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

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*** SPOTLIGHT: THE HIV/AIDS EPIDEMIC IN BOTSWANA ***
A new in-depth focus on how the epidemic is affecting
Botswana, with links to relevant news summaries,
reports, webcasts, and other organizations' Web sites.
http://www.kaisernetwork.org/spotlight/hivaids/botswana
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Tuesday, September 2, 2003

POLITICS AND POLICY
========================================
1. Bush Executive Order Limits State Dept. Funding To International Groups
That Provide Abortion Services; Exempts AIDS-Related Work


DRUG ACCESS
========================================
2. World Trade Organization Agrees on Deal To Allow Developing Countries To
Import Generic Drugs


GLOBAL CHALLENGES
========================================
3. AIDS in Africa 'Greatest Challenge' to Health; WHO To Announce
Antiretroviral Drug Program by Dec. 1, Report Says

4. Washington Times Examines Whether African Children's Basic Health Care
Is Overshadowed by HIV/AIDS Epidemic


ACROSS THE NATION
========================================
5. Massachusetts HIV/AIDS Prevention Programs for Young People Seeking
Funding Amid Increasing HIV Caseload


SCIENCE & MEDICINE
========================================
6. Incidence of Drug-Resistant HIV Strains May Increase in Africa With
Increased Availability of Antiretroviral Drugs

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

POLITICS AND POLICY


1. Bush Executive Order Limits State Dept. Funding To International Groups
That Provide Abortion Services; Exempts AIDS-Related Work

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19626

President Bush on Friday issued an executive order that prevents the State
Department from giving family planning grants to international groups that
provide abortion-related counseling, although he exempted groups in Africa
and the Caribbean that could receive funding through the global AIDS
initiative, the Los Angeles Times reports. The new policy is an expansion
of an executive order Bush issued in 2001 that restricts the U.S. Agency
for International Development from providing aid to international
organizations that use their own funds to provide abortions or abortion
counseling or to lobby foreign governments on abortion policy (Chen, Los
Angeles Times, 8/30). The so-called "Mexico City" policy -- which was
originally implemented by President Reagan at a population conference in
Mexico City in 1984, removed by President Clinton and reinstated by
President Bush on the first day of his presidency -- "bars U.S. money from
international groups that support abortion, even with their own money,
through direct services, counseling or lobbying activities" (Kaiser Daily
HIV/AIDS Report, 4/9). Bush said that he is expanding the 2001 order
"because family planning grants are awarded by the Department of State
outside of USAID, as well as through USAID." According to the Times, Bush
believes that U.S. taxpayer money should not be used to provide financial
assistance to international groups that provide abortion-related services
(Los Angeles Times, 8/30).

HIV/AIDS Exception


The order exempts agencies that operate in Africa and the Caribbean that
may receive funding through Bush's five-year, $15 billion global AIDS
initiative, the AP/Washington Post reports (AP/Washington Post, 8/30).
Bush said that even if such groups promoted family planning or provided
abortion services, they could still receive funds under the initiative if
they used them to treat people with HIV/AIDS. An overall ban on funding to
organizations involved in the fight against AIDS would have been
counterproductive to the "high-profile" initiative, unnamed administration
officials said, according to the Times. An anonymous U.S. official said
that Bush's new order would affect "only a small number of programs and was
issued to keep policy consistent across the government," the Times reports.
However, David Seldin, a spokesperson for NARAL Pro-Choice America, said
that the new order is "clearly yet another sign" of the administration
"putting the absolute commitment to ideological purity ahead of programs
that can prevent literally millions of unintended pregnancies" (Los Angeles
Times, 8/30). Terri Bartlett, vice president of Population Action
International, said, "At this time, the face of HIV/AIDS in Africa is a
young woman, and family planning services are integral."

Marie Stopes International Connection


Some critics of Bush's latest order said that it is a "byproduct" of the
State Department's recent decision to end funding for an HIV/AIDS program
for African and Asian refugees, the AP/Post reports (AP/Washington Post,
8/30). The State Department last week announced that it is discontinuing
funding for the program because of concerns that Marie Stopes International
-- which provides family planning counseling and abortion services and is
one of the seven groups that runs the program -- supports forced abortions
and involuntary sterilization in China. Although State Department
officials said they have no evidence that MSI is involved in forced
abortions and sterilizations, they expressed concern that the group works
as a partner in China with the United Nations Population Fund. The Bush
administration in July 2002 decided to permanently withhold UNFPA funding
-- withdrawing $34 million in financing for that year -- stating that the
organization "tacitly perpetuates a 'one-child' policy in China that has
led to abortions and sterilizations against women's will." A State
Department fact-finding team in May 2002 issued a report in which they
stated that there was no evidence that UNFPA funds were being used for
coercive practices in China. However, the administration rejected the
report's findings, stating that China "coerces women to have abortions by
charging them a prohibitive 'social compensation fee' for having children
without permission." An unnamed State Department official said that
although the group's program in China aims to reduce the number of
abortions there, "the fact that they're tied in with the government
management program is what triggered the concern. This wasn't an
ideological decision; it was a legal decision" (Kaiser Daily HIV/AIDS
Report, 8/27).

DRUG ACCESS


2. World Trade Organization Agrees on Deal To Allow Developing Countries To
Import Generic Drugs

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19627

The World Trade Organization on Saturday, after several days of "nonstop"
negotiations, unanimously agreed on a deal to allow developing countries to
import generic versions of patented medicines from countries that produce
the generic drugs, such as India or Brazil, without violating patent
rights, the New York Times reports. Public health advocates, who have been
asking for such an agreement for years, believe that the extent of health
epidemics such as AIDS, tuberculosis and malaria in developing nations
outweighs the "commercial considerations" of allowing poorer nations to
import generic treatments, the Times reports (Becker, New York Times,
8/31). WTO talks on generic drug access for poor nations had been stalled
since Dec. 31, 2002, when members missed a deadline to reach an agreement.
In February, U.S. negotiators refused to sign a deal under the Doha
declaration to allow developing nations to override patent protections to
produce or import generic versions of drugs to combat public health
epidemics unless wording was included to specify which diseases constitute
a public health epidemic. However, the United States in June made a
concession by dropping its demand that the agreement apply only to a
specified list of diseases. On Wednesday, the United States, Brazil,
India, Kenya and South Africa agreed to a compromise that would leave
intact the text discussed in December but add a three-page "chairman's
statement," delineating how the patent concessions could be used. The
policy agreed to on Saturday allows a country to issue a "compulsory
license" to import generic drugs if it confirms that it "has insufficient
or no manufacturing capacities in the pharmaceutical sector for the
product(s) in question." The statement says that the system "should be
used in the good faith to protect public health and ... not be an
instrument to pursue industrial or commercial policy objectives." In
addition, the chairman's statement says that "all reasonable measures,"
such as the use of special packaging and different drug coloring, should be
made to prevent the reimportation of generic drugs into wealthy countries
(Kaiser Daily HIV/AIDS Report, 8/29).

Negotiations


Final approval of the policy stalled last week when several countries asked
to make statements before the WTO General Council. Such statements can be
used to express reservations or to announce limits that countries will
place on their adherence to an accord, the AP/Philadelphia Inquirer reports
(Koppel, AP/Philadelphia Inquirer, 8/30). Some countries said that the deal
would create new complications in generic drug access, such as requiring
developing countries to justify their drug programs to the WTO and
potentially giving Western countries veto power, according to the
Washington Post. In addition, some negotiators expressed concern about
language in the statement that countries would not use the program as an
"instrument to pursue industrial or commercial policy objectives," saying
it could be broadly interpreted to prevent middle-income countries from
obtaining generic drugs (Gillis/Barbaro, Washington Post, 8/30).
Representatives of some developing countries said that the packaging and
pill coloring requirements could increase the price of the drugs or could
make it more difficult to obtain them (AP/Philadelphia Inquirer, 8/30).
Several trade representatives said that the United States "exert[ed] heavy
pressure behind the scenes" to gain approval of the compromise, the New
York Times reports (Becker, New York Times, 8/30). The final agreement
came after several African representatives noted in a joint statement that
nearly 2.2 million Africans have died from AIDS-related causes and other
diseases since progress on the issue stalled in December (New York Daily
News, 8/31).

Reaction


"This is a historic agreement for the WTO," WTO Director-General Supachai
Panitchpakdi said, adding, "The final piece of the jigsaw has fallen into
place, allowing poorer countries to make full use of the flexibilities in
the WTO's intellectual property rules in order to deal with the diseases
that ravage their people" (Washington Post, 8/31). "All people of good
will and good conscience will be very happy today with the decision that
the WTO members have made," Kenyan Ambassador Amina Chawahir Mohamed said,
adding, "It's especially good news for the people of Africa who desperately
need access to affordable medicine" (New York Daily News, 8/31). Several
advocacy groups said that the chairman's statement "essentially doom[s] the
accord" by placing too many restrictions and imposing too much bureaucracy
on the drug importation program, according to the New York Times. "Today's
deal was designed to offer comfort to the U.S. and the Western
pharmaceutical industry," Ellen 't Hoen of Doctors Without Borders said,
adding, "Unfortunately it offers little comfort for poor patients. Global
patent rules will continue to drive up the price of medicines" (New York
Times, 8/31). World Health Organization Director-General Dr. Jong-Wook Lee
on Monday at the start of the WHO's Africa regional meeting welcomed the
agreement but warned that it will fail unless countries are able to improve
the infrastructure of their health care systems, Reuters reports. "I want
to be optimistic ... it is a good, positive development. There are many
conditions attached to it, but we can solve them one by one," Lee said
(Harding, Reuters, 9/1). Pascal Lamy, trade commissioner for the European
Union, also highlighted the need for improved health care infrastructure,
saying that the deal has "solved about 10% of the problem of access to
medicines by developing countries" (Miller, Wall Street Journal, 9/2).
According to a statement from the Pharmaceutical Research and Manufacturers
of America, a drug industry trade group, "[N]ow that this issue has been
resolved, governments and the public health community can concentrate on
the immense practical problems of delivering needed medicines to patients
in the world's poorest countries" (New York Times, 8/31).

GLOBAL CHALLENGES


3. AIDS in Africa 'Greatest Challenge' to Health; WHO To Announce
Antiretroviral Drug Program by Dec. 1, Report Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19628

HIV/AIDS is the "greatest challenge facing us now," World Health
Organization Director-General Dr. Jong-Wook Lee said yesterday at the
opening of the WHO's regional committee for Africa meeting in Johannesburg,
South Africa, SAPA/Independent Online reports. Lee added that WHO plans to
announce a comprehensive, worldwide antiretroviral treatment strategy on
World AIDS Day, Dec. 1, 2003 (SAPA/Independent Online, 9/1). Lee, speaking
to representatives from the WHO African Region, which meets annually to
review and set WHO public health policy for the region, said that African
countries will be "major partners" in the WHO's "three by five" plan of
providing antiretroviral drugs to three million people by 2005, according
to Xinhua News Agency (Xinhua News Agency, 9/1). According to the 2002
annual report of the WHO regional director released yesterday, half of the
continent's population lacks access to essential medicines, the South
African Press Association reports (South African Press Association, 9/1).
In addition, only 50,000 of the 4.5 million HIV-positive people in Africa
who need antiretroviral therapy have access to the medicines, the report
says (Graham, Agence France-Presse, 9/1). Lee welcomed a WTO agreement
that will enable developing countries to import generic versions of
antiretroviral drugs but said that the program will fail unless poor
countries improve their health care systems, Reuters reports (Harding,
Reuters, 9/1). "Based on this, we can work further, so every person who
needs medicines can have access to them at an affordable price," he said
(Agence France-Presse, 9/1). The report also found that only 6% of African
people have access to voluntary HIV counseling, and only 1% of pregnant
women have access to services to reduce the risk of mother-to-child HIV
transmission (South African Press Association, 9/1).

Lack of Trained Health Workers


Lee said that Africa needs highly skilled health care workers in order for
WHO to reach its 2005 goal of treating three million HIV-positive people.
"Health systems depend most of all on skilled and dedicated personnel, and
here we face big challenges, particularly in this region, which, on top of
everything else, suffers heavy losses to the brain drain," Lee said (Agence
France-Presse, 9/1). The report found that the migration of health care
workers to other nations has caused the quality of health care to decrease
"significantly" in Cameroon, Ghana, Senegal, Uganda, Zimbabwe and South
Africa, the six countries included in the study, according to the South
African Press Association (South African Press Association, 9/1). Lee said
that WHO plans to work with countries on "innovative methods to train,
deploy and supervise health workers," according to Agence France-Presse.
Habib Doutoum, interim social affairs commissioner for the African Union,
said that countries to which African health workers migrated should provide
some compensation for the loss of staff, according to Agence France-Presse.
Doutoum said that such compensation, as well as incentives to retain
workers, are needed in order to stop trained health care professionals from
being "a free commodity for developed countries" (Agence France-Presse,
9/1).

4. Washington Times Examines Whether African Children's Basic Health Care
Is Overshadowed by HIV/AIDS Epidemic

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19629

The Washington Times on Sunday examined the child health care "dilemma
facing doctors and public health officials" in Africa. Some public health
experts are concerned that President Bush's five-year, $15 billion global
AIDS initiative could "wind up siphoning money away from other public
health crises." Because "resources are limited ... [a]mid huge need,"
doctors and public health officials are dealing with a "lack of pennies to
buy rehydration salts, vaccinations, antibiotics or daily vitamins."
According to the World Health Organization, only 3% of child deaths in
Africa are attributed to AIDS-related causes, while neonatal complications,
often stemming from malnutrition, account for 23% of deaths; respiratory
diseases -- primarily pneumonia -- make up 19% of child deaths; and 9% of
child deaths are attributed to malaria. Nicholas Eberstadt, a health and
population specialist with the American Enterprise Institute, said, "If
you're dealing with one disease, you tend to put blinders on the easily
preventable deaths." However, Mark Stirling, head of UNICEF's AIDS
section, said, "Increasingly, among (basic health) deaths, AIDS is a
contributing factor, directly or indirectly." Nils Daulaire, president of
the Global Health Council, said, "We have to live in the real world," in
which budgetary and political decisions often "trump public health
concerns" (Goldfarb, Washington Times, 8/31).

ACROSS THE NATION


5. Massachusetts HIV/AIDS Prevention Programs for Young People Seeking
Funding Amid Increasing HIV Caseload

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19630

HIV/AIDS prevention programs that target youth in Massachusetts are
"scrambling" to find funding, the Boston Globe reports. Although state and
federal funding for the state Department of Public Health's HIV/AIDS Bureau
increased between 1991 and 2001, funding has dropped by approximately $1
million since that time. In addition, the state Department of Education
has lost funding for its AIDS program, meaning that HIV/AIDS curriculums in
school health awareness programs "vary from school to school," the Globe
reports. Meanwhile, the number of HIV/AIDS cases among 13- to 24-year-olds
in the state has significantly increased since the state began tracking HIV
cases in 1999, the Globe reports. According to the health department,
adolescents and young adults accounted for 8.7% of all HIV cases reported
in 2002, up from 6.1% in 1999. Durrell Fox, project director for the New
England HIV Education Consortium program, said, "[T]here are more youth
living with HIV who are under 25 than ever before. They're living longer
and (displaying) the same behavior as other teens." He added, "The
reduction in prevention education means less people at the middle and high
school levels are getting baseline information to protect themselves." Fox
said that complacency also is contributing to a reduction in "massive"
HIV/AIDS prevention media campaigns, the Globe reports. "After 20 years of
information smacked in your face, you say the heck with it. People are
tuning folks out, and there are more and more reductions in HIV and
substance abuse programs," Fox said, adding, "We're taking steps backward
in Massachusetts" (Sweeney, Boston Globe, 8/28).

Dream Team


The Boston Globe on Thursday also profiled the Shrewsbury High School
"Dream Team," which stands for Daring to Reform Education on AIDS Matters.
The program's 200 students raise money for acupuncture for AIDS patients,
babysit HIV-positive children and volunteer with AIDS Project Worcester,
according to Richard Marchand, who helped found the program. Marchand
said, "People got complacent, people thought it wasn't an issue anymore.
Our kids are active helping people directly impacted by the virus"
(Sweeney, Boston Globe, 8/28).

SCIENCE & MEDICINE


6. Incidence of Drug-Resistant HIV Strains May Increase in Africa With
Increased Availability of Antiretroviral Drugs

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19631

The increased availability of antiretroviral drugs in African countries
with high HIV/AIDS prevalence rates may result in more drug-resistant HIV
strains, the San Francisco Chronicle reports. National HIV/AIDS treatment
programs, such as the one being developed in South Africa, and
international aid for the provision of medicines to treat the disease
cannot afford to downplay the risk of the development of multiple
drug-resistant strains of HIV, Dr. Robert Gallo, a co-discoverer of HIV,
said in July at an international AIDS conference. Gallo said in an
interview with the Chronicle that providing unrestricted access to
antiretroviral drugs could cause "multiple drug-resistant mutants of HIV
which become epidemic and cause new kinds of epidemics in the future." HIV
is "notoriously quick" to mutate when challenged by drugs, and the
appearance of resistant strains is "sounding an alarm" in the medical
community, according to the Chronicle. Studies have shown that 10% to 15%
of all new HIV infections in the United States and Europe are resistant to
some of the drugs.

Treatment Benefits


Although the cost of providing antiretrovirals in developing countries has
fallen due to the production of generic drugs and donations from drug
companies, the detection and treatment of people with drug-resistant HIV
strains is much more expensive, according to the Chronicle. In addition,
the delivery process for antiretrovirals in Africa is "chaotic," and the
continent is "ripe" for developing mutated HIV strains, the Chronicle
reports. Dr. Robert Grant, an assistant professor of medicine at the
University of California-San Francisco, said that concerns of resistance
should not cause people to lose sight of the "more important outcomes [of
providing antiretrovirals] -- prolonging of life, relief of suffering,
improved productivity and decrease in transmission." Gallo said that
African countries need to invest in health care infrastructure such as
training for medical personnel, developing treatment support mechanisms and
doing research on the effect of administering the drugs to "head off a
disaster," according to the Chronicle (du Venage, San Francisco Chronicle,
8/29).

________________________________________

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