HIV-AIDS

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Gates Foundation wants to make safe sex more fun | 

Happy Condoms
Flickr, bnilsen

The Bill & Melinda Gates Foundation thinks safe sex isn’t as much fun as it should be.

At least, that seems to be the gist of one request for a grant application from the world’s largest philanthropy as part of its Grand Challenges Explorations program. One of the goals for this round is to develop a better condom – and by better they basically mean a condom that doesn’t suck.

“It is a bit unusual,” said Stephen Ward, the program officer with the Gates Foundation administering the project.

In its request for proposals, the foundation opens with a detailed description of the global production of condoms (15 billion units per year), usage (750 million) and a ‘steadily growing market.’ When used properly, the Gates Foundation notes, condoms can protect females from pregnancy and both partners from sexually transmitted infections like HIV. They are cheap, ubiquitous and a great example of a ‘multi-purpose prevention technology.’

“The one major drawback to more universal use of male condoms is the lack of perceived incentive for consistent use.”

Yeah, they suck. They’re no fun. Continue reading

Obama Continues Path to AIDS-Free Generation in State of Union speech | 

Ten years ago, President Bush used the State of the Union to unveil the President’s Emergency Plan for AIDS Relief (PEPFAR). The program is a lasting legacy of the administration that has won praise from both sides of the aisle.

An initiative of this scale and ambition — the largest effort to fight a single disease in history — was utterly unexpected. Bush’s strongest political supporters had not demanded it. His strongest critics, at least for a time, remained suspicious. The President’s Emergency Plan for AIDS Relief (PEPFAR) existed entirely because of a willing leader, a creative policy team, a smattering of activists and a vast, bleeding need, wrote Michael Gerson in remembering the occasion.

Because of the success of PEPFAR, there have been expectations in development circles that President Obama may too seek to leave his mark in a similar manner. The ten year anniversary, to some, may have been the right moment to make a surprise announcement. What happened was a speech that leaned heavily on rebuilding the American economy, improving education, immigration reform, national security and passing  a gun bill.

SOTU

The President did manage to squeeze in a few lines about international development. In them, he gave quick mention to existing programs and put his support to accomplishing an AIDS-free generation. Continue reading

Without more money, it’s the end of the beginning of the end of AIDS | 

Tomorrow is World AIDS Day and most organizations that had something to say about this have already said it.

Most said: “We can end AIDS.”

Flickr, by Roger H. Goun

Secretary of State Hillary Clinton

Secretary of State Hillary Clinton called for creating an “AIDS-free generation” and on Thursday released the Obama Administration’s blueprint aimed at describing how we can achieve this. Unfortunately, as the Washington Post noted:

The document, however, contains no specific targets or a schedule for achieving them. It also doesn’t estimate how much more money it would cost to reach the “tipping point” in high-prevalence countries, or where the money would come from.

Michele Sidibé, head of UNAIDS (the UN’s program on HIV/AIDS), also released a report and a suggested game plan for ending the AIDS pandemic.

The UNAIDS report celebrated major gains in reducing new HIV infections in many countries, some of them in sub-Saharan Africa, and called for “Getting to Zero” in terms of new HIV infections worldwide. Most of these gains have been in preventing mother-to-child transmission of HIV in newborns.

UNAIDS

Michel Sidibé

“It is becoming evident that achieving zero new HIV infections in children is possible,” said Sidibé. “I am excited that far fewer babies are being born with HIV. We are moving from despair to hope.”

Others celebrated some of the scientific gains such as more conclusive evidence that getting people on anti-HIV treatment also prevents the spread of disease by significantly reducing viral loads in HIV-infected persons.

And though a vaccine still seems a distant hope, researchers have made progress and are making headway on the basic immunology in ways that have recently also moved the vaccine community from despair to hope.

ONE

A Positive Trend, new HIV infections vs people getting treatment to prevent AIDS

We can end AIDS. It’s true.

It is also true to say we can end hunger and extreme poverty, if only we put enough resources, talent and political will into those efforts. But we don’t.

And until we put in the effort needed to truly suppress HIV/AIDS, calling for an end to the global AIDS pandemic will be, despite some amazing progress made in the past decade, wishful thinking. Continue reading

Seattle AIDS vaccine scientists celebrate new clues – and uncertainty | 

Jim Kublin provides an overview of AIDS vaccine science at Seattle HVTN meeting

Seattle is home to the world’s largest HIV vaccine research network and, as a scientitic meeting here this week indicated, they’re quite comfortable with not knowing where they’re heading.

“We actually don’t know what the agenda is,” said Dr. Jim Kublin, executive director of the HIV Vaccine Trials Network (HVTN) based at Seattle’s Fred Hutchinson Cancer Research Center.

That drew a lot of laughs from the audience, since Kublin’s lecture title for the day was ‘Scientific Agenda, the Next Seven Years.’

“That’s the way science is,” Kublin told me after his talk. “Good science is based on uncertainty, on having an open mind and dealing with the unknown.”

But what makes it easier to laugh about not knowing where you’re going, he added, is that researchers today have a lot more tantalizing clues – beginning with the ground-breaking Thai vaccine trial known to this bunch as RV 144. Continue reading

Rhetoric versus reality on Obama Administration’s AIDS policies overseas | 

Jessica Mack

This is a guest post by Jessica Mack

Jessica Mack is a global gender specialist and freelance writer. She is currently based in Bangkok, Thailand where she works on issues of violence against women and girls in the Asia Pacific region. More at www.jessmack.com. You can also follow her on Twitter @fleetwoodjmack

The Obama Administration talks a lot about integrating and coordinating our various global health projects, and also about how important it is to empower women. That’s the rhetoric. Here’s one womens health advocate’s view of the reality.

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Preventing the spread of HIV and AIDS has a lot to do with promoting safe sex.

That may sound obvious, but it seems to remain a mystery to those in the U.S. Government who set our AIDS prevention policies overseas. Stemming the spread of HIV has as much to do with family planning and enabling safe sex as it does with ensuring access to affordable drugs, accurate education, or changing norms and mindsets at the community level.

So it would make a hell of a lot of sense if all money for HIV/AIDS prevention efforts also included money for family planning. But alas.

Though the US President’s Emergency Plan for AIDS Relief (PEPFAR) has been touted as one of our nation’s most successful initiatives in global health (and certainly one of President George W. Bush’s most positive legacies) it continues to miss the mark on this important point.

Oddly, PEPFAR will allow funds to be used for condoms — but only if they are promoted for protection against HIV as opposed to pregnancy.

PEPFAR recently released its 2013 country operational plan (COP), the framework for how its funding should be used by developing countries. This included what activities should and should not be supported – with one big bolded addition.

Under the section titled “Family Planning” – which extolls the importance of family planning as an effective means for reducing HIV/AIDS – is added this sentence: “PEPFAR funds may not be used to purchase family planning commodities.”

Um, come again?

This bizarre prohibition has had and will continue to have the effect of systematically cleaving contraceptive services from HIV/AIDS treatment and prevention services, oftentimes quite literally into different clinic sites and distinct service providers.

It doesn’t make sense, and it’s dangerous.

Continue reading

The Big Push — Celebs say ‘Don’t stop now’ in the global fight against AIDS, TB and Malaria | 

It’s about money, life and death. It’s the “Big Push” led by Arianna Huffington, and the Huffington Post.

It’s UN Week and that time of year when all of the leading the philanthropists and bigshot humanitarians come together in New York City to make their pitches. This one is deadly serious: If the international community wants to maintain the amazing progress made in saving millions of lives affected by AIDS, TB and malaria, governments and donors will need to make good on their promises:

A few notable leftovers from the big AIDS conference | 

The massive International AIDS Conference always puts out a lot of stories, with this year’s confab focused on emphasizing the positive and hope for “turning the tide” against the pandemic. Here are a few notable stories that you might have missed amid the whirlwind:

The moral economy of AIDS

Reasons why Zambians don’t get tested, don’t seek HIV treatment

PATH CEO Steve Davis asks Is the End of AIDS in sight?

A turning point for faith-based groups working on AIDS

Economist: Aim for victory

AIDS-free generation: What will it mean?

That last one by the “smart global health” gang explores the concept of an “AIDS-free generation” put forth at the confab by Sec. of State Hillary Clinton and others. The article examines several different meanings of the buzz phrase but tends to sidestep the thorny issue of actually accomplishing it.

Getting millions more people on anti-HIV treatment today appears to be the obvious first step, but most governments and donors are cutting donations to this cause (Global Fund) rather than increasing support.

Top 10 hits of the 2012 AIDS conference | 

The 19th International AIDS Conference is over. This year’s conference marked a return to the United States after 22 years of boycott due to our government’s prohibition of HIV-infected visitors, a ban which was repealed by the Obama Administration in 2010.

The theme for AIDS 2012 was “Turning the Tide Together.” Here’s an arbitrary selection of the top 10 hits from the conference:

Flickr, Monica's Dad

1. Orchestrated enthusiasm. This AIDS conference was characterized by ambitious language and hopeful buzz phrases like “End of AIDS” or “Creating an AIDS-free generation.” The idea was to highlight the progress made so far and to promote an even bigger, bolder game plan. Bill Gates was among a minority of speakers and participants who thought it was a bit over-the-top to claim we are on the verge of “ending AIDS.”

Laurie Garrett took it a step further, asking in response to the end-of-AIDS cheerleaders: What are you smoking? Some organizers and experts defended the positive messaging as a necessary defense against growing complacency, cynicism and indifference to the pandemic — and as a boost to policy makers trying to push against cutbacks in spending onAIDS globally.

Tom Paulson

Timothy Brown, Berlin patient, at press conference during AIDS 2012

2. Curing AIDS. The story of Timothy Ray Brown, aka the Berlin Patient, has inspired scientists to explore the possibility of curing AIDS. Brown was cured of his HIV infection by a bone marrow transplant, a risky procedure he received to treat his leukemia and which was reported on Thursday at AIDS 2012 to have also possibly cured two other transplant patients.

Before anyone gets too excited, it’s worth noting that the idea of curing AIDS through bone marrow transplantation is not new. But enough new insights have been gained to make it worth investigating. I should note Seattle scientists are among those looking into this.

Gilead

3. Yes, Treatment really is Prevention. The idea that you can prevent the spread of AIDS by treating HIV-infected people earlier has gained new scientific evidence and perhaps momentum. Experts now recommend everyone with HIV should be on medication, to improve their health and to reduce the spread of HIV.

The FDA’s recent approval of the HIV treatment drug Truvada to prevent HIV infection in those at high risk (sex workers, the uninfected partner of someone with HIV) was another example of this shift toward seeing treatment as prevention. A new study in Uganda has challenged the claims that this always work, but most studies indicate treatment does prevent spreading HIV.

In any case, the shift has happened so there goes the old treatment-vs-prevention debate.

Flickr, TW Collins

4. Global access to AIDS drugs for the price of Boston’s Big Dig. Or what the military spends (spent?) on air-conditioning in Iraq and Afghanistan. About $22 billion. That’s the amount UNAIDS estimates would be needed to get anti-HIV drugs to the 7-9 million more HIV-infected people living in Africa and the developing world.

The good news is that sharp declines in drug prices mediated through distribution programs like the U.S. government’s PEPFAR program and the multilateral Global Fund to Fight AIDS, TB and Malaria, more than 8 million people have been put on these life-saving drugs.

The bad news is that almost as many still need these drugs and many rich nations have either flat-lined their funding for AIDS relief overseas or even cut funding. Here’s a good story by NPR’s Richard Knox exploring funding schemes. Continue reading