Thursday, December 04, 2008

• Bill Gates Urges Obama To Increase U.S. Foreign Assistance for Global Health

Bill Gates Urges Obama To Increase U.S. Foreign Assistance for Global Health
[Dec 04, 2008]

      Bill Gates, co-founder of the Bill & Melinda Gates Foundation, on Wednesday urged President-elect Barack Obama to fulfill his pledge to double U.S. foreign assistance to $50 billion by the end of his first term for global health and other issues, the Washington Post reports. Speaking at George Washington University, Gates said that the U.S. must sustain funding for fighting disease abroad or recent advancements in global health could be reversed, adding, "In a crisis, there is always a risk that you take your eyes off the future and you sacrifice long-term investments for short-term gains. You have to seek both." In addition, Gates said that the current financial crisis could be an opportunity for innovation. "Difficult times can launch great ideas," he said (Rucker, Washington Post, 12/4).

According to CNN.com, Obama on his Web site has committed to increase foreign aid investment to $50 billion by the end of his first term to fund debt cancellation for developing nations, address HIV/AIDS and fight global poverty. Gates said he believes that Obama will follow through on this pledge, adding that Congress will need to vote for final funding decisions (Mooney, CNN.com, 12/3). Although the current economic situation might have "changed some people's view of what we can afford," if the U.S. "can support the president as he stands by his pledge to the poorest nations -- even in the face of our own financial crisis -- it will make a phenomenal statement about the kind of partner America plans to be in the world," Gates said. He added that the U.S. could "make the most of this downturn and the budget scrutiny that comes with it" by selectively cutting some aid programs while expanding others (Guth, Wall Street Journal, 12/4).

When asked about his legacy in 15 years, Gates said he hopes his foundation can spur "dramatic improvement in global health" and contribute to "dramatic reduction in disease in many of the top areas: malaria, tuberculosis, AIDS, childhood diseases" (Washington Post, 12/4).

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Number of HIV-Positive People Accessing Antiretrovirals in Botswana Increasing; Program Could Become Unsustainable, President Says
[Dec 04, 2008]

      Botswana's President Ian Khama on Monday said that the number of HIV-positive people accessing antiretroviral therapy in the country is expected to nearly double over the next eight years, Mmegi/AllAfrica.com reports. If current HIV/AIDS rates continue, the number of HIV-positive people accessing the drugs could increase to 220,600, up from an estimated 145,000 currently, according to Khama. He added that increases in the number of HIV-positive people accessing drugs are "largely due to the roll-out of the program to the more remote areas of the country." According to Khama, 81 satellite clinics offering antiretroviral treatment were in place as of the end of September (Dube, Mmegi/AllAfrica.com, 12/2).

According to Khama, the cost of providing the drugs could become unsustainable as more people access the government's treatment program, Mmegi/AllAfrica.com reports. Currently the government funds 90% of the program, which costs 1.4 billion Botswana pula, or about $175 million. Khama noted that the cost of enrolling an estimated 220,600 people in the treatment program by 2016 might be unaffordable. He added, "I wish to reiterate that no amount of money .... can compensate for the need for greater commitment. This is especially so since the level of response is unsustainable in the face of other competing development imperatives. At this rate, continued progress cannot be guaranteed" (Dube, Mmegi/AllAfrica.com [2], 12/2).

Botswana's treatment program has prevented 50,000 adult AIDS-related deaths as of the end of 2007, meaning that it can be expected to avert 130,000 deaths by 2016, according to Khama. He also highlighted the program's success preventing mother-to-child HIV transmission and said that this fact, along with high enrollment rates, "gives us hope that we are gradually approaching achievement of our goal of an HIV-free generation." Despite these successes, Khama said that the percentage of people who have been tested for HIV -- which currently stands at 60% -- is concerning. Khama urged individuals to play an active role in HIV prevention, adding, "The nation demands that every citizen must access treatment on time and all on treatment must adhere. This calls for individual discipline" (Mmegi/AllAfrica.com, 12/2).

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Chinese HIV/AIDS Advocate Forced Home After Attending World AIDS Day Ceremonies in Beijing
[Dec 04, 2008]

      An HIV-positive Chinese advocate on Tuesday was forced back to her home in central Henan province after participating in ceremonies in Beijing marking World AIDS Day, Reuters India reports. Li Xige, who had previously been under house arrest for more than two years because of her search for compensation and judicial action, contracted HIV from a blood transfusion in 1995 and transmitted it to her daughters, one of whom died from AIDS-related illnesses. Henan province was the center of numerous HIV/AIDS cases in the 1990s, when unhygienic blood-buying schemes and a lack of testing allowed the virus to spread to recipients of blood transfusions. The Henan government often has sought to block media coverage of the issue to avoid embarrassment from discontentment of people there living with HIV/AIDS, Reuters India reports (Hornby, Reuters India, 12/3).

In addition, "[a]fter years of denying that AIDS was a problem, Chinese leaders have shifted gears in recent years, confronting the disease more openly and promising anonymous testing, free treatment for the poor and a ban on discrimination against people with the virus," the AP/Google.com reports. However, advocates "walk a thin line in their work and are often detained, threatened or even attacked" (Sanderson, AP/Google.com, 12/3).

According to Reuters India, Li was escorted to her home Tuesday and warned to stop speaking out or she would be imprisoned. Li said she was being prevented from leaving her home by five officials (Reuters India, 12/3). She had escaped her home about 10 days ago and went to Beijing to also give a statement to the Supreme Court after a local court refused to hear her case demanding compensation from a local hospital where she contracted HIV; the Supreme Court turned her away, the AP/Google.com reports (AP/Google.com, 12/3). Li said she wants the Chinese government "to take responsibility for not having told me so many years that I had [HIV] ... I've been from government offices to court to government offices again, bounced about like a ball" (Reuters India, 12/3). Wan Yanhai, founder of a not-for-profit organization working on HIV/AIDS education and awareness, said that Li's case exposes how attitudes toward the disease in China need to change. "Every year on the AIDS Day we see leaders visiting AIDS patients. But we also see people who contracted AIDS and asked for compensation taken away by police" (AP/Google.com, 12/3).

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Cleveland Plain Dealer Examines Rising Number of HIV Cases Among Older People
[Dec 04, 2008]

      The Cleveland Plain Dealer on Tuesday examined the increasing number of new HIV/AIDS cases recorded among people over age 50 and efforts to curb the spread of the virus among the population. About one-third of the HIV/AIDS cases in the Cleveland area involve people older than age 50, and "not just because they're living longer" due to antiretroviral treatments, the Plain Dealer reports. An increasing number of new cases caused by unprotected sex among the demographic are being recorded, "prompting new calls for HIV/AIDS education and screening for that age group," the Plain Dealer reports.

Susan Schwarzwald -- director of benefits, enrollment and access initiative for the Western Reserve Area Agency on Aging -- said that physicians should ask older patients, regardless of age, questions about their sexual activity because sex is a primary mode of HIV transmission. Such discussions have "been a hard thing to do," she said. According to the Plain Dealer, a grant from the AIDS Funding Collaborative is financing a program run by Schwarzwald to educate older people about HIV/AIDS. "Some of the symptoms might mimic symptoms of normal aging," she said, adding, "The message is, 'You need to get treatment for this disease. You can live a longer life.'" Schwarzwald added that HIV prevention messages often are ignored by older people -- especially women who have gone through menopause and are not concerned about unplanned pregnancies -- who do not insist on condom use. Earl Pike, executive director of the AIDS Taskforce of Greater Cleveland, said that the population of people older than age 50 includes two different groups with separate needs -- older people who are newly diagnosed with HIV, and those who have been living with the virus for a longer period of time. "Clearly, those diagnosed in their 30s and 40s -- who are now in their 50s and 60s -- they're a very different group of people," he said, adding, "Their issues have as much to do with being a long-term survivor as being over 50."

The Plain Dealer reports that HIV testing has not been common among people older than age 50 in the past, despite 2006 CDC recommendations that all individuals ages 13 to 64 be tested as part of routine care. Most physicians have not considered people in the 50-and-older age group as being at risk for HIV because "[a]fter all, they weren't thought to be having unprotected sex -- or any kind of sex, for that matter -- or risky [injection] drug use," the Plain Dealer reports. According to the Plain Dealer, the rising number of new HIV cases involving older people is one of the reasons the American College of Physicians on Monday released new guidelines urging HIV screening for all patients over age 13, regardless of age (Townsend, Cleveland Plain Dealer, 12/2).

Broadcast Coverage
KQED's "QUEST" on Monday examined the effect of HIV/AIDS on the health of older people and the development of conditions such as dementia and heart disease. The segment included comments from Priscilla Hsue, founder of the HIV Cardiology Clinic and assistant professor of medicine at University of California- San Francisco; Elizabeth Blackburn, a molecular biologist at UCSF; and an HIV-positive man who also has other medical conditions associated with aging (Quiros, "QUEST," KQED, 12/1). Audio of the segment is available online.

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Arkansas HIV/AIDS Task Force Final Report Requests $3M for Awareness Efforts, Testing Sites
[Dec 04, 2008]

      The Arkansas HIV/AIDS Minority Task Force on Monday released its final report and said it will request $3 million in state funding over the next two years to fight the spread of HIV/AIDS in minority communities and establish testing sites, the Arkansas Democrat-Gazette reports (Frago, Arkansas Democrat-Gazette, 12/2).

The 19-member task force was formed in January by Gov. Mike Beebe (R) to examine HIV/AIDS among the state's minority populations and ways to strengthen HIV/AIDS prevention and treatment among blacks, Hispanics and other minorities in the state. The task force held a series of meetings in the state's four congressional districts to hear public comment on the issue, as well as to discuss HIV/AIDS incidence among minorities and the efficacy of current programs. The committee submitted a report of its findings and recommendations to Beebe, leadership in the state House and Senate, and Arkansas' Department of Health (Kaiser Daily HIV/AIDS Report, 7/17).

In the report, task force members said the money is needed to create counseling services and 15 HIV testing sites in black, Hispanic and other high-risk communities around the state. The report proposed an annual budget of $150,000 to hire two staff members to manage the services and to pay for overhead costs, such as office space, supplies and travel reimbursement. The task force said the testing and counseling sites would cost $975,000 annually. They also budgeted $225,000 annually for an HIV/AIDS awareness campaign.

In the past seven years, HIV/AIDS prevention efforts in the state have received $5,938 annually, according to Tere Roderick, head of HIV prevention for the state Health Department. "Our state has not addressed this issue," she said. Task force Co-Chair Rick Collins said that the state's tight budget might make it difficult for the state to allocate the requested money. But he added, "We're keeping our fingers crossed. We hope our state will step up to the plate" (Arkansas Democrat-Gazette, 12/2).

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Scale-up of Male Circumcision Programs for HIV Prevention Will Require 'Strong Political Backing,' Funding, NEJM Perspective Piece Says
[Dec 04, 2008]

      "In a radical departure from earlier strategies, public health officials are now arguing that circumcision of men should be a key weapon in the fight against" HIV in Africa, Ingrid Katz of the Beth Israel Deaconess Medical Center and Brigham and Women's Hospital and Alexi Wright of the Dana-Farber Cancer Institute write in a New England Journal of Medicine perspective piece. They add that some "skeptics argue that efforts to 'scale-up' circumcision programs on the continent that has the fewest physicians per capita may draw funds away from other necessary public health programs, ultimately threatening already tenuous health care systems."

According to the authors, "Key distinctions between penile surgery and less-invasive methods of HIV prevention" might "hinder momentum." They add that some African "officials remain wary of circumcision because of concerns about cost and safety." In addition, physicians currently are performing most circumcisions, but "many countries are hoping to decrease costs by training a cadre of lower-level health care workers ... to fill the provider gap that many countries face," the authors write, adding, "Adequate training is essential" to avoid complications associated with the procedure.

According to Katz and Wright, some policymakers also are "struggling with complex cultural barriers in societies where circumcision is not part of mainstream practice." They add that several "public health researchers fear that there are deeper reasons for some African governments' skepticism" about circumcision. For example, some researchers "speculate that Africa's colonialist history has left these leaders with lingering suspicions about possible oppression," according to the authors.

However, all involved "agree that implementation of circumcision on a national level will require in-country champions and strong political will to succeed," according to Katz and Wright. In addition, several international donors -- including the Bill & Melinda Gates Foundation and the President's Emergency Plan for AIDS Relief -- "agree that ramped-up circumcision efforts must be funded as add-on services to guarantee that they will not detract from other programs," the authors write, adding that officials from UNAIDS and the World Health Organization "are advising that countries offer a minimum package of services in addition to circumcision, including HIV testing, screening for sexually transmitted infections, promotion of condom use and counseling on safer sex."

According to the authors, reaching out to "women through other prevention methods is important because there is no direct evidence to date that circumcision reduces the risk of transmission from men to women." They add that although "circumcision has increasing support from researchers, donors and politicians, its status as a nonbehavior-based intervention may ultimately be its biggest obstacle." As programs "move forward, the scale-up of circumcision will require strong political backing, adequate funding and leaders to champion the cause to ensure that it is a safe, low-cost option available throughout Africa," the authors conclude (Katz/Wright, NEJM, 12/4).

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