Ottawa Targets Hospital Superbugs
Health agency acts as infection rate soars

February 4, 2008

The federal government is launching a national effort targeting the superbug methicillin-resistant Staphylococcus aureus in its bid to reduce the number of hospital-acquired infections that kill thousands of Canadians each year.

An estimated 220,000 Canadians develop hospital-acquired infections each year, of which MRSA is one type, according to Canadian Nosocomial Infection Surveillance Program figures. About 8,000 people die of them annually.

Until now, efforts to reduce the prevalence of superbug infections have been largely left to individual hospitals, which resulted in inconsistent policies and outcomes. The annual death toll of hospital-acquired infections dwarfs that of the 2003 SARS outbreak, which killed 44 people nationwide.

By targeting MRSA, Howard Njoo of the Public Health Agency of Canada said it is making patient safety in this country's hospitals a priority.

Superbugs are of such concern that almost all acute-care Canadian hospitals and nursing homes now applying for accreditation will have to provide their rates of MRSA or Clostridium difficile. The new requirement of the Canadian Council on Health Services Accreditation, effective as of last month, will compel those organizations to track the rate of those two types of bacteria as part of the accreditation process.

And although accreditation is voluntary, 99 per cent of Canada's acute-care hospitals participate, as do many nursing homes, some community health centres, home-care organizations and other health-care facilities.

"We recognize that both in the community and in the health-care setting, trying to decrease the transmission of infections is very important," Dr. Njoo, director-general of the agency's Centre for Communicable Diseases and Infection Control, said.

Hand washing and appropriate use of antibiotics are two measures that help reduce various forms of hospital-acquired infections, including MRSA, Dr. Njoo said.

While hand hygiene is a crucial and obvious step to reducing infections, prodding those who provide care to scrub up has been maddeningly difficult: only 40 per cent of Canadian health-care workers properly wash their hands.

Other measures proven to help reduce MRSA include screening patients for the superbug upon admission to hospital, isolating hospital patients who have it, proper cleaning of hospital rooms, and ensuring hospital visitors and health-care workers who come into contact with those who have MRSA don gloves, gowns and masks.

The federal effort - the largest national effort to date - comes after it said in September that it would develop a plan by January on how to reduce the staggering number of infections occurring in the nation's hospitals. At the time, it was considering three superbugs: MRSA, vancoymycin-resistant enterococci and C. difficile. In the end, MRSA was selected, in part, because it is highly responsive to proper hand hygiene.

Phil Hassen, chief executive officer of the Canadian Patient Safety Institute, said MRSA is causing a lot of grief in Canadian hospitals, adding that "this is a safety issue; this is about preventing harm to people."

The federal government has not yet set a target on how many MRSA infections it would like to reduce. Joanne Laalo, past president of the Community and Hospital Infection Control Association of Canada, the group co-leading the superbug initiative with the government, stressed that a figure still has to be determined, but a "reduction by 50 per cent would be wonderful."

MRSA can hide inside a nostril, on a hand or in soiled clothing. Symptoms can vary from a blotch of reddened skin treatable with a topical antibiotic to a merciless attack that causes blood poisoning, decayed lungs, pneumonia and infected heart valves.

The superbug has made significant inroads in Canada, where the rate of those colonized and infected over the past decade has increased tenfold. Some of the highest rates have been noted in Quebec and Ontario, according to the Canadian Nosocomial Infection Surveillance Program study, which looked at MRSA in 38 hospitals in nine provinces.

Ontario, for example, is something of an MRSA hot spot: 13,458 patients were found to be colonized or infected with it in 2006, the highest number the province has ever recorded, according to the most recent figures from Ontario's Quality Management Program - Laboratory Services.

The scourge of hospital-acquired infections have been the subject of marketing campaigns, buttons and posters, most of them aimed at encouraging health-care workers, patients and visitors to hospitals to wash their hands.

MRSA

What is MRSA? Methicillin-resistant Staphylococcus aureus is a bacterial infection resistant to the antibiotic methicillin.

Who is at risk? Hospital patients, the elderly, the very ill and frequent or long-term users of antibiotics run a greater risk of acquiring it.

How is MRSA spread? It is usually spread through hand contact. The hands of health-care workers can become contaminated by contact with patients, or the bug may cling to surfaces in hospitals and medical devices.

What are the symptoms? MRSA generally starts as small red bumps that resemble pimples, boils or spider bites. These can quickly turn into deep, painful abscesses that require surgical draining. Sometimes the bacteria remain confined to the skin but they can also burrow deep into the body, causing potentially life-threatening infections in bones, joints, surgical wounds, the bloodstream, heart valves and lungs.Other superbugs

Vancomycin-resistant enterococci: Enterococci are bacteria that live in the bowels of most people. VRE is a strain that has developed resistance to many commonly used antibiotics, specifically vancomycin.

C. difficile: Clostridium difficile is a bacterium that causes severe diarrhea.

By Lisa Priest, Toronto Globe and Mail

Conquering AIDS — If We Have A HAART

February 7, 2008

Dr. Julio Montaner: more aggressive AIDS treatment needed for those in helpless situations. 
photo by Brian Smith

AIDS Advocates Call For Support As Epidemic Grows In Aboriginal Communities

February 8, 2008

As the number of aboriginal people living with HIV and AIDS in Canada grows, efforts to address the situation should consider the social factors, such as poverty, behind the epidemic, advocates say.

But for much-needed progress to be made, the stigma and discrimination borne by aboriginal people with AIDS must end, according to the Canadian Aboriginal AIDS Network. That’s why the network is calling on First Nations, Métis, and Inuit leaders ahead of Valentine’s Day, and asking them to speak out on the issue in public.

"A lot of us take it for granted. If we’re healthy and living with friends and family and loved ones around us, we think that everything’s all right in the world," Kevin Barlow, the network’s executive director, told the Georgia Straight by phone from Ottawa. "In reality a lot of aboriginal people who are living with HIV and AIDS talk about the isolation and the rejection they experience."

Hearing leaders denounce discrimination and then endorse AIDS prevention, harm-reduction, and treatment programs, he said, will help create more supportive environments in aboriginal communities and encourage those at risk of or living with human immunodeficiency virus or acquired immune deficiency syndrome to get tested or seek assistance.

"When the awareness level is low, then you have higher levels of stigma and discrimination," Barlow said. "When you can inform and educate people, then you bring the stigma and discrimination levels down a bit, because people are more informed and they’re not afraid."

Statistics show aboriginal people—who compose 3.8 percent of Canada’s population, according to the 2006 census—are overrepresented among cases of HIV and AIDS in Canada, and the percentages continue to rise.

According to statistics published by the Public Health Agency of Canada, aboriginal persons made up 3.1 percent of reported AIDS cases with information on ethnicity from 1979 to 2003, and 23.4 percent of positive HIV-test reports from 1998 to 2003. In 2003, 13.4 percent of reported AIDS cases involved aboriginal persons, up from 1.2 percent before 1993. Aboriginal persons composed 25.3 percent of positive HIV-test reports in 2003, up from 18.8 percent in 1998.

Women and youth are also disproportionately represented among new infections in the aboriginal population, compared to the non-aboriginal population.

"Infection rates are far worse here amongst aboriginal people than they are among some Third World developing countries," Shawn Atleo, regional chief of the British Columbia Assembly of First Nations, told the Straight. "This should be a general public concern, not just an aboriginal-health issue."

Atleo said he’s willing to speak publicly to fight the stigma and discrimination that still surround AIDS and to support the work of people in the field.

"This is very personal, I think, for everyone in our community. You don’t have to go far," he said. "I lost one of my childhood friends to the disease, from Ahousaht, west coast of Vancouver Island—not on the Downtown Eastside. This is in our communities everywhere.

Ken Clement, president of the Canadian Aboriginal AIDS Network and executive director of the Vancouver-based Healing Our Spirit BC Aboriginal HIV/AIDS Society, said financial, human, and technical resources are needed in communities across the province to support aboriginal people living with the disease. Indeed, he said, the lack of resources in rural communities can lead people with AIDS to seek out services in Vancouver.

"If we don’t have those resources I talked about, it’s almost pointless to speak of our future as a nation if we don’t have the people," Clement said. "It’s kind of ironical that we talk about treaty process, but if we have our communities infected and affected by HIV and other health issues, then it seems to be a lost cause."

Both Barlow and Clement maintained social factors—such as poverty, lack of education and housing, foster care, and residential-school wounds—are driving the AIDS epidemic in aboriginal communities.

"When people are below poverty levels and they can’t get gainful employment and they’re struggling with mental-health challenges or these childhood wounds that come from things that they have no control over, it creates a very different dynamic for people," Barlow said.

Dirty needles are responsible for most new HIV infections among aboriginal people, he noted, adding that means there is much harm-reduction work to be done.

A study by the B.C. Centre for Excellence in HIV/AIDS, to be published in the March issue of the American Journal of Public Health, found aboriginal people in Vancouver who inject drugs are much more likely to have or to be infected with HIV than non-aboriginal injection-drug users.

Entering the study period, 25.1 percent of aboriginal participants were HIV-positive, compared to 16 percent of non-aboriginal subjects. Four years later, 18.5 percent of aboriginal participants reported new HIV infections, while only 9.5 percent of non-aboriginal persons did.

"Our findings demand a culturally appropriate and evidence-based response to the HIV epidemic among Aboriginal injection drug users," the study’s authors wrote, according to a draft.

By Stephen Hui , http://www.straight.com

Fair Play Or Morality Play?

February 9, 2008

London, Ontario - Barry Mann has been HIV-positive for 19 years and practises safe sex.

He learned to take precautions after watching many friends die of AIDS in the 1980s.

Now, at 53, he's scared -- not of infecting his sexual partners with the virus that causes AIDS, but of being accused of infecting them -- and going to jail.

"To date, I haven't had somebody who's out to get me," he says.

A recent criminal case in London -- one of four HIV-related cases before the courts here and one in St. Thomas -- has left Mann with an uneasy feeling the criminal courts are judging HIV-related cases on the basis of morality, not public protection.

Ryan Handy, 25, a young gay man with mental illness, was convicted last month of aggravated sexual assault. He testified that at one time he believed he had sweated out his HIV and was the Messiah.

After two unprotected sexual encounters with a 53-year-old man he met in an Internet chat room, Handy testified, he had a moment of clarity, realized he had the virus and immediately contacted the man and told him he was HIV-positive. His lack of disclosure of his HIV status required by law could send Handy to prison when he's sentenced next month.

There is a debate brewing -- and an opinion in the gay community -- that the victim in the case, who has remained virus-free, should have taken care of his own sexual health while engaging in high-risk sexual behaviour and not be accusing a young, vulnerable man of a criminal act.

Mann says the courts should stay out of people's bedrooms when it comes to disclosing HIV.

"It should not be tying up the courts," he says. "It's a health issue, not a criminal issue."

Breakthroughs in treatment have allowed Mann and many other HIV-positive people to live with the virus for decades. He's still legally obligated to tell his sexual partners he has the virus, something he admits doesn't always happen because he uses protection.

"I am constantly floored by how many people are willing to have sex with me without taking precautions. I'm the one who has to stop them," he says. "Society is still very nonchalant about this."

It's been 15 years since the death of Charles Ssenyonga, a man with a virulent strain of AIDS who was being tried for knowingly spreading the virus to several women -- some of whom died -- in London. He died just weeks before Superior Court Justice Dougald McDermid was to deliver a decision.

Half a generation later, there are suggestions it's time for HIV to be taken out of the Criminal Code.

There have only been 29 HIV-related cases in Canada and six are before the courts. It appears the majority on trial now are in the London area. All the current London cases involve men -- two straight and two gay -- said not to have disclosed their HIV status to sexual partners.

In the cases of people maliciously spreading the virus, there's a unified opinion inside and outside the criminal justice system those cases need to be tried criminally.

But in the Handy case, and in the Mark Hinton case that was dismissed this week, the facts involved allegations of consensual sex between people engaged in high risk activities. (Hinton, 41, who has been HIV-positive for 22 years, faced a charge of attempted aggravated sexual assault. A judge dismissed the charge).

Those cases, some activists say, could have best been handled by public health -- not the criminal justice system that they say seems to judge morality and not promote public protection.

"If you take the HIV out of there, it's still a crime," says Peter Hayes, executive director of the AIDS Committee of London, about HIV cases involving sexual assault and intentional spread of the disease.

But, he says, "when we make it about HIV-only, the law can be misinterpreted, or situations are not being addressed in the best interests of public health."

Hayes says cases like Handy's and others go to the most intimate piece of a relationship and solidify the stigma attached to disease that has gone from a death sentence to an often controllable condition.

Prosecution of such cases leaves the community with a false sense of security, he says. The reality, he says, is that the vast majority of HIV-positive people disclose their status not just to their partners, but to family, employers, doctors and anyone they believe could be at risk.

The majority of new transmissions are in the straight community and come from people who haven't been tested.

Brian Lester, director of prevention for the agency, says the best strategy to stop the transmission of the virus is to encourage testing and help people make informed decisions about their results. But criminalization "challenges that, he says.

"People don't want to deal with what could be a reality in their life," he says, and won't get the test. "A fully informed individual making a choice not to use a condom is putting themselves at risk."

Hayes says he's concerned there's not enough education in, and outside of, the criminal justice system about the virus and the disease.

He points to a 2003 study across Canada that showed people were less informed about HIV and AIDS than ever, with beliefs that only gay men and drug users and people living in Africa were at risk.

"Issues surrounding sex and drugs are being talked in a way that's not about health but more about morality," he says.

Lester says the health system has the tools to handle the cases.

Already, public health can issue orders that outline rules an HIV-positive person must follow, such as using condoms in all sexual encounters and not sharing needles. It also has the power to detain people, Lester says.

He adds the justice system adds to the stigma when prosecuting these cases as aggravated sexual assaults.

"I don't understand the term sexual assault in consensual sex," he says.


Even the failure to disclose during pillow talk needs to be prosecuted, some in legal circles say.

A London lawyer who successfully defended Hinton agrees HIV cases should be judged in criminal courts.

"It should absolutely be an offence," says Ron Ellis. "Because you can't consent to having sexual relations with someone if the act is so manifestly different than what you expected it was going to be.

"HIV changes the very nature and character of the sex you are consenting to such a degree."

HIV still remains potentially life-threatening, he says, and although not necessarily a death sentence, it requires a lifetime of treatment and medications. It restricts freedoms and choice of sexual partners.

"It's got to be worth something," Ellis says.

If Hinton had been found guilty, Ellis notes, he would have faced a prison sentence of three to six years.

"I think its a crime to put somebody at risk," Ellis says. "The law is you've got to disclose and it's a good law. It's there for the health and safety of the community."

Dr. Bryna Warshawsky, associate medical officer of health for the Middlesex-London Health Unit, says the spread of the virus is "certainly a health issue," and adds it's "very rare and unusual for people with HIV not to be responsible."

The Ryan Handy case has become a rallying point for some in the gay community -- a group of supporters was with him at his sentencing hearing last month.

Handy can be seen in a three-part interview on the Xtra magazine website denouncing what he calls unfair treatment by the criminal courts.

An editorial by managing editor Matt Mills in the gay magazine criticizing the victim in December prompted the victim in the Handy case to not submit a victim impact statement.

Mills says he thinks "it's really important that folks who are in the position he is in have the opportunity to tell their stories." He says his publication believes some men, particularly gay men, get "the short end of the stick on this legislation and these sentencing guidelines.

"We believe the criminal justice system is singularly unqualified and ill-equipped to handle this issue."

The Supreme Court of Canada, Mills says, in its decision that HIV-positive people have a duty to disclose their illness before having unprotected sex, "has put us in a position we are at each other's throat and suspicious of each other when it is a public health matter."

Mann, who also recently completed treatment for Hepatitis C, agrees.

"Nobody forced their pants down. Nobody forced them to have sex. Everybody's responsibility is to protect themselves."

He fears that whether he discloses his health status or not in the bedroom becomes hearsay in a courtroom.

"I can disclose to somebody and they can turn around and say I didn't disclose," he says, adding he fears the issue could evolve into civil cases in which former lovers are pitted against each other.

"We're already dealing with living with this disease and the stigma attached. We don't need this on top of it."

HIV And The Law

The Supreme Court of Canada ruled in 1998 that:

- HIV-positive people must disclose their status to sexual partners before having sex without a condom or sharing sex toys.

- They must tell people with whom they share drug equipment before sharing the equipment.

- Non-disclosure could lead to an order by a local public health unit that would outline rules that must be followed and could include using a condom in all sexual encounters or no sharing of needles.

- Criminal Code charges can be laid by a sexual- or needle-sharing partner. The charges range from common nuisance to aggravated sexual assault. Charges can be laid even if the partner is not infected.

Cases Before The Courts

- Edward Kelly, 31, was charged with aggravated sexual assault in May 2006, after a woman told police she had sex with a man who didn't tell her he was HIV-positive. He is next in Superior Court on Feb. 12.

- Tendai Mazambani, 33, was charged with four counts of aggravated sexual assault in October 2006. He is expected to set a date for an Ontario Court preliminary hearing.

- The case against Mark Hinton, 41, was dismissed this week after his complainant admitted HIV status was not a concern to him before engaging in "moderately high risk" sexual activities. Hinton, who didn't get the chance to testify, maintained he never had sex with the man.

- Ryan Handy, 25, a gay man who testified he is mentally ill and believed he sweated out his HIV, is to be sentenced for aggravated sexual assault March 27.

- Owen Antoine, 41, of Aylmer was convicted by a jury in St. Thomas this month of four charges, including aggravated sexual assault and criminal negligence causing bodily harm. Antoine was diagnosed HIV-positive in December 2004. The victim, a 29-year-old woman, testified she was at a bar with Antoine in April 2006 and has no memory after she drank a shooter he said he took to her. She woke up hours later in bed with him and he told her they had unprotected sex. She has since tested positive for HIV. Antoine did not tell her he had the virus.
 
By Jane Sims, http://lfpress.ca

Liberal Leader Dion Indicates Vancouver Safe Injection Site Is OK

February 8, 2008

Vancouver - The Liberal party has no intention of advocating the legalization of cannabis but leader Stephane Dion made it clear Friday that under a Liberal government, other Canadian cities could see safe injection sites like the one in Vancouver.

Dion, whose party could be embroiled in an election campaign this spring, took about 20 questions at a "town hall meeting" at the University of British Columbia.

The questions were wide-ranging and included the Liberal party's position on Afghanistan, the economy, climate change - and marijuana.

"It's not something we will campaign on in the next election," Dion said candidly. "But we need to have an approach about drugs that is more effective than the one the government has to date."

Without being asked about it, he told the crowd of about 150 students that Canada's only safe injection site - known as Insite and situated in the Downtown Eastside - "is something in which we believe.

"I think the current government has an ideological approach about that," Dion told the gathering that was co-ordinated by the Young Liberals of UBC.

"If the science is telling you that an initiative like that is saving lives, we need to continue it."

The Harper government has said that the city's safe injection site can remain open until June.

Health Canada announced in October it would extend the exemption from Canada's drug laws that allows Insite to operate. The exemption was set to run out at the end of the year.

The site provides a place for addicts to safely inject themselves with their own heroin under the supervision of medical staff.

A spokeswoman for Health Canada said the exemption will allow further research.

Dion added that a Liberal government would investigate if there are other communities in Canada "willing to address the problem this way."

Another student suggested that Canada often kowtows to the U.S. on many issues and wanted to know how Dion would deal with the U.S. administration.

"If you get into power, how are you going to handle the way Canada kind of lies down when they want us to do something but then when we want them to do something they kind of slough us off, right?" the student asked.

"For us Canadians, the United States is a friend," said Dion.

"It is an ally but it is not a model," he said to loud applause. "This difference between a friend and a model is not well understood by the current prime minister and it will be by me."

He also told the students that Canada must have its "economic sovereignty protected."

But as a trading nation with the U.S., he said Canada's "balance of trade is very advantageous for Canada.

"Our trade with the U.S. must be effective but it must be open as well because we are making a lot of money trading with them.
 
The Canadian Press

House GOP Opposes AIDS Program Changes

February 8, 2008

Washington - House Republican leader John Boehner and other Republicans warn that a successful program to combat AIDS in Africa would be in jeopardy if Democrats move ahead with plans to make changes.

Boehner, R-Ohio, said the Democratic proposal to renew the five-year, $15 billion anti-AIDS effort "will undermine this valuable program as we know it, placing at risk the work it does on behalf of millions."

In what is shaping up to be a political and ideological showdown, House Foreign Affairs Committee Chairman Tom Lantos, D-Calif., replied that his Democratic proposal reaffirmed the compromise he worked out with the late Rep. Henry Hyde, R-Ill., in 2003. It is a shame, he said, that the GOP minority is "failing to honor this spirit of compromise and is willing to endanger a valuable U.S. foreign policy program addressing one of the most serious health care challenges that humanity faces today."

The program expires this year and President Bush, who travels to Africa this month, has urged Congress to double funding to $30 billion over the next five years. The President's Emergency Plan for AIDS Relief is now treating 1.4 million people, with the focus on 15 mostly sub-Saharan African nations.

Democrats, backed by AIDS groups, say that's still not enough to cope with the continuing HIV/AIDS crisis, and Lantos' committee next Thursday is to vote on a bill approving $50 billion in funds and making several changes that have enraged social conservatives.

The Lantos bill would eliminate a provision in the 2003 bill requiring that one-third of all prevention spending go to abstinence programs. That amounts to about 7 percent of all spending. Critics say that while they don't oppose abstinence programs, inflexible funding requirements are counterproductive.

It also would remove a provision stating that all groups receiving money under the program must sign a pledge confirming that they do not support the legalization of prostitution or sex trafficking. The groups still may provide condoms or condom information to prostitutes. The provision, said its author, Rep. Chris Smith, R-N.J., was designed to "ensure that pimps and brothel owners don't become U.S. government partners."

Democrats said studies have shown that some groups will not or cannot make the pledge because of concerns it will alienate women they are trying to reach. Other groups say legalized and controlled prostitution could help slow the spread of HIV infection.

Third, Republicans claimed that the Democratic-written bill undoes carefully crafted rules that allow money to go to family planning groups for AIDS work as long as no money is spent on abortions. That change, Rep. Mike Pence, R-Ind., said at a news conference including anti-abortion groups, "would transform the program into a mega-funding pool for organizations with an abortion promotion agenda."

Lantos said the administration has endorsed a link between family planning and HIV/AIDS programs, and that his bill clarifies that additional contraceptive services may be provided under the law as long as these services are focused on stopping the transmission of HIV/AIDS.

His spokesman, Lynne Weil, said it is clear that funds are not available for abortion and it strengthens the "conscience clause" that allows faith-based groups to opt out of any program to which they have a moral objection.

By The Associated Press, www.365Gay.com 

Alleged Rape Victim Is HIV Positive

February 6, 2008

A court at the Old Bailey has been told that a 26-year-old man who accused a BBC Radio 4 reporter of raping him is HIV positive.

Nigel Wrench, 47, was open about his status and had made a documentary, Aids and Me about his experiences living with HIV and a later diagnosis of AIDS.

He is accused of drugging and sexually assaulting the 26-year-old after inviting him back to his flat in north London after meeting him at a New Years party.

Mr Wrench's defence barrister, Sarah Forshaw QC, told the court that the alleged victim did not mention his HIV status.

Constance Briscoe for the Crown Prosecution Service had earlier told the court:

"In order to get his way with the victim, he drugged him and he raped him and he sexually assaulted him.

The jury were told that he suffered from "flashes of darkness" and "periods of blackness," before finding himself naked on the Mr Wrench's bed as the radio reporter put a pill into his mouth.

Mr Wrench faces accusations of rape, sexual assault, together with administering the sleeping tablet, Temazepam, with the intention of overpowering his victim in order to have sexual intercourse on the 1st January 2007.

He denies all charges. The trial continues.

PinkNews.co.uk

HIV Infections Up 20% In Sweden

February 6, 2008

500 people were newly diagnosed as HIV positive in Sweden in 2007 according to data published by the Swedish Institute for Infectious Disease Control (SMI).

That number represents a rise of 20% on 2006.

There has been a 70% rise in the number of people infected within Sweden, though the majority of new HIV patients still come into contact with the virus abroad.

"We have especially seen an increase in the number of new infections among men who have sex with men and needle-users," SMI statistician Malin Arneborn told AFP.

MSM infections rose from 50 cases in 2006 to 80 in 2007.

"Interest in HIV/AIDS has gradually declined as people have become more accustomed to the threat," Claes Herlitz, an expert in Swedish attitudes to HIV, told AFP.

"They've seen that HIV hasn't spread as quickly as we thought it would in the late 80s, and there are new medicines making it more difficult to get AIDS. Fewer people are dying."

In the UK the Health Protection Agency revealed in November that 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 1 in 20 gay and bisexual men are now living with HIV and estimates suggest this figure is as high as 1 in 10 in London.

Furthermore, nearly half (47 per cent) of HIV infected gay men who visit a sexual health clinic leave without being tested for HIV.

Overall diagnoses in the UK remain high.

7,800 people were diagnosed last year, and the numbers living with HIV in the UK were 73,000 by the end of 2006.

One in three people do not know they are infected.

If rates continue the National AIDS Trust says that by 2010 there will be 100,000 people living with HIV in the UK.

The report also reveals worrying findings among young people with 1 in 10 (11 per cent) new diagnoses last year among 16 to 24 years old.

PinkNews.co.uk

African Women Slam Abuse of Females With HIV/AIDS

February 4, 2008

Ouagadougou - Hundreds of sub-Saharan Africans rallied Monday in Burkina Faso against the abuse of women infected with HIV/AIDS.

"There is no doubt that lots of human rights violations characterise the (HIV/AIDS) pandemic," said Bernice Heloo, president of the Society for Women and AIDS in Africa (SWAA).

"Women are the ones who most severely bear brunt of human rights abuse, have been prone to violences and other atrocities related to their gender and seropositive status.

"Many women have been driven from their marital homes, stripped of their hard-earned possessions and separated from their children and people they love," she told a conference attended by Burkina Faso Prime Minister Tertius Zongo.

She urged the international community to lend their technical and financial support to "strengthen the battle against gender inequality in Africa, a key factor in the spread of the pandemic and to contribute to the promotion of human rights for people living with and affected by HIV/AIDS."

Around 500 women from some 30 sub-Saharan countries are taking part in the four-day meeting debating violence against women and HIV/AIDS, their rights and access to treatment.

Although sub-Saharan Africa is home to just over 10 percent of the world's population, it is the most ravaged by HIV, carrying more than 60 percent of all people living with the virus that causes AIDS.

The conference has been organised by SWAA and its branch in Burkina Faso with the help of UNAIDS, the Burkina Faso government and a host of anti-AIDS non-governmental organisations.

AFP

Egypt: Stop Criminalizing HIV

February 5, 2008

New York - A series of arrests in Cairo sparked by one man's admission to police that he was HIV-positive endangers public health as well as human rights, Human Rights Watch said today. Human Rights Watch called on Egyptian authorities to overturn the convictions of four men for the "habitual practice of debauchery," and to free four others who are held pending trial. The government should end arbitrary arrests based on HIV status and take steps to end prejudice and misinformation about HIV/AIDS.

"These shocking arrests and trials embody both ignorance and injustice," said Scott Long, director of the Lesbian, Gay, Bisexual, and Transgender Rights Program at Human Rights Watch. "Egypt threatens not just its international reputation but its own population if it responds to the HIV/AIDS epidemic with prison terms instead of prevention and care."

The arrests began in October 2007, when police stopped two men having an altercation on a street in central Cairo. When one of them told the officers that he was HIV-positive, police immediately took them both to the Morality Police office and opened an investigation against them for homosexual conduct. The two men told human rights defenders that they were slapped and beaten for refusing to sign statements the police wrote for them. They spent four days in the Morality Police office handcuffed to an iron desk, sleeping on the floor. Police later subjected the two men to forensic anal examinations designed to "prove" that they had engaged in homosexual conduct.

Human Rights Watch has documented that such examinations to detect "evidence" of homosexuality are not only medically spurious but constitute torture.

Police then arrested two more men because their photographs or telephone numbers were found on the first two detainees. Authorities subjected all to HIV tests without their consent. All four are still in detention, pending prosecutors' decision on whether to bring charges of homosexual conduct. The first two arrestees, who reportedly tested HIV-positive, are being held in a Cairo hospital, handcuffed to their beds and only unchained for an hour each day.

Meanwhile, police apparently placed the apartment where one of the men had lived under surveillance. On November 20, two days after a new tenant had assumed the lease, police raided the apartment and detained four other men.

According to the arrest report, the men were fully dressed and were not engaging in any illegal acts at the time of the arrests. However, all were charged with homosexual conduct, apparently solely on the basis that they were found in a dwelling formerly occupied by one of the earlier detainees.

People who have spoken to the four men since their arrest told Human Rights Watch that a non-commissioned officer in the police station beat one detainee on the head several times. Police allegedly forced the four men to stand in a painful position for three hours with their arms lifted in the air. They were provided no food, drink, or blankets during their first four days of detention. Authorities also tested these men for HIV without their consent. One of the men reportedly said that the prosecutor, when informing him that he had tested positive for HIV, told him: "People like you should be burnt alive. You do not deserve to live."

A Cairo court convicted these four men on January 13, 2008 under Article 9(c) of Law 10/1961, which criminalizes the "habitual practice of debauchery [fujur] a term used to penalize consensual homosexual conduct in Egyptian law. According to defense attorneys, the prosecution based their case only on coerced and repudiated statements taken from the men, and neither called witnesses nor produced other evidence to counter the men's pleas of not guilty. On February 2, 2008, a Cairo appeals court upheld their one-year prison sentence. One of them is held in a Cairo hospital, chained to his bed 23 hours a day.

"These cases show Egyptian police acting on the dangerous belief that HIV is not a condition to be treated but a crime to be punished," said Long. "HIV tests forcibly taken without consent, ill-treatment in detention, trials driven by prejudice, and convictions without evidence all violate international law."

In private letters sent to the Egyptian Public Prosecutor, Counselor Abdel Meguid Mahmoud Abdel Meguid, on November 29, 2007 and on January 8, 2008, Human Rights Watch expressed its grave concern about the arrests and their consequences for Egypt's efforts against HIV/AIDS.

Human Rights Watch urged authorities to drop the charges, end the practice of chaining detainees in hospital, and ensure that the men receive the highest available standard of medical care for any serious health conditions. It also urged Egypt to undertake training for all criminal-justice officials on medical facts and international human rights standards in relation to HIV, and to halt immediately all testing of detainees without their consent.

Criminalizing consensual, adult homosexual conduct violates human rights protections to individual privacy and personal autonomy under international law. The apparent use of Article 9(c) in these cases to detain people on the basis of their declared HIV status, and to test them without their consent for HIV infection, also violates those international protections, and the right to bodily autonomy.

International human rights law clearly affirms that prisoners and detainees retain the absolute right to protection against torture and cruel, inhuman, or degrading treatment or punishment and enjoy the right to the highest attainable standard of health, as guaranteed in Article 12 of the International Covenant on Economic, Social and Cultural Rights, to which Egypt has been party since 1982.

Human Rights Watch, Reuters

Scientists Find New Receptor for HIV

February 11, 2008

San Francisco - Government scientists have discovered a new way that HIV attacks human cells, an advance that could provide fresh avenues for the development of additional therapies to stop AIDS, they reported on Sunday.

The discovery is the identification of a new human receptor for HIV The receptor helps guide the virus to the gut after it gains entry to the body, where it begins its relentless attack on the immune system.

The findings were reported online Sunday in the journal Nature Immunology by a team headed by Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases.

For years, scientists have known that HIV rapidly invades the lymph nodes and lymph tissues that are abundant throughout the gut, or intestines. The gut becomes the prime site for replication of HIV, and the virus then goes on to deplete the lymph tissue of the key CD4 HIV-fighting immune cells.

That situation occurs in all HIV-infected individuals, whether they acquired the virus through sexual intercourse, blood transfusions, blood contamination of needles and syringes, or in passage through the birth canal or drinking breast milk.

The findings appear to provide some, if not the main, answers to how and why that situation occurs.

Dr. Warner C. Greene, an AIDS expert and the director of the Gladstone Institute of Virology and Immunology here who was not involved in the research, said the findings were "an important advance in the field."

"They begin to shed light on the mysterious process on why the virus preferentially grows in the gut," Dr. Greene said in an interview.

Dr. Fauci, James Arthos, Claudia Cicala, Elena Martinelli and their colleagues showed that a molecule, integrin alpha-4 beta-7, which naturally directs immune cells to the gut, is also a receptor for HIV A protein on the virus’s envelope, or outer shell, sticks to a molecule in the receptor that is linked specifically to the way CD4 cells home in on the gut, the researchers said.

Binding of the virus to the integrin alpha-4 beta 7 molecule stimulates activation of another molecule, LFA-1, which plays a crucial role in the spread of the virus from one cell to another. The actions ultimately lead to destruction of lymph tissue, particularly in the gut.

Several other receptor sites for HIV are known. The most important is the CD4 molecule on certain immune cells; the molecule’s role as an HIV receptor was identified in 1984.

Two other important receptors, known as CCR5 and CXCR4, were identified in 1996. CCR5 is a normal component of human cells and acts as a doorway for the entry of HIV People who lack it because of a genetic mutation rarely become infected even if they have been exposed to HIV repeatedly.

"The work we did took nearly two years, and there’s little doubt that what we have found is a new receptor," Dr. Fauci said in an interview after giving a lecture here, adding that "we certainly have to learn a lot more about it."

Scientists have sought to identify receptors because they offer targets for the development of new classes of drugs.

For example, last year the Food and Drug Administration approved for AIDS treatment a Pfizer drug, Selzentry or maraviroc, which works by blocking CCR5.

Dr. Fauci said he hoped his team’s findings would encourage other scientists from different disciplines to explore new ways to attack HIV

A number of experimental drugs that block the integrin alpha-4 beta-7 receptor are being tested for the treatment of autoimmune disorders. Dr. Fauci said such drugs should also be studied for their potential benefit in AIDS treatment.

Organization of new trials in the next year or so could test such drugs in animals and humans to determine their safety and effectiveness against HIV, Dr. Fauci said.

One candidate is a drug, Tysabri or natalizumab, that is marketed for treatment of multiple sclerosis, Dr. Fauci said. Biogen/Elan makes Tysabri.

If trials for HIV are successful, Dr. Fauci said, the drugs could be added to existing treatment regimens.

By Lawrence K. Altman, The New York Times

Probiotics May Ease Gut Problems In People With HIV/AIDS

February 4, 2008

Probiotic supplements may ease the suffering from diarrhoea and nausea amongst people with HIV and AIDS, suggests a joint study by African and Canadian researchers.

The occurrence of diarrhoea was stopped by taking the gut-friendly bacteria among 24 people with HIV/AIDS in the sub-Saharan region of Africa, a population where many suffer from debilitating effects of diarrhoea, and only a few have access to antiretroviral therapy, reports the new study.

"This is the first study to show the benefits of probiotic yogurt on quality of life of women in Nigeria with HIV/AIDS, and suggests that perhaps a simple fermented food can provide some relief in the management of the AIDS epidemic in Africa," wrote lead author Kingsley Anukam in the Journal of Clinical Gastroenterology.

The researchers, from the University of Benin, Benson Idahosa University, and the Canadian Research and Development Centre for Probiotics at the University of Western Ontario, recruited 24 women with HIV/AIDS aged between 18 and 44 and with clinical signs of moderate diarrhoea, and assigned them to receive a normal or probiotic yoghurt (100 mL) for 15 days.

"Given the track record of probiotics to alleviate diarrhoea, conventional yogurt fermented with Lactobacillus delbruekii var bulgaricus and Streptococcus thermophilus was supplemented with probiotic Lactobacillus rhamnosus GR-1 and L. reuteri RC-14," explained the researchers.

The women were not receiving antiretroviral therapy or dietary supplements, and the average CD4 T-lymphocyte count (the immune system cells that the virus attacks) was over 200.

At the end of intervention period, Anukam and co-workers report that the occurrence of diarrhoea, flatulence, and nausea was resolved in all 12 subjects receiving the probiotic yoghurt, compared to only two out of the 12 in the normal (control) yoghurt.

Moreover, the average CD4 count remained the same in 92 per cent (11 out of 12 people) of the subjects in the probiotic group, while the level only remained the same in 25 per cent (three out of 12 people) receiving the control yoghurt.

White blood cells counts of the probiotic-supplemented group were 5.8 billion cells per litre at the start, and 6.0 billion cells per litre after 15 days. The level decreased slightly to 5.4 billion cells per litre 15 days after the supplementation period stopped.

The study, although small and short, suggests probiotics could play a role in improving the quality of life of people with HIV/AIDS, particularly in areas where diarrhoea is a debilitating condition.

A report published by the World Health Organisation in November 2005 showed that the number of people living with HIV was at its highest ever: 40.3 million. More than 3 million people died of AIDS-related illnesses in 2005, with more than 500,000 of these children.

Previously, researchers have reported that probiotic supplements (Lactobacillus rhamnosus GG) may provide added protection against gastro-intestinal infection and diarrhoea in infants. The study, published in the open access journal BMC Microbiology, was conducted in animals and showed that 59 per cent of animal subjects did not develop rotaviral diarrhoea when the probiotic was administered before infection with rotavirus.

Source: Journal of Clinical Gastroenterology
Publihsed online ahead of print, January 2008, doi: 10.1097/MCG.0b013e31802c7465
"Yogurt Containing Probiotic Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 Helps Resolve Moderate Diarrhea and Increases CD4 Count in HIV/AIDS Patients"
Authors: Kingsley C. Anukam, E.O. Osazuwa, H.B. Osadolor, A.W. Bruce, G. Reid

By Stephen Daniells, http://www.foodnavigator.com

HIV Drugs Make Breast-Feeding Safer, Study Finds

February 4, 2008

Washington - A drug that helps prevent babies from catching the AIDS virus at birth can also protect them while nursing, researchers reported on Monday.

Babies of HIV-infected women who were given the drug nevirapine while they breast-fed were half as likely to become infected, the researchers told a meeting in Boston of AIDS experts.

Nevirapine is already widely used to protect babies at birth. A single dose given to the mother as she goes into labor and to the baby at birth cuts transmission by 47 percent.

But babies continue to become infected after birth, via their mothers' breast milk, which can carry the virus. In many developing countries breast-feeding is the only option.

Dr. Brooks Jackson of Johns Hopkins University in Baltimore and colleagues in Ethiopia, India and Uganda wanted to see if they could safely continue giving the drug to babies for as long as six weeks.

They gave 2,000 new babies either nevirapine or a vitamin solution between 2001 and 2007.

"At 6 months of age, the risk of postnatal HIV infection or death in infants who received the six-week regimen was almost one-third less than the risk for infants given only a single dose," Johns Hopkins said in a statement.

The World Health Organization estimates that 150,000 infants are infected with the AIDS through breast-feeding each year. The fatal and incurable virus infects 33 million people globally.

Nevirapine is sold under the brand name Viramune by privately held Boehringer Ingelheim.

By Maggie Fox, editing by Will Dunham and Cynthia Osterman, Reuters

Diabetes Study Partially Halted After Deaths

February 7, 2008

For decades, researchers believed that if people with diabetes lowered their blood sugar to normal levels, they would no longer be at high risk of dying from heart disease. But a major federal study of more than 10,000 middle-aged and older people with Type 2 diabetes has found that lowering blood sugar actually increased their risk of death, researchers reported Wednesday.

The researchers announced that they were abruptly halting that part of the study, whose surprising results call into question how the disease, which affects 21 million Americans, should be managed.

The study’s investigators emphasized that patients should still consult with their doctors before considering changing their medications.

Among the study participants who were randomly assigned to get their blood sugar levels to nearly normal, there were 54 more deaths than in the group whose levels were less rigidly controlled. The patients were in the study for an average of four years when investigators called a halt to the intensive blood sugar lowering and put all of them on the less intense regimen.

The results do not mean blood sugar is meaningless. Lowered blood sugar can protect against kidney disease, blindness and amputations, but the findings inject an element of uncertainty into what has been dogma — that the lower the blood sugar the better and that lowering blood sugar levels to normal saves lives.

Medical experts were stunned.

"It’s confusing and disturbing that this happened," said Dr. James Dove, president of the American College of Cardiology. "For 50 years, we’ve talked about getting blood sugar very low. Everything in the literature would suggest this is the right thing to do," he added.

Dr. Irl Hirsch, a diabetes researcher at the University of Washington, said the study’s results would be hard to explain to some patients who have spent years and made an enormous effort, through diet and medication, getting and keeping their blood sugar down. They will not want to relax their vigilance, he said.

"It will be similar to what many women felt when they heard the news about estrogen," Dr. Hirsch said. "Telling these patients to get their blood sugar up will be very difficult."

Dr. Hirsch added that organizations like the American Diabetes Association would be in a quandary. Its guidelines call for blood sugar targets as close to normal as possible.

And some insurance companies pay doctors extra if their diabetic patients get their levels very low.

The low-blood sugar hypothesis was so entrenched that when the National Heart, Lung and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases proposed the study in the 1990s, they explained that it would be ethical. Even though most people assumed that lower blood sugar was better, no one had rigorously tested the idea. So the study would ask if very low blood sugar levels in people with Type 2 diabetes — the form that affects 95 percent of people with the disease — would protect against heart disease and save lives.

Some said that the study, even if ethical, would be impossible. They doubted that participants — whose average age was 62, who had had diabetes for about 10 years, who had higher than average blood sugar levels, and who also had heart disease or had other conditions, like high blood pressure and high cholesterol, that placed them at additional risk of heart disease — would ever achieve such low blood sugar levels.

Study patients were randomly assigned to one of three types of treatments: one comparing intensity of blood sugar control; another comparing intensity of cholesterol control; and the third comparing intensity of blood pressure control. The cholesterol and blood pressure parts of the study are continuing.

Dr. John Buse, the vice-chairman of the study’s steering committee and the president of medicine and science at the American Diabetes Association, described what was required to get blood sugar levels low, as measured by a protein, hemoglobin A1C, which was supposed to be at 6 percent or less.

"Many were taking four or five shots of insulin a day," he said. "Some were using insulin pumps. Some were monitoring their blood sugar seven or eight times a day."

They also took pills to lower their blood sugar, in addition to the pills they took for other medical conditions and to lower their blood pressure and cholesterol. They also came to a medical clinic every two months and had frequent telephone conversations with clinic staff.

Those assigned to the less stringent blood sugar control, an A1C level of 7.0 to 7.9 percent, had an easier time of it. They measured their blood sugar once or twice a day, went to the clinic every four months and took fewer drugs or lower doses.

So it was quite a surprise when the patients who had worked so hard to get their blood sugar low had a significantly higher death rate, the study investigators said.

The researchers asked whether there were any drugs or drug combinations that might have been to blame. They found none, said Dr. Denise G. Simons-Morton, a project officer for the study at the National Heart, Lung and Blood Institute. Even the drug Avandia, suspected of increasing the risk of heart attacks in diabetes, did not appear to contribute to the increased death rate.

Nor was there an unusual cause of death in the intensively treated group, Dr. Simons-Morton said. Most of the deaths in both groups were from heart attacks, she added.

For now, the reasons for the higher death rate are up for speculation. Clearly, people without diabetes are different from people who have diabetes and get their blood sugar low.

It might be that patients suffered unintended consequences from taking so many drugs, which might interact in unexpected ways, said Dr. Steven E. Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic.

Or it may be that participants reduced their blood sugar too fast, Dr. Hirsch said. Years ago, researchers discovered that lowering blood sugar very quickly in diabetes could actually worsen blood vessel disease in the eyes, he said. But reducing levels more slowly protected those blood vessels.

And there are troubling questions about what the study means for people who are younger and who do not have cardiovascular disease. Should they forgo the low blood sugar targets?

No one knows.

Other medical experts say that they will be discussing and debating the results for some time.

"It is a great study and very well run," Dr. Dove said. "And it certainly had the right principles behind it."

But maybe, he said, "there may be some scientific principles that don’t hold water in a diabetic population."

By Gina Kolata, The New York Times

News from the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston

a. Circumcising HIV Positive Men May Increase HIV Infections in Female Partners, But Fewer STIs Seen
b. Abacavir, Didanosine Linked to Increased Heart Attack Risk
c. Vicriviroc Shows Well in Treatment-Experienced Patients
d. Atazanavir in Treatment-Naïve Patients
e. Treatment Interruptions
f. Another New CCR5 Inhibitor – SCH532706
g. HIV Treatment and Infectiousness
h. Lactobacillus Supplementation Could Help Reduce Vaginal HIV
i. Start Treatment At A CD4 Cell Count Of 500 To Reduce Risk Of Serious Non-HIV-Related Illnesses?
j. Drug Level Monitoring
k. Vaccine Failure
l. Once- vs. Twice-Daily Kaletra Tablets: Similar Safety and Potency
m. Sexual Reinfection With HCV Following Treatment
n. Anticipated 'Slam Dunk' AIDS Treatment Fails
o. People Receiving TB Treatment No More Likely to Die Than Others Who Start ARVs
p. Researchers Use Technique to Identify, Generate Molecules for Microbicide Research, Development
q. Benefits To Starting Immediate Treatment When A Patient Has An Opportunistic Infection
r. Biomarkers May Explain Risk of Treatment Interruptions
s. Research Points to the Prospect of a Once-Monthly Anti-HIV Drug
t. GeoVax Labs, Inc.'s Promising HIV/AIDS Vaccine Trial Data Presented at Retrovirus Conference
u. Effectiveness of Second-Line Therapy
v. Lymphomas
w. Treatment to Prevent Mother-To-Child Transmission
x. Children Infected With HIV from Pre-Chewed Food
y. Herpes and HIV Transmission
z. Gene Therapy Offers AIDS Hope

Death March

February 10, 2008

Gideon Mendel/Corbis
An HIV-positive mother takes her medication, Lusikisiki district, 2004.

Sizwe’s Test: A Young Man’s Journey Through Africa’s AIDS Epidemic.
By Jonny Steinberg, published by Simon and Schuster

No matter how serious a disease may be, devising a cure or treatment or ways of prevention is only half the battle. The other half can be more mysterious. Throughout the world, people who should know better eat, drink or have sex in needlessly risky ways, or ignore medical danger signs until it is too late. These, the willful ignorers, are what interest the South African journalist Jonny Steinberg about the gravest medical crisis his country has experienced: AIDS. More than one out of every eight South Africans is HIV positive, Steinberg reports; every day roughly 800 South Africans die of AIDS and more than 1,000 additional people are infected. A recent survey found that in the previous month, the average South African was more than twice as likely to have been to a funeral as to a wedding.

Pushed hard by a determined citizens’ movement, the South African government has at last begun widely distributing antiretroviral drugs. Why, Steinberg asks in "Sizwe’s Test," do so many people dying of AIDS not take them? And why do millions of South Africans at risk not even get tested for the virus?

To answer these questions, Steinberg, a Johannesburg newspaper columnist who has written several previous nonfiction books, focuses on Lusikisiki, a district in the country’s Eastern Cape Province. It is one of the overcrowded black rural slums left behind by the centuries in which white farmers seized well over 80 percent of South Africa’s most fertile land. Almost one out of three pregnant women in Lusikisiki was HIV positive, but the area also had a first-rate AIDS treatment program: well-stocked clinics run in cooperation with the local health authorities by the respected Médecins Sans Frontières. It seemed the perfect place to study.

Steinberg presents the district largely through the eyes of one man, whom he calls Sizwe Magadla. Sizwe is 30, healthy and literate; as the owner of a small shop, he is a rare mover and shaker in a community with high unemployment, where most people are struggling just to get by. Reasonably sophisticated about medicine, Sizwe knows that antiretrovirals are the best AIDS treatment so far, and he actually urges a sick relative to get tested. But despite being at risk himself — he has had unprotected sex with many women before recently settling down with one — he refuses to take an HIV test. He becomes both Steinberg’s window onto Lusikisiki and an object of study himself.

Steinberg unfolds the story in a leisurely, almost rambling way, in successive layers, as he gets to know Sizwe and the community’s complex social network. The first layer has to do with the extreme lack of privacy. In Lusikisiki, everyone knows exactly who’s sleeping with whom: houses are small and packed with several generations of curious relatives, and even when a couple try to find some space of their own, dozens of pairs of eyes see them disappearing into the forest together. And if you get your HIV test results at one of the clinics, hundreds of your fellow villagers are waiting in line behind you. If you immediately leave the nurse’s office and go home, they know you’re HIV negative; if you’re kept behind for an hour of counseling, they know you’re positive.

The next layer down has to do with fear. Although he doesn’t yet have enough money for a car, Sizwe is relatively prosperous and worries about the envy of his fellow villagers since he has made his money from them. Not only that, but a rival shopkeeper with connections to a criminal gang has his eye on Sizwe’s business. He fears any sign of weakness or vulnerability could lose him customers or get him robbed.

But there’s an even deeper level to people’s resistance to testing and treatment. As with many indigenous peoples — I’ve encountered the same belief among Indians in the Amazon — the Xhosa people of Lusikisiki see sickness as a kind of bewitchment, something sent to you by ancestors you have offended or by those who wish you ill. If whites already took so much farmland and mineral wealth, the thinking goes, could not the very needle the white doctor or his nurses use to draw blood be what’s spreading AIDS in the first place? And if an enemy does attack you, what more deadly way than with an illness that seems connected to a man’s potency and ability to procreate? Men are anxious about these things the world over, but nowhere more so than when, in desperate poverty, they possess little else.

Although Steinberg writes in the first person, he largely keeps himself out of the story until about 30 pages from the end. And then, before returning to Sizwe again, he suddenly shares some intimate pieces of his own life. I will not spoil the effect of this forceful narrative twist by telling more, except to say that it greatly helps to etch the final layer he uncovers. This has to do with the immense power of stigma, the ways in which we mirror the real or imagined condemnation of others by internalizing it, and of how easily stigma becomes entwined with sexuality.

For all its sharp insights and value, "Sizwe’s Test" has one serious flaw. Steinberg devotes only a perfunctory few pages to Thabo Mbeki, South Africa’s president since 1999 and powerful deputy president for five years before that. Mbeki long denied that the HIV virus causes AIDS, embracing a small coterie of similarly-minded crackpot scientists and appointing a health minister who promoted, as a cure, the use of garlic, olive oil and various herbs. Drawing outrage from AIDS activists everywhere, these bizarre beliefs delayed the large-scale distribution of antiretroviral drugs year after precious year. Hundreds of thousands of South Africans who have died of AIDS might still be alive today if Mbeki had repeatedly spoken out about safe sex and AIDS testing and treatment, and had thrown the full weight of his ruling party apparatus behind such a campaign. Several other African leaders, most notably President Yoweri Museveni of Uganda, have done just this and have saved countless lives as a result. If Mbeki had been shown on TV getting an AIDS test, I bet Sizwe would have gotten his.

To play down Mbeki’s stubborn obscurantism in a book about AIDS in South Africa is like writing a book about Americans and global warming while ignoring seven years of stubborn obscurantism on that subject from the White House. It is precisely when folk beliefs, fear and stigma attached to serious illness are most deeply rooted, in the way Steinberg shows so well, that forceful truth-telling by a country’s leaders becomes most important to create a sea change in long-established attitudes and habits. The failure of leadership in South Africa has been a great tragedy for a long-suffering people who deserve better.

By Adam Hochschild, The New York Times
Adam Hochschild is the author of six books; his "Mirror at Midnight: A South African Journey" was reissued by Houghton Mifflin last year in an updated edition.

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