• House Passes PEPFAR Reauthorization Measure
  The House on Thursday voted 303-115 to approve a bill (HR 5501) that would reauthorize the President's Emergency Plan for AIDS Relief, the AP/New York Times reports. According to the AP/Times, President Bush supports the bill, which would allocate $48 billion for PEPFAR. The passage of the bill was "born out of a willingness to work together and put the United States on the right side of history when it comes to this global pandemic," Rep. Barbara Lee (D-Calif.) said. Rep. Howard Berman (D-Calif.) said that with the bill, the U.S. has "given hopes to millions infected with HIV, which just a few years ago was tantamount to a death sentence" (AP/New York Times, 7/25). The legislation allocates a total of $50 billion -- $48 billion of which would go to PEPFAR and $2 billion of which would go to American Indian issues. The bill also includes an amendment intended to increase oversight of the Global Fund To Fight AIDS, Tuberculosis and Malaria and encourage cost-sharing and transition strategies as part of agreements with countries that receive PEPFAR aid. The measure also includes a provision that would ease U.S. HIV/AIDS travel restrictions. One primary difference between the original House version of the legislation and the version passed on Thursday is that the original version would have allowed groups to use PEPFAR funding for HIV testing and education in family planning clinics but not for contraception or abortion services. The bill passed on Thursday does not mention family planning programs. The measure approved on Thursday also includes a provision that more than half of the program's aid go toward HIV/AIDS treatment and care. In addition, it would overturn an existing law that requires one-third of prevention funds be spent on abstinence and fidelity programs, instead requiring a report to Congress if countries do not spend half of prevention money on such programs. The bill also would direct 10% of funding to programs for orphans and vulnerable children, as well as allocate $2 billion for the Global Fund in fiscal year 2009. The legislation contains an existing requirement that organizations receiving PEPFAR aid have a policy that opposes commercial sex work. The bill would create links between HIV/AIDS and nutrition programs and set a target of recruiting 140,000 health care workers. In addition, the measure would allocate $5 billion for malaria programs and $4 billion for tuberculosis initiatives (Kaiser Daily HIV/AIDS Report, 7/24). Although Bush is expected to sign the legislation next week, some advocates are voicing concerns that Congress will not be able to provide the funding increase outlined in the bill, according to CQ Today. Congress developed its FY 2009 spending plan before the PEPFAR bill had taken its final form, and lawmakers might pass a continuing resolution to keep FY 2008 funding levels, CQ Today reports. "It terms of funding, it appears there is more rhetoric than reality," David Bryden of the Global AIDS Alliance said, adding that each year the U.S. falls behind in spending makes it even harder to catch up. Bush on Thursday said, "The challenge for future presidents and future Congresses will be to continue this commitment, so that we can lift the shadow of malaria and HIV/AIDS and other diseases once and for all" (Graham-Silverman, CQ Today, 7/24). Some Republicans expressed concerns about the bill's cost, according to Reuters. "We have big hearts, but we need to use our brains," Rep. Dana Rohrabacher (R-Calif.) said, adding, "We cannot afford $50 billion of generosity to foreigners." Rep. Henry Waxman (D-Calif.) praised the compromise bill but expressed concerns that it does not "explicitly encourage the close integration of HIV programs with family planning and other reproductive health services" (Cowan, Reuters, 7/24). "This bill will save millions of lives around the world," AIDS Healthcare Foundation President Michael Weinstein said, adding, "Congress is to be commended for swiftly adopting and ratifying the Senate version of the bill which preserves PEPFAR's priority on lifesaving treatment" (AHF release, 7/24).
• CBS' 'Evening News' Examines HIV/AIDS Among Blacks in U.S.
  CBS' "Evening News"on Thursday examined HIV/AIDS among blacks living in the U.S. According to CDC, blacks accounted for 49% of new HIV/AIDS diagnoses in 2006, despite making up only 13% of the population. In addition, 69% of AIDS cases among those ages 13 to 19 and 56% among those ages 20 to 24 are black, the "Evening News" reports. "No matter how you look at it through the lens of gender or sexual orientation or age or socioeconomic class or level of education or region of the country where you live, black folks bear the brunt of the AIDS epidemic in this country," Phill Wilson, founder of the Black AIDS Institute, said. Wilson added that early HIV/AIDS advocates did not send the right HIV prevention and education messages to the black community. "The mischaracterization of the epidemic in the early days ... made black folks think we didn't have to pay attention to the disease," Wilson said. According to the "Evening News," many advocates are saying that presidential candidates Sens. John McCain (R-Ariz.) and Barack Obama (D-Ill.) are not doing enough to address HIV/AIDS. In addition, many advocates are upset that the candidates have said more about addressing HIV/AIDS in Africa, rather than in the black community in the U.S. The segment also includes comments from Ida Blyther-Smith, who runs an HIV/AIDS community outreach program in Chicago (Pinkston, "Evening News," CBS, 7/24).
• About 40% of MSM in New York City Do Not Disclose Sexual Orientation to Physicians, Survey Finds
  Thirty-nine percent of men who have sex with men surveyed in New York City during the past year had not disclosed their sexual orientation to their physicians, according to data from the city's Department of Health and Mental Hygiene that was published in the Archives of Internal Medicine, the New York Times' "City Room" reports. According to health officials, the study's findings have implications for HIV prevention efforts because the survey found that MSM who disclosed their sexual behavior were twice as likely as MSM who did not to be tested for the virus. The survey examined data from the National HIV Behavioral Survey conducted in 2004 and 2005 by CDC. The New York City portion of the data involved 452 men who were interviewed anonymously at gay bars and clubs, tested for HIV, and offered medical and social services if needed. According to the survey, 63% of MSM who disclosed their sexual behavior to their physicians were tested for HIV, compared with 36% of MSM who did not. The survey also found that although 78% of MSM who identified themselves as homosexual said they had discussed their sexual orientation with their physicians, none of the MSM who identified themselves as bisexual had. The survey also found racial and ethnic differences in disclosure rates, with 60% of black MSM saying they had not discussed their sexuality with their doctors. This compared with 48% of Hispanic MSM, 47% of Asian MSM and 19% of white MSM. In addition, about three-quarters of MSM who identified themselves as bisexual were black and Hispanic. According to Monica Sweeney, assistant health commissioner for HIV prevention and control, the survey's findings reflect the stigma against MSM behavior in some minority populations. "There is a frequent phenomenon in the black community in which a man who is gay, by the conventional ways that we all know to identify somebody as gay, identifies himself as bisexual," Sweeney said (Chan, "City Room," New York Times, 7/23). Elizabeth Begier, the city's director of HIV epidemiology, said, "It's a combination of people being less comfortable with the term 'gay' or 'homosexual,' and discrimination they perceive they will experience if they are open about their sexual experiences and attractions." In addition, the survey found that about half of men younger than age 28 had discussed their sexuality with their doctors, compared with 69% of older men (Lite, New York Daily News, 7/24). MSM born in the U.S. were more likely than immigrants to discuss their sexual practices, and those with more education had higher disclosure rates than those with less education, according to the survey. In reaction to the survey, health officials called on patients to be more forthcoming, as well as on physicians to inquire about sexual history. "Health care providers should screen patients routinely for HIV," Begier said, adding, "They should also ask their patients about behavior that may put them at risk. And New Yorkers shouldn't hesitate to talk openly with their health care providers" ("City Room," New York Times, 7/24). Sweeney said that as a "group, doctors fail miserably" at asking patients about their sexual histories. "People were not reluctant to talk once you brought it up," she said, adding, "They're reluctant to initiate, but once you bring up highly emotional issues, patients will talk about it if you're not judgmental" (New York Daily News, 7/24). Gay Men's Health Crisis Executive Director Marjorie Hill said that although she is "distressed" by the survey's findings, she is not "at all surprised." She added, "Medical providers are not sufficiently trained in outreach and engagement with gay, lesbian, bisexual and transgendered people" ("City Room," New York Times, 7/23).
• Jamaica Gleaner Examines Issues Surrounding Pregnancies Among HIV-Positive Women
  Although the increasing availability of antiretroviral drugs has led a growing number of HIV-positive women in Jamaica to have children, many women say that health workers in the country do not always agree with their decision to become pregnant, the Jamaica Gleaner reports. According to the Gleaner, women account for approximately 50% of HIV cases in the Caribbean. In addition, 75% of HIV-positive people in Jamaica are in their reproductive years. Debbie Carrington, care and treatment coordinator for people living with HIV at the Jamaican Ministry of Health and Environment, said that HIV-positive women in Jamaica should not be made to feel that they do not have the right to become pregnant. According to Carrington, the ministry works to prevent unplanned pregnancies in HIV-positive women through counseling and family planning, "just as we do in those without HIV." Carrington added that when HIV-positive women become pregnant, the ministry takes steps to help women prevent mother-to-child HIV transmission. However, patients do not always receive counseling and reproductive health services from public health clinics, Tina Kong -- a physician at the Comprehensive Health Clinic in Kingston, Jamaica -- said. Family planning clinics often provide information about contraception, but health workers at general clinics and sexually transmitted infection clinics may not be trained to do so, the Gleaner reports. "Contraception services in clinics are integrated in thought but not in action," Kong said. In addition, staff shortages cause health personnel to spend less time with patients, limiting the amount of information that can be provided (Jamaica Gleaner, 7/23).
• Violence, Discrimination Against MSM in Africa Jeopardizing Efforts To Reduce Spread of HIV, Advocates Say
  Constant and increasing violence against men who have sex with men in Africa is jeopardizing efforts to reduce the spread of HIV on the continent both within the MSM and general populations, advocates said at a meeting earlier this month in Cameroon, IRIN/AllAfrica.com reports. At the meeting -- which was organized by the French nongovernmental organization AIDES and its partners -- advocates highlighted the vulnerability of MSM in Africa to HIV/AIDS. It is estimated that on average, HIV rates among MSM are four to five times higher than the general population, IRIN/AllAfrica.com reports. In Bamako, Mali, HIV tests administered to a few hundred MSM found that 37% were HIV-positive, according to the Mali-based group ARCAD-SIDA. According to official statistics, HIV prevalence among Mali's general population is about 1.3%, IRIN/AllAfrica.com reports. In addition, a 2005 survey conducted in Dakar, Senegal, found that 21.5% of MSM in the city were HIV-positive, compared with a prevalence estimated to be 0.7% in the general population at the time. The International Gay and Lesbian Human Rights Commission in its 2007 report, titled "Off the Map," said that "the vulnerability of same-sex practicing men and women [in Africa] is not due to any biological predisposition, but is the result of an interlocking set of human rights violations and social inequalities that heighten HIV risk," including the criminalization of homosexuality. According to IGLHRC, homosexuality in 38 of the 53 countries in Africa is still illegal. Steave Nemande, president of Alternatives Cameroun, said that by criminalizing homosexuality, "social homophobia is legitimized and it increases fear amongst MSM, who take further risks to live their sexual [lives] in secret." Herve Beute -- a member of Arc-en-Ciel+, an HIV/AIDS association for MSM -- said that even in countries that have no laws against homosexuality, MSM are not able to assert their rights. Beute added, "We are still fighting for (MSM to have) access to health centers." According to IRIN/AllAfrica.com, even when MSM are aware of the risks of HIV transmission, their exclusion from the majority of health policies in Africa makes it difficult for them to obtain what they need to protect themselves from the virus. In addition, the "clandestine existence" of MSM has put them, as well as the general population, at an increased risk for HIV because many have sexual relations with women or are married, IRIN/AllAfrica.com reports. Therefore, African governments should act quickly to protect MSM in the interest of the population as a whole, advocates said at the meeting (IRIN/AllAfrica.com, 7/23).

Reprinted with permission from kaisernetwork.org. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2006 Advisory Board Company and Kaiser Family Foundation. All rights reserved.