News (Updated August 20,
2006)
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There are days when he despairs as he watches his cache of drugs dwindle with no replenishment in sight.
"I feel very troubled when the supply drops to just eight to 10 days. The worst is when there's just a day's supply left, before the replenishment arrives," Meng told Reuters in a telephone call from Beijing.
"It often happens and I get very anxious because if (I develop resistance to these drugs), there'll be no more chance for me."
Experts at the 16th international AIDS conference in Toronto this week are discussing the difficulties in making AIDS drugs widely available to everyone around the world who needs them.
Some 650,000 people in China are living with HIV/AIDS, but only one in four who need HIV drugs received them in 2005, according to a recent report by the United Nations' UNAIDS.
And if patients fail to keep taking the medicine, they may develop resistance to the few drugs that are available and require new and more powerful medications.
So-called second-line AIDS drugs are seven to 28 times more expensive than those given as the first course of treatment. More importantly, key second-line drugs, such as tenofovir and lopinavir/ritonavir, known under the brand name Kaletra, are not sold in China even though they are available in many other countries.
Meng, who takes second-line Kaletra and lamivudine, counts himself as very lucky because he has been able to procure them from abroad -- at a cost of 160,000 yuan (US$19,500) a year.
"Lots of people need them in China, but they are not sold. For six months in 2003, I used drugs that were available in China, but I quickly suffered side effects, so I started on Kaletra in 2004," said Meng, who learned of his infection in 1995.
"My friends source the drugs for me, from Uganda, and other countries, all over the place. Every month they are searching for me. I get my stocks monthly. I don't have any stockpile, though a friend sent me stocks for two months recently."
WAITING TO DIE
"Therapy in China is not mature. People take whatever drug is available, so I am lucky," said Meng. "Most people don't have the money to buy drugs (from overseas). Some get to join clinical tests, and they are considered very lucky."
Meng belongs to the Ark of Love help group and travels throughout China to educate people about the disease.
"Some people are in need of second-line drugs but can't get them, so they are waiting to die. In Beijing, there are at least 11 or 12 people that I know," Meng said.
Suerie Moon, a senior adviser with Medecins Sans Frontieres (Doctors Without Borders) in Beijing, said the lack of drugs in China means patients cannot have the best that science can offer.
People who react badly to the few drugs that are available find they have nothing else to choose from.
For example, some users of Indinavir, a second-line drug, are known to have developed kidney stones. Meng felt numbness on one side of his body after taking Indinavir for six years.
"It's a fundamental problem that we don't have the drugs that we need," Moon said. "We shouldn't be in a situation that we have to make do with suboptimal medicines. We should have the best drugs that we can get. We should have the most powerful ones, the ones that are the safest, that have the least side effects."
Abbott Laboratories Inc. produces Kaletra, the biggest-selling of a class of HIV drugs known as protease inhibitors. Beijing is negotiating with Abbott over a price to supply the drug, but a deal is not expected any time soon.
Sources told Reuters that Abbott is asking US$1,000 for a full-year course but the Chinese government is unwilling to pay more than US$400.
Asked for comment, an Abbott spokeswoman said it was in discussions with China's health ministry regarding the availability of Kaletra but would give no other details.
Activists are critical of the company.
"In my opinion they are abusing their monopoly," said Moon. "They are abusing the patent rights they have by refusing to supply a life-saving medicine to a population that needs it."
Yang Songquan, former Communist Party secretary of Shangcai county in the central province of Henan, is accused of taking at least 100,000 yuan ($12,500) in bribes over a river treatment project, Xinhua news agency quoted Ding Lei, an anti-corruption official, as saying in an overnight report.
In the 1980s and 1990s, thousands of rural residents in Henan contracted HIV from commercial blood stations that combined the blood of sellers into common vats, separated the valuable plasma, and then pumped the tainted blood back into unwitting sellers.
China was widely criticised for its initial denial and cover-up of the mass infection and still harasses or detains journalists who report on HIV/AIDS in the province.
Yang was fired in August last year after residents complained of the county's "slow social and economic development", Xinhua said.
There was no evidence to suggest that Yang has embezzled money allocated for AIDS prevention and treatment, Xinhua quoted Ding as saying.
Shangcai, a poor, wheat-growing county with an estimated 1.2 million people, had 6,925 people with HIV/AIDS by the end of July, Xinhua said, with most having contracted it through contaminated blood donations or transfusions before 1995.
Xinhua said the number of HIV/AIDS cases in Henan stood at 35,000 in 2005, quoting provincial health department figures.
China has an estimated 650,000 people with HIV/AIDS, though some experts say the number may be higher and over one million might be infected in Henan alone.
By Tan Ee LynTue Aug 15, 8:54 AM ET
Mainland Chinese prostitutes, who flock to Hong Kong in large numbers to make a living, are failing to protect themselves, and the number of HIV/AIDS infections is expected to rise, social workers say.
Groups that counsel sex workers say prostitutes are frequently questioned by police, searched, detained and expelled if condoms are found on them. This is prompting many prostitutes from mainland China to ditch the prophylactics for fear that they will be caught.
Although condoms are legal and Hong Kong laws do not empower police to detain anyone found with a condom, police are intimidating and expelling prostitutes from China, the groups say. Prostitution is legal in Hong Kong, but foreigners violate the conditions of their stay if they are caught working.
Social workers say such police must stop this practice or it will fuel a rise in sexually transmitted diseases such as AIDS.
"Police must stop using condoms as an excuse to arrest women because this makes women vulnerable to disease," said Elaine Lam of Ziteng, the most established help group in Hong Kong that is devoted to commercial sex workers.
Loretta Wong of AIDS Concern, another Hong Kong group, added: "The government is contradicting itself. Although the Health Department is promoting condom use, the police (are) using it to prosecute sex workers."
Their call strikes a chord with key messages delivered at the 16th International AIDS Conference this week in Toronto. Experts agree that preventing transmission of the disease among prostitutes is crucial to controlling the AIDS pandemic.
"There are still far too many instances where punitive laws, stigma, gender inequities and lack of access to needed prevention and care services conspire to fuel the HIV pandemic," said conference Co-Chair Dr. Mark Wainberg, director of the McGill University AIDS Center.
At the conference opening on Sunday, Microsoft founder Bill Gates, whose foundation has given hundreds of millions of dollars to fight AIDS, criticized governments and politicians who refuse to talk to and help prostitutes.
"We need tools that will allow women to protect themselves. This is true whether the woman is a faithful married mother of small children, or a sex worker trying to scrape out a living in a slum. No matter where she lives, who she is, or what she does a woman should never need her partner's permission to save her own life," Gates said.
POVERTY
Some 650,000 people in mainland China are living with HIV/AIDS, according to the latest UNAIDS report, but only 32,500 are classified as female sex workers -- a figure that social workers say is a gross underestimation.
In Hong Kong, there are an estimated 300,000 prostitutes at any given time, half of whom are from mainland China, Ziteng said. This figure stood at 200,000 in 1991.
Since Hong Kong was returned to Chinese control in 1997, it has become increasingly easy for mainland Chinese to visit the city, and many flock here for higher wages, although they come illegally.
According to Lam, prostitutes in China earn as little as five yuan (US$0.60) in construction sites and along truckers' routes, to 300 yuan ($38) in posh karaoke bars for the very few lucky ones.
Many choose to come to Hong Kong, where they earn between HK$40 (US$5) and HK$150 (US$19) from each customer. They need to fork out, or borrow, at least 5,000 yuan (US$626) to secure two-way visas to Hong Kong, which are good for only seven days.
"Because they have such a short time to try to make money, many of the girls are desperate and have no bargaining power. When customers offer to pay more for unprotected sex, the girls will agree," said Chung Sze-wan of Ziteng.
Many women are also ignorant. "We know of girls who have never seen condoms in their lives," Chung said, adding that women who manage to recoup the money they paid to come to Hong Kong and make a profit are those who do not insist on safe sex.
"Many of them have children and husbands and they want to protect themselves, but they still take the risk. They literally ... risk their lives," she said.
Ziteng provides free health screenings for sex workers and in a 2005 survey, seven out of 58 women tested positive for the human papillomavirus, which is sexually transmitted. There are more than 100 strains of this virus and high-risk types can lead to cancer. Six of the seven women were mainland Chinese.
The health risk is not confined to China and Hong Kong as many of these Chinese women are traveling further afield.
"We see them going everywhere after transiting in Hong Kong. Malaysia, Singapore, Italy, Japan, Australia, Taiwan," said Lam.
"People see them as a carrier of the (HIV) virus but they are really victims because they are forced not to use condoms."
Sat Aug 19, 6:14 PM ET
China said initial test results of its first AIDS vaccine showed it could protect people against the HIV virus.
None of the participants in the clinical trial's first phase showed severe adverse reactions after 180 days and some showed immunity to the HIV-1 virus 15 days after receiving the vaccine, the State Food and Drug Administration said.
"Initially, this indicates the vaccine is effective in stimulating the body's immunity," the administration said in a statement on its website.
Researchers were still analysing the outcome of the initial trial before deciding whether further tests would be carried out, it said.
Kong Wei, the research team leader from Jilin University, told China Daily the initial results were "truly inspiring" although he said it was still too early to claim success.
The first phase tests began in March last year in southwestern China's Guangxi region, with 49 healthy men and women aged between 18-50 participating, the newspaper said.
The Ministry of Science and Technology said another 800 volunteers, including those from high-risk groups, would be needed for the second and third phases of the trial, the report added.
However, testing to ensure the vaccine's safety and effectiveness could take years.
China started its own research into an AIDS vaccine in 2003 and has already invested over 100 million yuan (12.5 million dollars) into projects for the treatment and prevention of the disease, China Daily said.
Around 650,000 people in China -- or 0.05 percent of its 1.3 billion population -- have the HIV virus, but the rate of infections is rising rapidly.
In 2006, 70,000 Chinese contracted the virus, according to official estimates, equivalent to 192 per day. The government and outside experts predict there could be 1.5 million cases by 2010.
Mon Aug 14, 1:52 AM ET
A disease control office in Beijing has opened the city's first officially sanctioned online gay chatroom, but most of the posts come from the Web site's managers, a newspaper reported on Monday.
A link marked "comrade forum" -- "comrades" being Chinese slang for gay men -- on the Chaoyang District Disease Prevention and Control Center's Web site (www.cystd.com) provides open threads for people to discuss their feelings and seek counseling, the Beijing Times said.
Few people apart from the site's managers have left posts since the forum opened two months ago, in part due to people's concerns about restrictions, the paper quoted Fu Qingyuan, an employee from the disease control center, as saying.
"Actually, such concerns are really unnecessary," Fu said, adding that apart from "people selling sex, obscene images and other unsavory content," posts would be largely untouched.
Fu, however, said health and disease prevention would be the main focus of the forum, an "obvious distinction" to other professional "comrade" Web sites set up by gay men.
"The purpose of the site is to let all gay people express their true needs, to allow health workers to better communicate with them and to prevent and control the possibility of AIDS risks developing," Fu said.
In China, homosexuality, while no longer officially considered a mental disorder, is still an off limits subject for many.
In a Beijing survey, only 15 percent of 482 men who had sex with men understood that they were at risk of contracting HIV, according to a 2005 report by the United Nations' UNAIDS.
China estimates it has five to 10 million gay men and about 80 percent have admitted knowing nothing about the spread of HIV/AIDS, state media have reported.
China reported 75,000 new HIV infections last year and estimates it has 650,000 HIV/AIDS cases, but some experts say the number may be higher.
And because the issue of homosexual sex is taboo in many Asian cultures, these men are difficult to identify and reach through public health campaigns, the American Foundation for AIDS Research, or AmFAR, and a group called TREAT Asia said in a joint report.
"Unless we address male to male sex and HIV risks and vulnerability, it is going to have a major impact on the general population because a lot of the people we work with are also married," said Shivandanda Khan of Naz Foundation International, a non-governmental organization that works with men who have sex with men (MSM) in India.
"In our culture it is also compulsory to get married. They have no choice," Khan told a news conference.
Many men who have sex with men are often married, the report said. For instance, 80 percent of men who admit to having sex with other men in China say they have married or plan to get married.
And many of the men have dangerously false beliefs about sexual health, the report said. Up to half of the men in some areas have never used a condom, the report said.
"A lot of men in Asia believe that anal sex is safer than vaginal sex," Khan said in an interview.
While in Western countries gay groups have been active in fighting the AIDS epidemic, the "gay identity" is not dominant among Asian men who have sex with other men, the report said.
Because of that, the advocacy pioneered by gay communities in the Western world over the past 25 years does not work in Asia, where men who have sex with other men are "invisible" and difficult to identify, the report said.
"In Africa, Latin America, Asia the current rates of HIV infections among men who have sex with men are really spiraling out of control," said Kevin Frost, AmFAR's vice president for global initiatives.
"The truth is, we shouldn't be in this position. We really cannot afford to relearn the lessons of the past 25 years in many parts of the world, in the developing world, particularly around MSM issues."
Public health experts use the term "men who have sex with men," or MSM, because many of these men are not strictly homosexual or even bisexual. The report gives some examples of why from Asia.
For instance, it says, 65 percent of MSM in Nepal have regular sex with females, and 45 percent of male sex workers have sex with women as well as with men.
It said 22 percent of MSM in Vietnam's Ho Chi Minh city have sex with women as well as men.
Thu Aug 17, 2006 08:14 AM ET
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TORONTO (Reuters) - Small victories are being won against the AIDS virus, experts said on Wednesday as a report showed that 10 times more people in Africa are getting life-saving HIV drugs than did three years ago, but overall most people who need treatment are still not getting it.
Studies showed the benefits of providing drugs would outweigh the costs, and one report predicted that if people were treated, they would be significantly less likely to pass along the virus.
Other research presented to the 16th International AIDS conference found that providing nutritious food to AIDS patients can benefit them as much as providing drugs can, and a report highlighted Thai programs as an example of how to use condom and drug distribution to cut infection rates in half.
"The moral imperative of universal access to HIV treatment has never been clearer," Dr. Helene Gayle, president of the International AIDS Society, told the conference.
The World Health Organisation published a survey showing that more than a million people in sub-Saharan Africa now receive drugs that help many with the virus live normal lives.
But only 24 percent of those in poor or middle income countries who should be taking the drugs get them, WHO said.
The findings suggest that a push has worked, at least partly, to get lifesaving drugs to the people who need them, WHO HIV/AIDS Director Dr. Kevin De Cock said.
At the end of 2003, 100,000 people in Africa were being treated -- about 3 percent to 4 percent of those who needed the drugs to stay alive, De Cock said. Now there are 1.04 million.
The AIDS virus infects nearly 39 million people globally, and has killed 25 million people since it was identified 25 years ago. Virtually all -- 95 percent -- of people infected with the virus live in the developing world.
There is no vaccine.
Dr. Julio Montaner of the Canadian HIV Trials Network presented evidence supporting a theory that people who take the drugs, thus suppressing the virus, are less likely to infect others.
His team at the British Columbia Centre for Excellence in HIV/AIDS released a computer model that showed the number of HIV-infected people would be reduced from 40 million to fewer than 1 million over 45 years if all people who need them got the drugs.
A GOOD EXAMPLE
Thailand provides a good example of how to try to achieve such results, the World Bank said in a report released at the conference.
A former hot spot for the virus, Thailand has more than halved the number of new HIV infections over the past decade by providing HIV drugs to nearly 80,000 Thais, more than 90 percent of those who need it, the World Bank said.
But many people are left out of drug treatment programs, notably injecting drug users, the conference was told.
"Outside of Africa, nearly one in three HIV infections comes from injecting drugs with contaminated equipment, yet in many countries drug users are not able to access HIV treatment," said Dr. Peter Piot, executive director of the Joint United Nations Program on HIV/AIDS or UNAIDS.
And programs also forget some of the other basics for good health, such as nutritious food, the World Food Program said.
It and UNAIDS said that between 3.8 million and 6.4 million people need nutritional support for 2006 to 2008. It costs 66 cents a day to provide nutritious food to an AIDS patient plus his or her family, the agencies said.
Scientists reported they had found some intriguing new clues about the virus. Dr. Bruce Walker of Harvard Medical School and colleagues said they had identified a group of HIV-infected people they dubbed "elites" because their bodies can control the virus without drugs.
They said as many as one in 300 HIV patients never gets sick and never suffers damage to their immune systems. They are trying to find as many of these people as possible, to study their genetic makeup and see why they escape the fatal effects of the virus.
"If we can figure out how people are doing that, we can try to replicate it," Walker said.
Wed Aug 16, 2006 12:40 AM ET
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TORONTO (Reuters) - Former President Bill Clinton leaped to the defence of the Bush administration's AIDS efforts on Tuesday, saying the United States is spending more to fight HIV than any other government.
Clinton joined Microsoft co-founder Bill Gates in praising President George W. Bush's President's Emergency Program for AIDS Relief, saying it has done more good than harm.
Such support for the conservative Bush government was unexpected at the 16th International Conference on AIDS, a meeting held every two years where activists join researchers, funding agencies and aid groups to discuss the pandemic and, usually, denounce most governments for doing too little.
Clinton, whose foundation negotiates cheaper prices for drugs and HIV tests in developing nations, said PEPFAR has done a lot of good, despite a requirement that 33 percent of prevention funding be spent on abstinence-only programs.
"If you take out the 30 percent of the money that has to be spent on that -- the other 70 percent is still a whopping amount of money and more money in federal aid than I think anybody else is getting," Clinton told a plenary session of the conference.
That said, Clinton joined the majority of experts who say abstinence-only programs do not work. Better, he said, are programs that include abstinence counseling as part of a range of options.
Other experts have noted that abstinence-only programs have little meaning in societies where young girls and women are forced into early marriage, forced to have sex, or raped.
HELP FOR SEX WORKERS
Clinton was less positive about a U.S. law requiring HIV/AIDS organisations that want PEPFAR funding to pledge to oppose commercial sex work.
"I wish they would just amend the law and say 'we disapprove of prostitution but here's the money -- go save lives'," Clinton said.
"They are people, too and they deserve the chance to be empowered to save their lives. To me it is a no-brainer."
A spokeswoman for PEPFAR said the program worked closely with sex workers, providing condoms, counseling and treatment.
"Nothing in U.S. law or policy prohibits the U.S. government, or any of our partners, from providing services to high-risk populations, including commercial sex workers," she said.
"We are committed to support all people infected and affected by HIV/AIDS with dignity and compassion."
PEPFAR, which Bush unveiled in 2003, aims to spend $15 billion over five years in 15 target countries. It provides drugs to HIV patients, distributes condoms and funds programs run by many aid groups.
Gates, whose Bill & Melinda Gates Foundation gave $500 million last week to the Global Fund to fight AIDS, Tuberculosis and Malaria, praised the program in his speech opening the conference on Sunday.
"The President's Emergency Plan for AIDS Relief has done a great deal of good, and U.S. President George W. Bush and his team deserve a lot of credit for it," Gates said.
Mon Aug 14, 2006 12:56 PM ET
By Maggie Fox, Health and Science Correspondent
TORONTO (Reuters) - A cream, gel or pill that women can use to protect themselves from the AIDS virus is key to stopping the AIDS pandemic, Microsoft founder Bill Gates, who has given hundreds of millions of dollars to HIV programs, said on Sunday.
Gates said he would step up funding for prevention research but said governments and other donors needed to do so, also.
"We want to call on everyone here and around the world to help speed up what we hope will be the next big breakthrough in the fight against AIDS -- the discovery of a microbicide or an oral prevention drug that can block the transmission of HIV," Gates said in a speech to open the 16th International AIDS Conference in Toronto.
"This could mark a turning point in the epidemic, and we have to make it an urgent priority."
A microbicide is a gel or a cream that a woman could use to protect herself against sexual transmission of the AIDS virus.
And some studies suggest that certain HIV pills might help protect people from infection.
The World Health Organisation estimates that half of the 39 million people infected with the human immunodeficiency virus today are women, and HIV is mostly transmitted through sexual intercourse between a man and a woman.
In sub-Saharan Africa, where 64 percent of all HIV patients live, more women are infected than men. Most children who are infected catch the virus from their mothers as newborns.
There is no cure for HIV and no vaccine against it.
"The amount of money needed for universal treatment or prevention far exceeds the amount any individual government or foundation can provide," Gates told a news conference.
"We will be upping the funding we are giving things like a microbicide or oral drugs that can prevent the transmission of
AIDS."
NEW WAYS TO USE OLD DRUGS
Researchers at Family Health International believe a pill already used in HIV drug cocktails called tenofovir, made by the California-based Gilead Sciences Inc. under the brand name Viread, could keep healthy people from getting HIV. They will tell the conference about a study showing women can take it safely.
And 16 potential microbicides are being tested in people, five of them in advanced studies.
They range from gels based on carrageenan, taken from sea algae and already used widely in foods and toiletries, to HIV drugs put into a gel or cream that could be applied vaginally.
"If you deliver tenofovir vaginally and get it into the cells in vaginal tissue, the (HIV) virus gets into the cell and it can't replicate and it dies," Dr. Zeda Rosenberg, chief executive officer of the International Partnership for Microbicides, said in an interview.
A woman could use one quietly, without having to ask her husband or partner to use a condom or to abstain from sex.
"We need to put the power to prevent HIV in the hands of women," Gates said. "We are determined to help medical science discover these new drugs and get them to the people who need them."
Melinda Gates, wife of the Microsoft founder, said the ABC approach -- which stands for Abstinence, Be faithful and use Condoms -- does not always work.
"Abstinence is often not an option for poor women and girls who have no choice but to marry at an early age," she said.
"Being faithful will not protect a woman whose partner is not faithful. And using condoms is not a decision that a woman can make by herself; it depends on a man."
Melinda Gates said condoms do not encourage promiscuity, and she said people have to get over their embarrassment about helping sex workers, who are key to fighting the pandemic.
Tue Aug 15, 2006 04:57 PM ET
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TORONTO (Reuters) - Maclarka Jeanet Rakhiba did what any good grandmother would do: she told her HIV-positive grandson a white lie to make him feel less alone and afraid.
She told the orphan she was infected too.
"I didn't know how to tell him," said Rakhiba, from Katlehong, South Africa, where she was counseled at a local workshop on what to tell the nine-year-old.
"I'm not positive. I was just lying to him so that he can be free. I thought maybe he would be scared and he'd feel that he's not like others."
As speakers at the 16th International AIDS conference in Toronto shift their attention to helping women protect themselves, an older generation of women -- the grandmothers -- compared notes on how they are protecting children left behind by mothers already swallowed up by the pandemic.
Rakhiba was among 300 grandmothers who traveled to Canada from sub-Saharan Africa for the three-day Grandmothers' Gathering on the sidelines of the conference.
"I feel it's very unfortunate because at the age that we're are now, we're supposed to be resting," said Rakhiba, who appears to be middle-aged, in an interview. "But we are not resting. And there's no one who cares for us. It's very difficult."
Rakhiba started to cry when she spoke about the death of the child's mother and a second daughter from AIDS, and caring for the boy.
"I said: 'Me and you are sick. We've got HIV. (We are) not going to die now. We're going to live it, with it. As long as me and you can eat the right food ... as long as we take our medicine on time, we will be all right'."
NOT ALONE
She told of how hard it was to explain death to the boy, who never met his mother.
"I used to tell him that everybody here in the world, it's not our permanent place. Sometimes we go somewhere, where we are going to sleep with the angels," said Rakhiba, who also lost a baby grandson to the disease and is caring for another healthy grandson who is almost two.
"Then I started to tell him that your mother is there, one day me or you, one of us will go there. We can't go at the same time. Each one must go at her time or his time."
The Grandmothers' Gathering is part of the Grandmothers to Grandmothers Campaign organized by the Stephen Lewis Foundation, which provides funding to 140 community-based projects in 14 African countries. Its board is chaired by the United Nations envoy to AIDS in Africa, Canadian Stephen Lewis.
Many of the women raising their orphaned grandchildren -- some caring for as many as 28 -- are also HIV-positive. Many had not realized AIDS is a global issue.
"I thought it's only Africa. I'm relieved. I'm relieved to see that I'm not alone," Rakhiba said.
Before she left the conference early to return to her grandchildren, Rakhiba blinked back her tears, saying the first thing she'll do when she gets home is kiss and hug her grandson and tell him she's happy to be back.
"I've gained a new life," said Rakhiba. "I'm going to tell him that it was so nice and I'm going to tell him that he's not alone, it's the whole world."
Tue Aug 15, 2006 07:24 PM ET
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BANGKOK (Reuters) - Nearly a year after Thailand rolled out Asia's biggest AIDS drug program, Boripat Bonmon is among those who slipped through the cracks.
The 43-year-old shopkeeper turned activist went off treatment eight months ago after his daily cocktail of antiretroviral drugs stopped working.
He needs expensive "second-line" drugs that are not covered by the publicly funded drug plan launched last October.
"I decided to stop because I can't pay," said Boripat, whose health insurance covered less than a third of the monthly 18,000 baht ($480) cost of an imported second-line drug.
Thailand has won international praise for its swift roll-out of the National Access to Antiretroviral Programme for People Living with HIV/AIDS (NAPHA), the latest weapon in the country's battle against the disease.
A former hotspot for the virus, Thailand has more than halved the number of new infections over the past decade and gradually expanded drug treatment since 2000.
But as people live longer and treatment gets more expensive, the government's commitment to provide universal access to care will face serious challenges, health experts say. Thailand's efforts are among the initiatives discussed at the 16th international AIDS conference in Toronto this week.
"It's quite impressive how they rolled out this program so quickly, but it has some teething problems," said Paul Cawthorne, the Thailand representative for Medicins Sans Frontieres.
NAPHA provides anti-retroviral treatment for 80,000 Thais, the most extensive program in a region where the virus infects more than 8 million people, including 580,000 Thais.
Under the plan, a patient can walk into a hospital or rural clinic and pay 30 baht (80 U.S. cents) for drug treatment now included in the national healthcare scheme for the country's 63 million people.
PATENT PROBLEM
But Cawthorne worries about gaps in coverage for drug users and prisoners, and for illegal migrant workers and ethnic minorities who do not have access to the public health system.
Nurses and doctors are also feeling the strain of handling more patients, he said.
MSF is training HIV-positive volunteers to help educate patients on their drug regimens and provide counselling.
"Getting these people into the system and treating them is not like surgery. This is lifelong treatment," Cawthorne said.
Costs will also rise in the next four to five years as more people like Boripat develop a resistance to their current treatment and need second-line drugs, he said.
Many of these drugs are patented, produced and sold by big pharmaceutical firms, and a regimen can cost more than 22,000 baht ($589) a month in Thailand.
By comparison, GPO-vir, a generic triple-drug combination made by Thailand's state drug firm, costs 1,200 baht ($32) a month.
"If the government wants to encourage local production of these drugs, they will have to issue compulsory licenses or put pressure on the multinationals to give them a better price," Cawthorne said.
TRADE WORRIES
Under World Trade Organisation rules, governments can declare a "national emergency" and issue so-called compulsory licenses, allowing others to produce a patented drug without consent from a foreign patent owner.
Such a move could help Thailand reduce its drug costs, said a World Bank study which projected second-line therapy would account for more than half of NAPHA's spending by 2010.
It said spending could reach $500 million a decade later, up from a 2006 budget of $70 million.
But overriding drug patents would require "high-level political resolve" because it would probably carry trade repercussions, the study said.
Critics of Bangkok's free trade talks with Washington, disrupted by protesters at a January meeting in Thailand and now stalled by a domestic political crisis, fear Thai negotiators will give away the override rights and gut its generic drug industry.
Sombat Thaenprasertsuk, director of the Public Health Ministry's HIV-AIDS division, played down those concerns.
"I can assure the public that we are keeping a close eye on this compulsory licensing issue. If the situation fits within the law, we will move ahead," he told Reuters.
But he added quickly that talks with drug companies had gone well, with some firms offering discounts of up to 20 percent on second-line combination therapies.
The government is currently offering second-line drugs through a pilot program to 1,600 patients and hopes to begin rolling them out more widely through the national health plan by the end of the year.
"We are going to launch this very soon. I can't say when for sure, but by the end of the year," he said.
Activists like Boripat say they will keep pressure on the government.
He has refused second-line treatment from MSF, saying most other Thais in his position do not have a similar way out.
"Of course I'm worried something will happen to me. I might get sick or my CD4 could drop fast," said Boripat, referring to his immunity level which his doctor says is already low enough to put him at risk of opportunistic infections like tuberculosis.
"People who need second line don't have the money. If we don't shout, nothing will be done," he said.
Sat Aug 19, 2006 01:13 AM ET
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TORONTO (Reuters) - South Africa's government remains "obtuse" and "negligent" in its approach to AIDS and should be denounced, researchers and diplomats said on Friday.
Top speakers at the 16th International Conference on AIDS reserved their closing remarks for a long and detailed critique of South Africa and President Thabo Mbeki's government, which at first denied that the human immunodeficiency virus causes AIDS and then resisted offering HIV drugs to its people.
One in nine South Africans is estimated to be infected with the virus, which is incurable and fatal but which can be kept in check by drugs.
"It is the only country in Africa, amongst all the countries I have traversed in the last five years, whose government is still obtuse, dilatory and negligent about rolling out treatment," Stephen Lewis, the U.N. special envoy on AIDS, told the closing session.
"It is the only country in Africa whose government continues to propound theories more worthy of a lunatic fringe than of a concerned and compassionate state."
Health Minister Manto Tshabalala-Msimang has been criticized for promoting traditional cures such as garlic, beetroot and lemon.
"We have waited far too long to make this the crucial issue of this time," agreed Dr. Mark Wainberg, director of the McGill University AIDS Centre in Montreal and a conference organizer.
Wainberg also noted that Canada's conservative Prime Minister Stephen Harper failed to appear at the meeting, which attracted 24,000 delegates from around the world, former U.S. President Bill Clinton and Microsoft co-founder and billionaire Bill Gates.
ABYSMAL FAILURE
"We as a world have sat back for far too long, watching South Africa continue to deteriorate in terms of thousands of people dying of HIV," Wainberg told a news conference.
"Why it is that a government can continue to remain in power ... despite evidence that it has abysmally failed to deliver all the essentials to its population, I do not understand. It is something that burns a hole through my heart."
The conference highlighted progress in treatment of HIV patients, with more than 1 million people in Africa getting lifesaving drugs. But 76 percent of the world's HIV patients who need HIV drugs still do not receive them, speakers noted.
And new prevention methods including circumcision of men, microbicides for women, and the use of drugs to prevent infection may offer what Gates called a "turning point" in the pandemic but are far from being fully studied or available.
Lewis said a crisis was looming in funding AIDS prevention, research and treatment. Funding was $8.3 billion in 2005, he said -- a huge jump.
"But we need $15 billion this year and $18 billion next year and $22 billion in 2008," he said. "We're billions and billions short of those targets."
Another big problem is a shortage of health care workers in the countries hardest hit by the epidemic. The World Health Organisation estimated that more than 4 million health workers are needed across the world to cope with HIV.
"No improvement in financing or medical products can make a lasting difference in people's lives until the crisis in the health workforce is solved," WHO Director-General Dr. Anders Nordstrom told the conference.
Study after study showed that even the poorest and least educated people will take HIV drugs if they can get them, and will stay healthy instead of leaving their children orphaned and economies in tatters.
"AIDS 2006 succeeded in demonstrating that communities across the world are delivering innovative prevention, care and treatment -- and doing it on a shoestring," Oxfam Policy Adviser Dr. Mohga Kamal-Yanni said in a statement.
But he said rich and poor governments were not doing enough.
"With a few notable exceptions, they are still not putting their full weight behind scaling up the response, rebuilding health systems, and removing barriers to access to medicines," Kamal-Yanni said.
Fri Aug 18, 2006 09:59 AM ET
By Terri Coles
TORONTO (Reuters Health) - First-line antiretroviral therapy reduced mortality rates when introduced in Uganda, a study presented Thursday at the 16th International AIDS Conference showed.
Even in adults with advanced AIDS, antiretroviral (ARV) therapy conferred a benefit, said Dr. Paula Munderi of the MRC/UVRI Uganda Research Unit, which conducted the study.
There are more than 800,000 adults taking first-line ARV therapy in Africa, but essential evidence of its effectiveness is limited, Dr. Munderi said.
Antiretroviral drugs work by slowing down HIV replication. The World Health Organization recommends that a first-line regimen for ARVs include two drugs from the nucleoside/nucleotide (NRTI) group and one drug from the non-nucleoside (NNRTI) group.
HIV-infected adults were followed in the Uganda Research Unit's cohort in Entebbe from October 1995 to December 2000. Free ARV therapy became available in Entebbe through the Duke University AIDS Research and Treatment Center (DART) in 2003.
The study looked at the causes of death before 2000 in the Entebbe cohort participants who met the criteria for entry to the DART-provided ARV therapy. That information was then compared to causes of death observed in the DART program from February 2003 to January 2006 to see the impact of the therapy.
The two-year survival rate in DART was 94 percent, and overall mortality was reduced 17-fold compared to a matched pre-ARV cohort. Improvement in survival was highest in patients with CD4 counts below 50.
CD4 counts show the strength of a patient's immune system and can indicate how far the disease has advanced. As HIV progresses, CD4 counts generally go down.
One HIV-related syndrome that caused death in the Entebbe cohort, HIV wasting, was virtually eliminated once ARV therapy was introduced. HIV wasting was involved in 29 percent of the deaths in the Entebbe group, but caused only one death in the DART group.
As it is a historical comparison, the study has limitations, Dr. Munderi said. Also, unknown causes of death for some patients limited the results.
Changes in areas outside of HIV treatment could also have affected mortality rates. "At least some of this effect could be due to improvements over time in other causes," Dr. Munderi said.
But ARV therapy did show a benefit, said Dr. Munderi, and there was still a significant survival benefit when CD4 counts were low.
"We do believe that the data indicates the importance that therapy can have on AIDS and death in Uganda," she said.
By Natalie ArmstrongFri Aug 18, 9:39 AM ET
Condoms are very much in style as a fashion accessory at the International AIDS Conference in Toronto, showing up on strait-laced men, shy teenagers and African grandmothers.
"There's a great need to de-stigmatize condoms around the world, especially in Africa," said Franck DeRose, executive director of The Condom Project, which aims to get people comfortable about condoms, especially those living in countries where the little piece of latex is considered taboo.
To do that, the project has a program that gets people making their own condom art pin. It all starts with a craft table, packaged condoms, scraps of colored paper, candy and other double-sided tape.
Toronto resident Maria Parish, 58, was making hers with a blue condom and blue and yellow paper. "I want something to symbolize the flag of Ukraine," she said. "I am of Ukrainian descent and AIDS is a global problem."
DeRose said that creating wearable art out of condoms attracts people who normally wouldn't wear the prophylactics, let alone touch them or even utter the word.
"It opens the door," said DeRose. "We find that we're very, very successful."
Almost 400,000 condoms have been decorated and turned into brooches or pins around the world including India, Thailand, Senegal and Burkina Faso, he said.
Just this week alone, about 30,000 of the pins have been decorated at the conference, DeRose said.
People from different cultures and backgrounds wear them, trade them and even argue over safe-sex related topics while making them, including when to broach the subject with kids, DeRose said.
"We're not pushing it on people. They come to us and the information is there," said DeRose, adding his group teams up with the local information groups in the communities where his team visits.
"I don't think it's healthy or appropriate to change a culture. But we can change the risky behavior within a community."
DeRose, an artist from Washington, D.C., came up with the idea three years ago while talking about ways to get more people to wear condoms to fight the HIV epidemic. The program has since spread around the world.
"I have grandparents making them in Togo and Ethiopia. I have groups of heterosexual men making them in Washington," said DeRose, 42.
He said he was also motivated by concern for his daughter, now 12, and 15-year-old son.
Adriana Bertini of Sao Paulo, Brazil, also was making a condom fashion statement. She had plastic mannequins sporting a dress made of orange condoms, a rose-colored mini, a blue harem outfit made of blue condoms, complete with a tight bodice and full-legged trousers.
"The idea is you will see it and think of AIDS," said Bertini, who says she has been making her condom fashions for 10 years.
TORONTO (Reuters) - Delighted that prevention is finally at the front of the AIDS agenda, researchers backing microbicides and male circumcision cautioned that they have years of hard work ahead of them before anyone will benefit from such methods.
Activists urged the outside world to keep up the pressure on political leaders in hard-hit countries such as South Africa, while other groups said that reducing violence and discrimination were also key to fighting the AIDS pandemic.
One big winner at this week's International AIDS Conference in Toronto was the field of microbicide research. Top speakers at the conference all stressed that microbicides and circumcision, as well as drugs, condoms and behavior change, were all key to stopping a pandemic that has killed 25 million people in 25 years.
Delivered as a cream, a gel or perhaps on a small vaginal ring, a microbicide would allow a woman to quietly protect herself against HIV, now transmitted mostly heterosexually.
"Not only are people saying it, but they are pronouncing it correctly," said Renee Ridzon, a program officer at the Bill & Melinda Gates Foundation, which has given $124 million (66 million pounds) to support microbicide development.
But there is one big obstacle -- no one has invented one yet. Tests are under way on several formulations.
"As we are undertaking the current set of studies of microbicides, which are largely gels, we should think of ways to improve formulations," said Dr. Salim Abdool Karim of the University of KwaZulu.
"Can we design a microbicide that could be taken once a week or once a month or once every three months?"
Delivery is also key, said Ridzon. "People are not going to use something that they don't like, that doesn't feel good," she said.
Similarly, men will not seek circumcision if they think it will hurt, said Carolyn Williams of the U.S. National Institutes of Health.
SIMPLE, SAFE, PAINLESS
"We need a simple, fast, safe method, with low costs, that nurses can do," said Dr. Bertran Auvert of the University of Versailles-Saint Quentin in France.
One South African study has shown that circumcised men were 60 percent less likely to become infected with HIV, and other studies are under way to try to confirm this.
But Auvert said if the studies show clearly that circumcision protects men, men will flock to have the procedure. "The demand will not be satisfied by the current health structure," he said. "We already see waiting lists in southern Africa."
Men will go to traditional practitioners instead, who may not use sterile methods. They could suffer potentially deadly infections. "It will be a nightmare," Auvert said at a news conference.
Many other groups also said the overall health care structure must be improved.
"It's not just a matter of supplying drugs," said Dr. Daraus Bukenya of the British-based African Medical and Research Foundation.
"Issues such as poverty, geographical isolation, crumbling health systems, stigma and cultural practices, all play a part in the failure of many HIV/AIDS programs."
Violence is another issue, said the Washington-based Global AIDS Alliance. It cited reports showing that nearly half of girls in Uganda have been raped, and many become infected with AIDS.
"Like HIV/AIDS, violence is taking place on an epidemic scale, and as that occurs, it fuels the HIV/AIDS pandemic," said Lisa Schechtman, who helped write the report.
And activists said politicians are still not doing enough.
"There is a deliberate holding back of leadership on the AIDS epidemic," said Mark Heywood of the AIDS Law Project at the University of Witwatersrand in South Africa.
"What is happening in South Africa is actually a human rights violation."
South Africa's government has been strongly criticized for years for first
denying that the human immunodeficiency virus causes AIDS and then questioning
the safety of lifesaving HIV drugs.
Fri Aug 18, 2006 02:53 AM ET
DHAKA (Reuters) - A Bangladeshi community group working to educate sex workers
in the country shared an international award for its contribution toward
prevention of
HIV/AIDS.
The Durjoy Nari Sangha distributes condoms, gives information about AIDS to sex workers, and provides for the education of their children.
The newly launched Red Ribbon Award, announced at the 16th International AIDS Conference in Toronto, was shared by four other groups from Ukraine, Thailand, Zambia and Zimbabwe, the United Nations development agency UNDP said in a statement on Friday.
Each of the winners will receive $20,000 in prize money on World AIDS Day, on December 1, this year.
The Bangladeshi group also fights for the rights of sex workers.
Fri Aug 18, 2006 06:52 AM ET
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TORONTO (Reuters) - Deep pockets are not so deep when it comes to the AIDS epidemic, Canadian researchers said on Thursday.
They released a study showing that for every person who died in the December 2004 Indian Ocean tsunami, about $35,336 (18,733 pounds) was donated, while $3,333 was given for every person affected by the disaster.
For Hurricane Katrina that struck the U.S. Gulf Coast in August 2005, $33.9 million was donated for every death and $44,286 for every affected person.
But for AIDS, just $1,968 was donated last year for every death, and $153 for each person affected, they told the 16th International AIDS Conference in Toronto.
"Countries were competing with each other to show who could give most to the tsunami," Timothy Christie of the British Columbia Centre for HIV/AIDS in Vancouver said in an interview.
"In HIV, we have countries reluctantly giving, and what little they do give, we have them put outrageous restrictions on them. Can't fund condoms, can't fund needle exchange, harm reduction," Christie added.
"None of those conditions apply to the tsunami. So there is a moral underpinning that's determining or driving how we do things."
Christie's team said that society needs to re-evaluate how it values human lives.
"Because if you work from the assumption that all human life is equal, of equal value, then you're going to try to respond in an equal way for things," he said. "That doesn't mean tsunamis should receive less. But it means HIV should definitely receive more."
Christie added that he did not mean to disparage funding for other diseases and disasters.
"What we wanted to show is there's a big discrepancy between how some diseases and disasters are treated compared to others and ask the hard questions about why that's allowed to happen," he said.
"Like HIV/AIDS, violence is taking place on an epidemic scale, and as that occurs, it fuels the HIV/AIDS pandemic," said Lisa Schechtman, lead author of the report by the Washington-based Global AIDS Alliance.
Speaking at the 16th International Conference on AIDS, Schechtman said global donors needed to stop looking at the issue of violence as separate from AIDS.
With studies showing rampant levels of violence against women and children -- much of it sexual in nature and particularly common in several east African countries -- the group urged donors to take a more social approach to funding.
According to studies cited by the group, nearly one in two girls has been raped in Uganda, and the rate is also extremely high in Ethiopia and Kenya.
Other surveys show links between violence and the AIDS epidemic, as women who have experienced violence may be up to three times more likely to get HIV.
Groups such as the World Bank, the U.N. AIDS agency UNAIDS, and the U.S. PEPFAR AIDS relief program have promised to address the issue. But Global AIDS Alliance said the pledges have been inadequate and little work has been done.
"As African women, we are enraged by the HIV/AIDS policies, programming and funding, and this is basically because of not integrating violence against women," Mary Wandia, women's right's coordinator for the South Africa-based anti-poverty group Action Aid, told a news conference.
"For African women, we go through violence throughout our life cycle."
The Global AIDS Alliance said it wants political leaders and donor groups to devote at least $2 billion per year to combating violence against women and children.
Paul Zeitz, the group's executive director, said what was needed are more laws to criminalize violence against women and children, health and education reform, and the establishment of community task forces to speak out against violence in their communities.
The AIDS virus currently infects about 39 million people worldwide and has killed 25 million people since it was identified 25 years ago.
Thu Aug 17, 2006 10:44 AM ET
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TORONTO (Reuters Health) - HIV infections are rising in black men and women living in developed nations that have otherwise made strides against the disease, said participants at the 16th International AIDS Conference in Toronto.
"AIDS in America is a black disease no matter how you look at it, by gender or sexual orientation or age or socioeconomic class or region in the country in which you live," said Phil Wilson, executive director of the Black AIDS Institute, at a press conference on Monday.
"Black people bear the brunt of this epidemic."
People of African and Caribbean descent -- particularly heterosexual women and men who have sex with men -- have higher HIV infection rates than the overall population in developed countries like Canada and the United States, said conference participants.
Blacks make up 13 percent of the United States population, but represent an estimated 42 percent of people living with HIV/AIDS. Ontarians of African and Caribbean descent make up less than five percent of the population but account for 14 percent of those with HIV/AIDS and 19.5 percent of new infections in 2004 in Ontario, a rise of 82 percent in five years. Their HIV infection rate is almost 13 times the overall rate.
AIDS is the leading cause of death for African American women aged 25 to 34, and in 2003, 60 percent of all American females living with HIV/AIDS were black. African American women make up 68 percent of new HIV cases in the U.S.
"If we, as black women, in America do not decide today and every day that AIDS is our face and fight, in 2020 there'll be no black women in America," said Grazell Howard, first vice president of the National Coalition of 100 Black Women.
A study released by the Centers for Disease Control in June 2005 showed that black men who have sex with men in the United States had HIV infection rates higher than in sub-Saharan Africa, at 46 percent.
Another CDC study presented at the conference showed that while American high school students were overall engaging in less sexual behavior that put them at risk for HIV infection since the early 1990s, decreases in sexual intercourse and increases in condom use in African American teenagers leveled off over the past few years, after progress throughout the early 1990s.
The study's findings showed that there may be a need to intensify prevention efforts in black and Hispanic adolescent populations in the United States, said Dr. Laura Kann of the
CDC.
It's not only in the developing world that people die due to lack of access to treatment, said the Canadian Treatment Action Council. In the conference's host country, a variety of barriers stand in the way of treatment for HIV-positive immigrants, said Esther Tharao of the council.
Stigma -- both in the general population and their own cultural communities -- makes it hard for vulnerable populations to get care. Immigrants and refugees without residency status in Canada don't qualify for the country's public health care, and they face further difficulties due to differences in culture and language.
"We need a Canadian strategy to support communities from countries where HIV is endemic, and we need funding to make it work," said Tharao in a statement.
Several conference activities focused on mobilizing populations of African and Caribbean descent in the fight against HIV.
"For too long, our community has sat idly by as this epidemic has ravaged our families and claimed the lives of our brothers and sisters," said Cheryl Cooper, executive director of the National Council of Negro Women.
"We need to make some noise. Everyday, everywhere we need to start by saying, I am fighting against HIV. If we take to the streets and the churches and we use all these platforms, we can beat this," said Maxine Waters, a Representative from California.
Wed Aug 16, 6:16 AM ET
News, comment, cricket scores -- and contraception.
Faced with the alarming spread of HIV/AIDS, officials in Andhra Pradesh on Tuesday taped a pack of three condoms to the front page of thousands of newspapers delivered to people in 50 villages and four towns in a bid to spread a message of safe sex.
"Earlier we distributed condoms at wine shops and bars, through milk vendors and at pan (tobacco) shops but we met with lukewarm response," says Ashok Kumar, the director of Andhra Pradesh State for AIDS Control Society.
A recent study by the National Aids Control Organization indicated a 25 to 28 percent increase in the number of HIV infections in Andhra, making it the worst affected state in the country, with nearly one million known cases in 2005.
The latest attempt to rein in HIV was centered on Nizamabad town, 170 km (105 miles) northeast of Hyderabad, the state capital.
Thirty-nine million people are infected with HIV/AIDS worldwide, and the United Nations' AIDS body says 5.7 million people are living with the virus in India. Activists say the true figure may be far higher.
Conservative attitudes to sex and contraception, a lack of awareness and discrimination all make it hard to tackle the virus in India, especially in rural areas.