SA medics worried about poor training, doctor shortages

The shortage of medical professionals and inadequate training are the two biggest concerns facing the future of the South African medical profession.

This is according to over 630 doctors interviewed in a recent Professional Providence Society (PPS) survey, which revealed that only 45% of respondents felt confident about the future of the country's health care system over the next five years.

Doctors responded that the biggest challenges facing the profession included inadequate training (37% felt this), staffing levels (33%), ageing infrastructure (20%) and lack of medical supplies (9%).

Growing pressure to train more doctors
According to Dr Mark Sonderup, Vice-Chairman of the SA Medical Association, the doubts expressed about medical training are likely related to the growing pressure to train more doctors at the country’s existing medical schools:

“The major challenge we're currently facing is the finite available capacity we have to train new doctors. Hence, with increased numbers and strained capacity, a concern is being expressed that the quality of those being trained could be affected.”

To turn this around, training capacity must be accelerated, says Sonderup.

Read: Dire shortage of Aids docs
“The proposed new medical school in Limpopo is at an advanced stage of planning and should now be accelerated. Other plans that should be rapidly developed are a school in the Northern Cape and a Port Elizabeth-based satellite undergraduate medical campus of Walter Sisulu University. More resources need to be made available and more money needs to be invested in research. Furthermore, priority needs to be placed on specialist training as well as looking at partnerships with the private sector to assist with training.”

Doctor shortage stresses junior professionals
The survey supports a recent call from the Junior Doctors Association of South Africa (Judasa), to the effect that the doctor shortage placed unnecessary pressure on junior medical professionals, who were often forced to work up to 36 hours at a time. Medical students are currently petitioning Health Minister Aaron Motsoaledi to review their working hours. They are arguing that exhaustion from working long shifts is putting both doctors’ and patients’ health at serious risk.

Read: Anaesthesia schock: fatal decisions

On a more positive note, the survey results showed that 62% agreed with the principles underpinning the proposed National Health Insurance (NHI) system. However, 54% of respondents were not prepared to enter into an arrangement with the Department of Health to work part-time at  rural public health facilities, which were part of the NHI pilot sites.

Two thirds support community service for young doctors
The survey also revealed that 66% believed community service for a year for qualifying doctors should be compulsory, with 34% saying that this period should in fact be longer.

Joubert pointed out that while community service may not be the answer to the issues doctors are currently facing, a longer period spent training in the field would help prepare junior doctors more adequately.

Source:http://www.health24.com/Medical/HIV-AIDS/News/SA-medics-worried-about-poor-training-doctor-shortages-20140604

WHO warns HIV 'exploding' among gay men

HIV infections are rising among gay men in many parts of the world, the World Health Organisation warned Friday, urging all men who have sex with men to take antiretroviral drugs to prevent infection.

"We are seeing exploding epidemics," warned Gottfried Hirnschall, who heads WHO's HIV department.

Infection rates are rising again among men who have sex with men - the group at the epicentre of AIDS pandemic when it first emerged 33 years ago, he told reporters in Geneva.

While images of skeletal men dying of AIDS in the 1980s pushed the world to act, a younger generation that has grown up among new treatments that make it possible to live with HIV are less focused on the disease, he suggested.

Today, this group is 19 times more likely than the general population to be infected by HIV, Hirnschall said.

Read: Why HIV is increasing among gays and prostitutes 

In Bangkok for instance, the incidence of HIV among men who have sex with men stands at 5.7 percent, compared to less than 1.0 percent for the overall population, he said.

In its new recommendations for combating the HIV/AIDS pandemic, published 11 July 2014, the UN health agency therefore for the first time "strongly recommends men who have sex with men consider taking antiretroviral medicines as an additional method of preventing HIV infection".

Read: Would you take antiretrovirals to prevent HIV infection?

Taking pre-exposure prophylaxis medication, for instance as a single daily pill combining two antiretrovirals, in addition to using condoms, has been estimated to cut HIV incidence among such men by 20-25 percent, WHO said, stressing that this could avert "up to one million new infections among this group over 10 years".

The new guidelines also focus on other high-risk groups, pointing out that men who have sex with men, transgender people, prisoners, people who inject drugs and sex workers together account for about half of all new HIV infections worldwide.

Read: HIV guidelines to help gays

Putting overall progress at risk

At the same time, they are often the very groups who have least access to healthcare services, with criminalisation and stigma often dissuading them from seeking help even when it is available.

When people fear seeking health care services it "will inevitably lead to more infections in those communities," Rachel Baggaley, of the WHO's HIV department, told reporters.

Globally, transgender women and injecting drug users, for instance, are around 50 times more likely than the general population to contract HIV, while sex workers have a 14-fold higher chance of getting infected, WHO said.

Read: Failure to aid drug users drives the spread of HIV 

The world has overall been making great strides in tackling HIV, with the number of new infections plunging by a third between 2001 and 2012, when 2.3 million people contracted the virus.

And by the end of 2013, some 13 million people with HIV were receiving antiretroviral treatment, dramatically reducing the number of people dying from AIDS.

"Progress is however uneven," Hirnschall said, warning that failing to address the still sky-high HIV incidence among certain groups was putting the overall battle against the deadly disease at risk.

Most countries focus the lion's share of their attention on fighting HIV infections among the general populations, paying relatively little attention to the most high-risk groups.

This is especially true in sub-Saharan Africa, which is home to 71 percent of the some 35.3 million people worldwide living with HIV, the expert said.

Read: 6 Million South Africans living with HIV

Hirnschall stressed that tackling infections among the most at risk should be a general concern.

"None of these people live in isolation," he said, pointing out that "sex workers and their clients have husbands, wives and partners. Some inject drugs. Many have children."

Decriminalising and destigmatising these groups would greatly help bring down HIV infections among them, WHO said.

Promoting condom use, wide-spread voluntary HIV testing, treating at-risk individuals with antiretrovirals, voluntary male circumcision and needle exchange programmes figure among the other WHO recommendations for battling the disease.

Source: http://www.health24.com/Medical/HIV-AIDS/News/WHO-warns-HIV-exploding-among-gay-men-20140711

'Anti-gay laws spread HIV like poison'

ampaigners at the world AIDS conference are taking aim at countries with anti-gay laws, accusing them of creating conditions that let HIV spread like poison.

Read: HIV exploding among gay men

Powerfully mixing concerns over human rights and health, the issue threatens to divide Western donor countries, where gay equality is making strides, from poor beneficiary nations where anti-gay laws persist or have been newly passed, say some.

A barrage of fire

Nobel laureate Francoise Barre-Sinoussi, who co-discovered HIV and co-chairs the six-day conference, seized Sunday's opening ceremony to lay down a barrage of fire at laws targeting minorities who bear a disproportionate share of the global pandemic.

"The cruel reality is that in every region of the world, stigma and discrimination continue to be the main barriers to effective access to health," she said.

"We need again to shout out loud that we will not stand idly by when governments, in violation of all human rights principles, are enforcing monstrous laws that only marginalise populations that are already the most vulnerable in society."

Experts point to bitterly-won experience in the war on AIDS, which has claimed 39 million lives in 33 years: HIV spreads stealthily from stigmatised minorities and into the mainstream population, where it then can spread like wildfire.

If gays or bisexuals are jailed or persecuted, this discourages them from taking an HIV test or seeking treatment if they are infected. It creates a toxic atmosphere of silence and fear – a perfect breeding ground for HIV.

Equal rights

The scenario is similar, say specialists, when sex workers and intravenous drug users are criminalised.

Read: Sex work and the law

The 12 000 delegates attending the 20th International AIDS Conference are being urged to sign a "Melbourne Declaration" which insists that all gay, lesbian and transgender people " are entitled to equal rights and to equal access to HIV prevention, care and treatment information and services".

But just as more and more Western countries have passed laws enshrining equal rights to marriage, health care and pensions for gays, other countries have pushed through legislation to prosecute them.

According to a report issued last week by the UN agency UNAIDS, 79 countries have laws that criminalise same-sex practices, and seven of them have the death penalty for it.

Recent adopters of anti-gay legislation include Uganda and Nigeria. India has restored colonial-era anti-sodomy laws. Russia has passed legislation banning even the distribution of information about homosexual orientation.

Kene Esom, a Nigerian who works in South Africa for a gay campaign group, the African Men for Sexual Health and Rights, said these laws sometimes crippled efforts to spread the word about safe sex and expand access to life-saving HIV drugs.

"Some laws ban freedom of assembly and freedom of association" for gays, he said.

Buying drugs

"That means groups can't meet or even receive funds." In a keynote speech, former Australian high court justice and human rights advocate Michael Kirby said patience was wearing thin among Western countries which donated roughly half of the $19 billion in funds to fight AIDS in developing economies last year.

Most of the money is spent buying drugs that keep millions of infected people alive.

"Someone must tell those who will not act the practical facts of life in our world," Kirby said acidly.

"They cannot expect taxpayers in other countries to shell out, indefinitely, huge funds for antiretroviral drugs if they simply refuse to reform their own laws and policies to help their own citizens."

Jean-Francois Delfraissy, head of France's National Agency for AIDS Research (ANRS), said he feared the medical consequences if the money stopped flowing.

Punishing patients

Donor frustrations at repressive laws were best voiced through the Global Fund to Fight AIDS, TB and Malaria to avoid charges of interference by rich countries in the domestic politics of poor ones, he told AFP.

"I'm a doctor, so my reflex is to think that these countries need antiretrovirals like everyone, and we should not be punishing patients in the hope of getting a government to shift its position.

"However, the Fund is not just a bank, it's a moral entity," he said. "It can set general lines (for disbursement), so funding can be conditional."

Source: http://www.health24.com/Medical/HIV-AIDS/News/Anti-gay-laws-spread-HIV-like-poison-20140721

Gates Foundation awards $25 million to HIV vaccine

Oregon researchers developing a vaccine that has shown promise in preventing HIV infection in primates said on Wednesday they have been awarded a $25 million grant from the Bill & Melinda Gates Foundation.

Eliminating the virus

Oregon Health & Science University scientists, in announcing the award, said they hope to develop a vaccine that not only prevents the HIV virus from infecting people exposed to it, but also eliminates the virus from those already infected.

The grant follows research published by the scientists seeking to show their vaccine candidate halting the transmission of, or eliminating altogether, a form of the virus in about half of more than 100 monkeys tested.

"In effect, we helped better arm the hunters in the body to chase down and kill an elusive viral enemy," lead researcher Louis Picker wrote in the magazine Nature, which published lab results last year. "And we're quite confident that this vaccine approach can work exactly the same way against HIV in humans."

Read: Breakthrough in hunt for HIV vaccine

While the annual number of new HIV infections has declined in recent years, more than 35 million people globally were living with HIV and an estimated 2.1 million people were newly infected with the virus that causes AIDS last year, according to the World Health Organization.

Larger-scale testing

Although AIDS-related deaths have dropped in recent years due to antiretroviral drug therapy, some 1.5 million people still died from the disease last year, the organisation said.

In the United States, the annual rate of diagnosis with HIV fell by a third between 2002 and 2011, according to a study in the Journal of the American Medical Association.

The grant will be used over the next five years to establish whether the vaccine can be used safely on humans in a clinical trial and to help Picker develop a version of the vaccine suitable for larger-scale testing, which is required to bring it to market and will take at least a decade.

The grant will largely be used to develop the preventative vaccine, which could also be used for therapeutic and antiretroviral therapies, the university said in a statement.

The National Institutes of Health cited Picker's research among its "promising medical advances" of 2013, the researchers said.

The Bill and Melinda Gates Foundation aims to eradicate the world's most deadly diseases and poverty. 

Source: http://www.health24.com/Medical/HIV-AIDS/Disease-prevention/Gates-Foundation-awards-25-million-to-HIV-vaccine-research-20140904

Homosexuality ban threatens HIV progress in Uganda

After Uganda passed a law that punished gay sex with long prison sentences, Daisy Nakato got a visit from the police.

The country's Red Pepper tabloid had outed hundreds of gays after President Yoweri Museveni signed the anti-homosexuality bill in February and Nakato's name was on a list.

Police targeting gays

Over the following six hours, Nakato, a bisexual sex worker, begged the police not to arrest her.

Read: Activists watching leaders

"I had to stay in hiding for over a week without taking ARV (antiretroviral) medication. A lot of people are going through the same thing. A lot of people have run to neighbouring countries," Nakato told delegates at an AIDS conference in the Australian city of Melbourne on Monday.

The law has broad support in religiously conservative Uganda, which is among 37 African nations where homosexuality is illegal.

But one of the major concerns of the gathering of 12,000 AIDS activists, scientists and people living with HIV is how the criminalisation of groups at high risk of HIV – such as gay men, sex workers and transgender people – is threatening progress in the global effort to fight Aids.

Prostitution is illegal in 116 countries, and in 78 countries, having a same-sex relationship is a criminal offence.

Major concerns

"We know that criminalisation is bad health policy. It is bad public policy. It doesn't work to prevent the spread of disease. In fact, it does just the opposite," the US ambassador to Australia, John Berry, told a discussion on the state of legislation in India, Nepal and the United States, among others.

Read: Gay rights activist: no more bullying

"The global fight against HIV and Aids will not be won by relegating segments of the population to the shadows."

According to the World Health Organization (WHO), female sex workers are 14 times more likely to have HIV than other women, gay men are 19 times more likely to have HIV than the general population and transgender women are almost 50 times more likely than other adults to have HIV.

Yet the same groups are least likely to get HIV prevention, testing and treatment services, the WHO says.

Bad health policy

It's not only gays and lesbians who feel persecuted in Uganda, Nakato said. Sex workers are among those under pressure from an anti-pornography law, locally dubbed the anti-mini skirt law, which seeks to police erotic behaviour.

"These laws are just there to drive us underground, to harass us," Nakato told the session.

India gay rights activist Ashok Kavi described the "incredible sense of despondency" after India's Supreme Court reinstated a ban on gay sex in December, following a four-year period of decriminalisation that had helped bring homosexuality into the open in the socially conservative country.

Read: Gay and HIV not a punishment from God

Manisha Dhakal, a Nepalese transgender activist, said certain laws in Nepal – while not criminalising transgender sex workers – were deliberately used against them.

"When we are walking in the street, people are gathered to see us and there are traffic jams because the taxi drivers also want to see us," Dhakal said, adding that the commotion often ended in arrest under the Public Offences Act.

By contrast, the United States is working on changing laws that criminalise HIV transmission, said Nick Rhoades, an American whose conviction for the criminal transmission of HIV in the state of Iowa was overturned last month by the Supreme Court.

 

Source:  http://www.health24.com/Medical/HIV-AIDS/News/Criminalisation-threatens-fight-against-HIVAids-20140722

Tribute to Aids researchers killed on flight MH17

Moment of remembrance

A one minute global moment of remembrance was held in their honour with eleven former, present and future presidents of the International Aids Society onstage together with representatives from those organisations who lost colleagues, the World Health Organization, Aids Fonds, Stop Aids Now, The Female Health Company, the Amsterdam Institute for Global Health and Development and members of the Dutch HIV research community.

A letter of condolence and support was also read out by Mr Lambert Grijns, The Dutch Ambassador for Sexual and Reproductive Health and Rights and HIV/Aids.

Condolence books are circulating onsite at the conference for the duration of the event. On Tuesday July 22 at 18.00 AEST, a candlelight vigil will be held at Federation Square in the centre of Melbourne.

Some 12,000 participants from all over the world have gathered in Melbourne for the start of the 20th International Aids Conference (Aids 2014). Under the theme Stepping up the Pace, during the five days of the conference delegates will discuss the latest research developments and will hear about the status of the epidemic from world renowned experts. The conference runs through until Friday, 25 July at the Melbourne Convention and Exhibition Centre.

Discriminatory laws

Aids 2014 will offer delegates a strong scientific programme with presentations around hot topics including HIV cure strategies and challenges; HIV prevention via Pre-Exposure Prophylaxis (PrEP), Treatment as Prevention (TasP), and voluntary medical male circumcision; Tuberculosis and Hepatitis C co-infection; and HIV and hormonal contraception.

In addition, several studies will discuss the impact of discriminatory laws and the costs related to HIV prevention and care.

Read: Thinness associated with HIV/Aids

At the Aids 2014 Opening Sessions, speakers discussed the encouraging data related to access treatment and reducing new HIV infections, but reminded the audience that HIV is far from being defeated and that stigma and discrimination towards Key Affected Population pose a major barrier to the end of the epidemic.

"The tremendous scale-up of HIV programmes has, for so many people transformed HIV from a death sentence into a chronically manageable disease,” Professor Françoise Barré-Sinoussi, Aids 2014 International Chair, President of the International Aids Society (IAS) and Director of the Regulation of Retroviral Infections Unit at the Institut Pasteur in Paris told delegates attending the opening session on Sunday night.

“One-third of people living with HIV, who need treatment now have access to it.

"Nevertheless, these remarkable achievements are still not enough, 22 million people still do not have access to HIV treatment. The official Aids 2014 theme reminds us that we need to step up the pace and redouble our efforts. Too many countries are still struggling to address their HIV epidemic with their most vulnerable people consistently being left behind”.

Access to anti-retrovital therapy

UNAIDS Executive Director Michel Sidibé said that efforts to increase access to antiretroviral therapy are working. In 2013, an additional 2.3 million people gained access to the life-saving medicines. This brings the global number of people accessing ART to nearly 13 million by the end of 2013. Based on recent scale-up, UNAIDS estimates that as of July 2014 as many as 14 million people were accessing ART.

“If we accelerate a scale-up of all HIV services by 2020, we will be on track to end the epidemic by 2030,” said Mr Sidibé. “If not, we risk significantly increasing the time it would take, adding a decade, if not more.”

"There is so much to admire in Australia's well documented response to HIV. Its bipartisan political approach, its inclusion of key affected communities and the capacity building in science and research have all been major drivers in Australia having one of the lowest rates of HIV infection worldwide," said Professor Sharon Lewin, Local Co- Chair of Aids 2014, Head of the Department of Infectious Diseases, Alfred Hospital and Monash University and Co-Head of the Centre for Biomedical Research at the Burnet Institute in Melbourne.

Read: Aids epidemic could be under control by 2030

"But, as much as the Australian experience has been successful, our neighbours in the Asia Pacific region have not lived the same experience. It is a key objective of the 20th International Aids Conference to shine a light on those men who have sex with men, sex workers, transgender people and people who use drugs who do not have the same access to treatment, care and prevention as their Western colleagues may do."

The Aids 2014 Melbourne Declaration was also referred to by the speakers, reaffirming the importance of non-discrimination for an effective response to HIV and, more in general, to public health programmes.

The enforcement of discriminatory, stigmatizing, criminalizing and harmful laws leads to policies and practices that increase vulnerability to HIV. These laws, policies, and practices incite extreme violence towards marginalized populations, reinforce stigma and undermine HIV programmes, and as such are significant steps backward for social justice, equality, human rights and access to health care.

Endorsement

World leaders, scientists, philanthropists and Nobel laureates have already endorsed the declaration, as have hundreds of organizations. Individual endorsement can be done online here:  
http://www.avaaz.org/en/petition/AIDS_2014_Melbourne_Declaration_Nobody_left_behind/

Source: http://www.health24.com/Medical/HIV-AIDS/News/Tribute-to-Aids-researchers-killed-on-flight-MH17-20140721

Bringing HIV testing and prevention to the people

An extensive study on HIV prevention in Africa is underway in the Western Cape, with community workers, known as Community HIV Care Providers (CHiPs), visiting people at their homes in nine communities in and around Cape Town.  

“We are very excited about this study and are watching it closely. It’s important for the future of HIV programmes not just here in South Africa, but worldwide,” said Steve Smith, the Health Attaché at the US Embassy, following a meeting with researchers from the Desmond Tutu TB Centre (DTTC), Department of Paediatrics and Child Health, at Stellenbosch University.

Aim to bring down new infections

“We need the evidence to demonstrate how to improve HIV prevention with the aim of bringing down new infections,” said Smith.

Read: Suicide intervention 'tool' for HIV patients

CHiPS are visiting people in communities over a period of three and a half years for the trial – which is part of the HIV Prevention Trials Network and called HPTN 071 (The Population Effects of Antiretroviral Therapy to Reduce HIV Transmissions - PopART). The study is also being conducted in 12 communities in Zambia, led by the ZAMBART group.

Some of the study’s funders from the Office of the US Global AIDS Coordinator (OGAC), through the President’s Emergency Plan for AIDS Relief (PEPFAR) in  Washington D.C. recently visited one of the Cape Town communities and were encouraged by the work done so far.

“The scope is enormous and it’s a giant undertaking, but I think they’re doing a fantastic job. We continue to be impressed by the compassion of the CHiPs and their ability to talk to people in the community about HIV and TB in a very de-stigmatised way,” said Nancy Padian, Senior Technical Advisor for PEPFAR.

Community members are provided with home-based HIV counselling and testing. They are also screened for tuberculosis and Sexually Transmitted Infections (STIs), and provided with condoms in the home.  Community members are referred to the nearest local clinic for HIV care, TB treatment, STI treatment, and offered the option of medical male circumcision.

Read: SA needs a combination of measures to prevent HIV

Trial conducted

This is a randomized controlled trial conducted in nine communities around Cape Town that are assigned to one of three arms, A, B or C.  The Intervention is conducted in the three communities assigned to Arm A and three communities assigned to Arm B.  In Arm A, CHiPs test people for HIV in their homes, with immediate antiretroviral therapy (ART) available in the clinic for those who test HIV positive.  In Arm B, CHiPs  also test people for HIV in their homes, with ART being offered in the clinics according to provincial guidelines. The three Arm C communities do not have CHiPs and health services in the clinic follow provincial guidelines. 

The research component runs for four years and measures the number of new cases of HIV.  Professional nurses and research enumerators carry out the research in nine communities around Cape Town.

The DTTC at Stellenbosch University is heading up the study in South Africa and is working in collaboration with the London School of Hygiene and Tropical Medicine (LSHTM) and Imperial College in London.

Blia Yang, Project Manager of the Intervention team from the DTTC said community leaders were supportive and recognized the study’s goal of striving to bring down the rate of HIV. 

Read: Prevention of HIV infection

“We’ve been working evenings and weekends as well as during the day to make sure we see people at their homes. It’s important to bring home the message that HIV can be prevented through a range of measures,” said Yang.

Further credit

Yang also credited the Western Cape Department of Health and the City of Cape Town Health Directorate for their support. The government partners have been working alongside the DTTC to ensure that the research is carried out effectively, particularly when clients are referred for HIV treatment at its clinics. 

HPTN 071 (PopART) is sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), with funding from PEPFAR. Additional funding is provided by the International Initiative for Impact Evaluation, with support from the Bill & Melinda Gates Foundation, as well as by NIAID, the National Institute on Drug Abuse (NIDA) and the National Institute of Mental Health (NIMH), all part of  the National Institutes of Health (NIH).

Source: http://www.health24.com/Medical/HIV-AIDS/News/Bringing-HIV-testing-and-prevention-to-the-people-20140807