AIDS 2006
World leaders urged to commit to HIV agenda

Researchers, activists and political and civil society leaders opened the first full day of the XVI International AIDS Conference (AIDS 2006), held in Toronto, Canada from 13-18 August, with a unified call for a greater global commitment to HIV services and programmes guided by the needs, rights and active involvement of affected communities.

“There are still far too many instances where punitive laws, stigma, gender inequities and lack of access to needed prevention and care services conspire to fuel the HIV pandemic,” said conference co-chair Dr Mark Wainberg, chair of the Toronto Local Host Board and director of the McGill University AIDS Centre.

“Today we issue a clarion call to leaders the world over to stand with affected communities to find meaningful solutions to the challenges at hand.” Dr Helene Gayle, Conference co-chair and president of the International AIDS Society, said: “Universal access to HIV prevention, care and treatment will remain elusive until there is a global commitment to programmes and policies driven by the human rights of affected communities.

“Underlying issues such as poverty, gender inequality and homophobia continue to thwart efforts to expand access. Combating these entrenched obstacles is fundamental to an effective response to AIDS.”

Identifiable factors

In the conference’s opening plenary session, Dr Chris Beyrer (United States) of Johns Hopkins Bloomberg School of Public Health examined the risk contexts of emerging and sustained HIV epidemics.

He cited data and examples underscoring the urgent need to extend rights- and evidence-based services to injecting drug users (IDUs), men who have sex with men (MSM) and girls and young women in order to improve their social contexts and reduce individual- level risks of HIV infection.

According to Dr Beyrer, HIV epidemics among IDUs in Eurasia are driven by greater availability of opiate and heroin due to production increases in Afghanistan, the limited use of evidencebased prevention programmes, and environments marked by harassment, high incarceration rates, human rights violations and social stigma. Dr Beyrer also noted mounting evidence of severe, concentrated epidemics among MSM in parts of Asia, Latin America, Eastern Europe, and Africa marked by criminalisation, discrimination, stigma and limited prevention services. UNAIDS estimates that, globally, fewer than one in ten MSM is reached by appropriate prevention and care services.

Viral variability

Dr Julie Overbaugh (United States) of the Fred Hutchinson Cancer Research Center in Seattle highlighted accumulating evidence regarding risk of re-infection, which may have implications for the direction of future vaccine efforts.

Overbaugh discussed the results from several recent studies which found that persons with preexisting HIV-1 infection are at continued risk of re-infection by another partner.

These studies suggest that the immune responses to HIV- 1 that arise during chronic infection may not be adequate to protect against subsequent infections. Dr Overbaugh also offered insights into variables that impact HIV transmission.

She described a variety of factors related to the virus and the human host that may impact risk of HIV acquisition, including the recent observations that the types of HIV variants being transmitted tend to be those with fewer sugars on the envelope protein coat of the virus particle. One role of sugars is to shield the protein from the host immune responses.

She suggested that a future challenge to the field will be to understand why such viruses are favoured for transmission, and noted that this research direction could provide important clues as to the very early dynamics between the virus and host that result in HIV infection.

HIV strategies

Louise Binder (Canada), vice-chair of Ontario’s Voices of Positive Women and chair of the Canadian Treatment Action Council, emphasised that while HIV among women and girls is a grave situation, it is not insurmountable.

Binder cited community based programmes in Rwanda and Limpopo, South Africa, and the role of women in the progress of microbicide research as concrete examples of successful women-led projects addressing HIV prevention, access to treatments, gender-based violence, poverty relief and economic security.

Binder called on all nations to develop a comprehensive HIV strategy that encompasses women’s health and development issues, includes a plan to end gender-based violence, and is integrated into reproductive health systems.

Binder urged that women living with HIV/AIDS lead the development of these strategies and called upon community and political leaders to openly support their interconnection with development strategies that ensure women are educated, trained and given access to microfinance.

Human rights

Anand Grover (India), cofounder of the Lawyers Collective HIV/AIDS Unit, delivered the Jonathan Mann Memorial Lecture, named in memory of scientist Jonathan Mann, credited with building the World Health Organisation’s AIDS programme from the ground up.

Grover examined the crucial need for the autonomy of people living with HIV/AIDS in making HIV-related policies and called for strengthening gains made in this area over the past 25 years. Grover argued that optout routine HIV testing is problematic as a public health strategy. He also raised concerns about some strategies to prevent parent-to-child transmissions, which he stated are shortsighted due to infringing upon the rights of women.

With the continuing expansion of treatment options, Grover highlighted the right to treatment as one of the central components of rights-based HIV initiatives in the years ahead.

UNAIDS report 2006
AIDS epidemic threat grows in MENA region
UNAIDS says data they’ve received indicates that, although HIV prevalence is generally low in the Midde East-North Africa region, the threat of an epidemic is increasing, particularly in countries such as Iran and Libya, where increasing intravenous drug use is seen as an important factor in HIV transmission.

These details are highlighted in the 2006 Report on the global AIDS epidemic, released in New York in June. The annual publication offers the most indepth HIV/AIDS data for all countries. The 2006 issue marks a quarter century since the first cases of AIDS were reported.

In that time AIDS has killed more than 25 million people and orphaned millions of children. It is estimated that there are now nearly 40 million people living with HIV/AIDS worldwide. And the number of people caught in the pandemic continues to increase from year to year.

In the past year an estimated 4.1 million became newly infected with HIV and an estimated 2.8 million lost their lives to AIDS. (See table below.) Kofi Annan, Secretary- General of the United Nations puts it succinctly: “What was first reported as a few cases of a mystery illness is now a pandemic that poses one of the greatest threats to global progress in the 21st century.”

AIDS in the MENA region – An excerpt from the 2006

Report on the global AIDS epidemic Except for Sudan, national adult HIV prevalence in the countries of the Middle East and North Africa is very low, and does not exceed 0.1%.

However, available data suggest that the epidemics are growing in several countries, including in Algeria, Islamic Republic of Iran, Libyan Arab Jamahiriya and Morocco.

Across the region, an estimated 64,000 [38 000–210 000] people were newly infected with HIV in 2005, bringing the total number of people living with the virus to some 440,000 [250 000–720 000]. Sudan accounts for fully 350,000 [170 000–580 000] of those people. Against a backdrop of uneven access to antiretroviral treatment in this region, AIDS killed an estimated 37,000 [20 000–62 000] adults and children in 2005.

Just 5% of the estimated 75,000 people needing antiretroviral therapy were receiving it at the end of 2005 (WHO/UNAIDS, 2006). In Sudan, national adult HIV prevalence was an estimated 1.6% [0.8%–2.7%] in 2005.

The epidemic is most severe in the country’s southern areas (which are flanked by countries with comparatively high HIV prevalence). HIV prevalence of 2.2% was found at antenatal clinics in White Nile state in 2005, for example (Ministry of Health Sudan, 2006).

Recent surveys among adults in the community and among pregnant women found HIV prevalence levels of 4.4% and 3%, respectively, in the town of Yei (which lies close to the Ugandan border) and 0.4% and 0.8% in Rumbek (which is further inland) (Kaiser et al., 2006).

There are recent signs of significant HIV spread in Khartoum, in the north (Ministry of Health Sudan, 2005). Among displaced pregnant women seeking antenatal care in Khartoum in 2004, for example, HIV prevalence of 1.6% was found, compared to under 0.3% for other pregnant women (Ministry of Health Sudan, 2005).

The main mode of HIV transmission in this region is unprotected sexual contact, although injecting drug use is an increasingly important factor, especially in the epidemics in the Islamic Republic of Iran and Libyan Arab Jamahiriya.

With risk behaviour widespread among Iran’s large population of injecting drug users, high HIV infection levels are being found: when tested, 15% of male injecting drug users attending Tehran drug treatment centres were HIV-positive.

Most of the injecting drug users were sexually active, and exchanging money for sex was common; yet, only about half had ever used a condom (Zamani et al., 2005; Ministry of Health and Medical Education Iran, 2004). In Marvdasht, two in three injecting drug users seeking treatment reported sharing needles, and one in five said they had done so in prison (Day et al., 2005).

Indeed, an important risk factor for HIV infection among injecting drug users appears to be incarceration (Rahbar et al., 2004). Given that a large proportion (almost half, by some estimates) of the total prison population in Iran comprises persons detained for drug-related offences, there is an urgent need to expand HIV prevention including methadone maintenance therapy) programmes, especially in correctional settings Zamani et al., 2005).

A similar challenge confronts the Libyan Arab Jamahiriya, where HIV prevalence of 18% has been found among prisoners Sammud, 2005). This is not surprising, given the ten-fold increase in HIV infections in young men in Libya since the turn of the century; unsafe drug injecting practices were responsible for about 90% of those infections.

Risk behaviour associated with injecting drug use boosts the likelihood of HIV outbreaks among injecting drug users in several other countries, as well. According to various studies, in Algeria some 41% of injecting drug users shared injecting equipment, as did 55% in Egypt and 65% in Lebanon Mimouni and Remaoun, 2005; Elshimi et al., 2004; Khoury and Aaraj, 2005).

Unprotected sex including during paid sex and sex between men) is the other major factor in the region’s epidemics, in countries such as Egypt, Morocco and Saudi Arabia, for example. About half the HIV infections detected during a study in the Saudi Arabian capital, Riyadh, occurred during heterosexual intercourse.

There, the majority of women with HIV were married and probably acquired the virus from their husbands, who were most likely infected during paid sex (Abdulrahman et al., 2004).

Sex work is a significant risk factor in several countries: 9% of female sex workers tested in Tamanrasset, Algeria, in 2004 were HIV-positive, while in Morocco, studies have found HIV prevalence of 1.9% (in 2004), and in Sudan, 4.4% (in 2002) among female sex workers (Fares et al, 2004; Ministe`re de la sante´ Maroc, 2005; Federal Ministry of Health, Sudan, 2002).

Algeria’s epidemic has expanded into the wider population, with HIV among women in antenatal care in parts of the south exceeding 1% (Institut de Formation Parame´dicale de Parnet, 2004).

Very little is known about the spread of HIV in other countries in the region, due to the limited information about the patterns of HIV transmission and behaviour (especially the roles of sex work and of sex between men in the epidemics). It is possible that hidden, localised epidemics could be occurring undetected in some places.

HIV-related prevention information and services are in short supply across the region. Knowledge of AIDS tends to be poor, and preventive practices rare, even among populations most at risk of becoming infected. HIV prevention strategies and services need to be strengthened to curb the mostly nascent epidemics in this region, and major efforts are needed to tackle stigma and discrimination, which hamper current efforts.

The full report can be downloaded from the Internet at:

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