Sperm washing may no longer be necessary according to new NICE guidelinesback to top
22nd May 2012
Updated guidelines on fertility treatment in the UK drafted by the National Institute for Health and Clinical Excellence (NICE), state that sperm washing may no longer be necessary for serodiscordant couples where the male partner is HIV positive. The new guidelines specify that an HIV positive man can have unprotected sex with his HIV negative partner in order to conceive, providing he adheres to treatment, has an undetectable viral load, is free of other infections, and limits sexual intercourse to ovulation.
The update reflects research from a number of studies that have been published since the original NICE guidelines were issued in 2004, showing that an HIV positive person on antiretroviral treatment with an undetectable viral load has a very low risk of transmitting HIV to someone else. As a result, NICE states that "sperm washing may not further reduce the risk of infection and may reduce the likelihood of pregnancy." Sperm washing is a process used to prevent HIV transmission from an HIV positive man to his partner during conception. It involves separating sperm cells from seminal fluid, testing these cells for HIV, then inserting the cells into the woman's womb (intrauterine insemination), or directly into the egg (in vitro fertilisation or intracytoplasmic sperm injection).
Advances in research and treatment options means that serodiscordant couples can dramatically reduce the risk of transmitting HIV to their partner, and to their child. Therefore, serodiscordant couples should be afforded the same fertility treatment options as HIV negative couples.
Source:NICE
UN campaign launched to end new infections among childrenback to top
14th May 2012
UNAIDS, the UN agency with an HIV and AIDS mandate, has recently launched a global action campaign entitled ‘Believe it. Do it’ to raise awareness of the goal to end HIV infection in children. It also focuses on mothers living with HIV to ensure they stay healthy – an estimated 42,000 women living with HIV die from complications related to the virus and pregnancy each year. The campaign is part of a global commitment by world leaders that was made at a UN High Level Meeting in June 2011 to end new HIV infections among children by 2015.
At the end of 2010, there were 3.4 million children living with HIV around the world and an estimated 390,000 children became newly infected with HIV in that year alone. Nine out of ten children infected with HIV were infected through their mother either during pregnancy, labour and delivery or breastfeeding, highlighting the urgent need to increase coverage of prevention of mother to child transmission (PMTCT) services. Almost 90% of children living with HIV/AIDS live in Sub-Saharan Africa, the region of the world where AIDS has taken its greatest toll.
The UNAIDS campaign has three main objectives to engage the public and encourage them to act on this issue: to raise awareness about the facts about ending new HIV infections among children, to send a message about the issue and the actions people can take, and to develop public support for mothers through organisations working with families.
Source:UN News Centre
FDA Advisory Committee recommends use of PrEP in USback to top
11th May 2012
The Food and Drug Adminstration (FDA) advisory panel has recommended the antiretroviral drug, Truvada, be used for the prevention of HIV infection among at risk groups in the US. These include men who have sex with men (MSM) and serodiscordant couples (couples where one partner is living with HIV). These are only recommendations at this point, a final decision for the approval of Truvada will be made by the FDA on 15 June 2012. Truvada is a pre-exposure prophylaxis (PrEP) drug, which would be provided to people who are not infected with HIV, but are considered at risk of exposure to the virus.
While the use of such a drug would have potential to reduce the number of new HIV infections, there are other considerations that must be factored in. The use of PrEP has been met with some resistance by healthcare professionals and HIV activists, who believe that use of PrEP in this way may give rise to complacency, an increase in risky sexual behaviour and a false perception about an AIDS cure. In addition, the drug is expensive and will come with accessibility challenges, particularly for at risk groups who may already experience problems accessing HIV services. Reliance on such a drug could also lead to drug resistance, particularly if people are not 100% adherent.
If used in the correct way and under the right circumstances PrEP as an HIV prevention method could be effective, but should be used in conjunction with other HIV prevention methods, such as condoms. It is important to remember that there is no cure or vaccine for HIV and that no one strategy can single-handedly stop the HIV epidemic - a comprehensive approach to HIV prevention is needed.
Source:BBC
Global Fund announces additional $1.6 billion funding for 2012-2014back to top
10th May 2012
Good news from the Global Fund to Fight AIDS, Tuberculosis and Malaria, who have announced that an estimated $1.6 billion additional funds will be available for the 2012-2014 period. In November 2011, the Global Fund announced that their 11th round of funding would be cut and replaced by an emergency transitional funding mechanism (TFM) to support essential services for existing recipients only. The move was taken due to a lack of funding and new grants had been effectively frozen until 2014. The Global Fund is the largest funding mechanism for HIV and AIDS interventions, and the impact of Round 11 cuts has been felt around the world.
The availability of additional funds is believed to be the result of renewed confidence in the Global Fund following its commitment to restructuring the organisation to improve its performance. New donations have been received from some countries and private donors, and others have brought forward their pledges to fill the funding gap. In addition, certain countries have volunteered to give up funds to benefit others with a more urgent need.
While the level of funds available is subject to final confirmation, particularly as the grant requests under the TFM are still being assessed, this is positive news for countries who had been reliant on Round 11 to fund their national responses to HIV and AIDS.
To learn more about the Global Fund, have a look at our dedicated page.
Source:Global Fund
UN SG urges countries to step-up response to the AIDS epidemic back to top
2nd May 2012
A report on HIV and AIDS released by UN Secretary-General Ban Ki-moon has declared that efforts to curb the global AIDS epidemic need to be strengthened and refocused in order to meet targets set out at last year’s High Level Meeting on AIDS. It is his first report since the meeting, and it urges countries to step up to their original commitments and shift their perception away from aid as charity, to aid as a ‘smart investment’.
The Political Declaration on HIV/AIDS: Intensifying our Efforts to Eliminate HIV/AIDS was agreed at a High Level Meeting in June 2011, which brought together government and civil society representatives from across the globe. It outlined bold targets for 2015, including halving new HIV infections in adults; eliminating mother-to-child-transmission; halving HIV infections in injecting drug users (IDUs); halving TB deaths in people living with HIV; and committing to reaching 15 million people living with HIV with antiretroviral treatment.
The Secretary-General states that whilst significant gains have been made in the past year, “the current response is unlikely to result in the ambitious 2015 targets being reached,” and that “the response must be smarter and more strategic, streamlined, efficient and grounded in human rights.”
At country level, there has been an inadequate focus on HIV prevention aimed at high-risk groups, including IDUs, men who have sex with men, and sex workers. Nations should identify the barriers to access of HIV prevention, treatment and care services, including stigma and discrimination, and gender inequalities; with legal and policy frameworks being reviewed to ensure that these gaps are filled. He also highlighted the need for a new approach to HIV investment and funding, projecting that an additional $8 billion is needed to reach the 2015 target. He implored donor governments to step-up to their original commitments, however emphasised a shared responsibility on the part of emerging economies and affected countries as well, so to ensure a sustainable response.
Source:
East Africa regional HIV Bill - human rights not criminalisationback to top
1st May 2012
The recently passed East Africa Community HIV and AIDS Prevention and Management Bill aims to harmonise HIV prevention and treatment policy across the region. The Bill has a human rights focus with a view to protecting the rights of people living with HIV, and is being celebrated by activists as it does not criminalise the deliberate transmission of HIV.
Criminal transmission of HIV is hotly debated and is often seen to violate the rights of people living with HIV and increase stigma. However, the criminalisation of intentional HIV transmission is a complex issue. While at first glance it might seem obvious to prosecute someone for recklessly or intentionally infecting another with a virus such as HIV, this assumption, and its consequences, can present numerous problems. You can read more about the issues surrounding the criminalisation debate on our dedicated page.
In East Africa, the new Bill is being seen as a positive step towards a regional response to the HIV epidemic, promoting regional collaboration and ensuring the provision of healthcare regardless of HIV status. It is hoped that the human rights approach adopted will provide a blueprint for national level legislation.
Source:Plus News
$1.46 billion in PEPFAR funds for country programmes withheldback to top
30th Apr 2012
AIDS activists are alarmed that an estimated $1.46 billion of PEPFAR funds earmarked for national AIDS programmes, are being withheld by the US government after country disbursements remained unspent for periods of up to 18 months or more. The US Global AIDS Coordinator, Ambassador Eric Goosby, stated that the funds remained unspent largely due to ‘inefficient bureaucracies’ and declining costs in HIV treatment. Countries such as Kenya, Zambia, Tanzania and Mozambique, to name a few, will loose out on tens of millions of dollars in vital funds to fight their AIDS epidemic, as the stagnant funds will likely be moved towards other programmes.
Kenya is set to be the biggest loser, with $502 million in unspent funds, which activists state will severely hamper efforts to put one million Kenyans on antiretroviral (ARV) treatment by 2015, as pledged by the government last year. Acting head of the Kenyan National AIDS and STI Control Programme (NASCOP), Peter Cherutich, stated that the government were surprised to hear of the unspent funds, and that they will begin a dialogue with the US government for the “urgent release of the funds.” Inefficiencies in Kenya’s two health ministries have been blamed for Kenya’s inability to spend the money in time.
Ambassador Goosby admitted that the unspent funds were a contributing factor to the $550 million reduction in the US global AIDS programme budget for the 2013 fiscal year, an 11% reduction on the previous fiscal year. The US are hoping to counteract this by increasing their contribution to the Global Fund by 57% this year. Yet if the budgets are approved as is, this will equate to an overall decrease in HIV and AIDS funding by the US for the coming year.
Whilst the production of generic ARVs has meant that the cost of treatment has indeed decreased in Kenya, meeting the government's goal is still a long way off. Current WHO and UNAIDS estimates state that 432,600 Kenyans were on treatment in 2010, with an estimated ARV coverage of 61%. Reclaiming these PEPFAR funds will help Kenya on the road to universal access.
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New York appeals court to re-hear HIV criminalisation caseback to top
27th Apr 2012
New York’s top court will re-hear a case of an HIV positive man imprisoned for aggravated assault, after his saliva was deemed to be a ‘dangerous instrument’ by a local county district judge. David Plunkett was jailed in 2007 for ten years after an altercation with police officers where he allegedly bit one of them. The appeal will review whether or not saliva can be considered a ‘dangerous instrument’, and if successful, Mr. Plunkett’s sentence will be reduced.
The original sentencing displays a lack of knowledge of HIV and HIV transmission. Viruses such as HIV are transmitted by body fluids, such as blood and semen. Whilst saliva does contain HIV, the virus is only present in very small quantities and as such has never been known to cause HIV infection. Lambda Legal, a US legal support group for lesbians, gays and people living with HIV, condemned the original conviction, stating that not only was the evidence flawed, it also fuels a culture of stigma and discrimination towards people living with HIV in the United States.
There are an increasing number of cases where individuals have been criminalised because of their HIV positive status. Whilst this is both a moral and practical minefield, judicial decisons should be made on correct scientific evidence and common sense.
Source:Alert Net
Sexual violence, witchcraft and HIV in Papua New Guinea back to top
23rd Apr 2012
Women in the island nation of Papua New Guinea in the Pacific Ocean are facing increased risk of HIV infection, with estimates predicting that over half a million people will be living with HIV by 2025 if nothing is done to curb the epidemic. Papua New Guinea has the highest rate of HIV in the region, where an estimated 30,000 people are living with HIV, 59% of whom are women. Violence against women and a strong cultural belief in witchcraft are being cited by health experts as exacerbating factors, which are considerably increasing the vulnerability of women to the virus.
Gender-based violence in Papua New Guinea is commonplace with an estimated 70% of women reported to have been abused by their husbands. Gender inequality is considered a major driver of the HIV epidemic, particularly as polygamy and the practice of men having multiple sexual partners are culturally accepted. Witchcraft and magic are also widely practiced in rural areas, with women being six times more likely to be accused of witchcraft than men. This is often used to justify violence against women, and to accuse them of spreading HIV.
The HIV and AIDS epidemic has had a unique impact on women across the world, which has been exacerbated by their role within society and their biological vulnerability to HIV infection. Generally women are at a greater risk of heterosexual transmission of HIV. Biologically women are two times more likely to become infected with HIV through unprotected heterosexual intercourse than men. In many countries women are less likely to be able to negotiate condom use and are more likely to be subjected to non-consensual sex.
Source:PlusNews
New WHO guidelines recommend increased HIV testing and treatment for couplesback to top
20th Apr 2012
New guidelines published by the World Health Organisation (WHO) recommend increased uptake of couples HIV testing and counselling (CHTC), and the provision of antiretroviral (ARV) treatment to all HIV positive partners in serodiscordant relationships (where only one partner is living with HIV). It is hoped that these guidelines will help avert new HIV infections by making people aware of their status, facilitate mutual disclosure, and enable access to HIV treatment and prevention options.
The guidelines state that knowledge of one’s HIV status is low in middle and low-income countries, with reported high levels of HIV transmission between partners in stable relationships. Giving couples the opportunity to test together will ensure status disclosure in a safe environment with councellor support; mutual disclosure will also ensure that preventative measures are taken to reduce risk of HIV exposure for their partner. The guidelines also recommend starting ARV treatment for all people living with HIV and in a serodiscordant relationship, regardless of their CD4 count, so to prevent transmitting HIV to their partner. For more information, see our page on treatment as prevention.
It is estimated that half of people living with HIV have a long-term sexual relationship with an HIV negative partner. Yet there has been limited guidance on the issue, despite the obvious personal and public health benefits. UNAIDS Executive Director Michel Sidibé, has praised the guidelines stating that “this development begins a new era of HIV prevention dialogue and hope among couples.” It is hoped that the guidelines will facilitate testing, treatment and support, and will decrease vulnerability to HIV infection for many people.
Source:
HIV testing and treatment scale-up in South Africaback to top
17th Apr 2012
South Africa is gearing up to meet ambitious HIV testing and treatment targets set out in its new National Strategic Plan (NSP) for HIV, STIs and tuberculosis (TB) 2012-2016 launched on 1st April 2012. The country has committed to reducing new HIV infections by at least 50%; to start at least 80% of eligible patients on antiretroviral (ARV) treatment; to reduce the number of new TB infections and deaths by 50%; to ensure a legal framework that protects and promotes human rights to support implementation of the plan; and to reduce self-reported stigma related to HIV and TB by at least 50%.
In Gauteng province the Department of Health has committed to test 3 million people for HIV and put an additional 1 million people on life-saving treatment in the next year alone. A counseling and testing campaign launched in 2010 will be the basis for HIV and TB testing in the region, with a view to reducing deaths through early diagnosis. HIV prevention to reduce new infections continues to be the underlying thrust of interventions in the province and the country as a whole.
An estimated 5.6 million people were living with HIV and AIDS in South Africa in 2009, the highest number of people in any country. In the same year, it is estimated that 310,000 South Africans died of AIDS-related causes, reflecting the huge number of lives that the country has lost to AIDS over the last three decades. TB is the leading cause of death in South Africa and an estimated 482,000 people are living with TB, 70% of whom are co-infected with HIV. While many challenges lie ahead the country is confident about taking control of the HIV/AIDS and TB epidemics and meeting the targets of the new NSP by 2016.
Source:
Report recommends opening further safer injection facilities in Canadaback to top
13th Apr 2012
A report published this week has renewed the debate regarding safer injection facilities (SIFs) in Canada. The Toronto and Ottawa Supervised Consumption Assessment (TOSCA) report recommends SIFs be opened in the cities of Ottawa and Toronto, where HIV prevalence among injecting drug users (IDUs) are 11% and 4% respectively, and Hepatitis C prevalence is significantly higher. They estimated that there are currently 9,000 IDUs in the two cities, and that the facilities will help avert new hepatitis and HIV infections, save lives, and be cost effective.
SIF is a harm reduction measure, providing an environment where drug users can inject in a safer manner and under medical supervision. They also aim to offer drug education and referral for treatment, reduce public disorder issues and risks associated with injecting drug use, such as large congregations of injectors in public places and litter, particularly syringes. They are also considered to be cost effective, given the cost of an HIV infected individual to the health care system over their lifetime.
Vancouver, Canada, is currently home to the only SIF in North America, Insite. It has experienced repeated threats of closure from the conservative Canadian government, who are morally opposed to the idea. Yet Canada’s Supreme Court upheld their right to remain open on the grounds of the constitutional and human rights of IDUs. There has been mixed views regarding the opening of SIFs in the cities, yet advocates state that the philosophical debate should be put to the side, so as to fully consider the public health benefits over the long run.
Source:Huffington Post
Children missing in the fight against HIV in Nepalback to top
5th Apr 2012
Civil society in Nepal have expressed concern that children affected by and infected with HIV and AIDS in the country have been neglected by the government. Whilst many children might be getting the antiretroviral treatment (ARVs) that they need, there is a lack of care and support services to really help these children and their families through the challenges of living with HIV.
Most children living with HIV in Nepal were infected via mother-to-child transmission. Accessing prevention of mother-child-transmission (PMTCT) services is a challenge, especially in rural populations where distance and a rugged geographical terrain are major barriers to HIV testing and HIV prevention services. Stigma and discrimination is also a major obstacle for Nepal, and children can be especially vulnerable to this because of social exclusion.
National statistics show that there are currently around 5,000 children living with HIV in Nepal. Yet NGOs and health professionals are worried that this number could be larger. Deepa Bohara, an AIDS activist and coordinator for a local NGO stated, "there could be many more orphans and children living with HIV, but the government of Nepal has failed to pay any attention to their plight. Supplying medicines is not enough." Due to limited funding, his services can only offer ARVs, and no support for schooling or counselling. In a country where the HIV and AIDS epidemic is concentrated largely among sex workers and injecting drug users, steps need to be taken to ensure that children are not neglected in the fight against HIV in Nepal.
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New regulatory framework for medicines in East Africa launchedback to top
4th Apr 2012
A new regulatory framework to improve access to essential medicines in East Africa was launched last week in Tanzania by the East African Community (EAC). The Medicines Registration Harmonisation Project will ensure improved access to safe and high-quality medicines in the region, and improve efficiency in getting these medicines to those who need it most. Dr Richard Sezibera, Secretary General of the EAC stated, “the programme we are launching here today will put in place a uniform and standardized medicines regulatory framework for both good health outcomes and economic gains.”
UNAIDS Deputy Executive Director, Dr Paul De Lay praised the move, stating that a regional regulatory agency “would allow faster roll out of drugs, stronger quality assurance, greater public confidence and the enhancement of African ownership of a sustainable AIDS response.” According to UNAIDS, for the 5 million people living in Africa on antiretroviral drugs (ARVs), currently 80% of these are sourced from abroad, with most countries relying heavily on external funding. It is hoped that this framework will encourage local production of ARVs and other essential medicines, reducing their dependence on external sources.
The project is in partnership with the World Bank, the Bill and Melinda Gates Foundation, the UK Department for International Development and the Clinton Health Access Initiative. It has been lauded as the first step in the creation of a broader African Regulatory Harmonisation Programme, with the goal of increasing Africa’s ownership of their own public health and development agendas.
Source:UNAIDS
New US guidelines recommend treatment for all people infected with HIV back to top
2nd Apr 2012
The United States Department of Health and Human Services (DHHS) have updated their HIV treatment guidelines, recommending all people living with HIV in the US to begin antiretroviral treatment (ART). Previous guidelines only recommended treatment for those whose CD4 count was below 350 cells/mm3. The guidelines have since been expanded with special emphasis on initiating treatment to people with a CD4 count below 500 cells/mm3.
The guidelines also include a new section on HIV and older people, recommending that all people over 50 and living with HIV start treatment, regardless of CD4 count. Over 50’s are at an increased risk of non-AIDS related problems and other co-morbidities, and thus would benefit from an immediate initiation of treatment. The guidelines also recommend increased monitoring for this group.
These updates are in response to a mounting body of evidence demonstrating the benefits of early initiation of ART. Not only does it prove to reduce mortality and AIDS-related morbidity, it is also increasingly proven to reduce the risk of HIV transmission, giving reference to the treatment as prevention debate. Regardless, the guidelines also emphasise "the willingness and readiness of the patient to initiate therapy, and the availability of resources," when deciding on commencing treatment.
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