AFRO-NETS> Kaiser Daily HIV/AIDS Report - Thu, 28 Jun 2001

[Cecilia Snyder <csnyder@ccmc.org>]

Kaiser Daily HIV/AIDS Report - Thu, 28 Jun 2001
-----------------------------------------------

* House International Relations Committee Approves $1.3B for Interna-
  tional HIV/AIDS Effort; Appropriations Subcommittee Approves $474M
* U.N. Conference Endorses Plan to Fight HIV/AIDS on a Global Scale
* Mbeki Visits Merck, Calls Vaccine Work 'Encouraging'
* TAC Threatens to Sue South African Government for Failing to Pro-
  vide Antiretrovirals to Pregnant Women
* South African Program Brings AIDS Prevention Messages to Young Peo-
  ple Through Frank Discussions of Sex
* The Nation Spotlights Global AIDS Epidemic


--
House International Relations Committee Approves $1.3B for Interna-
tional HIV/AIDS Effort; Appropriations Subcommittee Approves $474M

The House International Relations Committee yesterday approved the 
compromise reached by Chair Henry Hyde (R-Ill.) and Reps. Barbara Lee 
(D-Calif.) and Tom Lantos (D-Calif.) that calls for $1.36 billion in 
U.S. funding for global HIV/AIDS initiatives, National Journal News 
Service reports. The committee approved the compromise, a substitute 
amendment to HR 2069, by a vote of 32-4. The revised bill would au-
thorize $560 million in bilateral HIV/AIDS funds to be administered 
through USAID for FY 2002, $750 million for the Global AIDS and 
Health Fund and $50 million for a pilot drug program in developing 
nations. In addition, the approved bill would create a 12-member 
Global Health Advisory Board to assist the president, secretary of 
state and USAID administrator in implementing international health 
programs. The bill would also eliminate a 25% cap on contributions to 
multilateral aid (Warner, National Journal News Service, 6/27). Hyde 
said, "America must contribute its fair share as we work to leverage 
additional funds for this crusade from other developing countries. By 
providing this level of authorization, we can ensure that the contri-
butions made by the United States will be adequate, and also yield 
the commitments from other countries to make this effort a truly 
global war on AIDS" (International Relations Committee release, 
6/27). Hyde added that he "was prepared" for liberals to say that the 
bill's funding levels are "too low" and for conservatives to say they 
are "too high." But he said, "We think we have arrived at a workable 
figure that is not too low and not too high" (Zwillich, Reuters 
Health, 6/27). Lee said that the bill was a "good step in the right 
direction," but added that the United States needs "to invest much 
more money in this effort" (Lee release, 6/27). Lee said she would 
offer an amendment that would increase the $750 million figure to 
$1.2 billion (Reuters Health, 6/27). 

Approving Palliative and Hospice Care

The committee also approved by voice vote an amendment by Rep. Chris 
Smith (R-N.J.) that would ask the government to promote the use of 
and provide assistance to international palliative and hospice care 
facilities (National Journal News Service, 6/27). Smith's amendment 
would make funds available to existing organizations that provide 
palliative and hospice care. He said, "The situation in many develop-
ing nations -- particularly in sub-Saharan Africa -- is so desperate 
that for most HIV/AIDS patients, therapeutic treatment is simply not 
an option. My amendment will help to expand existing hospice and pal-
liative care networks to ensure that terminal HIV/AIDS sufferers are 
allowed to face the end with a measure of compassion, dignity and hu-
manity" (Smith release, 6/27).

A Different Amount

In a separate action yesterday, the House Appropriations foreign op-
erations subcommittee voted to provide $474 million for international 
HIV/AIDS efforts, including $100 million for the Global AIDS and 
Health Fund and $200 million for international disaster assistance. 
The Washington Post reports President Bush had requested those 
amounts (Washington Post, 6/28). Because the foreign operations sub-
committee "approved a far lower figure" than the amount the Interna-
tional Relations Committee approved, it is unclear "how much of that 
money will eventually be appropriated," National Journal News Service 
reports (National Journal News Service, 6/27). Rep. Jim Leach (R-
Iowa), who co-sponsored the foreign operations subcommittee bill, 
predicted, "The challenge here is going to be on the appropriations 
side" (Reuters Health, 6/27).


--
U.N. Conference Endorses Plan to Fight HIV/AIDS on a Global Scale

Delegates to the U.N. General Assembly special session on HIV/AIDS 
unanimously endorsed a Declaration of Commitment outlining a global 
strategy for the fight against HIV/AIDS yesterday, the New York Times 
reports. The document, "while in no way enforceable by the interna-
tional community, is nonetheless extraordinary in both its language 
and its tact," and acknowledges that HIV/AIDS is "something far be-
yond a medical issue, framing it instead as a political, human rights 
and economic threat," the Times reports (Steinhauer, New York Times, 
6/28). U.N. Secretary-General Kofi Annan called the declaration a 
"clear battle plan for the war against HIV/AIDS, with clear goals and 
a clear time frame. It is a blueprint from which the whole of human-
ity can work in building a global response to a truly global chal-
lenge" (Farley, Los Angeles Times, 6/28). 

Goals and Targets

Labeling AIDS a "global emergency," the document "details" the demog-
raphy of the disease and outlines many factors in the spread of the 
virus. The document also lists a series of targets for the reduction 
of HIV infections, increased education and prevention measures and 
implementation of treatment programs (Steinhauer, New York Times, 
6/28). One of the main goals of the declaration is a 25% reduction in 
infections among young people between the ages of 15 and 24 in the 
worst affected nations by 2005 and an international reduction of 25% 
by 2010. The declaration also seeks to establish "national prevention 
targets" that "recogniz[e] and addre[ss] factors leading to the 
spread of the epidemic and increasing people's vulnerability" by 2003 
(AP/South Florida Sun-Sentinel, 6/28). That language is part of a 
compromise reached when members of the Organization of Islamic Coun-
tries objected to references to homosexuals, sex workers and intrave-
nous drug users as specific HIV "vulnerable groups." Document framers 
agreed to drop the language in exchange for a stronger stance on the 
rights of women. The document "explicitly" states that "empowering 
women is essential for reducing [HIV] vulnerability" and notes that 
illiteracy, "social exclusion" and "sexual exploitation" of women 
have all contributed to the spread of the disease. The declaration 
also asks nations to do away with "harmful traditional and customary 
practices," which "appears to be an allusion to things like genital 
mutilation," a procedure that may spread the virus through the use of 
contaminated knives. "If there is one idea that stands out clearly, 
it is that women are in the forefront of this battle," Annan said 
(New York Times, 6/28). Archbishop Javier Lorenzo Barragan, the rep-
resentative from the Vatican, which also opposed the references to 
vulnerable groups, told the assembly that although "many groups were 
disappointed to see supportive references to gays and other groups 
deleted from the declaration," most still viewed the document as a 
"victor[y]." Annan acknowledged that the debate brought "painful dif-
ferences" to the surface. He added, "Like AIDS itself, these differ-
ences need to be confronted head on, not swept under the carpet" 
(Garrett, Newsday, 6/28). 

Treatment Called 'Integral'

The declaration calls prevention the "mainstay" of international 
HIV/AIDS efforts, but acknowledges that treatment "must be an inte-
gral part of all national and international programs." The document 
asks countries to "cooperate constructively in strengthening pharma-
ceutical policies and practices, including those applicable to ge-
neric drugs and intellectual property regimes." The Washington Post 
reports that "[e]ven the United States, which has been the most pow-
erful proponent of prevention over treatment," appears to have 
"shift[ed]" policies. Secretary of State Colin Powell, who co-chaired 
the U.S. delegation to the conference, said "only an integrated ap-
proach," including treatment, "makes sense." Duff Gillespie, a USAID 
official, said that prevention remains the United States' "highest 
priority," but added that antiretroviral treatment is "also impor-
tant." Doctors Without Borders, which has advocated treatment, said 
that the declaration "puts treatment firmly on the map [and] confirms 
... that there can be no choice between prevention and treatment -- 
they are mutually reinforcing" (DeYoung, Washington Post, 6/28). Bar-
ragan said treatment is a "moral imperative," adding "that there is a 
'social mortgage' on all private property, and that this concept can 
also be applied to 'intellectual property'" (Newsday, 6/28). However, 
the Health GAP Coalition, a group of AIDS activists, said the docu-
ment only makes the "vaguest of gestures" toward treatment, "barely 
mentioning drug patents as a hindrance to drug access and failing to 
insure that the bulk purchase of generic drugs will be included in 
the portfolio of the proposed global AIDS fund." Paul Davis, a Health 
GAP organizer and a member of ACT UP/Philadelphia, called the docu-
ment a "very weak tool" for advocates (Collins, Philadelphia In-
quirer, 6/28).

Using the Declaration

UNAIDS Executive Director Peter Piot called the declaration a "major 
instrument for accountability" that can be "forcefully" used with 
governments. Annan called the document a "yardstick, a standard" that 
people can use to "challenge their governments on what they are doing 
and not doing." However, Davis said it is "hard to imagine how" peo-
ple can use the declaration (Zimmerman/Harris, Wall Street Journal, 
6/28). Phillipe Leveque, director of CARE-France and head of CARE's 
13-member delegation to the conference, said his group was "obviously 
hoping for a more strongly worded document," but called the declara-
tion a "step in the right direction," adding that the "test now is 
whether the nations of the world can translate words into a global 
response to the disease" (Ahmed et al., Atlanta Journal-Constitution, 
6/28). 

Setting Up the Fund

Much of the uncertainty surrounding the plan revolves around the pro-
posed AIDS trust fund. Although the declaration endorsed the Global 
AIDS and Health Fund, it did not lay out the specifics of how the 
fund will operate or who will oversee it. Annan said that the details 
of operation will be determined "by year's end" and added that he 
"expects" the fund to be run by an "independent, not-for-profit 
board" that will include representatives from the United Nations and 
WHO, as well as representatives from donor and recipient nations. So 
far, $961 million has been contributed to the fund (Wall Street Jour-
nal, 6/28). The Global AIDS Alliance, a coalition of AIDS advocacy 
groups from the United States and Africa, said yesterday that it is 
concerned about the direction of the fund because "key" decisions 
about its design and operation are "still being made behind closed 
doors among the wealthy donor nations, with little civil society in-
put." Dr. Paul Zeitz, GAA co-director, said, "That reflects a domi-
neering, colonialist pattern of behavior, not a real partnership with 
people in affected nations," and called for greater inclusion of 
other groups in the decision-making process (GAA release, 6/27). To 
view a copy of the declaration, click here. Please note that links 
are available only to readers of the report's Web version.       3. Annan 
Unanimously Nominated for Second Term as U.N. Secretary General

The U.N. Security Council yesterday unanimously nominated U.N. Secre-
tary-General Kofi Annan to serve a second five-year term as the head 
of the United Nations, the Washington Post reports. The council's 
vote is "all but certain" to be endorsed tomorrow by the 189-member 
General Assembly. Annan has declined to speak about the election un-
til after the Assembly's vote and has instead promoted the General 
Assembly special session on HIV/AIDS, which concluded yesterday, and 
appealed for international donations to the Global AIDS and Health 
Fund (Lynch, Washington Post, 6/28). While the vote typically occurs 
at the end of the year, Bangladeshi Ambassador Anwarul Chowdhury, who 
is also Security Council president, proposed "moving up the process," 
a move seen as a "gesture of support" on the last day of the special 
session that Annan conceived (Farley, Los Angeles Times, 6/28). Annan 
has made the fight against AIDS his "personal priority" (Kaiser Daily 
HIV/AIDS Report, 4/26).


--
Mbeki Visits Merck, Calls Vaccine Work 'Encouraging'

South African President Thabo Mbeki yesterday visited a Merck & Co. 
research and manufacturing facility outside of Philadelphia, where he 
met with Merck Chair Raymond Gilmartin, who informed him of the com-
pany's progress on an HIV vaccine, the Associated Press reports. 
Mbeki called the research an "extraordinary movement forward" in the 
fight against HIV/AIDS. "Everybody is grappling with this issue, what 
do we do about AIDS," he said. "What Merck is saying to us .. is that 
(scientists) are working on a vaccine which would have an impact on 
the immune system, that the immune system is then able to fight the 
virus. I think that is really a major breakthrough," he added. Gil-
martin said because of the "uncertainty of the drug-discovery proc-
ess," more research is needed before scientists can predict when a 
vaccine would possibly be ready (Bergstrom, Associated Press, 6/27). 

National Press Club Appearance

After his hour-long visit to Merck, Mbeki returned to Washington, 
D.C., where he had met on Tuesday with President Bush to discuss 
plans for Southern Africa's economic future, to address a National 
Press Club luncheon about the African economic recovery plan and how 
South Africa plans to deal with the AIDS epidemic. Mbeki's visit to 
the United States coincided with the U.N. General Assembly's special 
session on HIV/AIDS, but he did not attend the conference in New 
York. He explained that the U.N. assembly was a "ministerial" confer-
ence and that the South African delegation attending the meetings 
deals with HIV/AIDS on a day-to-day basis. "What the ministers said 
at the U.N. AIDS conference is no different from what I would have 
said," he added. He also noted that he had not yet arrived in the 
United States when the South African delegation spoke at the confer-
ence. Addressing a question about his previous statements doubting 
whether HIV causes AIDS, Mbeki said his views on the causal link be-
tween HIV and AIDS had been distorted by "misreporting." He told the 
gathering that immune deficiency can be caused by a "variety of 
things," including malnutrition and contaminated water, "not just a 
virus." He said he has lobbied for the government to take a "compre-
hensive approach" to AIDS to "address [the] condition of human be-
ings," which cannot be addressed "merely with drugs and medicine." 
When asked if he now believed HIV causes AIDS he said that he did not 
think his "personal belief" was "relevant to scientific fact" and 
added that acknowledging HIV as the only cause of immune deficiency 
is a "difficult position to sustain." 

Drug Access

The South African government has declined to provide antiretroviral 
therapy for HIV/AIDS patients, even after settling the lawsuit 
brought by the world's major pharmaceutical companies against the 
country's Medicines and Related Substances Act, which allows the gov-
ernment to import or manufacture generic medications. Mbeki said that 
the government is "very concerned" about drug access, particularly 
for the bulk of the population that is "very poor," but when asked 
whether the government will pursue the use of cheaper generic drugs 
he said that infrastructure and oversight of the therapy was needed 
first. He added that when the drug companies agreed to drop the law-
suit, they also pledged to aid the country's medical system in over-
seeing drug distribution and monitoring (Heather Schomann, Kaiser 
Daily HIV/AIDS Report, 6/28). South African AIDS activists announced 
earlier this week that they plan to file suit against the government 
for not providing pregnant HIV-positive women with drugs that can re-
duce the odds of vertical transmission (Warner, Philadelphia In-
quirer, 6/28).


--
TAC Threatens to Sue South African Government for Failing to Provide 
Antiretrovirals to Pregnant Women

The South African AIDS group Treatment Action Campaign said on Tues-
day that it will take the South African government to court for not 
allowing HIV-positive pregnant women to receive nevirapine and AZT to 
prevent vertical transmission, Reuters reports. The group said it has 
"no option" but to seek a court ruling that would "uphold citizens' 
constitutional rights to proper health care" by allowing the drugs to 
be dispensed to pregnant women with HIV (Swindells, Reuters, 6/26). 
The South African government has "refused" to allow the drugs to be 
distributed through its public health system because of concerns over 
cost, the drugs' toxicity and the "ability of the country's health 
care infrastructure to deliver" the medicines (Dow Jones Interna-
tional News, 6/27). TAC "countered" that the medicines are not too 
costly, noting a study commissioned by the South African Health Min-
istry that shows that a national program of nevirapine to prevent 
vertical transmission "would save 14,000 babies at a cost of $10.9 
million per year, or just $779 per child." Mark Heywood, national 
secretary for TAC, said that giving nevirapine to pregnant women 
could reduce the number of South African children born with HIV by 
20,000. Although the country has established research sites that 
would dispense nevirapine and provide counseling services, Heywood 
said that the sites are "limited, too late and a drop in the ocean" 
(Reuters, 6/26). The Congress of South African Trade Unions, a 
"strong ally" of the ruling African National Congress, said that the 
government's "excuses" for not providing nevirapine are "prevarica-
tion[s]" and amount to "fiddling whilst Rome burns." The group 
pointed to Brazil as a successful example of a country with "similar 
income disparities" that has provided medication to its HIV-positive 
citizens (Dow Jones International News, 6/27). South African Health 
Minister Dr. Manto Tshabalala-Msimang told delegates gathered at the 
U.N. General Assembly special session on HIV/AIDS that the South Af-
rican government will provide HIV-positive pregnant women with a 
"package of care" to prevent vertical transmission (Reuters, 6/26). 


--
South African Program Brings AIDS Prevention Messages to Young People 
Through Frank Discussions of Sex

Delegates attending the U.N. General Assembly special session on 
HIV/AIDS said that AIDS prevention programs in Africa could possibly 
be modeled after a South African effort that uses billboards and 
other media outlets to spread prevention messages to young people, 
the San Francisco Chronicle reports. Called loveLife, the program 
aims to promote discussion among young people about sex and AIDS 
through messages on billboards, television and the radio. Designed by 
South Africans, loveLife is a joint effort between the Kaiser Family 
Foundation, the South African government and the Bill and Melinda 
Gates Foundation. The program engages in "overt discussions of sexu-
ality" on the radio and television and at sporting events to engage 
teens in a dialogue on the issue (Russell, San Francisco Chronicle, 
6/27). It also distributes pamphlets describing how to feel sexual 
pleasure "in a healthy way" through activities that pose a low risk 
of acquiring STDs, such as masturbation or Tantric sex, a spiritual 
type of intercourse (Sithole, Reuters, 6/26). UNAIDS estimates that 
half of all new HIV infections worldwide occur among people between 
the ages of 15 and 24 (San Francisco Chronicle, 6/27). And a KFF 
study found that 20% of South Africans ages 12 to 17 had their first 
sexual experience at age 12 or younger (Murphy, Baltimore Sun, 6/27). 
"Young people everywhere are at the epicenter of this epidemic. 
Clearly programs for youth need to be at the core of a successful 
prevention strategy," Michael Sinclair, director of South African 
programs for the Kaiser Family Foundation, said. loveLife, which op-
erates on a five-year, $100 million budget, is garnering interest 
from countries such as China and Nigeria that hope to employ similar 
programs (San Francisco Chronicle, 6/27).

Love and Basketball

Another aspect of the loveLife campaign uses the basketball court as 
a forum for games and AIDS discussion, the Baltimore Sun reports. At 
the games, coaches "are just as likely to advise players on protect-
ing themselves from STDs as on perfecting lay-up shots," the Sun re-
ports. As an incentive for young people to participate in the pro-
gram, organizers offer free coaching and court privileges in exchange 
for participation in sexual health classes and homework study ses-
sions (Baltimore Sun, 6/27).


--
The Nation Spotlights Global AIDS Epidemic

This week's issue of The Nation reports on the global HIV/AIDS pan-
demic in a feature titled, "AIDS and the New World Order." Below is a 
round up of the AIDS-related articles appearing in the magazine. 

* "Global Apartheid": This feature article, written by Salih Booker, 
executive director of Africa Action, a group mobilized to address so-
cial and economic issues related to Africa, and William Minter, a 
senior research fellow at Africa Action, examines how the HIV/AIDS 
epidemic in Africa and other developing nations represents one exam-
ple of "global apartheid," defined by the authors as "an interna-
tional system of minority rule whose attributes include: differential 
access to basic human rights; wealth and power structured by race and 
place; structural racism, embedded in global economic processes, po-
litical institutions and cultural assumptions; and the international 
practice of double standards that assume inferior rights to be appro-
priate for certain 'others,' defined by location, origin, race or 
gender." Booker and Minter state that the HIV/AIDS epidemic is a 
prime example of apartheid because it "exposes the fact that the dis-
tribution of current suffering associated with global inequality ... 
is clearly linked to place and race." They describe how slavery, co-
lonialism and racism have tipped the balance against developing na-
tions and how the inequality can be rectified (Booker/Minter, The Na-
tion, 7/9). 

* "Annan's AIDS Crusade": This op-ed by Pranay Gupte, a columnist for 
Newsweek International, discusses how U.N. Secretary-General Kofi An-
nan has used his "bully pulpit" as the head of the United Nations to 
"advance public support for helping victims of HIV/AIDS." Projecting 
a "recharged image" of the United Nations, Annan will hold several 
international meetings over the next eighteen months aimed at 
"get[ting] leaders of rich and poor countries to commit at least mod-
est new amounts of money to tackle the widening problems of poverty" 
and AIDS. To secure these financial commitments, Gupte writes that 
"Annan's strategy has been to link AIDS to the broader issues of 
jump-starting economic growth and insuring environmental security" 
(Gupte, The Nation, 7/9). 

* "The AIDS Fund Fight": Although Annan has made an "eloquent plea" 
for contributions to the Global AIDS and Health Fund, his call for 
greater efforts to fight HIV/AIDS in developing nations "guarantees 
neither that the rich countries will provide the needed resources nor 
that the fund will be structured wisely," Robert Weissman, editor of 
the Multinational Monitor, writes in an op-ed. Weissman notes that 
there are still questions concerning the level of money in the fund, 
its administration and its priorities. He concludes, "Tragically, 
Kofi Annan's grand vision may well be giving way to a modest resource 
mobilization and potentially flawed institutional arrangement. Per-
haps what takes shape will be just the beginning, but it is also pos-
sible that the present political momentum to do something about 
HIV/AIDS will be lost once the fund is created" (Weissman, The Na-
tion, 7/9). 

* "ACT UP Goes Global": This piece describes how ACT UP has "rededi-
cated itself" to the causes of racism and poverty "both in local and 
global contexts, and is part of an international antiglobalization 
alliance that concentrates on access to health care" (Kim, The Na-
tion, 7/9). 

* "Stop Global AIDS": A Nation Web exclusive, this article documents 
the Stop Global AIDS March that took place in New York on June 23 to 
"rall[y] around ... the three Ds of the global AIDS movement: Dol-
lars, Debt and Drugs" (Kim, The Nation Web site, 6/23). 

* "Morality Test": Also available on the Nation Web site is a test 
developed by Africa Action that aims to measure a participant's "Ac-
quired Morality Deficiency Syndrome." The test asks general questions 
on the impact of HIV/AIDS on developing nations and asks readers 
whether they agree or disagree with statements such as "Brazil's suc-
cess in combating the AIDS epidemic is not a good model because they 
went too far in violating the patent rights of drug companies" (The 
Nation Web site, 6/27). 

--
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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