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Archive for the ‘HIV/AIDS’ Category

While in Lusaka, Zambia with our congressional study tour, I had a chance to speak with some of the leading community activists about issues of concern related to the treatment financing gap, their input into agreements being negotiated between the U.S. and Zambia, and the urgency of Zambia’s pending application to the Global Fund for treatment funding.  They also commented on the importance of HIV counseling and testing for couples.

On Aug. 22, I spoke with Miriam Banda, a member of the Community of Zambian Women Living with HIV/AIDS (COZWA), and Michael Gwaba, of the Community Initiative for TB, HIV/AIDS & Malaria (CITAM+). Mr. Gwaba is a global ambassador with the Here I Am Campaign, and he will soon be visiting the U.S. on a speaking tour sponsored by RESULTS. Both are living with HIV.

In this first section, both activists discuss the importance of providing counseling and testing to couples as a way of involving men.

In this second section, they discuss the large projected gap in financing required to enable some modest scale up of access to antiretroviral therapy. JSI Deliver has worked with the Zambian government to estimate a gap of $8.2 million in 2011, growing to $57.6 million in 2015. We discuss innovative ways in which Zambia could raise funds on its own to help close the gap.

We also discuss how important it is that Zambia’s application for treatment resources via Round 10 of the Global Fund be successful. They state that, despite problems the Fund has encountered in Zambia, they are confident Fund resources would reach people in need (the funds would not be channeled through the Ministry of Health but rather through the UNDP).

In this last section below, I asked these activists about how open the President’s Emergency Plan for AIDS Relief (PEPFAR) program is to input from civil society. I asked about the negotiations over the PEPFAR Partnership Framework with Zambia.  They said they urged that compensation for community health workers be included in the agreement.

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Male circumcision (MC) was a recurring theme throughout our congressional study tour, since the intervention has been shown to provide up to 60 percent protection for men from HIV infection from a female partner. There is also evidence that it reduces the chance of the female partner contracting some genital infections that could lead to cancer of the cervix.

Access to MC is being scaled up across many parts of Africa. It is particularly important given the significant proportion of discordant couples in which the man is HIV negative and the woman is HIV positive (about 40 percent in Kenya, for instance).

Zambia has a circumcision rate of about 13 percent.  In only one area of the country, the northwest, the practice is a normal part of male initiation ceremonies.

A young man waits in line to be circumcised at the Livingstone General Hospital male circumcision unit. "It's good for my health and my parents want me to get it done," he said.

A recent study by the U.S. Agency for International Development found that a rapidly scaled up MC effort in Zambia would avert 28 percent of HIV infections, with an enormous cost savings in the long term.  The study found similar results for many other countries.

At our hotel in Livingstone, in southern Zambia, we asked some of the young male workers about the experience with circumcision, and they were not shy about the topic.  (more…)

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When Mark Heywood helped found the AIDS Law Project in South Africa in 1993, there were slightly fewer than one million South Africans infected with HIV/AIDS.  There was no national antiretroviral treatment (ART) program, and drugs were extremely expensive, making it almost impossible for people living with HIV/AIDS to get treatment. 

Mark Heywood, founder of the Treatment Action Campaign and the AIDS Law Project, speaking to Congressional staffers last week in South Africa.

The AIDS Law Project aimed to improve the lives of those infected by using the legal process to garner more rights.  For example, they launched a case against South African Airlines for refusing to employ those infected with HIV/AIDS as cabin crew.  “If you had HIV, you were blocked in your life experiences,” Heywood said when speaking with Congressional staffers last week at his Johannesburg office. He spoke about the current state of the HIV/AIDS epidemic in South Africa and discussed the challenges in the fight against the deadly disease.

Almost two decades later, more one million people are currently receiving ART thanks to funding from programs like the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund.  About 40 percent of people who require treatment are receiving it.  Now Heywood, also one of the founders of the Treatment Action Campaign, is the deputy Chairperson of the South African National AIDS Council and the director of Section27, a public interest law center that seeks to influence, develop and use the law to protect, promote and advance human rights.

Section27, which incorporates the AIDS Law Project, was established in May of this year and is named after section 27 of the South African Constitution, which provides that everyone has the right to have access to sufficient food and water, social security and health care, including reproductive health care. (more…)

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Here are some quick summaries of technological newsmakers from the past week:

  • Two cancer drugs stop HIV in its tracks: Using a mixture of two anti-cancer drugs already on the market, researchers at the University of Minnesota say they have found a promising new treatment for HIV. During lab experiments with mice,” the drugs gemcitabine and decitabine caused the HIV virus to “mutate itself to death, researchers said. The drugs are already approved by the Food and Drug Administration for the treatment of other diseases, and researchers say the study sheds light on a new way of attacking the virus without causing toxic side effects.  It will be some time before the treatment is available to humans.

 

  • HIV hides in the brain: New findings in studies of the spinal fluid of patients treated with antiretrovirals suggest that the brain can act as a hiding place for HIV, perhaps suggesting more needs to be done in the HIV drug development arena to incorporate how these treatments affect HIV in the brain. A thesis from the University of Gothenburg, Sweden, showed about 10 percent of patients had traces of virus in their spinal fluid but not in their blood – a larger proportion than previously realized.  

 

  • Blood test for TB might soon be a reality:  Scientists have found a “genetic signature” in the blood of patients with active tuberculosis, which could help with the development of a blood test for the disease as well as better treatments. More than 2 billion people worldwide are estimated to be infected with tuberculosis, the majority of who are asymptomatic.  The test would distinguish the 10 percent of people infected with TB who will go on to develop the full-blown disease from the 90 percent of healthy carriers who have the latent, asymptomatic form of the lung infection.  The study appears in the latest issue of the journal Nature

 

  • Vitamin A increases HIV MTCT during breastfeeding: Vitamin A and beta-carotene supplements should be avoided by HIV-positive women who are breastfeeding. That’s according to a new article in the American Journal of Clinical Nutrition and the Journal of Nutrition. The supplements might boost the excretion of HIV in breast milk, increasing the chances of transmitting the virus to the infant.

Stay tuned to ScienceSpeaks for regular scientific updates.

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The One Blog this week posted a video (accompanies this post) from David Rochkind, an award-winning photographer working on a project to illustrate the impact of tuberculosis on the world. In the video, Mariana Bernofsky tells of her experiences as a pregnant woman with TB in Balti, Moldova. More of Rochkind’s work is available on his blog.

Sten Vermond, a member of our Scientific Advisory Committee, recently published a review in Clinical Infectious Diseases of two promising strategies for “treatment as prevention:” preexposure prophylaxis and “test and treat.” He and co-authors argue that the HIV epidemic can be controlled by maximizing the potential of these existing methods, developing new strategies for prevention, and then combining them effectively.

A new World Health Organization (WHO) recommendation that mothers who are HIV-positive and on ARV treatment can breastfeed their children for up to twelve months without passing on the infection has created confusion among (more…)

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Director of  The Center for Global Health Policy Christine Lubinski recalls her recent trip to South Africa and Zambia, where she and other Center staff hosted five congressional staff members on tours of U.S. government funded programs to address HIV and TB. 

While visiting Livingstone, Zambia, several of us had the opportunity to visit Family Health International’s (FHI) Corridors of Hope program, a community-based prevention program aimed at sex workers.  Our visit took us to the heart of an impoverished community where this group meets weekly outdoors to discuss challenges and problems associated with their lives — from negotiating condom use to remaining adherent to their HIV medications.  Most of the weekly groups focus on a particular topic.

A group of women gather in their neighborhood to participate in the FHI Corridors of Hope program in Livingstone, Zambia.

On this particular day, some 35 women came out to meet with our group of American visitors.  They ranged in age from late teens to middle age.  They represented a mix of clients of the program and peer educators—many of whom were retired sex workers who had been trained by FHI staff.  Many had babies and young children in tow, and virtually all of them reported being mothers.  In fact, about half of them indicated that in addition to their own children, they were raising the children of others who had died from AIDS.  A number of them were responsible for raising as many as five children.  Children played in the dust around their mothers, some of them with empty condom wrappers that were ubiquitous in the compound.

The women clearly found the program and the support group a help and a respite from challenging lives.  Many spoke about wanting to continue their education.  Unplanned pregnancies had clearly interrupted the education of some.  Now, the care of children and the fees associated with even public education seemed an insurmountable barrier for many in the group.

The program provides these women with HIV and TB screening, sexually transmitted infection diagnosis and treatment, and linkages to HIV treatment.  It also provides the group support that empowers them to demand that their clients use condoms.  FHI staff and their peer educators also work to assist the women in identifying other ways to earn a living, although it was clear that job opportunities are slim in this community.  These energetic, articulate women reminded us all that structural interventions, which respond to the poverty and vulnerability of these women and their families, are also key to reducing the toll of HIV on these young women and their children.

The program is funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) through a grant from the U.S. Agency for International Development to FHI.

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Secretary of State Hillary Clinton spoke to students of the Johns Hopkins University School of Advanced International Studies on Monday regarding the Global Health Initiative. Her speech focused on “how the Obama Administration is building upon our country’s long standing commitment to global health,” she said, with an emphasis on integrating and improving existing health programs, but in a new way. One that pursues a sustainable delivery system in which countries develop their own capacity to support the health of their own people.

She started her speech by saying many in the audience might be wondering why the secretary of state is spending her time talking about global health, but she quickly made the connection between global health and foreign policy.

Secretary of State Hillary Clinton speaks on Monday on the Global Health Initiative.

“We invest in global health to strengthen fragile states… and support the rise of capable partners that can help us solve global problems,” Clinton said, adding that orphaned children, depleted work forces, and the destabilizing impact of AIDS led the Clinton Administration to categorize the AIDS pandemic not only as a health threat but as a security threat.

On the funding topic, (more…)

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