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Posted at 7:19 p.m., Monday, July 15, 2002

Clinton will rally coalition on AIDS
                                                    
By Black Voices
July 15, 2002

Instead he's asked the former president to talk about AIDS --for the second year in a row.

"Poverty, illiteracy, famine, lack of drinkable water, lack of education, lack of publicity are all factors in the HIV  epidemic," Jackson said. "The poorest people have it. The least able to get tests and medical treatment once it's detected have it."

Clinton, who spoke about AIDS in America at last summer's conference, will focus his July 22 remarks on AIDS internationally. He has said he plans to make the AIDS problem one of his primary focuses during his post-White House years.

"He knows of its devastation," said Jackson, who gave spiritual counsel to Clinton during the Monica Lewinsky scandal. "I walked with him in Africa looking at children devastated."

Jackson said his organization, as part of the five-day conference, will call for 1 million men worldwide to take HIV tests this fall. "We want ministers to take it before their congregations.

We want disc jockeys to take it. We want high-profile athletes to take it," he said. "We want heads of state to take it publicly."

Jackson's group hopes to push the HIV-testing message by inviting leaders from hard-hit nations to join Clinton on a panel discussion, such as Dr. Faida Mitifu, ambassador of the Democratic Republic of Congo; Mildred Trouillot Aristide, Haiti's first lady; Stella Obasanjo, Nigeria's first lady; and Mary M. Kanya, the ambassador of the kingdom of Swaziland.

A United Nations report issued this month suggests more than 68 million people will die of AIDS in the next two decades without vast intervention efforts. Health officials say about 22 million people have already died of AIDS worldwide and 40 million more are HIV-positive.

"Most of those people lived in the developing world," said Lydia Watts, health director for Rainbow/PUSH.

African nations are among the hardest hit.

"We will end up losing generations of people," Watts said. "It probably, inevitably, will destabilize the entire continent."

The conference, "From Slavery to Freedom: Leveling the Education and Economic Playing Fields," will address issues beyond AIDS. Other workshops will focus on the death penalty, slave-era insurance policies, African-American coaches, education funding and the hip-hop industry.

The conference will be held Saturday to July 24 in the Hyatt Regency, 151 E. Wacker Drive.

Copyright 2002 Black Voices.

                                                                                                                                                                                     Posted at 6:17 p.m., July 11, 2002  

Haiti project shows HIV care for poor can work  

By Stephen Pincock, Reuters Writer

BARCELONA (Reuters Health), July 11 - The debate over how to get AIDS drugs to poor countries has sometimes seemed complicated as experts discussed the issue this week at the International AIDS Conference, but on Thursday one physician showed how the problem can be tackled in a straightforward and inexpensive way.

In 1998, Dr. Paul Farmer of Harvard Medical School in Boston, Massachusetts and others began an HIV treatment program in rural Haiti, the poorest country in the Western Hemisphere, without ongoing financial support from government or major international agencies, without the high-tech tests used to monitor disease and without extra medical staff. It currently monitors 2,000 people, about 240 of whom are taking triple-therapy.

"It's a small project for a big problem," Farmer told Reuters Health. "But we've done it in Haiti under adverse conditions of every description--no roads, no communication, a rural area where you have to walk or use a donkey to get around," he explained.

"Our position is--come on--if it can be done there it can be done anywhere."

Despite the fact that drug prices have dropped for many in the developing world, large treatment programs in Africa or elsewhere have not yet materialized as governments and agencies debate issues such as whether efforts to stop people getting HIV are more cost-effective than treatment.

"No one seems to have actually done such projects in the world's poorest communities, although HIV is now the leading cause of young adult death in almost all of them," Farmer said in a speech delivered at the conference on Thursday.

"There's thus a lack of know-how regarding who should receive (anti-AIDS drugs), what enrollment criteria would be, how to manage drug supply and how best to monitor therapy in resource-poor settings," Farmer noted.

The Haiti project added AIDS treatment to existing HIV prevention and tuberculosis (TB) programs without needing any extra staff. And in the absence of expensive tests to decide when to begin treatment, the clinicians use more straightforward approaches.

"As a clinician, if you have someone who shows up and looks like a skeleton and does not have TB and is seropositive, what are you going to do?" Farmer asked.

"For a lot of these patients if you are good at ruling out active TB they are probably skeletal because of HIV and they need antiretrovirals. Even without CD4 counts and viral load--which God knows we would love to have--we can save a lot of lives."

To make sure people take the drugs regularly the program enrolls volunteers from the community to visit patients every day.

"We've underlined the solidarity element of this, with one community member serving another, one usually who is sick and the other who is well--sometimes both with HIV, by the way--so we've called them accompagnateurs, one who accompanies," Farmer said.

These measures mean that the drugs--which run to $122 per patient each month for a three-drug combination--make up 75% of the cost of the program. The other 25% is for salaries and treating acutely ill patients.

"Our own experience in Haiti suggests that, even without making claims for reduced transmission (of HIV), it is clear that the impact of a 'low-tech' HIV prevention-and-care project could be measured," Farmer said in his presentation.

To illustrate the point, he showed two photographs of a man who got drugs through the program, the first showing him emaciated with ribs and collar-bones protruding, his skin dull. In the second photograph his normal weight and coloring have returned.

He quoted the man: "I was a walking skeleton before I began therapy. I was afraid to go out of my house and no one would buy things from my shop. But now I am fine again.... My wife has returned to me and now my children are not ashamed to be seen with me."

If Haiti gets funds from the new United Nations ( news - web sites) Global Fund for AIDS, TB and Malaria, the program could expand, Farmer said.

"I think this is the year that things are going to change for the better," he added. "But I think that we also have to remember that we're playing catch-up with what we should have been done years ago.

Copyright 2002 Reuters Limited.                                                                                                                                        

Whole world responsible for AIDS, says Clinton  

By Patricia Reaney, Reuters Writer

BARCELONA, Spain (Reuters), July 11 - Bill Clinton urged governments on Thursday to do more to fight AIDS and assured young people that wealthy nations would provide extra funds to battle the epidemic if they knew how it would be spent. Photos

The former U.S. president, who is the co-chairman of the International AIDS Trust, described the AIDS epidemic as the biggest single problem for the world, barring nuclear war.

"For the first time in history the world has to take responsibility for a global health crisis," he said during a youth forum at the world's biggest AIDS conference.

Africa is most severely affected by HIV/AIDS but it is spreading quickly in Asia, gaining pace in the Caribbean and threatens to explode in India, so no country or government can be complacent, he warned.

Less than a third of the estimated $10 billion needed annually to provide life-saving drugs to poor nations has been pledged to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Clinton said governments must do more.

"It is important that every government has a plan," he said.

"We know you need more money, but I would argue that you will get more money if you have a specific plan to spend the money."

Clinton fielded questions on topics ranging from stigma and condoms to poverty and religion as the youths clustered around him during the informal taping of an MTV special on HIV/AIDS.

LACK OF POLITICAL WILL

Getting antiretroviral drugs, which have transformed HIV/AIDS from a certain death sentence to a treatable illness, and better prevention has been the overriding theme of the week-long conference.

The World Health Organization laid the groundwork to increase access when it announced new guidelines this week to simplify treatment with the goal of getting antiretroviral drugs to three million people by 2005.

Cheaper generic drugs have been shown to work and scientists know they can be administered in countries without sophisticated infrastructures.

But Julio Frenk, Mexico's health minister, told the meeting progress has been obstructed by the lack of political will.

"I am saddened, as you are, by the death of people in a time when effective treatment exists and I feel the same indignation, as you, when it happens," he said.

"It is the responsibility of each and every one of our governments to undertake measures to increase antiretroviral therapy on a national level."

Graca Machel, the wife of former South African President Nelson Mandela and a former first lady of Mozambique, said some countries have initiated prevention programs to stem the epidemic.

"But it is clear that prevention is inextricably tied up with treatment and care, yet many governments continue to be unclear about support for care, and hesitant if not fatalistic about enabling increased access to treatment," she said.

ECONOMIC IMPACT

The International Labor Office said in a new report that the economic and social impact of HIV/AIDS was far more severe in sub-Saharan Africa than previously thought and would decimate the continent's pool of teachers, doctors and nurses.

Earlier activists had urged South African leaders to heed the messages heard at the conference that anti-AIDS drugs can save lives.

"There is no excuse for not bringing in a national treatment program for people in South Africa," said Mark Heywood, the general secretary of Treatment Action Campaign (TAC).

One argument against scaling up anti-AIDS treatment in poor countries, apart from the cost of drugs, has been the lack of infrastructure and trained medical staff to administer the complex drug regimens and monitor their impact on patients.

But Paul Farmer, of Harvard Medical School, used treatment programs in Haiti to show that introducing antiretroviral drugs in poor countries was possible and effective. "It's not as if poor people are a different species. These drugs work for everyone," he said.

Copyright 2002 Reuters Limited.                                                                                                                                              

South Africa AIDS crisis continues unabated

ByDeborah Mitchell, Reuters Health Writer                                                                                                                                                                                 BARCELONA (Reuters Health), July 11 - In the absence of a major breakthrough in prevention or treatment, the South African Department of Health predicts that the nation's total number of AIDS deaths may reach 4.5 million by 2010. Audio/Video Delegates Urge Access To Life-Saving Drugs (Reuters)

Zackie Achmat, founder of the Treatment Action Campaign in South Africa, spoke to members of the International AIDS Conference at a plenary session here Wednesday. His message was heard via videotape because he was too ill to attend the conference. Achmat, who is HIV positive, has refused to take antiretroviral drugs until these drugs are made available to his fellow countrymen.

In addition to the predicted high death toll, the Department of Health reports that in 2000, AIDS-related illness accounted for 628,000 hospital admissions, or 24% of all public hospital admissions. The cost is at least 3.6 billion Rand annually, or 12.5% of the nation's budget.

Achmat pointed to evidence for the feasibility of providing antiretroviral therapy to South Africans. Since the last International AIDS conference 2 years ago in Durban, Medecins sans Frontieres (Doctors Without Borders began to offer the drugs to HIV-infected patients in Khayelitsha, outside of Cape Town.

Most of these patients initially had very low levels of the infection-fighting CD4+ cells targeted by the AIDS virus, as well as very high levels of the virus in their blood, Achmat said. Yet after 6 months of treatment, 90% of the patients had no detectable virus in their blood and improved immune system function.

These findings, Achmat pointed out, follow the success achieved in Haiti by Dr. Paul Farmer of Partners in Health. Farmer, who is also affiliated with Brigham and Women's Hospital in Boston, Massachusetts and a professor at Harvard Medical School, and his colleagues have implemented a program of directly observed therapy with highly active antiretroviral therapy. The strategy is similar to the approach that has been used with tuberculosis with great success.

"Treatment does work; treatment is cheaper than letting people fall ill and die; and treatment is attainable," AIDS activist Judge Edwin Cameron of South Africa told conference participants. Cameron, who also has AIDS, echoed his call to action that energized the Durban conference. "Treatment for the world's people with HIV living in resource-poor settings is an obtainable goal," Cameron continued. What is now needed, he said, is $10 billion per year for the Global Fund.

"We also need to appeal to the drug companies to issue voluntary licenses with small royalties" to poor countries, he added.

"South Africa's response to HIV has been one of confusion--one of lack of sufficient political will--one of paralysis, stemming in part from the government's denial about the cause of AIDS and how to treat it.

"It is expected in 2002 that 300,000 people in South Africa will die of AIDS," Cameron added. "Thousands, and eventually millions, of South Africans like myself will die because they do not have access to these treatments."                                                                                                                                                                                        Copyright 2002 Reuters Limited.                                                                                                                                                     

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