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AFRO-NETS> Kaiser Daily HIV/AIDS Report - Wed, 9 May 2001

Kaiser Daily HIV/AIDS Report - Wed, 9 May 2001

* Powell Announces Trip to Africa to 'Highlight U.S. Concern' over
* NIAID Announces Plan to Combat 'Deadly Troika' of HIV, Malaria, TB
* Botswana Goes from 'Hopeless to Hopeful' with Arrival of Free AIDS
* New York Times' Coverage of HIV/AIDS Issues Draws Response from
* Social Stigmas in Arab Countries Interfere with HIV/AIDS Education,
* Cipla Announces Plan to Manufacture Three-In-One AIDS Pill

Powell Announces Trip to Africa to 'Highlight U.S. Concern' over 

U.S. Secretary of State Colin Powell will travel to Uganda, Mali, 
Kenya and South Africa this month to "highlight U.S. concern over the 
devastating spread of AIDS," State Department officials said Monday. 
Powell has "spoken frequently" about HIV/AIDS, calling the epidemic 
"an economic crisis, a health crisis, a security crisis" in Senate 
testimony in March. President Bush's $23.1 billion budget request for 
foreign affairs includes an approximately 10% increase over last 
year's $300 million allocation to fight global AIDS (Strobel, Free 
Press Washington, 5/8).

NIAID Announces Plan to Combat 'Deadly Troika' of HIV, Malaria, TB

In a meeting Monday with international infectious disease special-
ists, Dr. Anthony Fauci, director of NIH's National Institute of Al-
lergy and Infectious Diseases, announced the agency's new "global 
plan" to combat HIV/AIDS, malaria and tuberculosis in developing 
countries. The "NIAID Global Health Research Plan for HIV/AIDS, Ma-
laria and Tuberculosis" outlines "short-, mid- and long-term objec-
tives" in the fight against this "deadly troika," according to an NIH 
release. The plan concentrates on four "key" research areas: vaccine 
and prevention studies, drug development, diagnostic improvement and 
"enhancements" to research capabilities. Vaccine research and devel-
opment remains the plan's "top priority." The NIAID plan also in-
cludes "multiple goals" for improving and expanding research facili-
ties in developing areas and training local doctors and researchers 
to "better provide for the needs of their communities" (NIH release, 
5/7). The document is a "living plan" that can expand to include 
other diseases as developments occur (Manning, USA Today, 5/8).

What Can Be Done?

The three diseases annually account for more than 5 million deaths 
and "greatly affect" the health of nearly half a billion more people 
every year, Fauci said. But currently there are no vaccines for HIV 
or malaria, and the TB vaccine does not prevent adult lung disease, 
which develops in nearly eight million people a year. Research insti-
tutes like NIAID "must develop comprehensive plans that bring inter-
national scientists together to launch a multi-pronged attack" on the 
diseases, Fauci added. New drugs are also needed to treat the dis-
eases, especially in light of the development of new "drug-resistant 
microbe strains" and the "toxic" side effects of some of the current 
drugs. Better diagnostic tools will allow for "more rapid and accu-
rate" identification of the diseases, enabling doctors to "administer 
effective treatment more quickly" (NIH release, 5/7). Fauci cited as 
a model a malaria research center in Mali, where "the local community 
is intensively involved in decision-making, the infrastructure is de-
veloped and we're training a new generation of scientists who will 
give it sustainability." Fauci also said that "multidisciplinary re-
search programs" are needed as part of the "scientific basis for a 
global health research plan in the 21st century," especially now that 
"global health has ... integrated itself into this nation's foreign 
policy." On Monday, NIAID officially opened its Malaria Vaccine De-
velopment Unit, dedicated to finding an "effective vaccine within the 
next five to 10 years (USA Today, 5/8). To view the plan, click here. 
To read the World Health Organization's G8 summit background fact 
sheet on the three diseases, click here.        

Botswana Goes from 'Hopeless to Hopeful' with Arrival of Free AIDS 

In the coming months, the Botswana government will provide "most" of 
the country's HIV-positive population with antiretroviral drugs 
through public hospitals and with monetary help from Debswana, a dia-
mond mining joint venture between the government and mining giant De 
Beers, the New York Times reports. The government, which is planning 
to distribute the medications through public hospitals in the na-
tion's two largest cities, Gaborone and Francistown, expects to pay 
$600 per person for one year of anti-AIDS drugs, in a nation where 
36% of adults are HIV-positive. Botswanan President Festus Mogae in 
his national address this year spent almost half of his time speaking 
about AIDS and has "personally led the crusade to save his people 
from what he describes as the 'threat of annihilation,'" the Times 
reports. The "diamond-rich" country is currently "upgrading its 
health care system, poring through the medical literature and moving 
forward in an effort to save its most precious industry and its peo-
ple." The news of access to free medications has "sent hopes soaring" 
among Botswanans, and HIV testing has risen by 30% as people learned 
that "a positive result means likely treatment, not certain death." 
Dr. David Marumo, who estimates that 80% of his patients are HIV-
positive, said, "We used to say there is nothing we can do, but we 
are going from hopeless to hopeful. If you are HIV-positive now, it 
doesn't mean you are dying. ... Most people now are planning."

Hope Sparkles in the Mining Sector

Debswana, which has pledged to cover 90% of the cost of treatment for 
its HIV-positive employees, has allocated $5 million for medications 
this fiscal year. The company discovered in 1999 that more than one-
third of its workers between the ages of 24 and 40 were living with 
the virus after workers agreed to be tested. In addition, the number 
of sick days taken by workers "surged" to 9,384 in 1999 from 2,032 in 
1995 and the number of AIDS-related employee deaths tripled in that 
time. Under the Debswana plan, workers must be tested and examined by 
a company-selected physician prior to beginning treatment. The 
spouses of employees are also covered, although the policy restrict-
ing coverage to only one spouse in a society where polygamy is ac-
ceptable has generated controversy, as has Debswana's refusal to 
cover the children of workers at this time. The offer has created 
concern among company officials that more employees, who "no longer 
fear dying from AIDS," will stop using condoms and engage in risky 
sexual behavior again. Doctors also worry that patients will be un-
able to comply with the complicated regimen of pills and will spread 
drug-resistant strains of HIV. And some employees worry that the Deb-
swana plan will publicize their disease in a society that "shun[s]" 
those suspected to be HIV-positive. But Debswana officials say that 
in time the disease will lose its stigma and more workers will seek 
testing (Swarns, New York Times, 5/8).

New York Times' Coverage of HIV/AIDS Issues Draws Response from Field

Sunday's New York Times published a number of letters to the editor 
from people in the HIV/AIDS field, responding to the paper's coverage 
of recent news in that area. The following is a summary of the com-

* Responding to an April 29 Times article on the funding needed to 
finance anti-AIDS programs in sub-Saharan Africa, Global AIDS Alli-
ance Co-Directors Paul Zeitz and Chatinkha Nkhoma criticize a state-
ment by a U.S. treasury official who was quoted as saying that Afri-
cans "lack a requisite 'concept of time' necessary for adhering to 
complex drug regimens." Zeitz and Nkhoma write, "This reflects a rac-
ist stereotyping that has no place in American policy," but add that 
"more serious" is the statement's implication that the United States 
"might respond to the challenges of combating AIDS by limiting fi-
nancing" for anti-AIDS programs in developing nations. Zeitz and 
Nkhoma conclude, "The health infrastructure in Africa does need sig-
nificant improvements, but this is all the more reason for the United 
States to contribute the billions of dollars necessary to combat HIV 
and AIDS" (Zeitz/Nkhoma, New York Times, 5/6).

* In response to a Times article on the efficacy of different anti-
HIV efforts, Lucille Atkin, director of the Margaret Sanger Center 
International, the international arm of the Planned Parenthood Fed-
eration of America, writes that preventive approaches should combine 
parenting and peer education that address sexuality and gender equal-
ity. She also advocates "widespread access to condoms," which allow 
people to "lead healthy and fulfilling lives." Atkin concludes that 
funding for anti-AIDS efforts "should be used to support creative 
initiatives that bring together secular and religious groups and non-
government and government agencies in partnerships that are rooted in 
local communities and cultures" (Atkin, New York Times, 5/6).

* Ronald Brinn, a non-government representative at the United Na-
tions, writes in response to an April 29 Times article, "As we draw 
closer to a coordinated and coherent plan for global AIDS relief, we 
are still denying the global crime and corruption that are driving 
and sustaining the world's disease pandemics" -- drugs and prostitu-
tion. Brinn notes that the drug and sex trades are "key pathogenic 
factors in the AIDS crisis and an outgrowth of political failure and 
economic greed." He concludes, "Confiscation of a small percentage of 
the trillion-dollar crime and corruption assets would go a long way 
to stop the spread of AIDS and pay for the needed health, education 
and social services that lie within our grasp" (Brinn, New York 
Times, 5/6).

Social Stigmas in Arab Countries Interfere with HIV/AIDS Education, 

In Arab countries, the stigma of HIV/AIDS breeds "silence" and "igno-
rance" about the disease, AP/ reports. Much of the problem 
is rooted in Arab countries' reluctance to educate people about safe 
sex, as "strict interpretations of Islamic prohibitions against pre-
marital sex, adultery and homosexuality, coupled with stern conserva-
tive traditions means that publicly discussing sex ... is taboo." 
Egyptians continue to think of AIDS as a "foreign disease" and "re-
fuse to admit that homosexuality or prostitution exists in Egypt." On 
the other hand, some "argue" that Islamic "strictures" on sex will 
"protect Arab countries from an AIDS epidemic." According to Nasr el-
Sayed, director of Egypt's National AIDS Control Program, even some 
doctors "don't believe AIDS can strike in Egypt." But experts say 
that the disease has already reached Arab countries in numbers "far 
greater than reported," as the stigma associated with the disease in-
terferes with reporting. For example, the United Nations estimated 
that there were about 8,100 HIV cases in Egypt at the end of 1999, 10 
times as many HIV cases as governmental officials recorded. Even 
Egyptian officials "admit" that their records reflect an HIV-positive 
population "well below the real number." Like Egypt, Yemen's Health 
Ministry says that the actual number of HIV cases in the country is 
"much higher" than the 1,200 officially recorded cases, and Saudi 
Arabia does not even maintain an official estimate of HIV infections. 

Avoiding Taboos

Arab countries have been forced to navigate their HIV/AIDS education 
campaigns around these societal sexual taboos. For example, Jordan 
has distributed ads and leaflets about HIV/AIDS, but the materials 
"stop short of discussing safe sex." Egypt's National AIDS Control 
Program launched an AIDS hotline in 1996, advertising it through 
leaflets and posters on buses and in subway stations. But the organi-
zation decided against creating a "homosexual support group for fear 
of being accused of encouraging homosexuality," making it difficult 
to reach high-risk groups, Sana' Nassif, who heads an AIDS program 
for the international group CARITAS, said. Nassif also noted the dif-
ficulties Arab women face in protecting themselves from HIV, since 
the societies are traditionally male-dominated. Jihane Tawilah, WHO's 
regional adviser on STDs, added, "Its really tragic how women are un-
able to negotiate their own protection in wedlock or outside it" 
(AP/, 5/7).

Cipla Announces Plan to Manufacture Three-In-One AIDS Pill

Indian generic drug maker Cipla Ltd. plans to develop a three-in-one 
AIDS "cocktail" pill that may cause prices of antiretroviral medi-
cines to "fall even further" than they did when Cipla first announced 
it would supply generic drugs to Doctors Without Borders for $350 per 
patient per year in February, Reuters Health reports. Cipla Chair Yu-
suf Hamied told Reuters Health, "We are applying for Indian govern-
ment permissions to launch three AIDS drugs -- stavudine, nevirapine 
and lamivudine -- in one tablet. ... We will offer the new combina-
tion pill to [Doctors Without Borders], other non-government bodies 
and governments in general for them to supply free." The new pill, to 
be called Triomune-LNS, will be the first combination pill of the 
three drugs, as they are each controlled by three different pharma-
ceutical companies. GlaxoSmithKline has patented lamivudine, Boe-
hringer Ingelheim holds the patent on nevirapine and Bristol-Myers 
Squibb controls stavudine. Despite these controls, Cipla is permitted 
by Indian law to manufacture products under international patent, and 
Hamied noted, "We expect to launch the new product in India later 
this year and are in the process of applying for marketing permis-
sions in some African countries, including South Africa, in due 
course." He added that the three-in-one pill will hopefully increase 
patient compliance, as patients would only have to "take one pill 
each in the morning and night, (rather than) three of each drug twice 
a day." The combination pill will be sold in a box of 720 pills, or 
one year's dosage. GlaxoSmithKline also markets a combination pill 
called Trizivir, composed of zidovudine, lamivudine and abacavir 
(Shankar, Reuters Health, 5/8).

Cecilia Snyder

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