Kaisernetwork.org (Washington, DC)
4 August 2008
AIDS 2008
XVII International AIDS Conference Opens Amid Calls for Universal Access to Treatment, Disappointing Vaccine, Microbicide Trials
[Aug 04, 2008]
More than 22,000 researchers, policymakers and advocates gathered in Mexico City on Sunday for the opening of the XVII International AIDS Conference, which has the theme "Universal Action NOW," AFP/Sydney Morning Herald reports (AFP/Sydney Morning Herald, 8/4). According to the Wall Street Journal, about 25 million people have died of AIDS-related conditions since 1981, and there are currently about 33 million HIV-positive people worldwide (Chase, Wall Street Journal, 8/2).
The conference was opened by several world leaders and health officials, including Mexican President Felipe Calderon and United Nations Secretary-General Ban Ki-moon (XVII International AIDS Conference release, 8/3). "As the fight against AIDS nears the end of its third decade, we are still facing a huge shortfall in resources," Ban said, adding, "The responses to HIV and AIDS require long-term and sustained financing. As more people go on treatment and live longer, budgets will have to increase considerably over the next few decades. In the most affected countries, donors will have to provide the majority of the funding."
Peter Piot, executive director of UNAIDS, said, "The end of AIDS is nowhere in sight," adding, "Every day, almost three times as many people become newly infected with HIV as those who start taking antiretroviral therapy."
Piot said, "We must categorically reject any attempt to so-called 'normalize' AIDS, or treat this epidemic as just one of many medical problems. Now, more than ever, do we need an exceptional response ... there's not 'too much money going to AIDS' but too little.'"
Margaret Chan, director-general of the World Health Organization, said, "AIDS is the most complex, the most challenging and probably the most demanding infectious disease humanity has ever had to face," adding, "We dare not let down our guard. ... We are going to be in this for the long haul."
Keren Dunaway-Gonzalez, a 13-year-old Honduran girl with HIV, during the opening ceremony said, "Many of us want to be doctors or teachers. I want to be a singer. But these dreams will only be possible when we have medicines, when we're accepted in schools, and when we can grow up in an atmosphere free from violence, stigma and discrimination" (AFP/Google.com, 8/4).
A major increase in funding for HIV/AIDS treatment and reduced prices for antiretroviral drugs have enabled nearly three million HIV-positive people in developing countries to receive the drugs. "There has been a spectacular advance, but we are still very short of the mark," Jean-Francois Delfraissy, head of France's National Agency for AIDS Research, said ahead of the conference. He added, "One of the tasks of the conference is to address the fact that there are three million people who now get the drugs, but another nine million who do not" (Agence France-Presse, 8/3).
Pedro Cahn, president of the International AIDS Society, said that the U.N. General Assembly has a commitment to provide antiretroviral drugs to all who need them by 2010, but there are signs that governments and international agencies are retreating from that promise and instead aiming for universal access by 2015. "After so much progress it appears that we are poised to accept defeat when victory is still within our grasp," Cahn said, adding, "This cannot be allowed to happen."
Stephen Lewis, former U.N. envoy for HIV/AIDS in Africa and current co-director of the group AIDS-Free World, said it is "reprehensible" that governments appear to be backing away from the universal access target, adding, "I don't believe for a moment this could break the bank. ... There is a humanitarian necessity of investing in prevention" (Picard, Globe and Mail, 8/4).
IAS Executive Director Craig McClure said, "HIV has spawned an interest in health systems that was never there before, and (investment in HIV) is helping to drive the expansion of public health systems globally to reach all those who need it." Cahn added that there is "no doubt that in order for us to achieve the 2010 universal access targets, health systems must be further strengthened" (Green, Star, 8/4).
First Conference in Latin American Country
The conference is the first to be held in a Latin American country, and attendees will focus on curbing the epidemic in the region, Inter Press Service reports (Ebrahim, Inter Press Service, 8/3). The U.N. Population Fund last week said that more than 500,000 Latin Americans ages 15 to 24 are HIV-positive, a 5% increase since 2006. Nils Kastberg, UNICEF regional director for Latin America and the Caribbean, said that regional taboos related to HIV/AIDS have delayed prevention campaigns in Latin America, adding that most governments in the region have not achieved universal access to antiretroviral treatment (Xinhua News Agency, 8/2).
The first international March Against Stigma, Discrimination and Homophobia "set the tone for the conference" -- that HIV among men who have sex with men "is an overlooked epidemic," Inter Press Service reports. McClure said that "stigma, discrimination and human rights would indeed be the focus of the conference" (Inter Press Service, 8/3).
Drug, Vaccine Development Expectations
Some experts have said they do not expect a "breakthrough" announcement to be made at the conference about HIV/AIDS drug development, but they are bracing for confirmation that research on HIV vaccines and microbicides are "mired in setbacks," AFP/Google.com reports (AFP/Google.com, 8/3).
According to the Journal, failed tests on vaccines, microbicides, diaphragms and a herpes treatment have caused researchers to "refocus" on the basic questions of what makes an effective HIV immune response and how researchers can create neutralizing antibodies that block HIV (Wall Street Journal, 8/2). Disappointing news in the field of HIV vaccine research came last year when Merck halted clinical trials of an experimental vaccine over safety concerns, Reuters Africa reports. The announcement "spurred a major shift" in U.S. government-funded vaccine research, leading to a recent announcement by NIH to abandon plans for a large-scale trial of another experimental vaccine that is similar to Merck's candidate. NIH has said it will focus funding on smaller studies aimed at increasing basic knowledge of HIV.
"We are in an interesting, and some would say, difficult period," Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said, adding, "The obvious empirical approaches have not worked." Seth Berkley, president of the International AIDS Vaccine Initiative, said, "There has been a sense ... that every vaccine trial is do or die," adding, "Most people don't understand that the product development process is rife with failures. The assumption is most candidates won't work. We are just looking for any signal of hope" (Quinn, Reuters Africa, 8/1).
Positive Developments
According to Reuters Africa, the "gloom" over disappointing research results "threatens to overshadow more positive" HIV/AIDS-related news, such as findings that male circumcision might reduce the likelihood of HIV transmission and that giving antiretroviral drugs to "high-risk" HIV-negative people could help protect them from infection -- a concept referred to as pre-exposure prophylaxis, or PrEP (Reuters Africa, 8/1). Robert Grant of the Gladstone Institute and the University of California-San Francisco is using funding from NIH and the Bill & Melinda Gates Foundation to test daily use of Gilead Science's antiretroviral drug Truvada among high-risk HIV-negative volunteers in Brazil, Ecuador, Peru and the U.S. Results are scheduled for 2010 but might come earlier, the Journal reports.
"[S]omething like PrEP has a good chance of becoming available before we have a 100% efficacious vaccine," Bill Gates, co-founder of the Gates Foundation, said, adding, "The challenges are a little less daunting. If we have that tool, it could have a very big impact." The Gates Foundation has allocated $93 million for PrEP research. The rest of the organization's $1.49 billion allocated for HIV prevention is spread between promoting existing prevention tools, such as condoms, and conducting research on new tools, such as vaccines, microbicides and drugs (Wall Street Journal, 8/2).
Kaisernetwork.org is the official webcaster of the XVII International AIDS Conference in Mexico City. Click here to sign up for your Daily Update e-mail during the conference. A webcast of the opening press conference is available online at kaisernetwork.org. A webcast of the opening ceremony also is available online. An interview with McClure also is available online at kaisernetwork.org.
Additional Coverage
Several media outlets included coverage related to the opening of the conference. Summaries appear below.
AP/Google.com featured an interview with Dunaway-Gonzalez (Olson, AP/Google.com, 8/4).
Deutsche Welle on Sunday posted an interview with German researcher Hans Jaeger about the progress of research on HIV vaccines and treatments (Usi, Deutsche Welle, 8/3). A transcript of the interview is available online.
The Toronto Star on Saturday reviewed progress since the XVI International AIDS Conference in Toronto in 2006, as well as previewed hot topics for the current conference (Toronto Star, 8/2).
VOA's "Our World" on Friday previewed the conference. The segment includes comments from Piot, VOA reporter Rosanne Skirble, McClure and conference Co-Chair Pedro Cahn (Honig, "Our World," VOA, 8/1). Audio and a transcript of the segment are available online.
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Media Outlets Profile Attendees at HIV/AIDS Conferences in Mexico City
[Aug 04, 2008]
Several media outlets recently profiled attendees at the International People Living With HIV Conference and the XVII International AIDS Conference, which are both being held in Mexico City.
HIV-Positive Advocates
Inter Press Service reports that about 350 delegates from HIV advocacy organizations gathered in the Mexican capital for a two-day conference that opened Thursday. The conference, organized by the group International People Living With HIV, is titled "Living 2008: The Positive Leadership Summit."
According to Inter Press Service, People Living With HIV launched in 1983 at a conference in Denver, during which a group of advocates for the first time publicly expressed the needs of HIV-positive people and voiced the idea that "personal experiences should help shape the design of policies." The group took on an international dimension in 1994, when 42 countries signed the Paris Declaration, also known as the Declaration of Greater Involvement of People Living With HIV/AIDS.
Although advocates have successfully increased their "influence and visibility" in the past 10 years, HIV-positive people "continue to face discrimination, isolation and criminalization for HIV transmission," Inter Press Service reports. The conference aimed to address various issues, such as the criminalization of HIV transmission, HIV prevention, support for HIV-positive people, universal access to treatment, and sexual and reproductive rights (Godoy, Inter Press Service, 7/31).
In addition, thousands of advocates marched through Mexico City on Saturday to protest discrimination against HIV-positive people ahead of the XVII International AIDS Conference, which opened Sunday, AFP/Google.com reports. According to AFP/Google.com, several first ladies from Latin America and Caribbean countries met Saturday to discuss the HIV/AIDS epidemic among women (AFP/Google.com, 8/2).
Commercial Sex Workers
Reuters on Sunday profiled commercial sex workers who say they intend to protest the XVII International AIDS Conference because they cannot afford the conference's registration fees. Elma Delea, an advocate and transsexual sex worker near Mexico City, said Mexican health officials have told her and other advocates they did not have enough money for "everyone who wanted scholarships" to attend the conference. Elvira Madrid, an advocate working for the rights of sex workers in Mexico City, said, "The conference is a place to exchange opinion, but now only those in power have a say."
Commercial sex work is illegal in Mexico but is "widely tolerated," Reuters reports. Delea said it is important for society to acknowledge sex workers. Police officers in Mexico often detain sex workers when they are found with condoms, which makes it more difficult to practice safer sex, Delea said. Delea added that fellow protesters want to teach women how to protect themselves when customers refuse to use condoms (Tan, Reuters, 8/3).
Singer-Songwriter Annie Lennox
According to the AP/Google.com, singer-songwriter Annie Lennox also will attend the XVII International AIDS Conference as an ambassador for Oxfam. Lennox said complacency threatens to slow the fight against HIV/AIDS and is urging musicians, filmmakers and women to continue to promote the issue (AP/Google.com, 8/2). She added, "This dialogue must not go off the table" (AP/Google.com, 8/3).
Lennox also has launched a campaign called "Sing," which includes a song she recorded with 23 female singers to raise money for HIV/AIDS. She also is campaigning on behalf of South African women and children living with HIV/AIDS (AP/Google.com, 8/2).
Kaisernetwork.org is the official webcaster of the XVII International AIDS Conference in Mexico City. Click here to sign up for your Daily Update e-mail during the conference.
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Across The Nation
CDC Releases Updated Estimates on New HIV Infections
[Aug 04, 2008]
CDC on Saturday ahead of the XVII International AIDS Conference, which opened Sunday in Mexico City, released updated national estimates of the annual number of new HIV infections that occur in the U.S., the Washington Post reports (Brown, Washington Post, 8/3). The new data were published Sunday in a special HIV/AIDS issue of the Journal of the American Medical Association, which was released at the AIDS conference (CDC release, 8/3).
The new analysis found there were about 56,300 new HIV infections in 2006, the most recent year for which data are available, about 40% higher than CDC's long-standing estimate of 40,000 for each of the last several years (Washington Post, 8/3). According to CDC, the number of new infections likely was never as low as the previous estimate of 40,000 and has been relatively stable overall since the late 1990s (CDC release, 8/3). According to the Post, the estimate is based on data from a new advanced testing method, which enabled researchers to detect recent HIV infections (Washington Post, 8/3). The study did not calculate the total number of U.S. residents living with HIV/AIDS, although such estimates are expected soon. Earlier projections estimated that about 1.2 million people in the U.S. are HIV-positive, and CDC is updating that number, the Boston Globe reports (Smith, Boston Globe, 8/3).
Among sub-groups, the report found that:
Men who have sex with men accounted for 53% of all new infections;
Non-Hispanic blacks accounted for 45% of new infections (Sternberg, USA Today, 8/2);
People in their 30s had the highest number of new HIV infections, while people younger than age 30 accounted for 34% of all new infections;
73% of new infections were recorded among men (Washington Post, 8/3);
Injection drug users accounted for 12% of infections; and
Heterosexuals made up 31% of new infections.
Although the report indicates general stability in new infections nationally, as well as reductions in new infections among both IDUs and heterosexuals over time, it also shows increases among MSM (CDC release, 8/3).
HIV incidence in 2006 among blacks was 83.7 infections per 100,000 people, seven times as high as the rate of 11.5 per 100,000 among whites and three times as high as the 29.3 infections per 100,000 people among Hispanics (Altman, New York Times, 8/3). According to the data, although new infections among blacks are higher than among any other racial or ethnic group, the number has been relatively stable since the early 1990s (CDC release, 8/3).
Historical Analysis
According to the analysis, new HIV infections peaked at about 130,000 annually in the mid-1980s and decreased to a low of about 50,000 annually in the early 1990s. The number of new infections increased in the late 1990s and has been relatively stable since then, with estimates of between 55,000 and 58,500 new infections annually in the three most recent time periods that were analyzed, according to the study (New York Times, 8/3).
Prevention, Funding
According to the Post, CDC spends about $750 million each year on prevention efforts. About half of CDC's HIV prevention budget targets blacks, Kevin Fenton -- director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention -- said. However, he added that the increasing incidence in MSM -- particularly in young black MSM -- is evidence that prevention campaigns have "not reached all those who need it" (Washington Post, 8/3).
According to Fenton, the recent relative stability in incidence is somewhat good news because the overall number of people living with HIV who could potentially pass the virus on to others is increasing as HIV-positive people are able to live longer due to antiretroviral drugs. That suggests those people are taking steps to prevent spreading the virus, the San Francisco Chronicle reports (Stannard, San Francisco Chronicle, 8/3). "Over 95% of people living with HIV are not transmitting to someone else in a given year," David Holtgrave of the Bloomberg School of Public Health at Johns Hopkins University said, adding, "What that says is the transmission rate has been kept very low by prevention efforts" (Washington Post, 8/3).
An analysis last year by Holtgrave and Jennifer Kates, a Kaiser Family Foundation vice president and director of HIV policy at the foundation, showed a correlation between the amount of funds spent on prevention and HIV incidence. "You get what you pay for," Holtgrave said, adding, "I think the new statistics are the most important AIDS story in the U.S. since the advent of the new treatments" (USA Today, 8/3).
Comments
According to the Globe, the fact that more people than previously thought might have contracted HIV since the late 1990s will have "profound consequences" for physicians, policymakers and HIV/AIDS advocacy groups (Boston Globe, 8/3).
CDC Director Julie Gerberding said that the new data likely will influence decisions about efforts to control the epidemic. She added that although HIV incidence is "certainly too high," it is "stable." According to Gerberding, a "stable number of new infections in a world that has got more and more people with HIV and people with AIDS living in it suggests that we are keeping up with that pressure for transmission" (New York Times, 8/3).
Several HIV advocates expressed anger at CDC's delay in releasing the data, which were available in October 2007 when the agency completed the study, the Wall Street Journal reports. UNAIDS Director Peter Piot said that "timely information is important for prevention." Kate Krauss, a spokesperson for Physicians for Human Rights, said, "Science-based AIDS prevention means having access to accurate data about how many people are becoming infected," adding, "Without it we are shooting in the dark" (Chase, Wall Street Journal, 8/4).
The agency's delay in releasing the data also has fueled criticism that the Bush administration has not done enough to fight HIV/AIDS in the U.S., according to the Times. Rep. Henry Waxman (D-Calif.) said HIV prevention efforts have been "underfunded and too often hindered by politics and ideology," adding that, when adjusted for inflation, the administration's domestic spending on HIV/AIDS has decreased by 19% since 2002. Waxman also said he plans to hold congressional hearings on why CDC has had "less and less money to actually get [HIV prevention] programs to the communities that need them."
Gerberding responded to the criticism, saying that the data have "been scrutinized by some of the best statisticians in the country and is much better now than when we started this process" (New York Times, 8/3). Gerberding added that the new data represent the "most reliable estimate" since the "beginning of the epidemic" (Stobbe, AP/San Francisco Chronicle, 8/3).
Fenton said, "It's important to note that the new estimate does not represent an actual increase in the number of new infections but reflects [CDC's] ability to more precisely measure HIV incidence and secure a better understanding of the epidemic" (CDC release, 8/3). However, Fenton added that the "fact remains that there are far too many people becoming infected in the United States every year. Therefore, these findings should be a wake-up call ... that the epidemic in the United States is far from over" (San Francisco Chronicle, 8/3).
Comments From Presidential Candidates
Presumptive presidential candidates Sens. John McCain (R-Ariz.) and Barack Obama (D-Ill.) on Sunday in response to the new estimates pledged to increase the fight against HIV in the U.S., AFP/Google.com reports. Obama said that if elected president, he would develop a national strategy to reduce new infections, expand testing and education, and eliminate stigma. McCain vowed to reduce drug costs, as well as to target testing and prevention in highly affected communities.
"These new figures should bring new focus to our efforts to address AIDS and HIV here at home," Obama said in a statement, adding that the focus should be on "expanding access to testing and comprehensive education programs." The fight against HIV/AIDS also "demands closing the gaps in opportunity that exist in our society so that we can strengthen our public health," Obama said, adding, "We must also overcome the stigma that surrounds HIV/AIDS -- a stigma that is too often tied to homophobia."
McCain in a statement said that if elected, he would "work closely with non-profit, government and private-sector stakeholders to continue the fight against HIV/AIDS." He added, "By focusing efforts on reducing drug costs through greater market competition, promoting prevention efforts, encouraging testing, targeting communities with high infection rates, strengthening research and reducing disparities through effective public outreach, we as a nation can make great progress in fighting HIV/AIDS" (AFP/Google.com, 8/3).
More Comments
Kates said the new data "corroborate what many" HIV/AIDS researchers "suspected -- that the epidemic is worse than we thought" but that it "doesn't seem to be getting worse" (Washington Post, 8/3).
Mark McLaurin of the Community HIV/AIDS Mobilization Project said the new estimate "means little if it does not serve as the spark to inflame our collective anger about the deadly neglect of an acute emergency" (Fox, Reuters, 8/2).
Michael Weinstein, president of the AIDS Healthcare Foundation, said, "There is absolutely no good news here. Without an accurate picture of the epidemic, vastly underestimated for the last 10 years, we have missed countless opportunities to intervene with effective public health strategies."
Phill Wilson, founder and CEO of the Black AIDS Institute, added that the new figures "confirm that AIDS in America is a black disease and has been neglected for far too long" (Maugh, Los Angeles Times, 8/3).
An abstract of the study is available online. More information on the new estimates are available online from the CDC.
A kaisernetwork.org interview with Fenton is available online. Kaisernetwork.org is the official webcaster of the XVII International AIDS Conference in Mexico City. Click here to sign up for your Daily Update e-mail during the conference.
Multimedia Coverage
CBS' "Evening News": The program on Saturday reported on the study and included comments from Fenton and Sean Barry of the New York AIDS Housing Network (David, "Evening News," CBS, 8/2).
CNN's "House Call with Dr. Sanjay Gupta": The program on Saturday reported on the study. The segment includes comments from Bambi Gaddist, executive director of the South Carolina HIV/AIDS Council (Gupta, "House Call with Dr. Sanjay Gupta," CNN, 8/2). A transcript of the segment is available online.
NBC's "Nightly News": The program on Saturday reported on the study (Bazell, "Nightly News," NBC, 8/2).
NPR's "All Things Considered": The program on Saturday reported on the study and the beginning of the conference (Knox, "All Things Considered," NPR, 8/2).
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Hartford Courant Examines Funding for HIV/AIDS Programs Targeting Blacks in Hartford
[Aug 04, 2008]
Many people with HIV/AIDS in Hartford, Conn., are "frustrated" that programs serving blacks in the city appear to be "rapidly drying up," the Hartford Courant reports. Thirty-eight percent of Hartford residents living with AIDS are black and 40% are Hispanic. One-third of all funding for HIV/AIDS prevention programs in Hartford is targeted at blacks, according to William Gerish, spokesperson for the state Department of Public Health.
Recently, city budget problems nearly forced the Burgdorf clinic at the Hartford Health Department to close. The clinic had cared for residents in Hartford's North End, home to many black residents. An "eleventh-hour intervention of AIDS activists and educators, with the assistance of a few state lawmakers," allowed the clinic to remain open for another year, the Courant reports.
According to some Hartford HIV/AIDS advocates, low funding in the black community has been a long-term problem. Preventive services through the city's health department and the Urban League of Greater Hartford had been "readily available in the North End" about 10 years ago, but the local Urban League chapter is no longer involved and "new programs are scarce," the Courant reports.
In addition, some advocates and care providers said that programs targeting Hispanics are expanding, largely because the community has a "stronger infrastructure of community-based organizations vying for the funding," according to the Courant.
Angelique Croasdale, an HIV program manager for the Hartford Health Department, said, "When you look at the proportion of services on the south side of Hartford, compared to the north side, it doesn't break out evenly." She added, "We don't have a strong African American-based agency advocating for services in the North End. All that is going to rest on the (entire) community to take action."
Danielle Warren-Dias, an educator for the University of Connecticut Health Center, said, "If it weren't for the few watchdogs that we have, the African-American community would definitely fall off the radar. There is a disparity in the accessibility, and it's our fault, too. There was a national mandate by the [CDC] to test African-Americans, but that didn't happen" (Brown, Hartford Courant, 8/1).
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Baltimore Sun Examines Group That Conducts HIV/AIDS Outreach in City's Dance Clubs
[Aug 04, 2008]
The Baltimore Sun on Thursday examined a group of outreach workers that since May has been promoting HIV/AIDS prevention and testing in the city's densest concentration of nude dance clubs. The group on Thursday nights offers no-cost condoms and tests for HIV, syphilis and hepatitis C. Workers also provide referrals for drug treatment programs and help clients take steps to qualify for Medicaid.
The initiative is a joint effort of the Baltimore City Health Department and the group Sisters Together and Reaching. According to the Sun, the initiative "addresses what's long been an open secret" -- among nude dancers, "bouncers and public health authorities, there is wide acknowledgment that drug addiction and sexual activity are common among women who perform" in the area. Jacky Ruben, a graduate student at the Johns Hopkins Bloomberg School of Public Health, accompanies the outreach workers and conducts private interviews with dancers to develop a profile of their lifestyles. "There's a lot of drug use, lots of oral, vaginal sex going on in the clubs," Ruben said, adding that most report condom use. Many say that they use clean needles but pass them on to others, according to Ruben. To date, the health department has distributed 1,300 clean needles in the area, an average of about 130 nightly, Deputy Health Commissioner Richard Matens said (Bor, Baltimore Sun, 7/31).
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Global Challenges
Former President Clinton Completes Tour of Africa Aimed at Fighting HIV/AIDS
[Aug 04, 2008]
At the conclusion of a four-nation tour of Africa on Sunday, former President Clinton discussed progress in HIV treatment access and costs, the role of nutrition among HIV-positive children and other issues, the AP/Google.com reports.
According to the AP/Google.com, the Clinton Foundation has helped negotiate agreements to lower the prices of rapid HIV tests and antiretrovirals in the developing world and has collaborated with UNITAID to provide low-cost antiretrovirals. Clinton said the cost of antiretrovirals in 2006, when UNITAID was created, was $600; the same drugs now cost $60.
"The same people who sell them today at U.S. $60 did not all the sudden have a conversion where they said, 'I'm being greedy and now I'll be generous.' They charged that because they had a small volume with a lot of fixed costs," Clinton said. He added, "Now, because of the UNITAID funding, there is a big volume with absolutely certain payments. So they can charge a small profit margin on each individual lifesaving medication." Nevertheless, "we're still a long way from universal coverage," Clinton said.
According to the United Nations, only two million of the 22 million HIV-positive people in Africa have access to antiretrovirals. Clinton said about 30% of pregnant HIV-positive women give birth to infants with HIV but added that antiretrovirals can reduce that rate to 2%. He added that since 2006, the number of children in the developing world with access to antiretrovirals has increased from 10,000 to more than 200,000.
Nutrition
Clinton also discussed malnourishment among HIV-positive children in the developing world. Clinton said that during his tour, he saw children in Ethiopia who "cannot live" because they are unable to absorb antiretroviral drugs because of malnourishment. Clinton also traveled to Liberia, Rwanda and Senegal.
"If you look at the rising price of petroleum, the rising price of food around the world, we are all going to have to re-examine how we produce food, where we produce it, how we consume it," Clinton said, adding, "It's not just a question of energy prices, it's not just a question of global warming. It's a question of how we are going to keep our kids alive" (Pitman, AP/Google.com, 8/3).
French Contributions
During a stop in Dakar, Senegal, Clinton also praised France for its financial support through UNITAID, AFP/Google.com reports. Clinton said, "It is possible to honor the World Health Organization [treatment] guidelines, in my opinion, only because of UNITAID and the government of France." He added, "It may be the single most important contribution of France to the rest of the world since the end of the Second World War."
UNITAID receives the majority of its funding from a tax on airline tickets that was introduced by France in July 2006; several other countries said they also would institute a similar airline tax. Clinton said, "A huge number" of HIV-positive children "will live because of this idea."
Clinton is scheduled to attend the XVII International AIDS Conference on Monday (AFP/Google.com, 8/3).
Kaisernetwork.org is the official webcaster of the XVII International AIDS Conference in Mexico City. Click here to sign up for your Daily Update e-mail during the conference. A live webcast of a session featuring Clinton on HIV/AIDS and health system reform will be available at 2:15 p.m. ET (18:15 GMT).
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'Growing Belief' Among Men in Swaziland That Circumcision Provides Complete Protection Against HIV, IRIN News Reports
[Aug 04, 2008]
There is a "growing belief" among some men in Swaziland that circumcision provides complete protection against HIV -- a perception that is concerning nongovernmental organizations working to combat the spread of the virus in the country -- IRIN News reports. According to IRIN News, some public health officials in Swaziland recently have "lauded" male circumcision as a procedure that can reduce a man's risk of HIV.
Siphiwe Hlope -- founder of the Swazis for Positive Living, an HIV/AIDS support group -- said the "problem is not with the procedure, but the way it is abused by men, so that men think they are now immune from" HIV. She added that members of the support group are becoming more aware of an attitude that circumcision protects men from HIV while also providing an excuse not to use condoms. Although Hlope does not dispute the advantages of male circumcision in reducing HIV transmission, she said that gender dynamics in Swazi culture should be considered. "AIDS in Africa has a woman's face," Hlope said, adding, "People think the disease originates with women. Why? Because it is the women who are tested first, when they are about to give birth."
An unnamed Zambian physician who treats people living with HIV/AIDS at government hospitals said, "It's the law of unintended consequences," adding, "Introducing the procedure, there was insufficient attention given to cultural factors, attitudes and human psychology." The physician noted, "Many of the men I speak with think circumcision is like an AIDS vaccine. It's not. It's a useful tool to reduce chances of infection at a time and place where few other tools are available, but you can still contract HIV and pass it on to a partner."
According to a recent study by the United Nations Development Program, 20% of men in Swaziland consistently use condoms, which Hlope said might indicate that circumcised men did not stop using condoms after the procedure but had never used them in the first place. She added that education about the procedure should stress a clear and consistent message that it should be part of a variety of HIV prevention measures. "Until that happens, women will be infected with HIV this way, and ... male circumcision may do more harm than good if it is misused to deny women full protection," Hlope said (IRIN News, 7/31).
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Increase in Commercial Sex Work, Sexual Violence in Kenya Following Violence Will Undermine HIV/AIDS Efforts, AP/Google.com Reports
[Aug 04, 2008]
Both the number of teenage girls participating in commercial sex work and sexual violence have increased in Kenya following the December 2007 presidential election that resulted in political violence, and experts have said the increase will undermine the country's progress in the fight against HIV/AIDS, the AP/Google.com reports.
A recent report by the Gender Violence Recovery Center at Nairobi Women's Hospital said there already is "great fear that the gains made to reduce the prevalence of HIV in Kenya would be lost" following the violence. Teresa Omondi, head of GVRC, added, "With time, we'll start feeling the impact of this conflict on HIV and AIDS." Kenya's National AIDS Control Council also has launched a study on the effects of sexual violence on efforts to fight HIV/AIDS.
Agnetta Mirikau, a child protection specialist with UNICEF Kenya, said the increase in teenage girls working as sex workers is more noticeable in areas that were heavily affected by the violence. The mayor has expressed concern that the increase in sex work will facilitate the spread of HIV. Sammy Rutto -- mayor of Eldoret, Kenya, which was highly affected by the violence -- has ordered police to stem the spread of sex work after reports that girls as young as age 12 were seen in bars (Kennedy/Ndangi, AP/Google.com, 7/31).
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Science & Medicine
New York Times Examines Research Efforts Into Pre-Exposure Prophylaxis
[Aug 04, 2008]
By the middle of next year, more people from around the world will be enrolled in trials to test pre-exposure prophylaxis as an HIV prevention method than in trials for HIV vaccine candidates or microbicides, according to a report released Sunday by the AIDS Vaccine Advocacy Coalition at the opening of the XVII International AIDS Conference in Mexico City, the New York Times reports. After "bleak findings" from trials testing other HIV prevention methods, including microbicides and HIV vaccines, many HIV/AIDS experts have said that PrEP is the most promising research in HIV prevention, the Times reports.
Initial findings from the trials could be available as early as next year. The trials are testing whether the antiretroviral tenofovir can be used alone or in combination with the antiretroviral emtricitabine to prevent HIV transmission. The trials also aim to establish whether it is safe for HIV-negative people to take the drugs and what effect PrEP has on people who contract HIV while taking the drugs.
Up to 15,000 people -- including men who have sex with men; heterosexual men and women; and discordant couples, in which one partner is HIV-positive and the other is HIV-negative -- in Botswana, Brazil, Ecuador, Kenya, Malawi, Peru, South Africa, Tanzania, Thailand, Uganda and the U.S. are expected to be enrolled in the trials by mid-2009. USAID, CDC and NIH are providing partial funding for all of the trials, while the Bill & Melinda Gates Foundation is providing support for two of the trials, the Times reports.
According to AVAC, even if PrEP is proven successful, it will need to be combined with other prevention measures, including safer sex practices and use of clean needles.
In addition, the findings are likely to raise additional questions, such as whether taking PrEP just before sexual contact can be effective in preventing HIV transmission, the report said (Altman, New York Times, 8/4).
The report also identifies five priority issues for PrEP:
Ensuring that current trials have the best chance of producing data to determine the next steps;
Identifying and investing in additional research on PrEP;
Planning for optimal use of PrEP;
Preparing for global procurement and delivery of PrEP; and
Providing adequate funding (AVAC release, 8/3).
"We cannot wait for the study results to begin to prepare for the optimal use and delivery of PrEP," Pedro Goicochea, an investigator for a PrEP study in Ecuador and Peru, said. He added, "Instead we should look ahead to consider all of the possible outcomes of these trials and make real plans for making PrEP available to those who can benefit from it as quickly and safely as possible if it is proven effective" (New York Times, 8/4).
AVAC Executive Director Mitchell Warren added that the HIV/AIDS research community "cannot shy away from discussing issues such as potential drug resistance, the difficulty of adhering to a once-a-day pill regimen for people who are [HIV-negative] or the cost of providing PrEP," adding that the report "lay[s] the groundwork for these important discussions" (AVAC release, 8/3).
The report is available online (.pdf).
Kaisernetwork.org is the official webcaster of the XVII International AIDS Conference in Mexico City. Click here to sign up for your Daily Update e-mail during the conference.
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Human Growth Hormone Could Reduce Fat Deposits Caused by HIV Treatment, JAMA Study Finds
[Aug 04, 2008]
Low doses of human growth hormone can reverse some of the abnormal fat distribution caused by HIV treatment and lower the risk of cardiovascular disease, but the hormone could increase the risk of side effects in people who have early stages of diabetes, according to a study published in the Journal of the American Medical Association and presented Sunday at the XVII International AIDS Conference, the Los Angeles Times reports.
According to the Times, about 40% of males and 16% of females who take antiretroviral drugs develop visceral fat in the stomach, neck and cheeks, which is associated with higher levels of cholesterol and triglycerides and can increase the risk of heart attacks and stroke. Such patients typically have abnormally low levels of growth hormones, and researchers had hoped that replacing those hormones with genetically engineered human growth hormone might reverse the effects, the Times reports. However, previous studies using higher levels of the hormone produced "unacceptable" side effects, including tissue swelling and joint pain, according to the Times.
The study, led by Steven Grinspoon of Harvard Medical School, involved 56 people with HIV who had fat deposits in their stomachs and low blood levels of the hormone. Half of the people received daily doses of 0.33 milligrams of the hormone -- less than the two to four milligrams used in previous studies -- and the other half received a placebo. During the 18-month study, stomach fat dropped by 8.5% in people receiving the hormone, compared with 1.6% with the placebo group, the Times reports. However, tests showed some elevation of blood sugar in patients receiving the hormone, particularly among those who had abnormal glucose tolerance tests at the beginning of the study. The researchers did not study cardiovascular risk among the patients.
Grinspoon said the hormone produced good results but would have to be used carefully to avoid inducing diabetes (Maugh, Los Angeles Times, 8/4). He also said use of the hormone is "not a panacea" (Tanner, AP/Google.com, 8/3). Grinspoon added that future trials should involve a diabetes drug, such as metformin, to reduce side effects (Los Angeles Times, 8/4). New antiretrovirals that produce fewer side effects also are needed, according to Grinspoon.
Jeffrey Lennox, an AIDS expert at Emory University, said that although there were fewer side effects with lower doses, the results of the study were "disappointing." Lennox said the results suggest hormone injections at best have limited use for treating fat abnormalities associated with HIV treatment (AP/Google.com, 8/3).
The study is available online.
Kaisernetwork.org is the official webcaster of the XVII International AIDS Conference in Mexico City. Click here to sign up for your Daily Update e-mail during the conference.
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Public Health & Education
HIV Risk Behaviors Among U.S. High School Students Decline, Study Finds
[Aug 04, 2008]
The percentage of U.S. high school students engaging in sexual behaviors that can spread HIV and other sexually transmitted infections declined between 1991 and 2007, according to a study published Friday in CDC's Morbidity and Mortality Weekly Report, Reuters Health reports.
For the study, researchers analyzed data from several Youth Risk Behavior Surveys conducted during the study period and found that the percentage of high school students who were sexually experienced decreased by 12%. The researchers also found that the percentage of students who had multiple sexual partners decreased by 20% and that the percentage who were currently sexually active decreased by 7%. During the study period, the percentage of students who used a condom increased by 33% (Reuters Health, 7/31).
Between 1995 and 2007, the prevalence of injection-drug use among high school students remained below 4%. The study did find a significant increase in injection-drug among black and Hispanic students (MMWR, "Trends in HIV- and STD-Related Risk Behaviors Among High School Students-United States, 1991-2007," 8/1).
According to the report's findings, risky behaviors among black, Hispanic and male students did not decrease to the same extent as observed in the overall study group. In addition, from 2005 to 2007, the researchers found no significant changes in the prevalence of risky behaviors, according to Reuters Health.
In a related report, CDC researchers found that most U.S. secondary schools include HIV prevention education as part of their health curricula. Of the states surveyed, New York had the highest percentage of schools that taught HIV prevention at 99.3%, and Arizona had the lowest percentage at 35.6%. The researchers also found that only a few of the school surveyed provide information on all 11 prevention topics listed on the study questionnaire. According to the authors, schools "should increase efforts to teach all HIV prevention topics" to help reduce HIV-related risk behaviors (Reuters Health, 7/31).
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Drug Access
Merck To Sell Discounted Antiretrovirals to Mexico
[Aug 04, 2008]
Mexican Health Secretary Jose Angel Cordova said drugmaker Merck has agreed to sell two antiretroviral drugs at a reduced price in Mexico, the AP/International Herald Tribune reports.
Cordova said that Merck will sell Stocrin, a first-line antiretroviral, and Isentress, a newer antiretroviral, at discounts of up to 40%. Cordova added that about 22,000 HIV-positive people in the country being treated by the Public Health Department take Stocrin and about 200 take Isentress (AP/International Herald Tribune, 8/1).
At a recent meeting with officials representing 50 humanitarian organizations, Mexican President Felipe Calderon announced that the country was in talks with the pharmaceutical industry to cut the cost of antiretrovirals. Calderon also said he would establish a commission to help negotiate the price of drugs and work to achieve fairer prices to help HIV-positive people receive treatment.
According to Prensa Latina, antiretrovirals are four times more expensive in Mexico than in other countries with comparable incomes (Prensa Latina, 7/30).
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Opinion
Donors, Recipient Countries Deserve Credit for Gains on HIV/AIDS, Los Angeles Times Editorial Says
[Aug 04, 2008]
Amid the negative reaction that UNAIDS' recent report on the HIV/AIDS pandemic drew from some global health advocates, "it's easy to lose sight of the fact that the news on AIDS is more good than bad," according to a Los Angeles Times editorial. According to the editorial, the reaction to the report "was mostly a lot of sniping" about "rich countries' slow response to the problem," political interference preventing funding from being spent appropriately and "anger that the U.S. government seems more interested in fighting the disease overseas than among African-Americans at home."
According to the editorial, "Progress might seem painfully slow" to those affected by HIV/AIDS, but "it's happening." The Times notes that the UNAIDS' report found worldwide deaths from AIDS declined by 10% in 2007, the number of people taking HIV/AIDS medication increased 10-fold over the last six years and the rate of new infections among children is declining. In addition, Congress recently agreed to triple U.S. funding for HIV/AIDS and other diseases to $48 billion over five years.
The editorial states that "AIDS advocates have a tough time acknowledging good news because they don't want donor nations to get complacent," adding that even with more funding to fight AIDS, the world likely will not reach UNAIDS' goal of universal access to treatment by 2010. The editorial concludes that "[d]onors and recipient countries are still doing plenty of things wrong," but they are "doing plenty right, too, and for that they deserve more credit than they usually get" (Los Angeles Times, 8/2).
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HIV/AIDS Treatment Efforts Need To Focus More on Nutrition, Opinion Piece States
[Aug 04, 2008]
"Tens of billions of dollars have been pledged to combat AIDS, yet donor countries have largely overlooked the role of nutrition, somehow ignoring both the scientists and the beneficiaries," Princess Haya Bint Al Hussein, a United Nations Messenger of Peace and a founding board member of Kofi Annan's Global Humanitarian Forum, writes in a Toronto Globe and Mail opinion piece. She continues, "The donors have been asked for help often enough and there are United Nations and [nongovernmental organization] projects out there to fund, but they are not getting the cash they need to provide good, nutritious food to people" living with HIV/AIDS.
Bint Al Hussein writes, "Micronutrient deficiencies often plague HIV-infected adults and children, and they can only be ended with diversified diets, fortified foods or supplements." She adds, "As food prices soar, poor families are already substituting less-nutritious foods for meat, fish, eggs and vegetables," and the "poorest families are being forced to choose between food and medicine for loved ones."
She notes that some organizations, such as Medecins Sans Frontieres, have begun to promote "food itself as necessary for healing, and not just for those affected by AIDS or tuberculosis."
She concludes, "It is time to change the way we help. Drugs alone are not a solution for AIDS or TB," asking, "What doctor would admit a patient to a hospital, give them the most advanced medications -- and then leave them to starve?" (Bint Al Hussein, Toronto Globe and Mail, 8/1).
Kaisernetwork.org is the official webcaster of the XVII International AIDS Conference in Mexico City. Click here to sign up for your Daily Update e-mail during the conference. A webcast of an Aug. 3 conference session on food security and HIV/AIDS is available online.
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Recent Releases in HIV/AIDS
Reports Released on HIV/AIDS Programs in Resource-Limited Settings and HIV/AIDS Among Hispanics; Special JAMA Issue Includes HIV/AIDS-Related Articles, Commentaries and Editorials
[Aug 04, 2008]
"From the Ground Up: Building Comprehensive HIV/AIDS Care Programs in Resource-Limited Settings," Elizabeth Glaser Pediatric AIDS Foundation: The three-volume publication provides guidance for health care workers, managers and policymakers on HIV/AIDS prevention, care and treatment in resource-limited settings, particularly in sub-Saharan Africa. The publication includes contributions from more than 230 public health experts on their experiences, insights and recommendations for the international HIV/AIDS community. In addition, each chapter provides a comprehensive summary of crucial considerations for current and future HIV/AIDS programs (Elizabeth Glaser Pediatric Foundation release, 8/1).
"The Crisis of HIV/AIDS Among Latinos/Hispanics in United States, Puerto Rico and U.S. Virgin Islands" (.pdf), Latino Commission on AIDS: The report, released in advance of the XVII International AIDS Conference in Mexico City, says that Hispanics are the second most affected community of people living with HIV in the U.S. Despite representing only 15.3% of the U.S. population, Hispanics constituted 22% of the HIV/AIDS cases diagnosed in 2006, Commission President Dennis de Leon said, adding that the situation had reached a "crisis level." According to de Leon, the commission will continue to advocate for all individuals to be tested for HIV, for culturally targeted services and for a "comprehensive response" to HIV/AIDS. In addition, de Leon called for the current and next U.S. presidential administration to formulate a "robust domestic AIDS agenda sensitive to the needs of all communities and relevant to the cultures of Hispanic communities." Guillermo Chacon, vice president of the commission, added that Hispanic communities need HIV/AIDS awareness campaigns in both Spanish and English and that outreach should extend to both rural and urban areas (Latino Commission on AIDS release, 7/30).
Theme Issue on HIV/AIDS, Journal of the American Medical Association: The Aug. 6 issue of JAMA includes articles, commentaries and editorials on HIV/AIDS, including a study from CDC providing new estimates of HIV incidence in the U.S. Other articles cover HIV-associated obesity, antiretroviral and anti-tuberculosis treatment, risk factors for HIV in Uganda and highly active antiretroviral therapy in injection drug users living with HIV. The issue also contains commentaries on HIV in Mexico, universal access to treatment and criminalization of HIV transmission, as well as an editorial on the past, present and future of HIV/AIDS (JAMA, 8/6).
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