AFRO-NETS> Kaiser Daily HIV/AIDS Report - Mon, 25 Jun 2001

[Cecilia Snyder <csnyder@ccmc.org>]

Kaiser Daily HIV/AIDS Report - Mon, 25 Jun 2001
-----------------------------------------------

* U.N. General Assembly Opens Special Session on AIDS in New York
* Powell Urges European Union to Increase Contribution to Global AIDS
  Fund
* Human Rights Watch Report Says Kenya 'Neglecting' AIDS Orphans
* WHO TB Drug-Purchasing Plan Could Serve as Model for Global AIDS
  Fund
* Former President Clinton Urges U.S. Commitment to 'War on AIDS' on
  Eve of U.N. Session
* More Comments on U.N. HIV/AIDS Conference


--
U.N. General Assembly Opens Special Session on AIDS in New York

The U.N. General Assembly today will begin its special session in New 
York to address HIV/AIDS, marking the first time that the group of 
189 nations has "focused on a single disease," the Philadelphia In-
quirer reports. During the three-day meeting, U.N. officials hope to 
"galvanize political support" for efforts to fight the disease, "ac-
celerate" efforts to prevent and treat HIV infection in the develop-
ing world and raise billions of additional dollars to combat AIDS in 
"impoverished" sub-Saharan Africa, where 70% of the world's 36 mil-
lion people with HIV reside (Collins, Philadelphia Inquirer, 6/24). 
The Los Angeles Times reports that the conference "caps a series of 
recent, meaningful shifts indicating that the campaign against the 
disease is moving forward at a pace long hoped for" by AIDS activists 
(Farley, Los Angeles Times, 6/24). "For the first time, political 
leaders from all over the world are recognizing that AIDS is a crisis 
and we've got to do something," Peter Piot, executive director of 
UNAIDS, said (Collins, Philadelphia Inquirer, 6/24). He added, "We 
know what works, we know what we have to do and the biggest job now 
is to get resources to get the job done." However, U.N. delegates 
have "struggled" over proposed language for the Declaration of Com-
mitment, which outlines "goals and targets" for nations to combat 
AIDS (Wren, New York Times, 6/24). Several Muslim nations, for exam-
ple, have objected to language about homosexuality, intravenous drug 
use and women's rights. In addition, delegates have drawn "strong 
battle lines" over whether the United Nations should highlight pre-
vention or treatment of the disease. Delegates will debate the decla-
ration during the conference and hope to issue a final version by 
Wednesday.

Matter of Money

U.N. delegates also hope to build a "war chest big enough" to fund 
the fight against AIDS worldwide. According to a UNAIDS report re-
leased Thursday, an "effective" HIV prevention, treatment and care 
program for developing nations would cost $9.2 billion by 2005, but 
philanthropy groups, governments and insurers today spend only $1.8 
billion on the effort. In addition, the Global AIDS and Health Fund, 
which has about $525 million, has fallen "far short" of efforts to 
raise $7 billion to $10 billion from western nations, philanthropy 
groups and corporations (Collins, Philadelphia Inquirer, 6/24). A 
draft of the Declaration of Commitment would provide $4.8 billion for 
prevention and $4.4 billion for treatment for HIV patients and their 
families, including $1.13 billion to purchase and distribute antiret-
roviral drugs in developing nations (Garrett, Newsday, 6/24). How-
ever, AIDS activist groups have criticized UNAIDS for placing "too 
much emphasis" on prevention and "not enough" on treatment (Collins, 
Philadelphia Inquirer, 6/24). "We are deeply concerned that the draft 
declaration puts a lot of emphasis on prevention. Prevention has been 
the main response of the international community so far, and when you 
look at the soaring numbers, we know that it does not work," Dr. 
Anne-Valerie Kaninda of Doctors Without Borders said (Russell, San 
Francisco Chronicle, 6/24). She added, "The medical ethics tells us 
you cannot simply write off 34 million people in the developing 
world" (Collins, Philadelphia Inquirer, 6/24). On Saturday, hundreds 
of AIDS activists demonstrated in New York, calling for increased 
support for individuals with AIDS worldwide (Roth, Associated Press, 
6/23). Demonstrators "argued" that the U.N. conference "won't do 
enough" to fight the AIDS pandemic, urging western nations to commit 
more funds to AIDS treatment and "forgive the crippling debt" that 
many developing nations face (Robin, Newsday, 6/24). The Washington 
Post reports that a number of groups plan to "air their differences" 
with UNAIDS in demonstrations, marches and alternative news confer-
ences (DeYoung, Washington Post, 6/24).

Who's in the House?

According to the San Francisco Chronicle, 24 heads of state, includ-
ing 17 from Africa, will attend the U.N. conference. South African 
President Thabo Mbeki will likely not attend (San Francisco Chroni-
cle, 6/24). In addition, "not a single head of state" from South Asia 
or Eastern Europe, regions that may face an AIDS epidemic in the fu-
ture, plans to attend the U.N. meeting (Collins, Philadelphia In-
quirer, 6/24). A 50-member U.S. delegation, headed by Secretary of 
State Colin Powell and HHS Secretary Tommy Thompson, will attend, as 
well as representatives from non-governmental sectors with a "stake 
in the AIDS pandemic" (Washington Post, 6/24). According to the 
Philadelphia Inquirer, drug industry representatives will attend the 
conference, but will "play little more than a supporting role." They 
plan to "downshif[t] mightily to deliver the message" that the indus-
try "is merely one player among many" in the AIDS pandemic (Warner, 
Philadelphia Inquirer, 6/24). U.N. officials remain "optimistic, even 
buoyed" that the world has begun "tackling" the AIDS epidemic. "It is 
technically, politically and financially feasible to contain HIV/AIDS 
and dramatically reduce its spread and impact," U.N. Secretary-
General Kofi Annan said (Collins, Philadelphia Inquirer, 6/24). 
Still, the New York Times reports that although the "greatest suc-
cesses" in "eradicating" a single disease have resulted from "single-
issue campaigns," such as the U.N. conference, a "narrow approach" to 
AIDS also holds a number of risks (Flanders, New York Times, 6/24). 


--
Powell Urges European Union to Increase Contribution to Global AIDS 
Fund

"The E.U. has got to give a lot more," Secretary of State Colin Pow-
ell said today in an interview with the Associated Press, voicing his 
"frustrat[ion] over the bare trickle" of European donations to the 
Global AIDS and Health Fund as world leaders converge in New York to-
day for the opening ceremonies of the U.N. General Assembly's special 
session on HIV/AIDS. "Everybody should be coming up on this, every 
European country," he added. So far, the fund, which UNAIDS on Friday 
estimated will need $9.2 billion a year to fight HIV/AIDS in the de-
veloping world, has amassed $582 million in donations. The United 
States has pledged $200 million, while Great Britain and France have 
added contributions of $100 million and $127 million respectively, 
with the remainder coming from private donors. Powell "expressed 
hope" that the special assembly would cause other nations to "ante 
up" and contribute to the fund. "That's not a bad start but it is no-
where near meeting the need," Powell said, adding that donations need 
to come from other E.U. members and not just "big, affluent, former 
colonial powers" such as Britain and France. At the recent meeting 
between President Bush and E.U. officials in Goteborg, Sweden, Powell 
said Bush made a "rather passionate" plea for contributions, and Pow-
ell shared his assessment of the situation in Africa after his first 
official visit to the continent last month. "I was very candid. I 
said, 'You've got to find a way quickly to show your commitment to 
this,'" he said. Powell holds "no illusions" that international do-
nors will themselves contribute enough money to make a "big differ-
ence" in the fight against HIV/AIDS. However, he said he hopes the 
fund will be the start of a "worldwide mobilization" of public and 
private efforts against the epidemic. The recent announcement of a 
joint initiative between Coca-Cola and UNAIDS that will utilize 
Coke's distribution network to disseminate condoms and HIV/AIDS in-
formation is one such example, he said. "That kind of involvement is 
probably as valuable as a financial contribution. A number of compa-
nies are now looking for this kind of creative response," he added. 
Developed nations can also assist by procuring anti-AIDS medicines 
and helping to build health care infrastructure, as well as providing 
AIDS education, which Powell said he would like to see "drill[ed] 
into" children as young as seven, "just like we do here with anti-
smoking and other types of campaigns." Strong political leadership in 
affected nations is also needed, he said, citing Ugandan President 
Yoweri Museveni as an example of someone who "cuts no slack" and "de-
liver[s] a strong message" on HIV/AIDS. Powell, who along with HHS 
Secretary Tommy Thompson is heading the U.S. delegation to the spe-
cial assembly, will address the session today (Ross, AP/Baltimore 
Sun, 6/25). The three-day meeting will conclude Wednesday, when dele-
gates are expected to endorse a declaration of commitment to fighting 
HIV/AIDS on an international level.


--
Human Rights Watch Report Says Kenya 'Neglecting' AIDS Orphans

The Kenyan government is "neglecting" millions of children affected 
by HIV/AIDS, about one million of them orphans, according to a report 
released yesterday by Human Rights Watch, the AP/Contra Costa Times 
reports. The report, titled "In the Shadow of Death: HIV/AIDS and 
Children's Rights in Kenya," criticizes the Kenyan government for 
"failing to take responsibility" for children who are often "forced" 
to drop out of school in order to go to work to support themselves or 
to take care of sick family members (England, AP/Contra Costa Times, 
6/25). Those jobs, sometimes including prostitution, are often "dan-
gerous," the report said. The report, "timed to coincide" with the 
U.N. General Assembly's special session on HIV/AIDS, also accused 
President Daniel arap Moi and the entire Kenyan government of "not 
doing enough to stamp out the 'stigma' of HIV/AIDS," which the report 
said has made AIDS orphans "untouchables." Report author Joanne Csete 
said, "The rights of children have been the missing piece of the AIDS 
crisis. If their parents had died in any other way, these children 
would have been at the top of the agenda. But because their parents 
died of AIDS, with all of the stigma that implies, they're at the 
bottom" (Palmer, London Independent, 6/25). "If families are not 
there to help these children, then the state has the responsibility 
to provide protection," she added (AP/Contra Costa Times, 6/25). In 
the report, HRW encouraged the Kenyan government to reform certain 
"cumbersome" legal processes that are "ill-suited to claimants who 
are minors" and to pass laws allowing orphans more access to such 
processes (Agence France-Presse, 6/25). The report "praised" the gov-
ernment" for its recent passage of the Intellectual Property Bill, 
which will allow the country to manufacture or import generic drugs 
in "times of emergency," and "urged" the government to ratify the In-
ternational Labor Organization convention on "hazardous labor" for 
children (AP/Contra Costa Times, 6/25).


--
WHO TB Drug-Purchasing Plan Could Serve as Model for Global AIDS Fund

The World Health Organization's new program for purchasing tuberculo-
sis drugs in bulk, which has lowered TB drug prices and increased 
drug access, could serve as a "model" for the purchase of anti-AIDS 
drugs for Africa and the developing world, the New York Times re-
ports. The WHO program, which began in March with a $10 million grant 
from the Canadian government, has utilized "competitive bidding" to 
lower the price of a six-month TB treatment course from between $15 
and $20 to about $10, fund manager Dr. Ian Smith said. The TB drugs 
are supplied by MEG/Svizera, a generic drug manufacturer with offices 
in the Netherlands and India. Dr. David Heymann, WHO's executive di-
rector in charge of communicable diseases, said the plan will "serve 
as an example" for the Global AIDS and Health Fund proposed by the 
United Nations. However, the Times notes that the use of generic AIDS 
drugs may draw protest from pharmaceutical companies that want to en-
sure that their patents are respected. Unlike many TB drugs, most 
anti-AIDS drugs are relatively new and are still protected from ge-
neric competition in most countries. Heymann said he was unsure 
whether generic manufacturers would be permitted to offer bids to 
provide the anti-AIDS drugs, but WHO has stated that it supports the 
manufacture of generic drugs as long as the quality of the medica-
tions is "ensured" and their use "does not violate patent laws." Of-
ficials will determine exactly how the drug-purchasing arm of the 
global AIDS fund will operate later this summer. Mark Grayson, a 
spokesperson for the Pharmaceutical Research and Manufacturers of 
America, said his organization will "oppose any effort" that includes 
the use of generic drugs that are patent-protected. "The global fund 
should abide by intellectual property laws," he said, adding that the 
patent-holding drug manufacturers already offered "steep" discounts 
in the developing world. Smith noted that the TB fund does not use 
the competitive bidding process to purchase any of the newer patent-
protected TB drugs. Participant countries in the TB program "must 
agree to abide by detailed treatment rules" meant to ensure that pa-
tients abide by drug regimens in order to decrease the risk of devel-
oping drug-resistant strains. Smith added that such a system could 
also be applicable to AIDS treatment (Petersen, New York Times, 
6/22).


--
Former President Clinton Urges U.S. Commitment to 'War on AIDS' on 
Eve of U.N. Session

The United States "must confront the AIDS epidemic as we would any 
other life-and-death struggle: with overwhelming determination," for-
mer President Bill Clinton writes in a Washington Post opinion piece. 
Clinton states that the United States "has profound interests in re-
versing" the spread of HIV/AIDS in developing nations because "the 
health of our economy relies on the sustained vitality of foreign 
markets, many of which are threatened by the AIDS pandemic." Clinton 
notes that countries such as Uganda, Senegal and Brazil have "proven 
that with strong leadership, popular commitment and proportionate re-
sources, they can slow or even reverse the rate of new infection and 
provide life-prolonging treatment for the sick." However, he says 
that "we can't fight this war on a shoestring budget." He calls the 
$10 billion Global AIDS and Health Fund proposed by U.N. Secretary-
General Kofi Annan a step "in the right direction" and states that 
the United States should "commit its share of the war chest -- ap-
proximately 22% of the total, to about 1% of the recently passed tax 
cut." He says that the United States "can afford to devote these re-
sources," adding, "To shirk this responsibility is to abdicate Amer-
ica's timeless role as a beacon of hope and promise." He concludes, 
"The question is no longer whether we can or can't win the war on 
AIDS. Of course we can. The question is: Will we or won't we? ... The 
price of neglect will be far higher over the long run" (Clinton, 
Washington Post, 6/24).


--
More Comments on U.N. HIV/AIDS Conference

With the U.N. General Assembly's special session on HIV/AIDS set to 
begin today, editorials and opinion pieces in newspapers nationwide 
have commented on the meeting's prospects and how the United Nations 
has handled the HIV/AIDS epidemic thus far. Below are some of the 
commentaries. 

Editorials

* Washington Post: Although the special U.N. session "is the latest 
sign that the international response to the [AIDS] crisis is gaining 
momentum," disputes have already arisen over the Global AIDS and 
Health Fund, a Washington Post editorial states. The editorial states 
that the first "argument" concerns administration of the fund -- 
wealthier nations in line to contribute to the pool "want to keep it 
free of U.N. bureaucracy, rightly preferring to have some nimbler or-
ganization run it," while poorer countries "favor the U.N. structure 
because it gives them more say." The editorial says that the U.N. 
meeting must "persuade developing nations that an agile fund is in 
their own interests and to come up with a management formula that 
placates rival development agencies that want to play first fiddle." 
The Post adds that governments and health experts are disputing how 
much emphasis the fund should place on prevention as opposed to 
treatment. Since drug discounts and "promising treatment programs in 
places such as Brazil have proved that treatment should be part of 
AIDS-control programs," the editorial says that both prevention and 
treatment efforts should receive funding, with money also going to-
ward vaccine research. But there is a "pressing need" to find more 
resources for the fund, the editorial states, adding that "the Bush 
administration should be ashamed by its meager offering of $200 mil-
lion." The editorial concludes, "AIDS has become a catastrophe be-
cause of human denial -- especially among poor-country governments 
and their people. A plague of rich-country denial about the likely 
cost of meeting the challenge is the last thing that is needed" 
(Washington Post, 6/24).

* New York Times: This week's U.N. session on HIV/AIDS "is a sign 
that the world is realizing the urgency of the AIDS catastrophe," but 
there is also a "danger ... that nations might content themselves 
with little more than symbolism," a New York Times editorial states. 
The editorial notes that the "most heated and important controversy 
will concern AIDS treatment." Although "[i]t is legitimate to worry 
that treatment could gobble up the [Global Health and AIDS Fund's] 
budget," treatment is "imperative" and must be included along with 
prevention efforts, the editorial states. The editorial says that the 
"overriding question" concerning the fund is its lack of resources, 
adding that "[e]ven the optimists today believe that only about $1 
billion will be raised by the end of the year -- not enough for even 
basic prevention programs, let alone the more expensive treatment 
programs." The editorial concludes, "The U.N. session can pave the 
way for generosity by creating an AIDS fund that is effective, ac-
countable and responsive to the needs of the sick. But the real power 
is with the donors. The way to keep relatively expensive AIDS treat-
ment from crowding out prevention is to give enough money to do both" 
(New York Times, 6/24).

* Newsday: The UNAIDS report outlining the need for a $9.2 billion 
global fund to combat HIV/AIDS is an example of a "specific, coherent 
and workable anti-HIV strategy" and provides a "reason for hope" that 
greater progress against the disease will be made, a Newsday edito-
rial states. The editorial says that "crucial support" from the Bill 
and Melinda Gates Foundation and Winterthur Insurance signals 
"[a]nother reason for hope." But "[p]lenty of pitfalls lie ahead," 
the editorial states, pointing to upcoming debates over funding allo-
cation and the implementation of treatment programs (Newsday, 6/24).

* Baltimore Sun: The extent of the AIDS epidemic "boggles the mind," 
a Sun editorial states. To curb the epidemic, "A greater commitment 
by [the United States] is clearly needed, as well as the donations of 
other governments and private groups." The paper notes that antiret-
rovials "account for the fact that many of us know people who are 
living with AIDS, even as so many Africans are dying from AIDS." How-
ever, this "conundrum" makes the "tragedy" of the epidemic "more pal-
pably real -- and the special U.N. session ... all the more impor-
tant" (Baltimore Sun, 6/25).

* Minneapolis Star Tribune: "Such an enormous, international life-
and-death threat" as the AIDS epidemic "demands a mammoth, worldwide, 
coordinated response," the Star Tribune writes, adding, "That is what 
dozens of world leaders need to accomplish this week" at the U.N. 
special session on AIDS. Achieving the "worthy goal" of designing and 
implementing a "set of general marching orders for every nation" to 
respond to the epidemic "requires vigorous leadership, strong mul-
tisector support and additional funding." Thus, "[i]nternational gov-
ernment and business support is crucial, but the most-affected na-
tions must also adjust their priorities to fight the disease." The 
editorial urges "world nations" to divert resources away from "war 
and internal conflict" and towards AIDS. In addition, "Leaders at the 
summit need to put aside religious and other differences, listen to 
the success stories outlined at the summit, then make it a national 
priority to combat HIV/AIDS" (Minneapolis Star Tribune, 6/25).

* South Florida Sun-Sentinel: "Even before the United Nations begins 
its first special session on AIDS today, there are signs of trouble," 
a Sun-Sentinel editorial states. Leaders disagree on "key elements" 
of the U.N. guidelines to combat the epidemic, clashing on the issues 
of "social taboos, religion and politics." In addition, industrial-
ized nations "also are fighting among themselves over the U.N. anti-
AIDS plan," disagreeing over whether it should call for the protec-
tion of "vulnerable individuals" or "concentrate on at-risk groups." 
The editorial urges the "international community" to "stay focused on 
the goal, which is to beat a growing epidemic." The editorial con-
cludes, "Combatting a global AIDS epidemic means dealing with taboos, 
biases and political preferences. These should be secondary to the 
survival and well-being of the human race" (South Florida Sun-
Sentinel, 6/25).

* Detroit Free Press: The Free Press urges countries and global busi-
ness to "do more -- not just to do right but to assure their own fu-
tures." It adds, "If AIDS keeps speeding down its pandemic track, Af-
rican nations will never succeed in their slow crawl toward democracy 
and capitalism." The editorial cites Coke's donation to the global 
AIDS fund last week as a "laudable" effort that also won the company 
some "cheap public relations." But it concludes, "Goodwill gestures 
are never bad, but fighting AIDS requires further digging into the 
deepest pockets" (Detroit Free Press, 6/25).

Op-Eds

* New York Times: Annan writes in an op-ed to the New York Times, 
"[I]n the last few months the world has awakened at last, not only to 
the scope of the problem, but to the reality that we are not power-
less against it." The U.N. special session comes at a time "when we 
have more reason for hope than we have had in the last 20 years," he 
adds. Annan predicts that more donations to the global AIDS fund will 
be announced at this week's session, writing, "I am sure more coun-
tries will announce contributions." He adds, "I believe the public in 
the richer nations is also ready to contribute significantly," not-
ing, "It is in these nations' self-interest to do so, since no coun-
try can be unaffected by a global disaster of this magnitude" (Annan, 
New York Times, 6/25).

* Los Angeles Times: As world leaders at this week's session prepare 
to answer "the real questions" of how to fund the "war" against 
HIV/AIDS, they should consider debt cancellation for the world's 
poorest countries, Salih Booker writes in a Los Angeles Times op-ed. 
Booker, executive director of the not-for-profit group Africa Action, 
writes that Africa's external debt currently totals more than $300 
billion and costs governments of African countries more than $13 bil-
lion annually in debt payments. Booker states, "Africa's debt burden 
has led to a dramatic decline in human development indicators (such 
as life expectancy) and an increase in extreme poverty and has con-
tributed to the loss of more than 16 million lives to AIDS." Although 
Booker praises the proposal for the General AIDS and Health Fund, he 
adds, "To suggest that Africa can even survive the onslaught of AIDS 
with a scattering of philanthropy, while continuing to pay far 
greater amounts to international financial institutions, is a cruel 
fantasy." Booker writes that debt cancellation is "affordable" and 
would "immediately permit a greater financial commitment from African 
governments to tackle" HIV/AIDS. "Unless the external debts of Afri-
can countries are canceled outright this year, any overall strategy 
to defeat AIDS will surely fail," he writes (Booker, Los Angeles 
Times, 6/24).

* Los Angeles Times: Sunday's Times also featured a letter from Ka-
bati Ishaya, an HIV-positive high school student from Nigeria, to the 
delegates at this week's U.N. session. In the letter, which was pro-
vided by UNICEF, Ishaya describes how HIV is spreading among young 
African girls. "I am the face of HIV/AIDS. There are millions more 
like me. If you don't act immediately, there will be millions more to 
come," she concludes (Ishaya, Los Angeles Times, 6/24).

* Philadelphia Inquirer: Although the world "seems to be coming to 
grips" with the AIDS epidemic -- with money and drug discounts "flow-
ing" to developing nations -- "no one has figured out the smartest 
way to spend the money as it becomes available," columnist William 
Raspberry writes in a Philadelphia Inquirer op-ed. Raspberry states 
that although "most of the world knows how AIDS is spread, ... too 
many people go right on spreading it." He adds that although he sup-
ports funding to treat people with HIV, "it does seem clear that our 
spending won't be nearly as effective as it might be unless the lead-
ers of the most devastated countries also undertake to change the be-
havior that spreads HIV." He concludes, "Money is necessary, but it 
isn't everything. In the long term, with a behavior-spawned plague 
like AIDS, it may not even be the most important thing" (Raspberry, 
Philadelphia Inquirer, 6/23).

* Washington Times: "While money alone will not solve the [HIV/AIDS] 
problem, it is a vital part of the solution, and funds earmarked for 
confronting the epidemic are currently much too low," World Bank 
President James Wolfensohn writes in a Washington Times op-ed. Wolf-
ensohn states that the World Bank, in partnership with African gov-
ernments, has launched the Multi-Country HIV/AIDS Program (MAP), 
which has given 10 African countries $500 million over the past year 
to help them "scale up effective prevention, care and treatment" ef-
forts. He states that the World Bank plans to give an additional $500 
million to 15 more African countries next year for the same purposes, 
and adds that the bank has also launched a $150 million fund to fight 
HIV/AIDS in the Caribbean and a $40 million effort to combat the dis-
ease in Bangladesh. Despite these efforts, "no one on its own -- not 
the bank, donor agencies, national governments, NGOs or the private 
sector -- will be able to provide the scale of money and support 
needed to engage HIV/AIDS at the global and country level and ulti-
mately prevail," he writes. Wolfensohn states that the World Bank 
"strongly supports the establishment of the [Global AIDS and Health 
Fund] within the context of meeting the International Development 
Goals" that call for reductions in poverty and maternal, infant and 
child mortality. "Collectively we have the resources, and we surely 
have the need. All we lack is the political will," he concludes 
(Wolfensohn, Washington Times, 6/24).   

--
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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