KAISER DAILY HIV/AIDS REPORT
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http://www.kaisernetwork.org/dailyreports/hiv

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*** MEDIA TELECONFERENCE: IAS Paris Conference***
Leading HIV/AIDS researchers answer reporters’
questions at a media teleconference in anticipation
of the International AIDS Society Conference, being
held in Paris, France from July 13 - July 16, 2003.
http://www.kaisernetwork.org/healthcast/ias/02jul03
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________________________________________



Monday, July 7, 2003

POLITICS AND POLICY
========================================
1. Bush Set To Begin Five-Nation Trip in Africa; HIV/AIDS, Development Aid,
Peacekeeping on Agenda


ACROSS THE NATION
========================================
2. New York City Failing To Provide Housing for People With HIV/AIDS, Audit
Says

3. Eastern Virginia Medical School Reopens Clinics Serving Uninsured AIDS
Patients


SCIENCE & MEDICINE
========================================
4. Thai Ministry Says AIDSVAX Trial Using ALVAC Vaccine Not Affected by
VaxGen's Withdrawal From Other Trial


OPINION
========================================
5. 'Indifferent Politicians' Preventing Access to Antiretroviral Drugs in
Africa, Opinion Piece Says

6. Kaiser Daily HIV/AIDS Report Summarizes Editorials Regarding Bush's Trip
to Africa

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

POLITICS AND POLICY


1. Bush Set To Begin Five-Nation Trip in Africa; HIV/AIDS, Development Aid,
Peacekeeping on Agenda

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18640

President Bush is scheduled to leave tonight for a five-day, five-nation
tour of Africa that will focus on the fight against HIV/AIDS and
development aid; however, the trip has "taken on a new cast in recent
weeks" because of the escalating conflict in the west African nation of
Liberia, the New York Times reports (Stevenson, New York Times, 7/7). Bush
on Friday added a "sense of urgency" to his trip by ordering military
advisers to go to Liberia to determine if U.S. troops are necessary to
enforce a cease-fire, a situation that could "shadow and possibly dominate"
his planned focus on economic development and HIV/AIDS in the region, the
Chicago Tribune reports (Kemper, Chicago Tribune, 7/6). However,
administration officials said that the president is "determined" to
demonstrate that the United States has "another face [to its] foreign
policy" besides "exercising its military power," the Times reports (New
York Times, 7/7).

AIDS Fight, Development Not Possible With War


Bush is scheduled to visit Senegal, South Africa, Botswana, Uganda and
Nigeria through July 12. During the trip, the president is expected to
promote several initiatives that focus on Africa, including his five-year,
$15 billion AIDS initiative (HR 1298), which he signed into law in May.
The global AIDS initiative seeks to prevent seven million new HIV
infections, provide care for 10 million people living with the disease and
provide treatment to two million HIV-positive people. Bush is also
expected to discuss the Millennium Challenge Account, which calls for
increasing aid to developing countries in exchange for a range of political
and economic reforms (Kaiser Daily HIV/AIDS Report, 6/27). Bush said, "We
not only care deeply about the pandemic of AIDS, we hear the cries of those
who are sick and tired of corruption on the continent of Africa. And
therefore we've got a new approach" (Sammon, Washington Times, 7/7).
Walter Kansteiner, assistant secretary of state for African affairs, said,
"You can't build an HIV/AIDS clinic, you can't protect the landscape, you
can't encourage African entrepreneurs if there's a shooting war going on"
(Hillman, Dallas Morning News, 7/7).

AIDS Funding Questioned


Some advocates have expressed concern that Bush's trip to Africa, including
his focus on HIV/AIDS, is "little more" than an opportunity to spotlight
the president's "compassionate conservative" reelection platform, the Times
reports (New York Times, 7/7). Jeffrey Sachs, director of the Columbia
University Earth Institute, said, "The U.S. gives almost no help to Africa.
... Our aid [to the continent] amounts to $4 per American per year,"
adding, "It's all talk." Some advocates said that most of Bush's
initiative to combat AIDS in Africa "exist[s] only on paper," as Congress
has yet to appropriate funding for the program, the Washington Post reports
(Dobbs, Washington Post, 7/7). A House Appropriations subcommittee could
"trim ... back" appropriations for the initiative because of a tight budget
and the failure of the administration to fully implement the program, the
Times reports (New York Times, 7/7). Bush on Wednesday made a step toward
implementing the program, naming Randall Tobias, former chair and CEO of
drug maker Eli Lilly, as head of a new State Department office assigned to
oversee the global AIDS initiative (Kaiser Daily HIV/AIDS Report, 7/3).
However, Rep. Jim Kolbe (R-Ariz.), chair of the House Appropriations
foreign operations subcommittee, said, "We're not really prepared in the
first year to spend that vast amount [authorized in the global AIDS bill]
on bilateral programs" (New York Times, 7/7). Some advocates said that the
initiative will "come at a cost" to the Global Fund to Fight AIDS,
Tuberculosis and Malaria because the administration has "failed to fund
[the project] at levels that match the United States' economic power," the
Baltimore Sun reports (Murphy, Baltimore Sun, 7/7). Paul Zeitz, executive
director of the Global AIDS Alliance, said that Bush "stood before the
world, and promised $3 billion [to fight HIV/AIDS]. Anything less than
that would demonstrate that America does not keep her promises."

Have 'Patience,' Others Say


Other advocates urged "patience," saying that Bush is the first world
leader since the beginning of the AIDS pandemic to "bring the policy
discussion into the multibillion dollar range" necessary to fight the
disease, the San Francisco Chronicle reports. Dr. Eric Goosby, president
of the Pangaea Global AIDS Foundation, said that Bush is "rapidly moving
his agenda out of Washington, D.C., to where the problem is. The Africa
trip is a very visible gesture to show the importance the administration is
placing on this problem." He added, "This is an emergency, and I think the
White House understands it" (Russell, San Francisco Chronicle, 7/7). Jamie
Drummond, executive director of DATA, which advocates for debt relief,
trade reform and AIDS funding for Africa, said, "This trip needn't be just
about tourism because there are the beginnings of an historic change in
policy toward Africa, permitted by a Republican Congress, we hope, and led
by ... a Republican president. That's put us in a fascinating situation"
(New York Times, 7/7). Bush said that the trip will create "political
momentum" for the HIV/AIDS initiative, according to the Chronicle. "I want
to use this trip to say here's an example of what is possible, and let's
make sure we follow our hearts as a society," he added (San Francisco
Chronicle, 7/7). Bush is scheduled to arrive in Senegal tomorrow and
continue to South Africa, Botswana, Uganda and Nigeria. In Uganda, Bush
will honor President Yoweri Museveni for his efforts to reduce the HIV
prevalence in that country (Ba, Reuters, 7/6). Africa advocates said they
do not expect any new policies or programs to be announced during the trip
(Superville, AP/Fort Worth Star-Telegram, 7/6).

Media Coverage


The following broadcast programs reported on Bush's trip to Africa:

* CBS' "Evening News": The segment examines the trip to Africa as a public
relations mission and includes comments by Bush and Bill Fletcher,
president of the TransAfrica Forum (Knoller, "Evening News," CBS, 7/6/03).
The full segment is available online in RealPlayer.

* NPR's "Morning Edition": The segment examines the effect of Bush's trip
on the funding of the global AIDS initiative and includes comments from
Drummond and Chester Crocker, former assistant secretary of state for
Africa (O'Hara, "Morning Edition," NPR, 7/7/03). The full segment is
available online in RealPlayer.

* NPR's "Weekend Edition Saturday": In this segment, NPR's Jason Beaubien
discusses Bush's five-day agenda (Simon, "Weekend Edition Saturday," NPR,
7/5/03). The full segment is available online in RealPlayer.

* NPR's "Weekend Edition Sunday": The segment includes an interview with
Center for Global Development Senior Fellow Steve Radelet discussing the
trip (Schorr, "Weekend Edition Sunday," NPR, 7/6/03). The full segment is
available online in RealPlayer.

ACROSS THE NATION


2. New York City Failing To Provide Housing for People With HIV/AIDS, Audit
Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18641

New York City is failing to meet its "legal obligation" to provide housing
for residents with HIV/AIDS, according to an audit released on Wednesday by
city Comptroller William Thompson, Long Island Newsday reports. The audit
says that the city's HIV/AIDS Services Administration is in "disarray"
because case managers and supervisors are unsure of their duties.
Approximately 30,000 New York residents with HIV/AIDS live in "inadequate"
housing, shelters or on the street, and HASA case managers often do not
track housing applications, leaving people "stranded in homeless shelters
for months," according to Newsday. According to the audit, case managers
followed up on 10 of the 142 housing applications filed from July 2001 to
August 2002 by 104 clients. "I am troubled by a number of weaknesses that
make it difficult for HASA to find permanent housing for people with HIV
and AIDS," Thompson said, adding, "People are looking to the city for help
and instead are facing delays and roadblocks. This needs to stop." Armen
Merjian, senior staff attorney with the not-for-profit advocacy group
Housing Works, said that the most "disturbing" aspect of the housing
situation is the "health status of people being affected," adding, "The
gravity of the situation is accentuated when you consider these are people
with AIDS. We know for a fact that stable housing is critical to fighting
the illness." The city's Human Resources Administration, which oversees
HASA, said that it agreed with the report's negative findings. Since the
audit was completed, HASA has changed procedures and "overhauled" their
referral process, Newsday reports (Ramirez, Long Island Newsday, 7/2).

3. Eastern Virginia Medical School Reopens Clinics Serving Uninsured AIDS
Patients

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18642

Eastern Virginia Medical School on Tuesday after a three-month hiatus
reopened two clinics -- one on the EVMS campus and one on Colley Avenue in
Norfolk, Va. -- aimed at serving uninsured AIDS patients in the city, the
Virginian-Pilot reports (Szabo, Virginian-Pilot, 7/2). A contract dispute
between the parties regarding billing practices resulted in the revocation
of the clinics' Ryan White funds on April 11. EVMS clinics were using a
billing method in which doctors received 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. However, the federal government on June 27 approved a
contract between the city of Norfolk and EVMS regarding the administration
of Ryan White funds (Kaiser Daily HIV/AIDS Report, 7/2).

More Clinic Openings Planned


Dr. Edward Oldfield, creator of EVMS' clinic system, said that reopening
the clinics is "a huge relief," but he added that rebuilding the clinic
network likely will be "extraordinarily hard." The clinic at the Virginia
Beach Health Department is scheduled to open today and the Portsmouth
Health Department clinic is scheduled to open on July 14, according to EVMS
officials. A fifth clinic, based at the Chesapeake Health Department, had
enough funds to remain open during the three-week period. In addition,
Oldfield said that he hopes to reopen a clinic in Williamsburg in August
and one in Hampton in September, according to the Virginian-Pilot.
Oldfield also said that Norfolk has fixed several problems with the EVMS
clinic system, including allowing doctors seeing AIDS patients to treat
them for other STDs and allowing medical case managers to assist patients
with "non-health care needs," including transportation. According to the
Virginian-Pilot, some patients who had used clinic services have
experienced "hassles" and long waits at other clinics during the three-week
period and said that they were happy to hear that the clinics were
reopening (Virginian-Pilot, 7/2).

SCIENCE & MEDICINE


4. Thai Ministry Says AIDSVAX Trial Using ALVAC Vaccine Not Affected by
VaxGen's Withdrawal From Other Trial

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18643

A new clinical trial of an AIDS vaccine regimen involving VaxGen's AIDSVAX
and Aventis Pasteur's ALVAC in Thailand will not be affected by VaxGen's
expected decision to withdraw its financial support from a separate Thai
AIDSVAX trial, the Bangkok Post reports (Bhatiasevi, Bangkok Post, 7/3).
Although the decision has not yet been confirmed, VaxGen has informally
stated its intention to withdraw from the ongoing AIDSVAX trial because it
did not have the money to fund the final analysis of trial data, according
to Xinhua News Agency (Xinhua News Agency, 7/3). Dr. Kajit Choopanya,
principal investigator of the trial, said that despite the company's
funding withdrawal, researchers plan to complete the data analysis with
assistance from the U.S. government (Nation, 7/2). The new trial, which
will involve 16,000 HIV-negative volunteers from the Rayong and Chon Buri
provinces, will begin by the end of the year. In that trial, AIDSVAX will
be used as a booster for the ALVAC vaccine (Chevajumroen, Nation, 7/3).
The new trial will be run jointly by the Thai Public Health Ministry and
the Armed Forces Research Institute for Medical Sciences, a joint research
and disease surveillance institute that addresses militarily important
infectious and tropical diseases. AFRIMS has purchased sufficient amounts
of AIDSVAX to carry out the five-year study, according to the Post (Bangkok
Post, 7/3).

OPINION


5. 'Indifferent Politicians' Preventing Access to Antiretroviral Drugs in
Africa, Opinion Piece Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18644

AIDS advocates' "moral outrage" over the inaccessibility of antiretroviral
drugs should be directed "not at greedy drug companies, but at indifferent
politicians in both rich and developing countries who have failed to come
up with the money and legal framework" to make HIV/AIDS drugs widely
available in developing nations, columnist Steven Pearlstein writes in a
Washington Post opinion piece. Although the majority of HIV-positive
individuals worldwide live in Africa, the cost of antiretroviral drugs and
the lack of a supporting medical infrastructure have prevented access to
the drugs for most HIV-positive Africans, Pearlstein says. Last year,
"[a]fter getting beat up pretty badly in the press," pharmaceutical
companies that manufacture antiretroviral drugs agreed to waive their
patent rights to allow the world's poorest nations to purchase cheaper,
generic versions of the drugs, Pearlstein states. However, instead of
acting "quickly to seal the deal and move ahead with production and
distribution," developing nations -- under the "guise of rescuing Africans
from the scourge of AIDS" -- began to "see the chance" to insist that drug
firms relinquish the patent rights to all of their drugs, according to
Pearlstein. Although U.S. trade negotiators rejected the demand, their
"offers to compromise by widening the circle of exempted drugs and
countries have come to naught," he writes. Pearlstein concludes, "The
trick is to persuade rich countries to finally come up with the money and
mechanism" to buy antiretroviral drugs for the "desperately poor" without
"screwing up the economics" of the pharmaceutical industry (Pearlstein,
Washington Post, 7/4).

Increased Access Stopping Development of New Drugs


If incentives are not provided for pharmaceutical companies to balance out
generic competition and the declining profitability of antiretroviral drug
development and production, HIV-positive people will "continue to suffer,"
Roger Bate, director of Africa Fighting Malaria, writes in a Washington
Times opinion piece. Although antiretroviral drug prices have fallen by
more than 90% in developing nations, a lack of trained medical personnel
and sufficient health infrastructure have prevented widespread access to
the drugs, Bate says. In addition, the development of new drugs is down by
33% over the past five years, he states. Smaller companies and those
companies "whose reputations are not currently linked to AIDS research are
quietly slipping away from the field," unwilling to "assum[e] the risk of
clinical trials without the possibility of an eventual monetary reward,"
Bate says. While one would expect AIDS advocacy groups to "praise"
companies still willing to do such research, the groups continue to attack
pharmaceutical companies, he continues. In addition, while the Bush
administration's plan to increase access to antiretroviral drugs is
"commendabl[e] ... it seems to be unaware of the long-term harm of the
anti-pharma campaigns," Bate says. Bate concludes, "It's ironic that
activists have scared drug companies into action that will harm AIDS
patients in the long run. For while government and activists can blame
capitalism and the drug giants and profiteering, the latter acutally
develop solutions; the former just talk about them" (Bate, Washington
Times, 7/6).

6. Kaiser Daily HIV/AIDS Report Summarizes Editorials Regarding Bush's Trip
to Africa

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18645

Several newspapers have recently published editorials discussing their
views regarding President Bush's trip to Africa this week. The following
is a summary of some of the editorials:

* Atlanta Journal-Constitution: While Bush expressed a "laudable
commitment" to AIDS in his State of the Union address, "his actions at home
indicate he has no intention of keeping that promise, at least not in the
near term," a Journal-Constitution editorial says. It is the president's
"moral dut[y] ... after scoring a tremendous public relations coup," to
"follow through" on his promise and amend his budget request to increase
spending on AIDS treatment and prevention to $3 billion, the editorial
concludes (Atlanta Journal-Constitution, 7/7).

* Baltimore Sun: Bush's promise on HIV/AIDS will "ring hollow unless he
moves quickly to make good on it," a Sun editorial says. Bush's request of
only two-thirds of the $3 billion anticipated for the first year of the
initiative and his appointment of Tobias as head of the global AIDS program
have caused AIDS advocates to "warily watc[h]" and "question why the
administration isn't taking a more urgent approach to get the initiative
going," according to the Sun. The editorial concludes that Bush must show
his support by urging the passage of a bipartisan effort expected to come
before Congress this summer to raise AIDS spending for next year to the
full $3 billion (Baltimore Sun, 7/7).

* Memphis Commercial Appeal: While Bush's proposals for aid to African
nations may be "insufficient to make a dent in the continent's agony, ...
U.S.-supported programs could make a difference in hundreds of thousands of
African lives," and the president's support could be the "start of a far
greater awareness about Africa -- and also of a sustained systemic
approach" to the region, a Commercial Appeal editorial says. While "the
misery in Africa ... is such that it will be many years before the worst of
it is alleviated," the president's visit could "enliven" hope on the
continent and could "signal a commitment that will not disappear when some
other issue pulls at us," the editorial says. The editorial concludes that
it is not for "prudential reasons alone" that the administration aims to
spend $15 billion in the fight against AIDS, but "[b]y helping Africa, the
United States can help itself" (Memphis Commercial Appeal, 7/5).

* Milwaukee Journal Sentinel: "Sub-Saharan Africa generally deserves a
greater commitment than successive U.S. presidents have given it," and
while "Bush has done better than most," the continent "will never get
sustained, high-level attention unless domestic political pressure can be
brought to bear on Congress and the White House," a Journal Sentinel
editorial says. African-Americans and others must "mobilize public opinion
and generate political pressure on behalf" of Africa in order to prevent
the continent from "languish[ing] in neglect as well as poverty and
conflict," the editorial concludes (Milwaukee Journal Sentinel, 7/6).

* New York Times: Bush must "press Congress to provide ample financing for
his multiyear AIDS and development initiatives ... [and] speak plainly with
African leaders about steps they themselves need to take," a Times
editorial says. He must persuade South African President Thabo Mbeki,
whose failure to properly confront HIV/AIDS has "caused public health
damage [in South Africa] and hurt efforts elsewhere to overcome the
stigmatization that undermines effective prevention and treatment, ... to
follow a more enlightened course, [which would help] America's AIDS
assistance programs" save more lives, the Times says. In addition, Bush
must push Botswanan President Festus Mogae to expand on his country's
efforts to fight the disease, modeling the program on Uganda's AIDS
programs, the editorial concludes (New York Times, 7/7).

* Tennesean: While "Bush has indicated that he understands the need to
tend to the problems of Africa ... [h]e must now dedicate himself to seeing
that Congress shares his vision," a Tennessean editorial says. Because
Congress is "far removed from the poverty and distress the president will
witness" on his trip and is "wrestling with a budget that has become
increasingly complex," Bush must "remind Congress that nothing would help
the cause of stamping out terrorism, the cause of boosting the global
economy and the cause of peace on earth more surely than addressing the
issues that plague Africa," the editorial concludes (Tennessean, 7/7).

* Washington Post: "In a world where 'failed states' and regions of
perpetual conflict are breeding grounds for terrorism ... like it or not,
[Africa's] conflicts are now America's problem, too," a Post editorial
says. While the president's trip will "force the world to focus ... on
some of the good news coming from the continent ... the bad news will be
hard to avoid," the editorial says. Bush's visits to South Africa,
Botswana and Uganda will put him at the "center of the AIDS crisis," and
while he "has lately been active" on the issue, "the strength and endurance
of [his] commitment remain questionable," according to the Post. The
president must involve drug companies, ensure efficient and effective
programs and invest "political time and effort" in the initiative, the
editorial concludes (Washington Post, 7/7).

* Washington Times: Bush is "wise to make Africa a priority ... [and] must
soon make efforts to ensure that Congress agrees," a Times editorial says.
Upon returning from his trip, Bush must "make the case clear to Congress
... that Africa is important to U.S. interests" in order to get financial
backing for foreign aid programs, including his global AIDS initiative, the
Times concludes (Washington Times, 7/5).

________________________________________

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