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Wednesday, July 9, 2003

POLITICS AND POLICY
========================================
1. Bush Makes Stops in Senegal, South Africa; Says U.S. Prepared To Help
Africa 'Turn Tide' Against AIDS


GLOBAL CHALLENGES
========================================
2. HIV/AIDS Greatest Barrier to Development in Poor Nations, UNDP Report
Says

3. 'New Variety' of Famine Caused By Disease Has Agencies Retooling
Strategies To Provide Long-Term Food Aid


DRUG ACCESS
========================================
4. U.S. Efforts To Shape Drug Patent Laws in Developing Countries,
Worldwide 'Go Beyond Global Standards'

5. Ireland, Clinton Foundation Sign $158.2 Million Agreement To Provide
AIDS Drugs to Mozambique

6. Early Treatment for HIV Act Could Reduce Death Rate of HIV-Positive
People on Medicaid by 50%, Study Shows


MEDIA & SOCIETY
========================================
7. POZ Magazine Publishes Special Issue on HIV/AIDS in Black Community

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

POLITICS AND POLICY


1. Bush Makes Stops in Senegal, South Africa; Says U.S. Prepared To Help
Africa 'Turn Tide' Against AIDS

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18691

President Bush yesterday continued his five-day, five-country trip through
Africa, speaking in Senegal about HIV/AIDS and denouncing slavery, the
Philadelphia Inquirer reports (Thomma, Philadelphia Inquirer, 7/9). Bush
is scheduled to visit Senegal, South Africa, Botswana, Uganda and Nigeria
before leaving the continent on Saturday. 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 (Kaiser Daily HIV/AIDS
Report, 7/8). Speaking in Senegal before departing for South Africa, Bush
said, "In the face of spreading disease, we will join with you in turning
the tide against AIDS in Africa" (Philadelphia Inquirer, 7/9). In South
Africa -- which has the largest HIV-positive population of any nation in
the world -- Bush met with President Thabo Mbeki, lauding the country's
efforts to fight HIV/AIDS (BBC News, 7/9).

Botswana


Bush tomorrow heads to Botswana for a seven-hour visit that is scheduled to
include talks with President Festus Mogae about HIV/AIDS and trade (South
African Press Association, 7/8). Botswana, which is using comprehensive
programs involving prevention and treatment to fight AIDS, has received
grants for its universal access antiretroviral drug program totaling more
than $100 million over five years from the Bill & Melinda Gates Foundation
and drug maker Merck. In addition, the Harvard AIDS Institute has built a
$4.5 million AIDS research laboratory and is training health care workers
to address the epidemic (Kaiser Daily HIV/AIDS Report, 7/8). First lady
Laura Bush and Botswana's first lady Barbara Mogae tomorrow are scheduled
to visit Gabrone Princess Marina State Hospital's Children's Clinical
Centre of Excellence, which treats HIV-positive children (South African
Press Association, 7/8). According to official estimates, 38% of
Botswana's 1.5 million residents are HIV-positive. Mogae said that
HIV/AIDS and the stigma surrounding the disease are "threaten[ing]
Botswana's future," according to the Associated Press. He added that
"[a]ll gains are being reversed by HIV/AIDS." Mogae also said that he
wants Botswanans to see HIV/AIDS as "any other" disease and to consider HIV
tests "routine" (Kraft, Associated Press, 7/9).

Uganda


Bush on Friday will travel to Uganda, which has "waged a successful fight
to reduce" HIV prevalence "by enlisting frank discussion about sex," the
Washington Post reports (Wax, Washington Post, 7/9). Uganda has had
success in lowering HIV prevalence rates by employing the "ABC" HIV
prevention model -- abstinence, be faithful, use condoms (Kaiser Daily
HIV/AIDS Report, 5/28). Bush has cited Uganda's program as a model for his
global HIV initiative (Kaiser Daily HIV/AIDS Report, 6/23). The program
has led to a drop in the country's HIV prevalence from 30% of the
population to 5% in a little more than 10 years. But Uganda's program
"heavily promote[s]" condom use, which could put the president "at odds"
with Ugandans, according to the Post. Michael Etukoit, manager of TASO, an
AIDS support group, said, "I won't mind telling Mr. Bush when he visits
that young children need to know about condoms here. It's too idealistic
to say abstain when I serve 50,000 people for AIDS alone in my clinic."
Health care workers in the country said that they hope Bush will "put
health concerns ahead of political and religious ideology" when he sees the
conditions brought about by the epidemic and that he endorses discussions
"about options instead of only abstinence," according to the Post
(Washington Post, 7/9).

* ABC's "Nightline" yesterday focused its full program on AIDS in Africa,
reviewing the events that led to Bush's push for funding to fight the
epidemic. The program also examined the state of the HIV/AIDS epidemic in
Uganda and what efforts the country is taking in fighting the disease
(Wright, "Nightline," ABC, 7/8). Correspondent Michel Martin interviewed
Ugandan President Yoweri Museveni and discussed the success of Uganda's
AIDS program. The program includes comments by Samaritan's Purse President
Rev. Franklin Graham, Africa Action Executive Director Salih Booker and
White House Office of National AIDS Policy Director Dr. Joseph O'Neill
(Martin, "Nightline," ABC, 7/8). A segment of Martin's interview with
Museveni is available online in RealPlayer.

* NPR's "Morning Edition": NPR's Don Gonyea discusses Bush's visit to
Pretoria, South Africa (Edwards, "Morning Edition," NPR, 7/9). The full
segment is available online in RealPlayer.

* NPR's "Tavis Smiley Show": AllAfrica.com Senior Writer Charles Cobb and
ABC Nightline Correspondent Michel Martin discuss Bush's motivations for
his focus on Africa and the AIDS crisis (Smiley, "Tavis Smiley Show," NPR,
7/8). The full segment is available online in RealPlayer.

GLOBAL CHALLENGES


2. HIV/AIDS Greatest Barrier to Development in Poor Nations, UNDP Report
Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18692

HIV/AIDS is the greatest barrier to development for poor nations,
according to the Human Development Report 2003 report released yesterday by
the United Nations Development Programme, the Toronto Globe and Mail
reports (Malarek, Globe and Mail, 7/7). According to the report, of the
eight Millennium Development Goals agreed upon by the 191 U.N. nations,
progress has been made only in improving access to drinking water. One of
the goals aims to stop and begin to reverse the spread of HIV and the
incidence of malaria and other major diseases (APA News Service, 7/8).
According to the report, the number of HIV-positive people worldwide has
more than quadrupled, from 10 million in 1990 to approximately 42 million
worldwide in 2001, the most recent year for which data are available (Globe
and Mail, 7/7). In addition, HIV/AIDS is one of the reasons developing
nations have been unable to meet other development goals, according to the
report (APA News Service, 7/8). For example, South African dropped 28
places on the Human Development Index, which is calculated based on life
expectancy, education and income in a country, between 1990 and 2001.
According to John Ohiorhenuan, the UNDP resident representative in South
Africa, "South Africa has slipped mainly because of lower life expectancy
due to AIDS, and the drop in (primary education) enrollment rates, again
due to HIV/AIDS" (Degli Innocenti/Reed, Financial Times, 7/9). The report
says, "HIV/AIDS destroys more than lives. By killing and incapacitating
adults in the prime of their lives, it can throw development off course."
In addition, the report says that China, India and Russia are at risk of
seeing a dramatic increase in HIV prevalence by 2025 (Globe and Mail, 7/7).

Development Goals Not Likely To Be Met in 59 Countries


According to the report, 54 countries are poorer now than they were in
1990, 21 countries have worse hunger problems than they did in 1990 and 34
countries have experienced declines in life expectancy since 1990,
primarily because of HIV/AIDS (Koppel, Associated Press, 7/8). Thirty of
the 34 "low human development" countries ranked lowest on the HDI are in
sub-Saharan Africa, due in large part to the HIV/AIDS pandemic in the
region. For the second year in a row, Norway ranked number one on the
index and Sierra Leone ranked last (Xinhua News Agency, 7/8). The report
says that 59 "priority" countries -- including 24 countries with high HIV
prevalence -- will fail to meet the Millenium Development Goals by 2015
unless "urgent action" is taken (UNDP release, 7/8).

3. 'New Variety' of Famine Caused By Disease Has Agencies Retooling
Strategies To Provide Long-Term Food Aid

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18693

A "new variety" of famine that is caused by disease, specifically the
HIV/AIDS epidemic, is causing aid agencies to retool their strategies in
order to provide long-term food aid to southern African countries that have
been hit hard by AIDS and drought, the Wall Street Journal reports.
Usually, when the cause of famine is "weather, war, failed government
policy or crop disease," a country can recover relatively quickly,
requiring only short-term food aid, according to the Journal. However,
"[a]s the AIDS crisis spreads, food shortages increase. As food shortages
increase, so does malnutrition," making people more susceptible to diseases
that take advantage of a weakened immune system, the Journal reports.
According to Alex de Waal, an official with the U.N. commission on AIDS and
governance in Africa, the epidemic could cause chronic food shortages and
large populations could be left "reliant for their survival on a long-term
program of international social welfare."

No Recovery In Sight


Across southern Africa, governments and relief agencies estimate that seven
million farmers have died of AIDS-related causes, leaving many families
with no tools or experience to farm. "A drought is usually in certain
areas of a country, but AIDS is all over. It is an unbelievable
impoverishment agent," Derek von Wissell, national director of Swaziland's
National Emergency Response Council on HIV/AIDS, said. He added that
from1992 to 2002, the proportion of women visiting prenatal clinics who
tested HIV-positive rose from 4% to 38%, and in the same time period, per
capita agricultural output dropped by more than one-third. Sarah Laughton,
the World Food Programme's emergency coordinator in Swaziland, said that in
the country, "the drought combined with illness has pushed people over the
edge. Even if the rains come, they won't recover" (Thurow, Wall Street
Journal, 7/9).

DRUG ACCESS


4. U.S. Efforts To Shape Drug Patent Laws in Developing Countries,
Worldwide 'Go Beyond Global Standards'

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18694

The United States is helping some developing countries rework their drug
patent laws in ways that "go beyond global standards" in protecting
pharmaceutical companies and that could "undercut" President Bush's
five-year, $15 billion AIDS initiative by making antiretroviral drugs more
expensive and more difficult to obtain, the Wall Street Journal reports.
Bush, who is in Africa this week to promote economic development and the
AIDS initiative, is trying to strike a "difficult balance" between African
nations that desperately need U.S. assistance and large drug makers that
"play a major role" in the U.S. economy and that make major contributions
to the Republican party, according to the Journal. "[T]here are many ways
that the Bush administration has contravened the letter and spirit" of
international efforts to improve access to drugs in developing countries,
Asia Russell, international policy coordinator at the Health GAP, said.
However, Richard Mills, spokesperson for the U.S. trade representative,
said that the United States is taking actions to ensure that developing
nations can use special rules allowing them to access generic drugs to
treat major epidemics, such as HIV/AIDS, malaria and tuberculosis.

Nigerian Case


However, U.S. officials working on a project in Nigeria to help the country
craft "strict" intellectual property laws have created "controversy,"
according to the Journal. The U.S. Agency for International Development in
2000 started funding a $1.2 million project administered by the Commerce
Department aimed at helping the Nigerian government to strengthen its
oversight of publicly financed projects and to rework its regulatory
systems, including its patent laws. The United States said that the effort
would assist the country in meeting new international intellectual property
standards and would help to curb the sale of counterfeit goods. As part of
the program, the Commerce Department in 2002 subsidized travel expenses for
100 Nigerian government officials and trade-group representatives to attend
two patent-law writing conferences. The Department failed to extend a
similar invitation to nongovernmental public-health representatives but
allowed the representatives to attend after protests. Olayide Akanni, a
representative of the Treatment Action Group, presented an analysis of
Nigerian draft patent legislation that found that the measure's protections
exceeded those required by the World Trade Organization. The measure would
require a complex court process to override international patent laws to
license low-cost, generic versions of drugs to treat public health
epidemics instead of the simpler governmental administrative process
required under WTO rules. In addition, the legislation would impose a
four-year waiting period for the issuing of generic licenses not included
in WTO rules. Finally, the bill would prohibit nongovernmental health
organizations from applying for generic licenses and would impose criminal
sanctions on violators; the WTO requires civil sanctions.

Conflict of Interest?


Nnamdi Ezera, the commercial development program manager for the Commerce
Department, said that the department "did not influence the process,"
adding that Nigerian officials and patent lawyers drafted the legislation.
AIDS advocates disagreed, questioning whether the United States can provide
neutral assistance in light of the large stake that U.S. companies have in
the outcome of patent talks, according to the Journal. These suspicions
have been heightened by the U.S. stance in stalled WTO talks over enabling
developing nations to import or produce generic drugs to combat public
health crises (Schroeder, Wall Street Journal, 7/9). WTO talks 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, including HIV/AIDS. The countries hope
to reach a compromise before the September WTO ministerial meeting in
Cancun, Mexico (Kaiser Daily HIV/AIDS Report, 7/2).

5. Ireland, Clinton Foundation Sign $158.2 Million Agreement To Provide
AIDS Drugs to Mozambique

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18695

Irish Prime Minister Bertie Ahern on Monday signed an agreement with
former President Bill Clinton to donate up to $158.2 million to the William
J. Clinton Presidential Foundation for the purchase of antiretroviral drugs
for HIV-positive people in Mozambique, making the country the world's third
largest buyer of AIDS drugs, the Irish Examiner reports. Under the
agreement, Ahern committed the country to providing $71.9 million over five
years with the possibility of an additional allocation of $86.3 million.
The grant will enable Mozambique to provide access to HIV/AIDS treatment
for up to 500,000 people, according to the Examiner (Sheahan, Irish
Examiner, 7/8). The agreement provides for a collaborative effort between
the Clinton Foundation and the government's Development Cooperation
Ireland, making the country the first nation to publicly declare its
support for increasing access to antiretrovirals, Clinton said at the
signing (McKenna, Irish Independent, 7/8). The Clinton Foundation HIV/
AIDS Initiative aims to assist nations in implementing large-scale
treatment, care and prevention programs (Clinton Foundation Web site, 7/8).

6. Early Treatment for HIV Act Could Reduce Death Rate of HIV-Positive
People on Medicaid by 50%, Study Shows

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18696

The Treatment Access Expansion Project, a collaborative project of the
HIV/AIDS community, health care providers and the pharmaceutical industry,
last week released the results of a study conducted by
PriceWaterhouseCoopers on the health, economic and public health benefits
of providing early access to HIV treatment as outlined under the proposed
Early Treatment for HIV Act (SB 847), according to a TAEP release (TAEP
release, 7/2). ETHA, which was introduced in the Senate in April by Sens.
Gordon Smith (R-Ore.) and Hillary Rodham Clinton (D-N.Y.), would provide
Medicaid coverage for HIV-positive, low-income people before they develop
AIDS. The bill also would provide additional Medicaid funds to states that
invest in HIV treatment, and the legislation would allow states with budget
deficits to continue to provide medical treatment to HIV-positive,
low-income individuals (Kaiser Daily HIV/AIDS Report, 4/11). Under current
Medicaid rules, HIV-positive people must wait until they can be categorized
as "disabled" before receiving treatment through the program. For the
study, PwC developed an HIV cost model and used traditional budget analysis
and "true cost" analysis to assess the costs and benefits of the proposed
changes under ETHA (TAEP release, 7/2). Based on estimates of low-income
populations currently ineligible for Medicaid, the study assumes that
30,000 people would enroll in ETHA if all states participated in the
program (Rodgers/Yip, "An Analysis of The Early Treatment for HIV Act,"
5/27).

Results


The study found that over 10 years, ETHA could reduce by 50% the death rate
for HIV-positive people on Medicaid. In addition, over 10 years, disease
progression could be slowed and health outcomes improved, meaning that
35,000 more HIV-positive people than under baseline Medicaid care would
have CD4+ T cell levels under 500. PwC found that under traditional budget
analysis rules, ETHA would cost $359 million over five years and about $2.5
billion over 10 years. Taking into account other possible benefits and
savings under ETHA, including $192.8 million in costs resulting from a
declining death rate and more people staying on Medicaid, the "true cost"
of ETHA is $55.2 million over five years, saving $31.7 million over 10
years, according to the study (TAEP release, 7/2).

MEDIA & SOCIETY


7. POZ Magazine Publishes Special Issue on HIV/AIDS in Black Community

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18697

The monthly HIV/AIDS magazine POZ has published a special edition
focusing on HIV/AIDS and the black community, the first national consumer
magazine to do so, according to a POZ release. The issue, which is
currently available on newstands, features a cover story with R&B singer
and AIDS advocate Mary J. Blige and interviews with former NBA star Earvin
"Magic" Johnson, Democratic presidential candidate Rev. Al Sharpton and
hip-hop star Keith Murray. In addition, the issue includes stories on the
"critical role" of black churches in the fight against HIV/AIDS and on men
who have sex with both women and men without informing their partners.
More than 200,000 copies of the magazine will be made available to
community groups, AIDS services organizations, and churches serving the
black community and at special events across the country. Louise Sloan,
the magazine's special projects editor, said, "With HIV and AIDS now
disproportionately impacting people of color, POZ is committed to providing
the black community with a resource that speaks to their unique concerns
and provides them with the tools they need to take control of their lives
and health" (POZ release, 7/7).

________________________________________

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