National HIV Testing Day

Welcome to this installment of The AIDS Pandemic. June 27, 2010 is National HIV Testing Day. For many people, this news probably is met with ambivalence. We have a day for everything, it seems. So here it is - another day with another name. We shouldn't, though, link National HIV Testing Day with the made-by-Hallmark days. This day should be different.

On National HIV Testing Day, we all should remind ourselves of the vital role testing plays in our continuing efforts to rid the world of HIV/AIDS. According to the CDC, 1.1 million Americans are infected with HIV. Approximately 1 in 5, however, do not know they are infected. This needs to change. When one knows his or her HIV status, he or she is less likely to transmit the virus. Knowing one's status can lead to earlier treatment, and earlier treatment results in better outcomes. For women, knowing one's status can help decrease the rate of mother to child transmission.

National HIV Testing Day is more than just a day marked on the calendar. This day is a reminder to all of us that testing, along with education and prevention, are necessary and interlocked components of our ongoing efforts against this pandemic.

So how can one get tested? Use this helpful testing locator, provided by aids.gov. And tell your friends.

Opportunistic Infections in Developing Nations: A World Away

In the United States and other developed nations, for many people, AIDS has become a manageable disease. With adequate care and lots of medication, HIV positive individuals can live with relatively few serious complications for a long time. In the US, 71% of HIV-infected individuals have at least started HAART therapy, decreasing deaths per infected individuals per year from 30/100 to 5/100 since the 1980’s. In developed nations, however, HIV positive individuals do not have the luxury of adequate care. In areas like Africa where the burden of disease is highest, HIV positive individuals must face an array of opportunistic infections as their CD4 counts dip lower and lower.

Because these opportunistic infections are generally localized to areas where HAART is not available, it is both hard for us to understand the difficulties in treatment and to determine which infections are endemic to what populations. For example, MAC (for Mycobacterium avium complex) is a common, life-threatening opportunistic infection in Asia causing a significant portion of AIDS-related mortalities. In Africa, however, MAC is rare. In addition, tuberculosis is a particularly life-threatening coinfection that is particularly common in many developing areas, especially Sub-Saharan Africa and Asia. Many opportunistic infections in these nations have developed resistance to the drugs typically used to treat them. Determining which disease populations have resistance to what medications can be exceptionally difficult given how isolated some of these areas are.

The HIV/IDS prevalence is highest in sub-Saharan Africa

The most reputable source for information like this is undoubtedly the World Health Organization. The WHO publishes information on the geography, morbidity, symptoms and treatment of various opportunistic infections for different nations and settings. While it is hard to determine where exactly the WHO gets their sources for information from developing nations, it is clear that they get their information from all parts of the globe. However, it is also hard to pick apart the complicated interactions of HIV and opportunistic infections in a multitude of settings, and even harder when there are additional complicating factors such as malnutrition, social unrest, and a lack of medical infrastructure for reporting treatment schemes. Many times, the WHO provides useful information about the scope of opportunistic infections in developing nations, but they often miss the deeper and more individual issues that a given region may have. If first-line drugs for opportunistic infections are not available in these developing areas (due to oppressively high costs or restrictive storage conditions), the WHO lacks vital information on how to cope.

The availability of antiretrovirals in lowest in sub-Saharan Africa

While it is not the fault of the WHO that there is a dearth of useable information for medical workers in low-resource environments, it is clear that there is a lack of necessary medical care in these nations that perpetuates a cycle of poverty and illness and that millions of HIV-positive individuals are dying as a result of a lack of ARVs. In a situation where prohibitively high costs of necessary drugs prevents individuals from being treated for HIV, we need to focus more on preventative efforts and HIV prophylaxis in the form of vaccines or microbicides. In this sense, the US and other developed nations are providing a massive amount of resources in trying to find a vaccine and developing useful microbicides to prevent HIV infection from happening in the first place. Because of the massive amount of people infected in areas that lack the resources to treat them, the disease needs to be treated when it is least expensive to do so. While it is hard to know what the future holds for those with HIV in developing nations, it is sure that we need to develop better ways of treating opportunistic infections and preventing the development of AIDS from HIV.

For more information on the global context of the AIDS pandemic, please visit:
Avert.org
WHO

US to lift HIV travel ban

“This week, Congress voted to expand a vital program that is saving lives across the developing world — the Emergency Plan for AIDS Relief, also known as PEPFAR. I thank members of Congress from both sides of the aisle for working with my Administration to pass this important bill, and I will be honored to sign it into law next week.”

With those words, President Bush on Saturday indicated his strong approval of the PEPFAR legislation passed last week by Congress. The bill provides an additional $48 billion over the next 5 years to fight HIV/AIDS, primarily in sub-Saharan Africa. According to Pres. Bush:

“When we first launched this program five-and-a-half years ago, the scourge of HIV/AIDS had cast a shadow over the continent of Africa. Only 50,000 people with AIDS in sub-Sahara Africa were receiving antiretroviral treatment. Today, PEPFAR is supporting treatment for nearly 1.7 million people in the region. PEPFAR has allowed nearly 200,000 African babies to be born HIV free. And this program is bringing hope to a continent in desperate need.”

But this legislation does more than provide much needed money. The bill also repeals the 20 year ban on travel into the US by HIV positive people. Enacted in 1987, the current policy prevents HIV positive foreigners from obtaining visas as tourists, immigrants, or students. The US is among only a small number of countries worldwide with such a ban. According to Senator Gordon Smith, a Republican from Oregon, “Our government still treats individuals with HIV/AIDS as modern-day lepers, categorically banning these individuals from entering into the US.”

More information about how this new legislation will affect travel to the US by people with HIV/AIDS can be found at the Immigration Equality web site.


Until next time, I’m Dave Wessner.

Social Components of HIV/AIDS Transmission in Mwandi, Zambia

I'm Dominique Maietta.

Mwandi is a relatively rural village in the South-Western corner of Zambia. The town is home to the Mwandi Christian Hospital, which has a catchment area of approximately 25,000 individuals. During the summer of 2006, I traveled to Mwandi in order to study the psychological and social components associated with HIV/AIDS there. Here I will talk about some of my findings.

The incidence of HIV in the village is around 30-40% and the percentage of HIV positive people is larger within the Mission Hospital patient population according to interviews with medical officers on the hospital staff. The majority of the interviewees expressed their feelings that economic hardship is a major social component of the spread of HIV in Mwandi, just as it is in the rest of Sub-Saharan Africa. Despite the influx of education and knowledge regarding HIV and it’s spread, including mandatory classes in the schools and public service campaigns around the country, the low financial status of the Mwandi community is the root cause for many of the risky behaviors associated with HIV transmission, such as multiple partners and non-use of condoms. This need to engage in risky behaviors appeared to be a particular problem for women and girls who have no other way of making an income other than through sex. Sex for them is not about emotion, but instead about survival.

The problem of poverty affecting HIV rates in Mwandi has further been exacerbated by the construction of a new paved road linking this relatively rural village to other towns and countries. The relatively recent accessibility of Mwandi to the outside world has introduced truckers and migrant workers as passer-bys to the village, and thus created a uniquely new set of problems for HIV transmission in Mwandi. These migrant individuals provide both a source of income for the impoverished village, but also a ready supply of HIV positive individuals to transmit the disease to villagers. As one social worker explained to me, when people come, they come looking for women. Thus the presence of the road, and the truckers from neighboring countries provide a source of income for destitute women and girls with no other means of providing income for their families. Interestingly, the use of sex for money in Mwandi is not so much acceptable, but merely a behavior that occurs, and according to one nurse I spoke with, “this is one of the poorer parts of Zambia, and if a woman has to keep her family, especially if her husband is not around, she will do it somehow”.



Gender disparity issues, then, apart from womanizing on the part of men, is also seen as a major social component of HIV transmission in Mwandi. While men have the power and social standing to hold jobs and make money, women and children have no similar means of providing for their families. Furthermore, although some male orphaned heads of household are given governmental support such as fishing nets which can be used to make a living, young females in similar situations are given minimal support. Thus when husbands die or children are left orphans due to the death of their parents, (generally as a result of AIDS), there is little those children or women can do to raise money other than to fall back to prostitution.

The lack of finances for much of the Mwandi community was also linked by many of the people I spoke with to excessive alcohol consumption, which contributes to promiscuous sexual behavior among Mwandi townspeople. A majority of village leaders perceived that the paucity of jobs and alternative activities in Mwandi village led to the abuse of alcohol followed by unscrupulous sexual activity, (especially by men), which in turn exacerbated the already present problem of HIV transmission. The custom of casual sex and multiple partners was prevalent among men before the HIV pandemic, and is viewed in Mwandi as the “normal mode of boy existence”. This acceptance of male promiscuity also appears to be a key contributor to the continuance of HIV transmission in Mwandi. Lack of sexual control exerted by women, (especially wives), combined with a lax view of expected fidelity in men has resulted in a growth of HIV transmission as husbands will sleep with several partners, become infected, and then infect their wives.

Although it was generally recognized that women lacked the social dominance and power necessary to prevent their husbands from suffering the results of their risky behavior, there were conflicting views as to whose behavior was “responsible” for the spread of HIV. Many of the male interviewees implicated the social behaviors of young people and prostitutes in the spread of HIV. In Mwandi many traditional family cultural values are being challenged with the introduction of the “modern life. As a result, many perceive that young people and their rampant and unprotected sexual behavior is a major social problem contributing to the spread of HIV. This behavior is most often the result of children behaving in a manner mimicking their adult counterparts.

Thus, in Mwandi, extreme poverty combined with alcohol abuse, accessibility to outsiders, and a lack of role models attempting to change behavior are the main factors contributing to the spread of HIV. As the village and the rest of the world becomes more aware of these social factors, changes can be gradually made to stop those underlying social behaviors that support transmission of HIV. Already in Mwandi village leaders have begun to address the issues of poverty and gender disparity by supporting religious and governmental run support groups and clubs to promote sustainable income by women there. Furthermore, use of traditional drama has been incorporated in order to increase public knowledge about the connection between underlying social factors and the spread of HIV in order to stop the cycle of transmission. Although there is much work to be done, the residents of Mwandi are moving in the right direction to combat the social facets contributing to HIV transmission in Mwandi.

“Rethinking” AIDS: The Dissident Movement

On October 25th, 2007, AIDS activist Ron Hudson posted an entry on his blog describing three apparently fraudulent e-mails he had received over the past month. Each of these messages appeared to come from a prominent member or group of the mainstream AIDS establishment (Dr. Robert Gallo, Dr. Luc Montagnier, and AIDSTruth.org), but each also supported the unconventional view that the HIV virus does not cause AIDS. This disputed notion is the primary tenet of a controversial group of activists who seek to overturn much of what is widely accepted about HIV and AIDS. Variously called the AIDS dissident movement, the AIDS reappraisal movement, and the AIDS denialist movement, this loosely affiliated community has various beliefs and goals but is united by the shared conviction that AIDS is not caused by HIV. In this podcast, I will examine the dissident movement’s tactics and its relation to the global AIDS pandemic.

The primary strategy employed by the AIDS dissidents is discrediting the existing scientific consensus while constructing their own dissident consensus in its place. Often this dual approach can be hypocritical. For example, dissidents vehemently reject studies or even whole groups of evidence that support the mainstream view on the basis of just one flaw or educated guess, and at the same time they selectively extrapolate from findings in other studies to arrive at conclusions consistent with their own beliefs. Additionally, they rebuff research papers published by mainstream scientists, arguing that their credibility is compromised by their funding sources or lack of expertise with HIV-AIDS, while simultaneously citing lists (like the one on Reappraising AIDS’ website) of dissident scientists, many of whom have a financial interest in “alternative” AIDS treatments or work in fields not even tangentially related to virology or epidemiology. These twin strategies used by dissidents to replace the mainstream AIDS consensus with a dissident version serve to mislead the public and obscure the truth.

A related tactic used by dissidents is “moving the goalpost”. When members of the mainstream AIDS movement offer new data in support of their view, dissidents regularly call for more or “better” evidence. Christine Maggiore, founder of the dissident website Alive & Well AIDS Alternatives, declares, “Since 1984, more than 100,000 papers have been published on HIV. None of these papers, singly or collectively, has been able to reasonably demonstrate or effectively prove that HIV can cause AIDS.”

A more subtle tactic employed by the AIDS dissidents is the exploitation of the widespread disenchantment with the scientific and medical establishment. The movement finds an eager audience among those frustrated with the high-priced treatments currently available for AIDS and the apparent lack of progress toward a vaccine or cure. This dissident strategy is especially effective among developing countries, racial and sexual minority groups, and others who have been historically exploited or oppressed by the predominantly wealthy, white, and Western establishment. Some dissident groups like VIRUSMYTH portray mainstream AIDS researchers as greedy capitalists profiteering from a fraudulent conspiracy that exploits the less fortunate. Such techniques engender skepticism and distrust toward the scientific mainstream among the public and continue to attract many individuals to the AIDS dissident movement.

So ultimately, given their occasionally disingenuous strategies, how should the AIDS dissident movement be viewed in the context of the global AIDS pandemic? I asked Ron Hudson, the activist I mentioned at the beginning of this installment, for his view on this controversial group, based on his previous interactions with them. He expressed his concern over their effect on efforts by mainstream AIDS activists to reduce and prevent the spread of HIV. He worries that the speculation and inadequately tested therapies offered by some dissidents may be construed as valid guidelines for AIDS treatment and prevention and therefore increase the risk of individuals for exposure to HIV. At the same time, however, Ron also supports the respectful exchange of ideas between individuals in the dissident movement and those belonging to the AIDS mainstream. I think that Ron makes an important distinction here regarding the dissidents, that between productive dissent and dogmatic denialism. Dissent can facilitate understanding and illuminate previously unexplored facets of HIV and AIDS, but denialism fosters animosity and suppresses established scientific facts regarding the disease. In order for the dissident movement to positively affect the AIDS pandemic, the scientific community should discourage detrimental denial and promote constructive dissent. This strategy, in my opinion, will prove to be the most effective in dealing with the AIDS dissident movement in the future.

Thanks for listening. I’m Bill Stokes.
References:

Myths and Misconceptions about HIV/AIDS

Myths and misconceptions about HIV and AIDS have been around since the very beginning of the pandemic. The first myths stemmed largely from the lack of information on this relatively new disease. One of the first myths, one that claimed that AIDS was a gay disease only, was strongly encouraged by the media. This exacerbated problems with prevention as misinformation was widely circulated. Since then, new myths have emerged. These myths have emerged despite the fact that there is now more accurate information on HIV. These new myths also create problems with prevention as people unknowingly put themselves at risk to contract the virus.

Myths and Misconceptions about Prevention and Transmission
There are many contemporary myths and misconceptions about HIV prevention and transmission and they originate from many parts of the world. Some are about the demographics of the virus and claim that HIV/AIDS is a Black Person’s Disease only or that it only affects IV drug users. There is also the misconception in parts of Africa that there are young “virgin” prostitutes or special villages free from AIDS. There is also the speculation that HIV/AIDS is worse in Africa because Africans are hypersexual. Others come from theories on the origins of the virus. Some people think that HIV was engineered by the government for the purposes of exterminating Africans, African Americans and homosexuals. Others think that HIV was sent by God as punishment for sin. Other myths and misconceptions are about prevention and transmission. Among these are the misconceptions that only promiscuous people contract HIV, that women cannot transmit HIV to men, that people with HIV look sickly or have body odor, and that HIV does not cause AIDS. One very dangerous misconception about transmission is that two HIV positive people do not need to use condoms during intercourse. This misconception is dangerous because infection with multiple strains of the virus can occur. Paranoia has led to many myths. Some of those myths claim that HIV-Positive criminals are lurking, ready to stab victims, that AIDS can be contracted from a toilet seat, and that hugging an HIV-infected person will lead to infection. People also believe that HIV can be transmitted through kissing, or eating from the plate of an infected person.
A recent article documented a very popular myth among prostitutes in Malaysia. According to Sarawak AIDS Network, or SAN, “prostitutes and their customers shake up a can of coca cola and spray their genitals before sex”. The belief is that the bubbles in the soda will kill the virus. Dr. Andrew Kiyu, a SAN member, said that this myth likely emerged because people have seen doctors use detergent to cleanse the wounds of patients. Other myths have emerged based on current information about HIV/AIDS. As a result of scientists saying that HIV can be transmitted to women via bruises within the vagina, one popular myth states that if sexual intercourse can take place without bruises through which the virus can gain entry into the blood stream, infection will not occur. Some people believe that HIV cannot be contracted from getting tattoos and body piercings based on the fact that HIV is unlikely to be transmitted via kissing. Another myth, this time based on the knowledge of false-positives and false-negatives in testing, states that you can test negative once you’ve tested HIV-positive.

Myths and Misconceptions about a Cure
Other myths and misconceptions come from ideas about possible cures for HIV. People from diverse religious backgrounds believe that there are lucky charms, magic potions, or special rituals that can be used to prevent or cure the virus. There are also many proclaimed herbal and chemical cures; some include armenicum, colloidal silver, tetrasil, and virodene. Others think that taking ‘Immune Boosters’ or vitamins can cure AIDS. Some South Africans believe that a product called Ubhejane that is sold in pharmacies is a cure for AIDS. The creator of Ubhejane, Zeblon Gwala, says that it reduces viral load and increases CD4 counts in HIV positive people. Despite the fact that scientists have tested Ubhejane in the lab and found that it demonstrates minimal benefits, Ubhejane continues to sell.

Image Courtesy of Avert. “The fake AIDS cure Ubhejane on sale in a South African pharmacy.”

Other myths stem from celebrities and their HIV/AIDS status. Because some celebrities, like Magic Johnson and Andrew Stimpson, have been diagnosed with HIV and have not yet developed AIDS after a number of years, another popular myth is that there is a cure, but only rich people know about it because they can afford it.
One very popular myth that often leads to violence against women and young children is the myth of virgin cleansing. In parts of Africa it is widely believed that having sexual intercourse with a virgin will cure HIV. The belief is so widespread that leaders have launched campaigns to dispel it. In Zambia, billboards that depict small children and state that sex with them doesn’t cure AIDS have been placed in many areas.

Image Courtesy of Avert. “A road sign in Zambia confronting the "virgin AIDS cure myth."

In addition to this myth of virgin cleansing, is the myth of animal cleansing or specifically, that having sex with animals will cure HIV. People have also ingested and injected hydrogen peroxide because some alternative health practitioners have advocated it as a cure for HIV.

Problems with Prevention
These and other myths lead many people to expose themselves to HIV despite information that proves the contrary. This creates problems in the endeavor to curtail the spread of the virus. Though many of these myths are popular and affect those in the developing world, some of them do pose problems in the United States. Sex workers in different countries who, because of poverty, cannot switch their profession in the face of the AIDS pandemic may rely on some of these myths. Addicted drug users, who frequently encounter contaminated needles, may rely on some of these myths. The naïve adolescent who may be about to engage in sexual intercourse for the first time, may rely on some of these myths. There are present efforts in place to dispel these myths and most of the initiatives take the form of websites. However, more efforts are required before all of these myths and misconceptions are finally put to rest.

I’m Shanawa Richardson. Thanks for Listening.

The Stigmatization of Homosexuals and Individuals Living with HIV/AIDS in Jamaica, W.I.

The HIV/AIDS epidemic hit the Caribbean in the early 1980s and was primarily transmitted by homosexual men. However, this trend was greatly reversed in the mid-1980s in which the main mode of transmission became heterosexual sexual contact. Despite the reversal of the mode of transmission from homosexual men to heterosexuals, there remains a large group of individuals in the Caribbean that still view HIV/AIDS as a “gay disease”. In the Caribbean, the most stigmatized groups that have HIV/AIDS are homosexuals (particularly men) and sex workers. As a result of this stigmatization, homosexuals and sex workers are denied health care and are victims of harassment and hate crimes in many Caribbean islands. Jamaica has the third largest population in the Caribbean of people living with HIV/AIDS. Of the Caribbean islands, Jamaica has dealt with major social issues caused by the stigmatization of homosexuals and people living with HIV/AIDS. A great deal of these issues is perpetuated by ignorance, politics, and one of Jamaica’s major genres of music, dancehall reggae.

Homophobia in the Caribbean stems from deep rooted cultural beliefs and values. Heterosexism in the Caribbean is centered on the ideals of masculine dominance; therefore, individuals that veer from such standards are ostracized and criminalized within these communities. HIV/AIDS is on an increase in Jamaica with an estimated 1.5 percent of people infected. However, the stigma of Jamaican homosexuals with HIV/AIDS which are enforced by law enforcement and the public has caused HIV positive homosexuals to be reluctant about seeking help for their illness. The link between HIV/AIDS and homosexuality in Jamaica has also resulted in HIV prevention programs and services to be negatively targeted within the community. People infected with HIV/AIDS in Jamaica also face difficulties receiving treatment in health facilities because health workers discriminate against them, provide poor care, talk to them in demeaning manners and even denying them treatment.

The stigma associated with HIV/AIDS and homosexuality in Jamaica is also perpetuated within political organizations. Jamaica has one of the most strict sodomy laws of any Caribbean island. Jamaica’s Offences against the Person Act, Article 76, states: “Whosoever shall be convicted of the abominable crime of buggery (anal intercourse) committed either with mankind or with any animal, shall be liable to be imprisoned and kept to hard labor for a term not exceeding ten years.” This law is definitely an impediment of human rights and serves as a justifying tool for police officers who harass, beat, and incarcerate homosexuals. There have been cases in which police officers have stopped HIV prevention and support groups from helping men who have sex with men. On a political scale, the Jamaica’s Prime Minister, PJ Patterson has been unresponsive to reports by the HIV/AIDS program’s repeal of discriminatory legislation. Additionally, the Jamaican Labor party encouraged the discrimination of homosexuals in 2001 by adopting the song called “Chi Chi Man” as their theme song. The song celebrates the killing and burning of gay men. On the eve of World AIDS Day 2006, Steve Harvey, a Jamaican gay leader and prominent AIDS activist was abducted from his Jamaica home and killed by four gunmen. Harvey was an open homosexual and the director of an AIDS Support outreach program in Jamaica that focused on helping sex-workers and homosexuals.

In Jamaican dancehall and reggae music there are repeated antigay lyrics that encourage violence, murder, and the segregation of homosexuals. Such lyrics refer to homosexuals as: “battyman” or “chi chi man”, which are derogatory words in the Jamaican Creole known as “patois”. The word “battyman” comes from the term “batty” which means buttocks and refers to homosexual men that have anal intercourse. Likewise, the word “chi chi man” is a derogatory slang for men who have intercourse with other men. In the song “Boom, bye, bye”, the reggae artist Buju Banton sings: “Boom, bai bai, iina battybwoy hed/ Ruud buai no promuot no naasi man/ Dem hafi dead/... Sen fi di matic ahn di Uzi instead/ Shuut dem, no come ef ei shuut dem”. In translation, the singer is saying: “Boom, bye, bye, in a faggot’s head/ Rude boys don’t promote nasty men/ They have to die/... Send for the automatic and the Uzi instead/ Shoot them, don’t come if we shoot them.” This song is one example of many anti-gay songs that are popular and well-liked in Jamaican and Caribbean culture.

So, what has been done to combat the homophobic and HIV/AIDS issues in Jamaica? The Jamaican Government’s Ministry of Health is aware of the impact that the country’s homophobic stigma has on individual willingness to seek treatment for HIV/AIDS. Likewise, they have noted that a key priority area is the development of human rights policies and legislation to protect individuals with HIV/AIDS. However, such policies have still not been developed. In 2001, the Caribbean Community (CARICOM) established the Pan Caribbean Partnership on HIV/AIDS (PANCAP). The PANCAP focuses on AIDS prevention, treatment, care, support, and ensuring the incorporation of international human rights protections in legislation and policies on HIV/AIDS. In late 2006, youths in Jamaica created radio public service announcements to reduce the stigma and discrimination linked to HIV/AIDS and to promote the rights of infected children. Such efforts like the PANCAP and public service announcements are some of the first steps in the reduction of the stigma associated with HIV/AIDS and the development of human rights protections in Jamaica. However, until the Jamaican government health care, law enforcement, and popular culture take active steps to end the stigmatization associated with HIV/AIDS and homosexuality, there will be no progression against the discrimination.

Courtesy of Jamaica Forum for Lesbians, All-Sexuals, and Gays.
This picture shows a Jamaican man attacked with machetes and
sticks because he was thought to be gay.

The Plight of AIDS Orphans

Since the 1980’s, our knowledge of HIV has expanded greatly. However, in developing countries this information is either lacking or has not been taken to heart by the people who live in these cultures. One of the main reasons people are so clandestine in conducting conversations about AIDS is due to the fear and stigma attached to the word. AIDS orphans have a particularly difficult experience. An AIDS orphan is defined as someone who has lost one or both parents to HIV/AIDS. These children struggle to obtain even the basic necessities of every day life.

Children whose lives become entangled with people infected with HIV/AIDS have a difficult time coping and understanding their situation. Currently, there are more than eighteen million children who have been orphaned as a result of losing someone to HIV/AIDS. More than an estimated twelve million live in sub-Saharan Africa. Although inaccurate, the projected number of orphans as a result of HIV/AIDS in Zambia was 710,000. Zambia had fifty seven percent of all orphans nationally in 2005. In sub-Saharan Africa more than 55% of people living with either HIV or AIDS are women and young girls. However, these numbers are severely inaccurate for reasons which range from reporting to people failing to get tested. The children often suffer physical and emotional neglect long before the passing of their parents. Many of these children observe their parents wilting away right before their eyes. This would no doubt present a traumatic experience for anyone. In speaking with the only social worker in Mwandi, I was told that many of these orphans suffer abuse and exploitation at the hands of the very people who are entrusted to care for them. Other children experience what is known as the “sugar-daddy/momma” phenomena. This occurs when young children perform favors, which are usually sexual in nature, for older adults. It is not uncommon for these children to have several sugar daddies/mommas. Many of these adults infected with HIV believe that by having sex with a virgin they would somehow cure themselves of the disease. Both the social worker and the head clinical officer stated to me that these children undergo a great deal of psychological distress. Many of the children must be treated for bouts of depression, anger, as well as anxiety. Orphaned children often experience greater anxiety and depression when they are separated from their siblings and placed in different homes.

HIV/AIDS has put such a strain on the family structure and had such an impact on household situations, that establishments like the Orphans and Vulnerable Children’s Center has become a necessity in Mwandi, Zambia. In Mwandi alone, there are an estimated one thousand three hundred orphans or vulnerable children. With thirty-five percent of the Mwandi population infected with HIV/AIDS, the number of orphans in the area is certain to rise. These establishments have provided a safe haven for AIDS orphans for approximately four years. The OVC met some opposition from townspeople when the idea was first brought to the forefront. Now a few members of the community assist the OVC by bringing firewood for the oven. In many cases, the one meal that the OVC provides on a daily basis is the only meal some of the children will eat all day. The objectives of the OVC are to provide nutritional support by utilizing the feeding a program that provides one meal a day for children ranging in ages from six months to fifteen years old. The Orphan and Vulnerable Children Center also provides children with a daily multivitamin, to keep them from becoming ill often. They also assist in the continuance of good health and hygiene, by conducting health checks as well as teeth cleaning. Children in the OVC who are HIV-positive are given extra food and must get monthly checkups at the local hospital, the UCZ Mission Hospital. Although the program is designed to feed well over one hundred children, there are still many children in Mwandi who go to work and school with little to eat. The director, Fiona Dixon, of the OVC in Mwandi has implemented a vegetable garden as a means of assisting the feeding program. They have also begun selling extra tomatoes in the village in order to raise more money for the OVC.
Clothing has also another problem that confronts children in the rural area of Mwandi. Most of the clothes children wear are third or even fourth generation clothing. The criteria for receiving clothing and becoming a part of the feeding program, consists of being listed as one of the following: a double orphan, child-run household, single orphan-no father, single orphan-no mother, or a vulnerable child. However, the OVC is more than just a place where children can come and eat. This past August, the center began a bathing program in which the children were afforded the opportunity to shower every Saturday with soap. In Mwandi, soap is a luxury item that many parents and guardians can not afford. The OVC also received containers filled with hygiene bags that consisted of soap, toothpaste, a toothbrush, nailbrush, a towel, and a face cloth. The OVC also covers the educational costs for some of the children to attend school in either Mwandi or Sesheke. These costs include items such as boarding fees, school fees, uniforms, shoes, as well as stationary.

It also serves as a place where the children of Mwandi can gather and enjoy recreational and educational activities. Many of the children play football, known in the United States as soccer. I had the opportunity to play soccer with a group of young boys one day. As I played, I had to remind myself that these children were potential AIDS orphans and that they could possibly have HIV themselves. I found that these children were living with loss and possibly HIV to be incredible because they seemed to be so happy playing and interacting with their peers. Later on, I was astounded to be informed that the children at the OVC are not told of their status if they are HIV-positive until they are eighteen years old. This is the harsh reality of AIDS orphans in Mwandi, Zambia with the OVC as their only refuge.
The orphans must undergo a great deal of emotional and physical hardships after the loss of one or both parents to AIDS. Plainly put, HIV/AIDS orphans are not stable. Many of them tend to be rough in nature and do not relate well with their peers. In their formative years AIDS orphans tend to be very agitated. Overall, AIDS orphans need to be seen as more than damaged goods. The discrimination they face on a daily basis needs to be put to rest, and their rights need to be acknowledged and enforced. Unless these steps and many others are completed, there will be a generation of young people who are affected financially, emotionally, and socially. Their status may also play a role on the future of politics.

My name is James Hammonds. Thanks for listening.

HIV Research Funding

It is often said that we know more about HIV than any other virus, and it’s likely to be true. In the 1980’s a staggering amount of scientific research regarding the genome, viral receptors, transmission of HIV, and drug development – including the FDA’s approval of AZT was accomplished. Scientists were hopeful that a vaccine could be developed within a few years, and it seemed that HIV might soon become a problem of the past. However, there is still much to be learned about the virus – and we have yet to see a successful vaccine. Since the 1980’s billions of dollars have been allocated for HIV/AIDS research and drug development. For 2007 alone, 2.6 billion dollars was allocated by the federal government for research on HIV.

Funding for HIV research is higher than for any other virus. But is it in the right places?
Image coutesy of the National Institutes of Health

Most of the funding for HIV research today can be categorized as either marketable and cure-finding, or non-marketable. Marketable research includes research to find a vaccine, drug development, and microbicides. These can be called marketable because they include research that has a potentially huge payback in the form of drug sales or scientific reputation. Global vaccine funding in 2006 was a whopping 933 million dollars, with significant contributions from the NIH (around 600 million), the European Commission, and the Gates foundation. Drug development still takes the largest chunk of the NIH’s HIV research budget at a little over 620 million dollars. Global funding for microbicide development in 2006 was roughly 222 million dollars – significantly less, but still an extremely substantial proportion of HIV research in total. Alone, vaccine and microbicide development take the great majority of research funding both globally and domestically, leaving little for other, less marketable research. Research concerning prevention for at-risk populations and highly impacted communities (especially those in poor nations) remains lacking as compared to budget increases for microbicide development. Without the potential payback that drug sales and vaccine development present, research is much harder to fund and therefore, less gets done. Even though HIV is the most researched virus by any measure, there are still aspects of its actions that are both poorly understood and poorly funded.

2.6 billion dollars is a huge sum of money for research, and not all of it is used by labs operated by the government. The NIH awards some of their allocated budget to other laboratories (often academic laboratories), thereby increasing the amount of researchers involved in HIV science. What can we do with our budget? Recently researchers have experienced a huge setback in vaccine development, as the most advanced vaccine in drug trials was scrapped because test subjects with the vaccine were contracting AIDS at the same rate as a placebo group. With the failure of the most promising vaccine so far, researchers are less hopeful that a vaccine can even be developed. Microbicides are a more recent addition to the field and have become popular recently as an alternative to traditional vaccines, as they are meant to be applied before intercourse to prevent the virus from taking hold. In their proposed budget for 2008 (which differs little from the 2.9 billion dollar budget of 2007), the NIH notes microbicides as an exciting field of research that will receive the most increased funding of any area of research. No matter what the immediate outcome, it seems that we’ll be spending many more billions of dollars before research rewards us with a solution to the AIDS crisis.

Merck announces failure of V520 HIV vaccine candidate

On September 21, 2007, Merck announced the disappointing news that the Phase IIb testing of it’s V520 as an HIV vaccine candidate would be cut short per recommendations of the study’s Data Safety and Monitoring Board. The National Institute of Health and the National Institutes of Allergy and Infectious Diseases worked with Merck in a clinical trial that began in 2004 named the Step Study involving 3,000 HIV-negative, but “high-risk” individuals in North America, South America and Australia. During a preliminary review of data, the DSMB found 24 of the 751 volunteers who received one dose of V520, and 19 of the 672 who received two doses became infected with HIV. They found nearly identical rates of infection in those who had received placebo. Moreover, those who became infected after being vaccinated with V520 did not show significantly reduced viral loads, indicating that the vaccine did not have the desired therapeutic effects.

Also put on hold was a study of the same vaccine candidate in South Africa. The so called Phambili study (from the Xhosa word for ‘moving forward’) began in February 2007 and involved around 800 candidates. V520 had been developed against the B subtype of HIV that is more common in the Americas, but smaller trials had shown that the vaccine had the potential to produce cross-clade immunogenicity to the C subtype that is prevalent in South Africa. The Phambili study also differed from the Step study in that in was aimed primarily at heterosexuals at high risk for infection, while the Step study centered on homosexuals. No more volunteers in either group will receive vaccinations, but those who have already been vaccinated will continue to be monitored.


Most previous vaccine attempts focused on the stimulation of production of antibodies capable of neutralizing the virus before infection is able to occur. This tactic makes successful vaccination difficult because of the high level of diversity that exists in HIV envelope proteins. The highly conserved portion of gp120 that binds with CD4 is not easily accessible to antibodies and so far current vaccination methods have not been able to produce a high enough titer of antibodies to provide immunity. In the V520 vaccine, Merck followed a different approach, aiming not for the production of neutralizing antibodies, but for a strong cytotoxic response capable of killing HIV-infected cells.

V520 is a modified adenovirus, the class of virus often responsible for the common cold. It was altered to display three synthetic HIV genes, gag, pol, and nef. The virus was changed in such a way that it was unable to replicate, and did not contain other HIV genetic information, so there was no chance of accidental infection. Gag, pol, and nef, code for HIV viral core proteins, enzymes necessary for replication and integration, and transcription regulatory proteins. By infecting human cells with a virus coding for these internal proteins of HIV, Merck sought to prime a cytotoxic T cell response directed against cells displaying these more conserved antigens, rather than trying to stimulate antibodies to HIV surface proteins. The vaccine was designed to stimulate the replication of enough cytotoxic T cells specific to gag, pol, and nef antigens that should HIV enter the body, infected cells would be killed before the virus spread to other cells. It was thought that if infection was still viable after vaccination, then the primed cytotoxic response might at least slow the rate of viral replication. Unfortunately, neither of these outcomes occurred.

While the failure of the vaccine was a disappointing setback in the quest for a cure, the study may still provide a useful example for future vaccine candidate trials. In most cases, the efficacy of a vaccine is not put to the test until phase III studies. These studies generally require around 10,000 volunteers and can cost more than $100 million to conduct. The Step study was what is often referred to as phase IIb, or a ‘test of concept’ study. While not in itself sufficient to license a vaccine, test of concept studies provide a less costly intermediate between phase II and phase III studies that allow researchers a relatively quick way of determining if it is worth it to proceed to phase III testing.

Despite this setback, other HIV vaccine research is still proceeding as planned. Sanofi-Aventis currently has a potential vaccine in a phase III trial in Thailand. The vaccine is also aimed at generating a cytotoxic response, but uses a modified canarypox virus as the vector and contains additional gene insertions. Sanofi-Aventis is expected to release data from the study in 2009.

I'm Andrew Johnson. Thanks for listening.

Cognitive Dissonance Theory & HIV/AIDS Prevention

Welcome to The AIDS Pandemic, a podcast hosted by Dr. David Wessner from the Department of Biology at Davidson College. I'm Ali Cundari.

Beyond the obvious physical symptoms associated with AIDS, there are many psychological and social implications surrounding this debilitating disease that we don’t often consider. Mass media efforts and expensive awareness campaigns have done a good job at spreading information to the general public, however, these programs have not been highly successful in reducing risky sexual behavior. Talking about sexuality and proper protection is a topic very uncomfortable to many people, even in today’s world, and this is the reason why many people fail to practice safe sex despite the vast knowledge about how this disease is transmitted. Additionally, a perplexing phenomenon exists among individuals outwardly preaching safe sex, but in reality, not using protection in their own sex lives. This type of insensible behavior is particularly prevalent among sexually active college students, who are aware of the risks and severity of AIDS, but proportionately, very few of them actually use condoms. Recently, several social psychologists have examined this hypocrisy by researching the effects of cognitive dissonance theory on safer sex practices.

Cognitive dissonance theory has been an integral component of social psychology for nearly 50 years, and according to this theory, dissonance arises when a person possesses two contradictory beliefs, or when a person’s attitude conflicts with an action that they chose to perform. This clash between attitude and behavior results in feelings of discomfort, and subsequently the conflicted individual strives to change either their beliefs or behavior to reduce this tension. Hypocrisy is considered a special type of cognitive dissonance, produced when a person decides to promote a behavior that in actuality, they do not practice. Several experiments have been conducted in an attempt to apply this theory to AIDS prevention.

Elliot Aronson was the major contributor to this field of research, and his original study (1991) placed young college students in the role of a HIV prevention educator, who is asked to advocate condom-use to others, but hypocritically does not use condoms in their own sex life. Half the students were asked to compile a list of their past failures to use condoms, when they had deemed it to be too awkward or impossible to do so. Each subject was then asked to compose a speech about the dangers of AIDS and the importance of using condoms for every sexual encounter. The students were quite willing to take on this role, believing it was a good idea to encourage sexually active people to use protection. Then, some of the students recited their speech in front of a video camera, after being informed that this tape would be played in a high-school sex-education class. This produced a high level of dissonance in the subjects. They were now preaching condom-use to others, but hypocritically had failed to practice this at earlier points in their lives. In order to remove this dissonance, the subjects would have to change their attitude to bring it in line with the position they were advocating. Essentially, they’d have to start practicing what they preached. Sure enough, Aronson’s results supported this hypothesis, and after the conclusion of the experiment, the students were far more likely to purchase condoms, which were available on a display table outside the experimental room. Several months later, Aronson followed up with these same students, and they reported that they were regularly using condoms and practicing safer sex.

Many further studies have been conducted, all producing results quite similar to Aronson’s findings. The results of these experiments could have a profound impact on the future of AIDS education and risk reduction efforts, forcing people out of a state of denial and into safer sex practices. Although almost everybody today would agree that AIDS is a huge danger and using condoms is important, the reality is very few of these people actually use condoms themselves. Aronson suggests that the solution to this problem is relatively simple. Society attempts to insulate themselves from a state of dissonance through denial, so in order to cut through this denial, we must directly confront people with their own hypocrisy. Whether it’s through personal and direct surveys or questionnaires, we need to make people realize their past failures and strive to regularly practice safer sex. People need to realize that AIDS is not just a problem for other people, but they themselves are at risk as well. Overall, cognitive dissonance seems to have a strong impact on human behavior, and we can hope to use such theories to encourage safer sex and address the growing social problem that is AIDS.

Thanks for listening. Until next time, this is Ali Cundari.

Testing and Treatment of HIV/AIDS in Children

According to a 2006 UNAIDS/WHO AIDS Epidemic Update, there are approximately 39.5 million people living with HIV/AIDS throughout the world. Of those infected, 2.3 million are aged 15 or younger. Approximately 90% of children infected with HIV acquire the virus perinatally, meaning it is transmitted from a mother to her child during pregnancy, labor, delivery or through breastfeeding. According to the CDC, the prevalence of mother-to-child transmission of AIDS in the US has dropped significantly due to effective testing of pregnant women and treatment of those found to be infected; in resource poor settings, however, the testing and treatment of infected women is far less common. In 2005, the UNAIDS/WHO AIDS Epidemic Update found that only 9% of pregnant women in resource poor countries were offered any sort of prevention services, leading to a higher prevalence of pediatric HIV/AIDS infection in less developed countries. As the prevalence of women of childbearing age who are infected with HIV increases in resource poor settings, it can be expected that the number of babies infected from mother-to-child transmission will likewise increase.

Children infected with HIV/AIDS are confronted with an extremely high rate of illness and death. The World Health Organization has found that because of their unique metabolic and immunologic circumstances, HIV progresses rapidly in children, with an estimated one third of infants dying by the time they reach their first birthday and half dying by their second birthday. Although in most developed countries identification and treatment of HIV infected babies is quite successful, which allows those children to lead healthier and longer lives, the situation is quite different in resource poor countries where testing, much less treatment of infants and children is relatively unavailable. To begin with, testing may be unavailable to individuals in developing countries due to the distance, expense and impracticality of reaching those hospitals and clinics that provide testing. Even when testing is locally available, parents may be unwilling to test their babies for fear of stigma and prejudice associated with an HIV positive status. Furthermore, testing of infants in developing countries can require far more time than in developed countries. PCR tests are among the fastest and most effective ways to diagnose infants as they can be done within 48 hours of birth and results are available to the mother within 6 weeks of the completion of the test. PCR tests are rarely accessible and prohibitively expensive in resource poor settings where antibody tests are the norm. These antibody tests only begin to give accurate results 18 months after birth, and so babies in developing countries are oftentimes diagnosed far later than in developed countries, if they are diagnosed at all.

Aside from the difficulties in testing infants and children for HIV in resource poor settings, there continues to be a dearth of treatment for children found to be positive for the virus. Although both prophylaxis and HAART or highly active antiretroviral therapy can be extremely effective in treating HIV/AIDS and preventing opportunistic infections in children, the unique difficulties associated with treating children in resource poor settings mean that these therapies are widely underused. UNAIDS found in 2006 that “an estimated 380,000 children died of AIDS-related causes” and that, “the vast majority of these deaths could have been prevented either by treating opportunistic infections or providing HAART.” Similarly, a UNAIDS/WHO report found that nearly 90% of children who could benefit from ARV treatments are not currently receiving it. This lack of treatment can be attributed to several factors.

In many resource poor settings, antiretroviral treatment may simply be unavailable. Those countries where the HIV/AIDS burden is greatest such as in Sub-Saharan Africa are oftentimes the least able to provide treatment, and so a lack of resources oftentimes translates into a lack of prophylaxis and/or antiretrovirals. Prophylaxis has been found to be extremely effective in staving off opportunistic infections in HIV positive children and is useful in delaying the need for HAART in pediatric populations. Although prophylactic drugs are widely available and relatively cheap, a UNAIDS/WHO study has found that currently nearly 4 million children who could benefit from such treatment are not receiving it. This is probably the result of lack of available treatment sites and infrastructure in resource poor settings. This dearth of available treatment translates to ARVs as well as prophylactic treatments. Even in areas where adult ARV treatment is present, there is rarely a comparable pediatric treatment site. This is due to the fact that suitable pediatric drug formulations are oftentimes prohibitively expensive and impractical. Little research had been conducted in the area of pediatric dosages because in the developed world effective mother to child prevention had limited the need for pediatric ARVs. Because so few drugs are available in pediatric dosages, and those that are available tend to be far more expensive than those made for adults, most caregivers in resource poor settings are limited to providing either expensive and unpleasant tasting syrup formulas or cutting and crushing adult tablets to provide ARVs for their pediatric patients. Crushing the pills provides an inexact measure of the amount of medication that is administered. Since under dosage can result in resistance of the virus to the drugs, and over dosage can result in amplified side-effects, the lack of correct dosages inherent in using adult drugs for pediatric patients means this mode of drug administration is far from ideal.

Important steps have been taken to begin to provide better treatment for pediatric AIDS patients. In August of 2007 the US Food and Drug Administration (FDA) approved a special tablet for children with HIV that combines three antiretroviral drugs into one pill. The tablet can be dissolved in water for ease of administration which is required only twice a day. The drug is produced by the manufacturer Cipla Limited, a generic pharmaceutical company based in India. Though unapproved for use in the US, the drug has been authorized for use in developing countries where the need and demand is greatest. Despite the enormous implications for successful treatment of pediatric AIDS that this drug will bring, there are still substantial obstacles to be overcome before pediatric care and treatment of AIDS is fully complete. Mother-to-child transmission must be diminished in resource poor settings. In situations where prevention of mother-to-child transmission is not achieved, suitable infrastructure for administration of prophylactic and antiretroviral drugs to pediatric patients must be established. Movements and groups such as the “Stop AIDS in Children” campaign are working towards prevention of mother-to-child transmission and improvement of treatment for infected children. With support of both developed and resource poor countries, the relatively ignored problem of HIV/AIDS in children can be successfully addressed.

Until next time, this is Dominique Maietta for the AIDS Pandemic Podcast.

PRODUCT(RED): Philanthropy or Exploitation?

Product(RED)



An earlier installment of this podcast from a year ago called attention to the launch of PRODUCT(RED) in the United States. Since the brand’s introduction, (RED) watches, sunglasses, t-shirts, cell phones, and iPods have been extensively marketed and sold, with some of the revenues going to support the fight against AIDS in Africa. Nevertheless, the (RED) brand has been a target of criticism for its commercial approach to a philanthropic endeavor. In this installment, I intend to take a close look at PRODUCT(RED) and its impact on the AIDS pandemic.

(RED)’s business model embodies the strategy of cause marketing, where for-profit companies and non-profit organizations collaborate in a joint initiative for their mutual benefit. (RED) currently has partnerships with several distinctive consumer goods companies, including Motorola, The Gap, Converse, Apple, and Emporio Armani. PRODUCT(RED) gives its partners permission to brand certain products as (RED), and in return the partners send a share of their profits from those products to the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Hip, humanitarian, and business-savvy, PRODUCT(RED) panders simultaneously to Americans’ munificence and to their conspicuous consumption.

According to the PRODUCT(RED) website, as of September 2007 the sale of (RED) products has generated more than $45 million for the Global Fund. This money has been directed toward AIDS treatment and prevention programs for women and children in Ghana, Swaziland, and Rwanda. (RED) points out that its contribution to the Global Fund will be a steady, constant stream of revenue rather than a one-time lump sum donation, ensuring that the brand will have a sustained impact on its beneficiaries.

Most criticism against the brand has centered on the belief that its partners are taking advantage of the AIDS problem in order to turn a profit. Early detractors of the brand encouraged consumers to donate their money directly to charity and thereby bypass the middle-men (RED) partners siphoning off most of the revenues. Later, a particularly scathing article in the magazine Advertising Age cited the disproportionately large amount of money spent by the brand’s partners promoting their (RED) products compared to the amount the partners actually raised for the Global Fund from the product sales. More recently, Ben Davis, creator of a parody campaign called BUY(LESS), has written an open letter to (RED) CEO Bobby Shriver requesting both more transparency in the distribution of profits from (RED) products and a more direct way for consumers to contribute directly to the Global Fund without having to buy (RED)-branded products.

In the end, it is important to consider what PRODUCT(RED) really is. It is not a charity, but “an economic initiative”, according to its website. Accordingly, its partners’ financial interest in the (RED) brand gives them an incentive to ensure its continued success. So what if the amount of money spent by the partners promoting their (RED) products exceeds the amount they turn over to the Global Fund? The money is already designated for their advertising budgets and would be spent anyway. This way, it at least goes toward publicizing a good cause. And besides, strictly fiscal measurements of PRODUCT(RED)’s impact (in terms of dollars alone) understate the heightened general awareness that the brand engenders among consumers.

Debating whether (RED) is more philanthropic or exploitative in nature misses the point. Even its most ardent critics would agree that the brand is making a positive contribution to the fight against AIDS. The question is, could PRODUCT(RED) do more to achieve its stated goal to “expand opportunities for the people of Africa”? I think it could.

Thanks for listening. I’m Bill Stokes.


References:
Bennett, J. Does Shopping for a Good Cause Really Help?. Newsweek. 14 March 2007.
Davis, B. Buy (Less), Give More. accessed 09 October 2007.
Kim, R. Africa’s Poor Had the Best Week Ever. The Nation. 15 October 2006.
The Persuaders, LLC. 2006. (RED). accessed 09 October 2007.
Vallely, P. The Big Question: Does the RED campaign help big Western brands more than Africa?. The Independent. 09 March 2007.

Integrase Inhibitor Isentress Provides a New Way to Treat AIDS Patients

Welcome to this installment of The AIDS Pandemic, a podcast hosted by Dr. David Wessner from the Department of Biology at Davidson College. I’m Mike Neri.

In this podcast, I will talk about the optimism surrounding the recently FDA approved AIDS drug Isentress, including how it works, what step in the HIV replication cycle it affects, and what preliminary data show about the drug’s effectiveness and side effects. Ever since the discovery of HIV as the causative agent of AIDS, scientists have searched for weaknesses in its life cycle that they can exploit. As early as 1990, scientists had identified 13 pathways in the life cycle of HIV where the virus was susceptible to treatment. Unfortunately, due to the years of trial and error necessary to produce safe and effective drugs, new AIDS medications are developed slowly, and often have many side effects.




But optimism is high after the new drug Isentress showed very promising results when acting on a novel pathway to inhibit HIV replication. Isentress, also called Raltegravir, was developed by the Merck Corporation. It’s the first drug in a new line of AIDS medications called integrase inhibitors. As the name suggests, these drugs target an enzyme called integrase that the virus brings with it into an infected cell. Integrase, along with two other enzymes called reverse transcriptase and protease, is essential for HIV’s replication within the host. Therefore, scientists believe that if they can find a compound that stops integrase, they may be able to stop HIV from replicating.

After HIV has entered the cell by fusing with the membrane of its target cell, the virus dumps its genetic material and enzymes inside. It then makes copies of its own genetic material and uses integrase to insert them into the DNA of its host. This allows the virus to replicate its genome using the host’s machinery, and essentially take over the infected cell for its own reproductive purposes. The goal of integrase inhibitors is to prevent integrase from working correctly, therefore keeping the HIV genetic material out of the host’s genome and hindering viral replication. Previously, there had been only four pathways that drugs target in the HIV life cycle, and none of them had targeted integrase. However, integrase is an attractive target molecule for drug development for a number of reasons. First of all, integrase does not resemble any known human proteins, meaning the chances of side effects are reduced. In addition, by going after a new viral pathway for infection, doctors can combine integrase inhibitors with drugs targeting different pathways, which prevent the virus from becoming resistant to an entire class of drugs.

Scientists have long wanted to develop an integrase inhibitor, but the road to creating an effective drug and gaining FDA approval for it is a long one. According to Merck’s website, research into integrase inhibitors began in 1993 and eventually resulted in the identification of a class of compounds that could impede the function of the enzyme. These compounds work by binding to the active site of the integrase, thus preventing it from binding and cutting the host DNA, which prevents the viral genome from being inserted. After this discovery, researchers worked with these compounds in the lab to create the best integrase inhibitor, and tested it in virus cultures and animals. The use of animals allowed them to get an idea of the severity of the side effects and an approximate idea of the appropriate drug dosage. The final product of this drug testing was named Isentress. After emerging from the laboratory phase, Isentress was put through three phases of clinical studies involving groups of healthy and sick people. Results from the studies of Isentress given with a combination of other AIDS drugs were compared to a placebo given with the same drugs. From these data, researchers were able to get an idea of the effectiveness of the drug in treating the virus and fine-tune dosage information, all while closely monitoring side effects. At the end of this process, Merck submitted the data from all of the tests and clinical studies to the FDA for it to decide whether the drug was safe to be offered on the market. And on October 12, 2007, Isentress was officially approved by the FDA for treatment in AIDS patients, specifically those with HIV strains resistant to all other drugs. Most of the optimism surrounding the approval and release of the drug comes from the data obtained in the clinical studies. In the later phases of these trials, Isentress and a standard combination of other drugs were given to the most drug-resistant patients and compared to a placebo group. After 16 weeks, the Isentress treatment reduced the viral load to almost undetectable amounts in nearly 80% of patients, compared to only 43% in the placebo group.

While questions concerning Isentress still remain, such as whether the drug will work over longer periods of time and what the long term side effects might be, the preliminary results suggest that Isentress will have a significant impact on the treatment of AIDS immediately. As mentioned before, Isentress is initially expected to be used in patients who have exhausted all other drug treatment options. However, the overwhelming success of the drug so far has medical professionals wondering whether it can eventually be used as a front-line treatment against HIV. The true impact of Isentress cannot be known until it has been used by all types of AIDS patients over long periods of time. Nevertheless, the approval of Isentress is a sure sign for optimism in the AIDS community and a great success for the drug and pharmaceutical companies that have spent years producing and testing it.

I’m Mike Neri, and thanks for listening.

HIV/AIDS: The Brazilian Response

In the arena of HIV/AIDS prevention and treatment, Brazil has become a beacon of hope, particularly among developing countries. Countries around the globe are now looking towards their system of universal AIDS care for guidance.

In the early 90’s it was estimated that within a decade, the number of HIV+ people in Brazil would be near 1.2 million. Instead, recent estimates suggest that only half that amount (about 660,000 people) are infected. How have they been so successful in limiting the spread of this deadly disease? With a three pronged government program focusing on prevention, treatment, and reducing the stigma associated with AIDS patients.

The first aspect of Brazil’s plan hopes to prevent the spread of HIV, particularly among the highest risk groups. After a brief stint of abstinence education failed early in the epidemic, the government looked towards other alternatives. Surprisingly, even in a country that is dominated by the Catholic Church, promoting condoms has proven very effective. The government has plans to distribute millions of condoms through local clinics, particularly to those involved in the commercial sex industry. Condom distribution is intensified during Carnival, a lively celebration before Lent where “free condoms are passed out like candy.” They have even encouraged the adult films industry to incorporate condoms into their films, and have produced prime time TV ads promoting condom usage in homosexuals. Additionally, a government funded needle exchange program hopes to slow down the spread among IV drug users.

A particularly intriguing aspect of Brazil’s treatment program has been their ability to supply anti-retroviral drugs to any AIDS patient needing them. As of September 2005, over 170,000 patients who required treatment were receiving it for free from the government. On a recent visit, the head of Uganda’s Parliamentary Committee on HIV/AIDS affirmed that “being able to provide the same standards of care to all citizens irrespective of their status in society is something to emulate.” This program, which began in 1997 as the first of its kind in the developing world, has lead Brazil to seek cheaper prices in order to keep costs down. A government sponsored company produces generic forms for many of the most widely used drugs. They have even broke patents on some of the newer drugs as costs have continued to skyrocket. Under fear that the Brazilian government will bypass the patent system, many companies have opted to cooperate and lower their prices. Even still, treatment makes up about 80% of their AIDS budget.

Contrary to many aspects of the US AIDS program, the Brazilian government has worked to gain the support of many of the most at risk groups. In 2005, Brazil rejected over $40 million from the United States because they would have had to pledge that they oppose commercial sex work; having the support of the sex industry has been integral in their fight against AIDS. Additionally, focusing on treatment instead of solely on prevention has encouraged testing and reduced stigma for those suffering with AIDS.

The model system that Brazil has implemented is envied by many countries around the world. Even the United States could learn from Brazil’s focus on condom distribution and treatment, as well as their support for constructive dialogue about the disease.

For more information about the current status of HIV/AIDS in Brazil, go to Brazil’s page of the UNAIDS website.

I’m Ben Young, thanks for listening.

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.

I'm Page Bomar. Thanks for lsitening.

VIRIP: A new anti-HIV compound?

Welcome to this installment of The AIDS Pandemic. I’m Dave Wessner.

Could our own bodies be producing potent inhibitors of HIV? According to research published in today’s issue of Cell, the answer may be ‘Yes.’ And these interesting findings eventually may lead to the development of new anti-retroviral drugs.

Since the isolation of HIV in 1983, numerous naturally occurring human factors have been postulated to have anti-HIV properties. Today, a group of researchers in Germany have added another factor to this list. By studying hundreds of small molecules isolated from human blood, the researchers identified a short peptide, or protein fragment, that effectively blocked HIV from infecting cells. Termed Virus-Inhibitory Peptide, or VIRIP, this peptide represents a small piece of a larger protein normally found in our blood – alpha1-anti-trypsin.

To demonstrate the inhibitory effects of VIRIP, the researchers infected cell lines with HIV-1, added VIRIP to the cells, and then determined how many additional cells subsequently became infected. VIRIP decreased the infection rate in a dose-dependent manner. In other words, when higher concentrations of VIRIP were used, the effect was greater. The effect also was very specific for HIV; the peptide did not block the infectivity of other types of viruses. Interestingly, the researchers showed that if they altered the VIRIP peptide slightly, it’s inhibitory properties increased dramatically. Finally, VIRIP was equally effective against strains of HIV that were resistant to other anti-retroviral drugs, yet resistance to VIRIP was not observed.

Mechanistically, it appears that VIRIP blocks HIV infection by binding to the viral protein gp41 and preventing fusion between the viral envelope and the cell membrane. An existing drug, T20, or Fuzeon, works in a similar manner.

The path from an initial discovery like this and a marketable drug is a long and winding path, filled with potholes. Promising candidate molecules rarely become FDA-approved drugs. So, the odds are against VIRIP. But, based on this report, it’s certainly worth keeping our eye on it.

Until next time, I’m Dave Wessner.

Kiva: Using microfinancing to help people in developing countries

Paul Farmer, one of the founders of Partners in Health, describes the ‘great epi divide,’ the epidemiological divide that exists between developed countries and developing countries, between affluent neighborhoods and less well-off neighborhoods, between the haves and the have-nots. Morbidity and mortality associated with infectious diseases, Farmer notes, correlate well with economic disparities.

HIV/AIDS is no exception. Certainly, HIV can, and does, infect people of all walks of life. Increasingly, though, the HIV burden is highest among developing countries and the poor within developed countries. The reasons for this correlation are many. In economically challenged areas, medical care and treatment often are unavailable or unaffordable. In these areas, access to education may be limited. The list goes on.

One could argue, then, that improving the economic independence of people is the ultimate weapon against the spread of HIV. One group addressing the issue of economic independence in developing countries is KIVA. Kiva, Swahili for ‘agreement,’ is a non-profit organization designed to help people gain economic independence through microfinancing. Individuals can search the Kiva web site for people in Africa, central Asia, eastern Europe, and other parts of the world, who have great ideas, but need some initial capital. Through Kiva, one can make small, interest-free loans to these individuals. In some cases, a few hundred dollars may be all that a person needs to open a small bakery or expand a pottery shop.

The loans aren’t guaranteed; as a donor, you may never be repaid. But the results could be transformative. A little seed money may be all a person needs to become self-sufficient and cross the great epi divide.

Find out more about Kiva and help someone make their dreams a reality.

Until next time, I’m Dave Wessner.

Refrigeration and HIV Meds in Resource-limited Settings

I'm Charlie Raver.

One of the distinguishing characteristics between the AIDS epidemic in the developed world and that in Africa and the developing world is a simple lack of the infrastructure to deal with the disease. Infrastructure includes everything from roads to electricity to hospitals. One example that most of us rarely think of as a gift, couldn’t dream of walking into a home and not finding, and would be lost without is something to which many in the developing world do not have access. What am I talking about? Refrigeration. Without this amazing piece of technology we would not be able to easily enjoy fresh meats, fish, dairy, and many simple nutritional luxuries that we as Americans take for granted. In addition to problems with food preservation, hospitals and health clinics would be unable to store blood, vaccines, heat intolerant medicines, and many laboratory supplies.

For many in the developing world that is exactly the problem. Without refrigeration they have no means to store many of the supplies necessary for maintaining a health clinic. Without this infrastructure, access to basic care, essential for the treatment of AIDS, is extremely limited. Recently, the WHO recommended the use of a ritonavir boosted protease inhibitor as part of the drug regimen. Aside from being able to obtain the drug, one problem is that ritonavir requires refrigeration in hot climates. Currently only one of the ritonavir boosted PIs is available in a heat stable form which, obviously puts a huge constraint on the availability of the drug in the developing world. A confounding issue is the high rates of coinfection of diseases such as tuberculosis and malaria in these resource poor areas. In addition to proper care, access to testing for HIV and TB has been cited as one of the first obstacles to fighting the epidemic. The WHO estimates that less than 10% of people living with HIV/AIDS in parts of Sub-Saharan Africa are aware of their HIV status.

In addition to poor access to health care, the epidemic is only made worse by the staggering rates of malnutrition. In their recommendations for antiretroviral therapy, the WHO emphasized the importance of nutrition not just for the overall health of the affected individuals but also because of the link between nutrition and the effectiveness of ART. However, in some parts of Sub-Saharan Africa, it is estimated that as much as 50% of the population is malnourished. Many Africans do not even have the means to buy or grow the most basic foods. This problem is again only made worse by the lack of refrigeration. Some form of food preservation could allow rural communities and individuals to grow crops in excess and store the surplus to either sell and trade with other communities or even just maintain a supply during the non-productive parts of the year. However, when you consider that over 500 million people in Sub-Saharan Africa do not have access to electricity the idea of refrigeration is a long shot.

Unfortunately providing those in rural Africa with electricity is a problem unto itself. Without economic stability there is little room for expansion and improvement of infrastructure whether it is roads, electricity or health care. These lacks in infrastructure only make the AIDS epidemic harder to fight which further hinders economic growth. However, small improvements like access to refrigeration could be a catalyst for change.

One type of refrigeration that requires no electricity is sorption refrigeration. This form of refrigeration works by having two chambers connected by some type of tube. One chamber, the hot side, contains an absorbent material. The other chamber, the cold side, contains a refrigerant. The tube connecting the two would be filled with refrigerant vapor. The vapor in the tube is then absorbed on the hot side causing a drop in pressure in the connecting tube. This causes evaporation of the refrigerant which in the process absorbs heat and causes cooling on the cold side. This continues until all the refrigerant has vaporized and been absorbed on the hot side. To restart the cooling process, the hot side must be heated gently to drive the refrigerant vapor out of the absorbent material and back to the cold side. In the late 1920s, Powell Crosley Jr. developed a commercial version using ammonia and water that was used throughout the rural United States prior to wide-spread access to electricity. Although this is by no means a large scale solution to the infrastructure problem, adaptation of these ideas for use in the developing world could provide one of the basic necessities for health care and food preservation.