HIV-AIDS

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December 1, 2011 | 10:15 AM | By

Wordy word AIDS Day

Flickr, Pink Sherbet Photography

No, that’s not a typo.

I’ve decided to mark this 30th anniversary of the recognized beginning of the pandemic as Wordy AIDS Day rather than use its official name, World AIDS Day, because most of what the international community is doing is saying they want to continue the fight against AIDS even as they retreat.

As Sarah Boseley of The Guardian writes, the Global Fund to Fight AIDS, TB and Malaria is threatening to ‘collapse’ thanks to governments reneging on their promised donations. The bottom line here is that there is insufficient funding to meet the existing challenge while politicians like Sec. of State Hillary Clinton proclaim we are on the verge of an “AIDS-free generation.” Says Boseley:

If this were not so deadly serious it would be absurd. As Clinton declares the end of AIDS is nigh with one massive last push, the donor governments, mostly in Europe, sit on their wallets. HIV/AIDS has gone out of favour.

It needs to be said that there has been progress, with a remarkable scale-up in getting people on treatment (about 40 percent of those who need the drugs in Africa) and 20-25 percent reductions in mortality.

Recent scientific studies have shown that getting people on anti-HIV drugs prevents transmission of the virus so it is possible, in theory anyway, to halt the pandemic by getting everyone infected on treatment.

Yet even as we may be at a beneficial ‘tipping point’ in the fight against AIDS, the world community’s commitment to the fight is flagging. Funding for the global fight against HIV/AIDS dropped by 10 percent last year. IRIN called it a Deadly Funding Crisis.

Two old-time warriors in the fight ask, on CNN, if what we should be celebrating is Another 30 Years of AIDS?

One of the presumed bright spots in this gloomy landscape was celebrated today with President Barack Obama’s announcement that the U.S. plans to “win this fight’ and has increased its global commitment to get anti-HIV drugs to two million more people by 2013.

Obama’s announcement was webcast by the ONE Campaign with commentary from a slew of other bigwigs like Bono, Bill Clinton and George W. Bush.

The Obama Administration’s new commitment to the global fight will be good news if it actually happens. Little noticed was the fine print that said this would be accomplished not by donating more money but by “increasing efficiency.” Only the domestic HIV/AIDS needs got actual new money, $50 million.

Here are some other worthy links for this day, Wordy AIDS Day:

Alanna Shaikh at UN Dispatch: The End of the Beginning of the End of AIDS?

ONE’s Erin Hohlfelder: Act V, The End of AIDS

George W Bush in Wall Street Journal: No Retreat in the Fight Against AIDS

NPR: What a lack of funding could mean for Africa

The Independent: Victory is in sight but cuts in funding could spoil it all

Simon Bland of Global Fund: Yes, we’re alive but progress in peril

FILED UNDER: Health, Alanna Shaikh, Barack Obama, Bill Clinton, Bono, Erin Hohlfelder, George Bush, Global Fund, HIV-AIDS, Sarah Boseley, Simon Bland, World AIDS Day
November 23, 2011 | 8:45 AM | By

A bad turn in the global fight against AIDS

Flickr, Benny Sølz

As the Los Angeles Times and others reported this week, the global effort to fight AIDS has paid off with a 21 percent decline in deaths since the pandemic’s peak in 2005:

The number of people getting lifesaving (drugs) rose 20% from 2009 to 2010. Three African countries, Botswana, Nambia and Rwanda, achieved universal access, defined by UNAIDS as access for 80% or more of those eligible. Four African countries, Kenya, Ethiopia, Swaziland and Zambia, had coverage for between 60% and 80% of infected people.

In short, this international response to fight disease in poor countries has truly paid off.

Which is why it’s so painful to learn that the organization leading this response, the Global Fund for Fighting AIDS, TB and Malaria, announced this week it will have to suspend its next round of funding for these efforts due to a shortfall in donations.

Global Fund Executive Director Michel Kazatchkine said the “conversion rate” for pledges to donations (meaning, how many governments or other donors keep their promises) has dropped sharply as compared to earlier commitments made.

Some of this may be due to the economic downturn. But some may also be due to earlier allegations of financial mismanagement that caused some donors, most notably Germany, to withhold promised contributions to the Global Fund.

Many, including me, saw some of the media reports of “fraud” as a bit over-the-top given the actual amount of money alleged to have been misspent, but the public image of the initiative has suffered — and perhaps given donors the excuse they needed to renege on their promised commitments.

A crisis looms, writes Sarah Boseley at The Guardian, in which this means people will die:

There is no doubt that people who could have been spared will instead fall ill and die as a result of the drying up of funds. There is also a Damoclean sword hanging over the heads of people who are alive and well thanks to drug treatment for their HIV infection. The Global Fund – together with Pepfar (the President’s emergency plan for Aids relief) has been the main source of money to pay for drugs. Those who start the combination treatments to prevent HIV causing Aids must stay on the drugs for life. If they stop, there is a danger the virus will become resistant to the drugs they are on.

Similarly, the group variously known as Doctors Without Borders or Médecins Sans Frontières says:

The dramatic resource shortfall comes at a time when the latest HIV science shows that HIV treatment itself not only saves lives, but is also a critical form of preventing the spread of the virus, and governments are making overtures that there could be an end to the AIDS epidemic.

 

FILED UNDER: Health, Global Fund, HIV-AIDS, Michel Kazatchkine
October 11, 2011 | 11:45 AM | By

Gates-backed AIDS project in India prevented 100,000 HIV infections, study says

Mike Urban, 2003

Nisha visits her son Allwyn's grave in Delhi. He died from AIDS, unknowingly transmitted to her by her husband.

A $258 million initiative sponsored by the Bill & Melinda Gates Foundation aimed at preventing AIDS in India appears to have paid off overall, researchers say, resulting in more than 100,000 fewer new HIV infections over five years.

Many aren’t quite ready to judge this project, Avahan, a success, however.

The project failed in three of the six Indian states where it was tested. And many are concerned that the amount of money spent to achieve these mixed results makes the approach highly impractical for poor countries.

The analysis of this project’s impact was done by the University of Washington’s Institute for Health Metrics and Evaluation, also sponsored by the Gates Foundation. This awkward situation is hardly unusual, as the Seattle philanthropy is now one of the primary funding sources for all things global health.

But before anyone gets too excited about the potential conflict of interest, which is real but which I can also attest has been repeatedly and vigorously debated within the UW Institute, it should be emphasized that the analysis was peer-reviewed by editors at The Lancet before publication.

The UW authors admit that their study results are preliminary and incomplete. Even with all the caveats, lead author Marie Ng says:

“The take-home message here is that prevention programs can be effective. Despite the heterogeneity of these results, it is clearly significant that we found more than 100,000 HIV infections were prevented.”

Continue reading →

FILED UNDER: Health, Science, Avahan, Bill & Melinda Gates Foundation, HIV-AIDS, Institute for Health Metrics and Evaluation, Marie Ng
September 29, 2011 | 10:12 AM | By

Three new studies on HIV — the good, the bad and the economists

Three studies or reports of note regarding HIV-AIDS:

Experimental AIDS vaccine shows promise of weakening HIV to level of herpes infection (Daily Mail) A new HIV vaccine could turn the once deadly condition which has killed millions of people into a ‘minor chronic infection’ like herpes, say scientists.

Setback for HIV preventive microbicide as clinical trial is halted (plusnews.org) Hopes for a female-controlled HIV prevention tool have been dealt a blow by the termination of one part of a large African trial after it failed to show effectiveness.

Economists say adult circumcision is not the best anti-HIV tactic (USAToda) A group of top world economists said Wednesday that adult male circumcision is not nearly as cost-effective as other methods of prevention. The economists rated HIV vaccine research as tops.

SIDE NOTE: It’s not a study, but it will affect research. The U.S. military, mostly at the Walter Reed Army Institute of Medical Research, has been a leader in AIDS vaccine research — most notably running the so-called Thai prime-boost study, the only vaccine trial so far to show protection against HIV. Congress is looking at cutting funding to such research, ScienceSpeak reports.

FILED UNDER: Health, HIV-AIDS
September 21, 2011 | 12:00 PM | By

Why we still don’t have a cure for AIDS — a novel explanation

Open Door Press

If someone discovered a cure for AIDS, would the pharmaceutical industry be able to – or even want to — develop it?

That’s one of the questions explored in Through These Veins, the first novel by Anne Marie Ruff, a veteran journalist who has covered AIDS, medical research, biodiversity and other international issues for many publications.

It’s perhaps also a question worth asking in reality this week as international leaders have been meeting at the United Nations and throughout New York City to debate, among other things, how best to fight disease in poor countries.

HIV infection is today, in rich countries at least, no longer a death sentence but rather a manageable, chronic disease almost like diabetes thanks to the development of effective anti-HIV drugs.

That’s obviously of life-saving benefit to millions of people infected with HIV who can get these drugs.

It’s also one of the great success stories for what some might call the “medical-industrial-complex.” At the risk of sounding a bit crass, people with HIV, like people with other chronic diseases, have to keep buying these products in order to stay alive.

Is there just as much market incentive for a drug company to spend hundreds of millions of dollars to find a cure for AIDS? Ruff doesn’t think so.

“I would challenge you to show me a pharmaceutical company that can afford to undertake the very expensive, risky, and long-term research necessary to develop a cure for HIV/AIDS, or almost any other disease for that matter,” she told me. “The sales model simply will not support the effort.”

(Maybe not for drug companies. But I should note that there are medical scientists at the Fred Hutchinson Research Center exploring a gene-modification approach to curing HIV infection.)

Ruff says she isn’t necessarily criticizing the drug industry (though one fictional company, Klaus Pharmaceuticals, is certainly the bad guy in her novel). Drug makers are simply responding to market forces, she says, and are legally required to their shareholders to pursue the most lucrative business strategy.

Unfortunately, she says, the money is in treating and not curing. And the scientific community, Ruff adds, tends to follow the money also. Continue reading →

FILED UNDER: Health, Anne Marie Ruff, drug industry, HIV-AIDS, UN Week
August 22, 2011 | 10:00 AM | By

HIV in the Middle East and North Africa — Behind a Veil?

Brain scientists say we can really only think about one thing at a time.

And when it comes to AIDS, I think it’s fair to say we tend to think of Sub-Saharan Africa as the place where the HIV pandemic continues to spread. As this report from NPR’s Linda Thrasybule illustrates, such simplistic thinking is both incorrect and dangerous.

Tariq Mahmood AFP Getty Images

By Linda Thrasybule

HIV epidemics are emerging among men who have sex with men in the Middle East and North Africa, researchers say. It’s a region where HIV/AIDS isn’t well understood, or studied.

More than 5 percent of men who have sex with men are infected by HIV in countries including Egypt, Iran, Lebanon, Morocco, Sudan and Tunisia, according to a recent study in PLoS Medicine. In one group of men in Pakistan, the rate of infection was about 28 percent. (For reference, in 2008, rates of HIV infection among men who have sex with men in the U.S. ranged from 16 percent among white men up to 28 percent of black men, according to the CDC.)

Risky behavior, low condom use, injectable drug use and male sex workers are some of the factors that could cause HIV rates to rise in the region, the researchers say. On average, the men who have sex with men group had between four and 14 sexual partners within the past six months, with consistent condom use falling below 25 percent.

Lack of HIV surveillance and low access to treatment and prevention are a concern for researchers, who believe the window of opportunity to prevent the epidemic from spreading across the region is growing smaller.

Read more here at NPR’s Shots blog

FILED UNDER: Health, HIV-AIDS, Middle East, North Africa
July 18, 2011 | 10:00 AM | By

Big AIDS meeting few care about opens in Rome, and GOOD map on AIDS pandemic

The International AIDS Society is holding its meeting in Rome this week. I’ll be doing a round-up of the meeting as soon as something newsworthy comes out of it. So far it’s mostly been folks giving their perspectives on the news already reported or calling for more funding to expand treatment:

AIDS conference organizers say their meeting is important milestone

Question: Why isn’t the media interested?

Answer: Maybe because of the gecko AIDS treatment story

Meanwhile, GOOD has created this cool-looking (but somewhat confusing?) infographic and map of the global state of affairs in the HIV/AIDS pandemic:

GOOD

FILED UNDER: Health, HIV-AIDS
July 13, 2011 | 10:24 AM | By

Studies provide proof of powerful new HIV/AIDS prevention strategy

Gilead

Two clinical studies done in Africa, the largest done by Seattle scientists involving nearly 10,000 people in Uganda and Kenya, have shown that the same drugs used to treat HIV infection can be used to prevent the infection.

“This is huge news because of the impact it could have on prevention worldwide,” said Jared Baeton, one of the leading researchers at the University of Washington on the study, which was funded by the Bill & Melinda Gates Foundation.

“These results are tremendously exciting and confirm we are at a pivotal period in the AIDS epidemic,” said Mitchell Warren, a leading voice on HIV-AIDS prevention matters and director of the AIDS Vaccine Advocacy Coalition.

A number of earlier studies have shown that getting people who are HIV infected on anti-HIV drugs significantly reduces the risk of spreading the virus. Now, Warren said, it seems clear that people who are at high risk for HIV can also be protected if they take the drugs prior to being exposed to the virus.

The approach is known as pre-exposure prophylaxis, or PrEP. The other study cited today as demonstrating PrEP’s potential was done by the U.S. Centers for Disease Control and Prevention in Botswana involving more than 1,200 volunteers.

Connie Celum

“This study demonstrates that anti-retrovirals (anti-HIV drugs) are a highly potent and fundamental cornerstone for HIV prevention and should become an integral part of global efforts for HIV prevention,’ said Celum, who was among the first to show the power of these drugs to prevent infection.

The UW study in Uganda and Kenya was of 4,758 “discordant” couples (in which one partner has HIV and the other does not) was called Partners PrEP and led by Celum and Baeten. On Sunday, scientific advisers monitoring the UW study ordered the placebo arm halted and the results released early.

Earlier studies of PrEP strategies had shown conflicting results, some effective and some not, but many experts say these new studies will resolve the uncertainty.

The UW study, which compared a single anti-HIV drug regimen vs a combo drug regimen, found that giving non-infected partners these drugs reduced the risk of infection by 62-73 percent (depending on if it was the single or combo drug).

But, as AIDS prevention advocate Warren noted in his statement heralding these results, science is one thing and implementing treatment or prevention programs in the real world is another.

Many millions of HIV-infected people living in poor countries and who right now need access to these drugs to save their lives are not getting them. Programs such as the Global Fund to Fight AIDS, TB and Malaria have not been fully funded by donors and governments.

 

FILED UNDER: Science, Connie Celum, HIV-AIDS, prevention, treatment