More widespread use of antiretroviral drugs (ARVs) to treat HIV infection has led to drug resistance in low- and middle-income countries, but the level “is not steep enough to cause alarm, said a survey released by the World Health Organization on Wednesday,” Agence France-Presse reports. “In low- and middle-income countries, drug resistance stood at 6.8 percent in 2010, the WHO said in its first-ever report on the matter,” the news agency writes, adding, “High-income countries, many of which began widescale treatment for HIV years earlier and used single or dual therapies that can also encourage resistance, face higher rates of resistance, from eight to 14 percent, said the study” (Sheridan, 7/18).
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The goal of an “AIDS-free generation” “requires an ambitious implementation-science agenda that improves efficiency and effectiveness and incorporates strategies for overcoming the stigma and discrimination that continue to limit the uptake and utilization of [treatment, prevention and care] services,” AIDS 2012 Co-Chair Diane Havlir of the University of California-San Francisco School of Medicine and Chris Beyrer of the Johns Hopkins Center for AIDS Research write in a New England Journal of Medicine opinion piece. They note that “[r]esearch efforts on HIV vaccines will also probably be key, and the field has been reinvigorated” by recent study results. “A combination approach to prevention that includes HIV treatment can generate tremendous gains in the short term by curtailing new HIV infections, but ending the AIDS epidemic will probably require a vaccine, a cure, or both,” they write.
Jennifer Furin, an infectious diseases physician and medical anthropologist who specializes in the management of tuberculosis (TB) and HIV in resource-poor settings, writes in a post in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog that “when it comes to the great advancements made in global HIV and TB care, children are being left behind.” She continues, “All children with HIV and TB deserve access to diagnosis and treatment, and the death of even a single child from either one of these diseases signifies a global failure. … It is time to require that pediatric formulations of TB and HIV medications be developed.” She notes that StopTB.org will host a talk show on July 22 featuring women and young people who have been affected by TB and HIV (7/17).
As part of its “AIDS Turning Point” series, GlobalPost examines how the United States and its African partners are designing clinical trials at four African sites to test whether a combination of prevention methods and strategies — “notably the vaccine-like preventative effect on transmission when someone starts taking AIDS drugs, as well as the life-long protection afforded to many due to male circumcision” — could “put them on the road to a Holy Grail: the numbers of HIV infections tumbling down.”
Advocates In Sri Lanka Call For Change To Laws That Criminalize, Stigmatize Sex Work, Same-Sex Relationships
“Sri Lanka has long enjoyed a low 0.1 percent HIV prevalence but, as the number of fresh infections rises steadily, experts are calling for a change in the country’s archaic laws that make sex work illegal and criminalizes homosexual activity,” Inter Press Service reports. “In the first quarter of the current year there were 40 new cases of HIV compared to 32 and 27 in the first quarters of 2011 and 2010 respectively, according to the National STD/AIDS Control Programme (NSACP),” the news service notes, adding “an estimated 41,000 commercial sex workers (CSWs) and 30,000 men who have sex with men (MSMs)” live in Sri Lanka. “‘In the past two years new infections are seen to be rising among those below 24 years, and 50 percent of them are MSMs,’ says NSACP director Nimal Edirisinghe,” IPS writes.
“A year after independence, South Sudan is still battling a lack of staff and resources as it tries to end its distinction of having the highest maternal mortality rate in the world,” VOA News reports. “[M]ore than 90 percent of births in South Sudan happen without the help of a skilled birth attendant, and more than 2,000 women die for every 100,000 live births,” the news service notes, adding, “This makes South Sudan one of the most dangerous places in the world to have a baby.”
Though the FDA’s Monday approval of the antiretroviral drug Truvada for pre-exposure prophylaxis (PrEP) to reduce the risk of HIV infection among people at risk of contracting the virus “was hailed by many as an important step in the fight against AIDS, concerns that people will incorrectly use the drug — potentially spurring drug resistance — led others to blast the agency for not laying down tougher rules,” the Wall Street Journal’s “Health Blog” writes. “Instead of requiring that people prove they are HIV-negative before getting a prescription filled, the FDA slapped a boxed warning on the drug, saying it must only be used by people who have a confirmed HIV-negative test prior to getting a prescription, and then get tested at least every three months while they are using it,” the blog notes (Marcus, 7/16).
“High levels of unmet need for contraception around the world have a very negative impact on women’s and children’s health and survival as well as on the prosperity of communities and nations,” Rep. Carolyn Maloney (D-N.Y.) writes in the Huffington Post’s “Global Motherhood” blog. “If these women had access to dependable voluntary contraception, unintended pregnancies would fall by more than 70 percent, 100,000 fewer women would die in childbirth, and nearly 600,000 fewer newborns would die each year,” she continues, adding, “If every woman had the option to leave a two-year gap between a birth and a subsequent pregnancy, deaths of children under five would fall by 13 percent.”
Trade Agreements Could Harm Access To Antiretroviral Drugs In Asia, Pacific, Experts And Activists Warn
“Pressure on developing countries to adopt clauses affecting intellectual property rights could limit access to generic antiretroviral (ARV) drugs in Asia and the Pacific, experts and activists warn,” PlusNews reports. According to Steven Kraus, director of the UNAIDS program in Asia and the Pacific region, only about one-third of the people in need of treatment in the region receive it, and the long-term sustainability of even that proportion will be challenging in the current economic climate, the news service notes. Kraus said World Trade Organization (WTO) member states should take advantage of flexibilities under the Trade Related Aspects of Intellectual Property Rights (TRIPS) agreement to manufacture and procure generic versions of medications “to ensure sustainability and the significant scale-up of HIV services to reach people most in need,” PlusNews continues.
The WHO and FDA approve drugs to treat malaria, tuberculosis and other diseases in low- and middle-income countries, but “some of the manufacturers, predominantly Chinese and Indian firms, may be knowingly producing” poor quality medicines, according to “the conclusion of my research teams’ studies, published this week in the journal Research and Reports in Tropical Medicine,” Roger Bate, resident scholar with the American Enterprise Institute and lead author of the studies, writes in a Washington Post opinion piece. “With little or no oversight, these companies may be cutting corners in the manufacturing process — or worse, watering down the active ingredient in their drugs, perhaps when the price of the raw material spikes and supply becomes harder to obtain,” he states, adding, “By exposing people to insufficient doses of the active ingredient, the drugs may also accelerate drug resistance and cause tremendous harm to whole populations in the long run.”