US travel ban lifted- at last!

Following the announcement on 30 October 2009 and after the routine 60 day waiting period, the US travel ban restricting entry of persons with HIV and AIDS has been removed. President Obama announced the policy was to be repealed following consultation with experts and the public.

Prior to the final rule being lifted entrants to the US with HIV were considered to have a "communicable disease of public health significance" and denied entry on the sole basis of their HIV status, per the Immigration and Nationality Act. Persons will not be required to undergo HIV testing as part of the medical examination demanded of migrants to the US.

AVERT welcomes this significant development which removes infamous discrimination in place since 1987. It is to be hoped that the remaining countries with similar bans will follow this lead.

(source: Immigration Equality and BBC accessed: 04.01.10) 

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Ugandan Bill threatens progress on HIV

MPs in Uganda's Parliament will today debate the "HIV and AIDS Prevention and Control Bill," which, amongst other things, proposes the death sentence for homosexual sex under certain conditions.  Under the Bill, "same sex attraction is not an innate and immutable characteristic" and as such it is punishable under law to engage in homosexual behaviour.

Alongside the repressive measures for homosexuals, it calls for mandatory testing for HIV and forced disclosure of HIV status. It also criminalises the willful transmission of HIV, the failure to "observe instructions on prevention and treatment," and misleading statements on preventing or controlling HIV. It is feared the bill will blame women for mother-to-child transmission of HIV rather then targeting the problem of treatment shortages.

This proposed bill has many areas of concern and shows a step backwards for Uganda - from the successful policies of the 1990s that brought the HIV rate under control, to a situation that will effectively discriminate against marginalised groups, such as homosexuals. It is hoped that Uganda will respond to widespread international criticism and not allow the Bill to progress further with the current discriminatory measures. 

 (Sources The Time Online and Human Rights Watch accessed 18.12.09)

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Former SA Minister of Health dies

The former South African Minister of Health Manto Tshbalala-Msimang has died at the age of 69 from liver disease. Her death comes as South Africa moves away from its HIV denialist past of which the former health minister was a leading participant.

Dr. Tshabalala-Msimang will leave a mixed legacy to those in South Africa. She was a leading member of the ANC and passionately promoted gender equality within the party but she was also an outspoken denialist of HIV.  Alongside former President Thabo Mbeki she denied millions the ability to access vital HIV medication (ARVs) and instead promoted dangerous alternative remedies. She will be remembered as 'Dr Beetroot' for one such alternative remedy but olive oil, lemon, and potatoes were also recommended as potential 'medicine'. During the denialist period, it is estimated that 330,000 people died between 2000-2005 because they did not have access to treatment.

AVERT wishes to convey their condolences to Dr. Tshablalala-Msimang's family, children and friends. However, it is hoped that Dr. Tshablalala-Msimang's actions will not leave a lasting legacy and that President Zuma continues the encouraging overhaul of the Government's HIV policy.

(Sources BBC and Sowetan accessed 17.12.09)

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Study results show that PRO 2000 microbicide is ineffective

Results from the PRO 2000 microbicide study have shown the gel has failed to protect against HIV. The results are from the largest microbicide study to date and it was hoped the data would be more promising than previous studies.

An earlier trial of the gel showed that PRO 2000 had reduced the risk of HIV infection by around 30% but the true effectiveness was not clear. At the time many reports had been optimistic about the trial, even though the results had not been statistically significant.

The MDP said today that today's results "demonstrates conclusively that PRO 2000 was not effective in preventing HIV infection". Of the 3,156 women who were given the PRO 2000 microbicide, 130 became infected with HIV, while 123 of the 3,112 women given the placebo gel become infected with the virus.

The need to develop a microbicide that shows a significant level of protection is vitally needed. Women are often unable to negotiate condom use and the idea of a microbicide is popular. However, there still remains the need for additional methods of reducing the risk of infection and while set backs have been suffered to previous trials, hopefully positive results will be seen in the future.

For more information regarding microbicides go to AVERT's page on Microbicides.

(Source AIDSmap and Microbicides Development Programme accessed 14.12.09) 

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Man injects wife with HIV-infected blood

A 35- year old HIV positive man has injected his wife with his blood in order to deliberately infect her with HIV. The couple are reported to have been experiencing relationship problems after it was discovered that he was HIV positive in 2004. While the couple decided to stay together for the children, the wife was scared of having sex with her husband for fear of contracting HIV.  

It is reported that the man twice pricked his wife with a sewing needle tainted with his blood. After noticing a sting-like mark on her thigh, the wife became suspicious. Later, she saw her husband handling a syringe of blood. During a routine check-up it became apparent that the wife had become infected with HIV. After she confronted her husband, he admitted to pricking her with an infected needle. The husband has been charged with deliberately infecting his wife with the virus and if convicted he can face up to 14 years in prison.

This case is highly unusual as most people living with HIV try to prevent transmission to anyone else. Transmission through blood is a more effective method than unprotected sex and this explains why the wife was infected so quickly. The case is tragic in its consequences and highlights the need for continued support when diagnosed with HIV.

(Source: BBC and Sydney Sunday Herald accessed 07.12.09)

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South Africa to expand treatment for HIV positive pregnant women and babies

On World AIDS Day, South African President Jacob Zuma announces that all HIV positive pregnant women and HIV/TB co-infected patients with CD4 counts below 350 cells/mm³ will receive treatment. Children under the age of 1 year will also receive treatment.

Working on the recommendations announced by the World Health Organisation, pregnant women and TB patients will receive access to treatment at an early stage of their HIV infection. Previously, people living with HIV have only been able to receive treatment if their CD4 counts were at 200 cells/mm³. Usually, this would not be soon enough to prevent a person from developing opportunistic infections.

While WHO recommendations stated that all people living with HIV with a CD4 count of below 350 cells/mm³ should receive treatment, South Africa has chosen to prioritise groups. This compromise is designed to target treatment to the groups where treatment may have the greatest impact of limiting new infections.

However, it could be a sign of difficult decisions that have to be made in situations where resources are limited. South Africa has not explained how this treatment expansion will be funded or how many more people will need access to treatment.

If Universal Access is to be achieved difficult decisions will need to be made and without a continued emphasis on prevention more decisions will have to be made.

For more about improving access to prevention, treatment and care, see our Universal Access video, produced for World AIDS Day.

(Source: AIDSmap accessed 01.12.09)

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WHO abandons old recommendations on exclusive breast-feeding and HIV

Long overdue recommendations for preventing mother-to-child transmission (PMTCT) have been released today by the WHO with radical changes to old guidelines.

Last updated in 2006, WHO recommended that HIV-positive women should receive treatment from their 28th week of pregnancy but no firm guidelines were offered for feeding options for their infants, except exclusive breastfeeding until 6 months. Now, clear recommendations have been offered. HIV-positive mothers should exclusively breastfeed their infants for the first 6 months of life, followed by complementary foods and breastmilk until 12 months old. The guidelines intend to make breastfeeding safer through providing ART to either mother or infant. If formula is available, this would be recommended instead of breastfeeding.

Access to antiretroviral drugs (ARVs) is at the heart of the new PMTCT recommendations with complex regimens being promoted to stop infants becoming infected. In the 2006 guidelines, treatment was recommended for HIV-positive mothers from 28 weeks and not during the breastfeeding period. Now, women are recommended to start treatment at 14 weeks of pregnancy and continue until the end of the breastfeeding period. This could potentially mean HIV-positive mothers will receive a year’s worth of ARVs for the benefit of their infant, when they otherwise would not necessarily require the drugs.

Other recommendations made are that all patients should start ART when their CD4 counts are at 350 cells/mm³ regardless of whether they show symptoms. There should be a phase out of the ARV, stavudine (d4T), widely used in low- and middle-income countries, due to its long-term, irreversible side effects.

To implement these recommendations there must be a radical scale-up of treatment availability and PMTCT services. This will prove difficult in resource-limited countries where limited human and financial resources hamper HIV prevention, treatment and care programmes.

For more about improving access to prevention, treatment and care, see our Universal Access video, produced for World AIDS Day.

(WHO Press Release accessed on 30.11.09)

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Decade has seen significant decline in new HIV infections

Global HIV infection rates and AIDS-related deaths have dropped significantly in recent years, according to a new UNAIDS report. The number of new infections has dropped by 17% since 2001, and thanks to increased availability of HIV drugs, deaths have declined by 10% over the past five years.

Some of the most encouraging signs come from sub-Saharan Africa where 400,000 fewer people were infected last year than at the start of the decade. East Asia has also seen a dramatic 25% decrease in annual infections between 2001 and 2008.

The success of prevention programmes is contributing to these trends. However, Executive Director of UNAIDS, Michel Sidibé believes there is room for improvement: “[I]f we do a better job of getting resources and programmes to where they will make most impact, quicker progress can be made and more lives saved.”
 
The 2009 AIDS Epidemic Update also highlights that great progress has been made in tackling HIV where prevention and treatment programmes are integrated with other areas of health and social welfare. Calling for an end to AIDS being dealt with in isolation, Sidibé said: “Already research models are showing that HIV may have a significant impact on maternal mortality. Half of all maternal deaths in Botswana and South Africa are due to HIV. This tells us that we must work for a unified health approach bringing maternal and child health and HIV programmes as well as tuberculosis programmes together to work to achieve their common goal.”

It is encouraging that progress is being made to combat the HIV and AIDS epidemic but the momentum needs to continue. The response must also adapt to the changing patterns of HIV infection. According to the report, in Eastern Europe and Central Asia, the epidemic is spreading from injecting drug users, who are the majority of affected people, to their sexual partners. In parts of Asia where sex work and drug use were the drivers of the epidemic, heterosexual couples are becoming increasingly affected.

Improving access to treatment and care is vital in order to support the more than 33 million people living with HIV worldwide, and greater prevention efforts are needed to suppress the infection rate even further.

 Source: UNAIDS accessed 24/11/09

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South African mortality increases by 32% since 2004

The Minister of Health, Dr. Aaron Motsoaledi, has announced that mortality has increased by 32% since 2004. South Africa is estimated to have 5.7 million people living with HIV but only has 0.7% of the world's population. Average life expectancy has been significantly reduced to 56 years for women and 51 years for men. In 2007, 57% of deaths of children under the age of 5 are reported to be caused by HIV.

The devastating effects of HIV are being felt throughout South Africa. When asked, Dr. Motsoaledi blamed this appalling situation on former President Mbeki's destructive denialist policies which prevented people from accessing vital ARVs. South Africa aims to reduce the rate of infections by 50% by 2011 and cover 80% of people who need ARVs. However, the country is still far away from these targets and this week's news, that mortality has increased by 32% since 2004, clearly shows that much more needs to be done.

South Africa has a chance to tackle their HIV epidemic and by focusing on prevention, care, and treatment, this might be possible.

(South Africa's Department of Health accessed 12/11/09)

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U.S. to lift travel ban after 22 years

President Obama announced on Friday that the United States will remove the travel ban that prevents HIV-positive people from entering the States. At a White House ceremony, Mr. Obama stated that the removal of the ban would take effect after a routine 60-day waiting period.

Widespread praise has been given for the move, including from UN Secretary-General Ban Ki-moon who congratulated the U.S. President for announcing the removal of the restrictions. However, Ban Ki-moon also urged that 'all other countries with such restrictions [should] take steps to remove them at the earliest', as travel restrictions should 'fill us with shame'.

The United States is one of around a dozen countries that prevent people living with HIV from entering their countries. Obama said the restrictions were 'rooted in fear rather than fact' and it is encouraging that America has finally moved away from such discriminatory measures. Hopefully, with America setting a new course, other countries will follow by example and remove all existing travel restrictions for people living with HIV.

 (New York Times accessed 2/11/09) (UN News Service accessed 2/11/09)

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Kenyan homosexual census to be launched

Kenya is to carry out a census of its gay population as part of its efforts to tackle HIV and AIDS. Kenya is estimated to have between 1.5 and 2 million adults and children living with HIV but it is unknown how many homosexual men live in the country.

Men who have sex with men are particularly vulnerable in Kenya. It is illegal to be homosexual and anyone convicted of the crime can face up to 14 years imprisonment. The chances that accurate information will be gathered is limited as many gay men will be reluctant to come forward for fear of reprisal. It has been suggested that the census will gather information by gay men identifying one another.

As a group that lacks access to accurate information, it is vital that the gay community in Kenya is reached. The Kenyan Government proposes that HIV tests and information will be provided for those who are included in the census.

The Kenyan Government must assure gay men that they will not be punished for coming forward and being counted. 

(BBC accessed 29/10/09)

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Is the Thailand AIDS vaccine trial a step forward or back for HIV prevention?

The further results published today make it clear that only time and further analysis will determine whether the vaccine was actually effective, even in a mild way, in preventing HIV infection. But while the researchers go back to the labs, the question needs to asked about the effect the widespread publicising of these results has had on current HIV prevention efforts.

In many parts of the world difficult choices are having to be made between providing more people with treatment, and continuing with, or even intensifying existing HIV prevention programmes. People around the world have been informed that there is a partially effective vaccine, and in many cases the word “partial” will have been omitted as the information spreads across the world. As a result many people will now believe that an effective vaccine is only a few years away.

According to Annabel Kanabus, Director of AVERT, “these beliefs could now contribute to decisions being made about the cutting back of existing highly effective HIV prevention programmes”.

So should the researchers have been more cautious, and chosen their words more carefully before they informed the world of their results? And if it turns out in due course that this vaccine is not after all effective, then will the researchers be equally keen to tell the world of this result?

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HIV Vaccine results are questioned

US army and Thai researchers announced on September 24th that an HIV combination vaccine had produced a ‘statistically significant’ result with a 31% reduction in new infections in a trial of more than 16,000 people in Thailand. At the time the results of the trial were only made public through news conferences and press releases, instead of waiting for the formal publications of their findings. The complete results were never made public.

A secondary analysis of the results that came out today is now suggesting that the vaccine was possibly not as successful as researchers initially thought, reducing infections by only 24% which is not considered statistically significant. The first analysis included all 16,000 people who participated in the trial and produced the promising result. However, the secondary analysis, which is part of the protocol for any vaccine trials, excluded patients who did not follow some experimental guidelines. The results therefore turned out to be less convincing, in other words, the previous successful results could be due to chance alone and not due to the vaccine.

Full details of the trials are expected to be made public on October 19th in Paris. In the meantime, the limited disclosure of the initial results raises important questions of whether the Army, the Thai government and the US national Institute of Health rushed to give a "positive spin" on a trial that might actually turn out to be inconclusive.

(The Wall Street Journal accessed 12th Octover 2009)

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Four Million people receiving ART at the end of 2008

Released today by UNAIDS and the WHO, the report: "Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector", shows that there has been an 36% increase in access to ARVs for those living with HIV in just one year. Access to ARVs has been expanding at a rapid rate and progress has been seen most in Sub-Saharan Africa. Price decline has been seen at rates of 10-40% for First line therapy between 2006-2008 but Second line therapies are still relatively expensive.

The report also sheds new light on the situation of Mother-to-child-transmission. Approximately 45% of HIV positive pregnant women are now receiving ARVs when only 35% of women had access in 2007. This is a positive step towards lowering mother-to-child transmission and means that less babies are being born HIV positive. The number of children now receiving ARVs has increased from 198,000 in 2007 to 275,700 children in 2008, allowing children the chance to live a longer life.

Overall the results from the report shows that access to treatment is increasing but it does warn against the potential impact of the economic slowdown. If the funding gap increases then the possibility to sustain the levels of people on treatment is damaged and more people may not have access to life-prolonging drugs. However, while access to treatment is important to tackling HIV, HIV and AIDS prevention methods such as education, increased access to condoms and increased emphasis on Mother-to-child transmission would reduce the number of people becoming infected with the virus.

 ("Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector" accessed 30/09/09)

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Positive results seen in AIDS vaccine trial

For the first time an HIV vaccine candidate has been found to lower the rate of infection in humans. The largest trial of its kind, which recruited 16,402 young adults in Thailand, found infection rates cut by just under a third (31.2%).

Of those who received a placebo 74 people became infected with HIV, compared to 51 receiving the vaccine candidate.

Trial participants in the vaccine group were given a combination of ALVAC, designed to stimulate a cellular response to HIV, and AIDSVAX, which promotes the production of antibodies to the virus. As the latter product had failed in previous trials there was hope that combining it with ALVAC would produce a more promising result.

President and CEO of the International AIDS Vaccine Initiative, Seth Berkley welcomed the findings:

“The outcome is very exciting news and a significant scientific achievement. It’s the first demonstration that a candidate AIDS vaccine provides benefit in humans. Until now, we’ve had evidence of feasibility for an AIDS vaccine in animal models. Now, we’ve got a vaccine candidate that appears to show a protective effect in humans, albeit partially.”

All of the trial participants received education on how to prevent HIV infection and were tested for HIV every six months for three years following the vaccination. Those who became infected with HIV were provided with counselling and antiretroviral drugs.

While the results are statistically significant and therefore encouraging, greater research is needed to find out how the potential vaccine can cut the risk of infection even further. It is likely to be many years before an effective vaccine is available for worldwide use. In the meantime there should be increased focus on established HIV prevention methods and access to antiretroviral treatment.

The official results will be presented on 19th October at the AIDS Vaccine Conference in Paris.

(International AIDS Vaccine Initiative accessed 24/09/09)

(U.S. Military HIV Research Program MHRP accessed 24/09/09)

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Mother to child transmission-free zones to be created

UNAIDS in conjunction with the Millennium Villages Project are to join forces to cut mother to child transmission in Africa. Areas targeted will be 14 ‘Millennium Villages’ across ten African Countries including Ethiopia, Ghana, Kenya, Malawi, Mali, Nigeria, Rwanda, Senegal, Tanzania and Uganda. Announced today at the Second Annual Millennium Promise Partner’s Meeting the plans aim to drastically reduce the transmission of HIV from mother to child.

The prevention of mother to child transmission in sub-Saharan Africa remains uneven with less than half of pregnant women living with HIV receiving antiretroviral prophylaxis; an essential treatment to prevent transmission. While transmission of HIV to children has fallen to fewer than 300 children in 2007 for Western Europe, sub-Saharan Africa saw 370,000 cases.

Michel Sidibe, the Executive Director of UNAIDS said “ we have a major opportunity now to eliminate mother-to-child transmission of HIV in Africa and save thousands of lives each year.” The new initiative will use existing infrastructure, human capacity and technical resources in the villages combined with community-centred health services to stop AIDS in children.

(UNAIDS accessed 22/09/09)

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