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Africa: Daily HIV/Aids Report

Global Challenges

Israeli Doctors Providing Male Circumcision in Swaziland in Effort To Prevent Spread of HIV

[Oct 22, 2007]

Teams of Israeli surgeons have begun providing male circumcision in Swaziland in an effort to prevent the spread of HIV, the Washington Post reports. Health officials in Swaziland, which has fewer than 100 doctors and the world's highest HIV prevalence, say that over the next five years, they hope to offer the procedure to 200,000 sexually active men at a rate of roughly 200 daily -- 20 times faster than the current pace. According to the Post, six Israeli doctors are scheduled to work for two weeks in Swaziland this year under a program organized by the Jerusalem AIDS Project and underwritten by the U.S.-based Jewish organization Hadassah and other donors.

The Israeli doctors primarily are expected to train Swazi doctors on how to perform circumcision among adult men. However, many Swazi doctors already know how to perform the surgery. According to some Swazi doctors, what they primarily need from the Israeli doctors are "extra hands to help get enough done to impact the epidemic," the Post reports. The demand for circumcision -- especially surgeries that are no cost or subsidized -- appears to "far outstrip supply in Swaziland," according to the Post. The health system "routinely runs low" on basic medical supplies -- such as sutures, gloves, dressings and surgical tools -- the Post reports. In addition, there is a "major constraint" on surgeons and doctors, Dudu Simelane -- executive director of the Family Life Association of Swaziland, a nongovernmental group hosting the Israeli doctors -- said.

Some Swazi surgeons have shown that they can each perform 10 circumcision procedures -- which take about 25 minutes -- daily during the country's occasional series of "Circumcision Saturday" events, the Post reports. According to medical experts, it would take four doctors at each of five separate facilities to perform 1,000 circumcisions weekly if Swazi doctors can maintain that speed every weekday (Timberg, Washington Post, 10/21).

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Election 2008

Groups Calling on U.S. Presidential Candidates To Commit to Fight Against HIV/AIDS

[Oct 22, 2007]

The Global AIDS Alliance Fund and other groups are calling on U.S. presidential candidates to sign a pledge to commit to the fight against HIV/AIDS domestically and worldwide, the Keene Sentinel reports. The pledge also calls on candidates to commit $50 billion to such efforts. According to the Sentinel, New Mexico Gov. Bill Richardson (D) is the only candidate who has signed the pledge. GAAF also has created an online citizen's pledge that calls on voters to urge the next U.S. president to "create, support and fund a comprehensive plan to address the HIV/AIDS pandemic."

The organization New Hampshire Fights AIDS, which works with GAAF, ahead of the state's presidential primary invited Beatrice Were -- co-founder of the National Community of Women Living With HIV/AIDS in Uganda -- to speak last week at Keene State College in an effort to raise awareness about HIV/AIDS issues. "Given what is happening now, New Hampshire is a strategic state to influence (the) election," David Bryden of GAAF said, adding that voters should ensure presidential candidates make fighting HIV/AIDS a priority. "We feel this is a moment when candidates are open to these kinds of issues," Bryden said.

Were said that she aims to encourage voters to "look at AIDS as a global issue." She added that the U.S. has been a "leader" in global HIV/AIDS efforts and that it is "important" the country does not "stall." She also called on New Hampshire residents to "vote for a leader that makes sure [HIV/AIDS] issues are sustained" (Haigh, Keene Sentinel, 10/18).

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Across The Nation

Advocates of Legal Drug Injection Center in San Francisco Discuss Support of Idea

[Oct 22, 2007]

Supporters of a potential city-funded, legal center in San Francisco where injection drug users can use drugs under medical supervision gathered Thursday to discuss the idea, the San Francisco Chronicle reports. The event was sponsored by the San Francisco Department of Public Health and the Alliance for Saving Lives, a coalition that includes the San Francisco AIDS Foundation, the Mission Neighborhood Resource Center, the Harm Reduction Coalition and San Francisco General Hospital's Opiate Treatment Outpatient Program.

Supporters of the center say it can reduce the spread of HIV and hepatitis C, prevent deaths from drug overdoses and prevent used needles from circulating in the community. Advocates are collecting signatures on a letter to send to San Francisco Mayor Gavin Newsom, the San Francisco Board of Supervisors, and Mitch Katz, the head of the health department. In the letter, advocates "call on San Francisco to create a legal safer injection facility staffed with trained medical professionals. ... Please help us make this critical program a reality" (Knight, San Francisco Chronicle, 10/19).

Organizers of the event said it could take years to establish a center, citing potential state and federal legal issues and political opposition, the AP/Google.com reports (Leff, AP/Google.com, 10/19). Advocates for the center cited the success of a similar program, Insite, in Vancouver, Canada, which they said has helped reduce the spread of HIV and other diseases and prevent deaths (San Francisco Chronicle, 10/19).

There are about 11,000 to 15,000 IDUs in San Francisco, most of whom are homeless men. The city operates a needle-exchange program to help reduce the spread of HIV and other diseases. San Francisco is the first U.S. city to consider a drug injection center. Sixty-five such centers exist in 27 cities in eight countries, Hilary McQuie, Western director of HRC, said. Possible locations for a center in San Francisco include homeless shelters, HIV/AIDS clinics or drug treatment centers, Andrew Reynolds, a program coordinator for the city's sexually transmitted infection clinic, said.

According to San Francisco Fire Department Captain Niels Tangherlini, overdoses from injection drug use represented one of every seven emergency calls handled by city paramedics between July 2006 and July 2007. He added that the number of deaths from drug overdose decreased from a peak of 160 in 1995 to 40 in 2004 (AP/Google.com, 10/19).

Reaction

Newsom on Thursday said that although he is not "ideologically against" the center, he is doubtful that any neighborhood in the city would be willing to host the center (San Francisco Chronicle, 10/19). Newsom spokesperson Nathan Ballard said that the mayor does not want to discourage debate about the establishment of a center but added that Newsom is "not inclined to support this program because, quite frankly, it may create more problems than it supposedly addresses."

Bertha Madras, deputy director of demand reduction for the White House Office of National Drug Control Policy, said the consideration of a drug injection center is "disconcerting" and "poor public policy." She added that establishing such a center would be a "form of giving up." McQuie said that if such a center is established in the U.S., "it will most likely start in San Francisco." She added that the establishment of a center "depends on if there is a political will" and that the "main factor" is "how long it takes for that political will to develop" (AP/Google.com, 10/19).

NPR's "Day to Day" on Thursday included a discussion with Thomas Kerr, lead scientist at Insite, about the San Francisco proposal (Brand, "Day to Day," NPR, 10/18). Audio of the segment is available online.

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Drug Access

European Medicines Agency Panel Recommends Approval of Gilead, BMS, Merck Antiretroviral Atripla

[Oct 22, 2007]

A panel of the European Medicines Agency has recommended for approval the once-daily antiretroviral drug Atripla -- which is manufactured jointly by Gilead Sciences, Bristol-Myers Squibb and Merck -- the companies announced on Thursday, Reuters reports (Reuters, 10/18). Atripla is comprised of efavirenz, marketed by BMS and Merck, and the Gilead drugs emtricitabine and tenofovir (AP/Yahoo! Finance News, 10/18).

According to a BMS release, the Committee for Medicinal Products for Human Use recommended that Atripla be approved for HIV-positive adults with a viral load of less than 50 copies per milliliter of blood for more than three months on their current combination therapies. The CHMP recommendation also says that the drug should be used only by adults who have not experienced virological failure on any prior treatment regimen or developed significant resistance to any of the drugs contained in Atripla before initiating their first treatment regimen (BMS release, 10/18).

BMS, Merck and Gilead said they expect a full EMA decision on Atripla by the end of this year (AP/Yahoo! Finance News, 10/18). If approved, Atripla would be the first once-daily antiretroviral available to most people living with HIV in the European Union (BMS release, 10/18).

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Opinion

HIV Prevention Efforts, Including Those Aimed at Addressing Multiple Sex Partners, Offer Ultimate Hope for Curbing Pandemic, Opinion Piece Says

[Oct 22, 2007]

Although HIV/AIDS treatment and care programs should be expanded worldwide, it is "only by preventing new infections" that the world can "ultimately hope to turn back this devastating disease," Daniel Halperin, senior research scientist at the Center for Population and Development Studies at Harvard University's School of Public Health, writes in a Washington Post opinion piece in response to a recent Post opinion piece by Richard Holbrooke, president of the Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria. Holbrooke was "correct to emphasize the importance of HIV testing, especially for providing the main gateway into treatment," Halperin writes, adding, "There is, however, little evidence that knowing one's HIV status fundamentally alters behavior." According to Halperin, although Holbrooke also "listed a number of other key elements of a viable prevention strategy" -- including education, counseling, no-cost condoms, empowerment of women, increased male circumcision and abstinence -- he "neglected to mention the central role that multiple sexual partnerships play in infection rates."

"Broad interventions are needed to address" the factor of multiple sex partners, Halperin writes. He adds that although approaches such as testing, condom use and abstinence are "important," no "magic bullet exists" to prevent HIV, Halperin writes. According to Halperin, "rigorous evidence" suggests that there needs to be a "vigorous expansion" of behavior-change programs in Africa to encourage partner reduction and increased access to safe male circumcision on the continent. It also would be helpful to expand HIV testing programs, "if not primarily for prevention purposes, then at least to help facilitate the care and treatment programs that are also vital to mitigating" the HIV/AIDS pandemic, Halperin concludes (Halperin, Washington Post, 10/22).

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