Important priorities for prevention and treatment of HIV/AIDS

November 25, 2004

Ahead of World AIDS Day on December 1, a series of commentaries in this week's issue of THE LANCET outline the current and future priorities in the global effort to curb the HIV/AIDS pandemic.

The first commentary is a call to action for a renewed public-health strategy to prevent sexually transmitted HIV. Against a background of twenty years of debate over the value of different behaviour-change approaches, authors Daniel Halperin (University of California San Francisco, USA) and colleagues outline evidence-based objectives for the various populations at risk: an emphasis on abstinence for young people not yet sexually active, the importance of fidelity and consistent condom use for people already sexually active; and programmes and policies aimed at reducing the number of sexual partners and promoting correct and consistent condom use in high-risk groups. The commentary is a consensus statement signed by over 140 HIV/AIDS experts from 36 countries, and includes such notable endorsers as Archbishop Desmond Tutu, President Museveni of Uganda, Special UN Envoy Stephen Lewis, and representatives from the World Bank, Global Fund for AIDS/TB/Malaria, and five UN agencies, the heads of the HIV-AIDS programs in several countries including Ethiopia, India, Jamaica and Uganda, as well as prominent technical, religious and other organizations working on HIV-AIDS. The commentary concludes: 'The time has come to leave behind divisive polarisation and to move forward together in designing and implementing evidence-based prevention programmes to help reduce the millions of new infections occurring each year.'

With an estimated 5 million new HIV infections worldwide in 2003, the context in which people are vulnerable to HIV infection is discussed by Catherine Hankins (UNAIDS, Geneva, Switzerland). The commentary outlines how changing the social, legal, and economic environments in many populations--especially among women and children in developing countries--is critical if any future public-health interventions to reduce HIV transmission are to be successful.

The provision of contraception for women on antiretroviral drugs is seen as a priority, especially in Africa, write James D Shelton and E Anne Peterson (USAID). Compelling reasons for widespread availability of contraception include: prevention of maternal-to-child transmission of HIV, avoiding the potential risk of antiretroviral drugs harming the fetus, and avoiding the high risk of maternal and infant morbidity and mortality. The authors conclude: 'There are compelling human, medical, social, and programmatic reasons to make high-quality, highly accessible, effective, and voluntary contraception available to women on antiretroviral drugs in Africa. It is morally imperative and programmatically pragmatic. As programmes scale-up to the challenge of providing antiretrovirals, they should be designed to strengthen family planning and other integral and vital health services from the beginning. At USAID we have begun serious efforts to make contraception available to women on antiretroviral drugs. We call on providers and other partners in international health to do the same.'

Thomas Kerr (British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada) and colleagues highlight the HIV/AIDS issues relating to injecting-drug users (IDUs), especially how 'Heroin dependence is the underlying condition fueling the HIV epidemic in many countries.' A March 2005 meeting is seen as crucial for the acceptance of two effective opiod substitutions (methadone and buprenorphine) to be recommended therapies by WHO to the Essential Drugs List. The authors conclude: 'Given what is now known about the effectiveness of opioid-substitution therapy in HIV prevention and treatment, a decision to add these drugs to the list is needed to help ensure greater access to substitution therapies and antiretroviral treatments, and in turn to help to bring the HIV/AIDS epidemic among IDU under control.'

The final commentary paints an ominous picture for South Africa and other African countries. Jerome A Singh (Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban) discusses a recent report highlighting the decline in South Africa's population growth because of HIV/AIDS, with future projections suggesting that the country's population may decrease by 5 million people (from a population of 45 million today) by the year 2050. This direct effect of HIV/AIDS on the South African population has serious implications for stability in other African nations. Dr Singh concludes: "The relative peace currently prevailing in conflict-riddled countries, such as Liberia, Burundi, and the Democratic Republic of the Congo has been attributed, in part, to the presence of about 2800 South African peacekeepers in these and other African hotspots. However, the South African Government's refusal to deploy HIV-positive troops on UN peacekeeping missions will likely become increasingly unsustainable because 17-22% of South Africa's defence force is HIV positive. The effect of AIDS-related natural attrition, combined with a rise in rates of infection with HIV among South African troops in the years ahead, can be expected to reduce the number of South African troops eligible for peacekeeping missions in troubled African regions. The downscaling of South African peacekeeping operations because of these factors could threaten peace and stability in regions where South African troops currently serve, or could be called upon to serve in."
-end-
Contact:

1. Professor Daniel Halperin, University of California, San Francisco, USA: T) (author is based on East Coast) 1-240-535-3327 or 1-301-589-2683; dhalp@worldwidedialup.net

2. Dr Catherine Hankins, Social Mobilisation and Strategic Information Department, UNAIDS-Joint United Nations Programme on HIV/AIDS, CH-1211 Geneva 27, Switzerland; T) 41-79-202-1845; hankins@unaids.org

3. Jim Shelton, USAID GH/PHR, Washington DC, USA; T) 1-202-712-0869; JShelton@usaid.gov or Harry Edwards, 1-202-712-5174; HEdwards@USAID.Gov

4. Dr Thomas Kerr, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada; T) 1-604-806-9116; tkerr@cfenet.ubc.ca

5. Dr Jerome A Singh, Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, DDMRI Building, Umbilo Rd, Durban, South Africa; T) 27-31-260-4555 / 260-4664; singhj9@ukzn.ac.za or jerome.singh@utoronto.ca

Lancet

Related HIV Articles from Brightsurf:

BEAT-HIV Delaney collaboratory issues recommendations measuring persistent HIV reservoirs
Spearheaded by Wistar scientists, top worldwide HIV researchers from the BEAT-HIV Martin Delaney Collaboratory to Cure HIV-1 Infection by Combination Immunotherapy (BEAT-HIV Collaboratory) compiled the first comprehensive set of recommendations on how to best measure the size of persistent HIV reservoirs during cure-directed clinical studies.

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).

Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.

Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.

The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.

Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.

NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.

Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.

Read More: HIV News and HIV Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.