Chronic Diseases must learn from HIV/AIDS

African Institute for Social Development(AISD) support and welcome the global intitiative to integrate Health in HIV activities. AISD Director, Mr Amdani Juma, who firmly believes in integrating health in HIV has started to get support from both national and international voices. in our news update

 September 2011 - Health officials in sub-Saharan Africa are finally focusing on non-communicable diseases (NCDs) such as cancer, diabetes and chronic lung disease, having spent much of the past decade concentrating on HIV/AIDS and malaria.


The growth of NCDs in developing countries has gone almost unnoticed, having been largely perceived as a problem affecting affluent countries. But NCDs have overtaken infectious diseases as the leading cause of death worldwide, with nearly 80 percent of these deaths occurring in low- and middle-income countries, according to the World Health Organization (WHO).

The UN High-level Meeting on NCDs on 19-20 September sought to identify concrete actions to tackle the issue. The last time the UN held such a meeting on a disease was 10 years ago for HIV/AIDS and the similarities do not end there.

Countries grappling with HIV prevalence are now faced with rising epidemics of chronic diseases. UNAIDS has warned that diabetes cases, for example, will rise by 50 percent globally and by 100 percent in sub-Saharan Africa between 2010 and 2030.

As more HIV-positive people access antiretrovirals and live longer, their risks of contracting illnesses such as diabetes and heart disease are growing. In South Africa, the fourth most common cause of death in people living with HIV is hypertension, while diabetes comes in at number six.

Great resource
According to Miriam Rabkin, director for health systems strategies at Columbia University's International Center for AIDS Care and Treatment Programs (ICAP), HIV and NCDs are often seen as completely separate challenges.

"In fact, HIV and NCD departments are often siloed and separated at every level of the health system, from the health facility to the Ministry of Health, up to the WHO. But from a health systems perspective, HIV, a chronic communicable disease, and NCDs, chronic non-communicable diseases, actually have a great deal in common and it is important for us to learn from each other," she told IRIN/PlusNews.


"In many countries, HIV programmes are actually the first large-scale chronic disease programme, and can be a great resource... it's important to avoid 'reinventing the wheel'," Rabkin noted.


The responses to HIV and NCDs can take similar approaches, including appointment and medication reminders, transport support, and counselling to support adherence and ongoing behaviour change
 
In 2010, Columbia University and the Ethiopian Diabetes Association conducted a study looking at whether the tools and approaches used for HIV could be applied to the care of adults with diabetes. "It was a small study, but we did show that the quality of care for diabetes improved quite rapidly over a period of six months," said Rabkin.


However, Catherine Hankins, scientific adviser for UNAIDS, suggested more could be done to integrate the treatment of chronic diseases into the health sector. "Pregnant women who get gestational diabetes - what happens to them? You may have an antenatal system that has worked really well now for HIV. You know to put them on antiretroviral treatment, but then maybe there is no referral set-up for diabetes because there is no diabetes care," Hankins told IRIN/PlusNews on the sidelines of the recent AIDS Vaccine conference.

Countries are slowly beginning to combine HIV services with chronic disease care. According to Shanthi Mendis, coordinator of WHO's Chronic Disease Prevention and Management, HIV services and cervical cancer screening have been integrated in some settings. Kenya's Ministry of Health and the Kenya Cardiac Association have begun to screen people tested for HIV for hypertension, and to refer them to the appropriate care and treatment services.

Funding gap

Funding, or lack thereof, however, remains a problem for both HIV/AIDS and NCDs - more so for chronic diseases that lack the high-profile activist campaigns and celebrities found in the AIDS sector.

The US Centre for Global Development estimates that less than 3 percent (US$503 million) of the almost $22 billion spent in 2007 on global development assistance for health was spent on NCDs.

"We can be efficient and creative; we can avoid redundancies and build on the lessons of HIV scale-up. But the idea that because we have invested so heavily in HIV we can somehow treat NCDs for free is a dangerous illusion," Rabkin cautioned.

Mendis admitted that social and community mobilization for chronic diseases will "require more advocacy and will take more time", unlike AIDS, which had had a "devastating impact" on families and societies and galvanized communities quicker. "NCDs impact on families but... the impact is more prolonged... People with HIV provide a powerful image of sickness. NCDs, on the other hand, are silent killers and most of the time do not even cause symptoms."
 
You can also find Foreign Affairs .
 
The African Institute for Social Development (AISD)  started , since 1999,to integrate Health in HIV activities and have been inviting local NHS workers to work in collaboration to promote general health and prevent ill health in the community as African are disproportionately affected by Mental Health conditions, TB, Diabetes, Cancers, Heart Diseases etc... these are due to many factors affecting a newly arriving community  including poverty, late presentation and lack of information and advice of how to prevent diseases and keep a healthy live. 
 
African Health Policy Network(AHPN) formaly African HIV Policy Network once our HIV umbrella have now become our Health umbrella and this move have been very well received by AISD both members and clients. AISD can continue to get support both on research and policy from the AHPN and can continue to be an ecceftive regional hub feeding to the national and international work
 
end of news update      
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Better Hope to have healthy children with HIV

First UK use of PrEP for couples hoping to have a Child African Institute AISD looks into the benefits of PrEP Roger Pebody Published: April 2011

Pre-exposure prophylaxis is starting to be used in the UK, to help HIV-positive men and their HIV-negative female partners have children together, Yvonne Gilleece told the British HIV Association (BHIVA) conference in Bournemouth last week. Only a handful of couples have used the procedure so far, but there have been no HIV transmissions. Also this month, other research has shown how couples wishing to conceive value the ‘normality’ that a pregnancy signifies, but find that a medical intervention like sperm washing undermines this normality. When antiretroviral treatment reduces a partner’s viral load to an undetectable level this can enable couples to feel more confident about conceiving through ‘real sex’.

Pre-exposure prophylaxis

Pre-exposure prophylaxis (PrEP) is the use of antiretroviral drugs by HIV-negative people to help prevent infection. Last year an international trial showed that daily PrEP substantially reduced infections in men who have sex with men. European clinicians have previously described using PrEP as an additional tool, alongside HIV treatment that reduces the HIV-positive partner’s infectiousness, to allow heterosexual couples to have timed intercourse in order to achieve a pregnancy, with a low risk of HIV transmission. At the BHIVA conference, Dr Gilleece outlined the pre-conception services provided by the Royal Sussex County Hospital in Brighton and Birmingham Heartlands Hospital. These clinics work with both local couples and those who have been referred from other hospitals. Couples require extensive information, discussion and counselling before proceeding. It is important to explore other options such as sperm washing and adoption, as well as to fully explain the available data on HIV treatment and infectiousness. Moreover, couples need to have a ‘no blame’ attitude and to have considered the worst-case scenario. Because this use of antiretroviral drugs is unlicensed and a risk of HIV transmission remains, couples must provide written consent before proceeding. Gilleece noted some of the reasons couples choose to use pre-exposure prophylaxis - they may be unable to obtain NHS funding for sperm washing (particularly if they already have a child) and unable to pay for sperm washing privately. Sperm washing requires travel to London and disruptive procedures, whereas when using PrEP, conception may feel more natural. However there are a number of situations where the use of PrEP would be inappropriate – when a partner is co-infected with hepatitis, when fertility interventions are required, when HIV viral load is detectable in blood or semen, or when a partner is very anxious about HIV transmission. The HIV-negative partner is advised to take one or two doses of tenofovir or Truvada (tenofovir and FTC combined in one pill) between 24 and 36 hours before sex, and then another dose one to two hours afterwards. Couples are advised to limit unprotected sex to the days of the month during ovulation (and taught how to do so). Only five couples have gone through the programme so far. There have been four pregnancies, resulting in one live birth, one pregnancy that is still ongoing and two miscarriages. One couple stopped using PrEP when the male partner had a series of viral load blips (all men had an undetectable viral load on entering the programme). Couples had unprotected sex an average of three times before pregnancy was achieved (minimum one, maximum five). These numbers are far too small to give any reliable data on safety, but there have been no HIV transmissions. Gilleece said that these early data – the first from the UK – suggests that the approach is a safe and effective way of reducing risk. Demand for it is likely to increase, but current PrEP trials are not exploring this approach. She said that other UK clinics should only use PrEP in collaboration with more experienced centres, and that data from across the UK should be gathered collectively in order to assess the safety and efficacy of PrEP on a larger scale.

Assessing risk

A separate study of men and women in sero-different couples (where one person has HIV and the other does not) has shed light on how risks and interventions are weighed up when there is a desire to have a child. Carmel Kelly conducted in-depth, qualitative interviews with six women and four men living in Northern Ireland. Some of the participants were HIV-positive and others were HIV-negative, but each had a partner of a different HIV status. The participants were born variously in Ireland, Africa and Eastern Europe. For each interviewee, decisions about having children could no longer be taken for granted or made without discussion with clinicians. Biomedical understandings of risk and possibilities became central to their plans for the future. In fact some participants had previously assumed that it would now be impossible to have a child, and dialogue with HIV clinicians helped many understand and believe that having a baby in the context of HIV was relatively safe and normal. However these feelings could sometimes be challenged by distressing encounters with fertility specialists and other non-HIV clinicians who questioned a person’s aspiration to have a child. “He [doctor] said, ‘I have to think about the protection for my nurses and the doctors and you also have to think about the protection of your wife’. Now he made me feel that I was a threat to the entire medical staff and my family. And I had gone there for help. I didn’t go there to be told, as if I was a divisive enemy or weapon.” Participants talked about how having HIV had affected their sex lives and about wanting things to be as ‘normal’ as possible. Several of the men put a particular value on unprotected sex, which was felt to be ‘real sex’. “I am here trying to cope with treatment, not telling people my diagnosis and now I can’t even have my wife. For how long? A night? Two months? A year? Two years? No. Forever. From now onwards sex is out of the question. I mean real sex. Now that is another prison. Another sentence.” The women were more likely to find condoms acceptable. They were more likely to enjoy sex when they knew they were protecting their partner from HIV. For several interviewees, the decision to have a child with their partner was a key step in their relationship and was a sign of normality for each other and for the outside world. One HIV-negative woman explained how her pregnancy would provide a distraction to community members who had suspicions about her partner’s HIV status. Another interviewee struggled to find the English to explain how fundamental the desire to have a child was to his sense of self. “Since then I have had that idea of having a baby because I consider myself a human being. I was someone who (my English find it hard) to procreate. When we are healthy, when we are born and grow up we have that idea to procreate because we were procreated... But when I became HIV positive I think it is finished for me. I can’t have anymore. Having one woman, one wife and having healthy kids. These things affect me very much. When I think about it I think I am not useful anymore for people... I take the risk to do it because I want to feel as a man.” But the same man and his wife were uncomfortable with the idea of sperm washing: “I talk to the doctors. We discuss, they told me, they showed me the way I could have a baby without harming the baby is [sperm] washing... It is not how people want it. They want to have a baby a normal way, you know. Like my wife, when we discuss, she said, ‘no’, she can’t do this. It is better not having a baby. She born, when she born, she didn’t born that way. All babies she going to have in the future she want to have them the way she was born, normal way, you know.” Sperm washing involves the man’s sperm being treated in a laboratory before it is artificially inseminated in his partner. The high cost of the procedure means that there can be wrangles with health bodies over payments and availability. Each attempt at a conception (of which there may be several) requires a trip to London. Another man had considered sperm washing but expressed his preference for a pregnancy “the normal way, without any of the interventions”. It is notable that the reduction of viral load through antiretroviral treatment felt normal to him and was not perceived to be an extra intervention. “You know they had suggested the various ways of how we could do it and we sat down and we discussed it and thought, ah well, seeing that I have been able to control the virus, and maintaining the viral load we will just do it the normal way, without any of the interventions.” A number of participants had had unprotected sex on numerous occasions (sometimes including a period before HIV had been diagnosed), and this informed a faith or confidence they had in the possibility of having sexual relations without transmission occurring. This faith had been augmented by a growing awareness of the relevance of medication and viral load to transmission risks. One HIV-negative woman explained how the transmission risk came to feel unexceptional to her. “The second time [second pregnancy] it had become quite normal. You know it was not a big deal... You know, having unprotected sex with someone who is HIV-positive to become pregnant. To another person would be, like ‘what, you have done what, are you crazy?’ you know whereas to us now it’s like, you know, yeah, if you want to have another one.” However her confidence in a low transmission risk applied only to times when she was trying for a baby; unprotected sex was not an option at other times. Concluding her study, Carmel Kelly says that her findings demonstrate how personal priorities and meanings are central to the negotiation of risk in sexual relationships. Biomedical understandings of risk (including those based on viral load) are balanced against a broader set of expectations, meanings and desires.

References

Gilleece Y et al. Pre-exposure prophylaxis exposure for conception as a risk-reduction strategy in HIV positive men and HIV negative women in the UK. 17th annual British HIV Association conference, Bournemouth, abstract O27, 2011.

Amdani Juma the Director of AISD would like to extend our thanks to NAM and all our NAHIP partners for the valuable work we all provide nationally and those who read us internationally.

Please contact us at africaninstitute@live.co.uk, visit us http://www.africaninstitute.org.uk/, and http://www.doitright.uk.com/ text us on 07834459076 or call us free on 0800 0967 500 for HIV and Sexual Health information and advice it doesn't matter whether you speak English, French, Arabic, Swahili, Shona, Luganda, Lingala, Portiguese etc... we are here happy to help and we are always recruiting more volunteers for healthier and better communities

HIV costs lives and funds as we age and can be prevented

African Institute AISD is looking at HIV, Aging and other health conditions linked to HIV from our NAM updates Jan 2011

Thanks to treatment, many people with HIV can expect to live well into old age.

But there is concern that some people with HIV are developing diseases associated with older age sooner than would be expected in the general population.
The causes aren’t clear, but they could include damage caused by HIV, lifestyle factors such as smoking, and the side-effects of some anti-HIV drugs.
Now US researchers have found that ‘ageing’ of the immune system may increase the risk of cardiovascular disease for HIV-positive women.
The immune system deteriorates as we age. For this study, doctors in New York compared the immune function of HIV-positive and HIV-negative women. They found that women with HIV were more likely to have an ‘aged’ immune system.
This was linked to changes to the carotid artery that can increase the long-term risk of cardiovascular disease.
Separate research has also shown that some diseases of old age meant that people with HIV were less able to perform daily tasks.
But overall the study showed that differences in physical function between HIV-positive and HIV-negative people were small.
Staying active and exercising regularly were associated with an improved ability to perform daily tasks.
The December edition of HIV Treatment Update includes a report (‘The prescription for old age’) on the recent British HIV Association community symposium on ageing.
HIV Treatment Update is available free to anyone affected by HIV – and paid subscriptions are available to professionals. Contact us on 020 7840 0050 or info@nam.org.uk for more information, or browse the online archive for a flavour of the content.

Cost of HIV care in the UK

The annual cost of HIV treatment and care in the UK could be over £750 million by 2013, a new study suggests.
The National Health Service (NHS) provides some of the best quality HIV treatment and care in the world. Taxation funds the NHS. All the services and treatment provided by NHS clinics are free at the point of delivery to people who are entitled to use the NHS for free.
Annual HIV costs increased substantially between 1996 and 2007, and researchers think they’ll increase still further, reaching around £750 million by 2013.
The increases in cost are because treatment means that people with HIV are living longer and treatment is lifelong. They are also due to high levels of new diagnoses.

Analysis conducted by the researchers showed that early HIV treatment, and therefore reducing levels of HIV-related illness, was cost-effective – the cost of HIV treatment and care increased as patients became sicker.

But they think that the only real way to reduce costs is to cut the number of new infections. They call for increased emphasis on HIV prevention. and AISD director, Mr Amdani Juma, stressed this as it is the good deal for our communities who represent the real future active population who contribute into the UK economy and form an important source of income for their large and needy families in Africa


Once-daily darunavir approved for treatment-experienced patients

The boosted protease inhibitor darunavir (Prezista) is an important treatment option for people who have been on other anti-HIV drugs.
This powerful drug usually works against HIV that is resistant to other protease inhibitors.
It’s now been approved for once-daily dosing for treatment-experienced adults, as long as they don’t have any resistance to the drug.
The once-daily dose is 800mg, taken as two 400mg tablets, with 100mg of ritonavir (Norvir).
But treatment-experienced patients are recommended only to take the once-daily dose if their CD4 cell count is above 100 and their viral load below 100,000 copies/ml.
Patients with a lower CD4 cell count or a higher viral load should take the twice-daily dose – 600mg darunavir with 100mg ritonavir.


HIV and cardiovascular disease – stroke

The proportion of HIV-positive patients in the US hospitalised because of stroke has increased, new research shows.
Researchers looked at admissions to hospitals because of stroke between 1997 and 2006.
Stroke can occur when arteries are damaged by factors such as smoking or the build-up of cholesterol.
In 1996, just 0.09% of stroke patients were HIV-positive. This had increased by 67% to 0.15% in 2006.
The number of people with HIV admitted to hospital because of stroke increased from 888 in 1997 to 1425 in 2006.
The researchers also noticed that it was only strokes caused by blocked blood vessels in the brain that were increasing.
Stroke occurred at a younger age in HIV-positive patients than HIV-negative individuals.
Reasons for the increase in stroke may include the inflammatory effects of HIV, or increases in cholesterol caused by some anti-HIV drugs.
Screening for the early warning signs of cardiovascular disease is an increasingly important component of HIV care.

Fatty liver disease and hardening of the arteries

US researchers have found a possible early warning sign of future heart problems.
Research involving 223 adults showed that hardening of the coronary artery was associated with fatty liver disease.
Just over a third of patients had some evidence of hardening of the coronary artery, and 13% had fatty liver disease.
Overall, 59% of patients who had a fatty liver also had hardening of the arteries.
The researchers conclude, “Fatty liver disease is associated with underlying cardiovascular disease and should be considered as a novel marker for risk stratification among HIV-infected persons.”

Predicting the success of HIV treatment

Researchers have developed an online computer programme that can help doctors choose the best possible combination of anti-HIV drugs for patients who’ve taken a lot of treatment in the past (‘treatment experienced’).
The programme considers factors such as resistance, treatment history, CD4 cell count and viral load and then suggests the five most appropriate drug combinations.
Two studies showed that doctors found the programme useful, but they sometimes changed the combinations suggested by the programme to take into consideration the preferences of their patients.
The programme is still in development, and its researchers have emphasised that it’s intended to be used by doctors. It should not be considered a replacement for proper consultations between doctors and patients.
The online programme is available on the HIV Treatment Response Prediction System website. To use the system you have to register for an account, confirming you are a healthcare professional or research scientist.