The developed nations are happy to send aid, but reluctant to ask uncomfortable questions.

International meetings inevitably produce pledges to commit more funding to combat diseases like HIV and malaria. There are delays, but most of the pledges are eventually met. However, far more important than the amounts spent is that recipient governments are not forthcoming in detailing how the money is spent and are even more reticent in sharing the results of that spending.

The sad truth, according to Alex Preker, a leading economist at the Health Nutrition and Population Department at the World Bank, is that the money, if results are measured at all, is modestly effective at best and actually harmful at worst. Dr. Preker has been giving the same speech around the development community for the past year. He explains that foreign aid crowds out domestic government expenditure: On average, in the period he measured (1998-2002) 82% of health sector aid displaced local government or private support. In other words, for every $100 given in aid for health work, there is only an $18 increase in the total expenditure on health.

Preker is the kind of economist who gives the World Bank a good name: intellectually honest, hard working and intelligent. He does not push loans on countries, but helps their officials with technical assistance and recommends either grants or loans where respectively advantageous. The recent analysis by Preker shows the kind of role the Bank under Robert Zoellick could play, but it makes uneasy reading for donors. After all if only 18% of health aid actually makes a financial difference what does that mean about its impact on health? And what does it mean for increases in aid in the future?

There are several possible readings of Preker’s analysis. The first is the most benign. Donors often want to support specific disease programs, so they can say they’re combating HIV or TB and provide details to taxpayers at home. Aid recipients know this, so they transfer the funding they would have spent on disease programs into health systems development (building clinics, training doctors, subsidizing insurance schemes for the poor etc.). There is some evidence that Senegal and a few other African countries have done this. The second interpretation is that the funds are spent on equally useful non-health programs, such as road building, power station development, or more controversially on armaments and internal security—Ethiopia springs to mind in this category, where aid has improved systems but also allowed internal oppression. The third interpretation is that the funds are simply squandered, delivered to government programs so incompetently or corruptly that nothing much is achieved at all. Kenya is a classic example of this woeful scenario. The fourth possibility is that the funds simply end up in personal bank accounts (quintessentially in Switzerland, but often in neighboring nations) of poor country elites – Congo under Mobuto is the classic of this variety.

But since there is very little measurement by donors or recipients of what is done with the money, it is impossible to know exactly which countries fall into which categories. In reality there is a mix of all four scenarios in most countries, but the allocation share among the scenarios is often simply unknown.

Aid, like welfare, definitely has negative impacts on the private sector; analysts have explained that aid undermines or weakens private sector provision of services, since foreigners often provide services for free. Since the time of Preker’s analysis, private provision is likely to have been weakened further, because there has been a more than doubling of international aid to health from over $4 billion to about $9 billion. In addition, as funds have mostly been directed at specific disease programs, this has the unfortunate effect of placing a greater burden on already weak health systems. Few funds have been allocated to the measurement of any impacts of this aid.

There is some good news. Domestic health spending in a few poor countries, such as Senegal and Ghana, has increased, according to Laurie Garrett of the Council on Foreign Relations, which should improve the health systems and make disease spending in these countries more useful.

Meanwhile, G8 leaders continue to gloss over, or simply choose not to know, whether the funds they commit actually do any good at all. This telescopic philanthropy, as Charles Dickens described it, is purely for donor benefit—to show they care. But they obviously don’t care, or they’d find out if it did any good.

source:www.american.com

AIDS Healthcare Foundation Observes CDC's National HIV

HIV Testing in Conjunction with SAG Celebrity Press Conference on HIV Awareness in the Black Community When: Monday, June 25th 10am - 11am Where: Screen Actor's Guild 5757 Wilshire Blvd. Los Angeles, CA NOTE: AIDS Healthcare Foundation's M-POWER-U Mobile Testing Unit (named in partnership with, and honor of Magic Johnson) will provide HIV testing to celebrity participants as a way to raise awareness and promote National HIV Testing Day events within the Black community. CONTACTS: Ged Kenslea, AHF Director of Communications 323.860.5225 work 323.791.5526 mobile Whitney Engeran III, AHF Director of Prevention 213.405.5822 work 562.682.1075 mobile

The statistics are startling: of the 1.3 million Americans living with HIV/AIDS, nearly 50 percent of them are Black. Black Americans represent more than 54 percent of the new HIV/AIDS cases in the United States. AIDS is the leading cause of death for African-American women aged 24-34. A study by the CDC showed that forty-six percent of Black gay men in America might already be HIV positive. Twenty-five percent of HIV positive people in the U.S. do not know they are infected. Clearly, Black Americans are disproportionately affected by HIV/AIDS. On Monday, June 25th, in conjunction with the CDC's Kickoff of National HIV Testing Week, AIDS Healthcare Foundation (AHF) will provide HIV testing during a celebrity press conference on HIV/AIDS awareness in the Black community in front of the Screen Actors Guild's Los Angeles headquarters.

Other AHF Testing & Outreach Activities During National HIV Testing Week: AHF's Out Of The Closet Free HIV Testing Site Schedules -- Monday, June 25th - Sunday, July 1st 2007

AHF's Out Of The Closet Thrift Store testing sites in Hollywood and West Hollywood will feature all day testing from 10am - 7pm on National HIV Testing Day, June 27th, in addition to their regular testing schedules from 3pm - 7pm, 7 days per week.

M-POWER-U Mobile Testing Unit -- Wednesday, June 27th 8am - 4pm Chesterfield Square Shopping Center Slausen & Western Avenues, Los Angeles, CA -- Thursday, June 28th 8am - 4pm Century Plaza 3351 West Century Blvd., Los Angeles, CA

AHF's M-POWER-U Mobile Testing Unit will participate in this second annual, 2-day HIV Testing Marathon, co-sponsored by AHF, Magic Johnson Foundation, Minority AIDS Project, Charles R. Drew University and the LA County STD Mobile Unit. Everyone tested will receive a free gift donated by local businesses, including free movie passes to AMC Theaters.

West Hollywood Mobile Testing Unit Wednesday, June 26th -- 8pm -2am Thursday, June 27th -- 8pm - 2am Saturday, June 30th -- 8pm - 2am Sunday, July 1st -- 12pm - 5pm 745 N. San Vicente Ave. West Hollywood, CA Friday, June 29th -- 5pm - 10pm 8612 Santa Monica Blvd. West Hollywood, CA

In addition to the regularly scheduled testing in West Hollywood, the MTU will also provide Rapid HIV Testing and Counseling at the Nate Holden Performing Arts Center, 4718 W. Washington Blvd., LA, CA 90016 from 4pm - 8pm on Wednesday, June 27th; and on the corner of Wilshire and Normandy in Koreatown from 12pm - 4pm on Thursday, June 28th.

AHF provides more than 13,000 free HIV tests each year in California through its innovative testing program via testing sites at three (3) AHF Out of the Closet thrift store locations throughout Southern California; via its Mobile Testing Units traveling throughout greater Los Angeles; and through its Partner Counseling and Referral Services (PCRS). AHF also provides HIV testing in the L.A. County Jail System. In addition, AHF currently provides over one- third of the 39,000 HIV tests done annually in Los Angeles County.
source:www.earthtimes.org

HIV positive widow ostracised in village

In yet another instance of social ostrasication of AIDS/ HIV positive affected, a widow in Kasimpur village under Remuna block of the district has been forced to lead the life of an outcast along with her three children.

Destiny played a dirty game with 30- year-old Basanti (name changed) after her husband Laxman Das died of the killer disease.

Laxman contracted the virus while working in Mumbai port. He returned to Balasore earlier this year and died on June 21. In a matter of few days, Basanti tested HIV positive and was socially boycotted.

Worse, even though her children are yet to be tested positive, they are not being allowed to mingle with other children in the village. Basanti’s in-laws want to help her out but are unable to do so due to financial constraints and the villagers’ ire.

Although there are provisions to provide free medicines to HIV patients, no such step is being taken by the district health authorities for this widow. Besides, she is deprived of other financial benefits as she isn’t a BPL card-holder.

Contacted, Balasore Collector A C Padhiary said he was not aware of the case. However, he promised to conduct an inquiry into the matter and provide Basanti all possible help as per Government rules and regulations.
souce:www.newindpress.com

Discrimination hurts AIDS fight

CHAIRPERSON of the National AIDS Coordinating Committee (NACC) Angela Lee Loy says the newly established HIV Training Centre will be a success once the high level of stigma and discrimination against infected persons is effectively dealt with.

Speaking at the launch of the TT National Training Centre which will provide training in HIV/AIDS for Health Providers, she said the HIV Human Rights Desk has documented numerous reports of discrimination against persons living with HIV.

The launch was held at the Children’s Hospital at the Eric Williams Medical Sciences Complex, Mount Hope and was observed by members of the Caribbean HIV/AIDS Regional Training (CHART) Network in Jamaica, Bahamas and Barbados, the University of Washington and other guests via video conference.

Lee Loy said many complaints about discrimination emanate from experiences with health service institutions and with health care providers.

“It is clear the decentralisation process envisioned by the Ministry of Health has not been fully realised, due in part to insufficient training of health care providers,” she said.

Lee Loy added the effort to decentralise the duties of the Health Ministry received a tremendous boost with the opening of the training centre. “With the support and facilitation of CHART and our regional and national partners, we have taken a giant step towards building the capacity of health care providers and key stakeholders to better serve the needs of the infected and affected community,” she said.

Lee Loy added that leadership is a key ingredient in any national response to HIV and AIDS.

“This training centre will be a success if it helps build informed leaders within the health sector and other sectors that can reverse the stigma and discrimination affecting persons living with HIV, whilst improving access, treatment, care and prevention services across the country,” she said.

The Training Centre will be located at the San Fernando General Hospital and classes can be accessed through video conferencing, a move applauded by most during the launch.
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SOURCE:www.newsday.co.tt

AIDS Action Council Calls Senate Appropriations Committee Recommendations Inadequate To Meet Growing Epidemic

The Senate Appropriations Committee yesterday recommended a very modest overall increase for domestic HIV/AIDS care and treatment programs and flat funding for treatment education and training and domestic HIV prevention programs. The Senate committee's proposed funding is much less than recommendations from the House of Representatives subcommittee and significantly less then the actual needs for HIV/AIDS care, treatment, education and prevention programs. The Senate committee's recommended funding is inadequate overall to meet the growing needs of those living with HIV/AIDS in the United States.

There are estimated to be more than half a million people in the U.S. who are infected with HIV but are not in medical care. At least half of that number, 250,000 or more people, is unaware of their HIV status. People under 25 years of age account for approximately half of new HIV infections. African Americans and Latinos together account for over 60% of people living with HIV/AIDS.

"We at AIDS Action Council are very disturbed that the committee's funding levels are not enough to keep pace with the growing infection rate, especially in communities of color, or to address the treatment and care needs of people living with HIV/AIDS in our country," said Rebecca Haag, Executive Director, AIDS Action Council. "Current funding amounts are not sufficient to ensure that life-saving drugs and medical treatment are available to all who are infected, not enough to reduce the estimated 40,000 new HIV infections every year and not enough to provide outreach and testing to people who are unaware of their HIV status. The reality is we need significantly more funding."

We are very dismayed that the Senate bill contains $30 million for the new Early Diagnosis Grant Program, for which no state is currently eligible, while providing no increased funding for HIV preventions programs or funding for increased HIV testing and counseling. AIDS Action Council does, however, commend the Senate committee for cutting by $28 million funding for community- based abstinence-only programs. These programs have been shown to be ineffective and should be replaced with educational programs that are comprehensive and scientifically sound.

AIDS Action Council is also concerned that the AIDS Education and Training Centers (AETCs) and the Dental Reimbursement Program were the only Ryan White programs that did not see funding increases in either the Senate or House committee's bill. AETCs are responsible for building and maintaining a well- educated health professional workforce, which is vital in light of growing caseloads. The dental program increases access to oral health care services for HIV-positive individuals who cannot afford routine dental care while providing education and clinical training for dental providers, especially those located in community based-settings. Both programs are critical to maintaining the health of those living with HIV.

AIDS Action Council urges legislators in both the House and Senate to amend the legislation to increase funding to keep pace with this growing, deadly epidemic.

"The President has rightfully called for a significant increase in our commitment to the global HIV/AIDS pandemic. We cannot leave people living with HIV/AIDS or those at risk here in our own country behind. The Senate committee's measure falls short of meeting the challenges of a still growing domestic HIV/AIDS epidemic. Congress needs to do more" Haag added.

AIDS Action Council is a Washington non-profit organization that advocates on behalf of people living with HIV and AIDS and that helped to create and ensure passage of the original Ryan White CARE Act in 1990 and the Ryan White HIV/AIDS Treatment Modernization Act of 2006 last December.
source:www.medicalnewstoday.com

Spread of AIDS in Africa Is Outpacing Treatment

South Africa--Amid the morning bustle of Johannesburg Hospital's AIDS clinic, Francois Venter darts from room to room, poking his head inside and asking both doctor and patient, ``Are you OK?''

More and more, they are. The clinic he helps oversee is one of the continent's best at distributing antiretroviral drugs. The waiting room fills each day with more than 100 patients whose full faces contradict the stereotype of hollow-cheeked Africans with AIDS.

But beyond the walls of this hospital, Venter says, doctors are not winning--and probably cannot win--the war against the epidemic, because it is spreading far more quickly than doctors are treating its victims. Even as billions of dollars are spent expanding access to antiretroviral drugs, the goal of controlling AIDS in Africa remains remote.

``At the moment, I just see a never-ending sea of disaster,'' said Venter, 37, president of the Southern African HIV Clinicians Society.

Underlying his frustration are grim statistics: For every South African who started taking antiretroviral drugs last year, five others contracted HIV, the same ratio as on the continent as a whole, U.N. reports say. A South African turning 15 today has a nearly 50 percent chance of contracting the virus in his or her lifetime, research shows.

The problem is not the medicine, which is among the most powerful in the world. In places such as the United States and Europe, where prevention programs were already succeeding against much smaller epidemics, the arrival of antiretroviral drugs was a turning point in the battle against AIDS.

But in sub-Saharan Africa, prevention programs have mostly failed to curb the behavior--especially the habit of maintaining several sexual partners at a time--that drives the epidemic, research indicates.

So while antiretroviral drugs have prolonged and improved the lives of hundreds of thousands of Africans, millions more are being newly infected with a disease that is still incurable and, for most, terminal.

In South Africa, AIDS deaths are projected to increase at least through 2025 despite steadily improving access to antiretrovirals, according to the Actuarial Society of South Africa. The prognosis on the rest of the continent is at least as bleak.

Global health officials and AIDS activists once predicted that expanding treatment would bolster prevention efforts by encouraging more openness about the disease and making it easier to educate people on how to protect themselves from HIV.

But among African countries with the most serious AIDS epidemics, the only one to report a recent drop in HIV rates is Zimbabwe, which has one of the region's smallest treatment programs.

In neighboring South Africa, attention has shifted from attempting to prevent new infections to treating existing ones, said Suzanne Leclerc-Madlala, an anthropologist at the University of KwaZulu-Natal and a director of one of South Africa's largest AIDS organizations. In meetings, she said, maybe 10 minutes is spent discussing prevention for every hour focused on treatment.

``The whole way of thinking is toward treatment,'' Leclerc-Madlala said. ``But it doesn't solve the problem.''

- - -

Venter was a doctor in training at Johannesburg Hospital, a vast, hilltop government facility, when he saw a hemophiliac patient receive antiretroviral drugs through a feeding tube as he lay, nearly lifeless, on a bed. A few weeks later, walking unassisted, the man was discharged.

``It was phenomenal,'' Venter recalled of his first encounter with the medicines that prevent HIV from reproducing. ``It was nothing short of a miracle.''

The year was 1997, and antiretrovirals were already becoming widely available in wealthy nations. With the drugs, all but the most seriously ill AIDS patients were able to restore their immune systems, control opportunistic infections, regain lost weight and return to work.

But in those early years, the medicine cost thousands of dollars annually for each patient. Faced with millions of infected people, the South African government balked at paying the bill. And President Thabo Mbeki controversially questioned the drugs' safety and effectiveness.

Venter, though, was a believer. Through clinical trials and an informal smuggling ring run by AIDS activists, the hospital was able to keep several hundred patients alive. Finally, international pressure on pharmaceutical companies brought down the prices of antiretrovirals, and even the sickest patients began to recover. Such results spurred a wave of optimism about treatment that eventually swept away political resistance to a mass rollout of antiretrovirals in Africa.

President Bush gave the effort a powerful boost in January 2003 by vowing to spend $15 billion to fight AIDS over the next five years. The South African government announced its own treatment program that August. And that Dec. 1, on World AIDS Day, the United Nations announced a goal of putting 3 million people on antiretroviral drugs by the end of 2005.

- - -

With international money flowing in, Johannesburg Hospital slashed the waiting lists at its AIDS clinic, added new patients and hired more staff.

The plastic chairs in its waiting room, which looks like a small bus station, filled up every morning but were virtually empty by noon because of the availability of doctors and drugs. New patients were typically prescribed antiretrovirals in a couple of weeks. The on-site pharmacy distributed the medicine in less time than it took to have a pizza delivered.

The government did little to publicize treatment programs; three times as many South Africans died last year of complications from the disease as started taking antiretroviral drugs. But a recent episode of the soap opera ``Isidingo'' featured a woman with AIDS whose boyfriend flew to London in search of a rare new antiretroviral, which on the show was called ``V.'' It saved her life.

The next morning, several patients at the clinic asked their doctors for ``V.''

Venter assured one of them, a woman in her 30s, that she could get ``V''--actually the relatively new antiretroviral tenofovir--but cautioned: ``You only really need it if you're having side effects. If your treatment's working, your treatment's working.''

Yet despite the speed with which antiretrovirals became more available, Venter said he never saw signs that treatment was contributing to a decline in new infections. As the drugs began to work, appetites for both food and sex returned. A startling proportion of the women--Venter estimated 5 to 10 percent--became pregnant, which he took as evidence that the clinic's efforts to distribute condoms were not working.

National prevention programs, which have emphasized condom use and HIV testing but rarely featured frank discussions of the dangers of multiple sex partners, have done no better, Venter said. Health officials have also shown little enthusiasm for expanding access to circumcision, despite research showing that it can dramatically slow the pace of new infections.
source:

``South Africa has had huge money poured into it for prevention and done diddly squat,'' he said.

Charity worker Ingrid Moloi, HIV-positive but her disease controlled by antiretrovirals, has seen the roster of AIDS orphans whose care she oversees continue to grow--it numbers 450 now. And as orphans reached their mid-teens, Moloi saw them adopting the same sexual behaviors that had led many of their parents to contract HIV.

Boys generally kept several girlfriends, and girls often had two or more boyfriends, she said.

``People are not abstaining. People are not using condoms,'' Moloi said. ``People say it's boring.''

A pregnant 16-year-old orphan only two years earlier had lost her own mother, probably to AIDS. Moloi learned from a neighbor that the girl had two boyfriends and urged her to take an HIV test. She refused.

``They are breaking my heart,'' Moloi said. ``I see AIDS. I'm not seeing life.''

- - -

Despite the growing availability of antiretroviral drugs, waiting lists in South Africa and other African countries often run into months. Because of heavy stigma, many of those with AIDS die without acknowledging they have the disease. And others living beyond the reach of the best health facilities struggle to find doctors who have access to antiretrovirals.

The international aid group Doctors Without Borders reported last month that severe shortages of doctors and nurses threaten to stall the rollout of AIDS treatment programs in southern Africa, home to the world's most severe epidemics.

Keeping patients on the medicine, which generally must be taken twice a day for the rest of their lives, has proved more daunting than health officials once predicted.

The World Health Organization reported in April that 1.3 million Africans were taking antiretrovirals, an increase from 100,000 just three years earlier. But most programs lack the ability to track how many of their patients continue taking the medicine.

Boston University epidemiologist Christopher Gill studied African treatment programs that did monitor the outcomes of all of their patients, a group that encompassed 66,753 people in 13 countries. Gill found that 40 percent of the patients could not be accounted for after two years, meaning that they had stopped taking their medicine, transferred to another program or died.

Johannesburg Hospital, with resources unimaginable in most of the continent, is doing much better.

Yet Venter has come to regard using antiretrovirals to fight an AIDS epidemic as akin to using chemotherapy and surgery to fight lung cancer. It would cost less, and save many more lives, to find some way to curb smoking.

At best, he estimates, South Africa's medical system might find a way to reach about half of those who need antiretrovirals, instead of the 20 percent receiving them now.

``On the public health level, it's not going to make much of a difference,'' he said. ``I don't think we're going to treat ourselves out of this epidemic. ... No way.''
source:www.cantonrep.com

Spread Of HIV In Africa Outpacing Treatment Efforts, Washington Post Reports

Although "billions of dollars are spent" on expanding access to antiretroviral drugs in Africa, the "goal of controlling" the spread of HIV on the continent "remains remote," the Washington Post reports. The "problem is not the medicine, which is among the most powerful in the world," according to the Post. Prevention programs in places like the U.S. and Europe already were successful against smaller-scale HIV/AIDS epidemics when antiretrovirals became available and created a "turning point in the battle against AIDS," the Post reports. However, prevention programs in sub-Saharan Africa "have mostly failed to curb the behavior -- especially the habit of maintaining several sexual partners at a time -- that drives the epidemic," according to the Post.

International health officials and HIV/AIDS advocates "once predicted" that expanding treatment access would improve prevention efforts by promoting openness about the disease and facilitating education efforts, the Post reports. But among the African countries most affected by the disease, only Zimbabwe -- which has one of the region's smallest treatment programs -- has reported a recent decrease in HIV cases.
source:www.medicalnewstoday.com

New amfAR research grants to optimize HIV treatmen

New amfAR research grants to optimize HIV treatment

HIV :: New amfAR research grants to optimize HIV treatment

amfAR, The Foundation for AIDS Research, will grant almost $1.2 million for 10 new research projects aimed at increasing understanding of the social and biological factors that influence the treatment of HIV/AIDS, Dr. Rowena Johnston, amfAR’s vice president of research.
Among those projects is a study exploring the potential benefits of maraviroc, a new antiretroviral drug expected to be approved by the FDA soon. Maraviroc works by blocking the cell surface protein CCR5 and thus preventing the virus from entering cells. amfAR funded research 10 years ago that played a leading role in spurring the development of maraviroc.

The drug also has the potential to prevent disease progression by reducing the activation state of the immune system, said Dr. Nancy Shulman of Stanford University and the Palo Alto VA Medical Center, who received the grant.

“Immune activation has been implicated in promoting HIV disease,” she said. “If maraviroc can decrease HIV disease both by blocking HIV entry into cells as well as decreasing immune activation, this could have implications for broadening the use of maraviroc – even in patients who might otherwise seem to be unsuitable candidates for the drug.”

amfAR will also fund several projects related to the social factors contributing to HIV infection, including one that examines how stigma associated with HIV affects the level of care that patients receive.

“Although progress has been made over the past 25 years in protecting the rights of people with AIDS, the stigma associated with being HIV positive can still contribute to lower quality health care in those with HIV infection,” Dr Johnston said. New research funded by amfAR and being conducted by Dr. Jennifer Sayles of the University of California, Los Angeles aims to identify factors that contribute to HIV-related stigma in women, with the long-term goal of improving the quality of their health care.

Also being funded by amfAR are several projects concerning recent recommendations by the U.S. Centers for Disease Control and Prevention (CDC) that HIV testing be included in routine medical care. The recommendations have raised questions about how best to implement testing among wide-ranging populations.

Dr. Marya Gwadz of the National Development and Research Institutes will study the impact that the recent recommendations will have on homeless youth. These young people are at particularly high risk for HIV infection and yet they are often not tested for the virus or do not return for test results.

And Dr. Roland Merchant, based at Brown University in Providence, RI, will compare the perceptions and success of current opt-in HIV testing procedures to the opt-out recommendations advanced by the CDC, in a study that will inform the implementation of the new recommendations around the United States.

“Despite the sophistication of health care in the United States, physicians are still grappling with overarching issues of identifying and appropriately caring for HIV positive populations,” Dr. Johnston said. “amfAR’s most recent research funding promises to make valuable contributions to optimizing the treatment of HIV infection.”

The recipients of this $1.2 million round of funding and their projects are:

Grants

Marya Gwadz, Ph.D.NDRI USA Inc., New York, NY$119,598Recent changes in HIV testing recommendations – Impact on youth at risk: Homeless youth are at particularly high risk of HIV infection and yet are often not tested for the virus or do not return for test results. Because the CDC has recently recommended that all people be tested for HIV, Dr. Gwadz plans to study how often homeless youth are tested, which factors influence their decision to be tested, and how HIV test counseling and access to medical care might change testing practices among homeless youth. Results of her studies will be used to design and test interventions aimed at increasing HIV testing rates in this population.

Elias Haddad, Ph.D.Université de Montréal, Quebec, Canada$107,568Impact of PD-1 on the establishment and maintenance of the HIV-1 reservoir: The PD-1 molecule has recently been shown to be associated with the reduced ability of certain immune cells to survive and proliferate during HIV infection. Dr. Haddad will test the hypothesis that PD-1, which is present in increased amounts in immune cells specialized to fight HIV, is also involved in the establishment and/or maintenance of the HIV reservoir. This reservoir contains HIV that is resistant to both antiretroviral therapy as well as the immune system’s efforts to destroy it, and so constitutes the major barrier to curing HIV infection. Discovering the role of PD-1 in establishing and maintaining the reservoir may lead to new therapies designed to eradicate the virus from the body.

Stephen Kent, M.D.University of Melbourne, Melbourne, Australia$120,000Establishment of the HIV reservoir during acute infection: The HIV reservoir, where HIV persists during the entire course of infection beyond the reach of the immune system or antiretroviral therapy, is the major hurdle that needs to be overcome in order to cure HIV infection. Scientists believe the reservoir is established during acute infection and so the most effective interventions aimed at eradicating it might have to be applied very early during infection. Dr. Kent plans to study the nature of the virus strains that become part of the reservoir, as well as the timing of the reservoir’s establishment, in order to gain a better understanding of how interventions designed to cure HIV infection must work.

Lori Leonard, Sc.D.Johns Hopkins School of Public Health, Baltimore, MD$120,000How to test – policy and practice after the CDC recommendations: The CDC has recently recommended that all patients seeking medical care be routinely tested for HIV. Dr. Leonard plans to investigate how doctors and adolescent patients implement these findings in a clinic in Baltimore, and how the low-income and mostly minority adolescents in that clinic respond to the implementation of these new testing guidelines. Via surveys and interviews, Dr. Leonard will gather information that will inform other regions around the United States on how to best implement the CDC testing recommendations.

Roland Merchant, M.D., M.P.H., Sc.D.Brown University, Providence, RI$120,000CDC HIV testing guidelines – unresolved ethical concerns: In response to CDC recommendations that all patients seeking medical care be routinely tested for HIV, Dr. Merchant and colleagues will conduct surveys of clinicians, advocates and patients regarding their concerns and experiences of opt-in versus opt-out HIV testing. Patients will be asked about their perception of coercion, how well they understand informed consent, and their knowledge of various HIV-associated risk factors and prevention. This study will lead to a greater understanding of the potential benefits and pitfalls, as well as outstanding ethical concerns, involved in the roll-out of routine HIV testing.

Robert Remien, Ph.D.Research Foundation for Mental Hygiene Inc, New York, NY$119,654Acute HIV Infection awareness and entry into care among high risk populations: The risk of transmitting HIV to others is particularly high during the first few months of HIV infection and as such represents an important time for counseling newly infected people as well as their partners. Dr. Remien will interview at-risk populations from community-based organizations, as well as physicians and test counselors, in order to develop an educational program aimed at raising awareness of the importance of acute HIV infection and promoting behavioral ski lls to minimize harm to both newly infected people as well as their partners.

Jennifer Sayles, M.D.University of California Los Angeles, Los Angeles, CA$120,000The impact of stigma on access to HIV treatment and care: The stigma associated with being HIV positive can be compounded by gender, race, poverty and other factors, all of which can contribute to lower quality of health care in those with HIV infection. Less is known about the contributions of these factors to health care quality in women compared to other populations. Dr. Sayles plans to test the validity of a new measure of HIV-related stigma in women, with the long-term goal of identifying factors that might guide future interventions to improve quality of health care in HIV-positive women.

Nancy Shulman, M.D.Stanford University and Palo Alto VA Medical Center, Palo Alto, CA$107,644Immunologic benefits of CCR5 inhibitor intensification: The new antiretroviral maraviroc works by blocking the cell surface protein CCR5 and thus preventing the virus from entering cells. Dr. Shulman postulates that the drug might also prevent disease by reducing the activation state of the immune system. Immune activation has been implicated in promoting HIV disease – if maraviroc can decrease HIV disease both by blocking HIV entry into cells as well as by decreasing immune activation, this could have implications for using maraviroc even in patients who might otherwise seem to be unsuitable candidates for the drug.

Fellowships

Christina Meade, Ph.D./Mentor: Steven Safren, Ph.D.Harvard Medical School, Belmont, MA$124,000Impulsivity, drug abuse, and HIV medication adherence – an fMRI study: While it is well known that drug abusers tend not to adhere as well to antiretroviral therapy as those who do not use drugs, the cognitive and biological mechanisms linking drug abuse with poor adherence are not completely understood. Dr. Meade, who has won several pre-doctoral awards and has been invited to present her work at several conferences around the world, will use functional MRI brain scans to compare the brain functioning of cocaine abusers and those with no history of drug abuse while they conduct a cognitive test designed to measure decision making processes. The results of her studies may be used to design interventions to improve adherence to antiretroviral therapy among drug users.

Miranda Xhilaga, Ph.D./ Mentor: Sharon Lewin, Ph.D.Monash University, Melbourne, Australia$125,000 Viral persistence in MGT of RT-SHIV infected macaques on HAART: se xual transmission remains the leading cause of new HIV infections, and many cases are due to the presence of HIV in semen. The extent to which the virus can survive and persist in semen when the patient is taking antiretroviral therapy is unclear. Dr. Xhilaga, the recipient of several previous graduate and postdoctoral awards, including the prestigious Fellows Award for Excellence in Research, will conduct systematic studies in several regions of the male genital tract of monkeys, testing the ability of the virus to persist during the early stages of infection and in the presence of antiretroviral therapy. Her studies will determine the importance of the reservoir of virus in semen as a target for therapies aiming to cure HIV infection.
source:www.spiritindia.com

UN to ensure patient confidentiality in HIV data collection

HIV :: UN to ensure patient confidentiality in HIV data collection

Aiming to protect the almost 40 million men, women and children living with HIV from potential stigma and discrimination, the main United Nations agency dealing with AIDS released new guidelines to ensure that patient confidentiality is not compromised in the process of collecting and storing information on the virus.
The Interim Guidelines on Protecting the Confidentiality and Security of HIV Information were developed through a workshop supported by the Joint UN Programme on HIV/AIDS (UNAIDS) and the United States President’s Emergency Plan for AIDS Relief.

According to the guidelines, using data for public health goals must be balanced against the rights of individuals to privacy and confidentiality. Among the recommendations, they call for countries to adopt privacy and confidentiality laws.

“Ensuring this information is securely stored and confidentially maintained will avoid potential stigmatization and discrimination of individuals and communities, and enhance the quality of the information collected,” said Eddy Beck, UNAIDS Senior Technical Officer.

Together, stigma and discrimination constitute one of the greatest barriers to dealing effectively with the epidemic, according to UNAIDS. They discourage governments from taking timely action against AIDS, and they deter individuals from finding out about their HIV status.

They also inhibit those who know they are infected from sharing their diagnosis and taking action to protect others and from seeking treatment and care for themselves, the agency said.
source:/www.spiritindia.com

US HIV testing day

AIDS (Acquired Immunodeficiency Syndrome or Acquired Immune Deficiency Syndrome, sometimes written Aids) is a human disease characterized by progressive destruction of the body's immune system. It is widely accepted that AIDS results from infection with HIV (Human Immunodeficiency Virus).

On National HIV Testing Day at events across the United States, thousands of Americans will obtain a potentially life-extending piece of information: their HIV test result.

Whether they test positive or negative, all of them will be taking an important step in protecting their health and the health of their loved ones and advance our nation’s fight against the spread of HIV.

Of the more than 1 million Americans now estimated to be living with HIV, one-quarter do not realize they are infected. As a result, they do not receive medical care that could help them live longer, fuller lives. And without knowing it, they may also be transmitting HIV to others. CDC estimates that the majority of se xually transmitted HIV infections are transmitted by people who are unaware of their infection.

A combination of HIV testing approaches is needed to make sure all Americans learn whether they are infected with HIV. Everyone should have the opportunity to get tested when they visit a doctor, an emergency room, or some other health care provider. CDC recommends routine HIV screening for all patients aged 13 to 64 in health care settings. At the same time, we need innovative programs that take HIV testing and counseling services straight to people at risk, in their own communities. From testing events at local places of worship to outreach with mobile vans and testing at community events, efforts are underway across the United States.

source:www.spiritindia.com

HIV-AIDS bill In India by this year

AIDS (Acquired Immunodeficiency Syndrome or Acquired Immune Deficiency Syndrome, sometimes written Aids) is a human disease characterized by progressive destruction of the body's immune system. It is widely accepted that AIDS results from infection with HIV (Human Immunodeficiency Virus).

HIV :: HIV-AIDS bill In India by this year

As the government continues deliberations with NGOs over the HIV/AIDS bill, the legislation aimed at preventing discrimination of those infected with the dreaded disease at workplace, education and healthcare sectors, has been delayed.
"The HIV/AIDS bill has been delayed because we are still carrying out discussions with more NGOs on the issue," Indian Health Minister Anbumani Ramadoss told PTI.

The minister had earlier announced that the bill will be introduced in the Budget session of the Parliament.

"We plan to bring it by this year," he said.

The bill has been drafted by the Lawyers Collective HIV/AIDS unit in consultation with the government, people living with HIV, healthcare providers and NGOs.

It addresses the issue of discrimination in employment, healthcare, education and other places, besides informed consent for testing, treatment and research.

The bill also envisages to provide a safe working environment for healthcare workers.

It also proposes protection of inheritance and property rights and recognises community-based alternatives to institutionalisation for vulnerable and affected children.
source:www.spiritindia.com

Treatment outcomes of patients with HIV and tuberculosis

AIDS (Acquired Immunodeficiency Syndrome or Acquired Immune Deficiency Syndrome, sometimes written Aids) is a human disease characterized by progressive destruction of the body's immune system. It is widely accepted that AIDS results from infection with HIV (Human Immunodeficiency Virus).
HIV :: Treatment outcomes of patients with HIV and tuberculosis

In a retrospective study of 700 patients with culture-positive tuberculosis (TB), relapse rates were found to be significantly higher in HIV-infected patients compared to HIV-uninfected patients following a rifamycin-based regimen.
Furthermore, TB relapse rates were higher in HIV-infected patients who received intermittent or standard 6-month therapy when compared to those receiving daily or longer treatment.

The results appear in the first issue for June 2007 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

Payam Nahid, M.D., M.P.H., of the University of California, San Francisco General Hospital, and eight associates reviewed TB cases reported to the San Francisco Tuberculosis Control Program from January 1, 1990, through December 31, 2001.

As a rationale for their study, the researchers state that the optimal duration of TB therapy in HIV-infected subjects is unknown and may differ from HIV-uninfected individuals.

According to the authors, the current preferred regimen for treating drug-susceptible TB in HIV-uninfected patients is a 6-month, rifamycine-based regimen that includes pyrazinamide during the first two months. Current guidelines for the treatment of TB do not distinguish between those infected with the virus that causes AIDS and those who are uninfected in terms of the optimum length of treatment when using rifamycine.

"Standard 6-month therapy may be insufficient to prevent relapse in patients with HIV," said Dr. Nahid.

The TB relapse rate for HIV-infected patients was found to be 6.6 percent versus 0.8 percent in uninfected/unknown patients. This finding was in contrast to other studies that did not find any significant difference between HIV-infected and HIV-uninfected/unknown patients. However, this finding was corroborated by a similar study that also used molecular genotyping as a relapse indicator.

HIV-infected patients who received 6 months of rifamycin-based TB treatment or who were treated intermittently (one to three times per week), were four times more likely to have a reoccurrence than those r who took their medicine daily or who were treated for longer periods.

The study also found that the use of highly active antiretroviral therapy (HAART) during TB treatment was associated with a faster Mycobacterium tuberculosis negative culture conversion, and an improved survival rate. Prior studies by others have shown HAART treatment beneficial in preventing TB in HIV-infected individuals, but reported no beneficial TB treatment outcomes.

HIV-infected patients were significantly more likely to develop drug resistance (4.2 percent in HIV-infected versus 0.5 percent in HIV-uninfected) to rifampin , and to experience adverse reactions to TB regimens.

The investigators noted that there is a need for large randomized clinical trials to establish the optimal duration for TB therapy in HIV-infected patients, and the timing of HAART treatment in patients with HIV-related TB.

According to an editorial commenting on the research in the same issue of the journal, future HIV-related TB treatment regimens and relapse studies should broaden their focus to include rates of acquired drug resistance. The editorial cites a report published in the Lancet of an extensively drug resistant TB strain found in a HIV co-infected South African patient as particularly worrisome.

Citing the journal article, the editorialists also cast the HAART findings (quicker reduction of mycobacterial burden) as relevant in deterring TB drug resistance. They suggest that short-course, intermittent regimens may be necessary in areas where resources are limited, and that additional research on regimens (including the use of secondline drugs) suitable for field use must continue.
source:www.spiritindia.com