U Of A Researchers Find Potential HIV Treatment

Discovery helps make significant advances in HIV research-Barr

March 4, 2008

Edmonton - Scientists at the University of Alberta have uncovered a human gene that stops the spread of HIV, potentially opening the door to new treatments in the battle against AIDS.

HIV BREAKTHROUGH Dr Barr and colleagues have discovered the human gene TRIM22, which stops HIV from spreading. (Photo by Mike Otto)

The team of researchers, led by molecular virologist Dr Stephen Barr, a post-doctoral fellow in the Department of Medical Microbiology and Immunology, first identified the gene—known as TRIM22—as a possible antiviral protein three years ago.

TRIM22 is one of hundreds of genes turned on by interferons, chemicals produced by our immune system to combat viral infections.

“It’s been known for a long time that interferon treatment of cells can block HIV infection, but nobody really knew how or what the genes were that were involved,” Barr explained.

“We found that TRIM22 was turned on quite a bit in response to interferons [...], and our later studies showed that [it] actually blocked [HIV] by trapping the virus within cells so it can’t get out to infect other cells.”

According to Barr’s study, published last week in the journal Public Library of Science Pathogens, TRIM22 interacts with the major protein that is required for HIV assembly, and this interaction, Barr said, somehow blocks the assembly of the virus.

“These results are very exciting [...] because they show that our bodies have a gene that is capable of stopping the spread of HIV,” he explained.

Although HIV replication can be blocked at earlier stages in the virus’ life-cycle, this is the first time that an antiviral protein has been shown to interfere specifically with the later stage of HIV assembly. The unique activity of TRIM22, Barr explained, identifies a new strategy for treating HIV infection.

“The goal would be to basically harness this antiviral activity,” he said, noting that the ultimate, but long-term, goal of his research is the development of new drugs and vaccines capable of halting the spread of HIV and the onset of AIDS.

“If we can find ways to slow the release of virus so that it can’t infect other cells, that has the potential of slowing or preventing the onset of AIDS in patients,” he continued.

Dr James Smiley, a Canada Research Chair in Molecular Virology and a professor at the U of A who operates the lab in which Barr worked, is enthusiastic about the impact these findings will have on the HIV field and what they will mean for the University’s reputation.

“These types of discoveries help to solidify and enhance the U of A’s profile in the area of infection and immunity,” Smiley said, adding that “the U of A provides an environment where talented post-doctoral fellows such as Steve Barr can pursue their research in any area that they choose.”

Barr, who began his work in Smiley’s lab over two years ago, will next turn his attention to what he says are the two major outstanding questions from his research: how exactly TRIM22 interferes with HIV assembly and why this gene doesn’t appear to work in people infected with HIV.

With approximately 33 million people worldwide reported to be living with HIV and 2 million deaths caused each year by HIV/AIDS, Barr expects that his research will provide hope to those living with the so-far-incurable disease.

With emerging drug-resistant strains and failed vaccine trials, Barr said, “there’s been a real dark cloud put over HIV research fairly recently.” However, he added that “we are making significant advances.”

http://www.thegatewayonline.ca

International Report Urges Ottawa to Drop Safe Drug Site and Safe Crack Kits

March 6, 2008

Victoria - A United Nations monitoring body wants the Canadian government to close Vancouver's safe injection site and end the distribution of safe crack kits in Toronto, Ottawa and on Vancouver Island.

But while the International Narcotics Control Board is critical of Canadian drug policies in its annual report, proponents of Canada's harm-reduction approach said Thursday the board's policies are irrelevant.

Sen. Larry Campbell, a former mayor of Vancouver and supporter of the city's safe injection sites, said the UN monitoring body is picking on Canada because it borders the United States, but has a more Liberal approach to drugs.

"This organization quite frankly are simply stooges for a failed U.S. war on drugs," he said.

In an annual report released this week, the UN monitoring board said the distribution of crack kits in some Canadian jurisdictions contravened part of the UN's Convention against Illicit Traffic in Narcotic Drugs.

"The distribution of drug paraphernalia, including crack pipes, to drug users in Ottawa and Toronto, as well as the presence of drug injection sites is also in violation of the international drug control treaties, to which Canada is a party," the report said.

The disposable crack pipe mouthpieces have been provided to addicts in some parts of Canada to avoid passing on blood-borne diseases.

Federal Health Minister Tony Clement said the government's policies on crack pipes and Vancouver's safe injection site are currently under review.

"The International Narcotics Control Board has gone on record, as it has done in the past, with the message calling upon the government of Canada to end programs such as the safer crack kits," Clement said.

"We are in a period of review and certainly this is additional information that we will have regard for when a decision is rendered."

Vancouver's safe-injection site, called Insite, allows addicts to inject their own heroin and cocaine under the supervision of a nurse.

Studies in top medical journals such as the Lancet have suggested the only facility of its kind in North America has reduced overdoses and blood-borne infections such as HIV because addicts are given clean needles.

But after opening almost five years ago, Insite's fate remains uncertain because it's currently operating under an exemption from Canada's Controlled Drugs and Substances Act while the government decides whether it should stay open.

Campbell said he will not allow the safe injection site to close.

"I will stand at the doorway if necessary when they try to close it," he said. "What are they going to charge me with? I'm not supplying drugs. I'm supplying health."

Thomas Kerr, a research scientist at the B.C. Centre for Excellence in HIV-AIDS, said he hopes Canada won't base its decision on the narcotics board's report because the treaties it cites are irrelevant and were formed long before HIV and AIDS existed.

"I wouldn't be surprised if the federal Conservative government uses it as an excuse to try and continue to stop harm reduction interventions from operating and to further justify its completely non-evidenced anti-drug strategy approach," Kerr said.

He said the board never divulges that the international treaties allow signatory countries to deviate from some of the drug-controlled provisions for scientific and medical purposes, which allowed Canada to create the exemption for Insite.

The board's position on Canada also contradicts the opinion of United Nations lawyers who have said safe injection sites don't violate international treaties, Kerr said.

"The INCB never released that, they never acknowledge it and their position is totally disingenuous."

Kerr said it's also interesting that while the board is urging Canada to close Insite they don't mention several other countries, such as Switzerland, the Netherlands and Germany, with similar facilities "because these countries have been ignoring the INCB forever."

Richard Pearshouse, of the Canadian HIV/AIDS Legal Network, echoed Kerr's sentiments, saying the board's criticisms of Canada are out of step with common sense.

"The INCB report is driven more by ideology and a war on drugs ideology than the research and the scientific evidence that supports these as a public health intervention."

Canadian Press

Reaction: Harm-Reduction Advocates Outraged At UN Call To Shut Insite

March 08, 2008

Supporters of Canada's harm-reduction approach to drug addiction are livid that a United Nations monitoring body wants Ottawa to slam the door shut on Vancouver's safe-injection site -- and put an end to distribution of "safe" crack kits to addicts.

In an annual report by the International Narcotics Control Board released this week, the UN board said distribution of the kits in some areas of Canada contravened part of the UN's Convention against Illicit Traffic in Narcotic Drugs.

The board said the drug programs violate international drug-control treaties to which Canada is a party.

The disposable crack-pipe mouth pieces -- usually rubber-tipped glass tubes -- are given to addicts to avoid the spread of blood-borne diseases, including HIV and hepatitis, when addicts share pipes.

Vancouver's Downtown Eastside safe-injection site, known as Insite, allows addicts to inject their own heroin and cocaine under the supervision of a nurse, who provides them with clean needles.

Medical journals report that Insite, the only facility of its kind in North America, has reduced overdoses and blood-borne infections.

But five years into operation, the site's fate is uncertain. It operates under an exemption from Canada's Controlled Drugs and Substances Act, which runs out in June.

The Conservative government has not said whether it will extend the exemption.

But the UN report incensed supporters of Insite.

Sen. Larry Campbell, a former mayor of Vancouver and a former coroner, called the narcotics board "stooges for a failed U.S. war on drugs" and told reporters he would personally block Insite's doorway if officials tried to close it down.

Vancouver Mayor Sam Sullivan also dismissed the board's report by insisting it simply didn't understand Insite's success.

"The way we've approached drug addiction worldwide has been a failure," Sullivan told reporters. "We need new approaches. We need to be open to innovations."

Thomas Kerr, a research scientist at the B.C. Centre for Excellence in HIV-AIDS, voiced concern that Ottawa would seize on the report as an excuse to close Insite.

Richard Pearshouse, speaking for the Canadian HIV/AIDS Legal Network, told reporters the report was "driven more by ideology and a war-on-drugs ideology than the research and the scientific evidence that supports these as a public-health intervention."

By Christina Montgomery,The Vancouver Province

Also: Needle Exchange Expected To Move To Pandora, Next To Our Place

March 6, 2008

Victoria's controversial needle exchange may soon be moved into a building on Pandora Avenue, beside the Our Place homeless drop-in centre.

The new exchange is to also be a home for doctors, nurses, mental health workers and police.

The Vancouver Island Health Authority is in the final stage of inking a deal to buy the $2-million-plus, 12,000-square-foot St. John House, at 941 Pandora Avenue, next door to Our Place.

The ambulance association will temporarily operate out of the Gorge Road Hospital.

"I'm optimistic. The discussions are fairly advanced," said VIHA president Howard Waldner. "We have a real opportunity to make a difference here."

Derek Allan, owner of Fotoprint copying store at 945 Pandora Avenue, was visited by Victoria Mayor Alan Lowe and Waldner Thursday to tell him about his new neighbours. Lowe expects VIHA will make an official announcement next week.

"We are just digesting it," Allan said. "The one positive with which we are holding on to - with our finger nails for dear life - is that there will be a community policing centre there as well."

Allan said he already finds needles all over his store's property, including the roof, from clients of the needle-exchange located about two streets over on Cormorant Street - run by AIDS Vancouver Island and funded by VIHA. It has been evicted and must vacate its premises by summer.

The facility serves 1,500 intravenous drug users, and has become infamous over the last year because some homeless clients, once they get new needles, hang around outside where they shoot up and leave behind a trail of dirty syringes, blood and human waste.

Hampered by insufficient staff and inadequate space, operators found controlling the problems near impossible - forcing VIHA to step in with $125,000 recently to clean up the operation and find it a new home.

"We are concerned about the drugs and the transient population," Allan said. "The drugs are the big concern."

The new needle-exchange in St. John House will be decentralized - sharing responsibilities with satellite and mobile locations to be located in yet to be designated areas throughout the city.

As well, it will be integrated with other services as part of an overall homeless, health and social strategy including several agencies. The new two-story building will house up to about 30 people including an Assertive Community Team working with the downtown's homeless, doctors, nurses, support staff, mental health care workers, and street outreach workers.

As well, Our Place has suggested moving its medical clinic into the building. The City of Victoria has given VIHA $100,000 towards the purchase of the new building and offered to locate a community police office there, Waldner said.

"That is a very significant contribution to our joint planning and provides a wonderful opportunity," he said.

The VIHA president said the new operation will be more professional and clients will be expected to use the facility to drop off and pick up needles only. There will be no loitering.

"This is absolutely not a safe-injection site," Waldner said.

As well, police are expected to keep public order. "I don't think it will solve it completely but I think it will be a great help," Waldner said.

All the details must still be worked out, he added.

Lawyer Danielle Topliss, one of several neighbours taking legal action against the Cormorant Street needle exchange, was ecstatic the facility had found a new home.

"It's fantastic. It's a much better facility and a much better physical plant," Topliss said. Having integrated services available at the facility is an important addition, she said.

Last year, AIDS Vancouver Island said the needle exchange distributed 740,000 clean needles in Victoria - for a total of one million on Vancouver Island - and saw 770,000 dirty needles turned in.

Health and city officials strongly support the needle exchange because it's proven to help prevent the spread of HIV/AIDS and hepatitis C through the sharing of dirty needles.

By Cindy E. Harnett, Times Colonist

Blood Agencies Keep Ban on Gay Donors

Expert insists new screening minimizes risk

March 7, 2008

Gay men will continue to be barred for life from donating blood in Canada despite appeals Thursday from two Montreal experts on HIV-AIDS.

Officials with both Hema-Quebec and Canadian Blood Services said they will maintain their current policies even though they conceded that lifting the ban -- with certain restrictions -- wouldn't result in a significant risk of contaminating the blood supply.

Mark Wainberg and Norbert Gilmore, of the McGill University AIDS Centre, urged the two agencies to follow the lead of Australia, which has lifted its lifetime ban on homosexuals.

Gay men in that country can give blood as long as they've abstained from "male-to-male" sex for at least 12 months. Once blood is donated, all samples are screened in the lab for HIV, syphilis and other viruses.

The rationale for the change in policy by the Australian Red Cross is that if a gay man had sex within 12 months, an HIV infection could be missed in the post-donation screening, but after that period, the tests would conclusively pick it up. Gay men who make false declarations to the Australian Red Cross risk criminal prosecution.

Wainberg noted that the current nucleic-acid test that screens for HIV in donated blood is 10,000 times more sensitive than the serological tests used in the 1980s, when the ban came into force.

"The tests have moved forward, but the policies of Hema-Quebec and the Canadian Blood Services are in a time warp circa 1983," Wainberg told a news conference to kick off the sixth annual Quebec HIV symposium. "These current policies discriminate unfairly against gay men."

Wainberg cited a study that calculated that the risk of lifting the ban could result in one unit of contaminated blood being introduced in the Quebec supply once in 69 years. For Canada as a whole, the risk was found to be one contaminated unit in 18 years.

Gilmore estimated that if the ban were lifted, the Canadian blood supply would gain about 136,000 donations each year from gay men.

Marc Germain, Hema-Quebec's vice-president (human tissues), said there's no consensus in the transfusion community to lift the ban.

"Right now, the usual practice and the consensus is a lifetime deferral," Germain said. "Listen, we have a system in place that is extremely safe."

Germain, who co-authored the study that Wainberg cited on the risk of lifting the ban, argued that the ultimate decision must be made by transfusion patients as well as regulators.

"The question as to whether this is acceptable has to be discussed more widely than just by scientists. Patients who are likely to receive a transfusion have a right to say, 'Well, that's acceptable,' or 'No, that's not acceptable.'

"That's where we are right now."

By Aaron Derfel, The Calgary Herald

Also:

Blood Service Defends Gay Discrimination

March 7, 2008

London, England - PinkNews.co.uk has challenged the National Blood Service to explain why it continues to discriminate against any man who has ever had sex with another man.

Currently, a man who has ever had oral or anal sex with another man, even with a condom, is barred from donating blood for life because they are deemed to be more at risk of passing on sexually transmitted diseases.

A National Blood Service spokesperson said the ban on gay and bisexual men giving blood is "justified" despite the fact that lifting the order would dramatically increase depleted stocks.

Campaign group BloodBan.co.uk has branded current guidelines "outdated and discriminatory" and called for an overhaul of the policy.

Despite the fact that the National Aids Trust (NAT) state that black Africans are an equally high risk group for blood-borne STDs, they are not subject to a blanket lifetime ban in the way that men who have had gay sex are.

The only other people who are permanently banned from donating blood are individuals who have ever received money or drugs for sex and individuals who have ever injected, or been injected, with drugs.

Guidelines from the UK Blood Safety Leaflet specify that any individual donating:

"must wait twelve months after sex with a partner who has, or you think may have been sexually active in parts of the world where HIV/AIDS is very common, including most countries in Africa."

The twelve-month wait is not an option for gay or bisexual men, even one who has been celibate for most of his life.

A man who received oral sex once as a teenager is branded a health risk forever.

In addition, while the number of heterosexuals contracting sexually transmitted diseases (STIs) is rapidly increasing, the donation guidelines remain the same.

The NBS claim that excluding men who have had sex with another man has reduced the risk of HIV infections via transfusions.

A spokesperson told the Metro newspaper this morning that the ban was justified and had been "extremely successful."

Yet every blood donation is automatically tested for HIV, Hepatitis B and C and other diseases, which in effect should negate any risk whether or not gay and bisexual men are banned.

A spokesperson for the NBS told PinkNews.co.uk:

"Screening heterosexual's blood and not the blood of homosexual men is neither a question of cost, nor of sexuality, it is a question of safety.

"The National Blood Service screens every donation.

"Of those who had made previous donations before testing positive for HIV, between October 1995 and June 2006, 48 out of 116 individuals were men who in a subsequent interview admitted they had had male to male sex."

48 out of 116 individuals "admitting" to gay sex represents 41% or two in five cases.

The three in five heterosexual infections are not regarded as grounds for a ban.

The spokesperson continued:

"Current screening tests for blood still fail to pick up a very small number of infected donations, for example from people with very early HIV infection who will still test negative for the markers of infection.

"So for the sake of blood safety, donors from high risk groups are asked not to donate."

The latest Health Protection Agency findings released by National AIDS Trust show diagnoses of heterosexuals infected in the UK have increased by 50 per cent since 2003.

Figures for the Health Protection Surveillance Centre 2007 also reveal that of the newly diagnosed cases of HIV in 2007, 53% were acquired through heterosexual contact while only 21% were through male-to-male sexual contact.

Yusef Azad, Director of Policy and Campaigns at the NAT said:

"It is absolutely paramount that the blood supply is protected and it remains the case that gay men are the largest group affected by HIV in the UK.

"However, we do believe that the current rules should now be reviewed in the light of changes in practices in other countries, and alternatives such as a time limited ban be actively considered. "

Russell Hirst, founder of the Bloodban campaign, told the Metro that an alternative would be to require gay and bisexual donors to be tested for STDs beforehand and bring an 'all clear' certificate with them when giving blood.

Yet NBS show no intentions of changing their policy, while continuing to use the insulting form of words of "high risk group" to describe every single man who has ever had any sexual contact with someone of their own sex.

"Asking people in high risk groups not to donate has resulted in an excellent safety record," the NBS spokesperson said.

"Since testing for HIV was introduced in 1985 there have been only three cases where donors who were in the "window period" were responsible for transmission of HIV through blood transfusions."

By Lucy Durnin, http://www.pinknews.co.uk

Prescribing Powers Gained by 15 Pharmacists

March 7, 2008

A group of 15 pharmacists in Alberta has become the first in Canada given powers to prescribe new medications to patients without needing final authorization from a doctor.

They were part of a pilot project to ensure all future pharmacists wanting additional prescribing powers under Alberta's Pharmacists Act are rigorously evaluated before taking on the new responsibility.

"Pharmacists are quite highly educated, and to just be stuck doing dispensing-type things, it's not really a good use of our training and expertise," said Christine Hughes, a pharmacist since 1994.

The move to give pharmacists prescribing powers was initially met with resistance from doctors. The Alberta Medical Association questioned whether pharmacists had the training and education to handle the extra responsibility.

Hughes has now received approval to prescribe new drugs -- other than narcotics, anabolic steroids and barbiturates, such as morphine and codeine -- to patients. Her powers go beyond giving prescription refills to people who have run out of birth control pills or asthma inhalers before scheduling a doctor's appointment. More than 90 per cent of Alberta pharmacists can adapt prescriptions or prescribe in an emergency after going through an orientation course.

But Hughes can write brand new prescriptions, change drug therapies and significantly adjust dosages. For 10 years, she has worked with HIV/AIDS patients out of an infectious disease clinic at the University of Alberta Hospital and has a detailed understanding of how anti-retroviral drugs affect patients.

Hughes said patients probably won't even notice the new powers pharmacists have.

"It just legalizes and improves some of the efficiencies of the system," she said. "I think it is important, that sharing of responsibility. And I think . . . it will improve care and efficiency and off-load some very routine things that might get hung up on a physician's desk and they can focus in on more complex patients."

By Jodie Sinnema, Edmonton Journal

UN Programme to Work toward Elimination of HIV Travel Restrictions

March 5, 2008

Calling travel restrictions on HIV positive people, in place in 104 countries, discriminatory and unnecessary, the Joint United Nations Programme on HIV/AIDS (UNAIDS) has set up an international task force to work toward their elimination.

“Travel restrictions based on HIV status again highlight the exceptionality of AIDS, especially short-term restrictions," Peter Piot, Executive Director of UNAIDS, said in a news release published on its website yesterday.

"No other condition prevents people from entering countries for business, tourism, or to attend meetings. No other condition has people afraid of having their baggage searched for medication at the border, with the result that they are denied entry or worse, detained and then deported back to their country,” he added.

According to data collected by the European AIDS Treatment Group, a total of 104 countries have some form of HIV-specific travel restrictions, 12 of which ban HIV-positive people from entering for any reason or length of time.

Most of the restrictions require people to indicate their HIV status before entering or remaining in a country, with some countries having them undergo mandatory HIV testing, without safeguards, to which UNAIDS objects particularly strongly.

The most common arguments give for the restrictions involve the protection of public health and the high possible costs associated with care, support and treatment of people living with HIV.

Whatever the reason, UNAIDS said, HIV-related travel restrictions raise fundamental human rights issues involving non-discrimination and freedom of movement in a mobile world in which the World Tourist Organization (WTO), in 2000, estimated that there were 698 million international arrivals worldwide, most as part of short trips.

The International Task Team on HIV-related Travel Restrictions convened for the first time in Geneva on 25-26 February, in a meeting, co-chaired by UNAIDS and the Norwegian Government.

In that meeting, it brought together representatives of governments, inter-governmental organizations, civil society groups, the private sector and networks of people living with HIV, UNAIDS said.

The next regular meeting of the task team is scheduled to take place from 31 March to 2 April in Geneva.

http://www.un.org

Many Not Yet Told Of Possible Exposure to HIV, Hep C in Clinic Needle Scandal

March 7, 2008

Las Vegas, Nevada - Health officials used an incomplete patient list to notify people exposed to hepatitis and HIV at a Las Vegas clinic, an epidemiologist testified Thursday.

``We know of patients who had been there whose names were not on the list," Southern Nevada Health District epidemiologist Brian Labus told a state legislative committee on health care.

The public hearing was the first investigating the spread of hepatitis C from unsafe practices at the Endoscopy Center of Southern Nevada. An outbreak of six cases of acute hepatitis C was made public last week. The surgical centre and five other affiliated clinics have been closed.

Nearly 40,000 patients who received treatment at the center from March 2004 to mid-January have received letters telling them they are at risk for exposure and urging to be tested for hepatitis B and C, and HIV.

Labus said the patient list was provided by the centre and based on financial records. He did not explain why some patient names would not have appeared.

Health officials believe the clinic spread the virus by reusing syringes and vials of medication. Health District chief Lawrence Sands said it was a well-known violation of common safety standards.

The clinic's records show the practice of using single-patient vials of medication to treat more than one patient has been in use since March 2004, when the clinic underwent a renovation and expanded operation, Labus said. Inspectors could not be certain the practice wasn't in place before March 2004, he said.

The clinic's majority owner, Dipak Desai, and member of the governor's commission on health care, has refused to answer questions about the allegations. He took out a full-page ad in Sunday's Las Vegas Review-Journal insisting that needles had not been reused and that the chances of contracting an infection at the centre in most of the last four years were ``extremely low."

The Associated Press, www.365Gay.com

Bareback Porn Withdrawn from Sale after Investigation

March 5, 2008

London - The BBC news programme Newsnight has reported that three porn films have been withdrawn from sale after the programme revealed that some performers are becoming infected with HIV.

Two of the DVD titles show eight young men having sex with each other "in various combinations" without using condoms. Four of them were diagnosed as HIV positive shortly after filming.

One of the men told Newsnight that he was "distressed that footage which he believed showed him becoming infected had been put on sale."

So-called 'bareback' porn now accounts for 60% of all sales.

Ceri Evans, Senior Sexual Health Adviser at West London Centre for Sexual Health, told the BBC:

"I think that there is a possibility of something being called condom fatigue.

"We have been talking about condoms so long that people are bored or think they know it all.

"Education in schools is not what it could be, for anybody, for heterosexual but particularly if you are gay."

Figures from the Health Protection Agency show that HIV infections from gay has increased by 55% in the past five years.

The number of gay and bisexual men diagnosed with HIV in the UK is at its highest rate since the start of the epidemic.

2,700 gay and bisexual men were newly diagnosed last year, the highest number ever.

Across the UK one in 20 gay and bisexual men are now living with HIV and estimates suggest this figure is as high as one in 10 in London.

Last week 48-year-old Rufus Ffoulkes, of Alexander Road in Lowestoft, was sentenced to two years and eleven months in prison for inciting a child into pornography.

Floulkes recruited young men for his homemade porn films from the website Gaydar - one brought along the 16-year-old boy.

Ffoulkes paid the teenager £500 to appear in a photo shoot then directed him in a bareback porn film.

The prosecution told the court that the 16-year-old was later concerned at having unprotected sex.

"Distasteful though this sort of activity is, the reality is that the gay pornography industry is sizeable and apart from the age of this young man, is legal," Miranda Bevan, Ffoulkes' lawyer, said, according to www.edp24.co.uk .

"Unprotected sex is standard in the gay porn industry."

http://www.pinknews.co.uk

Also: Porn Company Abandons Bareback after BBC Investigation

March 6, 2008

Tony Grew

London - British porn producer Icreme has agreed to stop filming bareback scenes.

The company claims to produce more adult material than any other in the UK.

Icreme told the BBC that all their porn performers would use condoms from now on.

This evening BBC news programme Newsnight broadcast an investigation into bareback porn and the possible link with performers contracting HIV.

"The vast majority of porn nowadays is done without condoms," Icreme claims on www.icreme.co.uk , its website.

NOTE: Website contains sexually explicit images.

"To operate safely, all of our models must have a test every 28 days.

"We pay for an NHS test, which conclusively proves a negative HIV status within the last 48 hours. We will not tolerate anyone who acts in an unsafe way in their private lives."

There is no information about how they monitor the behaviour of their models.

In a statement to the BBC they said that all models will use condoms from now on.

A man convicted last week of inciting a child into pornography was a former Icreme employee.

48-year-old Rufus Ffoulkes, of Alexander Road in Lowestoft, was sentenced to two years and eleven months in prison.

Floulkes recruited young men for his homemade porn films from the website Gaydar, one brought along a 16-year-old boy.

He paid the teenager £500 to appear in a photoshoot then directed him in a bareback porn film unconnected with Icreme.

Ffoukles was banned from using the internet to recruit young men and from working with children.

He was also sentenced to 12 months, to run concurrently, for deception.

The cheques he wrote to pay his porn performers bounced.

Last year Ffoulkes issued a statement to Boyz magazine about Icreme models being infected with HIV.

Clyde, a 20-year-old Londoner who made bareback porn and subsequently found out he had contracted HIV, recently spoke to PinkNews.co.uk.

He said that was approached on the internet site Gaydar just after his 18th birthday.

He had had a profile on the site since he was 16.

"I can't remember exactly what they said but they were two guys who were working together and they both messaged me several times until I eventually agreed to meet up and do an 'interview,'" he explained.

"That was basically just masturbating in front of a camera. They wanted me to come back and do a shoot."

The porn producers asked him to bring along two forms of identification to verify his age.

"They told me that most of the work would be bareback, and that they would normally check certificates from GUM clinics."

On the various shoots he took part in during his short on-screen career he noticed laxity in the ad hoc system of checking the HIV status of performers.

"I presented a certificate about half the time.

"They would normally take your word for it. At my local clinic you have to pay £25 to get a certificate."

He was told everyone else was HIV negative, but never saw anyone else's certificates.

By Tony Grew, http://www.pinknews.co.uk

China Releases New Regulations That Aim To Strengthen Supervision, Management of Blood Collection Centers

March 4, 2008

China's Ministry of Health on Friday released new regulations that aim to strengthen the supervision and management of blood collection centers in the country, China Daily reports. According to the health ministry, the regulations -- which went into effect on Saturday and are applicable to the country's 145 collection centers -- will play an important role in preventing the spread of bloodborne diseases, including HIV and hepatitis (Juan, China Daily, 3/1).

Blood selling practices during the 1990s in China's central Henan province contributed to the spread of HIV, which, according to some advocates, affected about one million people. The situation in Henan led officials to pledge reform, and the health ministry has said that it maintains stringent supervision of blood collection centers in the country. According to the ministry of health, it closed about 150 illegal collection and supply agencies nationwide in 2004, the last year for which official figures are available. The health ministry in July 2007 also ordered all blood collection centers in the country to install video cameras to ensure that medical staff members are following regulations. Despite the health ministry's efforts, the country's State Food and Drug Administration in June 2007 discovered fake plasma being used in at least 18 hospitals in northeastern China.

SFDA last year announced a new policy under which all blood products in the country will be screened for HIV and other bloodborne diseases and approved before entering the market (Kaiser Daily HIV/AIDS Report, 9/14/07).

Under the new regulations, areas where prevalence of diseases such as HIV is high are prohibited from establishing blood collection centers. In addition, provincial-level health officials are required to approve blood collection centers before they are established, and areas that hope to establish centers should have the capacity to collect at least 30 tons of plasma annually. Also under the regulations, areas where voluntary blood donations do not match the local demand for two years will be prohibited from opening a new center.

The regulations also establish corporate responsibility and liability guidelines for manufacturers of plasma-based products to establish and operate collection centers. The guidelines were commissioned by the health ministry in 2006. Other requirements under the new regulations include having qualified technical staff, quality sanitation and proper blood-testing equipment. In addition, all blood donors will have to pass a health test before they can donate blood. Donors also are not permitted to give blood within two weeks of their last donation under the regulations. Those appointed to manage the centers will be held fully responsible for the safety and quality of the blood collected, China Daily reports (China Daily, 3/1).

http://www.kaisernetwork.org

Disalcid Improves Inflammation, But Has Liver Toxicity

March 3, 2008

The anti-inflammatory drug Disalcid (salsalate) reduces blood vessel inflammation, which may decrease the risk of a heart attack in people living with HIV, according to study results published in the March 12 issue of AIDS.

http://www.aidsonline.com/

The authors caution, however, that use of the drug may be associated with liver-related side effects, which could limit its use as an adjunctive HIV treatment.

The endothelium is the thin layer of cells that line the inner surface of blood vessels. When the endothelium becomes inflamed, blood vessels have difficulty expanding and contracting as needed, potentially leading to blood clots. Disalcid, a non-steroidal anti-inflammatory drug (NSAID) sometimes used to treat rheumatoid arthritis, has been eyed as a potential strategy to reduce the inflammation and endothelial dysfunction that can be caused by HIV.

Samir Gupta, MD, of the Indiana University School of Medicine in Indianapolis, and his colleagues enrolled 11 people living with HIV who were not taking antiretrovirals, but who had endothelial dysfunction. This was determined using flow-mediated dilation (FMD), a cardiovascular test that measures the ability of blood vessels to expand.

The average age of the patients was 38 years, and 55 percent were black. The average FMD before starting Disalcid was 2.7 percent, which is considered very low and a sign of significant inflammation.

Gupta’s team provided the patients with the maximum daily dose of Disalcid, which is 1500 mg twice daily for eight weeks, in order to increase the chance that a treatment effect would be observed. By week eight, FMD had nearly doubled on average—a statistically significant difference, meaning that the difference was too great to have occurred by chance.

During the course of the study, however, two patients had serious elevations in their liver enzymes and had to stop taking Disalcid. Two other patients had less serious elevations, but had to reduce their dose of Disalcid by half. Though Disalcid and other anti-inflammatory drugs can cause liver toxicity in people who are HIV-negative, it is quite uncommon, and Gupta’s team hadn’t expected so many HIV-positive people in the study to have this side effect.

Gupta’s team again measured FMD eight weeks after stopping treatment in the two patients who’d had the best response to Disalcid. They found that FMD levels returned to pre-treatment levels, indicating that people who need to take anti-inflammatory drugs for this purpose will likely require continuous treatment.

The team comments that, although reducing blood vessel inflammation in people living with HIV is a worthwhile goal, future studies should employ lower doses of Disalcid or agents without known liver side effects. Notably, a separate study conducted in 2007 found antiretroviral therapy on its own can reduce HIV-associated inflammation and improve endothelial function.

http://www.poz.com

HIV Breakthrough: Researchers Identify Protein That Fights Immunodeficiency

March 4, 2008

A Canada-U.S. research team has solved a major genetic mystery: How a protein in some people's DNA guards them against killer immune diseases such as HIV. In an advance online edition of Nature Medicine, the scientists explain how the protein, FOX03a, shields against viral attacks and how the discovery will help in the development of a HIV vaccine.

"HIV infection is characterised by the slow demise of T-cells, in particular central memory cells, which can mediate lifelong protection against viruses," said lead researcher Rafick-Pierre Sékaly, a Université de Montréal professor and a researcher at the Centre Hospitalier de l'Université de Montréal and the French Institut national de la santé et de la recherche médicale (Inserm).

"Our group has found how the key protein, FOX03a, is vital to the survival of central memory cells that are defective in HIV-infected individuals even if they are treated," added Dr. Sékaly, who produced his study with CHUM and Inserm colleagues including Elias El Haddad and Julien van Grevenynghe. Collaborators also included Jean-Pierre Routy, a McGill University Health Centre researcher and professor at McGill University and Robert S. Balderas, Vice-President of Research and Development at BD Biosciences of San Diego, CA.

Public support for the research came through Genome Canada and Génome Québec, among others, while private contributions came via a segment of BD (Becton, Dickinson and Company). "Public-private collaborations such as this play an important role in advancing medical research," Robert S. Balderas. "BD Biosciences was pleased to provide powerful research instruments, reagents and technical expertise to support this breakthrough research."

FOX03a Preserves Immune Memory

The breakthrough emerged by studying three groups of men: One HIV-negative sample, a second HIV-positive group whose infection was successfully controlled through tritherapy and a third group whose HIV did not show any symptoms. Called elite controllers, this third group fended off infection without treatment because their immune system, which would normally be attacked by HIV, maintained its resilient immune memory through the regulation of the FOX03a protein.

"Given their perfect resistance to HIV infection, elite controllers represent the ideal study group to examine how proteins are responsible for the maintenance of an immune system with good anti-viral memory," said Dr. Haddad. "This is the first study to examine, in people rather than animals, what shields the body's immune system from infection and to pinpoint the fundamental role of FOX03a in defending the body."

Beyond HIV treatment, Dr. Sékaly said his team's discovery offers promise for other immune diseases. "The discovery of FOX03a will enable scientists to develop appropriate therapies for other viral diseases that weaken the immune system," he said, citing cancer, rheumatoid arthritis, hepatitis C, as well as organ or bone marrow transplant rejection.

Paul L'Archevêque, president and CEO of Génome Québec, lauded Dr. Sékaly's team for their breakthrough and the people who volunteered for the study. "This discovery, the first such study in humans, is a major step forward in the understanding of how our immune system responds to life-threatening infections such as HIV. This advance stems directly from research co-financed by Génome Québec, which demonstrates the impact that genomic research can have in improving healthcare."

Dr. Sékaly and his team are now recruiting 50 HIV-infected, elite controllers to take part in his next study. Interested parties can apply at hiv_controllers@umontreal.ca

Partners in research:

This research was made possible by public and private institutions across Canada, the United States and France: the Université de Montréal, CHUM , Inserm, MUHC, Genome Canada, Génome Québec, Fonds de la recherche en santé du Québec, Canadian Institutes of Health Research, National Institutes of Health and BD Biosciences.

http://www.medicalnewstoday.com

Neural Progenitor Cells as Reservoirs for HIV in the Brain

March 5, 2008

Impaired brain function is a prominent and still unsolved problem in AIDS . Shortly after an individual becomes infected with HIV, the virus can invade the brain and persist in this organ for life. Many HIV-infected individuals experience disturbances in memory functions and movement, which can progress to serious dementia. How the virus causes brain disease is still unclear.

Dr. Ruth Brack-Werner and her team at the Institute of Virology of the German Research Center for Environmental Health previously demonstrated that HIV invades not only brain macrophages but also astrocytes. Astrocytes are the most abundant cells in the brain. They perform many important activities which support functions of nerve cells and protect them from harmful agents. HIV-infected astrocytes normally restrain the virus and prevent its production. However, various factors can cause astrocytes to lose control over the virus, allowing the virus to replicate and to reach the brain. There HIV can infect other brain cells as well as immune cells that patrol the brain and may carry the virus outside the brain.

Thus astrocytes form a reservoir for HIV in infected individuals and represent a serious obstacle to elimination of the virus from infected individuals. Whether this also applies to other types of brain cells was unclear until now. In a study recently published in AIDS, Dr. Brack Werner, together with Ina Rothenaigner and colleagues present data indicating that neural progenitor cells can also form HIV reservoirs in the brain. Neural progenitor cells are capable of developing into different types of brain cells and have an enormous potential for repair processes in the brain.

Dr. Brack-Werner's team used a multi-potent neural progenitor cell line, which can be grown and developed to different types of brain cells in the laboratory, for their studies. After exposing these neural progenitor cells to HIV, they examined the cultures for signs of virus infection for 115 days. HIV was found to persist in these cultures during the entire observation period. The cultures released infectious HIV particles for over 60 days and contained information for production of HIV regulatory proteins- Tat, Rev and Nef- for even longer. Dr. Brack-Werner and her team also examined neural progenitor cell populations cells with persisting HIV for differences from uninfected cells. They found that HIV persistence had an influence on the expression of selected genes and on cell morphology, but did not prevent their development to astrocytes. Thus HIV persistence has the potential to change neural progenitor cells.

Dr. Brack-Werner's summarizes, "Our study indicates that neural progenitor cells are potential reservoirs for HIV and that HIV persistence has the potential to change the biology of these cells." In future studies the researchers are planning to investigate the influence of HIV infection on important functions of neural progenitor cells. These include migration to diseased regions of the brain and development of different types of brain cells. Subsequently they will investigate how HIV changes neural progenitor cells and, importantly, how to protect neural progenitor cells from harmful effects of the virus in HIV infected individuals.

Article adapted by Medical News Today from original press release.

This release is available in German.

Publication:
Rothenaigner, I., Kramer, S., Ziegler, M., Wolff, H., Kleinschmidt, A., Brack-Werner, R. (2007): Long-term HIV-1 infection of neural progenitor populations. AIDS 21:2271-2281.

Source: Ruth Brack-Werner

Helmholtz Zentrum München - German Research Center for Environmental Health

http://www.medicalnewstoday.com

Studies Begin to Define Who Will Do Best On Bevirimat

March 6, 2008

Liquid and tablet bevirimat doses of between 250 – 400mg yield good reductions in HIV viral load in treatment-experienced patients, according to the latest results of studies into the investigational product that have been released by its manufacturer, Panacos Pharmaceuticals, in a press release. These results also showed which patients were most likely to benefit from bevirimat therapy.

Bevirimat is an experimental drug that belongs to a new class of antiretrovirals called maturation inhibitors. It is currently in Phase IIB clinical trials that are designed to find the drug’s most effective and safe drug. These studies involve patients who have taken a lot of anti-HIV treatment before and are having difficulty finding effective antiretroviral therapy.

Five doses of bevirimat – 250, 300, 350 and 400mg liquid doses and a 400mg tablet - were tested in five separate cohorts of patients. In these studies, which lasted 14 days, 46 patients were given bevirimat and 13 patients received a placebo. All the patients were heavily treatment-experienced and received no other antiretroviral drugs apart from their study medication.

The mean fall in viral load was 0.60 log10 in the bevirimat-treated patients. However, the investigators found that the fewer polymorphisms in the HIV gag protein a patient had, the better their response to bevirimat. Gag polymorphisms are common in patients who have received past therapy with multiple anti-HIV treatment regimens. Patients who did not have any polymorphisms had a mean fall in their viral load of 1.26 log10.

Panacos has conducted an analysis of their database of over 100 HIV-positive patients, most of whom have advanced HIV disease and extensive experience of antiretroviral therapy. Analysis of this database showed that approximately 50% of these patients could benefit from bevirimat therapy. And a preliminary study of a larger patient database suggests that the drug might work in a much larger proportion of patients.

Investigators have also looked at the blood levels of bevirimat needed to achieve a good treatment response. They found that liquid and tablet doses of 250mg and above all provided adequate drug levels in patients who lacked the key gag polymorphisms.

Bevirimat appears to be safe as there was no difference in reported side-effects between the patients who received the drug and those who were given the placebo.

By Michael Carter, www.aidsmap.com

Improved Tuberculosis Screening Test for HIV Victims

March 6, 2008

World Health Organization (WHO) figures show that each year an estimated 9 million new cases of tuberculosis (TB) arise in the world. The growth of this disease remains particularly strong in Africa owing to a high proportion of HIV patients (nearly 13% compared with less than 1% in Asian countries for example). This region of the world is experiencing accelerating advance of a deadly combination of AIDS and TB, developed because the virus weakens the immune system of TB-infected individuals. A person infected by HIV who is also contaminated with Koch's bacillus bears a greater risk of developing active TB than a non HIV-infected individual. Latent TB infection diagnosis has for several decades been founded on a positive response to the tuberculin skin test (TST). However, TST's reliability is limited in highly TB-endemic geographical settings because the presence in the environment of mycobacteria similar to that which causes TB plus the BCG vaccination people receive in early infancy can skew the results. Moreover, in HIV-carrying patients, the sensitivity of the test is drastically reduced owing to their inability to develop an allergic reaction, the very basis of the skin test. TB is a strong contributing factor to HIV mortality, therefore it is of crucial importance to be able to diagnosis latent infection early in order to adopt an appropriate treatment and prevent the development of the full disease.

The development of new IGRA3 tests is based on in vitro measurement of T-cells secretion of interferon when challenged with antigens specific to Mycobacterium tuberculosis, the bacterium causing tuberculosis. Such assays now provide a means of getting round the drawbacks of the tuberculin skin test (TST). Yet, although these new screening methods are more effective than TST in a situation of low TB endemicity, their validity in populations subject to high risk of latent TB infection still has to be clearly established. Results recently published of an investigation conducted in Senegal, coordinated by IRD in conjunction with other scientific institutions,1 yield important information on the comparative efficiency of the immunological method and the standard TST. The research team set up two cohorts of patients living in the Dakar area: the first one made up of HIV-infected individuals but with no detected TB; the second consisting of TB patients and people from the treatment centre who had been in contact with them during a given period.

For the first cohort, 285 adults newly infected by HIV and showing no clinical or radiological sign of TB were selected at the Fann National University Hospital Centre (Dakar) between 2003 and 2004. An ELISPOT test and a TST were performed for each patient at the beginning of the study. The TST indicated that 21% (53/247) of them had a TB infection at the moment of the test. However, this proportion reached 51% (125/247) with the ELISPOT test. It appears therefore that the latter is more sensitive than the TST whatever the stage of development of the disease. Nevertheless the ability to respond to the ELISPOT test decreases with the decrease in CD4 lymphocyte count, which appears to indicate the limits of this type of test in severely immunosuppressed individuals, as advanced-stage HIV infected patients can be.

In parallel, a cohort of 243 TB patients was followed up for 2 years. The objective this time was to determine the ability of the ELISPOT test to predict, among people living in contact with these individuals, those who run the greatest risk of developing the disease. Between January 2004 and March 2005, 3072 contacts were identified for the whole set of TB patients. Preliminary results showed the sensitivity of the two tests to be comparable with this cohort, although ELISPOT is doted with a better specificity since it is not influenced by recent BCG vaccination.

The data gathered from the studies must now be analysed in greater detail in order to determine if the new tests based on measurement of the immune response to M. tuberculosis-specific antigens can serve as a reliable diagnostic method for TB infection in geographical areas where the disease is endemic and BCG coverage is strong. Such investigations should also found out if in the future these tests could be used as markers of the development of the disease within a given population.

Grégory Fléchet - DIC

1. This research work, coordinated by IRD was conducted in the context of the AFTBVAC project (Development of a Tuberculosis Vaccine in Africa), jointly with research scientists from: the British Medical Research Council; University of Oxford; Institut Pasteur, Brussels; Laboratoire de Bactériologie et Virologie, Hôpital Le Dantec (Senegal); Service de Maladies infectieuses, Service de Pneumologie, Centre Hospitalier National de Fann (Dakar).

2. The measurement test of the release of interferon- (IFN-) by the T cells stimulated by antigens specific to the tuberculosis pathogen (Mycobacterium tuberculosis). The number of T cells secreting IFN- is determined by counting the spots on a membrane covering the wells of an ELISA plate. Each spot represents a T cell secreting IFN-.

3. These tests are named with the generic term IGRA (Interferon- Release Assays). The commercially available versions are QuantiFERON-TB-Gold and T-SPOT TB.

Source: Press Office

Institut de Recherche Pour le Développement

Article adapted by http://www.medicalnewstoday.com

Swiss Guidelines Take A Troubling Turn

March 7, 2008

In February 2008, the Swiss National AIDS Commission published an article about safer-sex practices. Specifically, the Commission stated that HIV-positive people are not at risk for transmitting HIV to their partners if they meet all of the following requirements:

* they are adherent to highly active antiretroviral therapy (HAART)

* their viral load in the blood is consistently below the lower level of detection (usually 50 copies in Canada and 40 copies in Switzerland)

* they are in a “stable relationship”

* they do not have any sexually transmitted infections (STIs)

Readers should note that the Swiss Commission’s statements about unprotected sex are based on opinion and not fact. We urge all sexually active people to continue to practice safer sex and take other precautions so as not to acquire or pass on HIV to their partners and to protect themselves from other STIs, many of which can be symptom-free.

In response to the Swiss Commission’s opinion, the following agencies have recently reinforced the importance of safer sex in preventing HIV infection:

* the Public Health Agency of Canada (PHAC)

* the American Centers for Disease Control and Prevention (CDC)

* the French Ministry of Health

* the World Health Organization (WHO)

* UNAIDS (the United Nations program on AIDS)

That the Swiss have issued guidelines that appear to weaken prevention messages against HIV transmission is disheartening, particularly at a time when HIV infections are on the rise in the high-income regions of North America and Western Europe.

What’s Up?

There are many problems with the opinion of the Swiss Commission. Perhaps most disturbing is that it is based on an apparent belief and not robust scientific data. Moreover, some of the references cited by the Swiss do not appear to support their opinion. The assumptions made by the Swiss Commission are weak, as they appear to have overlooked, forgotten or misunderstood important research.

A key assumption made by the Swiss is that a suppressed viral load in the blood results in a suppressed viral load in other parts of the body, particularly in the genital tract. In this article we summarize evidence showing that this is not the case. We also address other weaknesses that significantly undermine the foundations of the Swiss Commission’s opinion.

The Limits of Therapy

Introduced in high-income countries in 1996, highly active antiretroviral therapy, or HAART, which consists of potent combinations of anti-HIV drugs, has helped save and extend the lives of many HIV-positive people. The drugs work by impairing HIV’s ability to infect cells and produce new viruses. This gives the immune system a chance to begin to repair the damage caused by HIV.

However, after many years of HAART and good adherence in HIV-positive people, researchers have not been able to cure HIV infection. Attempts at a cure have consisted of intensifying therapy, adding unusual medications to regimens and, later, the cessation of HAART. But once HIV-positive people stop taking HAART, virus levels surge, damaging the immune system and increasing the risk of death.

It is important to bear in mind that HAART can also cause unpleasant and dangerous side effects. Although much progress has been made in the past 25 years against AIDS, HIV remains an incurable and deadly infection.

Viral Load—Undetectable May Be Misleading

To ensure that anti-HIV therapy is working, doctors regularly have blood samples from their patients assessed for viral load, as one of the goals of HAART is to suppress viral load in the blood as low as possible. Commercially available technology can usually assess viral loads as low as 50 copies. When a viral load result returns with an “undetectable” reading—below the 50-copy mark—it does not mean that HIV is not replicating. New copies of HIV could be produced and new infections could be occurring in the body, but the test cannot accurately assess viral loads below the 50-copy mark. Tests that can count viral load below the 50-copy mark are restricted to research laboratories and not used for routine care.

Viral Load—Focus On 2%

It is also worth remembering that only 2% of the body’s immune cells are carried in the blood at any given time. The vast majority (98%) of the immune cells, including CD4+ cells, spend most of their time in the lymph nodes and lymph tissues lining the gastrointestinal tract. Since so little HIV is actually produced in the blood, we cannot be sure that routine viral load testing accurately reflects the amount of HIV present in other parts of the body. Thus an undetectable viral load in the blood does not necessarily indicate a low or a high level of HIV replication in other parts of the body.

A Word About Blips

In addition, many people on HAART experience “blips” in their viral loads. These are periods when the amount of HIV temporarily increases into the detectable range, generally anywhere from 51 to 500 copies. Usually the viral load drops back below detectable limits without a change in therapy. What causes these “blips,” how often they occur, and how long they last is not generally well understood. And the fact that blips are relatively common pokes yet another hole in the assumptions made by the Swiss Commission about the stability of viral load.

Timing Of Viral Load Tests

It usually takes a few weeks before viral load test results are sent to a doctor’s office. By the time a patient has returned to the doctor’s office for the results, several weeks or even a month may have passed since the test was done. During this time, viral load could rise depending on a number of factors. The viral load at the last test does not necessarily represent the viral load at another point in the future. One factor that can affect viral load is the ability to take medications every day, exactly as prescribed. This behaviour is called adherence.

Adherence and Viral Load

A recent American clinical trial documented how adherence can change over time, whether HAART is taken once or twice daily. As adherence degraded in the study, viral load rose above the 50-copy mark. When participants were told that their viral load had risen and they needed to submit another blood sample to confirm this result, their adherence improved and viral load fell below the 50-copy mark.

Adherence is a dynamic behaviour: It can go up or down and change yet again—and so can viral load. Therefore, relying on viral load measures to prevent HIV infection is fraught with risk.

Blood vs. semen

The genital tracts of men and women can have a different viral load from that of the blood. Men taking HAART may have a suppressed viral load in the blood, but viral load in the semen may not simultaneously be suppressed. Here is one reason for this:

* HAART may not fully penetrate and suppress HIV in the genital tract.

In one study at the University of Pittsburg, researchers with experience finding HIV in different parts of the body monitored the health of eight men taking HAART for five years. During this time, viral load in their blood was below the 50-copy mark. However, the research team was able to find that HIV had been replicating, at low levels, in both blood and semen samples from the men over the five years of the study. This replication was not due to drug resistance but likely because drugs could not accumulate in all regions of the genitals. The team was also able to find a greater proportion of HIV-infected cells in semen samples than in blood, even though there are more cells to infect in the blood than in semen. This finding occurred throughout the study.

The source of HIV that occurs in semen is not clear. Some researchers have fingered the prostate gland as a possible reservoir of HIV. However, more recent research, focusing on men who do not have STIs, suggests that there may be other parts of the male genital tract that harbour HIV.

Other studies have also assessed HIV levels in semen samples from men whose viral load in the blood was less than 50 copies. Depending on the study, the proportion of these men with detectable HIV in their semen has been between 7% and 40%.

Overall, these studies highlight the risk of exposure to semen, even if viral load in the blood was less than 50 copies.

The Swiss Commission suggests that men with viral loads below the 50-copy mark may have HIV in their semen that might not be capable of causing infection. We argue against that. Researchers who have conducted long-term studies of HIV-positive people on HAART have found HIV in cells from their blood and elsewhere that can replicate. The idea that HIV in semen may have special properties that render it non-infectious seems strange, given that sexual transmission is the most common way that HIV is spread.

Semen—More Than HIV

Researchers have found that HIV is not the only virus that can be found in semen. Several teams have isolated the following viruses from human semen samples:

* cytomegalovirus

* hepatitis B virus

* hepatitis C virus

* herpes simplex virus

* human herpes virus-8

* human papilloma virus

Avoiding exposure to semen (and other fluids from the male genital tract) can reduce not only the risk of HIV infection but also other viral infections.

Women and Viral Load

Research on HIV in the female genital tract appears to be more limited than in men. However, results similar to those in men have generally been found. Specifically, HIV can be detected in the genital secretions of women, whether or not they are taking HAART and regardless of the viral load level in their blood. Similar to the situation in men, not all anti-HIV medications can enter and reach high levels in the female genital tract.

And Don’t Forget The Rectum

Researchers in Seattle, Washington, have assessed HIV not only in the blood but also in semen samples and rectal tissue from 64 men. Twenty-seven, or 42%, of these men were taking anti-HIV medications. The study team found that these medications reduced viral load in the blood and semen. But HIV could still be detected in the semen of these 27 men on medication. Furthermore, HIV could also be found in the rectums of the men, whether or not they took anti-HIV therapy.

Sneaky STIs

STIs in the genital tract can cause inflammation and activate latent HIV hiding inside cells. This activation stimulates HIV out of hiding and turns cells into virus factories. Increased HIV in the genital tract together with inflammation heightens the risk of transmitting HIV.

The Swiss Commission does suggest that HIV-positive people be educated about the symptoms of STI infection. This approach to detecting possible STIs, while well intentioned, is at best problematic. Here is why:

A study by the San Francisco Department of Public Health of men who have sex with men found many cases where men were infected with STIs but were unaware of it because the infections were free of symptoms. Moreover, because the infections were at different places in the body, simply screening the urethra (the tube in the penis through which urine flows) for STIs would have missed detecting these infections elsewhere in the body. Here are some findings from their study:

* 85% of cases of rectal infections with either chlamydia or gonorrhea were symptom-free.

* 53% of chlamydia infections and 64% of gonorrhea were in either the throat or rectum

* 70% of chlamydia infections occurred in men who did not also have gonorrhea.

The San Francisco researchers say that these findings prompt the need for screening different parts of the body for these infections. They also underscore the fact that STIs can occur without causing symptoms.

Another study in Birmingham, Alabama, focusing on men, found that another STI—genital herpes—can occur in the absence of symptoms.

Overall, these findings confirm that self-checks for symptoms of STIs may not be the most reliable way to assess infection with these germs.

Misreading The Data

One of the key studies upon which the Swiss Commission’s assumptions rest, is an observational study from Spain. Observational studies are not the most reliable way to investigate a research question. These studies can find associations but are unable to link cause and effect.

In the Spanish study, researchers recruited heterosexual couples where one partner was HIV positive and the other partner presumed to be HIV negative. This was done between 1991 and 2003. Mostly the men were HIV positive. Researchers interviewed the other partner and collected blood for testing.

The researchers found that the partners of HIV positive people were more likely to be HIV negative if they joined the study in 1999 or after, compared to people who joined the study before this time. From this finding, the Swiss Commission inferred that using HAART reduced the risk of HIV transmission. However, there are several reasons why their inference may not be correct, as follows:

* only a small proportion (about 15%) of the HIV positive people in the study took HAART.

* viral loads were not included in the data analysis so we have no idea how many people were on suppressive HAART.

* importantly, the team performed a statistical analysis that took many factors into account (called a multivariate analysis). This revealed that use of HAART did not have an impact on HIV transmission.

* when asked about the use of condoms in the past six months, roughly half the participants noted that they were consistently practicing protected intercourse.

A factor significantly associated with HIV transmission in this study was having unprotected sex.

Toward the end of the report on their study, the Spanish team cautions that an increase in unsafe sex could “cancel or even reverse” any beneficial effect that HAART might have on transmission on HIV. In closing they make this point:

* “This is why it is important not to forget that the main preventive measure for HIV sexual transmission remains the avoidance of risky sexual practices.”

It is significant to note that the studies of sero-discordant couples used by the Swiss Commission in developing their guidelines investigated HIV transmission among heterosexual couples where the primary mode of transmission is vaginal intercourse. There is very little data on the impact of HAART on transmission through unprotected anal intercourse which is the most infectious mode of sexual transmission.

Reality Check

There are many factors that can affect the risk of HIV transmission during sex, including type of sexual activity, the presence of sexually transmitted infections, use of condoms, and so on. Furthermore, these factors may change over time and from one situation to another. Because of these and perhaps other factors, calculating the precise risk of HIV transmission during sex is difficult.

Relying on the presence of a low viral load in the blood is not sufficient information to prevent infection, as HIV replication continues to take place in the body despite a low viral load in the blood. New copies of HIV can be produced in many parts of the body, such as the male and female genital tracts as well as the rectum.

STIs can cause infection without triggering symptoms. This means that self-checks for STIs are not a reliable way of assessing if these germs are present. And, even if the Swiss guidelines are restricted to people in stable relationships, in reality people have affairs and do not tell their spouse or partner.

Currently the scientific data do not support the claim that HIV positive people whose viral loads are undetectable cannot transmit HIV. More research is needed to find out the relationship between viral load, HAART and HIV transmission.

Practicing safer sex can help minimize the risk of transmitting and acquiring STIs, HIV and new drug-resistant strains of HIV.

Resources

The Canadian AIDS Society developed guidelines to help assess the risk of HIV transmission during sex. These are available from its website:

http://www.cdnaids.ca/

The Public Health Agency of Canada recently issued a statement emphasizing the importance of safer sex to prevent the transmission of HIV. That statement is available at:

http://www.phac-aspc.gc.ca/aids-sida/new-nouv-eng.html

Acknowledgements

We thank the many doctors and infectious disease specialists across Canada who have given us their analysis of the Swiss Commission’s opinion. We particularly thank Tim Rogers, PhD, Paul MacPherson MD, PhD, Curtis Cooper MD and Jonathan Angel MD, for their assistance, helpful discussion, research and review in writing this article.

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Sheth PM, Danesh A, Shahabi K, et al. HIV-specific CD8+ lymphocytes in semen are not associated with reduced HIV shedding. Journal of Immunology. 2005 Oct 1;175(7):4789-96.

Zuckerman RA, Whittington WL, Celum CL, et al. Higher concentration of HIV RNA in rectal mucosa secretions than in blood and seminal plasma, among men who have sex with men, independent of antiretroviral therapy. Journal of Infectious Diseases. Jul 1 2004;190(1):156-161.

Coombs RW, Lockhart D, Ross SO, et al. Lower genitourinary tract sources of seminal HIV. Journal of Acquired Immune Deficiency Syndromes. 2006 Apr 1;41(4):430-8.

Shehu-Xhilaga M, de Kretser D, Dejucq-Rainsford N, et al. Standing in the way of eradication: HIV-1 infection and treatment in the male genital tract. Current HIV Research. 2005 Oct;3(4):345-59.

Craigo JK, Patterson BK, Paranjpe S, et al. Persistent HIV type 1 infection in semen and blood compartments in patients after long-term potent antiretroviral therapy. AIDS Research and Human Retroviruses. 2004 Nov;20(11):1196-209.

Furtado MR, Callaway DS, Phair JP, et al. Persistence of HIV-1 transcription in peripheral-blood mononuclear cells in patients receiving potent antiretroviral therapy. New England Journal of Medicine. 1999 May 27;340(21):1614-22.

Chan DJ, Ray JE. Quantification of antiretroviral drugs for HIV-1 in the male genital tract: current data, limitations and implications for laboratory analysis. Journal of Pharmacy and Pharmacology. 2007 Nov;59(11):1451-62.

Sharkey ME, Teo I, Greenough T, et al. Persistence of episomal HIV-1 infection intermediates in patients on highly active anti-retroviral therapy. Nature Medicine. 2000 Jan;6(1):76-81.

Nunnari G, Leto D, Sullivan J et al. Seminal reservoirs during an HIV type 1 eradication trial. AIDS Research and Human Retroviruses. 2005 Sep;21(9):768-75.

Sizemore JM Jr, Lakeman F, Whitley R, et al. The spectrum of genital herpes simplex virus infection in men attending a sexually transmitted disease clinic. Journal of Infectious Diseases. 2006 Apr 1;193(7):905-11.

Cu-Uvin S, Snyder B, Harwell JI, et al. Association between paired plasma and cervicovaginal lavage fluid HIV-1 RNA levels during 36 months. Journal of Acquired Immune Deficiency Syndromes. 2006 Aug 15;42(5):584-7.

Eron JJ, Jr., Smeaton LM, Fiscus SA, et al. The effects of protease inhibitor therapy on human immunodeficiency virus type 1 levels in semen (AIDS clinical trials group protocol 850). Journal of Infectious Diseases May 2000;181(5):1622-1628.

Bujan L, Daudin M, Matsuda T, et al. Factors of intermittent HIV-1 excretion in semen and efficiency of sperm processing in obtaining spermatozoa without HIV-1 genomes. AIDS. Mar 26 2004;18(5):757-766.

Leruez-Ville M, Dulioust E, Costabliola D, et al. Decrease in HIV-1 seminal shedding in men receiving highly active antiretroviral therapy: an 18 month longitudinal study (ANRS EP012). AIDS. Feb 15 2002;16(3):486-488.

Barroso PF, Schechter M, Gupta P, Bressan C, Bomfim A, Harrison LH. Adherence to antiretroviral therapy and persistence of HIV RNA in semen. Journal of Acquired Immune Deficiency Syndromes. Apr 1 2003;32(4):435-440.

Lafeuillade A, Solas C, Chadapaud S, Hittinger G, Poggi C, Lacarelle B. HIV-1 RNA levels, resistance, and drug diffusion in semen versus blood in patients receiving a lopinavir-containing regimen. Journal of Acquired Immune Deficiency Syndromes Apr 1 2003;32(4):462-464.

Dornadula G, Zhang H, VanUitert B, et al. Residual HIV-1 RNA in blood plasma of patients taking suppressive highly active antiretroviral therapy. Journal of the American Medical Association Nov 3 1999;282(17):1627-1632.

Smith DM, Wong JK, Shao H, et al. Long-term persistence of transmitted HIV drug resistance in male genital tract secretions: implications for secondary transmission. Journal of Infectious Diseases. 2007 Aug 1;196(3):356-60. Epub 2007 Jun 19.

van Leeuwen E, Ter Heine R, van der Veen F, et al. Penetration of atazanavir in seminal plasma of men infected with human immunodeficiency virus type 1. Antimicrobial Agents and Chemotherapy. 2007 Jan;51(1):335-7.

Castilla J, Del Romero J, Hernando V, et al. Effectiveness of highly active antiretroviral therapy in reducing heterosexual transmission of HIV. Journal of Acquired Immune Deficiency Syndromes. 2005 Sep 1;40(1):96-101

Sabatté J, Ceballos A, Raiden S, et al. Human seminal plasma abrogates the capture and transmission of human immunodeficiency virus type 1 to CD4+ T cells mediated by DC-SIGN. Journal of Virology. 2007 Dec;81(24):13723-34.

UNAIDS and WHO. Antiretroviral therapy and transmission of HIV. Statement. 1 February, 2008. Available at: http://data.unaids.org/pub/PressStatement/2008/080201_hivtransmission_en.pdf

By Sean R. Hosein, From Canadian AIDS Treatment Information Exchange (CATIE). For more information visit CATIE's Information Network at http://www.catie.ca

More from Microbicides 2008

Third-Generation Microbicides Might Act As ‘Bacterial Vaccine’

March 4, 2008

Studies are underway of genetically engineering naturally-occurring vaginal bacteria to produce microbicides against HIV, and in one case such a strategy has already proved effective in preventing HIV infection in monkeys, the Microbicides 2008 Conference heard last week in Delhi.

Qiang Xu of ‘bacterial therapeutics’ company Osel, Inc. of California reviewed the latest progress on getting naturally-occurring Lactobacillus bacteria to produce the microbicide Cyanovirin-N.

Cyanovirin-N is a protein originally derived from algae that has shown promising efficacy as both a vaginal and a rectal microbicide. However it is a large molecule that might be prohibitively expensive to develop as a gel.

Dr Xu’s team inserted a gene into the genome of Lactobacillus jensenii 1153, a variety of the naturally-occurring bacteria that colonise the vagina. These already confer some protective effect by generating hydrogen peroxide, which has a microbicidal effect – see this report for a study of lactobacilli presented at CROI.

The researchers were able to induce the modified bacteria to colonise the vaginas of female rhesus macaques (which naturally harbour lactobacilli) for over two months. In vitro experiments showed that the Cyanovirin-N produced inhibited CCR5-tropic HIV, with a 50% inhibitory concentration one one nanomolar, which is comparable to systemic antiretrovirals.

Studies are needed to establish whether the colonizing bacteria can produce enough Cyanovirin-N in situ to have a microbicidal effect, and also on fermentation techniques to produce bulk amounts of the bacteria. Asked about the possibility of escape of genetically-modified bacteria, Dr Xu said that they could be completely cleared with a short course of the antibiotic azithromycin and did not survive outside the body in water or air.

Another novel approach is to engineer altered versions of naturally-occurring CCR5 inhibitors which act, like maraviroc and vicriviroc, the ones developed as treatments, by blocking a co-receptor molecule needed by HIV to gain entry to CD4 cells.

The natural ligand (molecule that naturally attaches to) the CCR5 co-receptor is the chemokine molecule RANTES, which acts as a means of mobilising immune-cell activity in cases of injury or infection.

Because of RANTES’ immune activity and short half-life it cannot be used as an anti-HIV treatment or preventative in itself.

Dr Oliver Hartley of the University of Geneva in Switzerland has been developing an analogue or altered version called PSC-RANTES as an HIV treatment. This works by inducing CD4 cells to downregulate their CCR5 receptors, in other words to pull the molecules inside the cell surface where they can no longer act as chemokine or viral receptors.

In experiments in monkeys, PSC-RANTES was shown to protect against transmission in the macaque model – see this report for progress up to the previous microbicide conference. However PSC-RANTES still acts as an immune-signalling chemical (it excites immune activity) and would also be impossible to produce in bulk cost-effectively.

Hartley generated a variety of other RANTES analogues and has found one called 5P12-RANTES that can be manufactured in bulk by fermentation methods. It acts as a CCR5 inhibitor but it neither induced CCR5 downregulation nor immune activation. It shows equivalent activity to PSC-RANTES and in the macaque model, when applied topically as one-micromolar solutions in saline, protected five out of five female macaques from vaginal SHIV infection.

Finally, in experiments combining both approaches, Luca Vangelista of the San Raffaele Scientific Institute in Italy has engineered the same lactobacilli as in the Xu study to produce human-type RANTES and is currently engineering another variant that will produce an analogue called C1C5-RANTES, and also small peptides – sections – derived from RANTES to see if these have anti-HIV activity.

References

Xu Q. Development of a live topical microbicide for women. Microbicides 2008 Conference, Delhi. Abstract AO17-221. 2008.

Hartley O. Fully recombinant chemokine analogues provide complete protection in the macaque vaginal challenge model. Microbicides 2008 Conference, Delhi. Abstract AO21-286. 2008.

Vangelista L. Expression of RANTES derivatives in Lactobacilli: a novel strategy for the development of vaginal microbicides. Microbicides 2008 Conference, Delhi. Abstract AO18-235. 2008.

By Gus Cairns, www.aidsmap.com

Group Releases Report on Rectal Microbicides

Mar 4, 2008

"Less Silence, More Science: Advocacy To Make Rectal Microbicides a Reality," International Rectal Microbicides Advocates: IRMA recently at the Microbicides 2008 conference in New Delhi, India, released the report, which provides a background on developments and efforts in rectal microbicide research. The report also examines global challenges, as well as advocacy goals and strategies, to move forward with research. Rectal microbicide research has been hindered by a lack of funding, the report found. According to IRMA, about $7 million worldwide was allocated for the research in 2006, and it is estimated that a minimum of $350 million during the next 10 to 15 years, or about $35 million annually, is needed to create a comprehensive research program. The group therefore has called for a fivefold increase in spending to ensure the development of a rectal microbicide (IRMA release, 2/24).

http://www.kaisernetwork.org

AIDS and Evangelists in Africa

There is no single answer to the problem of HIV/AIDS, but solutions cannot be imposed from the outside

March 5, 2008

The Invisible Cure

By Helen Epstein

Africa, the West and the fight against AIDS

Viking 978 0 670 91356 5

On one of her many trips to Africa in recent years to investigate the state of the AIDS epidemic, Helen Epstein (no relation) visited the main hospital in a district known for its tea plantations, about 200 miles from Uganda’s capital, Kampala. There was one doctor at the facility, and on occasion some nurses. The X-ray machine could be powered up for an hour a day at best. Those patients not sleeping on the floor were sharing beds. The bathrooms had been gutted and served “as aviaries for the finches that made their nests in the porcelain scraps on the floor”. Some patients had AIDS; others, suffering from onchocerciasis, or “river blindness”, had long parasitic worms that formed wriggly lumps beneath the skin.

To write about AIDS in Africa for a Western audience is to confront a sharp narrative dilemma. How do you tell stories – often painful, sometimes overwhelming – without re-inforcing a sense of awful inevitability about Africa’s many problems? How do you convey the startlingly different logic by which life operates there, without trafficking in myths and stereotypes, and without solidifying a perception of Africa as radically “other”, and thus unknowable and unreachable? Epstein, a scientist turned essayist, has been piecing this account together for more than a decade in a series of lucid articles published in the New York Review of Books. Collecting that material between the covers of a single volume is a tremendous service – even if, as so often is the case for books with such origins, she has failed to eliminate distracting repetition across chapters or solve some basic problems of exposition. (Why are elementary facts about AIDS treatment and testing in Africa relegated to an appendix?) But her keen eye for detail, suspicion of conventional wisdom, and compelling prose carry the reader along. She does not shy away from telling horror stories about East and Southern Africa, home to about 40 per cent of the world’s cases of HIV infection. There are stories not just of deplorable conditions, tragic missteps and profound institutional failures, and sometimes of the hideous things that people do to one another – like the case of the South African teenage boys who stoned to death their neighbour, an HIV-positive AIDS counsellor, because she had brought “shame on the community”. But Epstein also juxtaposes failures with impressive accomplishments. Though her portraits are vividly painted, her desire is not to describe but to explain. And if she succeeds better than most in avoiding the standard portrayal of Africa as unfathomable and unchangeable, it is because she interweaves her storytelling with careful analysis. She shows how human efforts to control disease often fail but sometimes succeed, and by placing outcomes and actions squarely in their historical and cultural context – including, not incidentally, the long historical ripple effects of Western colonialism that continue to promote the spread of disease while hindering its containment – she shows us why people believe what they believe or do what they do. Finally, by linking what happens in Kampala and Pretoria to what goes on in Geneva, Washington, DC, and elsewhere, Epstein shows how the intractable dilemmas that come to seem quintessentially “African” are often caused, or compounded, by forces and agendas that originate elsewhere and over which Africans themselves exercise limited control.

Epstein’s analysis of AIDS in Africa centres on two vital questions. The first one concerns the epidemiology of transmission: why is the AIDS epidemic so much worse in sub-Saharan Africa than anywhere else in the world? More than 35 per cent of all adults in certain African countries are HIV-positive, while in the United States, Russia and India, the figures have never gone higher than 1 or 2 per cent, and the expert prediction that Asia would go the way of Africa has, thankfully, not yet come to pass. The second question concerns the sociology and politics of disease prevention as practised on the ground in different African countries: why have certain countries, such as Uganda, seen sharp declines in rates of infection with HIV, while others, such as Botswana and South Africa, continue to fare so poorly?

Although these questions prove difficult to answer, Epstein has interesting things to say about them, and draws thoughtfully on an eclectic mix of theories and findings from the natural and social sciences. To explain the devastating spread of HIV in Africa, Epstein begins by casting doubt on a range of popular hypotheses, from the plausible (weakened immune systems from malnutrition and parasitic infections) to the dubious and frankly racist (exotic tribal rituals involving blood). She points in particular to the frequency of so-called concurrent sexual relationships – that is, sustained relationships with more than one partner at a time, as opposed to either serial monogamy or monogamy punctuated by one-night stands – describing one study in which 40 per cent of Ugandan men and 30 per cent of women reported that at least two of their most recent relationships overlapped for several months or years. Mathematical models show how a sexually transmitted infection can blaze through such a population at an astonishing rate, much faster than when individuals have many sexual partners over the years but only one at a time. While those engaging in one-night stands with strangers or prostitutes may be more likely to use condoms when doing so, participants in concurrent relationships, who know, love and trust their various partners, may be far more inclined to dispense with protection altogether.

This is an ingenious explanation, but Epstein lacks the detailed comparative data that would clinch her case. Although she rightly points to the regulative effect exerted by the Western cultural ideal of true love, she doesn’t tell us much about what people outside Africa actually do sexually. Consider the findings from the National Health and Social Life Survey (published in 1994 as The Social Organization of Sexuality), which stands as the most rigorous statistical study to date about sexual practices in the US. While the researchers found low numbers of sexual partners among those respondents who were married, nearly a quarter of those who were unmarried but living together reported multiple sexual partners in the previous year. Moreover, of all those respondents who had two partners in the preceding year, half reported a period of overlap between partners, but only a quarter reported having a one-night stand. These data suggest that sexual concurrency, as Epstein defines it, may not be so exclusively an African phenomenon, and that her contrast between Africa and countries such as the US may be overdrawn.

On the crucial question of responses to the epidemic, Epstein finds no simple answer, but many suggestive hints of great potential significance. In Uganda, where the HIV rate fell by two-thirds between 1992 and 2003, AIDS became an urgent topic of collective conversation and an opportunity for social cohesion: “Kampala taxi drivers talked as passionately about AIDS as taxi drivers elsewhere discuss politics or football. And they talked about it in a way that would seem foreign to many in South Africa because it was so personal: ‘my sister’, ‘my father’, ‘my neighbor’, ‘my friend’”. Moreover, the Ugandan fight against AIDS, taken up by hundreds of small, community-based organizations, became closely connected with the campaign for women’s rights, to the mutual benefit of both struggles. South Africa, by contrast, has been the chief site of official denial of the realities of AIDS, from the office of the presidency on down. And the emphasis there on reaching those deemed at highest risk, such as prostitutes and truck drivers, left grave misunderstandings about how much the disease had penetrated the population, and who was really at risk of infection, while doing nothing to reduce the stigma associated with the condition.

In the end, Epstein tells us, there can be no single answer to the problem of HIV/AIDS – neither antiretroviral drugs (no cure-all, even when available) nor an AIDS vaccine (which remains elusive) nor any particular behavioural model of prevention and education. She is refreshingly skeptical of the AIDS prevention campaigns brought in by the global public-health establishment, not only because of their often narrow presuppositions about what motivates human behaviour, but also because of the assumption that solutions are portable – that an AIDS campaign designed in Geneva can, with modest tinkering, do the trick in Botswana. In the end, she suggests that “African people often know best how to solve their own problems”, and the kind of heartfelt social mobilization that appears to have made such a difference in Uganda is something that no public-health “social marketing” campaign can engineer or foment. African nations cannot do it alone, she suggests, but neither can Western scientists, missionaries, or consultants impose solutions in countries they have not begun to understand. Indeed, outsiders have often made things predictably worse, including the “helicopter scientists” who “parachuted in, took data, and didn’t work with local African experts”, and the pharmaceutical companies who found in Africa a place where drug trials could be conducted on the cheap, without the inconvenience of having to respect the rights of the participants.

Perhaps the most frightening stories that Epstein tells about the impact of outsiders concern the practices of the current administration in the US. President George W. Bush has expanded the funding for AIDS prevention in Africa, while promoting abstinence and fidelity. Yet this emphasis has little basis in scientific data. In Uganda, for example, Epstein reports that during the years when the national HIV rate fell by about 70 per cent, the teen pregnancy rate remained essentially unchanged – suggesting that abstinence had little to do with the remarkable reduction in new infections. What such programmes do support, however, is the promotion of God’s work, as understood by Bush’s conservative Christian backers. “AIDS has created an evangelism opportunity for the body of Christ unlike any in history”, according to Ken Isaacs, a spokesperson for the Christian charity Samaritan’s Purse. And while US law supposedly stands in the way of using Federal funds for evangelizing, Epstein reports that “every abstinence event I attended involved much praying and discussion of Jesus”. Sadly, it is precisely in Uganda, Epstein’s success story, where the tide appears to have turned in recent years, and where Epstein now encounters condom burnings in the name of Jesus. Reversing this alarming trend is now among the most crucial steps in supporting the work of Africans who struggle to solve the wrenching problem of AIDS.

By Steven Epstein is Professor of Sociology and Director of the Science Studies Program at the University of California, San Diego. He is the author of Impure Science: AIDS, activism, and the politics of knowledge, 1996, and Inclusion: The politics of difference in medical research, 2007.

http://entertainment.timesonline.co.uk

POZ Publishes Article on Native HIV/AIDS Awareness Day

March 7, 2008

POZ in its March issue examined the HIV/AIDS situation among American Indians in recognition of National Native HIV/AIDS Awareness Day on March 20. HIV cases among American Indian, Alaska Native and Native Hawaiian communities are estimated at 11.5 cases per 100,000 people -- 40% higher than cases among whites.

Many American Indians avoid seeking testing and treatment because of concerns about discrimination and a lack of HIV/AIDS education, according to POZ. The Indian Health Service, which serves most American Indians, lacks the resources to provide adequate care for people living with HIV/AIDS, POZ reports.

HIV/AIDS awareness efforts aimed at the population have increased during the past year, and a national conference on the issue, called "Embracing Our Traditions," was launched in 2006.

However, some advocates say little has improved. "Nothing gets done," Kory Montoya, an HIV-positive New Mexico Apache who serves as interim executive director at a New Mexico AIDS service organization, said of developing programs and funding. He added, "People come and they want our input...[b]ut nothing gets done."

Advocates say that more HIV-positive American Indians should begin speaking out to help increase awareness and raise funds. They also noted that reaching American Indians will require tailoring programs to their cultures, such as educating elders and incorporating tribal health techniques, POZ reports (Scott, POZ, March 2008).

http://www.kaisernetwork.org