Botswana's campaign to circumcise about 500,000 men by 2012 will prevent nearly 70,000 new HIV cases by 2025, according to a report published Thursday in the Journal of the International AIDS Society, AFP/Yahoo! News reports. The government's national campaign aims to circumcise 460,000 men over the next five years, and the country has begun airing television and radio advertisements to encourage men to be circumcised at local clinics. "Scaling up safe male circumcision has the potential to reduce the impact of HIV/AIDS in Botswana significantly," according to the study. The report puts the estimated cost of the circumcision campaign at about $47 million. A UNAIDS report estimates that the HIV prevalence among pregnant women in Botswana was 43% in 2003, the year that antiretroviral drug access was introduced in the country (AFP/Yahoo! News, 5/28). An abstract of the study is available online .

Congressional lawmakers who are crafting a plan to overhaul the U.S. health care system might be able to look to state health insurance programs in Massachusetts and Tennessee for ideas, the AP/Minneapolis Star Tribune reports. Health reform legislation modeled after Massachusetts' near-universal health insurance law "is likely to emerge" in Congress, "although details remain unsettled," the AP/Star Tribune reports. The plan also could include components of Tennessee's CoverTN program, which charges beneficiaries who smoke or are overweight higher premiums. Lawmakers in the Senate already have discussed a lifestyle tax funding mechanism, such as taxes on alcohol and sugary beverages. According to AP/Star Tribune, Massachusetts "chose to cover virtually everyone," while Tennessee "chose to get just a few more people bare-bones insurance at a budget price with limits on how much plans would pay for hospital stays."Alan Weil of the National Academy for State Health Policy said, "The belief that we should all have health insurance coverage is broadly held," but "there are tremendous differences around the country in beliefs on how to achieve that goal." He added, "We learn from Massachusetts that a bold objective matters. If it can be sustained, that's terrific," and "[i]t would be nice if you had a southern state that had achieved universal coverage and did it in a different way, but we don't have that" (Johnson, AP/Minneapolis Star Tribune, 5/28). American Public Media's "Marketplace " on Thursday reported on a study published in Health Affairs that looked at the Massachusetts program. The segment included comments from Jon Kingsdale, director of the Massachusetts Health Insurance Connector Authority, and University of North Carolina Health Care System CEO Bill Roper (Babin, "Marketplace," American Public Media, 5/28).

Aetna , Cigna and Humana ranked highest nationally on criteria including speed of health claim payments and fewest claims denied, according to the 2009 PayerView Rankings, the Boston Globe reports. The rankings -- prepared by Athenahealth in collaboration with Physicians Practice management journal -- evaluated 172 national, regional and government payers in 40 states.According to the data, insurers paid physicians an average 5.3% faster in 2008 and denied an average of 9% fewer medical claims compared with 2007 figures. On average, national health insurers paid physicians in 33 days and denied 9.2% of claims.According to the Globe, the rankings reveal some of the obstacles that can result from the complexities and bureaucracy involved in the medical billing process, with each insurer operating in different ways. Jonathan Bush, chair and CEO of Athenahealth, said, "This is the biggest problem we have in health care -- the inability to close supply chains and to practically and tactically connect doctors with payers and patients," adding, "These connections are broken" (Weisman, Boston Globe, 5/28). The rankings are available online .

The opportunity to enact health care reform legislation could be missed unless Congress passes it this year, President Obama on Thursday said to thousands of supporters in a phone call made from Air Force One, the AP/USA Today reports. In a call to members of his political organization, Organizing for America , Obama said, "If we don't get it done this year, we're not going to get it done," adding, "I think the status quo is unacceptable and that we've got to get it done this year." Obama also said that any action on overhaul legislation could be delayed unless volunteers pressure lawmakers to support the administration's goals for health care reform (AP/USA Today, 5/28). Obama said, "Some of you are in states and districts where politicians are resistant to bringing about change, so we need you to get involved" (Zeleny, "The Caucus ," New York Times, 5/28). Obama told volunteers that it was time to "remobilize" after their successful campaign to get him elected, adding that "we have gotten a lot of things done during our first four months. But health care, that's a big push" (AP/USA Today, 5/28).David Plouffe, Obama's presidential campaign manager and head of Organizing for America, during the call said, "If the country stands with the president and if the country is demanding health care reform, [then] we'll get it done," adding, "Washington will not have any option but to follow us." He added, "You need to take ownership of this" ("The Caucus," New York Times, 5/28).

Organizing for America Campaign The conference call was in preparation for the launch of Organizing for America's health care campaign, the AP/USA Today reports (AP/USA Today, 5/28). Organizing for America has scheduled grassroots organizing events beginning June 6, when Obama will release a video message about his principal goals for reform. The ideas generated at the events will be used to plan public service events that will be held on June 27. Mitch Stewart, executive director of Organizing for America, said, "Reforming [our] health care system is going to require each and every one [of] us to get involved" (Davis, "Washington Wire ," Wall Street Journal, 5/28).

Senate Health, Education, Labor and Pensions Committee Chair Edward Kennedy (D-Mass.) is circulating an outline of health care overhaul legislation that includes a requirement that all individuals obtain coverage and requires contributions from employers, the Washington Post reports. According to the Post, the legislation "closely resembles" the Massachusetts health insurance law enacted in 2006, the Post reports. According to the draft summary, the bill calls for a public, government-sponsored health insurance option that would compete with private insurers. The measure also would expand Medicaid eligibility, according to the Post. Kennedy spokesperson Anthony Coley said that the outline is not yet finalized. He said, "We are still actively negotiating with members" of the Senate HELP Committee. According to a top White House official, Kennedy is expected to introduce his measure on Monday. A timetable released by Kennedy's office calls for Senate HELP Committee Democrats to meet June 2 (Connolly, Washington Post, 5/29). A bipartisan walk-through of Kennedy's bill is scheduled for June 5 and June 9. Hearings on the bill would then take place on June 10 or June 11. The mark up of the bill is scheduled from June 16 through June 25 (Bogardus, The Hill , 5/28). If Kennedy holds to the schedule, he will be ahead of other congressional Democrats, including Senate Finance Committee Chair Max Baucus (D-Mont.), on proposing overhaul legislation (Washington Post, 5/29). Coley said, "These are target dates that are not set in stone." Although Senate Democrats are hoping to pass health care reform legislation before the August recess, several senators have questioned whether that timeline is feasible (The Hill, 5/28).

Reform Supporters Call For Removal of Ad In related health reform news, Democracy for America and the Service Employees International Union on Thursday demanded that Washington, D.C.'s NBC television affiliate refuse to air a 30-minute infomercial funded by Conservatives for Patients' Rights , Politico reports. According to a letter from SEIU to NBC4 , the ad, scheduled to run after "Meet the Press " on Sunday, "will be false, deceitful and a distortion." The union added that the station has a responsibility to pull the ad because it has a duty to protect the public from misleading advertising. In the letter, the union wrote that the conservative group has a history of running "demonstrably false" ads. According to Levana Layendecker, the online campaigns director for Health Care for America Now , CPR could face fines from the Federal Communications Commission if the ad is run, adding that it contains false statements. CPR spokesperson Keith Appell said, "It's no surprise that they would try to block the public from seeing any information about the dangers of government-run health care," adding, "This program is full of compelling first-person accounts that every American should hear." He said that CPR stands by its ad. An NBC network spokesperson would not comment on the infomercial or the request, deferring questions to NBC4. The affiliate's general manger, Michael Jack, did not return a request for comment (Frates, Politico, 5/28).

Certain human immune cells known as macrophages are composed of hybrid HIV strains that elude treatment and antiretroviral drugs, according to a new study by researchers from the University of Florida and other institutions, the Gainesville Sun reports. For the study, researchers examined tissue from HIV-positive people and discovered that as much as half of the macrophages present were hybrids, made from genetic material from several HIV viruses that when combined formed new HIV strains. Marco Salemi -- assistant professor of pathology, immunology and laboratory medicine at the University of Florida's College of Medicine -- said that macrophages likely make HIV more aggressive over time, adding, "If we want to eradicate HIV, we need to find a way to actually target the virus specifically infecting the macrophages." According to the Sun, current research and treatment target T-cells, and although antiretrovirals are effective at blocking infection from new cells and lowering viral loads, they are unable to reduce the viral level in an HIV-positive person to zero. The Sun notes that macrophages can be targeted by HIV multiple times, and once they are infected, they can live for months, unlike T-cells. The team of researchers, led by Michael McGrath of the University of California - San Francisco , is developing macrophage-targeting drugs through a grant from the National Institute of Mental Health , the Sun reports (Chun, Gainesville Sun, 5/28).

Isaac Muliloa -- national coordinator of the HIV and sexually transmitted infections unit at the Solomon Islands' Ministry of Health -- recently said that a lack of national HIV/AIDS laws is hindering efforts to address the disease, the Solomon Times reports. Recent World Health Organization estimates said that the number of HIV cases in the Solomon Islands could reach 350 by 2010. Muliloa said that legislation is needed to address continued discrimination against HIV-positive employees in the workplace. He added that the HIV/AIDS and STI unit is relatively new in the health ministry, as is the Solomon Islands' National AIDS Council. According to Muliloa, officials are continuing to work toward implementing policies. The Times reports that the Solomon Islands does not have laws in place criminalizing the intentional transmission of HIV (Solomon Times, 5/27).

The Thai AIDS Treatment Action Group recently called on the country to launch a comprehensive harm reduction program for injection drug users in an effort to help curb the spread of HIV, Thailand's The Nation reports. According to the group, many IDUs are unable to access drug treatment and substation therapy because of the stigma surrounding drug use in the country. Karyn Kaplan, director of development and policy for the group, said, "Health care workers have denied many injecting drug users access to an antiviral drug and the use of methadone." Public Health Minister Witthaya Kaewparadai recently announced that the country's harm reduction programs have helped to curb the spread of HIV among IDUs, adding that local substitution programs have reduced the number of HIV-positive IDUs and that the country needs increased support from UNAIDS for such efforts. TTAG called for the government to provide prevention and treatment options, such as substitution therapy and needle-exchange programs. The Nation reports that methadone treatment is offered at hospitals across the country as part of the national health care scheme, but many health care workers refuse to administer treatment. In addition, government treatment is offered for 45 days. Kaplan said that the government should revise its policy regarding treatment access for IDUs, as a majority of IDUs are incarcerated and living with HIV or hepatitis-C without treatment access. She called on the government to "implement the international standards of medical treatment for [IDUs], without discrimination and human rights violations" (The Nation, 5/27).

National HIV prevention strategies in at least five African countries are not reaching the groups most at risk of infection, according to a report from UNAIDS and the World Bank conducted in conjunction with the national HIV/AIDS authorities of Kenya, Lesotho, Mozambique, Swaziland and Uganda, IRIN/PlusNews reports. The study was conducted between 2007 and 2008 to determine how and where most HIV cases were occurring in each country. It also aimed to examine whether prevention programs and spending aligned with those findings. According to the report, most prevention initiatives are not based on evidence of the behaviors that spread HIV in the five surveyed countries. For example, most new infections in Lesotho occur because of concurrent sexual partnerships, both before and after marriage. However, the country does not have any prevention strategies aimed at concurrent partnerships, or couples who are married or in long-term relationships. In addition, the report found that in Mozambique, an estimated 19% of new HIV infections were spread through commercial sex work, 3% from injection drug use and 5% among men who have sex with men. According to the report, few programs in the country target sex workers, while none are tailored to IDUs or MSM. According to the report, spending on HIV prevention often is low in the surveyed countries. Lesotho spends 13% of its national HIV/AIDS budget on prevention, while Uganda spends 34%. Director of the World Bank's Global HIV/AIDS Unit Debrework Zewdie said that the economic downturn makes it important to maximize the impact of HIV prevention investments. "These syntheses use the growing amounts of data and information available to better understand each country's epidemic and response and identify how prevention might be more effective," she said. The report includes recommendations on how the surveyed countries can better implement evidence-based prevention efforts. It said that Lesotho should revise its prevention messages to address multiple concurrent partnerships and integrate the subject into future initiatives. In addition, Mozambique should focus condom promotion on groups such as sex workers, the report said. According to IRIN/PlusNews, the five-country program aims to enhance capacity to ensure that the countries can conduct similar studies in the future (IRIN/PlusNews, 5/27). The report is available online .

"Nearly 30 years after the discovery of HIV and AIDS, the epidemic is still ravaging black neighborhoods in Baltimore and across the nation," Kevin Fenton -- director of CDC 's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention -- writes in a Baltimore Sun opinion piece. Fenton writes that "complacency about HIV and the continued stigma associated with the disease are hindering progress by preventing too many African-Americans from seeking either HIV testing and treatment or support from their friends and family," adding that "this is a challenge that can be overcome."According to Fenton, the Obama administration last month "took an important step in confronting the United States' HIV epidemic" when CDC and White House officials announced a five-year campaign called Act Against AIDS , which is "designed to refocus the nation's attention on the HIV crisis here at home." Fenton notes that 14 black civic organizations -- including the NAACP , the National Urban League , the Southern Christian Leadership Conference and the National Council of Negro Women -- are "joining the CDC to increase knowledge, awareness and action within black communities across the country." He adds that the campaign "will harness the strength and reach of these organizations by enhancing their ability to make HIV prevention a core component of their daily activities." "By raising the visibility of HIV and AIDS, the new campaign also aims to confront and overcome the fear and stigma that help keep HIV alive in black communities," Fenton says. He adds that he has "been encouraged in recent years to see black leaders, including black faith leaders, speak out more openly across the nation about the need to confront HIV and the stigma that persists surrounding this disease." Fenton writes that "[e]nding this epidemic will require not only frank and difficult discussions about HIV but also a shared sense of responsibility and commitment," concluding, "All of us can and must be part of the solution" (Fenton, Baltimore Sun, 5/27).