Investigating the Impact of Treatment on New HIV Infections

via PLoS Collections

The HIV Modelling Consortium aims to strengthen the support that mathematical modelling and related quantitative disciplines can provide to global decision-making in HIV. In November 2011 the HIV Modelling Consortium held a meeting in South Africa to focus on the cross-cutting issues of the impact of new scientific findings about HIV treatment preventing new infections. The group considered the feasibility of interventions, potential epidemiological impact, affordability, and new scientific observational studies and community trials. The nine reviews and one research article which comprise this collection arose from that meeting and provide insights into the factors which will support evidence-based decision-making in HIV prevention, with a focus on the use of antiretroviral treatment to prevent HIV transmission.

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Botswana's 'Stunning Achievement' Against AIDS

via NPR, by Jason Beaubien

The southern African nation of Botswana has one of the highest rates of HIV in the world. Nearly 25 percent of all adults in the country are infected with the virus. Only the nearby kingdom of Swaziland has a higher rate.

But Botswana is also remarkable for its response to the epidemic. It has one of the most comprehensive and effective HIV treatment programs in Africa. Transmission of HIV from infected mothers to their fetuses and newborn babies has been brought down to just 4 percent.

A decade ago, Botswana was facing a national crisis as AIDS appeared on the verge of decimating the country's adult population. Now, Botswana provides free, life-saving AIDS drugs to almost all of its citizens who need them.

"From the beginning of the epidemic, there's been tremendous leadership on the part of the government of Botswana to address the epidemic head on."

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PEPFAR Program Outlines End of Year Progress to the Congress

via Science Speaks, by Meredith Mazzotta

PEPFAR releases 8th annual report to Congress: The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program delivered its 8th annual report to Congress recently. The five-page document outlines the program’s progress as of the end of fiscal year 2011 in various areas including:  supporting 3.9 million people on antiretroviral treatment; testing 9.8 million pregnant women for HIV in the course of the year; providing prevention of mother-to-child transmission services to more than 660,000 HIV-infected pregnant women allowing 200,000 babies to be born HIV-free; and providing care and support for nearly 13 million people, including more than 4.1 million orphans and vulnerable children. The report also stressed the importance of “leading with science” as we respond to the pandemic, smart investments including spurring private-sector engagement, country ownership, and shared responsibility.

TB institute confirms 8 patients resistant to all known TB drugs:  According to this article in the Hindustan Times, eight of the 12 patients originally reported as having what was coined “totally” or “extremely” drug resistant TB (neither term is recognized by the World Health Organization) have received confirmatory sputum sample testing that show resistance to all first- and second-line TB drugs. Since the original diagnoses of the dozen patients, three have died and, according to a city TB officer, of the six patients that remain in Mumbai, five are undergoing treatment for extensively drug-resistant TB, and one is being treated at Hinduja hospital.

Nonprofit TB Vaccine Developers Sign MOU to Accelerate Progress: Aeras announced it will be joining with the Tuberculosis Vaccine Initiative (TBVI) to “enhance and strengthen collaborative efforts to advance the world’s most promising TB vaccine candidates.” The memorandum of understanding between the two organizations will work to address opportunities and challenges in TB vaccine development that were outlined in the strategic blueprint released by advocates in late March, and published in the journal Tuberculosis, just before World TB Day. According to the Aeras press release, the two organizations will advise each other on vaccines in development, work to streamline the process of candidate selection and review, as they work together to achieve the goals outlined in the blueprint.

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

AVAC Updates: Newest Issue of Px Wire and M2012 Road Map are Now Available!

via AVAC.org

This update provides a summary of and link to download the newest issue of Px Wire, as well as a roadmap for advocacy and communications-related sessions at the upcoming International Microbicides Conference (M2012).

Px Wire

Download the current issue of Px Wire (Volume 5, Issue 2), a quarterly update on biomedical HIV prevention research worldwide.

In this issue of Px Wire, we are excited to showcase a new ARV-based prevention timeline graphic, just in time for M2012. The timeline shows estimated efficacy trial end-dates, related confirmatory studies and dates of possible regulatory submission for a range of prevention options including oral PrEP with TDF, oral PrEP with TDF/FTC, vaginal and rectal formulations of tenofovir gel and the dapivirine-containing vaginal ring.

We also hope you enjoy reading the feature story in Px Wire where we describe the ongoing work of advocates who are working to influence PEPFAR Country Operating Plans.

Other highlights in this issue of Px Wire include:

• Information on how advocates can contribute their voices to the US FDA’s May 10 public meeting on Gilead Science’s submission for TDF/FTC (Truvada) as PrEP for HIV-negative adults

• Summaries of new AVAC resources: PrEP Using Daily Oral TDF/FTC or TDF in Women (and Men) — What the science tells us in March 2012, and new advocacy resources for voluntary medical male circumcision

• Upcoming events

2012 International Microbicides Conference (M2012)

Next week advocates, policy makers, researchers and funders will meet at the 2012 International Microbicides Conference taking place April 15-18 in Sydney, Australia. Building on past conferences, M2012 is a platform to discuss the latest in microbicides, PrEP and other ARV-based prevention research, as well as the basic science, structural, social and community issues that affect research and eventual rollout of these new tools. M2012 will feature several sessions that focus on advocacy and the role community advocacy and communication plays in the field. Our online conference “roadmap” highlights a number of these sessions. If you will be attending the conference, we invite you to join us at these events. Please visit the AVAC M2012 page for updates on these activities.

If you are not able to participate in M2012 in Sydney, please watch out for information on special AVAC post-M2012 webinars covering critical issues that emerge at the conference. For key updates during the conference visit NAM/AIDSMAP.

As always, if you have any questions please contact us at avac@avac.org.


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

Activists Protest Against Obama's PEPFAR Budget Cuts

via Plus News

Almost a thousand Swazi and South African HIV activists marched to the United States consulate in Johannesburg on 22 March 2012 to demand that the US continue supporting the Global Fund to Fight AIDS, Tuberculosis (TB) and Malaria, and safeguard funding of its President's Emergency Plan for AIDS Relief (PEPFAR), which US President Barack Obama's latest proposed budget will cut by 12 percent.

The march organizers - a coalition of international and regional HIV organizations, including the global medical charity, Médecins Sans Frontières (MSF), the World AIDS Campaign, and the AIDS Rights Alliance Southern Africa - also called on the British and Australian governments to join their American counterparts in kick-starting a response to solve the Global Fund's financial crisis.

Without an emergency donor meeting, the Fund - already in need of at least US$ 2 billion - will only secure additional funding at its next scheduled replenishment in 2014.

"We're not asking for charity, we are asking for social justice," said Daygan Eagar, a researcher at the South African human rights organization, Section27. "The US spends more money in one day of war than we're asking for the Global Fund."

Representatives from MSF, Section27 and the South African AIDS lobby group, Treatment Action Campaign, were to meet with consular and PEPFAR representatives to discuss their concerns.
The demonstration was also endorsed by the two million-member Congress of South African Trade Unions (COSATU). It followed similar protest action at US representative offices in Swaziland, according to Siphiwe Hlophe, a founder of the NGO, Swaziland for Positive Living (SWAPOL).

"If we are here, if we are laughing, it is because we are on drugs," she told the crowd. "Before the Global Fund we didn't have food, we didn't have pyschosocial support, we didn't disclose our HIV status - that all started when the Global Fund came. Look at how many of us are here today - that is the Global Fund."

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

Major Budget Cuts Hinder HIV/AIDS Treatment

via Nature News, by Erika Check Hayden

Preventing the spread of HIV used to mean testing people for infection and encouraging them to practise safe sex. Increasingly, it also means prescribing drugs, as studies show that giving infected people or their uninfected partners antiretroviral drugs as soon as an infection is diagnosed can help to check the spread of AIDS.

Yet at this week’s annual Conference on Retro­viruses and Opportunistic Infections in Seattle, Washington, there was growing concern that financial austerity in the United States and elsewhere is eating away at the funding needed for a worldwide prevention effort.

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.”

Last month, US President Barack Obama’s 2013 budget request proposed a 10.8% cut to direct international aid for HIV programmes under the President’s Emergency Plan for AIDS Relief (PEPFAR) which, together with previous cuts, would slice more than US$1 billion from the fund’s 2010 level. And last November, the Global Fund to Fight AIDS, Tuberculosis and Malaria said that it would not hand out any more funds for scaling up AIDS treatments until 2014 because of tightening budgets in donor countries.

The shortfalls come as a slew of results presented this week reinforce a growing consensus about the power of early treatment for HIV infections. The latest data are part of a trend that accelerated last May, when HPTN 052, a clinical trial run by the multinational HIV Prevention Trials Network, showed that giving antiretroviral drugs to people who are HIV-positive can stop them from passing the virus to their uninfected partners. In light of such results, the World Health Organization is expected to issue new guidelines for managing HIV in couples soon.

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

AIDS Battle Risks Being Derailed by Global Financial Crisis

via Nature, by Meredith Wadman

Thirty years after AIDS was first recognized as a human scourge, major recent gains in treatment and prevention risk being derailed by the global financial crisis.

On 23 November, the Global Fund to Fight AIDS, Tuberculosis and Malaria announced that it will not fund new grants for prevention and treatment until 2014, owing to “substantial budget challenges in some donor countries”. The fund's HIV activities run the gamut from counselling and testing pregnant women in India to providing medications to infected children in Kenya.

And on 7 December, a report from Policy Cures in Sydney, Australia, a group that monitors global research and development for neglected diseases, showed that public and private funders last year cut their commitments to HIV/AIDS research targeted at the developing world by US$67.5 million, or 5.9%. The decline was due entirely to cutbacks by wealthy nations, which slashed spending by $72.6 million; poorer countries actually increased funding by $5.1 million. Where research is concerned, “AIDS had a bigger drop in dollar terms than any other disease”, says Mary Moran, the executive director of Policy Cures and the lead author on the report.

The threat comes even as US President Barack Obama last week promised that the United States will step up its worldwide attack on AIDS. Breaking the White House's past reticence on the issue, he urged nations to honour their unmet pledges to the Global Fund.

“Countries that have committed to the Global Fund need to give the money that they promised,” he said on 1 December, World AIDS Day. “Countries that haven't made a pledge, they need to do so,” he added, singling out emerging nations such as China that are recipients of funds “but now are in a position to step up as major donors”.

The United States has given $6.1 billion to the Global Fund since 2004, and last year pledged to contribute $4 billion between 2011 and 2013. Congress approved $1.05 billion in 2011, meaning that allotments must increase substantially in 2012 and 2013 to honour the pledge. Obama has asked Congress to provide $1.3 billion in 2012, but Senate lawmakers have so far resisted the increase.

Obama pledged to increase by 50% — to 6 million — the number of people receiving antiretroviral therapy (ART) worldwide by 2013 through the President's Emergency Plan for AIDS Relief (PEPFAR), the nation's major global treatment and prevention programme. He also said PEPFAR would aim to provide ART to an additional 1.5 million pregnant women with HIV in the next two years. The international promises came with no new money immediately attached. But Obama has asked Congress to provide nearly $7.2 billion — a 6% increase — for PEPFAR in 2012, part of the unfinished budget bills still being debated.

Advocates said that his speech marked a significant turning point. “This is the first time he's signalled that he's going to champion global HIV in this way,” says Jennifer Cohn, an assistant professor of infectious diseases at the University of Pennsylvania in Philadelphia, and a policy adviser in Nairobi for Médecins Sans Frontières (MSF; also known as Doctors Without Borders). “Whether or not this gets translated into the president's 2013 budget request, or what Congress chooses to protect during the 2012 budget negotiations — that's what I'm waiting to hear.”

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

Global Fund to Fight AIDS, TB and Malaria Cancels Funding

via The Guardian, by Sarah Boseley

"If we lose the ground we have gained, we will be back to square one – all that effort and investment, lost. The decisions you make here today will determine the outcome."

In what must be seen as a serious setback in the progress made against the major infectious diseases in poor countries, a board meeting of the Global Fund to Fight Aids, TB and Malaria in Accra, Ghana, has effectively cancelled its next round of grant-making.

The fund has been staring at a financial black hole ever since its big replenishment meeting in New York a year ago failed to deliver the sums it hoped for. It wanted $20bn. It got $11.7bn. That was in spite of exhortations to donors to pledge money from the UN secretary general, Ban Ki-moon, who warned that the stakes were high and that lives would be lost if pressure on the big killer diseases was not maintained.

It once seemed unthinkable that the money would not continue to stream into programmes to treat people with Aids, TB and malaria and to prevent others becoming infected. But that is what is happening. There is no doubt that people who could have been spared will instead fall ill and die as a result of the drying up of funds. There is also a Damoclean sword hanging over the heads of people who are alive and well thanks to drug treatment for their HIV infection. The Global Fund – together with Pepfar (the President's Emergency Plan for Aids Relief) – has been the main source of money to pay for drugs. Those who start the combination treatments to prevent HIV causing Aids must stay on the drugs for life. If they stop, there is a danger the virus will become resistant to the drugs they are on.

The Global Fund's board is buying time by telling governments not to put in new applications for funding for round 11, which is supposed to provide money for 2011 to 2013. It is offering a "transitional funding mechanism", which will allow countries to ask for money to cover essential needs. In recognition of the danger of stopping HIV treatment, this should allow countries to continue to supply drugs to people who are already taking them.

But, as Secretary of State Hillary Clinton said in her recent address, the need now is to step up the fight against HIV by providing more drugs – not less. Scientific studies showed this year that treatment makes people with HIV less infectious. Failure to keep rolling out the drugs to more and more people will waste an opportunity to deliver what she and others have hopefully termed "an Aids-free generation".

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

The Beginning of the End of AIDS

via The Huffington Post, by Sheila Nix

Everyone loves a good "they said it couldn't be done" story. From a man on the moon to a personal computer in every home, the nostalgic in each of us loves to reflect about how, throughout history, individuals have run up against the status quo, defied the odds, and achieved something inspirational for society at-large. Those of us in the AIDS advocacy community have experienced our fair share of doubters telling us "it can't be done."

30 years ago when HIV/AIDS cases were first documented, it was a mysterious infection that couldn't be treated. Positive diagnosis was a death sentence. With no treatment, stigma and fear grew, representing what Dr. Anthony Fauci calls "the dark years." But with scientific innovation came the discovery in 1987 of AZT, the first drug approved to treat HIV. Over the next few years, AZT was replaced with more sophisticated combination drug therapy, and by 1996 highly active antiretroviral therapy had been developed. The new drugs were hugely expensive, however, costing $10,000 per year or more. Many HIV-positive people feared that without Magic Johnson's checkbook, they wouldn't be able to get the drugs they needed to keep them alive. Today, AIDS treatment costs just a few hundred dollars per year in poor countries -- a victory for HIV-positive communities around the world.

In the early 2000s, as President Bush and bipartisan Congressional leaders were launching a program called PEPFAR and as the Global Fund to Fight AIDS, Tuberculosis, and Malaria was just getting started, the doubters loomed large. Many believed there was no way to get antiretroviral treatment to millions -- particularly in Africa where some infamously suggested "Africans don't have watches" and so couldn't be expected to take drugs in a consistent manner. Others argued that mobilizing the financing required to hit PEPFAR and Global Fund targets was impossible. Yet global funding for AIDS skyrocketed, growing six-fold between 2002 and 2008. African leaders also stepped up, committing to spend 15% of their budgets on health. Today, the results speak for themselves: 6.6 million HIV-positive people, including those in remote communities, are alive today because of treatment, and countless others have remained HIV-negative thanks to prevention efforts.

In spite of these achievements, economic recessions have a unique way of allowing the "it can't be done" mantra to reemerge. Indeed, as budgets constrict and leaders turn their attention inward, it's easy to see why a renewed push on global AIDS doesn't seem possible. Yet 2011 marks a critical inflection point in our fight against AIDS. Game-changing studies have offered exciting new tools in the fight to prevent HIV -- including new data that shows treatment works as prevention, reducing the likelihood of passing on HIV by as much as 96%. Collectively, these advances show that bending the curve on AIDS is possible in our generation.

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

Ribbons Without Rights Don't Save Lives

via The Huffington Post, by Serra Sippel

Last month, the President's Emergency Plan for AIDS Relief (PEPFAR), in partnership with George W. Bush Institute, Susan G. Komen for the Cure, and UNAIDS, launched the global "Pink Ribbon Red Ribbon" campaign, an initiative that integrates cervical and breast cancer education, screening, and treatment with HIV services. It's a move that has the potential to reduce the number of cancer deaths among women living with HIV and improve their overall health. Given that women living with HIV are at an increased risk of developing cervical cancer, it makes sense. It's a logical and critical part of what PEPFAR is calling care and support services.

What doesn't make sense is that planning a family and preventing further HIV transmission is not part of what PEPFAR is calling care and support. HIV was responsible for 60,000 maternal deaths in 2008, and pregnancy alone could put women at higher risk of transmitting and acquiring HIV. Integrating and linking voluntary family planning, HIV, and cervical cancer prevention saves lives, improves access to quality care and promotes human rights. Including family planning in Pink Ribbon Red Ribbon would help women manage childbearing and protect themselves and their partners from infection or re-infection (think female condoms) and should be automatic.

UNAIDS has stated as much. "We must take AIDS out of isolation and provide young girls with opportunities to negotiate their sexual relationships and receive sexuality education so that they can protect themselves from infection," said UNAIDS Executive Director Michel Sidibé at this year's Commission on the Status of Women. "If we don't do this, our vision of zero new infections will remain a dream."

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

An end to AIDS is within our reach

via The Washington Post, by Desmond Tutu

A study published in the New England Journal of Medicine last month has demonstrated that antiretroviral treatment can prevent the spread of HIV, in addition to saving those infected from sickness and death.

Armed with this new data, President Obama should lead the world in a massive effort to expand access to treatment and rid humanity of AIDS — the most devastating disease of our time.

But just as the end of AIDS has finally come within reach, we are witnessing an unprecedented drop in financial and political support for the cause.

The Joint United Nations Programme on HIV/AIDS and the Kaiser Family Foundation reported in August that donor funding for HIV/AIDS leveled in 2009 and then declined — 10 percent — in 2010 for the first time ever. The United States, which accounts for more than half of global contributions to fight the disease, disbursed $700 million less in 2010 than in 2009. And projected U.S. funding in 2011 is roughly $28 million less than in 2010.

This is a great shame, as millions of people receiving treatment worldwide depend on these funds to stay alive.

Our support should be increasing. AIDS remains the leading cause of orphanhood and of death among women of reproductive age. It is a major driver of opportunistic infections — particularly tuberculosis — and keeps tens of millions of Africans mired in poverty.

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

Harvard School of Public Health to study "unique combination of HIV prevention strategies" in Botswana

via The Financial

A new four-year, $20 million grant from the U.S. Centers for Disease Control and Prevention (CDC) will enable Harvard School of Public Health (HSPH) researchers to evaluate the impact and cost-effectiveness of a unique combination of HIV prevention strategies in Botswana. The CDC grant is part of a U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) initiative that commits $45 million to examine the effectiveness of combination approaches to HIV prevention over four years. The largest evaluation of its kind, the research initiative is poised to help partner countries strengthen their efforts to prevent new HIV infections and save lives.

Principal investigator Max Essex, professor of health sciences and chair of the Harvard School of Public Health AIDS Initiative, and co-principal investigator Victor De Gruttola, professor of biostatistics and chair of the Department of Biostatistics at HSPH, predict that their prevention strategies can reduce HIV infection by at least 50 percent.

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