AIDS: THIRD WORLD : 1999-2009
from

Global Issues of the Twenty-First Century
and United Nations Challenges
A GUIDE TO FACTS AND VIEWS ON MAJOR OR FUTURE TRENDS

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by Christopher Spencer
Former Senior Advisor International Organizations,
Canadian Department of Foreign Affairs and International Trade
Updated: 25 MAY 09


(A) COST/PATENT DILEMMA; GLOBAL REACTION
(B) INFECTION RATES; SOCIO-ECONOMIC ISSUES
(C) MEDICAL DEVELOPMENTS AND CHALLENGES
(D) POLICY ISSUES AND CONFERENCES



(A) AIDS: THIRD WORLD: COST-PATENT DILEMMA; GLOBAL REACTION

Donald G.McNeil Jr."Drug Companies and the Third World: A Case Study in Neglect"in New York Times 21 May 1999:-this substantial report deals with an extremely serious global issue. Major pharmaceutical firms are deeply dependent upon stockholders/markets for their competitive survival and the huge investments (billions of dollars and years of work)now required to do the R&D necessary for developing new drugs. They therefore concentrate on drugs which, if successful, will have a very large market(i.e. the rich world), insulate their investments with patents, and charge the highest possible (monopoly?) prices while the patents last. The appalling result is that very little commercial R&D or production is allocated to cures, treatments, or techniques mainly or wholly relevant to the bulk of the world that is poor(i.e. offers a small market), while those with global relevance are available at a cost often far beyond the reach of poor peoples. The author uses sleeping sickness as a tragic case study but this dilemma lies behind the AIDS crisis. Barbara Crossette,"Gore Presides Over Security Council Debate on AIDS"NYT 11 Jan 2000:-US Vice-President Gore, chairing a UNSC session on the AIDS crisis in Africa, pledged $150m to help combat AIDS and other infectious diseases in the poorest countries, plus funds to share US expertise on controlling AIDS in the military with African nations. The debate recognized the epidemic as an international security issue since it could "decimate the economic, political and military establishments in many countries[and]is being more effective than war in destabilizing[them]". Peter Piot(UNAIDS)said he needed $1-3b a year in Sub-Saharan Africa alone. The Economist 29 Apr 00"Africa’s Twin Scourges"(17-8);"Aid for AIDS"(76):-these articles are valuable in going beyond the schemes to fund urgent research on cures for Third World diseases(as pharmaceutical companies see no profit),to also consider market costs. Already AIDS kills 2.5m and malaria 2m annually, mostly in Africa and climbing fast. The economic impact is huge. Malaria's cost is over 1% of GNP. Since AIDS weakens/kills prime workers, skills and productivity are hit hard. Moreover, in any given country a year of basic HIV medical treatment for one now costs 2-3 times per capita GNP, and once the adult infection rate reaches 8%(the case in 21 countries), per capita growth is lowered .4%(Africa recently averaged only 1.2%). Yet global AIDS vaccine research in 1999 drew only $300m, of which a tiny fraction was specifically for LDCs. Since any successful vaccines must be marketed very cheaply there, the authors urge that donors heavily subsidize both research and distribution. The costs of tackling malaria are estimated at $1b annually, but this could benefit sub-Saharan Africa’s combined GNP $3-12b. Neil A. Lewis"Clinton Tries to Expedite AIDS Drugs Into Africa"NYT 11 May:- article reports that, in spite of strong opposition from the pharmaceutical industry, President issued an executive order on 10 May declaring US government will not seek to interfere with any countries in sub-Saharan Africa that may violate American patent law in order to provide AIDS drugs at lower prices. (An identical Congressional proposal was withdrawn because of industry opposition.) The order would allow African states to licence local companies to produce cheap generic versions or import the drugs cheaply from third countries without paying US prices kept high by patents. Reuters"Roche Says to Slash AIDS Drugs Prices"11 May:-Swiss pharmaceuticals giant Roche announced it would slash prices of AIDS drugs for LDCs, and offer free logistics support, under a UN initiative responding to the African crisis. Arrangement also involves four other companies, but the timing and prices are”subject to negotiations”. McNeil"Companies to Cut Cost of AIDS Drugs for Poor Nations"NYT 12 May:-the next day five major pharmaceutical companies offered to negotiate, with WHO and other aid groups, steep cuts in the price of their patented AIDS drugs for Africa and other poor regions. UNAIDS acknowledged a“promising step in a long-term process [but] only one critical factor in what must become a much broader and more urgent effort". The allusion is to the additional need globally for much more Third World-relevant medical research and much better AIDS-related education and health systems in the Third World(see Economist 14 Aug 99, 29 Apr 00, Olson op.cit.). McNeil"Prices for Medicine Are Exorbitant in Africa, Study Says"NYT 17 Jun:-article reports huge anomalies in the prices of vital drugs. One study found "the price of life-saving medicine in Africa, where the need is greatest and the poverty is worst, is often higher than in Europe and North America... [T]he medicine...patients need for AIDS...are often available only at exorbitant prices”(by any standards)-particularly in South Africa. A UNAIDS study of prices in Brazil, which like India ignores Western patents and makes cheap copies of new drugs, found them very low compared with Africa or US, but also unreliable. Many poor countries use a low-price WHO bulk-purchasing system, but have high loss rates. Kenyan Health Minister summed up the basic problem:”How can we be denied access to drugs that prolong life when people are dying?” Reuters,“SADC(Southern African Development Community) Ministers Unable to Respond to AIDS Drugs Offer”NYT 17 Jun:-five leading drug companies offered to cut the prices of HIV/AIDS therapies by up to 80% for poor countries as part of a UN deal, but the SADC concluded they still had neither the funds nor infrastructure to afford the offer. McNeil“Writing the Bill for Global AIDS”NYT 02 Jul:-an AIDS expert explains that in the Third World the epidemic is”really a welfare and education issue rather than a medical one”. The $2b estimated in a UNAIDS report as the annual cost of providing Africa with ”minimum prevention and care”would have to go almost entirely for preventive measures even if cheap drugs were available. Of the 34m HIV-infected people worldwide, at least 30m are so desperately poor that most have to be simply“written off”so limited funds available/realistic can be invested in prevention, not treatment. Financial triage. Lawrence Goldyn“Africa Can’t Just Take a Pill for AIDS”NYT 06 Jul:-President Mbeki of South Africa has been justly criticized for doubting the (proven) value of AZT and the (clear) sequence from HIV to AIDS, but he was right in claiming that the pharmaceutical-based model of HIV care in the West is not applicable to(South)Africa. “Cost is the obvious barrier to drug therapy”; even if subsidized to 10% of their cost in the West, they would be well beyond African means. But "the lack of social, economic and medical structures to support drug treatment"means that even if cheap“drugs arrived by the shipload” - as proven by past TB programs, the problem is getting people to take them.”What Africa most needs is an HIV vaccine” - but potential African returns are not so far worth massive research investment by drug companies. Moreover, controlling HIV in(South)Africa would require a huge international investment, not merely sufficient to create incentives to produce drugs, but also to distribute them, and to provide clean water, sanitation, clinics, health education, refuge for women, and care for children. Lawrence K. Altman“A Call for Fair Access to Future AIDS Vaccine”NYT 07 Jul:- reports on a “blueprint” proposed by the International AIDS Vaccine Initiative, a research consortium that works closely with UNAIDS. This addresses exactly the dual economic and infrastructure challenges just outlined. The consortium urges that:”Though a vaccine to prevent AIDS is years away, steps should be taken now to enable a vaccine to be distributed widely in the third world as soon as it becomes available”. It admits both public and private sectors must learn new ways of doing business to accomplish "sweeping changes in the way vaccines are produced, licensed, priced, bought and distributed"-and offer special delivery systems and counselling. There is usually a 15-year lag between availability of key vaccines in rich and poor countries; but an avoidable 5-year lag in distributing an AIDS vaccine would severely damage many African economies - and cost at least 20m lives! Existing WHO programs can be exploited, but pricing structure is WTO business. Reuters “Botswana Pres.: Nation Faces Extinction From AIDS”NYT 08 Jul:-”AIDS has put the people of Botswana, probably more than any other, on a knife-edge between prosperity and poverty”. Perhaps the most democratic and prosperous state in Africa now has the highest rate of HIV/AIDS infection in the world - mainly spread by the sex trade. One in three adults is already infected, and advanced AIDS will not peak for 5-10 years, so President Mogae was not being rhetorical when he told the Reuters journalist a country of 1.6m people“faces extinction from the disease”. No antiretroviral drugs are available: even at reduced prices, they are simply too expensive even for“successful”African states to buy, distribute and administer. Reuters“Gates, Merck to Give Botswana $100m AIDS Help”NYT 10 Jul:-in direct response to Mogae’s statement to Reuters, the Gates Foundation and Merck and Co. will contribute $100m over five years in cash, expertise, antiretroviral drugs, etc. to”help Botswana strengthen its primary health care system. German/British/Dutch firms will also donate medication and expertise. McNeil“As Devastating Epidemics Increase, Nations Take On Drug Companies”NYT 09 Jul:- an extraordinary article containing extraordinary information. It relates to attempts by Pfizer, supported by the US government, to defend its patent, and high prices, for fluconazole, an effective anti-fungal treatment for cryptococcal meningitis, an AIDS complication that blinds and then kills within two weeks, and attacks about 9% of all AIDS patients(20+% in Thailand). Fluconazole’s cost in Kenya is $18 per pill. Treatment requires two a day for 8 weeks($1,080), then one a day for the rest of the patient’s life($540 a month). Good Kenyan earnings would be $40-45 a month; the national health budget averages $5 per person per year. Local doctors at a foreign aid agency are"so furious at Pfizer’s pricing policy"they illegally smuggle generic Thai fluconazole pills(60 cents)into Kenya -"part of the titanic struggle...between pharmaceutical companies and public health advocates over the cost of drugs like fluconazole and who has the right to produce and market them". Thai action is based on 1994 World Treaty on Intellectual Property(TRIPS)that allows countries to manufacture or import generic drugs to avert national disaster(AIDS) -“compulsory licensing”. When South Africa first proposed to use this clause, both Pfizer and the US government threatened severe sanctions, but when it became a presidential campaign issue, the US changed its position. Pfizer will now provide fluconazole free to any South African with AIDS who could not afford it; the offer might eventually be extended to all Africa. Associated Press“US Hopes To Raise Anti-AIDS Funding”NYT 11 Jul:-article reports that US government is raising its budget to stop the spread and effects of AIDS to more than $200m, double the 1999 amount, but hopes for similar increases from other donor countries. Head of the White House AIDS office stressed that,“With no vaccine or cure in sight, we are at the beginning of an epidemic, not at the end”. Reuters“HIV Drugs for All Would Cost $60 Billion - Report”NYT 11 Jul:-Panos Institute(London) report estimates at least 12m with HIV worldwide(40% of those infected)need antiretroviral therapy at a cost of $60b a year at current prices. Building national health systems and providing skilled personnel ”would cost additional billions”, so prices must fall by 95% for the drugs to be available to the majority of people infected. Hence, Panos recommends “compulsory licencing” which grants the right to manufacture and sell locally at low prices. Since most drug companies oppose this, debt relief is another possible solution. Joseph Kahn“U.S. Offers Africa Billions to Fight AIDS”NYT 19 Jul:-the US Export-Import Bank will offer Sub-Saharan Africa $1b in loans annually to finance the purchase of American AIDS drugs and medical services. Most of the new loans would be provided at commercial interest rates(now about 7%)but at long(5-year)terms, although a few “might be at a lower concessional rate”. This decision follows the agreement by five multinational drug companies to cut the prices they charge African states for drugs to combat AIDS, since these will still be expensive at prices discounted 80-90%. Some argue that the straight donation of drugs is necessary; others that debt forgiveness of as much as $100m globally would be a better way to free up funds. The UN estimates the cost of fighting AIDS in Africa at”$3b annually if the nations hardest hit are to make significant progress in education, prevention and care”. It is exploring the possibility of Africa buying generic drugs from Brazil and India at even lower than 90% discounted prices (still $2000 per patient per year). Reuters“Australia Hikes Overseas Spending on HIV/AIDS”onhealth.com, 27 Jul:-FM Downer announced at a regional conference that the Australian pledge for ODA on world AIDS assistance had been raised from A$130m to A$200m. Most will be allocated to the Asia-Pacific region which has been relatively successful in holding the HIV epidemic at bay. Only three Asian countries have infection rates above 1% among 15-49 year olds according to UNAIDS. These are Cambodia, Myanmar and Thailand, and Thailand has been praised for instituting a successful program to control an already serious outbreak. While the Australian six-year overseas initiative already is committed to projects in Indonesia and Papua New Guinea, much funding is available for new projects. This may be fortunate: the low UNAIDS rates are known to miss huge numbers of already infected Asians. In India, 3.7m are known/admit to be infected already; in China, .5m - mainly drug users - are(officially?)estimated to have HIV/AIDS. XINHUA“SADC Calls for Cheaper Anti-AIDS Drugs” onhealth.com, 07 Aug:-the SADC Council of Ministers, with UN cooperation, met the pharmaceutical companies’ unrealistic offer of discounted anti-AIDS drugs alone with the reasonable counter-proposal that if very poor countries are expected to accept(and pay for)the drugs package, it must be“as comprehensive as possible” and provide not only medicines but “the whole range of services needed to make these interventions effective”. Rachel L. Swarns, “Loans to Buy AIDS Drugs Are Rejected by Africans”NYT 22 Aug:-US Export-Import Bank offered 24 African countries $1b in annual loans(at commercial rates: 7%)to finance purchase of anti-AIDS drugs - but none has accepted or is likely to, however desperate their health situations. Those officials consulted for the article(South African, Namibian, AIDS experts at the 14-member SADC)all said poor African countries are“already burdened by debt. Making drugs affordable is the solution rather than offering loans that have interest”. Ironically, the West is currently planning to forgive as much as $100b of poor countries’ debt precisely to free scarce funds for health etc., and UNAIDS is seeking a steep drop in prices of costly anti-AIDS therapies from drug firms for poor regions stricken by the pandemic. Further, South Africa and Thailand recently authorized seizure of patents for AIDS drugs(with full US government approval)and India, Bangladesh and Brazil simply ignore drug patent treaties in such circumstances and produce generic drugs. Marc Lacey“President Urges Nigeria to Fight Tyranny of AIDS”NYT 28 Aug:-Clinton, on Nigerian visit, rightly urged elimination of AIDS-associated taboos:“we need to fight AIDS, not people with AIDS”. He offered no new funds but promised duty-free status to Nigerian exports and noted AIDS education is part of the military course US troops offer Nigerian peacekeepers. President Obasanjo gives AIDS priority, but pointedly stressed:”We don’t see it as a Nigerian disease. We see it as a world disease that is ravaging Africa most”. The Economist 30 Sep“Generic Genius: Indian Pharmaceuticals”(66-9);“A Problem of Patents”(69):-related articles illustrate the fact that the global pharmaceutical industry is in a period of rapid and important change: more/critical discoveries; huge/desperate needs; evolving manufacturing/trade; bitter conflicts over patents; wildly divergent prices for some life-saving drugs. More specifically the first reveals: drugs with sales of $40b are likely to lose patent protection in the next three years; some Third World countries are major producers of cheap generic drugs(some before patents run out); and some of India’s 20,000 drug makers in particular are trying to break into rich world markets. The second article sees such low-cost producers as a possible means of getting more expensive new drugs to the poor. Fluconazole, protected by patents, now costs $10 a pill wholesale in the US, but only 25 cents in India where its patent is not recognized and there are no R&D costs to recoup. Medecins Sans Frontieres want to expand sales of affordable drugs from capable generic companies in Brazil, India, Thailand in other poor countries. However, the latter also must have a “loose”patent policy. Those with tough patent laws(e.g. South Africa)have to apply for special dispensation from the patent holder, or invoke the TRIPS “national disaster”clause(see above) - and all countries are now under obligation from WTO to implement strong TRIPS-type laws. AIDS is getting even costlier for the poor.


(HENCEFORTH, I’m afraid coverage of items will have to be shorter, or it will simply not be possible to keep up with the media. The gist of articles can be derived from their titles, UNLESS titles are so ambiguous/ uninformative that brief notations are necessary. Unless it is otherwise indicated, all articles were published for, or at least in, New York Times(NYT). Authors' names are identified fully only the first time they are listed. After that, they may be identified only by surnames. Dates are identified by: two-digit day-number, followed by first three letters of month. All four (or last two) numbers of year ONLY IF AMBIGUOUS/NEW.)



A1. SOURCE/LEVEL OF DRUG PRICES IN NEEDY COUNTRIES(COST)


McNeil“Selling Cheap‘Generic’ Drugs, India Copycats Irk Industry”01 Dec 00. Indian patent law allows for generic drugs to be produced in the country, angering many pharmaceutical companies. Tina Rosenberg“Look at Brazil” 27 Jan 2001:-Indian/Brazilian examples of how the AIDS cost-patent crisis may be soluble: Third World generic production and sale. Reuters"Brazil May Defy U.S. and Make More AIDS Drugs”03 Feb:-Brazilian patent law which enables patients to take free antiretroviral drugs is being criticized by the US due to intellectual property rights. AP“Drug Co. Offers Cheap AIDS Drugs”07 Feb:- company, Cipla Ltd, to sell AIDS drugs for $350 a year rather than $10 000. Reuters“Indian Firm Offers AIDS Cocktail for $1 a Day”07 Feb:-Cipla Ltd. will sell cheap triple-cocktail of AIDS drugs to developing nations. McNeil“Indian Company Offers to Supply AIDS Drugs at Low Cost in Africa”07 Feb:-Cipla Ltd. to sell their generic drugs at $350 a year. AP“OXFAM Takes Aim at Pharmaceuticals” 11 Feb:-Oxfam is urging the WTO to renew its position towards patent laws so that poor nations can receive generic versions of AIDS drugs. Sara Chartrand“ Patents: In Health Emergencies, Brazil Allows the Copying of Drugs”19 Feb. Reuters“ S.Africa Okays Pfizer AIDS Drug Distribution”21 Feb:-US pharmaceutical Pfizer to give its AIDS drug Diflucan for free distribution within hospitals in order to prevent resale of the drug. AP“South Africa to Get Free AIDS Drug”21 Feb:-same coverage as above. Reuters“CIPLA to Meet With WHO on Discounted AIDS Drugs”26 Feb:-:Cipla’s offer to the charity is aimed primarily at Africa, where antiretroviral drugs used in the West are out of reach of virtually all the 25.3 million people on the continent who are infected with the HIV virus”. Reuters“Firm Creates Africa AIDS Fund to Deliver Free Drugs”28 Feb:-small US firm Phyto-Riker creates $250m fund to buy and distribute AIDS drugs free in Africa. Reuters“Merck Leads New Round of AIDS Drug Price Cuts”07 Mar:-US pharmaceutical Merck and Co Inc. says it will distribute their AIDS drugs in poor nations at cheaper price even though the company will receive no profit on their sale. Reuters “AIDS Drugs Land in South Africa Amid Patent Dispute”08 Mar. Pharmaceutical Manufacturers Association of South Africa (PMA)is in a legal dispute with the S. African government over the free distribution of AIDS drugs donated by US. Sheryl Gay Stolberg“AIDS Drugs in Africa: If Cedes to When”10 Mar:-PMA who represents 39 drug companies have sued S. African government over distribution of free AIDS drugs while protesters demand price cuts in region. McNeil“Yale Pressed to Help Cut Drug Costs in Africa”12 Mar:-legal battle among university students and the university’s patent contract agreement with Bristol-Myers Squibb over the distribution of the AIDS drug d4T to Africa. AP“Romania to Get HIV Drug Price Cut”12 Mar:-Merck & Co. to provide reduced prices on their AIDS drugs due to “only 40 percent of AIDS and HIV infected patients receive drug therapy”. AP“Studies: HIV Drugs a Good Buy”14 Mar:-US study shows AIDS drugs are of better value at extending patients’ life than drugs for other illnesses. Petersen and McNeil“Maker Yielding Patent in Africa for AIDS Drug”15 Mar:-US pharmaceutical Bristol-Myers Squibb will no longer try to stop cheap generic versions of AIDS drugs “d4T”, since they are distributed to many infected people in Africa. AP “Abbott Cuts African AIDS Drug Prices”27 Mar:-US drug maker Abbott Laboratories will sell their AIDS drugs “Kaletra” and “Norvir” at extremely cheap prices to African nations. Reuters“Brazil Wins Fight Over Prices of Merck AIDS Drugs”29 Mar:-due to pressure from the Brazilian government, US drug manufacturer Merck and Co. will reduce the price of its two AIDS drugs “Indinavir” and “Efavirenz” in the country. Petersen and Larry Rohter“Maker Agrees to Cut Price of 2 AIDS Drugs in Brazil”31 Mar:-Swiss pharmaceutical Hoffman-La Roche is also pressured by the Brazilian government to slash the price of their AIDS drug “nelfinavir”. Bloomsberg News“ F.T.C. Accuses Drug Makers of Collusion to Delay Generics”03 Apr:-Federal Trade Commission has discovered a $90m payment by many big pharmaceutical companies to small generic drug maker firms in order to delay the distribution of low-cost AIDS drugs. Reuters“6 Companies in New AIDS Pact”06 Apr:-UNSG Annan wins agreement from major drug companies to continue cutting prices of AIDS drugs to poor nations. Petersen “Consumer Groups Unite To Fight For Generic Drug” 08 Apr:-US consumer groups have filed a lawsuit to Bristol-Myers Squibb because the company is trying to block other cheap generic versions of their drugs available to the public. AP“Bush Plan Cuts Drug Reimportation”09 Apr:-Bush administration will not allow cheap, re-imported US-made drugs to be distributed within the country. AP“South Africa Drug Suit Postponed”18 Apr:-lawsuit by pharmaceutical companies to the S. African government over patent rights on the distribution of AIDS drugs, is receiving wide criticism by AIDS activists and labour unions and demand the lawsuit to be removed. Rachel L. Swarns“Drug Companies Begin Talks With South Africa”18 Apr:-amidst popular and international dissent over the lawsuit by the 39 pharmaceutical companies, the drug companies are negotiating with the S. African government over importing generic drugs. Swarns“Drug Firms Drop South African AIDS Case”19 Apr:-the attempt to stop S. Africa importing/producing cheaper anti-AIDS medication ends. Andrew Pollack“New Analysis: Defensive Drug Industry Fuels Fight Over Patents”20 Apr:-editorial dealing with pharmaceutical companies and their protection of patent laws are under attack due to the high cost of the drugs in which people in poor nations cannot afford to buy. AP“Profits Still Plague AIDS Drug Cos.”21 Apr:-closer look as to how several major drug companies are concerned over patent laws and the rise of public opinion weakening its importance. Petersen“Lifting the Curtain on the Real Costs of Making AIDS Drugs”24 Apr:-generic drug-makers talk about the low cost of producing generic AIDS drugs and how if benefits the survival of many HIV infected victims. Reuters“Global AIDS Fund To Push Drug Firms To Cut Prices”01 May:-British ministers propose rich nations to contribute money to the UN’s Global AIDS Fund in order to pressure pharmaceutical companies to lower their prices of AIDS drugs. Barbara Crossette“Brazil’s AIDS Chief Denounces Bush Position On Drug Patents”03 May:-Bush accused in being tough on Brazilian generic AIDS drugs. AP“Drug Companies Cut Africa Prices”03 May:-many pharmaceutical companies considerably reducing the price of their AIDS drugs, among these companies Swiss-based Novartis. WHO and Medecins Sans Frontieres are grateful for the offers. Terence Neilan “President Pledges $200 Million to New Fund To Fight AIDS”11 May:-money to be given to developing nations especially Africa. AP“WHO Adopts Weakened AIDS Statement”19 May:-US and European states dismiss any authority the WHO has over the patent laws, which they claim the WTO is responsible. Reuters“Glaxo to Cut Cost of AIDS Drugs for Kenya”24 May:-major AIDS drug maker will reduce price after Kenyan threat to acquire cheaper drugs. AP “Pfizer expands Free AIDS Drug Plan”06 Jun:-US company will lower price of AIDS drugs to 50 poor nations. Crossette“AIDS Fungus Drug Offered to Poor Nations”07 Jun:-same story. Andrew Ross Sorkin “Bristol-Myers Squibb to Acquire DuPont Unit”08 Jun:-$7.8b paid for drug unit in order to compete in world market. AP“Swiss Insurer Gives to UN AIDS Fund”08 Jun:-the first corporate donation of $1m by Winterthur Insurance to the UN AIDS Fund. Don Colarusso“Hope for AIDS Vaccine Fuels a Stock’s Ascent”10 Jun:-Vaxgen a small US pharmaceutical company has been using human test subjects for their newly developed AIDS drug “AIDS vax” which has proven to be effective, giving them a rise on the company’s stock price, many researchers are skeptical of the effectiveness of the drug. Robert Pear “Measure Easing Imports Passes in House”12 Jul:-US House of Representatives allowed for public to import cheap generic drugs for personal use, angering many pharmaceutical companies. AP“Gates Donates $100M to U.N. for AIDS”19 Jun. AP“Coca-Cola to Help Africa AIDS Fight”20 Jun:-among other MNCs allowing for transport t/distribution of AIDS drugs in many AIDS-stricken regions of the continent particularly S. Africa. McNeil “U.S. at Odds With Europe Over Rules on World Drug Pricing”20 Jul:-Bush and the EU debating as to how to better distribute AIDS drugs to developing nations. The US president stance is to protect patent rights of the AIDS drugs while the EU is pushing for more generic drugs to be allowed in poor countries. Christopher S.Wren “Holbrooke Has New Role: Leading Fight Against AIDS”20 Jun:-former US ambassador to UN pressing MNCs to contribute to AIDS costs in LDCs. AP“U.N. Welcomes Corporate AIDS Funds”21 Jun:-Due to many MNC’s such as Coca Cola and Chrysler contributing by giving donations for the fight against AIDS, UN is encouraging them to give to the Global AIDS fund as well . Crossette “U.S. Drops Case Over AIDS Drugs in Brazil”26 Jun:-US allows patent case to be settled out of court. Peterson”Drug Maker Is Set to Ship Generic Prozac”02 Aug. US company awaiting the Food and Drug Association (FDA)approval in order to ship their product all over the world. Reuters ”Central America Teams Up to Buy AIDS Drugs”11 Aug:-six countries to buy drugs at bulk-price from major companies. AP“Brazil to Strip Patent on AIDS Drug”23 Aug:-claiming national emergency, Brazil removes patents on AIDS drugs distributed by Roche pharmaceuticals. AP“HIV Vaccine Creators Share Patents”24 Aug .US and British drug manufacturers have signed a three year agreement on the ownership of their AIDS vaccine which is in a testing phase. Peterson “Roche Asks for Meeting With Brazil Health Minister”24 Aug. Reuters “Brazil and Roche Agree on AIDS Drug Price Cut”31 Aug:-Brazil persuaded Roche to lower price since its government will allow for the production of the“nelfinavir”a generic AIDS drug that Roche manufactures. Mcneil“A Rush for Cipro, and the Global Ripples”17 Oct:-As the US is desperate to buy Cipro, an antibiotic designated to cure against Anthrax, from cheaper generic companies, the developing nations will copy the US’s move for the purchase. Pollack“Drug Makers Wrestle With World’s New Rules”21 Oct:-major drug companies claim that their production of antibiotics such as Anthrax is due to US demand for countering bioterrorism but their real priority reflects the US government’s creation of a rich market for Anthrax cures. Edmund L.Andrews“Bayer Reaches Deal on Cipro to Protect Patent in Canada”23 Oct. Keith Bradsher with Edmund L.Andrews “U.S. Says Bayer Will Cut Cost of Its Anthrax Drug”24 Oct:-A price concession between the Bush administration and Bayer has been made in order for the US to buy Cipro at a patent price. AP “Smallpox Vaccine Makers Watch Feds”25 Oct:-Pharmaceutical industries are worried that the US will not purchase their vaccine drugs but rather generic. Economist“Dealing with anthrax: Patent problems pending”25 Oct:-Article discusses how developed nations are able to break patent laws while developing nations cannot. Bradsher “Bayer Halves Price for Cipro, but Rivals Offer Drugs Free”26 Oct:-Keith Bradsher with Melody Peterson “Drug Companies Aim to Please”27 Oct:-Major drug companies are looking to maintain their patent laws through public relations and their contribution to bio-terrorism in the US. Daniel Akst “It’s Time for Teamwork on New Drugs”04 Nov:-an editorial commenting the problems of patent laws and its effect on poorer nations who cannot afford to buy AIDS drugs. Leslie Wayne and Melody Petersen“A Muscular Lobby Tries to Shape Nation’s Bioterror Plan”04 Nov:-Major pharmaceutical companies winning concessions to maintain their patent laws in the US while maintaining a close relationship with the Bush administration. McNeil“Patens or Poverty? A New Debate Over Poor AIDS Care in Africa”05 Nov. Milt Freudenheim“ Court Reverses U.S. Approval of Generic”07 Nov:-US federal court overturned the government’s approval for the distribution of a generic pill. Amy Harmon“Suddenly , ‘Idea Wars’ Take on a New Global Urgency”11 Nov:-As the meeting for global trade in Doha, Qatar is near, many questions by developing nations emerge over the US handling of patent laws. Reuters“Trade Round Hopes Rise After WTO Deal on Drugs”12 Nov:-An agreement over the sale of generic drugs to developing nations has emerged during the Doha Round conference. McNeil“Tuberculosis Group Tries to Spur Research for New Antibiotics”15 Nov:-Pharmaceutical companies research for cure that bring in $1billion yield of return, many diseases such as tuberculosis do not get the proper research due to the lack of financial incentive. Louis Uchitelle “U.S. Industries Largely Favor Decision on Global Trade”15 Nov:-Generic medicine can be made in developing nations for the treatment of AIDS and other lethal epidemics. Celia W.Dugger “A Catch-22 on Drugs for the World’s Poor”16 Nov:-Poor countries do not have the essential resources for the possibility of producing generic medicine for the treatment of AIDS. Jennifer L.Rich“Brazil Welcomes Global Move on Drug Patents”16 Nov. AP“Activists Slam Drug Dev. Cost Study”30 Nov:-A study shows that pharmaceutical companies’ claim for the cost of their medicine is deliberately overpriced. AP“Profits From AIDS Drug Help Samoans”14 Dec:-The healing knowledge of a particular tree in Honolulu might bring a cure for AIDS. Larry Rohter“Brazil Sees Promise in Jungle Plants, but Tribes See Peril”23 Dec:-By having “nearly one-quarter of the world’s plant species”, Brazil is pushing for restrictions that will allow these plants to be researched for medicinal purposes only. McNeil “New List of Safe AIDS Drugs, Despite Industry Lobby”21 Mar 2002:-WHO listed/approved generic drugs thus angering multinationals. AP “AIDS Group Battles GlaxoSmithKline”27 May:-Activists are arguing that the British pharmaceutical is still overpricing its product. Economist “The bitter pills”05 Jun:-Bristol Meyer, US drug company, being sued over its prevention of not allowing for generic medicine. Reed Abelson“Glaxo Freezes Prices AIDS Drugs in U.S.”21 Jun. Elizabeth Olson“U.S. Backs New Trade Rules on Drugs”25 Jun:-US agrees on the sale of generic drugs against AIDS to be available in poorer nations. Reuters “AIDS Conference Opens Amid Controversy”07 Jul:-Barcelona international AIDS conference was overshadowed due to AIDS activists demanding for cheaper drugs to be sold to poorer nations. NYT“Brazil to Share AIDS Drugs”09 Jul. Reuters“AIDS Activists Trash EU Commission Stand at Meeting”10 Jun:-AIDS activists in Spain want the EU to contribute to the AIDS effort. Economist“AIDS: Hope for the best, Prepare for the worst”11 Jul:-A concise article dealing with the positive results from the AIDS conference in Spain. Howard W. French“Whistling Past the Global Graveyard”14 Jul:-Richer nations reluctant to contribute to AIDS fund due to their focus on terrorism or the gulf war. Economist“Generic drugs: A good week for copycats”01 Aug:-Generic manufacturers receive legislative support in producing their medicine. Henri E. Cauvin“Mining Company to Offer H.I.V. Drugs to Employees”07 Aug:-A company in South Africa is supplying AIDS drugs to its employees. Economist“Business and AIDS: Digging Deep”08 Aug:-South African miners receive AIDS drugs from its employer. Economist“AIDS and South African business: Strategic Caring” 03 Oct:-Many companies in South Africa are initializing new policies to stop the spreading of AIDS. AP“FDA to Review New AIDS Drug Fuzeon”11 Oct:-An expensive AIDS drug has been discovered in which its approval process will be shortened. NYT“Annan Warns China of an AIDS Epidemic”15 Oct:-Gregory Crouch“Europeans Investigate Resale of AIDS Drugs”29 Oct:-Trafficking of AIDS drugs which were meant to be sold to poorer nations are being sold in the European market. Economist“Face value: The acceptance face of capitalism?”12 Dec:-Drug companies’ bosses need an exceptional public relations image in order for their companies to be seen credible. Economist“Drugs and Developing Countries: Pill Paupers”19 Dec:-Report on the WTO pushing for a concession between drug companies and the generic manufacturing of their product. Elizabeth Becker“U.S. Official to Discuss Trade as Africa Hopes to Talk AIDS”11 Jan 2003:-Elizabeth Becker and Edmund L.Andrews“Performing a Free Trade Juggling Act, Offstage”08 Feb:-US trade representative will decide if generic drugs should be sold to sub-Saharan Africa. Economist 22 May“The Cost of AIDS: An Imprecise Catastrophe”(68-71):-"The most dreadful cost of AIDS is in lives lost. A second cost, shared by those not infected, is economic. However, estimating the damage done by the disease, especially in southern Africa’s mostly feeble economies, is an inexact exercise even by the standards of economics, because AIDS has struck hardest in areas where data are least accurate: subsistence farming, casual labour markets, rural barter and so forth”; Amelia Gentleman & Hari Kumar“AIDS Groups in India Sue to Halt Patent for U.S. Drug”NYT 11 May 2006:-“AIDS groups this week brought important test of India’s new patent law, which restricts ability of Indian companies to produce low-cost generic drugs. Two patients-rights groups sued to stop Gilead Sciences, California biopharmaceutical company, from patenting the antiretroviral drug Viread - company’s brand-name version of tenofovir, which is available [in India] as a generic drug. If it is patented, the groups contend, making the cheaper versions will become illegal, and the drug will become too expensive for patients...in developing countries... Doctors Without Borders [stated:] ‘People in Africa and Caribbean are relying on India to produce these drugs. Quality matches that of US-manufactured drugs, but prices affordable’. Lawyers for two [Indian] groups... presented arguments contending tenofovir not new drug, but modified version of earlier drug, and therefore not eligible for new patent under India’s new law. Those backing legal challenge hoping to gain legal precedent for use in other patent applications... WHO recently recommended tenofovir for patients just starting treatment for AIDS and those who have been receiving antiretroviral treatment therapy but resistant to other treatments. In [rich] countries, Gilead’s tenofovir costs $5,718/person/year. Cipla, one of largest companies in India, marketing version called Tenvir, at cost of $700/person/year in India. Chairman Cipla said drug eventually available in Africa for about half that price. But Tenvir would have to be withdrawn if Gilead were given patent,.. in effect for 12 years. Gilead Sciences said... ‘[W]e believe Viread represents innovation and parentable under Indian law. We will use this patent responsibly, and not block access to our medication in India or other resource-limited countries where HIV epidemic hit hardest’. Company... ‘pursuing broad policy of nonexclusive voluntary licensing under patent to generic manufacturers in India for local Indian market as well as provision for manufacturers to export product to 97 developing-world countries included in Gilead’s access program’”;


A2. EFFECT/ADJUSTMENT OF DRUG PRICES IN NEEDY COUNTRIES


Jennifer L. Rich“Explosion of Generics About to Occur in Brazil”23 Nov 2000:-joint venture between Teva, generics manufacturer, and local Loboratorios Biostetica, makes more generics available. Reuters“Chirac Says EU Not Doing Enough to Combat Aids”01 Dec:-French President claims EU should increase anti-AIDS work in Africa. Swarns“South Africa to Distribute $50 Million in Donated AIDS Drugs”02 Dec. AP“U.N. Steps up AIDS Fight in Africa”07 Dec:-UNSG Annan and African leaders pledge to unite political-economic resources to conquer AIDS. AP“U.S. to Help Fight AIDS in Botswana”12 Dec. McNeil“Romania’s AIDS Children: A Lifetime Lost”07 Jan 2001. Reuters “Bill Gates Gives $100 Million for AIDS Vaccine”27 Jan. Reuters“Economic Leadership Lacking in Global AIDS Epidemic”05 Feb:-Dr. Jeffrey D. Sachs claims economic response to AIDS pandemic ‘utterly inadequate’. McNeil“Oxfam Presses to Make Drugs Cheaper for Poor Countries”13 Feb. Reuters“UN Agency Urges Drug Cooperation”16 Feb:-head of Joint UN Program on HIV/AIDS(UNAIDS)urges cooperation among activists, pharmaceutical firms, governments. Economist “Science and Profit”17 Feb:-Editorial argues drug companies must cover R&D costs somewhere. They would be willing to increase their sales in poor countries through extremely low prices there - if they could maintain their profits in the West. “The case for much more generous provision of life-saving drugs to the developing countries is irresistible both morally and as a matter of economics. But it is naive, wrong, and in the long run counter-productive, to expect the cost of this aid to be met out of drug-company profits.” Reuters“AIDS Drug Costs Must Fall in Poor Nations: UN”21 Feb:-UNSG Annan’s report to UNGA states: "people in developing countries are dying needlessly for lack of appropriate care”; hence drug companies and governments must do more”through all possible means”to bring down the cost of AIDS therapies so patients in poor nations can gain access. AP“Priest To Import AIDS Drug to Kenya”21 Feb:-US priest working with HIV-positive orphans in Kenya plans to import cheap generic drugs from India. McNeil“Bush Keeps Clinton Policy on Poor Lands’ Need for AIDS Drug”22 Feb. AP“Aid Agency To Distribute AIDS Drugs”24 Feb:-Doctors Without Borders will buy anti-AIDS cocktail from Indian company Cipla for 10 poor countries. Reuters “Protests As Drug Firms Take on S.African Govt”05 Mar. AP“South Africa Fights Over Aids Drugs”05 Mar. Reuters“South African AIDS Drug Case Postponed Until April”06 Mar. AP“Botswana Firm Subsidizes AIDS Drugs”07 Mar:-DeBeers (diamonds)will subsidize anti-AIDS drugs. AP“S.Africa: AIDS Drug Need Is Heeded”08 Mar:-Merck and Co plans to sell two key AIDS drug to poor countries at 1/10 normal price, while Indian-based Cipla offers to sell cheap generics. Swarns“South Africa May Cite Crisis to Lower Cost of AIDS Drugs”12 Mar:-government considering declaration of national emergency to eliminate legal obstacles to importing/producing cheap generic HIV/AIDS drugs. AP“No State of Emergency in S. Africa”14 Mar:-President Mbeki refuses to declare state of emergency over AIDS epidemic. Swarns “No National Emergency, South African Leader Says”15 Mar. AP“Ivory Coast Winning AIDS Drug War”19 Mar:-Ivory Coast quietly importing generic AIDS drugs for years without problems. Swarns“AIDS Obstacles Overwhelm a Small South African Town”29 Mar:-in Hlabisa, single doctor must dispense all desperately-needed anti-AIDS drugs. Reuters“South Africa Says Key AIDS Drugs Still Too Costly”06 Apr. AP“Mali Gets Deal on Western HIV Drugs”08 Apr:-Mali to obtain cut-rate HIV drugs from four major firms. AP“Few Benefit From African HIV Deals”11 Apr:-six sub-Saharan countries strike deals with major Western drug firms but only few thousand expected to benefit. Reuters“South Africa Confident of Winning Drug Court Case”12 Apr:-government(sic) expects to win landmark patent case against world’s most powerful drug firms. Economist “Economics Focus: Markets for Ideas”12 Apr:-discusses the economic arguments pro and con intellectual property rights, concluding that since ideas are not reduced through use, “Poor countries have every reason to question the [intellectual property-related] trade-policy bargain”. Reuters“Mandela Slams Drug Makers, Chides S. African Government”20 Apr:-former president castigates 39 major drug firms for taking South Africa to court to prevent import/manufacture of cheap AIDS drugs. AP“Africa Ministers OK AIDS Drug Plan”25 Apr:-agree on joint declaration to import generic AIDS drugs, and boost spending dramatically on AIDS programs. Reuters“A Call for AIDS Superfund”26 Apr:-UNSG Annan proposes global superfund to halt/reverse pandemic which kills 2.8 million annually. AP“African Leaders Discuss AIDS Drugs”27 Apr. NYT “Africans Unite in Seeking More Funds to Halt Spread of AIDS”28 Apr. Joseph Kahn“Rich Nations Consider Fund of Billions to Fight AIDS”29 Apr. Crossette “Experts Say That Cheaper Drug Treatments Alone Are Not Enough”30 Apr:-claim need more effective education/prevention, better clinics, more trained health care workers, imaginative development projects to tackle AIDS epidemic. Reuters“Annan Calls on Foundations to Back AIDS War Chest”30 Apr:-UNSG calls on US foundations to throw financial weight behind new global AIDS fund. Crossette“U.N. Chief Asks for New Funds to Fight AIDS”09 May:-Annan asks Bush Administration to give more for Africa. Reuters“Glaxo To Cut Cost Of AIDS Drugs For Kenya”24 May. Reuters“UN’s Annan Warns AIDS Wrecks World Economic Growth”01 Jun:-Annan tells US Chamber of Commerce,”As AIDS creates more poverty and deepens inequalities, it fuels the growing public backlash against globalization.” Economist“Aid and AIDS: Gambling with Lives”31 May:-an independent global fund to pay for ending global diseases is attainable through voluntary donations. Among donors: UN, rich and poor countries, NGOs. Reuters“South Africa Seeks Cheaper Drugs After Court Win”04 Jun:-gains legal victory over companies trying to stop import of generic AIDS drugs. AP“Pfizer Expands Free AIDS Drug Plan”06 Jun. Crossette“AIDS Fungus Drug Offered To Poor Nations”07 Jun:-Pfizer offers 50+ poor nations unlimited free supply of AIDS-related drug. Reuters “African Ministers Say AIDS Drugs Too Costly”08 Jun. AP“Swiss Insurer Gives To UN AIDS Fund”08 Jun:-Winterthur Insurance first corporate donor to new UN AIDS fund. Don Colarusso“Hope For AIDS Vaccine Fuels A Stock’s Ascent”10 Jun:-despite skepticism, shares of biotech company Vaxgen soar. AP“In Africa, HIV Treatment Erratic”18 Jun:-widespread poverty makes chances of treatment very uncertain. AP“Gates Donates $100M To UN For AIDS”19 Jun. Christopher S. Wren “Holbrooke Has New Role: Leading Fight Against AIDS” 20 Jun:-ex-US Amb. to UN returns to international arena. Robert Pear“Measure Easing Drug Imports Passes in House”12 Jul. AP“Study: Fighting AIDS May Cost $9B”18 Jul. AP“Health Experts Ask G8 for AIDS Money”18 Jul. Reuters“G8 to Launch AIDS Fund, But Short of U.N. Target”20 Jul. AP“Coca-Cola to Help Africa AIDS Fight”20 Jul. McNeil“US at Odds With Europe Over Rules On World Drug Pricing”20 Jul. AP“UN Welcomes Corporate AIDS Funds”21 Jul. Crossette“US Drops Case Over AIDS Drugs in Brazil”26 Jul:-US unexpectedly withdraws patent complaint and agrees to settle out of court. Petersen“Drug Maker is Set to Ship Generic Prozac”02 Aug. Reuters“Central America Teams Up to Buy AIDS Drugs”23 Aug:-six nations buy AIDS drugs in bulk in attempt to negotiate lower prices. AP“Brazil To Strip Patent on AIDS Drug”23 Aug. AP“HIV Vaccine Creators Share Patents”24 Aug. Petersen and Rich“Roche Asks for Meeting With Brazil Health Minister”24 Aug:-Brazil may break Roche patent in order to produce generic AIDS drugs. Reuters“Brazil and Roche Agree On AIDS Drug Price Cut”31 Aug. AP“S.Africa Official: AIDS Drugs Costly”13 Sep:-while drug companies have cut price of medications, country still cannot afford to provide them. Agence France-Presse“Nigeria Buying Generic Drugs for an AIDS Treatment Trial”30 Sept:-will begin trial program in order to receive cheap imported generic drugs. Marc Lacey“Kenya Losing Needed M.D.’s as Low Pay Causes Flight”07 Oct:- Many Kenyan doctors are leaving for Southern parts of Africa due to better working conditions/wages. AP“Generic AIDS Drug in South Africa”07 Oct:-S. African drug manufacturer will be allowed to produce and sell three key AIDS medicines in region. McNeil“Patents or Poverty? A New Debate Over Poor AIDS Care in Africa”05 Nov. AP “Study: Cycling Drugs May Curb AIDS”03 Dec:-AIDS patients take drug combination for week and then stop for week. May be able to control HIV, reduce side effects and cut costs in half. Daniel Altman “Diagnosis of World’s Health Focuses on Economic Benefit”21 Dec:-WHO claims foreign aid plus poor governments’ own funds could improve health of people. Report states how money from donor states could tackle AIDS, malaria, tuberculosis and diseases common to Third World. AP“Generic AIDS Drugs Come to S. Africa”29 Jan 2002:-humanitarian aid organization importing three AIDS medicines into S. Africa due to country’s refusal to legalize these cheap copies of patented AIDS drugs. Reuters“Global Anti-AIDS Fund Swings Into Action”29 Jan:-Geneva-based UN organization, Global Fund, calling all countries to suggest projects to contain spread of AIDS, tuberculosis and malaria, and generate funds from donor states. Reuters“W. Bank Sets $500 Million Anti-Aids Loan for Africa”07 Feb:-total World Bank anti-AIDS assistance is $1 billion in financial year, “helping African countries act with much greater speed and flexibility against HIV”. Sheryl Gay Stolberg“AIDS Fund Falls Short of Goal and U.S. Is Given Some Blame”13 Feb:-Annan urges donors to contribute $7 billion a year in fight against AIDS. US pledge of only $200 million sets poor example. Kahn“A Star Close to the Heart of Aid Policy”15 Mar:-Bono, lead singer of band U2, has lobbied White House to contribute more to fight AIDS. McNeil“New List of Safe AIDS Drugs, Despite Industry Lobby”21 Mar:-WHO releases list of manufacturers of safe/cheap AIDS drugs, challenging pharmaceutical multinationals -who want only patent-holders to decide what discounts to offer on products. Reuters“Calls for Help Exceed Global AIDS Fund Resources”25 Mar:-large number of requests by poor nations, particularly African, seeking $1.15 billion this year to fight AIDS, tuberculosis and malaria. Global Fund states amount is 50% more than it has available. Adam Clymer“Helms Reverses Opposition to Help on AIDS”26 Mar:-former US senator Jesse Helms has changed his negative view on AIDS funding, by pushing for $500 million to be put towards $27 billion requested. AP“Cheap AIDS Drugs Not Getting to Africa”28 Mar:-25,000 of 2.5 million people infected by AIDS are receiving drugs. Causes: high cost of daily treatments and price of medicine in Africa. NYT“Demand For AIDS Funds Exceeds Supply”28 Mar:-poor nations seek $1.7b, more than half Global Fund has been able to collect from donors. AP“U.S. to Help Caribbean Fight AIDS”21 Apr:-US agrees to send health experts to Caribbean and pledges to give $500m this year, and proposes to give $1.1b next year to fight AIDS. McNeil“W.H.O. Moves to Make AIDS Drugs More Accessible to Poor Worldwide”23 Apr:-WHO releases guidelines on which AIDS drugs poor nations should use, while allowing competition between patent-based and generic-drug manufacturers. AP “AIDS Fund Issues $378M in Grants”25 Apr:-Africa will receive 52% of money with rest to be distributed to other poor nations. Economist“How to live with it, not die of it”05 May:-Africans infected with AIDS could later create negative economic impact due to rise in orphaned children, halting much-needed development. Economist“AIDS in southern Africa: Fighting back”05 May:-southern region of Africa, especially Botswana and Mozambique, with world’s highest rate of HIV infection, could create 1m orphans, poverty, and violence in region. Stolberg“Unlikely Coalition Stirs Congress in AIDS Battle”12 May:-Republican reps in US are pushing to add $200m towards Global AIDS Fund. AP“Zimbabwe Lifts Import Restriction on AIDS Drugs”28 May. Henri E. Cauvin“Zimbabwe Acts to Obtain AIDS Drugs at Low Prices”01 Jun:-HIV has become national emergency in Zimbabwe, allowing it to obtain generic drugs at low prices. AP“Bush Proposes Spending $500 Million on AIDS”19 Jun:-money intended only to stop transmission of virus from mother to child during pregnancy and after birth. Stolberg “Bush Offers Plan to Help Mothers Avoid Passing H.I.V. to Babies”20 Jun:-provides treatment for 2m mothers in Africa and Caribbean over each of next 5 years. Altman“Modest Anti-AIDS Efforts Offer Huge Payoff, Studies Say”05 Jul:-research provided by variety of government and private groups shows that proper measures(e.g. condom distribution, improved status of women, voluntary counselling)would save 29m from AIDS. AP“Caribbeans to Buy AIDS Drugs at Discounts”07 Jul:-6 AIDS drugs manufacturers allow sales at lower prices. Reuters“AIDS Conference Opens with Call for Drugs for Poor”07 Jul:- 14th International AIDS Conference in Barcelona: activists and top officials demand AIDS drugs at lower prices in countries where most needed. NYT“Brazil to Share AIDS Drugs”09 Jul:-through donation of generic drugs, plus knowledge of drugs. Reuters“AIDS Activists Trash EU Commission Stand at Meeting”10 Jul:- activists push EU to donate more towards Global Fund against AIDS. AP “Health Gap in Rich, Poor Countries”11 Jul:- AIDS Conference illustrates need for wealthier nations to contribute more for AIDS epidemic. Projects life expectancy of 30 years in many AIDS-stricken regions of Africa. Economist “AIDS: Hope for the best, Prepare for the worst”11 Jul:- AIDS Conference has allowed positive changes to take effect: better treatment for infected; cheaper AIDS drugs for poor nations. Economist“AIDS: The long war”11 Jul:-as number of people dying reaches 9,000 a day, crucial need for donor nations to provide more to stop virus. Reuters“Clinton to Tell West to Pay Up for AIDS Treatment”11 Jul:-Being the co-founder of the International AIDS Trust, Clinton sees AIDS as the most troublesome issue in world. Altman“ Former Presidents Urge Leadership on AIDS”13 Jul:-Nelson Mandela and Bill Clinton urged heads of state and business executives to take a stand against AIDS. Howard W. French “Whistling Past the Global Graveyard”14 Jul:- AIDS epidemic is slowly affecting other nations who were not affected by the disease, such as Russia and China. Experts argue that in future all countries in world will be affected by disease. Reuters“S.Africa Health Minister Slams AIDS Global Fund”21 Jul. AP“African AIDS Activists Unite”22 Aug:-the movement organized in South Africa are pushing for easier accessibility of AIDS medicine. Agence France-Presse“China Raises Estimates of HIV Cases and Warns of Increases”06 Sep. Elisabeth Rosenthal “China Now Set to Make Copies of AIDS Drugs”07 Sep. Economist“China: Owning up to AIDS A “state secret” is revealed”12 Sep:-Chinese government has allowed for AIDS drugs which have expired patents across world, are permitted to be produced. Economist“Intellectual property: Patently problematic”12 Sep:-Intellectual-Property Rights (IPR) known for its patent and copyright laws have modified their views on the need for AIDS medicine to be copied from existing drugs. Economist“Intellectual property: Imitation v inspiration”12 Sep:-A debate among pro/anti patent supporters when dealing with developing nations. AP“China OKs Generic Anti-AIDS Drug”16 Sep. AP“AIDS Group Files Drug Price Complaint”19 Sep:-AIDS activists are pushing for two companies to drop the price on their anti-AIDS drug. Reuters“Cheap Vaccine Sought for Africa”20Sep:-Aid agencies are urging drug companies to make cheaper drugs against a new strain of meningitis in Africa. Geoff Dyer“UN-backed Aids fund approves generic drugs”12 Oct:-Global AIDS fund is issuing a list from WHO which indicates generic AIDS drugs at cheaper price. McNeil“U.N. Disease Fund Opens Way to Generics”16 Oct:-Global Aids Fund to fight AIDS will encourage poor countries to buy cheap generic medicines. Gregory Crouch“ Europeans Investigate Resale of AIDS Drugs”29 Oct. Reuters”World Trade Talks Struggle Over Cheap Drugs Access”25 Nov:-25 WTO members debate in a conference in Geneva as to which developing nations are able to receive cheap AIDS generic drugs or should there be any restrictions. Reuters “Trade Talks Fail to Break Deadlock Over Cheap Drugs”27 Nov. Agence France-Presse“Limits Proposed on Low-Cost Drug Program”29 Nov:-Drug manufacturers arguing that cheap medicine should only be available to countries that are suffering major epidemics and not for other less dangerous diseases” AP“Diplomats Prod U.S. on Affordable Drugs”17 Dec:-Members who participated in Geneva Conference are blaming Bush administration for not allowing cheaper medicines to be attainable for poor countries. Elizabeth Becker“U.S. Official to Discuss Trade as Africa Hopes to Talk AIDS”11 Jan 2003:-Social unrest as US ambassador is travelling to discuss his country’s decision to block trade deals to import generic drugs into poor countries. AP“Chinese Co. Distributes Anti - AIDS Drug”28 Jan. Economist “AIDS: The other war”30 Jan:-With Bush promising to pledge $15 billion over 5 years in the fight against AIDS, questions arise as to how the money should be spent. James Lamont“UN Fund to Fight Aids in Jeopardy”30 Jan:-Global Fund to fight Aids agency has declared that it will run out of money and not be able to afford new projects. Rachel L. Swarns“Free AIDS Drugs in Africa Offer Dose of Life”08 Feb:- Outlook of town in South Africa that suffers from AIDS victims and its government’s perception. Richard W.Stevenson“Bush to Allow AIDS Money to Supporters of Abortion”16 Feb:-US president will give donations to countries who have organizations which allow for abortions under some certain conditions. Stolberg“Redeeming a $2 billion Pledge for Global AIDS”23 Feb:-AIDS activists are criticizing Bush administration for lowering promised donation amount for fight against the disease. NYT“Lawmakers Agree on AIDS Bill Details”17 Mar:-Members of US House of Representatives are pushing for Bush’s promised donations to become larger. Stolberg“Politics of Abortion Delays $15 Billion to Fight Global AIDS”06 Mar:-Debate between Bush administration and opposition on allocation of promised funds by president: on the exact amount and which poor country will receive money. Economist“The World Health Report: Battle Ready”15 May 2004:-Article states this year’s WHO report concentrates on “3 by 5”anti-AID initiative that agency and several collaborators announced and whose aim is to provide anti-AIDS drugs to 3m people in poor countries by end of 2005. Marc Santora & Lawrence K.Altman"Rare and Aggressive H.I.V. Reported in New York"New York Times 12 Feb 2005:-disturbing report introduces a potentially very serious medical development in the global threat of HIV/AIDS. Item states:"Rare strain of HIV, highly resistant to virtually all anti-retroviral drugs and appears to lead to rapid onset of AIDS, detected in New York City man...It was first time strain of HIV had been found that both showed resistance to multiple drugs and led to AIDS so quickly, the officials said. While extent of disease's spread unknown, officials...say that situation alarming...Virus found in...man in mid-40's who engaged in unprotected anal sex...with hundreds of partners...While HIV strains resistant to some anti-retroviral drugs have been on rise in recent years,...new case worrisome. Viral strain in unnamed patient resistant to 3 of 4 classes of drugs used". The potential seriousness of this pandemic report justifies printing here a collection of recent/unusually-striking articles on the truly global crisis of infectious diseases - which convey both encouraging and shocking facts, and are relevant to the health/life of every human being - whether we want to know about them or not. One very serious survey of the global situation is found in major source that is op.cit.: Laurie Garrett Betrayal of Trust: The Collapse of Global Public Health. Another broad global survey is found in Dennis Pirages"Containing Infectious Disease". His 17-page essay contributes to serious broad subject addressed in the annual: Worldwatch Institute State of the World 2005: Redefining Global Security, also op.cit.. Its careful research on global issues is summarized/sub-titled:"Reducing worldwide death toll from infectious disease should receive the highest priority". The Dynamics of Disease Outbreaks. Environmental change can upset established equilibriums between people and pathogens, facilitating new disease outbreaks. Each year more than 2.3m people, primarily in poor countries, die from eight diseases that could easily be prevented by vaccination. Widespread and often indiscriminate use of antibiotics and other anti-bacterial agents is creating families of drug-resistant microbes. The Current State of"Microsecurity". Table 3-1. Deaths from Major Communicable Diseases, 2000 and 2002. Most worrisome near-term threat from traditional diseases is posed by influenza. Table 3-2. Healthy Life Expectancy in Selected Countries, 2002. Economic Consequences of Infectious Diseases. Ranks of the most productive people in some of the world's poorest countries are being systematically depleted by HIV/AIDS. Table 3-3.Countries Most Affected by HIV/AIDS. Managing Future Disease Outbreaks. Box 3-1 HIV/AIDS in the Military. Box 3-2 Biowarfare. Number of countries in which polio is endemic has declined from 125 to just 6 - Afghanistan, Egypt, India, Niger, Nigeria, Pakistan. There is pressing need to create innovative mechanisms to provide affordable drugs to disease victims in poor countries. The rest of this concentrated item includes serious and related subjects found over just a few weeks. Associated Press"Religious Leaders Talk AIDS Prevention"NYT 13 Dec 2004:-More than 80 religious leaders, Muslim and Christian, met at UN-sponsored Cairo conference on HIV/AIDS."[D]ebated methods to halt spread of AIDS - usually taboo subject in conservative Arab world - but stopped short of agreeing to recommend use of contraceptives to prevent the disease". Community made move from only supporting abstinence/fidelity to a new message of compassion/helping ill people/fighting discrimination. Donald G.McNeil Jr."Furor in Africa Over Drug for Women With H.I.V."NYT 21 Dec :- "A series of articles critical of past trials of an important AIDS drug has created a furor in Africa, causing many public health experts to worry that some countries will stop using the drug, which prevents mothers from infecting their babies with virus that causes AIDS." Nevirapine long been part of arsenal of antiretrovirals. NYT article reports both medical and political positions relevant in (South)Africa and US. Nicholas D.Kristof "It's Time to Spray DDT"Op-Ed Columnist in NYT 08 Jan 2005:-argues that West's refusal to provide DDT to malaria-ravaged countries has contributed to surge of the disease - probably killing 2m-3m people/year. "Instead, UN/Western donors encourage use of insecticide-treated bed nets/medicine to cure malaria", but they are not enough."Existing anti-malaria strategy is an underfinanced failure." While harm DDT can cause in environment recognized,"overall, one of the best ways to protect people is to spray inside of a hut, about once a year, with DDT." This uses tiny amounts, and is acceptable/essential. Donald G.McNeil Jr."A Path to Cheaper AIDS Drugs for Poor Nations"NYT 26 Jan 05:-US"Food and Drug Administration has approved first generic triple-therapy AIDS cocktail, opening way for US taxpayer dollars to be used to buy cheaper medicines for use in poor countries." South African-made drugs are priced 1/3-1/2 of brand-name ones. WHO already endorses dozens of generic AIDS drugs. AP"Number of People Using HIV Drugs Improves"NYT 26 Jan 05:-"Though numbers... using HIV/AIDS drugs in developing world, including Africa and Asia, nearly doubled in 2004, more work needed to meet...goals of 3m getting treatment by end of 2005",warned WHO/Joint UN Program on HIV/AIDS heads. Needed: better access to cheaper drugs and help to ensure preventative education; 72% still missing drugs in Africa."About 40m worldwide infected with AIDS virus, and 5m new cases recorded annually. [E]pidemic now pushing deep into Asia." Sharon LaFraniere"Poor Lands Treating Far More AIDS Patients"NYT 27 Jan 05:-"AIDS patients receiving life-saving drug treatment in poor/middle-income nations rose 60% in past 6 months, WHO said...,largely because of huge influx of international aid funds and a growing determination by governments to confront the pandemic...Still, anti-retroviral treatment reaches only one in eight needy people in developing world, leaving estimated 5.1m without such protection. Last year, disease took more than 3m lives, 75% of them in sub-Saharan Africa."The Economist 29 Jan 05"The Gates Foundation: Missionary Zeal"(Edit.10); "Global Health: Foundation"(76-7):-major essay tells much about global action against tropical diseases. Focus:Bill Gates' second gift of $750m to Global Alliance for Vaccines and Immunisation (GAVI) which is aimed at giving comprehensive vaccine protection to 90% of newly born children - and is more demanding of donor governments to help meet its $8-12b need by 10 years. Gates' total foundation is richest charity in world, with endowment worth $28b. Its most ambitious aim is"to free the world - and, in particular, those regions of it that are poor - of ill health.It has formed largest non-governmental gifts to the Global Fund to Fight AIDS, Tuberculosis and Malaria, set up by UNSG Kofi Annan. Economist 02 Jul 05"G8: Helping Africa Help Itself"(Edit.11):-Lots more money for Africa will not make poverty history. But it might just do some good";"Aid to Africa: The $25 Billion Question"(Special Report 24-6):-"Years of mistakes have taught donors a bit about how to spend aid money better"; "Lexington: Evangelicals and Aid: Right On" (34):-"Bob Geldof and Bono have some unlikely friends in America... During discussion of a plan to spend $15 billion fighting AIDS, [US President Bush] turned to his silver-penned speech writer... 'Mr President', came the reply, 'if this is possible , and we don't do it, we will never be forgiven'"; "AIDS In South-East Asia: There's Good News and Bad News"(38-9):-"Good prevention work has tamed the AIDS epidemic in some countries, yet it is getting much worse in others"; "The Grand Challenges in Global Health: 43 Ways To Save the World"(69-70):-"The Gates Foundation's latest largesse has just been announced. It will pay for some intriguing and original research. But will it translate into healthier people? [References to several AIDS research projects]; "AIDS: Moving Targets" (70):-"Progress, and problems, in treating AIDS around the world". Economist 08 Oct 05 "Pharmaceuticals in South Africa: Aspen's Upward Slope"(74):-item asks: "Can South Africa's generics manufacturer become a global giant?.. Number of South Africans with HIV-AIDS tragic and alarming. [O]ver 800,000 people need treatment -but only about 100,000 are getting it... Aspen Pharmacare is local firm doing most to supply the market with the generic drugs South Africa will need. It now has ambitions to do the same for rest of Africa - and then to expand into market for generic HIV-AIDS drugs in US and Europe... Both government and health insurers - keen to keep medical costs down - have pushed for generics against the more expensive patent-protected drugs. As result, over 40% of prescribed drugs in South Africa are now generics. Government and local pressure groups have arm-wrestled with pharmaceutical multinationals over anti-retrovirals (ARVS) - the drugs used to fight HIV-AIDS. As result, companies such as Merck and Eli Lilly have licensed local manufacturers to produce their patent-protected drugs... Aspen now offers six different ARVS"; Donald G.McNeil Jr."Clinton in Deal to Cut AIDS Treatment Costs"NYT 12 Jan 2006:-"Former [US] President Bill Clinton plans to announce today that his foundation has negotiated lower prices on AIDS tests and on two important AIDS drugs. Four companies, from US, India and China, will offer rapid HIV tests for 49 cents to 65 cents, which will reduce typical cost of a test in poor countries by half, Clinton said in written statement. Another four companies - three from India and one from South Africa - will make antiretroviral drug efavirenz for as little as $240 per patient per year. One of Indian companies, Cipla, will also make the antiretroviral abacavir for $447"; Donald G.McNeil Jr."Bristol-Myers Allows Powerful AIDS Drug to Be Sold Cheaply"NYT 15 Feb 06:-"One of the newest and most powerful AIDS drugs will be licensed to generic drug makers in India and South Africa so that it can be made inexpensively for patients in many poor countries. Drug is atanazavir, made by the Bristol-Myers Squibb Co. under the brand name Reyataz and introduced only last year in many wealthy countries. It is a protease inhibitor, which is useful in second-line treatments for patients who have developed resistance to their first antiretroviral cocktails. It will be licensed, without charge, to Emcure Pharmaceuticals Ltd. of India and Aspen PharmaCare of South Africa. Under the deal, the generic companies will set the pricing for atanazavir in Africa and India. At moment, second-line treatments in Africa cost $3,000 to $6,000 a year for each patient, compared to about $200 for first-line treatments... However, guidelines from WHO require that protease inhibitors be given with what is called a booster drug - usually ritonavir, sold under brand name Norvir [, which] must be refrigerated, especially in hot climates. As a result, move by Bristol-Myers puts pressure on Abbott Laboratories, maker of ritonavir, to make a heat-stable version"; AP"Clinton Urges Help for Kids With AIDS"NYT 18 Feb 06:-"Former [US] President urged governments and public foundations to buy anti-AIDS drugs from low-cost manufacturers so more children can receive treatment for the disease. Clinton... said last month that Cipla and 3 other Indian pharmaceuticals would offer antiretroviral drugs at prices up to 30% cheaper than current market rate... Since his Clinton Foundation's 2002 HIV/AIDS initiative began, foundation has concentrated on making affordable drugs available, buying second line AIDS drugs from generic drug makers for 21 countries in Asia, Africa and the Caribbean, he said. His foundation planned to get anti-AIDS drugs to 60,000 children in worst-affected countries this year... 'We've had a 3-year partnership with Cipla, and because of them an enormous number of HIV/AIDS-infected people are alive', he said. India has 5.13m cases of the illness, second largest number of people infected with HIV after South Africa. Indian government claims its anti-AIDS campaign has stabilized the epidemic and says there has been a sharp decline in the number of new HIV cases"; Reuters"Clinton Group, India to Train Nurses in AIDS Care"NYT 19 Feb 06:-"Former US President and Indian government announced a joint plan to train nurses in AIDS care in a country which has world's second-largest number of HIV/AIDS cases... Partnership between National AIDS Control Organization of India (NACO) and Clinton Foundation, aims to develop training material and program for nurses... 'Nurses not only deliver clinical care, needed to keep people alive, but they also act as counselors and play an important role in reducing the myths, stigma, and discrimination surrounding this disease', [Clinton said]"; Reuters "Relief Group Seeks Access to New HIV Drug in Africa"NYT 15 Mar 06:-"A humanitarian group urged US drugmaker Abbot Laboratories Inc. on [15 Mar] to make a new HIV drug accessible in developing countries, especially Africa. Relief organization Medecins Sans Frontieres said a new formulation of Abbot's lopinavir/ritonavir drug had critical advantages for patients in poor countries, including lower daily pill count, storage without refrigeration and no dietary restrictions... Sub-Saharan Africa has about 10% of world's population but 60% of people living with HIV/AIDS... More than 3m Africans became infected with HIV in 2005, representing 64% of all new infections globally and more than in any previous year for the impoverished continent, according to UNAIDS. MSF provides anti-retroviral drugs for over 60,000 patients in nine countries in Africa, Asia and Latin America. It said it urgently needed the new drug because refrigeration is unavailable to many people in poor countries. The new formulation, marketed under the name Kaletra, is in tablet form and does not melt at high temperatures unlike the old version which is in capsules. MSF said the new version of Kaletra, which was approved by US Food and Drugs Administration [Oct 05], was not available in any developing country. It urged Abbot to register the new version in developing countries, sell it at less than $500 per patient per year and remove patent barriers to allow production of generic versions... Abbott said it was pursuing registration for the new formulation in developing countries as rapidly as possible. It also said it was making its HIV medicines available in 69 of the world's poorest countries... Kaledra is a 'second line' drug which can be used when standard anti-retroviral drugs stop working... One MSF program found that after four years of ARV treatment, 16% of patients needed second-line drugs"; Economist 01 Apr 06"Treating AIDS: A Missed Target"(64-5):-"World Health Organization(WHO)'s attempt to roll out AIDS drugs in poor countries has missed its target. A shame, but not a disaster[op.cit. AP 28 Mar]. The '3 by 5' initiative to get 3m HIV-positive people in poor/middle-income countries on to anti-retroviral drugs by end of 2005 has got less than halfway there. [WHO/UNAIDS reported] a mere 1.3m of those infected in target countries are on courses of drugs. [Yet shift from pure prevention to care offered incentives for] those who might...be infected[: new] reason to find out the truth [and encourage modified behaviour to reduce transmission. Also, even 3+ times the previous number under treatment] averted about 250,000 premature deaths in 2005. One problem [was] that in most countries the [essential] infrastructure... did not exist. [Hence] the initiative may have been more successful than [new] figure suggests, since part money has gone on infrastructure [and] this sort of work has spin-offs beyond the treatment of AIDS. Expense of treatment also tackled[:] big change...in market for AIDS drugs. Clinton Foundation HIV/AIDS Initiative has helped to defragment market for generic anti-retroviral drugs by signing contracts... in India and South Africa that guarantee large order-volumes and reliable payment. As result, price in some cases... below $150 per person per year.. Progress, then, being made. [Possible] 3m figure by end of 06"; AP"AIDS Conference Ends With Appeals"NYT 26 Apr 06:-"International AIDS conference [in Cape Town, of 1,000 scientists/ researchers,] ended [26 Apr] with impassioned appeals to political/pharmaceutical industry leaders to fund development of a virus-killing [vaginal] gel to protect women from the disease and so save millions of lives. Peter Piot, head of UNAIDS,.. said safe/effective microbicides could be ready in 5-7 years, with only minimal additional funding, and thus turn the dream of saving millions of lives into reality... In the hard hit African countries, women account for nearly 60% of infections. Most are infected through heterosexual intercourse... UNAIDS/WHO have long promoted microbicides as a potentially valuable weapon in fight against the epidemic, not least because it allows women to protect themselves without having to rely on partners who refuse to wear a condom or be faithful. Yet despite this, research has proceeded slowly. [Piot] said investment in microbicide development should be doubled - and even then would still only reach about US$150m per year... Microbicides can take the form of a gel, cream, sponge or ring that releases an ingredient that can kill or deactivate HIV during intercourse. There are currently five different products being tested[, mainly in Africa on thousand of women]. Dozens of agents that could interrupt HIV transmission have so far been identified. There are also hopes that the microbicides could be used to prevent other sexually transmitted diseases and unwanted pregnancies. One of the products, cellulose sulphate, has the potential to be a contraceptive and shield against HIV... Another microbicide, Carragard, coats vaginal cells and prevents the virus from entering... Much of the funding for research comes from Gates Foundation and US government... Trying to dismiss fears that microbicides would mainly be used in developing countries and therefore offer only low profit margins, [WHO] cited their potential for use in contraception in wealthy countries"; Amelia Gentleman & Hari Kumar“AIDS Groups in India Sue to Halt Patent for U.S. Drug”NYT 11 May 2006:-“AIDS groups this week brought important test of India’s new patent law, which restricts ability of Indian companies to produce low-cost generic drugs. Two patients-rights groups sued to stop Gilead Sciences, California biopharmaceutical company, from patenting the antiretroviral drug Viread - company’s brand-name version of tenofovir, which is available [in India] as a generic drug. If it is patented, the groups contend, making the cheaper versions will become illegal, and the drug will become too expensive for patients...in developing countries... Doctors Without Borders [stated:] ‘People in Africa and Caribbean are relying on India to produce these drugs. Quality matches that of US-manufactured drugs, but prices affordable’. Lawyers for two [Indian] groups... presented arguments contending tenofovir not new drug, but modified version of earlier drug, and therefore not eligible for new patent under India’s new law. Those backing legal challenge hoping to gain legal precedent for use in other patent applications... WHO recently recommended tenofovir for patients just starting treatment for AIDS and those who have been receiving antiretroviral treatment therapy but resistant to other treatments. In [rich] countries, Gilead’s tenofovir costs $5,718/person/year. Cipla, one of largest companies in India, marketing version called Tenvir, at cost of $700/person/year in India. Chairman Cipla said drug eventually available in Africa for about half that price. But Tenvir would have to be withdrawn if Gilead were given patent,.. in effect for 12 years. Gilead Sciences said... ‘[W]e believe Viread represents innovation and parentable under Indian law. We will use this patent responsibly, and not block access to our medication in India or other resource-limited countries where HIV epidemic hit hardest’. Company... ‘pursuing broad policy of nonexclusive voluntary licensing under patent to generic manufacturers in India for local Indian market as well as provision for manufacturers to export product to 97 developing-world countries included in Gilead’s access program’”; UNAIDS2006 Report on the Global AIDS EpidemicUN NYC 30 May 06:-to special UNGA; text at: www.unaids.org/en/HIV)_data/2006GlobalReport/default.asp. Sub-titles: 1 Introduction 2 Overview of the global AIDS epidemic 3 Progress in countries 4 The impact of AIDS on people and societies[corrected] 5 At risk and neglected: four key populations 6 Comprehensive HIV prevention 7 Treatment and care 8 Reducing the impact of AIDS 9 The essential role of civil society 10 Financing the response to AIDS 11 Getting the best out of national responses 12 From crisis management to strategic response. Text in english|french| russian|spanish; whole is downloadable; Reuters“25 Years On, Anti-AIDS Drive Still Falling Short”NYT 30 May 06:-“Twenty-five years after AIDS first recognized, world still falling short in its battle against the disease with severe gaps in prevention and treatment, UN said [30 May]. ‘Response to AIDS epidemic to date has been nowhere near adequate’, said UNAIDS... Since...1981, AIDS and HIV virus that causes it have spread relentlessly from a few widely scattered hot spots to virtually every country in the world, infecting 65m and killing 25m, UNAIDS said in 630p report... Anti-AIDS initiatives and their results vary widely from country to country, and many are falling short of benchmarks set in a landmark high-level UNGA session in 2001, UNAIDS said... Dr. Peter Piot of UNAIDS... expected long-term commitments at this week’s meeting...and hoped for $20m annually by 2010... Global AIDS incidence rate is believed to have peaked in 1990s. About 1.3m in developing world now on life-extending antiretroviral medicines, which saved about 300,000 lives last year alone. Still, some 4.1m were newly infected and 2.8m died in 2005... Global supply of condoms was less than 50% of what was needed, and antiretroviral drugs, while more widely available, remained costly and hard to get. Ignored in many countries are prostitutes, said... ex-dir of UN Population Fund... However, final statement by governments at conference this week not expected to refer to prostitutes, drug users or homosexuals, due to objections from Islamic nations, some Catholic countries and US, which fear that merely mentioning these groups would endorse their behaviour. Infected individuals still suffer from ostracism and discrimination, while vast majority of world’s 40m infected have never been tested for HIV and are unaware of their status, report said. While $8.9b expected available in 2006, $14.9b will be needed, UNAIDS said. By 2008, it predicted $22.1b would be needed, including $11.4b for prevention plans alone. Report called for more and better-targeted education and prevention strategies, more treatment opportunities, and more drug research, particularly on drugs for children, whose needs ‘have been largely left out of the research agenda’”; Lawrence K.Altman “U.N. Urges Tripling of Funds by ‘08 to Halt AIDS”NYT 01 Jun 06:- “Stopping epidemic of AIDS will require $22b/year by 2008 and possibly more in following years, officials of UNAIDS program said. The $22b is nearly triple the $8.3b spent 05 by all sources, including governments and private sector. Urging that countries spend more, UNSG Kofi Annan said a costlier and more sustained effort needed because AIDS "has spread further, faster and with more catastrophic long-term effects than any other disease"... Of projected figure, half is needed for prevention and a quarter for treatment and care of infected people. Remainder is for care of orphans, children at risk of becoming infected and program costs. UNSG and Piot of UNAIDS spoke as UNGA began meeting aimed at renewing political commitment and setting new goals for expenditures and for measuring progress... Annan urged delegates to challenge countries trying to avoid goals that mention gay people, prostitutes, intravenous-drug users and others at high risk of becoming infected. ‘Governments concerned need to be realistic and responsible’, UNSG said. He also said that ‘if we are here to try to end the epidemic, we will not succeed by putting our head in the sand and pretending that these people do not exist or they do not need help’... Report cards showed that most countries missed more goals than they met. More than 20m have become infected since 2001 meeting. Now countries must fundamentally change the way they think and deal with epidemic, moving from crisis management to ‘sustained attention and the kind of “anything it takesresolve that member states apply to preventing global financial meltdowns or wars’, Piot said... Global Business Coalition on HIV/AIDS released a study showing that private companies have become more likely to provide treatment for employees as cost of antiretroviral drugs has fallen over last six years, to $140-$300/year, from $10,000. In African countries with a high prevalence, more than 70% of companies surveyed are fully subsidizing access to HIV treatment, coalition said. Study...found increasing trend to expand such treatment to employees’ dependents. Companies also offering access to voluntary testing/counseling”; Lawrence K.Altman & Elisabeth Rosenthal“U.N. Strengthens Call for a Global Battle Against AIDS”NYT 02 Jun 06:-“[UNGA] adopted strongly worded declaration [02 Jun] aimed at pressing nations of the world to strengthen their battle against AIDS, global pandemic [UNSG] calledgreatest challenge of our generation’. Language of document surprised even anti-AIDS groups, which said that while it did not satisfy all their objectives, they had feared it would be watered down... Nonbinding declaration reaffirms commitments made in 01, when UN defined AIDS as far more than a medical issue, framing it in terms of political/human rights/ economic survival... New document is political blueprint, not plan of action. Calls for strong commitment to bolster the rights of women/girls so they can protect themselves from infection with HIV... Declaration calls on countries to: use scientifically documented prevention strategies, including condoms;make clean needles accessible to drug users; take steps to provide universal access to prevention programs/ care/antiretroviral drugs. Includes politically charged terms like ‘condoms’/‘vulnerable groups’, though those groups not specified... Countries expected to measure their progress over next 5 years against targets to be determined by UN... Said world will need to spend up to $23b/year by 2010... Earlier in day, UNSG Annan delivered a gloomy assessment, saying world was losing the battle. ‘The epidemic continues to outpace us’, he told packed UNGA. ‘There are more new infections than ever before; more deaths than ever before; more women/girls infected than ever before’... [US’s] Mrs.Bush speech steered away from many of the criticisms that have been labled against administration, notably that it promotes sexual abstinence over scientifically proven strategies, particularly condom use. Indeed, she said, ‘ABC’ model - initials stand for abstain, be faithful and use condoms - had brought sharp declines in infections in Africa. Britain’s international development [minister] said in interview: abstinence alone did not work ...Dr. Peter Piot [UNAIDS] said: while no document could make anyone ‘100% happy’, final version was ‘a major advance’ and far stronger than weaker drafts circulating earlier in week”; Reuters “Nations Resist New Financial Commitments on AIDS”NYT 02 Jun 06:-“A major UN meeting on AIDS strategy fell short of concrete financial commitments but recognized the growing spread of the disease among women and their right to protect themselves. Last day of 3-day meeting brought together heads of state, PMs and health officials from 151 countries... ‘I know that none of you got all you wanted in this declaration’, UNGA President Eliasson said in closing session. But he said thanks to advocacy groups, ‘the draft got stronger - not weaker’... Document says $23b will be needed annually by 2010 to fight AIDS ...Nations agreed to search for additional resources to ensure universal access to treatment by 2010. But delegations did not commit themselves to a timetable for raising the funds as they did in 2001 when the financial target was met... Squeamishness over sex was evident.,. with Islamic groups and conservative Roman Catholic countries using the term ‘vulnerable groupsrather than referring to prostitutes, homosexuals and drug addicts... Yet the document, in addition to abstinence, advocated male and female condoms and ‘harm reductionefforts related to drug use, a euphemism for needle exchange programs for addicts... Declaration called for sex education, reproductive health services and condemned ‘abuse, rape and other forms of sexual violence’ as well as ‘trafficking in women and girls’”; [For the time being, I must limit guides to AIDS items by normally summarizing only 1-2 of their (initial) key paragraphs, since both number/length of the relevant articles(2-3 pages long) being published is so high. ‘Basic text’ underlining, then, is also not necessary. In addition, since all the items relate to POLICY ISSUES and the very special 16th International AIDS Conference (16IAC) in Toronto, all are listed under sub-section D. Rather than re-list virtually all of them four times in each of the sub-sections on AIDS issues, I simply ask you to survey material on all four topics under POLICY for the time being.]




B. INFECTION RATES; SOCIO-ECONOMIC ISSUES (PANDEMIC)


Economist 02 Jan 1999"AIDS in the Third World: A Global Disaster"(42-4):-statistics to date are disturbing: at least 47m people have been infected with AIDS virus and pandemic is “still nowhere near its peak. If India, China and other Asian countries do not take it seriously, the number of infections could reach `a new order of magnitude’, says... head of UN’s AIDS programme... For many poor countries, there is no greater or more immediate threat to public health and economic growth. Yet few political leaders treat it as a priority.”(42) Since finding a vaccine is “hugely difficult” and expensive, LDCs’ only course is to stress prevention, but this is hard because: condoms are unpopular, myths abound, many cannot afford antibiotics against the facilitating STDs, migrant labor/armies draw prostitutes, much forced sex and alcohol contribute. Apathy and embarrassment are the most serious blocks to AIDS control. Lawrence K. Altman"More African Women Have AIDS Than Men"New York Times 24 Nov 99:-UNAIDS-WHO have reported the latest global information on the HIV/AIDS pandemic. This year about 5.6m persons will become infected with HIV. This brings to over 50m the total infected since the virus was recognized in 1981. AIDS has already killed 16m, of which 2.6m will die in 1999, a record for any year. Threat of HIV has not diminished in any country; despite research, AIDS remains fatal. Future numbers now depend mainly on infections in Asia, but are unpredictable. Steepest increase in infection rates in 1999 was in former USSR, with Russia recording nearly half its cases in the first nine months. AIDS is the single greatest threat to development in many countries. Sub-Saharan Africa has the highest incidence of HIV: 22.3m or 8% of all adults, 70% of all cases in the world, and life expectancy likely to drop from almost 60 years back to 45 years over the next decade. Surprisingly, new data shows 55% of those Africans infected are women. Economist, 27 Nov 99"AIDS: Bust the Stigma"(49):-article on same report, but with some differences in stress(of the 5.6m infected in 1999, 570,000 will be children). Article includes a chart listing:% of adults infected; infected people(m); infected in 1999(m); % of infected who are women, both for the whole world, and divided into eight geographical areas. The key point made:“ignorance, complacency and the stigma attached to the disease are potent killers...above all, the epidemic has to be given public recognition”. Altman,"U.N. Issues Grim Report on the 11 Million Children Orphaned by AIDSNYT 02 Dec:-a UNAIDS-UNICEF report issued on World AIDS Day(01 Dec) estimated that more than 11m children have been orphaned by AIDS since the epidemic was recognized in 1981. This number is expected to reach 13 million by the end of 2000, and is believed to far outstrip the total orphaned by other causes. (These orphans are defined as children 15 and under who lost either their mother or both parents to AIDS.) All but 5% of the orphans live in Sub-Saharan Africa, where in 1998 alone over 2m people died of AIDS compared with 200,000 in all types of conflict, “and the worst is yet to come”. The key UN official predicts the number of AIDS deaths could eventually undermine the stability of affected countries. The orphans also face the stigma and discrimination that go with AIDS, leaving them isolated, deprived and vulnerable. Economist 22 Apr 2000"The Caribbean: Deadly Silence"(34):-"Africa apart, nowhere in the world suffers more from AIDS than the countries of the Caribbean...the impact is broad, growing and potentially devastating”. However, the stigma of having HIV-AIDS means that few talk about it, making it much harder to track down and control. In the area, only Cuba has set up an effective screening and reporting system, i.e. it alone has the critical information on who has HIV but does not yet show visible symptoms. This fact alone makes it much easier to follow the speed, location and demographic structure of infection, and so get a much better idea of how the HIV is spread, and what preventive, medical, and care facilities and staff are, and will be, necessary. Reuters"Study Says AIDS Will Devastate African Workforce"NYT 08 Jun:-article summarizes the dismal findings of a study of one future impact of AIDS on Africa, released by the International Labor Organization(ILO). It reports that AIDS will destroy the labor market of sub-Saharan Africa“with projected workforce declines of up to a fifth or more in the worst-hit countries by 2020"(Namibia 22%; Botswana/Zimbabwe 21%; Mozambique 19%; South Africa 17%; Kenya 15%; Malawi 13%; Uganda 12%). Orphans, widows, elderly will have to fill the gaps, and business costs will increase. This huge challenge will also be unusually difficult to deal with economically, medically and socially because of the special circumstances in Africa. Donald G. McNeil Jr.,"AIDS Is Moving Into Rural Areas, U.N. Study SaysNYT 23 Jun:- more alarming facts on the AIDS situation. This article reports UNAIDS sees the epidemic “shifting strongly to rural areas in the Third World [with] dire implications for people with the disease and the countries that are involved [because] HIV hits particularly young adults, and they are the core of the labor force, the keystone of the farm household.” Farms may collapse and/or city food supply suffer. Transmission in/to rural areas can result from part-time urban work, prostitution along truck routes, and poverty-created sexual vulnerability. Also, preventive programs are as rare as pre-AIDS sexual customs are prevalent. Altman,”U.N. Warning AIDS Imperils Africa’s YouthNYT 28 Jun:-a new UNAIDS report:”The world has never before experienced death rates of this magnitude among young adults of both sexes across all social strata”. More specifically, about half of all 15-year-olds in the worst-affected African countries will eventually die of AIDS even if their rates drop substantially. If current rates continue, two-thirds will die - and ominously most people with HIV do not know they are infected. Thus the African pandemic will grow much worse unless $2b annually is given for minimum prevention and care, and most governments start high-priority control programs. Already 16 African countries have adult rates over 10%(11% in Ethiopia, 20% in South Africa, 36% in Botswana). Washington Post“AIDS in NumbersJul 00:-statistical chart showing the estimated life expectancy and death rate of AIDS victims worldwide corresponding the year 2000. Washington Post“A Difference of 15 Years”Jul 00:-Africa map containing the number of the population infected with AIDS. NYT"Young People Found Uninformed on AIDS"12 Jul:-United Nations Children’s Fund(UNICEF) annual report concludes that”a dangerously large number of young people in the developing world do not know how to protect themselves from the virus that causes AIDS”. Girls are especially ignorant about the disease: a survey of 34 countries found that in about half, more than 50% of girls 15-19 said they did not know that a person with HIV-AIDS could appear healthy(in Chad, 83%; in Niger, 81%; in Nepal, 80%). The gap helps explain the higher HIV infection rate among girls in many countries, but efforts to reach and inform them are hampered by”poverty, local customs, violence and social or religious bias”. Even some knowledge of how HIV is transmitted does not necessarily change young people’s perceptions about their vulnerability, or change behaviour. In Haiti, Zambia and Zimbabwe more than half of sexually active girls said they did not consider themselves at risk. APNearly 28 Million Orphaned by AIDSNYT 13 Jul 00:-even more discouraging projections on the orphan crisis than those put forward by UNAIDS-UNICEF(2 Dec 99 above)are contained in a USAID report “Children on the Brink 2000". It estimates than”nearly 28 million children in Africa will have lost at least one of their parents to AIDS by the year 2010", and the disease”will continue to create millions of new orphans for decades”. There are already nearly 16m children who have lost at least one parent, about 90% of these in Africa. These estimates do not even count the rapidly growing number of babies born with HIV since most of them will likely die before they reach age 5. “The best way to deal with the crisis is not to put the children in...orphanages... but to [help] their extended families...cope”. Reuters,”UN Council Calls for AIDS Training for UN TroopsNYT 17 Jul:-UNSC voted unanimously“to intensify AIDS education among peacekeepers and encourage voluntary testing so they did not contract or spread HIV/AIDS while on UN missions”. The resolution also urges countries to consider developing effective long-term strategies to roll back the epidemic in the military and to encourage voluntary and confidential HIV/AIDS testing, counselling and treatment ”as an important part of their preparation for their participation in peacekeeping operations”. The US representative claimed, ”Peacekeepers bring AIDS with them and take it home...Wherever peacekeepers go they attract prostitutes”. Earlier, the UN decided to distribute a condom a day to each soldier it planned to send abroad this year. While discussed by Vice-President Gore earlier, this was the first resolution making AIDS an international security issue, and the head of UNAIDS agreed that, with 16 African countries in which more than 10% of the population between 15 and 49 years of age was infected,”No wonder that AIDS is the first health and development issue to be considered a threat to global peace and security”. Itar-Tass,"Over 53,000 HIV-Infected Registered in Russia”onhealth.com 25 Jul:-according to the head of the national anti-AIDS center, 53,170 HIV-infected people are currently registered in Russia, with the highest concentrations in Moscow and the southern Siberian Irkutsk region. Over the past five years, AIDS has mostly been spreading among drug addicts, who comprise half the above total(81% are men). Very much more ominous are two other figures. (1)Over 22,000 of those registered contracted HIV this year - almost 305% more than in the same period of 1999. If this reflects the actual rate of increase, Russia will have 600,000 infected by the end of the year. (2)It was stressed that only 10% of those infected are registered. If true, at the current pace of infection, Russia would have six million persons with HIV-AIDS by the close of 2000, and the center believes the rate of infection is growing in the general Moscow and St. Petersburg areas, and both east and west of the central Urals, all zones with big population pools to draw on. Khadija Magardie,"Women Are Worst-Hit By AIDS"Mail and Guardian/onhealth.com 07 Aug:-an eye-opening collection of reliable social, statistical and medical facts about how and why poor women are suffering disproportionately from HIV/AIDS. Though focused on South Africa, most comments apply in most LDCs. The key points, derived from a new UNAIDS report, and each then forcefully amplified, are:”[W]omen comprise a marginalized group [with] increased vulnerability to the virus. This is due to a variety of factors, but mainly because of fewer contraceptive choices, unequal health care access, and, for many... physical and psychological violence that critically affects their health”. Norimitsu Onishi"AIDS Cuts Swath Though Africa’s Teachers"NYT 14 Aug:-a very disturbing personal account of the disastrous impact of AIDS on African rural education. While highly-mobile soldiers and truck drivers are rapid distributors of infection,(mostly male)village teachers, often the only educated people in rural areas, have also been dying at an exceptional/ expanding rate - the combined result of boredom, ignorance, prestige and hence the availability of willing partners. Condoms(when available)are highly unwelcome to both men and women(the latter because use implies doubt regarding their virtue). Already classrooms are badly overcrowded, many schools remain closed for lack of staff and the death rate is“expected to be catastrophic in the near future”. “AIDS constitutes one of the...biggest threats to the global education agenda that we have known...There is no other single factor in the world today that so systematically undermines the gains of decades of investment in human resources, education, health and the well-being of nations”(UNAIDS). David Gonzalez"Caribbean, Badly Hurt, Is Promised Help on AIDS"NYT 13 Sep:-a slightly more hopeful report than that in Economist, which emphasized lack of government action. Caribbean still faces the highest rate of HIV infection outside Sub-Saharan Africa(2% compared with 8%)with social and economic development under threat in the region’s small economies. Official estimates of total HIV/AIDS cases is 360,000, but many experts believe it is actually over 500,000 because of under-reporting. A vast number of cases are in Haiti and Dominican Republic (parts of Haiti have an infection rate of 12%), but even in the English-speaking Caribbean it is leading cause of death for men and women aged 15 to 44. Its spread has been fueled by tourism, inter-island migration, poverty, and religious and cultural resistance to the use of condoms and sex education. Local leaders now recognize the need for urgent, cooperative action; at a Caribbean Conference on AIDS, donors/banks pledged $120m to regional strategy($85-100m IBRD loans). AP“China To Combat Rise in STDs”06 Nov:-8m Chinese people are infected with STD. Beijing to set up a new medical center“State Diseases Control Center”which will oversee treatment for victims. Barbara Crossette “Nurse in Malawi Wages War on AIDS and Apathy”07 Nov:-UN awarded Mrs. Phiri for her work in setting up an AIDS support group in her country. Economist 11 Nov"Myanmar Sickening : Growing Health Problems"(55):-"Thanks to a combination of ravaging infectious diseases, an atrocious health care system, and the military regime’s refusal to admit that anything is amiss, public health officials fear that average life expectancy...could fall to as low as 45 years in the next two decades”. While the junta claims only 25,000 people are infected with HIV, the IBRD estimates over 700,000 in a population of 48m. Perhaps 8% of soldiers are HIV-positive, while the growing use of intravenous drugs and more production of heroin and amphetamines by ethnic minorities exacerbate the epidemic. Besides AIDS, malaria, anthrax and malnutrition(in Asia’s former rice-bowl)are “decimating” the population. Near Thailand, a new combined epidemic may have killed 10,000 since July, and medical facilities/supplies are totally inadequate. The regime, denying any crisis, has launched a literacy program that may empower women, thereby helping slow HIV transmission, but no sex/drugs education is required. AP“Report: 3M AIDS Deaths in 2000"24 Nov:-WHO study finds 80% of people infected will come from Africa. Elizabeth Olson“AIDS Infections Rise Globally, but Sub-Saharan Cases Stabilize”25 Nov:-WHO study reports that 3.8m new victims were infected in the region in the year 2000, in contrast with 4m victims in 1999. AP“U.N. Warns of AIDS Complacency”28 Nov:-UN director of UNAIDS, Peter Piot, reports on how wealthy countries are investing less in AIDS education programs even though the threat of the disease is rising throughout the world. AP“Worldwide, Regional Impact of AIDS”28 Nov:-UN statistics chart shows the numbers of infected with AIDS in the world. Reuters “HIV / AIDS Infections Rise to 36 Million in 2000"28 Nov:-with 5m newly infected cases according to UNAIDS, Africa being the worst area hit by the disease. AP“African AIDS Outlook Is Bleak”28 Nov:-UNAIDS programs targeting Africa’s youth to delay having sex for three years, AIDS activists pleased on the rate of the disease becoming stable in Sub-Saharan Africa. Reuters“AIDS Epidemic Threatens Ukraine, Experts Say”01 Dec:-nationwide study shows the rate of AIDS is higher than other countries in Europe. EU and US to contribute $4m for treatment/prevention programs. Reuters“AIDS to Hit African Work Force Hard, ILO Says”01 Dec. Reuters“African Leaders Urge Urgent Action Against AIDS”03 Dec:-leaders at conference on HIV/AIDS in Ethiopia warn of spreading of disease, and the impact on social and economic structures of their nations. Elizabeth Rosenthal“Chinese Media Suddenly Focus on a Growing AIDS Problem”17 Dec:-article dealing with unprecedented media reports of AIDS cases in rural China, which local officials tried to cover up. Reuters“AIDS Taking Deadly Toll on S. African Youth”10 Jan 2001:-200 infants born with HIV every day in the region, public questions Mbeki’s government disallowing AIDS drugs which prevents mother to child transmission. Christopher S.Wren“U.N. Council Takes Up Issue of H.I.V. Among Peacekeepers”20 Jan:-Security Council meeting on the cost-related AIDS tests of peacekeepers which many countries cannot afford. Reuters“South Africa Stops AIDS Plan Over Fear of Attacks”11 Jan:-notification process which allows for public HIV testing in the country has been stopped by the S. African government due to fear of violent discrimination against AIDS victims. Reuters“One in 10 Urban Gays Have HIV, Study Finds”05 Feb:-US government study shows most blacks are victims of the disease. Reuters“African AIDS Crisis Is Still Largely Ignored”05 Feb:-discussion at the 8th Annual Retroviral Conference in Chicago on the alarming rate of deaths caused by AIDS(80% of people)come from Africa. Altman“New Ideas Sought to Help AIDS Orphans”05 Feb:-12m orphans in Africa, since their family members are also affected by the rapid spread of the disease, according to an AIDS expert working in the region. AP“Catching HIV in Single Sex Act Low”08 Feb:-US study shows the probability of getting AIDS without the use of condoms is one in 588. Results encouraged the impact of AIDS drugs in containing the spread of the disease. Reuters“South Africa Mining Firms Test Workers for AIDS”13 Feb. Reuters“AIDS Treatment May Lead to Unsafe Sex”15 Feb:-US health study finds that HIV victims taking AIDS drugs are getting other types of STD’s, it may be result of unprotected sex. Reuters “Condom Under - Use Fuels AIDS Epidemic”16 Feb:-”15 billion too few condoms are used globally each year” according to a US expert. Reuters“World Bank Warns on AIDS Increase in Cameroon”15 Feb:-with one out of nine people that are sexually active are infected in the country. Reuters“India Underestimates AIDS Cases, Says Activist” 16 Feb:-AIDS activist points out the misrepresented number of people with AIDS in rural areas of the country. Reuters “South African AIDS Campaign Targets Pre - Teen Sex”20 Feb:-LoveLife an AIDS sponsored organization funded by the Bill and Melinda Gates Foundation, found that many S. African teens are vulnerable due to the country’s highest rate of rape in the world. Reuters“China Admits Having More Than 22,000 HIV Carriers”26 Feb:-Chinese Health ministers blame drug users within rural areas for the increase of infections. Crossette“In India and Africa Women’s Low Status Worsens Their Risk of AIDS”26 Feb:-Annan argues that women are vulnerable to get infected due to their “weaker ability to negotiate safe sex, and their lower social and economic status”. Reuters“Russia Rings Alarm Bells on Drugs, HIV Surge”13 Mar:-Moscow reports of increasing drug use among young people through needle sharing, has multiplied 20-fold over the last 10 years. AP“South Africa: More HIV Than Thought”20 Mar:-government study shows that 4.7m are infected with HIV, Mbeki refuses to declare a state of emergency in which generic drugs could be imported. Rachel L. Swarns“Newest Statistics Show AIDS Still Spreading, in South Africa”21 Mar:-S. African government study shows optimism that the disease has reached its peak with 4.7m people infected. Rosenthal“Deadly Shadow of AIDS Darkens Remote Chinese Village”28 May:-coverage on Donghou residents in which “80 percent of adults carry H.I.V., and more than 60 percent are already suffering debilitating symptoms”. AP“New Study Sees AIDS Rates Jump”31 May:-4.4 percent of newly infected each year is within gays and bisexuals according to a CDC study. Reuters“UN Says AIDS Has Killed 22 Million, Worst to Come”05 Jun:-UN is asking for $7 to $10 billion a year towards the rapid spread of AIDS in Africa. C. Claiborne Ray“Q&A: AIDS in Africa”05 Jun:-continent’s economic, political and medical factors contribute to the high rate of AIDS. AP“U.N. Discusses 20 Years of AIDS”05 Jun:-UNAIDS director Dr. Peter Piot, warns that AIDS could spread to other countries who have never been affected. Ian Fisher “Europe’s East Sees AIDS on the March”13 Jun:-needle sharing in Eastern Europe as the main reason for the infection rate to rise. Crossette“AIDS Hidden in Myanmar, Expert Says”25 Jun:-US AIDS expert claims that the Myanmar government is falsifying infection-rate statistics due to alarming results of being the second worst country in the world with the pandemic. Reuters“South Africa AIDS Orphans Struggle to Survive”21 Jun:-Study by Mandela shows that the disease has left an increasing number of orphans close to starvation. Seth Mydans “Fighting AIDS: A New War Is Killing Cambodians” 07 Jul:-170 thousand people affected according to UN statistics, making the country hit hardest with the disease in Asia. Washington Post“HIV Cases in Russia Rise Sharply”29 July:- 50,000 people infected with HIV has allowed for the disease to spread at the rate of African nations, according to Russian health officials. Douglas Frantz“Drug Use Begetting AIDS in Central Asia”05 Aug:-increase of drug trade, unreported AIDS statistics and low standard of living could allow for the disease to spread within Central Asia according to a US medical study. Rosenthal“Doctor’s Dirty Needles Spread Hepatitis in China”20 Aug:-”overuse of medical injections helps explain the alarming spread of blood-borne infections in China, to a lesser extent, AIDS”. AP“Hepatitis Rate Spikes in China”22 Aug:-two thirds of China’s population(1.26 billion)has been infected with Hepatitis due to the use of un-sanitized needles by the nation’s hospitals, and has also allowed the AIDS pandemic to spread. AP“Reported AIDS Cases in China Climb”23 Aug:-a 67% increase of HIV infected cases from last years findings has been reported by health officials in Beijing, blaming drug users and prostitutes for the spread. Reuters“China Admits ‘Very Serious’ AIDS Epidemic”23 Aug:-similar coverage as above, Chinese health officials focusing on Henan province as being hit the most with the pandemic. Rosenthal“China Now Facing an AIDS Epidemic, a Top Aide Admits”24 Aug:-Chinese health minister criticizes his government for trying to cover up the rise of AIDS and not developing prevention measures. AP “AIDS Leads Causes of Thailand Deaths”31 Aug:-nation’s health officials agreed that 16 percent of all deaths result from AIDS. Gina Kolata“The Genesis of an Epidemic: Humans, Chimps and a Virus”04 Sep:-scientific perspective on the origin of AIDS from a mutated virus to humans getting the disease from primates in Africa. Reuters“Report Says AIDS Leading Cause of Death in S. Africa”16 Sep:-S. African medical report shows that 40 percent of deaths last year. were AIDS related. Economist“AIDS in Asia: Sex Bomb”04 Oct:-rate on the rise of the pandemic in Asia in contrast with its leaders and the WHO attending an AIDS congress in Melbourne agree that the disease is being contained. Rosenthal “Poorly Prepared Asian Countries Warned of AIDS Epidemic”05 Oct:-UNAIDS report shows an increase of the infection rate mainly in China and India due to its population size. AP“AIDS Cases Rise in China”27 Oct:-Beijing reports 5,616 new cases of AIDS have been found, drug abuse, prostitution and homosexual activity are believed to be the cause. AP“Russian City Is Closed to Foreigners” 08 Nov:-suspected reason for the closure of the Siberian city of Norilsk may be due to a high percentage of the population infected with HIV. AP“UN Warns of AIDS Spreading in China”13 Nov:- China’s first AIDS conference, UN estimates that “600,000 Chinese had been infected with HIV in 2000". Swarns“A South African Hospital Fights AIDS and Despair”26 Nov:-S. African hospital coping with an increasing number of AIDS victims without proper equipment and space to treat them. McNeil“AIDS Crisis Leaves Africa’s Oldest Ways at a Loss”27 Nov:-S. African traditional healers not able to cure their patients but are aware of the cause and symptoms of HIV. AP“AIDS Epidemic Hits Russian Teens”28 Nov:-UN report shows that in Eastern Europe the infection rate is highest in the world with more youths doing drugs and having unprotected sex. Reuters“World AIDS Epidemic on Rise; E. Europe Cases Swell”28 Nov:-similar coverage as listed above. McNeil“Witnesses to an Epidemic Shrug Off Shame to Fight a Dangerous Fear”28 Nov:- how people in S. Africa with HIV create awareness groups for public discussion. McNeil“A Lonely Crusade Warning Africans of AIDS”28 Nov:-recollection of a S. African doctor, Dr. Jorgensen who tried desperately to create an AIDS prevention center by showing the rise of the pandemic in 1991. McNeil“Rare Condoms, Deadly Odds for Truck-Stop Prostitutes”29 Nov:-S. African health study shows that truck drivers who have sex with prostitutes is the primary reason for rampant spread of AIDS. Economist "AIDS: Unhappy Anniversary”29 Nov:-”Almost 70% of new infections and existing cases-a daunting 28.1m people-are in sub-Saharan Africa.”. Altman“H.I.V. ‘Explosion’ Seen in East Europe and Central Asia”29 Nov:-UN report on AIDS shows that both continents face an infection rate that is 15 times more than the rate it was three years ago. McNeil“AIDS and Death Hold No Sting for Fatalistic Men at African Bar”29 Nov:-conversation of men in a small village in S. Africa and their negative views on condoms, and their lack of knowledge of sex education. McNeil“South African Victims Face Rapists and H.I.V.”30 Nov:-public health system in S. Africa does not provide AIDS drugs to rape victims, “country widely believed to have one of the highest rape rates”. Reuters“Pope Sends World AIDS Day Message to Sufferers”01 Dec:- Vatican to be working alongside AIDS scientists to find a cure. Reuters“South Africans Protest Rape of Five - Month - Old Baby”04 Dec:-protesters demand that their government’s judicial system convict the HIV infected rapists, the belief of having intercourse with a virgin will cure people infected with AIDS is rampant in the region. Economist“AIDS in Africa: Burkina Faso’s fight against AIDS”12th international conference on AIDS with “thousands of scientists, activists and politicians...are publicly alarmed” for the rate of the disease with 2.3m Africans who have perished last year. Rosenthal “A Poor, Ethnic Enclave in China Is Shadowed by Drugs and H.I.V.”21 Dec:-the impact of intravenous drug use by young people in poorer rural areas of the country due to drug trafficking from Myanmar. Reuters“S.Africa Drops Baby Rape Charges Against Six Men”17 Jan 2002:-DNA testing proves the men were not the perpetrators, 21,000 child rape cases were reported to the country’s police last year. Fisher“AIDS in Ukraine Jumps to the General Population”23 Jan:-1 percent of the country’s adult population are infected, UN trying to raise $50m to provide for a three year AIDS prevention program aimed at young people. Reuters“AIDS Set to Surpass Black Death as Worst Pandemic”25 Jan:-NGO health official is advocating for AIDS drugs to be distributed to the 40m people affected with the disease. Reuters “Official: AIDS in Russia Being Ignored”10 Feb:- Russian health expert warns that the infection rate of AIDS will increase if the public is unaware of the social impact the disease will bring, e.g. “children orphaned by the disease”. AP “Scientists Warn on Primate Meat Sale”19 Feb:-illegal, large-scale commerce in primate(“bush”)meat, as non-essential, exotic food in Africa and elsewhere, threatens to spread deadly infections(human AIDS virus may have originated via chimpanzee bushmeat), and dangerous reductions in the species. The latter would also affect medical research on AIDS and other deadly diseases for which chimpanzees are critical. Andrew Pollack“Technique May Improve Safety of Donated Blood”02 Apr:-US Cerus Corporation devised a new process of blood transfusion ”pathogen inactivation”that will eliminate AIDS and other blood related bacteria. Emma Daly “U.N. Says Elderly Will Soon Outnumber Young for First Time” 09 Apr:-UN study in S. Africa and India shows that AIDS is responsible for poverty, and the decrease of younger people. AP“Mogae: We Must Hand out AIDS Medicine”09 Apr:-Botswana’s president plans to open more treatment clinics and is looking to provide AIDS drugs to victims of the disease, 19% of the population is known to be infected. AP“China Announces Jump in AIDS Cases”11 Apr:-Beijing shows 17% increase in number of victims infected with AIDS. Needle-sharing and unsanitary blood-donations are the cause. Rosenthal“China Raises H.I.V. Count in New Report”12 Apr:-Beijing health officials state that 68 percent of HIV cases were due to needle sharing, while 9.7 percent is due to unprotected sex, and 7.2 percent comes from poor maintained blood banks. Economist“Worry about the Children”07 May:-”The spread of HIV/AIDS has undercut many of the development gains of the past decade, devastating in particular the lives of children in sub-Saharan Africa.” Diana Jean Schemo“Education Suffers in Africa as AIDS Ravages Teachers”08 May:-World Bank study shows teachers parts of Africa are dying from AIDS, while nations are not able to train new replacements. Economist“AIDS in southern Africa: Fighting Back”09 May:-”About 5m South Africans are living with HIV and, at the current rate of infection, about half the country’s teenagers under 15 can expect to contract it.” Henri E. Cauvin“H.I.V. Survey in South Africa Suggests Plateau in Infections”11 Jun:-annual survey shows that the infection rate of the country has levelled at about one quarter of the population. Crossette“U.N. Finds AIDS Knowledge Still Lags in Stricken Nations”23 Jun:-UN global study on AIDS shows that people in poor nations are aware of the disease but are not taking precaution measures to protect themselves from it. AP“U.N. Predicts Chinese AIDS Epidemic”27 Jun:-UN AIDS report projects 10m chinese to be infected by 2015, study also is urging Beijing to spend on more sex education and prevention programs. Rosenthal“U.N. Publicly Chastises China for Inaction on H.I.V. Epidemic”28 Jun:-similar coverage as above. AP“China Officials Reject AIDS Report”28 Jun:-Chinese health officials argue that prevention programs have proven to be unsuccessful, and argue that Beijing has funded $2 million for five years on these programs. AP“U.N. Says HIV / AIDS Spreading Rapidly”02 Jul:-UN report shows the rapid increase of AIDS in the world mainly in areas such as China, southern Africa, and Eastern Europe, UNAIDS director Peter Piot warns that its only the beginning of the epidemic. AP“Zimbabwe Plagued by AIDS Crisis”02 Jul:-UNAIDS statistics show that the country has the second-highest HIV infection rate in the world, leaving 900,000 orphaned children. Altman“U.N. Forecasts Big Increase in AIDS Death Toll”03 Jul:-UN will present a world AIDS report that predicts that 65m people will be infected by 2020 at the 14th International AIDS Conference in Barcelona. AP“45 Million More AIDS Cases Predicted”05 Jul:-a scientific statistical report published in the Lancet medical journal predicts that 29m people could be saved if $27 billion is put towards prevention programs across the world. NYT“Russia Lacks AIDS Funds”05 Jul:-Russian AIDS expert states that Moscow is not funding enough for AIDS prevention/treatment programs. Altman“Modest Anti-AIDS Efforts Offer Huge Payoff, Studies Say”05 Jul:-similar coverage of Lancet report, scientists also claim that improving women status, condom promotion and distribution, sex education for young people will prevent 29m people to be infected. NYT “World Briefing Africa: African H.I.V. Strains Feared More Resistant”06 Jul:-US scientists warn that the AIDS virus may mutate in order to become immune to retroviral drugs. Reuters“Asia Criticized for Silence in Face of AIDS Menace”08 Jul:-AIDS activists along with UN officials denounced Asian leaders for allowing the disease to spread due to the government’s lack of public awareness, activists are also advocating for reducing AIDS drugs in poor countries. Economist“The Menace of AIDS”08 Jul:-”The UN report predicts that unless there is a massive increase in prevention and treatment, 68m people will die of AIDS in the 45 most-affected countries between 2000 and 2020.” Reuters“HIV in Young May Soar by 70 Percent by 2010"09 Jul:-US statistics presented at the AIDS conference projects that 21.5m teens will be infected, due to the number of new infections which were mostly children and young people mostly from sub-Saharan Africa. Altman“AIDS Leaving Grim Legacy of Orphans, Report Says” 10 Jul:-joint UN and US study shows that there will be 20m orphans in Africa in 2010. AP“UN: AIDS to Make More Kids Orphans”10 Jul:-similar coverage on the number of orphans in 2010, another statistical report by a Swiss research group claims that 100m orphans will be seen by 2010. AP“AIDS Infections Up Among Young Women”10 Jul:-Scientists at the AIDS conference state that half of the new infections are from young women. US study has found that rape in many African nations is the most probable cause for the spread of AIDS. Economist“AIDS: The Long War”11 Jul:-”Every day, 15,000 more people are infected. And most of these people will be young...AIDS kills predominantly in poor countries”. AP“Needle Exchange Key to AIDS Effort”13 Jul:-prevention programs for needle sharing in Spain getting attention at AIDS conference since they provide safe needles to drug addicts and hence lower the infection rate in the country. Economist“AIDS: Hope for the Best. Prepare for the Worst”11 Jul:-”Conferences on AIDS...are as much councils of war as scientific meetings. They offer an opportunity to take stock, review progress and plan the next phase of the campaign.”. AP“Health Gap in Rich, Poor Countries”11 Jul:-debate over who is to provide financial aid to control spread of AIDS: rich nations, pharmaceutical companies, or African nations themselves, was one of the highlights at the AIDS conference. Howard W. French“Whistling Past the Global Graveyard”12 Jul:-”The world stood by when AIDS was spreading in Africa; we can’t do the same thing now that it is spreading in Eastern Europe, at the doorsteps of the E.U.” states UNAIDS director Dr. Peter Piot. Altman“The Urgent Search for an AIDS Plan”16 Jul:-editorial illustrating the impact of AIDS killing over 20m people since 1981, the author stressing that 45m people currently infected will die due to lack of distribution of AIDS drugs and blood testing facilities in developing nations. Steven Lee Myers“Alarming Portents on Frontier of Russia’s AIDS Crisis”21 Jul:-description of prevention programs in the city of Kaliningrad in the form of vans distributing condoms to local prostitutes, due to a 30 percent increase of AIDS infection in the region in 2001. Economist“AIDS in Uganda: Was the Miracle Faked?”15 Aug:-”No one seriously disputes that infection rates have been falling in Uganda, but many doubt that they have dropped as precipitously as the authorities claim.”. AP“Case of 2nd HIV Infection Documented”04 Sep:-Swiss researchers and GlaxoSmithKline a pharmaceutical company have found that AIDS victims can also be infected with a second strain of the disease. AP“China: Year End AIDS Cases at 1M”06 Sep:-the nation’s health official also states that the rate of infection has been declining. UN reports that 10m people could be infected by 2010. Agence France-Presse“China Raises Estimates of HIV Cases and Warns of Increases”06 Sep:-similar coverage as above, with UN statistical figures of 1.5m currently infected in China. AP“A Look at AIDS Statistics in Africa”16 Sep:-UN statistics on the newly infected cases in sub-Saharan Africa in 2001, with 28.5m people infected and 58 percent of women and children mostly infected. AP“HIV Infection Rate Is Skyrocketing”18 Sep:-UNICEF warns that 80 percent of newly cases have been reported in Eastern Europe and Russia, and the majority of new victims of the disease are people under 29 years old. Economist“AIDS in Russia: A Looming Plague”26 Sep:-”The first big wave of AIDS-connected deaths will probably hit Russia in 2007. By then, it is feared, some 2-3% of its people [approximately 150m] will be HIV-positive. So far the medical service is hopelessly ill-prepared.”. AP“Russia, China, India Face HIV Crisis”01 Oct:-US intelligence report states that 75m cases will be seen by 2010 mainly in populated areas of Asia and Africa. The findings also estimate that 23m people in the area are currently with infected. Altman“AIDS in 5 Nations Called Security Threat”01 Oct:-similar coverage as above, US studies lists China, Ethiopia, India, Nigeria and Russia with 40 percent of the world’s population as a national threat by 2010. Economist“AIDS: The next wave”17 Oct:-detailed article on the functions of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the shortage of pledges to the organisation by developed nations to combat these three diseases. AP“AIDS Kills More in S. Africa Prisons”21 Oct:- S.African study shows that 1,000 prison inmates have died last year, and 45,000 could also perish by 2011. Rape, needle sharing and lack of AIDS testing in prisons are the cause of the deaths. AP“WHO Ranks Top Health Hazards”31 Oct:-unsafe sex ranks as the second worst health hazard in the poorest areas of the world, mainly sub-Saharan Africa. Amy Waldman“As AIDS Spreads, India Struggles for a Workable Strategy”11 Nov:-AIDS care facility in Tamil Nadu a rural village faces the increase of AIDS victims which has the world’s second highest number of cases. AP“AIDS Main Killer of S. Africa Women”21 Nov:-government study shows 9.8% of female deaths(compared to 8.7% of all deaths)were AIDS-related and concludes women are more at risk than men since biologically vulnerable and lack control in sexual relationships. Cauvin“ Stability of Africa Is Threatened as AIDS Infects Armies”24 Nov:-African military, with undetermined but high infection rates, threaten to raise national rates as they are demobilized/ dispersed(e.g. in Angola where 5.5% of adults already have HIV). Due to increased strategic interest in Africa, and military’s stabilizing role there, US is assisting vulnerable African countries to control military-related AIDS“explosion”. AP “Report: Women Make Up Half of HIV Cases”26 Nov:-UN study shows that AIDS has spread in Eastern Europe and Asia, to countries never affected before and with as many women as men being targeted. Reuters“U.N. Report Finds Women Make Up 50 Percent of HIV Infections”26 Nov:-”AIDS will have killed 3.1 million by the end of this year... 42 million people, half of them women, are living with HIV/AIDS, according to the latest figures from UNAIDS”. Reuters“U.N. Envoy: AIDS Root of Africa Food Crisis”27 Nov:-UN officials claims that 14m people facing food shortage is due to the lack of the agricultural workforce in which AIDS has decimated. Altman“Women Catch Up to Men in Global H.I.V. Cases”27 Nov:-”Of the 38.6 million adults living with H.I.V. worldwide, 19.2 million are women.” UNAIDS director Peter Piot states that sexual intercourse is the main cause for women to be infected. Economist“A Continent of Orphans”27 Nov:-”Africa already had 34m orphans last year. By the end of the decade, that is predicted to 42m, half because of AIDS.”. Economist“AIDS”28 Nov:-“An estimated 3.1m people will have died of AIDS in 2002, according to new figures from UNAIDS and the WHO.”with a chart illustrating which continents have been hit the most with the disease. AP“India AIDS Activist Crusades for Change”29 Nov:-US CIA study estimates that 4m people are infected with AIDS in India, and the number will rise to 25m people by 2010. Reuters“Britain Has Record Number of HIV Diagnoses in 2002"29 Nov:- British health experts state that a 20 percent increase of HIV cases has arisen in their country since the 1990's, 41,200 people are known to be infected in Britain. Nicholas D. Kristof“China’s Deadly Cover-Up”29 Nov:-article dealing with Beijing’s denial of the figures given by the UN which 10 m people will die from the disease in 2010, but rather the country arrests journalists covering the epidemic, and bans humanitarian organizations trying to help AIDS victims. AP“Chinese AIDS Estimate Gains Credibility”30 Nov:-after ignoring the UN projected figure of AIDS victims of 10m people, Beijing is active in promoting preventive and awareness measures of the disease. Reuters “Stigma Major Barrier to Fighting AIDS, Says Piot”30 Nov:-Piot warns that social prejudice towards AIDS victims could prove to be as fatal as AIDS, since it deprives them from health support. AP“Study: AIDS Rampant Among S. Africa Kids”05 Dec:-survey spearheaded by former president Nelson Mandela shows that 5.6 percent of children in the region are infected with HIV while a 13 percent of children have become orphans due to the epidemic. Economist“South Africa and AIDS: No More Denial”05 Dec:-”...South Africans are well informed about AIDS. Some 80% are sure, unlike Mr Mbeki, that HIV causes AIDS...young people aged between 15 and 24 are changing their sexual behaviour.”. Melissa Fay Greene“What Will Become of Africa’s AIDS Orphans”22 Dec:-coverage of orphans living conditions in Addis Ababa, Ethiopia which is estimated that 1m children have lost their parents due to AIDS. Swarns“South Africans With AIDS Seek Out a Quiet Place to Die”28 Dec:-”South Africa is believed to five million people infected with H.I.V. Nearly a quarter of all adults are infected. Government officials have often closed their eyes to the devastating epidemic.”. Kofi A. Annan“In Africa, AIDS Has a Woman’s Face”29 Dec:-editorial stating the link between AIDS creating famine in Africa, and how women in the region play a central role in agrarian society is being undermined due to their numbers declining. Rosenthal“Despite Law, China’s H.I.V. Patients Suffer Bias”14 Jan 2003:-HIV victims in Guangzhou, China are being discriminated due to their disease, and are also unable to find living quarters since landlords in the area won’t allow them to rent. Reuters“AIDS Epidemic Overshadows U.S. - Africa Trade Deal”17 Jan:-US trade officials warn that AIDS threatens the labor workforce in Africa, which can result in deterring US investment to take shape. Reuters “Zimbabwe Crisis Dims Anti - Hunger Gains in Africa”29 Jan:-UN humanitarian envoy finds that AIDS has killed 7m people in the country over the course of 10 years and, due to the death of many agricultural workers, famine has set in. Stolberg“The White House Gets Religion on AIDS in Africa”02 Feb:- President Bush has promised to donate $15 billion dollars to the Global AIDS Fund over the course of five years to African countries as well as Haiti and Guyana. McNeil“Where AIDS Stalks, Everyone Lives in Fear”02 Feb:-similar coverage as above, with 50,000 out of 30m people in Africa are taking antiretroviral drugs. Reuters“AIDS Seen Worsening Africa Hunger”04 Feb:-UN World Food Program(WFP)states the impact of AIDS which has disrupted the flow of food supplies and services in Africa, “2 1/2 million AIDS orphans, infection rates among adults--depleted public health infrastructure and private economies”. Economist“Cursed, Twice Over”13 Feb:-”...most of the 30m HIV-infected Africans are young women and men in their most productive years...With Fewer hands to plant and harvest, crop yields drop.”. Economist“South Africa: A Town Like Alice” 10 Apr 2004(37-9):-unusually informative article about the successes, failures and prospects of the South African situation after the first decade of democracy. The article offers description that not only has relevance to the republic, but history that can be applicable in numbers of other cultures in the world. Issues discussed include the general policies of African National Congress(ANC), liberation movements that ruled the country since apartheid was finally ended; the employment trends and serious problems of black and white inhabitants; the important yet inadequate welfare, education/training, housing and legal situations; fastest-growing and valuable tourism industry. The last half-page describes an inadequate - but widespread - local policy falling totally behind the HIV/AIDS situation. Economist 17 Apr 04“AIDS in India: When Silence is Not Golden”(10);“AIDS in India: Abating, or Exploding” (21-3):-clear-worded Editorial and well-researched Special Report offer masses of facts on a expanding epidemic and a still imperfect official Indian policy. Economist 22 May“The Cost of AIDS: An Imprecise Catastrophe”(68-71):-”The most dreadful cost of AIDS is in lives lost. A second cost, shared by those not infected, is economic. However, estimating the damage done by the disease, especially in southern Africa’s mostly feeble economies, is an inexact exercise even by the standards of economics, because AIDS has struck hardest in areas where data are least accurate: subsistence farming, casual labour markets, rural barter and so forth.” Economist 02 Jul 2005 "The Grand Challenges in Global Health: 43 Ways To Save the World"(69-70):-"The Gates Foundation's latest largesse has just been announced. It will pay for some intriguing and original research. But will it translate into healthier people? [References to several AIDS research projects]; "AIDS: Moving Targets" (70):-"Progress, and problems, in treating AIDS around the world". Economist"AIDS In South-East Asia: There's Good News and Bad News"02 Jul 2005(38-9):-"Good prevention work has tamed AIDS epidemic in some countries, yet it is getting much worse in others".

[Reference to Earlier, But Relevant, Book: Laurie Garrett Betrayal of Trust: The Collapse of Global Public Health (New York: Hyperion 2000):-this major(750+pp) - but selective - volume of criticism about the serious global inadequacy of identifying, constraining, preventing, handling and curing of current/ potential infectious diseases could be all read in sequence (i.e. from page 1 to page 585). Alternatively, the volume could be used for reference, not simply of individual diseases or societies but of serious types of health problems now found in much more than one location. The publishers' guide states inter alia: "Garrett takes on perhaps the most crucial global issue of our time... Using riveting detail and finely honed story-telling and reportorial skills, Garrett exposes the underbelly of the world's globalization." Following the Preface and Introduction, the very distinct six chapters describe different and serious health problems as follows: ONE: Filth and Decay: Pneumonic plague hits India and the world ill responds. TWO: Landa-Landa:An Ebola virus epidemic in Zaire proves public health is imperiled by corruption. THREE: Bourgeois Physiology:The Collapse of all semblances of public health in the former Soviet Socialist Republics. FOUR: Preferring Anarchy and Class Disparity:The American public health infrastructure in an age of antigovernmentalism. FIVE: Biowar:Threatening biological terrorism and public health. SIX: Epilogue:The changing face of public health and future global prophylaxis.]

Laurie Garrett"The Next Pandemic?"[First essay in four-item Special Section, all summarized as in]Foreign Affairs Vol.84/No.4 (Jul/Aug 2005):-"Since it first emerged in 1997, avian influenza has become deadlier and more resilient. It has infected 109 people and killed 59 of them. If the virus becomes capable of human-to-human transmission and retains its extraordinary potency, humanity could face a pandemic unlike any ever witnessed." Michael T.Osterholm"Preparing for the Next Pandemic":-If an influenza pandemic struck today, borders would close, the global economy would shut down, international vaccine supplies and health -care systems would be overwhelmed, and panic would reign. To limit the fallout, the industrialized world must create a detailed response strategy involving the public and private sectors." William B.Karesh & Robert A.Cook"The Human-Animal Link":-Recent outbreaks of avian flu, SARS, the Ebola virus, and mad cow disease wreaked havoc on global trade and transport. They also all originated in animals. Humanity today is acutely vulnerable to diseases that start off in other species, yet our health care remains dangerously blinkered. It is time for a new, global approach." Laurie Garrett"The Lessons of HIV/AIDS":-"To get a sense of the broader damage a new pandemic might do, it helps to consider the one the world is currently enduring: HIV/AIDS. Because this deadly scourge moves slowly, many of its social, political, and economic effects have yet to be understood. But the impact is hard to overstate. And it is growing."

Jim Yardley"New Estimate in China Finds Fewer AIDS Cases"New York Times 25 Jan 2006:-"China countered the long-held suspicion that it has undercounted the number of people with HIV and AIDS by releasing a new, more extensive estimate that found the opposite: that the country had actually overestimated its number of cases. New estimate, conducted with World Health Organization and UN AIDS program, lowered the country's estimated number of HIV and AIDS cases to 650,000 from the official figure of 840,000 released by government in 2003. Many experts and AIDS workers have long believed that China has at least 1.5 million cases, possibly far more, and some expressed skepticism that the new figure was any more reliable than past estimates. At a news conference..., Chinese and international health officials endorsed the new findings but also warned that while the overall number of cases is less than previously believed, the rate of infection is still rising, with 70,000 new cases in 2005. Drug users and prostitutes are transmitting HIV... in most of new cases, but the report also found that the disease is now spreading from such high-risk groups into the general population, raising the risk of broader infection"... [article over 2.5 pages long]; Reuters"China Overestimated Number of People With AIDS, Report Says"NYT 25 Jan 06:-related 1.5 page article; Associated Press"China Lowers Estimate of HIV Cases"NYT 25 Jan 06:-another related 1.5 page article; AP"Clinton Urges Help for Kids With AIDS"NYT 18 Feb 06:-"Former [US] President urged governments and public foundations to buy anti-AIDS drugs from low-cost manufacturers so more children can receive treatment for the disease. Clinton... said last month that Cipla and 3 other Indian pharmaceuticals would offer antiretroviral drugs at prices up to 30% cheaper than current market rate... Since his Clinton Foundation's 2002 HIV/AIDS initiative began, foundation has concentrated on making affordable drugs available, buying second line AIDS drugs from generic drug makers for 21 countries in Asia, Africa and the Caribbean, he said. His foundation planned to get anti-AIDS drugs to 60,000 children in worst-affected countries this year... 'We've had a 3-year partnership with Cipla, and because of them an enormous number of HIV/AIDS-infected people are alive', he said. India has 5.13m cases of the illness, second largest number of people infected with HIV after South Africa. Indian government claims its anti-AIDS campaign has stabilized the epidemic and says there has been a sharp decline in the number of new HIV cases"; Reuters"Clinton Group, India to Train Nurses in AIDS Care"NYT 19 Feb 06:-"Former US President and Indian government announced a joint plan to train nurses in AIDS care in a country which has world's second-largest number of HIV/AIDS cases... Partnership between National AIDS Control Organization of India (NACO) and Clinton Foundation, aims to develop training material and program for nurses... 'Nurses not only deliver clinical care, needed to keep people alive, but they also act as counselors and play an important role in reducing the myths, stigma, and discrimination surrounding this disease', [Clinton said]"; Reuters"Clinton, Australia Launch Tri - Nation AIDS Campaign"NYT 22 Feb 06:-"Former US President Bill Clinton and Australia announced plans to combat AIDS in China, Vietnam and Papua New Guinea, warning that 40% of all new infections could be in Asia-Pacific region by 2010... [Combined] money...would be used to make anti-retroviral drugs... more readily available and to improve testing and monitoring systems in the three countries... Clinton...said about 500,000 children died of AIDS around the world in 2005... Vietnam, China and Indonesia face fastest-growing HIV epidemic in the world. Papua New Guinea... faces an epidemic of similar proportions... With an annual infection rate increasing by 33% a year, country is on verge of an African-style disaster that could kill millions and destroy the economy"; Reuters"Schools Teach Survival to Africa's AIDS Orphans"NYT 23 Feb 06:-"...Swaziland has world's highest rate of HIV/AIDS, which is killing key workers and whittling away the tiny country's capacity to deal with a drought that has left some 10 to 12 million people in southern Africa dependent on food aid. Around a quarter of Swaziland's 1 million people rely on the UN World Food Program and many families eat just one basic meal of corn or rice a day. UN Food and Agriculture Organization (FAO) launched junior farmer field and life schools in Mozambique 2003 and has since opened schools in Kenya, Nambidia and Zambia, targeting some 1,000 young people between the ages of 12 and 18. FAO has now launched first phase of the project in Swaziland... Program combines farming skills with lessons on personal hygiene, money management and, crucially, about dangers of HIV in country where some 40% of adults are infected with virus that causes AIDS"; Reuters "Relief Group Seeks Access to New HIV Drug in Africa"NYT 15 Mar 06:-"A humanitarian group urged US drugmaker Abbot Laboratories Inc. on [15 Mar] to make a new HIV drug accessible in developing countries, especially Africa. Relief organization Medecins Sans Frontieres said a new formulation of Abbot's lopinavir/ritonavir drug had critical advantages for patients in poor countries, including lower daily pill count, storage without refrigeration and no dietary restrictions ... Sub-Saharan Africa has about 10% of world's population but 60% of people living with HIV/AIDS... More than 3m Africans became infected with HIV in 2005, representing 64% of all new infections globally and more than in any previous year for the impoverished continent, according to UNAIDS. MSF provides anti-retroviral drugs for over 60,000 patients in nine countries in Africa, Asia and Latin America. It said it urgently needed the new drug because refrigeration is unavailable to many people in poor countries. The new formulation, marketed under the name Kaletra, is in tablet form and does not melt at high temperatures unlike the old version which is in capsules. MSF said the new version of Kaletra, which was approved by US Food and Drugs Administration [Oct 05], was not available in any developing country. It urged Abbot to register the new version in developing countries, sell it at less than $500 per patient per year and remove patent barriers to allow production of generic versions... Abbott said it was pursuing registration for the new formulation in developing countries as rapidly as possible. It also said it was making its HIV medicines available in 69 of the world's poorest countries... Kaledra is a 'second line' drug which can be used when standard anti-retroviral drugs stop working... One MSF program found that after four years of ARV treatment, 16% of patients needed second-line drugs"; Reuters "Women, Hit Hard by AIDS, Need Own UN Agency: Envoy" NYT 17 Mar 06:-"Women and girls are far more vulnerable to AIDS than men and need their own UN agency to defend them, just as the UN children's fund UNICEF protects young people, a top UN envoy said. 'What has happened to women is such a gross and palpable violation of human rights that the funding must be found', said Stephen Lewis, UNSG Kofi Annan's special envoy for AIDS in Africa. 'We must right the wrong'. Lewis... said 56% of pregnant women between 25 and 29 years old in Swaziland were infected with HIV... In Lesotho, roughly 30% of girls 15 to 17 years of age were infected, he added. 'Reconfirms yet again the wildly disproportionate vulnerability of women and girls'. An estimated 57% of infected adults 15 to 49 years old in Lesotho are women... Lesotho and Swaziland broadly reflect what is happening across Africa, he said, arguing that situation would be different had a well-funded and powerful agency representing women's interests been in place... Across all of sub-Saharan Africa,.. estimated 4.6%of young women age 15 to 24 are infected with HIV, compared to 1.7% of young men, according to the latest available UN statistics"; AP"AIDS Said Orphaned 1.5M Asia - Pacific Kids"NYT 22 Mar 06:-"AIDS has orphaned an estimated 1.5m children in Asia-Pacific region, but they are often overlooked in the mix of other issues surrounding a disease that has historically focused on adults, officials told a regional conference... About 121,000 children in the region have been infected by the disease, according to UNAIDS figures from 2004. Another 35,000 also need anti-retroviral drug treatment to survive. Three-day meeting has drawn some 250 delegates from UN agencies, governments and NGOs to Hanoi to discuss what can be done to limit spread of the disease among youth and how to help children already infected or orphaned by it... UNICEF regional director... said there needs to be increased prevention efforts targeting youth, more focus on prevention of mother to child transmission, provision of drugs to children suffering from the disease, and creation of support groups for kids infected with the virus or orphaned by it... A Save the Children survey... found that many children cannot go to school because someone in their family is sick with the disease, they are commonly ridiculed and ostracized by society and are sometimes forced to work as slaves or sex workers after becoming orphans"; AP"Group Warns of More Child AIDS Deaths"NYT 24 Mar 06:-"Number of children orphaned by AIDS in East Asia-Pacific region could grow from 450,000 to 1.7m in less than a decade if resources aren't increased for prevention and treatment, UNICEF official said... Also said number of child deaths could reach nearly 20,000 a year during that time if more isn't done... It would take up to $5.5b annually until 2015 to lessen effects of HIV/AIDS on children in the region, in increasing to an estimated $6b a year after that, he said... [UNICEF epidemiologist also said] there are an estimated 450,000 children in the region who have lost one or both parents to the disease, and that could grow to 1.7m by 2015 without more funding... A document released at end of conference called for reducing the stigma and discrimination associated with HIV, boosting steps to prevent mother-to-child transmission, and enhansing care and protection for children. Other provisions included more pediatric HIV testing and greater access to anti-retroviral drugs for children. HIV/AIDS epidemic is growing faster in East Asia than anywhere else in the world. In many countries epidemic still largely concentrated in high-risk groups; AP"Bid to Give AIDS Drugs to Poor Nations Lag"NYT 28 Mar 06:-"UN's attempt to put 3m HIV-infected people around the world on antiretroviral drugs by last year fell far short of its goal, but it saved hundreds of thousands of lives nonetheless, [WHO] said. So-called '3 by 5 program' - 3m people on antiretroviral drugs by end of 05 - was launched in Dec 03. However, a progress report issued by WHO said only 1.3m people in poorer countries were being treated at end of 05... Program helped lay groundwork for more ambitious goal of achieving nearly universal access to medicine by 2010, set by leaders of G8 nations in 05... Some 3m people die of AIDS each year, [Global AIDS Alliance exec.dir.] said, and WHO believes program averted between 250,-350,000 deaths in 05... WHO report said world spent $8.3b on AIDS 05, up from $4.7b in 03... Treatment in southern Africa, a focus of program, has risen sharply... Other regions also of concern, such as India where large number of people infected and treatment access still very low. A general goal is to expand testing because most people who are HIV-positive don't know it. Testing for children in particular needs to be more widespread so that infected youngsters can be identified quickly and started on treatment, WHO AIDS director said. Health workers have to act quickly because about half of AIDS-infected children die before age of 2"; Lawrence K.Altman "Study Finds Drop in H.I.V. Cases in South India"NYT 31 Mar 06:-"Prevalence of new HIV infections has fallen significantly in southern India, region of that country where the disease has occurred most often, scientists reported. Many health officials have predicted major increases in HIV in India, which has world's second highest number of infected people, after South Africa. But new infections among young aduts declined by more than a third from 2000 through 2004, according to a statistical study. [Article contains selected statistics from study and varied information about sources.] Authors attributed favorable trend to an increasing use of condoms by men and an insistence by prostitutes that their partners use them. That decline, in turn, reduced transmission of HIV to spouses. Experts cautioned against drawing too firm a conclusion from one study and added that the new findings did not mean India's HIV epidemic was over. Still, the study has two key implications, researchers said. One is that strategies that emphasize education about how HIV can be transmitted and the use of condoms offer the best hope for reducing the spread of the virus in India. Second is that routine monitoring of HIV and other sexually transmitted diseases are powerful and cost-effective ways to control AIDS in India. But experts urged constant vigilance for signs of a reversal of the favorable trend... Reductions were more modest in 14 northern states, where prevalence of HIV infections is about one-fifth that in the four southern states"; Economist 01 Apr 06"Australia and AIDS: Help Thy Neighbour"(35):-"Partnership between Australian government and Clinton Foundation[op.cit.]... will work in China, Vietnam and Papua New Guinea (PNG), mainly to supply tests and anti-retroviral drugs... HIV has grown alarmingly in PNG to reach 50,000 estimated cases, about 2% of adult population.... Possibly rising to 500,000 cases by 2025. Unprotected sex has driven most of the spread in PNG. In China (500,000 estimated cases) and Vietnam (260,000 cases), contaminated blood transfusions, prostitution and intravenous drug use are the main avenues... AIDS left unchecked could prove another potential source of regional instability along with terrorism... Having 8.3m people infected with HIV in Asia and the Pacific threatens the economic life of Asia, especially that of China... The outlook is grim: the number of sufferers is forecast to more than double to 20m by 2010 unless rich countries... start exporting their own successful experience in curbing AIDS"; Economist 01 Apr 06"Treating AIDS: A Missed Target"(64-5):-"World Health Organization(WHO)'s attempt to roll out AIDS drugs in poor countries has missed its target. A shame, but not a disaster[op.cit. AP 28 Mar]. The '3 by 5' initiative to get 3m HIV-positive people in poor/middle-income countries on to anti-retroviral drugs by end of 2005 has got less than halfway there. [WHO/UNAIDS reported] a mere 1.3m of those infected in target countries are on courses of drugs. [Yet shift from pure prevention to care offered incentives for] those who might...be infected[: new] reason to find out the truth [and encourage modified behaviour to reduce transmission. Also, even 3+ times the previous number under treatment] averted about 250,000 premature deaths in 2005. One problem [was] that in most countries the [essential] infrastructure... did not exist. [Hence] the initiative may have been more successful than [new] figure suggests, since part money has gone on infrastructure [and] this sort of work has spin-offs beyond the treatment of AIDS. Expense of treatment also tackled[:] big change...in market for AIDS drugs. Clinton Foundation HIV/AIDS Initiative has helped to defragment market for generic anti-retroviral drugs by signing contracts... in India and South Africa that guarantee large order-volumes and reliable payment. As result, price in some cases... below $150 per person per year.. Progress, then, being made. [Possible] 3m figure by end of 06"; Reuters"S.Africa in New Row with AIDS Group Over UN Meeting"NYT 03 Apr 06:-"South Africa's Health Ministry has barred the country's top AIDS activist group from a major UN forum on the epidemic, the group said, sparking a new row over AIDS policy. Treatment Action Campaign(TAC), nominated for Nobel prize in 2004, said government excluded it from a list of South African groups invited to UNGA Special Session(UNGASS), to be held 31 May-02 Jun in NYC. 'We can only speculate (we have been barred because) we have taken an approach that doesn't play around with the issues and that we ask the questions that need to be asked', TAC gen-sec told Reuters. Health Ministry officials conceded TAC had been taken off official list of invitees. 'There was concern raised as to the position they have taken traditionally', spokesman said. TAC's campaign for anti-retroviral (ARVs) drugs has frequently pitted it against President Thabo Mbeki's government, which bowed to pressure in late 2003 to provide public treatment in the country worst affected by the disease. TAC and other critics say the roll-out since has been too slow, due partly to a lack of political will... South Africa's ARV program is second largest in the world after Brazil's, with more than 100,000 people on treatment. Activists say 900 South Africans die of AIDS-related diseases every day, and official data estimates 5.6m of country's 45m people are infected with HIV. Health Department said prepared to meet with TAC to try find an amicable solution"; Richard Cockett "Chasing the Rainbow: A Survey of South Africa" Economist 08 Apr 06(5-6):-Summary of major section on government's HIV/AIDS policy only: "[G]reatest weakness of [ruling African National Congress] ANC's top-down system is that party is inclined to dismiss ideas from outside its own bureaucracy. Most obvious example has been [President Thabo] Mbeki's well-documented response to the HIV/AIDS crisis. For a long time [op.cit.] Mbeki stood out against the combined weight of world medical opinion on the causes/treatment of AIDS, and particularly on use of anti-retroviral drugs. Main group campaigning for their use, Treatment Action Campaign, was made up almost entirely of ANC members, and Mbeki seems to have resisted their arguments as much because he felt they were breaking party ranks as for their prescriptions on AIDS (with which he disagreed). In 2003, government eventually caved in to domestic/ international pressure and gracelessly introduced a comprehensive management regime involving anti-retroviral drugs to combat HIV/AIDS. May have signalled change of policy by government, but not, it seems, much of a change of mind. In a country with 5.2m HIV-positive people on record, the largest number in the world, there is almost no public acknowledgement of the problem or public education about it. [M]inisters (with a few honourable exceptions) still seem loth to talk about the illness, which kills about 900 people a day and undermines much else the country is trying to achieve. It handicaps the army, with an infection rate said to be up to 40%, breaks up families and kills much-needed teachers. Chillingly, Actuarial Society of South Africa estimates that it will be another ten years before the pandemic peaks. Tardiness with which government responded to HIV/AIDS crisis, together with Mbeki's own strange take on underlying science, has tarnished own reputation, as well as that of ANC. Critics argue government remains ambivalent about its commitment to fighting pandemic with anti-retroviral drugs. Government's plan to combat HIV/AIDS may be model of its kind in intent, but it is already falling behind. By end of 2006 about 225,000 patients will be receiving anti-retroviral drugs, well short of the plan's target of 380,000 by 2005-06. Mbeki's unorthodox views on causes/cures of HIV/AIDS undoubtedly have something to do with his agenda of finding African solutions (rather than expensive Western ones) to Africa's problems... But AIDS saga, together with ANC's unresponsiveness to its own supporters and its failure to deliver on its promises, has diminished aura of moral authority it has earned"; Celia W.Dugger"Ukraine: World Bank Suspends TB and AIDS Fund"NYT 14 Apr 06:-"The World Bank [IBRD] has suspended a $60m loan to Ukraine for prevention and treatment of tuberculosis and HIV/AIDS. After three years, government has spent only 2% of the money. Ukraine has one of the fastest growing rates of HIV infection in Europe, with more than 1% of the adult population already infected, but government has resisted the Bank's suggestion that the funds be given to nonprofit groups that could act more quickly to reach prisoners, drug users and prostitutes at high risk of infection, said Nicholas van Praag, bank spokesman"; Reuters"Triple Treatment Cuts Malaria in HIV Patients"NYT 14 Apr 06:-"Combining anti-AIDS drugs, an antibiotic and bed nets treated with insecticide could cut the rate of malaria infections in people infected with HIV by up to 95%, researchers said. Malaria and HIV are leading infections in sub-Saharan Africa. In adults/children with HIV, malaria is more common and can be more severe... Researchers found that antiretroviral drugs, the antibiotic co-trimoxazole and bed nets are each effective in combating malaria in HIV patients, but when combined their impact is cumulative. Malaria... kills more than a million a year, mostly young children in Africa. HIV weakens the patient's immune system, making it more vulnerable to opportunistic infections such as malaria and AIDS... Co-trimoxazole, a standard treatment worldwide for patients infected with HIV, reduced the incidence of malaria in patients by 76%. When combined with anti-AIDS drugs it hit 92% and cut cases by up to 95% when bed nets were included. Researchers... believe the impact of the anti-AIDS drugs was due to its effect in strengthening the immune system rather than any direct effect of the drugs on the malaria parasite... Most malaria deaths occur in Africa, where the disease kills a child every 30 seconds, according to WHO. More than 40m woldwide are living with HIV/AIDS; more than 25m in sub-Saharan Africa. In 2005 about 2.4m in the region died from HIV/AIDS; AP"AIDS Conference Ends With Appeals"NYT 26 Apr 06:-"International AIDS conference [in Cape Town, of 1,000 scientists/researchers,] ended [26 Apr] with impassioned appeals to political/pharmaceutical industry leaders to fund development of a virus-killing [vaginal] gel to protect women from the disease and so save millions of lives. Peter Piot, head of UNAIDS,.. said safe/effective microbicides could be ready in 5-7 years, with only minimal additional funding, and thus turn the dream of saving millions of lives into reality... In the hard hit African countries, women account for nearly 60% of infections. Most are infected through heterosexual intercourse... UNAIDS/WHO have long promoted microbicides as a potentially valuable weapon in fight against the epidemic, not least because it allows women to protect themselves without having to rely on partners who refuse to wear a condom or be faithful. Yet despite this, research has proceeded slowly. [Piot] said investment in microbicide development should be doubled - and even then would still only reach about US$150m per year... Microbicides can take the form of a gel, cream, sponge or ring that releases an ingredient that can kill or deactivate HIV during intercourse. There are currently five different products being tested[, mainly in Africa on thousand of women]. Dozens of agents that could interrupt HIV transmission have so far been identified. There are also hopes that the microbicides could be used to prevent other sexually transmitted diseases and unwanted pregnancies. One of the products, cellulose sulphate, has the potential to be a contraceptive and shield against HIV... Another microbicide, Carragard, coats vaginal cells and prevents the virus from entering... Much of the funding for research comes from Gates Foundation and US government... Trying to dismiss fears that microbicides would mainly be used in developing countries and therefore offer only low profit margins, [WHO] cited their potential for use in contraception in wealthy countries"; Sharon LaFraniere"Circumcision Studied in Africa as AIDS Preventive"NYT 28 Apr 06:-"Growing number of clinicians/policy makers in [southern Africa] are pointing to a simple and possibly potent weapon against new infections: circumcision for men... New studies suggest that male circumcision can reduce chance of HIV infection in men, and perhaps in women... Validity of the approach is still being tested... Evidence so far, while intriguing, is not definitive... Most striking studies suggest that men can lower their own risk of infection by roughly two-thirds, and that inflected men can reduce the odds of transmitting the virus to their partners by about 30%, simply by undergoing circumcision. Research suggests that the cells on the underside of the foreskin are prime targets for the virus and that tears and abrasions in the foreskin can invite the infection. But WHO experts say it would be premature to recommend circumcision until results come in from two controlled trials... Preliminary results could be released by late Jun... Of the nearly 5m people worldwide who became infected last year, 3.2m live in sub-Saharan Africa, [UNAIDS] said... An epidemiologist and HIV specialist in Africa for USAID argues that low rates of circumcision and high rates of multiple, concurrent sexual partners are the main reasons that the AIDS epidemic has raged in southern Africa but left western Africa mostly unscathed. According to a study, seven southern African countries, where fewer than one in five men were circumcised, had HIV prevalence in adults of 14% to 26% in 1998. In nine western African countries, where more than four in five men were circumcised, HIV prevalence rates were below 5%... Studies appeared to show that uncircumcised men were more than twice as likely to be infected than circumcised men. Perhaps the most compelling evidence came from a study, financed by France, of 3,274 men outside Johannesburg. Half of them underwent circumcision; the others were uncircumcised. After 17 months, 49 of the uncircumcised men became infected with HIV, while only 20 of the circumcised men caught the virus... Researchers estimated that the procedure reduced the risk of contracting HIV by roughly two-thirds [and] that circumcised men infected with HIV were about 30% less likely to transmit it to their female partners ... Worries: if circumcision is oversold, circumcised men may think they are free to engage in risky sex... Other specialists concerned that studies may encourage unsafe circumcisions by traditional healers"; Ian Fisher"Debate Over Condoms and AIDS Tests the Pope"NYT 01 May 06:-"Even at the Vatican, not all sacred beliefs are absolute. Thou shalt not kill, but there is still 'just' war. Now, behind the quiet Vatican walls, a clash is shaping up between two poles of near-certainty: the church's long-held ban on condom use and its advocacy of human life. The issue is AIDS. Church officials recently confirmed that Pope Benedict XVI has requested a report on whether it might be acceptable for Catholics to use condoms in one narrow circumstance: to protect life inside a marriage when one partner is infected with the HIV virus or is sick with AIDS. Whatever the pope ultimately decides, church officials and other experts broadly agree that it is remarkable that so sensitive an issue is being taken up. But they agree that such an inquiry is logical, and particularly significant from this pope, who as Cardinal Joseph Ratzinger was Pope John Paul II's strict enforcer of church doctrine... The issue has surfaced repeatedly in recent years as one of the most complicated and delicate facing the church. For years, some influential cardinals and theologians have argued for a change for couples affected by AIDS in the name of protecting life, while others have fiercely attacked the possibility as demoting the church's long advocacy of abstinence and marital fidelity to fight the disease. [W]ith regard to condoms, the only change being considered, according to reports, is in the specific case of a married couple. But any change, however narrow, would be unpopular with conservative Catholics... It is too soon to know where the pope is heading... The debate has two levels: one on moral theology and church doctrine, the other public relations and politics. Many factors are driving the debate: The church is experiencing its greatest growth in Africa, which has the most severe AIDS problems. Much health care in Africa is provided by Catholic charities, whose workers, barred from providing condoms, have often spoken of being torn between church doctrine and the need to prevent disease. More broadly, critics of the current Vatican policy say it is hard for the church to remain consistent on 'life' issues, like its opposition to abortion and euthanasia and the death penalty, when condom use can help prevent the spread of AIDS. But there is a deep vein of feeling against any change... The moral arguments stretch back nearly two millennia, to the idea that the church has a responsibility, in difficult moral cases, to advocate the 'lesser evil'... There are other related arguments: One is of 'self defense', in which an uninfected partner could demand condom use to protect against infection. Another is that using a condom against AIDS could be considered medical intervention rather than contraception. But the 'lesser evil' argument is not universally accepted among Catholic thinkers, and the theology is complicated. Among many other issues, there is the user's intent: whether it is possible to use a condom without the intention of contraception... A change would address a relatively small part of the problem since most transmission of AIDS is not between married couples"; AP"Vatican Re - Examines Ban on Contraception"NYT 03 May 06:-"A Vatican study on whether it could permit condoms to battle AIDS has a very narrow scope; [b]ut its theological underpinnings are centuries old, and could lay the groundwork for an end to church's blanket ban on contraception. The principle of 'double effect' entered mainstream Catholic debate more than 300 years ago and draws on questions about the 'lesser of two evils' raised by theologians [long ago]. Some groups, including the Southern Africa Catholic Bishops Conference, have even given a tacit nod to condoms for married couples with one partner infected. The Vatican - however tentatively - now could be moving to formally recognize that position... There's no chance the Vatican would fundamentally revise its opposition to contraception, [b]ut even the targeted discussions... are further evidence of Pope... shedding [his] tradition-bound reputation... Benedict, a widely respected theologian, has shown a willingness to re-examine church attitudes toward advances in genetic engineering and in-vitro fertilization. But none approach the sensitivity of whether to open the door - even a crack - for condoms... If the Vatican allows condoms as an AIDS control measure within a marriage, it would open the way for Catholic groups to take a more direct role in anti-AIDS campaigns in ravaged places such as Africa... '[L]esser of two evils' views boil down to moral damage control. A priest should always advise against doing 'evil', but encourage a 'lesser evil' if they can't stop the act"; Reuters "Zimbabwe Running Out of AIDS Drugs as Crisis Worsens"NYT 03 May 06:-"Zimbabwe is running out of anti-retroviral drugs to treat HIV/AIDS as a foreign currency shortage hobbles government efforts to provide 20,000 people with the life-saving medicine, state media said. Acting director of Zimbabwe's National Pharmaceutical Company said his firm was struggling to find funds to buy ARVs for people with AIDS, which experts say kills an average of 3,000 Zimbabweans every week, Herald newspaper said... Health sector is among those hardest hit by Zimbabwe's severe economic crisis [super-inflation]... The embattled southern African country also lies close to the heart of Africa's HIV/AIDS epidemic, with the government estimating 1.61m people infected with the virus. But in a rare bit of good news, Zimbabwe's adult HIV prevalence has fallen to about 20% from 25% five years ago, apparently due to increased condom use and people having fewer sexual partners"; AP"HIV / AIDS Conference Eyes Indigenous People"NYT 04 May 06:-"More than 1,000 people gathered for five-day conference on HIV and AIDS for indigenous people in North America. 'HIV/AIDS is rapidly becoming a terrible predator in native communities, and most of these communities are unprepared to protect themselves', said... keynote speaker... 'Cases are being reported in even the most remote communities'. [P]rofessor... said researchers need to study the effectiveness of medication on native peoples... Conference participants included...natives.,.as well as physicians, nurses, pharmacists, researchers, elders and spiritual leaders"; Reuters"In Tiny Kingdom, Bono Presses New Africa Agenda” NYT 16 May 06:-“Irish rock star Bono began a new African tour in Lesotho where he will unveil a new initiative to fight AIDS in its ailing textile industry... Bono has billed this as ‘Measuring Success and Promisesto highlight the progress in the treatment of HIV/AIDS in Africa, the search for economic growth and rich nations’ pledges to cancel some debts and more than double aid to Africa by 2010... Lesotho...has history of food shortages caused by drought, and struggles with one of the world’s highest rates of HIV/AIDS with nearly a third of its adult population infected. Bono is due to announce a new initiative to fight HIV/AIDS in Lesotho’s textile and garment industry with US clothing maker Gap Inc... Gap is contributing 50% of its profits from the sale of GAP Red products to a global fund for AIDS in Africa and has committed to make some of the Red Products in Africa. The Apparel Lesotho Alliance to Fight AIDS (ALAFA) project will ensure workers have access to free drug therapy for the prevention and treatment of AIDS among factory workers”; Celia W.Dugger"Letter From Kenya: Where AIDS Galloped, Lessons in Applying the Reins"NYT 18 May 06:-major article describes/discusses US influence on Kenya policy, but summary mainly on current pandemic conditions. "Kenya rarity in Africa: nation where experts say AIDS shows signs of easing. So... attracting policy makers/researchers looking for keys to slowing relentless spread of AIDS on continent. Trends heartening. Medical experts estimate new HIV infections... plummeted over last decade from peak of more than 200,000/year to fewer than 90,000. And changes in sexual habits seem contributing to decline. Men say having sex with fewer partners, and women report losing virginity later. Many teenagers, once sexually active, say they are abstaining entirely. Such shifts... suggest abstinence programs... have some chance of success...Kenyan health officials frankly acknowledge evidence lacking on effectiveness of programs that promote condoms or abstinence. According to UN AIDS agency, Kenya, Uganda, Zimbabwe: the sub-Saharan with documented declines in HIV prevalence. Researchers agree fall partly because AIDS deaths have reduced population of HIV-positive people. But also say likely behaviour change has helped. In Uganda, increased use of condoms important. Health officials [in Kenya] say spread of knowledge about how to prevent infection and rising tide of death been catalytic... As donors racheted up financing of anti-AIDS programs, landscape for prevention changed. Since...2003, US dominant donor in Kenya: $208m this year to combat AIDS... More than half that financing feverish drive for diagnosis of AIDS and treatment of infected... AIDS patients receiving drug treatment rocketed to 70,000 from fewer than 10,000 in 2003. Paradoxically, explosive growth in testing/treatment may be US's most important contribution to preventing spread of disease. Once people know AIDS not a death sentence, more willing to be tested, and once know their HIV status they can protect themselves/sexual partners... Experts' judgement[:] more than half new infections in Kenya are with couples in which one partner HIV-positive. US also paying programs aimed at changing behaviour. This year,.. $15.7m on programs that promote abstinence/faithfulness, and $7.8m to prevent sexual transmission of HIV, including... condoms to high-risk groups. [D]ebate that rages in WashDC over AIDS/sex sometimes seems [here] more reflection US culture wars than African realities... Under guidelines, US funds can be used to educate children 14/younger about abstinence/faithfulness, with condom education added for 15/older... Scholars say much work remains to figure out which of so-called ABC programs - abstain, be faithful, use condoms - effective...But efforts to prevent spread of AIDS will not wait for definitive evidence. [If] sex can lead to death, many people on both sides of ideological divide agree abstinence for the young should be embraced. Also clear many young people will have sex despite the dangers, and that abstinence programs alone will not protect them"; Reuters“Children Called “Missing Face” of AIDS Pandemic”NYT 27 May 06:-“Some 2.3m children under 15 years of age are living with HIV, with little access to treatment, according to a report by child advocacy groups. ‘Children are the missing face of the AIDS pandemic’, executive director of UNICEF told a news conference [NYC] in introducing a report by seven humanitarian groups. Over 90% of children with HIV... are in sub-Sahara Africa, where diagnosis rare, treatment expensive and most available drugs produced for adults, report said... Vast majority of infants are infected by their mothers during pregnancy, where drugs are available to prevent transmission to infants but only about 10% receive them. Children rarely given needed anti-retroviral drugs, report said... AIDS among adolescent females as well as mother-to-child transmission increasing, despite affordable treatments available over past 15 years. New report/earlier one by UNICEF showed that each year more than 650,000 children under 15 account for 1 in 6 AIDS-related deaths. A child under 15 dies of an AIDS-related illness every minute, and a young person aged 15-24 contracts HIV every 15 seconds. All officials emphasized lack of research to combat AIDS in children, which means treatment is less precise and more expensive. Development of new drugs are focused mainly on adults. Although Africa governments pledged to spend 15% of their budgets on public health, less than a third have done so... [P]ledges from G8 industrial nations have not fully materialized. [Officials] spoke out in favor of sex education, tailored to age groups, and the need to keep girls in school. In some African nations, one third of girls under 18 are the victims of forced sex, often during forced marriages... Report on children was released ahead of UNGA Session on AIDS”; Seth Mydans“Shunned, Women With H.I.V. Join Forces in Vietnam”NYT 28 May 06:-“The dying women [who] have gotten together again...are members of a support group for people infected with HIV in a society where they are widely shunned, where drugs are scarce/treatment is expensive, and where a diagnosis of infection is still, for most people, a sentence of death... In the face of discrimination and in absence of adequate health care, they are for most part one another’s only support. [Vietnam] is a country teetering on brink of a nationwide epidemic, with more than 250,000 people infected with virus that causes AIDS, and only 10% of those who fall ill receiving treatment they need, according to UNAIDS... Country’s health care system is well organized, but the disease has until now been concentrated among intravenous drug users and has not been treated as a priority. Experts say it is beginning to spread quickly into the broader population, and one of the chief barriers to prevention/treatment is the stigma that makes outcasts of those who carry [HIV]. Support group - called Haiphong Red Flamboyant - is expanding.,.and a model for similar groups around the country. What the women rarely talk about... is near-certainty that in time they, too, will fall ill, and that they will be feeding/bathing/ consoling one another, and caring for one another’s children, as one by one they die... Over past 3 years scores of women have been members of Red Flamboyant. Many have died, but group has only grown - and spawned new groups - as more infected women step from the shadows and join. Most of the women gathered... said they had been infected by their husbands, in a city where drug addiction is widespread, and most said their husbands had already died. All had lost their jobs when their employers discovered they were infected... The government is preparing new legislation now to combat the epidemic, some $50m in assistance is arriving from abroad, and more drugs are becoming available”; UNAIDS2006 Report on the Global AIDS EpidemicUN NYC 30 May 06:-to special UNGA; text at: www.unaids.org/en/HIV)_data/2006GlobalReport/default.asp. Sub-titles: 1 Introduction 2 Overview of the global AIDS epidemic 3 Progress in countries 4 The impact of AIDS on people and societies[corrected] 5 At risk and neglected: four key populations 6 Comprehensive HIV prevention 7 Treatment and care 8 Reducing the impact of AIDS 9 The essential role of civil society 10 Financing the response to AIDS 11 Getting the best out of national responses 12 From crisis management to strategic response. Text in english|french|russian|spanish; whole is downloadable; Lawrence K.Altman“Report Shows AIDS Epidemic Slowdown in 2005"NYT 30 May 06:-“New surveys suggest that global AIDS epidemic has begun to slow, with decline in new HIV infections in about 10 countries, leader of UNAID program said. Outside of those countries,.. number of new AIDS infections continues to rise or hover at its current pace. Meanwhile, public health efforts are reaching only a small proportion of people at risk, Dr.Peter Piot, executive director of UNAIDS, said at news conference in UN NYC ...India has 5.7m infected people and South Africa 5.5m, but India’s population far greater. Showing no sign of decline, South Africa has a prevalence rate of about 19% of 47m people. In India, rate is less than 1% of its population of 1.1b. Progress against AIDS in some regions represents dividends from a surge in financing since 2001, when UN pledged its commitment to stem epidemic by 2010. Declaration called for countries to report regularly on their responses to AIDS. This week, UNGA will receive the progress that 126 countries have said they have made. Report(op.cit.), most comprehensive survey ever compiled from country data, pointed to the 2001 UN meeting as a turning point for AIDS financing. In 2005,.. world spent $8.3b on AIDS, compared with $1.6b in 2001. ‘We are seeing the impact’, Piot said. He cited increased condom use, a rise in postponement of sexual intercourse and a decrease in number of sex partners as factors in slowing of epidemic. Summarizing report’s findings, Piot said ‘2005 was least bad year in the history of the AIDS epidemic’... Despite the positive trends, Piot reported grim findings from China, Indonesia, Papua New Guinea, Russia and Vietnam(op.cit.), with signs of outbreaks in Bangladesh and Pakistan. Ending the pandemic will depend largely on changing social norms like empowering women, reducing stigma of the disease and encouraging a greater reduction in the number of sex partners, report said. Most countries have strong foundations for building an effective response against AIDS, report said, but systems to carry out plans remain inconsistent. Thoroughness of the individual national reports varied, and many countries did not provide data for all categories... Still, replies identified significant weaknesses, he said. Fewer than 50% of young people achieved comprehensive knowledge levels about HIV, far fewer than the 90% goal. Only 9% of gay men and fewer than 20% of intravenous drug users received any kind of HIV prevention help in 2005. Services to prevent HIV infections in infants have not scaled up as rapidly as programs to provide antiretroviral therapy. Just 9% of pregnant women were covered... Report shows that epicenter of the epidemic remains in sub-Saharan Africa. There epidemic has reached peak, but incidence remains unacceptably high, Piot said. Across most of Africa, HIV prevalence among pregnant women attending clinics has remained roughly level for several years. UN disputed contentions by some observers that the leveling off showed a turning point in the AIDS epidemic in Africa... Piot said, ‘actual number of people infected continues to rise because of population growth’”; Reuters“25 Years On, Anti-AIDS Drive Still Falling Short”NYT 30 May 06:-“Twenty-five years after AIDS first recognized, world still falling short in its battle against the disease with severe gaps in prevention and treatment, UN said [30 May]. ‘Response to AIDS epidemic to date has been nowhere near adequate’, said UNAIDS... Since...1981, AIDS and HIV virus that causes it have spread relentlessly from a few widely scattered hot spots to virtually every country in the world, infecting 65m and killing 25m, UNAIDS said in 630p report... Anti-AIDS initiatives and their results vary widely from country to country, and many are falling short of benchmarks set in a landmark high-level UNGA session in 2001, UNAIDS said... Dr. Peter Piot of UNAIDS... expected long-term commitments at this week’s meeting...and hoped for $20m annually by 2010... Global AIDS incidence rate is believed to have peaked in 1990s. About 1.3m in developing world now on life-extending antiretroviral medicines, which saved about 300,000 lives last year alone. Still, some 4.1m were newly infected and 2.8m died in 2005... Global supply of condoms was less than 50% of what was needed, and antiretroviral drugs, while more widely available, remained costly and hard to get. Ignored in many countries are prostitutes, said... ex-dir of UN Population Fund... However, final statement by governments at conference this week not expected to refer to prostitutes, drug users or homosexuals, due to objections from Islamic nations, some Catholic countries and US, which fear that merely mentioning these groups would endorse their behaviour. Infected individuals still suffer from ostracism and discrimination, while vast majority of world’s 40m infected have never been tested for HIV and are unaware of their status, report said. While $8.9b expected available in 2006, $14.9b will be needed, UNAIDS said. By 2008, it predicted $22.1b would be needed, including $11.4b for prevention plans alone. Report called for more and better-targeted education and prevention strategies, more treatment opportunities, and more drug research, particularly on drugs for children, whose needs ‘have been largely left out of the research agenda’”; Reuters“New Battle Lines Emerging in Asia Anti - AIDS Fight”NYT 31 May 06:-“While Thailand is a success story in the battle against HIV/AIDS, Myanmar and Vietnam[op.cit.] threaten to emerge as new regional hotbeds... Failure to work hard enough on prevention and a dearth of access to treatment were feeding growing HIV/AIDS epidemics [there]... Even Thailand, a former HIV/AIDS hot spot which has more than halved the number of new infections over past decade, could suffer a resurgence if public vigilance waned... According to report,.. Vietnam has seen HIV spread to all of its 59 provinces and cities. Out of population of 84m, 260,000 live with HIV. In Myanmar... 360,000 had HIV in 2005 and proportion of adults with HIV was 1.3% versus 0.3% in Vietnam... A major focal point in the fight against HIV/AIDS has been Asia, where some 8.3m were HIV-positive at end of 2005 - and two-thirds of them in India... In China, injecting drug users account for almost half the 650,000 with HIV... Women all over Asia are seen as increasingly vulnerable due to straying partners and a robust sex trade... The disease had yet to have a serious impact on Bangladesh, Philippines, Indonesia and Pakistan, but prevention methods needed to be improved to keep the disease from burning out of control, report said”; AP“AIDS Activists Protest at U.N. Building”NYT 31 May 06:-“Police used bolt cutters to separate AIDS activists who had chained themselves to each other in the lobby of the building that houses US mission to UN”; Lawrence K.Altman “U.N. Urges Tripling of Funds by ‘08 to Halt AIDS”NYT 01 Jun 06:-“Stopping epidemic of AIDS will require $22b/year by 2008 and possibly more in following years, officials of UNAIDS program said. The $22b is nearly triple the $8.3b spent 05 by all sources, including governments and private sector. Urging that countries spend more, UNSG Kofi Annan said a costlier and more sustained effort needed because AIDS ‘has spread further, faster and with more catastrophic long-term effects than any other disease’... Of projected figure, half is needed for prevention and a quarter for treatment and care of infected people. Remainder is for care of orphans, children at risk of becoming infected and program costs. UNSG and Piot of UNAIDS spoke as UNGA began meeting aimed at renewing political commitment and setting new goals for expenditures and for measuring progress... Annan urged delegates to challenge countries trying to avoid goals that mention gay people, prostitutes, intravenous-drug users and others at high risk of becoming infected. ‘Governments concerned need to be realistic and responsible’, UNSG said. He also said that ‘if we are here to try to end the epidemic, we will not succeed by putting our head in the sand and pretending that these people do not exist or they do not need help’... Report cards showed that most countries missed more goals than they met. More than 20m have become infected since 2001 meeting. Now countries must fundamentally change the way they think and deal with epidemic, moving from crisis management to ‘sustained attention and the kind of “anything it takesresolve that member states apply to preventing global financial meltdowns or wars’, Piot said... Global Business Coalition on HIV/AIDS released a study showing that private companies have become more likely to provide treatment for employees as cost of antiretroviral drugs has fallen over last six years, to $140-$300/year, from $10,000. In African countries with a high prevalence, more than 70% of companies surveyed are fully subsidizing access to HIV treatment, coalition said. Study...found increasing trend to expand such treatment to employees’ dependents. Companies also offering access to voluntary testing/counseling”; Reuters“Annan Tells Leaders to Help Prostitutes on AIDS”NYT 01 Jun 06:-“UNSG challenged world leaders to protect the most marginal groups in society from AIDS - prostitutes/drug users/homosexuals. Annan and UNGA President Jan Eliasson opened 3-day conference on AIDS that includes thousands of activists/ministers/diplomats to assess progress so far. [I]n a final statement now under negotiation,... many delegations prefer citing ‘vulnerablegroups, fearing that specific mention would endorse [prostitutes/drug users/homosexuals]. Also in dispute are rights for girls and sex education, among other issues. US took same position at last major UNAIDS conference in 2001, but US officials said this no longer was the case... Annan also stressed the increase of women contracting the disease... Particularly disadvantaged are women who have been raped, including child brides by their husbands, and women who are never diagnosed/treated. ‘I believe we are having such a big epidemic, among other reasons, because of the lack of control of women over sexuality’, [said] Piot of UNAIDS”; Reuters “Nations Split at AIDS Meeting”NYT 01 Jun 06:-“President of UNGA sought to break deadock over UN declaration on AIDS, with Islamic countries objecting to empowerment for girls and US/others resisting defining financial targets. Under pressure from more than 800 advocacy groups, [UNGA] President Eliasson produced a new draft compromise text... Peter Piot of UNAIDS...said delegates were being more flexible since Eliasson produced compromise. US, backed by Islamic nations, objects to any firm commitments to international financial goals”;Reuters“Wealthy Nations Accused of AIDS Funding Shortfall”NYT 01 Jun 06:-“AIDS advocates accused wealthy nations of falling behind on 2005 pledge to greatly step up their contributions to global programs set up to combat pandemic in developing countries. Looming shortfall...repesents ‘a scandalous betrayal’ of commitments made by G-8 at summit last Jul, said Stephen Lewis, UN special envoy for HIV/AIDS in Africa”; Lawrence K.Altman & Elisabeth Rosenthal“U.N. Strengthens Call for a Global Battle Against AIDS”NYT 02 Jun 06:-“[UNGA] adopted strongly worded declaration [02 Jun] aimed at pressing nations of the world to strengthen their battle against AIDS, global pandemic [UNSG] calledgreatest challenge of our generation’. Language of document surprised even anti-AIDS groups, which said that while it did not satisfy all their objectives, they had feared it would be watered down... Nonbinding declaration reaffirms commitments made in 01, when UN defined AIDS as far more than a medical issue, framing it in terms of political/human rights/ economic survival... New document is political blueprint, not plan of action. Calls for strong commitment to bolster the rights of women/girls so they can protect themselves from infection with HIV... Declaration calls on countries to: use scientifically documented prevention strategies, including condoms;make clean needles accessible to drug users; take steps to provide universal access to prevention programs/ care/antiretroviral drugs. Includes politically charged terms like ‘condoms’/‘vulnerable groups’, though those groups not specified... Countries expected to measure their progress over next 5 years against targets to be determined by UN... Said world will need to spend up to $23b/year by 2010... Earlier in day, UNSG Annan delivered a gloomy assessment, saying world was losing the battle. ‘The epidemic continues to outpace us’, he told packed UNGA. ‘There are more new infections than ever before; more deaths than ever before; more women/girls infected than ever before’... [US’s] Mrs.Bush speech steered away from many of the criticisms that have been labled against administration, notably that it promotes sexual abstinence over scientifically proven strategies, particularly condom use. Indeed, she said, ‘ABC’ model - initials stand for abstain, be faithful and use condoms - had brought sharp declines in infections in Africa. Britain’s international development [minister] said in interview: abstinence alone did not work ...Dr. Peter Piot [UNAIDS] said: while no document could make anyone ‘100% happy’, final version was ‘a major advance’ and far stronger than weaker drafts circulating earlier in week”; Reuters “Nations Resist New Financial Commitments on AIDS”NYT 02 Jun 06:-“A major UN meeting on AIDS strategy fell short of concrete financial commitments but recognized the growing spread of the disease among women and their right to protect themselves. Last day of 3-day meeting brought together heads of state, PMs and health officials from 151 countries... ‘I know that none of you got all you wanted in this declaration’, UNGA President Eliasson said in closing session. But he said thanks to advocacy groups, ‘the draft got stronger - not weaker’... Document says $23b will be needed annually by 2010 to fight AIDS ...Nations agreed to search for additional resources to ensure universal access to treatment by 2010. But delegations did not commit themselves to a timetable for raising the funds as they did in 2001 when the financial target was met... Squeamishness over sex was evident.,. with Islamic groups and conservative Roman Catholic countries using the term ‘vulnerable groupsrather than referring to prostitutes, homosexuals and drug addicts... Yet the document, in addition to abstinence, advocated male and female condoms and ‘harm reductionefforts related to drug use, a euphemism for needle exchange programs for addicts... Declaration called for sex education, reproductive health services and condemned ‘abuse, rape and other forms of sexual violence’ as well as ‘trafficking in women and girls’”; Economist 03 Jun 06Special Report: Twenty-Five Years of AIDS: Unhappy Anniversary”(24-5):-“Quarter of a century on, AIDS epidemic shows signs of peaking. But now the cost of its consequences is becoming clearer... According to UNAIDS, world spent $8b+ in 2005 trying to prevent spread of HIV... in poor/middle-income countries... and care for those already infected - about 39m. [Since UNGA commitments in 2001,] increase in fraction of population infected has slowed dramatically; in sub-Saharan Africa where 60% of infected live, this fraction has remained unchanged for 5 years [and] prevalence rate... rising only at rate population as whole is growing... Need today...is for a few success stories[:] AIDS can be contained if prepared to spend the money to contain it... UNAIDS report contains evidence prevention methods are working in parts of Africa where they did not seem to work before. In 8 of 11 African countries studied in detail, people having sex before they reached 15 has dropped; use of condoms increased; and in six there was decline of 25%+ from peak prevalence among those aged 15-24. Drop at this end of age range suggests reduced infection rates, rather than increased mortality...Figures for treatment are going in right direction, too. More being treated with anti-retroviral drugs. Figure at end of 2005 was 1.3m [-] less than half target of 3m UNAIDS had set itself, but not negligible. [M]aking these drugs available to all who need them by end of decade is still within reach[:] goal is to see 10m treated by 2010... Rate money has been made available for AIDS from all sources... underwent a step change in 2001[:] pledge was to find $7-10b by 2005, and what turned up was $8.3b. [Money particularly via two large funds.] Global Fund to Fight AIDS, Tuberculosis and Malaria...has internationalist credentials that most activists like. Financed by many countries/large charities/contributions from business [and] novel feature is regular assessment of its projects by outside consultants. [Other major fund is] PEPFAR, President’s Emergency Plan for AIDS Relief, [by US’s] George Bush. [A]ctivists are happy to take... US taxpayers’ money, but... comes with strings they do not like [, and] when large sums are at stake, tensions may be inevitable... AIDS is still incurable. Treatment works only as long as take the drugs. [A]ll realise on a mission without an end [, yet] 50th anniversary of AIDS may be more cheerful than the 25th”; Economist 17 Jun 06“AIDS: Nef Off”(87):-“The reason HIV is so virulent may have been found... The human immunodeficiency virus, HIV-1, is the most intensively studied pathogen in history. It still has secrets to reveal. One is why it is so deadly. Many of man’s primate relatives in Africa harbour similar viruses. Yet,.. simian immunodeficiency viruses (SIVS) have little impact on their hosts’ health... Investigation suggests it is result of a change in the role of a single viral gene, called nef...In most SIVS, one role of nef is to remove a protein called TCR-CD3 from the surfaces of the cells that host the virus. Host cells in question are immune-system cells called T-cells. Specifically, they are ‘helper’ T-cells, which orchestrate the immune system’s response to pathogens such as viruses... In the case of AIDS, immune system continues to be stimulated, and this prolonged stimulation results in high death rates among T-cells. Eventually, that exhausts immune system’s capacity to regenerate itself. Result is a collapse in the number of T-cells, and the accompanying symptoms of AIDS. In most simian infections, this does not happen because nef keeps the TCR-CD3 level too low for this exaggerated response to occur. That is also true in a rarer form of human AIDS caused by a virus called HIV-2. This form of AIDS is found in West Africa, but has not spread much beyond that part of the world. Indeed, of the 16 immunodeficiency viruses, all but five had nef genes that removed TCR-CD3 from the cell surface. Three of those five were closely related monkey viruses. The fourth was HIV-1. The fifth was the chimpanzee virus that is the direct ancestor of HIV-1"; [For the time being, I must limit guides to AIDS items by normally summarizing only 1-2 of their (initial) key paragraphs, since both number/length of the relevant articles(2-3 pages long) being published is so high. ‘Basic text’ underlining, then, is also not necessary. In addition, since all the items relate to POLICY ISSUES and the very special 16th International AIDS Conference (16IAC) in Toronto, all are listed under sub-section D. Rather than re-list virtually all of them four times in each of the sub-sections on AIDS issues, I simply ask you to survey material on all four topics under POLICY for the time being.]



C. MEDICAL DEVELOPMENTS AND CHALLENGES


Abigail Zuger“Epidemic: An Overview”in New York Times 02 Dec 1999:-a brief, non-technical and extremely clear account of the development of the AIDS epidemic, and the stages involved in determining what it did, what it was, how and why it spread. The article then describes how methods were gradually found to reduce or slow its spread and lethality - at the cost of constantly developing new drugs. “HIV is a virus with thousands of different strains and mutations, and it can develop resistance to drugs very quickly”. More important, in the poor countries of Africa and Asia where the vast majority of the HIV-infected are now found, and where the pandemic is spreading with frightening speed, current treatments are far too expensive ($15,000+ a year) and require good health systems. “For these countries, the best hope against AIDS lies in the development of a vaccine that can prevent people who are exposed to HIV from acquiring the infection. But the same variability that allows HIV to elude drugs also makes it very difficult to trap the virus into a vaccine”.Research is now along two lines. First, we need safe, easy and effective drugs to keep already-infected people from getting sick(see next). Second, HIV must be stopped from passing person-to-person and causing new infections. Pending a vaccine, it means education, HIV testing, reduced illicit drug use, increased condom use. Donald G. McNeil Jr.,“Simple Antibiotic Urged for Africans With H.I.V.”NYT 06 Apr 2000:-WHO/UNAIDS advise that the 23m Africans infected with HIV be given regular preventive doses of Bactrim, a common, affordable antibiotic already available in most village pharmacies, to ward off fatal secondary infections. Many could add years to their lives and have longer gaps between debilitating complications for $8-17 a year. Two one-year studies cut death rates and dangerous complications by 50%, so it was decided not to wait to determine longer-term effects. Its use in Africa seems appropriate against bacterial pneumonias, diarrheal diseases, some septicemias, and perhaps parasitic infections. Preventive Bactrim use in Asia is pending study results there. But meanwhile, Barbara Crossette"Most Nations Fail to Supply Safe Blood, W.H.O. Finds"NYT 07 Apr:-WHO claims over two-thirds of the world’s nations are failing to supply safe blood to their people. This adds significantly to the spread of HIV, as well as potentially deadly forms of hepatitis and other diseases. These nations, containing 80% of the world’s population (4.8b), are already the poorest and most unhealthy. The Reasons: not only costs, but the low priority given to public health and essential hygiene. The Result: WHO estimates that annually tens of thousands pick up HIV, and millions are infected with hepatitis B and C, which can lead to liver failure or liver cancer, simply through receiving or selling infected blood. On the other hand, Lawrence K. Altman"US to Study Vaccine’s Ability to Suppress HIV Levels"NYT 11 May:-a major test is being made of Remune, a vaccine for people already infected with HIV, that may stop the virus progressing into AIDS. Altman"New Therapy Strategies Pushed as AIDS Drugs’ Promise Fades"NYT 12 Jul:-”As the widely publicized hopes of a cure for AIDS have vanished and the limitations of standard drug therapy have become increasingly apparent, scientists are urgently seeking new strategies to make better use of therapies they have”. A US government scientist has announced “promising early findings”from two new trials aimed at giving long breaks in treatment to people infected with HIV. The aim is to help the body cope with the virus on its own for varying periods and also help patients absorb(and afford)the drug more easily. This would not be a cure, but would address indications that drug combinations can lose effectiveness if continued for too long, let alone for a lifetime. Optimum doses and time schedules are still being tested, but longer time cycles seem feasible, easing both costs and side-effects. HIV-level tests are essential, and would have to be expanded in Africa. Katrina Woznicki"On-and-Off Approach for AIDS Drugs"onhealth.com 12 Jul:-a description of the same trials, but here the procedure is called”structured intermittent therapy”, and the hope is raised that it might reduce the chance of the AIDS virus developing resistence to medication. Altman"Hopes for Anti-HIV Treatment Dashed"NYT 13 Jul:-”Women at high risk of contracting [HIV] should not use the widely sold spermicide, nonoxynol-9, because it may increase the risk of HIV” according to UNAIDS. It had been hoped it would act against HIV. Over 50 other compounds are being tested because of the great need in Africa. Woznicki"New AIDS Drug in the Works"onhealth. com 14 Jul:-scientists are hopeful a new drug may help AIDS patients who have not responded to standard treatments. An”entry inhibitor”,” T-20 is an experimental treatment that works by blocking the virus from getting inside blood cells, its primary means of spreading in the body. Standard AIDS drugs work by preventing the virus from replicating itself”. In a test, T-20"significantly cut viral levels in 41 patients”, but did not help 16. As regards the heart-breaking number of babies born with HIV or contracting it soon after birth, two articles(run together here because of their direct relationship)report on two apparently conflicting test results. Altman"Report Dims Hope for AIDS Therapy"NYT 08 Jul:-this article offers another warning about Africa’s special problems. A UN-sponsored AIDS study has”confirmed earlier reports that a relatively simple drug regimen can stop many infected mothers from infecting their children during pregnancy and childbirth. But it also found that the protection does not last for as long as experts had hoped, and the therapy appears to leave children vulnerable to infection from breast milk”.By 18 months all benefit is lost. The insuperable dilemma is that long“breast-feeding...is [already a serious] medical risk but a cultural, religious or economic necessity for millions of African women”-plus now to hide the fact that they are infected(see below). However Altman"AIDS Studies on Infants Appear to Conflict"NYT 14 Jul:-reports that second study found another simple drug regimen“given to women during labour and to their newborns in first three days of life”seems to protect babies from HIV. As both systems meet African low-cost capabilities, resolution of the dilemma created by the findings will get top priority. Economist 15 Jul"The Battle With AIDS"(Edit.17-8);"A Turning-Point For AIDS?"(77-9):-remarkable essay (backed by Editorial), that conveys a mass of information about the pandemic, analyses why it spreads so fast, and suggests how to stop it. Fatal social attitudes simplify its blitzkrieg(particularly in Africa): silence, stigma, discrimination and denial. These block transfer of vital pre- and post-exposure information; isolate, hide or punish the infected; stifle the reality that AIDS“is a disease of ordinary people leading ordinary lives”. Yet AIDS’ tastes are fastidious: it kills those -both men and women- in the prime of their lives, producing”social dislocation on a grand scale”. Using Senegal and Uganda as rare cases where AIDS has been prevented/controlled, the essay deals with three components involved in stopping a mainly sexually-transmitted disease: (1)its ”transmissability”; (2)the average rate at which an infected person acquires new, uninfected partners; (3)the average length of time someone is infectious. Counter-actions: (1)AIDS is not easily transmissable. Hence a substantial defense can be offered by(a combination of): condoms(plus increased female”bargaining power”); microbicides to kill the virus in the vagina; treatment of other sexually-transmitted diseases(lesions make people more vulnerable). To reduce transfers from mothers to(unborn)children: give infected pregnant women antiviral drugs just before giving birth, and avoid breast-feeding(but see above). (2)Rate of infection can also be reduced by less mating between high-risk(prostitutes/addicts) and low-risk groups. Female bargaining power(to refuse, or at least demand condoms) is also useful here, but the best defense is(self)control through effective public information. (3)The real solution to the length of time the disease remains infectious is a vaccine, which is not yet available. While current drugs help, they are costly, and viruses become resistant. Fairly effective and cheap vaccines are much better than none. Reuters"Intron Research May Lead to New HIV Therapies"onhealth.com 27 Jul:-US researchers claim introns, small pieces of genetic material that can be inserted into targeted areas of DNA,”may hold the key to new therapies to fight HIV”. They might be”used to shut off the function of a gene or to introduce new functional genes”at specific DNA sites. Thus introns might be used as gene therapy to halt HIV replication, but an efficient mechanism needs to be developed for introducing introns into cells. New Vision(Kampala)"Canadian Firm in Novel AIDS Kit Marketing Bid"onhealth.com 27 Jul:-Canadian pharmaceutical company, Medmira Inc., has begun distributing in Uganda “a rapid HIV testing kit that gives results in two minutes...[T]he test is quick, portable, can be done by a lay person, and does not require refrigeration”. Distributed only through hospitals, clinics and pharmacies, the company would hold”sensitization workshops on the use and significance of the...kits”. The company representative said they have now stocked”enough to supply the entire nation and the Great Lakes region” and that stocks could be replenished within seven days. Kits are also in use in China, Russia and Europe. Woznicki"Stress Speeds Up AIDS Progression" onhealth.com, 01 Aug:-”A patient’s ability to cope with adversity and everyday stresses in his or her life can affect the progression of AIDS”. A researcher at the University of North Carolina claims:”if we can develop treatments to help people deal with stress and cope with stressful life events and HIV, perhaps we might see these as having some efficacy for the course of this disease”. [Tragically, if true this constitutes a sentence of earlier death for those with HIV in most poor countries. Life is stressful enough to survive in the first place. The usually unanswerable question of being infected or not, adds more stress. Once confirmed, the stress multiplies: probably social ostracism, plus lack of anti-HIV treatment, concluded by an inadequately mitigated death - all with no hope for any sort of anti-stress medication except alcohol.] XINHUA"China-Made Anti-AIDS Drug Experimented in Thailand"onhealth.com, 07 Aug:-reports that clinical trials in Thailand on 28 people with AIDS“have proven that a China-made compound pharmaceutical drug is effective in the treatment of AIDS”. After three months’ tests, the virus in nine patients were reduced considerably. The infection remained stable(controlled?)in 16 others. The drug was derived from 13 years of tests on 1000 kinds of medicinal herbs; 150 were found active against the AIDS virus, and a compound drug was created using five of them as the principal ingredients. It has also“proven safe, non-toxic and cheap”.Reuters "Experimental Cancer Drug May Battle HIV"onhealth.com, 11 Aug:-researchers have discovered that a drug being studied for cancer treatment may“hold promise”as an HIV therapy. Flavopiridol apparently blocks HIV cells from making copies of themselves. It also works at concentrations much lower than those being tested in cancer trials, and so gives indications of having less side effects. One of the major obstacles in treating HIV is the ability of the virus to mutate into drug-resistant strains; but in this case the replication process is related to body, not viral, cells so patients would theoretically not develop resistance to flavopiridol. Economist 16 Sep"Science and Technology: AIDS Wars"(87-8):-excellent and up-to-date report on the various theories now under study regarding origin of HIV/AIDS. Main and most interesting element is the story of the influence, and then almost total debunking, of the theory that AIDS was the accidental result of a polio vaccination campaign conducted in central Africa in the 1950s. Most theories, however, now start from the assumption that HIV-1 was a chimpanzee virus that has leapt the“species barrier”to man. Its apparently 20th century appearance more or less simultaneously in different forms in different locations in Africa is another interesting mystery. Two theories are mentioned: (1) African population growth increased opportunities for both human promiscuity and contact with chimpanzees; (2) wide multi-use of syringes increases virulence. Gina Kolata“Vaccine Controls AIDS Virus in Early Tests on Monkeys”20 Oct:-monkeys were injected with DNA of two AIDS virus genes that would enable to control the disease by not allowing the animals to become ill. Philip J. Hilts “Company Tried to Bar Report That H.I.V. Vaccine Failed”01 Nov:-a pharmaceutical company is pushing to stop the publication of its failed AIDS drug Remune and is asking $7m dollars in damages. Reuters“Work on AIDS Drugs Shows Long Road Ahead”01 Dec:-report on the US funding labs in order to find a cure for AIDS, since 21 million people across the world are infected with the disease and some AIDS medicine have lost their potency. AP“Modified Protein May Fight AIDS”12 Jan 2001:-a genetically modified protein, 5-Helix is able to protect cells from being infected from the AIDS virus. Andrew Pollack“When Gene Sequencing Becomes a Fact of Life”17 Jan:-gene sequencing machine will allow to map the genes of the AIDS virus in order for doctors to prescribe the proper AIDS medications, is being distributed for public use. Reuters“Back Off a Bit on HIV Drugs, Experts Decide”18 Jan:-medical AIDS experts are relaxing their usual methods of prescribing strong AIDS drugs with better treatment tactics. Reuters“Italy AIDS Vaccine at Human Testing Stage”19 Jan:-a new type of AIDS vaccine, TAT protein, will be allowed to be used for human testing in order to stop the spreading of the disease in the body before it has time to grow within the human cells. Reuters“Goal for HIV Vaccines Said to Be Set Too High”24 Jan:-HIV researcher Dr. Jay A. Levy argues that a vaccine to prevent the AIDS virus to spread all over the human body is more foreseeable than a vaccine to get rid of the disease all together. Lawrence K. Altman“The AIDS Questions That Linger”30 Jan:-a 5-part article on the questions AIDS scientists will propose at the Chicago conference on the pandemic. Article also gives a historical analysis of AIDS and its impact throughout the globe. Altman“U.S. Panel Seeks Changes in Treatment of AIDS Virus”04 Feb:-health experts are recommending for longer treatment methods to AIDS victims due to the overuse of retroviral drugs. Reuters“Scientists Grope for Small Gains at AIDS Meetings”04 Feb:-the forthcoming 8th Annual Retrovirus Conference being held in Chicago will gather the AIDS experts across the world to discuss the development of HIV drug cocktails and the proper dosage of the drugs. AP“C.D.C. Hopes to Cut New AIDS Cases”07 Feb:-Centers for Disease Control and Prevention has planned to cut the number of new HIV infections in half by 2005, through identifying unaware HIV victims within the US. Altman“Study Reports Drug- Resistant Strains Have Increased to 14 Percent Among New H.I.V. Cases”08 Feb:-within Canada and the US. Altman “Newly Discovered Molecule Is a Clue to the Spread of AIDS”09 Feb:-AIDS researchers have identified dendritic cells who transmit the HIV virus to the rest of the body are responsible for the disease to spread much faster. Altman“To Combat the Wily H.I.V., Newer and Safer Drugs Are Necessary”13 Feb:-3-part article on the medical advances of AIDS drugs but many health experts warn of the overuse of the medicine while other experts warn of the increasing rate of the pandemic in developing nations. Reuters“HIV Vaccine Shown Effective in Monkeys”23 Feb:-a drug developed by GlaxoSmithKline through the combination of HIV molecules and a vaccine to improve the immune system. Reuters “Britain And Italy Propose Global Medicines Fund”26 Feb:-a global fund to allow for the delivery of HIV, malaria and tuberculosis drugs to developing nations have been approved by Britain and Italy, bringing relief to the UN and other AIDS supporters such as Nelson Mandela. Reuters“Molecule Produced by Pregnant Women Blocks HIV”02 Mar:-a molecule located in the placenta within the umbilical cord prevents the growth of HIV within pregnant women. AP“Study Backs AIDS Drug Combo”06 Mar:-a drug without “protease inhibitor”(current use of medicine to contain HIV from spreading) is shown as being equally effective. AP“AIDS Vaccine Goes on Trial in Africa”06 Mar:-report on the first vaccine trial in Kenya. AP“AIDS Vaccine Experiments Are Said to Be Promising”09 Mar:-a vaccine that has allowed for HIV-infected monkeys to stay healthy is showing optimism throughout the medical core, the drug uses proteins of the AIDS virus and smallpox vaccine. Reuters“AIDS Drugs Extend Survival Time Fourfold”14 Mar:-a study by the Center for Disease Control and Prevention has showed “that drug treatment has quadrupled to four years”. Abigail Zuger“A Molecular Offspring, Off to Join the AIDS Wars”20 Mar:-new AIDS drug “stavudine” to be distributed to the Third World. Ian Fisher“In a Kenyan Preacher’s Prayer, an Instant AIDS ‘Cure’”01 Apr:-people in the region who cannot afford to buy AIDS drugs, are looking for other ways to be healed. Barnaby J. Feder“South Africa Expected to Approve Use of Blood Substitute”10 Apr:-due to AIDS spreading in the country, S. African doctors are allowed to use purified cow’s blood to replace human blood supplies. Denise Grady“Generic Medicine for AIDS Raises New Set of Concerns”24 Apr:-AIDS drugs may be available to 25m people in sub-Saharan African victims. Health experts are worried re proper dosage of the drugs. AP “AIDS Drugs, Transmissions Studied”24 Apr:-combination of two AIDS drugs lowers the chances for pregnant mothers to transmit HIV to their offspring. Stolberg“In AIDS War, New Weapons and New Victims”03 Jun:-report on AIDS victims in the US and coping with the effects of retroviral drugs. Kolata“On Research Frontier, Basic Questions”05 Jun:-new treatment of newly infected HIV victims which allows for their immune system to control the virus to spread without the need of AIDS medicine. Grady“Quest for AIDS Vaccine Rises From Ashes of Dashed Hopes”05 Jun:-report on the lack of vaccine of diseases such as AIDS, Malaria and Tuberculosis. AP“Uganda Gets AIDS Training Center”11 Jun. Reuters “Tracking H.I.V.’s Lightning Attack on Cells”19 Jun:-researchers looking at how AIDS virus kills immune cells. Sharon Lerner“Product to Protect Women From H.I.V. Is Elusive”03 Jul:- AIDS prevention products “vaginal microbicide” in developing nations are in decline. Altman“Recollections on the Age of AIDS”03 Jul:-author remembering the spread of AIDS and the world’s approach to the disease from the 1970's to the 1980's. AP“Study Backs AIDS Drug Cocktails”10 Jul:-current retroviral drugs are able to control the virus from spreading without the need of higher dosages. AP“SAfrican Bishops Consider Condom Use”11 Jul. AP“HIV Program in Thailand Cuts Risk”19 Jul:-the infection rate of mother-to-child transmissions has declined due to programs designed to treat and test women for AIDS. NYT “Study Finds Condoms Usually Block H.I.V.”20 Jul. Reuters“Experts Caution Against an AIDS Therapy”20 Jul:-AIDS drugs must be given to patients at all times even if there are debilitating symptoms. Washington Post“AIDS Vaccine Hopes Rise From Africa”11 May:-discovery of a stronger immune system in Kokutona, Kenya among its inhabitants may allow for a vaccine to be distributed. Linda Villarosa“A Charge to Take AIDS Messages From a National to a Global Scale”28 Aug:-interview of senior advisor of the Bill and Melinda Gates Foundations , a program designed to contribute donations towards the AIDS crisis. AP“Predictions on HIV Infections Made”31 Aug:-42% increase in HIV infections by 2005 due to ineffective AIDS drugs. Elizabeth Rosenthal“China Asks U.S. Agency to Help Combat H.I.V. Epidemic” 31 Aug:-CDC cooperating with Beijing to control spread of AIDS since threat of “20 million Chinese carrying the virus by 2010". AP“Virus May Help Fight HIV”05 Sept:-apparently harmless/common GBV-C virus is found to block HIV’s ability to enter and fatally infect blood cells. AP“AIDS Vaccines May Protect Infected”07 Sep:-drugs designed to protect the healthy from catching AIDS, may be prescribed for the already-infected to boost their immune systems. AP“Gene-Based AIDS Test Hits Market”27 Sept:-Trugene, a testing device by Visible Genetics Inc, is approved by US to identify when a virus starts to mutate against a drug therapy being used, so it can be switched. AP“AIDS Vaccine Said Ready in 10 Years”07 Oct:-US researchers believe vaccine prototypes now being developed could be effective against some strains of disease in 5-10 years. AP“Study: Drug Cocktail Cut Death Rate”21 Sept:-combination of protease inhibitors and AIDS drugs as effective in children in lowering death rates. Reuters“Formula Supported for Mothers With H.I.V.”21 Nov:-Kenyan study finds formula-feeding vs breast-feeding reduces HIV transmission 44%, but makes no significant difference to child mortality or general illness rate. AP “Study: Faster HIV Blood Tests Help”22 Nov:-when seeking optimum drug cocktail, viral-level blood tests taken just 6 days after patients start any new HIV drug is found best. AP“Some With AIDS Visit Voodoo Doctor”01 Dec:-Haiti has among highest infection rates in Caribbean(5.2%),but has only $8m/year for care. As full AIDS treatment costs up to $4000, 400 a month consult voodoo doctor for $6.30. AP“Study: Cycling Drugs May Curb AIDS”03 Dec:-US researchers found that drug therapy consisting of taking stronger dosages one week and stopping the week after will cut down on side-effects and costs. Jeff Stryker“H.I.V. Patients Get Fresh Hopes for Donor Organs”11 Dec:-due to better drug cocktails and therapy in the US, HIV victims are able to receive donor organs. AP“AIDS Fund Officials to Meet Soon”17 Dec:-Global Fund to organize and allocate $1.6 billion to AIDS-stricken nations. AP“Half of American HIV is Drug - Resistant”18 Dec:-a study shows HIV mutation impedes AIDS drugs to be ineffective. AP“Monkey Dies in AIDS Vaccine Test”16 Jan 2002:-study by Merck & Co.’s researchers in the US found that the disease creates stronger types of immune cells for countering the vaccine. AP“HIV - Like Virus Found in Wild Chimp”17 Jan:-Dr. Hahn trying to find the origin of the virus, found a chimp in Tanzania found to have a different strain of AIDS proves the theory that the disease originated from monkeys. Gina Kolata“Chimp Study Clouds Origins of AIDS”29 Jan:-similar report of Dr. Hahn research on the different genetic HIV virus in monkeys which is not as deadly as it is to humans who contract the virus. AP“AIDS Expert Cites New Opportunities”09 Feb:-HIV treatment reduces HIV to spread from mother to baby according to the director of US National Institute of Allergy and Infectious Diseases. Grady “Cocaine and Intensity of H.I.V. are Related in a Study of Mice”15 Feb:-US study shows cocaine allows HIV to spread faster. AP“AIDS Care Improving, Government Says”26 Feb:-CDC announced an increase in the number of americans with AIDS is due to the successful disease treatment/therapy which allows for them to live longer. AP“AIDS Vaccine Shows Promise in Tests”26 Feb:-drug developed by Merck & Co.’s which protects human’s immune system shows promising results in monkeys. AP“Genetic Test Shows Risk of AIDS Drug”27 Feb:-the drug “abacavir” shows which AIDS drugs could prove fatal to patients after long exposure. Economist“HIV microbicides: Free to choose”28 Feb:-pharmaceutical companies are not investing in the production of microbicides which allows for the protection of women from AIDS. AP“Study: AIDS Drugs May Raise Heart Risk”28 Feb:-at the ninth annual Retroviral Conference, researchers have found that AIDS Drugs could create permanent damage to the human body. AP“AIDS Vaccine May Be 10 Years Away”15 Mar:-according to US AIDS experts. McNeil“New List of Safe AIDS Drugs, Despite Industry Lobby”21 Mar:-WHO released a list of manufacturers of safe AIDS drugs, including some generic counterparts. AP“Co. Withdraws AIDS Drug Application”22 Mar:-the drug “nevirapine” which prevents HIV transmission from mother to child will not be allowed to be used in the US due to the FDA’s finding of the drug standards. Pollack“AIDS Drug Fares Well in Big Trial”19 Apr:-a drug “T20" which prevents the HIV virus to infect the cells of the immune system could be available by 2003. AP“HIV May Target Attacking Cells”01 May:-the National Institute of Health(NIH) found that cells that guard against the disease virus“CD4 T”have five times more HIV than other human cells. AP “Researchers Develop HIV Fighter”02 Jun:-an MIT developed chemical agent RNA(ribonucleic acid)stops the genes which produce proteins used by the HIV virus to infect human cells. Stolberg“AIDS Drugs During Pregnancy Don’t Harm Fetus, Study Finds”13 Jun:-study conducted by the NIH. AP“New HIV Treatment Guidelines”06 Jul:-HIV victims must wait longer to receive treatment to increase the effectiveness of the AIDS drugs and lower their side effects says the International AIDS Society. Altman“Drug Reduces H.I.V. Rates in Newborns, Thai Study Shows”07 Jul:-findings were shown at the 14th annual International AIDS conference in Barcelona. AP“Discarded AIDS Drugs Help Africans”08 Jul:-Starfish Project, a charity group collects unused AIDS drugs and gives them to HIV victims in Nigeria. Reuters“Asia Criticized for Silence in Face of AIDS”08 Jul:-10m people are expected to get AIDS in China in 2010, which Beijing is in a state of denial, AIDS activists are pushing for AIDS to be reduced in price are some of the highlights from the AIDS conference in Spain. Altman“Drug Offers Hope With Resistant H.I.V., Scientists Say”09 Jul:-report on the “T20" drug which showed positive results in two “large late-stage” trials which increases immunity cells to counter the HIV virus. Reuters “Protesters Blast U.S. over AIDS Funding”09 Jul:-angry AIDS activists at the Barcelona Conference heckled US Health representative for not contributing more to the AIDS cause. AP“Thailand to Host HIV Vaccine Trial”09 Jul:-5 year experiment conducted by the US. Economist“AIDS: Hope for the best. Prepare for the worst”11 Jul:- “Surprisingly, the mood in Barcelona, where the 14th of these conferences has just been held, was cautiously optimistic.” Howard W. French“Whistling Past the Global Graveyard”14 Jul:-Indifference to AIDS spreading in the developing nations due to lack of coverage of AIDS conference in Spain in wealthier countries. Altman“Cheaper Drug Prevents H.I.V. in Newborns, Study Shows”14 Jul:- S. African study shows that the cheap drug “nevirapine” prevents the infection. Altman“The Urgent Search for an AIDS Plan”16 Jul:-report on the rapid spread of AIDS in which 45 million people to be infected with AIDS by 2010. Swarns “South African Village, Fearing AIDS, Trusts God More Than Drugs”10 Aug. David Tuller“New Tactic to Prevent AIDS Spread”13 Aug:-CDC to spend$3.8m on providing AIDS education for HIV victims. AP“Gates Foundation Gives $46M for HIV”28 Aug. AP“Study: Chimps May Have Survived AIDS”29 Aug:-a theory by Dutch researchers explains how chimps are resistant to the AIDS virus due to their highly-evolved immune system. AP“S. Africa to Manufacture AIDS Drugs”26 Sep:-three new vaccines will be manufactured and tested by humans in Cape Town. AP“Agency Links HIV, Syphilis Outbreak”26 Sep:-CDC study shows an increase in syphilis among gay/bisexual men in New York indicating a rise of unprotected sex in the area. Pollack“Scientists Say They’ve Found Protein That Might Help Fight AIDS”27 Sep:-AIDS Research Center in New York found a protein in the human immune cells(CD8 T)which produces an antiviral factor which limits the spread of HIV in the body. McNeil“Global War on AIDS Runs Short of Key Weapon”09 Oct:-decline of condom donations by rich nations to poor nations. AP“FDA to Review New AIDS Drug Fuzeon”11 Oct:-drug companies Roche and Trimeris await approval of their expensive drug aimed at HIV victims with drug-resistant strands of HIV and to be used in combination with other AIDS drugs. Alan Cowell“Extracurricular Task: Testing Condoms”25 Oct:-German company Condomi allows condom testing to be done by young British people. AP“Vatican Prefers Chastity to Condoms”06 Nov. Stolberg“Drug Agency Approves a Quick Test for H.I.V.”08 Nov:-20 minute blood test to detect HIV might encourage more people to get tested, claims the FDA. Bill Gates“Slowing the Spread of AIDS in India”09 Nov:-report on the increase of AIDS in India “25 million(with HIV)by 2010". Amy Waldman“Gates Foundation to Give $100 Million to Fight AIDS in India”11 Nov. Waldman“As AIDS Spreads, India Struggles for a Workable Strategy”11 Nov:-Indian city, Tamil Nadu, having the world’s second highest number of HIV cases caused by a weak health system and prevention efforts. AP“Gates Ups India Investment to $400M”12 Nov. AP“Therapeutic AIDS Vaccine Said Promising”22 Dec:-US experimental vaccine reduced the spread of HIV by 50% in monkeys. David Gonzalez“A Haitian Doctor’s Success in the Fight Against Disease”22 Dec:-UN to grant Dr. Jean W. Pape $25m due to his preventive measures which have lowered the AIDS epidemic in the country. Nicholas D. Kristof“The Secret War on Condoms”10 Jan 2003:-critique of the Bush administration’s view of condoms while AIDS activists and UN health experts argue that it saves lives. Elizabeth Becker“U.S. Official to Discuss Trade as Africa Hopes to Talk AIDS”11 Jan:-US ambassador Robert Zoellick to be confronted by AIDS activists due to the US opposition for poor nations importing generic AIDS drugs. NYT“The War Against Women”12 Jan:-Bush administration undermining women’s right of abortion by elevating the right of the fetus. Jane E. Brody“Fact of Life: Condoms Can Keep Disease at Bay”21 Jan:-US study shows that young adults are not using condoms consistently. AP“Chinese Co. Distributes Anti - AIDS Drug”28 Jan:-unprecedented distribution of cheap generic drugs(dd1 and d4t)by a Chinese company to Shanghai. Stolberg“Bush to Seek $16 Billion for Epidemic of AIDS in U.S.”01 Feb:-US president to ask Congress for the sum. AP“Vaccine Said Unlikely to Protect From AIDS” 12 Feb:-AIDS researchers in Boston announce that vaccines to aid the human immune system still needs to be studied. Reuters“Human Trial of AIDS Vaccine Starts in Uganda”12 Feb:-prototype HIV vaccine to be given to volunteers who suffer from the disease. Altman“Officials Push Use of a 20-Minute H.I.V. Test”12 Feb:-at the 10th Conference on Retroviruses in Boston, CDC wants the 20 min. test to be part pf routine health care for americans who are at risk. AP “Virus May Block HIV’s Destructive Power”13 Feb:-AIDS experts in Boston have discovered an ancient virus(GB virus C)which has proven to minimize HIV infection within humans. AP“Outlook for People With HIV Is Improving”14 Feb:-study conducted by a British medical school shows that the “risk of AIDS or death has fallen by 80 percent”. Altman“AIDS Expert Helps Doctors Learn From Autopsies”18 Feb:-British pathologist presents autopsy results during the Boston Conference, showing the grizzly infections of HIV on the human immune system. Economist“AIDS in Haiti: H For Hope”19 Jun 2004:-in encouraging contrast to nation’s terrible political and economic situations, it has pretty good record in tackling HIV/AIDS -reversal of disaster which hit Haiti both hard and early. Economist“Women and HIV: The New Face of AIDS” 27 Nov 2004:-describes report on new global estimate of HIV spread, and on women’s special problems with HIV/AIDS, particularly in Africa.“[R]eport on global AIDS epidemic ...by UNAIDS...estimated 4.9m new infections in 2004, and 3.1m people died of AIDS. About 40m people now infected, a small majority...male. But women catching up fast. In sub-Saharan Africa, 57% of those infected are female. Economist 27 Nov“Health Care in Poor Countries: Doctors’ Dilemma”:-although health workers very scarce in Africa, insufficient numbers being educated and many of these work in better paying countries. Economist 27 Nov“AIDS in Jamaica: The Fear That Spreads Death”:-reports serious homophobian /religious social problems that complicate an HIV/AIDS epidemic. “Caribbean has world’s highest HIV prevalence after sub-Saharan Africa, with 2.3% of adults infected”. Economist 04 Dec“AIDS in Angola: Good News, Maybe”(46):-could postwar state become second African to roll back AIDS? Fact that AIDS has not yet taken hold means[may be time to educate young how to protect themselves and strengthen anti-AIDS fight].”There may be hope. Economist 02 Jul 2005"G8: Helping Africa Help Itself"(Edit.11):-Lots more money for Africa will not make poverty history. But it might just do some good";"Aid to Africa: The $25 Billion Question"(Special Report 24-6):-"Years of mistakes have taught donors a bit about how to spend aid money better"; "Lexington: Evangelicals and Aid: Right On" (34):-"Bob Geldof and Bono have some unlikely friends in America... During discussion of a plan to spend $15 billion fighting AIDS, [US President Bush] turned to his silver-penned speech writer... 'Mr President', came the reply, 'if this is possible , and we don't do it, we will never be forgiven'"; "AIDS In South-East Asia: There's Good News and Bad News"(38-9):-"Good prevention work has tamed the AIDS epidemic in some countries, yet it is getting much worse in others"; "The Grand Challenges in Global Health: 43 Ways To Save the World"(69-70):-"The Gates Foundation's latest largesse has just been announced. It will pay for some intriguing and original research. But will it translate into healthier people? [References to several AIDS research projects]; "AIDS: Moving Targets" (70):-"Progress, and problems, in treating AIDS around the world". AP"Clinton Urges Help for Kids With AIDS"NYT 18 Feb 06:-"Former [US] President urged governments and public foundations to buy anti-AIDS drugs from low-cost manufacturers so more children can receive treatment for the disease. Clinton... said last month that Cipla and 3 other Indian pharmaceuticals would offer antiretroviral drugs at prices up to 30% cheaper than current market rate... Since his Clinton Foundation's 2002 HIV/AIDS initiative began, foundation has concentrated on making affordable drugs available, buying second line AIDS drugs from generic drug makers for 21 countries in Asia, Africa and the Caribbean, he said. His foundation planned to get anti-AIDS drugs to 60,000 children in worst-affected countries this year... 'We've had a 3-year partnership with Cipla, and because of them an enormous number of HIV/AIDS-infected people are alive', he said. India has 5.13m cases of the illness, second largest number of people infected with HIV after South Africa. Indian government claims its anti-AIDS campaign has stabilized the epidemic and says there has been a sharp decline in the number of new HIV cases"; Reuters"Clinton Group, India to Train Nurses in AIDS Care"NYT 19 Feb 06:-"Former US President and Indian government announced a joint plan to train nurses in AIDS care in a country which has world's second-largest number of HIV/AIDS cases... Partnership between National AIDS Control Organization of India (NACO) and Clinton Foundation, aims to develop training material and program for nurses... 'Nurses not only deliver clinical care, needed to keep people alive, but they also act as counselors and play an important role in reducing the myths, stigma, and discrimination surrounding this disease', [Clinton said]"; Reuters"Clinton, Australia Launch Tri - Nation AIDS Campaign"NYT 22 Feb 06:-"Former US President Bill Clinton and Australia announced plans to combat AIDS in China, Vietnam and Papua New Guinea, warning that 40% of all new infections could be in Asia-Pacific region by 2010... [Combined] money... would be used to make anti-retroviral drugs... more readily available and to improve testing and monitoring systems in the three countries... Clinton...said about 500,000 children died of AIDS around the world in 2005... Vietnam, China and Indonesia face fastest-growing HIV epidemic in the world. Papua New Guinea... faces an epidemic of similar proportions... With an annual infection rate increasing by 33% a year, country is on verge of an African-style disaster that could kill millions and destroy the economy"; Sharon LaFraniere"Slowly, Africa Starts to Care for AIDS Children"NYT 08 Mar 06:-"Staff members of the new pediatric AIDS clinic [in Maseru, Lesotho] are used to seeing sick children. But rarely had they seen one so ill... In Lesotho, as throughout much of sub-Saharan Africa, children with AIDS were generally considered a lost cost. Treatment, to the extent it existed, was limited to adults, for whom antiretroviral therapy is cheaper and easier. Now, that is slowly changing. Through some charitable foundations, pediatric AIDS medication is available for as little as $200 a year, half of what it used to cost and only $60 more a year than adult medication. Governments, international agencies and private charities have begun to train region's ragtag care corps to treat children... Still, only a few children get help... Death comes swiftly for those who go without... 'We just haven't stepped up to the plate to make sure they get it'. There are several reasons. Fewer children are infected - an estimated 2.1m in sub-Saharan Africa, compared with 25m adults. Specialized and costly tests are needed to determine whether a child under 18 months is infected, although treatment can begin based on symptoms alone". [Total article 4 pages long]; Reuters "Relief Group Seeks Access to New HIV Drug in Africa"NYT 15 Mar 06:-"A humanitarian group urged US drugmaker Abbot Laboratories Inc. on [15 Mar] to make a new HIV drug accessible in developing countries, especially Africa. Relief organization Medecins Sans Frontieres said a new formulation of Abbot's lopinavir/ritonavir drug had critical advantages for patients in poor countries, including lower daily pill count, storage without refrigeration and no dietary restrictions... Sub-Saharan Africa has about 10% of world's population but 60% of people living with HIV/AIDS... More than 3m Africans became infected with HIV in 2005, representing 64% of all new infections globally and more than in any previous year for the impoverished continent, according to UNAIDS. MSF provides anti-retroviral drugs for over 60,000 patients in nine countries in Africa, Asia and Latin America. It said it urgently needed the new drug because refrigeration is unavailable to many people in poor countries. The new formulation, marketed under the name Kaletra, is in tablet form and does not melt at high temperatures unlike the old version which is in capsules. MSF said the new version of Kaletra, which was approved by US Food and Drugs Administration [Oct 05], was not available in any developing country. It urged Abbot to register the new version in developing countries, sell it at less than $500 per patient per year and remove patent barriers to allow production of generic versions... Abbott said it was pursuing registration for the new formulation in developing countries as rapidly as possible. It also said it was making its HIV medicines available in 69 of the world's poorest countries... Kaledra is a 'second line' drug which can be used when standard anti-retroviral drugs stop working... One MSF program found that after four years of ARV treatment, 16% of patients needed second-line drugs"; AP"Ugandans Report Mixed Messages on AIDS Plan"NYT 18 Mar 06:-"Question of why Ugandans didn't use a condom is at the heart of a dispute between some health activists and US government. Activists, as well as some Ugandan officials, accuse US of blunting the condom message in favor of abstinence, while the Americans say they are victims of misinformation and have actually increased nearly tenfold the number of condoms they supply to this African nation of 26 million... Billboards urging condom use have disappeared from the capital, Kampala. In their place are posters, some funded by US government, urging youth to delay sex until marriage... HIV prevalence crept up to 7.1% in 2004-2005, after stagnating at around 6% the preceding three years, according to government figures"; AP"Gilead AIDS Drugs Show Prevention Promise"NYT 27 Mar 06:-substantial article discusses current global hopes in seeking action both against and avoiding HIV/AIDS. Begins: "Twenty-five years after the first AIDS cases jolted the world, scientists think they soon may have a pill that people could take to keep from getting the virus that causes the global killer. Two drugs already used to treat HIV infection have shown such promise at preventing it in monkeys that officials last week said they would expand early tests in healthy high-risk men and women around the world...'If it works, it could be distributed quickly and could blunt the epidemic'. Condoms/ counseling alone have not been enough - HIV spreads to 10 people every minute, 5 million every year. A vaccine remains the best hope but none is in sight. If larger tests show the drugs work, they could be given to people at highest risk of HIV - from gay men in US cities to women in Africa who catch the virus from their partners... The drugs are tenofovir (Viread) and emtricitabine, or FTC (Emtrive), sold in combination as Truvada by Gilead Sciences Inc."; Reuters"Clinton Supports Wider AIDS Testing" NYT 28 Mar 06:-"Former US President Clinton voiced support for mandatory testing for HIV/AIDS in countries with high infection rates and means to provide lifesaving drugs... Clinton said countries where there was no discrimination against people with the illness and where anti-AIDS drugs were available should now consider universal testing... More than 40m people worldwide are estimated to be living with HIV/AIDS but many do not know they are infected. 'Now we can save people's lives and we can reduce the stigma. There is no way we are going to reduce the spread of this epidemic without more testing because 90% of the people who are HIV positive don't know it', he added... A budget of $100m could pay for 200m tests... Clinton Foundation HIV/AIDS Initiative(CHAI)... is working with 22 countries in Africa, Caribbean and Asia to provide anti-AIDS drugs to more than a quarter of a million patients through special drug deals"; Economist 01 Apr 06"Australia and AIDS: Help Thy Neighbour"(35):-"Partnership between Australian government and Clinton Foundation[op.cit.]... will work in China, Vietnam and Papua New Guinea (PNG), mainly to supply tests and anti-retroviral drugs... HIV has grown alarmingly in PNG to reach 50,000 estimated cases, about 2% of adult population.... Possibly rising to 500,000 cases by 2025. Unprotected sex has driven most of the spread in PNG. In China (500,000 estimated cases) and Vietnam (260,000 cases), contaminated blood transfusions, prostitution and intravenous drug use are the main avenues... AIDS left unchecked could prove another potential source of regional instability along with terrorism... Having 8.3m people infected with HIV in Asia and the Pacific threatens the economic life of Asia, especially that of China... The outlook is grim: the number of sufferers is forecast to more than double to 20m by 2010 unless rich countries... start exporting their own successful experience in curbing AIDS"; Economist 01 Apr 06"Treating AIDS: A Missed Target"(64-5):-"World Health Organization (WHO)'s attempt to roll out AIDS drugs in poor countries has missed its target. A shame, but not a disaster[op.cit. AP 28 Mar]. The '3 by 5' initiative to get 3m HIV-positive people in poor/middle-income countries on to anti-retroviral drugs by end of 2005 has got less than halfway there. [WHO/UNAIDS reported] a mere 1.3m of those infected in target countries are on courses of drugs. [Yet shift from pure prevention to care offered incentives for] those who might...be infected[: new] reason to find out the truth [and encourage modified behaviour to reduce transmission. Also, even 3+ times the previous number under treatment] averted about 250,000 premature deaths in 2005. One problem [was] that in most countries the [essential] infrastructure... did not exist. [Hence] the initiative may have been more successful than [new] figure suggests, since part money has gone on infrastructure [and] this sort of work has spin-offs beyond the treatment of AIDS. Expense of treatment also tackled[:] big change...in market for AIDS drugs. Clinton Foundation HIV/AIDS Initiative has helped to defragment market for generic anti-retroviral drugs by signing contracts... in India and South Africa that guarantee large order-volumes and reliable payment. As result, price in some cases... below $150 per person per year.. Progress, then, being made. [Possible] 3m figure by end of 06"; Richard Cockett "Chasing the Rainbow: A Survey of South Africa"Economist 08 Apr 06(5-6):-Summary of major section on government's HIV/AIDS policy only: "[G]reatest weakness of [ruling African National Congress] ANC's top-down system is that party is inclined to dismiss ideas from outside its own bureaucracy. Most obvious example has been [President Thabo] Mbeki's well-documented response to the HIV/AIDS crisis. For a long time [op.cit.] Mbeki stood out against the combined weight of world medical opinion on the causes/treatment of AIDS, and particularly on use of anti-retroviral drugs. Main group campaigning for their use, Treatment Action Campaign, was made up almost entirely of ANC members, and Mbeki seems to have resisted their arguments as much because he felt they were breaking party ranks as for their prescriptions on AIDS (with which he disagreed). In 2003, government eventually caved in to domestic/ international pressure and gracelessly introduced a comprehensive management regime involving anti-retroviral drugs to combat HIV/AIDS. May have signalled change of policy by government, but not, it seems, much of a change of mind. In a country with 5.2m HIV-positive people on record, the largest number in the world, there is almost no public acknowledgement of the problem or public education about it. [M]inisters (with a few honourable exceptions) still seem loth to talk about the illness, which kills about 900 people a day and undermines much else the country is trying to achieve. It handicaps the army, with an infection rate said to be up to 40%, breaks up families and kills much-needed teachers. Chillingly, Actuarial Society of South Africa estimates that it will be another ten years before the pandemic peaks. Tardiness with which government responded to HIV/AIDS crisis, together with Mbeki's own strange take on underlying science, has tarnished own reputation, as well as that of ANC. Critics argue government remains ambivalent about its commitment to fighting pandemic with anti-retroviral drugs. Government's plan to combat HIV/AIDS may be model of its kind in intent, but it is already falling behind. By end of 2006 about 225,000 patients will be receiving anti-retroviral drugs, well short of the plan's target of 380,000 by 2005-06. Mbeki's unorthodox views on causes/cures of HIV/AIDS undoubtedly have something to do with his agenda of finding African solutions (rather than expensive Western ones) to Africa's problems... But AIDS saga, together with ANC's unresponsiveness to its own supporters and its failure to deliver on its promises, has diminished aura of moral authority it has earned"; Reuters"Triple Treatment Cuts Malaria in HIV Patients"NYT 14 Apr 06:-"Combining anti-AIDS drugs, an antibiotic and bed nets treated with insecticide could cut the rate of malaria infections in people infected with HIV by up to 95%, researchers said. Malaria and HIV are leading infections in sub-Saharan Africa. In adults/children with HIV, malaria is more common and can be more severe... Researchers found that antiretroviral drugs, the antibiotic co-trimoxazole and bed nets are each effective in combating malaria in HIV patients, but when combined their impact is cumulative. Malaria... kills more than a million a year, mostly young children in Africa. HIV weakens the patient's immune system, making it more vulnerable to opportunistic infections such as malaria and AIDS... Co-trimoxazole, a standard treatment worldwide for patients infected with HIV, reduced the incidence of malaria in patients by 76%. When combined with anti-AIDS drugs it hit 92% and cut cases by up to 95% when bed nets were included. Researchers... believe the impact of the anti-AIDS drugs was due to its effect in strengthening the immune system rather than any direct effect of the drugs on the malaria parasite... Most malaria deaths occur in Africa, where the disease kills a child every 30 seconds, according to WHO. More than 40m woldwide are living with HIV/AIDS; more than 25m in sub-Saharan Africa. In 2005 about 2.4m in the region died from HIV/AIDS; AP"AIDS Conference Ends With Appeals"NYT 26 Apr 06:-"International AIDS conference [in Cape Town, of 1,000 scientists/researchers,] ended [26 Apr] with impassioned appeals to political/pharmaceutical industry leaders to fund development of a virus-killing [vaginal] gel to protect women from the disease and so save millions of lives. Peter Piot, head of UNAIDS,.. said safe/effective microbicides could be ready in 5-7 years, with only minimal additional funding, and thus turn the dream of saving millions of lives into reality... In the hard hit African countries, women account for nearly 60% of infections. Most are infected through heterosexual intercourse... UNAIDS/WHO have long promoted microbicides as a potentially valuable weapon in fight against the epidemic, not least because it allows women to protect themselves without having to rely on partners who refuse to wear a condom or be faithful. Yet despite this, research has proceeded slowly. [Piot] said investment in microbicide development should be doubled - and even then would still only reach about US$150m per year... Microbicides can take the form of a gel, cream, sponge or ring that releases an ingredient that can kill or deactivate HIV during intercourse. There are currently five different products being tested[, mainly in Africa on thousand of women]. Dozens of agents that could interrupt HIV transmission have so far been identified. There are also hopes that the microbicides could be used to prevent other sexually transmitted diseases and unwanted pregnancies. One of the products, cellulose sulphate, has the potential to be a contraceptive and shield against HIV... Another microbicide, Carragard, coats vaginal cells and prevents the virus from entering... Much of the funding for research comes from Gates Foundation and US government... Trying to dismiss fears that microbicides would mainly be used in developing countries and therefore offer only low profit margins, [WHO] cited their potential for use in contraception in wealthy countries"; Sharon LaFraniere"Circumcision Studied in Africa as AIDS Preventive"NYT 28 Apr 06:-"Growing number of clinicians/policy makers in [southern Africa] are pointing to a simple and possibly potent weapon against new infections: circumcision for men... New studies suggest that male circumcision can reduce chance of HIV infection in men, and perhaps in women... Validity of the approach is still being tested... Evidence so far, while intriguing, is not definitive... Most striking studies suggest that men can lower their own risk of infection by roughly two-thirds, and that inflected men can reduce the odds of transmitting the virus to their partners by about 30%, simply by undergoing circumcision. Research suggests that the cells on the underside of the foreskin are prime targets for the virus and that tears and abrasions in the foreskin can invite the infection. But WHO experts say it would be premature to recommend circumcision until results come in from two controlled trials... Preliminary results could be released by late Jun... Of the nearly 5m people worldwide who became infected last year, 3.2m live in sub-Saharan Africa, [UNAIDS] said... An epidemiologist and HIV specialist in Africa for USAID argues that low rates of circumcision and high rates of multiple, concurrent sexual partners are the main reasons that the AIDS epidemic has raged in southern Africa but left western Africa mostly unscathed. According to a study, seven southern African countries, where fewer than one in five men were circumcised, had HIV prevalence in adults of 14% to 26% in 1998. In nine western African countries, where more than four in five men were circumcised, HIV prevalence rates were below 5%... Studies appeared to show that uncircumcised men were more than twice as likely to be infected than circumcised men. Perhaps the most compelling evidence came from a study, financed by France, of 3,274 men outside Johannesburg. Half of them underwent circumcision; the others were uncircumcised. After 17 months, 49 of the uncircumcised men became infected with HIV, while only 20 of the circumcised men caught the virus... Researchers estimated that the procedure reduced the risk of contracting HIV by roughly two-thirds [and] that circumcised men infected with HIV were about 30% less likely to transmit it to their female partners ... Worries: if circumcision is oversold, circumcised men may think they are free to engage in risky sex... Other specialists concerned that studies may encourage unsafe circumcisions by traditional healers"; Economist 29 Apr 06"AIDS: Bitter Fruit"(85):-"Another idea for stopping AIDS falls flat... This is that, if applied to the vagina, [lime juice] might protect a woman from HIV infection, and thus from AIDS... Women have been putting acids into their vaginas for millennia, in the hope of preventing pregnancy and sexually transmitted diseases. Indeed, cleaning with lime juice is common practice in parts of Africa. [A]re they sensible to do so? Acids immobilise sperm and kill pathogens, including HIV... And, in addition to its high citric-acid content, lime juice has a second attractive feature: it literally grows on trees. However, there is also the matter of the damage that citric acid causes to the vaginal lining. [Studies] have shown that anything more concentrated than a one-to-one dilution of lemon juice would damage the cells that line the vagina. Such damage would make it easier, rather than harder, for HIV to get into the bloodstream... There is a second problem... Seminal fluid is alkaline. The need to overcome this alkalinity means it takes at least a 50% solution of lime juice to inactivate the virus during real sexual intercourse. The upshot is that, as a microbicide, lime juice is safe when it is ineffective, and effective when it is unsafe"; Ian Fisher"Debate Over Condoms and AIDS Tests the Pope"NYT 01 May 06:-"Even at the Vatican, not all sacred beliefs are absolute. Thou shalt not kill, but there is still 'just' war. Now, behind the quiet Vatican walls, a clash is shaping up between two poles of near-certainty: the church's long-held ban on condom use and its advocacy of human life. The issue is AIDS. Church officials recently confirmed that Pope Benedict XVI has requested a report on whether it might be acceptable for Catholics to use condoms in one narrow circumstance: to protect life inside a marriage when one partner is infected with the HIV virus or is sick with AIDS. Whatever the pope ultimately decides, church officials and other experts broadly agree that it is remarkable that so sensitive an issue is being taken up. But they agree that such an inquiry is logical, and particularly significant from this pope, who as Cardinal Joseph Ratzinger was Pope John Paul II's strict enforcer of church doctrine... The issue has surfaced repeatedly in recent years as one of the most complicated and delicate facing the church. For years, some influential cardinals and theologians have argued for a change for couples affected by AIDS in the name of protecting life, while others have fiercely attacked the possibility as demoting the church's long advocacy of abstinence and marital fidelity to fight the disease. [W]ith regard to condoms, the only change being considered, according to reports, is in the specific case of a married couple. But any change, however narrow, would be unpopular with conservative Catholics... It is too soon to know where the pope is heading... The debate has two levels: one on moral theology and church doctrine, the other public relations and politics. Many factors are driving the debate: The church is experiencing its greatest growth in Africa, which has the most severe AIDS problems. Much health care in Africa is provided by Catholic charities, whose workers, barred from providing condoms, have often spoken of being torn between church doctrine and the need to prevent disease. More broadly, critics of the current Vatican policy say it is hard for the church to remain consistent on 'life' issues, like its opposition to abortion and euthanasia and the death penalty, when condom use can help prevent the spread of AIDS. But there is a deep vein of feeling against any change... The moral arguments stretch back nearly two millennia, to the idea that the church has a responsibility, in difficult moral cases, to advocate the 'lesser evil'... There are other related arguments: One is of 'self defense', in which an uninfected partner could demand condom use to protect against infection. Another is that using a condom against AIDS could be considered medical intervention rather than contraception. But the 'lesser evil' argument is not universally accepted among Catholic thinkers, and the theology is complicated. Among many other issues, there is the user's intent: whether it is possible to use a condom without the intention of contraception... A change would address a relatively small part of the problem since most transmission of AIDS is not between married couples"; AP"Vatican Re - Examines Ban on Contraception"NYT 03 May 06:-"A Vatican study on whether it could permit condoms to battle AIDS has a very narrow scope; [b]ut its theological underpinnings are centuries old, and could lay the groundwork for an end to church's blanket ban on contraception. The principle of 'double effect' entered mainstream Catholic debate more than 300 years ago and draws on questions about the 'lesser of two evils' raised by theologians [long ago]. Some groups, including the Southern Africa Catholic Bishops Conference, have even given a tacit nod to condoms for married couples with one partner infected. The Vatican - however tentatively - now could be moving to formally recognize that position... There's no chance the Vatican would fundamentally revise its opposition to contraception, [b]ut even the targeted discussions... are further evidence of Pope... shedding [his] tradition-bound reputation ... Benedict, a widely respected theologian, has shown a willingness to re-examine church attitudes toward advances in genetic engineering and in-vitro fertilization. But none approach the sensitivity of whether to open the door - even a crack - for condoms... If the Vatican allows condoms as an AIDS control measure within a marriage, it would open the way for Catholic groups to take a more direct role in anti-AIDS campaigns in ravaged places such as Africa... '[L]esser of two evils' views boil down to moral damage control. A priest should always advise against doing 'evil', but encourage a 'lesser evil' if they can't stop the act"; Reuters "Zimbabwe Running Out of AIDS Drugs as Crisis Worsens"NYT 03 May 06:-"Zimbabwe is running out of anti-retroviral drugs to treat HIV/AIDS as a foreign currency shortage hobbles government efforts to provide 20,000 people with the life-saving medicine, state media said. Acting director of Zimbabwe's National Pharmaceutical Company said his firm was struggling to find funds to buy ARVs for people with AIDS, which experts say kills an average of 3,000 Zimbabweans every week, Herald newspaper said... Health sector is among those hardest hit by Zimbabwe's severe economic crisis [super-inflation]... The embattled southern African country also lies close to the heart of Africa's HIV/AIDS epidemic, with the government estimating 1.61m people infected with the virus. But in a rare bit of good news, Zimbabwe's adult HIV prevalence has fallen to about 20% from 25% five years ago, apparently due to increased condom use and people having fewer sexual partners"; AP"HIV / AIDS Conference Eyes Indigenous People"NYT 04 May 06:-"More than 1,000 people gathered for five-day conference on HIV and AIDS for indigenous people in North America. 'HIV/AIDS is rapidly becoming a terrible predator in native communities, and most of these communities are unprepared to protect themselves', said... keynote speaker... 'Cases are being reported in even the most remote communities'. [P]rofessor... said researchers need to study the effectiveness of medication on native peoples... Conference participants included...natives.,.as well as physicians, nurses, pharmacists, researchers, elders and spiritual leaders"; Amelia Gentleman & Hari Kumar“AIDS Groups in India Sue to Halt Patent for U.S. Drug”NYT 11 May 2006:-“AIDS groups this week brought important test of India’s new patent law, which restricts ability of Indian companies to produce low-cost generic drugs. Two patients-rights groups sued to stop Gilead Sciences, California biopharmaceutical company, from patenting the antiretroviral drug Viread - company’s brand-name version of tenofovir, which is available [in India] as a generic drug. If it is patented, the groups contend, making the cheaper versions will become illegal, and the drug will become too expensive for patients...in developing countries... Doctors Without Borders [stated:] ‘People in Africa and Caribbean are relying on India to produce these drugs. Quality matches that of US-manufactured drugs, but prices affordable’. Lawyers for two [Indian] groups... presented arguments contending tenofovir not new drug, but modified version of earlier drug, and therefore not eligible for new patent under India’s new law. Those backing legal challenge hoping to gain legal precedent for use in other patent applications... WHO recently recommended tenofovir for patients just starting treatment for AIDS and those who have been receiving antiretroviral treatment therapy but resistant to other treatments. In [rich] countries, Gilead’s tenofovir costs $5,718/person/year. Cipla, one of largest companies in India, marketing version called Tenvir, at cost of $700/person/year in India. Chairman Cipla said drug eventually available in Africa for about half that price. But Tenvir would have to be withdrawn if Gilead were given patent,.. in effect for 12 years. Gilead Sciences said... ‘[W]e believe Viread represents innovation and parentable under Indian law. We will use this patent responsibly, and not block access to our medication in India or other resource-limited countries where HIV epidemic hit hardest’. Company... ‘pursuing broad policy of nonexclusive voluntary licensing under patent to generic manufacturers in India for local Indian market as well as provision for manufacturers to export product to 97 developing-world countries included in Gilead’s access program’”; Celia W.Dugger"Letter From Kenya: Where AIDS Galloped, Lessons in Applying the Reins"NYT 18 May 06:-major article describes/ discusses US influence on Kenya policy, but summary mainly on current pandemic conditions. "Kenya rarity in Africa: nation where experts say AIDS shows signs of easing. So... attracting policy makers/researchers looking for keys to slowing relentless spread of AIDS on continent. Trends heartening. Medical experts estimate new HIV infections... plummeted over last decade from peak of more than 200,000/year to fewer than 90,000. And changes in sexual habits seem contributing to decline. Men say having sex with fewer partners, and women report losing virginity later. Many teenagers, once sexually active, say they are abstaining entirely. Such shifts... suggest abstinence programs... have some chance of success...Kenyan health officials frankly acknowledge evidence lacking on effectiveness of programs that promote condoms or abstinence. According to UN AIDS agency, Kenya, Uganda, Zimbabwe: the sub-Saharan with documented declines in HIV prevalence. Researchers agree fall partly because AIDS deaths have reduced population of HIV-positive people. But also say likely behaviour change has helped. In Uganda, increased use of condoms important. Health officials [in Kenya] say spread of knowledge about how to prevent infection and rising tide of death been catalytic... As donors racheted up financing of anti-AIDS programs, landscape for prevention changed. Since...2003, US dominant donor in Kenya: $208m this year to combat AIDS... More than half that financing feverish drive for diagnosis of AIDS and treatment of infected... AIDS patients receiving drug treatment rocketed to 70,000 from fewer than 10,000 in 2003. Paradoxically, explosive growth in testing/treatment may be US's most important contribution to preventing spread of disease. Once people know AIDS not a death sentence, more willing to be tested, and once know their HIV status they can protect themselves/sexual partners... Experts' judgement[:] more than half new infections in Kenya are with couples in which one partner HIV-positive. US also paying programs aimed at changing behaviour. This year,.. $15.7m on programs that promote abstinence/faithfulness, and $7.8m to prevent sexual transmission of HIV, including... condoms to high-risk groups. [D]ebate that rages in WashDC over AIDS/sex sometimes seems [here] more reflection US culture wars than African realities... Under guidelines, US funds can be used to educate children 14/younger about abstinence/faithfulness, with condom education added for 15/older... Scholars say much work remains to figure out which of so-called