Fauci to Present Research Update at World AIDS Conference in Bangkok

At the XVth International AIDS Conference in Bangkok, Thailand, Anthony S Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID) and chief of the NIAID Laboratory of Immunoregulation (LIR), will present his laboratory’s latest findings on how aberrant immune activation underlies HIV pathogenesis. NIAID is part of the National Institutes of Health.

Dr. Fauci is scheduled to deliver his special lecture, entitled „Pathogenic Mechanisms of HIV Disease: The Role of Viral Replication and Immune Activation,“ on July 15 at 12:30 p.m. Bangkok time (1:30 a.m. Eastern Time). He will present new data that underscore the paradoxical nature of HIV infection: the very immune cells that are activated to destroy the virus provide a permissive environment for virus propagation and persistence.

A detailed news backgrounder on his talk can be found at www2.niaid.nih/Newsroom/Releases/aidsbangkok.htm.

NIAID is a component of the National Institutes of Health, an agency of the U.S. Department of Health and Human Services. NIAID supports basic and applied research to prevent, diagnose and treat infectious diseases such as HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis, malaria and illness from potential agents of bioterrorism.

NIAID also supports research on transplantation and immune-related illnesses, including autoimmune disorders, asthma and allergies. Press releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at niaid.nih.

CONTACT:
Nancy Touchette, Ph.D.
301-451-1402

American Association For Homecare Disputes Validity Of Internet Power Wheelchair Prices As Basis For Reimbursement Of Services In Medicare

The American Association for Homecare vigorously disputed the validity of using Internet prices for power wheelchairs as a basis for setting reimbursement rates for power wheelchairs provided to seniors and disabled beneficiaries in Medicare.

The Association outlined its concerns in letters sent to Daniel Levinson, Inspector General for the U.S. Department of Health and Human Services Office of Inspector General (OIG), and to Congressman Pete Stark (D-Calif.), who chairs the House Ways and Means Subcommittee on Health.

On October 30, the OIG issued a report titled, „A Comparison of Medicare Program and Consumer Internet Prices for Power Wheelchairs,“ which concluded that, „Medicare and its beneficiaries could have achieved savings during the first quarter of 2007 had Medicare reimbursements more closely resembled prices available to consumers over the Internet.“ AAHomecare strongly questions the appropriateness of the OIG comparison and its policy implications for Medicare reimbursement rates.

Tyler J. Wilson, president of the American Association for Homecare, commented, „This study and the inappropriate comparison of Medicare and Internet pricing will be used by some members of Congress to justify further cuts to power wheelchair Medicare reimbursement rates and defend the new competitive bidding program. We urge Congress to evaluate Medicare reimbursement for power wheelchairs in the correct context.“

In today’s letters to both Inspector General Levinson and Congressman Stark, the Association made several points:

– The cost of acquiring power wheelchairs used by Medicare beneficiaries through the Internet does not in any way compare to the cost of providing these devices to Medicare beneficiaries while adhering to the appropriate standards of care. The implied cost savings of Internet pricing is extremely misleading.

– In a previous OIG analysis of power wheelchair prices titled, „A Comparison of Prices for Power Wheelchairs in the Medicare Program“ from April 2004, the OIG acknowledged that, „The estimates of potential program savings presented in the findings of the report would be lower if median prices had included any supplier administrative costs.“

– Internet pricing does not account for the specialty evaluations performed by certified medical professionals, training, repairs and other non-equipment costs that are required in furnishing power wheelchairs to Medicare beneficiaries. Under Medicare, durable medical equipment providers must shoulder the expense of evaluating the beneficiary’s specific needs, assessing the home, assembling the wheelchair, delivering the equipment to the home, conducting customized on-site fitting to accommodate the individual’s seating needs, performing on-site training, processing claims for payments to insurers, and maintaining facilities to provide service and repair. Any accurate analysis of costs required to provide the expected Medicare standard of care must take into account these services and administrative costs, which are distinct from the costs of acquiring the equipment.

– Internet prices for power wheelchairs are an inappropriate and inaccurate source of data for establishing Medicare fees for these devices. Use of such data would skew the median price downward because the data does not account for all of the required services and activities necessary to furnish power wheelchairs to Medicare beneficiaries in a manner that ensures the beneficiary’s safety and complies with standards applicable to Medicare enrolled providers.

The American Association for Homecare is working on scheduling meetings with both Congressman Stark and with Inspector General Daniel Levinson to rebut the „apples to oranges“ comparisons made by the OIG study.

The American Association for Homecare represents providers, equipment manufacturers, and other organizations in the homecare community. Members serve the medical needs of millions of Americans who require oxygen equipment and therapy, mobility assistive technologies, medical supplies, inhalation drug therapy, home infusion, and other medical equipment and services in their homes.

American Association for Homecare

Standardized Echinacea product reduces the severity and duration of cold & flu

Canadian-based Company, Factors R & D Technologies Ltd, has achieved a breakthrough as a science and research company.
The Company has definitively proven that its standardized Echinacea product – ECHINILIN® — reduces the severity and duration
of cold and flu symptoms.

A British journal has published the Company’s clinical trial results by its science team regarding the early intervention
with an Echinacea purpurea preparation, ECHINILIN, for effectively treating the common cold. Focus on Alternative and
Complementary Therapies (also known as FACT) reviewed the Phase II clinical trial results in the September issue of its
quarterly publication.

According to the review, as published on the FACT site (ex.ac/FACT),

the Factors R & D Science team was „the first to use a standardized Echinacea extract (alkamides, cichoric acid and
polysaccharides) to demonstrate statistically significant evidence of consistent effectiveness against naturally acquired
cold viruses.

Dr. Richard Barton, Department of Biochemistry and Molecular Biology at the University of British Columbia and co-director of
the human clinical studies says, „We saw a sustained increase in nature killer cells (NK cells) in participants when they
were given ECHINILIN which no doubt contributed to a more active immune system resulting in the destruction of virus-infected
cells.“

„The end result was a remarkably high reduction in both severity of symptoms and duration of the infection,“ says Dr.
Barton.

Dr. Barton says, „There have been numerous studies examining the immune-modifying potential of Echinacea preparations. But
none, to my knowledge, have used a standardized extract“.

He says that the rationale for the standardization, selected component ratios and dosing levels for Echinacea products are
further supported by the conclusive results obtained in this particular clinical trial.

This is the second published study for Dr. Barton and his team. The Journal of Clinical Pharmacy and Therapeutics published
an article on Dr. Barton’s study earlier this year.

Estimates suggest that colds and flu affect approximately 72 per cent of Canadians each year. It is believed that the social
costs surrounding the common cold are at least $400-million per year which makes it more costly than asthma, congestive heart
failure and chronic obstructive pulmonary disease combined. Visit our website at echinilin

Factors R & D Technologies Ltd. is Canada’s leading research organization in evidence-based phytopharmaceuticals. The
Company’s science team is comprised of international experts in their field-some of whom hold positions at universities in
Alberta, British Columbia, Dalhousie, and Toronto in Canada and in Graz in Austria. Factors R & D coordinates all research
and development of the 500-plus products for the Factors Group. Research projects include the agronomy of herbal and other
medicinal plants, organic farming methods, extraction processes, laboratory testing and human clinical trials.

For further information or interview requests, please contact:
Kate Jobling
Media & Public Relations
Factors R & D Technologies Ltd.
Direct: 604-415-4181
Email: kjoblingfactorstechnologies

Kansas State University researcher working to improve alternatives to equine antibiotics

Antibiotics can save lives, but the increasing occurrence of antibiotic-resistant bacteria presents a number of challenges for researchers in medicine.

Veterinary medicine is no exception and Dr. Elizabeth Davis, assistant professor of equine internal medicine at Kansas State University, is working to help improve alternative methods for combating infectious diseases in horses.

„In veterinary medicine and medicine in general, we’re running out of antibiotics, so we have to be extremely careful of the antibiotics we use, the duration that we use them and the species that we use them in,“ Davis said.

To help better prepare the horse industry for a limited number of effective antibiotics, Davis has researched the presence of antimicrobial peptides in horses. According to Davis, antimicrobial peptides are produced by the body as an immediate immunological response to pathogens and generally target and kill bacteria. Davis recently found genetic information relating to two of these peptides in horses.

The idea of stimulating the immune system to help animals efficiently and naturally fight infection is nothing new, Davis said. There are a number of commercial immune stimulants on the market, but they are rather mild and often have to be used in conjunction with antibiotics.

Specific DNA sequences found within one such stimulant are known as CpG motifs. These specific DNA sequences might be what stimulate an effective immunological response, Davis said. With hopes of helping to develop more powerful immune stimulants, Davis is examining different DNA sequences containing immunostimulatory CpG motifs to identify which sequences contain the most effective motifs.

„In effect, what we may be able to do is specifically turn on antimicrobial peptide production and other immune response factors that help ward off infection,“ Davis said. „What it would mean is we hope we could use shorter antibiotic therapy.“

Davis said she also hopes to find which motifs are the most stimulating to equine immune cells as well as how the immune response is initiated. Such research would continue to drive the development of more effective commercial immune stimulants.

„I think we could improve on something that works well,“ Davis said about the commercial stimulants. „The ultimate goal would be to reduce antibiotic usage for infectious diseases. People do commonly use the commercial products, so I think there would be some interest to have something that was better.“

Davis is completing her Ph.D. under the direction of Dr. Frank Blecha.

„The antimicrobial peptide cloning/sequencing work has been part of my graduate work; the immunomodulation with CpG DNA studies are my current focus,“ Davis said.

Contact: Elizabeth Davis, DVM
edavisvet.k-state.edu
785-532-5700
Kansas State University

New Bacterial Signaling Molecule Could Lead To Improved Vaccines

Many disease-causing microbes carry pumps that expel antibiotics, making the bugs hard to kill with standard drugs.

Ironically, these same pumps could be the bugs‘ Achilles heel.

University of California, Berkeley, scientists have found that the molecular pumps in Listeria bacteria, and perhaps in other pathogens, also expel small signaling molecules that stimulate a strong immune response in the cells they infect. A robust immune response, involving mobilization of killer cells and a host of other defenses, is needed to kill bad microbes before they can do damage

The surprising find that bacteria pump out a totally new and highly immunogenic molecule suggests that it may be possible to improve vaccines that use live or disabled bacteria to activate the immune system. These vaccine-grade bacteria could be engineered to ramp up production of the signaling molecule or ramp up the number of pumps, for example.

„We think this could translate directly into better vaccines,“ said Daniel Portnoy, UC Berkeley professor of molecular and cell biology and of public health and associate faculty director of the campus’s Center for Emerging and Neglected Diseases. „We can certainly get Listeria bacteria to make more of this molecule; we already have a mutant that does that.“

The researchers report their discovery, funded in part by the American Recovery and Reinvestment Act (ARRA) through the National Institute of Allergy and Infectious Diseases of the National Institutes of Health, in the May 28 issue of the journal Science.

For more than 20 years, Portnoy has been studying Listeria monocytogenes bacteria, which cause the serious foodborne illness listeriosis, to understand how they generate an unusually strong immune response in host cells. What he learns could help boost the effectiveness of a Listeria vaccine, but he also hopes to use the bacteria’s powerful immunogenicity to boost the effectiveness of vaccines for other diseases and even for cancer. Several years ago, in collaboration with investigators at Aduro Biotech, he successfully inserted cancer antigens into Listeria to stimulate both an „innate“ immune response and a potent „acquired“ immune response, in effect delivering a one-two punch to cancer cells.

So far, Portnoy has found that the Listeria bacteria have to be alive and able to enter the cell’s guts, the cytosol, in order to stimulate a strong innate immune response. Once the bacteria are detected, the cell responds with the release of Type I interferon, a molecule that actives immune cells and other defenses, and is currently used to increase the effectiveness of treatments for cancer and viral infections.

The mystery was what live Listeria secrete to stimulate the production of interferon by the host cell.

„We think this is the magic molecule we have been searching for for years,“ Portnoy said. „This is the molecule Listeria use to activate that so-called cytosolic surveillance pathway that leads to interferon.“

He and post-doctoral chemist Joshua Woodward discovered the small molecule, cyclic-di-AMP, by studying mutant Listeria that, when infecting immune cells called macrophages, overproduce interferon. Based on previous work in Portnoy’s lab, they knew that these mutants actually make an unusually large number of pumps, which are known as multidrug efflux pumps because they typically can rid bacteria of a variety of drugs.

Woodward collected fluid from cultures of mutant bacteria and, to determine its constituents using mass spectrometry, enlisted the help of Anthony Iavarone, a research scientist with the California Institute for Quantitative Biosciences (QB3) at UC Berkeley.

Of the molecules in the fluid, only one stimulated interferon production in macrophages. Woodward and Iavarone identified it as cyclic-di-AMP, a molecule discovered only two years ago in the bacteria Bacillus subitlis and thought to be involved in the production of spores. Its role in Listeria is unknown.

„We actually think that the bacteria are probably secreting it all of the time, and that the molecule only gains access to the cytosol when Listeria breaks open that vacuole and the molecule tells the host that the bacteria has also gotten in,“ Woodward said.

A search through the genomes of other pathogens shows that not only Listeria, but also the Staphylococci, Streptococci, Mycobacteria, Mycoplasma and Chlamydia bacteria, have the gene for cyclic-di-AMP. The gene is also found in Archaea, indicating that cyclic-di-AMP is an ancient signaling molecule.

„Most intracellular pathogens like Listeria turn on the same interferon response, but we don’t know how the other ones do it yet,“ Portnoy said. „Maybe they all have small molecules we haven’t seen. We don’t know how general this discovery is.“

Bacteria engineered to make altered amounts of cyclic-di-AMP may be more potent vaccines, he said.

The next step, Woodward said, is to discover how cyclic-di-AMP actually turns on interferon. For this, he and Portnoy plan to use mutant strains of Listeria in which the cyclic-di-AMP gene can be turned on and off at will.

„By studying innate immunity, we discovered an essential bacterial molecule that somehow got missed over 50 years of basic bacteriology research,“ Portnoy said. „We’ve uncovered a whole new area for our field.“

Source:
Robert Sanders
University of California – Berkeley

PREZISTA(R) Now Available For Pediatric Patients Six Years Of Age And Older As Part Of HIV Combination Therapy

Tibotec Therapeutics, a division of Centocor Ortho Biotech Products, L.P., announced the availability of a lower-dose (75 mg) formulation of PREZISTA (darunavir) for pediatric patients with HIV. The announcement follows the FDA approval of PREZISTA, co-administered with ritonavir (PREZISTA/r) and with other antiretroviral agents, for the treatment of HIV infection in pediatric patients six years of age and older, granted December 18, 2008. PREZISTA was developed by Tibotec Pharmaceuticals, Ltd. and is marketed in the U.S. by Tibotec Therapeutics.

According to the most recent reports from the Centers for Disease Control (CDC), there were 2,587 children under 13 years of age living with HIV and 1,116 children under 13 years of age living with AIDS in the U.S. at the end of 2006. The CDC estimates that 56,500 young people between the ages of 13 and 24 years were living with HIV in 2006.

„The HIV epidemic continues to affect thousands of children in the U.S., and these patients have fewer treatment options than adults,“ said Ram Yogev, M.D., Director of Pediatric, Adolescent and Maternal HIV Infection at Children’s Memorial Hospital in Chicago. „The availability of PREZISTA in a formulation designed especially for children over the age of six provides an important new option for these patients.“

In October 2008, PREZISTA received traditional (full) approval for treatment-naive and treatment-experienced adult patients as part of combination therapy.

The pediatric indication for PREZISTA is based on 24-week analyses of pharmacokinetics, safety, tolerability and antiviral activity from DELPHI (TMC114-C212), an open-label Phase 2 trial in which antiretroviral treatment-experienced HIV-1 infected pediatric patients (6 to

Specific pediatric dosing is based on weight as follows:

— At least 44 lbs to less than 66 lbs: 375 mg PREZISTA/50 mg ritonavir twice daily

— At least 66 lbs to less than 88 lbs: 450 mg PREZISTA/60 mg ritonavir twice daily

— 88 lbs or more: 600 mg PREZISTA/100 mg ritonavir twice daily

Before prescribing PREZISTA, children should be assessed for the ability to swallow tablets. If a child is unable to reliably swallow a tablet, the use of PREZISTA tablets may not be appropriate. Do not use PREZISTA once daily dosing in pediatric patients. The safety and efficacy of PREZISTA/r in pediatric patients ages 3 to

Clostridium Difficile Infection: Best Strategies For Care Of Older Adults

Over the past several years, the incidence and mortality rates of Clostridium difficile infection (CDI) have increased dramatically. CDI is a serious condition, particularly in older adults. Not only are older adults at increased risk for developing CDI, they also have a higher CDI-associated mortality. It is imperative that healthcare professionals be aware of the risk factors, diagnostic considerations, and treatment strategies for CDI in this patient population.

To address the need for current education on CDI in older adults, Robert Michael Educational Institute LLC (RMEI) and Postgraduate Institute for Medicine (PIM) are jointly sponsoring a complimentary continuing education monograph for registered nurses and nurse practitioners. This activity is supported by an educational grant from ViroPharma Incorporated.

Faculty for this monograph include Erik R. Dubberke, MD, Assistant Professor of Medicine in the Infectious Diseases Division of the Department of Medicine at Washington University School of Medicine and Medical Director in Infection Control at Missouri Baptist Medical Center in St. Louis, Missouri and Suzanne F. Bradley, MD, Professor of Medicine in the Department of Internal Medicine at the University of Michigan Medical School in Ann Arbor, Michigan.

Healthcare professionals can visit RMEI/CDI060 to access this continuing education monograph.

„Quality continuing education is vital to developing and increasing knowledge and skills and enhancing patient care,“ says Robert Michael Educational Institute LLC President and CEO, Robert M. Colleluori.

RMEI is a medical education company that specializes in independent, accredited and nonaccredited education. The goal of all accredited RMEI educational offerings is to promote a spirit of lifelong learning and continuous professional development. RMEI works closely with medical experts to design activities that improve diagnosis and treatment. These activities include national and international symposia, teleconferences, live meetings, enduring print materials, and interactive Internet programs.

For other educational opportunities, please visit RMEI.

RMEI
RMEI

Program In Costa Rica Will Allow Sex Workers To Learn HIV Prevention Methods From Colleagues

Commercial sex workers in Costa Rica will have the opportunity to learn about HIV prevention methods from other sex workers through a new program implemented by a local nongovernmental organization and funded by the World Bank, the EFE/Market Watch reports. Officials with the NGO — called the „La Sala“ Association for the Improvement of Quality of Life of Sexual Workers — will train 22 sex workers to deliver messages about prevention, including condom use, and information about the sex workers‘ rights. Project coordinator Maria Diaz said the goal of the program is to „empower sexual workers in the matter of prevention.“

The program is expected to have a multiplier effect in the commercial sex work industry and raise awareness among customers, brothel owners and workers. „This part will be difficult,“ Diaz said, adding, „What we want is for the (brothel) managers to understand the advantages of having their locales free of HIV and for them to promote them as places where they apply preventive practices.“ The program will begin in San Jose and expand to Limon and Puntarenas. The World Bank donated $50,000 to the program (EFE/Market Watch, 1/25).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Less Is More In Blood Transfusion Study

A new study suggests that blood transfusions for hospitalized cardiac patients should be a last resort because they double the risk of infection and increase by four times the risk of death.

The analysis of nearly 25,000 Medicare patients in Michigan also showed that transfusion practices after heart surgery varied substantially among hospitals, a red flag that plays into the health care reform debate.

A wide variation in care is a hot-button issue, as lawmakers and health reform experts discuss the best ways to address the variations. Some experts believe the country needs a system of medical guidelines, supported by scientific evidence, to aid doctors in decision-making. In fact, the Institute of Medicine has called for a national initiative of comparing the benefits and harms of certain methods to improve the delivery of care — an effort referred to by health-care insiders as „comparative effectiveness“ research.

Blood transfusion is an area that could be well served with stronger, research-based guidelines, since the current clinical practice is all over the map, said study co-author Neil Blumberg, M.D., professor of Pathology and Laboratory Medicine and director of Transfusion Medicine at the University of Rochester Medical Center.

„Doctors are simply doing what they were trained to do, but it turns out that their actions are more harmful than helpful in many cases,“ Blumberg said. „This is an instance in which clinical practice got way ahead of research. And changing the liberal use of transfusions is going to be difficult despite the evidence showing it is usually not essential.“

The study was published July 31, 2009 in the journal, BMC Medicine. It was designed to assess patient outcomes as well as hospital variation in blood use.

Blumberg and lead author Mary Rogers, Ph.D., of the University of Michigan Health System, analyzed patient records in 40 hospitals, from admission to 30 days after discharge. All had received coronary artery bypass graft surgery from 2003 to 2006. They found that 30 percent of variation in transfusion practices seemed to be due to widely varied practices among hospital sites.

Also, blood use among women patients ranged from 72.5 percent to 100 percent, and blood use among men varied from about 50 percent to 100 percent. Transfusions with donor blood were associated with infections of the genitourinary system, respiratory tract, bloodstream, digestive tract and skin, the study said.

The risk of death in the hospital was nearly 5 times greater among patients who received a blood transfusion, and the risk of death in the next 30 days was nearly three times greater. Some of the risk may’ve been due to the underlying condition that led to transfusion but an increasingly convincing body of evidence demonstrates that some of the effect is almost certainly due to the transfusion itself, Blumberg said.

Blood transfusions are extremely common in the United States. Some of the typical reasons for transfusions include prevention of anemia and improving oxygen delivery in heart failure.

Blumberg has been a long-time advocate for fewer transfusions and, when they are necessary, for using blood from which the donor’s white cells have been removed. This process, called leukoreduction, is believed to diminish the chances of infection and inflammation, research has shown.

„Blood transfusions are certainly necessary in life-threatening situations,“ Blumberg said. „But this study and other studies confirm they should be a last resort, not a first resort, as they often are.“

For decades the URMC has been a leader in the study of blood transfusions, and Strong Memorial Hospital at URMC was among the first in the country to begin using leukoreduced blood for all its patients.

More recently, a team at Strong began to further refine the guidelines for blood transfusion. As a result the hospital has already seen a 10 to 15 percent drop in transfusions during the past six months. The improvement program is still in its early stages, and Blumberg said they will closely monitor the use of transfusions at Strong in the coming months.

Source:
Karin Christensen

University of Rochester Medical Center

HIV/AIDS Epidemic Affecting Swaziland’s Population, Experts Say

Preliminary results of Swaziland’s national census released last month found that since 1997, the country’s population has decreased by 17,489 people to 912,229, and many experts have attributed demographic changes to the HIV/AIDS epidemic, Toronto’s Globe and Mail reports. The government has not finalized the results of the census, but if the figure holds, it would mean that the country is 300,000 people below what was projected as the likely rate of growth 20 years ago, according to the Globe and Mail.

The country grew by more than 200,000 people from 1986 to 1997, Solomon Dlamini, head of the national university’s department of demography and statistics, said, adding, „But it’s the period between these two censuses (1997 and 2007) when the [HIV/AIDS] epidemic reached its apex.“ Swaziland has the highest HIV prevalence in the world: 26% of adults, 49% of young women between the ages of 25 and 29 and 43% of pregnant women are HIV-positive. According to the Globe and Mail, the population decline could be attributed both to people dying of AIDS-related conditions and because HIV infection lowers the number of children women have.

„I don’t think anybody quite realized what the depth of HIV would be in Swaziland.“ Derek von Wissell, director of the National Emergency Response Council on HIV/AIDS, said, adding, „Even if they undercounted by 10%, we’re down 25% from where we should be.“ However, Rob Dorrington, a professor of actuarial science at the University of Cape Town, said, „Experience has taught me to be skeptical of census data in general.“ He added, „It is not unusual for there to be an undercount of children and of men [in a census], and deaths would have to have been implausibly high, given the estimated level of prevalence, for one to be able to detect this through the change in the numbers counted by the census.“ Amos Zwane, Swaziland’s senior statistician, wrote in his preliminary report on the census that „a population decline or stagnation was not expected and this result is most surprising.“ He said that his office is going to search for a logical explanation and will not speculate on the cause until it produces final numbers in the middle of 2008.

According to the Globe and Mail, a „toxic mix“ of factors has fueled the country’s HIV epidemic, including a highly virulent strain of the disease circulating among residents; a culture that „condones, even encourages“ promiscuity and polygamy among men and denies women the right to negotiate condom use; a „limited economy“ that relies on sending men to work in South Africa for long periods of time; and a „playboy“ king with an „ever-expanding stable“ of wives who has denied the magnitude of the problem, according to the Globe and Mail. In addition, the country’s understaffed and underfunded health system could not treat people when the epidemic hit in the 1990s and, as a result, „achingly slow progress“ has been achieved in delivering antiretroviral drugs to those in need, the Globe and Mail reports. The rates of new HIV cases have begun to decrease minimally among young people, but the rates remain stable or are increasing among people in their 30s. About one-third of people who need antiretrovirals are getting the drugs (Nolen, Globe and Mail, 12/22/07).

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