Asperger's dropped from revised diagnosis manual

CHICAGO (AP) — The now familiar term "Asperger's disorder" is being dropped. And abnormally bad and frequent temper tantrums will be given a scientific-sounding diagnosis called DMDD. But "dyslexia" and other learning disorders remain.

The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by the nation's psychiatrists. Changes were approved Saturday.

Full details of all the revisions will come next May when the American Psychiatric Association's new diagnostic manual is published, but the impact will be huge, affecting millions of children and adults worldwide. The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education.

This diagnostic guide "defines what constellations of symptoms" doctors recognize as mental disorders, said Dr. Mark Olfson, a Columbia University psychiatry professor. More important, he said, it "shapes who will receive what treatment. Even seemingly subtle changes to the criteria can have substantial effects on patterns of care."

Olfson was not involved in the revision process. The changes were approved Saturday in suburban Washington, D.C., by the psychiatric association's board of trustees.

The aim is not to expand the number of people diagnosed with mental illness, but to ensure that affected children and adults are more accurately diagnosed so they can get the most appropriate treatment, said Dr. David Kupfer. He chaired the task force in charge of revising the manual and is a psychiatry professor at the University of Pittsburgh.

One of the most hotly argued changes was how to define the various ranges of autism. Some advocates opposed the idea of dropping the specific diagnosis for Asperger's disorder. People with that disorder often have high intelligence and vast knowledge on narrow subjects but lack social skills. Some who have the condition embrace their quirkiness and vow to continue to use the label.

And some Asperger's families opposed any change, fearing their kids would lose a diagnosis and no longer be eligible for special services.

But the revision will not affect their education services, experts say.

The new manual adds the term "autism spectrum disorder," which already is used by many experts in the field. Asperger's disorder will be dropped and incorporated under that umbrella diagnosis. The new category will include kids with severe autism, who often don't talk or interact, as well as those with milder forms.

Kelli Gibson of Battle Creek, Mich., who has four sons with various forms of autism, said Saturday she welcomes the change. Her boys all had different labels in the old diagnostic manual, including a 14-year-old with Asperger's.

"To give it separate names never made sense to me," Gibson said. "To me, my children all had autism."

Three of her boys receive special education services in public school; the fourth is enrolled in a school for disabled children. The new autism diagnosis won't affect those services, Gibson said. She also has a 3-year-old daughter without autism.

People with dyslexia also were closely watching for the new updated doctors' guide. Many with the reading disorder did not want their diagnosis to be dropped. And it won't be. Instead, the new manual will have a broader learning disorder category to cover several conditions including dyslexia, which causes difficulty understanding letters and recognizing written words.

The trustees on Saturday made the final decision on what proposals made the cut; recommendations came from experts in several work groups assigned to evaluate different mental illnesses.

The revised guidebook "represents a significant step forward for the field. It will improve our ability to accurately diagnose psychiatric disorders," Dr. David Fassler, the group's treasurer and a University of Vermont psychiatry professor, said after the vote.

The shorthand name for the new edition, the organization's fifth revision of the Diagnostic and Statistical Manual, is DSM-5. Group leaders said specifics won't be disclosed until the manual is published but they confirmed some changes. A 2000 edition of the manual made minor changes but the last major edition was published in 1994.

Olfson said the manual "seeks to capture the current state of knowledge of psychiatric disorders. Since 2000 ... there have been important advances in our understanding of the nature of psychiatric disorders."

Catherine Lord, an autism expert at Weill Cornell Medical College in New York who was on the psychiatric group's autism task force, said anyone who met criteria for Asperger's in the old manual would be included in the new diagnosis.

One reason for the change is that some states and school systems don't provide services for children and adults with Asperger's, or provide fewer services than those given an autism diagnosis, she said.

Autism researcher Geraldine Dawson, chief science officer for the advocacy group Autism Speaks, said small studies have suggested the new criteria will be effective. But she said it will be crucial to monitor so that children don't lose services.

Other changes include:

—A new diagnosis for severe recurrent temper tantrums — disruptive mood dysregulation disorder. Critics say it will medicalize kids' who have normal tantrums. Supporters say it will address concerns about too many kids being misdiagnosed with bipolar disorder and treated with powerful psychiatric drugs. Bipolar disorder involves sharp mood swings and affected children are sometimes very irritable or have explosive tantrums.

—Eliminating the term "gender identity disorder." It has been used for children or adults who strongly believe that they were born the wrong gender. But many activists believe the condition isn't a disorder and say calling it one is stigmatizing. The term would be replaced with "gender dysphoria," which means emotional distress over one's gender. Supporters equated the change with removing homosexuality as a mental illness in the diagnostic manual, which happened decades ago.

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner .

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7 missing in collapse of highway tunnel in Japan

TOKYO (AP) — At least seven people were feared missing and several dead after about 150 concrete panels fell from the roof of a tunnel on the main highway linking Tokyo with central Japan.

Efforts to rescue any survivors trapped inside the tunnel were hindered by heavy smoke after one vehicle caught fire inside the Sasago Tunnel, about 80 kilometers (50 miles) outside Tokyo.

Rescuers also temporarily suspended work because of fears of a further collapse. They were attempting to reach at least several vehicles believed buried in the rubble, including a truck whose driver was trapped inside and had called his company for help.

"I could hear voices of people calling for help, but the fire was just too strong," said a woman interviewed by public broadcaster NHK after she escaped from the tunnel.

The Fire and Disaster Management Agency issued a statement late Sunday saying five people were confirmed to have been in a car that burned inside the tunnel, and at least one other was in a truck. However, officials said they could not confirm the exact number of people believed dead.

Executives for Central Japan Expressway Co. said the company was investigating why the concrete panels had given way. A check of the 4.7-kilometer (3-mile) tunnel's roof in September and October found nothing amiss, they said.

It said two people were confirmed hurt, but the injuries were not severe.

The tunnel, which opened in 1977, is one of many in mountainous Japan. The location of the collapse, about 1.7 kilometers (a mile) inside the tunnel, was complicating rescue efforts, reports said.

Police vehicles, fire trucks and ambulances were massed outside the tunnel's entrance.

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NKorea says it will launch long-range rocket soon

SEOUL, South Korea (AP) — North Korea announced Saturday that it would attempt to launch a long-range rocket in mid-December, a defiant move just eight months after a failed April bid was widely condemned as a violation of a U.N. ban against developing its nuclear and missile programs.

The launch, set for Dec. 10 to 22, is likely to heighten already strained tensions with Washington and Seoul as the United States prepares for Barack Obama's second term as U.S. president and South Korea holds its own presidential election on Dec. 19.

This would be North Korea's second launch attempt under leader Kim Jong Un, who took power following his father Kim Jong Il's death nearly a year ago. The announcement by North Korea's space agency followed speculation overseas about stepped-up activity at North Korea's west coast launch pad captured in satellite imagery.

A spokesman for North Korea's Korean Committee for Space Technology said scientists have "analyzed the mistakes" made in the failed April launch and improved the precision of its Unha rocket and Kwangmyongsong satellite, according to the official Korean Central News Agency.

KCNA said the launch was a request of late leader Kim Jong Il, whose Dec. 17, 2011, death North Koreans are expected to mark with some fanfare. The space agency said the rocket would be mounted with a polar-orbiting Earth observation satellite, and maintained its right to develop a peaceful space program.

Washington considers North Korea's rocket launches to be veiled covers for tests of technology for long-range missiles designed to strike the United States, and such tests are banned by the United Nations.

North Korea has capable short- and medium-range missiles, but long-range launches in 1998, 2006, 2009 and in April of this year ended in failure. North Korea is not known to have succeeded in mounting an atomic bomb on a missile but is believed to have enough weaponized plutonium for at least half a dozen bombs, according to U.S. experts, and in 2010 revealed a uranium enrichment program that could provide a second source of material for nuclear weapons.

Six-nation negotiations on dismantling North Korea's nuclear program in exchange for aid fell apart in early 2009.

In Seoul, South Korean officials have accused North Korea of trying to influence its presidential election with what they consider provocations meant to put pressure on voters and on the United States as the North seeks concessions. Conservative Park Geun-hye, the daughter of late President Park Chung-hee, is facing liberal Moon Jae-in in the South Korean presidential vote. Polls show the candidates in a close race.

Some analysts, however, question whether North Korean scientists have corrected whatever caused the misfire of its last rocket.

"Preparing for a launch less than a year after a failure calls into question whether the North could have analyzed and fixed whatever went wrong," David Wright, a physicist with the Union of Concerned Scientists, wrote on the organization's website this week.

The United States has criticized North Korea's pursuit of nuclear weapons and ballistic missiles as a threat to Asian and world security. In 2009, North Korea conducted rocket and nuclear tests within months of Obama taking office.

North Korea under its young leader has pledged to bolster its nuclear arsenal unless Washington scraps what the North calls a "hostile" policy. North Korea maintains that it is building bombs to defend itself against what it sees as a U.S. nuclear threat in the region.

This year is the centennial of the birth of national founder Kim Il Sung, the grandfather of Kim Jong Un. According to North Korean propaganda, 2012 is meant to put the North on a path toward a "strong, prosperous and great nation."

"North Korea appears to be under pressure to redeem its April launch failure before the year of the 'strong, prosperous and great nation' ends," said Koh Yu-hwan, a North Korea expert at Dongguk University in Seoul.

He added that a successful rocket launch would raise North Korea's bargaining power with South Korea and the United States "because it means the country is closer to developing missiles capable of carrying nuclear warheads."

Before its last two rocket launches, North Korea notified the International Civil Aviation Organization and the International Maritime Organization about its intentions to launch. IMO spokeswoman Natasha Brown said that as of Friday the organization had not been notified by North Korea.

The North's announcement comes two days after South Korea canceled what would have been the launch of its first satellite from its own territory. Scientists in Seoul cited technical difficulties. South Korea's Foreign Ministry said in a statement that the North's planned launch is "a grave provocation and a head-on challenge to the international community."

North Korea's missile and nuclear programs will be a challenge for Obama in his second term and for the incoming South Korean leader. Washington's most recent attempt to negotiate a freeze of the North's nuclear program and a test moratorium in exchange for food aid collapsed with the April launch.

In Japan, Prime Minister Yoshihiko Noda said he would coordinate with the U.S., South Korea, China and Russia in strongly urging the North to refrain from the rocket launch.

The Korean Peninsula remains in a state of war because the 1950-53 Korean conflict ended in a truce, not a peace treaty. Washington stations nearly 30,000 troops in South Korea as a buttress against any North Korean aggression. Tens of thousands more are in nearby Japan.

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Associated Press writers Jean H. Lee and Sam Kim in Seoul, Jill Lawless in London and Elaine Kurtenbach in Tokyo contributed to this report.

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EBay’s double tax base prompts calls for investigation

LONDON (Reuters) – Britain and Germany may have missed out on a combined $ 1 billion in sales tax since online marketplace eBay picked a tiny Luxembourg office as its base for EU sales, a shift that lawmakers say should now be investigated.

EBay’s nomination of Luxembourg unit eBay Europe Sarl – with a staff of nine – as its provider of services to EU clients allows it to charge customers in Europe a low rate of sales tax, often known as Value Added Tax, helping it to compete against rivals.

However, the unit doesn’t actually receive the money from sales. Instead, eBay said it continues to channel revenues through a Berne-based unit, allowing the company also to benefit from what Swiss tax lawyers say is the most competitive corporate income tax regime in Europe.

EU rules allow companies to establish subsidiaries in Luxembourg and levy VAT at Luxembourg’s low VAT rate on sales to customers across the bloc.

However, the rules also allow individual EU taxmen to challenge any claim to Luxembourg residence, and the right to charge Luxembourg VAT, in their domestic courts, if the taxman feels a Luxembourg-based subsidiary does not have sufficient staff or assets to support its claim to be the true supplier of goods or services.

Tax experts say eBay’s arrangement, which appears to give eBay the best of both income and sales tax worlds, could be open to challenge, and lawmakers in the UK and Germany want their taxmen to investigate.

“I hope that HMRC (UK tax authority Her Majesty’s Revenue and Customs) takes note … and takes prompt action,” said Margaret Hodge, member of parliament and chairman of the Public Accounts Committee (PAC), which monitors government finances.

“I will be seeking assurance that they are, next time we take evidence from HMRC,” she added. Officials from HMRC are due to testify to the PAC in early December as part of the committee’s investigation into tax matters.

Sven Giegold, member of the European Parliament for Germany’s Green Party, said he wanted the German tax authorities to “have a very critical look at this”.

It is common for companies to seek to reduce their tax bills, and a number of multinationals have established bases in Luxembourg so they can charge customers lower levels of VAT.

EBay said HMRC was aware of all its tax arrangements and that it was confident it met all its tax liabilities in the UK and elsewhere.

“In all countries and at all times, eBay is fully compliant with national, EU and international tax rules (including the OECD) including the remittance of VAT to the appropriate authorities,” an eBay spokesman said in an emailed statement.

The UK, German, French and Luxembourg tax authorities declined to comment on eBay, citing rules on taxpayer confidentiality.

LOWER THRESHOLD

Big companies’ tax practices have risen to the top of the political agenda in Europe in the past year, with lawmakers growing increasingly frustrated with the way in which companies such as search engine company Google pay almost no income tax in countries where they have billions of dollars in sales.

The companies escape liability for income taxes in countries like the UK by arguing the value created by their business, and therefore the location where the profit should be realized, is not the place where the customer resides, but rather in the location where the intellectual property underpinning the product or service is based.

Chas Roy-Chowdhury, head of taxation at the Association of Chartered Certified Accountants, said this was a valid economic argument and that if, for example, HMRC wants to claim more income tax from Google, it has to prove the company is generating more value in the UK than it is declaring.

This would require a thorough deconstruction of its business model and supply chain.

However, it is easier to establish liability to VAT, since this tax hinges simply on the location of the buyer and seller.

“The threshold is lower,” said Simon Newark, head of VAT at accountants UHY Hacker.

“There are a lot more aspects for HMRC to challenge in VAT than in direct (income) tax.”

For tax purposes, the EU deems eBay’s online platform an “electronically supplied service”, a category that also covers e-Books and music downloads.

Under EU rules, suppliers of such services based within the bloc are supposed to charge EU customers VAT at the rate prevailing in the country where the supplier is based.

A number of suppliers of electronic services, including Amazon.Com Inc and Apple Inc’s iTunes have established European headquarters in Luxembourg to enable them to charge customers lower VAT rates than prevail in their customers’ countries.

Luxembourg has traditionally charged the lowest standard VAT rates in the European Union. Its 15 percent rate compares with rates of 19-25 percent in most other EU members.

By charging customers VAT at Luxembourg’s rate eBay is better able to compete with rivals based elsewhere in the EU, such as Britain’s eBid, which must charge customers VAT at the standard UK rate of 20 percent.

However, to be entitled to charge Luxembourg rates, a company has to be able to prove in British, German or EU courts that it is genuinely based in the Grand Duchy.

Companies selling to EU customers from outside the EU – as eBay was until the 2007 nomination of eBay Europe Sarl as supplier to EU clients – must charge European customers VAT at the rate prevailing in the country where the customer resides, and to pay that VAT to the taxman in the customer’s country.

There is no definitive checklist that determines the true base of a company and any decision by a national court can be challenged in the European Court of Justice. In the UK, HMRC said it approached the matter on a case-by-case basis, and disputes are often resolved in court.

“HMRC will challenge any arrangements where it is claimed that supplies are made from a particular country but the business does not have the necessary resources to make those supplies,” a spokesman said.

EUROPE EXPANSION

EBay, which is headquartered in San Jose, California, moved into Europe in 1999 when it established eBay International in Berne. Switzerland’s low income tax regime for foreign companies was highly beneficial for the auction site. “We do have a very favorable international tax structure,” then-Chief Financial Officer Rajiv Dutta told analysts in 2002 when asked how the company managed to pay such low taxes on its non-U.S. income.

The Swiss base also meant, initially, that the company didn’t have to charge EU customers VAT. But in 2003, Brussels changed the rules, which forced eBay to charge EU sellers on its platform VAT based on their residence. The VAT gathered was remitted to the tax authority in the customer’s country.

Not all customers are charged VAT. Most medium-sized and big businesses are legitimately exempted from paying VAT on some purchases, such as eBay seller fees.

EBay’s Swiss-based European public relations head declined to say what portion of its EU customers were liable to be charged VAT. James Cordwell, equities analyst at Atlantic Equities, estimated that such customers accounted for 40-50 percent of sales in Europe.

Since the 2007 creation of its Luxembourg operation, eBay has had German fee revenues of $ 6.1 billion and UK revenues of $ 5 billion, its annual accounts show.

If the services were supplied from Switzerland or another non-EU country, and assuming only half of customers should have been charged VAT, EU rules would have obliged eBay to collect $ 580 million in VAT for the German taxman and $ 500 million in VAT for HMRC since 2007.

EBay’s entitlement to charge Luxembourg VAT on sales and to pay this to the Luxembourg taxman rests on being able to prove in court that eBay Europe Sarl is the provider of services to EU clients.

But despite German and UK fee income of $ 3.1 billion last year, eBay Europe Sarl recorded turnover of only 5 million euros in 2011.

John Hemming, an MP with the Liberal Democrats, the junior partner in the British coalition government, said the fact eBay’s sales revenues did not go through the Luxembourg unit undermined the claim that it was the true provider of services to EU clients.

“If it’s a real transaction, you would expect the money to pass with it, and not pass someplace else,” he said.

Rather than going to Luxembourg, the money generated from customers continues to go to Berne-based eBay International AG, a spokeswoman said.

When Reuters visited in mid November, staff at the Luxembourg office, just opposite the central post office, declined to discuss what operations the unit conducted for eBay.

A spokesman later said the office conducted activities including billing, data privacy, contracting, regulatory, management and some customer services operations.

By contrast, Amazon and iTunes do report their sales of ebooks and music downloads to EU customers through their Luxembourg units.

Prem Sikka, professor of accounting at Essex University, along with Newark and Roy-Chowdhury said a cash trail through a unit was one of the key factors used as evidence that the unit was the true supplier of a service.

UK and German tax authorities could argue that the shift in eBay’s supply base to Luxembourg from Berne was therefore not genuine. If successful, they could claim back the VAT lost.

EBay declined to say why it channeled sales through Switzerland. Tax advisors say the country can still offer some companies lower tax rates than other European low-tax jurisdictions such as Ireland and Luxembourg.

Indeed, EBay’s closest rival Amazon, which channels about half its non-U.S. earnings through Luxembourg, reported average income tax on overseas earnings of 6 percent in the past four years. EBay paid just 3 percent over the same period.

(Additional reporting by Brenda Goh; Editing by Will Waterman)

Tech News Headlines – Yahoo! News

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JLo tones down concert in Indonesia

JAKARTA, Indonesia (AP) — Jennifer Lopez wowed thousands of fans in Indonesia, but they didn't see as much of her as concertgoers in other countries — the American pop star toned down both her sexy outfits and her dance moves during her show in the world's most populous Muslim country, promoters said Saturday.

Lopez's "Dance Again World Tour" was performed in the country's capital, Jakarta, on Friday in line with promises Lopez made to make her show more appropriate for the audience, said Chairi Ibrahim from Dyandra Entertainment, the concert promoter.

"JLo was very cooperative ... she respected our culture," Ibrahim said, adding that Lopez's managers also asked whether she could perform her usual sexy dance moves, but were told that "making love" moves were not appropriate for Indonesia.

"Yes, she dressed modestly ... she's still sexy, attractive and tantalizing, though," said Ira Wibowo, an Indonesian actress who was among more than 7,000 fans at the concert.

Another fan, Doddy Adityawarman, was a bit disappointed with the changes.

"She should appear just the way she is," he said, "Many local artists dress even much sexy, much worse."

Lopez changed several times during her 90-minute concert along with several dancers, who also dressed modestly without revealing their chests or cleavage.

Most Muslims in Indonesia, a secular country of 240 million people, are moderate. But a small extremist fringe has become more vocal in recent years.

They have pushed through controversial laws — including an anti-pornography bill — and have been known to attack anything perceived as blasphemous, from transvestites and bars to "deviant" religious sects.

Lady Gaga was forced to cancel her sold-out show in Indonesia in May following threats by Islamic hard-liners, who called her a "devil worshipper."

Lopez will also perform in Muslim-majority Malaysia on Sunday.

"Thank you Jakarta for an amazing night," the 43-year-old diva tweeted to her 13 million followers Saturday.

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South Africa makes progress in HIV/AIDS fight

JOHANNESBURG (AP) — In the early 90s when South Africa's Themba Lethu clinic could only treat HIV/AIDS patients for opportunistic diseases, many would come in on wheelchairs and keep coming to the health center until they died.

Two decades later the clinic is the biggest ARV (anti-retroviral) treatment center in the country and sees between 600 to 800 patients a day from all over southern Africa. Those who are brought in on wheelchairs, sometimes on the brink of death, get the crucial drugs and often become healthy and are walking within weeks.

"The ARVs are called the 'Lazarus drug' because people rise up and walk," said Sue Roberts who has been a nurse at the clinic , run by Right to Care in Johannesburg's Helen Joseph Hospital, since it opened its doors in 1992. She said they recently treated a woman who was pushed in a wheelchair for 3 kilometers (1.8 miles) to avoid a taxi fare and who was so sick it was touch and go. Two weeks later, the woman walked to the clinic, Roberts said.

Such stories of hope and progress are readily available on World AIDS Day 2012 in sub-Saharan Africa where deaths from AIDS-related causes have declined by 32 percent from 1.8 million in 2005 to 1.2 million in 2011, according to the latest UNAIDS report.

As people around the world celebrate a reduction in the rate of HIV infections, the growth of the clinic, which was one of only a few to open its doors 20 years ago, reflects how changes in treatment and attitude toward HIV/AIDS have moved South Africa forward. The nation, which has the most people living with HIV in the world at 5.6 million, still faces stigma and high rates of infection.

"You have no idea what a beautiful time we're living in right now," said Dr. Kay Mahomed, a doctor at the clinic who said treatment has improved drastically over the past several years.

President Jacob Zuma's government decided to give the best care, including TB screening and care at the clinic, and not to look at the cost, she said. South Africa has increased the numbers treated for HIV by 75 percent in the last two years, UNAIDS said, and new HIV infections have fallen by more than 50,000 in those two years. South Africa has also increased its domestic expenditure on AIDS to $1.6 billion, the highest by any low-and middle-income country, the group said.

Themba Lethu clinic, with funding from the government, USAID and PEPFAR, is now among some 2,500 ARV facilities in the country that treat approximately 1.9 million people.

"Now, you can't not get better. It's just one of these win-win situations. You test, you treat and you get better, end of story," Mahomed said.

But it hasn't always been that way.

In the 1990s South Africa's problem was compounded by years of misinformation by President Thabo Mbeki, who questioned the link between HIV and AIDS, and his health minister, Manto Tshabalala-Msimang, who promoted a "treatment" of beets and garlic.

Christinah Motsoahae first found out she was HIV positive in 1996, and said she felt nothing could be done about it.

"I didn't understand it at that time because I was only 24, and I said, 'What the hell is that?'" she said.

Sixteen years after her first diagnosis, she is now on ARV drugs and her life has turned around. She says the clinic has been instrumental.

"My status has changed my life, I have learned to accept people the way they are. I have learned not to be judgmental. And I have learned that it is God's purpose that I have this," the 40-year-old said.

She works with a support group of "positive ladies" in her hometown near Krugersdorp. She travels to the clinic as often as needed and her optimism shines through her gold eye shadow and wide smile. "I love the way I'm living now."

Motsoahae credits Nelson Mandela's family for inspiring her to face up to her status. The anti-apartheid icon galvanized the AIDS community in 2005 when he publicly acknowledged his son died of AIDS.

None of Motsoahae's children was born with HIV. The number of children newly infected with HIV has declined significantly. In six countries in sub-Saharan Africa — South Africa, Burundi, Kenya, Namibia, Togo and Zambia —the number of children with HIV declined by 40 to 59 percent between 2009 and 2011, the UNAIDS report said.

But the situation remains dire for those over the age of 15, who make up the 5.3 million infected in South Africa. Fear and denial lend to the high prevalence of HIV for that age group in South Africa, said the clinic's Kay Mahomed.

About 3.5 million South Africans still are not getting therapy, and many wait too long to come in to clinics or don't stay on the drugs, said Dr. Dave Spencer, who works at the clinic .

"People are still afraid of a stigma related to HIV," he said, adding that education and communication are key to controlling the disease.

Themba Lethu clinic reaches out to the younger generation with a teen program.

Tshepo Hoato, 21, who helps run the program found out he was HIV positive after his mother died in 2000. He said he has been helped by the program in which teens meet one day a month.

"What I've seen is a lot people around our ages, some commit suicide as soon as they find out they are HIV. That's a very hard stage for them so we came up with this program to help one another," he said. "We tell them our stories so they can understand and progress and see that no, man, it's not the end of the world."

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Why Obama is pushing for stimulus in 'fiscal cliff' deal

How about a little government economic stimulus?

That may sound incongruous considering the budget deficit and the push from Republicans to cut government spending.

But President Obama’s first offer to avoid going over the "fiscal cliff" holds out the hope of at least some stimulus. This would include extending the 2 percentage point Social Security payroll tax cut, boosting a tax incentive to businesses, establishing a $50 billion bank for long-term infrastructure projects, and extending unemployment benefits.

RECOMMENDED: 'Fiscal cliff' 101: 5 basic questions answered

The total bill: about $255 billion out of the federal government's pocket – an amount the GOP would likely say needs to be offset by spending cuts elsewhere.

The argument in favor of such stimulus? The tax measures, at least, could minimize the drag on the economy from Mr. Obama's proposed tax increases on the wealthy.

“The increases in the top two income tax brackets would put a drag on consumption, so I think, from the Obama point of view, the spending or tax cuts are designed to offset that drag to consumption,” says Michael Brown, an economist at Wells Fargo Securities in Charlotte, N.C.

But to some budget experts, Obama’s list seems more like an opening round of negotiations, where he has asked for a lot more than he will get.

“It looks to me like these are bargaining chips,” says Pete Davis of Davis Capital Ideas, which advises Wall Street firms. “Even most Democrats had given up on the prospect of getting the payroll tax cut extended.”

Mr. Davis considers the odds of most of the stimulus proposals passing Congress “very low.”

What's needed most, say others, is just buckling down and negotiating an end to the fiscal cliff. “Cancelling the fiscal cliff is economic stimulus,” says Stan Collender, a budget expert and partner at Qorvis Communications in Washington.

If Obama's stimulus were passed, however, here is a look at the impact the four elements might have.

SOCIAL SECURITY PAYROLL TAX CUT

The largest chunk of the Obama plan is the extension of the payroll tax cut. This is the money that comes out of an individual’s paycheck as a contribution to Social Security. Two years ago, in an effort to stimulate the economy, Congress decreased the individual contribution from 6.2 percent to 4.2 percent. The employer’s contribution of 6.2 percent remained unchanged.

The Obama administration estimates extending the cuts would cost the government as much as $115 billion in revenue.

The argument for extending the tax cut is that it helps lower-income workers who live paycheck to paycheck. “The difference in the paycheck might be the ability to pay the electric bill for someone or the chance to go to a sit-down restaurant once a month,” says Chris Christopher, an economist at IHS in Lexington, Mass.

The argument against continuing the cut is that it is weakening the Social Security Trust Fund. In order to make up for the loss of contributions, the government taps the general tax revenues, says Pamela Tainter-Causey, a spokeswoman for the National Committee to Preserve Social Security and Medicare.

“It sets up Social Security to compete for funding from the general fund,” she says. “It’s a perfect set up for people who are gunning for the program and claim we can’t afford it now.”

BUSINESS TAX INCENTIVE

The second largest program proposed by Obama would be the extension of accelerated depreciation for business, which would cost the US Treasury about $65 billion in fiscal year 2013, according to the Congressional Budget Office.

Two years ago, business was allowed to accelerate the write-off of 100 percent of its spending on certain capital equipment. Capital spending on equipment and computer software soared by 18.3 percent in 2011.

Then, this year, the benefit to business was cut in half to 50 percent. Capital spending sank in the third quarter by 2.7 percent compared with the same quarter the prior year. With business interest in using the tax break diminishing, economist Gregory Daco of IHS says “it’s a goner.”

INFRASTRUCTURE BANK

Obama has also proposed a $50 billion infrastructure bank. The idea is to fund roads, bridges, tunnels and other large projects that last for a long period of time. “At the moment the funding is done on a cash basis – you have to pay for it as you build it,” says Mr. Collender.

Democrats have been trying to get Congress to fund the bank for the past 10 years, he says. “It does not have a chance of getting through the House," which is controlled by the Republicans, says Mr. Collender.

UNEMPLOYMENT BENEFITS

And, finally, Obama wants to extend unemployment benefits, which would cost about $30 billion.

Under current law, if Congress does nothing, the maximum number of weeks in which an individual could receive jobless will drop to 26 from the current 73 weeks for states with unemployment over 9 percent and 63 weeks for states with unemployment over 7 percent.

If Congress does nothing about the program during the lame-duck session, some 2.1 million jobless will lose their benefits in the first week of January, says Judy Conti, a federal advocacy coordinator at the National Employment Law Project (NELP) in Washington. By the end of the March, she says, another 900,000 people will lose their benefits.

“Forty percent of the unemployed are long term unemployed,” she says. “They have been out of the workforce for over six months.”

RECOMMENDED: 'Fiscal cliff' 101: 5 basic questions answered

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Shoppers' habits not changed by garment plant fire

NEW YORK (AP) — Before purchasing a shirt, shoppers will run their hands over the fabric, look at the price tag and wonder how it will hold up in the washing machine. Some might even ask if it makes them look fat.

The one detail, however, that is rarely considered: What are the conditions like for the workers making the shirt?

A horrific fire that raced through a Bangladesh garment factory Saturday, killing 112 people, has put the spotlight — at least temporarily — back on those workers and their sometimes treacherous work environment.

The factory, owned by Tazreen Fashions Ltd., made clothing for several retailers around the globe including Wal-Mart, Sears and The Walt Disney Co. All three companies have distanced themselves from responsibility for the incident, saying they didn't know that their subcontractors were using the factory.

Holiday shoppers have also maintained their distance from the tragedy.

"Truthfully, I hadn't even thought about it," said Megan Miller of Philadelphia as she walked out of the Disney Store in Times Square. "I had Christmas on my mind and getting my kids something from New York."

Shoppers from Cincinnati to Paris to Singapore all said the same thing: They were aware of the fatal factory fire, but they weren't thinking about it while browsing stores in the days since. Brand name, fit and — above all — prices were on their minds.

"Either our pockets get lighter or we have to live with more blood on our hands," said Amy Hong, a college student who was at a store in Singapore. "I try not to think about it."

Experts who survey shoppers say the out of sight, out of mind attitude is nothing new.

"When you talk to them about their biggest concerns, where something is made, or the abuses in some country, almost never show up," said C. Britt Beemer, chairman of America's Research Group, which interviews 10,000 to 15,000 consumers a week, mostly on behalf of retailers. "The numbers are so small, I quit asking the question."

Convenience is much more important to shoppers.

Take Tammy Johnson who was at a Walmart in Bloomington, Minn. this week. She lives nearby and appreciates that the store has a large grocery section in addition to clothing and other goods.

"It's easier and it's cheaper," she said of her decision to shop there. "I hate that, but it is true."

Even those who want to make socially responsible purchases a priority have little information available to work with.

There's no widespread system in place to say where all the materials in a shirt come from let alone whether it was made in a sweatshop or not.

A label saying "Made in USA of imported fabrics" doesn't provide as much information to shoppers as they might think. Maybe tailors assembled it under good working conditions, but what about the people who wove the fabrics? Another label saying that a shirt is made from 100 percent organic cotton fails to say anything about the conditions of the factory in which it was made.

"What do they know at the point of sale about where it comes from, other than the tag?" said Paco Underhill, founder of Envirosell, which studies consumer behavior. "Our hearts are generally are in the right places. It's the question of making sure we have the knowledge and pocketbook to follow."

And it's not just clothing. It is hard to tell where televisions or laptop components are made.

Companies selling products say they even struggle to tell. Work is often given to subcontractors who themselves use subcontractors. While many major companies stipulate ethics and standards that their subcontractors must follow, policing them is a costly, time-consuming process that sounds easier than it is.

In the case of the Bangladesh factory, Wal-Mart said it had received a safety audit showing the factory was "high-risk" and had decided months before the blaze to stop doing business with Tazreen. But it said a supplier had continued to use Tazreen without authorization.

In recent years, consumers have become much more aware about the food they eat, and where it comes from.

Supermarkets are full of eggs laid by free-range chickens, organically-grown apples and beef from grass-fed, hormone-free cows. Some upscale restaurants now name the farm that provided them with pork chops. And customers pay a premium for these foods.

The difference: They perceive a direct benefit, since the food is going into their bodies.

Ethical choices when buying clothing — or the latest version of Apple's iPhone — are much more blurred.

Jean MacLeod, who was shopping at a Walmart on the south side of Indianapolis, is willing to pay more for goods if they are made in an ethically responsible manner and does it all the time when she buys food.

Walmart wants the best prices for its customers, she said, but the company also has power as a buyer to make sure factories have decent working conditions.

"They should be able to say, 'Look it, we don't want to buy from you unless you do things a little more our way,'" MacLeod said. "If they don't want to buy from them, then that means that factory will go out of business."

Arguments have been made that producing items with cheap labor isn't necessarily a bad thing.

Factories in the Third World can provide jobs with wages well above a region's average. They can help lift families out of severe poverty. The catch is that there are fewer safeguards to protect workers from being exploited from unscrupulous employers.

At the Bangladesh factory, locked exits prevented many workers from escaping after fire broke out.

It draws eerie parallels to New York's Triangle Shirtwaist Fire of 1911, where 146 people died within 18 minutes of a fire starting in a factory with locked exits.

That fire was the catalyst for widespread changes in labor laws in U.S. But in the 100 years since, the desire for cheap clothing hasn't abated and costly labor has just shifted to factories overseas.

"To put it maybe too frankly, profit and efficiency and competition always trump safety and health," said James A. Gross, a labor relations professor at Cornell University.

Not every company sees things that way.

Los Angeles-based American Apparel promotes itself as a line of "sweatshop free" clothing. Its founder and CEO, Dov Charney, said that companies can control working conditions — they just need to bring production closer to home. American Apparel knits, dyes, cuts and sews all of its products in-house.

"When the company knows the face of its worker, that's important," Charney said. "You can control working conditions and quality."

Yes, American Apparel spends more on labor, but it isn't as much as you would expect. Charney estimates that an imported T-shirt selling for $6 at Walmart would cost about $6.30 if produced domestically thanks to the company's massive scale.

"The consumer can care. They can buy from companies that are committed to fair trade and try to seek out those companies," he said.

Take Nike.

In the mid-1990s, the sneaker giant came under pressure to change its ways after numerous reports of child labor, low wages and poor working conditions. Eventually wages climbed, minimum age requirements were put in place and Nike increased monitoring at its factories.

But such change only comes after persistent public pressure.

"Clothes makers will always do what they want, but the buyer should educate himself," said Paris shopper Pierre Lefebvre.

Not all buyers have that luxury. Family budgets are tight.

"Especially with this economy, we like our money to go as far as it can," said Lesley Schuldt, who left a Cincinnati Macy's this week with five shopping bags worth of jewelry, cookware and gifts. "I have no idea where half the stuff I bought was made, but I imagine it was not in the U.S."

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Associated Press reporters Amanda Lee Myers in Cincinnati, Josh Freed in Bloomington, Minn., Tom Murphy in Indianapolis, Meghan Barr in New York, Heather Tan in Singapore and Thomas Adamson in Paris contributed to this report.

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Scott Mayerowitz can be reached at http://twitter.com/GlobeTrotScott.

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Adkins explains Confederate flag earpiece

NEW YORK (AP) — Trace Adkins wore an earpiece decorated like the Confederate flag when he performed for the Rockefeller Center Christmas Tree Lighting but says he meant no offense by it.

Adkins appeared with the earpiece on a nationally televised special for the lighting on Wednesday. Some regard the flag as a racist symbol and criticized Adkins in Twitter postings.

But in a statement released Thursday, the Louisiana native called himself a proud American who objects to any oppression and says the flag represents his Southern heritage.

He noted he's a descendant of Confederate soldiers and says he did not intend offense by wearing it.

Adkins — on a USO tour in Japan — also called for the preservation of America's battlefields and an "honest conversation about the country's history."

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Online:

http://www.traceadkins.com

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Ukraine fights spreading HIV epidemic

BUCHA, Ukraine (AP) — Andrei Mandrykin, an inmate at Prison No. 85 outside Kiev, has HIV. He looks ghostly and much older than his 35 years. But Mandrykin is better off than tens of thousands of his countrymen, because is he receiving treatment amid what the World Health Organization says is the worst AIDS epidemic in Europe.

Ahead of World AIDS Day on Saturday, international organizations have urged the Ukrainian government to increase funding for treatment and do more to prevent HIV from spreading from high-risk groups into the mainstream population, where it is even harder to manage and control.

An estimated 230,000 Ukrainians, or about 0.8 percent of people aged 15 to 49, are living with HIV, the virus that causes AIDS. Some 120,000 are in urgent need of anti-retroviral therapy, which can greatly prolong and improve the quality of their lives. But due to a lack of funds, fewer than a quarter are receiving the drugs — one of the lowest levels in the world.

Ukraine's AIDS epidemic is still concentrated among high-risk groups such as intravenous drug users, sex workers, homosexuals and prisoners. But nearly half of new cases registered last year were traced to unprotected heterosexual contact.

"Slowly but surely the epidemic is moving from the most-at-risk, vulnerable population to the general population," said Nicolas Cantau of The Global Fund to Fight AIDS, Tuberculosis and Malaria, who manages work in Eastern Europe and Central Asia. "For the moment there is not enough treatment in Ukraine."

Stigma is also a big problem for those with HIV in Ukraine. Liliya, a 65-year-old woman who would give only her first name, recently attended a class on how to tell her 9-year-old great-granddaughter that she has HIV. The girl, who contacted HIV at birth from her drug-abusing mother, has been denied a place in preschool because of her diagnosis.

"People are like wolves, they don't understand," said Liliya. "If any of the parents found out, they would eat the child alive."

While the AIDS epidemic has plateaued elsewhere in the world, it is still progressing in Eastern Europe and Central Asia, according to Cantau. Nearly 21,200 new cases were reported in Ukraine in 2011, the highest number since the former Soviet republic registered its first case in 1987, and a 3 percent increase over 2010. As a result of limited and often delayed treatment, the number of AIDS-related deaths grew 17 percent last year to about 3,800.

Two years ago, Mandrykin, the prisoner, was on the verge of becoming part of that statistic, with his level of crucial CD4 immune cells — a way to measure the strength of the immune system — dropping to 11. In a healthy person, the CD4 count is usually over 600.

"I was lying in the hospital, I was dying," said Mandrykin, who is serving seven years for robbery, his fourth stint in jail. "It's a scary disease."

After two years of treatment in a small prison clinic, his CD4 count has risen to 159 and he feels much better, although he looks exhausted and is still too weak to work in the workshop of the medium-security prison.

The Ukrainian government currently focuses on testing and treating standard cases among the general population. The anti-retroviral treatment of more than 1,000 inmates, as well as some 10,000 HIV patients across Ukraine who also require treatment for tuberculosis and other complications and all prevention and support activities, are paid for by foreign donors, mainly the Global Fund.

The Global Fund is committed to spending $640 million through 2016 to fight AIDS and tuberculosis in Ukraine and then hopes to hand over most of its programs to the Ukrainian government.

Advocacy groups charge that corruption and indifference by government officials help fuel the epidemic.

During the past two years, Ukrainian authorities have seized vital AIDS drugs at the border due to technicalities, sent prosecutors to investigate AIDS support groups sponsored by the Global Fund and harassed patients on methadone substitution therapy, prompting the Global Fund to threaten to freeze its prevention grant.

Most recently, Ukraine's parliament gave initial approval to a bill that would impose jail terms of up to five years for any positive public depiction of homosexuality. Western organizations say it would make the work of AIDS prevention organizations that distribute condoms and teach safe homosexual sex illegal and further fuel the epidemic. It is unclear when the bill will come up for a final vote.

AIDS drug procurement is another headache, with Ukrainian health authorities greatly overpaying for AIDS drugs. Advocacy groups accuse health officials of embezzling funds by purchasing drugs at inflated prices and then pocketing kickbacks.

Officials deny those allegations, saying their tender procedures are transparent.

Much also remains to be done in Ukraine to educate people about AIDS.

Oksana Golubova, a 40-year-old former drug user, infected her daughter, now 8, with HIV and lost her first husband to AIDS. But she still has unprotected sex with her new husband, saying his health is in God's hands.

"Those who are afraid get infected," Golubova said.

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