Late Diagnosis - More AIDS Deaths

posted: 11/04/2011

12 years of UK HIV data shows that people diagnosed late with HIV (when the CD4 count was under 350) are 6 times more likely to die of AIDS than other people with HIV.Three quarters of all the people who die with an AIDS diagnosis were diagnosed with HIV late – when their CD4 cell count was below 350.
 

The researchers who gave this news to the British HIV Association Conference in Bournemouth last week, used the UK’s national HIV surveillance system data and death certificates at the Office of National Statistics, for the years 1997 to 2008.
 

While HIV deaths have plunged since combination treatments began in the mid 1990s, over 500 people with HIV die each year, and the HIV death rate is still five times higher than for the general population.
 

Over these 12 years, almost half the deaths were due to AIDS (49%). The proportion varied during this time but is not falling steadily, as we would hope.

The researchers milked the data by using advanced statistical tools. That is how they discovered that being diagnosed when the CD4 is below 350 makes people six times more likely than others with HIV to die of AIDS. They also estimate that 74% of all AIDS deaths are explained by late diagnosis. Even among people infected in the UK, 66% of AIDS deaths are linked to late diagnosis.

• Men were more likely than women to die of AIDS.
• But men who have sex with men were less likely to die than heterosexually infected men and women, whether this was in Africa, the UK or anywhere else.
• Injecting drug users had a much higher risk of death than all others.

The most common causes of AIDS deaths were PCP (a type of pneumonia common with advanced HIV illness), other AIDS-related pneumonias, non-Hodgkin's lymphoma, TB and neuro-cerebral causes.
These findings make very clear how important it is to reduce late diagnosis – NorthWest England is the worst region in England for late diagnosis.

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Gay Men and HIV Losses

posted: 12/05/2010

If you are 50 or older, a gay man and willing to talk about how HIV affected you in the early days of the epidemic, a researcher is keen to talk with you and is looking for another 30 older gay men to talk with.

Dana Rosefeld is a senior lecturer in Sociology at Keele Univerity, who is doing PhD research into the early UK epidemic.

Her study is called: ‘The Lost Generation’: The Social Worlds of Older Gay Male Survivors of the AIDS Epidemic.’

She wants to find out how older gay men experienced the AIDS epidemic, how it affected them and their friends, and how they handled the illness and deaths of friends and partners. She wants to know how the early epidemic of the 1980s and 1990s affected the men's social networks, and how the men rebuilt those social networks. And how did the HIV epidemic affected the men’s personal lives?

It will take about 1-2 hours - at a time and place of your chosing - and you will be paid £10 for your time. She may do some interviews at George House Trust.

Please contact Dana by email if you are interested.

Please avoid leaving a phone message - she may be away and not able to respond - 01782 733932.

Full details - most of your questions will be answered here

Making panels for the UK AIDS Memorial Quilt was one way for people to express their experiences of HIV in the early years.

Mbeki and HIV - 330,000 died

posted: 28/11/2008

The HIV policies of the former South African president Thabo Mbeki's government were directly responsible for the avoidable deaths of a third of a million people in South Africa, according to research from Harvard University.

South Africa has one of the most severe HIV epidemics in the world. About 5.5 million people, or 18.8% of the adult population, have HIV, according to the UN. In 2005 there were 900 deaths a day.

But from the late 90s Mbeki turned his back on the scientific consensus that HIV is caused by a viral infection which can be combated, though not cured, by sophisticated treatment. He came under the influence of maverick scientists known as AIDS-denialists, most prominent among whom was the notorious Peter Duesberg from Berkeley, California.

anti-poverty not anti-virus

In 2000 Mbeki called a round-table of experts, including Duesberg and his supporters but also their opponents, to discuss the cause of HIV. Later that year, at the international AIDS conference in Durban, he publicly rejected the accepted wisdom. AIDS, he said, was indeed brought about by the collapse of the immune system - but not because of a virus. The cause, he said, was poverty, bad nourishment and general ill-health. The solution was not expensive western medicine but the alleviation of poverty in Africa.

In a new paper Harvard researchers have quantified the death toll resulting from Mbeki's stance, which caused him to reject offers of free drugs and grants and led to foot-dragging over a treatment programme, even after Mbeki had taken a vow of silence on the issue.

"We contend that the South African government acted as a major obstacle in the provision of medication to patients with AIDS," write Pride Chigwedere and colleagues from the Harvard School of Public Health, Boston, in the Journal of Acquired Immune Deficiency Syndrome.

S African delays while treatment rolls out elsewhere

They have made their calculations by comparing the scale-up of treatment programmes in neighbouring Botswana and Namibia with the limited availability of drugs in South Africa from 2000-2005.

Expensive antiretrovirals came down in price dramatically as a result of activists' campaigning and public pressure. In July 2000 the pharmaceutical company Boehringer Ingelheim offered to donate its drug nevirapine, which could prevent the transmission of HIV from mother to child during labour. But South Africa restricted the availability of nevirapine to two pilot sites a province until December 2002.

Eventually, under international pressure, South Africa did launch a national programme for the prevention of mother to child transmission in August 2003 and a national adult treatment programme in 2004. But by 2005, the paper's authors estimate, there was still only 23% drug coverage and less than 30% prevention of mother to child transmission.

By comparison, Botswana achieved 85% treatment coverage and Namibia 71% by 2005, and both had 70% mother to child transmission programmes coverage.

more than 330,000 people died unnecessarily in South Africa

The authors estimate that more than 330,000 people died unnecessarily in South Africa over the period and that 35,000 HIV-infected babies were born who could have been protected from the virus but would now probably have a limited life.

Their calculations will withstand scrutiny, they say. "The analysis is robust," said Dr Chigwedere. "We used a transparent and accessible calculation, publicly available data, and, where we made assumptions, we explained their basis. We purposely chose very conservative assumptions and performed sensitivity analyses to test whether the results would qualitatively change if a different assumption were used."

The authors conclude: "Access to appropriate public health practice is often determined by a small number of political leaders. In the case of South Africa, many lives were lost because of a failure to accept the use of available ARVs to prevent and treat HIV in a timely manner."

Since Mbeki's ousting from the leadership of the African National Congress in September, South Africa has urgently pursued new policies to get treatment to as many people as possible under a new health minister, Barbara Hogan.
 

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