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U.S. Works As Vietnam Ally in War on AIDS
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By TINI TRAN
.c The Associated Press
BA VI, Vietnam (AP) - Clad in red or blue uniforms, hundreds of young women stream to and fro through the iron gates, some heading to work as embroiderers, others coming back from farm fields. But this place is different. It's a rehabilitation camp for 560 drug addicts and prostitutes, a quarter of whom are infected with HIV.
They are living warnings of Vietnam's new war - against AIDS and the threat posed to its economic miracle by spiraling infection rates. But now the country has a fighting chance of stopping the epidemic.
Two weeks ago, President Bush added Vietnam to his $15 billion global AIDS initiative, the first and only Asian country on the list of 15. It was a surprising and controversial decision to those who had expected the choice to be India or China, with their much larger infected populations.
U.S. Global AIDS Coordinator Randall Tobias was in Hanoi Friday, seeking a clearer picture of the communist country's struggle to keep the disease contained.
International organizations, aid groups and U.S. officials in Hanoi say the country of 80 million presents the perfect test case for whether targeted funding can stem an AIDS crisis in the making.
They cite several factors: a disease that hasn't yet spread into the general population, effective local prevention programs, and a renewed commitment from the communist country's leadership.
``Vietnam is at a place where a combined effort could result in arresting a majould easily soar to 1 million people by 2010, a rate proportionally even higher than China's or India's.
``Injection drug use is the engine of the epidemic. But sexual transmission is where the real epidemic explodes. We potentially have a major epidemic on our hands,'' said Nancy Fee, country coordinator for UNAIDS.
What stung the government into action, say public health workers and international aid groups, was the threat to the young, strong, inexpensive labor force that has powered Vietnam's economicacle by spiraling infection rates. But now the country has a fighting chance of stopping the epidemic.
Two weeks ago, President Bush added Vietnam to his $15 billion global AIDS initiative, the first and only Asian country on the list of 15. It was a surprising and controversial decision to those who had expected the choice to be India or China, with their much larger infected populations.
U.S. Global AIDS Coordinator Randall Tobias was in Hanoi Friday, seeking a clearer picture of the communist country's struggle to keep the disease contained.
International organizations, aid groups and U.S. officials in Hanoi say the country of 80 million presents the perfect test case for whether targeted funding can stem an AIDS crisis in the making.
They cite several factors: a disease that hasn't yet spread into the general population, effective local prevention programs, and a renewed commitment from the communist country's leadership.
``Vietnam is at a place where a combined effort could result in arresting a major epidemic - so you could have a success story on AIDS instead of a tragedy,'' said Jordan Ryan, head of the UN Development Program.
Most of Vietnam's estimated 200,000 infected people are intravenous drug users and prostitutes. But recent figures suggest that the disease has begun making inroads into the greater public - through men infecting wives and mothers infecting newborns.
Experts worry that new HIV infections have increased tenfold in the last seven years - with most victims in their 20s - and could easily soar to 1 million people by 2010, a rate proportionally even higher than China's or India's.
``Injection drug use is the engine of the epidemic. But sexual transmission is where the real epidemic explodes. We potentially have a major epidemic on our hands,'' said Nancy Fee, country coordinator for UNAIDS.
What stung the government into action, say public health workers and international aid groups, was the threat to the young, strong, inexpensive labor force that has powered Vietnam's economic growth, second only to China's in the region.
One in 75 households has an HIV-positive family member, according to UNAIDS. ``Vietnam has done so much to try and build a future for itself after the war. ... Now the epidemic is moving to threaten that future and I think that began hitting home,'' Fee said.
The AIDS strategy announced this year has been praised for its comprehensive and progressive approach - which promote condom usage and needle exchanges.
In a country where billboards still condemn AIDS, along with drugs and prostitution, as a ``social evil,'' public attitudes are slowly changing. State television has aired interviews with AIDS sufferers, and campaigns against stigma and discrimination have featured popular entertainers. Even the highly secretive Vietnamese military has agreed to work with its U.S. counterpart on AIDS to train its new recruits in disease prevention.
Under the Bush program, Vietnam would be eligible for an extra $8-10 million a year. Vietnam currently spends about US$20 million annually on AIDS programs, 80 percent of that funding comes from international donors.
Though it hasn't been determined exactly how the money will be spent, U.S. officials say they expect it will focus on treatment and care of AIDS victims. Some 10,000 patients are at the stage of needing AIDS drugs, but Vietnam's budget only pays for about 100 patients, at an annual cost of $2,000 each.
Money could also go toward innovative programs like the one at the Ba Vi rehabilitation center, located 40 miles northwest of Hanoi, where women serve mandatory two-year programs aimed at detoxification, health education, and job training.
One of dozens of camps around the country where Vietnam quarantines addicts and prostitutes, the Ba Vi center has fostered its own homegrown initiative pairing AIDS orphans with HIV-positive inmates, many of whom stay on voluntarily to care for the children after their time is served.
In a brightly lit nursery littered with colorful toys and plush animals, Nguyen Thi Hoa, 28, has both arms full of squirming toddlers. Hoa, who became infected through heroin use, says she feels an obligation to care for the infected children as her own healthy 10-year-son is being raised by her mother.
Abandoned at local hospitals or orphaned by infected parents, 16 children ranging from five months to six years old are being raised here.
``There are no boundaries here,'' said Nguyen Thi Phuong, the center's director. ``They have come to love each other like mother and child.'' ) + 7 8 P Í Î ∞6 <=6 pL vL R RR úR ûR 0j p Bp Dp 4Å Ñ 4Ü à Là òà öà (• *® T® X® \® 4™ ÷™ ‹™ 2¨ US women with AIDS show sharp increase amid mixed messages over sex: UN
BANGKOK, July 9 (Agence France-Presse) - The burden of HIV is shifting to the female population in the United States at a faster rate than anywhere else in the world amid a bombardment of cultural messages that "sex is cool", the UN warned Friday.
Changing sexual behaviour and pressure on women to have sex without condoms has contributed to the proportion of women among Americans with HIV and AIDS rising from 20 to 25 percent, the United Nations Development Fund for Women said.
UNIFEM said the trend was a reflection of the "feminisation" of AIDS around the globe, with women comprising 48 percent of the estimated 35.7 million adults living with HIV and AIDS and the proportion is rising.
However, the greatest crisis remains in sub-Saharan Africa where nearly 60 percent of people living with the virus are women.
Stephanie Urdang, an adviser for UNIFEM, said the epidemic was thought to be under control in the US where antiretroviral drugs were widely available but the number of women with HIV/AIDS leapt from 180,000 in 2001 to 240,000 two years later.
"A one third rise is very dramatic," she told AFP ahead of the fifteenth International AIDS Conference which starts Sunday with up to 20,000 people due to attend.
But the overall rate of HIV-AIDS in the US stands at 0.6 percent, considerably lower than rates of nearly 40 percent that have been seen in the worst hit countries of sub-Saharan Africa.
American popular culture is awash with sexual innuendo with provocative sexuality in its mass media and easy access to Internet pornography.
"This is having an enormous impact on young people and their minds," Urdang said. "Among young people in America, there is a feeling that sex is cool, that it's okay to be growing up and to be sexually experienced."
The epidemic has increased most dramatically among African American and Hispanic women, who together represent less than one fourth of all women in the US but accounted for 80 percent of all AIDS cases reported among women in 2000.
Fueling the rising HIV rates in the developed world is the assumption among youths that HIV is easily treatable with drugs, or it remains merely a disease afflicting high-risk groups including gay men and injecting drug users.
UNIFEM took aim at the US education system, saying schools have failed to inform students about protection, focusing instead on abstinence and faithfulness.
"When education is based solely on abstinence, that's all people get. Then in the heat of the moment when they give up their virginity pledge, they have no knowledge of how to deal with the moment," Urdang said.
"Women are biologically and socially more vulnerable than men," Urdang said. "If women were able to negotiate safe sex we would have a disease and not a raging epidemic."
U.N. Warns of Global HIV Women's Crisis
By VIJAY JOSHI
The Associated Press
BANGKOK, Thailand (AP) - The United Nations warned Friday of a global health crisis among women due to a dramatic rise in HIV infections among them, largely because poverty has robbed them of the confidence to demand safe sex.
Since 1985, the percentage of HIV/AIDS suffers who are adult women has risen from 35 percent to 48 percent. Young women now make up 60 percent of the 15-to-24-year-olds living with the disease, said the U.N. Development Fund for Women.
``Women are now firmly in the grip of the HIV/AIDS epidemic,'' Stephanie Urdang, UNIFEM's gender and HIV adviser, told a news conference.
The rising rate of infections among women is due largely to the fact that they are much less likely to be financially independent, are fearful of violence by men and in many parts of the world are regarded as socially inferior.
Women also bear the burden of caring for family members with the disease. Girls are withdrawn from schools to become caregivers for family members, and women are often required to work harder than men even though they may themselves be suffering from the disease.
Widows trying to provide for their children are frequently driven into the sex trade, the U.N. says. But because they desperately need the money, they are in no position to demand their customers wear condoms.
``They are often powerless to negotiate safe sex,'' said Urdang. ``This should be a surprise to no one. Women have always been the most vulnerable group to HIV.''
UNIFEM will release a comprehensive report on the emerging female crisis on Wednesday at the 15th International AIDS Conference in Bangkok, calling for greater political commitment, funding and collective leadership to be placed on gender issues, especially in Africa and Asia, the continents hit hardest by the epidemic.
Some 77 percent of all HIV positive women in the world live in sub-Saharan Africa.
``Some countries such as Uganda and Senegal have shown the political commitment but there is a long way to go,'' said Urdang.
Gender inequality is not just in Africa and Asia but also in the United States, where the HIV prevalence rate among women has jumped from 20 percent to 25 percent between 2001 and 2003, according to UNIFEM. A vast majority - 80 percent - of them are African-American and Hispanic.
In part, this is because women are not given adequate sex education in schools and the U.S. government does not believe in promoting condom use among young people.
Around the world, monogamy in marriage is also no guarantee for women against HIV, because they often cannot force unfaithful husbands to wear condoms.
There is now fear that Asia could become the next Africa because of a number of similarities such as endemic poverty, low levels of education and second-class status of women, said Lucita Lazo, UNIFEM's regional director.
The biggest danger zones are Cambodia, Myanmar and Thailand, where a recent U.N. study showed that only 23 percent of women aged 15 to 24 had a comprehensive understanding of HIV/AIDS. VR tR †R ¢R hT jT BV DV XW ZW "Y
INEXPENSIVE TEST FOR CD4 COUNT
AUSTIN (AP) - Researchers at the University of Texas have developed a device that allows doctors in remote areas to quickly and cheaply conduct a key diagnostic test for the AIDS virus.
The toaster-sized device was expected to be unveiled next week at the International AIDS Conference in Bangkok, Thailand.
John McDevitt, a UT chemistry professor, developed the microchip sensor technology that the machine uses to count a type of white blood cell in HIV-positive patients in 10 or 15 minutes instead of days.
Current technology used in the test is expensive and bulky.
Frank Young, a former Food and Drug Administration commissioner, said that's the most important test in helping doctors determine when to start treatment and how to tailor the so-called drug cocktails that patients take.
Longtime Austin entrepreneur Richard Hawkins has been lured out of semi-retirement to run LabNow Inc., the company created to make and market the device.
``This project has the chance to change the way the disease is managed,'' Hawkins told the Austin American-Statesman in Friday's online edition.
He was scheduled to go to Bangkok for the device's launch.
Young is now chairman and chief executive officer of the Cosmos Alliance, a Washington-based biotech investment group that examined LabNow's technology. The Bill and Melinda Gates Foundation and the Doris Duke Charitable Foundation helped pay for the device's development.
Devices that measure AIDS patients' cells, called CD4 lymphocytes, are as big as refrigerators and cost about 75,000. Hawkins said he hopes to get LabNow's device down to 1,000, with each test costing 5.
Drugs for treating AIDS in developing countries now cost 300 a year or less per patient, said the United Nations AIDS program UNAIDS, thanks to government purchasing programs and generic versions. LabNow's device will help doctors decide how to best use the drugs.
``For developing countries, this is going to be extremely important,'' Young said.
An estimated 38 million people worldwide are infected with HIV, according to the United Nations, adding that 90 percent of people who urgently need treatment aren't getting it. -- POTENTIALLY INEXPENSIVE DEVICE TO TEST
Top U.S. AIDS Adviser Visits Vietnam
By MARGIE MASON
The Associated Press
HANOI, Vietnam (AP) - The top U.S. AIDS adviser got a firsthand look Friday at Vietnam's swelling HIV problem as he met with government officials and HIV-positive patients in a country where the epidemic threatens to cross over from high-risk groups into the general population.
Global AIDS Coordinator Randall Tobias, on a three-day visit to Hanoi, was hoping to get a clearer picture of the communist country's struggle to keep the disease contained to mostly intravenous drug users and sex workers.
The trip comes after President Bush last month named Vietnam as one of 15 countries eligible for funding from America's 15 billion global AIDS plan. It was the only Asian nation included in the plan and drew criticism from some who expected China or India to be higher on the list because of their much more alarming infection rates.
``Vietnam is a country where the epidemic ... is on the verge of exploding into the general population,'' Tobias said after touring Bach Mai hospital, the country's leading HIV/AIDS treatment facility.
He said new infections in Vietnam were on pace to increase eightfold to 1 million by 2010, compared to three times and 7.5 times for India and China, respectively. The program will add an additional 10 million this year to the 8 million Vietnam was already receiving from the U.S. government.
Tobias met with Health Minister Tran Thi Trung Chien and was expected to call on Deputy Prime Minister Pham Gia Khiem during his visit. He will travel Saturday to Bangkok for the 15th International AIDS Conference that begins the following day.
He said the funds would target prevention, treatment and care, but added it has not been determined exactly how the money will be spent.
``I'm very interested in learning more about the strategy that Vietnam has put in place and the specific ways in which the United States government and Vietnam can work together as we all tackle this horrible pandemic that is facing the world,'' Tobias said.
During his visit, Hanoi on Friday unveiled its first condom vending machine at a popular restaurant and beer garden packed with lunchtime patrons.
The pilot project took some persuasion before it could be implemented in a country where sex is a taboo topic. More than a dozen venues refused to install machines in their men's bathroom because of the negative stigma attached to condoms.
``We want condoms to be treated just like toothpaste or deodorant,'' said Lin Menuhin, deputy director of not-for-profit condom distributor DKT International, which spearheaded the project.
``A lot of people are still embarrassed about buying condoms, even at the pharmacy. So this takes away the need for a personal transaction.''
The red machine stocks OK brand condoms, Vietnam's most popular, that sell for 3 cents apiece.
The government's family-planning committee backed the project and helped convince Lan Chin restaurant owner Le Viet Chin to allow the machine inside her business.
``We are Asian, so we are very shy,'' she said. ``At first I was very reluctant to allow them to place the vending machine here in our restaurant, but ... I decided that I would let them so that I could make a small contribution to the prevention of HIV/AIDS in Vietnam.''
DKT hopes to install 20 vending machines in the capital by August and expand the project to other major cities such as Ho Chi Minh City and Haiphong.
Vietnam has recorded a total of 81,206 HIV-positive cases, of which 12,684 have developed full-blown AIDS and 7,208 have died, according to the Ministry of Health. However, health officials believe the actual number of HIV-infected people is closer to 200,000. ¢ú §ú ¿ù ¬ù Äû Çû »ü ü Ï° Ó° £ £ ®
WOMEN - HIV/AIDS
VIETNAM HIV/AIDS DAILY REPORT FROM BANGKOK:
women & sex in USA & WORLD; Vietnam; new cheap device to count CD4 cells
1. 2. 3. omen & sex in USA & World India;
2. How to Help India's AIDS Victims
By JULIAN MORRIS
Wall Street Journal July 9, 2004
Next week, around 10,000 people will converge on Bangkok for the biennial conference of the International AIDS Society, which has as its theme, "Access for All." No doubt activists will use the occasion once again to promote their view that access to medicines is being limited by evil pharmaceutical companies that use patents to drive up prices. If only it were so simple. Sadly, the patent red herring has diverted attention from the real reasons why people in poor countries are not getting medications. In Asia, this is a crucial issue, as AIDS sweeps through the region. And for India in particular, which is home to 61% of all HIV-infected people in Asia.
According to a report issued by UNAids, just over 5 million people in India are infected with HIV. Of these, perhaps 500,000 would benefit from anti-retroviral (ARV) therapy, but only around 30,000 people are currently receiving treatment. Why? It's not because of patents -- India doesn't recognize patents on pharmaceutical products. And it's not for a lack of local production, either. India is home to around 20,000 pharmaceutical companies, several of which produce ARVs. No, India's access problem, like its poverty, is a function of inept, inefficient and corrupt governance.
From the local land courts to the central government, India remains bound in red tape. Entrepreneurship is undermined by absurd restrictions on the ownership of land and the operation of business. Tradesmen of all kinds, from the lowliest rickshaw driver to the wealthiest doctor, are constantly harassed by police, who use daft rules to extract bribes. As a result, about 90% of India's population operates "informally" -- at the edge of the law. So, in spite of the rapid growth of Bangalore's IT industry, the majority of India's population remains in abject poverty, unable to escape from the lowest rung.
With over 600 million people living on about a dollar a day, the ability to pay for medicine of any kind is clearly limited. Even more so AIDS medicines, which still cost hundreds of dollars a year -- and must be taken day in, day out forever because, although massive advancements have been made in treatment, there is still no cure.
Distribution is another major problem. At the border between Delhi and Uttar Pradesh, India's largest state, trucks queue for miles, apparently aimlessly, their drivers sitting on the roadside drinking tea. Very gradually, the front of the queue moves forward, as another driver finally gets his border chit processed -- a task that can take a day or more. In this time, the contents of the truck often perish, or are stolen by bandits. In temperatures of 90 degrees Fahrenheit or more, medicines can simply melt. On the other hand, transporting them in refrigerated trucks drives up costs, making them less affordable.
But distribution does not end with the trucks transporting medicines. Far more important is the oversight of trained medical practitioners. Yet the country's health-care system is a shambles. The state-run system is a bad joke, with hospitals and clinics massively understaffed and under-funded. (Bureaucrats in New Delhi look in awe at Britain's crumbling National Health Service.) As a result, most Indians receive their health care from the private sector, but even that does not reach many. Meanwhile, most of the thousands of charities that supply health-care service to the poor cannot afford to treat more than a few people with AIDS.
Medical provision of ARVs requires not only a constant supply of medicine but also regular monitoring to ensure that patients take the correct doses of appropriate combinations of medicine. Adverse reactions to ARVs are common, and it is very important to ensure that people are given appropriate drugs and that they continue taking them. For if they stop taking them, this can lead to resistance.
Lack of clean water poses a further substantial problem. HIV weakens the immune system and makes patients susceptible to disease -- it is the nature of AIDS that victims die of other illnesses. In most of India, public water supplies are contaminated with all manner of bacteria, making them deadly to those with weak immune systems. So, even if one were able to solve the problem of distributing AIDS medicines, many HIV positive people would still die from drinking the water they take them with.
These problems do not lend themselves to a simple solution. In fact simple "solutions" may make the problem worse. Merely increasing spending on AIDS -- as the U.N. proposes -- is unlikely to resolve the problems of poverty or lack of clean water and, while it may pay for a few doctors for a short period, it is highly unlikely to make much impact on India's medical infrastructure.
Those concerned about improving AIDS treatment in India would do well to consider these underlying issues and promote solutions that come from empowering Indians to solve their own problems. It is far better to create a sustainable medical infrastructure, based on private-sector investment, than to support fly-by-night clinics built with foreign aid.
Likewise, it is far better for Indians to be able to pay for their own health care than to be reliant on external intervention. For that, India must improve its system of property rights and contracts and remove layers of bureaucracy. In addition, stronger intellectual-property rules -- especially those relating to product patents -- far from acting as a barrier to access, may actually provide the incentive for the development of new AIDS therapies in India. As resistance to existing therapies increases, this will become an important aspect of enhancing access. There are no simple solutions to India's AIDS problem, but these are some of the relatively simple things that can be done that might lead to a solution.
Mr. Morris is director of the International Policy Network, a London-based think tank focusing on international development issues.
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