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

Experts killed – blow to hope of Aids cure

The world of Aids research was in a state of shock on Friday after dozens of leading experts in the field were killed when a Malaysian plane was shot down over Ukraine, dealing a blow to hopes of curing the disease.

Among them was Joep Lange, who researched the condition for more than 30 years and was considered a giant in the field, admired for his tireless advocacy for access to affordable Aids drugs for HIV positive patients living in poor countries.

"He's one of the icons of the whole area of research. His loss is massive," Richard Boyd, professor of immunology at Monash University in Melbourne, told Reuters.

As many as 100 people heading to the Aids 2014 conference in Melbourne were on the doomed flight, Fairfax Media reported, including Lange, a former president of the International Aids Society (IAS) which organizes the event.

Read: HIV diagnosis rate falls by a third in the US

"The cure for Aids may have been on that plane, we just don't know," Trevor Stratton, a HIV/Aids consultant who was attending a pre-event in Sydney, told the Australian Broadcasting Corp.

"You can't just help but wonder about the kind of expertise on that plane."

The conference started on Sunday features former US President Bill Clinton among its keynote speakers and is expecting around 12,000 participants.

The IAS said it was still working with authorities to confirm the number of conference delegates on the flight. "In recognition of our colleagues' dedication to the fight against HIV/Aids, the conference will go ahead as planned and will include opportunities to reflect and remember those we have lost," it said in a statement.

Tributes pour in

Peers paid tribute to Lange, a Dutch professor of medicine at the Academic Medical Centre at the University of Amsterdam.

Read: Breakthrough in HIV detection in newborns

The Malaysian Airlines Boeing 777 was en route from Amsterdam to Kuala Lumpur when it was shot down on Thursday by a surface-to-air missile in an area of eastern Ukraine where Moscow-backed rebels have been fighting government forces.

Lange pioneered access to key Aids medicines in poor countries, including combination drugs to control HIV and antiretroviral medicines to prevent transmission of the virus from mothers to their babies.

"Joep had an absolute commitment to HIV treatment and care in Asia and Africa," said David Cooper, a professor at the Kirby Institute at the University of New South Wales, co-director with Lange on an HIV research project in Bangkok.

More than 4,000 HIV patients in Thailand have received up-to-date medication thanks to the scheme over 15 years, said Praphan Phanuphak, co-director of the HIV project in Bangkok with Lange and Cooper.

Jeremy Farrar, director of the London-based international health charity the Wellcome Trust, said he was "deeply saddened" by the news.

Read: Acne meds may help fight Aids

"Joep was a great clinical scientist," he said in an emailed statement. "He was also a personal friend. He is a great loss to global health research."

He will be remembered

The World Health Organization (WHO) said media spokesman Glenn Thomas was among those on board Flight MH17.

Gregory Hartl, a WHO spokesman, told a news conference in Geneva that Thomas had been with the organization for more than a decade. "Glenn will be remembered for his ready laugh and passion for public health," he said. "He will be greatly missed by those who had the opportunity to know him and work with him. He leaves behind his partner Claudio and his twin sister Tracey."

Thomas, a British national, was in charge of promoting the WHO's report issued last week that said five key groups including gay men had stubbornly high rates of HIV.

Source:http://www.health24.com/Medical/HIV-AIDS/News/Experts-killed-blow-to-hope-of-Aids-cure-20140721

The Clever Dick campaign kicks off in the Cape

 A campaign to promote medical male circumcision has been stepped up in the Western Cape with the launch of two mobile surgical theatres.

Circumcision, which can be done in 30 minutes, protects men against HIV, as well as sexually transmitted infections.

The mobile surgical theatres, about the size of an average bread truck, will travel through the Winelands, Overberg and Eden areas in the Western Cape, stopping off at towns, villages and communities along the way.

They were launched by the SACTWU Worker Health Program (SWHP) at a community soccer event at Stellenbosch at the end of August 2014.

Research trials in South Africa, Kenya and Uganda have shown that MMC reduces the risk of contracting HIV by 60%. The government has set a target of medically circumcising 4.3 million men in South Africa by 2016.

Read: Why South Africans need to be educated about Medical Male Circumcision

Image: Professional nurse, Poli Lubabalo, HIV lay counsellor, Steven Windvogel and professional nurse, Bantu Mfana.  (Photographs by Kim Cloete)



Read: Circumcision helps against HIV

Life-saving procedure

“It’s an ambitious goal, but we want to ensure we achieve it. By getting circumcised, as well as using condoms and taking care of your health, HIV could be reduced remarkably,” said Dayanund Loykissoonlal, Programme Manager for MMC in the National Department of Health.

Over 1.3 million men have been circumcised in South Africa since the government launched its MMC campaign in 2010.

MMC is potentially a life-saving procedure for thousands of South Africans by reducing the risk of HIV transmission between heterosexuals.

Read: Circumcision vs. Aids?

“We’re finding very few men are asking for MMC at clinics. We need to think out of the box – so we’ll be launching radio adverts and putting branding on taxis and spaza shops to encourage men to get medically circumcised through our 'Get Wise, Circumcise’ campaign,” said Nikki Soboil, CEO of SWHP.

A cartoon character, "Clever Dick" is the campaign’s ambassador.

Feeling good

At the launch, men and women gathered at the sports ground in Stellenbosch to play five-a-side soccer. Men also popped in to the mobile surgical theatres to be circumcised.

“I’ve been wanting to do this for a long time because I want to lower my risk of getting HIV and Sexually Transmitted Diseases. It was easy to do and I feel good about it. I’ve done it for my own health, as well as to protect my girlfriend,” said a young man resting after his circumcision.

James Kruger, deputy director of HIV/Aids, TB and STIs for the Western Cape Department of Health’s Cape Winelands office, said the campaign and its use of "Clever Dick" was a creative way of getting men to talk about health issues.

WHP has also partnered with the Desmond Tutu TB Centre (DTTC) at Stellenbosch University in helping to roll out MMC at nine clinics in the Winelands and in and around Cape Town.

1 000 infections per day

“DTTC is excited to be associated with SWHP’s MMC programme and the Department of Health in the scale up of MMC which plays an important role in HIV prevention along with other interventions including safe sexual practices, condoms, treatment of sexually transmitted infections and antiretroviral treatment.” said Peter Bock of the DTTC and principal investigator of the HPTN 071 (PopART) trial.

Read: UN backs circumcision for HIV
The PopART HIV prevention trial led by the DTTC in South Africa includes MMC as one of its key interventions.  Men will be able to go to any of the nine clinics where the PopART study is being conducted in the Western Cape to get circumcised by SWHP and department of health staff.

Loykissoonlal said there was still a great need to reduce the number of HIV infections in South Africa.

Over six million people in South Africa are currently infected with the virus, with 1 000 HIV infections reported on a daily basis.

Source:http://www.health24.com/Medical/HIV-AIDS/News/Circumcision-campaign-gains-momentum-20140901

Moment of remembrance for Aids conference delegates

The 20th International Aids Conference, officially began last night (Sunday 20 July) in Melbourne, Australia, with moving tributes to the six delegates who lost their lives aboard flight MH17.

Representatives of the organisations that lost colleagues – the World Health Organisation, Aids Fonds, Stop Aids Now, The Female Health Company, and the Amsterdam Institute for Global Health and Development – joined eleven former, present and future presidents of the International Aids Society (IAS) and members of the Dutch HIV community on the main stage in front of more than 5,000 delegates from around the world for a moment of remembrance.

Discussion and debate

Read: 'Gene editing' could make T cells HIV resistant

“I strongly believe that all of us being here for the next week to discuss, to debate and to learn is indeed what our colleagues who are no longer with us would have wanted,” Prof. Françoise Barré-Sinoussi, International Conference Chair of Aids 2014 and President of the International Aids Society told the gathering. ”We will remember their legacy and forever keep them in our hearts.”

Prof. Barré-Sinoussi went on to say: “The tremendous scale up of HIV programmes has begun to reverse the spread of HIV. According to the new UNAIDS report released a few days ago, nearly 14 million people living with HIV in low and middle-income countries are now being treated. Millions of lives are saved. But this is far from being enough and we still have plenty to do. Let’s show the world that neither brutality nor hatred can stop us. Let’s join our forces to build a better future for all.”

In welcoming the gathering to host-country Australia, the local Co-chair of Aids 2014, Prof. Sharon Lewin, said: "I am delighted that this week we will hear about some truly ground-breaking advances in new treatments of hepatitis C and tuberculosis, two of the most significant co-infections in people living with HIV. As a scientist, I remain passionate that the search for a vaccine and cure must continue. I sincerely hope that what you learn and see in Melbourne rapidly translates to action, action that contributes to our collaborative and escalating efforts to see the end of HIV."

Focus on HIV cure

At a press conference this morning, Prof. Lewin said the focus of efforts for an HIV cure was currently on developing treatments leading to remission. She said the latest research and findings were significant in that ''they have shown us that we can wake up the virus reservoir and make enough of the virus to leave the cell, making it visible to an immune response.''

Read: HIV findings offer hope for 'cure'

Today’s conference activities (Monday 21 July) began with plenary presentations about the latest advances for an HIV cure (Jintanat Ananworanich of Thailand), latest trends in HIV epidemiology (Salim Abdool Karim of South Africa), and how people with HIV are participating in the contemporary global response to HIV (Lydia Mungherera of Uganda).

Also this morning were two key symposiums: one addressing hepatitis co-infection among people living with HIV; and another looking at the barriers to effective HIV prevention created by the discrimination against key affected populations and criminalisation of HIV transmission, exposure and non-disclosure in some parts of the world.

Role of law enforcement

A joint press conference on the role police are playing in HIV prevention was held by senior representatives of police and law enforcement agencies from Seattle Police Department, Vietnam, Ghana and the UN to speak to the launch of a new report by the Open Society Foundation.

Today also featured the opening ceremony for the Aids 2014 Global Village, an international showcase of community related HIV programmes and activities. Speakers included Michael Sidibé, Executive Director, UNAIDS, and Melbourne Lord Mayor Robert Doyle.

This afternoon will feature several special sessions including symposiums on viral latency and reservoirs, tuberculosis co-infection among people living with HIV, the future of science in the global HIV response and galvanizing a movement for ending the Aids epidemic by 2030.

Read: Doctor convinced HIV cure is real

Other activities will include a special session chaired by UNDP Administrator and former New Zealand PM Helen Clark on human rights and HIV law reform.

Source: http://www.health24.com/Medical/HIV-AIDS/News/Moment-of-remembrance-for-Aids-conference-delegates-20140721

New technique forces HIV out of hiding place

The elusive quest for an HIV cure received a boost at the world Aids conference Tuesday as scientists said they had forced the virus out of a hiding place where it had lurked after being suppressed by drugs.

The experiment, carried out with six HIV-infected volunteers, is an important advance in the so-called "kick-and-kill" approach for a cure, they said.

The technique aims to force the human immunodeficiency virus (HIV) from its last redoubt after it is beaten back by antiretroviral drugs.

Read: Acne meds may help fight Aids

These drugs can bring HIV in the blood to below detectable levels, enabling sick patients to return almost miraculously to normal life. But the therapy has to be taken every day, is costly and carries potential side effects.

If the drugs are stopped, HIV usually rebounds within a few weeks and starts once more to infect other immune cells, exposing the body to opportunistic microbes.

A step forward

So scientists, for the last three years, have focused on ways to kick HIV out of its bolthole and then kill the hideaway cells.

In a presentation at the International Aids Conference in Melbourne, researchers from Aarhus University in Denmark described a step forward in the first stage of this process.

Read: Algae to ward off HIV?

Six patients who were on antiretrovirals took an anti-cancer drug called romidepsin, which prompted virus production in HIV-infected cells to crank up to between 2.1 and 3.9 times above normal. In five patients, the level of virus in the blood increased to measurable levels, an important threshold.

The pilot study sought only to see if it was possible to flush out the hiding virus and make it detectable.

Further work will show whether all the remaining virus was exposed this way. And a way has to be found to destroy the holdout cells where HIV reproduces after waking up.

"We have now shown that we can activate a hibernating virus with romidepsin and that the activated virus moves into the bloodstream in large amounts," said lead researcher Ole Schmeltz Sogaard.

Read: HIV hides out in bone marrow cells

"This is a step in the right direction but there is a long way to go and many obstacles to overcome before we can start talking about a cure against HIV."

'HIV 'fingerprint'

Seen through a microscope, the reactivated virus leaves a trace on the outside of infected CD4 immune cells as it returns to the bloodstream, he said.

The hope is that this tiny smear, rather like a fingerprint at a crime scene, can be spotted by so-called killer T-cells, the immune system's heavy armour.

The researchers now hope to combine romidepsin to wake up the dormant HIV and then use a vaccine called vacc-4x to prime T-cells to recognise and then destroy the bolthole.

The six volunteers did not suffer any major side effects from romidepsin, apart from known complaints such as passing fatigue and nausea, and the lymphoma drug did not interfere with their antiretrovirals.

Read: How HIV infection begins

Cure research suffered a big disappointment in the run-up to the 2014 Aids forum with the news that a strategic prong – delivering a powerful dose of antiretrovirals at a very early stage of infection – is unlikely to work.

No sign of virus

Hopes had centred on an American infant known as "the Mississippi baby", who was born with HIV. She was given drugs immediately at birth and the treatment continued for 18 months, when physicians lost track of her.

When doctors next checked her five months later, they found no sign of the virus. Now, though, it has been found that after the child had lived for 27 months without HIV and drugs, the virus has bounced back.

Research on lab monkeys published in the journal Nature suggests HIV's haven, formally called the reservoir, is established within days of infection.

On Monday, scientists at Temple University in Philadelphia reported using an enzyme to snip out HIV genes from infected human cells in a lab dish, a useful but still very early contribution towards a cure.

Source: http://www.health24.com/Medical/HIV-AIDS/News/New-therapy-aims-to-kill-hideaway-HIV-cells-20140722

Decriminalisation of drug use – key to ending HIV

Delegates to AIDS 2014, the 20th International Aids Conference, were told today that decriminalisation of illicit intravenous drug use is a key measure for ending HIV transmission around the world.

Read: Tribute to Aids researchers killed on flight MH17

Impact of drug policies
 One of the key sessions discussed the impact of drug policies on people who inject drugs, the spread of HIV and the co-morbidities of tuberculosis and hepatitis. During this session Global Drug Commissioner, Sir Richard Branson, who joined by video link, said the global war on drugs had failed both in terms of drug and public health outcomes, particularly in relation to HIV and hepatitis C, and that the time has come to replace the criminalisation and punishment of drug users with treatment and health care.

“Drug policy reform should not be seen in isolation” Sir Richard Branson said. “It has the potential to affect change in other areas such as the world’s chronically overcrowded penal system or of reducing the negative impact of policing on some communities.

Read: HIV/Aids education encourages informed decisions

Proper channeling of money

“Globally, we’re using too much money and far too many precious resources on incarceration when we should be spending this money on education, vocational training, and in the case of drug users, on treatment, proper medical care and re-entry.”

Today’s conference activities (Tuesday 22 July) began with plenary presentations about barriers to effective HIV prevention practice. Issues discussed included strengthening health systems (Olive Shisana of South Africa), overcoming gender inequality (Jennifer Gatsi-Mallet of Namibia), and improving financial investments in HIV responses (Mark Dybul, MD of The Global Fund).

Day two also included two key symposiums: one addressing youth leadership in the global HIV response; and another focussed on how better engagement with the science of HIV can improve access to HIV treatments.

This afternoon featured a symposium on HIV and sex workers based on work commissioned by the leading medical journal The Lancet. Several other panel discussions also took place on a range of subjects such as: improving the wellbeing of people with HIV by promoting safe drinking water, sanitation and hygiene; the pros and cons of biomedical and scientific advances in HIV prevention technology; and the HIV-related impact of anti-gay laws among men who have sex with men.

Honouring crash victim delegates

This evening, the AIDS 2014 Candlelight Vigil will take place to remember the 35 million people who have been lost as a result of HIV or Aids related causes, and to celebrate the triumphs of science, medicine, policy and community in the fight against HIV and Aids. Starting at 6pm at Federation Square, this moving event will take on extra significance as delegates honour the six conference delegates who were killed in the MH17 plane disaster.

Read: South Africans make up a third of those on ARV's

The Vigil will follow the AIDS 2014 Conference ‘Mobilisation March’ though Melbourne’s city centre.

The Global Village, the conference’s international showcase of community related HIV programmes and activities, will continue to feature a range events including music and dance performances as well as Q&A sessions on young people and sexual health as well as the practice of HIV prevention in disaster and war zones.

All our videos including a daily wrap up from the Global Village are featured on the conference YouTube channel: http://www.youtube.com/user/iasaidsconference
 Source : http://www.health24.com/Medical/HIV-AIDS/News/Allowing-drug-use-is-a-key-goal-for-ending-HIV-20140722

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Could legalising sex work stop HIV spread?

A study presented at the International Aids Conference in Australia claims that scrapping laws that ban sex work would almost halve the number of new HIV infections within next decade.

But given the study is based mainly on research in Asia, would it work in South Africa? News24 investigates.

Why focus on sex workers?

HIV is by no means limited to one section of society in South Africa. It runs rife across the country, affecting almost one in five people between the ages of 15-49, according to the World Health Organisation (WHO).

But the South African National Aids Council (Sanac) has identified that sex workers, their partners and their clients account for 20% of all new HIV infections.

For Sanac then, sex workers are an “important community” and are “crucial in our plans to combat the spread of HIV”.

Read: US to consider decriminalising prostitution 

Can’t we just promote condom use?

Condom promotion has helped reduce HIV incidence in sex workers and their clients by more than 70%, according to research by Professor Linda-Gail Bekker Professor Linda-Gail Bekker, principal investigator at the Desmond Tutu HIV Centre.

But with more than 400 000 new HIV infections occurring in 2012, South Africa still suffers acutely – and was ranked first for HIV incidences across the globe, a recent survey by the Human Sciences Research Council (HSRC) found.

Read: Sex workers should be part of the national HIV plan 

For many sex workers, condoms are not an option. Lesego Tlhwale from the Sex Workers Education and Advocacy Taskforce (Sweat) said that many workers do not carry them for fear of being prosecuted by the police. She said: “Police officers use condoms as evidence that you are a sex worker.”

Furthermore, as Lisa Vetten, gender researcher at the Wits Institute for Social and Economic Research, points out, women get paid more for having sex without a condom.

Watch: Methods that will help control HIV/AIDS 

So what does the study say?

Researchers reporting at the 20th International Aids Conference said of all the policy options – such as promoting condom use or changing policing practices – decriminalising sex work would be the most effective way of reducing the spread of HIV.

The study, published by The Lancet, estimates that up to 46% of HIV infections could be averted in the next decade. 

How do they know?

The researchers, led by Kate Shannon of the University of British Columbia in Vancouver, based their study on 204 published investigations. But most of these were conducted in Asia – with very few taking place in sub-Saharan Africa.

The researchers acknowledged they had blanks in their database and also admitted that depending on the location, other methods could be useful.

They said that in Kenya, for example, if infected sex workers were given access to virus-suppressing drugs, this would help to reduce new cases of HIV by more than a third over the next decade.

Read: HIV and sex workers - the situation

Is there any evidence that decriminalisation works?

Yes. In Brazil, sex work is officially recognised as an occupation, entitling sex workers to labour rights.

According to The Lancet, community empowerment among legalised sex workers has reduced the odds of HIV in Brazil by 32%.

Could it help in South Africa?

Marcus Low of the Treatment Action Campaign said that the transmission of HIV among sex workers and their clients can have a significant impact on the wider HIV epidemic.

He added: "There are no good reasons to think that this is not true in the South African context."

For Vetten, decriminalising sex work is a “long burning argument”. She said that we can’t assume that research done predominantly in Asia would achieve the same results here in South Africa.

She said the patterns of sex workers in Asia could be very different to those in South Africa. However, she admitted that “it is very interesting that this research supports the decriminalisation of it”.

Read: Criminalising gay relationships threatens the fight against HIV/AIDS 

How might it help?

Sex workers and their clients are criminals in the eyes of South African law – which drives the practice underground.

This leaves sex workers without police protection and therefore more vulnerable to violence.

As Sweat’s Tlhwale explains: “They can’t report anything to the police, as the police would arrest them first for being a sex worker. Their clients know this.”

It also means that sex workers have limited access to services that are readily available to the rest of society’s workforce: the law or to healthcare services for example.

By legalising sex work, the police would have to protect workers more. But workers could also protect themselves more – they would be more likely to get advice about safe sex, use condoms and gain access to drugs that suppress the Aids virus.

Read: The basic rights of people living with HIV/AIDS

Then it’s about worker’s rights?

For Tlhwale, above anything legalising sex work is about making sure the human rights of sex workers are recognised, helping to create safer working conditions.

Certainly, the Commission for Gender Equality (CGE) concluded last year that the current legal regime that criminalises sex work has failed sex workers and perpetuated substantive abuse of their Constitutional rights.

It said: “The CGE is of the firm view that sex workers in South Africa cannot be denied these rights, regardless of any moral or religious response to the practice of sex work in our society.”

Vetten agrees, putting it simply: “They deserve rights”.

“I would want to see a process that puts more power into the hands of the workers themselves,” she said, pointing out that the workers often do not receive the lion’s share of the profits.

But she also pointed out that if legalised, sex workers could provide key “on-the-ground” information from the streets that may help make our society safer – such as instances of child prostitution and trafficking.

“These will never, ever be legal,” she said. “Sex workers see a lot of what’s going on, they are a good source of information.”

Source: http://www.health24.com/Medical/HIV-AIDS/News/Could-legalising-sex-work-stop-HIV-spread-20140723

Clinton advocates more efficient use of HIV resources

Just a month before the publication of a book by Pulitzer-prize winning journalist Lucinda Franks about the reasons behind his sex addiction, Bill Clinton, founder of the Clinton Foundation and 42nd President of the United States, is a key note speaker at the Aids 2014 conference in Melbourne.

Read: Could legalising sex work stop HIV spread?

Progress of incoming HIV epidemic

The former US President has told delegates at Aids 2014, the 20th International Aids Conference, that finding more economically efficient ways to respond to HIV is vital to saving lives and preventing the spread of the virus.

Mr Clinton, who advocates globally for health security through the Clinton Health Access Initiative (CHAI), made the comments at the conference in Melbourne as he reflected on the progress made so far in overcoming the HIV epidemic, as well as the challenges that lie ahead.

His speech, which attracted hundreds of scientists, activists and journalists, was briefly interrupted by protesters holding placards, demanding a "Robin Hood" tax on financial transactions to fund the fight against HIV and Aids.

Read: New technique forces HIV out of hiding place

Resources must be used effectively

Mr Clinton said meeting global HIV prevention and support targets is possible within the “existing funding envelope”, but only if resources are used more effectively. “The development of super-efficient systems can help us achieve the 90 / 90 / 90 goals,” Mr Clinton said, referring to the UNAIDS 2020 targets of 90% of people with HIV knowing their status, 90% of people with HIV receiving antiretroviral treatment and 90% of people on treatment having an undetectable viral load.

Mr Clinton said one of the biggest challenges is delivering care to patients in a better way in rural and remote areas. “How can we reduce the distance they travel to the clinics, the time they wait, the money they spend? How can we launch programmes to ensure they feel supported in their communities without the stigma that makes people still, after all these years, drop out of care,” Mr Clinton said.

Mr Clinton said ending mother to child transmission of HIV, and supporting children with HIV is another challenge – as well as a tremendous opportunity for sustaining progress in the response to HIV. “Almost 50% of all new paediatric infections occur during the breastfeeding period. So keeping these women in care until the end of the breast-feeding period is the single most important thing we can do to achieve an Aids-free generation.”

Read: Why life insurance is important for those who are HIV positive

Encouraged to step up pace

Mr Clinton indicated that the Aids 2014 gathering was more of a movement than a conference, and encouraged delegates and those involved with HIV around the world to step up the pace and continue to make in-roads in the global response to HIV. He also paid his respects to the victims of MH17 including the six delegates due to attend Aids 2014.

He said the delegates who died, through their work for the global HIV response “gave their entire lives to the proposition that our common humanity matters a hell of a lot more than our differences.”

Today’s conference activities (Wednesday 23 July) began with plenary presentations about improving outcomes for marginalised populations of people affected by HIV. The theme of the conference today, including the opening plenary session, was “Nobody left behind”.

Issues discussed included addressing the needs of people who use drugs through drug policy and harm reduction (Khuat T. M. Oanh of Vietnam), increasing support for people living with HIV and tuberculosis co-infection (Diane Havlir of the US), and reducing the impact of HIV on sex workers (Daisy Nakato of Uganda) and on indigenous populations (James Ward of Australia).

Also yesterday morning was a symposium on how momentous political and cultural change in South East Asia is impacting on the HIV response in the region and the lessons learned from countries which are moving through periods of major transition.

Other sessions included a discussion of how police forces can better support HIV prevention efforts, and how organisations from around the world are helping to reduce barriers to HIV prevention and care for transgender people.

Read: Experts killed – Blow to hope of Aids cure

Other symposiums

Yesterday afternoon featured a symposium on how religious faiths can work to overcome sexual taboos that have negatively contributed to the HIV epidemic. Other sessions this afternoon explored a range of subjects such as: responding to the HIV prevention and support needs of migrants, refugees and mobile populations; maximising the preventive benefits of HIV treatments; and novel ways to increase HIV testing among at-risk populations.

One of the most moving sessions of the conference was when a panel of people living with HIV discussed how they have directly and personally been affected by injustice, control and punishment based on their HIV status.

Their stories will deal with issues such as HIV criminalisation, reproductive rights, employment and migration as well as stigma and discrimination. Mr Clinton commented in the opening address that it is “unbelievable” that after all this time, “stigma and discrimination are on the rise in some contexts.”

The Global Village, the conference’s international showcase of community related HIV programmes and activities, featured a range events including HIV-related fashion shows, film screenings, music recitals and dance performances, as well as discussions on a variety of issues such as: understanding travel restrictions for migrants living with HIV migrants and travellers; empowering sex workers in Asia and the Pacific, and innovative approaches to engaging young people through social media and digital platforms.

Source: http://www.health24.com/Medical/HIV-AIDS/News/Clinton-advocates-more-efficient-use-of-HIV-resources-20140724