Kaisernetwork.org (Washington, DC)
14 August 2008
Across The Nation
NPR Program Profiles HIV/AIDS Advocates
[Aug 14, 2008]
NPR's "Tell Me More" on Wednesday profiled two HIV-positive advocates in the black community. According to a recent report from the Black AIDS Institute, nearly 600,000 blacks in the U.S. are living with HIV/AIDS, and more than 20,000 blacks contract the virus annually. HIV/AIDS also is the leading cause of death for black women ages 25 to 34, according to "Tell Me More."
Rae Lewis Thornton, an HIV/AIDS advocate who has been HIV-positive for almost 20 years, said there continues to be a "disconnect" in the U.S. between one's personal life and HIV. "The earlier images of HIV really impacted America," Thornton said, adding, "We still by and large believe it's white, we believe it's male, we believe it's gay, we believe it's other, we believe it's, you know, women who are promiscuous, and we think it's not me." According to Thornton, the "fact of the matter is that people hear about HIV and we know about HIV but we never believe that HIV could happen to us."
Marvelyn Brown -- author of the book "The Naked Truth: Young, Beautiful and (HIV) Positive," who was diagnosed with HIV in 2003 at age 19 -- added that many teenagers are aware of HIV but are more concerned with other issues. "I'm pretty sure HIV presented itself several times, I just never thought it could happen to me so I didn't care," Brown said. Thornton added that the black community has not "done a very good job" on educating people on "what it really means to have to manage this disease on a day-to-day basis."
Brown and Thornton during the program also discussed HIV-associated stigma, reaction from family about their HIV diagnoses and HIV prevention in the black community (Martin, "Tell Me More," NPR, 8/13).
A kaisernetwork.org interview with Brown is available online. A press conference about HIV/AIDS among blacks in the U.S. that took place at the XVII International AIDS Conference also is available online.
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Global Challenges
Commission on AIDS in Asia Releases Report About Prevention Efforts in Region
[Aug 14, 2008]
The Commission on AIDS in Asia last week at the XVII International AIDS Conference in Mexico City released a report about prevention efforts being made by countries in the region, the Jakarta Post/Asia News Network reports. According to the report, Cambodia, Myanmar, Thailand and some states in India are among areas with high HIV/AIDS burdens that have experienced successes with their prevention efforts. The report also found that China, Malaysia, Indonesia, Nepal and Vietnam and some states in India with low HIV/AIDS prevalences are among areas with moderate HIV/AIDS risks but have seen limited success with prevention initiatives.
According to the report, men's resistance to condom use in Indonesia could contribute to a large increase in the number of HIV/AIDS cases in the country during the next few years. Nafsiah Mboi, secretary to Indonesia's National AIDS Commission, said, "Our prevention measures have yet to reach optimum success because many high-risk people here still refuse to use condoms even though we have actually managed to reach them" through campaigns promoting condom use. She added, "This is different from Cambodia, for example, where people are willing to comply with the government campaigns for use of condoms."
Although about 5% of men in Indonesia visit commercial sex workers, only 30% of this population are willing to use condoms, Kemas Sirefar, deputy secretary for development at the AIDS commission, said, adding that if Indonesia does not take increased action to curb the spread of HIV/AIDS, the number of people living with the disease could increase to more than one million by 2020. According to Mboi, the increase in HIV/AIDS in part would be because of the growing number of male clients of commercial sex workers, as well as the stigmatization of groups such as men who have sex with men (Maulia, Jakarta Post/Asia News Network, 8/14).
Kaisernetwork.org was the official webcaster of the XVII International AIDS Conference in Mexico City. A webcast of a session about HIV/AIDS in Asia and the Pacific is available online.
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Married Women in India Who Experience Physical, Sexual Abuse by Husbands More Likely To Contract HIV, Study Finds
[Aug 14, 2008]
Married women in India whose husbands physically and sexually abuse them are about four times more likely to contract HIV compared with married women in the country who do not experience abuse, according to a study published recently in the Journal of the American Medical Association, Reuters UK reports. Researchers, led by Jay Silverman of the Harvard School of Public Health, examined data from India's National Family Health Survey between 2005 and 2006. The data included information about 28,139 married women.
More than one-third of the women in the study reported experiencing physical violence with or without sexual abuse by their husbands. Of these women, 28% experienced only physical violence, while 7.7% reported both physical and sexual abuse. The risk of HIV among the women who experienced both physical and sexual violence increased by a magnitude of 3.9 compared with women who did not experience abuse, according to the study.
The researchers said that they confirmed earlier studies indicating that men who have extramarital relationships, including unprotected sex with commercial sex workers, are the primary source of HIV among women in India. More than 95% of HIV-positive Indian women report being monogamous, the researchers said, adding that extramarital relationships on the part of their husbands help explain why many women who experience abuse are contracting the virus. "A woman who is abused by her husband is truly placed in a situation of 'double jeopardy' regarding HIV infection," Silverman said, adding that a husband's "sexual behavior outside of the marriage makes it more likely he is infected with the virus, and his abusive behavior inside the marriage leaves her with little over control sex or sexual protection" (Reuters UK, 8/12).
An abstract of the study is available online.
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Mathematicians, Graduate Students Travel to Botswana To Develop Formulas To Address HIV/AIDS, Other Diseases
[Aug 14, 2008]
Two Canadian mathematicians and a team of 25 Canadian and African graduate students will travel to Botswana next week for a workshop on controlling the spread of infectious diseases -- such as HIV/AIDS, malaria and tuberculosis -- using mathematical equations and formulas, CP/CBC News reports.
According to Arvind Gupta -- scientific director of Mathematics of Information Technology and Complex Systems, a Canadian math research network that is organizing the trip -- the team intends to develop mathematical models "so that when there's a disease outbreak, health officials have some idea how to answer 'what if' questions." The models can increase understanding of a disease by examining how people interact with others, Gupta said, adding that these interactions could help predict how the disease might spread. "Once you understand how much interaction there is, you can actually start predicting when you think the disease will get to other groups," Gupta said. In addition, the mathematical models could help officials develop plans detailing which groups to target with education campaigns and where to send medical supplies.
Abba Gumel, a math professor at the University of Manitoba who is leading the project, added that it is important for people in developed countries to design such projects because outbreaks of TB and other diseases in "one part of the world" make the rest of the world "vulnerable" because of international travel (CP/CBC News, 8/12).
The workshop -- co-funded by Industry Canada through the International Partnership Initiative -- is part of a series of activities of the MITACS Canada - Africa Biomath Network, which aims to encourage collaboration between mathematicians and public health scientists from Canada and Africa to control the spread of malaria, TB, HIV/AIDS and other diseases using mathematical science (Canada Business News Network, 8/12).
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Uganda Launches Male Circumcision Drive To Help Curb Spread of HIV
[Aug 14, 2008]
Uganda has launched a male circumcision drive in an effort to curb the spread of HIV in the country, Reuters reports. According to Reuters, the campaign -- which aims to circumcise more than 3,000 local young men between ages 12 and 18 -- aligns with a month-long traditional "circumcision season" practiced by some tribes in Uganda. Male circumcision is socially "uniting," and it is "gratifying" that the procedure has been shown to reduce a man's risk of HIV, Kibale Wambi, chair of the Sironko district in eastern Uganda, said.
Some HIV/AIDS advocates say that more funding and effort is needed for making circumcision available worldwide, according to Reuters. However, some critics of male circumcision say that the procedure can be dangerous, especially in settings where the same instruments are used for multiple circumcisions. For this campaign, the Ugandan government has implemented a one-knife-per-procedure policy to prevent the spread of infections, Reuters reports. "If a knife is to be re-used on another person, it first has to be sterilized," Wambi said, adding, "We have also discouraged the traditional practice of forcing the circumcised males into sexual intercourse to prove their manhood after the wound heals to avoid the spread of" sexually transmitted infections. Some experts have expressed concerns that newly circumcised men might believe they are immune to HIV/AIDS following the procedure, which could contribute to an increase in risky sexual behavior, according to Reuters (Nyakairu, Reuters, 8/13).
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Science & Medicine
Researchers Hoping That 'Elite Controller' Could Help in HIV/AIDS Vaccine Development
[Aug 14, 2008]
An HIV-positive woman who has never shown symptoms of the virus might provide insights into HIV/AIDS vaccine development, researchers from Johns Hopkins University said in a study recently published in the Journal of Virology, Reuters reports.
The woman, a so-called "elite suppressor," contracted HIV 10 years ago from her husband, a former injection drug user. Although her husband takes antiretroviral drugs to control his viral load, the woman does not need to take the drugs to keep her viral load at undetectable levels. The couple, who has been monogamous for at least 17 years, has the same strain of HIV. According to the researchers, the key difference in their ability to control the virus is the woman's immune system.
Joel Blankson, who led the study, said that the role of the woman's immune system is a "good sign in terms of developing a therapeutic vaccine," which would not prevent transmission of the virus but could be used to prevent HIV-positive people from progressing to AIDS (Fox, Reuters, 8/12).
The researchers said the study disproved some theories about elite suppression, including those that claimed such suppression always involved a defective or weakened HIV strain, which is easier for the immune system to attack, or that genetic variants confer a protective effect in suppressors. According to Blankson, "This an extremely rare case of coinfection in a controlled, monogamous relationship, which showed us how a strong immune system in the elite suppressor kept the virus from replicating and infecting other cells." Blankson added, "Our findings offer hope to vaccine researchers because they reveal that the immune system's primary offense, known as CD8 killer T-cells, can effectively halt disease progression by a pathogenic form of HIV" (IANS/Yahoo! News, 8/12).
Tests conducted by the researchers indicate that the woman's CD8 cells stalled HIV replication by as much as 90%, while the man's cells stalled replication by 30%. In an apparent response to this attack by her immune system, the woman's HIV also has mutated to become weaker, while the man's HIV has remained strong, Reuters reports.
According to Blankson, the researchers are trying to figure out how the woman's T-cells work to inhibit viral replication. According to Reuters, the researchers determined that while the man's T-cells make only one kind of cytokines -- which are immune system signaling proteins -- called gamma interferon, the woman's made that one and another called tumor necrosis factor. However, the cytokines cannot explain the woman's ability to suppress HIV, Reuters reports, because HIV/AIDS researchers have tried using such immune system proteins in patients and found they did not work well. Furthermore, the woman's immune cells seem to respond in this manner only when they encounter the virus. Blankson said the case could be explained by the possibility of the woman having unusual activity in her human leukocyte antigen system, which helps recognize bacterial and viral antigens (Reuters, 8/12).
The study is available online.
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