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

Want to dress like a Spice Girl?

British fashion designer and former pop star Victoria Beckham is giving away 600 pieces of clothing, including several evening dresses, to raise money and awareness for mothers living with HIV in sub-Saharan Africa.

Read: SA needs a combination of measures to prevent HIV

Beckham's iconic, white Dolce and Gabbana dress worn for the 2003 MTV Video Music Awards is just one of the items to go under the hammer in aid of mothers2mothers (m2m), a charity that works to prevent the transmission of HIV from mothers to babies in nine countries including South Africa, Swaziland and Kenya.

Other pieces are from Beckham's days with the Spice Girls pop group, fashion shows, parties and red carpet appearances with husband and former England soccer captain David Beckham.
The money raised from the auction of Beckham's evening gowns, hats, shoes, bags, jewellery and costume pieces will be "transformational" for the organization that trains and employs mothers living with HIV to mentor other HIV-positive mothers in their community, m2m founder, Mitch Besser, said.
The women work alongside doctors and nurses in understaffed health centers as members of the healthcare team.

Read: Where does AIDS come from?
"We've reached 1.2 million mothers since we started, but with more resources, we can reach more mothers. With more reach we prevent more infections and we keep more mothers alive to take care of their kids," said Besser, an obstetrician and gynaecologist by training.
"The funding is absolutely transformational for an organization like ours," he told Thomson Reuters Foundation.
With an annual budget of around $20 million, m2m receives up to two thirds of its funding from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) - a program to combat AIDS started by former U.S. President George W. Bush.
THE OUTNET.COM, the online fashion outlet which will host the private online sale from Aug. 20-25, said Beckham chose to donate proceeds to m2m after visiting South Africa in February and meeting some of the mothers affected by HIV.
"After spending just a few days with these remarkable women and learning more about the charity from Mitch, and his lovely wife Annie Lennox, I wanted to do as much as I could," Beckham said in a statement.
"It really was a life-changing experience. I've never experienced anything like it."
Sub-Saharan Africa is still the region hardest hit by HIV, with 24.7 million HIV-positive people in 2013.
Women account for 58 percent of those living with HIV in the region, which is also home to 85 percent of pregnant women living with HIV, according to UNAIDS.

Read: Why HIV is still winning
Nevertheless there have been great strides in reducing the number of children infected with HIV worldwide - from 580,000 in 2001 to 240,000 in 2013.
Yet stigma, under-funded and under-equipped healthcare systems and problems engaging men are some of the obstacles to ending the epidemic in Africa, Besser said.

Source: http://www.health24.com/Medical/HIV-AIDS/News/Want-to-dress-like-a-Spice-Girl-20140806

Improper condom use puts gay men at increased HIV risk

Black men who have sex with men are more likely to report problems with broken or improperly used condoms, putting them at higher risk of contracting or transmitting HIV, according to a new study.

About 40 percent of black men who reported having sex with men within the past three months said their condoms broke or weren't used correctly, compared to about a third of white men who had sex with men, researchers found.

The results suggest condoms may provide less protection against HIV, the virus that causes Aids, and other sexually transmitted infections to black men who have sex with men, compared to their white counterparts.

"According to our data, condoms may be used more frequently by black (men who have sex with men), but they are also used less effectively and with more errors," the researchers write in the journal Sexually Transmitted Infections.

Currently, more than 1.1 million people in the U.S. are living with HIV, but about 16 percent are unaware of their infection, according to the Department of Health and Human Services. More than half of new HIV infections diagnosed in the U.S. are attributed to unprotected sex between men.

Black men at higher risk

The study team, led by Dr. Alfonso Hernández-Romieu from Emory University in Atlanta, writes that black men who have sex with men are about six times more likely to be diagnosed with an HIV infection, compared to white men who have sex with men.

Increased prevalence of HIV among blacks, lack of access to treatment and prevention services, stigma and discrimination may partially explain the increased likelihood of HIV diagnosis among black men who have sex with men, but condom breaks and improper condom use may also play a role, they write.

For the new analysis, the researchers used data from a study of 801 men who have sex with men, all from the Atlanta area. The men were recruited into the study between June 2010 and December 2012. They reported a same-sex sexual encounter in the past three months.

Read: Straight, gay or bi?

Overall, 475 men reported using a condom as the insertive sexual partner during the previous six months. Of those, about 59 percent were black and 41 percent were white.

Only about 31 percent of black men said their condoms worked effectively, compared to about 43 percent of white men.

Black men were more likely than white men to report condoms breaking, slipping during sex or slipping while pulling out. They were also more likely to report taking condoms off early and not putting on condoms at the start of sexual encounters.

Incorrect usage of condoms

The researchers also found that black men were more likely to report incorrectly using condoms, compared to white men. For example, black men were more likely to completely unroll condoms before applying them and were also more likely to use oil-based lubricants, which can weaken some condoms and cause them to break.

Black men were also more likely to report issues with how condoms fit or felt.

The researchers write that the difference in effective condom use between black and white men who have sex with men was not completely explained after taking into account usage errors and problems with condom fit and feel.

Read: How to eroticise safer sex

There could be other factors that they didn't measure that influence the racial difference between groups, they add.

The researchers suggest proper condom use and reducing the use of oil-based lubricants should be incorporated into HIV prevention programmes.

Companies should also consider the development of better condoms for men who have sex with men, they add.

Source:  http://www.health24.com/Medical/HIV-AIDS/News/Improper-condom-use-puts-gay-men-at-increased-HIV-risk-20140807

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

Male circumcision lowers HIV risk for women

A campaign to promote male circumcision to prevent Aids infection also indirectly benefits women by reducing their risk of contracting the HIV virus, according to a study presented at the world Aids forum on Friday.

Lower risk of HIV infections

In a South African community where large numbers of men had been circumcised, women who only had sex with circumcised partners had a 15-percent-lower risk of being infected by HIV compared with women who also had uncircumcised partners, it found.

"The risk reduction is small, but it is a start," said investigator Kevin Jean of France's National Agency for Aids Research (ANRS).

Read: Decriminalisation of drug use – key to ending HIV

The study was presented on the final day of the 20th International Aids conference in Melbourne.

The World Health Organisation (WHO) recommends voluntary circumcision as an option for men in 14 sub-Saharan countries struggling with high rates of human immunodeficiency virus (HIV).

The guidelines – which have triggered a multimillion-dollar programme – are founded on evidence from three trials carried out in South Africa, Kenya and Uganda.

These concluded that circumcision resulted in a reduced HIV risk – for men – of between 50 and 60 percent.

What has been fiercely debated, though, is the impact of male circumcision on women.

Read: How circumcision reduces HIV transmission risk

Key questions asked

Key questions included whether, if large numbers of men were circumcised, the infection risk for women would fall too.

Another issue raised was that circumcised men might think wrongly that they were fully shielded from HIV and ignore advice to wear a condom – thus increasing the risk for women.

Looking at these questions, the new study enrolled 2,452 women aged between 15 and 29 who lived in Orange Farm in South Africa, where the first of the landmark trials was carried out in 2002.

Read: New estimates for HIV deaths slashed by a quarter

The women's blood was tested in 2007, 2010 and 2012, and they were also asked questions about their sexual behaviour, as was a representative sample of local men.

During this time, the prevalence of circumcision among men in the community rose from 12 percent to 53 percent.

Over 30 percent of women reported having sexual relations only with circumcised men: 17.8 percent became infected during the study period.

But among women who had sex with uncircumcised men, the prevalence of HIV was almost twice as high, at 30.4 percent.

Read: Male circumcision is linked to less sexual pleasure

Indirect benefit

In an interview with AFP, Jean said women who had only circumcised partners were relatively a small group.

Statistically speaking, they were less likely to have multiple sex partners, a well-known boost of infection risk.

This explained in part why the risk reduction – 15 percent, averaged out over the whole period – seems relatively small, Jean said.

Further work will show whether this protection improves over time as more men in the community become circumcised and uninfected younger men have the operation, he said.

There was also good news from the questions on sex behaviour: men were unlikely to engage in unprotected intercourse after being circumcised, he said.

"What we are seeing is an indirect effect," he said. "Circumcision reduces HIV among men, and if fewer men are infected, they are less likely to infect women."

Read: 'Anti-gay laws spread HIV like poison'

He stressed, though: "The message still has to be made that they use condoms."

Incentive for circumcision

An earlier presentation at the Melbourne conference found that offering men compensation in the form of food vouchers worth around $9 or $15 was a useful incentive for circumcision.

Most countries in the voluntary circumcision campaign remain far short of reaching their target numbers.

Investigators have found that many men are deterred by the loss of wages from time off work to have the operation, and the cost of travelling to and from the clinic to have it carried out.

The protective effect from circumcision appears to lie in removal of cells in the foreskin which are especially vulnerable to penetration by HIV.

 

Source:  http://www.health24.com/Medical/HIV-AIDS/News/Male-circumcision-lowers-HIV-risk-for-women-20140725

Why life insurance is important for those who are HIV positive

In South Africa there are an estimated 6.4 million people living with HIV/Aids, the National HIV Prevalence, Incidence and Behaviour Survey 2012 study by the Human Sciences Research Council (HSRC) revealed.

This showed an estimated overall prevalence of HIV increase from 10.6% in 2008 to 12.2% in 2012.

Yet despite these staggering numbers, most of these people do not have life insurance cover.

Most people take out life insurance either to take care of themselves in the event they become disabled, or to provide financially for their family in the event that they die from natural causes, an illness or an accident.

Read: An end to HIV?

Why life insurance is important

Having access to life insurance is not only about ensuring the financial stability of one’s family and beneficiaries in the event of your death, but it has an impact on how you life your life too.

And with statistics showing that more and more people are living longer with HIV, their quality of life may be hindered by the fact they do not have life insurance. The reason for this is that having life insurance gives them better access to loan finance to buy property or the opportunity to invest in business prospects while they are still healthy.

On a psychological level, having life insurance despite being diagnosed with a condition such as HIV can do wonders for the HIV+ person as it serves to remind that HIV is no longer a death sentence, but rather a chronic disease with can be managed with the right treatments.

And with the government’s ever expanding ART treatment programme, the number of people living with HIV for extended periods is growing rapidly.

Read: Zim crisis driving HIV decline

The HSRC survey indicated that more than two million people were on ART by mid-2012, suggesting that the country was on its way towards universal access to treatment.

The survey also indicated that increased prevalence of HIV in 2012 was largely due to the combined effects of new infections and a successfully expanded antiretroviral treatment (ART) programme which had dramatically increased survival among HIV-infected individuals.

Yet living longer with a chronic disease such as HIV can take its toll, with many people failing to realise that being able to live longer means they still need to plan for their future, however long that may be. 

 

Source: http://www.health24.com/Medical/HIV-AIDS/News/Why-life-insurance-is-important-for-those-who-are-HIV-positive-20140530

Belgian infant contracts HIV via breast milk

In 2012, a one-year-old boy in Belgium acquired HIV through his mother's breast milk, a rare but not impossible form of transmission in industrialised countries, doctors say.

"Breast milk transmission has been recognized as an efficient mode of mother to child transmission of HIV for almost 30 years," said senior author Dr. Philippe Lepage.

Read: Where does Aids come from?

This transmission is common for mothers who were already infected before giving birth in developing countries, but it's extremely rare in industrialised countries, where HIV positive women are encouraged not to breastfeed, Lepage said.

Lepage is the head of the department of paediatrics at the Hopital Universitaire des Enfants Reine Fabiola in Brussels, Belgium.

Healthy at time of birth

In this case, according to a report in the journal Paediatrics, the boy's mother was tested for HIV during pregnancy and soon after delivery. The tests were negative both times.

His parents, both from the Democratic Republic of Congo, and three siblings were all healthy at the time of his birth.

But at one year of age the child was hospitalised for bronchitis, where he and his mother were diagnosed with HIV.

"If mothers become HIV infected while they're breastfeeding, their babies are at very high risk of getting the infection," said Jean Humphrey, director of the Zvitambo Institute for Maternal Child Health Research in Harare, Zimbabwe.

She speculated that in this case, the father contracted the infection after the child was born and gave it to his wife.

Read: South Africans not faithful and not using condoms

More screening wouldn't help prevent this kind of transmission, since by and large the mother will have already given the infection to her child by the time she tests positive, she said.

"The real way to prevent this kind of infection is to make women who are breastfeeding understand that having unprotected sex while breastfeeding is putting their babies at very high risk," Humphrey said.

In Africa, it has been suggested that all breastfeeding women use condoms during sex to drive home the message of prevention, she said.

"Sometimes, here, men take greater notice of the fact that sleeping around puts their baby at risk compared to putting their wife at risk," she said.

The only way to prevent this kind of transmission is strong counselling of both parents, Humphrey said.

Lepage and his co-authors suggested the same solution in the case report.

Interventions

"These interventions should focus on parents from high-HIV frequency countries and also on health care professionals counseling pregnant women who might be unaware of the possible risk associated with breastfeeding," he told Reuters Health by email. "Counselling should address condom use and also include education on the high risk of HIV postnatal transmission after heterosexual exposure during breastfeeding."

For a pregnant woman who knows she has HIV, whether or not she will breastfeed depends on where in the world she lives, which has been one of the most tumultuous public health policy decisions in the past 20 years, Humphrey said.

Read: Child 'cured' of HIV remains virus free

As Lepage noted, in North America, Europe and Australia, HIV positive women do not breastfeed, since safe alternative formulas are available.

For a time women in Africa were also encouraged to formula feed, but that policy led to a wave of diarrhoea deaths, Humphrey said.

"In developing countries, breastfeeding is so important to prevent infections," she said.

"Now there are drug regimens in all African countries that reduce breast milk transmission rates to under 2 percent if it's done right," she said.

With drugs that lower transmission rates, the benefits of breastfeeding now outweigh the risks in Africa, she added.

"Still it's extremely emotive, giving different policies on breastfeeding to poor women and to wealthy women," she said.

Source:http://www.health24.com/Medical/HIV-AIDS/Transmission-of-HIV/Belgian-infant-contracts-HIV-via-breast-milk-20140819

Breastfeeding vs. formula – a complex decision

In addition to containing all the vitamins and nutrients new-borns need in the first few months of life, breast milk is overflowing with disease-fighting substances that protect newborns from illnesses. This is according to Dr. Avron Urison, Medical Director at AllLife, insurance provider for HIV-positive people.
Urison said that the replacement feeding option, when the infant receives no breast milk but is fed with formula, is a nutritious alternative to breast milk. However, none of the antibodies found in breast milk are found in replacement feeding; this means that formula does not provide the baby with the added protection against infection and illness of breast milk. For this reason, breastfeeding is highly recommended.

HIV makes things more complex

“Mothers who opt for the replacement feeding option should seek professional medical guidance on the safety and appropriate use of formula,” he suggested. “That way, they can avoid poor feeding practices which may cause malnutrition, diarrhoea and possibly lead to death of children.”
Urison indicated that the situation becomes more complex when HIV comes into the picture, adding that 25 % of infants born to HIV-positive mothers, who do not receive antiretroviral treatment, will be infected by the virus. However, that percentage drops to less than 1 percent if those women are on HIV medication.
“HIV-positive mothers, who are receiving HIV treatment, are low-income earners and possibly without access to clean water, sanitation and health services should continue breastfeeding exclusively,” he added. “This is due to the fact that the inappropriate choice to formula feed under conditions that are not acceptable, feasible, affordable, sustainable and safe, carries a greater risk of death compared to breastfeeding – which may contribute to the death rate of 13% for children under the age of five, globally.”
In the case of high-income earning women, who are living with HIV and are on ART and whose access to clean water and health facilities is not restricted, Urison said that replacement feeding is the best option because for them the risk of HIV transmission is far greater when breastfeeding than when using replacement feeding.
However, he recommended that HIV- positive women should go for antenatal counselling sessions on infant feeding in order to help them make the feeding choice that would be most appropriate for their individual situations.

Source: http://www.health24.com/Medical/HIV-AIDS/From-Our-Sponsors/Breastfeeding-vs-formula-a-complex-decision-20140804

SA needs to be educated about male circumcision

Reputable research reports have found that male circumcision can provide HIV-negative heterosexual men with up to 60% protection against HIV infection.

While this is a remarkable finding, South Africa needs adequate education campaigns directed at women, and at informing people about what it means to get circumcised as HIV-positive heterosexual men.

These are the remarks made by Dr. Avron Urison, Medical Director at AllLife, as he acknowledged the progress South Africa has made with respect to combating HIV/Aids, as well as advocating for initiatives intended to raise awareness concerning circumcision for HIV-positive heterosexual men.

Benefits of male circumcision

"It has been proven that circumcision can help protect HIV-negative heterosexual men from HIV because cells under the foreskin are vulnerable to the virus," said Urison. "Removing the foreskin, as such, may act directly to reduce the risk of HIV acquisition by decreasing the ability of the virus to attach to and enter cells."

Some of the benefits of male circumcision, according to Urison, include preventing herpes genitalis, protection against penile cancer, risks of urinary tract infection, prostate cancer, sexually transmitted diseases and, in female partners, cervical cancer.

“This is useful information, and it appears to have been well communicated to many HIV-negative heterosexual men throughout the country,” he said. “However, are South Africans aware that the recommended male circumcision, with respect to HIV, is not a replacement for the existing prevention methods such as the use of condoms?”

“Do the majority of South African women understand that this is not a directly protective method for them? Are heterosexual men, living with HIV in South Africa, clear that although they can get circumcised, their benefits in this regard are close to none – if any?”

Surgery from unsafe providers

“Many South African women and HIV-positive heterosexual men are not informed as to how, if at all, male circumcision can benefit them. Therefore, while the effort to prevent the spread of HIV/Aids is greatly prioritised, South Africa needs to also implement and highlight the efforts aimed are reducing the number of people who die due to Aids-related sicknesses, thereby promoting methods that can also benefit the people who are already living with HIV/Aids.”

Citing World Health Organisation on the issue, he said that circumcision for HIV-positive men is not recommended, but denying them will possibly increase the stigma among HIV-positive men who are not circumcised. This might also increase the chances of HIV-positive men seeking surgery from unsafe providers if they are turned away from medical points of service.

Consequently, Urison stressed the importance of implementing initiatives that are aimed at addressing the socio-cultural context of the situation, as well as ensuring that HIV-positive heterosexual men are aware that they can only get circumcised if their CD4 count is 350 or higher and that circumcision has no HIV benefit for them.

 

Source: http://www.health24.com/Medical/HIV-AIDS/From-Our-Sponsors/SA-needs-to-be-educated-about-male-circumcision-20140804

Fungus deadly to Aids patients grows on trees

Researchers have pinpointed the environmental source of fungal infections that have been sickening HIV/Aids patients in Southern California for decades. It literally grows on trees.

Life-threatening infections

The discovery is based on the science project of a 13-year-old girl, who spent the summer gathering soil and tree samples from areas around Los Angeles hardest hit by infections of the fungus named Cryptococcus gattii (CRIP-to-cock-us GAT-ee-eye).

Cryptococcus, which encompasses a number of species including C. gattii, causes life-threatening infections of the lungs and brain and is responsible for one third of all Aids-related deaths.

Read: HIV and fungal infections

The study, which appears in PLOS Pathogens, found strong genetic evidence that three tree species – Canary Island pine, Pohutukawa and American sweetgum – can serve as environmental hosts and sources of these human infections.

"Just as people who travel to South America are told to be careful about drinking the water, people who visit other areas like California, the Pacific Northwest and Oregon need to be aware that they are at risk for developing a fungal infection, especially if their immune system is compromised," said Deborah J. Springer, Ph.D., lead study author and postdoctoral fellow in the Centre for Microbial Pathogenesis at Duke University School of Medicine.

In search of fungi

A few years ago, Duke's chairman of Molecular Genetics and Microbiology, Joseph Heitman M.D., was contacted by longtime collaborator and UCLA infectious disease specialist Scott Filler, M.D., whose daughter Elan was looking for a project to work on during her summer break. They decided it would be fun to send her out in search of fungi living in the greater Los Angeles area.

Read: No fun in fungus

The student sampled 109 swabs of more than 30 tree species and 58 soil samples, grew and isolated the Cryptococcus fungus, and then sent those specimens to Springer at Duke. Springer DNA-sequenced the samples from California and compared the sequences to those obtained from HIV/Aids patients with C. gattii infections.

She was surprised to find that specimens from three of the tree species were genetically almost indistinguishable from the patient specimens.

The researchers also found that the C. gattii isolated from the environment were fertile, reproducing either by sexual or asexual reproduction.

"That finding is important for long-term prevalence in the environment, because this fungal pathogen will be able to grow, reproduce, disperse spores, and serve as a source of ongoing infections," Springer said.

Image: Foot fungus disease from Shutterstock

Source:  http://www.health24.com/Medical/HIV-AIDS/News/Fungus-deadly-to-Aids-patients-grows-on-trees-20140822