Thursday, May 31, 2007

Bush advocates $30B for PEPFAR

Welcome to this installment of The AIDS Pandemic, a podcast hosted by Dr. David Wessner from Davidson College. I’m Dave Wessner.

Yesterday, President Bush implored Congress to extend PEPFAR, the President’s Emergency Plan for AIDS Relief, for an additional 5 years and allocate an additional $30 billion to the program. Initially proposed in the President’s 2003 State of the Union address, PEPFAR targets HIV/AIDS treatment in 15 countries with high HIV/AIDS burdens.

As President Bush noted, the $15 billion allocated to PEPFAR thus far has resulted in antiretroviral drugs for 1.1 million people in these resource limited countries and the increased funding could result in treatment for as many as 2.5 million people. This drug therapy, obviously, will extend and improve the lives of these lucky individuals. Arguably, then, PEPFAR is changing the HIV/AIDS landscape.

The plan cannot, however, be considered an unqualified success. Approximately 30 million people in sub-Saharan Africa alone are HIV positive. Providing treatment to 2.5 million of them is not enough. Until all people, in all countries, have access to the life-saving antiretroviral drugs, we can not be satisfied with any existing plan.

More importantly, we need to examine the restrictions associated with PEPFAR funds. One third of allocated funds must be spent on abstinence programs, despite the clear evidence that condoms are the most effective means of preventing the sexual spread of HIV. No funds can be spent on clean needle exchange programs, despite the clear evidence that needle exchange programs prevent the transmission of HIV and do not lead to increased injection drug use. The $15 billion currently allocated to PEPFAR has made a difference. And the additional $30 billion proposed by President Bush will make an even greater impact on the pandemic. President Bush should be commended for this initiative and his leadership. But President Bush also should be admonished for ignoring the scientific evidence. When it comes to the AIDS pandemic, decisions need to be based on evidence, not one person’s faith-based morality.

Until next time, I’m Dave Wessner

Friday, May 18, 2007

True Colors Tour for the Human Rights Campaign

Welcome to this installment of The AIDS Pandemic, a podcast hosted by Dr. David Wessner from Davidson College. I’m Dave Wessner.

We opened this installment with a short segment from True Colors, by Cyndi Lauper, the iconic voice of ‘80s pop. Long supported by and a supporter of the gay, lesbian, bisexual, and transgender communities, Lauper recently announced her plans for this summer’s True Colors tour in support of the Human Rights Campaign. Along with Debbie Harry, the Dresden Dolls, Erasure, and others, Cyndi Lauper will headline this tour that opens June 8th in Las Vegas. A portion of all tickets sales will go to the Human Rights Campaign.

Throughout its 25-year history, HIV/AIDS has been inextricably linked to human rights issues. Sexual violence against women, stigma associated with men who have sex with men, young girls forced into prostitution – all of these human rights violations have contributed to the spread of HIV/AIDS. The Human Rights Campaign fights tirelessly to rid the world of these injustices. You certainly can help by becoming a member of the HRC and contributing to them directly. And this summer, you also can help simply by attending a great concert.

As Cyndi Lauper states on the Tue Colors Tour web site, “We should all have the right to live with the same dignity, opportunity and safety. It shouldn’t matter what anyone’s sexual orientation is.”

Until next time, I’m Dave Wessner.

Sunday, May 06, 2007

Microbicides: Empowering women

Current global AIDS statistics are staggering, to say the least. Approximately 40 million people worldwide are living with the disease, while 14,000 new infections occur each day. Women make up almost 50% of adult infections, but this figure is higher in sub-Saharan Africa, where women are 30% more likely to be HIV-positive than men. Due to physiological differences, women are twice as likely as men to contract HIV from an infected partner, but many lack the necessary tools for protection. Even if the tools are available, poverty and inequality can make it impossible for women to have control over their sexual interactions. The ABCs of prevention (abstain, be faithful, and use condoms) are useless without male cooperation. The ABCs are even more ineffective for married women with non-monogamous husbands because, as Melinda Gates states, “abstinence is unrealistic, being faithful is insufficient, and the use of condoms if not under their control.”
Microbicides are a new and important HIV prevention method that can put the power of protection in the hands of women. Microbicides are formulated as gels, creams, suppositories, or films that can kill or neutralize viruses when applied before sexual intercourse, thus preventing infection. Because women could apply the microbicide without the cooperation or awareness of their partners, they would have more control over preventing an HIV infection. Ideal microbicides would also protect against other STDs that can facilitate HIV transmission and come in spermicidal or non-spermicidal formulations that allow pregnancy while still offering protection. An ideal microbicide should be active upon application, remain active for an extended period of time, and be tasteless, odorless, and invisible in order to prevent detection and interference with sexual activity. Finally, for distribution and accessibility, an ideal microbicide must be cheap and easy to store.
There are three major approaches a microbicide can use to prevent infection. Some microbicides act as physical barriers that prevent HIV from entering tissue. They are liquid at room temperature, but become gel-like inside the body and work like a condom. Others contain molecules that inhibit the virus itself. They might create an acidic environment in which the virus cannot survive, or contain known anti-HIV drugs, such as AZT. Still others prevent infection by interfering with viral surface proteins, therefore preventing attachment. Researchers hope that multiple methods of prevention will be combined into one microbicide to increase effectiveness.
While no microbicides have been approved for general use, twelve versions are currently undergoing various phases of clinical trials. However, there are several important issues that stand between microbicide development and widespread use. Most microbicides are developed by small biotech companies and educational research institutions. Only 1% of federal research funding goes toward microbicide research, and pharmaceutical companies are unwilling to invest because the women who need their products will be unable to pay for them. Once microbicides are developed, they must go through a series of clinical trials. International support to build the necessary infrastructure for trials in developing countries is crucial so testing can occur in the locations where products will be most used. Microbicide producers are concerned about the low efficacy of first-generation microbicides and the potential for increased risk behavior, such as condom substitution. However, most agree that since condom use is rarely consistent, microbicides can provide better protection than nothing at all. Finally, only 20% of the population at high risk of infection currently has access HIV prevention methods. Even a 100% effective product does little good if it cannot be distributed to those who need it most.
While microbicide development is currently facing many challenges, there is no doubt that microbicides are a powerful HIV prevention tool. By giving women more control over HIV protection we can drastically reduce the number of new infections each year and save millions of lives.

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