December 3, 2004

This Week in Washington
1. AIDS Action Releases Updated “State Facts
2. World AIDS Day Event Focuses on Empowering Women
3. World AIDS Day Event Highlights Film about Women Living with HIV in the United States

In the News
1. UNAIDS Reports on HIV Worldwide
2. Popular Abstinence-Only Curricula Contain False, Misleading Information, New Report Finds

Announcements
1. AIDS Action Executive Director Marsha Martin To Speak at African-American HIV Summit
2. NMAC Holds North American AIDS Treatment Action Forum

This Week in Washington
1. AIDS Action Releases Updated “State Facts”
In honor of World AIDS Day—December 1, 2004—AIDS Action provided updated State Fact Sheets to all Members of the U.S. Congress. AIDS Action’s State Fact Sheet series is updated annually and contains data on the epidemiology of HIV and AIDS in each U.S. state and territory and on the federal funding they receive for HIV programs and services.* The series also has a United States Fact Sheet with information about the country as a whole. Members were provided with fact sheets for their respective states and for the U.S.

A new addition to the State Fact Sheets this year is a section that explains the HIV reporting options available to states and territories: name-based, code-based, and name-to-code-based. All U.S. states, Guam, Puerto Rico, and the Virgin Islands are now reporting HIV infections in combination with AIDS diagnoses.

The State Fact Sheet data, which is presented in graphics and text, can be used as a resource for Senators and Representatives and their staffs as they make key policy and funding decisions to shape the response to the HIV epidemic in this country. With the State Fact Sheets in hand, they will have easy access to comprehensive quantitative information on the epidemic and the federal government’s response to it. Feedback from Congressional staff members who have seen the State Facts Sheets includes comments such as “You have it all in here—great”; and “This is exactly the information I had been looking for on the Web. I am glad your organization put it all together in one place.”

The AIDS Action State Fact Sheets are done entirely in-house. “The value of this staff-driven process is that we, as a staff, become keenly aware of the scope and nature of the epidemic throughout the United States and can communicate that information more effectively to Congress and our membership,” stated AIDS Action’s Associate Executive Director Jenifer Johnson.

One realization to emerge from the data collection process was that the number of people living with HIV and diagnosed with AIDS is increasing everywhere. According to Donna Crews, AIDS Action’s director of government affairs, “Looking at these fact sheets, Members of Congress, their staffs—or anyone else for that matter—cannot ignore the increasing impact that HIV is having on every state in the United States.”

As of 8:00 p.m. this evening, Friday, December 3, all the updated State Fact Sheets will be available online through AIDS Action’s Web site, http://www.aidsaction.org. Members of AIDS Action will receive copies of their respective State Fact Sheets as well as the U.S. State Fact Sheet next week.

*Due to certain state or jurisdiction-level data not being available, fact sheets for the following jurisdictions are still being updated: Mississippi, New York, Tennessee, Utah, District of Columbia, Pacific Islands, and Virgin Islands.

2. World AIDS Day Event Focuses on Empowering Women
World AIDS Day, December 1, has been commemorated around the world every year for the last seventeen years. This year’s World AIDS Day campaign focuses on Women and Girls.

To commemorate the campaign theme of this annual observation, the International Center for Research on Women (ICRW), MAC AIDS Fund, UNAIDS, and the Global Coalition on Women and AIDS held a forum on December 1 at the National Press Club in Washington, DC. AIDS Action Executive Director Dr. Marsha Martin, along with AIDS Action Council Board Chair Craig Thompson, who serves as executive director of AIDS Project Los Angeles, Council Secretary Cornelius Baker, the executive director of Whitman-Walker Clinic in Washington, DC and Iris Ovadiya, AIDS Action associate program coordinator, attended this invitation-only event.

Dr. Geeta Gupta, president of ICRW, opened the forum by welcoming the event’s attendees. “Around World AIDS Day, we recognize the cataclysmic impact of AIDS, experience horror of it all, the injustice; and World AIDS Day motivates us to action,” she observed. Dr. Gupta continued by emphasizing that current responses are falling short of meeting women’s needs. She thanked MAC AIDS Fund and UNAIDS for supporting the ICRW event and reiterated the theme of the gathering: “empowered women are an important key to turning the tide of the epidemic.”

John Demsey, chairman of MAC AIDS Fund then delivered remarks. He opened his speech by saying that MAC AIDS Fund is the heart and soul of MAC (Cosmetics) and continued by stressing the importance of lending MAC’s voice to the cause. He noted that the company has donated 40 million dollars to efforts against HIV thus far and reminded attendees that HIV related illness is the leading cause of death among African-American women in the United States. He urged other companies to raise money for the disease and to increase awareness of HIV. He concluded his speech by saying, “It’s not hallmark; every day is World AIDS Day at MAC.”

Mr. Dempsey then introduced actress and social activist Glenn Close as the moderator for the forum. Ms. Close showed her support and appreciation for MAC’s efforts by saying that she uses the lipstick whose sales help generate funds for HIV. Ms. Close then introduced Dr. Peter Piot, executive director of UNAIDS, with a personal story. Ms. Close shared that she got to know Dr. Piot when he was working in the Congo many years ago and has known him to be an inspired leader ever since.

Dr. Piot emphasized the need to better understand the role of gender in the epidemic and to place it at the center of HIV programs--otherwise, he cautioned, people will have no chance against the disease. Dr. Piot focused on “the changing face of AIDS.” According to Dr. Piot, HIV was associated almost exclusively with white gay men in the 1980s; however the virus is increasingly being associated with woman, particularly young woman. Teenage girls are seven times more likely to contract HIV than boys. As a solution to this situation, Dr. Piot suggested giving more options to girls: the option to decide when to have sex and when to be faithful. He added that other options for girls include earning better incomes since girls in some developing countries must survive on $2 a day. Opening options to girls will in turn increase access to services and information, reduce girls’ vulnerability, and change long-standing traditions as an approach to prevention, he concluded.

The next speaker was Ambassador Randall L. Tobias, the U.S. Global AIDS Coordinator. Ambassador Tobias focused who highlighted the interventions targeting women funded through the President’s Emergency Plan for AIDS Relief (PEPFAR). They include drug therapy to prevent mother to infant transmission (or vertical transmission), training 15,000 health workers to prevent vertical transmission; localized behavior change programs to protect girls against sexual coercion, anti-violence programs targeting boys, and programs for building healthy relationships. Ambassador Tobias concluded his speech by calling on to leaders around the world to join the effort and said that the world must respond to this human crisis with human compassion.

Jack Valenti, president of Friends of the Global Fight against AIDS, Tuberculosis and Malaria, then spoke. He explained that his impetus for joining efforts against HIV was learning about children whose parents have died from HIV related causes. He said that every fourteen second a child becomes an orphan due to AIDS, and by the end of this decade there will be twenty five million orphans. He called efforts toward eradicating HIV, “the most important crusade in the world” and said that “we are all in the same army.”

Next Dr. Antonia C. Novello, Health Commissioner of New York and former U.S. Surgeon General focused on the facts: women are less likely to be tested, are subject to abuse and domestic violence, and are under psychological distress—conditions which pose barriers to care. Dr. Novello then mentioned a number of activities that could make it easier for women to access care. They included making culturally specific health information available in languages other than English and in multiple settings; creating multi-centered care services consisting of primary health care, mental health care, nutrition, and child care; creating job placement services; and assisting families for the future of the households.

The next speaker shared her first-hand experience of HIV. Ms. Asunta Wagura, executive director of Kenya Network of Women Living with AIDS, shared with the audience her personal story of contracting HIV sixteen years ago. “Life has never been the same,” Ms. Wagura said with regard to her diagnosis. Ms. Wagura shared the common reality of women in Africa—how women are told to be obedient and be faithful while men are encouraged to be unfaithful, and how women are taught to be mothers but never managers or directors. Against the societal norm, Ms. Wagura started her own organization, which addresses women and HIV.

Dr. Khuat Thu Hong, who is the director of the Institute for Social Development Studies—the only resource center on gender and sexuality in Vietnam—focused on Vietnamese women and HIV. She noted that women account for 14% of AIDS cases in Vietnam, where the belief is still that it is a men’s epidemic. Stigma prevents HIV positive women from getting married (being married is an important social status indicator) and they can be refused service at hospitals and have to travel form one hospital to another. Dr. Hong concluded with the explanation of the importance of women standing up for their own rights which would be key in adequately addressing the epidemic.

In closing, Dr. Gupta of ICRW reemphasized that women have restricted access to resources, are less able to negotiate safe sex, fall into sex work due to having less economic possibilities, are less likely to leave abusive relationships, and are being subject to sexual violence and rape. She said the current ABC (Abstain, Be faithful, use a Condom) strategy was falling short of what is needed before introducing a “Call to Action” known as the ABCs Plus. The “Plus” refers to approaches beyond those recommended in the ABC model and are as follows: 1) Improve access to information on reproductive health. Abstinence education must be accompanied by condom information for the time when individuals decide to be sexually active; 2) Provide post-primary education and make it more girl-friendly and use the power of education to change social norms; 3) Design programs to overcome barriers such as work load constraints and travel time for health care and treatment services; and 4) Provide for other disease prevention options, such as microbicides and the female condom. Dr. Gupta emphasized that disempowerment of women is killing the young and urged the United States to act now on these priorities without any further delays.

3. World AIDS Day Event Highlights Film about Women Living with HIV in the U.S.
On World AIDS Day, Wednesday, December 1, AIDS Action staff attended a screening and discussion of the film, HIV Goddesses: Stories of Courage “Diary of a Filmmaker,” sponsored by the Women’s Research & Education Institute (WREI) as part of the first annual HIV Goddesses Empowering Conference.

The event was opened with words of welcome by Susan Scanlan, president of WREI. She then introduced Sharon Sopher, the writer, producer, director, and star of the film. Also a reporter, Ms. Sopher has received an Emmy award and Oscar nomination for her work. Ms. Sopher explained that she made this movie after spending five years living with HIV while being misdiagnosed by 27 doctors. Eventually, she diagnosed herself with the use of information on HIV symptoms from Internet sites; today she still wonders, “Why had the doctors missed her symptoms for so long?” Following her self-diagnosis, she went to a doctor and requested an HIV test—and her suspicions were thus confirmed. Ms. Sopher said she realized that there must be other women going through this type of ordeal to determine an HIV diagnosis, and this realization spurred her decision to make the film.

Next on the program was Sue Ann Thompson, wife of Department of Health and Human Services Secretary Tommy Thompson. Ms. Thompson, the president of the Wisconsin Women’s Health Foundation, which was established in 1997, spoke on the topic “Mainstreaming AIDS as a Women’s Health Issue.” Ms. Thompson cited the statistic that AIDS is the fifth leading cause of death for women in the United States. She shared with the audience that this was something that she had learned only in the last two years, and this knowledge led her to realize the importance of making HIV a regular consideration in women’s health. Ms. Thompson noted that education is key in the prevention of HIV, and women’s health organizations must do all they can to get information about HIV into the hands of women. She continued by stressing that women should learn the early symptoms of HIV to make early diagnosis and treatment more likely. She compared women diagnosed with breast cancer, as she was in the 1990s, to women diagnosed with HIV or AIDS. She explained that with breast cancer there is a “sisterhood” of supporters, but this is not so with HIV – in too many instances, HIV positive women suffer alone and in silence.

HIV Goddesses: Stories of Courage “Diary of a Filmmaker” was then shown to the audience. The movie traces Ms. Sopher from her initial HIV diagnosis to her “rebirth”—the point at which she was able to begin working again after a seven-year period during which she had been too sick to work. She said that she knew she was dying, but no doctors could explain why. She asked one doctor why women were so seldom tested for HIV. Responding, he explained that many doctors think it’s an insult to a woman who is sexually active—whether they are married, single, divorced—to suggest an HIV test. The film also featured stories from other women who are living with HIV. One African American woman who Ms. Sopher interviewed on camera stated, “I didn’t get AIDS. I married it.” Another woman explained that when her employer, a supermarket, found out she was HIV positive, she was told that there was no work available “for people like you.” She sued the employer and won.

Ms. Sopher wants HIV positive women to know they are not alone. She believes that too many women have been told of their HIV positive status and asked not to say anything to anyone for fear of retaliation against their families, neighbors, jobs, and friends. Ms. Sopher hopes her film will help women to talk about HIV to each other and to their friends; the reduction of stigma and increase in HIV education are the best prevention methods for women, she said. This latter idea is echoed in the slogan for Ms. Sopher’s organization, the HIV Goddesses Project – Women’s Wellness & Empowerment: “An educated woman is the best prevention there is.”

In the News
1. UNAIDS Reports on HIV Worldwide
Every year around the time of World AIDS Day, UNAIDS releases a report chronicling the scope, trends, latest developments, and human toll of the epidemic, which continues to affect every region of the world. This year’s edition, AIDS Epidemic Update 2004, touches on the World AIDS Day theme, “Women, Girls, and HIV/AIDS” by featuring a special section documenting HIV’s effect on women. This news brief provides an overview of some of UNAIDS’ principle findings for the world and for women overall before moving into a more focused discussion of its findings on the epidemic in the United States.

HIV the World Over
The number of people living with HIV has been rising in every region of the world and the number of individuals living with HIV reached its highest level ever this year. With an estimated 4.9 million new infections in 2004, there are now 39.4 million people living with the virus. In addition, over three million (3.1 million) are estimated to have died from HIV related causes this year. The steepest increases in HIV are occurring in East Asia, Eastern Europe, and Central Asia; however sub-Saharan Africa remains the worst-affected region, according to UNAIDS, with 64% of the world’s HIV infections, over three-quarters of which are in woman (76%). To keep HIV in check, UNAIDS calls for programs that can stem the spread of HIV among the “most vulnerable” population groups. However, it notes, “inadequate resources and a failure of political will and leadership still bars the way—especially where HIV has established footholds among marginalized and stigmatized population groups such as women who sell sex, injection drug injectors and men who have sex with men.” Thus, UNAIDS warns that HIV will spread more extensively in many countries that, until now, have been experiencing minor epidemics “unless reticence is rapidly replaced with pragmatic and forward-looking approaches, HIV will spread more extensively in many countries which until now have escaped with only minor epidemics.” Moreover, despite gains in global funding for HIV, the report notes a lack of “coherent, nationally-led AIDS responses in many heavily-affected countries and cautions that “it is essential to pre-empt the risk of duplication and fragmentation in AIDS responses.

Women and HIV
Globally, just under half of all people living with HIV are female. In sub-Saharan Africa, women and girls compose 57% of HIV infections, and young women are being particularly heavy hit: 76% of young people (aged 15–24 years) living with HIV are female. In most other regions, the report continues, women and girls represent an increasing percentage of people living with HIV, compared with the data five years ago.”

According to UNAIDS, these trends indicate “serious gaps in the AIDS response.” It calls for services that can protect women against HIV to be expanded and notes that women and girls “need more information about AIDS.” To support this assertion, the report points to a recent UNICEF survey which found that up to 50% of young women in high-prevalence countries did not know the basic facts about AIDS. Improving women and girls knowledge, however, will not be sufficient on its own for the risk of HIV infection to women and girls is also borne from their pervasive disempowerment. UNAIDS explains, “Most women around the world become HIV-infected through their partner’s high-risk behaviour, over which they wield little if any control. The plight of women and children in the face of AIDS underlines the need for realistic strategies that address the interplay between inequality—particularly gender inequality—and HIV.”

The U.S. Epidemic
In the United States, “the epidemic has altered demonstrably during the past decade.” While the estimated number of new infections annually has remained at 40, 000 over this time period, the epidemic is now “disproportionately lodged among African Americans and is affecting much greater numbers of women.”

African Americans now have the poorest survival rates among people diagnosed with AIDS which, UNAIDS speculates, probably reflects “late diagnoses (often after the disease has become symptomatic) and inadequate access to quality health care services.” Citing statistics from the Centers for Disease Control and Prevention, UNAIDS reveals that AIDS has ranked among the top three causes of death for African American men aged 25–54 and for African American women aged 35–44 years since the turn of the century. Although African Americans represent just 12% of the U.S. population, they comprise over half of the new HIV diagnoses in recent years. African American women are especially impacted by this epidemic, accounting for up to 72% of new HIV diagnoses in all U.S. women.

Continuing, the report links the disproportionate impact of HIV within African American populations to the disproportionate impact of “poverty and other forms of socioeconomic deprivation” Black Americans face and which are known to increase vulnerability to HIV infection. It is estimated that 25% of African Americans live in poverty, and as UNAIDS reports, “some studies in the U.S. have discerned a close relationship between higher AIDS incidence and lower income.” The report also raises the possibility that “high incarceration rates, particularly for African American men, could be an amplifying factor in the epidemic through injecting drug use and unprotected sex in prison institutions.” For men in general, and for African American men in particular, the vast majority of HIV infections occur during injection drug use and sex between men, the report further mentions. Moreover, high levels of risk behavior continue to be found especially among younger men who have sex with men.

Heterosexual intercourse accounts for most HIV diagnoses among women of all races and ethnicities, and “there are strong indications that the main risk factor for many women acquiring HIV is the often-undisclosed risk behaviour of their male partners,” the report indicates. According to UNAIDS, recent research in a low-income area of New York City has shown that women were more than twice as likely to be infected by a husband or steady boyfriend than by casual sex partners. Thus unsafe sex with other men on the part of male partners, along with injection drug use, “appears to be a significant risk factor for some women.”

The report closes its discussion of the U.S. epidemic by pointing out that men who have sex with men represent the majority of people living with HIV in the 2004. The report then notes that increases in syphilis cases and other sexually transmitted diseases in this population had “triggered concerns that risk behaviour was on the rise and that a new wave of HIV infections could follow. However, the report reveals that new research suggests that “those increases have not had a substantial impact on HIV incidence, which stayed steady in 1999–2002 among men who have sex with men.” The report continues, “In addition, a new, 16-state study indicates that a majority of HIV-positive men who have sex with men have been taking precautionary measures (including condom use, abstinence or staying faithful to one partner) to prevent further HIV transmission. The study urges, though, that more intensive prevention efforts should reach the small number of HIV-positive men who still practice unsafe sex with other men.”

To read the full report on which this news brief is based, link to
http://www.unaids.org/wad2004/report.html.

2. Popular Abstinence-Only Curricula Contain False, Misleading Information, New Report Finds
A press release issued on Wednesday, December 1 by Congressman Henry A. Waxman announced the findings of a new report showing that many federally funded abstinence-only education programs teach adolescents false and misleading information about reproductive health, including HIV transmission and infection rates. According the report’s executive summary, abstinence-only curricula contain scientific errors. It noted that one curriculum “incorrectly lists exposure to sweat and tears as risk factors for HIV transmission. These curricula also contain false information about the effectiveness of contraceptives. For example, one curriculum presented the following as scientific fact: ‘“[I]n heterosexual sex, condoms fail to prevent HIV approximately 31% of the time”’—information the report cites as “erroneous.”

The report, The Content of Federally Funded Abstinence Only Education Programs, is the result of a comprehensive evaluation requested by Representative Waxman which reviewed the content of the curricula used in federally funded abstinence-only education programs. As explained in the report, the evaluation is based on a review of the 13 most popular abstinence-only programs used by grantees of Special Programs of Regional and National Significance—Community-based Abstinence Education (SPRANS). As the largest and fastest growing source of funding for abstinence-only education, SPRANS received $104 million of the $170 million appropriated by the federal government for abstinence-only education in FY 2005. This funding level marks a more than 100% increase from the abstinence-only budget in FY 2001.

In addition to SPRANS, there are two other principal sources of federal funding for abstinence-only education—Section 510 of the 1996 Welfare Reform Act and the Adolescent and Family Life Act. Collectively, these three funding streams enable abstinence only education to reach millions of children and adolescents in the United States each year. Further, the report continues, “given the scarcity of comprehensive sex education courses in schools across much of the United States, abstinence-only education programs may be the only formal reproductive health education that many children and adolescents receive. It also notes that “the curricula used in SPRANS and other federally funded programs are not reviewed for accuracy by the federal government.”

Yet according to the findings of several studies on the effectiveness of abstinence-only education, abstinence-only “does not appear to decrease teen pregnancy or the risk of sexually transmitted diseases, the report indicates. What’s more, one recent Columbia University study on the same topic found that abstinence-only programs may actually increase participants’ risk. The report suggests that the “serious and pervasive” lack of accuracy in abstinence-only curricula ‘may help explain why these programs have not been shown to protect adolescents from sexually transmitted diseases and why youth who pledge abstinence are significantly less likely to make informed choices about precautions when they do have sex.”

“In contrast,” the report adds, “comprehensive sex education that both encourages abstinence and teaches about effective contraceptive use has been shown in many studies to delay sex, reduce the frequency of sex, and increase the use of condoms and other contraceptives.”

“It is absolutely vital that the health education provided to America’s youth be scientifically and medically accurate,” Representative Waxman stressed. “The abstinence-only programs reviewed in this report fail to meet this standard. Something is seriously wrong when federal tax dollars are being used to mislead kids about basic health facts.”

To read the press release and report on which this news brief is based, link to http://www.democrats.reform.house.gov.

Announcements
1. AIDS Action Executive Director Marsha Martin To Speak at African-American HIV Summit
On Saturday, December 4, The African American Community Development Initiative will host “The Cost & Casualties of Silence: An African American HIV/AIDS Summit” in Los Angeles, California. Political commentator and television personality Tavis Smiley will host the event, which is timed to coincide with World AIDS Day. The day-long summit will feature panelists from the local and federal government, media, and faith- and community-based organizations.

AIDS Action Executive Director Dr. Marsha Martin will be featured on a panel entitled “Faith, Treatment, and Care.” The entire event is free and open to the public. In addition to the speakers, free HIV testing will be offered all day.

2. NMAC Holds North American AIDS Treatment Action Forum
The National Minority AIDS Council (NMAC) will be holding the 2004 North American AIDS Treatment Action Forum (NATAF) in St. Louis, MO from December 9 to 12. The 2003 forum brought more than 400 treatment professionals from the United States, Canada, and Mexico together to improve their skills, acquire new knowledge, and develop inclusive strategies to ensure the continuity and success of the treatment advocacy movement.

NATAF is open to all parties interested in broadening their knowledge of HIV research and treatment issues and learning to apply this knowledge to advocacy on behalf of people living with HIV. According to the NMAC Web site, participants include the volunteers, staff and board members of community-based organizations, case managers, social workers, AIDS educators, outreach workers, pharmaceutical and government representatives, health care professionals, and HIV positive individuals.

For more information on NATAF and to register for its St. Louis event, link to http://www.nmac.org/conferences/nataf2004/default.htm.

The AIDS Action Weekly Update
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