China has cut AIDS mortality by almost two-thirds since it began distributing antiretroviral drugs nine years ago, according to a study released in May by Chinas national centre for control and prevention of AIDS Roughly 63 percent of AIDS patients who require drugs now receive them, up from virtually none in 2002, resulting in a 64 percent drop in mortality in terms of “person-years” an estimate of how long someone would have lived without the disease AIDS mortality dropped to 142 per 100 person-years in 2009, down from 393 in 2002 Despite the success story, the Global Fund to Fight AIDS, Tuberculosis and Malaria has frozen hundreds of millions of dollars worth of grants to China over disagreements about how China manages the money, in particular its hostility towards community-based organisations About 740,000 people are infected with HIV or AIDS in China, a number that is expected to grow to 12 million by 2015, and AIDS continues to be a major killer The disease claimed 7,743 lives on the mainland in 2010, a 1679 percent increase from the previous year, making it the countrys top killer among infectious diseases for the third year in a row, according to a Ministry of Health report in February The rise was attributed to patients infected with HIV in the late 1990s who are now developing full- blown AIDS Hao Yang, the deputy director of the ministrys disease prevention and control bureau, also noted that many AIDS-related deaths in previous years went unaccounted for Wu Zunyou, an AIDS expert and director of the National Centre for AIDS/STD Control and Prevention, told China News Agency that one of the main reasons for the increase in deaths was the large number of patients who refuse testing for fear of stigmatisation, leaving treatment until it is too late He said that among the cases of AIDS-related deaths in the last five years, 80 percent had refused treatment “Its common to see misunderstanding and discrimination against AIDS patients,” Wan Yanhai, Chinas most outspoken AIDS activists who left China for the United States Last year, tells IPS on email AIDS patients seeking surgical treatment for other diseases are often refused, and sent to hospitals that treat only HIV/AIDS patients, which often lack proper surgical facilities, Xinhua News Agency reported this month Stigmatisation is fuelled by misinformation, Wan says, pointing to a survey conducted by the Chinese Journal of Health Education, which found that 51 percent of respondents said they would not shake hands with HIV carriers and 80 percent would not buy products from infected people A study conducted this March by the United Nations Joint Programme on HIV/AIDS, the Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria, and Renmin University found that 49 percent of 6,000 respondents in six Chinese cities believed AIDS was transmitted through mosquito bites Over 18 percent said they could be infected if they shared a bathroom with an AIDS patient, and another 183 percent thought they might be infected if an AIDS patient coughed or sneezed near them Meanwhile, HIV/AIDS patients continue to face hardship Liu Cuiqin, a 32-year-old AIDS patient in Fuyang city, Anhui province, was diagnosed nine years ago when she delivered her baby After she tested positive for HIV, which she picked up through a blood transfusion, her husband abandoned her, and her parents severed ties, she tells IPS Tian Xi, a 24-year-old from Zhumadian city, Henan province, received blood transfusion in March 1996 In 2004, he was diagnosed with AIDS, hepatitis B and hepatitis C He filed a lawsuit against the hospital in which he was infected, but local courts refused to hear the suit Tian is currently serving one year in prison for “intentional destruction of property” He damaged some office property in the hospital where he was infected after the hospitals president refused to speak with him, according to Tians father Chinese law forbids discrimination against HIV/AIDS patients and ensures them the right to proper treatment The government began addressing the issue seriously after an outbreak in the early 1990s, when contaminated blood was injected into tens of thousands of poor farmers In February, the State Council issued a notice requiring all relevant government departments to safeguard the rights of AIDS patients The notice also asked government departments to strengthen medical services for AIDS patients, help alleviate economic burdens on patients and families, increase the production of medicine, and offer tax subsidies on drugs But the government has largely shunned grassroots groups in the fight to control AIDS, denying them funds it had promised under the Global Fund agreement China has received 539 million dollars from the Global Fund since 2003, with an additional 295 million dollars in the pipeline Audits last year found that China had failed to give an agreed 35 percent of a 283 million dollar AIDS grant to community-based organisations This prompted the Global Fund to freeze the money “I think the Ministry of Health was fooling the Global Fund,” Wan says
In a New England Journal of Medicine opinion piece, Peter Hotez of the Sabin Vaccine Institute and colleagues, including Jeffrey Sachs of the Earth Institute of Columbia University, outline how integrating treatment of neglected tropical diseases (NTD) into HIV/AIDS, tuberculosis and malaria control efforts could speed up progress toward attaining the sixth Millennium Development Goal.
“The extensive geographic overlap between the big three diseases and the highest-prevalence NTDs, together with the evidence that these infections either promote susceptibility to or worsen the course of the big three, argues for integrating control and elimination efforts – as does consideration of the potential operational synergies,” they write (6/2).
Ahead of the U.N. High Level Meeting on AIDS, the Stop TB Partnership released five guidelines aimed at preventing tuberculosis, which results in one in four AIDS-related deaths, the U.N. News Centre writes. The five steps “include providing testing for HIV and TB every three years in places where both diseases are prevalent, as well as prompt TB treatment to every person living with HIV with active TB – or treatment to prevent TB” (6/6).
In related news, Peng Liyuan, “the wife of Xi Jinping, China’s likely next president and Communist Party chief,” will serve as a WHO Goodwill Ambassador for TB and HIV/AIDS, the Wall Street Journal’s “China Real Time Report” notes (Page, 6/7).
Middle-income countries with large numbers of people living with HIV will no longer benefit from preferential pricing when buying antiretroviral drugs from large pharmaceutical companies, according to the annual Médecins Sans Frontières (MSF) drug pricing report, Untangling the Web of ARV Price Reductions.
“The main bad news in the study is the fact that a number of pharmaceutical companies will no longer be providing preferential pricing to middle-income countries like Brazil, China, India and Thailand,” Nathan Ford, medical director at MSF’s Campaign for Access to Affordable Medicines, said at the launch of the report at the sixth International AIDS Society conference on HIV pathogenesis, treatment and prevention in Rome.
According to the report, pharmaceutical firm ViiV Healthcare – owned by Pfizer and GlaxoSmithKline – no longer offers reduced prices to middle-income countries, even when their programmes are fully funded by the Global Fund to fight Aids, Tuberculosis and Malaria.
Merck has also ceased to offer discounted prices to all lower middle- and upper middle-income countries, proposing instead to negotiate discounts on a case-by-case basis. Previ
“For the first three years we never engaged in sex, but I gathered courage and we began using condoms,” Omollo says But Omollo is well aware that this is not 100 percent safe “Every encounter still fills me with fear, the condom could burst and my fate would be sealed,” explains Omollo But now she has some hope Omollo and other Kenyan couples in discordant relationships where one partner is HIV-positive and the other is HIV-negative have welcomed findings of a recent study that found taking a daily dose of antiretrovirals ARVs reduced ones chances of contracting HIV While it is good news, it is uncertain whether the Kenyan government has the resources to provide ARVs for these HIV-negative people as the country is still struggling to provide treatment for large numbers of HIV-positive people “I am hopeful that an antiretroviral pill taken daily could reduce my chances of getting infected even if the condom were to burst,” Omollo says Peter Mathenge, whose girlfri is HIV-positive, agrees “It is very stressful constantly wondering whether every sexual encounter with your girlfri has left you infected with HIV It puts a strain in the relationship, if an ARV pill taken daily can be my additional protection, I think it would change the lives of many of us living with HIV-positive partners,” explains Mathenge, who has been in a relationship with his girlfri for the last two years The findings seem like a slow but sure shift from curative to preventive measures in the fight against HIV Africa carries the greatest burden of HIV infections and deaths resulting from AIDS It is also home to more than 15 million children who have lost one or both parents to HIV/AIDS and whose lives will never be the same again But years of fighting the disease have not drastically reduced the number of those infected in many African countries Neither has societys improved level of HIV/AIDS awareness made a difference to the high infection rate This comes as the Kenyan ministry of special programmes says that the number of new infections have risen to a high of 100,000 a year “Despite the devastating impact that HIV has had on peoples lives and development as a whole, a lack of significant positive behavioural change can be construed to mean that people are still not taking the disease seriously in spite of the fact that we are all either infected or affected,” says Dr John Ongech, a gynecologist and HIV specialist in Nairobi The Kenya National Aids Control Council, a corporate body which works towards an HIV-free society, has confirmed that being in a stable sexual relationship, either homosexual or heterosexual, increases ones chances of being infected as unfaithful partners continue to widen the web of infection as they veer off into highly risky sexual behaviour “We now know that close to half of all new infections come from people within steady unions and maybe it will be most logical to focus on such groups and come with effective preventive measures in which the non-infected partners are also taken into full consideration,” explains Girmay Haile a Senior Institutional Development Adviser at UNAIDS Various studies, the most recent and outstanding having been carried out in both Kenya and Uganda, have been touted as a breakthrough in the fight against HIV/AIDS Similar studies are being conducted in Tanzania, Malawi and South Africa In Kenya, the study dubbed the Partners PrEP trial, was carried out among 4,758 HIV discordant couples at Kenyas largest referral hospitals, Kenyatta National Hospital and Moi Teaching and Referral Hospital, in conjunction with the Kenya Medical Research Institute and the University of Washington in the United States The results of the study released on Jul 14 proved that taking a combination of antiretrovirals tenofovir and truvada, or a combination of tenofovir and emtricitabine already in use in Kenya for treatment of HIV, can reduce the risk of HIV infection by up to 73 percent “It is prevention that will win us the war against the epidemic in the absence of a curative treatment The research to find a curative measure is still underway,” explains Haile He adds: “If you look at national responses and the prevention revolution that is required to reduce new infections to manageable proportions, and then to zero infections, within a short period it is the way to go” Dr Nelly Mugo, a gynecologist in Nairobi and a leading researcher in the PrEP study, is quick to warn that ARVs should be used in combination with other methods, such as male circumcision, which has been proven to reduce HIV infection by at least 60 percent, and condoms “The drugs taken daily by the participants is a significant preventive therapy,” she emphasises As various stakeholders and medical experts rally behind the PrEP trial, providing ARVs to HIV-negative people in Kenya will greatly strain resources that are yet to cater for those already infected In Kenya at least 400,000 people of the 14 million people infected are on ARVs The Kenyan government also only provides ARVs to those with a CD4 count of at least 200 This is opposed to the World Health Organization guidelines that say people with a CD4 count of at least 350 should be on ARVs The strain to cater for the already high number of HIV-positive people in need of ARVs is a challenge that needs to be acknowledged “When we talk of HIV-negative persons accessing and using ARVs, it means a much greater burden on available resources to respond to the epidemic However, this latest finding has created a momentum towards narrowing further and preparing to address the pockets of new infections in a much more focused and effective manner,” Haile says
The WHO “called on Wednesday for an immediate halt to the use of blood tests to detect active tuberculosis [TB], saying they were faulty and leave millions of people at risk,” Reuters reports.
The agency had never recommended the tests, which are manufactured in Europe and North America and “are often targeted at countries with weak regulatory mechanisms for diagnostics, where questionable marketing incentives can override the interests of patients,” WHO TB specialist Karin Weyer said during a press conference to announce the policy recommendation, according to Reuters (Evans, 7/20).
The move represents the first time the WHO has issued an “explicit ‘negative’ policy recommendation against a practice that is widely used in tuberculosis care.