AIDS campaigners dismayed over UK Global Fund pledge

International development organisations in the UK have expressed dismay over the UK’s new pledge to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which they say falls far short of expectations.

The Global Fund is an international funding facility that provides grants to developing country governments and organisations that are tackling AIDS, Malaria and TB. The UK, one of the Fund’s biggest donors, has provided £100 million (approx. $ 200 million) to the fund every year for the past three years. The international development secretary, Douglas Alexander has now promised £1 billion over the next eight years, which equates to around £ 125 million per year.

While the new pledge is an increase on previous donations, it does not tie-in with the promise made by the G8 in July this year to triple donations to the Global Fund by 2010. It has also come as a great disappointment to many who were hoping Gordon Brown, the UK’s new Prime Minister, would continue his previously demonstrated interest in international development issues by increasing international aid.

"It is astonishing how quickly promises become meaningless. In June the G8 promised to treble the size of the Global Fund by 2010, in order to tackle three diseases that kill 6 million people each year. Then in July, at the UN, Gordon Brown claimed moral leadership by warning the world that promises to tackle poverty and disease must be not be broken. Yet today the government has done exactly that, and sadly the effect will be felt by millions of people affected by Aids, TB and malaria across the world," said Steve Cockburn of the UK’s Stop AIDS Campaign.

The UK’s pledge is important both for financing Global Fund programmes and for encouraging others to increase their donations to the Fund. The USA for example has agreed to provide one third of total Global Fund money each year. The less money fellow donors pledge, the less the USA is therefore obliged to donate.

Greater funding for AIDS in particular is desperately needed to achieve the international target of universal access to HIV treatment, care and prevention by 2010. A new report from UNAIDS this week suggested that there is already a US$ 8.1 billion funding gap for 2007 alone. By 2010, around $ 42 billion will be required to ensure that at least 80% of people living with HIV worldwide have access to the services they need. At the current rate of increase, only around $ 17 billion is actually likely to be available.

“The lack of investment 10-20 years ago in the AIDS response, particularly in strengthening health systems and on issues contributing to the drivers of the epidemic such as violence against women and education has resulted in a more serious epidemic and the higher levels of funding needed today,” UNAIDS claims.

The report presents two scenarios for reaching universal access worldwide. The first would see universal access achieved by 2010 and would require a dramatic expansion of services in all low- and middle-income countries affected by AIDS. The second would achieve universal access in 2015 through a phased scale-up based upon individual country targets. This would allow countries to expand services at a more manageable pace and would cost less in the long-term, but more lives would ultimately be lost.

More information about the Global Fund to Fight AIDS, TB and Malaria and the Universal Access by 2010 goals are available on the AVERT website.

New report highlights strengths and weaknesses of major AIDS donors

A new report by HIV/AIDS Monitor and the Center for Global Development has for the first time provided a comparative evaluation of the three major donors of AIDS-related funding: the Global Fund for AIDS, Tuberculosis and Malaria, The World Bank and the US President’s Emergency Fund for AIDS relief.

The report, entitled “Following the funding for HIV/AIDS: a comparative analysis”, focuses specifically on the organisations’ work in Mozambique, Uganda and Zambia. Highlighting the strengths and weakness of each project, it highlights how much developing countries have come to rely on funding provided by the three agencies. In Mozambique for example, government contributions currently make up just 2% of the total sum being spent on AIDS in the country, the rest being derived from PEPFAR, and to a smaller extent, the Global Fund and World Bank.

PEPFAR is by far the largest donor of international funding for AIDS in the three countries, providing 62% of AIDS resources in Zambia, 73% in Uganda and 78% in Mozambique. The programme was praised for its ability to distribute fund quickly and directly. However, much of PEPFAR’s funding is channelled through international (often American) non-governmental organisations, meaning there is little government involvement, and no clear way of handing over responsibility to local stakeholders in the long-term.

The report welcomed the Global Fund’s transparent and flexible funding agreements arranged largely by national governments, but pointed out that a lack of capacity to absorb and process large sums of money meant the distribution and spending of funds was often very slow and involved a great deal of bureaucracy.

Finally, the World Bank, the smallest funder of the three, was praised for its work on strengthening government capacity to cope with AIDS, but as with PEPFAR, doubts were raised about its rigid donor-dictated requirements that mean money is usually allocated according the prerogative of the Bank rather than the country in question.

The paper goes on to recommend greater collaboration between the three agencies, both so funding can be allocated evenly and appropriately, and so each organisation can learn from the others’ successes and failures.

“By learning from each other to fix what is not working and by sharing what is working, PEPFAR, the Global Fund and the World Bank MAP can individually and collectively improve their performance in the fight against AIDS in Africa,” the report states.

Spending on AIDS-related programmes has increased 30-fold since 1996, and last year stood at US$ 8.9 billion. However, this is still far short of the amount that UNAIDS estimates is needed to meet the Millennium Development Goal of reversing the spread of HIV by 2015, and the goal of providing universal access to HIV treatment by 2010.

You can read more about PEPFAR, The Global Fund and other major financing initiatives for AIDS on the AVERT website.

Millions more faulty condoms recalled in South Africa

The South African Department of Health has called for the return of millions of condoms distributed as part of the government's HIV prevention efforts, after some were found to be defective.

This new development comes two months after the government recalled 20 million faulty condoms made by a company called Zalatex. An official from the South African Bureau of Standards (SABS) has been accused of accepting bribes to approve the Zalatex condoms, which failed to meet quality standards.

Now it has emerged that five batches of condoms made by Kohrs Medical Supplies have failed an air burst test. This shows the condoms were not as strong as they should have been, though it does not necessarily mean they would have burst during normal use. There is no evidence that bribes were involved in this case.

One million Kohrs condoms are already in quarantine and the government is appealing for the return of all others bearing the batch number 6809/MED. It is thought that up to four million such condoms may be in circulation. So far barely half of the 20 million Zalatex condoms have been recovered.

Experts fear the recalls could undermine public confidence in condoms and jeopardise South Africa's HIV prevention campaigns.

"It's very frustrating. Condoms are one of the few things we are getting right on prevention," said Dr Francois Venter, president of the Southern African HIV Clinicians' Society. "Heads should roll."

The government has cancelled its contracts with Zalatex and Kohrs. This leaves five companies supplying the 425 million condoms distributed each year.

In a statement to the media, South Africa's Minister of Health, Dr. Manto Tshabalala-Msimang, sought to reassure the public.

"The SABS has indicated that extensive controls and verifications have been implemented throughout the testing and certification process to ensure that all condoms supplied under the SABS mark and under the Choice brand, comply with standards set by the World Health Organisation," said the health minister.

"The two incidents involving Zalatex and Kohrs should not be allowed to impact negatively on the significant progress we have made in promoting condom use in the country."

AVERT.org has more about AIDS in South Africa.

AIDS vaccine may have worsened risk of HIV infection

Hundreds of South Africans who received an experimental AIDS vaccine have been warned that it may have increased their risk of HIV infection.

The study, which began in January, was meant to establish whether a product made by the pharmaceutical company Merck could protect people from HIV. It was stopped last month after researchers found no evidence of effectiveness.

Now it has been revealed that the infection rate was higher among people who received the vaccine than among those given a placebo. Nineteen vaccinated volunteers acquired HIV, compared to eleven in the placebo half of the study.

Every trial participant is now being told whether they received the vaccine or the placebo, and is being warned of the possible consequences.

Merck's vaccine candidate was separately trialled in 3,000 volunteers from the USA, Canada, Australia, Peru and the Caribbean. That study, which began in 2004, was halted at the same time as the South African trial. The ethics board has yet to decide whether to inform the participants - mostly gay men - if they received the vaccine or the placebo.

Experts say the vaccine itself could not have caused HIV infection, but it may have increased the risk of transmission by affecting immune responses.

"Given the complexity of the issue, we feel the best conclusions will be reached when all the data are analyzed in their entirety," said Mark Feinberg, vice president for medical affairs and policy for Merck.

More details are likely to emerge when vaccine researchers meet in Seattle early next month.

Not only is this outcome a major disappointment for researchers, but it may also affect people's willingness to take part in similar trials in the future. A trial of an HIV microbicide was stopped in January after it too found more infections in the treated group compared to those who received a placebo.

AVERT.org has more about AIDS vaccines and microbicides.

Mbeki still unconvinced of HIV/AIDS link, says biographer

A new biography of the South African President, Thabo Mbeki, has uncovered ongoing ‘dissident’ beliefs about HIV and AIDS, an article in The Guardian newspaper has revealed.

Mbeki courted much controversy in 1999 by questioning the safety and efficacy of AZT, one of the first antiretroviral drugs. He then caused a similar storm in 2000 by repeatedly casting doubt on the widely held belief that HIV is the cause of AIDS.

Mbeki officially withdrew from the debate on the cause of AIDS in 2000, though arguments continued within the government. In 2002, Pregs Govender, the chair of a parliamentary committee on the status of women resigned over the issue, and several fellow members of the government strongly criticised Mbeki's views. The President has stayed away from the debate in recent years, though the new biography by the respected author Mark Gevisser reveals that he remains unconvinced of the HIV/AIDS connection to this day, and is aggrieved that he was silenced by colleagues who believed his opinions to be damaging for the country. Though Mbeki has never expressly said that HIV does not cause AIDS, his obvious scepticism has had a deep impact on the government’s reaction to the AIDS crisis. His views are also now shared by the country’s health minister, Manto Tshabalala-Msimang.

In the book, Gevisser describes how Mbeki contacted him personally to tell him of a paper he had secretly authored six years previously and distributed anonymously among senior members of the Africa National Congress. The paper, which Mbeki took care to have personally delivered to Gevisser, compared AIDS scientists to Nazi concentration camp doctors and depicted black people who accepted the standard rhetoric on AIDS as victims of a slave mentality. The paper also describes the "HIV/Aids thesis" as entrenched in "centuries-old white racist beliefs and concepts about Africans".

Much of Mbeki’s career was spent fighting against Apartheid during the many years that South Africa was a nation divided by race. As a consequence, says Gevisser, Mbeki holds a deep suspicion of white ‘colonial’ orthodoxies, and believes AIDS to be a prime example of racist attempts to demean and repress black Africans. He also believes that much of the Western world is in league with pharmaceutical companies in their attempts to make money out of AIDS by selling potentially dangerous treatments.

Over two million people have died of AIDS in South Africa since the first cases were reported, and about nineteen percent of adults are thought to be infected with HIV. The government has in recent years made greater efforts to address the epidemic, and began to distribute antiretroviral drugs in 2003, "but that did not mean, in any way, that [Mbeki] had changed his mind," writes Mr Gevisser. "When I asked him in 2007 how he felt about having to withdraw from the Aids debate, he told me it was 'very unfortunate' that his initiative had been 'drowned'."

Mark Gevisser's biography of Thabo Mbeki goes on sale in South Africa from 7th November.

Generic antiretroviral manufacture has saved Brazil US$ 1 billion.

Brazil’s policy on AIDS drugs has saved the country around US$ 1 billion since 2001, a new study in PLOS medicine has found.

In 1996, Brazil became the first developing country to commit to universal access to antiretroviral AIDS drugs for all HIV positive Brazilians that needed them. To achieve this goal, the country significantly expanded its drug manufacturing capabilities, and today produces eight different antiretroviral drugs (ARVs) in ‘generic’ (i.e. copied) forms. For drugs that are still within their patent period and cannot be copied under intellectual property laws, Brazil has either broken the patent using a compulsory license (in the case of efavirenz) so it can import generic versions from abroad, or it has negotiated significant price reductions for the brand named versions.

The bold programme has proven controversial with major pharmaceutical companies and the US Trade Representative, as they see it as breaching the intellectual property rights of the original manufacturer. However, under World Trade Organisation guidelines, Brazil’s actions are completely legal.

The study, published by researchers at the Harvard School of Public Health in the United States, described Brazil’s efforts and the $ 1 billion saving as “remarkable”, yet they also warned that the relatively high cost of generic ARVs in Brazil, and the increasing HIV positive population may cause problems in the future. The lack of competition for generics manufactured in the country (all are produced on government orders) means that they are more expensive than generics found in other nations (such as in India). The country has an adult HIV prevalence rate of 0.5% and is currently treating around 180,000 people, with numbers growing all the time.

The study’s authors hope that their work will be of use to other developing countries facing an ever-expanding bill for antiretroviral treatment.

“The trends this study highlights provide important information about how AIDS treatment costs are likely to evolve in other developing countries as efforts are made to provide universal access to life-saving ARVs.” the researchers stated. “The specific application of the Brazilian model to other countries will depend, however, on the strength of their health systems, intellectual property regulations, epidemiological profiles, AIDS treatment guidelines, and differing capacities to produce drugs locally.”

AVERT.org has more about AIDS in Brazil and generic antiretroviral treatment.

CDC set to announce big rise in US HIV infections

The US Centers for Disease Control and Prevention (CDC) is set to announce a dramatic increase in the annual number of HIV infections occurring in the USA, an article in the Washington Blade has claimed.

Current CDC literature states that around 40,000 people become infected with HIV every year, a rate that has remained stable since 1992. However, sources at the CDC have told the Washington Blade that the actual figure may now be over 60,000.

It is unclear exactly what has caused the increase, and the CDC is officially remaining tight-lipped on the subject. Greater HIV testing in a wider range of venues, a CDC initiative introduced last year, may be one explanation. Two employees of the agency have also suggested that more accurate reporting techniques recently introduced across the US may have contributed to the rise. If this were the case, it would suggest that annual incidence may have been underreported for some years.

“My view is it’s both better data collection and increased testing as well as a higher rate of [HIV] conversion that is causing the spike in the CDC numbers,” said David Reznik, the head of an HIV dental clinic in Atlanta, Georgia, and former member of the Presidential Advisory Council on HIV/AIDS.

“However, our prevention messages aren’t reaching those at most risk,” Reznik said. “And I believe it’s time to rethink our prevention strategy.”

Government prevention efforts in the USA mainly consist of encouraging greater HIV testing, and there is currently no national scheme to encourage safer sex. If the new statistics are accurate, it is likely that many AIDS organisations will call for a reappraisal of this situation.

The CDC has admitted it is unlikely it will publish the new data, or its annual HIV/AIDS surveillance report, before World AIDS Day this year, stating that it needs more time to subject the data to peer review. Such a move has however drawn accusations of an attempted cover-up.

“The word we’re hearing now is they’re leaning against releasing such bad news on World AIDS Day,” said Jim Driscoll, a Washington adviser to the AIDS Healthcare Foundation. “There’s some talk of them releasing the new figures during the week between Christmas and New Year’s, when the fewest possible people will be paying attention.”

While a quiet launch of the figures may cause less embarrassment for the CDC, it would represent a major missed opportunity to highlight the ongoing seriousness of the AIDS epidemic in the United States.

To find out more about AIDS in the USA, please visit our HIV & AIDS in America section.