Most Democratic presidential candidates would support lifting a ban on federal funding for needle-exchange programs and replacing abstinence-only sex education with comprehensive HIV prevention programs if elected, according to a survey released Wednesday ahead of World AIDS Day, the AP/Sioux City Journal reports. The survey was conducted by AIDS Project of Central Iowa, Planned Parenthood of Greater Iowa and several other groups in the state. It included three questions and was sent to Democratic and Republican presidential candidates (AP/Sioux City Journal, 11/29).

The questions are:

• Do you support the Early Treatment for HIV Act (ETHA), which expands Medicaid for HIV-positive people who would otherwise need to become completely disabled in order to qualify for Medicaid-covered services?
  
  
• Do you support the replacement of funding for international and domestic "abstinence only" HIV prevention programs with scientifically based, comprehensive, age-appropriate sexuality education programs?
  
  
• Do you support access to sterile syringes, as a means of protecting public health, by lifting the ban on federal funding for syringe exchange? (Survey text, 11/28).
  

Among the Democratic candidates, Sen. Joe Biden (Del.), former Sen. John Edwards (N.C.), Sen. Barack Obama (Ill.) and New Mexico Gov. Bill Richardson met the deadline for the survey and all answered "yes" to the three questions. Answers from Sen. Hillary Rodham Clinton (N.Y.) were too late to be included in materials distributed by the coalition. However, her campaign "did respond 'yes' to the questions" after the deadline, Becky Johnson with the AIDS Project of Central Iowa said.

Former New York City Mayor Rudy Giuliani and former Massachusetts Gov. Mitt Romney, both of whom are running for the Republican presidential nomination, declined to answer the questionnaire. The remaining Republican and Democratic candidates did not respond, according to the AP/Journal.

The coalition in a statement said there has been a "lack of leadership at all levels that has allowed HIV to continue to spread through inaction and failed promises." The other agencies involved in the questionnaire include the American Red Cross Central Iowa Chapter, Lutheran Services in Iowa Refugee Cooperative, Urban Dreams, Community HIV/Hepatitis Advocates of Iowa Network and Creative Visions (AP/Sioux City Journal, 11/29).

The questionnaire is available online (.pdf)

  BEIJING, Dec. 2 (Xinhua) -- Members of public, celebrities and condom manufacturers embarked on a "Great AIDS Walk" at the Great Wall on a chilly Sunday morning to generate funds for the country's fight against HIV/AIDS and raise public awareness of the disease.

    The four-kilometer walk at Juyongguan Great Wall, jointly organized by UNAIDS and China Red Cross Foundation and with the support of the Global Business Coalition on HIV/AIDS, TB and Malaria (GBC), attracted more than 2,000 people.

    Joining the public were health officials, international organization representatives, NGOs, 1960s ping-pong world champion Zhuang Zedong, Miss China International, foreigners and private sector sponsors.

    Volunteers, most college students, decorated their clothes with blown-up condoms while handing out condoms to passers-by, and children enjoyed themselves by ballooning condoms. Health Minister Chen Zhu warned last week, "Sex has become the main channel of contracting HIV in China."

    Su Juxiang, vice-president of the Red Cross Society of China (RCSC), said at the foot of the Great Wall that the RCSC, as a non-governmental organization that played an increasingly important role in China, would be "committed" to the "humanitarian control and prevention of AIDS"

 "AIDS is a strategic issue concerning the rise and fall of the nation," said Su.

    By the end of October 2007, a total of 223,501 people had been officially reported to have contracted HIV, including 62,838 AIDS patients, according to an appraisal report by the Ministry of Health, the World Health Organization (WHO) and UNAIDS.

    Southwest China's Yunnan Province, the hardest-hit place by the disease, has nearly a quarter of the country's total HIV carriers, a large proportion of whom contracted the virus by sharing intravenous drug needles.

    Though the rate of AIDS growth has slowed, the government has admitted the situation "remains grave" in a country with a population of 1.3 billion. Official reports say there are estimated to be as many as 700,000 people living with HIV/AIDS in China.

    Khalid Malik, UN Resident Coordinator in China, said discrimination was the biggest challenge faced by the fight against the disease, but Chinese leaders including Hu Jintao and Wen Jiabao had vowed to eliminate discrimination, as shown by the theme of this year's World AIDS Day -- "leadership"-- which was marked on Saturday.

    According to the RCSC, the event was aimed at raising awareness of AIDS issues in China, mobilizing leaders in various sectors and generating funds to support the AIDS campaign via the China Red Cross Foundation (CRCF).

    Wang Rupeng, the CRCF secretary-general, said a total of 150,000 yuan (19,700 U.S. dollars) had been raised through the event as each participant had donated at least 100 yuan (13.16 U.S. dollars).

    "All donations for this event will be used to build a 'Sunlight Garden' to conduct peer education and training related to AIDS treatment and care," said Wang.

    The campaign received sponsorship worth more than 600,000 yuan(79,000 U.S. dollars), including 50,000 U.S. dollars from the UNAIDS and more than 400,000 yuan (52.6 U.S. dollars) from the country's private sectors.

China's efforts to fight HIV/AIDS-related discrimination in the country are failing to prevent widespread stigmatization of people living with the disease, United Nations officials said Wednesday, Reuters reports. The officials were speaking at the launch of a United Nations Development Programme initiative, called "Positive Talks," that will train 35 people living with HIV to participate in advocacy, prevention, care and awareness efforts at schools, businesses and hospitals across the country (Reuters, 11/28). UNDP earlier this year called on China's commercial media and private business sectors to increase their efforts to fight HIV/AIDS-related stigma and discrimination in the country.

Stigma and discrimination have been significant obstacles to universal access to HIV prevention, treatment, care and support programs in China. A survey conducted earlier this year at 12 Beijing universities considered to be some of the most progressive in the country found that nearly 25% of students would oppose having HIV-positive classmates. The survey also found that 4% of respondents said people should be refused jobs based on their HIV status (Kaiser Daily HIV/AIDS Report, 8/6).

Subinay Nandy, director of UNDP in China, said that the country has done a "tremendous job" in enacting legislation and policies to prevent HIV/AIDS discrimination but that enduring stigma still prevents HIV-positive people from seeking treatment. "We all will agree, widespread stigmas and discrimination in all sections of societal life here in China as elsewhere still exist at a very high level," Nandy said, adding, "There is a stronger need than ever to reach the general public and humanize the face of the HIV epidemic." UNAIDS Country Director Bernhard Schwartlander said, "People who feel stigmatized will not come forward or dare to seek medical treatment and guidance, and by doing so put further fuel on the fire for the spread of HIV."

According to Reuters, the number of new HIV cases in China has been increasing in recent months. Government data found that the number of new HIV cases on mainland China increased from an average of 3,000 monthly during the first six months of this year to an average of 3,200 monthly from January to October (Reuters, 11/28). UNAIDS has estimated that about 650,000 people in China are living with HIV/AIDS (Kaiser Daily HIV/AIDS Report, 11/7).

A lack of HIV prevention efforts and an increase in risky sexual behaviors among men who have sex with men are fueling an increase in new HIV diagnoses among the group, Kevin De Cock, director of the World Health Organization's HIV/AIDS Department; Ronald Valdiserri of the U.S. Department of Veterans Affairs; and Harold Jaffe, a public health professor at the University of Oxford, write in a commentary in the Nov. 28 issue of the Journal of the American Medical Association, the Washington Times reports.

According to the commentary, the number of HIV/AIDS cases among U.S. MSM increased by 13% -- from 16,167 to 18,296 -- between 2001 and 2005. Syphilis cases also increased 10-fold among MSM (Wetzstein, Washington Times, 11/28). In addition, recent surveys have found an increase in risky sexual behavior among MSM who do not know their partners' HIV status, the authors write (Jaffe et al., JAMA, 11/28).

According to the authors, a lack of awareness about HIV and a decrease in HIV prevention efforts are fueling the increase. HIV/AIDS is "not as frightening as it was" when the epidemic first surfaced because antiretroviral drugs have allowed HIV-positive people to live longer, the authors write. In addition, younger MSM are unfamiliar with the effects of HIV among U.S. MSM in the 1980s, the commentary says.

The authors called on public health and community leaders to increase HIV prevention efforts and education about safer-sex behaviors to help curb the spread of the virus. Leaders also "must call for the end of stigma toward MSM, which may mitigate the internalization of homophobia leading to sexual risk behavior," the authors write. They add that leaders also should "advocate for legal domestic partnerships as a way to promote stable, longer-term" relationships among MSM (Washington Times, 11/28). In addition, HIV testing rates among MSM should be increased because many members of the group are not aware of their HIV status, the authors write. "Failure to address" issues such as testing, funding for public health strategies and community leadership "implies that the HIV/AIDS epidemic in MSM must be accepted as inevitable," the authors write, concluding that "this cannot be allowed to happen. The tragedy of the epidemic for an earlier generation of MSM must not be repeated" (JAMA, 11/28).

A summary of the commentary is available online.

  "Missing the Target #5: Improving AIDS Drug Access and Advancing Health Care for All," International Treatment Preparedness Coalition: The report looked at HIV/AIDS drug access in 14 countries and says that although scale-up is working, high costs, unreliable supplies, and patent and registration issues are primary impediments to improved drug delivery. The report also examined broader issues in HIV/AIDS drug access in nine countries -- Cambodia, Cameroon, China, the Dominican Republic, India, Kenya, Russia, Zambia and Zimbabwe. In addition, the report lists specific issues and makes recommendations to improve drug access in the 14 included countries (ITPC release, 11/27).

Sen. Hillary Rodham Clinton (N.Y.), who is running for the Democratic presidential nomination, on Tuesday while campaigning in South Carolina is expected to announce a plan to fight HIV/AIDS domestically and abroad, the New York Times reports. Clinton's "two main rivals" for the Democratic nomination -- Sen. Barack Obama (Ill.) and former Sen. John Edwards (N.C.) -- already have released HIV/AIDS plans, the Times reports. The three plans are "similar in terms of spending, goals and differences with President Bush's AIDS policy," according to the Times.

Clinton's plan, like Edwards' and Obama's, will propose spending at least $50 billion by 2013 on initiatives to fight HIV/AIDS worldwide. The Bush administration has allocated $30 billion for the same time period. Clinton's plan also will propose doubling funding for HIV/AIDS research at NIH to $5.2 billion annually. Edwards' plan, which was released in September, pledges to "strengthen" spending for such research, while Obama, who released parts of his plan at different times throughout the year, said he would "expand" research funding.

According to the Times, the three plans would not focus HIV prevention strategies on abstinence-only education. A paper provided by Clinton's campaign that outlines her plan says that she supports providing young people with "age-appropriate information about HIV/AIDS and how to protect themselves against it." Clinton, Edwards and Obama also all support federal funding for needle-exchange programs.

In addition, the paper outlining Clinton's plan says that she would work to "significantly" reduce the number of new HIV cases in the U.S. each year, as well as to establish measureable targets and timelines for expanding prevention and treatment services. Obama's plan for reducing new cases is "almost identical to what [Clinton] proposes," the Times reports. Edwards has said that his plan for reducing new cases includes holding his HHS secretary "accountable" for releasing an annual HIV/AIDS report that demonstrates progress toward Edwards' targets. Edwards also has said that he would appoint a "strong" director for the White House Office of National AIDS Policy.

Clinton, Edwards and Obama all pledge to provide HIV-positive people with improved medical care, primarily through health insurance programs that the three candidates have proposed this year. According to Clinton campaign advisers, she thinks that the current federal plan to combat HIV/AIDS is "diffuse and uncoordinated," according to the Times.

Although HIV/AIDS plans have not been a primary topic among the leading Republican presidential candidates, some have spoken about how increased efforts are needed, according to the Times. Former New York City Mayor Rudy Giuliani, who is running for the Republican presidential nomination, has said that he would increase funding for Bush's HIV/AIDS programs in Africa. He added that he would provide aid to fight malaria in Africa, as well as aim to bolster trade between the U.S. and the continent (Healy/Altman, New York Times, 11/27).

Washington, D.C., Mayor Adrian Fenty's administration on Monday pledged to triple within one year the number of no-cost condoms distributed by the city, as well as to work with hospitals to increase HIV testing in emergency departments, in an effort to curb the spread of the virus, the Washington Post reports (Nakamura, Washington Post, 11/27).

The announcement follows the release of a report that called HIV/AIDS a "modern epidemic" in the district with "complexities and challenges that continue to threaten the lives and well-being of far too many residents." According to the report, almost 12,500 district residents were known to be living with HIV/AIDS in 2006. Thirty-seven percent of HIV cases were transmitted through heterosexual contact, compared with 25% that were transmitted among men who have sex with men.

The number of HIV cases in the district began declining in 2003, but the decrease likely is the result of underreporting or delayed reporting, the report said. One in 20 district residents is HIV-positive and one in 50 is living with AIDS, according to Shannon Hader, head of the city's HIV/AIDS Administration. The city's cumulative number of AIDS cases is more than 17,400.

More than two-thirds of AIDS cases in the district during the past 10 years were among people who progressed to AIDS within one year of being diagnosed with HIV, compared with 39% of AIDS cases nationwide, the report found. The report also found that more people ages 40 to 49 were being diagnosed with HIV than any other age group. In addition, all of the 36 children in the district who tested positive for HIV since 2002 contracted the virus during birth (Kaiser Daily HIV/AIDS Report, 11/26).

Hader said the HIV/AIDS Administration plans to scale up several initiatives that began before she started at the administration in October, the Post reports. Hader also said that she hopes to increase the number of no-cost condoms distributed by the city to three million by 2009 to help prevent the spread of HIV. She added that she wants to "challenge" all hospital EDs to offer "rapid HIV testing" to help diagnose the virus in earlier stages. George Washington University Medical Center and Howard University Hospital have the only EDs that currently offer HIV testing, Hader said. In addition, Hader said she plans to collaborate with the city's seven birthing centers to draft guidelines and set up outreach and testing sites to help prevent mother-to-child HIV transmission.

"These things have already been started, but we want to use the report to build on them," Hader said, adding, "We're using all the tools in the tool kit, and we're also looking at all of our tool kits, figuring out where there are gaps." Hader said she does not plan to request more HIV/AIDS funding in the coming year but added that if early testing and treatment rates are increased, the programs could become more costly (Washington Post, 11/27).

Related Editorial
The figures in the report are "harrowing," but "with a new director of HIV/AIDS administration, plenty of funding and, now, data, the district stands a chance of beating back this killer that has no cure," a Post editorial says. According to the editorial, doctors and hospitals need to routinely test pregnant women for HIV, and prevention and treatment efforts "must be accelerated." The Post adds that Fenty and Hader have committed themselves to this goal, but "their efforts will be useless if people think they are somehow immune to the epidemic." The editorial concludes that "AIDS is an equal-opportunity killer" (Washington Post, 11/27).

NPR's "The Bryant Park Project" on Tuesday included a discussion with Larry Bryant, an outreach and advocacy worker in the district, about the report ("Bryant Park Project," NPR, 11/27). Audio of the segment is available online.

In addition, WAMU's "The Diane Rehm Show" on Tuesday is scheduled to include a discussion with Anthony Fauci, director of the National Institute of Allergy and Infectious Disease at NIH, about the report and other issues related to HIV/AIDS ("The Diane Rehm Show" Web site, 11/27). A broadcast schedule and additional details about the segment are available on the program's Web site. Audio of the segment will be available online about one hour after the broadcast.

Ahead of the Commonwealth Heads of Government Meeting, which opened on Friday, Queen Elizabeth II on Thursday praised efforts of health organizations and the Ugandan government to combat the spread of HIV in the country, AFP/Yahoo! News reports (AFP/Yahoo! News, 11/22). Queen Elizabeth also visited a clinic and children's hospital run by U.K.-based charity Mildmay.

Queen Elizabeth in a speech to members of Uganda's parliament and President Yoweri Museveni said the "scourge of HIV infection and AIDS has touched the lives of so many of Uganda's people," adding, "Yet there are growing numbers of people and organizations whose work gives cause for real hope." The role of centers such as the Mildmay-run clinic will be "central to achieving our common aim of controlling" HIV/AIDS, Queen Elizabeth said. Museveni in a speech praised Uganda's partnership with the United Kingdom, adding that the country is "ready to work with Britain on a range of global issues" (Jones, Press Association, 11/22).

Commonwealth Countries Should Take Action Against HIV/AIDS, Group Says
In related news, Para 55, also known as the Commonwealth Action Group on HIV and AIDS, on Saturday called on countries in the Commonwealth of Nations to take action against HIV/AIDS and provide universal access to antiretroviral drugs, Xinhua News Agency reports. According to statistics, Commonwealth countries account for 60% of the global HIV/AIDS burden and are home to the majority of AIDS orphans.

The group urged Commonwealth leaders in their final document to be released following the Heads of Government Meeting, which ended on Nov. 25, to "make a bold commitment to work together and take action to deliver on improved health for all and keep the promise" to achieve "all health-related Millennium Development Goals by 2015." The group also called on member states to fully utilize World Trade Organization provisions that secure access to affordable drugs, Xinhua News Agency reports.

Anton Kerr, deputy chair of Para 55, said, "Greater collaboration among Commonwealth member states is needed to overcome key barriers, including appropriate levels of financing, to realize the promise to provide universal access to HIV prevention, treatment, care and support by 2010." Richard Matikanya of Para 55 said, "It is only through a determined, comprehensive and collective response by Commonwealth member states that we can significantly turn the tide against HIV and deliver the promise of universal access" (Xinhua News Agency, 11/24).

New UNAIDS figures that indicate between 900,000 and one million people in Russia are HIV-positive are "exaggerated," Gennady Onishchenko, the country's top health official, said on Monday, RIA Novosti reports. Onishchenko added that the "data gathering techniques" used by the agency are not "understandable" to Russian officials (RIA Novosti, 11/26). UNAIDS in a report released last week said that Russia represents 66% of the number of newly diagnosed HIV cases among former Soviet Union countries. Michel Kazatchkine -- executive director of the Global Fund To Fight AIDS, Tuberculosis and Malaria -- on Monday when discussing the Russian estimates said that UNAIDS had completed substantial work "in order to obtain objective figures," AFP/Yahoo! Health reports (AFP/Yahoo! Health, 11/26).

Onishchenko said that Russia has registered 403,000 HIV cases since 1987, when the first case of the virus was reported in the country. "Russia is the only country which carries out testing of risk groups," he said, adding that this year, 22 million people will be tested for HIV (RIA Novosti, 11/26). Russian experts say the actual number of HIV-positive people in the country is about 1.3 million (AFP/Yahoo! Health, 11/26).

Washington, D.C., health officials on Monday released new data on HIV/AIDS in the city, the Washington Post reports. The report, which is the first update on HIV/AIDS in the district since 2000, is a statistical analysis and not an estimate of HIV prevalence in the district, according to the Post.

According to the report, almost 12,500 district residents were known to be living with HIV/AIDS in 2006. The number of HIV cases in the district began declining in 2003, but the decrease likely is the result of underreporting or delayed reporting, the report said. One in 20 district residents is HIV-positive and one in 50 is living with AIDS, according to Shannon Hader, head of the district's HIV/AIDS Administration. The city's cumulative number of AIDS cases is more than 17,400, according to the Post.

More than 80% of the HIV cases diagnosed in the district between 2001 and 2006 were among black men, women and adolescents, the report found. Nine in 10 women who tested positive for HIV were black, according to the report. In addition, about 37% of HIV cases were transmitted through heterosexual contact, compared with 25% that were transmitted among men who have sex with men, the report said.

More than two-thirds of AIDS cases in the district during the past 10 years were among people who progressed to AIDS within one year of being diagnosed with HIV, compared with 39% of AIDS cases nationwide, the report found. The report also found that more people ages 40 to 49 were being diagnosed with HIV than any other age group. In addition, all of the 36 children in the district who tested positive for HIV since 2002 contracted the virus during birth.

"HIV/AIDS in the district has become a modern epidemic with complexities and challenges that continue to threaten the lives and well-being of far too many residents," the report said. The report added that the analysis will offer the district a "new tool to help improve the scope, quality and distribution of care, and treatment and prevention services."

Reaction
According to Hader, the report's finding that more than 37% of HIV cases were spread through heterosexual contact "blows the stereotype out of the water." She added that HIV is "everybody's disease" in the district. District Mayor Adrian Fenty in a letter accompanying the report said that city officials "must take advantage of this information with the sense of urgency that this epidemic deserves." The HIV/AIDS Administration said it will use the report to determine the next steps in curbing the spread of the virus. Health officials added that they will not focus on any one aspect of the disease or on a single group at high risk of HIV/AIDS. "We don't have the luxury of only picking one," Hader said, adding, "We have the imperative to do it all" (Levine, Washington Post, 11/26).

Multimedia Coverage
ABC's "Nightline" on Friday reported on HIV/AIDS in Washington, D.C., and efforts to educate teenagers about the disease. The segment includes comments from Nicole Styles and Arnita Michelle Wilson of Metro TeenAIDS, as well as Christopher Barnhill, an HIV-positive district resident (Tapper, "Nightline," ABC, 11/23). Premium video of the segment and expanded ABC News coverage are available online.

In addition, NPR's "Bryant Park Project" on Monday reported on the data (Martin, "Bryant Park Project," NPR, 11/26). Audio of the segment is available online.