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AFRO-NETS> Kaiser Daily HIV/AIDS Report - Mon, 18 Jun 2001

Kaiser Daily HIV/AIDS Report - Mon, 18 Jun 2001

* Disagreements Over Language Preventing Consensus on U.N. Special
  Session on HIV/AIDS Draft Declaration
* After Dipping in Recent Years, International Funding for African
  Condom Distribution May Increase
* Mbeki Warns Youth About the Threat of AIDS on Anniversary of 1976
  Soweto Uprising
* After HIV/AIDS Warning Went Unheeded in 1990s, Peter Doyle Reempha-
  sizes Intervention in South Africa
* Newsday Examines International Efforts to Halt Global HIV/AIDS Epi-

Disagreements Over Language Preventing Consensus on U.N. Special Ses-
sion on HIV/AIDS Draft Declaration

Diplomats from more than 100 countries preparing a draft declaration 
on HIV/AIDS treatment and prevention standards for approval at the 
June 25-27 U.N. General Assembly special session are struggling to 
agree on acceptable language, the AP/Chicago Sun-Times reports. Ac-
cording to the AP/Sun-Times, diplomats have engaged in "intensely an-
gry, frustrating and emotional" meetings since May in an attempt to 
find a consensus on the 19-page draft document that is "acceptable to 
all 189 U.N. member countries" (AP/Chicago Sun-Times, 6/17). The 
document seeks to create "tough" universal standards for all coun-
tries, including: the development of national programs to increase 
the availability of HIV drugs by 2003; a 25% reduction in the number 
of 15- to 24-year-olds infected in the "most affected countries" by 
2005; a 20% reduction in the number of infants infected through ver-
tical transmission by 2005 and a 50% reduction in the number of HIV-
positive infants by 2010; and the development of national AIDS 
strategies, including financing plans, by 2010 (AP/Reuters/Toronto 
Star, 6/16).

U.S., Muslim Countries Raise Objections

Finding a consensus for the implementation of these standards, how-
ever, remains a challenge. Many Muslim nations "that view homosexual-
ity as a sin punishable by death" have objected to "men who have sex 
with men" being listed as a group vulnerable to HIV/AIDS and in need 
of protection. Egyptian diplomat Amr Rashdy, who called the phrase 
"shocking for my society," has instead proposed that homosexuality be 
called "irresponsible sexual behavior" that contributes to the spread 
of HIV. Rashdy's proposal led the Norway representative to do the 
"diplomatically unthinkable" and threaten to cut foreign aid to Egypt 
if it "continued to oppose the original phrasing." In addition, the 
United States has met opposition from European and Latin American na-
tions, as well as "most Americans," for its proposal that a "long 
list of groups targeted for protection" be replaced with the phrase 
"vulnerable individuals," including those who engage in "risky sexual 
behavior." The AP/Sun-Times reports that the United States believes 
that the current language focused on risk groups would create "po-
litical problems" and would "conflict with the U.S. Constitution, 
which recognizes the rights of individuals rather than groups." But 
many diplomats and advocates say that a "watered-down version" of the 
document will only have limited effectiveness in the battle against 
HIV/AIDS. Gregg Gonsalves of Gay Men's Health Crisis, one of many ad-
vocacy groups that will participate in the special session, said, "We 
know that prevention programs work best when they are targeted spe-
cifically to the needs of the individual communities. These are the 
people that we need to reach, and if governments cannot utter their 
names, what chances do we have of stopping the epidemic?" (AP/Chicago 
Sun-Times, 6/17). To view the "disputed language" of the draft decla-
ration, click here (Associated Press, 6/15). Please note that this 
link is available to Web readers only.

After Dipping in Recent Years, International Funding for African Con-
dom Distribution May Increase

International funding for condoms, the "cheapest preventive measure" 
against HIV, "fell sharply" over the last two years, despite an em-
phasis by "rich governments" on HIV prevention, the Boston Globe re-
ports. After peaking at $68.1 million in 1996, funding for condom 
distribution programs fell to about $40 million each year in 1999 and 
2000, mostly due to cuts from European and Japanese donors, resulting 
in shortages in many sub-Saharan countries. Christian Saunders, who 
oversees condom purchases for the U.N. Population Fund, cited "donor 
fatigue" for the decrease in funding. But John Wilson, a health lo-
gistics specialist for global health firm John Snow Inc., said "more 
nuanced" factors may be to blame, explaining, "It's very hard for do-
nors to keep up funding for things that work well. [Donors] are often 
attracted to try out new things, unproven things, things that are 
said to be innovative. What's the glory in buying billions of con-
doms?" However, a renewed emphasis on HIV prevention has "generat[ed] 
more enthusiasm" for condom distribution, the Globe reports. The 
United Nations said it plans to purchase $20 million worth of condoms 
this year, up from $8 million worth in 1999 and 2000, thanks in part 
to grants from the Dutch and British governments. And USAID, the 
"world leader in condom procurement," is aiming to improve on the 
$13.5 million it spent last year on 350 million condoms. The agency 
may seek to waive a "buy America" clause that requires it to purchase 
more expensive American-made condoms. USAID currently pays Custom 
Services International, an Alabama condom manufacturer, 6.3 cents per 
condom, but the agency could procure condoms from foreign manufactur-
ers at 2.5 cents each. American and UN officials are also considering 
a "sharp increase" in the number of female condoms they provide.

Increasing Usage

Getting people in developing countries to use condoms has also been a 
challenge. Paul Delay, head of USAID's HIV/AIDS programs, said the 
agency is utilizing a "Coca-Cola model" for condom marketing and dis-
tribution, making condoms widely available at kiosks and other small 
"outlets" throughout rural areas. Packaging also impacts usage. Kate 
Roberts, a spokesperson for Population Services International, a not-
for-profit health services group, said unmarked silver foil packages 
containing free government condoms are less popular than ones dis-
tributed at small stores with "flashy" names. She also explained how 
the condoms can be more effectively marketed, "There's Lovers Plus in 
Eastern Europe, Maximum for parts of Africa, or something that re-
lates to the local people. In Angola, the condom name is Legal, which 
is slang for 'cool,' or 'acceptable'." USAID is also set to undertake 
a multimillion-dollar project in conjunction with African mosques and 
churches, aimed at "overcoming religious obstacles to condom use." 
Delay added, "We may need to go on and have a condom summit and get a 
better estimate on needs and demand, and raise the resources" (Don-
nelly, Boston Globe, 6/18).

Mbeki Warns Youth About the Threat of AIDS on Anniversary of 1976 
Soweto Uprising

South African President Thabo Mbeki on Saturday spoke about AIDS at 
Youth Day, the annual commemoration of a June 16, 1976, "schoolchil-
dren's revolt against apartheid education" in Soweto, the Associated 
Press reports. Mbeki stated, "The youth of our country has itself a 
responsibility to look after themselves," as they are "a very valued 
resource of our country." He "urged" young South Africans to protect 
themselves from HIV, which has infected 11% of the nation's popula-
tion (Associated Press, 6/16). Youth Day commemorates a march in 
which 23 students were shot and killed as they protested the use of 
the language Afrikaans in public schools. June 16 was declared a na-
tional public holiday when the African National Congress won the 
country's first democratic election in 1994. The date "remains an im-
portant marker of black opposition to white rule," but this year's 
march was more focused upon HIV/AIDS than politics, Reuters reports 
(Thomas, Reuters, 6/16). In his remarks, Mbeki said, "As we remember 
the heroes of 1976, we must ensure that we educate the youth, but if 
they value their fallen heroes they must participate in the process 
of transformation." The African National Congress Youth League, a 
youth group supporting the mission of the ANC, cited AIDS as one of 
the biggest challenges for South African youth today. ANCYL President 
Malusi Gigaba said, "We are the first generation to live in a free 
society. We still have the challenges of building non-racialism, non-
sexism, democracy and a better life for all, but new tasks have 
emerged. Now we must fight against preventable diseases ... like 
HIV/AIDS and poverty linked to the disease" (Agence France-Presse, 

After HIV/AIDS Warning Went Unheeded in 1990s, Peter Doyle Reempha-
sizes Intervention in South Africa

In 1990, then-head actuary of Metropolitan Life Insurance Peter Doyle 
predicted "with uncanny accuracy the coming devastation" of AIDS in 
South Africa, but the Doyle Model, as his original forecast came to 
be known, was received with "disbelief, derision -- and inaction," 
the Philadelphia Inquirer reports in a feature on Doyle. The Doyle 
Model was established on the assumption that different groups are at 
different levels of risk for the virus, such as those with multiple 
partners versus single partners, and is based on the "intimate under-
standing of the sexual habits of various population groups." The 
model also projected a range of directions the AIDS epidemic could 
move in South Africa, but the "best scenario" was dependent upon con-
dom acceptance among the public, the promotion of monogamous rela-
tionships and the development of a campaign to treat STDs "aggres-
sively." The country has only recently implemented condom distribu-
tion, and "has not dared to take on taboo issues about sexual rela-
tions," according to the Inquirer. "People take a long time to inter-
nalize AIDS," Doyle said, adding that the disease is "laced with 
sexuality and racism issues." With South Africa in transition from a 
white minority government to the presidency of Nelson Mandela in the 
early 1990s, and the subsequent threat of civil war, "AIDS just never 
made it to the top of the agenda," Doyle explained. The Inquirer re-
ports that Doyle predicts that by 2010, 22.5% of the South African 
workforce will be HIV-positive. Although he conceded that his model 
"conveys an idea of inevitability," he stated, "Despite the loss of a 
window of opportunity, at any point intervention can be powerful. We 
could save 20 million lives worldwide if we act now" (Maykuth, Phila-
delphia Inquirer, 6/15).

Newsday Examines International Efforts to Halt Global HIV/AIDS Epi-

In part seven of its "AIDS at 20" series, Newsday examines the inter-
national response to HIV/AIDS, particularly in Africa. The article 
cites last summer's International AIDS Conference in Durban, South 
Africa, as a "turning point" in the international community's efforts 
to fight HIV/AIDS that created the "momentum" leading to both U.N. 
Secretary-General Kofi Annan's call for a global AIDS fund and a spe-
cial three-day session of the U.N. General Assembly on AIDS later 
this month. The article also examines the impact and controversy of 
globalization in treating the epidemic, including patent protections 
and intellectual property disputes surrounding the purchase, manufac-
ture and distribution of HIV medications (Garrett, Newsday, 6/17). 

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 
Family Foundation. All rights reserved.

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