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Treatment Chronicles, January 1999

January 1999

$10 Million Pledged for AIDS Orphans. President Clinton announced on World AIDS Day, December 1, 1998, $10 million in grants for the care of AIDS orphans and spotlighted a 30 percent increase in funding to the National Institutes of Health for global HIV prevention research. The grants will likely have the greatest effect on Africa, where there are nearly eight million AIDS orphans and at least one million HIV-positive children. Sandra Thurman, the AIDS policy advisor to the president, will travel to southern Africa to view conditions and report on how the United States can help children orphaned because of AIDS. The announcements came as some activists claimed that the Clinton administration was not adequately addressing the disease.

A Deadly Disease That Is Getting Deadlier. Tipper Gore, mental health policy advisor to President Clinton, states that high-intensity anti-HIV efforts must continue and that people must not become complacent, even though advancements in treatment have helped to curb the epidemic. In a Los Angeles Times commentary, Gore reminds that an estimated 33 million individuals worldwide carry HIV. In the United States, 40,000 people contract the virus annually, and the Centers for Disease Control and Prevention have reported that over 110,000 people aged 13 to 29 have been diagnosed with AIDS in the United States. According to Gore, adults have a duty to help combat the spread of the disease in the younger population. Gore notes that the Clinton administration has taken steps to ensure that the disease is addressed, increasing funding to the CDC and the National Institutes of Health and launching prevention initiatives. However, she contends that "the most important thing we can do to protect our children from the threat of HIV/AIDS is to take responsibility in our communities, in our schools and in our homes" by speaking candidly about the disease to our children.

Brundtland Calls for Youth-Friendly Health Services. On December 1, 1998, the director-general of the World Health Organization, Dr. Gro Harlem Brundtland, called on health services to become more youth-oriented in order to help stop the spread of HIV. She cited a study of pregnant South African teenagers aged 15 to 19 that found 13 percent of participants were infected with HIV, 9.5 percent of whom contracted the virus before the age of 15. Speaking as part of World AIDS Day, Brundtland noted that unfriendly staff, excessive paperwork and the perceived lack of confidentiality can all contribute in deterring young people from health services.

Officials Announce New HIV Initiatives. The District of Columbia Administration for HIV/AIDS announced at a World AIDS Day event (on December 1, 1998) at Howard University that it will spend $900,000 on HIV prevention initiatives. Specifically, the money will go to programs for African-American women, African-American and homosexual men, and young people. The AIDS rate in the city is eight times greater than the national average.

City Blocks Needle Exchange Effort. Washington, D.C.'s Whitman-Walker Clinic had planned to circumvent federal budget measures preventing it from funding needle-exchange programs with government money by establishing a privately financed program. However, District officials are now preventing the clinic from creating the private group, asserting that the city council must pass an authorization law before the clinic proceeds. The clinic previously had a contract with the D.C. AIDS Administration under which 17,000 needles were distributed throughout the city each month. Rep. Todd Tiahrt (R-Kan.), the congressman who introduced the amendment that bars the use of government money for needle exchanges in the city, said his intention was not to outlaw all programs in the District. Instead, he sought to get the city to stop using taxpayers' money for the program, which he feels does not work. In commenting on the situation, the deputy administrator for AIDS administration in the city, Stephen Miller, said, "We are very disturbed, but our hands are completely tied."

AIDS Blamed for Reversing Health Gains in Poor Nations. The United Nations Children's Fund asserts that the AIDS crisis in many poorer nations threatens to eliminate 50 years of progress. In 23 countries, including many in sub-Saharan Africa, the crisis is already reversing gains in child survival. Carol Bellamy, executive director of UNICEF, explained that "more children are dying and they're dying sooner, even though your immunization programs might be more successful. The fact is that the improvements that were being made are being reversed." Bellamy also said that the number of orphans due to AIDS is increasing; some experts estimate that there will be 40 million AIDS orphans by 2020. In eight sub-Saharan nations, over one-quarter of children under 15 years have already lost at least one parent. These children are more likely to drop out from school and are less likely to receive immunizations at health clinics. Bellamy also said that UNICEF is instituting programs designed to address the problem of AIDS among the 10-to-24 age group, focusing more on adolescent sex education.

AIDS' Tragic Toll. A report released recently by the United Nations indicates that there are extremely high rates of HIV infection in sub-Saharan Africa and that some countries there will see a major drop in their average life expectancy. According to Lester R. Brown, president of the Worldwatch Institute, the problem is becoming a humanitarian crisis as many of the nations cannot generate the fiscal resources or leadership to properly address the issue. He notes in a Washington Post commentary that an increasing number of children are affected by the disease, either by carrying the virus or through the death of parents to AIDS. Brown also points out that "in contrast to most fatal infectious diseases, AIDS takes its toll not so much among the very young and the elderly but among the young professionals...needed to develop the country." The author states that there are two lessons which should be drawn from this situation: the need to quickly confront a disease before it moves out of control and that population growth must be slowed before governments are overtaken by "demographic fatigue."

AmFAR Poll Shows Cavalier AIDS Attitude. A Harris poll by the American Foundation for AIDS Research (AmFAR) indicates that most Americans are not particularly concerned with their risk of contracting HIV. According to Mithilde Krim, chairman of AmFAR, "Most Americans think they are more likely to be shot by a total stranger or go completely deaf rather than be infected with HIV, the virus that causes AIDS." Fear of AIDS ranked last on a list of 11 different accidents and illnesses in the poll. Despite the fact that deaths due to AIDS have decreased in the United States, AIDS is still a major global problem. In the United States, half of all new HIV infections occur in people under the age of 24 years; however, respondents aged 18 to 24 also ranked HIV/AIDS last in the survey.

Ligand AIDS Drug Gets FDA Panel Clearance, Not as Main Treatment. An advisory panel for the Food and Drug Administration recommended the approval of the Panretin gel, produced by Ligand Pharmaceuticals, for patients with AIDS-associated Kaposi's Sarcoma. However, the skin lesion treatment was not recommended as a primary treatment; the manufacturer is seeking approval for the drug as a primary treatment to be used two to four times daily. The company estimates that between 30,000 and 50,000 people have the AIDS-related Kaposi's sarcoma in the United States and Western Europe.

Female Condom: a Market Wallflower. The only female condom on the market in the United States, Female Health Company's Reality condom, has been available since 1993 but has yet to receive widespread use. According to Kris Kim, a spokeswoman for Planned Parenthood, the female condom remains unpopular in the United States because of its looks, its reported tendency to squeak, and user squeamishness about inserting the device. Overseas, however, the device has found a market. The United Nations AIDS programs and other groups have promoted the female condom because it can help protect against HIV infection and gives women greater control. The organizations have helped to provide female condoms to millions of people in South Africa, Zimbabwe and Zambia. According to Female Health Company executives, overseas sales of the condom have more than doubled in the past year, reaching 7.4 million.

Nationline: HIV Controversy. The Maine Supreme Judicial Court unanimously upheld a ruling allowing Valerie Emerson to refuse HIV-treatment for her four-year-old son. Emerson will not treat her son with combination therapy, believing the anti-HIV drugs could kill him; her three-year-old daughter died while taking AZT. The court's ruling does allow for change if the boy's condition worsens.

Women, Minorities With AIDS Less Likely to Get New Treatment. According to a study presented at the "AIDS at the Millennium" conference on November 18, 1998, women, minorities and heterosexuals with AIDS are less likely to get effective, new treatment for HIV. The study, conducted by Dr. Valerie Stone of Brown University School of Medicine, found that 75 percent of men with AIDS received protease inhibitor treatment, while just 50 percent of women received the medication. Additionally, three-quarters of whites were given protease inhibitors, while just 58 percent of African-Americans and 50 percent of Hispanics took the drugs. A total of 81 percent of homosexuals and 61 percent of those who contracted HIV through intravenous drug use received protease inhibitor therapy, but only half of heterosexuals were treated with the drugs. According to Stone, patients who were aware of the treatment and asked for it appeared to be more likely to receive the drugs.

Improving Patient Compliance with HIV Treatment Regimens. In a letter to the editor of the Journal of the American Medical Association, Peter J. Ungvarski of the Visiting Nurse Service of New York responds to a recent article on patient adherence to anti-HIV regimens, noting that clinicians play a major role in treatment success through their prescription of medication. Ungvarski cites a study of 202 HIV-infected patients which found that about 40 percent of prescriptions for the patients had incorrect dosing schedules, suboptimal dosages, and/or protease inhibitors ordered as monotherapy. "To tackle the problem of adherence to antiretroviral therapy or, on a broader scale, antibiotic therapy in general requires acknowledgment that the complete picture includes clinicians and their knowledge, attitudes and practices toward adherence and not just patients' ability to manage their antiretroviral prescriptions,"he asserts. In response, the authors of the original articles, Drs. Mark A. Wahlberg and Gerald Friedland, of the McGill University AIDS Center and Yale University School of Medicine, respectively, note that their article places the burden of adherence on patients, as well as cliniicans, pharmaceutical companies and the health care system.

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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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