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THE good news that HIV infection rates in infants in South Africa have been halved from 8% to 3,5% and that access to medical male circumcision is rapidly expanding was released this week at the 5th SA AIDS Conference in Durban (as reported in The Times today).
And equally encouraging are the breakthroughs in HIV prevention research – in trials using ARVs for prevention – that have been reported in science journals over the last year.
These positive results were a major focus at the four-day conference (more detail in the Sunday Times).
The latest scientific results influenced debates on prevention and treatment between scientists and doctors at this conference and will impact on the drafting of South Africa’s new National Strategic Plan, due to be finalised by the end of this year.
The NSP 2012-2016 is expected to have realistic, measurable targets that are more achievable than the aspirational goals of the 2006-2011 NSP (which had targets like halving the rate of new infections by 2011).
The drafting of the plan – and each province is expected to submit a clear operational plan – will take place at the same time as the restructuring of SANAC, the SA National AIDS Council.
These steps – a focused new NSP, provincial plans for HIV/AIDS, a restructured SANAC, the contributions of experienced activists – combined with the tireless leadership of the Health Minister Dr Aaron Motsoaledi and his team could help to reverse the HIV epidemic in South Africa.
This is the last day of the 5th SA AIDS Conference and maybe it is possible that by the next conference in Durban in 2013, delegates will be reporting that South Africa has succeeded in turning the tide against the epidemic.
“REMAINING ignorant of your HIV status is not a human right,” Professor Lucy Allais, director of the Wits Centre for Ethics, said today at a discussion on HIV testing and human rights.
Allais was speaking at the 5th South African AIDS Conference about whether- in theory in a country with a high HIV prevalence – it would be a human rights violation for the government to require every individual to know their HIV status.
Since April last year the government has dramatically scaled up voluntary HIV counselling and testing (HCT) and through its national HCT campaign 12 million people have found out their HIV status.
“A policy of ‘mandatory knowledge‘, in which the individual is required to find out their HIV status and demonstrate he or she has this knowledge, would not be a human rights violation,” Allais stated.
A mandatory knowledge policy would not require the individual to disclose their status, nor the health professional to break confidentiality nor demand ‘mandatory testing’ (where the health professional demands an HIV test),” she said.
HIV testing is not risky, nor invasive, nor painful and the only plausible harm to the individual was the psychological impact of finding out he or she had HIV, she said.
But not knowing one’s status can be harmful, while finding out one’s status has proven benefits.
“Knowing one’s status has benefit for the individual, his or her partner and for public health,” Allais suggested, “but most people do not realise these benefits since they do not know their status or start treatment until late (in the disease).”
If a state infringes on an individuals’ fundamental freedoms then it is are violating that person’s rights, said Allais, but a “mandatory knowledge” policy would not violate the right to privacy (HIV results would remain confidential),
Putting rights in a broader context than that of health, she explained that HIV testing would not violate the right to autonomy nor to bodily integrity.
“We would argue that mandatory knowledge is not at odds with informed consent since it does not require testing without consent.”
One of the delegates expressed relief that Allais’ view was theoretical and not practical.
But Allais is raising an important issue and maybe it’s time to debate this in real time in the real world.
Professor David Serwadda spoke at the 5th SA AIDS Conference this morning
HIV/AIDS studies conducted in Africa are making a significant contribution to understanding the disease, a leading public health expert Dr David Serwadda said today.
The importance of the viral load in HIV transmission, the preventative value of medical male circumcision, the efficacy of mother-to-child-HIV prevention and other breakthroughs in research have been proven in trials conducted in African countries said Serwadda.
Dean of the Makerere University School of Public Health in Uganda, Srwadda said major international funding had played a role in boosting research and science capacity in countries like Uganda, South Africa and Kenya over the past 25 years.
For example, 37% of HIV funding by the NIH in the US, has been directed to Africa.
Serwadda said the funding had improved training, infrastructure and service provision to patients.
He said HIV had impacted severely on health systems, for instance, leading to overcrowding in hospitals and had taken its toll on healthworkers.
“We need to increase investment and resources for health systems,” Serwadda said.
He also called for greater leadership and accountability.
Serwadda spoke at the plenary session this morning of the 5th SA AIDS Conference in Durban
5th SA AIDS Conference chairman Professor Francois Venter opens the conference
The 5th SA AIDS conference started in Durban today with a call to prioritise young people in the next HIV/AIDS National Strategic Plan.
Young people have a high rate of HIV infection, too many of them confront violence every day and many of the youth urgently need access to education Mark Heywood, deputy chairman of the SA National AIDS Council, said at the opening session.
“The bottom line is that the lives of young people have not improved,” he said.
Heywood shared the platform with a courageous young woman Mandisa Dlamini, whose mother Gugu was killed in 1998 for publicly disclosing she had HIV.
“I saw my mother dying but I nearly became infected with HIV. Two years later I was pregnant,” said Dlamini, talking about how young women can make wrong decisions and get into destructive cycles simply to survive.
The vulnerability and exploitation of young women is visible in any South African city. Leaving the International Conference Centre at 10pm tonight, I saw young female sex workers hanging out on street corners only a few blocks away looking for business.
One measure of the success of this conference and the next five-year National Strategic Plan (NSP) will the difference it makes the lives of women like them.
Conference chairman Professor Francois Venter reported on what great progress has been made on tackling HIV/AIDS in South Africa since the first conferences were held in Durban in 2000 and 2003.
But Venter, also president of the HIV Clinicians Society of Southern Africa, warned against being complacent, particularly in gains made around access to antiretroviral treatment.
“Antiretrovirals are magic muti. You go from zero to 100,” said Venter, commenting on how he has seen skeletal children and adults recover from near death to lead healthy lives again.
He warned that if funding for treatment runs out doctors could be telling patients, as they were back in the ‘80s in the US: “We have what it takes to keep you alive but we won’t pay for it”.
About 1.4 million South Africans — 100 000 of them children — are now on ARV medicines but still roughly 50% of people who need the life-saving drugs do not have them.
HIV prevention needs to be prioritised, Venter said, but not at the expense of cutting back on treatment.
18th Conference on Retroviruses and Opportunistic Infections
Viruses and microRNA, and HIV/AIDS treatment and prevention in Malawi were the topics of the opening session last night at CROI, the world’s premier scientific conference on HIV.
“The epidemic at 30″ will the focus of the closing plenary on Wednesday in Boston, in the US.
Pre-prophylaxis exposure (PrEP) – in particular HIV-negative people taking tablets to avoid infection – drug resistance, novel antibodies and HIV’s interaction with TB, herpes and opportunistic infections also featured on the programme.
CROI is more focused on science, like immunology, virology and molecular research, than other popular HIV conferences like the biennial International AIDS meetings.
As the latest webcasts and podcasts show, the frontiers of laboratory science and therapeutic approaches are advancing and providing new insights into the prevention and treatment of HIV/AIDS.
But it’s difficult even to decipher the content of sessions, like those under the theme “New Findings and Controversies“, for non-scientists like myself.
At least the South African researchers attending CROI 2011 are likely to report on how these findings impact on their work at the 5th SA AIDS Conference, to be held from 7 to 10 June in Durban.
The 3rd HIV and AIDS Workplace Conference to be held next week will focus on strengthening prevention efforts and research in the workplace.
“The conference will, for the first time, reflect on the intersection of workplace HIV responses, academic research and surveillance,” the organisers say.
The forum has also attracted delegates from other countries.
“Businesses cannot ignore the impact the pandemic has on productivity and the welfare of employees,” says senior researcher at the Health Economics and HIV and AIDS Research Division (HEARD), Gavin George.
“This conference will provide an opportunity to disseminate cutting-edge research that we hope will inform and improve prevention strategies in the workplace.”
The SA Business Coalition on HIV/AIDS (SABCOHA), HEARD, Wits Business School and the Foundation for Professional Development are major players in the private sector response to HIV/AIDS.
SABCOHA CEO, Brad Mears, says: “We aim to bring the private sector on board in playing a more participative role in addressing HIV and AIDS in the workplace.
“The conference offers business an opportunity to step back, reflect and review HIV and AIDS programmes in the workplace and to establish more results driven initiatives to ensure efficiency in addressing issues concerning the epidemic.”
“The 3rd HIV/ AIDS Conference invites the private sector, including business leaders, as well as concerned members of the community to attend the conference and “to take a more active role in addressing pertinent issues affecting business and African communities”.
The conference will take place from 9 – 11 November 2010 at the Gallager Estate, Midrand, Johannesburg , and the Minister of Health, Dr. Aaron Motsoaledi , will open event.
*To register for attendance, visit www.sabcoha.org/conference
The spread of HIV among injecting drug users across Europe – outside of sub-Saharan Africa one in three new cases of HIV area among users – will be high on the agenda at the International AIDS Conference in Vienna, Austria, which starts on Sunday.
In Eastern Europe and Central Asia, injecting drug use is the “primary cause” of the rapid spread of new infections.
Ahead of the 18th AIDS meeting, experts from across the world have released the “Vienna Declaration” calling on governments and the UN to promote rational drug policies that promote human rights and public health.
“As scientists, we are committed to raising our collective voice to promote evidence-based approaches to illicit drug policy that start by recognizing that addiction is a medical condition, not a crime,” they stated, warning that the criminalisation of illicit drug users fuels HIV.
Yesterday three former Latin American presidents from Brazil, Mexico and Columbia yesterday signed the declaration, along with Brazilian writer Paulo Coelho, Peruvian writer Mario Vargas Llosa and Nicaraguan writer Sergio Ramírez.
“The war on drugs has failed,” said former Brazilian president Fernando Henrique Cardoso.
“In Latin America, the only outcome of prohibition is to shift areas of cultivation and drug cartels from one country to another, with no reduction in the violence and corruption generated by the drug trade.”
AIDS 2010 Chair Dr. Julio Montaner, president of the International AIDS Society (IAS), said: “I hope that the Vienna Declaration will inspire many more political leaders to cast aside the drug war rhetoric and embrace evidence-based policies that can meaningfully improve community health and safety.”
The International AIDS Society, the International Centre for Science in Drug Policy, and the BC Centre for Excellence in HIV/AIDS initiated the declaration.
The criminalisation of men who have sex with men is driving gay relationships underground in Africa and this discrimination is contributing to the spread of HIV on the continent.
The urgent need for access to health services for men who have sex with men, respect for their sexual orientation and protection in law, and lobbying for their human rights, emerged clearly at the M2010 Microbicides: Building Bridges in HIV Prevention conference in Pittsburgh, in the US, this week.
That was a key point in my article in the Sunday Times today – but I feel concerned that the headline “Secret gay sex fuels HIV spread in Africa” conveys a negative message.
What I feel negative about is the intolerable discrimination against men who have sex with men and how that isolates them from prevention, care and treatment.
As Michel Kazatchkine, executive director of the Global Fund to fight Aids, TB and Malaria, said in response to the recent imprisonment in Malawi of two men for having a gay relationship: “The criminalisation of individuals based on their sexual orientation is not just a human rights issue – it also … drives sexual behaviour underground and creates an environment where HIV can more easily spread.”
NOW that the M2010 Microbicides conference in Pittsburgh, in the US is over, the next big date on the microbicide and HIV prevention calendar is the 21 July 2010.
On that day the results of the first microbicide trial with a candidate using antiretrovirals will be announced at the XVIIIth International AIDS Conference in Vienna, Austria.
Professor Salim Abdool Karim, the director of Centre for AIDS Programme of Research in SA, will present data from the CAPRISA 004 study “to assess the safety and effectiveness of a vaginal gel containing the antiretroviral drug tenofovir” at the conference.
Tenofovir is an antiretroviral drug that is very effective in treating AIDS and it is also being tested in another big microbicide study.
“If a tenofovir gel is found to be safe and effective in preventing HIV infections in this trial, confirmatory studies involving more women will likely be required before the product could undergo an approval process by the relevant drug authorities, such as the SA Medicines Control Council,” Karim said.
ANYONE who is going to take antiretroviral drugs for prevention – either orally or through a microbicide – must know his or her HIV status to avoid drug resistance developing, Dr John Mellors from the University of Pittsburgh said at the M2010 Microbicides conference today.
”If someone is infected and takes PrEP (pre-exposure prophylaxis) this would be really bad,” he said, explaining how that person would promote the spread of resistant HIV strains.
An expert on resistance, Mellors said some drug resistance among people taking antiretroviral therapy was inevitable.
About 80% of people currently on treatment have suppressed their virus. Most (4/5) of the 20% who have not, have some resistant virus.
Mellors expressed concern at the “substantial overlap in the drugs being used for treatment and those being studied for prevention”.
He said in a worst case scenario widespread resistance at a population level to these drugs could end up rendering them ineffective for both treatment and prevention.
But he added: “It is very rare to become infected with a virus we can’t treat today.”
Dr Susan Schader from McGill University said in reality resistance wasn’t an “all or nothing” problem.
Patients could increases doses, and could switch therapies if the higher levels proved toxic to them, she said.
But in South Africa and other African countries the latest, sophisticated drugs are relatively inaccessible because they cost far more than the first line treatments.
Dr Ume Abbas from the Cleveland Clinic Foundation said she had done a mathematical model on drug resistance if PrEP were to be rolled out at a population level.
“We found if an individual was already infected at baseline (in other words the person wanted PrEP not realising it was too late since they had HIV) that would be a major factor in fuelling the spread of drug resistance,” she said.
Dr Regina Osih from Wits University listed the public health concerns if PrEP were to be rolled out as adherence, resistance, the capacity of the health care system, identifying the ideal target populations and ethical choices.
