Drug resistant TB a threat to China’s HIV response
China has the second largest number of tuberculosis cases in the world and one of the highest levels of drug resistant cases of the virus, a study has found.
The open-access BioMedCentral Infectious Diseases journal reports nearly 10 per cent of China’s TB cases were multi-drug resistant, compared to global estimates of 4.8 per cent, reports Science and Development Network and Reuters.
As well as population and economic factors, the high rate of drug resistant virus is also closely related to the prevalence of HIV and AIDS, with co-infections with both viruses common, the researchers say.
Plea to Obama
A plea for new leadership and evidence-based, rational HIV/AIDS policies from the incoming Obama Administration has emerged as the new Democratic team prepares to take office.
It’s come in the form of two letters to President-elect Obama – one from HIV/AIDS activists and another women’s health advocate, reports Reproductive Health Reality Check, which is running both pieces of correspondence on its site.
Essentially, the demands centre on one key issue – the need to combine country-level HIV/AIDS programs with other reproductive health and family planning services, and with programs.
The aim, they say, is to promote basic education, eliminate child marriage, and address gender-based violence as well as run good HIV programs.
Journalism sites to watch
To keep up with journalism news that goes beyond the latest newspaper closures, television station layoffs and the dire financial straits of media companies, you cannot go past journalism.co.uk.
The British-based website keeps a good global eye on media developments, and has a great list of journalist bloggers and online courses that might be of interest to fellow reporters.
These 2009 predictions for media are particularly interesting, and sobering, while another useful site of this kind is MediaShift.
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by Dr. Laura Guay
Lancet examines UNAIDS legacy
Formed in 1996 at a time when there was little cooperation between UN agencies dealing with HIV, the United Nations Joint Program on HIV/AIDS was launched with the hope of generating decent funding levels and a unified response to HIV from institutions and from countries.
This detailed piece from The Lancet looks at UNAIDS’s original goals and asks where it should be focused into the future.
One of the main criticisms levelled at UNAIDS is its quests for “AIDS exceptionalism” – the prioritising of HIV/AIDS over all other health problems, the authors, Pam Das and Udani Samarasekera, write. Another is its failure to focus on prevention of HIV, leading to millions more infections.
While this piece does quote some of the usual suspects, such as Elizabeth Pisani, who wrote The Wisdom of Whores, it does raise some ongoing and legitimate concerns regarding UNAIDS and is therefore well worth our attention.
Sodomy laws trap gays in colonial backlash
Human Rights Watch is urging countries to reject the legacies of colonialism and repeal laws that criminalise homosexual sex.
In a report out last week, it reveals more than half of the world’s remaining anti-sodomy laws are “relics of British Colonial rule”.
Wherever these laws remain, HIV education, prevention and treatment are compromised as they result in gay men and lesbians being shut out of programs, jailed, harassed or discriminated against because of their sexuality.
Countries with these laws include, in Asia and the Pacific: Bangladesh, Bhutan, Brunei, India, Kiribati, Malaysia, Maldives, Marshall Islands, Burma, Nauru, Pakistan, Papua New Guinea, Singapore, Solomon Islands, Sri Lanka, Tonga, Tuvalu, and Western Samoa.
In Africa: Botswana, Gambia, Ghana, Kenya, Lesotho, Malawi, Mauritius, Nigeria, Seychelles, Sierra Leone, Somalia, Swaziland, Sudan, Tanzania, Uganda, Zambia, and Zimbabwe.
And 11 former British colonies in the Caribbean also retain sodomy laws derived from a different British model than the one imposed on India.
Kenyan kids at risk
Up to 50,000 children with HIV in Kenya do not have access to life-saving antiretrovirals, a Human Rights Watch report has found.
It says if left untreated, half of all children born with HIV will die before they turn two. And while 25,000 children do have access to the drugs, up to 40,000 will likely will die in the next two years if they do not receive antiretroviral treatment.
However the Kenyan Government has denied children are at risk, more than 30, 000 children with HIV are currently receiving antiretroviral therapy in over 350 health facilities around the country, according to a report on the Kenyan Broadcasting Corporation.
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Reporting risk and statistics
In medical and science reporting, the relevant statistics can often stand in the way of a good headline or clutter the story with so many figures that readers may be dissuaded from engaging.
But it’s a fine line between translating a complicated science or medical story into easy-to-understand journalism and presenting risk and probabilities in ways that cloud the intended message, warns assistant professor and author Andrew Pleasant on SciDevNet.
His feature takes us through the basics of good science reporting, from whether to represent quantitative evidence as numbers or words – say “about half” (51.2 per cent) – to ensuring that you go the extra step for your reader or viewer by fully representing how a calculation is made.
So instead of saying “20 per cent of 215 people” or “20 per cent of the sample”, say “43 of the 215 people sampled (20 per cent)”, Pleasant writes. It’s only a few more words in a sentence, but it accommodates multiple ways of understanding the evidence.
It’s well worth reading the full article – he also goes into whether to report relative risk or life-time risk as well as different, and more accurate, ways of representing figures.
Drug use and substitution treatment
One of the most successful ways to prevent HIV transmission amongst injecting drug users is substitution treatment – that is, providing methadone or other opiate substitutions as part of a treatment program aimed at helping users stop injecting.
(Remember it’s sharing needles and other injecting equipment that places users at very high risk of contracting HIV and other blood-borne diseases such as hepatitis C, so along with providing clean injecting equipment, substitution treatment rates highly in HIV prevention terms.)
The International HIV/AIDS Alliance has produced a great guide to substitution treatment, which includes tracing its growth around the world and examining why it is important for HIV prevention and treatment, along with implementation issues and advocacy priorities.
And two articles on PLoS (Public Library of Science) look at the disconnect between programs such as methadone maitainence programs, and the ongoing criminalisation of drug users that puts them at even greater risk of HIV and other harms.
This editorial discussed how public health efforts are often compromised by law enforcement policies, while this study examines the inherent contradiction in drug policy in China, where both substitution treatment programs and harsh criminal laws work against each other.
Entertainment harnessed in fight against HIV
The Kaiser Family Foundation has led the way in engaging media on the issue of HIV/AIDS – not just news media but mass media entertainment such as soap operas, music TV and other forms of popular culture.
On World AIDS Day, they announced a handful of new productions, including Are You Positive, which confronts stigma around HIV in the African American community as well as The Christina Show (the most watched Spanish language talk show in the world), which devoted an episode to the impact of HIV on the Latino community.
You can go to the Global Media AIDS Initiative site for more information about regional media partners and upcoming programs to help journalists and media organisaitons with HIV reporting.
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by Dr. Laura Guay
Preserving life
In a beautiful piece of storytelling, eight Magnum photographers have focused on the lives of people with HIV as they battle the disease and the rigours of treatment in a project called Access to Life.
Capturing images from nine countries - Mali, Russia, India, Swaziland, Rwanda, Vietnam, South Africa, Peru and Haiti - the Global Fund-sponsored project illustrates both the struggle to provide access to HIV treatment and the individual stories of hope and survival.
Featuring audio, still photographs, simple captions and some embedded video to tell the story of people before they start their drug regime and the changes four months after, the exhibition has moved from the US to Mexico and has just Paris, before travelling to London London, Berlin, and Rome throughout 2009.
Access to Life a great example of the use of Soundslides - photographs and audio - to tell the HIV story. If you're interested this technology is available to download very cheaply and the audio package that goes with it (Audacity) is free.
Homophobia fuels HIV spread
Gay men and men who have sex with men are often shut out of HIV prevention and treatment programs because of homophobic laws that criminalise their sexual behaviour.
That means they often have the highest rates of HIV transmission – a particular problem in Africa, where 38 out of 53 countries criminalise gay sex, the International Conference on AIDS and Sexually Transmitted Infections in Africa heard last week.
In Africa men who have sex with men are nine times more vulnerable to contracting HIV that the general population, Agence France-Presse reports.
It was the first time that men who have sex with men were openly represented at the crucial closing ceremony of the conference, indicating that, however slow it may be, change is in the wind.
"Gays in Africa are a reality," Steave Nemande, a gay doctor from Cameroon and a delegate at the conference told SkyNews.
Testing and treatment regime
In a bold prediction, researchers writing in the Lancet say that a massive scale up of voluntary HIV testing combined with immediate antiretroviral treatment could stop the epidemic in its tracks.
There have been criticisms that the research does not provide costings for such a large scale program but the bigger problem seems to rest with the issue already discussed in this week’s posting – access to treatment being hindered by laws that criminalise behaviour such as gay sex, sex work or injecting drug use.
Stigma and discrimination, coercion and the long-term management of people on antiretrovirals are also potential hurdles with such a program.
It would also be vital that such a program did not ignore other means of prevention such as condom use and access to clean injecting equipment, the Star reported.
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by Dr. Laura Guay
Sidibé wins top HIV job
After what seems to have been an extremely long recruitment process, UNAIDS has finally named a successor to Peter Piot, who is moving on after 13 years to take up the directorship of the new Institute for Global Health at Imperial College in the UK.
Michel Sidibé has been appointed the next executive director of the Joint United Nations Program on HIV/AIDS, stepping up from his UNAIDS deputy director role and assistant secretary-general of the United Nations.
In an editorial in the Lancet on October 18, Sidibé was described as having an impressive record in “working with international and local organisations at all levels is impressive, as is his commitment to human rights, especially for women and girls, and to greater involvement of people living with or affected by HIV/AIDS”.
His great challenge will be to defend the organisation against charges of irrelevancy and claims HIV/AIDS receives too much of the international health dollar. He must do this while meaningfully increasing prevention efforts and treatment programs and properly building the capacity of developing countries to care for those living with HIV.
Journalists tell their story
Dr Lawrence Altman, medical correspondent for the New York Times, Sarah Boseley, health editor of the Guardian and Gideon Mendel, photojournalist, discuss the challenges of reporting on the HIV/AIDS epidemic on CNN’s International Correspondent program.
This report was released on World AIDS Day.
If your news organisation created something different for World AIDS Day, post it here so we can all share it – I am sure many of you, 25 years into the epidemic, sometimes struggle to find a fresh World AIDS Day angle. I know I do.
330,000 deaths atttributed to Mbeki's policy of denial
In one way it is hard to quantify the damage done by the AIDS-denying former South African President Thabo Mbeki, as so much of it was about destroying confidence in evidence-based medicine and proven treatments.
Researchers at Harvard University has attempted to quantify the death toll from his stance -- they say at least 330,000 people died of AIDS in South Africa because his government’s decision to substantially delay the introduction of life-saving antiretroviral drugs, the Telegraph reports.
They compared the number of people who received antiretroviral treatment and prevention of mother to child transmission between 2000 and 2005 and compared it to “reasonably feasible” treatment levels in that country.
Along with the hundreds of thousands of deaths from AIDS, the study also found that 35,000 babies were unnecessarily born with HIV during that period, the Guardian reports.
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