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

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*** WEBCASTS: South African AIDS Conference ***
View webcasts of sessions from the 2003 South African
AIDS Conference in Durban, including:
Plenary 2: "HIV Genetics," "Challenges of HIV and the
Public Sector in South Africa," and "Implementing
Antiretroviral Therapy - Experiences from the Western Cape"
http://www.kaisernetwork.org/healthcast/sa-aids2003
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Wednesday, August 6, 2003

GLOBAL CHALLENGES
========================================
1. HIV/AIDS Advocates, Researchers Call for National HIV/AIDS
Antiretroviral Policy at Close of South African AIDS Conference

2. Global Fund, UNAIDS Sign Memorandum of Understanding Reaffirming
Commitment to Fighting AIDS, TB, Malaria

3. U.S. Public Health Experts Send Letter to Chinese Premier Protesting
Arrest of HIV-Positive Farmers

4. Nigeria Facing Gaps in HIV/AIDS Awareness, Infrastructure; Could Result
in Spread of Disease


DRUG ACCESS
========================================
5. States, Territories Negotiate $65M in Annual Price Concessions for
HIV/AIDS Drugs From Eight Pharmaceutical Companies


IN THE COURTS
========================================
6. Luc Montagnier To Testify at Trial of Health Care Workers Accused of
Deliberately Infecting Libyan Children With HIV


PUBLIC HEALTH & EDUCATION
========================================
7. Oakland Tribune Examines OraQuick Rapid HIV Test That 'Could Alter' HIV
Diagnosis, Treatment


MEDIA & SOCIETY
========================================
8. NPR's 'Tavis Smiley Show' Interviews POZ Magazine Editor About Special
Issue on HIV/AIDS in Black Community


OPINION
========================================
9. Choices About Internet Filters Should be Better Informed, Opinion Piece
Says

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

GLOBAL CHALLENGES


1. HIV/AIDS Advocates, Researchers Call for National HIV/AIDS
Antiretroviral Policy at Close of South African AIDS Conference

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19213

HIV/AIDS researchers and advocates at the close of the South African AIDS
Conference 2003 today in Durban, South Africa, called for a "rapid ...
rollout" of a national antiretroviral therapy policy to address the
country's epidemic, Reuters reports (Quinn, Reuters, 8/6). Research
presented at the conference shows that 600 people out of the 14,000 people
newly infected with HIV worldwide each day live in South Africa. In
addition, AIDS-related death rates in the country are beginning to surpass
the number of new HIV infections (Kaiser Daily HIV/AIDS Report, 8/5).
Salim Abdool Karim, scientific chair of the conference, said, "The message
is: don't wait. You've got to do something, and you have got to do it now.
This is not an attack on the government. This is a scientific fact."
Although South African President Thabo Mbeki and Health Minister Manto
Tshabalala-Msimang have questioned the use of antiretroviral drugs, Reuters
reports other officials say that "change may be coming," as the cabinet
prepares to receive a "long-delayed" report detailing the cost of a
national antiretroviral drug plan. Health Ministry Director-General Ayanda
Ntsaluba said that the question now is "when, not if" the government will
implement an antiretroviral drug policy, adding, "All of us are seized with
a sense of urgency on this issue."

Orphans, Vertical HIV Transmission


Pediatrician and University of Natal researcher Raziya Bobat said at the
conference that if no AIDS treatment plan was implemented between now and
2010, the country could have 20 million orphans, Agence France-Presse
reports. She added that in order to address the problem, treatment to
prevent mother-to-child HIV transmission is "vital," according to Agence
France-Presse (Graham, Agence France-Presse, 8/5). Her comments came as
the Medicines Control Council is considering barring the use of the
antiretroviral drug 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, 8/5). 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 July 2002 ruling by the
Constitutional Court that said 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, 8/5). "As
we progress with mother-to-child treatment, the number of HIV-infected
children will come down, and it will be an easier problem to handle," Bobat
said (Agence France-Presse, 8/5).

Hospital, Clinic Transmission


There could be a "high risk" of HIV transmission at hospitals and clinics
because of poor clinical practices, inadequate sterilization facilities and
a high HIV/AIDS prevalence rate among young health care workers, according
to a Human Sciences Research Council study presented at the conference,
Business Day reports. Researchers surveyed 2,000 health care workers and
2,000 patients in more than 200 hospitals and clinics throughout the
country and found that 86% of workers had access to protective gloves and
56% had access to protective gowns. In addition, 59% never stocked HIV
testing kits, Business Day reports. Researchers also found that more than
16% of health care workers are HIV-positive; 20% of participants between
the ages of 18 and 35 tested positive, and 16.6% of respondents between the
ages of 36 and 45 tested positive. Olive Shisana, executive director of
the HSRC's HIV/AIDS research programs, said that the results raise "the
question of bloodborne infection in health care facilities" and present
"major implications for the future supply of health care professionals"
(Kahn, Business Day, 8/5).

Treatment Action Campaign


Treatment Action Campaign Chair Zackie Achmat said that the conference has
shown "that there is overwhelming support for the government to develop a
treatment plan" (Reuters, 8/6). Achmat said that the fight against the
disease has become a "political issue, because everyone that is infected
needs access to anti-AIDS drugs." He added that the reason the country
cannot move forward with a national HIV/AIDS plan is because Mbeki and
Tshabalala-Msimang are "HIV denialists" (Agence France-Presse, 8/6). TAC
on Sunday concluded its own conference by voting to renew civil
disobedience to force the government to provide antiretroviral drugs to all
HIV-positive people (Kaiser Daily HIV/AIDS Report, 8/4). The African
National Congress, the country's ruling party, yesterday called for
"patriotic South Africans" not to participate in TAC's civil disobedience
campaign. ANC spokesperson Mtholephi Mthimkhulu said, "We view this as an
irresponsible act that seeks to undermine all constructive discussions"
that took place at the conference. He added, "Our democratically elected
government is always prepared to engage in constructive debates around many
issues, including HIV/AIDS. The call by TAC is, therefore, tantamount to
reducing the challenge of HIV/AIDS to an inhumane public relations
exercise" (South African Press Association, 8/5).

Archbishop Calls AIDS 'As Serious As Apartheid'


Anglican Archbishop of Cape Town Njongonkulu Ndungane yesterday said that
the HIV/AIDS epidemic has become "a world disgrace as serious as
apartheid," according to the South African Press Association (South African
Press Association, 8/5). He said, "We as a church feel let down by our
elected government, who shows no political will at all in trying to save
the lives of people who are dying each day from AIDS." Ndungane added that
he is "embarrassed" when traveling outside of South Africa because "people
know that this country is failing its people." He said, "We have a crisis
on our hands that is only getting worse as we see more AIDS orphans, more
households headed by children and grandmothers in frailty and poverty and
having to raise families." The archbishop also said that the country's
Constitutional Court "thought it best to give mothers and babies
nevirapine. How can the government now want to ignore that? It makes no
sense" (Sylvester, Associated Press, 8/5). The national health department
said that Ndungane's remarks demonstrate that he is uninformed about the
government's role in the situation. The department said that the
government had "no role in regulating medicines, including nevirapine"
because "in terms of the law, this is the responsibility of an independent
Medicines Control Council." The health department also said that it was
"unfortunate" that the archbishop "had chosen to issue an irresponsible and
politically dangerous statement at the time when government and civil
society are meeting in Durban to address the very challenge of HIV and
AIDS" (South African Press Association, 8/5).

Die Burger Editorial


The Cape Town-based newspaper Die Burger today in a front-page editorial
called on the government to end the "insanity" in dealing with HIV/AIDS,
Agence France-Presse reports (Agence France-Presse, 8/6). 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" (Kaiser Daily HIV/AIDS Report,
8/5). Die Burger Editor Arrie Rossouw said that placing the editorial on
the front page -- directly below the masthead -- was an unusual step (South
African Press Association, 8/6). Rossouw said, "It is the strongest form
of protest available to us to express the concern and disapproval of our
editorial staff and our readers over the government's handling of the
crisis" (Agence France-Presse, 8/6).

SABCNews.com yesterday reported on the MCC's decision not to deregister
nevirapine (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.

2. Global Fund, UNAIDS Sign Memorandum of Understanding Reaffirming
Commitment to Fighting AIDS, TB, Malaria

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19214

The Global Fund to Fight AIDS, Tuberculosis and Malaria and UNAIDS on
Monday signed a Memorandum of Understanding to "reaffirm their mutual
engagement to strengthen the global response" to AIDS, TB and malaria,
according to a Global Fund release. The memorandum says that the Global
Fund is a "critical financing mechanism" for helping to curb the spread of
the three diseases in the developing world and that UNAIDS is a "key source
of strategic analysis, policy advice and technical expertise," according to
the release. UNAIDS Executive Director Dr. Peter Piot said, "For the first
time in the short history of the AIDS epidemic -- and decisively in the
case of malaria and TB -- we have the potential to reverse these epidemics
through increased political and financial commitments." He added, "The
Global Fund is an indispensable resource in seizing this historic
opportunity and accelerating the response to these three diseases. The U.N.
system stands committed to making the Global Fund a success." Global Fund
Executive Director Richard Feachem said, "The finance of the Global Fund
must be complemented by technical support to countries, so that both public
and private recipients can maximize their efforts to fight AIDS, TB and
malaria. The world depends on the in-country assistance provided by UNAIDS
as well as its tireless role in global advocacy and coordination." Feachem
added, "Fighting these diseases is a job for all of us." A fact sheet on
the Global Fund and the United Nations is available online at the Global
Fund Web site (Global Fund release, 8/4).

3. U.S. Public Health Experts Send Letter to Chinese Premier Protesting
Arrest of HIV-Positive Farmers

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19215

The China AIDS Solidarity Network, a group of mainly U.S.-based public
health experts, has sent an open letter to Chinese Premier Wen Jiabao
urging the release of seven farmers arrested in a dispute over HIV/AIDS
treatment and criticizing the country for the way it is handling the
epidemic, Agence France-Presse reports. The letter, which was signed by 41
researchers and professors from major universities, said that China is
"shooting itself in the foot" by detaining people who are advocating for
improved national AIDS policies, according to Agence France-Presse
(Agence-France Presse, 8/5). In one incident, hundreds of police officers
in June 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, 8/4). Of the 13 farmers originally jailed, seven remain
in custody, including five HIV-positive individuals, according to Agence
France-Presse. "The harassment of people with HIV/AIDS and their advocates
diminishes China's ability to halt its AIDS epidemic, which is advancing
rapidly and threatens to rival the epidemics in Africa and India in the
near future," the letter said. As many as two million HIV-positive
individuals who were infected through unsafe blood collection practices may
live in Henan province, according to CASN. The United Nations estimates
that last year China had approximately 1.5 million HIV-positive people in
2002, but many health officials say that the true figure could be "much
higher," according to Agence France-Presse. The United Nations has said
that China could have 10 million people living with HIV by 2010. In
October 2002, U.N. Secretary-General Kofi Annan said that China "stands on
the brink of an explosive AIDS epidemic" and must act immediately to stop a
potential "catastrophe," Agence France-Presse reports (Agence-France
Presse, 8/5).

Additional information on AIDS in China is available online through
kaisernetwork.org's Issue Spotlight on HIV/AIDS.

4. Nigeria Facing Gaps in HIV/AIDS Awareness, Infrastructure; Could Result
in Spread of Disease

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19216

Nigeria is facing a "huge gap" in awareness of HIV/AIDS issues that could
"turn a serious national problem into a disaster," the Financial Times
reports. Although the country currently has a lower HIV prevalence than
other countries in sub-Saharan Africa, Nigeria's "huge population" of 128
million people could mean that the country has the third highest number of
HIV-positive people on the continent, according to the Nigerian Health
Ministry. Nigeria also faces infrastructure and cultural diversity
problems that could "overwhelm efforts to promote AIDS treatment and
prevention," the Times reports. The government has established a national
oversight group for its HIV/AIDS prevention and treatment programs, which
aim to provide antiretroviral drugs to 10,000 HIV-positive adults and 5,000
HIV-positive children. But "big questions remain" about the programs'
efficiency, according to the Times. The country has not yet received the
drugs for the children's program, and some of the medicines for the adult
program are not reaching hospitals or are being held by officials seeking
"bribes in exchange for treatment," according to the Times. Mohammed
Farouk, executive director of the Lagos-based nongovernmental group AIDS
Alliance in Nigeria, said, "The antiretroviral project isn't working the
way they want it to work. People are not getting access to drugs." Also,
the country's efforts to combat HIV/AIDS are "hampered" by a "strong"
Christian and Muslim population, the Times reports. For example, the
Nigerian Red Cross Society said that some churches asked the organization
to change its "ABC" AIDS prevention campaign from "abstinence, be faithful,
use condoms" to exclude any mention of contraception. Dr. Kunle Aderanti,
principal health officer for the Nigerian Red Cross, said, "The problem
that we have in Nigeria is mainly cultural. It's culturally taboo for
children to discuss sex with adults -- it's taboo even to discuss sex
openly" (Peel, Financial Times, 8/5).

DRUG ACCESS


5. States, Territories Negotiate $65M in Annual Price Concessions for
HIV/AIDS Drugs From Eight Pharmaceutical Companies

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19217

State and territorial health officials have negotiated about $65 million
in annual price concessions from eight major pharmaceutical companies for
antiretroviral drugs supplied through their AIDS Drug Assistance Programs,
the Wall Street Journal reports (Fuhrmans, Wall Street Journal, 8/6).
ADAPs, which are state-managed, federally funded programs, provide HIV
treatment to low-income, uninsured and underinsured HIV-positive
individuals (Kaiser Daily HIV/AIDS Report, 7/10). About 84,000
HIV-positive people -- one-third of the U.S. market for HIV/AIDS-related
drugs -- procure their medications through such programs, which cost about
$850 million each year (Wall Street Journal, 8/6). As of June, fifteen
states had waiting lists or access restrictions on their ADAPs, and six
more states anticipated having to impose new or additional restrictions on
their programs in fiscal year 2003, according to a report from the National
Alliance of State and Territorial AIDS Directors. ADAP representatives
from California, Florida, Maryland, Massachusetts, New Jersey, New York,
North Carolina and Texas -- states that collectively account for 75% annual
ADAP drug expenditures -- since March have been negotiating with
representatives from Bristol-Myers Squibb, Roche, GlaxoSmithKline, Merck,
Pfizer, Abbott Laboratories, Boehringer Ingelheim and Gilead Sciences to
discuss ways of alleviating the budget shortfalls that state ADAPs are
currently facing (Kaiser Daily HIV/AIDS Report, 7/10). The initiative
marks the first time that all 56 state and territorial ADAPs have come
together to increase their leverage in negotiating price discounts. BMS,
which was the last company to reach an agreement with the group, said that
its agreement provides as much as $35 million in drug discounts over 20
months, covering the company's five main AIDS-related treatments, including
its new protease inhibitor Reyataz.

Price Concessions


For competitive reasons, the companies and ADAP directors agreed not to
divulge price concessions and rebates for specific treatments, but the
discounts apply to dozens of the most commonly used HIV/AIDS medications,
including new medicines such as Roche's Fuzeon (Wall Street Journal, 8/6).
The FDA in March approved Fuzeon, which is designed for HIV/AIDS patients
who have failed to respond to other medications. The drug costs about
$20,000 per patient per year, double the price of the most expensive HIV
treatments currently on the market (Kaiser Daily HIV/AIDS Report, 6/2).
Twenty-two state programs have added or plan to add Fuzeon to their
formularies, and Roche currently is in negotiations to have the drug added
to other programs. However, many programs are offering the drug only in
limited quantities due to its high price (Wall Street Journal, 8/6).
Despite the agreements, some state ADAP officials still have concerns
regarding congressional appropriations for the program, which appears to be
"far less" than the amount needed for fiscal year 2004, according to a
NASTAD release (NASTAD release, 8/5). NASTAD says that it needs an
additional $282 million for FY 2004 in order to avoid waiting lists and
additional restrictions, but budget talks in Congress so far have called
for only a $25 to $38 million increase over FY 2003 spending, according to
the Journal (Wall Street Journal, 8/6). Dwayne Haught, ADAP coordinator
for Texas, said, "We were disappointed with last year's federal
appropriation for ADAP and this year's appears bleak as well. The
manufacturers have stepped forward to at least partially fill the hole left
by the federal budget" (NASTAD release, 8/5).

IN THE COURTS


6. Luc Montagnier To Testify at Trial of Health Care Workers Accused of
Deliberately Infecting Libyan Children With HIV

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19218

Dr. Luc Montagnier, the French researcher who co-discovered HIV, is
expected to testify at the trial of one Palestinian and six Bulgarian
health care workers who have been accused of deliberately infecting 393
Libyan children with HIV, Bulgarian radio reported on Monday,
AFP/news24.com reports. In addition, Italian AIDS researcher Vittorio
Colizzi, who co-wrote with Montagnier a report on the case that they
submitted to Libyan authorities in April, will also testify at the trial
(AFP/news24.com, 8/4). The health workers have been detained in Libya
since early 1999 on charges that they deliberately infected children with
HIV through contaminated blood products while working at a hospital in
Benghazi, Libya. Montagnier visited the hospital in 2002 and concluded
that the outbreak of HIV at the facility was likely caused by basic medical
errors, such as inadequate equipment, unskilled staff and the reuse of
unsterilized needles (Kaiser Daily HIV/AIDS Report, 11/19/02). The trial
has been postponed until Sept. 3, according to AFP/news24.com. If the
health care workers are found guilty, they will face the death penalty
(AFP/news24.com, 8/4).

PUBLIC HEALTH & EDUCATION


7. Oakland Tribune Examines OraQuick Rapid HIV Test That 'Could Alter' HIV
Diagnosis, Treatment

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19219

The Oakland Tribune on Monday examined the use of OraSure's OraQuick rapid
HIV test, which can deliver a result in about 20 minutes, saying that the
test "could alter diagnosis and treatment for thousands." An estimated
25% of the almost one million HIV-positive people in the United States are
unaware of their status, according to the CDC, partly because nearly 50% of
people who undergo HIV testing never return for their results. However,
with the OraQuick test, "there's little time to ponder the outcome," which
can present a challenge for HIV counselors who must deliver the results to
clients, according to the Tribune. Although a traditional laboratory-based
antibody test is required to confirm any positive OraQuick result, the test
did not have any false-positive results in clinical trials (Vesely, Oakland
Tribune, 8/4). The complete article is available online.

MEDIA & SOCIETY


8. NPR's 'Tavis Smiley Show' Interviews POZ Magazine Editor About Special
Issue on HIV/AIDS in Black Community

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19220

NPR's "Tavis Smiley Show" yesterday included an interview with Akiba
Solomon, consulting editor for a special edition of the monthly HIV/AIDS
magazine POZ that focuses on HIV/AIDS in the black community (Smiley,
"Tavis Smiley Show," NPR, 8/5). The issue features a cover story with R&B
singer and AIDS advocate Mary J. Blige and interviews with former NBA star
Earvin "Magic" Johnson, Democratic presidential candidate Rev. Al Sharpton
and hip-hop star Keith Murray. The issue also includes stories on the role
of black churches in the fight against HIV/AIDS and on men who have sex
with both women and men without informing their partners. More than 200,000
copies of the magazine will be made available to community groups, AIDS
services organizations and churches serving the black community and at
special events across the country (Kaiser Daily HIV/AIDS Report, 7/9).
According to Solomon, the supplement reaches the black community in ways
that standard issues of the magazine, which covers HIV/AIDS in ways that
"aren't culturally specific," may not. Solomon discussed the issue's
contents and also commented on a feature in Sunday's New York Times
Magazine on African-American men on the "down low," an expression that
describes some black men who have sex with men but who do not tell their
female sex partners, friends or family members ("Tavis Smiley Show," NPR,
8/5).

The full segment is available online in RealPlayer.

OPINION


9. Choices About Internet Filters Should be Better Informed, Opinion Piece
Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19221

School officials and public librarians need to "understand how Internet
filters work and make informed choices on whether to use them to block more
than pornography," as the filters can also block important health
information, including information on AIDS and other sexually transmitted
diseases, Vicky Rideout, vice president of the Kaiser Family Foundation,
writes in a USA Today opinion piece (Rideout, USA Today, 8/6). The Supreme
Court in June upheld 6-3 the Children's Internet Protection Act -- which
requires public libraries that receive federal funding to put
anti-pornography Internet filters on their computers or lose their funding
-- saying that the law does not violate the First Amendment. A Kaiser
Family Foundation study published in December 2002 found that filters set
at the least restrictive level block 87% of pornography and 1.4% of general
health sites. Programs set at the most restrictive setting blocked 24% of
general health sites and 50% of sexual health sites. Among the sites
blocked by the programs were a CDC site on sexually transmitted diseases;
an FDA site on birth control failure rates; and a Princeton University site
on emergency contraception (Kaiser Daily HIV/AIDS Report, 6/24). Three out
of four older teenagers have gone online to look for health information,
and almost 50% of them say that they have been blocked from nonpornographic
sites in the process, Rideout says. In order for local officials -- many
of whom are "woefully uninformed" about how filters work -- to make
decisions about what kinds of sites to block, information about filters
must be brought "out in the open," she writes. In addition, filtering
companies should "provide more flexibility," create a default mode that
only blocks pornography and create a single Web site where providers of
online information -- including not-for-profit organizations that may lack
monitoring resources -- can check to see whether their pages are being
blocked, Rideout concludes (USA Today, 8/6).

________________________________________

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