[hivaids-twg] Today's News (2009.11.10ex)

[Diaz, Clara]

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

 

 

 

AFRICA AND MIDDLE EAST    

1. Mail & Guardian, SA - Child rape epidemic in Zimbabwe

2. New Vision, Uganda - 1,000 Babies in Kitgum And Gulu Get HIV Care 

3. IRIN-PlusNews - Zambia: New Infections On the Rise 

4. APS, Senegal - Plaidoyer pour un dépistage volontaire du virus du sida  

 

ASIA AND PACIFIC

1. Bangladesh News24 - Govt to strengthen HIV-AIDS committee

2. My Republicat, Nepal - Net-based prostitution racket busted in Valley    

3. Brunei Times - Brunei's HIV Infection Rate Lowest In Southeast Asia

4. New Nation, Bangladesh - HIV epidemic feared 

 

EUROPE

1. Reuters, UK - Lack of health care worsens women's life quality: WHO

2. Pravda, Russia - AIDS Is Leading Cause of Women's Deaths Globally, WHO Says 

3. El País, Spain - "Hay que facilitar que las mujeres se protejan contra el sida"

4. Le Monde - Les femmes plus vulnérables face à la maladie 

 

LATIN AMERICA AND CARIBBEAN

1. El Nacional, Venezuela - Falta de asistencia médica principal causa de mortalidad femenina 

2. Folha de S. Paulo, Brazil - Fazer trabalho militar na Amazônia qualifica e dá experiência, diz médico  

 

NORTH AMERICA

1. New York Times - AIDS Divisions of 2 Large Drug Makers Form Company to Focus on the Disease

2. New York Times - Money to Fight AIDS (Letter)

3. Washington Post - In raw oyster trade, FDA's safety proposal is tough to swallow

4. NPR - AIDS Patients Now Living Longer, But Aging Faster

5. PLoS Medicine - Efficacy of Short-Course AZT Plus 3TC to Reduce Nevirapine Resistance in the Prevention of Mother-to-Child HIV Transmission: A Randomized Clinical Trial 

6. Washington Post - Blunted needles (Editorial)

 

UNAIDS WEB.SITE

1. UNAIDS - UNAIDS and Economic Commission for Africa discuss innovative financing for health in Africa

 

 

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AFRICA AND MIDDLE EAST

 

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Child rape epidemic in Zimbabwe
Mail & Guardian, SA

10/11/2009

 

Tens of thousands of children have been sexually abused in Zimbabwe in a growing epidemic that has shocked human rights activists. 

 

A single clinic in the capital, Harare, says it has treated nearly 30 000 girls and boys who were abused in the past four years -- an average of 20 per day. Experts believe that the country's economic collapse under Robert Mugabe has led to widespread family breakdown and left many children vulnerable.

 

Dr Robert-Grey Choto, a paediatrician and co-founder of the Family Support Trust Clinic, said the increase was alarming. "In the last four years we have seen over 29 000 cases, and in the last 10 years we have more than 70 000 at this clinic alone," he told the BBC's Network Africa programme. "It's a tip of the iceberg -- the problem is enormous. We need drugs and any assistance we can get."

 

A 12-year-old patient at the clinic, part of the main referral hospital in Harare, told the BBC he had been gang-raped in a township last month. "Four men waylaid me on my way from school," he said. "I was taken to a shop where they showed me pornographic material."

 

The boy said he was then drugged and sodomised for more than a week. His father added: "This is unbearable, all I want is justice for now."

 

Other organisations dedicated to helping victims are on the back foot because of Zimbabwe's tense political climate. Betty Makoni, founder of the Girl Child Network (GCN), which has rescued more than 35 000 girls from sex abuse, was forced into exile last year because of threats against her.

 

Speaking from London, she said the real number of victims was likely to be double that recorded by the Family Support Trust Clinic. The GCN says 10 girls report rape every day in Zimbabwe and a further 10 victims probably remain silent. The youngest known victim was a baby of one day; the oldest was a woman aged 93.

 

Makoni told the Guardian: "We have children forced to marry under the age of 13. We have children who were held hostage and raped in militia camps during the political violence who are now giving birth to their own children. We still have children being raped because of the myth that if a man with HIV has sex with a virgin he will be cured of his virus."

 

She said men were able to perpetrate the crime with impunity because of 4 000 known rape cases per year, only 500 resulted in a prosecution. The GCN's research indicates that on average a man can rape 250 children before his crimes become public knowledge.

 

"The justice system has collapsed in Zimbabwe. A syndicate of men uses its economic and political muscle to escape justice. We also have 10 000 boys going to train as youth militia; they become vicious and make girls succumb to sex through fear."

 

The economic meltdown, political violence and starvation in Zimbabwe over the past decade have driven numerous people abroad, with three million fleeing to South Africa alone. Often they leave their children in the care of extended family or friends and try to send money home.

 

Many more children have been orphaned by HIV/Aids or other diseases in a country where the average life expectancy has plummeted to 37 for men and 34 for women, among the lowest in the world.

 

Chipo Mukome, a counsellor at the Family Support Trust Clinic, told the BBC: "Due to the economic situation where we have seen a lot of parents going to neighbouring countries, like South Africa, in search of greener pastures, they are leaving their children to the care of others -- uncles and aunts for example. These people, in the end, are abusing these children."

 

Zimbabwe's fragile unity government has limited capacity to intervene after years of neglect of welfare state structures. The priority in recent months has been the reopening and maintenance of crumbling schools that were once the envy of Africa.

 

David Coltart, the education minister, said: "I suspect that a third of households in Zimbabwe have been broken up as a result of the economic chaos. But the social welfare department has all but collapsed. There are hardly any social workers left."

 

Coltart, a member of prime minister Morgan Tsvangirai's Movement for Democratic Change, said the child sex abuse statistics were indicative of a wider epidemic. "In the last few decades we allowed a culture of violence to pervade our society," he said. "It's compounded by the fact that those responsible are generally immune from prosecution. The breakdown of the rule of law means this culture is all-pervasive.

 

"It is not just intra-political parties. It spreads to domestic violence and the abuse of children."

 

Last month Coltart launched a campaign, Learn Without Fear, aimed at ensuring schools are safe places for children. It noted that while teachers have been responsible for abusing girls in schools, there has been a developing trend in which girls are abused by senior boys, with some cases going unreported. - guardian.co.uk © Guardian News and Media 2009

 

2

1,000 Babies in Kitgum And Gulu Get HIV Care
New Vision, Uganda

09/11/2009

 

Chris Ocowun

 

Kampala — OVER 1,000 babies produced by HIV-positive mothers in Kitgum and Gulu districts have received equipment to facilitate their care. The equipment that included a Land Cruiser vehicle, two motorcycles, computers and digital cameras, all worth sh128m, were given to Health Alert, a local NGO supported by SAVE the Children.

 

Gabriel Oling Olang, the Save the Children Gulu manager, said the equipment would also improve the living conditions of the 1,491 children and adolescents living with HIV/AIDS in the two districts.

 

He disclosed that only 32 of the 1,000 babies tested HIV-positive. About 200 HIV-positive mothers have formed five post-test groups and each will get a revolving loan of sh400,000 from Health Alert.

 

Olang explained that the vehicle and equipment would enable the organisation reach out to more children living with HIV in the two districts. He thanked Save the Children Denmark for helping the children in the north access care and support services to improve their lives.

 

Walter December Anywar, the group's acting coordinator, said the babies would also receive milk. "We feed the children born by HIV-positive mothers under the prevention of mother-to-child transmission programme on milk for one year to avoid infection," he said.

 

Anywar expressed concern that few men were involved in the HIV prevention programme.He said in most cases, the women seek for the services without their partners, saying this affects the quality and sustainability of the HIV care and support programme for the children.

 

Judith Oroma, the Health Alert chairperson, urged medical workers not to segregate against children living with HIV.

 

3

Zambia: New Infections On the Rise 

IRIN-PlusNews

09/11/2009

 

Lusaka — An estimated 82,700 Zambians will become newly infected with HIV in 2009, up from just over 70,000 in 2007, according to new figures from the National AIDS Council.

 

The 2009 Zambia HIV Prevention Response and Modes of Transmission Analysis noted that the percentage of new HIV infections had stabilized, but the absolute number of new infections increased due to population growth.

 

As many as 71 out of every 100 new infections occur as a result of sex with a non-regular partner, while people who reported having only one sexual partner accounted for around 21 percent of new infections.

 

"This shows significant HIV risk even for those who are faithful. The country is facing new and tough challenges to reduce the infection rate because the disease is threatening the foundation of families and marriages," the report commented.

 

Other drivers of Zambia's epidemic are low levels of male circumcision in most parts of the country and inadequate condom use, particularly among discordant couples (in which one partner is HIV-positive and the other negative).

 

Although Zambia has recorded successes in its prevention of mother-to-child transmission (PMTCT) programme, ensuring a safe blood supply, and behaviour-change communication campaigns, the authors recommended urgently focusing future prevention efforts on curbing common practices such as having multiple concurrent partners, transactional sex and inter-generational sex.

 

"Multiple concurrent partnerships are the leading cause of HIV infection in Zambia. Within these relationships, correct and consistent use of condoms remains dismally low despite condoms being readily available, in most cases free of charge," President Rupiah Banda said at the opening of the National HIV Prevention Convention in Lusaka, the capital, last week, and called for more concerted efforts to curb new infections.

 

However, the report revealed that the annual estimated requirement was 200 million male condoms and 2 million female condoms, yet only 96 million male and 500,000 female condoms were available.

 

Vice President George Kunda blamed the high number of new infections on the poor uptake of HIV/AIDS services and reluctance to change risky behaviours.

[ This report does not necessarily reflect the views of the United Nations ]

 

5

Plaidoyer pour un dépistage volontaire du virus du sida  
Agence de Presse Sénégalaise

09/11/2009

 

Saint-Louis — Le président de l'association sénégalaise des personnes vivant avec le VIH/Sida, Ismaila Diédhiou, a plaidé pour un dépistage volontaire, estimant que "connaître son statut sérologique contribue à se protéger et à protéger son environnement."

 

M. Diédhiou s'exprimait au lycée Ameth Fall à l'occasion du lancement de la campagne nationale de lutte contre le sida sur le thème : "Droits humains et accélération de l'accès universel".

 

Pour le président de l'association nationale, "un porteur qui s'ignore est une bombe à retardement pour la société". Porteur du virus depuis 1994, il se souvient qu'à l'annonce de la nouvelle par un médecin toutes ses pensées étaient d'abréger sa vie.

 

Mais finalement, grâce à l'accompagnement de sa famille et des responsables médicaux, il se ressaisira et entamera une opération pour sauver sa vie. Ainsi il commencera le traitement anti-rétroviral qui lui permet depuis lors de vivre sa séropositivité sans problème.

 

Le secrétaire exécutif du conseil national de lutte contre le Sida, Dr Ibra Ndoye, a profité de cette tribune pour appeler les jeunes filles à oeuvrer dans le sens de diminuer la féminisation de la pandémie.

 

Signalant que chez les jeunes, sur trois porteurs, deux sont des filles, il a plaidé pour un changement de comportement et un respect des valeurs comme la virginité jusqu'au mariage. Dr Ibra Ndoye a rappelé les efforts faits par le Sénégal où le taux a été maintenu depuis environ une vingtaine d'année à moins de 1 %.

 

Il a demandé aux populations d'avoir une attitude normale vis-à-vis des porteurs qui ne doivent pas étre stigmatisés et estimé que leur fréquentation ne constitue pas un danger car le virus ne transmet généralement que par voie sexuelle et par d'autres procédés bien identifiés.

 

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ASIA AND PACIFIC

 

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Govt to strengthen HIV-AIDS committee
Bangladesh News24

10/11/2009

 

Dhaka, Nov 10 (bdnews24.com)–The prime minister has said her government will strengthen the national committee on curbing HIV-AIDS. 

 

Sheikh Hasina was speaking with Nafis Sadik, special adviser to the UN secretary general on HIV-AIDS, on Tuesday, her deputy press secretary Mahbubul Haque Shakil told reporters after the meeting. 

 

The prime minister informed Sadik that her administration was taking active steps to prevent the deadly disease, Shakil said. 

 

"The religious instructions, social values and family bonds help people in resisting AIDS," Shakil quoted the prime minister as saying. 

 

Sadik expressed satisfaction with the government steps and said Bangladesh could be a good example among the Muslim countries in resisting AIDS. 

 

The prime minister's health advisers Dr Moshiur Rahman and Dr Syed Modasser Ali, secretary at the prime minister's office Molla Wahiduzzaman were also present there. 

 

Earlier, newly appointed Bangladesh envoy to Nepal Neem Chandra Bhowmik called on the prime minister. 

 

Hasina asked the new envoy to work for strengthening the relationship between the two friendly countries. 

bdnews24.com/sum/su/bd/1547h.

 

2

Net-based prostitution racket busted in Valley    
My Republica, Nepal

10/11/2009

 

SUNDAR KHANAL 

 

KATHMANDU, Nov 10: Adding to a series of crackdowns and unraveling quite a new dimension in the organized flesh trade, Police busted an internet-based prostitution racket operating in the capital, on Monday evening.

 

Amit Gautam, one of two Kathmandu-based members of the racket who have been running the business through a portal, nepalsexguide.com, for four months, was ambushed at Naxal by a team from the Metropolitan Police Range Kathmandu. The racket, controlled by a leader based in New Delhi, India, is said to have been supplying Nepali girls chiefly to Indian nationals visiting here. 

 

A police officer leading the crackdown told Republica that Amit, 21, a resident of Samakhusi, had been working as the local contact for the racket and is identified as ´John´ in the homepage of the website. Police extracted from him a mobile phone numbered 977-9849055457, the same mentioned in the home page referring to contact person ´John´.

 

The police team was searching for Ameet´s business partner, a woman named Sangeeta Shrestha, a resident of Tahachal, as this news was being prepared and they believe she would be nabbed anytime during the night.

 

According to the homepage of the website, the racket is described as a ´´guide to beautiful Nepali women and Asian escorts offering their unrivaled services at our Nepal Sex Guide escort agency."

 

"We currently have 40 escort girls who are offering companionship to businessmen and discerning gentlemen at five star hotels or exclusive residence. Our collection of thrilling beauties includes college girls, aspiring and established models, young professionals and even some from Nepal Film Industry," goes part of the text under the header ´About us´.

 

The website asks to drop a note about oneself by phone or email at nepalsexguide at gmail.com and states that after receiving a complete email, the aspiring client will be given a phone number for further personal contact.

 

The racket seems to have charged clients differently under three categories--College Students (NRS 25,000), Models (NRS 50,000) and Celebrities (NRS 100,000 onwards).

 

Besides services in Nepal, according to the website, the racket is also operating in seven major Indian cities and girls are supplied at various rates on hourly basis.

 

According to police, things will be clearer with the arrest of the Nepali woman who is said to be partnering with Amit in Kathmandu.

 

3

Brunei's HIV Infection Rate Lowest In Southeast Asia
Brunei Times

10/11/2009

 

Written by Fitri Shahminan

 

Bandar Seri Begawan - HIV epidemic remains a main health problem in the Southeast Asian and now even in the Pacific regions but infection rate in Brunei has been one of the lowest, the head of the Asean's Health and Communicable Diseases Division yesterday.

 

Dr Bounpheng Philavong told the local media that Brunei is viewed as among the top three countries in Southeast Asia to have the lowest prevalence rate of human immunodeficiency virus (HIV) infections together with Laos PDR and the Philippines.

 

He said that in 2007 there were less than five million HIV infections reported in Southeast Asian and Pacific regions with 380,000 infections estimated each year.

 

"Brunei is among the country that has the lowest prevalence rate of HIV infections in the region...there are also other countries such as Lao PDR and the Philippines which have very low prevalence rate of HIV," he said during the 17th Asean Task Force on Aids (ATFOA) Meeting at the Rizqun International Hotel in Gadong.

 

Dr Bounpheng congratulated the Sultanate for being able to maintain a low HIV infection rate in the region.

 

"That shows the high commitment of Brunei decision-makers and also the hard work of the Ministry of Health of Brunei Darussalam in collaboration with partner organisation, and several other society organisations in fighting HIV, so we hope that this HIV trend in Brunei will remain really low and Brunei will continue setting a good example to Asean member states," he added.

 

Although no statistics were released to support his statement, Dr Boupheng observed that Brunei has a lower number of high risk group of people for HIV infection, compared to other countries in the region.

 

"So Brunei Darussalam can also continue the education activities so its people continue to be aware on the risk of infection and let its people know that not just only the high-risk people can be infected but also other people so I think education still remains very important," Dr Bounpheng said, adding that intervention or prevention is just as vital.

 

He reminded Asean member countries not to be complacent as the risk of infection varies from one country to another.

 

"At the present time, the high risk group of HIV infection includes for example, injectable drug-users, men who have sex with men (transgender), sex workers and also migrant workers. But we cannot say that the normal sub-population are not at risk, you can see that at this moment, HIV/Aids is a silently growing epidemic as the number of new infections among women with one partner or spouse is rising and more children are also infected and affected," he said.

 

He continued to say sexual transmission remains to be the main mode of HIV transmission in most of the Asean countries, therefore the most important thing was to promote faithfulness among the spouses and promote use of protection.

 

Dr Bounpheng said to date, there were no plans to observe World Aids Day at a regional level, however, he encouraged individual Asean member states to work to prevent spread of HIV.

 

In her opening remarks, the Director General of Health Services Dr Hjh Rahniah Hj Mohd Said said that HIV and Aids is a notifiable disease in Brunei, under the Infectious Disease Order 2003 requiring all medical practitioners to report cases seen in their settings.

 

A total of 56 cases have been notified to the Disease Control Division until October 2009, since the establishment of sero-surveillance for HIV in August 1986, she said.

 

She added that clinical care including anti-retrovirals, support and counselling for HIV positive citizens and permanent residents were continued to be given free of charge."As a low-prevalent country, we are closely monitoring our situation in the light of observed changing population behaviours, lifestyles, social structure and values as well as population mobility," she said.The three-day meeting which is scheduled to end tomorrow, will discuss several key issues on HIV-and Aids- related problems, work programmes and best practices as well as future implementation. 

 

4

HIV epidemic feared
New Nation, Bangladesh

10/11/2009

 

Staff Reporter

 

The spread of Human Immunodeficiency Virus (HIV) may turn into epidemic as the virus is being originated in the country apart from spreading through migrated people in recent years.

 

The number of HIV carrying people in the country is at least 1500 which was 1207 and 1495 in 2007 and 2008 respectively. 'The scenario has changed as we have noticed that the virus is being originated in the country and its spread through migrated people has apparently reduced,' said former Vice Chancellor of Bangabandhu Sheikh Mujib Medical University (BSMMU) Professor Dr Md Nazrul Islam on Monday.

 

He said this in his keynote speech at a seminar , 'Responsibility of the youth for prevention of HIV/AIDS', organised by Shaheed Dr Fazle Rabbee Foundation at Daffodil International University (DIU).

 

Male are infected by HIV than woman in the country, he said adding if we could not prevent the virus from originating in the country, the ratio of male and female HIV infection would gradually become equal.

 

BSMMU conducted a survey which revealed that 50 percent of male who came for HIV test at the university are students and 80 percent of them got it through mixing with prostitutes. 

 

Students who stay at Hall, Dormitory and hostel are more vulnerable to HIV infection than those living with families, he said. Nazrul Islam said that 75-85 percent people of the world get infected through sexual intercourse. Transmission of HIV usually occur mainly through blood, semen, vaginal fluids and breast milk from the infected people. 

 

'Washing hand with soap thoroughly can inactivate HIV', said the former BSMMU VC. In this context he suggested that the important method of prevention and control of HIV/AIDS is care and support of people Living with HIV (PLHIV) through which the source of virus is contained. 

 

He stressed the need for availability of Voluntary Counselling and Training (VCT ) at all Thana Hospitals.

 

Prof Dr AK Azad Chowdhury, former VC, University of Dhaka, Prof Dr Aminul Islam, VC, Daffodil University, Dr Md Yeasin Ali, Fellow, World Health Organisation (WHO) and Wahida Banu, Chairperson, STI/AIDS Network of Bangladesh among others, spoke. 

 

Stressing on behavioural change, AK Azad said, "Behavioural change and precaution could prevent the spread of the disease." Knowledge, he said is the best way to fight with the disease. People should overcome social taboo and be frank to prevent the spread the deadly virus, he said.

 

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EUROPE

 

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Lack of health care worsens women's life quality: WHO
Reuters,UK

10/11/2009

 

By Laura MacInnis

 

GENEVA (Reuters) - Despite living six to eight years longer than men, women lack essential health care throughout their lives, particularly as teenagers and elderly people, the World Health Organization said on Monday.

 

In a report, the WHO said that women around the world are "denied a chance to develop their full human potential" because many critical medical needs are ignored.

 

"Women generally live longer than men, but their lives are not necessarily healthy or happy," Margaret Chan, the head of the United Nations health agency, said at the WHO on Monday.

 

Though women tend to seek out medical services more often than men -- particularly before, during and after pregnancy -- they often fail to get adequate treatment to cope with violence, depression and problems related to old age, such as dementia.

 

"The obstacles that stand in the way of better health for women are not primarily technical or medical in nature. They are social and political," Chan said.

 

Childbirth assistance can be particularly hard to access for unmarried and marginalized women, teenagers and sex workers, WHO said in its first attempt to log differences between men's and women's health over their lifetimes.

 

"In many countries, sexual and reproductive health services tend to focus exclusively on married women and ignore the needs of unmarried women and adolescents," the report said.

 

"Paradoxically, health systems are often unresponsive to the needs of women despite the fact that women themselves are major contributors to health, through their roles as primary care givers in the family and also health care providers," it said.

 

WHO also said some 99 percent of the estimated 500,000 women who die every year giving birth are in developing countries where medical supplies and skilled workers are in short supply.

 

But while emphasizing the many links between poverty and ill health, the report also stressed that many shortcomings affect women across income brackets and geographical regions.

 

Depression and anxiety affect far more women than men, and women are more likely to catch sexually transmitted diseases.

 

Women are also overwhelmingly more likely to be victims of sexual violence than men, and elderly women's health problems such as eyesight and hearing loss, arthritis, depression and dementia are often untreated.

 

Unequal access to education, employment and fair wages can also present obstacles to women's health, especially in markets where medical insurance is linked to work or where user fees are required to access basic services, the WHO report found.

 

3

AIDS Is Leading Cause of Women's Deaths Globally, WHO Says
Pravda, Russia

09/11/2009

 

According to WHO's first research on women's health worldwide, the AIDS virus appears to be the leading cause of death and disease among women between the ages of 15 and 44, the World Health Organization said Monday

 

Unsafe sex is the leading risk factor in developing countries for these women of childbearing age, with others including lack of access to contraceptives and iron deficiency, the WHO said. Throughout the world, one in five deaths among women in this age group is linked to unsafe sex, according to the U.N. agency. 

 

"Women who do not know how to protect themselves from such infections, or who are unable to do so, face increased risks of death or illness," WHO said in a 91-page report. "So do those who cannot protect themselves from unwanted pregnancy or control their fertility because of lack of access to contraception." 

 

The data were included in a report that attempts to highlight the unequal health treatment a female faces from childbirth through infancy and adolescence into maturity and old age, The Associated Press reports. 

 

It was also reported, despite considerable progress in the past decades, societies continue to fail to meet the health-care needs of women at key moments of their lives, particularly in their adolescent years and in older age, according to a women and health report released by the UN agency. 

 

"If women are denied a chance to develop their full human potential, including their potential to lead healthier and at least somewhat happier lives, is society as a whole really healthy? What does this say about the state of social progress in the 21st century?" said WHO Director-General Margaret Chan when launching the report. 

 

According to the report, women worldwide provide the bulk of health care -- whether in the home, the community or the health system, yet health care continues to fail to address the specific needs and challenges of women throughout their lives. 

 

Up to 80 percent of all health care and 90 percent of care for HIV/AIDS-related illness is provided in the home -- almost always by women. Yet more often than not, they go unsupported, unrecognized and unremunerated in this essential role, Xinhua reports. 

 

News agencies also report, women make up 80% of the workforce when it comes to care, working in nursing homes, in supportive role positions, and nursing staff, but their own needs are not adequately being fulfilled. 

 

“It’s time to pay girls and women back, to make sure that they get the care and support they need to enjoy a fundamental human right at every moment of their lives, that is their right to health,” said WHO Director General Margaret Chan. 

 

“We will not see significant progress as long as women are regarded as second-class citizens in so many parts of the world,” Chan concluded, dBTechno reports. 

 

4

"Hay que facilitar que las mujeres se protejan contra el sida"
El País, Spain

09/11/2009

 

E. DE BENITO- Madrid

 

Hay dos cosas que la ghanesa Kate Adoo-Adeku tiene claras: que "el sida no se combate sólo con medidas sanitarias. La educación es un factor clave", y que todavía no hay un método de protección pensado para las mujeres, aunque éstas son la mayoría de las infectadas por el VIH en el África subsahariana, la región del mundo que concentra a un 70% de los afectados. Y alrededor de esas dos ideas clave se mueve. Es catedrática de Educación para Adultos en la universidad de Ghana y licenciada en Filosofía -"pon lo de catedrática, que me ha costado mucho", insiste-, directiva de la Sociedad de Mujeres con Sida de África (SWAA), y ha creado su propia ONG, People and Development (PAD), que financia con su sueldo. Una idea de la importancia del reto lo acabade dar la OMS. El sida es la primera causa de murte en mujeres entre 15 y 24 años de los países pobres.

 

Adoo ha estado en España invitada por la ONG Planeta salud para entrevistarse con parlamentarios españoles y hacer campaña para que fomenten la investigación en microbicidas, geles o cremas vaginales que se espera que sean el método barrera del futuro para frenar la transmisión del VIH durante las relaciones sexuales, la primera vía de infección del virus. Con satisfacción comenta que "algunos ya sabían de lo que les estaba hablando".

 

Que todavía no haya un microbicida disponible no quiere decir que no haya trabajo que hacer. Mientras se investiga, hay que llevar a cabo una importante tarea sobre el terreno: promoverlo para que cuando esté disponible las mujeres lo usen. El fracaso del preservativo femenino, que no ha conseguido popularizarse, es una prueba de que no basta con idear soluciones si luego son difíciles de llevarlas a la práctica. "Hay que facilitar que las mujeres se protejan. Nosotras estamos siempre en desventaja. Hasta los condones femeninos son más complicados de usar que los de los hombres" Por si cabe duda, saca uno del bolso, y muestra las instrucciones. "¡Seis pasos! Nadie hace cosas sencillas para la mujeres", se queja. "Y además son más caros que los masculinos. Eso no tiene sentido, porque ellos son más ricos", añade.

 

En ese momento se transforma. La tímida mujer explica gráficamente los problemas del condón femenino, lo que cuesta ponérselos y lo fácil que es que se escurran. "Son tan grandes que asustan. Hay que insertarlos y estar pendiente, y en el clímax, se te olvida que lo tienes puesto. Eso es peligroso", insiste.

 

Otro ejemplo de lo importante que es tener en cuenta el público al que está dirigido un remedio es el impedimento que ya prevé a los microbicidas, y que seguramente no estaba en los planes iniciales de los investigadores (occidentales) que los desarrollan. "Son fáciles de usar y dan la posibilidad a la mujer de decidir cuándo lo hace, pero en muchos sitios de África se practica el sexo seco. Es lo que hace que hombres y mujeres disfruten. La falta de lubricante [conseguida mediante abrasivos] les hace sentir más. Y las cremas dan una sensación húmeda. Si queremos que los microbicidas tengan éxito, hay que investigar más. ¿Por qué no crean uno que sea en polvo?", comenta.

 

Lo que queda claro es que la solución no va a ser única. "El sida no es sólo una cuestión sanitaria. No compete sólo a médicos y enfermeras. También es un problema de cultura". Y pone un ejemplo claro: "Yo sé lo que tengo que hacerle a mi marido si quiero sexo; cómo y dónde le tengo que acariciar. Pero la mayoría de las mujeres de los pueblos africanos no pueden decidir cuándo van a tener relaciones. Lo hacen ellos. Muchas son analfabetas, y esa falta de formación aumenta su sumisión ante el hombre. Por eso hay que darles también educación". Un objetivo claro, que tiene otro inconveniente implícito. "Ellos también tienen que ser educados. Tienen que aceptar que sus mujeres se formen. Debe ser una tarea conjunta". Lo dice con entusiasmo. Algo imprescindible para sacar adelante su trabajo.

 

5

Les femmes plus vulnérables face à la maladie
Le Monde

09/11/2009

 

LEMONDE.FR avec AFP

 

Les femmes restent plus vulnérables face à la maladie que les hommes en raison de la persistance d'inégalités sociales, prévient lundi l'Organisation mondiale de la santé (OMS) dans un rapport intitulé "Les femmes et la santé".

 

"Il est temps que les filles et les femmes reçoivent ce qui leur est dû ; de faire en sorte qu'elles obtiennent les soins et le soutien dont elles ont besoin pour jouir d'un droit humain fondamental à chaque moment de leur existence, c'est­-à-dire de leur droit à la santé", explique la directrice de l'OMS, le Dr Margaret Chan. Alors qu'elles assurent la grande majorité des soins de santé prodigués dans le monde, elles ne bénéficient pas en retour des réponses médicales appropriées à leurs besoins et problèmes spécifiques, souligne l'OMS.

 

Dans son rapport, l'organisation s'inquiète particulièrement de la situation des femmes âgées, toujours plus nombreuses en raison du vieillissement de la population et d'une espérance de vie plus longue que celle des hommes. "La société doit se préparer dès à présent à prendre en charge les problèmes de santé et les coûts associés à la vieillesse", prévient le rapport.

 

L'OMS demande aux gouvernements de faire des efforts financiers pour "assumer les coûts de la prise en charge sanitaires de ces femmes âgées", notamment dans les pays développés, où le poids est souvent porté par les familles. "Il faut élaborer [dans les pays les plus démunis] des politiques concernant le financement de la santé, la réforme des retraites et des impôts, (...) et, enfin, la prestation de soins en établissement et dans la communauté", insiste le rapport. Répondre aux besoins de santé de ces femmes âgées passe par une meilleure compréhension des maladies dont elles souffrent, selon l'OMS.

 

Alors que le sida, la tuberculose et les risques associés à la grossesse restent les principales causes de mortalité chez les femmes entre 15 et 45 ans, les plus de 60 ans souffrent surtout de troubles cardiaques et d'accidents vasculaires cérébraux, des maladies considérées comme plus fréquentes chez les hommes.

 

"Les femmes présentent souvent des symptômes différents des hommes, ce qui contribue au fait que les maladies du cœur sont moins diagnostiquées chez les femmes", fait remarquer l'OMS.

 

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LATIN AMERICA AND CARIBBEAN

 

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Falta de asistencia médica principal causa de mortalidad femenina  
El Nacional, Venezuela

09/11/2009

 

Este año cuatro millones de niñas morirán por enfermedades que pueden prevenirse y 2,5 millones de ancianas se quedarán ciegas por causas evitables debido a las dificultades que las mujeres tienen para obtener asistencia sanitaria, según la OMS.

 

Bajo el título de la "Las Mujeres y la Salud", la Organización Mundial de la Salud (OMS) presentó este lunes un informe que revela esas necesidades sanitarias femeninas.

 

El informe, el primero que se elabora con una perspectiva general desde el nacimiento a la muerte de la mujer, muestra que las desigualdades entre hombres y mujeres son tan amplias, que las ventajas biológicas y de comportamiento preexistentes en las féminas no son suficientes para tener una vida más sana y prolongada, como debería esperarse.

 

Según la investigación, incluso en el caso de que el trastorno sea el mismo que el de los hombres, las mujeres tienen más dificultades para curarse a causa de las desigualdades en materia de educación, ingresos y empleo.

 

"El principal obstáculo para la salud de las mujeres no es médico, sino social y político, al carecer las féminas de un buen acceso al sistema sanitario. La pobreza es el principal determinante", señaló la directora general de la OMS, Margaret Chan, quien agregó:

 

"El problema principal es que en muchos países las mujeres son ciudadanos de segunda clase".

 

La OMS estima que este año medio millón de mujeres morirá de sida, otro medio millón de tuberculosis, y otras 500.000 por causas derivadas del embarazo y el parto, todas ellas dolencias relacionadas con la sexualidad.

 

A nivel mundial, la causa principal de muerte de las mujeres en edad reproductiva es el sida.

 

Por su parte, la mortalidad materna es la principal causa de muerte de las mujeres de entre 15 y 19 años, y es la que más separa países ricos y pobres, dado que el 90 por ciento de los casos se dan en países en desarrollo.

 

"Las niñas y las mujeres son particularmente vulnerables a la infección por el VIH debido a una combinación de factores biológicos y desigualdades de género, sobre todo en las culturas que limitan el conocimiento sobre el virus, y su capacidad de protegerse y de negociar relaciones sexuales sin riesgo", reza el texto.

 

Precisamente, las relaciones sexuales forzadas y las violencia sexual es otro de los principales factores de riesgo para la salud de las mujeres.

 

"La violencia contra las mujeres es un hecho que ocurre en todo el mundo y que tiene serias implicaciones sanitarias", señala el informe.

 

"Cada año 73 millones de mujeres padecen una depresión profunda, muchas veces relacionada con la violencia a la que son sometidas, psicológica, física y sexual", agregó Chan.

 

Según un estudio de la OMS, entre 15 y 71% de las mujeres han sufrido abusos físicos o violencia sexual por parte de sus maridos o compañeros masculinos.

 

Otra de las formas de violencia contra las féminas y que puede acarrear la muerte inmediata, o transtornos físicos y psicológicos para toda la vida es la mutilación genital femenina, o ablación del clítoris.

 

Se estima que 92,5 millones de niñas en África sufrieron ablación del clítoris, un fenómeno que no cesa, más bien al contrario, y que además cada vez se practica a una edad más temprana.

 

Toda esta violencia ejercida contra las féminas genera que el suicidio sea una de las causas principales de muerte en las mujeres entre los 20 y los 59 años de edad.

 

Finalmente, el informe muestra las contradicciones de que "los sistemas de salud desatiendan las necesidades de las mujeres a pesar de que éstas contribuyen mucho a mejorar la salud de la sociedad mediante su función como cuidadoras principales de la familia, y que, además, las féminas constituyan la columna vertebral del sistema sanitario, pero raras veces estén representadas en los puestos de gestión".

 

4

Fazer trabalho militar na Amazônia qualifica e dá experiência, diz médico  
Folha de S. Paulo, Brazil

09/11/2009

 

KÁTIA BRASIL

DA AGÊNCIA FOLHA, EM MANAUS

 

Na Amazônia, médicos que optaram por cumprir o serviço militar depois de formados afirmam que trabalhar no Exército lhes dá experiência e qualificação.

 

Na 12ª Região Militar, em cidades de fronteira em Rondônia, Roraima, Amazonas e Acre, apresentaram-se neste ano 133 médicos.

 

Ao iniciar no serviço, o médico incorporado recebe instrução de disciplina e aprende a marchar e a atirar.

 

Recebe a patente de segundo-tenente em seis meses. O salário é de R$ 5.000 mais ajuda de custo e bilhete aéreo para familiares.

 

Como não há dedicação exclusiva, pode ter outro emprego em unidade médica pública ou particular.

 

O primeiro-tenente Alexandre Souza, 31, é especialista em medicina tropical e infectologia. Nascido em Oriximiná (PA), formou-se em 2003 na Universidade Federal do Amazonas. Depois passou a cumprir o serviço militar em um quartel de infantaria, em Manaus. 

 

Hoje o tenente é chefe do serviço de infectologia do Hospital Geral do Exército. Também é gestor do programa de DST/ AIDS no eixo Manaus das Forças Armadas e da ONU. "Entrei inexperiente e hoje sou o único médico da Força que atua na área de doenças infecciosas", afirma.

 

Atualmente seriam necessários 250 profissionais atuando em 25 unidades, incluindo brigadas e pelotões de selva, segundo o Exército.

 

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NORTH AMERICA

 

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AIDS Divisions of 2 Large Drug Makers Form Company to Focus on the Disease
New York Times

10/11/2009

 

By DONALD G. McNEIL Jr. 

 

Two of the world’s biggest drug makers last week spun off their divisions that manufacture AIDS drugs and combined them into one company focusing on the disease.

 

The new company, ViiV Healthcare, will initially be 85 percent controlled by GlaxoSmithKline and 15 percent controlled by Pfizer. With headquarters in London, the company initially has a portfolio of 10 licensed drugs, including some of the earliest, like AZT and lamivudine, and later ones, like maraviroc, with combined sales of about $2.7 billion in 2008. It also has seven drugs in the pipeline. 

 

The companies say they will try to develop new drugs and new formulations of existing ones, like combination doses for children. ViiV Healthcare will also seek partnerships with other companies to develop multidrug cocktails.

 

Some in the field were pleased. Dr. Jorge Bermudez, executive secretary of Unitaid, an agency based in Geneva that buys AIDS drugs for the poor, quickly invited ViiV to join its “patent pool” holding licenses on medicines so they can be made generically. 

But Mark Harrington, executive director of the Treatment Action Group and a longtime AIDS activist, was skeptical. Mr. Harrington said he worried that separating AIDS work from the larger companies could result, for example, in too little money for a big clinical trial. And the mergers of the last decade meant fewer scientists assigned to AIDS research. 

 

“We’d love to be proved wrong,” he said, “but we’re worried that fewer companies in the field could mean innovation is slowed down.” 

 

A version of this article appeared in print on November 10, 2009, on page D6 of the New York edition.

Copyright 2009 The New York Times Company

 

2

Money to Fight AIDS (Letter)
New York Times

09/11/2009

 

To the Editor:

 

Re “As Donors Focus on AIDS, Child Illnesses Languish” (news article, Oct. 30):

 

Doctors Without Borders knows from experience the immense burden that pneumonia, diarrhea and other underfunded diseases have on children every day. We have treated hundreds of thousands of children and recognize that diarrhea and respiratory infections are among the main causes of death among this population.

 

But this is not a zero-sum equation: the answer is not to flatline AIDS funding and redistribute it. The only solution is to increase total funding. 

 

AIDS is no less an emergency now than it was a decade ago. An estimated six million people need treatment today and will die without it. Doctors Without Borders, which is treating 140,000 H.I.V. patients, is already seeing the dangerous effects of shifting donor priorities outside our programs. In Uganda, from where I recently returned, H.I.V. services are being rationed and long-running programs are suspending treatment for new patients. 

 

A decade of AIDS progress is under threat. It is of critical importance that all governments redouble their efforts on global AIDS while also expanding support for other long-neglected killers like malnutrition, pneumonia and diarrhea. We refuse to accept that H.I.V. and these neglected diseases be pitted against one another.

 

Matthew C. Spitzer, President

Doctors Without Borders USA

New York, Oct. 30, 2009

 

3

In raw oyster trade, FDA's safety proposal is tough to swallow
Washington Post

10/11/2009

 

By Lyndsey Layton

Washington Post Staff Writer 

 

Glistening oysters cradled on beds of ice have provoked a political battle, with fishing industries along the Gulf Coast and their allies in Congress pitted against food safety officials in the Obama administration, who are determined to sanitize raw oysters. 

 

The fight is over whether the government should require that Gulf Coast oysters headed for raw bars around the country first be treated to kill vibrio vulnificus, a bacterium naturally found in oysters harvested from warm waters. 

 

Eager to deliver on their pledge to improve food safety, federal officials say sanitizing oysters is a simple way to save lives. But oystermen, state officials and their representatives on Capitol Hill say the federal government is overreaching and aiming to destroy a gastronomical delight. 

 

Most of the raw oysters eaten in the United States carry vibrio vulnificus, but healthy consumers are unlikely to be affected by it. However, for those with diabetes, liver disease, cancer, AIDS and other chronic conditions, the infection can be deadly. About 30 cases of the infection are traced to Gulf Coast oysters annually, and half of those cases are fatal, according to the Centers for Disease Control and Prevention. 

 

The debate over the mollusks affects not only oyster shacks along the Gulf but raw bars around the country. The Gulf Coast supplies 67 percent of oysters consumed nationwide, and many of those oysters end up in Maryland, Virginia and other places where demand is high and the local supply is down, said Dave Burrage, a fisheries specialist with the Mississippi State University Coastal Research and Extension Center. 

 

The Food and Drug Administration stunned the oyster industry last month when it announced plans to require that oysters harvested from the Gulf between April and October undergo one of several types of processes to kill bacteria before the shellfish can be served raw. 

 

"There's just a very clear public health case," said Michael Taylor, the top food safety official at the FDA. "Vibrio is one of the most horrific infections we know about. Fifteen people a year die from this. It's excruciating. And the people who don't die suffer life-changing injuries. But we can prevent this." 

 

Federal officials, who are emphasizing food safety improvements, point to California as an example. Between 1991 and 2001, 40 people in California died of vibrio infection. In 2003, the state banned raw untreated oysters from the Gulf during warm months and fatalities dropped to zero, Taylor said. 

 

The oyster industry says that antibacterial processing, which is similar to pasteurization, will ruin the taste of raw oysters, triple their cost and place undue burdens on a business that has deep cultural and culinary roots. 

 

"This is unprecedented -- how they're trying to regulate shellfish," said Al Sunseri, co-owner of P&J Oyster of New Orleans, the nation's oldest continuously operating oyster dealer. In the 133 years that Sunseri's family has been selling oysters, it has never been linked to a vibrio illness, he said. 

 

He said the FDA is unfairly targeting oysters. "If they're a public health agency and if they feel they can bring illnesses down, why aren't they requiring fruits and vegetables be irradiated?" he said. 

 

The proposal, which would take effect in 2011, set off a flurry of political action. Last week, Sen. Bill Nelson (D-Fla.) filed legislation that would block the FDA from using federal dollars to enforce the policy. A similar bill was filed in the House by Rep. Charlie Melancon (D-La.). On Tuesday, a group of Gulf Coast senators, including Louisiana's Mary Landrieu (D)and David Vitter (R), Thad Cochran (R-Miss.) and Jeff Sessions (R-Ala.), plan to meet with Taylor. 

 

And in Louisiana, state officials are talking about defying the federal government. "It's likely that we'll do our own thing," said Alan Levine, Louisiana's secretary of health and hospitals. The FDA's authority extends only to foods that are transported across state lines. 

 

Levine said he thinks the FDA action seems like overkill because of the relatively few fatal cases involving vibrio. 

 

"Almost all of those deaths are people who are immune compromised," Levine said. "I don't understand why shutting down an industry makes sense in the scope of the larger picture." 

 

Darrell Dishon, 40, is not so certain. He tried oysters for the first time at a raw bar in Panama City, Fla., in July, two days before his wedding. He came out of a coma two weeks later, with his legs amputated. Dishon, who is diabetic, said he had no idea that eating raw oysters posed a health risk. 

 

"I just don't want this to happen to someone else," said Dishon, who lives in Lebanon, Ohio. "You sit down for dinner with your family, and the next thing you know you're in a wheelchair for the rest of your life. Or worse." 

© 2009 The Washington Post Company

 

4

AIDS Patients Now Living Longer, But Aging Faster
National Public Radio

09/11/2009

 

The introduction of protease inhibitors and drug cocktails in the 1990s meant that AIDS patients could live longer than ever thought. 

 

Before 1996, when new drugs were rolled out, life expectancy was 18 months post-diagnosis. Now, AIDS patients regularly live decades with the disease. But as these patients live longer, unanticipated side effects — caused by the disease itself, medications to treat it or both — introduce a new set of maladies. 

 

David France, a contributing editor at New York Magazine, was motivated to write a story on AIDS-related aging after noticing that a number of his friends with the disease were having what he describes as cognitive issues.

 

"[They were] forgetting things, forgetting appointments, forgetting whole conversations," France told NPR's Steve Inskeep. 

 

Researchers are finding that patients who live longer with AIDS also begin to suffer from osteoporosis, various forms of cancer, kidney disease and cardiovascular disease. 

 

"[It] makes them seem 25 years older than they are," said France, who believes some of the medications used to treat the disease may cause these problems. 

 

Joe Westmoreland has suffered from this type of early aging. He was diagnosed with HIV in 1982. In 1995, he was diagnosed with AIDS. Before then, he was fairly healthy. 

 

His AIDS diagnosis came just before new drugs were released. He was one of the first to use the medications. After starting on them, his T cells began rising — the drugs worked.

 

But as time went on, he got sick. Westmoreland began suffering from neuropathy, a type of nerve damage that can occur in the feet. It later spread to his hands. He started showing signs of osteopenia, a less advanced type of osteoporosis. Then came forgetfulness. But Westmoreland didn't think much of it. 

 

"I've taken a lot of this stuff for granted," said Westmoreland, who is in his early 50s. "Just par for the course."

 

Blame The Drugs Or The Disease? 

Researchers still don't know what to blame for symptoms like Westmoreland's — AIDS or the drugs used to treat it. Most experts assume that the drugs cause neuropathy. Many others are starting to believe that those drugs cause bone loss, as well. 

 

France sees many new questions raised by this emerging crisis. 

 

"The question now is why don't we have more drugs, less toxic drugs?" he asked. "Where is AIDS activism? Why aren't the people with HIV themselves organizing to call for research into the next frontline medications?"

 

But the reality of people living longer with the disease lessens the urgency, and deciding what to do with American resources to fight AIDS has become an issue that crosses the globe. 

 

"The energy for AIDS activism and AIDS thinking has moved globally," France said. "[It] has taken the spotlight off the ongoing [domestic] epidemic clinically.

 

"What is AIDS today?" France asked. "And are we finished thinking about how to take care of it today?"

 

5

Efficacy of Short-Course AZT Plus 3TC to Reduce Nevirapine Resistance in the Prevention of Mother-to-Child HIV Transmission: A Randomized Clinical Trial  
PLoS Medicine

27/10/2009

 

James A. McIntyre1, Mark Hopley2, Daya Moodley3, Marie Eklund2, Glenda E. Gray1, David B. Hall4, Patrick Robinson4, Douglas Mayers4¤, Neil A. Martinson1,5*

 

1 Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa, 2 Boehringer Ingelheim, Johannesburg, South Africa, 3 Department of Obstetrics and Gynaecology, Nelson Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa, 4 Boehringer Ingelheim Pharmaceuticals, Ridgefield, Connecticut, United States of America, 5 Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America

 

Abstract 

Background

Single-dose nevirapine (sdNVP)—which prevents mother-to-child transmission of HIV—selects non-nucleoside reverse-transcriptase inhibitor (NNRTI) resistance mutations in the majority of women and HIV-infected infants receiving it. This open-label, randomised trial examined the efficacy of short-course zidovudine (AZT) and lamivudine (3TC) with sdNVP in reducing NNRTI resistance in mothers, and as a secondary objective, in infants, in a setting where sdNVP was standard-of-care.

 

Methods and Findings

sdNVP alone, administered at the onset of labour and to the infant, was compared to sdNVP with AZT plus 3TC, given as combivir (CBV) for 4 (NVP/CBV4) or 7 (NVP/CBV7) days, initiated simultaneously with sdNVP in labour; their newborns received the same regimens. Women were randomised 1:1:1. HIV-1 resistance was assessed by population sequencing at: baseline, 2, and 6 wk after birth. An unplanned interim analysis resulted in early stopping of the sdNVP arm. 406 pregnant women were randomised and took study medication (sdNVP 74, NVP/CBV4 164, and NVP/CBV7 168). HIV-1 resistance mutations emerged in 59.2%, 11.7%, and 7.3% of women in the sdNVP, NVP/CBV4, and NVP/CBV7 arms by 6 wk postpartum; differences between NVP-only and both NVP/CBV arms were significant (p<0.0001), but the difference between NVP/CBV4 and NVP/CBV7 was not (p = 0.27). Estimated efficacy comparing combined CBV arms with sdNVP was 85.6%. Similar resistance reductions were seen in infants who were HIV-infected by their 6-wk visit.

 

Conclusions

A short course of AZT plus 3TC, supplementing maternal and infant sdNVP, reduces emergent NNRTI resistance mutations in both mothers and their infants. However, this trial was not powered to detect small differences between the CBV arms.

 

Trial registration

www.ClinicalTrials.gov NCT 00144183

 

Citation: McIntyre JA, Hopley M, Moodley D, Eklund M, Gray GE, et al. (2009) Efficacy of Short-Course AZT Plus 3TC to Reduce Nevirapine Resistance in the Prevention of Mother-to-Child HIV Transmission: A Randomized Clinical Trial. PLoS Med 6(10): e1000172. doi:10.1371/journal.pmed.1000172

 

Academic Editor: Lynne Mofenson, National Institute of Child Health and Human Development, United States of America

 

Copyright: © 2009 McIntyre et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

 

Funding: Boehringer Ingelheim, the developer and manufacturer of nevirapine, funded this trial, designed the study, was involved in data collection, and was responsible for data management and involved in the analysis. The decision to publish and preparation of the manuscript included employees of the sponsor, which gave an assurance that all authors have full access to the trial dataset.

 

Competing interests: M. Hopley, M. Ekelund, D. B. Hall, and P. Robinson are employed by Boehringer Ingelheim, the sponsor of the study, and D. Mayers was employed by Boehringer Ingelheim at the time of the study. Employees of the sponsor were involved in protocol design, were responsible for data management and statistical analyses, and assisted with the preparation of the paper. J. A. McIntyre and G. E. Gray have received research funding, travel grants and speaker's honoraria from Boehringer Ingelheim and Glaxo SmithKline. N. A. Martinson and D. Moodley declare no competing interests.

 

Abbreviations: AZT, zidovudine; 3TC, lamivudine; CBV, combivir; CI, confidence interval; HAART, highly active antiretroviral therapy; IQR, interquartile range; MTCT, mother-to-child transmission; NNRTI, non-nucleoside reverse-transcriptase inhibitor; NVP, nevirapine; PMTCT, prevention of mother-to-child transmission; sdNVP, single-dose nevirapine

 

* E-mail: martinson at hivsa.com

¤ Current address: Idenix Pharmaceuticals, Cambridge, Massachusetts, United States of America

 

Editors' Summary 

Background

Currently, about 33 million people are infected with the human immunodeficiency virus (HIV), which causes AIDS. HIV can be treated with combination antiretroviral therapy (ART), commonly three individual antiretroviral drugs that together efficiently suppress the replication of the virus. HIV infection of a child by an HIV-positive mother during pregnancy, labor, delivery, or breastfeeding is called mother-to-child transmission (MTCT). In 2007, an estimated 420,000 children were newly infected with HIV, the majority through MTCT. Most of these mothers and children live in sub-Saharan Africa where child and maternal mortality rates are high and mortality in HIV-infected children is extremely high. MTCT is preventable and there is a global commitment, agreed at the UN General Assembly Session on HIV/AIDS in 2001, to reduce the proportion of infants infected with HIV by 50% by 2010.

 

Why Was This Study Done?

In many resource-limited settings, MTCT is prevented by giving a single dose of nevirapine (an antiretroviral drug which has a long duration in the body and protects the fetus during labor and delivery only) to HIV-infected women in labor and also to a baby within 72 hours of birth. However, nevirapine, a non-nucleoside reverse-transcriptase inhibitor (NNRTI), which suppresses the replication of the virus, is associated with increased resistance of HIV, in mother and child, to NNRTI. This resistance reduces the effectiveness of future treatments of both mother and child with combination ART that includes an NNRTI; such regimens are the mainstay for long-term treatment of HIV in developing countries. The researchers investigated whether giving other antiretroviral drugs with nevirapine, during labor and delivery, to both mother and her newborn reduced the chances of them developing resistance to NNRTIs.

 

What Did the Researchers Do and Find?

The researchers selected 406 HIV-positive pregnant women for study across five sites in South Africa between February 2003 and May 2007. The women and their newborn babies were randomly assigned to receive, either (i) a single dose of nevirapine, (ii) a single dose of nevirapine plus combivir (zidovudine combined with lamivudine) for four days, or (iii) a single dose of nevirapine plus combivir for seven days. At two days, two weeks, and six weeks after delivery blood was collected from mothers and babies. HIV virus from blood samples was analyzed for resistance mutations, and mothers and children with resistance mutations were monitored for a further 96 weeks until no resistance was detected or combination ART (also called “HAART”) was started. Enrollment into the single-dose nevirapine arm was stopped early because a very high rate of NNRTI resistance mutations was found and other investigators reported long-term bad consequences of NNRTI-resistance on subsequent ART. The two nevirapine plus combivir arms were continued. The researchers found that selection of resistance mutations by single-dose nevirapine was reduced in mother and child by the addition of zidovudine and lamivudine for a short period; resistance mutations were found in 59.2% of women who got nevirapine only but only 11.7%, and 7.3% of women treated nevirapine plus four days combivir, and nevirapine plus seven days combivir respectively. A reduction was also seen in new NNRTI resistant mutations in the HIV-infected infants that received combivir. The study did not have enough women to show that there was a real difference between the resistance in the four-day and seven-day combivir regimens.

 

What Do These Findings Mean?

These findings show that a short-course treatment of zidovudine and lamivudine in addition to a single dose of nevirapine during labor and birth reduces the selection of NNRTI resistance mutations in both mother and child. The drug regimens appeared safe, and easy to provide and adhere to. Preliminary results from this study contributed to a change in clinical practice for the care of pregnant women with HIV; in 2004 the World Health Organisation guidelines introduced a short course of combivir with nevirapine for the management of pregnant HIV-infected women. However, the study had some limitations. It used HIV-positive women who were mainly infected with a subtype of HIV called HIV-1 clade C and who had a lot of virus in their blood. NNRTI resistance after treatment with nevirapine is more common in clade C than in others and this study does not address the effect of these combinations for preventing NNRTI resistance in other HIV subtypes. Also, World Health Organization, national, and international guidelines recommend combination ART during pregnancy, as it decreases HIV transmission from mother to child in the uterus to <2% in resource-limited settings. Although long-term combination treatment may not be available in all locations, this study does not tell us how the short-term combinations during and after delivery tested would compare to longer-term combinations given to pregnant women in reducing both HIV transmission and HIV drug resistance.

 

Additional Information

Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1000172 .

 

This study is further discussed in a PLoS Medicine Perspective by Lehman et al.

The US Centers for Disease Control and Prevention provide information for HIV treatment and prevention

 

MedlinePlus provides extensive information on symptoms and treatment for HIV/AIDS as well as access to related clinical trials and medical literature

aidsmap, a nonprofit, nongovernmental organization provides information on HIV and supporting those living with HIV

The World Health Organization gives information on the prevention of mother-to-child transmission of HIV

Full-text: http://clinicaltrials.ploshubs.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000172



6

Blunted needles (Editorial)
Washington Post

10/11/2009

 

PROGRAMS THAT allow drug addicts to swap their dirty needles for sterile syringes are effective in reducing the transmission of HIV, the virus that causes AIDS. A 2008 report from the Centers for Disease Control and Prevention notes that an 80 percent reduction in the incidence of HIV in intravenous drug users over the past 20 years can be attributed in part to such programs funded by private organizations and localities. But Congress appears intent on gumming up the works. 

 

At first glance, the congressional goings-on seem promising: The promise is to lift a 21-year-old ban on federal funding of needle-exchange programs. But the small print makes this promise all but worthless, because Congress would prohibit those programs from operating within 1,000 feet of a school, library, park, college, video arcade or any place where children might be present. In other words, just about anywhere. 

 

Pending legislation is particularly punitive to the District. Just last year, Congress finally allowed the District the spend its own money on clean-needle programs. Now a bill would apply the same 1,000-foot restrictions to District programs both with federal money and with its own. This would effectively shut down the District's four needle-exchange programs. 

 

Thank Rep. Jack Kingston (R-Ga.) for hobbling this city's efforts. He's "concerned for the safety of schoolchildren and the negative impact of sending them mixed messages when it comes to drug prevention," his spokesman told us. Mr. Kingston's concern doesn't jibe with the facts. The CDC, the American Medical Association, the National Institutes of Health and the World Health Organization concur that needle-exchange programs reduce the spread of HIV without increasing drug use. 

 

The bills have already passed the House. It's now up to the Senate to strip the restrictions from the legislation. We urge it to do so. Cities need every resource at their disposal to fight the HIV/AIDS epidemic. 

 

7

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UNAIDS WEB.SITE

 

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UNAIDS and Economic Commission for Africa discuss innovative financing for health in Africa

UNAIDS

09/11/2009

 

The Executive Director of UNAIDS Michel Sidibé met with the Executive Secretary of the Economic Commission for Africa (ECA) Mr Abdoulei Janneh earlier today in Addis Ababa, Ethiopia. 

 

They held broad-ranging discussions on the relationship between health and development and the need to find innovative ways to generate financial resources to fund future HIV treatment for people in need. The importance of resource monitoring and evaluation of results for the Millennium Development Goals was also underlined. 

 

Mr Abdoulei Janneh also updated Mr Sidibé on the Coalition for Dialogue in Africa (CoDA) which was launched earlier this year as a joint venture between the African Development Bank and the ECA to stimulate discussions on African socioeconomic issues and explore new ways for Africa development.

 

The CoDA initial advisory board includes Dr Frene Ginwala, Former Speaker of the National Assembly of South Africa; Mr Mo Ibrahim, Chair, Mo Ibrahim Foundation; Dr. Spciosa Wandira Kazibwe, former Vice President of the Republic of Uganda; and The Right Honourable, Mr. Paul Martin, former Prime Minister of Canada. 

 

While in Addis this week Mr Sidibé is attending the board meeting of the Global fund to Fight AIDS, TB and Malaria.

 

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