South African mortality increases by 32% since 2004

The Minister of Health, Dr. Aaron Motsoaledi, has announced that mortality has increased by 32% since 2004. South Africa is estimated to have 5.7 million people living with HIV but only has 0.7% of the world's population. Average life expectancy has been significantly reduced to 56 years for women and 51 years for men. In 2007, 57% of deaths of children under the age of 5 are reported to be caused by HIV.

The devastating effects of HIV are being felt throughout South Africa. When asked, Dr. Motsoaledi blamed this appalling situation on former President Mbeki's destructive denialist policies which prevented people from accessing vital ARVs. South Africa aims to reduce the rate of infections by 50% by 2011 and cover 80% of people who need ARVs. However, the country is still far away from these targets and this week's news, that mortality has increased by 32% since 2004, clearly shows that much more needs to be done.

South Africa has a chance to tackle their HIV epidemic and by focusing on prevention, care, and treatment, this might be possible.

(South Africa's Department of Health accessed 12/11/09)

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U.S. to lift travel ban after 22 years

President Obama announced on Friday that the United States will remove the travel ban that prevents HIV-positive people from entering the States. At a White House ceremony, Mr. Obama stated that the removal of the ban would take effect after a routine 60-day waiting period.

Widespread praise has been given for the move, including from UN Secretary-General Ban Ki-moon who congratulated the U.S. President for announcing the removal of the restrictions. However, Ban Ki-moon also urged that 'all other countries with such restrictions [should] take steps to remove them at the earliest', as travel restrictions should 'fill us with shame'.

The United States is one of around a dozen countries that prevent people living with HIV from entering their countries. Obama said the restrictions were 'rooted in fear rather than fact' and it is encouraging that America has finally moved away from such discriminatory measures. Hopefully, with America setting a new course, other countries will follow by example and remove all existing travel restrictions for people living with HIV.

 (New York Times accessed 2/11/09) (UN News Service accessed 2/11/09)

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Kenyan homosexual census to be launched

Kenya is to carry out a census of its gay population as part of its efforts to tackle HIV and AIDS. Kenya is estimated to have between 1.5 and 2 million adults and children living with HIV but it is unknown how many homosexual men live in the country.

Men who have sex with men are particularly vulnerable in Kenya. It is illegal to be homosexual and anyone convicted of the crime can face up to 14 years imprisonment. The chances that accurate information will be gathered is limited as many gay men will be reluctant to come forward for fear of reprisal. It has been suggested that the census will gather information by gay men identifying one another.

As a group that lacks access to accurate information, it is vital that the gay community in Kenya is reached. The Kenyan Government proposes that HIV tests and information will be provided for those who are included in the census.

The Kenyan Government must assure gay men that they will not be punished for coming forward and being counted. 

(BBC accessed 29/10/09)

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Is the Thailand AIDS vaccine trial a step forward or back for HIV prevention?

The further results published today make it clear that only time and further analysis will determine whether the vaccine was actually effective, even in a mild way, in preventing HIV infection. But while the researchers go back to the labs, the question needs to asked about the effect the widespread publicising of these results has had on current HIV prevention efforts.

In many parts of the world difficult choices are having to be made between providing more people with treatment, and continuing with, or even intensifying existing HIV prevention programmes. People around the world have been informed that there is a partially effective vaccine, and in many cases the word “partial” will have been omitted as the information spreads across the world. As a result many people will now believe that an effective vaccine is only a few years away.

According to Annabel Kanabus, Director of AVERT, “these beliefs could now contribute to decisions being made about the cutting back of existing highly effective HIV prevention programmes”.

So should the researchers have been more cautious, and chosen their words more carefully before they informed the world of their results? And if it turns out in due course that this vaccine is not after all effective, then will the researchers be equally keen to tell the world of this result?

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HIV Vaccine results are questioned

US army and Thai researchers announced on September 24th that an HIV combination vaccine had produced a ‘statistically significant’ result with a 31% reduction in new infections in a trial of more than 16,000 people in Thailand. At the time the results of the trial were only made public through news conferences and press releases, instead of waiting for the formal publications of their findings. The complete results were never made public.

A secondary analysis of the results that came out today is now suggesting that the vaccine was possibly not as successful as researchers initially thought, reducing infections by only 24% which is not considered statistically significant. The first analysis included all 16,000 people who participated in the trial and produced the promising result. However, the secondary analysis, which is part of the protocol for any vaccine trials, excluded patients who did not follow some experimental guidelines. The results therefore turned out to be less convincing, in other words, the previous successful results could be due to chance alone and not due to the vaccine.

Full details of the trials are expected to be made public on October 19th in Paris. In the meantime, the limited disclosure of the initial results raises important questions of whether the Army, the Thai government and the US national Institute of Health rushed to give a "positive spin" on a trial that might actually turn out to be inconclusive.

(The Wall Street Journal accessed 12th Octover 2009)

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Four Million people receiving ART at the end of 2008

Released today by UNAIDS and the WHO, the report: "Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector", shows that there has been an 36% increase in access to ARVs for those living with HIV in just one year. Access to ARVs has been expanding at a rapid rate and progress has been seen most in Sub-Saharan Africa. Price decline has been seen at rates of 10-40% for First line therapy between 2006-2008 but Second line therapies are still relatively expensive.

The report also sheds new light on the situation of Mother-to-child-transmission. Approximately 45% of HIV positive pregnant women are now receiving ARVs when only 35% of women had access in 2007. This is a positive step towards lowering mother-to-child transmission and means that less babies are being born HIV positive. The number of children now receiving ARVs has increased from 198,000 in 2007 to 275,700 children in 2008, allowing children the chance to live a longer life.

Overall the results from the report shows that access to treatment is increasing but it does warn against the potential impact of the economic slowdown. If the funding gap increases then the possibility to sustain the levels of people on treatment is damaged and more people may not have access to life-prolonging drugs. However, while access to treatment is important to tackling HIV, HIV and AIDS prevention methods such as education, increased access to condoms and increased emphasis on Mother-to-child transmission would reduce the number of people becoming infected with the virus.

 ("Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector" accessed 30/09/09)

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Positive results seen in AIDS vaccine trial

For the first time an HIV vaccine candidate has been found to lower the rate of infection in humans. The largest trial of its kind, which recruited 16,402 young adults in Thailand, found infection rates cut by just under a third (31.2%).

Of those who received a placebo 74 people became infected with HIV, compared to 51 receiving the vaccine candidate.

Trial participants in the vaccine group were given a combination of ALVAC, designed to stimulate a cellular response to HIV, and AIDSVAX, which promotes the production of antibodies to the virus. As the latter product had failed in previous trials there was hope that combining it with ALVAC would produce a more promising result.

President and CEO of the International AIDS Vaccine Initiative, Seth Berkley welcomed the findings:

“The outcome is very exciting news and a significant scientific achievement. It’s the first demonstration that a candidate AIDS vaccine provides benefit in humans. Until now, we’ve had evidence of feasibility for an AIDS vaccine in animal models. Now, we’ve got a vaccine candidate that appears to show a protective effect in humans, albeit partially.”

All of the trial participants received education on how to prevent HIV infection and were tested for HIV every six months for three years following the vaccination. Those who became infected with HIV were provided with counselling and antiretroviral drugs.

While the results are statistically significant and therefore encouraging, greater research is needed to find out how the potential vaccine can cut the risk of infection even further. It is likely to be many years before an effective vaccine is available for worldwide use. In the meantime there should be increased focus on established HIV prevention methods and access to antiretroviral treatment.

The official results will be presented on 19th October at the AIDS Vaccine Conference in Paris.

(International AIDS Vaccine Initiative accessed 24/09/09)

(U.S. Military HIV Research Program MHRP accessed 24/09/09)

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Mother to child transmission-free zones to be created

UNAIDS in conjunction with the Millennium Villages Project are to join forces to cut mother to child transmission in Africa. Areas targeted will be 14 ‘Millennium Villages’ across ten African Countries including Ethiopia, Ghana, Kenya, Malawi, Mali, Nigeria, Rwanda, Senegal, Tanzania and Uganda. Announced today at the Second Annual Millennium Promise Partner’s Meeting the plans aim to drastically reduce the transmission of HIV from mother to child.

The prevention of mother to child transmission in sub-Saharan Africa remains uneven with less than half of pregnant women living with HIV receiving antiretroviral prophylaxis; an essential treatment to prevent transmission. While transmission of HIV to children has fallen to fewer than 300 children in 2007 for Western Europe, sub-Saharan Africa saw 370,000 cases.

Michel Sidibe, the Executive Director of UNAIDS said “ we have a major opportunity now to eliminate mother-to-child transmission of HIV in Africa and save thousands of lives each year.” The new initiative will use existing infrastructure, human capacity and technical resources in the villages combined with community-centred health services to stop AIDS in children.

(UNAIDS accessed 22/09/09)

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Opposition grows to proposed sex education guidelines

This week at the Fourth Biennial International Sex and Relationship Education Conference being held in Birmingham, UK, new guidelines are being issued on how sex education could be taught, the content of which has created widespread controversy.

The guidelines are the result of a 2 year review by UNESCO (United Nationals Educational, Scientific and Cultural Organisation) in conjunction with UNAIDS, UNICEF and the WHO. The draft proposal would be distributed to education ministries, school systems and teachers around the world to help advise teachers on what to teach young people about their bodies, sexual relations and STDs. 

However, the proposals have been met with hostile attacks from conservative and religious groups, mainly from the US, due to the fact it recommends discussion of homosexuality, unwanted pregnancy and masturbation with children as young as 5 years old. Abstinence is given a minor roll as being recommended as "only one of a range of choices available to young people' to prevent STDs, which has upset traditionalists.

UNESCO staff have been receiving hate email, in particular the co-authors.

The importance of accurate sex education is critical to the prevention of HIV and AIDS as Mark Richmond, UNESCO Global Coordinator for HIV & AIDS highlighted, "in the absence of a vaccine for AIDS, education is the only vaccine we have". With parents no longer taking an active roll in sex education, it is often left to schools to educate young people about puberty, sex, and relationships which has not been easy.  It is vital that accurate sex education reaches children at a young age and is age appropriate, so that young people have the knowledge to progress from childhood to adulthood with valid information and confidence.

(International Guidelines on Sexuality Education accessed 10/09/09)

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Number of new HIV cases in Australia reaches a plateau

In wake of the 2009 Australasian HIV/AIDS Conference in Brisbane, the number of Australians diagnosed with HIV every year had plateaued. In 2008 the figures lowered a fraction from 1,046 in 2007 to 995 in 2008. While the decline may not seem significant, it may show that new cases of HIV are reaching a stable point.

In 2000, Australia had 763 new cases of HIV diagnosed and these rates have been rising to a peak in 2007.  In 2008, new diagnoses of HIV were found to be among men who have sex with men (66%), followed by heterosexual contact (27.1%) and the remaining cases were linked to injecting drug users or "undetermined".

While it is a positive step that new diagnoses of HIV are showing signs of steadying, people should not be content with nearly 1000 new diagnoses a year. More effort needs to be spent on raising awareness of HIV risks and a greater emphasis needs to be taken on prevention methods.  

The 2009 Australian Sexual Health Conference ran from 7th-9th September and is followed by the Australasian HIV/AIDS Conference from 9th-11th September. We look forward to hearing more from this conference.

 (HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report accessed 09/09/09)

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Hitler, Stalin, and Saddam Hussein star in steamy HIV awareness campaign

Regenbogen e. V. in conjuction with 'das comitee' have produced a shocking new HIV awareness campaign using infamous historical characters. Highlighting the fact that millions have already died from AIDS, the charity aims to link HIV with previous mass murderers in history such as Adolf Hitler, Saddam Hussein and Joseph Stalin. The campaigns are to be shown on German TV next week to raise public awareness about HIV. They include a steamy video of a couple undressing and having sex. At the end of the advert the man is revealed as Hitler. 

In a similar way that the Grim Reaper campaign by the Australian Government in 1987 created fear and social ostracism for those living with HIV, the concern is that we have not learnt from history. With treatment improvements in Europe, HIV is no longer a death sentence and people living with HIV can live a normal life for decades. While the adverts end with the statement "AIDS is a mass murderer", there is no obvious public health message, such as encouraging regular condom use.

Although the adverts are shocking, it raises concerns that the adverts are insensitive and stigmatise those with HIV due to the fact they are linked to infamous mass murderers. Rather than explicitly linking AIDS with mass murder, it is the person passing on HIV that is labelled as a mass murderer through the association with Hitler, Stalin or Saddam Hussein. As such, while shock campaigns may raise awareness about HIV, it is necessary to stress that HIV is preventable and those living with HIV should not be discriminated against.

('AIDS is a Mass Murderer' accessed 07/09/09)

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Female condoms facing funding crisis in Uganda

In July 2009 the Ugandan government announced that it would try again to release female condoms into the country in an effort to reduce the risk of HIV transmission. After failing 10 years ago, the government decided that it would introduce a mere 100,000 condoms and if further supported, would continue and expand the programme in the future.

However, the economic funding crisis has seen the idea hit problems even before the programme has expanded. Major funders of HIV and AIDS prevention programmes have shown little if no enthusiasm for the plan and many have decided not to back the move or review their support. The female condom enables women to negotiate condom use and if their partner refuses to use a condom, women have the choice to use theirs. Yet, the condom has failed to take off as they are expensive and difficult to use, which has meant that it is not as popular as the male condom.

Major funders such as PEPFAR (U.S. President's Emergency Plan for AIDS Relief) have been especially skeptical about the Ugandan Government's plan saying that "since we try to be an evidence-based operation, we're waiting to see any evidence that this is a cost-effective method of protecting women against unwanted pregnancies and HIV transmissions". Further calling the female condom a 'niche market', it is felt that Uganda is better off focusing on its current prevention programmes. PEPFAR will be reviewing their stance towards the programme.

Overall, the situation displays just one of the many difficult decisions that will have to be made if the global funding gap for HIV and AIDS is not closed or tackled.

(Time accessed 1/09/09)

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Global Summit on HIV and AIDS, Traditional Medicine and Indigenous Knowledge begins

The 3rd Global Summit on HIV and AIDS, Traditional Medicine and Indigenous Knowledge is being held in Kusmasi, Ghana which hopes to foster sustainable partnerships between traditional health practitioners and conventional health practitioners.

In areas of the world where it is difficult to access Western medicine, it is common for people to use alternative therapies. In relation to HIV and AIDS, in situations where there are no antiretroviral treatment, people will use alternative therapies to try and combat opportunistic infections or delay the development of AIDS.  While Western medicine will attempt to incorporate all approaches that have been rigorously tested through scientific trials this can put it against complementary and alternative medicine which remains largely unproven by Western standards.

However, this does not mean that it is not important to continue exploring alternative medicine to compliment HIV treatment. As such, the Summit will look at the review and development of patent laws that will protect traditional medicine knowledge and allow its sustainable development.

The conference runs from the 31st August until the 3rd September

The 3rd Global Summit on HIV and AIDS, Traditional Medicine and Indigenous Knowledge

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U.S. to consider circumcision to reduce the spread of HIV

The American Centres for Disease Control and Prevention are considering draft recommendations for promoting routine circumcision for all baby boys born in the United States to reduce the spread of HIV.  Proposals are being debated at the C.D.C’s National HIV Prevention Conference, being held in Atlanta.

Clinical trials in African countries such as Uganda, Kenya and South Africa, showed that adult males who were circumcised had up to 60% reduced risk of contracting HIV from a HIV positive woman. However, circumcision does not offer women any protection from HIV. Circumcision would be recommended for infant boys but also adult males whose sexual practices put them at high risk.

Infant circumcision has fallen in the US where the procedure is not recommended by the American Academy of Paediatricians and is not covered under state Medicaid programs. Concern has been raised as the surgery can be seen as medically unnecessary and will be performed effectively without the infants consent.

Many see the potential benefits of routine circumcision as outweighing any potential risks. While it is true that circumcision does offer a level of protection to men it does not provide protection to women and measures, such as using condoms must always be used to avoid HIV transmission and STDs.

(New York Times accessed 24/08/09)

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HIV positive patients abandon ARVs in the face of hunger

In the drought-hit region of Eastern Uganda, HIV positive patients are abandoning their antiretroviral regimens as food becomes scarcer. A prolonged dry sell within the region has destroyed crops and this is leaving thousands of people hungry.
 
Those providing HIV treatment within the region are worried for those living with HIV, as a poor diet can severely weaken an HIV positive patient’s immune system due to weight loss. In addition, it has been reported that those on ARV are beginning to stop taking treatment because taking the drugs without food has side effects such as vomiting and feel weak. If an HIV positive patient is weak from hunger and decides that the treatment side effects are too much to bare then treatment resistance can develop, which can cost lives.
 
The Ugandan government is being urged to take immediate action to provide food relief to encourage people to continue taking their medication. While nearly 10 million U.S. dollars have already been spent this is not enough. More relief needs to be provided so that those living with HIV and those who are HIV negative have equal access to food.

(Plus News accessed 18/08/09)

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Countries failing their migrant population with potential for HIV and AIDS increase

The economic crisis and universal access to HIV services for Migrants.

Concerns are mounting that the current economic crisis will be a disastrous repeat of 1997-1999 Asian financial crisis with the potential for an increase of HIV and AIDS infection within the region. With economic growth declining from 8.8% in 2007 to 5.8% in Jan 2009 within Asia and the Pacific region, it has been estimated that over 25 million people are unemployed and this has raised concerns about the potential spillover effect on HIV prevention and treatment.

With countries such as Malaysia, Cambodia and Indonesia heavily dependent on exporting as part of their economy, the recent economic downturn has seriously effected employment rates and national Government's ability to finance HIV programs. Cambodia was reported to have had a decline in the garment industry of 31% and 70,000 jobs, mostly consisting of migrant women, have been lost.

The United Nations Development Program report highlighted the real concern of the economic crisis for migrant workers. On a national level, an economic slow down will cause problems for funding and cuts will have to be made, which many fear will target more localised programs. The report also highlighted that during an economic crisis it is common for governments to adopt a well publicised anti-immigration policy. In Malaysia, the Government has placed a freeze on the re-issuing of work visas and revoked work visas for 55,000 Bangladeshis. If formal routes of movement are not open to migrants, this will mean that migrants will explore informal methods of movement and this can put them in conditions with a greater risk of vulnerability to HIV. Migrants' perceived risk, knowledge of HIV, and use of condoms are low, which puts them at high risk. However, when migrants start to explore informal routes of immigration this can result in illegal activity and further reduces their access to education and healthcare.

 On an individual level, with high unemployment or lowered wages, it may not be possible for HIV positive people to continue their vital HIV treatment. Women who are made unemployed can consider to enter the sex industry as reported in Cambodia where the garment industry has declined and women are entering into an unsafe sex industry outside of the HIV prevention framework

Overall, the UNDP report on migration highlights the potential challenges that will arise during the economic slowdown and shows that in order to commit Universal Access it is necessary to confront the issues now before vulnerable groups are forgotten.

(UNDP 'The threat posed by the economic crisis to universal access to HIV services for Migrants' accessed 17/08/09)

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