AFRO-NETS> Kaiser Daily HIV/AIDS Report - Wed, 18 Jul 2001

[Cecilia Snyder <csnyder@ccmc.org>]

Kaiser Daily HIV/AIDS Report - Wed, 18 Jul 2001
-----------------------------------------------

*Bush Recommends World Bank, IMF Provide Grants Instead of Loans to
  Poor Nations for Education, Health
*G8 Summit
*Religious, Health Groups Urge Bush to Push for Debt Relief at G8
  Summit
*Harvard Plan Calls for AIDS 'Drugstore' for Developing Nations
*Kenyan Family Features Red Ribbons on Death Announcement, Testing
  National AIDS Taboo
*Kaiser Daily HIV/AIDS Report Rounds Up Reaction to Kenyan Presi
  dent's Suggestion That Country Abstain From Sex for Two Years

Politics & Policy

Bush Recommends World Bank, IMF Provide Grants Instead of Loans to
Poor Nations for Education, Health

President Bush yesterday called on the World Bank to provide a larger
proportion of its financial assistance to developing nations through
direct grants instead of loans for needs such as health care, the New
York Times reports. Speaking at World Bank headquarters yesterday,
Bush proposed that the bank provide up to 50% of its assistance to
developing countries through grants, thus allowing the countries to
"alleviate the debt that burdens" their economies (Bruni/Sanger, New
York Times, 7/18). A number of lawmakers, AIDS groups and African
groups have called on international lending institutions such as the
World Bank and the International Monetary Fund to forgive the debts
of developing nations, stating that debt reduction would help the
countries allocate more funding toward HIV/AIDS and other health ini-
tiatives. In April, California Reps. Barbara Lee (D) and Maxine Wa-
ters (D) introduced a bill (HR 1567) calling for debt relief for na-
tions in the IMF's Heavily Indebted Poor Countries Initiative (HIPC),
as well as "any other country heavily affected by HIV/AIDS" (Kaiser
Daily HIV/AIDS Report, 4/26). Bush said yesterday that providing
grants instead of loans would help developing countries more than
debt relief, which he called a "short term fix." He added, "The pro-
posal today doesn't merely drop the debt, it helps stop the debt"
(Bush statement, 7/17). But the New York Times reports that Bush did
not elaborate on whether the United States might pay for the "added
cost" of shifting from loans to grants. The World Bank currently
spends $6 billion annually on loans to developing nations, and the
United States contributes $803 million to the bank each year. The
bank has estimated that over the next decade the United States would
need to double its contribution "just to maintain the current level
of aid" (New York Times, 7/18). Jeff Lamb, director of resource mobi-
lization for the World Bank, said that when the bank issues money
without receiving payment, "donors -- or somebody -- either have to
start making up all of those grants that we've been making or else
the capacity of [the International Development Association] to help
other poor countries just goes in the toilet." Grants currently ac-
count for less than 5% of the funds allocated by the World Bank to
developing countries (Curl, Washington Times, 7/18). Meanwhile, World
Bank President James Wolfensohn has placed a "different emphasis" on
aid to developing nations, stating that free trade, not debt relief,
is the "most important step" developed nations can take to aid poorer
countries (New York Times, 7/18).

G8 Summit


At the meeting yesterday, Bush also reiterated his support for the
Global AIDS and Health Fund proposed by U.N. Secretary-General Kofi
Annan, saying that he plans to advocate the fund during the upcoming
G8 summit in Genoa, Italy. "[T]he Genoa summit will formally launch a
new global fund to combat HIV/AIDS, malaria and tuberculosis. The
United States ... [is] proud to have been a leader in developing the
fund's structure and its focus on prevention with a broad strategy
that includes treatment and care." The United States has pledged $200
million toward the fund, but Bush said that he is "ready" to contrib-
ute more "when it demonstrates success." Bush added that he is
"proud" that the United States allocates nearly $1 billion each year
toward international efforts to fight HIV/AIDS and other diseases and
"remind[ed]" meeting participants that this amount is "twice the
amount of the second largest donor." Bush also said yesterday that
Secretary of State Colin Powell and Andrew Natsios of the U.S. Agency
for International Development will develop an initiative to "improve
basic education and teacher training in Africa, where some countries
are expected to lose 10% or more of their teachers to AIDS in the
next five years" (Bush statement, 7/17).         Religious, Health Groups
Urge Bush to Push for Debt Relief at G8 Summit

Thirty advocacy and religious groups sent President Bush a letter
Monday urging him to mandate "deeper and broader debt relief" for de-
veloping nations at the upcoming G8 summit in Genoa, Italy. The let-
ter, which was signed by religious organizations, African-American
groups and AIDS groups "working in Africa," calls for the "full can-
cellation" of debts owed by "impoverished countries" to the World
Bank and the International Monetary Fund. The letter states that the
signatory groups are "concerned that [the Bush administration] may
not yet be fully taking into account the tremendous potential of
deeper and broader debt relief and we are concerned that the U.S.
delegation opposed the call for deeper debt relief at the U.N. spe-
cial assembly on HIV/AIDS." The letter notes that Uganda, Tanzania
and Cameroon have used some money freed up by debt cancellation to
fight HIV/AIDS, adding that extending debt cancellation to other na-
tions "would effectively build upon these successes." The letter
urges debt cancellation for Nigeria, Bangladesh and Haiti in particu-
lar. David Bryden, spokesperson for the Global AIDS Alliance, said,
"We hope this sends a clear message to President Bush that discussing
AIDS at Genoa without seriously addressing debt as well will be re-
jected by a wide range of AIDS advocacy groups." Groups signing the
letter include the Africa AIDS Initiative, the Episcopal Church USA,
the Health GAP Coalition, the Global AIDS Alliance, Jubilee USA Net-
work, the National Association of People Living With AIDS, the Pres-
byterian Church USA, the Rainbow/PUSH Coalition, the Treatment Action
Group, the Conference of American Rabbis and the United Methodist
Church (Global AIDS Alliance release, 7/16).

Drug Access

Harvard Plan Calls for AIDS 'Drugstore' for Developing Nations

A plan created last month by Harvard School of Public Health Dean
Barry Bloom calls for the establishment of an AIDS "drugstore" to
"buy, warehouse and distribute" medications to fight HIV/AIDS in de-
veloping nations, the Boston Globe reports. The "Global HIV/AIDS
Pharmacy" would also create an Internet database of current drug
prices and aid in providing "quality assurance" and customs assis-
tance. The plan, laid out after a series of "private" meetings with
French Health Minister Bernard Kouchner and Harvard doctor Jim Yong
Kim, founding chair of WHO's Green Light Committee, which procures
and distributes drugs to fight drug-resistant tuberculosis, also
stipulates that drugs be given only to countries with a "demonstrated
political commitment to comprehensive AIDS prevention, care and
treatment" and a "functioning" program for fighting TB or other in-
fectious diseases, "technical expertise" in HIV/AIDS treatment and
"enough money" to see the program through without "compromising other
health functions." Bloom presented his proposal last month in a let-
ter to U.N. Secretary-General Kofi Annan, who asked WHO Director-
General Gro Harlem Brundtland and UNAIDS Director Peter Piot to "ex-
plore the idea further." The proposal draws on "elements" from the
Green Light Committee, which has "driven down" TB drug prices by 60%
to 90%; the Mectizan program, a 20-year-old partnership between
Merck, WHO and the World Bank that provides medicine to prevent river
blindness; and the Global Alliance for Vaccines and Immunizations, a
partnership among the Bill and Melinda Gates Foundation, WHO, UNICEF
and vaccine companies that delivers vaccines to those in developing
countries.

More Action, Less Talk

Those seeking to get wider treatment access for HIV/AIDS patients in
developing countries have grown "increasingly frustrated" with the
slow response to their calls for action, the Globe reports. Kim esti-
mated that it will take "at least" two years before "wide scale" drug
distribution can occur, based on his experience with the Green Light
Committee. Kim added that in the face of six million more AIDS-
related deaths in that time span, he has been "shocked by how much
talk there is, how much political maneuvering there is, and how lit-
tle is in place in a concrete way to get [treatment] moving." How-
ever, some global health experts say that the wait is necessary be-
cause "most of Africa is not ready" to manage HIV/AIDS treatment be-
cause of "weak" health infrastructure and a lack of "scientific pro-
tocols" for drug distribution. Some point out that those in charge of
treatment and drug distribution will have to deal with the "thorny
ethical issu[e]" of "who among the vast sick populations receive the
drugs first."

Moving Ahead

Bloom and his supporters argue that there is "no choice but to move
ahead" with treatment initiatives, despite an "imperfect" delivery
system and "trial and error" methods. "This is going to be difficult.
... It may be expensive, we may not be totally satisfied with what we
need to be doing, but we will learn with time," Jose Esparza, HIV
vaccine initiative coordinator for WHO and UNAIDS, said. Eric Cheval-
lier, special adviser to Kouchner, said last week that Bloom's plan
was "good as long as it goes together with the strengthening of
health capacities." Kouchner recently got the European Union and the
governments of France, Spain, Italy, Portugal and Luxembourg to agree
to the establishment of "hospital partnerships" with health centers
in Africa. The partnerships, which are expected to be operational by
the end of the year, can be "connect[ed]" to the drugstore proposal
to increase treatment access, Chevallier said. Paul DeLay, head of
the HIV/AIDS division at USAID, said that the creation of a drugstore
committee raises the "large concern" that the bureaucracy could "re-
strict access," resulting in "fewer" people being treated. However,
Kim called for the inclusion of HIV-positive people on the committee
in order to assure a "sense of urgency" among its members. "The ten-
dency of public health officials and doctors is to slow everything
down. But in this case, we need to speed everything up," he added.
Kim and others will testify about drug access in a congressional
hearing on Friday (Donnelly, Boston Globe, 7/17).


Global Challenges

Kenyan Family Features Red Ribbons on Death Announcement, Testing Na-
tional AIDS Taboo

A Kenyan family yesterday decorated a relative's death announcement
with two red ribbons to reveal that he had died of AIDS-related
causes, testing a national "taboo" and marking the first time a Ken-
yan newspaper obituary featured the ribbons, Reuters/Boston Globe re-
ports. Margaret Muigai, the sister of the late Paul Omukuba, said the
family included the ribbons in an effort to combat the stigma of AIDS
in Kenya. "We wanted to make a statement, to tell the public, not
just in Kenya, but in the world. We have to come out and fight AIDS.
I don't want anybody to suffer the way we did," she explained. In an
"extremely rare sight at Kenyan funerals," many mourners at the fu-
neral wore red ribbons on their clothing to "remind people to avoid
behavior" that could place them at risk for the disease (Green,
Reuters/Boston Globe, 7/18).

Opinion

Kaiser Daily HIV/AIDS Report Rounds Up Reaction to Kenyan President's
Suggestion That Country Abstain From Sex for Two Years

Kenyan President Daniel Arap Moi's suggestion that Kenyans abstain
from sex for two years to slow the spread of HIV/AIDS has garnered
worldwide press attention. Outlined below is a sampling of some of
the opinions:

*Kampala New Vision: Arap Moi's "radical suggestion" that Kenyans re-
main celibate for two years is "idealistic and hard to implement" but
"indicates a burning desire to fight and banish [HIV/AIDS] once and
for all," a Kampala New Vision editorial states. The editorial en-
courages arap Moi to "stand firm" on his decision to import 300 mil-
lion condoms for his citizens because the religious leaders who op-
pose this plan "will soon come round to back the use of condoms when
they have buried enough relatives and fellow clergymen." The edito-
rial concludes, "The Kenyan clergy should do their work and preach to
the people to abstain from sex and leave the government to use the
more practical methods to prevent HIV transmission" (Kampala New Vi-
sion, 7/15).

*Canada Globe and Mail: Arap Moi's "off-the-cuff advice" on abstain-
ing from sex was likely "little more than wishful musing," but sug-
gestions such as these "set back efforts to reach high-risk men, who
have been particularly hostile to AIDS education as an affront to
their masculinity," a Globe and Mail editorial states. The editorial
adds that arap Moi's recommendation "is not the message these men
need to hear," stating that high-risk men need to be informed that
they "face a practical choice between condoms and AIDS, not an impos-
sible choice between abstinence and AIDS." The editorial notes that
although arap Moi's advice has "been attacked as silly and impracti-
cal," the president "still deserves much praise for most of his AIDS
work," particularly his decision to import condoms. The editorial
concludes, "If Mr. Moi is sincere in this battle, and he surely is,
he must resist comments aimed only at appeasing Kenya's conservative
religious groups" (Globe and Mail, 7/16).

*Scottish Daily Record: Arap Moi's suggestion that Kenyans abstain
from sex for two years "takes the caramel wafer," columnist Bob
Shields writes in a Scottish Daily Record op-ed, adding that arap Moi
perceives his recommendation as "an alternative to footing the coun-
try's huge bill for importing condoms." Shields writes that arap
Moi's recommendation "went down with the locals like a bent 50 pence
[piece] in a Durex machine." In conclusion, Shields quotes Kenyan
citizen Felix Githingi, a computer operator, who said, "How can I do
that? Am I not a Kenyan man? There are three important things for a
Kenyan man: to drink beer, to eat the meat of the goat and to have
sex" (Shields, Scottish Daily Record, 7/14).

*Tampa Tribune: Although arap Moi's suggestion "will likely provide
jokes for talk show hosts, it does have a bright side," a Tampa Trib-
une editorial states. The editorial notes that arap Moi's plan to im-
port condoms shows that he is "looking inward for solutions" to
Kenya's HIV/AIDS epidemic and demonstrates that "the most crucial de-
mand he could make of his people is [that] they change the habits
that brought on the problem in the first place." The "good news" is
that arap Moi has become another African leader who has "shed his
veil of denial of the AIDS epidemic," the editorial states. The edi-
torial concludes, "[T]hose Kenyans who laugh at his request for a
two-year abstinence from sex should consider what he proposed last
month: the death penalty for people who knowingly infect others with
HIV/AIDS" (Tampa Tribune, 7/14).

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

Contact daily reports staff editorial
Tel: 202-672-5952
Fax: 202-672-5767
Mailto:dailyreports@kaisernetwork.org


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