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ASIA-PACIFIC: Address TB Challenges Now or Lose Fight Against TB: WHO Warns
U.N. expert: AIDS crisis in the world's prisons
Poverty and HIV are strongly linked, CDC survey finds
Early HIV treatment will save lives and money, WHO says
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ASIA-PACIFIC: Address TB Challenges Now or Lose Fight Against TB: WHO Warns
Xinhua News Agency (07.25.10) - Tuesday, July 27, 2010
At a Stop TB Technical Advisory Group meeting held in the Philippines, the World Health Organization's regional director for the Western-Pacific region warned that HIV "poses a major threat and has the potential to reverse the gains achieved by the TB control efforts" made over the past decade. Shin Young- soo called for more financial and technical support for TB services, noting that programs in the region continue to face significant challenges. "The TB epidemic tends to concentrate in vulnerable and marginalized populations who have limited access to health care and are difficult to reach," he said. In the past decade, more than 1.3 million patients in the region have been diagnosed with TB and nearly 90 percent are successfully treated each year, WHO said. Estimated regional TB incidence has dropped from 3.6 million in 2000 to 2 million in 2008 due to successful expansion of quality TB services, while TB deaths have declined, WHO said.
Posted 28/07/2010
U.N. expert: AIDS crisis in the world's prisonsAssociated Press - July 23, 2010
Veronika Oleksyn, Associated Press Writer
The U.N.'s top investigator on torture and punishment warned Friday that overcrowded prisons are breeding grounds for AIDS. Often, inmates are held in inhumane conditions in which the HIV virus is spread through the use of non-sterile drug injection equipment, sexual contacts, tattooing and sharing of razors, Manfred Nowak said. "There is a global prison crisis," he told an international AIDS conference. Nowak, who has visited detention facilities around the world, urged authorities to inform prisoners of the risk of HIV transmission and to offer them free condoms, HIV testing and counseling. He also pressed prisons to offer needle and syringe programs, opiate substitution therapies and methadone treatments. "Science tells us exactly what we have to do, it's just a question of political will to implement it," Nowak said. In addition, prison guards should live up to their obligation to prevent rape and other forms of coercion that thrive in packed environments. "One of the most important measures to prevent HIV transmission would be the reduction of overcrowding," since it leads to violence and conditions that are conducive to the spread of the virus, he added. Nowak said that, although reliable figures are hard to come by, the prevalence of HIV in prisons is generally much higher than in a country's wider population.
In Ukraine, for example, the prevalence of HIV in prison is at least 10 times that of the overall population, he said. Dmytro Shermebey of the All-Ukrainian Network of People Living with HIV/AIDS - who was diagnosed with HIV, tuberculosis and hepatitis after spending nine years in a Ukrainian jail - stressed that inmates have a right to both treatment and protection from the disease. "They have the right because they are human," Shermebey said. While about 10 million people are incarcerated every year, some 30 million enter and leave prisons annually - making it a public health problem for society, according to Nowak. "Prison health is public health," he said.
Posted 28/07/2010
Poverty and HIV are strongly linked, CDC survey finds
Los Angeles Times - July 20, 2010
Thomas H. Maugh II, Los Angeles Times
Regardless of race or ethnicity, heterosexuals living in low-income communities are up to five times more likely to be HIV-positive than the rest of the U.S. population.
Heterosexuals living below the poverty line in U.S. cities are five times as likely as the nation's general population to be HIV-positive, regardless of their race or ethnicity, the federal Centers for Disease Control and Prevention said Monday.Their neighbors in the impoverished communities who live above the poverty line are 2.5 times as likely to be infected, according to the first comprehensive study of groups that aren't involved in risky behaviors. Because African Americans are 4.5 times as likely as whites to live in poverty and Latinos are four times as likely to do so, the findings could account for many of the ethnic and racial disparities in human immunodeficiency virus infections in this country, said Dr. Paul Denning, a medical epidemiologist at the CDC. Denning was the lead author of the study, which was released in Vienna at the International AIDS Conference.
In the United States, the overall HIV prevalence rate for blacks is eight times that for whites, while that for Latinos is three times that for whites. "That disparity appears to disappear in very-low-income areas, at least in this study," Denning said at a news conference. The findings, based on studies of more than 9,000 people in 23 U.S. cities, indicate that these areas now have what the United Nations defines as a generalized HIV epidemic. In the past, the United States has been said to suffer from what is known as a concentrated epidemic, confined primarily to two high-risk groups: gay men and injection drug users. Those individuals were excluded from this survey. The new results indicate that the epidemic is now firmly established in the heterosexual population and will continue there even if it could be controlled in the high-risk groups. "There is a powerful link between poverty, low socioeconomic status and HIV," said Dr. Kevin Fenton, director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. "In communities with a generalized epidemic, we need to reach everyone in the community with prevention information and interventions. "We need to address larger environmental issues, such as poverty, homelessness and substance abuse, which are well beyond the traditional scope of HIV intervention. Addressing those is as essential to HIV prevention as providing condoms."
The study found that 2.1% of heterosexuals living in high-poverty urban areas were HIV-positive. That included 2.4% of those living below the poverty line as defined by the Census Bureau, and 1.2% of those living above it. More than half of the households in the survey had annual incomes below $10,000, Denning said. Overall, the HIV prevalence rate was 2.1% among blacks, 2.1% among Latinos and 1.7% among whites. In the U.S. at large, 0.45% of the population is HIV-positive. Because the data from all 23 cities were pooled, results for individual cities are not available. In general terms, however, Western cities had lower rates than those in the Northeast and the South. In the United States, an estimated 1.1 million people are thought to be HIV-positive and an additional 56,000 are infected each year -- a number that has remained constant for more than a decade. The new findings suggest that, by focusing prevention efforts on the high-risk groups, the government has been overlooking a crucial population.
About 18,000 Americans die of AIDS each year.
Posted 28/07/2010
Early HIV treatment will save lives and money, WHO says
BBC News - 19 July 2010
HIV-related deaths could be reduced by 20% over the next five years if treatment begins earlier, the World Health Organisation (WHO) says in fresh guidance. There were over 5m people receiving treatment for the virus at the end of 2009, up more than a million from 2008 - the largest ever increase in a year.
The guidelines would raise the number needing treatment to 15m by 2015. But there are concerns about funding as countries potentially cut back on aid.
Unveiling its first new guidance for four years at the Aids 2010 conference in Vienna, the WHO says it wants treatment with a cocktail of drugs to begin before the virus seriously undermines the patient's immune system. This means changing the threshold at which a drugs regimen should be started from 200 CD4 cells per microlitre of blood to 350, regardless of symptoms. These cells are the key marker of the health of the immune system. Starting treatment sooner could prevent opportunistic infections such as tuberculosis, which is the number one killer of those with HIV. "In addition to saving lives, earlier treatment also has prevention benefits," says Dr Gottfried Hirnschall WHO director of HIV/Aids. "Because treatment reduces the level of virus in the body, it means HIV-positive people are less likely to pass the virus on to their partners." Expanding treatment to more people will push the costs for 2010 up to $9bn, according to UN estimates. But experts stress that extra costs would be more than offset by decreased hospital costs, increased productivity, fewer children orphaned by Aids and a fall in new HIV infections. "The investments we make today can not only save millions of lives but millions of dollars tomorrow," says Dr Bernhard Schwartlander of UNAIDS. "People with weaker immune systems who come late for treatment require more complex and costly drugs and services than those who start treatment earlier and are healthier."
Front of the queue
The new threshold, which many doctors in richer countries already follow, is thought most likely to be applicable to those states with the resources and infrastructure for treating people earlier. There remain more than 4m poor people whose infections are progressing and who cannot access treatment even under the old criteria. The WHO says that despite its new guidance, the principle remains that those most in need of treatment should remain the priority. More also needs to be done to encourage people to seek testing early, as many wait until symptoms appear when the viral load is already high. The new drive takes place against a backdrop of uncertainty about the future of funding to fight the disease. A report published by UNAIDS found that overall support for the global AIDS effort from donor nations flattened out last year in the midst of the global economic crisis. The Global Fund to fight Aids, Tuberculosis and Malaria says it needs up to $20bn over the three years to maintain progress on tackling HIV infections. The UK, for instance, last month put the fund and many other agencies on notice to prove that the spending works or face cuts. The charity Medecins Sans Frontieres said there had been rapid progress in 2009 but it was concerned about the fate of 10m waiting to start treatment amid signs of a decreased commitment. "Today international donors expect doctors to tell patients to come back for treatment when they're at death's door," said Dr Eric Goemaere, medical co-ordinator at MSF in South Africa.
"This is bad medicine. As a doctor I'd much rather give a patient pills today and send her home, than delay treatment and see her in six months at the hospital with complicated tuberculosis."
Posted 28/07/2010
