New data reveal that HIV incidence in the USA is 40 percent higher than previously thought

 Improved surveillance methods show that HIV incidence in the USA is 40% higher than previously estimated, according to the US Centers for Disease Control and Prevention (CDC), in a study released at the XVII International AIDS Conference in Mexico City this week.

 The new statistics were produced using more precise methods for estimating annual HIV incidence, or the number of people who become newly infected with HIV in a given year. They show that 56,300 HIV infections occurred in the United States in 2006 (the most recent year for which data are available), compared to the previous estimate of 40,000.

The CDC’s previous HIV incidence estimate was based only on reported HIV diagnoses, which can give a misleading picture of the epidemic as some people are tested years after they become infected with HIV. The new method for measuring HIV infection involves a laboratory test that can distinguish recent from long-standing HIV infections. 

Dr Kevin Fenton of the CDC, said, “The new estimate does not represent an actual increase in the number of new infections, but reflects our ability to more precisely measure HIV incidence and secure a better understanding of the epidemic.”

The new surveillance system also shows that the impact of HIV remains greatest among certain groups such as men who have sex with men, who accounted for 53 percent of new infections; and rates of HIV among African American communities were found to be 7 times higher than among whites.

“Unfortunately we are far from winning the battle against this preventable disease,” said Julie Gerberding of the CDC. “We as a nation have to come together to focus our efforts on expanding the prevention programs we know are effective.”

AVERT has more about HIV/AIDS in America.

 (CDC Press release, 03/08/08)

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UNAIDS release new global AIDS report

The new UNAIDS 2008 biannual report shows the number of people living with HIV has stabilised at around 33 million people. The stabilisation is partly credited to the success of HIV prevention programmes. Yet the number of people living with HIV is still at an unacceptably high level, with women facing a higher risk of infection than men, especially in many African countries.

Whilst a number of countries have seen a decline in the number of new HIV infections, rates are rising in many areas including Kenya, Mozambique, China, Indonesia, Vietnam, Papua New Guinea, Russia and Ukraine. In developed countries such as Britain, Germany and Australia the incidence of infection is also increasing.

HIV is predominantly spread by heterosexual intercourse within Africa, whereas outside Africa the main routes of transmission remain amongst MSM, sex workers and intravenous drug users.

In the report UNAIDS Executive Director Dr Peter Piot highlights the evidence that HIV prevention programmes have played a vital role in the stabilisation of the epidemic. However, he emphasises that this stabilisation is not a signal to start celebrating. Dr Piot says that these short-term gains in prevention

"should serve as a platform for reinvigorating combination HIV prevention and treatment efforts and not spur complacency."

Some have recently criticised UNAIDS for its exceptional approach to AIDS and the vast amount of money it says is needed to fight the epidemic. Yet it is clear from this report that efforts to combat AIDS can prove very effective, and much may be gained by intensifying these initiatives.

For more information see AVERT's Introduction to the AIDS epidemic page.

(IRIN 30/07/08)

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PEPFAR to be reauthorised

The US House of Representatives has voted in approval of the reauthorisation of PEPFAR. The bill will now be passed on to President Bush to sign.

The global AIDS bill, which passed by 303-115 votes in the House, will more than triple the current $ 15 billion funding over five years. There was some worry that the House would not be in agreement with the Democratic-led Senate version of the bill but after some compromise and co-operation between the two divisions of Congress the Senate bill was approved.

Some of the key parts to the bill will:

• Approve $ 48 billion over the next five years for HIV/AIDS, tuberculosis and malaria programs in Africa and other afflicted areas of the world. It will also approve $ 2 billion for American Indian health, water and law enforcement programs.
• Stipulate that 10 percent of funds are allocated for orphans and vulnerable children.
• Stipulate that "more than half" of funding for AIDS programs go for treatment and care.
• Reverse a current law preventing HIV-infected people from receiving visas to come to the United States as immigrants, student or tourists.

The bill has repealed the earmark requiring 1/3 of HIV prevention funds to be spent on abstinence programmes; countries now need to spend only 50% of funds for the prevention of the sexual transmission of HIV on abstinence and faithfulness programmes. Those who do not comply with this stipulation will have to report to Congress, thus facing the potential risk of having their funding removed.

There are some significant goals in the bill including:

• The prevention of 12 million new HIV infections.
• Treating more than 2 million people.
• Supporting care for 12 million people infected with or affected by HIV/AIDS, including 5 million orphans and children.
• Training at least 140,000 new health care workers and paraprofessionals.

With more than half of funding going on treatment and care, AVERT is calling for there to be an increased focus on home-based care, as the issue of home-based care is one that is often neglected. For more on this read the news article below.

Update 31/07/08: Bush has now signed the PEPFAR reauthorization legislation which will make it into law.

(Associated Press, 25/07/08)

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Carers becoming infected in AIDS home-based care crisis in South Africa

Efforts to provide care and support for those dying of AIDS in South Africa are being undermined by cases of carers themselves becoming infected with HIV, due to a lack of both education and basic resources.

“With carers becoming infected, and people dying of AIDS on cold rotten mattresses, we are facing a crisis in home based care in parts of South Africa”, says Annabel Kanabus, Director of AVERT, having recently returned from visiting South Africa’s KwaZulu Natal and Eastern Cape provinces.

As the American PEPFAR initiative is about to be reauthorized, the international AIDS charity AVERT is calling for sufficient money and effort to be provided for home based care alongside the more high profile areas of HIV/AIDS work, such as providing antiretroviral treatment for HIV.

In South Africa, many rural hospitals are in danger of being overwhelmed by the number of patients. Overstretched health care professionals lack the time and resources to help communities provide care for those who can’t access ARV drugs, or who are failing on their treatment. It is these people who urgently need care at home. 

One of the major problems is that carers are not being provided with the necessary education or basic supplies to protect themselves from becoming infected with HIV. Simply using gloves would protect many carers from infection through repeated contact with infected body fluids. AVERT is aware of cases where carers have been reduced to ripping up strips of plastic bin bags and winding them around their hands to try to prevent HIV infection.

Additional supplies such as plastic sheeting would also improve the quality of life for those dying. People in the late stages of AIDS will often be incredibly weak, bed-bound and perhaps be suffering from diarrhoea and unable to reach a latrine. Simple resources such as plastic sheeting and adult diapers (provided that someone is available to change them) would help to restore the dignity of those suffering in this way.

Contact AVERT about this story.

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Landmark Swiss AIDS case rules HIV testing irrelevant to criminal transmission

On 30th June this year the Swiss federal court found a man guilty of criminal HIV transmission even though he had not been tested for HIV at the time of having unprotected sex.

The man in question was convicted in 2005 by Zurich District court after having unprotected sex with a woman who was later diagnosed HIV positive. The man had a history of unprotected sex, but had not taken an HIV test before having sex with her, and did not seek one based on the knowledge of her HIV status. Furthermore, he had been aware of the HIV positive diagnosis of another previous partner since 2000.

The court concluded that the defendant had reasonable grounds to suspect that he might be infected with HIV, and found him guilty under both criminal and public health law, which both cover HIV transmission. Article 122 of the Swiss penal code states that “anyone who causes intentionally another grievous injury to a human being’s body” is liable for punishment; and Article 231 allows prosecution by the police of “anyone who intentionally spreads a dangerous transmittable human disease”.

The man won an appeal to the Zurich Cantonal Court against the conviction in 2007, however the 2008 ruling effectively reverses the outcome of that appeal.

Switzerland has particularly severe laws against criminal HIV transmission. The country’s first prosecution for HIV transmission was brought in 1988, and since then over 30 people have been prosecuted for HIV transmission. Of these, more than 20 have been convicted. According to Groupe Sida, a Swiss HIV/AIDS organisation, most convictions have been Swiss nationals, however several African men have also been convicted who have often been deported from Switzerland after imprisonment.  

This ruling is the first anywhere in the world to bring charges against a person unaware of their HIV status of passing on the infection. Whilst only applicable in Switzerland, the ruling means that those who do not disclose past unprotected sex to new partners may be criminally liable in the event of HIV transmission.

This development may also shift the course of the debate over whether laws against deliberate HIV transmission discourage HIV testing. The fact that someone who had never tested for HIV has been convicted for criminal transmission could make the lack of an HIV test no longer an effective defence against prosecution for criminal transmission.

AVERT has more about the criminal transmission of HIV.

 (Aidsmap, 18/07/08, THT and Global Network of People living with HIV/AIDS, Criminalisation of HIV transmission in Europe)

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America to develop National AIDS Strategy

A Senate committee has approved $ 1.4 million for the development of a long-awaited national AIDS strategy.

With the near completion of the President's Emergency Plan For AIDS Relief (PEPFAR), ready to support countries with strategies addressing their own AIDS epidemics, the Bush administration has come under some criticism for not holding the same standards to America itself. These criticisms, it would seem, are about to be answered.

The Senate Appropriations Committee included the $ 1.4 million last week in their appropriations bill for the coming fiscal year for the White House Office of National AIDS Policy to develop a domestic strategy. The funding will support general costs in the development of a strategy that will hopefully address the domestic epidemic.

"HIV/AIDS in the U.S. is at crisis levels, while the Administration has failed to respond appropriately to address the domestic epidemic and the pervasive disparities across race, gender and socio-economic status, we need a national strategy to drive a more effective, outcomes-oriented domestic response to HIV/AIDS," said Ronald Johnson, Deputy Executive Director, AIDS Action.

The encouragement of both chambers of Congress supporting this development will help with the continuity of the government response and will ensure that resources and efforts to combat the epidemic are maximised.

The success of this decision and input of funds comes after years of campaigning and lobbying by hundreds of organisations and individuals within America. And now with a National Strategy being drawn up this has come as welcome news to the one million people thought to be living with HIV within America.

It is strongly believed that the introduction of a National AIDS Strategy will help improve support services, reduce the number of new infections and ensure a better quality of life for those living with the disease in America.

For more information go to AVERT's HIV & AIDS in America page.

(marketwatch.com 18/07/08)

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New research suggests genetic trait may boost AIDS risk in people of African descent

Scientists have found that African-Americans and Africans could be much more susceptible to HIV due to a genetic trait only found in people of African descent.

The new research suggests that this trait could be an answer as to why Africa is the continent hardest hit by the epidemic. In the research scientists found that a genetic trait found in 60% of African-Americans and in 90% of Africans makes HIV infection 40% more likely among this group. The trait is virtually non-existent in whites.

It is thought that this trait, which evolved to protect people against a form of malaria that no longer exists, is now unfortunately making people of African descent particularly susceptible to HIV.

Matthew J. Dolan, co-author of the study, believes this increased susceptibility could account for millions of extra cases of HIV. The researchers also believe, however, that people who have this particular genetic trait are able, on average, to live an extra two years longer than others if they become infected with the virus.

Rowena Johnston, Vice President of research with the Foundation for AIDS Research, admitted that while the information was able to offer an insight into the biology of the virus it will not be easy to make the information useful, adding that:

“Since any one individual has tens of thousands of genes, each of which may influence susceptibility in one direction or another, it's difficult to predict the outcome for any individual with any one particular genotype".

Some people also have an issue with the research itself. The geneticist David Goldstein says that because African-Americans have a higher rate of infection in general and also carry the genetic trait as part of their African heritage, the apparent association of the gene with HIV infection could be coincidental.

Although the discovery appears to be of significance the findings will still need to be validated by other researchers.

For more information on AIDS in Africa go to AVERT's HIV and AIDS in Africa page.

(washingtonpost.com 17/07/08)

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PEPFAR moves closer to reauthorisation as US Senate approves new funding for HIV/AIDS

Last night the US Senate voted to reauthorize PEPFAR, the President’s Emergency Plan For AIDS Relief. The draft legislation would allocate a massive $ 48 billion to combating HIV/AIDS, tuberculosis and malaria around the world.

PEPFAR began in 2003 when President Bush approved $ 15 billion to address the worldwide HIV/AIDS epidemic. That act expires at the end of September, and is due to be replaced and expanded by the new legislation, which will be the most ambitious foreign public health programme ever launched by a US government.

The Senate bill is in most ways similar to a bill approved by the House of Representatives on April 2nd. Both bills would overturn the controversial 2003 requirement that one-third of funding for HIV prevention be spent on the promotion of abstinence and fidelity. There are however a few significant differences between the two versions.

The bill passed by the House of Representatives would approve $ 50 billion for spending on HIV/AIDS, tuberculosis and malaria. The Senate version diverts $ 2 billion of this total for improving the lives of American Indians, according to the view that Congress should not neglect a humanitarian crisis closer to home.

The House version of the bill would add a further 17 countries to the existing 15 focus countries supported by PEPFAR, the majority being in the Caribbean but with three more (Malawi, Lesotho and Swaziland) in Africa. The Senate version makes no mention of adding extra focus countries.

Another difference between the two bills is that the Senate version contains a 50% earmark for spending on HIV treatment, which is not included in the House version.

Significantly, the Senate bill includes a provision that would end controversial restrictions on HIV positive people travelling to or seeking residency in the United States. Democratic Senator John Kerry described the ban as “an antiquated, knee-jerk reaction” to people living with HIV. “There's no excuse for a law that stigmatizes a particular disease,” he added.

Usually, a bill passed by the Senate must be brought into line with the equivalent bill approved by the House of Representatives before being sent to President Bush to become law. However, according to Senator Joseph Biden, it is possible that Senators will avoid conferring with the House, and will send their bill straight to the President. 

AVERT has more about PEPFAR and its focus countries.

 (Associated Press, 17/07/08, Atlantic.com, 16/07/08)

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Health officials renew investigation of South African AIDS doctor

Health officials in South Africa have renewed their investigation of a doctor who provided HIV positive pregnant women with the antiretroviral drug AZT to prevent their babies being born with HIV.

Dr Colin Pfaff of Manguzi Hospital, in KwaZulu-Natal province, began giving AZT to HIV positive pregnant women in August 2007, purchasing the drug with money donated by the AIDS organisation AVERT to the Manguzi Mission Fund. In February 2008 the provincial health department charged Dr Pfaff with misconduct for contravening government policy, even though the South African government officially endorsed the use of AZT in January 2008.

Within days the charges were dropped, following an outcry among rural doctors, scientists, AIDS activists and organisations. On May 21st the Treatment Action Campaign (TAC - South Africa's largest AIDS activist group) met with the ANC’s leadership in KwaZulu Natal including the head of the provincial health department, Peggy Nkonyeni. It was resolved that the Department of Health would convene a meeting to amicably resolve the dispute. This meeting was never held.

Now Ms Nkonyeni has renewed her campaign against the doctor. She has asked the provincial treasury to "probe the disposal of donor funding" used to purchase AZT for preventing mother-to-child HIV transmission. The treasury has hired private consultants, Ubunye Consortium, to carry out the investigation.

AVERT, as the AIDS organisation that provided the funding, is fully satisfied with how its money has been used, and is pleased that so many children’s lives have been saved as a result of them not being born with HIV.

TAC have said: "Ms. Nkonyeni's smear campaign against the doctors of Manguzi Hospital has undermined health care service delivery in the district, further exacerbated the province's already acute shortage of human resources for health, and jeopardised the future of Manguzi's exceptional prevention of mother to child transmission programme, potentially putting the lives of many women and infants at risk."

AVERT believes that the investigation of Dr Pfaff is unjustified and should be dropped.

(TAC, 03/07/08; IOL, 22/06/08; Sunday Tribune, 17/02/08)

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Annual Red Cross Report: “The AIDS epidemic is a disaster”.

The new 2008 World Disaster Report from the International Federation of the Red Cross and Red Crescent Societies has labelled the AIDS epidemic a disaster comparable to floods or famine. The report’s editor Lindsay Knight said the HIV/AIDS epidemic is a disaster, the scale and extent of which could have been prevented. “Ignorance, stigma, political inaction, indifference and denial all contributed to millions of deaths,” she said.

The decision to focus on HIV/AIDS this year results from what the Red Cross have witnessed as a humanitarian organisation and from their belief that much more must be done to tackle the disaster head-on.

The humanitarian work they achieve in many countries is often made all the more challenging due to the impact and nature of the AIDS epidemic. Nowhere is this truer than in sub-Saharan Africa, an area where AIDS has had a greater impact than in any other part of the world. It is because of this that the 248-page report focuses primarily on the epidemic in sub-Saharan Africa.

The report calls for much more to be done by governments and communities in tackling HIV, especially in areas, like sub-Saharan Africa, where other factors such as poverty and inequality play such a huge role. The report stated that it is the groups living on the fringes of society, especially in the developing world, that “often face stigma, criminalization and little, if any, access to prevention and treatment services.”

The report believes it to be the responsibility of humanitarian and aid organizations in times of crisis and emergencies to be better prepared, with well-planned and well-implemented national programmes that are able to deal with HIV/AIDS effectively.

From the findings has come the resolve ‘to do much more and much better’ in a collective endeavour against the disaster.

What is needed, they say, is more attention to be paid to AIDS as an issue in the overall response to natural disasters and armed conflicts from governments as well as non-governmental organisations.

(International Federation of the Red Cross and Red Crescent Societies 26.06.08; Reuters 26.06.08)

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UN holds High-Level Meeting on AIDS

The United Nations held a conference on AIDS this week to review the progress made in implementing the 2001 Declaration of Commitment and the 2006 Political Declaration, which set global targets for the response to the epidemic. Ban Ki-moon, Secretary General of the UN, opened the conference by saying that although there have been some important developments since 2001, there are many things that are still unacceptable. He warned that the gap between available resources and actual need was making universal access goals unattainable.

Ban Ki-moon also called for an end to discrimination against HIV positive people, an issue that was a key point throughout the conference. He said that 60 years after the Universal Declaration of Human Rights was adopted, “ it is shocking that there should still be discrimination against those at high risk”.

Heartfelt pressure to lift travel restrictions on HIV positive people came from foreign nationals who, if America hadn’t allowed them to travel especially for the conference, would have been denied entry.

“I am a person living with HIV, and by revealing my HIV status publicly, I am taking a risk of being banned from entering this country and over 70 other countries around the world,” said AIDS activist Ratri Suryadarma of Indonesia.

Despite this despondent tone the Secretary General did say that the AIDS response is starting to show results, highlighting a global decrease in new HIV infections and AIDS deaths over the last decade.

The report appears to show that the annual rate of new HIV infections has decreased over the last decade, with an estimated 2.5 million people newly infected with HIV in 2007 – down from 3.2 million in 1998.

The Secretary General also highlighted the unprecedented scale-up of access to antiretroviral treatment in the developing world, which rose by 42% in 2007. Michael Kazatchkine, Executive Director of the Global Fund to Fight AIDS, TB and Malaria said it was a remarkable achievement and showed what can be done with sufficient global and political will.

The UN Special Session on AIDS ended with a closing statement by H.E. Mr Srgjan Kerim, President of the 62nd session of the General Assembly. In this he said that the HIV/AIDS pandemic is a public health risk as well as a development issue, and an effective response must become a central feature of development efforts. Kerim reiterated the issue of stigma and discrimination, saying that its only function is to drive the pandemic underground. He said that mother-to-child transmission must be eliminated in developing countries, with the UN’s role critical if national efforts are to be coordinated effectively.

Mr Kerim finished his speech by saying, “History will judge how effectively we rose to the challenge of HIV and AIDS”.  

Only two and a half years remain to achieve the targets that UN members set in 2006.

(Aljazeera.net 11/06/08; UN 12.06.08)

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3 million now receiving AIDS drugs, says new report

Three million people living with HIV in low- and middle-income countries are now receiving antiretroviral therapy, according to a new report published by the World Health Organisation (WHO). This marks the belated attainment of a target set by the WHO's "3 by 5" initiative, which aimed to have three million on treatment by the end of 2005.

"Reaching that target even two years late is quite a remarkable achievement," said Dr. Kevin De Cock, director of HIV/AIDS at the WHO.

Nearly one million people began taking antiretroviral treatment during 2007 - the largest increase yet recorded. Nevertheless, more than two-thirds of those in need of the drugs are still not receiving them, and there is no guarantee that the rate of expansion will continue to accelerate.

Dr. De Cock now considers the 2005 deadline to have been "excessively aspirational". In the new report his organisation concedes that the current "all by 2010" target - to which world leaders committed in 2006 - will also be missed. "As we look ahead, it is clear that ... most countries will not meet the goal of universal access by 2010," says the WHO. For example South Africa - which has more people living with HIV than any other country - provides treatment to only 28% of those in need.

The report identifies several key challenges in the rollout of treatment. Perhaps the most critical issues are weak infrastructure and a shortage of health workers in the countries worst affected by AIDS. Having established successful treatment programmes at urban hospitals, many countries are struggling to extend coverage to rural areas. And timely diagnosis is another major concern - only 11% of people in low- and middle-income countries have ever received an HIV test and the test results.

The report cautions against focussing only on the number of new patients recruited. The drugs are not effective unless they are taken every day for life, which entails regular trips to the clinic. Patient retention is "emerging as a critical issue" and a recent study "suggests that the infrastructure and number of staff required to document and trace the people lost to follow-up are becoming increasingly inadequate due to the pressure on public health programmes to start the maximum number of new people on antiretroviral therapy as part of efforts to scale up treatment," writes the WHO.

The recent expansion in treatment coverage has been made possible by reductions in the prices of antiretroviral drugs. In low- and middle-income countries, the prices of most first-line medicines decreased by 30–64% from 2004 to 2007. Yet second-line combinations (taken by people who have to switch drugs because of drug resistance or side effects) still cost several hundred or even thousands of dollars per person per year. Currently only around 3% of people receiving treatment in developing countries are taking second-line therapy; this number will grow substantially in the near future, increasing the need for further price cuts.

And price remains an issue in first-line treatment. Nearly two-thirds of adults receiving antiretroviral therapy in low- and middle-income countries are taking d4T as part of their combination therapy. This drug is no longer recommended for use in Europe and North America because it is associated with side effects including lipodystrophy (disfiguring fat redistribution), peripheral neuropathy (pain and numbness in the hands and feet) and lactic acidosis (which causes nausea, vomiting and abdominal pain). The reason for the continued use of d4T-based therapy is that, at $ 92 per person per year, it costs less than a third as much as the alternative preferred in the West.

While mostly focusing on treatment access, the report contains a few pages on the prevention of mother-to-child transmission. It estimates that 33% of pregnant women living with HIV received antiretrovirals to prevent transmission to their children in 2007, compared with only 10% in 2004.

(LA Times, 03/06/08; WHO, 02/06/08)

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HIV positive man sentenced to 35 years after jury determine saliva is ‘deadly weapon’

A 42 year-old man was sentenced to 35 years in prison last week by a Dallas jury for ‘harassing a public servant with a deadly weapon’, after he allegedly spat at a police officer and then taunted him, saying he was HIV positive.

Since the defendant, Willie Campbell, had previously been convicted of attacking two other officers in a similar manner and biting two inmates, he was indicted under a habitual-offender statute that increased his penalty to a minimum of 25 years.

The draconian verdict comes despite the fact that HIV has never been passed on through contact with saliva. This fact has been emphasized by the US Centers for Disease Control and Prevention, who stated that, “contact with saliva, tears or sweat has never been shown to result in transmission of HIV”.

Several UK organizations have also expressed serious concern regarding the ruling.

Deborah Jack, Executive Director of the National AIDS Trust said, “It is shocking that in the same country which has some of the most advanced research into HIV and its treatments, there can be such ignorance within the legal system as to how HIV is transmitted. This is not justice but a victory for fear, myth and prejudice.”

This is not the first time that the US legal system has given prison terms to people living with HIV for spitting. Eight previous cases have resulted in convictions for HIV exposure, including two convictions for attempted murder, two for criminal exposure to HIV, one for assault with a deadly weapon, two for assault, and one for battery by body waste. Sentences have ranged from 90 days to life imprisonment.

It is feared that the recent ruling will undermine proven public health policies that combat HIV and AIDS, and could lead to public confusion about the ways that HIV is passed on.

It is also thought that the verdict could further increase the ignorance and fear that fuels the negative stigmatization of HIV positive people.

AVERT has more on the criminal transmission of HIV.

(Aidsmap, 16/05/08)

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Executive Director of UNAIDS announces departure from role

Dr Peter Piot, the Executive Director of UNAIDS, announced his resignation from his current position last night at a lecture given in London.

Dr Piot, who has been in the role since the inception of UNAIDS in 1995, revealed at the end of his lecture at the London School of Economics that he will be leaving the post at the end of this year. This was a very unexpected announcement, and no reason was given as to why he was leaving or what he will be moving on to next.

The lecture entitled 'The future of AIDS: Exceptionalism Revisited' addressed current trends in the progress of AIDS globally as well as looking at the long-term view of the epidemic.

During the lecture Dr Piot spoke openly about some of the issues standing in the way of tackling the disease, primarily the stigma and inequality that are still rife in many parts of the world. He said it is “wrong to think of AIDS as a disease of poverty but rather it is a disease of inequality”.

He said that he did not know how the AIDS epidemic would evolve in the long term, as there will always be constant social change.

The issue of funding the international response to HIV and AIDS was also covered. Dr Piot said that while countries sometimes do not have a choice, it is not healthy for a nation to rely on foreign donors. He believes that every middle-income country, with the exception of South Africa, should fund the domestic response to HIV/AIDS.

He admitted that funding does not always go to the right places, and criticised “bad politics” such as America’s ‘abstinence only’ programmes, which he called a “waste of money”.

He ended the lecture by calling for a strong activist movement devoted to social change as a method of reducing the number of HIV infections, and also for proper investment in capacity and resource allocation.

As well as being Under Secretary General to the UN, Dr Piot has been widely respected in his role as Executive Director of UNAIDS. He is a distinguished academic who has focussed a great amount of his scientific career on AIDS and women’s health in developing countries worldwide.

Through challenging world leaders to view AIDS in the context of social and economic development as well as security, and from being a committed activist and advocate for worldwide change, he has achieved a great amount and the results of his work and practice will hopeful continue long after he departs at the end of this year.

For more information go to AVERT's epidemic and statistics sections.

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Senators block renewal of multi-billion dollar HIV/AIDS programme

 A group of Republican senators are blocking legislation to renew the US President's Emergency Plan For AIDS Relief (PEPFAR), which could postpone the passage of the bill until next year.

 The new bill, which would authorise billion in spending over the next five years, has already been passed in the House of Representatives, and in order to become law, it must now pass the Senate and be signed by President Bush.

At a press conference in Washington D.C., seven Republican senators announced their objection to the removal of a requirement that a minimum of 55 percent of spending should be directed to treatment for HIV positive people. The seven have signed a hold letter, which will postpone a vote on the bill indefinitely.

Senator Tom Coburn, one of the seven senators blocking the legislation, said that his current goal is to restore a treatment target. "Any HIV/AIDS bill that moves through the Congress must prioritize saving lives," he said. 

The seven senators are supported by the American charity AIDS Healthcare Foundation, whose director, Michael Weinstein, said, "the removal of the language that requires PEPFAR to direct a specific amount of its funds toward lifesaving AIDS care and treatment will cost millions of lives."  

The action has sparked strong criticism. John Bradshaw, director of Physicians for Human Rights, said that the PEPFAR programme must be "flexible and respond to what is needed in each country - and people on the ground are in the best position to make those decisions, not senators in Washington dictating artificial, numerical targets." 

Fellow Republican Michael Gerson, who played a key role in the first PEPFAR bill, described the actions of the seven senators as “destructive”. 

According to Gerson, supporters of PEPFAR reauthorization now estimate a 50 percent chance it will be shelved until next year.

AVERT has more about PEPFAR. 

 (AllAfrica.com, 14/05/08)

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AIDS epidemic in Eastern and Southern Africa is outpacing response, says UNAIDS

Efforts to combat HIV/AIDS in Eastern and Southern Africa are failing to keep up with the growth of the epidemic, according to experts from UNAIDS ahead of a review of the global HIV/AIDS response.

In June 2008, UN member states, government officials and AIDS activists from around the world will meet in New York to track progress on targets adopted by the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) in 2001.

Countries submit reports every two years on targets including 25 core indicators on national HIV prevalence, education, provision of antiretroviral treatment (ART), uptake of condoms, and assistance to orphans.

Having assessed recent reports from Eastern and Southern Africa, the regions worst affected by the HIV/AIDS crisis, experts from UNAIDS have concluded that despite significant progress in areas such as treatment, many of the UNGASS targets are still far from being reached.

Director of UNAIDS for Eastern and Southern Africa, Mark Stirling said, "The data presented by countries confirms that overall the rate of progress in expanding access to all services is failing to keep pace with the expansion of the epidemic in this region.”

While treatment coverage has increased by 50 percent in low and middle-income countries in the region between December 2006 and the end of 2007, UNAIDS experts reported disappointing progress in HIV prevention in the region. Some countries showed a decrease in HIV prevalence among people aged 15 to 24, but others reported no change or slight increases.

The reported lack of progress has sparked debate among AIDS organisations about the usefulness of short term targets like those set by UNGASS, as opposed to strategies with an extended timeframe that focus on the social and cultural factors driving the HIV/AIDS epidemic.

The renewed focus on progress in HIV prevention is hoped to provide fresh impetus to all working towards HIV/AIDS prevention throughout the world to redouble their efforts.

AVERT has more on the impact of AIDS in Africa.

(PlusNews, 24/04/08)

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