[hivaids-twg] Today's News (2009.11.06ex)

Fri Nov 6 12:08:54 GMT 2009

Please find attached the following AIDS-related articles compiled by UNAIDS

AFRICA AND MIDDLE EAST    

1. Mail & Guardian, SA - Don't backtrack on Aids, MSF warns Western donors  

2. UN IRIN - MAURITANIA: Don’t abandon us, HIV-positive community tells donors 

3. Ghana News Agency - More Kayayei embrace HIV/AIDS education 

4. Concord Times, Sierra Leone - Pado Educate Students On HIV/Aids, Child Rights 

ASIA AND PACIFIC

1. Channel News Asia - Cambodia aims to raise AIDS/HIV awareness among drivers

2. Phnom Penh Post - Bar owners get HIV/AIDS training

3. Express News Service, India - ‘Three lakh HIV victims in India to be treated 

EUROPE

1. European Public Health Alliance - Commission strategy for combating HIV/AIDS in the EU and neighbouring countries 2009-2013

2. Alan Whiteside.com - A Response to 'Experts want African aid funds channelled away from HIV'

3. The Lancet, UK - Europe urged to fund more tuberculosis research

4. New Statesman, UK - The NS Interview: Linda-Gail Bekker 

5. The Irish Times - Concerns raised over HIV treatment 

LATIN AMERICA AND CARIBBEAN

1. Kaieteur News, Guyana - Local artistes partake in HIV/AIDS testing

2. El Tiempo, Colombia - Por cada dos hombres con VIH ya hay una mujer infectada en Colombia, revelan la ONU y Minprotección

3. Prensa Latina, Cuba - Fondos destinados a combatir sida podrían congelarse en 2010 

4. Pioneiro-RS, Brazil - UCS desenvolve novo teste de HIV 

NORTH AMERICA

1. Washington Post - Slowed funding threatens AIDS fight, group says

2. New York Times - Research Shows Neighborhoods Where AIDS Treatments Lag

3. ATCWorks.org - Why mHealth Initiatives Should Not be Sustainable

4. S. Francisco Chronicle - HIV drug study needs volunteers with dark hair 

UNAIDS WEB.SITE

1. UNAIDS - UNAIDS participate in Netherlands Multi Party Initiative

2. UNAIDS - Antiretroviral treatment for prevention 

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AFRICA AND MIDDLE EAST

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Don't backtrack on Aids, MSF warns Western donors  
Mail & Guardian, SA

05/11/2009

JOHANNESBURG - Cutting funding for HIV/Aids treatment would condemn millions of poor people to death, international medical NGO Médicins sans Frontières said on Thursday, amid signs of Western governments starting to backtrack on their commitments. 

Two major funders of Aids treatment in poor countries -- the Global Fund to Fight Aids, Tuberculosis and Malaria and the United States President's Emergency Plan for Aids Relief (Pepfar) -- are considering scaling back or freeze their funding levels, MSF said in Johannesburg.

The Global Fund is considering taking a "gap year" from funding Aids programmes in 2010 while Pepfar plans to freeze funding at the same level for two years -- despite previously promising to increase its funding for treatment, according to MSF.

Many African countries rely heavily on either or both of these two sources to fund the treatment programmes that keep millions of their HIV-positive citizens alive.

Freezing or cutting funding to these programmes -- after world leaders in 2005 promised to support universal Aids treatment coverage by 2010 --"would be an international betrayal," said Dr Eric Goemaere, MSF medical coordinator in South Africa.

Freezing funding at the same level would mean that new patients could not be enrolled on treatment until someone else died.

Four million HIV-positive people are currently on anti-retroviral therapy worldwide.

More than six million more people are in need of the treatment, according to MSF, which released a report entitled Punishing Success? Early signs of a Retreat from Commitment to HIV/Aids Care and Treatment.

"The HIV/Aids emergency is definitely not over," warned Dr Tido von Schoen-Angerer, Director of MSF's Access to Essential Medicines Campaign.

Some donor governments are trying to divert resources from HIV/Aids to other diseases that are cheaper to treat, but said Schoen-Angerer: "This cannot be an either/or game. Cutting HIV/Aids funding is not the answer." -- Sapa-dpa

2

MAURITANIA: Don’t abandon us, HIV-positive community tells donors
UN IRIN

05/11/2009

NOUAKCHOTT, 5 November 2009 (IRIN) - People living with HIV in Mauritania are voicing their concerns about the suspension of HIV/AIDS funding by the World Bank and the Global Fund to fight AIDS, Tuberculosis and Malaria. They feel powerless in the face of the decisions, of which they are suffering the consequences. 

On 14 October dozens of people living with HIV organized a sit-in in front of the World Bank building in the capital Nouakchott to draw the Bank’s and the international community’s attention to their situation. 

"By suspending their programmes without consulting us, donors have not taken our distress into account," Fatimata Ball told IRIN/PlusNews. Ball represents people living with HIV at the SENLS (the national AIDS committee) Executive Secretariat, the government body implementing Global Fund and World Bank programmes. 

"We, people living with HIV, did not bring about these problems, so should we suffer the consequences?" she added. "The reason donors give millions to Mauritania is that we are a poor country. They gave us hope of a second life when we had given up on that hope; they should not drop us." 

US$21 million of World Bank funding through 2009 was suspended in August 2008 following the military coup against President Sidi Mohamed Ould Cheikh Abdallahi. 

Shortly afterwards the Global Fund suspended HIV/AIDS funding, $15 million over five years which was granted in 2006, following suspected irregularities in grant management. An audit in September 2009 confirmed “embezzlement” had occurred, which led the World Bank also to carry out an audit. 

In accordance with the Global Fund’s terms for reinstating funding the new government, named in September following June presidential elections, began proceedings against four SENLS members suspected of being involved in the embezzlement. The State has also promised to return $1.7 million to the Global Fund and to provide supporting documents on the use of a further $2 million. Finally, the government has also committed to re-structuring the CCM (Country Coordinating Mechanism), the country’s Global Fund funding management body; weakness of the CCM is seen as contributing to the problems. 

Commitments 

While SENLS members recognize the problems that have occurred over the last few months, they are convinced that the new government is keen to resolve the situation as quickly as possible. "The State has made a strong commitment to clearing up the situation. We asked the state general inspectorate to carry out audits and they are now underway,” Ahmed Aida, the recently appointed interim SENLS national executive secretary, told IRIN/PlusNews. 

"Corrective measures have been taken to ensure things go smoothly in the future. We need [partners] to join us,” he urged.

In the meantime SENLS wants to ensure that medical care and support issues are addressed. "The government is willing to take responsibility for treatment,” Aida said. In theory, access to treatment is safeguarded under a law introduced in 2007. 

The Global Fund have said they are aware of the government’s commitment and will do all they can to limit the impact the suspension has on people living with HIV. "We are 100 percent committed not to break up treatments and we will do whatever we can … to continue the grant,” Jon Lidén, Head of Communications at the Global Fund in Geneva, told IRIN/PlusNews. 

"There is a difficult situation [because of] corruption… but the Global Fund is very committed to continue working in the long term to re-establish a way to deliver services in a safe and predictable way, and to expand them as planned,” he added. 

The World Bank reaffirmed it is keen to clear up the situation as quickly as possible, but also that they are available to help people living with HIV overcome this crisis. 

"We are aware of the urgent nature of the situation and we continue to look after the sick,” François Rantrua, World Bank representative in Mauritania, told IRIN/PlusNews. In terms of care and support for new patients, "we are well on our way to finding a very short-term funding solution,” he added. 

While Global Fund-financed HIV/AIDS programmes have been suspended this has not affected patients who were already on ARVs before the irregularities were discovered – just over 1,000 people have continued to receive their medication; but it has not been possible to add any new patients (totalling around 40 people a month) to the treatment programme. 

And other activities in the fight against AIDS funded as part of these programmes have also come to a standstill, such as prevention activities and support (psychological, socio-economic) for people living with HIV. 

"We are not against [donors] checking [the accounts] because this will make our lives more secure", said Ball. "But what is affecting us is that things stopped so suddenly. If we had had some warning we would have been able to mobilize to find other solutions. We are already suffering due to AIDS; we don’t want to be victims of procedures too.”

3

More Kayayei embrace HIV/AIDS education 

Ghana News Agency

05/11/2009

Accra, Nov. 5, GNA - The education on the prevention of HIV and AIDS seems to be going down with Ghanaians and people are now being more careful of their lifestyles.

Basic information about the A, B and C (Abstinence, Be faithful and use a Condom) has become a household word and Kayayee (women porters) who have been described as vulnerable, are using these three alphabets as their guiding principles.

A Voluntary Counselling and Testing (VCT) exercise conducted for 150 kayayei from Agbobloshie and Mallam Atta markets had all of them testing negative.

The test, which was conducted three consecutive times just to be sure of the results, was done by Society for Women against AIDS in Africa (SWAA) in collaboration with the Ministry of Health and supported by the UNFPA.

The VCT was a follow-up of training of 50 Kayayei selected from the two markets in Accra early this year where they were trained as peer educators on HIV and AIDS and Sexual Reproductive Health (SRH) issues among their peers.

The training formed part of UN reform focusing on division of labour in relation to HIV and AIDS, which focused more on prevention intervention, targeting young people, women and vulnerable groups.

Speaking to the Ghana News Agency (GNA) in an interview Mrs Cecelia Lodonu-Sam, Executive Director of SWAA, said her outfit would engage the kayayei in intensive education that will let them remain HIV negative.

She explained that the aim of the collaboration was to build the capacity of the kayayei in reproductive rights to enable them to make health decisions and have negotiation skills.

"People have always underestimated these kayayei and we consider them as very vulnerable and they have proved us wrong. With a little push in education and support, they could also make it in life and rub shoulders with their colleagues in the formal sector."

She said kayayei, though vulnerable, were able to control themselves because of their cultural belief about incriminate sex, fear of unfortunate things happening to them or incurring the wrath of their ancestors and gods. They would therefore rather keep to themselves and have their blessings.

As part of the efforts to improve their economic status, 20 condom outlets have been opened in the two market centres and are being operated by the kayayei.

Mrs Loddonu-Sam said the project of the training and equipping the kayayei with economic skills would be extended to the men porters who had complained that they had been left out of the training which they had seen to be very useful.

She appealed to other stakeholders to help assist in training and equipping the women and men porters with requisite skills that would improve their economic status and social lifestyles.

Ms Esi Awotwi, HIV and AIDS Programme Officer of UNFPA, expressed UNFPA's excitement about the negative reports of the VCT conducted on the kayayei and pledged continuous support in intensifying the peer-to-peer education to further reduce the spread of the virus.

She supported the idea of bringing on board the men porters saying this "will enable them to appreciate gender role, sexual reproductive health rights and HIV and AIDS and also empowerment of women".

Ms Awotwi bemoaned the notion that kayayei had been neglected and were not being involved in any activity that would bring them development and improve their lives.

She said the training was also aimed at strengthening the legal literacy campaign, counselling and testing on the pandemic as well as human rights violations and how to deal with such situations.

The kayayei were taken through the concept of peer education, human anatomy and physiology, pregnancy and child bearing, abortion, sexually transmitted infections, SRH rights, basic facts about HIV and AIDS, stigma and discrimination, condom use and demonstration, facilitation skills, care and support prevention, gender based violence and sex.

They were also taught personal hygiene, communication skills, record keeping and prevention of mother to child transmission of HIV and AIDS. 

Ms Mariama Sulley, a leader of the kayayei at the Mallam Atta market, commended UNFPA and SWAA for empowering them with knowledge and information on HIV and AIDS as well as other reproductive health issues.

"We now feel part and parcel of society and we are contributing our quota to the development of the nation by serving as agents of change," she said.

She added that as peer educator, she had been able to influence the lives of many of her colleagues and expressed her happiness that the HIV testing conducted on them proved negative.

"Empowering us with this useful information and skills would help us to manage our lives well and lead meaningful lives so that we can also in a way contribute our quota to national development."

Mr Mohammed Salifu a youth leader pleaded with government to reconsider the plans of evacuating them from their present place of abode.

5

Pado Educate Students On HIV/Aids, Child Rights
Concord Times, Sierra Leone

05/11/2009

Mohamed L Bangura

Freetown — A community based organization, peacock farm awareness and development organization in collaboration with goal Sierra Leone has ended a quiz competition and sensitization forum for over ten schools.

The main purpose of organizing the programme was to educate the pupils to help fight against HIV/AIDS, malaria and the rights of the child.

The programme attracted many stakeholders including teachers, community members in the east end part of the city.

A representative from goal Sierra Leone, Kadiatu Koroma said her organization always give their support to community base organizations to capacitate children.

The quiz competition involved primary schools like Evangelical primary school, Kulafia Rashideen primary school, Koya town community school, Winners school of prosperity and the Baptist primary school.

Coordinator of the program, Ishmael Koroma said the quiz and sensitization forum was a demonstration of development in the Wellington community.

"It helps to capacitate the pupils in the area of healthcare in the community. We have done more sensitization and debates in the community," he said.

The best quizzers of the competition go to Sheiku Gbla of Fatibo secondary and Momodu Kamara of Olivet primary school.

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ASIA AND PACIFIC

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Cambodia aims to raise AIDS/HIV awareness among drivers
Channel News Asia

06/11/2009

By Wang Eng Eng

PHNOM PENH: Cambodia's battle against AIDS and HIV infection has hit the road. 

From this year, new drivers will have to learn more than just how to handle a vehicle; they will also be quizzed on their knowledge of AIDS/HIV infection. 

"Every year, we have more than 20,000 people who want to get a driver's licence. So during the examination, we'll put 12 questions on HIV prevention," said Lim Sidenine, director of Planning and Admin General Department, Ministry of Public Works & Transport, Cambodia. 

Questions include how AIDS/HIV infection is transmitted and how to protect oneself against the disease. 

The Ministry of Public Works & Transport is also taking the lead in educating truck and lorry drivers, as this group is considered at greater risk of AIDS/HIV infection. 

Truck and lorry drivers play a key role in Cambodia's infrastructure growth as they transport building materials across the country. 

However, most of the infrastructure and road improvement projects are concentrated in towns with a high prevalence of AIDS/HIV infection such as Poipet, which is at the Thai-Cambodia border. 

Cambodia's HIV infection rate has fallen in recent years from 0.9 per cent in 2006 to 0.7 per cent in 2008 - mostly due to government efforts to promote condom use in brothels. - CNA /ls

2

Bar owners get HIV/AIDS training
Phnom Pehn Post

06/11/2009

Kim Yuthana

ABOUT 200 entertainment venue owners and local officials throughout Phnom Penh participated in a meeting about HIV/AIDS prevention on Thursday.

Organised by Population Service International (PSI) and the Phnom Penh Municipal Health Department, the meeting aimed to empower individuals in preventing an HIV/AIDS epidemic in their community. 

Nuth Sokhom, director of the National AIDS Authority (NAA), urged bar and club owners to distribute condoms to customers at their venues. 

“This meeting is very important because it could help reduce HIV/AIDS,” he said.

Nou Savann, a communications manager for PSI, said it was the first time that people from the entertainment industry had participated in such an event. 

He estimated that about 99 percent of men who would like to have sex with women in entertainment venues use condoms, but that only 82 percent of them know how to use condoms properly.

3

‘Three lakh HIV victims in India to be treated
Express News Service, India

06/11/2009

BANGALORE: Only about 75,000 out of the one lakh people living with HIV (PLHIV) in the state are registered and are receiving the Anti Retroviral Treatment (ART). Highlighting the importance of care for PLHIV, a two-day convention on “Convergence for HIV Care”—A National Best Practice Workshop, organised by Snehadaan, a city-based NGO working for PLHIV, was inaugurated here on Thursday.

Dr Bachani, deputy director, National Aids Control Organisation (NACO) gave a clarion call for a sustainable common minimum programme for care and support for PLHIV which can be implemented across the country.

“At present, 2.70 lakh PLHIV are on ART in the country. This number is expected to touch 3 lakh and we would achieve the target set for March 2012 by March 2010. Global Fund is ready to continue the support with grants for the next six years,” she said.

RR Jannu, project director, Karnataka State AIDS Prevention Society said, “In Karnataka, the goal is to achieve comprehensive, competent and compassionate care for all people living with HIV and their affected families.

This is being done through 34 ART centres, 565 Integrated Counselling and Testing Centres (ICTC) and 36 Community Care Centres (CCC) spread across the state.” Poster exhibitions depicting success stories of care centres and ART centres, satellite skill-building workshops addressing themes such as encouraging positive speakers, prevention of infection, reduction of stigma and discrimination in health care settings are being held across the country.

feedback at epmltd.com <mailto:feedback at epmltd.com> 

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EUROPE

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Commission strategy for combating HIV/AIDS in the EU and neighbouring countries 2009-2013
European Public Health Alliance

05/11/2009

The European Commission has been involved in the fight against HIV/AIDS in the EU and neighbouring countries since 2005, the date of the adoption of its first strategy. In October 2009, the Commission renewed its efforts by adopting a strategy for the period 2009-2013.

The number of people living with HIV/AIDS in the EU has increased over the past years and today affects approximately 730 000 people. HIV does not follow a single model, there is disparities between the cases and different modes of transmission.

The new strategy tackles these differences by concentrating on three key areas : HIV prevention and testing, priority groups most at risk and priority regions.

Of particular concern is the high number of persons who are not aware of their infection : about 30% of people in the EU and up to 70% of people in neighbouring countries. These late diagnoses usually lead to late treatments with less chances of success, which increases the need for a coordinated approach at the European level.

HIV infections rising in neighbouring countries Concerning priority regions, HIV infections are particularly high in the neighbouring countries of the Union which reinforces the need for exchange of knowledge, good practices on prevention, testing, treatment and care between countries. Such a good cooperation should reduce new infections and improve the life of people living with HIV/AIDS.

In regards to priority groups, the biggest impact on the epidemic could be achieved if the situation of the most at-risk populations is efficiently addressed. Depending on the country, it can be men having sex with men, migrants or injecting drug-users. In order to contain the epidemic in Europe and beyond, a strategy needs to reach these groups.

Based on three key issues, the overall objectives of the 2009-2013 strategy are to reduce new HIV infections across all European countries by 2013, to improve access to prevention, treatment, care and support, and finally to improve the quality of life of people living with, affected by or most vulnerable to HIV/AIDS in the European Union and neighbouring countries.

For more information :

 Commission’s press release 

 EATG press release

2

A Response to 'Experts want African aid funds channelled away from HIV'  (Letter)
Alan Whiteside.com

04/11/2009

Blog

Dear Editor,

Last Sunday you published an article headed ‘Experts want African aid funds channeled away from HIV’. The story bears little resemblance to the title, which is sensational and certainly does not reflect my views.

There are an estimated 33 million people living with HIV across the world and numbers are rising. Only 30 percent of people needing treatment have access to drugs. It is misleading at best and thoroughly dangerous at worst to publish such bold headlines that I, nor the majority of those working in this field ascribe to. In the article itself, I state that AIDS spending is vital ‘for those already on or requiring treatment.’

The unmet health needs for those in the developing world, be it for malaria, diarrhea or AIDS highlight the importance of and obligation to greater funding. It is not HIV/AIDS funding that is the problem but rather that funding for global health is wholly insufficient. A recent conference on ‘Global Responsibilities for Global Health Rights’ in Brussels stressed the failings of donor countries in fulfilling their aid pledges. If only 0.7% of the gross domestic product of developed countries was committed and 15% of this used for health, then $38 billion would be raised instantly. This would go a long way to reaching the Millennium Development Goals.

Corruption is a problem. But can we promise if funds for HIV were reallocated that this would still not be the case? I believe the big capital projects and arms deals attract greater corruption. Rather than focusing on this as an excuse for truncating AIDS funding, the inefficiencies both in recipient and donor governments, should be explored.

Global health is critical. Prevention is critical. I do not regard one above the other. Neglect of funding and health has created the conditions where children are dying unnecessarily. AIDS activists held governments to account, and considerable sums of money to AIDS and health more broadly. Their ingenuity, innovation and tenacity should be replicated for better health for all.

Your sincerely

Alan Whiteside

© 2009 ALAN WHITESIDE

The Observer article full-text: http://www.guardian.co.uk/world/2009/oct/25/aids-hiv-africa-aid-scientists

3

Europe urged to fund more tuberculosis research
The Lancet, UK

07/11/2009

Volume 374, Issue 9701, Page 1584

Kelly Morris

Most European nations are failing to contribute their fair share of funding for tuberculosis research and drug development, according to a new report. Kelly Morris investigates.

European nations are being urged to commit more funds to tuberculosis research and drug development following an analysis which highlighted the region's poor contributions.

The report by Médecins Sans Frontières (MSF) found that all European countries, except Sweden, “have failed to prioritise” tuberculosis, contributing to a “huge global underfunding” for the disease. Overall, the European contribution is estimated at about a third of its fair share—the proportion of the total financial need relative to gross income—whereas the USA contributes two-thirds of its fair share.

The report examined public funding through grants to individuals, institutions, and organisations such as the Global Alliance for TB Drug Development (TB Alliance). Indirect funding of European Commission research—which includes projects to develop a tuberculosis vaccine and rapid point-of-care diagnostics to detect resistance—was also included.

The analysis showed that France and the UK each invest around half of their calculated fair share, whereas Germany and Italy contribute only 23% and 11%, respectively.

MSF is “focusing on tuberculosis because we have a special operational need and because the disease burden is large”, the report's co-author Oliver Moldenhauer told The Lancet. MSF treats about 30 000 people with tuberculosis per year and the number of patients with resistant disease has increased. Christophe Fournier, president of MSF International, told a symposium to launch the report that the organisation is “facing up to the hard facts that we can't treat tuberculosis properly with the drugs and diagnostics at our disposal and that means losing significant numbers of patients”.

The global investment needed to fully scale up research and development of new tuberculosis tools is estimated as at least €1·45 billion, but only around €350 million is currently invested—a global deficit of 75%.

Compared with some other infectious diseases, tuberculosis presents additional challenges to the development of drugs, vaccines, and diagnostics, acknowledges Moldenhauer. But “progress has been made on other complex diseases when they are profitable”, he notes. Since tuberculosis research has only just restarted after decades of neglect, all available compound libraries should be tested for anti-tuberculosis action, representing “low-lying fruit” for the pharmaceutical industry, he says.

MSF is also drawing attention to two innovative funding mechanisms to advance research. One is increased investment in product development partnerships, such as the TB Alliance, to encourage new drug development and trials. The TB Alliance has several new compounds in the pipeline that are set to enter into expensive clinical trials in the coming years. The other proposal is a prize fund to stimulate research on new point-of-care diagnostics. An ideal development would be a test suitable for field use that does not depend on sputum. There is also the promising technology already developed by the US military to detect other pathogens that have the potential to rapidly and simply diagnose patients with tuberculosis and drug resistance based on DNA detection, explains Moldenhauer. Sputum microscopy currently detects only about half of tuberculosis cases, and is more ineffective in people with HIV/AIDS and in children. MSF estimates that a prize of €50 million would be a sufficient incentive for companies, and adds a pull incentive to other financing mechanisms.

MSF will continue to follow progress on the issue, and Moldenhauer is hoping that the Swedish European Union Presidency and the change of German Government will bring new action for tuberculosis funding.

“When we ask the question are we doing everything we can, clearly the answer in Europe is no”, says Nils Billo, executive director of International Union Against Tuberculosis and Lung Diseases. “Changing the current reality will take political commitment for sustaining funding over many years. Europe needs to prioritise tuberculosis.”

4

The NS Interview: Linda-Gail Bekker
New Statesman, UK

05/11/2009

Sophie Elmhirst

Your work focuses on HIV and tuberculosis. What does that involve? What's the plan?

Here in Southern Africa, children are getting TB in huge numbers. They don't get the disease immediately, but they become infected. When you superimpose the HIV epidemic on top of that, you speed up the progress of the illness - so the TB infection becomes TB disease in young adulthood because of their immune deficiency. We have to think of TB and HIV together almost as a new disease. That requires us to go back to fundamentals, but also to think outside the box. What will be the new interventions? What else could we be doing?

What drew you to work in the field?

I was born in Zimbabwe, and came to UCT [the University of Cape Town] to do my medicine degree. It was the late 1980s and the HIV epidemic was just breaking for us. I remember a strong sense of frustration, anxiety, impotence - I didn't fully understand what was going on and wanted to know more. I went on to do my PhD in host immunology, which I am still fascinated by. But as time has gone on, I've been drawn to the hands-on side of things. I'm really a closet social worker these days.

Are you engaged in the politics of South Africa?

Well, I think we are activists at heart simply because, again, you can't work in this field and not be politically aware. We work hard to change policy, but through evidence. And that's a slow and often arduous process.

Do you personally feel political? Do you vote?

Oh, yes. I came from Zimbabwe, perhaps politically quite naive, to UCT, which was a very liberal university in those days. I had quite a political awakening as a result of that.

In what way?

I came to university in the 1980s, an incredibly volatile time in SA's history. And the 1990s was the most extraordinarily liberating period. That initial starry-eyed, honeymoon phase is a little bit over. We really need to roll up our sleeves and say: "What are the issues at hand?"

Do you think there's been a lack of political leadership in South Africa?

Yes. Civil society became the leaders: we have had to take on the government on some occasions. On other occasions we've taken on the pharmaceutical companies with the government. SA has huge challenges still - some days you kind of recognise that it's a big job, and how ever are we going to meet all the challenges? But the little triumphs along the way do count. I think we are making progress.

You've just won the Royal Society Pfizer Award for your research into HIV and tuberculosis. What does the prize mean to you?

I'm overwhelmed. I think one of the aspects of working in this part of the world is that you get on with the job, you get lost in the day-to-day work. So when somebody stops and acknowledges you, it's a very pleasant surprise.

It's said you marry science and humanity.

HIV and TB are just so much a part of our lives. A good part of our workforce lives openly with HIV. I have had TB and had to take treatment. 

It really is very tangible for us: you're dealing with it not only at work, but in everyday life.

How do you balance your work with the rest of your life?

I married someone in exactly the same field. He's the director of the HIV centre at UCT and I'm deputy director, and we run the foundation together, so a lot of our work comes home. But we have a great work team who can be relied upon. We have two grown-up children and a seven-year-old, Oliver, who started life with an embryonic carcinoma, so the first three years of his life we camped at the Red Cross children's hospital because he needed chemotherapy. Once you've got beyond that, you pretty much feel you could cope with most things!

Is there anything you regret?

I've loved being a mother. I could have quite enjoyed another child. But no, I don't think I have any regrets at all. The only thing is that I would have done more of everything.

Would you ever like to live anywhere else?

I'm inherently an African: I'm fourth-generation. It's hard for me to think of living anywhere other than Africa. Certainly, the work I do seems most relevant here. I lived for some time in New York and I loved it. But what makes me want to stay here for the moment is just the relevance. I'm a hands-on person. I like to engage with the community, with the staff. I think that's where my talent is.

Are we all doomed?

I don't think so, but I can see why you would ask. When you look at TB-HIV figures you wonder what the next terrible virus or pathogen is that's waiting around the corner. But the thing that strikes me daily is the resilience of humanity. Human beings find a way.

Linda-Gail Bekker is deputy director of the Desmond Tutu HIV Centre at the University of Cape Town and chief operating officer of the Desmond Tutu HIV Foundation.

Read a longer version of the interview.

5

Concerns raised over HIV treatment
The Irish Times

05/11/2009

KITTY HOLLAND

Poor availability in Ireland of a medical treatment which can prevent HIV infection after a person has been potentially been exposed to the virus was an area of "major concern and dissatisfaction", a conference in Dublin heard today.

Addressing the 8th Nordic HIV conference, Maeve Foreman of the School of Social Work and Social Policy at Trinity College presented findings from a landmark study of Irish HIV services. 

The study relied on detailed questionnaires filled in by about 20 per cent of the HIV positive population attending the five major HIV clinics in the State. 

"Overall the majority of people lauded the support and care they got from services," said Ms Foreman. 

"Several areas of dissatisfaction were highlighted, first and foremost of which was inadequate information on the availability of post-exposure prophylaxis (PEPs),” she said. 

"In fact it is very worrying that that so few are aware of PEPs when it should be so much part of stopping the spread of the virus." 

PEP is a short-term antiretroviral treatment which reduces the likelihood of HIV infection after potential exposure, either occupationally or through sexual intercourse. It is most effective when started within hours of the potential exposure, and treatment is given over the course of about a month. 

Ms Foreman said it was generally not available from GPs, that it should be available at all A&Es but many had to wait until they got to a HIV clinic to get treatment. "Many people simply don't know about it though and that is worrying." 

Conference chairwoman Mary O'Shea said there was a perception HIV was not longer being transmitted. However, infection rates were increasing, by 3.6 per cent last year when 405 new cases were confirmed, as compared with 2007. 

"HIV and AIDS need to remain on the agenda. It is still infecting people and the highest number of new infections are among heterosexuals." 

She said discrimination against sufferers persisted and called for the initiation of a national sexual health strategy "if we are serious about addressing issues of HIV and sexual health in Ireland". 

President Mary McAleese, who delivered the key-note address, said the positive progress in treating HIV gave rise to a risk of complacency about the virus. She too mentioned "rising infection rates here".

© 2009 irishtimes.com

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LATIN AMERICA AND CARIBBEAN

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Local artistes partake in HIV/AIDS testing
Kaieteur News, Guyana

05/11/2009

As the National Week of Testing approaches, the Ministry of Health in collaboration with the National AIDS Programme Secretariat (NAPS) has got on board a number of local artistes to participate and be tested for HIV/AIDS.

Playing their role in society yesterday was Melissa Roberts (Vanilla), Michelle King (Big Red), Adrian Dutchin, Roger Hinds (Young Bill Rogers), Jessica Xavier, Desiree Edghill, Wilbur Levans (Lil Man) and Tenneisha, all of whom took an HIV/AIDS test at the NAPS building.

All of these artistes shared the view that by their participation in the event, young people will be motivated to get tested and to know their status.

Programme Manager of NAPS, Dr. Shanti Singh, explained that the secretariat has recognised the influence and power that artistes have on their supporters and the fan base, as many persons, especially youths, look up to them.

According to Dr. Singh, the fact that the artistes are testing for HIV should be testimony to the importance for every Guyanese to know their status. She added that the entertainment industry is an influential factor to young people in risk taking.

“Your presence here demonstrates that we can all have a good time together but in a safe way,” Dr. Singh said.

National Week of Testing will commence from November 14, 2009 and will be held under the theme, “take action; take the test.

Delivering remarks on behalf of Kross Kolor Records was Adrian Dutchin who noted that the recording company recognises how important the event is and what it would mean for young people.

Dutchin committed that the company will definitely be on board to support anything that has to do with helping young people and the world, tantamount to the fact that HIV is something that is definitely affecting the world.

The entertainer also explained that there is this growing trend where men are afraid to get tested. In this regard, he urged for this to be changed.

“So fellas, Adrian Dutchin and the entire Kross Kolor Crew is saying to come out get tested, because it is important to know your status,” Dutchin advised.

Meanwhile, Minister of Health, Dr. Leslie Ramsammy who was also tested yesterday reiterated that artistes have huge influence in any country and as such thy have an important role to play in society.

“We all talk about everybody has a role and some of us have greater roles to play and unfortunately you carry a burden, which is not to only entertain people but because of the following you have among the population. I think you have a responsibility…it might be an unfair responsibility but you chose that responsibility when you chose to be an entertainer,” Dr. Ramsammy told the artistes.

He also lauded Artistes in Direct Support for the work being done in promoting information about the virus. According to the Health Minister, Artistes in Direct Support is one of the best-known organisations in Guyana in its fight against HIV/AIDS as it is one of the best Non Governmental Organisation and Civil Society Organisation not only in Guyana but also in the Caribbean.

Dr. Ramsammy also explained that over the years the Health Ministry has made tremendous improvement in effectively tackling the virus.

For the National Week of Testing, the Health Ministry has established an ambitious target of reaching out to 20,000 persons to be tested for HIV/AIDS.

To facilitate countrywide testing, a total of 310 testing sites have been established across the country. These sites are appropriate for testing, as there are guaranteed confidentiality and has been certified by the NAPS.

Some news sites established for this year includes the City Mall, all of the outlets of Scotia Bank and of Republic Bank.

2

Por cada dos hombres con VIH ya hay una mujer infectada en Colombia, revelan la ONU y Minprotección
El Tiempo, Colombia

05/11/2009

El proceso en el país, y en vastas regiones del planeta, se ha dado en forma tan rápida que expertos lo llaman la feminización del sida. Violencia y machismo, entre los responsables de ese situación. 

Hace dos décadas, por cada 13 hombres infectados con el virus de inmunodeficiencia humana (VIH), que causa el sida, había una mujer afectada. Hoy, esa relación es de dos hombres por cada colombiana. 

El Fondo de Población de las Naciones Unidas y el Ministerio de la Protección Social llevaron a cabo dos estudios (uno cualitativo, entre población femenina en general, y el otro cuantitativo, entre trabajadoras sexuales), para establecer cuáles son las condiciones que hacen más vulnerables a las colombianas frente a esta enfermedad.

De acuerdo con Martha Lucía Rubio, asesora en VIH sida del Fondo, la principal conclusión del primero de esos estudios (hecho con grupos focales en Bogotá, Barranquilla, Bucaramanga, Cali y Medellín) es que las mujeres están en un altísimo grado de vulnerabilidad, porque no se protegen lo suficiente contra el virus del sida.

A partir del análisis de la información obtenida, los investigadores concluyeron que, en buena medida, las causas se encuentran en una serie de condicionantes a los que históricamente han estado expuestas las mujeres.

"Entre ellos se cuenta -dice Rubio- el hecho de que la sexualidad femenina siempre ha estado bajo el control del grupo familiar, de la pareja y hasta de los profesionales de la salud, a grado tal que ellas lo perciben como algo natural".

'Las mujeres que vivimos con VIH nos sentimos culpables'

"Me llamo Ceci y cumplí 45 años. Estuve casada 26 años con Eduar, que fue mi segundo novio. Empecé a tener relaciones sexuales con él porque me dijo que si no lo hacía, me dejaba. 

"Con mi primer embarazo tuve que dejar de estudiar y me fui a vivir con él. Eduar no me respondía con lo del niño y me maltrataba. A los cuatro años de estar juntos empezó a trabajar en bares y tuvo otra mujer. 

"Por esa época me enfermé y me estaba desapareciendo. El médico me ordenó una prueba del sida, pero la autorizaron a los seis meses. Ahí supe...

"Él casi no se hace el examen, y la moza ahí. Me tocó contarles a mis hijos y a mi familia. Así duramos varios años, pero la cachetada y el maltrato seguía. Mi hijo se fue de la casa y yo me fui a vivir con mi familia.

"Creo que las mujeres nos sentimos culpables, que si decimos que vivimos con VIH nos van a tildar de trabajadoras sexuales y vamos a perder el respeto. Nos encerramos porque nos sentimos culpables".

No usan preservativo por ellos

También se encontró que la infidelidad masculina sigue siendo un hecho recurrente y tolerado cuando es con otras mujeres (no si es con hombres), "el problema grave es que aquellas que son fieles a su pareja estable creen, erróneamente, que no son vulnerables al VIH, tanto que la mayoría no contempla el uso del condón con su compañero", señala el estudio.

Las mujeres más jóvenes, vale decirlo, tienen una mayor aceptación del preservativo, pero no lo usan cuando sus parejas dicen sentir incomodidad o disminución del placer sexual.

Como en la mayoría de los casos estudiados predomina la dependencia económica femenina; en cuanto a su sexualidad, su preocupación principal es evitar embarazos: "La única información que muchas han recibido sobre prevención de enfermedades de transmisión sexual y VIH ha sido durante controles del embarazo", dice el estudio.

En general, señalan los investigadores, pese a las campañas de prevención, buena parte de las mujeres incluidas en el estudio dijeron tener relaciones difíciles con el personal de salud. La principal queja es la negligencia médica, la falta de programas adecuados y la negación de las pruebas diagnósticas del VIH. Buena parte de ellas considera que la distribución de anticonceptivos no es óptima.

Rubio explicó que el propósito de los estudios era hacer un análisis de los contextos socioculturales de mujeres de distintas condiciones, algunas de las cuales viven con el virus del sida.

La idea es incorporar estos factores, que las exponen más a adquirir este virus, a las estrategias de promoción y prevención de la enfermedad.

La principal vía de infección con VIH en Colombia es la sexual

Desde que la epidemia de sida empezó en Colombia a mediados de los años 80 se han registrado, oficialmente, 64.729 casos de sida.

De acuerdo con el Ministerio de la Protección Social, sólo durante el 2008 se reportaron 4.250 casos. 

Se desconoce la forma en que las personas adquirieron el virus en 26.313 de los casos. En cuanto a los 38.416 restantes, se identificó que el 96 por ciento de las transmisiones ocurrió por vía sexual (el 62 por ciento de estas personas eran heterosexuales; el resto, homosexuales o bisexuales).

Se estima que 1.022 casos de infección ocurrieron por transmisión perinatal (de madre a hijo); de las 131.273 embarazadas que el año pasado se sometieron al examen del sida, 266 dieron positivo al VIH.

Se tiene información de 227 nacidos vivos, de los cuales cuatro fueron diagnosticados positivos. 

En el mundo, de acuerdo con el último informe de Onusida, hay cerca de 33 millones de infectados con VIH. El número de personas con acceso a tratamientos con medicamentos antirretrovirales aumentó en un millón en todo el mundo, pero la cantidad de nuevos infectados creció a un ritmo de casi 2,7 millones anuales.

CARLOS F. FERNÁNDEZ, SONIA PERILLA S.

REDACCIÓN SALUD

3

Fondos destinados a combatir sida podrían congelarse en 2010  
Prensa Latina, Cuba

05/11/2009

Johannesburgo, 5 nov (PL) Los fondos foráneos destinados a terapias de VIH seropositivos, podrían congelarse en 2010, de acuerdo con una advertencia de una entidad médica internacional difundida hoy en esta capital.

  Un informe de la organización Médicos Sin Fronteras (MSF) denunció que sería inaceptable la congelación de esos recursos, pues podrían socavarse los avances en la reducción de la mortalidad en los enfermos de SIDA.

De acuerdo con la misma institución, la lucha contra esa enfermedad sigue siendo prioritaria y una señal de esto es que en Botswana 80 por ciento de los decesos todavía se deben a su incidencia.

La extensión por el mundo de las terapias con antirretrovirales ha hecho retroceder la mortalidad en varias regiones y también ostensible en el sur de África.

En 2007, Suráfrica disminuyó en 18 por ciento la cifra de fallecidos a causa del VIH con el uso de antirretrovirales, logro sobresaliente pues se trata de una de las naciones con mayor número de infectados.

Un país como Lesoto depende totalmente de la ayuda y colaboración internacional para aplicar los tratamientos.

4

UCS desenvolve novo teste de HIV
Pioneiro-RS, Brazil

05/11/2009

Ministério da Saúde usará kit em pesquisa nacional com mulheres a partir de janeiro 

A portaria 151 do Ministério da Saúde (MS) ratificou um trabalho do Laboratório de Pesquisas em HIV/Aids (LPHA) da Universidade de Caxias do Sul (UCS). Publicada em 16 de outubro, ela autorizou testes para a detecção do vírus HIV com sangue seco, usando a coleta com papel filtro, método pesquisado pela UCS há três anos. Até então, o diagnóstico oficial era apenas dado por meio da análise de sangue in natura coletado por seringa.

Além de uma redução de 20% a 30% nos custos com material de coleta, a amostra de sangue seco armazenada no papel filtro suporta até 12 semanas sem refrigeração, podendo ser enviada pelos Correios para o laboratório. Assim, o MS poderá ampliar o acesso aos testes a moradores de regiões distantes. Pelo método tradicional, o sangue precisa ser refrigerado, e os exames têm de ser feitos em até duas horas após a coleta.

— O Brasil é um país continental e muitas localidades não dispõem de laboratórios. Com a validação dos testes em sangue seco, esse acesso fica garantido. Isso possibilita que um ribeirinho do Amazonas também possa efetuar o teste — exemplifica o médico, pesquisador e chefe do LPHA, Ricardo da Silva de Souza.

Para confirmar a eficácia do diagnóstico com o papel filtro, o laboratório realizou mais de 11 mil testes, que comparam o método novo ao antigo. Os resultados, garante o pesquisador, sempre coincidiram. Outra vantagem da pesquisa caxiense, aponta Souza, é a padronização:

— Já existiam outros estudos, mas conseguimos obter uma padronização de exames que facilitará o uso em todo o país.

O método de coleta é considerado bastante simples e é semelhante ao do teste do pezinho, usado para a detecção de doenças metabólicas, genéticas e infecciosas em recém-nascidos. São necessárias apenas algumas gotas de sangue para umedecer o papel. O LPHA criou um kit com papel filtro, lanceta (espécie de agulha retrátil para perfurar o dedo), sachê de lenço com álcool, envelope em papel alumínio para preservar a amostra e envelope de carta-resposta (gratuita para quem responde).

Os novos testes rápidos começarão a ser usados pelo Ministério no projeto Sentinela, envolvendo 44 mil mulheres do país, a partir de janeiro de 2010. Conforme o método passar a ficar conhecido, a expectativa é que ele seja usado por gestores da saúde em Estados e municípios.

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NORTH AMERICA

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Slowed funding threatens AIDS fight, group says
Washington Post

06/11/2009

By Karin Brulliard, Washington Post Foreign Service 

JOHANNESBURG -- Slowed funding from international donors, including the United States, is imperiling recent dramatic gains in treating AIDS patients in the developing world, according to a new report. 

Billions of aid dollars channeled toward the epidemic in the past decade have helped provide life-prolonging drugs to more than 4 million people, but the rate of infection still outpaces that of treatment. Now the global economic crisis and other factors are causing financial support to taper, undermining progress in nations such as Uganda, where some clinics are refusing new patients or accepting them only after a current patient dies, according to the report by Doctors Without Borders. 

Those are early signs of the manifestation of a dilemma some public health experts warned about after President George W. Bush launched a multibillion-dollar U.S. AIDS fund that now pays for the treatment of more than 2 million people. Because the medication must be taken for life, some said, the United States was essentially committing to fund treatment indefinitely -- and had a moral duty to do so. 

But after years of expansion, funding for the President's Emergency Plan for AIDS Relief, or PEPFAR, has leveled off, and less of its budget is dedicated to treatment, according to the report. President Obama, during last year's campaign, promised to increase funding, but it has remained about level since he took office. 

"The donors, I think, are getting cold feet about committing to a long-term, chronic disease," Tido von Schoen-Angerer, director of Doctors Without Borders' Campaign for Access to Essential Medicines, told reporters Thursday. "Lives are in the balance as donors are backtracking on funding commitments." 

Cuts are also threatening the Global Fund to Fight AIDS, Tuberculosis and Malaria, which distributes nearly a quarter of all HIV/AIDS donor money, according to the report. But shortfalls have caused the fund, whose main contributors are the United States and European countries, to cut approved grants by 10 percent and to consider canceling a 2010 funding round, the report said. 

Though the global funding retreat has not yet resulted in major cuts to AIDS treatment, it is threatening its growth, or "scale-up," said officials with Doctors Without Borders. 

Continued expansion is key to fulfilling a pledge by the world's wealthiest nations to provide "universal access" to antiretroviral medication -- defined as treating 80 percent of the population. About 6 million people worldwide, the vast majority in sub-Saharan Africa, still lack access to the drugs. 

U.S. officials have said that they remain committed to PEPFAR but that a tightened economic climate necessitates sustaining, not growing, programs. 

"The landscape around us is changing, with the need to balance a broad portfolio of global challenges at a time of financial crisis," Eric Goosby, the U.S. global AIDS coordinator, wrote in an August letter to American ambassadors. "As a result, we need to plan for the next stage of PEPFAR's development in this context and cannot assume the dramatic funding growth of PEPFAR's early years will be repeated." 

Though they acknowledged that the economic crisis had shrunk donor budgets, officials with Doctors Without Borders asserted that "political" motivations were also driving funding withdrawals. They criticized intensifying claims by some public health researchers that a disproportionate amount of global health funding goes to AIDS programs at the expense of cheaper treatments for more deadly illnesses such as diarrhea. 

A recent study published in the Lancet medical journal found that 23 percent of global health funding in developing countries has gone to fight AIDS, while programs to tackle tuberculosis and malaria -- which together kill more people -- have received one-third as much. 

In announcing a $63 billion, six-year "global health initiative" this year, Obama seemed to acknowledge that assessment, pledging to broaden the U.S. approach to global health by focusing on tropical diseases and other preventable illnesses, in addition to AIDS. 

"Some policymakers say AIDS is expensive, we should focus on cheap and easy things," von Schoen-Angerer said. "This cannot be an either-or game. . . . It's not that HIV is overfunded. Global health is underfunded." 

2

Research Shows Neighborhoods Where AIDS Treatments Lag
New York Times

05/11/2009

By CAROL POGASH

The map of San Francisco in the city’s health department is bathed in shades of blue. The color, usually associated with the city’s liberal politics, has a different import on the map. A light shade covers most neighborhoods. A slightly darker one covers the Castro, the center of the city’s gay culture.

And, like an elongated, bearded profile, a dark stain covers Potrero Hill and Bayview. It shows where the sickest AIDS patients live. Many are untreated. The map is the product of a groundbreaking effort to identify where care should be focused. 

The research combines medical records and epidemiological tools to show the intensity of the illness, measured by individual’s viral load, the number of viral particles in a patient’s bloodstream. The ultimate goal is to provide treatment and stop transmission of the disease. 

Using the data of individuals’ viral load levels, the city can track where the virus is circulating and focus attention on the deepest reservoirs of H.I.V. Successful anti-retroviral treatment reduces the load in an individual so it is undetectable in the blood. The less virus in the blood, the lower the chance of infecting others.

Dr. Grant Colfax, director of H.I.V. prevention and research in the Public Health Department, calls San Francisco’s mapping of the viral loads measured from 2005 through 2007 “a thermometer.” 

“We’re taking an individual marker and making it a marker for community health,” Dr. Colfax said.

Other communities have mapped the presence of H.I.V., but those have been basic efforts: counting the number of H.I.V./AIDS cases in a geographical area. In effect, those efforts show the surface of the water; the new effort shows the water’s depth. 

“H.I.V. is fully treatable and preventable,” said Dr. Julio Montaner, president of the International AIDS Society and head of the division of AIDS at the University of British Columbia. “We have not been able to fully control H.I.V. in developed areas of the world to the extent our knowledge would allow.” 

“These hot spots are perpetuating themselves,” Dr. Montaner said, “increasing infection in marginalized communities. This is unacceptable. As long as we don’t deal with that problem, the reservoir of H.I.V. will ensure that we’re promoting the continued spread of H.I.V. in perpetuity.”

San Francisco’s approach, he said, is important because “you can identify hot spots where, in all likelihood, most transmission is occurring.”

Dr. Colfax worries about disparities both in viral load and in care. The Castro, for example, has more H.I.V. cases, but individuals in lower-income neighborhoods tend to have higher viral loads, the new research shows.

San Francisco has more than 15,000 reported cases of H.I.V./AIDS. Those numbers continue to rise. The new findings show that the sickest individuals tend to be African-American, homeless and transgender. The viral loads of African-Americans are about one-third higher than that of Latinos or whites. 

“One of the biggest tragedies is our failure to really deal with this in the African-American community,” said Dr. Paul Volberding, a professor and vice chairman of medicine at the University of California at San Francisco Medical School, who treated patients before the disease even had a name.

The results of the mapping were not surprising to James Loyce, executive director of Black Coalition on AIDS in San Francisco. “This scientific evidence supports the community’s notion,” Mr. Loyce said.

Historically, he said, sections like Potrero Hill have felt “benign neglect,” suspecting that services were geared to the Castro, where more H.I.V.-infected people in the city live. 

Mr. Loyce said, “There is no sound-bite answer.” The sickest people of color, he said, have many issues: violence, heart disease, diabetes, obesity and the preceived stigma of homosexuality.

“It’s not that it isn’t there,” Mr. Loyce said, “but the belief system is that it isn’t. On Third Street, if you approach young brothers to talk about H.I.V., it will be a short conversation.” 

In the early years of the epidemic, H.I.V./AIDS was tracked by the number of monthly deaths. With effective medicines, it became a chronic disease. And as diagnostic tools improved and fear of the illness dissipated, it was easier to track patients’ health. H.I.V. patients’ viral load numbers are reported to the state, but until now no one had tracked communal viral load. 

The mapping in San Francisco is “ the next step in tracking the epidemic,” said Michael Cloutier, chief executive of the San Francisco AIDS Foundation. 

Dr. Colfax, the city’s senior investigator, agreed, saying: “If any place is able to reduce infections by treating people effectively, San Francisco should have the best chance. We’re hoping it will be a model.”

Others are paying attention. Commending San Francisco for its “novel approach,” Dr. Irene Hall, the chief of H.I.V. surveillance for the federal Centers for Disease Control and Prevention, said via e-mail that the agency was considering expanding viral-load mapping nationwide.

Dr. Moupali Das-Douglas, the lead investigator on the mapping project, said: “If you’re monitoring the epidemic by just following the number of cases there are, you haven’t prevented new cases. If you have a marker upstream that may predict new cases, you can know where to target your services to prevent transmission.” 

Michael Petrelis, an AIDS blogger and self-proclaimed provocateur, said, “It’s feeding two birds with one seed, helping a patient extend his life by keeping his viral load down, and that in turn makes him less infectious.” 

Despite the fact that the city’s population is well-educated, about 800 residents contract H.I.V. every year, Dr. Colfax said. There are those who know they are ill but do not avail themselves of care. And 15 percent to 20 percent of the H.I.V.-positive population does not know it is positive.

The new study found that city residents with H.I.V. had an average of 22,000 H.I.V. particles in their blood. The health department wants to reduce that to undetectable levels — below 50. 

“I like to think of the city the way I think of an individual patient sitting in front of me,” Dr. Das-Douglas said. “The more people I start on medication, the more people will be virologically suppressed and the less likely they will be to transmit H.I.V..” 

The city’s decisions on how to act on the new information will be controversial, all involved agree. 

Officials must decide whether to shift services, create pocketed marketing campaigns or go directly to the individuals with the highest viral load and offer them appropriate care. But going to individuals could feel like “a police state” and cause some to run away, Dr. Montaner said.

Dr. Colfax said, “You have to balance confidentiality with the fact that nobody in San Francisco should be walking around with a viral load of 100,000.” 

The medical community once believed that if a patient began treatment too early, the effectiveness of the medications could wear off. And there were severe side effects. “As the treatment has gotten easier and less toxic, those equations need to be rethought,” Dr. Volberding said.

“One of the big reasons for prescribing medications,” he said, is to protect the public. 

Dr. Colfax must balance individual and communal care. “I think we’re asking the right questions,” he said. “Now the issue is, What are the answers?”

A version of this article appeared in print on November 6, 2009, on page A19A of the New York edition

3

Why mHealth Initiatives Should Not be Sustainable
ATCWorks.org

28/10/2009

Whenever we talk about mHealth, there is always much hand-wringing around sustainability. And by that we usually mean we want to find the mHealth model that can be like mobile phones - paid by users and funded by deep-pocketed, aggressive private firms. That way, we can escape the limitations of donor funding and move past the many mHealth pilots that never seem to scale, to truly global healthcare solutions.

I would like to be a heretic and put forth an idea that's be brewing since last week's Technology Salon sustainability discussion where our comments even suggested that all ICT4D efforts are sustainability failures:

mHealth isn't sustainable

International development efforts in mHealth focus on bringing resources and solutions to communities who are unable to provide their own. This can mean remotely checking on patients in rural areas miles from the nearest clinic, or delivering health PSA's to urban youth in Nairobi nightclubs, to even educating affluent women in India on their menstrual cycle. 

But in all these instances and more, the recipient is either unwilling or unable to pay for the service. So why do we keep looking for ways to have them fund mHealth initiatives? Why do we think private payment is the sole sustainable model? Let's look at who has the will to pay for such services and expect them to underwrite mHealth initiatives.

mHealth is fundable

Public health is a high priority for governments. A healthy population is a happy, productive one, and therefore every government has a keen interest in providing healthcare solutions to its populace. Some of these solutions are government funded without question - in the USA we don't expect the Centers for Disease Control or Medicaid to be self-funded in a pay-for-service model. Some solutions are a public-private hybrid - general healthcare services are almost always a mix of public, business, insurance, and private funds. And other solutions can be either - HIV testing and treatment varies by country and even by client.

But in any of these scenarios, do we hear talk about sustainability? Outside arguments about the cost of these programs, no one is advocating that governments stop funding for CDC's or HIV treatments. So why then, when we talk of mHealth, do we try to force a fully private-payer model?

Finding funding is the problem

One reason that this private-payer sustainability model is so desired is the high variability of donor funding and a paucity of government funds. mHealth projects are multi-year endeavors - multi-decade if you want to effect a real change, but few donors can see past the next 2-5 year donor cycle. Even worse, almost no donor wants to fund an ongoing project - they want to launch the new-new solution. This can leave great ideas unfunded just as they are about to scale. 

But let's be honest, donor funding exists because many developing world governments do not have the political will or bureaucratic efficiency to run their own mHealth programs. Even when they are shown the public and economic benefits of effective healthcare solutions, local government change and adoption comes agonizingly slow.

Accept donor funding as sustainable

I actually do believe mHealth is sustainable, just not with the common definition of sustainability. If we open up what we mean by sustainable to include all funding - and especially donor funding - as valid sources of project income, then mHealth can be very sustainable. One example is FrontlineSMS.

Started in 2005 by Ken banks, FrontlineSMS has grown in scale to be called "one of the largest and most ambitious mHealth programs in the world," by a UN report. Its used all over the globe, by everyone from Zimbabweans supporting HIV/AIDS awareness and terminal illness to Cambodians reporting landmine victims. But not a single end user pays Ken Banks to use FrontlineSMS. 

Ken and his growing consortia of FrontlineSMS applications (Medic, Credit) are all donor funded - by many donors in many ways. Yet, they all have an income, the project keeps growing and innovating, and we're all envious of their user growth - very real indicators of sustainability.

I can also see Ken charging for specialized services - brining a private-payer model to Frontline, if he hasn't done so already, but again, this pay-for-service would be with governments, multi-laterals, and foundations buying services for large initiatives, not individual client income.

So the next time you hear a moan about the lack of mHealth sustainability, question the complaint. mHealth can be sustainable, if you're willing to think outside the private-payer box.

4

HIV drug study needs volunteers with dark hair
San Francisco Chronicle

05/11/2009

Victoria Colliver, Chronicle Staff Writer

Wanted: Dark-haired HIV-negative men and women to participate in a study designed to measure drug levels in hair.

It's called the "Strand Study" and it's part of a larger effort by AIDS scientists to look at whether people who are HIV-negative can benefit from prophylactically taking anti-HIV drugs to reduce their chances of infection.

Researchers from the San Francisco Department of Public Health and UCSF want to test people's hair to see if it could be used to measure how well people are complying with their drug regimen along with how efficiently the drug is metabolized by the body.

"Currently, we don't have a truly accurate measure of how well people are taking their medications and how well they process drugs," said Dr. Albert Liu, director of HIV Prevention Intervention Studies for San Francisco's Health Department. Blood measurements show the short-term presence of drugs, but do not capture the effect of a drug in the body's system over time, he said.

Liu said researchers intend to use the hair method as a tool when conducting drug studies to determine whether results are being affected by adherence to the prescribed therapy. 

But why dark hair? 

That's simply a matter of pigment. Drug molecules bind to the pigment in hair. Because dark hair has higher levels of pigment, the drug is more likely to bind, making it easier to measure. Liu said binding quality has no relation to drug absorption; light-haired people are not known to metabolize drugs any differently than their dark-haired counterparts.

The Strand Study, which is funded by the National Institute of Mental Health, requires volunteers to take various dosages of tenofovir, which is one of the drugs used in the global prophylactic studies. Liu said tenofovir has fewer side effects than other HIV drugs and a favorable safety profile.

Volunteers will be paid up to $1,300 to take three different dosing regimens of the drug, each lasting six weeks: one pill two times a week, four times a week and every day. Liu said the pill must be taken in the presence of the study researcher at UCSF or at the Van Ness offices of the Health Department. 

The study also requires one 24-hour hospital stay, during which blood levels will be measured. "It's quite an involved study," Liu said. 

Volunteers have already started enrolling and researchers hope to begin the study in the next couple of months. They are seeking just 24 people, and hope to have an equal mix of men and women, who are over 18 years old and are not pregnant or planning to get pregnant during the study. 

The study 

For more information about the study, go to www.helpfighthiv.org.

E-mail Victoria Colliver at vcolliver at sfchronicle.com.

This article appeared on page C - 1 of the San Francisco Chronicle

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UNAIDS WEB.SITE

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UNAIDS participate in Netherlands Multi Party Initiative

UNAIDS

06/11/2009

UNAIDS Executive Director, Mr Michel Sidibé took part in a meeting earlier this week organized by the Netherlands Multi Party Initiative on HIV/AIDS. The meeting was co-organized by the Dutch NGOs “STOP AIDS NOW!” and Aids Fonds under the banner AIDS in a Time of Financial Crisis, to explore together how to face the challenges posed by the global financial crisis. 

The event was opened by the Dutch AIDS Ambassador Marijke Wijnroks. 

Speaking at the meeting, Mr Sidibé congratulated the Netherlands for their outstanding leadership and stressed the key role the country is playing in the global AIDS response. 

“We see the Netherlands as a strong likeminded partner. Together we have achieved much in the battles against discrimination and forwarding the human rights agenda,” said Mr Sidibé

“But for every 2 persons who are placed on antiretroviral treatment, 5 people are newly infected – we look forward to a continued strong relationship with the Dutch government to break the trajectory of the epidemic,” Mr Sidibé asserted. 

Also participating in the meeting was the Dr Michel Kazatchkine, Executive Director of the Global Fund to Fight TB, Malaria and HIV, Mr Ewout Irrgang, chair of the Multi Party Initiative and Mrs Kathleen Ferrier, vice chair for the Multi Party Initiative. 

The Netherlands Multi Party Initiative on HIV/AIDS consists of members of parliament across party lines in the Dutch Parliament. It was established in February 2007 by Kathleen Ferrier, MP. 

The primary goal of this informal network is to ensure HIV as well as sexual and reproductive health and rights and related issues are kept on the agenda. The group also raises awareness at the national, regional and international level through the Dutch Parliament, the Council of Europe and the European Parliament.

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Antiretroviral treatment for prevention
UNAIDS

06/11/2009

People living with HIV who are following an effective antiretroviral therapy regimen can achieve undetectable viral loads – the amount of virus in a body fluid such s blood, semen or vaginal secretions – at certain stages of their treatment. Research suggests that when the viral load is undetectable in blood the risk of HIV transmission is significantly reduced. This approach has been called “Antiretroviral treatment (ART) for prevention”. 

To explore the issue WHO earlier this week convened a meeting to review the scientific data available on the use of ART for prevention and also explored the implications of this approach for individuals and communities as well as take into consideration human rights and ethical and public health implications. 

Participating in the meeting, UNAIDS Deputy Executive Director, Dr Paul De Lay, provided closing reflections. Dr De Lay said the meeting had raised the hard fact that many people living with HIV - including many who need treatment today - are unable to access HIV testing and counseling and to initiate timely treatment, as a result of a range of social, cultural and economic barriers.

Dr De Lay congratulated the participants in their effort to identifying scientifically sound and innovative ways to accelerate progress toward universal access to HIV prevention, treatment, care and support, and maximizing the effects of ART both for extending full and productive life for people with HIV, and also for primary prevention. 

"These are exciting and challenging times. The diverse perspectives heard in this meeting reflect the best of the AIDS response, and continuing this dialogue - this committed questioning and the research agenda coming from this meeting - will undoubtedly lead to more lives saved and fewer new infections" continued Dr De Lay. 

UNAIDS strongly recommend a comprehensive package of HIV prevention approaches and advocates for an evidence informed and human rights based approach to HIV prevention. 

A comprehensive HIV prevention package includes, but is not limited to, delaying sexual debut, mutual fidelity, deduction of the number of sexual partners, avoidance of penetration, safer sex including correct and consistent male and female condom use, and early and effective treatment of sexually transmitted infections. 

The WHO hosted antiretroviral treatment (ART) for Prevention was held in Geneva from the 2 to the 4 of November, 2009

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