World HIV Situation

HIV Positive and Pregnancy

2008-10-16T06:09:00.000-07:00

HIV testing during pregnancy is important because antiviral therapy can improve the mother's health and greatly lower the chance that an HIV-infected pregnant woman will pass HIV to her infant before, during, or after birth. The treatment is most effective for babies when started as early as possible during pregnancy. However, there are still great health's benefits to beginning treatment even during labor or shortly after the baby is born. CDC recommends HIV screening for all pregnant women because risk-based testing (when the health care provider offers an HIV test based on the provider's assessment of the pregnant woman's risk) misses many women who are infected with HIV. CDC does recommend providing information on HIV (either orally or by pamphlet) and, for women with risk factors, referrals to prevention counseling.

Some side effects are appearing to be more common in HIV+ women than men. This may be due to the fact that women have higher levels of certain HIV drugs in their bloodstreams, even though they take the same doses as men. A woman’s smaller body size, metabolism, or hormones may cause the higher levels. For example, with the PI (protease inhibitor) Norvir, women seem to experience more nausea and vomiting but less diarrhea than men. Despite the difference in drug levels and side effects, women seem to benefit as much from HIV therapy as men. No changes in dosing have been recommended for women.

Being an HIV – positive mother to be does not guarantee that your child will be born HIV positive. HIV transmission usually occurs during delivery ,but can also before birth in the mothers womb .If an HIV positive mother receives appropriate care throughout her pregnancy ,including medication to lower the amount of virus in her blood ,HIV may not spread to the child .Without treatments .risk of HIV transmission to the child is higher but with medications taken regularly throughout the pregnancy ,as well as delivery by caesarian section ,the risk of transmission is lowered. dramatically – to about a 1-2%chance of transmission .It is important to note that all children are born with their mothers antibodies, and will therefore test positive on HIV antibody screening tests, regardless of their actual status. These antibodies will usually clear sometime between 6-18 months after birth and viral load testing can be done around 6months to determine the infant’s actual status.

A study sponsored by the National Institute of Allergy and Infectious diseases (NIAID) in Uganda found a highly effective and safe drug for preventing transmission of HIV from an infected mother to her newborn. Independent studies have also confirmed this finding .This is more affordable and practical than any other examined to date .Results from the study show that a single oral dose of the antiretroviral drug nevirapine (NVP)given to an HIV infected woman in labor and another to her baby within 3 days of birth reduces the transmission rate of HIV by half compared with a similar short course of AZT(azidothymidine).In developed countries like the U.S,formula feeding is strongly recommended over breastfeeding for babies of HIV –positive mothers .Whether choosing breastfeeding or formula ,there should be little or no switching between the two as doing so could put the child at a higher risk of contracting HIV, since baby formula can be harsh and weaken the lining of a babies stomach, giving a path for HIV to enter the baby’s bloodstream.

The term Lipdystropy is used to describe a number of body shape changes and metabolic problems that can occur in HIV+ people. While HIV+ men and women both experience body shape changes, women are more likely to experience fat gain in the breasts and stomach. Lipodystrophy can dramatically alter your appearance. If you are concerned about how you look, speak to your doctor before making any changes to your HIV medication schedule that might jeopardize your health. Some of the symptoms of lipodystrophy have been linked with heart disease and strokes, so make sure to go to your doctor regularly and have your triglycerides, blood pressure,cholestrol, monitored. You can also support your body, and especially your heart, with a healthy diet, giving up smoking and regular exercise.

By Johnson Pinto Pinto

About the author:
HIV,AIDS,HIV Cure,HIV Treatment,HIV Infection,HIV Dating,HIV Positive,HIV Symptoms. Article Source: http://www.Free-Articles-Zone.com

TGP can help to prevent HIV/AIDS

2008-10-16T06:02:00.000-07:00

- Mohammad Khairul Alam -
- HIV/AIDS programme Consultant -

Now a day AIDS is increasing all over the world in an enormous position. No country could face it successfully. It turns very unique position in some countries of Africa like Uganda, Gayer, Cambodia, and Sub Sahara region etc. East Asian some countries are also affected by this. In South Asian country like India is the second largest country in the world for HIV/ AIDS. There are 5.1 million people carry or suffer of this. It will be the main reason of our country for vulnerable of HIV/ AIDS. Because we have to depend in various reason of that country. Mainly our internal Business fully depends on it. Such there many way we bound to go India. Burma is another neighbor country is already a large number affected in here. AIDS surveillance specialist Mr. Parvage Shajjad Mollik said, “There are so many cultural values and socio economical systems are responsible for this increasing like this dieses, poverty and illiteracy is also responsible for this increasing. This indicator is not fully responsible but it helps to change behavior on so that. So if we want to prevent of this at first we have to emphasize to try to change sexual behavior. We did success to find out our vulnerable target groups and why they become vulnerable”.

HIV/ AIDS is a sexual disease, but it is deferent from other sexual transmission disease (STDs, STI). Other STDs have proper medicine and these diseases don’t create cause of die, but AIDS is very dangerous, there are no any alternative way to survive after it infection, it can end of life. We find out first vulnerable group in Bangladesh is injection drug user (IDUs) and second is professional sex worker. There are many reason every year are increasing IDUs all over in Bangladesh. It easy to get in every location in Bangladesh and chipper than other is the main reason for this; other reasons are political and socio-economical frustrations. Last year 4th surveillance report was about 4% IDUs are infected with HIV/AIDS all over in Bangladesh, but after one year we see the one area of Dhaka City this raise to 8.9%, this report we get from 5th surveillance survey. This ratio will be clouded in our social norm and can help to hamper our economical condition. Our country is very poor so we are not able to face a large number of patients like this disease.

So we have to take necessary steps to prevent it’s increasing. We need several level of advocacy champing to build up awareness of HIV/AIDS. We need to encourage gender/ reproductive health education, which not only prevent HIV/AIDS but also help to prevent others STDs/STI (Sexual Transmission Disease). We can influence our government education authority to include about HIV/AIDS details our primary and secondary level’s curriculum.

Gender education is essential in our country’s adolescent boys & girls. This education can play a vital role of empowerment our illiterate society. It can help to develop our adolescent into a proper knowledge. Religious superstition & fundamentalism prevents to get such kind of education from their childhood. But this knowledge is very important for mental & physical development, it can help their social interaction, social behavior, reproductive health & sanitation, sexual behavior, to able to adopt all kinds of social change, to awareness them of their rights etc. Individually lack of knowledge these one can create other problems.

We also increase peer educator for professional sex worker, peer educator means a group of person or individual who are take from target group or brothel to give them proper training. After training they can able to awareness others.

We need to take TGP (Target Group Promoter) strategy for residence or other sex worker. It is very affected for residence sex workers or hidden sex workers. TGP is a newly invention idea (Proved by Rainbow Nari O Shishu Kallyan Foundation) which help to prevent HIV/AIDS. TGP is a one kind of source/ broker/ sealer (Called in Bengali is Dalal), who collects clients/ customers for residence sex workers; they encourage people to buy sex. Without TGP (Their nominated source) the residence sex worker doesn’t allow any new client. TGP will play a vital roll in our action. Residence Sex Workers (RSW) lives together three to ten in a house. They continue their business under a Guidance or Governance or a Teem Leader (is called Sharderni in Bengali). These teem leaders communicate with some local people, who help them by delivering customer or client, these people is called source (in Bengali called Dalal). They depend on each other. Some times those sources shelter them from local unexpected situation or from police harassment. If we could continue this action then TGP will play very important role. Because residence sex workers don’t stay long time in a house, they change their house after three to six months, but they always keep contact with their source (TGP) for continuing their business. For this reasons TGP is very important programme.

In some areas a group of drug user uses one syringe when they take drug. It is very dangerous for increasing HIV/AIDS. So we should try to alert them, and give advice them two or more drug user don’t use drug by a one syringe.

Mohammad Khairul AlamHIV/AIDS programme Consultant
Rainbow Nari O Shishu Kallyan Foundation
24/3. M. C. Roy Lane
Nowbabgonj- Section
Dhaka-1211
Bangladesh
www.plusbangla.com
Rainbowngo@gmail.com

About the author:
Rainbow Nari O Shishu Kallyan Foundation
Article Source: http://www.Free-Articles-Zone.com

Ayurvedic Management of HIV/AIDS

2008-08-22T22:37:00.000-07:00

Article sources : http://www.articlecity.com/
by: Dr AbdulMubeen A Mundewadi

At present, there is no scientifically proved cure for HIV /AIDS. Globally, the number of infected HIV /AIDS patients is increasing at an alarming rate; with a current estimate of 33.2 million people who are living with HIV 1. Hence, there is a dire need to search for a safe, effective and economical treatment for HIV /AIDS.

In a retrospective study in 55 patients, Ayurvedic treatment has proved to be very promising in the management of HIV/AIDS. Fifty-Five adult patients were given Ayurvedic treatment for HIV/AIDS, during the period from April 1999 to November 2004.Each patient had tested positive for HIV/AIDS on at least 2 different occasions. No patient was taking anti-retroviral drugs at the time of commencing Ayurvedic treatment. All patients were started on treatment after written, informed consent.

The Ayurvedic Herbal Combination ( AHC ) comprises of eleven different herbs in different dosage strengths, based upon their respective potencies, reported anti-viral and immunomodulatory properties, and their traditional usage according to Ayurvedic principles of medicine 2 -4 .The constituents of AHC with their respective dosages are as follows:-Terminalia arjuna: 250 mg. ;Zinziber officinale: 250 mg. ;Phyllanthus niruri :1 gm ;Glycyrrhiza glabra:1gm. ;Withania somnifera:1gm. ;Eclipta alba: 250mg. ;Centella asiatica: 250mg. ;Boerhavia diffusa: 250mg. ;Emblica officinalis: 250mg. ;Tinospora cordifolia: 250mg. ;Rubia cordifolia: 250mg. This AHC was dispensed in a combined dose of 5 gms. t.i.d., to be taken with water after meals. Aqueous herbal extracts of all the medicines were used, in tablet form.

All patients were advised to eat a well-balanced, nutritious diet. Therapeutic counseling sessions were conducted regularly to help the patients achieve mind relaxation, to modify their risk behavior , and to increase adherence and compliance to therapy.

All patients were followed up at monthly intervals. Detailed clinical examination was done at each visit and significant findings were recorded. In addition, in affording and willing patients, investigations like CBC, Hb, Liver and Renal functions, X-Ray of chest, Western Blot, CD4 count and Viral Load were done wherever possible. Other investigations were done, if required, for Opportunistic Infections (O.I.).All O.I. were promptly and aggressively treated with modern medicines. A close watch was kept for adverse reactions of the drugs.

Therapeutic outcome was assessed by overall clinical examination, change in Karnofsky score (assessment for overall well-being of patients), change in weight, occurrence and response to O.I., and change in CD4 and Viral Load values. Maximum number of patients was in the age ranging from 20 - 39 years (80 %). Of the total number of 55 patients, 39 were male (71 % ) and 16 were female (29 %), with the male: female ratio being 2.4: 1. There were 7 couples who took treatment together.

Of the 55 patients, 5 patients died, 42 patients took treatment for varying periods and then stopped treatment, while 8 patients continued treatment till the end of the study period. The 5 patients who died were critically ill at the time of presentation, and died mostly within the first two months of starting Ayurvedic treatment. The cause of death varied ; 1 patient died from cirrhosis of the liver, 3 died of extensive Pulmonary Tuberculosis (multi-drug resistant) and 1 died of a combination of Pulmonary Tuberculosis and demyelination disease of the brain.

In the 50 patients who were alive till the time of their last follow-up , there was an average weight-gain of 2.3 kgs.(range = - 4 to + 7.5 kgs), usually within the first 3 months. In those patients who took continuous treatment for more than 3 months, the Karnofsky score increased from an average of 75.9 at the commencement of treatment to 87.4 at the last follow-up. Almost all the patients had 1-3 O.I. at the time of presentation. Other than Tuberculosis, all the O.I. cleared up rapidly within the first 2 months of treatment.

Long-term administration of Ayurvedic medicines (upto 30 months) did not seem to have any major adverse effects. In fact, in a few patients, the tests for liver and renal function appeared to normalize further, with treatment. Haemoglobin readings gradually improved in those patients taking regular, prolonged treatment.The most striking effect of the Ayurvedic medicines was on the Viral Load and CD4 counts. Because of financial constraints, only 15 patients (27 % ) agreed to do either the Viral Load or the CD4 count, or both. In most patients, there was a definite and steady decrease in the Viral Load, and an increase in the CD4 cell counts.

Antiretroviral medicines are the mainstay in the modern treatment of HIV/AIDS. However, a plethora of side-effects, development of resistance to drugs and escalating treatment costs are serious concerns. In the absence of a definite cure for HIV/AIDS, Ayurvedic medicines may provide a useful alternative for long-term management of patients, since these medicines are economical and devoid of serious side-effects. However, scientific research is necessary to determine efficacy of these medicines. This retrospective study is one such effort to assess long-term therapeutic effects of an Ayurvedic Herbal Combination in the management of HIV /AIDS.

In this study, 4 patients died within the first 2 months of commencing treatment. Onset of therapeutic effect is slow with Ayurvedic medicines, and these patients probably could not benefit from Ayurvedic treatment. This emphasizes the need to start treatment as early as possible in immuno-compromised patients. The causes of death indicate that Tuberculosis and CNS involvement are major killers in HIV patients. Multi-drug resistance to Tuberculosis is also a major concern.

16 patients ( 29% ) did not come back after just one ( 11% ) or two ( 18% ) visits. The reasons cited were, a complete inability to pay for treatment, or a search for a ‘better’ or a ‘guarenteed cure’. Fortunately, perceptions have changed in the last few years. Even illiterate patients from the lower socio-economic strata are no longer asking for a ‘guarantee’ or a ‘cure’. ‘Long-term management with minimum expenses’ is a mantra being readily accepted by the HIV positive patient of today.

All the patients who took medicines regularly, had a high-protein diet and kept themselves busy, improved very well and put on weight. Even 2 to 3 years after stopping Ayurvedic treatment, most of the patients are doing very well, some inspite of very low CD4 counts. This is probably one of the biggest long-term advantages of taking Ayurvedic medicines for HIV /AIDS. However, patients with socio-economic difficulties and a lot of psychological pressure who could not have access to regular treatment, started losing weight after initially improving with treatment. A comprehensive management of each patient thus needs to address several issues relevant to each individual patient.

This study also brought forth some interesting results. One patient who subsequently died, had severe demyelinating disease of the brain (as diagnosed in a major hospital), and had lost most of his motor control and sensory senses, since several months. After being given Ayurvedic treatment for about 1 ½ months he became alert, and could speak clearly, albeit temporarily, for 1 week. Another patient with Nephrotic syndrome resulting in long-standing generalized oedema (2 years ) had complete regression of the oedema after 2 months of Ayurvedic treatment without any other treatment. One HIV positive patient with suspected malignancy of lung in the right upper lobe was steadily losing weight. After starting Ayurvedic treatment, he started putting on weight. Another patient with history suggestive of HIV Encephalopathy was semi-conscious at presentation. He was passively fed on liquid diet and a combination of both modern drugs and Ayurvedic treatment. This patient be!

came ambulatory within 2 weeks, and after 2 months of treatment he was faring well, even with a CD4 count of just 6.The above 4 instances indicate that the Ayurvedic medicines may have multi-faceted properties and need further evaluation.

Thus,the retrospective study of 55 HIV positive adult patients treated with an Ayurvedic Herbal combination from April 1999 to November 2004 proved the Ayurvedic medicines to be highly effective as anti-viral and immuno-stimulant,and safe on long-term use. A nutritious diet, Ayurvedic baseline therapy, timely allopathic treatment of Opportunistic Infections and regular counseling support appears to be an ideal combination in the management of HIV/ AIDS patients.

References
1. UNAIDS. Global Summary of the AIDS Epidemic. Update December 2007.
2. Foundation for Integrative AIDS Research. Potential Anti- HIV Herbs. 15/9/2002.
3. Sharma P.V. Vegetable Drugs. Vol. II. IV Edition. Chaukhamba Publications.1978.
4. Dahanukar S A, Kulkarni R A, Rege N N. Pharmacology of Medicinal Plants and Natural Products. Indian Journal of Pharmacology, 2000; 32: S81 - S118.

About The Author
Dr. A. A. Mundewadi is Chief Ayurvedic Physician at Mundewadi Ayurvedic Clinic based at Thane, Maharashtra, India. He is available as an online Ayurvedic Consultant at http://www.ayurvedaphysician.com/ and can be contacted at info@ayurvedaphysician.com

Dr. A. A. Mundewadi, B.A.M.S., is a practicing Ayurvedic physician since the last 22 years. He is a graduate of R. A. Podar Medical (Ayurvedic ) College, Worli, Mumbai, India. During this period of 22 years, he has obtained considerable experience in the clinical treatment of a vast array of patients.

Ayurveda , basically means, a “ Science of Life”, and involves maintaining the health of healthy persons, and treating sick patients. Dr. Mundewadi has studied and experienced extensively all the principles of Ayurveda , involving a healthy life-style, diet regimes, body-cleansing through panch-karma procedures, and treatment with herbal and herbo-mineral compounds.

In addition to his background in Ayurveda, Dr. Mundewadi has also studied the therapeutic effects of Reiki( he is a 3rd degree Reiki Master), Acupuncture ( he has done a basic and an advanced course in Acupuncture), Hypnotherapy and Magnetotherapy. His current style of clinical practice is a culmination of his experience with all these different treatment modalities.

Dr. Mundewadi has been doing clinical research work since the last 9 years. He has published his findings of herbal treatment of HIV / AIDS in 55 patients in the Bombay Hospital Journal, Mumbai, India, July 2005 issue,which can be viewed at www.bhj.org/journal/2005_4703_july.html/original_aretrisoective_255.htm . He has also successfully completed a clinical trial of herbal extract medicines in Schizophrenia compared to modern anti-psychotics, in 200 patients( See www.clinicaltrials.gov/ct/show/NCT00483964 ). He has also conducted preliminary studies of Ayurvedic herbal extracts in the treatment of Bipolar Disorder, Vascular Dementia, Alzheimer’s Disease, Parkinson’s Disease, Attention Deficit Hyperactivity Disorder, Autism, Mental Retardation, and Tobacco and Alcohol Dependence. He also has a special interest in the herbal treatment of Age Related Macular Degeneration and different types of Cancer.

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Natural Remedy Succeeds Against Cancer And Hiv In South Africa

2008-08-17T00:22:00.000-07:00

by: Tony Isaacs

Article Source: http://www.articlecity.com

Years ago, when I first began research into the amazing oleander plant, I ended up as a member of two Yahoo Health Groups about oleander. One was named "Anvirzel" (after the patented Oleander medicine which had passed FDA phase 1 trials a few years earlier) and the other "Oleandersoup" (named for the home remedy version of the patented medicine). I became friends and acquaintances with many people close to oleander and Anvirzel, as well as some opponents - one of whom later came after me with hired thugs posing as US Marshalls after I helped expose his fake cancer drug scheme (but that will have to wait for another story).

One of the people I met was a noted South African humanitarian, entrepreneur, crusader and researcher named Marc Swanepoel. Mr. Swanepoel was keenly interested in the oleander plant due to the epidemic of HIV-AIDS in his native country as well as the number of indigent cancer patients who could not afford mainstream treatment options (which were largely ineffective anyway). Like several of us in the groups, Mr. Swanepoel began making his own oleander home remedy after the instructions were posted by Ed Hensley "The Father of Oleander Soup" and the first moderator of the Yahoo "Oleandersoup" group. Unlike the rest of us, Mr. Swanepoel took things a few steps further and he began searching the Brazilian Rain Forest and his native South Africa for other botanicals to combine with oleander.

After testing various combinations, Mr. Swanepoel settled on two similar botanical supplements which consisted of 80% oleander extract made exactly according to the oleander soup instructions. The first supplement was for HIV/AIDS patients and it added extracts of the agaricus blazei murrill (ABM) mushroom, cats claw, and pau de arco, while the second supplement, intended for cancer, substituted the relatively rare chrysobalanus icaco (red-tipped coco plum) for the pau de arco. All of the rain forest botanicals added to the oleander have their own histories of successful immune boosting and cancer fighting abilities, some dating back centuries among the indigenous Amazon peoples. I asked Marc why he used oleander for 80% or the mix and he confided that, as potent as the other botanicals were, he felt that oleander was by far the most effective botanical he had ever found.

Mr. Swanepoel soon selected a Brazilian manufacturing facility named Takesun do Brasil to make his supplements for him and he also licensed them to market his supplements around the world. Takesun is managed (or was) by a German PhD named George Otto (The Takesun website, a bit rough in the English version, can be found at http://www.agaricus.net - but I do NOT recommend that you buy any of their products at this time! I will just say that I believe that there are better and more reliable sources and that Marc Swanepoel agrees and leave it at that.)

Ultimately, the OPC product grew to be quite successful, especially in Dr. Otto's native Germany. So much so, that two clinic were built which used only the OPC and Agaricus products and Dr. Otto ended up moving back to Germany where plans are in the works for a hospital built around an oleander/agaricus protocol.

Meanwhile, in South Africa, Mr. Swanepoel returned to his native South Africa and made notable progress of his own - first getting the government to embrace the use of his oleander supplements for HIV and cancer and then getting it accepted by various doctors and clinics as well as gaining some support at the university level. Over the past three years, he and I have kept in touch and he has told me many times of the success his supplements have had in helping HIV and cancer patients, but I have too admit that I was somewhat remiss in digging a bit deeper and finding out the true scope of the success until the first part of this year when I asked Mr. Swanepoel how the patients in South Africa were faring and he reported back:

"Everything still ok here and cancer patients as well as HIV patients on the oleander mix are doing well. The medical doctor in Cape Town who is using the mix for all his cancer patients has continued to have good results. The oncologist where he sends his patients to (a woman) was so impressed with the results that she is now using it herself for prevention.

. . to date, the only patients that did NOT make it on the oleander mix were three patients with very advanced cancer that had metastasized to the liver and who had been on intensive chemo treatments. In my opinion, the effect of the chemo on the and liver and heart eventually led to failure of those organs."

Needless to say, I was very impressed with the news, but after thinking about it, I started to wonder "3 patients out of how many did not make it"? So, to try to get a better perspective I asked Marc in a follow up message and the response I received astounded me! Just when I thought I could not possibly be even more impressed with oleander, based on my research and first hand experience with oleander users including friends and members of my own family, I got this incredible message from Marc:

"Hi Tony,

"Approximately 350 HIV/AIDS patients have used it and about 80 cancer patients on a regular basis. Of the cancer patients, 5 arrived when they had about a week to 10 days to live and they were too weak to keep the mix down. They died without really being able to try the mix. 3 (the ones I mentioned to you) died of liver and heart failure. All the others are still alive, some now for nearly three years. One breast cancer patient who was given a few months to live eventually became the patient of the oncologist who is now also using the mix. She was declared free of cancer by the oncologist approximately 1 year ago and is still doing well. Others used it for a few months until their cancers were gone and we have not heard from them again. One patient with a festering hole of 1cm diameter on his nose (about half a cm deep) have been using it for three months after doctors were unable to cure the tumor with radiation. The hole is now half the size and not festering anymore. It should be healed in about 3 - 6 months. The doctor in Cape Town whose own wife had metastasized cancer to the bones, is now cancer free. She has been on overseas trips and lives a normal life."

Unfortunately, I do not have time to keep track of all the patients. They just collect the mix from me and phone me from time to time to say that they are doing well. It also seems to help for asthma, male impotence and diabetes. One advanced MS patient have now used it for 2 months and is reporting that it seems to help for the pain in her legs. All the distribution is happening by word of mouth and I don't advertise at all. I have had orders from the UK from people who had heard about the successes in South Africa. A documentary maker there was filming the progress of his wife on a weekly basis but, unfortunately, she was one of the liver complications. He still believes very firmly that the mix gave his wife an extra 5 months of high quality life."

I was almost dumbfounded to hear such news. 100% success on HIV and almost the same for cancers? I knew that oleander was almost always successful, but I had never really seen numbers like that before! If I had not known Mr. Swanepoel for years now and know his character and accomplishments I would have doubted such numbers myself - and I am maybe the number one oleander fan in the galaxy!

The numbers Mr. Swanepoelquote, mirror the results I am familiar with from around the world and in my own family, friends and health forum - especially those who combine a good diet and lifestyle and do not depend on oleander alone. For years, it has pretty much been used as a stand alone product. Marc, like myself, has recommended cleansing and de-toxing along with a very healthy diet and lifestyle to go along with the oleander. I take it a step further and recommend that other immune boosting and cancer fighting supplements also be used - not because I have any doubts in the magical powers of oleander, but because I think the more weapons in your arsenal, the more likely you are to win the battle and the war.

Recently, I received yet another update:

"Tony -

Since my last update to you when the total number of HIV/AIDS patients were about 350 and the total number of cancer patients were about 80, I have given the new mix to an additional 130 people with advanced AIDS and to a further 15 people with cancer. The people with AIDS, without exception, are doing fine and mostly resume their normal activities after 6 - 8 weeks. The son of the senior nurse at the clinic where I am doing my research was a case with advanced AIDS, badly swollen legs and barely walking with the aid of crutches. After 4 weeks, he does not need the crutches anymore and his mother reports that he is now singing in the morning. There are many similar cases and I have no doubt that the oleander mix can control HIV/AIDS better than the antiretrovirals.

I do not supply the mixture to many new cancer patients locally myself, but the doctor in Cape Town as well as two other people are regularly taking a total of at least 15 bottles of the mixture (500ml) from me every month for patients and friends who hear about it by word of mouth. The guy with the hole in the nose is now ok and the wound is nearly gone. He has brought another friend with a similar open cancerous wound on the nose that doctors have been unable to cure and he is taking the mix as well as an ointment that I make (ozonated olive oil mixed with the oleander). He has been taking it for 3 weeks and reports that he can already see a difference.

Two of the cancer patients who were in remission had recurrences of small tumours (but not in the same place as before). Against my advice, they had both stopped using the mix after their doctors had declared them clear of any tumours. As I mentioned to you before, I believe the cancer will always return UNLESS one changes the things that caused the cancer in the first place. The oleander and all other successful treatments allow one the breathing space to give effect to such changes.

Regards,

Marc"

As a final note: Mr. Swanepoel has recently began manufacturing his own OPC oleander supplement and, after a lengthy period of testing, also changed the formula to 80% oleander and 20% sutherlandia frutescens (the South Africa "Cancer Bush". He reports that the new addition does more than the other three combined ingredients in the other formulations. Mr. Swanepoel is in fact, doing a doctoral thesis based on the use of oleander in combination with s. frutescens that should be completed in a few months.

For those who would like to know a bit more about the South Africa "Cancer Bush", you can find a wealth of information at http://www.sutherlandia.org

Live long, live healthy, live happy!

About The Author
Tony Isaacs is a natural health researcher and author of books and articles about natural health and alternative remedies including "Cancer's Natural Enemy" and "Collected Remedies" (http://www.rose-laurel.com)

Reducing HIV AIDS vulnerability among adolescents

2008-01-26T21:39:00.000-08:00

By anirudha alam [ 11/04/2007 ]

Reducing HIV/AIDS vulnerability among adolescents

Anirudha Alam

To reduce HIV/AIDS vulnerability among adolescents, there is a need to develop strategies and methods for effective curriculum focusing on sex education and life skills especially. Internalizing more participatory learning-teaching method, it is felt that a stronger integration of prevention education vis-à-vis sex & reproductive health approaches is essential for improving the high-quality HIV prevention & care. It is estimated that there are 1.2 billion adolescents in the world. Near about eighty seven percent of these adolescents live in the developing countries. More than eighty five percent adolescents of Bangladesh do not know what reproductive health is and how to practice safe sex. Most of them are not aware of how to undermine the vulnerability to HIV/AIDS. To make them free from such encumbrance as HIV/AIDS, we have to ensure a healthy and promising environment. It is believed that if the adolescents have qualitative reproductive health literacy ultimately HIV/AIDS prevention programs initiated by GOs and NGos will be successful.

Only effective education can ensure qualitative reproductive health literacy. This kind of literacy helps adolescents analyze thoroughly basic information, core messages, values and praxis related to HIV/AIDS prevention. Simultaneously they are able to inculcate caring and supportive attitudes towards people living with HIV/AIDS (PLWHA). They possess the basic facts and information bringing about acquisition of knowledge and development of attitudes, values, skills and practices (KAVSP) as to undermining the spread of HIV/AIDS. Consequently they have profound awareness on practicing safe sex, use of condoms, gender equity, harmful effect of early marriage, premarital sex and unplanned pregnancy.

Reducing HIV/AIDS vulnerability among adolescents may be promoted auspiciously through evaluating the attitudes and values within community based social norms/beliefs, cooperation and teamwork. From the salad days, adolescents have to be guided by active and participatory learning that they may analyze, study ideas, solve problems and apply what they learn. It is important to ensure that active learning would be fast-paced, enjoyable and personally engaging. In this regard, cooperative learning may play a vital role to make the adolescents aware of HIV/AIDS significantly. It is one kind of effective group approaches with a view to learning with common objectives, mutual rewards, shared resources and complementary roles. Through this approach, group members are stimulated to help each other to master the lesson or activity. Thus an atmosphere of mutual trust and respect are established. Eventually the learning environment is warm as well as adolescents are made to express their views, opinions, attitudes and behaviors freely.

Adolescence is the prime and sensitive period of so many physical, emotional and cognitive developments. So adolescents have to experience many changes unexpectedly. In most cases, they remain unaware of how to efficiently cope with these kinds of physical and psychological changes. Attitudes to sexuality are being developed gradually during puberty. In this time, if adolescents are misguided or deprived of acquiring reproductive health literacy they will suffer all the time in their lives. There is no doubt that sexual maturity leads to happiness and fulfillment in future personal and social relationships. So there is no alternative for adolescents to learn about issues related to reproductive health from parents, teachers and other elders for being able to understand and develop a healthy attitude.

Vulnerability to HIV/AIDS is skyrocketing in the developing countries jeopardized by lack of qualitative reproductive health literacy among the adolescents. But reproductive health literacy itself offers one of the key hopes against HIV/AIDS epidemic as well as its influential eventualities. In fighting the pandemic, reproductive health literacy comprising transfer of skills and attitudes to reduce adolescents’ vulnerabilities to HIV/AIDS is the most effective means. It is seriously necessary to reduce the fear of HIV/AIDS any how. Reproductive health literacy can do a lot to combat HIV/AIDS facilitating adolescents in attaining the knowledge, attitudes and skills that they need to delay sexual intercourse, reduce their number of sex partners, prevent illicit drug/substance use and avoid infection by using condoms.

The academic curriculum of the developing countries like Bangladesh should provide adolescents with opportunities to learn and practice life skills, such as decision-making and communication skills, which can strengthen other important areas of early life development. It is expected that different aspects of inclusive HIV/AIDS/STI study must be built-in into all suitable subject areas, such as reproductive health, human rights & legal aids, home economics, gender development & women empowerment, social studies and science.

Anirudha Alam
Assistant Director (Information & Development Communication)
BEES (Bangladesh Extension Education Services)
183, Lane 2, Eastern Road, New DOHS
Mohakhali, Dhaka 1206
Bangladesh.
Website: http://www.bees-bd.org/

Phone: 01718342876, 9889732, 9889733 (office), 8050514 (res.)
E-mail: anirudha.alam@gmail.com, info@bees-bd.org, bees@worldnetbd.net

Ref: FHI, UNESCO, World Bank

Article Source : http://www.free-articles-zone.com/

Community based strategic plan to curb spread of HIV AIDS

2008-01-20T02:29:00.000-08:00

By anirudha alam [ 11/04/2007 ]

Community based strategic planto curb spread of HIV/AIDS
Anirudha Alam

Curbing the spread of HIV/AIDS is a human rights issue. A commitment to solidarity, hope and compassion promotes comprehensive campaign as for HIV/AIDS prevention. It may result in a holistic effort to strengthen community based network through advocacy, capacity building and behavioral change communication (BCC). Having no minimal amenities, community people are led to vulnerabilities to HIV/AIDS enormously. They are mostly disadvantaged due to having no access to basic rights. If there is any community based common plan in support of the local response to HIV epidemic the reasons of vulnerability may be removed gradually and effectively.

Community based strategic plan to address HIV/AIDS should be outlined to prevent escalation of epidemic through action research in ways that recognize human rights and self-respect. In this aspect, it is greatly essential to organize social mobilization and accelerate support form local stakeholders and development partners involved in the community based response to HIV. There is no doubt that community based approach is a fundamental mechanism to stimulate the local contribution to deal with HIV/AIDS. To gather maximum support for community based efforts on HIV/AIDS, at first programs have to emphasize on coming in close contact with the local people. This is the effective means to be familiar with the values and perception of local people. Then they will be made to understand and perform the desired responsibility in response to HIV/AIDS.

Community based strategic plan encompassing local expertise and constructive commitment should be initiated to subvert the prevalence of HIV/AIDS in the light of national HIV policy framework and Millennium Development Goals (MDGs). It would allow a profound and greater understanding of the nature of epidemic, its spread and eventuality.

According to UNAIDS estimates, over half of new HIV infections are occurring among young people (15-24 years) – or over 7,000 new infections a day worldwide. Around 95% of people with HIV/AIDS live in the communities of developing countries. Nowadays HIV is a common threat to men, women and children in all communities throughout the world. The challenges in responding to HIV/AIDS may vary enormously from community to community owing to geographical location, livelihood status, social infrastructure and so on. Cross border movement, women trafficking, neighboring to high prevalent communities, gaps in health care delivery, low levels of HIV/AIDS awareness and sexual bondage because of poverty make the communities vulnerable affecting public health systems. To combat this vulnerability with regard to HIV/AIDS, there is no single solution. But integrated community approach may play an influential role to protect from sexually transmitted infections (STIs). This is why adopting a gender sensitive and human rights based approach, community oriented strategic plan will be well-equipped and groomed with a wide range of local stakeholders’ support and participation to address HIV/AIDS. Side by side community people will be efficient to discuss and develop norms, values and practice as to safe sexual behavior.

Community focused strategic plan for HIV/AIDS has to be based on the reality of the epidemic engendered from thorough case studies. The prevalence of HIV may remain low in communities. But there are some considerable factors that can play vital role to fuel its rapid spread extensively. Polygamy, dowry, gender violence & discrimination, believes in superstitions as well as lack of safe health practice may kindle the spread of HIV/AIDS. If the awareness is not shaped fruitfully community wise, all of the programs to undermine the spread of HIV/AIDS will be failed. For instance, HIV/AIDS prevalence was low for many years in Indonesia even with lots of risky behavior. But in the past two or three years, the circumstances have been changed. At present, HIV/AIDS prevalence is growing severely in several communities of the country.

At last we may infer that any kind of community based strategic plan should be comprehensive, consistent, coordinated, constructive, consequence oriented and above all committed to community exclusively. Capitalizing on these key characteristics indicated by six C’s, it will be possible to attain a high watermark of success to combat skyrocketing vulnerability to HIV/AIDS.

Anirudha Alam
Assistant Director (Information & Development Communication)
BEES (Bangladesh Extension Education Services)
183, Lane 2, Eastern Road, New DOHS
Mohakhali, Dhaka 1206
Bangladesh.
Website: http://www.bees-bd.org

Phone: 01718342876, 9889732, 9889733 (office), 8050514 (res.)
E-mail: anirudha.alam@gmail.com, info@bees-bd.org, bees@worldnetbd.net
Ref: UNAIDS, UNESCO, UNISEF

Article Source : http://www.free-articles-zone.com

Women Empowerment, Cornerstone of HIV Prevention

2008-01-20T02:26:00.000-08:00

By anirudha alam [ 10/04/2007 ]

Women Empowerment, Cornerstoneof HIV Prevention
Anirudha Alam

There are some forms of risky behavior that directly makes women vulnerable to HIV/AIDS in the developing countries like Bangladesh. It should be cornerstone of life to get rid of risky behavior through improving living standard any how. For the greater involvement of vulnerable women in every aspect of curbing epidemic, they have to be able to respond to the epidemic in a meaningful manner.

In a society, if women and girls are not empowered to develop life skills they are severely vulnerable to HIV/AIDS. Gender discrimination, sexual violence, women trafficking, dowry, early marriage and low levels of reproductive health literacy are considered as key factors in the spread of STIs.

A large proportion of women is infected with HIV from regular partners who were infected during paid sex. For instance, in Mumbai and Pune (in Maharashtra), 54% and 49% of sex workers, respectively, had been found to be HIV-infected in 2005. Across sub-Saharan Africa, women are more likely than men to be infected with HIV. The unfortunate fact is that vulnerability among women is mounting all over the world. Only women empowerment can contain this vulnerability.

Profound advocacy can be an important and familiar way of breaking down barriers for undermining gender discrimination and stigma. The spread of HIV/AIDS is being fueled among the women of developing countries through such risky factors as exorbitant prevalence of HIV in the neighboring countries, increased population movement both internal & external, existence of commercial sex with multiple clients, high prevalence of STIs among the commercial sex workers, unsafe sex practice through bridging population, sexual bondage, the trend of rise of HIV among injecting drug users, unprotected pre-marital sex as well as dire poverty. On the other hand, sustainable family bondage as well as integrated praxis of religious and social values make these countries less vulnerable comparatively.

According to AIDS researcher Mohammad Khairul Alam, “Women empowerment is the first step to stamp out gender discrimination and stigmatization. If we promote gender equality poverty will be reduced significantly. It is recognized that poverty helps to trigger vulnerability to HIV/AIDS. So women empowerment through development initiatives should be ensured to keep HIV/AIDS in bay. In this aspect, such promotional activities as organizing gender sensitization workshop, seminar, symposium, open discussion, popular theatre, door to door work, advocacy session and so on may play important role bringing about effective social mobilization. Thus counting on local resource mobilization and capitalizing on collective action, women empowerment program may be led by integrated approach more efficiently to undermine vulnerabilities to HIV/AIDS.”

It is estimated that more than 14,000 people are getting infected with HIV all over the world every day. Among of them, 2000 are children under 15 years mostly getting infection of HIV through mother to child transmission. So mother to child transmission (MTCT) is considered as an important issue in spreading HIV/AIDS. There is scientific evidence of likely presence of HIV virus in breast milk. Therefore gender issues comprising improved services as to maternal & child care should be ensured through the HIV/AIDS prevention program.

As per the findings of National Assessment of Situation and Responses to Opioid/Opiate use in Bangladesh (NASROB) conducted in 2001, 14% of the female heroin smokers started heroin use below 18 years of age and 38% by 18 year. 22% of the current female injectors started injecting drug by 19 years of age. BEES (Bangladesh Extension Education Services) found that 90% young girls (15-25 years) of Bangladesh are very much vulnerable to AIDS and STIs that they do not know how to take care of their reproductive and sexual health. They have no inclination or are not enough empowered to believe it necessary to seek advice on safe reproductive health as well.

Reproductive health is still a taboo in Bangladesh, particularly with adolescent girls. With very limited access to health care facilities, knowledge and education, they have no understanding about the ways of protecting themselves. But women should be empowered through developing life skills that they can have more control over their reproductive and sexual health. Consequently HIV/AIDS prevention program will sustain comprehensively attaining high watermark of success in reducing vulnerabilities to STIs.

Anirudha Alam
Assistant Director (Information & Development Communication)
BEES (Bangladesh Extension Education Services)
183, Lane 2, Eastern Road, New DOHS
Mohakhali, Dhaka 1206
Bangladesh.
Website: http://www.bees-bd.org

Phone: 01718342876, 9889732, 9889733 (office), 8050514 (res.)
E-mail: anirudha.alam@gmail.com, info@bees-bd.org, bees@worldnetbd.net

Article Source : http://www.free-articles-zone.com

Stamping out Gender Discrimination to Prevent HIV AIDS

2008-01-20T02:21:00.000-08:00

By anirudha alam [ 10/04/2007 ]

Stamping out Gender Discriminationto Prevent HIV/AIDS
Anirudha Alam

Gender discrimination saps social consistency jeopardizing health and educational development. It is increasingly recognized as a key factor that makes women gravely vulnerable to AIDS and STIs (Sexually Transmitted Infections). Improving and intensifying poverty reduction strategies pragmatically, overall development programs should be en-gendered. Otherwise development achievements may be endangered failing to contain epidemic.

Approximately 17.7 million women were living with HIV/AIDS in 2006 all over the world. Multiple vulnerabilities like social, cultural, economical and biological factors intertwined as a vicious circle may make prevalence sky-high anytime among women in the developing countries of Asia. So we have to raise a clarion call on combating the spread of epidemic through ensuring gender equality.

Gender discrimination promotes unequal access to resources and opportunities, sexual violence, practice of unprotected sex, women trafficking and women’s paltry representation and participation in social development activities. All of this result in power disparities that characterize personal relationships between male and female undermine the development of not only women but also a nation to a great extent. In this context, capitalizing on capacity building initiatives for vulnerable women encompassing sensitization, training & orientation, exchanging information, experience & views and networking may play an important role to reduce the incidents of HIV as a whole.

Having significant and multifaceted impact on public health, education, technology, business and administration sector as well as on demography, household, macro economy and society on a great scale, HIV/AIDS continues to spread in Asia and the Pacific. Comprehensive HIV/AIDS prevention programs have been initiated successfully in some countries. Nonetheless several grave factors like illiteracy, gender inequality, unprotected extra marital sexual behavior, increasing use of intravenous drugs, isolation from generic health care services as well as lack of outreach treatment and care services are contributing to the spread of HIV/AIDS gradually from most-at-risk population to the general population. As a result, the number of HIV infections among women is increasing day by day. This is why focusing very appropriately and timely on the importance of women empowerment, policy makers should be made gender sensitized necessarily.

Adopting an inter-sectoral approach to gender equality and establishing links between gender, development and HIV/AIDS, vulnerable nations have to have technical supports to confront epidemic. There is no alternative to integrate gender into such major development areas as good governance, poverty alleviation, disaster management & recovery, sustainable environment promotion, information & development communication (IDC) as well as HIV/AIDS prevention.

An in-depth study entitled ‘The impact of women empowerment on HIV/AIDS prevention in Bangladesh’ conducted by BEES (Bangladesh Extension Education Services) indicates that women are mostly vulnerable to HIV/AIDS due to their inherited conservative behavior, beliefs in superstitions and religious dogmas. They are deprived of enjoying their minimal rights as well. Consequently they are affected by gender discrimination severely. A recent survey initiated by Rainbow Nari O Shishu Kallayan Foundation showed that only 22% young women (15-25 years) had heard of HIV/AIDS and do not know how to protect themselves from AIDS/STIs.

HIV/AIDS epidemic is mounting all over the world especially in the developing countries being the greatest impediment to human development. Young girls and women are greatly vulnerable due to their lack of power and means to protect themselves from practice of unsafe sex and ignorance as regards reproductive health. Through a gender lens, multisectoral development strategies should be both pro-poor and pro-women supporting the integration of HIV/AIDS prevention into the development planning activities. Millennium Development Goals (MDGs) are intended to halve extreme poverty and hunger by 2015. So in the course of reducing poverty, promotion of gender equitable behaviors through gender awareness will be able to contribute to reversing the spread of HIV/AIDS as per the desired achievement .

Anirudha Alam
Assistant Director (Information & Development Communication)
BEES (Bangladesh Extension Education Services)
183, Lane 2, Eastern Road, New DOHS
Mohakhali, Dhaka 1206
Bangladesh.
Website: http://www.bees-bd.org

Phone: 01718342876, 9889732, 9889733 (office), 8050514 (res.)
E-mail: anirudha.alam@gmail.com, info@bees-bd.org, bees@worldnetbd.net
Ref: UNDP, UNESCO, World Bank

Article Source : http://www.free-articles-zone.com

Gender Equality, Beacon of Hope for AIDS Prevention

2008-01-20T02:10:00.000-08:00

By anirudha alam [ 10/04/2007 ]

Gender Equality, Beaconof Hope for AIDS Prevention

Anirudha Alam

Gender equality, a well-defined by-product of human development, always entrenches inclination on how to focus attention on women empowerment. Simultaneously women empowerment confronts challenges consecutively in translating the responsibilities to gender equality into action. Gender discrimination is the prime source of endemic poverty leading to skyrocketing HIV prevalence. With a view to making gender equality a reality as a core commitment, women empowerment has to be the stepping stone to sustainable development.

HIV/AIDS epidemic is raging in Africa and mounting all over the world mostly due to gender discrimination, stigmatization and unsafe sex practice. To make the spread of epidemic flagged, widening gender gaps must be combated. Nowadays young women and girls are at a much higher risk than men. As per the findings of surveys and case studies conducted in Africa, adolescent girls are 5-6 times more likely to be infected by HIV virus than boys.

Taking an inclusive approach to gender awareness, people should be stimulated to move towards a common interest for sexual rights. Sexuality comprising sex, gender identities, amusement, sensualism as well as reproduction is considered as the cornerstone of being human all over the life through experiencing and sharing thoughts, beliefs, perception, values, fantasies, excitement, desire, interest, attitudes, praxis, behavior, relationships and so on. In the name of gender equality, sexuality may be guided positively and creatively by social, economical, biological, legal, ethical, racial, political, historical, religious, psychological and cultural factors interwoven inextricably. As a result, it would be easy to take any kind of promotional activities fruitfully for reducing vulnerabilities to STDs (sexually transmitted diseases) and HIV/AIDS.

Sexual and reproductive ill-health results in dire poverty led to widespread vulnerabilities to HIV/AIDS. Sexual and reproductive health problems account for about 20% of ill-health of women globally and 14% of men occurred owing to lack of appropriate sexual and reproductive health. In Saudi Arabia, approximately half (46 per cent) of HIV infection was eventuated due to unprotected sex in 2005. All are mostly the consequences of gender discrimination attributed by religious dogmas, social ill-beliefs and monopolistic male hegemony intertwined with unsafe sex practices.

According to the social development specialist Saiful Islam Robin, “It should be realized that there is no alternative to develop and enhance life skills of vulnerable girls and women to cope with epidemic. They may be assisted on the various levels to become engaged in grooming their confidence and organized. At the same time, their voices should be allowed to be heard loud and clear. Thus the collective effort of women is born with the sense or purpose that they will be stirred up to share perceptions improving their access to reproductive health related information and services.”

Gender equality helps vulnerable women to be benefited from poverty reduction, activities for sustainable development, access to information & communication technology as well as HIV prevention. As a cross-cutting dimension of human development, campaigning for gender equality underpins human rights protected in law and practice. It supports fruitfully capacity development of women enhancing women’s participation in development activities.

As per the findings of a recent research entitled ‘Role of Poverty Reduction to Reduce Vulnerability to HIV/AIDS in Bangladesh’ initiated by Rainbow Nari O Shishu Kallayan Foundation, “To track how epidemic often widens when vulnerability deepens, gender mainstreaming in poverty reduction strategies has to integrate multi-disciplinary approach specially focusing on good governance and gender equality through promoting participatory resource planning and internalizing HIV/AIDS prevention into overall development initiatives. Poverty is closely associated with illiteracy and women’s so called participation in development programs. As a result, vulnerability to HIV/AIDS is fueled promoted by gender discrimination and power imbalances between male and female.”

An essential fact is that everybody should be committed to gender mainstreaming. Gender mainstreaming is the keystone in human development. So every development program like HIV/AIDS prevention should be deliberate in providing support to establish human rights that women may be benefited equally from gender neutral development strategies.

Anirudha Alam

Assistant Director

(Information & Development Communication)

BEES (Bangladesh Extension Education Services)

183, Lane 2, Eastern Road, New DOHS

Mohakhali, Dhaka 1206

Bangladesh.

Website: http://www.bees-bd.org/

Phone: 01718342876, 9889732, 9889733 (office), 8050514 (res.)

E-mail: anirudha.alam@gmail.com, info@bees-bd.org, bees@worldnetbd.net

Ref: UNDP, WHO, UNAIDS, Family Care International

Article source http://www.free-articles-zone.com/

Human Immunodeficiency Virus A Nurses Guide

2008-01-20T02:03:00.000-08:00

By James McLean Bowie Bowie [ 02/03/2007 ]

Human Immunodeficiency Virus (HIV) is an RNA virus which converts RNA to DNA, which makes it a retrovirus. Retroviruses use single stranded RNA as a template to make double stranded DNA using a viral enzyme. A person who becomes infected with HIV results in a complex clinical disease known as acquired immune deficiency syndrome(AIDS), which may take ten years or more to develop.

HIV contains a protein that is called “reverse transcriptase” which is crucial for viral replication inside of T-cells. This eventually causes the immune system to shut down causing an extremely low tolerance to infectious diseases and eventually death.

HIV is passed on when the virus from an infected person gets into the blood stream of someone else, this can occur during unprotected sex between same sex and or heterosexual couples, there is a small chance of infection through unprotected oral sex, although the exact size of this risk is unclear. There is no method of barrier protection that completely eliminates the risk; however the use of condoms is considered the safest form of protection.

HIV can also be passed on when people use dirty needles for injections or tattoos; this can be avoided by using single use or sterilized needles. People who inject drugs can avoid infection by never sharing injection needles; it can also be transmitted, in rare cases, through being stuck with a needle that has been used by an infected person. Additionally, a baby can contract the disease by being born to an infected mother or by breastfeeding from an infected woman.

Because the early symptoms of HIV are not always obvious, a person may be able to pass on the virus before they realize that they are infected. HIV cannot be passed on through normal day to day contact, such as sitting on toilet seats or by shaking hands.

Like all viruses, HIV is comprised of only genetic material, a few proteins and a protective envelope, its genetic material, carried by single stranded RNA molecules, contains all the information needed to make more viruses. HIV can not reproduce itself outside of a cell, but when HIV invades a living cell, it turns the cell into a factory for making more HIV.

The development of HIV occurs when the virus infects CD4 T-lymphocytes; a type of white blood cell, HIV weakens the immune system and leaves the infected individual open to deadly infections. The viruses gain access to a T-lymphocyte by attaching to CD4 proteins on the outer surface of the cell membrane. HIV infects certain human cells by binding its envelope glycoprotein’s gp120 and gp41 to specific molecules on the surface of the cells. Only cells which carry the appropriate molecules are susceptible to infection by HIV.

In the 1980s, scientists quickly recognised that a molecule called CD4, which is found particularly on certain T-lymphocytes (a type of white blood cell), was the primary binding site, but it was only in 1996 that other co-receptors that are also required for infection were identified. Fusion of the virus with the cell membrane permits the viral nucleotide to enter the cell.

As HIV disease progresses, HIV variants called synctium-inducing (SI) strains evolve within the individual’s body. SI variants can use an additional co-receptor on human cells, called CXCR4. This may allow HIV to infect a wider range of cells. Once fusion has taken place, reverse transcription then occurs to convert the viral genomic RNA into double-stranded DNA. The viral DNA is transported to the cell nucleus and is integrated, or inserted, into the normal cellular chromosomal DNA.

When the right activation signals are present, the process of making new virions begins. Using the replication machinery of the host cell, the integrated viral DNA is transcribed to make messenger RNA (mRNA) and new strands of viral genomic RNA. The viral mRNA is then translated into a protein string that is cleaved into specific viral proteins.

Assembly of new virions then takes place within the cell, and the new HIV particles are released by budding from the cell surface, taking a piece of the cell membrane as their envelope.

HIV replication can directly kill CD4 + T-lymphocytes. The loss of these cells paralyses the immune system and is one mechanism by which HIV infection causes AIDS.

People who have HIV may look and feel completely well, but their immune systems may nevertheless be damaged. There are no set symptoms for HIV or AIDS, usually if a person becomes infected with HIV they do not notice they have been infected, some may however suffer from a flu like illness shortly after infection. It is important to note that once someone is infected they can pass HIV on, even if they feel well.

The more time passes, the more likely damage is to have occurred to the immune system. Once the immune system is compromised, the person may be susceptible to ‘opportunistic infections’, these are infections that are around us all the time and can normally be fought off by a healthy immune system. Also, some tumours or cancers can occur as a result of a damaged immune system and can cause damage to the brain and nervous system. These ‘symptoms’ are not caused by HIV, but by the opportunistic infections, so until the immune system is so damaged that other infections begin to cause health problems which become increasingly difficult to treat.

The only way to know if a person is infected is for them to have and HIV Antibody Test. HIV and AIDS is such a world wide epidemic it is vitally important that people are educated in the disease.

Zidovudine (brand name retrovir), formerly known as AZT from its synthetic chemical name, azidothymidine, is the drug most commonly used in the treatment of HIV infection. The drug inhibits the replication of HIV by interfering with the process of reverse transcription, which is necessary for the production of new virus particles.

Zidovudine was shown by clinical trials in 1986 to be effective at improving survival in patients with AIDS, and has since then been licensed as the first choice treatment for HIV infection in Europe, North America and Australia. The drug appears temporarily to delay the progression of disease and death in people who have HIV infection symptoms, but does not significantly delay the development of AIDS in HIV-positive people without symptoms.

Zidovudine is increasingly prescribed as part of a combination of antiviral drugs, and a recent international study conducted in Britain and the United States showed that this approach results in greatly enhanced survival when compared with Zidovudine treatment alone.

It appears to have a significant protective effect against HIV related brain disease and dementia. This is due to the ease with which the drug crosses the blood brain barrier, a quality not shared by other anti HIV drugs that have come into use subsequently. Because of the lack of effective treatment for HIV, more importance is put on preventive strategies. All blood donors are screened for HIV, greatly reducing any chances of contracting HIV through a blood transfusion, or through factor VIII for haemophiliacs.

A key preventive strategy has been to change behaviour through education and promotion of safe sex. This has been promoted through advertising and education, with television taking the lead in promoting the use of condoms, especially to young people.

The transmission of HIV through intravenous drug users is also reduced by education, and there is also a Government sponsored needle exchange programme, where clean needles can be collected free of charge, thus stopping the infection being passed on by the sharing of dirty needles.

About the author:
James McLean Bowie is an author and book dealer who resides in East Yorkshire England. He owns a number of web sites which are book related and offer resources for writers, collectors hobbyist's and webmasters. http://jamesbowiebooks.com http://bowiebooks.com

Article Source: http://www.Free-Articles-Zone.com

What You Need to Know About HIV

2007-11-24T20:03:00.000-08:00

HIV is an abbreviation for Human Immunodeficiency Virus. Acquired Immunodeficiency Syndrome or AIDS as it is generally called, is the result of this virus. When a person has AIDS, the immune system gradually break downs. The patient then becomes highly susceptible to infections and illnesses, which could even, be fatal. History dates its origin to June 5th 1981 in Los Angeles where the virus was found in five homosexual men. It was then called GRID or Gay-Related Immune Deficiency because people thought it only affected homosexual people. This theory was soon blown to pieces when cases were reported from all over. Today, AIDS has reached epidemic proportions. It has plagued most countries around the world and is considered a highly dangerous disease.

To gain a better understanding of HIV, we must first explore how it is transmitted.

a. HIV is a sexually transmitted disease. What does this mean? The mucous membrane lines different parts of the body such as the lips, genital areas, nostrils etc. When the mucous membrane comes in contact with sexual secretions of an infected HIV patient, the virus transfers from one to another. This is why the main cause for the spread of AIDS is unprotected sexual intercourse.

b. HIV is also transmitted through infected blood. Therefore, one has to take extreme precaution when undergoing blood transfusions. It is always advisable to go to a reputed hospital or clinic where infected syringes are not used. Intravenous drug users and hemophiliacs are at high risk to get HIV.

c. HIV can be transmitted from a mother to a child either in the womb, during childbirth or duing breast-feeding. The chances of this happening have been reduced with drugs and other procedures.

Some of the early symptoms include sinusitis, bronchitis, otitis, pharyngitis, weight loss, dry cough, unexplained fatigue, unusual blemishes on the tongue, herpes zoster and oral ulcerations. During the more advanced stages patients may have chronic diarrhea, continuous fever, extreme weight loss, oral hairy leukoplakia and candidiasis and pulmonary tuberculosis.

It is extremely important for people to be tested for HIV. In some communities, partners are required to take the HIV test prior to marriage. This is because it not only affects the infected individual but also can spread to the spouse and the unborn child. It is difficult telling someone you love that you have AIDS. However, is very vital for their health and safety.

Doctors, nurses and Medicare professionals are also exposed to this virus as they deal with syringes and needles on a daily basis. If you have AIDS and if you are looking for a doctor, then do some preliminary research on the doctor before you meet him or her. The doctor should be reliable and must be aware of the nuances of the field. You should choose a doctor who you are comfortable with.

About the author:
James Daugherty reports about the latest HIV news - http://myhivstory.blogspot.com/ on his blog.
Article Source: http://www.Free-Articles-Zone.com

Notes on AIDS and HIV

2007-11-24T19:57:00.000-08:00

By David Stanley [ 18/06/2006 ]

In 1981, scientists in the United States and France first recognized the Acquired Immune Deficiency Syndrome (AIDS), which was later discovered to be caused by a virus called the Human Immunodeficiency Virus (HIV). HIV breaks down the body's immunity to infections leading to AIDS. The virus can lie hidden in the body for up to 10 years without producing any obvious symptoms or before developing into the AIDS disease, and in the meantime the person can unknowingly infect others. Currently, an estimated 40 million people worldwide are HIV carriers, and three million a year are dying of AIDS.

HIV lives in white blood cells and is present in the sexual fluids of humans. It's difficult to catch and is spread mostly through sexual intercourse, by needle or syringe sharing among intravenous drug users, in blood transfusions, and during pregnancy and birth (if the mother is infected). Using another person's razor blade or having your body pierced or tattooed are also risky, but the HIV virus cannot be transmitted by shaking hands, kissing, cuddling, fondling, sneezing, cooking food, or sharing eating or drinking utensils. One cannot be infected by saliva, sweat, tears, urine, or feces; toilet seats, telephones, swimming pools, or mosquito bites do not cause AIDS. Ostracizing a known AIDS victim is not only immoral but also absurd.

Most blood banks now screen their products for HIV, and you can protect yourself against dirty needles by only allowing an injection if you see the syringe taken out of a fresh unopened pack. The simplest safeguard during sex is the proper use of a latex condom. Unroll the condom onto the erect penis; while withdrawing after ejaculation, hold onto the condom as you come out. Never try to recycle a condom, and pack a supply with you, as it can be a nuisance trying to buy them on short notice.

HIV is spread more often through anal than vaginal sex, because the lining of the rectum is much weaker than that of the vagina, and ordinary condoms sometimes tear when used in anal sex. If you have anal sex, only use extra-strong condoms and special water-based lubricants, since oil, Vaseline, and cream weaken the rubber. During oral sex you must make sure you don't get any semen or menstrual blood in your mouth. A woman runs 10 times the risk of contracting AIDS from a man than the other way around, and the threat is always greater when another sexually transmitted disease (STD) is present.

The very existence of AIDS calls for a basic change in human behavior. No vaccine or drug exists that can prevent or cure AIDS, and because the virus mutates frequently, no remedy may ever be totally effective. Other STDs such as syphilis, gonorrhea, chlamydia, hepatitis B, and herpes are far more common than AIDS and can lead to serious complications such as infertility, but at least they can usually be cured.

You should always practice safe sex to prevent AIDS and other STDs. You never know who is infected or even if you yourself have become infected. It's important to bring the subject up before you start to make love. Make a joke out of it by pulling out a condom and asking your new partner, "Say, do you know what this is?" Or perhaps, "Your condom or mine?" Far from being unromantic or embarrassing, you'll both feel more relaxed with the subject off your minds, and it's much better than worrying afterwards if you might have been infected. The golden rule is safe sex or no sex.

An HIV infection can be detected through a blood test, because the antibodies created by the body to fight off the virus can be seen under a microscope. It takes at least three weeks for the antibodies to be produced and in some cases as long as six months before they can be picked up during a screening test. If you think you may have run a risk, you should discuss the appropriateness of a test with your doctor. It's always better to know if you are infected so as to be able to avoid infecting others, to obtain early treatment of symptoms, and to make realistic plans. If you know someone with AIDS, you should give them all the support you can (there's no danger in such contact unless blood is present).

About the author:
David Stanley is the original author of Lonely Planet guidebooks to Eastern Europe, Cuba, and Canada's Maritime Provinces. His personal collection of Cuba travel photos is on Cuba Pictures.

You have permission to publish this article electronically or in print, free of charge, so long as the byline and resource box are included. Please do not use this article without the byline and resource box. Many thanks!

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Sexually transmitted diseases.The Price of Sexual Freedom

2007-11-24T19:49:00.000-08:00

By Anne Wolski [ 30/04/2006 ]

In this modern era, sexual freedom is taken for granted and little is thought of promiscuity as it was in past generations. However, the reality is that this sexual freedom also carries with it the very real threat of sexually transmitted disease. Because not all sexually transmitted diseases are curable, it is essential to take steps to avoid them.

A sexually transmitted disease or STD is actually a combination of several different conditions that are all acquired through sexual intercourse. AIDS, a disease caused by the HIV virus, is the most serious of the sexually transmitted diseases and, despite some progress in recent years, is still incurable and is usually fatal.

Some of the other problematic STDs include syphilis, gonorrhea, genital herpes, and non specific urethritis. There are also a few other diseases such as pubic lice, genital warts, trichomoniasis, and monilia that are classed as STDs but are of a less serious nature.

The incidence of sexually transmitted diseases has increased over time and today there are more recorded cases than at any time in the past three decades. This is because people, especially young people, feel that the use of contraception allows more sexual freedom and has led to a change in the views of sexual behaviour. It is also a fact that this sexual freedom has led to people becoming sexually active at an increasingly younger age. However, not all contraception can stop the spread of infections caught during sexual intercourse.

Syphilis
One of the most serious STDs is syphilis which is highly infectious and, if it remains untreated, can result in death. Even if it is not fatal, the probability of disability is high.

Not only can the syphilis bacteria be contracted during sexual intercourse, but it can also be passed to the unborn child of an infected mother. The baby is then born with a condition known as congenital syphilis. This is quite uncommon in this era as all pregnant women undergo routine blood testing.

The incubation period for syphilis varies. The first symptoms can also vary, thus making early diagnosis difficult. Usually, the first symptom is a painless ulcer around the genital area, the anus, or the mouth. Because this ulcer heals without any medical intervention, the person doesn’t normally do anything about it, thinking that it is nothing important.

If this disease is not treated early, it is likely to result in death. It is therefore essential that, if a person believes he or she may have been in contact with an infected person, that medical advice is obtained immediately.

Gonorrhea
Another serious and very common disease contracted by sexual intercourse is gonorrhea. Often, the female is unaware that she is infected because around eighty percent have no symptoms. Other women suffer from dysuria (pain while urinating) or from lower abdominal pain. This is because it involves the fallopian tubes and can therefore lead to sterility.

The disease is more obvious for the male, resulting in dysuria followed by a discharge from the penis. This occurs within a week of contracting the infection. Gonorrhea in the male is usually confirmed by laboratory testing of the discharge.

A dose of penicillin is the normal treatment for gonorrhea in both male and female sufferers. It is also vital that the person abstain from alcohol and from sexual intercourse for a period of several weeks. Although the treatment relieves the symptoms quickly, it is essential that the person continues to have medical maintenance to ensure that the cure is complete. A responsible person should inform any sexual partners of their infection so that they may be examined and treated if necessary.

NSU
The most common sexually transmitted disease is nonspecific urethritis or NSU which continues to increase at an remarkable rate. Many cases of NSU are caused by the Chlamydia germ but not all. NSU is an inflammation of the urethra and has no identifiable cause.

The primary symptom is a discharge from the penis. This may be nothing more than moistness at the tip of the penis but this can vary. The discharge is different to the discharge in gonorrhea and makes it easier to recognize. There is also pain on urinating.

Genital herpes
Genital herpes, another sexually transmitted disease, has reached epidemic proportions in the Western world. This is because the herpes virus cannot be cured and so, once infected, the person carries the germ permanently. Thus, any person infected adds to the population of carriers.

There are two herpes viruses. The first one, HSV 1, is normally found around the mouth and is known as cold sores. The second one, HSV 2 , is an infection passed by sexual contact and is normally found in the genital area and the anus, as well as on the bladder, the buttocks, the thighs and the legs of both male and female sufferers.

After the first attack the virus lies dormant in the body. It will then recur time and time again, usually in the same place, appearing as a painful blister. When any of these blisters are open, the carrier is extremely infectious. Usually, the attacks are linked to emotional or physical lows such as depression, stress, or injury.

Genital herpes causes pain and distress to an adult but is not fatal. However, if the herpes virus is passed to an infant during its journey down the birth canal of an infected mother, it is often fatal. It is important for the mother to inform the medical professionals so that they can monitor her pregnancy and possibly advise her to have the baby by cesarean section.

Genital herpes cannot be cured but there are ways of making the attacks more bearable. By keeping the affected area clean and dry, the carrier can ward off secondary infections. Pain can be kept to a minimum by the application of cold compresses and also by taking salt baths.

Female sufferers need to have a pap smear annually as genital herpes has been linked to cervical cancer.

In women, vaginal discharge may constitute reasons for concern. However, if the discharge is clear, it is unlikely to be the result of disease. If the discharge is offensive and discolored and causes irritation to the vagina and vulva, it would suggest the presence of infection which may need to be investigated. It is essential that this is not allowed to continue and medical advice should be sought as soon as possible, especially if this is accompanied by abdominal pain and fever as it may be an indication of a sexually transmitted disease.

Prevention
Obviously, the best way to avoid sexually transmitted diseases is by abstinence or monogamy. However, if considering sex with a new partner, it would be wise to use a condom until you are sure about the person. If you are worried, cleaning the genital area thoroughly with soap and water after intercourse will kill many of the bacteria. This is true for both males and females.

It is extremely dangerous to apply antiseptic lotions to the genital area and particularly to pour strong antiseptic into the urethra or vagina as it can cause serious and permanent internal damage.

If you believe there is any possibility that you may have an STD, do not hesitate to seek medical attention. Everything that happens is confidential and no information is given to anyone without your permission.

Remember that the staff are there to help you, not to judge you, and the atmosphere is usually very friendly and helpful.

About the author:
Anne Wolski has worked in the health and welfare industry for more than 30 years. She is a co-director of http://www.magnetic-health-online.com and http://www.betterhealthshoppe.com which are both information portals with many interesting medical articles. She is also an associate of http://www.timzbiz.com which features many articles on internet marketing and resources.

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My Cure Theory for HIV - AIDs

2007-11-24T19:45:00.000-08:00

By leo le [ 12/01/2006 ]

My Cure Theory

HIV has many different strands or forms making it almost impossible to find an efficient answer for vaccination. Over in other countries (Asia and Africa to name a few) where there is prostitution, scientists have discovered that prostitutes have become immune to the virus in a couple different ways. Scientists have discovered that the immune system of prostitutes has found a way to fight the virus. How could this be? HIV is being stopped in its tracks from becoming Aids. Is the virus, HIV fighting against different strands or forms of itself? Think about it. You have different strands of the virus, meaning several different partners with different types of strands of HIV. You have a prostitute with one type of strand (the control patient). The resultant different strands introduced to a control patient with one strand equals different outcomes. After years of research and billions of dollars in funding, ironically, sexually, prostitution has found a key to fighting Aids. There are no known cures for viruses or even for the common cold. But figuratively speaking why try so hard to fight an enemy, when you can use an enemy against themselves. With the discovery of different strands and forms of viruses, is there a possible way we can use a virus against itself? Bottom line is that sometimes finding a cure for something can seem almost impossible but fighting fire with fire can result in the ultimate answer. Keep in mind with every new idea or answer arises many questions for the long term outcome. Our answers to life may give us new hope but may also be our ultimate downfall. I wrote this just to get a professional medical research opinion. This virus has been around for ages and needs to be stopped like all other bad diseases and viruses. I just wanted to post my idea in good faith to help find a cure.

About the author:

Article written by Nghiep Khuu “Leo Le” on Sunday, December 18, 2005. Updated today 1/12/06.

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Sexually transmitted diseases (STD) guide

2007-11-24T19:37:00.000-08:00

Sexually transmitted diseases are escalating nowadays when more people have started entering into multiple sexual relationships. They might not consider this ethically wrong but the fact remains that such people are more prone to sexual diseases. However, if unfortunately one gets infected by any such disease, it is better to start ailment as soon as possible for these diseases have the potential to ruin your entire life. People often are embarrassed and scared to disclose their problem to others even to their friends but they fail to realize that delaying diagnose is compromising with their life. Thus, as soon as you fear a sexually transmitted infection, approach a doctor.

This article informs the readers about certain primary STDs and their symptoms.

1. AIDS and HIV

• Transmitted through- AIDS and HIV are two more or les related diseases. The HIV stands for the ‘human immunodeficiency virus’ and the disease that spreads through it is known as AIDS i.e. ‘acquired immune deficiency syndrome’. HIV travels through blood. It can be transmitted from one HIV positive person to his partner through sex. It can also pass on from the HIV positive mother to her child through infected breast milk and even from an infected syringe or other equipments that come into contact with the blood of the HIV positive to any other individual who is treated with the same devices.

• Symptoms- weak immune system and susceptible to more infections than usual. HIV gets translated to AIDS when the HIV patient acquires a particular indicative illness.

• Preventive Measures- not much available yet. But avoid taking drugs. Maintain hygiene.

2. Chlamydia-

• Infected via- the bacteria Chlamydia trachomatis is the cause of this infection. Once this bacterium enters the individual’s body it affects his mucous membranes, eyelids and even reproductive tissues.

• Symptoms- the symptoms Chlamydia often confused with another similar STD called Gonorrhea and even with Conjunctivitis due to eyelid infection. The common symptoms to this disease are pain during sex, burning and abnormal discharge. Chlamydia can be without any typical indications also

• Prevention- the disease is curable. As a precautionary measure one should maintain hygiene during sex and get medical check up done in order to avoid infection.

3. Pelvic Inflammatory Disease- usually women are afflicted by this disease. It is a an infection in the upper genital tract and reproductive organs including ovaries, uterus and fallopian tubes.

• Spreads through- Chlamydia and Gonorrhea are the two STDs that are most often responsible for this disease. Women between 15 to 25 years of age are more prone to be infected by it. Excess douching can also lead to PID for it cleanses the naturally beneficial bacteria from the women’s vagina.

• Symptoms- When ailing PID, women might experience pain during intercourse, burning and even fever.

• Precautions and Cures- antibiotics are useful to cure PID. But it is recommended to get frequent check ups done and in case the disease is discovered medicines and proper treatment should commence the very moment for PID can be unexpectedly harmful in later stages.

4. Gonorrhea- infects the individual’s sensitive tissues of reproductive system.

• An individual can acquire this disease through all types of sexual contacts like oral sex.

• Indications- the indicators to Gonorrhea are very few which makes it all the more difficult to adjudicate it and so stop it from being transmitted from one to the other person through sex. Symptoms are akin to Chlamydia so the two diseases are liable to be confused with each other. A person suffering from Gonorrhea experiences unusual discharge, burning, pain during sexual activity, swelling, fever and other infections like women may have bleeding between periods.

• Remedies and Safety- treatment should commence in initial stages to cure Gonorrhea. Those who are pretty active in their sexual life should get check ups done on a regular basis to be on a safer side.

Apart from these there are several other STDs not discussed here like Hepatitis, Scabies, Herpes, Syphilis, HPV etc. which are most common in ones. It is better to acquire information about them once you are sexually active and consult a gynecologist every now and then to avert from all kinds of STDs.

About the author:
Mansi gupta writes about sexually transmitted diseases Learn more at http://www.treatyourstd.com

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TGP can help to prevent HIV-AIDS

2007-11-24T19:33:00.000-08:00

TGP can help to prevent HIV/AIDS
- Mohammad Khairul Alam -
- HIV/AIDS programme Consultant -

Now a day AIDS is increasing all over the world in an enormous position. No country could face it successfully. It turns very unique position in some countries of Africa like Uganda, Gayer, Cambodia, and Sub Sahara region etc. East Asian some countries are also affected by this. In South Asian country like India is the second largest country in the world for HIV/ AIDS. There are 5.1 million people carry or suffer of this. It will be the main reason of our country for vulnerable of HIV/ AIDS. Because we have to depend in various reason of that country. Mainly our internal Business fully depends on it. Such there many way we bound to go India. Burma is another neighbor country is already a large number affected in here. AIDS surveillance specialist Mr. Parvage Shajjad Mollik said, “There are so many cultural values and socio economical systems are responsible for this increasing like this dieses, poverty and illiteracy is also responsible for this increasing. This indicator is not fully responsible but it helps to change behavior on so that. So if we want to prevent of this at first we have to emphasize to try to change sexual behavior. We did success to find out our vulnerable target groups and why they become vulnerable”.

HIV/ AIDS is a sexual disease, but it is deferent from other sexual transmission disease (STDs, STI). Other STDs have proper medicine and these diseases don’t create cause of die, but AIDS is very dangerous, there are no any alternative way to survive after it infection, it can end of life. We find out first vulnerable group in Bangladesh is injection drug user (IDUs) and second is professional sex worker. There are many reason every year are increasing IDUs all over in Bangladesh. It easy to get in every location in Bangladesh and chipper than other is the main reason for this; other reasons are political and socio-economical frustrations. Last year 4th surveillance report was about 4% IDUs are infected with HIV/AIDS all over in Bangladesh, but after one year we see the one area of Dhaka City this raise to 8.9%, this report we get from 5th surveillance survey. This ratio will be clouded in our social norm and can help to hamper our economical condition. Our country is very poor so we are not able to face a large number of patients like this disease.

So we have to take necessary steps to prevent it’s increasing. We need several level of advocacy champing to build up awareness of HIV/AIDS. We need to encourage gender/ reproductive health education, which not only prevent HIV/AIDS but also help to prevent others STDs/STI (Sexual Transmission Disease). We can influence our government education authority to include about HIV/AIDS details our primary and secondary level’s curriculum.

Gender education is essential in our country’s adolescent boys & girls. This education can play a vital role of empowerment our illiterate society. It can help to develop our adolescent into a proper knowledge. Religious superstition & fundamentalism prevents to get such kind of education from their childhood. But this knowledge is very important for mental & physical development, it can help their social interaction, social behavior, reproductive health & sanitation, sexual behavior, to able to adopt all kinds of social change, to awareness them of their rights etc. Individually lack of knowledge these one can create other problems.

We also increase peer educator for professional sex worker, peer educator means a group of person or individual who are take from target group or brothel to give them proper training. After training they can able to awareness others.

We need to take TGP (Target Group Promoter) strategy for residence or other sex worker. It is very affected for residence sex workers or hidden sex workers. TGP is a newly invention idea (Proved by Rainbow Nari O Shishu Kallyan Foundation) which help to prevent HIV/AIDS. TGP is a one kind of source/ broker/ sealer (Called in Bengali is Dalal), who collects clients/ customers for residence sex workers; they encourage people to buy sex. Without TGP (Their nominated source) the residence sex worker doesn’t allow any new client. TGP will play a vital roll in our action. Residence Sex Workers (RSW) lives together three to ten in a house. They continue their business under a Guidance or Governance or a Teem Leader (is called Sharderni in Bengali). These teem leaders communicate with some local people, who help them by delivering customer or client, these people is called source (in Bengali called Dalal). They depend on each other. Some times those sources shelter them from local unexpected situation or from police harassment. If we could continue this action then TGP will play very important role. Because residence sex workers don’t stay long time in a house, they change their house after three to six months, but they always keep contact with their source (TGP) for continuing their business. For this reasons TGP is very important programme.

In some areas a group of drug user uses one syringe when they take drug. It is very dangerous for increasing HIV/AIDS. So we should try to alert them, and give advice them two or more drug user don’t use drug by a one syringe.

Mohammad Khairul Alam
HIV/AIDS programme Consultant

Rainbow Nari O Shishu Kallyan Foundation
24/3. M. C. Roy Lane
Nowbabgonj- Section
Dhaka-1211Bangladesh
http://www.plusbangla.com/
Rainbowngo@gmail.com

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Drug Users are Vulnerable for STDs-STI in Bangladesh

2007-11-24T19:26:00.000-08:00

Drug Users are Vulnerable for STDs/STI in Bangladesh

Mohammad Khairul Alam

HIV/AIDS Programmme Consultant

The over all HIV/AIDS epidemics situation is low in Bangladesh. But it is increasing very high in some heterogeneous group who are actually vulnerable of HIV/AIDS. HIV/AIDS spread out very quickly in all over the population. There are many ways in Bangladesh to HIV/AIDS increasing issue.

The cause of poverty, gender discrimination, low prevalence of health facility, lack of reproductively knowledge, illiteracy and high risky behavior may be called epidemic in future of Bangladesh. The atmosphere, which is needed to spread HIV as epidemic of HIV/AIDS, those are present in Bangladesh.

It seems that there are three issues that are appearing to play a crucial position in HIV transmission in Bangladesh: female sex work substance use, Intravenous drug use, professional blood donor and mobility. Female sex workers and their clients have been a major factor in the heterosexual transmission of HIV. Separate but unstable epidemics have been seen in some IDU populations in Dhaka city. And mobile populations, particularly at national borders are at higher risk of HIV acquisition due to the fact of being away from home, community and the anonymity and loneliness of traveling. The following three segments focus on the monitoring of the HIV epidemic in these vulnerable populations.

Commercial/Professional sex workers operate in all over the country. But it is important to know how large the sex-worker population may be to adequately interpret surveillance results. It is hypothetical that in some region, rapid increases in the absolute numbers of sex workers have resulted from significant political, social or economic changes. The nature of sex work and the profile of sex workers vary enormously within and between countries. There are most female sex workers, and those that work full-time, part-time or seasonally. Sex workers may operate in variety of settings such as brothels, riverbanks, bars, parks, under contraction buildings, street corners, hotels, etc. Sex work does not consider in Bangladesh, expect 14 reported brothels. Some HIV/AIDS or social workers suspected that brothel sex worker in Bangladesh is limited, near about 35,000 to 45,000, but other category sex workers is no countable, it is suspected more then 1,00,000. Dhaka city, for example, has approximately 5,000-15,000 female sex workers--an estimate (Source: Rainbow Nari O Shishu Kallyan Foundation). In most Cities, however, validated estimates of the numbers of sex workers are almost non-existent.

All estimates require regular updating and validation but these two approaches are worthy of repetition in other settings. Neither method can work without the trust and involvement of commercial sex workers themselves. Frequency of exposure to HIV infection through sexual intercourse is the key factor for transmission of HIV among sex workers. For example, there are many countries; a significant proportion of sex workers is infected with HIV. The rates might vary from less than 1 percent to 40 percent or higher in some settings.

Even where HIV infection has not yet increase extensively, STD infection is often very high among sex workers. For example, in one brothel area in Bangladesh, 95 percent of 466 sex workers tested positive to antibodies for genital herpes virus and 60 percent for syphilis, although HIV was not detected among any of them. With the sequence of the epidemic, HIV tends to increase where other STDs are present.

There are many aspects to the nexus of drug use and HIV infection, In most of Bangladesh, people who choose to use drugs (Smoking-drug, morphia, heroin, hashish, Medicare-drug some kinds of sleeping pill, cold syrup, injections etc) that are not all socially sanctioned are treated as entirely outside society, enemies even of the social structure. The factor of Injection/ intravenous Drug Users (IDUs), which is directly can influence of HIV/AIDS, STDs/STI. For the majority of injecting drug users (IDUs), it means that lip-service is paid to the principles supposedly learned through the course of the epidemic: in relation to IDUs and the risks of HIV transmission, issues such as human rights, peer education, community participation, and legal and social change are unachievable fictions.

Besides, better estimation of populations at risk (i.e., those currently injecting drugs, or sex partners of IDUs and populations coming to be at risk), and a better understanding of the dynamics of drug utilization and social association of drug use are all necessary for targeting interventions efficiently.

Populations in Bangladesh are moving across land and sea borders in increasing numbers. International trade supports this growth in population mobility, international border between India and Bangladesh, more than 500 trucks come daily. Also occurring in Bangladesh are high levels of maritime trade, and seamen on fishing vessels travel widely in the region, enabling the transmission of HIV to populations in areas where the virus was previously unfamiliar.

Crossing land or sea borders often requires overnight stays, leaving the individual with idle time and opportunities to visit drinking and gambling establishments and brothels. HIV surveillance data for female sex workers, male STD clinic patients and young males at two sea ports – Cittagong & Mongla --show a clustering of high prevalence sites.

About the author:

Rainbow Nari O Shishu Kallyan Foundation

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AIDS and women in the world

2007-11-24T19:21:00.000-08:00

AIDS and women in the world

Al-Haz Dr. M. A. Matin
Senior Section Officer
Institute of Social welfare & Research
Dhaka University

Women are in nature more vulnerable than men to HIV infection. “Rainbow Nari O Shishu Kallyan Foundation” have found that male to female transmission appears to be 2 to 4 times more efficient than female to male transmission, in part because semen contains a far higher concentration of HIV than vaginal fluid. Adolescent girls are predominantly vulnerable. Their immature cervixes and low vaginal mucus production presents less of a barrier to HIV infection.

The developing world is now bearing the full brunt of the human immune- deficiency virus (HIV) epidemic. More than 90 per cent of new infections are in developing countries and the virus has spread to most areas. In many areas of sub-Saharan Africa, where infection has been prevalent for a decade or more, HIV has already become the leading cause of adult illness and death. Similarly profound changes in patterns of disease and death are likely in those regions of Asia and Latin America where the virus has more recently become epidemic.

Most parts of the world have reported cases of HIV infection and AIDS. Although Sub Saharan Africa is the worst affected region, containing perhaps three-quarters of all cases, the virus is now spreading most rapidly in India and South-East Asia. Heterosexual and vertical transmission of the virus has resulted in its wide distribution in the general population, in sexually active adults and adolescent.

The economic, gender discrimination, social and physical right imbalance between men and women contributes to the lack of safety in sexual relationships and the difficulty for many women in negotiating safer sex. To do so may have serious repercussions, ranging from stigma to fear of violence or desertion.

The right differential between men and women is compounded by age differences. Women naturally marry or have sex with older men, who have been sexually dynamic longer and are more possible to have become infected. Men are also beginning to seek younger sexual partners believing that these girls are less likely to be infected with HIV.

The majority infections take place in infants or young children and adolescent, sexually active adults. Women tend to become infected an average of 5 to 10 years earlier than men. Women also have a higher risk of acquiring infection which may, in East Africa, be from 1.2 to 1.5 times greater in females than males. Most adults who die are economically active and have many dependants. Major social and economic problems are emerging: orphans, changes in the dependency ratio, loss of skilled and unskilled labor.

Women are vulnerable to coerced sex, including rape and other sexual abuse - within and outside the family - and forced sex work. Any non-consensual or coerced penetrative sex can carry an increased risk of HIV transmission, particularly as men are not likely to use condoms in these situations.

Subordination in education, employment, social and legal status makes women more vulnerable to HIV/AIDS. Women who have limited access to financial resources are more likely to become economically dependent on men, relegated to the subsistence sector or forced into commercial sex work.

About the author:
Rainbow Nari O Shishu Kallyan Foundation
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The HIV-AIDS epidemic has been fuelled by gender inequality

2007-11-17T18:53:00.000-08:00

Mohammad Khairul AlamHIV/AIDS Programmme Consultant

Worldwide, rates of sexually transmitted infections among young people are soaring: one-third of the 340 million new STIs each year occur in people under 25 years of age. Each year, more than one in every 20 adolescents contracts a curable STI. More than half of all new HIV infections occur in people between the ages of 15 to 24 years. The sexual health needs for adolescent girls are generally overlooked, Stigma and vulnerability affects particular groups of men as well as women. Although men generally have more access to information on sexual issues than women, and more decision-making power regarding sexual behavior, Access to information, and treatment for other infections which facilitate the transmission of HIV and onset of AIDS, including sexually transmitted infections, are limited because of weak public health services, health workers’ negative attitudes, and the high cost of treatment.

If the adolescents are informed and thought about their sexual and reproductive health, they might take the decisions about it independently. But the physiological, behavioral and social factors that make adolescents more vulnerable than adults to STDs/STI. Seeing that girls have a large mucosal surface area exposed to infection and have not yet developed mature mucosal defence systems, the cells that line the opening of the cervix are particularly susceptible to chlamydia, gonorrhoea and HIV.

Social powerlessness, poverty and economic dependence contribute to the vulnerability of adolescent girls. The HIV/AIDS epidemic has been fuelled by gender inequality. Unequal power relations, sexual coercion and violence is a widespread phenomenon faced by women of all age-groups, and has an array of negative effects on female sexual, physical and mental health. HIV/AIDS infection reveals the disastrous effects of discrimination against women on human health, and on the socio-economic structure of society.

Usually, girls do not have the same educational and employment opportunities as boys, and they face family and societal forces for early marriage and childbearing. Early marriage and early childbearing are the norm in Bangladesh, although age at marriage is rising in all the countries mentioned. Finally, there is evidence that an increasing proportion of unmarried adolescents are sexually active.

Now a day, age at marriage is increasing, and this raises its own issues and concerns. Sometimes Later marriage increases premarital sex. Sex outside marriage is normally considered immoral and adolescents who engage in it particularly girls are strongly condemned.

In many societies, people from groups associated with high incidences of HIV infection – including injecting drug users, men who have sex with men, and commercial sex workers are subjected to a culture of fear and punishment when their HIV status is suspected.

Source: Rainbow Nari O Shishu Kallyan Foundation

About the author:
Source: Rainbow Nari O Shishu Kallyan Foundation
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Social Cultural and economic forces make women more likely to contract HIV infection than men

2007-11-17T18:46:00.000-08:00

Mohammad Khariul AlamHIV/AIDS Programmme Consultant

The view of poor & developing countries, In generally we found that women & adolescent girls are more vulnerable to HIV infection on each sexual encounter because of the biological nature of the process and the vulnerability of the reproductive tract tissues to the virus, especially in adolescent girls. For example, young women are generally disadvantaged by gender disparities. In terms of food intake, access to health care and growth patterns, girls are often worse off than boys. The inequalities become evident soon after birth, and by adolescence many girls are grossly underweight. Social Cultural and economic forces make women more likely to contract HIV infection than men. Women are often less able to negotiate for safer sex due to reasons such as their lower status, economic dependence and fear of violence, adolescent girls in the countries.

Adolescents in poor families often do not have the option to make real choices about their sexual and reproductive lives, such as when and whom to marry, whether and when to have children and how many to have, and whether to use contraceptives. Women tend to marry very young: nearly two thirds of adolescents in most South Asian countries marry before 18 years of age, and many even before 15 years, despite laws exclusion such early marriage.

In many poor regions, Women’s limited economic opportunity, and relative powerlessness, may force them into sex work in order to survive with household financial disaster. This exposes them to HIV infection and they in turn will transmit HIV to their clients. In those areas girls are particularly vulnerable to HIV infection, because of intergenerational sexual relationships, violence, and limited access to information. In addition, discrimination and stigma obstruct adolescent girls’ access to health services. Poverty causes increased migration to look for work.

Gender analysis, in relation to HIV/AIDS, has tended to focus on women of reproductive age, and infrequently on young girls, because Young women and girls are increasingly being targeted for sex by older men seeking safe partners and also by those who erroneously believe that a man infected with HIV/AIDS will get rid of the disease by having sex with a virgin. So HIV/AIDS epidemic has been fuelled by gender inequality or discrimination. Unequal power relations, sexual coercion and violence is a widespread phenomenon faced by women of all age-groups, and has an array of negative effects on female sexual, physical and mental health.

In many developing countries, poverty, and gender discrimination between women and men, are both strongly linked to the spread of HIV/AIDS. Gender and age analysis shows the ways in which women and girls of different ages are vulnerable to the infection, and in require of support to allow the survivors to overcome the financial and social effects of the epidemic. In responding to HIV/AIDS and poverty alleviation approaching are interconnected. Therefore health and development workers should work on holistic policies and programmes to reduce poverty and address HIV/AIDS, and Emphasize the need for special efforts to be made to protect women and girls exposed to the risk of HIV/AIDS. Ensure that the legal, civil and human rights of those affected and infected are protected and that women have access to treatment, counselling and support on an equal footing with men.

Source: Rainbow Nari O Shishu Kallyan Foundation

About the author:
Source: Rainbow Nari O Shishu Kallyan Foundation
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Female Sex Workers are vulnerable for HIV-AIDS in Bangladesh

2007-11-17T18:41:00.000-08:00

Female Sex Workers are vulnerable for HIV/AIDS in Bangladesh,

Mohammad Khairul AlamHIV/AIDS Programmme Consultant

The over all HIV/AIDS epidemics situation is low in Bangladesh. But it is increasing very high in some heterogeneous group who are actually vulnerable of HIV/AIDS. HIV/AIDS spread out very quickly in all over the population. There are many ways in Bangladesh to HIV/AIDS increasing issue.

The cause of poverty, gender discrimination, low prevalence of health facility, lack of reproductively knowledge, illiteracy and high risky behavior may be called epidemic in future of Bangladesh. The atmosphere, which is needed to spread HIV as epidemic of HIV/AIDS, those are present in Bangladesh.

It seems that there are three issues that are appearing to play a crucial position in HIV transmission in Bangladesh: female sex work substance use, Intravenous drug use, professional blood donor and mobility. Female sex workers and their clients have been a major factor in the heterosexual transmission of HIV. Separate but unstable epidemics have been seen in some IDU populations in Dhaka city. And mobile populations, particularly at national borders are at higher risk of HIV acquisition due to the fact of being away from home, community and the anonymity and loneliness of traveling. The following three segments focus on the monitoring of the HIV epidemic in these vulnerable populations.

Commercial/Professional sex workers operate in all over the country. But it is important to know how large the sex-worker population may be to adequately interpret surveillance results. It is hypothetical that in some region, rapid increases in the absolute numbers of sex workers have resulted from significant political, social or economic changes. The nature of sex work and the profile of sex workers vary enormously within and between countries. There are most female sex workers, and those that work full-time, part-time or seasonally. Sex workers may operate in variety of settings such as brothels, riverbanks, bars, parks, under contraction buildings, street corners, hotels, etc. Sex work does not consider in Bangladesh, expect 14 reported brothels. Some HIV/AIDS or social workers suspected that brothel sex worker in Bangladesh is limited, near about 35,000 to 45,000, but other category sex workers is no countable, it is suspected more then 1,00,000. Dhaka city, for example, has approximately 5,000-15,000 female sex workers--an estimate (Source: Rainbow Nari O Shishu Kallyan Foundation). In most Cities, however, validated estimates of the numbers of sex workers are almost non-existent.

All estimates require regular updating and validation but these two approaches are worthy of repetition in other settings. Neither method can work without the trust and involvement of commercial sex workers themselves. Frequency of exposure to HIV infection through sexual intercourse is the key factor for transmission of HIV among sex workers. For example, there are many countries; a significant proportion of sex workers is infected with HIV. The rates might vary from less than 1 percent to 40 percent or higher in some settings.

Even where HIV infection has not yet increase extensively, STD infection is often very high among sex workers. For example, in one brothel area in Bangladesh, 95 percent of 466 sex workers tested positive to antibodies for genital herpes virus and 60 percent for syphilis, although HIV was not detected among any of them. With the sequence of the epidemic, HIV tends to increase where other STDs are present.

There are many aspects to the nexus of drug use and HIV infection, In most of Bangladesh, people who choose to use drugs (Smoking-drug, morphia, heroin, hashish, Medicare-drug some kinds of sleeping pill, cold syrup, injections etc) that are not all socially sanctioned are treated as entirely outside society, enemies even of the social structure. The factor of Injection/ intravenous Drug Users (IDUs), which is directly can influence of HIV/AIDS, STDs/STI. For the majority of injecting drug users (IDUs), it means that lip-service is paid to the principles supposedly learned through the course of the epidemic: in relation to IDUs and the risks of HIV transmission, issues such as human rights, peer education, community participation, and legal and social change are unachievable fictions.

Besides, better estimation of populations at risk (i.e., those currently injecting drugs, or sex partners of IDUs and populations coming to be at risk), and a better understanding of the dynamics of drug utilization and social association of drug use are all necessary for targeting interventions efficiently.

Populations in Bangladesh are moving across land and sea borders in increasing numbers. International trade supports this growth in population mobility, international border between India and Bangladesh, more than 500 trucks come daily. Also occurring in Bangladesh are high levels of maritime trade, and seamen on fishing vessels travel widely in the region, enabling the transmission of HIV to populations in areas where the virus was previously unfamiliar.

Crossing land or sea borders often requires overnight stays, leaving the individual with idle time and opportunities to visit drinking and gambling establishments and brothels. HIV surveillance data for female sex workers, male STD clinic patients and young males at two sea ports – Cittagong & Mongla --show a clustering of high prevalence sites.

Source: Rainbow Nari O Shishu Kallyan Foundation

About the author:Source: Rainbow Nari O Shishu Kallyan Foundation
Article Source: http://www.free-articles-zone.com/author/846

female sex workers in Bangladesh

2007-11-17T18:37:00.000-08:00

female sex workers in Bangladesh-Mohammad Khairul Alam

Although Bangladesh continues to be a low prevalence area, it is surrounded by high prevalence countries (High prevalence of HIV/AIDS in neighboring India). We however must not adopt a complacent attitude in respect as our country has all the determinants for an explosive outbreak of HIV/AIDS epidemic. Curses of poverty, illiteracy, ignorance, proximity of Bangladesh to the so-called 'Golden Triangle' & high prevalence of STDs, make our country seriously vulnerable. Drug use increases the HIV risk and can start very early-for example, glue-sniffing by youngsters living or working on the streets. The danger of becoming infected with HIV by sharing injecting equipment is well known, and real. Unemployment, slum housing, family fragility, frequent cross-border movement of people, lack of information, unsafe blood transfusion, physical and sexual abuse-that create a "risk environment" of violence for many young people in the region. In addition increased number of migrant workers, unsafe practice in health service, unsafe sex practice etc. movement of population, less use of condom, polygamy, homosexuality, extra-marital relations, further increases the susceptibility.

In Bangladesh, the intravenous drug users (IDU) are the most potential carriers of HIV/AIDS among the vulnerable groups in the country. The fourth round of national HIV and behavioural surveillance report showed that the HIV infection rate among the injection drug users (IDUs) is now 4 per cent, up from 2.5 per cent previously which is just short of the 5 per cent mark of a concentrated epidemic. About 93.4 per cent IDUs in central Bangladesh admitted that they share same syringe while taking drugs. Even they use the same syringe several times for taking drug.

UNCDP estimates that between 500,000 and 1,00,000 people in Bangladesh are addicted to drugs. Although HIV rates are comparatively lower (one per cent) among the sex workers but Sexually Transmitted Infection (STI) rates are still quite high (20 per cent) among this group.

On the other hand, brothel-based female sex workers in Bangladesh report the highest turnover of clients than anywhere in Asia (an average of 18.8 clients per week). Meanwhile, most of the people of country are unaware about the deadly disease. The 1999-2000 Bangladesh Demographic and Health Survey found that only 31 per cent of married women and 50 per cent of newly married men had heard of AIDS. Over 90 per cent of rickshaw pullers could not identify a single method of HIV prevention.

About 13,000 to 17,000 people are living with the incurable virus in Bangladesh, according to the UNAIDS report 2001.

According to the National AIDS Committee and surveillance team members and experts, the rate is quite alarming as it remains one per cent less than the highest five per cent HIV epidemic index. The rate of HIV/AIDS remains less than one per cent among the other vulnerable groups -- truckers, migrant workers, gay, hijras (hermaphrodites), professional blood donors, heroin smokers and, hotel, brothel and street based commercial sex workers.

Bangladesh is bordered with India, the second largest HIV infected country in the world; the country is therefore at high risk for the HIV epidemic, said Morten Giersing, UNICEF's country representative.

About the author:
Rainbow Nari O Shishu Kallyan Foundation
24/3. M. C. Roy Lane
Nowbabgonj- Section
Dhaka-1211Bangladesh
http://www.plusbangla.com Rainbowngo@gmail.com
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Geographical location of Bangladesh and vulnerability to AIDS

2007-11-17T18:34:00.000-08:00

Geographical location of Bangladesh and vulnerability to AIDS-Mohammad Khairul Alam

Bangladesh, with a population of 136 million, had about 13,000 adults and children living with HIV infection at the end 2002, according to UNAIDS estimates. However, only 248 HIV cases have actually been reported. Significant underreporting of cases occurs because of the country's limited voluntary testing and counseling capacity and the social stigma, which leads to the fear of being identified and detected as HIV positive.

The HIV-prevalence rate among adults between the ages of 15 and 49 is still relatively low, at 0.1 percent of the population. As expected, rates are higher in specific groups, such as injecting drug users who have left treatment (1.7 percent) and commercial sex workers (0.5 percent), according to a national behavioral and serological surveillance undertaken in 2001.

Although overall HIV prevalence is low, behavior patterns and extensive risk factors that facilitate the rapid spread of the infection are prevalent, making Bangladesh highly vulnerable to an HIV/AIDS epidemic. These risk factors are gender discrimination, A large commercial sex worker/ brothel sex worker, a large number of hidden/residence sex worker, Lack of basic sexual knowledge, Lack of proper knowledge of sexually transmitted diseases(STDs/STI) etc.

There are fourteen government reputed brothel in Bangladesh, where roughly 40,000 sex workers live in there, the number of per sex worker’s client/customer is 18.8 per week, and 44 clients per week for hotel-based workers. And non countable client meet to residence sex workers or street sex worker, who are very vulnerable for HIV/AIDS. Significant prevalence of sexually transmitted diseases (STDs) among sex workers in Central Bangladesh. About 43 percent of female sex workers and 18.2 percent of male sex workers have syphilis. This and other STDs facilitate the spread of HIV infection and serve as indicators for low condom use and other high risk sexual behaviors. The majority of brothel-based sex workers report at least some sex without condoms with their clients. Among the clients, such as rickshaw pullers and truck drivers, about 83 percent have never used condoms when buying sex.

Now a day Injection Drug Users are increasing all over in Bangladesh. In Central Bangladesh, among 93.4 percent of over 500 injecting drug users, needle sharing is routine. These drug injectors are not an isolated population—they are often married and sometimes sell sex to customers and their own blood to hospitals and clinics.

Lack of knowledge may be creating most problems for Bangladesh of HIV/AIDS epidemic in future. While knowledge of HIV is nearly universal among sex workers and their clients, it is extremely low among the general population. In 1996-97, only 19 percent of women who have been married and 33 percent of men had ever heard of AIDS. In 2001, many still could not identify the basic routes of HIV transmission.

By keeping South Africa outside, India has the largest number of people living with HIV, estimated at 5.1 million (range: 2.5 million – 8.5 million) in 2003. Most infections are acquired sexually, but injecting drug use is playing a bigger role than previously thought. It is also a great threat for Bangladesh, because every day a large number of people are going to India for various reasons. Bangladesh has twenty custom and immigration point in the border with India, and Indian track crosses of this border every day with loaded goods. But Indian track drivers are highly infected HIV/AIDS. So it is also creating the scope of scattering HIV/AIDS in Bangladesh.

About the author:
Rainbow Nari O Shishu Kallyan Foundation
24/3. M. C. Roy Lane
Nowbabgonj- Section
Dhaka-1211Bangladesh
http://www.plusbangla.com Rainbowngo@gmail.com
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The Red Ribbon Story

2007-10-27T22:44:00.000-07:00

On February 7, 1985 at 2:00 p.m. the US Drug Enforcement Administration (DEA) agent Enrique (Kiki) Camarena was attacked by five men while opening his truck doors intending to drive and meet his wife for lunch. The beige Volkswagen where he was forced in disappeared that warm winter afternoon in the streets of Guadalajara, Mexico. One month later, Camarena’s body was found savagely and grotesquely murdered.

When Camarena joined the US DEA, after having served as a Marine and becoming a police officer, his mother tried to convince him to resign, but he was determined to make a difference. In 1974, he was transferred to Guadalajara, Mexico, the center at the time of the drug trafficking empire and working as an undercover agent was investigating a major drug cartel believed to include officers in the Mexican army, the police and the government. A firm believer of the notion that even one person can make a difference in this world, Camarena, at the age of 37, sacrificed his life to prevent drugs from entering the United States schools and streets.

Honoring his memory, family and friends from his hometown in Calexico, California began wearing red badges of satin signifying his battle against illegal drugs. Soon, coalitions were formed and adopted the symbol of Camarena’s memory: the red ribbon. In 1988, three years after his torture and death, the National Family Partnership organized the first National Red Ribbon Campaign in an effort to reach million of US children and expand Camarena’s dedication to prevent drug use around the world.

Since Camarena’s murder, the Red Ribbon Celebration and every associated campaign has touched the lives of millions of people each year. Annually, during October 23rd to 31st, more than 80 million young people and adults show their commitment to a healthy, drug-free life by wearing or displaying the Red Ribbon. This nationwide effort has become a major force for raising public awareness and mobilizing communities to combat alcohol, drug and tobacco use among youth.

Years later, the red ribbon gained international appeal as a symbol of the fight against AIDS when it was worn by Jeremy Irons at the 1991 Tony Awards. Created by the New York-based Visual AIDS Artists Caucus, this visual symbol demonstrated compassion for people living with AIDS and support to their families. Inspired by the yellow ribbons honoring American soldiers servicing in the Gulf war and the US hostages of the American Embassy in Tehran, the color red was chosen for its connection to blood and as a symbol of passion. After becoming a politically correct fashion accessory, the Red Ribbon is worn on December 1st, each year in memory and support of the HIV/AIDS victims and also to increase public awareness and thus, research funding.

About the Author: John Gibb is the owner of ribbon resources, For more information on ribbons check out http://www.ribbon-advice.info

What You Need to Know About HIV

2007-10-27T22:41:00.000-07:00

HIV is an abbreviation for Human Immunodeficiency Virus. Acquired Immunodeficiency Syndrome or AIDS as it is generally called, is the result of this virus. When a person has AIDS, the immune system gradually break downs. The patient then becomes highly susceptible to infections and illnesses, which could even, be fatal. History dates its origin to June 5th 1981 in Los Angeles where the virus was found in five homosexual men. It was then called GRID or Gay-Related Immune Deficiency because people thought it only affected homosexual people. This theory was soon blown to pieces when cases were reported from all over. Today, AIDS has reached epidemic proportions. It has plagued most countries around the world and is considered a highly dangerous disease.

To gain a better understanding of HIV, we must first explore how it is transmitted.

a. HIV is a sexually transmitted disease. What does this mean? The mucous membrane lines different parts of the body such as the lips, genital areas, nostrils etc. When the mucous membrane comes in contact with sexual secretions of an infected HIV patient, the virus transfers from one to another. This is why the main cause for the spread of AIDS is unprotected sexual intercourse.

b. HIV is also transmitted through infected blood. Therefore, one has to take extreme precaution when undergoing blood transfusions. It is always advisable to go to a reputed hospital or clinic where infected syringes are not used. Intravenous drug users and hemophiliacs are at high risk to get HIV.

c. HIV can be transmitted from a mother to a child either in the womb, during childbirth or duing breast-feeding. The chances of this happening have been reduced with drugs and other procedures.

Some of the early symptoms include sinusitis, bronchitis, otitis, pharyngitis, weight loss, dry cough, unexplained fatigue, unusual blemishes on the tongue, herpes zoster and oral ulcerations. During the more advanced stages patients may have chronic diarrhea, continuous fever, extreme weight loss, oral hairy leukoplakia and candidiasis and pulmonary tuberculosis.

It is extremely important for people to be tested for HIV. In some communities, partners are required to take the HIV test prior to marriage. This is because it not only affects the infected individual but also can spread to the spouse and the unborn child. It is difficult telling someone you love that you have AIDS. However, is very vital for their health and safety.

Doctors, nurses and Medicare professionals are also exposed to this virus as they deal with syringes and needles on a daily basis. If you have AIDS and if you are looking for a doctor, then do some preliminary research on the doctor before you meet him or her. The doctor should be reliable and must be aware of the nuances of the field. You should choose a doctor who you are comfortable with.

About the Author: James Daugherty reports about the latest HIV news on his blog.

HIV Home Testing

2007-10-27T22:33:00.000-07:00

HIV Home Testing – What It Really Means to Test Positive or Negative for HIV?

Making the decision to get tested for HIV, the virus that causes AIDS, is a big choice to make. Taking the option of getting tested at home is a relief to many. Today, there are HIV home testing kits available for you to insure confidentiality of your results.Many people ask the question, "Why should you get tested for HIV?"There are a lot of reasons that people get tested for HIV. Maybe you’re sexually active and have engaged in behaviors that put you at risk of HIV infection. Maybe you’re starting a new relationship and have decided to get tested together. Whatever the case, there are many reasons why you should consider getting tested for HIV.

If you've had sexual intercourse (vaginal, oral, or anal) without a condom or you've learned that a partner was not monogamous, or you have been sexually assaulted. Sometimes condoms are not reliable and they break.If you have been sharing needles or syringes to inject drugs (including steroids) or for body piercing, tattooing, or any other reasons.
If you have had multiple sexual partners, found out that a partner has shared needles, learned that a past or current partner is HIV-positive, discovered that a partner has been exposed to HIV, had a recent diagnosis of another sexually transmitted disease (STD) or if you are pregnant.

HIV home tests can tell if you have been infected with HIV. When HIV infection occurs, the body develops antibodies to the virus. The HIV test checks to see if your body is making these antibodies. However, it doesn’t test for AIDS.There are three different ways to be tested for HIV: a blood sample, saliva or a urine sample. HIV home testing kits require a blood sample, which can be easily obtained by pricking your finger. HIV home test kits come with a detailed instruction booklet with illustrations which will take you through pre-test registration and counseling; collecting your blood sample; shipping that sample to an accredited laboratory then calling back for test results. You have the option of post-test counseling and referrals. Your results will then be available anywhere from 3-7 days, depending on which HIV home testing kit you purchase.

A positive test result means that your body is making HIV antibodies. If the test finds antibodies, that means you are infected with HIV. However, it doesn’t mean you have AIDS or will develop AIDS soon.

A negative test result means no HIV antibodies were found in your body. But, you could still be infected if you have been exposed to HIV in the last six months. Your body may not have produced enough HIV antibodies to show up yet. Consider getting tested again in a few months.

If you test positive, find a health-care professional who has experience with HIV treatment. The earlier you begin treatment, the more likely the virus will develop slowly, so you can stay healthy longer. Many HIV positive people live for many years without developing AIDS, but the odds are better the earlier you start treatment.

If you test negative, practice abstinence or practice safer sex. Use a latex condom during each act of vaginal, oral, or anal intercourse. Don’t share needles or syringes to inject drugs or for any other reason. Remember, if you had unprotected sex or any other risky behavior that can transmit HIV in the last six months prior to getting tested, you will need to get a follow-up test in six months to be sure you are not infected.HIV home testing kits offer anonymity because they use code numbers or names to identify your test. Your name is never used. You use the code to get your results. You are the only person who knows your results. With anonymous testing, you get to decide who to tell and when.

About the Author: The article is prepared by Christy Berger who writes for TestCountry.com. Some information about this article is taken from these resources Drug Testing Kits & HIV Home Tests www.testcountry.com/site_map/HIV_TESTS.htm HIV Express Home Test Kit – Confidential Home Access HIV Testing www.testcountry.com/site_map/CONFIDENTIAL_HIV_EXPRESS_TEST_KIT.htm Longer Version of Article can be found at HIV Home Testing http://resources.testcountry.com/HIV-Home-Testing.htm

Mix in a Multivitamin as an Aids Natural Herbal Remedy

2007-09-14T21:45:00.000-07:00

Source : http://www.articlesbase.com/health-articles/mix-in-a-multivitamin-as-an-aids-natural-herbal-remedy-214975.html

Author: Lac Tran

Take a daily multivitamin supplement to prevent common deficiencies associated with the disease. Other more focused herbal remedies for AIDS have been found to work well to keep AIDS symptoms at bay. Taking 400 mcg a day of selenium under a doctor’s supervision can result in fewer infections, a healthier appetite, and other benefits. Take 800 mg a day of the supplement N-acetyl cysteine to slow the decline in immune function. Support CD4 cell counts by taking 990 mg a day of this herbal extract containing leaves and stems.

Go gluten-free as part of a Acquired Immunodeficiency Syndrome

(http://conditionsinfo.mitamins.com/AIDS/Acquired-Immunodeficiency-Syndrome-Herbs.html) Diet

Forego foods made with wheat, rye, barley, or oats to reduce symptoms of diarrhea, a body weakening aspect of AIDS. Going gluten-free is a helpful part of AIDS Diet(http://multiconditions.mitamins.com/AIDS/Acquired-Immunodeficiency-Syndrome-Acrodermatitis.html) and will show its effects quickly. Eating a balanced regular diet with AIDS is also crucial to maintain a good condition with the syndrome. Slow HIV progression by exercising three to four times each week. Loss of strength and lean body mass are frequent complications in people with AIDS. Drug therapy with anabolic steroids is sometimes used to counteract these losses. Preliminary trials suggest that progressive resistance training (i.e., weight training) may be used as an alternative or adjunct to steroids in this disease. In a preliminary trial, people with HIV who did progressive resistance training three times per week for eight weeks had significant increases in their lean body mass. AIDS dieting and exercising are keys to a longer, healthier status with AIDS or HIV.

A cure for AIDS(http://conditionsinfo.mitamins.com/AIDS/Acquired-Immunodeficiency-Syndrome-Cure.html)?

AIDS is an extremely complex disorder, and no AIDS cure is currently available despite large sums of money going towards this cause. Certain drugs appear to be capable of slowing the progression of the disease but they cannot be said to cure AIDS. However, the above AIDS-related nutritional factors may be helpful. Please be careful though. Because of the complicated nature of this disorder, medical supervision is strongly recommended with regard to AIDS dietary changes and AIDS nutritional supplements.

About the Author:
Author Bio: Mitamins teambd@mitamins.net
AIDS - Find Authoritative Natural Treatment Information, Plus Vitamins and Nutritional Supplements for Supporting AIDS Treatments, Symptoms, Causes.
vitamin support for AIDS treatments(http://conditionsinfo.mitamins.com/)

Herbal and Natural Aids Cure Hiv

2007-09-14T21:32:00.000-07:00

Source : http://www.articlesbase.com/alternative-medicine-articles/herbal-and-natural-aids-cure-hiv-61434.html

Author: Drrao

The word HIV/AIDS is so threatening that it had created a fear in the mind of the people. This is a deadly disease where the people are knowingly or unknowingly getting addicted to it. Many innocent people are becoming victims to this disease.

The medications which are curable with no harm and side effects that is the dietary supplements. So ultimately you have chosen a right place for your medications which are tried, tested and the proven ones with no side effects and no harm.

When we see the stats of the chronic diseases like aids, cancer and others are increasing in number than decreasing. This happens due to these main things that are improper diet, lack of nutrition, breathing impure air, having junk foods, getting addicted to the bad habits and many more. The people are really not thinking of the healthy living they just want to lead the life of their wish. And this is the main reason why the man is getting affected with such chronic diseases.

More information meets: dr jack

HIV AIDS is an infectious disease which causes lots of death in the world wide. This is deadly disease where the person battles with the life and death. He fights for the survival and getting rid of the disease. But this fatal disease does not allow them to lead a life. It goes on killing the person with depression or any with other reasons.

What is HIV and AIDS?The word HIV stands for Human Immune Deficiency Virus and AIDS stands for Acquired Immune Deficiency Virus. The HIV is a viral that uses the nutrients and energy provided by the human cells to grow and reproduces to infect the human cells. AIDS is the next final stage of HIV which makes breakdowns the immune system of the human body and makes unable to fight against infections or the other illness. But sometimes it takes decade or two to turn out from HIV to AIDS if the person has started to undergo the medical care. The symptoms may not be seen for years together to some they may get it later also.

This disease can be seen even in man, woman or even children. According to the estimates of the United Nations HIV/ AIDS says that there are approximately 40 million of HIV/AIDS sufferers. But this is not getting an end at all. Day by day this disease is increasing in the people. They are getting affected with it in one or the other way. This disease has killed millions of people and have left millions of the children as orphans away from the love of parents. It has made its wide by conquering the place of the deadly diseases like malaria and tuberculosis. The wide spread of this disease in the world has made it to stand in the fourth position for the more death causes in the present generation. The transmission of this disease is as follows:

Unprotected sexual intercourse with the positive person either vaginal or anal.
Unprotected oral sex with the someone who has HIV.
Sharing needles and syringes with someone who has HIV without sterilizing it.
Infection during pregnancy.
Mother to child in the womb.
Breast feeding to the baby.
From a blood transfusion from positive person to healthy person.

How to prevent the disease from
Not sharing the needles and syringes which are used to inject drugs after used by a person. either he may be a positive or not.
Not to have sexual intercourse with many and if you have
then their is an urge to use the protection condom during it.

Not to have the sexual relationship with the person who has been positive.Have a test over the blood before its transfusionUse the sterilized or new needlesEducate yourself and try to spread about this to the people who are vulnerable about it

The utmost and bottom line is that you should treat someone with HIV or AIDS the same as anyone else. In fact, they need your friendship and support more than ever. Just think how you would feel in their place. Now a man can survive for years together after getting HIV infection. This can happen when the man starts to have medical care before they begin to get sick. Knowing that you are HIV positive you will take precautions to prevent others being affected from it. But yet the HIV is scary stuff as it has no cure, no medicine, and no vaccine to prevent AIDS. But we have to be thankfully that the virus doesn't easily enter the body from person to person. And Aids Is surely cure by herbal and natural products these are the effective and safe treatment for HIV aids

About the Author:
Dr Jack is a Conventionally Trained Western Medical Doctor from India and fellow of American Academy of Pediatrics (AAP). He is also trained in traditional supplements since the age of 5 years to practice complimentary alternate supplements.For more information contact: dr jack

Papua New Guinea Government Should Expand HIV/AIDS Education Campaigns To Rural Areas

2007-08-31T06:48:00.000-07:00

Source : http://www.emaxhealth.com

Some HIV/AIDS advocates in Papua New Guinea have called on the government and aid agencies to extend HIV/AIDS awareness campaigns from cities and towns to rural areas to fight mistreatment of and discrimination against people living with the disease, AFP/Yahoo! News reports. Margaret Marabe, who works with the group Igat Hope, spent five months carrying out an HIV/AIDS education campaign in the country's remote Southern Highlands. She recently told reporters that she saw five people buried alive because they were living with HIV/AIDS (AFP/Yahoo! News, 8/27).

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AIDS victims 'buried alive' in PNG

2007-08-31T06:29:00.000-07:00

source : http://news.yahoo.com/

Mon Aug 27, 12:26 PM ET

PORT MORESBY (AFP) - Some AIDS victims are being buried alive in Papua New Guinea by relatives who cannot look after them and fear becoming infected themselves, a health worker said Monday.

Margaret Marabe, who spent five months carrying out an AIDS awareness campaign in the remote Southern Highlands of the South Pacific nation, said she had seen five people buried while still breathing.

One was calling out "Mama, Mama" as the soil was shoveled over his head, said Marabe, who works for a volunteer organisation called Igat Hope, Pidgin English for I've Got Hope.
"One of them was my cousin, who was buried alive," she told reporters.

"I said, 'Why are they doing that?' And they said, 'If we let them live, stay in the same house, eat together and use or share utensils, we will contract the disease and we too might die.'"
Villagers had told her it was common for people to bury AIDS victims alive.

Marabe appealed to the government and aid agencies to ensure the HIV/AIDS awareness programme carried out in cities and towns was extended to the rural areas, where ignorance about the disease is widespread.

Women accused of being witches have been tortured and murdered by mobs holding them responsible for the apparently inexplicable deaths of young people stricken by the epidemic, officials and researchers say.

A recent United Nations report said PNG was facing an AIDS catastrophe, accounting for 90 percent of HIV infections in the Oceania region.

HIV diagnoses had risen by around 30 percent a year since 1997, leaving an estimated 60,000 people living with the disease in 2005.
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My comment : I feel so sad about this news. There are still many people all over the world that misunderstood about AIDS. Someone think that if only live with HIV patients, they can be infected by HIV (The truth is HIV can be spread by sexual transmission, by blood, mucous or semen). So this's the tragedy for our world, therefore Education and announcement about AIDS/HIV are such important missions for everyone,also UNAIDS.

Could green tea prevent HIV?

2007-08-25T21:43:00.000-07:00

source : http://www.accessmylibrary.com/

Green tea: fact or fiction

Publication: HIV Treatment: ALERTS!
Publication Date: 06/01/2007
Author: Nance, Christina L.

The Center for AIDS: Hope & Remembrance Project

Scientists have discovered that a substance in green tea prevents HIV from attaching to our immune system cells by getting there first. According to researchers from Baylor College of Medicine in Houston and the University of Sheffield in the England, in a report that appears in the Journal of Allergy and Clinical Immunology (1), a compound in green tea called catechin, (also known as epigallocatechin gallate [EGCG] or flavonoid) blocks the ability of HIV to enter and destroy the immune system.

The health effects of brewed green tea are attributed to numerous chemical substances that make up 30% of dried leaf extract. Of these, EGCG is the most active. Similar substances in other plants have been found to be less plentiful and have fewer medicinal properties. EGCG binds well to many molecules and affects a variety of enzyme. It is this specific aspect of green tea that researchers think is responsible for its many reported health benefits.

Animal studies have shown that drinking green tea is associated with a lower rate of cancer in humans. The major component of green tea, EGCG, is thought to be the most potent cancer-preventive component of the catechins. This protective effect of green tea has been evaluated in pancreatic, colon, rectal, skin, breast, prostate, liver, and lung cancel: Recently EGCG has emerged as a potential candidate in the fight against AIDS. Investigators have found that its antiviral effects can be targeted at HIV infection. However, this does not mean you should start drinking gallons of green tea every day. But, there is some encouraging news.

HIV infection results in damage to the immune system when the gpl20 glycoprotein (a protein that has sugar molecules attached to it) latches onto the T cell. Even though gpl20 produces antibodies that help light against the virus, HIV manages to escape, leading to infection. Ever since the discovery of the virus as the cause of AIDS, there has been an intense effort to develop methods to slow down or prevent HIV infection. Until now, scientists have spent much of their time trying to find ways to build up the immune system to prevent HIV from attaching itself to the T cells. Christina L. Nance, PhD, and William T. Shearer, MD, PhD, of Baylor College of Medicine and Texas Children's Hospital, and Mike R Williamson, PhD, of the University of Sheffield, began looking at ways to get high enough levels of EGCG into the body for it to be able to protect the body against HIV. They paired the T cell with gpl20, then paired the T cell with EGCG. By studying the physical structure of the T cell, they realized that EGCG hooks onto the same exact pocket on the T cell as gp 120. This ability to block gp 120 is its most important feature since it prevents the initial encounter of HIV with T cells.

If EGCG proves to have value as an HIV treatment, it probably will not be used alone. It would be part of a combination of drugs. The researchers do not recommend that people drink large quantities of green tea with the expectation that it will prevent infection with HIV. These studies are designed to determine whether a drug derived from green tea would have that effect. The next phase of the research will be testing EGCGin humans.

(1) Journal of Allergy and Clinical Immunology 118(6): 1369-74, Dec 2006. Christina L. Nance, PhD, is Instructor and Research Laboratory Supervisor at Baylor College of Medicine, Department of Allergy/Immunology, Texas Children's Hospital.

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My comment : It's such a good news that brings much hope for many HIV patients, but I doubt can it works in human. There are also just a few research,so it dosen't mean that patients should drink a gallon of green tea. Instead of drinking green tea as water, they should beware of their health, exercise to be healthy, take off drugs as the practitioner prescribes ontime (Important: don't forget it) and just relax their mind. All of these are much more important to have a good quality of life.

Red ribbon history

2007-08-25T21:28:00.000-07:00

source : http://www.worldaidsday.org

Who created the red ribbon?
The red ribbon has been an international symbol of AIDS awareness since 1991. The Red Ribbon Project was created by the New York based organisation Visual AIDS, which brought together artists to create a symbol of support for the growing number of people living with HIV in the US.

What does it symbolise?
The red ribbon is worn as a sign of support for people living with HIV. Wearing a red ribbon is a simple and powerful way to challenge the stigma and prejudice surrounding HIV and AIDS that prevents us from tackling the global epidemic.

Who owns the red ribbon?
The red ribbon is the result of collaboration between community artists who wanted to create a non-copyrighted image that could be used as an awareness-raising tool by people across the world.

When did the red ribbon go international?
The first international celebrity to wear a red ribbon was Jeremy Irons at the 1991 Tony Awards. The symbol came to Europe on a mass scale on Easter Monday in 1992, when more than 100,000 red ribbons were distributed during the Freddie Mercury AIDS Awareness Tribute Concert at Wembley stadium. More than 1 billion people in more than 70 countries worldwide watched the show on television. Throughout the nineties many celebrites wore red ribbons, encouraged by Princess Diana’s high profile support for AIDS.

HIV and AIDS in africa

2007-08-25T01:34:00.000-07:00

Source : http://www.avert.org/aafrica.htm - AVERT is an international AIDS charity

Sub-Saharan Africa is more heavily affected by HIV and AIDS than any other region of the world. An estimated 24.5 million people were living with HIV at the end of 2005 and approximately 2.7 million additional people were infected with HIV during that year. In just the past year, the AIDS epidemic in Africa has claimed the lives of an estimated 2 million people in this region. More than twelve million children have been orphaned by AIDS.

The extent of the AIDS crisis is only now becoming clear in many African countries, as increasing numbers of people with HIV are becoming ill. In the absence of massively expanded prevention, treatment and care efforts, it is expected that the AIDS death toll in sub-Saharan Africa will continue to rise. This means that impact of the AIDS epidemic on these societies will be felt most strongly in the course of the next ten years and beyond. Its social and economic consequences are already widely felt, not only in the health sector but also in education, industry, agriculture, transport, human resources and the economy in general.

How are different countries in Africa affected?

Both HIV prevalence rates and the numbers of people dying from AIDS vary greatly between African countries. In Somalia and Senegal the HIV prevalence is under 1% of the adult population, whereas in South Africa and Zambia around 15-20% of adults are infected with HIV.
In four southern African countries, the national adult HIV prevalence rate has risen higher than was thought possible and now exceeds 20%. These countries are Botswana (24.1%), Lesotho (23.2%), Swaziland (33.4%) and Zimbabwe (20.1%).

West Africa has been less affected by AIDS, but the HIV prevalence rates in some countries are creeping up. HIV prevalence is estimated to exceed 5% in Cameroon (5.4%), Côte d'Ivoire (7.1%) and Gabon (7.9%).

Until recently the national HIV prevalence rate has remained relatively low in Nigeria, the most populous country in Sub-Saharan Africa. The rate has grown slowly from below 2% in 1993 to 3.9% in 2005. But some states in Nigeria are already experiencing HIV infection rates as high as those now found in Cameroon. Already around 2.9 million Nigerians are estimated to be living with HIV.

Adult HIV prevalence in East Africa exceeds 6% in Uganda, Kenya and Tanzania.

Trends in Africa's AIDS epidemic

Large variations exist between the patterns of the AIDS epidemic in different countries in Africa. In some places, the HIV prevalence is still growing. In others the HIV prevalence appears to have stabilised and in a few African nations - such as Kenya and Zimbabwe - declines appear to be underway, probably in part due to effective prevention campaigns. Others countries face a growing danger of explosive growth. The sharp rise in HIV prevalence among pregnant women in Cameroon (more than doubling to over 11% among those aged 20-24 between 1998 and 2000) shows how suddenly the epidemic can surge.

Overall, rates of new HIV infections in Sub-Saharan Africa appear to have peaked in the late 1990s, and HIV prevalence seems to be levelling off, albeit at an extremely high level. Stabilisation of HIV prevalence occurs when the rate of new HIV infections is equalled by the AIDS death rate among the infected population. This means that a country with a stable but very high prevalence must be suffering a very high number of AIDS deaths each year. Although prevalence remains stable, the actual number of Africans living with HIV is rising due to general population growth.

What is the effect of these high levels of HIV infection?

Over and above the personal suffering that accompanies HIV infection, the AIDS epidemic in sub-Saharan Africa threatens to devastate whole communities, rolling back decades of development progress.

Sub-Saharan Africa faces a triple challenge of colossal proportions:

Providing health care, support and solidarity to a growing population of people with HIV-related illness, and providing them with treatment.

Reducing the annual toll of new HIV infections by enabling individuals to protect themselves and others.

Coping with the cumulative impact of over 20 million AIDS deaths on orphans and other survivors, on communities, and on national development.

What is the impact of AIDS on Africa?

HIV & AIDS are having a widespread impact on many parts of African society. The points below describe some of the major effects of the AIDS epidemic. For a more detailed examination, visit our African impact page.

In many countries of Sub-Saharan Africa, AIDS is erasing decades of progress made in extending life expectancy. Millions of adults are dying from AIDS while they are still young, or in early middle age. Average life expectancy in Sub-Saharan Africa is now 47 years, when it could have been 62 without AIDS.

The effect of the AIDS epidemic on households can be very severe. Many families are losing their income earners. In other cases, income earners are forced to stay at home to care for relatives who are ill from AIDS. Many of those dying from AIDS have surviving partners who are themselves infected and in need of care. They leave behind orphans, grieving and struggling to survive without a parent's care.

In all affected countries, the HIV/AIDS epidemic is putting strain on the health sector. As the epidemic develops, the demand for care for those living with HIV rises, as does the number of health workers affected.

Schools are heavily affected by HIV/AIDS. This a major concern, because schools can play a vital role in reducing the impact of the epidemic, through education and support.

HIV/AIDS dramatically affects labour, setting back economic activity and social progress. The vast majority of people living with HIV/AIDS in Africa are between the ages of 15 and 49 - in the prime of their working lives. Employers, schools, factories and hospitals have to train other staff to replace those at the workplace who become too ill to work.

Through its impacts on the labour force, households and enterprises, HIV/AIDS can act as a significant brake on economic growth and development. HIV/AIDS is already having a major affect on Africa's economic development, and in turn, this affects Africa's ability to cope with the epidemic.

HIV prevention in Africa

A continued rise in the number of Africans living with HIV and dying from AIDS is not inevitable. There is growing evidence that HIV prevention efforts can be effective, and this includes initiatives in some of the most heavily affected countries.

In some countries there have been early and sustained HIV prevention efforts. For example, effective HIV prevention campaigns have been carried out in Senegal, which is still reflected in the relatively low adult HIV prevalence rate of 0.9%. Also, the experience of Uganda shows that a widespread AIDS epidemic can be brought under control. HIV prevalence in Uganda fell from around 15% in the early 1990s to around 5% by 2001. This change is thought to be largely due to intensive HIV prevention campaigns.

More recently, similar declines have been seen in Kenya, Zimbabwe and urban areas of Zambia and Burkina Faso. However, the extremely severe AIDS epidemics in South Africa, Swaziland and Mozambique continue to grow.

Overall a massive expansion in prevention efforts is needed, and although there is no single or immediate tool to prevent new HIV infections, the major components of a successful HIV prevention programme are now known.

Condom use & HIV
Condoms play a key role in preventing HIV infection around the world. In Sub-Saharan Africa, most countries have seen an increase in condom use in recent years. In studies carried out between 2001 and 2005, eight out of eleven countries in Sub-Saharan Africa reported an increase in condom use.

The distribution of condoms to countries in Sub-Saharan Africa has also increased: in 2004 the number of condoms provided to this region by donors was equivalent to 10 for every man,4 compared to 4.6 for every man in 2001.

In most countries, though, many more condoms are still needed. For instance, in Uganda between 120 and 150 million condoms are required annually, but less than 40 million were provided in 2005.

Relative to the enormity of the HIV/AIDS epidemic in Africa, providing condoms is cheap and cost effective. Even when condoms are available, though, there are still a number of social, cultural and practical factors that may prevent people from using them. In the context of stable partnerships where pregnancy is desired, or where it may be difficult for one partner to suddenly suggest condom use, this option may not be practical.

Provision of Voluntary HIV Counselling & Testing (VCT)
The provision of voluntary HIV counselling and testing (VCT) is an important part of any national prevention program. It is widely recognised that individuals living with HIV who are aware of their status are less likely to transmit HIV infection to others, and that through testing they can be directed to care and support that can help them to stay healthy. VCT also provides benefit for those who test negative, in that their behaviour may change as a result of the test. The provision of VCT has become easier, cheaper and more effective as a result of the introduction of rapid HIV testing, which allows individuals to be tested and find out the results on the same day. VCT could – and indeed needs to be – made more widely available in most Sub-Saharan African countries.

Mother-to-child transmission of HIV
Around 2 million children in Sub-Saharan Africa were living with HIV at the end of 2005. They represent more than 85% of all children living with HIV worldwide.7 The vast majority of these children will have become infected with HIV during pregnancy or through breastfeeding when they are babies, as a result of their mother being HIV-positive.

Mother to child transmission (MTCT) of HIV is not inevitable. Without interventions, there is a 20-45% chance that a HIV-positive mother will pass infection on to her child. If a woman is supplied with antiretroviral drugs, though, this risk can be reduced significantly. Before this measures can be taken the mother must be aware of her HIV-positive status, so testing also plays a vital role in the prevention of MTCT.

In many developed countries, these steps have helped to virtually eliminate MTCT. Yet Sub-Saharan Africa continues to be severely affected by the problem, due to a lack of drugs, services and information. The shortage of testing facilities in many areas is also contributing. Fewer than 6% of pregnant women in Sub-Saharan Africa were offered services to prevent MTCT in 2005.8
Given the scale of the MTCT crisis in Africa, it is remarkable that more is not being done (by both the international community and domestic governments) to prevent the rising numbers of children becoming infected with HIV, and dying from AIDS. AVERT is calling for vast improvements in preventing MTCT strategies through our Stop AIDS in Children campaign. This crisis is discussed in more detail in our PMTCT worldwide page.

HIV/AIDS related treatment and care in Africa

Antiretroviral drugs
Antiretroviral drugs (ARVs) - which significantly delay the progression of HIV to AIDS and allow people living with HIV to live relatively normal, healthy lives – have been available in richer parts of the world since around 1996. Distributing these drugs requires money, a well-structured health system and a sufficient supply of healthcare workers. The majority of developing countries are lacking in these areas and have struggled to cope with the increasing numbers of people requiring treatment.

For most Africans living with HIV, ARVs are still not available - fewer than one in five of the millions of Africans in need of the treatment are receiving it. Many millions are not even receiving treatment for opportunistic infections, which affect individuals whose immune systems have been weakened by HIV infection. These facts reflect the world’s continuing failure, despite the progress of recent years, to mount a response that matches the scale and severity of the global HIV/AIDS epidemic.

Botswana pioneered the provision of ARVs in Africa, starting its national treatment programme in January 2002. By 2005 this programme was providing treatment to the vast majority of those in need. According to World Health Organisation figures, 84,000 people were receiving treatment at the end of 2006, including those using the private sector, giving a coverage rate above 95%.9 Thousands of lives have been saved as a result.

While most African countries have now started to distribute ARVs, progress in providing sufficient quantities of the drugs has been uneven and Botswana’s success has not been emulated elsewhere. Among the other countries that have made advances are Rwanda and Namibia, where more than 70% of people in need of ARVs are receiving them. In Cameroon, Côte d’Ivoire, Kenya, Malawi and Zambia, between 25% and 45% of people requiring antiretroviral drugs were receiving them in December 2006. While South Africa is the richest nation in Sub-Saharan Africa and should have led the way in ARV distribution, its government was slow to act; so far, only 33% of those in need of treatment in South Africa are receiving it. In other countries, such as Ghana, Mozambique, Nigeria, the United Republic of Tanzania and Zimbabwe, the figure is less than 20%.

Nonetheless, the overall situation is slowly improving; the number of people receiving ARVs in Africa doubled in 2005 alone.11 International support has helped this increase, with numerous governments and international organisations encouraging progress. In 2003 the World Health Organisation (WHO) initiated the ‘3 by 5’ programme, which aimed to have three million people in developing countries on ARVs by the end of 2005. While this target was not reached, a number of African nations made substantial progress under the scheme. The latest international target, ‘All by 2010’, is aiming at universal access to treatment by 2010. In pursuit of this goal it is hoped that considerable progress will be made in Africa's fight against AIDS.

There are still, however, a number of impediments to ARV provision. One major challenge is the fact that the majority of African countries have a poor healthcare infrastructure and a shortage of medical professionals. A considerable emphasis needs to placed not only on the availability of ARVs, but also the availability of professionals who are able to administer the drugs.

Another major challenge is ensuring that drugs are not only supplied to a lot of areas, but that sufficient quantities of drugs are supplied to those areas. This is critically important, because once an individual starts to take ARVs they have to take them for the rest of their life. If, for instance, their local hospital runs out of ARVs, the interruption that this causes in their treatment could result in them becoming resistant to the drugs. To improving treatment programs, African countries face the double challenge of getting new people to start treatment and maintaining the supply of treatment to those who are already receiving ARVs.

Other forms of treatment and care
Treatment and care for HIV consists of a number of different elements apart from ARVs. These include voluntary counselling and testing, food and management of nutritional effects, follow-up counselling, protection from stigma and discrimination, treatment of other sexually transmitted infections, and the prevention and treatment of opportunistic infections. All of these things can, and indeed should, be provided before ARVs are available. This does not exclude the provision of ARVs when they are available. Indeed, when ARVs do become available the provision of antiretroviral therapy should be easier and quicker to implement because many of the things apart from drugs that are needed for successful treatment are already in place.

What needs to be done to make a difference in Africa?

International support
One of the most important ways in which the situation in Africa can be improved is through increased funding. More money would help to improve both prevention campaigns and the provision of treatment and care for those living with HIV. Developed countries have increased funding for the fight against AIDS in Africa in recent years, perhaps most significantly through the Global Fund to fight AIDS, Tuberculosis and Malaria. The Global Fund was started in 2001 to co-ordinate international funding and has since approved grants totalling US $3.3 billion to fight HIV and AIDS in Africa. Around 60% of the fund’s grants have been directed towards Africa and 60% has been put towards fighting AIDS. This funding is making a significant difference, but given the massive scale of the AIDS epidemic more money is still needed.

The US Government has shown a commitment to fighting AIDS in Africa through the President’s Emergency Plan For AIDS Relief (PEPFAR). Started in 2003, PEPFAR provides money to fight AIDS in numerous countries, including 15 focus countries, most of which are African. In Fiscal Year 2005, PEPFAR allocated US $1.1 billion to these African focus countries.14 The US Government is also the largest contributor to the Global Fund.

Among other things, organisations like PEPFAR and the Global Fund provide vital support to local and community groups that are working 'on the ground' to provide relief in Africa. These groups are directly helping people in need, and many rely on international funding in order to operate. Getting money from large, international donors to small, 'grassroots organisations' can present a number of difficulties though, as money is lost or delayed as it is passed down large funding chains. Our page about getting money to local organisations discusses these issues, and the work that such groups do.

Domestic commitment
More than money is needed if HIV prevention and treatment programmes are to be scaled up in Africa. In order to implement such programmes, a country’s health, education, communications and other infrastructures must be sufficiently developed. In some African countries these systems are already under strain and are at risk of collapsing as a result of AIDS. Money can also only be used efficiently if there are sufficient human resources available, but there is an acute shortage of trained personnel in many parts of Africa.

In many cases, African countries also need more commitment from their governments. There are promising signs that some governments are starting to respond and becoming more involved in the fight against AIDS, and this commitment needs to be sustained if the severe impact of Africa's AIDS pandemic is to be reduced.

Reducing stigma and discrimination
HIV-related stigma and discrimination remains an enormous barrier to the fight against AIDS. Fear of discrimination often prevents people from getting tested, seeking treatment and admitting their HIV status publicly. Since laws and policies alone cannot reverse the stigma that surrounds HIV infection, more and better AIDS education is needed in Africa to combat the ignorance that causes people to discriminate. The fear and prejudice that lies at the core of HIV/AIDS discrimination needs to be tackled at both community and national levels.

Helping women and girls
In many parts of Africa, as elsewhere in the world, the AIDS epidemic is aggravated by social and economic inequalities between men and women. Women and girls commonly face discrimination in terms of access to education, employment, credit, health care, land and inheritance. These factors can all put women in a position where they are particularly vulnerable to HIV infection. In Sub-Saharan Africa, around 59% of those living with HIV are female.

In many African countries, sexual relationships are dominated by men, meaning that women cannot always practice safe sex even when they know the risks involved. Attempts are currently being made to develop a microbicide – a cream or gel that can be applied to the vagina, preventing HIV infection – which could be a significant breakthrough in protecting women against HIV. Women could apply such a microbicide without their partner even knowing. It is likely to be some time before a microbicide is ready for use, though, and even when it is, women will only use it if they have an awareness and understanding of HIV and AIDS. To promote this, a greater emphasis needs to be placed on educating women and girls about AIDS, and adapting education systems (which are currently male-dominated) to their needs.

The way forward
Tackling the AIDS crisis in Africa is a long-term task that requires sustained effort and planning - both within African countries themselves and amongst the international community. One of the most important elements of the fight against AIDS is the prevention of new HIV infections. HIV prevention campaigns that have been successful within African countries need to be highlighted and repeated.

The other main challenge is providing treatment and care to those living with HIV in Africa, in particular ARVs, which can allow people living with HIV to live long and healthy lives. Many African countries have made significant progress in their treatment programmes in recent years and it is likely that the next few years will see many more people receiving the drugs.

Scouts get the HIV message

2007-08-25T01:16:00.000-07:00

source : http://www.unaids.org/

16 August 2007

As part of the international scout jamboree held in Britain over the summer, UNAIDS ran workshops on HIV prevention, personal responsibility in HIV transmission and respect for the human rights of positive people.

This summer, residents of Chelmsford, a town in eastern England, woke up to an unusual array of sights and sounds.

The banging of early morning drums and excited screeches of hundreds of teenage boys and girls filled the air – this was the international scout jamboree, and the 40,000 teenagers attending from all over the world wanted to make sure everyone knew it!

For UNAIDS staff attending the jamboree to run special workshops on HIV prevention, personal responsibility in HIV transmission and respect for the human rights of positive people, it was a bit of an eye opener. “We would look at each other and think: ‘Are you as lost as I am?’ ” laughs Bhatupe Mhango, coordinator of UN Plus – the UN system-wide group of staff living with HIV, who took part in the event with Alex McLelland, an intern with UNAIDS, in the Civil Society Partnerships Unit. “But we became hooked on those sessions every morning. I still hear them drumming and humming in my ears,” she says.

This was a particularly significant jamboree, as it marked the centenary of scouting and 40,000 teenagers attended from all over the world. UNAIDS had an area in the Global Development Village, a section dedicated to workshops on human rights and the work of UN agencies.
“The scouts as a movement has so much potential to mobilize towards the HIV response,” says Alex, who is studying for a degree in International Development at York University in Toronto, Canada . “They are eager to get further engaged. With approximately 28 million young people as members you can see the possibilities.”

Bhatupe and Alex planned and ran five workshops on the topic “HIV Sensitisation and Safeguarding Human Rights.” One of the UNAIDS objectives was to initiate a dialogue on the need for a policy to work with HIV positive scouts, and for UN Plus to look for possible partnerships.

“We established that there are some Positive scouts in several countries, particularly Africa, and UN Plus could foster a partnership with them,” says Bhatupe.

Over three days, he and Bhatupe spoke to youngsters from Norway , Germany, Italy, Chile, Brazil, Denmark, Britain, Turkey and Finland.

In spite of the big subject, it was all very informal. “Most of the workshops took place outside because the young scouts wanted to lie on the grass,” says Bhatupe. She and Alex shared their personal stories as people living with HIV. Scouts asked questions about stigma, treatment, nutrition guidelines and human rights issues for people living with HIV.

Bhatupe also did a live radio interview with the jamboree radio station, to promote the workshops and encourage scouts to be aware of the means of protecting themselves from HIV transmission.

There were the obvious drawbacks of talking about sex to teenage boys: “A memorable moment was watching young, Italian boys laughing hysterically at a UNFPA-led workshop we participated in, demonstrating male condoms using bananas,” says Bhatupe.

But many of the scouts showed real insight and understanding into the issue – Alex and Bhatupe were delighted by a group of 14-16 year old girls from Chile, who were well informed about HIV, AIDS and sex, having studied the subject at school. The girls held a debate on abstinence versus early sex.

“The maturity of the debate convinced me that the message on HIV prevention and empowerment of young girls is getting across,” says Bhatupe.

The girls were evenly divided - indicating that no one method is the obvious solution to managing yourself as a young woman in a relationship.
The views expressed included:

“If I love my boyfriend and I trust him…and if he has gone for an HIV test and tells me he is HIV negative, why should I not express my feelings for him and have sex with him? If that is what I want to do, I will just go ahead…if you love someone, you can not put controls on what you can do with that person.”

“For me I say no. I have to wait until I am married before I have sex. It is scary. I am scared of getting HIV or falling pregnant so the best thing to do is to wait.”

For Bhatupe and Alex, the UNAIDS messages were getting across: prevention, personal responsibility in HIV transmission, the need for more support and less stigma for positive people.

Alex was encouraged to see so much focus on AIDS at the jamboree.
“There were other workshops from UNFPA, UNICEF, UNESCO, as well as the South African and Ugandan Scout associations. The Girl Guides did a big presentation about HIV. The ILO discussed child labour and vulnerability to HIV.

“There’s a quite a lot of awareness among the Scouts. It was gratifying to see so much going on,” he said.

Perspectives on Asia Pacific AIDS conference

2007-08-25T01:03:00.000-07:00

Source : http://www.unaids.org

17 August 2007

The eighth International Congress on AIDS in Asia and the Pacific (ICAAP) takes place in Colombo, Sri Lanka from 19-23 August 2007. In the run up to the event, UNAIDS Deputy Executive Director, Deborah Landey and UNAIDS Regional Director for Asia and the Pacific, Prasada Rao, share their hopes and expectations for the conference that will host an expected 3,000 participants from some 60 countries throughout the region.

Visions for ICAAP8: Deborah Landey, UNAIDS Deputy Executive Director

Why is this conference important?
I think this conference is extremely important for the world and it’s very important for Asia. Many of the countries in Asia and the Pacific have relatively low prevalence and it’s an opportunity for us to take stock of what’s happening in the region and to come out with the goal of keeping Asia a low prevalence area of the world in terms of AIDS.

What are the focus areas for UNAIDS at this conference?
We are very concerned to emphasize the importance of leadership in responding to the epidemic at all levels—from governments to civil society, all players, actors must be involved.
It’s absolutely vital for countries to ‘know their epidemics’ – and by this we mean really having the most recent, developed data on what is going on with the epidemic in order to be able to use relatively scare resources effectively. In particular we are interested in understanding what we call the ‘drivers of the epidemic’ – the underlying systemic issues such as gender inequality, stigma and discrimination—and getting at these issues so that countries can make fundamental changes to get ahead of their epidemics.

We also want to emphasise that AIDS is going to be with us for a long time to come and therefore the long term agenda and all the issues we need to be thinking about for future generations are extremely important for us to consider here at this meeting.

What can this conference achieve?
If we can get a good analysis and understand what is happening in the region in terms of the epidemic so that we ‘know’ this epidemic in the region, what would be one outstanding outcome. Secondly – we want to know what is happening on the ground, what is working and what is not working? What are the lessons learned, where are we having successes and how can they be replicated? Establishing where the major challenges are will also be a goal.

Visions of Colombo: Prasada Rao, UNAIDS Asia Pacific Regional Director

What’s make the 8 th ICAAP an important meeting?
ICAAP has always been the rallying point for stakeholders such as civil society, people living with HIV, experts, national programme managers, UN partners and donors to focus world’s attention on the special problems of this large region which is home to the 60% of world population. AIDS need to be understood in this specific Asia Pacific context and ICAAP has always provided the best platform for it.

What are the most important issues that are going to be raised and discussed at ICAAP this year?
This ICAAP will specially address the changing AIDS scenario in the region. Recent revision of numbers in some countries has led to a great deal of public and media attention and this is an opportunity to look at the issues squarely and give clarifications. ICAAP will also look at some controversial issues of the moment, such as condom promotion, sex education at school and voluntary testing and counseling, within the Asian context. There will also be clear message about universal access to prevention, treatment, care and support and the need for increased provision of second generation antiretroviral drugs. The Conference also provides a platform for launching two important regional networks of men who have sex with men and sex workers.

What can you tell us about the AIDS epidemic in this region?
The AIDS epidemic in Asia and the Pacific is still increasing and there were approximately 1 million new infections in the last 2 years. Country like Papua New Guinea, Viet Nam Indonesia, Bangladesh and Pakistan are showing an increasing trends of new infections. However, there is good news in some countries. In addition to from Thailand and Cambodia we are seeing a reversal of the epidemic in the southern part of India which has a large population at risk. Infection has remained low in countries like Philippines and Sri Lanka despite large movement of workers for employment outside these countries.

How are countries of Asia and the Pacific scaling up towards universal access to HIV prevention, treatment, care and support?
The universal access agenda has given a great push to the effort of the countries in this region. Based on the political resolution on universal access adopted in UN in June 2007, countries in this region have initiated grassroots planning for setting ambitious target for prevention and treatment. Civil society groups have also enthusiastically participated in this exercise. Today, as many as 16 countries have set universal access targets and nine have prepared national strategic plans and identify resources for implementing them. Asia and the Pacific region can set high standard of achievement for the universal access process.

Myanmar: Towards universal access

2007-08-25T00:58:00.000-07:00

source : http://www.unaids.org

21 August 2007 What will it take to reach universal access to HIV prevention, treatment, care and support in Myanmar ? This was the central discussion of a satellite meeting held as part of the 8 th International Congress on AIDS in Asia and the Pacific (ICAAP) on Monday 20 August.
Over the past year the response to AIDS in Myanmar achieved significant progress: a new National Strategic Plan was developed, including the completion of the costed Operational Plan; and in late 2006 the 3-Diseases Fund was launched and became operational in early 2007. “With these key developments, in 2007 there is a real and tangible opportunity to continue to expand the AIDS response in Myanmar with the aim of reaching universal access,” said UNAIDS Country Coordinator, Brain Williams.

Organized by the United Nations Theme Group on AIDS in Myanmar, the satellite session presented an overview of the current epidemic situation; outlined recent gains in the response to AIDS in Myanmar; and highlighted the needs for, and opportunity to, support a further expansion of the response.

Myanmar ’s Deputy Minister of Health Prof. Mya Oo highlighted the country’s commitment to respond to AIDS and outlined efforts underway including the production of a multi-sectoral National Strategic Plan emphasizing reaching out to people most at risk. The Deputy Minister thanked the Three Diseases Fund for their investment in HIV care and prevention services in Myanmar and called for increased resources to be made available to Myanmar to fully enable the response to expand and succeed.

The second keynote speaker, representative of people living with HIV Ms. Naw She Wah, spoke of the needs of people living with HIV to have access to treatment, the need for self-help groups to have expanded support including official recognition from the authorities, and called on international organizations to increase their financing to expand coverage beyond the mere 10% of HIV positive people in need of treatment who are currently receiving it.

Technical presentations were made by the National AIDS Programme Manager Dr. Min Thwe, Dr Wiwat Peerapatanapokin an epidemiologist from the East-West Center and recently participated in an HIV prevalence workshop in Myanmar, and Dr. Frank Smithius , Country Representative, Médecins Sans Frontières Holland (AZG), Myanmar.

“The session underscored the progress that has been made over recent years in Myanmar in demonstrating that services can be delivered to people in need, but highlighted that low coverage requires increased financial support from international and domestic sources in order to achieve Universal Access,” Brian Williams said.

Living With HIV

2007-08-25T00:55:00.000-07:00

Source : http://www.unaids.org/

Almost 40 million men, women and children are living with HIV today. People living with HIV often understand each other's situation better than anyone else and are well placed to educate, counsel and advise one another. Around the world, wherever HIV is present, people living with HIV have established support and advocacy groups and networks. Increasingly, members of these groups are called on participate in decision and policy making forums.

Since AIDS emerged, people living with HIV have been a key driving force in the AIDS response and few of the advances made in the last 25 years would have happened without the tremendous efforts, expertise and advocacy of people living with HIV and affected communities. With appropriate support, people living with HIV can and must take a central role in their own country, region, or locality in the direction and delivery of AIDS programmes. Their involvement gives personal power and immediacy to AIDS efforts, improves the relevance of programmes and inspires others into action.

Today the principle of greater and meaningful involvement of people living with HIV is central to many interventions worldwide, People living with HIV are involved in a wide variety of activities at all levels of the AIDS response; from sharing their personal stories and supporting others locally through counseling and treatment literacy initiatives to participating in major global decision and policy-making activities.

Yet there is still much to be done to maximize the participation of people living with HIV in the AIDS response. One crucial aspect is the need to build the capacity of organizations and networks of people living with HIV and ensure their sustainable funding. This is essential if they are to participate fully in the response and properly represent the needs of their constituencies. Capacity building can include assistance for strategic planning and to build organizational, managerial, programmatic, communications and financial expertise within the organization.
Tackling the stigma and discrimination experienced by many people living with HIV and affected communities is also fundamental to creating the kind of environment where people living with HIV can contribute in a meaningful way.

People living have been at the forefront of advocating for universal access to treatment. Ensuring people living with HIV have universal access to treatment, along with appropriate prevention and care services, must go hand with the efforts described above.

Orphans with HIV/AIDS and Family Health and Wellness Programs to Benefit from Constella's Enhancing Human Health Grants

2007-08-25T00:16:00.000-07:00

Source : http://findarticles.com
Business Wire, July 30, 2007

DURHAM, N.C. -- Constella Group, a leading global provider of professional health services, announced that it has awarded $20,000 to four organizations to improve the lives of orphans living with HIV/AIDS, to reduce stigma and discrimination associated with HIV and sexually transmitted diseases, to promote health and wellness programs for families, and to improve overall health and well-being of children.

"Through our corporate philanthropy program, we encourage employee volunteerism by awarding Enhancing Human Health grants to organizations where employees actively volunteer," said Donald A. Holzworth, Constella Group chairman and CEO. "We are proud to support organizations dedicated to improving the health and lives of children, individuals and families. The important work of each organization and its members exemplifies volunteerism at its best and advances Constella's vision of enhancing human health around the world, every day."

Constella awarded $7,500 to Reaching a Generation, Inc. (RaG-ZA), a non-profit charitable organization headquartered in South Africa, which strives to empower communities to provide relief care for HIV/AIDS orphans, HIV/AIDS prevention education for children and life-skills training for educators across South Africa. Constella's grant will enable RaG-US to extend its existing website services, to create new collateral fundraising materials and to further develop a child sponsorship program in the United States.

Constella awarded $5,000 to the Decatur Education Foundation, a not-for-profit organization that nurtures and supports academic achievement and enrichment opportunities for children in Decatur, Georgia. The grant will support "Strength and Conditioning," a wellness program for selected adolescents, who are either overweight, at risk of becoming overweight or struggle with poor self-image. The program will offer fitness coaching to encourage physical activity and healthy eating habits.

Constella awarded $5,000 to the Blue Diamond Society (BDS), an organization in Nepal that supports and protects the rights of sexual minority (lesbian, gay, bisexual, transgender) communities. Its mission is to create societal acceptance of sexual minorities; to reduce stigma, discrimination, violence and brutality against sexual minorities; to reduce high-risk sexual behaviors and to encourage the use of Sexually Transmitted Infections (STI) services among sexual minorities to prevent STI/HIV infection. The organization also provides care and support for those sexual minorities who are HIV positive. BDS will use the grant to support its HIV/STD prevention and medical services.

The Foundation for the University of North Carolina at Asheville (UNCA), awarded $2,500, offers a health and wellness program designed and facilitated by students enrolled in the health and wellness undergraduate curriculum. Getting Into Fitness Together (GIFT) is a program for families struggling with weight or fitness issues. Participants engage in physical activity and receive mentoring and incentives for healthy habits. GIFT 2007 families represented multiple minority groups where there is an increased likelihood of obesity and obesity-related disease. Constella will enable expansion of the program by covering the cost of equipment, supplies and incentives. The funding will also allow an honorarium for a student intern to assist in directing the program.

"On behalf of Nepalese sexual minority communities, Blue Diamond Society would like to express our gratitude to Constella Group for this grant," said Sunil Pant, president of BDS. "This support is much needed during what is a crucial time in Nepal for HIV/STD related services. We are also very proud of our friend Philippa Lawson (a Constella Group employee) for her long-term voluntary support which has been, and will be, extremely valuable and important to our struggle for justice and health services needed for sexual minority communities in Nepal."

About Constella Group's Corporate Philanthropy Program
In 2006, Constella established its Corporate Philanthropy Program to support non-profit organizations across the world that share the company's goal toward achieving a healthy and disease-free world. The program encourages employee volunteerism and community service by limiting Enhancing Human Health Grants only to organizations where employees actively volunteer. Under the leadership of its corporate philanthropy officer, Constella established a company-wide representative committee responsible for reviewing grant applications and deciding which grants, and at what amount, Constella should fund. For more information on Constella's Corporate Philanthropy Program contact Jesse Milan, corporate philanthropy officer, at 202.777.0945 or at jmilan@constellagroup.com

About Constella Group
Constella Group is a leading provider of professional health services worldwide, dedicated to enhancing human health around the world, every day. Through its work in health sciences, international development, and pharmaceutical product development, Constella creates and provides health intelligence to help industry and government clients identify and solve critical problems affecting human health. The company's 1,500 employees serve clients from company headquarters in Durham, N.C., from U.S. offices in Research Triangle Park, N.C.; Washington, D.C; Rockville and Frederick, Md.; Glastonbury, Conn.; Atlanta; and Morgantown, W.Va., from U.K.-based offices in Bath, Oxford and Cambridge; from offices in Cologne, Germany; Paris, France; and New Delhi, India; and from client sites and other offices across the world. For more information, visit http://www.constellagroup.com/.

COPYRIGHT 2007 Business WireCOPYRIGHT 2007 Gale Group

Urban action networks; HIV/AIDS and community organizing in New York City

2007-08-25T00:11:00.000-07:00

Source : http://findarticles.com
SciTech Book News, March, 2007

Yesterday I found a news about an interesting book. Let's see!

Urban action networks; HIV/AIDS and community organizing in New York City.
Lune, Howard.
Rowman & Littlefield
2007
229 pages
$24.95
Paperback
RA643
In 1994, the AIDS community targeted then-New York mayor Giuliani's threat to close the city's largest service organization for this population. Lune (sociology, William Paterson U. of New Jersey) presents his ethnographic studies of this and other informal HIV/AIDS action networks in theoretical, historical, political, and organizational contexts, and argues for a multi-organizational approach to research on such informal networks and contentious politics. A summary table lists the participating organizations.

HIV/AIDS funding gap could hit 50% by 2007: U.N. agency

2007-08-25T00:03:00.000-07:00

source : http://findarticles.com/
Asian Economic News, July 19, 2004

BANGKOK, July 12 Kyodo

Despite a sharp increase in global funding in fighting against HIV/AIDS in the recent years, global funding would still face a 50 percent shortfall by 2007, a U.N. agency predicted Monday.

For an adequate response to the HIV/AIDS epidemic, UNAIDS said in the report ''Financing the Expanded Response to AIDS,'' an estimated $12 billion in global funding will be needed annually by 2005 and $20 billion by 2007.

But the agency projects the availability of only $8 billion for 2005 and $10 billion for 2007, based on funding trends over the past three years and future funding commitments.

''The gap will go from 25 percent (this year) to 50 percent (in 2007),'' Paul De Lay, UNAIDS's director of evaluation, told reporters at the weeklong 15th International AIDS Conference, which began Sunday in Bangkok.

''Probably the most challenging area is how much major donors say they're going to spend in the future,'' he said.

The report noted that most of the funding will still need to come from external donors rather than domestic spending, noting that worst-affected countries of Asia and sub-Saharan Africa rely on funds from international donors to meet most of their needs.

Of the $20 billion needed in 2007, $8.6 billion will be needed in sub-Saharan Africa, $5.6 billion in Asia and $3.4 in Latin America and the Caribbean, and the rest elsewhere.

Included in the $20 billion estimate is $10 billion for prevention services, $7 billion for care and treatment, $2 billion for orphan support, and $1 billion for policy, advocacy and administration.

Despite this year's $6 billion in global funding, most people in poor and middle-income countries still do not have access to AIDS prevention and care services.

According to a report on coverage on HIV/AIDS service in 2003 by the Joint U.N. Program on HIV/AIDS, only 3 percent of all pregnant women in 73 affected countries received drugs to prevent HIV transmission to their babies.

In addition, only 3.6 percent of injecting drug users had access to harm-reduction services while only some 6.9 billion condoms were used worldwide compared with the estimated 12 billion condoms needed for effective HIV prevention, the report said.

AIDS education in primary schools only reached 10 percent of Asian students last year compared with 60 percent in Africa, Eastern Europe and Latin America, according to John Stover, vice president of research organization Future Group International.

''The services that are available are usually located in capital cities...not in the rural areas,'' Stover told the same press conference.

COPYRIGHT 2004 Kyodo News International, Inc.COPYRIGHT 2004 Gale Group

-----------------------------------------------
My comment : I say "Now is year 2007. What's going on about the fund?

FUZEON: avoiding injection-site reactions

2007-08-24T23:56:00.000-07:00

source : http://findarticles.com

AIDS Treatment News, Nov-Dec, 2006

On January 31 the FDA announced that the FUZEON (enfuvirtide) package insert had been changed to include precautions to avoid injection-site reactions, either using a needle, or the Biojector(r) 2000 needlefree injection system. For example, here is one place where changes were made (this is from the new version):

"Patients and caregivers should be instructed on the preferred anatomical sites for administration (upper arm, abdomen, anterior thigh). FUZEON should not be injected near any anatomical areas where large nerves course close to the skin, such as near the elbow, knee, groin or the inferior of medial sections of the buttocks, skin abnormalities, including directly over a blood vessel, into moles, scar tissue, bruises, of near the navel, surgical scars, tattoos or bum sites."

Foods debunked as alternatives to AIDS meds

2007-08-24T23:41:00.000-07:00

source : http://www.msnbc.msn.com/id/20394521/

Study disputes S. African official’s claims that garlic, lemon can replace pills

Updated: 3:53 p.m. ET Aug. 22, 2007

CAPE TOWN, South Africa - A study by South African scientists said Wednesday there was no evidence that foods such as garlic and beetroot were a substitute for AIDS medicine, disputing claims by the country’s health minister.

The report — confirming what experts worldwide have said — was likely to increase pressure on the minister, who has been ridiculed for promoting olive oil, garlic, lemon and the African potato for people with AIDS and for questioning the effectiveness of anti-retroviral drugs.

Health Minister Manto Tshabalala-Msimang is also under fire because of the dismissal of her deputy and over newspaper allegations her liver transplant may have been needed because of alcohol abuse. Recent news reports also said she was banned from Botswana for 10 years in the 1970s after being accused of theft at a hospital.

“The panel has concluded that no food, no component made from food, and no food supplement has been identified in any credible study as an effective alternative to appropriate medication,” said professor Barry Mendelow, one of the authors of the 300-page study by the Academy of Science of South Africa.

Nutrition can help
The 15-member panel said healthy eating does appear to help slow the progression of AIDS and tuberculosis. But it cautioned that there was little reliable evidence about the influence of nutrition on the diseases.

"This contrasts dramatically with the huge cloud of often acrimonious controversy that hangs over the subject and has become a source of widespread concern in, and about, the government, both within and outside the country,” the panel said.

Tshabalala-Msimang’s spokesman could not be reached for comment on the report.
Controversy about the country’s AIDS policy has raged for years, with critics accusing the government of doing too little to slow the epidemic, which affects an estimated 5.4 million South Africans. An estimated 900 people die each day of the disease in South Africa, and some 1,400 are newly infected. A report last year warned that only half the 15-year-olds now alive would live to celebrate their 60th birthdays.

readmore : http://www.msnbc.msn.com/id/20394521/

Thailand HIV/AIDS Situation

2007-08-24T21:39:00.000-07:00

Source: UNAIDS - http://www.un.or.th

Country Situation Analysis

Thailand is known for its success in fighting HIV/AIDS, one of a very few countries in the world that has managed to reverse the spread of the epidemic. However, the challenge now is to ensure that this success does not lead to complacency and inaction. The prevalence of the disease is still relatively high, affecting many lives, and Thailand is still vulnerable to a resurgence of a generalized epidemic. If Thailand falters in its effort to control the disease, the impact would be far-reaching, dealing a major blow to the global response to HIV/AIDS, to UNAIDS, and to the many countries of the world struggling to follow Thailand’s example, bringing into question the effectiveness of the prevention-based paradigm.

Achievements

Thailand has achieved a stunning 83 per cent reduction in new infections, dropping from the 1991 peak of 142,819 new infections per year to an estimated 21,260 in 2003.

An early multi-sector response involving several key ministries, municipalities, NGOs, media, communities, private sector, and the police, focused largely on risk reduction in commercial sex, has enabled Thailand to achieve this turn-around in HIV infections.

Strong political commitment in the early 1990s and the formation of the National AIDS Prevention and Control Committee under the Office of the Prime Minister and PM’s own chairing of NAPCC (National AIDS prevention and Control Committee) ensuring participation of all ministry supported by a comprehensive multi-ministerial plan by the NESDB (National Economic and Social Development Board)

Financing for HIV/AIDS reaching 89.85 million US dollar in 1996 (per capita investment of 1.32 USD) of which 91.2% came from Royal Thai Government (RTG).

Overall, three factors contributed to reducing sexual transmission of the HIV virus: reducing brothel visits, condom compliance, and improved STI control through the introduction of powerful antibiotics, thereby reducing risk of HIV infection.

Kenya: HIV Patients Suffer As Drug is Recalled

2007-08-22T06:21:00.000-07:00

source: http://allafrica.com/

The Nation (Nairobi)
9 August 2007Posted to the web 9 August 2007

Caroline WafulaNairobi

Several Aids patients have had to switch to alternative medicine following the recall of a key anti-retroviral drug from the market.

Viracept, an ARV agent for use in HIV therapy, was withdrawn from the European Union market in June by Swiss pharmaceutical company Roche after it was found to be contaminated with cancer-causing by-products.

Patients taking the drug started complaining in May that it was emitting a strange smell and a subsequent analysis revealed impurities with higher-than-normal levels of methane sulfonic acid ethyl, a substance that can damage DNA and may generate cancer.
Mr William Burns, the chief executive officer of Roche's pharmaceutical division, said the contamination had been caused by the interaction of two chemicals in a vessel where the drug is produced.

Generic name
In Kenya, a total of 7,152 packs of the drug have been collected from various batches, including those already collected by patients. They are to be destroyed.
Viracept, a second-line HIV and Aids drug, is authorised for the treatment of infected adults and children.

The drug, whose generic name is Nelfinavir, is considered to be an important defence against HIV and is used by patients who don't respond to first-line drugs or suffer side effects and also in the prevention of mother-to-child transmission.
The recall has left patients with the painful choice of discontinuing the life-saving medicine or switching to expensive options, which many cannot afford.

Free of charge
In Kenya, most patients get the drug free of charge under President Bush's Emergency Plan for Aids Relief.

Dr Antony Wanyoike, Roche's regional manager, said the affected packs were worth Sh44 million and that between 800 and 900 patients were using the drug.

He told the Nation that the company had managed to recall 99 per cent of the affected batches. "We have all the 7,152 packs in quarantine in our warehouse and we are waiting to have them destroyed," he said.

No complaint
The official added that no complaints had been reported from Kenyan patients.

In the courts, a man was yesterday charged with unlawfully importing drugs and Part 1 poisons.
Mr Anthony Kibe Gitau denied that last July 31, at Jomo Kenyatta International Airport, he was found to have unlawfully imported 45,000 tablets of Metakelfin. He was released on a cash bail of Sh300,000.

Additional reporting: Jonathan Konuche

Morality Gets a Massage

2007-08-11T07:46:00.000-07:00

Source: The Nation - http://www.thenation.com

editorial posted May 10, 2007 (May 28, 2007 issue)

So far, the most significant player to show up on Washington madam Deborah Jeane Palfrey's much-discussed client list is USAID chief Randall Tobias, the former pharmaceutical company CEO who ran Bush's global AIDS initiative for its first three years. His ignominious tenure as AIDS ambassador was marked by a preference for pricey brand-name HIV drugs over cheap generics, which sharply reduced the number of people who could be treated. Ironically, given his regular "massages" from call girls, when we can surmise he ignored the abstinence-only instruction to "keep all of your clothes all the way on all of the time," Tobias was also an avid defender of the President's puritanical approach to HIV prevention.

Tobias was the hatchet man who forced every US grant recipient to publicly condemn prostitution--even struggling outfits doing the sensitive work of persuading destitute sex workers to use condoms. A forthcoming study from the Center for Health and Gender Equity of five Asian countries where commercial sex is driving the AIDS epidemic found that the policy has resulted in the closure of drop-in centers for street prostitutes and a scaling back of other successful prevention efforts.

It was Tom DeLay's ethically challenged Congress that slapped the global AIDS initiative with a one-third abstinence earmark on prevention. Tobias promoted this approach so zealously that in some countries, like Nigeria, nearly 70 percent of all US dollars granted to prevent the sexual transmission of HIV were channeled toward abstinence.

Tobias is not the first abstinence czar to leave his job after running afoul of the moral agenda he promoted. Claude Allen, once the leading White House abstinence advocate, stepped down as domestic policy adviser last year after he was caught stealing. Ted Haggard, once head of the National Association of Evangelicals--powerful boosters of abstinence-only spending--resigned last fall after a gay hustler named him as a client. But Tobias's fall comes as momentum is finally building against the $2.5 billion-and-counting abstinence boondoggle.

Though the Institute of Medicine called for the elimination of abstinence-only programs in 2000, Bush set about doubling their budget instead. Last month the Administration's own study--mandated by Congress a decade ago but delayed while ideological spinmeisters handicapped the criteria to help produce favorable results--was finally released. Posted quietly on the web without even a press release, it affirmed what every academic study had found before: Preaching abstinence doesn't produce it. Numerous studies show that contraceptive access cuts teen pregnancy rates and condom education dramatically reduces HIV transmission.
As with opposition to the war, the American people are ahead of Congress on this issue. A recent study found that 82 percent of Americans want comprehensive sex education for their kids. Nine states have now turned down the tempting pot of abstinence money, including "red state" Montana. Abstinence funding should go the way of Randall Tobias. Legislation like the Pathway Act, which would revoke the abstinence earmark on global AIDS spending, and the Real Act, which would allocate funds for comprehensive sex ed, both introduced by Barbara Lee, need muscle from Democratic leaders. When the President's AIDS initiative comes up for reauthorization in two years, Congress should strike the prostitution pledge and the ban on needle exchange.

The moral contradictions of the abstinence-mongers speak eloquently to the folly of basing public health decisions on religious injunctions and fantasies of social control. It's time for Congress to stop this dangerous crusade, both here and abroad.

An African Solution

2007-08-11T07:39:00.000-07:00

Source: The Nation - http://www.thenation.com

posted May 24, 2007 (June 11, 2007 issue)

Andrew Rice

One afternoon in the fall of 2005, I was sitting at an outdoor cafe along a pleasant tree-lined street in Kampala, the capital of Uganda, flipping through the local newspaper, when the sight of an old friend's face stopped me cold. I'd lived in Uganda for two years in the early part of the decade, but I'd been gone for a while, and I'd been wondering what had become of him, an attorney in his 50s. I'd known him as an insightful and opinionated man. When we'd last met, many months before, we'd talked about his country's contentious democracy and his hopes for a new project he'd started, a legal fund to assist the victims of Uganda's past dictators. Now I saw my friend's distinguished face at the center of a black-bordered newspaper announcement, above a quote from Thomas Paine and the legend: "Loved and Remembered By Your Entire Family."

It had just started to rain, and Ali, my regular newspaper hawker, sat down at the table to wait out the storm beneath the cover of the cafe's awning. Ali had known the lawyer too. I pointed to the death notice. "Oh, yes, it was very sad," Ali said. "He was sick."

I understood what Ali was trying to tell me. In Uganda, you heard it all the time. When the foreign minister took ill and died, the local journalists whispered, "He was sick." When my neighbor, an economics professor, started acting strangely, hiring a witch doctor to make him potions, his nephew confided, "Uncle is sick." When my former housekeeper, a shy young born-again woman, began wasting away before my eyes, anyone could tell she was sick. I helped her buy medicine, but she was dead by Christmastime. The word "sick" is a euphemism Ugandans use when they want to say "AIDS." About 91,000 Ugandans died of the disease in 2005, the last year for which data are available, and estimates say a million people there are infected with HIV, the virus that causes it. In the United States, a country with ten times the population of Uganda, AIDS kills roughly one-sixth as many people each year.

As an American who grew up in the 1980s, I remember a time when this was supposed to be our future, not just Africa's. Back then, in the first years after AIDS burst out of the bathhouses of New York and San Francisco, a sense of terror gripped this country. Rock Hudson died, the Surgeon General issued grave warnings and a generation of gym teachers were issued dildos and condoms and pressed into service as safe-sex educators. Today those fears seem quaint, like the cold war-era films where students were instructed to take cover from nuclear attacks under their desks. Predictions that the disease would spread widely among heterosexuals in the United States have so far proved mercifully wrong. Antiretroviral drugs have turned HIV into a manageable--though still incurable--condition. More than fifteen years after announcing his HIV diagnosis, Magic Johnson is developing real estate and looks a lot healthier than Larry Bird.
For all our worrying, the "HIV rate in the United States never exceeded one percent," Helen Epstein writes in her new book, The Invisible Cure. "At first, some UN officials predicted that HIV would spread rapidly in the general population of Asia and eastern Europe, but the virus has been present in these regions for decades and such extensive spread has never occurred." Sub-Saharan Africa is a different story. In some countries there, well over 30 percent of adults younger than 50 are thought to be infected with HIV. To appreciate the scale of the epidemiological disaster, consider this: Heart disease, the leading cause of death in the United States, killed some 650,000 Americans in 2004. If AIDS had hit this country as hard as it has Zimbabwe or Botswana, 3-4 million Americans would be dying of AIDS every year.

This is an immense crisis, and the developed world, to its credit, has roused its conscience. Bono, Madonna and Oprah have lent their famous monomials to initiatives meant to halt the disease's spread and soothe its consequences. Warren Buffett and Bill Gates have pledged their fortunes to the search for a vaccine and other vital research. Bill Clinton has made the continent's AIDS epidemic a focus of his post-presidential philanthropy. President Bush, not to be outdone, has promised $15 billion to fight AIDS in Africa, an initiative that for all its many weaknesses does represent "the biggest international health intervention ever attempted," journalist Stephanie Nolen writes in her book 28: Stories of AIDS in Africa. Yet for all these worthy efforts, the disease kills an estimated 5,500 Africans a day. Though Africa is the poorest continent, and certainly the least healthy one, its uncommon vulnerability to AIDS can't simply be explained by lack of wealth or access to medicine. Indeed, one lesson a reader takes away from the two books under review is that the epidemic is egalitarian: It kills the children of African farmers, businessmen and presidents alike.

In 1987, at the most panicked juncture of America's AIDS epidemic, journalist Randy Shilts published And the Band Played On, the finest piece of journalism ever written about this--and maybe any--disease. To date, no book on the African epidemic has managed to capture it so masterfully. In part, that's because most of them have been written by outsiders who can scarcely aspire to understand a foreign continent the way Shilts, one of America's first openly gay reporters, knew Castro Street. But the early AIDS epidemic also lends itself to a very traditional kind of narrative: It's a detective story in which doctors, scientists and gay rights activists scramble to identify and stop a killer. In their books on Africa, Epstein and Nolen must describe a far murkier state of affairs. Their contribution is to ask: Why is AIDS so difficult to stop in Africa, and why is our society, the richest and most technologically sophisticated in the world, unable to save Africans as we have ourselves? The story makes grim reading; it's a mystery to which there may be no solution.

Over the years, many medical researchers have tried to solve this deadly conundrum. Some point to biology, some to behavior and some to just plain bad luck. The inquiry, however, has been hindered by the nature of the disease. "AIDS is not an event, or a series of them; it's a mirror held up to the cultures and societies we build," Nolen writes in her introduction. "The pandemic, and how we respond to it, forces us to confront the tricky issues of sex and drugs and inequity." Moreover, in Africa it has required the international public health community--a group that's largely European and American, and therefore white--to address the sexuality of black people, an issue fraught with racial and colonial overtones. Some African leaders, notably South Africa's President Thabo Mbeki, are so sensitive to seeing their people stereotyped as lustful savages that they've given a platform to fringe scientists who deny that AIDS is sexually transmitted. The public health community, on the other hand, sometimes overcompensates, policing unconventional thoughts about the disease's origin and spread with the vigor of Soviet-era commissars. Writers who run afoul of this orthodoxy risk vituperative attacks. This is why I suspect the great AIDS book yet to come will be written by an African, and will probably be a novel, perhaps a satirical one.

It takes a great deal of confidence to name a book about this disease The Invisible Cure. Luckily, Helen Epstein has a compelling thesis, and she explains it in lucid, sometimes extraordinary, prose. She has clearly benefited from a literary upbringing: Her parents, Barbara and Jason Epstein, were co-founders of The New York Review of Books, and several of her chapters first appeared as essays in that magazine. But she is also a molecular biologist, though seemingly a disillusioned one. With unstinting self-awareness, Epstein describes how, in the early 1990s, she went to Uganda to search for a "magic bullet," a scientific answer to the disease: an HIV vaccine. She was so enthusiastic that she paid her own way on the trip. "I felt like a pioneer," she writes. "The hour of the lone scientist following his or her imagination into the unlit corners of nature is passing." In the end, Epstein's imagination didn't lead her to a breakthrough, and her faith in scientific solutions waned. (In fact, HIV mutates so quickly that some experts now doubt whether it is even possible to engineer an effective vaccine.) But she did acquire a healthy skepticism for the pieties of humanitarian work as she toiled in labs alongside better-funded colleagues. "I was just a hitchhiker, and as hitchhikers sometimes do, I became a little arrogant," she writes. "Hitchhikers live cynical, parasitic existences, but sometimes they see the landscape more clearly than drivers."

The landscape of Uganda in the early 1990s was far different from the one I encountered a decade later. At the time Epstein arrived there, the country was recovering from two decades of tyranny and civil war, and people were dying of AIDS in numbers far greater than today. Uganda was the first country in Africa to feel the full force of the epidemic, which first emerged in the fishing villages ringing Lake Victoria in the late 1970s. (The origin of the virus, which probably crossed the species barrier from monkeys to humans less than a century ago, is another great mystery. Epstein speculates that it might have been inadvertently spread by colonial-era vaccination campaigns.) By the early 1990s, it was estimated that one-third of all adults in Kampala were HIV positive. The disease seemed to strike the very people a rebuilding society could least afford to lose: university students, their professors, lawyers, journalists and especially doctors.

"Then something remarkable occurred," Epstein writes. In the early '90s, unbeknownst to anyone else in Uganda at the time, the rate of HIV prevalence began to fall. At first, it seemed like a fluke. But Uganda's prevalence rate kept plummeting, from 30 percent to 20 percent to less than 10 percent, where it remains today. People called it a "miracle," and wondered what Ugandans were doing right, because elsewhere in Africa the virus was still spreading exponentially. Epstein had an idea, but she didn't yet recognize its significance. "Back then I was still subject to magic bullet thinking--the idea that serious public health problems could be addressed without considering their social and political causes," she writes. "The Ugandans seemed to know better, but their message was lost on me."

What was Uganda's secret? In public health circles, the argument continues to this day. There are basically three theories. One says the secret was in the statistics. The early estimates that 30 percent of the population had HIV may have been overstated, and the subsequent drop might be explained by the cold fact that infected people were dying. A second theory says the secret was on the billboards. In the 1990s, advertisements promoting condom brands called Lifeguard and Protector appeared all over the country, with the support of Uganda's youthful president, Yoweri Museveni, who urged his people to set aside the traditional value placed on having large families. The third theory says the secret was in the bedroom. It's commonly believed that Africans, many of whom come from cultures that practice polygamy, are relaxed about sexual mores and promiscuity, at least of the heterosexual variety. But the fear of AIDS, this theory suggests, forced them to change their behavior.

Epstein finds each of these explanations wanting. If the prevalence of HIV in Uganda was dropping just because deaths from AIDS were outpacing new infections, why hasn't this pattern repeated itself elsewhere in Africa? It's hard to measure condom use--in the average sexual encounter, only two people really know what happened--but anyway, Epstein writes, it appears Uganda's infection rate was falling before the marketing campaigns began. (And even with all the AIDS deaths, the country's population has almost doubled since 1990, which suggests that birth control has not exactly caught on.) As for the notion that Africans are more promiscuous, studies indicate that the average Ugandan has sex with fewer people over the course of a lifetime than the average American.

So something else was going on. "Because HIV prevalence in Africa is highest among heterosexual men and women, most people suspected it must have something to do with sex," Epstein writes. "But what were Africans doing differently?"

When it comes to African culture, there may be no word more charged than "polygamy." It brings to mind those titillated travelogues by Victorian explorers, with their descriptions of bare-breasted women and chiefs in leopard skins. But this is how polygamy usually works in contemporary Africa. I have a Ugandan friend--I'll call him David--whose father is a well-off merchant. When David was a young man, his father was often away from home on business trips. When he got a little older, David discovered that there was another reason for his father's absences: He'd taken up with a younger woman. David's mother knew, and she was furious, but there wasn't much she could do. Ugandan divorce laws are skewed against women, and she and her children depended on her husband's income. David's parents stayed together, and his father's second wife, and second life, was never mentioned around the house. When David reached adulthood, he decided he wanted to meet his half-siblings, and they cautiously got to know one another. But some tension remains between the two sides of the family over David's father's money and favor. It's a messy, emotionally difficult arrangement--one that might not seem entirely unfamiliar to many "blended" American families.

There is an important difference, though, and Epstein believes it explains Africa's exceptional susceptibility to AIDS. Americans tend to leave one relationship for the next. Ugandans--or, rather, Ugandan men--don't have to choose. Another way of describing this phenomenon is to say that Europeans and Americans typically have lovers consecutively, while Africans--men and women alike--are commonly involved in several overlapping relationships. Studies have found that such "concurrent or simultaneous sexual partnerships are far more dangerous than serial monogamy," Epstein writes, "because they link people up in a giant web of sexual relationships that creates ideal conditions for the rapid spread of HIV." In any given sexual encounter, an HIV-positive person has around a 1-in-100 chance of passing on the virus. That's a long shot in the context of a one-off tryst with a prostitute, but extended over the course of an enduring relationship, the chance of infection rises to near-certainty. Also, in many African cultures, men are not circumcised, which considerably increases their vulnerability. (Recent studies suggest this simple procedure cuts in half a man's risk of infection.) Epstein produces a series of charts that the reader can view like a flip book, showing how a single case of HIV can spread through a network of concurrent relationships in just a few months.

In the early years of the epidemic in Africa, much of the medical community's response was geared toward intervening with so-called high-risk groups: truckers who crisscrossed the continent; migrants who toiled in South African mines; the bar girls and prostitutes who serviced them. As the role of concurrency came to be understood, the true perversity of the epidemic revealed itself. In Africa, the biggest risk factor is trust.

Whatever the "invisible cure" might have been--and Epstein has an interesting hypothesis--it's fairly certain that Ugandans came up with it themselves. "It seemed to me that what mattered most was something for which public-health experts had no name," Epstein writes. "It is best described as a social movement characterized by a shared sense of humanity, collective action, and mutual aid that is impossible to quantify or measure." That sounds a bit nebulous, and the fuzziness points to a weakness in her book: It's better at analyzing societies than describing individuals. In a way, she's made an understandable authorial choice: The world doesn't need another book that caricatures helpless African victims. But social movements are made of people, of millions of solitary commitments born of personal experience and tragedy.

Stephanie Nolen's book shows how AIDS is affecting Africans in their everyday lives, and gives us some idea of the form Epstein's social movement might take. Nolen presents brief profiles of twenty-eight people, a number she chose because 28 million Africans are estimated to be living with HIV. A South Africa-based correspondent for the Toronto Globe and Mail, Nolen has traveled widely around the continent, interviewing everyone from Nelson Mandela to shantytown prostitutes. She is an evocative and empathetic writer, and her journalism doesn't succumb to the affliction of so much other writing about Africa, the tendency to reduce people to categories that fit the reader's, and the author's, preconceptions: corrupt or honest, victim or killer, sinner or saint. When Nolen rides shotgun with an HIV-positive long-haul trucker who claims to have bedded 100,000 women, she doesn't condemn him to her readers; she just lets him tell his tale.

The people introduced here give one a sense of the breadth of the epidemic. They're not exactly representative, though; a more descriptive title for Nolen's book might have been The Exceptions. All of the people she interviews meet two conditions: First, they're alive, and second, they're willing to talk frankly about AIDS, which in Africa is unusual. "Stigma is one of the most used words in the AIDS pandemic, a two-syllable shorthand for the shame and fear that cling to this disease," Nolen writes. There is "a particular distaste saved for those diseases where the sick are viewed as the authors of their own misfortune, and a particular shame that comes with a disease most often transmitted by sex."

Consequently, Nolen's profile subjects are largely a self-selected group. Many are HIV-positive people who have started advocacy groups, or who work for Western nongovernmental organizations. You get the feeling you might run into a couple of them crossing the lobby of the Nairobi Hilton the next time the UN holds an AIDS conference there. But Nolen is such a gifted writer that her book transcends its limitations. To read the stories of Malawi's Alice Kadzanja, a nurse who contracted HIV from her husband, a philandering college administrator; or Zimbabwe's Prisca Mhlolo, who lost her husband and her daughter and was shunned by her family because AIDS "was a disease for prostitutes"; or Uganda's Gideon Byamugisha, an Anglican priest who admits he "did some good things...and failed in some" in relating how he passed HIV on to his late wife, is to see Helen Epstein's thesis about concurrency brought to life. The book's finest moments, however, are the ones that take Nolen by surprise: An AIDS counselor she knows in Zambia tests positive; a little girl she met in Johannesburg dies. When her dreadlocked artist friend Thokozani, who's told her he always uses condoms, finds out he has the virus, she reflects:

At first I used to marvel at it--at why people have gone on making such choices in defiance of what might seem like the most basic survival instinct. But in talking to [Thokozani], I realized that it's not, in the end, so hard to understand. Infection rates are much higher here than in, say, Canada and France, but the variables that go into decisions about love and sex and intimacy, those are no different here. People have sex without condoms because it feels good to say you trust someone that much--or because there is a particular pleasure that comes in taking risks. Or, my friend points out, just because it feels nice. We all do things we know we shouldn't--especially when we're in love, or filled with lust, or lonely.

As it happens, Epstein believes that recognizing human nature was the key to Uganda's early success in bringing the HIV infection rate under control. She contrasts contemporary South Africa, with its culture of denial that extends up to the president, with Uganda in the early 1990s. Back then, every Ugandan was talking about AIDS: the president, newspaper columnists, taxicab drivers. People started support organizations, and churches got involved. The most successful program, Epstein argues, was a local initiative called Zero Grazing (Ugandans favor cattle metaphors). "Zero Grazing was a compromise," she writes, "and its real message was this: 'Try to stick to one partner, but if you have to keep your long-term mistresses, concubines and extra wives, at least avoid short-term casual encounters with bar girls and prostitutes.'"

At the same time, the AIDS crisis also galvanized Uganda's women's rights movement. In Africa, many women are stuck in "transactional" relationships with men, relying on their money and lacking power to demand faithfulness. In the early 1990s, "women were being urged to keep their daughters in school, start small businesses, and challenge laws and practices that discriminated against women," Epstein writes. The activists also used the Zero Grazing campaign as ammunition to confront men about their behavior: "In bars and discos that were once mobbed with men and single women, men now sat drinking among themselves." The number of people reporting casual sexual partners dropped. This "partner reduction" strategy worked, Epstein says, because such casual encounters served as "on-ramps" through which HIV entered concurrent-relationship networks.

If Zero Grazing was as successful as Epstein says, you'd think international organizations would have paid to reproduce the campaign all over the continent. But they didn't--for reasons that are once again more about our preconceptions than Africa's needs. On the one hand, Western conservatives couldn't stomach a program that countenanced polygamy. On the other--and Epstein doesn't explicitly make this connection--the early 1990s coincided with a huge homegrown evangelical revival in Uganda, and many of the loudest women's rights activists were also born-again Christians. This association made many Western liberals--the type who work for organizations like the UN--quite uncomfortable. "There was a sense that promoting fidelity must be totally wrong if it was a message favored by the Christian Right," the former head of one humanitarian group told Epstein.

Near the end of her book, Epstein notes with some sadness that Zero Grazing is now a museum piece. These days, Uganda's approach to AIDS is ruled by pieties--both religious and secular. The locally devised programs of fifteen years ago have been replaced by a bland package of somewhat conflicting strategies known by the acronym ABC: abstain, be faithful, use a condom. The Bush Administration and the evangelicals push A, the public health community stresses C and no one pays much attention to B, because there's no money in nuance. Meanwhile, on the strength of its "miracle," Uganda has become an AIDS pilgrimage spot. "The big hotels in the capital play host to a perpetual round of AIDS-related conferences and workshops, and the streets are jammed with the vehicles of AIDS NGOs," Epstein writes.

The influx of money has brought profiteers, both white and black. A recent investigation revealed massive corruption in the Ugandan Health Ministry's administration of grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria. That's just the beginning of the graft. And yet for all the many millions flowing in, HIV prevalence rates have not fallen much since the year 2000. Men aren't sitting alone at bars anymore, and statistics suggest that casual sex may once again be on the rise. For a fleeting moment, in a time of unimaginable tragedy, Ugandans found it within themselves to fight this epidemic. But AIDS has a way outlasting vigilance. It's a disease of human fallibility, and for that there is no cure.

FDA Approves First Oral Fluid Based Rapid HIV Test Kit

2007-08-11T06:26:00.000-07:00

Source: http://www.fda.gov/bbs/topics/news/2004/NEW01042.html

March 26, 2004

FDA today approved the use of oral fluid samples with a rapid HIV diagnostic test kit that provides screening results with over 99 percent accuracy in as little as 20 minutes. Until now, all rapid HIV tests required the use of blood in order to get such rapid results.

The original version of this rapid test -- the OraQuick Rapid HIV-1/2 Antibody Test, manufactured by OraSure Technologies, Inc., Bethlehem , Pa. -- was approved November 7, 2002 for detection of antibody to HIV-1 in blood. On March 19, 2004 , FDA approved the test for detection of HIV-2 (a variant of HIV that is prevalent in parts of Africa but rarely found in the United States ) in blood. Today's approval represents another significant new use for the test. As when used on blood, this test can quickly and reliably detect antibodies to HIV-1 and can be stored at room temperature and requires no specialized equipment.

"Before the approval of this rapid test in November, 2002, many people being tested for HIV in public clinics did not return for the results of standard tests," said HHS Secretary Tommy G. Thompson. "Where the rapid test is available, those tested get their results within minutes. This oral test provides another important option for people who might be afraid of a blood test. It will improve care for these people and improve the public health as well."

To perform the test, the person being tested for HIV-1 takes the device, which has an exposed absorbent pad at one end, and places the pad above the teeth and against the outer gum. The person then gently swabs completely around the outer gums, both upper and lower, one time around. The tester then takes the device and inserts it into a vial containing a solution. In as little as 20 minutes, the test device will indicate if HIV-1 antibodies are present in the solution by displaying two reddish-purple lines in a small window on the device.

Although the results of rapid screenings will be reported in point-of-care settings, as with all screening tests for HIV, if the OraQuick test gives a reactive test result, that result must be confirmed with an additional more specific test. The OraQuick test has not been approved to screen blood donors. Although the test is approved to detect antibodies to HIV-1 and –2 when used on blood, today’s approval of the test for use on oral fluid is limited to detection of antibodies to HIV-1.

The OraQuick Rapid HIV-1/2 Antibody test for use on blood was categorized as a waived test under CLIA (Clinical Laboratory Improvements Amendments of 1988) in January, 2003. A waived test system can be given in facilities with any CLIA certificate, rather than only in facilities certified for higher complexity tests. As such, a test categorized as a waived test can be used in many more health care settings by many different health providers.
All new test systems are categorized as high complexity systems until they are submitted for categorization under CLIA.

"I strongly urge the OraSure company to apply for a CLIA waiver for this test using oral fluid samples as well," said Acting FDA Commissioner Lester M. Crawford, D.V.M., Ph.D. "If the FDA finds that the company’s data proves that the OraQuick test used with oral fluids is both easy and safe to use in the waived lab setting - as it is with used with blood - then more people will likely be tested for HIV infection. In addition, any risk to healthcare workers of performing the test will be greatly reduced since they will not be exposed to blood."

The Centers for Disease Control and Prevention (CDC) has estimated that one fourth of the approximately 900,000 HIV-infected people in the U.S. are not aware that they are infected. Because of the potential public health benefits of rapid HIV testing, the CDC and the Centers for Medicare and Medicaid Services (CMS) have worked with state and other health officials to make the test widely available and to offer technical assistance and training for its use.

Niger's Religious Leaders Form Alliance To Prevent Spread Of HIV

2007-08-11T05:59:00.000-07:00

Source: http://www.medicalnewstoday.com

Article Date: 10 Aug 2007 - 18:00 PDT

Catholic, Muslim and Protestant religious leaders in Niger have formed an alliance to teach youth in the country about HIV/AIDS, Reuters reports. The alliance aims to help the government fight the spread of the virus by promoting HIV tests and through better integration of HIV-positive people into society.

According to Reuters, 95% of Niger's population is Muslim, and Islamic leaders have a large influence over the country's population. Religious Affairs Minister Labo Issaka said that religious groups are "ideally placed to influence people's values and behavior" because of "their impact on communities and households, and the way they are organized and present on the ground."

According to Reuters, about half of Niger's population is under age 15. About 1% of the population ages 15 to 49 is HIV-positive, according to United Nations estimates. Although Niger's HIV prevalence is low in comparison to many other sub-Saharan African countries, the country's population is growing rapidly, which could lead to an increase in HIV cases, and government officials have pledged not to be complacent.

Earlier this summer, government officials set up 40 medical centers in the country's capital, Niamey, where people can receive no-cost HIV tests. About 9,000 young people came forward to be tested, but authorities had anticipated 22,000, according to Reuters. HIV/AIDS prevention education is difficult in Niger because less than half of children attend school, and eight in 10 adults are illiterate, Reuters reports (Massalatchi, Reuters, 8/6).

New AIDS figures show low prevalence (India)

2007-08-11T03:24:00.000-07:00

Source: http://www.ndtv.com

Mohuya Chaudhuri
Thursday, July 5, 2007 (New Delhi)

After several disputed surveys about India's HIV/AIDS figures, an official survey by the National Aids Control Organisation makes clear that India is not sitting on an AIDS time bomb.
The new figures, which will be released on Friday, say that India has 2.5 million HIV positive people, and not 5.7 million people as believed earlier.Last estimates by NACO, collected from samples taken from high-risk groups like sex workers and STD clinics, had put the figure at 5.7 million in the 15 to 49 age group.But questions arose about the accuracy of those numbers when the third National Family Health Survey, a population based study, showed that the number could actually be around three million people.

The study, however, did not include high-risk groups like sex workers, truckers or migrant labourers as they don't live in households.''There are two surveys that were done by the NFHS and second by an expert committee - WHO Geneva, CDC Atlanta, UNAIDS and NACO. They compiled data of sentinel sites; they say prevalence point is 0.9 to 0.4,'' said Dr Anbumani Ramadoss Union Min for Health & Family Welfare.

While the numbers controversy may be behind them, the government needs to now strengthen its response to the disease and tackle the widespread problem of discrimination and stigma.The recent cases of HIV positive children being kept of school and a father made to deliver his baby as his wife was HIV positive show how tough the task is.But for the moment, the government can afford to celebrate. Finally they have a method that assesses the progress of HIV AIDS more accurately.

The story about Dr Krisana Kraisintu.

2007-08-11T01:14:00.001-07:00

The work of Dr Krisana Kraisintu, who has spent years helping countries to produce generic drugs locally, has been widely recognised and publicised in the West for many years. However, her work in Africa became widely known back in her home country only after the interim Thai government decided to adopt the Compulsory License (CL) scheme for HIV.

read more | digg story

Greytown Hospital Kept Open with Help of Umvoti AIDS Centre Volunteers

2007-08-07T22:49:00.000-07:00

Source : http://www.aids.org.za/news.htm?more=73

Amber Bechtel

The South African national public service sector strike began on 11 June and lasted for almost 3 weeks. Many essential service staff opted to stay away from work as negotiations on salary increases dragged on between union and government officials. The absence of public service workers during this period resulted in the closure of institutions such as schools, clinics and hospitals leaving many people in need of care across the country.

On 14 June, AFSA partner Umvoti AIDS Centre (UAC) in Greytown Kwa-zulu Natal, received a call for help from the District Health Department Manager, Jabulani Mndebele. He requested the assistance of UAC volunteer caregivers to fill-in for striking public service staff at Greytown Hospital. According to Mamsie Mkhize, UAC Home Based Care Manager, the organization was contacted because its home based care workers are, “becoming famous for serving the whole district.”

Umvoti AIDS Centre is active in providing care and support to PLWHA in a wide geographic area in the heart of Kwa-Zulu Natal province. Currently their services are available in much of Umzinyathi, a rural district with a population of 483,573 and high rates of HIV infection. Eighty eight percent (88%) of the population of Umzinyathi is uninsured and thus relies on the public health services for health care. Umvoti AIDS Centre’s home based care programme is respected for its quality of care, and because caregivers have proven they can be trusted to keep their clients’ HIV status confidential.

At 7:00pm, only a few hours after receiving the Health Department’s call for aid, Mamsie and UAC Social Worker, Thembile, had assembled 17 dedicated volunteers at the organization’s office. After their security had been guaranteed at Greytown Hospital (Mamsie feared retaliation from striking workers) the volunteers proceeded there.

Once inside they helped attend to patients’ needs for bathing, feeding and linen-changing. Nurses from the local private hospital, also working in a volunteer capacity, supervised the UAC caregivers who performed additional duties as instructed. The following day, a fresh shift of 25 UAC volunteers worked in the hospital.

When asked of the volunteers’ reaction to their experience keeping hospital doors open Mamsie said, “They thoroughly enjoyed helping the sick people. They’re just born like that! All of them are very willing to care for the sick – and they’re hard workers!” She further expressed her gratitude to all of the volunteer caregivers, and her own pride from being part of the response.

The support UAC received from Mndebele and his staff at the District Health Office should be noted. The District Coordinator for Home Based Care formally thanked the Umvoti Centre volunteers at their recent monthly meeting. Volunteers coming from distant rural areas to lend their assistance were accommodated at Lotgrey Bed and Breakfast.

The events which occurred in Greytown during the public service strike highlight the importance of volunteer caregivers in providing basic primary healthcare to people in under-resourced areas across South Africa. Umvoti AIDS Centre and the AIDS Foundation encourage government to consider formally recognizing the knowledge and dedication of these community health workers by creating formal employment opportunities for them within the public healthcare system.

The AIDS Foundation of South Africa offers our thanks to Umvoti AIDS Centre, Mamsie Mhkize and all of the volunteer health workers who gave their time to help patients during the strike.

Kwa-zulu Natal Provincial Department of Health, “Umzinyathi Health District.” Available: http://www.kznhealth.gov.za/umzinyathi.htm.

Guangdong faces severe HIV situation

2007-08-07T22:41:00.000-07:00

Source : http://english.peopledaily.com/

South China's Guangdong Province is facing a severe HIV situation after having spotted HIV carriers in 90 percent of its counties, experts said at the Guangdong AIDS Prevention and Treatment Symposium which opened here Tuesday.

Some 110 counties among the total 122 have reported HIV carriers, said Liu Zoulu, director of Guangdong Provincial Academyof Preventive Medicine.

About 5,051 HIV carriers and 190 AIDS patients were reported in the province in 2003 and Guangdong became the fourth Chinese region with a serious HIV situation after Yunnan Province, Xinjiang Uygur Autonomous Region and Guangxi Zhuang Autonomous Region.
Among the province's HIV carriers, 84 percent are males and 80 percent are in their youth and prime between 16 to 35.

Guangdong police have registered nearly 200,000 drug addicts, who are most vulnerable to the HIV virus and a growing number of HIV infection cases were coming from the sex trade.
Experts appealed for the provincial government to input more funds and step up legislation to fight AIDS and deal with the increasing number of crimes committed by HIV carriers or AIDS patients.

Source: Xinhua

UN corrects itself, India’s HIV situation isn’t that bad

2007-08-07T22:37:00.000-07:00

Source : http://www.hindustantimes.com/

Sanchita Sharma, Hindustan Times

New Delhi, July 06, 2007

India's "AIDS time bomb" is not ticking as fast as you were made to believe. Good news for the country, bad news for UN experts who over the past decade had labelled India as the theatre of the coming HIV-AIDS holocaust.

After consistently deriding India for under-reporting AIDS data, UNAIDS has conceded the situation is not half as bad as what it had been predicting. New government data — gathered with the help of UNAIDS — showed there were 2.47 million people with HIV/AIDS in India in 2006, less than half the previous year’s estimates, Health Minister Anbumani Ramadoss announced on Friday. The HIV prevalence rate was 0.36 per cent, he said, down from 0.9 per cent in 2005.

Experts from UNAIDS and WHO told Hindustan Times the estimate was reliable. "This estimate is more reliable than before because the data base has been expanded to include 1,122 sentinel (surveillance) sites — up from 702 in 2005 — and household survey information from the National Family Health Survey-III," said Dr Peter D Ghys, UNAIDS’s Geneva-based manager of epidemic and impact monitoring.

UN agencies had earlier painted a grim picture. In 1997, UNDP’s Common Country Assessment report said there were up to 5 million infected people in mid-1996. A 2002 UNAIDS report showed over 3 lakh AIDS deaths in India in 1999, when actually 11,000 deaths were recorded. In 2002, the US Intelligence Community Assessment predicted 20-25 million HIV-positive people in India by 2010.

"Everyone always found fault with our data and accused India of underestimating the epidemic," Ramadoss said at the launch of the third phase of the five-year Rs 11,585-crore National AIDS Control Programme. Ashok Alexander, director of Avahan — Bill and Melinda Gates Foundation’s HIV project in India — said although the decrease in prevalence was good news, there were still a large number of people affected. "India cannot afford to decrease the pressure," he said.

Ten Tips on Injecting Fuzeon

2007-08-07T10:28:00.000-07:00

Source : http://www.thebody.com/fuzeon/tips.html

Fuzeon -- A Review of the First Entry Inhibitor

By Karlissa Foy, R.N., B.S.N. and Calvin Cohen, M.D., M.S.
2003

1.Add the Fuzeon powder to the sterile water solution provided. To ensure that the powder dissolves completely into the solution, roll the vial slowly at an angle. It should look like water when it has completely reconstituted.

2.If it's more convenient, while preparing one dose, you can always prepare the "next" dose. This means you can reconstitute two vials at once, using one immediately and refrigerating the second vial (vials can be prepared at most up to 24 hours in advance). However, always make sure the vial is at room temperature before you use it to inject. Some people say that after refrigerating the Fuzeon, it is not only easier to inject it, but there are fewer skin reactions at the spot where they inject.

3.Try a hot bath or shower just before injecting. This may make your skin more supple and easier to inject into.

4.Don't be afraid to try other needles besides those supplied to you by the pharmacist. Ask your doctor about insulin or tuberculin syringes. These have slightly smaller needles (in width) that do not automatically retract. Some people find these needles easier to work with.

5.Be sure to change the places where you inject, so no one spot becomes too tender or develops too severe a reaction. Don't worry if you don't have enough fat under your skin. There is no clear evidence that people with less fat have worse skin reactions.

6.You can inject in your "love-handles" -- some patients have noted that they have fewer skin reactions to the injections in areas where there is more fat.

7.Pay attention to the angle of the needle when injecting. If you don't have a lot of fat on your body, pull your skin up a little and make sure you're injecting only into your skin. If you have enough fat under your skin it will be easier. The idea is to avoid muscle injections, which can be painful.

8.Use a clothespin or clip to pinch the skin in areas of injection that you find hard to reach.

9.Vigorously massage the area where you are going to inject the Fuzeon for 3-5 minutes both before and after injection, with the emphasis on "vigorous." Use a vibrator as a tool for vigorous massage!

10.Apply a warm (not hot) towel to the site of injection immediately following injection.

For more information on injecting Fuzeon, click here.

Glossary http://www.thebody.com/fuzeon/glossary.html

Conclusion: Fuzeon's Role in Treatment

2007-08-07T10:26:00.000-07:00

Source : http://www.thebody.com/fuzeon/conclusion.html

Fuzeon -- A Review of the First Entry Inhibitor

By Calvin Cohen, M.D., M.S.
2003

Remember that Fuzeon is, ultimately, not a whole lot different from the HIV medications that came before it. Although it works differently than previously approved HIV medications, and has the novelty and challenge of being injected -- requiring a new set of skills by providers and the people using it -- it ultimately is just another HIV medication.

The suppression of HIV provided by Fuzeon in combination with other mediations can last a long time and help your immune system rebuild itself. This can help your health improve over time.

However, Fuzeon has some of the same vulnerabilities and challenges shared by all medications. Although HIV can develop resistance to it, it works best and lasts longest when it is combined with at least one other working medication, preferably two other potent medications. It can provide substantial HIV suppression when used within an already-working regimen and can more than double the rates of suppression when incorporated into the regimens of people facing resistance to the other drug classes.

Fuzeon is a vital drug to understand as we confront the formidable task of providing effective treatment for the many people facing resistance to prior regimens. It is the only drug from a new class that will be available during the next few years. When used correctly, it has provided real and long-lasting HIV control, and has been a critically important contribution to the fight against HIV.

Fuzeon's Side Effects

2007-08-07T10:23:00.000-07:00

Source : http://www.thebody.com/fuzeon/side_effects.html

Fuzeon -- A Review of the First Entry Inhibitor

By Calvin Cohen, M.D., M.S.
2003

What is clear from the big clinical studies on Fuzeon is that most HIV treatment-experienced people felt physically better once Fuzeon was included in their regimen. Many of the most common side effects reported with other HIV medications -- such as nausea or diarrhea -- were actually less common in people receiving Fuzeon. This is partly because Fuzeon does not appear to cause these problems, and partly because some of these toxicities were potentially caused by HIV and with HIV under better control, the success of the treatment made these symptoms less common.

Fuzeon's only common side effect is a skin reaction around the area where the drug is injected. While most everyone who takes Fuzeon notices some irritation at the injection site, only about 4 percent of people found this uncomfortable enough to stop the drug within a year.
In clinical studies, about half the people taking Fuzeon rated these reactions as "mild" -- which means that they were relatively small, lasted only a day or so and did not require any treatment for discomfort. However, about 25 percent of patients did report having "moderate" reactions. This may mean that the reactions were a bit larger, lasted a bit longer or had made their skin more tender. But again, these side effects were manageable even after people took Fuzeon for one year.

Researchers are trying to assess what techniques might assist people who are dealing with these reactions, in terms of how to inject differently or what to do after receiving an injection. However, a few observations have been shared by many nurses involved in these studies that may be of help:

Inject only superficially in the skin. Avoid going deeper -- injections anywhere near the muscle are more painful.

Avoid injecting near a spot that is already tender, since a second injection might increase that discomfort. It is important to inject in different places.

Other observations are being gathered and will be shared by researchers as they are verified over time. See our ten tips on injecting Fuzeon for more advice.

Who Fuzeon Works Best For

2007-08-07T10:15:00.000-07:00

Source : http://www.thebody.com/fuzeon/patients.html
Fuzeon -- A Review of the First Entry Inhibitor

By Calvin Cohen, M.D., M.S.
2003

Is there one type of patient who would most benefit from Fuzeon? After analyzing the TORO studies, researchers discovered four factors that could statistically predict whether a person's viral load will drop below 400 copies after 24 weeks of taking an optimized background regimen with Fuzeon.

People were more likely to be successful on this regimen if, at the time they started it:
Their CD4 count was more than 100.
Their viral load was less than 100,000.
They had already used 10 or fewer HIV medications.
They began Fuzeon treatment with at least two other HIV medications that still worked against HIV, as judged by a resistance test.

The TORO studies showed that Fuzeon tends to work better for people with less-advanced HIV infection -- a conclusion that is similar to most of the findings for all other HIV medications currently in use. However, what is notable about these results is that they reinforce important issues with regard to the timing of using this drug.

Because Fuzeon was developed for people who had low CD4 counts and who were already resistant to NRTIs, NNRTIs and PIs, doctors might choose to "save" Fuzeon for this late stage of treatment. Clearly, for those with low CD4 counts and few other options, Fuzeon does represent an important breakthrough option, because it might provide at least partial suppression and increase a person's CD4 count.

However, what is clear from these analyses is that there are people with less-advanced disease who may also benefit from the inclusion of Fuzeon in their regimen. For example, someone who has already developed resistance to one NRTI/NNRTI-based regimen and one PI-based regimen -- and who is about to start on a third regimen -- might also benefit from including Fuzeon as the "anchor" in his or her next regimen. The timing of using Fuzeon is among the most complex discussions that doctors must have with patients when dealing with resistance and treatment options.

In summary: While there are many details that must be considered when deciding on your next regimen and predicting its success, it is at least important, based on the data currently available, to consider adding Fuzeon to your regimen well before you develop complete resistance to virtually all other medications. Waiting until that happens will only limit Fuzeon's benefit.

What We Know About Fuzeon

2007-08-07T10:09:00.000-07:00

Source : http://www.thebody.com/fuzeon/efficacy.html

Fuzeon -- A Review of the First Entry Inhibitor

By Calvin Cohen, M.D., M.S.
2003

Efficacy: Just How Good Is This Drug?
In initial studies of Fuzeon, it was given to people alone (not as part of a regimen with other drugs) for about one month. This is the standard way to evaluate how powerful an impact a new drug will have on the ability of HIV to reproduce itself. From these studies, we learned that Fuzeon is about as powerful as most of the other potent HIV medications. We saw that an average person's viral load would decline by about 1.5 logs, or about 96 percent, when Fuzeon was used alone as a single drug.

Translating this into viral load: If someone had a viral load of 10,000, a decline of 96 percent would result in a viral load of just under 400. However, since we know that HIV can develop resistance to Fuzeon -- just like HIV does with any other drug when more complete suppression of HIV is not established -- the largest clinical studies on Fuzeon were all conducted with a combination of medications that included Fuzeon, in order to give everyone the best chance possible of suppressing HIV.

Clinical Trial Results
The big clinical studies conducted with Fuzeon were called the "TORO" studies. They enrolled about 1,000 people on several continents. To be eligible, people had to be "treatment experienced" -- that is, they had to have taken all three of the other classes of HIV medications: NRTIs, NNRTIs and PIs. The researchers made this group the target population primarily because they are most in need of a new class of HIV medications -- they are resistant to all three classes of HIV medications and had run out of options for finding a regimen that would durably suppress HIV replication, so they had the most to gain if Fuzeon worked.

The studies were designed to closely resemble what doctors would normally do in their clinical practice, in order to make these trials as easy and as relevant as possible. Patients who were eligible were randomly chosen to receive either the best HIV treatment combination their physician could put together using three to five HIV medications (called the "optimized background"), or this same "optimized background" regimen with Fuzeon added.

To create the optimized background regimen, doctors were allowed to use a combination of three to five of the approved HIV medications that were available at the time. People were given a resistance test before they were accepted into the study so doctors could select the best drugs for them. In addition, doctors had a complete treatment history for each person to help them more accurately choose drugs that would be as well tolerated as possible.

The treatment-experienced patients enrolling in this study had, on average, low CD4 counts and high viral loads. The average CD4 count in these studies was about 90 cells/mm3, and the average viral load was just over 100,000 copies/mL. Nobody took a placebo -- everyone in the study received either the standard "optimized background" regimen, or an optimized background regimen plus Fuzeon.

There was a humane aspect to the design of these studies. If in the first year a person's regimen failed to suppress HIV while on the background arm, he or she was permitted to "cross over" and receive Fuzeon plus a new background regimen.

The results -- which were measured after 24 weeks and again after 48 weeks -- demonstrated the importance of adding Fuzeon to a background regimen. Overall, by week 24, those receiving Fuzeon plus an optimized background regimen had approximately doubled their chances of achieving viral suppression (to either below 400 copies or even down to below 50 copies). This additional rate of suppression occurred since, on average, Fuzeon made the optimized background regimen almost 90 percent more effective. This means that these people had a nearly 90 percent lower viral load than people who were only taking an optimized background regimen.

Of note, those on just the optimized background had, on average, a total viral load drop of only 0.7 log, which is about the same viral load drop that we see when starting a treatment-naive patient on just AZT (zidovudine, Retrovir) alone. This study documented just how much resistance there was among treatment-experienced people in this study.

In summary, analyses of this study demonstrated the success of Fuzeon in people who are already resistant to many other HIV medications. For example, when researchers used one definition of success -- i.e., a viral load that is at least 90 percent lower than at the start of the study -- about twice as many people were able to achieve treatment success after 24 weeks just by adding Fuzeon to their regimen. After 48 weeks, 37 percent of the people taking Fuzeon still had viral load reductions of at least 90 percent, while only 17 percent of people in the optimized background arm were able to maintain such a decline in their viral load.

There are two types of viral load tests: one that can't detect viral loads below 400, and a more stringent one (which is usually used in the U.S.) that can't detect viral loads below 50. Regardless of which measure was used in this study, over twice as many people taking Fuzeon with their regimen had "undetectable" viral loads as people who were not taking Fuzeon. At week 48, for instance, 30 percent of people on Fuzeon had viral loads less than 400 copies, compared to only 12 percent of people on an optimized background regimen alone.
Using the more stringent goal -- reaching a viral load of less than 50 -- 18 percent of people on the optimized background plus Fuzeon, versus 8 percent on only the optimized background, had an "undetectable" viral load to this degree.

Of note, a similar percentage of people with a viral load of less than 400 and less than 50 copies was noted at weeks 24 and 48. This reinforces the idea that lowering viral load to these levels is one important way to achieve a durable degree of viral suppression. As a result of this improvement in people whose viral load was suppressed, there was a corresponding larger increase in CD4 counts when the study reached week 48 in those receiving Fuzeon plus an optimized background (91 cells/mm3 increase) versus those people only on an optimized background (45 cells/mm3).

Resistance Still a Danger With Fuzeon
As with every HIV medication, resistance to Fuzeon can develop. Early studies in which only Fuzeon was used to fight HIV clearly established this. This resistance is made apparent in the form of "genotype mutations," although there are few if any commercial tests that can do such testing now.

What remains less clear so far is how powerful Fuzeon might be even after resistance develops. Is it like other HIV medications, such as 3TC, where HIV can still be partially suppressed even if there is resistance? While research is ongoing to understand this more fully, the research so far suggests that it's possible. Regardless, with Fuzeon (as with any other HIV medication), it is important to attempt to establish robust suppression -- preferably pushing a viral load to less than 50 copies, or at least less than 400 copies.

How Does Fuzeon Work?

2007-08-07T10:07:00.000-07:00

Source : http://www.thebody.com/fuzeon/how_work.html

Fuzeon -- A Review of the First Entry Inhibitor

By Calvin Cohen, M.D., M.S.
2003

As mentioned in the last section, HIV inserts a glycoprotein into the CD4 cell wall, and that protein then acts like a zipper to bring HIV directly into contact with the CD4 cell. Fuzeon is like a piece of clothing that gets stuck in the zipper: When Fuzeon attaches to a specific part of the glycoprotein which HIV has inserted into a CD4 cell wall, the glycoprotein can no longer zip itself together, which completely halts the process of HIV fusing with the CD4 cell. Once this process is stopped, as long as Fuzeon remains effective, HIV cannot progress in your body.

That is why entry inhibitors are also known as fusion inhibitors -- they stop the fusion of HIV to a CD4 cell.

Because fusion is completely unrelated to all the other steps in HIV's life cycle that current HIV medications are designed to block, no cross resistance exists between the other classes of HIV medications and Fuzeon. This means that, essentially, everyone with HIV is susceptible to fusion inhibition with Fuzeon. This new class, then, can provide an important "anchor" in a new treatment combination for those who are switching regimens. Therefore, Fuzeon provides a new opportunity to reestablish control of HIV infection.

Fuzeon has several unique features. One is that, unlike all the other HIV medications, Fuzeon must be taken by self-injection. What this means is that to get Fuzeon into your bloodstream, you would be given a small syringe for a simple injection under the skin, similar to how people take insulin. Fuzeon is given as an injection for a similar reason to why insulin is an injection: Fuzeon is a type of molecule that, if taken orally as a pill, will be destroyed in the process of digestion.

Although at first you might feel uncomfortable using a syringe, in most every doctor's office there is someone -- usually a nurse -- who can teach you how to inject this medication by yourself at home.

Entry Inhibitors: A New Class of HIV Medications

2007-08-07T10:03:00.000-07:00

Source : http://www.thebody.com/fuzeon/entry_inhibitors.html

Fuzeon -- A Review of the First Entry Inhibitor

By Calvin Cohen, M.D., M.S.
2003

How Does HIV Enter Our Cells?
To damage the immune system, HIV must first get inside your CD4 cells, which are responsible for fighting off diseases inside your body. After HIV enters your CD4 cells, it uses several enzymes to turn the cells into factories that produce more HIV. Two of the key enzymes that HIV uses once it gets inside a CD4 cell are the reverse transcriptase and protease enzymes, which have been the focus of the first three available classes of HIV medications.
Researchers have figured out several of the critical steps that HIV follows to get inside CD4 cells. This has been broken down into a few stages. Here's a play-by-play look at what happens:
First, HIV attaches to a CD4 receptor.

Then HIV attaches to a "co-receptor."

After this dual attachment (to CD4 and then to a co-receptor), HIV inserts a harpoon-like anchor called a glycoprotein into the CD4 cell wall.
Then HIV "zips" together the two ends of this glycoprotein (one end is in the CD4 cell; the other end is still attached to the virus). This action allows HIV to literally pull itself close enough to the CD4 cell wall so it can actually fuse with the CD4 cell.

To complete this step of connection (or fusion), an opening is created in the CD4 cell, and -- through a process scientists still do not completely understand -- HIV inserts its viral RNA into the CD4 cell. This allows HIV to begin the process of completely taking over the CD4 cell.
The goal of Fuzeon, the first entry inhibitor to be approved in the U.S., is to prevent HIV from entering CD4 cells by stopping it from "zipping" together the two ends of the glycoprotein.

Introduction: Why Do We Need a New Class of HIV Medications?

2007-08-07T09:58:00.000-07:00

Source : http://www.thebody.com/fuzeon/intro.html

Fuzeon -- A Review of the First Entry Inhibitor

By Calvin Cohen, M.D., M.S.
2003

Reason #1: Resistance to Current Drugs
Treating HIV infection involves many challenges, including occasionally troublesome side effects and the difficulty of taking once- or twice-daily medications for a long period of time.
But one of the most difficult challenges is what to do when a medication no longer has any effect on HIV. When this happens, we say that HIV is "resistant" to a medication. This means that the amount of HIV in your body is able to grow despite the presence of that medication in your body.

Once resistance develops, it's not the initial return of HIV reproducing inside your body that causes a problem for the immune system; after all, HIV usually doesn't return in very high numbers. The problem is that once HIV is given even a little leeway to grow, it tends to begin mutating -- that is changing its genetic structure -- more and more. Each mutation helps HIV thrive, and as it does, it can cause additional immune damage.
And, of course, the more your immune system is damaged, the more vulnerable you are to a host of other, often dangerous, infections. Researchers continue to look for ways in which you can maintain a healthy immune system despite the low-level presence of HIV. In addition, researchers are always looking for combinations of HIV medications that can contain HIV for long periods of time despite this low-level presence.

One clear goal of HIV treatment is to avoid resistance and to "suppress" HIV, or stop HIV from reproducing itself. When HIV is fully suppressed, it is "undetectable" in your blood, meaning that although HIV is still present in your blood, we cannot see it with the viral load tests currently available. (It should be noted, however, that viral load tests do not measure the presence of HIV in body tissues such as the lymph nodes or the brain, just the presence of HIV in the blood.)

Once HIV is "undetectable," resistance usually does not occur and treatment will be far more reliable, long-lasting and successful.

Reason #2: Cross Resistance
Another challenge in HIV treatment is the occurrence of "cross resistance." Cross resistance occurs when a mutation in HIV allows HIV to "ignore" or resist the effect of more than one medication -- including a medication that someone may never have taken. So, despite the fact that we have about 20 different FDA-approved HIV medications, if your HIV becomes resistant to almost any of these medications, there will be some degree of cross resistance to other medications -- even though you have not yet used them.

Cross resistance is particularly a concern if, when you were first infected with HIV, you were infected with a strain of HIV that already had some resistance mutations. When this is the case, even before your treatment begins, there may be fewer combinations of HIV medications that will work reliably.

It is important to understand that cross resistance occurs within a specific "class" of antivirals. Researchers categorize each HIV medication within a class based on similarities in the way each medication stops the growth of HIV in the body. For the past several years, HIV treatment has been based on a combination of at least three different medications from one or more of three classes: nucleoside reverse transcriptase inhibitors (NRTIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs).

So, for example, if you develop resistance to one NNRTI such as nevirapine (Viramune), you're almost guaranteed to have cross resistance with another NNRTI such as efavirenz (Sustiva, Stocrin).

Cross resistance, however, is much more likely to happen with NNRTIs than with NRTIs or PIs. With NRTIs and PIs, another drug within the same class can still be used if you develop resistance to the first one you try. For example, if you are resistant to 3TC (lamivudine, Epivir), which is an NRTI, you will be cross resistant primarily to FTC (emtricitabine, Emtriva), but cross resistant to a much lesser extent with other NRTIs, such as tenofovir (Viread) or d4T (stavudine, Zerit).

It should be noted that even if there is not complete cross resistance between two drugs, it is possible for the mutations that made HIV resistant to one drug give HIV a "head start" in creating additional mutations that can eventually make HIV resistant to other drugs.

These problems explain why so many people with HIV now have treatment-resistant strains of HIV. Many HIV-positive people have a hard time finding treatment combinations that will reliably suppress HIV for years and not cause many side effects. Therefore, if their HIV is not completely suppressed, they develop strains of HIV that have become at least partially resistant to several available medications. Furthermore, there are now many people who have at least some degree of resistance to all three classes of antivirals used in initial therapy.

Fortunately, cross resistance occurs only within a class of drugs, not between classes. In other words, if you've become resistant to NNRTIs, you're still probably going to be fully susceptible to NRTIs and PIs (i.e., your HIV will remain vulnerable and able to be attacked by those classes of drugs). And when HIV is fully susceptible to enough new drugs, it can be fully suppressed.
For several years now, it has been understood that when you switch from one treatment combination to another after resistance has developed, choosing an "anchor" drug from a new class of medications is among the best ways to reliably reestablish HIV suppression. This is particularly true if most of the drugs available are less than fully potent because you have some degree of cross resistance.

The newest class of HIV drugs is the entry inhibitors, also known as fusion inhibitors. The first approved medication in this class is Fuzeon (enfuvirtide, also known as ENF or T-20). This breakthrough HIV medication offers an important option for people dealing with resistance.

Changing Antiretroviral Therapy: Why, When, and How

2007-08-07T09:44:00.000-07:00

Source : http://hivinsite.ucsf.edu/InSite?page=kb-03-02-06
(See Reference and Table 1-3)

HIV InSite Knowledge Base Chapter
June 2006

Timothy Wilkin, MD, MPH, Weill Medical College of Cornell University
Marshall Glesby, MD, PhD, Weill Medical College of Cornell University
Roy M. Gulick, MD, MPH, Weill Medical College of Cornell University

Introduction

Once antiretroviral therapy (ART) is initiated, patients generally remain on medications indefinitely. A change in the ART regimen is often necessary because of both acute and chronic toxicities, concomitant clinical conditions, and development of virologic failure. The approach to patients who need to change ART will differ depending on several issues, including the reason for change, the amount of previous ART experience, and the available treatment options. For example, when patients develop an adverse effect to a drug during their first ART regimen, effective treatment may be easily accomplished by substituting another agent for the offending drug in the regimen. At the opposite end of the spectrum are patients with advanced HIV disease who have experienced toxicities, virologic failure, and drug resistance during multiple past treatment regimens and thus require a new treatment regimen. This chapter reviews these circumstances and provides clinical evidence and strategies for changing therapy.

Acute Toxicities

Toxicities from ART are common and may necessitate changes in medications (Table 1). These toxicities are typically not life threatening but can affect quality of life and negatively affect patients' willingness to adhere to their regimens. In fact, several cohort studies have suggested that toxic effects are a more common reason for changing ART than are virologic failures.(1-4) A review of published cohort studies that examined modification of initial ART regimens found that antiretroviral intolerance and toxicity were the most common reasons for changing therapy in 8 of 11 studies.(4) Gastrointestinal disturbance such as nausea, vomiting, and diarrhea was the most frequently cited toxicity leading to a change in an initial ART regimen, and this has been confirmed in a separate cohort study.(3) Most of the modifications due to intolerance in these studies occurred within 3 months of starting ART.(4) The large majority of the patients in these cohort studies were taking protease inhibitor-based regimens.

Investigators monitoring an Italian cohort of HIV-infected patients examined the outcomes of patients whose first ART regimens were based on nonnucleoside reverse transcriptase inhibitors (NNRTIs).(5) They found that clinical drug toxicity, which occurred in 18% of patients starting a nevirapine-based regimen and in 10% of patients starting an efavirenz-based regimen, was the most common reason for changing an initial ART regimen. In contrast to gastrointestinal disturbance with protease inhibitor-based regimens, hypersensitivity (eg, rash and hepatitis) was the most common reason for discontinuing a nevirapine-based regimen (12%), and central nervous system toxicity was the most common reason for discontinuing an efavirenz-based regimen (5%). In addition to the toxicities mentioned above, rash, headache, fatigue, and abnormalities in hematologic and liver function tests are common toxic effects leading to a change in ART.(3) In some resource-constrained settings, where ART regimens usually consist of an NNRTI (typically nevirapine) in combination with either zidovudine or stavudine plus a second nucleoside analogue, high rates of acute toxicities necessitating antiretroviral changes have been reported (6-8) These adverse effects include rash, hepatotoxicity, and anemia.

No absolute guidelines exist for determining when to change regimens if these toxicities occur. Given that many patients improve within a few weeks of starting ART, providers often attempt to control adverse effects with short-term palliative medicine (eg, loperamide for diarrhea and prochlorperazine or metoclopramide for nausea). Efavirenz-associated central nervous system toxicity often subsides within a few weeks after starting the medication (9) and is usually managed by reassuring the patient. In the case of acute toxicity attributable to a specific antiretroviral drug, same-class substitution of a drug with a differing toxicity profile is accepted clinical practice, based largely on anecdotal experience and descriptive data from clinical trials (eg, abacavir or tenofovir for zidovudine-related gastrointestinal intolerance). The decision to change antiretroviral medications is based on consideration of the severity of symptoms, efficacy of palliative medications, options for substitution, and risks associated with those options. The occurrence of adverse effects has been associated with reduced adherence,(10) and providers generally should offer a change in medications for patients who report diminished adherence due to toxicity. Modification of ART because of toxicity in patients who are starting an initial ART regimen does not seem to be associated with subsequent virologic failure.(11,12)

Chronic Toxicities

Certain toxicities emerge months to years after the initiation of antiretroviral medications. These include neuropathy, changes in body composition (commonly termed lipodystrophy), and metabolic toxicities (eg, dyslipidemia and insulin resistance) that are associated with an increased risk of cardiovascular events. Researchers have shown great interest in the strategy of changing antiretrovirals to manage these chronic toxicities. The presumed multifactorial etiology of such complications makes their study a challenge because >1 drug or class of drugs in a regimen may contribute pathogenetically to the toxicity. Nonetheless, investigators have addressed chronic toxicities by substituting drugs that have been linked epidemiologically to specific adverse effects.

Lipoatrophy

Lipoatrophy (eg, loss of subcutaneous fat in the face, extremities, and buttocks) is a component of lipodystrophy. Thymidine analogue use has been associated with lipoatrophy, and, in particular, stavudine use has been identified as a risk factor in several studies.(13,14) Although fat loss was once thought to be irreversible, small proof-of-concept studies have suggested that substituting zidovudine or abacavir for stavudine was an approach worthy of further examination.(15,16) In a landmark study, subjects with lipoatrophy were randomized to continue stavudine or zidovudine or to switch the thymidine analogue to abacavir. Those who switched had statistically significant increases in both subcutaneous abdominal tissue volumes by computed tomography and peripheral fat mass by dual-energy X-ray absorptiometry (DEXA) scanning at 24 weeks of follow-up.(17) Although these short-term changes were not clinically significant, further follow-up to 2 years demonstrated continued improvements in lipoatrophy.(18) Other studies have demonstrated improvements in lipoatrophy after substituting abacavir,(19,20) tenofovir,(20) or zidovudine (19) in place of stavudine, suggesting that this approach may be reasonable to consider if a patient's treatment history permits safe substitution. A patient with a history of abacavir hypersensitivity or documented resistance to abacavir would not be an appropriate candidate for this switch. Similarly, a history of single or dual nucleoside analogue therapy is associated with an increased risk of virologic failure after changing to abacavir, probably because of preexisting nucleoside resistance mutations, and precludes such a switch.(21)

Observational data have suggested that protease inhibitors may act synergistically with nucleoside analogues in the development of lipoatrophy.(22) Several small, randomized controlled studies in which a protease inhibitor was switched to an alternative agent, however, have not shown objective improvements in lipoatrophy.(22,23,24) For example, among 77 subjects randomized either to switch from a protease inhibitor to nevirapine or efavirenz or to continue the protease inhibitor, the 58 subjects with lipodystrophy at baseline showed no changes in body composition by DEXA or anthropometric measurements after 1 year of follow-up.(22) Contrasting results came from a subgroup analysis of a larger trial in which 8 subjects taking a regimen containing zidovudine and a protease inhibitor switched their protease inhibitor for abacavir. On average, these subjects gained small amounts of leg fat over 48 weeks, as assessed by DEXA, compared with 7 control subjects who remained on a zidovudine-based regimen that included a protease inhibitor.(25) Taken together, these data suggest that substituting another agent for a protease inhibitor is not likely to have a clinically significant impact on lipoatrophy, at least in the short term.

Central Fat Accumulation

Because increased truncal (visceral) fat has been linked epidemiologically to protease inhibitor use, the effect on truncal fat of switching to regimens that do not contain a protease inhibitor has been explored in several small studies, most of which have lacked a control group and objective end points.(26-28) In 1 randomized study, subjects with increased visceral abdominal tissue volume at baseline had greater reductions after switching from a protease inhibitor-containing regimen to abacavir, nevirapine, adefovir, and hydroxyurea compared with controls who stayed on protease inhibitor-containing regimens.(29) Lipoatrophy, however, worsened in those randomized to the change in regimens. In a metabolic substudy of a large randomized trial, no significant improvement was found in body composition abnormalities 24 months after patients switched from a protease inhibitor to abacavir, nevirapine, or efavirenz.(24) Overall, the approach of switching from protease inhibitors has not proven successful and cannot be recommended as a strategy for addressing increased truncal fat. Specific therapies for this condition are an active area of research.

Dyslipidemia

Hypertriglyceridemia and hypercholesterolemia have been clearly associated with the use of specific protease inhibitors and may occur within weeks after initiation. These toxicities have been managed successfully by switching within the protease inhibitor class or by switching to drugs from other antiretroviral classes. As an example of the first approach, replacing ritonavir with nelfinavir or nelfinavir plus saquinavir improved lipid profiles in a small, randomized study.(30) Similarly, substituting atazanavir for a protease inhibitor improved lipid profiles in uncontrolled studies (31,32) and in a randomized comparison with lopinavir-ritonavir.(33) The effect of substitution of a protease inhibitor with the combination of atazanavir and low-dose ritonavir is less clear; in 1 randomized study, atazanavir-ritonavir appeared to affect total cholesterol and triglycerides favorably, whereas lopinavir-ritonavir appeared to worsen these parameters.(34) Several studies have examined the approach of switching a protease inhibitor to an NNRTI or abacavir. These studies are reviewed in detail elsewhere.(35) In general, substitution of nevirapine (24,36) or abacavir (21,24,37) has had favorable effects on triglycerides and often on total cholesterol, whereas substitution of efavirenz has yielded mixed results.(27,36,38). However, in a randomized study, triglyceride levels decreased in the first 12 months after substitution of efavirenz, nevirapine, or abacavir for a protease inhibitor, but returned to baseline by 24 months.(24) Changing to efavirenz or nevirapine may increase high-density lipoprotein cholesterol,(35,36) but may have variable effects on low-density lipoprotein (LDL) cholesterol.(24,36)

Nucleoside analogues also may contribute to dyslipidemia in HIV-infected patients. Stavudine has been associated with greater adverse lipid effects in 2 randomized, controlled studies when compared with zidovudine or tenofovir, in conjunction with lamivudine and efavirenz or nelfinavir.(39,40) Several studies have suggested that substituting tenofovir for stavudine may improve total cholesterol and LDL cholesterol; the effect on triglyceride levels is less clear.(20,41)

Insulin Resistance/Diabetes Mellitus

The effect of drug substitution has been characterized less well for insulin resistance than for dyslipidemia. Whereas indinavir clearly causes decreased insulin sensitivity when administered to healthy, HIV-uninfected volunteers,(42,43) the relative effects of other protease inhibitors have not been clearly discerned in vivo. In vitro data concerning insulin resistance (44) and diabetes mellitus associated with protease inhibitor use,(45) however, do suggest that certain other drugs within the class may induce insulin resistance directly or indirectly. Switching a protease inhibitor to abacavir,(24,46) efavirenz,(24,27) or nevirapine (24,26) appears to have a favorable effect on insulin resistance; few data exist on the effect of substituting atazanavir for another protease inhibitor. Substituting an alternative drug for a protease inhibitor may therefore be a reasonable strategy for patients with other risk factors for diabetes mellitus, such as obesity and positive family history,(47) although no data are available on the efficacy of such a strategy in preventing the development of diabetes mellitus. Because insulin resistance is associated with increased cardiovascular risk in the general population,(48) reducing insulin resistance may have long-term benefits.

Life-Threatening Toxicities

Life-threatening toxicities are rare, but remain an important reason for changing ART. Severe rash such as Stevens-Johnson syndrome or erythema multiforme is an indication to change ART.(49) These rashes have been reported most commonly with NNRTIs: delavirdine (rarely), efavirenz (0.1%), and nevirapine (1%).(50-52) Lactic acidosis is potentially fatal and is most commonly associated with stavudine, but it has been reported with all nucleoside reverse transcriptase inhibitors.(53,54) In the case of symptomatic hyperlactatemia or lactic acidosis, retrospective data suggest that it is generally safe to change the presumed offending agent (typically stavudine or didanosine) to an alternative nucleoside analogue considered to have similar virologic activity but less propensity to injure mitochondria (typically abacavir, lamivudine, or tenofovir).(55) This substitution is generally made after a treatment interruption to allow resolution of the initial toxicity. Other potentially fatal toxicities include didanosine-associated pancreatitis (56) and abacavir hypersensitivity.(57) Rechallenge with the offending agent after the onset of any of these life-threatening toxicities should not be attempted.

Adherence/Quality of Life

Much progress has been made in simplifying ART so that regimens are easier for patients to take in a consistent manner. In the mid- to late 1990s, combination ART involved taking medications at least 3 times a day, often with food and water restrictions and high numbers of pills. These complex regimens are gradually giving way to simpler regimens involving fixed-dose combination pills, newer drugs or formulations that can be taken once daily, and the use of ritonavir for pharmacokinetic enhancement of other protease inhibitors (Table 2). Given these new options, many patients with stable virologic suppression on more difficult regimens can change to regimens with lower pill burdens and minimal dosing complexity, thus improving adherence and quality of life.

Investigators have studied many approaches to simplifying complex ART regimens with the aim of improving adherence and quality of life, and thereby reducing rates of virologic failure. The most widely studied approach has been replacing a protease inhibitor with nevirapine, efavirenz, or abacavir in patients with full virologic suppression while taking a protease inhibitor-based regimen. In 2 studies, adherence improved in subjects randomized to switch from a protease inhibitor to efavirenz (58) or to abacavir (37) compared with those who continued the protease inhibitor-based regimen. In both studies, time to virologic failure was delayed in the switch arms, suggesting that the improvement in adherence was clinically relevant. Other investigators have reported improvements in quality of life, as assessed by questionnaires, in 2 randomized studies in which protease inhibitors were switched to nevirapine (59) or to either nevirapine or efavirenz (22) compared with continuing the protease inhibitor.

Clinicians who are contemplating changing an ART regimen for quality-of-life considerations should keep in mind the potential for adverse effects of the new regimen. In a large, randomized study that assessed the efficacy of simplifying protease inhibitor-based regimens by substitution with abacavir, efavirenz, or nevirapine, approximately 50% of subjects had new adverse events, although few of those events resulted in discontinuation of the regimen.(60) With the advent of several simpler protease inhibitor regimens that include options for once-daily dosing with decreased pill burden and fewer adverse effects, clinicians may have less need for the strategy of replacing protease inhibitors merely for the purpose of simplification.

Changing ART in Patients with Virologic Suppression

When considering changing an ART regimen for any of the reasons discussed above in a patient with virologic suppression, it is critical to examine the patient's treatment history. Previous virologic failure on an NNRTI, whether or not resistance testing was performed, or documented resistance to this class of agents is a contraindication to switching to nevirapine or efavirenz. Similarly, previous monotherapy or dual therapy with nucleoside analogues increases the risk of virologic failure when changing to abacavir because of selected nucleoside resistance mutations. Of note, substituting abacavir for a protease inhibitor or NNRTI typically results in a triple nucleoside regimen, which has been shown to be virologically inferior to efavirenz-based regimens as initial therapy.(61) Although switching a virologically suppressed patient to a triple-nucleoside regimen may differ from using such a regimen as initial treatment, a randomized simplification trial in which subjects on protease inhibitors were switched to abacavir, nevirapine, or efavirenz showed a trend toward a greater rate of virologic failure in the abacavir arm.(60) Thus, drug substitution that results in a triple-nucleoside combination without additional drugs cannot be recommended for most patients.

Concomitant Medical Conditions

A patient's changing clinical status often mandates a change in ART. For example, certain antiretroviral medications are less favored in pregnancy. Efavirenz is teratogenic in animals and was linked to birth defects in several reported cases,(62,63) so this agent should be substituted with nevirapine or an appropriate protease inhibitor-based regimen in pregnant women.(63) Caution should be used with nevirapine in pregnancy because it has been associated with an increased risk of fatal hepatitis in pregnant women, especially in women with higher CD4 counts; nevirapine generally should not be initiated in women whose CD4 count is >250 cells/µL.(64) The oral solution of amprenavir should not be used in pregnant women because of the high content of polyethylene glycol,(65) and hyperbilirubinemia induced by atazanavir and indinavir is a theoretical risk for the newborn.(66,67)

Medications used to treat comorbid illnesses often interact with antiretroviral agents. A prime example is the interaction of rifampin, a first-line drug for the treatment of tuberculosis, with both NNRTIs and protease inhibitors.(68) This interaction may be avoided by substitution of efavirenz for nevirapine, perhaps by dose adjustment of efavirenz,(69) or by substitution of rifabutin for rifampin in the case of protease inhibitors.(68) Other important drug interactions include cholesterol-lowering "statins" with protease inhibitors,(70) oral contraceptives with NNRTIs or protease inhibitors,(71) and ergot derivatives with protease inhibitors.(72) The activity of tenofovir, emtricitabine, and lamivudine against hepatitis B has encouraged many providers to include these medicines in the ART regimens of patients with chronic hepatitis B.(73-75) (See chapter "Coinfection with Hepatitis Viruses and HIV.")

Suboptimal Immunologic Response

Patients starting ART may fail to have a significant increase in CD4 cells despite control of viral replication. Investigators from the Swiss HIV Cohort Study reported that 38% of patients with stable suppression of HIV during ART for >5 years failed to reach a CD4 count of at least 500 cells/µL.(76) In some cases, the particular ART regimen may be problematic; several studies have shown suboptimal increases, or even decreases, in the CD4 count in patients treated with virologically suppressive ART regimens that include the combination of didanosine and tenofovir.(77,78) Generally, however, the causes and clinical significance of this phenomenon are unclear, but remain a concern for both patient and provider. Treatment intensification (supplementing an existing regimen with additional antiretroviral drugs) in the setting of poor CD4 recovery has not been shown to increase the CD4 count.(79) Interleukin-2 has been shown to increase CD4 cells, but its relationship to clinical outcomes has been lacking and adverse effects are common.(80) The Evaluation of Subcutaneous Proleukin in a Randomized International Trial (ESPRIT) study is a large ongoing trial that is assessing clinical end points (eg, death, new opportunistic infections) with subcutaneous interleukin-2 versus placebo in patients taking ART. However, this study is limited to individuals who have CD4 counts >300 cells/µL at baseline. Without additional data, the best strategy for patients with virologic suppression and suboptimal immunologic response is probably to continue their current regimens.

HIV-Related Clinical Events

Clinical events such as opportunistic infections or AIDS-associated malignancies are uncommon in patients with virologic suppression during ART. The ART Cohort Collaboration, involving 13 cohort studies of patients starting a first ART regimen, estimated the risk of an AIDS-defining illness or death within 3 years of starting ART. Among those patients with virologic suppression 6 months after starting ART, the estimate of risk ranged from 14% for those with a 6-month CD4 count of <25>350 cells/µL.(81,82) Limited data are available on whether to change ART for patients who develop AIDS-defining illnesses. Certainly, a regimen should be changed if the patient has detectable viremia and if viable alternatives exist to ensure maximal suppression of HIV and to enhance immune reconstitution. Other infections such as herpes simplex virus reactivation, herpes zoster, pneumonia, and human papillomavirus-associated squamous intraepithelial lesions (eg, cervical and anal dysplasia) can occur in patients with stable virologic suppression during ART and do not indicate a need for changing ART.

Caution should be used in interpreting clinical events that occur soon after the initiation of ART (eg, within 3 months). During this period, patients starting ART with lower CD4 cell counts, especially <100>Changing ART for Virologic Failure

The treatment guidelines of the U.S. Department of Health and Human Services suggest criteria for assessing virologic failure: HIV RNA >400 copies/mL at 24 weeks of therapy, HIV RNA >50 copies/mL by 48 weeks of ART, or repeated detection of viremia after virologic suppression.(71) A single elevated HIV RNA level should be confirmed with a second measurement because an isolated increase ("blip") in HIV RNA may occur in up to 40% of patients and is not associated with virologic failure.(84) However, repeated or sustained increases in HIV RNA levels are associated with an increased risk of virologic failure.(85)

Cause of Failure

Once a patient has experienced virologic failure, the cause of the failure should be explored. If adherence, toxicity, and pharmacokinetic reasons can be excluded, then virologic failure of the current regimen has been established. The initial approach to treatment failure is to carefully review the patient's antiretroviral history, including each specific drug (noting the formulation) and each previous regimen, the duration of each regimen, any adverse effects or toxicities, and the response in HIV RNA levels and CD4 cell counts (if known). This information is essential for assessing the likelihood of archived resistance mutations to individual drugs or drug classes. The patient should be encouraged to continue the current regimen during the assessment of virologic failure because discontinuing ART, even in the setting of virologic failure, may lead to both a rapid increase in HIV RNA level and a decrease in CD4 cell count, with or without clinical events.(86)

Resistance Testing

Resistance testing gives information only about the most prevalent viral strain circulating at the time the blood specimen is obtained. Therefore, resistance testing should be performed while the patient is taking the failing treatment regimen, because virus that harbors resistance mutations may not be detected readily after the selective pressure of drug is removed, but nevertheless will remain archived in tissue reservoirs. In separate studies, both genotypic testing (87,88) and phenotypic testing (89) led to significantly improved virologic responses with the subsequent ART regimen as compared with the strategy of using the antiretroviral history alone in selecting the regimen. (See chapter "Genotypic Testing for HIV-1 Drug Resistance.") Although current guidelines recommend the use of resistance testing in the management of antiretroviral failure,(71,90) it is not clear whether the optimal test is a genotype, a phenotype,(91) or both.(92) Used together, a careful ART history and resistance testing yield the most complete assessment of both archived and present resistance mutations, and this strategy optimizes selection of the next ART regimen.

Expert Advice

Evaluation and management of antiretroviral-experienced patients are complicated. Because HIV clinicians may have limited knowledge about resistance testing,(93) expert advice is recommended. In the Havana study, resistance testing and expert advice for selecting subsequent ART regimens were each associated with improved virologic responses.(94) Current guidelines suggest obtaining expert advice when managing treatment-experienced patients.(71)

Pharmacokinetics

Drug concentrations are associated with virologic responses in treatment-experienced patients. For example, as part of the Viradapt study, protease inhibitor concentrations were measured in patients taking combination regimens and were assessed as optimal or suboptimal (<2-fold>Selecting the Next Regimen.

For a patient experiencing virologic failure, how is the next ART regimen optimally designed? The initial approach was simply to use drugs that the patient had not yet taken, but in early clinical studies such as AIDS Clinical Trials Group studies 359 and 398, this strategy achieved maximal virologic suppression in only about 30% of patients.(101,102) However, these early studies did suggest factors that were associated with better virologic responses, including a lower baseline HIV RNA level at the time of regimen change; use of 2 protease inhibitors, rather than 1, in the next regimen; and use of a new class of agents (eg, NNRTIs). The initial studies of resistance testing also led to the recommendation that the new ART regimen for a patient experiencing virologic failure should contain at least 3 active (on the basis of resistance testing) antiretroviral agents to achieve an optimal virologic response.(71,87)

One study incorporated several of these factors in its design by enrolling 70 patients who had experienced failure of only 1 protease inhibitor, had not taken NNRTIs, and had HIV RNA levels ranging from 1,000 copies/mL to 100,000 copies/mL.(103) The subjects substituted lopinavir/ritonavir (at either of 2 randomly assigned doses) for their current protease inhibitor and also added nevirapine (introducing a new drug class for these subjects) and at least 1 new nucleoside analogue.(103) At 48 weeks in an intent-to-treat analysis, 70% of subjects had HIV RNA levels <400>

Conclusions

Changing an ART regimen is common in clinical practice for patients with either suppressed virologic replication or virologic failure. Those with virologic suppression usually have changes in ART in an attempt to alleviate acute toxicities, control chronic toxicities, or improve quality of life. This strategy generally appears safe as long as relevant issues such as previous ART use are considered. The benefits of changing ART must be weighed against the possibilities of encountering new toxicities and increasing the risk of virologic failure. The management of virologic failure among treatment-experienced patients has improved over the last several years. The establishment of clear criteria for assessing virologic failure, the development and availability of HIV resistance testing, the identification of factors leading to improved virologic responses in subsequent regimens (eg, 3 active drugs in the regimen), the development of new antiretroviral agents with activity against resistant virus, and the exploration of therapeutic drug monitoring have contributed to progress in the field.

Nutrition and HIV

2007-08-07T09:28:00.000-07:00

Source : http://www.thebody.com/content/living/art2516.html
(You can read this website for more informations and reference.)

San Francisco AIDS Foundation

By Liz Highleyman

Winter 2005/2006

Good nutrition is key to a healthy lifestyle, regardless of whether one is living with HIV/AIDS. Optimal nutrition can help boost immune function, maximize the effectiveness of antiretroviral therapy, reduce the risk of chronic illnesses such as diabetes and cardiovascular disease, and contribute to a better overall quality of life.
In the early years of the AIDS epidemic, many people with HIV were dealing with wasting and opportunistic infections (OIs) linked to unsafe food or water. While these problems are less common today in developed countries with widespread access to highly active antiretroviral therapy (HAART), many HIV positive people have traded these concerns for worries about body shape changes, elevated blood lipids, and other metabolic complications associated with antiretroviral therapy.

Fortunately, maintaining a healthy diet can help address these problems. As HIV positive people live longer thanks to effective treatment, good nutrition can also help prevent problems (such as bone loss) associated with normal aging. But there is no single, optimal eating regimen appropriate for every person living with HIV/AIDS. Instead, HIV positive people should adopt a sensible balanced diet and consult an experienced nutrition specialist for individualized recommendations.

Food for Life
Food is essential for life, providing the fuel the body needs to function and the building blocks that make up cells, tissues, and organs. The energy provided by food is expressed in terms of calories. The body requires a certain number of calories simply to carry out its basic metabolic functions such as respiration and maintenance of body temperature. Additional calories are needed to support physical activity, fight infection, and rebuild damaged tissues.
If a person does not take in enough calories, fat is broken down to provide fuel. Once the fat is consumed -- or if an individual's metabolism is disrupted due to illness -- lean body mass (muscles and organs) is then used for fuel and raw materials. Conversely, if a person takes in more calories than needed, the extra energy will be stored as fat. The average person needs about 10-20 calories per pound (depending on physical activity level and other factors) to maintain a stable body weight; this requirement is likely to be higher for people with HIV, especially those with advanced disease.

But all food is not equal. While all contain calories, different foods vary widely in the nutrients they provide. A balanced diet is comprised of the following components.

Protein: Protein provides the building blocks of lean body mass. When a protein-rich food is consumed, it is broken down into amino acids, which are reassembled to create enzymes, hormones, and bodily tissues. Most nutrition experts recommend that protein should contribute about 15-20% of the total calories in a person's diet. Good sources include meat, poultry, fish, eggs, dairy products, tofu, nuts, and legumes (e.g., dried beans, lentils).

Carbohydrates: Carbohydrates, which are converted to glucose in the body, are a primary source of energy. Carbohydrates are classified as simple or complex; complex carbohydrates take more time to break down, and thus provide fuel over a longer period of time. Despite the recent popularity of "low carb" diets, most nutrition experts recommend that carbohydrates -- primarily complex ones -- should make up at least 50% of one's total daily calorie intake. Simple carbohydrates are found in processed sugar, honey, fruit and juice, and lactose (milk sugar). Complex carbohydrates are found in grain products such as bread, pasta, and rice; legumes; and starchy foods such as corn, potatoes, winter squash, and root vegetables.

Fats: Fat in food is a source of energy and has a high concentration of calories. Excess energy from any source -- not just fatty food -- is converted to fat in the body and stored for later use. Cholesterol (found in animal products like meat and eggs) and triglycerides are present in food, but are also produced when the body metabolizes sugar and saturated fat. Everyone needs some dietary fat, but getting too little is rarely a problem. More important is the type of fat. Saturated fats promote elevated blood levels of low-density lipoprotein (LDL) "bad" cholesterol, which can clog arteries and increase the risk of cardiovascular disease. Saturated fat is found in meat, butter, tropical oils (e.g., coconut, palm), and "trans" fats or hydrogenated oils (which are chemically altered to make them solid at room temperature). Polyunsaturated fats (found in safflower, sunflower, corn, and soybean oils) are generally considered more healthful, and monounsaturated fats (found in olive and canola oils, nuts, seeds, and avocados) can help raise levels of high-density lipoprotein (HDL) "good" cholesterol, which protects against heart disease. A balanced diet also contains essentially fatty acids, including omega-3 (found in flax and cold-water fish). Most experts say fats should make up no more than 25-30% of total calorie intake, with less than 10% being saturated fat.

Fiber: Also known as "roughage," fiber is indigestible plant matter such as cellulose. Insoluble fiber plays an important role in digestion, helping food move smoothly through the colon (large intestine); this type of fiber is found in the skin and pulp of many fruits and vegetables, whole grains, popcorn, and seeds. Soluble fiber helps stabilize blood sugar and may reduce LDL cholesterol levels; this type of fiber is found in oatmeal and oat bran, legumes, nuts, and fruits such as apples, oranges, pears, and grapes.

Vitamins and minerals: Along with the "macronutrients" described above, a balanced diet also contains many "micronutrients," organic and inorganic substances necessary for proper biological functioning. Water-soluble vitamins (B and C) are excreted in the urine and must be consumed more often; fat-soluble vitamins (A, D, E, and K) are stored in the liver and can reach toxic levels if taken in large doses. Most vitamins must be obtained from food, although the body manufactures vitamin D when the skin is exposed to sunlight and others are produced by bacteria in the gut. Minerals (including the electrolytes chloride, potassium, and sodium) are inorganic substances found in the environment. The body needs several trace elements in tiny amounts, including boron, chromium, cobalt, copper, iodine, manganese, molybdenum, selenium, and zinc. Cooking and processing can destroy some vitamins and minerals. For information on the function and food sources of specific vitamins and minerals, see the chart below.

Antioxidants: Free radicals are unstable oxygen molecules that contain unpaired electrons. This allows them to set off damaging chain reactions when they bind with and "steal" electrons from other molecules in the body -- a process known as oxidative stress. Antioxidants scavenge and neutralize free radicals. By disrupting the oxidation process, antioxidants help protect cells from damage. Antioxidants include vitamins C and E, beta-carotene, the minerals selenium and zinc, and glutathione.

Phytochemicals: Among the advantages of obtaining nutrients from a balanced diet rather than supplements is that there are substances in whole foods that may offer unrecognized benefits. While most vitamins and minerals were isolated early in the 20th century, plant compound called phytochemicals are just now being discovered. Among these are allyl sulfides (found in garlic and onions), anthocyanins (in blueberries and blackberries), carotenoids (including beta-carotene in orange fruits and vegetables, lycopene in tomatoes, and lutein in dark green leafy vegetables), catechins (the tannins in green and black tea), flavonoids (in dark chocolate, red wine, tea, and many fruits), isothiocyanates (in broccoli and other cruciferous vegetables), limonoids (in citrus fruits), and sulforaphane (also in cruciferous vegetables). Some phytochemicals work as antioxidants, but others appear to have different mechanisms of action.

How HIV Impacts Nutrition ... and Vice Versa
In the early years of the epidemic, healthcare providers soon learned that people with AIDS commonly experienced both overt protein/calorie malnutrition and deficiencies of specific nutrients. But nutrient depletion may also begin to occur earlier in the course of HIV disease, even among individuals with relatively intact immune systems. Several factors can contribute to nutritional problems in people with HIV/AIDS.
Malabsorption: HIV or associated infections can damage the lining of the gastrointestinal tract, which can interfere with absorption of nutrients. Some HIV positive people experience specific problems, such as fat malabsorption, which can impair absorption of fat-soluble vitamins.

Opportunistic infections: Various bacterial, viral, fungal, and parasitic infections can interfere with proper nutrition. Malignancies (cancers) and mycobacterial illnesses such as tuberculosis are often characterized by wasting. Several OIs cause vomiting and diarrhea, which can lead to poor absorption or loss of nutrients. Other infections -- such as thrush (oral candidiasis), gingivitis (gum inflammation), and cytomegalovirus esophagitis (throat inflammation) -- can make eating painful.

Medications: Antiretrovirals, OI drugs, and other medications can contribute to nutrient deficiencies and imbalances, either due to direct drug-nutrient interactions or drug side effects. Vomiting and diarrhea can lead to dehydration and depletion of nutrients. Loss of appetite (anorexia), fatigue, and taste alterations can make it difficult to eat enough. Antibiotics may interfere with nutrition by killing off beneficial bacteria in the gut. Food requirements -- the need to take medications either on a full or an empty stomach or with specific types of food -- can disrupt normal eating patterns. Finally, some antiretroviral medications are associated with metabolic changes such as blood lipid and glucose abnormalities.

Inadequate intake: Ill people often experience anorexia. OI symptoms and medication side effects -- nausea, diarrhea, sore mouth or throat, altered sense of taste or smell -- can further reduce the desire or ability to eat. This may be compounded by lack of money, depression, or feeling too fatigued to shop and prepare food.

Altered nutritional requirements: By altering metabolism (how the body processes and uses nutrients), acute or chronic illness -- including HIV disease and OIs -- and the resulting immune response can increase the body's energy needs. People with HIV/AIDS may require more calories, macronutrients, and specific vitamins and minerals. Chronic illness may also alter hormone and cytokine levels, which may have nutritional implications.

Conversely, nutritional deficiencies can impair immune function, potentially worsening HIV disease progression. Research has shown that depletion of vitamins A, C, and E, the B-complex vitamins, and the minerals selenium and zinc can interfere with cell-mediated immunity (CD4 cell, natural killer cell, and neutrophil proliferation and activation), antibody production, and normal cytokine signaling.

Studies looking at the prevalence of nutritional deficiencies in people with HIV/AIDS have produced conflicting data, but on the whole, depletion of nutrients (e.g., vitamins A and E, and minerals including magnesium, selenium, and zinc) appears to be common, especially among individuals with advanced disease. In particular, having HIV seems to decrease the body's store of antioxidants, as they are needed to offset increased oxidative stress. Researchers have uncovered evidence of subtle nutritional deficiencies among people who appear to be eating an adequate diet and are not suffering from frank protein/calorie malnutrition.

Experts don't yet understand the clinical significance -- if any -- of subtle changes in laboratory values relative to the norms seen in the HIV negative population, nor do they know how much of any given nutrient people with HIV/AIDS need for optimal immune function and overall health. Due to a lack of research on nutritional status in the setting of HIV disease, and because nutritional requirements vary dramatically from person to person, there are few definitive recommendations for nutritional supplementation in the HIV positive population.

Waste Not, Want Not
Wasting -- also known as cachexia -- was a prominent feature of AIDS in the early years of the epidemic; even today, AIDS is referred to as "slim disease" in Africa. Experts define wasting as involuntary or unwanted loss of 10% or more of body weight. As Steven Grinspoon, MD, and Kathleen Mulligan, MD, discuss in an April 2003 special issue of Clinical Infectious Diseases (CID) devoted to nutrition and HIV, "wasting ... has been associated with increased mortality, accelerated disease progression, loss of muscle protein mass, and impairment of strength and functional status." Even a 5% loss has been linked to increased illness and death.
In classic HIV-related wasting, lost weight is in the form of lean body mass rather than fat, especially in men. People with HIV/AIDS (and other chronic illnesses) require more calories simply to maintain their weight, due to increased metabolism, higher energy demands, hormone and cytokine imbalances, inefficient absorption and utilization of nutrients, and/or accelerated tissue breakdown (catabolism).

While effective antiretroviral therapy has dramatically reduced the incidence of severe wasting, moderate weight loss is still a prominent feature of HIV disease. For example, as reported in the September 1, 2005 Journal of Acquired Immune Deficiency Syndromes (JAIDS), Alice Tang, MD, from Tufts University Medical School and colleagues found a steady increase in the rate of 5% or greater loss of body weight between 1995-1997 (pre-HAART) and 1998-2003 (HAART era). In an analysis of 713 HIV positive participants in the Nutrition for Healthy Living cohort, 53% lost at least 5% of their body weight during any six-month period. Weight loss was significantly associated with nausea, diarrhea, thrush, poverty, history of drug use, CD4 cell count below 200 cells/mm3, and HIV viral load above 100,000 copies/mL. The authors were unable to pinpoint the reasons for the increased rate of wasting in the HAART era.

In another study (reported in the October 15, 2005 issue of CID), Adriana Campa, PhD, from Florida International University and colleagues found that 17.6% of 119 HIV positive, mostly homeless drugs users in Miami showed evidence of HIV-related wasting. In this study, wasting was associated with cocaine and heavy alcohol use, "food insecurity" (not eating for one or more days in the past month), and higher HIV viral load. Participants taking HAART were more likely to experiencing wasting than those not receiving anti-HIV treatment (86% vs 67%).

Rather than dramatic whole-body weight loss, today many HIV positive people on HAART experience lipoatrophy, or fat loss in the face, limbs, and buttocks. Paradoxically, this may coincide with fat accumulation in other areas of the body (discussed below). Lipoatrophy is most strongly associated with use of nucleoside reverse transcriptase inhibitors (NRTIs), especially d4T (stavudine or Zerit). For this reason, U.S. government treatment guidelines no longer recommend d4T as part of a first-line regimen for people starting HAART.

Since HIV positive people and their clinicians may not recognize the early signs of wasting, it is important to monitor weight regularly to detect subtle changes. Underlying factors contributing to weight loss -- such as OIs or hormone imbalances -- should be promptly addressed. But, as Grinspoon and Mulligan point out, "no therapeutic guidelines currently exist for the management of weight loss and wasting in HIV-infected patients."

When it comes to weight loss, prevention is often easier than cure. To add calories, focus on proteins and complex carbohydrates rather than "junk food" that contains mostly sugar and fat. Consider eating several small meals and snacks throughout the day rather than two or three large meals. Nutritional supplements such as Ensure or Boost may benefit individuals who find it difficult to eat solid foods. Some cities offer food delivery programs for people with HIV/AIDS who are unable to shop or prepare meals (e.g., Project Open Hand in San Francisco, God's Love We Deliver in New York City, Moveable Feast in Baltimore).

The appetite stimulant megestrol acetate (Megace) tends to promote fat rather than muscle gain and can cause side effects including edema (swelling). Certain antidepressants and other medications may also enhance appetite. Some patients swear by medical cannabis or dronabinol (Marinol), a pill that contains a synthetic version of marijuana's active ingredient, THC.

While recombinant human growth hormone (HGH, Serostim) is FDA-approved for the treatment of HIV-related wasting, it is extremely expensive and can cause side effects including carpal tunnel syndrome, joint pain, and insulin resistance. Anabolic (muscle-building) steroids such as testosterone and oxandrolone (Oxandrin) help some patients gain weight, but can also cause adverse effects. Hormone replacement therapy is most useful for individuals who have low levels; there is little evidence that "supraphysiological" doses (higher than the natural physiological range) are beneficial, and they may be harmful (see "HIV and Hormones" in the Summer 2004 issue of BETA). Research has shown that anabolic steroids work better when combined with resistance exercise; in fact, some studies suggest resistance exercise works better than steroids, without the cost or side effects.

Weights and Measurements
Body weight alone is not the best indicator of body composition. Various other metrics can give a better sense of relative proportions of lean body mass and fat. Each method has its pros and cons; ask your healthcare provider which are most appropriate given your individual situation.

Body mass index (BMI): an equation that relates weight to height (weight in kilograms divided by height in meters squared). BMI below 18.5 indicates that a person is underweight; 18.5-24.9 is normal weight; 25.0-29.9 is overweight; and 30.0 or above is obese.

Waist-to-Hip Ratio: waist measurement (at the narrowest point) divided by hip measurement (at the widest point). Weight carried around the waist (an "apple" shape) is associated with greater cardiovascular risk than weight distributed around the hips and thighs (a "pear" shape). A healthy waist-to-hip ratio is below 0.9 for men or 0.8 for women. This measure may not be appropriate for HIV positive individuals with lipodystrophy.

Bioelectrical impedance analysis (BIA): a technique for determining body composition using a mild electrical current that travels more easily through muscle than fat.

Skinfold thickness: a technique that uses calipers to assess the amount of subcutaneous fat under the skin at multiple sites.

Hydrostatic weighing: a technique for assessing body density in which a person's weight measured when dry is compared to his or her underwater weight, accounting for residual air in the lungs and gastrointestinal tract.

Magnetic resonance imaging (MRI): a noninvasive method for viewing soft tissues of the body using a magnetic field.

Dual-energy X-ray absorptiometry (DEXA): an X-ray technique used to measure body composition, including proportion of fat and bone mineral density.

Computerized tomography (CT or CAT scans): a method of visualizing tissues of the body using X-rays.

Too Much of a Good Thing
For many HIV positive people in the developing world today, severe overall wasting due to protein/calorie malnutrition is not a major concern. In fact, some research suggests obesity may be a bigger problem. For example, Valerianna Amorosa, MD, and colleagues from the University of Philadelphia reported in the August 15, 2005 issue of JAIDS that in a cohort of nearly 1,700 HIV positive individuals, 31% of men and 30% of women were overweight, and 11% and 28%, respectively, were obese (in contrast, just 9% overall experienced wasting). Obesity was not associated with age, income, employment status, education, history of injection drug use, HIV treatment, or viral load, but in women it was more common among African-Americans. In Tang's study discussed above, the proportion of patients categorized as overweight was greater in the HAART era than before the advent of effective antiretroviral therapy (35% vs 30%). And HIV positive people are hardly alone: the National Center for Health Statistics reports that two-thirds of all Americans are overweight and nearly one-third of adults are obese -- double the proportion in 1980.
While "garden variety" obesity remains common, HIV positive people on HAART may also experience accumulation of fat in specific areas of the body including the belly, breasts, and back of the neck ("buffalo hump"). This abdominal or truncal lipohypertrophy is composed of deep visceral fat surrounding the internal organs. Both lipoatrophy (described above) and lipohypertrophy are features of lipodystrophy syndrome; however, as discussed in an article by Denise Jacobson, PhD, and colleagues from Tufts in the June 15, 2005 issue of CID, experts now recognize that these are two distinct processes, not simply redistribution of fat from one area to another.

Lipodystrophy syndrome also includes elevated blood lipid levels and blood glucose abnormalities (see "Insulin Resistance and Diabetes" in the Winter 2004 issue of BETA). While most research indicates that lipodystrophy is associated with antiretroviral therapy -- in particular protease inhibitors (PIs) -- it is likely a multifactorial condition related to long-term HIV infection or immune reconstitution, since some people who develop the syndrome have never taken HAART. In a recent study by Peter Bacchetti, PhD, and colleagues, for example, abdominal fat accumulation was not linked to HAART, and was actually more common among HIV negative than HIV positive men (see "News Briefs," in this issue.)

Obesity, and in particular visceral abdominal fat, has been linked to increased risk of cardiovascular disease in the general population. While it is still uncertain whether HIV positive people on HAART have higher rates of heart attacks and strokes (studies have yielded mixed data), it is likely that traditional cardiovascular risk factors -- advancing age, male sex, cigarette smoking, high LDL cholesterol and triglyceride levels, insulin resistance, elevated blood pressure, and being overweight -- are as important for HIV positive people as for anyone else (see "Cardiovascular Disease in People with HIV" in the Summer/Autumn 2002 issue of BETA).

While early nutritional guidelines for people with AIDS often emphasized packing on the calories -- adding cream, cheese, peanut butter, gravy, and the like to foods -- many HIV positive people today would be better served by adopting a balanced, low-fat diet.

Lifestyle changes, including diet modification, weight loss (if needed), exercise, and smoking cessation, are the first line of defense against cardiovascular disease. In order to lose weight, HIV positive people must follow the same rules as everyone else: burn more calories than one takes in. But reducing the amount of fat and cholesterol in the diet is not always enough to reverse fat accumulation or bring blood lipids within a healthy range, and exercise may not have much effect on visceral fat. When this is the case, lipid-lowering medications (including the statin and fibrate classes) are often used. Altering one's antiretroviral regimen to include drugs less linked to high blood fat -- such as substituting atazanavir (Reyataz) for another PI -- is often effective. Researchers have tried treating lipodystrophy with human growth hormone and anabolic steroids, with mixed results. Although it is not yet clear what are the best interventions to address increased cardiovascular risk among HIV positive people on HAART, experts agree that a healthy diet certainly can't hurt, and is likely to be part of the solution.

Healthy Diet Basics
A healthy diet provides adequate nutrition without a lot of empty calories. "Balanced" means eating a variety of foods from all the important food groups, since no food alone provides all the nutrients the body needs. The traditional Food Guide Pyramind offers guidelines about how much to eat from each food group. (The traditional food pyramid was replaced in 2005 with a new pyramid, an online tool at www.MyPyramid.com. Because the new pyramid is more difficult to interpret, however, many nutrition experts continue to use the traditional version.) It recommends 6-11 servings per day of grain products such as bread, cereal, rice, and pasta; 3-5 servings of vegetables; 2-4 servings of fruit; 2-3 servings of dairy products such as milk, yogurt, and cheese; 2-3 servings of high-protein foods such as meat, poultry, fish, eggs, and legumes; and small amounts of fat, oil, and sugar.
This may seem like a lot, but a "serving" is smaller than many people realize. A "serving" as per the guidelines would be, for example, a 3-ounce portion of cooked meat (about the size of a deck of playing cards), one chicken leg, a 2-inch cube of cheese, an 8-ounce glass of milk, a single tortilla or slice of bread, 5-6 crackers, one-third cup of cooked pasta, one-half cup of cooked vegetables, or one medium-size apple or orange. The amount of food typically served in restaurants, therefore, actually accounts for multiple "servings."

The 2005 revision of the food pyramid focuses less on quantity and more on quality, while also emphasizing the importance of physical activity. At least half of one's daily consumption of bread and cereal products should be comprised of whole grains; as a rule, less processed foods contain more nutrients. Simple carbohydrates tend to make blood glucose spike soon after eating and then fall, while complex carbohydrates tend to promote more stable levels over time. But what really matters is a food's "glycemic index," a measure of how quickly it is broken down in the body. Foods with a high glycemic index are broken down rapidly, causing blood sugar to rise sharply, while low glycemic index foods help the body maintain a steadier glucose level.

Eat vegetables of various colors -- including dark green and deep orange -- since these contain different vitamins, minerals, and phytochemicals. Whole fruit is preferable to juice, which is high in sugar and calories and typically lacks fiber. Since cooking can destroy vitamins, it is usually recommended to eat vegetables raw or lightly steamed. However, this may not be the best advice for people with severely compromised immunity who are at risk of infection with microorganisms that can be killed by cooking.

In the dairy group, select low-fat or non-fat products. People who choose not to consume dairy foods should be sure to obtain enough calcium from other sources. In the protein group, the new pyramid recommends eating more legumes, nuts, seeds, and fish -- which contains heart-healthy omega-3 fatty acids. When eating meat or poultry, remove visible fat and skin. Broiling, baking, and grilling are healthier cooking methods than frying.

In terms of fats, avoid animal-derived fats and chemically altered hydrogenated oils, instead substituting plant-derived monounsaturated and polyunsaturated oils. This is good advice even for people who do not need to lose (or could stand to gain) weight, since animal fats increase the risk of cardiovascular disease. Fortunately, thanks to consumer demand, it is easier than ever to find commercial baked goods, snack foods, salad dressings, and the like that do not contain saturated fats. Another boon for the heart: a low-sodium diet can help keep blood pressure under control.

In addition to eating a balanced diet, it is also important to consume enough fluids. Experts traditionally recommend eight 8-ounce glasses of water per day. Herbal tea, broth, and fruit or vegetable juices can also be good fluid sources. But beverages that contain caffeine or alcohol have a diuretic effect, and can cause loss of water due to increased urination. It is especially important to drink enough fluid to prevent dehydration when suffering prolonged vomiting or diarrhea. People with very low CD4 cell counts concerned about infections such as cryptosporidiosis due to contaminated tap water should use filtered or bottled water.

Facts Versus Fads
The traditional dietary guidelines are not free of controversy. Some critics contend that in putting together the recommendations, the federal government has been unduly influenced by the food industry. They argue, for example, that adults really do not need to consume cow's milk at all. Some believe the pyramid recommends more protein than most people need, while others argue that humans evolved to eat a "hunter-gatherer" diet much lower in carbohydrates.
"Low carb" diets (related to the Atkins plan) containing small amounts of carbohydrates and larger amounts of protein and fat have gained considerable popularity in recent years -- so much so that many people have come to believe that carbohydrates per se are "fattening." While such diets may produce temporary weight loss, they are usually short on fiber, can stress the liver and kidneys, and may lead to dangerously elevated blood lipid levels.

More people are also adopting vegetarian or vegan diets, which have been linked to reduced risk of cardiovascular disease and cancer. Most people can obtain adequate nutrition from a diet that contains little or no meat or other animal products, though this may be more challenging for growing children or people with chronic illness who have increased energy needs. The trick is to learn how to combine proteins from different sources (such as grains, legumes, nuts, and soy) to obtain a full complement of essential amino acids; vitamin B12 supplementation may also be needed.

An increasing number of healthcare providers now recommend a "Mediterranean diet" -- including olive oil, tomatoes, garlic, and red wine -- since people from areas that consume such a diet tend to have lower rates of heart disease. A Japanese-style diet that contains lots of fish and soy products is also a healthy option.

Notwithstanding these caveats, the consensus recommendation to eat a range of foods from a variety of categories remains sound. Most experts suggest a breakdown of about 50-60% carbohydrates, 15-20% protein, and no more than 25-30% fat. But because individual nutritional needs vary widely, it is difficult to recommend a specific diet suitable for all people with HIV/AIDS. A trained dietitian who has experience working with HIV positive people can help devise an appropriate individualized eating plan.

Learn how to read the "Nutrition Facts" label, which contains a wealth of information about the nutritional content of packaged foods: www.cfsan.fda.gov/~dms/foodlab.html.

What About Supplements?
As a rule, it's usually best to obtain nutrients from food. Swallowing handfuls of pills will not make up for a poor diet. But even HIV positive people who eat well can have low levels of various important nutrients -- at a time when their nutritional needs may be increased -- and thus may benefit from supplementation. The U.S. government's Daily Values (formerly known as Recommended Dietary Allowances) for nutrients do not necessarily reflect the amount required for optimal health, just the minimum needed to stave off deficiency symptoms in the average healthy person. It is not yet known whether accepted recommended nutrient levels for the general population are adequate for people with HIV/AIDS.
Dietary supplements are products such as vitamins, minerals, amino acids, herbs, and antioxidants; they are usually taken orally in the form of tablets, capsules, powders, or liquids. Due to the lack of strict quality control and labeling requirements, marketed products can vary widely in contents, strength, and purity. Although regulated by the U.S. Food and Drug Administration (FDA), supplements do not need to undergo rigorous clinical trials of safety and efficacy as required for approval of pharmaceutical drugs. In fact -- because there is little financial incentive to spend money developing products that cannot be patented -- there have been few rigorous, controlled studies on the use of nutritional supplements in people with HIV.

In the mid-1980s, Barbara Abrams, DrPH, and colleagues from the University of California at Berkeley began a large observational study of dietary intake in 296 HIV positive men; results were reported in the August 1993 issue of JAIDS. By one measure, the risk of developing AIDS decreased as consumption of 11 different micronutrients increased -- significantly so for riboflavin, vitamin E, and iron, and approaching significance for thiamin, niacin, and vitamin C. This study was susceptible to selection bias, however, since people who ate healthier diets or took supplements might have had healthier lifestyles overall.

More recently, researchers in Thailand showed that a low-cost multivitamin and mineral supplement improved the survival of HIV positive people who were not taking HAART. As reported in the November 21, 2003 issue of AIDS, Sukhum Jiamton, MD, and colleagues conducted a double-blind, placebo-controlled trial in which nearly 500 HIV positive individuals with CD4 cell counts of 50-550 cells/mm3 were randomly assigned to receive either a placebo or a supplement containing 12 vitamins, eight minerals, and the amino acid cysteine twice daily. After 48 weeks, about twice as many people died in the placebo arm compared with the supplement arm (15 vs 8 deaths); among those with baseline CD4 counts below 200 cells/mm3, the mortality rate was significantly lower in the supplement arm. On the other hand, an earlier study in Zambia found that multivitamin supplementation had no effect on CD4 cell count or mortality.

In the July 1, 2004 New England Journal of Medicine, Wafaie Fawzi, DrPH, from Harvard School of Public Health and colleagues reported on a double-blind, placebo-controlled study in which 1,078 HIV positive pregnant women in Tanzania received either daily supplements of vitamin A; a multivitamin supplement containing vitamins B, C, and E; or both. After a median follow-up of 71 months, 67 out of 271 women (24.7%) who received the multivitamin either died or progressed to advanced HIV disease (stage IV as defined by the World Health Organization), compared with 83 out of 267 women (31.1%) who received the placebo. Women in the multivitamin arm -- but not those receiving vitamin A alone -- also had significantly lower HIV viral load, higher CD4 and CD8 cell counts, and improved birth outcomes.

In a June 10, 2005 AIDS editorial reviewing the current state of knowledge about micronutrient supplementation in people with HIV/AIDS, Tang and colleagues concluded that "a combination of vitamins may afford some benefits to undernourished HIV-infected populations, particularly those with more advanced disease," but conceded that "the role of individual micronutrients ... is less clear." Most healthcare providers agree that HIV positive people can benefit from a daily multivitamin and mineral supplement. (Due to the potential harmful effects of iron, many recommend an iron-free supplement for anyone other than menstruating women and people with iron deficiency). But when it comes to specific nutrients, expert opinion -- and the little relevant research conducted to date -- remains sharply divided.

Higher amounts of various substances have been proposed to improve immune response, ameliorate symptoms and drug side effects, and slow HIV disease progression, on the basis of theoretical understandings about how an agent is expected to behave, laboratory research looking at the effects of a substance in vitro, cross-sectional studies showing specific nutritional deficiencies in a population, or -- less commonly -- controlled trials. Several nutrients that have received the most attention with regard to HIV/AIDS are discussed below.

"[A]ddressing obesity is likely to become an increasingly common part of the management of HIV infection."

-- David Wohl, MD

Vitamin A
Richard Semba, MD, from Johns Hopkins and colleagues reported in 1993 that among a cohort of 179 HIV positive and HIV negative injection drug users in Baltimore, vitamin A deficiency was linked to lower CD4 cell counts and increased risk of mortality. Two years later, he reported that vitamin A deficiency among pregnant HIV positive women in Malawi was associated with increased risk of mother-to-child HIV transmission (32% among deficient women vs 7% among women with normal levels) and higher infant mortality. Similarly, a U.S. study found that vitamin A-deficient women were about five times more likely to transmit HIV to their babies. Some studies have found vitamin A deficiency to be associated with greater vaginal shedding of HIV and higher levels of virus in breast milk -- although Fawzi's study described above actually found a significantly higher rate of mother-to-child transmission via breast-feeding in women given vitamin A supplements.
Several large controlled studies looking at supplementation with vitamin A or beta-carotene (a vitamin A precursor) for HIV positive pregnant women in parts of Africa where frank deficiency is common, however, have failed to detect decreased rates of mother-to-child transmission; results have been mixed concerning reductions in miscarriages, premature births, and infant morbidity and mortality. In Fawzi's Tanzanian study, vitamin A alone did not produce outcomes significantly different from those seen in the placebo arm, and adding vitamin A to the multivitamin seemed to reduce its beneficial effects. Since the benefits are unclear and high doses can cause liver toxicity and other problems, most experts do not recommend vitamin A supplementation -- beyond the amount found in a typical multivitamin pill -- for people with HIV/AIDS.

Vitamin C
In laboratory studies, vitamin C has been shown to inhibit viral replication in vitro; it also plays an important role in tissue repair. Thus, it is not surprising that megadoses of this vitamin have been touted as a cure for everything from the common cold to cancer to HIV/AIDS. Controlled clinical trials comparing vitamin C to placebo for the treatment of colds and flus have yielded mixed results, and the data have been even less promising concerning HIV disease. While vitamin C deficiency does appear to impair various aspects of the immune response, research has not provided evidence that supplementation delays HIV disease progression or improves survival.

Vitamin E
Vitamin E plays a role in metabolism and proper immune function, and laboratory studies suggest it has an antiviral effect. For example, Alonso Heredia, PhD, from the University of Maryland and colleagues reported in the May 20, 2005 issue of AIDS that addition of vitamin E to cell cultures from 10 HIV positive individuals significantly reduced HIV production, as indicated by p24 antigen levels. The authors suggested that supplementation might slow HIV replication enough to inhibit the emergence of drug-resistant virus in resting cells and to delay viral rebound after treatment interruption. But while low (or decreasing) levels of vitamin E have been linked to CD4 cell declines and HIV disease progression, this does not imply causality.
The jury is still out on the benefits and risks of high-dose vitamin E supplementation, but data from recent large studies in the HIV negative population do not look good. In the Women's Health Study (a primary prevention trial that included nearly 40,000 healthy, HIV negative women), subjects randomly assigned to receive 600 IU of vitamin E every other day not only did not have reduced rates of cancer or cardiovascular disease relative to women in the placebo arm, but actually showed a nonsignificant increase in total mortality. Results of a meta-analysis of 19 clinical trials with a total of nearly 136,000 subjects published in the January 4, 2004 Annals of Internal Medicine led authors Edgar Miller, MD, and colleagues to conclude that, "High-dosage [400 IU or more daily] vitamin E supplements may increase all-cause mortality and should be avoided." In the absence of large controlled studies in the HIV positive population, the same advice is sound for people with HIV/AIDS as well.

Selenium
The trace element selenium -- also known to play a role in proper immune function -- has received considerable attention as a treatment for HIV/AIDS and a variety of other diseases. Some in vitro research indicates that HIV requires selenium in order to replicate. A study of 125 HIV positive injection drug users by Marianna Baum, PhD, and colleagues from the University of Miami (published in 1997) revealed that after adjusting for various factors including CD4 cell count, selenium deficiency was significantly associated with increased mortality. "When all nutrient factors that are associated with survival are considered together," Baum concluded in a later review article, "only selenium deficiency is a significant predictor of mortality." And in a study of 670 HIV positive pregnant women in Tanzania (reported in the June 1, 2005 issue of JAIDS), Roland Kupka, DSc, from Harvard School of Public Health and colleagues found that low plasma selenium levels were associated with increased risk of miscarriage, infant death, and mother-to-child HIV transmission.
But the fact that low selenium levels are linked to worse disease progression does not necessarily mean supplementation will improve matters. HIV nutrition expert Mary Romeyn, MD, has reported anecdotal evidence that selenium supplementation leads to clearance of thrush. On the other hand, while low selenium levels were linked to increased likelihood of cervical dysplasia (precancerous cell changes) among HIV positive women in one study, selenium supplements did not reduce the risk.

And, as reported in the December 15, 2004 issue of JAIDS, Scott McClellend, MD, from the University of Washington and colleagues found that in a study of 400 nonpregnant HIV positive women in Kenya, supplementation with a multivitamin plus selenium led to increased vaginal shedding of HIV, which has implications for sexual and perinatal transmission. Among women who started out with normal selenium levels, those who received supplements were more than twice as likely to shed HIV in their vaginal secretions and had higher vaginal HIV viral loads than women who received a placebo; a similar effect was not seen, however, in selenium-deficient women brought up to normal levels. While supplementation resulted in higher CD4 and CD8 cell counts, the authors concluded that, "The potential benefit of micronutrient supplementation in HIV-1-seropositive women should be considered in relation to the potential for increased infectivity."

Zinc
Zinc deficiency has been linked to impaired immune function and supplementation has been suggested as a treatment for people with HIV/AIDS, but studies to date have produced conflicting results. While some suggest that zinc enhances the body's ability to fight HIV and improves disease symptoms, others have found it has a detrimental effect. In one study of injection drug users, lower zinc levels were associated with reduced CD4 cell counts, but this does not necessarily mean one caused the other. In an early nutritional survey of nearly 300 HIV positive men followed for seven years, high doses of zinc were associated with faster HIV disease progression. Some researchers have hypothesized that this may be related to the fact that HIV requires zinc-containing structures called "zinc fingers" to produce functional viral progeny.
More recently, Raziya Bobat, MD, and colleagues reported in the November 26, 2005 issue of The Lancet that in a randomized, placebo-controlled trial of 96 HIV positive South African children aged six months to five years, zinc supplementation for six months reduced the incidence of diarrhea and pneumonia, and did not appear to promote viral replication. Given the degree of uncertainty, most experts do not recommend zinc supplementation beyond the amount contained in a multivitamin and mineral pill.

Antioxidants
Vitamin C, vitamin E, selenium, and zinc act as antioxidants, helping prevent cell damage caused by highly reactive free radicals (oxidative stress). While free radicals play a role in immune defense against invading pathogens, they can also harm surrounding cells. Research has shown that people with HIV and other chronic infections have higher levels of free radicals, which promote viral replication. Conversely, antioxidants appear to reduce oxidative stress, inhibit HIV activity, and possibly slow HIV disease progression. Antioxidants may also reduce liver fibrosis in people with hepatitis B or C and protect the liver from toxicity as it metabolizes drugs.
The body manufactures certain antioxidants as needed, but this process requires adequate amounts of several nutrients. Studies suggest that a major intracellular antioxidant, glutathione, may help reduce the rate of HIV disease progression. Nutrients that help raise glutathione levels include selenium, alpha-lipoic acid, N-acetyl-cysteine (NAC), acetyl-L-carnitine, L-glutamine, and coenzyme Q10. In one small study, high-dose NAC supplementation led to decreased HIV viral load. There have been several case reports and small studies in which supplementation with antioxidants or precursors including NAC, acetyl-L-carnitine, and coenzyme Q10 seemed to counter lactic acidosis (a sign of mitochondrial toxicity) related to antiretroviral therapy. What's more, Andrew Hart, MD, and colleagues from the Royal Free and University College Medical School reported in the July 23, 2004 issue of AIDS that acetyl-L-carnitine supplements helped reverse nerve damage and alleviated the pain of peripheral neuropathy associated with certain NRTI drugs.

But antioxidant supplements may also have deleterious effects. In a small pilot study by Grace McComsey, MD, and colleagues from Case Western Reserve University (reported in the August 15, 2003 issue of JAIDS), while supplementation with vitamin C, vitamin E, and NAC slightly reduced elevated LDL cholesterol levels and abdominal fat accumulation in 10 subjects with HIV-related lipodystrophy, the antioxidants also raised blood glucose levels and worsened insulin resistance. "We should never assume that high doses of vitamins are safe," the authors cautioned. "They are not safe until clinical studies prove them to be safe."

Omega-3 Fatty Acids
Omega-3 fatty acids, found in cold-water fish such as salmon and herring, have been associated with reduced cardiovascular disease risk in the general population; one study of more than 4,700 adults over age 65 showed that eating fish 3-4 times per week was associated with a 30% reduction in congestive heart failure. In the November 15 issue of CID, David Wohl, MD, from the University of North Carolina at Chapel Hill and colleagues reported that omega-3 may also help address one cardiovascular risk factor in people with HIV/AIDS. In this open-label study, 52 HIV positive individuals on HAART with fasting triglyceride levels above 200 mg/dL were randomly assigned to receive either omega-3 fish oil supplements (eicosapentaenoic acid and docosahexaemoic acid) plus nutritional counseling or else nutritional counseling alone. After 16 weeks, subjects receiving fish oil supplements experienced a 19.5% reduction in fasting triglyceride levels, compared with a 5.7% decrease in the counseling-only arm (though seemingly substantial, this difference was not statistically significant). However, LDL cholesterol levels increased by 22.4% in the fish oil arm, while remaining stable in the counseling-only arm; HDL levels did not change in either group. The authors acknowledged that "whether this increase [in LDL] attenuates any benefit in lowering triglyceride levels is unclear."

Special Supplements
Various functional supplements have been developed to augment levels of particular compounds thought to have specific beneficial effects. For example, two small studies presented at the 7th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV in November 2005 showed that a supplement called NucleomaxX -- a sugar cane extract containing the nucleoside uridine -- helped reverse lipoatrophy in individuals taking NRTIs. Jussi Sutinen, MD, and colleagues from Finland reported than in a study of 20 patients taking d4T or AZT (zidovudine, Retrovir), those taking NucleomaxX three times daily for 10 days gained significantly more arm and leg fat (about 900 grams) than subjects taking placebo; the NucleomaxX group also gained visceral abdominal fat. Likewise, McComsey reported that both patients and their physicians reported significant improvement in lipoatrophy in a study of 14 subjects taking d4T who received NucleomaxX three times daily every other day for 16 weeks. (An open-label Phase II study of NucleomaxX for lipoatrophy is currently enrolling; see "Open Clinical Trials," in this issue).

Good Nutrition is Not a Cure for HIV
While supplementing a range of micronutrients may contribute to improved health, this is not to suggest that nutritional supplements alone can take the place of HAART. A few years ago, South African Health Minister Manto Tshabalala-Msimang raised a furor when she suggested that people with HIV/AIDS should consume garlic, lemon, and olive oil, while her government was resisting efforts to expand access to antiretroviral therapy. This past May, UNAIDS director Peter Piot, MD, blasted vitamin entrepreneur Matthias Rath, who placed ads in South African newspapers promoting vitamins as a treatment for AIDS, claiming that antiretroviral drugs are toxic and cause birth defects. "Vitamins are no cure or treatment for AIDS," stated Piot, "and anybody who claims the contrary is a charlatan."

Nevertheless, according to World Health Organization Director-General Jong-Wook Lee, greater attention must be paid to the nutritional needs of people with HIV/AIDS in the developing world. "We do know that sound nutrition helps maintain the immune system, increases body weight, and boosts energy levels," he said at an April conference in Durban. "Most of the 30 million HIV-infected people in Africa don't even have secure access to the basic nutrients any human being needs to live a healthy life."

More Is Not Always Better
With all this conflicting data, it can be difficult for HIV positive people to make informed decisions about supplements. The bottom line, according to Judith Nerad, Mary Romeyn, and colleagues in the April 2003 CID special issue: "[T]here is little documentation in the literature that supplementation beyond what is recommended has had any impact on clinical outcome." But, "[i]f a patient's vitamin or mineral status is deficient, supplementation is clearly necessary."
People with HIV/AIDS commonly have subtle nutritional deficiencies, and research to date has shown that daily multivitamin use is safe and at least potentially beneficial in this population. Different experts have suggested various supplementation regimens. For example, Romeyn -- in her book Nutrition and HIV: A New Model for Treatment -- suggests a basic regimen that includes:

a multivitamin, without extra iron, twice daily;

a trace element supplement once daily;

an antioxidant supplement once daily.
Others, such as nutritionist Margaret Davis, RD, recommend only the multivitamin, plus increased consumption of fruits and vegetables.

As previously noted, nutritional needs vary widely from person to person, and there is no one diet or supplement regimen appropriate for all people with HIV/AIDS. Further, the presence of a nutrient deficiency does not necessarily mean supplementation is the solution, since poor absorption, underlying infections, metabolic changes, or hormone imbalances could be contributing to the problem.

When using supplements, do not take more than the recommended dose on the label unless advised to do so by a knowledgeable healthcare provider. As some of the studies discussed above illustrate, more is not necessarily better. A recent case underscores this warning. As reported in the September 2005 International Journal of STD and AIDS, an HIV positive man in London developed severe liver inflammation with skyrocketing ALT levels after taking more than a dozen dietary supplements, many at high doses -- as much as 67 times the recommended daily value; fortunately, once he stopped taking the supplements, his liver function returned to normal.

Certain vitamins and minerals (including the fat-soluble vitamins A, D, and E) can be toxic at high doses, and they may cause deleterious effects even at lower doses beyond what is provided in a typical multivitamin pill. Remember that "natural" does not necessarily mean "safe." Beware of any supplement touted as a "cure" for a range of ailments -- if something sounds too good to be true, it probably is. Verify that health claims are supported by reliable research. Some supplements may not be harmful, but simply a waste of money. Seek medical advice before starting a new supplement or beginning any unusual diet. Tell healthcare providers about any use of supplements (as well as over-the-counter medications, recreational drugs, and herbal remedies), since these can potentially interact with antiretroviral drugs.

Eat Right for Life
Nutritional management should be a regular part of HIV/AIDS care. Even if an HIV positive person has no obvious nutritional problems such as wasting, a healthy diet can still help stave off illness and improve quality of life. But, as Tang and colleagues noted in their review, dealing with nutritional issues "may not be part of the traditional care or thought process of the HIV care provider." A registered dietitian (RD) who has experience working with people with HIV/AIDS can be an invaluable resource.
The American Dietetic Association recommends a baseline nutritional and body composition assessment soon after HIV diagnosis. Follow-up assessments should be conducted at least once annually for asymptomatic individuals with well-controlled HIV disease, and every few months for patients with AIDS or known nutritional problems. Tasmin Knox, MD, from Tufts recommends anthropometric measurements of body composition (see "Weights and Measurements" above for an explanation of various methods); laboratory tests of protein and micronutrient levels in the blood; tests of metabolic parameters such as blood lipids, blood glucose, and liver enzymes; and clinical assessment of eating patterns, supplement use, functional status, physical symptoms, and psychological or socioeconomic issues that may impede adequate nutrient intake. Some experts recommend that people keep a daily diary of everything they eat, along with any dietary problems they encounter.

Once such an assessment is complete, promptly address any underlying problems -- such as infections, hormone imbalances, or metabolic disorders -- that may be interfering with proper nutrition. The next step is to develop an appropriate, individualized nutrition plan. Seniors, growing children, pregnant or breast-feeding women, and people with active OIs are among the many groups that have special nutritional needs. While supplements can offer important benefits, they do not replace a well-balanced diet. When it comes to good nutrition, there is no "quick fix." It's better to develop long-term healthy eating habits, such as cutting back on saturated fat and consuming more fruits, vegetables, and whole grains. But set realistic goals: it's fine to splurge occasionally if one normally adheres to a healthy diet. Fortunately, small changes in eating habits can often make a big difference in terms of health.

Since many people with HIV/AIDS use dietary supplements in addition to HAART, it's crucial to learn more about how nutritional supplementation impacts HIV disease and vice versa. According to Tang and colleagues, areas ripe for further research include the role of micronutrient supplementation in people with well-controlled HIV disease, whether micronutrients can enhance CD4 cell responses, the role of antioxidants in countering increased oxidative stress due to HIV infection or its treatment, whether micronutrient supplementation can help reduce morbidity associated with coinfections such as hepatitis B or C, the role supplements might play in addressing metabolic manifestation such as lipodystrophy and bone loss, and the appropriate doses of supplements for HIV positive people at various stages of disease.

"Attempts to improve dietary quality and micronutrient status may play an overall role in maximizing health for the HIV-infected individual, particularly in undernourished populations," Tang and colleagues concluded, "and may also play a role in the more subtle management of HIV infection in the future."

Liz Highleyman (liz@black-rose.com) is a freelance medical writer and editor based in San Francisco.

The Sydney Declaration: Good Research Drives Good Policy and Programming - A Call to Scale Up Research

2007-08-07T09:09:00.000-07:00

Source: http://www.iasociety.org/Default.aspx?pageId=63

4th IAS Conference on Pathogenesis, Treatment and Prevention
22 – 25 July 2007
Sydney, Australia

Ten per cent of all resources dedicated to HIV programming should be used for research towards optimizing interventions utilized and health outcomes achieved.

The evolution of HIV prevention, treatment, and care over the past quarter century is one of the great successes of medical science. Committed and sustained research efforts have provided the evidence on which approaches to programming are based. These same scientific efforts are now resulting in new prevention technologies and drugs, and new strategies to manage and deliver both. Good research drives good policy.

In recent years resources have dramatically increased for delivery of existing interventions in resource-limited settings. Although funding remains insufficient to meet the increasing need for services, it is imperative that the global community does not lose sight of the future while responding to the immediate crisis. An effective response to HIV/AIDS requires a sustained commitment to ensure that interventions and approaches to service delivery are continuously improved over time. For example, as current first-line antiretroviral regimens become increasingly available in resource-limited settings, there is an urgent need to identify optimum, durable, and well-tolerated standardised first-line and second-line regimens, and to monitor and respond to resistance patterns as they emerge. Outcomes will not necessarily be the same in diverse settings across the globe.

Operations research is critical, in addition to basic, clinical, prevention, social, and policy research. We must identify which approaches are effective in the field, which are not, and why. We must also learn how to integrate HIV-specific services with primary, tuberculosis, malaria, prenatal and postnatal, and sexual and reproductive health services. None of these services have been as effectively linked to scale-up of HIV programming as is possible or necessary. Furthermore, greater understanding of the social, political, and cultural barriers that perpetuate stigma and discrimination can contribute to ensuring that governments act in the interests of public health.

Operations research will enable rapid implementation of new technologies to prevent, diagnose, and treat HIV infection, and can help to ensure that health systems are strengthened as a result of scaling-up HIV prevention, treatment, and care. Unfortunately, few granting agencies or national health budgets commit designated funds to operations research, and where such funding is available, it is often underused. The Global Fund to Fight AIDS, Tuberculosis and Malaria, for example, allows up to 10% of each grant to be allocated for operations research, but this provision is rarely used by countries and the research community is rarely represented on Country Coordinating Mechanisms (CCMs). The lack of participation on CCMs further reduces the likelihood that operations research will be a priority in funding applications.

An ancillary benefit of integrating research into the overall approach to scale-up in the developing world will be an expanding cadre of health-care workers trained in research methodologies and practice. Such research should not be seen as an additional burden on the various funding bodies or ministries of health but, on the contrary, as the only means by which we can refine our understanding of what is and is not effective.

Last but not least, all areas of research can further strengthen the efforts of the global AIDS community to confront the absurd theories of AIDS denialists as well as the “magic” cures that continue to confuse policymakers, health-care professionals, and communities of people at risk of and living with HIV/AIDS throughout the world. HIV professionals must continuously build on the evidence base to ensure sound and effective policies and practices in HIV/AIDS prevention, treatment, and care.

The undersigned individuals and organisations call on national governments and bilateral, multilateral, and private donors to allocate 10% of all resources for HIV programming to research. We believe that without such funding we will fail to maintain a sustained and effective response to the AIDS pandemic.

Million more AIDS deaths forecast in South Africa by 2010

2007-08-07T08:58:00.000-07:00

Source : http://www.aidsmap.com/en/news/B18F5362-0F97-4EC0-804B-C240271CD21D.asp

Keith Alcorn, Tuesday, June 19, 2007

Even the fastest rate of treatment scale up in South Africa will be unable to prevent around one million AIDS deaths between now and 2010, according to projections from Massachusetts General Hospital presented on Saturday at the HIV Implenters’ Meeting in Kigali, Rwanda.

The study, carried out by Rochelle Walensky of Brigham and Women’s Hospital, and Mariam Fofana of Massachusetts General Hospital, Boston, modeled the effects of four different rates of treatment expansion in South Africa between now and 2010.

The first scenario, zero growth, assumed that treatment availability would grow at the same rate as it has done over the past two to three years.

The second scenario, constant growth, assumed an acceleration beyond current levels of growth, such that treatment would be available for 65% of those who need it by 2010 – a rate broadly in line with the stated aims of South Africa’s National Strategic Plan on AIDS, agreed earlier this year.

Two more rapid rates of growth were also modeled – one rate at which expansion of treatment services would make ART available to 80% by 2009/2010, and another rate, in which treatment would expand even more rapidly, and would reach 70-80% during 2008 and 90-100% by 2010.

Expansion of treatment at the rate demanded by South Africa’s National Strategic Plan for 2008-2011 - the constant rate of growth - will fail to prevent a larger number of deaths – 300,000 in 2010 alone.

The model makes a number of assumptions, based on treatment outcomes from South African cohorts. It assumes that 84% of those on treatment will have undetectable viral load after 48 weeks on treatment, with an average CD4 cell count of 184 cells/mm3. If adherence is poorer and second-line treatment is not affordable for everyone, death rates could be higher.

On second-line treatment, the model assumes that 70% will achieve undetectable viral load. Again, if this is not attainable due to inappropriate treatment or poor adherence, death rates could be higher.

When the model was adjusted in order to take into account the effect of starting people on treatment at a CD4 cell count of 200 cells/mm3, rather than on the basis of symptoms, the death rate was substantially reduced.

The worst-case scenario – no growth in the rate of new treatment slots available, and no use of CD4 cell counting to determine treatment eligibility – could result in 2.19 million deaths from AIDS in the end of 2010 in South Africa.

The best-case scenario – rapid scale-up that would reach 90-100% of those in need, with treatment eligibility determined by CD4 cell count – would still result in 1.16 million AIDS deaths by the end of 2010, according to the model.

“It’s very sobering that even if you get the most rapid scale-up, South Africa will still face more than one million deaths by 2010,” said Dr Kevin de Cock, head of the World Health Organization’s HIV department.

“The rapid growth scenario is probably quite unrealistic, but we wanted to show the consequences of the zero or constant growth scenarios,” said Mariam Folama, presenting the results.

Findings presented at the Third South African AIDS Conference earlier this month suggest that even the ‘constant’ rate of growth may be unachievable without significant improvements in recruitment of health care workers.

A full analysis of the model will not be released until publication in a peer-reviewed journal (a policy of Boston University), which hampers full appreciation of the policy implications of the findings. This is regrettable given the stated objective of the study, which was to highlight the human consequences of different rates of treatment scale-up in South Africa.

Reference

Walensky R, Fofana M. Antiretroviral treatment rollout in South Africa: alternative scenarios and outcomes. HIV Implementers’ Meeting, Kigali, Rwanda, abstract 1755, 2007.

Brazilian President Silva Issues Compulsory License for Merck's Antiretroviral Efavirenz

2007-08-07T08:47:00.000-07:00

Source : The body - http://www.thebody.com/content/art40865.html

Henry J. Kaiser Family Foundation • International News

May 7, 2007

Brazilian President Luiz Inacio Lula da Silva on Friday issued a compulsory license to produce a lower-cost, generic version of Merck's antiretroviral Efavirenz, the AP/Forbes reports (Sequera, AP/Forbes, 5/4). World Trade Organization regulations allow governments to declare a "national emergency" and issue compulsory licenses on any grounds without consulting the foreign patent owner. Brazilian Health Minister Jose Gomes Temporao late last month signed a decree declaring that the country would purchase from an India-based drug maker a generic version of Efavirenz if Merck did not offer the drug at a lower price. According to the decree, Efavirenz is a "public interest" medicine.

Temporao at a news conference last month said the country did not issue the decree "as a threat, nor to lower the price of other medicines, but to guarantee its program of attending (AIDS) patients." Brazil gave Merck seven days to negotiate a lower price for the drug. Officials from the Brazilian Ministry of Health last week rejected an offer from Merck to sell Efavirenz at a 30% discount in the country, an unnamed spokesperson with the ministry said on Thursday. Brazil asked Merck to reduce the cost of Efavirenz to 65 cents per dose from $1.57 per dose. An unnamed source said that Merck offered to sell the drug for $1.10 per patient daily, but Brazil rejected the offer. Merck sells Efavirenz for $1.80 per daily dose in most middle-income countries (Kaiser Daily HIV/AIDS Report, 5/4). According to the AP/Forbes, a generic version of the drug would save Brazil about $240 million by 2012, when Merck's patent on Efavirenz expires.

Reaction
Merck in a statement released Friday after Silva's announcement said that Brazil "has a greater capacity to pay for HIV medicines than countries that are poorer or harder hit by the disease." HIV/AIDS advocates worldwide praised Silva's move, while the U.S.-Brazil Business Council criticized the move as a step backward, according to the AP/Forbes (AP/Forbes, 5/4). Jeffrey Sturchio, a vice president at Merck, said that if Brazil "expropriates our intellectual property, it will have a chilling effect on whether companies research diseases of the developing world and in the long term will have an impact on the poorest countries." Sturchio added that emerging economies, such as Brazil, must help the developed world in covering production costs of new drugs and in funding future drug innovation. Michael Weinstein -- president of AIDS Healthcare Foundation, which operates clinics in Latin America -- said Silva's decision on Friday is a "victory for AIDS [advocates] and patients everywhere and proof that drug companies will go down in defeat every time they place themselves in the way of justice for AIDS patients" (Jack/Lapper, Financial Times, 5/5).

Related Editorial
The compulsory license is a reason to be "downright worried," a Wall Street Journal editorial says. The editorial says that drug patents are "only worth the paper they're printed on unless governments protect them," adding that Brazil's move is a "slap in the face" of WTO regulations and the market system for drug innovation. Developing new medications is a "risky business," and pharmaceutical companies will not be "willing to sink hundreds of millions of dollars into research and development, especially on diseases that affect the poor and sick in developing countries, if they fear their intellectual property will be stolen," according to the Journal. The editorial concludes that if other countries issue compulsory licenses, it "would be bad for intellectual property rights worldwide, and it would be a disaster for the world's poor" (Wall Street Journal, 5/7).

American Public Media's "Marketplace" on Friday reported on the compulsory license. The segment includes comments from Frederic Scherer, an economist at Harvard University; Mark Ravera, an analyst at Strategic Pharma Consultants; and Weinstein (Palmer, "Marketplace," American Public Media, 5/4). Audio and a transcript of the segment are available online.

This document was provided by the Centers for Disease Control and Prevention.
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