The Review of International HIV News
from HIVHope International
October 2013 - Vol. IV, No 3
When God allowed me to facilitate the very first HIV Educator Seminars in Myanmar and Thailand in July of 2006, I had no idea where this ministry would take me. During August/September of this year, we reached a couple of milestones. I have now facilitated 51 seminars in 20 countries on four continents. As a result, there are now more than 1,000 people around the world empowered to create innovative approaches to HIV education and ministry that are uniquely designed to motivate the people in their own local culture. God has used this ministry to change people in so many ways, they cannot be counted. There is no way I could have done this. It is all God who has accomplished so much through the participants in these seminars. I am just thankful for the opportunity to witness Him at work. Now I look forward to seeing where He is going to take me next and what He is going to do through the people He educates and equips.
To those of you who have hosted these seminars, my thanks for all you have done and continue to do. To seminar participants, keep up the good work and continue to rely on God to give you the insights and provide all of the resources you need to communicate the Gospel of Jesus Christ through your HIV education and ministry efforts. I am blessed to have been able to be part of your journey to serve the living God.
Duane Crumb
Founder & Director
HIVHope International
CORRECTION
We've been Wrong!
For some time, our HIV Educator Seminars have been teaching something we believed to be true but now know is not correct. Please forgive me and change what you are teaching people.
While standing in line for a flight in Africa last month, I was talking to two other passengers about ways to reduce the risk of transmitting HIV from an infected mother to her baby through breast feeding, part of what is known as Prevention of Mother to Child Transmission (PMTCT). We were talking about the recommendations of the World Health Organization (WHO) that infected women should breast feed exclusively until the baby is six months old. That is all correct.
I went on to tell them what I had been told and have taught in seminars; at six months the mother should stop breast feeding and begin feeding the baby other with other foods for two reasons. First, the baby can be adequately nourished with other foods at that age. Second, at about six months a baby starts to get teeth which can result in exposure to the mother’s blood through biting. Since the concentration of HIV in blood is much greater than in breast milk, the risk of transmission goes up.
That is when another passenger turned around to challenge what I was saying. He is a scientist who was involved in drafting the WHO guidelines. Isn't it amazing how God puts us in contact with people?
He informed us that the guidelines do not recommend stopping breast feeding at six months, just stopping “exclusive” breast feeding at that age because the child needs more nourishment than is provided by breast milk. He also challenged that idea that teething is part of the reason for the six month time. He, and the ladies I started talking with, said that, while it is possible that an infant could bite a mother’s nipples when it starts developing teeth, the likelihood of this is very small and had nothing to do with the WHO guidelines.
Since this conversation, I have researched the guidelines more deeply revealing that he is right and I have been wrong. It is embarrassing to have to write this correction. Please accept my apology. I work hard to be sure that the things we teach are accurate and so must come to you promptly with this correction so that you know the truth and can be teaching others the truth.
Please let me know if you learn of anything else that might be questionable in the content of our teaching or if you have any questions. With God’s help, we will continue to provide the most reliable information possible in ways that can be understood clearly by any audience.
IN THE NEWS
The impact of HIV globally
AIDS Map - The overall annual death rate from AIDS has fallen by 21% since 2006, the most recent study of the Global Burden of Disease (GBD) series shows. However, while some countries with large HIV epidemics have been able to reduce rates of death and illness significantly, there are huge variations between countries and regions.
The GBD study compiles causes of death and disability and calculates disability-adjusted life-years (DALYs) lost to health conditions.
HIV and AIDS ranks fifth in the conditions that cause illness and death internationally. HIV is responsible for 3.3% of all DALYs lost worldwide, though in high-prevalence countries such as South Africa it is responsible for up to 40% of DALYs lost. It is the number one cause of DALYs lost for women aged 25 to 45 and men aged 30 to 45.
HIVHope - We keep hearing people talk about other diseases that kill more people than HIV. That is true. However, this article makes it clear that the number of deaths is not the only way to measure the devastation of HIV. When we look at the most productive time of life (under age 45), we find that HIV takes away more years than other diseases. The impact continues to be profound.
New WHO Guidelines on HIV Treatment and Prevention
Media for Freedom (07.05.2013) By Bobby Ramakant - During the seventh International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention, the World Health Organization (WHO) released new HIV treatment and prevention guidelines that recommended offering antiretroviral therapy (ART) to HIV-infected adults whose CD4 cell count fell to 500 cells per cubic millimeter or lower. The guidelines also recommended ART for certain HIV infected people – children under five, pregnant and breastfeeding women, partners of uninfected people, those co-infected with hepatitis B, and people with active TB – regardless of CD4 cell count. The guidelines endorsed treating adults, pregnant women, adolescents, and older children with a single, fixed-dose pill containing three classes of ARV. WHO updated the guidelines to reflect recent evidence that “earlier ART” could help HIV infected people live longer, healthier lives and reduce HIV transmission substantially.
WHO’s 2010 guidelines, adopted by 90 percent of all countries, recommended offering ART at 350 CD4 cells per cubic millimeter or lower. By the end of 2012, approximately 9.7 million people were taking ART. Adoption of the 2013 guidelines might prevent 3 million deaths and 3.5 million new HIV infections between now and 2025.
According to Dr. B.B. Rewari from India’s National AIDS Control Organization, the new guidelines will help reduce the gap that exists between the standard of care in developed and developing countries. Ongoing challenges included increasing HIV testing so that more people know their status, supplying ART to those who require it, and retaining HIV patients in care.
HIVHope - WHO guidelines are the standard used by most governments. The goal has been universal access to ARVs by 2015. This has been defined as 80% of those who need treatment receiving it. By December 2005, 1.3 million people were receiving ARV treatment. In 2010, WHO dramatically increased the number of people considered to need ARVs by calling for people to be eligible to receive treatment when their immune systems are stronger (from a CD4 (T cell) count 200 to 350. This resulted in 14.6 million people "needing" treatment from 10 million under the previous standard. As of this year, it is estimated that 9.7 million people are receiving treatment, still far below the 80% considered "universal access." The guideline recommended above is expected to add another 9.2 million people to those who are eligible for treatment. How is it going to be possible to offer treatment to so many more people? Not only does this require far more money for medicines. The real barrier is that there are just not enough trained medical personnel in the developing countries where most of those who need medication live. WHO estimates that the global shortage of trained health care staff exceeds four million. Pray with us that God will provide the way to meet this need so that those who would benefit from treatment can receive it and lead productive lives. Don't miss the next two articles that offers additional thoughts on the issue of treatment.
Starting HIV treatment
HIV Weekly 07 August 2013 - There’s currently renewed debate about the best time to start HIV treatment. Treatment guidelines in the UK take a cautious approach recommending that most people living with HIV should start taking anti-HIV drugs when they have a CD4 cell count of around 350. However, much earlier treatment is recommended in US guidelines and some doctors believe that HIV treatment would be beneficial for all patients, regardless of CD4 cell count.
But a group of authors writing in the influential scientific journal AIDS say that there is not enough evidence to support the universal use of HIV treatment.The authors included senior HIV doctors and researchers as well as a community representative.
They looked at several sets of HIV treatment guidelines. The recommendations in these guidelines about the best time to start therapy varied considerably. The authors also found that the way in which the guidelines evaluated the strength of evidence from clinical trials and other studies was very inconsistent. This is why the various guidelines make different recommendations about when to start treatment.
We are still awaiting the results of a large clinical trial (called 'START’) to see if starting HIV treatment with a CD4 cell count above 350 has extra benefits. At the moment, recommendations in the US and some other guidelines about the use of treatment at higher CD4 cell counts are based on data from studies that have monitored groups of patients over a number of years. The authors point out that not all the data from these studies show that starting HIV treatment with a higher CD4 cell count has extra benefits.
HIVHope - This article calls into question whether the change in WHO guidelines reported above might be premature or even inappropriate. We will continue to watch this issue closely.
HIV treatment: the impact of a detectable viral load
AIDS Map - Viral load is the term used to describe the amount of HIV in the blood. The aim of HIV treatment is an ‘undetectable’ viral load – that is, a level so low that it cannot be detected in a blood sample by a viral load test. (Tests used most commonly have a lower limit of detection of around 50 copies/ml, and if your viral load is below 50, it is usually said to be undetectable.)
For people on HIV treatment, having a higher viral load can be an indication that their current combination of anti-HIV drugs is not working as well as it should. It can also increase the risk of resistance developing to those drugs, and possibly to other drugs in the same class. However, not everyone on HIV treatment achieves and maintains an undetectable viral load. It has not been clear what the effect of having a very low – but detectable – viral load over the longer term would be.
Now researchers in Canada have found that having a constantly detectable viral load over a period of time is linked to an increased risk of that treatment combination not working. Even if viral load was still very low – between 50 and 199 copies/ml – people with viral loads at this level over a period of six months had twice the risk of treatment ‘failure’, compared to people whose viral loads were always undetectable.
Results were similar when the investigators looked at the persistence of low-level, but detectable, viral loads for nine and twelve months. However, the research didn't look at whether there were any differences in the effect of low-level detectable viral loads depending on which anti-HIV drugs people were on.
The authors suggest their findings confirm the importance of acting promptly if viral load is detectable over a number of months. This might include looking at adherence levels, possible interactions with other medications and closer monitoring, as well as possibly changing HIV treatment combinations.
HIVHope - It is important that people on ARV treatment be monitored regularly to be sure that the medicines are working properly. This article highlights the need for more trained health care workers and more easily available equipment for testing viral loads and CD4 counts so that people can receive the treatment that will be most effective. However, WHO says that there is a need right now for more than four million more trained health care workers around the world, especially in those developing countries hardest hit by HIV. Pray with us that God will provide wisdom for strategies to fill this huge need for trained people.
Seven African countries cut child HIV infections by half
LONDON, Reuters, Tue, Jun 25 2013 - By Kate Kelland Seven countries in sub-Saharan Africa have cut the number of new HIV infections in children by 50 percent since 2009, the United Nations AIDS programme said on Tuesday.
The dramatic reductions - in Botswana, Ethiopia, Ghana, Malawi, Namibia, South Africa and Zambia - mean tens of thousands more babies are now being born free of HIV. Overall, across 21 priority countries in Africa, there were 130,000 fewer new HIV infections among children in 2012 - a drop of 38 percent since 2009 - mostly due to increased drug treatment of pregnant women with the virus.
"The progress in the majority of countries is a strong signal that with focused efforts every child can be born free from HIV," said Michel Sidibé, UNAIDS' executive director. "But progress has stalled in some countries with high numbers of new HIV infections. We need to find out why and remove the bottlenecks which are preventing scale-up."
Among places causing concern, UNAIDS said, are Angola and Nigeria, where new infections in children have increased and remained unchanged respectively since 2009. Nigeria has the largest number of children acquiring HIV in the region, with nearly 60,000 new infections in 2012. And for those children who do become infected, access to AIDS drugs that can keep their disease in check is "unacceptably low", UNAIDS said, with only 3 in 10 children getting the AIDS medicines they need in most priority countries.
The report said much of the reduction in new HIV cases in children was thanks to more use of AIDS drug treatment for HIV-positive pregnant women. Coverage rates were above 75 percent in many of the priority countries, it said.
AIDS medicines not only improve the health of mothers with HIV, but can also prevent HIV from being transmitted to their children.
HIVHope - Here is some very good news mixed with the sobering fact that there is still so much to be done. The article provides some clues as to what can be done to reduce the risk of children being born infected with HIV.
Group Combats HIV/AIDS in Ethiopia with Community Conversations
BET.com (07.23.2013) By LaToya Bowlah – Holding peer-led discussion groups in communities has contributed to a significant drop of HIV/AIDS transmission in Ethiopia. KMG-Ethiopia, a community-based advocacy organization, initiated community conversations to halt cultural practices that often lead to HIV/AIDS and other sexual health issues. According to KMG, practices such as female genital mutilation and forced marriage fuel HIV/AIDS.
According to KMG, “Young women are given away to men who are much older than themselves. Young women in these communities do not have a choice. This harmful practice violates young women’s rights to choice and freedom of association and puts them at risk of HIV and AIDS.” By asking communities to elect peers for facilitator training, KMG said there are now 50 peer-led community conversations throughout Ethiopia that discuss basic facts about AIDS, relationship power structures, and negotiating condom use.
Ethiopia’s HIV transmission rates have dropped by 90 percent between 2001 and 2011, the largest drop in all African countries. Additionally, the country has seen a 53 percent drop in AIDS-related deaths, from 113,825 to 53,831 people from 2005 to 2011. Due to KMG’s success, the government has recently added community conversations into its HIV/AIDS prevention strategy.
Persuading communities to let go of their traditions can be difficult, but after a trip to observe the Ethiopian community conversations, Michel Sidibé, executive director of the Joint United Nations Program on HIV/AIDS, noted that during discussion groups, people would change their opinions about taboos and misunderstandings surrounding sex. HIV, and age-old practices like arranged marriages.
Dr. Moustapha Gueye, who first developed the method, took the idea to the United Nations Development Program, which then reached out to KMG to run a trial program in Ethiopia. KMG founder Bogaletch Gebre won the first African Development Prize, sponsored by the Belgium-based, King Baudoin Foundation, for her work on this project.
HIVHope - These Community Conversations sound very much like some of the things participants in our seminars are doing. The goal is to motivate people to rethink their traditional ways to understand which traditions are helpful to the culture and the ones that are very dangerous. It is conversations like these (especially when they include traditional leaders) that change the way people think and act. You may want to contact KMG Ethiopia to learn more about their approach so that you can use it where you are. Their website is http://www.kmg-ethiopia.org/.
HIV Spread 'By Wife Swapping' in Kenya - Report By Katy Migiro, 29 July 2013 Nairobi — HIV is being spread by "wife swapping" and infidelity according to a report in Kenya, where most new infections occur among heterosexual couples in stable relationships. In Nairobi, couples have adopted "MBA" - Married But Available - behaviour, where they openly have other sexual partners, Kenya's Daily Nation newspaper said.
"It is a worrying trend that is gaining momentum. There is a puzzling attitude, which is growing among young people, who go on outings in groups and later on engage in wife swapping."
People in a steady heterosexual relationship make up 44 percent of new HIV infections. This is nearly triple the rate of new infections among men who have sex with men (15 percent) and sex workers (14 percent). Women make up almost six out of 10 of adults living with HIV in Kenya. Transmission to newborns is also high, with nearly 13,000 babies infected during birth in 2011, according to government statistics.
Experts say that it is often hard for married women to insist on condom use because of the threat of violence and their economic dependence on men. Nairobi has the highest number of people in Kenya living with HIV/AIDS, at 199,100 people, and also the highest number of new HIV infections in 2011, at 13,510 people, according to the report. Its prevalence rate - the rate of infection among those over 15 years old - is 8.6 percent, higher than the national average of 6.2 percent, the Daily Nation said. Around 1.6 million Kenyans live with the disease.
HIVHope - It appears that "wife swapping" is another way to describe the "multiple concurrent long-term relationships." If you are not familiar with the concept, either you have not participated in one of our seminars or were in one prior to June of 2008. If you would like more information, please write and let us know. This article makes it clear that the problem continues and is prevalent not only in rural areas but in the cities as well. However, it does not explain the connection between this behavior and high viral loads that makes the behavior so effective in speeding the spread of HIV. How are you addressing this issue to help the people in your culture?
An AIDS Cure in Two Years? Prostratin Could make it Possible
Healthline (09.09.2013) by David Heitz – Scientists researching a cure for HIV have projected that a cure could be available in 18 to 24 months. The researchers were working on two natural compounds – prostratin and bryostatin – that they reproduced in the laboratory for medical purposes.
Prostratin comes from the bark of the Samoan mamala tree. It has been found in experiments that it flushed out the virus from cells where it was hiding. Drugs are able to kill the virus when it is in the open, but not when it is hiding in cells. When patients stopped taking their medication, the virus resurfaced and quickly multiplied.
Scientists were able to recreate the drug and design new variants and have made it 100 times more powerful than that obtained from the tree. The AIDS Research Alliance (ARA) is developing prostratin and reports they are two thirds of the way through necessary experiments before the drug would be ready for market. Researchers had performed initial tests on animals and now were conducting tests on blood from AIDS patients who had been on immunosuppressive therapy.
Bryostatin, a compound that comes from a sea creature called bryozoan, also has healing qualities. Researchers have created bryostatin variants 1,000 times more powerful at flushing HIV from cells than prostratin. However, additional work is necessary before it could be considered a successful drug candidate. The National Institutes of Health is helping to fund the research.
HIVHope - It's always very encouraging to see stories predicting major medical advances against HIV. Our prayer is that these medications will work out to be what they are hoping they will be. However, in the 30+ years we have known about this disease, there have been countless headlines like this one only to be followed by disappointing results from the research as more is learned. The problem is that people see these headlines and think the end of the disease is right around the corner. We all for giving people hope. However, false hope is worse than no hope at all. Thus, our belief is that a wait-and-see attitude is the best way to look at reports like this along with fervent prayer that God will give someone the insights and wisdom to find a way to bring an end to this awful disease.
Copyright © 2013 HIVHope International, a ministry of Equip Int'l, All rights reserved.
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from HIVHope International
October 2013 - Vol. IV, No 3
When God allowed me to facilitate the very first HIV Educator Seminars in Myanmar and Thailand in July of 2006, I had no idea where this ministry would take me. During August/September of this year, we reached a couple of milestones. I have now facilitated 51 seminars in 20 countries on four continents. As a result, there are now more than 1,000 people around the world empowered to create innovative approaches to HIV education and ministry that are uniquely designed to motivate the people in their own local culture. God has used this ministry to change people in so many ways, they cannot be counted. There is no way I could have done this. It is all God who has accomplished so much through the participants in these seminars. I am just thankful for the opportunity to witness Him at work. Now I look forward to seeing where He is going to take me next and what He is going to do through the people He educates and equips.
To those of you who have hosted these seminars, my thanks for all you have done and continue to do. To seminar participants, keep up the good work and continue to rely on God to give you the insights and provide all of the resources you need to communicate the Gospel of Jesus Christ through your HIV education and ministry efforts. I am blessed to have been able to be part of your journey to serve the living God.
Duane Crumb
Founder & Director
HIVHope International
CORRECTION
We've been Wrong!
For some time, our HIV Educator Seminars have been teaching something we believed to be true but now know is not correct. Please forgive me and change what you are teaching people.
While standing in line for a flight in Africa last month, I was talking to two other passengers about ways to reduce the risk of transmitting HIV from an infected mother to her baby through breast feeding, part of what is known as Prevention of Mother to Child Transmission (PMTCT). We were talking about the recommendations of the World Health Organization (WHO) that infected women should breast feed exclusively until the baby is six months old. That is all correct.
I went on to tell them what I had been told and have taught in seminars; at six months the mother should stop breast feeding and begin feeding the baby other with other foods for two reasons. First, the baby can be adequately nourished with other foods at that age. Second, at about six months a baby starts to get teeth which can result in exposure to the mother’s blood through biting. Since the concentration of HIV in blood is much greater than in breast milk, the risk of transmission goes up.
That is when another passenger turned around to challenge what I was saying. He is a scientist who was involved in drafting the WHO guidelines. Isn't it amazing how God puts us in contact with people?
He informed us that the guidelines do not recommend stopping breast feeding at six months, just stopping “exclusive” breast feeding at that age because the child needs more nourishment than is provided by breast milk. He also challenged that idea that teething is part of the reason for the six month time. He, and the ladies I started talking with, said that, while it is possible that an infant could bite a mother’s nipples when it starts developing teeth, the likelihood of this is very small and had nothing to do with the WHO guidelines.
Since this conversation, I have researched the guidelines more deeply revealing that he is right and I have been wrong. It is embarrassing to have to write this correction. Please accept my apology. I work hard to be sure that the things we teach are accurate and so must come to you promptly with this correction so that you know the truth and can be teaching others the truth.
Please let me know if you learn of anything else that might be questionable in the content of our teaching or if you have any questions. With God’s help, we will continue to provide the most reliable information possible in ways that can be understood clearly by any audience.
IN THE NEWS
The impact of HIV globally
AIDS Map - The overall annual death rate from AIDS has fallen by 21% since 2006, the most recent study of the Global Burden of Disease (GBD) series shows. However, while some countries with large HIV epidemics have been able to reduce rates of death and illness significantly, there are huge variations between countries and regions.
The GBD study compiles causes of death and disability and calculates disability-adjusted life-years (DALYs) lost to health conditions.
HIV and AIDS ranks fifth in the conditions that cause illness and death internationally. HIV is responsible for 3.3% of all DALYs lost worldwide, though in high-prevalence countries such as South Africa it is responsible for up to 40% of DALYs lost. It is the number one cause of DALYs lost for women aged 25 to 45 and men aged 30 to 45.
HIVHope - We keep hearing people talk about other diseases that kill more people than HIV. That is true. However, this article makes it clear that the number of deaths is not the only way to measure the devastation of HIV. When we look at the most productive time of life (under age 45), we find that HIV takes away more years than other diseases. The impact continues to be profound.
New WHO Guidelines on HIV Treatment and Prevention
Media for Freedom (07.05.2013) By Bobby Ramakant - During the seventh International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention, the World Health Organization (WHO) released new HIV treatment and prevention guidelines that recommended offering antiretroviral therapy (ART) to HIV-infected adults whose CD4 cell count fell to 500 cells per cubic millimeter or lower. The guidelines also recommended ART for certain HIV infected people – children under five, pregnant and breastfeeding women, partners of uninfected people, those co-infected with hepatitis B, and people with active TB – regardless of CD4 cell count. The guidelines endorsed treating adults, pregnant women, adolescents, and older children with a single, fixed-dose pill containing three classes of ARV. WHO updated the guidelines to reflect recent evidence that “earlier ART” could help HIV infected people live longer, healthier lives and reduce HIV transmission substantially.
WHO’s 2010 guidelines, adopted by 90 percent of all countries, recommended offering ART at 350 CD4 cells per cubic millimeter or lower. By the end of 2012, approximately 9.7 million people were taking ART. Adoption of the 2013 guidelines might prevent 3 million deaths and 3.5 million new HIV infections between now and 2025.
According to Dr. B.B. Rewari from India’s National AIDS Control Organization, the new guidelines will help reduce the gap that exists between the standard of care in developed and developing countries. Ongoing challenges included increasing HIV testing so that more people know their status, supplying ART to those who require it, and retaining HIV patients in care.
HIVHope - WHO guidelines are the standard used by most governments. The goal has been universal access to ARVs by 2015. This has been defined as 80% of those who need treatment receiving it. By December 2005, 1.3 million people were receiving ARV treatment. In 2010, WHO dramatically increased the number of people considered to need ARVs by calling for people to be eligible to receive treatment when their immune systems are stronger (from a CD4 (T cell) count 200 to 350. This resulted in 14.6 million people "needing" treatment from 10 million under the previous standard. As of this year, it is estimated that 9.7 million people are receiving treatment, still far below the 80% considered "universal access." The guideline recommended above is expected to add another 9.2 million people to those who are eligible for treatment. How is it going to be possible to offer treatment to so many more people? Not only does this require far more money for medicines. The real barrier is that there are just not enough trained medical personnel in the developing countries where most of those who need medication live. WHO estimates that the global shortage of trained health care staff exceeds four million. Pray with us that God will provide the way to meet this need so that those who would benefit from treatment can receive it and lead productive lives. Don't miss the next two articles that offers additional thoughts on the issue of treatment.
Starting HIV treatment
HIV Weekly 07 August 2013 - There’s currently renewed debate about the best time to start HIV treatment. Treatment guidelines in the UK take a cautious approach recommending that most people living with HIV should start taking anti-HIV drugs when they have a CD4 cell count of around 350. However, much earlier treatment is recommended in US guidelines and some doctors believe that HIV treatment would be beneficial for all patients, regardless of CD4 cell count.
But a group of authors writing in the influential scientific journal AIDS say that there is not enough evidence to support the universal use of HIV treatment.The authors included senior HIV doctors and researchers as well as a community representative.
They looked at several sets of HIV treatment guidelines. The recommendations in these guidelines about the best time to start therapy varied considerably. The authors also found that the way in which the guidelines evaluated the strength of evidence from clinical trials and other studies was very inconsistent. This is why the various guidelines make different recommendations about when to start treatment.
We are still awaiting the results of a large clinical trial (called 'START’) to see if starting HIV treatment with a CD4 cell count above 350 has extra benefits. At the moment, recommendations in the US and some other guidelines about the use of treatment at higher CD4 cell counts are based on data from studies that have monitored groups of patients over a number of years. The authors point out that not all the data from these studies show that starting HIV treatment with a higher CD4 cell count has extra benefits.
HIVHope - This article calls into question whether the change in WHO guidelines reported above might be premature or even inappropriate. We will continue to watch this issue closely.
HIV treatment: the impact of a detectable viral load
AIDS Map - Viral load is the term used to describe the amount of HIV in the blood. The aim of HIV treatment is an ‘undetectable’ viral load – that is, a level so low that it cannot be detected in a blood sample by a viral load test. (Tests used most commonly have a lower limit of detection of around 50 copies/ml, and if your viral load is below 50, it is usually said to be undetectable.)
For people on HIV treatment, having a higher viral load can be an indication that their current combination of anti-HIV drugs is not working as well as it should. It can also increase the risk of resistance developing to those drugs, and possibly to other drugs in the same class. However, not everyone on HIV treatment achieves and maintains an undetectable viral load. It has not been clear what the effect of having a very low – but detectable – viral load over the longer term would be.
Now researchers in Canada have found that having a constantly detectable viral load over a period of time is linked to an increased risk of that treatment combination not working. Even if viral load was still very low – between 50 and 199 copies/ml – people with viral loads at this level over a period of six months had twice the risk of treatment ‘failure’, compared to people whose viral loads were always undetectable.
Results were similar when the investigators looked at the persistence of low-level, but detectable, viral loads for nine and twelve months. However, the research didn't look at whether there were any differences in the effect of low-level detectable viral loads depending on which anti-HIV drugs people were on.
The authors suggest their findings confirm the importance of acting promptly if viral load is detectable over a number of months. This might include looking at adherence levels, possible interactions with other medications and closer monitoring, as well as possibly changing HIV treatment combinations.
HIVHope - It is important that people on ARV treatment be monitored regularly to be sure that the medicines are working properly. This article highlights the need for more trained health care workers and more easily available equipment for testing viral loads and CD4 counts so that people can receive the treatment that will be most effective. However, WHO says that there is a need right now for more than four million more trained health care workers around the world, especially in those developing countries hardest hit by HIV. Pray with us that God will provide wisdom for strategies to fill this huge need for trained people.
Seven African countries cut child HIV infections by half
LONDON, Reuters, Tue, Jun 25 2013 - By Kate Kelland Seven countries in sub-Saharan Africa have cut the number of new HIV infections in children by 50 percent since 2009, the United Nations AIDS programme said on Tuesday.
The dramatic reductions - in Botswana, Ethiopia, Ghana, Malawi, Namibia, South Africa and Zambia - mean tens of thousands more babies are now being born free of HIV. Overall, across 21 priority countries in Africa, there were 130,000 fewer new HIV infections among children in 2012 - a drop of 38 percent since 2009 - mostly due to increased drug treatment of pregnant women with the virus.
"The progress in the majority of countries is a strong signal that with focused efforts every child can be born free from HIV," said Michel Sidibé, UNAIDS' executive director. "But progress has stalled in some countries with high numbers of new HIV infections. We need to find out why and remove the bottlenecks which are preventing scale-up."
Among places causing concern, UNAIDS said, are Angola and Nigeria, where new infections in children have increased and remained unchanged respectively since 2009. Nigeria has the largest number of children acquiring HIV in the region, with nearly 60,000 new infections in 2012. And for those children who do become infected, access to AIDS drugs that can keep their disease in check is "unacceptably low", UNAIDS said, with only 3 in 10 children getting the AIDS medicines they need in most priority countries.
The report said much of the reduction in new HIV cases in children was thanks to more use of AIDS drug treatment for HIV-positive pregnant women. Coverage rates were above 75 percent in many of the priority countries, it said.
AIDS medicines not only improve the health of mothers with HIV, but can also prevent HIV from being transmitted to their children.
HIVHope - Here is some very good news mixed with the sobering fact that there is still so much to be done. The article provides some clues as to what can be done to reduce the risk of children being born infected with HIV.
Group Combats HIV/AIDS in Ethiopia with Community Conversations
BET.com (07.23.2013) By LaToya Bowlah – Holding peer-led discussion groups in communities has contributed to a significant drop of HIV/AIDS transmission in Ethiopia. KMG-Ethiopia, a community-based advocacy organization, initiated community conversations to halt cultural practices that often lead to HIV/AIDS and other sexual health issues. According to KMG, practices such as female genital mutilation and forced marriage fuel HIV/AIDS.
According to KMG, “Young women are given away to men who are much older than themselves. Young women in these communities do not have a choice. This harmful practice violates young women’s rights to choice and freedom of association and puts them at risk of HIV and AIDS.” By asking communities to elect peers for facilitator training, KMG said there are now 50 peer-led community conversations throughout Ethiopia that discuss basic facts about AIDS, relationship power structures, and negotiating condom use.
Ethiopia’s HIV transmission rates have dropped by 90 percent between 2001 and 2011, the largest drop in all African countries. Additionally, the country has seen a 53 percent drop in AIDS-related deaths, from 113,825 to 53,831 people from 2005 to 2011. Due to KMG’s success, the government has recently added community conversations into its HIV/AIDS prevention strategy.
Persuading communities to let go of their traditions can be difficult, but after a trip to observe the Ethiopian community conversations, Michel Sidibé, executive director of the Joint United Nations Program on HIV/AIDS, noted that during discussion groups, people would change their opinions about taboos and misunderstandings surrounding sex. HIV, and age-old practices like arranged marriages.
Dr. Moustapha Gueye, who first developed the method, took the idea to the United Nations Development Program, which then reached out to KMG to run a trial program in Ethiopia. KMG founder Bogaletch Gebre won the first African Development Prize, sponsored by the Belgium-based, King Baudoin Foundation, for her work on this project.
HIVHope - These Community Conversations sound very much like some of the things participants in our seminars are doing. The goal is to motivate people to rethink their traditional ways to understand which traditions are helpful to the culture and the ones that are very dangerous. It is conversations like these (especially when they include traditional leaders) that change the way people think and act. You may want to contact KMG Ethiopia to learn more about their approach so that you can use it where you are. Their website is http://www.kmg-ethiopia.org/.
HIV Spread 'By Wife Swapping' in Kenya - Report By Katy Migiro, 29 July 2013 Nairobi — HIV is being spread by "wife swapping" and infidelity according to a report in Kenya, where most new infections occur among heterosexual couples in stable relationships. In Nairobi, couples have adopted "MBA" - Married But Available - behaviour, where they openly have other sexual partners, Kenya's Daily Nation newspaper said.
"It is a worrying trend that is gaining momentum. There is a puzzling attitude, which is growing among young people, who go on outings in groups and later on engage in wife swapping."
People in a steady heterosexual relationship make up 44 percent of new HIV infections. This is nearly triple the rate of new infections among men who have sex with men (15 percent) and sex workers (14 percent). Women make up almost six out of 10 of adults living with HIV in Kenya. Transmission to newborns is also high, with nearly 13,000 babies infected during birth in 2011, according to government statistics.
Experts say that it is often hard for married women to insist on condom use because of the threat of violence and their economic dependence on men. Nairobi has the highest number of people in Kenya living with HIV/AIDS, at 199,100 people, and also the highest number of new HIV infections in 2011, at 13,510 people, according to the report. Its prevalence rate - the rate of infection among those over 15 years old - is 8.6 percent, higher than the national average of 6.2 percent, the Daily Nation said. Around 1.6 million Kenyans live with the disease.
HIVHope - It appears that "wife swapping" is another way to describe the "multiple concurrent long-term relationships." If you are not familiar with the concept, either you have not participated in one of our seminars or were in one prior to June of 2008. If you would like more information, please write and let us know. This article makes it clear that the problem continues and is prevalent not only in rural areas but in the cities as well. However, it does not explain the connection between this behavior and high viral loads that makes the behavior so effective in speeding the spread of HIV. How are you addressing this issue to help the people in your culture?
An AIDS Cure in Two Years? Prostratin Could make it Possible
Healthline (09.09.2013) by David Heitz – Scientists researching a cure for HIV have projected that a cure could be available in 18 to 24 months. The researchers were working on two natural compounds – prostratin and bryostatin – that they reproduced in the laboratory for medical purposes.
Prostratin comes from the bark of the Samoan mamala tree. It has been found in experiments that it flushed out the virus from cells where it was hiding. Drugs are able to kill the virus when it is in the open, but not when it is hiding in cells. When patients stopped taking their medication, the virus resurfaced and quickly multiplied.
Scientists were able to recreate the drug and design new variants and have made it 100 times more powerful than that obtained from the tree. The AIDS Research Alliance (ARA) is developing prostratin and reports they are two thirds of the way through necessary experiments before the drug would be ready for market. Researchers had performed initial tests on animals and now were conducting tests on blood from AIDS patients who had been on immunosuppressive therapy.
Bryostatin, a compound that comes from a sea creature called bryozoan, also has healing qualities. Researchers have created bryostatin variants 1,000 times more powerful at flushing HIV from cells than prostratin. However, additional work is necessary before it could be considered a successful drug candidate. The National Institutes of Health is helping to fund the research.
HIVHope - It's always very encouraging to see stories predicting major medical advances against HIV. Our prayer is that these medications will work out to be what they are hoping they will be. However, in the 30+ years we have known about this disease, there have been countless headlines like this one only to be followed by disappointing results from the research as more is learned. The problem is that people see these headlines and think the end of the disease is right around the corner. We all for giving people hope. However, false hope is worse than no hope at all. Thus, our belief is that a wait-and-see attitude is the best way to look at reports like this along with fervent prayer that God will give someone the insights and wisdom to find a way to bring an end to this awful disease.
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