Kaiser Daily HIV/AIDS Report - Mon, 10 Sep 2001
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* Colin Powell Responsible for 'Forward-Looking' HIV/AIDS Policy for
Africa, National Security Adviser Condoleezza Rice Says
* Mathematical Model Suggests that a Partially Effective AIDS Vaccine
Could Lead to Decline in HIV Transmission
* Support for Treatment Should Not be Sacrificed for Fear of Hamper-
ing Prevention Efforts, Opinion Piece States
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Colin Powell Responsible for 'Forward-Looking' HIV/AIDS Policy for
Africa, National Security Adviser Condoleezza Rice Says
Speaking on NBC's "Meet the Press" yesterday, President Bush's Na-
tional Security Adviser Condoleezza Rice said that Secretary of State
Colin Powell was an integral part of the administration's AIDS in Af-
rica policy. "I have no closer relationship than I have with Colin
Powell," Rice said, adding, "He is the chief voice on foreign policy.
He is the person to whom the president turns. ... [W]ithout his skill
as a diplomat ... [w]e would not have a forward-looking policy on
HIV/AIDS and Africa" (Russert, "Meet the Press," NBC, 9/9).
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Mathematical Model Suggests that a Partially Effective AIDS Vaccine
Could Lead to Decline in HIV Transmission
An AIDS vaccine with an efficacy rate of as low as 25% could stem the
spread of the disease in Africa "under certain circumstances," re-
searchers said Friday at the conclusion of the AIDS Vaccine 2001 con-
ference in Philadelphia. The Washington Post reports that Ronald Gray
of Johns Hopkins University presented a mathematical model testing a
hypothetical vaccine in the Rakai district of Uganda, "one of the
worst-hit nations in Africa." According to this model, developed by
Gray with help from researchers at Columbia University and Uganda's
Makerere University, a vaccine that is 50% effective would have to be
taken by everyone in the district in order to make the "reproductive
number" of the epidemic -- the average number of people infected by
an HIV-positive person before he or she dies -- less than one, which
would "theoretical[ly]" lead transmission of the virus to "abate ...
and eventually burn out." A vaccine that is 75% effective would have
to be taken by 50% of the population to achieve the same result, and
a 25% effective vaccine that was taken by 75% of the population would
reverse the tide of transmission only if HIV-positive individuals re-
ceived HIV treatment according to HHS guidelines. While HIV treatment
such as this "does not exist in Africa now ... the possibility is not
entirely out of the question," the Post reports. Gray cautioned that
if people reacted to the development of a vaccine by "increasing
their risky sexual behavior even a little," this effect would "com-
pletely wipe out the benefit of the vaccine."
--
Support for Treatment Should Not be Sacrificed for Fear of Hampering
Prevention Efforts, Opinion Piece States
Treatment access campaigns that have won price concessions from drug
makers have "converted the public perception of AIDS from an insolv-
able tragedy to a moral issue and an opportunity to save lives," "in-
stilled hope in millions of individuals" and "mobilized broader soci-
ety in some of the most severely affected countries," Alan Berkman, a
faculty member at the HIV Center for Clinical and Behavioral Research
of the New York State Psychiatric Institute and Columbia University,
writes in an American Journal of Public Health opinion piece. As
treatment access campaigns make gains, "demands that governments and
international agencies develop a comprehensive plan to stop the
global epidemic" have increased. One such plan is the Global AIDS and
Health Fund proposed by U.N. Secretary-General Kofi Annan, he states.
The proposed $7 billion to $10 billion fund would seek to control
AIDS, malaria and tuberculosis in the developing world by improving
health infrastructure, treating those already infected, strengthening
prevention efforts and funding vaccine and drug research. But the
plan has "proved controversial" because some fear that HIV "will be
'medicalized' and prevention efforts will be lessened," he continues.
Treatment Must Accompany Prevention
Prevention efforts alone are "inadequate in countries with estab-
lished, high-prevalence epidemics," Berkman states. Programs that
"only offer condoms or counsel abstinence" are "woefully inadequate
and cannot penetrate the inertia and sense of hopelessness that ac-
companies epidemic death and dying," he adds. Treatment offers people
hope, preserves and strengthens society's "human infrastructure" by
keeping HIV-positive individuals who are often the "most effective
and committed advocates for prevention" alive and offers people a
"powerful life-or-death incentive" to be tested. Treatment will also
help lower the number of children born with HIV by bringing in more
pregnant women for testing, he continues, adding that women who "know
that they can save themselves" along with their babies are more
likely to be tested, Berkman says. Treatment may also reduce trans-
mission of the virus, he writes, citing studies that have found that
people with lower viral loads were less likely to transmit HIV to
their sexual partners. "Whether the same is true for someone whose
viral load is reduced by medication is unanswered, but it is scien-
tifically plausible," he adds. Setting up a health care infrastruc-
ture for treatment will also aid in the distribution of an HIV vac-
cine, should one become available, Berkman states. The U.N. Global
AIDS and Health Fund's plan is "unabashedly optimistic," but "not
necessarily utopian," he writes. "Debates that counterpose prevention
and treatment can potentially undermine the momentum that has been
generated by treatment access campaigns in both high-income and low-
income countries. The world has been humbled by the HIV epidemic and
enriched by the lives and lessons of those who have struggled against
it. We need to take the next step toward ending it," Berkman con-
cludes (Berkman, American Journal of Public Health, September 2001).
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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. � 2001 by National Journal Group Inc. and Kaiser
Family Foundation. All rights reserved.
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