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.

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."

S.African drug company recalls AIDS treatment medicines

A major pharmaceutical company in South Africa, which has the world's highest HIV rate, on Friday issued a recall of generic anti-retroviral drugs due to a packaging error."Adco-Nevirapine tablets, with the batch number 1J, and expiry January 2009, and Adco-Zidovudine tablets, batch number 1Z and expiry date November 2008 should be returned without delay," the company said in a statement.

The recall is a result of improper labelling, with certain Adco-Nevirapine tablets packed in Adco-Zidovudine cartons.

The company recently won a 663 million rand (86 million dollar, 57 million euro) government contract to supply the life-saving AIDS drugs to public hospitals.

The company would not say how many of the drugs had already been distributed.

"Adcock Ingram is committed to the quality, safety and efficacy of its products and deeply regrets the error," said a statement.

The firm and its parent company, Tiger Brands, have previously faced hefty fines by the Competition Commission.

Early this year, Adcock Ingram's Critical Care division was slapped with a 53.5 million rand for price fixing.

South Africa has the world's highest rate of HIV with some 5.5 million of the 47 million population affected by the virus.

Tiger Brands is one of the few local companies competing for drug distribution.

Few HIV patients tested for tuberculosis

A new report suggests that only 1 percent of HIV-positive patients worldwide have been screened for tuberculosis, a curable infection that frequently kills those living with the AIDS virus.The low TB screening rate is "unacceptable," researchers from the Advocacy to Control TB Internationally (ACTION) coalition said during a press conference at the International AIDS Conference underway here.

"A mere one percent of people living with HIV/AIDS are reported to have been screened for TB," said Dr. Jim Yong Kim, chief of the division of social medicine and health inequalities at Harvard Medical School. "One of the great tragedies of this epidemic is that people who are living with HIV, after hard-fought battles for access to antiretroviral treatment, go on to die needlessly from TB."

Quoting WHO statistics, the report says that of the 33 million HIV-positive people worldwide, only 314,394 individuals had been tested for tuberculosis. Of those who had been screened, over one in four were found to have active tuberculosis, according to a press release issued by ACTION.

"Persons living with HIV/AIDS are 50 times more likely to develop tuberculosis, than those who are HIV negative," the release cautions. "Without treatment, approximately 90% of persons living with HIV/AIDS die within a few months of developing TB."

"We are facing a preventable plague inside a devastating epidemic," said Michel Sidibe, assistant secretary general and deputy executive director of UNAIDS.

Screening for tuberculosis is not mandatory in the programs being funded by the three major international donors -- Global Fund, PREPFAR and the World Bank, the release states.

The ACTION group recommends universal TB screening of all people living with HIV/AIDS and access to the 3 "I"s -- Intensified case finding, Infection control, and Isoniazid preventive therapy.

Screening tests for tuberculosis are inexpensive compared to the cost of the drug cocktails used to treat HIV/AIDS, Kim said in response to a question at the press conference.

An integrated HIV/TB approach is needed, Kim told Reuters Health.

"TB is a curable disease," he said. "It is a crime not to test for tuberculosis."

"Found" needles pose low infection risk for kids

Children who are accidentally stuck with an improperly discarded needle or syringe appear to be at low risk for acquiring hepatitis or HIV, new research suggests.In a study published in the journal Pediatrics, Canadian researchers found that of 274 children with needlestick injuries, none became infected with HIV or the hepatitis B or C viruses.

Nevertheless, parents should immediately seek medical advice whenever a child is stuck by a potentially contaminated needle, say Dr. Caroline Quach and her colleagues.

To insure efficacy, "most prophylactic (preventive) measures need to be given early after the injury," Quach, from Montreal Children's Hospital and McGill University, told Reuters Health.

For their study, Quach and her colleagues assessed the risk of infection among 274 children who'd been stuck by a potentially contaminated needle and were seen over a 19-year period at two major pediatric hospitals in Montreal.

The children, most of whom received therapies to prevent infection, were followed for six months. This is the longest period of time over which someone could develop antibodies against the viruses in question and therefore show they were infected, Quach explained.

After six months the investigators found no hepatitis B, hepatitis C or HIV infections among the children they were able to test.

Children frequently find discarded needles in "safe" areas such as parks and around home, Quach said. Children may pick up these needles and intentionally stick themselves "not realizing there is a potential health threat associated to a needlestick injury," she noted.

The children in her study were 8 years old, on average, and in most cases had been stuck by a discarded needle found in the street or a park. About 65 percent of the children intentionally picked up the needle.

The number of needlestick injuries followed and treated in this study "is large enough to comfort us in the low risk of transmission of infections," Quach said.

Still, she and her colleagues say, children may need to be better educated about the dangers of discarded needles.

SOURCE: Pediatrics, August 2008.

AIDS forum closes with calls for funds, action on prevention

The world AIDS conference ended here Friday with appeals for further funds to care for people infected by HIV and a scaleup of efforts to root out AIDS stigma and prevent the lethal virus from spreading."Lives are being saved on an unprecedented scale," said Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, at closing ceremonies to the six-day parlay.

But, he warned, "We cannot leave Mexico with any sense of complacency."

Kazatchkine named three priorities: defeating the discrimination in which the AIDS virus flourished; focussing research on smarter, coordinated paths rather than a scattergun approach; and beefing up health systems in poor countries.

He named his fourth priority as ensuring that the surge in funding for fighting AIDS in poor countries, which began in mid-decade and in 2007 reached 8.1 billion dollars, was sustained.

So far, less than a third of the 9.7 million poor, badly infected people have been able to grasp the antiretroviral drug lifeline, leaving precious little time to reach the goal of universal access of 2010 enshrined by the UN General Assembly and Group of Eight (G8) countries.

"We... should be deeply concerned that with less than two years to go before our deadline for universal access, the G8 has committed little more than a third of the resources that it has promised to deliver by 2010," Kazatchkine said.

He also called on countries to pitch in more to tackle their own HIV problems.

The conference staged seminars, skills-building workshops, round tables and presentations of scientific research dwelling on almost every aspect of the fight against AIDS.

On the medical front, the search for a preventative vaccine and virus-thwarting vaginal gel is mired in problems, the conference heard.

Optimistic news, though, surfaced about male circumcision.

Surgical removal of the foreskin decreased the risk of contracting HIV by 65 percent, according to the latest data from a US-led study in Kenya.

Those findings, three and a half years after the project began, compared favorably with 60 percent protection measured at the two-year mark.

But transforming this research breakthrough into an on-the-ground campaign to encourage circumcision among men in sub-Saharan Africa, where two-thirds of the people with HIV live, will take time.

It will need funding and long preparations to ensure that operations are performed in hygienic conditions and with full consent. Any mistakes could cause the strategy to fail disastrously, experts aid.

As in past AIDS conferences, other key themes in Mexico City included vital, but often unacknowledged, grassroots work to encourage condom use, prevent violence against women and roll back the stigma that lets HIV flourish in sidelined groups such as gays, intravenous drug users and sex workers.

"Ignoring the needs of children and adolescents and women affected by HIV and continuing to marginalise groups at greatest risks for infection will only lead to more infections and fewer people on treatment," said Luis Soto Ramirez, a Mexican virologist who co-chaired the conference.

"We will pay for such foolishness in the future."

The Mexico City conference is the 17th to be held since acquired immune deficiency syndrome (AIDS) emerged in 1981.

Two years later, French and US researchers identified the pathogen as a virus that subverts and then destroys key immune cells, leaving the body exposed to common infections.

More than 25 million people have been killed by AIDS and 33 million people today are infected with HIV. Treating those in need is likely to cost tens of billions of dollar by 2015, as the regimen of drugs is daily and for life.

The conference, the first to be staged in Latin America, gathered 20,716 scientists, policymakers and fieldworkers from around the world, according to figures issued by the International AIDS Society (IAS) on Friday. It had previously put the tally at around 22,000.

Gift cards key to new AIDS prevention strategy

Could the AIDS virus be stopped with gift cards? Desperate for a way to stop the escalating spread of HIV among young gay men, public health officials are looking to novel strategies, such as enlisting local gay opinion leaders to urge their peers to practice safe sex.Promising signs from such a project in North Carolina led the Centers for Disease Control and Prevention to begin rolling it out on a broader scale, to more than 200 community groups. The budget is $1.5 million over a two-year period.

The idea is to give gift coupons to popular, influential men in the gay community and encourage them to talk up condom use, regular HIV testing and other responsible actions.

It may sound frivolous, but little else has proven effective for the men most affected by the epidemic.

Last week, new figures showed still-rising HIV infections in gay and bisexual men, with about 53 percent of new cases in that group. Meanwhile, HIV rates among injection-drug users and heterosexuals is declining.

The CDC says it's also committed $5 million to a five-year social marketing campaign to promote HIV testing to young black gay and bisexual men, who have been diagnosed with HIV at especially high rates.

"The CDC is committed to ensuring that its resources are going to the populations hardest hit by the epidemic," said Richard Wolitski, acting director of the CDC's Division of HIV/AIDS Prevention.

The new approaches are an encouraging sign of help, but the funding behind them doesn't come close to raising prevention spending to the level most experts say it should be, said Julie Scofield, executive director of the National Alliance of State and Territorial AIDS Directors.

"It's a drop in the bucket," she said.

Scrutiny of U.S. prevention efforts increased after the CDC's release last weekend of new estimates of annual HIV infections. The CDC said the nation had roughly 56,300 new infections of the AIDS virus in 2006 — a dramatic increase from the 40,000 annual estimate used for the last dozen years.

The agency acknowledged it had been undercounting but said new testing technology offered a more accurate picture of trends in the U.S. epidemic. For example, the new report found infections are falling among heterosexuals and injection drug users, even as they continue to rise in men who have sex with men, especially among blacks.

Advocates have complained that prevention spending in general has been too low, and that what is spent is not targeted properly.

The CDC's HIV prevention budget has remained at roughly $700 million since 2001, while costs have risen. (That's about 3 percent of what the federal government spends on AIDS; much of the rest is on medicines, health care and research.)

Meanwhile, prevention programs that target gays and bisexuals are scattershot. Even in progressive cities, these efforts sometimes amount to little more than offers of testing and free condoms, some experts said.

Great attention was focused on the gay community when AIDS first hit the United States in the 1980s. But the epidemic gradually became perceived as a threat to the general population, and some political leaders have kept the focus away from gay men, said Leroy Blea, a Berkeley, Calif., health official who is past president of the National Association of County and City Health Officials.

"It's not a very easy population to fund," Blea said. "It's often more politically viable to fund programs for women and children and youth.

The CDC's Division of HIV/AIDS Prevention estimates that about 42 percent of its fiscal 2007 funding was targeted at gay and bisexual men. That translates to about $280 million.

But with 53 percent of new HIV infections occurring in men who have sex with men, that's not enough, some experts said.

"At a minimum, we need to be matching percentages to where the epidemic is," said David Holtgrave of Johns Hopkins University.

Prevention programs are largely funded at the state and local level, and funding has not quite kept up on those levels either.

In California, about 70 percent of HIV infections occur in men who have sex with men, but about 64 percent of the state health budget targeting HIV is focused on gay and bisexual males.

Some experts say it's been hard to find prevention efforts proven to work, and that's especially true for black and Hispanic gays.

Weaknesses in prevention became clear about five years ago in North Carolina, with an outbreak of HIV among male students at some historically black colleges.

The North Carolina Department of Health and Human Services tried a program that had been tested in white gay men in London.

With $1 million in funding from the CDC, North Carolina health officials went to gay nightclubs in Charlotte, Raleigh and Greensboro and recruited men who were well-liked and socially influential.

These opinion leaders were given four $25 gift cards, along with marketing materials, to talk up safe sex. A study of the effort, published in June in the American Journal of Public Health, indicated more men were practicing safe sex.

The research was based on repeated surveys over time of about 300 men. It found a 32 percent reduction in unprotected anal intercourse during 2005, and a 40 percent reduction in the average number of sexual partners.

The funding ran out and the program ended. And the surveys weren't backed up by HIV testing.

But CDC officials are impressed enough to package it, and are identifying other cities where it can be tried. The training of community activists in the strategy should start in a few months, Wolitski said.

War on AIDS: Money nightmare seems set to return

"Save someone's life and you have a burden for life," goes the proverb, and its truth seems horribly apt for the campaign against AIDS.After years of battling for funds and anti-HIV drugs for needy people in poor countries, activists are finally making headway.

But the 17th International AIDS Conference that ended here Friday has highlighted the dilemma of this success: the more lives you save, the more the bill goes up.

With no cure or vaccine in sight, and with the lifeline comprising a regimen of powerful drugs that must be taken daily, the money crunch is doomed to return -- and with a vengeance.

"It is extremely improbable that we will have the structure and financial ability to take on all the people who require ART [antiretroviral therapy] and then treat them for life," Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases (NIAID), warned on Wednesday.

In 2007, 8.1 billion dollars were mustered to fight HIV/AIDS in the developing world, home to 90 percent of the 33 million people with the human immunodeficiency virus (HIV), according to the UN agency UNAIDS.

That effort is already a Herculean advance compared with the start of the decade, yet even so, less than a third of the 9.7 million poor people whose immune systems are so impaired by HIV that they urgently need the drugs have access to them.

At the current pace of scaleup, 22 billion dollars will be needed in 2015 just to get antiretrovirals to eight million infected people.

And that's just the minimum.

If the world is serious about achieving universal AIDS drug and care access by 2010, a goal enshrined by the UN General Assembly in 2006 and endorsed by the Group of Eight (G8), the bill rises almost exponentially.

The cost of universal access would be 42.2 billion dollars in 2010, five times 2007's expenditure -- and in 2015 it would be a whopping 54 billion dollars, to keep 21.9 million infected people alive.

"If you add the current 35 billion that is being spent in the developed world, you're talking at that time [about annually needing] almost 90 billion dollars, in a continuous fashion," Seth Berkley, head of the New York-based International AIDS Vaccine Initiative (IAVI), told AFP.

"And that doesn't even take into account complications with secondary resistance to drugs and other issues."

With no cure in sight, the pendulum of debate is swinging from treatment to prevention to stop the tally of infections from rising further.

One of the big focuses of the conference was on how to reinvigorate grassroots work.

This often-overlooked business involves promoting safe sex among young people, ending coercive sex for women and easing stigma against gays, intravenous drug users, sex workers and other groups where the virus finds fertile ground for leaping into the wider population.

By far the brightest news from the conference was about male circumcision.

Surgical removal of the foreskin decreases the risk of contracting HIV by 65 percent, according to the latest data from a US-led study in Kenya.

Those findings, three and a half years after the project began, compared favorably with 60 percent protection measured at the two-year mark.

This extraordinary evidence will put pressure to launch a broad campaign of circumcision among men in sub-Saharan Africa, where two-thirds of the world's HIV population resides.

Experts warn, though, that such a campaign has to be thoroughly prepared and financed, as botched operations and cultural or religious resistance could cause the whole strategy to backfire disastrously.

Veteran AIDS campaigners, questioned at the conference by AFP, agreed that there seemed to be a lull in a war that has claimed more than 25 million lives since the disease emerged in 1981.

Stephen Lewis, former UN special envoy for AIDS in Africa, attacked what he called "a kind of curious passivity among the international AIDS establishment" after the achievements in money-raising and drug access over the past two or three years.

He believed that "generational change" would come, as younger people would take the baton handed on by the men and women in their fifties and sixties who had been fighting AIDS for two decades or more -- a sign indeed that the world is in for the long haul in combating this peril.

HIV-positive Indian couple commits suicide

An Indian couple poisoned their three young children, then hung themselves from a ceiling fan because they were depressed about being HIV-positive, police said Saturday.A relative found the bodies of Ishwar Thevar, 39, a film distributor, and his wife as well as their two sons and a daughter in an apartment in Mumbai, India's financial and entertainment capital, earlier this week, said Rajkumar Vatkar, a senior police official.

Vatkar said the children, aged between 4 and 10, had been fed food laced with poison before the couple hung themselves.

A brother of Thevar told police that the couple had tested positive for the AIDS virus two years ago and found out two months ago that their daughter also was infected, Vatkar said.

"Thevar had told his brother, father and other close relatives that he was depressed and didn't want to live," the police officer said. "The immediate cause was clearly depression."

Nearly 2.5 million people in India are infected with the AIDS virus.

There have been numerous reports of sufferers losing jobs, being denied treatment in hospitals and having their children thrown out of schools.

The government has been trying to end discrimination by providing counseling and free medical care in state-run hospitals to affected people and firing doctors who neglect them.

Genital herpes treatment does not prevent HIV

Long-term treatment of genital herpes with the drug acyclovir does not reduce the rate of new HIV infections, researchers reported at the International AIDS Conference here last week.They said the findings are surprising, because prior infection with herpes simplex virus type 2 (HSV-2), the virus that causes genital herpes, has been reported to increase the risk of HIV many fold.

In a randomized multicenter trial, Dr. C. Celum of the University of Washington, Seattle, and colleagues evaluated the effects of acyclovir in 1,814 gay men who have sex with men from the United States and Peru, and in 1,358 women from Zimbabwe, Zambia and South Africa. All were infected with HSV-2 but not with HIV, the virus that causes AIDS.

Subjects took acyclovir or placebo pills twice daily and were followed monthly for up to 18 months.

While the incidence of genital ulcers was significantly lower in the acyclovir group, the incidence of HIV infection was the same in both the groups, the researchers observed.

They suggest that infection with the genital herpes virus may be a risk marker, not a risk factor, for HIV infection. Alternatively, perhaps, the interventions against HSV were not potent enough.

Abused Indian women at greater risk of HIV: study

Married women in India who are physically and sexually abused by their husbands are four times more likely to become infected with the AIDS virus than married women who were not abused, a Harvard study said on Tuesday.India has the world's third-largest number of people infected with HIV at 2.47 million cases, according to the latest figures, but health workers say the number is rising rapidly and spreading to new population groups.

Researchers at the Harvard School of Public Health said they confirmed earlier studies suggesting that men who engage in extramarital sex, including unprotected sex with prostitutes, are the main source of HIV for Indian women.

More than 95 percent of HIV-positive married Indian women report being monogamous, the Harvard researchers said, adding that the extramarital sex by their husbands explains why so many victims of abuse are becoming infected.

"A women who is abused by her husband is truly placed in a situation of 'double jeopardy' regarding HIV infection," said Jay Silverman, lead author of the study published in the Journal of the American Medical Association.

"His sexual behavior outside of the marriage makes it more likely he is infected with the virus, and his abusive behavior inside the marriage leaves her with little control over sex or sexual protection," said Silverman, an associate professor at the Harvard School of Public Health.

The study examined data from India's National Family Health Survey between 2005 and 2006, with a sample that included 28,139 married women.

More than a third reported experiencing physical violence with or without sexual violence from their husbands. Of these, 28 percent experienced physical violence alone, while 7.7 percent suffered both physical and sexual abuse.

The risk for HIV infection among those who experienced both physical and sexual violence from their husbands was increased by a magnitude 3.9 over the infection risk for women who were not abused, the researchers said.

"Elite" HIV wife may hold secret to AIDS vaccine

A woman who has never shown symptoms of infection with the AIDS virus may hold the secret to defeating the virus, U.S. researchers said on Tuesday.Infected at least 10 years ago by her husband, the woman is able somehow to naturally control the deadly and incurable virus -- even though her husband must take cocktails of strong HIV drugs to control his.

She is a so-called "elite suppressor," and studies of her immune cells have begun to offer clues to how her body does it, the team at Johns Hopkins University in Baltimore said.

"This is the best evidence to date that elite suppressors can have fully pathogenic virus," said Dr. Joel Blankson, who led the study.

"The feeling was initially that they had defective virus," Blankson added in a telephone interview.

But the couple has been monogamous for at least 17 years, Blankson said, and tests show they are infected with the same strain of virus. What is different is the immune system of the wife, who cannot be named for privacy reasons.

"That's a good sign in terms of developing a therapeutic vaccine," Blankson said. Such a vaccine would not prevent infection but might be used to treat patients.

The AIDS virus infects at least 33 million people globally and more than a million in the United States. It has killed 25 million people since it was identified in the early 1980s.

New figures show 56,000 people are infected every year in the United states, mostly gay and bisexual men but also injecting drug users and their sexual partners, both male and female, as well as newborns and recipients of contaminated blood transfusions.

STALLING REPLICATION

Both the man and the woman, who are from Baltimore, were diagnosed 10 years ago, Blankson said. The husband is a former injecting drug user.

Tests showed that immune cells known as CD8 T-cells from the wife stalled HIV replication by as much as 90 percent, while the husband's T-cells stopped it by only 30 percent, Blankson's team reported in the Journal of Virology.

Her virus has also mutated in apparent response to this immune attack, becoming weaker, while her husband's virus has remained strong.

"Elite suppression offers clues to vaccine researchers on many fronts: how CD8 killer T-cells can attack HIV and how a stronger immune response can force HIV into a permanent defensive state," Blankson said.

"We are trying to figure out exactly how the T-cells work in her to inhibit viral replication," he added. "We are just trying to see what kind of cytokines they make."

Cytokines are immune system signaling proteins. One thing the researchers have noticed is that while the husband's T-cells make just one, called gamma interferon, hers made both that one and another called TNF, or tumor necrosis factor.

That cannot be the whole story, though, because AIDS researchers have tried using such immune system proteins in patients and they did not work well.

And her immune cells seem to make the response only when they encounter the virus.

Another clue: the woman may have unusual activity in her human leukocyte antigen system, or HLA, Blankson said. This important component of the immune system helps recognize antigens -- protein identifiers -- of enemies such as bacteria and viruses.

Uganda turns to mass circumcision in AIDS fight

Ugandan authorities have launched a mass circumcision drive with the hope it will reduce HIV/AIDS rates in the east African country.Some studies indicate circumcision could be 70 percent effective in protecting men against infection by the disease during heterosexual intercourse, when used in conjunction with condoms and other safe-sex practices.

Government officials in Kampala have decided to take advantage of a month-long traditional "circumcision season" practiced by some tribes to drive the message home.

"Socially, it is uniting, and now it has also been proven medically, that is gratifying and it is part and parcel of now the strategy for fighting AIDS," Kibale Wambi, chairman of Sironko district in eastern Uganda, told Reuters.

The government plans to circumcise more than 3,000 local youths between the ages of 12 and 18. HIV activists say there needs to be more money and efforts like this on a global scale.

But some critics of circumcision in Uganda say it is brutal and dangerous. In traditional settings like Sironko, circumcisers have used the same knife for each young man.

This time, the government has introduced a strict one knife per operation ruling to ensure no infections are passed on.

"If a knife is to be re-used on another person, it first has to be sterilized," Wambi said, wearing a traditional hat covered with cowrie shells.

"We have also discouraged the traditional practice of forcing the circumcised males into sexual intercourse to prove their manhood after the wound heals, to avoid the spread of sexually transmitted diseases."

Some experts fear that some of the newly circumcised men may believe they are immune following the procedure -- translating into even more risky sexual behavior.

"All I know is that when I am circumcised, it will not be as easy for me to get infected with HIV/AIDS," said one young man, Kizeja Michael, as he lined up for the operation.

"People who are circumcised are not able to get AIDS," said his friend, Peter Kibatsi.

Uganda has been widely praised for an education campaign about condoms that is credited with cutting HIV prevalence rates from 30 percent two decades ago to about 6 percent today.