As the world marked the 20th AIDS Day on December 1st, President G W Bush reiterated his government’s commitment to fight HIV/AIDS globally. His statement was followed by President-Elect, Barack Obama, who informed of a national strategy to fight HIV/AIDS.

Barack Obama said “Today is World AIDS Day, a day we reaffirm our commitment to fight HIV/AIDS at home and abroad.” Obama praised Bush for his endeavors and promised to continue this ‘critical work’.

President G W Bush said the target of treating two million people that he had set had been reached several months early. “It’s the largest international health initiative dedicated to a single disease.. (the program) is bringing hope and healing to people around the world.”

Over two million people living with HIV/AIDS, mainly in sub-Saharan Africa, have been aided with antiretroviral treatments since the end of September, thanks to the US initiative. The program targets people in:

- Botswana
- Ethiopia
- Guyana
- Haiti
- Ivory Coast
- Kenya
- Mozambique
- Namibia
- Nigeria
- Rwanda
- South Africa
- Tanzania
- Uganda
- Vietnam
- Zambia

The Saddleback Civil Forum was attended by G W Bush, the First Lady Laura Bush and hosted by Pastor Rick Warren. Barack Obama, who was at Chicago at the time, sent a video-message.

– Click here to read the Full Transcript of the G W Bush conversation with Pastor Warren.

– Click here to see the 20-Minute Video Of Barack Obama Commemorating the 20th Annual World AIDS Day

Below are some quotes from G W Bush and B Obama

“Too many people are unaware that while HIV/AIDS is incurable, it is 100 percent preventable. And far too many people have become infected because they lack basic information about how this disease is spread. I intend to confront the stigma surrounding HIV/AIDS – a stigma which is too often tied to racism, sexism and homophobia. That is what Michelle and I tried to do by taking a public HIV test in Kenya a few years ago. We must engage in honest, open dialogue and reach out to those most at risk. My administration will educate people about HIV/AIDS, ensure people living with HIV/AIDS have access to treatment, and work with Congress to enact an extensive program of prevention, including access to comprehensive age-appropriate sex education for all school age children. We will also keep faith with the millions of people living with HIV/AIDS around the world by continuing to support the work of the Global AIDS Fund and maintaining our strong leadership through the President’s Emergency Plan For AIDS Relief.”
Barack Obama

“I insisted upon measurable goals because I felt that lives needed to be saved. And if you don’t have measurable goals, lives might not be saved. This is — we live in a process world in government. Oftentimes people said, well, what are the inputs? This is an administration that tried to get people to ask the question, are we actually doing something? And so we set a goal of saving 50,000 — well, when we got started there were 50,000 people getting antiretrovirals in all sub-Sahara Africa. And we set a goal of 2 million by five years to get antiretrovirals.”
George W Bush

Some experts and doctors recently have voiced concerns that people who were diagnosed with HIV/AIDS in the early years of the epidemic are experiencing “prematur[e]” or “disproportionate numbers” of ailments associated with aging, the New York Times reports. CDC estimates show that the number of people ages 50 and older living with HIV increased by 77% between 2001 and 2005 and that this population now represents more than 25% of all HIV/AIDS cases in the U.S. The “graying of the AIDS epidemic” has raised interest in the link between AIDS and cardiovascular disease, certain cancers, diabetes, osteoporosis and depression, the Times reports.

Cardiovascular disease and diabetes are associated with lipodystrophy, which results in fat redistribution that can leave the face and lower limbs gaunt, the stomach swollen and the back humped. Lipodystrophy also raises cholesterol levels and causes glucose intolerance, which could be particularly harmful to black people, who are predisposed to heart disease and diabetes. According to the Times, there are no data that compare the incidence, age of onset and cause of aging-related diseases in the general population with long-term survivors of HIV. However, experts say they do not see HIV-negative people in their mid-50s with hip replacements associated with vascular necrosis, heart disease or diabetes related to lipodystrophy, or osteoporosis without the usual risk factors.

The most comprehensive research has come from the AIDS Community Research Initiative of America, which has studied 1,000 long-term survivors in New York City. The ACRIA study, published in 2006, found unusual rates of depression and isolation among older people living with HIV.

The NIH-funded Multi-Site AIDS Cohort Study — which has followed 2,000 subjects nationwide for the past 25 years — will examine the effects of HIV/AIDS and aging over the next five years. MACS investigators and other researchers say the slow pace of research on HIV/AIDS and aging is a result of numbers. They note that the first generation of people diagnosed with HIV/AIDS in the mid-1980s had no effective treatments for 10 years and died in large numbers, leaving few people to participate in studies.

Charles Emlet — an associate professor at the University of Washington-Tacoma and a leading HIV and aging researcher — said HIV/AIDS and aging research has been slow to start because of “the rapid increase in numbers.” CDC’s most recent data, from 33 states that meet certain reporting criteria, showed that the number of people age 50 and older with HIV or AIDS was 115,871 in 2005, compared with 64,445 in 2001. In addition, the “routine exclusion” of older people from drug trials by large pharmaceutical companies has undermined such research, the Times reports. The studies are designed to measure safety and efficacy but not long-term side effects of drugs. The lack of research also limits a patient’s care, the Times reports.

“AIDS is a very serious disease, but longtime survivors have come to grips with it,” Emlet said, noting that although some patients experience unpleasant side effects from the antiretroviral drugs, a vast majority find a regimen they can tolerate. “Then all of a sudden they are bombarded with a whole new round of insults, which complicate their medical regime and have the potential of being life threatening. That undermines their sense of stability and makes it much more difficult to adjust,” he added (Gross, New York Times, 1/6).

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Mutations found in four amino acids in the protein that surrounds HIV might make the virus vulnerable to the immune system, according to a study published in the January issue of PLoS Medicine, ANI/Thailand News reports.

For the study, Julie Overbaugh of the Fred Hutchinson Cancer Research Center and colleagues analyzed the HIV strain of a woman living in Mombasa, Kenya, whose virus was inactivated by antibodies produced by her body. The study found that the woman’s virus contained mutations in four amino acids located in HIV’s outer envelope protein. Two of the amino acids when introduced to unrelated HIV strains in a laboratory setting provided sensitivity to inactivation by a number of antibodies produced by HIV-positive people, according to the researchers.

The researchers said that such mutations might cause changes in the overall structure of the envelope protein, which might result in exposure to regions of the immune system that normally are hidden from HIV. According to ANI/Thailand News, further research is needed to confirm the theory that vaccines containing envelope proteins with the mutations might be able to stimulate an antibody response to protect against HIV (ANI/Thailand News, 1/3).

The study is available online.

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The New York Times on Saturday examined how the President’s Emergency Plan for AIDS Relief could be President Bush’s “most lasting bipartisan accomplishment.” According to the Times, PEPFAR is a “rare exception” to several of Bush’s other initiatives, which are “not fully embraced by Democrats.” About 1.4 million HIV-positive people have received antiretroviral drugs through PEPFAR, an increase from 50,000 receiving U.S.-funded drugs before the initiative was launched. In addition, PEPFAR has provided care to about 6.7 million people affected by HIV/AIDS, including 2.7 million orphans and other children, according to government figures. Drugs to prevent mother-to-child HIV transmission provided through PEPFAR have prevented an estimated 152,000 pediatric HIV cases, according to the government.

PEPFAR, which was announced in Bush’s 2003 State of the Union address, initially called for $15 billion for HIV/AIDS prevention, treatment and care and focused on 15 countries with high HIV prevalence. Bush now is calling on Congress to reauthorize the program at $30 billion for five years. Bush in February plans to visit Africa to “make his case” for PEPFAR’s reauthorization and to “burnish the compassionate conservative side of his legacy,” according to the Times.

Critics of the program have expressed concern about a requirement that at least one-third of HIV prevention funds focus countries receive through PEPFAR be used for abstinence-until-marriage programs. Paul Zeitz, executive director of the Global AIDS Alliance, said the program has been limited by “ideologically driven policies.” Despite such reservations, many critics conclude that through PEPFAR, Bush has “spawned a philosophical revolution” and has “put to rest the notion that because patients were poor or uneducated they did not deserve, or could not be taught to use, medicine that could mean the difference between life and death,” the Times reports.

According to Michael Gerson, a former speechwriter for Bush, PEPFAR “fit a broader conception of [Bush's] view of America’s purpose in the world, which included not just the liberation of other people, but their treatment for disease.” According to the Times, several Democrats, including Sen. John Kerry (Mass.), “find it difficult to argue” with the success of PEPFAR. “It’s a good thing that [Bush] wanted” to start the program, Kerry said, adding that PEPFAR “represents a tremendous accomplishment for the country.”

Some HIV/AIDS experts have said that PEPFAR funding could be spent more efficiently, and other advocates say that $50 billion — not $30 billion as Bush has requested — is needed. However, the “fight is not over whether to reauthorize the program, but how,” according to the Times (Stolberg, New York Times, 1/5).

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If the President’s Emergency Plan for AIDS Relief is to “expand to help ensure everyone who needs AIDS-related care can get it, we will need to see strong leadership” after President Bush leaves office, Steve Scheffler, president of the Iowa Christian Alliance, writes in a Des Moines Register opinion piece. Scheffler adds that is why he believes it is “incumbent on all candidates vying to become the leader of the free world, regardless of their party affiliation, to explain in detail how they would carry [PEPFAR] forward during their term in office.”

“Thanks to the support” of PEPFAR, African organizations, including many churches, are having a “broad-based impact” on HIV/AIDS by providing education about issues such as agricultural productivity and sustainability, medical care, community leadership and abstinence, Scheffler writes. PEPFAR is “crucial in laying the basis for broader, sustained success by faith-based groups” in fighting HIV/AIDS and other diseases in developing countries, he adds, noting that by the end of 2008 the U.S. will be providing antiretroviral treatment to about one-third of those who need it. “Will all candidates pledge to sustain that level of support if they are elected president?” Scheffler asks.

“The needs of our brothers and sisters transcend politics,” Scheffler writes, adding, “Although great headway has been made through the service of Christians, the global Christian community’s efforts on care for orphans and those suffering from disease still have a long road ahead.” Scheffler concludes that the U.S.’s “moral obligation and strategic imperative are to protect life and help those in need, and we will need presidential leadership to achieve lasting success” (Scheffler, Des Moines Register, 1/2).

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The Vermont Department of Health on Wednesday announced an increase in the number of recorded syphilis cases in the state, the Barre Montpelier Times Argus reports (Hirschfeld, Barre Montpelier Times Argus, 1/3). According to the AP/Burlington Free Press, nine cases of syphilis — which can increase the risk of HIV — were reported last year in the state, compared with three in 2006 and one in 2005 (Rathke, AP/Burlington Free Press, 1/3). The increase of syphilis cases in the state follows a nationwide increase in recent years.

According to Vermont epidemiologist Cort Lohff, nearly all the cases involve men who have sex with men. Lohff added that some of the cases were contracted in the state, whereas in the past, most of the cases diagnosed in the state had been contracted outside Vermont (Barre Montpelier Times Argus, 1/3). “The key here is that this infection has found its way into Vermont, and it’s being spread among sexually active [MSM] here in Vermont,” Lohff said.

Hannah Hauser — co-director of health and wellness for the R.U.1.2? Queer Community Center in Burlington, Vt. — said the increase indicates that more people are being tested for the disease and seeking treatment (AP/Burlington Free Press, 1/3). Nancy Mosher, president and CEO of Planned Parenthood of Northern New England, said the increase in syphilis cases in the state represents “good reason to give some renewed public messaging and education about” syphilis, HIV/AIDS and other sexually transmitted infections (Barre Montpelier Times Argus, 1/3).

According to CDC officials, the number of syphilis cases in the U.S. reached an all-time low in 2000 but increased annually from 2000 to 2005, the most recent year for which the agency has figures. CDC analysts estimate that in 2000, MSM accounted for 7% of syphilis cases in the country but accounted for more than 60% in 2005. According to CDC, syphilis incidence in the overall population was 2.1 cases per 100,000 people in 2000, compared with three cases per 100,000 people in 2005, or 8,724 cases (Kaiser Daily HIV/AIDS Report, 8/14/07).

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Actress Gloria Reuben, who played an HIV-positive woman on NBC’s television drama “ER” and left the show in 2000, on Thursday rejoined the cast for a “one-time appearance,” the Los Angeles Times reports.

Reuben before leaving the show played a physician’s assistant named Jeanie Boulet who contracted HIV from her husband after he had sex with another woman. The character represented the first time a prime-time series showed an HIV-positive woman continuing “with her life and career despite the stigma surrounding the virus,” according to the Times (Braxton, Los Angeles Times, 1/2). When Reuben left the show, she and the producers decided to avoid sending a negative message about HIV/AIDS by not having the character die, according to the Pittsburgh Post-Gazette (Owen, Pittsburgh Post-Gazette, 1/3). In Thursday’s episode, Boulet is directing two HIV/AIDS clinics and sends her son to the emergency department at the fictional hospital where the show is set after he is injured in a gym class.

According to the Times, since Reuben’s departure from the program, she has begun working as an advocate for HIV/AIDS. She has spoken during World AIDS Day and this year produced a program, “Positive Voices: Women and HIV,” for Showtime, on which she interviews women living with or affected by the virus. In addition, she has co-starred in an HBO film “Life Support,” which featured Queen Latifah as an HIV-positive woman (Los Angeles Times, 1/2). According to the Post-Gazette, Reuben became an HIV/AIDS advocate after reading about high death rates among black women with HIV/AIDS (Pittsburgh Post-Gazette, 1/3).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Indian Railways is considering offering fare concessions to people living with HIV/AIDS in the country to facilitate their travel to the National AIDS Control Organisation’s antiretroviral treatment centers, which offer subsidized treatment at 127 locations, the Indian Express reports.

According to the Express, Indian Railways is considering offering concessions as high as 75% to people living with the disease regardless of their purpose for traveling. Indian Railways already offers fare concessions ranging between 50% to 75% to people living with various medical conditions, including tuberculosis, leprosy, hearing and speech disorders, and heart and kidney disorders. The consideration to expand fare concessions is seen as one of Railway Minister Lalu Prasad Yadav’s “big ticket” items for the Rail budget, which is scheduled to be released in February, the Express reports.

An unnamed senior Railway official said, “The demand to offer concessions in fare to HIV and AIDS patients has been there for the past couple of years with even [NACO] seeking the benefit for” people living with the disease, adding, “However, it is for the first time that the ministry has taken up the proposal and started working out the modalities” (Rao, Indian Express, 1/1).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

President Bush last week signed a $555 billion fiscal year 2008 omnibus spending bill (HR 2764) that effectively lifts a ban on city funding for needle-exchange programs in Washington, D.C., the New York Times reports. Since 1999, the district has been the only U.S. city barred by federal law from using local funds for needle-exchange programs. A report released last month by district health officials found that injection drug use was the second most common cause of HIV transmission in the city (Urbina, New York Times, 12/27/07).

Mayor Adrian Fenty in a recent statement said the city plans to include needle exchanges in a larger program to reduce the spread of HIV/AIDS. About $1 million in city funds will be allocated for needle-exchange programs in 2008. District City Council member Jim Graham said a city-funded needle-exchange program will have a significant impact on the city’s high rate of HIV/AIDS. He added, “This program will save lives” (Manning, AP/Google.com, 12/27/07).

Rep. Jose Serrano (D-N.Y.), chair of the House Subcommittee on Financial Services and General Government, said, “For too long, Congress has unfairly imposed on the citizens of D.C. by trying out their social experiments there.” He added, “The ban on needle exchanges was one of the most egregious of these impositions, especially because the consensus is clear that these programs save lives” (New York Times, 12/27/07).

Omnibus Provisions
The omnibus bill signed by Bush, which combined 11 unfinished spending measures, will fund the Department of State, USAID, and other global health and international aid programs. It also affects the Millennium Challenge Corporation, which aims to encourage economic and political reforms in developing countries. The measure provides $6.5 billion for U.S. and global health activities, including emergency spending, which is $1.4 billion more than was allocated in 2007 and $796 million more than Bush’s request, according to the House Appropriations Committee.

Five billion dollars in foreign operations spending will go to the President’s Emergency Plan for AIDS Relief — at least $1.2 billion more than the program received last year. The measure also includes a provision that would allow overseas HIV/AIDS programs relief from abstinence-education mandates. By law, at least one-third of HIV prevention funds that focus countries receive through PEPFAR must be used for abstinence-until-marriage programs.

Under the bill, the Global Fund To Fight AIDS, Tuberculosis and Malaria will receive about $841 million. The amount includes $546 million in the State-Foreign Operations section and $295 million in the Labor-HHS-Education section of the bill. Bush had requested $300 million for the Global Fund, all of which was allocated in the Labor-HHS bill.

In addition, the measure provides $1.8 billion for global health and child survival programs, including $347 million for HIV/AIDS programs. Funding for maternal and child health programs will increase by $101 million, and malaria and TB funding will increase by $101 million and $72 million, respectively. The measure will reduce funding for MCC to $1.54 billion — about half of Bush’s requested $3 billion. A proposal to change the way MCC funding is dispersed was dropped.

The measure also will increase funding for AIDS Drug Assistance Programs — federal- and state-funded programs that provide HIV/AIDS-related medications to low-income, uninsured and underinsured HIV-positive individuals — by $19 million to $809 million (Kaiser Daily HIV/AIDS Report, 12/19/07).

Related Editorials

* New York Times: Congress and Bush have “done the right thing” by lifting the ban against city funding for needle-exchange programs in the district, but an “even broader more damaging law” that prohibits federal funds for such programs in the U.S. and abroad “must also be rescinded,” a Times editorial says. According to the Times, the “most important medical and public health organizations” in the U.S. endorsed needle-exchange programs more than 10 years ago, and the programs have proven to be “highly successful” worldwide. The law prohibiting the use of federal funds for these “crucial” programs has “hobbled” HIV/AIDS prevention efforts in the U.S. and abroad. Health organizations that use U.S. tax dollars “should be encouraged rather than blocked from developing” needle-exchange programs, the editorial says, concluding, “Eliminating the federal ban would save many thousands of lives every year” (New York Times, 12/28/07).

* Pittsburgh Post-Gazette: The “change in the law” regarding funding for needle-exchange programs in the district “owes more to a change in the leadership of Congress” than to the “grim facts” about the city’s HIV/AIDS rate, a Post-Gazette editorial says. Because “Democrats were prepared to face reality at the intersection of compassion and common sense,” Bush was “sent a budget bill that allowed the district to use its own funds for needle-exchange programs,” the editorial says, adding that to “his credit,” Bush signed the bill into law. “The Democratic-controlled Congress can’t claim a long list of great achievements since taking up the reins of power, but little things can make a big difference,” the Post-Gazette says, concluding, “This was one. A blow was struck for good sense in a matter of life and death” (Pittsburgh Post-Gazette, 12/31/07).

NPR’s “Morning Edition” on Thursday reported on needle exchange programs in the district (Inskeep, “Morning Edition,” NPR, 12/27/2007). Audio and a partial transcript of the segment are available online.

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Although HIV/AIDS in developing countries requires “continued attention” and preventing deaths from the disease remains “imperative,” other public health needs should not be “ignored,” Daniel Halperin, a researcher at the Harvard School of Public Health, writes in a New York Times opinion piece.

According to Halperin, the “well-meaning promises” of some 2008 presidential candidates to nearly double U.S. aid to fight HIV/AIDS worldwide is “missing the mark.” Spending more than $50 billion on foreign health assistance “does make sense, but only if it is not limited to HIV/AIDS programs,” Halperin writes. He adds that in many developing countries, access to clean water is “inadequate,” while shortages of food and basic health services — including vaccinations, prenatal care and family planning — have contributed to larger families, as well as high child and maternal mortality. Large donors — including the President’s Emergency Plan for AIDS Relief and the Global Fund To Fight AIDS, Tuberculosis and Malaria — have not “directly addressed such basic health issues,” according to Halperin.

Halperin writes that in Botswana, much of the funding from PEPFAR and other donors “remains unspent” as its HIV clinics “cannot absorb such a large influx of cash.” He adds that in Africa, there is “another crisis exacerbated by the rigid focus on AIDS: the best health practitioners have abandoned lower-paying positions in family planning, immunizations and other basic health areas in order to work for donor-financed HIV programs.”

The “AIDS experience” has shown that developing countries can make complex treatments, such as antiretroviral drugs, accessible to many people, Halperin writes. He adds, “Regimens that are much simpler to administer than antiretroviral drugs — like antibiotics for respiratory illnesses, oral rehydration for diarrhea, immunizations and contraception — could also be made widely available.” According to Halperin, it is “important, especially for the U.S., the world’s largest donor, to re-examine the epidemiological and moral foundations of its global health priorities.” Halperin concludes that the “real-world needs” of Africans — including the “ubiquitous ravages of hunger, dirty water and environmental devastation” — should not be “subsumed by the favorite causes du jour of well-meaning yet often uninformed Western donors” (Halperin, New York Times, 1/1).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.