Tuesday, December 1, 2009

Discrimination and Treatment Targeted on World AIDS Day

Calls to end discrimination rang out across the globe today in a tidal wave of RED ribbons as countries marked World AIDS Day.

World AIDS Day, observed December 1 each year, is dedicated to raising awareness of the AIDS pandemic caused by the spread of HIV infection. It is common to hold memorials to honor persons who have died from HIV/AIDS on this day. Government and health officials also observe the event, often with speeches or forums on the AIDS topics. Since 1995, the President of the United States has made an official proclamation on World AIDS Day. Governments of other nations have followed suit and issued similar announcements.

The color RED has come to represent the movement to find a cure, as well as a non-profit organization that raises funds to fight the disease worldwide and provide treatment to those in need.

AIDS has killed more than 25 million people between 1981 and 2007, making it one of the most destructive epidemics in recorded history. Despite recent, improved access to antiretroviral treatment and care in many regions of the world, the AIDS epidemic claimed an estimated 2 million lives in 2007, of which about 270,000 were children. World AIDS Day began in 1987.

To read an important blog about the day, the disease, and taking precautions, please read my buddy BISH’s post.

South Africa, the nation worst affected by the pandemic, rolled out a new battle plan to defeat the virus. South Africa's President Jacob Zuma said today that his government will treat more AIDS patients and expand testing for HIV. He said the goal is to treat 80 percent of the country's affected people by 2012.

China warned today that the occurrence of the virus among homosexuals is gaining pace. President Hu Jintao called on the public to not discriminate against those with HIV.

Protesters actually interrupted an AIDS conference to focus attention on the stigma of having the disease, and the tendency for the government to deny needed treatment to homosexuals.

In the South Korean capital, protesters filed a petition with the country's human rights watchdog seeking an end to mandatory HIV tests for some foreign workers.

On Monday, White House officials said a longtime ban on HIV-positive visitors to the United States will be lifted early next year.

Washington also announced its plans to host the International AIDS Conference in 2012, and to spend 120 million dollars for treatment to help victims worldwide.

U.S. Secretary of State Hillary Clinton said Monday that President Barack Obama is dedicated to enhancing America's leadership in the fight against global AIDS. The previous administration of President George W. Bush began the process of lifting the HIV ban for visitors, which as been in effect for 22 years. The ban is expected to be lifted on Jan. 4, 2010. The conference is scheduled for July 2012.

The International AIDS Society said in a statement Monday that the new U.S. entry policy for people living with HIV reflects the country's key role in global efforts to combat AIDS. The U.S. last hosted the conference in 1990.

The United Nations says that last year, at least 33.4 million people globally were living with HIV and that 2.7 million new infections were reported. The U.N. also says two million deaths were due to AIDS last year.

While the war against HIV/AIDS is still far from over, 2009 is proving to be a watershed year in terms of advances in prevention and treatment, experts say.

In fact, earlier this month a U.N. report found that the number of people infected with HIV globally has remained unchanged, at about 33 million, for the past two years, but may have peaked in the late 1990’s.

Why the change? One big reason could be expanded access to antiretroviral drugs. A report released in October by the World Health Organization, UNICEF and UNAIDS found that 42 percent of people in the developing world who carry HIV now have access to life-extending medications. By the end of 2008, more than 4 million people worldwide were on antiretroviral medicines – 2.9 million of them in sub-Saharan Africa, where the bulk of HIV-positive people live. That's a tenfold increase in access over the prior five years!

"I think this has come about through a number of organizations that have been trying to get drugs to be available to people in the developing world," said Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases. He especially credited the President's Emergency Plan for AIDS Relief (PEPFAR), begun under the second Bush presidency, which he said "is responsible for over 2 million people being on therapy."

Other nonprofit groups – most notably the Clinton Foundation and the Gates Foundation – have also led the charge, helping to broker price-reduction schemes with pharmaceutical companies for the cheap distribution of AIDS drugs in poorer nations.

More widespread access to treatment may also pay dividends in prevention, one expert noted.

"I think this is an interesting story that's been emerging this year, as well – the possibility that people who are on antiretroviral therapy are less infectious," said Rowena Johnston, director of research for the Foundation for AIDS Research (amfAR), based in New York City. She said that while the effect of widespread treatment on infectivity has yet to be proven, decreased viral load in infected people might help reduce the odds of their passing HIV on to others.

In fact, the U.S. Centers for Disease Control and Prevention and the U.S. National Institutes of Health are planning major studies in New York City and Washington, D.C., to see if better identification and treatment of HIV-positive people can help keep infection rates down across the community as a whole, Johnston said.

There was also promising news this year in terms of the search for an effective AIDS vaccine.

In October, researchers reporting in the New England Journal of Medicine confirmed that a combination of two vaccines brought about a modest, 31 percent reduction in infection rates among a cohort of 16,000 young adult volunteers in Thailand who were tracked for about three years. Analysis of the trial data suggested that the vaccines' effect faded with time, however, and was less effective in those at highest risk of HIV, such as sex workers or IV drug abusers.

For these reasons, no one is calling the trial a success. However, "the reason that we think it is potentially important is that it's the first time that we've ever seen the slightest positive signal" that immunization against HIV might work, Fauci said. "So, mild as [this result] is, at least it's a step in the right direction."

Johnston agreed, and called the trial an important stepping stone to further research.

"There's going to be a lot of intensive effort looking at blood samples of the people who seem to have done well on the vaccine," she explained. "If anybody can tease out what the magic ingredients are, that will form the cornerstone of how we move forward on AIDS vaccine development."

There were also new glimmers of hope in terms of treatment. One major story was reported as a case study in February in the New England Journal of Medicine. The patient in question was both HIV-positive and had leukemia, and received a stem cell transplant to help cure the cancer. The transplant was unique, however, in that the donor carried a rare gene mutation providing virtual immunity to HIV.

The result: post-transplant, the patient now has no detectable level of HIV in his system.

Johnston stressed that such a therapy could never become a widespread treatment for HIV/AIDS, because the donor pool is so scarce and bone marrow transplants carry a 30 percent risk of death. But the case does offer intriguing possibilities.

"It's a proof of concept that maybe you can cure HIV," she said. "So, there's been interest in finding out where you could do something similar with using gene therapy, for example," bypassing the need for dangerous stem cell transplants.

Other advances in HIV/AIDS made headlines as well in 2009. In February, a topical microbicide gel was found to cut the odds of HIV infection in at-risk African women by 30 percent, while in September researchers at the International AIDS Vaccine Initiative said they'd discovered two immune-system antibodies that might become powerful, broad-spectrum targets for vaccine research in the future.

And as already mentioned in policy news, the Obama administration in late October lifted a decades-old ban on foreigners with HIV entering the United States. As reported by the Associated Press, Obama described the ban as a policy "rooted in fear rather than fact," and said its removal would encourage HIV testing and help save lives.

Still, despite this year's advances, HIV/AIDS continues its decades-long swath of destruction, both in the United States and globally.

As Fauci pointed out, the annual rate of new infections in the United States has been stuck at a dismal 56,000 for the past decade. "We've sort of hit a wall to get below that number," he said. "We need to intensify the multifaceted prevention efforts that are ongoing."

Susan Smith Ellis, CEO of RED, wrote the following in today's Huffington Post:

“The novelist David Rhodes once wrote that life's fundamental narrative begins with ‘I’ and ends with ‘you.’ Everything in between is conveyance from one person to another. What we convey is what matters.

“The basic idea of (RED)™ is transactional conveyance; I buy a (RED)-branded product, be it an Apple iPod, a Nike shoelace or a Gap tee-shirt, and a percentage of the profit from that sale goes to the Global Fund. The Global Fund administers a well-managed network of health care projects in sub-Saharan Africa to help stem the spread of AIDS. Somewhere in Ghana or Rwanda or Botswana, someone gets antiretroviral medication which keeps them alive or reduces the likelihood that they will transmit HIV to their unborn or just-born child. And so that someone, who otherwise might die or be destined to die, lives or bequeaths a more promising life instead. It's a good deal.

“On World AIDS Day, we don't celebrate with fireworks or champagne. We take note of what has been accomplished and we resolve to keep at it. We are proud of what our partners have accomplished. We like to say that they have gained market share for life (and for themselves) and in so doing they have changed the course of a part of human history.

“In 2006, it was estimated that only 8 percent of HIV-positive pregnant women in Ghana received the antiretroviral medicine necessary to reduce the chance of transmitting HIV to their unborn children. Without the medicine, the chances of HIV transmission were (and are) roughly 50-50. With the medicine, the chances of HIV transmission drop to between 1 and 2 percent. By the end of 2008, nearly 40 percent of Ghanaian women in need received the medicine that will transform the lives of their children. That is market share for life. And it is growing year-over-year.

“On this World AIDS Day, there is improvement in HIV detection across sub-Saharan Africa. The percentage of pregnant women who were able to take an HIV test increased from 17 percent in 2007 to 28 percent in 2008. We have every reason to believe that the percentage figure will increase substantially again this year (the final data are not yet available). The goal obviously is to keep ramping up testing until the chain of HIV transmission from mother to child is one day broken altogether. That day is coming, if we keep after it.

“AIDS is not just an African disease, of course. World AIDS Day is testament to the fact that AIDS is a global problem. (RED) focuses on AIDS in Africa because that is where the need is most acute. Nearly 14 million children in Africa have been orphaned because of AIDS. There are an estimated 2 million children living with HIV around the globe, 90 percent of them are in Africa. More than 90 percent of the children living with HIV are infected through mother-to-child transmission during pregnancy, around the time of birth or through breast-feeding. This is a fixable catastrophe ($26 covers the cost of providing medication to a pregnant woman to sharply reduce the risk of HIV transmission to her child). And that is where your (RED) dollars go, $26 at a time.

“All around the world tonight, from San Francisco to Chicago to Pittsburgh to Los Angeles to Salt Lake City to Dublin, Ireland and London, England, cities will bathe their municipal buildings and town halls and key landmarks and architectural masterpieces in (RED) lights. All across the Internet, on the pages of Facebook and Twitter and Google, there will be links to (RED) and its partners. An ocean and a world away, in the pre-dawn hours of sub-Saharan Africa, men and women will begin their daily work of doing battle with a viral killer, a battle financed in part by the purchases of (RED)-branded products by people like you.

“As the CEO of (RED), I have the privilege of working with great partners at the Global Fund and at some of the world's most iconic brands. Every day, I get to work with a dedicated group of professionals who have devoted themselves to a great conveyance. On behalf of all of them, I thank you for your support of (RED) branded products and the work that it enables.

“World AIDS Day this year is better than it was a year ago. It will be better still a year from now. We just have to keep after it,” she concluded.

She keep after it for more information.

In this era of increased global understanding, it is vital that we use this important momentum to put down bigotry, homophobia and xenophobia to find an AIDS cure, and in the meantime, to get treatment to everyone who needs it throughout the world. This issue is bigger than any one country, ideology, or political agenda. Real people are dying, adults and children! These people can be helped. How can we call ourselves civilized if we fail to hear their cries?
 — The Curator

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