AIDS Action Weekly Update
April 25, 1997
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Advocacy groups representing people with AIDS, women, and children are concerned about recent revelations regarding U.S.-funded clinical trials involving pregnant women who are HIV-positive. A total of nine studies, which are being conducted in Africa, Asia, and the Caribbean, and funded by either the National Institutes of Health (NIH) or the Centers for Disease Control and Prevention (CDC), involve two groups of women, the experimental group which receives dosages of AZT at different stages of pregnancy, and the control group which receives a placebo. Groups such as Public Citizen's Research Group, a non-profit consumer advocacy organization, have expressed outrage that the women in the control group are being denied access to a proven effective intervention such as AZT during these trials.
Since early 1994 providing AZT has been a standard of care for HIV-infected pregnant women in the United States when it was demonstrated that the drug can reduce the risk of perinatal HIV transmission to the infant by about two-thirds. Because the AZT regimen costs significantly more than the annual health care budget per person in developing countries and because many of the women in these countries do not seek early prenatal care, the trial seeks to examine less expensive options with a shorter treatment regimen; this includes administering AZT during the final stages of pregnancy, and during labor and delivery. Given the research it is unclear why the placebo control group is necessary in order to conduct these experiments. Public Citizen further charges that the trials violate all major international, ethical guidelines, including four of the ten Nuremberg principles which were enacted as a result of the unethical medical experiments conducted on Jewish people in Nazi Germany.
The Centers for Disease Control and Prevention (CDC) and the Council of State and Territorial Epidemiologists will conduct a consultation meeting to examine the goals of HIV surveillance in the U.S., which will include a close look at the future direction of HIV surveillance. Currently there are no federal mandates on HIV reporting. This is an issue of critical importance as the AIDS death rates decrease and the seroprevalance rates (number of individuals living with HIV disease) increase. While the increasing seroprevalance rates could be an argument for improved HIV surveillance, some make the argument that identifying individuals with HIV will result in at risk persons not coming forward to be tested for fear of breach of confidentiality and discrimination. Currently 26 states implement mandatory names reporting of HIV-positive individuals including Texas and Connecticut who only report pediatric cases. The meeting is scheduled for May 21-22.
The most recent statistics from the CDC reveal that 584,129 AIDS cases have been reported in this country from 1981 through December 1996. Of those, 362,004 have died.
Over a week has gone by since the missed statutory deadline for the budget resolution, and it appears that GOP leaders and the Administration are not any closer in their balanced budget negotiations. House Budget Committee members are under increased pressure to mark up a budget resolution by next week with or without Administration buy-in. On the Senate side, Republican leaders have listed a budget resolution as one of their priorities in the weeks leading to the Memorial Day recess, with a target date for floor action set for May 19. According to officials on both sides, the Administration and the GOP leadership are still far apart in terms of how much and what to cut in order to attain a balanced budget agreement with both sides under pressure not to give away too much.
As budget negotiations drag on, it appears more likely that an automatic continuing resolution (CR) will be attached to the FY 97 supplemental appropriations bill. The automatic CR was offered as an amendment to the supplemental appropriations bill, which will provide disaster relief and finance international peacekeeping efforts in Bosnia, during the House Appropriations Committee mark-up, but was withdrawn. The Senate Appropriations Committee is expected to mark-up the bill next week, and the automatic CR, which has a lot of support in the Senate is expected to be a part of their bill. If this occurs, the House will probably cede to the Senate during conference negotiations. The CR, would fund programs in appropriations bills that have not been passed by the end of the fiscal year at 98 percent of the current fiscal year levels. Such a cut would prove disastrous to federal AIDS programs, which are already overburdened due to increasing caseloads and demand for services in AIDS prevention, treatment, research, and housing.
This article was provided by AIDS Action Council. It is a part of the publication AIDS Action Weekly Update.