By David Brown
Washington Post Staff Writer
Wednesday, November 26, 2008; Page A04

A strategy of testing adults every year for HIV and immediately treating every person found to be infected could virtually end the AIDS epidemic in Africa in about a decade, new research suggests.

While nobody is seriously espousing that approach, the “thought experiment” outlined this week in the Lancet journal emphasizes the usefulness of antiretroviral drugs as tools for preventing the spread of HIV infection as well as treating it.

The power of AIDS drugs to dramatically slow the epidemic is the consequence of two well-established facts.

The first is that the amount of virus circulating in the bloodstream is the most important factor determining whether an infected person transmits the disease to another during a high-risk encounter. The second is that AIDS drugs can lower this “viral load” in the bloodstream to one-millionth of what it is without treatment.

The researchers who constructed the mathematical model used in the new study found that if a testing-and-treatment approach were pushed aggressively enough, it could prove to be “the greatest strategy for reducing transmission” of HIV, said Reuben M. Granich, a biostatistician at the World Health Organization in Geneva.

[...]
Read full article at Washington Post

By Seamus Mirodan in Freetown and Sebastien Berger
Last Updated: 2:28PM GMT 26 Nov 2008

The United Nations Children’s Fund (Unicef), which receives funding from British taxpayers, supplies essential drugs and mosquito nets to the government in Freetown. The aid is supposed to be distributed free of charge by the authorities, but has been discovered on sale in private pharmacies across the country, according to an investigation for BBC1’s Panorama programme.

The sellers are said to be shopkeepers with no qualifications as pharmacists, and the buyers often poor families who should be receiving them anyway from the authorities.

In Sierra Leone, ranked bottom in the UN Human Development Index, more children will die before reaching their fifth birthday than anywhere else on earth. There are only three fully qualified paediatricians in the country.

Mohammed Barrie is a trainee paediatrician and one of only five medical graduates who qualified in his year to stay and work in the country. He is working alongside Unicef in Sierra Leone’s child survival intervention programme in the diamond-rich province of Kono. Despite its resource wealth and with its war-torn past it is home to some of the country’s poorest families and most vulnerable HIV-positive children, for whom Unicef is supplying cotrimoxazole, an anti-bacterial medicine used to boost their immune systems.

“I would say that out of the 100 pharmacies we have here in Kono as many as 98 are selling Unicef drugs illegally,” said Dr Barrie.

“It’s a very serious problem because this one of the country’s poorest and most war-torn areas. Children from Kono are some of the most vulnerable in Sierra Leone.”

In six out of seven pharmacies the programme-makers were able to buy bottles of Unicef-supplied cotrimoxazole, and when confronted some of the owners even admitted they had bought the drugs from government stores and hospitals.

“Do you have the Unicef drugs?” one shopkeeper was asked. “Yes we have this one,” he replied. “Three thousand leones.”

The sum is only about 70p, but poverty in the area is so dire that some parents have to go without food for two days to pay for the drugs.

Asked why the medicines were being sold when they were meant to be free, another shopkeeper said: “We are not supposed to sell them, that’s what the constitution says. The reason why we’re selling them is that the government is selling them to us. We’re getting them from the government.”

Read full article at Telegraph.co.uk

By CELIA W. DUGGER
Published: November 25, 2008

JOHANNESBURG — A new study by Harvard researchers estimates that the South African government would have prevented the premature deaths of 365,000 people earlier this decade if it had provided antiretroviral drugs to AIDS patients and widely administered drugs to help prevent pregnant women from infecting their babies.

The Harvard study concluded that the policies grew out of President Thabo Mbeki’s denial of the well-established scientific consensus about the viral cause of AIDS and the essential role of antiretroviral drugs in treating it.

Coming in the wake of Mr. Mbeki’s ouster in September after a power struggle in his party, the African National Congress, the report has reignited questions about why Mr. Mbeki, a man of great acumen, was so influenced by AIDS denialists.

And it has again caused soul-searching about why his colleagues in the party did not act earlier to challenge his resistance to broadly accepted methods of treating and preventing AIDS.

Reckoning with a legacy of such policies, Mr. Mbeki’s’s successor, Kgalema Motlanthe, acted on the first day of his presidency two months ago to remove the health minister, Manto Tshabalala-Msimang, a polarizing figure who had proposed garlic, lemon juice and beetroot as AIDS remedies.

He replaced her with Barbara Hogan, who has brought South Africa — the most powerful country in a region at the epicenter of the world’s AIDS pandemic — back into the mainstream.

“I feel ashamed that we have to own up to what Harvard is saying,” Ms. Hogan, an A.N.C. stalwart who was imprisoned for a decade during the anti-apartheid struggle, said in a recent interview. “The era of denialism is over completely in South Africa.”

For years, the South African government did not provide antiretroviral medicines, even as Botswana and Namibia, neighboring countries with epidemics of similar scale, took action, the Harvard study reported.

The Harvard researchers quantified the human cost of that inaction by comparing the number of people who got antiretrovirals in South Africa from 2000 to 2005 with the number the government could have reached had it put in place a workable treatment and prevention program.

They estimated that by 2005, South Africa could have been helping half those in need but had reached only 23 percent. By comparison, Botswana was already providing treatment to 85 percent of those in need, and Namibia to 71 percent.

The 330,000 South Africans who died for lack of treatment and the 35,000 babies who perished because they were infected with H.I.V. together lost at least 3.8 million years of life, the study concluded.

Epidemiologists and biostatisticians who reviewed the study for The New York Times said the researchers had based their estimates on conservative assumptions and used a sound methodology.

“They have truly used conservative estimates for their calculations, and I would consider their numbers quite reasonable,” James Chin, a professor of epidemiology at the University of California at Berkeley’s School of Public Health, said in an e-mail message.

[...]

Read full article at NY Times

25 November 2008
By Jasper Tumuhimbise

Your article on health: “Anti Malarial-Saying Bye to the Bitter Tablet” The New Vision, Monday, November 10 attracted attention because it is part of the good news that will help save about 110,000 Ugandan children who die annually due to malaria.

Again on Saturday November 22, The New Vision ran an article about ‘Malaria Drugs running out’. The article pointed out that Uganda was running out of malaria drugs in public hospitals, after having lost funding from the Global Fund over accountability problems.

In our Anti-corruption Week campaign of 2007, it was revealed that leakages of essential medicines is up to 73% and since the drugs are meant for the rural and peri-urban poor, such leakages have only led to increased mortality rates for the vulnerable groups, mainly children and women.

If the accessibility of this drug is enhanced, it means that we can control malaria mortality to a figure of about 30 children per day compared to the current disquieting figure of 329 per day on average.

Since it is clear that the Government has branded these medicines-thanks to the Ministry of Health, the President, the National Medical Stores and National Drug Authority — what is left is to roll out the said branded medicines to lower health centres and to ensure proper use.

As a national coalition in the week ending November 16, we moved around the country and the truth is that nothing has changed in terms of costs for essential drugs like Coartem (when obtained legally or illegally).

However, there is some level of readiness in our regional coalitions in Teso, Kigezi, Rwenzori, Apac, northern Uganda, West Nile and Bunyoro regions to follow and monitor distribution of essential drugs to ensure better service delivery in this sector that has had its share of corruption.

According to statistics from the health ministry, as quoted by the Sustainable Development Centre Makerere University, malaria, acute respiratory infections, diarrhoea and malnutrition contribute to over 70% of overall child mortality in Uganda, in particular malaria is known to account for 25% of mortality among children who are less than five years of age while pneumonia and diarrhoea account for 19% and 17% respectively.

This being the case, however, in 2005, the proportion of children under five years with fever, diarrhoea and pneumonia seeking care within 24 hours of illness was 30%, but this only rose to 54% in 2006/7.

Similarly, the proportion of children under five with acute diarrhoea receiving oral rehydration therapy increased dismally from 37% to 43% in the same period; the proportion of children under five with pneumonia receiving appropriate antibiotic treatment increased modestly from 30% to 47%. Against this background, the health ministry, in its mid-term review 2007/8 has set target of 60%, 80% and 80% respectively for these indicators by the year 2009/10.

The national drug policy emphasises providing essential medicine that is to say those that are required for the treatment of the most common conditions in the majority of the population.

They should be availed in all health units at all times. Essential drugs for children that the health ministry supplies under the essential drugs are Arteminisinin Combination Therapy (ACT) for example Coartem and Duact, and Quinine for malaria; Oral Rehydration Salts, Cotrimoxazole tablets, Amoxicillin, de-worming tablets (Mebendazole and Albendazole)”.

It is the leakage in malaria drugs that needs to be followed if the situation of the children noted above is to be reversed and the goals set by the Government in the context that development goals are to be achieved and a reduction of child morbidity and mortality will happen.

In this regard, we are aware of the child survival strategy for Uganda that has been formulated by the health ministry. The strategy is to work within the framework of development goals to guide the actions for scaling up effective and affordable interventions to reduce child mortality and morbidity to achieve the Millennium Development Goal 4; and to contribute to the achievement of Poverty eradication targets during the period of 2007/8-2014/15.

The above shows that within 12 weeks, we have lost 1094 Ugandans due to malaria out of 2,384,330 reported cases. If you estimate an average cost of sh5,000 per reported case (as treatment fees), then about sh11.9m has been used in such a short time by poor patients.

The solution lies in Coartem with a success rate of over 95%. Coartem, as one of the Artemisinin- based combination therapy. A fixed dose that has been approved for treatment of malaria is a welcome initiative and since the Government has reduced it from an average of sh15,000 to sh14,000 for children dose and sh18,000 for adult dose as current market prices) to sh400 in a government facility and 800 in a private facility respectively.

Our appeal is that an effective scheme is taking long to be implemented and the average malaria deaths per day have not decreased since this was announced in September 2008.

Let us translate words into action and our nation will have better services especially in the social sectors Health, Education, Water, Agriculture as we grapple on the way to handle grand corruption that seems official. Only then can we say there is hope for the poor rural folks.

The writer is coordinator Anti-Corruption Coalition Uganda

Read article at New Vision Online

Mon, Nov 24, 2008
The Jakarta Post

IT SOUNDS like a notion from a science-fiction film.

The provincial legislative council of Papua, Indonesia, is set to pass a bylaw on HIV/Aids that requires certain sufferers living with the disease to be implanted with a microchip, so their movements can be monitored.

“This will violate the rights of people living with HIV/Aids,” said Mr Constan Karma, executive director of the Papua Aids Commission (KPAD).

Councillor John Manangsang said the microchips would be implanted only in HIV patients who were deemed to be “aggressive”.

“Aggressive means actively seeking sexual intercourse. This is one way to protect healthy people,” he said.

“Do not misunderstand human rights; if we respect the rights of the people living with HIV/Aids, then we must also respect the rights of healthy people.”

He said the public should judge the bylaw draft as a whole rather than by its constituent articles.

“The draft, for example, requires everyone to take HIV/Aids tests so that preventative measures can be taken early,” he said.

“I am a doctor, saving lives is my profession. If we want to save the limited number of Papuans, we have to take real action because 47 per cent of the country’s HIV/Aids cases are in Papua.”

Papua is the largest province of Indonesia and comprises the larger part of the western half of the island of New Guinea.

The 40-article-long bylaw also stipulates that the KPAD executive director should be a physician who understands epidemiology.

A liaison officer of the West Papua chapter of the NGO Save Papua, Mr Gunawan, said he disagreed with the bylaw.

“People with HIV/Aids do not always have sex, especially those with full-blown Aids,” he said. “And how do you measure aggressiveness?”

Mr Gunawan said Indonesia would be the worst human-rights violator if the implant plan was passed.

Ms Enita Rouw, coordinator of the Papua branch of the Indonesian Network of People Infected with HIV, said incidences of discrimination against people with HIV/Aids had declined.

“However, the stigmatisation is still there,” she said. “So please don’t use microchips. We’re humans, not animals.”

The number of people living with HIV/Aids in Papua is increasing, with 319 new cases reported as of October this year, taking the total to 4,114 reported cases.

-The Jakarta Post/Asia News Network
View article at AsiaOne