AFRO-NETS> Kaiser Daily HIV/AIDS Report: Friday - Tuesday June 1-5th 2001

[Cecilia Snyder <csnyder@ccmc.org>]

Kaiser Daily HIV/AIDS Report: Friday - Tuesday June 1-5th 2001
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1. Global Challenges
2. Media & Society
3. Opinion
4. Drug Access

1. Global Challenges

Up to 95% of HIV-Positive People are Unaware of Their Status, Piot
Says

UNAIDS Executive Director Peter Piot said yesterday that up to 95% of
HIV-positive people are not aware of their status, "making investment
in preventing the virus from spreading crucial," Agence France-Presse
reports. Piot said at a news briefing that the ignorance is due to a
lack of testing facilities, stigma and "denial." Piot added, "That's
why it is so important that one of the priority investments is to de-
velop, on a large scale, testing and counselling services, which cer-
tainly do not exist at the moment." Piot also said yesterday
that he believed the global AIDS fund would take approximately five
years "to get up and running." He also noted that funding should be
divided between prevention and care efforts "in a balanced approach,"
adding, "Not everyone (who) is HIV-positive needs treatment right
now. ... Because of concerns of resistance development to these drugs
and also the side effects, the recommendation today is to start
later" (Agence France Presse, 5/31).

Piot Reflects on 20 Years

The UNAIDS coordinating board, which is meeting in Geneva through
Friday, is devising a strategy for the 29 U.N. agencies that have
"joined forces" to fight the epidemic. Piot said at the meeting that
when he first read a June 5, 1981, U.S. government bulletin on what
later came to be known as AIDS, "I never imagined I was looking at
the first sign of an epidemic that in just 20 years would have in-
fected 60 million people, killed 22 million and achieved the status
of the most devastating epidemic in human history." Piot said that
several regions have shown "a clear failure" in prevention efforts
and was hesitant to predict the future scope of AIDS, saying that
"much depends on China and India, where a 1% infection rate would
equal the entire population of some African countries." However, Piot
said he "saw room for hope," adding, "Where we will be in the next 20
years depends entirely on how we respond to the epidemic today. If 20
years ago, we had done what we had to do, we wouldn't be in the
situation we are now" (Nullis, Associated Press, 5/31).

United Nations Appoints 'Special Envoy for AIDS in Africa'

Canadian diplomat Stephen Lewis has been named by the United Nations
as a "special envoy for AIDS in Africa," the New York Times reports.
Lewis recently served as a special adviser for Africa to the execu-
tive director of UNAIDS (New York Times, 6/2). Lewis said that "plum-
meting drug prices" and the "imminent launch" of a global AIDS trust
fund have given him a "cautious sense of hope" that efforts to combat
HIV/AIDS in Africa may prove effective. He added, however, that he is
"no starry-eyed Pollyanna," stating, "I understand full well what a
massive undertaking it is to mobilize the policies and programs and
the physical ingredients and the infrastructure and the partners and
the sheer human commitment to turn things around." Lewis added that
the U.N. General Assembly is slated to implement a "definitive frame-
work" for fighting the epidemic at a special session later this month
(Evenson, National Post, 6/2).

Annan Addresses U.S. Chamber of Commerce, Global Health Council

U.N. Secretary-General Kofi Annan last week delivered speeches about
HIV/AIDS before the U.S. Chamber of Commerce and the Global Health
Council. Below is a summary of his remarks:

U.S. Chamber of Commerce: Calling HIV/AIDS an "unparalleled night-
mare," Annan called on business leaders at a U.S. Chamber of Commerce
breakfast on Friday to educate their workers about the disease and
encourage treatment for HIV-positive employees (Reuters, 6/1). Annan
said that the economic repercussions of HIV/AIDS are likely to be
"catastrophic," with the infrastructure, services and productive ca-
pacity of the "worst affected" countries "facing total collapse."
Noting that 42% of U.S. exports go to markets in the developing
world, Annan said that "the business community needs to get involved,
to protect its bottom line." Stating that American business leaders
have "yet to be fully utilized in the campaign against HIV/AIDS," An-
nan offered several ways in which the business community could help
fight the epidemic. He called on employers with workers in the devel-
oping world to collaborate with the employees to develop
"effective AIDS policies," including prevention education programs.
Annan also recommended that employers provide antiretroviral treat-
ment for employees already infected with HIV, adding, "[I]t is now
more profitable for companies to treat their HIV-positive employees
than to recruit and retrain new ones, as untreated workers die. In-
deed, one recent study in Africa showed that treating HIV-positive
workers paid for itself up to 10 times over." Annan concluded that as
"respected leaders" in their communities, business leaders should of-
fer their "expertise" in public affairs, marketing and human re-
sources, should donate toward prevention and treatment efforts and
should link their company names to "a goal of social responsibility"
(U.N. release, 5/31).

Global Health Council: Addressing the GHC's awards banquet, Annan
said that improving women's education and financial situations is key
to stemming the spread of HIV/AIDS in the developing world (Associ-
ated Press, 6/1). Stating that "at least" half of all new HIV infec-
tions worldwide occur among women, Annan added that poverty, abuse,
violence, "coercion by older men" and a lack of information all con-
tribute to the high prevalence rate. "Across all levels of society,
we need to see a deep social revolution that transforms relationships
between women and men, so that women will be able to take greater
control of their lives -- financially as well as physically. And we
must encourage men to replace risk-taking behavior with
taking responsibility," Annan said (U.N. release, 6/1). At the meet-
ing, Annan also "expressed regret" that Chinese AIDS activist Gao
Yaojie was not granted permission by China to attend the ceremony
(Kniazkov, Agence France-Presse, 6/1). Gao was due to travel to the
United States to receive the Jonathan Mann Award for Global Health
and Human Rights from the GHC, but was reportedly denied a passport
because she was accused of "working for anti-China forces" (Kaiser
Daily HIV/AIDS Report, 5/30). Although Annan did not "directly criti-
ciz[e]" China, Annan said women like Gao are "inspiring examples to
draw upon" (Agence France-Presse, 6/1).

2. Media & Society

More Money for Global AIDS Fund Should Come From 'All Around the
World,' Powell Says on NBC's 'Meet the Press'

Secretary of State Colin Powell, discussing U.S. financial contribu-
tions to help fight AIDS in Africa on NBC's "Meet the Press" on Sun-
day, said, "We're giving a lot more than $200 million," which was
"our most recent contribution" to the global AIDS trust fund. Powell
said that the $200 million is "on top of something in the neighbor-
hood of $500 million that's already in the State Department accounts
for this purpose." He added, "We do need more money. And that more
money needs to come from all around the world, (other countries, the
European Union, Asian nations )that have the ability to give. It
should come from wealthy individuals. It is a global trust fund, not
a single appropriation to be spent in a single year. And I
think the United States and especially President Bush should be given
credit for designating [HHS] Secretary [Tommy] Thompson and I to work
on this issue and then seeding this global health trust fund  I
hope that in the future we'll be able to find more resources and in
the next appropriation cycle ask for more money to put into that
trust fund." Powell said it is "a bit off to criticize the United
States" for not finding another $200 million to fight AIDS, which he
called "a health problem, a social problem, an economic prob-
lem, a destroyer of societies"
(Russert, "Meet the Press," NBC, 6/3).

Newseum Panel Discusses AIDS in the Media

The Washington, D.C.-based Newseum, an interactive museum of news run
by the Freedom Forum, a non partisan, international foundation that
promotes free press and free speech, on Thursday hosted a panel dis-
cussion on how the media has reported the AIDS epidemic. The forum,
title "Reporting AIDS," was hosted by Frank Bond, Newseum correspon-
dent and 22-year veteran of broadcast news, and featured Mark Gray-
son, PhRMA senior director of public relations, Bob Roehr, freelance
journalist and AIDS activist, Steve Sternberg, writer for USA Today,
and Philip Tazi, president of the African Correspondence Association.
In addition to the participants on stage, Countess Albina du Boisrou-
vray, president of the Association Francois Xavier Bagnaud, which
works with children affected by AIDS, participated in the discussion
from the audience. Participants discussed the media's response to
AIDS, its responsibility in reporting the disease and how
the media could be used to better disseminate information to youth
about HIV/AIDS, and answered questions from the audience, which in-
cluded a group of school children from New Jersey (Browett, Kaiser
Daily HIV/AIDS Report, 6/4).

AIDS Activists, Politicians React to Nkosi Johnson's Death

AIDS activists and politicians from around the world this weekend re-
acted to the death of Nkosi Johnson, the 12-year-old AIDS orphan whom
the New York Times called the "darling of an infected [South Africa]
and a living indictment of the government's policies in the face of
the epidemic." Nkosi, who received international attention when he
criticized the government's slow response to South Africa's AIDS epi-
demic at last July's 13th International AIDS conference in Durban,
died Friday morning (McNeil, New York Times, 6/2).
Outlined below are reactions to Nkosi's death.

As a "tribute to Nkosi's life and work," the Francois-Xavier Bagnoud
Foundation and Association on Wednesday released a film, "Nkosi: A
Voice for Africa's AIDS Orphans," depicting Nkosi's activism on
behalf of AIDS orphans and children with AIDS. The video, produced by
Globalvision of New York, features excerpts from several of Nkosi's
speaking engagements in the United States and South Africa, includ-
ing the Durban conference, where Nkosi's comments "stung" South Afri-
can President Thabo Mbeki, who has been openly skeptical of the
causal link between HIV and AIDS. The video also contains excerpts
from "Nkosi's Mission," a documentary produced for South African
television about the legal fight to enroll Nkosi in a public school,
and from "Living With AIDS," a 1990 film profiling Nkosi and his fos-
ter mother. FXB President Albina du Boisrouvray called Nkosi "a war-
rior, an AIDS activist, a children's right crusader," adding that he
"gave the world a human face emblematic of the scourge of children
affected by AIDS" and that "his death is a call to all of us to con-
tinue his work on behalf of children who suffer from, and because of,
AIDS" (FXB release, 6/1). FXB's Action for Orphans is also circulat-
ing a petition calling for more action on AIDS orphans to be pre-
sented to the U.N. General Assembly in September.

On Friday, ABC's "Nightline" ran a piece on Nkosi, which Danny
Schechter, who produced the FXB video, called an "impressive and mov-
ing portrait." Schechter noted that the "Nightline" piece made no
mention of the word "orphan," stating, "Nkosi was not just a 'poster
boy' for AIDS ... but a spokesperson for AIDS orphans, the growing
crisis within the AIDS crisis. By narrowing its focus, [the piece]
elicited sympathy about one child's fight for life but did not really
connect his experience to the millions of other African kids who have
not been lucky enough to be taken in by a white middle-class family"
(Schechter, Mediachan-nel.org, 6/2).

Former South African President Nelson Mandela called Nkosi an "icon
of the struggle for life," adding that "[c]hildren such as Nkosi
Johnson should be enjoying a life filled with laughter and happiness.
On a frightening scale, HIV/AIDS is replacing that joy, laughter and
happiness with paralyzing pain and trauma"
(AP/Washington Post, 6/2).

Winnie Madikizela-Mandela, Mandela's ex-wife and head of the ruling
African National Congress' Women's League, called Nkosi a "lesson to
us as a government to do our best to deal with AIDS" (New York Times,
6/2).

"We have lost a voice," U.N. Secretary-General Kofi Annan stated in
response to Nkosi's death (Braid, London Independent, 6/2).

Treatment Action Campaign leader Zackie Achmat called Nkosi a "mar-
tyr" (New York Times, 6/2). But Time.com's Tony Karon said in a reac-
tion piece that Nkosi is not a martyr because martyrs "are those who
choose death in pursuit or in defense of their beliefs . Nkosi did
not choose death. Death chose him"
(Karon, Time.com, 6/3).

A UNAIDS statement said, "In his short life, [Nkosi] strove hard for
the removal of stigma and discrimination that so many people suffer
as a result of this disease. His call at the [Durban conference] for
HIV positive people to be treated equally will be remembered in his-
tory as a turning point in the fight against AIDS. Nkosi has shown
that individuals can make a difference. His leadership and courage
will be missed"
UNAIDS release, 6/1).

A memorial service for Nkosi will be held Wednesday at a Soweto soc-
cer stadium, followed by a multi-faith funeral service scheduled for
Saturday (New York Times, 6/2).

U.N. Secretary-General Kofi Annan Praises AIDS Rally as 'Fine Exam-
ple' of Activism

In a release commenting on the June 3 Action AIDS rally in Washing-
ton, D.C., U.N. Secretary-General Kofi Annan called the demonstration
a "fine example of the kind of response we need across the world in
facing up to HIV/AIDS." Annan noted that three million people world-
wide died of AIDS-related complications last year -- a number equiva-
lent to the population of "five cities the size of Washington, D.C."
He said, "To defeat this epidemic that haunts humanity, and to give
hope to the millions infected with the virus, we need a response that
matches the challenge. And that is why the commitment of all of you
here today is so important." Annan said that when delegates convene
for this month's upcoming special session of the U.N. Gen-
eral Assembly on HIV/AIDS, "it is essential that they hear people
speak up about the virus and demand decisive action against it." An-
nan concluded, "On behalf of the United Nations, I thank you for tak-
ing part today. You have understood that AIDS is our problem, and
nothing less than a test of our common humanity" (Annan release,
6/3).
The rally, sponsored by the National Minority AIDS Council, Project
Inform, AIDS Research Alliance, various chapters of ACT UP and other
groups, included a march to the White House, Congress and the Pharma-
ceutical Research and Manufacturers Association, and was officially
titled, "Remember the Dead -- Renew the Struggle" (Kaiser Daily
HIV/AIDS Report, 6/1).

3. Opinion

Major Pharmaceutical Companies Have Ignored Microbicide Development
That Could 'Save Thousands,'
Commentary Says

Researchers have identified almost 60 microbicides, topical ointments
and gels that could be used to prevent the spread of HIV and other
STDs such as chlamydia and herpes, but interest in the research,
which short of a vaccine "could be our best hope for preventing HIV
infection," has been lacking on the part of the major pharmaceutical
companies because "there's simply no money in it for them," science
and technology reporter Paul Raeburn writes in a Business Week com-
mentary piece. Microbicides could be cheap enough to sell in develop-
ing countries and safe enough to sell without a prescription, but
have been "shunned" by drug makers. Raeburn writes that drug compa-
nies "are not going to spend millions of dollars on the large-scale
clinical trials ... required by the FDA to produce an ointment that
sells for a few dollars." Stephen Schondelmeyer, a pharmacist and
economist at the University of Minnesota, said he was "not aware of a
big pharmaceutical company ever searching for a new drug they're go-
ing to introduce over-the-counter." According to the Alliance for Mi-
crobicide Development, 38 biotech companies, 28 not-for-profit groups
and six public agencies are investigating microbicides, and Phase III
clinical trials should begin soon on the three "most promising com-
pounds." The studies will evaluate the compounds' efficacy and "ac-
ceptability" and will include "consumer education" as part of the
compounds' development. However, it will be "at least" two years
before any compound trials are completed.

Closing the Funding Gap

The lack of interest from the major drug manufacturers has left a
funding gap in research, Raeburn writes.
Currently, the bulk of funds for microbicide research comes from NIH
(nearly $25 million per year ) and the Global Microbicide Project,
which was established with a $25 million grant from the Bill and
Melinda Gates Foundation. However, more money is needed to bring the
microbicides to market, Raeburn writes. ealth advocates have asked
NIH to triple the current budget for research to $75 million per
year. "The Bush White House, despite its wariness of government in-
tervention in the market, should support the hike," Raeburn con-
cludes, adding that because a vaccine for HIV "could still be years
away," microbicides "could save tens of thousands of lives" (Raeburn,
Business Week, 6/4).

South Africa Needs Larger Health Care Work Force, New York Times Let-
ter Says

"The need for more South African health care professionals is cru-
cial" to curbing the spread of AIDS in that country, Alfie DeMoss,
vice president of the group Medical Education for South African
Blacks, writes in a letter to the New York Times. "Increasing federal
spending on AIDS in Africa, while imperative, should not be our only
response" to the epidemic, DeMoss adds, noting that effective deliv-
ery of treatment and prevenive care for South Africans also depends
on "well educated and trained" South African health professionals.
DeMoss notes that her organization has been working with South Afri-
can educational institutions for more than 16 years to "increase the
number of doctors, nurses and midwives who live and work in the poor
and rural communities most devastated by the disease" (DeMoss, New
York Times, 6/1).

4. Drug Access

South African Government Issues First Draft of Legislation Allowing
Importation of Discounted Pharmaceuticals

Following the withdrawal of a pharmaceutical industry lawsuit against
South Africa's 1997 Medicines and Related Substances Control Act, the
South African government has issued a 70-page draft of legislation
that would "allow it to shop around for the cheapest drugs, particu-
larly those that can treat infections associated with AIDS," the
Washington Post reports (Washington Post, 6/5). The lawsuit filed by
39 drug firms had stalled the enactment of the 1997 legislation,
which would allow for "parallel importation," in which patented drugs
can be "acquired on the international market, instead of from local,
more expensive suppliers." The withdrawal of that suit has paved the
way for the law's implementation. The draft would require anyone
wishing to import patented drugs into South Africa to apply for a
permit from the health minister. If the permit is granted, the im-
porter must then apply to register the drug with South Africa's Medi-
cine Control Council. Once approved, the patent-holder in South Af-
rica "would then be unable to block the drug's importation and dis-
tribution," allowing South Africa to look for the cheapest medicines.
These parallel import licenses would be valid for up to a year, but
could be renewed (Cohen, Associated Press, 6/4). South African Health
Minister Manto Tshabalala-Msimang said that the government tried to
balance its "international responsibilities in terms of the TRIPS
provision with [its] central objective of accessing more affordable
medicines to benefit our people" (Swindells, Reuters, 6/4). The TRIPS
agreement permits a country to enact national laws permitting the use
of a patented product without authorization of the patent-holder un-
der certain specified circumstances, such as declaration of a na-
tional emergency (Kaiser Daily HIV/AIDS Report, 3/16). Tshabalala-
Msimang added that the "interested parties," including the drug in-
dustry, have three months to respond to the draft (Reuters, 6/4). Af-
ter public hearings are concluded, the health department will
then "make changes it deems necessary" and the regulations will be-
come public law (AP/Salt Lake Tribune, 6/5).

Antiretrovirals Still Out of Reach

  Although the law will allow South Africa to import a variety of dif-
ferent pharmaceuticals, AIDS activists and South African health offi-
cials say that the health ministry will likely focus on medicines
treating AIDSrelated opportunistic infections rather than antiretro-
virals. Health department spokesperson Jo-Anne Collinge said, "An-
tiretrovirals are still expensive. They are beyond the budget of the
health department." Health experts said that South Africa "could not
expect great savings on shopping around for antiretrovirals as the
price differentials set by the drug firms were not that great," add-
ing that "only" compulsory licenses would "sufficiently drive" down
the cost. Collinge said that the government will likely aim to import
antibiotics that treat oral thrush and respiratory problems, as well
as medicines for malaria, tuberculosis and STDs (Reuters, 6/4).

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.

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