Kaiser Daily HIV/AIDS Report - Fri, 22 Feb 2002
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* South African Government Takes Out Newspaper Ad Clarifying HIV/AIDS
Policy, Position on Nevirapine
* Head of U.N. Agricultural Development Agency Says AIDS is 'Ravag-
ing' African Farm Workers
* Two Doctors' Groups Refute Analysis That Said Patents Not a Barrier
to HIV/AIDS Therapy in Africa
* Columnists, Newspapers Weigh In on Powell's MTV Condom Remarks
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South African Government Takes Out Newspaper Ad Clarifying HIV/AIDS
Policy, Position on Nevirapine
The South African government today placed an advertisement in three
Johannesburg newspapers clarifying its HIV/AIDS policy and position
on the provision of the antiretroviral drug nevirapine for the pur-
pose of preventing vertical HIV transmission, Agence France-Presse
reports. The full-page ad, which appears in the Star, the Sowetan and
the Afrikaans daily Beeld with the heading "Government's program to
reduce HIV infection in babies -- A Message From The Government,"
quotes "extensively" from President Thabo Mbeki's Feb. 8 state of the
nation address, reiterating that prevention of mother-to-child trans-
mission is "part of Government's program of HIV/AIDS prevention" and
part of a "broader strategy to combat HIV/AIDS that depends criti-
cally on building partnerships across society." The ad says that the
government stands by its policy of providing nevirapine through 18
test sites, where officials are able to "monitor side effects and
build the capacity to supply the drug effectively." The ad does not
say whether the government has plans to extend the program but notes
that "[a]ny expansion of the pilot sites will continue to be guided
by research results and by available resources -- including human re-
sources and the standards we have set for comprehensive care" (Agence
France-Presse, 2/22). Treatment advocates in December won a court de-
cision requiring the government to extend the test project to include
all public hospitals. However, health ministry officials have de-
clined to expand the project, citing "safety, cost and capacity is-
sues as obstacles to universal access" (Reuters, 2/21). In the ad,
the government states that it will continue with its appeal of the
court ruling, "not because we are against expanding the current
mother-to-child program ... [but] because we need to gain clarity on
whether the courts or the elected government decides on the detail of
providing health services." The ad notes, "This is a critical ques-
tion about the division of powers in our democracy. The wisdom of the
Constitutional Court should be applied to it" (South African Press
Association, 2/22).
LAT Reviews South Africa's Situation
Today's advertisement appears to be prompted by growing dissent
within the ruling African National Congress over the government's
HIV/AIDS policy. That rift was exacerbated when the head of Gauteng,
an ANC-controlled province, announced on Monday that his government
would provide nevirapine through the public health system in defiance
of national policy. The Los Angeles Times today reviews the political
developments over the last week, including the decision by several
provinces to break rank with the national government on HIV/AIDS and
reaction from health, business and political leaders (Simmons, Los
Angeles Times, 2/22). The full article is available online.
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Head of U.N. Agricultural Development Agency Says AIDS is 'Ravaging'
African Farm Workers
AIDS is "ravaging" farmers in rural Africa and is taking a "tremen-
dous toll" on the continent's ability to produce food, Lennard Bage,
president of the U.N. International Fund for Agricultural Develop-
ment, said Wednesday. The United Nations estimates that among the 25
African countries worst affected by HIV/AIDS, seven million farm
workers have died of AIDS-related causes, and an additional 16 mil-
lion workers could die by 2020. Bage, who was speaking at the
agency's annual meeting in Rome, warned that HIV/AIDS will have a
detrimental effect on African farmers and the continent's economy.
Noting that "most people with AIDS" in Africa live in rural areas,
Brage stated that the disease is "devastating rural life" on the con-
tinent. "You have a disappearing generation," Brage said. He stated
that HIV/AIDS is reducing the labor pool of farmers, "severely hin-
dering" Africa's efforts to achieve the U.N. goal of halving hunger
and poverty by 2015 (Brough, Reuters, 2/21).
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Two Doctors' Groups Refute Analysis That Said Patents Not a Barrier
to HIV/AIDS Therapy in Africa
Two letters appearing in the Feb. 20 issue of the Journal of the
American Medical Association refute an October analysis that said
patents are not a barrier to initiating HIV/AIDS drug therapy in sub-
Saharan Africa. In the Oct. 17, 2001, issue of JAMA, Amir Attaran of
the Center for International Development at Harvard University and
Lee Gillespie-White of the World Intellectual Property Organization
submitted a "special communication" in which the researchers asked
the intellectual property divisions of eight major pharmaceutical
companies to disclose "each patent or similar legal right" they held
on 15 antiretroviral drugs in 53 African nations between October 2000
and March 2001. After reviewing the patent regulations, Attaran and
Gillespie-White concluded that it is "doubtful" that patents on anti-
retroviral drugs are blocking access to the treatments in most Afri-
can nations. They noted that while some major drugs such as lami-
vudine, zidovudine, nevirapine and nelfinavir were patented in the
majority of nations, most of the 15 listed drugs were patented in a
median of only three African nations. Instead, they said that the
real barriers to antiretroviral treatment are the high price of the
drugs, a "lack of political will," poor health infrastructure and
care, high tariffs and "inefficient drug regulatory procedures that
exclude competing products from the marketplace" (Kaiser Daily
HIV/AIDS Report, 10/17/01).
Patents Affect Drug Combinations
In the first letter, a group of doctors from the departments of pub-
lic health and clinical sciences at the Prince Leopold Institute of
Tropical Medicine in Antwerp, Belgium, state that "'[d]ifferential
pricing' of antiretroviral medications between industrialized and de-
veloping drug markets should be systematically and promptly adopted"
because patents "do matter" and "have caused and are still causing
significant delays in providing appropriate medications, especially
in South Africa." The authors say that the patents on zidovudine and
nevirapine block the use of the triple drug combinations zi-
dovudine/lamivudine/nevirapine and stavudine/lamivudine/nevirapine in
33 of 53 and 25 of 53 African nations, respectively, in the Atta-
ran/Gillespie-White survey. Those combinations are "often considered
among the most appropriate for developing countries because of a
relatively simple dosing schedule and acceptable toxicity profile,"
they add. Patents will continue to block access to affordable medica-
tions "until public health takes precedence over patent law protec-
tion in developing countries," the authors conclude (Boelaert et al.,
JAMA, 2/20).
Let Developing Countries Use TRIPS Provisions
In the second letter, a group of medical personnel from Doctors With-
out Borders agrees with the assertion that Attaran and Gillespie-
White's analysis did not take the "drug combinations required for ef-
fective therapy" into context and asserts that developing nations
have the right to import or produce generic drugs under the Trade Re-
lated Aspects of Intellectual Property Rights agreement. Zidovudine
and lamivudine are "central to AIDS treatment," representing 60% of
nucleoside reverse transcriptase inhibitor sales in major pharmaceu-
tical markets, they state, noting that the combination is patented in
37 of the 53 countries in the survey. Doctors Without Borders uses
the two drugs along with nevirapine as its first-line treatment regi-
men in its programs in Cameroon, Kenya, Malawi and South Africa. That
combination is patented in 75% of the African nations surveyed, the
authors write. They state that if patented medications remain too ex-
pensive, "developing countries must be supported to use safeguards in
TRIPS to produce or import lower-priced generics." They note that de-
veloping countries' rights under TRIPS are "significantly undermined
by claims by industry lobbyists and certain governments, using the
ungrounded conclusions of the article by Attaran and Gillespie-
White," and conclude that if developing nations cannot secure cheaper
AIDS drugs, "the consequences for global public health could be dis-
astrous" (Goemaere et al., JAMA, 2/20).
--
Columnists, Newspapers Weigh In on Powell's MTV Condom Remarks
Newspaper and syndicated columnists from across the country have be-
gun to weigh in on remarks Secretary of State Colin Powell made last
week on an MTV youth forum in which he urged condom use as a way to
prevent the spread of HIV. On Sunday, Powell defended his remarks on
CNN's "Late Edition." When asked by host Wolf Blitzer if he had "sec-
ond thoughts" about what he said, Powell answered, "Absolutely not,"
adding, "[W]e have to do everything we can to teach people that, if
they're going to be sexually active, they have to protect themselves"
(Kaiser Daily HIV/AIDS Report, 2/19). The following is a sample of
the columns, in alphabetical order by author, that have recently been
published:
* Joseph Dolman, Newsday: Powell's "honest" and "pragmatic" statement
on condom use was an "unabashed act of heroism" deserving of "another
bronze star," Newsday columnist Joseph Dolman writes. Although the
comment produced an "uproar" among conservatives Gary Bauer and Fam-
ily Research Council President Kenneth Connor, Powell spoke the
"unvarnished truth" when he "strongly implied that -- if you're going
to have sex in the age of AIDS -- you're infinitely better off with a
condom," Dolman continues. The "awful part" is that the "sound and
the fury" that have resulted from Powell's comments "erode prevention
efforts -- at a time when we need them most," as some AIDS drugs are
losing effectiveness in some HIV-positive patients and HIV rates re-
main steady, Dolman concludes (Dolman, Newsday, 2/20).
* Georgie Anne Geyer, Washington Times: The fact that Powell's "com-
monsensical" advice should need to be given at all in "a world where
AIDS is ravaging whole societies and destroying cultural norms" is
"strange," nationally syndicated columnist Georgie Anne Geyer writes
in the Washington Times. "[S]uch basic ideas should simply be given
to rational and sensitive people," Geyer continues. The "fuss" from
the "far right" concerning Powell's advocation of condom use for the
sexually active indicates that "these constituents ... are not only
against abortion" but are also opposed to family planning and birth
control, Geyer concludes (Geyer, Washington Times, 2/22).
* Arianna Huffington, Los Angeles Times: "With AIDS claiming three
million victims last year and another 42 million people infected with
HIV, Powell's message is one that can't be repeated often enough --
especially on MTV," syndicated columnist Arianna Huffington says in
the Los Angeles Times. The "anti-condom cabal" that "attacked" Powell
for recommending that sexually active young people should use condoms
to protect themselves from HIV/AIDS is "trying to roll back the clock
to the 1950s -- or at least the sitcom version of the 50s -- where
Ricky and Lucy slept in separate beds," Huffington writes. "But this
isn't 'Leave It To Beaver,' and our kids are having sex," she contin-
ues. "Instead of being excoriated, Powell deserves to be celebrated
for abandoning the double talk that is the lingua franca of those in
power and confronting this life and death issue head-on," she con-
cludes (Huffington, Los Angeles Times, 2/20).
* Mary McGrory, Washington Post: Although Powell "br[oke] formation"
by advocating condom use for the sexually active, he has "as much job
security as is available in Washington," columnist Mary McGrory
writes in the Washington Post. The Republican Party's official posi-
tion is to support abstinence-only education, but "millions of con-
doms" are shipped to developing nations as part of U.S. policy, so
Powell's comment "sounded more heretical that it actually was,"
McGrory continues. In addition, although Bush is "court[ing]" reli-
gious conservatives, only the "usual voices" of some small conserva-
tive religious organizations were raised in response to Powell's com-
ments, while the Pope and the U.S. Conference of Catholic Bishops
have had "no comment," McGrory concludes (McGrory, Washington Post,
2/21).
* Clarence Page, Chicago Tribune: Although Powell's remarks "sparked
an angry backlash from some who seem to be living in a dream world,"
he was actually in line with "long-standing American policy abroad"
in advocating condom use for sexually active people, Clarence Page
writes in his Chicago Tribune column. In the "real world," there is
"no real need to polarize the politics around condom use. ... [M]any
lives can be saved with these low-tech devices," Page continues. Pow-
ell's advice to young people "makes up in a modest way" for the Bush
administration's "failures to come up with more dollars" to fight
HIV/AIDS worldwide, Page says, concluding that the "world is looking
to America for leadership in the global fight against AIDS. Powell's
words were right on target" (Page, Chicago Tribune, 2/20).
* Kathleen Parker, Orlando Sentinel: Powell "didn't go far enough" in
his remarks, Kathleen Parker says in her Orlando Sentinel column. In
addition to recommending condom use for sexually active teenagers, he
should have added that abstinence is the "best defense against dis-
ease and pregnancy" and that condoms are only 85% effective in pre-
venting HIV transmission, which is "not enough," according to Parker.
Powell should have also said that sex is "too important to waste on
an encounter that means nothing and risks everything. That's part of
what we hope to impart through abstinence education," she concludes
(Parker, Orlando Sentinel, 2/20).
* Leonard Pitts, Miami Herald: Powell's comments do not indicate that
he is against abstinence but instead show that he has "accept[ed] the
reality" that teenagers may not abstain from sex, Leonard Pitts
writes in his Miami Herald column. "[A]pparently the secretary thinks
one of the things we should talk about is how to save children from
their impulsive, impatient selves," he says. Asking Focus on the Fam-
ily President James Dobson, who criticized Powell for his comments,
"What planet are you from?" Pitts concludes, "[T]ry not to be too
hard on Secretary Powell. Like many of us, he's afflicted with an im-
perfection that makes it difficult for him to see things as you do:
He's from Earth" (Pitts, Miami Herald, 2/21).
* Tracy Quan, Salon.com: By advocating condom use for sexually active
teenagers, Powell "is aligning himself with realists who acknowledge
that most human beings will eventually have sex," Tracy Quan, a
writer and call girl, says in a Salon.com op-ed. While Quan "ap-
plauds" Powell's advocation of condom use, she says that "condoms
alone" -- without proper education and training about condom use --
"are not the answer" (Quan, Salon.com, 2/20).
* Tom Teepen, Omaha World-Herald: After telling "a plain but impoli-
tic truth" that condoms are an "important defense" against HIV, Pow-
ell will be able to "keep his head and even his job" because he is in
the "right administration," Cox Newspapers columnist Tom Teepen
writes in the Omaha World-Herald. Although Powell's statement is
"nothing more than common sense" to most Americans, Surgeon General
Joycelyn Elders took the same stance as Powell and was "smeared as
'the condom queen'" and eventually "run out of Washington" for sug-
gesting that masturbation discussions should be a part of sexuality
education, Teepan says. Surgeon General David Satcher also "blew any
chance at reappointment" when he released a scientific sexuality
study as a public health issue. Powell can "count himself lucky" that
"declar[ing] [him] the condom king" is not "in the GOP's interest
this time," Teepen concludes (Teepen, Omaha World-Herald, 2/20).
* DeWayne Wickham, USA Today: Powell's support for condom use among
sexually active teenagers "put an unwanted spotlight" on the Bush ad-
ministration's policy regarding condoms, DeWayne Wickham writes in
his USA Today column. Although "Republican right-wingers" want the
administration to support abstinence as the "only acceptable means"
for preventing HIV transmission, the administration seems to be "do-
ing little to block the teaching of other forms of sex education,"
Wickham says. "Powell's MTV remarks were targeted at the worldwide
AIDS crisis, but they are just as instructive for people in Baltimore
as for those who live in sub-Saharan Africa, Asia or South America.
... Colin Powell deserves to be praised, not panned," Wickham con-
cludes (Wickham, USA Today, 2/20).
Editorials
Several newspapers have also weighed in on Powell's remarks this
week. Editorials include the following, listed in alphabetical order:
* Chicago Daily Herald: Powell was being a "realist" when he advo-
cated condom use for the sexually active, and "harsh criticism" of
him is "hardly fair," a Chicago Daily Herald editorial says. "Absti-
nence has a prominent place in discouraging teens from engaging in
reckless, risky sexual relationships. But it's naive to believe teens
are going to uniformly acknowledge the wisdom of abstinence," the
editorial continues. Powell and Bush realize that both abstinence and
condom use "need to be highlighted," the Daily Herald concludes (Chi-
cago Daily Herald, 2/19).
* South Florida Sun-Sentinel: "Ignorance will not keep [young people]
chaste," a South Florida Sun-Sentinel editorial says, adding that
Powell gave "sound advice." Although abstinence should be taught as a
way to "keep the body as well as the soul pure," the editorial says,
not every young person will abstain from sex. "Promoting the use of
condoms as a way to prevent AIDS is a public health issue. Young peo-
ple should not be shielded from this information," the Sun-Sentinel
concludes (South Florida Sun-Sentinel, 2/19).
* St. Louis Post-Dispatch: Seeing the "devastating presence" of AIDS
throughout the world and especially in Africa has seemingly convinced
Powell that "doublespeak" about HIV/AIDS is "the last thing this gen-
eration of young people needs to hear," a St. Louis Post-Dispatch
editorial says. Powell "brought a renewed sense of urgency" to the
fight against HIV/AIDS when he "chose frankness" and delivered a
"sensible position" on condom use to 17- to 25-year-olds in 375 mil-
lion households across the world. His well-timed message "adds a new
dimension to the debate" at a time when the administration is propos-
ing to spend $135 million to promote abstinence "at the expense of
other potentially effective remedies, such as condom use," the edito-
rial concludes (St. Louis Post-Dispatch, 2/19).
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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. � 2002 by National Journal Group Inc. and Kaiser
Family Foundation. All rights reserved.
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