Turmoil Deepens in AIDS Funding Crunch
Service groups kept in dark about fed HIV funding

April 22, 2008

"It's like constantly wondering, 'What are we going to do?'" says John McTavish from Kingston, speaking about planning AIDS prevention programs. "You wonder, 'what's next?' You're always trying to think ahead, to what we should be doing in the future."

But that's just gotten a lot more complicated, says McTavish, the director of HIV/AIDS Regional Services for Kingston (HARS). He doesn't know what AIDS programming will be available to residents there a year from now.

That's because service groups across the country are being kept in the dark about what the federal government's contribution to their programming will look like past March 2009.

HARS has two part-time employees working on HIV prevention and education, both sponsored by the feds. They give out important health information to high-risk youth, the gay community, and others.

"It's hard to keep your staff and for them to want to commit," says McTavish. "Stress level goes up — for not just of those staff, but for all the staff. So you have turnover, and then you have to begin all over again."

Brian Lester agrees. He heads up prevention work at the AIDS Committee of London. There, the federal programming pays for one full-time employee to run education campaigns in bathhouses, bars and in gay chatrooms online.

"That money helped us dedicate resources to the gay-bi-MSM community," says Lester. "We would lose our capacity to do the extensive outreach we do."

In Canada, the provinces typically pay for AIDS groups' core funding. The community, through fundraising, pays for most of the service delivery. The feds kick in for HIV prevention, education and some support work.

Or they have, historically.

There are less than 11 months of federal AIDS cash remaining. Last month, the clock ran out on federal funding for hepatitis C work. It has yet to be replaced.

It serves as a chilling precedent. It also means that AIDS groups, which often provide hep C programming, are already feeling the pinch.

HARS received federal hep C money "off and on" over the last five years. It has always been "piecemeal," says McTavish.

"We have people living with hep C coming through our office every week. Especially when it comes to services, we don't want to say, 'No we can't help you,'" he says.

And in Kingston, "we don't have anywhere else to send them," says McTavish.

"We may have been the only game in town for hep C," he says. "Whereas in larger urban centres, there may have been other people doing the work or a little bit of the work."

McTavish may see hep C money again. But that uncertainty makes planning difficult. Elsewhere, groups like the Toronto-based Africans in Partnership Against AIDS still haven't heard if money is coming in between now and March 2009.

"We submitted a request and are still waiting for a response," says Fanta Ongoiba, the program's director, in an email to Capital Xtra. "I know that some agencies have already received their approval letter and some not yet. So we don't know if it has been approved or not."

Historically, funding has been issued in four-year blocks. But since the Conservative Party took the helm, they have simply extended existing funding in six-month and one-year increments. The result is perpetual uncertainty for groups that receive funding — and no opportunity for new groups to apply.

The problems are magnified for AIDS Service Organizations (ASOs) in areas that are rapidly growing. Durham Region is growing by 10 percent every five years. It's home to some of Ontario's quickest expansion — between 2001 and 2006, the city of Whitby grew by over 27 percent. Some estimates suggest Durham region will double in population by 2020.

AIDS Durham has been shut out of federal funding since 2000. Peter Richtig is the director.

"That's part of the problem," says Richtig. "But there's never been an adequate pool of money for AIDS organizations, so it's incredibly competitive. Emerging agencies don't have that kind of staff and they don't have the capacity to jump through all the hoops."

"We're the only people providing unconditional support, and we're out panhandling in the community when we should be in the office with clients," he says.

It's an even more bitter pill to swallow because the envelope was supposed to get bigger in 2007, not smaller. For Ontario, $1 million in promised additional federal funding was yanked in 2007, with a further $1 million of promised money gone for 2008-2009. By 2012, the federal funding envelope will be $7 million smaller.

Murray Jose is from PWA Toronto. Like in Kingston, PWA Toronto's federal money runs out next March.

"Many organizations that were not successful in the last grant application round have had no opportunity to re apply and get federal funding — so there is huge disparity between ASOs," says Jose.

"We would have applied and been able to create new programs or adjust our work to most effectively respond to changing needs of our clients."

As for the Public Health Agency of Canada (PHAC), they're keeping their cards close to their chest. On hep C funding, they've committed to renewing their contributions later this year. But they're silent about community AIDS programming.

"We continue to work with community organizations that make a positive impact on addressing the hepatitis C epidemic in Canada, and we look forward to supporting more community projects on a national and regional scale," says PHAC's Phillipe Brideau in a written statement to Capital Xtra.

He says that in 2007-08, the "main focus" of hep C spending was on "strategic planning," including meetings with service providers across the country.

"We are anticipating announcing our planned approach in the coming weeks," he continues. "We realize that community organizations have been waiting for some time to hear news of federal funding, and we are optimistic that our renewed approach will provide our partners with the support they need."

But with AIDS funding, they won't even say what the shape of the review looks like.

"As for the overall Grants and Contributions fiscal review, final decisions have not yet been made on the budget levels," he writes.

Groups in Ontario, Quebec and Alberta are fighting back. Last month, the Ontario AIDS Network started a postcard campaign, calling on the Conservative government to restore funding to promised levels.

They've also launched a national website, increasedAIDSfunding.ca.

The message to politicians is that cash promised in 2005 needs to be delivered, says Rick Kennedy, director of the Ontario AIDS Network.

That would mean increasing federal contributions to ASOs to $13.9 million in Canada, or $4.5 million for Ontario.

"They've never said that the money is not necessary or not needed," says Kennedy. "They've only said that they can't afford it because of across-the-board cuts to PHAC. We're left wondering where their leadership is on this."

The frontline workers agree.

"We're concerned overall with the direction that this government," says Lester from AIDS Committee of London. "It's about commitment to the issue."

Stop the cuts. www.IncreaseAIDSfunding.ca

By Marcus McCann, Capital Xtra

Canadian AIDS Care Nurses Voice Support for Harm Reduction
Harm reduction is part of professional and ethical nursing standards

April 22, 2008

Ottawa - Nurses caring for people with HIV/AIDS have a professional obligation to promote the health and well-being of their patients, which includes supporting strategies that reduce harm to patients dealing with addictions, says the Canadian Association for Nurses in AIDS Care (CANAC).

At the close of CANAC's eighth annual conference, held April 21 - 22 in Ottawa, the association is calling on municipal, provincial and federal governments to immediately implement evidence-based harm reduction programs throughout the country and to continue supporting those already operating.

"Nurses are concerned about the lack of support for essential harm reduction programs in Canada," says CANAC President Greg Riehl. "Harm reduction has been dropped from the current government's new 'Anti-drug Strategy', and many vital programs are being threatened, including needle exchanges, the safer crack kit program in Ottawa, and the supervised injection site (Insite) in Vancouver, despite research showing that these programs work."

The City of Ottawa recently withdrew support for the city's safer crack kit program and is now considering imposing a restrictive one-for-one needle exchange policy.

"These actions represent a major step backwards," Riehl continues. "We need maximum - not restricted - access to programs that prevent disease and suffering."

Insite is also under threat as the federal government must decide whether to extend the exemption under which the facility legally operates. The current exemption expires June 30, 2008.

Research on supervised injection sites show that these programs are effective, says Liz Evans, a nurse and the director of the Portland Hotel Society in Vancouver. The Portland Hotel Society operates Insite in partnership with Vancouver Coastal Health.

"The federal government's own hand-picked expert advisory committee recently confirmed that the facility prevents disease and death," explains Evans. "We should stop talking about whether Insite should stay open and instead start talking about expanding access to supervised injection sites throughout Canada."

Nurses in Vancouver have also initiated a supervised injecting program at the Dr. Peter Centre, a facility that operates a day program and residence for adults living with HIV/AIDS. According to the Dr. Peter Centre's executive director Maxine Davis, the decision to provide such a service was made after consultation with the College of Registered Nurses of British Columbia (CRNBC).

"The College told us that, according to the requirements outlined in the Standards for Nursing Practice in B.C., and the Canadian Nurses Association Code of Ethics for Registered Nurses, there is a professional obligation to provide clients with this evidence-based care and support so that they can give themselves intravenous injections more safely," Davis explains.

Registered nurses are upholding professional and ethical standards of practice by supporting harm reduction measures, adds Dr. Bernie Pauly, assistant professor at the University of Victoria's School of Nursing.

"Harm reduction is a vital component of health care. This may be a controversial matter to some Canadians, but it shouldn't be. At a basic level, it's simple: this is a nursing practice issue," says Pauly. "Harm reduction is congruent and consistent with established professional nursing values of safe, competent and ethical care, health and well-being, dignity and social justice."

For interview requests or further information relating to the announcement, please contact Stephen Burega, media relations, 604-506-3734, stephen.burega@karyo-edelman.com. For onsite media relations, please contact Laura Espinoza, 647-883-3565, laura.espinoza@edelman.com.

About the Canadian Association for Nurses in AIDS Care
The Canadian Association of Nurses in AIDS Care (CANAC) is a national professional nursing organization committed to fostering excellence in HIV/AIDS nursing, promoting the health, rights and dignity of persons affected by HIV/AIDS and to preventing the spread of HIV infection.

About the Portland Hotel Society in Vancouver
The Portland Hotel Society (Vancouver, British Columbia) is a non-profit organization that seeks to promote, develop and maintain supportive affordable housing for adult individuals who are hard to house and at risk of homelessness due to their physical and/or mental health, behaviour, substance dependencies, and forensic history. The Portland Hotel Society operates Insite, Vancouver's supervised injection site, in partnership with Vancouver Coastal Health.

About the Dr. Peter Centre
The Dr. Peter Centre is an HIV/AIDS day health program and 24-hour residence in Vancouver, British Columbia. In addition to being HIV-positive, most Dr. Peter Centre clients struggle with additional health issues, including mental illness and addictions.

About the School of Nursing, University of Victoria

The University of Victoria School of Nursing is committed to providing leadership in nursing education throughout British Columbia and Canada. Our approach to teaching and learning is based on our respect for learners, and we see teaching and learning as based on partnerships where learners' experiences are valued. Throughout our programs we focus on the experiences of clients as central to nursing practice.

www.marketwire.com

Blood Agencies' Ban on Gay Donors is Outdated and Unjustified

April 24, 2008

Giving blood is not a right.

The overriding responsibility of blood collection and distribution agencies is not to ensure all Canadians are allowed to join in this altruistic act, but to ensure the safety of blood and blood products for recipients.

To do so, agencies such as Canadian Blood Services and Héma-Québec must not focus on concerns about rights. Instead they must discriminate - in the true sense of the word.

Héma-Québec and CBS can and must exclude individuals (and sometimes entire groups) from donating to protect the integrity of the blood supply.

At the same time, these agencies must strive to ensure there is an adequate supply of blood, which saves the lives of thousands upon thousands of people each year.

This is not an easy balancing act, particularly in a country such as Canada, where the tainted blood tragedy has left us acutely sensitive to safety concerns.

There are, and always will be, restrictions on blood donors. Currently in Canada, you can't donate blood if you are under the age of 17 or over the age of 71, if you weigh less than 110 pounds (50 kilograms), if you have a cold or the flu, or if you've had a tattoo or piercing in the past six months.

There are also "indefinite deferrals" - or lifetime bans, if you prefer - on members of certain groups. These include diabetics who use insulin and people who have lived in African countries such as Cameroon, Congo and Nigeria, where rates of HIV-AIDS are exceedingly high.

Because of fears of variant Creutzfeldt-Jakob disease (the human version of mad cow), CBS excludes from blood donation anyone who has spent three months or more in Britain or France between 1980 and 1996. (Héma-Québec puts the British time limit at one month.)

Anyone who has used intravenous drugs or who has taken money for sex cannot give blood. Also facing a lifetime ban from blood donation is any man who has had sex with another man, even once, since 1977.

Some donor exclusions are justifiable and necessary. Some are perhaps justifiable but are neither necessary nor useful. Regardless of what exclusions are in place, there is the additional safeguard of testing. Blood is tested for HIV-AIDS, hepatitis C, hepatitis B and syphilis, and these tests are quite sensitive. Is there still, then, a sound basis of scientific evidence for some of these deferrals?

When there is sufficient evidence, it's not enough to simply state the rules; you need to explain them to the public.

And rules should be continually updated.

We owe it to ourselves to question these policies. For example, the ban on donations by visitors to Britain and France seems arbitrary and unjustified. It gives the illusion of doing something but, in effect, all it does is remove a huge pool of donors without any appreciable safety benefit.

The same appears true of the lifetime ban on men who have had sex with men.

That approach was entirely appropriate when it was introduced in 1983. At the time, the vast majority of those infected with HIV-AIDS were gay men with multiple partners and tests were quite crude.

Today, the policy seems horribly outdated, based on current science. (Again, rights are not the issue. The sole criterion is the balancing of risk and benefits.)

It makes little sense to defer a heterosexual man who has had unprotected sex with a female prostitute from blood donation for a single year, but to impose a lifetime ban on a homosexual man who has been celibate for many years.

Mark Wainberg and Norbert Gilmore of the McGill University AIDS Centre in Montreal (and two of the world's leading researchers in the field) have been lobbying to have the policy changed, and their arguments are convincing.

They note that the "prohibition against all gay men from being blood donors forever fulfills no useful scientific purpose" and results in a tremendous loss of potential donors.

A recent study estimated that lifting the lifetime ban would result in 136,000 more donations annually without compromising safety. The same study calculated that there was a theoretical risk of one more contaminated unit of blood every 18 years, a risk that was classified as "infinitesimally low."

To its credit, the CBS is not standing pat. It has commissioned a risk assessment, a survey of donors and at least three academic studies of donations.

Most research looking at the risk of blood donations by gay men have focused on the high-risk population, those with multiple partners. But few studies have been done on those - the majority - in long-term, stable relationships. There is no reason to believe their risk profile differs from most heterosexuals.

Continuing study cannot be an excuse for inaction in the face of overwhelming evidence, as it was during the tainted blood scandal.

Australia has recently changed its rules. It now refuses blood donations from gay men who have had "man-to-man sex" in the past 12 months. Italy, for its part, asks donors if they have had a new sexual partner or unprotected sex during the past year.

In our blood system, safety must be paramount. But as the science evolves, so too must the rules.

Giving blood is the gift of life. It is a gift by civic-minded people who operate largely on an honour system. We must discriminate for the purposes of safety, but we must not thwart these heartfelt, life-saving donations for no good reason.

By Andre Picard, www.globeandmail.com

AccolAIDS Winners

April 23, 2008

 Several gay activists were honoured this month for their dedication to BC's HIV/AIDS movement at the seventh annual AccolAIDS gala hosted by the BC Persons with AIDS Society (BCPWA).

Ken Coolen was among the nine award recipients. Honored with the philanthropy award, Coolen says providing community support is an intrinsic part of his nature.

"People often say we should make a change, but I dive headfirst into projects. I say, 'If it's not me, then who? If it's not now, when?'"

Coolen, who is also treasurer of the Vancouver Pride Society, says extensive support from his family, community and colleagues has helped him reach his goals.

The Community Based Research Centre (CBRC) was also acknowledged for its innovative approach to research and gathering sexual health information in the gay community.

The CBRC has been conducting the annual Sex Now Survey to gauge sexual health and trends among gay and bisexual men since 2002. This year's findings indicate a sharp increase in risky sexual behaviour in gay men 30 years and younger.

"We recognized in the late '90s that nobody was doing this type of research and checking in with gay people to find out how they were doing," says CBRC director Rick Marchand.

"There is a perception in the bureaucracy that we [gay men] have all the support we need. [Heterosexuals] often don't think about the kind of supports needed."

"Virtually all our friends are dead," adds CBRC research director Terry Trussler. "We're [doing research] to prevent another crisis from happening."

By Shauna Lewis, Xtra West

Grandmothers Helping Grandmothers

April 27, 2008

An estimated 13 million children have been orphaned by AIDS in sub-Saharan Africa, and it’s the grandmothers of the country who have stepped up to care for them.

After burying their own children, these women take in their grandchildren and attempt to feed and clothe them while continuing to work.

In their 50s, 60s and even 70s, they become parents again. And not only to their own family, but to their neighbour’s orphaned kids as well. Some grandmothers take care of up to 20 children. One in particular has been known to care for 28.

This is the information provided by the Stephen Lewis Foundation that South Surrey resident Mary Harris heard at a workshop in Vancouver last fall. She had been aware of Lewis’ humanitarian efforts towards people with HIV/AIDS in Africa, after hearing him speak at a dinner a few years ago.

"I’ve always admired Stephen Lewis from the point of view that I trust him and I trust his work," she said.

But it was the Vancouver workshop that had the biggest impact on Harris. Two grandmothers from Africa had travelled to B.C. to speak at the workshop about their plight.

Harris, a grandmother of three, was touched by the women’s spirit.

"I saw these very vibrant, energetic women," she said.

And she also saw a bit of herself. It was then and there that she decided to do something to help.

The Stephen Lewis Foundation’s Grandmothers to Grandmothers campaign aims to support grandmothers in Africa by fundraising and spreading awareness.

Since the launch in 2006, nearly 200 groups of Canadian grandmothers have assembled, raising more than $2 million for the cause.

With no such group in the White Rock/South Surrey area, Harris brought her attention back home. She contacted the foundation and received the materials to start her own chapter of grandmothers.

And she named the group The Oneness Gogos – the word gogo meaning ‘grandmother’ in the Zulu language, and ‘oneness’ reflecting how everyone is equal.

The Oneness Gogos, like many other grandmother groups, will have three main focuses – fundraising, advocacy and education. Three committees will be formed to head up each task, and the group will work together to meet the goals.

"Anyone can be a part of the group," Harris said.

Money raised will go to the Stephen Lewis Foundation, which directs the funds to community-level organizations in 15 sub-Saharan African countries that provide grandmothers with food, housing grants, school fees for their grandchildren and grief counselling. It’s a cause Harris feels strongly about. Even after travelling to Africa about two years ago, she can’t fathom the challenges some African grandmothers are faced with every day.

"(I) just can’t imagine anything like that," she said.

Harris said it’s important to support the campaign, because without the grandmothers looking after orphans, there wouldn’t be anybody.

"There would be no food for the children – they wouldn’t be looked after."

For more information about The Oneness Gogos, call Lucinda Lyall at 604-541-2206.

http://www.bclocalnews.com

PAWS Protects Pets of Those Who Need Them Most

April 19, 2008

San Francisco - Imagine you are diagnosed with a disabling illness such as HIV/AIDS or cancer.

You live alone in San Francisco on a fixed income of $900 a month, and struggle each day to pay for food, housing and medicine. Imagine you have no companionship, save your beloved dog or cat. And imagine, on some days, you face a grueling decision: Who will get to eat, you or your pet?

In 1986, that was the heartrending discovery San Francisco AIDS Foundation volunteers made while providing food to AIDS patients. They learned that their clients, for whom nutrition plays an especially vital role in their well-being, were giving their rations to their pets instead of using it for themselves. As a remedy, volunteers began stocking pet food, but demand was so great that in 1987, a new nonprofit organization was created.

Today, PAWS (Pets Are Wonderful Support) is a well-known and valued service that permits lower-income San Francisco residents to keep their pets by providing emotional and physical support through a number of services. These include a pet food bank, subsidized veterinary care, in-home animal care and counseling/advocacy services for animal and housing issues.

"In the late 1980s there was a lot of misinformation about HIV/AIDS, and many patients lost the support of their family and friends," said John Lipp, president of PAWS.

"All they had left was the unconditional love of their pets. PAWS began as a grassroots movement to help HIV/AIDS patients keep their animal companions. The community rolled up their sleeves and said, 'We'll take care of our own.' "

However, the importance of animal companionship is not limited to the HIV/AIDS community. And recognizing that, five years ago PAWS expanded its scope of services to include people living with mental health problems or life-threatening illnesses. In 2007, they added low-income seniors.

"Too often, seniors live isolated lives and don't have a lot of support," Lipp said. "Pets are a lifeline for them."

Indeed, he has seen the PAWS client base increase 35 percent over the past two years. "We currently have about 650 active clients, and over half of those receive monthly pet food and supplies," he said. "About 25 percent of our clients are homebound, and in those cases, we deliver to them."

Lipp is referring to the 360 volunteers who are assigned to help clients walk their dogs, provide foster care for pets when there is an emergency, and offer rides to veterinarian and grooming appointments. Volunteers also perform in-home animal care such as changing cat boxes, since bacteria-laden feces can be hazardous to someone with a compromised immune system.

These deceptively simple services are a godsend to people who might have otherwise faced relinquishing their pets because of health or finances. One such grateful recipient is a minister who goes by the name Phoenix. When the 48-year-old Philadelphia transplant suffered a heart attack, his doctor recommended that he get a dog to encourage exercise.

Phoenix, who is also HIV-positive, worried about paying veterinarian bills on his fixed income. But two years ago, those concerns vanished when he was strolling through San Francisco's Animal Care and Control kennel and fell in love with Dusty, a spunky 1-year-old terrier mix.

"I took him home, and that was one of the best things I've ever done," said Phoenix, who has since appeared on the Travel Channel as a San Francisco tour guide, with Dusty hamming it up by his side. "When I think of what this dog means to me, I get teary-eyed."

He recalls that when Dusty was diagnosed with kennel cough and later ate something that made him ill, both times he was nursed back to health thanks to the veterinary support offered by PAWS. "If it weren't for them, I wouldn't have been able to get a dog."

As any pet owner knows, a trip to the veterinarian's office can often result in an emptied wallet. "That's why every client is given up to $200 annually for vet care," Lipp said. "We also offer free annual wellness exams in partnership with Pets Unlimited, in addition to a critical-care fund for emergencies."

PAWS serves eligible San Francisco residents only. However, as the first of its kind, it has mentored similar organizations nationwide. Lipp said PAWS hopes one day to have a permanent facility with on-site grooming, kennel space for animals whose guardians need emergency hospitalization or treatment, and increased space for the food bank because "the more we can take in, the more we can give out."

Phoenix said that after his heart attack, he was fearful of doing too much, a common concern. This fear led to him staying home and becoming a TV-watching recluse.

"Besides losing several friends to HIV, the realization of having to retire because of my heart attack knocked the wind out of my sails," he said. "Until I got Dusty and rejoined the human race, I didn't realize the toll my illnesses had taken on me. Dusty ensures that I have to be responsible because how can I take good care of him if I don't take good care of me?"

And that's what PAWS is all about.

To learn more about PAWS go to www.pawssf.org

By Eileen Mitchell, San Francisco Chronicle

HIV-Positive Men Find a True Home and Friends At Jo-Ray House
One of the disease's most crippling effects is social isolation, says a resident aided by the home's founder, Ida Byther-Smith

April 20, 2008

Chicago - After years of living a street life, Woody Easley has finally found a home, and a new life, at a residential facility in Chicago's Roseland neighborhood.

Easley, 60, was asked to leave another residential house in Chicago when he disclosed he was HIV positive. Now, he is one of six residents of Jo-Ray House, a home for HIV-positive men on the South Side.

The men come from different backgrounds and have varied pasts. Some have held promising careers, some have struggled with addiction, others have had run-ins with the law.

But they all have one thing in common: They found Ida Byther-Smith, the founder of Jo-Ray House, or she found them.

Byther-Smith cashed in her life savings and started Jo-Ray House in 2003 after meeting a man who contracted HIV through prison rape. His family threw him and everything he touched out when he told them he was HIV positive.

But it is her own experience that allows Byther-Smith to identify with the men on a personal level.

"[HIV] is a pot. It doesn't matter how you got in, whether you jumped in or got pushed," she said. "All that matters is we are all in the same pot."

Byther-Smith, 58, was diagnosed with HIV in 1991 and learned soon after that her husband had had affairs with men and women.

Instead of focusing on anger and turning her back on her husband, Byther-Smith took care of him until he died eight years later. People who know her story are sometimes surprised that she decided to take in men with HIV, she said.

But she believes in the end that she also is helping women.

"If I can reach one man with HIV and help him get past his anger, maybe I can save one woman from being infected like me," Byther-Smith said.

And as long as she has space, the men are welcome at Jo-Ray House, which is named after relatives, she said.

"Ida's door is always open," said John Brady, 42, one of Jo-Ray's original boarders, who is in his fourth residency at the house.

"She loved me until I learned how to love myself," said Brady, now a volunteer group leader for Haymarket Center, an alcohol and drug treatment program on the West Side.

There are house rules, but the men are free to come and go as they please. They each pay $360 a month for rent, though it's not a requirement. Byther-Smith doesn't turn anyone away because of income, she said.

She also has qualified for grants from the AIDS Foundation of Chicago, which reports that one of the biggest obstacles for people with HIV/AIDS is finding adequate housing.

"The housing issue is becoming a public health issue," said Arturo Bendixen, housing director for the AIDS Foundation of Chicago. Bendixen said 50 percent to 60 percent of people living with HIV/AIDS reported being homeless or experiencing housing instability.

"It is very difficult to find a place to store your medicine and to refrigerate it when you're homeless," said Bendixen, who added that the homeless with HIV/AIDS are five times more likely to die. "Some HIV/AIDS regimens require taking [medication] different times of the day. People on the streets or in a shelter don't have a lot of control over their regimens."

The men at Jo-Ray House speak openly about being HIV positive.

In an upstairs bedroom, Shelly Crum, 37, and Ed Phelps, 52, watch TV as they recount being diagnosed with HIV.

"I was just 24 years old," said Crum, a former postal worker. "I was trying to purchase life insurance and got a call that I needed to see my doctor."

Crum said he contracted the virus from a girlfriend who has since died.

Phelps, a native New Yorker, said he tested HIV positive three years ago on Valentine's Day.

As he sat on a twin-size bed with his legs crossed, he talked about survivor's guilt and his 14-year battle with addiction. His partner died of AIDS soon after finding out he was infected, Phelps said.

The hardest obstacle he had to overcome was social isolation, said Phelps, who was once married.

"I was angry with the universe," he said. "The real killer is not the possibility of a physical death, it's the social death."

Byther-Smith hopes the stigma of HIV vanishes when you walk through the doors of Jo-Ray House. But keeping the doors open has been a struggle.

Byther-Smith said her faith has kept her going. "God knew that there was going to be a little black lady in Chicago that would contract HIV from her husband. That was my destiny," Byther-Smith said.

"But my choice was what I was going to do with [HIV]."

By Deanese Williams-Harris, www.tribune.com

Tainted Blood Inquiry Announced

April 23, 2008

Details of a Scottish public inquiry into the infection of NHS patients with hepatitis C and HIV through blood products have been announced.

Health Secretary Nicola Sturgeon said previous government-led inquires into the issue lacked independence.

Hundreds of people in Scotland, including haemophiliacs, were given the tainted blood in the 70s and 80s.

The previous Holyrood government resisted calls from campaigners for a public inquiry into the issue.

A total of £3m has been earmarked for the independent inquiry, which will be chaired by the former judge and sheriff, Lady Cosgrove and is expected to start hearing evidence towards the end of the year.

It will also specifically look into the deaths of two infected patients, 72-year-old Eileen O'Hara and Rev David Black, 66, in 2003.

In a separate case, judge Lord Mackay quashed a previous decision not to hold fatal accident inquiries into the cases, and ruled their human rights were breached.

Ms Sturgeon told the Scottish Parliament: "The transmission of hepatitis C and HIV through blood and blood products is a tragedy that has blighted the lives of many people in Scotland.

"That is why we are committed to a thorough inquiry to get to the bottom of this.

"We owe an explanation to patients and the public of what took place. We are determined to provide that."

The Scots investigation is expected to look into where NHS blood and blood products previously came from, whether they were effectively screened and whether heat treatment could have been introduced earlier.

It will also probe the practices of the blood transfusion service at the time.

Ms Sturgeon said the events took place at a time when evidence about blood-borne viral infections was more limited - but said, even then, there were indications that tainted blood supplies existed.

"There is no doubt that the people affected and their families deserve nothing less than answers to these questions," she told MSPs

"If they are to achieve any sort of closure, we need to get to the bottom of what has been one of the most tragic episodes in NHS Scotland in the provision of treatment with blood and blood products."

One patient, haemophiliac Robert Mackie, who was diagnosed with hepatitis C and HIV in the early 80s, said an inquiry would provide some answers but would never give him back the life which he said was stolen from him.

He told BBC Scotland: "The day I was told I was infected, my life ended as far as I was concerned. Life as I knew it was over.

"None of us knew of these risks or were even told of these risks."

The Conservatives and Liberal Democrats welcomed the inquiry, as did Labour - although the party questioned what extra benefit it could bring, given a similar investigation was currently under way in England.

http://news.bbc.co.uk

Iran Offers Addicts Condoms, Syringes from Vending Machines

April 16, 2008

Tehran - Iran is installing vending machines in Tehran to sell cheap condoms and syringes to drug addicts to prevent the spread of AIDS and hepatitis, an official said on Wednesday.

"Five of these machines which have been made will be installed in five of Tehran city's welfare shelters for addicts," the deputy head of Iran's anti-narcotics organization, Mohammad Reza Jahani, said.

"Condoms, syringes, bandages and plasters will be easily accessible just by inserting a coin. This protects addicts from acquiring AIDS and hepatitis," he added, according to the semi-official Fars news agency.

He said that a single 500 rial (five cents) coin is required to purchase the items.

"The machines will be used for a three month trial period and if the scheme is successful then we will upgrade them and increase their distribution to other shelters," he added.

Iranian officials admit the country has a serious drug abuse problem. They normally estimate the number of regular drug users at two million in a country with a population of more than 71 million
Iran is situated along one of the main trafficking routes for cannabis, heroin, opium and morphine produced in Afghanistan, and designer drugs have also found their way into the Iranian market in recent years.

Out of 2,500 tonnes of narcotics that enter Iran from neighbouring Afghanistan annually, some 700 tonnes are consumed in the country, officials say.

Condoms are freely available in Iranian pharmacies.

The Islamic republic in the 1990s started actively promoting contraception as it encouraged families to have just two children to prevent the country's population growth increasing further.

Iran has tried to change its approach to drug addicts by treating users as "people who need help" rather than throwing them into already overcrowded jails.

AFP

Peace Corps Fires Man with HIV

April 22, 2008

New York City - The American Civil Liberties Union has sent a letter to the Peace Corps demanding that it change its policy of barring people with HIV from serving as volunteers.

The letter was sent on behalf of a Denver, Colorado volunteer who was sent home from his post in the Ukraine and terminated after he tested positive.

"I joined the Peace Corps because I wanted to learn more about the world and help people," said Jeremiah Johnson.

"It was hard enough to learn that I had contracted HIV, but to then be shipped home and told I was unworthy of finishing my service was incredibly humiliating."

Johnson, now 25, began his tour as a Peace Corps volunteer in December 2006.  He tested negative for HIV prior to beginning his service.  

For nearly thirteen months, he was the sole volunteer in Rozdilna, Ukraine, where he taught English to middle and high school students.

In January 2008, Johnson, who was in Kiev to attend a Russian language program with other volunteers, received a midservice medical examination and opted to take an HIV test.  

After the results confirmed that he was positive for the disease, he was immediately told that he could no longer work in the country because of a Ukrainian law barring people with HIV from working in the country.  He was also told he would not be able to finish his service elsewhere.  

Although he had no health problems, he was only allowed to return to Rozdilna for two days to pack his bags and say goodbye to the people he had met during his tour, the ACLU said in a statement.

He was forced to abandon projects that he had been developing to help the community.  Johnson was then sent to Washington, D.C., for an end-of-service medical exam.  

The ACLU said that while in DC, he again asked Peace Corps officials to explain why he was being terminated and asked if he could continue his service elsewhere, but these requests were denied.  Instead, he was given an automatic medical termination, stating HIV as the reason for his termination.

The ACLU’s demand letter charges that it is illegal under the Rehabilitation Act for the Peace Corps to discriminate against Johnson because he has HIV.  

The letter cites a recent federal appeals court decision finding that it is illegal for the Foreign Service to bar people with HIV from serving.  In that case, the Foreign Service, which also sends workers around the globe, had argued that it was justified in barring people with HIV from service in order to protect the health of people with HIV who would be stationed in areas with limited access to medical treatment.  The court rejected that rationale.

"There is not a single justifiable reason for the Peace Corp to bar people with HIV from serving as volunteers," said Rebecca Shore, an attorney with the ACLU’s AIDS Project.

"Jeremiah was, and continues to be, in good health, fully capable of performing his responsibilities.  It is especially disappointing that an agent of our government would have an illegal and discriminatory policy barring people with HIV from trying to make the world better."

The ACLU’s letter demands that the Peace Corps change its policy or confirm that it does not have a policy of automatically excluding all people with HIV. According to the ACLU, the Peace Corps must consider on an individualized basis whether an applicant with HIV can volunteer, including making every effort to place those who are able to serve in a country that doesn’t bar people with HIV from working in the country.  

"It was hard being sent home the way I was." Johnson said.  "I had no time to plan for my return."

"I was forced to have a lot of conversations I wasn’t really ready to have.  I had no money, no job and no place to live.  Fortunately, my family welcomed me back with open arms and helped me get back on my feet," said Johnson.  "But one thing I’ve come to realize is that having HIV won’t stop me from realizing my dreams of helping others.  I hope by bringing attention to what happened to me, the Peace Corp will realize that too."

http://www.365gay.com

Genetic Immunity Announces Data Related to the DermaVir Nanomedicine Patch in the Journal of Immunology

April 21, 2008

Data Supports Use of HIV-specific T cell Precursors with High Proliferative Capacity (PHPC) Marker to Predict Reduction of Viral Load

Mclean, Va., And Budapest, Hungary - Genetic Immunity(R), a US/Hungarian clinical-stage company focused on patented nanomedicines for immune amplification, announced today that the Journal of Immunology published findings on a key biomarker currently being used in clinical studies of its lead HIV/AIDS nanomedicine candidate, the DermaVir Patch. The paper, entitled "HIV-1-Specific T-Cell Correlate with Low Viremia and High CD4 Counts in Untreated Individuals," highlights data from a study conducted by Sandra Calarota, Ph.D., of the Research Institute for Genetic and Human Therapy (RIGHT).

In Dr. Calarota's study of 32 HIV-1 infected individuals, high immunological responses measured by a novel assay of T cell Precursors with High Proliferative Capacity (PHPC assay) better correlated with viral suppression and positive immunologic outcomes, than did the traditional ELISPOT assay.

These data further validate and support results from a clinical study of Genetic Immunity's DermaVir Patch presented in February 2008 at the 15th Annual Conference on Retroviruses and Opportunistic Infections (CROI). The study demonstrated that the DermaVir Patch induced a significant increase of PHPC counts in all 9 HIV-1-infected participants, suggesting that the DermaVir Patch may promote a targeted amplification of the immune system capable of reducing the amount of circulating HIV virus.

Dr. Franco Lori, the lead author of the study said, "The correlation between high PHPC counts and low viral load in HIV-infected subjects suggests that the presence of a greater number of T-cells that have retained their ability to expand and function normally may be a better predictor of patient outcomes. This new PHPC assay may also be a valuable tool in the development and testing of urgently needed nanomedicines, immune therapies and prophylactic vaccines for a number of diseases in addition to HIV/AIDS."

Julianna Lisziewicz, Ph.D., Co-Founder and CEO of Genetic Immunity, said, "The design and testing of the DermaVir Patch has long focused on PHPCs as a marker. We see these results as validation that our approach has been scientifically sound.

About Genetic Immunity(R)

Genetic Immunity is a US/Hungarian development stage biopharmaceutical company establishing leadership in Nanomedicines for immunity amplification. next-generation biopharmaceuticals. Nanomedicine, an offshoot of nanotechnology, refers to highly specific medical intervention at the molecular scale for curing disease or repairing damaged tissues, such as bone, muscle, or nerve. The Company is leveraging its proprietary immune amplification platform technology, Genetic Immunity aims to create new markets for infectious diseases, cancer and allergies through the discovery, development and commercialization of topically administered nanomedicines. These indications represent a significant unmet medical need and the potential for alternative treatment approaches. Genetic Immunity's founders discovered the lead product nanomedicine candidate, the DermaVir Patch for the treatment of HIV/AIDS. The DermaVir Patch is in Phase II clinical development and could be the first nanomedicine immune therapy approved for HIV-infected individuals. DermaVir Patch has demonstrated excellent safety, immunogenicity and antiviral efficacy in preclinical studies. Phase I/II trials to date have confirmed safety and tolerability and indicate the induction of long-lasting HIV-specific T cells.

About the Nanomedicine Technology Platform

Genetic Immunity's immune amplification platform technology is used to develop nanomedicines comprised of two principal components: NanoComp and DermaPrep. NanoComp is a patented nanoformulation technology that includes disease-specific plasmid DNA encoded antigens. DermaPrep is the topical administration device that delivers NanoComp into a patient's lymph node dendritic cells to induce T cell mediated immune responses that can alleviate a broad spectrum of diseases. These two components together make up the DermaVir Patch. The plasmid DNA within DermaVir Patch's NanoComp nanoparticles is specific to HIV and topically delivered via DermaPrep to amplify the immune system to kill only HIV-infected cells.

Contacts: The Ruth Group Investors Media Sara Ephraim Janine McCargo +1-646-536-7002 +1-646-536-7033 sephraim@theruthgroup.com jmccargo@theruthgroup.com
Genetic Immunity

PR Newswire

Scientists Test Device to Track Medication Adherence in Patients with HIV/AIDS

April 21, 2008

Gainesville, Florida - Most of us have missed a dose of antibiotic or forgotten to take a daily vitamin. But when the stakes are higher — as they are for people with HIV/AIDS — a skipped pill could mean the difference between health and hazard for the entire population.

Now, a breath monitoring device developed by scientists at the University of Florida and Xhale Inc. could help prevent the emergence of drug-resistant strains of HIV by monitoring medication adherence in high-risk individuals.

"For HIV, it’s been shown that if you don’t take a very high percentage of your medication, you may as well not take medication at all," said Richard Melker, M.D., a professor of anesthesiology at the UF College of Medicine and chief technology officer for Xhale.

Patients who take some but not all of their medication increase the likelihood the virus will mutate into a deadlier, drug-resistant form. Experts have tried literally hundreds, if not thousands, of ways to monitor drug adherence, ranging from daily log books to blister packs that record the time each pill is dispensed. Despite the money, time and effort devoted to these methods, Melker said only one works well: directly observed therapy, or DOT.

"If you have a disease that is deemed to be a public health risk, authorities can put you into a program where you have to come to the clinic every day and be observed putting the pill into your mouth and swallowing it," Melker said.

But that process is inconvenient for patients, as well as for clinic personnel who have to track them down when they fail to show up. A breath-monitoring device developed by UF scientists and Xhale could change that, allowing patients to participate in a type of virtual DOT from home.

"The machine sits in your home and when it’s time for you to take your medication, it makes a beeping noise. If you don’t hit a button after about five minutes, it’s going to beep louder and louder until you come," Melker said. "If you don’t come after a certain amount of time, the machine can call the clinical trial coordinator and indicate that subject or patient didn’t take the medication as prescribed."

The device, which is slightly smaller than a shoebox, records the results of each breath test, allowing patients to bring a memory card or USB key to the clinic once a month and receive a printout of their results. Eventually, the researchers hope to reduce the size of their detection device to fit inside a cell phone. But for now, they’re satisfied that the technology works.

"The doctor can see how often you took it and exactly what time. If it made the patient really sick or dizzy and they didn’t take it, they can find out why," Melker said. "It’s not just a question of did I or didn’t I take it, but when you took it or why you didn’t take it."

The researchers developed the adherence monitor by incorporating minute amounts of an alcohol into a gel capsule. The additive, called 2-butanol, is one of many GRAS — Generally Recognized as Safe — compounds approved by the Food and Drug Administration for use in foods.

"We wanted (patients) to swallow a chemical and have it transform into something else that’s easy to monitor," said Matthew Booth, Ph.D., an assistant professor of anesthesiology at the UF College of Medicine and an investigator in the study. "When it hits the stomach lining and liver, an enzyme converts the alcohol to a gas that can be measured in the breath."

To determine how well the byproduct could be detected, six healthy volunteers swallowed empty pills in which the capsules contained trace amounts of 2-butanol. After five to 10 minutes, the scientists could measure the volatile byproduct in the volunteers’ breath using a small detector. The scientists say their device could also be used to monitor medication adherence in patients with other communicable diseases, such as tuberculosis.

"It is encouraging that the biological and chemical elements of the adherence system work as predicted. We were able to conclusively show who swallowed the capsules containing the 2-butanol. With further optimization, we are optimistic the device will perform very well," said Donn Dennis, M.D., the Joachim S. Gravenstein professor of anesthesiology at the UF College of Medicine and an investigator in the study.

The researchers say the device may prove equally helpful for monitoring adherence in clinical trials.

"If you enroll HIV/AIDS patients in a clinical trial and they don’t take the medication, then you may not get adequate proof that the drug is effective," Melker said. "It might be effective, but some of the patients aren’t taking it."

Phase 2 trials are often conducted in the community, rather than at research institutions, making it difficult for researchers to monitor adherence. As a result, many trials enroll a larger group of subjects than needed, in hopes they’ll obtain enough data to determine the safety and efficacy of the medication.

"If we had a good way of doing DOT that’s realistic, instead of having someone come to your house or you going to clinic every day of your life, then we would know whether these people stopped taking their medication and why. Right now, nobody knows any of that." Melker said. "The implications of being able to understand what normal human behavior is in a clinical trial and, of course, in the real world, are huge."

By Ann Griswold, http://www.eurekalert.org

‘No Benefit' From Diabetes Self-Tests

April 23, 2008

Two studies have cast doubt on the impact of encouraging people with type 2 diabetes to monitor their own blood sugar levels.

The findings suggest the move may have little effect on improving care and also be a waste of NHS resources.

Published in the British Medical Journal, one study indicated that patients who self-test are more likely to end up depressed than in better health while another claimed that self-testing costs £90 extra per patient per year and may lead to a worse quality of life.

While monitoring blood sugar levels means patients, such as those with type 1 diabetes who need to take insulin, can control their disease, there has been a move in recent years to encourage self-testing for those patients who have type 2 diabetes.

A trial of 180 people who had been newly referred to a hospital diabetes clinic in Northern Ireland found self-monitoring did not improve blood glucose control compared with normal care.

Study leader Dr Maurice O’Kane said: "What we can say is if people do not want to monitor there’s no evidence their care will be inferior."

University of Oxford researchers looked at the cost-effectiveness of self-monitoring in type 2 diabetes.

Study leader Dr Judit Simon said routine self-monitoring did not prove to be cost-effective and there was a negative effect on the quality of life for some people.

Diabetes UK said decisions on self-monitoring had to be made on an individual basis with patients being educated on what to do with the results.

http://www.hc2d.co.uk

Patients May Not Need Tests While On AIDS Drugs

April 25 2008

London - Patients with HIV who are not monitored with the expensive laboratory tests commonly used in rich countries may survive just as long as those who do get the tests, a new study says.

In a paper published in The Lancet medical journal Friday, experts found only a slight difference between the survival rates of HIV patients on AIDS drugs who were monitored with laboratory tests and those who were not. Lab tests can be an early indication of problems in HIV patients that are not yet obvious.

The research was based on computer modelling, and while the results must be verified, they could influence how HIV patients across Africa and Asia are treated.

As drugs to combat AIDS have been distributed in developing countries, some doctors worry that without lab monitoring, patients will either die earlier or develop drug resistance faster. But based on the evidence to date, that has not happened.

"We often get stuck in letting the perfect be the enemy of the good," said Jennifer Kates, an HIV expert at the Kaiser Family Foundation in Washington. She was not connected to the study.

"Waiting for the perfect lab infrastructure to be ready before rolling out antiretroviral therapy (AIDS drugs) means that millions of people will die," Kates said. "This study says we shouldn't wait."

Andrew Phillips and colleagues from the Royal Free and University College Medical School in London used a computer model that simulated patient details based on HIV progression in real patients. They then projected the patients' survival for up to 20 years. Data from real patients are not yet available.

Phillips and his colleagues essentially found that 83 per cent of patients who were monitored with lab tests survived five years, compared with 82 per cent for those who went without the tests. Over two decades, 67 per cent of those who got lab tests survived versus 64 per cent for those who did not.

The difference is negligible - and contradicts long-held beliefs that AIDS drugs must be accompanied by regular laboratory monitoring to benefit patients.

Phillips developed the original computer model with funding from Pfizer Inc., makers of many of the drugs used to fight HIV and AIDS.

Some experts worry that because people who are not monitored with lab tests stay longer on drugs that do not work, they could be spreading drug-resistant HIV.

Nathan Ford, head of Medecins Sans Frontieres' medical unit in South Africa, said there are no signs that drug resistance is developing more quickly in Africa than elsewhere. Ford was not involved in the study.

AP, www.ctv.ca

Elite HIV Patients Offer Vaccine Clue
Montreal scientists uncover how infected patients stay AIDS-free

April 25, 2008

A major chink in the armour of the HIV virus has been opened up by a largely Canadian team of researchers who appear to have discovered - and learned how to counter - the key chain of events that leads to immunodeficiency in most people infected with the disease.

The researchers, led by Dr Rafick-Pierre Sékaly of the University of Montreal and Dr Elias Haddad of McGill University, identified the vital transcription factor, named FOXO3a, by examining blood from "elite controllers." These are the small class of HIV-infected patients who remain AIDS-free even without antiretroviral treatment because their immune system never fails. Their results are published in the March issue of Nature Medicine.

Elitist Attitude

About one in 300 HIV-infected people is an elite controller, but most are never identified because they never develop any symptoms and never get an HIV test. They also don't pass the disease on to others, because their viral load is negligible.

"Given their perfect resistance to HIV infection, elite controllers represent the ideal study group to examine how proteins are responsible for the maintenance of an immune system with good anti-viral memory," Dr Haddad told the media. "This is the first study to examine, in people rather than animals, what shields the body's immune system from infection and to pinpoint the fundamental role of FOXO3a in defending the body."

A large part of the elite controllers' secret is now revealed. We already knew that their viral load remains low because their central memory CD4+ T cells don't die off as they do in the majority of infected people. In grossly simplified form, what the new research uncovers is that these cells die in most people because each time the immune cell's receptors are triggered, FOXO3a transcription factor is driven into the nucleus, where it triggers production of proteins associated with programmed cell death, or apoptosis.

Culture Club

When T cells from elite controllers and from aviremic HIV patients successfully treated with antiviral therapy were studied in culture with repeated receptor triggering, they proliferated equally, but those from the elite controllers survived far longer, with a half-life of 13.1 days compared to just 4.3 days for the successfully treated patients. By 12 days the elite controller cultures had 2.5 times as many central memory CD4+ T cells left as did cultures drawn from successfully treated patients. By day 19, almost all of the latter group's cells were dead, but the elite controllers' cells were still proliferating merrily.

In fact the elite controllers' central memory CD4+ T cells were considerably more robust than those of HIV-negative blood donors whose blood was also studied as a control. The researchers had only to add this piece of the puzzle to a vital finding they made last year - that FOXO3a is the key pathway in T cell apoptosis - to come up with a pretty good hypothesis on what is preventing T cells from disappearing in these rare elite controllers. Namely, that their FOXO3a pathway doesn't work as it does in most people.

Better yet, it gave them an idea what to do about it, and this is the part that really grabbed the world's attention and set this work apart. Taking the cells of their successfully treated HIV patients, they infected them with lentiviruses carrying a "dominant-negative" form of the transcription factor, FOXO3a Nt, which can travel to the nucleus and compete with the transcriptionally active FOXO3a for binding to DNA.

The cells from the successfully treated HIV+ subjects, when infected with this virus, showed far lower levels of the apoptotic factors that had previously been shutting them down. Sure enough, in vitro, their lifespan dramatically increased, so that these cultures, like the elite controllers' cultures, still had plenty of T cells left at 26 days, and almost all of those still alive were the ones that had been infected with the mutant-carrying lentivirus. In effect, this in-vitro culture had been vaccinated against AIDS.

Long and Winding Road

Of course it's a long way from this kind of study to a real human treatment. The lentivirus, by day 12, had only infected about a quarter of the T cells in each culture, and the others went on to die as usual. But neither is this anything like the typical cell biology study, which researchers claim "may lead" to future treatments. These researches have suggested and tested a specific approach that has huge clinical promise, both as a vaccine and as a treatment.

It would be unlikely to provide sterilizing immunity, since a vaccine based on this approach does no direct harm to HIV. But HIV vaccine research has shifted focus anyway in recent years from the fruitless search for sterilizing immunity to an approach that seeks to break secondary transmission after infection by keeping the viral count low.

The FOXO3a pathway is a completely new avenue of attack, and one that may have a role to play far beyond HIV/AIDS. "The discovery of FOXO3a will enable scientists to develop appropriate therapies for other viral diseases that weaken the immune system," said Dr Sékaly, adding that he foresaw potential uses in cancer, rheumatoid arthritis, hepatitis C, and transplant rejection.

By Owen Dyer, http://www.nationalreviewofmedicine.com

Interview: Stephen Lewis
Africa: Activist Praises Europe, Slams U.S. on AIDS

24 April 2008

Stephen Lewis is a renowned and vigorously outspoken Canadian diplomat who has worked extensively to reduce the impact of HIV/AIDS in Africa and to advocate for those living with the disease.

Formerly the special envoy for HIV/AIDS in Africa for United Nations Secretary-General Kofi Annan, he is now chairman of the board of the Canada-based Stephen Lewis Foundation, which endeavors to ease the pain of HIV/AIDS in Africa by funding grassroots projects. Lewis is also co-director of AIDS-Free World, a new international AIDS advocacy organization based in the United States.

In a wide-ranging interview with AllAfrica's Cindy Shiner, Lewis discussed current efforts to fight HIV/AIDS and how Africans are coping. This is the second of a three-part series.

Do you feel the international community is doing enough now to address HIV/AIDS in Africa?

No, they're not. It's much better than it was three to five years ago but the international community still is not galvanized enough in sufficient support of Africa to respond to the pandemic. If it were we would long ago have supplied much more help in the replenishment of the lost human resources… [and] in the repair of health infrastructures.

We would have years ago put in place the prevention of transmission from mother to child [of the virus] during the birthing process. We would have invested much more in the orphaned children. We still have millions of people in need of treatment. It's unlikely we will reach the goal of universal access to treatment by 2010.

What is your view of the President's Emergency Plan for AIDS Relief (Pepfar), the 50-billion-dollar initiative of the Bush administration in the United States?

Everybody is so shocked at getting a sizeable amount of money that they forget that there are tremendous flaws in Pepfar, most of which are destructive towards women. The amount of money is not sufficient and they should be clamoring for much more instead of this endless acting as a cheerleader for the administration.

Do you have some specific examples of ways in which you say it falls short?

Pepfar still insists that up to 50 percent of the preventative monies be spent on abstinence and fidelity when abstinence clearly isn't a choice for so many women, not only young women who are already sexually active, but women in marriage. Fidelity isn't the problem of the women in marriage; it's the problem of the men in the marriage … It's an outrageous continuation of an ideological weapon wielded by an administration which is reactionary and out of touch with the real world.

Then there is the prostitution gag rule, where you can't work with sex workers when in fact they are a high-risk group with whom organizations must work. That's another attack on women. And then there's the fact that you can't do reproductive and sexual health in conjunction with work on HIV/AIDS when obviously the two are inexorably linked. That's another attack on women.

Here you have a piece of legislation where the money is inadequate and the flaws are all rooted in misogyny… in attacks on women. People are applauding it as if it's some sort of contemporary Marshall Plan. That's crazy and it should be seen for what it is – both inadequate and irresponsible in many respects.

What do you think should be done?

People should demand more – much more. No one denies that when you pump several billion dollars into a response it will mean something. Of course it will; millions of people will be treated. That's terribly important.

But that's what we deserve to expect from the United States. You don't kneel down before a country because it's doing… something that the world has a right to receive. The American administration is so discredited, George Bush is such a lamentable president, that when anything of a positive kind happens people are prostrate at the unlikelihood of it and they shouldn't be.

The defining reality is that the United States is spending somewhere between 12.5 and 15 billion dollars a month on the war in Iraq and people are celebrating the fact that [it] will spend 10 billion dollars a year to fight the three worst communicable diseases in the world, which collectively have taken between 30 and 50 million lives. In the case of AIDS alone there are 33 million people living with the virus.

So the distortion of priorities for conflict rather than human need is grotesque. People should not be cheering the United States for giving a pittance for fighting disease but should rather be asking: how can you be giving so little to the human condition and so much to the perpetuation of war?

How about the response of the United Nations to HIV/AIDS in Africa?

There is just so much more to be done. Frankly, one of the things that is inadequate is the United Nations agencies. Some of it is bewildering. For example, you get the Minister of Health in South Africa (Dr. Manto Tshababala-Msimang) attacking and dismissing circumcision as a preventive technology. Here you have three determinative studies, definitive studies, we have UNAIDS and WHO encouraging male circumcision as a way of reducing transmission and you get an attack on it by the minister of health in South Africa. Where is the United Nations' voice? Why haven't they taken on the minister? Why haven't they said what should be said, which is that she's effectively dooming people to death and it need not be done? You have to have a much stronger voice of advocacy from the United Nations in dealing with disease and related matters.

What's going on in Congo, the terrible war on women, the terrible sexual violence and rape … you have more and more women turning up HIV positive. Where is the involvement of the United Nations? Where are they on the ground? Unicef is the only agency that appears to be doing anything of a serious kind to protect the women or to work with the women on the ground in Congo.

All of these agencies, these ten agencies that are involved in UNAIDS, why… isn't there an emergency plan being put in? It wasn't the United Nations that brought down the [antiretroviral] drug prices, it was the Bill Clinton Foundation… [which did it] by getting the generic drugs from India. Why should it have been a foundation rather than the world multilateral institution?

So when I say the international community [should do more], I mean above all the G-8, but I also mean the United Nations itself.

How would you gauge the response of the private sector to HIV/AIDS?

It is very uneven. There are some major multinational corporations that do good things for their workers. They provide testing, counseling and treatment and do some work in the community. I honor them for that, salute them for that. But there are many, many companies in the private sector that refuse to get involved and won't acknowledge the impact of the virus.

And the private companies have never given to the Global Fund to Fight AIDS, Tuberculosis and Malaria, what should have been given. I think this year signaled the first year that there was a significant financial contribution from a multinational company and that's from Chevron… which has given 30 million dollars over five years. Bono has raised more from the Red Campaign than has been given by the multinational corporations out of their own philanthropic envelopes and that's just ugly, frankly.

The multinationals should be much more conscious of their commitment. I've always believed that they should be giving 0.7 percent of after-tax income as part of a philanthropic contribution to mirror the target of the governments.

Will you be naming companies specifically as part of your advocacy work, pointing out which ones that you feel have not contributed sufficiently?

There is no question that we will be challenging the behavior of the private sector and multinationals. Everybody now uses the phrase "corporate social responsibility" and that seems regularly to apply to questions of climate change and global warming. It should equally apply to health and disease.

To what extent might addressing international trade practices have an impact?

If we got a fair international trading regimen, a fair set of property rights that wouldn't put the profits of pharmaceutical companies above respect for human life, if we really did forgive all of the debts that should be forgiven, then countries would have a much greater chance of reaching the Millennium Development Goals.

The crisis for Africa is compounded by the refusal of the G-8 to achieve the 0.7 percent of gross national product for foreign aid. As Jeffrey Sachs has pointed out, if we got to 0.7 percent we would generate a sufficient amount of foreign aid to be able to meet virtually all of the Millennium Development Goals… instead of falling so painfully short on everything from primary school education to maternal mortality and malaria and tuberculosis and HIV.

The basic problem is dealing with poverty, health and the consequences of conflict. All of those areas are sabotaged by the refusal to contribute the foreign aid which we committed ourselves to back in 1970 and have betrayed now for 30 years, always making promises, always betraying the promises.

I don't want to seem to be a curmudgeon. I don't want to be seen refusing to acknowledge what has been achieved. Obviously much more is going on than there was three or four years ago. But I cannot cleanse from my mind the fact that from 2000 and 2006, when death was so pervasive throughout Africa, when everything was spiraling out of control as a result of the infection, the international community responded so very slowly and so pathetically and inadequately to the carnage that should have triggered an emergency response and never did, for whatever reason. I don't understand. I'll never understand it.

Do any countries stand out as shining examples of what other nations should be doing in the battle against HIV/AIDS and achieving the Millennium Development Goals?

Norway and the United Kingdom, those two in particular, and France is beginning to move up the ladder. They really set the example. If the United States was doing anything comparable to the United Kingdom we'd already be routing the diseases and the poverty, we'd be reaching the Millennium Development Goals.

The United Kingdom is moving determinedly towards 0.7 percent by 2013. They've made that commitment and they're moving towards it. They've got a huge amount of money, which they're dispensing in every direction. All of it seems to me to be intelligent. They're funding critical areas and because they have been increasing the percentage of GDP every year in every budget it's made a very significant difference.

France is moving towards the 0.7 percent. They have more and more money, which they're pouring into Francophone Africa.

Norway has just announced this billion dollar program over 10 years for maternal and child health. Norway's official development assistance is greater than Canada's, and Canada has 35 million people and Norway has 4.5 million people.

By Cindy Shiner, www.allAfrica.com