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This Week in HIV/AIDS News

Apr 10th, 2009 | one responsePosted by OIA Staff in Health & Lifestyle

HIV/AIDS Presents ‘Opportunity’ for Social Change, UNAIDS Chief Sidibe Says

Although HIV/AIDS poses significant challenges, the disease also presents opportunities for social change, UNAIDS Executive Director Michel Sidibe said recently during a visit to Senegal, AFP/Google.com reports. Sidibe said people should not regard HIV/AIDS simply as a problem but rather should use HIV/AIDS as an “entry point” to discuss social issues and “bring about changes in legislation.” According to Sidibe, HIV/AIDS presents a “political opportunity to trigger profound changes in society, to talk about difficult issues like sex education, homophobia and human rights issues in general, like the position of women in society.” He added that he regards UNAIDS “as a political agent which has to demand change” rather than as an organization with “clearly outlined programs.” He said, “UNAIDS has to be the voice for the voiceless, it should have political courage.”

In addition to presenting opportunities for social changes, HIV/AIDS garners financial resources that could contribute to improvements in local health care systems, AFP/Google.com reports. According to Sidibe, of the $25 billion needed to fund universal access to HIV/AIDS treatment, $9 billion is “earmarked for overhauling health care systems.” He said that stakeholders should “make sure” that such funding is not used exclusively for HIV/AIDS programs, adding that these resources “could be a way to transform and rebuild society around the social needs of the population.”

Sidibe also discussed efforts to secure additional financial resources for the Global Fund To Fight AIDS, Tuberculosis and Malaria, which currently is seeking $4 billion for the period between 2008 and 2010. According to Sidibe, stakeholders “need to continue to mobilize resources and redouble our efforts to make sure the Global Fund is totally financed.” However, rather than pressure international donors to contribute funding during the economic downturn, UNAIDS should consider how to optimize partnerships, Sidibe said. He added that the agency should “make sure that we can demand a certain performance, with an accountability and obligation to produce results” in addressing HIV/AIDS. Sidibe said, “Universal access to care, treatment and prevention is my number one priority,” adding that “money is essential” to achieve this goal.

According to AFP/Google.com, Sidibe during his visit also met with Senegalese President Abdoulaye Wade and discussed the recent prison sentences of nine Senegalese men who have sex with men who belonged to an HIV/AIDS advocacy organization (Parayre, AFP/Google.com, 4/9).

“Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report , search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.”

Study Supporting Earlier Antiretroviral Treatment ‘Not Definitive,’ NEJM Editorial Says

Although the results of a study comparing early and deferred antiretroviral treatment scheduled to be published in the April 30 issue of the New England Journal of Medicine are “striking,” they “cannot be considered definitive evidence that everyone with HIV should start receiving antiretroviral therapy,” Paul Sax and Lindsey Baden of the Division of Infectious Diseases at Brigham and Women’s Hospital write in an NEJM editorial.

According to the authors, the “absence of a controlled, prospective study comparing early and deferred therapy has forced treatment guidelines to rely largely on data from observational cohort studies.” Current antiretroviral treatment guidelines state that the “optimal time to start therapy for an asymptomatic patient … is unknown.” The study found that patients who did not begin antiretroviral therapy until their CD4+ T cell counts were 350 or less had a 69% increased risk of death, while those who did not begin antiretroviral therapy until their T cell counts were 500 or less had an “increased risk of death of 94%.” The authors add that although the study had a “relatively large” sample size, used “advanced statistical methods” and used “survival (rather than AIDS progression or death) as the end point,” it was not a “randomized trial and the patients who chose to begin therapy early might have differed in other important ways from those who chose to defer therapy — ways that improved survival but were not measured.”

The editorial adds that the study could not measure the “sort of ‘health-seeking’ behavior” of “patients who were offered and began potent combination antiretroviral therapy with a high T cell count in the late 1990s.” The authors write that these patients were “ideal” because they were “highly adherent, committed to doing whatever they could to prevent AIDS, and willing to push through the sometimes punishing side effects and drug-regimen burdens of the early therapies.” In addition, about 45% of patients in “each study-specified stratum of T cell counts either did not initiate antiretroviral therapy or did not have a decline in the T cell count,” yet because they are not a part of the comparative analysis, “we have no way of knowing whether antiretroviral therapy would have been beneficial in this group,” the authors write. They add that it “will be important” to follow up with these patients to “better understand the deleterious effects of poorly controlled HIV infection on end-organ dysfunction” and determine whether “some of the deaths might have been related to underlying differences (including lifestyle choices) between the two nonrandomized study groups.”

Sax and Baden add that although the study has some “limitations,” it “adds to a growing body of data supporting earlier treatment for HIV infection.” The editorial concludes that “a conclusion would require data from a randomized, prospective clinical trial, and at least three such studies are either ongoing or planned” but that evidence supporting the benefits of earlier antiretroviral therapy “continues to increase, making strategies to identify patients with HIV infection before the onset of substantial immunodeficiency all the more compelling” (Sax/Baden, New England Journal of Medicine, 4/30).

The editorial is available online. The study also is available online.

U.S. Launches Five-Year, $45M Domestic HIV/AIDS Awareness Campaign

White House, HHS and CDC officials on Tuesday announced the launch of a five-year, $45 million campaign to increase HIV/AIDS awareness in the U.S, the Washington Post reports. The campaign, titled Act Against AIDS, aims to address complacency about the disease by informing the public that one person in the U.S. contracts HIV every nine-and-a-half minutes. Kevin Fenton — director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention at CDC — said the goal “is to put the HIV epidemic back on the front burner, on the radar screen.” He explained the first phase of the communication campaign also will focus on reaching black communities, which are disproportionately affected by HIV/AIDS (Fears, Washington Post, 4/8). According to CDC, blacks represent 12% of the U.S. population but account for nearly half of new HIV cases and more than half of AIDS-related deaths each year (McKay, Wall Street Journal, 4/8). A separate phase of the campaign will target Latinos, who make up 15% of the U.S. population and 17% of new HIV infections. Melody Barnes, director of the White House’s Domestic Policy Council, added that HIV/AIDS in Washington, D.C., is of concern. A recent report found that 3% of district residents are living with the disease. According to Fenton, an estimated one in five people in the U.S. who have HIV are not aware of their status (Washington Post, 4/8). CDC will provide funding for the campaign out of the agency’s existing budget (Wall Street Journal, 4/8).

Act Against AIDS will promote HIV awareness through public service announcements, text messages and advertising on several modes of public transportation (Washington Post, 4/8). According to USA Today, the campaign also will include radio advertisements, airport dioramas, online banner ads, and online videos in English and Spanish (Sternberg, USA Today, 4/8). The campaign’s Web site, also launched Tuesday, includes prevention information and provides users with HIV testing locations. According to CDC, the agency plans to work with the Kaiser Family Foundation to encourage major entertainment and media outlets to promote the campaign messages (Wall Street Journal, 4/8). “The media and entertainment industries are powerful forces in breaking through complacency and focusing national attention on important issues,” Kaiser Family Foundation President and CEO Drew Altman said. The campaign also includes other community and public health partners from around the country, including national African-American groups, that will help spread message of Act Against AIDS (CDC release, 4/7). According to USA Today, the campaign aims to “recapture some of the urgency” from the early days of the HIV/AIDS epidemic (USA Today, 4/8).

Fenton said that health officials “need to create a basic core awareness and a national dialogue” about HIV/AIDS (Wall Street Journal, 4/8). According to Barnes, the campaign’s goal is “to remind Americans that HIV/AIDS continues to pose a serious health threat in the United States and encourage them to get the facts they need to take action for themselves and their communities” (Fox, Reuters, 4/7). Jeffrey Crowley, director of the White House Office of National AIDS Policy, said the administration will shape campaign messages based on “what works and what doesn’t” for a national HIV/AIDS strategy. This strategy might include several initiatives that President Obama supports, including needle-exchange programs, contraceptive distribution and age-appropriate sex education that includes information about contraception, USA Today reports (USA Today, 4/8).

However, some HIV/AIDS advocates have expressed concern that the campaign’s approach will be inadequate. Michael Weinstein, president of the AIDS Healthcare Foundation, said that of the more than one million HIV-positive people in the U.S., more than 300,000 have never taken an HIV test. Weinstein said, “A $45 million communications plan, no matter how well-intended, will do little to help identify those 300,000″ HIV-positive people who unknowingly could be spreading the disease (Washington Post, 4/8). David Holtgrave of Johns Hopkins University said that an “investment of $9 million a year isn’t going to reduce HIV” cases in the U.S. He said, “It’s an important piece of the puzzle, but not the whole puzzle.” According to Holtgrave, CDC’s HIV prevention budget would have to increase to $1.3 billion annually from $800 million to reduce new HIV cases by 50%, potentially through initiatives such as large-scale counseling, testing programs, preventive services and programs targeting high-risk groups (USA Today, 4/8).

PEPFAR Helped Prevent More Than 1M AIDS-Related Deaths in Africa, Study Says

The President’s Emergency Plan for AIDS Relief has helped prevent more than one million AIDS-related deaths and reduced AIDS-related mortality by an average of 10.5% annually in 12 African focus countries as more people gained access to antiretroviral drugs, according to a study published online Tuesday in the Annals of Internal Medicine, Bloomberg reports. According to the study, the program did not have any effect on overall HIV prevalence. The Agency for Healthcare Research and Quality provided funding for the study.

Eran Bendavid, an infectious diseases and health policy fellow at Stanford University, and Jayanta Bhattacharya, associate professor of medicine at Stanford, used data compiled by UNAIDS to examine HIV/AIDS data in sub-Saharan Africa (Chase, Bloomberg, 4/6). They examined the period prior to PEPFAR’s launch — 1997 to 2002 — and the period during PEPFAR’s implementation — from 2004 to 2007. The researchers compared HIV/AIDS-related mortality and prevalence among residents of 12 PEPFAR focus countries with residents of 29 other sub-Saharan African countries that did not receive PEPFAR funds (Steenhuysen, Reuters, 4/6). The PEPFAR countries examined were Botswana, Cote d’Ivoire, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia. The researchers did not include Guyana, Haiti and Vietnam — three non-African countries receiving PEPFAR funds — in their analysis (Bloomberg, 4/6).

According to the study, both the countries receiving and those not receiving PEPFAR funding had similar HIV/AIDS-related mortality rates during the period prior to PEPFAR’s launch. After the target countries began receiving PEPFAR funds, the researchers found that mortality rates decreased by about 10.5% in the PEPFAR countries, compared with the non-focus countries. The researchers also estimated that the program helped prevent about 1.1 million AIDS-related deaths (Reuters, 4/6). According to the New York Times, antiretroviral treatment provision accounts for about half of PEPFAR funding (McNeil, New York Times, 4/6). The study also found that PEPFAR’s cost per death averted was $2,450 between 2004 and 2007.

According to Bendavid, the study demonstrates that PEPFAR has allocated “a lot on treatment and treatment has worked” (Bloomberg, 4/6). Mark Dybul, former U.S. Global AIDS Coordinator and PEPFAR administrator, said that it is “great news that even in the first three years [of PEPFAR], the American people supported the saving of more than a million lives” (Dinan, Washington Times, 4/7). Peter Piot, former executive director of UNAIDS, added that the program “is changing the course of the AIDS epidemic.” Piot said, “People are not dying. That is spectacular.” However, he added, “The irony — and it is a positive irony — is that the more people are staying alive, the higher the percentage” of people living with HIV will be. According to Bendavid, any increase in HIV prevalence “probably reflects the decreasing death rate and may have several public health spillover benefits.” For example, HIV-positive adults who live longer lives “may be able to support their children and dependent elderly family members, reducing the burden of orphans and elderly care” (Bloomberg, 4/6).

Despite the study’s promising findings, challenges remain for reducing HIV/AIDS prevalence in high-burden countries, the researchers said. For example, as increased treatment distribution allows more HIV-positive people to live longer, the cost of providing treatment to the affected population will increase. According to the study authors, “The gap between the available funds and those needed will continue to increase unless the incidence of HIV in Africa is substantially reduced” by “striking the right balance between treatment and prevention.”

According to the authors, about 20% of PEPFAR funding was allocated to prevention under the Bush administration, with about one-third earmarked for abstinence-only efforts (Reuters, 4/6). When Congress reauthorized the program in 2008, the abstinence provision was removed. Bendavid said that the challenge will be to make prevention a “serious component of the program in the next five years” (Bloomberg, 4/6). Smita Baruah, government relations director for the Global Health Council, said that although PEPFAR initially focused on treatment, it should now expand its focus to prevention. She said, “As you move from emergency to sustainability, it’s not going to work just to treat your way out of the infection. You now need to figure out how do we prevent new infections” (Washington Times, 4/7). According to Bendavid, “You need to reduce the number of new people infected by at least as many as the number of people you’re keeping alive” (Bloomberg, 4/6).

First Lady Obama To Partner With French First Lady Bruni-Sarkozy on Global HIV/AIDS Efforts

First lady Michelle Obama and French first lady Carla Bruni-Sarkozy on Friday in Strasbourg, France, agreed to collaborate on efforts to address HIV/AIDS worldwide, AFP/Google.com reports. Michelle Obama and Bruni-Sarkozy met while President Obama and French President Nicolas Sarkozy attended talks leading up to the NATO 60th anniversary summit. A spokesperson for Bruni-Sarkozy said the first ladies plan to continue discussing joint HIV/AIDS efforts in the coming weeks and finalize a plan by the end of the year, AFP/Google.com reports. Bruni-Sarkozy in December 2008 was named a goodwill ambassador to the Global Fund To Fight AIDS, Tuberculosis and Malaria, and made her first trip in the role to Burkina Faso in February (AFP/Google.com, 4/4).