World AIDS Day 1 December, 2010
Theme: Universal access and human rights
Commonwealth countries make up over 30% of the world’s population. Over 60% of people living with HIV and AIDS reside in Commonwealth states.
This theme encourages us to deepen understanding, develop partnerships and challenge discriminatory laws, policies and practices that stand in the way of access for all to HIV prevention, treatment, care and support. Within the 54 independent states of the Commonwealth, 47 classify same-sex sexual conduct as illegal and only 6 legal. Laws may either enable or obstruct a comprehensive HIV response. They contribute to the ability of those who are discriminated against to claim their rights and also increases awareness of HIV stigma and discrimination in policies and programmes. Without including those who are particularly vulnerable to HIV programmes to combat the spread of HIV will be inhibited.
In addition to the question of citizen’s rights there is an important link to the way in which prevention of spread and the treatment of those with HIV/AIDS are dealt with. A common approach is not feasible due the differences in the status of the programmes and the laws in the countries in which we practice. As well as specifically maintaining up to date knowledge of treatment of individuals we should not lose sight of the wider importance of considering the professional needs for different groups in the population. Our activities should reflect not only the professional standards to which we aspire but also the context in which these are applied in the communities where we live.
Highlighted below is material indicative of the recent publications and developments in this field.
Information and Activities in 2010
- A landmark document was signed between UNAIDS and the Stop TB Partnership. The agreement binds the two organizations together in a common goal: to strive towards halving the number of people living with HIV who die from TB by 2015, compared to 2004 levels. Provision of life-saving antiretroviral treatment for all TB patients living with HIV is another key objective.
- African leaders meeting in Zambia called for an accelerated response to AIDS.
- Rwanda has launched a plan for action specifically aimed at women and girls.
- The latest United Nations Children’s Fund (UNICEF) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) report assessed HIV/AIDS progress in 144 low- and middle-income countries in 2009 and found:
- 15 countries, including Botswana, Guyana and South Africa, were able to provide more than 80% of HIV-positive pregnant women in need, the services and medicines to prevent mother-to-child HIV transmission;
- 14 countries, including Namibia, provided HIV treatment to more than 80% of the HIV-positive children in need;
- 8 countries, including Rwanda, have achieved universal access to antiretroviral treatment (ART) for adults.
- Remarkable progress in Eastern and Southern Africa, the region most severely affected by HIV, offers hope. In this region, HIV treatment coverage has increased from 32% to 41% in one year. Half of the pregnant women were able to access HIV testing and counseling in 2009.
- In 2009, 5.25 million people had access to HIV treatment in low- and middle-income countries, accounting for 36% of those in need. This represents an increase of over 1.2 million people from December 2008, the largest increase in any single year. The good news has been counterbalanced by data showing a large increase in HIV cases in Asia and Eastern Europe.
- Preventing mother-to-child transmission of HIV is critical to achieving Millennium Development Goals in Africa. Approximately 400,000 infants acquire HIV infection each year as a result of mother-to-child transmission. Only about half of infants born to HIV-infected mothers in some African countries receive a minimum preventive dose of the drug nevirapine to help reduce the risk of mother-to-child HIV transmission. To reduce this risk WHO recommends that all women with HIV should receive antiretroviral drugs to protect against HIV transmission during pregnancy, delivery or breastfeeding. UNICEF will distribute the boxes to 30,000 pregnant women in Kenya, Cameroon, Lesotho and Zambia. The organization said that each box costs around $70, which is less than half the cost of one year of drug treatment for an HIV-positive infant.
- A change is happening among young people across the world, especially in parts of sub-Saharan Africa. Young people are waiting longer to become sexually active, have fewer multiple partners and are increasingly using condoms among those with multiple partners. As a result, HIV prevalence among young people is dropping in many key countries according to a new analysis by UNAIDS.
Reports on the Disease Diagnosis and Treatment
There is a growing recognition that rapid HIV testing is a vital tool in battling the rising incidence of this disease around the world. Testing is critical because it is the only way for individuals to become aware of their HIV status. The advent of more effective therapies means that more people are willing to be tested because, if they turn out to be HIV-positive, there are viable treatment options to which they can then turn. Progress with testing is now moving towards including a combination antigen/antibody test capable of determining HIV status during the period between infection and the onset of immune response.
Current approach suggests early and aggressive treatment should be made for all those found to be HIV positive. HIV infected patients whose treatment is delayed not only become sicker than those treated earlier, but also incur significantly higher costs over the first few years of their treatment. Late presenters are hospitalised more often, need to be put on costly antiretroviral therapy and antibiotics, and often must be treated for other diseases that have been exacerbated by a weakened immune system.
A Canadian study showed that 1 in 4 HIV patients have neurological symptoms such as headaches/migraine, nerve pain in limbs, memory loss, movement disorders, seizures and dementia. These were twice as common in those with AIDS. American studies showed that HIV positive babies with stabilised infections were suitably treated with nevirapine and that most of those with CMV retinitis being treated under the HAART scheme did not deteriorate further if not given specific CMV medicines. The same powerful drugs that have extended the lives of people with HIV come with a price such as insulin resistance that can lead to diabetes and cardiovascular disease. Research now shows that HIV protease inhibitors directly interfere with the way blood sugar levels are controlled in the body. This leads to insulin resistance. Another study showed poor kidney function is common among HIV-Infected injection drug users. The American FDA has issued a warning that the combination Invirase (saquinavir) plus Norvir (ritonavir) can cause life threatening heart arrhythmias.
Canadian researchers reported a strong link between depression and risky sexual behaviours such as improper condom use, transactional sex and relationship violence among young people in South Africa. The research shows that depression is common among young South Africans, and could be making a significant contribution towards the HIV epidemic. As well, the researchers believe that depression could be contributing to risky sexual behaviours around the world, and that preventing or treating it may reduce the global burden of sexually transmitted diseases, including HIV and AIDS.
Current or recently completed research projects include:
– Once daily 3TC efavirenz and DDI for HIV infection
-TDF/FTC oral HIV prophylaxis trial
-Resistance study in adult antiretroviral treatment
-Text messaging reminders to improve HIV medication adherence
-Pharmacokinetics in HIV infected women
-Durability of adherence in self-management of HIV
-Integration of HIV care and treatment into ante-natal care
-Optimizing paediatric HIV treatment
-Alcohol in emollient gel as topical male microbiocidals
-Computerized counseling to promote positive prevention and HIV health
-Extending HIV care beyond the rural health centre
-Effect of medication diaries on adherence to HAART among HIV infected children
-Cell phone intervention to support antiretroviral adherence
-Breast feeding, antiviral and nutrition study
Including Botswana, India, Kenya, Malawi and South Africa
-Preventing sexual transmission of HIV with anti-HIV drugs
Including Kenya, Malawi, Rwanda, South Africa, Tanzania and Zambia
-Safety study of dapivirine vaginal ring in Africa
-Mentor mothers, sustainable family intervention in South Africa townships
-Paediatric nevirapine resistance study
-Effectiveness of DOTS therapy in combined HIV/TB treatment in resource limited setting
-Treatment options for protease inhibitor exposed children
-Impact of peer health workers and mobile phones on HIV care
-Comparison of facility and home-based ART delivery systems
-Adherence and acceptability to and blood levels of tenofivor gel and tablets in HIV infected women
-Interactions between HIV and malaria in African children
Professional Activity indicated on the World AIDS Day website with locations
Barbados, Bridgetown – Launch of the Charter on HIV/AIDS and Human Rights in the Workplace in Barbados
Cameroon – will present an Exhibition, round table conferences, workshops in different provinces, sensitization campaigns and free HIV screening test,
Canada – various cities hosting raising awareness events
Ghana, Kumasi Lions Club organising HIV / AIDS and Hepatitis B awareness creation, screening and counselling programme at the Kwame Nkrumah University of Science and Technology
India, Bathinda (Punjab) – Seminars under the programme “Know aids, no aids”.,Trivandrum (Kerala) Seminar for school students on HIV care, counselling and prevention and seminar on safe blood donation preventing HIV AIDS
Kenya, Nairobi – Using sports and urban culture to deliver HIV education to young people, enhancing their sensitivity, understanding, and responsiveness to HIV/AIDS for enabling sustainable healthy lives while working to eradicate stigmatization of infected and affected persons.
Nigeria, Lagos – University medical school debate “Condom use rather than abstinence should be preached to secondary school students”.
South Africa, World AIDS Campaign: Lusikisiki – two days of workshops highlighting issues around SRHR, cultural practices, gender violence and the spread of HIV
United Kingdom, London University College – Lunch Hour Lecture: Can HIV treatment stop the AIDS epidemic? Commonwealth Institute Lecture: HIV & AIDS in the Commonwealth.
The London School of Hygiene & Tropical Medicine is hosting an event, bringing together some of the world’s leading experts on the pandemic, to discuss future projections for the AIDS pandemic.
Lecture jointly organised by the Commonwealth Foundation, the Commonwealth HIV/AIDS Action Group and the International HIV/AIDS Alliance on “The Commonwealth HIV and Human Rights”, Marlborough House, London. Speaker: Justice Ajit Prakash Shah who during his distinguished career in the High Courts of Bombay, Madras and Delhi over turned Section 377, a 150-year old British law banning gay sex between consenting adults, finding it a “violation of fundamental rights” that will be most remembered. To be chaired by Cherie Booth QC
World AIDS Day 2010 on You Tube