KAISER DAILY HIV/AIDS REPORT
A service of kaisernetwork.org
http://www.kaisernetwork.org/dailyreports/hiv
________________________________________



Friday, July 18, 2003

POLITICS AND POLICY
========================================
1. Senate Appropriations Committee Passes Foreign Aid Bill With $1.4B To
Fight AIDS; Democrats Will Push for More Money


SCIENCE & MEDICINE
========================================
2. CDC, Other Agencies Publish Guidelines on Incorporating HIV Prevention
Messages Into Medical Care of HIV-Positive People


ACROSS THE NATION
========================================
3. Washington, D.C., Has Higher AIDS Incidence Rate Than Baltimore, San
Francisco, New York

4. Indianapolis Star Examines HIV Confidentiality, Disclosure Laws


IN THE COURTS
========================================
5. Ribapharm Loses Ruling on Hepatitis C Drug; Finding Allows Generic
Competition for Ribavirin


GLOBAL CHALLENGES
========================================
6. U.S. News & World Report Profiles Botswana HIV/AIDS Treatment,
Prevention Program


MEDIA & SOCIETY
========================================
7. MTV To Broadcast Nelson Mandela 85th Birthday Special, Including
Discussion of HIV/AIDS, Other Issues


OPINION
========================================
8. Countries Attending Global Fund Supporters Meeting 'Overlook Facts,'
Only 'Inch Up' Their Contributions, Opinion Piece Says

9. HIV Prevention Must Overcome Denial, Focus on Human Consequences of
Disease, Health Journalist Says

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

POLITICS AND POLICY


1. Senate Appropriations Committee Passes Foreign Aid Bill With $1.4B To
Fight AIDS; Democrats Will Push for More Money

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18883

The Senate Appropriations Committee yesterday approved an $18.1 billion
fiscal year 2004 foreign aid spending bill, including $1.4 billion to fight
AIDS, but Democrats said that they will push for more money to fight the
epidemic, Reuters reports. Additional money for the five-year, $15 billion
global AIDS initiative (HR 1298) is expected to be included in other
spending bills that the committee has yet to consider, according to Reuters
(Allen, Reuters, 7/17). The House Appropriations Committee on Wednesday
approved its version of the FY 2004 foreign aid spending bill, which
includes $1.43 billion for AIDS. The House so far has approved a total of
$2 billion for the AIDS initiative in FY 2004, an increase of about $500
million over FY 2003 spending. The full House on July 10 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
(Kaiser Daily HIV/AIDS Report, 7/17). The House, which authorized up to $3
billion for the fight against AIDS, expects to appropriate about $2.1
billion -- a 70% increase in spending over last year's total -- according
to the Christian Science Monitor (Chaddock, Christian Science Monitor,
7/18).

Amendment Expected in Senate Floor Debate


The $1.4 billion in the Senate measure includes $700 million for U.S.-run
programs under the global AIDS initiative, up to $250 million for the
Global Fund to Fight AIDS, Tuberculosis and Malaria and $150 million for
the International Mother and Child HIV Prevention Initiative, according to
CongressDaily/AM (Caruso/Hess, CongressDaily/AM, 7/18). President Bush in
June 2002 announced a three-year, $500 million international HIV/AIDS
initiative focused on preventing mother-to-child transmission of HIV in
Africa and the Caribbean (Kaiser Daily HIV/AIDS Report, 6/19/02). Sen.
Patrick Leahy (D-Vt.), ranking member of the Foreign Operations
Appropriations subcommittee, said that when the measure is debated on the
floor he plans to offer an amendment to the bill that would increase
HIV/AIDS spending by $1 billion (CongressDaily/AM, 7/18). The full Senate
last week approved 78-18 a nonbinding resolution calling for $3 billion in
2004 to fight AIDS overseas, even if the amount exceeds the ceiling
mandated in Congress's annual budget resolution (Kaiser Daily HIV/AIDS
Report, 7/17).

Defense Bill


The full Senate yesterday passed a $368.6 billion defense spending bill (S
1382), voting 71-24 to defeat an amendment by Sen. Robert Byrd (D-W.Va.)
that would have transferred $1.1 billion from defense spending to the AIDS
initiative (Guggenheim, AP/Philadelphia Inquirer, 7/18). Republicans
yesterday said that AIDS funding should not be in the defense bill but
should be "dealt with in other bills," according to Reuters (Reuters,
7/17). The Senate defense bill will be reconciled with a similar measure
passed last week in the House (Guggenheim, AP/Las Vegas Sun, 7/17).
Democrats and AIDS advocates have said that U.S. credibility will be
damaged if Congress fails to appropriate $3 billion for the first year of
the AIDS initiative (Kaiser Daily HIV/AIDS Report, 7/11). "Just as we
feared, the $3 billion turned out to be an empty promise to some of the
most desperate people in the world," Paul Zeitz, executive director of the
Global AIDS Alliance, said (Reuters, 7/17).

SCIENCE & MEDICINE


2. CDC, Other Agencies Publish Guidelines on Incorporating HIV Prevention
Messages Into Medical Care of HIV-Positive People

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18884

The CDC, along with the Health Resources and Services Administration, NIH
and the HIV Medicine Association of the Infectious Diseases Society of
America, yesterday released in the MMWR Recommendations and Reports
guidelines for doctors and other health care providers that discuss how
they can incorporate HIV prevention messages into the routine medical care
of their HIV-positive patients, the Atlanta Journal-Constitution reports.
The guidelines suggest that providers take three steps: screen for
high-risk behaviors using questionnaires and tests for other STDs; discuss
proper condom and needle use; and encourage notification and counseling for
sex and drug partners (Wahlberg, Atlanta Journal-Constitution, 7/18). The
recommendations are "general and apply to incorporating HIV prevention into
the medical care of all" HIV-positive adolescents and adults -- "regardless
of age, sex, or race/ethnicity," the guidelines state. In addition, the
guidelines focus on high-risk sexual and injection drug use behaviors
because "these behaviors are responsible for nearly all HIV transmission in
the United States," according to the guidelines (Jaffe/Janssen, MMWR
Recommendations and Reports, 7/18). CDC Director Julie Gerberding said,
"It's time we merge prevention services for HIV-infected persons into the
mainstream of medical care" (Reuters, 7/17). Dr. Robert Janssen, head of
the CDC's Division of HIV/AIDS Prevention, said, "We focused in the past on
people at risk of becoming infected. Now we're trying to bring up to speed
interventions for people who are infected and can transmit the virus to
others" (Atlanta Journal-Constitution, 7/18).

Too Much Burden?


Dr. John Bartlett, chief of infectious diseases at Johns Hopkins University
School of Medicine and a member of the panel that developed the guidelines,
said that the new recommendations place "a lot of the burden of the
prevention message on the provider." Dr. Ronald Valdiserri, deputy
director of the CDC's National Center for HIV, STD and TB Prevention, said,
"It's not the easiest thing for many physicians to be able to talk about
sex and drug use with their clients," but he added that some studies
indicate that doctors who go through only one day of training significantly
improve their ability to talk about these issue with their patients,
according to the AP/Las Vegas Sun (Yee, AP/Las Vegas Sun, 7/17). Some
HIV/AIDS advocates lauded the new guidelines but expressed concern that
doctors who are "already stressed for time and burdened by paperwork" would
not be able to implement the guidelines' suggestions, the
Journal-Constitution reports. Jeff Graham, executive director of the AIDS
Survival Project in Atlanta, said, "This is an area that has been
overlooked for far too long, but I am concerned that most of these
recommendations will be ignored" (Atlanta Journal-Constitution, 7/18).

Part of New Prevention Strategy


The recommendations come after Gerberding in April called for new HIV/AIDS
prevention strategies (AP/Las Vegas Sun, 7/17). The agency in the April 18
issue of the Morbidity and Mortality Weekly Report outlined new prevention
guidelines, which include provisions for an opt-out testing program for
pregnant women in an effort to reduce mother-to-child HIV transmission. The
strategy calls for all pregnant women to be tested for HIV, along with a
battery of other routine tests already conducted on pregnant women,
including tests for syphilis, rubella, group B Strep and hepatitis. The
guidelines also include: offering routine HIV tests as a part of medical
appointments for patients at high risk; offering rapid HIV tests in
non-medical settings, including jails and homeless shelters; and tracing
partners of those who test positive for HIV in order to offer them testing
and prevention education (Kaiser Daily HIV/AIDS Report, 4/18).

ACROSS THE NATION


3. Washington, D.C., Has Higher AIDS Incidence Rate Than Baltimore, San
Francisco, New York

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18885

Washington, D.C., has a higher AIDS incidence rate than Baltimore, San
Francisco and New York, according to research findings scheduled to be
presented on July 28 at the National HIV Prevention Conference in Atlanta,
the Washington Post reports (Vargas, Washington Post, 7/17). Guy-Oreido
Weston, director of the data and research division of the District of
Columbia Department of Health's HIV/AIDS Administration, and colleagues
administered a questionnaire to AIDS surveillance coordinators for cities
and incorporated places included in the Census Bureau's ranking by 2000
population size. The questionnaires requested data on annual AIDS
incidence by year of diagnosis through June 30, 2000. Researchers
determined 40 cities' incidence rates using Census Bureau data on
population size for denominators and then ranked the cities by AIDS
incidence rate. According to updated 2001 data, researchers found that
Washington, D.C., had the highest AIDS incidence rate -- 119 AIDS cases for
every 100,000 people -- among cities with more than 500,000 residents.
Other cities with high AIDS incidence rates included Baltimore, with 117
cases per 100,000 people; San Francisco with 67 per 100,000; New York City
with 64 per 100,000; and Philadelphia with 58 per 100,000. Researchers
also found that the median AIDS incidence rate among the 27 largest U.S.
cities was 22 cases for every 100,000 people (Weston et al., Study
abstract, 7/17). The study is the first to compare the district to other
cities rather than to states, Weston said.

Injection Drug Use, Access to Care


The district's high AIDS incidence rate is associated with the city's high
rate of injection drug use and may point to problems with access to health
care, according to national health officials. Weston said that his
research shows that cities in the Northeast and the South had the highest
AIDS incidence rates, which he said is highly correlated with injection
drug use. A needle-exchange program is "severely needed" in the district
to address the problem of injection drug use and HIV transmission,
according to Michael Cover, a spokesperson for the Whitman-Walker Clinic, a
Washington, D.C.-based health organization. The city ran its own
needle-exchange program prior to 1998, when Congress prohibited the
district from using locally raised tax money to support the program, an
action that Cover called "simply shameful." In addition, Floyd Nelson, a
spokesperson for the D.C. HIV/AIDS Administration, said that African
Americans, who account for 61% of the city's population, represent almost
80% of all new AIDS cases. "Studies from national data show us that if
you're African-American, you're less likely to be treated sooner," Tom
Coates, director of the University of California-San Francisco AIDS
Research Institute, said, adding that the findings suggest "that those
infected with HIV in D.C. ... are not getting the medical care that they
should be getting" (Washington Post, 7/17).


kaisernetwork.org's HealthCast will webcast select sessions of the National
HIV Prevention Conference. Additional information regarding the conference
and the sessions to be webcast is available online.

4. Indianapolis Star Examines HIV Confidentiality, Disclosure Laws

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18886

While it is a felony in Indiana for an HIV-positive person to engage in
high-risk behavior that deliberately exposes another person to the virus,
whether such actions are first discovered by the police or by the health
department determines whether the public is notified of the person's
behavior, the Indianapolis Star reports in an examination of the state's
HIV confidentiality laws. Under the state's laws, if the health department
determines that an HIV-positive person may be putting others at risk for
infection, the department can notify people who may be endangered but must
keep all other information confidential, even to police and prosecutors,
according to department spokesperson Jennifer Dunlap. Health officials
have sent out 25 notices since 2001 to HIV-positive people who were
suspected of exposing other people to the virus. The health department can
file a civil suit in court to put restrictions on HIV-positive individuals
only as a last resort, and such cases must remain confidential. Since
March 2001, the health department has referred five cases to the courts,
according to the Star. Nationwide, since the late 1990s states have been
implementing tougher laws against deliberately exposing a person to HIV
infection. "The goal is to reach these individuals with support," Julie
Scofield, executive director of the National Alliance of State and
Territorial AIDS Directors, said. Without such privacy protections, people
at risk for HIV might be less likely to get tested for fear that they would
be ostracized if they test HIV-positive. In addition, they might be less
likely to reveal their partners, according to Scofield and others.
However, if the police are the first to learn that a person might be
exposing other people to HIV, they can file public criminal charges, making
any information regarding the HIV-positive person public knowledge
(Kightlinger, Indianapolis Star, 7/17).

IN THE COURTS


5. Ribapharm Loses Ruling on Hepatitis C Drug; Finding Allows Generic
Competition for Ribavirin

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18887

A federal judge in U.S. District Court in Los Angeles on Wednesday dealt a
"potentially severe blow" to California-based Ribapharm and its majority
owner, ICN Pharmaceuticals, ruling that a new generic formulation of
Ribapharm's hepatitis C drug ribavirin would not infringe on patents owned
by ICN, the Los Angeles Times reports. The ruling allows Teva
Pharmaceuticals, Three Rivers Pharmaceuticals and Novartis to produce
generic versions of Ribapharm's top-selling drug (White, Los Angeles Times,
7/17). Officials for Ribapharm and ICN said that they intend to appeal the
ruling, Reuters/Los Angeles Times reports (Reuters/Los Angeles Times,
7/17). In 2002, Ribapharm had sales of about $865 million for ribavirin in
the United States and about $387 million in Europe. Schering-Plough
licenses ribavirin from Ribapharm and markets it worldwide as a dual
therapy with hepatitis C drug Peg-Intron, Schering's version of pegylated
interferon. "With this court ruling, I expect the FDA to approve multiple
ribavirin generics within the next month," Scott Kay, a Banc of America
Securities analyst, said (Los Angeles Times, 7/17).

GLOBAL CHALLENGES


6. U.S. News & World Report Profiles Botswana HIV/AIDS Treatment,
Prevention Program

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18888

U.S. News & World Report in its July 21 issue profiles Botswana's AIDS
program, including the country's universal provision of free antiretroviral
drugs (Whitelaw, U.S. News & World Report, 7/21). Botswana has the highest
HIV prevalence in the world; 36% of the country's 1.6 million people are
HIV-positive. AIDS experts predict that by 2010, more than 50% of
Botswana'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,
7/11). 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, 7/10). The drug program "is akin to a revolution" for a country
with such high HIV prevalence and provides a "sliver of hope in the
otherwise bleak AIDS pandemic," U.S. News reports. Many critics of such
drug programs say that Africa's "feeble health care infrastructure" would
not be able to reliably distribute the medicine -- a "real fear" because
lapses in treatment can lead to the development of drug-resistant HIV
strains. Botswana has taken "extraordinary steps" to prevent such a
scenario, requiring patients to have a "buddy" to monitor drug adherence
and to attend monthly checkups and pill counts, according to U.S. News.
However, the success of Botswana's mobilization in fighting the disease is
due in part to its "better than average health care facilities, enlightened
leadership, well-targeted aid and vast diamond wealth," U.S. News concludes
(U.S. News & World Report, 7/21).

MEDIA & SOCIETY


7. MTV To Broadcast Nelson Mandela 85th Birthday Special, Including
Discussion of HIV/AIDS, Other Issues

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18889

MTV today will air an hour-long program, titled "Meeting Mandela: A
Staying Alive Special," to mark former South African President Nelson
Mandela's 85th birthday, Christian Science Monitor. During the program,
Mandela speaks with young people about AIDS, war and other issues (Itano,
Christian Science Monitor, 7/18). The program, to be hosted by singer
Beyonce Knowles and produced in association with the Nelson Mandela
Foundation, UNAIDS, World Bank, Kaiser Family Foundation and Family Health
International's YouthNet, will premiere on MTV at 8 p.m. ET as part of the
"Fight for Your Rights: Protect Yourself" sexual health awareness campaign.
The show will be available for free to third-party broadcasters throughout
the world, and many have already signed on to air the special, including
CCTV (China), Doordarshan (India), SABC (South Africa), TV Africa
(pan-African network) and Network Ten (Australia). In addition, for the
second year in a row, the European Broadcasting Union will distribute the
campaign's programming free via satellite to its 71 member broadcasters in
52 countries in Europe, North Africa and the Middle East. The program is
expected to be viewed by more than two billion young people (Kaiser Daily
HIV/AIDS Report, 7/2). Mandela said, "Young people face so many difficult
decisions to make in life today. It is important to talk openly about
subjects like HIV/AIDS, war, political leadership and religion so that
young people can make informed decisions about these issues" (Brown, West
Australian, 7/17). Speaking at the launch of an educational satellite
channel, Mandela said that he remains "passionate about dealing with [South
Africa's] health care challenges, particularly in the area of HIV/AIDS."
He added, "I will spend the rest of my days trying to help secure a more
educated and healthier South Africa" (AFP/Yahoo!News, 7/16).

A video preview of the program is available online in RealPlayer. The
excerpt shows a discussion between Mandela and Henry, a Ugandan HIV
advocate involved in peer counseling and education.


Media Coverage


Several newspapers profiled Mandela's work against apartheid and in raising
awareness of the AIDS pandemic:

* Christian Science Monitor, "Mandela energizes AIDS fight" (Christian
Science Monitor, 7/18).

* Johannesburg's Mail & Guardian, "Celebrating Mandela" (Mail & Guardian,
7/18).

* London's Independent, "Mandela at 85 -- The man, the myth" (Whitaker,
Independent, 7/18).

* Toronto's Globe and Mail, "Amid a flood of praise, Mandela marks 85
years" (Nolen, Globe and Mail, 7/18).

OPINION


8. Countries Attending Global Fund Supporters Meeting 'Overlook Facts,'
Only 'Inch Up' Their Contributions, Opinion Piece Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18890

The "spin" from each country that attended Wednesday's meeting of
supporters of the Global Fund to Fight AIDS, Tuberculosis and Malaria was
"that it is doing no worse than the other rich countries," Jeffrey Sachs,
director of Columbia University's Earth Institute, writes in a Financial
Times opinion piece, adding that each country "takes refuge in the fact
that it is doing its part and overlooks the fact" that the total amount
contributed to the fund so far is "woefully inadequate." The meeting
"definitely had its surreal aspects," Sachs adds, saying that the fund is
chaired by HHS Secretary Tommy Thompson "in spite of the fact that
President George W. Bush has essentially starved the fund of financial
resources." Sachs says that Thompson was a "peculiar spectacle ... gamely
talking up the very fund his president had been undermining." In addition,
speakers offered "eloquent testimonials" to the value of the fund in
fighting the diseases but "at the end of the day ... only inched up their
contributions and failed to commit enough to meet the fund's minimum need
of $3 billion for programs in 2004," Sachs says. While the world "should
not be overly impressed" by U.S. claims that it is doing enough through
other means -- such as bilateral assistance -- or by claims that the
country's budget is "too tight," there is also no excuse for Europe's
"neglectfulness," according to Sachs. On the closing day of the meeting,
"while ... rich countries gave their speeches and paraded their paltry
generosity, AIDS, tuberculosis and malaria claimed the lives of another
15,000 Africans," Sachs concludes (Sachs, Financial Times, 7/16).

9. HIV Prevention Must Overcome Denial, Focus on Human Consequences of
Disease, Health Journalist Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=18891

Although public health campaigns that encourage youth to delay sexual
intercourse or have fewer partners "remain vitally important" in the fight
against AIDS, "to date, many HIV prevention programs in Africa have proven
surprisingly unsuccessful," public health journalist Helen Epstein writes
in the July 17 issue of the New York Review of Books. While "many public
health experts have tended to regard HIV prevention in Africa as merely a
technical problem," Epstein says that more may be required, such as "some
shift within the minds of individual people and in the social atmosphere so
that AIDS is recognized as the immediate threat that it is." In Uganda,
however, AIDS prevention programs have proven successful, and experts
attribute this to the "enlightened policies" of the government,
governmental support for community-based AIDS organizations and an
"unusually active" response to HIV/AIDS by "ordinary people." In addition,
some research has shown that straight talk about sex and the effects of
AIDS in local communities was the prime factor in convincing Ugandans to
change their sexual behavior and stem the spread of the disease. Epstein
says that while Ugandans are "not unusually compassionate people" and
discrimination against those with AIDS persists, the country's stronger
social networks may make them more likely than their counterparts in South
Africa, where apartheid broke down many such networks, to talk more openly
about these issues.

South Africa and loveLife


Uganda's success at reducing its HIV prevalence "has been hard to repeat in
... South Africa," Epstein says. Part of the problem lies in the
"adversarial relationship" that the South African government has with many
nongovernmental organizations, according to Epstein, which she argues "has
almost certainly undermined efforts to prevent the spread of HIV." A group
of public health experts in South Africa and the United States in 1998
created loveLife, a $20 million a year HIV-prevention campaign -- the
"largest and most ambitious" HIV prevention program in South Africa -- that
seeks to overcome the limitations of similar campaigns while avoiding the
controversial issues of treatment and care. The South African government
provides approximately 12% of loveLife's current annual budget. Major
funding is provided by the Kaiser Family Foundation and the Bill & Melinda
Gates Foundation. Additional funding is provided by the Nelson Mandela
Foundation and UNICEF. LoveLife combines a sustained multimedia campaign
including television, radio and billboards with youth friendly services in
government clinics countrywide and a national network of recreation
centers, known as Y-Centers, which facilitate a comprehensive approach to
HIV prevention by offering youth activities, seminars and family planning
and STD services through affiliated clinics to create a more "positive and
cheerful" approach to AIDS prevention.

Using Sex To Sell Prevention


Through the advertising campaign, loveLife's creators seek to use the theme
of sex commonly found in marketing and advertising to get people to think
and talk about sex in a way that will make them realize the "virtues of
abstinence, fidelity and the use of condoms," according to Epstein.
However, while sex is openly confronted and discussed in all aspects of the
campaign, the "experience of AIDS is not," and while the biological aspects
of the disease are discussed, its effects on people's lives are not,
Epstein says. One Y-Center GroundBreaker -- older youths who promote
sexual restraint through leading loveLife seminars and discussion groups --
said, "We know that if we just came out and started lecturing them about
AIDS they wouldn't listen. They would just turn off. So we talk about
positive things, like making informed choices, sharing responsibility and
positive sexuality." According to Epstein, the "striking and deeply
mysterious" denial of AIDS in South Africa "has to be confronted," because
"[o]vercoming such denial" may be what made the "greatest difference" in
fighting AIDS in Uganda. And although "people like the colorful, frank
advertising and the basketball games sponsored by loveLife ... its programs
may be reinforcing the denial that poses so many obstacles to preventing
HIV in the first place." Epstein concludes that a more realistic approach
to HIV might pay "greater attention to the real circumstances in people's
lives that make it hard for them to avoid infection" and could be more
frank about the "real human consequences of the disease" (Epstein, New York
Review of Books, 7/17).

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