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Bill and Melinda Gates
called on world leaders to "put the power to prevent HIV into the
hands of womenat the opening of the Sixteenth International AIDS Conference
in Toronto yesterday. Over 24,000 delegates are registered for this
year's conference, and Bill Gates told the opening ceremony that "we
need to be much more aggressive about getting all of today's prevention
tool to everybody who needs them". Melinda
Gates added "today, fewer than one in five people at greatest risk
of HIV have access to proven approaches like condoms, clean needles,
education and testing. That's a big reason why we have more than four
million new infections every year " Few delegates will have missed
the implicit criticism of the Bush administrations favoured ABC approach
to HIV prevention. Emphasis
was also placed by Bill and Melinda Gates on the need to develop new
methods of HIV prevention that women can control. Recently, the Gates
Foundation provided $287 million to HIV vaccine research , but Bill
Gates said not nearly enough was being done to develop new prevention
tools, such as a vaginal microbicide gel or pre-exposure prophylaxis
(PREP - taking anti-HIV drugs to prevent infection with HIV). He called
on drug companies, governments, activists and organisations such as
WHO and UNAIDS to play a role in the development of these technologies.
Melinda Gates spoke of the stigma that often undermines HIV prevention
work, and once again implicitly criticised the approach of the Bush
administration to HIV prevention by calling sex workers "crucial allies
in the fight to end AIDS."
South Asian nations must provide better HIV prevention measures for groups at an increased risk of contracting the virus to stop the spread of the disease, according to a World Bank report presented at the XVI International AIDS Conference in Toronto, Reuters reports (Le Gras, Reuters, 8/14). The report, titled "AIDS in South Asia: Understanding and Responding to a Heterogeneous Epidemic" tracks the spread of HIV; reports on conditions in the region; and offers strategies to combat the virus in Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka (Agence France-Presse, 8/14). The report finds that the region's HIV/AIDS epidemic is fueled by commercial sex work, drug use, stigma and discrimination, poverty, illiteracy, the low social status of women, migration, cultural taboos, high rates of sexually transmitted infections and low levels of condom use (World Bank release, 8/14). In addition, the report finds that the mobility of sex workers and their clients fuels the spread of HIV in Afghanistan, Bangladesh, India and Pakistan. For example, a "high proportion of female sex workers in India move, often as frequently as every two weeks," the report says, adding, "Clients of female sex workers are also highly mobile ... increasing the pace at which high-risk networks are linked, and this pattern can amplify local epidemics." The report highlights the challenges of programs geared toward sex workers, such as "maintaining continuous outreach and peer education and condom supplies" (Reuters, 8/14). South Asian countries must create better prevention programs that target sex workers and their clients, intravenous drug users and their sexual partners and men who have sex with men, the report says. "South Asia's HIV epidemic is severe, but further spread is preventable," according to the report. According
to World Bank South Asia Human Development Director Julian Schweitzer,
"There are absolutely no grounds for complacency." He added that the
epidemic is "like stuffing a genie into the bottle, it could burst
out at any moment if we get complacent" (Agence France-Presse, 8/14).
Thailand's HIV/AIDS prevention and treatment programs should serve as a model for other countries with limited resources to fight the disease, according to a World Bank report released on Wednesday at the XVI International AIDS Conference in Toronto, Reuters UK reports. The report examines Thailand's antiretroviral drug provision program, which was launched in October 2005 and provides access to treatment for almost 80,000 HIV-positive people in the country. Under the program, a person can access treatment for about 80 cents at any hospital or health clinic. According to the report, widespread condom distribution and other prevention programs launched about 10 years ago -- combined with a network of hospitals and clinics -- enabled Thailand to control its HIV prevalence. The report also finds that if Thailand had not launched widescale HIV/AIDS prevention programs, the country would have recorded 7.7 million HIV cases and 850,000 AIDS cases in 2005 -- 14 times the number of cases the country currently records. Thailand also has avoided spending an additional $18.6 billion on treatment from 2002 to 2012 because of its prevention and treatment programs, the report says. According to Mead Over, a World Bank economist and report co-author, Thailand saved about $43 in treatment for every $1 the country spent on prevention. The report recommends that countries -- such as India and China -- with HIV/AIDS epidemics in earlier stages model their HIV/AIDS prevention and treatment programs after the ones implemented in Thailand. "Thailand's past success with prevention is the most important reason the country can afford universal access to (AIDS treatment) today," Over said, adding, "Furthermore, it is an essential condition of its continued ability to afford treatment in the future." According
to the report, costs associated with Thailand's treatment program
will rise as increasing numbers of HIV-positive people require access
to second-line drugs, which are seven to 28 times more expensive than
first-line drugs. Because many second-line drugs are under patent,
Thailand will have to pay full price for the drugs, negotiate prices
with the pharmaceutical companies that hold the patents or issue compulsory
licenses for drug production under a World Trade Organization agreement
provision. Thailand could save about $3.2 billion in health-related
costs through 2015 by issuing compulsory licenses, according to the
report (French, Reuters UK, 8/16).
Actor and HIV/AIDS advocate Richard Gere at the XVI International AIDS Conference in Toronto joined media officials from the Caribbean, India, Russia and South Africa to promote the media's role in raising HIV/AIDS awareness, the Associated Press reports (Duff-Brown, Associated Press, 8/14). Gere in 2004 co-founded the Heroes Project -- which uses celebrities from Bollywood films, sports figures, business leaders and government officials as spokespeople to increase public discussion of the Indian HIV/AIDS epidemic with television, radio and print advertisements (Kaiser Daily HIV/AIDS Report, 10/24/05). Gere has collaborated with Peter Mukerjea, CEO of STAR India television, to reach an estimated 70 million viewers with its HIV/AIDS public service announcements, in partnership with Avahan, the India AIDS initiative of the Bill & Melinda Gates Foundation and the Kaiser Family Foundation (Heroes Project release, 8/14). Star CEO Peter Mukerjea and Gere at a press conference said STAR is renewing a five-year commitment worth $23.16 million to continue the Heroes Project campaign. "When it comes to HIV/AIDS, we did not bat an eyelash to bringing it on ourselves to do something to make a difference," Mukerjea said (Associated Press, 8/14). "As a media company, the most effective thing we could do was use our platform and reach out to the millions of people who watch television shows every evening with messaging that was going to connect with them in a society which is extremely sensitive to the subject as a whole," Mukerjea added. "I deeply love India, and I will continue to deeply love India," Gere said, adding, "And it's deeply important to me that India not make the mistakes that we made in America -- where we had no leadership, we didn't take it seriously and hundreds of thousands of people died who didn't have to" (Ubelacker, Canadian Press, 8/14). According
to a report released last week by India's Registrar-General and Census
Commissioner, an estimated 11 million people in India could die of
AIDS-related illnesses by 2026 (Priest, Globe and Mail, 8/15). Although
advocates, health care workers and scientists "long ago gave up the
idea" that they could end the HIV/AIDS pandemic "with a single blow,"
participants at the XVI International AIDS Conference discussed the
idea that it "might be possible to bleed it to death with a thousand
cuts," the Washington Post reports. Various prevention strategies
were discussed at the conference -- including microbicides, male circumcision,
herpes treatment, single doses of antiretroviral drugs taken before
sex and providing universal access to HIV tests. In addition, several
studies presented at the conference "provided yet more evidence" that
increased access to antiretroviral drugs is a "great strategy for
prevention," the Post reports. In one of the "more provocative presentations,"
Julio Montaner, director of British Columbia Centre for Excellence
in HIV/AIDS, presented a mathematical model that predicted the outcome
of treating all reported HIV cases worldwide. According to the model,
global HIV prevalence decreased to "basically" zero by 2050, and treatment
costs "took a clear downward turn" beginning in 2015 as the number
of new HIV cases decreased, the Post reports. Mark Wainberg, co-chair
of the conference and head of the McGill University AIDS Centre, said,
"Treated people just simply become less infectious. This is win-win.
This is not a subject that requires debate." According to the Post,
the "real power of treatment's preventive effect is that it would
synergize" with other prevention methods that might be made widely
available over the next five to eight years. Although researchers
and advocates are "hesitant to announce the dawning of an era of [HIV]
prevention that could eventually lead to the epidemic's end," there
was "little doubt the meeting ended on a note of optimism and anticipation,"
the Post reports (Brown, Washington Post, 8/19).
Leading HIV experts today called on the global HIV community to intensify collaboration on tuberculosis control, to prevent the deaths of a quarter of a million people living with HIV (PLHIV) a year. At the XVI International AIDS Conference in Toronto, HIV Director Dr Kevin De Cock and TB/HIV Coordinator Dr Paul Nunn, both from WHO, were joined by Dr Helene Gayle, the International AIDS Society President . Together, they urged HIV health workers to target and scale-up joint activities for tuberculosis and HIV. "TB prevention, diagnostic and treatment services must become core functions of all HIV services," said Dr De Cock. "People living with HIV are more vulnerable to TB, even if they're on antiretroviral therapy. TB can be treated and cured so most of these deaths are absolutely preventable. HIV policy-makers, health ministers and health workers all have a vital role in making sure that deaths from TB are reduced." "Joint TB and HIV interventions can save lives and must be accelerated," said Dr Gayle. "More than a third of all people infected with HIV are also infected with the tuberculosis bacillus, which causes the deaths of a quarter of a million people living with HIV, every year." Today's call was backed by initial findings from a Brazil-based study, showing that TB can be prevented in those with HIV, carried out by CREATE (Consortium to Respond Effectively to the HIV TB Epidemic). "This is important research which shows that TB preventive treatment is successful in reducing TB cases in PLHIV, even for those who are already taking life-saving antiretroviral drugs." said Dr Richard Chaisson, Principal Investigator of the study. He also emphasized that research into new TB drugs, diagnostics and vaccines appropriate for PLHIV, and operational studies and effective models to deliver the services to those who need them, are urgently needed. "We have the essential know-how and policy guidance to address TB among PLHIV and progress has been documented. However, the progress has been slow, compared to the scale of the problem," said Dr Paul Nunn of WHO's Stop TB Department. "In countries dually affected by TB and HIV these interventions should be rapidly scaled up and implemented through effective collaboration between HIV and TB control programmes, and general health services. Two years ago, Nelson Mandela warned the world that ‘We can't fight AIDS unless we do much more to fight TB.’ "Mr Mandela's warning on HIV and TB still needs to be translated into large scale action. Commitments made at the G8, UN and African Union summits must be experienced by the actual communities most affected by the dual epidemics, particularly in Africa where HIV-related TB deaths are the highest in the world To do this, sustainable funding is critical." Also adding
her voice to the call for action was TB/HIV activist, Lucy Chesire
from Kenya. She urged HIV patients to press their governments for
more investment on TB control, to ensure joint activities for tuberculosis
and HIV are prioritised and implemented. Globally, TB is second only
to HIV as an infectious killer of adults, causing nearly nine million
cases of active TB disease and two million deaths every year. In countries
with a high prevalence of TB, HIV programmes must scale up TB prevention,
diagnosis and treatment. These and other recommended measures are
outlined in WHO's Policy on Collaborative TB/HIV Activities. |
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Put
the power to prevent HIV into the hands of women