Kaiser Daily HIV/AIDS Report - Tue, 29 May 2001
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* Concluding Africa Trip, Powell Restates U.S. Commitment, Pledges
US$ 50 Million to Expand Ugandan AIDS Program
* International Aid Group to Begin Administering AIDS Drugs to Small
Group of Poor South Africans
* Piot Urges More Focus on AIDS Prevention Rather Than Price of AIDS
Drugs
* AIDS Placing 'Extra Burden' of Funeral Costs on South Africa's Poor
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Concluding Africa Trip, Powell Restates U.S. Commitment, Pledges $50
Million to Expand Ugandan AIDS Program
Secretary of State Colin Powell concluded his four-country tour of
Africa Sunday in Uganda, pledging US$ 50 million over five years for
the expansion of an HIV/AIDS prevention program that has successfully
cut the country's rate of HIV infection among adults from 30% to 10%,
Reuters reports. The funds will be divided into two blocks -- $20
million to expand the prevention program to new areas of the country
and $30 million to go toward programs for Uganda's 1.7 million AIDS
orphans (Wright, Reuters, 5/27). Powell praised Uganda's anti-AIDS
efforts and told a group of health workers and volunteers in Kampala
that "[t]here is no war on the face of the earth right now that is
more serious, that is more grave than the war we see here in sub-
Saharan Africa against HIV/AIDS," adding that they have "taken the
battle to the enemy" (Strobel, Philadelphia Inquirer, 5/28). Speaking
Sunday in Nairobi, Kenya, at a meeting with members of private hu-
manitarian organizations, Powell told the relief workers that "the
United States is in this battle with you. We will do everything we
can to help you win this battle. And hopefully it's a battle we can
win." Powell said he was "deeply moved" by what he had seen during
his tour and "promised to try and persuade President Bush and Con-
gress" to dedicate more money to fighting HIV/AIDS in Africa (Raum,
Associated Press, 5/27). Speaking on Saturday's CBS Evening News, Dr.
Paul Zeitz, co-director of the Global AIDS Alliance, called the
United States' $200 million donation to the proposed global AIDS fund
"not much of a start" and added that he would like to see a contribu-
tion of $2.5 billion. The White House has said it has "nothing to
apologize for," calling the initial contribution "seed money" (Cowan,
CBS Evening News-Saturday, 5/26). Powell "suggested" that he agreed
with the critics and said, "Activists would always want to see more,
and I encourage them to keep pressing us. We should try to do more"
(Nichols, USA Today, 5/29).
Protests in South Africa
Powell finished his visit to South Africa on Friday with a speech be-
fore 3,000 at the University of Witwatersrand in Johannesburg that
was met with applause, as well as "skeptical inquiries" and protests.
Powell, who said he was speaking on "behalf" of Bush, received a
standing ovation after his speech, which called on Africans to "em-
brace free markets, democracy, the rule of law and foreign invest-
ment" (Strobel, Philadelphia Inquirer, 5/26). He told the audience
that the United States would be Africa's partner "every step of the
way" as the continent turned toward democracy, development and free
trade, but he stressed that the United States "cannot be the leading
force to make peace" on the continent. Powell did not set forth any
"detailed goals," and many in Africa have criticized his visit as a
"symbolic gesture" meant to "assure Africans that they will not be
marginalized" under the current administration (Murphy, Baltimore
Sun, 5/26). Powell was met by protestors outside the university who
blocked his motorcade for over a half-hour in a sometimes "tense"
standoff with school officials (Philadelphia Inquirer, 5/26). The
protestors, members of Muslim and communist groups, passed out leaf-
lets that likened Powell to an "Uncle Tom for both Bushes" and called
him a "war criminal" for bombing Iraq.
A Better Reception in Soweto
The demonstration was in "sharp contrast" to the reception Powell re-
ceived earlier in the day at the Village of Hope, a Soweto township
AIDS clinic, where one patient called him a "role model to the men in
Africa." Florence Ngobeni, an HIV-positive South African woman, told
Powell, "[E]ven though you have not brought anything, as the media
said, your visit means a lot to us. The government has always let us
down, but you have promised and always delivered." When asked if the
United States would help provide antiretroviral medications to Afri-
cans, Powell said he could not "specifically" answer that question
and added that the United States will "do everything we can" to help
ease the African AIDS epidemic. "[T]hat was the message I wanted to
leave here with," he added (Barber, Washington Times, 5/26). Powell
said HIV/AIDS is a "health care problem, but it is also a problem of
poverty, adding that it is "an economic crisis, a social crisis, a
crisis for democracy, a threat to stability, a threat to the very fu-
ture of Africa, because it is decimating the very people who build
that more prosperous democratic, peaceful future" (Lacey, New York
Times, 5/26).
Judging Powell
Speaking to Newsday, Salih Booker, executive director of the Africa
Policy Information Center, said that "[h]ow Powell handles the AIDS
issue will ultimately determine how history remembers him." The AIDS
crisis is "solvable, [and] history will judge him harshly if the
United States fails to provide leadership and finance," Booker said,
adding, "There are going to be more deaths than there were in the bu-
bonic plague, the Black Death and the Spanish flu epidemic." Critics,
such as Moeletsi Mbeki, a researcher at the South African Institute
of International Studies and brother of President Thabo Mbeki, said
HIV/AIDS is "our problem and we must solve it" (Mulugeta, Newsday,
5/26). The trip made "clear" that Powell has a "mastery of issues"
and an "ease in official settings," USA Today reports. Powell "made a
point" of criticizing what he labeled Africa's "big men" -- leaders
like Zimbabwe's Robert Mugabe and Kenya's Daniel arap Moi -- who have
"suppressed democracy." He also publicly "challeng[ed]" Mbeki's pub-
lic questioning of the link between HIV and AIDS. "Let us be clear,
our enemy is the HIV virus that causes AIDS. Our enemy is not its
victims," he told a group in Johannesburg (USA Today, 5/29).
Reflecting on the Trip
Reflecting on his African trip en route to Budapest for a NATO summit
on the Balkans, Powell admitted his understanding of the continent's
AIDS epidemic had previously been more "academi[c]," adding that the
journey had given him a "full[er] appreciation" of the scope of the
epidemic (Lacey, New York Times, 5/29). According to the Philadelphia
Inquirer, Powell "strove to make it clear that his interest in the
continent was not just personal, but reflected Bush's priorities."
Powell, speaking to reporters aboard his plane, said that the trip
"made clear to Africa that it will be a priority for us" and acknowl-
edged that there had been "some doubt about that" (Strobel, Philadel-
phia Inquirer, 5/29). Barring the protests at Witwatersrand, the
overall response to Powell was "magnetic," especially among foreign
leaders, according to one official who attended most of the meetings
on the trip. Powell said that the good reaction was "principally be-
cause I'm the secretary of state of the United States of America, but
underneath that there's a bit of pride that I'm an African American"
and added that he was "pleased there is that subtext." Kenyan opposi-
tion leader Mwai Kibaki was among those impressed with Powell and the
trip. "I do not know what the Bush administration will do in the fu-
ture, but this is a good start," he said (Wright, Reuters, 5/28).
Things Left Unsaid
Powell "repeatedly" spoke of the need for continued emphasis on pre-
vention of HIV transmission, but never once said the word "condom"
during his trip. He also never addressed the hiring practices at some
U.S. embassies in Africa, which his agency oversees. Some embassies
have required potential local employees to take an HIV test and have
denied employment to those who tested positive, a practice that would
be illegal in the United States. The U.S. embassy in Kenya has put an
end to the testing there, and the State Department has conducted a
review of the testing policies and the "insurance implications of
hiring HIV-positive workers" at other embassies (New York Times,
5/29). A new policy, designed to serve as a "human rights model that
will encourage other governments to end the stigmatization of HIV and
AIDS patients," will be issued "soon," according to State Department
officials. Without addressing the embassy practices, Powell said Sun-
day at a Ugandan AIDS clinic, "[B]ecause someone has HIV does not
make them any less valuable as a human being, does not make them any
less valuable in our eyes or in the eyes of God." The change is ex-
pected to increase yearly insurance premiums, which are based on na-
tional prevalence of the virus, for U.S. posts in Kenya and South Af-
rica alone by more than $1 million each. The shift may also lead to
"personnel shortages" as a result of increased absenteeism by those
who are infected. However, the State Department said the change in
policy may be a "solid investment" because the agency can use the
shift to "expand its role" in HIV and AIDS activities and "formally"
incorporate prevention "best practices" into embassy programs by
training employees to be peer educators. U.S. Foreign Service offi-
cers and their families stationed abroad will continue to be tested
before being dispatched and at "regular" two-to-three-year intervals.
Because the government is responsible for diplomats' medical care,
HIV-positive members of the Foreign Service are "restricted" as to
where they can be posted as a result of "inadequate medical support"
and the potential acceleration of HIV disease progression in tropical
climates (Wright, Los Angeles Times, 5/29).
Reaction to Powell's Trip
Several editorials critiquing Powell's trip appeared in newspapers
this weekend. The following are excerpts of several:
* Baltimore Sun: Powell's African trip "reflects his personal priori-
ties, not his president's," a Baltimore Sun editorial states. Powell
has made it "clear he cares, is engaged and hopes to offer U.S. re-
sources to help African efforts on behalf of health, democracy,
peace, law and order," the editorial continues, adding that "combat-
ting diseases" is a "good and necessary" policy (Baltimore Sun,
5/26).
* Washington Times: "The international community must be careful to
invest wisely in Africa," a Washington Times editorial states. "Aid
dollars should go towards empowering Africans, fortifying democratic
institutions and improving the foundations of basic services," the
editorial continues, adding that "[k]nee-jerk and often ineffectual
attempts to treat AIDS and its related problems" should be "avoided."
Powell's "commitment" to Africa is "admirable and well-placed"; how-
ever, the AIDS epidemic is a "symptom of larger problems: ignorance
of how the disease is transmitted ...; official corruption, govern-
ment lack of accountability, generally weak democratic institutions
and therefore insufficient basic services for the population," the
editorial states. "While the AIDS epidemic is a colossal tragedy, the
international community should be careful to target the real causes
of the region's problems," the editorial concludes (Washington Times,
5/27).
* Atlanta Journal-Constitution: The United States must commit medical
assistance -- "not just drugs, and certainly not just payments to
countries" -- in the fight against HIV/AIDS, an Atlanta Journal-
Constitution editorial states. The complex nature of HIV treatment
makes monitoring patients "necessary" and Africa has neither the
"funding [n]or people for the job," the editorial continues. The gov-
ernment must also "insist that Africa's leaders take the reins," the
editorial says, stating that Mbeki's "reluctan[ce] to acknowledge the
need for AIDS medications is inexcusable," especially "given [South
Africa's] leadership role on the continent and the fact that AIDS is
rampant" in the country. The Bush administration would be wise to
follow a Nigerian proverb that states: "One should keep one's eyes on
one's destination, not on where one stumbled," the editorial con-
cludes (Atlanta Journal-Constitution, 5/27).
* Wall Street Journal Europe: Powell's "new approach" in addressing
African leaders and African problems is "blunt and forceful," a Wall
Street Journal Europe editorial states. Powell "didn't mince words"
during his tour, unlike other western leaders who have been held back
by their "colonial pasts," civil rights records, "left-wing guilt"
and "political correctness," the editorial continues. "The surest
sign of friendship is hard and honest talk, especially for those in
Africa who need to hear it most," the editorial concludes, calling
Powell's approach a "better way" (Wall Street Journal Europe, 5/28).
* San Jose Mercury News: "Lip service and 'photo ops' won't overcome
skepticism by some Africans who still view the White House's agenda
with suspicion," a San Jose Mercury News editorial states. The ad-
ministration "noticeably falls down" with its "paltry" and "embar-
rassing" commitment of $200 million to the global AIDS fund, the edi-
torial states, adding, "The world's richest nation must set an exam-
ple by contributing considerably more money." However, the editorial
continues that the administration's ability to handle trade and
health issues on the continent give reasons for optimism, but con-
cludes, "[W]e will reserve our applause until the administration lays
out a more detailed vision that leads to significant, long-term dip-
lomatic policies" (San Jose Mercury News, 5/28).
--
International Aid Group to Begin Administering AIDS Drugs to Small
Group of Poor South Africans
International medical aid agency Medecins Sans Frontieres on Friday
began providing triple drug antiretroviral therapy to a small group
of poor South Africans, the Wall Street Journal reports. The program,
independently financed and run by the group in Khayelitsha township
outside Cape Town, will "assess the feasibility of providing antiret-
roviral therapy in a poor township from primary health-care centers
run by local government." The South African government has been re-
luctant to provide the drugs to its citizens, saying that they are
"too expensive and too complex to administer." Toby Kasper, coordina-
tor of MSF's Access to Essential Medicines Campaign, said, "Given the
heated political context, we will be monitoring the project care-
fully." HIV-positive pregnant women in Khayelitsha township have to
date been the only poor South Africans with access to the drugs,
which have been used to reduce the risk of HIV transmission to their
infants (Wall Street Journal, 5/29).
--
Piot Urges More Focus on AIDS Prevention Rather Than Price of AIDS
Drugs
As the United Nations prepares for its first session dedicated solely
to HIV/AIDS next month, UNAIDS Executive Director Dr. Peter Piot has
voiced concerns that efforts to combat the epidemic have shifted away
from prevention strategies and more toward the affordability of anti-
retroviral drugs, the New York Times reports. Noting that thousands
of communities still lack access to basic prevention methods, includ-
ing condoms, Piot said, "We feel very strongly that the response to
AIDS has to be a balanced one: prevention and treatment. In the cur-
rent climate, people forget that. I'm really getting tired of the
fact that a terribly complex problem of treatment and care for people
having HIV is reduced to the price of antiretroviral drugs." Under-
scoring Piot's concerns, the Global Treatment Access Campaign, a coa-
lition of AIDS activists, is expected to protest outside the U.N.
meeting next month, demanding a "war chest" of $16 billion to fight
AIDS, the cancellation of developing countries' debts and a halt to
the United States' efforts to "protect drug companies from patent
challenges in poor countries." Piot contends that before large
amounts of money can be spent in developing countries, "more effec-
tive prevention, testing and delivery systems must be put in place."
Piot said, "We start with the real problem: building the infrastruc-
ture. For AIDS you need more than health care, you need the school
system, you need all the communications." Piot said that pharmaceuti-
cal companies, governments and the community must be engaged in
fighting the epidemic, adding, "We work with everybody who's part of
the problem to find a solution. I think that very soon the issue of
the price of antiretroviral drugs will be off the table." He added,
"The government sets policy, makes sure there are resources and all
that, but it's not government that's going to promote condoms in gay
bars at night -- nowhere in the world. To promote condoms you don't
need doctors. You use commercial outlets, all these kiosks with women
selling soap, beer, cigarettes -- that's were people go for condoms,
not to a clinic." However, Piot said that in areas that will never
have access to antiretrovirals, both male and female condoms need to
be more readily available. Noting that "very conservative views"
sometimes block the development and distribution of female condoms,
Piot said, "This seems to me ... a really sexist approach, not think-
ing that women need something also that's under their control. Let's
make sure that we increase the options for women to protect them-
selves -- and increasing means from zero to one option" (Crossette,
New York Times, 5/28).
--
AIDS Placing 'Extra Burden' of Funeral Costs on South Africa's Poor
Mounting numbers of AIDS-related deaths are placing an "enormous fi-
nancial burden" on poor South Africans facing funeral costs that
start at over twice what most people earn in a month. The Christian
Science Monitor reports that AIDS and poverty are "subtly changing
the fabric of social life" in the country, as an increasing number of
people are turning to burial practices like cremation and using a new
patented cardboard coffin. These practices were once considered "ta-
boo" in a country where the black community places an "enormous im-
portance on the quality of the funeral provided by family members."
Black South Africans have a "very sentimental cultural attachment to
their loved ones" who have died, Royal Ntombela, director of cemeter-
ies and crematoria in Durban, said, adding that dead family members
are referred to as "ancestors" and relatives perform "special rituals
to remember them." AIDS more than doubled the mortality rate in South
Africa between 1994 and 1999, and the World Health Organization esti-
mates that AIDS-related deaths accounted for half of the nation's to-
tal death rate in 1999, totaling nearly 250,000 AIDS-related deaths.
In rural black communities the overall death rate has reached 25 or
30 deaths per 1,000, compared to six per 1,000 in white communities.
Not only has the number of funeral parlors increased, but Ntombela
reports that within five years all of Durban's cemeteries will have
reached capacity, as cemeteries in two of the city's largest town-
ships are already full.
Changing the Culture
A group of South African business associates has begun marketing a
patented cardboard coffin for about $12, half the price of the "tra-
ditional" wooden "pauper's" coffin. They reported sales of over 2,000
coffins in the first two months of availability and have a contract
to manufacture 6,000 coffins per month for a company in Mozambique.
The cost of funerals and the poverty throughout most of the nation
have forced people to consider burial options such as the new coffins
or cremation, a practice almost unheard of in Durban five years ago,
but which has grown to 3% of burials today. Durban has launched a
"massive education campaign" to "gain acceptance" for cremation and
the practice of "grave recycling." The program focuses on "eliminat-
ing the stigma of cremation and pointing out the cost-saving benefit
of the practice." Musi Myeni, the owner of a chain of funeral homes
and a funeral insurance network in the KwaZulu Natal province, said,
"The economics of this whole thing will change the attitudes of the
people. It's ridiculous to spend a huge sum of money on a box that
people see for only two hours" (Itano, Christian Science Monitor,
5/25).
--
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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