TAC notes that recommendations and practice have been divided between the promotion of exclusive breastfeeding (mainly in Kwazulu-Natal) and formula feeding (mainly in Western Cape and Guateng).

Following recent studies showing that the risk of transmitting HIV during breastfeeding can be reduced significantly with antiretroviral (ARV) treatment for the mother or prophylaxis for the infant, the South African government plans to implement a new infant feeding policy from April 1 2012. This policy recommends exclusive breast feeding for the first 6 months and then the introduction of complementary foods and continuing breastfeeding until the infant is 12 months old. This will be accompanied by the provision of ARV treatment for women so indicated and nevirapine prophylaxis for infants of HIV positive mothers not yet indicated for treatment in South Africa.

The TAC statement calls for the new policy to cater for women who are unable to exclusively breastfeed for various reasons. TAC also stresses the regional variation in risk from formula feeding in South Africa and the importance of responsible introduction of the new policy, with an emphasis on the provision of ARVs. They are concerned that the Department of Health intends to end formula milk provision by September 2012, which, they are concerned is far too abrupt.

They state that patient education and counselling and provision of ARVs at PMTCT sites are critical for the success of the policy. And, that there should not be a sudden withdrawal of formula milk.

For more information info@tac.org.za.

16 FEBRUARY 2012 | GENEVA – WHO has concluded, on the advice of its Guidelines Review Committee, that women living with HIV or at high risk of HIV can safely continue to use hormonal contraceptives to prevent pregnancy. The recommendation follows a thorough review of evidence about links between hormonal contraceptive use and HIV acquisition.

Current WHO recommendations in the Medical eligibility criteria for contraceptive use (2009 edition) therefore remain: there are no restrictions on the use of any hormonal contraceptive method for women living with HIV or at high risk of HIV. Couples seeking to prevent both unintended pregnancy and HIV should be strongly advised to use dual protection – condoms and another effective contraceptive method, such as hormonal contraceptives.

A study published in Lancet Infectious Diseases in October 2011 suggested that hormonal contraceptives, such as the pill or injectable contraceptives, may increase a woman’s risk of HIV infection. It also found that women living with HIV and using hormonal contraception may be more likely to transmit the virus to their partner than women who did not use hormonal contraception.

WHO convened a technical consultation from 31 January – 1 February 2012 to review findings from all recent epidemiological studies on the issue. The meeting brought together 75 experts from 18 countries to review existing WHO recommendations in the light of these findings.

The experts recommended that women living with HIV, or at high risk of HIV, continue to use hormonal contraceptives to prevent pregnancy, but emphasised the need to also use condoms to prevent HIV acquisition and transmission. They also stressed the need for further research on the issue and the importance of offering a wider choice of contraceptive options.

On 15 February 2012 WHO’s Guidelines Review Committee upheld the recommendations.

Source WHO press release:
http://www.who.int/mediacentre/news/notes/2012/contraceptives_20120216/ en/index.html

It is with great pleasure, and considerable relief that we report that the New York State Supreme Court Justice Louis B. York granted summary judgment in favor of Richard Jefferys in a defamation lawsuit brought by an AIDS denialist named Celia Farber. [1] Jefferys was represented in the case by Joseph Evall of Gibson, Dunn & Crutcher.

The suit against Jefferys arose out of a May 12, 2008, comment he submitted via the now-defunct website for “Whistleblower Week,” conference. [2]

Jefferys was responding to an announcement that one of the conference sponsors was planning invite the AIDS denialists Celia Farber and Peter Duesberg to testify before a “tribunal” (including several Congresspeople), in the guise of whistleblowers.

In his comment, Jefferys asserted that Farber and Duesberg “are not whistleblowers, they are simply liars who for many years have used fraud to argue for Duesberg’s long-discredited theory that drug use and malnutrition – not HIV – cause AIDS.”

Jefferys wrote that he could provide “many, many examples, including their altering of quotes from the scientific literature, false representations of published papers, etc.” He stated that including Farber and Duesberg in this event “will, regrettably, discredit and demean your efforts to support the very real issues of recrimination against legitimate whistleblowers.”

Justice York found Farber to be a “limited purpose public figure,” which means that a defamation case can only be sustained if the alleged defamatory comments were malicious and knowingly false. Also, since HIV is a matter of public concern and debate, Jefferys would have to be shown to have been grossly negligent regarding the factual accuracy of his statements.

Justice York decided that Jefferys comments reflected his sincere and informed opinions and therefore met neither of these criteria. Justice York’s full opinion, which is available on the New York Courts website [3], provides a potted history of the AIDS denialism controversy and Celia Farber’s role within that controversy. But this decision is not a judicial verdict on AIDS denialism. Instead, it is a strong defense of freedom of speech on contested questions of public policy.

NY Law School Professor Arthur Leonard wrote: “In effect, Farber was contending that defamation law can be used to stifle criticism of a controversial position on a matter of great public importance.”

This report is edited from Arthur S. Leonard’s excellent detailed legal analysis of this case. [1]

References:

1. New York Court Rejects Journalist’s Defamation Claim Against AIDS Activist. (12 November 2011).
   http://newyorklawschool.typepad.com/leonardlink/2011/11/new-york-court-rejects-journalists-defamation-claim-against-aids-activist.html
2. Whistleblower Week In Washington (May 12-16 2008)
   http://web.archive.org/web/20080517225306/http://www.w3conference.org/contact.htm
3. Justice York, Supreme Court, New York. (09 November 2011).
   http://decisions.courts.state.ny.us/fcas/fcas_docs/2011NOV/3001063992009001SCIV.pdf

A recent post covered a review by Beth Jamieson and Tammy Rickabaugh describing the parallel effects of HIV infection and aging on the pool of naïve T cells in humans. [1]

Three recent papers address different aspects of naïve T cell loss, including the first study to document a decrease in this population in people with chronic hepatitis C infection.

In PLoS One, Beth Jamieson’s group reports on a study of naïve CD4 T cell levels in younger (20-32 years) and older (39-58 years) individuals with untreated HIV infection, compared to age-matched HIV-negative controls. [2]

The researchers use a cell surface marker named CD31 to discriminate between naïve CD4 T cells that have recently been produced by the thymus (CD31+) and those that have proliferated in the circulation (CD31-). Consistent with previous studies, HIV infection had a strong effect on naïve CD4 T cell levels that was additive to that seen in aging; the absolute number of CD31+ naïve CD4 T cells in the younger individuals mirrored those measured in HIV-negative controls who were 17-28 years older. While both HIV infection and aging were associated with declines in CD31+ naïve CD4 T cell numbers, loss of CD31- naïve CD4 T cells was only observed HIV infection; in this case the effect was independent of aging as the absolute loss was similar in both the younger and older HIV-positive participants. In a separate longitudinal analysis of the effects of antiretroviral therapy, CD31+ naïve CD4 T cells achieved levels comparable to age-matched controls after two years of treatment. However, CD31- naïve CD4 T cell levels remained significantly reduced.

The researchers also evaluate telomere lengths in both naïve CD4 T cell subsets, finding them to be reduced both as a result of HIV infection and aging; as was seen for CD31+ naïve CD4 T cell numbers, the effects were additive. Jamieson and colleagues conclude by suggesting that their results likely explain why disease progression occurs more rapidly among HIV-positive individuals over the age of 50, because this older population already has reduced numbers of naïve CD4 T cells, making the impact of HIV infection more severe. They also note that incomplete recovery of naïve CD4 T cells may play a role in increasing the risk of aging-associated diseases in people with HIV.

One commonly cited causative mechanism of naïve T cell depletion in HIV is the persistent activation of these cells, which leads to their differentiation into memory cells. Another contributing factor is lymphoid tissue fibrosis (a type of scarring damage associated with immune activation & inflammation). Naïve T cells continually recirculate through lymphoid tissue and depend on signals received in that environment for their survival.

A recent study by Ming Zeng and colleagues delves into this link between lymphoid tissue fibrosis and naïve T cell loss in both SIV and HIV infection. [3]

The researchers find that fibroblastic reticular cells (FRC)–which form the pathways along which T cells travel in lymph nodes–are the major source of IL-7, a cytokine essential for naïve T cell survival. Fibrotic damage (measured by the accumulation of collagen) is shown to disrupt the FRC network and therefore impede the ability of T cells to access IL-7, causing an increase in T cell apoptosis. Both naïve CD4 and CD8 T cells are affected. Additional studies reveal that the loss of T cells in turn exacerbates the damage to FRCs by reducing the production of a cytokine called lymphotoxin-É¿, which is vital for maintaining FRC networks. The results suggest that there is a vicious cycle in which fibrosis damages FRCs, which causes T cell loss, which then further exacerbates FRC loss.

Continuing their investigative work, Zeng et al look for a source of collagen and find that production of the cytokine TGF-beta by regulatory T cells is increased in HIV, and TGF-beta induces collagen production by fibroblasts. In lab experiments, the antifibrotic drug pirfenidone blocks TGF-beta signaling and reduces collagen production, leading the researchers to conclude that this drug may deserve consideration as an adjunctive therapy for promoting immune reconstitution in HIV.

Lastly, a study published in the 1st March issue of the Journal of Infectious Diseases demonstrates that another persistent chronic infection, hepatitis C, can accelerate naïve CD4 T cell loss. The authors conclude that their findings provide an explanation for the reduced response to vaccinations observed in people with chronic HCV. [4]

Source: TAG basic science blog (17 Mar 2011)

http://tagbasicscienceproject.typepad.com

References:

1. Jamieson B and Rickabaugh T. A challenge for the future: aging and HIV infection. Immunol Res. 2010 Aug 24. [Epub ahead of print]
   http://www.springerlink.com/content/np150557h6u06316/
   See
   http://tagbasicscienceproject.typepad.com/tags_basic_science_vaccin/2010/09/losing-immunological-naivete.html
2. Rickabaugh TM et al. The Dual Impact of HIV-1 Infection and Aging on Naïve CD4 T-Cells: Additive and Distinct Patterns of Impairment. PLoS One. 2011 Jan 26;6(1):e16459.
   http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0016459
3. Zeng M et al. Cumulative mechanisms of lymphoid tissue fibrosis and T cell depletion in HIV-1 . J Clin Invest. doi:10.1172/JCI45157.
   http://www.jci.org/articles/view/45157
4. Yonkers NL et al. Reduced Naive CD4 T Cell Numbers and Impaired Induction of CD27 in Response to T Cell Receptor Stimulation Reflect a State of Immune Activation in Chronic Hepatitis C Virus Infection. J Infect Dis. 2011 Mar;203(5):635-45. Epub 2011 Jan 10.
   http://jid.oxfordjournals.org/content/203/5/635.abstract

AIDS Law Project in South Africa have produced statement which your organisation is invited to endorse. Please also endeavour to secure the endorsements of prominent individuals, such as religious leaders, influential professional persons, heads of organisations and others with a respected public profile. The statement is self-explanatory. Kindly submit your endorsement on or before 12h00, Monday, 29 March (SA time). Please supply the full name of your organisation together with your full name, office address, telephone contact details and organisational website. Please also indicate in your email that you have been authorised by your organisation to endorse the statement.

Please send your endorsement to Ms Adila Hassim of the AIDS Law Project at:
hassima@alp.org.za

Please copy your email to Ms Phumi Mtetwa of the Lesbian and Gay Equality Project at:
phumi@equality.org.za

STATEMENT BY AFRICAN CIVIL SOCIETY

We, the individuals and organisations from African countries listed hereunder, recognise the universality of the human rights of all persons.

We affirm that the right of men and women to have same sex relationships is a fundamental human right.

We are further guided in the knowledge that all forms of discrimination, in particular against vulnerable groups, undermine the human dignity of all in Africa.

We are therefore profoundly disturbed by the nature, content and potential impact of the Anti-Homosexuality Bill (“the Bill”) that was recently tabled in and is currently being considered by the Parliament of Uganda.

We believe that the Bill, if enacted, will cut deeply into the fabric of Ugandan society by:

• Violating the rights of an already vulnerable and severely stigmatised group of persons by attacking their dignity, privacy and other constitutionally protected rights;
• Disrupting family and community life by compelling everyone, by the threat of criminal sanction, to report those suspected of engaging in same-sex sexual activity;
• Seeking to withdraw Uganda from the family of nations by reneging on the country’s international law obligations;
• Undermining public health interventions such as HIV prevention, treatment, care and support;
• Promoting prejudice and hate and encouraging harmful and violent action to be taken against those engaging in same sex relations.

We respectfully call on the Parliament of Uganda to reject the Bill in its entirety.

We also call on African governments and the African Union to call on the President and Government of Uganda to withdraw the Bill and to respect the human rights of all in Uganda, without exception.

The decision came largely as a result of the lifting of restrictions for people with HIV entering the United States, which was announced by President Obama in October.

The US HIV travel ban was consistently opposed by HIV activists and the decision taken by the IAS to refuse to hold meetings in the US was widely supported.

The 2012 meeting, held from 22-27 July, is expected to attract more than 25,000 delegates from nearly 200 countries, including more than 2,500 journalists.

Source: Press release, International AIDS Society. The IAS announces Washington, DC, as site of the 19th International AIDS Conference in July 2012: removal of entry restrictions on People Living with HIV by the U.S. allows for return of conference after 22-year absence. (30 Nov 2009).

The IAS maintains a detailed global database on HIV-related travel restrictions:
http://www.hivtravel.org

On 2 November 2009, the US Department of Health and Human Services published final regulations that will remove HIV from its list of communicable diseases of public health significance and will remove the HIV test from the routine medical exam for lawful permanent resident applicants. The regulations will go into effect on 4 January 2010, following a routine implementation period.

This was announced during the presidential press briefing for the fourth reauthorisation of the Ryan White CARE Act, and included the following statement:

“Twenty-two years ago, in a decision rooted in fear rather than fact, the United States instituted a travel ban on entry into the country for people living with HIV/AIDS. Now, we talk about reducing the stigma of this disease – yet we’ve treated a visitor living with it as a threat. We lead the world when it comes to helping stem the AIDS pandemic – yet we are one of only a dozen countries that still bar people from HIV from entering our own country. If we want to be the global leader in combating HIV/AIDS, we need to act like it. And that’s why on Monday, my administration will publish a final rule that eliminates the travel ban effective just after the New Year. Congress and President Bush began this process last year, and they ought to be commended for it. We are finishing the job. It’s a step that will encourage people to get tested and get treatment, it’s a step that will keep families together, and it’s a step that will save lives.” (Applause)

Source:

Obama B. Press Statement “Remarks by the President at signing of the Ryan White HIV/AIDS Treatment Extension Act of 2009. (30 October 2009).
http://www.whitehouse.gov/the-press-office/remarks-president-signingryan- white-hivaids-treatment-extension-act-2009

Related links:

Immigration resource with focus on HIV
http://immigrationequality.org/template.php?pageid=177

Report on Kaiser Network
http://globalhealth.kff.org/Daily-Reports/2009/November/02/GH-110209- HIV-Travel.aspx

IAS press release “IAS applauds White House announcement of repeal of the United States’ discriminatory and ineffective HIV entry and immigration ban”. (30 October 2009).
http://www.iasociety.org/Default.aspx?pageId=379

Global database on HIV travel restrictions
http://www.hivrestrictions.org

The Human Sciences Research Council (HSRC) published its much awaited 2008 HIV prevalence, incidence, behaviour and communication Survey in June 2009. [1] This is the third such survey. The previous ones were conducted in 2002 and 2005. Previously the survey only included people over two years old, but this one included all ages.

This year’s report is much shorter than the other two and contains less detail. The HSRC explains that more detail will be made available in journal articles that will be submitted for publication. The report contains a plethora of interesting data.

Sample

The sample consisted of 15,000 households, 15 from each of 1,000 enumeration areas. Of these 13,440 (90%) were valid occupied households. The occupants of 10,856 (81%) agreed to be interviewed.

23,369 individuals were identified as eligible to be interviewed (a parent or guardian was interviewed for children aged 11 and under). 20,826 (89%) completed a behavioural interview. 15,031 (64%) agreed to provide a blood sample to be tested for HIV. The HIV tests were anonymously linked to the interview. The acceptance rates for HIV tests by sex were 62% for males and 69% for females, and by race were 69% for Africans, 53% for whites, 75% for coloureds and 48% for Indians.

The researchers extensively analysed factors associated with refusal to have an HIV test that could have biased the results. They concluded, “Although some associations were statistically significant due to the large sample sizes, the differences between those tested and not tested were all less than 10% and most were less than 5%. Based on this more detailed analysis of HIV risk-associated characteristics in survey respondents who were interviewed and tested and those who were interviewed but refused HIV testing we conclude that the HIV survey results were not biased due to HIV testing refusal.”

At most four people from any household were interviewed, one from each of these age groups: under 2, 2-14, 15-24, 25 and above. Calculations were weighted to compensate for under-representation of enumeration areas, households and individuals.

The survey does not include people in institutions, e.g. prisons, army barracks, university residences and boarding schools.

Prevalence

The weighted HIV prevalence rate was 10.6%. No confidence interval was provided for this estimate. For people over the age of two there was no significant difference in prevalence at a national level from 2002 to 2008:

• 2002: 11.4% (95%CI 10.0-12.7)
• 2005: 10.8% (95%CI 9.9-11.8)
• 2008: 10.9% (95%CI 10.0-11.9)

The consistency across all three surveys implies that we can say with confidence that prevalence among people in South Africa over the age of two who are not living in institutions is approximately 11% and that it has not changed significantly in recent years.

At a provincial level, there is only one significant change in prevalence. In 2002, the Western Cape prevalence was 10.7% (95%CI 6.4-15.0). This changed to 1.9% (95%CI 1.2-3.0) and 3.8% (95%CI 2.7-5.3) in 2005 and 2008 respectively. As can be seen, the change from 2002 to 2005 is significant but not from 2005 to 2008. There is no reason why the prevalence in the Western Cape should have dropped so much from 2002 to 2005, even taking into account the province’s successful prevention of mother-to-child transmission programme (PMTCT) programme, whose effect on prevalence in any case would be partially or wholly offset by the corresponding success of the HAART programme. [2] Furthermore the Western Cape antenatal HIV prevalence increased from 12.4% to 15.7% from 2002 to 2005. Most likely, this is a sampling problem or statistical anomaly in one or more of the three HSRC surveys.

When broken down by the three older age groups, there is a significant drop in prevalence in the 2-14 age group from 2002 to 2008. This possibly reflects some effectiveness of the PMTCT programme. There was no significant change in the 15-24 and 25+ age groups across the three surveys. See Table1.

ADD TABLE

Table 1: HIV prevalence by province for people aged above two years old in the three HSRC household surveys. Percentages are weighted. Taken from page 32 of the 2008 report.

The 2008 survey also introduced prevalence measures for people in groups at high risk of HIV infection, an important development, which will hopefully provide a rich source of data. See Table 2.

Table 2: HIV prevalence in groups at risk

It is worth noting that 4,238 males over 15 agreed to have an HIV test. Of these 86 affirmed that they have sex with other men, ie 2%. Taken from page 36 of the 2008 report.

Incidence

The HIV/AIDS National Strategic Plan was published in April 2007. It set a target to reduce HIV incidence by 50% by 2011. Consequently the HSRC report has a detailed discussion on incidence.

The 2005 survey used the BED-assay to estimate incidence. In December 2005 a UNAIDS reference group released a statement on the reliability of this method. The group explained, “Based on the … evidence, the Reference Group recommends that at present the BED-assay not be used for routine surveillance applications, neither for absolute incidence estimates, nor for monitoring trends.” [3] The BED-assay methodology for estimating incidence has subsequently been improved, though it is complex and should ideally be corroborated with additional studies. [4]

The BED-assay calculation of incidence was not ready at the time the 2008 survey went to print. Instead the survey determined incidence for each year of age for 15 to 20 year-olds by deriving it from single year age prevalences. It concluded that, “there was a substantial decrease in incidence in 2008 in comparison to 2002 and 2005, especially for the single age groups 15, 16, 17, 18, and 19.” This is an unusual incidence calculation method that works as follows (using an example in the report):

• Proportion of 14-year olds infected is 0.0311 (ie prevalence is 3.11%).
• Proportion of 15-year olds infected is 0.0389 (ie prevalence is 3.89%).
• The difference in prevalence between 14 and 15-year-olds is 0.0389 – 0.0311 = 0.0078.
• The proportion of the population of 14-year-olds that is uninfected is 1 – 0.0311 = 0.9689.
• Incidence is calculated as the change in prevalence divided by the proportion of the population at risk, ie 0.0078/0.9689 = 0.008 (ie incidence for 15-year olds is 0.8%).

The calculation assumes that incidence remains the same from one calendar year to the next and that prevalence in the 15-20 year age group is unaffected by AIDS (hence the calculation cannot be done for older ages). The validity of these assumptions is uncertain. More critically, the method does not calculate confidence intervals or p values. The report also does not provide confidence intervals for prevalence for each year of age 15 to 20. However, given that the national 95% confidence intervals for prevalence in 15-24 year olds are wide and overlapping across the three surveys (7.5%-11.4% in 2002, 8.7%-12.0% in 2005 and 7.2%-10.4% in 2008), it is unlikely that any incidence calculation for 15-20 year-olds based solely on prevalence estimates would show a statistically significant decline.

It is plausible that incidence has declined from 2002 to 2005 to 2008. However, there is insufficient evidence to conclude this from the HSRC report.

Unless more compelling data is published by the HSRC it will be difficult to assess whether the incidence target of the NSP has been achieved. Hopefully the BED-assay results will provide a robust estimate of incidence. If not then researchers should consider doing large longitudinal surveys in some of the country’s high-risk areas, so that we can better understand incidence. One recent such study found an incidence of 3.4 per 100py (95%CI 3.1-3.7) in Umkhanyakude district, Kwazulu-Natal and no sign of decline over a five year period. [5]

Behavioural measures

The report examined these behavioural determinants of HIV incidence: sexual debut, intergenerational sex, multiple sexual partners and condom use. In contrast to the prevalence measure, this part of the survey depends on the manner in which questions are phrased, how well they are understood and the willingness of interviewees to tell the truth.

Nationally, 5% (95%CI 3.8-6.5) in 2002, 8.4% (95%CI 7.2-9.9) in 2005 and 8.5% (7.1-10.1) in 2008 of 15 to 24 year-olds said they had sex before reaching 15 years old. While there is a significant difference between 2002 and the 2005 to 2008 period, it is difficult to interpret this. At provincial level, the increase between 2002 and the 2005-2008 period was only significant in North West and Free State.

In 2005 2% of males (95%CI 1.0-4.2) and 18.5% (95%CI 13.7-24.4) of females in the 15-19 age group said they had a sexual partner at least five years older than them. In 2008 0.7% (95%CI 0.2-2.7) of males and 27.6% (95%CI 21.7-34.5) of females said they had a sexual partner at least five years older than them. This was not measured in 2002. The differences between 2005 and 2008 are not statistically significant.

Among males aged 15 to 49, 9.4% (95%CI 8.1-10.9) in 2002, 17.9% (95%CI 15.5-20.6) in 2005 and 19.3% (95%CI 17.3-21.6) in 2008 said they had more than one partner in the past 12 months. Amongst females aged 14 to 49, 1.6% (95%CI 1.1-2.3), 2.9% (95%CI 2.3-3.7) and 3.7% (95%CI 2.9-4.8) made the same claim. It is not clear why there was a large and significant rise from 2002 to 2005. (Tables 3.15 and 3.16 of the HSRC report appear to give contradictory data for 15 to 49 years olds nationally in 2002. I have assumed Table 3.16 has an error.)

It is plausible that both these factors, ie high rates of intergenerational sex of female youth and high rates of multiple partners of males are drivers of the HIV epidemic.

The survey reports significantly increased reported condom use overall, by sex and by age group between the 2005 and 2008 reports. Reported condom use at last sex was 35.4% (95%CI 33.4-37.3) in 2005 and 62.4% (95%CI 60.2-64.6) for people 15 years and older. Reported condom use was similar between males and females. It is unclear how condom use could have increased so massively over a three year period. Perhaps the increase reflects reality, but it could also be that it has become more socially desirable to report use of condoms.

Amongst people who reported multiple sexual partners, reported condom usage was 75.2% (95%CI 69.2-80.4), with no significant change since 2002 and 2005. There was also no significant difference between males and females.

Awareness of HIV status

The survey found that the percentage of people who reported having had an HIV test in the last 12 months and knowing the results doubled between from 11.9% in 2005 to 24.7% in 2008. More women said they know their status than men (28.7% v. 19.9%). These results are significant, though worryingly low and probably explain why so many people present so late for HAART. Among groups defined as being at high risk, 35.7% (95%CI 32.5-39) of African women aged 20-34 years said they had been tested in the last 12 months and learnt their status. Next were MSM, but the confidence interval was very wide (95%CI 17.2-40.3). For African men aged 25-49 it was 25% (95%CI 21.6-28.7).

Knowledge of HIV

The survey measured knowledge of HIV prevention. If interviewees agreed with these two statements they were scored as knowledgeable about HIV prevention:

• To prevent HIV infection, a condom must be used for every round of sex
• One can reduce the risk of HIV by having fewer sexual partners

The survey reports large and significant declines in this measure since 2005 in people aged 15 to 49 years. Participants who answered yes to both questions declined from 64.4% (95%CI 62.5-66.3) in 2005 to 44.8% (95% CI 42.9-46.7) in 2008.

This is implausible. Knowledge is unlikely to deteriorate in what is essentially the same population over a three year period and certainly not by such a large amount. On the contrary it is only likely to increase. Much more plausible explanations are: this is a statistical anomaly; there is something different about the samples between the 2005 and 2008 surveys; the HIV knowledge questions were asked differently; or there was a something different about the way the interviewers carried out their functions.

Furthermore, the wording of the two test statements could have been better; they are not a convincing measure of HIV prevention knowledge. For example, with regard to the first statement, interviewees might consider having an undetectable viral load sufficient to prevent HIV infection. With regard to the second statement interviewees might believe that using condoms consistently negates the risk of having multiple partners. Even if these views are incorrect (and it is not clear that they are), they imply a sophisticated knowledge of HIV prevention.

Participants had to correctly indicate whether these statements were true or false to be marked as knowledgeable about AIDS myths:

• There is a cure for AIDS
• AIDS is caused by witchcraft
• HIV causes AIDS
• AIDS is cured by having sex with a virgin

63.8% (95%CI 62.5–65.1) of people got all four correct. This was not significantly different from 2005.

(Note: The survey also included measures of the exposure of four HIV communication programmes, but I have omitted these in this report.)

References

1. Shisana et al. South African national HIV prevalence, incidence, behaviour and communication survey 2008: A turning tide among teenagers? 2009. Cape Town: HSRC Press.
http://www.hsrc.ac.za/Document-3238.phtml
2. Azevedo V. City Health: Khayelitsha. July 2007.
http://www.tac.org.za/community/files/KhayelitshaCapeTownCityCouncil-July2007.pdf
3. UNAIDS. UNAIDS Reference Group on Estimates, Modelling and Projections statement on the use of the BED-assay for the estimation of HIV-1 incidence for surveillance or epidemic monitoring. December 2005.
http://www.epidem.org/publications/bed%20statement.pdf
4. CDC. Using the BED HIV-1 Capture EIA Assay to Estimate Incidence Using STARHS in the Context of Surveillance in the U.S.
http://www.cdc.gov/hiv/topics/surveillance/resources/factsheets/bed.htm
5. Bärnighausen T. Lack of a decline in HIV incidence in a rural community with high HIV prevalence in South Africa, 2003-2007. AIDS Res Hum Retroviruses. 2009 Apr. 25(4) 405-9.
http://www.ncbi.nlm.nih.gov/pubmed/19320571

The groups said that respect for human rights and HIV prevention should be at the heart of the policy, but that critical elements had been stripped from the final declaration. They called on member governments to refuse to support the declaration, which is being considered at the high-level segment of the Commission on Narcotic Drugs (CND) this week in Vienna.

“Government delegations could have used this process to take stock of what has failed in the last decade in drug-control efforts, and to craft a new international drug policy that reflects current realities and challenges,” said Prof. Gerry Stimson, executive director of the International Harm Reduction Association. “Instead, they produced a declaration that is not only weak – it actually undermines fundamental health and human rights obligations.”

What is at issue is a series of measures known collectively as “harm reduction services,” which have been endorsed by UN health and drug-control agencies, including the UN Office on Drugs and Crime, UNAIDS and the World Health Organization. These measures include needle and syringe exchange and medication-assisted therapy (for example, with methadone), both inside and outside prisons, as essential to address HIV among people who use drugs. The groups noted that a wealth of evidence proves harm reduction is essential to HIV prevention for people who use drugs. The action was taken against the direct advice of UNAIDS, the Global Fund to fight AIDS, Tuberculosis and Malaria, and the UN special rapporteurs on health and on torture.

Up to 30 percent of all HIV infections outside of sub-Saharan Africa occur via unsafe injecting drug use. The groups said there is clear evidence that harm reduction interventions can halt or even reverse HIV epidemics among people who inject drugs.

“This political declaration fails public health,” said Craig McClure, executive director of the International AIDS Society. “Coming less than 12 months after UN member states convened a high level meeting in New York to restate the international commitment to fight HIV, the denial of any reference in the declaration to life-saving harm reduction programs is unacceptable and unconscionable.”

The political declaration also fails human rights. In country after country around the world, abusive law enforcement practices conducted under the banner of the ‘war on drugs’ result in extensive, and often horrific, human rights violations. In addition, overly restrictive interpretations of the international drug-control treaties at national level result in the denial of access to essential pain medications to tens of millions of people worldwide.

Both of these issues were raised by the UN special rapporteur on health and the UN special rapporteur on torture, who wrote to the CND to urge explicit support for human rights within the political declaration. All member states of the UN have ratified at least one of the core UN human rights treaties, and the UN General Assembly has consistently stated that drug enforcement must be carried out in a manner consistent with respect for human rights.
“Given the widespread human rights abuses around the world directly resulting from drug enforcement, human rights must be placed at the heart of UN drug policy,” said Joseph Amon, director of Human Rights Watch’s health and human rights division. “But the political declaration makes scant reference to the legal obligations of member states under international human rights treaties, nor does it insist on respect for human rights in drug policy.”

The groups called on member states not to lend their names to a political declaration that does not sufficiently prioritize the centrality of harm reduction and human rights within the global response to drugs, and join the call from other civil society organizations for further efforts across the UN system to find a more effective, coherent, and relevant response to drugs.

Source: Joint HRW, IAS and IHRA press release ‘New 10-Year Pllan Omits Critical l Protections on HIV and Human Rights’. (11 March 2099)

The UN Political Declaration on Drugs

http://www.unodc.org/unodc/en/press/releases/2009-12.03.html

January 2009 overview by IHRA and HRW “International l Support for Harm Reduction”

http://www.hrw.org/en/news/2009/01/19/international-support-harm-reduction

Human Rights Watch’s work on drug policy

http://www.hrw.org/en/news/2009/03/09/un-drug-summit-undo-decade-neglect

The successful applicant must be self-motivated and able to work in a very dynamic and challenging environment. The editor will be responsible for establishing and maintaining the Southern African HIV Nursing Magazine. This will include:

• Responsibility for acquiring, reviewing and editing all articles published in this magazine.
• Maintaining the magazines standards and editorial policies in line with international standards.

Qualifications

Degree level education, preferably in nursing or another health-care related field, with a post-graduate degree in journalism or other relevant discipline, or equivalent experience with progress towards such a preferred qualification.

Experience

• 10 years practical work experience
• Experience and/or knowledgeable of the HIV/AIDS sector

Experience with an NGO, implementation-focused donor or development organisation

Experience and/or knowledge in the academic publishing field

Proven track record as a published author in academic publications

Remuneration

Remuneration is dependent on skills, experience and qualifications.

To apply

To apply, please submit a detailed CV, including contact details of three referees, a letter of Motivation and a copy of an original (and unedited) writing sample to:

The General Manager,
The Southern African HIV Clinicians Society,

by email to: 
fatimas@sahivsoc.org

Closing date 28 August 2009

Only short-listed candidates will be contacted. For more information about the Society visit:

http://www.sahivsoc.org

Several years ago, allegations from a fringe group of HIV denialists who claiming that foster children in New York were used as guinea pigs for adult HIV drug trials, gained media publicity when used as a basis for a BBC documentary. It is important that these have been quashed following a lengthy investigation, detailed in a recent article in the New York Times. [1]

Complaints to the BBC after the documentary was aired in 2004, also resulted in a lengthy apology and retraction recognising the inappropriate balance used in their programme. [2]

An independently commissioned investigation determined that city officials had acted in good faith and in the interests of the children, many of whom were seriously ill.

The report, from the Vera Institute of Justice, an independent nonprofit group, is now available online [3]. It also found that foster children were not removed from their families because a parent had refused to consent to a child’s treatment, and that researchers did not specifically select foster children for enrollment in the trials. While the foster children were overwhelmingly black and Hispanic, as some critics, this mirrored the demographics of children with HIV infection in the city at the time.

COMMENT

This was probably one of the most inappropriate and inflammatory HIV-realted stories to picked up by mainstream media who themselves failed to appropriately research the real issues: that children are generally denied access to potentially life-saving pipeline compounds until after they have been approved for adult care.

References
1. Foderaro L. Study refutes claims on AIDS drug trials, New York Times (27 January 2009).
http://www.nytimes.com/2009/01/28/nyregion/28foster.html?_r=1
2. BBC Admits that “Guinea Pig Kids” is Misleading, Erroneous: Apologises for HIV Denialist Bias and False Allegations about NYC AIDS Drug Trials
http://www.aidstruth.org/BBC-Apologizes-for-HIV-Denialist-Bias.php
Link to BBC letter
http://www.aidstruth.org/Complete-BBC-complaint.pdf
3. Ross T et al. The Experiences of New York City Foster Children in HIV/AIDS Clinical Trials. Available online:
http://www.vera.org/cyj/hivtrials-pubs.html