Bulgaria To Press Charges Against Libyan Police Officers In HIV Infection Case

A Bulgarian senior prosecutor on Wednesday said the country within four months will bring charges against 11 Libyan police officers for allegedly torturing five Bulgarian nurses into confessing to allegedly intentionally infecting hundreds of Libyan children with HIV, Reuters reports (Reuters, 1/31). The five nurses and a Palestinian doctor in May 2004 were sentenced to death by firing squad for allegedly infecting 426 children through contaminated blood products at Al Fateh Children's Hospital in Benghazi, Libya. They also were ordered to pay a total of $1 million to the families of the HIV-positive children. The Libyan Supreme Court in December 2005 overturned the medical workers' convictions and ordered a retrial in a lower court. A court in Tripoli, Libya, last month convicted the health workers and sentenced them to death. The health workers say they are innocent of the charges, claiming that they were forced to confess and that they were tortured by Libyan officials during interrogations. The European Parliament on Jan. 18 in a resolution called on European Union member states to review their trade relations with Libya and to urge the country to release the medical workers (Kaiser Daily HIV/AIDS Report, 1/30). A Libyan court in June 2005 acquitted nine police officers who had been charged with torturing the medical workers and forcing them to confess (Kaiser Daily HIV/AIDS Report, 6/9/05). Sofia, Bulgaria, prosecutor Nikolay Kokinov said the charges would allow him to begin a judicial investigation, which could lead to a trial. "After completing the necessary police investigation, we believe there is enough evidence proving a crime," Kokinov said. Othman al-Bizanti, a Libyan lawyer representing the five nurses, on Monday said that the nurses have been accused of slandering the police officers with the torture claims and that they will be questioned on Feb. 11. Bulgarian chief prosecutor Boris Velchev said the slander charges are "an obscenity," adding, "The evidence that we have points out that the nurses were indeed tortured. Nobody in Bulgaria has any doubts about that." Trayan Markovski, coordinator of the nurses' Bulgarian defense team, said the questioning on the slander charges is a "good opportunity for the truth to be heard in Libya" (Simeonova, AFP/France 24, 1/30).

Italy's Prime Minister Discusses Medical Workers Release With Gaddafi
In related news, Italian Prime Minister Romano Prodi on Monday during an African Union summit in Ethiopia met with Libyan leader Muammar Gaddafi to discuss the release of the six medical workers, Reuters reports. Prodi said he approached Gaddafi in a "very heartfelt way because this is a problem that has been going on for eight years." Prodi added that Gaddafi said that there still are "problems of reparations and compensation" to the families of the HIV-positive children but that "he would reflect on what [Prodi] told him and [they] would talk about it again" (Reuters, 1/30). Libya earlier this week proposed a plan to release the medical workers, Seif al-Islam Gaddafi -- the son of Muammar Gaddafi and head of Gaddafi International Foundation for Charity Associations -- said in a statement to a Bulgarian newspaper. "We have proposed a road map with solutions (satisfying) all parties: the parents, the Libyan government, the Bulgarian side, the E.U.," Seif al-Islam Gaddafi said. He added that the plan calls for "substantial compensation for the families of those affected" and the release of Libyan officer Abdelbaset Ali Mohmed al-Megrahi, who is in a Scottish jail for the 1988 Lockerbie bombing. According to Seif al-Islam Gaddafi, he has discussed the proposal with the foreign ministers of Germany and France (Kaiser Daily HIV/AIDS Report, 1/30). The U.S. on Tuesday responded to Seif al-Islam Gaddafi's announcement. Sean McCormack, a spokesperson for the U.S. State Department, said, "If, in fact, the Libyans do act on what this gentleman has said, certainly that would be welcome ... news on many, many fronts" (AFP/Yahoo News, 1/30).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Thai Health Ministry Takes 'Bold Step' In Breaking Patent, Issuing Compulsory License For Antiretroviral Kaletra, Editorial Says

Thailand's Ministry of Public Health is "taking a bold step" in ensuring that the country "takes full advantage" of the World Trade Organization's Trade-Related Aspects of Intellectual Property Rights agreement by breaking the patent on Abbott Laboratories' antiretroviral drug Kaletra, a Bangkok Post editorial says (Bangkok Post, 1/31). The health ministry on Monday said that it has broken a patent on Kaletra by issuing a compulsory license to produce a lower-cost version of the drug. According to Health Minister Mongkol na Songkhla, the compulsory license was signed into law and took effect on Friday. WTO regulations allow governments to declare a "national emergency" and issue compulsory licenses without consulting the foreign patent owner. Thailand, which has 580,000 people living with HIV/AIDS, has won international recognition for its quick launch of a national drug program that treats more than 82,000 HIV-positive people. However, the government's commitment to providing universal access to care is facing increasingly high drug costs. The compulsory license could save the country as much as $24 million annually (Kaiser Daily HIV/AIDS Report, 1/30). The editorial "applaud[s] the government for using all legal methods possible to ensure Thai patients get the cheapest and best drugs available." However, the editorial says that the government also "should be careful not to unnecessarily further push away foreign investment," adding that even though the government is "not legally required to negotiate with drug companies before issuing a compulsory license doesn't mean it should not do so." The Thai government should "insist on procuring quality drugs" from World Health Organization-approved factories, especially for HIV/AIDS medications, according to the editorial. Although Thailand's Government Pharmaceutical Organization's factories do not meet WHO standards, Thai officials say their generic antiretrovirals are of high quality, the editorial says, adding that it "would be nice to remove the cloud of suspicion." According to the editorial, Thailand should import generic antiretrovirals from India until a new GPO facility that meets WHO standards is complete. This would allow the government to procure antiretrovirals with funds from the Global Fund To Fight AIDS, Tuberculosis and Malaria, which "refuses to finance Thai-produced drugs because they don't meet international standards," the editorial says. According to the editorial, the money the government saves by using drugs produced in India "could be used to expand patient education." The editorial adds that "[m]uch of the resistance to Thai generic HIV/AIDS drugs is attributed to patients who misunderstand how to take the drugs" and that there is little point in "expanding drug coverage if the drugs will prove ineffective due to incorrect usage" (Bangkok Post, 1/31).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

House Passes $463B Spending Bill That Would Allocate $1.3B Increase To Fund International HIV/AIDS, TB, Malaria Programs

The House on Wednesday approved 286-140 a $463 billion spending resolution (HJ Res 20) for fiscal year 2007 that includes a $1.3 billion increase for international HIV/AIDS, tuberculosis and malaria programs, the Washington Post reports (Kane, Washington Post, 2/1). The resolution would bring the total for the President's Emergency Plan for AIDS Relief to $4.5 billion. PEPFAR is a five-year, $15 billion program that directs funding for HIV/AIDS, TB and malaria primarily to 15 focus countries and provides funding to the Global Fund To Fight AIDS, Tuberculosis and Malaria. The $4.5 billion for PEPFAR includes $3.2 billion for the State Department's Global HIV/AIDS Initiative, $712 million for USAID's Child Survival and Health Program, and $494 million for CDC and HHS global HIV/AIDS activities, according to a House Appropriations Committee summary. Of these amounts, $724 million would be allocated for the U.S. contribution to the Global Fund, with $625 million coming from the State Department and USAID, and $99 million from HHS. In addition, $248 million would be allocated to expand programs under the President's Malaria Initiative, an increase of $149 million. The resolution also allocates an additional $75.8 million in funding for the Ryan White CARE Act, which provides care and services to people living with HIV/AIDS in the U.S., to bring its funding to $1.2 billion (Kaiser Daily HIV/AIDS Report, 1/30). "With the increase ... the U.S. is much better placed to go to other countries and urge them to increase their contributions" to the Global Fund, the Global AIDS Alliance said. According to GAA, there were 4.3 million new HIV/AIDS cases worldwide last year, and outbreaks of malaria and drug-resistant TB continued (Cowan, Reuters, 1/31). "Given the incredibly difficult budget situation, the U.S. Congress made a bold decision to help those affected by AIDS, TB and malaria around the world," Natasha Bilimoria, executive director of Friends of the Global Fight, said (Friends of the Global Fight release, 1/31). "What House and Senate leadership have proposed on HIV/AIDS is nothing short of heroic," Pamela Barnes, president and CEO of the Elizabeth Glaser Pediatric AIDS Foundation, said, adding, "We were facing a nightmare situation where treatment for hundreds of thousands of people was seriously threatened" (EGPAF release, 1/31). The Senate must pass the continuing resolution by Feb. 15 to prevent a "partial government shutdown," the Post reports. The White House has indicated that President Bush will sign the measure if it is approved (Washington Post, 2/1).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Microbicide Trials Halted In Africa, India Because Of Possible Increased Risk Of HIV Transmission

Arlington, Va.-based Conrad on Wednesday announced that it has halted Phase III trials of the microbicide Ushercell, also known as cellulose sulfate, in Africa and India after an independent scientific committee during a routine check found an increased risk of HIV transmission among women who used cellulose sulfate compared with women who used a placebo gel, the New York Times reports (Altman, New York Times, 2/1). Microbicides include a range of products -- such as gels, films and sponges -- that could help prevent the sexual transmission of HIV and other infections (Kaiser Daily HIV/AIDS Report, 12/13/06). According to the Wall Street Journal, the trials involved about 1,300 women in Benin, India, South Africa and Uganda. Thirty-five women in both the cellulose sulfate and placebo groups became HIV-positive during the trial, the Journal reports. Although a breakdown of incidence rates for each group is not available, there were more new cases in the cellulose sulfate group, the Journal reports (Chase, Wall Street Journal, 2/1). Final numbers are expected in March, according to a Conrad spokesperson. A separate study of Ushercell involving 1,700 participants in Nigeria and conducted by Triangle Park, N.C.-based Family Health International also was halted in response to the findings of the Conrad study. According to the Times, the FHI study had found neither an increased risk of HIV transmission nor a benefit in preventing transmission of the virus. Both the Conrad and FHI studies were funded with $20 million from the Bill & Melinda Gates Foundation and USAID (New York Times, 2/1). According to the Journal, it is still unknown if researchers will be able to develop a "chemical that is tough enough to repel or kill HIV, yet gentle enough to spare the female genital tract from corrosive chemical effects that have the effect of favoring infection." However, the Journal reports that it is "premature to declare defeat" with the World Health Organization and UNAIDS saying that there are three other Phase III microbicide trials currently underway. The Population Council is conducting a study of Carraguard in South Africa, with results expected by the end of the year. The U.K. Medical Research Council is conducting a study of PRO 2000 in South Africa, Tanzania and Uganda, with results expected by 2009. In addition, NIH is conducting a study of PRO 2000 used in combination with BufferGel in Malawi, South Africa, Zambia and Zimbabwe, with results expected in 2008 (Wall Street Journal, 2/1).

Reaction
According to researchers, the findings are surprising because 11 smaller trials involving more than 500 women conducted since 1999 have found that cellulose sulfate is safe and effective against HIV transmission in laboratory tests (New York Times, 2/1). "This development saddens everyone," Zeda Rosenberg, CEO of the International Partnership for Microbicides, said, adding, "We cannot let it paralyze us. Globally, 17.7 women are living with HIV, and thousands more are infected every day. Prevention is the only way out of this epidemic." Nick Hellmann, interim director of HIV/AIDS and tuberculosis at the Gates Foundation, called the results a "disappointment" but said that drug development is a "long, tortuous road." He added that "we have to proceed, stay the course and learn more lessons about what is required for the optimum microbicide product" (Wall Street Journal, 2/1). Lori Heise, director of the Global Campaign for Microbicides, said that "we wish the results had been different, but learning what doesn't work can be just as important to progress as learning what does work." Mitchell Warren, director of the AIDS Vaccine Advocacy Coalition, said, "Each trial result is a puzzle piece, and together they make up the complex picture that will show us how to develop successful new HIV prevention tools" (Global Campaign for Microbicides release, 1/31). Pedro Cahn, president of the International AIDS Society, said, "While extremely disappointing, this setback is also an opportunity to learn why some women who used Ushercell were found to be at increased risk of HIV infection. This will strengthen future microbicide research and increase our overall knowledge of how such compounds work" (IAS release, 2/1).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Red Cross Launches Appeal For $50M To Expand HIV/AIDS Programs In Southern Africa

The International Federation of Red Cross and Red Crescent Societies on Tuesday launched an appeal for almost $50 million to expand HIV/AIDS programs in Southern Africa, VOA News reports (Schlein, VOA News, 1/30). The funds will be allocated to initiatives that are part of a five-year HIV/AIDS control plan launched in 10 Southern African countries in November 2006, according to an IFRC release (IFRC release, 1/30). The plan is part of the new International Federation Global HIV and AIDS Alliance, which seeks to prevent new HIV cases and bolster treatment and support. The five-year initiative will cover Angola, Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe, Francoise Le Goff, IFRC's chief representative in the region, said. She added that the program aims to reach 50 million people, as well as provide services to more than 250,000 HIV-positive people and 460,000 children who have lost at least one parent to AIDS-related illnesses (Kaiser Daily HIV/AIDS Report, 11/2/06). "HIV has destroyed the very fabric of communities in many sub-Saharan countries and is on the increase across Asia and Eastern Europe," Mukesh Kapila, IFRC special representative for HIV/AIDS, said, adding, "We must not let the virus do to Asia, or any other continent, what it has done in sub-Saharan Africa. That would be unforgivable." IFRC in 2007 plans to increase HIV/AIDS services in Southern Africa and to increase efforts to combat the disease in Asia and Eastern Europe, the AP/International Herald Tribune reports (AP/International Herald Tribune, 1/30). The $50 million for Southern Africa is part of IFRC's call for $286 million to fund its work in 2007, especially in the areas of climate change and HIV/AIDS (VOA News, 1/30).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.