AFRO-NETS> Kaiser Daily HIV/AIDS Report - Thu, 26 Jul 2001

[Cecilia Snyder <csnyder@ccmc.org>]

Kaiser Daily HIV/AIDS Report - Thu, 26 Jul 2001
-----------------------------------------------

* Sens. Clinton, Frist Introduce Bill to Expand International Fight
  Against HIV/AIDS
* West African Bone Marrow Donor Ban, Arising From HIV Concerns, Un-
  der Reconsideration


--
Sens. Clinton, Frist Introduce Bill to Expand International Fight 
Against HIV/AIDS

Sens. Bill Frist (R-Tenn.) and Hillary Rodham Clinton (D-N.Y.) on 
Tuesday proposed a bill "designed to improve coordination" among the 
Pentagon, HHS and Departments of State and Labor by authorizing $850 
million in annual congressional spending through 2006 for fighting 
HIV/AIDS, tuberculosis and malaria in developing nations, Reuters 
Health reports. The "Global Leadership in Developing an Expanded Re-
sponse Act," or GLIDER, would create a new AIDS medical corps to en-
able health care professionals to perform international AIDS work for 
up to two years overseas (Zwillich, Reuters Health, 7/25). The legis-
lation also would expand and improve care; provide assistance to AIDS 
orphans and families; support infrastructure development; establish a 
database to facilitate the coordination process; and set up a task 
force to "ensure broad level policy discussions" among cooperating 
agencies. At a press conference on Tuesday, Clinton joined Frist, HHS 
Secretary Tommy Thompson and State Department Undersecretary for 
Global Affairs Paula Dobriansky to introduce the bill, saying of the 
measure, "[T]here can be no alternative: the United States must con-
tinue to play a leading role in eradicating this global threat to 
health and security around the world. By improving hospice, pallia-
tive, and treatment services, we can help bring relief to the mil-
lions of people worldwide suffering from HIV/AIDS, tuberculosis and 
malaria" (Clinton release, 7/24). 

Real-Life Examples

To show an example of ongoing cooperation among U.S. organizations 
and African nations, Clinton highlighted the work of the New York-
based Foundation for Hospices in Sub-Saharan Africa, saying that the 
group "set[s] an example" of the collaboration that the legislation 
encourages. The foundation -- which provides African hospices with 
vitamins, medical supplies and technical assistance -- works with de-
veloping nations in a way similar to the envisaged Health Care Corps, 
which would be modeled after the Peace Corps to recruit medical and 
social workers to work in a developing nation for one month to two 
years (Libbon, Syracuse Newspapers, 7/25). Thompson mentioned the 
possible creation of a "volunteer medical corps in Africa" at a Re-
publican breakfast meeting in June, but HHS spokesperson William 
Pierce said at the time that "[t]here are no specific or explicit de-
tails" (Kaiser Daily HIV/AIDS Report, 7/10). At the Tuesday press 
conference, Thompson said, "Governments can devote hundreds of mil-
lions of dollars, create countless programs and set policy, but it is 
the commitment of individuals who will truly make a difference in 
this struggle" (Clinton release, 7/24)

--
West African Bone Marrow Donor Ban, Arising From HIV Concerns, Under 
Reconsideration

The United States' two largest bone marrow registries are reconsider-
ing a five-year-old ban -- implemented due to concerns about possible 
HIV transmission -- that precludes certain people who have lived in 
eight West African countries from donating their marrow. The shift 
comes after lobbying by a relative of a Nigerian born-man with leuke-
mia living in Maryland who was unable to find a suitable donor be-
cause of the restriction, the Washington Post reports. Samuel Nwagbo, 
a 50-year old taxi driver who immigrated to Lanham, Md., outside of 
Washington, D.C., from Nigeria, had gone through five unsuccessful 
series of chemotherapy treatments and was in need of a bone marrow 
transplant. After a search for a suitable donor "among his relatives 
and the donor volunteer registries" failed, friends of his "tried to 
mount a donor drive" among the large Nigerian population that has 
settled in the region. But they "ran into" the registry ban, which 
prevents all people who have lived in the Western African countries 
of Nigeria, Cameroon, the Central African Republic, Chad, Congo, 
Equatorial Guinea, Gabon or Niger after 1977 from serving as donors. 
The ban, which followed a similar 1996 FDA recommendation for the na-
tion's blood banks, was implemented because a strain of HIV known as 
HIV-1 Group O, which is different from the prevalent U.S. strain, is 
found in these countries, and the "only way to determine" whether do-
nors who lived in these nations are "free of [this] strain ... is to 
use a test, called Western blot, that is too time-consuming and la-
bor-intensive to be used in mass blood screenings," the Post reports.

Dialing Through Bureaucracy

Believing the ban unnecessary, Nwagbo's distant cousin, Joseph 
Nnadike, who is also a physician, set out to convince donor officials 
to lift the restriction, "reason[ing]" that the Western blot test was 
an effective and practical tool for screening bone marrow donors. The 
Post reports that while the West African ban may make sense for blood 
donors, bone marrow donors "must undergo much more detailed screening 
before their tissue can be transferred to another person," thereby 
making the Western blot test "appropriate" in these circumstances. 
Nnadike "dialed his way through the donor system bureaucracy" and got 
Dennis Confer, chief medical officer for the National Marrow Donor 
Program, the nation's largest registry, to listen. Confer, who noted 
that Nnadike was the first person to "complain" about the rule, 
"agreed to waive the ban in Nwagbo's case," and is now considering 
whether to end it, a policy change also being weighed by the Caitlin 
Raymond International Registry, the nation's second-largest donor 
registry. Discussing the 1996 decision, Confer said, "We frequently 
follow the same rules that are set for blood donors. And we adopted 
the (West African ban) without realizing that it really had an impact 
on a particular ethnic group." The Post reports that the removal of 
the ban "could be a major boon to immigrants" from the West African 
countries because "patients have a dramatically higher chance of 
finding a matching donor within the same ethnic group" -- "at least" 
a 50% success rate for those who go through the National Marrow Donor 
Program. Even though Confer agreed to waive the ban for Nwagbo, the 
decision came too late for him to "wait for the results of the donor 
drive," and he was forced to undergo a "risky transplant" from one of 
his sons, giving him only a 5% chance of success as opposed to a 20% 
to 30% chance from a "better match." Nnadike said, "There's no words 
to describe the necessity" of lifting the ban. "It will save many, 
many lives" (Aizenman, Washington Post, 7/26)

--
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. ¸ 2001 by National Journal Group Inc. and Kaiser 
Family Foundation. All rights reserved.


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