIV infection (Kaiser Daily
HIV/AIDS Report, 9/3/2002). If the manufacturers of V-1 are convicted of
making false claims about the product, they could be sentenced to up to
three years in jail, in addition to about $1,000 in fines. According to
the United Nations, approximately 675,000 Thais are HIV-positive (Boston
Globe, 5/4).


OPINION

8. San Francisco Officials Should Address Crystal Meth Use, HIV Risk Among
Gay, Bisexual Men as 'Public Health Crisis,' Editorial Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=17580

When San Francisco officials meet tonight to discuss "escalating concerns"
over crystal methamphetamine use and HIV risk among men who have sex with
men, "they should treat it with the urgency of a public health crisis," a
San Francisco Chronicle editorial says. The issue was recently highlighted
in a Chronicle series, which said that 30% of men newly diagnosed with HIV
infection last year reported using crystal meth. "Even more alarming" is
that gay men in California who use the drug are twice as likely as gay men
who do not use the drug to be HIV-positive, the Chronicle states, adding
that "statistics alone can't convey the dangerous sexual behavior that is
being practiced in the gay community." According to the editorial, condom
use is lower among gay crystal meth users and "untold numbers" of
HIV-negative people are beginning to use the drug, "making them more
susceptible to risky behavior." Noting the "gay public bath debacle" that
occurred 20 years ago when HIV first emerged, the editorial says that city
health officials "know too well" what can happen when there is a "slow
response to a public health crisis" and "political sensitivities override
sound public health policy." The Chronicle concludes, "Whether it requires
more stringent monitoring of the late-night club scene or launching public
education and prevention programs to alter the rise in drug use and risky
sexual behavior, city and state leaders need to move with all due speed to
battle the epidemic" (San Francisco Chronicle, 5/7).


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