Kaisernetwork.org (Washington, DC)
15 August 2008
AIDS 2008
Science Examines HIV/AIDS Prevention, Treatment Strategies Discussed at Last Week's Conference in Mexico City
[Aug 15, 2008]
The journal Science in its Aug. 15 issue examined the "intense scrutiny" that HIV/AIDS prevention and treatment received during last week's XVII International AIDS Conference in Mexico City. Mike Cohen of the University of North Carolina-Chapel Hill at the conference said the two efforts "keep going to the altar," but "[t]hey never get married. They have to get married today."
According to Cohen and other delegates at the conference, although there have been considerable gains in HIV/AIDS treatment, such efforts have overshadowed prevention needs. Science reports that three million people in low- and middle-income countries now have access to antiretroviral drugs but that an estimated five people contract HIV for every two provided with treatment. UNAIDS Executive Director Peter Piot said, "There has not been that push for prevention as there's been for treatment," adding, "If we thought the first phase was hard, we have to prepare for even tougher times."
Science reports that a significant issue surrounding treatment and prevention is that the success of antiretrovirals in lowering viral loads and making HIV-positive people less infectious has led to the "increasing awareness that treatment is prevention, both for individuals and populations." However, "the degree to which the drugs can prevent infections has proved highly contentious," according to Science. For example, a study by the Swiss Federal Commission for HIV/AIDS concluded that couples with one HIV-positive partner do not need to use condoms to prevent HIV transmission provided that the HIV-positive person is taking antiretrovirals, has had an undetectable viral load for six months and has no other sexually transmitted infections. Kevin de Cock, head of the World Health Organization's HIV/AIDS Department, said, "It just doesn't seem like a cautious public health recommendation," adding, "I don't think anyone's shown the threshold below which people cannot transmit" HIV.
Further contention surrounding treatment and prevention at the conference, according to Science, included the degree to which ongoing treatment can prevent transmission on a population-wide scale. Although a study published in the Canadian Medical Association Journal found that treatment led to a decrease in HIV transmission in the province of British Columbia, epidemiologist Geoffrey Garnett of Imperial College London said that antiretrovirals are unlikely to have a large effect on transmission on a global scale. About 80% of HIV-positive people are not aware of their status, and of those who do, most are not eligible for no-cost treatment until their immune systems have been damaged. According to Science, this means that most HIV transmissions "occur long before people are taking the drugs."
Garnett and others encouraged HIV/AIDS researchers to embrace the notion of "combination prevention." According to Garnett, by combining treatment with preventive measures, such as condom use and male circumcision, it might be possible to create "a natural synergy." He added, "Rather than arguing for a single magic bullet, we really need to be trying to focus everything that we can on what works to realize these natural synergies" (Cohen, Science, 8/15).
Kaisernetwork.org was the official webcaster of the XVII International AIDS Conference in Mexico City. Kaisernetwork.org interviews with Science correspondent Jon Cohen during the week of the AIDS conference are available online.
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Global Challenges
Organizations, Health Insurance Company Launch Insurance Program for HIV-Positive People in India
[Aug 15, 2008]
Nongovernmental organizations and a health insurance company on Wednesday launched an insurance program for people living with HIV in the Indian state of Karnataka, The Hindu reports. The program -- the first of its kind in India -- was launched by Population Services International, the Karnataka Network for Positive People and the insurance company Star Health and Allied Insurance (The Hindu, 8/14). The program also is supported by USAID.
More than 250 HIV-positive people will be included in the project's initial stages, according to the Hindustan Times (Sharma, Hindustan Times, 8/13). The group health plan will provide coverage worth 30,000 rupees -- or about $700 -- for HIV-positive people, including 15,000 rupees -- or about $350 -- for hospitalization at the onset of AIDS and $350 for treatment. The premium of 1,500 rupees -- or about $30 -- will be subsidized by up to 50% by the groups involved in the program, according to the Indian Express.
The program was introduced in the districts of Bangalore, Bellary, Kolar, Mangalore, Mysore and Udupi. Hospitals have been told about the program and instructed not to turn away people living with HIV, according to C.P. Udayachandran, assistant vice president at Star Health and Allied. Although India's National AIDS Control Organisation is not directly involved in the program, NACO has started speaking with insurance companies at the national level to develop a nationwide plan for people living with HIV and their families, the Express reports. NACO Director Sujatha Rao said, "We are trying to work on an insurance policy that will provide a package of services. We want to include even healthy people and families of those with HIV." According to Rao, a "scheme for only [HIV-positive people] would mean higher premiums" (Indian Express, 8/14).
The program is a "milestone in the fight against the discrimination of people living with HIV," Asha Ramaiah, general secretary of the Karnataka network, said, adding, "This health insurance will allow us to get the best possible treatment and change the perception that we are a financial burden on our families." Rao added that the program is a "first step to breaking down financial barriers of HIV-positive people in accessing treatment" (Hindustan Times, 8/13).
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HIV-Positive Drug Users in Thailand Experience Difficulties Accessing Treatment, Advocates Say
[Aug 15, 2008]
Although many injection drug users in Thailand are HIV-positive, the government's campaign to curb drug use makes it difficult for IDUs to access no-cost antiretroviral treatment provided by the government, advocates said recently, VOA News reports. According to VOA News, an estimated half of the country's 100,000 to 250,000 IDUs are HIV-positive. Some groups say that because health care providers often share IDU's medical records with police, the population is unwilling to seek treatment. Thailand's policies on illegal drug use -- which some human rights groups say resulted in almost 3,000 deaths among users and dealers in 2003 -- lead many IDUs into hiding, where their risk of contracting HIV is increased because of shared needles and a lack of services, according to VOA News.
The groups Human Rights Watch and the Thai AIDS Treatment Action Group say that many HIV-positive drug users regularly are denied treatment at public hospitals in Thailand. Karyn Kaplan, director of policy and development with the Thai AIDS Treatment Action Group, said the majority of people the group works with are HIV-positive IDUs who do not have access to HIV/AIDS services "because the government has neglected the issue" despite a "20-year epidemic raging amongst this community." Petchsri Sirinirund, senior expert in preventive medicine at Thailand's Department of Disease Control, said that although some health care providers might not provide HIV-positive IDUs no-cost treatment, the government has "adopted programs to train workers to treat such patients." She said that health officials have been trying to use the "perspective" of people living with HIV to improve interactions between health care providers and patients. In addition, Petchsri said that the National Health Security Office next year will begin publicly funding methadone treatment programs for IDUs. Rights groups have said that in order to help all people living with HIV/AIDS in Thailand, the government should end human rights violations against drug users and work to eliminate prejudices toward the group (Goodman, VOA News, 8/13).
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USAID Launches Short-Film Competition To Promote HIV/AIDS Awareness, Prevention in Nepal
[Aug 15, 2008]
USAID recently launched a short-film competition, called "You Are No Exception," to promote HIV/AIDS awareness and prevention in Nepal, the Kathmandu Post reports. According to a report by the agency, many people living in rural parts of Nepal do not use condoms because they associate them with commercial sex work and immoral behavior.
Organizers said the competition provides eight Nepali filmmakers with the opportunity to create short films to educate audiences about HIV/AIDS, convey prevention messages and promote better understanding of individual risk. Participant Punendu Jha added that the competition aims to address social taboos and myths associated with the purchase and use of condoms, increase individual understanding of HIV risk and promote the use of condoms.
Alok Nembang, a filmmaker associated with the competition, said, "If we really want to prevent HIV from spreading, perhaps the first thing we need to let people know is, HIV/AIDS is not limited to any specific group of people," adding that HIV/AIDS "is not an endemic restricted to sex workers or drug users only." Dovan Rai, the scriptwriter of a film featured in the competition, said, "When it comes to HIV/AIDS, it is more than just a disease. The social harassment and stigmatization to [HIV-positive people] persist because we've still not been able to accept that we're not an exception either."
The Post reports that the selected films will be screened throughout the country and are expected to reach about 70% of the population. The initiative also includes other activities to promote awareness and prevention, including a celebrity advocacy campaign and a partnership with the Hotel Association of Nepal to provide condoms to their clients. USAID's Nepal project, which is run by the Academy for Educational Development, also is undertaking prevention campaigns that address stigma and discrimination associated with HIV/AIDS and promote empowerment. The project also aims to increase the availability and use of products and services for family planning, maternal and child health, HIV and other sexually transmitted infections (Kathmandu Post, 8/13).
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Drug Access
Ugandan Pharmaceutical Company To Produce Drugs Aimed at Preventing Mother-to-Child HIV Transmission
[Aug 15, 2008]
The Ugandan pharmaceutical company Quality Chemicals later this year will begin producing antiretroviral drugs aimed at preventing mother-to-child HIV transmission in the country, George Baguma, the company's director of marketing, announced on Tuesday, the Monitor/AllAfrica.com reports. The company expects to start producing the drugs by November, according to the Monitor/AllAfrica.com. More than 25,000 children annually in Uganda contract HIV from their mothers during labor or through breastfeeding. "These drugs will allow [HIV-positive] mothers to safely breastfeed without any worry about infecting their children," Baguma said.
Of the estimated 50,000 children in Uganda who need antiretrovirals, only about 12,000 have access to the drugs, the Monitor/AllAfrica.com reports. According to Baguma, Quality Chemicals imports the latest ingredients used in the production of low-cost antiretrovirals to ensure widespread access and to prevent drug resistance (Lugya, Monitor/AllAfrica.com, 8/14).
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