News (Updated August 29, 2010)

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August 25, 2010,

China Urged to Close Health Gap

You’ve heard about the wealth gap, the digital divide and development disconnect. Now, give some consideration to health inequality, another area where standards in developing countries like China and India pale next to those of rich countries.

ZUMApress.com

Zhang Meichun, left, 91, gets a physical in Wenling City .

A new report aims to rebalance the world’s approach to health in developing countries like China , and in particular to revolutionize cancer treatment. Among the recommendations is a call for pharmaceutical companies to lower prices in poor countries for cancer drugs as was done with medicine for the HIV-AIDS epidemic.

The report, published by Cantreat, a British nonprofit that advocates improved cancer treatment, gets straight to the depressing point. “By 2020, cancer is expected to kill more than twice as many people worldwide as it did at the turn of the millennium. In low- and middle-income countries, however, the death rate will be more than five times greater than in the industrialized world,” it says.

The report, released on the sidelines of the World Cancer Congress in Shenzhen last week, is the product of input from several different health agencies and organizations, without pharmaceutical company or equipment supplier funding, according to Joseph Saba, its main author and CEO of Paris-based consulting firm Axios. “Let’s speak with one voice to say there is a problem,” the former United Nations health official said.

“It is estimated that up to 80% of cancers in low- and middle income countries may be incurable by the time they are diagnosed,” the report says.

While 50% of cancers are controlled or cured in rich countries, Saba says, perhaps less than 15% are in the developing world.

The findings are jarring, if at times the numbers seem like common sense: A basic reason cancer deaths will likely soar in the developing world is that that is where population growth will be and large numbers of people live. The world is also aging, it notes, and cancer is likelier a late-stage disease.

Cancer also is a result of better times in places like China . A two-thirds increase in life expectancy in China in the past 40 years will inevitably lead to more cancer being detected, according to the report. It says chronic disease tracks to economic advances – obesity is one sign.

Saba says China ’s ongoing healthcare reform aims to address chronic disease, and that likely first involves more screening for cancers.

Some of the data seem conflicting. The report says globally one in eight deaths is caused by cancer but also that only 35% of the world population, according to a finding in 2000, live in places that systemically register cause of death.

The authors hope that cancer will be on the agenda of a September 2011 UN meeting of world leaders on the global health systems. Saba points to a 1994 summit where 42 heads of state addressed the AIDS crisis at the UN (PDF) and called it a “threat to humanity.”

A backbone of the study is the developing world’s experience treating HIV-AIDS. “As experience in AIDS has demonstrated, treatment can enable more effective prevention, and prevention makes treatment affordable,” the report says.

The report concedes cancer treatment is often more complex than dealing with HIV, but its prescription is similar. “As an immediate step, private industry can implement sharply tiered or no-profit pricing of cancer drugs in low- and middle-income countries. This approach has proven essential to recent treatment breakthroughs in the global AIDS response,” it says.

“Ensuring access to cancer treatments in developing countries is entirely feasible,” the report concludes.

China 's growing HIV crisis, a result of social stigma

Beijing :  43-year-old Bei Fang is a former Chinese television anchor. But these days he is a counsellor for men who have sex with men, also known as MSM.
 
His new role is crucial given the fact that homosexual transmission of HIV is increasing rapidly in China . Over 12 per cent MSM are infected with HIV.

In China the odds of MSM having HIV is 45 times higher than the general population. High levels of HIV among MSM have been reported globally. 
 
"Fewer than one in ten MSM have access to HIV prevention services epidemic continues to increase within this group.Whereas we see some successes in general population, we are seeing resurgence of HIV prevalence in western countries among MSM, and of course ongoing crucial epidemic MSM in developing countries," said Andy Seale, Senior Advisor for Sexual and Gender Diversity, Global Fund, China.

In China , the biggest barrier is stigma and homophobia in society. Bei Fang, who is an MSM himself, has not been able to come out of the closet to his family. Many MSM disguise their sexual preferences and marry women, which also puts their wives at risk. A majority of MSMs cannot access the HIV prevention services openly.
 
"Maybe the timing is not yet right, but we don't have a public figure or celebrity in China who is open about his status as MSM. Sometimes there is speculation, based on rumours about his marriage or from the way he behaves or dresses," said Bei Fang, Counsellor, Quiet Garden , China .
 
Though largely invisible, estimates say there are nearly 10 million MSM in China .
 
The Government has now launched a large scale campaign to address MSMs. Clinics have opened in 61 cities for HIV testing and counselling. While the patient's confidentiality is maintained, there is strong promotion of condom use, and treatment for sexually transmitted infections.
 
The effort is to mainstream services for MSMs from a rational, public health perspective. There are a few clinics run by NGOs that operate from Government hospitals.

But a wide spread acceptance of MSM is what many think, will be the best HIV prevention programme.

Young people 'don't really care' about STIs

What is the culture that lies behind the latest increase in number of sexually transmitted infections (STIs) in the UK ?

Andrew is an HIV positive 21-year-old who now works at the Sylvia Pankhurst sexual health centre in East London's Mile End Hospital .

"I would go out, drink alcohol, maybe use some substances that I shouldn't and meet someone in a bar or a club, have sex and wake up the next morning and... not worry too much about it," he says, recalling his youth.

"Sometimes it was protected, sometimes it wasn't. It wasn't of great importance to me at the time."

He says the young people he sees in his work often do not pay much attention to STIs.

"They know of the complications that can arise, like unintended pregnancy and STIs, but they don't really care, they don't see it as important," he says.

"They're very much more a here and now generation, they go out, they have sex and don't really think anything of it until a problem arises."

Making a difference

Andrew had been sexually active from the age of 12 and had his first test for STIs just before his 14th birthday.

"I went to a deputy head teacher at my high school and said I was a bit concerned and I wasn't sure where to go," he says.

"She actually took me to a local clinic to be tested. It was very scary, but it was worthwhile, and after that I felt more comfortable going to the clinic."

The clinic where Andrew works attempts to make it easier for young people to face up to STI testing.

Open the doors, and you are greeted by bright colours and posters. It does not feel like a hospital or a place where people come to get tested for STIs.

"Things are much more relaxed. Young people... are not frightened to actually come into the service," says Carol Wallace, general manager of the clinic.

"Nobody knows what you're actually coming in for. It could be for a packet of pills, it could be for a full STI screen."

After working in the field for 10 years, she believes young people now are much less embarrassed about going for a test.

It is the older people, she says, who still find the subject difficult.

But with STI re-infections on the rise, Andrew warns that young people's behaviour and attitude towards sex and STIs will change only if sex education is improved.

"I truly believe that sex education makes a difference", he says.

"I had really poor sex education at school, to the point that the person who came in to teach us did not want to talk about condoms… [they were] only really there because they had to be.

"People think [you] can get treated for every STI, which isn't the case. We do have STIs like HIV which you have for life.

"It only takes one sexual experience for an STI to be transmitted."

Obama Requests More Money For HIV/AIDS, Other Health Programs

24 Aug 2010   

On Friday, President Obama updated his pending fiscal year 2011 HHS budget request to include $400 million more for HIV/AIDS programs, high-risk insurance pools and health worker training, CQ HealthBeat reports. He made the request to House Speaker Nancy Pelosi (D-Calif.).

Obama seeks an additional $30 million for state programs that provide drugs for people living with HIV and $35 million more for HIV/AIDS prevention initiatives and research programs. The administration has been facing criticism from the AIDS Healthcare Foundation and other advocacy groups that claim it has not devoted enough money to HIV/AIDS programs.

Obama's letter calls for $250 million for programs to train primary care physicians and health care workers who focus on care for seniors. The president also requested more funding for programs related to the health reform law (PL 111-148), including an additional $55 million to help states establish high-risk insurance pools and $30 million more for consumer information about health insurance.

White House officials said the request proposes several spending offsets, including a reduction in buildings, facilities and construction funding for NIH, as well as cuts to CDC grants (Young, CQ Today, 8/20).

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