Treatment for Prevention

posted: 04/06/2010

"The strongest evidence to date" shows that HIV treatments can be used to prevent the passing on of HIV, reports the medical journal The Lancet. Treating HIV-positive heterosexual people in one recent African study reduced the risk of HIV transmission to their sexual partners by 92 percent. That is as good or better than condoms in cutting the risk of HIV transmission.

HIV transmission risks
More than 3,400 heterosexual couples, in which one partner had HIV and the other did not, in seven African countries (Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia), were in the study.
 

"At the beginning of the study, the HIV-infected members had high CD4 counts and were not on antiretroviral treatment. Couples were provided with counselling and prevention services, followed for up to two years, with regular CD4 measurements and ART [Anti-Retroviral Therapy = HIV treatments] referrals made when they became eligible for ART".
 

After treatment of HIV positive partners: one infection
349 of the partners living with HIV in this study began taking HIV treatments. While 103 partners became HIV positive during the study, only one caught HIV after their partner with HIV started taking HIV treatments.
 

Deborah Donnell of the Vaccine and Infectious Disease Institute in Seattle, Washington state, USA, who was the study’s leading author, said HIV treatments cut the HIV Viral Load to low levels, making people far less infectious. 70% of the partners taking HIV treatments in this study saw their Viral Load fall to very low levels. A randomized trial has now begun to check this reduction in HIV transmission between partners continues.
 

"While awaiting those results, our study indicates that initiation of antiretroviral therapy may have a significant public health benefit as well as clinical advantages for the individuals being treated," Donnell said in a statement.
 

Test and Treat Prospects
This supports earlier research that suggested “the spread of HIV in hard-hit African nations could be cut by 95 percent in a decade, if all those infected started taking medicines immediately. That so-called test-and-treat theory has been disputed in other mathematical models that say those projections are based on flawed assumptions".
 

Warnings
The authors, like many clinicians, are worried that people with HIV will treat this news as permission to give up condoms. One of several critical requirements is avoiding sexually transmitted infections (STI). If either partner has an STI, that raises the risks of HIV being passed on. Many STIs show no symptoms. This study was of heterosexual couples – and HIV transmission risks for men who have sex with men are rather higher than for heterosexual couples.
 

"Although the 92% reduction in HIV-1 transmission that we report is highly encouraging, on an individual basis, counselling is needed to reinforce understanding that potential for HIV-1 transmission to partners remains after ART initiation," write the authors of the study. "This cohort received frequent counselling during 3-monthly follow-up, and we noted no evidence of behavioural risk disinhibition after ART initiation."
 

Test and Treat?

The authors conclude: "As countries strategise for optimum use of resources to expand ART provision beyond individuals with low CD4 cell counts, targeting of treatment to those with high plasma HIV-1 concentrations could be a cost-effective strategy to achieve maximum population-level reductions in HIV-1 transmission, as a step toward universal ART provision to all patients with HIV-1".
 

"We should not wait for the results of further models, observational studies, or the ongoing couple-based prevention trial before engaging in population-based trials of test-and-treat," the authors of a Lancet comment say. "Prevention of new infections would be the main goal but individual-level benefits can also be expected; to be evaluated against initially increased costs to the health-care system. Indeed, today's results argue powerfully for a new generation of research on HIV prevention at the population level with the best possible scientific methodology, including cluster-randomised trials".
 

Source 
Other research 
Lancet
Lancet editorial
University of Washington press release 
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Broken Treatment Promises for Africa

posted: 27/05/2010

International aid organisations are breaking their promises to Africa, to provide universal HIV treatment. This risks undermining years of positive achievements and will cause many more unnecessary deaths, warns humanitarian aid group Médecins Sans Frontières (MSF) in their new report.

Effects in 8 African countries

Their report No time to quit: HIV/AIDS treatment gap widening in Africa looks at eight sub-Saharan countries. It shows how major international funding institutions such as PEPFAR, the World Bank, UNITAID, and donors to the Global Fund, have decided to cap, reduce or withdraw their spending on HIV treatment over the past year and a half.

9 Million Still Need Treatment
“How can we give up the fight halfway and pretend that the crisis is over?” said Dr. Mit Philips, Health Policy Analyst for MSF and one of the authors of the report. “Nine million people worldwide in need of urgent treatment still lack access to this lifesaving care - two thirds of them in sub-Saharan Africa alone. There is a real risk that many of them will die within the next few years if necessary steps are not taken now. Also, the current donor retreat will prevent more people from accessing treatment and will threaten to undermine all the progress made since the introduction of ARVs.”
 

USA cuts and others planned
The US President’s Emergency Plan for AIDS relief, PEPFAR, reduced its budget for the purchase of ARVs in 2009 and 2010, and also introduced a freeze on its overall HIV/AIDS budget. Other donors, such as UNITAID and the World Bank, have announced reductions over the coming years in the funding for antiretroviral drugs in Malawi, Zimbabwe, Mozambique, Uganda and the Democratic Republic of Congo (DRC).

Global Fund is short of cash
The Global Fund, the largest funding institution in the fight against HIV/AIDS, faces a major funding shortfall. The US, the Netherlands and Ireland have already announced that they will be providing lower contributions to the Global Fund. In 2009-2010, contributions to already approved country grants were reduced by 8 to 12 percent.

6 times fewer treated
Overall funding cuts have translated into a reduction in the number of people able to start their ARV treatment, as seen in South Africa and Uganda, and in DRC – where the number of new patients able to start ARV treatment was cut six-fold. Fragile health systems become increasingly strained by an increasing number of patients who will now need more intensive care.

Drug stock-outs and disruptions in drug supply are already a reality, and will become more frequent without enough funding. MSF has been asked by governments and others to help with emergency drug supplies in Malawi, Zimbabwe, DRC, Kenya and Uganda.

More deaths and orphans
“If there is reduced funding, then it will mean more people will die, and we will have more orphans,” said Catherine Mango, an HIV patient from Kenya. “The ones that are positive often need to assist others, like their children. People will lose hope and die. It will be the end. If there are no drugs there is no future.”

ARV treatment is lifesaving but also lifelong. This means that the number of patients under treatment increases cumulatively each year, thus requiring incrementally growing and sustainable funding.

“The HIV / AIDS crisis remains a massive emergency that still requires an exceptional response. MSF calls for a sustained and renewed commitment by donors and national governments in the fight against HIV/AIDS, so that this disastrous public health crisis can be addressed appropriately,” concluded Dr. Philips.

Source
 

Africans Talking About Sex

posted: 24/05/2010

Over 1 in 3 Africans living in England don’t know how to talk about sex with a new partner. Research in BASSLine, which assessed the sexual HIV prevention needs of African people in England, found that a disproportionate number were putting their health at risk by not asking questions about their partner’s sexual health.
 

Handy tips for talking
Mambo health and lifestyle magazine encourages people to feel more confident when talking about sex with their partners and HIV.
In its latest lead feature the magazine, which is distributed through African organisations, provides a list of tips to help get the difficult conversation started as well as dispelling some common myths about sex.
 

Mambo’s editor Joseph Ochieng said:
“We need to have the confidence to talk about sex to make sure we’re not putting ourselves and our partners at risk. There are no perfect guidelines about how to bring the subject up in conversation, but agreeing a few basic rules can help reduce the risk of sexually transmitted infection or unplanned pregnancy. In this issue of Mambo, we look at some possible approaches and offer useful tips on how a couple can have great – and safer - sex”
 

Other articles in the new issue include an interview with former American basketball John Amaechi, talking openly about his experiences as a gay man; healthy eating options for Africans who are new to the country and news of a successful HIV testing service for Africans.
 

Mambo and image
BASSline

Source – Voice

Malawi, HIV and Jailing Gay Men

posted: 24/05/2010

UPDATED 2 June - see at end

The Stop AIDS Campaign says that it is with grave dismay that they learnt of the imprisonment of Steven Monjeza and Tiwonge Chimbalanga (the Malawian gay couple jailed for 14 years with hard labour). They join with numerous southern African organisations in condemning the decision and the impact it will have on the individuals and the principle of universal human rights.

The denial of human rights of all kinds has a very negative effect on the response to HIV. Men who have sex with men are at risk of HIV transmission in all regions of the world, including Africa. The more marginalised they become, the higher the risk, and this decision – which runs contrary to stated government policy on HIV and the rights enshrined in the constitution of Malawi – will drive them further away from the information and services essential to an effective HIV response. Stigma and discrimination have potent consequences – countless thousands have died from HIV as a result of silence and fear.
 

A commitment to human rights is essential to securing equitable and fair development. It must be an intrinsic part of the effort to end the spread of HIV. The eyes of the world are now on the government of Malawi. We have written to the Malawi high commission calling on them to demonstrate its government's commitment to universal human rights and an effective, inclusive Aids response by releasing the men and moving to repeal laws which deny human rights. We also call on them to take action to combat homophobia in Malawi and to lead an honest and open dialogue on the impact of discrimination against key populations, such as men who have sex with men, drug users and sex workers, on the African Aids response.
 

Alan Smith
Chair, Stop Aids Campaign
 

Source - letter to the Guardian 
 

Malawi already knows what to do

It was just over one year ago that the Malawian president's secretary for nutrition and HIV told Malawi's HIV conference that a key need is to follow a human rights approach to HIV that includes gay men. 

Recognizing the rights of Malawi's gay population is essential if the spread of HIV is to be checked, the president's secretary for nutrition and HIV said. "There is a need to incorporate a human rights approach in the delivery of HIV and AIDS services to such risk groups like men who have sexual intercourse with men," Mary Shawa said at the opening of a two-day AIDS conference in Lilongwe.

1 in 4 gay Malawian men have HIV

While prevention campaigns are credited with lowering Malawi's overall HIV prevalence from 14% to 12%, the Center for the Development of People, which serves the gay community, estimates that 25% of Malawi's gay men are HIV-positive.

2 June UPDATE

Malawi Pardons Couple

Although the Malawian President has pardoned the gay couple who were jailed for the 14 years maximum with hard labour, they have now been separated and forced to live apart. And the human rights and HIV prevention problems for men who have sex with men in Malawi remain unaffected by the President’s decision.
 

A gay couple sentenced to serve 14 years in jail in Malawi were pardoned after their country's president met Ban Ki-moon, the UN secretary general. Steven Monjeza, 26, and Tiwonge Chimbalanga, 20, were tried and found guilty of sodomy and indecency earlier this month in a move that sparked international condemnation.
 

But after talking with Ban, Malawi's president, Bingu wa Mutharika, announced the pair would be freed.
"These boys committed a crime against our culture, our religion and our laws," he said after the meeting, at State House. "However, as the head of state, I hereby pardon them and therefore ask for their immediate release with no conditions. I have done this on humanitarian grounds, but this does not mean that I support this." He added: "We don't condone marriages of this nature. It's unheard of in Malawi and it's illegal."
 

Ban praised the decision, but said: "It is unfortunate that laws criminalise people based on sexuality. Laws that criminalise sexuality should be repealed."
 

He is due to address Malawi's national assembly later and is expected to ask legislators to look at this.
Joseph Amon from Human Rights Watch said the president was responding to the international outcry following the couple's conviction and sentence.
 

"I hope that other leaders of African countries with anti-gay laws see that this is just not acceptable in the international community," he said.
 

Source
 

Lazarus Effect - Treatments in Africa

posted: 24/05/2010

The Lazarus Effect follows the stories of four people living with HIV/AIDS in Africa. It’s a documentary by Lance Bangs that follows four Africans living with HIV and shows how their lives are transformed by effective HIV treatment.

It's beautifully filmed, hopeful for the future and life affirming.

It was shown today on Channel 4 and is now available in High Definition on YouTube.

In 2002, more than 29 million people in sub-Saharan Africa had HIV, but only 50,000 people could afford the $10,000 a year treatment then costed to stay alive. Today, thanks to increased political support, a push by global health organisations and some proce reductions by drug companies, the cost of ARV medication is around 20 pence a day in Africa, and more than three million people in Africa are receiving treatment. However very many Africans’ incomes are below $1 a day.
 

Monday 24 May, 11.05 - 11.35pm on Channel 4. Not available on the web at 4 on Demand.

It is on YouTube.