McCain Stumbles on H.I.V. Prevention

Monday, March 19
"The unthinkable has happened. Senator John McCain met a question, while sitting with reporters on his bus as it rumbled through Iowa today, that he couldn't -- or perhaps wouldn't -- answer.

Did he support the distribution of taxpayer-subsidized condoms in Africa to fight the transmission of H.I.V.?

What followed was a long series of awkward pauses, glances up to the ceiling and the image of one of Mr. McCain's aides, standing off to the back, urgently motioning his press secretary to come to Mr. McCain's side."
--Adam Nagourney, NYTimes Blog

Read the full story at:
McCain Stumbles on H.I.V. Prevention
MediaMatters for America

Parallel messages, similar results

A recent New York Times editorial on the ineffectiveness of Phillip Morris’ anti-smoking ads bears more than a little resemblance to current debates about abstinence-only education for teenagers.

We’ve all seen the Phillip Morris ads saying, “Think, Don’t Smoke” and recent ads target parents, telling them to warn their children against smoking. In short, “just say no”.

A recent research study published in the American Journal of Public Health found that the ads have had no beneficial effect on teenagers and that those aimed at parents actually had an encouraging effect on teenagers.

The study found a direct relationship between exposure to the ads and likelihood of smoking in the past 30 days.

The New York Times observed that “their theme—that adults should tell young people not to smoke mostly because they are young people—is exactly the sort of message that would make many teenagers feel like lighting up.” The Times also noted that the goal of the ads is not actually to prevent smoking for a lifetime, but to put it off until adulthood, and that the ads have no mention of the fact that smoking is addictive or even harmful.

Likewise with abstinence-only education. Nearly two-thirds of US high school seniors have had sexual intercourse and there were 822,000 reported pregnancies among women 15-19 years old in the year 2000. While there is no evidence to show that abstinence-only classes changes this, there is evidence to show that education about contraception and sexually-transmitted infections reduces risk-taking and pregnancy among teens (see PP, Kaiser, ACLU, Guttmacher). And if the goals of abstinence-only programs are the same as the anti-smoking ads—to delay intercourse until adulthood (i.e. marriage)—then we will still have rampant ignorance about STIs, protection, and reproductive health.

While the motivations of the two campaigns may be different (those behind the Phillip Morris ads are looking to keep sales (i.e. smoking) up while “avoiding a governmental crackdown” and those preaching abstinence-only arguably do want to keep teens from having sex), each scenario, through the evasion of straightforward conversation and disregard for proven studies, threatens young people with bitter ends: lung cancer and AIDS.

Signs of a new Congress: Questioning the roots of US HIV/AIDS policy

The Boston Globe reported yesterday on some important questions that Democrats are asking about President Bush’s faith-based initiatives:

• Have current faith-based initiatives violated the separation of church and state?
• Did the Bush administration really give 98.3 percent of the faith-based foreign-aid money to Christian groups? How does this affect, among other things, our foreign relations?
• What are the effects of such faith-based initiatives on our fight against AIDS?

Questions such as these are being articulated mainly by Representative Barbara Lee (D) from California and Representative William Delahunt (D) of Massachusetts.

Representative Lee is sponsoring a bill that would overturn a measure that requires that one-third of the money spent by the US government on AIDS prevention overseas go for "abstinence until marriage" programs. This is a $1 billion measure and many Democrats have suggested that the money could be better spent on other measures such as condoms. "When you look at what has been exposed and revealed, I think we have a factual basis to move forward with this," Representative Lee said.

Representative Delahunt, who will soon chair the International Relations subcommittee on Oversight and Investigation, said that if US-funded Christian groups work in Muslim-dominated countries, the effort could be "perceived to be proselytization and it can generate a harsh negative reaction that implicates and impacts in a negative way on America's image in the world and have significant consequence to our foreign policy goals."

Democrats are also attempting to repeal a measure that required US groups receiving faith-based funds to have a policy opposing prostitution. Many groups have said the pledge impedes their work with sex workers who are at high risk for HIV. Organizations have also raised a question of the constitutionality of the pledge as compelled speech. Two federal judges have ruled that the pledge is unconstitutional and the Bush administration has appealed these rulings. Read more.

Regarding the AIDS fight, Representative Tom Lantos, the California Democrat who will chair the International Relations Committee in January, said, "Our global HIV/AIDS policy should be about saving lives…It is inconsistent with this goal to place ideologically driven restrictions on the implementation of efforts to prevent spreading the virus."

HRW: World AIDS Day 2006: Ideology Trumps Action as Epidemic Worsens

Governments Must Respect Rights to Advance AIDS Fight

(New York, November 29, 2006) – Twenty-five years after AIDS was first identified, programs to fight the disease continue to be undermined by conservative ideologies and moralistic approaches, Human Rights Watch said ahead of World AIDS Day on December 1.

“The most effective approaches for preventing HIV/AIDS are not being used,” said Joe Amon, director of the HIV/AIDS program at Human Rights Watch. “Governments are refusing to adopt evidenced-based programs that respect individual rights, and are instead promoting ideological campaigns that make people more vulnerable to infection.” Human Rights Watch identified a number of examples from around the world affecting those most at risk of HIV infection, including youth, women, and injecting drug users.

• In sub-Saharan Africa, a majority of young adults lack adequate knowledge of HIV transmission. Yet some governments emphasize “abstinence-only” approaches and promote inaccurate information about the effectiveness of condoms. For example, in Uganda the government promotes “virginity parades” and restricts the availability of condoms to youth while the epidemic – in a country once considered a “success story” – has worsened dramatically.
  
• Women are increasingly recognized as the “face” of AIDS, but governments refuse to address the human rights abuses that cause their vulnerability. One in three women will face some form of gender-based violence in her lifetime, and studies have found that women who experience violence are up to three times more likely to become infected.
  
• One in three new infections outside Africa affects injecting drug users. Few governments, though, are adopting such proven strategies as substitution therapy for drug addiction or the provision of clean needles. In Russia, where the epidemic is concentrated among injecting drug users, the government has refused to permit the use of methadone and has hindered the widespread availability of clean needles.

Six months ago, UN members signed a declaration recognizing that the protection and realization of human rights is essential in the global fight against AIDS. “The theme for this year’s World AIDS Day is ‘Keep the Promise,’” Amon said. “But unless governments adopt effective approaches that respect the rights of those most vulnerable to the disease, their broken promises will add up to millions more infected with HIV.”

At the International AIDS Conference in Toronto last August, Human Rights Watch collected audio testimony from AIDS activists and individuals living with HIV worldwide, who present personal stories and perspectives on what is needed in the global AIDS fight. “Listen to their stories and you can begin to understand the impact of the AIDS epidemic and the failure of the world’s governments to address it,” Amon said. To hear the testimonies of AIDS activists and those living with HIV which Human Rights Watch recorded at the 16th annual International AIDS Conference, please visit: http://www.hrw.org/campaigns/aids/2006/toronto/audio.htm

For broadcast-quality audio interviews of other leading AIDS activists around the world, as well as a 30-minute radio program produced by Human Rights Watch for the International AIDS Conference, please visit: http://www.hrw.org/campaigns/aids/2006/toronto/audio2.htm

Chinese Release Detained AIDS Activist

On November 24th, Dr. Wan Yanhai, an advocate for AIDS patients in China and founder of the AIZHIXING Institute, was taken in for questioning by the Beijing police and detained for 48 hours. His detention forced the cancellation of a planned workshop, “Blood, Safety, AIDS, and Legal Human Rights”, which planned to focus on the rights of people infected with HIV/AIDS through blood transfusions. After Dr. Wan cancelled the workshop, he was released.

Dr. Wan has been detained before. In 2002, he was in police custody for four weeks after posting information on the internet about unsafe blood exchanges that were contributing to the rising incidence of AIDS in the province of Henan. He was charged with “illegally leaking state secrets.” Upon his release, Dr. Yanhai declared, “If this incident helps attract more concern and support for victims of AIDS and their families and children here in China, then it can be considered an opportunity we should grasp.''

The detention of Dr. Wan by the Chinese authorities on the eve of World AIDS Day emphasizes the restrictions on the rights of people living with HIV/AIDS in China. A press release by the Network of Chinese Human Rights Defenders (CRD) states that the Beijing police have been working to block villagers living with HIV/AIDS from entering the city—whether to visit or to express grievances to the government—in part as preparation for the 2008 Olympics.

UNAIDS reported in its 2006 annual report that the epidemic in China has reached more than 650,000 individuals. In contrast to most regions, the epidemic began in rural areas and spread to the cities, perhaps explaining why awareness has remained low and stigma has soared. Nearly half of the people living with HIV in China are believed to be infected from injecting-drug use. In some provinces such as Henan, one percent of pregnant women are found to be HIV-positive. UNAIDS also cites blood and plasma donations as a contributing factor to the epidemic, the issue that Dr. Wan has focused on. HIV-positive persons find little protection or help—the UNAIDS report estimates that “almost one in three (30%) health professionals in Yunnan Province…said they would not treat an HIV-positive person.”

Dr. Wan’s work continues to drawn attention to not only the discrimination facing people living with HIV/AIDS in China, but also the denial of the civil and political rights of those fighting on their behalf. Learn more about his work:

Human Rights Watch talks with Dr. Wan (7/2006)

Network of Chinese Human Rights Defenders press release (11/27/06)

“China Frees AIDS Activist After Month of Outcry” (9/21/02)

“China Now Set To Make Copies of AIDS Drugs” (9/7/02)

“China's Top AIDS Activist Missing; Arrest Is Suspected” (8/29/02)

New York Times: Needles, AIDS, China

To the Editor:

In "China's Muslims Awake to Nexus of Needles and AIDS", Howard French shows one bright spot in China's war against the AIDS epidemic: in Xinjiang, authorities are beginning to offer methadone to drug users.

However, the article does not show an uglier piece of the picture. Every year, authorities around the country also forcibly detain thousands of drug users in prisons, "treatment centers" in name only. As a researcher at Human Rights Watch, I visited one such facility and interviewed detainees from others. Under Chinese law, police may sentence individuals to three to six months --sometimes, longer-- in these prisons, without trial. Detainees are kept in unclean, overcrowded cells. They get no counseling. They are compelled to take part in forced, unpaid labor, working long hours on farms or in sweatshops that profit the prisons. Chinese sex workers also face similar detention.

As interviewees told me, all this punitive approach accomplishes is to marginalize those at high risk of HIV infection and drive them underground, away from authorities and any program that could teach them about HIV and how to prevent its spread. China should abolish these fake "treatment centers" and replace them with real ones.

Sara Davis
Executive Director
Asia Catalyst

Abstinence Forever

USA today reports that the federal government is targeting unmarried adults up to age 29 as part of its abstinence-only programs because unmarried women in the 20-29 year age group are having children.

But really, why stop at 29? I bet there are 30 year old women, even perhaps 35 and 40 year old unmarried women having sex, and having babies too.

I don't know if it was taken out of context, but Wade Horn, assistant secretary for children and families at the Department of Health and Human Services, was quoted in the article as saying: "The message is 'It's better to wait until you're married to bear or father children,' " Horn said. "The only 100% effective way of getting there is abstinence."

The only 100% effective way of getting "there" - meaning to be married with children? - is abstinence??? Has HHS decided to totally abandon evidence, and pursue its ideological goals untethered to data? The article goes on to say:

The revised guidelines specify that states seeking grants are "to identify groups ... most likely to bear children out-of-wedlock, targeting adolescents and/or adults within the 12- through 29-year-old age range." Previous guidelines didn't mention targeting of an age group.

"We wanted to remind states they could use these funds not only to target adolescents," Horn said. "It's a reminder."

Last year, 46 states applied for the federal abstinence-education money, to fund programs in schools, neighborhood clubs and faith-based organizations.

Hmmm, so if HHS is telling states they can target 29 year olds with abstinence messages, how will they do that: schools? probably not. Neighborhood clubs? doubtful. Faith-based organizations? Bingo.

ONDCP: Misconstruing evidence on needle exchange programs.

The ONDCP (Office of National Drug Control Policy) has a blog called “Pushing Back” which recently featured an interview with Dr. David Murray, an ONDCP policy analyst and “expert” on needle exchange. The blog entry was entitled “What’s Wrong with Needle Exchange Programs?”

In the interview Dr. Murray claims that recent research about the programs’ effectiveness in lowering HIV infection has been inconclusive, and that their effect on continued drug use is unknown. These claims form the basis of the Federal Government’s refusal to fund needle-exchange programs. Dr. Murray says that endorsing needle exchange programs conflicts with the “primary burdens for any public health intervention” which are to:

“…produce the effect that they intended to produce, that they do not introduce harmful unintended consequences, and that they are demonstrably superior to other interventions that could produce better outcomes”

Ok, let’s look at these criteria:

1) produce the effect that they intend to produce –

Murray cites a recent Institute of Medicine report , and says that evidence concerning the effect of these programs on HIV infection is “limited and inconclusive”. However, the report specifically says:

“a large number of studies and review papers…show that participation in multicomponent HIV prevention programs that include NSE [needle and syringe exchange] is associated with a reduction in drug-related HIV risk behavior, including self-reported sharing of needles and syringes, unsafe injection and disposal practices, and frequency of injection.”

2) do not introduce harmful unintended consequences –

Dr. Murray also misrepresents the IOM report when discussing the effects of needle exchange on drug use itself. While Dr. Murray says that evidence on this is “inconclusive”, the IOM report says:

“the few studies that have examined the unintended consequences of programs that include NSE found no evidence that they lead to more new drug users, more frequent injection among established users, expanded networks of high-risk users, changes in crime trends, or more discarded needles in the community.”

3) are demonstrably superior to other interventions that could produce better outcomes –

Dr. Murray states: “The single most important point, however, is that there is a superior intervention that reduces the risk of disease transmission and that reduces the danger from the drugs themselves -- that intervention is drug treatment.”

Drug treatment is clearly essential, but why should it be only drug treatment, and what is ONCDP doing to make treatment more available worldwide? UNAIDS estimates that there are now 13 million injecting drug users worldwide. Where drug treatment is available at all, it is often ineffective or punitive. In Russia, with an estimated two million IDUs, “treatment” is often restricted to medically managed withdrawal. Prescription medication to reduce cravings for illegal opiates (substitution treatment) is illegal. Across Asia, many drug users are confined to centers that are more like prisons than health care facilities, and that offer little or no psychosocial or medical support.

It’s one thing for the Federal Government to decide not to fund needle exchange programs and leave it up to the states. It’s quite different for them to misconstrue the evidence of their important role in battling HIV-infection. The Institute of Medicine is not alone in its findings. In 2002 Surgeon General David Satcher issued a report to Congress that concluded:

“After reviewing all of the research to date, the senior scientists of the Department and I have unanimously agreed that there is conclusive scientific evidence that syringe exchange programs . . . are an effective public health intervention that reduces the transmission of HIV and does not encourage the use of illegal drugs.”

Additional organizations that support needle-exchange programs as effective tools for protecting the public health of communities include:

American Academy of Pediatrics
American Bar Association
American Foundation for AIDS Research
American Medical Association
American Public Health Association
Association of State and Territorial Health Officials
National Alliance of State and Territorial AIDS Directors
New York Academy of Medicine

New report:Sterile injecting equipment and opiate substitution for IDUs

The Institute of Medicine recently published Preventing HIV Infection among Injecting Drug Users in High Risk Countries: An Assessment of the Evidence (2006), highlighting research that found that access to sterile injecting equipment and opiate substitution treatment effectively reduces the spread of HIV among injecting drug users (IDUs). Outside Africa, UNAIDS estimates that nearly one in three HIV infections is due to injecting drug use, yet HIV prevention services reach only 5 percent of the world's injection drug users. The report highlights this alarming fact by focusing on China, Thailand, and Russia and calls on governments to take immediate action to curb HIV among IDUs.

Unfortunately, there is a stark absence of a human rights framework. The article fails to hold governments accountable to adopting effective policies, saying for example "...HIV prevention interventions for IDUs should be tailored to local circumstances and implemented in a culturally appropriate manner". Too often "cultural norms" have been used as an excuse for horrendous rights abuses against individuals who use drugs. In order to effectively apply the research presented by IOM's scientists, a rights-based approach is necessary to overcome local stigma and discrimination.

Needle Exchange Debates

Progress in New Jersey

New Jersey has long prohibited the distribution of hypodermic needles in government-sanctioned programs and is the only state in the union still to do so. Now, 4 in 10 cases of HIV infections in New Jersey result from injecting drug use with contaminated needles. 14 years after the legislation was first introduced, lawmakers are reviewing a bill that finally appears to have enough support to win passage. The bill would allow needle-exchange programs and even Governor Jon Corzine has expressed support.

The New York Times reported on this story (September 25): http://www.nytimes.com/2006/09/25/nyregion/25needles.html


US AIDS policy: Still hostile to Evidence and Rights

On an international front, American officials withdrew their support for needle exchange programs at the WHO’s Asia-Pacific conference last week. They submitted last-minute proposals to a resolution calling for universal access to HIV/AIDS treatment that, in Peter Hodgson’s view, New Zealand’s Health Minister, would have watered down the resolution. He said “[the U.S.] position is that if they have needle exchanges then people will use needles more and use intravenous drugs more…I think it is demonstrably wrong”.

“Demonstrably wrong” pretty much says it all.

The Associated Press reported on this story in the IHT (September 25):
http://www.iht.com/articles/ap/2006/09/22/asia/AS_MED_WHO_Asia_AIDS.php

Report from New York City: the turbulent history of HIV/AIDS education

The HIV/AIDS curriculum of public schools in New York State and New York City has been the subject of important debate for much of the 25 years since the start of the AIDS epidemic – and each twist and turn of the debate has reflected wider debates occurring about AIDS.

Since 1987, the New York State Education Commissioner Regulations have required that every board of education in the state provide education on HIV/AIDS to students K-12. The content of that education has varied, since it’s dependent on the current Chancellor and political context. For example, in 1991 Chancellor Joseph A. Fernandez proposed distribution of free condoms in schools. This was the subject of fierce controversy over the next year and finally passed with fear mongers suggesting that there would be a big increase in sexual behavior.

A decade later, movement in the public school curriculum regarding HIV/AIDS education was initiated by Scott Stringer, then NYS Assembly member (now Manhattan Borough President), who, in 2003, wrote a comprehensive report entitled “Failing Grade: Health Education in NYC Schools” (http://www.assembly.state.ny.us/member_files/067/20030622/index.html). In “Failing Grade” Stringer criticizes the vast discrepancy between local mandates for health education and actual practices. The report found that the majority of districts violate New York City’s minimal mandates on health education; often this is simply out of ignorance of the mere existence of regulations.

The need for more sex education is clear—New York City is still the American epicenter of HIV/AIDS (New York City accounts for 15.5 percent of all AIDS cases in the U.S. and more than half of high school students identify as sexually active. The Guttmacher Institute, in a report entitled, “Facts on Sexually Transmitted Infections in the United States” released in August 2006 cited, “although teens and young adults represent only 25% of the sexually active population, 15–24-year-olds account for nearly half of all STI diagnoses each year” (http://www.guttmacher.org/pubs/2006/09/12/USTPstats.pdf).

In November 2005, Chancellor of the NYC Department of Education, Joe Klein, issued a revised curriculum on HIV/AIDS. The new document prioritizes reducing the stigma around people with AIDS, stating as one of its key goals that it will “enable [students] to feel comfortable around people with HIV/AIDS”. To the teachers, it says: “It is important to clarify that it is risk behavior they should avoid, not the people who have AIDS”. It suggests homework to encourage greater parental involvement.

However, it also includes revisions to the health education curriculum that are not necessarily a step in the right direction. The document incorrectly labels abstinence as 100% effective, which does nothing to reduce stigma around sex. The changes include adjustments to the free condom distribution program, instituted in 1991. Now, all parents and guardians have the option of prohibiting their children from the taking advantage of the program: “their children’s identification numbers are placed on a list to ensure that they will not participate”.

This amendment violates the often-stated goal of universal access to prevention that vulnerable teenagers need and will lead only to further delay in effectively addressing HIV/AIDS among adolescents. Plus, really, how hard will it be for a kid whose parents haven’t objected to pick up condoms for a kid whose parents have?

Caucus for Evidence-Based Prevention

At the Toronto conference, the Caucus for Evidence-Based Prevention will promote HIV prevention efforts supported by sound science, report on HIV prevention-related proceedings to a wide audience, and alert the community when ideology, prejudice, or opinion interfere with evidenced-based approaches to reducing the further spread of HIV/AIDS.

Advocates.com also posted information describing plans by abstinence-only opponents during this conference.



Tags: AIDS 2006 Toronto HIV+Prevention