"Mother-Baby Packs" to Curb Mother to Child Transmission

via The New York Times, by Nicholas Bakalar

The medicines that prevent the transmission of H.I.V. from mother to child are highly effective when they are used properly — that is, taken at the right time in gestation and in the right doses by both mother and newborn. But in resource-poor countries, mothers often give birth at home and rarely visit health clinics. So the problem is getting the medicines to the mothers and babies who need them, and making sure the doses and timing are right.

Several years ago, health workers in several African countries hit on an idea: The first time a pregnant woman visits a health clinic, she should be tested for H.I.V. If she is positive, give her the medicines that she and her baby will soon need, as she may never return to the clinic.

Clinic workers began packaging the antiretroviral drugs — pills for H.I.V.-infected mothers and liquids for their babies — in paper bags with instructions on how to use them. The Mother-Baby Pack was born.

Read the rest.


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

Research Linking Contraceptives to HIV Raises Policy Questions

via PBS Newshour, by Talea Miller

A study showing injected hormonal birth control could make women more vulnerable to HIV is raising big questions about medical guidance in regions with high HIV rates.

Research conducted by the University of Washington in seven African countries found use of injected hormonal contraceptives doubled women's risk of contracting HIV and the chances of passing HIV to a partner.

Policymakers are moving cautiously in response to the findings, which were first released this summer at an HIV conference and published again this week by the Lancet. The World Health Organization has scheduled a January 2012 review of the research, but for now the organization and the U.S. Agency for International Development are making no new contraceptive recommendations and the two groups have emphasized the study's limitations.

In a statement released in August when the study first surfaced, USAID noted flaws in the study's design and called for a randomized, controlled version to flesh out the results. The agency also noted that while a few previous studies show a connection between hormonal contraception and HIV transmission, the majority of previous research found no association.

"USAID does not believe that a change in contraceptive policy or programming is appropriate or necessary at this time," the statement said, and a USAID spokesperson said Tuesday that finding still stands.
The WHO also took issue with the study's reliance on data based off observations in a written response to the Lancet publication.

Read the rest.



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

Closure of oral Tenofovir arm in VOICE Pre-Exposure Prophylaxis trial: PrEP as a “niche intervention”?

via Incidence, by Roger J. Tatoud

The Microbicides Trial Network (MTN) September 28th that its VOICE (Vaginal and Oral Interventions to Control the Epidemic, MTN003) HIV Pre-Exposure Prophylaxis (PrEP) prevention study will discontinue the daily oral tenofovir arm of the trial. The decision follows an interim review of the trial’s data by its Data Safety and Monitoring Board (DSMB) which recommended that VOICE stops evaluating the oral tenofovir tablet (TDF, brand name Viread), because it will not be possible for the study to show a difference in effect between the drug and the placebo tablet (futility) for the prevention of HIV infection in the context of that study. Importantly, the DSMB did not found any safety issues associated with the use of TDF in any arm of the trial.

This is the third PrEP trial, after FEM-PrEP and TDF2, for which an interim review of the trial’s data led to a change of course of the study. Because the four other arms of the VOICE trial continue, there are no data available publicly yet to explain why tenofovir would not show effectiveness in this study when three other studies showed a dramatic reduction in the risk of HIV infection with tenofovir alone or in combination with another antiretroviral (see table below). However, Sharon Hillier and Ian McGowan of the Microbicide Trials Network noted that the study’s population – predominately women in their 20’s, could be an important factor.

“If there’s one thing we’ve learned over the years it’s that unmarried women in their 20s are in a very different place in their lives than married women in their 30s. People in different circumstances will make different choices about their use of condoms, their choice of partners and whether or not to use a biomedical prevention product. As we continue the VOICE trial we recognize that there could be many factors that influenced the outcome with oral tenofovir, and even when we have more information available to us, understanding what exactly happened (or not) will not be simple.”

If confirmed (a full analysis of the data will not be available before several months) this would add to the challenge of defining a strategic use for PrEP in the general population or in populations at risk.

Read the rest.


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

An integrated structural intervention to reduce vulnerability to HIV and sexually transmitted infections among female sex workers in Karnataka state, south India

via BMC Public Health, by Vandana Gurnani, Tara S Beattie, Parinita Bhattacharjee , Cfar Team, H L Mohan , Srinath Maddur, Reynold Washington, Shajy Isac, B M Ramesh, Stephen Moses and James F Blanchard

Abstract

Background:

Structural factors are known to affect individual risk and vulnerability to HIV. In the context of an HIV prevention programme for over 60,000 female sex workers (FSWs) in south India, we developed structural interventions involving policy makers, secondary stakeholders (police, government officials, lawyers, media) and primary stakeholders (FSWs themselves). The purpose of the interventions was to address context-specific factors (social inequity, violence and harassment, and stigma and discrimination) contributing to HIV vulnerability. We advocated with government authorities for HIV/AIDS as an economic, social and developmental issue, and solicited political leadership to embed HIV/AIDS issues throughout governmental programmes. We mobilised FSWs and appraised them of their legal rights, and worked with FSWs and people with HIV/AIDS to implement sensitization and awareness training for more than 175 government officials, 13,500 police and 950 journalists.

Methods:

Standardised, routine programme monitoring indicators on service provision, service uptake, and community activities were collected monthly from 18 districts in Karnataka between 2007 and 2009. Daily tracking of news articles concerning HIV/AIDS and FSWs was undertaken manually in selected districts between 2005 and 2008.

Results:

The HIV prevention programme is now operating at scale, with over 60,000 FSWs regularly contacted by peer educators, and over 17,000 FSWs accessing project services for sexually transmitted infections monthly. FSW membership in community-based organisations has increased from 8,000 to 37,000, and over 46,000 FSWs have now been referred for government-sponsored social entitlements. FSWs were supported to redress >90% of the 4,600 reported incidents of violence and harassment reported between 2007-2009, and monitoring of news stories has shown a 50% increase in the number of positive media reports on HIV/AIDS and FSWs.

Conclusions:

Stigma, discrimination, violence, harassment and social equity issues are critical concerns of FSWs. This report demonstrates that it is possible to address these broader structural factors as part of large-scale HIV prevention programming. Although assessing the impact of the various components of a structural intervention on reducing HIV vulnerability is difficult, addressing the broader structural factors contributing to FSW vulnerability is critical to enable these vulnerable women to become sufficiently empowered to adopt the safer sexual behaviours which are required to respond effectively to the HIV epidemic.


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

Whatever Happened to the AIDS Vaccine?

via The Huffington Post, by Michael Warren

"Now is exactly the time to maintain commitment. Now is exactly the time to hold a steady course in funding for basic science, clinical trials and product development. It's good business sense: Our investments are paying off -- and the dividend, in the form of an effective vaccine, would have value beyond our wildest dreams."

Recent news about HIV/AIDS has focused on the good -- promising trial results that prove the antiretroviral (ARV) drugs used to treat HIV can also prevent HIV infections -- and the bad -- retreats in donor commitment that imperil the substantial gains that have been made in treating global AIDS, at the precise moment that treatment has been recognized as a powerful prevention strategy. In discussions about whether AIDS treatment can be used to end the AIDS epidemic, scant attention is paid to the search for an AIDS vaccine.

When AIDS vaccines do get mentioned, it is often in the context of questions about whether a vaccine is still needed, or whether the search for an AIDS vaccine is affordable in today's economic climate.
Researchers and advocates who gathered Sept. 12-15 in Bangkok, Thailand, for the AIDS Vaccine 2011 conference have clear answers: Yes, we still need a vaccine, and yes, we need to continue to invest in AIDS vaccine research.

Read the rest.


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