Kaisernetwork.org (Washington, DC)
6 January 2009
Drug Access
India Introduces Second-Line Antiretroviral Treatment in Eight States
[Jan 06, 2009]
India's National AIDS Control Organization is expanding the availability of second-line antiretroviral treatment to HIV-positive people resistant to first-line drugs, the Times of India reports. Now available in eight states, previously, only Mumbai's J. J. Hospital and Chennai's Tambaram ART Center offered second-line treatment. Under the program, the drugs will be available from the School of Tropical Medicine in Kolkata, B. J. Medical College in Ahmedabad, and additional clinics in Bangalore, Hyderabad, Manipur and Varanasi.
According to Sujatha Rao, NACO director general, the centers in Bangalore and Hyderabad already have introduced second-line therapies and six additional centers have begun recruiting eligible patients for treatment. Rao added that NACO has provided viral load testing kits to the centers and trained physicians to administer the second-line drugs. B. B. Rewari, NACO's national program officer, said the program aims to place 3,000 people living with drug-resistant HIV on second-line antiretroviral treatment by 2009. He added that patients who already are registered in NACO's antiretroviral treatment centers will be eligible for second-line treatment after approval by a panel of experts. All patients on second-line drugs will receive a treatment course of seven tablets per day and must undergo three rounds of mandatory counseling, Rewari said.
According to Rewari, UNITAID will donate the second-line drugs to India at no cost through the William J. Clinton Foundation for the first two years of the program, after which NACO will negotiate with five Indian pharmaceutical companies to purchase the drugs. About 160 HIV-positive people in eight Indian states are currently receiving second-line treatment, the Times of India reports. India in January 2008 began introducing second-line treatment, which costs NACO about 100,000 Indian rupees, or about $2,055, per patient annually. According to NACO estimates, of the 195,000 people receiving HIV treatment in India, about 3% likely will become resistant to first-line drugs, primarily because of poor treatment adherence. NACO currently provides antiretroviral treatment through 190 centers and aims to expand access to 250 centers by 2012, according to the Times of India (Sinha, Times of India, 1/5).
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Public Health & Education
Cell Phone Soap Operas Promote Condom Use, HIV Awareness
[Jan 06, 2009]
A new campaign aims to provide women with messages about HIV awareness, safer sex and condom use through a series of 12 soap opera vignettes that can be viewed on a cell phone, the AP/Atlanta Journal-Constitution reports. Rachel Jones, an educator at Rutgers University's College of Nursing, developed the campaign using professional actors and scripts based on focus groups with women in Newark and Jersey City, N.J.
The soap opera's 20-minute episodes feature "nitty gritty stories of risk and risk reduction" with which women can identify, Jones said. She added that cell phones allow women to have privacy when viewing the episodes and enables them to watch them repeatedly. Jones said she believes that "knowledge alone is not effective at changing behaviors" but that woman in the targeted communities might change their behaviors if they identify with characters in the videos. According to Jones, many women experience pressure from their partners to have unprotected sex, and "[t]hese relationship concerns can feel much more important in the moment for some women than reducing HIV/AIDS, which can feel more distant." She added that the videos aim to "normalize condom use." According to Jones, 82% of new HIV infections affecting people ages 18 to 29 are transmitted through heterosexual sex with an HIV-positive partner. Jones said the percentage of HIV cases transmitted through heterosexual sex is "astounding" because the virus is a "completely preventable infection."
The Healthcare Foundation of New Jersey provided funding for the project and NIH recently granted $2 million for a study assessing the effectiveness of the campaign. For the NIH study, which will involve 250 women, one group of participants will watch the soap operas on their cell phones. Researchers will then measure their risk-reduction behavior against a control group receiving text messages, but no video, encouraging condom use. At the end of the study, all participants will receive a DVD of the soap opera episodes, which also will be available online (Delli Santi, AP/Atlanta Journal-Constitution, 1/5).
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Global Challenges
Debate Over Mandatory HIV Testing Increases in Malaysia, New Cases Up Among Married Women
[Jan 06, 2009]
The Malaysian government plans to expand a rule requiring HIV screening for all couples, despite protests from HIV/AIDS experts and civil rights advocates who argue that such a policy does not prevent transmission of the virus and violates individual rights, Inter Press Service reports.
A limited mandatory testing policy recently was extended by Muslim clerics to cover all Muslim couples seeking to get married, based on an argument made by non-Muslim organizations, individuals and religious groups that HIV transmission can be curbed only through mandatory testing of all couples. Najib Razak, deputy prime minister, has expressed support for extending the mandatory testing policy to all couples, and Inter Press Service reports that he has strong support from the public and other officials. Some Malaysian officials also have suggested rules that would prevent couples with HIV from having sex or reproducing and that would quarantine HIV-positive people in specially constructed camps or isolated islands to "safeguard" the general population, according to Inter Press Service.
According to Inter Press Service, the debate over the mandatory screening policy has "exposed fear and ignorance within government" and has "revealed a deep gulf in thinking" in Malaysia. The debate comes as Malaysian officials report a 50% decrease in the number of HIV cases in recent years since the introduction of a campaign to curb needle sharing among injection drug users through no-cost needle distribution and harm-reduction methadone treatment programs. However, a 35% increase in the number of cases among married women ages 21 to 35 was reported, "a new trend that has alarmed the government," Inter Press Service reports. The report, by the Ministry of Health and UNICEF, found that HIV cases transmitted through sex among married women increased from 5% in 1997 to 16% in 2007. According to Inter Press Service, the government has ordered a more in-depth study regarding the increase, and experts are attributing the increase to husbands who contract the virus through unprotected sex with commercial sex workers and then transmit it to their wives.
Malaysia's health ministry reported that the number of new HIV cases decreased from 6,900 in 2007 to 5,400 in 2008. The ministry expects the number of new cases to drop to 3,500 in 2009. According to the United Nations, more than 85,000 HIV cases have been recorded in Malaysia since 1986, and estimates show that about 80,000 people are currently living with the virus (Kuppusamy, Inter Press Service, 1/5).
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IRIN/PlusNews Profiles PNG Commune for People Living With HIV/AIDS
[Jan 06, 2009]
IRIN/PlusNews on Friday profiled a commune operated by HIV advocate Paul Ari designed for HIV-positive people who have experienced stigma and discrimination near Mount Hagen, the capital of Papua New Guinea's Western Highlands province.
According to IRIN/PlusNews, people are able to stay at the commune for as long as they need, and relatives are encouraged to visit to help fight stigma related to the virus. Ari said he "show[s] (family members) there's no way they can get the virus" by eating and sharing with the people at the commune, adding that he wants the families to take "ownership" of the commune's clients before they leave. Ari and the commune receive "next to no financial support" to operate the facilities, which include a traditional raffia hut for women and older married men, a smaller hut for younger men and a "contemplation center" for meditation, IRIN/PlusNews reports. Funding to care for the 14 people currently staying at the commune is generated through farming and livestock efforts.
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