HIVHope's International Newsletter
March 2013 - Vol. IV, No 1
We are praying that you and your family are well, that God is using you in wonderful ways to help people understand HIV and respond to it as God would direct.
One thing we have become aware of in the past few months is that we need to change the way we address the issue of stigma and discrimination. Along with the rest of the HIV world, we have been talking about reducing or stopping stigma. We now realize that this is not enough. There is a need for a positive response. Thus, we encourage you to focus on replacing stigma with compassion, caring, and hope. It is not enough to not do something negative. Rather it is important to actually do something positive to replace the negative. In Luke 11:24-26, Jesus tells us not to just cast out evil spirits, but replace them with the Holy Spirit. Otherwise, the evil spirit will come back, find the house empty, and bring in seven more evil than itself.
News stories about HIV continue. I think you will find the ones below to be of interest. My hope is that they will be helpful to you in your HIV education and ministry work.
Duane Crumb for the HIVHope Team
Breaking Story
Doctors Cure Baby Born with HIV for First Time
Medical News Today: 04 Mar 2013 - 1:00 PST - A baby who received antiretroviral therapy within 30 hours of birth has been cured, researchers from Johns Hopkins Children's Center, the University of Mississippi Medical Center and the University of Massachusetts Medical School reported. Treating an HIV+ infant (or one with suspected HIV infection) in such a way so soon after birth is not common.
This is described as a “functional cure” meaning there is a lack of detectable viral replication in the absence of ongoing retroviral therapy. The patient, now 2½ years old, has not been on any HIV medications for some time and has no sign of functioning virus. This is the first case of a "functional cure" in an HIV-positive infant, the researchers announced. They say their finding could help pave the way towards the elimination of HIV infection in children.
After receiving aggressive antiretroviral therapy (ART) within thirty hours of being born, the infant underwent remission of HIV infection. The team believe that the prompt administration of ART probably led to the baby's cure by stopping the formation of difficult-to-treat viral reservoirs - dormant cells which are responsible for reigniting the infection in the majority of HIV patients soon after they stop therapy.
The authors believe this is exactly what happened to the infant they described in their report. The infant, who is now "functionally cured" - has achieved and maintained long-term viral remission without lifelong treatment and standard clinical tests found no evidence of HIV replication in the blood.
What is the difference between a functional cure and a sterilizing cure? A sterilizing cure occurs when all viral traces are completely eradicated from the body. A functional cure means that the viral presence is so minimal that it cannot be detected by standard clinical tests, but may be discernible by ultrasensitive methods.
Ten months after treatment had been discontinued, the patient underwent a series of blood tests. The doctor had expected so see high viral loads in the baby. However, according to all the tests, the child was HIV free. Suspecting there may have been an error in the laboratory the doctor ordered further tests - they all came back negative.
There is not enough data to recommend a change to current practice when treating high-risk infants, the researchers emphasized. However, this latest infant's case provides compelling evidence to start proof-of-principle studies in all high-risk newborns. "Our next step is to find out if this is a highly unusual response to very early antiretroviral therapy or something we can actually replicate in other high-risk newborns."
The New York Times mentioned that some experts who were not involved in the study said they were not completely convinced that the infant had really been infected with HIV. If there was no infection, this would simply be a case of prevention, which has already been achieved in babies born to HIV-positive mothers. The research team is certain the baby had been infected. During the child's first month of life there were five positive tests. As soon as the treatment commenced, viral blood levels dropped in the pattern typical of infected patients.
The primary goal for babies, the researchers stressed, continues to be the prevention of mother-to-child transmission of HIV "despite the promise this approach holds for infected newborns. Prevention really is the best cure.”
HIVHope - This story must be read with much caution along with the hope it offers. As the authors make clear, it is far too early to assume that this is a major breakthrough. It is only one case. People are all very different from one another. What works in one often does not work in another. However, the story also offers some wonderful hope if the results can be repeated in other infants. You are likely to hear a lot about this. We wanted to bring it to you now so that you have some background. Of course HIVHope will be following the story and will bring you updates as they become available.
In Other News
Condom use infrequent despite rising HIV rates
KAMPALA, 21 September 2012 (PLUSNEWS) - Despite nationwide efforts to increase HIV awareness and common fears of unplanned pregnancy, young, sexually active Ugandans continue to have risky sex without using condoms consistently, spurring new measures to promote the prophylaxis.
Only 36.2 percent of women and 52.9 percent of men between 20 and 24 used a condom during their last sexual intercourse in the past 12 months, according to the National AIDS Indicator Survey. Among those who had more than two partners in the past 12 months, only 23.4 percent of women and 30 percent of men reported using a condom during their last intercourse. The research also reveals that a majority of young Ugandans lack comprehensive knowledge about HIV; just 39 percent of men and women aged 15 to 24 have all the facts on how HIV is spread and how it can be prevented.
Greater fear of pregnancy
Some students at Kampala's Makerere University seem more concerned about pregnancy than about contracting sexually transmitted infections. Even so, many do not use condoms. "Of course I trust my boyfriend, [but] I fear getting pregnant because my parents will refuse to pay my tuitions fees, We would rather continue using morning after pills."
For many young couples, condom use stops after a certain comfort level is reached within a relationship.
HIVHope - This is another article demonstrating that condoms are not the answer to HIV. They are part of the answer, but when young people who know the risks are not willing to use them, condoms cannot be relied on as the first line of defence against this disease. Saving sex just for marriage continues to be the best strategy. However, sadly, most government and other programs refuse to encourage it.
Decades later, HIV stigma lingers
KAMPALA, 20 September 2012 (PLUSNEWS) - Ugandans have grown familiar with HIV over the past three decades, but new research suggests that many are still scandalized by it. Many people still attach shame and blame to people living with the virus. "It surprises us at this stage of the epidemic [that] there are still negative attitudes towards HIV-positive people. We must change our perceptions towards these people. We must accept them."
"Ultimately, such attitudes allow societies to excuse themselves from responsibility of caring for and looking after those infected. More importantly, stigma leads to secrecy and denial that hinder people from seeking counselling and testing for HIV, as well as care and support services." The issue of stigma is all the more important because, thanks to life-prolonging antiretroviral drugs, more people than ever are living with HIV.
Stigmatization Slows Kenya's Efforts to Avert Mother-to-Child HIV Transmission
Global Times (China) (11.19.12):: Xinhua News Agency - Pregnant women in Kenya are giving birth to HIV-infected babies either because they do not know their HIV status or they are avoiding the hospitals. Stigma and discrimination are driving their behaviors. In spite of the country’s great improvements in the fight against HIV, stigmatization is still a challenge. People with the disease are frowned upon, and, as a result, the fear keeps women away from the hospital.
Discrimination is worse for pregnant women, and it begins with the family. Also, at the hospital, some nurses stigmatize patients, abuse them, and make negative comments. As a result, the women may choose not return to the hospital or clinic. In addition, violence against women and poverty contribute to mother-to-child HIV infections. Women are unable to negotiate condom use with their husbands or make them go for an HIV test, and many men who know their status do not inform their wives. Some women breastfeed their infants because they cannot afford to buy formula, and thus may pass the disease to a baby that was born healthy.
HIVHope - Why are experts surprised that stigma continues? We believe it is time to change the focus from “eliminating stigma” to “replacing stigma with compassion and hope.” Merely attempting to stop negative attitudes is not nearly as effective as replacing them with the positive attitudes God wants us to have toward people.
Government adopts new PMTCT strategy
KAMPALA, 14 September 2012 (PLUSNEWS) - The government of Uganda has launched the UN World Health Organization's (WHO) "Option B+" to boost the prevention of mother-to-child HIV transmission (PMTCT). Uganda currently uses a PMTCT system similar to WHO's Option A, which involves single-dose antiretroviral (ARV) drugs for the mother - if her CD4 count is over 350 - from the 14th week, as well as ARVs during labour, delivery and one week post-partum. Pregnant women with CD4 counts below 350 are advised to start taking ARVs for their own health.
Option B - which WHO introduced alongside Option A in 2010 – involves triple therapy ARVs from the 14th week of pregnancy until one week after breastfeeding has ended, which can be up to one year.
In April of 2012, WHO added Option B+ to its repertoire; it involves providing the same triple ARV drugs to all HIV-infected pregnant women beginning in the antenatal clinic setting, and continuing this therapy for the rest of their lives. Some of the benefits of the new option include PMTCT for future pregnancies, protection of a woman's HIV-negative sexual partner from infection, and enabling continuity in ARV regimens, which reduces the chances of resistance.
Option B+ was pioneered by Malawi in 2010; Swaziland has also expressed its intention to use the strategy, which was recently called a "game-changer and one of the most exciting developments in decreasing vertical transmission and paediatric HIV in recent years".
HIVHope - There is a great deal of interest in this B+ strategy for prevention of transmission of HIV from mothers to babies. It appears to be a good idea. However, it is not without its problems and concerns as you will see in the next two articles.
Global evidence of lower adherence to ARVs after giving birth
Carole Leach-Lemens, Published: 25 September 2012 - Antiretroviral therapy (ART) adherence levels among pregnant women with HIV, in both high- and low-income countries, during pregnancy and especially after giving birth are significantly below what is recommended for viral suppression and prevention of drug resistance, according to a report published this month in AIDS.
Reported barriers include: physical, economic and social stressors, depression (notably after giving birth), alcohol or drug use and frequency of ART dosage. Conversely disclosure of HIV status and strong social support was linked to high ART adherence, so where safe and feasible both should be encouraged.
As prevention of mother-to-child transmission (PMTCT) programmes move toward universal lifelong ART for all pregnant women with HIV (World Health Organization [WHO] Option B+) the likelihood of multi-class drug resistance for both the mother and the child will increase and the safety and scale-up of these programmes be compromised.
Adverse birth outcomes more frequent in women exposed to ART during pregnancy, largest-ever study confirms
Carole Leach-Lemens - Published: 30 October 2012 - Among HIV-infected women in Botswana, starting combination antiretroviral therapy during pregnancy was associated with an increased risk for adverse birth outcomes, including pre-term delivery, small for gestational age, stillbirth and neonatal death, researchers report in the largest study of birth outcomes to date among HIV-positive women with access to ART in pregnancy.
An editorial noted that such adverse pregnancy outcomes are not surprising since HIV-positive women are additionally at increased risk for co-infections, including tuberculosis and malaria, which are also associated with adverse pregnancy outcomes. In resource-rich settings the effect of pre-term delivery on infant death and disease may be limited because of the level of care available. However, in resource-poor settings any increased risk for pre-term delivery because of ART “could have enormous impact, because options for care of preterm infants are limited and millions of HIV-infected women become pregnant each year”.
HIVHope - With this evidence of lower adherence to ARVs resulting in resistant forms of the virus and negative birth outcomes, it seems to us that more research needs to be done into the B+ option before it is widely adopted. Add to these problems the fact that Africa does not have nearly enough doctors and nurses to follow all of the HIV patients currently on ARV therapy. Where are the additional professionals going to come from that will be necessary to provide proper care to the women who are taking ARVs for life under the B+ option? This is a question we don’t even see anyone asking, much less being able to answer.
Increased Risk of Stomach and Esophageal Cancer in People With AIDS
Gastroenterology Vol. 143; No. 4: P. 943-950.e2 (10..12):: E. Christina Persson; et al - A study indicated that there is an increased risk of cancers of the stomach and esophagus in people with AIDS. The researchers analyzed data from 596,955 people. They compared stomach and esophageal malignancies in people with AIDS with those of the general public.
Results show that people with AIDS have 69 percent and 44 percent increased risks of esophageal and stomach cancers. The incidence of both increased with age, and the risk of these cancers among people with AIDS did not decline across calendar years even with the introduction of highly active antiretroviral therapy in 1996.
HIVHope - Clearly, taking ARVs carries with it some risks. This article reveals an additional one. However, with all of the risks, there is still nothing better available other than avoiding infection in the first place. That will always be the best way to deal with HIV.
Non-HIV-related illnesses and the effect of treatment
HIV Weekly 12 October 2012 - Non-HIV-related illnesses are common in people who have been recently diagnosed with HIV, Spanish research shows. However, they found that starting HIV treatment reduced the risk of many of these diseases. The study adds to the growing body of evidence showing the wide range of benefits of antiretroviral therapy .
With the right treatment and care, many HIV-positive people have an excellent prognosis. Rates of HIV-related illnesses have fallen dramatically. Serious non-HIV-related illnesses such as cardiovascular, liver, and kidney disease are now important causes of serious illness and death in patients with HIV.
The most common non-HIV-related illnesses were mental health problems such as depression, liver disease, cancers, kidney disease and cardiovascular disease. However, rates of non-HIV diseases fell after 2007. At the same time, people were beginning HIV treatment at higher CD4 cell counts. The researchers therefore believe that starting HIV treatment reduces the risk of non-HIV-related illness. This was especially the case for mental health problems and kidney disease.
HIVHope - This article offers another positive side of treatment with ARV. It is encouraging and provides even more hope for those people living with HIV
Africa faces spike in older people living with HIV
By Justine Gerardy (AFP) – 19 October 2012 CAPE TOWN — Sub-Saharan Africa is likely to see a more than 200 percent increase in the number of older people living with HIV in the next 30 years, thanks to improvements in lifesaving treatment, experts said Thursday. "The proportion of people living with HIV aged 50 and over is going to increase a lot" a researcher said at a conference on ageing in Africa. Three million people aged 50 or older currently live with HIV in sub-Saharan Africa and that figure is expected to rise to 9.1 million by 2040.
"It's mainly driven by the fact that people are being treated with antiretroviral drugs and therefore will survive to be old," he said. The faster roll-out of treatment has allowed people to live longer with the disease as in first world countries, but HIV is still a leading cause of death. Policy makers on the continent were also not acknowledging the growing age group which has doctors and others working in the field worried.
"It's a huge problem that is being ignored. It's a huge problem for the older people themselves who are often going to miss out on treatment so they are going to die sooner than they should otherwise do."
Another presenter said many patients in Africa arrived for treatment when very sick, and often with other diseases and conditions like malnutrition and anaemia, but that HIV-caused deaths fell a year into treatment. "HIV positive elderly would need special attention because they seem to start ARV treatment very late," he said.
Older people know less about the disease and are less likely to be tested, and face difficulties with access to care. "I guess it's reasonable to focus on young people because that is where most new infections occur. But there seems to be an attitude that people over 50 don't have sex and therefore can't get infected and that's clearly incorrect." Infection prevalence levels among older people in the region is four percent, only one percent lower than that of people under 50.
HIVHope - This will come as a surprise to many. HIV has for so long been seen as a disease of young people. It is now clear around the world that the virus does not care anything about age. If we do things that put us at risk, we are at risk. The good news is that more and more people are living longer with HIV. In fact, they now are living long enough that, rather than dying because they have HIV, they are dying of the same things that are killing those who do not have the virus. That is progress!
Northwestern Team Develops Fast HIV Test for Infants in Africa
Chicago Tribune (10.26.12):: Peter Frost; Melissa Harris - In Sub-Saharan Africa, it can take up to three months for mothers to know if they have passed HIV to their babies, as the tests have to be sent off to a lab. Meanwhile, infected infants are not receiving treatment. To address this problem, researchers at Northwestern University have created a new device targeted specifically for testing infants in rural Africa. It will provide results in less than an hour.
The device is the size of a single-slice toaster and is battery powered. It can be used by less experienced nurses and community health workers and should cost less than $500. The researchers aim for the cost of each test to be less than $10, and to distribute the equipment to as many rural public health clinics as possible. The intention is that mothers of HIV-infected infants should leave the clinic with a month’s supply of antiretroviral drugs for the child.
HIVHope - Since babies are born with all of their mother’s antibodies, those whose mothers test positive for HIV also test positive. Thus, the normal antibody test does not work on infants until many are too old to benefit from treatment. Far more costly and difficult tests are available in a growing number of places. This new technology could make that testing far more available in all settings. Watch for news of its availability where you live and encourage its use.
Couples HIV Testing and Counselling Prompts Rapid Switch to Consistent Condom Use in South African Study
AIDSMAP (12.05.12):: Carole Leach-Lemens - Researchers report that HIV testing and counseling of couples resulted in consistent condom use among discordant couples in stable relationships in South Africa. The 508 HIV-infected participants self-reported behavioral data. Most of the couples were in long-term relationships with low levels of intimate partner violence. The HIV-positive participants were predominantly female (77 percent), with a mean age of 33 years.
The important factor in the study was the timing of HTC for the HIV-positive participant: 0-7 days after testing positive, 8-14, 15–30, and more than 30 days. Of the participants, 71 percent who recently learned their HIV status reported having unprotected sex as compared to 25 percent who knew their status for a month. One month later, after all the couples had received HIV testing and counseling and were aware of the discordant relationship, the proportion of participants reporting unprotected sex was reduced from 71 percent to 8 percent.
Monthly counseIing for the positive partner, quarterly individual or couples’ testing, counseling for the uninfected partner, and condom provision resulted in the couples maintaining low levels of unprotected sex for one year. The authors conclude that the findings provide evidence that couples HTC is effective at rapidly increasing condom uptake, facilitating on-going condom use, and lowering rates of transmission. They advise caution in generalizing the findings to other than stable relationships.
HIVHope - This is good news and it makes sense. When a husband or wife gets tested without their partner, it is extremely difficult for them to take appropriate steps without the cooperation of that partner. When it is possible to get both partners to be tested and counseled together, great benefits can be realized.
Africa - Towards the End of AIDS
5 December 2012 - Despite significant advances, the epidemic of HIV/AIDS is far from over. According to the most recent statistics from UNAIDS, there are still 2.5 million new HIV infections worldwide and 1.7 million deaths annually from this disease. Globally, there are 34 million people living with HIV and half do not know their HIV status. Nearly half of the people in need of antiretroviral treatment (6.8 million) do not have access to these lifesaving medications ... Sub-Saharan Africa continues to carry a disproportionate burden of disease, representing 69 percent of all people infected with the virus worldwide."
According to the most recent UNAIDS factsheet on SubSaharan Africa, the number of new AIDS infections a year declined from 2.4 million to 1.8 million over the decade from 2001 to 2011. Between 2005 and 2011, the number of people dying from AIDS-related causes went down from 1.8 million to 1.2 million a year. Progress has been significant.
But the human toll remains enormous. Africa remains the most heavily affected region, with 23.5 million people living with AIDS. And, while many African countries are now funding a larger portion of their anti-AIDS efforts from their own resources, global funding is still falling short, by some $6 billion a year, of the target needed for accelerated progress against the pandemic. U.S. budget cuts could impose further shortfalls.
Sub-Sahara Africa Records Decline in HIV Infections, AIDS-Related Deaths in 2012
Guardian-Nigeria (01.03.13):: Wole Oyebade - The Joint United Nations Programme on HIV/AIDS (UNAIDS) reported a sharp decrease in the number of new HIV infections and deaths from AIDS in sub-Saharan countries from 2004 to 2011. HIV incidence declined by 25 percent, and deaths from AIDS went down by 32 percent. Deaths from TB among HIV-infected people also dropped by 28 percent from 2004 to 2011.
UNAIDS attributed the decline in incidence and mortality from HIV/AIDS to increased availability of HIV screening and the growth of antiretroviral therapy programs. Testing campaigns focused on screening by health care providers, rapid tests, and home-based testing. The report estimated that 56 percent of HIV-infected people in sub-Saharan Africa receive HIV treatment—two percent better than the global average. More than half of funding for HIV efforts in sub-Saharan Africa comes from countries outside the region, but some countries have invested more funding in HIV efforts.
“Stigma and discrimination” are still barriers to effective HIV/AIDS initiatives in sub-Saharan countries. Women accounted for 58 percent of all HIV infections in the region in 2011. HIV-infected people in sub-Saharan countries report receiving verbal abuse and say they are denied access to dental and health care because of their status. Although the Prevention of Mother-To-Child-Transmission program was successful in cutting new cases among infants by 24 percent, more than 90 percent of all HIV-infected pregnant women and children with new HIV infections lived in sub-Saharan Africa in 2011. Almost 70 percent of HIV-infected people in the world live in the sub-Saharan region.
HIVHope - HIV is not about facts, figures, and statistics. It’s about people. However, from time to time it is good to get an updated picture of the numbers. There is some encouraging news in these numbers. However, we are still a very long way from the end of this pandemic. We cannot stop motivating people to make the life-choices that will keep them free of infection.
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