Compiled & edited by Gus Cairns
London hosted a major scientific conference in March, where nearly 1,000 delegates from 52 countries discussed microbicides.
Microbicides are substances that could be incorporated into lubes, creams or gels and used during sex to prevent HIV or STD transmission.
Several speakers at the conference emphasised the urgent need for such a prevention measure, particularly for women in the developing world, who have neither the money nor the power to ensure condom use.
Though microbicides for vaginal use are unlikely to be available till 2010 at the earliest, this year does see the start of five large phase III trials of six different substances. Early results from these are expected in 2007. Researchers are hoping these trials, which are among the most difficult scientific trials ever designed, both practically and ethically, will produce meaningful results.
 Hilary Benn: “Condoms not good enough” photo: gus cairns |
DfID Minister Hilary Benn said, “It’s not good enough that all we have is the male and female condom. We need to find products that enhance women’s reproductive health.”
Geeta Rao Gupta of the International Center for Research of Women, in a powerful speech, said that traditional ‘use a condom’ messages were utterly unsuitable for women. “Eighty per cent of Thai women with HIV were infected by their first and only sexual partner.” She related a conversation with a prevention worker in Ghana who said: “I cannot keep pushing the A-B-C (Abstain, Be faithful, Condom) message to women who cannot use it... I cannot keep on leading sheep to the slaughter.”
In the more distant future lie ‘hi-tech’ microbicides including anti-retroviral drugs, and microbicides for anal sex. But a seminar on rectal microbicides heard that the technical challenges for these are formidable. Animal studies have just begun, and no one is forecasting when one might be available.
PN features the Microbicides Conference next month
A 15-fold increase in syphilis cases in the last five years in San Francisco gay men has not led to a similar increase in HIV, researchers have found. And the incidence of HIV there may even be declining.
better,” said Dr Willi McFarland, the San Francisco Department of Health’s chief epidemiologist.
From 1998 to 2003, syphilis cases in San Francisco rose from 40 to 600 a year, prompting fears of a new wave of HIV infection.
But researchers at the 11th Retrovirus Conference, held in the city, reported
that recent HIV infection rates at two gay men’s STD clinics were holding
steady or even declining.
Study author Dr Kate Buchacz said: “We may be the first to say there
has been a reverse in the epidemic.”
Dr Jeffrey Klauser, San Francisco’s director of STD prevention, said that there were reasons a spike in syphilis infections might not be mirrored in an HIV spike.
He pointed out that syphilis is readily spread by oral sex where HIV is not. He said: “Perhaps as many as a quarter of these syphilis cases were transmitted through oral sex.”
 PHOTO: rob lewine©/corbis |
Girls are up to twice as likely as boys to get HIV before birth, a European study has found.
The study looked at over 3,000 babies who had been infected between 1986 and 2003. It found that the infection rate had declined from 14 per cent in 1986 to two per cent in 2003, thanks to anti-HIV treatment and Caesarean deliveries.
Only slightly more girls than boys were born with HIV. But there was a bigger difference when it came to the six out of 10 babies who were born using a Caesarean. In this group 6.2 per cent of girls and only 2.8 per cent of boys were born positive.
So it looks like girls are more likely to be infected in the womb, whereas boys, if infected, tend to get HIV during vaginal delivery. The difference may be due to different immune responses between boys and girls; girls also have lower viral loads.
Trevor Phillips, Chair of the Commission for Racial Equality, has rubbished the notion that Africans are responsible for spreading HIV in Europe. He said he was not in favour of mandatory HIV testing for immigrants because it was useless.
The 3rd National African HIV prevention Conference in London heard that 15,000 Africans are living with HIV in the UK, with Zimbabweans accounting for almost half of last year’s African diagnoses.
Phillips told the conference that HIV was a global health problem that needed global co-operation.
“ The UK must treat it as a public health issue and not an immigration one. This is a matter for Health Minister John Reid, and not David Blunkett. The Government has to consult with the African Community.”
Mr Phillips added that some African men don’t want to be associated with anything ‘too gay’, but that working together was essential for the fight against HIV.
He said: “If this is seen to stand in the way of the fight against HIV then appeals to cultural sensitivity will fall on deaf ears at the Commission.”
There is little known about the needs of African men who have sex with men. John Zavuga of Camden Primary Care Trust said this problem had prompted local organisations to create Club Afreaka for African gay men in order to do effective health promotion. About 150 punters turn up every third Thursday of the month at the Black Cap in Camden.
Edwige Fortier, policy adviser for the All Parliamentary Group on Aids, said
that with regard to the burden migrants supposedly place on the NHS, HIV
treatment represented less than one per cent of its total budget. HIV treatment
and prevention
costs were £279 million, whereas the NHS spends £3.8 billion a
year on alcohol-related illness and £7 billion on heart disease.
Lisa Power, Head of Policy and Campaigns at the Terrence Higgins Trust told
the conference that since the Mohammed Dica case THT Direct, the national
helpline, had been inundated with calls from people wanting to know what
the law states
about deliberate transmission. Kwangu Liwewe
“Nine million people developed tuberculosis last year, and two million of them died... this disease is causing so much suffering,” said Dr Lee Jong-Wook, Director General of the World Health Organisation, in his speech to the Second Stop TB Partners’ Forum, in New Delhi at the end of March.
The forum, hosted by the Indian government, brought together delegates from around the world, including ministerial representatives from TB high-burden countries.
Directly Observed Therapy Short Course (DOTS) programmes are now treating three million TB patients every year, an increase of more than one million patients compared to two years ago. However cases are not being detected at a fast enough rate to meet the 70 per cent detection target by 2005, due to the use of outdated techniques like sputum tests.
Dr Rowan Gillies, President of Médecins sans Frontières (MSF), gave a passionate presentation on the need for new methods.
“ I was in Malawi last month at our TB/HIV programme. The frustrations of TB treatment were obvious. The doctors are faced with patients sick with Aids and the dilemma of unreliable TB diagnosis.
“ For the patient, once they have their diagnosis, they have their own dilemma: committing to directly observed treatment, disrupting harvest or planting time, or instead making the choice of living and perhaps dying with untreated tuberculosis.”
The impact of HIV/Aids on fuelling the TB epidemic was emphasised by former US President Bill Clinton. He said: “To combat both epidemics, we need to strengthen the overall health system in poor countries.” Susan Cole
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The
Aids Healthcare Foundation (AHF), the largest Aids organisation in the USA,
has issued a parody of Abbott Laboratories’ recent ad campaign in order
to draw attention to the 400 per cent price increase imposed by Abbott in the
US for its protease inhibitor drug Norvir® (ritonavir). AHF has also filed
two legal complaints against Abbott for restrictive trading practices and false
advertising. But Abbott has pledged that the price increase will not apply
to federal and state drug assistance programmes. EU treatment advocates forecast
that the price increase for Norvir will be applied in Europe when a new solid-pill
formulation of the drug appears in 2005.