Kaiser Daily HIV/AIDS Report - Wed, 13 Feb 2002
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* Advocates, Lawmakers Say U.S. Setting 'Poor Example' for Donations
to Global AIDS Fund; Thompson to Testify in Senate on International
AIDS Efforts
* South African Opposition 'Demands' Statement From Government on
Nevirapine Project
* Uganda's Largest Kingdom Offers Televisions, Appliances, Cash to
Women Who Remain Virgins Until Marriage to Help Curb HIV
* PRI's 'The World' Reports on Child Rape and HIV Virgin Myth in
South Africa
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Advocates, Lawmakers Say U.S. Setting 'Poor Example' for Donations to
Global AIDS Fund; Thompson to Testify in Senate on International AIDS
Efforts
Donations to the Global Fund to Fight AIDS, Tuberculosis and Malaria
have fallen short of the $7 billion to $10 billion goal set by U.N.
Secretary-General Kofi Annan last spring, and some advocates and law-
makers "blame" the Bush administration for the shortfall, saying "its
pledge of $200 million this year sets a poor example for other coun-
tries," the New York Times reports. Sen. Richard Durbin (D-Ill.), who
yesterday introduced legislation that would authorize an annual com-
mitment to the fund of $1.2 billion, said that the administration's
pledge, which so far is $500 million over two years, "just does not
come close to meeting the need. It is a totally inadequate response
to a problem that could literally overwhelm the world." According to
one unnamed U.N. official, the United States is "really not setting
the example that is required." He explained, "In everyone's mind,
there is the juxtaposition with Afghanistan," which is receiving more
money for rebuilding than the U.S. government is contributing to the
fund. White House spokesperson Scott McClellan dismissed those
charges, calling the United States a "global leader in the fight
against AIDS" and noting that the country has pledged more than any
other country (Stolberg, New York Times, 2/13).
Senate Committee Will Address Fund
United Nations and U.S. government officials will testify today and
tomorrow before the Senate Foreign Relations Committee about the fund
and how it plans to ensure compliance with the rigorous standards for
obtaining a grant that it has already outlined. The Wall Street Jour-
nal reports that although most lawmakers are "convinced of the ur-
gency of addressing" AIDS, TB and malaria -- which kill six million
people a year -- they say they must be assured that the U.S. pledge
"won't disappear down a global rathole of corruption and ineffi-
ciency" (Schoofs/Phillips, Wall Street Journal, 2/13). HHS Secretary
Tommy Thompson will speak at today's hearing, where he is expected to
renew the administration's support for the fund. "We will pursue new
sources of financial support from governments and the private sector
worldwide," Thompson said in a release, adding that the administra-
tion has "no intention of slackening" its efforts against HIV/AIDS
(HHS release, 2/11). Some committee members are expected to question
the size of the government's donation during this week's hearings,
and others are expected to call for an increase in the amount
pledged. Sen. John Kerry (D-Mass.) said that he and Sen. Bill Frist
(R-Tenn.) are drawing up legislation to increase the U.S. contribu-
tion, but would not say by how much. Annan will also be in Washington
today to meet privately with members of the committee to update them
on the fund's progress and is expected to "make the case for more
money" (New York Times, 2/13).
Tough Standards
The fund is expected to hold grant applicants to the "highest medical
and financial standards" to assure that programs are effective and
that donors are satisfied and do not withdraw their contributions,
the Wall Street Journal reports. The applications will be reviewed on
their "public health merits" and "fiscal safeguards" by a 17-member
expert panel, and the first round of grants will be awarded in April.
"We envision a level of fiscal accountability and a level of substan-
tive accountability -- meaning results -- that's unheard of in inter-
national development assistance," an official with the Bush admini-
stration said. The accountability process will be modeled on WHO's
Stop TB Partnership, an international health program that supplies TB
medications to developing nations that has rejected many requests be-
cause monitoring plans were insufficient, and the Global Alliance for
Vaccines and Immunization, which has also declined assistance re-
quests or cancelled follow-up assistance because plans or results
were inadequate. "Just because you need the money, we're not giving
it to you unless you can show you can do something with it," Dr.
Helene Gayle, an adviser to the Bill & Melinda Gates Foundation, one
of GAVI's major partners, explained, adding that the approach is
"very different from the way the U.N. has worked (in the past), which
is almost an entitlement system." Such tight controls are necessary
not only to control spending but also to ensure that drug treatment
protocols are followed to lower the risk of patients developing re-
sistant disease strains (Wall Street Journal, 2/13).
--
South African Opposition 'Demands' Statement From Government on Nevi-
rapine Project
South African opposition party leaders yesterday "demanded" that the
government clarify its plans regarding the possible expansion of a
pilot project to reduce vertical transmission of HIV by providing
HIV-positive pregnant women with the antiretroviral drug nevirapine,
Reuters Health reports (Boyle, Reuters Health, 2/12). South African
President Thabo Mbeki, who has long been criticized for questioning
the link between HIV and AIDS, indicated on Sunday that the govern-
ment may expand the program even though problems at the pilot pro-
ject's 18 test sites have not yet been resolved (Kaiser Daily
HIV/AIDS Report, 2/12). However, Health Minister Manto Tshabalala-
Msimang said yesterday that the government is "not yet ready" to ex-
pand the project until further research is conducted. "We need to
have a policy that is informed," she said, noting that a report made
to national and provincial ministers at the beginning of the month
found a "range of problems" with the prevention program, including
"hostility from nurses toward HIV-positive mothers in rural areas"
and a reluctance by mothers to forego breastfeeding due to the social
stigma of baby formula use as an indicator of HIV infection. Tony
Leon, leader of the opposition Democratic Alliance, asked the govern-
ment yesterday for an "unequivocal statement" regarding its plans for
the nevirapine program, saying, "Why, on this life and death matter,
this war which is devouring our nation, do we have to ... read be-
tween the lines or study tea leaves? Why on earth, if he is changing
his policy, can the president not say so himself in a manner that is
intelligible and straightforward?" Leon also "demanded" that Mbeki
acknowledge the causal link between HIV and AIDS.
KwaZulu-Natal to Move Ahead
In related news, Mangosuthu Buthelezi, a senior cabinet minister and
leader of the Inkatha Freedom Party, said yesterday that he had told
the premier of the KwaZulu-Natal province to move ahead with plans to
offer pregnant women nevirapine, in defiance of the national govern-
ment and without testing and counseling "if necessary." Buthelezi
said, "Our nation is dying of HIV/AIDS. We can no longer hesitate or
falter," noting that 40,000 babies were born with HIV last year in
KwaZulu-Natal. "Henceforth, health facilities in KwaZulu-Natal will
ensure that children are not born with a death sentence. Nevirapine
will be made available to all mothers, whether or not they are HIV-
positive," he stated (Reuters, 2/12).
--
Uganda's Largest Kingdom Offers Televisions, Appliances, Cash to
Women Who Remain Virgins Until Marriage to Help Curb HIV
Buganda, the largest of Uganda's four kingdoms, will offer women who
remain virgins until marriage television sets, electrical appliances
or money as part of an effort to curb the spread of HIV, the Sunday
Telegraph/National Post reports. A woman's husband will be responsi-
ble for determining her sexual status on their wedding night and re-
porting it to a panel of sengas -- female mentors -- to be eligible
for the reward. "African tradition" is supposed to prevent young men
from falsely trying to win incentives, according to Health Minister
Robert Sebunya, who added that he is "convinced that our young people
are fair-minded and will enter into the spirit of the program." Ugan-
dan women who remained virgins until marriage were traditionally of-
fered a goat as an incentive to avoid sex.
Raising Objections
The updating of the mberera incentives, or "purity" customs, is part
of an attempt to expand the role of a recently established morality
committee. However, many young Ugandans last week objected to the
program and called for a "more contemporary policy" of HIV/AIDS pre-
vention. Sebunya defended the program, saying, "So many of our young
people have died or are dying. I am certain that this will become a
weapon in the fight against HIV and AIDS, so we must try it." He
noted that officials realized that a goat was "perhaps no longer
enough of an incentive for young people today" and said that the gov-
ernment will attempt to "come up with rewards that will tempt them to
preserve the good morals of the kingdom." An estimated 1.8 million of
Uganda's 23 million people have HIV/AIDS, and average life expectancy
in the nation is expected to drop to 35 years over the next 10 years
(Flanagan, Sunday Telegraph/National Post, 2/12).
--
PRI's 'The World' Reports on Child Rape and HIV Virgin Myth in South
Africa
PRI's "The World" on Monday examined the growing incidence of child
and infant rape in South Africa, a trend that some consider to be a
"disturbing result" of the myth that sex with a virgin will cure HIV-
positive men of the disease. Dr. Graham Pitcher, who has treated in-
fants who were raped, said, "I have no doubt that the nationwide in-
crease in [the infant rape] problem is related to individuals who are
acting according to this myth." Research on the sexual habits and be-
liefs of South African teenagers by loveLife, a national HIV preven-
tion program aimed at youth, found that one in four teenagers be-
lieved the HIV virgin cure myth to be true or thought it might be.
But Luke Lamprecht, director of the Teddy Bear Clinic for Abused
Children in Johannesburg, said that child and baby rape is a "complex
phenomenon" which shouldn't "be reduced to another offshoot of the
AIDS crisis." The full segment is available in RealAudio online
(Kruger, "The World," PRI, 2/11).
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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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