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.

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."

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."

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.