News (Updated June
26, 2011)
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The risk of contracting HIV through unprotected receptive anal sex is almost 20
times greater than the HIV risk associated with vaginal intercourse.
While this fact is often a focus in HIV prevention programming aimed at
men-who-have-sex-with-men (MSM), it has been largely left out of programmes for
heterosexuals, according to Zoe Duby of the University of Cape Town, South
Africa, and the Desmond Tutu HIV Foundation.
Duby presented the findings of her study, which interviewed almost 400 people in
“Safer sex programming has, in my opinion, failed to take into account varying
definitions of sex. The omission of anal sex in safe sex messaging has been
interpreted as meaning that anal sex is safe,” she told IRIN/PlusNews.
“What people preach out there, it’s just vaginal sex - not information on
anal [sex],” said a young woman from
Even more worrying was that research showed healthcare workers often held
similar views, and some incorrectly believed HIV was only present in vaginal
fluid. The virus is, in fact, also present in male sperm and blood.
“Me, I do not want to practice vaginal sex because that is the highest [risk]
sex that transmits HIV, so it is a belief… that non-vaginal sex does not
transmit HIV,” one Kenyan healthcare worker reported.
A nurse in
Virginity, pregnancy and pleasure
East African respondents said anal sex was also practiced as a way to prevent
pregnancy, increase sexual pleasure, or preserve a woman’s virginity, which
was only associated with vaginal sex.
“A lady got married a real virgin… and then she started showing symptoms of
HIV. When she was questioned… she started crying, saying that she was advised
to only have anal sex so that she would still maintain her virginity and respect
during marriage,” a Kenyan truck driver said during an interview.
“Youth today are
searching for these things that don’t make them lose their virginity but allow
them to still sort of engage in sexual activity,” according to another young
woman. Anal sex is seen as a cultural “loophole”.
“My religious friends who are trying to hold onto some sanctity of waiting
until they’re married to have sex, they feel that oral and anal sex are sex
that they can have that’s still not full sex,” a female respondent told Duby.
She said research about the use of anal sex to preserve virginity has noted
similar views among young South African women, especially in communities that
practice virginity testing.
Safe sex messaging
Duby cautioned that her results - part of a Family Health International
evaluation of an HIV programme for mobile populations - should not be
generalized, but did show that anal sex must be included HIV prevention
programming.
“Sex has largely been defined as penile-vaginal penetrative sex… We hear
this word ‘sex’ bandied about all the time but… we’re not really looking
at… how [people] are defining it in order to tailor safe sex messaging.” she
told IRIN/PlusNews.
“Due to the assumptions that sex refers to penile-vaginal penetration only,
people put themselves at a greater risk of contracting HIV in an attempt to
practice safe sex,” Duby added. “Unprotected anal sex can no longer be
ignored as a significant contributing factor in the global HIV epidemic.”
llg/kn/he
NAIROBI, 22 June 2011 (PlusNews)
- HIV and gay rights activists say new guidelines released by the UN World
Health Organization (WHO) on HIV programming for men who have sex with men (MSM)
will not only improve health service provision for MSM, but will also act as an
advocacy tool in the fight for the rights of this marginalized population.
"The document provides well-researched and evidence-based recommendations
for HIV prevention and treatment of MSM, which will be useful for
clinicians," said Kevin Rebe, a doctor with Health4Men, a South African
health service provider which caters specifically for MSM. "The language of
the paper is couched in human rights, and makes a strong call for
decriminalization of same sex sexual activity, so it will also be useful for
activists seeking to end discrimination."
The guidelines are designed for use by national public health officials and
managers of HIV/AIDS and STI (sexually transmitted infections) programmes, NGOs
and health workers. They contain MSM-specific programme activities such as the
use of water- and silicone-based lubricant for the correct functioning of
condoms during anal sex.
The guidelines do not advise medical male circumcision - a measure WHO
recommends for HIV prevention among heterosexual men - for HIV prevention among
MSM due to the lack of sufficient research on its effect of its use in MSM
sexual activity.
They further recommend that health services adhere to the principles of medical
ethics and the right to health, and ensure that MSM feel comfortable enough to
seek medical care, with MSM-specific health needs catered for within national
health systems.
"Like many other African countries, all men in South Africa are assumed to
be straight, so health workers are not aware of the need to identify people of
different sexualities during consultations; outside of centres like ours, there
is little competency in providing health care to MSM," said Rebe. "By
availing this knowledge, the guidelines will empower health workers to provide
better care to MSM."
Wake-up call
In countries like Uganda, where homophobia is deeply entrenched both within
society and the law, gay rights groups hope the new guidelines will serve as a
wake-up call to the government about the need to include MSM in HIV programming.
"I hope the new guidelines will be an eye-opener to the government, who
have so far ignored MSM within HIV prevention, treatment and support; it should
show them that MSM exist in Uganda and are at high risk," said Frank
Mugisha, executive director of the NGO Sexual Minorities Uganda. "They
therefore cannot be ignored and urgently require HIV interventions."
Mugisha noted that the WHO document added to growing pressure from other
international organizations calling for MSM to be included in HIV programmes -
including UNAIDS and the Global Fund to fight AIDS, TB and Malaria - and would
hopefully persuade the Ugandan government to change its policies.
According to WHO, criminalization of same-sex sexual activity plays a key role
in the vulnerability of MSM and transgender people to HIV; more than 75
countries currently criminalize same-gender sexual activity.
Rebe noted that even in countries like
"Rights on paper
only"
"These [MSM] rights are very much rights on paper only, they are not
guaranteed; homophobia remains widespread, with politicians frequently making
openly homophobic statements," he added. "If used widely, these
guidelines have the potential to help reduce stigma and improve the level of
care MSM receive."
Policymakers say the guidelines will help to inform planned HIV programming for
MSM. "One of the biggest problems we have for MSM seeking health care is
the attitude of health workers - these guidelines will build on the body of
knowledge we have on supporting this group," said Nicholas Muraguri, head
of
Muraguri noted that although the Kenyan penal code still criminalized same sex
sexual activity, the Constitution's Bill of Rights laid out the right of every
Kenyan to health.
"MSM don't live on the outside of society, they live with us and deserve
the same treatment as other members of society; recent studies show that in
Kenya MSM HIV prevalence is as high as 25 percent - and many of these men are
married and have girlfriends, so ignoring them is totally impractical," he
said. "HIV programming for MSM is not a matter of choice - it is a
necessity."
kr/cb
By Kate Kelland
(Reuters) - A class of
generic AIDS drugs often used to treat HIV in
In a study in the journal
Nature Genetics, British researchers found that the drugs, known as nucleoside
analog reverse-transcriptase inhibitors, or NRTIs, damage DNA in the patient's
mitochondria -- the "batteries" that power cells.
The scientists said it was
unlikely that newer cocktails of AIDS drugs made by firms like
"It takes time for
these side effects to become apparent, so there is a question mark about the
future and whether or not the newer drugs will cause this problem," Patrick
Chinnery of the
The findings do however
help explain why HIV-infected people treated with older antiretroviral AIDS
drugs sometimes show advanced signs of frailty and diseases such as heart
disease and dementia at an early age, the researchers said.
"The DNA in our
mitochondria gets copied throughout our lifetimes and, as we age, naturally
accumulates errors," said Chinnery, who led the study.
"We believe these HIV
drugs accelerate the rate at which these errors build up. So over the space of,
say, 10 years, a person's mitochondrial DNA may have accumulated the same amount
of errors as a person who has naturally aged 20 or 30 years."
NRTI drugs -- the best
known of which is AZT, also known as zidovudine and originally developed by GSK
-- were a big advance in HIV treatment when they first emerged in the late
1980s. They extended patients' lives and helped make HIV a manageable chronic
disease rather than the death sentence it once was.
Concerns about toxicity of
NRTIs, particularly with long-term use, mean the drugs are now less commonly
used in wealthy countries where they have been replaced by newer more expensive
combination AIDS drugs with fewer side-effects.
But in poorer countries,
where access to cheaper generic medicines is often the only option for HIV
patients to get treatment, NRTIs are still relatively widely used.
An estimated 33.3 million
people worldwide had the human immunodeficiency virus (HIV) that causes AIDS in
2009, according to the latest United Nations data, and 22.5 million of those
live in
"These drugs may not
be perfect, but we must remember that when they were introduced they gave people
an extra 10 or 20 years when they would otherwise have died," said Brendan
Payne of
"In
For their study,
Chinnery's team studied muscle cells from HIV-infected adults, some of whom had
previously been given NRTIs. They found that patients who had been treated with
NRTIs -- even as long as 10 years previously -- had damaged mitochondria similar
to that of a healthy older person.
The researchers are now
looking at ways to repair or stall some of the damage caused by the drugs and
say they believe that focusing on exercise -- which appears to have a beneficial
effect on patients with mitochondrial diseases -- may help.
(Editing by Erica
Billingham)
24 Jun 2011 09:55
Source: Content partner //
IRIN
"It is very hard to
maintain adherence in children because they rely on others to give them
medicine, some change regimens as they grow into adolescence and they can hardly
cope with the many drugs they are expected to take," said Dr Andrew Suleh,
medical superintendent at the Mbagathi District Hospital in the capital,
Nairobi.
HIV-positive children -
depending on their weight - can take up to four ARV pills a day; by the age of
15, a child may have taken upwards of 25,000 ARV tablets.
"You are faced with a
situation where, even when they fail first-line [treatment] and you initiate
second-line, success is not guaranteed because the factors [that hamper
adherence] still exist," Suleh said.
Treatment failure occurs
when first-line medication can no longer control HIV infection. Patients are
then usually put on second-line drugs, but these are not only less accessible
than the first-line option, they are often also several times more expensive.
According to the
government, an estimated 184,000 children were living with HIV by the end of
2009; 24 percent of those requiring ARVs had access to them.
Joy*, 11, has been on ARVs
for nearly two years. She was orphaned several years ago and has been passed
from relative to relative for most of her life; the constant change of guardians
means that her adherence to ARVs has not always been consistent.
"When you look at her
case you find she has started to develop rashes and mouth sores, and she has
diarrhoea, which are clinical signs that her treatment is failing," said
Suleh, who is treating Joy.
Joy's current guardian
says she was never fully briefed on the importance of strict adherence to ARVs
and Joy has occasionally skipped doses of her drugs.
"I thought she could
just take them on her own without being told because she has taken those drugs
for long, but when she started falling ill again, she told me wasn't taking
them," the guardian said.
The UN World Health
Organization (WHO) recommends the use of pill boxes, calendars, diaries and
other practical tools to support children's adherence.
Experts say a combination
of factors create treatment failure and put children's lives at risk, including
poor adherence, long-term use of ARVs, and improper actions by health workers,
who may miss or ignore the first signs of treatment failure in children rather
than referring them for a change of regimen.
"There are children
who are in need of second-line treatment but many are not receiving it. This is
not to say that the drugs aren't available, but most health workers have staging
fright and adopt a 'wait and see' attitude, or facilities do not request the
drugs," says Dr Judith Kose, technical director at the Elizabeth Glaser
Paediatric AIDS Foundation.
Other challenges include
the fact that some of the drugs - such as Didanosine suspension - recommended by
WHO - require refrigeration, which is inconsistent or unavailable in much of
rural
Officials say the biggest
problem is the high cost of second-line drugs, but the government is using
adherence monitors to boost treatment success and optimize the first-line
option.
Guardians� fear of
disclosure also hampers children's adherence. "As a child grows up, they
start to ask questions about why they are constantly on treatment yet they look
healthy," Kose said. "They wonder why those around them aren't taking
medicine, and this at times comes with rebellion where they refuse to take the
drugs, eventually."
Creating support networks
for HIV-positive children and educating guardians about systematic disclosure
were some of the ways to improve adherence in children, Kose suggested.
"It is not just about
health workers or guardians,� she said. �This calls for community
support from the schools they go to, even sensitizing their friends to support
them in taking the drugs."
ko/kr/he
By Pierre-Antoine Donnet (AFP)
– Jun 7, 2011
UNITED NATIONS — The
cost of drugs used to keep AIDS at bay will keep falling because of the huge
demand from millions of sufferers desperate for the lifeline, experts said at
the United Nations on Tuesday.
But nations still wrangled
ahead of a major three day AIDS summit over how many people will get treatment
in coming years.
The summit of about 30
presidents and government leaders must set the future direction of global AIDS
policies. Pop stars such as Alicia Keys and Annie Lennox joined pressure groups
in demanding rich nations pay the money needed to treat millions more sufferers.
The market economy will
drive down the prices of the retrovirals used to keep millions alive now,
according to Morolake Odetoyinbo, a board member of the Global Fund to fight
AIDS, Tuberculosis and Malaria from
The cost "can only
keep falling because they are trying to get more people on treatment, which
means there is a bigger demand and that big demand will drive down the
prices," she told AFP.
Odetoyinbo, founder of the
Positive Action for Treatment Access group in
There are an estimated 34
million people living with AIDS and more than nine million are still not getting
treatment, according to UN statistics. About 6.6 million people are getting
drugs and the rest do not know they have AIDS.
The annual cost of
retrovirals was about 10,000 dollars in 2001 but has tumbled to about 67 dollars
a year, according to Sharonann Lynch, an expert for the Medecins Sans Frontieres,
or Doctors Without Borders, group.
"Cost is
unfortunately the over-riding factor in terms of whether indeed we will be
getting the remaining nine million people on treatment who need it today in
order to live," Lynch said.
"The question of cost
is so important that it's actually driving poor decisions in terms of whether
governements participating will take the necessary steps and make the necessary
financial investments so that we can finally break the back of this
epidemic," the expert said.
Going into the summit, no
agreement had been reached on the final communique which was to set the numbers
who will receive treatment and how it will be paid for.
The UN Security Council on
Tuesday passed a resolution calling for a coordinated international response to
the AIDS pandemic, which it said was a threat to international peace and
security.
But pressure groups said
rich countries -- Europe and
In a sign of the anger of
many non-government groups, the AIDES and Act Up Paris groups accused
Celebrities have also
spoken out strongly in the AIDS campaign.
"Negligent non-action
as a response to the HIV-AIDS epidemic, as it affects women and girls is just as
bad, just as accountable as criminal action," said Scottish singer Annie
Lennox told a symposium on women and AIDS at the UN headquarters.
American star Alicia Keys
said world leaders had the means to save millions of lives in
Copyright © 2011 AFP. All
rights reserved.
By LAURAN NEERGAARD, AP
Medical Writer – 20 June, 2011
WASHINGTON (AP) — Too
many doctors are testing the wrong women, or using the wrong test, for a virus
that causes cervical cancer.
The days of
one-size-fits-all screening for cervical cancer are long gone. How often to get
a Pap smear — and whether to be tested for the cancer-causing HPV virus at the
same time — now depend on your age and other circumstances.
But a government study
reports Monday that a surprising number of doctors and clinics aren't following
guidelines from major medical groups on how to perform HPV checks, suggesting a
lot of women are getting unnecessary tests.
That wastes money and
could harm women who wind up getting extra medical care they didn't need, says
Dr. Mona Saraiya of the Centers for Disease Control and Prevention, who led the
research.
Even she wasn't protected
from the confusion. Saraiya was stunned to get a bill showing that her own
doctor had ordered testing for HPV strains not connected to cervical cancer.
The findings, reported in
the journal Obstetrics & Gynecology, show women have to be savvy to ensure
they're getting the right checkups — enough, but not too much.
"It's extremely
discouraging," says Debbie Saslow, gynecologic cancer director at the
American Cancer Society, who's had to argue with her doctor against testing too
often. "We have not been able to get that message across."
Cervical cancer grows so
slowly that Pap smears — which examine cells scraped from the cervix —
usually find it in time to treat, or even to prevent when precancerous cells are
spotted and removed.
For decades, Paps were the
only way to screen for cervical cancer. Now doctors know that certain strains of
HPV, the human papillomavirus, cause most cervical cancer. HPV testing isn't a
replacement for the Pap. But it can provide extra information to help determine
if a woman is at higher or lower risk and thus guide her ongoing care — if
it's used correctly.
The new CDC study, part of
a national survey of medical practices that included 600 providers of cervical
cancer screening, examined how doctors are using it.
The study found 60 percent
of doctors and clinics say they give a routine Pap-plus-HPV test to women who
are too young for that combination. Guidelines stress that so-called co-testing
is only for women 30 and older. If both tests are negative, they can wait three
years before their next screening.
Why the age limit? Saslow
says HPV is nearly as common as the common cold, especially in younger women —
but their bodies usually clear the infection on their own and only a years-long
infection is risky. Learning that a 20-something has HPV increases the odds of
more invasive testing that in turn can leave her cervix less able to handle
pregnancy later in life. Younger women are supposed to get HPV testing only if a
Pap signals a possible problem and doctors really need the extra information.
Then there's the question
of which test to use. Only a few so-called high-risk strains of HPV cause
cervical cancer, the strains doctors are supposed to test for. Before scientists
understood the different HPV types, a test already was on the market that
detects strains that can cause genital warts, not cervical cancer. The CDC's
Saraiya says there's no reason to use that old test because learning you have a
probably transient warts-causing strain doesn't alter your care.
Yet her study found 28
percent of doctors and clinics say they order tests for both the cancer-causing
and warts-causing strains, regardless of patient age. The study couldn't tell
why, although Saraiya says some doctors don't know there's a difference and some
order forms for the lab tests don't differentiate.
An HPV test costs $80 to
$100, on top of a $40 Pap. Saraiya says labs can bill for two HPV tests when
doctors order testing for both kinds of strains.
So what does a woman need
to know before her next checkup? The CDC has developed a consumer-friendly
brochure to help women understand their options for cervical cancer screening:
http://tinyurl.com/6g8de6v
And guidelines from the
—Routine Paps start at
age 21.
—Most women in their 20s
get a Pap every two years.
—Women 30 and older wait
three years between screenings if they've had a negative Pap and negative HPV
test, or three consecutive clear Paps.
—If a Pap is
inconclusive at any age, HPV testing may help rule out who needs further
examination and who can just repeat a Pap in a year.
—Anyone who's been
vaccinated against HPV, a relatively new vaccine, still must follow Pap
screening guidelines for their age group.
—Higher-risk women, such
as those with HIV or previous cervical abnormalities, need more frequent
screening.
EDITOR'S NOTE — Lauran
Neergaard covers health and medical issues for The Associated Press in
Copyright © 2011 The
Associated Press. All rights reserved.