AFRO-NETS> Kaiser Daily HIV/AIDS Report - Mon, 7 Jan 2002

[Cecilia Snyder <csnyder@ccmc.org>]

Kaiser Daily HIV/AIDS Report - Mon, 7 Jan 2002
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* U.N. Envoy for AIDS in Africa Says 2002 Could Mark 'Turning Point'
  in Africa's Battle Against Disease
* Kenyan Researchers Propose Model for Integrated Antiretroviral
  Therapy Approach in Lancet Infectious Diseases
* NPR's 'All Things Considered' Reviews South Africa's Appeal of Rul-
  ing Ordering Government to Supply Antiretrovirals to All HIV-
  Positive Pregnant Women
* 'World War' Against AIDS Needs More Money and Initiative, Nation
  Op-Ed Says


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U.N. Envoy for AIDS in Africa Says 2002 Could Mark 'Turning Point' in 
Africa's Battle Against Disease

Stephen Lewis, the United Nations special envoy for AIDS in Africa, 
said that 2002 could be "the turning point" for Africa's fight 
against the disease if wealthy nations demonstrate a financial com-
mitment to combatting the virus in the developing world, the Washing-
ton Times reports. "2002 is the year of truth in Africa; we must turn 
the tide this year," Lewis said, adding that such a turnaround is 
only possible if assistance from wealthier nations "isn't reallocated 
to counterterrorism activities." Noting that "[q]uite a remarkable 
amount of money has been found" to combat terrorism since the Sept. 
11 attacks on the World Trade Center and the Pentagon, Lewis said 
that "similar efforts should be made" to fund anti-AIDS efforts. 
Lewis said that 30 years after the Organization for Economic Coopera-
tion and Development countries set a voluntary target for development 
assistance at 0.07% of gross national product, expenditures have 
never reached the OECD goals and the average spending has fallen to 
0.02%. Calling the level of government assistance to developing na-
tions "appallingly low," he said that $110 billion to $120 billion in 
additional funding would be needed to pull current foreign aid spend-
ing up to the levels set by the OECD. But Lewis also "painted a posi-
tive picture" of the near future for the fight against HIV/AIDS by 
citing increasing worldwide awareness of the virus, broader access to 
AIDS drugs and the effectiveness of condom importation projects and 
programs to reduce vertical HIV transmission (Pisik, Washington 
Times, 1/7).


--
Kenyan Researchers Propose Model for Integrated Antiretroviral Ther-
apy Approach in Lancet Infectious Diseases

There is currently "no agreement on program infrastructure, a stan-
dardized [HIV treatment] regimen, drug procurement and distribution 
and no agreed-upon monitoring levels" in Kenya, making it difficult 
for a "common strategy and coordinated approach" against HIV/AIDS to 
be mounted, Miriam Taegtmeyer of the Liverpool School of Tropical 
Medicine and Kenneth Chebet, director of the AIDS Control Program in 
Kenya, write in the "Personal View" column of the January issue of 
the Lancet Infectious Diseases. Representatives from the Ministry of 
Health, National AIDS Control Council, the donor community, non-
governmental organizations and the private sector recently convened 
in Nairobi to discuss the "realities" of administering antiretroviral 
therapy to Kenyans. Only about 2,000 of 2.2 million HIV-positive Ken-
yans currently receive antiretroviral therapy, primarily through a 
network of private physicians and donor projects. According to the 
authors, each project varies in scope and has selected its own drug 
regimen, training module and monitoring system. "Despite good inten-
tions, the result [of the patchy network] may well be ... 'antiretro-
viral anarchy,'" they state, adding that the lack of comprehensive 
guidelines could lead to poor treatment adherence and the rise of 
drug-resistant HIV strains. At the Nairobi meeting, it was "clear 
that the private sector and the academic establishment in Kenya (who 
mostly double up as private practitioners) aim to maintain the high-
est standard" of care utilizing a physician-based treatment and moni-
toring approach, Taegtmeyer and Chebet write. However, Kenya has lim-
ited resources, with nutritional and other public health problems 
taking precedence, they state, adding that although the donor and po-
litical climate appear "committed to attempting a limited public sec-
tor approach" to antiretroviral treatment, "significant challenges" 
remain.

A Plan to Introduce Limited Treatment

Taegtmeyer and Chebet propose a three-pronged plan for a more inte-
grated introduction of antiretroviral therapy in Kenya. The first 
step is to choose a program design and a standard treatment regimen. 
The choice of program design depends upon "capacity as much as com-
mitment" and will impact drug distribution, treatment monitoring and 
supervision of the program as a whole, they write. They recommend 
following WHO guidelines for first-line treatment by introducing two 
nucleoside reverse transcriptase inhibitors and one non-nucleoside 
reverse transcriptase inhibitor and then using a "standard salvage 
regimen" for patients who do not respond. After a program and treat-
ment regimen have been agreed upon, officials must create a standard 
training program that covers dispensation and monitoring of the drugs 
and their side effects, Taegtmeyer and Chebet write. The government 
then must set up a licensing and accreditation agency for health per-
sonnel working with HIV/AIDS patients and centers distributing AIDS 
drugs. The health department has already established a standards and 
regulatory service that could be the "ideal forum for legal accredi-
tation and licensing of limited outlets" for dispensing the drugs, 
they note. "If there is the will to do so and a strong leadership 
role is taken by governments such as Kenya, then it is possible to 
overcome challenges and start to introduce antiretrovirals safely and 
effectively in parts of the world where they are most needed," the 
authors state. However, "[f]or any such program to work it needs to 
pull together the private and public sectors under a common umbrella 
and to harness the inputs of NGOs, multinationals and donor agen-
cies," they conclude (Taegtmeyer/Chebet, Lancet Infectious Diseases, 
January 2002).


--
NPR's 'All Things Considered' Reviews South Africa's Appeal of Ruling 
Ordering Government to Supply Antiretrovirals to All HIV-Positive 
Pregnant Women

Although South African President Thabo Mbeki has "never actually 
said" that HIV is not the cause of AIDS, his questioning of the link 
between HIV and AIDS has prevented health officials from speaking 
publicly in support of a national policy on providing antiretrovi-
rals, NPR's "All Things Considered" reported on Friday. Last month, 
South Africa's High Court ordered the government to provide antiret-
roviral drugs to all HIV-positive pregnant women to prevent mother-
to-child transmission of the virus. However, the Ministry of Health 
is appealing the decision in the nation's Constitutional Court, "say-
ing the judicial branch doesn't have the authority to tell the execu-
tive branch how to implement legislation." South Africa's HIV/AIDS 
treatment policy is now "caught up in a major political question ... 
[of] whether the political forces in the country will let one man 
have the power over life and death" (Wilson, "All Things Considered," 
NPR, 1/4).


--
'World War' Against AIDS Needs More Money and Initiative, Nation Op-
Ed Says

"Whether measured by numbers killed or nations wounded, by economies 
upended or families crushed, the AIDS pandemic is a deadlier global 
threat than that posed by terrorist groups," but U.S. lawmakers are 
not devoting as much money or attention to AIDS as they are to the 
"war on terrorism," Salih Booker, director of the advocacy group Af-
rica Action, writes in a Nation op-ed. Booker states that the cost of 
fighting AIDS worldwide is "modest compared with the sums quickly ap-
propriated" in response to the Sept. 11 attacks on the World Trade 
Center and the Pentagon. But "only a trickle of resources is reaching 
the AIDS battle fronts," he writes, adding that the United States can 
and should commit more funding and effort toward eradicating 
HIV/AIDS. HIV/AIDS, poverty, the debts of African nations and the 
"policies of international financial institutions" are all inter-
twined, but "these realities have not penetrated U.S. public dis-
course," Booker says. He adds that the U.S. government and interna-
tional monetary institutions have not realized that "paying for 
global public health is an obligation for those who have the means to 
pay." He writes, "Strong U.S. leadership in funding the global war 
against AIDS would turn the tide, but Washington fails to appreciate 
the link between the spread of poverty, desperation and insecurity 
and the increase in such global threats as AIDS and terrorism." 
Booker says that the Sept. 11 attacks illustrated "the common vulner-
ability that Americans share with others on the planet." The attacks 
"should serve as an impetus to a greater sense of solidarity" but 
have failed to do so, he states. "The world war against AIDS, less 
visible but more urgent than the war against terrorism, has not even 
been joined," he concludes (Booker, Nation, 1/7-1/14).

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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. © 2002 by National Journal Group Inc. and Kaiser 
Family Foundation. All rights reserved.

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