KAISER DAILY HIV/AIDS REPORT
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Monday, June 9, 2003

POLITICS AND POLICY
========================================
1. HHS To Review Studies Claiming Unsafe Medical Practices, Not Sex,
Primary Mode of HIV Transmission in Africa


ACROSS THE NATION
========================================
2. Fort Lauderdale Sun-Sentinel Series Examines AIDS in South Florida


DRUG ACCESS
========================================
3. National ADAP Working Group Calls for $145M in Emergency Supplemental
Funds for Fiscal Year 2003


GLOBAL CHALLENGES
========================================
4. Global Fund 'Urgently' Needs $700 Million To Fund Projects Up for
Approval This Year

5. Global Fund Money Expands HIV/AIDS Treatment, Prevention Programs in
Haiti

6. African First Ladies Focus on Ending HIV/AIDS Stigma


PUBLIC HEALTH & EDUCATION
========================================
7. Balm in Gilead Calls for 'Every Black Pulpit' To Talk About HIV/AIDS at
Meeting


MEDIA & SOCIETY
========================================
8. Musician Carlos Santana To Donate All Proceeds From Concert Tour to AIDS
in South Africa

9. Ugandan Children's Choir Tours Washington, D.C.-Area Churches To Raise
Money To Build Homes for AIDS Orphans


OPINION
========================================
10. State, Federal Governments, Drug Companies Must Make Fuzeon More
Affordable, Editorial Says

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

POLITICS AND POLICY


1. HHS To Review Studies Claiming Unsafe Medical Practices, Not Sex,
Primary Mode of HIV Transmission in Africa

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18136

HHS Secretary Tommy Thompson has launched a review of several recent
studies claiming that the primary mode of HIV transmission in sub-Saharan
Africa is unsafe medical practices not unsafe sex, the results of which
could change how money authorized under the recently signed five-year, $15
billion global AIDS bill is distributed, the AP/Fort Lauderdale
Sun-Sentinel reports (McMurray, AP/Fort Lauderdale Sun-Sentinel, 6/9). A
team of eight researchers from the United States and Germany led by
anthropologist David Gisselquist in March published three studies in the
International Journal of STD & AIDS supporting a theory that unsafe medical
practices are the primary route of HIV transmission in sub-Saharan Africa.
The same team published in May a similar study in the British Journal of
Obstetrics and Gynaecology. While most AIDS organizations say that
heterosexual contact has accounted for 90% of the HIV cases in Africa, the
studies claim 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, are a much greater threat (Kaiser
Daily HIV/AIDS Report, 5/7). Sen. Jeff Sessions (R-Ala.), who called a
Senate hearing on the issue in March, requested the HHS review, saying that
spending priorities in the global AIDS bill could be shifted if new
research supporting the theory surfaces. HHS officials declined to comment
on the likelihood of such a shift or when the investigation is expected to
be finished.

WHO Acknowledges Low Estimate


A WHO report dated Dec. 19, 2002, cites four different studies claiming
that unsafe medical practices are responsible for 8%, 15%, 41% and 45% of
HIV transmission in sub-Saharan Africa, respectively, according to the
Sun-Sentinel. The report concludes that "the lowest attributable fraction
calculated on the basis of the data provided ... (8%) exceeds our 2.5%
modeled attributable fraction, suggesting that our estimate is
conservative," the Sun-Sentinel reports. Yvan Hutin, a WHO researcher who
wrote the report, said that no matter what the true percentage, AIDS
organizations should consider education campaigns on unsafe needle use.
"It remains a very good investment to do injection safety," Hutin said,
adding, "It doesn't matter whether it's 2.5% or more or less" (AP/Fort
Lauderdale Sun-Sentinel, 6/9). However, a UNAIDS/WHO expert group in March
concluded that unsafe sex, not unsafe medical practices, is the primary
mode of HIV transmission in sub-Saharan Africa. In addition, researchers
from the University of Oxford in April published a study in the journal
Nature supporting the theory that unsafe sex was the primary transmission
route for HIV infection in Africa (Kaiser Daily HIV/AIDS Report, 5/7).

ACROSS THE NATION


2. Fort Lauderdale Sun-Sentinel Series Examines AIDS in South Florida

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18137

The Fort Lauderdale Sun-Sentinel on Sunday published a six-part series
called "AIDS in South Florida." The Sun-Sentinel reports that AIDS is "on
a rampage in our backyard" and is "spreading like a cancer, slowly killing
people" throughout the region. According to the series, HIV prevalence
"soared" in South Florida last year, increasing by "an unprecedented" 44%
in Palm Beach County, 30% in Broward County and 18% in Miami-Dade County.
The following summarizes each of the six articles in the series:

* "Chapter One: Survivors": The article looks at how HIV/AIDS drugs are
keeping people alive "longer than ever." Although medications keep the
virus under control, HIV still complicates the pre-existing health problems
of people who are HIV-positive (Doup, Fort Lauderdale Sun-Sentinel, 6/8).

* "Chapter Two: Children": The article looks at how 10 years ago, children
infected with HIV at birth were given "little hope" by physicians, but now
many of the offspring of HIV-positive women are born HIV-negative in large
part because of new medications. In addition, many children with HIV are
living longer due to the drugs, the Sun-Sentinel reports (Doup, Fort
Lauderdale Sun-Sentinel, 6/8).

* "Chapter Three: African Americans": HIV "stalks" the African-American
community and AIDS-related complications are the leading cause of death of
African-American men and women ages 25 to 44 in Florida, the Sun-Sentinel
reports. According to the Sun-Sentinel, one out of every 46 African
Americans in Florida has HIV, and many are "too fearful to get tested or
confront their partners" because they "fear losing their job, damaging
their reputation or even physical retaliation" (Doup, Fort Lauderdale
Sun-Sentinel, 6/8).

* "Chapter Four: Immigrants": The article looks at the "struggle" facing
immigrants with HIV/AIDS, whose illnesses are complicated by "daunting
roadblocks" such as language barriers and different cultures and beliefs.
In particular, immigrant women are "often frighteningly powerless" in
fighting the disease. The women, "even when infected by their husbands,"
often are "afraid to speak up" out of fear of abandonment or physical
violence (Doup, Fort Lauderdale Sun-Sentinel, 6/8).

* "Chapter Five: Young Gays": The article examines the prevalence of
HIV/AIDS among young gay people in the region. The Sun-Sentinel reports
that HIV transmission is sometimes "helped along by the party atmosphere"
in South Florida. In addition, many young gay men are not aware of their
HIV status and are not practicing safe sex, the Sun-Sentinel reports (Doup,
Fort Lauderdale Sun-Sentinel, 6/8).

* "Chapter Six: Solutions": The article looks at the many ways in which
health care workers and researchers are "finding ways to fight" HIV/AIDS,
including making AIDS awareness campaigns available in several languages,
eliminating the taboos surrounding HIV/AIDS, encouraging HIV testing and
condom use and teaching about the disease, abstinence and condom use in
schools (Doup, Fort Lauderdale Sun-Sentinel, 6/8).

DRUG ACCESS


3. National ADAP Working Group Calls for $145M in Emergency Supplemental
Funds for Fiscal Year 2003

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18138

The National ADAP Working Group is calling for $145 million in emergency
supplemental appropriations to maintain the AIDS Drug Assistance Program's
current levels of functioning through the end of this fiscal year, which
ends on March 31, 2004, according to a ADAP Working Group press release.
The recommendation is based on the findings of a recent National ADAP
Monitoring Project report (ADAP Working Group release, 6/6). According to
the report, which was released in April and was based on a survey by the
Kaiser Family Foundation, the National Alliance for State and Territorial
AIDS Directors and the AIDS Treatment Data Network, although the national
ADAP budget increased by $86 million during FY 2000, the program is running
out of money in more and more states. ADAPs provide prescription drugs in
all 50 states, the District of Columbia, Puerto Rico and Guam for
HIV-positive individuals who are uninsured and could otherwise not access
such drugs. However, at least 10 states, including Georgia, Maine and
Texas, have had to restrict access to antiretroviral drugs or cap program
enrollments because of limited funding (Kaiser Daily HIV/AIDS Report, 5/9).
Bill Arnold, executive director of the Working Group, said, "It is vital
that Congress appropriate $145 million in emergency funds immediately so
that ADAPs across the nation won't be forced to impose more drastic
limitations to access this year." He added that without those funds, ADAPs
will need an additional $283 million for FY 2004 "just to eliminate the
waiting lists and limitations in ADAP services that will result from
inaction now." Working Group Co-Chair Lei Chou said, "It's very simple. We
either pay this amount now or we pay enormous amounts later. The data is
clear and concrete" (Working Group release, 6/6).

GLOBAL CHALLENGES


4. Global Fund 'Urgently' Needs $700 Million To Fund Projects Up for
Approval This Year

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18139

The Global Fund to Fight AIDS, Tuberculosis and Malaria on Thursday said
that it "urgently" needs at least $700 million to fund projects that are up
for approval this year, Reuters reports. The amount is the gap between the
total amount asked for in project proposals set to gain approval this year
and the $300 million the fund has left to spend this year, according to
Reuters. Global Fund Executive Director Richard Feachem said, "We have a
shortfall of about $700 million and much work is going on to bridge that
gap" (Reuters, 6/5). The Global Fund board on Thursday agreed at its
three-day meeting in Geneva, which ended on Friday, that it would limit
proposals for the third round of grants to the amount of funds currently
available based on the proposals' merits, the Financial Times reports. The
fund has received more than 200 proposals from 85 countries requesting $2
billion over two years, and about half of those proposals will likely be
recommended to the board for approval (Williams, Financial Times, 6/7).
The fund has so far awarded $1.5 billion to 153 health programs in 92
countries (Reuters, 6/5).

New Pledges


The Global Fund welcomed new pledges, which have increased by $1.2 billion
to $4.6 billion through 2008 in the week since the G8 summit in Evian,
France (Global Fund release, 6/6). Feachem said that the United States and
France have led the way in making pledges to the fund, and the European
Union, Italy and Britain have made new pledges since the G8 summit.
However, the fund needs $3 billion to cover grant rounds during the
remainder of this year and next year (Associated Press, 6/6). Feachem
said, "In authorizing up to $1 billion for its 2004 fiscal year, President
Bush and the U.S. Congress challenged other donors to respond, and they
have. [French] President Chirac has led an effort for Europe to raise $1
billion and called on public and private donors outside the U.S. and Europe
to also raise $1 billion (Global Fund release, 6/6). Feachem added that he
is "more optimistic the money would be found" following the summit, where
member countries agreed to "step up support" for the fund, according to
Reuters (Reuters, 6/5). HHS Secretary Tommy Thompson, chair of the Global
Fund board, said, "I am pleased with the important progress we made" during
the meeting. He added, "But we recognize that there is much work to be
done, especially in the areas of increasing contributions and developing
innovative, aggressive strategies to fight HIV/AIDS, tuberculosis and
malaria" (Global Fund release, 6/6).

Grant Approvals


The Global Fund on Friday signed $60 million in grant agreements for
Romania, Bulgaria, Cuba and East Timor, according to a Global Fund release.
Romania will use $16.9 million to increase access to TB treatment. The
nation will use another $21.8 million to address HIV/AIDS in the country,
allowing the government to boost "prevention efforts in priority areas" and
strengthen treatment, care and support for people living with HIV/AIDS.
Bulgaria's $6.9 million grant will "cover all remaining program funding
gaps," according to the release. Cuba is the first Latin American country
to receive approval from the second round of Global Fund's grant
applications, according to the release. Cuba's $11.5 million grant will
subsidize the country's HIV/AIDS treatment and prevention programs,
including training counselors and peer educators and boosting access to
antiretrovirals. East Timor will use its $3 million to help control
malaria, as well as increase early detection and treatment and promote
community education (Global Fund release, 6/6). The Global Fund on Saturday
also awarded a $15 million grant to Sri Lanka for TB and malaria
prevention, Xinhua News Agency reports. Of those funds, $8.5 million will
go toward malaria prevention and $6.2 million will fund TB prevention,
according to Ministry of Health and Nutrition spokesperson Kapila
Bamunuarachchi (Xinhua News Agency, 6/7).

5. Global Fund Money Expands HIV/AIDS Treatment, Prevention Programs in
Haiti

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18140

The first disbursements of a two-year, $25 million grant to Haiti from the
Global Fund to Fight AIDS, Tuberculosis and Malaria are being used to
expand treatment and prevention programs and purchase antiretroviral drugs
for some of the island's 300,000 HIV-positive individuals, the
AP/Washington Post reports (James, AP/Washington Post, 6/8). Haiti is
scheduled to receive $67 million in grant money over the next five years
from the Global Fund. UNAIDS estimates that more than 5% of Haitian adults
ages 15 to 49 are HIV-positive, and last year, HIV/AIDS was responsible for
30,000 deaths in the country (Kaiser Daily HIV/AIDS Report, 4/16). About
2% of the Caribbean's population is HIV-positive, making it the second-most
affected region after sub-Saharan Africa, according to the AP/Post. Haiti
accounts for most of the cases in the region, but physicians say prevention
programs have been effective. Dr. William Jean Pape, a Cornell University
professor whose Gheskio clinic treated more than 21,000 HIV/AIDS patients
last year, said that he will use $1.7 million from the Global Fund to
upgrade treatment, prevention and testing at the new centers in clinics and
hospitals throughout Haiti, according to the AP/Post. Dr. Paul Farmer,
director of Partners in Health and a Harvard Medical School professor, said
that $2.5 million will be used to double the number of HIV/AIDS patients
seen at hospitals and clinics in the impoverished central plateau.
Partners in Health is obtaining cheaper antiretrovirals for patients, but
Farmer said that many needs remain. "We lose patients every week because
we don't have enough meds," Farmer said (AP/Washington Post, 6/8). Haiti
is also expected to receive funding under the five-year, $15 billion global
AIDS initiative that was recently signed by President Bush (Kaiser Daily
HIV/AIDS Report, 4/16).

A kaisernetwork.org video feature prepared by Fred de Sam Lazaro, a
correspondent for the NewsHour with Jim Lehrer, is available online, along
with additional information and resources about Haiti.

6. African First Ladies Focus on Ending HIV/AIDS Stigma

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18141

The first ladies of Kenya, Rwanda, Gabon and Uganda have pledged to end
the stigma that surrounds HIV/AIDS, U.N. IRIN/AllAfrica.com reports. The
women were meeting at a two-day conference, titled "United Against Stigma
and Discrimination," that began Thursday in Rwanda. The first ladies said
that HIV/AIDS is one of Africa's greatest threats but added that stigma
prompted by fear and shame has harmed prevention and treatment efforts.
Janet Kagame of Rwanda said that stigma originates from "[f]ear because
testing positive is tantamount to a death sentence and shame because the
HIV mode of transmission is surrounded by taboo and moral judgment."
Approximately 70% of HIV-positive individuals worldwide live in sub-Saharan
Africa, and 90% of new HIV infections occur in that region. The first
ladies said that they would work with other African leaders to help reduce
stigma. "The more alarm we raise about HIV/AIDS the more lives we will
save," Uganda's Janet Museveni said (U.N. IRIN/AllAfrica.com, 6/5).

PUBLIC HEALTH & EDUCATION


7. Balm in Gilead Calls for 'Every Black Pulpit' To Talk About HIV/AIDS at
Meeting

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18142

About 300 black church pastors and advocates at the end of last month
attended a Balm in Gilead conference on AIDS in the black community in
Charlotte, N.C., the AP/Wichita Eagle reports (Whitmire, AP/Wichita Eagle,
6/7). The not-for-profit group seeks to stem the spread of HIV/AIDS in the
black community by encouraging churches and faith-based groups to provide
education and support networks for all people living with and affected by
the disease (Kaiser Daily HIV/AIDS Report, 3/3). The Balm in Gilead also
sponsors the annual "Black Church Week of Prayer for the Healing of AIDS"
in March, which involves 12,000 congregations. The group offers technical
support to churches that want to become "more actively involved" in the
fight against HIV/AIDS, the AP/Eagle reports. The conference gave churches
ideas on how to mobilize their communities; where to seek funding; how to
teach abstinence; and how to teach teenagers "survival techniques,"
including awareness, condom use and abstinence, the AP/Eagle reports
(AP/Wichita Eagle, 6/7). Speaking at the meeting, Pernessa Seele, founder
of the New York-based group, called on churches to "talk about abstinence
first, then condoms" (Garfield, Charlotte Observer/Tallahassee Democrat ,
6/8). She also said, "Twenty-two years into this epidemic, the response to
this disease continues to be driven by politics and theology -- not by
public health and compassion. If we're looking for someone to come and
save us -- sorry." Seele added, "We cannot just compartmentalize our
response to HIV in our community. We have to do everything. We only have
one place to go now, and that's the church. We need every black pulpit
talking about HIV" (AP/Wichita Eagle, 6/7).

MEDIA & SOCIETY


8. Musician Carlos Santana To Donate All Proceeds From Concert Tour to AIDS
in South Africa

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18143

Rock guitarist Carlos Santana on Thursday announced that he plans to
donate all of the proceeds from his upcoming 23-city concert tour to
Artists for a New South Africa's Amandla AIDS Fund, AFP/Yahoo! News
reports. Santana, who is believed to be the first artist to donate all
concert proceeds to charity, expects to raise more than $3 million in
ticket sales and hopes to spread a "spiritual virus" of compassion for
HIV-positive people (AFP/Yahoo! News, 6/6). In addition, Santana plans to
use the tour as an opportunity to educate his fans about the AIDS pandemic
and ANSA through information tables at each concert stop and speeches by
ANSA artists in selected cities (ANSA release, 6/6). ANSA will use the
money raised on the tour to fund prevention and treatment programs and to
care for AIDS orphans in South Africa, Sharon Gelman, executive director of
ANSA, said (AFP/Yahoo! News, 6/6). Representatives of the group, including
actors Alfre Woodard and Samuel L. Jackson, as well as South African
Archbishop Desmond Tutu, attended a press conference on Thursday to
announce the pledge (Zeidler, Reuters, 6/5). "Apartheid tried to destroy
our people and apartheid failed," Tutu said, adding, "If we don't act
against HIV/AIDS it may succeed, for it is already decimating our
population" (AP/Yahoo! News, 6/6).

9. Ugandan Children's Choir Tours Washington, D.C.-Area Churches To Raise
Money To Build Homes for AIDS Orphans

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18144

The Washington Post on Saturday profiled the Watoto Children's Choir from
Uganda, which this weekend performed in several Washington, D.C.-area
churches to raise awareness of HIV/AIDS in Africa and raise money for the
Watoto Child Care Ministries, a Ugandan church group that is building homes
for some of the country's two million orphans. The children who make up
the choir are orphans, most of them because of AIDS, and live in "villages"
created by the Watoto Child Care Ministries. Each village consists of 36
homes on a 20-acre lot, a primary school, a clinic and a clean drinking
water project. Each house, which shelters eight children and a "house
mother," costs about $10,000 to build and furnish (Branigin, Washington
Post, 6/7). The complete article is available online.

OPINION


10. State, Federal Governments, Drug Companies Must Make Fuzeon More
Affordable, Editorial Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18145

Although the recently approved antiretroviral drug Fuzeon will "help many,
mainly those who have become resistant to traditional treatment, ... we
must not forget that the lack of affordability of such drugs is a large
concern in this country and funding shortfalls mean more people waiting for
treatment and more restrictions in governmental drug assistance programs,"
a Denver Post editorial says (Denver Post, 6/6). The FDA in March approved
Fuzeon, which is designed for HIV/AIDS patients who have failed to respond
to other medications. The drug costs about $20,000 per patient per year,
double the price of the most expensive HIV treatments currently on the
market. The total cost of treatment with Fuzeon could reach between
$30,000 and $40,000 per patient per year because the drug must be taken in
combination with other medicines (Kaiser Daily HIV/AIDS Report, 6/2). Drug
makers "must get with the program and work with the AIDS Drug Assistance
Programs to find ways to make the drugs more affordable," the editorial
says, adding that the federal government "also must continue to expand
funding to AIDS prevention programming." The Post concludes that Fuzeon
and "other drugs that treat HIV and AIDS must become more affordable for
those who need them" (Denver Post, 6/6).

________________________________________

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