Kaiser Daily HIV/AIDS Report - Fri, 21 Dec 2001
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SPECIAL NOTICE
The Kaiser Daily HIV/AIDS Report will not be published Monday, Dec.
24 through Tuesday, Jan. 1. We will resume publication on Wednesday,
Jan. 2.
Happy holidays!
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* Financial Dependence on Partners, Threat of Violence Prevent South
African Women From Protecting Themselves Against HIV
* Increased Investment in Global Health Could Provide 'Essential'
Treatment for AIDS, TB in Developing Countries, WHO Report Says
* Congress Takes 'Two Major Steps' Toward Fighting Global AIDS, San
Francisco Chronicle Editorial Says
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Financial Dependence on Partners, Threat of Violence Prevent South
African Women From Protecting Themselves Against HIV
The perceived lack of a right to safer sex, financial dependence on
male partners and the threat of violence for refusing sex prevent
women in South Africa's KwaZulu-Natal province from protecting them-
selves against HIV, according to a study in the fall issue of the
Journal of the American Medical Women's Association. Dr. Quarraisha
Abdool-Karim of the Department of Community Health at the Nelson Man-
dela School of Medicine at the University of Natal administered
structured questionnaires to 219 women between the ages of 15 and 44
in the urban town of Nhlungwane and the rural community of KwaXimba,
both in the KwaZulu-Natal province, from November 1991 to March 1993.
The women were asked questions about demographic characteristics,
sexual history, knowledge of HIV/AIDS, perception of risk for HIV,
knowledge of sex safe and skills related to safe sex practices and
perceptions of their rights to safe sex practices. The majority of
the women surveyed (88.1%) were sexually active and had "extensive"
knowledge of modes of HIV transmission and methods of preventing HIV
infection. However, the survey found several misconceptions regarding
HIV transmission. Nearly 40% of the women thought HIV could be trans-
mitted by sharing eating utensils and 59.8% though HIV could be con-
tracted by giving blood. About 80% of the women thought AIDS was cur-
able.
Reasons for Not Protecting Themselves
Although 94.5% of the women said they knew that condoms could prevent
HIV transmission, nearly half of the women (48.8%) did not think they
had the right to refuse sex with their partners and 46.1% did not
think they had the right to insist that their partners use a condom.
The study found that only 12.8% had ever used a condom, and 82.4% of
the women lacked the skills necessary to use a condom. About a third
of the women had never seen a condom. Nearly 60% of the women who
were sexually active indicated that they would like their partners to
use condoms, but 93.9% of these women said that asking for condom us-
age would indicate a "lack of trust." About half of the women sur-
veyed said that asking their partners to use condoms would anger the
men, with nearly 30% saying that their partners would leave them and
28.5% saying that their partners would threaten to use violence if
asked to use condoms. Abdool-Karim states that the majority of women
surveyed received money from their partners and that this money was
part of their "survival strategy." Most of the women were seeking em-
ployment and had an average of eight years of formal education. High
unemployment rates, limited education and exclusion from the formal
economy kept women from achieving economic independence. "Increasing
women's access to power and resources is the ultimate strategy to re-
duce women's vulnerability to HIV," Abdool-Karim concludes (Abdool-
Karim, JAMWA, Fall 2001).
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Increased Investment in Global Health Could Provide 'Essential'
Treatment for AIDS, TB in Developing Countries, WHO Report Says
Eight million lives could be saved and $186 billion in world income
now lost to illness could be recovered each year if the world's rich-
est nations donated $101 billion annually for medical research and
treatments for infectious diseases like HIV, malaria and tuberculosis
in the developing world, according to a report released yesterday by
the World Health Organization, the New York Times reports. A WHO com-
mittee headed by Harvard University economist Jeffrey Sachs reached
this conclusion after analyzing the correlation between public health
and economic development and how an influx of foreign aid, coupled
with affected governments' own budgets, could improve health world-
wide (Altman, New York Times, 12/21). The report, titled "Macroeco-
nomics and Health: Investing in Health for Economic Development," is
based on almost 90 studies and was funded in part by the Bill &
Melinda Gates Foundation (Schoofs, Wall Street Journal, 12/21).
Health spending in the developing world must rise to $38 per person
per year by 2015 if affected nations are to make "essential health
interventions" for AIDS, malaria, TB and childhood diseases, the re-
port concludes. Currently, the world's 60 poorest countries spend
only about $13 per person annually on health care. The increased
funds would also provide immunizations, prenatal care and other pre-
ventive services.
HIV/AIDS' Impact
According to the report, HIV prevention programs reach 10% to 20% of
people in developing nations, while 6% to 10% of HIV-positive people
are receiving treatment for opportunistic infections and less than 1%
are receiving antiretroviral treatment (Brown, Washington Post,
12/21). Earning potential lost to AIDS in sub-Saharan Africa amounted
to about 17% of the region's gross domestic product in 1999. HIV/AIDS
has hit the developing world, which was making health and economic
gains prior to the onset of the pandemic, especially hard by reducing
life expectancies and draining resources. The report calls on pharma-
ceutical companies to continue to lower prices for AIDS drugs and to
extend those discounts to other "essential medicines." The report
also says that poor nations should be allowed to import cheaper ge-
neric versions of the drugs as a "last resort" and calls for in-
creased research into new treatments.
Financing Improvements
The report estimates that about $66 billion in new funds is needed
annually to improve international health. The report suggests that
industrialized nations donate about $38 billion of that total and
that developing countries provide $28 billion a year by devoting an
additional 2% of their GDP to health and nutrition programs (Wall
Street Journal, 12/21). Sachs said he would like to see the United
States contribute about $10 billion a year to the effort. A commit-
ment of that size would double U.S. foreign aid to 1% of the federal
budget. The report's suggestions will likely face opposition in Con-
gress, where "foreign aid has many enemies ... and health aid, espe-
cially, is fraught with controversy," the Times reports (New York
Times, 12/21). However, health activists yesterday called on offi-
cials to heed the report. "We have long had the know-how and technol-
ogy necessary to reduce the tragic and unnecessary deaths of tens of
millions of people each year in the developing world," Dr. Nils Dau-
laire, president and CEO of the Global Health Council, said, adding
that the world's richest nations "must act now" (GHC release, 12/20).
--
Congress Takes 'Two Major Steps' Toward Fighting Global AIDS, San
Francisco Chronicle Editorial Says
Congress has taken "two major steps" in the past weeks to fund the
fight against the AIDS pandemic, a San Francisco Chronicle editorial
states. House and Senate negotiators this week "finally agreed" on
fiscal year 2002 appropriations for international AIDS efforts, de-
ciding on $475 million for individual country program support and
$200 million for the United Nation's Global Fund to Fight AIDS, Ma-
laria and Tuberculosis. In addition, the House last week authorized
an increase in international AIDS spending to $535 million for bilat-
eral programs and $750 million for the global fund for fiscal year
2003, although this bill does not actually appropriate the money. Ad-
ditional donations to the fund by the United States and other wealthy
nations are "utterly crucial" to balance funding of both prevention
and treatment, two "competing yet equally necessary halves of AIDS
work," the editorial says. Although the United States has tripled
spending for international AIDS efforts in the past two years, "much
more money is needed" to fight the pandemic, the editorial says.
While the United Nations estimates that the Global Fund needs $7 bil-
lion to $10 billion each year, it has received only $1.6 billion in
pledges so far, the editorial notes. Therefore, President Bush
"should support" Congress' "excellent" proposition to grant an emer-
gency $1 billion appropriation to the fund, as "America's war on AIDS
should be as resolute as its war on terrorism," the editorial con-
cludes (San Francisco Chronicle, 12/20).
AIDS Fight Needs More Money, Op-Ed Says
"AIDS got to where it is because America and other rich nations did
almost nothing to stop it," Amir Attaran, a scientist, lawyer and ad-
junct lecturer at Harvard University's Kennedy School of Government
and the Center for International Development, states in a Boston
Globe op-ed, adding that the United States' international AIDS fund-
ing is a "pittance." He points out that the United States spent $15
billion to "save the airlines" after the Sept. 11 attacks on the Pen-
tagon and the World Trade Center, but spends just over $400 million
each year -- the cost of "20 miles of freeway" -- on the "most lethal
pandemic in 650 years, exceeded only by the Black Death of 1347." An
"unprecedented problem" like the HIV/AIDS pandemic "justifies un-
precedented solutions, and fighting AIDS needs more money," Attaran
concludes (Attaran, Boston Globe, 12/20).
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The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org,
a free service of The Henry J. Kaiser Family Foundation, by National
Journal Group Inc. (c) 2001 by National Journal Group Inc. and Kaiser
Family Foundation. All rights reserved.
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