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

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*** WEBCASTS: South African AIDS Conference ***
View webcasts of sessions from the 2003 South African
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________________________________________



Tuesday, August 5, 2003

POLITICS AND POLICY
========================================
1. Bush Faces Criticism for Domestic HIV/AIDS Policy; Lauded for Efforts To
Fight Disease in Africa


GLOBAL CHALLENGES
========================================
2. 'Gloomy' HIV/AIDS Statistics Cited at South African AIDS Conference;
Demonstrators Criticize Government Inaction


ACROSS THE NATION
========================================
3. Bus Company, ACT UP/Philadelphia Settle Discrimination Complaint


PUBLIC HEALTH & EDUCATION
========================================
4. New York Times Examines Comprehensive HIV/AIDS Prevention, Treatment
Compliance Programs for Teens


OPINION
========================================
5. Global AIDS Bill Could 'Make Dent in Catastrophic Problem,' Dan Rather
Writes in Opinion Piece

6. Congress Should Not 'Turn Cheap' When Appropriating Funds for Global
AIDS Initiative, Dallas Morning News Editorial Says

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

POLITICS AND POLICY


1. Bush Faces Criticism for Domestic HIV/AIDS Policy; Lauded for Efforts To
Fight Disease in Africa

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19200

Although President Bush has been "applauded" by some HIV/AIDS advocates
for his efforts to fight the epidemic in Africa, he is also facing
criticism for his domestic AIDS policies, the Houston Chronicle reports
(Roth, Houston Chronicle, 8/3). Bush in May signed into law in a measure
(HR 1298) that authorizes $15 billion over five years to fight AIDS in
Africa and the Caribbean. The House so far has approved a total of $2
billion for the AIDS initiative in fiscal year 2004, an increase of about
$500 million over FY 2003 AIDS spending (Kaiser Daily HIV/AIDS Report,
7/31). Although Bush has increased total federal spending on domestic
HIV/AIDS programs -- the Office of Management and Budget says the
government will spend $15.1 billion in the current fiscal year, compared
with $13.4 billion during Bush's first year in office -- some advocates say
that he is "shifting funding away from prevention and toward AIDS testing
to avoid dealing with controversial programs," such as programs that teach
comprehensive sex education including condom use, the Chronicle reports
(Houston Chronicle, 8/3). In June, a group of 151 AIDS organizations and
other advocacy groups sent a letter to Bush outlining their concerns about
the administration's policies concerning domestic HIV funding levels and
the potential "censorship" of prevention programs and federally funded
research, as well as the CDC's new HIV prevention initiative. In the
letter, the groups asked the administration to increase funding for
domestic HIV/AIDS programs; ensure that new CDC HIV prevention guidelines
allow "comprehensive prevention strategies" for people most at risk of
contracting HIV; allow local groups to continue to operate "culturally
relevant" prevention programs without the "relentless and intrusive"
scrutiny of the CDC; allow comprehensive sex education programs that
address the use and efficacy of condoms; and protect science from the
"clear censorship of potentially life-saving information" (Kaiser Daily
HIV/AIDS Report, 7/1).


'More Attention'


Dr. Jim Curran, dean of Emory University's Rollins School of Public Health,
said, "There needs to be a lot more attention paid to the HIV epidemic in
the United States. People need to realize there's still no cure and no
vaccine. Our greatest enemy in HIV prevention is ... complacency about our
epidemic here" (Yee, AP/Long Island Newsday, 8/3). Tamara Kreinin,
president of the Sexuality Information and Education Council of the United
States, said, "I'm concerned that this administration is legislating a
particular view of morality rather than doing public health." Dr. Georges
Benjamin, executive director of the American Public Health Association,
said, "Public health always has a political element. But we're moving from
science with a big 's' and politics with a small 'p' to science with a
small 's' and politics with a big 'p'" (Wahlberg, Atlanta
Journal-Constitution, 8/3). Terje Anderson, executive director of the
National Association of People with AIDS, said, "You've got to recognize
the social environment risk happens in. There's a shared responsibility
for prevention and recognition that (HIV) positives and negatives need a
whole range of services. We need an approach that adds to both, not takes
away from one" (AP/Long Island Newsday, 8/3).

Administration Reaction


Dr. Robert Janssen, director of the CDC's Division of HIV/AIDS Prevention,
said that with "essentially flat funding" for domestic HIV/AIDS prevention
programs, the government cannot offer financial support for all education
programs, according to the Chronicle. He said, "We don't have the
resources to mount prevention programs for the general population,"
referring to the CDC's new HIV prevention strategy, which targets people
who are at high risk for contracting HIV. An unidentified senior Bush
administration official said that although the president has not publicly
met with AIDS patients in the United States, he has "privately" visited
people living with disease. The official added that Bush is "very, very
aware of [domestic HIV/AIDS] problems" (Houston Chronicle, 8/3).

Editorials


Newspapers continue to publish editorials related to the recently reported
increase in the number of newly diagnosed HIV cases among men who have sex
with men and an overall increase in the number of AIDS cases reported in
the United States. Summaries of two editorials follow:

* Oregonian: The increase in the number of HIV/AIDS cases shows that "we
aren't anywhere close" to "freezing" the overall number of HIV/AIDS cases
in the United States, an Oregonian editorial says. The editorial says that
the general public has an "unrealistic expectation ... that education about
AIDS can just be delivered once and the message should sink in." However,
"AIDS remains a disease without a cure," the Oregonian says, concluding,
"The new numbers show that the campaign against the disease -- our effort
to outwit it via education -- has to be continually renewed and reinforced.
The alternative to teaching is death" (Oregonian, 8/4).

* Philadelphia Inquirer: There is "little excuse" for an increase of HIV
and AIDS cases among people in the United States, where education and
prevention "have been an accepted part of our daily lives for so many
years," according to an Inquirer editorial. But "too many people,
especially young gay men," have become "fatally complacent about their
sexual behavior," the editorial says. They need to realize that "AIDS
remains a killer disease without a cure," and the decision "not to practice
safe sex ... or not to abstain, is as risky today as it was a decade ago,"
according to the Inquirer. The editorial concludes, "Safe sex and
abstinence are not just good ideas. They are behaviors that save lives"
(Philadelphia Inquirer, 8/4).

* Salt Lake Tribune: The reported increase in newly diagnosed AIDS cases
in the United States serves as "a reminder that the deadly disease is still
very much with us and that failing to face up to the danger only increases
it," according to a Tribune editorial. The editorial calls for more
"practical" sex education to help curb the increasing AIDS cases, saying
that "what is [taught in the schools] too often focuses only on abstinence"
and is "out of step with reality." The editorial concludes that the
"spread of AIDS among the younger population is first and foremost a health
issue, in some cases a matter of life and death. Not educating young
people -- either at home or in school -- about sexually transmitted
diseases and their prevention is a moral failure we all must bear" (Salt
Lake Tribune, 8/4).

GLOBAL CHALLENGES


2. 'Gloomy' HIV/AIDS Statistics Cited at South African AIDS Conference;
Demonstrators Criticize Government Inaction

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19201

Researchers yesterday at the South African AIDS Conference 2003 in Durban,
South Africa, presented "gloomy" statistics on HIV/AIDS prevalence in South
Africa, showing that of the 14,000 people newly infected with HIV worldwide
each day, 600 are in South Africa, SABCnews reports (SABCnews, 8/5).
AIDS-related mortality in South Africa is beginning to surpass the number
of new HIV infections, leading some researchers to say that the epidemic is
entering the "death" phase, Reuters reports. University of Natal researcher
Quarraisha Abdool Karim said that national mortality rates for South
African men between the ages of 20 and 40 have increased by more than 150%
since 1998, and the mortality rate for women between the ages of 20 and 35
has risen even more. Abdool Karim also said that although the increasing
death rates could "stabilize" the country's overall AIDS prevalence rate,
it would be "premature and foolish" to believe that AIDS was "under
control" in South Africa, according to Reuters. Some researchers said that
the country's actual AIDS-related death rate is difficult to pinpoint
because government statistics categorize some AIDS-related deaths as deaths
from tuberculosis or other individual HIV-related opportunistic infections,
Reuters reports (Quinn, Reuters, 8/4).

'Armaggedon'


Abdool Karim said, "Along with a rising number of deaths, there will
continue to be a high rate of infections and more AIDS orphans will be
stranded. A rising mortality rate should not be allowed to mask the fact
that many people are still being infected." She added, "We have reached a
critical period in this epidemic, which will have major implications for
decision makers" (Agence France-Presse, 8/4). Rod Hoff, acting chief of
the international research branch of NIH's National Institute of Allergy
and Infectious Diseases Division of AIDS, said at the conference,
"Mortality [in South Africa] is really just starting and won't peak for
another three to four years," adding, "The social and economic impact will
be considerable. Industry is really going to take a hit as people get sick"
(Reuters, 8/4). Dr. Jong-Wook Lee, director general of the World Health
Organization, in an interview with Agence France-Presse compared the
worldwide AIDS crisis to "Armageddon," saying that a large-scale increase
in efforts to fight HIV/AIDS worldwide is needed. "In the African continent
it would be wrong to talk about prevention, voluntarily counseling and
testing, when people are actually dying. You have to provide treatment as
well as prevention," Lee added (SAPA/AFP/Mail & Guardian, 8/5).

Historical Disease Progression


Abdool Karim also presented data on the progression of the disease in South
Africa from the early 1980s through 2001, Xinhua News Agency reports. She
said that although HIV was first detected in the country "largely" among
men who have sex with men and transfusion recipients between 1982 and 1987,
the virus has moved into the heterosexual population, with the country
experiencing an "explosive spread" of HIV between 1994 and 1998. According
to Abdool Karim, 50% of pregnant women in some parts of the country are
HIV-positive (Xinhua News Agency, 8/4). The data also indicate that HIV
prevalence among pregnant women in certain areas of the country is higher
than the prevalence among female sex workers, the South African Press
Association reports.

Government Rejects Nevirapine Data


The data come as the country's Medicines Control Council is considering
barring the use of nevirapine to prevent mother-to-child HIV transmission
unless drug maker Boehringer Ingelheim provides data proving that the drug
is safe (South African Press Association, 8/4). Last year, the South
African government approved nevirapine for universal distribution to state
hospitals in an attempt to reduce the nation's mother-to-child HIV
transmission rate. The announcement followed a Pretoria High Court ruling
in December 2001 that said the government must provide nevirapine to
HIV-positive pregnant women through the public health system. The
government appealed the decision, citing concerns over the drug's safety
and efficacy, but the Constitutional Court in July 2002 denied the appeal,
saying that the government's restriction of the drug's distribution to 18
pilot sites "fell short of its constitutional obligation to offer the best
treatment available." MCC officials last week rejected a 1999 Ugandan study
that showed the drug's efficacy in preventing vertical HIV transmission,
and MCC Chief Precious Matsoso gave the company 90 days to offer additional
safety and efficacy information. If the drug maker fails to provide
alternate data, the government says it will revoke nevirapine's temporary
approval (Kaiser Daily HIV/AIDS Report, 8/4).

Nevirapine Cost


The administration of nevirapine to an HIV-positive pregnant woman to
reduce the risk of vertical HIV transmission to her infant costs the South
African government about $4, while the government pays about $80 each month
to treat an HIV-positive infant, the South African Press Association
reports. In addition, an HIV-positive infant has an average life
expectancy of four years and will acquire medical bills costing the
government more than $3,760 over its lifetime (South African Press
Association, 8/4). Conference Chair Dr. Jerry Coovadia of the Nelson R.
Mandela School of Medicine at the University of Natal said, "The nevirapine
issue has to be faced. But I am more worried about the acrimony over the
issue. They (government officials) are caught in the web of their own
rhetoric. We can understand that. They are politicians. But we must all
make accommodation so that this epidemic can finally be addressed" (Quinn,
Reuters, 8/5). Inkatha Freedom Party health spokesperson Dr. Ruth
Rabinowitz called for a "revolt on behalf of the entire medical fraternity
so that we are not found guilty of complicity with genocide," adding, "The
South African government is determined to have its way. Doctors of
conscience should not assist them. Life, it appears, has become disposable
in the rainbow nation." Coovadia said that he was unsure if there was more
that doctors in the country could do regarding the provision of nevirapine,
the South African Press Association reports. He added, "We make a noise
whenever and however we can" (South African Press Association, 8/4).

Western Cape Model


Western Cape Director of Health Fareed Abdullah said today at the
conference that the approach used in the Western Cape province of South
Africa -- which has "pioneered" the administration of antiretroviral
therapy for pregnant women, infants and a growing number of adults -- could
serve as a model for a national treatment plan, according to Reuters
(Quinn, Reuters, 8/5). The South African government has repeatedly been
criticized for failing to establish a national HIV/AIDS plan, instead
saying that people living with the disease should focus on "nutritional
diets," Agence-France Presse reports (Graham, Agence-France Presse, 8/5).
The Western Cape started its program in 1999 focusing on mother-to-child
HIV transmission prevention, a program that is now universal in the
province, according to Reuters. Vertical HIV transmission in the Western
Cape has been reduced by 50% since 1999, according to Abdullah. In
addition, the province has introduced pilot programs to provide
antiretroviral drugs to adult AIDS patients in poor township areas such as
Khayelitsha. He said that although the pilot programs are small and rely
on funding from foreign nongovernmental groups such as Medicines Sans
Frontieres, the programs are proving that it is "possible to provide
antiretroviral therapy, even for poor people who live in shacks" (Reuters,
8/5). Abdullah also said that counseling and drug adherence support are
equally as important as providing antiretroviral therapy, according to the
South African Press Association. He said, "This is not a simple
intervention but its complexity should not be exaggerated." He added, "We
have to get as many people on treatment as soon as possible. We need to
build the infrastructure for a scale up and ensure medical staff get it
right [the] first time around through tight selection criteria of those put
on drug treatment programs, treatment preparedness and counseling" (South
African Press Association, 8/5).

Demonstrators Demand Treatment, Inclusion


Members of the South African HIV/AIDS advocacy group Treatment Action
Campaign yesterday demonstrated outside of the conference venue, calling
for South African health officials to resume talks with business leaders
and civil society to implement a "cohesive" national HIV/AIDS strategy, the
AP/Philadelphia Inquirer reports (Sylvester, AP/Philadelphia Inquirer,
8/5). TAC on Sunday concluded its own conference with TAC Chair Zackie
Achmat saying that he would begin antiretroviral therapy. Achmat, who was
diagnosed with HIV in 1990, five years ago said he would not take
antiretroviral medications until the South African government made the
medications available to all HIV-positive South Africans (Kaiser Daily
HIV/AIDS Report, 8/4). However, he said yesterday, "I am not going to die
because they want us to die" (AP/Philadelphia Inquirer, 8/5). Achmat
called for the "country's people to stand with us and fight the government
in any way they can," adding, "We cannot do the whole job without the
government. Their participation is crucial" (Graham, Agence-France Presse,
8/4). HIV-positive South African Supreme Court of Appeal Justice Edwin
Cameron yesterday also lead a delegation of people living with HIV/AIDS in
a protest over HIV-positive people being excluded from the conference, the
South African Press Association reports. He said, "This must be the first
AIDS conference I've attended in 10 years where there has been this
omission." He added that he was "immensely distressed" by the exclusion of
people living with HIV/AIDS. A conference organizer blamed Clarence Mini,
who was responsible for organizing the community section of the conference,
for the omission. Mini was unavailable for comment, according to the South
African Press Association. Cameron is scheduled to deliver the
conference's closing address tomorrow, the South African Press Association
reports (South African Press Association, 8/4).

Media Coverage


The following broadcast programs reported on the second day of the
conference:

* BBC News: HIV/AIDS advocates demonstrating at the conference "represent a
growing voice" in South Africa, the segment reports. The segment includes
comments from Achmat and South Africa's Director-General of Health Dr.
Ayanda Ntsaluba (Biles, BBC News, 8/4). The full segment is available
online in RealPlayer.

* SABCNews.com: The segment includes comments from Achmat ("Morning Live,"
SABCNews.com, 8/5). The full segment is available online in RealPlayer.

* SABCNews.com: The segment reports on South African Education Minister
Kader Asmal's announcement of a Human Sciences Research Council study that
will be the "largest HIV/AIDS survey yet" and will test blood samples from
25,000 teachers for the virus ("Morning Live," SABCNews.com, 8/5). The full
segment is available online in RealPlayer.

* Webcasts of selected sessions of the conference are available online
through kaisernetwork.org's HealthCast.

ACROSS THE NATION


3. Bus Company, ACT UP/Philadelphia Settle Discrimination Complaint

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19202

An Exton, Pa.-based charter bus company that agreed to offer a discount to
a group of AIDS advocates going to a legislative hearing in Harrisburg,
Pa., last summer settled a discrimination complaint with the group on
Friday, the AP/Philadelphia Inquirer reports (AP/Philadelphia Inquirer,
8/2). While transporting the members of the AIDS advocacy group ACT
UP/Philadelphia to the hearing, where they were planning to speak against
the creation of a state database containing the names of people who test
HIV-positive, the driver of the bus pulled over after he learned who his
passengers were, according to the AP/Long Island Newsday. The driver
refused to continue because he said he "didn't want to catch anything," the
AP/Newsday reports. After 90 minutes of negotiations with the driver to
continue the trip, the group arrived late in Harrisburg and missed part of
the hearing (Caruso, AP/Long Island Newsday, 8/1). Krapf Bus Companies
agreed to pay an undisclosed amount to each of the 10 passengers, retrain
its staff and post a nondiscrimination policy in each of its buses,
according to the AIDS Law Project of Pennsylvania, which filed the
complaint in March with the Pennsylvania Commission on Human Relations on
behalf of ACT UP. "It's just an unfortunate incident," Krapf attorney
Randy Schauer said, adding, "Certainly what the driver did was not the
company's policy." AIDS Law Project Executive Director Ronda Goldfein
said, "This complaint gave the bus company a chance to look at what this
driver did and say, 'That's not us.' And that's what they've done"
(AP/Philadephia Inquirer, 8/2). Goldfein said that the passengers are
pleased with the settlement (AP/Long Island Newsday, 8/1).

PUBLIC HEALTH & EDUCATION


4. New York Times Examines Comprehensive HIV/AIDS Prevention, Treatment
Compliance Programs for Teens

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19203

The New York Times today examines several comprehensive education programs
aimed at preventing HIV infection among youths or encouraging HIV-positive
youth to comply with their treatment regimens. According to data released
last week at the 2003 National HIV Prevention Conference in Atlanta, the
number of newly reported HIV infections among youth rose slightly in 2002,
a "small but troubling" increase, the Times reports. Of the approximately
40,000 new HIV infections reported last year, more than 50% are estimated
to be among people younger than 25, and most of those people contracted the
virus through sexual contact. "We are concerned about attitudes toward
AIDS in younger patients who have been sexually active since AIDS or HIV
infection has become a treatable disease," Dr. Harold Jaffe, director of
the CDC's National Center for HIV, STD and TB Prevention, said. One
after-school program run by the Children's Aid Society focuses on "creative
self-expression," urging youth to learn skills such as embroidery, drawing,
sports, bank account management or job interviewing. The program, which
was founded by Dr. Michael Carrera of CAS, also includes more traditional
sex education components. Carrera said that none of the 5,000 children who
have enrolled in the program in its 19 years of operation have tested
HIV-positive. He added that he believes the program's success can be
attributed to giving responsibility to the youth themselves. "We like to
say that we don't prevent HIV among our young people, they do," Carrera
said. The Times notes that the same type of program tailoring is being
applied to programs that help HIV-positive youth comply with their
treatment regimens. Some programs assign a nurse or counselor to
HIV-positive teenagers to help monitor their treatment compliance, and
other programs wait to prescribe medication until health care workers feel
that the patient is emotionally prepared to comply (Lerner, New York Times,
8/5).

Webcasts of selected sessions of the 2003 National HIV Prevention
Conference, including an interview with Jaffe, are available online through
kaisernetwork.org's HealthCast.

OPINION


5. Global AIDS Bill Could 'Make Dent in Catastrophic Problem,' Dan Rather
Writes in Opinion Piece

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19204

President Bush's plan for the United States to provide $15 billion over
five years to fight HIV/AIDS in Africa and the Caribbean is a chance to
"make a dent in a catastrophic problem," CBS Evening News anchor Dan Rather
writes in a Houston Chronicle opinion piece (Rather, Houston Chronicle,
8/2). Bush in May signed into law a measure (HR 1298) that authorizes $15
billion over five years to fight AIDS in Africa and the Caribbean. The
House so far has approved a total of $2 billion for the AIDS initiative in
fiscal year 2004, an increase of about $500 million over FY 2003 AIDS
spending (Kaiser Daily HIV/AIDS Report, 7/31). According to Rather, the
funds are "well-directed" at sub-Saharan Africa, where 70% of the world's
42 million HIV-positive people live and where only one-tenth of 1% of the
HIV-positive population currently has access to antiretroviral drugs.
Rather adds that "as bad as things are in Africa," the HIV/AIDS epidemic is
spreading fastest in Eastern Europe and Central Asia, just as HIV/AIDS
cases recently have increased in India, China and the United States.
Recent crises such as terrorism and severe acute respiratory syndrome, or
SARS, have "inspired worldwide action," but Rather says that neither of
those problems "holds a candle to the AIDS epidemic that rages still."
Rather concludes, "Right now, the relative complacency of the world's
richest nations in the face of AIDS has the look of the greatest tragedy of
all" (Houston Chronicle, 8/2).

6. Congress Should Not 'Turn Cheap' When Appropriating Funds for Global
AIDS Initiative, Dallas Morning News Editorial Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19205

Although the United States is "certainly ... in a budget crunch," the
Senate "needs to adequately fund the first year" of President Bush's global
AIDS initiative (HR 1298) when it returns from its August recess, a Dallas
Morning News editorial says, adding that the House "shortchanged the start
of the plan" by appropriating "about $2 billion" (Dallas Morning News,
8/3). Bush in May signed the measure, which authorizes $15 billion over
five years to fight AIDS in Africa and the Caribbean. The House so far has
approved a total of $2 billion for the AIDS initiative in fiscal year 2004,
which represents only two-thirds of the $3 billion authorized in HR 1298
but fulfills Bush's budget request of $2 billion. The Senate
Appropriations Committee last month approved an $18.1 billion FY 2004
foreign aid spending bill, including $1.4 billion to fight AIDS. Additional
money for the initiative is expected to be included in other spending
bills. In addition, the Senate on July 10 passed a nonbinding resolution
calling for $3 billion to be appropriated in FY 2004 to fight AIDS overseas
(Kaiser Daily HIV/AIDS Report, 7/31). "It's wrong for lawmakers suddenly
to turn cheap when it comes to writing the check for the first year" of the
initiative, the Morning News says. The battle against AIDS requires the
resources of the private sector and "the commitment of foreign
governments," the editorial says, adding that Bush "was right to put ours
on the line. Congress should keep it there." The Morning News concludes,
"If we have the resources to fight military battles, we certainly have them
to battle a deadly disease" (Dallas Morning News, 8/3).

________________________________________

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