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HomeFocusLocations and populations targeted in war against HIV/Aids

Locations and populations targeted in war against HIV/Aids

The [b]20th Annual Aids Conference[/b] held last week in [b]Melbourne, Australia[/b] drew the likes of former [b]US[/b] president Bill Clinton, singer Bob Geldorf and Professor Françoise Barré Sinoussi, outgoing president of the [b]International Aids Society[/b] and the [b]Nobel Laureate[/b] who co-discovered HIV. Marie McInerny writes on the [s]Crickey[/s] health blog that Mark Dybul, executive director of [b]The Global Fund to Fight Aids, Tuberculosis and Malaria[/b], spoke about the importance of targeting particular locations and populations in trying to end the HIV epidemic.

The [b]World Health Organisation (WHO)[/b], which presented its new guidelines in the run-up to the conference, says five groups of people are driving the global HIV epidemic: Men who have se x with men, se x workers, injection-drug users, transgender people, and people in prisons, reports [s]Medicinenet[/s]. HIV rates are ‘going down all over the world, with the exception of these key affected populations,’ Dr Fabio Mesquita, director of the HIV and viral hepatitis programme at the [b]Ministry of Health[/b] in [b]Sao Paulo, Brazil[/b] said. Men who have se x with men are up to 19 times more likely than people in the general population to be infected with HIV. Female se x workers are up to 14 times more likely to be infected. Transgender women are almost 50 times more likely to be infected.

A study has found that the campaign to promote male circumcision to prevent Aids infection also indirectly benefits women by reducing their risk of contracting the HIV virus. [s]Health24[/s] reports in [b]South Africa[/b] where large numbers of men have been circumcised, women who only had sex with circumcised partners had a 15% lower risk of being infected by HIV compared with women who also had uncircumcised partners. ‘The risk reduction is small, but it is a start,’ said investigator Kevin Jean of [b]France’s National Agency for Aids Research[/b]. The [b]WHO[/b] recommends voluntary circumcision as an option for men in 14 sub-Saharan countries struggling with high rates of HIV. The guidelines are founded on evidence from three trials carried out in [b]SA, Kenya[/b] and [b]Uganda[/b] that found circumcision resulted in a reduced HIV risk – for men – of between 50% and 60%. What has been fiercely debated, though, is the impact of male circumcision on women, the report says.

A [b]Kenya[/b] study has found that men do not engage in riskier behaviours after they are circumcised, reports [s]Science Newsline[/s]. Three clinical trials by researchers form the [b]University of Illinois[/b] at [b]Chicago[/b] showed that male circumcision significantly reduces the risk of acquiring HIV in young [b]African[/b] men. However, some experts have suggested that circumcision may increase promiscuity or decrease c ondom use. This 'risk compensation' could diminish the effectiveness of medical male circumcision programmes. Nelli Westercamp a former UIC research project coordinator says the study ‘provides the best evidence to date that concerns about risk compensation should not impede widespread implementation of voluntary male medical circumcision programmes.’

[s]Science Daily[/s] reports that researchers from [b]Temple University School of Medicine[/b] have designed a way to snip out for good integrated HIV-1 genes – the most common type of the virus that causes Aids and which has proved to be tenacious, inserting its genome permanently into its victims' DNA, forcing patients to take a lifelong drug regimen to control the virus and prevent a fresh attack. ‘This is one important step on the path toward a permanent cure for Aids,’ says Prof Kamel Khalili, chair of Neuroscience at Temple.

Researchers from [b]Duke University School of Medicine[/b] in [b]Durham, North Carolina[/b], say they have discovered a way to ‘neutralise’ antibodies invested with HIV-1 – the most predominant form of the virus – paving the way for such a vaccine. [s]Medical News Today[/s] reports that in this latest study, led by Dr Barton Haynes, Haynes and colleagues detailed the co-evolution of broadly neutralising antibodies (bnAbs) and pinpointed the viruses that trigger the production of these antibodies in an HIV-infected individual. The team discovered exactly how B cells – immune system cells that secrete antibodies into bodily fluids – are able to neutralise an array of HIV strains.

A study led by the [b]Translational Genomics Research Institute (TGen)[/b] provides insights into the interplay among bacteria, viruses and the immune system during HIV infection, reports [s]Medical News Today[/s]. Currently, doctors measure HIV-positive men's infectivity – their potential to infect others – based on their blood viral load. However, some men produce large amounts of virus in their s emen despite having low levels in their blood. And because of the importance of s emen in HIV transmission – in both homosexual and heterosexual populations – researchers sought to understand how HIV could be localised in the s emen. Significantly, the study revealed a link between higher levels of HIV and higher levels of both bacteria and cytokines, biochemicals that can be described as the immune system’s alarm bells. Senior study author Dr Lance Price, said that these findings could point to new ways to control the spread of HIV.

Researchers from the [b]University of KwaZulu-Natal[/b] and the [b]Harvard-linked Ragon Institute[/b] have concluded that South Africans, no matter how uneducated, can test themselves for HIV and get an accurate result. [s]The Times[/s] reports that a survey was conducted to find out whether a group of women with a low education level could understand the instructions for a simple HIV home testing kit developed by Ragon Institute researcher Dr Krista Dong and her team at the [b]Iteach Institute[/b] that uses a simple finger-prick test. The kit is cheaper and more sensitive than saliva tests. It also uses simple illustrations to describe its application. The researchers found that of the 233 women who used the kit, 231 got accurate results. Activists say self-testing will help people learn their status earlier and get treatment quickly. The report says in December, the [b]SA Pharmacy Council[/b] proposed removing the clause from the [b]Pharmacy Code of Good Practice[/b] that prevents its members selling test kits, but this is yet to happen. The [b]HIV Clinicians’ Society[/b] supports the self-testing kits and was considering putting pressure on the council to speed up the legal process, in the ‘public interest’.

Health activists and top doctors in [b]SA[/b] have, meanwhile, questioned the wisdom of Health Minister Aaron Motsoaledi’s announcement that the government plans to start treating HIV/Aids patients earlier, saying it will further strain already overstretched clinics and hospitals, reports [s]Business Day[/s]. Current guidelines say treatment with antiretroviral medicines should begin when an HIV/Aids patient’s CD4 count falls below 350. From 1 January, that threshold would rise to 500, the minister announced. The change will bring SA in line with WHO guidelines. But the [b]Treatment Action Campaign’s[/b] Marcus Low said the government’s priority should be to ensure that all those eligible for treatment under current guidelines were provided with the care they needed now, rather than setting ambitious new goals. The [b]Southern African HIV/Aids Clinicians Society[/b] has sent a letter to its members, advising them to assess patients individually to determine whether early treatment is appropriate.

[link url=http://blogs.crikey.com.au/croakey/2014/07/27/%E2%80%9Cvoice-is-coming-from-indigenous-people-themselves%E2%80%9D-at-ipchiv14-and-aids2014]Full Crikey health blog[/link]
[link url=http://www.medicinenet.com/script/main/art.asp?articlekey=179656]Full Medicinenet report[/link]
[link url=http://www.who.int/hiv/pub/guidelines/keypopulations/en]WHO guidelines[/link]
[link url=http://mg.co.za/article/2014-07-22-anti-cancer-drug-picks-hiv-out-of-cd4-cells-hiding-places]Full Mail & Guardian report[/link]
[link url=http://pag.aids2014.org/abstracts.aspx?aid=11267]Conference abstract[/link]
[link url=http://www.health24.com/Medical/HIV-AIDS/News/Male-circumcision-lowers-HIV-risk-for-women-20140725]Full Health24 report[/link]
[link url=http://pag.aids2014.org/Abstracts.aspx?SID=1121&AID=11010]Conference abstract[/link]
[link url=http://www.sciencenewsline.com/articles/2014072115060036.html]Full Science Newsline report[/link]
[link url=http://link.springer.com/article/10.1007%2Fs10461-014-0846-4]AIDS and Behavior abstract[/link]
[link url=http://www.sciencedaily.com/releases/2014/07/140721151905.htm]Full Science Daily report[/link]
[link url=http://www.pnas.org/content/early/2014/07/17/1405186111]PNAS abstract[/link]
[link url=http://www.medicalnewstoday.com/articles/280028.php]Full Medical News Today report [/link]
[link url=http://www.cell.com/immunity/abstract/S1074-7613(14)00123-X]Cell abstract[/link]
[link url=http://www.nature.com/nature/journal/v496/n7446/full/nature12053.html]Nature abstract[/link]
[link url=http://www.news-medical.net/news/20140725/Study-provides-insights-into-interplay-among-bacteria-viruses-and-immune-system-during-HIV-infection.aspx]Full News-Medical report[/link]
[link url=http://www.plospathogens.org/article/info%3Adoi%2F10.1371%2Fjournal.ppat.1004262]PLOS Pathogens abstract[/link]
[link url=http://www.timeslive.co.za/thetimes/2014/07/29/hiv-testing-for-dummies]Full report in The Times[/link]
[link url=http://www.bdlive.co.za/national/health/2014/07/24/hivaids-pills-at-early-stage-unwise]Full Business Day report [/link]

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