News (Updated August 30, 2009)

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AIDS, violence burden health care in SAfrica: studies

Mon Aug 24, 9:13 PM

JOHANNESBURG (AFP) - A lack of leadership has left South Africa 's health system burdened by rampant HIV, poor maternal and child health services, and violent crime, doctors said in The Lancet.

"Although South Africa is considered a middle-income country in terms of its economy, it has health outcomes that are worse than those in many lower income countries," South African doctors said in the British medical journal.

The journal published a series of articles highlighting the challenges facing South Africa 's health system, which has been transformed into a comprehensive national service 15 years after the end of apartheid.

But the country faces a collision of epidemics including AIDS and tuberculosis, as well as a high level of deadly violence and poor services for mothers and children, the articles said.

Health Minister Aaron Motsoaledi described the country's the health system as in trouble.

"Both the private and public sectors are in trouble. As government we take responsibility of the mistakes especially with regards to HIV/AIDS where wrong policies were adopted," he said at a press conference.

"However, some of the problems we have inherited from apartheid and colonialism," he added.

Motsoaledi met Monday with a team of international experts, including the articles' authors, in Johannesburg to discuss ways to battle South Africa 's health challenges, which the articles blamed on weak leadership.

"Failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies," South African researchers said in one article.

Former president Thabo Mbeki for years denied the threat posed by AIDS, questioning whether HIV causes the illness and delaying the rollout of life-prolonging drugs.

Lancet editor Richard Horten said the election of President Jacob Zuma earlier this year offered an opportunity to redress the mistakes of the past.

"The catastrophic failure of previous leadership to address certain health issues has broken the trust of the South Africa public and betrayed the trust of the international medical community," he said.

The articles highlighted gaping differences in health care among South Africa 's provinces, pointing to the lack of national coordination.

In the Western Cape , home to Cape Town , 80 percent of tuberculosis cases were cured in 2007. In KwaZulu-Natal , where the port city of Durban is located, the rate was as low as 40 percent.

Poor mother and child services mean South Africa was among just 12 nations that saw child mortality increase since 1990, the journal said.

AIDS remains the biggest challenge to South Africa 's health system, with 5.5 million people living with HIV -- about 17 percent of the world total.

But many people with HIV also suffer from tuberculosis, while ailments like obesity, heart disease, substance abuse and anxiety and depression are also on the rise, the articles said.

South Africa 's alarming crime rate poses another burden to the health system, the articles said, including the high incidence of homicide, domestic abuse and rape.

The violent death rate in South Africa is nearly five times the average worldwide, according to the report.

"Violence is profoundly gendered, with young men (aged 15-29 years) disproportionately engaged in violence both as victims and perpetrators," the researchers said.

"Half the female victims of homicide are killed by their intimate male partners and the country has an especially high rate of rape of women and girls."

 

PAKISTAN : HIV-positive cricket team bowls them over

28 Aug 2009 15:41:04 GMT

Source: IRIN

HYDERABAD , 28 August 2009 - Cricket is more than just a game in Pakistan ; it's an obsession. So when a team of HIV-positive players stepped onto the wicket recently for their first match, the stakes were even higher.

"For me, cricket has always been a passion and today, after winning this match, I feel good. It is my bid [to be] accepted in society," said Abdul Latif, the team captain.

HIV-positive people still find it hard to live openly in Pakistan , as widespread misconceptions about AIDS and high levels of stigma and discrimination persist.

Latif was working as a professional cook in Dubai when he found out about his HIV status in 2004 during a routine medical check-up and was deported. After returning to Pakistan he struggled to find a job because of his status, but is now a chef at a hospital for HIV-positive people.

The First Positive Cricket Club team will be competing with other cricket teams at city and district level. Their first match in Hyderabad , in the southern province of Sindh , was against a local youth club.

The stands were not as full as they are for some of the major matches, but the estimated 200 supporters cheered loudly for the rookie team. However, no family members came to watch, as some of the players had not disclosed their status, while others have been shunned by their relatives.

The club was formed under the aegis of the Pakistan Society [http://www.pakistansociety.org], an NGO working for the rights of people living with the virus and injecting drug users in Sindh Province .

"Cricket is what unifies all Pakistanis, and we wanted to get our message across in the best possible manner. The rationale behind the formation of the HIV-positive cricket team and cricket club is to give the general population an idea that being HIV positive is not a reason why some should be treated like an outcast," the head of the Pakistan Society, Dr Saleem Azam, told IRIN/PlusNews.

The team practiced every day after work for their first match. "We had all been playing it in our youth and continued watching it. However, after getting HIV, we started becoming withdrawn and even energy levels went down," said Saqib Khan (not his real name).

"Yet whenever a cricket match was on, we felt like watching it and would even ask our employer if we could stay at the office and watch it together. For us, it's about being together and playing together."

After a nail-biting innings, the team won handsomely, leaving their opponents and the fans amazed that HIV-positive players could be so active - one of the team members was asked whether antiretroviral medication was also a form of performance-enhancing drugs.

"We are thankful that the authorities were so cooperative with us, and provided us with the space that was needed for the match without any discriminatory attitude. Rather, their attitude was positive and encouraging," said Azhar Hussain Magsi, a manager at the Pakistan Society.

"More matches are scheduled to take place all over Pakistan in the coming weeks ... We are also having talks with other NGOs in India, and look forward to having an international HIV-positive cricket match."

 

KENYA : New PMTCT guidelines to save moms and babies

NAIROBI , 28 August 2009 (IRIN) - A more effective antiretroviral (ARV) regimen for pregnant HIV-positive Kenyan women lies at the heart of new national guidelines for the prevention of mother-to-child HIV transmission {PMTCT).

Now, a combination of three ARVs - zidovudine (AZT), nevirapine and lamivudine (3TC) - will be used for mother and baby, rather than the single dose of nevirapine administered previously, which led to some women and children developing resistance to the drug.

"With these guidelines we intend to move into more efficacious regimens," Dr Martin Sirengo, the PMTCT programme manger at the National AIDS and STD Control Programme (NASCOP), told IRIN/PlusNews.

Although the government intended phasing out single-dose nevirapine in PMTCT altogether, the new drug regimen will take some time to implement as it involves additional costs and training for health workers.

The guidelines, issued in the capital, Nairobi , on 26 August, also state that HIV-positive mothers should exclusively breastfeed their infants for six months, with replacement feeding recommended only when it was affordable, feasible, accessible, safe and sustainable. Earlier prevention guidelines were less specific about feeding options.

The strategy is also aimed at men. "Male involvement is key to our success in rolling out an effective programme for prevention of mother-to-child transmission of HIV," said Beth Mugo, Kenya 's Minister for Public Health.

According to the Ministry of Health, 90 percent of women attending antenatal clinics agree to be tested for HIV, but only 10 percent of their male partners accompany them and are also tested. Couples counselling and incentives like delivery vouchers for those who attend together are being implemented to encourage male participation.

NASCOP's Sirengo noted that female-specific HIV-prevention activities were crucial to reducing the number of infants born with the virus - three out of every five HIV-positive Kenyans are women.

"Because a majority of infants get infected through the mother, it is important to reduce the HIV burden among women if we are to succeed in eradicating paediatric HIV and preventing new infections involving children," he said.

Every year more than 114,000 babies are exposed to HIV, and at least 45,640 are born HIV-positive. Kenya has more than 4,000 health facilities offering PMTCT services, but more than half of all pregnant women opt for home births.

 

SOUTH AFRICA : Tackling HIV and TB - where there's a will, there's a way

JOHANNESBURG , 27 August 2009 (IRIN) - One in six HIV-positive people in the world live in South Africa , which is also experiencing a parallel tuberculosis (TB) epidemic, but years of weak leadership, poor policy implementation and inadequate resources have undermined efforts to control the twin health emergencies.

These are the findings of several leading local researchers and epidemiologists, who chronicle the history of the HIV and TB epidemics in "Health in South Africa", a new series published in the UK-based medical journal, The Lancet.

The evolution of South Africa 's HIV epidemic began with a concentration of cases mainly among gay men in the 1980s, spread rapidly via heterosexual transmission spurred by the migrant labour system in the 1990s, and peaked with a prevalence rate of 30.2 percent among pregnant women in 2005.

Since then the level of new HIV infections has remained high, but prevalence has stabilized or even declined in some age groups, largely as a result of HIV-related mortality.

Despite the belated roll-out of an antiretroviral (ARV) treatment programme, which started in 2004 and is now the largest in the world, average life expectancy has declined to 48.4 years for men and 51.6 years for women.

Starting in the late 1990s, the HIV epidemic has fuelled a sharp rise in TB incidence: 50 percent of new TB cases occur in patients co-infected with HIV, making TB the most common natural cause of death in the country.

The poor performance of TB control programmes and many years of low cure rates have seen the emergence of drug-resistant strains of the disease that are more difficult and costly to diagnose and treat - the caseload of drug-resistant TB now puts South Africa among the world's top 10 countries.

Strong leadership needed

These are grim statistics, yet The Lancet authors describe the government's response to the two epidemics in the past decade as marked by "denialism, ineptitude, obtuseness and deliberate efforts to undermine scientific evidence as the basis for action."

Important achievements, such as a vastly increased distribution of male condoms, the scale up of the ARV programme, and the development of well-formulated national strategic plans for HIV/AIDS and TB have not been enough to overcome a lack of high-level political commitment to controlling the health crises.

An international HIV/AIDS scorecard various elements in country-level programmes found South Africa 's performance worse than many of its lower-income neighbours.

The authors note that the change of administration in 2008 has provided a potential "window of opportunity" to tackle HIV and TB, and suggest a number of priority actions. In the area of TB control, they recommend improving case detection and cure rates, and integrating HIV and TB services.

The first step in strengthening HIV prevention efforts should be using all available data to generate a clearer picture of the demographic features and key drivers of the epidemic, followed by scaling up prevention of mother-to-child transmission, targeted behaviour-change programmes, and making male circumcision widely available.

HIV treatment efforts could be boosted by routinely offering testing at all health care facilities, and raising the threshold for starting ARV treatment to a CD4 cell count of 350.

Treatment programmes play an important part in prevention: studies show that patients who start ARV treatment early are less likely to transmit the virus, and more likely to access sexual and reproductive health services.

However, the authors note that successful implementation of these approaches will require "strong leadership, political will, social mobilisation, adequate human and financial resources, and sustainable development of health care services."

 

AIDS spreading rapidly among Canada 's aboriginals

25 Aug 2009 17:36:04 GMT

Source: Reuters

* Aboriginal share of AIDS cases doubles in 4 years

* Drug use bigger cause of infection than unsafe sex

By Rod Nickel

WINNIPEG, Manitoba, Aug 25 (Reuters) - AIDS is spreading faster among Canada's aboriginal people than in the general population, and a strong cultural stigma and links to rising drug use make the problem difficult to solve.

One health official compared it last week to the AIDS epidemic in Africa and warned that up to 30 percent of the aboriginal population in the western province of Saskatchewan could die of AIDS within a decade.

Saskatchewan 's top health official dismissed that prediction, but said the rapid spread of AIDS in the native population is a growing concern.

Many aboriginals, a broad term that includes Indians, Inuit and Metis, live in poverty and suffer poorer health than most other Canadians. They make up about 3.3 percent of the population, living mainly in western cities, the North and on rural reserves.

Despite their relatively small population, aboriginals accounted for almost one-quarter of Canada 's reported AIDS cases in 2006 for which ethnicity was known, double the rate six years earlier, according to the Public Health Agency of Canada.

Intravenous drug use, especially among women, is the cause of more than half the infections with the human immunodeficiency virus (HIV), which leads to AIDS. Canadian non-aboriginal infections are mostly linked to unsafe sex.

Aboriginals with HIV infections also tend to be younger than other infected Canadians and more often women.

"(It's) partly because of the vulnerabilities of that group -- (especially) if they're addicted and dependent on the sex trade for their income," said Dr. Moira McKinnon, chief medical health officer for Saskatchewan .

INFECTION RATE ON RISE

The rate of HIV infection in Saskatchewan has risen rapidly among natives, McKinnon said. The province of 1 million people, had 174 new HIV cases last year, up 40 percent from 2007. Sixty-five percent of the new cases were aboriginals.

An estimated 73,000 Canadians were infected with HIV as of 2007, according to the United Nations AIDS agency. Worldwide, 33 million people had the HIV virus as of 2007, with almost one-third in southern Africa .

The spread of the AIDS virus in Canada is most acute among young aboriginal people who have moved from rural reserves to cities, said Ken Clement, chief executive of the Canadian Aboriginal AIDS Network.

Rates of diabetes and tuberculosis are also higher among aboriginals than in the general population, causing HIV infection to become fatal more quickly, Clement said.

Some aboriginals, once infected, are reluctant to use HIV drugs. "It's scary and a real concern," Clement said. "HIV becomes another layer of their disease."

A strong stigma about AIDS within aboriginal circles can also discourage testing and treatment, said Art Zoccole, a gay aboriginal man who is infected with HIV.

"Once you get outside the urban centers, I find the stigma still exists," said Zoccole, 57, who lives in Toronto . "The reason is the lack of information."

It all adds up to a problem without a one-size-fits-all solution, said Phat Ha, public health policy analyst for the Assembly of First Nations (AFN). Most government attempts to control the spread of AIDS center on safe sex, he said .

"There's a large portion (of the population) that's not being addressed, in particular the injection junkies," Ha said.

Saskatchewan will soon take steps to increase access to testing and anti-viral drugs, McKinnon said. She hopes to see the trend to rising HIV cases reversed as quickly as it arose.

"I'm optimistic that within a couple of years, we'll see those figures go down," she said. (Editing by Rob Wilson)

 

Helene Gayle to advise Obama on AIDS

Tue Aug 25, 2009 8:36am EDT

PhotoWASHINGTON (Reuters) - AIDS expert Dr. Helene Gayle, president and chief executive of the charity CARE USA , has been named to chair the Presidential Advisory Council on HIV/AIDS, the U.S. government said on Monday.

Gayle, former head of AIDS research at the U.S. Centers for Disease Control and Prevention, will advise President Barack Obama on fighting the virus, which has infected an estimated 1 million Americans and 33 million people globally.

"As we organize numerous ways to engage the American people in confronting the HIV epidemic in our country, the Presidential Advisory Council on HIV/AIDS will play a critical role in developing and implementing a national HIV/AIDS strategy," Obama said in a statement.

Gayle has also headed AIDS efforts at the Bill & Melinda Gates Foundation.

 

Gates Foundation names Stefano Bertozzi as new director of HIV programs

Kristi Heim

Dr. Stefano Bertozzi is joining the Bill & Melinda Gates Foundation next week as its new HIV director in the global health program.

An expert in health economics, he will manage grants in HIV vaccine development, biomedical prevention research, diagnostics, development and resistance monitoring, and strategies for introduction and scaling-up of interventions, the foundation said.

HIV is one of the biggest programs at the foundation, which has spent nearly $12 billion on global health since 1994.

For the past 11 years Bertozzi has worked in the National Institute of Public Health (INSP) in Mexico as the director of its Center for Evaluation Research & Surveys, where he leads economics and statistics teams that conduct impact evaluations of large health and social programs.

He also chairs the Steering Committee of aids2031, an international consortium of people from diverse backgrounds looking for new ideas for the global response against HIV/AIDS. I found this video of him in which he talked about the need for a new approach to HIV that is longer term, and building more efficient management systems.

"We've been so caught up in the urgency of people dying that we haven't thought about how to win this fight over the long term," he said.... "It's foolish for us to take an emergency response to prevention."

Bertozzi co-authored this paper that discusses the spread of HIV from sex workers whose clients are willing to pay more not to have to use a condom.

"His intimate knowledge of the medicine, science, economics and policy of HIV will help make this important portfolio have the most impact," said Tachi Yamada, president of the Gates Foundation's global health program. Bertozzi worked with the foundation in his previous roles at UNAIDS, the World Health Organization (WHO) and the World Bank.

Stroger meets with irate AIDS activists over vaccine

Bob Roberts Reporting
WBBM Newsradio 780

CHICAGO (WBBM) - Cook County Board President Todd Stroger met Tuesday with a group of irate AIDS activists, who said he jumped the gun by trying to arrange the clinical testing of a vaccine to treat the deadly disease.

Stroger assured the activists he meant well.

"I thought this was something that would help people," he said.  "It's not about me.  It's about other people."

The GeoVax vaccine in question is reported to be testing well in preventive tests in 13 locations, in which the participants are uninfected.  The activists said this test would be different, in that it would be used in  therapeutic testing, which is being done nowhere else, and would require 10 HIV-positive patients to go off their current medications.

Papers signed by Stroger, by the Cook County Health and Hospital System, and by the CORE Foundation that administers county health services June 15 did not commit the county to the therapeutic test, but only gave the county's Ruth M. Rothstein CORE Center the ability to determine if it wanted to participate.  On June 24, the CORE Foundation board, headed by County Commissioner John Daley, wrote GeoVax that CORE administrators elected not to go forward.

With a solitary exception, those who spoke at the 90-minute meeting backed CORE Center 's decision not to go forward.

While others talked in abstract about their misgivings, one man was blunt.

"When I'm taken off my medications, I become ill," he said.  "I have diarrhea. I have fever.  I have fainting spells and my body shuts down.  In other words, I could die."

Several physicians affiliated with CORE Center backed their bosses' decision, saying that the test would give some patients false hope and was not well-designed.

"This is a safety trial to see if it is safe...for 10 patients.  That is what we got -- a single-site, 10-patient study," said CORE Center 's Dr. Toin Adeyeni.  "We didn't think that the risk of taking patients off their medications outweighed the benefit of anything, which there probably wouldn't have been."

Dr. Adeyeni suggested that GeoVax instead recruit patients at one of the 13 sites in which preventive testing is being done.

Not everyone who attended was in agreement.

"There will be a therapeutic trial," one man said.  "Do you want to be the one to say you did not allow that chance to happen?  It's doesn't make sense to me the risk of not finding out if this vaccine could work."

Others complained that the man did not realize the dangers that could result from the testing to participants.

Stroger communications director Eugene Mullins acknowledged speaking for two hours with CORE Center personnel about the decision not to go forward with the trial, but Stroger said Mullins did not communicate the conversation to him.

Even Stroger himself admitted he could have benefitted from a more in-depth briefing before taking a stand.

 


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