AIDS apathy worries activists at world conference

Dozens of US AIDS activists demonstrated at a world AIDS conference here Wednesday calling on White House candidates to commit to HIV prevention, as experts warned of emerging US public indifference towards the disease.
"This complacency cuts across all the main sectors of society and will be one of the main challenges we will have moving forward," said Kevin Fenton, director of the US Centers for Disease Control and Prevention (CDC).

The CDC, which last week increased its estimate of annual HIV infections in the United States by 40 percent to 56,300, called Wednesday for action in response to its new figures.

"These data are a wake up call to all of us," Fenton said, underlining that the organization itself supported activists' calls for a national US HIV plan.

The AIDS activists welcomed his comments, but called for more action to address the social problems behind the figures, which showed that gay and bisexual men, as well as and African American men and women, are the groups most affected by HIV.

"HIV is not just a disease, it's proof of social injustice," read some banners carried by demonstrators calling for better access to housing and healthcare for HIV-positive minorities.

"At what point are we going to stop making a footnote of the things that are driving these problems?" asked Kenyon Farrow from the Queers for Economic Justice organization in New York.

Meanwhile, after President George W. Bush last month signed legislation tripling funds to fight AIDS, malaria and tuberculosis in the world's poorest countries, many called for a similar plan at home.

African Americans, who make up 13 percent of the US population, accounted for 45 percent of the new infections in 2006, according to the latest figures.

"If black America was a separate nation, it would rank 16 in world HIV rankings," said congresswoman Barbara Lee. "I think it's about time we call for a national AIDS strategy and national AIDS plan."

But many of the 22,000 scientists, policymakers and field workers here wondered just how to rally the public to back such new initiatives in the era of antiretroviral drugs, which have transformed HIV infection from a death sentence to a chronic but manageable condition.

"The great fear I have is that AIDS itself will lose its power and interest," Seth Berkley, president and CEO of the New York-based International AIDS Vaccine Initiative (IAVI), told AFP.

"Partly this is because so many resources have been pumped in, people kind of feel, we've taken care of it, and as we know, we haven't."

He noted that, although the US figures had been underestimated, they had remained stable for 10 to 15 years, which suggested that AIDS prevention campaigns had run into a wall of complacency.

More than 25 million people have died from AIDS since the disease first emerged in 1981, and 33 million people today are living with HIV, two-thirds of them in sub-Saharan Africa.

Experts say better treatments needed for children with HIV

Children, long neglected in the fight against AIDS, still lack access to effective HIV detection programs and treatments, participants warned Thursday, at a six-day world AIDS conference.Experts at the 17th International AIDS Conference in Mexico City said most HIV-positive women have no effective means of preventing transmitting the virus to their unborn offspring, with 30 to 40 percent giving birth to an infected child.

Without proper treatment, "half of the children born with HIV will die before they reach the age of two," said Dr Fernando Parreno, a pediatrician for Doctors Without Borders in Zimbabwe.

According to UN AIDS of the 33 million people around the world who have tested positive for HIV, some two million were children in 2007, up from 1.6 million in 2001.

Almost 90 percent of those cases were in Sub-Saharan Africa, experts said at the conference here, which runs until Friday and is attended by some 22,000 participants.

About 370,000 children under 15 were infected in 2007, slightly down from 450,000 in 2002, including 90 percent who had contracted the ailment from their mothers.

The World Health Organization recently called for early detection programs and urged that babies be treated as early as possible.

However activists complained that tests for children are complicated and expensive, and called for more efforts from laboratories making medicines for children.

The Bristol-Meyers Squibb laboratory announced in March that it would, at the end of the year, end the commercialization of Efavirenz capsules which are particularly well adapted to pediatric use, because so little of the drug is being prescribed.

"The North pays for the research (into treatments), but the countries in the North don't have HIV-positive children," said Benjamin Coriat, a researcher in the economy of health.

Due to a lack of suitable medicines, adult pills are split in two or three pieces to give to children, said former French foreign minister Philippe Douste-Blazy, head of UNITAID, an international drug purchase facility.

Many in Mexico said that UNITAID had helped to increase the number of children treated worldwide from 75,000 to almost 200,000 in two years.

It plans to treat 100,000 more children per year by 2010, Douste-Blazy said.

Activists from the Clinton Foundation offer devices to cut up pills to make them easier for children to swallow.

There is also a bitter syrup for children on the market and therapies involving three anti-retroviral drugs in one pill, which are suitable for some children.

Meanwhile, some NGOs, such as the US Joint Learning Initiative on Children and HIV/AIDS network, support direct aid to families, bypassing aid groups and consultants.

Co-chair of JLICA Jim Kim said that even if medicines are free, "the price of a bus ticket prevents the poorest people from taking their children to health centers."

But others, like David Goetghebuer, advisor to the children with AIDS program of Doctors Without Borders, defend the involvement of aid groups in such programs.

"They've reinvented family allowances," Goetghebuer said.

Children, like adults with HIV, also have stigma and discrimination to contend with.

In the Llavecitas magazine, made by HIV-positive children in Central America, 10-year-old Angelical recounted how she was afraid to tell people of her HIV-positive status.

"I don't want to say I'm suffering from 'that' because people will like me less," she wrote.

Male circumcision could be even greater boon than thought

Circumcision appears to offer men even greater protection against the AIDS virus than thought and also partially shield them against a common sexually-transmitted disease, two studies presented at the world AIDS conference said Thursday.US researcher Robert Bailey of the University of Illinois at Chicago put forward long-term data from a trial in Kisumu, Kenya, that in its initial phase enrolled 2,784 uncircumcised uninfected men.

Half of the group were circumcised, and the others were circumcised at a later date and they were later tested for HIV.

Previously-published research from this trial found that, after two years, circumcised men were 59-percent less likely to contract the human immunodeficiency virus (HIV) than uncircumcised counterparts.

The benefit was so astonishing that at this 24-month mark, the uncircumcised men were offered circumision, as it would have been unethical not to have done so.

In a presentation at the 17th International AIDS Conference, Bailey said the estimate of protectiveness at 24 months had been adjusted to 60 percent in the light of refined lab tests from blood specimens.

And he also reported that at the 42-month mark, circumcision offered a protectiveness of 65 percent.

This extension of the study, conducted among 1,739 of the original 2,784 volunteers, will run until December 2009.

"The 60-percent protective effect against HIV acquisition ... over the first 24 months of the study, we now find to be sustained and possibly strengthened to approximately 65 percent over three and a half years of follow-up," Bailey said.

"These results further support the addition of male circumcision to our limited armamentarium of HIV prevention."

Meanwhile, South African researcher Dirk Taljaard reported on a new aspect of a now-famous circumcision trial at Orange Farm, South Africa.

This French-led trial was the first to show that surgical removal of the foreskin offered protection against HIV, also around 60 percent.

Taljaard said that analysis of other data from the Orange Farm trial showed that circumcision offered no shield to the man against gonorrhea.

It offered only "borderline" protection against trichomonal vaginitis, a parasite that dwells in the male and female sexual organs and is transmitted through vaginal intercourse.

But it provided protection of 36 percent against the human papillomavirus (HPV), a pathogen linked to cancer of the cervix and penis, he said.

Circumcision has emerged as one of the few bright areas of progress in the AIDS crisis, after the Orange Farm and Kisumu trials.

The discovery has sparked talk in some circles of a "surgical vaccine" -- a cheap, safe method for shielding men from HIV, especially in sub-Saharan Africa, home to two-thirds of the 33 million people with HIV.

But this enthusiasm has also been tempered by worries that circumcision may face a backlash on cultural, religious or sexual grounds, or may prompt men to abandon use of the condom.

Other work at the conference, ending Friday, suggested, though, that circumcision was widely accepted by men, some of whom believed that it enhanced sexual pleasure, and did not prejudice safe-sex practices.

According to French researcher Bertran Auvert, who led the original South African study, circumcision could avert up to 3.8 million infections and half a million deaths in sub-Saharan Africa between 2006 and 2016, and up to 5.8 million deaths by 2026.

The theory behind the effectiveness of circumcision is that the inner foreskin is an easy entry point for HIV. It is rich in so-called Langerhans cells, tissue that the AIDS virus finds particularly easy to latch onto and penetrate.

Other questions surrounding a circumcision campaign are the need to ensure that operations are done hygienically and with the full knowledge and consent of the male. Also unclear is what benefit, or otherwise, male circumcision has on women.

Homosexuality must be legal to beat Caribbean AIDS: activists

Sex between men, which is prevalent in the Caribbean region, must be decriminalized or AIDS will never be beaten there, experts at an AIDS conference in Mexico City said Thursday.Participants at the six-day International AIDS Conference, gathering more than 22,000 people, said it was very complicated for men to access AIDS tests and potential treatment in the region with the second highest figure of HIV/AIDS cases worldwide at one percent of the population.

The figure represents more than a quarter of a million people and is second only to Sub-saharan Africa.

Half of Caribbean men have had multiple sexual contacts with a member of the same sex, and between 80 and 90 percent have had sexual relations with another man at least once, according to figures from psychologists in Jamaica and Trinidad and Tobago.

"It will not be possible to have effective HIV/AIDS prevention in the Caribbean if we don't decriminalize (sexual) relations between men," said Michael Kleinmoedig, a West Indian journalist and social activist.

Stigma and discrimination, a problem worldwide for people with HIV/AIDS, were particularly bad in the region.

"Human rights are limited for those who have (sexual) relations with men. They are not recognized as a valid group by law and many countries silence them and deny them their rights," Kleinmoedig said.

Many of them are married and have children.

Moreover, some 20 percent of those with HIV in the region, mainly women, contracted the virus through their partner, said Peter Figueroa, director of epidemiology and AIDS for the Jamaican government.

On a rare positive note for the region, he highlighted universal access to AIDS treatment in Cuba.

Some 33 million people around the world are infected with HIV, 90 percent of whom live in developing countries

Asia must deal bravely with HIV/AIDS: U.N. official

A top U.N. official urged countries in Asia on Thursday to deal squarely and bravely with HIV/AIDS, which he said was being driven dangerously underground because of stigma and conservative attitudes.

"In Papua New Guinea, India, Malaysia where it is driven by injecting drug users, Indonesia, there are pockets of spread but because of stigma, it's all underground," Peter Piot, head of the U.N. AIDS agency UNAIDS, told Reuters in a telephone interview.

"Religion does not protect against AIDS. It's about sex and drugs. They have the means and knowledge, so it's a matter of political will and translating it into more openness about AIDS and having the courage to adopt education and prevention programs to reach those who are marginalized."

Piot, who was in China's northeastern city of Dalian for the World Economic Forum, said rapid economic development in Asia was fuelling the spread of HIV/AIDS.

According to UNAIDS' 2006 report on the incurable disease, 8.3 million people were living with HIV in Asia at the end of 2005.

Some 930,000 people were newly infected with HIV in 2005, a year when AIDS claimed around 600,000 lives. Only 1 in 6 people who need treatment in Asia are receiving it.

"Rapid economic development, societies in very rapid transition, a huge population mobility, a lot of new money, mobile men with money, that increases the risk of HIV in a big way," Piot said.

While governments were beginning to talk seriously about the disease, action was needed and governments needed to face the very groups that they normally shy away from, he added.

"The epidemic is growing tremendously all over Asia in groups that are marginalized in society, among men who have sex with men, injecting drug users, clients of sex workers," he said.

"These are not groups that governments like to deal with but there ought to be far more openness. There is an incredibly high level of stigma around AIDS and that is something governments and leaders in business and politics can do something about."

Piot said the U.N. was very worried about how the trafficking of girls and women in the Indian subcontinent, where they were then forced into prostitution, was fuelling the spread of HIV.

A recent study published by the Harvard School of Public Health found that 40 percent of Nepalese women and girls rescued after being forced into prostitution in India were HIV positive.

"In Nepal, when you look at HIV it is concentrated in those areas where the trafficking is going on, that illustrates that you can't deal with AIDS in just one country. This is a cross border, political issue," he said.

"We have brought together people working on this from India and Nepal to look into this."

World Bank shifts HIV/AIDS focus in Africa

The World Bank on Wednesday unveiled a four-year strategy to fight HIV/AIDS in Africa that shifts focus from emergency response to long-term development.The change was made possible after billions of dollars in grant funding became available from the U.S. Emergency Plan for AIDS Relief and the Geneva-based Global Fund to fight AIDS, Tuberculosis and Malaria which alone has committed $10.7 billion to fight disease.

The World Bank has sent $1.5 billion to more than 30 African countries to fight HIV/AIDS since 2000.

"With AIDS the largest single cause of premature death in Africa, we can't talk about better, lasting development there without also committing to stay the course in the long-term fight against the disease," said Elizabeth Lule, manager of the World Bank's AIDS Team for Africa.

The World Bank said it would concentrate on advising countries on how best to manage the new international funding, and at the local level try to help governments take a long-term view on how to best tackle the disease.

It plans to help governments integrate HIV/AIDS services with those for pregnant mothers and children and services which fight malaria, tuberculosis and other diseases.

New HIV/AIDS infections in Africa are rising. For every person starting HIV drug treatment, which can keep patients healthy for years and prevent the development of full-blown AIDS, another four to six are newly infected, the World Bank said.

However statistics do indicate falling prevalence in Kenya, parts of Botswana, the Ivory Coast, Malawi and Zimbabwe.

The bank said about 22.5 million people in sub-Saharan Africa were HIV positive. Some private firms are recruiting two workers for every job to replace those who die.

It said more than 60 percent of people living with HIV in Africa are women, and that young women are six times more likely to be HIV positive than young men. Also, an estimated 11.4 million children under age 18 have lost at least one parent to the disease.

"The World Bank reaffirms its long-term commitment to assist partner countries achieve universal access to HIV prevention, treatment, care and support by integrating AIDS into their national development agendas, scaling up responses, and strengthening national systems," said Peter Piot of the Joint United Nations Program on HIV/AIDS.

Vast distances a barrier to combating HIV/AIDS in India

Vast distances are a major hurdle to India's efforts to curb its soaring HIV rate. India, which has the world's third largest HIV-positive caseload, gives drugs for free to HIV/AIDS patients. But doctors say this is not enough to stop the spread of HIV which is making inroads in rural India, especially among women infected by itinerant husbands, and also children.

For three days a month, Sambit squeezes into a crowded and often filthy train for a three hour journey to Delhi to receive HIV treatment.

"There's no seat and I am very weak," said the 30-year-old former tailor, who asked that his full name not be revealed. He can't afford lodging in Delhi and can barely afford the train tickets.

"I need to borrow money from my family for all these trips," he said.

Many patients in the same position simply give up treatment, an anathema in HIV therapy as it gives rise to drug resistance. These patients may then need more powerful second line treatment, which is not freely available in India.

"Travel can affect drug compliance. Patients who don't get family support, women who may not like to travel alone will just give up," said a doctor at a New Delhi hospital, who spoke on condition of anonymity because he did not have permission to speak to reporters.

There are 147 "antiretroviral therapy" or ART centers in the country, part of a government drive that has been encouraged by the World Health Organization in a bid to prevent HIV from becoming a major health problem.

Delhi has nine such centers and is far better served than many other states. Up to 6,000 patients receive treatment in Delhi, nearly half of these live outside the capital.

The government now plans to build "link centers," small facilities that are closer to where patients live so people like Sambit can obtain their medications more easily.

"They just come to pick up the drugs if they have no side effects and they go home ... that saves transport and other costs," Rao said, adding that the plan was to have as many as 500 such centers all over India.

INFECTION FIGURES AREN'T GOING DOWN

India has 2.47 million HIV cases, according to the latest figures, but health workers say the number is rising rapidly and spreading to new population groups.

"Our numbers are going up," said Loon Gangte, South Asia coordinator of the Collaborative Fund for HIV Treatment Preparedness.

"It's not confined to high risk groups, it's going into the general population. It's not a problem of sex workers, drug users or truck drivers. These people have wives and children at home and the disease is making its way into the general population."

Sujatha Rao, director-general of the government's National AIDS Control Organization, says doctors are increasingly seeing women infected by their husbands.

In some clinics, 1 out of 100 women who come for ante-natal care checkups are HIV positive, she said.

"It is a generalized epidemic," she said. "We have pockets where the prevalence is more than 1 percent among ante-natal care mothers, so we need to intensify our work."

Out of India's 611 districts, HIV prevalence is more than 1 percent of the population in 156 districts.

"The epidemic is getting deeper into (certain) rural, general areas of the country ... it is migrant-related. They go to work and then they take back the infection to their homes," she said.

Even though HIV drugs are free, only about 155,000 people have access to retroviral drugs, up from 20,000 just two years ago.

Health expert say there are many people who do not know they are infected or who do not know that treatment is available.

Some health professionals believe India's HIV problem is closely intertwined with poverty and that the government must tackle poverty if it seeks to curb the spread of HIV.

"Many of these people are very poor, they worry about food, shelter. So they may not think their HIV status is a problem because they don't even know where their next meal is coming from," said Errol Arnette of the help group Sahara.

"A lot of AIDS patients die of TB because it's hard for hospitals to keep them (in hospital). HIV patients are just thrown in a corner because of heavy stigma."