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How HIV became a matter of international security

Governments around the world were slow to get to grips with HIV/AIDS. But a big change came when they started understanding it not just as a health issue but as a security threat too. Alexandra Ossola investigates.

Richard Holbrooke sat in a blue striped chair in the meeting room of the United Nations Security Council. It was a rainy, unseasonably warm January day in New York City, just ten days into the new millennium. Many people were still relieved that the Y2K millennium bug hadn’t wreaked havoc on computers, as some experts had feared. And yet, during the council’s seven-hour meeting, it was clear that a bigger, real threat was looming.

Doctors had identified HIV/AIDS more than 15 years before, but only by 2000 was its true global impact beginning to become clear. Holbrooke, the US ambassador to the UN, then sitting as president of the Security Council, had pushed for this meeting because he had seen first-hand how AIDS could devastate communities. In 1992, he had visited Cambodia and saw UN peacekeepers who, at the end of the day, would get drunk and visit brothels. Holbrooke was sure this behaviour was spreading HIV locally, and that the peacekeepers would bring the disease back with them to their home countries.

He had seen the impact even more dramatically in 1999, when he and his wife visited Africa. Children whose parents had died of the disease slept in gutters; even AIDS activists were so stigmatised they arrived to meet him in a curtained van. Conversations with leaders in countries like Namibia and South Africa showed Holbrooke they weren’t doing nearly enough to combat the disease. The trip galvanised him. AIDS was spreading, regardless of borders, in a way that threatened the stability of states. So, if national governments weren’t taking action, perhaps the world could.

But Holbrooke was met with resistance. Congressmen criticised him on television; friends and dignitaries warned him privately not to confuse humanitarian issues with national security. How could a disease be an issue of national security, they argued – no disease ever had been. “I was told by everyone, including my own staff, ‘You can’t do this; it’s not done; it’s not in the UN charter,’” Holbrooke said in a 2006 interview with PBS. “And I said, ‘But AIDS is a security issue, because it’s destroying the security, the stability of countries.’”

Luckily, Holbrooke found the Security Council more amenable as he pushed to discuss HIV/AIDS. Only Russia was opposed, which Holbrooke thought was ironic since the prevalence of HIV/AIDS in Russia and its surrounding countries was rising rapidly.

Eventually, Holbrooke prevailed. Russian representatives agreed to sit in on the meeting, but wouldn’t speak or participate. That suited Holbrooke just fine. And on 10 January 2000, representatives from all 15 countries took their blue seats in the Security Council meeting room to hear 40 speakers discuss the threat and impact of HIV/AIDS.

AIDS became the first epidemic in modern history to morph beyond a topic of public health into an issue of national and even international security. Without collaboration between countries, between scientists and military personnel, between industry and government, the disease would have claimed more than the 35 million lives it has to date.

There are other events that could qualify as turning points in the fight. The 2000 conference held in Durban, South Africa, at which Nelson Mandela delivered a heartfelt appeal to the international community. Or the 2002 G8 summit in Alberta, Canada, at which global leaders rolled out a plan to support Africa, in it mentioning their dedication to eradicate HIV/AIDS. Or 1987, when the US Food and Drug Administration announced AZT as the first approved treatment for HIV, due in large part to lobbying from gay activists. Or 1995, when the agency approvedHAART, the drug cocktail that most people with HIV/AIDS take every day to stop the progression of the disease.

But the Security Council meeting was critical. The meeting on that balmy January day marked the first formal discussion of HIV as an issue in which the government and military must get involved to protect a country and its interests. Seven months later, the Security Council passed a resolution calling for more training in AIDS prevention for UN peacekeeping forces and encouraging member states to work together for better prevention and treatment policies.

The rhetoric of national security has shaped the way activists and officials address epidemic diseases today, solidifying partnerships and funding streams. And though there are clear advantages to this large-scale, top-down approach of military involvement, there is much to learn about the best way to stop a pandemic.

By the early 1980s, diseases that ravaged the human population seemed like they might become a thing of the past. Smallpox had been eradicated worldwide by 1980; vaccination campaigns during the 1960s and 70s meant that diseases like polio, mumps and measles affected far fewer people. “People were talking about conquering infectious disease once and for all,” says Joshua Michaud, the associate director of global health policy at the Kaiser Family Foundation. “Nobel Prize-winning biologists were saying that we could see the end of infectious disease in our lifetime, and there were reasons to believe that.”

But when AIDS was discovered in 1981, that illusion was shattered. “We had a lot of magic bullets, we had technical fixes to everything. Then HIV happened,” Michaud says.

HIV/AIDS made for a scary assailant. It surfaced mostly among gay people in San Francisco and New York, a death sentence that catalysed activism among the gay community. This activism became critical in helping people gain access to experimental treatment. HIV became highly stigmatised, a “moral” disease, a plague of philanderers and drug addicts.

The disease hits hardest among adults of reproductive age who are otherwise healthy. It’s a threat that respects no border, as George Tenet, then director of the CIA, noted in 2003. And though the effects of AIDS can feel overwhelming when concentrated within communities, they are even more disastrous when taken at a macro scale.

“AIDS is a long-wave event,” says Simon Rushton, a lecturer in politics at the University of Sheffield. “It’s cross-generational. The impacts on societies are long-term, and they accumulate over time.”

More people would die from AIDS than from any other disease outbreak in human history, including the global influenza pandemic of 1918–19 and the bubonic plague in the 1300s, wrote Peter W Singer, then a postdoctoral fellow at the Brookings Institution, in a 2002 essay. If the disease continued to spread at the same rate in places like South Africa and Botswana – where 20 per cent and 38.5 per cent of the population respectively was infected in the year 2000 – life expectancies would plummet by more than 20 years and child mortality would triple within a decade, Singer said.

Intelligence experts estimated that AIDS would wipe out a quarter of all adults in Sub-Saharan Africa.

“[They] were making a logical case that this was going to keep getting worse and worse, that it will threaten viability of most infected states,” Rushton says. Researchers were struggling to understand the epidemic. “There was a fear, perhaps a well-grounded fear.”

Effects like that would put the political stability of these countries at risk, argued innumerable reports and assessments.

The disease would wipe out government officials and educated, trained professionals that make up the backbone of a society, leaving elderly people to care for orphaned children, a process the experts called “hollowing out”. Militaries, which have higher infection rates than civilian populations (in theory because as young, virile men move around, they engage in sexually risky behaviours, swapping diseases with locals and bringing them to the next deployment), would crumble. Destabilised states leave room for extremist groups to take hold, powered by armies of child soldiers under the command of some of the surviving adults.

This worried American intelligence officials. The US would be called upon to provide costly aid to failing states, according to a declassified CIA report from 1987. The Soviet Union would threaten the US’s strategic positioning in Africa – a key concern during the Cold War – by encouraging rumours that American scientists had created HIV and were spreading it throughout the continent to eliminate black people. The disease also seemed likely to spread to places considered geopolitically more important, such as India and China. The Cold War ended, but, as the epidemic persisted after 9/11, the potential rise of more extremist groups seemed even more threatening. Of course, US officials also feared the disease taking a stronger hold at home, affecting more than those groups relegated to society’s fringes. It could weaken the military and put America’s own stability at risk.

Intelligence agencies had been predicting the destabilising effects of AIDS since the 1980s, yet the world didn’t present a cohesive response until 2000. There’s no single reason why it took so long, but one was that the science on treatment and prevention was still murky, says Mitchell Warren, the executive director of AVAC, a global HIV/AIDS advocacy organisation. By the late 1990s, scientists had shown it was possible to treat and prevent the disease, which was enough to spur activists and political leaders to act. Short of a cure, the only way to stop the epidemic from ballooning was prevention.

§

A 25-year-old woman living in rural Malawi found herself very ill. She had shingles and malaria that wouldn’t go away; her weight had dropped precipitously. Though programmes to diagnose and prevent HIV had been running in the country for several years, this woman had never been tested, and neither had her four-year-old son. “She was living in denial, she didn’t want to discover she was HIV positive,” says David Odali, the director of the Umunthu Foundation, a non-profit that offers HIV testing and treatment and runs education campaigns in Malawi. The woman’s family encouraged her to go to Umunthu’s clinic in the small town of Bangwe, where both she and her son tested positive for HIV and started receiving treatment.

It saved her life; in the years since, the woman has had two more children, both of whom are HIV negative. The mother is able to do some work, more than she could do when she was ill, and the son is thriving in school. “He’s brilliant in school,” Odali adds. “He does come here sometimes on his own to get his treatment,” though his mother only recently helped him to understand why he was taking medicine every day when he didn’t feel sick.

Cases like this one are no longer uncommon. There’s no denying the huge impact that AIDS has had on the world population – in 2015, the World Health Organization (WHO) estimated that about 70 million people have been infected with the virus, and 35 million have died. And yet the effects have not been as dire as once feared; in 2001, experts predicted that 100 million would be dead from the disease by 2005.

Bold, creative individuals – scientists, activists, NGO workers, healthcare professionals – made this happen. But they wouldn’t have been there, their organisations unfunded, the research not conducted, without support from national governments.

The US government, for instance, allocated $6.6 billion to fight HIV/AIDS abroad in 2016 (independent of the $26.4 billion it spends on domestic programmes), making its budget many times larger than those of the UK, which allocated $980 million to fight AIDS in 2015, and Germany, at just over $200 million.

The bulk of the US money comes under the President’s Emergency Plan for AIDS Relief (PEPFAR), and trickles down through different government departments, such as Defense, State, and Health and Human Services, and diffuses into smaller agencies and non-profit organisations, or directly to foreign governments for their own treatment and prevention programmes, says Warren. About a fifth is carved out for the Global Fund. “Both of these organisations were the result of this call in 2000 of a need to change the way the world responded to HIV,” Warren says.

To Warren, it’s clear that the response would not have been as robust if HIV had not been considered a matter of national security. The reframing compelled tight-fisted government officials to make room in the budget. “At the end of the day, the most important people at the country level were not ministers of health. They’re ministers of finance,” Warren says.

The security dimension makes it a bigger political issue than public health, Simon Rushton says. It’s high politics. Peter Piot, who was director of UNAIDS for 13 years, says that this helped establish HIV/AIDS as an exceptional epidemic, requiring an unprecedented level of resources and coordination across sectors.

This produced real results. More than 18 million HIV/AIDS patients worldwide were receiving treatment in 2016, and the number of new cases per year dropped by 40 percent between 1997 and 2015.

It’s impossible to know what would have happened if the national security appeal hadn’t had this effect. As Warren puts it, if something didn’t happen, they’d succeeded. Some feared that the framing would divert funds from other public health issues, such as tuberculosis and malaria. Others said it would further stigmatise people. In Europe and Russia, for instance, people from Africa already faced discrimination in housing and the job market because they were feared to carry disease. The same happened to Haitians in the US.

And though it pulls in more money in the short term, framing one disease as a security issue may absolve countries from engaging with future epidemics that don’t present a security risk, wrote Susan Peterson, a professor of international relations at the College of William and Mary in Williamsburg, Virginia, in 2002.

The security framing may also shift the focus of the HIV/AIDS spending itself. When PEPFAR launched in 2003 with a budget of $15 million, its efforts initially focused on 15 countries. These were not the top 15 countries affected by AIDS at the time. “People have looked at that initial list,” says Rushton, “and it looks like it’s at least partly motivated by security concerns.” He notes that Vietnam, one of the 15 countries on the original list, had only 220,000 cases of HIV/AIDS in 2004 – a mere fraction of the number of people infected in Malawi (940,000), which did not receive initial attention from PEPFAR, and far less than Russia (more than 320,000), which similarly received no support.

And though countries like South Africa were at the centre of the AIDS epidemic and deserved the funding and attention they received, critics have suggested that global powers, including the US, might have been more invested in their political stability.

David Odali still struggles to get enough funding for Umunthu’s ambitious programmes, although a six-year partnership with the NGO AVERT has enabled them to reach out to more patients. Though he and his collaborators have had many successes, there were still 33,000 new cases of HIV in 2015 in Malawi. “As we are talking, someone out there is contracting the virus, through unprotected sex, through rape, through caring for a patient,” he says. “The infection is still there with us.”

§

When West Point was first dredged from the sea, in the 1940s, it was probably a beautiful place. This neighbourhood at the most northwestern point of Monrovia, Liberia, is a peninsula, cut off from the rest of the city by two rivers to the north and east, and with the Atlantic Ocean to the west. Its beaches are a sandy yellow, and a few palm trees dot the shore. But today, that beauty is only visible in fleeting moments, like afternoon light through slanted blinds. West Point is a slum, home to 75,000 people who live in densely packed houses cobbled together from roofing tin. Its beautiful beaches are coated with a layer of garbage. Many former child soldiers, disabled by war, live here; drug use is common. There is a market on the one main road that connects the neighbourhood with the rest of the city, on which patrons can buy shark freshly caught by the fishermen who shove off the beaches in long, narrow boats.

Since there’s only the one road, it wasn’t hard for the Liberian army to quarantine the neighbourhood one cool night in the heat of the Ebola crisis in August 2014. The week before, health officials quietly converted a school building into an Ebola holding centre; when the locals found out, some looted the facility, carrying off items that had likely been contaminated. So when the Liberian president issued a curfew on 20 August, West Point was also put under quarantine. Residents awoke that Wednesday morning to find their commutes thwarted by barbed wire; fishermen were stopped from pushing off in their boats.

The locals rioted. They rattled barricades and threw rocks at soldiers, who responded by opening fire. Food and water were hard to find, medical care was even rarer. After 10 days, the president lifted the quarantine. A 15-year-old boy died of complications from bullet injuries in his legs. “You fight Ebola with arms?” a 34-year-old resident yelled at the soldiers, according to the New York Times. No one in West Point was diagnosed with Ebola.

In the wisdom and comfort of hindsight, experts can assess the world’s response to emerging pandemics. The 2009 H1N1 (swine flu) outbreak was well-contained, partly because of good communication and partly due to simple luck: the disease wasn’t as deadly as feared. The Middle Eastern respiratory virus (MERS), which hit South Korea in 2015, didn’t spread because it didn’t evolve and was quickly contained.

But to many experts, the world’s response to Ebola was wanting. Public health officials admit that action wasn’t fast enough, that misinformation spread quickly among a largely illiterate population, that foreign policy makers lacked a cultural understanding, which allowed the disease to spread, and that governments in the most affected countries used too much force. As a result, more than 11,000 people died of the disease in West Africa.

And yet the death toll would have certainly been higher if not for the lessons learned from HIV.

The engineers of the world’s HIV response in the early 2000s knew that they were laying the groundwork to combat future epidemics. Richard Holbrooke, who died in 2010, said in his 2006 PBS interview: “There’s a possibility that we’re entering into an age where new diseases are beginning to break out… If that’s true – and a lot of friends of mine in the field think it is true – the first lesson is you’ve got to move really fast. The second lesson is you have to get away from mythology, stigmatisation and all these other things that created such a slow, slow reaction to AIDS.”

Because of HIV and those discussions that began in 2000, governments and international organisations have logistical protocols to address new epidemics. Emerging diseases are now discussed at the Security Council, as AIDS was. Should a new one arise, officials in the US government, along with international organisations such as the UN and the WHO, have designated procedures for assessing the threat and working with experts on the best way to respond. Time, they have learned, is of the essence – the slow growth of HIV diagnosis programmes meant that many people spent a long time unknowingly infected – during which time they infected others; physician and radio show host Stanley Monteith wrote in 1997 that the AIDS epidemic would have been preventable had health organisations acted earlier.

Now experts know that early response is key. By April 2003, six months after the severe acute respiratory syndrome (SARS) epidemic started, the US had 289 suspected cases, But the disease didn’t spread because of good planning and communication between local and federal health workers, public health officials told the New York Times. And the impetus for that was laid in the framing of the disease as a threat to national security.

In the process of meeting the need for HIV testing and treatment in remote areas, many African countries developed sophisticated systems to monitor emerging diseases. Ebola would have been a disaster if it had spread throughout Nigeria, the most populous country in Africa and a hub for international travel. But it didn’t, Warren says, because of systems put in place to combat HIV which were then used to fight Ebola. “The surveillance system and treatments of those Nigerians with Ebola was so rapid that the disease didn’t spread,” Warren says. “If you look at why, it’s because the health system had been developed and strengthened from the HIV response.”

Researchers are also in a better position to meet the challenge of a new infectious disease. Epidemiologists developed new techniques, such as contact tracing, in which scientists work backwards from a newly diagnosed patient to determine where else the disease might spread. Teams of scientists brought together to discover treatments for HIV have used their expertise to treat other rapidly mutating diseases – a team of HIV researchers at Walter Reed Army Institute of Research, based in Maryland but with facilities in Africa and South-east Asia, created one of the most promising vaccines to fight Zika virus. And when it comes to disease research within communities, scientists have found that they get much more cooperation if they work with local governments and community advisory boards before starting a project.

Charged by the national security argument, militaries – especially the US military – have become the quickest and most efficient force for quelling emerging infectious diseases. “The only institution that was felt could address Ebola at the scale at which it was needed was the US military,” Joshua Michaud says – the army had the communication, infrastructure and transportation to get the job done.

But that can come with a cost. The need to act quickly can sometimes elevate issues past the normal democratic checks and balances, so they are subject to less scrutiny. When security is at risk, it gives militaries licence to infringe on civil liberties. That’s what happened to West Point during the Ebola outbreak. It happened elsewhere, too – in the US, many questioned the quarantine practices of the Centers for Disease Control and Prevention. One woman, a nurse quarantined for two days after she returned from treating Ebola patients in Sierra Leone, tried to sue the governor of New Jersey for unlawful detainment (a judge dismissed the lawsuit in September 2016).

“One downside is that the security discourse can be misappropriated by those in power and used improperly to justify punitive policies and laws, which are only likely to fuel stigma, fear and spread of disease further,” Peter Piot says. “The military has a role to play, we just have to think in a considered, nuanced manner about how they can best support civilian-led efforts to contain pandemics.”

Each new pandemic will be different – where it starts, how contagious it is, how it’s transmitted. But as government agencies push to act quickly, more officials are realising that the first actions taken to fight a disease can determine whether the efforts are successful. If misinformation spreads early on, it can lead infected people to be stigmatised, which may inhibit them from receiving the best possible care. Warren recalls photos from the early days of the fight against Ebola in which healthcare workers were reluctant to touch patients.

“For a lot of us working with HIV, some of those pictures were harsh reminders for what it meant to be patient-centred in our care,” Warren says. “The stigma and culture around disease, around clinical research, is really intense. We need to be sensitive to that.” Public health workers had collaborated with community leaders before, but they had never tried to create these partnerships on such a massive scale until the HIV response. Ceremonies surrounding stages of life, such as birth and reaching sexual maturity, create different ways for disease to spread. Only with sensitivity to local cultural practices – what purpose they serve, and how they can be modified while still keeping the main point of the ritual intact – could doctors and researchers stop the spread of disease. Officials were faced with a similar challenge during the Ebola epidemic, when they discovered that traditional burial practices, such as the communal washing and cleaning of the dead body, were spreading the infection.

§

Public health emergencies come and go, but HIV appears to be here to stay, at least for the next few decades. Some fear that, as health workers settle in for a long fight, governments will no longer prioritise HIV as they did a decade ago, limiting the funding to support their efforts. Progress in reducing the number of new infections has slowed. “AIDS is slipping down the policy agenda because we’re also now in the long slog phase,” Simon Rushton says. “We know it’s not something that will be solved in the next five to 10 years – it demands a continued commitment for another 20 to 30 years at least. That’s a much less sexy policy sell. Policy makers like problems they can solve during their term.”

With the election of Donald Trump as President of the United States, the country’s role in the continued fight against HIV/AIDS is further called into question. During much of Trump’s campaign, no one was certain where the candidate stood. There were reasons to feel optimistic about the country’s continued support. In a 2008 speech, Vice President Mike Pence, then serving in the House of Representatives, had said that the US had a “moral obligation to lead the world in confronting the pandemic of HIV/AIDS”, bolstering his stance with a security argument.

But early signs from the new administration have not been heartening. In his first week in office, Trump signed an executive order that withholds funding from organisations that perform abortions or provide information about them. In the past, similar but less expansive policies have resulted in the closure of many rural clinics, often the only place where locals could receive drugs to treat HIV and AIDS. Now many organisations fear the effect will be even more dramatic.

In some ways it’s harder than ever to imagine a world in which infectious diseases no longer exist, the idealistic bubble burst by HIV. And yet in other ways, the world is better poised than ever before to make that fantasy into reality. That single January 2000 meeting set the stage for leaders within countries to have their own discussions about how to respond to the epidemic, about how to spend money to counter it within their own borders and beyond.

As the then US Vice President Al Gore said at the meeting, AIDS “is a security crisis because it threatens not just individual citizens, but the very institutions that define and defend the character of a society”.

“It was one of the most exciting days we had in the UN,” Richard Holbrooke told PBS, “and I think history shows that it helped redefine the issue.”

This article first appeared on Mosaic and is republished here under a Creative Commons licence.

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Science won’t stop until it beats AIDS, says HIV pioneer

Francoise Barre-Sinoussi, French virologist and director of the Regulation of Retroviral Infections Division (Unite de Regulation des Infections Retrovirales) at the Institut Pasteur, poses during an interview with Reuters, in Paris, France, October 1, 2015. REUTERS/Philippe Wojazer

Francoise Barre-Sinoussi, French virologist and director of the Regulation of Retroviral Infections Division (Unite de Regulation des Infections Retrovirales) at the Institut Pasteur, poses during an interview with Reuters, in Paris, France, October 1, 2015. REUTERS/Philippe Wojazer

Oct 9 More than 30 years after she identified one of the most pernicious viruses to infect humankind, Francoise Barre Sinoussi, who shared a Nobel prize for discovering HIV, is hanging up her lab coat and retiring.

Story via Reuters
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She’s disappointed not to have been able to claim ultimate victory in the battle against the human immunodeficiency virus (HIV) that causes the killer disease AIDS, but also proud that in three decades, the virus has been beaten into check.

While a cure for AIDS may or may not be found in her lifetime, the 68-year-old says, achieving “remission” – where infected patients control HIV in their bodies and, crucially, can come off treatment for years – is definitely within reach.

“I am personally convinced that remission…is achievable. When? I don’t know. But it is feasible,” she told Reuters at her laboratory at Paris’s Pasteur Institute, where she and her mentor Luc Montagnier discovered HIV in 1983.

“We have ‘proof of concept’. We have…the famous Visconti patients, treated very early on. Now it is more than 10 years since they stopped their treatment and they are still doing very well, most of them.”

Sinoussi is referring to a study group of 14 French patients known as the Visconti cohort, who started on antiretroviral treatment within 10 weeks of being infected and stayed on it for an average of three years. A decade after stopping the drugs, the majority have levels of HIV so low they are undetectable.

These and other isolated cases of remission, or so-called “functional cure”, give hope to the 37 million people worldwide who, due to scientific progress, should now be able to live with, not have their lives cut short by, HIV.

In developed countries at least – and in many poorer ones too – an HIV positive diagnosis is no longer an immediate death sentence, since patients can enjoy long, productive lives in decent health by taking antiretroviral drugs to control the virus.

It’s a long way from the early 1980s, when Sinoussi remembers sick, dying HIV-positive patients coming to the doors of the Pasteur and pleading with scientists there for answers.

“They asked us: ‘What we are going to do to cure us’,” she says. At that time, she says, she knew relatively little about HIV, but what she was sure of was that these patients would never live long enough to see a treatment developed, let alone a cure. “It was very, very hard.”

Yet this interaction with real patients, and with their doctors and later their advocates, gave Sinoussi an important insight into what was needed to make her life in science one with meaning and impact — collaboration.

Working across barriers – be they scientific disciplines, cultural, religious and political divides, international borders or gender distinctions, has been and remains Sinoussi’s driving force.

In her earliest days, feeling disengaged while working on her PhD and itching for action in a real-life laboratory, she hustled her way in to working at the male-dominated Pasteur Institute for free with a virologist researching links between cancers and retroviruses in mice.

While viruses are her thing, she has throughout her career worked with, cajoled and learned from immunologists, cancer specialists, experts in diseases of aging, pharmaceutical companies, AIDS patients, campaigners, and even the pope.

“When you work in HIV, it’s not only working in HIV, it’s working far, far beyond,” she said.

Freshly armed with her Nobel award and fired up about a lack of support for proven methods of preventing HIV’s spread, Sinoussi wrote an open letter to then-Pope Benedict XVI in 2009 criticising him for saying that condoms can promote the spread of AIDS.

In what was widely seen as a modification of his stance in response to such criticism, Benedict said in a book a year later that use of condoms could sometimes be justified in certain limited cases as a way to fight AIDS.

Sinoussi says: “HIV has shown the way to go in the field of science. You can’t be isolated in your laboratory. You need to work with others.”

And this, she adds, is the “all together” spirit with which she advises her successors to continue after she’s gone.

Many will be sad to see her leave, but she has faith that her chosen field will deliver for the people who need it.

“Of course, I would love to have stopped and to see we had a vaccine against HIV and another treatment that could induce remission – but that’s life. I encourage the new generation of scientists today to continue our work.

“Science never stops,” she says. “Just because a scientist stops, the science should not stop.”

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Lord Fowler: Fight against HIV going backwards because of anti-gay laws

Lord-Fowler

Former Health Secretary Lord Fowler says the fight against HIV is “going backwards” because of anti-gay laws in many parts of the world.

Lord Fowler, who served as Margaret Thatcher’s Health Secretary until 1987, told BBC Radio 5 Live: “The real problem is that you have got 35 million people living with HIV in the world today, but half of those don’t know they have the infection.

“And one of the reasons why they won’t come forward for testing is because of the prejudice and the laws against homosexuality, against gay people, against lesbians and the stigma connected with HIV.”
The Conservative peer added: “Unless we tackle that; my fear is we are going backwards.”

AIDS: Don’t Die of Prejudice, a book written by Lord Fowler, charting the worldwide HIV/AIDS epidemic, is due to be released on Monday, 9th June.

Uganda’s Ethics Minister Simon Lokodo last month accused the country’s HIV support groups of “promoting homosexuality” and warned that he will take action against them.

The Ugandan Parliament has passed a bill that will criminalise intentional transmission of HIV as well as attempted transmission of the virus.  Human Rights Watch (HRW) described Uganda’s HIV law as “deeply flawed” in part because it is based on what the group called “stigma and discrimination.”

Article via Pink News

Want to know more about Lord Fowler? – Check out these articles and get in the know!

 

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Tory warns sex health cash cuts could lead to rise in HIV cases

Tory councillor Roy Webb is concerned about the impact of spending cuts on sexual health services.

Tory councillor Roy Webb is concerned about the impact of spending cuts on sexual health services.

FEARS of an increase in HIV infection rates in Derby if cuts proposed by the city council go ahead have been voiced.

Tory opposition councillor Roy Webb’s comments came after a letter opposing one of the cuts was sent to the authority by us, Leicestershire Aids Support Services.

The authority is proposing to cut £430,000 from the sexual health budget in the 2014-15 financial year.  The mooted cut was included in its recent consultation on how it will find £9 million of savings on top of £20 million already found.

It says the move would involve “ending service contracts for specialist sexual health promotion services,” and renegotiating contracts for “sexually transmitted infections and pregnancy testing”.

The document adds that the council wants to “refocus free oral emergency contraception to under-18s available to pharmacy outlets only”.  The city council was, on Friday, asked for more details but said it was unable to provide them.

But Mark Tittley, cabinet member for adults and health, said that, if the cuts went ahead, the council “would still continue to fulfil our statutory and moral duty to provide open access sexual health services to all within our community who need them, including people affected by HIV/Aids”.

Mr Webb, who is shadow cabinet member for health and adult care, said part of the cuts would hit Derbyshire Positive Support which gives confidential, stigma-free, support to people with HIV, and their families.

He said: “The withdrawal of contract funding for Derbyshire Positive Support may well, if it follows the national trend, increase infection rates as it has in areas where similar services have been decommissioned.”

A letter to the council from Leicestershire AIDS Support Services carries another warning.

It says: “Cuts will increase the likelihood of early death, and ill-health resulting in high levels of need for costly social care support and can be avoided by maintaining effective local services.”

Mr Webb added that, having met with a “public health official”, it was clear that any savings made in the budget were not going to be used to improve services elsewhere but “just used to support the council’s budget position”.

He said: “I think this a dangerous position to take as the on-going health and social care cost of failing to support these services could be much more expensive than keeping them.”

Mr Tittley said: “It is important to note that if these proposals are accepted by the council, we will still continue to fulfil our statutory and moral duty to provide open access sexual health services to all within our community who need them, including people affected by HIV/Aids.”

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Sex Education & Government / Internet Censorship

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The #CensoredUK hashtag, spearheaded by the Sex and Censorship group, has been drawing attention to some of the unexpected sites that end up being blocked when internet providers buckle to government demands to censor “adult content”.

Nine out of 10 homes will have porn filters on their computers by the end of January, after a Government deal with four big internet providers. Web giants TalkTalk, Virgin, Sky and BT, have all agreed to introduce network filters which can block inappropriate content from all the online devices within the home.

Across several mobile internet providers, however, harmless sex and relationships education sites are being blocked by their web filters.  For example, the sexual health charity Brook, has turned up on website checkers as being default blocked. But this is plainly not adult content, so why?

Another site that is blocked in some cases is the NHS page about sex and young people, which contains questions and answers about the changes teens can expect during puberty, advice around not abusing alcohol, and support for people who want to remain abstinent.

Most mobile providers offer a service where you can report incorrectly categorised sites. It’s unclear what happens when sex ed sites are reported, however.

And a separate study shows over-zealous Wi-Fi filters are blocking many harmless and helpful sites. One in three public Wi-Fi hotspots are preventing access to harmless sex education and religious sites, the research by AdaptiveMobile carried out during September across 179 locations in Birmingham, Manchester and London found.

Sexual health is not “adult content”. Lumping important (and for many young people, the only) sexual health advice they will have access to in with porn is a mistake.  More to the point, politicians need to understand that making internet providers do so is not the Government’s job.

There is also a concern for LGBT teens, some of whom will not have the support of their families and may have little access to safe, reliable information about sex and sexuality. What about them?

Maybe internet providers mistakenly believe that good, thorough sex and relationships education is available in schools, but as the Wonder Women Better Sex Education campaign has demonstrated this year, it isn’t. Sex ed in schools as it currently exists is not fit for purpose. The teaching guidelines haven’t been updated in over a decade and make no mention of the internet.

There are of course a myriad of other problems with the filters system. Sites that are critical of the way sex and sexuality is reported in the media are at risk of being blocked; the problematic news stories that make the rounds about gay people, trans people, and others won’t necessarily be.

Once a Government gets a taste for censorship, they rarely stop at “adult content”, as well. Think that the blocks accidentally keeping young people away from educational resources is a one off? Just wait until a political blog or forum you read gets blocked under the excuse of “banning extremist speech”. It’s not a question of whether this will happen, it’s when.

The bottom line is understanding the deep irony that by presenting internet censorship in the wrapper of protecting kids, we may actually be keeping them from information that has been shown to actually protect them. The question now is: does the Government care?

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Doctors Criticise London HIV Drugs Cost-Cutting Deal

Medical professionals and patient support groups have raised concerns after people with HIV in London have been asked to switch to taking different antiretroviral drugs, as part of cost-cutting measures.

In April, London HIV Consortium, which is responsible for the capital’s HIV services, was tasked with saving £8m over two years, having to manage growing patient numbers on a budget that has not increased in line with inflation.

London Specialised Commissioning Group (LSCG), which commissions the capital’s HIV treatment, negotiated terms with atazanavir manufacturer Bristol Myers Squibb to receive discounts for larger orders of the drug.

As a result, clinics have been given new “prescription messages” – recommending doctors ask certain HIV patients who take a life-saving protease inhibitor other than atazanavir to switch to atazanavir – with saving money given as the overriding justification.

But now HIV doctors and support groups have raised concerns that switching prescriptions creates “medical risks” and raises “ethical issues”.

LSCG HIV drugs commissioner Claire Foreman said: “It is not in anyone’s interest – not our patients nor the taxpayer – to treat fewer people with more expensive drugs.

“There are no financial incentives for clinics to switch patients.”

No HIV patient will be prescribed an incorrect medicine as a result of this process” – Claire Foreman, Lead commissioner, LSCG

However, an HIV specialist at a London clinic, who wanted to remain anonymous, told the BBC: “Clinics are under financial pressure to contribute to the £8m savings.

“A confidential statement went out to doctors saying ‘there is a carrot and sticks approach to this. If you reach your targets each individual service will be set, there will be benefits for you this year, and clearly be benefits for you in next year’s budget’,” he added.

“Claire Foreman has back-pedalled on this.”

Ms Foreman denied this allegation, adding: “Doctors are taking a leading role to ensure patients can be treated despite the pressure on budgets.”  The clinician added it was “clearly evident” if doctors did not meet targets for patients switching to atazanavir.

“Doctors are under pressure from the LSCG to get patients to swap to cheaper prescriptions.  I’m not sure if it was taken into account the pressure that would put clinicians under,” he added.  “Not only does that discomfort the patient, it’s costing us in terms of clinic visits.”

Ms Foreman said this was not the case, adding: “No HIV patient will be prescribed an incorrect medicine as a result of this process.”

The anonymous specialist went on to say: “It’s difficult to prescribe certain pills in London, that people outside London can get, due to financial pressure from doctors’ managers.”

Patient Choice

LSCG said its prescription messages were in line with British HIV Association guidelines, but these were last updated in 2008 so did not consider drugs licensed since then.

More recent guidelines, including those of the European AIDS Clinical Society, recommend a range of drugs which are available through the NHS but are not suggested for prescription in LSCG’s messages.

However the specialist cited raltegravir as an example of an antiretroviral drug “that everyone wants access to, because it has few side-effects.

AHPN chief Francis Kaikumba fears African communities will be adversely affected

“But commissioners have stated it will only be used under certain circumstances.

“That’s entirely down to cost pressures. It would be easier to get outside London,” he said.  The specialist added: “The prescription messages stop putting patient choice at the centre of care in London.”

“This could potentially damage doctor-patient relationships.”

LSCG said: “All standard of care drugs licensed in the UK are available for use by HIV doctors.”

Dr Mike Youle, an HIV consultant at north London’s Royal Free Hospital, told the BBC about potential ethical and medical implications of switching patients’ prescription.

“When you’re talking about someone who has been stable on a drug for five years, I see no medical reason to change their prescription,” he said.

“There’s an ethical issue about switching people.”

But Prof Brian Gazzard, chairman of the drug purchasing group which advised the consortium, said: “All the doctor needs to do is note the reason the patient doesn’t want to switch.”

Meanwhile, African Health Policy Network chief Francis Kaikumba said: “Vulnerable African communities will be adversely affected as studies have shown African people are far less likely to question their health advisors.”

Ms Foreman said: “Clinicians and commissioners have been clear that any targeting would be unacceptable.”

Side Effects

Addressing the medical implications, Dr Youle said: “Every time you change medication with HIV, you run two risks.  One is having a side-effect. Something might go wrong.  The second is you might fail on the next drug. The virus might be resistant and you may put your health at risk.”

Prof Gazzard said: “Switching can involve side effects. If it does the patient will be told ‘we’ll switch you back’.”

Switching HIV drugs can involve side effects

Dr Yusef Azad, from the National Aids Trust, highlighted emotional pressures patients might come under saying: “With HIV, daily adherence is vital. Concerns about their medication might undermine a patient’s willingness to adhere to treatment.”

Prof Gazzard said: “If stress is being introduced into that system it’s a problem between the doctor and patient, not the London Consortium.”

Meanwhile, Dr Youle asked: “What happens when the next tender goes out and a different drug becomes the cheapest?”  You then have to say the drug you were originally on is cheaper and we’re going to move you back.”

Prof Gazzard said: “There will be a balance between the saving and the difficulties of switching people every two years.”

Some HIV support groups have said the deals between the LSCG and pharmaceutical companies were rushed through.

Robert Fieldhouse, editor of Baseline, a magazine for people living with HIV, said: “The consultation took place behind closed doors with the wider HIV community in the dark.”

But Ms Foreman said: “Commercially confidential processes mean specific prices of companies cannot be shared.”

Dr Asad said a wider debate should have been had before procurement.  “It would have been better to have a more open discussion earlier – asking ‘is it ok to switch stable patients simply on the basis of cost?’,” he said.

Meanwhile, with the government’s Health and Social Care Bill proposing to shake-up the way the NHS in England works, London’s HIV drugs procurement will be closely scrutinised to see how money savings could be implemented on a wider scale.

Original Article By Andy Dangerfield via BBC News

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Consultation To Start On Managing Urgent Care In Loughborough

Members of the public are being invited to have their say on the Walk-In Centre and the future of urgent care in Loughborough and surrounding areas.

West Leicestershire Clinical Commissioning Group (WLCCG), which will be responsible for commissioning or ‘buying’ local healthcare from April 2013, has been looking at urgent care services locally and how they are provided.

The CCG wants to ensure that when people need urgent care they can receive it as effectively as possible, whilst looking to work with other parts of the NHS to ensure that local services such as the community hospital are as effective as possible in bringing care closer to home.

As part of this a 12-week public consultation started last Wednesday (19 October) [Ed: We only received this news today, sorry for the delay], which offers two options:

· Option one is urgent care at the current Walk-In Centre at Pinfold Gate

· Option two is urgent care provided at Loughborough Hospital in Epinal Way

Option two is the preferred option as the hospital, which is 1.6 miles from Pinfold Gate, can provide more access to diagnostic tests, including more extended access to x-rays, potential access to ultrasound scans and blood tests. There are also beds where there is potential for patients to be kept in for observation and further potential for access to clinicians already working in the hospital.

Dr Nick Willmott, a GP and chairman of the group planning the development of urgent care in West Leicestershire, said: “This consultation is about enhancing services and making sure that patients receive the best care in the most appropriate setting for their health needs.

“We believe that our plans will provide an enhanced service for those who need urgent care, whilst we continue to encourage people to see their GPs when possible for less urgent needs.  Moving the Walk-In Centre could bring care closer to home for many patients accessing the urgent care service and could mean they wouldn’t have to travel into Leicester. It would also avoid duplication of services locally.”

Dr Edward Clode-Baker, of Parkview Surgery, added:

“GPs want, wherever possible, to be the first port of call if you’re in doubt about what care you need. We are doing all we can to improve access both to telephone advice and seeing patients appropriately. This will free up services at the Walk-In Centre to treat those with urgent need.”

The project group developing the proposals included GPs, a representative of Leicestershire Local Involvement Network (LINk), a patient representative, and officers of the West Leicestershire CCG. Feedback has also been received from staff at the Walk-In Centre, local government colleagues and the local MP. Leicestershire LINk has been involved in the consultation process and the engagement event held in August, and will be monitoring developments closely on behalf of patients and the public.

NHS West Midlands Clinical Commissioning Group have produced a document: “Loughborough Walk-In Centre, Managing Urgent Care In Loughborough – A Public Consultation” (pdf).  This document gives you the background to their public consultation about the Walk-In Centre and urgent care in Loughborough.

The Walk-In Centre provides urgent care services in Pinfold Gate for people living in or near Loughborough. they have proposals about how people can receive these services in future, and we need to understand what local people think about these proposals. They propose to create an urgent care centre
at Loughborough Hospital which will be supported by all the services available at
that centre. We believe this will produce an enhanced service for the local population with the coming together of the professional expertise and diagnostic services that can be provided by Loughborough Hospital. This can only be achieved by the movement of the Walk-In Centre and the resources that
support it.

Please take a few moments to read through the document, and then to answer the questions at the end.  The information and questionnaire are also
available online, at http://www.lcr.nhs.uk

During the consultation people will be able to have their say in a questionnaire which will be available from the Walk-In Centre, local libraries, GP surgeries and council buildings, as well as online by visiting http://www.lcr.nhs.uk before 11 January 2012. It will also be available to fill in at a series of public meetings, which take place on:

For more information, or to request a questionnaire via post, please call Jo Lilley on 0116 295 7626 or email jo.lilley@lcr.nhs.uk

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