HIV 30 years on, Challege snd Opportunity in 2012

 HIV/AIDS Challenge and Opportnity for Africans

The African Institute for Social Development(AISD) looking at HIV/AIDS 30 years on, the challenge and the opportunity in the eyes of global efforts.

This is the time to make real diffrence in prevention work, testing and getting every person living with HIV to be assessed and get treatment, be empowered and move on in a fulfilling and productive life.
                                                           African Institute Events 2012

'Much has been achieved in HIV prevention technologies, medical advances and treatment but Africans need a chance to access those and need a new world of educated, empowered african men and women with healthy children. A world that doesn't stigmatised people against HIV status' as reported by Amdani Juma, the African Institute Director.  

The Challenge

In the 30 years since HIV/AIDS was first discovered, the disease has become a devastating pandemic, taking the lives of 30 million people around the world. In 2010 alone, HIV/AIDS killed 1.8 million people, 1.2 million of whom were living in sub-Saharan Africa. Though life-saving antiretroviral treatment is available, access is not yet widespread; of the estimated 14.2 million HIV-positive individuals in need of treatment, nearly 8 million are not currently able to access it.
Even more troublesome, new HIV infections continue to outpace those added onto antiretroviral treatment. More than 390,000 infants and children were newly infected with HIV in 2010, and 2.7 million total new HIV infections occurred in the same year—a rate that has held relatively constant since 2006.
Because individuals in their most productive years (15-49 years old) are most commonly infected with HIV/AIDS, the disease has a wide socioeconomic impact that threatens development progress in many poor countries, especially those in sub-Saharan Africa. 14.8 million children in the region have already lost one or more parents to the disease. In South Africa alone, 1.9 million children have been orphaned due to AIDS, exacerbating a social dynamic that is already deeply challenged by crime, violence and unemployment. HIV/AIDS targets people during their most productive years, making economic progress in many sub-Saharan African countries even more of a challenge. Some estimates suggest that annual GDP growth in highly affected countries can be 2-4% lower than in countries with the absence of AIDS.
In 2005, world leaders at the G8 summit in Gleneagles and at the U.N. World Summit in New York pledged to reach universal access to prevention, care and treatment by 2010. Though this target was not achieved, leaders recommitted to the fight against AIDS in 2011 by agreeing to work toward achieving universal access to HIV prevention, treatment, care and support by 2015. Delivering these essential services will require a strengthening of health systems, especially in Africa, which is home to two-thirds of those requiring antiretroviral (ARV) treatment, but only 3% of the global health care workers to provide it.

The Opportunity

We are at a critical moment in the fight against HIV/AIDS. The world has made incredible progress in its efforts to understand, prevent and treat this disease, and progress has been particularly rapid during the last ten years. But by the end of 2010 more than 6.6 million people were on life-saving antiretroviral treatment, up from just 300,000 in 2002; of that 6.6 million more than 5 million were living in sub-Saharan Africa. Botswana, Rwanda, and Namibia have already achieved universal access to ARVs, while Benin, Guinea, Kenya, Lesotho, Senegal, South Africa, Swaziland, Togo, Zambia, and Zimbabwe have coverage rates between 50 to 80% and are making progress towards universal access.
Though we have not made enough progress on the prevention of HIV, we now have impactful new data and technologies to help us better prevent new infections in the years to come. More sophisticated treatment regimens now make it possible to prevent the transmission of HIV from mother-to-child in as many as 98% of cases. Nearly half of all pregnant women with HIV can now receive ARV prophylaxis for PMTCT and a global effort co-led by UNAIDS and the US Office of the Global AIDS Coordinator (OGAC) has called for leadership from the 22 highest-burden MTCT countries to help virtually eliminate transmission from mother-to-child by 2015.
New research over the last two years has also provided groundbreaking data on two fronts: the impact of treatment as prevention, and the role of male circumcision in prevention strategies. The HPTN 052 clinical trial showed that treatment acts as prevention, reducing the likelihood of an HIV-positive individual on treatment passing HIV on to others by up to 96%. Voluntary medical male circumcision, another powerful tool, was shown to reduce the likelihood of HIV infection by up to 60%. Combination prevention, including treatment-as-prevention and other strategies such as PMTCT, the ABC strategy to prevent sexual transmission (Abstain, Be faithful, & correct and consistent use of Condoms), male circumcision, and reduction of unsafe blood and medical injections, will play a central role in moving us towards ending the pandemic.
Now, for the first time in history, the world can look ahead to the beginning of the end of the AIDS pandemic. We have the tools necessary to achieve an AIDS-free generation if we focus our efforts on three interim goals: virtual elimination of mother-to-child transmission by 2015, expansion of antiretroviral treatment to 15 million people by 2015, and implementation of innovative prevention techniques to stop new infections. To bend the curve of the AIDS pandemic, these goals cannot be achieved in isolation from one another, nor can their achievement be the sole responsibility of a small number of donor countries. Only when working in parallel--through the broad support of donors, African governments, international organizations, and the private sector--will the beginning of the end of AIDS become a reality.
During a time of financial austerity and economic crisis in many parts of the world, it is essential for both donor and recipient countries to reaffirm their commitments to combating HIV/AIDS while making strategic investments. From 2002 to 2009, global funding for HIV/AIDS increased dramatically from $800 million to $6.8 billion annually, and these international investments are paying off: the Global Fund to Fight AIDS, Tuberculosis, and Malaria has helped 3.3 million people receive ARV treatment and conducted 190 million HIV counseling and testing sessions, while the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has directly supported 3.9 million people on ARV treatment and reached more than 13 million people with care services, including more than 4.1 million orphans as of 2011.
Sustaining our current progress, with an aim towards beginning to end AIDS, will require increased focus on prevention, expanded ARV treatment, and continued scientific research. At this critical juncture, it is imperative for all of us to make strategic investments and to keep an eye on the finish line.


For more information,

please visit AISD at: http://www.africaninstitute.org.uk/ or call on +44(0)7834459076

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To get HIV information and advice, call free on 0800 0967 500

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PrEP Technologies Tried in Africa as HIV Prevention Method

African Institute looks at a study of PrEPs technologies in Africa. It is a new technology that provides to couples of mixed HIV status where one partner is living with HIV and the other has no HIV but both partners want to have sex without using condoms for protection. We encourage our readers to read these new studies and technologies being introduced and realise that no perfect single intervention should be taken in isolation. We believe that condoms offer better protection with no side effects. If the PrEP becomes a popular way of prevention in the developed world that will only add into the HIV treatment bill and the probabilities are that no many countries will afford to offer those to the entire population that needs PrEP and manage to also pay for other treatments due to side effects caused by PrEP. 'We, therefore, think that both male and female condoms provide great prevention against HIV virus and fight the stigma attached to the virus.' said Mr Amdani Juma, the AISD Director                     Photo Gordon Brown in Kenya 

Kenyan heterosexual couples want a choice of antiretroviral prevention methods

Michael Carter   

Published:  May 2012

Approximately 40% of HIV-positive people in stable relationship with an HIV-negative person in Kenya have reservations about starting antiretroviral therapy early for the purposes of prevention, investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes.

Willingness to use pre-exposure prophylaxis (PrEP) was high among the HIV-negative partners. However, this finding is likely to have been influenced by the fact that the study involved couples involved in a PrEP study.

The investigators believe that their findings could have implications for the use of HIV treatment in prevention.

A possible HIV-1 prevention strategy for serodiscordant couples that will utilize both ART [antiretroviral therapy] and PrEP is for the HIV-1-uninfected partner to use PrEP until the HIV-1 infected partner is willing and able to initiate ART,suggest the authors. Such a strategy would be cost-effective, provide HIV-1 infected partners an opportunity to decide when to start ART, and may allow a bridge period for a few months after the infected partner starts ART, when transmission may still be high because viral load is not yet suppressed.

Antiretroviral-based strategies are among the most promising new approaches to HIV prevention.

Research involving serodiscordant heterosexual couples showed that early antiretroviral therapy reduced the risk of transmission of the virus by 96%.

Some research has also shown that antiretroviral drugs taken by HIV-negative people (PrEP) can reduce their risk of transmission.

Serodiscordant couples are a priority population for the use of HIV treatment. But, before strategies for its use are developed, it is important to understand the couples preferences for and concerns about the use of antiretrovirals for this purpose.

Investigators therefore recruited 181 serodiscordant couples in Kenya, enrolled in the Partners PrEP study, to a substudy enquiring about their willingness to use HIV treatment as prevention.

The HIV-positive partners all had a CD4 cell count above 350 cells/mm³ and were therefore ineligible for antiretroviral therapy according to Kenyan national guidelines. The study was conducted between March and July 2011, before the publication of research showing the efficacy of PrEP in heterosexual couples and of the results from the HTPN 052 study, which showed that early HIV therapy reduced HIV risk by 96% in serodiscordant heterosexual couples.

Both the HIV-negative and HIV-positive partners completed questionnaires.

HIV-negative individuals were asked: If we find that PrEP works to keep people free from HIV, would you be willing to take PrEP tablets every day for the next five years?

HIV-infected partners were asked: Would you be willing to start antiretrovirals before your CD4 count reaches 350 if it would lower your chances of giving HIV to your partner?

Participants were asked to describe their main concerns about early HIV treatment or PrEP. They were also asked to say which of these strategies they preferred.

Some 69% of HIV-positive men and 58% of HIV-positive woman said that they would be willing to take early treatment for the purposes of prevention.

An overwhelming majority of HIV-negative people (94% of men and 86% of women) expressed a willingness to take PrEP.

When asked to state a preference between the two approaches, 61% of HIV-positive men and 50% of HIV-negative women said they would prefer early HIV therapy.

A majority of HIV-negative participants expressed a preference for PrEP (57% of men and 56% of women).

In just over a quarter of couples (26%), both members preferred to have the HIV-negative partner take PrEP and in 22% of couples both members preferred early antiretroviral therapy for the infected partner.

Among HIV-positive participants, the primary concerns about early treatment for prevention were side-effects (51%), stigma (21%), pill burden (19%) and fears about resistance (18%).

A total of 14 HIV-negative people were unwilling to use PrEP. Their primary concerns were the duration of treatment (6/14), taking treatment when they were not sick (3/14), and side-effects (3/14).

In our study, not all couples would be willing to use ART prior to the HIV-1 infected partner having clinical symptoms and a perceived need for initiation; PrEP could be a suitable alterative for these couples,conclude the authors. As antiretroviral-based HIV-1 prevention strategies are incorporated into prevention policies and programs, it will be important to understand and accommodate couples 'preferences and willingness to use antiretroviral-based HIV-1 prevention.'

Reference: Heffron R et al. Willingness of Kenyan HIV-1 serodiscordant couples to use antiretroviral based HIV-1 prevention strategies. J Acquir Immune Defic Syndr, online edition. DOI: 10.1097/QAI.0b013e31825da73f, 2012.

For more information,

please visit AISD at: http://www.africaninstitute.org.uk/ or call on +44(0)7834459076

Campaign with us and learn more about HIV info http://www.idoitright.co.uk/

To get HIV information and advice, call free on 0800 0967 500

Text: 07860 002 014 start your text with INFO

NATIONAL CONDOM WEEK AND PREVENTION TECHNOLOGIES

THE FEMALE CONDOM

The African Institute has launched the National Condom Week in Nottingham on Monday 21st May and will run till 28th May. 2000 condoms were packed and mass distribution is underway from street, community businesses and live Radio media interview for condoms and lubs collection.

There is an urgent need to expand access to proven prevention methods, including clean needles, female and male condoms, risk reduction counselling, treatment of sexually 

transmitted infections, and other strategies. 

                                                                                              

  Below photo of Cllr Leon Unczur Sheriff of Nottigham then and current Lord Mayor
This year the AISD has made a focus on FEMALE CONDOM or FEMIDOM. "We want women to be in charge of their sexual health and share control, and pleasure with their male partners" said Amdani Juma, the Institute Director. He added that "each prevention technology present possibility of new option for individuals to help reduce their risk of HIV. no one of the interventions on their own can end the epidemic

The femidoms have improved greatly over years and we now have "Softer and more Sensual."

Imagine a tool that can be worn by a woman during sex, that protects against pregnancy, HIV, and other STIs. In case that isn’t enough, it also enhances pleasure for both her and her partner. It is inserted into the vagina before sex, and part of it stays outside of the woman’s body, where it increases the sensation of sex by rubbing against her labia and clitoris. 

It is strong, soft, and transparent, and is excellent at transferring heat. Her partner likes that it doesn’t constrict his penis, making sex feel more natural. And since it doesn’t rely on an erection, it can be inserted hours before sex, getting her in the mood and maintaining the flow of sex. What is this amazing thing? It’s a female condom!

The female condom has been on the market for 20 years and recently new innovations have emerged. The traditional female condom (FC2) – which has an inner and an outer ring – is made of synthetic latex, eliminating the noise that some people found distracting. There are also other female condoms available and under development, including a latex condom that has a firm sponge in the place of the inner ring, and another, Woman’s Condom, that can be inserted like a tampon, expanding during intercourse. 

demand for female condoms grows, we expect to see even more innovation in the market, because as we all know, variety is the spice of life!

Female condoms have several advantages. Women are in control when they use them. The use of male condoms often has to be negotiated over and over again and relies on the cooperation of men. Female condoms have to be negotiated only once. They can be inserted several hours before the sexual act takes place, so foreplay does not need to be interrupted.
Studies report a high satisfaction rate by both women and men who have used the female condom. Originally, the demand came mostly from women, but we see the number of male consumers increasing. In sum, the female condom is a commodity for safety, but also a pleasurable tool that should be accessible for all!

Prevention Technologies

Vaccines: An AIDS vaccine is an experimental strategy that aims to teach the body's immune system 

how to fight HIV to reduce the risk of infection or to reduce viral load in those who get the vaccine and 

go on to become infected. All of the candidate vaccines being studied are experimental; there are no 

effective AIDS vaccines available today. 

Pre-Exposure Prophylaxis (PrEP): PrEP is an experimental approach that uses antiretroviral 

medications (ARVs) to reduce the risk of HIV infection in HIV-negative people. During a study of gay 

men, transgender women and other men who have sex with men, a daily pill reduced the risk of HIV 

by 44%. Additional studies are ongoing in other populations. PrEP is not yet recommended for use. 

Note: PrEP must not be confused with post-exposure prophylaxis (PEP), which is available in the UK 

following exposure to HIV. 

Microbicides: The term microbicide refers to various strategies being tested that may reduce the risk 

of HIV transmission during sex. These include creams, gels, and suppositories that could be used 

vaginally or rectally. The large majority of microbicide candidates in testing today are formulated with 

antiretroviral (ARV) drugs. There is now proof of concept that a topical gel can reduce women’s risk of 

acquiring HIV during vaginal sex. However, more research is needed before such gels are available.

Male circumcision: Medical male circumcision (MMC) is the removal of all or part of the foreskin of 

the penis by a trained health professional. The term medical male circumcision differentiates 

circumcision that is performed by a trained health professional from traditional circumcision, which is 

performed as part of a religious ritual or cultural rite of passage. Adult medical male circumcision can 

reduce men’s acquisition of HIV by up to 65% when they have vaginal intercourse. However, there is 

no evidence that it also protects the female partners of men who are HIV positive and it remains 

unclear whether circumcision could have an impact on HIV transmission among gay men and other 

men who have sex with men. 

Treatment as prevention: Treatment as prevention is a term describing the use of antiretroviral 

drugs that are used to reduce the risk of passing HIV to others. The strategy would function as a 

secondary benefit of antiretroviral treatment after its primary purpose of improving an individual’s 

health. The rationale for this approach is that ARVs reduce viral load. Higher viral loads have been 

linked to increased risk of passing HIV to sexual partners. 

Treatment as prevention is an emerging area and there are different terms and phrases used to 

describe this approach, including "test and treat" and "testing and linkage to care plus" which 

recognizes that voluntary HIV testing and diagnosis is the first step to accessing care.

Sperm Washing: Sperm washing is a technique developed for couples who wish to conceive a child, 

where the male partner is living with HIV and the female partner is not. By isolating sperm from any 

elements in semen which may contain HIV, the risk of transmission of HIV to the female partner and 

subsequently her child is greatly reduced. A variety of assisted reproduction techniques can be used 

to fertilise the female partner with the washed sperm. Numerous observational studies have shown 

that sperm washing has not resulted in any seroconversions when correctly performed, and it is 

currently considered the safest method for serodiscordant couples wishing to conceive a child 

together. 

Sperm washing is available in the UK, however its availability is limited to two clinics and the dramatic 

variability of funding available throughout the country coupled with significant costs is a barrier for 

many couples. 

End of report.

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HIV Treatment to be free for Undocumented Migrants and non-UK Citizens

In this report: 

The African Institute for Social Development (AISD) welcome the Department of Health efforts to make HIV treatment free for all in England, like in Scotland and Wales, this will encourage Northern Ireland to allow HIV free treatment to all who needs it. AISD colleagues and other HIV advocates led by National AIDS Trust finally see a successful human right cause to its fruition. 

Mr Amdani Juma, the AISD Director said: "The DoH efforts to make HIV treatment free at the point of need in England will assist many Africans and other migrants fight onward HIV infection and will contribute to good health and happier life for Africans living and working in England"; contact Mr Juma at amdani@africaninstitute.org.uk. 

Roger Pebody

Published: 28 February 2012

The Department of Health has announced that it will soon make HIV treatment free for all who need it, regardless of citizenship or immigration status. While the change may be politically controversial, ministers are justifying it on the grounds of public health.

For a number of years, treatment of other sexually transmitted infections, tuberculosis and malaria has been free to all, regardless of normal rules on entitlement to NHS services. HIV treatment will now be provided in the same way, as long as the person seeking treatment has been in the UK for at least six months.

This is a significant victory for HIV advocates, led by the National AIDS Trust, which has persuaded government officials that charging for HIV care discourages migrants from testing for HIV, leads to undiagnosed individuals unwittingly passing their infection on, and means that when people are eventually diagnosed, the treatment they need is unusually expensive.

Citing the HPTN 052 study, the chief medical officer, Professor Dame Sally Davies, noted that effective HIV treatment reduces the risk of transmission by 96%.

However, immigration is a sensitive political issue, and this has led successive governments to tighten restrictions on free-of-charge NHS treatment for people subject to immigration control.

While individuals who are in the process of claiming asylum and people who have refugee status are entitled to NHS care, this is not generally the case for people who have been refused asylum, people who have overstayed a visa or illegal entrants. Moreover, people who have a visa for studies or for a short visit are not usually entitled to healthcare.

Nonetheless, the rules do allow doctors discretion in some areas and there are no charges for treatment of a number of serious communicable diseases.  

Last year, a select committee of the House of Lords, chaired by the former Conservative health minister Lord Fowler, recommended that anyone who is resident in England should have access to free HIV treatment if they need it.

As part of the Lords debate on the highly controversial Health and Social Care Bill, Lord Fowler introduced an amendment to that effect. In response, government ministers yesterday said that Fowler’s amendment was unnecessary as the government would itself introduce changes to theCharges to Overseas Visitors Regulations in the next few months which would have the same effect as his amendment.

Anne Milton, the public health minister and a former nurse, said: “This measure will protect the public and brings HIV treatment into line with all other infectious diseases. Treating people with HIV means they are very unlikely to pass the infection on to others.” However she added: “Tough guidance will ensure this measure is not abused.”

The government believes that early diagnosis of people with HIV will ultimately help cut costs.

Professor Jane Anderson, chair of the British HIV Association said: “I am delighted that Lord Fowler has finally won the argument on this point. It's a decision that will certainly save lives and improve the quality of life of many who were previously shut out from appropriate treatment.”

Deborah Jack, chief executive of the National AIDS Trust (NAT), commented: "NAT has been campaigning for HIV treatment to be free for all those who need it in England for many years - and we regard the Government's commitment on this to be a huge achievement. Free HIV treatment for all is a victory for public health and for the NHS.”

The new rules are likely to come into force in October – until then, charges may be made for treatment. The changes will initially apply only to the regulations in England. However, the Welsh and Scottish health services have rarely charged individuals for HIV treatment in the past. It’s not clear whether Northern Ireland will follow suit.

End of report

African Institute for Social Development(AISD)

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