KAISER DAILY HIV/AIDS REPORT
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Thursday, July 10, 2003

POLITICS AND POLICY
========================================
1. Bush Continues Africa Trip With Stop in Botswana; Calls AIDS 'Deadliest
Enemy Africa Has Ever Faced'


GLOBAL CHALLENGES
========================================
2. African Leaders Must Make Fight Against HIV/AIDS Top Priority, U.N.
Secretary-General Kofi Annan Says

3. Kenya Investigating Dozens of Nongovernmental AIDS Organizations in Fake
Charity Crackdown

4. Larger, More Comprehensive HIV/AIDS Treatment, Prevention Programs
Needed To Stem Spread of HIV


DRUG ACCESS
========================================
5. Pfizer/Agouron, GlaxoSmithKline, Boehringer Ingelheim To Increase
Financial Assistance to State ADAPs


SCIENCE & MEDICINE
========================================
6. Hepatitis C Treatment for Patients Without Liver Damage May Not Be Cost
Effective, Study Says


MEDIA & SOCIETY
========================================
7. PBS Series Examines Ethics of Clinical Drug Trials, Including Testing of
HIV/AIDS Medications

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

POLITICS AND POLICY


1. Bush Continues Africa Trip With Stop in Botswana; Calls AIDS 'Deadliest
Enemy Africa Has Ever Faced'

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18725

President Bush today continued his trip through Africa with a stop in
Botswana -- which has the highest HIV prevalence in the world -- saying
that HIV/AIDS is the "deadliest enemy Africa has ever faced'' and pledging
the United States' support in the fight against the disease, the AP/New
York Times reports (AP/New York Times, 7/10). Currently, 36% of Botswana's
1.6 million people are HIV-positive, London's Independent reports. By
2010, more than 50% of the country's children will be AIDS orphans and the
average life expectancy will have fallen from 47 years to 27 years. As a
result of the grim statistics, drug companies and not-for-profit
organizations are donating funds to the country's comprehensive prevention
and treatment efforts (Frith, Independent, 7/10). Botswana 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, 7/9).

Stigma Still a Problem


First lady Laura Bush and Botswanan first lady Barbara Mogae today visited
a hospital funded by the Gates Foundation and Bristol-Myers Squibb's Secure
the Future initiative (Independent, 7/10). The Children's Clinical Centre
of Excellence project is a partnership among BMS, Houston-based Baylor
College of Medicine's International Pediatrics AIDS Initiative and the
Republic of Botswana. The center houses a large outpatient clinic,
pharmacy, laboratory, medical library, conference center and offices and
provides nutritional, psychological, social and child life services along
with comprehensive primary and specialty care for infants and children who
are HIV-positive or who have been orphaned by the epidemic (Kaiser Daily
HIV/AIDS Report, 6/23). The building, which has state-of-the-art testing
facilities and air-conditioned treatment rooms, cost $2 million to build,
but some local AIDS advocates say that the stigma attached to the virus has
caused many parents to not take their children for tests there because it
will "mark them out," according to the Independent. A doctor in the
capital Gaborone said, "I think the companies wanted something that looked
good. I sometimes wonder how much good it will do when we can't even
persuade parents to get their children tested." Ernest Darkoh, operations
director of a large-scale treatment program in Botswana, said, "There has
been denial on a massive scale in this country." Abe Whendero of the
country's National AIDS Coordinating Agency said, "Botswana is faced with
extinction because of AIDS," adding, "Without help, our country will
disintegrate. What is so frightening is that the epidemic doesn't seem to
be flattening out, as it has in Uganda" (Independent, 7/10). During a
luncheon with President Festus Mogae, President Bush said, "The people of
this nation have the courage and resolve to defeat this disease and you
will have a partner in the United States of America" (AP/New York Times,
7/10).

South Africa


Bush yesterday met with South African President Thabo Mbeki, "press[ing]"
him to "deal with the epidemic more effectively," the New York Times
reports (Stevenson, New York Times, 7/10). Mbeki's administration has
faced criticism from people inside and outside of South Africa for its lack
of action in the fight against HIV/AIDS. Although Mbeki has rescinded
previous comments he made stating that HIV does not cause AIDS, advocates
continue to question his position on the disease (Kaiser Daily HIV/AIDS
Report, 7/8). Administration officials said that they were "optimistic"
about the country's efforts to combat the disease. "What we believe is
that the South African government, under the leadership of President Mbeki,
clearly understands the needs for [antiretroviral treatments]," a senior
administration official traveling with Bush said (New York Times, 7/10).
Bush said, "South Africa has recently increased its budget to fight the
disease, and we noticed and we appreciated that" (McQuillan, USA Today,
7/10).

Creating a 'Common-Sense Strategy'


Officials offered to include South Africa in the first round of the
five-year, $15 billion global AIDS initiative as a way to push Mbeki "to
move faster to bring all available weapons [against HIV/AIDS] to bear,"
according to the Times (New York Times, 7/10). The Bush administration
has not called for any preconditions for South Africa to participate in the
initiative, which the government sees as a vote of confidence in Mbeki's
leadership, South Africa's Business Day reports. Health Minister Manto
Tshabalala-Msimang is expected to prepare a proposal based on what the
United States is willing to provide, according to Business Day (Business
Day, 7/10). Bush said, "We need a common-sense strategy to make sure that
the money is well spent. And the definition of well spent means lives are
saved, which means good treatment programs, good prevention programs, good
programs to develop health infrastructures in remote parts of different
countries so that we can actually get antiretroviral drugs to those who
need help." However, some AIDS advocates said that Bush "missed an
opportunity" to make a "more direct public statement" about Mbeki's
approach to the epidemic, the Times reports. Mark Heywood, national
secretary of the Treatment Action Campaign, said, "There's no evidence that
President Bush's visit advanced the South African government's thinking.
We're still stuck with a government policy that is at odds with medical
thinking universally" (New York Times, 7/10).

Drug Access


During his visit to South Africa, Bush "affirmed the United States'
commitment" to an international trade agreement that would allow developing
countries to produce generic versions of antiretroviral drugs, Long Island
Newsday reports. But an administration official said that the president's
statement did not "signal a change" in the country's position on a 2001
World Trade Organization proposal on the issue (Mulugeta, Long Island
Newsday, 7/10). 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, unless wording was included to specify which diseases
constitute a public health epidemic. The United States said that without
such a list, developing nations could use patent overrides to produce
generic versions of any patented drug, including drugs that are not used to
fight public health epidemics. However, the United States last month made a
concession by dropping its demand that the agreement apply only to a
specified list of diseases (Kaiser Daily HIV/AIDS Report, 7/2). The
official said, "The WTO agreement includes other drugs that are not AIDS
drugs, such as aspirin and other commercial drugs. That's why we oppose
it" (Long Island Newsday, 7/10). Bush said, "The United States supported a
moratorium on the enforcement of patent laws concerning those drugs related
to diseases that were causing pandemics. We will continue to work with
South Africa, as well as other countries, to see if we can't reach a
common-sense policy that, on the one hand, protects intellectual property
rights, and on the other hand, makes life-saving drugs ... more widely
available at reasonable costs" (Agence-France Presse, 7/9). Heywood said,
"Whatever Bush said ... the U.S. is still blocking the production of these
drugs" (Long Island Newsday, 7/10).

Uganda


Bush on Friday is scheduled to visit Uganda, which has "launch[ed] a
credible battle against AIDS," Reuters reports (Busharizi, Reuters, 7/10).
Uganda has had success in lowering its HIV prevalence by employing the
"ABC" HIV prevention model -- abstinence, be faithful, use condoms. Bush
has cited Uganda's program as a model for his global HIV initiative. 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 (Kaiser Daily HIV/AIDS
Report, 7/9). In addition, condom use in the country has increased from 5%
in 1990 to 54% today, according to Agence-France Presse. Sam Okware, a
Ugandan health official and former head of the country's National AIDS
Control Council, said that the country's "tendency to face up to the
reality of HIV/AIDS ... has allowed Uganda to do so much in mitigating the
AIDS catastrophe over the last decade," according to Agence-France Presse.
Okware added that Bush's visit will be "good [because] it adds political
commitment at all levels. ... He is not coming empty handed," referring to
the global AIDS initiative (Morland, Agence-France Presse, 7/10). Bush is
scheduled to travel to Nigeria on Saturday (USA Today, 7/10).

Media Coverage


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

* CBS' "Evening News": The program reports on Bush's proposed AIDS funding
and the effects of the epidemic in South Africa (Plante, "Evening News,"
CBS, 7/9). The segment is available online in RealPlayer.

* NBC's "Nightly News": The program reports on AIDS in South Africa and
Bush's challenge of receiving congressional approval to fund the global
AIDS initiative (Brown, "Nightly News", NBC, 7/9). The segment is
available online in WindowsMedia.

* NPR's "Morning Edition": In the first of two segments on Bush's trip to
Africa, journalist Joe Davidson provides a commentary in which he raises
questions about how much funding Congress will appropriate for African
assistance (Davidson, "Morning Edition," NPR, 7/10). The segment is
available online in RealPlayer. Also on "Morning Edition," Don Gonyea
reports that Bush will focus on AIDS during his stop in Botswana (Edwards,
"Morning Edition," NPR, 7/10). The segment is available online in
RealPlayer.

* NPR's "Talk of the Nation": The program provides an overview of Botswana
and how the country is responding to the AIDS epidemic. The segment
includes comments by Heinz Klug, associate professor of law at the
University of Wisconsin (Neary, "Talk of the Nation," NPR, 7/9). The
segment is available online in RealPlayer.

* PRI's "The World": In the first of two segments on AIDS in Africa, the
program provides an overview of the global AIDS initiative and the role of
abstinence. The segment includes comments by Bush, Rep. Mike Pence
(R-Ind.) and Colin Jones, administrator of AIDS assistance for the Anglican
Church (Costello, "The World," PRI, 7/9). The segment is available online
in WindowsMedia. The second segment focuses on AIDS in Botswana and
includes comments by Emeldah Mathe, a business and development consultant
in Gaborone (Mullins, "The World," PRI, 7/9). The segment is available
online in WindowsMedia.

GLOBAL CHALLENGES


2. African Leaders Must Make Fight Against HIV/AIDS Top Priority, U.N.
Secretary-General Kofi Annan Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18726

African leaders must make fighting HIV/AIDS their top priority and
international donors must increase their support of HIV/AIDS prevention and
treatment programs, U.N. Secretary-General Kofi Annan said today in a
speech in Mozambique at the African Union Summit, Reuters reports. "(Make)
the fight against AIDS a priority second to none," he said to African
leaders at the meeting, adding, "Africa's efforts are being systematically
undermined -- by a virus so cruel that it strikes young adults as they are
poised to enter their most productive years, and assume the mantle of
leadership." Annan continued, "Spending on the fight against HIV/AIDS by
African governments, the U.S. and the E.U. has risen significantly, but it
is still not enough. Twice as much is needed, this year, next year, and
every year, for the foreseeable future" (Reuters, 7/10). UNAIDS estimates
that governments, international organizations, foundations and
nongovernmental organizations in 2003 will spend an estimated $4.7 billion
to address the AIDS epidemic in low- and middle-income countries, but that
amount is less than half of the more than $10.5 billion that will be needed
each year by 2005 to fight the epidemic in those countries (Kaiser Daily
HIV/AIDS Report, 6/27).

Treatment Focus


UNAIDS Executive Director Peter Piot, speaking at the summit's Global Forum
on Health and Development -- the first-ever international videoconference
on AIDS, tuberculosis and malaria to be held at the summit -- said, "Only
if AIDS is rapidly brought under control will social and economic
development be able to flourish. This can become a reality if African
leaders make it their business to invest in both AIDS prevention and care
and treatment" (UNAIDS release, 7/10). Only about 50,000 of the 30 million
HIV-positive people in Africa currently receive antiretroviral drugs,
according to Reuters. "The price at which antiretrovirals are available to
developing countries has dropped significantly, but technical facilities
and sustainable financing are still major barriers," Piot said (Reuters,
7/10). Piot added, "African governments must seize the opportunity to
expand access to HIV care and treatment in their countries" (UNAIDS
release, 7/10).

A kaisernetwork.org HealthCast of the videoconference forum will be
available online at noon ET today. Other participants include Richard
Feachem, chair of the Global Fund; Carol Bellamy, executive director of
UNICEF; Hoosen Coovadia, head of the department of pediatrics at the
University of Natal; HHS Secretary Tommy Thompson; Helene Gayle, director
of the Bill & Melinda Gates Foundation's HIV, TB and Reproductive Health
Program; and Jeffrey Sachs, director of the Earth Institute at Columbia
University.

3. Kenya Investigating Dozens of Nongovernmental AIDS Organizations in Fake
Charity Crackdown

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18727

Kenya's National AIDS Control Council, the agency that coordinates the
country's response to the AIDS epidemic, has recently cut off funding to
four fraudulent nongovernmental AIDS organizations and is investigating
another 10 organizations, the New York Times reports. In addition, the
government recently suspended the operations of several hundred NGOs that
did not have proper documentation for their funding; several dozen of those
groups reportedly focused on AIDS-related activities, according to the
Times. The large amount of money flowing into Africa to fight the
escalating AIDS-related death toll "is more than sufficient to attract the
attention of unscrupulous operators," the Times reports. Experts say that
while more support for anti-AIDS activities is needed, so are programs that
fight corruption and stimulate the African economy. "Ever since AIDS
arrived on the scene, we've had all manner of people, some with no
professional expertise, trying to elbow in on the pandemic," Frances
Angila, head of Kenya's oversight group for NGOs, said, adding, "The
potential for fly-by-night organizations is very high."

National AIDS Control Council Under Investigation


President Mwai Kibaki, who was elected in December 2002, has begun an
anticorruption crackdown in the country, which some say is "riddled with
corruption" after the 24-year presidency of Daniel arap Moi, according to
the Times. Kibaki's efforts have, among other things, led to the
investigation of the National AIDS Control Council. The group is accused
of mishandling money allocated for the fight against HIV/AIDS, and the
anticorruption unit of the Kenyan police is investigating whether the group
misspent $250,000 during the observance of World AIDS Day in 2001. Despite
the investigation, the Global Fund to Fight AIDS, Tuberculosis and Malaria
recently granted the government a $37 million grant to fight AIDS, with
some of the money set to go to the council. However, Jerry van Mourick,
the regional representative of the fund, said that he has urged Kenya to
carefully track how the money is spent. "We don't just write blank
checks," van Mourick said, adding, "A very important principle of the
Global Fund is we need some assurance that the grant monies are properly
spent" (Lacey, New York Times, 7/10).

4. Larger, More Comprehensive HIV/AIDS Treatment, Prevention Programs
Needed To Stem Spread of HIV

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18728

A drop in the cost of antiretroviral drugs has enabled governments,
foundations, pharmaceutical companies and international groups to support
treatment initiatives in developing countries, but ensuring access to the
drugs has proved to be a challenge, according to the current issue of
Newsweek. More than four million HIV-positive people in Africa need
treatment but only 50,000 people have access to the medicines.
Furthermore, experts estimate that even if the drugs were free, only one
million of the people who need treatment would have access to clinics that
are capable of dispensing the drugs. Last year, the Columbia University's
Mailman School of Public Health, with $50 million in foundation grants,
launched an initiative to prevent mother-to-child HIV transmission, called
MTCT-Plus; such programs can prevent the spread of HIV to infants with as
little as a single dose of antiretroviral medications, according to
Newsweek. In addition to preventing vertical HIV transmission, the
program, which builds on existing programs so that it can deliver treatment
quickly and efficiently, seeks to prevent children who do not contract HIV
during birth from becoming AIDS orphans by providing lifelong treatment for
their HIV-positive parents. Experts agree that larger and more
comprehensive treatment programs are needed. Such programs are being
developed by the government of Botswana with help from the Bill & Melinda
Gates Foundation, drug companies and the Harvard AIDS Institute and by the
governments of Rwanda, Mozambique and Tanzania with help from the William
J. Clinton Presidential Foundation. Similar programs will be implemented
through the global AIDS initiative, a $15 billion measure that "heralds a
new era in AIDS control," according to Newsweek (Cowley, Newsweek, 7/14).

DRUG ACCESS


5. Pfizer/Agouron, GlaxoSmithKline, Boehringer Ingelheim To Increase
Financial Assistance to State ADAPs

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18729

The National Alliance of State and Territorial AIDS Directors yesterday
announced that Pfizer/Agouron, GlaxoSmithKline and Boehringer Ingelheim
have agreed to partner with the ADAP Crisis Task Force to increase
financial assistance to federal-state AIDS Drug Assistance Programs,
according to a NASTAD release (NASTAD release, 7/9). ADAPs, which are
state-managed, federally funded programs, provide HIV treatment to
low-income, uninsured and underinsured HIV-positive individuals. As of
last month, fifteen states had waiting lists or access restrictions on
their ADAPs, and six more states anticipated having to impose new or
additional restrictions on their programs in fiscal year 2003, according to
a NASTAD report released last month (Kaiser Daily Reproductive Health
Report, 6/24). ADAP representatives from California, Florida, Maryland,
Massachusetts, New Jersey, New York, North Carolina and Texas -- states
that collectively account for 75% of the more than $850 million in annual
ADAP drug expenditures -- since March have been negotiating with
representatives from Roche, GlaxoSmithKline, Merck, Pfizer, Abbott
Laboratories, Boehringer Ingelheim, Gilead Sciences and Bristol-Myers
Squibb to discuss ways of alleviating the budget shortfalls that state
ADAPs are currently facing (Kaiser Daily HIV/AIDS Report, 5/1). Under the
new agreement, Pfizer has offered to temporarily provide its antiretroviral
drugs Viracept and Rescriptor for free or at steep discounts until Congress
reconsiders ADAP funding levels in 2005 (Long Island Newsday, 7/10). GSK
will provide $20 million in aid to state ADAPs, in addition to the
estimated $90 million in rebates and price reductions the company expects
to provide to state ADAPs in 2004 (GSK release, 7/9).

Seven Companies Have Agreed To Help


State ADAPs previously reached agreements with Gilead, Abbott, Merck and
Hoffman-LaRoche to freeze drug prices and provide rebates on the companies'
antiretroviral drugs. Gilead recently extended its special pricing for
ADAPs to its new antiretroviral drug Emtriva. Negotiations with BMS are
ongoing. The agreements with the seven companies amount to an additional
$50 million in ADAP assistance, which is "substantial in a year when the
current federal fiscal year appropriations only netted an increase of $75
million," Dwayne Haught, ADAP coordinator in Texas, said, adding, "Initial
increases for ADAP programs in FY 2004 in both House and Senate
subcommittees ($39 million and $25 million, respectively) are far less than
the savings these partnerships have achieved for ADAP programs" (NASTAD
release, 7/9).

SCIENCE & MEDICINE


6. Hepatitis C Treatment for Patients Without Liver Damage May Not Be Cost
Effective, Study Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18730

People with hepatitis C who do not have liver damage may not benefit from
beginning treatment early because of the potentially severe side effects of
the drugs, the "hefty cost" of treatment and the chance that treatment
could be ineffective, according to a study published in the July 9 issue of
the Journal of the American Medical Association, the Newark Star-Ledger
reports (Stewart, Newark Star-Ledger, 7/9). Researchers from the Harvard
School of Public Health's Center for Risk Analysis examined U.S. health
data for people with hepatitis C. There are 2.7 million people with
chronic hepatitis C in the United States, and 25,000 new cases are reported
annually. Most hepatitis C patients do not develop liver damage before
dying of other causes, Reuters reports. Researchers found that over a
30-year period the chance of developing cirrhosis, or inflammation of the
liver, for men with hepatitis C is between 13% and 46%, and female
patients' chances ranges between 1% and 29% (Reuters, 7/8). In addition,
three injections per week of interferon and oral ribavirin cost $20,000 per
person for the 48-week course of treatment (Newark Star-Ledger, 7/9).
Hepatitis C patients experienced treatment benefits "largely in the form of
improvements in health-related quality of life," instead of prolonged life,
according to the study. Therefore, although newer hepatitis C treatments
seem to be "reasonably cost-effective on average," the study's findings
"vary widely" across different patient subgroups and "depend critically on
quality-of-life assumptions," according to the authors. The researchers
concluded, "As the pool of persons eligible for treatment for [hepatitis C]
expands to the more general population, it will be imperative for patients
and their physicians to consider these assumptions in making
individual-level treatment decisions" (Salomon et al., JAMA, 7/9).

MEDIA & SOCIETY


7. PBS Series Examines Ethics of Clinical Drug Trials, Including Testing of
HIV/AIDS Medications

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18731

PBS stations nationwide beginning tonight will air an episode of the
15-part series, "Closer to Truth: Science, Meaning and the Future," titled
"Testing New Drugs: Are People Guinea Pigs?," which focuses on the issues
surrounding the development and testing of new drugs, including HIV/AIDS
medications, and the ethics of clinical trials in developing countries.
The series, which brings together leading scientists, scholars and artists
to explore the latest scientific research and philosophical thinking,
presents 30-minute "spontaneous and intimate" discussions moderated by
Robert Lawrence Kuhn, vice chair of the Geneva Companies, a financial
services company. Guests on the program will include Alexander Capron,
director of the Pacific Center for Health Policy and Ethics and former
chair of the U.S. Congress Biomedical Ethics Advisory Committee; Andrea
Kovacs, associate professor of pediatrics and pathology and director of the
HIV Family Clinic at University of Southern California's Keck School of
Medicine; and Robert Temple, associate director for medical policy and
chair of the FDA's Center for Drug Evaluation and Research. The television
program's Web site includes a glossary of key terms, as well as background
information about the program participants. Check local PBS listings for
show times (PBS release, 7/1).

The full transcript of the program is available online. A two-minute video
excerpt from the program's discussion on clinical trials and pediatric HIV
is available online in RealPlayer. A two-minute video excerpt of the
program's discussion on drug trials in developing countries also is
available online in RealPlayer.

________________________________________

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