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HIV/AIDS Chronicles

September 2001

HIV/AIDS Toll Could Hit 200 Million

At the International AIDS Society's Conference on HIV Pathogenesis and Treatment in Buenos Aires, the organization's president said that more than 200 million people could be infected with HIV in 20 years. "It's not unreasonable at all to project 200 million cases unless effective action is taken," said Stefano Vella. "This pandemic is not stabilizing. It's just beginning, it's just a baby -- that's what people don't understand." Most of the 36 million people with HIV live in Africa, where in some countries as many as one adult in four is infected. Vella said that experts fear similar epidemics are in the early stages in India, China, the former Soviet Union and Latin America. If the world does not begin to take more effective action in those regions than it has in Africa, "there are hundreds of millions who will die," he said. Vella cited the example of Botswana, where 35 to 40 percent of the nation's 1.5 million citizens are infected. "If we had the same prevalence in the North as they have in Botswana, then in Italy, we would have 12 million" HIV infections, and the United States would have 40 million. Vella said such a large number of HIV-infected persons would overwhelm even modern health care systems. "The figures are not unreasonable when you consider that the epidemic is just beginning in India, China, the former republics of the Soviet Union and in populous African nations such as Nigeria and Ethiopia," said Dr. Helene D. Gayle, director of the National Center for HIV, STD & TB Prevention at the CDC. Also agreeing with Vella's prediction was Julio Montaner, a director of the Canadian HIV Trials Network, who said that aside from humanitarian considerations, the effect of such unchecked epidemics would be economic catastrophe around the world.

Interrupting AIDS Treatment Shows Promise

A controversial treatment in which HIV patients take medications only on alternate weeks appears to hold HIV at bay without creating a drug-resistant virus, researchers heard on July 9 at the International AIDS Society's Conference on HIV Pathogenesis and Treatment in Buenos Aires. "Our results seem to be an indication that small cyclical treatment interruption could be a feasible option," said Dr. Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases. More than a year after the treatment program began with ten patients, Fauci said he has seen no evidence of the two most feared complications. During the one-week period in which patients went off the drugs, Fauci said no patient recorded an increase in viral levels. Further, no drug-resistant mutations have appeared either, Fauci said at the conference. Other structured treatment interruption (STI) programs have been tried, Fauci said, including two-months-on, one-month-off approach, but that strategy showed the ability of the virus to rebound above detectable levels. Now Fauci is focusing on the one-week-on, one-week-off regimen. "The short period of time off drugs does not appear to give the virus enough time to rebound," he said. Georgetown University researcher Dr. Franco Lori said the immune systems of some STI patients may be able to recognize the virus and attack it when it rebounds. He warned, however, that when the virus rebounds it can destroy some key immune cells that are slowly regenerating. Scientists also expressed fears that patients might try their own forms of STI, with disastrous results. While he called Fauci's results interesting and impressive, Dr. Joseph Eron, associate professor of medicine at the University of North Carolina at Chapel Hill, noted that the study involved just ten patients. Fauci said a larger trial of STI is being prepared.

Lack of Financing May End Trial of an AIDS Vaccine

On Friday, July 6, Pfizer Inc. announced that it was pulling out of its partnership with Immune Response to develop an AIDS vaccine, called Remune, after company officials reviewed results from a clinical trial. Immune Response will take over the trial but it is unclear how the company will pay for it. The company has only about $12 million, executives said, which is enough for six months. The company is close to raising more money, the executives said, but Pfizer's no-confidence vote could make potential investors reconsider. Pfizer had already paid $47 million to Immune Response and could have paid up to $30 million more. In 1995, the Food and Drug Administration warned the company not to manipulate data to show positive results. Last year, university scientists charged the company with trying to hinder publication of a scientific paper describing a clinical trial that failed. That trial of more than 2,500 patients failed to show that Remune improved survival or lengthened the time before HIV infection progressed to AIDS. The trial took place just as new AIDS drugs were coming into use that vastly improved survival of patients. That, the company argued, made it nearly impossible for Remune to show a benefit over the placebo. So newer trials looked to see whether Remune can suppress levels of HIV in the blood. But the company announced on June 1 that a trial in Spain found Remune no better than the placebo. The company argues, however, that the vaccine worked in a subset of patients with stronger immune systems, and will present this data at the International AIDS Society's Conference on HIV Pathogenesis and Treatment.


AIDS Drug Could Be Easier on the Heart

A preliminary study by Bristol-Myers Squibb suggests that a new AIDS drug may avoid the heart problems linked to many medications that are currently available. The study, presented on July 9 at the International AIDS Society meeting in Buenos Aires, compared atazanavir, an experimental protease inhibitor, to an older drug in 467 HIV patients. Cholesterol and triglyceride counts increased only slightly or dropped among patients on the new drug, compared with increases higher than 16 percent for those on the older drug. Physicians have become increasingly concerned about increases in cholesterol and other blood chemicals linked to heart disease among people taking protease inhibitors.

US Calls AIDS Worse than any War, Pledges More Money to Global Fund

Calling the AIDS pandemic worse than any war, US Secretary of State Colin Powell announced Monday, June 25, that the nation will provide more money for the global fund to fight the disease and will continue to lead the world in financing AIDS research. Speaking at the UN General Assembly's special session on AIDS, Powell decried that it had taken 20 years to gather the world's leaders to address the global scourge. "To date, our global response has been woefully inadequate. We have been blind to the fact that this promising new century has arrived in the time of plague," he said. "No war on the face of the world is more destructive than the AIDS pandemic. I was a soldier," said the retired four-star general. "I know of no enemy in war more insidious or vicious than AIDS, an enemy that poses a clear and present danger to the world." UN Secretary-General Kofi Annan has called for a war chest of $7 billion to $10 billion annually to fight AIDS. In May, President George W. Bush said the United States would give $200 million to the fund. "We hope this seed money will generate billions more from donors all over the world, and more will come from the United States as we learn where our support can be most effective," Powell said. "To date, the United States has dedicated over $1.6 billion to combat AIDS in [the] developing world. President Bush's budget for the next fiscal year seeks $480 million, more than double the fiscal year 2000 amount." He also said Bush is requesting more than $3.4 billion for AIDS research. Still, the key to ending the pandemic is "prevention, prevention and more prevention," Powell said.

Row over Gays Plunges UN Conference on AIDS into Disarray

The first UN General Assembly special session on HIV/AIDS was plunged into disarray Monday, June 25 by a vote to allow a gay and lesbian group to join discussions at the meeting. Two-and-a-half hours passed before 62 countries voted in favor of a Canadian motion to admit Karyn Kaplan, of the International Gay and Lesbian Human Rights Commission, to one of four round-tables during the three-day conference.

Thirty countries abstained, and most Islamic states refused to cast their votes after failing in a procedural challenge to Assembly President Harri Holkeri to have the motion thrown out. South Africa's ambassador to the UN, Dumisani Kumalo, warned delegates after the vote that they had trodden "a road that will make working in the UN more difficult than it is." He appealed to each side not to question the other's motives, saying all were "very good members of the United Nations" whose input was needed to halt the disease, which has already killed 22 million people. Australia's ambassador to the UN, Penny Wensley, said the final drafting session broke up at about 3:00 a.m. "with a sense that negotiations had run their course." There were disagreements about wording on human rights, the empowerment of women, obstacles to care and prevention of AIDS, and vulnerable groups, Wensley said.

British Secretary of State for International Development Clare Short addressed the issue of vulnerable groups: "All countries have in their populations men who have sex with men, commercial sex workers who have clients and intravenous drugs users who have sexual partners. Let me say to those countries and organizations that do not wish to mention these high-risk groups, that if you fail to face up the need to take action to protect such groups, you will sentence your countries to higher rates of infection."

Report Advises Planning Now for Global Access to a Future AIDS Vaccine

Even though an AIDS vaccine is years away, a report released on June 25 by the International AIDS Vaccine Initiative (IAVI) advised governments and international organizations to start thinking about how they would distribute one universally. "Access to AIDS vaccines is not tomorrow's problem," warned the IAVI report. "Waiting to address access issues until after AIDS vaccines are licensed will sentence millions to preventable illness and death." IAVI released the report at the UN conference on AIDS.

It is not unusual for new life-saving medicines and vaccines to reach the developing world years or decades after they are introduced in wealthier nations, said Dr. Seth Berkley, president and CEO of IAVI. To prevent similar delays in universal distribution of an AIDS vaccine, countries must act now. Berkley recommended the following:

  • The UN global AIDS fund should include an account dedicated to the purchase and delivery of vaccines.
  • Health officials should develop ways to direct vaccination campaigns targeting those groups at highest risk instead of concentrating solely on newborns and mothers.
  • A tiered pricing system should be implemented to afford poor countries access without denying profits for manufacturers.
  • Governments should support vaccine research and development.
  • The approval process for vaccines should be streamlined.
  • Drug manufacturers should be encouraged to increase their vaccine manufacturing capacity, even if public funds must be used to help build new facilities.
Getting an AIDS vaccine to the world's poor may be easier than providing cheap antiretroviral drugs because vaccination campaigns against smallpox, polio and other diseases have paved the way, according to Alf Lindbergh, an executive with French pharmaceutical company Aventis Pasteur, which is working on several vaccine candidates.

Women in Hard-Hit Areas Afraid to Say No to Unsafe Sex, Experts Say

Women in nations hardest hit by AIDS often are afraid of refusing unprotected sex, experts at the UN AIDS special session said Monday, June 25. Worldwide, nearly half of the 36 million people infected with HIV are women -- and the number is growing. Women now make up 60 percent of new infections. "They feel subservient; they feel as if they are not trained and have the type of support system that will allow them to speak out," said US Rep. Juanita Millender-McDonald (D-Cal.).

In sub-Saharan Africa, teenage girls are five times more likely to be infected than boys. Girls there are often denied schooling and "have to be educated," UN Population Fund Executive Director Thoraya Obaid said. Sex education could help by teaching men and women to respect one another, she said. "If they fulfill that then women will have the power to say no to sex as a whole or to unsafe sex." Giving women access to reproductive health resources, including condoms, also can cut the rate of infection, Obaid said, and providing pregnant women with drugs to help prevent the transmission of HIV to their babies is crucial. The international community should also focus on promoting and enforcing laws protecting women from sexual assault, delegates said.

UN Redefines AIDS as Political Issue and Peril to Poor

As it ended its three-day special session on AIDS on June 27, the UN General Assembly approved an ambitious declaration outlining how the world should fight the pandemic. The world body called on nations and private industry to provide the billions of dollars needed for the task. Though it has no force of law, the Declaration of Commitment views AIDS as far more than a medical issue, framing it instead as a political, human rights and economic threat.

It also addresses the roles that the exploitation of poor women and discrimination have played in the spread of HIV. UNAIDS chief Dr. Peter Piot called the document an "instrument for accountability" that would provide "a strong basis for future action." But both Piot and UN Secretary-General Kofi Annan recognized that many of the declaration's elements would be a hard sell in nations where rural women have few rights, gays are heavily stigmatized and sexual education is generally eschewed. "Some painful differences have been brought into the open," Annan said of the conflict, early in the session, in which Muslim countries successfully fought to have language about high-risk groups deleted from the final document. The declaration calls AIDS a "global emergency," details where it has hit hardest, and outlines factors contributing to its spread. It calls on governments to protect their infected citizens, and it states that "empowering women is essential for reducing vulnerability." It calls for the elimination of "harmful traditional and customary practices," an allusion to genital mutilation. There was an absence of leaders from Asia and Eastern Europe -- a fact Piot noted with alarm. But Annan, who hopes the global AIDS fund he proposed will be up and running by year's end, said that despite the stubborn nature of HIV/AIDS, "All in all, I feel even more confident today than I did three days ago that we can defeat this deadly disease."

Africa's AIDS Activists Question Value of UN Conference

The UN summit on AIDS and its resulting Declaration of Commitment are being met with skepticism in Africa, the continent worst affected by the pandemic. "I am tired of lip service," said Koketso Rantona, chair of the Botswana Network of AIDS Service Organizations. The declaration sets deadlines for governments to increase access to AIDS drugs, set up prevention programs, and reduce the number of infants with HIV. But while participants were promising to empower women to fight HIV/AIDS, Rantona's Society for Women Against AIDS continues its struggle to survive. Its funding ran out last year; Rantona's office is a trailer; and she cannot even afford to travel to villages to educate people about the disease. "People should stop talking and give us practical support. Communities are in need, they are impoverished, they are sick," she said. UN Secretary-General Kofi Annan has called for a world fund with $7 billion to $10 billion for fighting AIDS each year. Yet the conference ended with only $700 million committed (although a key US Congressional committee has approved an additional $750 million). "With the amount of money that's there at the moment they can't [offer treatment] or they can do it on a very small scale," said Nathan Geffen of South Africa's Treatment Action Campaign. He said the biggest success of the week was the withdrawal of a US complaint, filed with the World Trade Organization, over the law Brazil uses to keep down the cost of AIDS drugs. And at the very least, the declaration will allow activists to hold governments morally accountable, said Thanduxolo Doro, program manager for South Africa's National Association of People Living with AIDS. Activists plan to "keep on reminding, becoming a pain in their necks: 'Remember the UN summit. Remember the UN summit,'" he said.

Studies Show Virus 'Blips' Don't Necessarily Mean AIDS Drugs Aren't Working

Two studies published in the July 11 issue of the Journal of the American Medical Association (JAMA) suggest that the slight 'blips' in HIV virus levels that many AIDS patients experience while taking drug cocktails do not necessarily mean the treatment is failing. Doctors generally try to suppress the AIDS virus to levels undetectable by routine tests.

Up to now, doctors believed that when HIV rises back to detectable levels, it means that the virus is becoming drug-resistant and that the patient has to switch medications. "Unnecessary regimen switching may result in disruption of a patient's medication routine, toxic effects from new drugs, and premature discarding of useful drugs," according to one of the studies, led by Dr. Diane Havlir of the University of California at San Diego. Patients in both studies received standard cocktails of AZT and 3TC plus protease inhibitors. Havlir and colleagues analyzed data on 241 patients followed for about 16 months and a group of 13 followed for about 4.5 years. "Intermittent viremia" -- occasional, detectable AIDS virus levels -- occurred in about 40 percent of the 241 patients and in six of the 13. Persistently high virus levels indicating the treatment failed occurred in 30 patients, but were no more likely to occur in those with virus blips (JAMA 2001; 286: 171-179).

In the other JAMA report, Dr. Deborah Persaud from Johns Hopkins University Children's Center and colleagues studied blood samples of 20 AIDS patients on standard drug treatment for at least two years. They found that standard treatment seemed to block virus mutation even in patients with intermittent blips of virus activity (JAMA 2001; 286: 196-207). Dr. Steven Deeks of the University of California, San Francisco's AIDS Program, who wrote an accompanying editorial, noted that the studies are only preliminary, and their findings apply mainly to patients whose cocktails include a protease inhibitor.

CDC Urges Broader Testing for AIDS Virus

The CDC is urging health care workers to recommend HIV tests to patients living in areas with high infection rates. The recommendation, the second since 1993, is based on research conducted at Grady Memorial Hospital in Atlanta that found that patients were more than twice as likely to get tested for HIV when their doctors advised it. In a collaborative study with the CDC, researchers from Grady and the Emory University Center for AIDS Research compared the rate of HIV testing among urgent-care patients at the hospital between March and September 1999 and the same 24-week period in 2000.

In 1999, health care workers recommended HIV testing only to those patients who had symptoms of HIV infection or risk behaviors; in 2000, they recommended that all patients be tested. Dr. Carlos Del Rio, Chief of Medicine at Grady and principal investigator at the Emory AIDS Center, said more than twice as many patients were tested in 2000 as in 1999 or 2,787 vs. 1,100. As a result, 27 more HIV infections were diagnosed in 2000 or 74 compared with 47.

The CDC did not identify specific regions where doctors should recommend HIV testing for all patients. But the findings, published on June 29 in the CDC's Morbidity and Mortality Weekly Report, suggest that tests be recommended for patients seeking care in clinics associated with hospitals. "We are not advocating mandatory screening of patients," said Dr. Sheryl Lyss, a CDC epidemiologist. "We see this as an opportunity for patients who live in areas with high HIV prevalence to have more access to HIV testing. This will also help to ensure that infected patients get the care they need to protect themselves and their partners."

Sect Embraces HIV-Positive

"Santeria" refers to the synthesis of West African rituals and Roman Catholic saints, and its practice was shunned in Cuba for many years. But today, a small group of AIDS activists hopes to use the ancient Yoruba traditions and legends of Santeria to stop the spread of AIDS. Carlos Alejandro Diaz Martine, 33, an HIV-positive Santero and leader of the group Afro Ashe, hopes to target other Santeria devotees and priests, inform them about AIDS prevention, and teach them how they can pass that knowledge to their communities. Diaz Martin said the Santeria community attracts HIV/AIDS patients who seek solace in its powerful and protective orishas, or Yoruba deities. "I realized that many people who are infected come to this community for faith, for help," he said. "Now, we are using religion to get our message across."

According to a 1996 study of sexual behavior in Cuba, those with no religious beliefs and those who believed in Santeria were found to be at high risk for HIV infection. AIDS activists in Cuba have since launched several education campaigns, from discussion groups to a mobile van that distributes pamphlets and condoms. But Diaz Martin and others say Santeria has long been the religion of the lower class, and most Santeria followers are less likely to have information about HIV prevention.

So far, reactions to Santeria outreach have been mixed. "We explain the project, and the first thing they say is, 'Why are you focusing on us?'" said Iris Lugo Carro, a psychologist who works with Diaz Martin. "You have to have a lot of hope," added Diaz Martin. "It has been slow for people to understand the importance of the project so they don't see it as prejudice." If nothing else, Diaz Martin hopes to teach fellow Santeros to accept HIV-positive people and AIDS patients in their communities and show them the understanding he felt when he was diagnosed in 1999.

BCA Finds Black Churches Can Help Quietly Break AIDS Taboos

Recent media attention has focused on rising rates of HIV infection among men of color, particularly African-Americans. A CDC study found surging HIV infection rates among men: 4.4 percent of gay and bisexual men ages 23-29 are newly infected. Among African-Americans in that age group, the figure is 14.7 percent, or one in seven. Half of newly infected men in the United States are African-Americans, the CDC found.

Often obscured, however, is the growing infection rate among African-American women. The CDC has acknowledged that AIDS is now the number one killer among African-American women. And infection rates for African-American women over 50 are now similar to those for women ages 14-23. The Black Community, according to the Black Coalition on AIDS (BCA), faces enormous hurdles to getting the prevention message out. "There's a lot more homophobia in the Black Community," said BCA's David Wallace. "If a guy is a MSM [man who has sex with men] who also has sex with females, he's not going to tell a woman about that."

Racism is another factor, Wallace said, charging that a comparable epidemic among white women would get much more media exposure. Churches, which have long been support centers for the community in times of crisis, often reject homosexuality so vehemently that black gay people feel trapped.

The BCA's church-based campaign is called "In the Spirit of Health." The main poster shows a group of African-American women of varying ages, dressed in bright red choir robes, affectionate and happy. Under the heading "Get Tested," the poster urges, "Get Tested for HIV, as well as anything else your doctor suggests." The overall message is general health needs, like checking for osteoporosis, glaucoma, or breast cancer. But the message in addition is the high risk for African-American women over 50. "They may need to ask their doctor for an HIV test," Wallace said.

Needle-Trading Programs Have Few Inroads in US

Gary Langis, a former addict himself, delivers sterile hypodermic needles to heroin addicts through his work with an underground group of needle-exchange volunteers called New England Prevention Alliance. Needle exchange is explicitly legal in Massachusetts only in a handful of cities running pilot programs, and Lynn, a northern suburb of Boston where Langis delivers needles, is not one of them. "It's a violation of the law," said Lt. Tom Reddy of the Lynn police. The scientific consensus in favor of needle exchanges has steadily solidified. In May, the CDC issued findings that needle-exchange programs, which now number more than 130 in at least 31 states, "are an effective public health intervention that reduces transmission of HIV and does not encourage the illegal use of drugs." In Massachusetts, one of the most liberal states in the country, only four cities, including Boston, have opened needle exchange programs. Several cities that were offered grants to start exchanges turned the money down. The result, in Massachusetts and other states, is a patchwork unusual for criminal law: A town where it is legal to distribute needles sits next to a town where distribution remains a crime. Reddy said the police see the issue as a tradeoff between helping addicts and protecting the city's nearly 100,000 residents. He said he had heard the experience of other police departments was that needle exchange programs bring in drug users and pushers who increase the crime rate. But according to Langis, "We're going to continue our mission and we will provide sterile injection equipment to at-risk populations, no matter what ZIP code they live in."

Delaware Plans Computerized Disease-Reporting System

Delaware will develop the nation's first statewide computerized communicable disease reporting system with $1.8 million in federal funding, state health officials announced Monday, June 25. The system will help the medical community respond quicker to outbreaks of food-borne illnesses, STDs and a range of other illnesses, said state epidemiologist Leroy Hathcock. While security measures will be incorporated into the system, potentially sensitive cases involving AIDS and other STDs will be the last to be included, after officials ensure that the privacy safeguards are working properly, Hathcock said.

South Florida Center Offers Support to Heterosexuals with HIV

The not-for-profit organization Center for Positive Connections in North Miami is an oasis for more than 1,000 heterosexuals living with HIV -- a group often overlooked and misunderstood. Since July 1997, a total of 20,830 Floridians have contracted HIV, and 22 percent got it through heterosexual contact. Of Floridians with AIDS, 82,343, or 18 percent, became infected through heterosexual contact. Positive Connections offers counseling and support groups to the newly diagnosed as well as the long-timers, in addition to holistic treatments that include massage and acupuncture. Thomas Liberti, who heads the HIV/AIDS bureau of the Florida Department of Health, said "Florida has always been a state where the epidemic is very diverse. The epidemic has penetrated so many communities that it hasn't left out the alarm for the heterosexual community." Sheri Kaplan, founder of the organization, said most of her clients hear about the center by word of mouth. It provides a social lifeline to people whom otherwise would feel isolated with their illness. Positive Connections also offers an online personal ad service for those with the virus. "It's serving a whole community that previously had no place to go," Kaplan said. In addition to learning from each other's stories, people who visit the center can check out HIV/AIDS-related material from the small library and work out in the gym. The biggest problem Kaplan faces is the lack of money. It costs at least $10,000 a month to operate the clinic 40 hours a week, she said. Her projected yearly budget -- one that provides all the services she would like to offer -- is $325,000.

HIV Up: "Condom Fatigue" Blamed

A rise in the number of HIV cases over the last year in British Columbia (BC) among gays, people of color and heterosexuals is being attributed in large part to what researchers are calling "condom fatigue." Condom fatigue is an indifference displayed by men at risk of infection because they don't want to use latex protection, according to Dr. Michael Rekert of the BC Centre for Disease Control. "People are pretty tired of condoms, and they don't want to use them," Rekert said. Also complicating the fight against HIV infection is the growing misconception that AIDS is a chronic disease for which a cure will soon be found, Rekert added. Although the actual number of new HIV infections in BC has gone down for the sixth year in a row, the number of cases among certain demographic groups has gone up. Last year, 413 British Columbians tested positive for HIV, down from 427 in 1999 and 482 in 1998. But these figures do not show that infections among gay men rose by 36 percent last year, to 129 from 95 two years ago. Infection rates among men of Asian, black or Hispanic descent rose by 65 percent, to 56 from 34 two years ago. And in the first three months of this year, there have been 20 new HIV cases among heterosexuals, prompting projections of as many as 80 this year, Rekert said. Glen Hillson, chairman of AIDS Walk 2001 and the BC Persons with AIDS Society, said people have also come to lose their fear of the disease because it isn't nearly as deadly -- immediately -- as it was in the past. "There is a dangerous misconception that AIDS has been wrestled to the ground. Clearly, it would be a mistake to let our guard down," he added.

Trading Their Freedom -- HIV-Positive Cubans Get Care but Live in Quarantine

Cuba has one of the world's lowest HIV infection rates (well below 1 percent) in a region with one of the world's highest, even though it has the region's largest population and, according to surveys, some of its most liberal attitudes about sex. In the years since Cuba first tried to curtail the epidemic by quarantining those with HIV, its attitude has evolved into something resembling tolerance. In the sanatoriums for HIV patients, many gay Cubans find acceptance that is lacking in a society where homophobia prevails. "The Cuban point of view is that you have the right to be sick, but not to transmit it to anyone else," said Dr. Jorge Perez, who diagnosed the country's first AIDS patient and ran Havana's Sanatorium Santiago de las Vegas for 11 years. Cuba's policies contained AIDS, but critics complained that the forced quarantines violate patients' civil liberties. The government varied its approach in 1998, launching a day program in which patients were bused in for classes on AIDS and returned home at night. Many patients now go to the sanatorium as outpatients for checkups and medications, although doctors, not patients, decide who is permitted such freedom. HIV-positive Cubans enjoy a better diet than most of the population, and 157 of its more than 300 AIDS patients are receiving free antiretroviral drugs. But despite the food, medicine and housing, the lack of freedom bothers some. One HIV-positive man, who was able to avoid being relocated to the sanatorium only after lobbying his boss for a favorable letter to officials, said the facility was fine for homeless people but unnecessary for someone "who is functioning." "Why should I be surrounded by guards?" he asked. "When you can't live the way you want to, at what point are you still alive?"

World Bank Approves $155 Million to Fight AIDS in Caribbean

The World Bank on Thursday, June 28 approved a $155 million loan package to help fight the spread of HIV in the Caribbean. The region has one of the world's highest rates of HIV infection: 2 percent of the population. "It is absolutely necessary for the fight against AIDS," said Orsalia Kalantzopoulos, the bank's director for the Caribbean. "I see this as a first program," she said. "There will be a need for more." The bank's board also approved loans to support national prevention and control programs, offering $25 million to the Dominican Republic and $15.5 million to Barbados. Other countries will also be able to apply for loans, said bank spokesperson Joelle Dehasse.

Brazil to Produce Generic Anti-AIDS Drugs

The Brazilian Ministry of Health on Monday, July 9 registered the nation's first domestically produced generic AIDS drug. The drug, Lamivudina, will form part of a cocktail of medications that the government distributes free to 95,000 of the 580,000 Brazilians infected with HIV. Lamivudina will cost about half as much ($52 for 60 pills) as the imported brand-name medication, Epivir, produced by Glaxo Wellcome. Brazilian patent law permits local companies to manufacture a product owned by a foreign company if the foreign company does not produce it in the country within three years of patent. In June, the United States withdrew its World Trade Organization complaint against the law and agreed to settle the issue of production rights through negotiation. Brazil spends about $300 million annually on its drug program for people with AIDS. It produces seven of the 12 AIDS drugs it distributes. This strategy that has cut AIDS-related mortality by 40 percent since the program was implemented in 1997.

AIDS Grows Fastest in Eastern Europe; Specialists Warn of Possible Epidemic

Eastern Europe and the former Soviet Union, which already have the world's fastest-rising rates of new HIV infections, are headed for a large-scale epidemic if programs to combat AIDS do not go into full swing now, warned health officials from the region. The UN estimates that the number of infected people in the area has skyrocketed from 30,000 in 1995 to 700,000 as of last year. Experts suggested that the surge in infections is a result of the high rates of injection drug use (which account for 80 percent of new HIV infections there) and the swelling prison population.

Human Rights Group Accuses Kenyan Government of Neglecting AIDS Orphans

In a report titled "In the Shadow of Death: HIV/AIDS and Children's Rights in Kenya," New York-based Human Rights Watch accused the Kenyan government of not doing enough to reduce the social stigma attached to HIV/AIDS, and of doing little to protect the human rights of children orphaned by the epidemic. The report said the disease has orphaned about a million Kenyan children and at least 13 million in Africa.

Church May Back Use of Condoms to Curb AIDS in Africa

The Roman Catholic Church in southern Africa is set to consider supporting the use of condoms to combat AIDS. The idea, contained in a policy paper, discussed in July, by the Southern Africa Catholic Bishops Conference, runs counter to the church's fundamental principle of the sanctity of life, which outlaws condoms. It is expected to pit the traditionalist wing of the Catholic Church in the region against pragmatists who argue that the devastating effect of HIV/AIDS means the issue of condoms must be reconsidered. Bishop Kevin Dowling, from Rustenberg, South Africa, prepared a policy paper after discussions with local health workers who are facing HIV infection rates of up to 50 percent. The document reiterates the traditional view that sex should only take place within marriage, but said that the church should accept that a large proportion of people do not follow this rule. The paper suggests that the use of condoms should be supported as a way of reducing the spread of AIDS. "I do not expect what we have said in the draft to get universal approval among the bishops -- it will be contentious," Dowling said.

Somali Youths Brave Guns and Anger to Campaign for AIDS Awareness

Protected by their own guards toting AK-47 rifles, dozens of youths on Monday, June 25 braved conservative Somali society and its clan-based militiamen to do something Somalis have never done before -- raise public awareness about HIV/AIDS. Riding in ten trucks draped with banners in Somali reading, "Save Your Life By Just Avoiding Adultery" and "AIDS Is Not Shame," the young men used a loudspeaker to broadcast their message, provoking surprise, shock and anger from residents of the war-ravaged capital Mogadishu. "I first thought they were a religious group, but now I can see they are insane," one woman remarked. Most Somalis are conservative Muslims who don't accept that the disease, which they link with homosexuality and liberal Western habits, exists in their country. There is little data on the prevalence of HIV/AIDS in Somalia, mainly because the nation spent the last decade without a government. Following the 1991 overthrow of President Mohamed Siad Barre, the country descended into a chaos of fiefdoms ruled by faction leaders and their gunmen. Since August 2000, President Abidiqassim Salad Hassan and 245 legislators have sought to govern the country, whose infrastructure remains virtually destroyed. Dr. Sheikhdon Salad Elmi, director of the city's largest hospital, said ten cases of HIV had been detected in the city in the past twelve months. The young activists, who call their organization AIDSOM, said they decided to carry out their campaign lest HIV spread before people realize the danger it poses. During their ride, the youths were stopped three times by armed militiamen. Finally, the gunmen cut the loudspeaker's wires beyond repair, and the activists were forced to leave.

Home for Terminal AIDS Victims Opens

The Mai Hoa Center for AIDS patients opened July 3 in An Nhon Tay Commune, Cu Chi District, Ho Chi Minh City. The facility, Vietnam's first home and clinic for terminal AIDS patients, was set up by the Daughters of Charity of St. Vincent de Paul. The home includes two six-bed patient dormitories, a dining room, a kitchen, nurses' quarters and administrative offices. Six full-time registered nurses and twenty visiting doctors attend to the patients. The number of people diagnosed with HIV in Vietnam between 1990 and March 2001 is 33,297.

Completing a Four-Day Cycle of Hope; 2,000 Riders Go the Extra Mile, and Then Some, to Fight AIDS

The Washington AIDSRide is a four-day journey that riders say is equal parts endurance, remembrance and hope. "The rides are so energizing to me because so many people care about me or people like me," said Kevin Mischka, one of at least 75 HIV-positive riders on this year's 330-mile ride. The bicyclists, who began at dawn Thursday, June 21 in Raleigh, N.C., have endured sweltering days, grueling hills and wet gear. This year marks both the largest ridership and the greatest financial contribution in the Washington ride's history, with $6.7 million raised for the Whitman-Walker Clinic and Foods & Friends. "It takes everything you've got, but it's worth it," said Jo Dun, 60, a California real estate agent. Many cyclists said this year's ride, which comes twenty years after the first reported AIDS cases, has been both a celebration of the medical advances that have improved the odds for HIV and AIDS patients and a warning that prevention campaigns have dropped off. "It's a melting pot," said Craig Shniderman, 58, a veteran rider and executive director of Food & Friends. "It adds a certain poignancy," Shniderman said. "In some ways the visibility of the epidemic has dropped. This reminds us there is still a need."

Piece by Piece, AIDS Memorial Quilt Settles in to Atlanta Headquarters

The AIDS Memorial Quilt is already too large to ever be displayed in its entirety, but new panels continue arriving, slowly filling its warehouse with patches of fabric, each the size of a grave. It seems odd that the most powerful symbol of the epidemic that has taken 450,000 American lives is stored in a quiet warehouse district in Atlanta, where it was moved in March after nearly 15 years in San Francisco. Organizers said they did not just move the quilt because they needed cheaper warehouse space. They wanted to bring the quilt to the South, where people -- especially blacks -- are sometimes reluctant to discuss HIV/AIDS. The quilt started in San Francisco in 1987 as a way to honor AIDS victims, most of whom were white, gay males. It began with just 1,900 panels but has grown to more than 40,000, representing a diverse group of victims. The National NAMES Project Foundation has moved its offices from San Francisco to Washington, where it can lobby government and work more closely with other HIV/AIDS organizations. In Atlanta, volunteers and workers transfer the panels to and from huge boxed containers. They assemble small patches of eight or more panels that are displayed at churches, schools, public parks and conferences. New panels arrive at the warehouse constantly, and workers carefully archive and store them. Despite the quilt's enormity, the project has no plans to stop accepting panels. "It would be wonderful if we didn't have to add another panel but for those who have been victimized by this disease, it's here," said project consultant Jill Strickland.

AIDS Activist Honored

For eight years, Mercy Makhalemele, 30, has fought against all odds to become one of South Africa's leading AIDS activists -- a role that brings her to New York the UN special session on AIDS. Monday, June 25 found her mingling with heads of state at the world body; on Tuesday night she was scheduled to receive the Meade Bailey Award for her work, which includes lecturing on the perils of unsafe sex and lobbying for support for people with AIDS. Makhalemele's trip to New York, accompanied by her son Thabang, 12, was sponsored by Manhattan's Bailey House, which houses homeless people with AIDS. "Her courage and determination inspires us and puts us in awe," said Bailey House Executive Director Gina Quattrochi. Makhalemele's unlikely career as an activist began when she tested positive for HIV after becoming pregnant with her second child. She kept the news from her husband until their new daughter was six months old. When she finally broke the news to her husband -- who she is certain infected her with the virus -- he roughed her up and threw her out of the house. Berating her publicly at the shoe store she managed, he got her fired. Her husband died in 1995, followed one year later by their daughter. But Makhalemele did not surrender to grief. For the past year-and-a-half she has been running the Tsabotsogo Community Development and Training Center, a Johannesburg nonprofit that provides services to young people with AIDS. "There is a lot of fear in South Africa, and we need more education for health care workers, from doctors to nurses. There is a stigma even in the society here. AIDS is seen as a gay disease, so people begin to discriminate against people living with HIV/AIDS."

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This article was provided by AIDS Survival Project. It is a part of the publication Survival News.
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