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



Monday, August 11, 2003

DRUG ACCESS
========================================
1. South African Government Calls for Development of National HIV/AIDS
Treatment Program by October

2. Texas Health Department May Alter ADAP Rules if Program Goes Into Deficit


GLOBAL CHALLENGES
========================================
3. Ethiopian AIDS Research Center May Be Forced To Close Because of
Withdrawal of Funding by Dutch Government

4. Boston Globe Examines Senegal's 'Unheralded Efforts' To Reduce HIV
Transmission


ACROSS THE NATION
========================================
5. Ohio Children's Football League Reverses Decision, Allows HIV-Positive
Man To Fill Coaching Position


PUBLIC HEALTH & EDUCATION
========================================
6. Many New York City Residents With Multiple Sex Partners Unaware of HIV
Status, Fail To Use Condoms, Report Says


IN THE COURTS
========================================
7. Taiwanese Hemophiliacs File Lawsuit Against Bayer Over Blood-Clotting
Products Allegedly Made With HIV-Tainted Blood


OPINION
========================================
8. HIV/AIDS Prevention Programs Need a 'Jump-Start,' Los Angeles Times
Editorial Says

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

DRUG ACCESS


1. South African Government Calls for Development of National HIV/AIDS
Treatment Program by October

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19288

The South African government on Friday showed a "turnaround" in its
position on a national program to provide antiretroviral medications to
residents with HIV/AIDS and called for the Health Ministry to develop such
a program by Oct. 1, South Africa's Mail & Guardian reports. The
announcement came after a special meeting of the cabinet to consider a
Joint Health and Treasury Task Team cost report on providing HIV/AIDS drugs
to the public (Deane, Mail & Guardian, 8/9). South Africa has five million
people living with HIV/AIDS -- or more than 11% of its 43.8 million people
-- the largest number of HIV-positive individuals of any country in the
world, according to UNAIDS (SAPA/Mail & Guardian, 8/10). The cabinet said
in a statement, "Government shares the impatience of many South Africans on
the need to strengthen the nation's armory in the fight against AIDS.
Cabinet will therefore ensure that the remaining challenges are addressed
with urgency and that the final product guarantees a program that is
effective and sustainable" (Kraft, AP/Long Island Newsday, 8/9). The
cabinet also said that the program will follow World Health Organization
guidelines that describe the most effective combinations of antiretrovirals
and the "simplest acceptable laboratory tests" to monitor their use, the
New York Times reports (Altman, New York Times, 8/9). According to the
cabinet, "Policy and funding commitments made in the last two years leave
South Africa well placed to offer a comprehensive package of prevention and
care in the health sector" (AP/Long Island Newsday, 8/9). The South
African Health Ministry, assisted by South African HIV/AIDS physicians and
researchers and experts from the William J. Clinton Presidential Foundation
HIV/AIDS initiative, will develop the program (South African Press
Association, 8/9). According to people close to former President Clinton
and South African AIDS policy, Clinton has urged South African President
Thabo Mbeki to address HIV/AIDS treatment, the Wall Street Journal reports.

Cost Still Needs To Be Determined, Health Minister Says


Although the cabinet's announcement calls for the development of an
HIV/AIDS plan "as a matter of urgency," its statement does not "explicitly
promise" that the government will provide antiretroviral drugs, according
to the Wall Street Journal (Schoofs, Wall Street Journal, 8/11). Health
Minister Manto Tshabalala-Msimang said that "a number of questions must be
answered" before the South African government can establish a program to
provide antiretroviral medications to residents with HIV/AIDS, Agence
France-Presse reports. She said, "I can't say we have a roll-out, because
the plan has not been adequately costed" (Graham, Agence France-Presse,
8/10). In the past, Tshabalala-Msimang and Mbeki have questioned the use
and effectiveness of antiretroviral medications (Kaiser Daily HIV/AIDS
Report, 8/6). Tshabalala-Msimang has been quoted as saying that
antiretrovirals are "poison" and that a combination of garlic, onions,
olive oil and African potatoes would strengthen the immune systems of
people living with HIV/AIDS, according to Agence France-Presse (Agence
France-Presse, 8/10). Tshabalala-Msimang said that she supports the
cabinet's decision, adding, "As minister of health, I am part of the
cabinet and therefore this was a collective decision owned by all of us
ministers" (Bezuidenhout et al., Sunday Times, 8/10).

Concerns Over Implementation, Leadership


Democratic Alliance party officials yesterday questioned whether
Tshabalala-Msimang should lead the effort to develop the HIV/AIDS program.
DA spokesperson Mike Waters said, "I do not believe that she will be the
best person to drive the roll out of ARVs. She has almost run the entire
health system into the ground and she has made a mess of the program to
prevent mother-to-child transmission of HIV" (South African Press
Association, 8/10). Marthinus van Schalkwyk, leader of the New National
Party, said, "What will be vital now is the implementation and
sustainability of any such plan, and ... this government will need help and
we are willing to assist." Ruth Rabinowitz, spokesperson of the Inkatha
Freedom Party, said, "The decision is correct, long overdue and we hope it
will herald change in the public debate that has for too long been
characterized by acrimony and discord" (South African Press Association,
8/9). Waters also said that the South African government may have decided
to develop such a program because "with an election just around the corner,
their dithering on a proper response to the AIDS pandemic would hurt them
on election day," adding, "It is quite cynical of them to have waited till
now to make an announcement on antiretrovirals with a thousand people dying
each day" (South African Press Association, 8/10). Patricia de Lille, head
of the Independent Democrats party, said, "Tshabalala-Msimang should not
only resign, but she should be tried by the Human Rights Commission for
gross human rights violations (and) for her stubborn refusal in rolling out
treatment for AIDS sufferers," adding, "She is responsible for the deaths
of thousands" (Agence France-Presse, 8/10).

Reaction From Advocates


While many AIDS advocates lauded the announcement, some advocates
"privately expressed skepticism," the Journal reports (Wall Street Journal,
8/11). Treatment Action Campaign Chair Zackie Achmat said that he will
"wait to see the actual operational plan before celebration." He added,
"For all of us living with HIV in South Africa, and our families, this is
the first sign of hope" (New York Times, 8/9). TAC officials on Saturday
said that the group will end a civil disobedience campaign against the
HIV/AIDS policies of the South African government (Graham, Agence
France-Presse, 8/10). Earlier this month, TAC voted to renew a civil
disobedience campaign to force the South African government to provide
antiretroviral medications to residents with HIV/AIDS (Kaiser Daily
HIV/AIDS Report, 8/6). Professor Jakes Gerwel, chair of the Nelson Mandela
Foundation, said, "The government's decision is great news for the millions
of people living with HIV/AIDS," adding that former South African President
Nelson Mandela and the foundation are "overjoyed by the government's
announcement." Eric Goemaere, head of Medecins Sans Frontieres in South
Africa, said that the group supports the announcement, adding that MSF has
"witnessed first-hand the daily devastation caused by the AIDS epidemic in
South Africa, the clinical benefits of ARV treatment, and the hope that the
availability of treatment brings to the community" (Agence France-Presse,
8/10). HIV-positive South African Supreme Court of Appeals Justice Edwin
Cameron said that he was "elated and optimistic" about the "irreversible
commitment by government" to establish a national HIV/AIDS plan, adding, "I
think this is going to translate within months into many lives being saved.
... There is a long hard road ahead and at least we've now embarked on it"
(Sunday Times, 8/10). Swazi Hlubi, executive director of the Network of
AIDS Communities of South Africa, said, "Our hopes have been raised and
crushed many times before ... we will watch closely to ensure that ARV
treatment truly becomes a reality" (Agence France-Presse, 8/9).

2. Texas Health Department May Alter ADAP Rules if Program Goes Into Deficit

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19289

The Texas Department of Health has developed a contingency plan to revise
eligibility requirements for the Texas HIV Medication Program, the state's
AIDS Drug Assistance Program, to overcome a budget deficit the program may
face in coming years, the Houston Chronicle reports. Health officials
project that the ADAP have an $11 million deficit in two years, even though
the state Legislature recently increased the program's budget to $44.6
million (Ross Hughes, Houston Chronicle, 8/7). The federal-state ADAP
program provides free or low-cost medication to low-income HIV-positive
individuals. Many state ADAP programs are experiencing financial trouble
due to high demand for the drugs, soaring prescription costs and state
budget shortfalls (Kaiser Daily HIV/AIDS Report, 5/12). The four new
potential rule changes would only apply to new enrollees, according to the
Chronicle. The possible rule changes, which would be phased in as needed,
may include:

* Altering the medical criteria for drug assistance eligibility. To
control costs, the program would "wai[t] until a [new] patient's condition
worsens before starting the treatment";

* Prohibiting program participants from subtracting the cost of
antiretroviral drugs, which could cost up to $20,000 per year per person,
from their reported taxable income;

* Decreasing the income eligibility from $17,960 per year per person to as
low as $11,225 per year per person; and

* Closing enrollment to all new applicants until budget deficits are
eliminated.

Criticism


Terry Wilson, state coordinator of AIDS Coalition of Texas, questioned the
need to develop a deficit contingency plan for the ADAP because he believes
that "the budget could end in a surplus," according to the Chronicle.
Wilson said that his group sees the medical eligibility requirement as the
"least troubling" potential rule change, but he added that the "one
drawback" to the rule is that the government would "then start dictating
clinical practice to physicians and patients." Wilson said that
eliminating patients' ability to subtract the cost of antiretroviral drugs
from their taxable income would be "counterproductive," adding that the
change would result in "prompting workers contributing to the economy to
quit their jobs in order to access the drugs." Dr. Sharilyn Stanley,
associate commissioner for disease control and prevention at the Texas
Department of Health, said that the rules would not go into effect
immediately and would only be applied if they were needed to overcome a
deficit, according to the Chronicle. "The Legislature did give us $26.5
million (increased funding), which was an incredible, wonderful,
substantive act, but it doesn't fully meet our projected deficit," Stanley
said (Houston Chronicle, 8/7).

GLOBAL CHALLENGES


3. Ethiopian AIDS Research Center May Be Forced To Close Because of
Withdrawal of Funding by Dutch Government

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19290

The Ethiopian-Netherlands AIDS Research Project in Addis Ababa, Ethiopia,
is facing closure after the Dutch government announced that it will
withdraw its funding by December, researchers said yesterday, U.N.
IRIN/AllAfrica.com reports. The center, which focuses on physician
training and HIV/AIDS basic science and epidemiological research, was
established in 1994 and is currently supported by the Dutch government.
ENARP is also involved in a pilot antiretroviral drug testing program and
vaccine research in the country. According to Beate Gerlings of the Dutch
Ministry for Development Cooperation, the government has decided to focus
more on public health issues related to HIV/AIDS, such as poverty
reduction, family planning and HIV prevention. "The targets that we felt
were most important were not reached" through ENARP, Gerlings said, adding,
"We felt there were better ways of spending our money to combat poverty in
Ethiopia than supporting this program." Dr. Tshehaynesh Messele, head of
ENARP, said, "I am really sad because we have everything in place. If
[ENARP] is closed then it is going to have enormous negative effects on
AIDS research in Ethiopia." She said that some of the center's highly
trained staff are already leaving for more secure employment. Tshehaynesh
added that the center has made "a major contribution" to understanding
HIV/AIDS in Ethiopia. "We hope we will find partners because we have the
facilities and the expertise," she said (U.N. IRIN/AllAfrica.com, 8/7).

4. Boston Globe Examines Senegal's 'Unheralded Efforts' To Reduce HIV
Transmission

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19291

The Boston Globe yesterday examined the "largely unheralded efforts" of
Senegal to reduce the spread of HIV/AIDS in the country, which has "shown
how AIDS can be held at bay in places where the disease is a persistent,
voracious killer." In 12 other African nations, more than 10% of residents
between ages 15 and 49 have HIV, compared with 2% in Senegal. According to
the Globe, HIV prevention efforts in Senegal have "saved tens of thousands
of lives" (Donnelly, Boston Globe, 8/10). The complete article is
available online.

ACROSS THE NATION


5. Ohio Children's Football League Reverses Decision, Allows HIV-Positive
Man To Fill Coaching Position

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http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19292

The governing board of the Ellet Suburban Football League, a children's
football league outside of Akron, Ohio, on Thursday overturned an earlier
decision that barred an HIV-positive man from being an assistant coach and
restored the man to the position, the Akron Beacon Journal reports
(Wallace, Akron Beacon Journal, 8/8). Dan Gable, director of the league,
on Aug. 3 called a board meeting after receiving anonymous telephone calls
from people identifying themselves as parents of children in the league who
said that they were concerned about Stephen Derrig coming into contact with
their children on the field because of his HIV-positive status. The league
-- which is overseen by the Ellet Amateur Athletic Association --
subsequently voted to prohibit Derrig from coaching. However, at a meeting
the following night, almost all of the members of the board announced their
resignations when many parents said that the board was making an
"ill-informed" decision (Kaiser Daily HIV/AIDS Report, 8/7). League
President Mike Moye said that the board changed its position on Derrig --
who is the father of a child on the football team -- after meeting with
heath care professionals and an attorney. He added that restoring Derrig
to the position was "what the board had planned to do all along," according
to the Beacon Journal. Moye said that the board will require parents of
team members to sign a waiver stating that they are aware of Derrig's
HIV-positive status, a condition to which Derrig has agreed, the Beacon
Journal reports. Moye said, "We're fine with him coaching," adding, "It's
up to the parents now. If [the parents of] 28 [children] sign [the waiver]
and 12 don't, those 12 [children] won't be playing. Mr. Derrig will still
be coaching."

HIV Status Well-Known


According to the Beacon Journal, Derrig's HIV-positive status was
well-known in the community (Akron Beacon Journal, 8/8). The Beacon
Journal in October 2002 profiled Derrig, who formerly served as a
firefighter in Akron and has publicized his HIV status in an attempt to
convince the state Legislature to provide health care coverage for
firefighters who contract infectious diseases while on the job. Studies
have shown that firefighters, paramedics and other emergency workers are
more likely to contract HIV, hepatitis C and certain types of cancers than
the general population. As of October 2002, 20 states had passed laws
regarding the inclusion of hepatitis C, HIV and other diseases in workers'
compensation plans for emergency medical workers (Kaiser Daily HIV/AIDS
Report, 10/16/02).

Reinstatement Prevents More 'Embarrassment,' Editorial Says


"Fortunately," the Ellet Suburban Football League has overcome its
"irrational forebodings" over Derrig's HIV status and reinstated him as a
youth football coach, a Beacon Journal editorial says. The league's
earlier decision to remove Derrig from his coaching position was
"escalating into an embarrassment of national proportions," according to
the Beacon Journal. A "crash course on AIDS" showed the league's board
that the "odds of [HIV] transmission from coach to player were so small as
to be incalculable," the editorial says. The league's decision -- agreed
to by Derrig -- to request that parents sign a waiver confirming their
awareness of Derrig's HIV-positive status is "unneeded," but the waiver
will "force the parents who complained to confront their fears and follow
the same thought process as the league board," the editorial says.
Although the "outcry" over Derrig's removal as a coach shows that "most
parents were already well ahead of the learning curve," the Beacon Journal
concludes, "We hope the few who weren't do not automatically sign the
bottom line of a waiver form but make the same effort at understanding"
(Akron Beacon Journal, 8/10).

PUBLIC HEALTH & EDUCATION


6. Many New York City Residents With Multiple Sex Partners Unaware of HIV
Status, Fail To Use Condoms, Report Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19293

More than 50% of New York City residents who have multiple sex partners
are unaware of their HIV status, and about 40% did not use a condom the
last time they had sex, according to a report released online last week by
the city Department of Health and Mental Hygiene, the New York Times
reports (Perez-Pena, New York Times, 8/9). The report, titled "Sex in the
City: More HIV Testing and Condom Use Needed!," was based on data from the
2002 Community Health Survey, which included responses from 10,000 city
residents ages 18 and older (Associated Press, 8/9). The report, which the
department has not released formally, found that 26% of all respondents had
received an HIV test in the previous 18 months and 36% had used a condom
the last time they had sex. According to the report, 34% of respondents
who had sex with three or more partners in the previous year -- about 14%
of all respondents -- said that they had received an HIV test in the
previous 18 months, and 58% said that they used a condom the last time they
had sex. About 45% of male respondents who have sex with men said that
they used a condom the last time they had sex, compared with 38% of other
male respondents, the report showed. In addition, the report found that
24% of respondents between ages 45 and 64 said that they used a condom the
last time they had sex, compared with 61% of respondents between ages 18
and 24 (New York Times, 8/9).

Reaction


City Health Commissioner Dr. Thomas Frieden said, "While most New Yorkers
are having safer sex, many people still are not. HIV is preventable, but
too many people are not taking basic steps to protect themselves and their
partners" (Associated Press, 8/9). He added, "Sex in the city needs to get
safer, and HIV testing needs to be a routine part of medical care. Anyone
who's ever had sex, anyone who's ever used [intravenous] drugs, needs to
know their HIV status." Frieden said that city residents should discuss
HIV/AIDS and condom use with their sexual partners, according to the Times.
Frieden added, "I think there's a degree of complacency, of HIV precaution
burnout" (New York Times, 8/9).

IN THE COURTS


7. Taiwanese Hemophiliacs File Lawsuit Against Bayer Over Blood-Clotting
Products Allegedly Made With HIV-Tainted Blood

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19294

Lawyers representing seven Taiwanese citizens on Thursday filed a lawsuit
in California Superior Court in Los Angeles against the U.S. unit of Bayer
and four other pharmaceutical companies, alleging that the companies
knowingly sold blood-clotting products that could have been tainted with
blood from HIV-positive people, Reuters/Yahoo! India News reports
(Reuters/Yahoo! India News, 8/11). Cutter Biological, a unit of Bayer, in
the mid-1980s allegedly sold to Asian and Latin American hemophiliacs units
of Factor VIII concentrate -- a blood product that can stop potentially
fatal bleeding in people with hemophilia -- that had a high risk for
transmitting HIV to the patients. The suit claims that Cutter allegedly
knew the products carried a risk of HIV infection, and the company sold a
safer, heat-treated version of the product in the United States and other
Western countries (Kaiser Daily HIV/AIDS Report, 6/3). The suit -- filed
against Bayer, Baxter Healthcare Corp., Armour Pharmaceutical Co., Alpha
Therapeutic Corp., a unit of Japan's Mitsubishi Pharma Corp., and the
Aventis Behring unit of Aventis -- alleges that executives knew that the
untreated Factor VIII was potentially tainted with HIV and that the product
was sold on foreign markets for more than a year after the treated version
was available in 1984 to "avoid wasting existing stockpiles," according to
the Wall Street Journal (Dean, Wall Street Journal, 8/11).

Reaction


John McNicholas, an attorney for the Taiwanese plaintiffs, said that the
allegations are based in part on Cutter internal documents filed in a
separate U.S. class-action lawsuit (Dean, Asian Wall Street Journal, 8/11).
Bayer spokesperson Michael Diehl said that the company had not yet been
formally notified of the lawsuit but that Bayer "emphatically denies
misconduct in the marketing of these products in the mid-1980s," adding,
"Decisions made nearly two decades ago were based on the best scientific
and medical information of the time and were consistent with the
regulations in place at the time." Cutter, Bayer, Baxter, Armour and Alpha
in 1996 reached a $600 million settlement of a class-action suit involving
6,000 U.S. hemophiliacs who had been infected with untreated Factor VIII or
a similar product. The companies admitted no wrongdoing in the settlement,
saying that the plaintiffs' HIV infection occurred before the products were
replaced with heat-treated versions on the U.S. market (Wall Street
Journal, 8/11). Fifteen plaintiffs from Germany, Italy and the United
Kingdom in June filed a separate class-action suit in a San Francisco
federal court on behalf of patients in other countries who received tainted
Factor VIII (Reuters/Yahoo! India News, 8/11).

OPINION


8. HIV/AIDS Prevention Programs Need a 'Jump-Start,' Los Angeles Times
Editorial Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19295

Recent reports of the first U.S. increase in a decade in the number of
newly diagnosed AIDS cases and the emergence of college campuses as high
HIV transmission areas are "ominous signs of a stall in the war on AIDS," a
Los Angeles Times editorial says. AIDS awareness programs, which have
"proved effective in curbing the disease to a point," require "unceasing
engagement" by state and local governments, health officials, physicians,
churches and community groups, the Times says. In addition, HIV testing,
which "plays a crucial role in curtailing the harm" of the epidemic,
"should be ubiquitous, too," according to the Times. However, "individual
responsibility" is key to preventing HIV, and the rise in the number of
newly diagnosed AIDS cases offers a "sharp reminder that ... only fools get
complacent" in the fight against AIDS, the editorial says. The Times
concludes that "[c]learly, the campaign to halt [the] ravages [of AIDS]
needs a new jump-start" (Los Angeles Times, 8/9).

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