Kaiser Daily HIV/AIDS Report

* Powell Announces Trip to Africa to 'Highlight U.S. Concern' over
HIV/AIDS
* NIAID Announces Plan to Combat 'Deadly Troika' of HIV, Malaria, TB
* Botswana Goes from 'Hopeless to Hopeful' with Arrival of Free AIDS
Drugs
* New York Times' Coverage of HIV/AIDS Issues Draws Response from
Field
* Social Stigmas in Arab Countries Interfere with HIV/AIDS Education,
Reporting
* Cipla Announces Plan to Manufacture Three-In-One AIDS Pill

--
Powell Announces Trip to Africa to 'Highlight U.S. Concern' over
HIV/AIDS

U.S. Secretary of State Colin Powell will travel to Uganda, Mali,
Kenya and South Africa this month to "highlight U.S. concern over the
devastating spread of AIDS," State Department officials said Monday.
Powell has "spoken frequently" about HIV/AIDS, calling the epidemic
"an economic crisis, a health crisis, a security crisis" in Senate
testimony in March. President Bush's $23.1 billion budget request for
foreign affairs includes an approximately 10% increase over last
year's $300 million allocation to fight global AIDS (Strobel, Free
Press Washington, 5/8).

--
NIAID Announces Plan to Combat 'Deadly Troika' of HIV, Malaria, TB

In a meeting Monday with international infectious disease special-
ists, Dr. Anthony Fauci, director of NIH's National Institute of Al-
lergy and Infectious Diseases, announced the agency's new "global
plan" to combat HIV/AIDS, malaria and tuberculosis in developing
countries. The "NIAID Global Health Research Plan for HIV/AIDS, Ma-
laria and Tuberculosis" outlines "short-, mid- and long-term objec-
tives" in the fight against this "deadly troika," according to an NIH
release. The plan concentrates on four "key" research areas: vaccine
and prevention studies, drug development, diagnostic improvement and
"enhancements" to research capabilities. Vaccine research and devel-
opment remains the plan's "top priority." The NIAID plan also in-
cludes "multiple goals" for improving and expanding research facili-
ties in developing areas and training local doctors and researchers
to "better provide for the needs of their communities" (NIH release,
5/7). The document is a "living plan" that can expand to include
other diseases as developments occur (Manning, USA Today, 5/8).

What Can Be Done?

The three diseases annually account for more than 5 million deaths
and "greatly affect" the health of nearly half a billion more people
every year, Fauci said. But currently there are no vaccines for HIV
or malaria, and the TB vaccine does not prevent adult lung disease,
which develops in nearly eight million people a year. Research insti-
tutes like NIAID "must develop comprehensive plans that bring inter-
national scientists together to launch a multi-pronged attack" on the
diseases, Fauci added. New drugs are also needed to treat the dis-
eases, especially in light of the development of new "drug-resistant
microbe strains" and the "toxic" side effects of some of the current
drugs. Better diagnostic tools will allow for "more rapid and accu-
rate" identification of the diseases, enabling doctors to "administer
effective treatment more quickly" (NIH release, 5/7). Fauci cited as
a model a malaria research center in Mali, where "the local community
is intensively involved in decision-making, the infrastructure is de-
veloped and we're training a new generation of scientists who will
give it sustainability." Fauci also said that "multidisciplinary re-
search programs" are needed as part of the "scientific basis for a
global health research plan in the 21st century," especially now that
"global health has ... integrated itself into this nation's foreign
policy." On Monday, NIAID officially opened its Malaria Vaccine De-
velopment Unit, dedicated to finding an "effective vaccine within the
next five to 10 years (USA Today, 5/8). To view the plan, click here.
To read the World Health Organization's G8 summit background fact
sheet on the three diseases, click here.

--
Botswana Goes from 'Hopeless to Hopeful' with Arrival of Free AIDS
Drugs

In the coming months, the Botswana government will provide "most" of
the country's HIV-positive population with antiretroviral drugs
through public hospitals and with monetary help from Debswana, a dia-
mond mining joint venture between the government and mining giant De
Beers, the New York Times reports. The government, which is planning
to distribute the medications through public hospitals in the na-
tion's two largest cities, Gaborone and Francistown, expects to pay
$600 per person for one year of anti-AIDS drugs, in a nation where
36% of adults are HIV-positive. Botswanan President Festus Mogae in
his national address this year spent almost half of his time speaking
about AIDS and has "personally led the crusade to save his people
from what he describes as the 'threat of annihilation,'" the Times
reports. The "diamond-rich" country is currently "upgrading its
health care system, poring through the medical literature and moving
forward in an effort to save its most precious industry and its peo-
ple." The news of access to free medications has "sent hopes soaring"
among Botswanans, and HIV testing has risen by 30% as people learned
that "a positive result means likely treatment, not certain death."
Dr. David Marumo, who estimates that 80% of his patients are HIV-
positive, said, "We used to say there is nothing we can do, but we
are going from hopeless to hopeful. If you are HIV-positive now, it
doesn't mean you are dying. ... Most people now are planning."

Hope Sparkles in the Mining Sector

Debswana, which has pledged to cover 90% of the cost of treatment for
its HIV-positive employees, has allocated $5 million for medications
this fiscal year. The company discovered in 1999 that more than one-
third of its workers between the ages of 24 and 40 were living with
the virus after workers agreed to be tested. In addition, the number
of sick days taken by workers "surged" to 9,384 in 1999 from 2,032 in
1995 and the number of AIDS-related employee deaths tripled in that
time. Under the Debswana plan, workers must be tested and examined by
a company-selected physician prior to beginning treatment. The
spouses of employees are also covered, although the policy restrict-
ing coverage to only one spouse in a society where polygamy is ac-
ceptable has generated controversy, as has Debswana's refusal to
cover the children of workers at this time. The offer has created
concern among company officials that more employees, who "no longer
fear dying from AIDS," will stop using condoms and engage in risky
sexual behavior again. Doctors also worry that patients will be un-
able to comply with the complicated regimen of pills and will spread
drug-resistant strains of HIV. And some employees worry that the Deb-
swana plan will publicize their disease in a society that "shun[s]"
those suspected to be HIV-positive. But Debswana officials say that
in time the disease will lose its stigma and more workers will seek
testing (Swarns, New York Times, 5/8).

--
New York Times' Coverage of HIV/AIDS Issues Draws Response from Field

Sunday's New York Times published a number of letters to the editor
from people in the HIV/AIDS field, responding to the paper's coverage
of recent news in that area. The following is a summary of the com-
ments:

* Responding to an April 29 Times article on the funding needed to
finance anti-AIDS programs in sub-Saharan Africa, Global AIDS Alli-
ance Co-Directors Paul Zeitz and Chatinkha Nkhoma criticize a state-
ment by a U.S. treasury official who was quoted as saying that Afri-
cans "lack a requisite 'concept of time' necessary for adhering to
complex drug regimens." Zeitz and Nkhoma write, "This reflects a rac-
ist stereotyping that has no place in American policy," but add that
"more serious" is the statement's implication that the United States
"might respond to the challenges of combating AIDS by limiting fi-
nancing" for anti-AIDS programs in developing nations. Zeitz and
Nkhoma conclude, "The health infrastructure in Africa does need sig-
nificant improvements, but this is all the more reason for the United
States to contribute the billions of dollars necessary to combat HIV
and AIDS" (Zeitz/Nkhoma, New York Times, 5/6).

* In response to a Times article on the efficacy of different anti-
HIV efforts, Lucille Atkin, director of the Margaret Sanger Center
International, the international arm of the Planned Parenthood Fed-
eration of America, writes that preventive approaches should combine
parenting and peer education that address sexuality and gender equal-
ity. She also advocates "widespread access to condoms," which allow
people to "lead healthy and fulfilling lives." Atkin concludes that
funding for anti-AIDS efforts "should be used to support creative
initiatives that bring together secular and religious groups and non-
government and government agencies in partnerships that are rooted in
local communities and cultures" (Atkin, New York Times, 5/6).

* Ronald Brinn, a non-government representative at the United Na-
tions, writes in response to an April 29 Times article, "As we draw
closer to a coordinated and coherent plan for global AIDS relief, we
are still denying the global crime and corruption that are driving
and sustaining the world's disease pandemics" -- drugs and prostitu-
tion. Brinn notes that the drug and sex trades are "key pathogenic
factors in the AIDS crisis and an outgrowth of political failure and
economic greed." He concludes, "Confiscation of a small percentage of
the trillion-dollar crime and corruption assets would go a long way
to stop the spread of AIDS and pay for the needed health, education
and social services that lie within our grasp" (Brinn, New York
Times, 5/6).

--
Social Stigmas in Arab Countries Interfere with HIV/AIDS Education,
Reporting

In Arab countries, the stigma of HIV/AIDS breeds "silence" and "igno-
rance" about the disease, AP/MSNBC.com reports. Much of the problem
is rooted in Arab countries' reluctance to educate people about safe
sex, as "strict interpretations of Islamic prohibitions against pre-
marital sex, adultery and homosexuality, coupled with stern conserva-
tive traditions means that publicly discussing sex ... is taboo."
Egyptians continue to think of AIDS as a "foreign disease" and "re-
fuse to admit that homosexuality or prostitution exists in Egypt." On
the other hand, some "argue" that Islamic "strictures" on sex will
"protect Arab countries from an AIDS epidemic." According to Nasr el-
Sayed, director of Egypt's National AIDS Control Program, even some
doctors "don't believe AIDS can strike in Egypt." But experts say
that the disease has already reached Arab countries in numbers "far
greater than reported," as the stigma associated with the disease in-
terferes with reporting. For example, the United Nations estimated
that there were about 8,100 HIV cases in Egypt at the end of 1999, 10
times as many HIV cases as governmental officials recorded. Even
Egyptian officials "admit" that their records reflect an HIV-positive
population "well below the real number." Like Egypt, Yemen's Health
Ministry says that the actual number of HIV cases in the country is
"much higher" than the 1,200 officially recorded cases, and Saudi
Arabia does not even maintain an official estimate of HIV infections.

Avoiding Taboos

Arab countries have been forced to navigate their HIV/AIDS education
campaigns around these societal sexual taboos. For example, Jordan
has distributed ads and leaflets about HIV/AIDS, but the materials
"stop short of discussing safe sex." Egypt's National AIDS Control
Program launched an AIDS hotline in 1996, advertising it through
leaflets and posters on buses and in subway stations. But the organi-
zation decided against creating a "homosexual support group for fear
of being accused of encouraging homosexuality," making it difficult
to reach high-risk groups, Sana' Nassif, who heads an AIDS program
for the international group CARITAS, said. Nassif also noted the dif-
ficulties Arab women face in protecting themselves from HIV, since
the societies are traditionally male-dominated. Jihane Tawilah, WHO's
regional adviser on STDs, added, "Its really tragic how women are un-
able to negotiate their own protection in wedlock or outside it"
(AP/MSNBC.com, 5/7).

--
Cipla Announces Plan to Manufacture Three-In-One AIDS Pill

Indian generic drug maker Cipla Ltd. plans to develop a three-in-one
AIDS "cocktail" pill that may cause prices of antiretroviral medi-
cines to "fall even further" than they did when Cipla first announced
it would supply generic drugs to Doctors Without Borders for $350 per
patient per year in February, Reuters Health reports. Cipla Chair Yu-
suf Hamied told Reuters Health, "We are applying for Indian govern-
ment permissions to launch three AIDS drugs -- stavudine, nevirapine
and lamivudine -- in one tablet. ... We will offer the new combina-
tion pill to [Doctors Without Borders], other non-government bodies
and governments in general for them to supply free." The new pill, to
be called Triomune-LNS, will be the first combination pill of the
three drugs, as they are each controlled by three different pharma-
ceutical companies. GlaxoSmithKline has patented lamivudine, Boe-
hringer Ingelheim holds the patent on nevirapine and Bristol-Myers
Squibb controls stavudine. Despite these controls, Cipla is permitted
by Indian law to manufacture products under international patent, and
Hamied noted, "We expect to launch the new product in India later
this year and are in the process of applying for marketing permis-
sions in some African countries, including South Africa, in due
course." He added that the three-in-one pill will hopefully increase
patient compliance, as patients would only have to "take one pill
each in the morning and night, (rather than) three of each drug twice
a day." The combination pill will be sold in a box of 720 pills, or
one year's dosage. GlaxoSmithKline also markets a combination pill
called Trizivir, composed of zidovudine, lamivudine and abacavir
(Shankar, Reuters Health, 5/8).

Kaiser Daily HIV/AIDS Report - Thu, 10 May 2001
-----------------------------------------------

* Annan Meets With U.S. Officials to Discuss AIDS Trust Fund
* International Olympic Committee to Make $100,000 Donation to Global
AIDS Fund
* Actress Elizabeth Taylor Discusses AIDS Activism in AOL Chat
* AIDS Epidemic May Induce War in Developing World, Experts Say
* VSO Recruits HIV/AIDS Health Care Professionals to Volunteer in Af-
rica

--
Annan Meets With U.S. Officials to Discuss AIDS Trust Fund

U.N. Secretary-General Kofi Annan yesterday met with various U.S. of-
ficials in Washington, D.C., to discuss increasing the United States'
contribution to a proposed $7 billion to $10 billion global fund to
fight HIV/AIDS, the New York Times reports. Annan met with Secretary
of State Colin Powell and HHS Secretary Tommy Thompson, "[a]gainst a
background of rising anger in Congress" over recent votes that left
the United States off of the U.N.'s Human Rights Commission and In-
ternational Narcotics Control Board. Despite speculation that the re-
cent votes would affect the talks, no topics other than HIV/AIDS were
discussed during the meetings, according to deputy U.N. spokesperson
Manoel de Almeida e Silva. After the meeting, Powell told reporters
that the discussion had been "excellent." Annan was invited to return
to Washington on Friday, when President Bush is expected to announce
a $200 million pledge to the proposed fund. The United States may
provide additional funding if the United Nations can meet "certain
criteria for establishing the fund" and if other industrialized na-
tions contribute, an administration official said (Crosette/Sanger,
New York Times, 5/10). The initial $200 million pledge is well below
the amount proposed by Sen. Bill Frist (R-Tenn.) in an amendment to
the Senate Budget bill. That amendment calls for an increase of $200
million in FY 2002 and $500 million in FY 2003 above the $460 million
the United States already spends on global AIDS efforts, bringing the
U.S. total contribution to $1.1 billion over two years (Kaiser Daily
HIV/AIDS Report, 4/6). Annan also met yesterday with Frist, who is
chair of the Senate Foreign Relations subcommittee on Africa. Al-
though the United States annually contributes less than half of what
Frist proposed, it remains the world's largest contributor to global
AIDS efforts. In March, Frist commissioned a General Accounting Of-
fice study of USAID's African HIV/AIDS assistance that showed that
the agency was having "problems" with distributing aid, particularly
to African military personnel, 10% to 60% of whom are estimated to be
HIV-positive. Congressional restrictions limit aid to foreign mili-
taries, acting as a "disincentive" to "pursuing prevention campaigns
where they might be most needed," the Times reports (New York Times,
5/10).

Showdown Over 'Unexpected Votes'

Observers say it is "hard to judge what effect" the United States'
exclusion from the U.N. committees, which have always had U.S. repre-
sentation, will have on funding for Annan's proposed HIV/AIDS trust.
Before leaving New York for Washington yesterday morning, Annan told
a group of senior U.N. officials that he was "concerned" about con-
gressional calls for retribution against the U.N. and "recognized"
the United States' "significant contributions" to the Human Rights
Commission since its founding in 1947. Officials at the United Na-
tions added that Annan "regrets the unexpected votes" and hopes the
United States will be voted back onto the Human Rights Commission
next spring (Omaha World-Herald, 5/9). Powell said Tuesday that Annan
was "as distressed as we are" about the votes (New York Times, 5/10).

--
International Olympic Committee to Make $100,000 Donation to Global
AIDS Fund

International Olympic Committee President Juan Antonio Samaranch on
Tuesday announced at U.N. Headquarters that the committee will donate
$100,000 to the United Nations for the global fund to fight AIDS, ma-
laria and tuberculosis in developing countries. The announcement
comes on the heels of U.N. Secretary-General Kofi Annan's pledge to
donate his $100,000 cash award for the Philadelphia Liberty Medal,
which he will receive on July 4, in what will be the first contribu-
tion to his proposed global fund (U.N. release, 5/8). Samaranch made
the announcement during a ceremony in New York where he presented a
statue that will be displayed at the United Nations "whenever an
Olympic truce is in effect or is being discussed in the general as-
sembly" (Agence France-Presse, 5/8). The Olympic truce is an ancient
Greek tradition "that calls for a cessation of conflict during the
period of the Olympics." Speaking to the Olympic Truce Foundation's
Board of Directors on Tuesday, Annan said that the truce could offer
a "neutral point of consensus, a window of time to open dialogue and
a pause to provide relief to the suffering of the population" (U.N.
release, 5/8). Greek Foreign Minister George Papandreou, vice presi-
dent of the Olympic Truce Foundation, noted that UNICEF has used the
temporary halts in hostilities manifested by the truce to inoculate
"thousands of children against disease" (Agence France-Presse, 5/8).
In his speech at Tuesday's meeting, Annan said, "The United Nations
family has a long record of engaging the world of sports to advocate
a wide range of causes. World-class athletes have lent their names
and time to campaigns fighting AIDS and other diseases -- I am really
grateful to President Samaranch for his support in the fight against
AIDS -- drug abuse and poverty. Sport has been used to support educa-
tion and expand opportunities for youth; to encourage community de-
velopment in societies burdened by inequalities, poverty and the af-
termath of conflict; and to ease the trauma and discomfort of refu-
gees and internally displaced people" ( Annan speech text, 5/8).

--
Actress Elizabeth Taylor Discusses AIDS Activism in AOL Chat

Actress Elizabeth Taylor chatted with America Online members yester-
day about a variety of topics on AOL Live, including her work with
AIDS organizations such as the Elizabeth Taylor AIDS Foundation, the
American Foundation for AIDS Research and the amfAR fundraiser Cinema
Against AIDS 2001, to take place at the Cannes Film Festival. When
the topic of AIDS was introduced into the discussion, Taylor said,
"If you could see a map like we have at amfAR of the areas in Africa,
India, Asia that are black, that means that the areas are dark be-
cause the people have been killed off by AIDS and there is no life
there. And it is spreading so rapidly that those two continents are
in danger. There are areas in our own continent that are in danger
and which is frightening. When you see it on the map, the black,
creeping out like an octopus. I think it is the worst disease now
since the Black Death, the Flu after World War I." Taylor said that
"AIDS has become the passion of my life, and I would do anything in
the world if I could just wave a wand and find a cure. People have
been lulled into a false sense of relaxation because of the cocktail,
but this is not a cure. It does help to put people into remission,
but it is so costly that not everyone can afford it. And those that
can't afford, do read about it and still can't afford to have some-
thing that can extend their life. I get upset with the manufacturers
of the cocktail that charge so much when there are people who can't
afford it. I think that is so cruel." Taylor said that there is "so
much more" she wishes she could do for AIDS, but that her osteoporo-
sis makes walking and traveling difficult for her. However, Taylor
said she is planning a trip to Africa to discuss AIDS. "Nelson Man-
dela, my hero, has invited me so many times to go. But is it diffi-
cult, it is difficult for a white woman to get up and talk about AIDS
because the black man is very personal and private about sex and they
would not like some 'white momma' getting up talking to them about
their sex life. So we have to try and find ways that I can get the
message across to stop it or halt AIDS from moving across Africa
without talking about sex which is very difficult," Taylor said (AOL
transcript, 5/9).

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AIDS Epidemic May Induce War in Developing World, Experts Say

AIDS is "poised to lead poorer countries into a spiral of economic
ruin that could result in rebellions and violent conflict," according
to a group of "leading researchers and intelligence experts" who con-
vened at an Institute for Peace forum on Tuesday, Reuters Health re-
ports. The growing epidemic is likely to "undermine economies and
governmental revenues" and "drastically increase class polarization"
as poor people without AIDS drug access die from the disease. The ex-
perts said that the "potential cascade of ethnic tension and weaken-
ing governments," combined with "a proliferation of light weapons
left over from recent wars in many countries," will lead to a "dan-
gerous mix that could plunge vulnerable nations into internal war."
National Intelligence Council officer David Gordon, who helped put
global infectious diseases like HIV/AIDS on the U.S. national secu-
rity agenda, noted that the disease may reduce the gross domestic
products of sub-Saharan African nations by 20% by 2020, and will "ex-
acerbate all of the conditions that have made Africa extraordinarily
vulnerable to violent conflict." He also pointed out that AIDS will
have a "huge impact" on state institutions as physicians, lawyers and
civil servants become infected or leave the country to escape the
disease. And while experts predict that AIDS could incite instability
in the region, soldiers returning from combat to rural villages in
Rwanda and the Republic of Congo may also increase the spread of dis-
ease as they forgo the use of condoms in an effort to have children
to replenish the population, the WHO and American Red Cross note.
South Africa and Zimbabwe are two examples of nations hardest hit by
AIDS and experiencing "rising internal tensions" as a result, and In-
dia is predicted to face a "truly critical situation" as well, Thomas
Homer-Dixon, director of the Peace and Conflicts Study Program at the
University of Toronto, said. He added, "Disease is not going to lead
directly to violence, it is going to have indirect effects. Disease
will have a tremendous capacity to weaken the state" (Zwillich,
Reuters Health, 5/9).

--
VSO Recruits HIV/AIDS Health Care Professionals to Volunteer in Af-
rica

International development charity VSO yesterday launched a recruit-
ment campaign in London to solicit health professionals to join "the
fight against HIV" in Africa, BBC News reports. The campaign aims to
"alert" HIV/AIDS professionals, health educators and community nurses
of the "urgent need for their skills." Currently, 85% of HIV-related
health placements are unfilled, with the demand for volunteers tri-
pling in the first four months of 2001. VSO said that the need for
volunteers is "desperate, particularly in rural areas where there is
little or no access to health education and where the virus remains a
taboo subject." BBC reports that health care volunteers can "help
break these taboos" by "influencing community leaders and traditional
practitioners." Cathy Brown, head of health recruitment for VSO,
said, "As each day passes the crisis gets worse," adding, "AIDS un-
dermines every other area of development VSO is involved in -- it is
quite simply the most urgent crisis we have ever had to face. If you
are a health professional, there will never be a more crucial time
for you to use your skills." The charity is exploring ways to make
volunteer positions "more attractive," such as offering postings for
entire families. The current lack of health volunteers "goes against
the general trend at VSO," which has supplied "record numbers" of
workers over the last two years (BBC News, 5/8)

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The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org,
a free service of The Henry J. Kaiser Family Foundation, by National
Journal Group Inc. c 2001 by National Journal Group Inc. and Kaiser
Family Foundation. All rights reserved.