10/13/2005 - AUSTRALIA: Government Ups Number of HIV Screenings for Indigenous Women
Darrin Barnett, Australian Associated Press

Australian Health Minister Tony Abbott recently announced the federal government will spend $1 million Australian ($747,000 US) annually to link pregnant Aborigines to free HIV/STD testing.

The funds are part of a strategy to help prevent high HIV/AIDS rates in Papua New Guinea (PNG) from crossing to Australia's Torres Strait.

"PNG now has the Pacific region's highest rate of HIV/AIDS.. Australia has been aware of a potential HIV epidemic in the Torres Strait for over 10 years," said a report highlighting the strategy.

"We do have significantly higher rates of [STDs] in our indigenous population, mostly because the primary care system is inevitably less easy to access in remote areas," said Abbott. "It is almost standard, even for mothers in remote areas, to be in good contact with health services so this is a very good time to get people."

AIDS diagnoses have increased from 1.5 per 100,000 indigenous people in 2000 to 3.6 last year, said Abbott. That compares to 0.8 diagnoses per 100,000 in the general community, he said. Gonorrhea rates among Aborigines are 40 times the national average; syphilis rates are 100 times greater; and hepatitis C notifications are double those of the non-indigenous population.

Australia now spends $10 million ($7.5 million US) annually to promote sexual health among indigenous people.

10/12/2005 - INDIA: In Tamil Nadu, Women Lead the War Against HIV
Soma Basu, Inter Press Service

Recently in Madurai, a high-HIV-prevalence region in the southern Indian state Tamil Nadu, six HIV-positive women went public with their health status at an event organized by the Family Planning Association of India (FPAI). The event was an example of the concerted HIV/AIDS prevention and education efforts that women and people living with HIV/AIDS in Tamil Nadu have mounted over the past few years to change people's attitudes and behavior and improve quality of life for those with HIV.

Efforts to reduce stigma and discrimination have paid off in terms of fewer families breaking up because of the disease, parents accepting their HIV-positive children instead of taking them to orphanages, more support among villagers for the infected, and less discrimination in schools against HIV-positive children.

According to T. Raja of the Mother Saradadevi Social Service Society in Dindigul, resistance to people with HIV/AIDS now comes from medical personnel, who sometimes refuse to give treatment. "That's where we step in. by offering referral services and trying to help doctors, nurses, [and] paramedical staff cope with the treatment of HIV patients instead of being scared and remaining shrouded in ignorance," said Louis Paulraj of FPAI.

HIV prevalence in Tamil Nadu, home to 60 million, came down from 0.75 percent in 2003 to 0.50 percent in 2004. Tamil Nadu was the first Indian state to introduce AIDS education in high school, set up information hotlines, and launch awareness campaigns specifically attacking HIV ignorance and stigma.

Rather than target high-risk groups, the state made it compulsory for movie theaters to show AIDS awareness spots and introduced programs such as enrolling thousands of barbers in a program to promote condoms and disseminate information.

Nationally, India has 5.19 million HIV-positive people.

10/05/2005 - UNITED STATES: HIV-1 Seronegativity in a Child with Proved Perinatal HIV Infection on HAART
N. Desai; M. Mathur; K. Abu-Lawi, Sexually Transmitted Infections Vol. 81: P. 377-379

The researchers conducted a case study to report the unexpected absence of HIV-1 antibodies and provirus in the peripheral blood of a four-year-old with previously diagnosed perinatal HIV infection. The study included a review of clinic and laboratory records and confirmation of results of HIV-1 enzyme linked immunosorbent assay (ELISA), western blot and HIV-1 DNA PCR from reference laboratory.

The investigators found that the child had "high plasma viral load at the initiation of highly active antiretroviral therapy (HAART) at 10 months of age. Following undetectable HIV viremia continuously for a 3-year period, he had normal CD4 and immunoglobulin levels. When retested at request of the parent, HIV-1, ELISA, western blot and HIV DNA PCR were all negative, raising the question of misdiagnosis and the parental misperception of a 'cure.' A rebound increase in viral load on cessation of therapy led to these diagnostic tests becoming positive again, with better parental acceptance of the diagnosis and treatment plan.

"Patients and providers should exercise caution in interpreting negative serological tests in children on HAART," the authors concluded.

09/29/2005 - UGANDA: Heightened AIDS Risk Seen with Pregnancy: Study
Agence France Presse

A recent issue of The Lancet reported on a study conducted on more than 10,500 Ugandan women, roughly a fifth of whom were pregnant or breast-feeding. The researchers, led by Ronald Gray of Johns Hopkins University, routinely tested the volunteers for HIV during the study period and collected data on their social background, sexual activity, use of condoms and relationships with men. Accounting for behavioral and socio-economic factors, the investigators found that pregnant women were more than twice as likely to contract HIV as non-pregnant women.

The study's findings are similar to two previous studies in Africa, but this investigation is the first to factor in variables such as poverty and safe-sex practices. Gray and colleagues noted it was unclear why pregnant women appear to be especially vulnerable to the virus and called on other researchers to verify their results.

The investigators theorize that pregnancy causes hormonal changes that may thin the protective mucous lining of the vagina or may make a women's immune system more susceptible to HIV. "It would be prudent to warn women of this potential risk of HIV acquisition during pregnancy, and to promote safe sex (i.e. monogamy and condom use) or sexual abstinence where feasible," the researchers wrote.

The report, "Increased Risk of Incident HIV During Pregnancy in Rakai, Uganda: A Prospective Study" appeared in The Lancet (2005;366(9492):1182-1188).

09/15/2005 - WASHINGTON: Agency Dedicated to Women with HIV
Julie Davidow, Seattle Post-Intelligencer

Babes Network, a Seattle agency devoted to supporting women with HIV/AIDS, began as a small group of HIV-positive women gathering for potluck dinners at friends' houses in 1987. In 1989, the network applied for a grant through Northwest Family Services. Three years later, Babes became an independent nonprofit organization.

Currently, about 285 women take advantage of the group's services, which include support group meetings, peer counseling, and picnics. "We're basically just like each other's friends," said Peer Counselor Nicole Price, who runs Babes' new co-ed support group.

In March, due to funding concerns, Babes Network relinquished its independent nonprofit status and became part of the YWCA of Seattle-King County-Snohomish County. Pat Migliore, a founding member who is now on the group's advisory board, said the transition to a larger organization means security for Babes and continuity for its clients.

Around 10 percent of King County's 5,808 HIV/AIDS cases are female - a group increasing faster than others. Gary Goldbaum, an epidemiologist at Public Health - Seattle & King County, said African-born immigrant women are "at potentially increased risk" for HIV. "They're coming from parts of Africa where HIV is rampant," said Goldbaum.

That does not surprise Lina Ali, a Tanzania native who is HIV-positive. As a member of the King County HIV/AIDS Planning Council and a volunteer at Babes, Ali said persistent cultural stigma and concerns about seeking treatment without legal immigration status keep many African immigrants from getting tested for HIV or discussing their status. Ali aims to spread the word among other immigrant women that medical assistance and support are available.

09/11/2005 - CHINA: Clinton Foundation to Provide Free Drugs to China's HIV/AIDS Children
Agence France Presse

On Sunday, officials with the Bill Clinton Foundation's HIV/AIDS initiative announced the expansion of its program to provide free treatment for HIV-positive children in China. In June, the former president's foundation began treating 200 HIV-positive children in central China, most of whom were infected from birth or unsanitary blood transfusions. Many of the parents were farmers infected in the 1990s through unsanitary blood-buying operations.

"It hasn't been publicly announced but it has been made known to officials in China," said Aaron Patillo, a drug procurement specialist for the foundation. "We don't know the actual number of kids who need the drugs, but we'll treat up to 2,000, and we're actually going to work with the government to try and identify more kids, and if there are more, we will not leave them uncared for. I'm sure there are many more kids who need the drugs."

While China produces HIV/AIDS treatments domestically, its pharmaceutical companies do not make the drugs in pediatric formulations.

Foundation officials made the announcement after a Beijing ceremony, which Clinton attended, that recognized the foundation's effort to train Chinese doctors in the United States. Upon their return to China, the doctors will treat HIV/AIDS patients in rural areas and train local doctors. "Most of the expertise in dealing with HIV/AIDS is found in urban areas. but most HIV/AIDS patients are in rural areas," said Clinton.

The foundation is also working to help Chinese health officials obtain second-line HIV/AIDS drugs for patients whose virus is resistant to first-line treatment.

09/01/2005 - UNITED STATES: Access to Reproductive Health Services May Facilitate HIV Treatment
AIDS Weekly & Law

In order to "explore the integration of reproductive health services into HIV care and treatment programs," L. Myers and colleagues at Columbia University studied the "design and progress of the MTCT-Plus Initiative, which provides HIV care and treatment services to HIV-positive women as well as their HIV-positive children and partners. By emphasizing the long-term follow-up of families and the provision of comprehensive care across the spectrum of HIV disease, MTCT-Plus highlights the potential synergies in linking reproductive health services to HIV core and treatment programs."

"While HIV care and treatment programs in resource-limited settings may not be able to integrate all reproductive health services into a single-service delivery model," the investigators wrote, "there is a clear need to include basic reproductive health services, such as access to appropriate contraception and counseling and management of unplanned pregnancies."

"The integration of these services would be facilitated by greater insight into the reproductive choices of HIV positive women and men, and into how health care providers influence access to reproductive health services of people with HIV and AIDS," the authors concluded.

The study, "Focus on Women: Linking HIV Care and Treatment with Reproductive Health Services in the MTCT-Plus Initiative," appeared in Reproductive Health Matters (2005;13(25):136-146).

08/27/2005 - OHIO: School's Pregnancy Rate Shocks Adults
Regina McEnery, Plain Dealer

Adolescent health experts are having a difficult time trying to discover why 65 of 490 girls at Timken High School in Canton got pregnant during the 2004-05 school year.

"We shouldn't just be looking at it as an issue of pregnancy, because it doesn't answer what needs these teens are trying to fill," said Dr. James Fitzgibbon, director of adolescent medicine at Akron Children's Hospital. "I've seen way too many kids in the last 25 years [not] to know there are way too many kids having unprotected sex, and they don't all live in Canton. We have to be careful that we are not reacting to just a number and a location," Fitzgibbon said.

Health experts also worry that STDs, which have been on the rise among teens in recent years, may continue to escalate.

School administrators did not return calls seeking comment about what their sex-education program emphasizes and whether they plan to strengthen the curricula. About 2.5 years ago, the abstinence until marriage programs offered by Community Services of Stark County and the Pregnancy Support Center were discontinued after the Timken teacher working with the agencies retired. A couple of years earlier, Akron-based Abstinence, the Better Choice lost its footing in the school, also when a teacher left the school district.

"A pervasive Victorianism has prevented us from going in there and doing the kind of work that needs to be done," said Betsy Kaufman, who recently retired as CEO of Planned Parenthood of Greater Cleveland.

"I think they really should have a sex-education class," said one girl, 16, whose baby is due in one month. "Most of the girls don't really care about abstinence and most are having sex. An abstinence program would be good along with the sex education."

08/26/2005 - THAILAND: Children with HIV Still Facing Rejection
The Nation

Two cases of discrimination against children living with HIV recently surfaced in Thailand's Kaset Sombun district. An 11-year-old girl was forced to leave a school under intense pressure from parents who worried that the girl could pass the virus on to their children. A six-year-old girl in the same district was forced to stop attending a kindergarten for the same reason.

According to Jinda Khemthong, the leader of a network of people living with HIV/AIDS, the older girl has been living with a relative since her parents died of AIDS-related causes six years ago. She started antiretroviral therapy three months ago and was eager to attend school after being rejected by her former school. Jinda said her group has encouraged the community to learn about the disease in a bid to ease prejudice against the girl. "Unfortunately, they don't even let the poor girl drink water from the same container," said Jinda.

The six-year-old is also suffering mentally after being forced out from her kindergarten, said Jinda. Her parents died some years ago and she is being cared for by grandparents in their 60s.

08/12/2005 - VENEZUELA: Prevention Campaign Aimed at Women and Teens
Humberto Marquez, Inter Press Service

Venezuela is stepping up its HIV/AIDS prevention efforts by launching a new campaign that specifically targets women and young people; groups that are increasingly at risk for the disease worldwide. According to Health Minister Francisco Armada, Venezuela "is one of the few countries that guarantees universal access to treatment for all people with HIV/AIDS, and we are dealing with the shortfall that has existed until now with regard to prevention."

The campaign will use television and radio spots, newspaper ads, and billboards to raise HIV awareness. To complement the public-awareness ads, 1 million male and female condoms will be distributed for free in health care centers geared toward women and youth. The Health Ministry will also distribute up to 20 million condoms through public health facilities. One of the main goals of the campaign, said Deisy Matos, director of the ministry's HIV/AIDS program, "is for HIV/AIDS testing to become a routine practice for everyone, and particularly women."

According to Matos, "focusing on women in this campaign was not a random choice, but was based on concrete statistics." In the early 1990s, women accounted for one out of every 18 HIV infections in Venezuela; now they account for every one out of four, said Matos.

Libsen Rodriguez, the UNAIDS representative in Caracas, said, "This emphasis is a welcome inclusion of a gender perspective in addressing the problem of AIDS in Venezuela." The ads "have been produced with our support, and are aimed, for example, at helping women and young people not to feel guilty about taking measures to protect themselves from the risk of infection," added Rodriguez.

As the cost of providing free antiretroviral treatment to the 15,500 HIV/AIDS patients registered with the Health Ministry can average over $300 a month per person, "focusing on prevention and education is much better, and more cost-effective," said Matos.

08/04/2005 - NEW MEXICO: HIV Center Says Cases Among Hispanics, Youths Increasing
Associated Press

Workers at the Camino de Vida Center for HIV Services in Las Cruces report seeing an increase in HIV infections among Hispanics and youths. Five of the center's 185 clients died last year; already this year, five clients have died, said Martin Walker, a prevention program counselor. According to Donny Grooms, chairperson of a fundraiser held Saturday for the center, Hispanics comprise 54 percent of the center's caseload. The center's goal is to raise enough money to provide medical and psychological support, stock a food bank, and help patients pay medical bills. Walker and a colleague are developing a prevention outreach program they will take to rural communities.

07/15/2005 - RUSSIA: Rights Group Says HIV-Positive Pregnant Women, Babies Face Discrimination in Russia
Associated Press

A Human Rights Watch (HRW) report issued Friday said HIV-positive pregnant women and mothers face discrimination in Russia, and their children are often segregated for no medical reason.

Government data show Russia with some 300,000 HIV-positive people, although many experts put the number at closer to 1 million. A recent study by the Woodrow Wilson International Center for Scholars in Washington estimated the number of Russian AIDS deaths at 13,000, compared to the official figure of 4,800.

Official data show more than 9,500 HIV-positive women had given birth by February 2005. Of them, 10-20 percent had abandoned their babies, HRW said. Many of those children end up in segregated orphanages or hospital wards for HIV-positive children because of fear of contact with them.

Viktor Kreidich, chief doctor of a Moscow orphanage for HIV-positive children, said they were segregated for their own protection, "not because these children are dangerous for society," but the reverse.

HRW said in spite of international and national regulations to protect the children of HIV-positive women, "the Russian government is failing lamentably in its obligation to implement these standards." And although Russia has one of the world's most rapidly growing HIV infection rates, the government has done little to address the crisis.

The report said the Russian public, though highly educated, is practically as ignorant of HIV and how it is spread as it was 10 years ago when AIDS was nearly unknown in Russia. The report called on President Vladimir Putin and his government to help reduce HIV/AIDS stigma and increase public awareness. It recommended that the Russian Health Ministry end the segregation of babies abandoned by HIV-positive mothers and better train medical and child care workers to work with HIV-positive women and children.

07/15/2005: Beaded Accessories Made by HIV-Positive South African Mothers Gain Popularity in International Fashion World
Wall Street Journal

Beaded accessories created by women enrolled in a program for mothers and pregnant women that aims to prevent mother-to-child HIV transmission in South Africa are "being catapulted into the international fashion scene," the Wall Street Journal reports (Cooper, Wall Street Journal, 7/15). The Mothers' Programmes, in Khayelitsha township outside of Cape Town, South Africa, provides services to between 2,500 and 3,000 pregnant women each month. The women participate in entrepreneurial projects, such as beading and blanket-making groups, giving them a chance to become financially independent (Kaiser Daily HIV/AIDS Report, 7/12). In 2003, the program launched a beading project, called Mothers Creations, and the accessories they produce -- including cell phone pouches, bracelets, lanyards and carrying cases for condoms -- are the "next hot trend in charity fashion," according to the Journal. Fashion designer Kenneth Cole has ordered more than 5,000 beaded lanyards and is negotiating with the project to produce beaded sandals. The cable channel Showtime bought about 1,000 lanyards for a recent event, and Church & Dwight's Trojan division commissioned 500 condom-carrying cases featuring the brand logo in beads. Mothers Creations has netted more than $300,000 since it started, according to charity officials. The group sells cell phone covers -- one of which takes three days to make -- for about $20 each and lanyards for $12 each. Workers are paid in cash as soon as they complete an item.

07/12/2005 - AFRICA: Laura Bush Calls Attention to AIDS Battle
Jennifer Loven, Associated Press

As part of a three-nation African tour to raise AIDS awareness, first lady Laura Bush was in Cape Town today to visit a US-assisted program for expectant HIV-positive mothers. The Khayelitsha Maternity Obstetrics Unit, part of the Mothers to Mothers-to-be Program, enlists mothers who have avoided transmitting HIV to their infants to mentor newly pregnant women. About one-quarter of South African babies are born to an HIV-positive mother.

Located in a depressed part of the city, the project also aids mothers and mothers-to-be in generating extra income. Mrs. Bush was to observe the women crafting lanyards, cell phone cases, and other products that will be sold abroad.

Later today, Mrs. Bush is scheduled to hold a discussion about domestic violence. Her goal is to highlight how fighting domestic violence is an integral part of combating the HIV epidemic in South Africa and across the continent. Many African women become infected after their husbands have unprotected sex with others and then force sex on them. Mrs. Bush will also deliver a speech promoting an initiative unveiled earlier this month by President Bush seeking $55 million over three years to provide legal protections for African women who are victims of violence and sexual abuse.

For the second event, Mrs. Bush - a former public school librarian and a high-profile advocate of reading - selected the Center for the Book as the backdrop. Part of the National Library of South Africa, the center helps develop a culture of reading among South Africans, especially children, and promotes indigenous writing.

On Wednesday, Mrs. Bush will travel to Tanzania. She returns to Washington on Friday after a visit to Rwanda.

07/11/2005 - CHINA: China Boosts Fight Against HIV/AIDS Among Women
Stephan Grauwels, Associated Press

On Monday at a Beijing AIDS conference, China's Health Minister Gao Qiang said the proportion of HIV/AIDS patients who are women jumped from 19.4 percent in 2000 to 27.8 percent last year. "In March this year," the minister said, "the proportion of women rose to 28.1 percent."

Gao said the rising numbers reflect women's lack of knowledge about HIV/AIDS, especially women in poor rural areas, of whom fewer than 40 percent know how to prevent HIV/AIDS. Gao said health workers are distributing posters at schools in the countryside and talking to women and youths to raise awareness of prevention.

Although the virus has spread in China mainly through prostitution and intravenous drug use, Gao said sexual transmission was catching up rapidly as a source of infection for Chinese women. The minister said 55 percent of the HIV/AIDS patients infected through sexual transmission are now women, up from 44 percent in 2001.

If more aggressive prevention measures are not taken, UNAIDS has warned that more than 10 million Chinese could have HIV/AIDS by 2010. Government figures put HIV cases in China at 840,000 and AIDS cases at 80,000. UNAIDS said the true numbers are likely higher.

07/05/2005 - UNITED STATES: HIV Screening Urged for All Pregnant Women
Jennifer C. Yates, Associated Press

Today in the Annals of Internal Medicine, the US Preventive Services Task Force recommended that all pregnant women, not just those considered at high risk, be screened for HIV. In 1996, the panel of medical experts had declared there was insufficient evidence that screening all pregnant women had any benefit. The new recommendation reflects the fact that testing has helped prevent many potential mother-to-baby HIV transmissions.

HIV-infected pregnant women can take combination drug therapy, have Caesarean sections, and avoid breastfeeding to reduce to as low as 1 percent their risk of transmitting HIV to the babies. Without intervention, there is a one-in-four chance an HIV-positive mother's infant will become infected.

The new recommendation follows a 2001 CDC directive that emphasized HIV testing "as a routine part of prenatal care and strengthened the recommendation that all pregnant women be tested for HIV," said agency spokesperson Jessica Frickey.

Women account for about 27 percent of the estimated 40,000 Americans who become HIV-infected each year. Already, many pregnant women are offered the test but decline to take it. Dr. Diana Petitti, the vice-chairperson of the task force and a scientific adviser for health policy and medicine at Kaiser Permanente Southern California, said women need to understand that new HIV tests are nearly 100 percent accurate, and there is no shame in admitting that one might be at risk. As testing becomes more universal, the stigma associated with testing will decline, said Sharon Hillier, professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine.

The task force reiterated its recommendation that adolescents and adults at increased risk be tested, and it expanded its definition of "high risk" to include persons getting care at homeless shelters or STD clinics. The full report, "Screening for HIV: Recommendation Statement," was published in Annals of Internal Medicine (2005;143(1):32-37).

07/05/2005 - UNITED STATES: Pediatricians Denounce Abstinence-Only Education
Lindsey Tanner, Associated Press

The American Academy of Pediatricians has revised its 1998 teen pregnancy policy to omit the statement that "abstinence counseling is an important role for all pediatricians." The new AAP policy states that although doctors should counsel adolescents to postpone sexual activity, they should also ensure that all teens - not just those who are sexually active - have access to birth control, including emergency contraception.

"Even though there is great enthusiasm in some circles for abstinence-only interventions, the evidence does not support abstinence-only interventions as the best way to keep young people from unintended pregnancy," said Dr. Jonathan Klein, chairperson of the AAP committee that wrote the new policy.

Teaching abstinence but not birth control makes it more likely that youths, once sexually active, will engage in risky behaviors and contract STDs, said Dr. S. Paige Hertweck, a pediatric obstetrician-gynecologist at the University of Louisville who provided advice for the report.

Citing 2003 government data, AAP's report said that over 45 percent of high school girls and 48 percent of boys have had sexual intercourse. About 900,000 US teens get pregnant each year, and teen birth rates are higher in the United States than in other comparable industrialized countries. That could reflect greater contraceptive access in other countries, said the report.

President Bush favors abstinence-only sex education. Counseling abstinence-only, preferably until marriage, is the best message because it is clear and consistent, said Wade Horn, assistant secretary for children and families at the US Department of Health and Human Services. While sexually active youths should have contraceptive access, making it available to teens who are not sends a contradictory message, said Horn.

The revised policy, "Adolescent Pregnancy: Current Trends and Issues," was published in the journal Pediatrics (2005;116(1):281-286).

07/04/2005 - ASIA: Women Becoming New Face of AIDS in Asia
Agence France Presse

The number of women infected with HIV in Asia has risen 20 percent since 2003 to 2.3 million, compared with a 17 percent increase for the region's total population, UNAIDS said at the recent 7th International Congress on AIDS in Asia and the Pacific. In India, 2 million of the country's 5.1 million HIV/AIDS cases are female, said Periasamy Kousalya, head of the Positive Women Network, an activist group of about 5,000 HIV-infected Indian women.

Experts at the conference, held in Kobe, Japan, said the status of women in Asia's male-dominated culture makes them especially vulnerable to HIV. "Economically, culturally, socially, women are disadvantaged," said Kousalya. "They lack access to support systems for HIV."

Frika Chia Iskandar, an Indonesian representative of the Seven Sisters nonprofit for people living with HIV/AIDS, reported that she has occasionally been denied medical care because of her HIV-positive status. Iskandar said she feared further stigmatization at home because of her outspokenness about the disease abroad. "I am the new face of HIV in Asia," she said.

In Japan, HIV discrimination is more subtle, said an HIV-positive women who would only identify herself as "Nancy." "Social welfare is available for Japanese patients with HIV. But I live deep in the countryside, and if I apply for benefits, everybody in the community will know about my infection."

"Japan has good treatments available, good welfare systems," said Nancy. "But those systems are made by someone at the government, without inputs from people with HIV. We want to make our voices heard so that our thoughts and requests will be reflected in decisions of policymakers."

06/26/2005 - GLOBAL: Birth-Control Gel Also Might Kill HIV
Andy Dworkin, Times-Picayune (New Orleans)

According to doctors worldwide, the spermicide gel C31G could be a breakthrough in birth control and might fight diseases including HIV. The gel contains no hormones, which can cause side effects and require a prescription, is easy to use, and is packaged in an applicator similar to a tampon's.

A disease-fighting female contraceptive would have "a huge public health impact," said Heidi Milliken, manager of the Women's Health Research Unit (WHRU) at the Portland-based Oregon Health & Science University, which is helping test C31G's contraceptive power. The university is part of the Contraceptive Clinical Trials Network (CCTN), a group of 14 health centers financed by the National Institutes of Health.

Although condoms limit the spread of HIV/AIDS, women do not have control over their use. While female condoms might offer limited disease protection, no other contraceptive really fights diseases, according to the Food and Drug Administration.

For years, health experts thought the spermicide Nonoxynol-9 could limit STDs, but tests showed it irritated the body and made it more susceptible to diseases. C31G and Nonoxynol-9 work in similar ways, said WHRU Director Dr. Jeffrey Jensen. Early tests show C31G "highly potent" in fighting viruses and bacteria, but not as irritating as Nonoxynol-9, Jensen said. Scientists are researching C31G's disease-fighting ability in Africa with female volunteers at high risk for STDs.

Early tests suggest C31G is about 85 percent successful at preventing pregnancy, approximately the same rate as Nonoxynol-9 used alone. The CCTN testing sites are enrolling healthy women ages 18-40 in long-term sexual relationships with one partner. Two-thirds will get C31G and the rest will receive Nonoxynol-9.

06/15/2005 - UNITED STATES: HIV Striking More Women in South
Steve Sternberg, USA Today

On Tuesday at the 2005 National HIV Prevention Conference in Atlanta, researchers said AIDS is surging among women in the South.

About 1 million Americans are believed to be living with HIV, of whom some 25 percent are women. This population has remained relatively stable for the past few years, said CDC's Lisa Fitzpatrick, but HIV is much more concentrated in some groups than others. There are about 140 million US women; 29 percent of them live in the South; but they represent more than 76 percent of new HIV infections, according to data from the 32 states that report HIV infections to CDC. The Northeast and Mid-Atlantic regions are also hot spots.

Compared with white women, Fitzpatrick said, HIV diagnoses were four times higher among Hispanic women and 18 times higher among black women. Heterosexual sex was the transmission route for 71 percent of these cases, said Fitzpatrick. Females ages 13-19 in the South accounted for 8 percent of new diagnoses - four times that age group's HIV rate in other US areas.

Poverty, powerlessness, low AIDS awareness, and poor access to care are driving the epidemic among Southern women, researchers said. "Segregation concentrates poverty," said Adaora Adimora of the University of North Carolina School of Medicine. "Many people select their sexual partners from the neighborhood, and they're more likely to encounter a high-risk partner if they live in a high-risk neighborhood. This is a particular problem in the rural South."

Researchers are testing prevention programs that seek to help women build self-esteem and establish a balance of power in relationships so they can convince their partners to use condoms.

06/12/2005 - SOUTH AFRICA: Keeping Mom Alive Is the Best AIDS Tactic
Kristin Palitza, Inter Press Service

According to the National HIV and Syphilis Sero-Prevalence Survey in South Africa 200 - conducted by the Department of Health and released in September 2004 - 27.9 percent of pregnant women in the country had HIV/AIDS in 2003. Nearly one-third of South African newborns stand to lose their mothers to AIDS-related causes.

Dr. Tshidi Sebitloane of the University of Kwa Zulu-Natal said infant mortality of two-year-old HIV-negative children whose mothers are chronically ill or have died appears to be as high as mortality among HIV-positive children the same age. Yet, attention so far has focused more on preventing mother-to-child transmission than on the future health of HIV-positive mothers.

Sebitloane said that might partly reflect the fact that free antiretroviral (ARV) treatment has only begun to be available in South Africa in the past 18 months, and regulations to improve HIV-positive mothers' access to the drugs are not yet in place. Sebitloane said the Department of Health should make voluntary counseling and HIV and CD4-count testing available at all antenatal clinics.

A program to improve care for HIV-positive mothers, the Mother-to-Child Transmission Plus initiative, launched by Columbia University of New York City, has been implemented at 13 sites in sub-Saharan Africa and Asia and has given 7,000 mothers so far access to ARVs. Three sites are in South Africa.

Feeding babies a mix of breast milk and formula risks facilitating HIV transmission, possibly because this may irritate their bowels, making them more vulnerable to infections, research has shown. But only one-third of mothers responding to a recent survey had been properly advised to use one method exclusively, wean babies at three to four months, and choose formula feeding if they have access to the clean water needed to prepare it.

06/09/2005 - GLOBAL: Science Hopes to Give Women New Tools Against AIDS
Andrew Quinn, Reuters

Today in Durban, Salim Abdool Karim of South Africa's University of KwaZulu-Natal told an AIDS conference that new HIV prevention treatments for women might be available as early as 2009. Microbicides, which women could possibly use in gel or cream form to prevent HIV infection, do not need a partner's consent, Abdool Karim said.

UN estimates show 60 percent of the nearly 30 million HIV-infected people in sub-Saharan Africa are women, and this proportion is growing - especially in societies where women are less able to refuse sex or negotiate condom use. Female condoms, introduced to give women more control over their sexual health, have not been completely effective, as men may refuse to have sex with a woman who is wearing one, according to Abdool Karim.

Microbicides that kill the HIV virus in the vagina, block it from infecting other cells, or prevent it from multiplying are currently in human trials. Abdool Karim said results could be available by early 2008. Should microbicides prove effective, they could be available to women within one or two years after fast-track regulatory approval.

Experts estimate microbicides could prevent 2.5 million AIDS deaths over three years. Abdool Karim, who oversees one of five advanced human clinical trials, cautioned it is still to early to say if microbicides will prove effective. But in theory, Abdool Karim said, microbicides could protect women from HIV over a period of days, or could be applied after sex to prevent infection.

The research is complicated, and major pharmaceutical companies are not involved. Most microbicide projects are undertaken by small biotechnology companies, often funded through donations from agencies such as the US National Institutes of Health and the Bill and Melinda Gates Foundation.

06/07/2006 - KENYA: US University Wins Grant to Expand Kenyan HIV/AIDS Programs
Associated Press

A grant from the President's Emergency Plan for AIDS Relief will help Indiana University's School of Medicine triple the number of HIV/AIDS patients receiving antiretrovirals through its programs in Kenya. IUSM operates the program, known as AMPATH, in collaboration with Moi University School of Medicine in Eldoret, Kenya. The new $8.9 million grant is in addition to the $15 million IUSM received from PEPFAR for the effort in 2004. AMPATH now operates 15 clinics and health centers. With the new resources, it hopes to supply 18,000 patients with antiretrovirals by September 2007. The program will also expand HIV screening of pregnant women and seek to reduce TB incidence: More than 10 percent of new HIV patients in the region are co-infected with TB. The new money "will save tens of thousands of lives," said Robert Einterz, IUSM's associate dean for international programs and the director of AMPATH.

06/05/2006 - ZAMBIA: AIDS Will Orphan 20 Percent of Children by 2015
Mail & Guardian (Johannesburg)

On Monday, Zambia's Department of Foreign Affairs warned that approximately 20 percent of the country's children will be orphaned by HIV/AIDS by 2015. Currently more than 1.1 million children are orphans, mostly from HIV/AIDS. More than 71 percent of Zambia's 6 million children live in extreme poverty and deprivation. About 90,000 have HIV/AIDS, and thousand of others are vulnerable to abuse and exploitation due to high poverty levels. The Evangelical Fellowship of Zambia, which runs a program for street children and conducts mobile health clinics, said levels of STDs among street children have reached "alarming proportions." The Zambia Civic Education Association described the condition of Zambian children as "critical" and exhorted the government to immediately enact a child policy and action plan.

06/03/2006 - GLOBAL: UN Group Sets Compromise on AIDS Policy
David Brown, Washington Post

Early Friday morning, UN delegates to the 2006 High Level Meeting on AIDS reached agreement on a policy declaration that sets no treatment targets and indirectly refers to high-risk groups such as homosexuals, prostitutes, and IV drug users. However, the "Declaration of Commitment" does contain language recognizing the "feminization" of the global AIDS epidemic, as well as the need for pediatric treatment formulations and the importance of AIDS education for young people.

The eight-page document, an update of one adopted five years ago that helped turn resources and attention to the developing world, is a compromise between the United States, which opposed numerical treatment targets; Islamic countries, which did not want "vulnerable populations" defined in detail; and numerous activist groups pushing for statements of female empowerment as a tool in the AIDS fight.

The contentious negotiations were led by UN ambassadors from Thailand and Barbados.

The 2001 policy laid out targets for dollar amounts to be spent on AIDS and for the percentages of people who should receive prevention, testing, and treatment services. The new declaration only lists $20 billion to $23 billion as an "estimate" for annual needs beginning in 2010, and it does not commit donors or recipient countries to come up with that amount. It also sets no clinical targets.

"Vulnerable groups" are mentioned several times in the final document. In addition, the declaration specifies "male and female condoms and sterile injecting equipment" that at-risk people need to protect themselves.

Responses to the declaration varied among the 800 civil society groups at the meeting, the largest participation of outsiders in UN history. Though some criticized the lack of targets and the omission of vulnerable groups by name, others praised the acknowledgement of the connection between gender inequality and AIDS, and language condemning "harmful traditional and customary practices, abuse, rape, and other forms of sexual violence."

06/03/2005 - AFRICA: AIDS, Pregnancy, and Poverty Trap Ever More African Girls
Sharon LaFraniere, New York Times

The HIV/AIDS epidemic is reversing 25 years of progress that saw more African girls marrying later and staying in school. Now, orphaned and impoverished by parents' deaths, girls are engaging in sex at early ages to support themselves, their siblings, and often their own children.

"AIDS is reversing the trends that were improving for girls," said Margie de Monchy, regional child protection officer for UNICEF. "We really have to look at the kinds of lousy choices, and sometimes no choices, that they have for survival."

Of the 12 million AIDS-orphaned children in sub-Saharan Africa, girls tend to fare worse than boys because of females' lower status in society, their greater vulnerability to sexual exploitation, and their greater likelihood of contracting HIV due to anatomical reasons. Often, young girls have sex with men who falsely promise to take care of them.

A UNICEF study in Zimbabwe found that orphaned girls are three times more likely to contract HIV than those whose parents are alive. In Zambia, orphaned girls are the first to be withdrawn from school. A recent survey found some orphans' impoverished relatives send them into the street at night as young as 14 to earn their keep. UNICEF researchers found that in Lesotho, many orphaned girls are forced to work as maids or prostitutes.

"Orphaned girls are at the absolute margins," said James Elder, UNICEF's spokesperson in Zimbabwe. "They are the very bottom of the barrel. They are much more likely to engage in risky behavior just to survive."

UNICEF-supported charities, such as Mozambique's Reencontro, assist HIV/AIDS patients and orphans with food and urge children to return to school. But many have little time for classes and no money for textbooks and other necessities.

06/02/2006 - UNITED STATES: 25 Years of AIDS
Joyce Howard Price, Washington Times

On Friday, CDC published an analysis of the successes and failures in preventing and treating HIV/AIDS in the United States over the past 25 years.

Since it was first described in the Morbidity and Mortality Weekly Report published June 5, 1981, AIDS has "become one of the greatest public challenges both nationally and globally," having claimed the lives of at least 22 million people worldwide and more than 500,000 in the United States, CDC epidemiologists said. And though combination drug therapies that became widely available in the 1990s now allow patients to live longer, "HIV/AIDS remains a potentially deadly chronic disease," said the authors.

Though the first US diagnoses of AIDS occurred in young white gay men, the disease has since spread to take a heavy toll on minorities and women. While comprising just 13 percent of the US population, blacks accounted for more than half of new HIV diagnoses, according to federal data.

In 1987, heterosexual transmission accounted for about 6 percent of AIDS cases. Now, 30 percent of HIV/AIDS diagnoses are among heterosexuals. Women are especially vulnerable to HIV during sexual intercourse; in 2002, HIV infection was the leading cause of death for African-American women ages 25-34, CDC said.

CDC spokesperson Karen Hunter said the agency's "biggest success to date" is the reduction in mother-to-child HIV transmission. In the epidemic's early years, about 30 percent of babies born to HIV-positive women became infected. That figure is now less than 2 percent.

However, efforts to address HIV transmission among men who have sex with men have been less successful. "Men who have sex with other men account for approximately 45 percent of newly reported HIV/AIDS diagnoses, and nearly 54 percent of cumulative AIDS diagnoses," the report said.

The analysis, "Twenty-Five Years of HIV/AIDS - United States, 1981-2006," was published in the Morbidity and Mortality Weekly Report (2006;55(21):585-589).

06/02/2006 - GLOBAL: One Disease, Two Epidemics - AIDS at 25
Kent A. Sepkowitz, M.D., Morbidity and Mortality Weekly Report. (MMWR)

Twenty-five years have passed since the first cases of AIDS were recognized. During the first two decades, the epidemiology and clinical presentation of the disease were established, and potent antiviral therapies were developed - for use in patients who could afford them. The progress of the past five years has been less dramatic. Indeed, the most salient change was a widening of the gap between the haves and the have-nots, so that today a single virus is responsible for two distinct public health calamities.

Placed against the backdrop of the global AIDS epidemic, the AIDS-related problems in developed countries seem tame. Much current activity in high-income countries involves managing the predictable effects of any potent therapy - toxic effects and drug resistance - rather than scrambling to provide basic care. Of course, these problems are not trivial. After a decade of highly active antiretroviral therapy, the group of common side effects loosely called body-fat or metabolic abnormalities - lipodystrophy and lipoatrophy, diabetes, glucose intolerance and insulin resistance, and dyslipidemia - still have no established remedy. Adjustment of the antiretroviral regimen, improvements in diet and exercise, and additional medications help some of the people some of the time. Yet management of the disease often remains inadequate, a limitation that chills enthusiasm for the early initiation of therapy. Current guidelines recommend that no treatment be given to an asymptomatic person with a plasma human immunodeficiency virus (HIV) RNA concentration of less than 100,000 copies per milliliter, unless the CD4 cell count is below 200 per cubic millimeter.1

At the same time, the rate of drug resistance among circulating HIV strains continues to increase: from approximately 5 percent in samples gathered before 1996 to at least 15 percent in isolates obtained between 1999 and 2003.2 Patients should therefore undergo resistance testing before therapy is begun.

In the United States, approximately 1 million persons are living with HIV infection or AIDS, and 164,000 to 312,000 of them remain unaware of their infection.3 Experts hypothesize that most of the 40,000 new infections that occur annually in this country arise from contact with these undiagnosed persons. Given this likelihood, investigators have examined the potential benefit of routine screening, rather than testing of only those perceived to be at increased risk. This strategy appears to be as cost-effective as screening for colon, breast, or prostate cancer, and the availability of a rapid oral test has simplified broadscale testing.

Some worry, however, that routine testing could erode patient confidentiality by circumventing safeguards that were erected in the 1980s, when HIV infection seemed to be untreatable and universally fatal. Current debate focuses on whether these once-crucial laws paradoxically now impede the public health response to the epidemic by encumbering the testing process.

For those who have already tested positive, treatment has become more convenient but not more potent in the past five years, with the introduction of numerous once-daily dosing regimens. Enfuvirtide, the first fusion inhibitor, is effective in many persons with highly resistant virus, but twice-daily injections are difficult for some to sustain.1 The possibility that tenofovir, with or without emtricitabine, may be effective as prophylaxis has received attention on two different fronts. The first was a description of its frequent use as a "party" pill by uninfected persons who planned to engage in high-risk activity. The second was more recent studies showing that its use in high-risk populations reduces the infection rate. This approach, however, may accelerate the emergence of drug resistance and thereby compromise the effectiveness of the prophylactic or therapeutic use of these medications.

Meanwhile, the second epidemic - in low- and middle-income countries - has grown far vaster than that in the United States, as HIV continues its nightmarish expansion (see table). Only one fifth of people in developing countries who need treatment are receiving antiretroviral therapy.4

06/02/2006 - GLOBAL: Worldwide Prevalence and Incidence of HIV Infection and AIDS and Related Mortality in 1995, 2000, and 2005.
Kent A. Sepkowitz, M.D., Morbidity and Mortality Weekly Report. (MMWR)

The establishment of cheap, effective approaches to prevention has been similarly elusive. Until a vaccine is developed, prevention must continue to rely on more complicated and probably less useful options. The effect of male circumcision on HIV transmission remains controversial, despite a report from South Africa, where more than 3000 men were randomly assigned to undergo either circumcision or observation.5 The trial was stopped early because of a 61 percent reduction in the rate of new infections in the circumcision group that persisted after researchers had controlled for differences in sexual behavior, condom use, and health care-seeking behavior. The response to this study, however, remains wary and even dismissive, a hesitance that seems misplaced, given the role of HIV in forcing frank discussions of sexual activity.

Two long-considered prevention strategies appear to be ready for definitive clinical trials. Although monthly azithromycin given to prevent genital ulcer disease did not reduce the risk of HIV transmission, long-term antiviral therapy for genital herpes simplex - a tactic that may have a better biologic foundation - is now being examined. Similarly, studies of microbicides are finally advancing.

The provision of clean disposable needles for health care and the maintenance of a safe blood supply were high priorities for the United States in the 1980s. The cost of establishing similar programs in resource-poor countries is daunting, yet the risk of HIV transmission by either route is substantial - perhaps higher than the risk from sexual contact. Currently, because of its cost, only 30 percent of countries routinely screen blood. Screening potential donors is a cheaper approach, yet it may rely on the race-based exclusion of donors, creating a different dilemma.

Another concern has been the powerful reciprocal interactions between HIV and Mycobacterium tuberculosis. Although these interactions were demonstrated by outbreaks of multidrug-resistant tuberculosis in the United States 15 years ago, the devastation caused by these intertwined epidemics continues to startle. Tuberculosis kills as many as one of every seven people with AIDS worldwide, and one third of the increase in cases of tuberculosis over the past five years can be attributed to the HIV epidemic.

Control of tuberculosis in areas where HIV is endemic is complicated by several factors, including a growing fear of acquiring tuberculosis that makes some health care workers reluctant to care for those infected with HIV. A lone optimistic note has been the increasing interest in applying a tool that helped to tame tuberculosis in some countries - directly observed therapy - to the treatment of HIV infection. If effective, this tactic may preserve both individual health and the drug susceptibility of circulating virus.

It is unfortunate that for the past 25 years, the lessons learned about HIV prevention and control in one country have failed to inform decisions in others. As a result, the world has witnessed a slow-motion domino effect, as the disease overwhelms country after country. Typically, locals place the blame on foreigners and foreign behavior - just as the French once called syphilis "the Italian disease" and the Italians considered it "the French disease." This sort of buck passing has delayed the control of AIDS in every country. By the time the scale of the problem is finally appreciated, a mature epidemic is in place, and the cost in lives and money has increased exponentially.

We can only hope that the years ahead will be characterized not just by better drugs, new vaccines, and improved prevention methods, but also by the adoption of the humility necessary to control a disease that is transmitted through sexual activity and drug use - two of proper society's least favorite topics. The prime mover of the epidemic is not inadequate antiretroviral medications, poverty, or bad luck, but our inability to accept the gothic dimensions of a disease that is transmitted sexually. Only when we cease to dodge this fact will effective HIV-control programs be established. Until then, it is no exaggeration to say that our polite behavior is killing us.

06/01/2006 - ETHIOPIA: AIDS on the Rise Among Ethiopian Women: Prevalence Rate 5 Percent
Deutsche Presse-Agentur

According to a recent national surveillance report, HIV prevalence among Ethiopian women is now an estimated 5 percent, Dr. Kebede Worku, Ethiopia's Health Minister, said Thursday. The minister, speaking at the annual Ethiopian Medical Association conference in Addis Ababa, cited women's low socioeconomic status and biological vulnerability to infection as reasons for the increase from an earlier 4.4 percent estimate. "This is a wake-up call to the government and others working to curtail the spread of HIV/AIDS," he said. The minister also reported that about 35,000 patients are receiving free antiretroviral treatment provided by the government treatment program, which was launched in January 2005.

05/17/2005 - MYANMAR: Myanmar Launches UN-Sponsored Program to Prevent Mother-to-Child HIV/AIDS Transmission
Associated Press

On Tuesday, UNICEF announced that the UN and the government of Myanmar have launched a program to prevent mother-to-child HIV/AIDS transmission. The program started at the country's 10 largest hospitals and will gradually be extended throughout the nation, where HIV infections continue to rise. HIV-positive women give birth to at least 3,000-4,000 HIV-positive children in the country every year, UNICEF representative Carroll Long said in a statement. While Myanmar's government says more than 300,000 of the country's 54 million people have HIV/AIDS, UNAIDS estimates that more than 600,000 people ages 15-49 in the country have HIV. UNICEF spends an average of $2 million annually to support HIV/AIDS prevention and care programs in Myanmar.

05/11/2005 - OHIO: Microbicides Could Reduce AIDS Transmission to Women
Regina McEnery, Plain Dealer (Cleveland)

The Washington, D.C.-based Global Campaign for Microbicides (GCM), which builds awareness and political support for microbicide research, launched a Cleveland chapter - its ninth in the United States - with a forum at Case Western Reserve University. AIDS activists and researchers attended the forum, which featured the Cleveland-area premiere of "In Women's Hands: A Film on Women, HIV and Hope," focusing on women in the developing world.

GCM is lobbying for a Senate bill that would create a separate center for microbicide research within the National Institutes of Health and boost public spending for this research. Currently, only about 2 percent of the NIH AIDS budget is devoted to microbicides. Ideally, women could topically apply such a product before intercourse to prevent transmission of HIV and other STDs.

About 50 microbicides are in the drug development pipeline, with five in advanced phases of clinical trials, according to GCM's Bindiya Patel. Case's Center for AIDS Research has developed a novel protein that blocked HIV transmission in macaques, and scientists hope eventually to test the compound on humans.

According to Patel, more than half of new HIV infections in the developing world occur in women, the majority of whom were infected by their husbands. In 2003, 58 percent of the 26.6 million people with HIV/AIDS in sub-Saharan Africa were women.

Earl Pike, executive director of the AIDS Taskforce of Greater Cleveland, said a number of microbicides are also being tested for rectal use. "So there is significant hope that whatever application can be found for vaginal microbicides can also reduce HIV transmission among gay and bisexual men during anal intercourse," Pike said.