prevention

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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.

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The Seattle science that led to FDA approval of HIV-prevention drug | 

Gilead

The FDA today approved the first drug, known as Truvada, for preventing HIV in people at high risk of infection due to ‘discordance’ – science lingo for being HIV negative but having a sex partner who is HIV positive.

Seattle scientists, as I reported almost exactly a year ago, played a critical role in demonstrating the drug’s effectiveness in Kenya and Uganda studies.

It’s not a new drug and its use is not without some potential complications. But this still represents big news today:

FDA approves first drug to prevent HIV

FDA approves ‘landmark’ HIV prevention drug

As NPR’s Scott Hensley reports,  one of the ‘complications’ of Truvada will be its expense of anywhere from $11,000 to $14,000 per year.

In addition, the drug needs to be taken daily to be effective, so adherence may become a problem — and lack of adherence could pose a risk for creating drug-resistant HIV. Some studies have indicated Truvada is about 65 percent effective at preventing HIV infection and it does have some side effects.

Connie Celum

Still, in a recent Q&A (see below) with the University of Washington’s Connie Celum, the UW scientist says this drug represents a powerful new tool for preventing HIV among those now at high risk for the infection. Millions of people continue to become infected with HIV every year (some 50,000 in the U.S. alone) so new prevention weapons are needed.

Celum, who has done some of the most critical scientific studies supporting the concept that Treatment is Prevention, notes that drug maker Gilead has agreed to steep discounts for Truvada in poor countries, making it accessible to those most in need.

Here is an excerpt from the UW’s chat with Celum re Truvada:

Q: The drug needs to be taken every day. Won’t that be difficult for some people?

We need to make it clear this isn’t something for everyone. People need to be at sufficient risk to benefit from it. So far, the data from the trials suggests that people either took it or they didn’t take it. There weren’t a lot of intermittent users. The risk of resistance is if people take this drug when they are in the process of becoming infected. The other concern would be if people took it sporadically or they weren’t tested frequently enough for HIV.

 

Seattle scientific meeting on AIDS highlights potential, decries lack of funding | 

Flickr, Benny Sølz

The highly technical Conference on Retroviruses and Opportunistic Infections is meeting in Seattle this week, focused on reviewing the scientific studies being done worldwide to battle the AIDS pandemic.

One of the presenters was Dr. Jared Baeten of the University of Washington, who gave an update on a ground-breaking study known as the Partners PrEP (pre-exposure prophylaxis) study.

The results from this study, which showed the benefit of using anti-HIV drugs to prevent infection, were so dramatic investigators last summer halted it in order to announce the results — and get the therapy into wider use as a powerful new prevention strategy.

A number of studies have shown that common anti-HIV medications can reduce the viral load almost to nothing in infected individuals, likely preventing the spread of HIV. But as Nature reports out of the Seattle meeting, AIDS experts are frustrated at the lack of funding for putting this strategy into use:

Many scientists and advocates agree that there is now an “awesome possibility to prevent the spread of HIV”, says Sharonann Lynch, HIV policy adviser for Médecins Sans Frontières (MSF, also known as Doctors Without Borders) in New York. “If we decrease the money invested in treatment now, we are squandering the best opportunity we’re going to have to get ahead of the wave of new infections.”

Studies provide proof of powerful new HIV/AIDS prevention strategy | 

Gilead

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

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

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

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

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

Connie Celum

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

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

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

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

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

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

 

AIDS at 30: Progress being made or just more hopeful hype? | 

The Economist

The Economist is hopeful

A number of articles have marked the 30th anniversary of the discovery of AIDS by emphasizing the progress made so far against the disease and some recent scientific discoveries that raise hope.

To begin with, there is more evidence a vaccine is possible and new studies confirm that treatment IS prevention, so that expanding access to anti-HIV drugs could help stop the continuing spread of disease.

Others emphasize that the story so far is mostly a tragedy, a massive failure for the international community, as the loss of life today continues in poor countries where people lack access to these life-saving drugs.

Some 6 million people in the developing world have received the drugs due to initiatives such as the Global Fund to Fight AIDS, TB and Malaria — a big increase over the past 10 years — but more than 9 million who need them still lack access. And donors are not stepping up with new funds.

A few notable stories:

The Economist: The end of AIDS?

Reuters: 30 years on, AIDS fight may tilt more to treatment

New York Times: We are still learning from AIDS

Much of the current hopefulness, expressed most forcibly by The Economist, stems from this discovery that getting everyone who is HIV-infected on treatment could largely curtail the spread of AIDS. Here are a few of those skeptical of this idea:

Tim France, in Global Health Sushi, “More Spin Than Rigour” argues that it is extremely wishful thinking to assume that we can expand treatment to all who need it in the developing world. France, based in Chiang Mai and Geneva, has worked for decades as a consultant to leading global health organizations and served as editor for leading scientific journals. He criticizes The Economist and others in the media for raising false hopes::

So why all the excitement and focus on merely the potential positives of this new data? In my view it’s because the HIV response desperately needs some good news right now.

Similarly, Mead Over at the Center for Global Development, notes  in Still no reason to stall male circumcision, forget the HIV vaccine or throw away your condom that many are pointing to the new evidence that Treatment is Prevention as if it has already transformed the fight against AIDS.

But is the evidence surprising and powerful enough to be a “game changer” as Michel Sidibe, the director of UNAIDS declared, or “to end, or at least diminish, a bitter feud within the AIDS world over how much funding should go to treatment versus prevention,” as the Wall Street Journal has suggested?

Over says it is not.

Scientists discover (again): AIDS treatment prevents infection | 

Flickr, Benny Sølz

As MSNBC, the Wall Street Journal, New York Times and many other media report today:

People infected with the virus that causes AIDS are far less likely to infect their sexual partners if they are put on treatment immediately instead of waiting until their immune systems begin to deteriorate, scientists report.

The study, begun in 2005, was done by the National Institutes of Health and had such dramatically positive results it was ended five years early. As the Wall Street Journal’s Mark Schoofs writes:

The results were so overwhelming that an independent panel monitoring the research recommended the results be released four years before the large, multi-country study had been scheduled to end.

Connie Celum

What may be even more surprising is that a Seattle-based AIDS expert, Connie Celum, as well as some Swiss scientists had already discovered this!

Here’s my post on Celum’s findings last July, UW Study shows AIDS Treatment IS Prevention. As Celum and her team reported back then in The Lancet:

“We found a 92 percent reduction in transmission among those who went on (anti-HIV drug therapy),” said Celum.

The New York Times said the NIH study was convincing because it is the first time this was shown in a major randomized clinical trial and earlier studies had only “implied” this. That’s a little misleading and certainly ignores the power of what Celum and her colleagues showed. Continue reading

The Pope says condoms are okay, for prostitutes anyway | 

Flickr, by miqul

Pope Benedict

The world is still all abuzz with reaction to Pope Benedict XVI’s very limited benediction on condoms as a means for some people, like prostitutes, to avoid spreading or getting HIV.

Given how little the Pope actually said here, I can’t even begin to imagine the reaction if he and the Holy See decide to reverse the decision made in 1079 AD by Pope Gregory VII that priests should be celibate.

“There can be single justified cases,” Benedict said, “for example when a prostitute uses a condom, and this can be the first step toward a moralization, a first act of responsibility in developing anew an awareness of the fact that not everything is permissible and that we cannot do everything we want.”

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UW Study: AIDS Treatment IS Prevention | 

For the last few years, AIDS experts have been arguing about the claim made forcefully by some Swiss scientists that giving anti-viral drugs to people with HIV also prevents transmission of the virus to others.

While there had been some anecdotal and hypothetical evidence supporting this contention, there wasn’t much hard proof.

A Seattle team of scientists has now provided some pretty solid evidence, reported in the May 28 issue of The Lancet. Continue reading