News (Updated December 10,
2006)
[Home]
[Previous
news]
Tue Dec 5, 2006 2:53 PM ET
NEW YORK (Reuters Health) - It takes more than just passing along good
information to stop the spread of HIV, a new US-government-backed study on
HIV/AIDS prevention programs has found.
It takes "enhanced education, where you actually build their skills and don't just give them information," said lead author Cynthia Lyles of the Centers for Disease Control and Prevention in Atlanta in a statement.
To help arm local health agencies with the most effective HIV prevention programs, Lyles and colleagues examined 100 HIV behavioral intervention programs developed and tested between 2000 and 2004. Their findings appear in January's American Journal of Public Health.
They identified 18 programs that seem to have a significant effect on reducing HIV risk behavior and that could be adopted by local agencies and funded by the federal government.
Lyles and colleagues say the "best of" programs tend to share one thing in common -- they not only teach people about HIV and AIDS but also help them learn how to avoid falling into the trap of risky sex and what to do if they get in a high-risk situation. This is often accomplished through role-playing.
Other key components of effective HIV prevention programs include instruction on how to use a male or female condom properly and how to communicate better with others, including negotiation and assertiveness training.
"Most importantly, many of these newly identified efficacious interventions targeted populations disproportionately affected by the HIV/AIDS epidemic and in need of effective prevention tools," Lyles and colleagues write.
"However, important gaps still exist."
Lyles and colleagues point out that their government-backed review did not consider the value of needle-exchange programs, which provide clean needles to IV drug addicts, because these programs are not eligible for federal funding, despite evidence that they are effective.
"We were basically trying to target the prevention-providers that are looking to the CDC for funding," Lyles said. "They can decide if one of these is best suited for them."
SOURCE: American Journal of Public Health, January 2007.
The study, published on the Web site of the journal "AIDS," followed thousands of women in Africa and Asia and compared their patterns of contraceptive use to their risk of infection with HIV, the virus that causes AIDS.
"Understanding whether hormonal contraceptive use alters the risk of HIV acquisition among women is a critical public health issue," the study authors wrote.
Some 6,000 women, in Uganda, Zimbabwe and Thailand enrolled in the study were offered a choice of the most commonly prescribed forms of hormonal contraception, birth control pills or DMPA (depot-medroxyprogesterone acetate) injections, as well as condoms.
Before enrolling, the women, aged 18 to 35, were either using no hormonal contraceptives or had used them for at least three months before the study began. None were infected with HIV when they enrolled, the researchers wrote.
The participants primarily were women who sought family planning services at clinics. They were tested for HIV four to five times a year for 15 to 24 months.
By the time the study ended, 213 African women and four Thai women had tested positive for HIV. Because there were too few cases in Thailand for a valid statistical interpretation, those cases were excluded from the final analysis, they said.
When the 213 cases were considered together, researchers found no evidence that use of hormonal contraceptives increased a woman's chances of becoming infected with HIV, the study concluded.
"In summary, this large, multi-site study found no overall increased risk of HIV acquisition associated with hormonal contraceptive uses, " the study authors wrote.
However, the authors noted that their study could not rule out an increase in risk for HIV infection among those already at higher than normal risks, such as sex workers.
Thu Dec 7, 2006 4:05 PM ET
By Will Dunham
WASHINGTON (Reuters) - Malaria may be helping spread the AIDS virus across Africa, the continent hardest hit by the incurable disease, scientists said on Thursday.
The way the two diseases interact greatly expands the prevalence of both among people in sub-Saharan Africa, a team of scientists said in a study in the journal Science.
Malaria, a mosquito-borne disease caused by a parasite, greatly boosts viral load -- the amount of human immunodeficiency virus in the blood of infected people -- making them more likely to infect a sex partner with HIV, they stated.
"Higher viral load causes more HIV transmission, and malaria causes high HIV viral load," said lead study author Laith Abu-Raddad of the Fred Hutchinson Cancer Research Center in Seattle and the University of Washington.
Abu-Raddad, an AIDS researcher, estimated that malaria has helped HIV infect hundreds of thousands and perhaps millions of people in sub-Saharan Africa. AIDS was first identified a quarter century ago.
At the same time, HIV fuels malaria's spread because HIV-infected people are more susceptible to malaria as a result of HIV ravaging the immune system, the body's natural defenses, the researchers said.
AIDS and malaria are concentrated in sub-Saharan Africa. Abu-Raddad said scientists were puzzled when they realized that the risky sexual behavior by people in the region was not by itself sufficient to explain the swift spread of HIV, so other factors must be involved.
They focused their work on Kisumu, a Kenyan city by Lake Victoria where HIV and malaria are both common. They said 5 percent of HIV infections can be blamed on the increased HIV viral load due to malaria, and 10 percent of adult malaria cases can be blamed on HIV.
Since 1980, 8,500 more people got HIV infections, and there were 980,000 more episodes of malaria (a person can get it more than once) in a city whose adult population is 200,000, the study found.
PUBLIC HEALTH EFFORTS
The findings have implications for public health efforts, Abu-Raddad said, showing the importance for authorities to tackle these diseases together.
Of the 39.5 million people worldwide infected with HIV, 24.7 are in the poor countries of sub-Saharan Africa. About 2.1 million of the world's 2.9 million AIDS deaths in the past year were in this region.
Malaria kills more than a million people annually, mostly young children in sub-Saharan Africa.
The researchers produced their results with a mathematical model using HIV and malaria infection data gathered in Malawi by James Kublin of the Hutchinson Center. This enabled them to quantify for the first time the synergy between malaria on HIV and its toll on people.
Scientists previously determined that a lack of male circumcision and the incidence of genital herpes also were facilitating the spread of HIV. Abu-Raddad noted that circumcised men are much less likely to get HIV, and that genital herpes opens a door for HIV to infect a person.
Abu-Raddad said malaria now can be considered a third serious factor facilitating the spread of HIV.
The two diseases drive one another even though they have different modes of transmission -- malaria by mosquito and HIV predominantly by sexual intercourse, Abu-Raddad noted.
Abu-Raddad said once an HIV person gets malaria, his or her viral load goes up and stays higher for six to eight weeks, making the person far more infectious to others.
Mon Dec 4, 2006 8:23 AM ET
By Darren Schuettler
BANGKOK (Reuters) - The World Health Organization launched a new global effort on Monday to find a vaccine against malaria, which infects up to 500 million people each year, and the donors to pay for it.
The Malaria Vaccine Technology Roadmap aims to develop and license a first generation vaccine by 2015 against the mosquito-borne disease which kills more than one million people a year, mainly African children.
"The Roadmap marks the first concerted global attempt at mapping out a shared plan of action for making a preventive malaria vaccine reality," Marie-Paule Kieny, a top WHO official, said on the sidelines of a vaccine conference in Bangkok.
Malaria is one of the world's oldest diseases, but only $79 million was invested on researching a vaccine in 2004, according to a report by the Malaria Research and Development Alliance.
That is a fraction of the money spent on finding a cure for HIV/AIDS or, more recently, the H5N1 bird flu virus which has killed 154 people since 2003 but has fanned fears of a global human pandemic.
For years, malaria was not seen as a profitable area of research, but that is changing slowly through private-public partnerships, said Zarifah Hussain Reed, a WHO expert on vaccine and immunization issues.
"The attention drives the research. That's not to say bird flu doesn't deserve the attention, but it should not be about one disease hijacking the agenda," she told reporters.
The Roadmap aims to have a first-generation vaccine by 2015 that is 50-percent effective and would last longer than one year.
It sets a goal for a second-generation vaccine by 2025 that is more than 80 percent effective and offer protection for more than four years.
The WHO said more than 30 potential vaccines were under development, but there was not enough capacity or money to test them in clinical trials, especially in countries where the disease is endemic.
To overcome these and other hurdles the Roadmap makes a series of recommendations:
* Standardize procedures for assessing vaccine candidates and use the Internet to share information between laboratories and clinics.
* Diversify the search for a vaccine.
* Build up capacity for clinical trials in Africa and other areas where malaria is endemic.
* Secure sustainable funding and develop a regulatory strategy to speed up approval of a safe vaccine.
Malaria is caused by protozoan parasites which thrive in humans and are passed between them by female Anopheles mosquitoes.
There is no vaccine against the parasite, which has grown resistant to a number of well-known anti-malarial drugs, including chloroquine and pyrimethamine.
Artemisinin, a compound extracted from a Chinese herb, is regarded by medical experts as the best drug against malaria and the WHO recommended in 2001 it be used in combination with other drugs to slow down any development of resistance.
Despite international recognition of the need to halt the increasing HIV and AIDS pandemic and to deliver universal access to treatment, care and prevention by 2010, older people's susceptibility to the disease and the need for them to be included in HIV and AIDS strategies is not forthcoming.
Latest UNAIDS figures estimate that the number of people over 50 who are living with HIV is 2.8 million, which is 7 per cent of all those living with the disease. However, data on infection rates is only collected for country comparisons on women and men aged 15-49, so the spread of HIV among older age groups continues to go undetected and unreported. HelpAge International believes that this approach continues to convey an ambiguous and discriminatory message to programme implementers and policy makers.
Sixty-two year old, Dorothy Mdlela lives in Durban, South Africa. For the last year she has been HIV positive and cared for at home by her daughter and granddaughter.
Two of her children passed away from AIDS related illnesses two years ago. Dorothy was their full-time carer and believes the virus may have been transmitted while caring for them because she did not understand enough about HIV and how to protect herself from infection.
"Not long after my daughters died I started to feel ill, "explains Dorothy. "A local non-governmental organisation, the Muthande Society for the Aged, that works with older people suggested I go for a test.
"Clinic staff were reluctant to test me because they didn't think older people like myself were at risk, but the results came back positive. I have accepted the disease as it is there and I can't do anything about it."
Thembekile Hlubi, MUSA's Executive Manager says: "It's unbelievable that age discrimination is so widespread and institutionalised. Excluding older men and women like Dorothy from HIV and AIDS programmes has led many older people to believe that there is no treatment or support for them. It's not too late for Dorothy to access ARVs but how many men and women over 50 have given up hope because service providers and policy makers are ignoring their rights?"
MUSA works with older people in seven townships in Durban as part of it's HIV and AIDS programme in order to combat age-discrimination. In the last year MUSA has targeted information and training on HIV transmission and access to services to 3,000 older people who are both infected with HIV, and affected by the pandemic as carers of people living with HIV and AIDS, and of orphans.
MUSA also recognises the universal cultural taboo of older women and men receiving sexual related information from younger people. The organisation has trained 250 older peer educators and counsellors to raise awareness about HIV amongst older people and their families.
On World AIDS day, HelpAge International is calling on international
governments and organisations to recognise and include older people in HIV and
AIDS strategies and programmes, otherwise it warns the number of older people
living with HIV will increase.