News (Updated November 28, 2010)

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A quarter of British people with HIV do not know it

Experts worry about danger to partners but also that late diagnosis means there is less chance of successful treatment

Sarah Boseley, health editor

The Guardian, Friday 26 November 2010

Anti-retroviral drugs that suppress HIV. People diagnosed late because of ignorance of the condition stand less chance of successful treatment. Photograph: Krista Kennell/Zuma/Corbis

An estimated 86,500 people are living with HIV in the UK , according to figures released today, but around a quarter of them do not know they are infected.

"We're very concerned that a large number of people in the UK are unaware of their HIV status, and that half of all newly diagnosed people are diagnosed late, meaning they may not benefit from very effective treatments," said Dr Valerie Delpech, head of HIV surveillance at the Health Protection Agency which published the figures.

They show that HIV is more prevalent in certain areas of the country – particularly in London , Brighton and Manchester . Pilot projects looking at the acceptability of increased testing in such areas are underway.

"The HPA would like to see increased access to … testing in areas where rates of HIV infection are high. Pilot studies have shown that in these areas testing all adults registering at GPs or accessing certain hospital services can make an impact," said Delpech.

"The evidence shows that this testing is feasible to undertake and acceptable to patients. We would like to see this rolled out in areas where HIV infection is more common to reduce the number of people who are unaware of their HIV status and increase the chances of early diagnosis, when treatment is more successful."

People who seek medical help only when they have the symptoms of Aids are far more likely to die. In 2009, 547 people were diagnosed with Aids and hardly any of them had been for an HIV test. Of the 516 people with HIV infection who died last year, 73% had been diagnosed late, when the virus had already taken a big toll on their immune system.

In 2009, 6,630 people were newly diagnosed with HIV, 4,400 of whom were men and 2,230 women. This is a decline in new diagnoses, for the fourth year in a row, but the agency says there is no evidence of a drop in the numbers who are living in ignorance of their HIV status.

Deborah Jack, chief executive of the National Aids Trust, said the figures showed the need to increase testing. "Prevention is an immensely cost-effective activity … one HIV transmission is up to £360,000 in direct costs to the NHS."

The agency warned in July that the number of new HIV infections among over-50s had more than doubled in seven years.

 

 

3 big developments make AIDS outlook more hopeful

(AP) – 3 days ago

In the nearly 30 years the AIDS epidemic has raged, there has never been a more hopeful day than this.

Three striking developments took place Tuesday: U.N. officials said new HIV cases are dropping dramatically worldwide. A study showed that a daily pill already on pharmacy shelves could help prevent new infections in gay men. And the pope opened the way for the use of condoms to prevent AIDS.

"I don't know of a day where so many pieces are beginning to align for HIV prevention and treatment, and frankly with a view to ending the epidemic," said Mitchell Warren, head of the AIDS Vaccine Advocacy Coalition, a nonprofit group that works on HIV prevention research. "This is an incredibly opportune moment and we have to be sure we seize it."

President Barack Obama said the groundbreaking research on the AIDS drug "could mark the beginning of a new era in HIV prevention."

The U.N. report said that new cases dropped nearly 20 percent over the last decade and that 33.3 million people are living with HIV now.

"We can say with confidence and conviction that we have broken the trajectory of the AIDS pandemic," said UNAIDS Executive Director Michel Sidibe in Geneva .

Health officials credit part of the decline to wider condom use, and on Tuesday, in a historic shift in church teachings, the Vatican said that using a condom is a lesser evil than infecting a sexual partner with HIV.

Condoms remain the best weapon against AIDS, and the new prevention pill is not the chemical equivalent. But scientists called it a true breakthrough. The pill, Gilead Science's Truvada, is already used to treat people with HIV. A three-year global study found that daily doses cut the risk of infection in healthy gay and bisexual men when given with condoms, counseling and other prevention services.

The drug lowered the chances of infection by 44 percent, and by 73 percent or more among men who took their pills most faithfully. Researchers had feared the pills might give a false sense of security and make men less likely to use condoms or to limit their partners, but the opposite happened — risky sex declined.

The results are "a major advance" that can help curb the epidemic in gay men, said Dr. Kevin Fenton, AIDS prevention chief at the U.S. Centers for Disease Control and Prevention. But he warned they may not apply to people exposed to HIV through male-female sex, drug use or other ways. Studies in those groups are under way.

Because Truvada is already on the market, the CDC is rushing to develop guidelines for doctors who want to use it to prevent HIV, and urged people to wait until those are ready.

As a practical matter, price could limit use. The pills cost $5,000 to $14,000 a year in the United States , but roughly $140 a year in some poor countries where they are sold in generic form.

Whether insurers or government health programs should pay for them is one of the tough issues to be sorted out, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

"This is an exciting finding," but it "is only one study in one specific study population," so its impact on others is unknown, Fauci said.

His institute sponsored the study with the Bill & Melinda Gates Foundation. The findings were published online by the New England Journal of Medicine.

It is the third AIDS prevention victory in about a year. In September 2009, scientists announced that a vaccine they are now trying to improve protected 1 in 3 people from getting HIV in a study in Thailand . In July, research in South Africa showed that a vaginal gel spiked with an AIDS drug could cut nearly in half a woman's chances of getting HIV from an infected partner.

Gay and bisexual men account for nearly half of the more than 1 million Americans living with HIV. Worldwide, more than 7,000 new infections occur each day. Only 5 to 10 percent of global cases involve sex between men.

"The condom is still the first line of defense," because it also prevents other sexually spread diseases and unwanted pregnancies, said the study leader, Dr. Robert M. Grant of the Gladstone Institutes, a private foundation affiliated with the University of California , San Francisco . But many men don't or won't use condoms all the time, so researchers have been testing other prevention tools.

AIDS drugs already are used to prevent infection in health care workers accidentally exposed to HIV, and in babies born to infected mothers. Taking these drugs before exposure to the virus may keep it from taking hold, just as taking malaria pills in advance can prevent that disease when someone is bitten by an infected mosquito.

The strategy showed great promise in monkey studies using tenofovir (brand name Viread) and emtricitabine, or FTC (Emtriva), sold in combination as Truvada by California-based Gilead Sciences Inc.

The company donated Truvada for the study, which involved about 2,500 men at high risk of HIV infection in Peru , Ecuador , Brazil , South Africa , Thailand and the United States ( San Francisco and Boston ). The foreign sites were chosen because of high rates of HIV infection and diverse populations.

More than 40 percent of participants had taken money for sex at least once. At the start of the study, they had 18 partners on average; that dropped to around six by the end.

The men were given either Truvada or dummy pills. All had monthly visits to get HIV testing, more pills and counseling. Every six months, they were tested for other sexually spread diseases and treated as needed.

After a median follow-up of just over a year, there were 64 HIV infections among the 1,248 men on dummy pills, and only 36 among the 1,251 on Truvada.

Among men who took their pills at least half the time, the risk of infection fell by 50 percent. For those who took pills on 90 percent or more days, risk fell 73 percent. Tests of drug levels in the blood confirmed that more consistent pill-taking gave better protection, and in one subgroup, the reduction in risk was 92 percent.

The treatment was safe. Side effects were similar in both groups except for nausea in the Truvada patients. Weight loss also was more common in the drug group, but it occurred in very few. Further study is needed on possible long-term risks.

All participants will get a chance to take Truvada in an 18-month extension of the study to see if men will take the pill more consistently if they know it helps, and whether that provides better protection. About 20,000 people are enrolled in other studies testing Truvada or its component drugs around the world.

The government will review all ongoing prevention studies, such as those of vaccines or anti-AIDS gels, and consider whether people getting dummy medicines should now get Truvada since it has been shown effective in gay men.

Gilead may seek approval to market Truvada for prevention, said Dr. Howard Jaffe, president of the company's philanthropic arm. Doctors can prescribe it for this purpose now if patients are willing to pay for it, and some already do.

Some people have speculated that could expose Gilead to new liability concerns, if someone took the pill and then sued if it did not prevent infection.

"The potential for having an intervention like this that has never been broadly available before raises new questions. It is something we would have to discuss internally and externally," Jaffe said.

Until the CDC's detailed advice on Truvada is available, the agency said gay and bisexual men should use condoms consistently and correctly, get tested and treated for HIV and other sexually transmitted diseases, get counseling and reduce their number of sexual partners.

 

More than a third of S.African men admit to rape

(AFP) – 1 day ago

JOHANNESBURG — More than a third of South African men in a new survey admitted to committing rape at some point in their lives, the study's authors said Friday.

The survey, by the government-funded Medical Research Council and non-profit organisation Gender Links, found that 37.4 percent of men in the north-central province of Gauteng admitted to committing rape at some point in their lives, while 25.3 percent of women said they had been victims of rape.

It follows up on a national survey carried out last year that found that more than one in four South African men admitted to having raped a woman or girl.

"The previous level was so high that we didn't expect it to be even higher," Rachel Jewkes, a researcher at the Medical Research Council, told AFP.

Researchers surveyed 487 men and 511 women in Gauteng , the country's second-most populous province, which is home to Pretoria , the capital, and Johannesburg , the largest city.

The study group was 90 percent black and 10 percent white, reflecting the province's demographics, authors said.

Over half the women surveyed said they had experienced some form of violence -- emotional, economic, physical or sexual -- in their lifetimes, and 78.3 percent of men admitted to perpetrating some form of violence against women.

South Africa has one of the world's highest rates of reported rape, with 36,190 cases -- 99 per day -- reported to police in 2007, but experts say that only a small number of attacks are actually reported.

The MRC study found that only one in 25 rapes had been reported to the police.

South Africa has the highest number of HIV infections in the world, compounding the trauma rape victims face.

In the 2009 study, one in five confessed rapists tested positive for HIV.

Copyright © 2010 AFP. All rights reserved.

 

Philippines reports rise in HIV-AIDS infections

(AFP) – 2 days ago

MANILA — The Philippines on Thursday reported a sharp jump in HIV-AIDS cases which runs against a global trend of declining infection rates, with young homosexual men most at risk.

There were 1,305 confirmed new HIV infections in first 10 months of the year, compared with 835 for the whole of 2009, the health ministry said.

Sex between men accounted for nearly 80 percent of all cases this year, and more than half of those infected were aged between 20 and 29.

"From 2007 there has been a shift in the predominant trend of sexual transmission from heterosexual contact to males having sex with males," a health ministry report said.

The human immunodeficiency virus (HIV) attacks the human body's immune system, rendering it defenceless against infections and leading to AIDS.

Teresita Marie Bagasao, country coordinator of the UNAIDS programme, said that among all countries in Asia, only the Philippines and Bangladesh were now reporting increases in cases, with others stable or decreasing.

The United Nations also reported Tuesday that the number of new cases of HIV/AIDS around the world had dropped by about one-fifth over the past decade.

"They (Philippine authorities) need to actually address the factors which lead to infections," Bagasao told AFP.

"Providing treatment can only be sustainable if there is a very strong and comprehensive programme of preventing further infections."

She said the government needs to educate those at high risk, and provide them with condoms.

Apart from sexual contact, 11 percent of all new Philippine HIV cases were transmitted through needle-sharing by injecting drug users, and one percent were transmitted by a mother to her baby.

Copyright © 2010 AFP. All rights reserved.


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