KAISER DAILY HIV/AIDS REPORT
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Friday, July 11, 2003

POLITICS AND POLICY
========================================
1. House Appropriations Subcommittee Approves $1.3B in AIDS Funding for FY
2004; Senate Passes Resolution Calling for $3B

2. Bush Continues Africa Trip With Stop in Uganda; Advocates There Want
Signs Bush Is Serious About AIDS Fight

3. Congressional Hunger Center Chairs Highlight Relationship Between
HIV/AIDS, Food Shortage


PUBLIC HEALTH & EDUCATION
========================================
4. World Population Day Highlights Need for Reproductive Health, AIDS
Education, Services Among Adolescents


GLOBAL CHALLENGES
========================================
5. U.K. Should Not Implement Mandatory HIV Testing for Asylum Seekers,
Parliamentary Report Says


ACROSS THE NATION
========================================
6. Palm Beach County, Fla., Commission Endorses Plan To Ask Legislature To
Allow Mandatory HIV Testing of Jail Inmates


MEDIA & SOCIETY
========================================
7. Retiring Dean of UCSF School of Medicine Appointed To U.N. Commission
for HIV/AIDS and Governance in Africa


OPINION
========================================
8. Eastern Virginia Medical School Clinics Serving Uninsured AIDS Patients
'Never Should Have Been Closed,' Editorial Says

9. China's Central Government Should Condemn Raids by Local Police on Rural
AIDS Villagers, New York Times Editorial Says

10. Bush, Tobias Could 'Change Nature of AIDS in Africa,' Lancet Editorial
Says

11. Kaiser Daily HIV/AIDS Report Summarizes Opinion Pieces on Bush's Trip
to Africa, AIDS Initiative

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

POLITICS AND POLICY


1. House Appropriations Subcommittee Approves $1.3B in AIDS Funding for FY
2004; Senate Passes Resolution Calling for $3B

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18748

The House Appropriations subcommittee on foreign operations yesterday
approved a $17.1 billion fiscal year 2004 foreign operations appropriations
bill, including almost $1.3 billion in funding to combat HIV/AIDS overseas,
a 40% increase over the amount approved for this year, the Washington Post
reports. In a separate action, the Senate approved 78-18 a nonbinding
"sense of Congress" resolution calling for $3 billion in 2004 to fight AIDS
overseas, even if the amount exceeded the ceiling mandated in Congress's
annual budget resolution (Morgan, Washington Post, 7/11). The House
subcommittee approved $1.27 billion to fight AIDS internationally, which is
$86 million more than Bush requested. In addition, the full House
yesterday approved a bill (HB 6470) to provide funding for labor, education
and health programs, including $644 million for foreign AIDS research and
prevention and $155 million for combating other infectious diseases, such
as tuberculosis. As a result, total funding for global AIDS is now a
little more than $2 billion for FY 2004 (Allen, Reuters/Newark Star Ledger,
7/11).

Global AIDS Initiative


The money will go to fund the five-year, $15 billion AIDS initiative (HR
1298), which Bush signed into law in May. The 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, 7/9). The subcommittee "substantially
restructured" the AIDS plan, reducing funds controlled by a newly appointed
AIDS coordinator and increasing the U.S. contribution to the Global Fund to
Fight AIDS, Tuberculosis and Malaria (Washington Post, 7/11). The
U.S.-based arm of the initiative still needs to be staffed and criteria for
distributing money and oversight criteria must be developed. In addition,
the Senate must approve Randall Tobias, former CEO of Eli Lilly, who Bush
nominated to head the initiative. By shifting money to the already
established Global Fund, the subcommittee is trying to "jump-start" the
initiative, according to the Wall Street Journal (Cummings, Wall Street
Journal, 7/11).

Funding Levels


The $2 million represents two-thirds of the $3 billion authorized in HR
1298 but fulfills Bush's budget request of $2 billion. Subcommittee Chair
Rep. Jim Kolbe (R-Ariz.) said that spending the full $3 billion was
"unrealistic" in the initiative's first year since the program is "just
getting off the ground," according to the Associated Press (Abrams,
Associated Press, 7/10). White House Press Secretary Ari Fleischer
confirmed Bush's commitment to the $15 billion program, saying, "The
authorization is a full $15 billion over five years. There is a ramp up in
the first year. So (while) the funding will hit the $3 billion level, it
may not hit it in the first year for the appropriations." Rep. Mark Kirk
(R-Ill.) said that because the Senate has yet to confirm Tobias, the global
AIDS program's procedures for grant application, approval and oversight are
not yet in place and appropriating the full $3 billion to the program could
lead to "spending money so quickly that one of our contractors embarrasses
the program," turning the public against the initiative, the San Francisco
Chronicle (Epstein, San Francisco Chronicle, 7/11). Rep. Nita Lowey
(D-N.Y.) next week at a meeting of the full appropriations committee plans
to offer a $1 billion "emergency appropriation" amendment, which is not
covered in congressional budget spending limits (Washington Post, 7/11).
Final funding levels depend on the full appropriations committee meeting
and on negotiations between the House and Senate (Beattie, Financial Times,
7/11). The full House is expected to vote on the foreign aid
appropriations bill by the end of this month (Anderson/Chen, Los Angeles
Times, 7/11).

Reaction


Democrats and AIDS advocates said that U.S. credibility would be damaged if
Congress failed to appropriate the full $3 billion for the first year of
the AIDS initiative, according to the Associated Press (Associated Press,
7/10). Dozens of House members have signed a letter to Bush, written by
Rep. Barbara Lee (D-Calif.), urging him to lobby for the full $3 billion
(San Francisco Chronicle, 7/11). Sen. Jeff Bingaman (D-N.M.) yesterday
sponsored the Senate resolution calling for the full $3 billion to be
appropriated, but Senate appropriators have not yet written their spending
bills and are not expected to include a full $3 billion, according to the
Chicago Tribune (Zuckman, Chicago Tribune, 7/11). Secretary of State Colin
Powell said that he "would have preferred full funding" for the AIDS
initiative but that the State Department would "make the best use of the
money" Congress provides (Wall Street Journal, 7/11). "A plane doesn't
take off at 500 miles and it doesn't take off at 30,000 feet," Kolbe said,
adding, "It takes off slower and it climbs. And we do the same thing with
programs, which is how you ramp them up" (Stevenson, New York Times, 7/11).
Kolbe added that Bush has "compound[ed] the problem by continuing to talk
about $3 billion while he's in Africa" (Washington Post, 7/11). "When you
have a fire, you don't ramp up a response," Tom Hart of DATA, an AIDS
advocacy group founded by Irish rock star Bono, said, adding, "With $3
billion a year, instead of $2 billion, we could prevent 1.5 million
[people] a year from getting AIDS" (San Francisco Chronicle, 7/11).

2. Bush Continues Africa Trip With Stop in Uganda; Advocates There Want
Signs Bush Is Serious About AIDS Fight

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18749

President Bush today continues his trip through Africa with a stop in
Uganda, which has been "hailed as an African pioneer in fighting the
epidemic," Reuters reports (Green, Reuters, 7/11). 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 five-year, $15 billion global AIDS initiative. The
country's HIV prevalence has dropped from 30% of the population to 5% in a
little more than 10 years. In addition, condom use in the country has
increased from 5% in 1990 to 54% today (Kaiser Daily HIV/AIDS Report,
7/10). During his four-hour visit to Uganda, Bush was scheduled to meet
with President Yoweri Museveni and visit TASO, an AIDS support organization
and clinic (Xinhua News Agency, 7/11).

Advocates Call for Action


AIDS advocates in the country are calling for signs from Bush that "he
meant business with his [global AIDS initiative]" plan, according to
Reuters. Rosette Mutambi, coordinator of the Uganda Access Coalition,
said, "People are dying in thousands. I wouldn't want to think that he can
go against what he has committed himself to do" (Reuters, 7/11). Winnie
Byanyima, a former member of Museveni's party and the wife of exiled
presidential candidate Kizza Besigye, said that she is concerned Bush would
"put Museveni on a pedestal" for his efforts to combat HIV/AIDS and
"disregard" other problems in the country, according to the Washington
Post. She said, "We are a very unstable country. We can go up in flames at
any time. We have armed conflicts in the north. We have a government that
is not respecting the rule of constitutional law. We are at a very
dangerous point" (Wax, Washington Post, 7/11). Before Bush arrived,
Ugandan AIDS advocate Milly Katana said that Bush should not "leave [the
country] without signing a check" for $3 billion to fight AIDS in fiscal
year 2004 and without "making a promise" to pledge more funds to the Global
Fund to Fight AIDS, Tuberculosis and Malaria. Katana added, "This is not a
visit of looking good but [of] displaying the evil that disease has caused
to Uganda and Africa in general. To frontline workers, it is a visit for
transforming the AIDS response in Africa" (Boseley, Guardian, 7/11).

Appropriations Action Coincides With Botswana Visit


While Bush was in Botswana yesterday, the House Appropriations foreign
operations subcommittee approved almost $1.3 billion in funding for the
global AIDS initiative, the New York Times reports (Stevenson, New York
Times, 7/11). The subcommittee approved $1.27 billion to fight AIDS under
the FY 2004 foreign operations appropriations bill -- $86 million more than
Bush requested. The full House approved the Labor-Health and Human
Services appropriations bill, including an additional $644 million for AIDS
prevention and research overseas and $155 million for tuberculosis and
other infectious diseases, bringing the funding total to a little more than
$2 billion (Allen, Reuters/Newark Star Ledger, 7/11). Some Democrats in
the House have said that $2 billion is "inadequate" to meet the goals of
the president's initiative, and are calling for an additional $1 billion
for next year, the Washington Post reports. In addition, HIV/AIDS
advocates in Botswana and other countries are concerned about "receiving
less money than expected" because they were "counting on the help,"
according to the Post (Milbank, Washington Post, 7/11). Botswana has the
highest HIV prevalence in the world -- currently, 36% of the country's 1.6
million people are HIV-positive. 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 (Kaiser Daily HIV/AIDS Report, 7/10).
Botswana's Health Minister Joy Phumaphi said following Bush's visit that
his administration's AIDS proposal is "the most attention we've ever
received -- if it is actually delivered." She also said that the funds
would have a "significant impact," adding, "We are hoping that they will
deliver" (Washington Post, 7/11).

Reaction


Bush lauded Botswanan President Festus Mogae for "admitting that there is a
problem [with HIV/AIDS in the country] and then ... working to put a
strategy in place to prevent and treat it" (McQuillan, USA Today, 7/11).
Mogae said, "Recently, when Botswana appealed to the United States for help
in the fight against HIV/AIDS, you ... increased the funding for the ...
testing and counseling program." He added, "The assistance and cooperation
we have received clearly demonstrates that, in the United States, Botswana
has a true and dependable partner" (Kemper, Chicago Tribune, 7/11). "The
[AIDS testing and counseling] program is going very well," Mogae said. Dr.
Ernest Darkoh, operations manager of the new Botswana antiretroviral drug
treatment program, "welcomed" the global AIDS initiative, according to the
Dallas Morning News. However, he added, "Money is important, but it is not
the only important factor. The real issue is capacity building" (Hillman,
Dallas Morning News, 7/11). Bush is scheduled to conclude his trip to
Africa tomorrow in Nigeria (Xinhua News Agency, 7/10).

First Lady Visits Clinic


During the Botswanan leg of the trip, first lady Laura Bush and daughter
Barbara visited an AIDS care center established with U.S. assistance,
Reuters reports (Thomson, Reuters, 7/10). The Children's Clinical Centre
of Excellence project, funded by the Bill & Melinda Gates Foundation and
Bristol-Myers Squibb's Secure the Future initiative, is a partnership among
BMS, Houston-based Baylor College of Medicine's International Pediatrics
AIDS Initiative and the Botswanan government. 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, 7/10). Between 600 and 700 children are
treated with antiretroviral drugs through the center, and the hospital
provides the medicines to nearly 5,000 more people through the country's
treatment program. Gabriel Anabwani, the center's director, said, "Other
hospitals are picking up too, and the rollout program is under way. But we
are not close to achieving the target of giving treatment to all" (Reuters,
7/10). The first lady said that the global AIDS initiative is "showing
people [in Africa] what the real face of America is like, the compassion
that Americans have for the people here who are suffering with AIDS"
(Kraft, AP/Fort Worth Star-Telegram, 7/11).

Media Coverage


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

* NPR's "All Things Considered": The program reports on Bush's visit to
Botswana (Gonyea, "All Things Considered," NPR, 7/10). The segment is
available online in RealPlayer.

* NPR's "Morning Edition": The program includes two segments on Bush's
Africa trip, the first of which includes commentary by journalist Armstrong
Williams comparing the Bush administration's support for Africa with that
of the Clinton administration (Williams, "Morning Edition," NPR, 7/11).
The segment is available online in RealPlayer. The second segment reports
that Bush will visit an AIDS clinic during his stop in Uganda (Wilson,
"Morning Edition," NPR, 7/11). The segment is available online in
RealPlayer.

* NPR's "Talk of the Nation": The segment reports on Museveni's success in
fighting AIDS in Uganda and includes comments by American University
Professor of Economics George Ayittey and Museveni (Neary, "Talk of the
Nation," NPR, 7/10). The segment is available online in RealPlayer.

* PBS' "NewsHour with Jim Lehrer": In a two-part report, correspondent
Susan Dentzer examines Botswana's progress in fighting AIDS. The segments
include comments by Bush and Mogae (Dentzer, "NewsHour with Jim Lehrer,"
PBS, 7/10). Audio of the segment is available online in RealPlayer. Ray
Suarez also discusses the AIDS epidemic in Africa with Botswana's
ambassador to the United States Caesar Lekoa, World Bank Managing Director
for Health and Education Dr. Mamphela Ramphele and Coordinator of the
United Nations Millennium Project's task force on HIV/AIDS Josh Ruxin
(Suarez, "NewsHour with Jim Lehrer," PBS, 7/10). Audio of the segment is
available online in RealPlayer.

3. Congressional Hunger Center Chairs Highlight Relationship Between
HIV/AIDS, Food Shortage

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18750

Rep. Jo Ann Emerson (R-Mo.) on Wednesday said that ending world hunger and
fighting HIV/AIDS are two closely related battles, the Associated Press
reports. Emerson and Rep. James McGovern (D-Mass.), who are co-chairs of
the Congressional Hunger Center, traveled to Rome last week to meet with
officials from the World Food Programme. In an interview following the
trip, Emerson said, "The HIV/AIDS epidemic is decimating the populations of
[countries with food shortages], and it's very much connected to the whole
issue of hunger," adding that genetically altered crops "are, in many
people's opinion, part of the solution." Emerson and McGovern said that it
would be a mistake to focus solely on AIDS drugs in the fight against
HIV/AIDS because so few people have access to them. McGovern said, "Short
of that, you need to make sure people have proper diets. If you're not
eating and you don't have the proper diet, you get sicker and sicker, and
the disease comes upon you quicker" (Quaid, Associated Press, 7/9).

PUBLIC HEALTH & EDUCATION


4. World Population Day Highlights Need for Reproductive Health, AIDS
Education, Services Among Adolescents

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18751

In a message commemorating World Population Day, the theme of which is
"One billion adolescents: the right to health, information and services,"
U.N. Secretary-General Kofi Annan said that young people need such
information in order "to lead safe, rewarding lives and contribute to the
well-being of their families and communities" (U.N. release, 7/11). Half
of the world's 6.3 billion people are under the age of 25, and more than
one billion are between the ages of 10 and 19, the largest youth population
in human history (United Nations Population Fund release, 7/11). Annan
said that with education, women are more likely to marry later, have fewer
children and have healthy and better educated children, who can pass on
those benefits to the next generation. Annan also said that information
and services are "crucial" in the fight against HIV/AIDS -- especially in
those countries already hit hard by the epidemic -- because if young people
know how HIV is transmitted they can protect themselves from infection
(U.N. release, 7/11). Half of all new HIV infections occur among young
people. However, by "educating, empowering and mobilizing young people, we
can turn the AIDS epidemic around," UNFPA Executive Director Thoraya Ahmed
Obaid said. She added, "Young people have a right to reproductive health
information and services. Studies repeatedly show that education about
sexuality and reproduction does not increase irresponsible behavior. On
the contrary, it helps young people to make responsible, healthy decisions"
(UNFPA release, 7/11). The UNFPA World Population Day Web site provides
additional information regarding the day and events that are taking place
worldwide (UNFPA Web site, 7/11).

GLOBAL CHALLENGES


5. U.K. Should Not Implement Mandatory HIV Testing for Asylum Seekers,
Parliamentary Report Says

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http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18752

Mandatory HIV testing for asylum seekers upon entry to the United Kingdom
would violate the country's human rights obligations and could deter those
already in the country from undergoing HIV testing, a report released today
by an all-party parliamentary group on AIDS said, Reuters reports. The
175-member group launched an investigation in response to concerns that the
government was not properly consulting refugee groups in its probe of the
public health risks posed by immigrants (Reuters, 7/9). HIV-positive
people from abroad constitute up to two-thirds of the total number of
people receiving free antiretroviral treatment under Britain's National
Health System. Human rights legislation in the country entitles
HIV-positive people from developing nations where medical care is not
available to seek asylum in England and receive free NHS care, which can
cost up to $1.7 million over a lifetime. As a result, hundreds of
HIV-positive people have come to the country seeking treatment, which costs
an average of $25,000 a year per person. The government is considering how
to implement compulsory HIV screening for those entering England from
countries with high HIV prevalence (Kaiser Daily HIV/AIDS Report, 6/17).

Government Not Ruling Out Mandatory Testing


The report notes that under the European convention on human rights, asylum
seekers cannot legally be denied entry to a country on the basis of an
HIV-positive test result. Other immigrants to England are just as likely
as asylum seekers to be HIV-positive; therefore, immigration officials
would have to test all of the country's 12 million visitors each year if
the policy were to be anything but "blatantly discriminatory," the report
says, according to London's Guardian. The report also warns that singling
out HIV-positive people could discourage people already in the country from
getting tested. According to officials, two-thirds of HIV-positive people
in the country have not be diagnosed (Boseley/Travis, Guardian, 7/10). The
government responded that it will not rule out mandatory medical testing
for asylum seekers on arrival in the country, according to Home Office
Minister Beverly Hughes, who added, "What concerns me is the underlying
assumption that anybody with a significant illness -- as an asylum seeker
or a migrant -- should automatically get treatment in London" (BBC News,
7/10).

ACROSS THE NATION


6. Palm Beach County, Fla., Commission Endorses Plan To Ask Legislature To
Allow Mandatory HIV Testing of Jail Inmates

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18753

Palm Beach County, Fla., commissioners on Tuesday agreed to ask state
legislators to change state law to allow for mandatory HIV testing of every
county jail inmate, the Fort Lauderdale Sun-Sentinel reports. Under a plan
discussed at the meeting, inmates would be required to undergo testing
regardless of whether they had been convicted of a crime. Between 45,000
and 50,000 people each year are booked into the jail, and up to 70% of them
are awaiting trial, L. Diana Cunningham, executive director of the Palm
Beach County Criminal Justice Commission, said. Commissioner Addie Greene,
who has made mandatory HIV testing of prisoners a priority, said that he
believes that requiring HIV tests for prisoners would help stop the spread
of the virus, especially among minority groups. However, Greene on Tuesday
could not explain how the testing might achieve that goal. Ruth Gottlieb,
chair of the Palm Beach ACLU, said that curbing the spread of HIV among
minorities would take education because she said "you're only dealing with
a small percentage of the minority community" in prisons. Gottlieb added,
"Mandatory HIV testing is wrong. We don't believe in that." Gerald Adams,
program director of the county HIV Care Council, said that he "absolutely"
favored mandatory HIV testing for jail inmates, adding that it would be "no
different from kids being immunized prior to their entering school." He
also said that "all possible avenues" to prevent the disease from spreading
should be explored.

Questions Remain


Several commissioners acknowledged concerns regarding the plan.
Commissioner Mary McCarty said that the civil liberties implications of the
plan are a "sticky wicket," and Commissioner Warren Newell said that civil
rights issues would need to be studied. Commissioners Karen Marcus and
Tony Masilotti said that they wanted cost information; no one had cost
estimates on Tuesday, the Sun-Sentinel reports. Palm Beach County Health
Department Director Dr. Jean Malecki heard the commissioners' discussion,
but did not speak at the meeting. Later she said that people on both sides
of the issue have strong cases, but she declined to say whether she would
also support such a plan (Man, Fort Lauderdale Sun-Sentinel, 7/9).

MEDIA & SOCIETY


7. Retiring Dean of UCSF School of Medicine Appointed To U.N. Commission
for HIV/AIDS and Governance in Africa

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18754

Dr. Haile Debas, who is retiring as dean of the University of
California-San Francisco School of Medicine on Aug. 31, has accepted an
appointment to the U.N. Commission for HIV/AIDS and Governance in Africa,
the AP/Miami Herald reports. The commission, which is scheduled to have
its first meeting in September in Tunisia or Ethiopia, is expected to
advise African governments on how to best combat the HIV/AIDS epidemic
(Elias, AP/Miami Herald, 7/9). The commission's goal is to produce a
report within two years on recommendations on how to fight the epidemic and
how to address the impact of the disease on the ability of African
countries to develop their economies, the San Francisco Chronicle reports.
Debas will continue to work at UCSF on a new interdisciplinary research
program that is examining global health issues such as HIV, tuberculosis,
malaria and other diseases (San Francisco Chronicle, 7/10). Former FDA
Commissioner Dr. David Kessler will replace Debas, who has been dean of the
school for 10 years (AP/Miami Herald, 7/9).

OPINION


8. Eastern Virginia Medical School Clinics Serving Uninsured AIDS Patients
'Never Should Have Been Closed,' Editorial Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18755

Eastern Virginia Medical School clinics aimed at serving uninsured AIDS
patients in the city "delivered ... care and treatment in a way that other
cities envied and tried to copy" and "never should have been closed,"
according to a Virginian-Pilot editorial (Virginian-Pilot, 7/9). A
contract dispute between EVMS and the city of Norfolk regarding billing
practices resulted in the revocation of Ryan White funds for seven area
clinics 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. Last
week, EVMS after a three-month hiatus reopened two clinics and had plans to
open the others in the near future (Kaiser Daily HIV/AIDS Report, 7/7).
According to the editorial, Norfolk administrators were trying "to fix
something that wasn't broken," as there was "no financial reason" for the
temporary clinics' closure, which "pu[t] lives and health at risk."
Uninsured patients should "rejoice" that EVMS is "coming back to treat
them," the editorial says. The editorial concludes, "First-rate public
health care is rare in Virginia, so it was doubly sad to see the AIDS
clinics closed. The region, and especially uninsured AIDS patients, can
only hope that Norfolk will leave well enough alone" (Virginian-Pilot,
7/9).

9. China's Central Government Should Condemn Raids by Local Police on Rural
AIDS Villagers, New York Times Editorial Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18756

China's AIDS epidemic, which is expected to reach 20 million HIV-positive
people by the end of the decade, has been "driven in large part by
totalitarian habits," a New York Times editorial says. Although China's
stance on AIDS is "slowly" changing, the change is "apparently only at the
level of the central government," as a recent police raid and attack on
AIDS villagers in a rural area "shows how far China has to go," the
editorial says (New York Times, 7/11). Hundreds of police officers on June
22 raided the Chinese village of Xiongqiao in the rural province of Henan,
moving through homes, physically abusing residents and arresting 13 people
in what villagers said was a response to recent protests calling for better
access to medical care, including HIV/AIDS treatment (Kaiser Daily HIV/AIDS
Report, 7/8). "The central government should condemn these abuses and
arrest those involved," the Times says. If the government can stop the
abuses by local police, "it will show that its constructive talk is real,"
the editorial says, concluding, "China cannot save itself from AIDS until
officials understand that the enemy of the people is the disease, not its
sufferers" (New York Times, 7/11).

10. Bush, Tobias Could 'Change Nature of AIDS in Africa,' Lancet Editorial
Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18757

President Bush and recently named Global AIDS Coordinator Randall Tobias
could "change the nature of HIV/AIDS in Africa," according to an editorial
published in the July 12 issue of the Lancet (Lancet, 7/12). Bush last
week named 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 (HR 1298), which authorizes $3 billion a year over five years
for HIV/AIDS programs in Africa and the Caribbean. As global AIDS
coordinator, Tobias would work under the secretary of state, and he would
be able to distribute funds directly to nongovernmental organizations and
transfer funds between government agencies. The appointment, which must
still be approved by the Senate, will carry the rank of ambassador (Kaiser
Daily HIV/AIDS Report, 7/3). Some critics have questioned Tobias'
knowledge of AIDS and Africa, as well as his connections to the
pharmaceutical industry, the editorial says. In order to address those
concerns, Tobias needs a "[r]apid appointment of a team behind him with
proven African public-health and HIV experience," the Lancet says, adding
that a "detailed plan of how the Bush AIDS initiative will work with the
[Global Fund] ... would help." In addition, Tobias "needs quickly, and
publicly, to support purchasing of low-cost generics to provide ammunition
against those who charge that he is no more than a stooge of the drug
industry," the editorial says. He could also "go as far as to counter"
U.S. opposition to the 2001 Doha declaration that would allow developing
nations to override patent protections to produce or import generic
versions of drugs to combat public health epidemics, according to the
Lancet. "If all Tobias' targets are met, which is likely only if the full
$15 billion is appropriated by Congress, then he will have proven himself a
worthy Global AIDS Coordinator," the editorial says, concluding, "Tobias'
task then, surely, as befits his job title, will be to combat the emerging
HIV pandemic in Asia" (Lancet, 7/12).

The Right 'Kind of Leader'?


Although Bush's decision to "increase the United States' role in [the]
international fight [against AIDS] is a good sign," his naming of Tobias as
Global AIDS Coordinator "gives ... pause," a Billings Gazette editorial
says. The fight against HIV/AIDS "deserves a leader who can relate to
those most in need, the castaways in the global society who need medicine,
education and clean drinking water, not just a compassionate glance from
another guy in a suit," the Gazette says, questioning whether Tobias --
"with no discernable track record of field work" -- is "really the best
advocate for millions of people who cannot afford the necessary medicines
to survive." The editorial says that AIDS is not "another problem-solving
exercise for a retired CEO to tackle. It is a worldwide public health
epidemic that requires a unique leadership skill. It requires a person who
can relate to those living with the disease on all levels, not just as part
of an annual report." The Gazette concludes, "We're certain Tobias is an
outstanding leader," as evidenced by the success of Eli Lilly during his
tenure; however, "[w]e're not certain that Tobias is the kind of leader the
AIDS issue needs" (Billings Gazette, 7/10).

11. Kaiser Daily HIV/AIDS Report Summarizes Opinion Pieces on Bush's Trip
to Africa, AIDS Initiative

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18758

Many editorials and opinion pieces this week have focused on President
Bush's trip to Africa and the global AIDS initiative. Bush this week
visited Senegal, South Africa, Botswana and Uganda and will visit Nigeria
tomorrow before leaving the continent. During the trip, the president has
promoted several initiatives that focus on Africa, including the 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,
7/9). The following are summaries of some of the editorials and opinion
pieces:

Editorials


* Dayton Daily News: Bush is "eager to use [his trip to Africa] to take a
victory lap" for his AIDS initiative, but such action is "premature
[because] he hasn't earned the humanitarian laurels" yet, a Daily News
editorial says. The $2 billion in funding that Bush has requested from
Congress for the plan this year is "hardly a jump-start to a life-and-death
program." In addition, the AIDS initiative has been undermined by "narrow
ideology" in its requirement that one-third of the prevention funds go to
abstinence-only programs, and Bush's nomination of chair and CEO of drug
maker Eli Lilly Randall Tobias as head of a new State Department office
assigned to oversee the global AIDS initiative has left advocates skeptical
that he will support the use of generic antiretroviral medications,
according to the editorial. The editorial concludes that "deeds must
follow [Bush's] words" in order for his "signature humanitarian program" to
be seen as anything more than "a show" (Dayton Daily News, 7/9).

* Louisville Courier-Journal: While Bush is in Africa, he must deliver an
"on the one hand, on the other hand" message to African leaders, condemning
corruption and dictatorships in some countries while encouraging their
efforts to fight HIV/AIDS, a Courier-Journal editorial says. For example,
while Bush should "embrace Uganda's programs to combat AIDS," he should
also "push democratic reforms ... and condemn Ugandan involvement in
Congo's civil war." In addition, Bush should encourage South African
President Thabo Mbeki to apply his country's economic and political success
to neighboring Zimbabwe while also insisting that Mbeki "adopt a more
enlightened and determined" stance on South Africa's HIV/AIDS epidemic
(Louisville Courier-Journal, 7/9).

* Raleigh News & Observer: Bush's trip to Africa is a sign that he
"understands our nation's legitimate interest in the challenges Africa
faces," including the "direct threat to U.S. security" that the HIV/AIDS
epidemic, limited economic opportunities and abject poverty have created, a
News & Observer editorial says. However, his messages of "hope through
political and economic change" will "lose relevance if he doesn't follow
through," especially in lobbying Congress to appropriate adequate resources
for his AIDS initiative (Raleigh News & Observer, 7/10).

* Wall Street Journal: The entire world, including the United States,
could learn something about HIV/AIDS prevention from Uganda, where Bush is
visiting today, a Journal editorial says. Ugandan President Yoweri
Museveni has "used his bully pulpit" to teach Ugandans that "promiscuity
can be deadly," and he mentions AIDS in "virtually every public speech" he
gives, the editorial says. Museveni's "ABC" AIDS prevention model --
abstinence, be faithful, use condoms -- which has helped lower the
country's HIV prevalence from 15% 10 years ago to 5% today, was an
inspiration for Bush's five-year, $15 billion global AIDS initiative,
according to the Journal. The editorial concludes, "We hope that Mr.
Museveni's lesson instructs the rest of Africa and more than a few
precincts in America" (Wall Street Journal, 7/11).

* Washington Times: "Let there be no mistake, in terms of the economic and
human toll it takes annually in Africa, malaria is in many ways even more
devastating than AIDS," a Washington Times editorial says. While Bush is
"properly touting his AIDS initiative in Africa," it is important to
recognize that an "inexpensive, effective preventative to malaria is
available: the limited use of [the pesticide] DDT for insect control,"
according to the editorial. If Bush's motivation in working with AIDS is to
save lives, "he would be remiss if he neglected also to advocate" for the
limited use of DDT as a means to prevent the spread of malaria, the
editorial concludes (Washington Times, 7/10).

Opinion Pieces


* Linda Bilmes, Financial Times: "[N]othing like $15 billion will ever be
spent" on the global AIDS initiative, "not [because of] congressional
budget-cutting but [because of] the president's failure even to ask for the
amounts needed to fulfill his pledge," Bilmes, a professor of budgeting and
financial management at Harvard University's Kennedy School of Government
and assistant secretary of commerce under President Clinton, writes in a
Financial Times opinion piece. The new spending will be spent "not on
drugs nor health clinics but on bureaucratic reshuffling back in
Washington, [D.C.]," consolidating scattered U.S. initiatives into a single
program at the State Department, she says. Bilmes concludes that while the
initiative has "helped to put the fight against HIV/AIDS back on the
international policy agenda ... the U.S. still has to put its money where
its mouth is" (Bilmes, Financial Times, 7/7).

* Joseph Dolman, Long Island Newsday: Bush's motives in visiting Africa
and in supporting the global AIDS initiative are not important, the only
important things are for him to "behold -- through his own eyes -- the
continent's incredible misery as AIDS tightens its lethal grip" and to
"send money ... not $15 billion worth of promises, not $15 billion worth of
talk therapy, but $15 billion in negotiable currency," Dolman, a columnist,
writes in a Newsday opinion piece. Advocates who worry that Bush's plan
will interfere with the Global Fund to Fight AIDS, Tuberculosis and Malaria
and that the president will "waste billions of bucks paying chump retail
prices on antiretrovirals to help his political buddies in the
pharmaceutical industry" should "give the man a chance," Dolman says.
However, there is no more time for "fancy talk," Dolman says, concluding,
"It's time to send money" (Dolman, Long Island Newsday, 7/9).

* Thomas Donnelly/Vance Serchuk, Washington Post: "Despite ingrained
assumptions about the continent's strategic irrelevance, the Defense
Department has begun to realize that U.S. security interests in Africa ...
cannot be ignored," Donnelly and Serchuk, resident fellow and researcher,
respectively, at American Enterprise Institute, write in a Post opinion
piece. Increased U.S. military involvement in Africa is "simply sensible
policy," and while it cannot reduce HIV rates, neither can development aid
"depose authoritarian thugs or transnational terrorists," Donnelly and
Serchuk conclude (Donnelly/Serchuk, Washington Post, 7/7).

* Glen Elder, Burlington Free Press: Now "is not the time to be taking
money away from the multilateral" Global Fund, as Bush proposed, because
the fund is "scaling up successful programs" and "runs the risk of becoming
bankrupt and dumping half a million people from effective drug care
programs," Elder, board chair of Vermont CARES and an associate professor
of geography at the University of Vermont, writes in a Free Press opinion
piece. "The battle against HIV/AIDS will be won on several fronts," and
the Global Fund "has a proven track record" of providing support to
prevention programs run by local AIDS groups that "know the local context,"
Elder says, concluding, "While we support the president's initiative, it
should not be at the expense" of the Global Fund (Elder, Burlington Free
Press, 7/10).

* Janet Fleischman, AllAfrica.com: Pressure from conservative religious
groups threatens to influence the United States' approach to AIDS
prevention, leading to an emphasis on "abstinence-only" sex education
programs, which "divert attention from the broader prevention messages that
are proven to save lives," Fleischman, Washington director for Africa at
Human Rights Watch, says in an AllAfrica.com opinion piece.
Abstinence-only programs are "out of touch with the realities of the AIDS
epidemic in Africa," Fleischman says. She concludes that while the
initiative shows that Bush wants to be a leader in Africa, during his trip
to Africa this week he will "find millions of people looking for more than
speeches" (Fleischman, AllAfrica.com, 7/10).

* Chris Hennemeyer, Christian Science Monitor: Bush has "rightly made
[HIV/AIDS the] centerpiece of his humanitarian policy toward the
continent," and he should push Congress to appropriate the funds needed for
his AIDS initiative, Hennemeyer, an international human rights consultant,
writes in a Monitor opinion piece. In addition, the Bush administration
should use its business connections to convince pharmaceutical companies to
lower the cost of antiretroviral drugs, Hennemeyer says. "The president
has gone out on a limb ... [and he] deserves our full support and, when
necessary, our constructive criticism" in confronting the AIDS epidemic,
Hennemeyer concludes (Hennemeyer, Christian Science Monitor, 7/7).

* Jeffrey Herbst, Wall Street Journal: Bush's trip to Africa "solidif[ies]
one of his most surprising achievements ... [by] becoming the American
president most engaged with the African continent in U.S. history," Herbst,
chair of the Department of Politics at Princeton University, writes in a
Journal opinion piece. The achievement has been ignored by critics of the
administration, including former South African President Nelson Mandela,
who has let his annoyance over U.S. involvement in Iraq overshadow the fact
that Bush has done more to combat AIDS in South Africa than he or Mbeki or
Democrats, who fear that his efforts could make "Republican inroads" into
the overwhelmingly Democratic African-American constituency, Herbst says.
Despite the "tremendous amount still to be done ... the Bush
administration" deserves credit for its efforts in Africa, Herbst concludes
(Herbst, Wall Street Journal, 7/7).

* Noeleen Heyzer, Washington Post: Women's unequal status in Africa is
"the central cause of the rapid transmission of AIDS," and Bush should
"take the time to speak with African women infected and affected" by the
disease during his visit to the continent, Heyzer, executive director of
the U.N. Development Fund for Women, writes in a Post opinion piece.
HIV/AIDS prevention strategies have failed primarily because "women have
not played a significant role in the design and implementation of these
programs," Heyzer says, adding that the key to stopping the epidemic is
women's empowerment. Women's lack of power to refuse sex or to negotiate
for safer sex, their economic dependence and the burden they assume for
family care and farming must change in order to stop the spread of HIV,
Heyzer says. She concludes that while the "small component" of the AIDS
funding allocated to strengthening women's empowerment is an "important
first step ... many more resources must be tapped" (Heyzer, Washington
Post, 7/8).

* Cragg Hines, Houston Chronicle: While Bush's attitude toward Africa
during the 2000 election seemed to be "Bush to Africa: Drop dead," the
aftermath of the Sept. 11, 2001, terrorist attacks prompted a shift in the
way the administration views Africa, which is "manifest" in Bush's AIDS and
Millennium Challenge initiatives, Hines, a columnist, writes in a Chronicle
opinion piece. While critics see "lurking the administration's
ever-present favoring of Corporate America" in the initiative -- an
impression "not helped by Bush's appointment ... of ... former drug company
executive [Tobias] to be the administration's point man on AIDS" -- his
programs "should not be picked to death [but] ... funded by Congress and
activated by the administration," Hines concludes (Hines, Houston
Chronicle, 7/8).

* Jim Hoagland, Washington Post: Bush's AIDS initiative needs to be fit
into an "overarching and detailed international program that will last a
decade or longer" in order to "improve its chances of success," Hoagland, a
columnist, writes in a Post opinion piece. Because the president has
"recently shown a willingness to jump into raging political torrents abroad
... [h]is task now is to show he can sustain and expand that engagement
over time," Hoagland concludes (Hoagland, Washington Post, 7/9).

* Jesse Jackson, Philadelphia Inquirer: While the United States should
"applaud that the president feels it necessary to travel to Africa and at
least take some measures against the plague of AIDS that threatens to
destabilize a continent," it is important not to forget that he has not
shown the same attention to blacks in the United States, Jackson, a
Democratic party advocate, writes in an Inquirer opinion piece. Jackson
concludes that the president's refusal to meet with minority leaders in the
United States shows that "[r]eality seems to be making more progress over
ideology abroad than it is at home" (Jackson, Philadelphia Inquirer, 7/8).

* Julianne Malveaux, Hartford Courant: While Bush's AIDS initiative is
"laudable," he seems to be "content to let Congress handle the matter at
its own pace" instead of "engaging in [the] congressional arm-twisting" he
has used in the past with issues that he considers to be priorities,
Malveaux, a member of the board of directors for the Trans Africa Forum,
says in a Courant opinion piece. Therefore, Bush needs to "stop talking
about the $15 billion he will spend ... until he is willing to put his
political capital behind the matter of securing those funds," Malveaux
concludes (Malveaux, Hartford Courant, 7/10).

* Mary Mitchell, Chicago Sun-Times: Critics' fears that Bush's involvement
in Africa could win black voters "assumes that the majority of American
blacks have more than a romantic interest in the affairs of Africa" while
in actuality "Africa's troubles haven't been a priority ... with the
majority of African Americans," Mitchell, a columnist, writes in a
Sun-Times opinion piece. To have National Security Adviser Condoleezza
Rice and Secretary of State Colin Powell "in powerful positions at a time
when Africa is steeped in conflicts and reeling from AIDS is nothing short
of a blessing" and it will "be interesting to see if the Congressional
Black Caucus and other longtime advocacy groups give Bush" the support
needed for Congress to appropriate the $15 billion needed for his five-year
AIDS initiative, she says. Mitchell concludes that black people do not
have to vote for Bush because of his commitment to Africa, "but we do have
to give him credit" (Mitchell, Chicago Sun-Times, 7/8).

* Ralph Peters, New York Post: We "do not know the long-term effects AIDS
will have on Africa ... [if it] will only further impoverish African
societies, or lead to unexpected human innovations, from forms of
government to religion," as the plague did in 14th-century Europe, Peters,
an author and strategist, writes in a Post opinion piece. While HIV/AIDS
"is the great tragedy of our time ... [i]t also may be the prelude to a
better African tomorrow, to an Africa reborn," he concludes (Peters, New
York Post, 7/8).

* Jeffrey Sachs, New York Times: If the United States contributed $8
billion to global health, combined with increased investments from other
countries, eight million deaths each year could be prevented, Sachs,
director of the Earth Institute at Columbia University, writes in a Times
opinion piece. If the 400 richest people in the United States donated the
money they received from Bush's recent tax cut, it would total nearly $7
billion, a "huge chunk of the $8 billion that the United States" should
contribute to global health care efforts and an action that could "change
the course of Africa's history," he says. Sachs concludes that Bush's trip
to Africa should "open [the] eyes" of all Americans to the responsibility
we all should share in helping to "ease pain in the world" (Sachs, New York
Times, 7/9).

* Claire Short, Financial Times: "A significant advance for Africa is
possible" despite the effects of war, drought, malaria and HIV/AIDS, but
"little has been achieved," Short, former international development
secretary for the United Kingdom, writes in a Times opinion piece. The
promises of new resources to fight AIDS "looked better in headlines than in
detail," because Bush refuses to back multilateral efforts and insists on
sexual abstinence-based sex education programs, she says. Poverty,
disease, environmental degradation and conflict present "real danger[s]" to
the continent and it remains to be seen if "Bush has the wisdom and
patience to support a united international effort to end conflict and
support the building of competent, modern states capable of promoting the
locally led development that Africa needs," Short concludes (Short,
Financial Times, 7/8).

* Deborah Simmons, Washington Times: "The billions of dollars President
Bush has proposed spending on the African-Caribbean HIV/AIDS initiative --
and which Congress continues to debate the worthiness of -- are not
Monopoly dollars," Simmons, deputy editorial page editor of the Washington
Times, writes in a Times opinion piece. She says that the money is "real,"
as are the malaria and HIV/AIDS epidemics. "Millions of people in Africa
are dying and living in fear of dying," she adds, concluding that the money
from the global AIDS initiative "will not solve the problem, but [it] will
help" (Simmons, Washington Times, 7/11).

* Paul Zeitz/Jeffrey Sachs, Boston Globe: "If Bush really means what he
says about battling AIDS, he will support the full $3 billion" authorized
in the global AIDS initiative, including $1 billion for the Global Fund;
"[o]therwise, his trip [to Africa] could be a cruel illusion, heaping U.S.
'spin' on top of Africa's massive suffering," Zeitz, director of the Global
AIDS Alliance, and Sachs write in a Globe opinion piece. Although Bush's
plan calls for the creation of a new State Department office to disseminate
funding to African nations, "[t]here is a much more direct and meaningful
way to give the aid: directly to the Global Fund," Zeitz and Sachs write.
If the United States gave at least $1 billion to the fund, the donation
would leverage another $2 billion from other countries, they say. However,
"Bush unwisely has rejected multilateral approaches to combat infectious
diseases even though multilateral efforts have been the most successful in
the past, such as in the control of smallpox, African river blindness and
polio," the authors say, concluding that the "problem, from the
administration's perspective, may be that the Global Fund is not run by the
U.S. pharmaceutical industry" (Zeitz/Sachs, Boston Globe, 7/11).

________________________________________

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