Compiled by Martin Flynn & Brucec Wainwright
Children with HIV survive
against odds
Suprising new research suggests as many as one in four infected infants are
making it to their teens without treatment in Aids-hit African countries.
Research carried out for the Wellcome Trust by Drs Liz Corbett and Rashida
Ferrand counters a widely held assumption that few children with HIV survive
to adolescence.
“This doesn't fit with what we see in Zimbabwe and hear from neighbouring
countries,” said Dr Corbett.
“It is now being realised earlier assumptions were wrong and around
one in 10 infected infants, and perhaps even as high as one in four, survive
into late childhood or early adolescence without diagnosis or treatment.”
The study, carried out at the Connaught Clinic in Harare, Zimbabwe, shows
that older children and adolescents with HIV have all the features that would
be expected from long-term survivors of infant HIV infection.
There is a need for more services to be aimed at older children and adolescents
to provide accessible, sympathetic HIV testing and treatment services, counselling
and support.
There is also a need for drugs designed for low-weight individuals whose growth
may have been stunted by undiagnosed HIV.
“A delayed diagnosis means patients have a much higher risk of developing
infections that may cause significant and irreversible damage to vital organs,”
Dr Ferrand said.
“We also know antiretroviral therapies are less effective if started
in patients with advanced disease.”
The study, published in Clinical Infectious Diseases, points out that adolescents
have already suffered the indirect effects of orphan-hood, impoverishment
and the illness of parents and siblings.
They need support for adherence to treatment regimes and there is a need for
greater focus on chronic problems such as short stature and delayed puberty.
According to latest UNAIDS figures there are 2.3 million children under the
age of 15 living with HIV and over half a million children were infected last
year.
Chinese
Aids activist freed to receive award
A 79 year old Chinese Aids activist was freed from house arrest by Beijing
authorities last month and given special permission to travel to Washington
DC to receive a Global Leadership award, given to top woman leaders.
For the last decade, Dr Gao Yaojie has worked to treat the sick, slow the
spread of HIV and expose official complicity in central China.
Speaking about the blood selling scandal in Henan, where thousands of poor
people were infected with HIV, Dr Gao said of Chinese authorities: “They
are indifferent to the life and death of ordinary people and care only about
their power, position, salaries and the country’s reputation.”
Global Aids big guns back circumcision
The World Health Organisation and UNAIDS have given their backing
to the use of circumcision as an additional protection against the spread
of HIV.
This follows the three successful trials in Kenya, Uganda and South Africa
confirming the findings of a number of studies that identified geographical
correlation between lower HIV prevalence and high rates of male circumcision
(see report in PN129).
The evidence suggested circumcision reduced the risk of heterosexual transmission
by around 60 per cent and could reduce HIV transmissions in sub-Saharan Africa
by around 5.7 million over the next 20 years.
Although circumcision rates vary around the world, at present 665 million
men worldwide, or 30 per cent are circumcised.
However, Catherine Hankins of UNAIDS warned: “Male circumcision does
not provide complete protection against HIV,” and other methods of prevention
should also be used, including condoms, delayed sexual debut and a reduction
in the number of sexual partners.
“When performed safely, adult male circumcision is a powerful tool in
a comprehensive strategy to prevent new HIV infections,” said Dr Pedro
Cahn, president of the International Aids Society.
There is, as yet, no evidence whether circumcision has any impact on the risk
of infection for women or men who have sex with other men.
UKC chair Bernard Forbes warned without additional research into the implications
for women and gay men circumcision could prove to be a Trojan horse.
Arrests
at ACT UP NY birthday demo
500 people marched in New York last month as the original ‘in yer face’
activist group ACT UP celebrated their 20th birthday.
Demonstrators demanded a single-payer health care system in the US and drug
price controls, chanting “No more bullshit, health care for all”.
Pictured is leading HIV activist, dramatist Larry Kramer who said: “I
saw old friends I hadn’t seen in years and didn’t know were still
alive.”
US HIV epidemic ‘twice as
bad’ as in Europe
The HIV epidemic in the United States is ‘appreciably worse’ than
in any in any western European country, according a top American public health
expert.
Dr Harold Jaffe, former head of HIV programmes at the Centers for Disease
Control and Prevention, said: “Deaths due to Aids in the US are twice
as high as the highest western European country, which is Portugal, and 10
times higher than the UK.”
Speaking at a recent conference in Los Angeles, he added: “Over 50 per
cent of people newly diagnosed with HIV in the US are from African American
and Latino communities, but they only make up around 13 per cent of the surveyed
population.”
Half of new infections are in men who have sex with men. This is three times
higher than in Europe despite the fact they represent only five per cent of
the US population.
Meanwhile, research from New York health officials found those aged between
35 and 39 had the highest rate of new infections, while those aged between
40 and 49 were also high.
Suprisingly, the rate of new infections was less than half of that for all
age groups under 30.
Dr Tom Coates, researcher at the University of California, pointed out: “You
have to remember, these are the folks who lived through the worst of the epidemic.
“Perhaps some of it has to do with life transitions. Partners may die,
or partnerships split up, and that always puts folks at higher risk of unsafe
sex.”
Seniors boost HIV spread
Fifteen per cent of HIV positive patients in Sun City, Arizona, USA,
are older than 50, says Dr Amardeep Sodhi, a local GP.
What is different in this age group is that the diagnosis is almost always
attributable to heterosexual sex.
Since 1991, heterosexual transmission in men older than 50 has risen 94 per
cent and 107 per cent in women, according to the Centres for Disease Control.
In the 1990s seniors accounted for 10 per cent of HIV cases but by 1999 it
was 13.4 per cent.
“There has been a shift,” Sodhi suggests: “There are more
cases of heterosexual exposure. We assume the senior age group doesn't have
this problem or this disease. It's simply ignorance.”
“Seniors may be having more casual sex than we suspect. Many have lost
their long-term spouses so they may be unwittingly exposing themselves to
this infection,” added Sodhi.
Mark Kezios, of the Ryan White Foundation, added: “Seniors often have
trouble finding the right diagnosis and medications because HIV specialist
doctors typically practise in central Phoenix where more than 70 per cent
of Arizonans with HIV reside.
“In Sun City, however, community centres do not have HIV support groups
and doctors don't regularly test for HIV.”
Another reason for the increase is that the population is ageing. People are
no longer dying of HIV if it is treated with antiretrovirals and people are
able to live a normal life. expectancy.
Clinton celebrates GMHC
As the world’s first HIV support organisation celebrated its 25th birthday
in New York last month, US Senator Hilary Clinton praised Gay Men’s
Health Crisis for its services to people living with HIV. Honours were given
to leading HIV activists and funders at the $3,000-a-head evening and guests
were entertained by Cyndi Lauper and TV star Phil Donahue.
Words
“Two years on from the Gleneagles summit, 5,000 children
die every day from drinking dirty water. More than five million living with
HIV still do not have access to medicines. As the clock ticks, people’s
lives are lost.”
Matt Phillips, Save the Children
“A common misconception regarding HIV transmission prosecutions…
is that if the complainant and the defendant share the same HIV subtype the
defendant must have infected the complainant.”
ATU’s Edwin J Bernard
“The disparity between care of domestic animals in the developed
world and human beings in sub- Saharan Africa is obscene.”
Dr Raymond Towey, British Medical Journal
“Prisons have a rate of HIV infection five times greater than nationwide,
yet they are among the few places where condoms are almost impossible to get.”
Jeremy Miller, Chicago Tribune
“I was diagnosed HIV positive last January. I always practised safer
sex but was very unlucky. People need to take time to learn how it’s
transmitted and take care... Don’t be another statistic like me.”
Letter in The London Paper
“New HCV infections in people with HIV are a growing concern –
particularly for HIV positive men who have unprotected sex with other HIV
positive men.”
Liz Highleyman, Aidsmap
