News (Updated May 23, 2010)

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Tuberculosis most deadly of 'neglected' diseases

Wednesday, May 19 2010

More than nine out of ten cases of tuberculosis, which kills 1.8 million people each year, could be averted by 2050 with better testing, drugs and vaccines, according to a major review released Wednesday.

Treatment from 1995 to 2008 saved six million lives, according to the review, published in the medical journal The Lancet.

But TB remains a deadly scourge that fails to attract as many health pounds, dollars, euros and yen as other diseases claiming as many or fewer victims, the journal said.

Latest figures from the Health Protection Agency show that cases in Britain increased by 5.5 percent, from 8,679 in 2008 to 9,153 in 2009, the biggest rise since 2005.

Most were in London , with 3,476 in 2009, 38 per cent of the total.

Nearly three-quarters of cases occur in people born outside Britain .

"Tuberculosis is unfashionable these days," said Lesotho Health Minister Mphu Ramatlapeng at a press conference in Geneva , where the report was unveiled at the World Health Organisation (WHO).

Some 36 million people infected with TB during 1995-2008 were cured and incidence of the lung-wasting disease has begun to regress, but only by about one percent per year.

The most urgent -- and most easily remedied -- problem is poor diagnosis, the report said.

More than 80 percent of all TB cases occur in only 22 countries, including nine in Africa, 11 in Asia, and Russia .

Detection rates have improved over the last 15 years, but nearly 40 percent of active infections in those nations still go untreated.

Even worse, only a quarter of the estimated 1.4 million people infected with both tuberculosis and HIV/AIDS have been identified, the study reported. HIV increases the risk of TB 20 fold.

Up to two-thirds of cases in South Africa and Zimbabwe , for example, are thought to be caused by HIV co-infection.

Frequent testing for HIV and the early start of antiretroviral treatment (ART) would help cut incidence by reducing the number of people with compromised immune systems, it said.

Another looming threat are so-called "multidrug-resistant" (MDR) forms of TB.

Most types of tuberculosis can be cured with £9 worth of medicine if diagnosed early.

But when patients fail to complete a treatment, the Mycobacterium tuberculosis germ that causes the disease develops a resistance to frontline drugs such as isoniazid and rifampicin.

Treating the new superbugs can take two years and cost more than £2,000 per patient, and even then may fail.

"Without significant investment in technology and capacity for prevention, diagnosis and treatment, MDR-TB threatens to become the dominant strain of TB over the next few decades," the study warns.

"The future possibility of strains that are totally resistant to all anti-tuberculosis drugs is not inconceivable."

In 2008, some 440,000 cases of MDR-TB occurred worldwide, half of them in China and India . Only seven percent, however, of these infections were treated.

Turning back the tide on TB will require boosting basic health care infrastructure and targeted prevention measures, including improved vaccines, better use of antibiotics and reduction of risk factors.

There remains a "desperate need" for a more accurate, cheaper test for detection, and for so-called "biomarkers" that predict whether an individual is more likely to be cured by treatment or to relapse, and whether vaccines will work.

All of this takes money, which has fallen far short of needs: the funding gap in high-burden countries -- measured against the Global Plan to Stop TB -- is some half-a-billion dollars in 2010, the study reports.

"Tuberculosis can no longer be the neglected sister of HIV and malaria," the authors say, pointing out that the US National Institutes of Health (NIH) spend about seven percent as much on TB research as for HIV, even though both diseases kill roughly the same number of people worldwide.

Sex workers fear missing the party

Agnieszka Flak

JOHANNESBURG

19, 2010

JOHANNESBURG (Reuters) - Like other Johannesburg prostitutes, Zandile dreamed of getting rich from World Cup fans.

Now she complains that foreigners will be scared off by fear of AIDS and crime and there will be no World Cup bonanza.

South Africa has the world's biggest HIV caseload, with 5.7 million cases, and foreign fans have been repeatedly warned in their home countries about the dangers of casual sex.

Last year, some officials warned that 40,000 sex workers would invade this country from around Africa , but with the tournament only weeks away, the reality looks very different.

"It's great that the World Cup will be held here... I just wish we could have a bit of the pie," said Zandile, who works the streets of Sandton, one of Johannesburg 's richest suburbs and a glitzy hub for entertainment and business.

Zandile and her colleagues fear the refusal of authorities to create safe areas for prostitution during the tournament will make it nearly impossible to attract clients.

"Foreigners and tourists don't like to look for the girls on the streets," said Mudiwa, a sex worker from Zimbabwe .

"The government needs to create a safe space for us, so that the customers know where to find us. When you get into a car, you never know if you'll be able to see your child again."

Some politicians last year called for the creation of protected areas for prostitution during the World Cup, following examples of zones designated during the last edition of the tournament in Germany in 2006.

Instead, cities such as Cape Town have preferred to clean up the streets, following New York 's zero tolerance approach to crime.

Advocacy groups also unsuccessfully urged the government to put a moratorium on prostitution-related arrests.

"There are so many logistical and political issues inherent in the World Cup that sex work is very low on the agenda...it's politically much more expedient to ignore the problem than to deal with it head on," said Marlise Richter, a researcher who collaborates with sex worker advocacy groups.

LOST OPPORTUNITY

Germany changed its criminal law around sex work ahead of the event, but in South Africa "that opportunity has been wasted," Richter said.

The host cities have few plans for how to protect sex workers or their clients, saying that with prostitution still illegal, they were limited in what they could do.

Sibongile Mazibuko, the head of the World Cup team for Johannesburg, said the city would make condoms available, but had no plans for how to deal with the issue otherwise.

"We can't give them shelter because we can't be part of a crime...we can't have a banana republic that creates laws for an event for one month," she said.

The scourge of AIDS is also a powerful deterrent.

"People see us as breeders of AIDS, and that kills the business for us," said Mpho, another Sandton street girl.

Due to its clandestine nature, the number of sex workers in South Africa , the continent's economic mecca, is difficult to ascertain, with many operating from city brothels or suburban homes and some at high-end apartments, catering almost exclusively for foreign clients.

Others, like Zandile, try their luck on the streets, despite constant fear of violence, abuse and arrest.

POLICE ABUSE

"Police will abuse us. They will take us to the police station and will ask for sex. Or they will say 'girls, let's talk...that's to see if we can talk money," she told Reuters.

Prostitutes, especially those working the streets, are prone to being sexually and physically attacked. Others, who are pimped by gangsters or organized sex syndicates, are often at the mercy of criminals who also supply drugs.

"Presently the industry is regulated by criminals and 2010 offers those criminals opportunities to get away with very serious crime on a larger scale," said Eric Harper, Director of the Sex Workers Education and Advocacy Task Force (Sweat).

It is unclear if demand for paid sex will rise significantly during the June 11-July 11 tournament.

Some new arrivals from Zimbabwe , Botswana and other neighboring states have been spotted lining up along Johannesburg 's streets, but nowhere near the tens of thousands of prostitutes predicted by some officials last year.

Abikanile said she was one of a dozen who had hitchhiked down from Malawi in hopes of making money from players and fans.

"I was told I could make in a week what I would earn in a year back home, so why not?" the 35-year-old housewife said.

Yet if last year's Confederations Cup, a rehearsal for the World Cup, is anything to go by, business might be slow, Zandile said.

"I only had one customer from the games...but at least I was then able to pay my rent that month," she said.

Prostitution is a crime in South Africa and attempts to at least partially legalize it may take years.

Activists argue that decriminalizing the trade would protect sex workers and clients, ease their access to health care and help to contain the spread of HIV.

"The criminal law stigmatizes the profession, creates barriers to reporting gender-based violence and gives clients an immense amount of power over sex workers," Richter said.

(Additional reporting by Michael Georgy and Wendell Roelf; Editing by Barry Moody; To query or comment on this story email sportsfeedback@thomsonreuters.com)

Cut out HIV discrimination call in AMs' report

BBC 17 May 2010

More must be done to ensure people with HIV are not discriminated against when accessing healthcare, says a report by a cross-party group of AMs.

The report recommends better training for healthcare professionals who treat people with HIV.

It also recommends a public awareness campaign to dispel the myths associated with the virus.

The assembly equality of opportunity committee chair Ann Jones AM called the discrimination "unacceptable".

She said: "It is unacceptable that any person living with HIV should encounter discrimination by healthcare providers and although some improvements have been made, there is still work to be done."

The committee was told that patients with HIV often feel they are being unnecessarily referred to specialists when they could be given general health care.

Stigma

But evidence from healthcare professionals suggests that they believe they are acting in patients' best interests.

To combat this, the AMs' report recommends more effective training and easier access to HIV specialists for healthcare professionals.

The report also highlights that someone with HIV might be reluctant to make a formal complaint of discrimination, for fear of prejudicing any future treatment.

It recommends that HIV and AIDS charities should start letting local health boards (LHBs) know informally of cases of discrimination in their organisations.

Another recommendation of the report is that the assembly government targets the stigma surrounding the virus by encouraging LHBs to roll out routine HIV screening tests universally, instead of targeting high risk groups.

The report is being officially launched at Ysbyty Gwynedd in Bangor on Monday.

Ms Jones added: "A key point that this inquiry has highlighted is that there are differences in opinion about whether discriminatory behaviours are the result of a lack of knowledge and experience, or a reflection of discriminatory or prejudicial attitudes.

"The committee's recommendation that healthcare workers are sufficiently informed is therefore of pivotal importance."

The committee chair also said she hoped that the report will "help to improve the situation for those living with HIV and ensure that they are treated on an equal basis to others".

Let's Talk About Sex, Says New Issue Of Mambo Magazine, UK

19 May 2010   

Over one in three Africans in England don't know how to talk about sex with a new partner according to a recent survey¹, which means people could be putting their sexual health at real risk.

Not asking questions about someone's sexual health and not using condoms may lead to people taking unnecessary risks in exposing themselves to infections like gonorrhoea, syphilis, chlamydia, herpes, genital warts, hepatitis B and HIV.

The new issue of Mambo, the health and lifestyle magazine published by HIV and sexual health charity Terrence Higgins Trust (THT), aims to encourage readers to feel more confident talking about sex with their partners. In its lead feature, the magazine provides a list of useful tips to help get that conversation started, as well as busting some common myths about sex.

Joseph Ochieng, Editor of Mambo, said: "We need to have the confidence to talk about sex to make sure we're not putting ourselves and our partners at risk. There are no perfect guidelines about how to bring the subject up in conversation, but agreeing a few basic rules can help reduce the risk of a sexually transmitted infection or unplanned pregnancy. In this issue of Mambo, we look at some possible approaches and offer useful tips on how a couple can have great - and safer - sex."

Other articles in the new issue include an interview with former hero of American basketball John Amaechi, talking openly about his experiences as a gay man; healthy eating options for Africans who are new to the country or who may be struggling on a tight budget; and news of a successful HIV testing service for Africans in Willesden.

Mambo magazine is funded by the Pan-London HIV Prevention Programme, and is distributed through a range of participating African organisations.

Notes

1. BASS Line 2007 Survey: Assessing the sexual HIV prevention needs of African people in England ; Sigma Research; 2008.

2. MAMBO magazine is published as part of the Pan-London mass media programme aimed at promoting awareness of sexual health among Africans. The programme is being delivered by THT in partnership with the following African organisations: Neovenator Community Organisation, The African Eye Trust, Addington Afro Ethnic Group, and Bantu Welfare Trust Future Builders.

Source
Terrence Higgins Trust

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