February 2008

[New PEPFAR bill ends D.C. needle-exchange ban, increases funding for global health programs]
[Hairdressers Against AIDS program expands into Indonesia]
[$50 million initiative launched to expand HIV prevention programs in China]
[Doctor accused of infecting children with HIV files human rights complaint against Libya]
[WHO plans task-shifting strategy to ease worldwide HIV/AIDS health care worker shortage]

New PEPFAR bill ends D.C. needle-exchange ban, increases funding for global health programs

The ban on city funding for needle exchanges in Washington, D.C. has been lifted by a $555 billion omnibus spending bill signed by Pres. George W. Bush. The action was lauded by many as being life-saving and long overdue.

Since 1999, Washington, D.C. has been barred by federal law from using local funds for needle exchange programs.

The action was supported by Washington, D.C. Mayor Adrian Fenty, who said the city planned to include needle exchange programs in public health programs to reduce HIV/AIDS transmission. Washington, D.C. has the highest per capita incidence of HIV/AIDS in the United States, according to a recent report issued by the district’s Department of Health and HIV/AIDS Administration.

The bill will fund the Department of State, USAID and other global health and international aid programs and will affect the Millennium Challenge Corporation (MCC), which encourages economic and political reforms in developing countries, according to a recent Kaiser Daily Network HIV/AIDS Report. MCC funding was reduced to $1.54 billion.

Funds were increased from $19 million to $809 million for the AIDS Drug Assistance Programs, which are federal and state-funded programs that provide HIV/AIDS-related medications to low-income, uninsured and underinsured patients with HIV.

Funding includes $6.5 billion for U.S. and global health activities, which is $1.4 billion more than was allocated in 2007. The President’s Emergency Plan for AIDS Relief (PEPFAR) will receive $5 billion in foreign operations spending, which is about $1.2 million more than the program received for 2007. The measure also includes relief from abstinence-based education mandates in programs overseas. By law, at least one-third of HIV/AIDS prevention funding received by PEPFAR must be used for abstinence-until- marriage programs.

The Global Fund to Fight AIDS, Tuberculosis and Malaria will receive about $841 million under the spending bill, which includes $546 million for state-foreign operations and $295 million in the Labor, Health and Human Services Education portion of the bill. Funding provisions of $1.8 billion were also made to global health and child survival programs, which include $347 million for HIV/AIDS programs. Maternal and child health program funding will be increased by $101 million. Malaria funding will be increased $101 million and tuberculosis funding will be increased by $72 million.

Hairdressers Against AIDS program expands into Indonesia

In an effort to expand HIV/AIDS prevention eduction, Hairdressers Against AIDS has expanded in Indonesia. The program was launched in Jakarta, Indonesia in December 2007.

The program will train hairdressers to promote education on HIV/AIDS discussions with clients. Indonesia has one of Asia’s fastest growing HIV epidemics. Injection drug use and commercial sex work are the primary transmission modes there.

“Besides cutting hair, hairdressers spend most of their time interacting with clients,” said Linda Santiago Posadas, UNESCO Indonesia’s program specialist for basic science. “Hairdressers can also discuss personal topics because their relationship is built on trust.”

The HIV/AIDS prevention initiative was developed in 2004. It is used to educate hairdressers in 15 other countries. In Indonesia, seminars and educational programs to teach hairdressers how to educate others in the community about HIV/AIDS will be conducted with support from L’Oreal, UNESCO and the Indonesian AIDS Foundation.

$50 million initiative launched to expand HIV prevention programs in China

The Bill & Melinda Gates Foundation has donated $50 million in partnership with the Chinese government and various nongovernmental organizations to expand HIV prevention efforts.

Although less than 0.1% of China’s total population has HIV, rates of the disease are high among key risk groups, including injection drug users, sex workers and men who have sex with men.

Additionally, stigma and discrimination against those with HIV is high in China. Results from a 2005 study conducted in the Yunnan province showed that nearly a third of doctors said they would refuse to treat a patient with HIV.

“To effectively fight HIV/AIDS, we must ensure that prevention programs reach those most likely to become infected and transmit the virus to others. At the same time, we must combat the terrible stigma that still surrounds the disease in our country,” Wu Zunyou, MD, director of China’s National Center for AIDS/STD Control and Prevention, said in a press release.

The Gates Foundation funding will support programs such as prevention services for high-risk groups, HIV testing, prevention and support for patients with HIV and stigma reduction.

Of the total $50 million dollars allotted, $20 million will go to the Chinese Ministry of Health, and $30 million will be used to sponsor grants to local, national and international nongovernmental organizations. A team of Gates Foundation staff headed by Ray Yip, MD, current head of the foundation’s China offices and former country director of China for the CDC, will assist in administering the funding.

Doctor accused of infecting children with HIV files human rights complaint against Libya

The Palestinian doctor who was jailed in Libya with five nurses after all were accused of purposefully infecting hundreds of Libyan children with HIV filed a complaint against Libya with a United Nations human rights panel on Jan. 7.

The doctor, Ashraf Alhajouj, claims that he was tortured to confess to deliberately infecting the children. He and five Bulgarian nurses were jailed in Libya for eight years under the accusations. They were freed in July. All maintained their innocence throughout their trials and prison terms.

“It [the lawsuit] is over the violation of the right not to be tortured and the violation of the right to a fair trial,” Liesbeth Zegveld, Alhajouj’s Dutch lawyer, told Reuters. “The U.N. Committee will decide whether Libya has violated the international human rights treaty.”

Illegal detention and the eight-year trial delay are also components of the complaint. Alhajouj also seeks international recognition of his innocence because although he was pardoned, he was never found not guilty of the alleged crimes.

Scientific evidence from researchers in the United States and the United Kingdom indicated that the health care workers could not have infected the children because the HIV-strain types were present in the hospital well before their arrival. Scientists also pointed to practices at the Libyan hospital of reusing needles as a likely contributor to HIV transmission in the hospital.

Alhajouj filed a lawsuit against Libyan leader Muammar Gaddafi in France last month. In the lawsuit, he accuses Gaddafi of torture.

WHO plans task-shifting strategy to ease worldwide HIV/AIDS health care worker shortage

National health ministers, public health leaders and HIV/AIDS experts met Jan. 8 in Addis Ababa, Ethiopia, for the first international conference on task shifting.

The meeting was an effort to scale up access to HIV/AIDS treatment in part through scaling up the global public health work force. Under the task-shifting process, tasks are allocated to less specialized health workers so that doctors and nurses have time to work with more patients.

At least 57 countries – mostly African nations – are facing crippling health care worker shortages. WHO estimates that more than 4 million additional health workers are needed to fill health care gaps worldwide. Workers are needed to administer antiretroviral drugs, provide HIV/AIDS counseling and other tasks.

Task-shifting could rapidly expand the number of health workers and could make more efficient use of current human resources in the face of severe health care worker shortages.

“Task shifting not only addresses the two interlinked emergencies of the health worker crisis and the HIV/AIDS pandemic, but also offers long-term potential for strengthening health systems in a way that is consistent with the current renaissance in primary health care services,” said Anders Nordstrom, MD, WHO Assistant Director General, Health Systems and Services. “Doctors and nurses are essential but countries cannot afford to wait years while they complete their training.”

The conference was hosted by the government of Ethiopia and was co-sponsored by WHO, the United States President’s Emergency Plan for AIDS (PEPFAR) and UNAIDS.

The conference opened with the unveiling of new WHO guidelines to assist countries in implementing task shifting. Training a new community health worker takes from a few months to a year depending on expertise required, which contrasts with the several years training required for doctors and nurses.

Guidelines were developed by WHO in collaboration with PEPFAR and UNAIDS and are part of a larger initiative “Treat, Train and Retain” led by WHO. The initiative focus is on increased access to HIVAIDS treatment and care.

“A major strength in the development of the guidelines is the broad partnership, including public health, political and professional interests, that has gone into the process,” said Thomas Kenyon, MD, PEPFAR Principal Deputy Coordinator and Chief Medical Officer. “Country ownership, with the support of international and bilateral agencies, is vital to task shifting being accepted, effective and sustainable.”

Guidelines were the result of 18 months of consultation involving 167 top public health officials and HIV/AIDS experts and are based in part on program evaluations in countries that have already implemented task shifting. Countries that have made progress in implementing task shifting include Ethiopia, Haiti, Malawi and Uganda.

The WHO plan to meet the United Nations’ goal of providing universal access to antiretrovirals by 2010 is expected to cost $7 billion over three years. The plan calls for hiring an additional 2.4 million physicians, nurses and midwives in developing countries.

—Compiled by Kirsten H. Ellis