Turned away for treatment

The growth in US funding, which currently underwrites almost half of the world's AIDS relief, has slowed dramatically. At the same time the number of people requiring treatment has rocketed.

In Uganda, lauded for its early response to HIV, there has been an upturn in the rate of infection. The US currently meets about 70% of Uganda's HIV prevention and treatment costs but as the funding dries up waiting lists for treatment grow. Kampala's Joint Clinical Research Centre, founded in 1991 as a national AIDS research centre, is one of the largest providers of antiretroviral treatment in the world but is routinely having to turn new clients away.

Click here to learn more about universal access

 (Source: Wall Street Journal accessed 28/01/10)

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Haiti earthquake aftermath

The Global Fund to Fight AIDS, Tuberculosis and Malaria has announced, in common with other NGOs, that they are focussing resources in Haiti on efforts to ensure that people with HIV and AIDS continue to access vital drugs.

Haiti has the highest HIV infection rate outside Southern Africa. 36,000 people currently receive antiretroviral treatment (ART).

The Global Fund has pledged emergency funding of USD 800,000 to guarantee supply of ART for the next 6 months.

For an overview of HIV in Haiti please see AVERTs page on AIDS in the Caribbean.

 Source: Global Fund Accessed 26/01/10)

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Do ask, do tell!

President Obama has confirmed that he intends to work with Congress and the US military to repeal the law that denies openly gay Americans the right to serve in the armed forces. The announcement, repeating statements made in his election campaign, was made in the President's first state of the union address. The "don't ask, don't tell" law has been in place since 1993.

 (Source: The White House Accessed 27/01/10)

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Experimental drug fails late stage testing

The experimental HIV treatment vicriviroc has failed two Phase III clinical trials. Merck and Co, vicriviroc's developer, has told shareholders that it will not seek FDA approval for the drug “at this time”.

Testing to date has been on treatment-experienced patients. Merck will continue to trial the drug on treatment-naïve individuals.

Vicriviroc belongs to a new class of antiretrovirals called chemokine co-receptor 5 (CCR5) inhibitors.

(Source: Reuters Accessed 20/01/10)

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Glaxo to reveal anti-malaria secrets

Glaxo-SmithKline (GSK) has announced that they are to release details of 13,500 anti-malaria compounds into the public domain.

Andrew Witty, GSK CEO, suggests sharing what he calls the ‘open lab’ with the wider community of scientists and researchers demonstrates social responsibility alongside the need to give shareholder value.

More than 1 million children a year in sub-Saharan Africa die of malaria and the actions of GSK in this regard should be cautiously applauded. AVERT notes, however, that GSK has so far shown reluctance to join UNITAID’s patent pool to widen access to affordable HIV treatments.

(Source: The Guardian accessed 20/01/10)

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US travel ban lifted- at last!

Following the announcement on 30 October 2009 and after the routine 60 day waiting period, the US travel ban restricting entry of persons with HIV and AIDS has been removed. President Obama announced the policy was to be repealed following consultation with experts and the public.

Prior to the final rule being lifted entrants to the US with HIV were considered to have a "communicable disease of public health significance" and denied entry on the sole basis of their HIV status, per the Immigration and Nationality Act. Persons will not be required to undergo HIV testing as part of the medical examination demanded of migrants to the US.

AVERT welcomes this significant development which removes infamous discrimination in place since 1987. It is to be hoped that the remaining countries with similar bans will follow this lead.

(source: Immigration Equality and BBC accessed: 04.01.10) 

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Ugandan Bill threatens progress on HIV

MPs in Uganda's Parliament will today debate the "HIV and AIDS Prevention and Control Bill," which, amongst other things, proposes the death sentence for homosexual sex under certain conditions.  Under the Bill, "same sex attraction is not an innate and immutable characteristic" and as such it is punishable under law to engage in homosexual behaviour.

Alongside the repressive measures for homosexuals, it calls for mandatory testing for HIV and forced disclosure of HIV status. It also criminalises the willful transmission of HIV, the failure to "observe instructions on prevention and treatment," and misleading statements on preventing or controlling HIV. It is feared the bill will blame women for mother-to-child transmission of HIV rather then targeting the problem of treatment shortages.

This proposed bill has many areas of concern and shows a step backwards for Uganda - from the successful policies of the 1990s that brought the HIV rate under control, to a situation that will effectively discriminate against marginalised groups, such as homosexuals. It is hoped that Uganda will respond to widespread international criticism and not allow the Bill to progress further with the current discriminatory measures. 

 (Sources The Time Online and Human Rights Watch accessed 18.12.09)

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Former SA Minister of Health dies

The former South African Minister of Health Manto Tshbalala-Msimang has died at the age of 69 from liver disease. Her death comes as South Africa moves away from its HIV denialist past of which the former health minister was a leading participant.

Dr. Tshabalala-Msimang will leave a mixed legacy to those in South Africa. She was a leading member of the ANC and passionately promoted gender equality within the party but she was also an outspoken denialist of HIV.  Alongside former President Thabo Mbeki she denied millions the ability to access vital HIV medication (ARVs) and instead promoted dangerous alternative remedies. She will be remembered as 'Dr Beetroot' for one such alternative remedy but olive oil, lemon, and potatoes were also recommended as potential 'medicine'. During the denialist period, it is estimated that 330,000 people died between 2000-2005 because they did not have access to treatment.

AVERT wishes to convey their condolences to Dr. Tshablalala-Msimang's family, children and friends. However, it is hoped that Dr. Tshablalala-Msimang's actions will not leave a lasting legacy and that President Zuma continues the encouraging overhaul of the Government's HIV policy.

(Sources BBC and Sowetan accessed 17.12.09)

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Study results show that PRO 2000 microbicide is ineffective

Results from the PRO 2000 microbicide study have shown the gel has failed to protect against HIV. The results are from the largest microbicide study to date and it was hoped the data would be more promising than previous studies.

An earlier trial of the gel showed that PRO 2000 had reduced the risk of HIV infection by around 30% but the true effectiveness was not clear. At the time many reports had been optimistic about the trial, even though the results had not been statistically significant.

The MDP said today that today's results "demonstrates conclusively that PRO 2000 was not effective in preventing HIV infection". Of the 3,156 women who were given the PRO 2000 microbicide, 130 became infected with HIV, while 123 of the 3,112 women given the placebo gel become infected with the virus.

The need to develop a microbicide that shows a significant level of protection is vitally needed. Women are often unable to negotiate condom use and the idea of a microbicide is popular. However, there still remains the need for additional methods of reducing the risk of infection and while set backs have been suffered to previous trials, hopefully positive results will be seen in the future.

For more information regarding microbicides go to AVERT's page on Microbicides.

(Source AIDSmap and Microbicides Development Programme accessed 14.12.09) 

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Man injects wife with HIV-infected blood

A 35- year old HIV positive man has injected his wife with his blood in order to deliberately infect her with HIV. The couple are reported to have been experiencing relationship problems after it was discovered that he was HIV positive in 2004. While the couple decided to stay together for the children, the wife was scared of having sex with her husband for fear of contracting HIV.  

It is reported that the man twice pricked his wife with a sewing needle tainted with his blood. After noticing a sting-like mark on her thigh, the wife became suspicious. Later, she saw her husband handling a syringe of blood. During a routine check-up it became apparent that the wife had become infected with HIV. After she confronted her husband, he admitted to pricking her with an infected needle. The husband has been charged with deliberately infecting his wife with the virus and if convicted he can face up to 14 years in prison.

This case is highly unusual as most people living with HIV try to prevent transmission to anyone else. Transmission through blood is a more effective method than unprotected sex and this explains why the wife was infected so quickly. The case is tragic in its consequences and highlights the need for continued support when diagnosed with HIV.

(Source: BBC and Sydney Sunday Herald accessed 07.12.09)

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South Africa to expand treatment for HIV positive pregnant women and babies

On World AIDS Day, South African President Jacob Zuma announces that all HIV positive pregnant women and HIV/TB co-infected patients with CD4 counts below 350 cells/mm³ will receive treatment. Children under the age of 1 year will also receive treatment.

Working on the recommendations announced by the World Health Organisation, pregnant women and TB patients will receive access to treatment at an early stage of their HIV infection. Previously, people living with HIV have only been able to receive treatment if their CD4 counts were at 200 cells/mm³. Usually, this would not be soon enough to prevent a person from developing opportunistic infections.

While WHO recommendations stated that all people living with HIV with a CD4 count of below 350 cells/mm³ should receive treatment, South Africa has chosen to prioritise groups. This compromise is designed to target treatment to the groups where treatment may have the greatest impact of limiting new infections.

However, it could be a sign of difficult decisions that have to be made in situations where resources are limited. South Africa has not explained how this treatment expansion will be funded or how many more people will need access to treatment.

If Universal Access is to be achieved difficult decisions will need to be made and without a continued emphasis on prevention more decisions will have to be made.

For more about improving access to prevention, treatment and care, see our Universal Access video, produced for World AIDS Day.

(Source: AIDSmap accessed 01.12.09)

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WHO abandons old recommendations on exclusive breast-feeding and HIV

Long overdue recommendations for preventing mother-to-child transmission (PMTCT) have been released today by the WHO with radical changes to old guidelines.

Last updated in 2006, WHO recommended that HIV-positive women should receive treatment from their 28th week of pregnancy but no firm guidelines were offered for feeding options for their infants, except exclusive breastfeeding until 6 months. Now, clear recommendations have been offered. HIV-positive mothers should exclusively breastfeed their infants for the first 6 months of life, followed by complementary foods and breastmilk until 12 months old. The guidelines intend to make breastfeeding safer through providing ART to either mother or infant. If formula is available, this would be recommended instead of breastfeeding.

Access to antiretroviral drugs (ARVs) is at the heart of the new PMTCT recommendations with complex regimens being promoted to stop infants becoming infected. In the 2006 guidelines, treatment was recommended for HIV-positive mothers from 28 weeks and not during the breastfeeding period. Now, women are recommended to start treatment at 14 weeks of pregnancy and continue until the end of the breastfeeding period. This could potentially mean HIV-positive mothers will receive a year’s worth of ARVs for the benefit of their infant, when they otherwise would not necessarily require the drugs.

Other recommendations made are that all patients should start ART when their CD4 counts are at 350 cells/mm³ regardless of whether they show symptoms. There should be a phase out of the ARV, stavudine (d4T), widely used in low- and middle-income countries, due to its long-term, irreversible side effects.

To implement these recommendations there must be a radical scale-up of treatment availability and PMTCT services. This will prove difficult in resource-limited countries where limited human and financial resources hamper HIV prevention, treatment and care programmes.

For more about improving access to prevention, treatment and care, see our Universal Access video, produced for World AIDS Day.

(WHO Press Release accessed on 30.11.09)

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Decade has seen significant decline in new HIV infections

Global HIV infection rates and AIDS-related deaths have dropped significantly in recent years, according to a new UNAIDS report. The number of new infections has dropped by 17% since 2001, and thanks to increased availability of HIV drugs, deaths have declined by 10% over the past five years.

Some of the most encouraging signs come from sub-Saharan Africa where 400,000 fewer people were infected last year than at the start of the decade. East Asia has also seen a dramatic 25% decrease in annual infections between 2001 and 2008.

The success of prevention programmes is contributing to these trends. However, Executive Director of UNAIDS, Michel Sidibé believes there is room for improvement: “[I]f we do a better job of getting resources and programmes to where they will make most impact, quicker progress can be made and more lives saved.”
 
The 2009 AIDS Epidemic Update also highlights that great progress has been made in tackling HIV where prevention and treatment programmes are integrated with other areas of health and social welfare. Calling for an end to AIDS being dealt with in isolation, Sidibé said: “Already research models are showing that HIV may have a significant impact on maternal mortality. Half of all maternal deaths in Botswana and South Africa are due to HIV. This tells us that we must work for a unified health approach bringing maternal and child health and HIV programmes as well as tuberculosis programmes together to work to achieve their common goal.”

It is encouraging that progress is being made to combat the HIV and AIDS epidemic but the momentum needs to continue. The response must also adapt to the changing patterns of HIV infection. According to the report, in Eastern Europe and Central Asia, the epidemic is spreading from injecting drug users, who are the majority of affected people, to their sexual partners. In parts of Asia where sex work and drug use were the drivers of the epidemic, heterosexual couples are becoming increasingly affected.

Improving access to treatment and care is vital in order to support the more than 33 million people living with HIV worldwide, and greater prevention efforts are needed to suppress the infection rate even further.

 Source: UNAIDS accessed 24/11/09

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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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