Eliminate HIV

‘UNIVERSAL VOLUNTARY HIV TESTING WITH IMMEDIATE ANTIRETROVIRAL THERAPY AS A STRATEGY FOR ELIMINATION OF HIV TRANSMISSION: A MATHEMATICAL MODEL’

In November 2008, an article was published in the renowned medical journal, the Lancet. The article is co-authored by Reuben Granich, Kevin de Cock and Charlie Gilks. The authors of the article are leading members of World Health Organization (WHO) HIV and TB team, but the study is an independent work that has not been endorsed by the WHO. Based on computer modeling, the authors argued that universal HIV testing, followed by the immediate initiation of ART for those who were HIV-positive, could virtually eliminate HIV transmission in the future and reduce the number of people developing AIDS by 95%.

The article aroused heated debate amongst HIV activists, healthcare workers, scientists and officials at organizations like UNAIDS and the World Health Organization (WHO). The debate focused on the human rights implications of the implementation of universal mandatory testing, the potential criminalisation of HIV transmission, and the lack of consideration given to the negative outcomes proven to be associated with universal mandatory HIV testing. However debaters agreed that it is essential that new information that presents the possibility of a solution to HIV epidemic must be seriously considered and researched.

The WHO will hold a consultation in Geneva to discuss the implications of the article. From 28 – 30 April, TAC representatives attended a meeting organized by the AIDS and Rights Alliance of Southern Africa (ARASA) and the Open Society Initiative for Southern Africa (OSISA) in Johannesburg to discuss the article and to formulate a position with other Southern African HIV activists. This position will be presented at the WHO meeting in Geneva. TAC’s briefing on the article is being finalized, and district workshops are planned to discuss the contents of the article and the responses of TAC members to the strategies it proposes. Please click here for TAC’s full brief and response.

HIV-Positive People at Increased Risk of New Flu Strain

HIV-positive people worldwide are at an increased risk of the H1N1 flu strain, the World Health Organization said on Saturday in guidelines for health workers published on its Web site, Reuters India reports. According to WHO, people with immodeficiency diseases, such as HIV/AIDS, likely will be vulnerable to complications related to the flu strain, just as they are from the seasonal flu, which results in about 250,000 to 500,000 deaths annually. According to WHO, the H1N1 strain and HIV could prove to be a hazardous combination, similar to HIV and tuberculosis. "Although there are inadequate data to predict the impact of a possible human influenza pandemic on HIV-affected populations, interactions between HIV and A(H1N1) influenza could be significant," WHO said, adding that HIV-positive people "should be considered as a high risk and a priority population for preventive and therapeutic strategies against influenza, including emerging influenza A(H1N1) virus infection."

According to WHO, countries with high HIV/AIDS burdens, many of which are in Africa, should ensure that vulnerable people have drug access, including to medicines such as Tamiflu and Relenza. The agency added that it is best if people with the flu strain take antiviral drugs within 48 hours of the onset of symptoms. In addition, there are no known issues with taking flu medications with antiretroviral drugs, according to WHO (MacInnis, Reuters India, 5/2).

Life Insurance for HIV-Positive People

The insurance company Prudential will begin to offer life insurance policies to HIV-positive people in the United Kingdom, London's Daily Telegraph reports. According to the Telegraph, PruProtect -- a partnership between Prudential and a South African firm -- initially will offer the insurance to 7% of HIV-positive people and hopes to extend coverage to 20% of HIV-positive people. The policy will offer up to 250,000 British pounds -- or about $368,000 -- for a maximum of 10 years. The policy premiums will be higher than standard premiums for life insurance "to accurately and fairly reflect the risks involved." Premiums will be determined on an individual basis and dependent on medical history, the Telegraph reports.

Kevin Carr, director of protection development at PruProtect, said, "We are pleased to be the first mainstream insurer to provide life cover for people living with HIV," adding "I believe it is better to provide some cover for some people than nothing at all." The Terrence Higgins Trust said, "We welcome this move from PruProtect and are glad to see an insurer who recognizes the reality of living with HIV in the U.K. in the 21st century." The group added that it "hope[s]" the program "will be the start of a wider move to offer appropriate financial products to people with HIV" (Simon, Daily Telegraph, 4/29).

Australia Harm Reduction Strategies Serve as Model for Other Countries

The Australian government's efforts to curb the spread of HIV by advocating harm-reduction initiatives, such as needle-exchange programs and drug substitution therapy, for injection drug users serve as a model for other countries throughout the region, UNAIDS Asia Pacific Director Prasada Rao said recently, the AAP/Sydney Morning Herald reports.

Rao said that Australia has called on Asian states to increase harm-reduction programs and examine current drug laws, especially in those states where penalties for drug users can include the death penalty. Rao said, "Australia is a good model for harm reduction programs and also for looking at drug laws and revamping them. In fact, quite a few countries in Asia have learned their harm reduction strategies in good examples from Australia." Parliamentary Secretary for International Development Assistance Bob McMullan said that it is still possible for countries to adopt effective prevention and harm reduction strategies to combat HIV without encouraging drug use. He said that a "very big important part of the Australian government policy" is working "strongly" with drug users. He added that "in terms of reducing the spread of HIV, we have to focus on prevention." Rao's comments came as McMullan announced an additional 640,000 Australian dollars, or about $470,000, for nongovernmental organizations working in Asia (Corben, AAP/Sydney Morning Herald, 5/3).

HIV-Positive People in Wales Denied Treatment

Some HIV-positive people in Wales are being denied medical treatment for common illnesses, Olwen Williams, a physician specializing in sexually transmitted infections, said recently, BBC News reports. Williams noted that primary care physicians often refer HIV-positive people to hospitals or HIV specialists for common conditions, such as colds.

The British Medical Association denied that physicians are discriminating against people living with HIV/AIDS and said that some physicians might be more cautious in referring HIV-positive people to specialists. However, Williams said that HIV-positive people are experiencing "very subtle" discrimination, adding that they might disclose their HIV status to a provider and be told they need to visit their HIV specialist. "If I was someone with cancer and I went to a [PCP] with common cold and I was told, 'Sorry, I can't deal with that' because I've got cancer I'd be so amazed -- that's what our patients our experiencing," Williams said, adding that such practices "den[y]" care to HIV-positive people "at a point where they actually need it." Williams added, "My concern here is that we've still got fear and prejudice and ignorance that's actually driving discrimination and stigma in Wales. And I think this is something major that we have to tackle."

Andrew Dearden, chair of the British Medical Association's Welsh council, said it is "unprofessional and unethical" for physicians to discriminate because of an illness. Dearden added that some physicians might not feel they have adequate training to treat some conditions. "Remember that doctors always refer patients to other doctors ... when they feel there's a need for extra information, diagnosis, tests or treatment," Dearden said. A recent study found that about half of HIV-positive people in the United Kingdom had experience discrimination from a health worker in the previous year, according to a spokesperson from the Terrence Higgins Trust (BBC News, 5/1).

Economic Downturn Likely To Threaten HIV Treatment

IRIN/PlusNews on Wednesday examined a World Bank report published last week that suggests the current economic downturn could threaten antiretroviral treatment access for about 1.7 million HIV-positive people by the end of 2009. According to the report, developing countries could face drug shortages, treatment interruptions and an increase in HIV prevalence as a result of the global economic situation.

According to IRIN/PlusNews, the downturn is likely to have the greatest impact on programs in Southern and Eastern Africa. In addition, many HIV/AIDS programs in this region are heavily reliant on donor funding and have limited support from local governments, IRIN/PlusNews reports.

Joy Phumaphi, World Bank vice-president for human development, said that "[s]ocial services are likely to suffer as governments cut back on spending, currencies devalue and external aid donors come under pressure to maintain existing levels of foreign assistance." Tanzania this year announced plans to reduce its national HIV/AIDS budget by 25%, and similar actions in Kenya and Sudan already have led to medical supply shortages. According to the report, funding reductions might lead countries to reduce emphasis on prevention programs and instead allocate money for treatment initiatives, which produce short-term, easily measurable benefits. According to IRIN/PlusNews, groups such as commercial sex workers, injection drug users and men who have sex with men will likely be the hardest hit by reductions in prevention programs.

Although many countries will face difficult choices during the economic downturn, the report recommends that nations receiving substantial amounts of international assistance use early warning systems to identify any potential drug and funding shortages and avoid treatment interruptions (IRIN/PlusNews, 4/29).

The report is available online (.pdf).

Early HAART Initiation Improves Vaccine Response Among HIV-Positive Children

HIV-positive infants who begin treatment with highly active antiretroviral therapy within the first year of life can develop normal immune responses to childhood vaccines, according to a study published online Monday in the Proceedings of the National Academy of Sciences, Reuters Health reports. Vaccines function by stimulating the production of antibodies for a particular disease, but HIV causes a decline in these antibody-producing cells and therefore reduces immunity. Prior to the new study, researchers were unsure whether the timing of HAART initiation could help preserve these cells and promote normal immune responses to vaccines among children.

For the study, Paolo Rossi of the University of Tor Vergata in Rome and colleagues examined 70 children who contracted HIV through mother-to-child transmission and 50 HIV-negative control participants. Of the HIV-positive children, 13 received HAART during their first year, six received no treatment and the remaining children received therapy later in life. All of the children in the study group received the recommended vaccinations for measles and tetanus. According to the study's findings, children who received HAART during their first year maintained normal levels of antibody producing cells, while children in the other groups had lower levels of these cells.

According to Rossi, the timing of HAART initiation is a key factor in determining whether HIV-positive children will develop normal vaccine responses and how long the response will last. The authors write that their findings support early HAART initiation for the purpose of preserving normal immune responses among HIV-positive infants. However, they add that health officials might need to revise vaccine schedules for HIV-positive children who begin treatment after the first year of life (Reuters Health, 4/29).

An abstract of the study is available online.