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Global HIV/AIDS Focus of Senate Hearing

On April 11, the Senate Health, Education, Labor, and Pensions Committee held a hearing on global HIV/AIDS. Pointing out that HIV/AIDS is the fourth leading cause of death in the world, Sen. Edward Kennedy (D-MA) said that most new infections are among young adults and women. Sen. Kennedy also noted that the committee is drafting legislation that would provide new legal authority and funding to the National Institutes of Health, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, and the Department of Labor to join the global battle against HIV/AIDS by promoting community-based care models, providing better access to microbicide research and retroviral therapies, and funding research and treatment models to prevent the transmission of HIV/AIDS from mothers to their infants.

Sen. Hillary Rodham Clinton (D-NY) added that because the “issue has enormous impact” here and abroad, she hoped that the “U.S. efforts would be significant” in the battle against HIV/AIDS.

Sen. Bill Frist (R-TN) agreed saying that the United States has “an opportunity to address the global challenge of combating AIDS…. It is time for us to act.”

In her testimony, Sandy Thurman of the International AIDS Trust compared HIV/AIDS to “a plague of biblical proportion.” She said that, to date, 25 million men, women, and children have already died from HIV/AIDS and that it is projected that by the end of the decade, more than 44 million children will have been orphaned by the disease. Ms. Thurman stressed that given these statistics, the fight against HIV/AIDS can no longer be a choice between prevention and treatment. She said, “Survival is not an either or proposition. Prevention and treatment are both essential and mutually reinforcing strategies.”

Dr. Peter Mugyenyi of the Joint Clinical Research Center explained how HIV/AIDS has devastated Africa. He said that in Botswana, over 50 percent of women attending antenatal clinics are HIV-positive and of these women, over 30 percent will give birth to infected children. Dr. Mugyenyi also noted that during the early 1990s, Uganda had the highest prevalence of HIV/AIDS in the world. However, after the government implemented preventive measures such as improving public information, communication, and education, the rate of HIV/AIDS in some antenatal clinics was reduced from over 30 percent to 6.2 percent. Dr. Mugyenyi admitted that although this was a great advancement, the rate was still “unacceptably and appallingly high.”

Another witness, Dr. Allan Rosenfield of the Mother-To Child Transmission (MTCT) Plus Initiative testified that mothers and children are suffering the most from the HIV/AIDS epidemic, noting that more than 1.5 million women die each year from HIV/AIDS, while another 2.5 million become infected with HIV. According to UNAIDS estimates, in 2001, more than 2.6 million pregnant women were HIV-positive and more than half a million infants were born with the virus.

Dr. Rosenfield explained that the MTCT-Plus program “provides a path towards bringing HIV care to women and their children.” Currently, there are approximately 200 MTCT sites in more than 20 countries. Under the program, single doses of the antiretroviral drug, Nevirapine, are given to the mother and child. Nevirapine, Dr. Rosenfield said, “has been shown to cut transmission of the virus nearly in half and costs $4 for the mother and child.”

Although the programs to prevent mother-to-child transmission are a “tremendous step forward,” Dr. Rosenfield said that the downside is that “the children we save are likely to be motherless by the time they can walk.” Adding, “We face a social and moral imperative to treat the mothers,” he noted that MTCT-Plus will add care and treatment of HIV-infected mothers and families to existing MTCT prevention programs as an example of how prevention and care can come together.

Sir Elton John, the singer, said that since 1992, the Elton John AIDS Foundation has worked to eliminate prejudice against people with HIV/AIDS, to educate people about how to prevent HIV/AIDS, and tried to provide service and support to people living with HIV/AIDS and children orphaned by HIV/AIDS. He stressed that the “people out on the front lines fighting this disease need reinforcements,” reinforcement that would come with greater funding. He said that 95 percent of new infections occur in poor countries and that the people living in those countries do not have the resources to defeat it.

He concluded, “If the world is going to make a significant, decisive intervention to change the course of this pandemic, it’s going to have to start [with the United States]. And it might as well start now.”

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