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



Tuesday, June 3, 2003

POLITICS AND POLICY
========================================
1. Remaining G8 Representatives Release Summit Communique, Including Action
Steps on HIV/AIDS


IN THE COURTS
========================================
2. Hemophiliacs File Class Action Lawsuit Against Bayer Over Blood-Clotting
Products Made With HIV-Contaminated Blood


ACROSS THE NATION
========================================
3. EVMS HIV Treatment Network, Norfolk, Va., Officials Reach Tentative
Agreement on Ryan White Fund Administration

4. Philadelphia Inquirer Profiles AIDS Law Project of Pennsylvania


SCIENCE & MEDICINE
========================================
5. Postexposure Prophylaxis Should Not Be 'Automatic' Response for Children
Exposed to HIV, Clinical Report Says


OPINION
========================================
6. United States Must Continue To Do More in Fight Against AIDS
Internationally, Domestically, Rep. Barbara Lee Says

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POLITICS AND POLICY

1. Remaining G8 Representatives Release Summit Communique, Including Action
Steps on HIV/AIDS

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18051

Six of the eight heads of state and government remaining at the G8 summit
in Evian, France, have "wrapp[ed] up" talks and released their final summit
communique, the AFP/Age reports (AFP/Age, 6/3). The G8 Action Plan
"reaffirm[s]" the group's support of the Global Fund to Fight AIDS,
Tuberculosis and Malaria, including an international donors' and
supporters' conference to be held in Paris in July to "develop strategies
for mobilizing resources in order to secure sustainable long term financing
for the fund and other complementary efforts, and to achieve cost effective
results-targeted management of the Global Fund." The Action Plan also
calls for strengthening health systems in developing countries as a
"framework for increasing access" to health care, medicine and treatment.
In addition, the G8 calls for increasing access to medicines, which
includes resolving disagreements within the World Trade Organization
negotiations on expanding access to generic drugs, including those used to
treat HIV/AIDS, in developing countries (G8 Action Plan, 6/3). WTO talks
in Geneva over generic drug access have been stalled since members missed a
Dec. 31, 2002, deadline to reach an agreement. U.S. negotiators in February
refused to sign a deal under the Doha declaration to allow developing
nations to override patent protections to produce or import generic
versions of drugs to combat public health epidemics unless wording was
included to specify which diseases constitute a public health epidemic
(Kaiser Daily HIV/AIDS Report, 6/2). The Action Plan calls for a
"multilateral solution in the WTO to address the problems faced by
[developing] countries, rebuilding the confidence of all parties." The
communique concludes, "Global health crises call for close international
cooperation on policies and methods. ... We will work in partnership with
developing countries, the private sector, multilateral organizations and
nongovernmental organizations to help achieve these health goals" (G8
Action Plan, 6/3).

Commitment Questioned


International health workers at the Global Health Council's annual
conference last weekend in Washington, D.C., questioned the commitment of
Western countries to increasing contributions to the Global Fund, NPR's
"All Things Considered" reports. According to NPR, "many health workers"
were "baffled by the unkept promises of industrialized countries" (Wilson,
"All Things Considered," NPR, 6/2). The G8 summit made little progress in
increasing contributions to the international effort to combat HIV/AIDS
(Kaiser Daily HIV/AIDS Report, 6/2). President Bush "highlighted" a $15
billion, five-year U.S. plan to fight AIDS at the summit and "urged" other
G8 leaders to make similar commitments to the effort (White House fact
sheet, 6/2). Bush last week signed into law a bill that authorizes $15
billion over five years to fight AIDS in Africa and the Caribbean. In
addition, it authorizes up to $1 billion in fiscal year 2004 for the Global
Fund, but the amount actually appropriated is contingent upon the
contributions of other countries. Under the measure, the United States can
contribute up to $1 billion to the fund only if that amount totals no more
than one-third of the fund's total contributions. Therefore, in order for
the total $1 billion to be appropriated, other nations must contribute more
money (Kaiser Daily HIV/AIDS Report, 6/2). According to NPR, the United
Kingdom increased its pledge to the Global Fund to $280 million over the
next five years and France tripled its pledge to $150 million after next
year. However, the amounts are "far short" of the $1.5 billion currently
needed by the fund, NPR reports.

AIDS Advocates Comment


Stephen Talugende of Uganda's People's Defense Forces said at the meeting,
"I am very angry today. The G8 countries have failed to contribute their
pledges. But my anger is caused by the fact that a country like Uganda
managed to raise ... $2 million. Why [are] G8 countr[ies] failing to do
so?" Relative to its economy, Uganda's contribution is approximately four
times as much as the U.S. contribution, NPR reports. Jeffrey Sachs,
director of the Earth Institute at Columbia University and chair of the WHO
Commission on Macroeconomics and Health, said that the $200 million U.S.
pledge to the Global Fund proposed by Bush in his fiscal year 2004 budget
is a "pittance," adding, "We have to keep the truth in front of us, which
is that we're not doing our part, Europe's not doing its part, the Global
Fund cannot do its part." Anthony Fauci, head of the NIH National
Institute of Allergy and Infectious Diseases, said that the United States
"can be more effective" by assisting countries directly, adding that the
$200 million pledged to the fund in Bush's budget and future U.S.
contributions to the Global Fund are "meant to complement each other" ("All
Things Considered," NPR, 6/2). The full segment is available online in
RealPlayer.

IN THE COURTS

2. Hemophiliacs File Class Action Lawsuit Against Bayer Over Blood-Clotting
Products Made With HIV-Contaminated Blood

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18052

Thousands of hemophiliacs on Monday filed a class-action suit in federal
court against drug maker Bayer and other drug companies alleging that in
the mid-1980s the companies knowingly sold blood-clotting products that
were made with HIV- and hepatitis C-contaminated blood, the AP/Orlando
Sentinel reports. The suit, which comes less than two weeks after a New
York Times investigation publicized the issue, also alleges that the
companies continued to sell the product overseas after introducing a safer
version in the United States. The hemophiliacs filed the suit on behalf of
patients in other countries who received the medicine, called Factor VIII
concentrate, which can stop potentially fatal bleeding in people with
hemophilia (Curtis, AP/Orlando Sentinel, 6/2). The Times reported that
Cutter Biological, a division of Bayer, in the mid-1980s reportedly sold
millions of dollars worth of Factor VIII that had a high risk for
transmitting HIV to treat hemophiliacs in Asia and Latin America, while it
sold a safer, heat-treated version of the product in the United States and
other Western countries. In the early years of the AIDS epidemic, the
company used pooled plasma donations from about 10,000 people to make the
medicine. However, because there was not yet a test for HIV, thousands of
hemophiliacs became infected through the use of Factor VIII (Kaiser Daily
HIV/AIDS Report, 5/23). The lawsuit claims that there were precautions the
drug makers could have taken to help avoid contamination, including
screening donors or using volunteers, the AP/Sentinel reports. Attorney
Robert Nelson said, "Thousands of hemophiliacs have unnecessarily died from
AIDS and many thousands more are infected with HIV or hepatitis C," adding,
"This is a worldwide tragedy." Representatives from neither Bayer nor
Baxter Healthcare, which is also named in the lawsuit, returned phone calls
seeking comment after business hours yesterday, the AP/Sentinel reports
(AP/Orlando Sentinel, 6/2).

ACROSS THE NATION

3. EVMS HIV Treatment Network, Norfolk, Va., Officials Reach Tentative
Agreement on Ryan White Fund Administration

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18053

Eastern Virginia Medical School and Norfolk, Va., officials on Friday
announced that they had reached a tentative agreement to reopen six of the
seven clinics in the region that serve roughly 400 AIDS patients, the
Virginian-Pilot reports (Virginian-Pilot, 6/1). A contract dispute between
Norfolk, Va., officials and EVMS clinic doctors regarding billing practices
resulted in the revocation of the clinics' Ryan White funds on April 11.
EVMS clinics use a billing method in which doctors receive a set fee for
each patient, a practice that is reportedly not allowed under federal
government regulations. As a result, the clinics lost their Ryan White
money and had to cease operations (Kaiser Daily HIV/AIDS Report, 5/12).
Mayor Paul Fraim said that he is "frustrated" that Norfolk has "fumbled
such an important program," according to the Virginian-Pilot. He added,
"It's a concern, especially when people have such documented needs." Fraim
on Wednesday said that the city might hire an outside agency to
"permanently handle the grant," which would mark the grant's third
administration change in five years, according to the Virginian-Pilot. He
added that using a private contractor to administer the Ryan White funds
locally "would remove some of the bureaucracy" and allow the program to run
"more efficient[ly]."

'Harder Than It Needs To Be'


Some advocates are concerned because other proposals have failed in recent
months. They said that the city's administration "makes spending [Ryan
White Title I] money harder than it needs to be," which has prompted some
health care providers to leave the program, the Virginian-Pilot reports.
Over the past four years, Norfolk has failed to spend an average of $1
million per year from Title I Ryan White funds, and an estimated 900 local
residents living with HIV are not receiving care, the Virginian-Pilot
reports. Only two metropolitan areas out of the 51 that received funds
under Title I spent a smaller percentage of their funding in the fiscal
year that ended Feb. 28, 2002, than Norfolk. Susan Garvey, a psychologist
based in Norfolk, said, "We have the opportunity to be really cutting edge.
But now, it's just a chronic mess" (Virginian-Pilot, 6/2).
4. Philadelphia Inquirer Profiles AIDS Law Project of Pennsylvania

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18054

The Philadelphia Inquirer yesterday profiled the Philadelphia-based AIDS
Law Project of Pennsylvania, the country's only independent, not-for-profit
public-interest law center dedicated to the needs of people with HIV/AIDS.
The group, founded 15 years ago by lawyer David Webber, receives 1,700
calls each year. In the early days of the project, most calls were based
on issues of discrimination, but now only 10% of calls are based on such
cases. Clients who legal seek help at the Law Project today are usually
looking to obtain disability benefits, write wills or arrange trusts for
their children, Executive Director Ronda Goldfein said. Goldfein added
that the group "needs an office in Western Pennsylvania" due to the Law
Project's increasing number of clients and to "truly reflect its name"
(Slobodzian, Philadelphia Inquirer, 6/2).

SCIENCE & MEDICINE

5. Postexposure Prophylaxis Should Not Be 'Automatic' Response for Children
Exposed to HIV, Clinical Report Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18055

All children who are exposed to HIV should not "automatically" receive
antiretroviral drugs for postexposure prophylaxis, or PEP, and health care
providers should consider "whether the risk of infection is greater than
the risks associated with taking the drugs," according to a clinical report
in the June issue of the journal Pediatrics, Reuters Health reports
(McCook, Reuters Health, 6/2). Dr. Peter Havens of the Medical College of
Wisconsin and colleagues of the American Academy of Pediatrics Committee on
Pediatric AIDS conducted a literature review to examine the issues
surrounding HIV exposure among children and adolescents and to provide PEP
recommendations for such situations. Although the U.S. Public Health
Service has published guidelines for PEP for occupational and
nonoccupational exposures, the recommendations do not address situations
unique to children, such as exposure to breastmilk from an HIV-positive
woman or a puncture wound from a needle found on a playground. Because
antiretroviral drugs used for PEP can cause "significant toxicity," the
choice to start PEP should be made "in consultation with the patient, the
family and a clinician with experience in treatment of persons with HIV
infection." If begun, PEP should be initiated "as soon as possible" --
within 72 hours -- to the time of exposure and continued for 28 days, the
committee states. Health care workers should provide instructions on how
to prevent secondary transmission and conduct follow-up visits to address
emotional support, medication adherence, toxicity monitoring and serial HIV
antibody testing if necessary (Havens et al., Pediatrics, June 2003).
Havens said that antiretroviral drugs are expensive and can "cause a host"
of side effects, according to Reuters Health. He added, "There's no reason
to do all of that if you're not really at risk of HIV. So when you get
right down to it, the number of times that this would be recommended in
actual practice is quite low" (Reuters Health, 6/2).

OPINION

6. United States Must Continue To Do More in Fight Against AIDS
Internationally, Domestically, Rep. Barbara Lee Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18056

Although Congress's passage of and President Bush's signing of the global
AIDS bill (HR 1298) is a "significant benchmark" in the fight against
HIV/AIDS internationally, "we can and must do more," Rep. Barbara Lee
(D-Calif.), a cosponsor of the legislation and a member of the House
International Relations Committee, writes in a San Francisco Chronicle
opinion piece. "[A]s we move forward to attack the spread of AIDS within
our own country and around the world, we must not forget that AIDS is still
on the move, and we have a long way to go before we catch up," Lee says.
Although the $15 billion over five years that is authorized in the AIDS
bill "may seem like a lot of money," more funds are needed to cover
prevention programs and care and treatment for HIV-positive individuals
worldwide, she says. In addition, Lee writes that the United States needs
to provide more aid to countries that are "in the next wave" of the
epidemic, including countires such as China, Russia and India. "But most
especially, we must turn our attention to our own domestic AIDS crisis,"
she says, adding that the country's "wealth and scientific knowledge" has
not been enough to stem the spread of the virus or provide medical and
social services for HIV-positive people in the United States. Lee notes
that HIV/AIDS is "devastating communities of color," as AIDS-related death
is the leading cause of death among African Americans ages 25 to 44 and the
third leading cause of death among Latinos in the same age group. Despite
these "horrific" numbers, the United States has not increased funding for
domestic AIDS programs, Lee says, adding, "We cannot allow this trend to
continue." Lee writes, "At the same time, we cannot delude ourselves into
believing that a single act or initiative can stop AIDS," concluding, "It
will take a sustained effort that matches funding levels to actual needs,
targets dollars to those who are most vulnerable, and at the same time
ensures universal access to prevention, care and treatment services" (Lee,
San Francisco Chronicle, 6/2).

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