Harm Reduction Project News Digest June 4, 2007

News & Opinion This Week 1. The Abstinence Gluttons 2. Poland Probes Gay Teletubies 3. United States Among Least Peaceful Nations In The World 4. AIDS In Eastern Europe And Central Asia At Crisis Levels 5. United Nations' AIDS Program Under Fire (Two new books are forcing the United Nations' AIDS program to defend itself) 6. Robert Zoellick to Replace Wolfowitz As Head of World Bank 7. Gay Men Who Use Methamphetamine Have Greater Risk Of HIV Seroconversion 8. HIV-Negative Serosorters May Increase Their Risk for HIV, Study Says 9. Czech Republic: Time Bomb For Roma B Upcoming Conferences and Events C Quotes D How To Help E About HRP F Subscription Information ----- I. The Abstinence Gluttons by MICHAEL REYNOLDS June 18, 2007 ~ The Nation Over the past six years George W. Bush's faith-based Administration and a conservative Republican Congress transformed the small-time abstinence-only business into a billion-dollar industry. These dangerously ineffective sexual health enterprises flourish not because they spread "family values" but because of generous helpings of the same pork-heavy gumbo Bush & Co. brought to war-blighted Iraq and Katrina-hammered New Orleans--a mix of back-scratching cronyism, hefty partisan campaign donations, high-dollar lobbyists, a revolving door for political appointees and a lack of concern for results. One of the chief cooks is a media-shy 63-year-old Catholic multimillionaire, welfare privatizer and Republican donor named Raymond Ruddy. With close ties to the White House, federal health officials and Republican power brokers that date back to W.'s days as Texas governor, Ruddy has leveraged his generous wallet and insider muscle to push an ultraconservative social agenda, enrich a preferred network of abstinence-only and antiabortion groups, boost profits for his company and line the pockets of his cronies--all with taxpayer dollars. Following the money swirling around Ruddy offers an eye-opening glimpse into the squalor at the heart of the abstinence-only project. One top Bush adviser left to take a job at Ruddy's charity, Gerard Health Foundation, and a senior officer at Ruddy's for-profit company, Maximus, left to take a top-level position at the Department of Health and Human Services. Leaders of Christian-right organizations that are Gerard grantees have gained advisory HHS positions--and their organizations have in turn received AIDS and abstinence grants to the tune of at least $25 million. Maximus itself has raked in more than $100 million in federal contracts during the Bush era. As for Ruddy's abstinence-only policy, recent reports, including one contracted by Bush's HHS, show that after more than $1 billion has been poured into the enterprise, it simply doesn't work. Already nine states have opted out from federal funds for this faith-based boondoggle in favor of more comprehensive and effective programs of sex education for their youth. "I can't think of another federal program where so much money was spent without any oversight and to such little effect," said James Wagoner, president of Advocates for Youth, a national organization that promotes comprehensive sexual health policies. "It wasn't that policy-makers didn't know that abstinence-only didn't work. In 2000 the Institute of Medicine issued a scathing report on these programs. But they went full steam ahead despite the warning. It's beyond naïve. It's immoral." Raymond Ruddy sits on the board of Maximus, a giant government services provider in Reston, Virginia, that pioneered welfare privatization. As one securities analyst observed, "Maximus was in this segment before there was a segment." In 1995 Maximus was a $50 million-a-year enterprise. With passage of the Welfare Reform Act the following year, Maximus's earnings jumped to $105 million. Three years later its revenues tripled. Today it's a $700 million publicly traded global giant with more than 5,000 employees deployed across the nation and in Canada, Israel, Argentina and Egypt. It contracts with state governments to handle child-support collections, implement welfare-to-work and oversee managed care. For the Feds, Maximus handles collections on student loans and Medicaid appeals, manages the Social Security Ticket to Work program for the disabled and provides biometric "smart card" technology to the Secret Service, the Treasury, the IRS. Ruddy joined Maximus in 1985 and went on to serve as its chairman of the board and as president of Maximus Consulting Group and its research division, the Center for Policy Studies and Surveys, which focuses on welfare and healthcare. Since 2001 he has also headed the Natick, Massachusetts-based Gerard Health Foundation, built on the $115 million retirement package he got from Maximus on resigning as chair in 2001 (he returned as vice chair in 2004) and still entirely funded by his and his wife Marilyn's charitable trust. Few outside the Bay State have heard of Gerard or Ruddy, even organizations that monitor the religious right. As Gerard secretary John Malloy put it in a phone conversation in which he refused an interview with Ruddy, "Ray's the man, but we like to keep him under the radar." "There are three areas we're about," Malloy said. "We're promoting pro-life causes, abstinence and HIV/AIDS prevention in Africa and we're now moving with that into China." In addition to lavishly funding an army of antiabortion and abstinence-only groups nationwide, Gerard also pumps hundreds of thousands of dollars into the Federalist Society, Americans for Tax Reform, Concerned Women for America, the Family Research Council and other conservative causes. Through Gerard, Ruddy contracted Chuck Donovan, vice president of FRC, to write an "investigative" attack on Planned Parenthood, published in Crisis magazine. Gerard also underwrote a propaganda video touting Uganda's discredited abstinence-only HIV prevention program. Ruddy's ties to George W. Bush date back to the early days of Bush's first presidential campaign, when the Texas governor brought on Ruddy's colleague Stephen Goldsmith as chief domestic policy adviser on his campaign. Goldsmith, as Mayor of Indianapolis, had been an aggressive pioneer of faith-based and corporate outsourcing of social services, including abstinence-only education. During Goldsmith's failed bid for governor in 1996, he stumped Indiana with the slogan "I've been CEO of Indianapolis. I want to privatize all of Indiana." And he brought this approach into Bush's campaign. "My Administration will elevate abstinence education from an afterthought to an urgent goal," Bush told a crowd in New Hampshire in November 1999. In a speech in Indianapolis, Bush promised, "In every instance where my Administration sees a responsibility to help people, we will look first to faith-based organizations, charities and community groups." It just so happened that while Bush was pitching Goldsmith's dubious policies in New Hampshire and Indiana, Goldsmith was joining Ruddy on the board of directors of Maximus. "Nineteen ninety-nine," recalls longtime Democratic Texas House member Garnet Coleman. "That was the year Maximus started handling enrollment for Medicaid and CHIP [Children's Health Insurance Program] here. At the same time as Bush was pushing all this corporate privatization, he started his faith-based initiative, moving state money into these churches and evangelical groups to handle drug treatment and children's homes. It was a disaster." Even then, Coleman adds, "it was clear to me the goal was--and is--to cut back social services and cut it to their friends to make a shitload of money." When Bush slid into the presidency, Goldsmith, himself a Bush donor on the "Pioneer" level, left the Maximus board to assist Bush's transition team, where he was put in charge of setting up the Office of Faith-Based and Community Initiatives. Bush tapped Tommy Thompson, who as governor of Wisconsin had hired Maximus to run one of his state's welfare privatization programs, to serve as HHS secretary. More important for Ruddy's antiabortion, abstinence-only agenda were the strategic HHS appointments of Claude Allen as deputy secretary and Wade Horn as assistant secretary for the Administration for Children and Families (ACF). Horn, as head of the National Fatherhood Initiative, had worked with Maximus; Allen, after rising to White House domestic policy adviser and then resigning, charged with theft, joined the Gerard staff. Ruddy's ties at HHS were further strengthened when Horn brought in another National Fatherhood Initiative staffer, Jeffrey Trimbath, to head ACF's abstinence-only education program--and when one of Ruddy's project directors at Maximus, Grant Collins, was hired at HHS to oversee welfare contracts. These ties would prove lucrative in the coming years, not only in padding Maximus's bottom line but also in pushing Ruddy's right-wing religious agenda. Ruddy's new coziness with HHS was on display in February 2006 at a conference of abstinence-only federal grantees in Arlington, Virginia, hosted by Trimbath. Horn delivered the keynote; Collins and his old boss at Maximus, Ruddy, led workshops. But these ties had been paying off for years. When Bush took office, Maximus had just over $13 million in federal contracts. Within a year the amount tripled. By 2006 Maximus was doing $61 million in business with the Bush Administration. Over the past five years Ruddy has also spent nearly $1 million to make sure the Bush Administration and the Republican Congress were primed to fund his select network of "family values" projects. In 2002 Ruddy called on former Republican National Committee chair Haley Barbour at the offices of his lobbying powerhouse, Barbour Griffith & Rogers, tasking his team to seek "increased funding for abstinence-only education programs." Over the next four years Ruddy personally paid BG&R $720,000 to lobby HHS, the President and Congress. A year into BG&R's lucrative contract, the firm recruited Tommy Thompson's chief of staff, Robert Wood, to join the team on the Ruddy account. According to filings with Congress, Wood then worked his former colleagues on "federal welfare reform legislation," "federal funding for specific projects" (likely abstinence education programs) and "issues involving [the] President's global AIDS initiative." BG&R added Maximus to its client roster in 2005. Ruddy also hired the Stanton Park Group, a lobbying outfit run by James "J.D." Derderian--a member, with Goldsmith, of the Bush transition team. Derderian was connected with Wade Horn, too, as they had served together on the board of directors of the Institute for Youth Development, one of several abstinence-only groups on Gerard's grantee list. Together, milking their inside connections, BG&R and Derderian saw to it that millions of federal dollars went to Ruddy's network of abstinence-only outfits and antiabortion crisis pregnancy centers. As always, Ruddy returned the favor, putting his connections and financial muscle behind a Republican Party that was increasingly aligned with his ideological interests. In 2004 Ruddy began to mobilize his network of grantees for the coming elections, doing his part to implement Karl Rove's strategy of picking up 4 million evangelicals who had not gone to the polls in 2000. To achieve this, the Bush campaign created its own grassroots network among evangelical churches and religious-right nonprofits. Ruddy hired the Family Research Council's Donovan to put word out through antiabortion newsletters, promising Gerard grants to conservative charities that would develop ambitious voter registration drives. That year Ruddy also shoveled nearly $400,000 into James Dobson's Focus on the Family, which was then mounting anti-gay marriage campaigns in service of Republican candidates through its 501(c)4 arm. Ruddy put $172,000 into Redeem the Vote, a voter registration operation out of Montgomery, Alabama, targeting evangelical youth, and $117,916 into Life, Liberty and Family, an old antiabortion nonprofit. The latter donation went into a hardball anti-Kerry campaign, Your Catholic Voice, which attacked the Massachusetts Democrat for his prochoice politics in newspaper ads that ran across the country. He also maxed out his personal contribution to the Bush/Cheney ticket ($4,000) and spread more than $12,000 to the campaigns of select religious-right Republicans running for Congress, including Tom Coburn in Oklahoma and Billy Tauzin in Louisiana. For the 2006 midterms, Ruddy put hundreds of thousands into Common Sense Ohio, a Republican 527 that ran deceptive ads and conducted push-polling in seven states. With all this campaign largesse, Raymond Ruddy's sights were never set just on channeling government contracts to Maximus. He was also pulling strings to advance his ideological agenda--and the small circle of Christian-right groups he most trusted to deliver on it. The Virginia-based Institute for Youth Development and the Medical Institute for Sexual Health (MISH) in Texas have long been among his favorites: Between 2002 and 2005, Gerard put $716,148 into the Institute for Youth Development (IYD) and more than $1 million into MISH. The two organizations, not coincidentally, are also among the most well-connected Christian-right outfits within HHS. MISH was founded in 1992 by Joe McIlhaney, a medical doctor and religiously motivated abstinence advocate who served as Bush's health adviser when he was governor of Texas. During that time McIlhaney toured the state on the Texas taxpayers' dime with a slide show featuring bogus data and gross-out images of sexually transmitted infections as "proof" that condoms were ineffective in preventing pregnancy and sexually transmitted disease. In 2002 Bush appointed McIlhaney to his Presidential Advisory Council on HIV/AIDS and then as an adviser to the Centers for Disease Control and Prevention. The IYD, which provides training to abstinence-only groups, crisis pregnancy centers, "healthy marriage" programs and other Bible-based ministries in how to snare government grants, is even more connected than McIlhaney. Wade Horn served on IYD's board of directors until he became ACF head in 2001 and remains on the editorial board of the organization's journal, Adolescent and Family Health. Alma Golden was editor in chief of the publication before being named deputy assistant HHS secretary for population affairs in 2002. Patricia Ware, once educational policy director at the organization, was tapped by Bush as executive director of his AIDS advisory council--on which IYD's vice president, Anita Smith, just happened to sit. (Smith later became the council's co-chair.) To put icing on the cake, IYD's chief subcontractor, Performance Results Inc., in Gaithersburg, Maryland, is run by Claudia Horn, Wade's wife. Another Ruddy favorite is A Woman's Concern, into which Gerard poured another $1 million, accounting for a quarter of all donations to the Boston-area network of crisis pregnancy centers. Last fall, Bush named A Woman's Concern medical director Eric Keroack to replace Alma Golden at HHS, where the anti-contraception OB/GYN would oversee $283 million in annual grants to reproductive health and adolescent pregnancy programs. (Five months after his appointment, Keroack resigned, facing a Medicaid investigation.) Over the past four years, Ruddy has dropped more than $700,000 into Heritage Community Services, a South Carolina network of crisis pregnancy centers that provide abstinence-only programs, making him the group's largest private donor. With Barbour's and Derderian's firms greasing the wheels, Ruddy turned the federal government into a veritable matching fund for his grantees. For example, since Gerard was founded, in 2001, A Woman's Concern has received $1.5 million in federal grants for its abstinence-only program. Between 2002 and 2005, $9 million in federal grants went to Heritage Community Services. During this same period, MISH landed $1.5 million in federal grants and contracts. But of all Ruddy's favored abstinence-only groups, the IYD appears to have been the biggest federal beneficiary. In 2000 IYD had revenues of $270,000, $80,000 of that in government grants. Three years later IYD pulled in $4.1 million, nearly all--$3.8 million--coming in federal grants. Since Bush took office, IYD has received at least $11 million through HHS alone. Its partner organization, the Children's AIDS Fund, run by Anita Smith, has received at least $4 million from Bush's global AIDS initiative for faith-based abstinence programs in Uganda and Malawi--with more millions set to follow. In 2004 an expert panel for USAID rejected the Children's AIDS Fund grant application as "not suitable for funding," but the committee was swiftly overruled by USAID head Andrew Natsios, who ordered the grant be made to the Bush-connected Smith. In many cases this federal money seemed to flow not just to conservative organizations but to line the pockets of social conservatives themselves. Claudia Horn, through her firm Performance Results Inc., collects $1,551 per day for training groups in program and curriculum evaluation. According to its federal filing, PRI's 2005 sales to state and local governments were $1.1 million, with an additional $250,000 coming from the Feds, including such clients as the Department of Justice, the Office of Personnel Management, and Housing and Urban Development. But Claudia Horn's indirect public receipts are likely even higher, as her-private sector clients include IYD and the National Fatherhood Initiative (once headed by her husband, Wade), each of which is heavily funded through federal grants. Anne and Gordon Badgley, who received $9 million in federal grants for their nonprofit, Heritage Community Services, also set up Badgley Enterprises to market and sell their abstinence-only curriculum, Heritage Keepers. While Heritage's IRS 990s are sketchy and marked by vague expenses, even a student loan repayment, they clearly show that the Badgleys pocketed $174,201 from the taxpayer-funded nonprofit by buying the curriculum from their own private company. Then there is Rosenberg Communications, headed by Wade Horn's longtime friend and co-author Jeffrey Rosenberg, who served as communications director at Horn's National Fatherhood Initiative. When Horn took his HHS job in 2001, Rosenberg launched his PR firm, which has since netted $8.8 million in contracts from HHS--contracts that account for the bulk of the two-man company's income. Rosenberg's client list is rounded out by some familiar names--most of them recipients of federal money: IYD, MISH, the Children's AIDS Fund, Gerard, Focus on the Family and Pal-Tech, which joined IYD to run HHS's multimillion-dollar capacity-building program for faith-based groups. The IYD and the Children's AIDS Fund, though themselves nonprofits, have not been bad business for Shepherd and Anita Smith. Shepherd and Anita draw salaries and expenses from both groups: Shepherd as president of IYD and vice president of the Children's AIDS Fund; Anita, neatly, as president of the Fund and vice president of IYD. In 2003 their combined salaries were more than $200,000. To supplement that meager pay, each year since 2003 the Children's AIDS Fund has made substantial loans to the couple. The two groups also just happen to lease their shared offices in Sterling, Virginia, from an entity owned by the Smiths. According to IRS filings, the two nonprofits listed combined occupancy expenses of $66,000 for 1999. Two years later, the expenses jumped to $185,000, and by 2003 the two groups were paying a combined $203,000. Nonprofit experts contacted for this story said the huge jump in occupancy expenses combined with the fact that the two groups were paying a company owned by the Smiths raises a red flag. The two organizations have long played a role in pushing socially conservative approaches to AIDS--mandatory HIV testing, opposition to condoms and needle exchange and an abstinence-only approach to HIV prevention--and questioning condom efficacy through the creative manipulation of data. IYD has also insinuated itself into some of the country's most conservative Statehouses. In 1998 Virginia Governor Jim Gilmore and Claude Allen, then his secretary of health, threw their state's entire $1.5 million sex-ed budget into IYD's abstinence-only school program along with a statewide television and radio campaign crafted by the group. An even more lucrative future was rising for the group in Texas, where IYD sold its Right Choices for Youth initiative to the state as part of then-Governor Bush's aggressive faith-based policy there. In March 1999, Bush gave the welcoming speech at an IYD conference in Dallas--a harbinger of the close relationship to come. With Democrats now controlling Congress, this faith-based feeding trough may soon run dry. At press time, Democrats are poised to cut off one $50 million abstinence-only funding stream, through Title V, which requires renewal by June 30. Henry Waxman, the California Democrat who chairs the House government reform committee, is considering hearings on Bush's abstinence programs--hearings that could expose the conservative pork barrel they've become. Since February--perhaps to avoid those Waxman subpoenas--three ACF directors have resigned. First to leave was Jeffrey Trimbath, who jumped to a fundraising post with the Heritage Foundation. A month later Keroack vacated his post. Then on April 2 Wade Horn announced his resignation. But the revolving door of influence-peddling is still turning. Horn hired on with Deloitte Consulting, where according to a Deloitte statement he "will be a key advisor to health and human services clients of Deloitte Consulting's state government practice." Horn's former boss at HHS, Tommy Thompson, already heads Deloitte's Center for Health Solutions. As investigations unfold over the summer and fall, the Institute for Youth Development will continue to serve as a conduit for HHS's Compassion Capital Fund, through which IYD disperses grants to a select group of well-connected evangelical abstinence-only and crisis pregnancy centers. The money IYD disperses can be used for just about anything these organizations might need--from computers, software and office equipment to administrative training. While federal guidelines prohibit the use of these funds for "religious activities"--worship or proselytizing--it's clear that the infrastructure for these evangelical outfits is being subsidized by taxpayers. Even if the funds are not immediately applied to religious purposes now, they will remain to serve those purposes down the road. Without oversight and defunding from Congress, the money will continue to flow for the next five years into Raymond Ruddy's extended family of antiabortion, anti-condom, anti-gay, abstinence-only Protestant evangelicals and Catholics--a radical consortium that threatens the health of millions. --- 2. Poland Probes 'Gay' Teletubbies Poland official warned department may be turned into 'laughing stock' Reuters May 28, 2007 WARSAW - Poland's conservative government took its drive to curb what it sees as homosexual propaganda to the small screen on Monday, taking aim at Tinky Winky and the other Teletubbies. Ewa Sowinska, government-appointed children rights watchdog, told a local magazine published on Monday she was concerned the popular BBC children's show promoted homosexuality. She said she would ask psychologists to advise if this was the case. In comments reminiscent of criticism by the late U.S. evangelist Jerry Falwell, she was quoted as saying: "I noticed (Tinky Winky) has a lady's purse, but I didn't realize he's a boy." "At first I thought the purse would be a burden for this Teletubby ... Later I learned that this may have a homosexual undertone." Poland's rightist government has upset human rights groups and drawn criticism within the European Union by apparent discrimination against homosexuals. Polish Education Minister Roman Giertych has proposed laws sacking teachers who promote "homosexual lifestyle" and banning "homo-agitation" in schools. But in a sign that the government wants to distance itself from Sowinska's comments, Parliamentary Speaker Ludwig Dorn said he had warned her against making public comments "that may turn her department into a laughing stock." The 10-year-old Teletubbies, which features four rotund, brightly colored characters loved by children around the world, became a target of religious conservatives after Falwell suggested Tinky Winky could be homosexual. --- 3. United States Among Least Peaceful Nations In The World From LA Times Wire Reports May 31, 2007 The United States is among the least peaceful nations in the world, ranking 96th between Yemen and Iran, according to an index of 121 countries. According to the Global Peace Index, created by the Economist Intelligence Unit, Norway is the most peaceful nation and Iraq is the least, just after Russia, Israel and Sudan. The index was compiled based on 24 indicators. They included the number of wars in which a country was involved, arms sales, violent crimes and relations with neighboring countries. Fifteen of the top 20 most peaceful nations are in Western Europe, and higher income appeared to lead to higher levels of peace. --- 4. AIDS In Eastern Europe And Central Asia At Crisis Levels Current Drug Policies Blocking Progress SENLIS COUNCIL NEWS RELEASE 18 MAY 2006 AIDS in Eastern Europe and Central Asia at crisis levels: Current drug policies blocking progress Effective drug policy key in fight against AIDS Simple public health measures could prevent generalised HIV pandemic LONDON – Rising HIV/AIDS infection rates in Eastern Europe and Central Asia will skyrocket if a pragmatic drug policy approach is not integrated into preventive strategies, The Senlis Council, an international security and development think tank, warned on the occasion of the first conference on AIDS held in Moscow. According to the United Nations, between 30% and 80% of infections are caused by injecting drug use. “It is essential to address the critical link between injecting drug use and HIV/AIDS with a humanitarian, public health approach in order curtail the spread of the HIV,” said Emmanuel Reinert, Executive Director of The Senlis Council. “The spread of HIV is about public health, not politics. Governments must adopt public health measures for injecting drug users if any headway is to be made in tackling this killer disease.” Latest available figures show that there are currently an estimated 1.6 million people living with HIV or full-fledged AIDS in Eastern Europe and Central Asia. Russia, hardest hit by the bloodborne virus, has 350,000 registered HIV-infected patients, though most experts agree the real figure exceeds one million. The Council said that though there was an attempt to address the drugs issue at the Moscow AIDS conference, held from 15 to 17 May, not enough attention was being brought to the key issue of prevention through a pragmatic drug policy. “It is crucial that drug users are not forgotten in the fight against AIDS,” said Reinert. “People will continue to be infected through injecting drug use by sharing infected equipment. Simple policy measures such as clean needle exchange and substitution treatments could avoid an AIDS pandemic in Eastern Europe and Central Asia. But these are not being implemented for purely political reasons.” Recent years have seen an important rise in sexual transmissions, because drug users are getting older and more sexually active. Studies have shown that up to 80% of male injecting drug users regularly have unprotected sex. The think tank said that the current drug policy model is a major obstacle to reducing the growing instances of HIV/AIDS infection. The current approach does not include realistic – and often very simple and cheap – preventive public health measures that could save millions of lives. “Adopting a public health approach to drug use and HIV/AIDS is not just about the users, it is about the population as a whole,” Reinert said. “Eastern Europe and Central Asia must seize this opportunity to address the issue in an effective, humanitarian way. The governments owe it to their citizens to do everything possible to fight this epidemic.” --- 5. United Nations' AIDS Program Under Fire Authors accuse agency of putting politics before health By Erika Check ~ [email protected] The growth of better-funded projects has triggered an identity crisis at UNAIDS. Two new books are forcing the United Nations' AIDS programme to defend itself against claims that politics have distorted its mission. In one, Berkeley epidemiologist James Chin argues that the Joint United Nations Programme on HIV/AIDS (UNAIDS) has overestimated the potential size of the AIDS pandemic. That way, Chin says, the agency can claim credit when actual infection rates are lower than the projections. In the second, writer Helen Epstein says that UNAIDS has dodged the issue of sexual behaviour in Africa. Although reducing number of sexual partners can slow the spread of HIV, Epstein says UNAIDS has shied away from this message for political and cultural reasons. Some praise the books for providing much-needed scrutiny of UNAIDS. In a book review published today in Nature, Stephen Lewis, former UN special envoy for AIDS in Africa, calls them "liberating" (see 'Time for a change?'). And the University of Ottawa's Amir Attaran says the United Nations has a general problem with book-keeping. The United Nations has set a series of targets called the Millennium Development Goals, which call for improvements such as reducing HIV infection, child mortality and poverty by 2015. But Attaran alleges the United Nations has failed to properly measure progress towards these goals, rendering them all but meaningless. "It's got to be the greatest swindle in all of development," Attaran says. Defending party Other observers defend UNAIDS against the claim of distorting data. The crux of Chin's argument is that UNAIDS epidemiologists have erred by surveying pregnant women for HIV infection at prenatal clinics, then extrapolating to the general population. More recent surveys of HIV in the general population have prompted UNAIDS to lower its estimates in some African and Asian countries. But those who participate in the process say this was never about politics, but more about adapting calculations to the available data. And, they add, UNAIDS has always said that data from different methods aren't directly comparable. "It has always been a data-based, not a political process," says Tim Brown, an epidemiologist at the East-West Center in Honolulu who collaborates with UNAIDS. "The epidemiology team at UNAIDS has gone out of its way to stress that data can only be interpreted in terms of trends based on the same methodology," he says. UNAIDS also says that it has long emphasized the value of reducing the number of sexual partners, including in a 2005 document, "Intensifying HIV Prevention". Some observers support the claim. "As far as I am aware, reducing partner numbers has been a prevention message for the past 20 years," says Geoff Garnett at Imperial College London, which coordinates the UNAIDS Epidemiology Reference Group. Identity crisis The broader picture behind the criticisms is that UNAIDS is searching for relevance. The agency was formed a decade ago to focus attention on the disease when there was little international funding or political commitment to fight it. Now, huge entities such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the US President's Emergency Plan for AIDS Relief (PEPFAR) are pouring unprecedented resources into the problem. Leadership has largely shifted to these bodies and away from UNAIDS, which is hampered by bureaucratic constraints and a smaller budget. That makes UNAIDS a relatively soft target, some say. "UNAIDS is easy to shoot at, because they don't have a lot of money compared with donors such as PEPFAR and the Global Fund," says Chris Beyrer, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. "What are they supposed to do? They're not an enormously powerful entity." But that begs the question of what to expect from UNAIDS in the future. With little money and clout, the agency must find a way to deal with its identity crisis. Additional reporting by Emma Marris --- 6. Robert Zoellick to Replace Wolfowitz As Head of World Bank Democracy Now ~ May 30, 2007 The Bush administration has announced plans to name former Deputy Secretary of State Robert Zoellick to replace Paul Wolfowitz as head of the World Bank. Zoellick spent four years as the U.S. trade representative until 2005. He went on to the State Department before leaving to join the financial firm Goldman Sachs last year. Zoellick previously served as a paid advisor to the energy company Enron before its collapse. He was an early backer of the U.S. invasion of Iraq and a co-signatory of the neo-conservative Project for a New American Century letter calling for Iraq regime change. Public health advocates are criticizing the appointment. Dr. Paul Zeitz, Executive Director of the Global AIDS Alliance called Zoellick “a terrible choice”, saying: “He has been a close friend to the brand-name pharmaceutical industry, and the trade agreements he has championed block patients access to generic medication… As a market fundamentalist he is also much less likely to stand up for a strong and effective public sector.” --- 7. Gay Men Who Use Methamphetamine Have Greater Risk Of HIV Seroconversion Michael Carter, Tuesday, May 29, 2007 AIDSMAP Use of methamphetamine (often called crystal meth) by gay men is associated with unprotected sex and HIV seroconversion, according to two recently published American studies. Investigators from the Multicenter AIDS Cohort Study (MACS) found that gay men who used methamphetamine and poppers during sex, and who had unprotected sex with five or more partners had an extremely high risk of contracting HIV. Their findings are published in the May 1st edition of the Journal of Acquired Immune Deficiency Syndromes. A smaller study involving gay men in California, published in the June edition of Sexually Transmitted Diseases, also found a clear association between the use of methamphetamine and an increased risk of infection with HIV. The Californian investigators also found that methamphetamine use often occurred alongside the use of other illicit substances, reflecting the findings of UK research that the small number of British gay men who used methamphetamine were poly-drug users. Use of methamphetamine has been popular with gay men in the US for many years. It has a powerful stimulating effect on the central nervous system and many individuals report that it enhances sexual enjoyment. Previous studies have suggested that gay men who use methamphetamine are more likely to have unprotected anal sex. Few studies, however, have examined the link between use of methamphetamine and the risk of acquiring HIV infection. A better understanding of the relationship between drug use and HIV infection risk could, investigators believe, lead to the development of improved HIV prevention strategies. Use of poppers can also enhance sexual pleasure and some studies have also suggested that their use can be associated with an increased risk of acquiring HIV infection. There is also substantial evidence suggesting that methamphetamine and poppers are often used together. Large cohort study finds link between methamphetamine, unprotected sex, and HIV seroconversion Investigators from the MACS cohort, an ongoing longitudinal study involving thousands of gay men recruited in waves since the mid-1980s, therefore designed a study to examine the association between methamphetamine, and other drug use, and sexual risk behaviour amongst men who were HIV-negative when they entered the cohort. In particular, they wished to see if the use of methamphetamine or any other drug increased the risk of unprotected sex and HIV seroconversion. Every six months, men provided details of their drug taking and sexual behaviours and were tested for HIV. A total of 4,003 gay men, recruited to the cohort from 1985 to 2004, were included. After adjusting for potentially confounding factors, the investigators found that men who reported use of methamphetamine had a relative risk of HIV seroconversion of 1.46 compared to men who did not use the drug. This risk increased to 2.10 if methamphetamine was used with poppers. The investigators also established that the risk associated with methamphetamine use and HIV seroconversion increased, unsurprisingly, with the number of men a man had unprotected receptive sex with. A man reporting methamphetamine use and receptive unprotected sex with one partner had a relative risk of HIV seroconversion of 1.87. This risk increased to 9.32 for men who used methamphetamine and had receptive unprotected sex with five or more men. Men who used both methamphetamine and poppers had an even greater risk of HIV seroconversion. Again, this risk increased with the number of partners a man had unprotected receptive anal sex with, the risk being 2.71 for men reporting one partner, but 13.57 for men using methamphetamine and poppers during unprotected receptive sex with five or more partners. The investigators are unable to say from their research why the use of methamphetamine and poppers together contributed to an increased risk of HIV seroconversion, but speculate that “it is likely to be a multifactorial process involving behavioural disinhibition, anal trauma, and selection bias for higher risk sexual partners." Californian study – methamphetamine use often occurring within the context of other drug use Investigators in Los Angeles wished to determine the relationship between the use of illegal drugs and unprotected anal sex amongst gay men before and after seroconversion with HIV. They therefore designed a study involving 207 gay men with an estimated recent date of HIV seroconversion. These men were asked to provide details of their last three sexual partners and to say if drugs were used during sex with these men. Data were collected a median of 13 weeks after the estimated date of HIV seroconversion. The men had a median age was 35 years, 70% were white, 46% were college graduates, and the median number of sexual partners in the previous three months was nine. Overall, 12% of all sexual partners were known to be HIV-positive, 42% were known to be HIV-negative, and 46% were of unknown status. Before HIV seroconversion, unprotected sex was strongly associated with methamphetamine use (odds ratio, 7.12, p = 0.01). An association was also found between unprotected sex and the use of methamphetamine and other illicit substances (odds ratio, 4.06, p < 0.01). However, after diagnosis with HIV, no significant association was found between the use of methamphetamine and unprotected sex, but a significant relationship was found between the use of other drugs and risky sex (odds ratio, 3.25, p = 0.01). “Methamphetamine use was associated with a greater odds of unprotected anal intercourse before HIV diagnosis but was not associated with unprotected anal intercourse after diagnosis”, write the investigators, adding, “in contrast, use of substances other than methamphetamine were not associated with unprotected anal intercourse before HIV diagnosis but were associated with a greater likelihood of unprotected anal intercourse after diagnosis.” The investigators also recorded a “modest” reduction in the number of partners with whom men reported unprotected sex with after their HIV diagnosis. They suggest that this represents “a deliberate reduction in transmission behaviours.” “There was a considerable overlap in use of many different substances (i.e. poly-drug use) with a single partner among our participants”, note the investigators. The 2005 UK Gay Men’s Sex Survey found similar evidence of poly-drug use amongst the few men it identified as using methamphetamine. The investigators conclude “new interventions designed to reduce HIV transmission among men who have sex with men through cessation of substance use should consider different types of substance use, including poly-drug use.” --- 8. HIV-Negative Serosorters May Increase Their Risk For HIV, Study Says Michael Carter, Thursday, May 17, 2007 ~ AIDSMAP Individuals who believe themselves to be HIV-negative cannot rely on serosorting as an HIV prevention strategy, according to researchers from the university of California, writing in the May 31st edition of AIDS. The investigators developed a mathematical model that took into account the risk of HIV transmission posed by individuals who believe they are HIV-negative, but actually have acute HIV infection. They found that HIV-negative men were at much higher risk if they chose to have unprotected sex with men they believed to be HIV-negative, but who were actually seroconverting, than if they had unprotected sex with HIV-positive men on successful treatment. Infectiousness is highest during the first few months of HIV infection and serosorting behaviours by individuals with acute HIV infection may, the investigators conclude, actually be contributing to the spread of HIV. A recent study found that approximately half of all HIV infections are due to transmission from recently infected undiagnosed individuals, and studies conducted in Australia and the US suggest that gay men who believe themselves to be HIV-negative are having unprotected sex with partners who have declared themselves to be similarly HIV-uninfected. There is also anecdotal evidence from gay dating websites that increasing numbers of men are reporting they are “HIV and STD clean” and are insisting that their partners have the same perceived disease status. The results of the latest study suggest that rather than protecting their health, they may unwittingly be risking both their own and other men’s health. Correct and consistent use of condoms is an effective method of HIV prevention. But several studies have revealed that some individuals are selecting their sexual partners on the basis of reported HIV status to either minimise their risks of HIV infection or, if they are HIV-positive, the risks of onward transmission of HIV. If condoms are not used for penetrative sex, it is essential that HIV status is accurately reported. However, some individuals who say that they are HIV-negative (even if they have had a recent HIV test) may have been recently infected with HIV. Because the effectiveness of serosorting depends on accurate disclosure, investigators modelled the risks of HIV transmission for individuals disclosing that they were ‘HIV-negative’ and ‘HIV-positive.’ The model for ‘HIV-negative’ individuals took into account the transmission risks involved at different stages of HIV infection. Unsurprisingly, the investigators calculated that the transmission risk per 10,000 for individuals who were actually HIV-negative was zero. For individuals who believed themselves to be HIV-negative, but who had chronic, asymptomatic HIV infection, the transmission risk was calculated as seven in 10,000. This risk increased for individuals thinking themselves HIV-negative, but with advanced HIV infection to 36 in 10,000. The highest transmission risk of all was for ‘HIV-negative’ individuals with acute HIV infection who had a transmission risk of 82 in 10,000. The investigators then modelled the risk of HIV transmission from individuals who knew they were HIV-positive and disclosed this status. They calculated that asymptomatic individuals not taking antiretroviral treatment had a transmission risk of 7 per 10,000. This risk fell to 1 per 10,000 for individuals taking stable and effective antiretroviral therapy. However, for individuals with advanced HIV disease with risk was 36 per 10,000. “During the period of recent HIV infection, individuals typically have a much higher viral burden than they do for most of the time they are infected”, write the investigators. They add, “as the proportion of recently infected potential sex partners in the population increases, the effectiveness of disclosure for preventing HIV transmission by serosorting decreases.” Indeed, the investigators suggest that “as a result of differences in the proportion of potential partners who are recently infected, the risk of acquiring HIV from one sexual exposure with one randomly selected ‘HIV-negative’ discloser from a high-risk population may actually be greater than the risk associated with a randomly selected HIV-positive discloser.” They note that few in their cohort of HIV-positive individuals were taking potent HIV therapy so they “conservatively” estimated transmission to be one-seventh of that from untreated individuals with asymptomatic infection. “Our conservative calculations show that serosorting based on disclosure is not likely to be an effective prevention strategy when the prevalence of recently infected ‘HIV-negative’ disclosers comprises approximately 4% of the potential sex partner population. This is a realistic calculation based on current data.” They add that given the prevalence of undiagnosed acute HIV infection, “HIV-uninfected individuals who try to serosort may be more likely to become HIV infected than if they had not tried to serosort in the first place.” They conclude “individuals at greatest risk of HIV infection predictably belong to those very groups having the greatest proportions of recently infected people. By ignoring the increased potential for HIV transmission by recently infected individuals, serosorting may paradoxically increase the number of new HIV infections in certain populations.” --- 9. Czech Republic: Time Bomb For Roma TRANSITIONS ONLINE by Mia Malan and Jayalakshmi Shreedhar 31 May 2007 PRAGUE, Czech Republic | Milan Horvat wakes up every day and strolls into the street to meet his “clients.” The middle-aged man always wears the same clothes to work: a black suit, sleek black shoes and a white shirt, with the top two buttons undone. Four golden rings, two on each hand, gleam as he explains his routine. When he dons his large brown sunglasses and smiles, his freshly-shaved face exudes a strong whiff of perfume. He has the air of a high-caliber businessman. But his work in Prague is anything but normal. Every day, Horvat meets drug users in the capital city’s cobbled lanes and alleys. Most of them are Roma. He wants to help them to kick the habit, but it’s a complex, and sometimes hopeless, task. At the same time, he gives them new needles and syringes in exchange for their used ones. If they’re going to inject drugs, the equipment they use to give themselves their daily fixes must at least be clean, is Horvat’s attitude. EPIDEMIC WAITING TO HAPPEN? The medical basis of needle exchange is that it drastically lowers the chances of contracting HIV through drug use, because sharing needles that are contaminated with HIV is one of the surest ways to become infected with the AIDS virus. “I am from the streets myself. I am a Gypsy and I feel at home here, though I’ve never used drugs myself,” he mutters. “But I know what drugs mean.” Horvat has first-hand experience of the horrors of drug abuse: he and his family struggled for many years to help his brother fight addiction. Eventually, they were successful and his brother abandoned drugs. But the helper in Horvat had been awakened by his experience. “When I saw an ad in the paper saying, ‘We are looking for Romani street workers,’ I grabbed it,” he says. “I knew my job would be important.” Horvat is one of two street workers from the Romani organization Romodrom, which reaches out to drug users in this community in Prague. He believes drug use among Roma is a massive problem that is being underestimated. There are approximately 5,000 drug users in the city who’ve registered with Romodrom. At least 40 percent of them are Roma, the organization believes – even though Roma make up only an estimated 2 percent of the 10 million people in the Czech Republic. Last year, Romodrom had contact with about 6,000 clients and distributed 25,000 clean needles. About 140 Roma seek the center’s help every day, Horvat says. Romodrom has a special program devoted to drug users aimed at preventing their infection with various transmissible agents, such as hepatitis and HIV. In the Czech Republic in 2004, almost 9 percent of people with HIV became infected as a result of injecting drugs, according to The United Nations AIDS agency. No one, however, knows how many of those people were Roma, as Czech law prevents health data from being collected on the basis of ethnicity. A 2004 UN Development Program study on Roma and HIV/AIDS found a dramatic increase of HIV infection rates in Central Europe. According to the study, HIV/AIDS affects groups that are prone to high poverty rates, high mobility, and limited social services to a greater extent. Although the total number of people living with HIV in the Czech Republic is low, about 0.1 percent of the population according to a 2005 estimate by UNAIDS, the Roma seem to possess all the traits that make people vulnerable to contracting HIV: They are far more likely to be poor, women are generally disempowered, parents and children rarely talk about sexual matters, alcohol abuse is high, and condom use is extremely low. LIFE ON THE WRONG SIDE OF THE TRACKS What makes a dire situation even worse is that many Roma do not possess identification documents, aid workers say, so they therefore have limited access to health care. They’re therefore less able to receive preventive information on the virus or get tested for it. And those who do have access to health care and information have a deep distrust of the state health care system – especially Romani women, who in the past were often sterilized without their consent as a result of government fears of their high birth rate. Very little formal data exists about the health and drug problems among Czech Roma – especially with regard to HIV. And this void increases the potency of an already dangerous situation. A few kilometers outside Prague, a narrow path along a train track winds its way up a hill past a desolate playground. The smooth, asphalt pathway leads past a row of small houses until the pavement suddenly stops, as does any indication of development. Two rundown buildings, surrounded by pools of black mud, loom into view, at a distance from the other houses. A large white dog lies in front of one of the many cracked doors. The glass of many windows is broken and exposed electrical cables snake their way across the peeling walls. Each building has two floors – and families staying on the top floor don’t have toilets or bathrooms in their apartments. They share dirty, bad smelling communal bathrooms without hot water. This is where the Roma live – in isolated enclaves, “on the wrong side of the tracks” in the small town of Libcice nad Vltavou. Of the 150 Roma living here, only eight of 80 adults have ever held a job. The other 70 Roma in this part of town are children. Unemployment and poverty seem to follow the Roma wherever they go. A 2005 study by the Research Institute for Labor and Social Affairs in Prague estimated the jobless rate among Roma at 70 percent. Most Roma who do find jobs are limited to unskilled employment. As a result, most Czech Roma rely on state social payments either directly or through family members. Jozef, a sturdy man in his early thirties, is one of the few in the village with a job. He has better furniture and food in his house than most of his fellows. But he’s angry and paces up and down. He wants to talk about the drug problem in his community. His father, however, intervenes to stop him from speaking. Jozef’s father is worried that his family could suffer repercussions among their peers if they speak out about drug use. "Things can happen to you here," Jozef’s father mutters. He fears that people will start calling them traitors and troublemakers. By speaking, you can get your loved ones into trouble, the Roma say. “The Roma see drug use as a way of getting integrated into the larger society,” says Ivan Vesely, who heads Dzeno, one of the largest Roma advocacy groups in Prague. “It’s harder for us to integrate through education and employment – there’s so much discrimination against Roma in these fields. By taking drugs, the Roma imitate non-Romas and their lifestyle," he says. Roma living in cities usually take heroin and pervitin, a locally-made amphetamine, Horvat says. In rural areas, the drugs of choice are inhaled toluene, a cheap paint thinner, and Kanagon glue, which is chewed mostly by children, according to Marta Hudeckova, director of Manusa (People), a Romani women’s organization. Horvat says the situation is so serious that many “desperate mothers report their children to the police for false robbery just to get them jailed for a year or two” so that they can get off drugs, in the belief that drugs are less accessible behind bars. “Children as young as 12 and 13 have problems with addiction,” Horvat says. “But they can’t be helped – it’s against the law for NGOs to work with these children because they are under 15 and must have a legal representative.” NGOs like Romodrom and Manusha have responded by running information campaigns at schools to draw attention to the drug problem among Romani children. For young children they do dramatic skits that explain what to do when someone offers them drugs, or how to tell their parents that they are on drugs. “We want to really change something for our people,” says Marie Gailova, Romodrom’s chairperson. “We work 13 to 14 hours a day and help 300 Roma clients daily in the five regions where we work.” Not talking openly about drug use in communities is not the only challenge the Roma face. It’s equally unacceptable to talk about sex. “WE DON'T USE THOSE FUNNY THINGS” Jozef’s partner, Gabriela, 29, tightly clutches their two-year-old son in her arms. It’s clear that he’s her treasure. Jozef and Gabriela are not married. They don’t see the need. Theirs is a relationship based on trust – a relationship that strictly excludes discussions about sex or HIV. “I have never used a condom, because I can trust my partner,” Gabriela says. “I don’t know if my friends use condoms, because we don’t talk about sex. But I don’t think they do.” Neither Gabriela nor Jozef has ever taken an HIV test. A recent study by the Wisconsin Medical College in the United States found that condom use among the Roma in Central and Eastern Europe was rare and mostly associated with contraception. Starting in the 1950s, Czechoslovak authorities employed sterilization, sometimes accompanied by cash payments, to slow the growth of the Romani population. Several Romani women who claim they were sterilized without informed consent have sued the Czech and Slovak governments. Once women were sterilized they often refused to use condoms, as they perceived them to protect against pregnancy but not against sexually transmitted diseases. The study also showed that Romani men have far greater sexual freedom before and during marriage than women. They engage in unprotected sexual practices with outsiders and have much more power in relationships than women. The study found that Roma in Europe are aware of HIV, but don’t feel personally threatened by it. “Sex is something everyone does, but nobody talks about,” says Lida Polackova, a Romani adviser at the social affairs department in the city government of Ostrava, an industrial city in the eastern Czech Republic where many Roma live. “Almost no one in Roma communities knows whether they’re HIV-positive or negative. And premarital sex is completely natural, starting at 13 or 15 years of age.” Back in Libcice nad Vltavou, two teenage girls in tight jeans are coyly whispering about sex as they smoke outside one of the apartment buildings in the Romani neighborhood. They’re giggling and making jokes about it. Both have had sex with their 16- and 18-year-boyfriends. They blush when asked about condoms. “We don’t use those funny things," one says. “Condoms are not for us.” A long train lurches past on the nearby track, making talk impossible even if there were anyone the girls outside. There’s nothing around the two buildings, no greenery, no people, and no sign of hope. Instead of place where dozens of people live, the apartments could easily be mistaken for train station storage buildings. HIV prevention for the Roma can’t be addressed in isolation, Horvat says. Improved access to health care, education, and employment is part of the solution, nearly everyone agrees, from street workers to high-powered experts from the European Union and the World Bank. None of the many problems facing Roma in places like Libcice can be addressed on its own. Horvat and others who know the Romani community believe that it's unrealistic to expect Roma to quit drugs and in so doing cut their vulnerability to HIV/AIDS when drugs offer their only escape from the harsh reality of the poverty, discrimination, and segregation they face in everyday life. And when many Roma continue to live in rundown housing with inadequate hygiene, it’s too much to expect them to care about safer sex, even if they are informed about sexually transmitted disease. In his Prague office, a restless Horvat fidgets as he analyzes strategies to help his people. “For me the best moment in my job would be when I see that there are hardly any drug users or HIV infections anymore,” he says. “When services like mine are not needed anymore and everyone has access to services that can help them.” He sighs, and returns to his work. Redundancy still seems a very long way away for people like Milan Horvat. Mia Malan is the Internews Senior Health Journalism Adviser in Washington, D.C. Jayalakshmi Shreedhar is the Internews Project Director of the Local Voices Project in India. Lucia Curejova, Maria Husova, Petrana Puncheva, and Petru Zoltan contributed to this article, which was produced during a TOL health reporting seminar. --- B Upcoming Conferences and Events (send your event listings to [email protected]) The 2007 International Drug Policy Reform Conference December 5-8, 2007 Working Toward a New Bottom Line December 5-8, 2007 ~ Astor Crowne Plaza ~ New Orleans, LA ~ The Drug Policy Alliance's International Drug Policy Reform Conference is the world’s principal gathering of people who believe the war on drugs is doing more harm than good. No better opportunity exists to learn about drug policy and to strategize and mobilize for reform. 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