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AFRO-NETS> Kaiser Daily HIV/AIDS Report- Fri, 11 May 2001

Kaiser Daily HIV/AIDS Report- Fri, 11 May 2001

* Bush to Announce US$ 200 Million Contribution to Global AIDS Fund,
  But Money's Source Unclear
* AIDS Activists Urge Kenyan Parliament to Approve AIDS Drug Importa-
  tion Bill
* Kenyan Prostitutes' Immunity to HIV Infection May be Key to Effec-
  tive Africa-Specific Vaccine
* Canada's National Post Features Dualing Op-Eds Regarding Pros, Cons 
  of South African Drug Trial Settlement
* AIDS Compromising Africa's Social, Educational, Political Future

Bush to Announce US$ 200 Million Contribution to Global AIDS Fund, 
But Money's Source Unclear

President Bush, appearing alongside U.N. Secretary-General Kofi Annan 
and Nigerian President Olesegun Obasanjo, is expected today to an-
nounce a $200 million U.S. contribution to the global AIDS fund first 
proposed last month by Annan, the Washington Post reports. At last 
month's African AIDS summit in Abuja, Nigeria, Annan called for the 
establishment of a $7 billion to $10 billion annual trust fund dedi-
cated to fighting HIV/AIDS in the developing world. The expected an-
nouncement today will mark the first pledge from any nation to the 
fund, yet it "remained unclear" where the funds would come from, when 
the money will be made available and what, if any, conditions will be 
placed on its use, the Post says. U.S. officials reviewing a draft 
plan for the fund, to be released at a special meeting of the U.N. 
General Assembly next month, have voiced "deep disagreements" with 
some of the plan's proposals. Among the issues are whether to pur-
chase AIDS medications for Africa or to put "more emphasis" on pre-
vention programs. Administration officials have requested that men-
tions of sexual abstinence as a means to prevent the disease and 
clauses calling for the "protection" of drug companies' patent rights 
be added. Bush is also expected today to issue a "call for an inter-
national public-private partnership," whereby governments along with 
private foundations and corporations will contribute to the fund. 

Funding Sources Questioned

The US$ 200 million proposed by Bush "mirrors" the amount added to 
the "nonbinding" congressional budget resolution this week as part of 
an amendment proposed by Sen. Bill Frist (R-Tenn.), a former surgeon 
and chair of the Senate Foreign Relations subcommittee on Africa 
(DeYoung, Washington Post, 5/11). However, that allotment was 
"[d]ropped" from the final version of the FY 2002 budget resolution 
approved by a 53-47 vote yesterday in the Senate (Reuters Health, 
5/10). Secretary of State Colin Powell, speaking yesterday before a 
House panel on foreign operations funding, said the government will 
"use funds that we believe are available from other accounts, not 
taking away from any of the HIV funding we are doing now, to make a 
significant new contribution to this new proposal of a trust fund, 
and do it in a way that will encourage many other nations to join us 
and many other organizations and private citizens and nongovernmental 
organizations and kids dropping nickels and dimes in many boxes" 
(Lake, United Press International/, 5/10). Some worried that 
the money may be "carved out" of development assistance funds, a 
prospect that David Beckmann of Bread for the World called "unaccept-
able." Mark Malloch Brown, administrator of the U.N. Development Pro-
gram, added that it is "absolutely critical that this [comes from] 
additional resources, not extracted from elsewhere in the U.S. devel-
opment assistance budget" (Washington Post, 5/11). Rep. Nita Lowey 
(D-N.Y.), speaking at the hearing, said that although the "interna-
tional community," including the World Bank and the United Nations, 
"seem ready to commit" to a global fund, she "want[ed] to stress that 
[U.S.] bilateral programs run by [USAID] have been most effective in 
battling" the HIV/AIDS epidemic abroad (United Press Interna-
tional/, 5/10).

A 'Criminally Small' Amount, Some Say

When news of the impending announcement broke, AIDS advocates and 
NGOs began criticizing the amount of money earmarked for the fund. 
"It's criminally small. The United States has got ample money for 
this and the money has just got to be found -- something along the 
lines of $2.5 billion," David Bryden of the Global AIDS Alliance said 
(Jelinek, AP/Orlando Sentinel, 5/11). The GAA estimates that a U.S. 
contribution "proportionate" to U.S. economic strength would be $3 
billion, making Bush's proposed contribution only 6% of what the GAA 
says a "fair" government donation should be (Global AIDS Alliance re-
lease, 5/10). Sen. Patrick Leahy (D-Vt.) added that the amount "falls 
far short of what the wealthiest nation in the world should be con-
tributing" (Wall Street Journal, 5/11). The Health GAP Coalition 
called the amount "less than a drop in the bucket," adding that it 
equaled less than 1% of the administration's proposed $1.35 trillion 
tax cut.

Obasanjo and Bush to Discuss AIDS, Economics

Today's announcement was scheduled to coincide with Obasanjo's visit 
to Washington, marking the first visit by an African head of state to 
the Bush White House (Washington Post, 5/11). The Nigerian president 
arrived in Washington yesterday and met with Pentagon officials and 
lawmakers on Capitol Hill (AP/Orlando Sentinel, 5/11). Obasanjo and 
Bush will meet today in the Oval Office, after the Rose Garden cere-
mony announcing the trust fund money, to discuss the HIV/AIDS epi-
demic and economic development issues. Observers say that the visit 
demonstrates that the Bush administration will not "dismantle the in-
stitutional prominence" given to Africa by the Clinton administra-
tion. However, they predict that the current administration will fo-
cus on "big problems" like AIDS, debt relief and "stabilizing" Nige-
ria and South Africa, the continent's "two fledgling democracies," a 
move Timothy Bork of the Carnegie Endowment for International Peace's 
Africa Initiative called "wise." Experts add that the "person most 
responsible" for the administration's African focus is Powell, who 
met with Obasanjo yesterday, following a State Department announce-
ment that Powell will take his first official trip to Africa later 
this month. He will visit Mali, South Africa, Kenya and Uganda, plac-
ing a emphasis on the "devastation from AIDS suffered throughout Af-
rica." Powell had planned to attend the Abuja summit last month but, 
according to USA Today, withdrew because of "anger" from some admini-
stration officials that former President Clinton was to give the sum-
mit's keynote address (Nichols, USA Today, 5/11).       

AIDS Activists Urge Kenyan Parliament to Approve AIDS Drug Importa-
tion Bill

An international group of AIDS activists from the medical industry 
and nongovernmental organizations yesterday initiated a campaign to 
"pressure" Kenyan parliament members to approve a bill that would al-
low the country to import and manufacture cheaper AIDS drugs, the 
AP/Los Angeles Times reports (Simmons, AP/Los Angeles Times, 5/11). 
At a press conference yesterday in Nairobi, the Kenya Coalition for 
Access to Essential Medicines, a conglomerate of Kenyan and interna-
tional organizations, urged members of parliament to "ensure that 
public health takes precedence over private financial interests and 
that essential medicines are affordable." The group also "warned" 
that unless Kenya is "allowed to make full use of" parallel importing 
and compulsory licensing, millions are at risk of death from HIV/AIDS 
(Doctors Without Borders release, 5/10). The bill would adhere to the 
World Trade Organization's Trade-Related Intellectual Property Rights 
Agreement, which allows parallel importing and compulsory licensing 
if countries declare a health emergency. With an estimated 2.5 mil-
lion HIV-positive citizens and 500 AIDS-related deaths per day, Kenya 
"faces an AIDS emergency," according to Samantha Bolton, a Nairobi-
based spokeswoman for Doctors Without Borders (Los Angeles Times, 

Pharmaceutical Industry Backs Off

In the wake of the abandonment of the South African lawsuit brought 
by 39 pharmaceutical companies that caused a years-long delay on the 
implementation of a similar South African law, AIDS advocates "ex-
pressed concern" that the pharmaceutical industry "might try to im-
properly influence lawmakers to kill or amend the bill." However, 
Newton Kulundu, chair of the parliament's Health Committee, "dis-
missed claims that legislators could be manipulated." GlaxoSmith-
Kline, one of the companies involved in the South African lawsuit, 
said the company accepts Kenya's proposal but is "concerned about 
procedures for implementing it," GSK Commercial Director William 
Kiari said (Los Angeles Times, 5/11). According to industry sources 
in Kenya, representatives from GSK and Pfizer Laboratories had 
planned to meet with Kenyan MPs, but cancelled the meeting "at the 
last minute" following "adverse publicity" over the meeting. A Pfizer 
manager said, "There were a lot of obstacles put against the meeting 
because a misconception that we were lobbying for the dropping of the 
new ... [b]ill [made] the rounds and the whole thing had been inap-
propriately politicized." But the source "strenuously denied" allega-
tions that the meeting was convened to pressure MPs to exclude provi-
sions that would allow for parallel importing and compulsory licens-
ing, saying that Pfizer accepts the bill (Morland, Agence France-
Presse, 5/10). The parliament plans to vote on the bill upon return 
from its May recess (Los Angeles Times, 5/11).

Kenyan Prostitutes' Immunity to HIV Infection May be Key to Effective 
Africa-Specific Vaccine

Researchers who have documented and studied HIV immunity in more than 
100 Nairobi prostitutes have "concocted the first experimental vac-
cine expressly intended for Africa," and the initial phases of clini-
cal trials in Kenya show promise, the Washington Post reports. The 
vaccine prompts the same immunologic response observed "so strik-
ingly" in the immune sex workers: elevated levels of cytotoxic T-
lymphocyte cells, or the "killer T-cells" that most effectively fight 
HIV. The "operating theory" of the prostitutes' immunity is that it 
is "built up like a callus" over time. T-cell production in the blood 
increased with their first exposure to HIV, and the next encounter 
provoked even more T-cells, boosting immunity until the women proved 
essentially "uninfectable." Researchers noted that when several women 
left prostitution and then returned to it later, they ended up con-
tracting the virus, an observation that reinforced the theory that 
continuous exposure kept their T-cell levels high. Frank Plummer, 
scientific director of Canada's National Microbiology Laboratory and 
the first recorder of the immunity among Nairobi sex workers, 
stressed the need for a vaccine to come out of this observed immu-
nity, saying, "I'm all for [AIDS] treatment, but focusing on treat-
ment as the solution is not going to solve this" disease. Oxford Uni-
versity researcher Andrew McMichael and his team began developing a 
vaccine that appears to boost the production of T-cells in the same 
way that HIV would boost cell production in the prostitutes, and 
studies of blood taken from the 18 Kenyans who received the vaccine 
show "an 80 to 90% indication that it actually presents an immune re-
sponse." But McMichael pointed out that while the vaccine will make 
it more difficult to become infected, it will not provide "absolute 
insurance against the virus" (Vick, Washington Post, 5/11).     

Canada's National Post Features Dualing Op-Eds Regarding Pros, Cons 
of South African Drug Trial Settlement

Robert Goldberg's Wall Street Journal editorial "Fight AIDS in Africa 
With Reason, Not Rhetoric," is an "ill-informed opinion piece" that 
misses several important pieces of information, Dr. Anne-Valerie Kan-
inda, a medical adviser with Doctors Without Borders' Access to Es-
sential Medicines Campaign, writes in an op-ed in Canada's National 
Post. While Goldberg, a senior fellow at the National Center for Pol-
icy Analysis, called the recent abandonment of the lawsuit filed by 
39 drug giants against South Africa a "tragedy" because it will in-
hibit further research and development of AIDS drugs. However, Kan-
inda asks, "But for whom exactly is it a tragedy? Certainly not the 
4.7 million HIV-positive South Africans currently facing almost cer-
tain death because they cannot afford the antiretroviral medicines 
that have turned HIV/AIDS into a manageable illness in the United 
States and Europe." She calls the case a "victory for the nearly 30 
million other people in the developing world living with HIV. Armed 
with a newfound understanding of international trade law and boosted 
by the groundswell of international public support that the South Af-
rican case has generated, AIDS activists can now demand that their 
own governments do everything possible to make treatment available." 
Kaninda says that Goldberg "overlooks the fact that research and de-
velopment for many antiretrovirals was largely financed by the public 
sector. This, together with the reality that Africa represents little 
more than 1% of the worldwide drug market, ensures that companies can 
prosper and continue research and development into new AIDS drugs and 
vaccines even if drug prices are lower in poor countries." Kaninda 
concludes, "It is time to stop using lack of infrastructure, threats 
to drug company profits, and the cost-effectiveness of prevention 
alone as excuses for allowing thousands of people to die each day of 
a treatable disease. The message from South Africa is loud and clear: 
People with AIDS will no longer wait in silence to die" (Kaninda, Na-
tional Post, 5/10).

Goldberg Responds

In an accompanying op-ed, Goldberg writes that Kaninda "unfortunately 
[provides] more evidence in support of my original point: For many 
AIDS activists ... the real virus isn't HIV, it's capitalism and the 
profits which support research and development of the next generation 
of AIDS drugs and -- one hopes -- a vaccine against the disease." 
Goldberg writes that Kaninda's statement that "the end of the court 
case removes the barriers preventing the South African government 
from securing cheaper AIDS drugs" is "untrue." Bristol-Myers Squibb 
"never had a patent" on AIDS drugs in South Africa, he says, nor has 
Merck had a patent on the antiretroviral drug Crixivan there. Gold-
berg also disputes Kaninda's statement that the public sector fi-
nanced most of the research and development for many anti-AIDS drugs, 
pointing out that a private firm did the clinical trial work to de-
termine the efficacy and safety of AZT in humans, and private compa-
nies like Merck and Abbott discovered and developed "the current gen-
eration of nucleoside drugs." He continues, "None of these break-
throughs would be possible under the shaky sort of patent protection 
Dr. Kaninda envisions," adding, "even if all the HIV drugs needed to 
treat every person with AIDS in Africa were available for free, it 
would be difficult and even dangerous to administer them." Goldberg 
concludes, "If people in Africa continue to die in silence, it will 
not be due to the price of HIV drugs. It will be due, in part, to 
policies such as those Dr. Kaninda pushes that make it unprofitable 
and harder to develop and distribute a vaccine that can control or 
prevent the eruption of AIDS once and for all" (Goldberg, National 
Post, 5/10).

AIDS Compromising Africa's Social, Educational, Political Future

HIV/AIDS will continue to affect the economic, social and political 
structure of Africa unless the developed nations of the world, along 
with African governments, allocate more funding toward fighting the 
epidemic, Chinua Akukwe and Melvin Foote of the Constituency for Af-
rica write in a Foreign Policy in Focus brief. Foote, who serves as 
president and CEO of CFA, and Akukwe, a CFA board member, write that 
at least 10% of the population in 16 African countries have HIV, and 
in these countries almost 80% of all deaths among individuals ages 25 
to 45 will be "directly linked to AIDS." The virus is also taking its 
toll on the continent's health care system -- by 2005, it is esti-
mated that between 8% and 25% of doctors on the continent will die 
from AIDS-related infections. Thus, the construction and sale of cof-
fins is one of the fastest growing industries in southern Africa. 
One-fourth of women in southern Africa have HIV, and in some coun-
tries, between 10% and 20% of teen girls have the virus. The spread 
of the virus among young women may "revers[e] decades of slow but 
steady progress in female education," since HIV-positive girls are 
"more likely than boys to drop out of school." African military 
troops are also affected by the disease -- in some countries, 15% to 
20% of those in the military are infected with the virus. Travel by 
military troops, along with other mobility through migrant labor and 
shifts from rural to urban centers, "exacerbates" the spread of HIV. 
The article notes that although African social services and economies 
are "imploding from the deadly consequences" of HIV/AIDS, "political 
instability and violent conflicts keep many African governments from 
focusing on the AIDS crisis." However, this instability "will likely 
intensify as AIDS gobbles up scarce human and economic resources," 
the article states.

Stepping Up AIDS Funding

Akukwe and Foote write that the United States must step up its fund-
ing directed at fighting the epidemic and must also urge debt relief 
initiatives for developing nations affected by HIV/AIDS. They write, 
"The immediate goal of a reinvigorated U.S. policy should be the dis-
mantling of all legal and logistic obstacles to the provision of af-
fordable drugs to all Africans living with AIDS," adding that the 
U.S. government should "work closely" with drug firms to "ensure that 
all obstacles to speedy and effective delivery of AIDS medicines to 
poor nations are eliminated." They urge the United States to adopt 
the pledge: "No African Man, Woman, Child or Infant Should Be Denied 
Access to Lifesaving AIDS Drugs by December 2002." However, African 
nations must do their part, they write, adding that "even today, very 
few African nations match their AIDS rhetoric with commensurate 
budget allocations," although Uganda and Senegal are "prominent ex-
ceptions." Akukwe and Foote criticize the "corruption and the squan-
dering of scarce national resources" currently occurring in some Af-
rican countries, stating, "Government spending on wars, white ele-
phant projects and persecution of political and economic opponents is 
still rife across the continent." The United States and African gov-
ernments need to work together, they write, to ensure that the lead-
ers of developing nations allocate more funding toward anti-AIDS ef-
forts and engage in "pluralistic political and multisector campaigns 
against AIDS." In addition, efforts must be made to "end corrupt 
practices that siphon foreign aid and investments," and promotion of 
community-based health programs is also needed. Akukwe and Foote con-
clude, "A strong case can be made that the AIDS pandemic in Africa 
represents a direct threat to U.S. national interests and national 
security because of associated political instability, economic down-
turn and the intercontinental spread of infectious diseases. In the 
end, however, U.S. citizens and U.S. policymakers face a moral im-
perative and should ask: Have we done all we can to save 25 million 
fellow human beings from an avoidable death?" (Akukwe/Foote, Foreign 
Policy in Focus, May 2001).

The Kaiser Daily HIV/AIDS Report is published for, 
a free service of The Henry J. Kaiser Family Foundation, by National 
Journal Group Inc. c 2001 by National Journal Group Inc. and Kaiser 
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