Friday, May 09, 2008

• HIV Prevention Funding in Africa Should Be Shifted To Promote Male Circumcision, Partner Reduction Programs, Study Says

HIV Prevention Funding in Africa Should Be Shifted To Promote Male Circumcision, Partner Reduction Programs, Study Says
[May 09, 2008]

      Current HIV prevention strategies have had limited success in fighting HIV/AIDS in Africa and should be shifted to promote male circumcision and partner reduction programs, according to a study published Friday in the journal Science, BBC News reports (BBC News, 5/9). The article was published in a special issue of Science to mark the 25th anniversary of the discovery of HIV, London's Times reports (Henderson, Times, 5/9).

Daniel Halperin of the Harvard School of Public Health, Malcolm Potts of University of California-Berkeley School of Public Health and their eight colleagues wrote that HIV prevention strategies usually involve the promotion and provision of condoms, HIV testing, microbicide research, abstinence and the treatment of other sexually transmitted infections that can increase the risk of HIV, according to an HSPH release.

However, condom promotion has not been effective in parts of Southern Africa because the epidemic is generalized and primarily heterosexual in the region, the researchers wrote. Other studies also have shown that HIV testing and treating STIs have not had a significant impact, they noted (HSPH release, 5/9). "Despite relatively large investments in AIDS prevention efforts for some years now, it's clear that we need to do a better job of reducing the rate of new HIV infections," Halperin said, adding, "We need a fairly dramatic shift in priorities, not just a minor tweaking" (BBC News, 5/9). "The vast majority of donor investments in HIV prevention in the generalized epidemics of Africa continue to go to approaches for which the evidence of actual impact is increasingly unclear," he said, adding, "Many of these approaches ... do have important public health benefits and should be continued, but not because we believe they will definitely have a major impact on reducing HIV infections."

According to Halperin, there is "still some foot dragging on more fully implementing those approaches for which the evidence is much stronger, namely to scale up safe, voluntary male circumcision services and to more assertively promote partner reduction," he wrote (Times, 5/9).

According to the researchers, less than 1% of UNAIDS funding has been allocated for male circumcision programs. They add that other, more costly strategies have been less effective in preventing HIV in the region, London's Independent reports.

Studies have shown that routine male circumcision could reduce a man's risk of contracting HIV by at least 60%, but the procedure also could have benefits for women, according to researchers. "Over time, male circumcision, which has been called a 'surgical vaccine,' would probably protect more women, albeit indirectly, than nearly any other achievable HIV prevention strategy," the researchers wrote.

The added, "Unlike most other interventions, male circumcision is a one-time procedure that confers lifelong protection. Modeling suggests that male circumcision could avert up to 5.7 million new HIV infections and three million deaths over the next 20 years in sub-Saharan Africa, many of these among women."

Potts said, "It is tragic that we did not act on male circumcision in 2000, when the evidence was already very compelling," adding, "Large numbers of people will die as a result of this error" (Independent, 5/9).

Reaction
Michael Carter, spokesperson for Aidsmap said, "There is undoubtedly a growing sense of frustration about HIV incidence figures, and this inevitably leads to the search for methods of prevention that appear more effective." He added, "Circumcision and partner reduction do have a role and will have greater success in some settings than others."

Lisa Power, head of policy at the Terrence Higgins Trust said, "Different strategies are needed for different countries and with the United Kingdom's concentration of HIV in specific populations, targeted work is essential" (BBC News, 5/9).

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Kenya Launches Campaign To Increase TB Screening Among HIV-Positive People
[May 09, 2008]

      The Kenyan government on Tuesday launched a 60 million shilling -- or about $975,000 -- campaign to increase the number of HIV-positive people who are screened for tuberculosis at public hospitals, Kenya's Nation reports. The campaign also aims to educate health workers to test people with TB for HIV.

About half of the 1.2 million HIV-positive people in Kenya also have TB, James Nyikal, public health and sanitation permanent secretary, said at an event to mark the launch of the campaign at Mbagathi District Hospital in Nairobi, Kenya. He added that health workers detect about 20% of TB cases among HIV-positive people. According to Nyikal, there is a "strong link" between TB and HIV/AIDS. "That is why we want our health workers to ensure all patients are tested for both diseases in public, private and mission hospitals," he said (Mwaniki, Nation, 5/7).

Nyikal also said health workers are not immune to the stigma often associated with TB and HIV/AIDS, Africa Science News Service reports. He said a number of health workers reported knowing colleagues who seek treatment for HIV/AIDS in distant health clinics to avoid discrimination. "Health workers need to be encouraged to recognize the benefits of disclosure to support their work and health," Nyikal said. He also acknowledged that Kenya faces challenges in fighting HIV/AIDS- and TB-related stigma (Neondo, Africa Science News Service, 5/6).

According to Nyikal, Kenya has received a shipment of 800,000 doses of the BCG TB vaccine. A recent government shortage put more than 200,000 infants at risk of contracting the disease. There were 117,000 cases of TB in Kenya last year, and the disease killed about 74,000 people, the Nation reports (Nation, 5/7).

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Southeast Asian Officials Meet in Laos To Discuss HIV/AIDS Prevention
[May 09, 2008]

      Officials with the Association of Southeast Asian Nations recently met in Laos to examine methods of addressing the increasing rate of HIV/AIDS in the region, Xinhuanet reports. According to Xinhuanet, the officials discussed how increasing the involvement and empowerment of HIV-positive people could help curb the spread of the virus.

During a meeting on Wednesday, Lao Deputy Minister of Public Health Bounkouang Phichit said that HIV/AIDS has negatively impacted health care systems in Southeast Asia, as well as national budgets, especially in low-income countries. According to Sonam Yangchen Rana, United Nations Resident Coordinator in Laos, the meeting will help address the needs and concerns of people living with HIV/AIDS, as well as strengthen their involvement in the development and execution of ASEAN's HIV/AIDS efforts.

Rana also said that during the past few years, Southeast Asia has seen an increasing number of networks of HIV-positive people. According to Xinhuanet, the networks provide people with a communal platform to voice their concerns, as well as an opportunity to gather and offer services. ASEAN consists of Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Vietnam (Xinhuanet, 5/8).

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South Carolina Legislature Approves $2.4M for State ADAP
[May 09, 2008]

      South Carolina lawmakers have approved $2.4 million for the state's AIDS Drug Assistance Program, the Columbia State reports (Reid, Columbia State, 5/8). ADAPs are federal- and state-funded programs that provide HIV/AIDS-related medications to low-income, uninsured and underinsured HIV-positive individuals (Kaiser Daily HIV/AIDS Report, 4/9).

The Legislature approved $4 million for the state's ADAP last year, according to the State. South Carolina's contribution has increased from 5% of the program's budget in 2007 to 19% this year. South Carolina ADAP Director Sonya Bayone said that about 100 people in the state apply for ADAP monthly.

"We have finally, as a state, come to grips with HIV/AIDS and are willing to put resources to stem the spread of this disease," Rep. Joe Neal (D), who has led efforts in the state House to allocate money for HIV/AIDS services, said.

According to the State, the new money will help prevent waiting lists, such as the one that increased to 567 people after federal funding for the program was reduced last year. However, the program is expected to face federal funding cuts and increased costs again in the future, the State reports. Higher drug prices, new recommendations that HIV-positive people start treatment earlier and concerted efforts to increase HIV testing have contributed to rising ADAP costs, according to the State.

Helmut Albrecht, chief of Infectious Diseases at the University of South Carolina School of Medicine, said, "This is just bringing us up to where we should be," adding, "In all honesty, we had a lot of catching up to do." Bambi Gaddist, executive director of the South Carolina HIV/AIDS Council, said, "A health agenda is important for economic stability. In the past, we have left HIV off. It's important that we place HIV on that health agenda." About 800 people in South Carolina are diagnosed with HIV/AIDS annually (Columbia State, 5/8).

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Latino Commission on AIDS Project Focuses on HIV/AIDS Among Hispanic Immigrants in Deep South
[May 09, 2008]

      NPR's "Tell Me More" on Wednesday included a discussion with Tim Frasca of the Latino Commission on AIDS about the organization's Deep South Project. The project aims to develop strategies to address HIV/AIDS among Hispanics in Mississippi and six other Southern states with rapidly growing populations of new immigrants, Frasca, program coordinator for the project, said.

The rapid influx of Hispanic immigrants to the region has created a need for local organizations to address HIV/AIDS in "areas where infrastructure was not previously available," Frasca said. For example, the number of foreign-born residents in Mississippi has doubled since 2000, with half estimated to be Hispanic, according to the Center for Immigration Studies. Hispanic communities in the targeted states "are very different from what you will find in California, Texas or Florida," Frasca said.

Another challenge facing Southern states is a shortage of comprehensive data on the number of HIV cases among Hispanic immigrants. Any population data collected in Gulf Coast states prior to Hurricane Katrina are "completely out of date," Frasca said, adding that officials estimate that 3% of new cases in Mississippi occur among Hispanics. In North Carolina, more than 8% of new cases occur among Hispanics, which is "thought to be already substantially higher than the proportion of [Hispanics] in the state," he said (Martin, "Tell Me More," NPR, 5/7).

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Access to Generic HIV/AIDS Drugs Increasing Following Thailand's Decision To Issue Compulsory Licenses, Health Official Says
[May 09, 2008]

      Access to some antiretroviral drugs is increasing in Thailand because of the country's decision to issue compulsory licenses for certain medications, Winai Sawasdiworn, deputy secretary-general of the National Health Security Office, said recently, the Bangkok Post reports (Apiradee, Bangkok Post, 5/8). The Thai government in January 2007 issued a compulsory license to produce a lower-cost version of Abbott Laboratories' antiretroviral Kaletra. The drug company in May 2007 offered to sell Aluvia, an updated version of Kaletra, at a reduced price in Thailand on the condition that the country agree not to allow generic versions of the drug into the market. The Thai Ministry of Public Health in June 2007 confirmed that it would continue with its plan to issue a compulsory license for the drug after Abbott and the health ministry could not reach a price agreement during negotiations. Thailand's FDA in October 2007 completed the registration of a generic version of Aluvia for use under the country's compulsory licensing program. The generic version is manufactured by the Indian generic pharmaceutical company Matrix Laboratories (Kaiser Daily HIV/AIDS Report, 1/22).

According to Winai, the first batch of the generic version of Kaletra -- worth 21 million baht, or about $664,000 -- was delivered to state hospitals nationwide in February. He added that 153,776 bottles of a generic version of Merck's antiretroviral Efavirenz, for which Thailand also issued a compulsory license to produce, had been imported from India beginning in October 2007.

Winai was responding to recent criticism from a group of HIV-positive advocates, which said that the country has been slow to distribute the antiretrovirals. The group also questioned whether enough medication was being imported to provide treatment access to all people living with HIV who need the drugs. Wirat Poorahong, head of the Thai Network of People Living With HIV/AIDS and a member of an NHSO subpanel, recently called on the agency to increase its budget and bolster the number of health workers under the program. According to the Post, about 300 doctors in Thailand currently are authorized to change an HIV-positive person's drug regimen, and 27 blood screening centers are able to conduct HIV tests nationwide (Bangkok Post, 5/8).

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