Mapping Pathways is a multi-national project to develop and nurture a research-driven, community-led global understanding of the emerging evidence base around the adoption of antiretroviral-based prevention strategies to end the HIV/AIDS epidemic. The evidence base is more than results from clinical trials - it must include stakeholder and community perspectives as well.

31 October 2011

Bristol-Myers Squibb, Gilead Sciences in licensing deal to produce new combination HIV pill

via The Washington Post, by Assoicated Press

Drugmaker Bristol-Myers Squibb Co. will develop a once-a-day pill to treat the HIV virus that combines its popular Reyataz with an experimental drug from Gilead Sciences Inc., the companies said Wednesday.

Under the licensing deal, Bristol-Myers will formulate, manufacture and sell the pill. It will include Reyataz, a popular drug in the class called protease inhibitors, and Gilead’s cobicistat, which is designed to boost blood levels of some HIV drugs. It works by blocking an enzyme that breaks down drugs in the body.

Gilead currently is doing mid- and late-stage human tests using the two drugs together to treat newly diagnosed HIV patients.

The two companies already have a joint venture selling the three-drug combination pill Atripla, the top-selling HIV pill in the U.S., with more than $3 billion in global sales last year. It includes Sustiva, made by Bristol-Myers, and Gilead’s Viread and Emtriva.

Read the rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Two Mapping Pathways Abstracts Accepted for ICASA Conference


* Original content from our Mapping Pathways blog team
The Mapping Pathways initiative has had two conference abstracts accepted at the 16th International Conference on HIV/AIDS and Sexually Transmitted Infections in Africa (ICASA). The conference, which will be held in Ethiopia this year from December 4-8th, is the principal forum on HIV/AIDS and STIs in Africa. This year’s conference theme is “Own, Scale-Up and Sustain”, and as the ICASA website elaborates:

* Owning encompasses playing the lead role in HIV/AIDS and STI prevention, treatment, care and support at policy, strategy, programs, implementation as well as M&E levels by the primary stakeholders.

* Due to the current global financial and economic crises, HIV and AIDS programs are facing funding challenges. Such challenges may entail a sliding back from what has been gained thus far in Africa with respect to containing the pandemic, and mitigating its impacts. Therefore the theme is an alert call and an attempt to draw attention to the urgent need to sustain.

* Since there are huge gaps in prevention, treatment, care and support, sustaining what has been achieved is not enough. Therefore, we cannot think of sustaining without enhancing scaling up of all responses in order to address the critical gaps.

It is an honor that the Mapping Pathways team has been selected to conduct two poster presentations at the conference, which is expecting more than 10,000 delegates from around the world, including experts in the fields of HIV/AIDS, STIs, TB, and Malaria.. One presentation is more policy-oriented—it will highlight the key policy and program challenges and implications for future treatment strategies which use ARVs for HIV prevention. It will focus on what the evidence is saying and what policymakers need to be thinking about when making decisions.  The second presentation’s focus is on the comparative findings across the different parts of the Mapping Pathway study and what the project’s findings mean for the wider research agenda.

“This is a great way to engage with the international community on what we’re finding, and to get feedback on our research from key opinion leaders,” says Molly Morgan Jones of RAND Europe, a Mapping Pathways partner organization. Morgan Jones is currently conducting the Mapping Pathways Literature Review, a big-picture review of all the existing material published on ARV-based prevention strategies to date. The review, an important research component of the Mapping Pathways project, is a way to identify the overall nature of the existing evidence-base on ARV-based prevention strategies, including whether gaps exist. The aim is  identify to finding ways to fill these gaps. Read more about the Literature Review and some of the big-picture trends emerging here.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

28 October 2011

Mapping Pathways So Far: The Literature Review

 * Original content from our Mapping Pathways blog team

“People are very excited about these prevention strategies, but there’s not a lot of empirical evidence out there on how to implement them, or even whether they should be implemented.”

An important part of the Mapping Pathways project is the Literature Review (Read more about the Mapping Pathways project here). While the in-depth stakeholder interviews are a way to understand on-the-ground wisdom and expert knowledge from those in the field in South Africa, the US, and India, the Literature Review is a way to step back and identify whether there are any big-picture gaps in the evidence-base for ARV-based prevention strategies as a whole.

We checked in with Molly Morgan Jones from RAND Europe, a Mapping Pathways partner organization, to learn more about the Literature Review and some of the general trends that are emerging from her research so far.

MP: Please introduce yourself and tell us a bit about what you do.

MMJ: I study innovation and technology policy at RAND Europe, which is a non-profit organisation that works to improve public policy and decision-making through objective research and analysis. By innovation and technology policy I mean that I explore the way governments or institutions look at or support the translation of  research into new ideas or new technologies that society can make use of. I work across a range of sectors, but have a particular interest in biomedical innovation.

MP: How does this relate to PrEP and other ARV-based prevention strategies?

MMJ: I see ARV-based prevention strategies as a biomedical innovation in the way that we use drugs to fight existing diseases. It’s an innovation in how we can use existing technologies (ARVs) in a new way to approach the HIV epidemic.  Of course, innovation is very context dependent; an innovation relevant to one society is not relevant to another. In the US, you have a completely different healthcare system than in Africa and India. In South Africa, you have a very different kind of epidemic than in other places. So it’s critical to understand the wider social, cultural, and economic contexts in which innovation happens. In other words, we need to understand the system of actors, individuals, government bodies, NGO’s, and institutions in each country – all the different people and bodies that support the way innovations happens - and think about what that means in the context of ARV-based prevention strategies.

People are very excited about these prevention strategies, but there’s not a lot of empirical evidence out there on how to implement them, or even whether they should be implemented. We need to understand more before we can start thinking about putting money behind these strategies. Mapping the existing evidence-base, understanding what empirical evidence is out there, and identifying what research gaps exist that still need to be filled is where the Mapping Pathways project comes in. Through the stakeholder interviews and the Literature Review, we are trying to understand what are the needs of people in particular communities, and what evidence do they need to help them make these important decisions about how to use these prevention strategies.

MP: What exactly is the Literature Review? What outputs can we expect from it? How is it going to help in bringing more clarity to some of the questions or issues surrounding ARV-based prevention strategies?

MMJ: As far as we are aware, the Literature Review is the first, comprehensive big-picture review of all the material published on ARV-based prevention strategies so far. At its most basic level, it is a way to identify the gaps in the existing research base on ARV-based prevention strategies. To our knowledge nothing like this has been done before, and we are still in the midst of completing the review. Once completed, we will produce a detailed map and analysis of how the literature on ARV-based prevention strategies breaks down by strategy (PrEP, PEP, TLC+, Microbicides), what kinds of studies are being done, what studies still need to be done, and what gaps need to be filled in the evidence base before communities can move forward on this innovation.

In order to do this, we systematically review everything that has been published to date on this particular topic. First we found over 4,000 articles by using what are called ‘keywords’ to search academic databases. We then went through all of these and using a set of inclusion criteria, narrowed them down to the 422 that are the most relevant. These are the articles that are helping us learn about the different ARV-based prevention strategies, their effectiveness, their efficacy, in other words whether they work at a biological level to prevent transmission or infection, their cost-effectiveness, their impacts on public health, and their wider social, economic, political and clinical implications. By next month, we’ll be able to provide information about the state of the evidence base which is relevant to the US, India, and South Africa. Once the review is completed, we’ll be publishing papers on our findings and presenting our conclusions to the wider HIV prevention community. In fact, two of our abstracts have already been accepted at ICASA, where we will be presenting the findings of the Literature Review for the first time (read the Mapping Pathways blog post about ICASA here).

We are hoping that the Literature Review will serve as a great resource for the wider community. It is not just a comprehensive database of relevant information, but it is also a catalyst for new research that will help us think about how we can incorporate these new innovations into our existing health systems and structures, if at all.

MP: Even though this is still very preliminary, could you share some general trends you’re finding from reviewing all this information? What are some of the big research gaps that need to be filled?

MMJ: Well, we now have this great map about what literature exists, how it breaks down by strategy, and what kinds of studies are being done. We’re spending a lot of time now reviewing the articles in more detail, but broadly speaking we’re finding that from the 400+ articles we’ve identified, the most are on microbicides and PEP (over 100 for each) and slightly less are on TLC+ and oral PrEP prevention strategies.  Even though we’re still in the process of completing the review, we’re observing that most of the literature is evidence-based commentary or literature reviews like ours about specific strategies. The commentary articles are about people expressing opinions or commenting on what’s out there and using existing evidence to support their argument for or against the various ARV-based preventions strategies. Another trend we’re seeing is that it looks like the majority of this literature seeks to evaluate or comment on the efficacy and effectiveness (in a clinical or economic sense) of these strategies. Yet, there isn’t much data out there on new studies, new trials or new evidence.

There also aren’t many cost studies on these strategies, and those that have been done are mostly on PEP (which makes sense since PEP has been around a lot longer, and studies have shown that it is effective). So, we’re looking at the cost studies that have been done and are seeing what can be learned from them to develop new studies for the other strategies. Another interesting finding is that epidemiological modelling studies have mostly been done on TLC+, but there aren’t many for PEP, PrEP, and microbicides. These kinds of studies try and estimate what the future HIV/AIDS epidemic would look like if a given ARV-based prevention strategy was introduced and how much money it might cost over time. Such predictive efforts have to be based on many different assumptions, though, and there is real variation between the studies which we’re looking at.

So we’re going to use these types of observations from the review to generate new research ideas for phase 2 of the Mapping Pathways project. For example, we might be doing modelling of our own in the next phase, or conducting cost studies.

It’s really critical we know what research is and is not being done, what evidence does and does not exist, so that we have a solid understanding of the implications of these technologies in various social, economic, cultural, and political contexts that exist in different countries. It’s only then that we can begin to think about investing in them and the best ways to implement them. If we don’t have this solid foundation of knowledge, we run the risk of the innovations in ARV-based prevention strategies not being successful


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Contraceptive injections and HIV transmission risk - what happens now?

via aidsmap, by Roger Pebody

With new data suggesting that injectable contraceptives may double the risk both of acquiring and passing on HIV, how will this affect women’s contraceptive choices? What are the implications for family planning policy in countries with a high burden of HIV?

Panellists on a teleconference on the topic, organised by AVAC last week, agreed that the data do not yet provide definitive answers and that healthcare providers need to avoid frightening women away from contraceptive methods they know and trust.

Experts are mindful that the HIV-related risks need to be balanced with contraception’s benefits for maternal and child health. Family planning helps to prevent unintended pregnancies and the number of unsafely performed abortions, thereby reducing maternal deaths, disabilities and infertility. It can prevent high-risk pregnancies among adolescents, older women, women in poor health and women who have had many births or births spaced too closely together. Because it helps women to space births, child mortality rates are lower; mothers have more time to breastfeed, improving infant health; and women have more time to recover physically and nutritionally between births.

Moreover, preventing unwanted pregnancies in women with HIV is also one component of strategies to reduce mother-to-child HIV transmission.

At the International AIDS Society’s conference in Rome in July, Dr Renee Heffron of the University of Washington presented results from an analysis of data from the Partners in Prevention cohort in seven African countries. The results, reported on Aidsmap at the time, showed that HIV-negative women who were in a relationship with an HIV-positive man had twice the risk of acquiring HIV if they used hormonal contraception. Furthermore, HIV-positive women had twice the risk of transmitting HIV to their male partners if they used hormonal contraception.

Read the rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

27 October 2011

Don't Delay HIV Prevention for Gay and Bi Men

via The Huffington Post, by David Ernesto Munar

Lives will be saved when the Food and Drug Administration puts its stamp of approval on a groundbreaking preventative approach called pre-exposure prophylaxis, or PrEP, recently found to reduce HIV infections.

With PrEP, people who are not infected with HIV take a daily pill, usually used to treat the disease, to help prevent infection -- as part of a broad HIV prevention approach that includes condoms and safer-sex counseling.

But the longer the FDA waits before beginning its review of the HIV medication Truvada for prevention, the more lives will be unnecessarily lost. This is particularly true for those at greatest risk: gay and bisexual men.
We urge the FDA to immediately begin its review for approval of Truvada for PrEP for gay and bisexual men.

Last year the iPrEX trial, touted as the scientific breakthrough of the year by TIME magazine, found that gay, bi and other men who have sex with men who took Truvada, along with counseling and condoms, had 42 percent fewer HIV infections than with counseling and condoms alone. Among those who used the prevention pill most consistently, the drop in infections was far greater.

And remember the sobering context: between 2006 and 2009, the number of young gay African-American men infected with HIV in the United States increased by 48 percent, according to the U.S. Centers for Disease Control.

Read the rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Hormonal Contraceptives and HIV Prevention: The grey area

 * Original content from our Mapping Pathways blog team

“The policy implications are very complicated, and we certainly don’t want to undermine the family planning programs merely because of results like this.”

Big news in the HIV prevention world is the possibility that women using injectible hormonal contraceptives might double their chances of acquiring and transmitting HIV infection. Read more about this preliminary finding, which was first presented at an HIV conference held in Rome this July, in a recent article published in the Lancet. While this issue is a current hot topic, it’s not a new one in the prevention community. In fact, Dr. Tim Farley remembers this issue being raised back in the 1980’s when AIDS had just been identified. Dr. Farley, a former scientist with WHO's Department of Reproductive Health and Research in Geneva, who has been specializing in the area of HIV prevention and the interaction between HIV and sexual and reproductive health for the past 20 years, helped us better understand what this finding could mean in the context of HIV prevention and health policy.

MP: How did you become involved in this area? Was there a particular project you worked on that lead you to this field?

TF: Well, soon after the HIV epidemic was identified, all the different departments at WHO were tasked by Jonathan Mann, who headed up the global program on AIDS, to consider what impact this newly identified viral infection would have on our work. And so we scratched our heads and thought about all the issues that could potentially impact our work, not only our work on maternal health and sexual health but also, more technically, our work on prevention. At that time, all we knew about prevention was that condoms worked, and so the idea of promoting condoms not only for pregnancy prevention but also for the prevention of this new sexually transmitted infection was a new one. So we convened in the late 1980’s to discuss all these issues and map out what was going to be important for our work over the next 10 to 20 years, and in fact, some of those issues that we listed then are still very hot and remain unanswered. For example, the interaction between hormonal contraception and HIV infection -- does it increase women’s susceptibility to infection, does it increase women’s infectiousness, does it modify the course of HIV disease in a beneficial or adverse way? These were questions that were listed in that first consultation, and just recently we had some new data presented in Rome related very much to this issue of increased susceptibility to HIV infection and increased risk of transmission from women to men.

MP: What was this data exactly?

TF: This was data presented by Renee Heffron from the University of Washington. It was actually a secondary re-analysis of data from an earlier HIV prevention randomized control trial that was published a few years ago called the Partners in Prevention. That trial, conducted in seven Sub-Saharan African countries, had been looking at acyclovir to see whether the drug reduces the risk of transmitting or acquiring HIV infection associated with herpes simplex infection. The new data presented by Heffron was a reanalysis of this data, but concentrating on the issue of whether users of hormonal contraception were more likely to acquire infection than women using other contraceptive methods, and also whether women using hormonal contraception who were HIV positive were more likely to transmit to their HIV negative partner.

MP: Why is this an important issue to explore?

TF: Well, hormonal contraception is one of the most widely used reversible methods of contraception worldwide. And in the African region, injectible contraceptives and/or combined oral contraceptives are the backbone of the modern family planning programs. The data from this study, though very limited, do suggest a doubling of the risk of acquiring HIV infection for women users of an injectible hormonal contraceptive. Now whether this is a disaster or not, that needs to be considered very carefully in context. There are huge benefits, particularly in the African region, of avoiding an unwanted pregnancy, not only for the morbidity issues but also for mortality reasons. So one has to weigh very carefully any excess risk. Firstly, we need to work out whether this result is true or not. But even if it is true, it’s quite possible that we need to balance the benefits of avoiding an unwanted pregnancy against the small increased risk of acquiring HIV infection. A doubling of risk sounds quite dramatic, but in fact it’s the attributable risk, that is the difference in risk, which is really critical. And any women living in these generalized epidemic areas in Southern and Eastern Africa has to be taking very good care to reduce her risk of HIV infection—for example, by using condoms or by making sure her partner is regularly tested for HIV. So in the context of a good HIV prevention strategy for an individual woman, a small increased risk of HIV infection with DMPA (a popular hormonal contraceptive) may well be a risk worth taking when you consider the benefits of using a reliable hormonal contraceptive method. We desperately need more data to confirm whether this finding is true. But as I mentioned, even if it is true, the balancing of the risks and benefits of different contraceptive methods in the presence of the HIV epidemic is extremely complex. So the policy implications are very complicated, and we certainly don’t want to undermine the family planning programs merely because of results like this.

Dr. Tim Farley is an independent consultant in HIV and sexual and reproductive health and a former scientist with WHO's Department of Reproductive Health and Research in Geneva. WHO is convening a consultation in early February 2012 to review all the data and to try and understand the policy implications. But for now, WHO and the U.S. Agency for International Development are making no new contraceptive recommendations and the two groups have emphasized the study's limitations. To read more about the reactions to this data, click on the links below:

Research Linking Contraceptives to HIV Raises Policy Questions

http://www.pbs.org/newshour/rundown/2011/10/research-linking-contraceptives-to-hiv-raises-policy-questions.html

Hormonal Contraceptives and HIV Risk—Emerging Evidence in Context
www.guttmacher.org/media/.../hormonal-contraceptives-HIV.pdf

Hormonal Contraceptives May Raise HIV Risk For Men And Women
http://www.npr.org/blogs/health/2011/10/04/141043578/hormonal-contraceptives-may-raise-hiv-risk-for-men-and-women

Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(11)70247-X/fulltext


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

26 October 2011

Epidemiological impact of tenofovir gel on the HIV epidemic in South Africa

via pubmed.gov, by Williams BG, Abdool Karim SS, Karim QA, Gouws E.

Background

Tenofovir gel, an antiretroviral-based vaginal microbicide, reduced HIV acquisition by 39% in women in a recent randomized controlled clinical trial in South Africa.

Methods

To inform policy, we used a dynamical model of HIV transmission, calibrated to the epidemic in South Africa, to determine the population-level impact of this microbicide on HIV incidence, prevalence, and deaths and to evaluate its cost-effectiveness.

Results

If women use tenofovir gel in 80% or more of sexual encounters (high coverage), it could avert 2.33 (0.12 to 4.63) million new infections and save 1.30 (0.07 to 2.42) million lives and if used in 25% of sexual encounters (low coverage), it could avert 0.50 (0.04 to 0.77) million new infections and save 0.29 (0.02 to 0.44) million deaths, over the next 20 years. At US $0.50 per application, the cost per infection averted at low coverage is US $2392 (US $562 to US $4222) and the cost per disability-adjusted life year saved is US $104 (US $27 to US $181); at high coverage the costs are about 30% less.

Conclusions

Over 20 years, the use of tenofovir gel in South Africa could avert up to 2 million new infections and 1 million AIDS deaths. Even with low rates of gel use, it is highly cost-effective and compares favorably with other control methods. This female-controlled prevention method could have a significant impact on the epidemic of HIV in South Africa. Programs should aim to achieve gel use in more than 25% of sexual encounters to significantly alter the course of the epidemic.

Read the rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

24 October 2011

Kenyan government grapples with counterfeit ARVs

via PlusNews Global

Kenya's government is scrambling to remove thousands of batches of counterfeit antiretrovirals (ARVs) from circulation after patients and health workers reported irregularities in the appearance and texture of a widely used drug.

In September, nurses working with the medical NGO, Médecins Sans Frontières - which runs HIV and tuberculosis clinics in the capital, Nairobi, and western Kenya - reported irregularities in the appearance of the antiretroviral Zidolam-N, a combination treatment containing the ARVs zidovudine, lamivudine and nevirapine.

The ARVs were found to be falsified versions of a World Health Organization (WHO)-certified generic drug purchased through a distributor endorsed by the Kenya Pharmacy and Poisons Board (KPPB), the country's drug regulatory authority.

According to the KPPB, one batch of the fake Zidolam-N, with the number E100766, is marked as manufactured in 2009 and set to expire in May 2013, while a second carries the batch number A9366 with manufacture and expiry dates of June 2009 and May 2012 respectively. The main irregularities included discolouration, mould and crumbliness; the packaging is also of varying quality and the text differs in font and colour from the genuine drug.

Read the rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

22 October 2011

HIV No Longer a Death Sentence, but Many With HIV Still Undiagnosed, Untreated

via HIV Medicine Association

RWMPC_HIVMA_LogoSignificant strides in therapy and care have transformed HIV from a death sentence into a manageable chronic disease – but only when patients are diagnosed, receive good care and needed services, and take their medication. To ensure that all patients benefit, the HIV Medicine Association (HIVMA) and Ryan White Medical Providers Coalition (RWMPC) today published a policy paper in the journal Clinical Infectious Diseases describing the essential components of a comprehensive HIV care program and calling for innovative payment mechanisms and continued public health funding to support this care and expand it those who need it.

Of the nearly 1.1 million people with HIV, 20 percent don’t know they have the disease, and only 50 percent of people with HIV in the United States have reliable access to HIV treatment, which the recent HPTN 052 study showed not only saves lives but dramatically reduces sexual transmission of HIV from an infected partner to an uninfected one. More than 11,000 people still die of AIDS every year and thousands more are in poor health and struggling.

“HIV medicine is an incredible success story, and people with the virus are now living long, full lives thanks to improved therapy and comprehensive care,” said Joel Gallant, MD, lead author of the policy paper and a member of the HIVMA board of directors. “But it’s imperative that people learn their HIV status and get effective treatment. We have good strategies to achieve this, but it requires an integrated team approach, expertise, and a commitment to investing resources upfront that will reduce health care costs over the long-term.”

The president’s National HIV/AIDS Strategy and the Patient Protection and Affordable Care Act are providing an unprecedented opportunity to expand access to effective care shown to improve patients’ health and prevent new infections. But to turn this opportunity into reality, and to sustain the great gains made against this disease, it is critical that the essential components of HIV care be incorporated as health care reform is implemented. The U.S. government-funded Ryan White program has been critical to supporting the HIV care model, but as demand for care grows, innovative payment mechanisms for the Medicaid program, which covers 47 percent of people with HIV in care, are urgently needed. As health coverage is expanded, patients’ lives and our nation’s public health will be at risk if we do not build on the HIV care model and continue successful programs like Ryan White.

Read the rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

21 October 2011

How Would a PrEP Rollout Impact the HIV Epidemic?

via AIDS: Official Journal of the International AIDS Society, by El-Sadr, Wafaa M.; Coburn, Brian J.; Blower, Sally M.

Background

The HPTN 052 study demonstrated a 96% reduction in HIV transmission in discordant couples using antiretroviral therapy (ART).

Objective

To predict the epidemic impact of treating HIV discordant couples to prevent transmission.

Design

Mathematical modeling to predict incidence reduction and the number of infections prevented.
Methods

Demographic and epidemiological data from Ghana, Lesotho, Malawi and Rwanda were used to parameterize the model. ART was assumed to be 96% effective in preventing transmission.

Results

Our results show there would be a fairly large reduction in incidence and a substantial number of infections prevented in Malawi. However, in Ghana a large number of infections would be prevented, but only a small reduction in incidence. Notably, the predicted number of infections prevented would be similar (and low) in Lesotho and Rwanda, but incidence reduction would be substantially greater in Lesotho than Rwanda. The higher the proportion of the population in stable partnerships (whether concordant or discordant), the greater the effect of a discordant couples intervention on HIV epidemics.

Conclusions

The effectiveness of a discordant couples intervention in reducing incidence will vary among countries due to differences in HIV prevalence and the percentage of couples that are discordant (i.e., degree of discordancy). The number of infections prevented within a country, as a result of an intervention, will depend upon a complex interaction among three factors: population size, HIV prevalence and degree of discordancy. Our model provides a quantitative framework for identifying countries most likely to benefit from treating discordant couples to prevent transmission.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Because We Can: Clashes of Perspective Over Researcher Obligation in the Failed PrEP Trials

via Developing World Bioethics, by Bridget G. Haire

Abstract

This article examines the relationship between bioethics and the therapeutic standards in HIV prevention research in the developing world, focusing on the closure of the pre-exposure prophylaxis (PrEP) trials in the early 2000s. I situate the PrEP trials in the historical context of the vertical transmission debates of the 1990s, where there was protracted debate over the use of placebos despite the existence of a proven intervention. I then discuss the dramatic improvement in the clinical management of HIV and the treatment access movement, and consider how these contexts have influenced research practice. I argue that as HIV prevention trials oblige researchers to observe the rate at which vulnerable people under their care acquire HIV, there is an obligation to provide antiretroviral treatment to seroconverters and other health care benefits that fall within the scope of researchers’ entrustment, both to avoid exploitation and to enact reciprocal
justice. I argue against propositions that the obligations to provide specific benefits are vague, fall only upon researchers and sponsors, and create injustices by privileging the few over the many. Finally, I contend that the realisation of a broader standard of care in HIV prevention research broadens the role of research from being a simple tool to produce knowledge to a complex intervention that can play a part in the reduction of health disparities.

Read the full paper here.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

19 October 2011

FDA, Gilead And HIV Prevention-In-A-Pill?

via Pharmalot, by Ed Silverman


aids-ribbon1The debate over whether the FDA should approve an existing AIDS medication for preventing the spread of HIV has ratcheted up as more than a dozen advocacy groups are urging the agency to accelerate its review process and not wait for data about heterosexuals. The move comes just one month after one prominent advocacy group urged the FDA not to approve Truvada, which is sold by Gilead Sciences, for prevention, or as pre-exposure prophylaxis, for any group.

In a letter to the FDA and Gilead, the groups say that approval is needed as soon as possible in order to provide protection to gay and bisexual men and transgender women. And they cited data from a study released last November that found that men and transgender women who have sex with men and received a daily dose of Truvada, along with condoms and safe sex counseling, had an average of 42 percent fewer HIV infections than those who received only condoms and counseling (read here).
In fact, three PrEP trials have shown evidence that using Truvada or Gilead’s Viread, which is a component of Truvada, reduced the risk of infections. The other trials examined use by heterosexual men and women, and a so-called partners trial that looked at couples in which one partner is HIV-negative and the other is HIV-positive.But the advoacy groups complain that before results of the heterosexual study were released, the FDA and Gilead were believed to be ready to proceed with a review of PrEP for men who have sex with men, or MSM. And to them, delay means more infections.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Hormonal Contraception and HIV: A New Study Rekindles the Debate

* Original content from our Mapping Pathways blog team

Earlier this month, the Lancet published the results of a study conducted in Africa, which seemed to suggest that hormonal methods of contraception could lead to increased risk of HIV infection. The New York Times published a story on the study soon after, one that many HIV/AIDS experts are calling “alarmist”. There has been a great deal of press coverage on the study since then. As Dr. Adolfus Muyoti from the George Washington University said in a discussion on the IRMA (International Rectal Microbicide Advocates) listserv, “The news is all over Africa.”

The study, supported by the US National Institutes of Health and the Bill & Melinda Gates Foundation, followed 3,790 heterosexual HIV-1-serodiscordant couples across seven African countries. According to the Lancet, the aim of the study was to determine if hormonal contraceptive use had any effect on the risk of HIV acquisition by women as well as the risk of transmission from HIV-infected women to their male partners. As the below diagram used in The New York Times article illustrates, at first glance the results looks fairly disturbing.

However, as Heather Boonstra, Senior Public Policy Associate at the Guttmacher Institute, points out on the IRMA discussion listserv, “The study is less conclusive than at first appears, and leading experts in the field agree that, by itself, it does not warrant changes to current programs on the ground.”

Isobel Coleman from the Council of Foreign Relations echoes similar sentiments, “The study … adds urgency to a long-simmering debate over whether there is a link between hormonal contraception and HIV … no conclusive work has been done. The Lancet study is also not conclusive due to small sample sizes, and because the study was not specifically designed to examine contraception use.”  She does, however, add that, “The doubts raised are sufficient that a full-blown, conclusive study should be launched as soon as possible.”[1] (To read the complete write-up on the Council of Foreign relations website, click here.)

In Sub-Saharan Africa, where more than 60% of HIV infections occur in women, the ramifications of this link, if confirmed, would be huge. A hormonal shot every three months is the most popular contraceptive method in the region – about 12 million women between 15-49 years of age use these injectable hormones. If hormonal contraception suddenly became less acceptable, Africa would have to deal with the problems of affordability and access that surround other contraceptive methods.

Most healthcare professionals and researchers working in the field agree on the importance waiting for the results to be confirmed and not spreading large-scale panic. Says Mary Lyn Gaffield, an epidemiologist in the World Health Organization’s department of reproductive health and research, “We want to make sure that we warn when there is a real need to warn, but at the same time we don’t want to come up with a hasty judgment that would have far-reaching severe consequences for the sexual and reproductive health of women.”[2]

Perhaps it is Dr. Muyoti sums up the issue best and most succinctly: “This has the makings of a problem that will be highly contentious and will not be resolved in the short term.”


[1] http://blogs.cfr.org/coleman/2011/10/04/long-lasting-hormonal-contraception-and-the-hiv-epidemic/ 

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

17 October 2011

Impact of late diagnosis and treatment on life expectancy in people with HIV-1 in the UK

via British Medical Journal, by Margaret May, Mark Gompels, Valerie Delpech, Kholoud Porter, Frank Post, Margaret Johnson, HIV/AIDS, David Dunn, Adrian Palfreeman, Richard Gilson, Brian Gazzard, Teresa Hill, John Walsh, Martin Fisher, Chloe Orkin, Jonathan Ainsworth, Loveleen Bansi, Andrew Phillips, Clifford Leen, Mark Nelson, Jane Anderson, Caroline Sabin

Objectives

To estimate life expectancy for people with HIV undergoing treatment compared with life expectancy in the general population and to assess the impact on life expectancy of late treatment, defined as CD4 count <200 cells/mm3 at start of antiretroviral therapy.

Design

Cohort study.

Setting

Outpatient HIV clinics throughout the United Kingdom.

Population

Adult patients from the UK Collaborative HIV Cohort (UK CHIC) Study with CD4 count ≤350 cells/mm3 at start of antiretroviral therapy in 1996-2008.

Main outcome measures

Life expectancy at the exact age of 20 (the average additional years that will be lived by a person after age 20), according to the cross sectional age specific mortality rates during the study period.

Results

1248 of 17 661 eligible patients died during 91 203 person years’ follow-up. Life expectancy (standard error) at exact age 20 increased from 30.0 (1.2) to 45.8 (1.7) years from 1996-9 to 2006-8. Life expectancy was 39.5 (0.45) for male patients and 50.2 (0.45) years for female patients compared with 57.8 and 61.6 years for men and women in the general population (1996-2006). Starting antiretroviral therapy later than guidelines suggest resulted in up to 15 years’ loss of life: at age 20, life expectancy was 37.9 (1.3), 41.0 (2.2), and 53.4 (1.2) years in those starting antiretroviral therapy with CD4 count <100, 100-199, and 200-350 cells/mm3, respectively.

Conclusions

Life expectancy in people treated for HIV infection has increased by over 15 years during 1996-2008, but is still about 13 years less than that of the UK population. The higher life expectancy in women is magnified in those with HIV. Earlier diagnosis and subsequent timely treatment with antiretroviral therapy might increase life expectancy.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

HIV Drug Resistance Reduced by Availability of New Drugs

via The Lancet, by The Pursuing Later Treatment Option II (PLATO II) project team for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) Group

Background

Limited treatment options have been available for people with HIV who have had virological failure of the three original classes of HIV antiretroviral drugs—so-called triple-class virological failure (TCVF). However, introduction of new drugs and drug classes might have improved outcomes. We aimed to assess trends in virological and clinical outcomes for individuals with TCVF in 2000—09.

Methods

In our cohort study, we analysed data for adults starting antiretroviral therapy from 1998 in cohorts participating in the PLATO II project, which is part of COHERE, a collaboration of European cohorts. TCVF was defined as virological failure to at least two nucleoside reverse transcriptase inhibitors, one non-nucleoside reverse-transcriptase inhibitor, and one ritonavir-boosted protease inhibitor, with virological failure of a drug defined as one viral-load measurement of greater than 500 copies per mL after at least 4 months of continuous use. We used multivariable generalised estimating equation logistic models and Poisson regression models to study trends in virological suppression and incidence of AIDS or death after TCVF. We adjusted for sex, transmission group, age, AIDS status, CD4 cell count, plasma viral loads at TCVF, achievement of virological response (<50 copies per mL), and number of drug failures before TCVF.

Findings

28 of 33 cohorts in COHERE contributed data to the PLATO II project, of which four had no participants eligible for inclusion in this study. 2476 (3%) of 91 764 participants from the remaining 24 cohorts had TCVF and at least one viral load measurement in 2000—09. The proportion of patients with virological response after TCVF increased from 19·5% in 2000 to 57·9% in 2009 (adjusted p<0·0001). Incidence of AIDS decreased from 7·7 per 100 person-years in 2000—02 to 2·3 in 2008 and 1·2 in 2009 (adjusted p<0·0001). Mortality decreased from 4·0 per 100 person-years between 2000 and 2002 to 1·9 in 2007 and 1·4 in 2008 (unadjusted p=0·023), but the trend was not significant after adjustment (p=0·22).

Interpretation

A substantial improvement in viral load suppression and accompanying decrease in the rates of AIDS in people after extensive failure to drugs from the three original antiretroviral classes during 2000—09 was probably mainly driven by availability of newer drugs with better tolerability and ease of use and small cross-resistance profiles, suggesting the public health benefit of the introduction of new drugs.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

15 October 2011

Uganda Needs to Re-Discover its Prevention Success of the 1990s

via AllAfrica.com, by Henry Zakumumpa

"The trouble for us in Uganda is that we are falling behind in global efforts to rein in new HIV infection rates an endeavor we were renowned for in the 1990s.

What is troubling is that many more people in Uganda are going to need AIDS treatment because of the spike in new HIV infections, driven primarily by married couples, but also because people with HIV/AIDS are now living longer, at a time when western donor countries are actually cutting AIDS funding.

Many AIDS treatment centres in Uganda are already turning away new patients due to donor funding caps, with some centres tragically sharing drugs amongst their patients. What is going to happen when thousands of Ugandans newly require AIDS treatment and they are turned away at treatment centres?

Sadly, Uganda's losing HIV prevention effort is out of step with the rest of the world where prevalence is actually going down. Even the worse- hit Southern African countries have registered a 25% reduction in HIV prevalence according to UNAIDS."

Read the rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

14 October 2011

AIDS Treatment is a Good Value!

via PLoS ONE and Results for Development Institute, by Stephen Resch1, Eline Korenromp, John Stover, Matthew Blakley, Carleigh Krubiner, Kira Thorien, Robert Hecht, Rifat Atun

Despite the remarkable scale-up of AIDS treatment and prevention programs in low and middle income countries in recent years, each year two million people die from AIDS (most without ever having received antiretrovirals ART) and 2.7 million are newly infected by HIV.

A study released in PLoS ONE, co-authored by a group from Results for Development Institute and the Global Fund, argues that large scale investment in ART in low and middle income countries yields a stream of economic benefits that is likely to offset substantially or exceed the costs of delivering AIDS treatment to millions of patients in these countries.

The study, The Economic Returns to Investment in AIDS Treatment in Low and Middle Income Countries, is one of the first efforts to look systematically at the expected economic benefits (returns) to large scale investment in AIDS treatment.

The study models three streams of future economic benefits accruing to the roughly 3 million persons who were on Global Fund supported treatment in 2010 in 98 countries around the world: (1) restored labor productivity amongst workers with AIDS, (2) orphan care expenditures avoided because parents remain alive on ART, and (3) delayed end-of-life care costs associated with death from AIDS. These streams of economic benefits were selected because they offset the cost of treatment over short time horizons and therefore may be especially salient to policy-makers concerned with health budgets, household economic stability and societal-level economic growth.

Using recent ART prices and program costs, the study estimates that the discounted resource needs required for this cohort of patients over the coming decade are US$14.2 billion.This investment is expected to save 18.5 million life years and return $12-34 billion. This yields economic benefits from ART ranging from 80% to 290% of program costs

Read the rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Treatment alone will not win war against HIV

via Cape Argus, by Sipokazi Fokazi

If South Africa is to win the battle against HIV/Aids it cannot rely solely on treatment, and must explore prevention strategies that would target those most at risk, including women and children, a Cape Town scientist and HIV researcher has cautioned.

Professor Linda-Gail Bekker, head of the Desmond Tutu HIV Centre, at UCT, said although the effect of HIV treatment was starting to show with the number of deaths beginning to even out, the country would not win the battle with treatment alone.

Bekker was speaking during a meeting hosted by the Microbicide Media and Communication Initiative, an advocacy group that gathers research in microbicides by a range of organisations.

She warned that reliance on treatment would at some stage become unaffordable and unsustainable.

Finance continued to be a problem for many countries, and paying for antiretroviral drugs was becoming expensive.

“Given the financial difficulties, countries will somehow have to come up with plans on how to bring infection levels down.”

The focus needed to be on strategies that achieved behavioural change.

One of the most important things for South Africa was knowing its epidemic – who was most at risk, who was passing HIV to whom, and where the epidemic was concentrated.

UNAids information was that four population groups remained at risk: men who had sex with men, commercial sex workers, prisoners, and intravenous drug users.

In South Africa, young women and pregnant women could be added to that list.

Bekker suggested targeting, directing and tailoring prevention interventions to reduce infection rates.

“You need to know where most of your infections are occurring, and then to work out how best to intervene. I believe it has been a mistake to think one size fits all,” she said.

One area in which South Africa could start shutting the door was in the mother-to-child transmission of HIV.

“We need to wipe out paediatric infection.”

South Africa could not afford to allow transmission of the virus from mother to child.

“If we don’t prevent this, those children will need treatment for the rest of their lives and it will be expensive for the country. We can bring our mother-to-child HIVinfection rate to below 1 percent.”

Researchers had made great strides in HIV prevention studies, particularly in the field of microbicides.

Bekker said it was important that prevention packages be tailored to population groups that were most at risk.

Such strategies would have to take into account biomedical, behavioural and structural components.

“We are in a very exciting period where a whole range of biomedical technologies are showing partial but significant efficacy. Combinations of these prevention technologies in the future will give people options.”

Among the most promising interventions being researched by the Desmond Tutu HIV Centre and its partners was a rectal microbicide, for those practising anal sex. The proposed study would be carried out here and in other places around the world.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Aurobindo Pharma uses patent pool for generic AIDS drugs


India's Aurobindo Pharma has become the first major generic drugmaker to join a patent pool designed to make HIV/AIDS treatments more widely available to the poor, paving the way for it to sell cheap medicines in many countries.

The Medicines Patent Pool said on Tuesday the agreement would allow Aurobindo to make a range of AIDS drugs licensed to the pool by Gilead Sciences, the leading maker of HIV drugs, in July.

Aurobindo has also elected to take advantage of a key provision in the pool's licenses in order to sell one drug, tenofovir, to a wide range of countries without paying royalties. These could include several middle-income countries such as Argentina, Brazil, Chile, Colombia, Malaysia, the Philippines, Ukraine and Uruguay.

Around 33 million people worldwide have the human immunodeficiency virus (HIV) that causes AIDS. Most live in Africa and Asia, where medicines have to be very cheap to allow those who need them to be able to afford them.

The Medicines Patent Pool, launched by the UNITAID health financing system that is funded by a tax on airline tickets, aims to address the problem by creating a system for patent holders to license technology to makers of cheap generics.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

13 October 2011

Bureaucracy in Nepal Leads to HIV Deaths

via World Policy Blog, by Kyle Knight

Bureaucratic deadlock is starting to kill people in Nepal. The country’s NGO sector working with populations deemed high-risk for contracting HIV-AIDS are in desperate need of $10 million of donor funds currently held by the cash-strapped government. While stories of stagnant bureaucracy in Nepal’s fledgling democratic government are not new, the consequences this time will put those increasingly dependent on NGO support at great risk. The failures of Nepal’s ineffective—even Kafkaesque—bureaucracy have obstructed even the most basic services, leaving NGOs to care for the country’s population.

Working with the most at-risk groups in the country such as intravenous drug users (IDUs), men who have sex with men (MSMs), and Nepal’s sizable transgender (TG) population, these organizations are unable to help treat or prevent HIV from spreading, because of the government’s embarrassing financial disorganization. NGOs working with IDUs have already reported preventable deaths linked to the funding gap, and organizations working with MSMs and TGs have not been able to hand out condoms for nearly three months. “It’s not that we don’t know how to treat people, or that we don’t have the capacity—it’s that we don’t have the money, ” explains an activist working for an IDU NGO. “Basic infections are going un-treated. Staff are looking for jobs elsewhere. These are unnecessary deaths.”

This is nothing new for donor-dependent Nepal. Sadly, the country is used to funding crises, especially in its HIV-AIDS programs. A recent impending shortage of pediatric ARV (anti-retro viral) was averted, thanks to the intervention of the United Nations.

The UN action has been a lifeline for the medical community and Nepali children living with HIV-AIDS. But it is far from enough. The HIV prevalence rate in Nepal is believed to be below 1 percent of the adult population, but infection rates vary considerably, and are substantially higher in most at-risk populations. In 2009, the government announced that the prevalence rates were decreasing across the country. The blocked $10 million will surely and unnecessarily boost the number of people infected by the virus and erase any gains made in recent years. While the impassive government receives warnings from international organizations, the risk of a new wave of infection is reaching a critical point.

Read the rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Gates Foundation’s AIDS Program in India Has Made Uneven Progress Over 8 Years

via The New York Times, by Donald G. McNeil, Jr.

A large and costly AIDS prevention program that the Bill and Melinda Gates Foundation pioneered in India eight years ago has had mixed results, according to a preliminary analysis published on Monday in The Lancet.
 
The foundation spent $258 million on the program from 2003 to 2008. It has since put in $80 million more, but is shifting responsibility to the Indian government.

The program, called Avahan, focuses on high-risk groups, like drug addicts, gay and bisexual men, and prostitutes and their clients, including truckers. It pays for education campaigns, safe-sex counseling, syringes, condoms and treatment for other venereal diseases. (Above, a sex worker at a prevention meeting.)

When the program began, it was assumed that India, with its huge population and government officials reluctant to discuss the problem, would quickly surpass South Africa as the country with the most AIDS cases. A 2007 household survey allayed those fears; the epidemic had stayed largely within the risk groups. India is now thought to be in third place, behind Nigeria.

Read the rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

12 October 2011

Questions Surround PrEP Trials

via The New York Times, by David Tuller

In the past year, three landmark clinical trials have shown that a daily dose of the antiretroviral medication Truvada can protect individuals from infection with H.I.V. — a significant discovery, given the failure so far of all efforts to develop a vaccine against the virus.

Now researchers in San Francisco and Miami are planning to test this prevention strategy, called pre-exposure prophylaxis, or PrEP, in a pilot study supported by the National Institutes of Health. The researchers will soon recruit up to 500 uninfected men who have sex with men, especially those considered to be at greatest risk of infection, such as younger gay men and, in particular, African-Americans.

The men will be asked to take Truvada daily, and the researchers will monitor their compliance with the regimen, their sexual behavior and their health status. Already, though, the prospect of antiretroviral drugs’ being used for prevention as well as treatment is raising complex questions for researchers and advocates.

Will healthy uninfected people consistently take an expensive and powerful drug that can cause a range of side effects? Is it fair to provide medications to H.I.V.-negative individuals when so many of those already infected do not have access? Will those receiving the drug be more likely to engage in risky sex because they believe they are protected — even if they do not always take it as prescribed?

Read the rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

No Benefit to HAART in Patients With a CD4 Cell Count Over 500

via medscape.com

Starting highly active antiretroviral therapy (HAART) in patients with HIV whose CD4 cell counts are above 500/μL does not slow the progress of the disease, according to results from the Concerted Action on SeroConversion to AIDS and Death in Europe (CASCADE) study.

The study's findings were published by a writing committee for the CASCADE collaboration in the September 26 issue of the Archives of Internal Medicine.

The article lends weight to the argument that treating patients too early in the course of their infections can do more harm than good, Jay Levy, MD, a professor of medicine at the University of California, San Francisco, and codiscoverer of HIV, told Medscape Medical News. Many of the drugs used in HAART have strong adverse effects.

"Above 500, as far as I'm concerned, you have a long way to wait," he said. "I have been telling people, 'Be careful of treating too early.' You get resistance, and you get patients who are not going to stay on therapy."

At this time, the US Department of Health and Human Services guidelines say that antiretroviral therapy is indicated in all patients whose CD4 cell count is below 500/μL. The guidelines suggest considering the therapy for all patients from the time of HIV diagnosis.

For the observational cohort study, researchers from multiple institutions enrolled 9455 patients between the years 1996 and 2009, all of whom had not had HAART or developed AIDS at the time they were enrolled and had CD4 cell counts below 800/μL. The scientists enrolled new patients once every month, creating 161 sequential nested subcohorts.

The researchers then followed up the patients, noting the number of days until these patients either died or developed AIDS. If the patients initiated HAART, as nearly all did, the researchers noted the patients' CD4 counts at that point. The median follow-up time was 4.7 years (interquartile range, 2.0 - 9.1 years).

The authors found that patients who started HAART with CD4 cell counts from 0 to 49/μL were 68% less likely to die or develop AIDS. The advantage decreased to 52% in patients who started HARRT when their cell counts were from 50 to 199/μL, 41% in patients with cell counts from 200 to 349/μL, 25% in patients with cell counts from 350 to 499/μL, and −10% in patients with cell counts from 500 to 799/μL.

The research confirmed earlier findings on the benefits of the therapy in patients with cell counts below 500/μL, but conflicted with a 2009 study published in the New England Journal of Medicine by the North American AIDS Cohort Collaboration on Research and Design, which found benefits for patients with cell counts above 500/μL.

The CASCADE researchers acknowledged that their study is only observational, and a more definitive study would randomly assign patients with various cell counts to begin or defer HAART. Such trials are underway, but the results are not yet available.

Because the patients were not randomly assigned, there were differences between those who deferred HAART and those who started it. At baseline, those who started had higher viral loads, shorter duration of infection, and slightly lower CD4 cell counts compared with those who started HAART within each subcohort. However, they were also less likely to have a history of intravenous drug use and less likely to be coinfected with hepatitis.

In a commentary that accompanied the study, Harvard retrovirus researcher Daniel R. Kuritzkes, MD, lamented that the researchers were unable to study directly the effects of HAART on non-AIDS-defining HIV-1 complications such as cardiovascular disease, neurological disease, and other end-organ damage. "These complications may cause significant morbidity without contributing to mortality over the relatively short time frame considered herein," he writes. In addition, Dr. Kuritzkes explains, the CASCADE study did not measure the potential benefits of HAART on prevention of HIV-1 transmission.

However, he said the study provides important information that clinicians can use while awaiting the results of prospective randomized trials. "While awaiting more definitive data," Dr. Kuritzkes writes, "the pros and cons of starting HAART at CD4 cell counts above 500/μL should be weighed carefully by clinicians and patients."

Read the Abstract of the study here.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

11 October 2011

MSM in South India

via Deccan Herald, by Kalyan Ray

In what can emerge as a fresh public health challenge, literate young men in southern India are increasingly getting involved in high-risk activity of having sex with men without protection, making them vulnerable to HIV/AIDS. 

Though there is barely any reliable statistics available on the MSM (Men having Sex with Men) prevalence, as many as 8,615 members of the MSM community were interviewed in a new behavioural survey carried out in 15 districts of Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu.


In majority of the districts, HIV prevalence ranged from 5 to 30 per cent among high risk men while prevalence of other sexual diseases in the same community vary from 2 to 20 per cent.

The researchers claimed that actual numbers of the MSM population could be more because it was “representative sample”, which means only about 700 MSM people from each districts were interviewed for the study conducted between 2006 and 2010. The scientists took care to ensure that the same person is not interviewed twice.

Read the rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

10 October 2011

University freshers often green about dangers of HIV in Kenya

via PlusNews

They arrive at university looking forward to the freedom and challenges that come with life on campus, but researchers say few Kenyan "freshers" are prepared to navigate the murky waters of adult sexual relationships.

"In recent research, which has yet to be filed, we found that 70 percent of freshers [at Egerton University, in Kenya's Rift Valley Province] know how HIV is transmitted, but almost 90 percent have never attended [a] seminar or forum on HIV," said Bernard Kibor, HIV/AIDS coordinator at the university.

According to the Kenya demographic and health survey 2008/2009, 47 percent of women and 58 percent of men have had sexual intercourse by the age of 18, when many young people first start university. Although sex education in schools is part of the country's HIV prevention strategy, many teachers are not trained in the subject and young people often glean their knowledge of sex from their peers.

Read the rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Hunger and HIV in the Horn of Africa: Famine Exacerbates the Epidemic


An estimated 11.6 million people are struggling for basic nutrition and sanitation in the humanitarian crisis in the Horn of Africa – and experts have warned that this situation could have a serious effect on the health of people undergoing HIV treatment. The United Nations has said that 750,000 people could die if global assistance fails to meet the required target (so far, only 62% of the total has been contributed).

The worst drought in 60 years has led to large-scale food scarcity, which is a well-known barrier to antiretroviral (ARV) effectiveness. ARVs increase the appetite and a lack of food has been known to worsen the side-effects. Additionally, HIV-positive mothers may have to feed their children with a mixture of solid food and breast milk, thereby increasing the risk of transmission.

The number of sexual assault and rape cases also increases in refugee camps as regular societal and legal protection systems break down. With that, the risk of new HIV infections also rises. While post-exposure prophylaxis (PEP) may be available at some places, most rapes go unreported and HIV prevention awareness is low. Many women are also forced to turn to sex work to survive and procure food for their families, and the lack of condoms increases the chances of HIV infection.

Thousands of migrants will also face problems with adherence – the stigma attached to HIV makes it hard for them to approach unknown healthcare providers for services. Additionally, the already-limited health services are dealing with the ongoing starvation crisis and HIV treatment services are often not prioritized at such times.

You can read a UNAIDS feature story on this situation as well as an article on the IRIN website. The issue was also mentioned as one of the stories to follow during UN week in a blog post written by Mark Leon Goldberg, managing editor of the UN Dispatch blog.

Tell us – what do you think needs to be done to tackle a crisis such as this one? Africa has seen millions of people die from HIV infection, and the numbers are often exacerbated due to socio-political tumult in the region. How can we work towards a long-term solution to this problem, to try and limit the impact ofthe HIV epidemic? (Note: The Horn of Africa Initiative is one such effort, which has been working to “halt and reverse the spread and address the impact of HIV and AIDS in the Horn of Africa region.”)


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

07 October 2011

The 96 Percent Campaign: How Obama Can Help End the AIDS Crisis

via RealityCheck, by Matthew Kavanagh

President Obama has repeatedly stressed his administration’s commitment to science as one way to distinguish his leadership from that of his predecessor.  Right now that commitment is being put to the test on HIV and AIDS: if the President could do more to  end the crisis, would he?

A revolutionized response to the global AIDS crisis has just been made possible with the August publication of a US-funded study showing that antiretroviral AIDS medicines (ARVs) can cut the risk of HIV transmission from an infected to a non-infected partner  by 96 percent. Not only do AIDS drugs save lives—they are among the most powerfully effective prevention tools.

This double-benefit changes the equation in fighting AIDS at home and abroad and raises the question: Will the Obama administration respond?

That is why we are launching The 96% Campaign making clear the choice the President faces between action and inaction. AIDS treatment is not just science—it’s a reproductive, economic, and racial justice issue.

The Obama administration has had a decidedly mixed record on AIDS treatment. Now, the science and our communities are asking: Will he step up?

Read the rest.


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]