Tag Archives: hiv and aids

David Cameron’s HIV Hypocrisy

david cameron

Just a few weeks ago David Cameron and other MPs sat in the House of Commons and wore red World AIDS Day ribbons for a community they clearly don’t understand.

“The ribbon is the universal symbol of HIV awareness and it was good to see so many MPs showing solidarity with people who live with HIV in the UK and around the world,”  ​said Cameron in his statement on December 1st. “Whilst the overall number of new diagnoses last year was down slightly on 2010, there was an increase amongst men who have sex with men. And a quarter of people living with HIV don’t know they have it. I am absolutely clear that there can be no complacency in our fight against HIV and AIDS.”

Cameron concluded by saying how the red ribbon is about more than showing solidarity with those living with HIV in the UK and abroad.

“It should also be a spur to increase testing and a symbol of our commitment to carrying on work to reduce infection levels whilst tackling the stigma, discrimination and prejudice often associated with HIV and sexual health.”

But we’ve heard it all before. Politicians deliver compassionate messages one day and deliver crushing blows the next. Despite more and more young people  ​being diagnosed HIV positive because of a lack of information about the issue, the government has announced that there will be ​devastating cuts to the national HIV prevention programme in England.

Funding will be halved for the year commencing April 2015 and there is, as yet, no government commitment to fund further years of the programme. It seems like yet another complete refusal to believe that the most imperative is needed at ground-level.

“This is not the right time for the government to pare back spending on HIV prevention,” says Dr Rosemary Gillespie, Chief Executive at  ​Terrence Higgins Trust. “In recent years, we have made good progress in driving down rates of undiagnosed and late-diagnosed HIV. However, tens of thousands of people with HIV across England are still undiagnosed and at increased risk of passing the virus on unwittingly. We have not yet reached the tipping point in our fight against the epidemic, and halving government spending on HIV prevention now would be a regressive step that risks undermining the headway we have made.”

The government’s ill-considered decision is in direct contradiction to Simon Stevens’ ‘ ​NHS Five Year Forward View‘, released in October. “The future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health,” he wrote. “Twelve years ago, Derek Wanless’ health review warned that unless the country took prevention seriously we would be faced with a sharply rising burden of avoidable illness. That warning has not been heeded – and the NHS is on the hook for the consequences.”

Stevens’ report has been immensely influential and all the main political parties have expressed their support for its vision for the future of the NHS. It is striking that, within weeks of the government stating its support for the health vision of this publication, they are expressly contradicting one if its key tenets – the absolute centrality of prevention if we are to regain control of NHS finances.

“We have not yet reached the tipping point in our fight against the epidemic, and halving government spending on HIV prevention now would be a regressive step that risks undermining the headway we have made”  – Dr Rosemary Gillespie, Chief Executive, Terrence Higgins Trust

In 2004 there were 38,117 people with diagnosed HIV living in England. In 2013, that figure had risen to 74,760. Meanwhile, funding for HIV prevention work has drastically declined during that same period while transmission rates soared. Rather than increasing its efforts to tackle the spread of HIV and the existing stigma, the government’s response is to further squeeze the sector of its resources.

What’s more shocking still is how the government cuts affect two specific minority communities. The national HIV prevention programme focuses on two groups – men who have sex with men, and black African men and women. Yusef Azad of  ​National AIDS Trust agrees that the government is ignoring the needs of these communities.

“HIV is a health inequalities issue, since it disproportionately affects these minorities. Were British-born heterosexuals seeing the same percentages getting HIV as gay men and Africans there would be immense efforts by government to address the problem. When gay men and Africans experience such a public health crisis the response is to reduce further already inadequate funding.”

What this farce highlights is that the government, yet again, is looking for short-term gain at long-term sacrifice. Save money today, but let’s not think about the consequences of tomorrow.  Azad agrees. “All governments pay lip-service to this principle and to the fact prevention is cost-effective and often cost-saving. It is only in a time of budgetary pressure that we learn whether they really mean it.

Preventing just one HIV transmission saves the public purse ​£360,777, according to recent modelling. The national prevention programme pays for itself many times over. “This cut will not save £1 million, says Azad. “It will mean spending many millions in preventable treatment costs.”

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Teens Don’t Know HIV Is a Sexually Transmitted Disease

teenage silhouettes

A new study published by the MAC AIDS Fund shows a third of teens don’t know HIV is a sexually transmitted disease. Have the lessons of generations past been lost?

That’s the conclusion reading the results of a new survey put out by the MAC AIDS Fund (PDF). The online survey of about 1,000 teenagers was conducted this year by the communications firm Kelton, and does reveal some worrisome data about their attitudes and level of information about HIV and AIDS. Given its funding source, it makes sense that those facts would be the focus of the report. But taken as a whole, the results indicate that adolescents have a pretty good understanding of what choices are most likely to worsen their health over time.

The most startling and worrisome finding (helpfully highlighted by Vox) is that roughly a third of the respondents did not identify HIV as a sexually transmitted infection (STI). If a true reflection of teenagers’ knowledge of how HIV is spread, that number is troubling indeed. A 2002 study of youth at an urban clinic found that, despite spotty knowledge about STIs as a whole, HIV was identified as such by 91 percent, a larger number than identified any of the others. While a difference in study populations may account for some of that discrepancy between the two surveys, a drop to 67 percent in the span of a dozen years would be a precipitous decline in informedness.

Unfortunately, it’s difficult to know how much credence to give those findings. Unlike studies that typically appear in peer-reviewed journals, there is little information provided by Kelton in the report regarding the survey methods. While it’s certainly possible that teenagers have become drastically less informed about HIV than they should be, it’s hard to put aside skepticism about how solid those numbers are without seeing how the survey was worded.

Taking the numbers at face value, the survey finds that 88 percent of teenagers don’t perceive themselves to be at risk for lifetime HIV infection. In contrast, they are concerned about the risks of developing cancer (38 percent), diabetes (33 percent), heart disease (28 percent) and obesity (22 percent). Comparing the prevalence of HIV infection to mortality and obesity rates in the United States, those attitudes are actually pretty sensible. While 50,000 new HIV infections a year are far too many, on balance adolescents are at far more risk of developing those other health problems.

The survey reports that less than a third of respondents rated having unprotected sex as the most risky health behavior they could be engaging in. However, that’s still more than those who rated smoking or drinking (28 percent) or eating unhealthy foods (20 percent) as the riskiest. Without seeing the study’s methods, it’s impossible to know what those numbers really mean. Were respondents only given one choice or asked to rank several? Just because a teenager thinks drinking is the most risky thing she could be doing (which, given the effects of drinking on mortality, isn’t a crazy answer) doesn’t mean she perceives unprotected sex as being risk-free.

For an organization like the MAC AIDS Fund, it makes sense to look at the survey results and respond with alarm. Its focus is on HIV and AIDS, and the report certainly indicates that there is work to be done in communicating to youth about preventing infection. But when viewed as part of a bigger picture, it shows that teenagers have a good idea of what their long-term health risks truly are. Coupled with data showing decreased risk behavior among adolescents as compared to older generations, it’s actually rather encouraging.

What is truly discouraging are the numbers regarding new HIV infections among men who have sex with men (MSM), the group comprising the largest number of new diagnoses by far. Among MSM aged 13-24 years rates of new infections have actually risen over the past decade, while the overall rate of new diagnoses has dropped by 30 percent.  While medications like Truvada can be used to lower the risk of infection for those engaged in high-risk behaviors, that doesn’t mean attention to lowering those risks isn’t important.

Though reading of the report is that most teens have a good idea about the health risks they actually face, it remains important to inform adolescents about their risk of infection with HIV. The survey report contains no information about the respondents’ demographics beyond their ages, so it’s impossible to know how many fall into higher-risk groups. For those who do, giving them the information they need to lower that risk remains just as important as ever.

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Have we reached the beginning of the end of the fight against HIV/Aids?

The beginning of the end in the global fight against HIV and Aids is pencilled in for 2015. Experts believe a ‘tipping point’ will be reached whereby the number of people receiving treatment in a year is greater than the number of new infections.

Considering the first World Aids Day took place 25 years ago in 1988, it’s a remarkable achievement. Today, there are about 35million people with HIV and Aids in the world, with 9.7million receiving treatment that can enable a long and healthy life.

Ten years ago, just 300,000 people received such treatment so it’s clear there have been major gains, and although experts, campaigners and health practitioners are buoyed the ‘tipping point’ is on the horizon, hard work lies ahead. Erin Hohlfelder, global health policy director of the One Foundation and author of its report The Beginning Of The End?’, feels reaching the tipping point will be a landmark in the fight against HIV and Aids. ‘The disease has been outpacing us for decades, with more new infections than people being added to treatment.

‘To use an analogy, if you had five cuts on your hand, we’ve only had one plaster to treat the cuts, so you’re still bleeding,’ she said.

‘The tipping point, where we have more people living healthy lives through treatment for HIV, than newly infected people, means we’ve caught up with the disease and begun to get ahead of it, so it’s a critical moment. It’s a marker that signals for the first time HIV and Aids is on a downward curve,’ said Ms Hohlfelder.

0502-aids-part-1

Reaching the tipping point in 2015 would be seven years earlier than expected so what’s driving this accelerated progress?

‘Some 69 per cent of people with HIV are in sub-Saharan Africa… We found there are 16 African countries that are ahead of the curve and have surpassed this tipping point, so they’re leading the global trend, not following it,’ said Ms Hohlfelder.

‘Leaders such as Ghana, Malawi and Zambia have a political will to fight HIV and Aids with heads of state and ministers sending out consistent messages and they smartly combine international donor assistance with domestic finance, so there’s local ownership of HIV programmes – that’s important.’

Government attitudes towards marginalised groups can also play a big part in the battle.

‘In Zambia, the first lady recently spoke out against homophobia this is really important in accessing services and preventing the spread of HIV. Marginal groups could be homosexual communities, drug users, sex workers, migrant workers and in some cases, women, and if they’re unable to access services, support and treatment they can drive the HIV epidemic,’ said Ms Hohlfelder.

Dr Patricia Asamoah worked with HIV positive mothers in Tema Hospital, in Accra the capital of Ghana and has seen first hand how treatment has changed dramatically in the last ten years.

0502-aids-part-2

‘When I started in 2002, we saw people who were very ill through HIV, they were dying and we would go to sleep in the knowledge that when we woke up, some would be dead – it was as simple as that. There was not much we could do, at all,’ she said.

‘There has been huge progress: being diagnosed with HIV used to be a death sentence, now we are able to manage a chronic disease through treatment. I had one patient Ruth, a young woman who’s husband left her because she had HIV, however she got married to another gentleman who has HIV and through treatment they have had a son who is HIV free – it’s beautiful thing to see there is life after HIV, you can have babies, a career and a normal life,’ said Dr Asamoah.

Ms Hohlfelder and Dr Asamoah urge world leaders and the international community to commit to fund the fight against HIV and Aids, and achieve the tipping point in 2015.

‘In some ways, the fight’s a victim of its own success as people are living healthy and productive lives, so there’s much less fear than in the 1980s and 1990s, and as a result it’s lost its political momentum. If we don’t reinvigorate that momentum, it could stall or slide backwards,’ said Ms Hohlfelder.

Dr Asamoah feels we can’t rest on our laurels: ‘I never want to go back to those depressing, helpless times, when I could only tell people who came to my clinic they had HIV and do nothing to help them, so we cannot forget.’

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Should the “New” Russian HIV Strain Cause Concern?

test-tubes

There has been a lot of play in the press recently about a “new and more virulent strain of HIV” (Daily Mail, Oct. 17) that appears to be spreading quickly in parts of Russia and Central Asia.

According to the epidemiological reports, this new recombinant form of HIV-1 — called 02_AG/A — is spreading at a faster rate than the dominant subtype, HIV-1 A. Moreover, the prevalence rate in some parts of Siberia have spiked by as much as 700% in the past five years, with nearly one out of every 180 persons infected.

Of these, 50% can be attributed to 02_AG/A.

What’s causing the most concern among global health officials is the fact that Eastern Europe and Central Asia are the two areas in the world where HIV infections are actively increasing.

The question is whether this “new” HIV strain is the cause of the increase. Is it as virulent as some are claiming, or are there other factors playing a key role (e.g., social, behavioral)?

Looking at the epidemic up-close, injection drug users and their sexual partners still remain the major drivers for the epidemic in the majority of Russian regions. A steady drug trade from Central Asia through the western borders of Russia — combined with increases in migratory labor and international travel — have likely contributed to the genetic diversity in the regional HIV pool.  Over time, this gave rise a recombinant form of HIV that appears to be more “fit” than other forms of HIV, allowing it to predominate.

But does this, in and of itself, mean that 02_AG/A is a “meaner, scarier” version of HIV, able to infect more easily than other HIV strains?

In truth, the fact that it has spread so quickly, taking a leading position in some regions, does warrant concern. One study conducted by the New York University School of Medicine suggests that 02_AG/A is able to replicate nearly 1.5 times faster than parental subtype A. Simply put, the replication rate may allow the virus to “build traction” more quickly in an effected host, far in advance of an immune response.

But what all of this doesn’t suggest is that 02-AG/A is any more or less deadly than other forms of HIV. In fact, a four-year study by the University of Montepelier in France showed that the 02_AG strain (which predominates in Cameroon and West-Central Africa) does not differ from other forms of HIV in the region, either in terms of survival, disease progression, or CD4 cell decline.

However, none of this can downplay the fact that, unless Russian health authorities act now, the spread of 02_AG/A may thwart any effort to stave the alarming HIV infection rates in the region… or the spread the virus to other regions and continents.

Via About

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Teaching HIV/AIDS Denialism?

An Italian university is investigating whether a professor was right to teach a course denying a causal link between HIV and AIDS.

Marco Ruggiero does not believe that HIV causes AIDS. Image credit: M. Ruggiero

The University of Florence has launched an inquiry into the teaching activities of an academic who assisted on a course that denies the causal link between HIV and AIDS, and supervised students with dissertations on the same topic.

The Italian university’s internal ‘special commission’ will examine the “teaching behaviour and responsibility” of molecular biologist Marco Ruggiero, a university spokesman told Nature.

The move follows a letter to the institution’s rector, Alberto Tesi, by an Italian campaign group called the HIV Forum, which represents people infected with HIV and others concerned about the disease (view this letter here).  It calls on him to disassociate the university from the “science and activities” of Ruggiero, who, the group says, is “internationally known” for denying the widely accepted link between HIV and AIDS, and promotes a potential cure for HIV involving an enriched probiotic yoghurt for which there is no proven evidence.

Tesi replied on 29 February to announce the special commission. This “will examine whether professor Ruggiero’s conduct complies with the institutional guidelines on teaching contents and adherence to the objectives of the official curriculum of biological sciences”, says university spokesman Duccio Di Bari, who adds that any misconduct would be dealt with internally. The commission comprises Elisabetta Cerbai, the university’s vice-chancellor for research; Paola Bruni, the dean of the School of Science; Sergio Romagnani, an emeritus professor and expert in immunology; and Massimo Benedetti, who is responsible for university legal affairs. They will hold hearings behind closed doors.

Death Denial

The investigation is the latest twist in the fallout from a paper published in December in the Italian Journal of Anatomy and Embryology (IJAE) by researchers including Peter Duesberg, an academic at the University of California, Berkeley, well know for denying the link between HIV and AIDS. The paper, which challenges estimates of HIV–AIDS death tolls in South Africa, has received heavy criticism from scientists, who have questioned how it could have passed peer review, and has led two members of the IJAE editorial board to resign in protest (see ‘Paper denying HIV–AIDS link sparks resignation on Nature.com‘). That Ruggiero was one of the paper’s nine co-authors prompted the HIV Forum to write to the rector.

The forum cites two student dissertations (J Branca and C Matteuzzi) mentored or co-mentored by Ruggiero that argue against the consensus that HIV causes AIDS. “Most available evidence does not support a causative role for HIV in AIDS,” they both conclude.

The HIV Forum also refers to a short elective course, consisting of two half days, which is understood to have run twice in the 2010/11 academic year, and which Ruggiero collaborated on, entitled: ‘The revolution of immunotherapy: prospects for the treatment of cancer and AIDS’. According to the description, the course teaches “the role of HIV in the pathogenesis of AIDS; association but not causation”.

“What devastating effects can such false teaching have on future physicians and their patients?,” asks the HIV Forum, stressing that although academic freedom is fundamental in teaching and research, it should not be misused to spread theories that they say are “lacking any scientific evidence”.

“We hope the Commission will be scientifically rigorous and we hope that it will state that the best way to protect academic freedom is to teach according to the worldwide recognized scientific method,” says a forum spokesperson.
Parallel lines

Ruggiero, whose supporters have also written to the rector, says he has always operated with scientific integrity and is confident he will be able to give any explanations that the committee asks for. He draws parallels with an inquiry the University of California held two years ago into the conduct of Duesberg, which resulted in no charges.

“Florence is famous for having been the city of Galileo Galilei, the worldwide recognized symbol of the predominance of scientific freedom over dogmas. I am convinced that freedom of teaching and research is a stronghold of our university system,” he says. He adds that the student dissertations and the course were approved by the university.

The commission was welcomed by Fabio Marra, a professor of medicine at the university, who says the institution must shed “full light on the events”.

“I believe that every researcher has the right to submit his or her work through peer-reviewed journals, no matter how little credibility that data may have,” Marra says. “What is not acceptable is that personal theories, that are not supported by the weight of evidence, are taught to students that do not yet have the skills to form an independent opinion and to discriminate what they are being taught from what the bulk of the literature has shown.”

The special commission is due to report by 15 April.

Original Article by Zoë Corbyn at Nature.com

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