kaisernetwork.org: HIV/AIDS Daily Report

HIV Prevention Efforts in Five African Countries Not Reaching At-Risk Groups, Report Says

Fri, 29 May 2009 00:00:00 EST

National HIV prevention strategies in at least five African countries are not reaching the groups most at risk of infection, according to a report from UNAIDS and the World Bank conducted in conjunction with the national HIV/AIDS authorities of Kenya, Lesotho, Mozambique, Swaziland and Uganda, IRIN/PlusNews reports. The study was conducted between 2007 and 2008 to determine how and where most HIV cases were occurring in each country. It also aimed to examine whether prevention programs and spending aligned with those findings.

According to the report, most prevention initiatives are not based on evidence of the behaviors that spread HIV in the five surveyed countries. For example, most new infections in Lesotho occur because of concurrent sexual partnerships, both before and after marriage. However, the country does not have any prevention strategies aimed at concurrent partnerships, or couples who are married or in long-term relationships.

In addition, the report found that in Mozambique, an estimated 19% of new HIV infections were spread through commercial sex work, 3% from injection drug use and 5% among men who have sex with men. According to the report, few programs in the country target sex workers, while none are tailored to IDUs or MSM.

According to the report, spending on HIV prevention often is low in the surveyed countries. Lesotho spends 13% of its national HIV/AIDS budget on prevention, while Uganda spends 34%. Director of the World Bank's Global HIV/AIDS Unit Debrework Zewdie said that the economic downturn makes it important to maximize the impact of HIV prevention investments. "These syntheses use the growing amounts of data and information available to better understand each country's epidemic and response and identify how prevention might be more effective," she said.

The report includes recommendations on how the surveyed countries can better implement evidence-based prevention efforts. It said that Lesotho should revise its prevention messages to address multiple concurrent partnerships and integrate the subject into future initiatives. In addition, Mozambique should focus condom promotion on groups such as sex workers, the report said. According to IRIN/PlusNews, the five-country program aims to enhance capacity to ensure that the countries can conduct similar studies in the future (IRIN/PlusNews, 5/27).

The report is available online.

Report Estimates Significant Impact of Widespread Circumcision Effort in Botswana

Fri, 29 May 2009 00:00:00 EST

Botswana's campaign to circumcise about 500,000 men by 2012 will prevent nearly 70,000 new HIV cases by 2025, according to a report published Thursday in the Journal of the International AIDS Society, AFP/Yahoo! News reports. The government's national campaign aims to circumcise 460,000 men over the next five years, and the country has begun airing television and radio advertisements to encourage men to be circumcised at local clinics. "Scaling up safe male circumcision has the potential to reduce the impact of HIV/AIDS in Botswana significantly," according to the study.

The report puts the estimated cost of the circumcision campaign at about $47 million. A UNAIDS report estimates that the HIV prevalence among pregnant women in Botswana was 43% in 2003, the year that antiretroviral drug access was introduced in the country (AFP/Yahoo! News, 5/28).

An abstract of the study is available online.

Thai HIV/AIDS Advocates Urge Increased Treatment Access for IDUs

Fri, 29 May 2009 00:00:00 EST

The Thai AIDS Treatment Action Group recently called on the country to launch a comprehensive harm reduction program for injection drug users in an effort to help curb the spread of HIV, Thailand's The Nation reports. According to the group, many IDUs are unable to access drug treatment and substation therapy because of the stigma surrounding drug use in the country. Karyn Kaplan, director of development and policy for the group, said, "Health care workers have denied many injecting drug users access to an antiviral drug and the use of methadone."

Public Health Minister Witthaya Kaewparadai recently announced that the country's harm reduction programs have helped to curb the spread of HIV among IDUs, adding that local substitution programs have reduced the number of HIV-positive IDUs and that the country needs increased support from UNAIDS for such efforts. TTAG called for the government to provide prevention and treatment options, such as substitution therapy and needle-exchange programs. The Nation reports that methadone treatment is offered at hospitals across the country as part of the national health care scheme, but many health care workers refuse to administer treatment. In addition, government treatment is offered for 45 days. Kaplan said that the government should revise its policy regarding treatment access for IDUs, as a majority of IDUs are incarcerated and living with HIV or hepatitis-C without treatment access. She called on the government to "implement the international standards of medical treatment for [IDUs], without discrimination and human rights violations" (The Nation, 5/27).

Legislation Needed To Boost HIV/AIDS Efforts in Solomon Islands, Health Official Says

Fri, 29 May 2009 00:00:00 EST

Isaac Muliloa -- national coordinator of the HIV and sexually transmitted infections unit at the Solomon Islands' Ministry of Health -- recently said that a lack of national HIV/AIDS laws is hindering efforts to address the disease, the Solomon Times reports. Recent World Health Organization estimates said that the number of HIV cases in the Solomon Islands could reach 350 by 2010.

Muliloa said that legislation is needed to address continued discrimination against HIV-positive employees in the workplace. He added that the HIV/AIDS and STI unit is relatively new in the health ministry, as is the Solomon Islands' National AIDS Council. According to Muliloa, officials are continuing to work toward implementing policies. The Times reports that the Solomon Islands does not have laws in place criminalizing the intentional transmission of HIV (Solomon Times, 5/27).

Researchers Plan To Target Immune Cells Responsible for Eluding Antiretroviral Treatment

Fri, 29 May 2009 00:00:00 EST

Certain human immune cells known as macrophages are composed of hybrid HIV strains that elude treatment and antiretroviral drugs, according to a new study by researchers from the University of Florida and other institutions, the Gainesville Sun reports.

For the study, researchers examined tissue from HIV-positive people and discovered that as much as half of the macrophages present were hybrids, made from genetic material from several HIV viruses that when combined formed new HIV strains. Marco Salemi -- assistant professor of pathology, immunology and laboratory medicine at the University of Florida's College of Medicine -- said that macrophages likely make HIV more aggressive over time, adding, "If we want to eradicate HIV, we need to find a way to actually target the virus specifically infecting the macrophages."

According to the Sun, current research and treatment target T-cells, and although antiretrovirals are effective at blocking infection from new cells and lowering viral loads, they are unable to reduce the viral level in an HIV-positive person to zero. The Sun notes that macrophages can be targeted by HIV multiple times, and once they are infected, they can live for months, unlike T-cells. The team of researchers, led by Michael McGrath of the University of California - San Francisco, is developing macrophage-targeting drugs through a grant from the National Institute of Mental Health, the Sun reports (Chun, Gainesville Sun, 5/28).

Farmer Still Under Consideration for Obama Administration Position, Takes Harvard Medical School Appointment

Thu, 28 May 2009 00:00:00 EST

While Partners in Health co-founder Paul Farmer is still being considered for a senior role in the Obama administration, Farmer has been appointed chair of Harvard Medical School's Department of Global Health and Social Medicine -- Jeffrey Flier, the medical school's dean, said on Wednesday -- the Boston Globe reports. Flier said that Farmer will take a leave of absence from the medical school if he is offered a position with the administration. For now, Farmer is slated to succeed the current chair, Jim Kim, on July 1 (Smith, Boston Globe, 5/28).

Foreign Policy's "The Cable" reports that Farmer is "under consideration to head" USAID or "serve in a top administration international assistance post that would encompass it." An unnamed "international health activist" said that Farmer might be appointed USAID administrator "as an interim thing" and that he might go on to lead a new position focused on "global health in the process of foreign assistance reform over the coming year." Rep. Howard Berman (D-Calif.), chair of the House Foreign Affairs Committee, is organizing efforts to reform the Foreign Assistance Act later this year. The act was originally written in 1961 (Rozen, "The Cable," Foreign Policy, 5/26).

On Tuesday, Jack Lew, Deputy Secretary Of State for Management and Resources, said that the government is considering ways to significantly improve coordination of various agencies that work with global health assistance. "We're open to creative ideas about how to bring appropriate resources to bear," Lew said, adding, "When we look at public-private partnerships and recruiting, we're looking at how to cast the broadest net to bring in the right talent and commitment to address the challenge" (Boston Globe, 5/28).

Partners in Health said it is pleased that Farmer is being considered along with other strong candidates. Wendy Sherman, an advisor to Secretary of State Hillary Clinton, and Aaron Williams, a former USAID official who is now with RTI International, are among some of the "[p]reviously rumored contenders for the USAID administrator job," according to "The Cable."

Last week, Farmer had a meeting with Clinton, Partners in Health said. Andrew Marx, a spokesman for the group, said that one of the reasons why people are "excited about the idea of Paul is that he and Partners in Health in the past have been quite prepared to challenge the accepted wisdom." According to Marx, Farmer did not buy into the conventional approach to multi-drug resistant tuberculosis in the 1990s, when WHO's official policy was not to treat people who were diagnosed with the disease because it was complicated and the costs were high.

When asked if Farmer would be interested in a USAID administrator position that has strong democracy and governance components, Marx said, "Good governance and democracy are important to us," adding that the group's work focuses on building up countries' public health systems rather than creating independent health clinics.

David Bryden, senior program policy officer for the Center for Global Health Policy, said, "There are many exciting things about Paul Farmer." According to Bryden, Farmer "has been a person with a very practical mindset, he knows how to get the job done, put aside conventional wisdom when it's wrong. ... It's really exciting" ("The Cable," Foreign Policy, 5/26).

About 0.59% of Vietnamese Fishery Workers are HIV-Positive, Prevalence Could Rise by 2013, Survey Says

Thu, 28 May 2009 00:00:00 EST

An estimated 33,000 of the total 5.5 million workers in Vietnam's fishery sector, or about 0.59%, were living with HIV in 2008, according to a survey released Tuesday by Vietnam's fishery program, VNA/VOV News reports (VNA/VOV News, 5/27). The report also predicted that the number of HIV-positive people in Vietnam's fishery sector could rise to 58,000 by 2013. According to a second survey, conducted simultaneously, a lack of knowledge about the disease has contributed to the fishery sector's relatively high HIV prevalence. Vietnam's Ministry of Agriculture and Rural Development as part of its Strengthening of Fisheries Administration conducted the survey with support from the Danish International Development Agency.

For the first survey, researchers selected five provinces that were geographically and occupationally representative of the fishery industry. They surveyed 2,350 volunteers from four fishery trades: exploitation, processing, cultivation and provision. Fourteen of the survey participants disclosed that they had tested positive for HIV. Researchers then applied the Means of Transmission Model to estimate that about 0.59% of the country's fishery workers are HIV-positive. Do Thanh Nam, who led the survey, said the industry's "alarming" HIV rates are "caused by a lack of attention on HIV/AIDS risk among fishery workers" (VietNamNet Bridge, 5/27). Do also said that the survey might provide only a "snapshot" of the sector's HIV prevalence (VNA/VOV News, 5/27).

For the second survey, STOFA researchers surveyed 3,400 participants from nine provinces and found that many lacked sufficient knowledge about HIV. About 14.4% of survey respondents mistakenly believed HIV could be transmitted through mosquitoes or sharing tools; about 6.4% believed that hugging or kissing could transmit the virus; and about 15.8% believed having unprotected sex with commercial sex workers carried no risk of contracting HIV. In addition, 17.3% of male fishery workers reported using condoms with commercial sex workers. Le Thi Mong Phuong, who led the second survey, said that fishery workers often receive inadequate and unsystematic information about the disease. "Most of them learn about HIV/AIDS from television or radio, but rarely and irregularly," she said. Furthermore, many fishery workers reported spending long periods of time away from home, with 67% of 817 workers reporting absences of more than seven months per year and 21% reporting absences of four to six months per year.

Vu Van Tam, deputy minister for agriculture and rural development, said that his ministry will use the results of the survey to develop HIV prevention and control strategies for the industry. Peter Lysholt Hansen, Danish ambassador to Vietnam, added that HIV/AIDS could jeopardize the recent growth in Vietnam's agricultural sector because the disease poses high treatment costs for families, as well as costs from a weakened labor force. The surveys recommended that Vietnam address HIV/AIDS among fishery workers by strengthening a communications campaign and launching a program to provide condoms for high-risk groups (VietNamNet Bridge, 5/27).

About 75% of People in Rwanda Who Have Experienced Discrimination Are HIV-Positive, Survey Finds

Thu, 28 May 2009 00:00:00 EST

A recently released survey on stigma in Rwanda indicates that at least 74% of people in various segments of society who have experienced discrimination are HIV-positive, the New Times/AllAfrica.com reports. The discrimination often is in the form of isolation from family and physical harassment, according to the survey.

The study was conducted by the Association of Vulnerable Widows Infected and Affected by HIV and AIDS in conjunction with the Network of People Living with HIV and UNAIDS Rwanda. It found that although 87% of respondents reported never having been denied health services, 88% reported being denied other social services, such as family planning, because of their HIV status. An estimated one-third of respondents reported that their rights had been abused because of their HIV-positive status.

Chantal Nyiramanyana, AVVAIS president, said, "We conducted this survey as a way of providing basis for advocacy, policy change, and programmatic interventions by the government and other interested bodies to address stigma and discrimination related to HIV." The survey found that other groups experiencing stigma in the country include commercial sex workers and asylum seekers (Kwizera, New Times/AllAfrica.com, 5/27).

Thailand Aims To Halve New HIV Cases by 2011, Prime Minister Says

Thu, 28 May 2009 00:00:00 EST

Thailand has set a goal of reducing by half the number of new HIV cases in the country by 2011, Prime Minister Abhisit Vejjajiva said on Wednesday, TNA/MCOT English News reports. Abhisit was speaking at the opening ceremony of the three-day 12th National Seminar on AIDS, which more than 2,500 HIV-positive people, students, and participants from Thai agencies, private sector groups and international organizations are expected to attend. The seminar will focus on the government's plan to reduce new cases by 2011 and the national HIV/AIDS action plan.

"The government's plan, if successful, will be the result of cooperation from all sides," Abhisit said. He added that statistics indicate that one in four new HIV infections occur among men who have sex with men. In addition, new cases among married women in the country have increased by 30% to 40%, according to Abhisit. He said that he will be involved in a campaign to promote fidelity among married couples in the country (TNA/MCOT English News, 5/27).

Fishing Industry Contributing to Spread of HIV Around Africa's Lake Victoria

Thu, 28 May 2009 00:00:00 EST

The fishing industry and some cultural practices in communities living around Africa's Lake Victoria are contributing to the spread of HIV/AIDS and other sexually transmitted infections in the area, according to a panel of experts at a recent meeting in Kisumu, Kenya, The Citizen reports. According to the panel, cultural practices such as widow inheritance, commercial sex work for fish and the long-distance trucking industry have led to the spread of HIV/AIDS. HIV/AIDS prevalence among women and people who live along the beaches of the lake is particularly high, the meeting participants noted.

The four-day meeting was held by the Lake Victoria Basin Commission and involved members of the East African Community and other officials. Meeting delegates were taken to cross-border control posts along the Kenya-Uganda border to interact with people living with HIV/AIDS, commercial sex workers, long-distance truck drivers and district government officials. Doreen Othero, HIV/AIDS technical specialist at the LVBC Secretariat, said that the group "managed to bring together organizations working in HIV/AIDS along transport corridors to share information, improve coordination and build synergy among the various programs so as to have maximum impact on the corridors' most at risk populations."

Jean Claude Nsengiyumva, EAC deputy secretary general in charge of productive and social sectors, said that the fight against HIV/AIDS will be successful through a coordinated and collaborative effort among all stakeholders. He said that EAC has introduced a four-year Regional Multisectorial HIV/AIDS Strategic Plan, ending in 2012, that aims to address HIV/AIDS in the region. The region also is undergoing efforts to create more collaboration between regional, international and multisectorial organizations that have projects for HIV/AIDS education, care, treatment and testing. Othero said there are more than four million HIV-positive people and more than 3.5 million orphans and vulnerable children in EAC partner states (The Citizen, 5/27).

'Complacency,' 'Stigma' Hindering Efforts To Reduce HIV/AIDS in Black Communities, Opinion Piece Says

Thu, 28 May 2009 00:00:00 EST

"Nearly 30 years after the discovery of HIV and AIDS, the epidemic is still ravaging black neighborhoods in Baltimore and across the nation," Kevin Fenton -- director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention -- writes in a Baltimore Sun opinion piece. Fenton writes that "complacency about HIV and the continued stigma associated with the disease are hindering progress by preventing too many African-Americans from seeking either HIV testing and treatment or support from their friends and family," adding that "this is a challenge that can be overcome."

According to Fenton, the Obama administration last month "took an important step in confronting the United States' HIV epidemic" when CDC and White House officials announced a five-year campaign called Act Against AIDS, which is "designed to refocus the nation's attention on the HIV crisis here at home." Fenton notes that 14 black civic organizations -- including the NAACP, the National Urban League, the Southern Christian Leadership Conference and the National Council of Negro Women -- are "joining the CDC to increase knowledge, awareness and action within black communities across the country." He adds that the campaign "will harness the strength and reach of these organizations by enhancing their ability to make HIV prevention a core component of their daily activities."

"By raising the visibility of HIV and AIDS, the new campaign also aims to confront and overcome the fear and stigma that help keep HIV alive in black communities," Fenton says. He adds that he has "been encouraged in recent years to see black leaders, including black faith leaders, speak out more openly across the nation about the need to confront HIV and the stigma that persists surrounding this disease." Fenton writes that "[e]nding this epidemic will require not only frank and difficult discussions about HIV but also a shared sense of responsibility and commitment," concluding, "All of us can and must be part of the solution" (Fenton, Baltimore Sun, 5/27).

California Gov. Schwarzenegger's Plan To Reduce State Spending Includes Cuts to HIV/AIDS Services

Wed, 27 May 2009 00:00:00 EST

California Gov. Arnold Schwarzenegger (R) on Tuesday sent state lawmakers a plan to reduce more than $5 billion in spending that includes cuts to HIV/AIDS services, the Los Angeles Times reports (Rothfeld/McGreevy, Los Angeles Times, 5/27). The proposed cuts include $55.5 million in California's AIDS Drug Assistance Program and other state Office of AIDS programs. According to the San Francisco Chronicle, Schwarzenegger's plan would make HIV-positive people pay more for drugs, while HIV/AIDS programs such as counseling, monitoring and education would be reduced or eliminated. "We were expecting cuts, but this is much, much worse than what we were expecting," Courtney Mulhern-Pearson, policy and legislative associate for the San Francisco AIDS Foundation, said (Yi, San Francisco Chronicle, 5/27).

Tuesday's plan follows a separate proposal to cut $16 billion in overall state spending that Schwarzenegger announced two weeks ago. Aides say that Schwarzenegger plans to propose an additional $3 billion in reductions by the end of the week to offset a projected $24.3 billion budget shortfall. "Behind every one of these dollars that we cut there are real faces," Schwarzenegger said, adding, "Even though those are tough choices, what is the alternative?" (Los Angeles Times, 5/27).

Advocates at Kenya Conference Explore New Strategies To Combat HIV/AIDS in Africa

Wed, 27 May 2009 00:00:00 EST

Nearly 30 years after the emergence of HIV/AIDS, the global health community must develop new strategies to curb the spread of the disease in sub-Saharan Africa, some experts said Tuesday ahead of the Global Citizens Summit for Social Mobilization to End AIDS in Nairobi, Kenya, AFP/Google.com reports. The advocates also stressed the need for innovative approaches to health financing as international donors shift their attention toward other issues and as the ongoing economic downturn threatens fundraising prospects. The conference, which opens Wednesday, includes participants from 32 countries, primarily in Africa.

According to Wasai Jacob Nanjakululu of Oxfam, about 90% of HIV-positive people are unaware of their status and 70% of people in need of treatment are not accessing medical care. Leonard Okello, an HIV/AIDS specialist with ActionAid International, added that the global health community is "far from winning the struggle against" HIV/AIDS. Okello said the conference will examine the shortcomings of earlier HIV/AIDS policies and explore new methods to address the disease. "There are a lot of resources in HIV/AIDS programs but not much of that reaches the community," Okello said, asking, "What is it that we should radically change?" (AFP/Google.com, 5/26). According to IRIN/PlusNews, conference participants also plan to discuss "people-centered" approaches to combating HIV/AIDS at the Nairobi meeting.

ActionAid Report Calls For Improvements in Basic Health Care To Address HIV/AIDS
In related news, ActionAid ahead of the Nairobi conference released a report calling for countries to scale up local health care capacity in order to effectively address HIV/AIDS. According to the report, titled "Primary Concern: Why Primary Health Care is Key to Tackling HIV and AIDS," equipping local health centers with more resources is the best way to tackle HIV/AIDS. Advocates at the report's launch in Nairobi also called for governments to expand access to primary health care by establishing more clinics and improving existing centers.

Linda Mafu, Africa regional coordinator for the World AIDS Campaign, said, "Health centers need to be spread out and properly equipped, so they have the capacity to deal not only with HIV, but with other diseases that affect the population." Mafu added that this could help ease transportation burdens and delays from long waits to visit health centers. Okello added that health officials should train primary health care workers on "the skills to integrate HIV management into their other work."

Although an efficient public health sector could provide HIV/AIDS services, the private sector and nongovernmental organizations might need to support health systems for the foreseeable future, the report said. According to the report, many populations such as commercial sex workers choose to "opt out of the public health system," and delays in implementing HIV programs and strengthening health systems could "lead to higher numbers of AIDS-related deaths" (IRIN/PlusNews, 5/27).

The ActionAid report is available online.

South African Health Minister To Launch PMTCT Plan

Wed, 27 May 2009 00:00:00 EST

South African Health Minister Aaron Motsoaledi within the next two weeks is expected to launch a plan to address mother-to-child HIV transmission in an effort to reduce infant mortality in the country, The Times reports. The MTCT plan is part of a new health program adopted by President Jacob Zuma's administration, according to The Times.

"This is one of the most urgent things I want to (deal with) as the new minister," Motsoaledi said. According to Motsoaledi, a child dies every eight minutes in South Africa, and about 40% of child deaths are related to HIV/AIDS. The plan was developed by the Development Bank of Southern Africa at a July meeting of government and health sector stakeholders. Participants at the meeting also examined maternal deaths and the decrease in life expectancy among young adults because of HIV/AIDS. According to Motsoaledi, these and other issues have been identified as priorities for the Zuma administration if South Africa is to meet targets in the United Nations Millennium Development Goals. They also have been consolidated into a 10-point plan to help the Department of Health focus on urgent issues through 2015.

"Health and education are the biggest challenges for (the government) and we ought to be doing something drastic," Motsoaledi said, adding, "These are very serious issues in society." The health department's plan also calls for the revival of the National AIDS Council and says that the government should improve regulation of the private health sector. It also calls for the establishment of a national tuberculosis reference laboratory, a focus on infection rates among women ages 17 to 21 and the improvement of HIV prevention among commercial sex workers (Molele, The Times, 5/25).

World Cup Campaign To Build Centers To Provide HIV/AIDS Education, Other Services to At-Risk African Youth

Wed, 27 May 2009 00:00:00 EST

Authorities in South Africa have begun construction of one of the 20 planned Football for Hope centers in Africa -- part of a 2010 World Cup campaign called "20 Centers for 2010" aimed at reducing the prevalence of HIV/AIDS, poverty and crime in local communities -- the AP/Google.com reports. The center under construction in South Africa's Khayelitsha township will include a soccer field, community center and after-school programs that will focus on sex education and HIV/AIDS education. The International Federation of Football Association, or FIFA, in alliance with Streetfootballworld, a network of development groups, is providing the campaign with $10 million in funding. Ghana, Kenya, Mali, Namibia, Rwanda and other African countries will be home to the remaining 19 centers.

According to FIFA President Joseph Blatter, the campaign "emphasizes the power of football far beyond the boundaries of the pitch." He added that the centers will "provide a platform for communities to address social issues such as children's rights, education, health, HIV/AIDS prevention and will leave a legacy for Africa that will last long after the final whistle of the 2010 FIFA World Cup has been blown." Helen Zille, premier of the Western Cape Province, said construction of the center in the township "shows what we can do when we focus on getting things right rather than concentrating on what's wrong," adding that she hopes the center is successful with its HIV/AIDS education efforts. The center will be run by Grassroots Soccer, an HIV/AIDS education organization that uses the sport to educate youth. Nocawe Tyali, a life-skills and football teacher who works with teenagers, said the new center will give young people an alternative to high-risk behaviors and enable the area to offer more youth football programs that include an HIV/AIDS prevention message (Nullis, AP/Google.com, 5/25).