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Reduced Incidence Of Rape For Kenyan Girls Who Received Self-Defense Training

admin — Mon, 17 Jun 2013 12:18:41 +0000

Main Category: Women’s Health / Gynecology
Also Included In: Pediatrics / Children’s Health; HIV / AIDS; Sexual Health / STDs
Article Date: 17 Jun 2013 – 0:00 PDT

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Rape is shockingly common in the slums of Nairobi, Kenya, where as many as one in four adolescent girls are raped each year. But a short self-defense course can dramatically reduce the girls’ vulnerability to sexual assault, according to a new study from the Stanford University School of Medicine, Lucile Packard Children’s Hospital and an organization called No Means No Worldwide.

“Self-defense training taught these young girls to stand up and say ‘no’ with confidence, and empowered them to escalate their own defense to a higher level, if necessary,” said Neville Golden, MD, senior author of the new study, which is now available online on the Journal of Adolescent Health website. “To our knowledge, this is the first study to demonstrate that a self-empowerment/self-defense course can reduce the incidence of rape in adolescent girls,” added Golden, who is a professor of pediatrics at Stanford and the division chief of adolescent medicine at Packard Children’s.

The study looked at 402 girls who participated in a self-defense program developed by a Kenya-based nongovernmental organization, No Means No Worldwide, that taught them verbal and physical self-defense techniques, and gave them information about how to get help if they were assaulted. Conducted in high schools, the program was designed to combat a culture in which discussing sexual assault is taboo.

In the 10 months after receiving self-defense training, more than half of these girls reported using what they had learned to fend off would-be attackers. The proportion of them who were raped fell from 24.6 percent in the year before training to 9.2 percent in the 10-month period after.

“There is a strict code of silence among rape victims in Kenya, especially with the stigma of HIV and AIDS,” said Jake Sinclair, MD, the lead author of the new study and a pediatrician at John Muir Medical Center in Walnut Creek, Calif. “Typically, no one is going to admit that they were raped. Victim-blaming is the norm.” Sinclair and his wife, Lee, co-founded No Means No Worldwide and have developed sexual-assault prevention curricula for several audiences in Kenya, including self-defense programs for girls and women, and educational programs to help boys recognize the harm inflicted by sexual assault.

The subjects of the study were 522 high school girls, ages 14 to 21, in two impoverished Nairobi slums: 402 received 12 hours of self-defense training over six weeks, as well as two-hour refresher courses at three-, six-, nine- and 10-month intervals; 120 in a comparison group received a one-hour life-skills class that is the current national standard in Kenya. Before and 10 months after the training, both groups answered anonymous questionnaires about their recent experiences of rape.

At the start of the study, nearly one in four girls reported that they had been forced them to have sex in the prior year; 90 percent of the victims knew their attackers. The study focused on rape and did not assess the entire range of behaviors classified as sexual assault under U.S. laws.

Among girls who received self-defense training, 56.4 percent used the skills they learned to fend off attackers in the subsequent 10 months. Of these girls, half used verbal skills alone, one-third started with verbal skills and added physical skills, and 17 percent used physical skills alone. Not only did total assaults drop sharply, but assaults by the two most common groups of perpetrators, boyfriends and relatives, decreased significantly. After receiving training, girls who were raped were more likely to seek help following an attack.

In contrast, among girls who had life-skills classes, the proportion who became victims of rape remained about the same.

“We were pretty stunned that the self-defense training was so effective,” Sinclair said. “From the testimonials we collected, we saw that even a small girl could disable an attacker and get away, again and again.”

The self-defense classes, which trained and employed local Kenyan women as instructors, were also cost-effective: providing the training cost $1.75 per student, whereas immediate after-care for rape in Kenya costs $86, a figure that does not account for long-term costs such as new HIV infections or unwanted pregnancies.

No Means No Worldwide is now testing the effectiveness of their curriculum for boys, which focuses on teaching boys not to perpetrate sexual assault. They are also working to disseminate the girls’ self-defense curriculum more widely.

“Often, people focus on women as victims,” said Cynthia Kapphahn, MD, a clinical associate professor of pediatrics at Stanford and an adolescent medicine specialist at Packard Children’s who was also an author of the study. “This work shows that it’s also important to focus on them as empowered beings; that approach can have an important role in a woman’s ability to protect herself.”

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Article source: http://www.medicalnewstoday.com/releases/261927.php

Potential Zoonotic Disease-Transmission Sources Identified Based On Social Networks Tools

admin — Fri, 14 Jun 2013 11:55:49 +0000

Main Category: Infectious Diseases / Bacteria / Viruses
Also Included In: Tropical Diseases; HIV / AIDS
Article Date: 14 Jun 2013 – 0:00 PDT

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Spanish and US scientists have successfully identified animal species that can transmit more diseases to humans by using mathematical tools similar to those applied to the study of social networks like Facebook or Twitter. Their research – recently published in the prestigious journal PNAS – describes how parasite-primate interactions transmit diseases like malaria, yellow fever or AIDS to humans. Their findings could make an important contribution to predicting the animal species most likely to cause future pandemics.

Professor José María Gómez of the University of Granada Department of Ecology is the principal author of this research, in collaboration with Charles L. Nunn (University of Cambridge, Massachusetts, US) and Miguel Verdú (Spanish National Research Council Desertification Research Center, Valencia, Spain). They propose a criterion to identify disease-transmission agents based on complex network metrics similar to those used to study social networks.

As Prof Gómez explains, “most emerging diseases in humans are zoonotic, that is, they are transmitted to humans by animals. To identify animal species that are potential high-risk sources of emerging diseases it’s essential we set up mechanisms that control and observe these diseases”.

Study of 150 primate species

To conduct their study, the researchers constructed a network in which each node represented one of the approximately 150 non-human primate species about which we have enough data on their parasite fauna. “Each primate species is connected to the other primates as a function of the number of parasites they share. Once the network was constructed, we studied each primate species’ position – whether central or peripheral. A primate’s centrality is measured by its connection intensity with many other primates that are, in turn, closely connected”, says the University of Granada researcher.

The article published in PNAS reports the researchers’ discovery that the most central primates could be more capable of transmitting parasites to other species and, therefore, to humans, than the rest. “This is comparable to the idea that, in social networks, web pages that are central and have links to many other pages, spread their contents all through the Web”, José María Gómez affirms.

The researchers have confirmed their hypothesis by relating the centrality value of each primate with the number of emerging pathogens shared with humans. And, in effect, they have found that the most central primates were those that share more emerging pathogens with humans.

In conclusion, the study proposes a simple criterion to detect potential zoonotic agents of emerging disease transmission to humans: the centrality of these agents in their network interaction with their parasites. “The only information needed to construct these networks is the diversity and type of parasite infecting each host – and we already know about many zoonotic organisms. This is why we think that our approach will be useful in developing early warning plans for emerging disease in humans”, Prof Gómez concludes.

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Article source: http://www.medicalnewstoday.com/releases/261839.php

Antiretroviral Drug Reduces Risk Of Contracting HIV Among Injection Drug Users

admin — Thu, 13 Jun 2013 23:52:06 +0000

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Academic Journal
Main Category: HIV / AIDS
Article Date: 13 Jun 2013 – 6:00 PDT

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Researchers have found that people who inject drugs could reduce their risk of HIV infection by nearly half if they take daily tablets of an antiretroviral drug called tenofovir disoproxil fumarate (tenofovir).

This was the first trial to evaluate whether preventative treatment with HIV drugs could prevent HIV infection among people who inject drugs.

Jonathan Mermin, M.D., director of CDC’s Division of HIV/AIDS Prevention said that this is a “significant step forward for HIV prevention. We now know that pre-exposure prophylaxis (PrEP) can work for all populations at increased risk for HIV.”

The findings, published in The Lancet, come from the Bangkok Tenofovir Study, conducted by the CDC (Center for Disease Control and Prevention) in collaboration with the Bangkok Metropolitan Administration and the Thailand Ministry of Public Health.

The investigation was led by Dr Kachit Choopanya.

A total of 2,411 men and women participated in the study from 17 drug treatment clinics in Thailand.

Close to half of the participants (1204) were given a daily dose of tenofovir while the rest (1209) were given placebo.

The participants received risk-reduction counseling as well as monthly HIV testing.

After an average follow-up period of four years, there were only 17 confirmed cases of HIV infection among people taking tenofovir, compared to 33 cases in the placebo group. This translates into a reduction in HIV risk of 48.9% for those on the daily dose of tenofovir.

Additional analyses of the results indicated that the protective effect of tenofovir was best in participants who adhered closely to the prescribing regime, reducing their risk of HIV transmission by 74 percent.

There have been other studies which showed that pre-exposure prophylaxis (PrEP) is effective in reducing the risk of contracting HIV. However, the protective effects of these antivirals have only been established among heterosexual couples and men who have sex with men and mother to child transmission – the drug is safe to use during pregnancy, according to a study published in PloS Medicine.

HIV Prevalence Worldwide – developing countries at increased risk
This study confirms that the approach also protects people who inject themselves with drugs.

Among drug users, sharing and reusing syringes contaminated with HIV-infected blood is extremely risky. Injecting drug use accounts for close to ten percent of new HIV infections worldwide. However, in eastern Europe and central Asia these rates are much higher, with 80 percent of HIV cases in these areas caused by injecting drugs.

According to Dr Martin:

“This study completes the picture of PrEP efficacy for all major HIV risk groups – we now know that pre-exposure prophylaxis can be a potentially vital option for HIV prevention in people at very high risk for infection, whether through sexual transmission or injecting drug use.”

Martin said that adherence was a very important factor in the trial. The finding underscores the importance of achieving effective levels of adherence among people using pre-exposure prophylaxis to prevent HIV.

However, Professor Salim Karim, Director of the Centre for the AIDS Program of Research in South Africa (CAPRISA), stated that people who use drugs often engage in other high risk behaviors such as selling sex to fund their addiction. He noted that the protective effect of tenofovir among drug users identified in this study could be attributed to the previously established positive effects of PrEP among those who engage in risky sexual behaviors.

Professor Karim concluded:

“Even though questions remain about the extent to which PrEP can be effective in preventing either of the routes of transmission in this group, the overall result is that daily tenofovir does reduce HIV transmission in injecting drug users.
The introduction of PrEP for HIV prevention in injecting drug users should be considered as an additional component to accompany other proven prevention strategies like needle exchange programmes, methadone programmes, promotion of safer sex and injecting practices, condoms, and HIV counselling and testing.”

Tenofovir effective at preventing HIV

Tenofovir gel has proven to guard against HIV infection during vaginal intercourse and also defends against the viral spreading of HIV during anal sex too, according to research presented at the 18th Conference on Retroviruses and Opportunistic Infections (CROI).

Researchers from the USA, Belgium and Italy reported in the journal Cell Host Microbe that tenofovir, when formulated as a vaginal gel, was found to reduce herpes simplex risk in females.

In addition, when a partner in a couple has HIV and the other doesn’t, treatment with antiretroviral drugs can lower the risk of the infected partner passing along the disease to his or her mate, according to research published in The Cochrane Library.

Written by Joseph Nordqvist

Copyright: Medical News Today

Not to be reproduced without permission of Medical News Today

Additional
References
Citations

“Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial”

Kachit Choopanya MD, Dr Michael Martin MD, Pravan Suntharasamai MD, Udomsak Sangkum MD , Philip A Mock M, Manoj Leethochawalit MD , Sithisat Chiamwongpaet MD , Praphan Kitisin MD , Pitinan Natrujirote MD , Somyot Kittimunkong MD , Rutt Chuachoowong MD , Roman J Gvetadze MD , Janet M McNicholl MD, Lynn A Paxton MD , Marcel E Curlin MD, Craig W Hendrix MD, Suphak Vanichseni MD
The Lancet

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Article source: http://www.medicalnewstoday.com/articles/261888.php

5-Yearly Universal HIV Testing In India A Cost-Effective Approach

admin — Wed, 12 Jun 2013 11:42:37 +0000

Main Category: HIV / AIDS
Article Date: 12 Jun 2013 – 0:00 PDT

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A new study using a sophisticated statistical tool, has determined that providing universal HIV testing for India’s billion-plus population every five years would prove to be a cost-effective approach to managing the epidemic, even with more intensive testing for high-risk groups.

In India most people who are HIV positive don’t know it, yet testing and treatment are relatively cheap and available. It would therefore meet international standards of cost-effectiveness – and save millions of lives for decades – to test every person in the billion-plus population every five years according to a new study published in the journal PLoS One.

The findings are based on a careful analysis of India’s HIV epidemic using the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) International model, a sophisticated statistical tool that has already been used in HIV policymaking in France, South Africa, and other countries. A team of researchers at Brown, Yale, Massachusetts General Hospital, Harvard, and in Chennai, India, integrated scores of factors specific to the country to find that testing for the whole country, with greater frequency for high-risk groups and areas, would pay off despite India’s huge population and even in cases where conditions are worse than the researchers assume.

“Testing even 800 million adults is a public health undertaking of a historic magnitude,” said study co-lead author Dr. Kartik Venkatesh, a postdoctoral fellow at Brown University and Women Infants Hospital. Jessica Becker of Yale University is the other lead author of the study, which first appeared May 31. “But what we were able to show is that even if you increase the cost of HIV treatment and care pretty significantly and really decrease the number of individuals who would link to care, even under those dire circumstances, testing this frequently and this widely still was reasonable.”

Co-author Dr. Soumya Swaminathan, director of the National Institute for Research in Tuberculosis in Chennai, India, said the projections of the model will help the country in its battle with the epidemic, one of the world’s largest.

“The paper explores various strategies and suggests cost-effective options for HIV testing in India,” Swaminathan said. “As India moves ahead in its HIV prevention activities and aims for zero new infections, expanding testing will be a key priority and this analysis should help policymakers make the best decisions.”

Dollars per life-years saved

The main results from the model are projections of the dollar cost per year of extended lifespan. The World Health Organization’s standard for cost effectiveness is an expenditure that is less than three times the per capita GDP of a country. In India in 2010, per capita GDP was $1,300. A program is therefore cost-effective in India if the expense is less than $3,900 to save a year of someone’s life.

Modern antiretroviral therapies can give HIV-positive people a normal lifespan, and in India, which has a thriving generic pharmaceutical sector, first-line therapy costs only $8.61 a month (second-line therapy for those whose viruses prove resistant is $55.12 a month). HIV tests, meanwhile, cost only $3.33.

After extensive research to determine the best possible data for the country, Venkatesh, Becker, and the team coded several other parameters into the model including what percentage of people would refuse the test (18 percent), how many patients who test positive would get care (50 percent), the prevalence of HIV in the population (0.29 percent), and many other factors such as the monthly risk of opportunistic infection in positive patients, hospitalization costs, the effectiveness rate of therapy, and the likelihood of positive patients transmitting the virus to others.

They ran the models not only for the general population but also for people in high-risk districts and high-risk groups (e.g., with a higher prevalence of the virus but with more frequent testing today).

As they ran the numbers to determine the costs and effects on patients of broader and more frequent testing, they compared the results to what would happen under the status quo, in which there is less-than-universal testing.

Here is what they found:
Testing the general population just once would be “very cost-effective” because it would cost $1,100 per year of life saved (YLS) in general and $800 per YLS among high-risk populations.
Testing the population every five years would be “cost-effective” with a price of $1,900 per YLS saved in general, and $1,300 per YLS among high-risk groups.
Testing annually would not be cost-effective for the general population ($4,000/YLS), but would be for high-risk people ($1,800/YLS).
The general trends of cost effectiveness remained even after “sensitivity” analyses in which the researchers entered different statistical assumptions in the model in case their assumptions were too optimistic. But to make testing the general population every five years no longer cost-effective, the researchers had to tell the model that only 20 percent of the general population would agree to testing and only 20 percent of positive patients would get care.

Addressing an epidemic

Venkatesh said the main benefit of national testing would simply be getting more people to learn they are positive and therefore to seek effective care before they have full-blown AIDS and a complication. A secondary benefit, however, would be to curb transmission of the virus, both because behavior can change and because therapy can reduce transmissibility.

“Universal testing can have a big impact in catching a large number of individuals who are infected and getting them to seek treatment and seek services earlier in the course of their disease,” said Venkatesh, who traveled to India at least once a year for all eight of his years as an M.D. and Ph.D. student at Brown from 2005 to 2013. “The classic story in India has always been patients present to care, traditionally men, with TB, the most common opportunistic disease. Then they get an HIV test and are found to be infected. At that point they bring their female partner, who happens to be infected and sometimes it’s too late and a child has also been infected.

“If we tested earlier we may be able to have an impact on this kind of cascade of familial infection,” Venkatesh said.

Co-author Dr. Nagalingeswaran Kumarasamy, chief medical officer of the YRG Care Medical Center, a major non-governmental HIV clinic in Chennai, India, said he thought the study could have an important influence.

“With the background wave on test and treat, this article will be a useful scientific tool for the National AIDS Control Organization of India to plan the testing strategies nationwide,” he said.

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Article source: http://www.medicalnewstoday.com/releases/261750.php

Same Protein Complexes Are Hijacked To Promote Viruses In Hot Springs, HIV

admin — Wed, 12 Jun 2013 11:42:35 +0000

Main Category: HIV / AIDS
Also Included In: Infectious Diseases / Bacteria / Viruses; Tropical Diseases
Article Date: 12 Jun 2013 – 1:00 PDT

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Biologists from Indiana University and Montana State University have discovered a striking connection between viruses such as HIV and Ebola and viruses that infect organisms called archaea that grow in volcanic hot springs. Despite the huge difference in environments and a 2 billion year evolutionary time span between archaea and humans, the viruses hijack the same set of proteins to break out of infected cells.

In eukaryotes – the group that includes plants and animals – and in archaea – micro-organisms with no defined nucleus in their cellular construction – viruses co-opt a group of important protein complexes called the Endosomal Sorting Complexes Required for Transport, or ESCRT.

The researchers were studying Sulfolobus turreted icosahedral virus, or STIV, which infects Sulfolobus solfataricus, a species of archaea called a thermophile that can be found in volcanic springs, such those in Yellowstone National Park. Thermophiles are micro-organisms that survive in extremely hot environments. The researchers found that, as with a range of viruses that infect humans, STIV is also dependent upon its host’s ESCRT machinery to complete its life cycle.

“The new work yields insight into the evolution of the relationship between hosts and viruses and, more importantly, presents us with a new and simple model system to study how viruses can hijack and utilize cellular machineries,” said Stephen D. Bell, professor in the IU Department of Molecular and Cellular Biochemistry and Department of Biology. Bell is co-lead author on the paper that appeared in early online edition of the Proceedings of the National Academy of Sciences.

The researchers looked for interactions between STIV and ESCRT proteins by using a technique in molecular biology called two-hybrid screening, which identifies binding interactions between two proteins or a protein and a DNA molecule. After finding two examples where viral proteins (the major capsid protein B345 and the viral protein C92) interacted with ESCRT proteins (SSO0619 and SSO0910), epiflouresence microscopy and transmission electron microscopy were used to determine exactly where ESCRT protein components localized in STIV-infected cells.

Epiflouresence microscopy uncovered spots of the ESCRT protein Vps4 in STIV-infected S. solfataricus cells, while no Vps4 was found after similar analysis in uninfected cells. In testing with transmission electron microscopy, the researchers identified Vps4 localized in the seven-sided pyramid-like structures that form in the membrane of S. solfataricus prior to viruses causing cell breakdown when the viral protein C92 expressed. No localization of Vps4 was found in similar cells where C92 was repressed.

The work shows that Vps4 is recruited to viral budding sites – those seven-sided pyramid-like structures – in the S. solfataricus thermophile. Significantly, other scientists have shown that the Vps4 protein of the eukaryotic ESCRT machinery localizes to the HIV budding site in humans.

“We believe the ESCRT machinery plays two roles in STIV biology. First, by virtue of interaction between the viral B345 protein and the host protein SSO0619, ESCRT aids in the construction of the STIV viral particles,” Bell said. “Second, the strong association we find between the pyramid structures formed by C92 and ESCRT’s Vps4 protein allows us to hypothesize that the ESCRT machinery plays a vital role in opening those pyramid exit structures that then leads to cell disruption and the release of viral progeny.”

Just as the ESCRT machinery in plants and animals plays a key role in cell division, Bell’s lab has previously shown that the same is true for that similar yet less-complicated ESCRT complex in archaea. Also of importance, Bell added, is that the ESCRT apparatus both in eukaryotes and in archaea like S. solfataricus is co-opted by viruses.

“These parallels support the idea that the cellular ESCRT is ancient and that it is likely to have evolved prior to archaea and eukarya separating to become different domains of life,” Bell said.

Scientists date archaea back to 3.7 billion years, while the oldest eukaryote fossils date back to 1.7 billion years.

Additional
References
Citations

“Functional interplay between a virus and the ESCRT machinery in Archaea,” published June 10, 2013, in Proceedings of the National Academy of Sciences, was co-lead authored by Mark J. Young of Montana State University, and co-authored by Jamie C. Snyder and Susan K. Brumfield of Montana State University and Rachel Y. Samson of Indiana University, a graduate student scientist in the Bell laboratory.

Funding for the work came from the National Science Foundation, the National Aeronautics and Space Administration, the Wellcome Trust and the IU College of Arts and Sciences.

Indiana University

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Article source: http://www.medicalnewstoday.com/releases/261767.php

Dinner Raises Funds, Awareness for Hlalani Kum Center

Amy Zacaroli — Mon, 10 Jun 2013 19:38:16 +0000

Steve and Alta Jones opened their magnificent home at the foot of the Blue Ridge Mountains to 25:40 for a special dinner to raise awareness and funds for the Hlalani Kum Learning Center. Special guests included Lwazi Mbongo and her family. Ms. Mbongo is a third secretary at the South African embassy, whose portfolio is faith-based organizations and issues affecting women and youth, which ties in perfectly to 25:40’s mission in rural South Africa to boost communities to help them care for the orphans and vulnerable children.

South African embassy official Lwazi Mbongo blows out her birthday candle.

Ms. Mbongo spoke eloquently about the role of non-governmental organizations working hand-in-hand with the local governments in South Africa to address the needs of orphans and vulnerable children. She said her country is very thankful to have organizations like 25:40 that focus on the rural communities, where the local governments are not as effective in providing services. By working together, the needs of the orphans and their caregivers can be met fully.

The Hlalani Kum Learning Center will allow 25:40 to expand its current after school care program to serve more children. It also will be a training center for community workers in other villages to learn how to establish their own after school care programs, which has proven to be very effective in keeping children safe after school, boosting their performance in school, providing emotional and spiritual nurturing, monitoring their health, and teaching them life skills. The Center also will house a skills center open to the whole community to learn practical skills for self-sufficiency and income generation. Finally, the center will house a sexual abuse prevention and resource program for women and children.

The learning center is under construction, with Phase I – four of eight classrooms, bathrooms and a kitchen – built to roof height. The cost for finishing Phase I is $35,000. The entire project is expected to cost $350,000.

Guests enjoyed a delicious and beautifully presented dinner provided by Ernesto and Christine Cadima. Ernesto is executive chef at Wegmans in Woodbridge, VA, and his wife Christine is an event designer at DesignCuisine in Arlington, VA. Jazz musicians Craig Fraedrich, Bob Larsen, Jim Roberts and Paul Henry entertained the guests on the elegant front porch.

The event raised several thousand dollars for the learning center, but more importantly inspired guests to become involved in the ways that match their passions and talents. For more ideas, click here.

We want to thank so many people for making this event perfect – Steve and Alta Jones for hosting at their beautiful home in an idyllic setting; for the Cadimas for providing an elegant and delectable feast; for the talented jazz musicians; for Lwazi Mbongo who worked on her birthday; for Jack and Melanie Lewis, who flew up from Houston to join us, and for all our guests who now know about 25:40’s mission and want to be involved. To see more photos of the event, click here.

HIV Prevention Requires Social And Environmental Change In Europe And Central Asia

admin — Mon, 10 Jun 2013 11:27:07 +0000

Main Category: HIV / AIDS
Article Date: 10 Jun 2013 – 1:00 PDT

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Social and structural factors – such as poverty, marginalisation and stigma – and not just individual behaviours are shaping the HIV epidemic in Europe and central Asia. This is the main conclusion of a new report released by the World Bank Group, WHO/Europe and the London School of Hygiene Tropical Medicine. The study systematically reviews evidence on HIV vulnerability and response in all countries of the WHO European Region.

The report, HIV in the European Region: vulnerability and response, focuses on key populations most at risk of HIV infection: people who inject drugs, sex workers and men who have sex with men. It confirms that they are disproportionately affected by the growing HIV epidemic in Europe, where the number of reported HIV cases reached over 1.5 million in 2011. HIV cases in these three groups account for about 50% of total diagnoses. Economic volatility and recession risks are increasing vulnerability to HIV and infections.

“The appalling HIV rates among poor and marginalised communities of drug users in eastern Europe and central Asia underscore the critical importance and global relevance of the World Bank’s newly adopted goals: to end extreme poverty and promote shared prosperity,” said David Wilson, Global HIV/AIDS Program Director at the World Bank. “At the same time, the increases in HIV in southern European countries hit hardest by recession underscore the profound, reciprocal interactions between poverty, exclusion and illness.”

“Social exclusion is the core driver of HIV epidemics in Europe. It is a vicious circle: social marginalisation increases the risk of being affected by HIV, and HIV exacerbates social marginalisation, adding another layer of stigma. Exclusion from life-saving HIV prevention, treatment and care is often the end result,” said Martin Donoghoe, programme manager for HIV/AIDS, STIs Viral Hepatitis at WHO/Europe. “We are confident that our new regional policy framework, Health 2020, will support health systems strengthening for universal access to health for even our most marginalised citizens.”

“Now is an important time for Europe. The momentum of HIV prevention must be maintained in a climate of economic and funding uncertainty,” said Professor Peter Piot, Director of the London School of Hygiene Tropical Medicine. “The evidence gathered through our collaborations with the World Bank Group and the World Health Organization show how institutions can work together to generate the evidence and the policy to do this.”

Key findings in the report include the following:

25% of HIV diagnoses in Europe were associated with injecting drug use, with much higher proportions in eastern Europe (33%) than in western Europe (5%) and central Europe (7%).
HIV remains relatively low among female sex workers in Europe who do not inject drugs (less than 1%), but higher among those who inject drugs (over 10%) as well as among male and transgender sex workers.
Sex between men accounted for 10% of all HIV diagnoses in Europe, with higher rates reported in western Europe (36%), followed by central Europe (22%) and eastern Europe (0.5%). The increase was higher, however, in central and eastern Europe.

The analysis highlights the pivotal role of environmental factors in shaping HIV epidemics and HIV prevention responses. Barriers to successful HIV responses include the criminalization of sex work, of sex between men, and of drug use, combined with social stigmatization, violence and rights violations.

HIV prevention requires social and environmental change, and the report calls for policy-makers and HIV programme implementers to target the right policies and programmes to maximize the health and social impacts of Europe’s HIV responses and get higher returns on HIV-related investments.

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Article source: http://www.medicalnewstoday.com/releases/261638.php

How HIV Makes Immune Cells Commit Suicide

admin — Thu, 06 Jun 2013 22:57:21 +0000

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Academic Journal
Main Category: HIV / AIDS
Also Included In: Immune System / Vaccines
Article Date: 06 Jun 2013 – 8:00 PDT

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A new study from the US shows how the human immunodeficiency virus (HIV) causes infected immune cells to commit
suicide. The researchers believe the finding is an important lead on how to preserve the immune systems of people infected with
the virus that causes AIDS.

Lead author Arik Cooper and colleagues from the National Institute for Allergy and Infectious Diseases, which is part of the
National Institutes of Health, write about their findings in the 5th June online issue of Nature.

HIV has infected more than 60 million and killed neary 30 million people around the world. Every day in an infected person the
HIV destroys billions of infection-fighting CD4+ T cells, until the immune system is no longer able to regenerate or fight other
infections.

The virus does this in several ways. One way is by killing cells directly: it hijacks cells and uses their resources to make copies of
itself. These copies emerge as buds that burst through the cell membrane, killing the cell in the process. Another way HIV kills
the host cell directly is just by exhausting its resources.

And another way that causes host cells to die, is when the host cell machinery becomes grossly distorted from being used to
make virus copies, this can trigger a process known as programmed cell death or apoptosis.

This study reveals the underlying mechanisms of that process.

When HIV enters the host cell, it starts reprogramming its protein-building machinery by inserting its own genes into the cellular
DNA.

Cooper and colleages discovered that during this insertion step, a cellular enzyme called DNA-dependent protein kinase (DNA-PK)
becomes active. The enzyme normally helps repair double-stranded breaks in molecules that make up DNA.

But when HIV integrates its genes into host cell DNA, this results in single-stranded breaks at the insertion points.

To their surprise, Cooper and colleagues found that the DNA breaks occuring during HIV integration activates DNA-PK, which then
performs an unusually destructive role: it triggers a signal that causes apoptosis in the CD4+ T cell.

They conclude:

“We propose that activation of DNA-PK during viral integration has a central role in CD4+ T-cell depletion, raising the possibility
that integrase inhibitors and interventions directed towards DNA-PK may improve T-cell survival and immune function in infected
individuals.”

In other words, it may be possible to treat HIV-infected people in the early stages of infection by giving them drugs that block
those early steps in virus replication that occur up to and including DNA-PK activation.

And not only might this stop the virus being able to copy itself, but it could also preserve enough CD4+ T cells to keep the
immune system able to fight infection.

The researchers also suggest the findings help to explain the formation of reservoirs of resting HIV-infected cells, and give clues
as to how to eliminate them.

In another study published recently in Nature, describes how another team of researchers in the US has for the first
time, with the help of a supercomputer, cracked the
chemical structure of the capsid or protein shell of HIV.

Written by Catharine Paddock PhD

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Reduction In Child Mortality And Improvements In Maternal Health

admin — Tue, 04 Jun 2013 22:43:35 +0000

Main Category: Pediatrics / Children’s Health
Also Included In: Women’s Health / Gynecology; HIV / AIDS
Article Date: 04 Jun 2013 – 0:00 PDT

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Rapid expansion of programs to prevent HIV transmission to babies and vaccinate children show how results can be achieved in relatively little time

Some of the world’s poorest countries have managed to cut maternal and young child mortality rates by half or more, according to a new report from Countdown to 2015.

The report, Accountability for Maternal, Newborn and Child Survival, highlights successes in improving maternal health and reducing child mortality in some countries, while pointing out where progress has been lagging in others.

There has been remarkable progress in expanding the reach of programs that prevent mother-to-child transmission of HIV and vaccinate children against life-threatening illnesses like diphtheria, pertussis (whooping cough) and tetanus. These successes highlight what can be accomplished through political commitment and increased investment in effective interventions for maternal, newborn and child health.

Greater effort is needed to improve coverage of other life-saving interventions like antibiotic treatment of pneumonia and post-natal care for women and newborns.

Rwanda, Botswana, and Cambodia have made notable progress in reducing mortality since 2000, each ranking in the top five among the 75 countries studied in this report in regard to rate of reduction of mortality. This success is particularly notable in light of much slower progress in the 1990s, where in some cases, mortality rates rose due to conflict and instability and/or high HIV prevalence rates.

More than half of these countries have reduced both maternal and child mortality at a faster rate since 2000 than they did during the decade from 1990 to 2000.

“We are very pleased to see that many countries are making a major leap forward and have managed to save so many lives in a relatively short period of time,” says Mickey Chopra, MD, PhD, Chief of Health for UNICEF and Co-Chair of Countdown to 2015.

“Progress is especially happening in countries where governments are using evidence to guide investment and policy decisions, and where all stakeholders — including the UN, donors, corporates and civil society — are working together effectively to create real change for women and children.”

An approaching deadline

The new Countdown report has been produced by a global collaboration of academics and health professionals from Johns Hopkins University, Aga Khan University, Federal University of Pelotas in Brazil, Harvard University, London School of Hygiene and Tropical Medicine, UNICEF, the World Health Organization, UNFPA, Family Care International, Save the Children, and other institutions from around the world. The secretariat of the Countdown to 2015 initiative is based at The Partnership for Maternal, Newborn Child Health.

Countdown to 2015 assesses progress in the 75 countries that together account for more than 95% of all maternal and child deaths. This evidence is intended to support greater progress towards achieving UN Millennium Development Goals (MDGs) 4 and 5 by 2015. These MDGs call for reducing maternal deaths by three-quarters and the deaths of children under 5 years of age by two-thirds compared to 1990 levels.

Accountability for Maternal, Newborn and Child Survival reports on the extent to which women and children have access to key life-saving services in these 75 countries, including family planning, antenatal care, skilled birth attendance, post-natal care, vaccinations, and treatment for diarrhea, pneumonia and other leading killers of young children.

Together with one-page profiles for each of the 75 countries, this report provides a snapshot of progress on the 11 core indicators selected by the Commission on Information and Accountability for Women’s and Children’s Health, established in 2011 to develop a framework to monitor and track commitments to the Global Strategy for Women’s and Children’s Health, launched by UN Secretary-General Ban Ki-moon in 2010 to accelerate progress on the MDGs.

Findings reported by Countdown include:

The number of women who die each year from pregnancy- or childbirth-related complications dropped significantly from 543,000 in 1990 to 287,000 in 2010. Thirty of the 75 Countdown countries showed reductions of 50% or more in their maternal mortality ratios between 1990 and 2010. However, nine countries in sub-Saharan Africa where HIV infections rates among women are typically high reported increases in maternal mortality over this time period.
Deaths among children under five years of age dropped from nearly 12 million in 1990 to about 6.9 million in 2011. Thirty countries cut child mortality by half or more from 1990 to 2011, and two-thirds of the Countdown countries accelerated their progress since 2000 compared with the previous decade.

“Momentum is gathering,” says Elizabeth Mason, M.D., Director for Maternal, Newborn, Child and Adolescent Health for the World Health Organization. “But we still need to move faster. With less than 1,000 days until the 2015 MDG deadline, we need to maximize the power of time-tested basics like breastfeeding, soap and clean water alongside new medicines and technologies to keep even more mothers and children alive and healthy.”

Key areas for more progress

The report also highlights areas where more progress is needed, including:

Newborn Deaths. Newborn deaths, i.e., deaths within the first month of life, now account for more than 40 percent of child deaths in 35 Countdown countries, and 50 percent or more in 12 countries. As deaths in children under the age of five have decreased, the proportion of these deaths that occur during the newborn period has increased. At the same time, the rate of progress in reducing newborn deaths has been far slower compared with the rate of progress in reducing the deaths of older children.
Infectious Diseases. Malaria, pneumonia, diarrhea, sepsis, measles, AIDS, and other infectious diseases account for at least half of all young child deaths. Many of these deaths can be prevented with cost-effective interventions. These priorities are highlighted by several recent efforts to scale up action to reduce child mortality, including the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea, launched last month by WHO and UNICEF; the Global Vaccine Action Plan, endorsed by the 194 member-states of the WHO in 2012; and Committing to Child Survival: A Promise Renewed, led by the governments of India, Ethiopia and the US, supported by UNICEF.
Breastfeeding. Although early and exclusive breastfeeding would improve nutrition and reduce susceptibility to disease, coverage levels of these interventions vary widely across the countries studied. In many countries, fewer than half of all babies are breastfeed immediately after birth or exclusively breastfed during their first six months of life.

Reaching the most vulnerable

The Countdown report shows that some countries are moving more quickly than others, reporting wide differences in coverage levels for key interventions and services across countries where data is available (2007-2012).

For instance:

The median coverage of skilled birth attendance is slightly more than 60% for the countries studied (54), but the coverage between these countries ranges from 10% to 100%:
The median for postnatal care of babies is 26%, ranging from 5% to 77% among the 11 countries studied;
The median for antibiotic treatment for pneumonia is 42%, but the range is 7%-88%.

The Countdown report also reveals vast inequalities in coverage within countries, as richer families are more likely to seek and receive essential care, such as skilled attendance at birth, compared with poorer families. In every country studied, women with secondary or higher education are more likely than uneducated women to give birth with a skilled attendant. Greater attention is needed to providing universal access to care by reaching the poorest, and to educating girls and women.

Focus on newborn survival

“Around the world, 43% of child deaths occur during the first month of life and this percentage is continuing to rise. Reducing newborn deaths is essential if countries are to achieve MDG 4 and ultimately eliminate preventable child deaths, as the world has promised to do,” says Jennifer Requejo, Ph.D, lead author of the new Countdown report and manager of Countdown to 2015.

“By scaling up cost-effective interventions that can be delivered through antenatal, childbirth and postnatal care services – like antenatal corticosteroids, neonatal resuscitation, drying and thermal care for the newborn, cord care, kangaroo mother care and treatment for newborn sepsis – that terrible toll of newborn deaths can be reduced by three-quarters, without the need for intensive care,” she says. “And, improving antenatal, childbirth and postnatal care services has the added benefit of saving women’s lives and reducing stillbirths and preterm deliveries.”

Tracking reproductive health funding

Family planning is another key concern of Countdown to 2015 because of its contribution to reducing unintended pregnancies and unsafe abortions, as well as its contribution to enabling women to control their reproductive lives. More than half of the 75 countries studied in the report have a total fertility rate of four or more children per woman; 35 of these countries are in sub-Saharan Africa where contraceptive use is low.

A companion Countdown paper, Reproductive health priorities: Evidence from disbursements of official development aid, published in the May 19 issue of The Lancet medical journal, tracked the amount of official development assistance (ODA) for reproductive health over two years. This is the first time such a global analysis of ODA for reproductive health has been undertaken. Specific reproductive health activities tracked in this analysis includes prevention, care and treatment of HIV/AIDS for women of reproductive age (15-49); family planning; treatment of sexually transmitted infections; and sexual health.

The results show an increase from $5,579 million in 2009 to $5,637 million in 2010 — a slight increase of about 1%. However, more than half of ODA for reproductive health was directed to HIV/AIDS services; the share of funding for treatment of other sexually transmitted infections actually decreased. Only 7% of this ODA went for family planning. For example, when ranked by amount of reproductive health funding received per capita, countries from southern Africa top the list, but when funding for HIV/AIDS is excluded, those countries move further down the list, despite the high unmet need for family planning for many countries in the region.

“Although the volume of aid for reproductive health is quite substantial, such funding is not balanced across activities – if international targets are going to be met for universal access to reproductive health, more balanced aid needs to go to essential reproductive health services such as family planning,” says Justine Hsu, MSc, lead author of the paper and a researcher in health economics with the London School of Hygiene and Tropical Medicine.

Ms. Hsu notes that many commitments have been made to family planning over the past year, due largely to the London Family Planning Summit held last July. “We need to continue to analyze trends and breakdowns of data to understand what aspects of reproductive health are being supported, and to ensure donors are keeping to their commitments,” she says.

“While it is great news that funding for reproductive health overall has increased, this analysis highlights the importance of breaking down funding flows into their various components,” notes Ann Starrs, President of Family Care International. “The fact that funding for family planning actually declined between the two years is a serious concern, given that more than 220 million women around the world lack access to contraceptive services.”

Concern about inequities

Countdown to 2015 reports on inequities in care between richer and poorer populations, both within and across countries.

“Poor women and children are not getting the same access to life-saving interventions. Ethically and morally, these inequities are unacceptable,” says Cesar Victora, M.D., PhD, of the Federal University of Pelotas in Brazil and Chair of Countdown’s working group on equity.

In addition to addressing inequities in access to care, it is also important to improve the quality of care. Understanding the populations that need to be reached helps local health officials plan better services for underserved areas.

Some countries, notably Brazil and Peru, have managed to reduce the service gap between rich and poor. Bangladesh is also making progress toward that goal, while others, like Ethiopia and Malawi, are now training and deploying community health workers to reach rural populations in order to improve access

“The first step is to identify who is being left out,” says Dr. Victora. “Then, community delivery – training health workers to treat common diseases and conditions in the community – is a key strategy for reaching them with needed care.”

“Ten years ago, this data on equity just wasn’t generally available and the issue wasn’t getting enough attention,” he reports. “Now, a lot is happening on many fronts. Equity is a major focus in the development of post-2015 development goals.”

The work won’t stop in 2015

Countdown is also moving toward 2015 with in-depth case studies to identify key factors contributing to national progress. The initiative is supporting “Country Countdowns,” country-led efforts to increase the use of evidence in health planning and prioritization.

“It’s great news so many countries are making faster progress and that more countries than anticipated are showing potential to fulfill MDGs 4 and 5 and integrating services,” says Dr. Zulfiqar Bhutta, Professor at Aga Khan University in Pakistan and Co-Chair of Countdown to 2015. “The work must not stop, though, until we end preventable deaths for women and children.”

“We’re not closing shop in 2015,” he adds. “We can pause and congratulate the countries that have done well, but there is a lot more to do to helping others reach these goals; we have to keep going.”

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Article source: http://www.medicalnewstoday.com/releases/261329.php

Advances In HIV Care And Increased Focus On LGBT Health Lead To Improvement In HIV Treatment Adherence And Outcomes

admin — Tue, 04 Jun 2013 22:43:33 +0000

Main Category: HIV / AIDS
Article Date: 04 Jun 2013 – 0:00 PDT

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HIV-positive transgender people are just as likely to stay in care, take their medication and have similar outcomes as other men and women living with the disease, according to new research from the Perelman School of Medicine at the University of Pennsylvania and published online May 30 in Clinical Infectious Diseases. The study – which looked at almost 37,000 patients at 13 HIV clinics from 2001 to 2011 in the US – suggests an encouraging shift from earlier work documenting poor retention in care and drug adherence in transgender people, a high risk group for HIV.

In the retrospective analysis, led by Baligh R. Yehia, MD, MPP, MSHP, a clinical instructor in the division of Infectious Diseases at Penn Medicine, researchers found that transgender people receiving care had similar rates of retention, antiretroviral therapy (ART) coverage and HIV suppression as nontransgender men and women over the 10 year period.

Dr. Yehia says there are several factors that could explain why care and suppression rates have improved and become more equal. “It’s a combination of things: there have been great advances in HIV therapy and management over the last decade and increased attention from advocates and groups on identifying people infected with HIV quickly, linking them to care in a timely fashion, and starting treatment earlier,” he says. “In addition, there is an increased focus on lesbian, gay, bisexual, and transgender (LGBT) health in general.

“Over the past five years, leading federal institutions and national organizations, including the Institute of Medicine, American Medical Association (AMA), and the American Association of Medical Colleges, have emphasized the importance of improving the health of LGBT populations by understanding and addressing their unique health care needs, identifying research gaps and opportunities, and developing educational activities to address the needs of LGBT trainees, faculty, staff, and patients.”

For the study, Dr. Yehia and colleagues, including Kelly A. Gebo, MD, MPH, of the Johns Hopkins University School of Medicine, retrospectively looked at 36,845 patients from 13 clinics within the HIV Research Network, a consortium that cares for HIV-infected patients across the nation, from 2001 to 2011. Of the group, 285 self-identified as transgender.

Researchers found that transgender persons were retained in care, received ART, and achieved HIV suppression 80 percent, 76 percent, and 68 percent of the time during the 10 years, respectively. Similarly, men were 81 percent, 77 percent and 69 percent, while women were 81 percent, 73 percent, and 63 percent.

Transgender patients were more likely to be young, Hispanic, and have men who have sex with men as their HIV risk behavior compared to men and women living with HIV.

Little is known about the health outcomes of HIV-positive transgender people compared to other groups, but they are among the groups at the highest risk of the disease, with the highest percentages in blacks and Hispanics. In 2009, the Centers for Disease Control and Prevention reported newly-identified HIV infection rates of 2.9 percent for transgender persons compared to 0.9 percent for nontransgender males and 0.3 percent for females.

Past studies in the transgender population have documented decreased engagement in care, low ART coverage, and poor adherence to medication. Such disparities have been tied to discrimination, social isolation and the community’s concerns about ART’s effect on hormone replacement therapy – which is used to boost testosterone or estrogen levels as a way to bring one’s secondary sexual characteristics more in line with their gender identity.

Patients can, however, safely receive ART and hormone therapy, notes Dr. Yehia, and that seeking care from providers familiar with both will help to ensure they have safe levels of the therapies.

“Many physicians don’t feel comfortable taking care of transgender individuals because they are unfamiliar with their specific health needs and concerns,” says Dr. Yehia, who also serves on the AMA LGBT advisory committee. “We have a come a long way, but more needs to be done. We need more education and research to help fill this knowledge gap and improve familiarity with transgender health issues.”

Next steps are to identify the proportion of individuals not in care, and to work on getting them engaged.

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Article source: http://www.medicalnewstoday.com/releases/261328.php