AIDS Care Watch

Monday, April 30, 2007

AFRICA-NAMIBIA: HIV puts Malaria back in spotlight

By, IRIN PlusNews, April 25, 2007

Malaria is reclaiming the world's attention after years of playing second fiddle to HIV. Experts are now convinced that the disease plays a greater role in the AIDS pandemic than was previously thought.

"The disease has for too long been considered a separate health concern to HIV... it is high time that malaria was shown the same global dedication as HIV/AIDS," Malama Muleba, executive director of the Zambia Malaria Foundation (ZMF), told IRIN/PlusNews.

He acknowledged that growing scientific interest in the dangers of co-infection between the two diseases had helped put Malaria back in the spotlight.

Although the two infections have formed a deadly combination in most of sub-Saharan Africa for decades, earlier studies were not able to confirm the impact of malaria on HIV and vice versa.

Now, the findings of a recent study by the University of Washington's Public Health Sciences (PHS) research division show that malaria fuels the spread of HIV, while HIV has also boosted malaria-infection rates.

Published in the December 2006 issue of Science, a leading research journal, the study showed that because malaria increases the viral load [amount of HIV] in an HIV-positive person, it also makes HIV more transmissible to a sexual partner.

"Malaria has contributed considerably to the spread of HIV by increasing HIV transmission probability per sexual act," one of the study's co-authors, Dr Laith Abu-Raddad, confirmed in the Science article.

The researchers found that, conversely, HIV also plays a role in the spread of malaria, as the weakening of the immune system by the HI virus fuels a rise in adult malaria-infection rates, and may have facilitated the expansion of malaria in Africa.

The World Health Organisation (WHO) estimates that over 90 percent of the one million global malaria deaths per year occur in African countries, while the UN Children's Fund (UNICEF) says malaria is the leading cause of death in many parts of Africa, with one child dying from the disease every 30 seconds.

On the occasion of Africa Malaria Day, on 25 April each year, the Roll Back Malaria Partnership, an initiative created in 1998 by WHO, UNICEF, the UN Development Programme and the World Bank, announced its target of securing a 50 percent success rate for malaria grant applications to the Global Fund to Fight AIDS, Tuberculosis and Malaria, the largest international funder of malaria programmes.

"Malaria control works ... if the richest nations expand their support at the [upcoming] June G8 meeting in Germany, we can dramatically reduce the one million deaths a year from malaria," said Michel Kazatchkine, executive director of the Fund, in a statement on Africa Malaria Day.

Over 90 percent of the one million global malaria deaths per year occur in Africa.
In Namibia, where the HIV prevalence rate is close to 20 percent and malaria accounts for almost nine percent of all hospital deaths, the Social Marketing Association (SMA), a non-governmental organisation, also stressed the importance of ongoing support in combating the two diseases.

The SMA's regional coordinator, Mauritius Ngishindwa, told IRIN/PlusNews, "It [the malaria/HIV co-infection findings] is scary, but also very important because malaria, in a sense, had been sidelined by the AIDS pandemic ... it warrants more than an isolated annual event to really address the two diseases."

Echoing these sentiments, Malama Muleba, director of the Zambia Malaria Foundation, said events such as World AIDS Day and Africa Malaria Day should be ongoing initiatives, as infections and deaths by both diseases were a daily occurrence.

"The political will shown by the continent's health ministers during the recent African Union [AU] launch of the 'Africa Malaria Elimination Campaign' is a big step forward," added Muleba.

During the third session of the AU conference of health ministers, held in South Africa from 9 to 13 April this year, delegates committed themselves to reducing malaria morbidity and mortality by up to 75 percent by 2015 through universal access to prevention and control interventions.



Friday, April 27, 2007

60 pc HIV-infected living in rural India: WHO

By, Press Trust of India, April 16, 2007

Sixty per cent of the estimated 5.2 million HIV-infected adults in India are living in rural areas, according to a WHO report.

Though commercial sex is the major reason behind the prevalence of the pandemic in most parts of the country, injecting drug use (IDUs), especially in north-eastern states, Delhi, Mumbai and Chennai, is fast emerging as a major source of transmission.

"Analysis of surveillance data by place of residence indicates that HIV has been spreading to the rural areas," the report said.

"Of the estimated 5.2 million HIV-infected adults in India, 3.05 million or nearly 60 per cent were residing in rural areas. Of the reported AIDS cases, sexual transmission accounts for 86 per cent in India," the report said.

Apart from several states recording a higher HIV prevalence among rural sentinel surveillance sites than urban sites, the dreaded disease has now started penetrating the low-risk general population, the report pointed out.

"The HIV epidemic of Manipur that was once a concentrated epidemic among IDUs, is now considered a generalised epidemic," the report said.

In 2005, seven of the 10 ante-natal clinic sentinel surveillance sites in Manipur recorded an HIV prevalence of one per cent or above indicating the spread of infection from high-risk to low-risk populations, report said.

The report said HIV among IDUs increased markedly from seven per cent in 2002 to 23 per cent in 2005.

Increasingly, HIV infection rates are being observed among IDUs in not only in northeastern states, but other urban areas like Delhi, Mumbai and Chennai, it said.

The WHO report said that in five of the 35 states and union territories, the median adult prevalence rate is 1 per cent. These states are Andhra Pradesh, Karnataka, Maharashtra, Manipur and Nagaland.

Mumbai continues to remain the city where HIV prevalence among sex workers remained consistently high. The city continues to see 40 to 50 per cent prevalence among the this high-risk group for the past five years.

Though, HIV prevalence rates has begun to decrease in some of the southern states, it is increasing in the north-eastern states.

"In Maharashtra, where HIV prevalence among sex workers has remained as high as up to 50 per cent for several years, 18 of 30 districts and 16 of 25 districts in Karnataka have HIV prevalence of one per cent or above among ante-natal clinic attendees at government health centres," it said.

Highlighting the need for collecting data on HIV transmission among homosexuals, the report said there was "high HIV transmission among homosexuals".

"In India, HIV prevalence among this population ranged from one per cent to 40 per cent across the 18 targeted intervention sites," the report said.

The report said the early IDU epidemics in India were in the north-eastern states where up to 70 per cent of the IDUs were injected.


Wednesday, April 25, 2007

SWAZILAND: AIDS activists call for death penalty for HIV infection by rape

By, Reuters AlerNet, April 23, 2007

A rising incidence of rape in Swaziland, coupled with the world's highest level of HIV-infection, is fuelling a national debate on what punishment should be meted out to rapists, especially if the victims of sex crimes become infected with the disease.

"Giving a little girl HIV is like giving her a death sentence," Nonhlanhla Dlamini, director of the Swaziland Action Group Against Abuse (SWAGAA), told IRIN. The group offers medical and legal assistance as well as psychological counselling to victims of abuse, most of whom are women.

The debate about sex crimes and the high prevalence of HIV/AIDS has stalled passage of the Sexual Offences and Sexual Violence Bill, introduced last year. Originally the bill called for the death sentence for HIV-positive men who infected women they raped while knowing their medical condition, but parliament is now expected to debate the bill later this year.

However, Thembi Nkambule, National Coordinator of the Swaziland National Network of People Living with HIV and AIDS (SWANNEPHA), felt that "being HIV positive is not a criminal offence; we should not criminalise being HIV positive".

Those advocating more severe sentences for offenders who knowingly infect their victims said it was not the medical condition they sought to criminalise, but a violent act that was made worse by an infection that would lead to an incurable disease.

The Constitution enacted last year by King Mswati, the continent's last absolute monarch, provided for capital punishment for HIV-positive rapists, but after objections by human rights groups the penalty was replaced by a life sentence.

A five-year prison term for HIV-positive men and women who infect their sexual partners during consensual sex, dubbed the "condom clause" by one of the bill's consultants, is also included, and is a reflection of the sparse use of safer sex measures in a country where nearly four out of ten sexually active adults are HIV-positive, according to the Ministry of Health and Social Welfare.

The proposed legislation places the burden of proof of infection on the prosecution. "When a rape is attended by HIV and AIDS, the prosecution shall prove that the accused either knowingly or negligently or recklessly infected the victim with HIV and AIDS," the bill states.

SWAGAA, which worked closely with the government during the bill's formulation and is widely recognised as placing rape and violence against women on the national agenda, is adamant that infecting a person with HIV/AIDS through rape is the same as murder.

"We see more rapes in this country; we see more little girls infected with HIV through rape. They will need medical care for the rest of their lives, and they have received a premature death sentence, because at some point they will develop AIDS and die before their time," Dlamini said.

The argument for stiffer sentences was strengthened last week after an HIV-positive father in the southern Shiselweni region allegedly raped his 14-year-old daughter, and then beat her to try and prevent her from reporting the incident to the police. In reaction, Hlobsile Dlamini, SWAGAA's public relations officer, told the local press the case should be treated as murder.

SWANNEPHA, an umbrella body for support groups for HIV positive people, maintains that having an additional penalty for convicted rapists who are HIV-positive is a form of discrimination.

"We are already having a challenge getting people to know their HIV status," said a counsellor from the organisation. "This bill will have a chilling effect on our attempt to get people to know their status for their own good, so they can seek treatment. The law would be harsh on people who know their HIV status and then go on to infect other people, not just through rape but through negligence, or maybe if a condom bursts."

Fuelling the controversy this week was the sentencing of a 40-year-old man to a 20-year jail term after being convicted of raping an underage girl and possibly infecting her with HIV/AIDS.

Even without the new Sexual Offences Act on the statute books, the courts have been permitted discretionary power to give harsher sentences when HIV-infection takes place. In cases where this has not occurred, SWAGAA and women's rights groups have decried what they considered a light sentence for the convicted HIV-positive rapist.

"He can be released early for good behaviour, or as part of a nationwide mercy release that is done at some national anniversaries," said SWAGAA's Dlamini. "Meanwhile, the girl he raped may be dead from AIDS."

Justice Qinisile Mabuza, who presided over the rape case and lamented the belief that HIV/AIDS could be "cured" if an HIV-positive man had sex with a virgin, commented, "The crime of rape has become so prevalent that there is no week where there are not reports of it in the press."

However, the judge said the prosecution had failed to link the victim's HIV-positive status to the rapist and called for legislation to make HIV/AIDS testing mandatory for rape suspects.

While handing down judgment, Justice Mabuza took a moment to wonder what the future held for the HIV-positive girl allegedly infected by the rapist, a question that remains at the forefront of the heated national debate in Swaziland, where HIV/AIDS and violence against women and girls are proving an increasingly deadly combination.



Tuesday, April 24, 2007

India ticking with AIDS time bomb

By, The Times of India, April 23, 2007

KANPUR: Most of Mumbai bar girls, 95 per cent of them being from UP alone, were found to be infected with HIV. Summers are particularly conducive for spreading the scourge, as large number of migrant workers from UP and Bihar, working in the megapolis, come home and infect their spouses, according to Dr IPS Gilada.

HIV surfaces more in religious places than state capitals. After visiting temples, people believe that freed of their sins, they can resort to illicit sex. Surprisingly, temple town Tirupati has more HIV infected than a cosmopolitan Hyderabad. Likewise Varanasi has more people living with HIV / AIDS, than other cities. If the trend persists, then in the next 10 years, India would have the maximum number of HIV / AIDS cases, worldwide.

Dr Gilada, Mumbai based doctor, presented these chilling facts while delivering a guest lecture on `HIV-AIDS, what should we do,' here on Sunday, during GSVM Medical College golden jubilee celebrations. HIV is also transmitted with organ transplantation, breast milk, added Dr Gilada.

According to data, women constitute 40 per cent of HIV afflicted in India, 90 per cent of whom are monogamous. Now medicines are available that lowers the risk of transfer of HIV from infected mother to child, he added.

However, successful anti-aids vaccine would not be available until five years. Therefore Dr Gilada warned that taking precautions was the only way to protect oneself from HIV. Some vaccines are available that can prolong life of HIV / AIDS afflicted by 10 or 12 years, Dr Gilada added.

He also advised parents to tell children that they should resist those who touch their genitals or lure them with chocolates or take them to isolated spots. "In the era of cable TV and `choli' movies, ads about alcohol and sex, disco clubs, it is important to prepare the youth to face the world," remarked Gilada.

“Ab nahi aids khatarnak bimari- janch karane me hai samajhdari” , quipped Gilada. He advised people to go in for test after having unsafe sex or suspecting infection. "The test can confirm HIV presence between three weeks and three months," added Giladi.

Dr Brijendra Nigam, demanded an anti retrial therapy (ART) centre for the city as HIV / AIDS graph is going up drastically, on the lines of those existing in Lucknow and Varanasi.


Tuesday, April 17, 2007

Street Sex Workers Are Vulnerable to HIV/AIDS In Bangladesh

By, Mohammad Khairul Alam, Medical News Today, April 16, 2007

Sexually transmitted diseases/ infections - also known as STDs/STIs and once called venereal diseases - are infectious diseases that spread from person to person through intimate/ sexual contact. There are different kinds of STDs, Some kinds of STDs are very dangerous for human health. It can cause permanent damage, such as infertility (the inability to have a baby) and even death. HIV/AIDS is one of the STDs/STIs that are on the rise in sex workers and Injection Drug Users.

Sex work is central to an epidemic that is primarily spread by unprotected heterosexual intercourse. It is also a feature of all countries and cultures, encompassing a wide range of people and behaviours. Sex work can involve men and transgender people, as well as women. People who are engaged in selling sex obviously have multiple sex partners and are therefore highly vulnerable to several Sexual Transmission Diseases (STDs/STI) and HIV/AIDS infection. Because they have many sexual partners, they are also more likely to transmit the virus to other people unless condoms are always used. As mentioned by AIDS researcher Mr. Anirudha Alam, "Street Sex Workers contracting HIV/AIDS through unprotected sex with HIV infected men and sexual abuse has become a persistent problem, especially in South Asia".

Bangladesh is still a low prevalence country (HIV-infection rate is less than 1%), but there is a potential for expanding HIV/AIDS epidemic in the future, because the country is very receptive to HIV infection. Sex work exists at significant levels in Bangladesh, and condom use is low. In Bangladesh, sex workers in brothels as well as on the streets reported rather high client turnover, by Asian standards. Women working in brothels nationwide averaged 19 clients a week, and street workers reported between 12 and 16 in different cities. Consistent condom use is among the lowest in the region.

Street Sex Workers (SSWs) in Bangladesh would play a critical role of HIV/AIDS infections. Due to the types of their work, the lack of sexually transmitted infections (STI/STDs) knowledge and low acceptance of condom use, SSWs represent a highly vulnerable group in Bangladesh. The sharp rise in others sexually transmitted infections (STIs) in Bangladesh contributes to the spread of HIV and may lead to a extensive epidemic, as the heterosexual mode of others STI transmission accounts for an increasing percentage of HIV transmission. Studies of street beggars conducted by Rainbow Nari O Shishu Kallyan Foundation & L.R.B Foundation in mid-2006s at Kamrangir Char, Lalbagh and Polashi in Dhaka city in Bangladesh surveyors confirm the 40-45 per cent of homeless beggars (adult male) indulge in multi-partner sex with less than 10 per cent of them reporting condom use. Street Sex Workers are the main sexual partners of them.

Street Sex Workers are closely associated with the tourism and transport industries where they find a large supply of potential clients. They get their clients by waiting on the streets. Most of them run on their work separately, though some rely on brokers for help in getting clients. The favored method of work is to wait on busy streets, which make available custom as well as relative confidentiality to the contract, as opposed to the less frequented localities. Bus stops, railway stations, cinema halls and river-bank are the usual locations where the contract is negotiated, from where they go to cheap hotels, under constriction building, darkness park-place and lodges with their clients.

Day by day, Sex work is increase in Bangladesh. However Ms. Roushan Ara Rekha, Executive Director of GHARONI, an expert in the field, she said, 'On a regional basis, infected men probably outnumber infected women by a factor of 3 to 1 or more, since commercial sex clients, injecting drug users and men having sex with men have contributed most strongly to the rapid initial growth of the epidemic. This male/female ratio is expected to drop as the epidemic spreads into the general population through spread of HIV from clients of sex workers to their regular partners and spouses.'

M. C. M. Lokman Hossain, Executive Director of Association for Social Advancement & Rural Rehabilitation (ASARR) said, if we want to reduce sex trade we have to clarify our vision on sex work first. Traditional perspectives on prostitution have been repressive, moralising and controlling, perceiving sex workers and their customers to be objects rather than active subjects, excluding them from discussions and decisions around policy and legislation.

Reference: GHARONI report, ASARR report, Sex work network

Written by:
Mohammad Khairul Alam
AIDS Researcher
Association for Social Advancement & Rural Rehabilitation (ASARR)
24/3 M. C. Roy Lane
Dhaka-1211, Bangladesh


LESOTHO: New plan to reduce HIV infections in children

By, IRIN PlusNews, April 16, 2007

JOHANNESBURG - The Lesotho government has launched a four-year plan to reduce new HIV infections among children by 50 percent and ensure that all HIV-infected children have access to life-prolonging antiretroviral (ARV) treatment.

Mother-to-child transmission is the leading cause of HIV infection in children. Lesotho introduced prevention of mother-to-child HIV transmission (PMTCT) services in 2003 but, according to Dr Angela Benson of the World Health Organisation (WHO), only about five percent of HIV-positive pregnant women are making use of them.

The WHO and UNICEF are partnering with Lesotho's Ministry of Health and Social Welfare to implement a new plan that includes establishing universal access to PMTCT services and reducing the risk of mother-to-child transmission by 80 percent by 2011.

A review of Lesotho's PMTCT and paediatric ARV treatment has found that although all hospitals in the country as well as 20 health centres are providing PMTCT services, many of the local health clinics, where most women access antenatal services, still do not offer HIV testing, let alone PMTCT.

"It is imperative to scale up the PMTCT activities from the hospitals to the health centres, and from the health centres to the community and the family level, where women should receive the required support," said Aichatou Diawara-Flambert, UNICEF's Lesotho representative. Most women in Lesotho visit an antenatal clinic at least once during their pregnancy, but more than half still have their babies at home.

A shift to the "opt-out" testing approach, in which all pregnant women are tested for HIV unless they expressly refuse, has helped improve the number being tested, but Flambert suggested that the role of community health workers could be strengthened to reach more women. UNICEF plans to assist in training community health workers to follow up on HIV-positive pregnant women and their newborn children.

Dr Mphu Ramatlapeng, Minister of Health and Social Welfare, said the need to involve men was also critical to improving PMTCT outcomes, and strategies such as couples counselling and HIV testing would form part of the new plan.

With a population of just 1.8 million, UNAIDS estimates that 16,000 children in Lesotho are already living with HIV. Of the estimated 4,000 who need ARV treatment, about 1,160 are receiving the drugs.

The equipment to diagnose children younger than 18 months is not yet available in Lesotho, but UNICEF is supporting the transportation of blood samples to South Africa for testing, and is providing cotrimoxazole, an antibiotic that can protect HIV-infected babies from life-threatening opportunistic infections.

One of the major barriers to scaling up treatment for HIV-infected children in Lesotho has been the shortage of health workers trained in administering paediatric ARV treatment, but the new plan aims to reach all HIV-positive children needing treatment by 2011.

A key element in achieving this ambitious goal is training many more health care professionals, and the establishment of an accreditation process that will allow trained nurses and nursing assistants to manage paediatric medication, alleviating the burden on the country's tiny pool of doctors.


Monday, April 16, 2007

Drug Used To Prevent HIV Transmission From Mother To Child Damages DNA

By, Medical News Today, April 12, 2007

HIV transmission from mother to child can occur in utero, during labor or from breastfeeding. If left untreated, approximately 25 percent of newborns exposed to the virus from their infected mothers will become infected themselves and potentially develop AIDS. Fortunately, antiretroviral drug combinations, which typically include AZT (zidovudine), a nucleoside reverse transcriptase inhibitor (NRTI), have reduced the rate of transmission from mother to child to less than 2 percent in infants who are not breast fed.

NRTIs work by inhibiting the viral reverse transcriptase and by incorporating into the viral DNA and terminating nascent strands, thus preventing the virus from duplicating. However, previous research has shown that NRTIs also incorporate into the DNA of host cells, causing damage that could have long-term health consequences for those exposed to the drugs.

Two new animal studies have examined the cancer-causing effects of transplacental exposure to AZT in mice and rats and found increased rates of tumors and tumors with gene changes that frequently occur in human cancer. In addition, two human studies are the first to observe the induction of mutations and large scale chromosomal damage in red blood cells of newborns exposed to NRTIs in utero.

These, and other, studies were published in April 2007 in a special issue of Environmental and Molecular Mutagenesis that examines the latest research on DNA damage and potential health risks related to the use of NRTIs. Besides the effects of NRTIs on nuclear DNA and cancer risk, the issue also contains recent findings on the toxicity of these drugs toward mitochondrial DNA. Environmental and Molecular Mutagenesis, the official journal of the Environmental Mutagen Society, is published by John Wiley & Sons, Inc. and is available online via Wiley InterScience at (

Researchers led by Dale M. Walker of Experimental Pathology Laboratories in Herndon, VA, administered AZT in varying doses to female mice and rats during the last 7 days of gestation and examined the tissue of their offspring two years later. They found clear evidence of an AZT-induced increase in the incidence of hemangiosarcoma (cancer originating in cells that line the blood vessels) in male mice and mononuclear cell leukemia in female rats.

There was also some evidence of increased liver cancer and reproductive tumors. "Although the implications of these findings for the long-term health of human children exposed tranplacentally to AZT are uncertain, the possibility of increased cancer risk for a subset of these children in mid and late adulthood appears highly plausible," the authors state. The carcinogenic effects of AZT were further demonstrated by a study on mice led by Hue-Hua Hong of the National Institute of Environmental Health Sciences in Research Triangle Park, NC. This study found mutations in the K-ras and p53 cancer genes that are often mutated in human lung tumors. The development of lung cancer in these mice suggests that the incorporation of AZT or its metabolites into DNA, oxidative stress, and genomic instability may be the contributing factors to the pattern of mutations observed in the study, according to the authors. They conclude, "The cumulative mutagenesis data suggest that infants exposed transplacentally to AZT may be at increased risk for cancer as they age."

In the first of the two human studies, researchers led by Patricia A. Escobar of the University of Pittsburgh, in Pittsburgh, PA, measured DNA damage caused by AZT in the blood of newborns. They found increased frequencies of glycophorin A mutations in the red blood cells of newborns who had been exposed to AZT plus lamivudine (another type of NRTI) in utero, and these changes persisted for the most part through one year of age. The researchers note that although the combination of the two NRTIs is more effective at preventing transmission of HIV from mother to fetus, it is also more genotoxic than AZT alone. They conclude that "there is a need for careful monitoring of the future health of children who received peripartum AZT-based therapies, the development of new safer NRTIs, and the identification of antimutagenic drugs that will mitigate the side effects of NRTI-based highly active antiretroviral therapy."

In the second study involving humans, researchers led by Kristine L. Witt of the National Institute of Environmental Health Sciences in Research Triangle Park, NC measured the frequency of immature red blood cells (reticulocytes; RET) containing micronuclei (MN), indicators of chromosomal damage, in blood samples of HIV-infected women and their infants exposed to antiretroviral drugs during pregnancy. Most, but not all, of the prenatal treatment regimens in this study included AZT. At birth, the researchers observed ten-fold increases in the frequencies of micronucleated reticulocytes (MN-RET) in the women and infants whose prenatal drug regimen included AZT. No increases were detected in the women and infants who did not receive prenatal AZT. The frequency of MN-RET in the AZT-exposed newborns decreased over the first 6 months of life to levels seen in nonexposed infants. These findings imply a strong potential for AZT-induced genetic damage in the developing fetus. The authors state "We are concerned about the long-term health implications for these infants because the MN increases noted in this study add to the growing body of evidence that ZDV [AZT] readily induces genetic damage," The authors conclude by emphasizing that they do not advocate eliminating the use of AZT in the treatment of HIV because it is highly effective in preventing mother to child transmission of the virus. However they recommend long-term monitoring of AZT-exposed infants who are HIV uninfected.


HIV infections among under-24 youths on rise - report

By, Austin Beyadi, Guardian, April 14, 2007

The World Development Report 2007, just been launched at the national level in Dar es Salaam, shows that there is increased HIV/Aids prevalence among Tanzanian youths aged under 24.

The report covers development progress in the world generally and where necessary highlights specific issues.

This year�s report has revealed the proportion of 15-24 year old youths infected with HIV in the country to be high with girls between the specified ages taking the lead.

The report cites Zambia as leading among eight countries highlighted followed by Kenya, Cameroon with Tanzania coming fourth.

The Dominican Republic is the least country with a small number of women infected with the virus, while Ghana has been reported to have the smallest number of men infected by the virus.

According to the report, experience with health education, particularly in the context of HIV prevention has shown that knowledge alone does not lead to behaviourial change.

Instead it recommends on providing culturally appropriate knowledge about health risks and on increasing the capability of young people to practise healthy behavior.

The practice likely to change behaviour and reduce infections, the report suggests, should include negotiating safe sex with partners. Such practices are more likely to change behavior and reduce infections.

There is a strong relationship between education and health on one hand, and healthy decisions promoted by education and economic growth, which raises the prospect of higher lifetime earnings and a better life in the future, observes the report.

It further notes that education, often called a ``social vaccine,`` is considered by many to protect young people from engaging in risky behaviors leading to reduced new infections.

The countries highlighted in the report include Zambia, Kenya, Cameroon, Tanzania, Mali, Burkina Faso, Ghana and the Dominican Republic.


HIV cases hit record high in Shanghai

By, China Daily, April 14, 2007

This city reported a record number of new HIV infections last year, according to the municipal public health administration.
There were 718 HIV infections last year, and 53 HIV patients developed AIDS. The number of infections represents a 54 percent increase over the previous year and a record.

Despite the higher figures, the incidence rate of the disease in Shanghai is still lower than the national average, said Cai Wei, vice-director of the municipal public health administration.

Shanghai reported its first HIV infection in 1987. Since then, 2,313 infections had been reported by the end of 2006. One hundred people have died.

Cai attributed the increase to a variety of factors present in the city, including the sex trade and drug addiction. Health authorities have been working to combat the disease, but many underground businesses offering sex services continue to operate in the shadows, making it difficult to compile accurate data.

Health authorities have been working with police to shed light on such businesses. And Shanghai is planning to strengthen its public health system under a three-year plan. The city is also slated to open more methadone clinics for drug users.

"Shanghai is like other larger cities in East China, which have been reporting more HIV transmissions through sexual intercourse in recent years," said an official surnamed Zhuang from the city's disease control center.

"All government departments should be involved," Zhuang said. "HIV is not just an infectious disease, it is a social problem, and fighting it will take coordination from all departments, from legal and educational bodies, to the women's federation and border inspectors."

The city's recently published five-year plan against HIV/AIDS emphasizes government intervention and education. It requires 90 percent of government officials to be trained in how to deal with the disease and calls for most citizens and migrants to receive some sort of education about preventing HIV/AIDS and blood safety.

Sexually transmitted diseases are becoming increasingly common in Shanghai. In March alone, the city reported 935 syphilis cases, accounting for more than a quarter of the new cases of serious infectious diseases in the city .

Health authorities operate three hotlines dealing with HIV/AIDS prevention. They provide information about the disease, expert advice about prevention and medical advice for infected patients.

"The hotlines are effective in spreading information and helping intervention," Zhuang said. "The treatment of AIDS is covered by the city's medical insurance system."

He added that people who are not covered by the system can receive free medication if they apply.


Thursday, April 12, 2007

Asia/ Thailand sets the standard in the fight against HIV

By, Akiko Okazaki, The Asahi Shimbun, April 12, 2007

PROMANEE, Thailand--A record 914 people became infected with HIV last year in Japan, the only developed country where the number of people infected with the virus annually is increasing.

Across the globe, 4 million people become infected with HIV every year. But while the figure in Japan continues to increase, one of its Asian neighbors is drastically reducing the number of new patients.

Thailand, which saw a huge spread of HIV infections in the 1990s, has become a role model for countries seeking to decrease the numbers of HIV-infected people within their borders. The success stems from the joint efforts made by the government and the private sector.

Patin, a 40-year-old woman living in the village of Promanee, about 150 kilometers west of Bangkok, took an AIDS test five years ago after she lost her husband to the disease.

The test came back positive. She was infected with HIV but not full-blown AIDS. Her 7-year-old daughter, Kel, was also infected.

Patin suffered from skin diseases and high fevers. As her physical strength decreased, it became almost impossible for her to work.

But about a year ago, it became possible for her to undergo anti-retro viral (ARV) drug therapy free of charge. About six months ago, Kel also started taking the drugs.

"Thanks to the drugs, my daughter and I have become healthy again," Patin said.

In Thailand, the annual number of people infected with HIV reached about 140,000 at its peak in 1991. Now, the number has decreased to less than 20,000.

The reduction has been, to a large extent, due to the initiatives taken by the Thai government.

Starting in 2001, it became possible for HIV-infected people to undergo a lot of the medical treatment available at public hospitals for only 30 baht (about 100 yen). After the military coup in 2006, the treatment became free.

The ARV drug therapy was included under the program in 2005. Before that, only 5 percent of the estimated 100,000 people who needed ARV drug therapy were able to undergo it. At present, about 80 percent can receive it.

The spread of the ARV drug therapy was mainly due to the activities of AIDS patients' organizations.

In 2001, a nongovernmental organization TNP+, which brought together about 900 groups in Thailand, sued a U.S. pharmaceutical company that had monopolized the patents of ARV drugs.

In 2004, the NGO finally won the suit, making it possible for other pharmaceutical companies to manufacture and sell generic drugs at low prices.

"Thanks to the generic drugs, the monthly drug fee decreased from 10,000 baht to 1,250 baht per person. The decrease made it possible for all those infected with HIV to receive medical treatment," said Nimit Tien-udom, director of the AIDS Access Foundation, one of the groups involved in the lawsuit.

An official of the Thai Ministry of Public Health said the NGOs and the government had been working closely together.

"The goal of the government and that of patients organizations are the same. We are always exchanging information about what we can do."

More than 2 million migrant workers from foreign countries are said to be working in Thailand. Many of them work in the Sangkhla Buri district of Kanchanaburi province, bordering Myanmar (Burma).

A 19-year-old woman from Yangon (Rangoon) came to Thailand two years ago. She has been working as a prostitute to help repay her family's debts. On an average day, she earns 200 baht (about 640 yen). Most of her customers are Thai.

"I learned about HIV from NGO members. I always ask my customers to wear condoms," she says.

Most of the migrant workers are poor and have little knowledge of AIDS. According to the health ministry, legal migrant workers who are paying health insurance premiums can also receive ARV therapy free of charge.

But illegal immigrants, who account for about one-third of all the migrant workers, must pay high medical treatment fees. They often refuse to go to hospitals, making them more susceptible to HIV and more likely to spread it.

In order to prevent this, eight NGOs and the health ministry have joined forces with the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), a Switzerland-based organization funded by contributions from governments and private foundations throughout the world.

So far, they have distributed 1.7 million condoms for free. They have also published booklets in seven languages, including Burmese and Khmer for Cambodians.

They also set up 20 centers in Thailand to distribute the condoms and the booklets and to offer counseling.

In the Sangkhla Buri district, the GFATM is funding a hospital that provides free ARV drug therapy for illegal migrant workers.

In Japan, the infection of migrant workers is also a serious problem.

According to the AIDS Surveillance Committee of the Japanese Ministry of Health, Labor and Welfare, about 12,000 people were infected with HIV or were suffering from AIDS by 2006. Of them, 25 percent were foreigners.

A nonprofit organization, the Services for the Health in Asian and African Regions (SHARE), offers medical counseling for HIV-infected foreigners and also helps them return to their home countries.

The Japanese government has done little for them.

In April 2005, the government's aid organization, Japan International Cooperation Agency (JICA), and the Thai government's Ministry of Public Health did, however, jointly establish the HIV/AIDS Regional Coordination Center.

The center, located in Bangkok within the ASEAN Institute for Health Development (AIHD) of Mahidol University, nurtures experts for three years until 2008 to develop ways to prevent HIV/AIDS.

Experts from Thailand, Cambodia, Laos, Myanmar and Vietnam have been invited to take part.

JICA has sent three Japanese experts to the center. One of them, Yasushi Sawazaki, 45, cited Thailand's good healthcare network and the government's many capable officials as the reasons why the country has succeeded in curbing the spread of HIV and AIDS.

"Each local community also has a system in which people support each other under the leadership of NGOs or temples. There are many things Japan should learn from Thailand," he said.

Siripon Kanshana, inspector general of the Thai health ministry, points out that measures taken by Japan to deal with HIV and AIDS issues will have a big influence to Southeast Asia.

"A lot of Japanese culture, including manga, has spread to Thailand. If a Japanese comic book teaches about safe sex, it will serve as an important prevention measure for young Thai people. Measures against HIV/AIDS are not someone else's problems," she said.(IHT/Asahi: April 12,2007)


Tuesday, April 10, 2007

China's lack of HIV/AIDS awareness undermines control programs

By, Dune Lawrence,, April 9, 2007

Two-thirds of China's 1.3 billion people don't know how to protect themselves against HIV, undermining the nation's efforts to stem the spread of the virus that causes AIDS.

HIV/AIDS cases are increasing by 30 percent a year in China, with 84,000 new infections and 25,000 deaths recorded last year, according to the International Federation of Red Cross and Red Crescent Societies. The data was presented by the aid organization at a forum in Beijing late last week.

Programs have failed to improve awareness of the disease and to control its spread. Last year, 3 billion yuan ($388 million) was spent on HIV projects, equal to the cost of building 20 kilometers (12 miles) of road in Beijing, said Jing Jun, an adviser to the government on AIDS policy and director of the Social Policy Research Institute at Tsinghua University.

``China is entering a stage of AIDS fatigue,'' Jing told the forum. ``China is facing an enormous task, and we can't claim that we have won the battle, or even have a draw with the AIDS epidemic.''

At least 650,000 people in China are estimate to be living with HIV, or the equivalent of 0.1 percent of adults aged 15 to 49, according to the United Nations. That compares with the global prevalence of 1 percent.

``The government, in a very short period of time, has developed policies which are excellent,'' Henk Bekedam, the World Health Organization's representative in China, told the forum. ``While China is very much promoting intervention programs, it's also very clear that those intervention programs are not having good coverage.''

Sexual Transmission

While shared needles used by injecting drug users are the dominant cause of HIV transmission in China, accounting for about 38 percent of infections, sexual transmission is becoming the leading cause of new infections, said He Jinglin, Country Officer for UNAIDS in China.

``It's really changing in China,'' He said. In the past, injecting drug users and those donating blood were most at risk of infection, He said.

China had about 320 government-run clinics using methadone to treat drug addiction at the end of last year. Another 1,200 are needed to ensure adequate coverage, Bekedam said, adding that 75 percent of those living in China don't understand how AIDS is spread or how to protect themselves.

``China has made 10-fold more money available for HIV/AIDS over the last two to four years,'' he said. ``I'm not saying that's enough, but I do also want to note that in the provinces where we go, many counties have money but they don't know what to do with it.''

To contact the reporter on this story: Dune Lawrence in Beijing at


Thursday, April 05, 2007

Challenges of living with HIV

By, Becky Trout, Palo Alto Weekly, April 3, 2007

Virus no longer an automatic death sentence locally, but it still wreaks havoc -- and is still spreading

HIV is rampaging through Africa, Asia and eastern Europe, killing millions. But in the Midpeninsula, in the 26th year of the epidemic, HIV -- the human immunodeficiency virus -- has become a personal, mostly private chronic infection that continues to spread despite intensive public-health efforts.

Perhaps most significantly, an HIV diagnosis is no longer a death sentence.

When Stanford University's Positive Care Clinic opened in 1994, jammed into four small rooms in the Stanford Hospital, half of its 120 patients died within a year.

"Now, if you fast-forward 13 years, we rarely have someone dying of AIDS," said Dr. Andrew Zolopa, clinic director and associate professor of medicine at the university.

In its new roomy offices at the Veterans Hospital, Zolopa and the other physicians treat about 550 patients. Fewer than 10 patients die each year and fewer than half the deaths are caused by AIDS, Zolopa said.

Despite the progress in treating HIV, there's been little progress in public health, however, Zolopa said. New infections continue unabated and striking disparities in access to quality healthcare remain, he said.

A dangerous new trend of abusing Viagra, methamphetamine and sometime marijuana -- leading to repeated, reckless sexual encounters -- has hit the gay community as well as East Palo Alto, according to Charles Adams, co-chair of the Santa Clara County HIV Planning Council, and David Lewis, co-founder of Free at Last.

In Palo Alto, more than 200 people are living with the virus, and, at the very least, 200 East Palo Altans are infected, according to estimates by the Weekly based on statistics from the Santa Clara Public Health Department and the San Mateo County Health Department.

Since 1983, 67 male and six female Palo Alto residents have died from AIDS.

Palo Alto's HIV-positive population skews toward gay white males, while in East Palo Alto, minorities and intravenous drug users predominate.

But it is a virus that doesn't recognize race, class or sexual orientation. Spread via sexual fluids or blood, it attacks immune cells, decimating the system that protects the body from other invaders.

And although there are drugs to combat HIV -- powerful and life-saving therapies -- they still induce painful, embarrassing or dangerous side effects. In addition, the drugs only slow the progression of the disease. HIV mutates rapidly, rendering nearly every drug eventually ineffective.

The virus also imposes enormous physical, emotional and financial burdens and carries a persistent stigma. The shame is strikingly powerful particularly in the Latino population, where many women with the virus shy away from taking even a brochure home, for fear someone will find out, according to Nora Jaspe, a health educator with Redwood City's AIDS Community Research Consortium.

Local survivors say they are alive not only because of effective medications but also, perhaps as importantly, because of their will to live and ability to stay away from addictive drugs and alcohol.

Here are a few of their stories:

Charles Adams, 48, Palo Alto

If you search the Internet for information on AIDS in Santa Clara County, you'll come across Charles Adams' name and the address of the north Palo Alto home he shares with his partner, a longtime Palo Alto businessman.

Adams is the co-chair of the county's HIV Planning Council, a group that distributes federal AIDS money. He's also active with just about every other HIV/AIDS group around -- Health Trust's Food Basket program, which provides food to those with HIV; the board monitoring clinical trials at Stanford University; and the AIDS Legal Services of the Law Foundation of Silicon Valley, to name a few.

"Having my partner has enabled me to help," Adams said. "To me, (HIV) is just part of everyday life, and it's easy to talk about. I'm really lucky I'm in such a supportive environment."

Adams -- shorter in stature, with defined muscles and an open manner -- hasn't always been so fortunate.

Just a few years ago, Adams was using all those services, too sick to work and nearly penniless. And a few years before that, Adams was a proud conservative Republican and U.S. Army officer.

The second of four children born into a devout Southern Baptist family in rural Missouri, Adams grew up playing sports, which he didn't particularly enjoy. He dreamed of attending West Point Academy.

From a young age he knew he was gay and even tried to tell his parents. In response, they guided him toward religion and more sports, he said. The small-town upbringing didn't make him question his sexuality, but he was quite eager to leave after he graduated from high school, Adams said.

"I never gave being gay a second thought. . . . It was just part of life. It wasn't like I flaunted (it). I never drank or did drugs or smoked."

Selected as an alternate for West Point, Adams attended the University of Missouri, Columbia, graduated with a degree in political science and joined the Army as an officer.

He loved it -- the routine and discipline, the diversity and travel. HIV certainly wasn't on his mind.

"We'd all read about something going on (on) the coast. How did that affect me?" Adams said.

It did though. Adams got sick in 1983. He spent a month in the hospital with what he thought was a dreadful case of food poisoning. Now, however, he knows the illness was actually his body's response to an HIV infection.

Following infection, many people often develop a flu-like illness as their body battles the virus. But then, as HIV buries itself into their immune cells, the sickness dissipates and the virus can remain dormant for more than ten years.

Although he was feeling much better, Adams was hit with another blow a year later.

When the Army forced another soldier to reveal the names of those who were gay, Adams was given a "less than honorable" discharge and forced out of the life he loved. He returned to Missouri.

"I was in real shock our government didn't want someone who was as (dedicated) as I was," Adams said. His political views took a sharp turn to the left.

In 1987, HIV tests came out. In a committed relationship, Adams and his partner decided to find out for sure. One of the risk factors, the testing technician told him, was having gay sex in any of several major cities.

"I'd had sex in almost all of them. . . . By then I knew -- I knew HIV was possible."

Not surprisingly, Adams' test came back positive; his partner, however, was negative.

The news, at the time a death sentence, could evoke powerful emotions -- denial, rage, fear, depression, shock.

Adams, however, took the news in stride.

"I wasn't scared. You have to be responsible for your own choices," he said.

Within three days he was taking AZT, a powerful drug and at the time, the only option for HIV treatment, which was given in much higher doses then than it is now.

"I was really, really tired. I threw up a lot. It was really nasty," Adams said.

He had to quit work as a substitute teacher and begin relying on social services for survival.

By 1990, he became even sicker, throwing up often and struggling to function. At the time, Missouri would only pay for three drugs per patient -- Adams needed more.

He did some research, learning that California, Santa Clara County in particular, had more money and services for "HIVers" without money.

So after a few detours, Adams and his then partner moved to San Jose.

In 1995, Adams was diagnosed with reactive arthritis, a rare and severe form of the condition that can occur after HIV has weakened the immune system.

Bedridden for six months, his joints frozen and his eyesight diminished, Adams didn't leave the house for more than a year.

Adams calls the time "a really weird period."

"I've never been the type to get depressed about anything. I never felt sorry for myself. I just thought, 'I just don't want to live, if this is the way it's going to be.'"

Then, gradually, life got better.

Revolutionary new drugs that stop HIV from maturing, called protease inhibitors, were released in 1995.

"Without them, I probably would have died. ... (They) made all the difference in the world," Adams said.

He learned to walk again and figured out how to write using fat pens.

And he met his current partner.

"The reason I liked him so much was he asked, right away, 'What is your status?" Adams said. "There is this big 'Don't ask, don't tell' policy in the gay community."

Adams' partner is negative.

Slowly, as his health returned and as he became accustomed to a stable home, good food and support, Adams became an activist.

"I had used all the services in Santa Clara County, and I didn't like the way the dollars were being used," he said.

"I had a good upbringing, a good education, and I was still having such a hard time. . . . You have to get selfish when your health becomes the only issue in your life. Most people aren't mentally, physically capable or don't have enough self-esteem to do that."

Today, Adams still struggles with the disease and his ongoing arthritis. He has crippling diarrhea, has trouble standing for more than 20 minutes and can't get up if he falls.

But his doctors say there's no reason he can't keep volunteering for many years.

"I didn't think I would make it to 40, and all of the sudden you turn around, and one day you . . . have a life."

Carlton "Collie" Pierce, 55, and David Lewis, 51, East Palo Alto

Collie Pierce is HIV positive; David Lewis is not. Pierce has glasses, a pocked face and a single golden earring. Lewis is imposing, with a trademark mustache and graying hair. Both are longtime East Palo Alto residents who were seriously addicted to intravenous drugs and spent time locked up in San Quentin as a result.

And now, they're both working to help others in the grasp of drugs escape. Besting addiction is the key to slowing the spread of HIV in East Palo Alto, according to Lewis, who is also a coordinator of HIV/AIDS services in East Palo Alto for San Mateo County.

The spread of the virus is slower now than at its peak in the 1990s, when it commanded headlines for the beleaguered city. Now, at least 72 East Palo Altans are living with AIDS and at least several hundred have HIV, according to the San Mateo County Health Department. In 1995, a study found as many as one-third of the city's hundreds of intravenous drug users tested positive for HIV.

Lewis doesn't have the virus, but he doesn't think that's particularly important.

"In our community, it doesn't really matter," he said.

Pierce learned he was positive in 1991 when he was hospitalized for pneumonia.

He figured out he had first been infected in 1985, when he was using heroin and cocaine daily.

"Just like so many other people, I didn't know it," Pierce said. "It's so scary that they go on living normal lives ... (sleeping with) multiple partners. ... I was one of those people."

"My attitude was it would not and it could not happen to me. When I found out, I went on a death mission."

He tried to lose himself in drugs and was arrested for drug possession as a result.

His return trip to San Quentin, with HIV, was different, Pierce said. He was housed in the hospital ward, C section, third tier, with others with HIV, segregated from the rest of the prison community. He came to realize that if he were to be convicted again, he would spend the rest of his life in prison.

Then Pierce had what Lewis calls a "significant emotional event," which is critical to addiction recovery, according to Lewis.

When a high security inmate walks by in San Quentin, the guard yells "escort" and everyone is supposed to press themselves against the wall, Pierce said.

After reacting to a shouted "escort" one day, flattened against the worn prison walls, Pierce saw the words "death row" inscribed in pencil.

"For me, C section, third tier with HIV positive (people) was like death row. . . . I related to that (inscription)," Pierce said.

"That was my last trip to prison. I made a commitment to do anything I could not to return."

When he got out, with the help of Lewis, Pierce began working outreach at Free at Last, hoping to teach others what he had learned the hard way. He's been clean and sober for 11 years.

"I try to be the best advocate I can. That's why I am so very open. People need to know," Pierce said. "It still goes on. You might not hear about it. But it still goes on; that's why they call it 'the quiet killer.' People are still spreading it; people are still dying."

Pierce himself has been fortunate. He hasn't taken an HIV drug since 1999 and feels fine. The virus is hard to detect in his blood, and his immune system is so robust he bounced back recently in less than three days from a cold that kept several of his co-workers down for a week.

Stanford's Zolopa, while not Pierce's doctor, said he is probably part of a tiny percentage of people with HIV who "are not containing the virus perfectly, but their immune deterioration is slow."

He will probably eventually need medicine, Zolopa said.

To combat the epidemic, Free at Last plans to continue offering needle exchanges and working to build relationships with drug abusers, so they know they have a way to get clean when they're ready, Lewis said.

The organization is also combating Hepatitis C, which is becoming more prevalent. Hep C is a virus, transmitted with dirty needles, that attacks the liver.

Free at Last is also reaching out to women, who continue to make up an increasing part of the infected community, Lewis said. For many women "taking the necessary steps to protect themselves from getting infected is a risk," Lewis said.

Stephanie Marshall, 38, Hilmar, Calif.

Hilmar is a small town in the Central Valley, a few miles south of Turlock. Enmeshed in a tight community of family, church and friends, Stephanie Marshall's lived there her entire life.

Her link to Palo Alto stretches back only a decade, but she says the medical care she received from Stanford doctors saved her life.

Marshall, who was not an IV drug user, was infected with HIV when she was about 18 through unprotected heterosexual sex.

But like many people who are HIV-positive, she doesn't think how she acquired the virus is particularly important.

"We get this illness because of choices we made. ... We have to stand up and take responsibility," Marshall said. "We choose not to use protection. It's nobody's fault but our own. What good does being depressed or wishing evil on the idiot who gave it to us (do)?"

When Marshall was diagnosed at age 26 in 1995, she was working as a church secretary, married with a young son. Both her husband and son tested HIV negative. Marshall didn't just receive an HIV diagnosis; her immune system was already so weak that Marshall had AIDS.

"I knew nothing about AIDS. We don't have a large homosexual community. I didn't know anybody who had it. It just wasn't in my radar," Marshall said.

She quickly learned.

"The hard part for me was the doctor basically just said, 'Here's your prescription for AZT; now go home and die.'"

Self-described as "sassy," dying wasn't in Marshall's plans.

She refused to take AZT, however. Why take a drug that would make her so sick?

And as she got sicker, she decided to let everyone in the community know. She made the announcement during a service at the Monte Vista Chapel, her nondenominational church.

"The doctors got up and explained how you get it and how you don't get it. The elders laid hands on me," Marshall said.

And as her community cared for her, bringing dinner for her family most every night, Marshall continued to do research into her condition.

Then she fell in with a group that didn't believe HIV caused AIDS.

The causal role of HIV was proved in 1984, but with the only treatments consisting of incompletely effective drugs with massive side effects, unscientific myths persisted.

Marshall went to Santa Cruz for a bit to live with an aunt. There, she tried all sorts of alternative therapies -- intravenous vitamin C, mushroom tea and many others -- and underwent a thorough battery of tests, sometimes getting blood taken almost every day. Nothing capable of causing her symptoms, other than HIV, could be found.

Marshall began to accept the virus was responsible for her illness.

Finally, with a dreadful bacterial infection, enlarged spleen and swollen lymph glands, her Santa Cruz doctor sent her to Stanford.

She met Zolopa in 1997. At the time, she weighed only 90 pounds and was wasting away, Zolopa said.

He asked why she wasn't taking AZT, Marshall recalled. Marshall explained she didn't want to take such a harmful drug. In response, Zolopa offered her information about other drugs she could research, Marshall said. She hadn't known there were other drugs available.

"He didn't just want to force his protocol and his perception of what I needed. (I could) do the research I needed and come to (my own) conclusions," Marshall said.

Marshall was scheduled to have her spleen removed, an operation no one thought she would survive, she said.

Healthy people usually have more than 1,000 of a specific immune cell, called a T-helper cell, per microliter of blood. Marshall, at her lowest, had only three. An individual has AIDS if his or her T-cell count slips below 200.

Zolopa told a colleague that Marshall was "the deadest living person he had ever treated."

Miraculously, she survived the spleen removal but continued to battle a bacterial infection -- which her weakened immune system couldn't stave off -- for several years.

Now, Marshall drives to Palo Alto only four times a year. Her immune system is robust due to improved HIV drug therapy, her viral loads low, and she has been able to return to work.

"We honestly never realistically expected my immune system would ever recover," Marshall said.

Marshall's son is grown now, and she was divorced last year. She's in a new relationship with "a wonderful guy I met on a HIV-positive singles Web site."

"We understand where we're both coming from. ... We have each others' back."

Robert Boone, 57, Palo Alto

Robert Boone, who asked that his real name not be used, lives and works in Palo Alto.

Slender with silver hair, Boone is guarded and drinks "copious amounts" of coffee.

Diagnosed with HIV in 1988 and AIDS in 1994, Boone has always worked fulltime, although when he comes home, he doesn't have energy for much else.

Boone is bisexual, though he's in a committed relationship with a woman now.

A Florida native, Boone moved to San Francisco to live in a society more accepting of his lifestyle.

For about 13 years, Boone said he was very promiscuous.

"Did I play safe? Obviously not safe enough," Boone said.

"In 1980, I decided it was time to grow up and be respectable," Boone said. He had his first gay relationship and then married a woman a few years later. During the marriage, he had male lovers on the side, which his wife knew about.

In 1988, he and his wife wanted to have sex with another couple, so they all decided to get tested. The others were negative; Boone tested positive.

"I definitely knew it was in the realm of possibility. Was I expecting it? Probably not," Boone said.

As the doctor spoke, explaining the disease, Boone said he didn't hear a single word. The doctor had to discuss the diagnosis with his wife.

"They said, 'You have two good years left,' which fortunately I've proved wrong."

Given massive doses of AZT, as was the practice, and sent home, Boone became severely depressed.

"I did the dumb thing of not trying to get treated for it," Boone said.

His marriage started to unravel.

"It put a real damper on our sex life, to say the least," Boone said. "I'm just as much at fault. But finally she said, 'I just can't deal with you being sick.'"

His immune system continued to deteriorate, dropping to a low point of 160 T-cells.

Nonetheless, Boone still worked 40 hours a week. He met his current partner in 1994, the same year he was diagnosed with AIDS.

"Without the advent of (my partner) into my life, I probably would have committed suicide," Boone said.

This time, he sought out medical treatment for depression.

"Things started to level out and then go upwards."

Boone jokes that he got his "green card to Palo Alto" in 1995.

Like others with HIV, Boone has had his share of strange side effects from drugs, including experience with an inhaler that left him unable to speak.

Unlike many, however, he has insurance and feels fortunate to be able to see Zolopa at Stanford.

"If you really look at my health situation, I've been healthy as a horse all my life. Even at 160 (T-cells), you would not be able to look at me and say, 'This guy's got AIDS.'"

Brown said he has a love/hate relationship with the drugs.

"Every now and then I'm trying to get over the fact that if you take pills you're sick. I'm not sick, but I take pills."

AIDS is like diabetes now, Boone said, something you can live with.

"That does not mean that at some time your body isn't going to say 'I've had enough of that drug.' That's the scary part ... and, and, and 'Is this the beginning of the end?'"

Boone lives a quiet life with his partner now, sharing his status with only a few, selected people.

"I've given up the men in my life," Boone joked.

Boone is slow to preach or judge others' behavior.

"I told my mom, 'It doesn't matter how I've got it, the fact is, I've got it.' ... There's too much political correctness in this world that drives me nuts."

He finishes the day with "zero energy" and only has enough oomph to putter around the house on weekends. But he, unlike many, many of his friends, is still alive.


Tuesday, April 03, 2007

Illiteracy, poverty aggravating HIV among northern women

By, IRIN PlusNews, April 2, 2007

Kenya - Ignorance and overwhelming poverty are making HIV/AIDS a growing problem in Kenya's northern provinces, with women hit particularly hard, health workers have said.

Noor Sheikh Ahmed, an official at the HIV/AIDS and sexually transmitted infections department of Northeastern Province, told IRIN-PlusNews that the number of cases in the four districts of Garissa, Mandera, Wajir and Ijara had doubled to 20,000 in the past two years, most of them women.

"The [number of] HIV/AIDS patients are increasing at an alarming rate," he said. "People struggle to survive and risk their lives."

HIV prevalence levels in the sparsely populated and predominantly Muslim province are the lowest in the country. A 2003 Demographic and Health survey found that less than 1 percent of people were HIV positive, but that awareness levels and misconceptions about AIDS persisted: only 30 percent of women believed HIV could be avoided. Kenya has a national prevalence of 5.9 percent.

Ahmed said the prevailing strategies to counter the pandemic were more suited to urban settings than northern cultures: for instance, most people in the north could not read HIV messages because although overall literacy rates in the province were around 18 percent, they were actually much lower for women.

"Illiteracy means ignorance. The young girls, forced to marry, and then divorced, are being exposed to the virus every day," said Sofia Abdi, of Womankind, a local nongovernmental organisation. "They are unaware of the risks and how to protect themselves from HIV/AIDS transmission."

The harsh climatic conditions of northern Kenya mean people are forced to compete for limited food and water, making ethnic violence, food insecurity, drought and poverty endemic.

"My father was killed, our livestock stolen ... I had no alternative but to sell my body," said Halima Wario, a young HIV-positive woman who takes care of her three sisters. "Two months after the attack, I moved and started [commercial sex] work."

The chairperson of the cultural women's group in the northwestern town of Samburu, Rebecca Lolosoli, said many women contracted the virus during attacks on their families, and the health consequences of insecurity needed to be taken into consideration.

Womankind's Abdi said violence or disease often left impoverished, illiterate women at the head of young households that needed feeding, clothing and education, which exacerbated the HIV burden on women.

Most girls undergo female genital mutilation, which also exposes them to the risk of contracting HIV. "The campaigns and awareness are not enough; women from this region need to be supported and empowered with skills to protect them against relying on men," she said. "The young girls need to be taken to school and prevented from early forced marriages; many are becoming widows at a very early age."


Monday, April 02, 2007

Unsafe Sex: Do Feelings Matter?

By, Science Daily, April 1, 2007

According to the Centers for Disease Control (CDC), adolescents and young adults currently account for fifty percent of new HIV infections on an annual basis. As a result, ongoing research and information on HIV prevention has become a high priority for this age group. Now a new study reveals that helping adolescents manage their emotions may be just as important as providing them with information on the practical side of safe sex in order to prevent HIV and other sexually transmitted infections.

Researchers from the Bradley Hasbro Children’s Research Center and the Warren Alpert Medical School of Brown University studied 222 adolescents between the ages of 13 and 18 with psychiatric disorders and found that feelings do matter when it comes to making decisions about safe sex. Specifically, the findings suggest that lack of self-efficacy (the belief that one could effectively engage in a particular behavior) when confronted with the stress of using condoms is a powerful barrier to their use.

“We found that adolescents need help feeling more comfortable and less distressed about discussing and using condoms,” says lead author Celia Lescano, PhD, with the Bradley Hasbro Children’s Research Center and the Warren Alpert Medical School of Brown University.

Self-efficacy is akin to self-confidence and can be defined as a person’s beliefs about his or her own capabilities to produce effects or change in his or her life. In the context of this study, the authors found that teens with higher self-efficacy about condom use (i.e. they felt that they could effectively use condoms) were more likely to use them consistently even when feeling upset, bad about themselves, depressed or angry.

This study has wider implications for all teens engaging in sexual behavior because difficulty with distress during condom use is not confined to those who are clinically depressed, the authors say.

“As it turns out, managing the stresses associated with condom use is important. Adolescents can learn to decrease their anxiety about discussing and using condoms in order to use them safely and effectively,” explains Lescano.

Prior studies show that adolescents suffering from psychological distress may become overwhelmed in sexual situations because of relationship concerns (the fear of rejection), previous traumatic sexual experiences, or low self-esteem (little motivation to keep oneself healthy).

“Going forward, helping teens decrease distress and increase their effective skills is a critical component to HIV prevention strategies,” says Lescano.

While most HIV prevention interventions focus on acquiring practical behavioral skills like how to use a condom, the authors conclude that more needs to be done to protect oneself from HIV and other sexually transmitted diseases.

The role of emotions in the engagement of health promoting behaviors, specifically condom use in this case should not be overlooked, the authors conclude.

“Using active strategies to deal with how well one manages the distress that arises in the face of a difficult situation such as asking one’s partner to use a condom should be a priority for HIV intervention programs,” Lescano says; “those who work with adolescents should be aware of the need to focus on the emotional aspects of engaging in health-promoting behaviors.”

The findings appear in the Journal of Prevention and Intervention in the Community, Vol. 33. No.1/2 2007.