AIDS Care Watch

Friday, July 27, 2007

South Africa: Still No Verdict On Anti-HIV Gel

By, Tamar Kahn, Business Day (Johannesburg), July 26, 2007

Researchers are still unsure whether the Ushershell microbicide used in the aborted international study involving South African women was harmful, but it clearly did not protect women against HIV, the 4th International AIDS Conference heard yesterday.

"We don't think it's effective, and there may be an indication of increased risk (of contracting HIV)," said Lut van Damme, international clinical research manager with the US-based health research group Conrad.

The group stopped clinical trials of Ushershell in January, after interim analysis of trial data from about 1400 women in SA, Benin, Uganda and India showed the gel might do more harm than good. Half the women used the gel, which contained a cotton-based compound called cellulose sulphate, and the rest used a dummy version.

Ten earlier studies and two contraceptive trials had shown the gel to be safe.

Van Damme told delegates that final data analysis showed 25 women who used the Ushercell gel got HIV, compared to 16 women who had used the dummy. "It was a shock to all of us," she said.

Van Damme said there were several possible reasons why the gel might have failed to protect women from HIV, such as causing inflammation, or disturbing the natural vaginal flora. She said a new Ushershell safety study was planned, which would involve 60 women in the US.

"It would be unethical not to try and understand what's going on," she said.

SA is at the forefront of international research into anti-HIV microbicides as it has good research infrastructure and an HIV-positive population of more than 5,5-million.

Scientists hope microbicides will offer women a discreet way to reduce their risk of contracting HIV from an infected partner, particularly where men are reluctant to use condoms. The South African arm of the Ushershell research was headed by the Medical Research Council's Prof Gita Ramjee, and funded by the US Agency for International Development and the Bill and Melinda Gates Foundation.

A week after the trial was stopped, Health Minister Manto Tshabalala-Msimang ordered the National Health Research Ethics Council to investigate all anti-HIV vaginal gel trials in SA. It has yet to report its findings.

A second Ushercell study in Nigeria was also stopped as a precaution when the Conrad trial was halted.

A nalysis of the data from the Nigerian sites found no apparent increase in HIV risk among the women who used the cellulose sulphate microbicide, Willard Cates from Family Health International told the conference.


Thursday, July 26, 2007

Early treatment for babies with HIV shows higher survival rate

By, The Associated Press, July 25, 2007

New data showing that HIV-infected babies treated in the first weeks of life are four times more likely to survive than those left untreated highlights the importance of early diagnosis, a leading World Health Organization official said Wednesday.

Early results of a new study found that antiretroviral drug therapy given to infected South African infants not yet showing any HIV symptoms within the first three months of life helped those babies live longer than infants who started therapy after showing signs of the disease.

Current World Health Organization guidelines call for drugs to be administered only after signs of a weakening immune system are observed.

The early results of the South African study were so promising that the findings were set to be released to the WHO and other health officials for evaluation to consider changing the WHO guidelines.

"These are new and exciting and potentially very important data," the director of the WHO's AIDS program, Kevin De Cock, said on the sidelines of an International AIDS Society Conference in Sydney.

"It's obviously immensely important in its insight into pediatric treatment strategies," he added. "But the data will need to be looked at more before we really say what the implications are for treatment policy."

Every year, about half a million babies are born infected with HIV worldwide.

De Cock said the South African study, which was funded by the U.S. National Institute of Allergy and Infectious Diseases, highlighted the need for early HIV diagnosis in infants and children.

"You can't scale up therapy or provide appropriate treatment to people if they don't know their HIV status," he said. "There's a need across the board to scale up HIV testing."

The trials, involving 377 babies between 6 and 12 weeks old, were started in July 2005 in Soweto and Cape Town, South Africa. Of those given the drugs early despite no sign of illness, only 4 percent died, compared with 16 percent in the group where treatment was delayed until the babies showed signs of disease.

Last month, an independent safety and monitoring board in London concluded that the results were so overwhelming, the study should be altered to allow all of the infants to begin treatment and the early findings should be released to the scientific community.

"We're hoping that these results will have an implication in formulating guidelines all over the world," the lead co-author, Dr. Avy Violari of the University of the Witwatersrand in Johannesburg, said Tuesday. Violari presented the research to the Fourth International AIDS Society Conference on Wednesday, its final day.

At the AIDS conference on Tuesday:

Robert Bailey, a professor of epidemiology at the University of Illinois, said studies in Africa showed that uncircumcised men were 2½ times more likely to contract HIV from infected female partners. Only 30 percent of men worldwide have had the procedure, mostly in countries where it is common for religious or health reasons.

The American Foundation for AIDS Research said HIV infection rates among men who have sex with men were rising in Africa, Asia and Latin America, citing figures from Unaids. Studies also show that less than 5 percent of that group have access to HIV-related health care, the research group said.


Male circumcision called key to slowing AIDS

By, Meraiah Foley, Associated Press, July 24, 2007

SYDNEY, Australia — A U.S. health expert urged governments worldwide Tuesday to endorse circumcision to slow the spread of HIV, saying men without the procedure have a greater risk of contracting the virus from infected female partners.

Experts at an AIDS conference in Sydney also warned that HIV infection rates were rising among men who have sex with men in developing countries because of discrimination and lack of access to health services.

The World Health Organization says male circumcision reduces the risk of female-to-male transmission of the disease by about 60 per cent. But only 30 per cent of men worldwide have had the procedure, mostly in countries where it is common for religious or health reasons.

Robert Bailey, a professor of epidemiology at the University of Illinois, said studies in Africa showed that uncircumcised men were 2½ times more likely to contract HIV from infected female partners, although many health officials were still unclear about its benefits.

“If we had a vaccine that was 60-per-cent protective, we would be very happy and we would be rolling it out as fast as we can,” Mr. Bailey told reporters at an International AIDS Society Conference in Sydney.

“The next step is to get the leaders of countries to actually come up with policy statements endorsing the practice,” said Mr. Bailey, who has conducted circumcision-related studies in Africa and the United States.

Without local support, international agencies would be unlikely to encourage the procedure to avoid being seen as imposing foreign cultures or values, he said.

Circumcision – the removal of the foreskin from the penis – has long been suspected of reducing men's susceptibility to HIV infection because the skin cells in the foreskin are especially vulnerable to the virus.

In March, the WHO urged heterosexual men to undergo the procedure because of compelling evidence that it reduces their risk of getting the disease. It cautioned, however, that male circumcision is not a complete protection against HIV, and said men should still use condoms and take other precautions such as abstinence, delaying the start of sexual activity and reducing the number of sexual partners.

“Circumcision could drive the epidemic to a declining state toward extinction,” Mr. Bailey said. “We must make safe, affordable, voluntary circumcision available now.”

He also called on international agencies to ramp up funding for circumcision in countries hardest-hit by the epidemic.

Michel Kazatchkine, the executive director of the Global fund, a leading international health agency, also called for increased funding.

“I believe that the evidence is overwhelming for the efficacy of circumcision,” Mr. Kazatchkine told the Associated Press on the sidelines of the meeting. “And if countries come to us ... I see no reason at all why we wouldn't fund that.”

Mr. Kazatchkine said his organization had not received any requests for funding for circumcision, since the WHO advice on the topic was only released in March.

Also at the conference, a leading American AIDS research group said HIV infection rates among men who have sex with men were rising in Africa, Asia and Latin America, citing figures from UNAIDS.

Studies also show that fewer than 5 per cent of that group have access to HIV-related health care, the American Foundation for AIDS Research (amfAR) said.

“This is a massive failure of the HIV/AIDS response globally and I think one that needs to be addressed,” said Kevin Frost, amFAR's chief executive officer.

In Kenya, about 40 per cent of homosexual men are estimated to be HIV positive, compared with a 6-per-cent rate in the country's overall population, amFAR said. In Senegal, nearly 22 per cent are believed to be infected, compared with fewer than 1 per cent of the general population.

In Uruguay and Mexico, 21 per cent and 15 per cent are estimated to have the disease.

Under an initiative launched at the AIDS Society Conference, amFAR will seek to raise $3-million over the next three years to provide grants for AIDS education and research among men who have homosexual sex in developing countries.


Wednesday, July 25, 2007

GLOBAL: AIDS community moving too slowly on male circumcision

By, PlusNews, July 24, 2007

Sydney - Six years, over US$20 million, and probably one million new preventable infections; that's how much it took for AIDS researchers to be convinced that male circumcision should be considered as a prevention strategy.

Delegates attending the fourth International AIDS Society Conference on HIV Pathogenesis and Treatment this week, in Sydney, heard on Tuesday that studies showing the reduced risk of HIV infection were available as far back as 2001.

But it took three randomised, controlled trials in South Africa, Kenya and Uganda before the international health community could be persuaded to act on the evidence, said Prof Robert Bailey, principal investigator of the male circumcision trials in Kenya.

"I'm not sure what could have been done differently, but it does raise the question of whether we have raised the bar too high for converting evidence into action in the face of a crippling pandemic. Perhaps for the next intervention, the threshold of proof will not be quite so high and we can start acting sooner," he said.

Dr Thomas Coates, associate director of the AIDS Institute at the University of California, Los Angeles, is also puzzled by the lack of enthusiasm for male circumcision in the scientific AIDS community - particularly among social scientists, such as Prof Peter Aggleton, a researcher at the University of London, who has warned that introducing the procedure as a prevention strategy could create "new physical and social differences, around which division can solidify".

Coates accused social scientists of creating these divisions themselves. "If social scientists want to be taken seriously, they have to stop listing problems and start coming up with solutions," he commented.

"In terms of science ... this is as good as it gets ... this [evidence] is a scientist's dream. The next logical step is to go into the field and implement. Certainly, given the evidence, there's no reason to hesitate."

How to move from evidence to practice, and at what speed, is another matter. Models suggest that the faster male circumcision is scaled up, the more infections can be prevented, with each averted infection costing governments less.

Bailey noted that the cost-effectiveness of male circumcision, even at the most conservative estimates, compared "favourably" with other prevention services such as school-based prevention campaigns and treating sexually transmitted infections.

Although circumcision was another male-controlled prevention method, women could not afford to be ignored in plans to roll out this programme, Bailey warned.

"As sex partners, as sisters and mothers, women are going to be instrumental in assuring broad and rapid uptake of circumcision in these communities," he said.

Many questions still need to be researched. Bailey told IRIN/PlusNews that the protective effect regarding women, and men who have sex with men, remained unclear, and trials to look into these issues were only in the early stages.

While acknowledging the challenges, a frustrated and impatient Bailey called for male circumcision services to be made available "as soon as possible" in regions with high HIV prevalence rates.

"One cannot help but contemplate that if it were a drug or a compound or a shot with a fancy label, international agencies and donors would have been fighting to be the first to make it available many months, even years, ago," he said.

"But no one stands to profit from male circumcision - no one, that is, but the 4,000 men in Africa who will be newly infected tomorrow, their partners and their children. Haven't we delayed long enough?"


Monday, July 23, 2007

Nepal Health Official Tells Gay HIV Organization to ‘Find Something Better To Do’

By,, July 21, 2007

Nepal’s Blue Diamond Society (BDS) was told Wednesday to stop its ‘Care Support’ sexual health outreach program in Dhangadi and “to look for something better to do”.

This is causing further grave concern over the level of homophobia that exists amongst the Government officials and NGO workers in Nepal, BDS says.

It was two months ago that BDS set up the scheme, funded by the Elton John Aids Foundation and Sidaction in France, because of the increasing number of those living with HIV in the Dhangadi area in the far west of Nepal.

The plan was to coordinate and provide care support to those with HIV and their sexual partners.

Since the scheme started two months ago, more than 15 people living with HIV have been sent to Kathmandu for further support, treatment and hospice facility. The scheme dos not discriminate on grounds of sexuality, working with both the MSM and MSW communities, as well as TG groups.

At a regular monthly meeting organised by the District Public Health Office, BDS outreach educator Ram Awatar said he was astounded at what was said.

Krishna Bhatta, the Public Health Officer said that the “anus doesn’t have any sexual tissues, that’s why there is no chance of HIV/AIDS transmission” and that “there [are] no MSM/MSW/TG in Dhangadi, so I believe this Care and Support program in Dhangadi for MSM/MSW/TG is absolutely unnecessary”.

Then, Ms. Durga Shrestha from BASE, an NGO, told at the meeting: “If we allow this program in Dhangadi, this will promote homosexuality, which will pollute the entire society”.

It didn’t end there.

Santoshi Sharma, from women’s development, told the meeting that “people will copy the homosexual behavior, so there is no possibility for this program to continue in Dhangadi”.

Bhatta then told the meeting that he would find out who was providing the funding. I also need proof whether there are HIV+ people from MSM/MSW communities here,” he added.

Ram Awatar was then told that the donor providing funding for the BDS ‘Care Support’ scheme should come to the next meeting of the District Aids Coordinating Committee (DAAC) “we will discuss whether we should allow any program for MSM/MSW/TG in Dhangadi or not.”

Speaking in Kathmandu, Sunil Pant, the director of the Blue Diamond Society, said: “We are not sure where Elton John is available or not to visit Dhangadi for the next DACC meeting.

“This is another devastating blow against MSM/MSW/TG in a week by government departments,” he continued.

“Last Saturday, five métis (effeminate males) were brutally assaulted by Nepal police for carrying condoms in a Kathmandu park.

“With such attitudes of Government, public health officials and NGOs, sexual health and HIV prevention and care support treatment interventions for MSM/MSW/TG is impossible.”


Tuesday, July 17, 2007

Thailand To Launch Condom Campaign, Implement Legal Protection For Women Whose Partners Refuse To Use Condoms

By, Medical News Today, July 10, 2007

Thai Public Health Minister Mongkol Na Songkhla recently at Thailand's 11th annual national seminar on HIV/AIDS said he is concerned about the increasing number of HIV cases in the country, especially among married couples, the Bangkok Post reports. According to the Post, about 40% of the 18,000 new HIV cases diagnosed annually in Thailand occur among women who contract the virus from their husbands. About 28% of new cases are among men who have sex with men and 10% are among commercial sex workers, according to the Post.

Mongkol said he is considering launching a "family condom" campaign and encouraging married couples to be monogamous. "Using condoms should be regarded as showing respect to each other so that both husband and wife will be safe from sexually transmitted diseases such as HIV/AIDS," Mongkol said, adding that women also should "stand up for a better deal from their husbands."

The Thai National Committee on AIDS will carry out the condom-promotion program with Mechai Viravaidya, chair of the Population and Community Development Association. Mechai said that as part of the program, the committee will ask hotels to put complimentary condoms in guest rooms (Apiradee, Bangkok Post, 7/5).

In addition, Mongkol at the seminar said that Thailand soon will provide legal protection to women whose partners refuse to wear condoms during sex, the Thai News Service reports. According to an agreement reached at a recent UNAIDS meeting in Geneva, laws on social issues and gender equality should be implemented as primary solutions to curb the spread of HIV, Mongkol said (Thai News Service, 7/5).