Senate Committee Holds Hearing on HIV Transmission in Africa; Senate Republicans Question International HIV Prevention Strategies
The Senate Committee on Health, Education, Labor and Pensions yesterday questioned current international HIV prevention programs at a hearing regarding recent research indicating that unsafe medical practices, not unprotected sex, account for the majority of African HIV/AIDS cases, Reuters Health reports (Zwillich, Reuters Health, 3/27). The studies, published in the March issue of the International Journal of STD & AIDS, said that despite the consensus among AIDS organizations that heterosexual contact has accounted for 90% of HIV cases in Africa, only one-third of the total cases have been transmitted in this manner; the researchers conclude that unsafe medical practices are a "much greater risk" in HIV transmission. The findings are based on studies conducted by a team of eight researchers from the United States and Germany led by anthropologist David Gisselquist, in which they reexamined research on HIV epidemiology conducted in Africa up to 1988. The researchers state that previous studies failed to account for the fact that HIV transmission in Africa did not follow the same pattern of other sexually transmitted diseases and that high rates of HIV/AIDS can be attributed to contaminated blood transfusions, the reuse of dirty needles in the administration of vaccinations and injections and the use of improperly cleaned surgical instruments. An UNAIDS/WHO expert group earlier this month rejected the claim, saying that "such suggestions are not supported by the vast majority of evidence" (Kaiser Daily HIV/AIDS Report, 3/25).
Sen. Jeff Sessions (R-Ala.), who called the hearing, "expressed skepticism" about the effectiveness of sexual behavior-based prevention strategies in light of the research and accused the medical community of "ignoring" the study's findings on unsafe health care, Reuters Health reports. Sen. Mike Enzi (R-Wyo.) suggested that further research must be conducted, adding that "the results of such studies should certainly be factored into our global prevention strategies." However, HHS Deputy Secretary Claude Allen agreed with the findings of the UNAIDS/WHO expert group, saying, "We believe that the primary mode of HIV transmission continues to be sexual" (Reuters Health, 3/27). Gisselquist and Columbia University Clinical Health professor Maria Wawer, who has conducted research on AIDS in Uganda, testified at the hearing (Kaiser Daily HIV/AIDS Report, 3/25). The hearing could have a significant impact on the focus of proposed funding to fight AIDS worldwide. Wawer, whose findings indicate that fewer than 10% of new HIV infections in Uganda are due to injections, has said that reallocating funds to focus on unsafe medical practices instead of on heterosexual sex could "backfire" (Kaiser Daily HIV/AIDS Report, 3/25).
Senate Rejects AIDS Amendment to Budget
In related news, the Senate on Wednesday voted 51-47 to defeat an amendment to the fiscal year 2004 budget that would have allocated approximately $725 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria, Reuters Health reports (Reuters Health, 3/27). Sen. John Kerry (D-Mass.), who sponsored the amendment, said that the amendment was designed to increase the funding level to match the amount scheduled to be included in legislation to finance global AIDS prevention and treatment efforts. Kerry said, "[T]he amount of money annually allocated [to address AIDS] falls short of the promises almost every single year," adding, "I ask my colleagues to help us fulfill a promise that has been too long in coming." Senate Majority Leader Bill Frist (R-Tenn.), who sponsored similar legislation last year, expressed opposition to the amendment, saying that it would raise taxes by nearly $1.6 billion (Congressional Record text, 3/26).
A kaisernetwork.org HealthCast of the committee hearing is available online.