KAISER DAILY HIV/AIDS REPORT
A service of kaisernetwork.org
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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Wednesday, September 3, 2003

GLOBAL CHALLENGES
========================================
1. Asian Leaders Ignoring Pending AIDS Crisis, U.N. Envoy Tells UNESCAP
Conference

2. Global Fund Disbursements Total $113M to Programs in 53 Countries Since
Last Year

3. Richmond Times-Dispatch Examines HIV/AIDS Epidemic in Zambia in
Three-Day Series


DRUG ACCESS
========================================
4. NPR's 'Morning Edition' Reports on WTO Agreement on Deal To Allow
Developing Countries To Import Generic Drugs


SCIENCE & MEDICINE
========================================
5. African HIV/AIDS Patients Show Better Adherence to Antiretroviral Drug
Regimens Than U.S. Counterparts

6. Dutch Pharmacies To Sell Government-Tested Marijuana for Medical Use


PUBLIC HEALTH & EDUCATION
========================================
7. One-Quarter of Canadians Believe HIV Can Be Transmitted Through Kissing,
Mosquito Bites, Poll Says


OPINION
========================================
8. HIV Prevention Programs in Africa Should Continue To Promote Safer Sex,
Letter to Editor Says

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

GLOBAL CHALLENGES


1. Asian Leaders Ignoring Pending AIDS Crisis, U.N. Envoy Tells UNESCAP
Conference

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19647

Asian leaders are ignoring a pending "African-style" HIV/AIDS epidemic
that could jeopardize the region's economic and social development, U.N.
Special Envoy for HIV/AIDS in Asia Nafis Sadik said yesterday at the annual
meeting of the U.N. Economic and Social Commission for Asia and the
Pacific, Reuters reports. "Some leaders have buried themselves in the
illusion that HIV/AIDS is not really an Asian problem. ... This is a denial
of reality. Countries must tackle it head on," Sadik told the meeting of
ministers and officials from 47 Asia-Pacific countries. Although HIV
prevalence rates in Asia are lower than rates in southern African -- the
global epicenter of the disease -- experts say that the Asia-Pacific region
could account for 40% of new infections by 2010 if prevention efforts are
not increased (Schuettler, Reuters, 9/2). The region is home to 60% of the
world's population and includes the world's two most populous nations,
India and China. In the first half of 2003, China experienced a 17%
increase in newly reported HIV cases, according to Sadik, and the region
could expect as many as 10 million cases by 2010, according to U.N.
estimates. In India, there are nearly four million HIV-positive people,
and the number is expected to rise to between 20 million and 25 million by
2010. Sadik said that while leaders have frequently talked about the
importance of fighting the disease, they have largely failed to take action
(Agence France-Presse, 9/2).

HIV/AIDS and Development


In addition to being a public health issue, HIV/AIDS is a development
challenge, because 95% of the world's HIV-positive people live in
developing countries, Kim Hak-Su, executive secretary of UNESCAP, said at a
ministerial roundtable yesterday. Asian governments must "integrate
HIV/AIDS concerns into national development planning, into sectoral plans,
and into poverty reduction strategies," Kim said (Xinhua News Agency, 9/2).
"Two of the most advanced countries in [Africa], Botswana and South Africa,
are looking at the possibility of economic disaster and social
disintegration as a result of HIV/AIDS. It could happen here," Sadik said
(Reuters, 9/2). Botswana's President Festus Mogae, the session's guest
speaker, said that AIDS programs cannot be effective without the active
support of political leaders, according to Xinhua News Agency (Xinhua News
Agency, 9/2).

2. Global Fund Disbursements Total $113M to Programs in 53 Countries Since
Last Year

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19648

The Global Fund to Fight AIDS, Tuberculosis and Malaria has disbursed more
than $113 million to programs in 53 countries after beginning grantmaking
last year, according to a Global Fund release. In its first 18 months of
operation, the fund approved grants worth $1.5 billion over five years to
154 projects in 93 countries. Within six months of signing the first grant
agreements with the Global Fund, programs in Ghana, Haiti, Sri Lanka and
Tanzania have already received 23% of the total value of their two-year
grant disbursements. A total of 16 programs have received their second
disbursements based on "satisfactory progress," according to the release.
The Global Fund bases disbursements on progress reports indicating that
programs have achieved "agreed targets for treating people and running
effective prevention campaigns." Through its disbursements, the fund plans
over five years to expand antiretroviral treatment to more than 500,000
HIV-positive people in developing countries; expand voluntary HIV
counseling and testing tenfold; and provide support services, including
medical and community care, to 500,000 HIV/AIDS orphans. In addition, the
Global Fund expects to identify an additional two million cases of TB and
subsidize treatment for almost the same number of people, according to the
release (Global Fund release, 8/29).

3. Richmond Times-Dispatch Examines HIV/AIDS Epidemic in Zambia in
Three-Day Series

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19649

The Richmond Times-Dispatch examined the HIV/AIDS epidemic in Zambia in a
three-day series that concluded yesterday. The series -- which was written
by Times-Dispatch reporter Frank Green and photographed by freelance
photographer Joseph Rodriguez, both of whom are Dart Center fellows --
explored the epidemic's social and economic consequences, the lives of AIDS
orphans, prevention campaigns and HIV/AIDS in prisons, among other issues.
The series was funded by the Dart Center for Journalism and Trauma at the
University of Washington in Seattle. The Dart Center, a worldwide network
of journalists, journalism educators and health professionals, aims to
improve media coverage of "trauma, conflict and tragedy," according to the
Times-Dispatch (Richmond Times-Dispatch, 8/31). The following are short
summaries of the stories, organized by date of publication.


Sunday, Aug. 31


* "AIDS Strikes Hardest in Sub-Saharan Africa": The HIV/AIDS epidemic is
most severe in sub-Saharan Africa, where 29.4 million people live with the
disease, according to the Times-Dispatch. The AIDS charity AVERT warns
that without "massive expanded prevention, treatment and care efforts," the
death toll will increase throughout the decade and will have social and
economic consequences as well as effects on education, industry,
agriculture, transport and human resources (Green, Richmond Times-Dispatch,
8/31).

* "Lord, Cleanse Us": Resource-poor countries such as Zambia suffer most
from the HIV/AIDS epidemic. Antiretroviral drugs are often too expensive
for most Zambians, and the people who can afford them often have to choose
between the drugs and an adequate diet. Although prevention efforts have
reduced the number of new HIV infections over recent years in highly
affected urban areas, "HIV continues to spread" in the country, according
to the Times-Dispatch (Green, Richmond Times-Dispatch, 8/31).


Monday, Sept. 1


* "Families Reject Children": Nearly one in five Zambian children has lost
one or both parents, often due to AIDS-related death. Many HIV-positive
children are abandoned by family and friends because of the stigma that the
disease carries in Zambia (Green, Richmond Times-Dispatch, 9/1).

* "Lives Lost, Orphans Left": Zambia currently has between 600,000 and
700,000 orphaned children under age 15, and the number is expected to reach
one million by 2010 and could continue to grow until 2020. The "long-term
social, criminal justice and economic implications of the [orphan]
phenomenon" cannot be foreseen, according to the Times-Dispatch (Green,
Richmond Times-Dispatch, 9/1).

* "Magic: An Odyssey in Africa Leads From Darkness Into Light": Africa is
a "place of hope where one might expect only despair generated by
widespread poverty and the menace of AIDS" and a "place that can go from
wonderful to wretched and back again in the space of a few minutes," Green
writes in an opinion piece. Although the people in Africa range from
inspirational to reprehensible, "[m]ost are very poor," according to Green.
Zambia's average per capita annual income is less than $400 (Green,
Richmond Times-Dispatch, 9/1).


Tuesday, Sept. 2


* "Funds From U.S. Could Ease Crisis": President Bush's five-year, $15
billion global AIDS initiative "will not be a cure-all but could put a
significant dent in the epidemics" in Africa and the Caribbean, according
to the Times-Dispatch. The plan aims to prevent seven million new HIV
infections, treat two million people with antiretroviral drugs, provide
hospital care and lend support to AIDS orphans (Green, Richmond
Times-Dispatch, 9/2).

* "Education, Prevention Top Priorities": Prisons have been neglected by
efforts to prevent the spread of HIV/AIDS in Zambia, the Times-Dispatch
reports. According to Ochas Pupwe, prisons are "always last on the list of
consideration given by the public and charities" for allocating prevention
funding. Programs such as "In But Free," operated at the Kamfinsa Prison,
help educate inmates on how to prevent HIV transmission (Green, Richmond
Times-Dispatch, 9/2).

* "AIDS Behind Bars": HIV-positive Zambian prison inmates face many
challenges beyond living with HIV/AIDS, including a poor diet, lack of
antiretroviral drugs and overcrowding that can spread other diseases such
as tuberculosis. Pupwe and others encourage prisoners to learn their HIV
status so that they can adjust their behavior to limit the disease's spread
(Green, Richmond Times-Dispatch, 9/2).

DRUG ACCESS


4. NPR's 'Morning Edition' Reports on WTO Agreement 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=19650

NPR's "Morning Edition" today reports on the World Trade Organization's
unanimous agreement on Saturday on a deal to allow developing countries
import generic versions of patented medicines from countries that produce
the generic drugs, such as India or Brazil, without violating patent rights
(Silberner, "Morning Edition," NPR, 9/3). The three-page "chairman's
statement" 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 policy 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
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, 9/2). The NPR segment includes comments from Dr. Amir
Attaran of the Center for International Development at Harvard University,
WTO spokesperson Keith Rockwell and Global AIDS Alliance Executive Director
Paul Zeitz ("Morning Edition," NPR, 9/3).

The full segment will be available online in RealPlayer after noon ET.

SCIENCE & MEDICINE


5. African HIV/AIDS Patients Show Better Adherence to Antiretroviral Drug
Regimens Than U.S. Counterparts

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19651

Evidence is emerging that HIV-positive people in Africa follow their
antiretroviral drug regimens more closely than HIV-positive people in the
United States, the New York Times reports. Studies in Botswana, Uganda,
Senegal and South Africa have found that on average, AIDS patients there
take about 90% of the pills in their antiretroviral drug regimens, compared
with 70% among patients in the United States. Some doctors, politicians
and pharmaceutical executives have argued that it is unsafe to send
antiretroviral drugs to Africa for fear that poor adherence to drug
regimens will speed the mutation of HIV and the spread of drug-resistant
HIV strains throughout the world. Although drug-resistant strains are
inevitable, they are more likely to occur and to be passed on if patients
skip doses of medication, according to doctors. Most African patients are
"zealous" about adhering to their drug regimens and are more truthful than
their U.S. counterparts when estimating their adherence to a drug regimen,
Dr. David Bangsberg, a professor of medicine at the University of
California-San Francisco, said. On average, U.S. patients tell their
doctors that they are doing 20% better in adhering to their regimen than
they actually are. However, a study of 29 Ugandan HIV-positive people
found that while the patients estimated that they were taking 93% of their
pills, in reality they were taking 91% of the pills.

Reasons for Adherence


Adherence to drug regimens in Africa has become easier with the
introduction of a generic three-drug regimen that can be taken in as few as
two pills a day. Such pills are not yet available in the United States due
to patent problems -- no one company holds the patents on three medications
that are "ideal" for a three-drug regimen, according to the Times. In
addition, HIV-positive people in Africa are "highly motivated" to adhere to
regimens because they have seen friends or family members die, several
doctors in Africa said, according to the Times. In Botswana, which has the
world's highest HIV prevalence, pill counts on 400 of the 10,000 people
participating in a national antiretroviral drug program found that 85% were
adhering 100% to their drug regimen, according to Dr. Ernest Darkoh,
manager of the national program. However, other programs in Africa have
not been as successful. In Nigeria, the most populous country in Africa, a
program aimed at providing drugs for 15,000 HIV-positive people "has been
hampered by bureaucracy, corruption and a scarcity of laboratories,"
according to the Times. Dr. Ernest Ekong, an AIDS specialist at the
Military Reference Hospital in Lagos, said that adherence has been "no
problem" so far, but he added that some patients have shared pills, cut
back on the number of pills taken or resold the drugs. Although no formal
study has been conducted, Nigerian doctors have reported that some patients
who were adhering to their drug regimens were not benefiting from the
drugs, leading them to believe that drug-resistant HIV strains had
developed in other patients and had been passed on.

Successful Supervision


In a recent study of a pilot antiretroviral drug program in Khayelitsha,
South Africa, run by Doctors Without Borders, patient pill counts found
that after six months on a drug regimen, 96% of patients were still taking
95% of their pills. Blood testing, a more accurate measure of drug
adherence, found that after six months, 91% of patients had low levels of
virus in their bloodstream, and after 18 months, 83% of the patients had
low viral load counts. However, the organization has strict requirements
to enter the program -- patients must give up alcohol and drugs; complete
three months of taking a simple antibiotic; be on time for four consecutive
appointments; reveal their HIV status to their families; and have a "buddy"
who attends counseling, monitors their adherence and reports any problems
to health care workers, according to the Times (McNeil, New York Times,
9/3).

6. Dutch Pharmacies To Sell Government-Tested Marijuana for Medical Use

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19652

The Netherlands on Monday became the first country in the world to supply
marijuana as a medicine, by providing government-tested marijuana to
pharmacies for use in treating patients experiencing nausea or pain
associated with AIDS, cancer and other illnesses, the Associated Press
reports (Deutsch, Associated Press, 9/1). Two companies have been given
licenses to grow cannabis to sell to the country's Ministry of Health for
distribution (Los Angeles Times, 9/2). The cannabis will be tested by the
health ministry, and health insurers will cover the drug for the first time
under a law that went into effect in March, according to the Associated
Press (Associated Press, 9/1). The government recommends that the cannabis
be inhaled through a steam treatment or infused in water and drunk as tea
(de Hemptinne, Agence France-Presse, 9/1). The health ministry estimates
that up to 7,000 people in the Netherlands already regularly use cannabis
for medical reasons and believes that the number could double under the new
law. Analysts have said that England and parts of the United States,
Australia and Canada are considering similar programs and will "carefully
monito[r]" the Dutch system, according to London's Guardian (Osborn,
Guardian, 9/2).

PUBLIC HEALTH & EDUCATION


7. One-Quarter of Canadians Believe HIV Can Be Transmitted Through Kissing,
Mosquito Bites, Poll Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19653

Approximately one in four Canadians believes HIV/AIDS can be transmitted
through kissing and mosquito bites, indicating a "knowledge gap" in the
general public regarding the disease, according to a recently released
national poll commissioned by Health Canada, CanWest/Calgary Herald
reports. Market research firm Ipsos-Reid in March administered the survey
-- titled, "HIV/AIDS -- An Attitudinal Survey" -- by telephone to 2,004
Canadians over the age of 15. When participants were asked to name the
ways that HIV can be transmitted, 6% of respondents named kissing, 2% named
mosquito bites and fewer than 2% named casual contact, coughing or
sneezing. However, when respondents were specifically asked about kissing,
mosquito bites and coughing and sneezing as possible transmission routes,
25% indicated that kissing and mosquito bites could transmit the virus and
11% said that coughing and sneezing could spread the virus, CanWest/Herald
reports. According to the poll, 84% of Canadians said that unsafe sex
could transmit HIV; nearly 50% cited sharing injection drug needles as a
transmission route; and more than 33% said that blood transfusions could
transmit the virus. The poll also found that nearly 20% of participants
thought that AIDS could be cured if it was caught and treated early.

Tolerance


The poll also found that "tolerance and comfort levels" around HIV-positive
people were high "in theory" but not as much "in practice" among Canadians,
CanWest/Herald reports. Approximately 75% of participants said that they
did not believe people living with HIV/AIDS "have gotten what they
deserve." However, researchers posed a series of six scenarios as part of
the poll and found that less than 75% of respondents showed tolerance or
acceptance when in "direct contact" with HIV-positive people. According to
the report, nearly one in four Canadians surveyed showed a "low level of
comfort" with HIV/AIDS, meaning that they said they would be comfortable in
only one or two of the six scenarios, compared with 41% who indicated
comfort in two or three scenarios and 35% who indicated a high level of
comfort. According to current estimates, 49,800 Canadians were
HIV-positive in 1999, the most recent year for which data is available.
However, the actual number of HIV-positive people could be higher because
health experts estimate that 30% of all HIV-positive people in Canada are
not aware of their status, CanWest/Herald reports (Aubry, CanWest/Calgary
Herald, 9/1).

OPINION


8. HIV Prevention Programs in Africa Should Continue To Promote Safer Sex,
Letter to Editor Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19654

Unsafe sex "continues to be the predominant mode of HIV transmission in
sub-Saharan Africa" and should therefore continue to be the primary focus
of HIV prevention programs, Paulo Teixeira, HIV/AIDS program director for
the World Health Organization, and Marika Fahlen, director of social
mobilization and information for UNAIDS, write in a Washington Post letter
to the editor. Teixeira and Fahlen write in response to an Aug. 21 Post
opinion piece by Holly Burkhalter and Eric Friedman of Physicians for Human
Rights' Health Action AIDS Campaign that called for a shift in the focus of
HIV prevention programs from safe sex programs to the prevention of unsafe
medical practices. Although Burkhalter and Friedman "rightly" point out
the need to address unsafe health care procedures as part of a "combination
of prevention measures," such procedures account for only 10% of new HIV
infections, Teixeira and Fahlen say. UNAIDS and WHO recognize that a
comprehensive approach to HIV prevention is needed, including programs that
target unsafe sex, mother-to-child HIV transmission, unsafe blood and blood
products and unsafe injections, Teixeira and Fahlen say (Teixeira/Fahlen,
Washington Post, 9/3).

________________________________________

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