Kaiser Daily HIV/AIDS Report - Mon, 18 Jun 2001
-----------------------------------------------
* Disagreements Over Language Preventing Consensus on U.N. Special
Session on HIV/AIDS Draft Declaration
* After Dipping in Recent Years, International Funding for African
Condom Distribution May Increase
* Mbeki Warns Youth About the Threat of AIDS on Anniversary of 1976
Soweto Uprising
* After HIV/AIDS Warning Went Unheeded in 1990s, Peter Doyle Reempha-
sizes Intervention in South Africa
* Newsday Examines International Efforts to Halt Global HIV/AIDS Epi-
demic
--
Disagreements Over Language Preventing Consensus on U.N. Special Ses-
sion on HIV/AIDS Draft Declaration
Diplomats from more than 100 countries preparing a draft declaration
on HIV/AIDS treatment and prevention standards for approval at the
June 25-27 U.N. General Assembly special session are struggling to
agree on acceptable language, the AP/Chicago Sun-Times reports. Ac-
cording to the AP/Sun-Times, diplomats have engaged in "intensely an-
gry, frustrating and emotional" meetings since May in an attempt to
find a consensus on the 19-page draft document that is "acceptable to
all 189 U.N. member countries" (AP/Chicago Sun-Times, 6/17). The
document seeks to create "tough" universal standards for all coun-
tries, including: the development of national programs to increase
the availability of HIV drugs by 2003; a 25% reduction in the number
of 15- to 24-year-olds infected in the "most affected countries" by
2005; a 20% reduction in the number of infants infected through ver-
tical transmission by 2005 and a 50% reduction in the number of HIV-
positive infants by 2010; and the development of national AIDS
strategies, including financing plans, by 2010 (AP/Reuters/Toronto
Star, 6/16).
U.S., Muslim Countries Raise Objections
Finding a consensus for the implementation of these standards, how-
ever, remains a challenge. Many Muslim nations "that view homosexual-
ity as a sin punishable by death" have objected to "men who have sex
with men" being listed as a group vulnerable to HIV/AIDS and in need
of protection. Egyptian diplomat Amr Rashdy, who called the phrase
"shocking for my society," has instead proposed that homosexuality be
called "irresponsible sexual behavior" that contributes to the spread
of HIV. Rashdy's proposal led the Norway representative to do the
"diplomatically unthinkable" and threaten to cut foreign aid to Egypt
if it "continued to oppose the original phrasing." In addition, the
United States has met opposition from European and Latin American na-
tions, as well as "most Americans," for its proposal that a "long
list of groups targeted for protection" be replaced with the phrase
"vulnerable individuals," including those who engage in "risky sexual
behavior." The AP/Sun-Times reports that the United States believes
that the current language focused on risk groups would create "po-
litical problems" and would "conflict with the U.S. Constitution,
which recognizes the rights of individuals rather than groups." But
many diplomats and advocates say that a "watered-down version" of the
document will only have limited effectiveness in the battle against
HIV/AIDS. Gregg Gonsalves of Gay Men's Health Crisis, one of many ad-
vocacy groups that will participate in the special session, said, "We
know that prevention programs work best when they are targeted spe-
cifically to the needs of the individual communities. These are the
people that we need to reach, and if governments cannot utter their
names, what chances do we have of stopping the epidemic?" (AP/Chicago
Sun-Times, 6/17). To view the "disputed language" of the draft decla-
ration, click here (Associated Press, 6/15). Please note that this
link is available to Web readers only.
--
After Dipping in Recent Years, International Funding for African Con-
dom Distribution May Increase
International funding for condoms, the "cheapest preventive measure"
against HIV, "fell sharply" over the last two years, despite an em-
phasis by "rich governments" on HIV prevention, the Boston Globe re-
ports. After peaking at $68.1 million in 1996, funding for condom
distribution programs fell to about $40 million each year in 1999 and
2000, mostly due to cuts from European and Japanese donors, resulting
in shortages in many sub-Saharan countries. Christian Saunders, who
oversees condom purchases for the U.N. Population Fund, cited "donor
fatigue" for the decrease in funding. But John Wilson, a health lo-
gistics specialist for global health firm John Snow Inc., said "more
nuanced" factors may be to blame, explaining, "It's very hard for do-
nors to keep up funding for things that work well. [Donors] are often
attracted to try out new things, unproven things, things that are
said to be innovative. What's the glory in buying billions of con-
doms?" However, a renewed emphasis on HIV prevention has "generat[ed]
more enthusiasm" for condom distribution, the Globe reports. The
United Nations said it plans to purchase $20 million worth of condoms
this year, up from $8 million worth in 1999 and 2000, thanks in part
to grants from the Dutch and British governments. And USAID, the
"world leader in condom procurement," is aiming to improve on the
$13.5 million it spent last year on 350 million condoms. The agency
may seek to waive a "buy America" clause that requires it to purchase
more expensive American-made condoms. USAID currently pays Custom
Services International, an Alabama condom manufacturer, 6.3 cents per
condom, but the agency could procure condoms from foreign manufactur-
ers at 2.5 cents each. American and UN officials are also considering
a "sharp increase" in the number of female condoms they provide.
Increasing Usage
Getting people in developing countries to use condoms has also been a
challenge. Paul Delay, head of USAID's HIV/AIDS programs, said the
agency is utilizing a "Coca-Cola model" for condom marketing and dis-
tribution, making condoms widely available at kiosks and other small
"outlets" throughout rural areas. Packaging also impacts usage. Kate
Roberts, a spokesperson for Population Services International, a not-
for-profit health services group, said unmarked silver foil packages
containing free government condoms are less popular than ones dis-
tributed at small stores with "flashy" names. She also explained how
the condoms can be more effectively marketed, "There's Lovers Plus in
Eastern Europe, Maximum for parts of Africa, or something that re-
lates to the local people. In Angola, the condom name is Legal, which
is slang for 'cool,' or 'acceptable'." USAID is also set to undertake
a multimillion-dollar project in conjunction with African mosques and
churches, aimed at "overcoming religious obstacles to condom use."
Delay added, "We may need to go on and have a condom summit and get a
better estimate on needs and demand, and raise the resources" (Don-
nelly, Boston Globe, 6/18).
--
Mbeki Warns Youth About the Threat of AIDS on Anniversary of 1976
Soweto Uprising
South African President Thabo Mbeki on Saturday spoke about AIDS at
Youth Day, the annual commemoration of a June 16, 1976, "schoolchil-
dren's revolt against apartheid education" in Soweto, the Associated
Press reports. Mbeki stated, "The youth of our country has itself a
responsibility to look after themselves," as they are "a very valued
resource of our country." He "urged" young South Africans to protect
themselves from HIV, which has infected 11% of the nation's popula-
tion (Associated Press, 6/16). Youth Day commemorates a march in
which 23 students were shot and killed as they protested the use of
the language Afrikaans in public schools. June 16 was declared a na-
tional public holiday when the African National Congress won the
country's first democratic election in 1994. The date "remains an im-
portant marker of black opposition to white rule," but this year's
march was more focused upon HIV/AIDS than politics, Reuters reports
(Thomas, Reuters, 6/16). In his remarks, Mbeki said, "As we remember
the heroes of 1976, we must ensure that we educate the youth, but if
they value their fallen heroes they must participate in the process
of transformation." The African National Congress Youth League, a
youth group supporting the mission of the ANC, cited AIDS as one of
the biggest challenges for South African youth today. ANCYL President
Malusi Gigaba said, "We are the first generation to live in a free
society. We still have the challenges of building non-racialism, non-
sexism, democracy and a better life for all, but new tasks have
emerged. Now we must fight against preventable diseases ... like
HIV/AIDS and poverty linked to the disease" (Agence France-Presse,
6/16).
--
After HIV/AIDS Warning Went Unheeded in 1990s, Peter Doyle Reempha-
sizes Intervention in South Africa
In 1990, then-head actuary of Metropolitan Life Insurance Peter Doyle
predicted "with uncanny accuracy the coming devastation" of AIDS in
South Africa, but the Doyle Model, as his original forecast came to
be known, was received with "disbelief, derision -- and inaction,"
the Philadelphia Inquirer reports in a feature on Doyle. The Doyle
Model was established on the assumption that different groups are at
different levels of risk for the virus, such as those with multiple
partners versus single partners, and is based on the "intimate under-
standing of the sexual habits of various population groups." The
model also projected a range of directions the AIDS epidemic could
move in South Africa, but the "best scenario" was dependent upon con-
dom acceptance among the public, the promotion of monogamous rela-
tionships and the development of a campaign to treat STDs "aggres-
sively." The country has only recently implemented condom distribu-
tion, and "has not dared to take on taboo issues about sexual rela-
tions," according to the Inquirer. "People take a long time to inter-
nalize AIDS," Doyle said, adding that the disease is "laced with
sexuality and racism issues." With South Africa in transition from a
white minority government to the presidency of Nelson Mandela in the
early 1990s, and the subsequent threat of civil war, "AIDS just never
made it to the top of the agenda," Doyle explained. The Inquirer re-
ports that Doyle predicts that by 2010, 22.5% of the South African
workforce will be HIV-positive. Although he conceded that his model
"conveys an idea of inevitability," he stated, "Despite the loss of a
window of opportunity, at any point intervention can be powerful. We
could save 20 million lives worldwide if we act now" (Maykuth, Phila-
delphia Inquirer, 6/15).
--
Newsday Examines International Efforts to Halt Global HIV/AIDS Epi-
demic
In part seven of its "AIDS at 20" series, Newsday examines the inter-
national response to HIV/AIDS, particularly in Africa. The article
cites last summer's International AIDS Conference in Durban, South
Africa, as a "turning point" in the international community's efforts
to fight HIV/AIDS that created the "momentum" leading to both U.N.
Secretary-General Kofi Annan's call for a global AIDS fund and a spe-
cial three-day session of the U.N. General Assembly on AIDS later
this month. The article also examines the impact and controversy of
globalization in treating the epidemic, including patent protections
and intellectual property disputes surrounding the purchase, manufac-
ture and distribution of HIV medications (Garrett, Newsday, 6/17).
--
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.
--
Send mail for the `AFRO-NETS' conference to `<afro-nets@usa.healthnet.org>'.
Mail administrative requests to `<majordomo@usa.healthnet.org>'.
For additional assistance, send mail to: `<owner-afro-nets@usa.healthnet.org>'.