The Global Pulse Journal Blog

The World Bank and USAID are hosting a series of debates exploring emerging issues in global responses to HIV/AIDS and worldwide evolving approaches to development aid, .  The debates attempt to lay out the best evidence and information available to assist world governments, civil society organizations, and other development organizations in interpreting and responding to the shifting dynamics of the epidemic and our collective responses to the challenges it presents.

This global discussion series began this past May with a debate entitled “Test and Treat: Can We Treat Our Way Out of the HIV Epidemic?” which looked at testing and treating strategies with a focus on their role in Africa.

In June, a debate on “Behavior Change in HIV Prevention” took place looking at dynamics involved in behavior change approaches and their past ineffectiveness.

Check out these past debates and the ones still to come including theis week’s August 26th debate on “Discordant Couples and HIV Transmission” and continue to follow this debate series for future conversations.

A  new survey from the Centers for Disease Control and Prevention (CDC) suggests that  heterosexuals living in impoverished communities are as much as five times more likely to be HIV-positive than the general U.S. population, regardless of race or ethnicity. In the US, the overall HIV prevalence rate for African Americans is eight times the rate for whites, and the rate for Latinos is three times the rate for whites. Yet in very-low income areas this CDC study found that these disparities do not exist. The study examined 9,000 people in 23 cities, finding that 2.1% of heterosexuals living in high-poverty urban areas were infected with the HIV virus, including 2.4% of those living below the poverty line and 1.2% of those living above it. This is in comparison to the 0.45% rate of HIV infection in the general US population. The authors hypothesize that the findings could account for many of the ethnic and racial disparities in HIV infections in this country, since African Americans are 4.5 times as likely and Latinos four times as likely as whites to live in poverty.

The International AIDS Society in partnership with the Kaiser Family Foundation is providing online access to various developments taking place at the XVIII International AIDS Conference (AIDS 2010),  in Vienna, Austria.

Selected sessions are webcast live each day with past sessions also available for viewing. Find the complete guide-to-coverage as well as the webcasts already available for viewing including the Opening Session, Monday’s plenary with former President Bill Clinton, and Tuesday’s session on the study which found Microbicides containing HIV drugs lower the infection risk in women.

Today’s schedule includes:

This week at the International AIDS Conference in Vienna, Austria, the World Health Organization announced that 5.2 million people in low- and middle-income countries received antiretroviral drugs for their HIV infections in 2009. This represents the largest increase in the number of people accessing treatment in a single year, with an additional 1.2 million people added to the four million who received antiretroviral therapy in 2008. While the increasing access to antiretrovirals is encouraging, over 10 million people infected with the HIV virus worldwide are still in need of therapy.

The WHO is calling for earlier treatment of those infected with the HIV virus, suggesting that if people are treated before their immune systems become weakened by the virus, HIV-related mortality can be reduced by 20% between 2010 and 2015. In addition, early therapy also has a benefit in preventing transmission of the virus. These new guidelines expand the number of people eligible for antiretroviral therapy from around 10 million to about 15 million people. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that the cost needed for HIV treatment in 2010 will be about US$ 9 billion.

Figure 1.

For the first time in the 15 year-long search for an HIV prevention method that women can control, a vaginal microbicide gel called Viread has been shown to decrease the risk of HIV infection by as much as 54%.  Even though the microbicide does not prevent transmission in every woman who uses it, this is the first promising tool that women are able to use without the cooperation of the male partner.  This is an important consideration most of the new HIV infections in women living in Africa were acquired through forced sex with infected men who refuse to wear condoms. Women and girls represent 60 percent of the 22 million people infected with HIV living in Africa.

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Researchers at the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases have identified three naturally occurring monoclonal antibodies that are able to kill 91% of strains of the HIV virus. One of these antibodies, named VRC01, has a high affinity for the virus and works by mimicking the HIV receptor. This discovery makes the development of an effective vaccine against the virus a real possibility.

In an anti-drug conference held in Moscow recently, Russian President Dmitri Medvedev called for an a more globally unified effort to end the drug trafficking of opium from Afghanistan and the social problems that are a direct result from its trafficking. With over 90% of the world’s opium originating from Afghanistan, President Medvedev believes that that current efforts by international organizations such as the United Nations, NATO and Shanghai Cooperation Organization, are not enough. Opium poppies are the raw material used to make heroin.   According to the U.N. Office on Drugs and Crime, heroin has created a market worth $65 billion and caters to 15 million addicts world-wide.

The effects of Afghanistan’s 375 ton per year opium and heroin export are also felt at home through direct use and passive exposure such as  second-hand and third-hand exposure.  A new study that will be finalized this summer is expected to show that in Afghanistan 1.5 million people out of a total population of 30 million are addicts and that a quarter of those users are thought to be women and children.

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The following is a guest post by Farheen Qurashi, AMSA’s Jack Rutledge Legislative Director 2009-2010.

U.S. student activists

Just a few days ago, we celebrated World Health Day – the progress we’ve made in providing aid to patients around the world, the diseases prevented and the treatments admitted. But, we still have a long way to go, and as we celebrated, we also remembered that there is much to accomplish and continue in global health aid.

Two weeks ago, Rep. Barbara Lee (CA-9^th) introduced HR 4933, the Global HEALTH Act of 2010. This is a key piece of legislation that makes bounds towards creating a comprehensive and integrated global health aid strategy, focusing on strengthening health systems of developing countries to provide comprehensive primary to tertiary care as well as expanding the vital health care workforce – including doctors, nurses, midwives and community health workers—in needy areas. There is a dire international shortage of all kinds of health workers, and this is a bottleneck to providing sustainable and adequate care to patient populations – strengthening the health workforce is a key part of strengthening an overall health system.

Importantly, the Global HEALTH Act:

• Creates the Global Health Workforce Initiative, which emphasizes training, retention, and support for needed health workers
• Mandates the creation of a multi-year, in-depth strategy for health systems strengthening, and authorizes necessary support for this strategy
• Ensures country-ownership and accountability to health strategies
• Authorizes support for health strategies to ensure the swift achievement of US global health goals
• Prioritizes the needs of marginalized and vulnerable populations like women and girls, sex workers, etc.

On the cusp of the US’s own health system reform movement, we must also remember our patients in need around the world. The Global HEALTH Act makes a much-needed and bold step forward for global health aid, and AMSA is proudly one of its original supporters, along with Physicians for Human Rights, Health Alliance International, Health GAP (Global AIDS Project), and other organizations.

The Global HEALTH Act, HR 4933, is currently awaiting discussion in the Foreign Affairs and Financial Services Committees of the House of Representatives. For the ideas within the bill to receive recognition, support, and success, we must ask our Congressmen to show their support by co-sponsoring the legislation.

To send your Congressman a message, click here.

To find out more about the Global HEALTH Act, click here.

To read the full text of the bill, click here.

After over 20 years of research, scientists believe that they have discovered a breakthrough that will allow for more effective treatments for HIV/AIDS. In a recent article in Nature, scientists from Imperial College London and Harvard University report success at elucidating the structure of integrase, an enzyme which the HIV virus uses insert a copy of its genetic material into host DNA. Researchers hope that this new knowledge will lead to a better understanding of how integrase inhibitors work, how they can be improved and how we can prevent HIV from developing resistance to them.

For more see http://www.reuters.com/article/idUSTRE6101AQ20100201

From Science Speaks, an excellent blog from the staff of the Infectious Diseases Center for Global Health Policy, comes an interview with Dr. Eric Goosby, the U.S. Global AIDS ambassador.

Q: Roxana Rogers, USAID’s South Africa health team leader, said recently in South Africa that, “US government funding is going to come down dramatically over the next five years.” True?
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