Calling all our Indian Readers!

We request all Indian readers to take a few moments and read the facts below:

FACT: HIV prevalence in India is only about 0.3% – however, because of its massive population, India has the world’s third-largest population suffering from HIV/AIDS.

FACT: A fractional increase in prevalence (0.1%) would mean over half a million more people living with HIV.

FACT: While new HIV infections have declined drastically in India over the last 10 years, it’s not time to celebrate quite just yet – about 2.4 million Indians are still living with HIV.

FACT: At present, India spends about 5% of its health budget on HIV/AIDS. The World Bank has stated that India will have to scale up prevention efforts in order to avoid spending more of its health budget in the future.

India stands at a critical juncture in its fight against HIV/AIDS. Policy and funding decisions about treatment and prevention over the next few years could alter the entire course of this epidemic.

The Mapping Pathways project has recently launched on online survey to collect input from individuals in our target countries – one of which is India.

We encourage all Indian citizens who are interested in new ways to prevent transmission of HIV – and want to help shape our project goals and deliverables – to take a few minutes and fill in our survey.

Your efforts will be greatly appreciated!

Take the survey now.


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

Please take the Mapping Pathways survey and help shape the future of HIV prevention

The Mapping Pathways project has launched on online survey to collect input from individuals in our three target countries - India, South Africa, and the United States.

Folks who are interested in new ways to prevent transmission of HIV - and want to help shape our project goals and deliverables - are highly encouraged to take a few minutes and fill in our survey.

Your efforts will be greatly appreciated!

Take the survey now.

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

South Africa and HIV: Insights

Mark Chataway is co-chairman of Baird’s CMC, a Mapping Pathways partner organisation. Here, he talks about his visit to South Africa and his thoughts on the region in the context of HIV treatment and prevention strategies.

I was in South Africa last week, working with our Mapping Pathways colleagues to finalise the ExpertLens survey questionnaire. It’s a very exciting time – we’re going use this survey for in-depth discussions with high-level policymakers, key opinion leaders and pivotal civil society figures. The information we get will help us crystallise the project’s outputs. The idea is to make sure we provide data and analyses that are relevant and helpful for all the key stakeholders.

My visit to the country once again brought into sharp focus for me just how significant South Africa and the rest of the southern African region are in the context of HIV treatment and prevention strategies.

Sub-Saharan Africa is the most heavily affected region in the world with regard to HIV. Swaziland has an adult HIV prevalence of 26% (the highest in the world) – the epidemic reduced the country’s life expectancy rate to 31 years as of 2007. South Africa has the highest number of people living with HIV in the world – 5.7 million as of 2007. The incidence rate in South Africa is declining, but not nearly as fast as it needs to.

The pressure on South African decision-makers is even greater because of the manner in which the HIV situation was handled by former president, Thabo Mbeki, and his government. The links were often parodied: Mbeki did question the very link between HIV and AIDS as well as the value of antiretroviral drugs for treatment, but he was never as hostile as many suggested he was.  The Health Minister, Dr Manto Tshabalala-Msimang, suggested the use of garlic, lemon juice and beetroot but, probably, not as substitutes for antiretrovirals (although she was widely reported as having done so), rather as a way of managing opportunistic infections. There is no evidence that beetroot ever helped anyone but some traditional African medicines do seem to hold promise in managing fatigue and diarrhoea (in well-controlled trials, no less). There have been non-political controversies too; for instance, the evaluation of a US-funded behaviour change programme called LoveLife.

Keeping in mind the scale of the HIV epidemic, South African policymakers’ decisions about prevention and treatment are going to be crucial not just for their own country but for the entire region. They’ll have to take a call on where to spend money in the future, and the range of options is growing: circumcision, behaviour change, treatment, microbicides and vaccine research, just to name a few. South Africa has, in the past, funded a big AIDS vaccine research programme – in fact, I was on the government panel that reviewed it. The government is now making great efforts to get the funding required for larger trials for microbicides – it has put in a lot of its own money in and is hoping international donors will also provide funds.

The HIV budget is a massive part of South African government spending, and it will have to be justified in years to come. With all the other demands on government funding (education, housing, other health demands), decision-makers need to see whether their efforts are paying off and will continue to do so. The all-important question will remain: will continued action help force this epidemic into faster reverse?

I have worked in Southern Africa since the late 1980s and I think that governments in much of the region – and in South Africa, in particular – have more capacity now to act on good research than they have ever had before. Many South African government officials are very impressive and are hungry for objective findings with which to provide advice for their ministers. That’s why I think that Mapping Pathways is so important.



On a related note, the Mapping Pathways project is also in the process of trying to gather perspectives on these questions from folks in our current focus areas – the US, South Africa, and India. If you’re interested in new ways to prevent transmission of HIV – and want to help shape our project goals and deliverables – we encourage you to take a few minutes and fill in our survey.

Your efforts will be greatly appreciated!

Take the survey now.

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

To PrEP or not to PrEP?

An ongoing development in the PrEP landscape is the AIDS Health Foundation’s (AHF) campaign against Gilead Sciences – more accurately, Gilead Sciences’ pursuit of a new indication for prevention from the  FDA for its “AIDS drug” Truvada. While Truvada is currently approved by the FDA for use as part of antiretroviral therapy combinations for individuals already living with HIV or AIDS, whether the pill should be used as a form of pre-exposure prophylaxis for those not infected is what’s under contention by the AHF.

The Truvada pill, a drug compound that consists of Gilead’s drugs Viread (tenofovir DF) and Emtriva (emtricitabine), was studied in both the iPrEx and FEM-PrEP trials to test its efficacy as a form of treatment as prevention. iPrEx showed this successfully, and FEM-PrEP not so successfully. (Read the Mapping Pathways blog post about this here.)

AHF’s campaign to halt Gilead in its pursuit of FDA approval gained new momentum after the FEM-PrEP trial closure. Read more about the AHF’s thoughts about this here and at nomagicpills.org.

The organisation also recently conducted a survey with 822 men to examine “real world” reactions from prospective consumers about taking PrEP and gauging potential adherence issues. Among the findings: 79% of respondents answered “Yes” to the question: “If you could take a pill on a daily basis to prevent HIV, would you take it?” However, only 63% of respondents said they would be “Very Likely” to remember to take the prevention pill every day. Read more about the survey here.

While no-one is contending that PrEP requires a lot more thought before being rolled out fully, many advocates feel that the AHF’s methods of gathering “real world” information are based on half-truths and stereotypes rather than a solid evidence-base. Read this critical analysis of gaps in the AHF survey here.

All this just confirms the need for a lot more objective information from a variety of sources – communities, academics, policymakers and those infected with HIV – to help us understand the rapidly evolving and dynamic PrEP landscape and the various strategies that can be deployed to prevent and eradicate HIV/AIDS.

Jim Pickett, from the AIDS Foundation of Chicago, a Mapping Pathways partner organization, sums this up best: “This discussion is of the moment, everything has just coalesced now, everything is happening now, and communities across the world are grappling with these strategies, wondering, ‘How in the world do we do this when we have all these other struggles? But on the other hand, how do we ignore it; how can we possibly ignore a new tool that could reduce so much suffering?’ And we have to realize that there are going to be different answers for different places in the world, or even in different parts and populations of one country. We’re hoping that the Mapping Pathways initiative will be able to provide some guidance to help figure all this out. There are so many complex issues to unravel and it is our duty to weed through all of these challenges, all of the promises, and all of the potential perils of these new strategies.”

The Mapping Pathways project is also in the process of trying to gather perspectives on these questions from folks in our current focus areas – the US, South Africa, and India. If you’re interested in new ways to prevent transmission of HIV – and want to help shape our project goals and deliverables – we encourage you to take a few minutes and fill in our survey.

Your efforts will be greatly appreciated!

Take the survey now.


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

The Lancet: “HIV treatment as prevention – it works”

On May 21, The Lancet published a fascinating editorial on the compelling interim results of the HPTN 052 study, making a strong case for treatment as prevention. The article reinforces the fact that we appear to be on the cusp of a major overhaul with regard to both treatment and prevention. As it points out, “Findings now need to be translated into policy and action. Agencies such as President's Emergency Plan For AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria need to reassess their prevention portfolios and consider diverting funds from programmes with poor evidence (such as behavioural change communication) to treatment for prevention. There is now an ethical imperative for guidelines to be revised to start treatment much earlier than recommended.” Ironically enough, this has happened in the middle of the recession, so chances of procuring the necessary funds seem bleak – at least for the next couple of years.

While it is important to note that the HPTN 052 findings cannot be extrapolated to gay men and other MSM (the small number of gay men in the trial is a definite drawback), it seems reasonable to believe that the impacts would be similarly strong among them. Read the full article here, and tell us what you think!

Also, folks from the US, South Africa and India who are interested in new ways to prevent transmission of HIV – and want to help shape our project goals and deliverables – are highly encouraged to take a few minutes and fill in our survey.

Your efforts will be greatly appreciated!

Take the survey now.


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

Please take the Mapping Pathways survey and help shape the future of HIV prevention

The Mapping Pathways project has launched on online survey to collect input from individuals in our three target countries - India, South Africa, and the United States.

Folks who are interested in new ways to prevent transmission of HIV - and want to help shape our project goals and deliverables - are highly encouraged to take a few minutes and fill in our survey.

Your efforts will be greatly appreciated!

Take the survey now.

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