KAISER DAILY HIV/AIDS REPORT
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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"
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________________________________________



Thursday, August 7, 2003

GLOBAL CHALLENGES
========================================
1. South Africa, Global Fund Sign Grant Agreements Committing $41M Over Two
Years To Fight HIV/AIDS, Tuberculosis

2. South Africa's Medicines Control Council May Ban Use of Nevirapine Only
for Prevention of Vertical HIV Transmission, Official Says

3. Zambian President Disappointed by Failure of Donor Community To Fulfill
Pledges to Global Fund


DRUG ACCESS
========================================
4. South African Generic Drug Maker To Produce Country's First Generic
Antiretroviral Drug

5. Mexican President Announces Plan To Provide Drugs to All AIDS Patients


ACROSS THE NATION
========================================
6. Ohio Children's Football League Bars HIV-Positive Man From Coaching
Position


OPINION
========================================
7. Bush's Global AIDS Plan Lacks 'Good Solid Planning,' Providence Journal
Editorial Says

8. Education Needed To Avoid New AIDS 'Upsurge' in United States,
Winston-Salem Journal Editorial Says

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

GLOBAL CHALLENGES


1. South Africa, Global Fund Sign Grant Agreements Committing $41M Over Two
Years To Fight HIV/AIDS, Tuberculosis

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19237

The South African government and the Global Fund to Fight AIDS,
Tuberculosis and Malaria today signed agreements committing $41 million
over two years for HIV/AIDS and TB treatment and prevention programs,
according to a Global Fund release. The grants will help improve access to
antiretroviral therapy for HIV-positive people and bolster voluntary
testing and counseling programs in Kwa-Zulu Natal, the South African
province hardest hit by the epidemic. More than one-third of the
population in the province is estimated to be HIV-positive, and about 15%
of the country's total TB cases live in the province, according to the
release. Some funds will go to nationwide HIV prevention campaigns,
including loveLife and Soul City. "Today's grant signing is a turning
point in South Africa -- a signal of hope for those living with HIV and for
all Africans working together to turn the tide against these deadly
co-pandemics," Global Fund Executive Director Richard Feachem said, adding,
"In personally approving the proposal, [South African] President [Thabo]
Mbeki has enabled new energy and partnership in the fight against AIDS in
South Africa. Now we must work together to ensure the delivery of these
services, including the antiretroviral treatment that is desperately needed
by the South African people" (Global Fund release, 8/7). The South African
government and the Global Fund in April twice failed to sign the agreement
because of "technical details," including which government department would
be responsible for the grant money (Kaiser Daily HIV/AIDS Report, 4/14).
According to the release, the National Treasury will act as the principal
national recipient for the Global Fund money, which will be used by both
public and private partners. PriceWaterHouseCoopers will serve as the
Local Fund Agent and will "review financial and programmatic statements on
the progress of the grant" to trigger successive Global Fund disbursements,
according to the release. South Africa has more HIV-positive people than
any other country in the world, with one in 10 people estimated to be
HIV-positive (Global Fund release, 8/7).

2. South Africa's Medicines Control Council May Ban Use of Nevirapine Only
for Prevention of Vertical HIV Transmission, Official Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19238

South Africa's Medicines Control Council yesterday during a plenary
session on the final day of the South African AIDS Conference 2003 in
Durban, South Africa, said that it would not ban general use of the
antiretroviral drug nevirapine but might consider banning the drug to
prevent mother-to-child HIV transmission, the South African Press
Association reports (South African Press Association, 8/6). The MCC has
said that it was 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. MCC officials last week
rejected the results of a 1999 Ugandan study that found that the drug is
effective 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, 8/6). Matsoso said that there were "glaring
differences between the designs" of the Ugandan study and the South African
Intrapartum Nevirapine Trial (SAINT) (South African Press Association,
8/6). Matsoso said the MCC rejected the Ugandan trial as a "pivotal study"
and that the SAINT study was not "comprehensive" enough because of
"problems with its design," according to U.N. IRIN/AllAfrica.com. Although
the MCC is "mindful of the government's constitutional obligation to
provide" the drug under a July 2002 Constitutional Court ruling,
researchers and policy makers should consider "other options" in case the
drug is deregistered, Matsoso said.

Scientific Grounds


Dr. James McIntyre, head of the Chris Hani Baragwanath Perinatal HIV Unit,
said that differences between the nevirapine studies were "part of
scientific research" and did not "rule out" the findings of either trial,
according to U.N. IRIN/AllAfrica.com (U.N. IRIN/AllAfrica.com, 8/6).
Matsoso acknowledged that nevirapine is "important in public programs" and
that a generic version of the drug and other antiretroviral drugs have been
registered "to facilitate access to treatment" (South African Press
Association, 8/6). The South African Cabinet said in a statement that it
was considering the implications for current HIV/AIDS programs in the
country should the MCC decide to deregister nevirapine. The cabinet also
said that the MCC decision on nevirapine was an "independent one, taken on
scientific grounds," according the South African Press Association. The
cabinet added that it has "called on those who purport to have scientific
information on the efficacy of nevirapine" for mother-to-child HIV
transmission prevention to offer "information to the MCC within the window
period," adding, "[W]hatever approach is adopted by government will be
guided by its concern for the health of both mothers and babies affected
with HIV" (South African Press Association, 8/6).

Reaction


Dr. Nono Simelela, chief director of the South African Department of
Health's HIV/AIDS program, said that she has been "spending sleepless
nights asking what we are to do with mother-to-child transmission if we
can't have nevirapine." She added, "I have 80,000 women on this program.
I have to have an answer for them." U.N. Special Envoy for HIV/AIDS in
Africa Stephen Lewis said, "Africa is entering a desperate and difficult
period as the (HIV) infections become full-blown AIDS, and there is a sense
that the worst is still to come." Lewis, who recently completed a trip to
Uganda, Rwanda and Mozambique, said that some African countries are
"obsessed with treatment" and have a "desperate feeling that they need to
keep people alive (yet) had reached a point of no return" (Cullinan,
Health-E News, 8/4). In a speech at the close of the conference yesterday,
HIV/AIDS advocate Prudence Mabele called for an end to the "political game"
over the use of nevirapine to prevent mother-to-child HIV transmission,
asking the South African government to offer women the choice of whether to
take the drug, according to U.N. IRIN/AllAfrica.com (U.N.
IRIN/AllAfrica.com, 8/6). KwaZulu-Natal Health Minister Dr. Zwele Mkhize,
speaking on behalf of South African Health Minister Manto
Tshabalala-Msimang at the closing of the conference, said, "While we can't
prejudge the decisions of the MCC, which is an independent body, the value
of nevirapine to save babies' lives cannot be undermined and the program
itself must not be compromised." He added that a national antiretroviral
program for all people living with HIV/AIDS in the country is a "reality"
and not a matter of "if, but when," according to South Africa's Star.
Mkhize said, "There is no question about this. It must be placed on record
that this is not an ideological issue. With the rising mortality rate from
AIDS, one more death is too many" (Clarke, Star, 8/7).

AIDS Ribbon


Conference organizers have reported that a 1.49 mile-long AIDS awareness
ribbon has set a Guinness World Record for the largest awareness ribbon,
according to the Panafrican News Agency. The ribbon, crafted by the
Mayihlome Project, is 328 yards longer than the previous record holder.
Conference delegates were invited to purchase one of the 10,000 rectangles
used to create the ribbon, and the funds raised will be matched by a
donation from the Old Mutual Foundation. The money will be donated to
Shepherd's Keep, an organization which provides shelter, medication and
care for AIDS orphans in Durban (Panafrican News Agency, 8/7).

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

3. Zambian President Disappointed by Failure of Donor Community To Fulfill
Pledges to Global Fund

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19239

Zambian President Levy Mwanawasa on Tuesday during a meeting with U.N.
Special Envoy for HIV/AIDS in Africa Stephen Lewis "expressed
disappointment" that money promised by the Global Fund to Fight AIDS,
Tuberculosis and Malaria was being delivered slowly and urged the
international donor community to fulfill its pledges to the fund, Xinhua
News Agency reports (Xinhua News Agency, 8/5). The Global Fund has pledged
to provide $42 million over two years to Zambia to help fight HIV/AIDS and
TB (Kaiser Daily HIV/AIDS Report, 4/1). Already this year, the fund has
released $4 million to Zambia, according to Xinhua News Agency (Xinhua News
Agency, 8/5). Mwanawasa, speaking at the opening of the four-day Southern
African Network of AIDS Service Organisations Conference in Zambia, which
Lewis is also attending, said that Zambia is having difficulty providing
for the country's more than 600,000 HIV/AIDS orphans, according to Agence
France-Presse. "We now have 620,000 orphans and I am told the figure will
go up to 974,000 by the year 2014," Mwanawasa said, adding that any
economic or development aid would not be effective without also combating
HIV/AIDS, including increasing access to antiretroviral treatment (Agence
France-Presse, 8/5). Lewis said that the Global Fund has called for grant
recipient countries to implement administrative structures before the fund
will release grant money, according to Xinhua News Agency. "We are trying
to push the Global Fund to relax some of the conditionalities so that the
money is released," Lewis said, adding, "There is still a lot of money
which needs to be released to fight the pandemic" (Xinhua News Agency,
8/5).

Fighting HIV/AIDS Stigma


Lewis also said that although fighting HIV/AIDS in Africa is a "tremendous
challenge," African countries work on creating their own solutions to
encourage voluntary HIV/AIDS testing, home-based care, treatment and
prevention of mother-to-child HIV transmission (Mwanangombe, Associated
Press, 8/5). Lewis last week began a six-day trip to Uganda that has
focused on the impact of HIV/AIDS on the lives of the country's women and
children, including AIDS orphans. Lewis is traveling with children's
rights advocate Grace Machel, wife of former South African President Nelson
Mandela (Kaiser Daily HIV/AIDS Report, 7/30). Machel, who also spoke at
the conference on Tuesday, said that Africa needs to eliminate HIV/AIDS
discrimination and stigma, according to the Associated Press. She added
that Africans need to begin openly discussing sex to fight the epidemic
effectively. "Living with HIV/AIDS is not a shame. You can live with
AIDS," Machel said, asking, "Why do we then discriminate?" Lewis said,
"The strength of Africa lives at the grass roots. All we will need now is
to find resources that will deal with issues of orphans, home-based care
and all those areas that make it complicated to deal with the stigma and
fear of being associated with HIV/AIDS" (Associated Press, 8/5). According
to the government, 200 Zambians die of AIDS-related causes and another 500
people become HIV-positive each day(Kaiser Daily HIV/AIDS Report, 4/1).

DRUG ACCESS


4. South African Generic Drug Maker To Produce Country's First Generic
Antiretroviral Drug

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19240

Aspen Pharmacare, southern Africa's largest generic drug manufacturer,
yesterday announced that it will develop and produce the continent's first
generic antiretroviral drug, called Aspen-Stavudine, South Africa's Mail &
Guardian reports (Mail & Guardian, 8/6). The drug, manufactured under
voluntary license from Bristol-Myers Squibb, which markets stavudine as
Zerit, "marks a breakthrough" in the fight against AIDS in Africa,
according to Reuters (Chege, Reuters, 8/6). Under the terms of its
voluntary license, the company will be allowed to sell the drug to both the
public and private sector, according to Aspen CEO Stephen Saad. The drug
will cost between $3 and $4 per month per person, depending on dosing,
compared with about $5 per person for a month's supply of Zerit in South
Africa, the Associated Press reports (Nessman, Associated Press, 8/6). The
cost of the drug is within the range recommended by the World Health
Organization and will be competitive with the pricing of generic drugs
produced by Asian generic drug makers (Reuters, 8/6). The company has also
submitted registration applications to the country's Medicines Control
Council for its generic versions of Combivir, zidovudine, lamivudine,
didanosine and nevirapine, Saad said (Mail & Guardian, 8/6). Once the
generic drugs are registered, Aspen plans to sell a three-drug combination
regimen for less than $1 a day, according to Saad. Unlike Aspen-Stavudine,
however, the licenses obtained for the production of the other
antiretrovirals will allow the company to sell the drugs only to the public
health system (Associated Press, 8/6). Current three-drug combinations
using generics from Asian manufacturers cost about $1.40 per patient per
day.

Government Action


Aspen's announcement puts pressure on the South African government to roll
out a national antiretroviral treatment plan, according to health industry
officials, Reuters reports. The government's AIDS policies came under fire
yesterday at the close of the South African AIDS Conference 2003 in Durban
and health industry officials said that Aspen's announcement leaves the
government with "little room for excuses," according to Reuters. "We are
at a point when the government has sufficient options in place to consider
rolling out an antiretroviral treatment program," an unnamed pharmaceutical
industry official said (Reuters, 8/6). Trade and Industry Minister Alec
Irwin said that he could not determine whether the government would make
use of the new drug, adding that the rollout of the antiretroviral
treatment plan would "continue as planned," according to the
SAPA/Independent Online. "The advantage we now have is that a generic is
available from a South African company, so it certainly gives certain cost
advantages in the roll-out program," he said (SAPA/Independent Online,
8/6). South African AIDS advocacy group Treatment Action Campaign
"cautiously welcomed" the announcement but criticized the exclusive license
BMS granted Aspen, saying that only free competition among generic
companies would make the prices of drugs fall as low as possible, according
to the Associated Press. "While this is an excellent development, and it
does move us forward, it is not ideal," Eduard Grebe, TAC's treatment
project coordinator, said, adding, "It's in fact a transfer of monopoly and
not generic competition" (Associated Press, 8/6).

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



5. Mexican President Announces Plan To Provide Drugs to All AIDS Patients

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19241

Mexican President Vicente Fox on Tuesday announced that the government
plans to provide AIDS medications for "100%" of the country's AIDS patients
by the end of the year, the Associated Press reports (Associated Press,
8/5). About 10,000 Mexicans who cannot afford to pay for their own
treatment currently receive government funding for AIDS treatment, but it
is unclear exactly how many more patients will receive assistance under the
new plan (AP/Los Angeles Times, 8/6). Fox did not specify if the program
would serve only individuals with AIDS or if the program would extend to
all HIV-positive patients. The Mexican Health Department reports that in
2002 -- the most recent year for which data are available -- 16,231 new
HIV/AIDS cases were reported, and between 116,000 and 177,000 Mexicans were
already living with the disease. The department did not have data showing
the number of individuals in the country who have developed AIDS, the
Associated Press reports. Health department representatives on Tuesday
were unavailable for comment, according to the Associated Press (Associated
Press, 8/5).

ACROSS THE NATION


6. Ohio Children's Football League Bars HIV-Positive Man From Coaching
Position

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19242

The Ellet Suburban Football League, a children's football league outside
of Akron, Ohio, on Sunday announced that it would bar an HIV-positive man
from being an assistant coach, the Akron Beacon Journal reports. Dan
Gable, director of the league -- which is overseen by the Ellet Amateur
Athletic Association -- said that he had received anonymous telephone calls
from people identifying themselves as parents of children in the league
saying that they were concerned about former Akron firefighter Stephen
Derrig coming into contact with their children on the field because of his
HIV-positive status. The calls prompted Gable to call a board meeting to
discuss the issue, and the volunteer members on Sunday voted to prohibit
Derrig from coaching. Dr. Margo Erme of the Akron Health Department
attended the meeting at Derrig's request and said that "occupations such as
coaching present no risk for AIDS transmission," the Beacon Journal
reports. Following a "raucous" meeting on Monday night, almost all of the
members of the league's board announced their resignations after "parent
after parent" said the board was making an "ill-informed" decision.
Currently, Derrig's position with the team remains "in question," the
Beacon Journal reports (Wallace, Akron Beacon Journal, 8/5).

'Ignorance of Past'


The Ellet Suburban Football League's decision to bar Derrig from coaching
indicates that they are "stuck in the ignorance of the past," according to
an Akron Beacon Journal editorial. Although Gable said that he was
concerned about protecting the children, they are more likely to "break
their necks, or ... get hit by lightning" than be exposed to HIV because of
contact with Derrig, according to the editorial. According to the Beacon
Journal, the "real threat exists in such a miserable example of
decision-making, a process conspicuous for its lack of knowledge." The
editorial concludes that Derrig "deserves an apology" and should be
"welcomed back" to his position, adding, "The league should admit its
disgraceful error and prevent further embarrassment to the community"
(Akron Beacon Journal, 8/6).

OPINION


7. Bush's Global AIDS Plan Lacks 'Good Solid Planning,' Providence Journal
Editorial Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19243

While President Bush's "heart does seem to be in the right place" in his
global AIDS initiative, his approach to the problem "smacks more of wishful
thinking than good, solid planning," a Providence Journal editorial says.
So far "almost nothing" has been done to put his five-year, $15 billion
global AIDS initiative into effect, the Journal says. His proposed budget
includes less than the $3 billion originally pledged for the first year of
the initiative, and "[r]ather than relying on existing channels" of aid,
such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the plan
calls for the implementation of a "new U.S. system of delivering
assistance," the editorial says. In addition, during his trip to Africa
last month, Bush failed to use his diplomatic pull to insist on recognition
of the crisis by the government of South Africa and "did not seem to heed
the reality that pushing abstinence, as the administration favors, is
simply not enough," the Journal says. As a "moral matter ... the world
should do all it can to fight AIDS ... [a]nd practically speaking, for the
stability of a continent viewed as newly important to U.S. interests, AIDS
must be stopped," the editorial says, concluding that the United States
"would be better off contributing to multilateral efforts, while using its
diplomatic clout to prod reluctant governments" (Providence Journal, 8/7).

8. Education Needed To Avoid New AIDS 'Upsurge' in United States,
Winston-Salem Journal Editorial Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19244

People in the United States need to "get [the] message out loud and clear"
that AIDS is "still a terrible threat right here in the United States," a
Winston-Salem Journal editorial says. The United States has made "just
enough progress ... to be at a dangerous crossroads [and] ... after several
years of progress, this country may be on the brink of a new upsurge in
AIDS," the editorial says. The passage of time from the "terrible days" of
the height of the epidemic in the United States and the focus of news
reports on antiretroviral drugs and other AIDS treatments has "nurture[d] a
growing complacency" about the disease, according to the Journal. In
addition, news reports have shifted to focus on the toll of the disease
abroad, causing some to "wrongly assume that AIDS is not an American
problem anymore," the editorial says. However, the disease is still
"deadly and easily spread," the editorial says, concluding that "[p]ublic
health officials, schools, parents -- everyone who works with young people
-- should spread the word that AIDS is a killer and that safe sex is a
necessity, not just a slogan" (Winston Salem-Journal, 8/7).

________________________________________

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