High HIV prevalence among IDU's in Libyaback to top
2nd May 2013
A recent study published in the April edition of Journal of Acquired Immune Deficiency Syndromes (JAIDS), has found a concentrated HIV epidemic among injecting drug users's (IDU's) in Libya, with 84% of IDU's admitted to the only drug-treatment centre in the country testing positive for the virus. The researchers concluded that this may be one of, if not the highest rates of HIV in an environment with no harm reduction programmes.
The data was originally presented at the first National HIV Symposium in post-conflict Libya last June in Tripoli, which included participants from the World Health Organisation (WHO), UNAIDS and the United Nations Office on Drugs and Crime (UNODC). Prior to the revolution it was extremely difficult for data to be collected and programmes implemented. As a result, the HIV epidemic was allowed to go unchecked.
The elevated levels of HIV among IDU's came with mass opioid users transitioning from smoking the substance to injecting in the late 1990's. This was coupled with diminished availability of sterile syringes from pharmaceuticals because of a change in policy. However, it is unclear to what extent this policy effected IDU's, but may contribute to the 85% of IDU's having reported needle sharing in the past, and 29% in the previous month.
Current HIV prevention strategies rely on “fear based education in schools” and few campaigns aimed at expanding awareness among the general public, with little harm reduction strategies. Harm reduction programmes, which include needle and syringe exchange programmes and opioid substitution have yielded positive results in Ukraine and other countries. It is therefore fundamental for the country to change legislation so the UN's 9 harm reduction interventions can be adopted in Libya.
Source:JAIDS
Europe austerity measures impacting access to healthcareback to top
30th Apr 2013
Austerity measures that have been placed in many European countries, as a response to the financial crisis, are putting a strain on public safety nets including healthcare systems. This is having a negative impact on groups vulnerable to HIV, including migrant workers, sex workers, and marginalised ethnic communities, from accessing treatment and prevention services, according to a report published by international NGO, Médecins du Monde.
The report emphasises the vulnerability of undocumented migrant workers, as they are already less inclined to seek medical attention, in cases other than emergencies, because of language barriers and social marginalisation. This is likely to be further aggravated by the rise in attempts to save money through cutting back on health services.
In February, Belgium passed a law that meant undocumented migrants will no longer be automatically reimbursed for their antiretroviral (ARV) treatment. Groups in opposition to this law have argued it is misguided, as it would only lead to higher costs on treating AIDS-related illnesses in the future. Some countries such as Italy and the UK, make it a policy to provide life-long ARV treatment to undocumented migrant workers in need of them. However, as of 2012, 16 EU and European Economic Areas do not make ARV's available to them. Included in these countries is Spain, who has been one of the hardest-hit countries by the financial crisis. They have made it a procedure to exclude undocumented migrants and asylum seekers from public healthcare systems, following the shrinking of their health budget by 4.6%.
Médecins du Monde (MdM) hope their findings will “inspire policy-makers and help to bring about changes in the laws and practices which deny one of the most fundamental of human rights, the right to the highest attainable standard of health [for everyone]”.
Source:
American Supreme Court debates 'anti-prostitution' lawback to top
24th Apr 2013
The 2003 law that obliges organisations funded by PEPFAR (President's Emergency Plan for AIDS Relief) to explicitly denounce sex work was debated on Monday at the Supreme Court, the highest court in the United States of America. Currently, these organisations are required to sign an ‘anti-prostitution pledge’, meaning they are barred from providing effective HIV prevention, treatment and care services to sex workers.
Sex workers are a group that continue to be disproportionally affected by HIV, and are hard to reach by HIV prevention services due to stigma and other social factors. HIV/AIDS advocates and charities are arguing that the law violates freedom of speech, and that it restricts an organisations ability to take a non-judgemental stance when providing advice on HIV prevention to people who may be at risk of HIV infection. At the core of their argument is the notion that the law is too strongly driven by U.S. conservative ideology, and the government would be effectively dictating what autonomous organisations can, or cannot say.
As a consequence a number of organisations have declined funding from PEPFAR. In 2005 the Brazil government rejected US$ 40 million of conditional funding as they felt it would inhibit their HIV prevention programming. The debate has split non-governmental organisations, with 46 organisations backing the American governments decision as a reasonable ask for “groups receiving funds to fight AIDS, [to] also oppose prostitution and sex trafficking”.
The decision to repeal the 'anti-prostitution pledge' is expected in late June 2013. However, if the vote of the supreme justices is split, it's expected the final decision will be further delayed.
Source:
Performance-enhancing IDUs a missing group in HIV preventionback to top
19th Apr 2013
Research presented during the annual British HIV Association (BHIVA) conference in Manchester shows increases in the number of men injecting image- or performance-enhancing drugs. Of the men surveyed, it was found that 1.5% had antibodies to HIV, which is significantly higher than the general population in the UK. A further 5.5% and 8.8% were also shown to have had antibodies to Hepatitis C and B, respectively.
This is only the forth ever study conducted on the link between injecting steroid users and HIV. Considering 23,000 more people injected anabolic steroids than heroin in the UK last year, highlights the need for further research in ways this group can be better targeted by prevention strategies.
Other research was conducted that gave an insight into the profiles and behaviour of the participants that may account for the infection rate of HIV via routes other than needle sharing. It was found 20% had five or more female partners in the last year, 8% had ten or more female partners, and only 20% having reported consistently using a condom in the last year. Although this shows behaviours that put the participants in higher risk of transmitting HIV, only 17% had visited a sexual health clinic and only 31% had ever been tested for HIV.
Concluding the presentation of his results, the lead researcher emphasised the need for care to be taken when interpreting the findings; because of the sample size, and additional research suggesting other behaviours, not linked to injecting, that are putting participants at risk of acquiring HIV. However, the research and survey results highlight the need for greater attention to be given on the link between HIV and injecting anabolic steroids users.
Source:Aidsmap
Risky behaviour doesn't increase with PrEP in gay men back to top
17th Apr 2013
HIV-negative gay men in the US have been shown to not increase levels of risky sexual behaviour whilst on pre-exposure prophylaxis (PrEP), according to a study published in the JAIDS. Over the time scale of the study, both the incidence of unprotected a anal sex and numbers of sexual partners decreased, showing that PrEP can be efficacious in certain populations.
For the first time last year, the US approved the use of the antiretroviral drug, Truvada, to be marketed as PrEP. PrEP is provided to people who are not living with HIV, yet are considered at a high risk of exposure, such as with serodiscordant couples (when one partner is HIV negative, and the other is HIV positive), and men who have sex with men (MSM). The use of PrEP has the potential to reduce the number of new HIV infections, yet has been met with some resistance by activists and healthcare professionals. Concerns arise particularly around whether or not the use of PrEP in this way might give rise to complacency, an increase in risky sexual behaviour, and a false perception about an AIDS cure.
Yet this research suggests that among MSM in the US, PrEP can be beneficial, particularly by linking this high-risk group with behavioural interventions. The study authors noted: “Men in this study received risk-reduction counselling, condoms and lubricants, regular HIV/STI testing, and linkage to prevention services…which may explain the observed risk reduction and could explain the observed risk declines and could mitigate any potential for risk compensation.”
Last month AVERT reported on the well-publicised failure of a large-scale PrEP trial among young women across several southern African countries. This demonstrates the complexities of delivering HIV prevention interventions, and how packages of interventions need to be evidence-informed and tailor-made to the environment. Ultimately, there is no ‘one-size-fits-all’ approach to HIV prevention.
Source:Aidsmap
Quarter of pregnancy deaths in high prevalence settings due to HIVback to top
10th Apr 2013
A meta-analysis undertaken by the London School of Hygiene and Tropical Medicine has revealed that in high prevalence settings, pregnancy-related deaths due to HIV may be as high as one in four. The analysis showed that in certain countries women living with HIV are eight times more likely to die during or following pregnancy than uninfected women. Estimates indicate that in areas where HIV prevalence is 15 percent, 50 percent of pregnancy-related deaths can be attributed to HIV. In most cases, women were not on antiretroviral therapy (ART), and at a more advanced stage of illness.
The findings highlight that excess mortality due to HIV infection also affects women in low prevalence settings. For example, in a country with a national HIV prevalence of 2 percent, around 12 percent of pregnancy-related deaths can be attributed to HIV. While at global level, UNAIDS data reveals that an estimated 5 percent of pregnancy-related deaths are linked to HIV. In sub-Saharan Africa the figure is much higher, at around 25 percent.
This research was undertaken to help us understand more about how HIV contributes to mortality during and immediately after pregnancy. It has made clear that greater integration of HIV and sexual health services is needed in many parts of the world, particularly where HIV prevalence is high.
Source:Aidsmap
LGBT rights recognised by law in Hondurasback to top
5th Apr 2013
The National Congress of Honduras has recently amended its Penal Code to establish a legal provision to protect people from discrimination on the grounds of sexual orientation and gender identity. This move comes following a high number of fatal attacks and human rights violations committed against Lesbian, Gay, Bisexual, Transsexual (LGBT) populations in the country – more than 90 homophobic and transphobic killings took place between 2009 and 2012.
The lack of legal protection for these groups led the Minister of Justice and Human Rights to amend the Penal Code, making the “discrimination with hatred or contempt on the basis of sex, gender, religion, national origin, belonging to indigenous and Afrodescendant groups, sexual orientation or gender identity” punishable by up to 3-5 years imprisonment or a fine.
It is hoped that this move will help to improve access to HIV services by reducing stigma and discrimination of LGBTI populations through legal recognition of their rights. Men who have sex with men (MSM) are disproportionately affected by HIV in Honduras, with an estimated prevalence of 9.9%, compared to 0.6% among the general population. Transgender people also have a much higher chance of HIV infection due to various biological and structural factors that increase their vulnerability. Addressing legal barriers affecting the human rights of key population groups is the first step towards reaching the second of the UNAIDS ‘three zeros’ - zero discrimination.
The next step is “to ensure that all professionals are informed and trained on these new provisions to help ensure we reach zero stigma and discrimination” (UNAIDS Country Coordinator for Honduras and Nicaragua), and to challenge entrenched stigma among the general population towards LGBTI people, to ensure equal access to HIV and AIDS services.
Source:UNAIDS
Novartis lose case to patent cancer drug Gilvecback to top
2nd Apr 2013
A landmark case has been won in India, after Novartis lost their appeal to patent the anti-leukaemia drug, Gilvec. The Swiss pharmaceutical giant was originally refused the patent in January 2006, and has since been relentlessly pursuing legal action against the Indian authorities to overturn the decision. If Novartis had won, India’s status as the pharmacy to the developing world would have been seriously undermined, putting access to essential generic medicines for the world’s poorest in jeopardy. The decision has been applauded by activists around the world.
Generic versions of Gilvec have been produced by Indian manufacturers since before 2005, yet in January 2006 Novartis attempted to patent an ‘improved’ version of Gilvec. However the patent was rejected by the Indian authorities on the basis that it was not a significant improvement on the generic that was already being manufactured and distributed by Indian companies.
Under TRIPS (trade-related aspects of intellectual property rights), India has been obliged by the World Trade Organisation to offer patents on new drugs since 2005. However a clause in Indian patent law, Section 3(d), states that patents can only be granted on new medicines that show a significantly improved efficacy. Over the six years, Novartis has tried and failed to declare Section 3(d) unconstitutional. In this latest attempt, Novartis hoped to demonstrate the improved ‘efficacy’ of Gilvec. Campaigners have criticised Novartis of ‘evergreening’, a well-known process whereby pharmaceutical companies will make small modifications to already marketed drug so that they have new grounds on which to patent it, thus prolonging their profit margins. The decision made yesterday by the Indian Supreme Court upholds this view.
Although Gilvec is a cancer drug, the outcome of the Novartis trial has a significant impact on the provision of antiretrovirals (ARVs) for the treatment of HIV. India is the largest supplier of generic ARVs to low and middle-income countries, providing 80% of donor-funded ARVs in these countries. If Novartis had won, it would have weakened the Section 3(d) clause, allowing for further appeals by pharmaceutical companies, and setting the standard for future patent applications. One of the key organisations campaigning against Novartis, Médecins Sans Frontières (MSF), called the decision yesterday a ‘relief’. Jennifer Cohn, of MSF stated: "The fact that India says patents are to reward innovation as opposed to small changes does stay true to the concept of what a patent should be."
Source:The Guardian
One fifth of transgender women globally HIV positiveback to top
27th Mar 2013
A meta-analysis published recently by The Lancet Infectious Diseases has revealed that globally nearly one fifth of transgender women are living with HIV. The analysis comprised of 39 studies across 15 countries, with over 11,000 transgender women; defined for this purpose as “individuals who were born as biological males but who identified as women”. This is the first meta-analysis of its kind - previously little was known about the global HIV prevalence among transgender women.
The study estimates that globally transgender women are 49 times more likely to become infected with HIV, than individuals in the general population. The investigators have speculated that the reason for such a high HIV burden among this group is that they are often involved in sexual networks with high levels of HIV, and in certain regions it is common for transgender women to be involved in sex work. Additionally, the levels of stigma and exclusion experienced by transgender women can limit their access to HIV prevention, treatment and care services.
This research is a clear indication of the urgent need to address factors that prevent transgender women from accessing the HIV services they require. To learn more about some of these factors, have a look at AVERT’s new transgender people and HIV/AIDS page.
Source:aidsmap
Self-testing and home initiation of care increases treatment uptakeback to top
22nd Mar 2013
Self-testing for HIV, and home-based counselling and treatment delivery has been shown to triple the number of people linked to HIV care services, according to a study conducted in Malawi. Less than a quarter of adults in sub-Saharan Africa test for HIV every year, and devising interventions that can improve coverage of both HIV testing and subsequent linking to HIV support and treatment services is a major issue for low-resource settings.
Past studies have shown self-testing for HIV in the home to be highly effective in sub-Saharan Africa. However concerns remain regarding loss to follow-up after testing. In order to combat this, researchers in an urban neighbourhood of Blantyre, Malawi, compared two interventions: self-testing in the home, followed by a referral to HIV care services; and self-testing in the home, followed by home-based initiation of treatment, with the delivery of medication and support services for the first two weeks of therapy. They found that participants who were offered self-testing and HIV care in the home were more likely to disclose their status to healthcare professionals. They were also three times as likely to start treatment, compared to those who were referred to clinics.
Lead researcher Peter Macpherson stated, “our results suggest that most people who have self-tested positive do need extra help to get them into HIV care in a timely fashion.” More formal research needs to be done as to why people prefer home-initiation of care, and how this intervention can be factored into large-scale HIV care services.
Source:Aidsmap
Additional $1.6 billion a year needed to curb TBback to top
18th Mar 2013
Ahead of World TB Day, the World Health Organisation (WHO) and the Global Fund to Fight AIDS, TB and Malaria (GFATM) have announced that an additional annual investment of $1.6 billion is needed to prevent and treat tuberculosis (TB) globally. In the wake of an alarming rise in multi-drug resistant TB (MDR-TB) in recent years, the WHO and GFATM have described the situation as a major threat to progress to date. With an estimated 630,000 people with this form of TB, now is the time to act to ensure that the disease can be brought under control.
TB is the leading cause of death among people living with HIV in low-income countries. It is estimated that over a million people worldwide have TB and HIV coinfection, with rates in sub-Saharan Africa being particularly high. WHO has worked collaboratively with the Global Fund – the largest funder of TB interventions – and the Stop TB Partnership to support countries with the highest TB burdens to review their priorities and identify funding gaps. Almost 60 percent of the $1.6 billion gap identified relates to the WHO Africa region.
World TB Day is held each year on 24 March with the goal of raising awareness of the disease and the way if affects people in different parts of the world, as well as putting the spotlight on TB prevention and control efforts.
Source:The Global Fund
Microbicide and PrEP trial deemed a failureback to top
12th Mar 2013
One of the largest trials ever conducted on pre-exposure prophylaxis (PrEP) and microbicides was deemed a failure at a presentation last week at the Conference on Retroviruses and Opportunistic Infections (CROI) in Atlanta.
The VOICE (Vaginal and Oral Interventions to Control the Epidemic) trial included over 5000 women from South Africa, Zimbabwe and Uganda, and was investigating two different oral contraceptives for PrEP, and a vaginal microbicide gel to prevent HIV transmission. It was found that none of the prevention methods reduced HIV incidence among the women, with adherence being the major contributing factor to their ineffectiveness. PrEP and microbicides proved most ineffective in young and unmarried women, adding to further evidence from other trials, including among young gay men, that adherence is a major risk factor for young people. Further research needs to be conducted to see among which populations PrEP and microbicides might be a effective HIV prevention tool.
Women are disproportionately affected by the HIV and AIDS epidemic, and gender inequalities within society often mean they are less likely to be able to negotiate condom use. Female-initiated HIV prevention technologies are limited to female condoms; it was hoped that PrEP and microbicides would give women and girls another HIV prevention tool that they could control. The failure of this trial means that it is even more important to focus on structural interventions such as promoting positive gender roles and women’s human rights.
Source:Aidsmap
Mississippi baby 'functionally cured' of HIVback to top
5th Mar 2013
A baby born with HIV in the United States has been ‘functionally cured’ of the virus, according to research presented yesterday at the Conference on Retroviruses and Opportunistic Infections (CROI).
The ‘Mississippi baby’ was born to an HIV positive mother who was unaware of her status and diagnosed late into labour. As a result, prevention of mother-to-child transmission (PMTCT) procedures could not be followed, and doctors initiated triple-combination antiretroviral therapy (ART) as a post-exposure prophylaxis; yet after sensitive tests were conducted, the baby was confirmed HIV positive. This continued to be the case up until 20 days of life, after which the virus was undetectable. The baby remained on triple-combination ART until 18 months, when treatment stopped because mother and child did not return to care. When the child returned to treatment at 23 months, it was found that the viral load was still undetectable despite having ceased treatment for 5 months. After further testing, they found a very small amount of inactive HIV in the body, in a state where it was unable to replicate and spread- ‘a functional cure’.
This case has garnered significant press attention, and whilst the findings are positive, it should be stressed that very little is known as to why this child has been able to eliminate reproduction of HIV in their body. As a ‘cure’, the model cannot be replicated among adults, or children who have been diagnosed later, as what seems to have worked in this case is a very aggressive attack on the virus, early into life, and before the virus had time to penetrate the CD4 cells. Further research needs to be done on whether or not early initiation of an aggressive ART in infants can be used as a last resort, when PMTCT procedures have not been followed. Also, as the child is still so young, further follow-up is needed to ensure viral replication does not begin later in life.
Ultimately, the focus should always be on PMTCT, rather than treatment of an infection or ‘cure’. We know that this is effective – through treatment provision, mother to child transmission is reduced to less than 5%, and is virtually eliminated in high-income countries.
Source:
New funding model announced by the Global Fund back to top
1st Mar 2013
The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) has announced its long-awaited new funding model, following a period spent reviewing its grant process over the last year. The new model, which is designed to “enable strategic investment for maximum impact”, will follow the current transition phase and will provide grants for the 2014-2016 period. It is hoped that the model will give countries more flexibility around when they apply by means of funding ‘windows’, as opposed to the previous ‘rounds’ system, and will provide greater insight into the level of funding available. Additionally, the new model will accept civil society proposals, which has not previously been the case, and it will look to take a more “holistic, programmatic approach”.
Implementation of the new model will start once it has been established how much funding is available for the 2014-2016 period – it is currently estimated that this will be at the end of 2013. While countries looking to apply under the new funding model will have to wait for its launch, a handful of countries (Zimbabwe, El Salvador, Myanmar, the Democratic Republic of the Congo, Kazakhstan and the Philippines) and three regional programmes have been invited to apply as ‘early applicants’. These countries and programmes were selected based on the risk of service interruption due to lack of funding, and an assessment of whether they are currently being underfunded in accordance with levels established by the new model.
The Global Fund board has emphasised that the new funding model will have a key focus on improving services for underserved and most-at-risk populations, such as men who have sex with men and injecting drug users. Looking to the future, Mark Dybul, the newly appointed Executive Director, stated that the model will help to “leverage investment in a way that allows our partners to reach more people facing these diseases”.
Source:
WTO to decide on TRIPS extension for least-developed countriesback to top
27th Feb 2013
Access to essential and lifesaving medicines for the world’s poorest is under threat if members of the World Trade Organisation (WTO) decide not to extend the transition period on compliance to pharmaceutical property rights. At next week’s Trade-Related Aspects of International Property Rights (TRIPS) Council meeting, members will decide whether or not least-developed countries (LDCs) should continue to be considered exempt while they remain categorised as an LDC.
The health burden in LDCs is substantial. Of the 34 million people living with HIV around the world, 9.7 million live in these 49 countries and less than half of those who are eligible for treatment are receiving it. Incidence of non-communicable diseases, such as cancer, is also rising at an alarmingly high rate compared to developed countries. UNAIDS Executive Director, Michel Sidibe stated: “an extension would allow the world’s poorest nations to ensure sustained access to medicines, build up viable technology bases and manufacture or import the medicines they need.”
In 1995, WTO members signed the TRIPS agreement, imploring all member states to ensure international patents were protected. However, under the agreement there were a number of flexibilities, which sought to protect access to essential medicines for low-income countries. One such was flexibility was that LDCs had ten years to develop the capacities to comply to the TRIPS agreement. In response to the meeting UNAIDS and UNDP have released an Issue Brief to consider “continued special needs and requirements of LDCs in respect of their social and economic development”. For further information, see our weekly feature “Putting Patents before People” and our page on Generics.
Source:UNAIDS
