PrEP found to cut risk of HIV by 50% in IDUsback to top
17th Jun 2013
A clinical trial in Bangkok, Thailand, showed daily intake of antiretroviral (ARV) drug, tenofovir, cut HIV infections rates by 50 percent among injecting drug users (IDUs), indicating the use of ARVs as a promising approach to HIV prevention. This strategy is known as pre-exposure prophylaxis (PrEP), a relatively new method that has shown to reduce the risk of becoming infected with HIV in combination with other prevention methods.
The trial conducted by the Thailand Ministry of Public Health, in partnership with the U.S. Centers for Disease Control and Prevention (CDC), took place over a four year period. It included over 2000 IDUs who were randomly assigned a daily oral dose of tenoforvir or a placebo. Seven to eight per 1000 of the placebo group became infected with HIV, while only three to four per 1000 of the tenoforvir-taking group became infected. The participants were also offered to attend clinics on a monthly basis for HIV tests, risk-reduction counselling, and monitoring for any adverse effects to tenofovir, which were reported to be “tolerable”. This drug belongs to the class of ARVs that work by blocking crucial enzymes for the process of HIV replication, which stops the virus from spreading through the body.
The positive findings support previous studies on the efficacy of using treatment as prevention, however, there are potential concerns that need to be further looked into regarding adherence and doing more to reach the most marginalised IDU communities, as the trial only included those already attending drug treatment clinics.
With an estimated prevalence rate of 30-40 percent among IDUs in Thailand and a growing number of HIV-positive IDUs globally, especially in the Central Asian and Eastern European region, the Executive Director of UNAIDS, Michel Sidibé, welcomed these results – “The results of this study are important, and if used effectively in HIV programming could have a significant impact in protecting people who inject drugs from becoming infected with HIV.” UNAIDS also emphasised using a single intervention in isolation may not be enough to stop the spread of HIV, and therefore “advocates strongly for combination prevention” in curbing the epidemic.
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UN releases report on progress towards 2011 Political Declarationback to top
14th Jun 2013
At this week's meeting of the United Nations General Assembly in New York, Ban Ki-moon has stated that "we are paving the way to achieve an AIDS-free generation." His remarks were made with the release of a report that details the progress made towards achieving the goals set out by the 2011 Political Declaration on HIV and AIDS. Adopted in 2011 by the General Assembly, the Political Declaration brought leaders from around the work together to reinstate their commitment to fighting the AIDS epidemic, and “set out a new framework of shared responsibility and global solidarity.”
The report gives an update on the progress made in achieving an AIDS-free
generation, key actions that need to be made to continue and accelerate the
advancement of targets. It also urges for sustained commitment towards
achieving targets, such as, reducing sexual transmission of HIV by 50 percent. Much progress has
been made in reaching this goal, but many more changes must be made to
reach the 2015 deadline. For example, there is still a large disparity
between the supply and demand of condoms, with 10 billion condoms needed each year and
only 3.4 billion male condoms and 43.3 million female condoms procured and
distributed in low- and middle- income countries in 2011. Moreover, efforts
to increase male circumcision, an HIV
prevention method that has shown to reduce infection by up to 60
percent, has been slow. It was reported that by the end of 2011 only 5
percent of target males had been circumcised.
Ban Ki-moon states that Millennium Development Goal 6 to halt and reverse
the spread of HIV
has already been reached in more than 56 countries, and that new infection
rates have declined by a fifth. However, there are still many countries
struggling to realise this ideal. The problem, he noted, “cannot be
solved with more money. We all have to step up with courage and integrity
to protect vulnerable members of our human family”.
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Resolution passed to promote rights of groups affected by HIVback to top
12th Jun 2013
The Organisation of American States (OAS)- a coalition of 35 independent states from Latin America, North America and the Caribbean- have passed a resolution to promote and protect the human rights of people living, or affected by HIV in the region. The bold pledge aims to tackle obstacles faced by people living with HIV, and groups vulnerable to HIV. Entrenched stigmatisation and discrimination from community and religious leaders, and state officials were noted barriers in the draft resolution, as were the inadequacies in the access to health services, medical insurance and rights in the work place.
By approving the resolutions, during the 43rd General Assembly, delegates from the Americas are recognising there are still challenges that need to be addressed in the regions HIV response, despite the significant strides made in recent years. New infection rates in Latin America are approximately 10,000 down in 2011 from 2001, and treatment coverage is high resulting in a 10% decline in AIDS-related deaths between 2005 and 2011. While infection rates in the Caribbean are higher than any region outside of sub-Saharan Africa, it has seen a sharp drop in new infection, by 42% since 2001.
The draft resolution discusses the importance of executing mass campaigns to inform people, for improved prevention and treatment. But the most striking part of the draft resolution is the acknowledgement that that groups affected by HIV should play a more prominent role in the regions response to the epidemic. To intensify regional efforts the resolution urged member states to enforce legislations that protect human rights of people living with, or vulnerable to HIV, such as men who have sex with men, transgender people, sex workers, injecting drug users and indigenous populations.
The passing of the resolution is an important step forward. It shows the realisation that fundamental freedoms of people affected or living with HIV is an essential element in more effectively tackling the spread of HIV and giving more people access to treatment, support and care.
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Calls to decriminalise drugs at harm reduction conferenceback to top
10th Jun 2013
The International Harm Reduction Conference is taking place this week in Vilnius, Lithuania, with an emphasis on the social and ethical aspects of harm reduction philosophy. The conference has already seen high profile individuals such as British business magnate Richard Branson, musician Elton John, and Former Polish president, Aleksander Kwasniewski, calling for drug decriminalisation. Many believe punitive laws against drug users hinder the fight against HIV, as fear of arrest and stigma drive people away from HIV treatment and prevention services.
The four-day conference brings together key organisations, advocates, programmers, service users, and a host of others working in the field to discuss policy and developments relating to harm reduction. Harm reduction refers to programmes and pubic health policies that seek to reduce the negative consequences associated with drug consumption. These strategies range from needle exchange programmes and opiate substitution treatment, to peer-based education on the risks of HIV transmission for injecting drug users (IDUs). With some countries experiencing increasing HIV rates among IDUs, the conference is calling for “urgent” financial and political support to mitigate the spread of HIV within this group.
The conference has a special focus on Eastern Europe and Central Asia, home to a quarter of the world’s population who inject drugs, with up to one million IDUs living with HIV. Yet key countries in the region, notably Russia, have resisted implementing harm reduction programmes, despite evidence of their effectiveness. The Russian government is staunchly opposed to opiate substitution therapy, and they do not fund needle exchange programmes, meaning HIV prevention services are worryingly out of reach for the most at-risk group in the country. Over the course of the next few days, conference delegates will be discussing key issues affecting a harm reduction response in this region, including diminishing government funding, human right violations, and repressive laws and policies; follow what's going on via Twitter using #IHRC2013.
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Campaigning increases rates of pregnant women on ARTback to top
7th Jun 2013
A study carried out in two health districts in KwaZulu Natal province, South Africa, found targeted campaigning by health workers accelerated antiretroviral treatment (ART) access among pregnant women living with HIV by more than 50 percent. In contrast, rates of pregnant HIV positive women starting ART in a nearby district, without campaigning, showed no significant improvements. The interventions saw referrals of pregnant women on ART rise from an average of 79 each month, to 188 each month.
The six-month campaign, led by the district health management team, employed health workers and local leaders to “generate strong pubic endorsement” and awareness in the importance of testing and treatment of HIV to prevent mother-to-child transmission (PMTCT) and mortality. The approach was based on the successful North American ‘100,000 lives’ campaign, and the similar Welsh campaign, ‘1,000 lives’. These campaigns aimed to improve health care around a set of numerical goals to be met in a given time. Both the successful drives were accredited with saving lives and reducing patient hospitalisations, showing the high value of HIV advocacy initiatives in reducing mortality and morbidity in both low- and higher resource settings.
South Africa remains one of the hardest hit countries by the epidemic, with 5.6 million people living with HIV in the country, and only 68% of HIV positive pregnant women receive treatment in the region. Despite commitments by South Africa to increase rates of pregnant women living with HIV receiving treatment, through legislation change and targeted programmes, an estimated 40.5 percent of maternal mortality was attributed to HIV between 2008-2010.
The authors of the study concluded their results add to existing literature on the strengths of a campaign strategy to enhance performance of large-scale health programmes, and showed the strategy “to be effective in rapidly improving the performance of a key component of the PMTCT cascade.”
Source:JAIDS
UK: report shows young people most affected by STIsback to top
5th Jun 2013
New data indicates sexually transmitted infections (STIs) are continuing to increase in the UK, with a reported 5% rise of new infections in 2012. It is thought this increase is mostly due to improved data collection, according to a recently published report by Public Health England (PHE). Significantly enhanced methods and screenings for STIs, such as Chlamydia and Gonorrhoea, has meant the UK is seeing the diagnosis and treatment of “more infections that ever before”. Dr Gwenda Hughes, who heads STI surveillance at PHE, went on to emphasis the need for continued efforts to endure these trends – “on-going investment in programmes to increase sexual health awareness, condom use and testing, particularly for groups at most risk, is vital”.
Young people, under the age of 25, remain the most affected group by STIs. The report consequently encourages sexually active young people to screen for HIV and other STIs on at least an annual basis, and on a three-month basis if changing sexual partners regularly. It can be especially important to regularly test for STIs such as HIV for early identification and treatment, as it can often be asymptomatic.
The report highlighted how “men who have sex with men continue to experience high rates of STIs and remain a priority for targeted HIV and STI prevention and health promotion work”. Analysis also showed black ethnic communities to be disproportionally affected by HIV and STIs. A previous report by PHE found rates of HIV to be 3.7 percent and 0.4 percent among black African and black Caribbean communities in the UK, respectively, and black Africans to account for 69 percent of all new HIV infections in the UK. The prevalence among the white population stood at 0.09 percent at in 2008.
The report finished off by placing education as the “cornerstone of STI prevention” as it can be a tool to inform people on ways to adopt safer sexual behaviours that will improve their own, and their wider communities sexual health.
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UN releases post-MDG agenda back to top
3rd Jun 2013
The United Nations (UN) has released the long awaited report outlining the development agenda for beyond the millennium development goals (MDGs) that expire in 2015. The report was compiled by 27 high level leaders appointed by the UN Secretary General Ban Ki-moon, after consulting 500,000 people from 121 countries, following five meetings and up to 5,000 pages of submissions.
The report entitled “A new global partnership: eradicate poverty and transform economies through sustainable development” formed bold, but practical goals to build on the successes of the MDGs that has seen the “the fastest reduction in poverty in human history”. However, it additionally remarked on the MDGs lack of emphasis on reaching the most marginalised, and not encouraging better cooperation on social, economic and environmental features of sustainable development. Also, while three out of the eight MDGs have already been reached, progress on them has been uneven across countries.
One of the many calls from the report include continuing progress in ensuring universal health coverage through “broadening the range of integrated, essential services available to every person”, and highlighting the need for this commitment from countries of all income levels. It was acknowledged to reach this ideal outcome would require addressing barriers that hinder access to basic health care such as discrimination, stigma and affordability. This health focused goal builds on MDG 6 of reducing the burden of HIV/AIDS, malaria, tuberculosis (TB) and neglected tropical diseases. This goal has seen much progress revealed by the rate of new HIV infections having halved in the past decade. However, the new agenda has put the aim of reducing HIV/AIDS, malaria, TB and neglected tropical diseases as only the fifth and final part of Goal 4 (of ensuring healthy lives). Some have viewed the massive progress made in reducing the spread of HIV/AIDS resulting in its reduced attention from the post-2015 agenda– “ironically the AIDS response is being dealt a blow by its own success”. ‘HIV’ only appearing 5 times in the 81-page report can be seen to show this.
On receiving the completed report, Ban Ki-Moon spoke of the post-2015 agenda as “a chance to usher in a new era in international development – one that will eradicate extreme poverty and lead us to a world of prosperity, sustainability, equity and dignity for all”.
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UNITAID reduce cost for paediatric HIV treatmentback to top
30th May 2013
Negotiations by UNITAID with drug manufacturers have resulted in an 80 percent price reduction for key HIV, malaria and tuberculosis (TB) treatments for children, and a 60 percent reduction on second-line HIV treatments. The findings outlined in their recently published report also details how the organisation created a new market for paediatric HIV treatment, which was previously a neglected area – “UNITAID provided an incentive for manufacturers to create specially-adapted HIV drugs for children and over 400,000 children have been put on treatment”. The incentive was an award of US$17.3 million to The Drugs for Neglected Diseases initiative (DNDi). One of the challenges they aim to overcome in paediatric HIV treatment is to replace the “foul tasting” liquid formulation that requires several doses per day, to a more palatable version for children that does not require refrigeration. This will increase adherence and accessibility for the 3.4 million children living with HIV globally.
UNITAID is an initiative established by the governments of Chile, Brazil, United Kingdom, France and Norway, that takes a market-based approach to increase access to essential medication and diagnostics for these three ailments in developing countries. The initiative is mainly financed through a levy on air tickets; a small fee attached to the airline tickets. Through a rigorous grant-making process, the organisation ensures money is put into interventions that have the biggest impact for the best value, to accomplish “results beyond investment”.
Essential HIV treatments are inaccessible to many in low-resource settings, and especially infants because of high prices, with some such as the combination therapy HAART costing US$ 10000-15000 per person per year. As a result, civil society, advocacy groups, governments as well as UNITAID, have been working hard to encourage drug manufacturers to cut prices for essential HIV treatments and increase research. This report shows combined efforts have been successfully translated into material results.
Source:UNITAID press release
Women Deliver conference: Maternal health and HIV in Africa back to top
28th May 2013
Today is the start of the third 'Women Deliver' conference (May 28-30) that will see thousands of people from around the world gather in Malaysia to call for action on improving health, rights and empowerment of women and girls. Participants include policy-makers, healthcare professionals, civil society and many other development practitioners.
A key issue in the event will be women and girl's reproductive health. Despite efforts in reaching Millennium Development Goal 5 – a 75 percent reduction of maternal mortality by 2015 – high levels of maternal mortality persist in regions such as sub-Saharan Africa, where rates are more than double the global average. The high prevalence of HIV in sub-Saharan Africa has been widely accredited to this, as death rates among HIV-positive pregnant or post-partum women (following childbirth) are eight times higher than among their HIV-negative counterparts. From this it can be assumed that up to a quarter of all maternal deaths are associated with HIV. However, with a lack of robust studies, to what extent HIV contributes to maternal mortality, and how it does, is poorly understood.
In spite of the uncertainty in exact numbers, it is certain that interventions are needed to alleviate the negative effect of HIV on maternal mortality. In addition to expanded coverage of treatment among HIV-positive pregnant women, the provision and access of health facilities need to be strengthened, and greater knowledge on the connection of HIV to maternal mortality is needed. To achieve this requires greater investment and political will which the conference will, hopefully, gather support for.
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African leadership the 'magic bullet' in the fight against AIDSback to top
24th May 2013
The number of people on antiretroviral treatment in Africa has increased by 805 percent between 2005 and 2012, according to a new report released by UNAIDS this week. The report, entitled Update, reviews the response to the AIDS epidemic in Africa and was released to coincide with the 21st summit of the African Union (AU), which starts in Ethiopia this week and marks 50 years of the AU.
Over the years, the continent has overcome significant barriers to curbing the AIDS epidemic. In particular, there have been marked increases in the number of people on treatment, with one million people accessing treatment in the last year alone. New annual HIV infections are down by a third since 2001. AIDS-related deaths have also decreased by nearly a third since 2005. Update also paints a picture of the state of the AIDS epidemic across a number of countries, and includes personal stories from a number of people living with HIV. For example, Dr. Stephen Watiti of Uganda states that when he first started treatment in 2000, the ARVs cost twice his monthly salary, now in Uganda they are free.
UNAIDS Executive Director, Michel Sidibé, applauded the progress made in Africa, stating that leadership and shared responsibility have been the key drivers of this success: “Leadership, it turns out, was the elusive magic bullet.” He emphasised that Africa’s example in combating HIV and AIDS will provide a useful roadmap for other global health issues, including malaria and tuberculosis. In a summary of what was learnt from Africa’s experience, Sidibé states that it is the emphasis on the person and the community, as opposed to the disease, which will secure the most lasting affect on the AIDS epidemic; and that going forward, AU leadership is essential to ensuring that the momentum gained in fighting the AIDS epidemic is not lost.
Source:UNAIDS
Minimal programme and funding support for MSM in southern Africaback to top
17th May 2013
HIV and AIDS funding for gay men, other men who have sex with men (MSM) and transgender people in Southern Africa is grossly inadequate, according to a study published yesterday by amfAR and Johns Hopkins University. The study was released in time for International Day Against Homophobia and Transphobia (IDAHO), which is celebrated every year on May 17th. IDAHO is a UN-backed international day of awareness for issues relating to homophobia, with the hope of ending stigma and discrimination of people based on their sexual orientation or gender identity.
The report, Achieving an AIDS-Free Generation for Gay Men and Other MSM in Southern Africa, looks at programme implementation and funding for MSM and transgender people across six southern African countries: Botswana, Malawi, Namibia, Swaziland, Zambia, and Zimbabwe. Significant progress has been made across all of the region in combating the epidemic generally, however MSM and transgender communities represent a missing group in the response. The reality of being a part of these communities in these countries is stark. Many are unable or unwilling to engage with HIV prevention and treatment services because of homophobia, human rights violations, and laws criminalising same-sex behaviour.
Across many of these countries, there is minimal commitment on the part of national governments to combat HIV within gay, MSM and transgender communities. Laws criminalising homosexuality, and homophobia within the government, means there is limited information on the extent to which the epidemic is affecting these communities. This means that targeted interventions for these groups are often disjointed, and come from international donors, with little high-level national governmental support. The report states: “While the global conversation focuses on novel approaches to HIV treatment and prevention, GMT [gay men, other MSM and transgender people] struggle to obtain the most basic health services.”
International donor support for MSM and transgender communities from the two largest donors to the region, PEPFAR and the Global Fund, are also falling below the mark. For example, of the $1.5 billion allocated to these countries from the Global Fund, only 0.07% went towards programmes targeted specifically for these groups. This is despite both PEPFAR and the Global Fund having specific policies in place to ensure that these groups are included in HIV prevention and treatment interventions. The report calls on international donors, civil society and national governments to step up their response to fighting HIV within this group.
Source:amfAR
Sex workers in Benin benefit from targeted interventionsback to top
8th May 2013
Targeted interventions have resulted in reduced transmission of HIV and other sexually transmitted diseases (STDs), among female sex workers (FSWs) in Benin.
The 14-year project was implemented in Cotonou, the country's largest city. In this region, FSWs HIV prevalence rates are 12 times that of females of reproductive age in the general population. This higher prevalence rate among FSW is not unusual, as sex workers as a population are disproportionally affected by HIV, because their work is considered by some as illegal and immoral, marginalising them from society and hindering their access to treatment and prevention services.
This project, called “SIDA 1/2/3”, made use of local clinics, peer educators, field workers, police department and managers from sex worker sites, to promote changes in behaviour that increase their risk of HIV-infection, give out condoms, improve knowledge on HIV and STDs and run activities that empower FSW with the aim of increasing their confidence so they can better negotiate condom use. In Cotonou, where these interventions were being implemented, HIV prevalence among FSW decreased. In the same period, areas outside of the city where the interventions were not implemented saw an increase in prevalence by 34%.
This shows the success that can be achieved in combining different prevention strategies, and tailoring them to specific population to stop the spread of HIV and other STDs. As a result, the report concluded that “such interventions should be scaled up in all countries where specific vulnerable populations contribute disproportionally to the spread of HIV”.
Source:JAIDS
South Africa to overhaul drug patent lawsback to top
7th May 2013
South Africa is planning to close loopholes in the law that allow pharmaceutical companies to retain patent rights through applying minor adjustments to drugs.
The debate on intellectual property rights of drugs is increasingly synonymous with pharmaceuticals refusing to allow cheaper copies of life-saving drugs to be made. This is significant for the developing world where the high prices for antiretrovirals (ARV's) can be a barrier to effective treatment, and impedes efforts by government to strengthen health care systems as the money is instead being spent on high priced medication. Laws state companies have 20 years of exclusive sales on patents, before others can make cheaper copies of the drugs. Through slightly altering existing drugs whose patents are about to expire, profits of a drug can be protected for a further 20 years. This technique is known as 'evergreening', and is more easily exploited in South Africa as the application process for new patents is very lenient, meaning nearly all patents are approved.
The move by South Africa may be following from India's example. Although India has existing laws against 'evergreening', it was recently challenged in court by Swiss firm, Novartis, who attempted to patent protect an updated version of their Glivec cancer drug. The bid was rejected by the highest Indian court as the adjustments were deemed too minor.
There is backing from both international organisations and South African politicians alike for the overhaul to drug patent laws - "We have a policy position that says 'Let us have a strong system that does not grant easy patents,'” MacDonald Netshitenzhe, head of policy at the Department of Trade and Industry told Reuters. If passed by parliament, this change in intellectual property rights law could mean easier access to cheap medication for the 5.6 million South Africans living with HIV, the highest number of people in any country.
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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]”.
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