Pregnant and diagnosed with HIV: the group providing support for mothers

Thirteen years ago, when Babalwa Mbono was eight months pregnant with her second child, she went to her clinic in Cape Town, South Africa, to have a routine HIV test.

Article via The Guardian

“I went with confidence because my first child was negative and I was negative then,” she says. When the test came back positive, Mbono couldn’t believe it. “When the counsellor who tested me showed me the results I thought, ‘you’re joking!’ I even asked her if she was sure.”

Mbono left the clinic in a daze and went home to reflect on the news, still in denial. She looked healthy and well, unlike her sister who had died three years previously from Aids-related tuberculosis. “For me, [the result] was something that was not real,” Mbono adds.

Nowadays many people in South Africa know about HIV. The country has the biggest and most high-profile epidemic in the world, with an estimated 7 million people living with the condition, according to UNAids figures. But in 2003 it was not a big topic, and discussions usually revolved around death, says Mbono. The fear of what having HIV might mean for her unborn child started to creep in, and she worried that she would not live long enough to care for a baby who might be infected.

When Mbono found out that she had HIV, South Africa’s government was still deciding whether to make antiretroviral treatment (ARVs) available to all, despite a third of pregnant women testing positive. Today, 48% of infected South African adults are on ARVs.

Back at the clinic, Mbono was linked up to a mentor mother through Johnson & Johnson’s mothers2mothers (M2M) programme. The scheme started in 2001 and has helped 1.4 million HIV-positive mothers in nine sub-Saharan African countries. It currently operates in Kenya, South Africa, Malawi, Lesotho, Uganda, Swaziland and Zambia – seven countries where it has virtually eliminated mother-to-child transmission (MTCT) among its patients, with a 2.1% transmission rate (the UN classifies virtual elimination as less than 5%).

Mbono’s HIV-positive mentor allayed her fears about death and her anger towards her husband, whom she blamed for giving her HIV after he tested positive with a much higher viral load. Through M2M, Mbono learned about taking ARVs to reduce the risk of MTCT in the womb and during breastfeeding, and about how to change her lifestyle to live a long and happy life with her children.

Last year, South Africa was one of six priority countries (all in sub-Saharan Africa) to meet a Global Plan target of reducing MTCT by 90%, with 95% of pregnant women with HIV on ARVs and an 84% reduction in new HIV infections among children.

Over the past year, Cuba, Belarus, Armenia and Thailand – non-priority countries – managed to eliminate MTCT altogether. In South Africa, mother-to-child transmission of HIV has fallen to 3.5%, putting the country within reach of eliminating paediatric infections, although maternal mortality remains high.

The M2M programme “makes the person feel supported”, Mbono says. “It’s a sisterhood, and it makes you feel like you have a family to cry on.” Through counselling, which helps to breaks down the stigma still attached to HIV/Aids in South Africa despite its high prevalence, Mbono also found the courage to confide in her parents and siblings.

And six months ago, she decided to disclose her HIV status to her daughter Anathi, who had just turned 13. “It really felt shocking,” says Anathi, who feared that there would be no one to look after her seven-year-old brother, who was born HIV negative. “I was afraid that she would leave us.”

Mbono reassured her daughter that she had tested negative when she was 18 months old, but Anathi decided to go alone to the clinic and be tested anyway, where she also accessed free counselling from health workers.

“I was so, so scared, but eventually they just sat with me and told me to not freak out and to not think negative things about my mum,” Anathi says. Over the two days she waited for her results, she spent time with her mother and learned more about M2M, even reading her mentoring books.

Mbono’s experience with M2M made her give up unhealthy habits, such as not eating properly and drinking alcohol, and inspired her to become a mentor mother in 2003. “The [programme] gave me the strength to go out there and tell people about HIV and correct the mistakes that people are making and [that] I also made when I didn’t have any information.”

She has gone from counselling others on HIV/Aids and family planning, to training other mentors and seeing them become nurses, social workers and students.

“What makes me most happy [is] when I see a woman who had broken up in pieces when she was told about HIV … and when you see her on the next visit she is much better than the day she left.”

Some 95% of babies in M2M’s South Africa programme test negative for HIV at 18 months, and that also makes Mbono proud. “That makes me feel that I’ve done my job, because 18 months is a long time for the mother to be supported and to be educated. There are so many challenges that they come across, and we are there [for them].”

Anathi set up a counselling group at school to discuss HIV and sex with 18 girls and five teachers, as well as a drama group to perform plays to parents and pupils that discuss staying HIV negative and breaking down stigma.

“Most people don’t talk about it … Young people are not getting enough information about HIV,” she says. Anathi has a friend who she says became a recluse after she found out she is positive, and she knows two girls who have gone off the rails since their mothers recently died of Aids.

But for Anathi, dealing with her mother’s HIV has made them stronger and brought them closer together.

She still worries about how well her mother has slept or eaten when they are apart, even though learning about ARVs has lessened her fears of her mother falling ill and not recovering. “I just worry too much and I call,” she says. “She is like my daughter.”

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Organ transplants between HIV-positive patients show promise

People with HIV are living longer than ever, thanks to antiviral drugs. While that’s great news for those who live with HIV, it also means that we’re starting to face the medical complications that crop up with old age — like organ failure! Researchers have been experimenting with transplants between HIV-positive donors and HIV-positive recipients, and a new study shows that these can be done with increasingly promising results.

EARLY RESULTS LED TO THE US LIFTING A RESEARCH BAN

When doctors from Groote Schuur Hospital in South Africa first reported on their work transplanting kidneys between HIV-positive patients back in 2010, the results were so positive that it led the United States to lift a research ban on the practice. It’s now five years later, and that same hospital is publishing the results of how its original patients are doing in The New England Journal of Medicine. The report includes more than 20 additional patients, after an average of about three years following the transplant.

The hospital found that the survival rate following a transplant between HIV-positive patients is only modestly lower than the survival rates for a transplant in someone who is HIV-negative. For HIV-positive patients, there was an 84 percent survival rate one year after surgery and a 74 percent rate at five years. That’s compared to rates of 91 percent and 85 percent for HIV-negative patients in the same hospital unit. Though the trial focused entirely on kidney transplants, the doctors behind it believe that these results show the procedure has potential for broader use.

“Using HIV-positive donors might resolve some of the problems we are experiencing in getting enough donors for our patients with [chronic kidney disease] worldwide,” Elmi Muller, the study’s lead author, writes in an email to The Verge.

“THE QUESTION IS, ‘WHAT IS THE RISK OF GETTING THE TRANSPLANTS COMPARED TO THE RISK OF NOT DOING THE TRANSPLANT?'”

One early worry was that a more treatment-resistant form of HIV could transfer from a donor to a recipient; fortunately, the doctors saw no sign of increased viral levels after the transplant. That doesn’t mean there wasn’t some risk to the patients, though. Five patients died within a year after the transplant from various causes, including cancer and heart problems. And transplant rejection was also a problem: of the 24 patients who survived the transplant, five patients had rejections, with eight rejections occurring in total. Prior research has found that organ rejection is more common in HIV-positive recipients — so this may not be a complication specific to receiving an organ from an HIV-positive donor.

Even with the added risk, doctors still see reasons to pursue HIV-positive transplants. “The question is not, ‘What is the additional risk of doing the transplant?'” Dorry Segev, a transplant surgeon with Johns Hopkins Medicine, says.  “The question is, ‘What is the risk of getting the transplants compared to the risk of not doing the transplant?’ And in not doing the transplant, HIV patients have a much higher risk of dying on dialysis. Much higher than their HIV-negative counterparts.”

That’s particularly pertinent in South Africa, where HIV is more prevalent and more donors are needed. “Because of very high HIV rates in South Africa, more and more HIV-positive, brain-dead donors [are] presented to the Groote Schuur Hospital transplant team,” Muller writes. “In South Africa it made sense to try and marry this supply of donors with the group of HIV-positive patients without any treatment options in the country.” Only deceased donors were used in Muller’s study.

MULLER EXPECTS TO WORK WITH OTHER ORGANS IN “THE NEXT FEW YEARS.”

This is also about more than kidneys. Muller chose to begin with kidney transplants because, she says, kidney problems are “very prevalent in HIV-positive patients,” while other issues, like liver and heart failure, occur at rates similar to the general population. But it’s likely that the practice will eventually expand to other organs. “Liver transplants are more complicated and logistically more difficult,” Muller writes. “But I do think we will expand it over the next few years.

Segev hopes to see transplants between HIV-positive patients start soon in the US. In fact, following the release of Muller’s initial study, he worked with Congress to pass the HOPE (HIV Organ Policy Equity) Act in 2013, which could eventually lead to the use of organs from HIV-positive donors. At the time, President Obama expressed support for continued research. “The potential for successful organ transplants between people living with HIV has become more of a possibility,” the president said. Segev’s research has estimated that thousands of lives could be saved each year by accepting HIV-positive donors.

Though the HOPE Act has been passed, Segev says that the Health Department still needs to create the guidelines under which these trials can be run. He expects to see transplants start in the US in about a year. If it goes well, he says they could be widespread within about three years.

“THE OUTCOMES ARE ACTUALLY REALLY ENCOURAGING.”

It’s possible that some complications will come up bringing the procedure from South Africa to the United States. Because patients in South Africa may have less access to antiretroviral medication, there’s less resistance there and drugs are likely to be more effective. Still, Segev says that medications have come far enough that it shouldn’t significantly complicate US transplants. “It’s highly unlikely even in the US they will receive an [antiretroviral therapy] resistance that is untreatable,” he says.

“The biggest takeaways are that the outcomes are actually really encouraging,” Segev says. “…This really is another reminder that we need to move forward in the United States with doing this.”

via The Verge

 

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Shuga: The TV series that’s getting people talking about HIV.

A British-based film director is helping to break the stigma of HIV in Africa by making a fast-paced television drama that is being shown in 74 countries.

Biyi Bandele has made the eight-part series Shuga with funding from media giant Viacom, depicting sexual risk-taking among students in Nigeria’s capital, Lagos. It is seen as having a critical role in changing attitudes to sexual health in Nigeria, which, with 3.3 million patients, has the highest HIV rate in the world after South Africa.

Mr Bandele, who lives in Brixton, south London, has already won plaudits at the Toronto film festival this year for his feature film Half of a Yellow Sun, an adaption of Chimamanda Ngozi Adichie’s Orange-prize winning novel and featuring Hollywood  stars Chiwetel Ejiofor and Thandie Newton.

“I had always thought HIV was an urgent issue that we didn’t even talk about in Nigeria. People there will say: ‘We don’t have that problem’ but then you look at the statistics and it’s huge,” he told  The Independent.

Shuga is a funded by MTV’s Staying Alive Foundation and is being distributed to broadcasting networks free of charge. Mr Bandele’s Nigerian series is the third season.

The first two series, which  were filmed in Kenya and featured the love lives of Nairobi’s young middle class, have already had a marked effect in changing attitudes to HIV.

The title of the second series, Shuga: Love, Sex and Money, is an indication of how the serious message is told in the language of popular culture.

Research conducted by James Lees, senior lecturer in the HIV and AIDS programme at the University of Western Cape in South Africa, found the first episodes of Shuga have been far more effective than conventional teaching methods in conveying the threat of HIV to young people.

Prior to watching the programme, 65 per cent of young people told the study they believed they could “successfully navigate” the risk of HIV. That fell to 30 per cent after they viewed the drama, and to 5 per cent when they had taken part in a subsequent discussion relating to the TV show.

Mr Bandele said the secret was to use drama to engage with an audience not used to receiving messages in such  a format.

“Shuga doesn’t patronise the audience,” he said. “It’s doing something which society hasn’t done – it doesn’t stigmatise HIV or sex, it just says ‘this is life’ and it gets people talking.”

He has advised writers on the series to avoid any  moral judgments.

“On most Nigerian university campuses you will find posters promoting abstinence before marriage and if you ask where you can get a condom it’s almost possible.”

Mr Bandele, 46, who was born in northern Nigeria and moved to Lagos when he was 16, said the country was “aspirational” and that even audiences in poorer communities would respond to glamorous, uptown storylines.

“One of the reasons we chose the setting is that when you usually see Africans on TV they are queuing up for food aid. You would think it’s a continent made up entirely of victims.”

His series also attempts to address the rarely-discussed subject of domestic violence.

The director moved to England in 1990 after his skills as a playwright were recognised by the British Council.

He is travelling to film festivals in India, Dubai and Sweden for screenings of Half of a Yellow Sun, which will go on general release in the UK at the end of March.

His first episode of Shuga had a premiere in Lagos on  1 December and the series is to be shown in Britain on the entertainment channel BET from January.

“I just hope it gets people talking,” he said.

You can watch the whole series from the following link: http://www.youtube.com/user/MTVShugatv?feature=watch

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Nelson Mandela (1918 – 2013) His Enduring Legacy

Nelson Mandela, one of the world’s most revered statesmen, who led the struggle to replace the apartheid regime of South Africa with a multi-racial democracy has died at home, surrounded by his family at the age of 95.

Nelson Mandela had been hospitalised four times since December 2012 and was taken to a hospital in Pretoria four months ago with a recurring lung infection.  During this time, official news from the hospital had been quiet but family members had said that Mandela’s condition has improved and was expected to return home.

Mandela’s medical team advised President Jacob Zuma of a slight improvement in the former president’s health.  He visited Mandela in hospital in Pretoria after abandoning a planned trip to a summit in Mozambique.

Mandela’s health is “perilous” and he is being kept alive by life support, according to documents filed in the court

Yet, it was confirmed earlier this evening.  In a statement on South African national TV, Jacob Zuma said Mr Mandela had “departed” and was at peace.  “Our nation has lost its greatest son,” Mr Zuma said.

He said Mr Mandela would receive a full state funeral, and flags would be flown at half-mast.

Nelson Mandela was a South African anti-apartheid revolutionary and politician who served as President of South Africa from 1994 to 1999. He was the first black South African to hold the office, and the first elected in a fully representative, multiracial election. His government focused on dismantling the legacy of apartheid through tackling institutionalised racism, poverty and inequality, and fostering racial reconciliation. Politically an African nationalist and democratic socialist, he served as the President of the African National Congress (ANC) from 1991 to 1997. Internationally, Mandela was the Secretary General of the Non-Aligned Movement from 1998 to 1999.

He declined to run for a second term, and was succeeded by his deputy Thabo Mbeki, subsequently becoming an elder statesman.

You can find more information on the life of Nelson Mandela from the following links.

• Nelson Mandela – A life in Focus (Guardian.co.uk)
• Nelson Mandela (Biography.com )
• Nelson Mandela Centre of Memory

As an elder statesman, Mr Mandela focused on charitable work in combating poverty and HIV/AIDS through the Nelson Mandela Foundation which was founded in 1999.

In December 2000 Amidst a resounding standing ovation from the delegates at the Thirteenth International AIDS Conference in Durban, Nelson Mandela took the stage at the closing ceremony at the International Convention Centre and used this opportunity to add his voice to the worldwide struggle against HIV/AIDS.

Mandela said at the outset, ‘It is never my custom to use words lightly. If 27 years in prison and 27 years of silence in solitude have taught me anything, it is how precious words are!’

Referring to the controversy over major issues related to AIDS raised by South African President Thabo Mbeki, Mandela asked his countrymen to support their President and his scientific enquiry, saying, ‘The President of this country is a man of great intellect who takes scientific thinking very seriously and he leads a government that I know to be committed to those principles of science and reason.’

Stressing the need for us not to indulge in mud-slinging and worthless arguments, he said, ‘The ordinary people of the world, particularly the poor – who on our continent will again carry a disproportionate burden of this scourge – would wish that the dispute about the primacy of politics or science be put on the backburner and that we proceed to address the needs and concerns of those suffering and dying. And this can only be done in partnership. History will judge us harshly if we fail to do so right now.’

‘Wasting words and energy in worthless ridicule distracts us from our main course of action, which must be not only to develop an AIDS vaccine [sic], but also to love, care for, and comfort those who are dying of HIV/AIDS. A vaccine shall only prevent the further spread of HIV/AIDS to those not already infected; we must also direct our concern towards those who are already HIV positive.’

At the time, and still prevalent today in South Africa, employment opportunities and a dignified life are still a distant dream for HIV-positive patients even in the most advanced social set-ups.  HIV positive patients are refused basic treatment in many medical facilities if they reveal their HIV-positive status and some doctors remain unwilling to attend to HIV-positive patients.

Mandela did not mince words when speaking on the magnitude of the AIDS pandemic. ‘Let us not equivocate: a tragedy of unprecedented proportions is unfolding in Africa. AIDS in Africa today is claiming more lives than the sum total of all wars, famines, floods, and the ravages of deadly diseases such as malaria.

‘It is devastating families and communities, overwhelming and depleting health care services, and robbing schools of both students and teachers. Business has suffered, or will suffer, losses of personnel, productivity and profits; economic growth is being undermined; and scarce development resources have to be diverted to deal with the consequences of the pandemic.

‘HIV/AIDS is having a devastating impact on families, communities, societies, and economies. Decades have been chopped from life expectancy and young child mortality is expected to more than double in the most severely affected countries of Africa. AIDS is clearly a disaster, effectively wiping out the development gains of the past decades and sabotaging the future.’

Society at large remains largely unprepared to meet the challenge of the HIV/AIDS pandemic. A massive effort is required if we are to successfully tackle the menace of HIV/AIDS. As Mandela put it, we need to ‘move from rhetoric to action, and action at an unprecedented scale…’.

Mandela had also stressed that HIV is wholly preventable. ‘I am shocked to learn that 1 in 2, that is, half, of our young people will die of AIDS. The most frightening thing is that all of these infections were preventable.’

Speaking on strategies to prevent the further spread of HIV, he pointed out, ‘The experiences of Uganda, Senegal and Thailand have shown that serious investments in, and mobilisation around, these actions make a real difference. Stigma and discrimination can be stopped, new infections can be prevented, and the capacity of families and communities to care for people living with HIV and AIDS can be enhanced.’

Outlining the future course of the war to contain the spread of HIV in South Africa, Mandela exhorted the delegates to remember that, ‘The challenge is to move from rhetoric to action, and action at an unprecedented intensity and scale. There is a need for us to focus on what we know works. We need to break the silence, banish stigma and discrimination, and ensure total inclusiveness within the struggle against AIDS.’

‘We need bold initiatives to prevent new infections among young people, and large-scale actions to prevent mother-to-child transmission, and at the same time we need to continue the international effort of searching for appropriate vaccines. We need to aggressively treat opportunistic infections, and work with families and communities to care for children and young people, to protect them from violence and abuse, and to ensure that they grow up in a safe and supportive environment.’

Nelson Mandela succeeded in issuing a call to action as the world prepared to enter the new century facing one of the biggest public health disasters mankind has ever known.

46664

The non-profit organisation, “46664” (four, double six, six four) founded just a year prior to this speech takes its name from the prison number (prisoner number 466 of 1964) given to Mr Mandela when he was incarcerated for life on Robben Island, off Cape Town, South Africa.  Mr Mandela gave his prison number to the organisation as a permanent reminder of the sacrifices he was prepared to make for a humanitarian and social justice causes he passionately believed in.

In creating 46664 initially as a global HIV/AIDS awareness and prevention campaign, Mr Mandela realised that to reach the youth all over the world specifically, he needed to engage the support of the people who most appeal to them. This has been seen most visibly through the high-profile 46664 concerts of the early ‘00’s and the appointment of 46664 ambassadors.  The 46664 ambassadors are world famous and influential musicians, artists and sportsmen and women who are committed to supporting 46664 and the mandate its takes forward to find new hands to lift the burdens.

In addition, 46664 has expanded its focus from being a global HIV/AIDS awareness and prevention campaign into encompassing all areas of Mr Mandela’s humanitarian legacy as well as confronting issues of social injustice.

Makgatho Mandela

In January of 2005, Nelson Mandella announced that his eldest son, Makgatho Mandela has died of AIDS at the age of 54. Makgatho Mandela had been critically ill for several weeks after being admitted to a Johannesburg hospital late in 2004.

Mr Mandela cancelled several engagements over the holiday period to be close to his ailing eldest son and on Thursday, 6^th January 2005 announced the cause of his son’s death, the former president said: “Let us give publicity to HIV/AIDS and not hide it, because [that is] the only way to make it appear like a normal illness.”

Mandela’s candour about his son’s illness undoubtedly helped to erode the stigma and prejudice surrounding HIV/AIDS.  Compared to other world leaders, he has been forthright concerning the need to combat the pandemic.  For these reasons, we appreciate Mandela and admire him. There is, after all, very little international leadership in the fight against HIV.  Mandela’s commitment and openness is therefore commendable.  It contrasts with the dishonesty and neglect of HIV/AIDS by others, in the East, West and Developing worlds.

Legacy

Our friend, and International Patron, Archbishop Desmond Tutu, knows Nelson Mandela better than most people, and it was at Desmond Tutu’s house that Mandela spent his first night after his release from prison in 1990.  Desmond Tutu once said that the world would never have met Mandela the statesman had he not first been Mandela the prisoner.

The Mandela who entered prison in 1962 was an angry young man; a left-wing radical branded a terrorist.  But Desmond Tutu said prison reshaped Mandela’s soul.  It was there he learned forgiveness, which became the hallmark of his presidency and enabled him to heal some of the wounds between South Africa’s two racial solitudes.

Nelson Mandela is proof of humanity’s power to transcend even the widest divides and deepest hatreds.

That is his enduring legacy.

Nelson Rolihlahla Mandela, 1918 – 2013 now at rest.

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Information about the effort and influence surrounding HIV/AIDS prominent activists is available here.

Archbishop Desmond Tutu urges Uganda to drop the “Anti Homosexuality Bill”

Our International Patron, Archbishop Desmond Tutu has been a tireless campaigner for health and human rights, and has been particularly vocal in support of controlling TB and HIV.  He is also Patron of the Desmond Tutu HIV Foundation, a registered Section 21 non-profit organisation, and has served as the honorary chairman for the Global AIDS Alliance and is patron of TB Alert, a UK charity working internationally.  In 2003 the Desmond Tutu HIV Centre was founded in Cape Town, while the Desmond Tutu TB Centre was founded in 2003 at Stellenbosch University. Tutu suffered from TB in his youth and has been active in assisting those afflicted, especially as TB and HIV/AIDS deaths have become intrinsically linked in South Africa.

On 20 April 2005, after Cardinal Joseph Ratzinger was elected as Pope Benedict XVI, Tutu said he was sad that the Roman Catholic Church was unlikely to change its opposition to condoms amidst the fight against HIV/AIDS in Africa: “We would have hoped for someone more open to the more recent developments in the world, the whole question of the ministry of women and a more reasonable position with regards to condoms and HIV/AIDS.”

In 2007, statistics were released that indicated HIV and AIDS numbers were lower than previously thought in South Africa. However, Tutu named these statistics “cold comfort” as it was unacceptable that 600 people died of AIDS in South Africa every day. Tutu also rebuked the government for wasting time by discussing what caused HIV/AIDS, which particularly attacks Mbeki and Health Minister Manto Tshabalala-Msimang for their denialist stance.

Presently, Desmond Tutu urges Uganda to drop bid to jail gays and lesbians.

He has urged Uganda to scrap a controversial draft law that would send gays and lesbians to jail and, some say, put them at risk of the death penalty.

The Anti-Homosexuality Bill is expected to become law after Parliamentary Speaker Rebecca Kadaga offered it to Ugandans as a “Christmas gift.” The bill is believed to exclude the death penalty clause after international pressure forced its removal, but gay rights activists say much of it is still horrendous.

“I am opposed to discrimination, that is unfair discrimination, and would that I could persuade legislators in Uganda to drop their draft legislation, because I think it is totally unjust,” Tutu told reporters here on Tuesday at the All Africa Conference of Churches meeting.

Desmond Tutu is the former Anglican archbishop of Cape Town, South Africa, and was a hero of the anti-apartheid movement, he has emerged as a leading pro-gay voice both in the church and across Africa.

With African church leaders passionately preaching against homosexuality as sinful and against African culture, Tutu said the church must stand with minorities.

“My brothers and sisters, you stood with people who were oppressed because of their skin color. If you are going to be true to the Lord you worship, you are also going to be there for the people who are being oppressed for something they can do nothing about: their sexual orientation,” he said.

Tutu said people do not choose their sexual orientation, and would be crazy to choose homosexuality “when you expose yourself to so much hatred, even to the extent of being killed.”

“Kill The Gays” bill: Read the actual bill about to be debated by Uganda’s Parliament | VIDEO

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HIV Antibody Discovery Opens Door to Better Vaccine Design

A study from researchers in South Africa describes how a specific change in the outer coating of HIV in two infected women enabled them to produce deadly antibodies that are able to kill up to 88 per cent of HIV types from around the world. The discovery provides important information about how HIV escapes the immune system, and it is hoped it will help researchers to design better vaccines.

Will we ever have a HIV vaccine? (lass.org.uk)

Antibodies that recognise HIV and prevent it from infecting cells are a crucial element of immunity to the virus, but so far researchers have not been able to achieve this with vaccines. This is partly because the virus is highly skilled at escaping from antibodies by changing the appearance of its outer coating.

It has been known for some time that some HIV-infected people naturally develop antibodies that recognise many different types of the virus. Over the past five years, researchers from the Centre for the AIDS Programme of Research in South Africa (CAPRISA) have been studying HIV-infected people to understand the mechanism behind how these individuals are able to generate such broadly neutralising antibodies.

The team focused on two women in particular and found that their antibodies recognised a specific feature of the outer coat of the virus that was not present in the virus that they were initially infected with. The virus seemed to have changed its coat in response to antibodies that were produced earlier in the infection to try to escape immune attack; however, this shift revealed a vulnerability that enabled the women to produce more powerful antibodies that are capable of killing many different HIV types from around the world.

Dr Penny Moore, a Wellcome Trust Intermediate Fellow in Public Health and Tropical Medicine and lead author of the study, said: “Understanding this elaborate game of ‘cat and mouse’ between HIV and the immune response of the infected person has provided valuable insights into how broadly neutralising antibodies arise.”

Professor Salim Abdool Karim, Director of CAPRISA, said: “Broadly neutralising antibodies are considered to be the key to making an AIDS vaccine. This discovery provides new clues on how vaccines could be designed to elicit broadly neutralising antibodies.”

The study was published this week in the journal ‘Nature Medicine’. (click to read)

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Related articles

• New HIV Test is 10 Times More Sensitive and a Fraction of the Price (lass.org.uk)

A History of HIV & AIDS – 1995

As we prepare to enter our 25th year, we are reflecting on the global HIVevents from the last three decades.  HIV has swept across the globe touching communities on every continent.  Here’s an introduction to some of the key moments in the early global history of HIV.  Catch up on the story using the ‘Recent Posts’ link to the right.

By 1st January 1995, a cumulative total of a million cases of AIDS had been reported to the World Health Organisation Global Programme on AIDS.  Eighteen million adults and 1.5 million children were estimated to have been infected with HIV since the beginning of the epidemic.

AIDS had become the leading cause of death amongst all Americans aged 25 to 44.

Two research reports provided important new information about how HIV replicates in the body and how it affects the immune system.

The South African Ministry of Health announced that some 850,000 people – 2.1 percent of the 40 million population – were believed to be HIV positive. Among pregnant women the figure had reached 8 percent and was rising.

By the autumn of 1995, 7-8 million women of childbearing age were believed to have been infected with HIV.

By December 15th, the World Health Organisation had received reports of 1,291,810 cumulative cases of AIDS in adults and children from 193 countries or areas. The WHO estimated that the actual number of cases that had occurred was around 6 million. Eight countries in Africa had reported more than 20,000 cases.

Other organisations estimated that by the end of 1995, 9.2 million people worldwide had died from AIDS.

Worldwide during 1995, it was estimated that 4.7 million new HIV infections occurred. Of these, 2.5 million occurred in Southeast Asia and 1.9 million in sub-Saharan Africa. Approximately 500,000 children were born with HIV.

The WHO estimated that by the end of the century, 30 to 40 million people would have been affected by HIV.

British DJ and entertainer Kenny Everett dies from AIDS on 4 April 1995.

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Yoga Session Brings in £650 for The Global Natural Health Care Trust

It can be easy and pleasurable to generate funds to help support HIV work, both in the UK and Africa.  The following story is an example of how Yoga classes, an Auction and a Barbecue can help raise money for good causes.

The Global Natural Healthcare Trust (GNHCT) are a UK based registered charity founded by Cornish local Annette Montague-Thomas.  Annette has over 25 years experience in Africa where she has worked for UNICEF in Nairobi in Kenya, and in the past 9 years has been assisting young children who are afflicted and affected by the HIV/AIDS pandemic in South Africa.  Overseas, they are based on The Orange Farm informal settlement which is about one and a half hours South of Johannesburg.

The settlement is home to over 4 million Africans of varying tribes. The settlement is not only the largest in South Africa, but in the whole of Africa. It is fair to state that not even one quarter of the residents have any work and many are surviving at near starvation level.  They live in abject poverty with homes that are usually no more than shacks with no sewerage system.  Many of the homes don’t even have running water.

A recent event by “Yoga Rocks” at Lusty Glaze Beach raised £650 for he Global Natural Health Care Trust and this money will help support the charity’s work in Africa to help people affected by HIV.

The evening of yoga classes with some of the UK’s top teachers included a charity auction and a barbecue provided by chefs at Lusty Glaze and enjoyed by more than 150 people.

The charity runs a herbal clinic in the country’s worst-affected area, helping to save lives on a daily basis as well as providing homes for more than 10,000 orphans in its foster care system.

Yoga Rocks’ founders are yoga teacher Rhoda McGivern, Debbie Luffman from Finisterre and Gemma Ford from Love Yoga Online.

Mrs McGivern said: “The atmosphere was so lovely, we can’t believe how many people turned up on a rainy Monday evening to help us to raise money for a charity so close to our hearts.”

They have thanked everyone who volunteered to make the event happen, especially the team from Finisterre whose energy and enthusiasm were “simply amazing”.

The Yoga Rocks’ team is organising future events to be held in various venues around Cornwall, with potential venues also in London and America.

To offer help, please contact rhomcgivern@gmail.com or visit their websites:

• www.yogarocks.org.uk
• www.gnhct.com

Original article compiled from the above sources and thisiscornwall

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A Tale of Two Trials: How Adherence is Everything in PrEP

Adherence makes all the difference to the efficacy of pre-exposure prophylaxis (PrEP), the 19th Conference on Retroviruses and Opportunistic Infections (CROI) heard on Tuesday.

Further data were presented from two trials of PrEP (giving anti-HIV drugs to HIV-negative people to prevent infection), which announced dramatically different results last year.

In April 2011, the FEM-PrEP study found that giving HIV-negative women tenofovir/FTC (Truvada) pills to prevent their acquiring HIV was totally ineffective: there was no difference in HIV incidence between women taking Truvada and women taking placebo.

In July 2011, however, the Partners PrEP study found that Truvada was 73% effective in preventing HIV transmission between heterosexual partners of different HIV status.

How do we explain why giving HIV-negative women antiretroviral pills made no difference to the HIV infection rate in one trial, but prevented at least two in every three infections in the other? The difference, it appears, is that in the Partners PrEP trial, adherence to the study medication was very high, whereas in FEM-PrEP, despite counselling and support, less than half the women took their PrEP pills regularly.

The Partners PrEP study

The Partners PrEP study enrolled 4758 serodiscordant couples in Kenya and Uganda; the HIV-negative partner was female in 38% of couples. This study had three arms: a daily tenofovir pill, a daily Truvada pill, or placebo.

There were 17 infections in participants on tenofovir, 13 on Truvada and 52 on placebo. Efficacy overall was 75% in those assigned Truvada and 67% in those assigned tenofovir, though confidence intervals (44% to 81% in tenofovir and 55% to 87% for Truvada) overlapped, so the efficacy of the two regimens was the same statistically. The same was true of efficacy observed in women (65%) and men (70.5%).

Adherence according to pill counts of unused medication was 97%. A substudy (Donnell) compared tenofovir levels in the blood of 29 out of the 30 people who became infected in the two PrEP arms with levels in a random selection of 198 people who did not become infected.

Tenofovir was undetectable in the blood of 70% of the people who became infected but only 18% of the people who did not, indicating a ‘true’ adherence level of about 80% – and having a detectable level of tenofovir in the blood was associated with an 86% reduction in HIV risk in those taking tenofovir and a 90% reduction in those on Truvada.

The FEM-PrEP study

In the FEM-PrEP study, 2056 HIV-negative women in South Africa, Kenya and Tanzania were randomised to take a daily Truvada pill or a placebo. The trial was stopped when an interim analysis found near-identical HIV infection rates in both trial arms. There were 33 HIV infections in women taking Truvada and 35 in women taking placebo; this translates into annual incidence rates of 4.7% and 5.0% respectively. This 0.3% difference is no difference at all, statistically speaking (hazard ratio 0.94, 95% confidence interval 0.59 to 1.52, p = 0.81).

Participants in the study said they took their pills 95% of the time and adherence as measured by pill count was 85%. However when drug levels of tenofovir and FTC were measured in the blood of women assigned to Truvada, the investigators found that less than 50% of the women who should have been taking the drug had actually done so in the last 12 days, and less than 40% within the last 48 hours.

In infected participants, 26% had detectable levels of tenofovir in their blood in the last visit before they tested HIV positive, 21% at the visit they tested positive, and 15% at both visits; in non-infected participants whose samples were taken at the same visits they were 35%, 38% and 26% respectively.

Resistance

In FEM-PrEP, there were five cases of drug-resistant virus (all with the single M184V FTC resistance mutation), four in the Truvada arm and one on placebo. Two of the four cases in women assigned Truvada were clearly cases of transmission of virus that was already drug-resistant and not caused by women partially adherent to PrEP becoming infected, while the other two are still under investigation.

There were two cases of drug-resistant virus in Partners PrEP but in both cases these turned out to be people who were enrolled while suffering from acute HIV infection: there were no cases of drug-resistant virus amongst 74 infections post-randomisation.

One observation common to both studies was that the only side-effect that was measurably different between drug and placebo was nausea and vomiting. In Partners PrEP Truvada was associated with a modest increase in gastro-intestinal symptoms in the first month and in FEM-PrEP the rates were also significantly higher. Whether this is enough to deter participants from continuing their pills who are not strongly motivated needs further research.

Why were there differences in adherence?

Jared Baeten and Lut van Damme, principal investigators respectively of Partners PrEP and FEM-PrEP, were asked why they thought adherence was so much lower in FEM-PrEP than in Partners PrEP.

Baeten commented that they were very different populations. The men and women in Partners PrEP had to define themselves as being in a stable relationship – stable enough to last for at least the two-year length of the trial. Partners would have encouraged their spouse to take their pills, and a qualitative study has already confirmed that many participants saw PrEP as an opportunity to preserve their relationship despite the strain imposed by different HIV status.

He was asked why PrEP would be used in a couple where it would be more logical for the HIV-positive partner to be on treatment. He said one use of PrEP within couples might be to bridge the gap in time between the positive partner’s diagnosis and their starting treatment and becoming virally undetectable.

Van Damme said that the women in FEM-PrEP were much younger and had high levels of sexually transmitted infections (STIs). Initial qualitative surveys had shown that many did not believe themselves to be at high risk of HIV, despite high incidence in their community. There was also a high pregnancy rate in the study despite reported high levels of oral contraceptive use, showing that low adherence to medications was not restricted to Truvada. There was no evidence that participants were sharing their pills with others and, contrary to what the data initially suggested, the pregnancy rate was no higher in women taking PrEP, ruling out theories that interactions between the PrEP drugs and the menstrual cycle may have made women more vulnerable to HIV.

“What we have learned from this trial is that risk perception and understanding one’s own risk are important motivators for people to use biomedical prevention methods,” she concluded.

Dr Sharon Hillier of the Microbicides Trial Network, commenting on the PrEP trials at the conference, commented: “PrEP is very, very effective if you use it very, very well.”

References

Baeten J et al. ARV PrEP for HIV-1 prevention among heterosexual men and women. 19th Conference on Retroviruses and Opportunistic Infections, Seattle, abstract 29, 2012. The abstract is available on the official conference website.

Van Damme L et al. The FEM-PrEP Trial of Emtricitabine/Tenofovir Disoproxil Fumarate (Truvada) among African Women. 19th Conference on Retroviruses and Opportunistic Infections, Seattle, abstract 32LB, 2012. The abstract is available on the official conference website.

Donnell D et al. Tenofovir disoproxil fumarate drug levels indicate PrEP use is strongly correlated with HIV-1 protective effects: Kenya and Uganda. 19th Conference on Retroviruses and Opportunistic Infections, Seattle, abstract 30, 2012. The abstract is available on the official conference website.

A webcast of the session HIV prevention: PrEP, microbicides and circumcision, is available through the official conference website.

Original Article via NAM

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Mobile Testing Units Show Success in Linking People to HIV Care

Linkage to facility-based HIV care from a mobile testing unit is feasible, South African researchers report in the advance online edition of the Journal of Acquired Immune Deficiency Syndromes.

In a stratified random sample of 192 newly diagnosed individuals who had received CD4 test results, linkage to care was best among those who were ART eligible, Darshini Govindasamy and colleagues found.

The lower the CD4 cell count the greater the linkage to care: all of those with CD4 counts at or under 200 cells/mm3, two-thirds of those with CD4 counts of 201-350 cells/mm3 and a third of those with CD4 counts over 350 cells/mm3 linked to care.

An estimated two million people died as a result of HIV/AIDS in sub-Saharan Africa in 2008. South Africa now has the largest ART programme in the world, yet half of those in need of treatment do not get it. And a large number of those who do present for care, present late with low CD4 cell counts increasing their risk of early death.

In South Africa traditional HIV counselling and testing (HCT) sites at stationary facilities have increased and consequently so have the numbers tested. Yet this has not resulted in increased numbers on treatment and in care.

Transport costs, being male and having a low CD4 cell count have been well documented as the primary barriers of non-linkage to care.

Successful early diagnosis of HIV has to be accompanied by strategies that assure timely linkage to care and treatment so improving health outcomes.

Mobile testing units offer several advantages: people are often tested at an earlier stage of HIV; it is easier for hard-to-reach and high-risk populations to test; and they are cost-effective. However, maintaining on-going HIV care may prove difficult, requiring referral to stationery facilities.

The authors note no studies have looked at the performance of mobile testing units in linking people diagnosed with HIV to care at public health facilities.

The authors chose to look at whether disease progression as defined by CD4 cell count had an effect on access to care and the associated barriers in a nurse-run, counsellor-supported mobile testing unit.

From August 2008 until December 2009 those diagnosed for the first time with HIV were identified retrospectively from the mobile unit records. Those who got a CD4 cell count were prospectively followed from April to June 2010 to determine linkage to HIV care.

The unit, in the Cape Metropolitan region, Western Cape, South Africa, provides free HCT services to underserved communities.

Along with free client-initiated HCT free screening for other chronic conditions including high blood pressure, diabetes and obesity as well as TB is offered. The population is predominantly black Xhosa-speaking Africans.

Following rapid testing and a positive result and CD4 testing individuals are given detailed referral letters to help their access to care. Individuals are called when results of CD4 counts are available (within 72 hours). Those with no contact number are followed up by home visit or letter. Counselling is provided and patients are encouraged to go to clinics for either pre-ART care or to start ART as appropriate.

Of the 6738 records, overall prevalence of new diagnosis was 6.9% (463), of which 376 met the study’s inclusion criteria.

Because of a higher proportion of patients with CD4 counts at or above 350 cells/mm3 the authors took one-third of patients from this cohort (76), together with all 36 individuals with CD4 cell counts at or below 200 cells/mm3, and the 80 patients with CD4 counts between 201 and 350 cells/mm3.

Of the sample 27% (43) did not get their CD4 test result. Being female, having a CD4 cell count at or under 350 cells/mm3 and having a cellphone improved the likelihood of getting a CD4 count result. These results echo recent studies in South Africa showing a high loss to follow-up prior to receiving a CD4 test result; highlighting the critical need for point of care CD4 testing in both mobile and stationary facilities.

Of the 145 (73%) remaining individuals 10 refused to participate and 56 could not be traced in spite of previously having been contacted and receiving their CD4 counts.

52.5% (49) linked to care, including 100% of those ART-eligible. While the sample size is small, note the authors, the results are considerably higher than in studies of stationary facilities, where rates of post-diagnosis linkage to care varied from 30% to 80% among the ART-eligible.

Over 70% said that the mobile unit’s referral letter helped them access care at a public health facility.

Nonetheless over 30% of those eligible to start ART still had not started two months after their diagnosis but were still in the ART screening process. These results support other studies in sub-Saharan Africa also showing a delay in starting ART after diagnosis.

Having a higher CD4 count, no TB symptoms, not having disclosed and being employed increased the risks of not accessing care.

Not being able to access public health facilities was the most common barrier reported (41%) to linking to care. Other barriers included: 13% worried about ART toxicity and side effects and 9% fearing stigma and disclosure.

Extending hours and opening on the weekends at public facilities and setting up workplace programmes with mobile units could improve linkage to care for the employed, note the authors.

Limitations include the small sample size; the inability to track over 40% of eligible study participants in spite of persistent follow-up so potentially biasing the findings; and incorrect contact information. The study was undertaken 6-18 months after HIV diagnosis makingfollow-up especially challenging.

Strengths include validation of self-reported linkage to HIV care; trained bilingual counsellors assured minimal respondent bias; no incentives were given for participation.

The authors note HIV services at the mobile unit and public health facilities were free so their findings can be generalised to similar settings.

The authors conclude that while linkage to care was best among those ART-eligible, there is an urgent need to design interventions to improve linkage to care for the employed.

Original Article by Carole Leach-Lemens at Nam

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LASS offer a completely free and confidential rapid HIV test and you’ll get the results within 60 seconds from a simple finger prick test.  We use the Insti HIV test produced by BioLytical laboratories.  The test is 99.96% accurate from 90 days post contact for detecting HIV 1 and 2 antibodies.  We also have a mobile testing van which is often out in communities providing mobile rapid HIV tests.  Appointments are not always necessary, if you would like a test, please contact us on 0116 2559995