HIV/AIDS Treatment Programs Will Not Keep Pace Unless Number Of New Cases Decreases

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HIV/AIDS treatment programsin Africa will not be able to keep pace unlessthe number of new cases significantly decreases, experts said Tuesday at a Senate Health, Education, Labor and Pensions Committee hearing to reauthorize the President's Emergency Plan for AIDS Relief, the BostonGlobereports (Donnelly, Boston Globe, 12/12). PEPFAR'soriginal mandate is scheduled to expire in September 2008. President Bush inMay called on Congress to double current funding levels to $30 billion overfive years (Kaiser Daily HIV/AIDS Report, 12/3).

Experts at the hearing testified that the "most important battle" incurbing HIV/AIDS is stopping HIV transmission but disagreed on how to stop thespread of the virus, the Globe reports. Some witnesses at thehearing debated the effectiveness of a PEPFAR requirement that one-third of HIVprevention funds focus countries receive through the program be used forabstinence-until-marriage and fidelity programs (Boston Globe,12/12).

Norman Hearst, a professor at the University of California-San Francisco School of Medicine, said that encouraging married men to befaithful to their wives and delaying the onset of sexual intercourse are thetwo main ways to stop the spread of HIV in Africa(Walker, CQ HealthBeat, 12/11). Hearst added that Congressshould set target abstinence and fidelity rates for countries receiving PEPFARaid because prevention programs in such countries are designed by "Westernconsultants," who promote condom use as the primary way to prevent HIV.According to Hearst, programs that focus on promoting condom use have"never worked" in areas where HIV is generalized (Boston Globe,12/12). "It's easier to change sexual behavior than getting the people touse an imported sexual device all of the time," Hearst said (CQHealthBeat, 12/11).

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Helen Smits, co-chair of a recent Institute ofMedicine PEPFARreport, said that spending requirements should be dropped so that PEPFAR focuscountries can direct programs on their needs. "If a country discovers ithas a big problem with needle-sharing (spreading HIV), they could devote alltheir money in one year to stamp it out," she said. Sen. Edward Kennedy(D-Mass.), chair of the committee, also said he supports a comprehensiveapproach that would allow focus countries flexibility in spending money forprevention programs (Boston Globe, 12/12). Sen. Richard Lugar (R-Ind.)has introduced a measure (S 1966) that would remove PEPFAR's abstinence andfidelity requirement and instead allocate 50% of prevention funding forcomprehensive prevention programs, including abstinence and condom use, CQHealthBeat reports. The measure also would pledge $30 billion throughfiscal year 2013 for PEPFAR (CQ HealthBeat, 12/11).

Mark Dybul, U.S. Global AIDS coordinator who administers PEPFAR, said he favorsLugar's proposal because evidence supports abstinence and monogamy as ways toprevent the spread of HIV. Dybul added that this prevention strategy couldchange because he is not "sure 50% (of the budget) will be needed in fiveyears."

Other HIV prevention strategies discussed during the hearing include programsto prevent mother-to-child HIV transmission and expansion of male circumcision,the Globe reports (Boston Globe, 12/12). Thewitnesses at the hearing also discussed the importance of PEPFAR programs thatincrease laboratory capacity and improve access to antiretroviral drugs, diagnostictesting for infants and nutrition for people living with HIV/AIDS (CQ HealthBeat, 12/11).

Reprintedwith permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, and sign upfor email delivery at kaisernetwork.org/email . The Kaiser Daily HIV/AIDS Reportis published for kaisernetwork.org, a free service of The Henry J. KaiserFamily Foundation.

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