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Kaiser Daily Global Health Policy Report

In The News

WHO Retracts Claims That 'About Half' Of Greek HIV Infections Are Self-inflicted

The WHO has “retract[ed] claims that crisis-hit Greeks are intentionally injecting themselves with [HIV] to collect state benefits almost two months after the shocking allegation was revealed in a report [.pdf] that triggered global media coverage,” The Guardian reports (Smith, 11/26). “The startling claim was contained in a single sentence on page 112 of the organization’s European report, published in September and more broadly publicized by the agency in late October,” the New York Times notes (Hakim, 11/26). “WHO said HIV rates had risen ‘significantly’ in the debt-ridden country, with ‘about half’ of new HIV infections self-inflicted, allowing people to receive benefits of €700 [$950] per month,” Sky News writes (11/26). “WHO cited no one in making this claim, and offered no additional data to back it up,” according to the Wall Street Journal’s “Real Time Brussels” blog (Stevis, 11/26).

“In a statement [on Tuesday], the WHO apologized for the mistake and said it was the result of an editing error,” Fox Business notes, adding, “[T]he WHO said it would be accurate to say that slightly more than half of Greece’s new HIV cases are among those who inject drugs” (Egan, 11/26). “The WHO has admitted that the ‘erroneous reference’ is based on a study published in The Lancet by Alexander Kentikelenis and colleagues in September 2011,” according to RT News (11/26). “But that study found only a small number of anecdotal cases of Greek people infecting themselves with HIV to get benefit pay-outs,” Washington Post blogger Max Fisher writes in the newspaper’s “WorldViews” blog (11/26).

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Deaths From 2009 H1N1 Outbreak Likely Higher Than WHO Estimated, Analysis Shows

“Deaths from H1N1 influenza in 2009 may have been 10 times higher than previously estimated, killing 123,000 to 203,000 people from respiratory illness worldwide, according to a new analysis in the journal PLOS Medicine,” published on Tuesday, USA Today reports (Szab, 11/26). “The [WHO] had said there were about 18,500 laboratory-confirmed deaths,” HealthDay News notes (Preidt, 11/26). “The relatively modest number of deaths estimated by the WHO prompted some to question whether the overall response to the 2009 outbreak was excessive,” the Los Angeles Times writes. “However, [the authors of the new analysis] argued that lab-confirmed influenza deaths would underestimate the broad reach of the illness,” the newspaper adds (Morin, 11/26). “This study shows that the actual death toll was much higher than the official count because most infected people never got an H1N1 lab test,” a press release from the George Washington University states (11/26).

“The [new] estimated death toll closely matches that of a study published in June 2012 by the [CDC],” which “estimated that 201,000 people died of flu and respiratory causes and another 83,000 died of related cardiac problems,” the New York Times writes, adding, “Lone Simonsen, an epidemiologist at George Washington University’s School of Public Health who led the new study, said she found it ‘comforting’ that both studies had reached similar conclusions” (McNeil, 11/26). “The most important insight from the analysis, Simonsen says, is that the H1N1 swine flu was hugely variable in how it affected different parts of the world,” NPR’s “Shots” blog states (Knox, 11/26). “[T]he authors note that the vast majority of those non-pandemic deaths were in elderly people,” CIDRAP News reports (Roos, 11/26).

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Controversy Over TB Prize Shows 'Diplomatic Challenges' In Combating Disease, WSJ Reports

The Wall Street Journal examines controversy surrounding “the Kochon Prize, a prestigious honor for major contributions to the fight against [tuberculosis (TB)].” The selection committee chose a Tibetan TB program, the newspaper notes. However, the prize recipient must be approved by the WHO director-general, and “the WHO administration, which advises the director-general, didn’t approve the choice because the hospital has ties to the Tibetan government-in-exile,” which is not recognized by the U.N., the newspaper continues. “The controversy reflects the diplomatic challenges the WHO faces as it tries to combat TB and other health problems globally,” the Wall Street Journal writes (McKay, 11/26).

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IRIN Examines Efforts To Improve HIV Prevention, Treatment Access For Key Groups

“Around the world, the most marginalized groups in society — from Roma to HIV-positive people to sex workers to drug users — are reluctant to access basic health services because they fear arrest, intimidation and harassment,” IRIN reports. “While donors and governments spend vast amounts to put these critical services in place and maintain them, unless the most at-risk people are able to access them, the money is wasted and, perhaps more importantly, the health-related Millennium Development Goals will never be met,” the news service writes and examines a recent report from the Open Society Foundations (OSF), which “documents the impact of creative and low-cost grassroots legal initiatives that can help stop the most discriminated-against groups from falling through the health net” (11/26).

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Wired Examines Polio Eradication Efforts In Pakistan, Afghanistan

In a five-part feature in Wired magazine, journalist Matthieu Aikins examines efforts to eradicate polio, with a focus on Afghanistan and Pakistan. “The global campaign [against polio], decades in the making, has come down to this: an all-out, very expensive effort to eliminate the last few problem areas in some of the most troubled and undeveloped parts of the final three countries where polio is endemic: Afghanistan, Pakistan, and Nigeria. It is one of the most expensive and ambitious global health initiatives today, and it is tantalizingly close to victory,” he writes. The feature includes photography and video (Aikins/Taylor-Lind, 11/21).

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Kenya Vaccinates 5 Million Children Against Polio

“Kenya, which has declared a polio outbreak a public emergency, vaccinated more than five million children to curb the spread of the viral disease after a spate of cases in eastern Africa, the United Nations said,” Bloomberg reports. “While Kenya has confirmed 14 cases of polio since May 14 when the first case in almost three decades was detected, none have been recorded in the past four months, according to [UNICEF],” the news service writes, noting, “The outbreak in the region has been the worst in neighboring Somalia, where vaccination efforts have been prevented by a more than two-decade-long civil war” (Doya, 11/26).

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Rwanda Launches Non-Surgical Circumcision Drive In Effort To Cut HIV Infections

“Rwanda launched Tuesday a national drive to ‘non-surgically’ circumcise 700,000 men in a bid to cut rates of HIV infection, claiming to be the first country in the world to do so,” Agence France-Presse reports. “The government said circumcision was one of its key strategies for “achieving an AIDS-free generation” in Rwanda, AFP writes, noting, “The health ministry said it ‘aims to circumcise 700,000 adult men between ages 15-49’ by the end of 2016.” The news service adds, “Non-surgical circumcision involves a plastic device called PrePex comprising two rings and an elastic band that cuts off blood supply to the foreskin, which shrivels and is removed with the band after a week” (11/26).

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IRIN Examines Health Advancements In Bangladesh, Need For HIV Services Among Migrants

IRIN examines how Bangladesh has significantly improved some health indicators. The Lancet “recently published a series exploring Bangladesh’s surprising success, calling it ‘one of the great mysteries of global health,'” the news service writes. According to the series, non-governmental organization participation, improved access to health services, and the “growing participation of women in the work force and a ‘dramatic’ change in their social status” have contributed to the country’s success. In a separate article discussing health in Bangladesh, IRIN examines the need for HIV services among migrant populations. “Interventions aimed at curbing the burden of HIV among people migrating from Bangladesh to India in search of work risk having only temporary impact if such efforts are not institutionalized as part of cross-border policy, experts say,” the news service writes (11/26).

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DRC Reports Threefold Increase In Malaria Cases In Rebel Stronghold

“There has been a threefold increase in the number of malaria cases recorded in the former M23 rebel stronghold of Rutshuru, in the Democratic Republic of Congo’s (DRC) North Kivu Province, compared to past years,” IRIN reports, noting health officials say ‘[i]nsecurity is exacerbating the spread of the disease.” “Between 2009 and 2012, the cumulative number of malaria case has never exceeded 25,000 per year. But just in 2013, as of [November 20], we had 76,343 cases, of which 27,340 were children younger than five,” Félix Kabange Numbi, DRC’s health minister, told IRIN, the news service writes. “According to Numbi, the situation is ‘under control,’ with response activities ongoing,” IRIN continues, noting, “Supplies from the Global Fund to Fight AIDS, Tuberculosis and Malaria, such as medication, rapid diagnostic kits and other supplies, have been dispatched to health facilities in Rutshuru. A blood collection campaign is also planned” (11/27).

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Liberian Health Official Criticizes 'New Generation' Churches For Hindering HIV/AIDS Efforts

“An upsurge in ‘new generation’ churches that claim to be able to heal or perform miracles is having a damaging effect on Liberia’s progress in fighting HIV/AIDS, a government official said [Tuesday],” Thomson Reuters Foundation reports. “Speaking in the week before World AIDS Day, health ministry official David Logan said there had been a dramatic increase in new generation churches that link their preaching to prevailing local beliefs in healing or miracle cures, with the result that people with HIV were not seeking proper medical treatment,” the news service continues. “Liberia … has around 18,000 people who need antiretroviral therapy (ART),” with only 6,000 currently receiving ART, the news service notes. “The national program is now working closely with these new churches so that they direct known HIV cases to our designated centers for medical care while they provide spiritual support,” Logan said, according to Reuters (Hussain, 11/26).

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AIDS Activists Commend, Criticize Uganda's Option B+ Implementation

“Uganda has gotten plenty of kudos and some criticism over its roll out of the new antiretroviral therapy for pregnant women and their babies, known as Option B+,” Inter Press Service reports. “Recommended by the [WHO] in June 2012, Option B+ consists in life-long provision of [antiretroviral (ARV)] therapy to pregnant women regardless of their CD4 count,” the news service writes and summarizes comments from AIDS activists, who “welcomed the roll out but voiced some concerns.” According to IPS, the International Community of Women Living with HIV/AIDS in Eastern Africa (ICWEA) said in a statement, “We strongly support Option B+ … But we are gravely concerned … about two major early challenges, loss to follow-up and weak engagement of communities, which will lead to weak demand for this service” (Michael, 11/27).

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Multivitamins Help Delay Antiretroviral Use Among New HIV Patients, Study Shows

“New research from Africa suggests that basic multivitamin and selenium supplements might greatly lower the risk that untreated people with the AIDS virus will get sicker over a two-year period,” HealthDay News reports (Dotinga, 11/26). “Patients taking a daily combination of vitamins B, C and E along with selenium for two years were able to delay their need for antiretroviral therapies by about half compared with those given a placebo, according to research published in the Journal of the American Medical Association,” Bloomberg writes. “The findings are the first to show that vitamins and selenium can postpone illness in newly diagnosed HIV patients (Ostrow, 11/27). Study author Marianna Baum of Florida International University’s Stempel School of Public Health “didn’t have information about the costs of the supplements, but she said they are low,” HealthDay notes (11/26).

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Editorials and Opinions

U.S. Should Intensify Efforts To Expand HIV Treatment, Develop Vaccine, Find Cure

“[I]n a remarkable show of wise bipartisan support, on [November 19] the U.S. Congress reauthorized [PEPFAR] and the U.S. investment in the Global Fund to Fight AIDS, Tuberculosis and Malaria by passing legislation to extend the program’s authorization,” Myron Cohen, associate vice chancellor for global health at the University of North Carolina at Chapel Hill, and the architect and principal investigator of the multinational HPTN 052 trial, writes in The Hill’s “Congress Blog.” “This decision will save millions of lives and is a terrific example of the U.S. engaging in ‘health diplomacy,'” he states, adding, “But it is only one, vitally necessary step.”

“The week before, 40 U.S. legislators urged the president to double the number of people currently supported on treatment through PEPFAR,” Cohen notes, adding, “[W]e have known with certainty that early treatment of HIV dramatically reduces transmission of the virus” since the HPTN 052 trial was published three years ago. “By keeping people healthy and reducing new infections, early treatment of HIV proves to be a great investment,” he continues. “History tells us that when we are making progress against an infectious disease, we must not relax,” he writes, and concludes, “For HIV we must redouble our efforts in every regard: to get more people treated as quickly as possible, to make a vaccine, and to find a cure” (11/26).

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HIV Care Cascade Critical To Achieving AIDS-Free Generation

“The cascade of HIV care — an approach that links prevention outreach, testing and treatment services across a continuum of care — helps identify the key opportunities to improve services to stop the spread of HIV. This tool has come to Vietnam at a critical time,” Ward Cates, president emeritus of FHI 360, and Caroline Francis, deputy country director at FHI 360 Vietnam, write in the Huffington Post’s “Impact” blog. “The improvements that result from using the cascade approach can make a tangible difference in people’s lives,” they write and describe how the country is at a “tipping point.” Cates and Francis conclude, “FHI 360, through the Sustainable Management of the HIV/AIDS Response and Transition to Technical Assistance (SMART-TA) project funded by [USAID], is introducing the cascade to the Vietnamese government and civil society organizations across the country. … By supporting Vietnam in using the cascade and other tools in the fight against HIV, we believe that, together, we can achieve an AIDS-free generation in Vietnam and other countries” (11/26).

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Compassion Necessary Component For Ending AIDS

In an Atlantic opinion piece, singer and songwriter Sir Elton John writes about his experiences with HIV/AIDS and recounts the work of several organizations, including the Elton John AIDS Foundation. “I’ve seen the difference these heroes are making. … I’ve seen with my own eyes what’s possible when compassion is put into practice,” he writes. “It’s crucial to treat every single person — regardless of background or circumstance or HIV status — as a whole person, as an individual with dreams to fulfill and goals to achieve. When we treat people as worthy of love, their worth is realized for all the world to see. Ultimately, this is the most powerful weapon we have against stigma, and indeed against AIDS,” he continues, concluding, “Whether you are the richest man alive or you have absolutely nothing, you deserve to be treated with dignity and compassion. That is the insight that inspires the work of my foundation. And that, I have come to believe, is how we will end AIDS” (11/26).

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TB Is An Evolving Threat Globally, In U.S.

In a Newsweek opinion piece, Polly Price, an author and law professor at Emory University, examines the evolving threat of tuberculosis (TB) — “not only in the developing world, but also inside the United States, where the [CDC] recorded nearly 10,000 cases of TB last year.” She highlights the issue of drug resistance, examining the spread of and treatment options for “ordinary” TB, extensively drug-resistant tuberculosis (XDR-TB), and multidrug-resistant tuberculosis (MDR-TB). She discusses funding issues, noting, “TB treatment is time-consuming and expensive, even for the most routine, nonresistant occurrences of the disease.” She adds, “Public health is always ‘local,’ in the sense that it’s primarily about individuals, their loved ones, and communities. But preventing epidemics requires a broader vision and long-term investment” (11/26).

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From the Global Health Policy Community

Blog Examines CDC Data On Determinants Of HIV Treatment Attrition

In a joint post in the Center for Global Development’s (CGD) “Global Health Policy” blog, “the second in a series of three on the quality of PEPFAR’s HIV treatment programs,” Mead Over, a senior fellow at  CGD, and research assistant Yuna Sakuma examine “why some facilities do better than others [in reducing patient attrition over the course of the treatment cascade] and what factors contribute to treatment success.” They note that “the CDC has been collecting data at the facility level on three categories of the determinants of quality: the adequacy of input supplies (category 1) and the conformity to norms of managerial practice and clinical practice (categories 2 and 3),” and they discuss the data (11/26).

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Innovative Changes To Health Supply Chains Are Possible

Writing in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog, Wendy Prosser, a program manager with VillageReach, reflects on several “innovative approaches to improving health supply chains” recently presented at the Global Health Supply Chain Summit in Ethiopia. “The next critical step will be to continue these conversations at the country level, where many of these approaches would need to be implemented to actually effect change,” she writes, concluding, “Change cannot be made, however, without the political will and leadership from the ministries of health. And this will only happen through sharing the evidence base, continuing the conversation while recognizing these changes are not easy but they are possible” (11/26).

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New Mothers Need Good Nutrition, Education

“The dreams of new mothers are similar all around the world. Some of the details may vary at the edges, but at the center is a good education,” Roger Thurow, senior fellow for global agriculture and food policy at the Chicago Council on Global Affairs, writes in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog. “And critical to a good education is good nutrition, particularly in the 1,000 days from the time a woman becomes pregnant through the child’s second birthday,” he states, noting, “Any nutritional deficiencies — either from lack of food or a bad diet, or from parasites which deprive the body of the nutrients — delay the brain’s development, sometimes irreparably” (11/25).

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ONE Report Tracks Progress Toward End Of AIDS

“Beginning in 2012, ONE set out to write an annual accountability report, tracking just how much (or how little) progress was being made toward [ending AIDS]. And in this year’s report … we find encouraging news: if current rates of acceleration are sustained, we will achieve the beginning of the end of AIDS by 2015,” Erin Hohlfelder, ONE’s policy director for global health, writes in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog. She examines the factors behind this progress as well as challenges ahead, and writes, “[M]aking the beginning of the end of AIDS a reality requires new resources, new political commitment, and new energy. We hope that the findings of this report call attention to where the world has collectively fallen short, but that it also provides a source of encouragement and inspiration” (11/26).

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Blog Highlights Findings Presented At ASTMH Annual Meeting

The Global Network for Neglected Tropical Diseases’ “End The Neglect” blog features a round up of innovations and findings presented at the recent American Society for Tropical Medicine and Hygiene’s annual meeting. “The Global Network attended many of the sessions, ranging from how to integrate NTD treatments with water, sanitation, and hygiene programs and assessing progress in the fight against lymphatic filariasis to mapping NTDs,” the blog writes and discusses several highlights (Elson, 11/26).

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Aidspan Publishes New Issue Of 'Global Fund Observer'

Aidspan, an independent watchdog of the Global Fund to Fight AIDS, Tuberculosis and Malaria, has published Issue 232 of its “Global Fund Observer.” The issue includes an article on the investigation into allegations of corruption in Cambodia, a commentary on domestic HIV/AIDS spending, and an article on new Aidspan pledges and contributions pages, among other articles (10/26).

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