AIDS Group Accuses Airport Guard of Humiliation
Members say security employee in Prince George deemed them health risks, wanted lounge and plane wiped down after use

April 9, 2008

Members of a Prince George HIV-AIDS support group say they were humiliated when airport security deemed them health risks as they waited to board a plane at the municipal airport last week.

The group of 10, all members or employees of Positive Living North, were on their way to a conference in Vancouver on March 28 when their flight was delayed.

Eventually they found out they were the cause of the delay: A security guard had expressed concerns about them flying and suggested the airport lounge and WestJet plane would need to be "wiped down" after they left, said a spokesperson for the group.

Catherine Baylis, a Positive Living director, said airport staff at first asked the head of the group whether any members were intoxicated prior to the morning flight. Then they were told efforts were being made to seat them together, even though their seats together had already been allocated. Then they were told there were mechanical difficulties.

When the group leader was told it was suggested the lounge and plane would have to wiped down, she burst into tears, said Ms. Baylis, who was not a part of the group travelling to Vancouver.

"It just kept getting delayed. An attendant confirmed for her that a security guard had said this and the plane couldn't leave because he recognized one of our members," she said.

"He didn't name the disease or the person, only that he recognized them and everything would have to be wiped down on the plane after they left, and it was for the safety of everyone."

When the WestJet pilot realized what had happened, he overruled the security guard and the group boarded the plane, which departed about an hour late.

Tina Joyce, a 30-year-old HIV-positive office clerk, was in the group.

"I have never, ever experienced anything close to this. I was disgusted. [The security guard] has no idea who we are and where we come from," she said. "I would like him to step up and apologize and explain why he would cause all this trouble."

WestJet spokesman Richard Bartrem said wiping down an aircraft after it carries HIV-positive passengers is unnecessary and the airline would never consider doing it. He said there was frustration that the situation took so long to resolve.

"It's not that our captain realized there was an issue, it was more a question of realizing there was a non-issue. And unfortunately we took a delay in sorting this out," he said. "[Security workers] have a role to fulfill and 99 times out of 100 the whole system works very well."

Joe Gaviggin, spokesman for Garda World Security, which employs the security guards at Prince George Airport, said the company is investigating.

"We're aware of what the group said happened. We are looking into it to determine exactly what happened, and once we've done that, we will then be able to decide what actions we will need to take," he said.

Ms. Baylis said the Canadian Human Rights Commission is now brokering a resolution between Garda and Positive Living North that would have the security guards take part in an HIV-AIDS awareness program.

She said that would go some way toward rectifying the situation.

"[The 10 group members] are people who, for the most part, are living with HIV and are marginalized because of that. They were traumatized and humiliated by the experience. They all took it personally."

By Cathryn Atkinson, Globe and Mail


Further to this: Security Guard Resigns In Wake of AIDS Uproar

April 11, 2008

Prince George - The security guard who caused a stir by ordering a wipe-down of a plane transporting members of the HIV/AIDS support agency Positive Living North has resigned, according to Garda World Security.

The incident occurred March 28 at the Prince George Airport where a 10-person group, en route to a conference in Vancouver, was delayed about 40 minutes due to the guard's alleged concerns about "diseases."

"He offered his resignation and the company did accept that," Joe Gavaghan, a Boston-based spokesman for Garda, said Friday. "We have not disclosed the name of the individual."

The guard had allegedly recognized someone in the group when he asked for the wipe-down, which upset the members, most of whom are aboriginal. One of the people, 30-year-old Tina Joyce, who is living with HIV, felt the guard made a judgment call without understanding the facts.

"This really was an isolated incident with one of their employees," PLN co-executive director Carmen Nutter said. "The screening officers at security did not treat our members or our staff person in any unprofessional or inappropriate manner. They had gone through screening, and it was after the fact when they were waiting to board that this other employee became involved."

Gavaghan said Garda has apologized to Positive Living North.

"It was an unfortunate incident," he said. "When we reviewed it and investigated it, we found that the actions this individual took were inappropriate. They were done with the best intentions, they were not done maliciously. The guy genuinely believed he was doing the right thing, but nevertheless, that doesn't excuse the fact that it was not appropriate and it was not the approach that we would take with that."

Although PLN is satisfied with the resolution, Nutter said members who were on the flight may still decide to file a human rights complaint.

Despite the resignation, she said the agency will still be conducting sensitivity training with Garda staff in the future.

"They do receive that training, but it never hurts," Gavaghan said. "If there's a silver lining to an incident like this, it's that it can be used to educate people."

By Scott Stanfield, http://www.princegeorgecitizen.com

Gay Rights: You've come a Long Way, Baby

April 10, 2008

In 1991, Tom Lukiwski stood in a campaign office in Saskatchewan, looked into a video camera and made some very derogatory remarks about gay men, to the giggling delight of whoever was filming. In 2008, with Mr. Lukiwski a Conservative member of Parliament, a rival political party unearthed the video (by accident) and released it to the media (on purpose).

Everyone has agreed, at least in public, that the type of remarks Mr. Lukiwski made would be unacceptable today. If the video had been made last week or last month, some say, the calculations about his fitness for government would be different. But the rules were not the same in 1991, the argument goes, and words uttered 17 years ago should not be judged by today's standards — especially when it comes to an issue such as homosexuality, on which public attitudes have changed so markedly.

To many gays and lesbians, who found homophobia as hurtful and unjust in 1991 as they do today, this argument holds no water. And the question of whether individuals can really change their beliefs on such issues is one for psychologists and novelists more than pollsters. But pollsters can trace collective changes of heart over time. When it comes to acceptance of homosexuality and support for gay rights, Canadians might be surprised to learn just how different their country was two decades ago.

Environics first began polling on homosexuality and gay rights in 1987, around the time the provinces began to include sexual orientation as a protected category in human-rights codes. That year, only tiny minorities told us it was acceptable to give at least "some" consideration to a job applicant's gender (7 per cent), race (6 per cent) or religion (4 per cent) when hiring. But nearly a third of Canadians believed that an applicant's homosexuality should receive either some (13 per cent) or a lot (17 per cent) of consideration.

This relative acceptance of discrimination was underpinned by disapproval of homosexuality itself. When asked whether they approved, disapproved or were neutral about "homosexuals," just one in 10 Canadians said they approved, while 55 per cent disapproved and 34 per cent were neutral.

One especially inflammatory remark Mr. Lukiwski made on tape was the suggestion that gay men spread disease. The AIDS epidemic wrought terrible devastation in the gay community — devastation that was by no means finished by 1991. Blaming the disease's victims for their suffering is now acceptable to just a handful of Canadians.

But two decades ago, when Environics asked Canadians about the possible consequences of protecting gay rights in the human-rights code, 62 per cent said they believed it was at least somewhat likely that this legal move would cause AIDS to spread more rapidly.

In 2008, we marvel that this question was even asked. But the answers Environics received indicate that the attitude we were probing — that homosexuality and AIDS were somehow organically connected — was by no means outside the mainstream. It was the mainstream.

Some commentators have observed that the NDP, which released the Lukiwski tape, should rein in its moral indignation over other parties' failures in the diversity department. New Democrats might be especially inclined to dismount the high horse when they look at the past attitudes of their own party supporters. In the past, Canadians of all parties were more or less in line with the (relatively intolerant) attitudes of the day. For example, in 1987, 63 per cent of NDP supporters believed that protecting gays and lesbians from discrimination would cause AIDS to spread more rapidly — the same proportion as Progressive Conservatives (63 per cent) and a little higher than Liberals (60 per cent). NDP supporters were not much more likely (53 per cent) than Liberals (49 per cent) or Progressive Conservatives (48 per cent) to believe that gays and lesbians should be protected from discrimination by the Canadian Bill of Rights.

None of this is to defend Mr. Lukiwski's remarks. But it is worth contextualizing his statements in the climate of the time to remember that few Canadians (especially those of a certain age) sprung from the womb as enlightened as they are today.

How much have things changed? You can see some of the change without the benefit of polling data: Over the past week, Canadians have watched a Conservative MP come close to losing his job for making the kind of locker-room cracks that would have been nearly compulsory in another political era. But a look at the numbers is also instructive. As of 2004, the proportion of Canadians who said they personally approved of homosexuality was 48 per cent — nearly five times higher than in 1987. An additional 14 per cent were neutral, while 36 per cent disapproved.

Readers should not underestimate the importance of this shift just because approval remains below 50 per cent. A nearly five-fold increase in the proportion of Canadians who express approval of homosexuality is a very significant change. And answers to other survey questions indicate that even some who do not personally approve of homosexuality still believe in equality for gays and lesbians. In 2003, for example, the Pew Center in the United States found 69 per cent of Canadians agreeing that "homosexuality should be accepted by society." And on same-sex marriage, the most significant legal rights question of our time, polls have found majorities of Canadians supporting full equality for gay and lesbian relationships.

In short, Canadians have come a long way toward a more just and accepting society for minority groups in general and gays and lesbians in particular. So, perhaps, has Mr. Lukiwski. Canadians are justified in demanding an apology for the hurtful and discriminatory remarks on the video. But we shouldn't forget that times do change. Sometimes the change is so deep that we can hardly recognize ourselves when we look back.

Michael Adams is author of Unlikely Utopia: The Surprising Triumph of Canadian Pluralism and president of the Environics group of companies.

The Globe and Mail

Tiko Kerr's Lazarus Tree
ART / HIV-positive artist paints triumph textured over meds

April 9, 2008

Three times a week Tiko Kerr floats his 27-foot scull into the early morning or nighttime calm of Coal Harbour and casts off for a solitary rowing adventure to recharge his creative flow.

MY GOVERNMENT IS TRYING TO KILL ME. 'This one I did at my most desperate,' says Tiko Kerr, sitting in front of an ominous painting of an empty hospital room with a sterile made-up bed. (Mette Bach photo)

INSITE

1. Thomas Kerr Spots Errors in Tony Clement's Advisory Report on Insite

April 11, 2008

Today, Health Minister Tony Clement released an advisory panel's report on supervised-injection sites, and it echoes much of the research that has already been done.

The report stated that the average user at Vancouver’s supervised-injection site Insite has been injecting for 15 years, with 15 percent injecting cocaine and 51 percent injecting heroin.

"Insite staff have successfully intervened in over 336 overdose events since 2006 and no overdose deaths have occurred at the service," the report stated.

The report also noted that Insite provides a clean environment; the general public has positive views of Insite; it encourages users to seek counselling and treatment; and mathematical modelling shows it saves approximately one death by overdose per year.

Dr. Thomas Kerr, director of the urban health research program at the B.C. Centre of Excellence in HIV/AIDS, told the Georgia Straight that the report is quite positive, and confirms many of the findings from the centre’s evaluations.

"In some ways, it’s stating the obvious, and it’s too bad that Health Canada had to pay to tell us what we already know," Kerr said. "Really, now the question has got to move beyond should Insite stay open to how can we expand supervised-injection-site programming in Canada."

Kerr, one of the principal investigators of Insite, took exception to a couple of the panel’s conclusions, noting there were "important factual inaccuracies in the report", including the claim that Insite costs $3 million per year to operate.

"Insite does not cost $3 million a year to operate," Kerr said, adding that he thinks it’s closer to $1.5 million. "It’s a significant overestimate on their part."

The report also questioned the assumptions that researchers make about HIV prevention. Notably, the report stated that there was "limited local data available regarding baseline frequency" of injection and needle sharing.

Kerr described this claim as "ridiculous".

"I published a paper in The Lancet, which is no simple consultant report, which shows that there is about a 70-percent reduction in syringe-sharing, and that that reduction only occurred since Insite opened. We actually looked at historical syringe sharing."

By Charlie Smith, Georgia Straight


2. Safe Injection Facility in Vancouver in Limelight When Court Challenges Begin

April 13, 2008

Vancouver - As the deadline approaches for a federal government blessing for Vancouver's supervised injection site, supporters are preparing to head to court to argue that the controversial site is a healthcare facility and, therefore, the sole preserve of the province.

And British Columbia Health Minister George Abbott leaves no doubt that the province wants the site to continue to operate.

Regardless of the outcome of the upcoming court cases, Abbott has given strong indications that the facility may operate even if the federal government should withhold its blessing.

"Should they not renew that exemption I would hope we would be advised with a little notice," Abbott said. "We will then be turning the discussion intensively in another direction.

"I do not want to see Insite closed."

While Abbott steadfastly declined to state whether the B.C. government would operate it in defiance of federal drug laws, he is clearly a staunch backer.

"This is an opportunity for us as a society to reach out to them (addicts), to provide that measure of security and stability, to remind them that mental and physical health supports are available to them."

Abbott said he recently spoke with federal Health Minister Tony Clement. "I suggested to the health minister that we would like them to renew the exemption and we have formally asked for that. "He said he'd give full and serious consideration to my case."

Insite opened in 2003 as a pilot project in the Downtown Eastside for intravenous drug users to inject their own heroin and cocaine with clean needles and under the supervision of a nurse.

Addicts who get their fix at the site, instead of in alleys and decrepit hotels, can also access referrals to detoxification and rehabilitation services, including one that recently opened atop the Insite facility.

The federal government has twice exempted the site from federal legislation that would otherwise see operators charged under federal drug laws.

The current exemption expires June 30, when Clement must decide whether to grant another exemption to the Controlled Drugs and Substances Act or amend legislation that prohibits it.

But two lawsuits scheduled to be heard by the B.C. Supreme Court beginning April 28 will argue that the federal government is overstepping its jurisdictional bounds.

Lawyer Monique Pongracic-Speier, who will represent a group of addicts and the Portland Hotel Society in one of the legal challenges, said they will argue that the services provided at Insite are essentially health care and, therefore, the exclusive jurisdiction of the province of British Columbia.

"It is our contention the feds doesn't have a role to play in regulating Insite through section 56 of the (Controlled Drugs and Substances Act) or otherwise," said Pongracic-Speier.

The second part of the challenge is a Charter argument that asks: If the services are removed would it violate the "security of the person" of those using the site?

In addition to the lawsuit by the Portland society, which operates Insite along with the Vancouver Coastal Health Authority, another by the Vancouver Area Network of Drug Users will also challenge the federal jurisdiction.

Thomas Kerr, a research scientist at the B.C. Centre for Excellence in HIV/AIDS and an assistant professor of medicine at the University of B.C., has conducted or overseen many studies of the injection site and said there are few, if any, other novel public health interventions in Canadian history that have so many published studies supporting their effectiveness.

Kerr said a letter in Open Medicine - an international, peer-reviewed, international journal - was endorsed by more than 130 prominent researchers and practitioners, including the medical health officer of B.C. and the medical health officer of Montreal.

Studies have been published in, among others, the New England Journal of Medicine, The Lancet, the Canadian Medical Association Journal, the British Medical Journal and the American Journal of Public Health.

"These are the best medical journals in the world," said Kerr. "You can't publish junk science in these journals."

But support is not unanimous, and the RCMP and the Canadian Association of Chiefs of Police remain steadfastly against injection sites.

Chief Supt. Derek Ogden, the RCMP's director general of drugs and organized crime, said he would like further research.

"I absolutely cringe when I hear people talk of a safe injection site," he said in an interview from Ottawa.

Ogden says the RCMP position focuses more on enforcement, prevention and treatment, which can result in harm reduction without injection sites.

Colin Mangham, the director of research for the Drug Prevention Network of Canada, wrote in his 2007 critique that other studies' findings of a reduction in "public disorder" were "questionable and so limited in scope as to be misleading."

"The Insite evaluations as reported in various research journals include considerable overstating of findings as well as under-reporting or omission of negative findings, and in some cases the discussion can mislead readers," Mangham wrote.

A Health Canada spokesperson could not be reached but did reply to questions by e-mail to say that after the last exemption was granted in December, the federal health minister "determined that additional research was needed to identify the extent to which supervised injection sites affect crime, prevention and treatment."

"The minister will make a decision on Insite and supervised injection sites once he has had the opportunity to examine the research on how the site affects prevention, treatment and crime," spokesman Stephane Shank said in the e-mail.

A report released Friday by an expert panel appointed by Clement found mixed results in its review of the many studies of Insite.

It said less than five per cent of all injections in the notorious neighbourhood, limiting the direct impact despite the more than 220,000 "clean injections" that have taken place there.

The committee said more than 8,000 people have visited the facility since it opened but only 18 per cent of those account for 86 per cent of the visits and less than 10 per cent used Insite for all their injections.

The committee acknowledged the site had made a contribution to improving public disorder, helped get people into treatment and reduced HIV risk behaviour.

And it found that the general public has positive views of Insite and that users rate the facility as highly satisfactory.

The committee also said Insite staff have successfully intervened in more than 336 overdose events since 2006 and no overdose deaths have occurred at the service. That adds up to about one life a year saved as a result of intervention.

Perry Kendall, the province's chief medical health officer, said that if the exemption is not extended "you might have to think that it's ideological or political."

However, he admits to a "gut feeling" that it is "still going to be a bit of struggle to convince (Ottawa) about the science."

The Canadian Press

Children and HIV/AIDS

1. More than 2M Children Worldwide Living with HIV/AIDS, Report Says

April 7, 2008

More than two million children worldwide were living with HIV/AIDS in 2007, according to a joint report released Thursday by UNICEF, UNAIDS and the World Health Organization, Reuters reports (Worsnip, Reuters, 4/3).

According to the report -- titled "Children and AIDS" -- most children living with HIV/AIDS acquired the virus through mother-to-child transmission. The report also found that 290,000 children under age 15 died last year of AIDS-related causes and that 12.1 million children in sub-Saharan Africa lost one or both parents to HIV/AIDS (AFP/France 24, 4/3). In addition, the report found that young people ages 15 to 24 account for 40% of new HIV cases among people older than 15 (Deen, IPS/AllAfrica.com, 4/4).

The report highlighted four strategic areas of focus to address HIV/AIDS among children: prevention of MTCT; pediatric treatment of HIV; prevention among adolescents and young people; and protecting and supporting children affected by the virus. According to the report, 21 countries -- including Botswana, Brazil, Rwanda, South Africa and Thailand -- are on track to meet UNICEF's goal of providing MTCT prevention services to 80% of people in need by 2010, up from 11 in 2005. In addition, although the number of HIV-positive pregnant women receiving antiretrovirals to prevent MTCT increased by 60% from 2005 to 2006, only 23% of women in need receive such services. The number of HIV-positive children in low- and middle-income countries with access to antiretrovirals also increased by 70% from 75,000 in 2005 to 127,000 in 2006, the report said (AFP/France 24, 4/3).

However, the report added that "with millions of children and women not being reached, these results are in no way satisfactory." Treatment levels, risk-reduction programs and government services to address HIV/AIDS are insufficient and reach a low percentage of people in need, according to the report (Reuters, 4/3). The reported noted that "steady progress" has been made in addressing the virus in Eastern and Southern Africa but added that the "priority is now to implement new initiatives and scale up those that have already been tested and proven effective." HIV/AIDS has "starkly altered the experience of growing up" for millions of children worldwide, who have experienced "deepening poverty, school dropout and discrimination as a result of the epidemic," the report added.

The report recommended four strategies to fight HIV/AIDS among children:

     * Strengthening families and communities;

     * Reinforcing health, education and welfare systems to help support HIV/AIDS-affected children;

     * Integrating prevention of MTCT programs in maternal, infant and child health programs; and

     * Consolidating data to keep track of advances and shortfalls (IPS/AllAfrica.com, 4/4).

In addition, the report welcomed an increase in donor funds to fight HIV/AIDS. According to the report, about $10 billion in HIV/AIDS funding was available in 2007, compared with $6.1 billion in 2006 (AFP/France 24, 4/3).

Reaction
"Today's children and young people have never known a world free of AIDS," UNICEF Executive Director Ann Veneman said, adding, "Children must be at the heart of the global AIDS agenda." Peter Piot, executive director of UNAIDS, said "Much more needs to be done to prevent HIV amongst young people and adolescents if we are to make a major change in the direction of the epidemic" (IPS/AllAfrica.com, 4/4). Kevin DeCock, director of HIV/AIDS programs at WHO, added that "health systems and their most precious component, the health care work force, must be strengthened" to address HIV/AIDS in children (AFP/France 24, 4/3).

http://www.kaisernetwork.org


2. Across The Nation | Chicago Tribune Examines 'Unexpected Challenges' of Raising HIV-Positive Teens

April 8, 2008

The Chicago Tribune on Sunday examined the "unexpected challenges" that some parents of HIV-positive teenagers face. According to the Tribune, "thousands of parents who adopted" children living with HIV/AIDS in the late 1980s through the mid-1990s "had not planned" on the children surviving into adolescence and adulthood.

Before the introduction of antiretroviral drugs, between one-fourth and one-third of children who contracted HIV through mother-to-child transmission died by age two, and one-half lived to at least age nine, according to CDC. Since then, several studies conducted among HIV-positive infants who began antiretrovirals by age six months found no deaths after two to five years. "This is the frontier," Diana Bruce -- policy director at the AIDS Alliance for Children, Youth & Families -- said, adding, "We have never before dealt with these kids. They used to die and now they are not."

Parents of teens living with HIV/AIDS face the "usual struggles" associated with adolescence but at a "heightened intensity," the Tribune reports. Some HIV-positive teens experience depression and other mental health problems, skip school, resist antiretrovirals and struggle with telling friends about their HIV status. In addition, some parents of HIV-positive teens often wonder what will happen to their children when they die. The Illinois Department of Children and Family Services in 2004 began support groups for parents and teens affected by HIV/AIDS and sponsored a retreat for HIV-positive teens. The agency has plans to expand the program.

There are no data available on how many HIV-positive teens are being raised by adoptive parents, but a 2003 study in the Journal of Acquired Immune Deficiency Syndromes found that HIV-positive mothers in the U.S. who died between 1980 and 1998 left behind 20,715 HIV-positive children. IDCFS placed about 30 HIV-positive children in adoptive homes in 1989, the first year it worked with the population, according to Specialty Services Administrator Elizabeth Monk. More than 40 children who were placed in adoptive homes died of AIDS-related causes between 1986 and 1996, compared with 17 in the next decade. The most recent recorded death of a child in IDCFS care was in 2004, the Tribune reports (Casillas, Chicago Tribune, 4/6).

http://www.kaisernetwork.org


3. HIV/AIDS Website Supports Affected Children

April 8, 2008

A website offering support and advice to children with HIV/AIDS has been launched by volunteers based in Hanoi, with assistance from the Party Central Commission for Popularisation and Education.

The website www.childrenAIDS.com gives detailed information about the disease and aims to bring donors and HIV-positive children together. However, the victims’ identities are protected.

The volunteers include members of For a Bright Future-one-13 groups in the Bright Future Network of people living with HIV/AIDS in Vietnam, the World Health Organisation and the Party Central Commission for Popularisation and Education.

Do Dang Dong, a member of the For a Bright Future Group in Hanoi, said information about children infected by HIV/ADS would be regularly updated.

According to the deputy director of the Vietnam Administration of AIDS Control, Chu Quoc An, there are around 150,000 people living with HIV/AIDS in Vietnam – 0.9% of whom are children under 13 years old.

Dong said the group visited provinces and cities such as Hai Phong, Ninh Binh, Thai Nguyen and Thai Binh to gather information about HIV positive children in the country. They had details about 500 children infected with or affected by HIV/AIDS and information about 200 of these children had been posted on the website.

Dong said there were numerous ways the public could support young HIV/AIDS victims, such as by donating money or clothing, or by providing useful information and pictures for the website.

VNA, http://www.nhandan.com.vn


4. IRIN/PlusNews Examines Global Campaign Aimed At Reducing HIV/AIDS-Related Stigma among Youth

April 7, 2008

IRIN/PlusNews on Wednesday examined a global campaign, called "Does HIV Look Like Me?", that aims to reduce HIV/AIDS-related stigma and discrimination among youth. The campaign is organized by the U.S.-based organization Hope's Voice International, which partners with groups in other countries such as Cambodia, South Africa and Swaziland. The campaign operates in six countries and uses posters that feature the pictures of young people with the campaign slogan in an effort to reduce stigma associated with the disease. Adam Garner of the International Planned Parenthood Federation, which works with Hope's Voice on the campaign, said that a key component of the campaign is that local partners adapt the project to specific cultural contexts. "The epidemic is very different in all countries in the world in the way stigma manifests itself and in the way the virus is predominantly transmitted," he said. Sedumedi Soke, an ambassador for the campaign from South Africa, said that when he became aware of his HIV-positive status, it was "very difficult because of the environment I am in. There's more than the virus -- there are hate crimes, discrimination, stigma, people being labeled like they were the virus itself." He added that since becoming an ambassador, he "found that for the first time, I was looking at myself in the mirror and speaking openly to a broad group of people. It helped me get back the confidence, hope and self-esteem I had lost" (IRIN/PlusNews, 4/2).

http://www.kaisernetwork.org


5. Kyrgyz Babies Pass HIV to Mothers

April 9, 2008

Osh, Kyrgyzstan - Not long ago, she was a wife, mother and teacher. Now Dilfuza Mustafakulova is HIV-positive and has lost her husband and her job.

Mustafakulova's baby son was among 72 children infected with the virus at two Kyrgyz hospitals. Sixteen mothers also have contracted it — in some cases by breast-feeding their children.

The scandal has led to charges of negligence against 14 medical workers in the impoverished former Soviet republic, where investigators suspect the children were infected by tainted blood and the reuse of needles.

Although HIV infection from breast-feeding is rare, it is possible, usually when the baby has mouth sores and the mother has lesions on her nipples, according to AIDS experts. Mustafakulova, whose son was 7 months old at the time, said her breasts were cracked and bleeding.

Now, abandoned by her husband and shunned by her in-laws, she struggles to feed herself and her three children with little government support.

Since the first cases were discovered in July, hundreds of children and their parents have been tested in southern Kyrgyzstan. Health Minister Marat Mambetov announced Tuesday that the infections, which began in the summer of 2006, had been contained.

Some 1,600 people are infected with HIV in the Central Asian nation of 5 million people, according to official figures — 15 times more than in 2002. AIDS experts estimate the real number is closer to 6,000. The majority of cases stem from intravenous drug use.

The infected children are getting free antiretroviral drugs, but their mothers have been denied treatment.

Erkin Bakiyev, deputy director of the national AIDS center, said the women are not entitled to free drugs if they are in the early stages of infection, as Mustafakulova is. And the women have no money to buy the drugs themselves.

"These women are having huge financial difficulties. They should be getting nutritious food, but they are not able to get jobs or to provide decent food for themselves or their children," said Fatima Koshokova, director of Rainbow, a non-governmental agency assisting Mustafakulova and other infected mothers.

Mustafakulova's troubles began in June, when her son developed a high fever. She took him to the Nookat hospital, where she said doctors put him on an intravenous drip. When he did not get better, she took him to the hospital in Osh, the country's second-largest city.

After more than a month in the hospital, her son still was not well and she was also feeling weak, so they returned to their village of Zhani-Nookat, about 45 miles southwest of Osh. In October, they both tested positive for HIV. Mustafakulova's husband and two older sons, aged 6 and 12, tested negative.

It has not been established where the infection originated. Of the 72 children infected, some were treated only in Nookat and others only in Osh, so both hospitals are suspected.

"Where else could my child and I become infected if I don't use narcotics and don't live an immoral life?" Mustafakulova said during a recent visit to the Rainbow center. "This could only be the irresponsibility of doctors."

She was abandoned by her husband, who like many Kyrgyz men spends much of his time in Russia, where he can find work. No longer welcome in her in-laws' home, she and her children moved in with her parents. She sold her only possession, a small plot of land, to pay for her son's medical treatment.

"I have no faith in the future," said Mustafakulova, looking exhausted and thin, her eyes vacant. "What will become of my sons?"

The story of Mustafakulova's fellow villager, Zarifa Shamshiyeva, is remarkably similar. She took her daughter to the Nookat hospital in June 2006, where her little girl, then about 1, was put on an intravenous drip before being transferred to the bigger hospital in Osh. She and her child both tested positive in November.

Her husband, who tested negative, left her, though he occasionally sends money for food.

She has hidden her infection from her neighbors and even from her two teenage daughters, 14 and 16. The eldest is of marriageable age. "How could she find a good husband if our neighbors and everyone else knew about our diagnosis?" asked Shamshiyeva, 34.

Both children are being treated with antiretroviral drugs from the Nookat hospital. But Shamshiyeva said the doctor told her: "You're strong. You'll live as long as God wills."

Neither woman qualifies for welfare since they are still legally married. Their HIV-infected children are entitled to monthly payments of $23, a pittance even in Kyrgyzstan.

Their case has been taken up by Rainbow, which provides free legal assistance to people living with HIV/AIDS.

"The husbands of many of these women leave when they learn the diagnosis, and these women are left alone with their grief," said Fatima Khabibullina, a lawyer at the center.

By Leila Saralayeva, The Associated Press


6. Kaletra Tablet for Children Gets EU Marketing Approval

April 11, 2008

Formal EU marketing approval has been granted for a low-dose tablet formulation of Kaletra (lopinavir/ritonavir) for paediatric use.

As reported on AIDSmap.com, European approval means that the drug can receive a Certificate of Pharmaceutical Product (CPP), enabling its regulatory approval in many resource-limited countries.

In a press release, the makers of Kaletra, Abbott, said they were "working with regulatory agencies on a country-by-country basis to negotiate submissions before the CPP is available." It added that Abbott "intends to make the lower-strength tablet available or approved in 155 countries around the world".

Containing 100mg of lopinavir and 25mg of ritonavir, the lower-dose paediatric formulation of Kaletra contains half the standard adult dose. Approval in the US was granted in November 2007.

Like the adult Kaletra tablet dose the new paediatric tablet can be taken with or without food and does not require refrigeration.

The price of the new paediatric tablet will be half the price of the adult-strength tablet where it is available: approximately $250 per patient per year in resource-limited countries.

Following US approval in November, Abbott was able to start supplying the lower-dose tablet to some resource limited countries that issued approved waiver orders. It is currently available, or approved, in 53 countries in Europe, Africa, Asia and Latin and North America.

By Michael Carter, www.aidsmap.com

Why the Pope Is Wrong About Condoms
An interview with South African Bishop Kevin Dowling, an AIDS activist

April 10, 2008

Bishop Kevin Dowling of Rustenburg, South Africa, has made a name for himself defying the Roman Catholic Church's absolute ban on condom use. He determined the church's views were unacceptable after witnessing the AIDS epidemic up close for 16 years in a mining town west of Pretoria. There, impoverished women living in tin shacks sell their bodies to feed themselves and their children. Most contract the deadly HIV virus from having unprotected sex. Since opening his first AIDS clinic in 1996, Dowling now oversees nine clinics that treat nearly 1,000 adults and children with lifesaving antiretroviral drugs.

Arriving in Washington on the eve of the pope's visit, Dowling met with White House officials yesterday in an effort to get more funds for hospice care for AIDS patients in their final weeks of life. (Congress is in the midst of reauthorizing the President's Emergency Plan for AIDS Relief [PEPFAR] with plans to increase the five-year funding package from $30 billion to $50 billion.) He also sat down with U.S. News to explain why he believes preventing the spread of HIV must come before religious idealism.

Where do your views diverge from the pope's?
I don't believe I have the right to impose on the people I serve the particular official position of the church in terms of, for example, the use of condoms to prevent the transmission of a deadly virus. The platinum mines near Rustenburg have brought in thousands of job seekers from around South Africa and countries to the north. Sadly, so many single women have wound up in the worst poverty, living in shacks, engaging in sex for money. It's not prostitution in my view but simply a mechanism for them to survive. I believe the one way they can take control, in the desperation they're in, is by demanding that the men they have transactional sex with use a condom.

In the U.S., far less than 1 percent of people is infected with HIV, so most Americans don't know anyone with AIDS. What's the situation like where you live?
It's tragic. Every week, there are scores of funerals in my area, mostly young people who were born with HIV. In traditional rural villages, about 15 percent of people are infected with the HIV virus, but that's rapidly increasing. In Rustenberg, the infection rate is 25 to 30 percent, and at one of our large clinics, nearly 50 percent of pregnant women tested positive for HIV in 2004.

What do you do to try to stop the spread of HIV? Hand out condoms?
I don't have to hand out condoms since the South African government distributes them for free everywhere. I've spent my time building relationships with nurses and community leaders who know how to communicate, especially to teenagers. We give them full, accurate, and nonjudgmental information about HIV: what it is, how you get infected, its consequences, and what ways you have to protect yourself, including information about condoms. We tell them that although condoms aren't 100 percent effective, they're very successful at preventing HIV transmission if you use them consistently, carefully, and correctly every time.

Are there particular cultural challenges to implementing change in sexual practices?
Very much so. In South Africa, even more than in the United States, there are enormous pressures on young men to engage in sexually irresponsible behavior and "lay" as many girls as they can. In this strong patriarchal system, women are in a vulnerable position, feeling that they have to simply submit. We try to work with women to build up their self-esteem and make them aware that they're of infinite worth in God's eyes. We also have groups that go into primary schools to teach about sexuality in terms of honoring yourself and taking responsibility for others if you already have the virus. But we need scientific studies to see whether what we're doing is truly having an impact.

Is there talk among church officials about overturning the ban on condoms?
Cardinal Carlo Maria Martini has made statements supporting condom use in a marriage where one partner is HIV positive, recognizing that it shouldn't be demanded that a husband and wife cut off their sexual relationship. So I do think a principle has been established that condoms can be used to prevent the transmission of HIV. I don't think my own statements in support of condom use have made any kind of shift, but I think we all recognize that it's a very difficult question that needs to be grappled with. Some worry that as soon as you open the door a little bit, you're allowing people to be promiscuous in their behavior. But I don't believe this is the case. I'm not saying my position is the right one, but I do think there needs to be a more formal dialogue within the church.

What words do you wish to convey to the pope?
I would say that, like him, I believe in the ideals of abstaining from sex before marriage and remaining faithful to your partner within a stable marriage relationship. My problem is that in the desperate situations where I work, the promotion of these ideals does not meet the need. We, instead, need a more realistic approach, to be consistently pro-life from conception to death. I've sat with vulnerable women for years in their shacks, have seen them and the babies in their arms dying of AIDS. Their hopelessness has seared my heart and spirit. I believe Jesus's injunction to the Pharisees applies to me. He said that they are the ones who put impossible burdens on the shoulders of their people but will they lift a finger to help them carry them? Not they. I want to be the one who lifts a finger.

By Deborah Kotz, http://www.usnews.com

Egypt, HIV/AIDS Patients Victimized

1. International Pressure on Egypt over HIV Arrests

April 7, 2008

More than 115 organisations that advocate human rights and the rights of people living with HIV/AIDS have protested to the government of Egypt over a spate of recent arrests.

The groups signing the letter represent 41 countries on six continents, among them Human Rights Watch and Amnesty.

In a letter to the Health Ministry and the Egyptian Doctors' Syndicate, the groups said that doctors who helped interrogate men jailed on suspicion of being HIV-positive violated their own medical ethics.

Five more men face trial in Cairo on Wednesday in what has been called "a police crackdown" on people living with HIV/AIDS.

At least 12 men have been arrested and four have already been sentenced to a year in jail.

The most recent arrests occurred after police used information coerced from men already in detention, according to the Health and Human Rights Programme of the Cairo-based Egyptian Initiative for Personal Rights (EIPR).

As in all previous cases, authorities forced the new detainees to undergo HIV testing without their consent.

All those testing positive had been held in Cairo hospitals, chained to their beds.

After a domestic and international outcry, the Ministry of Health finally ordered the men unchained on 25th February.

All the men were charged with the "habitual practice of debauchery," a term which in Egyptian law includes consensual sexual acts between men.

EIPR reportedly found a document from the Ministry of Health and Population titled Questionnaire for Patients with HIV/AIDS in one of the men's case files.

It includes 'yes' or 'no' questions that doctors from the ministry apparently use to interrogate people in the crackdown about whether they had sexual relations 'with the other sex' or 'with the same sex,' and 'with one person' or 'with more than one person.'

Prosecutors included the men's answers that they had relations with the same sex as evidence of their guilt.

Malcolm Smart, director of the Middle East and North Africa programme of Amnesty International, said: "It is unacceptable for doctors to perform forcible HIV tests, or to examine people to 'prove' offences that should never be criminalised. Doctors who engage in or enable human rights abuses are violating their most elemental responsibilities."

Joe Amon, director of the HIV/AIDS programme at Human Rights Watch, said: "Doctors must put patients first, not join a witch-hunt driven by prejudice. Now more than 100 human rights groups are reminding Egyptian doctors of the oath they took to respect patients' privacy, autonomy, and consent. This is one of the oldest traditions of medical responsibility, as well as an obligation under human rights law."

To read the letter from 117 health and human rights organisations to Egypt's Health Ministry and the Egyptian Doctors' Syndicate click here.
http://hrw.org/english/docs/2008/04/07/egypt18439.htm

http://www.pinknews.co.uk


2. Egypt Sentences 4 Gay HIV-Pos Men to Prison

April 9, 2008

Cairo - An Egyptian court convicted five men Wednesday on charges of homosexual behavior and sentenced them to three years in prison, officials said.

Defense lawyer, Adel Ramadan, said the judge found the men guilty of the "habitual practice of debauchery" - a term used in the Egyptian legal system to denote consensual homosexual acts.

The convictions were confirmed by a judicial official, who spoke on condition of anonymity because he was not authorized to talk to journalists.

Homosexuality is not explicitly referred to in Egypt's legal code, but a wide range of laws covering obscenity, prostitution and debauchery are applied to homosexuals in this conservative country.

The five men were arrested in what human rights groups describe as a crackdown on people with the AIDS virus, using the debauchery charges as a means to prosecute them.

Four of the five men tested HIV-positive after all were forced to undergo blood tests in custody, Human Rights Watch says. The New York-based rights group issued a statement Tuesday signed by more than 100 other organizations around the world condemning the prosecutions.

Ramadan, a lawyer with the Egyptian Initiative for Personal Rights, said the five men were abused and tortured over the past several months to "extract confessions" from them.

Along with three years in prison, the men were sentenced to an additional three years of police supervision.

Ramadan said the defendants were shocked by their convictions.

"Two of them cried, screamed and shrieked," Ramadan said. He said the others "remained silent, but I saw anger in their eyes for the injustice they have been exposed to."

Ramadan said he appealed the verdict to Egypt's Court of Cassation, the country's highest appellate court.

Dozens of human rights groups have criticized this trial and other similar ones as being driven by ignorance and fear of AIDS. They have warned that the convictions could undermine AIDS prevention in Egypt.

The five convicted Wednesday were among 12 people arrested in a sweep that began in October, when police arrested a man during an altercation with another man on a Cairo street, Human Rights Watch said.

After one of the men said he was HIV-positive, authorities opened investigations into other men whose names or contact information were uncovered in interrogations of the first group of men, Human Rights Watch said.

Egyptian police have denied making any arrests because of a person's HIV condition.

In mid-January, four other HIV-positive men from the group of 12 were sentenced to one-year prison terms on similar charges of debauchery. Three others from the 12 were not prosecuted, Human Rights Watch said.

AP, www.365Gay.com

New Legal Service for HIV-Positive South Africans

April 9, 2008

www.ProBono.org, a nonprofit public-interest law service based in Johannesburg, has plans to start a weekly legal clinic for HIV-positive people to tackle issues of discrimination, the news site for the City of Johannesburg reports (joburg.org.za, 4/8).

Odette Geldenhuys, ProBono.org’s director, says the new service "seeks to help and focus on a group of people who are being marginalized and discriminated against, not on merit and ability, but on the basis of their well-being or HIV status."

According to the article, HIV-positive people in the city often face discrimination in the workplace and at home. The legal group will begin providing free advice and services mid-April in the hopes of eliminating such discrimination.

http://www.poz.com

HIV/AIDS China

1. Activist Says Chinese Police Beat, Detain AIDS Protesters

April 10, 2008

Beijing - Police beat, shocked and detained 11 people suffering from HIV/AIDS who were trying to protest in front of China's premier, a Beijing-based activist said Thursday.

Wan Yanhai of the Aizhixing Institute said the protesters, who all contracted HIV through blood transfusions, were attacked Saturday in front of the municipal government building in Shahe, a town in Hebei province outside Beijing.

Wan said the protesters were beaten with clubs, shocked with electric prods and sprayed in the face with an unknown substance that caused them to lose consciousness. He said they were taken to a hospital and later detained.

Wan said the 11 had hoped to draw the attention of Premier Wen Jiabao, who was visiting the area. The protesters were seeking compensation from the hospital where they contracted HIV from tainted blood in the mid-1990s.

Wan said the local court has repeatedly refused to accept the group's case against the hospital, and the local government has failed to follow through on a pledge to support them, he said.

Wang Weijun, a friend of the 11, said three women were later released on condition they drop their complaint against the government and not discuss what happened to them. The remaining six men and two women had not agreed to those conditions, Wang said.

A man who answered the phone Thursday at the Shahe police department said he had no information about the incident. He refused to give his name as is standard among Chinese police officers. The hospital had no listed telephone number.

HIV gained a foothold in China largely due to tainted blood transfusions in hospitals and unsanitary blood-buying schemes. Although the government acknowledges responsibility in the transfusion cases, victims still have trouble receiving compensation.

After years of denying that AIDS was a problem, Chinese leaders have shifted gears dramatically in recent years, confronting the disease more openly and promising anonymous testing, free treatment for the poor and a ban on discrimination against people with HIV. President Hu Jintao has been shown on state television shaking hands with people living with AIDS.

Associated Press


2. China's Industry, Commerce Administration Launches Program To Increase HIV Prevention, Education Services in Private Sector

April 10, 2008

China's State Administration for Industry and Commerce, with support from the China AIDS Roadmap Tactical Support Project, has begun to train leaders at private companies on HIV prevention and awareness to educate employees and other members of the community about the disease, Xinhua/China View reports. SAIC has trained more than 300,000 people involved in local industry and commerce offices as liaisons to communicate the country's HIV policies and prevention activities throughout local communities.

SAIC also has urged provincial industry and commerce bureaus to work with the private sector to expand HIV prevention services for migrant workers. In addition, SAIC has launched a pilot HIV education campaign for migrant workers in five provinces. According to Song Shaozhe, a researcher in SAIC's private economy supervision and management department, migrant workers often are not familiar with HIV or how to prevent it. The pilot projects have reached more than 10,300 migrant workers, Xinhua/China View reports. Shi Kai, a CHARTS program officer, said SAIC's efforts to involve the private sector in the country's HIV/AIDS strategy is an "important guarantee for the country eventually to win" the fight against HIV/AIDS.

Jiangsu Program
In Jiangsu province, one of the program's five pilot provinces, SAIC focused on nine private companies in the tourism, machine and garment industries. Before the program was implemented, Jiangsu officials conducted a survey to assess knowledge and attitudes about HIV among the companies' employees, Zhang Zhenfei, deputy director of the provincial industry and commerce bureau, said. The survey polled 1,740 workers at private companies and found that about 94% had heard of HIV/AIDS and that 40% believed they could contract the virus. About 55% of the workers believed that HIV-positive people should be separated from the general population. Officials at the nine participating companies are using the survey results to develop and explore ways to increase HIV education and prevention messages among employees.

The Langtaosha E-Mass Media Company, which owns 130 Internet cafes in the province, displays messages about HIV prevention on users' computers before they log on. Zhang Zijian, the company's general technology supervisor, said that about 25,000 people daily log on to the company's computers in the provincial capital, Nanjing. The shareholding company Diyi Group has linked a Web page about HIV prevention to the company's monthly magazine. The company also is training employees about safer-sex practices (Wen, Xinhua/China View, 4/8).

http://www.kaisernetwork.org

Thailand's New Campaign against Illegal Drugs Will Undermine HIV/AIDS Efforts, Advocates Say

April 10, 2008

Health advocates and nongovernmental organizations recently warned that Thailand's campaign against illegal drugs launched last week will undermine efforts to reduce the spread of HIV/AIDS, the South China Morning Post reports.

According to the Post, Interior Minister Chalerm Yubamrung was quoted by Thailand's Nation in February as saying it would be natural if around 2,700 people died in the course of the new campaign. Chalerm recently said, "I have never said that I have a policy of extrajudicial killing," adding, "I said drugs are very complicated. If you don't want to die, don't walk down that road." The country in 2003 launched its first "war on drugs" under former Prime Minister Thaksin Shinawatra. The campaign, which resulted in at least 2,500 deaths in three months, was criticized by human rights groups, which deemed the killings "extrajudicial." Former Interim Prime Minister Surayud Chulanont, who took over after Thaksin was removed from office in October 2006, called the killings a "crime against humanity."

Karyn Kaplan, policy director of the Thai AIDS Treatment Action Group, said the 2008 campaign "is dubbed a national security operation, with a complete disdain for human rights," adding, "The interests of public health and HIV prevention will be compromised." A recent UNAIDS report urged Asian countries to fight the impact of drug use by providing harm reduction services, including needle-exchange programs and opiate substitution treatment. The report, which was endorsed by U.N. Secretary General Ban Ki-moon, said governments should abandon counterproductive "wars on drugs," the Post reports. UNAIDS Executive Director Peter Piot said, "I look to Asian governments to amend outdated laws criminalizing the most vulnerable sections of society [such as injection drug users] and take all the measures needed to ensure they live in dignity."

Ton Smits, head of the Asian Harm Reduction Network, said ensuring easy access to clean needles for IDUs has been effective in combating HIV. However, only a few countries have implemented such programs despite endorsements from the World Health Organization and UNAIDS, Smits said. "It is important for drug enforcement agencies to do some soul searching and to recognize that the early stage of an HIV epidemic comes from drug users or sex workers," Smits said (Fawthrop/Mai, South China Morning Post, 4/9).

http://www.kaisernetwork.org

Combined Resistance Analysis Better Predicts Treatment Failures

April 7, 2008

Assessing the combined results of resistance tests for Prezista (darunavir) and Intelence (etravirine) may better predict treatment outcomes than assessing resistance only to the individual drugs, according to a report at NATAP from the 6th European HIV Drug Resistance Workshop in Budapest, Hungary.

Currently, when doctors try to determine from resistance tests which combination of drugs a heavily treatment-experienced patient may respond to, they usually factor in the resistance results of each drug individually. For example, say that a person’s virus has  only one or two resistance mutations—i.e., low-level resistance—to each of three different drugs. Based on the way that resistance is currently calculated, the patient’s doctor would probably say that a regimen made up of the three drugs together would also have a low level of resistance, and be very likely to work.

Jonathan Schapiro, MD, from the Sheba Medical Center in Tel Hashomer, Israel, and his colleagues wondered, however, whether that low level of resistance to the three separate drugs could add up and cumulatively equal a higher level of total resistance to a regimen, and thus a greater chance that the regimen may fail to work. To answer this question, Schapiro’s team conducted an analysis of data from the DUET studies, which were originally designed to evaluate the efficacy and safety of Intelence, and compared people taking Prezista and Intelence, plus an optimized background regimen of other drugs, with people taking Prezista and a placebo, plus an optimized background regimen. Specifically, the team looked at how patients’ resistance to Prezista and Intelence before they began taking the drugs affected treatment outcomes.

Schapiro’s team found that adding the number of resistance mutations to each drug together yielded a better prediction for who would have a treatment failure than assessing resistance only to each drug separately. For instance, people who had two Prezista mutations and two Intelence mutations should, based on previous analysis, have a fair chance of achieving treatment success, meaning virus levels of less than 50 copies after 24 weeks of treatment. This is especially the case with Intelence, as previous analysis found that it took three Intelence resistance mutations before a person’s chance for treatment success was greatly diminished. The team, however, found that a person with just two Intelence mutations was as likely to fail as a person with three such mutations, if they also had two Prezista mutations. In other words, combining the resistance results better predicted treatment success and failure than considering the results for each drug individually.

Schapiro and his colleagues conclude that future studies should examine the impact of combined resistance scores and suggest that doctors factor this in when building regimens for treatment-experienced patients.

http://www.poz.com

Protease Inhibitors Increase Fibrinogen Levels: Increased Risk for Hardening of the Arteries

April 8, 2008

Treatment with a protease inhibitor increases levels of a substance in the blood, fibrinogen, that is associated with hardening of the arteries, according to a US study published in the March 30th edition of AIDS. By contrast, patients treated with a non-nucleoside reverse transcriptase inhibitor (NNRTI) had lower fibrinogen levels than individuals who received a protease inhibitor, and also the HIV-negative control group.

HIV is associated with atherosclerosis, or hardening of the arteries, but the reasons for this are not fully understood. Earlier research suggests that treatment with a protease inhibitor increases the risk of atherosclerosis by 14% with each year of use.

Anti-HIV treatment can disturb the way the body metabolises lipids and glucose, leading to increased levels of cholesterol and blood sugars, and these are long-term risk factors for heart disease. But results from the D:A:D study have shown that protease inhibitor therapy increases the risk of atherosclerosis independent of such metabolic changes. Therefore the reason why protease inhibitors increase the risk of hardening of the arteries still needs to be explained.

Fibrinogen is an important substance involved in blood clotting and increased levels of fibrinogen are thought to contribute to hardening of the arteries. Inflammation, which can be caused by HIV, is thought to underlie the atherosclerosis that elevated fibrinogen levels can lead to. A meta-analysis of 31 prospective studies has shown that a 100mg/dl increase in fibrinogen levels increases the hazard ratio of illness or death due to vascular disease by 2.42 (95% CI, 2.24 – 2.60).

But studies investigating a connection between protease inhibitor therapy and fibrinogen levels have produced conflicting results. Increased adiposity (increased amounts of body fat) has been associated with elevations in fibrinogen levels. Anti-HIV therapy has been associated with the accumulation of fat around the trunk and between the shoulders.

The US FRAM Study (Fat Redistribution and Metabolic Changes in HIV Infection) employed MRI scans to monitor levels of adipose tissue in HIV-positive patients. Patients in the study also had regular blood tests. These meant that investigators were able to research the association between anti-HIV treatment, fat accumulation, inflammation, CD4 and viral load, and fibrinogen levels in a representative sample of HIV-positive patients.

A total of 1131 HIV-positive patients were included in the study, with recruitment taking place between 2000 – 2002. Some of the protease inhibitors now in routine use were not available at this time. The study design also included a control group that consisted of 281 HIV-negative 18- 30 year olds took part in a study into heart disease that took place in the mid 1980s.

Body Fat and Fibrinogen
Levels of subcutaneous fat were lower in HIV-positive men and women than the control group, and visceral fat was lower in HIV-positive men than the controls, but higher in HIV-positive women compared with controls (p = 0.009).

Median fibrinogen levels were 8% higher in HIV-positive men (345 mg/dl) compared with the men in the control group (320 mg/dl). Similarly, fibrinogen levels were 6% higher in HIV-positive women (373 mg/dl) than in the HIV-negative controls (352 mg/dl). After adjusting for lifestyle factors, demographics and levels of fat, fibrinogen levels were significantly higher (12%; p < 0.0001) in HIV-positive men than in HIV-negative men. However, there was no significant difference in fibrinogen levels between HIV-positive women and women in the control group.

Fibrinogen and Antiretroviral Therapy
Investigators then turned their attention to the effect of antiretroviral therapy on fibrinogen.

Patient treated with a protease inhibitor had median fibrinogen levels 11% higher than patients not taking this class of drugs (380 dg/ml vs. 341 dg/ml, p < 0.0001). Furthermore patients taking a ritonavir-boosted protease inhibitor (lopinavir/ritonavir included) had a 12% increase in their fibrinogen level compared to individuals not taking a protease inhibitor (p < 0.0001).

However, patients treated with an NNRTI had fibrinogen levels that were 9% lower than patients not taking this class of drug (median, 340 dg/ml vs. 372 dg/ml, p < 0.0001).

Levels of fibrinogen in patients taking both a protease inhibitor and an NNRTI were similar to those seen in control patients.

Multivariate Analysis
Factors significantly associated with higher fibrinogen levels in patients with HIV included age, African-American race, visceral fat levels, total subcutaneous fat, smoking, and current HIV viral load. When the investigators controlled for these factors, they found that treatment with a protease inhibitor, particularly indinavir or ritonavir increased fibrinogen levels (p < 0.0001), whereas therapy with an NNRTI (nevirapine, p =0.001; efavirenz, p = 0.049) lowered fibrinogen levels.

C-reactive protein levels (CRP), a reliable marker of inflammation, were strongly associated with increased fibrinogen levels in both HIV-positive patients and controls. But when the investigators controlled for CRP, they found that treatment with a protease inhibitor was still associated with increased fibrinogen levels. Similarly, the association between NNRTI therapy and lower fibrinogen levels also remained.

"Use of protease inhibitors as a group was associated with elevated fibrinogen levels", write the investigators, "elevation of fibrinogen levels…is seen with all protease inhibitors studied, suggesting a class effect."

Although the study was not able to include analysis of recently approved protease inhibitors, the investigators emphasise that an association between increased fibrinogen levels was seen in patients treated with Kaletra (lopinavir/ritonavir) and an association between "ritonavir at boosting doses with higher fibrinogen levels. Most current protease inhibitor regimes utilize ritonavir boosting."

The investigators suggest that protease inhibitors may have a direct effect on fibrinogen levels, a conclusion suggested by fibrinogen levels being independent of inflammation, as assessed by CRP levels.

NNRTI therapy’s association with lower fibrinogen levels could mean that therapy with this class of drug could help reduce a patient’s risk of heart disease. Treatment with NNRTIs is already thought to involve less of a risk of increased cholesterol and heart disease than many protease inhibitors.

Some limitations with the study are noted by the investigators, particularly its cross-sectional design. They call for further prospective studies to assess the relationship "between antiretroviral therapy and fibrinogen levels as well as cardiovascular disease."

Reference
Madden E et al. Association of antiretroviral therapy with fibrinogen levels in HIV infection. AIDS 22: 707 – 715, 2008.

By Michael Carter, www.aidsmap.com

Drug Prices

1. Brazil May Reject Gilead's AIDS Drug Patent

April 10, 2008

Rio De Janeiro - Brazil has decreed U.S. pharmaceutical firm Gilead's (GILD.O: Quote, Profile, Research) AIDS drug Tenofovir "in the public interest", signaling it may reject a patent request due to its high price and import a generic version.

The Health Ministry said in a decree published on Wednesday that patenting the drug in Brazil would generate "expectations of monopoly rights with an impact on the price of the product."

Latin America's largest country has an internationally-lauded AIDS prevention and treatment program, in which patients get free antiretroviral treatment.

The ministry said it had requested a priority examination of the patent filing by the company with the Brazilian INPI patent body, which will have to take into account the ministry's objections.

"If no patent is issued, Brazil will be free to negotiate prices of the drug, be it generic or brand name," a health ministry source told Reuters on Thursday, adding that the case was "not about compulsory licensing" or breaking patents.

A representative of Gilead Sciences Inc in Brazil declined to comment on the issue but said high-ranking Gilead officials were in contact with the ministry to discuss the case.

The Health Ministry said Tenofovir accounts for 10 percent of the money the government spends on its AIDS treatment program, which encompasses a cocktail of various drugs, including Tenofovir in some cases.

It said that this year, 31,300 Brazilians would be treated with Tenofovir at a cost of $1,387 per patient. The annual cost per patient, for some 180,000 people treated under Brazil's AIDS program, is about $2,500 worth of medicines a year.

The Health Ministry source said the case was different from last year's bypassing of a patent on Merck & Co Inc (MRK.N: Quote, Profile, Research) AIDS drug Efavirenz.

Last May, President Luiz Inacio Lula da Silva authorized Brazil to sidestep the patent on Efavirenz and import a generic version from India. It was the first time Brazil bypassed a patent to acquire cheaper drugs for its AIDS program.

That process also started with the government declaring the drug "in the public interest" and saying it was too expensive.

If the Tenofovir patent is rejected, Brazil may choose to import generic drug using a clause in World Trade Organization rules to flout drug patents in the name of public health.

Other countries, including Canada, Italy and Thailand, have also used the WTO clause to gain access to cheaper AIDS drugs.

The World Health Organization considers Brazil's AIDS strategy -- which also includes large-scale distribution of free condoms as well as free and fast testing for the HIV virus -- a model for developing nations.

Brazil's AIDS infection rate, after climbing until the early 1990s, has steadied and even reversed course. The prevalence of the HIV virus dropped to 0.5 percent in 2006 from 0.6 percent in 2005, its first fall in seven years. The numbers of new AIDS cases and AIDS deaths have also been declining. Brazil has an estimated 600,000 people infected with HIV/AIDS.

Additional reporting by Pedro Fonseca and Andrei Khalip, Writing by Andrei Khalip; Editing by Tim Dobbyn, Reuters


2. Middle East & Africa: HIV/AIDS – Prices Down, Treatment Up

April 10, 2008

With World Health Organisation backing, GlaxoSmithKline is cutting the prices of AIDS drugs for Africa. But do such steps go far enough?

In a boost for HIV/AIDS sufferers in sub-Saharan Africa, GlaxoSmithKline in February slashed by 31 per cent the price of Abacavir, its in-demand second-line antiretroviral treatment.

The pharmaceutical giant announced it would reduce the cost to least developed countries of Abacavir tablets to $438 per person per year. The price is higher than the cheapest generic version, the Aubrindo-distributed treatment that costs $395 a year, but Abacavir has the backing of the World Health Organisation, which wants to standardise antiretroviral treatments, or "regimens", to make them cost-effective for poor countries.

Second-line treatments are for AIDS patients who need to switch from first choice drugs that have stopped working. At present, many second-line antiretrovirals are under patent, which means prices are high because of lack of competition. And the goal of simplifying choice of first and second-line drugs could mean they remain expensive for poor countries, as the WHO selection includes newer drugs that cost more and have fewer generic competitors.

In 2001 the World Trade Organisation allowed for poor countries to develop drugs under compulsory licence if they could justify it as being in the public interest. Both India and Thailand have taken this route but claim active lobbying for stricter patents from pharmaceutical companies has created obstacles.

http://www.ethicalcorp.com

Immunotherapy May Come Handy to Fight Off AIDS

April 9, 2008

Melbourne - Immunotherapy could be used to fight off the incidental infections and immune breakdown that lead to AIDS in HIV-infected people, a new study has revealed.

According to researchers at the Melbourne University, who have carried out the study on mice, immunotherapy offers a worthwhile avenue to explore the possibility of developing a workable AIDS vaccine.

"We infuse fresh blood cells which have been mixed with peptides -- or short proteins -- spanning the virus. We have found these induce a very strong immune response enabling the body to fight off both the immunodeficiency virus and other opportunistic infections in laboratory models.

"We take the whole viral sequence, or parts of it, and make a series of overlapping peptides based on it. These trigger the body’s immune cells, the T cells, to recognise the presence of a virus like HIV much more clearly -- and to attack it more effectively, reducing levels of the virus and preventing the destruction of the immune system.

"This in turn frees up more of the immune system to deal with other infections," lead researcher Prof Stephen Kent was quoted by the ‘scienceAlert’ as saying.

According to Prof Kent, immunotherapy can potentially be used in conjunction with anti-retroviral drugs, but has several advantages in that it is simple, easier to deliver and should have fewer side-effects.

"They are just proteins we are delivering. There should be no toxic side-effects," he said.

According to the researchers, these features also make immunotherapy a promising approach for use in Third World countries where modern drug treatment is not only difficult but also expensive to deliver and administer.

"A possible challenge for immunotherapy is HIV’s innate ability to change itself to counter measures taken against it. However we have found this comes at a fitness cost to the virus.

"Every time it mutates to deal with a new threat, it weakens itself a little. This may mean that a patient’s HIV could gradually become weaker and weaker over time, which will also help them in fighting off the infection and slow the progression to AIDS," he said.

http://www.expressindia.com

Last Bite

1. Apples May Reduce Risk For Heart Disease, Diabetes

April 8, 2008

An apple a day may just keep the doctor away after all by reducing the symptoms that can lead to heart disease, says a new study.

According to the study, adults who eat apples or applesauce or drink apple juice have a reduced risk for developing metabolic syndrome, a group of health problems that can be precursors to heart disease and diabetes.

The study was presented at the recent Experimental Biology 2008 meeting in San Diego. The research was gleaned from data collected between 1999 and 2004 in the National Health and Nutrition Examination Survey, the largest food consumption and health database of the United States government.

Those who consumed apple products were 27 per cent less likely to be diagnosed with metabolic syndrome, compared to those who don't eat apple products.

Lead study author Dr. Victor Fulgoni said: "We found that adults who eat apples and apple products have smaller waistlines that indicate less abdominal fat, lower blood pressure and a reduced risk for developing what is known as the metabolic syndrome."

The researchers did not come to any conclusions about how apples lower a person's risk for the symptoms of metabolic syndrome. But previous studies have exhibited health benefits from eating apples that range from being able to lose weight more easily to having a decreased risk for developing certain cancers.

Researchers also found that those who eat apples have healthier diets overall. They ate more fruit and consumed more nutrients such as fibre, vitamins A and C, calcium and potassium. They also ate less fat, saturated fat and added sugar.

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2. Alligator Blood May Put the Bite on Antibiotic-Resistant Infections

April 8, 2008

Despite their reputation for deadly attacks on humans and pets, alligators are wiggling their way toward a new role as potential lifesavers in medicine, biochemists in Louisiana reported today at the 235th national meeting of the American Chemical Society.

They described how proteins in gator blood may provide a source of powerful new antibiotics to help fight infections associated with diabetic ulcers, severe burns, and "superbugs" that are resistant to conventional medication.

Their study, described as the first to explore the antimicrobial activity of alligator blood in detail, found a range of other promising uses for the gator’s antibiotic proteins. Among them: combating Candida albicans yeast infections, which are a serious problem in AIDS patients and transplant recipients, who have weakened immune systems, the scientists say.

"We’re very excited about the potential of these alligator blood proteins as both antibacterial and antifungal agents," says study co-author Mark Merchant, Ph.D., a biochemist at McNeese State University in Lake Charles, La. "There’s a real possibility that you could be treated with an alligator blood product one day."

Previous studies by Merchant showed that alligators have an unusually strong immune system that is very different from that of humans. Unlike people, alligators can fight microorganisms such as fungi, viruses, and bacteria without having prior exposure to them. Scientists believe that this is an evolutionary adaptation to promote quick wound healing, as alligators are often injured during fierce territorial battles.

In collaboration with Kermit Murray and Lancia Darville, both of Louisiana State University in Baton Rouge, Merchant and colleagues collected blood samples from American alligators. They then isolated disease-fighting white blood cells (leucocytes) and extracted the active proteins from those cells.

In laboratory tests, tiny amounts of these protein extracts killed a wide range of bacteria, including MRSA (methicillin-resistant Staphylococcus aureus), the deadly bacteria that are moving out of health care settings and into the community. These "superbugs" are increasingly resistant to multiple antibiotics and cause thousands of deaths each year.

The proteins also killed six out of eight different strains of Candida albicans, the researchers say. Their previous research also suggests that blood proteins may help fight HIV, the virus that causes AIDS.

The scientists are working to identify the exact chemical structures of the antimicrobial proteins and determine which proteins are most effective at killing different microbes. The gator blood extract may contain at least four promising substances, they estimate.

With the chemical structures in hand, scientists can begin developing them into antibacterial or antifungal drugs, including pills and creams, for fighting infections. These drugs show particular promise as topical ointments, Merchant says. Gator-blood creams could conceivably be rubbed onto the foot ulcers of patients with diabetes to help prevent the type of uncontrolled infections that lead to amputations, he says. The creams could also be applied to the skin of burn patients to keep infections at bay until damaged skin can heal, the researcher adds.

Merchant suggests that the proteins might be called "alligacin." If studies continue to show promise, the drugs could land on pharmacy shelves in another seven to ten years, he estimates. Until then, don’t try to create your own home-remedies using alligator blood, as raw, unprocessed blood could make you sick or even kill you if injected, the researcher cautions.

Similar antimicrobial substances might also be found in related animals such as crocodiles, Merchant notes. In the future, he plans to study blood samples from alligators and crocodile species throughout the world to test their disease-fighting potential. The state of Louisiana and the National Science Foundation provides funding for this research.

By Charmayne Marsh, EurekAlert!

Further information: www.acs.org