Crunch Time for Microbicides

posted: 25/05/2010

Professor Robin Shattock, director of the microbicide research at at St George’s Hospital in London, warned the opening session of Microbicides 2010 Conference in Pittsburgh, USA that “we stand at a critical time point in microbicide development. There is a recognised need to prioritise and accelerate efficacy testing in clinical trials,” before funders lose interest in microbicides.
 

Since all the first attempts at non-ARV-based microbicides have failed, there are now just three possible microbicides being studied.
 

Three possible microbicides left
 

• The first is CAPRISA in South Africa, a phase 2b trial of tenofovir gel - expect results in July at the Vienna International AIDS Conference 
• VOICE, a phase 3 trial testing tenofovir gel and tenofovir and tenofovir/FTC PrEP, is recruiting now with results next year. 
• The long-awaited IPM009 trial of dapivirine in a vaginal ring and/or gel is not due to start till 2012.

Microbicides once were the best new hope for prevention, but now what is called ‘pre-exposure prophylaxis’ – giving HIV drugs to people who do not have HIV to prevent HIV infection - is pulling ahead. There are now more ‘pre-exposure prophylaxis’ trials underway or planned than the three trials we have for microbicides.
However, microbicides still look far more hopeful than attempting to make a workable HIV vaccine.
 

Microbicide possibilities
There are now 13 different compounds that might work if used in microbicides being tried out, and more than 20 studies. The compounds that might be used for microbicides range from drugs as familiar as tenofovir, to ones as exotic as nucleocaspid protein inhibitors, and broadly neutralising antibodies. These have all been shown to block HIV infection in monkeys.
 

Next steps – and some of the problems
“Biological plausibility for microbicides has never been stronger,” he said. “But how can this knowledge bridge to better human trials?”

• One problem is making sure any drug reaches the place it needs to, in the right amount, and in a state which will work. We need better ways of measuring these things in people. People are already working on solving this.

Real life practicalities

• An even bigger problem is designing microbicides that will work in the real world. Doctors and researchers usually describe this as an adherence problem – making sure people use the microbicides properly. But if the instructions are unreasonable and don’t fit with real life needs and situations, any unreasonable instructions will be ignored. We learnt that many women simply find it impossible to re-apply a microbicide, when they have sex more than once a night. We learnt this from the Carraguard trial which failed two years ago precisely because this turns out to be a real life requirement.

Professor Shattock told the conference that we need better formulations to maximise adherence. New ways of monitoring adherence would also be needed to measure how well the new microbicides work in real life. Vaginal rings, like those used for contraception, that supply a constant level of drugs, would be one way to overcome this 'adherence' problem.
 

• Microbicides which use a combination of two of three drugs also look a good prospect for investigation.

Money is the key
The challenge now, Shattock told a press conference, is not developing more possible things that might work as a microbicide – there were plenty of those – but finding the money to start trials.
 

Anti-HIV drug microbicides cheaper
You need very little of a HIV drug in a microbicide for it to work – far less than you need when treating someone with HIV. That makes using the same drugs in microbicides relatively cheap compared with the cost of treating someone after infection. A single maraviroc tablet has enough of the drug for up to 20 doses if it is used as a microbicide. “But,” he added, “Without success or even an indication of success soon it will be impossible to sustain the funding for microbicides.”
 

Nono Eland of the South African Treatment Action Campaign, speaking after Shattock, commented that “if we fail on prevention, we will lose the progress we’ve made on treatment,” because funders will be unwilling to provide ever-expanding funding for an uncontainable disease.
 

Waiting women

We seem to have reached a critical moment for the future of microbicides. Microbicides need money now if we are ever to have any that will work. Microbicides are a gender issue. Women's need for an independent form of protection must be taken seriously.
 

Women are still waiting for any type of HIV prevention that will work when men won’t use condoms or it is too risky to suggest this to men. Microbicides are one of the best hopes we have for offering HIV prevention to women.

Source
Shattock R. State of the ART for microbicides. Opening plenary, Microbicides 2010 Conference, Pittsburgh. Presentation #1. 2010.
 

Part-Time HIV Jobs

posted: 24/05/2010

The Brunswick Centre, the HIV and sexual health charity for Calderdale and Kirklees in West Yorkshire, now has four part time jobs to fill. The main towns in these two metropolitan districts are Halifax (where the Brunswick is based), and Huddersfield.

• Prevention Worker – Inequalities 18.5 hours per week

HIV prevention work with communities most at risk of HIV infection with particular reference to Africans and Black Africans living locally. The post will link into the existing posts and structure of the charity to ensure a joined up approach to the HIV support and prevention needs of service users and local communities at risk. Salary: SCP6.26 – SCP6.28 / £21,937 - £23,405.

• Intervention, Support and Prevention Worker – Engagement 25 hours per week

Work with other Intervention, Support and Prevention workers supporting and advocating for people with HIV and be the charity’s champion on engagement. The post links into the existing posts and structure of the charity to ensure a joined up approach to the HIV support and prevention needs of service users and local communities at risk. Salary: SCP6.26 – SCP6.28 / £21,937 - £23,405.

• Well-being co-ordination – 6 hours per week

The post-holder will assist in the delivery of groups, drop-ins and activities for service users and for people affected by HIV. Work with charity colleagues to drive forward the well-being of service users using a self-care management approach. Salary: SCP5.23 - £19,940.

• Chlamydia Screening Outreach Coordinator – 7 hours per week. Fixed term Contract to 31st March 2011

Coordinate and deliver outreach Chlamydia screening to young people. Salary: SCP6.26 – SCP6.28 / £21,937 - £23,405.

All jobs

All posts have a 6% pension contribution; essential car allowance £65 per month pro-rata; 31-days annual leave pro-rata; Simply Health membership; Expenses paid. Flexible approach to work with a friendly and supportive team. All posts are subject to Enhanced Criminal Record Bureau Disclosures and probationary period.

For Job application packs
call 01422 341 764
email 

Closing date for applications 14 June 2010
Interviews will be held on the 22 June 2010
 

Pregnancy – Risks for Men and Women

posted: 24/05/2010

Men have twice the risk of catching HIV when their partner is pregnant, say researchers. A study of more than 3,000 couples in Africa also backed earlier research that showed women are more at risk of HIV infection when they are pregnant. And pregnant women can transmit HIV to their baby, although this can now be almost always prevented. The researchers speculate that changes in a pregnant woman's immune system may increase the chance that her partner gets HIV.
 

Microbicides hope too
The findings were presented at the International Microbicides Conference in Pittsburgh, USA, alongside a separate study showing a microbicidal gel is safe to use during pregnancy to prevent HIV transmission.
 

Pregnancy HIV risks – to men as well
Several studies have shown evidence that pregnancy puts women more at risk of catching HIV from their partner, but this is the first time researchers have shown that men are more at risk of HIV susceptible to infection if their partners are pregnant.
 

The study, carried out in Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia, involved 3,321 couples in which one partner was HIV-infected and the other not.
 

Over two years there were 823 pregnancies, and analysis showed that pregnancy increased both male-to-female and female-to-male infection. For the women, it seemed that factors other than pregnancy contributed to the increased risk of HIV infection.
 

But for the men, the link between pregnancy and their risk of infection was much clearer, even after accounting for other factors, such as having unprotected sex. The woman’s viral load and CD4 couple made no difference to whether HIV was passed on to the man.
 

Study leader Dr Nelly Mugo, from the University of Nairobi and the University of Washington in Seattle, said it could be that biological changes during pregnancy make a woman more infectious: "increased female-to-male transmission of HIV during pregnancy may be due to physiological and immunological changes that occur with pregnancy." It may also be affected by the couples sexual behaviour.
For more information on the Pittsburg conference M2010, go to: http://www.microbicides2010.org
 

Source
 

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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