Tuberculosis is an African emergency

African health ministers meeting in Mozambique have declared tuberculosis (TB) an emergency in the African region. The ministers, representing 46 countries, made the announcement at a meeting of the World Health Organisation (WHO) Regional Committee for Africa.

The WHO spelt out why this action was needed: “The declaration was made in response to an epidemic that has quadrupled the annual number of TB cases in 18 African countries since 1990 and continues to rise across the continent, killing more than half a million people every year.”

The continuing rise in African TB cases is mainly due to the spread of HIV, which weakens the immune system and makes people much more likely to develop the active, contagious form of the disease. TB is a leading cause of death among HIV positive people, accounting for up to a third of all AIDS deaths worldwide.

It is hoped that the emergency declaration will lead to rich nations committing more money to fight TB and AIDS in sub-Saharan Africa, where more than 25 million people are living with HIV. The declaration is part of a wider WHO programme that calls for $2.2 billion in new funding to control African TB in 2006-07.

AVERT.org has more about HIV and tuberculosis.

(Reuters, 26/08/05)

U.S. withholds funding for Abstinence-only group.

The Bush administration has announced it is to suspend a federal grant for the pro-abstinence education group, the Silver Ring Thing, because it appears to be using taxpayers’ money to further its religious ideals.

The decision has caused some surprise among many sex education groups, who had until now had presumed that the President’s own endorsement and support of Christian-based abstinence-until-marriage education meant that the government would turn a blind eye to groups that incorporated overt religious teachings in their work.

However, three months ago the American Civil Liberties Union filed a lawsuit against the US Department of Health and Human Services, claiming that the Bush Administration was illegally using tax dollars to promote Christianity.  Under current US law, groups can mention religion in their promotion of more responsible sexual practices, but they cannot use federally funded programmes to promote any one religion.  Clearly wary of the issues raised by the ACLU lawsuit, the HSS has now told the Silver Ring Thing, one of the biggest abstinence-until-marriage groups in the US, that it will have to submit a “corrective plan of action” if it is to receive the $75,000 grants it is hoping for.

The organisation, which describes itself as ‘faith-based’, insists that their religious activities are kept quite separate from its abstinence programme, which asks young people to take a pledge of chastity in return for a silver ring.  However, their virginity oath must be taken “before God Almighty”, the ring is inscribed with a passage from the bible reminding the wearer to “keep clear of sexual sin”, and most meetings are held in churches, which has led some, including the US government, to cast doubt on the group’s true motivations.

Abstinence-only education has been heralded by many as the best AIDS prevention measure available in the US, but statistics on HIV rates among young people have as yet failed to show that the programmes are having any impact.

(Washington Post, 24/08/05)

Global Fund suspends Ugandan AIDS, TB & Malaria Grants

 The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) has suspended all grants to Uganda following concerns about possible corruption within the Ugandan Health Ministry, according to a letter leaked to the UK’s Financial Times newspaper.

All grants issued by the Fund are carefully monitored by a Local Fund Agent (LFA) within the country to ensure that the money is being used for its intended purpose.  However, according to the letter seen by the FT, a routine investigation carried out by Uganda’s LFA (the business services firm PwC), found evidence of “serious mismanagement” of funds.  Around $280,000 is believed to have been siphoned off by someone in the Ministry after the American dollar grants were converted into Ugandan Shillings using false exchange rates.  Around $45 million has been spent on AIDS, TB and Malaria related projects in Uganda so far.

The Fund have not yet specified exactly who they believe is responsible for the discrepancies, but have made suggestions that it is either a partner or someone within the Health Ministry’s special Programme Management Unit (PMU) which was set up specifically to administer Global Fund grants back in 2003.  They have now asked for the Ugandan government to reorganise its mechanism for receiving and disbursing grants so that the PMU is excluded.

News of the suspension comes just one day after The Global Fund issued a press release stating that their programmes had exceeded targets set for 2005.  Seven out of eight of the Fund’s key goals on AIDS, TB and Malaria were surpassed, with the greatest achievement being among children orphaned by AIDS.  66% more orphans than expected are now receiving care and support thanks to GFATM money.  “It is extremely gratifying to see that our grant portfolio is doing well – even better than expected,” said the chair of the Fund, Dr Carol Jacobs, “It indicates that the Global Fund’s financing structure, which lets countries design and implement their own programs and which rewards good performance, works even in countries that traditionally are not able to use external financing well.”

However, as keen to reward good behaviour as the Fund may be, the Ugandan situation and the GFATM’s recent withdrawal from Burma, suggest that officials have no qualms about punishing bad behaviour in equal measure.  The suspension of funding may be extremely serious for the people of Uganda, but the GFATM has always maintained that in the long term, fraud and financial mismanagement are far more damaging to the economy and health of a nation.  Avoidance of corruption through transparency has therefore always been key in all Global Fund activities and all Principal Recipients are warned that irregularities will be met with suspension and possibly cancellation of funding.  

With the third voluntary replenishment conference for donors due to be held in London next month, the Global Fund has everything to play for if it wants to secure the funding it needs to continue its work.  However, ironically, it may not be the stories of AIDS orphan support networks or exceeded AIDS treatment targets that ultimately persuade the large donor nations to part with their cash, but the simple fact that the Global Fund can and will uncover and combat corruption.  In an age when mistrust in the leaders and governments of developing nations is fuelling cynicism and apathy, this guarantee could provide a vital boost in aid donation worldwide, and ensure that this aid actually reaches the people that need it most. 

AVERT.org has more about the Global Fund and Uganda

 (Financial Times, 24/08/05 & GFATM Press Release, 23/08/05)

Swaziland ends chastity rite so King can marry

Young girls in Swaziland are to be released early from a five-year chastity pledge imposed by King Mswati III in 2001 to prevent the spread of HIV.

The "umchwasho" is an ancient rite that requires all girls under the age of eighteen to wear a woollen tassel as a symbolic badge of virginity. Any man who attempts to embark on sexual relations with a girl wearing a tassel is fined one cow, or around 1,300 Swazi emalangeni.

The king himself was fined in 2001 after choosing a seventeen-year-old as his ninth wife. Initially he tried to insist that the ban only applied for casual sex, not marriage, but a 300-women strong protest at his palace forced him to hand over the required cow, which the protesters then roasted and ate in celebration.

The Umchwasho was reintroduced by the King in an effort to tackle the country's enormous AIDS epidemic. Nearly 40% of Swazis are HIV positive, giving the country the highest prevalence rate in the world. However, many have criticised the rite, saying it is ineffective, out-dated, sexist, and bankrupts parents who have 'promiscuous' sons.

The King has given these objections as reasons for ending the ban one year early, but many suspect that his true motive is the annual 'Reed Dance' at the end of August. Up to 20,000 bare-breasted young girls will dance before him at the event, after which he is expected to choose his fourteenth wife. 

 (Associated Press, 22/08/05)

Global Fund to stop grants for Burma

The Global Fund to Fight AIDS, TB and Malaria has announced it is to stop all funding programmes in Burma due to increasingly strict regulations on travel in and out of the country.

The withdrawal is a first for the Global Fund, which operates in more than 100 countries around the world, and officials have called the decision 'regrettable'. Burma, also known as Myanmar, has an HIV+ population of around 600,000 and is thought to have one of the highest rates of tuberculosis in the world. The Global Fund had agreed to spend $100 million over five years in the country, but all the organisation's work and funding will now stop on 1st December 2005.

Rosie Vanek, spokesperson for the Global Fund, told reporters "the travel restrictions appear to be the most recent manifestation of a gradual change in the government's attitude towards international and national humanitarian efforts in Myanmar over the past few weeks." She added, "The Global Fund has now concluded that the grants cannot be implemented in a way that ensures effective programme implementation."

The Global Fund just the latest in a long line of humanitarian organisations to complain that their work is being blocked by the Burmese government. The country is ruled by a military junta that has been accused of serious human rights abuses, but UN efforts to intervene have so far failed.

AVERT.org has more about the Global Fund.

(BBC.co.uk, 19/08/05) 

FDA and WHO reach agreement

The World Health Organisation and the US Food and Drug Administration (FDA) have agreed to cooperate to speed up the approval and distribution of a number of essential generic antiretroviral medications in Africa.

The WHO have been monitoring the quality of generic AIDS drugs for a number of years, and recently reinstated a number of important Indian generic drugs to their list (see "WHO reinstates 7 antiretrovirals to approved drugs list" below). However, their authority and testing is not recognised by USAID, the American Development Agency that run the President's AIDS programme (PEPFAR).

In recent months, many of the drugs already approved by the WHO have therefore had to undergo further testing by the American FDA before being cleared for purchase using PEPFAR funding. PEPFAR officials met with unexpected resistance in June (see "FDA and WHO clash over generic drug approvals" below) when four African nations refused to accept the FDA's stamp of approval as adequate, insisting that they would only allow drugs cleared by the WHO to be used in the country. For a time it appeared as though this could present a major stumbling block in the roll out of universal treatment in Africa, as the two authorities have had a difficult relationship in the past. However, they appear to have put their differences aside in the new agreement, and have promised greater streamlining of the approval process and improved cooperation. The FDA will share all information about the drugs it approves with the WHO, who have agreed to automatically add those not already featured to their registered drugs list.

It is hoped that if all goes according to plan, generic drugs bought with PEPFAR money should begin to be distributed within two to three months.

Avert.org has more about generic drugs and treatment targets and results.

(Boston Globe, 14/08/05)

WHO reinstates 7 antiretrovirals to approved drugs list

The World Health Organisation has reinstated seven generic antiretroviral drugs to their list of 'approved' medications for the treatment of HIV. The drugs, made by the Indian generics manufacturer, Ranbaxy Laboratories Ltd, were voluntarily removed by the company from the WHO's list last year after questions were raised about their 'bio-equivalency'. For a generic drug to be considered bio-equivalent, it has to be proven that it has the same potency and medicinal effects as its brand-named counterpart.

After several months of further research and testing by a number of globally recognised research firms, all the drugs removed from the list have now been certified as safe and equivalent. Ranbaxy insists that this has always been the case, but discrepancies in testing last year raised questions over the accuracy of data, forcing them to withdraw their drugs from the WHO's list until the problems had been solved.

For countries relying on WHO-approved lost cost generic drugs to treat their people, the reinstatement will come as very good news. Fixed dose combination pills (tablets that contain two or three different drugs) invented by Indian manufacturers such as Ranbaxy have brought down the cost of first-line AIDS therapy in Africa to $140-$400 per patient per year, according to WHO estimates. In comparison, brand-name drugs still cost around $400-$600 per person.

For more about generic drugs, please visit out Generics, patents and TRIPS page

(Reuters, 12/08/05)

Fixed dose combination AIDS drug fails again

A once-a-day fixed-combination antiretroviral drug that could simplify the treatment of thousands of people on anti-AIDS medication has failed tests to prove it is 'bioequivalent' for a second time. The product first failed testing in April of this year.

The drug is being developed through a unique collaboration between two pharmaceutical companies - Bristol-Meyers Squibb Co. and Gilead Sciences Inc. They are aiming to combine two separate drugs (Gilead's Truvada and BMS's Sustiva) into one pill. However, in order to go into production, scientists must prove that the effects and potency of the combined drug are identical to taking two separate pills. As yet, they have been unable to do so, and a third round of development, in which the companies hope to test three new formulations, will now be needed.

Failure to produce the drug may harm Gilead more than Bristol-Meyers Squibb. Gilead is a relatively small pharmaceutical company and relies almost solely on its range of HIV drugs to make a profit. Shares in the company dropped by almost 5% after the announcement was made.

If the next round of studies is successful however, the companies hope to register the product with the US Food & Drug Administration in the first half of 2006.  

(Business Week, 09/08/05) 

Drug Companies cut AIDS drug prices in Latin America

 More than 20 pharmaceutical companies including Abbott Laboratories and Gilead Sciences Inc., have agreed to reduce the cost of their antiretroviral drug formulations by as much as 55% in Latin America. The agreement, the first of its kind to cover such a wide area and involve such a high number of different drug companies, was reached after two days of intensive talks in Buenos Ayres last week.

Many South American countries have large populations of HIV positive people, but few are able to provide universal treatment because of the high cost of drugs. Estimates suggest that Latin America is home to around 1.5 million HIV positive people, 350,000 of whom need anti AIDS therapy. However, only around 73% of those in need actually receive treatment. The new agreement will however allow eleven of the most seriously affected nations in the region (including Brazil, Mexico and Argentina) to cut antiretroviral drug spending by at least 9%.

At present, the only country in South America to provide universal treatment for its citizens is Brazil, who spend around $123 million every year on drugs and care. The price reductions will enable the country to save just over $11 million per year. Argentina is expected to save even more, slashing its annual spending from $20 million, to just $15.4 million. Other countries to have signed up include Bolivia, Chile, Colombia, Ecuador, Paraguay, Peru Uruguay and Venezuela.

  (Bloomberg.com, 05/08/05)

South African graveyards 'overcrowded'

City authorities in Johannesburg have warned that every graveyard in the city will soon be full unless drastic action is taken soon. Urbanisation, and the enormous scale of the AIDS epidemic in South Africa mean that some cemeteries are seeing more than 200 burials a week.

Many graveyards have had to close their gates already, and some families have been forced to bury loved ones in the same plot as a relative or friend. Officials have urged people to opt for cremation rather than burial, but traditional beliefs mean that uptake is low.

A spokeswoman for Johannesburg City Parks (responsible for municipal burial grounds) has said that she expected a 5 to 10 percent increase in deaths every year for the foreseeable future. However, she was reluctant to blame AIDS, and said she liked to think that the problem was "mainly down to urbanisation".

With 6.5 million people infected with HIV in South Africa, and only a handful taking antiretroviral therapy, lack of graveyard capacity is a problem throughout the country. New cemeteries are being built, but officials agree that the only true way to prevent them filling up is to reverse the AIDS epidemic that is killing so many.

AVERT.org has more about AIDS in South Africa 

 (Reuters, 03/08/05)

HAART: a lifesaver wherever you live

A new study by a group of international HIV specialists published in this week's edition of The Lancet has found that Highly Active Antiretroviral Therapy (HAART) is even more effective at tackling HIV than previously thought. The research, which used data from a Swiss HIV Cohort Study, compared the outcomes of people on three-drug HAART or a two-drug 'dual' regime with those that had never taken antiretrovirals. 3245 individuals were included in the study, which was conducted between 1996 and 2003. It found that HAART reduced progression to AIDS or death by around 86% overall compared with no treatment, and that the benefits increased over time.

The only group in the study for which HAART did not prove such a dramatic benefit, were Injecting Drug Users. This is possibly because adherence is often worse in IDUs, but also because of the inherent risks of injecting drugs, and the poor levels of general health amongst many users.

ARVS aren't just good news for people in developed countries either. A separate study conducted by the University of Alberta published last week has found that people on antiretroviral therapy in developing countries do just as well as those in richer nations, particularly if their drugs are provided for free. Some had questioned whether the complexity of treatment regimes and the comparative lack of support from physicians, pharmacists and social workers, would mean HAART was a less effective option in resource poor settings. However, in a review of over 100 research papers on the topic, the scientists concluded that this was an unfounded belief, and that HAART appeared to be equally beneficial for everyone.

 (The Lancet, 30/07/05-05/08/05 & Medical News Today, 30/07/05)

International AIDS Society Conference draws to a close

The 3rd International AIDS Society (IAS) Conference on HIV Pathogenesis and Treatment ended today after four days of intense debate on issues affecting HIV sufferers around the world.

The conference, being held in Rio de Janeiro, Brazil, was designed to give a platform to researchers and AIDS organisations to discuss the epidemic and possible ways of combating it.

It was opened by Stephen Lewis, the UN Secretary-General's Special Envoy for HIV/AIDS in Africa, who told delegates "What we desperately need in the response to AIDS today are voices of advocacy: tough unrelenting, informed. The issues are so intense, the situation is so precarious for millions of people, the virus cuts such a swath of pain and desolation, that your voices, as well as your science, must be summoned and heard,".

One of the key issues raised was that of male circumcision. Researchers from the French Agence Nationale de Recherches sur le SIDA (ANRS), announced that a trial carried out in Gauteng province in South Africa among men aged 18-24 years had found that circumcision made them around 70% less likely to contract HIV. The benefits of circumcision have long been suspected (the delicate inner membrane of the foreskin is thought to be very vulnerable to HIV), but this is one of the most extensive and high-profile trials ever to look at the true implications of the procedure.

Members of UNAIDS and the WHO were however cautious in welcoming the discovery, saying more trials need to be conducted before they can recommend it an HIV prevention measure. Circumcision may be routinely performed in some cultures, but in others it is unheard of, or even seen as undesirable. The dangers of such a delicate surgical procedure being offered by untrained individuals, also mean its practical use as a method of HIV prevention could be fraught with difficulties.

Also discussed at the conference was the problem of HIV and injecting drug use, which is becoming an increasingly common method of transmission in many parts of Asia and Eastern Europe. According to scientists, the epidemic appears to be following the route of the heroin trail from Afghanistan, through Central Asia and the former Soviet Union into Eastern Europe. In certain parts of Europe the number of people infected with HIV is growing more rapidly than in many African nations, and with few countries agreeing to legalise needle exchange and harm reduction programmes, the epidemic looks set to accelerate in the future.

The conference was summed up by Peter Piot, head of UNAIDS, who drew particular attention to the rapidly expanding epidemic in Asia and Eastern Europe, warning that that AIDS was "still an emerging epidemic. Just now we're getting into the globalization phase... Globalization isn't just for profits and markets, it is also for AIDS."

The next IAS conference will be the XVI International AIDS Conference set to be held in Toronto, Canada in August 2006. 

  (BBC.co.uk & Aidsmap.com, 24 - 27 July 2005)

Rate of infection down among gay San Francisco men

 San Francisco health officials may be revising their estimate on the number of new infections occurring in the city every year, after a study carried out by the CDC (Center for Disease Control) found that the spread of HIV was slowing.

Current estimates state that men in the city are becoming infected at a rate of 2.2 percent per year. However, the CDC study, which was based on the testing of a sample of 365 men recruited from a range of venues around the city, found that men were becoming infected at a rate of just 1.2 percent per year.

Surveys of infection rates at city clinics and information collected by the San Francisco based Stop AIDS Project have also demonstrated a clear downturn in infection rates in the area.

San Francisco, the city where AIDS was first identified, saw infection rates reach epidemic proportions in the 1980s. By 1988, half of the city's gay population was infected, with infection rates among the general population reaching 8.5 percent. There had been some concern in 2000 that a resurgence of the epidemic was going to push infection rates up to similar levels. However, it would now appear that this 'second wave' has peaked without the disastrous consequences some had predicted.

Mitch Kantz, city health director, has said that the most likely explanation for the fall are antiretroviral treatments that are lowering the level of virus in HIV positive men, making it harder for them to transmit HIV. The practice of 'sero-sorting' - choosing a partner of the same HIV status - may also have had an impact, as might the fact that of the 24 percent of positive men testing positive in the survey, 23 percent were already aware that they had the virus. People who know their status are far more likely to have received education on HIV transmission, and are therefore more likely to employ methods to prevent transmission of the virus to others.

  (San Francisco Chronicle, 20/07/05)

Shooting of AIDS protesters condemned

Forty members of the TAC were injured in the protests, ten of whom were treated for rubber-bullet wounds. The campaigners were believed to have been peaceful and unarmed, but eyewitnesses reported that police brutally attacked them and then opened fire unexpectedly. South African Law requires that police issue an audible caution if they are intent to use violence, but no such warning was given.

Less than ten people have been put on antiretroviral treatment in the Eastern Cape since the beginning of the year, and heated talks between the region's health department and South African AIDS activists have now been going on for over six months. In the metropolitan area of Queenstown, where the attacks took place, just 190 people are currently receiving drugs out of the 2000 that need them. Their cause is not helped by a National Health Minister who has questioned the safety, efficacy and need for antiretrovirals, and a President who has in the past cast doubt on the link between HIV and AIDS.

The TAC has started a petition calling for an investigation into the incident, which they have asked all sympathetic AIDS organisations to sign. At the time of writing, over 100 concerned groups and individuals from all over the world had added their names to the list.

For more on treatment and South Africa, please visit our AIDS in SA page, and our Treatment and Care section 

 (TAC Sign on Letter & allAfrica.com, 13.07.05)

Ugandan MP to offer scholarships to virgins

A member of the Ugandan parliament has offered to use government-funding to pay the university fees of any girl that can prove she is still a virgin when she graduates from high school.

Sulaiman Madada, MP for the county of Bbaale, hopes that by offering scholarships to virgins, it will encourage young girls to go to university, delay marriage and thus avoid HIV & AIDS.

However, the plan may have one flaw. To qualify, Mr Madada has suggested that all girls undergo a medical examination by a gynaecologist to confirm that they have never had sexual intercourse. But the standard gynaecological test for virginity (the presence of an intact hymen) is far from an exact science, and could lead to some young girls being denied a scholarship and wrongly labelled as promiscuous when they have in fact never had sex. It also discriminates against girls that may have been raped or sexually abused in childhood.

Uganda has courted controversy in recent months by redirecting the focus of its very successful anti-AIDS programme towards abstinence-until-marriage education, as opposed to the comprehensive ABC approach (Abstain, Be faithful, use a Condom) that saw HIV rates fall dramatically in the 1990s. Critics have commented that this approach could be counter-productive in the long run, as abstinence is virtually impossible to enforce, and is not therefore a guarantee that HIV will not be transmitted, even within marriage. 

AVERT.org has more on AIDS in Uganda

  (The Guardian, 20/07/05)

Thailand to provide treatment for all HIV+ citizens

Thailand is to begin offering antiretroviral treatment to all patients that need it for under $1 as part of the government's low-cost healthcare scheme.

At present, it is estimated that there are around 500,000 people living with HIV in Thailand, but only about 50% of those who need it are actually receiving treatment. From October, the government hope that this figure will rise to 100%.

Universal treatment has been made possible in Thailand because the country's Pharmaceutical Organisation has developed a one-a-day fixed-dose combination tablet of generic antiretroviral drugs, that makes therapy simple, cheap and easy to monitor. The country already exports the drugs to neighbouring nations, such as Cambodia, but now hopes to share the technology with several African countries as well.

Thailand is only the second high-prevalence country to implement a national antiretroviral drugs distribution plan. In 1996, Brazil introduced universal HAART access for all its positive citizens, resulting in a dramatic drop in AIDS deaths and a significant rise in life expectancy for those with HIV. It is hoped that the scheme in Thailand will have similar results. 

For more on Thailand and antiretroviral therapy, please visit our Thailand, Generics and ARV access pages.

  (BBC.co.uk, 14/07/05)

G8 make important commitments to Africa

The tragic terrorist bomb attacks in London may have diverted media attention away from Africa last week, but at the G8 conference in Gleneagles, the collective plight of continent's 800 million people remained front-page news.

Having very publicly made Africa one of two key priorities at the conference, Tony Blair was never going to allow the summit to end without some sort of positive press-friendly agreements being made. However, many protesters and activists taking part in the Make Poverty History campaign have been pleasantly surprised by the extent to which their demands were actually met. Their call for a doubling of aid will be acheived by 2010. The external debt of eighteen countries has been wiped out, with several more to follow. Trade, the most thorny issue, has even been addressed to a certain degree, with Mr Blair stating that discussions in Hong Kong later this year should produce an end date for the controversial EU agricultural subsidies. The agreements may not be one hundred percent perfect, but they are still more comprehensive and show more political will for change than many had thought possible.

For AIDS & HIV organisations, most notably those participating in the UK AIDS Consortium's STOP AIDS campaign, victory was especially sweet. In section 18 of the Gleneagles communiqué, the G8 leaders state that they will work "with WHO, UNAIDS and other international bodies to develop and implement a package for HIV prevention, treatment and care, with the aim of as close as possible [achieving] universal access to treatment to all those who need it by 2010." Campaigners had been concerned that the imminent failure of the 3 by 5 initiative (which aims to get three million people on treatment by the end of 2005) would mean the 'universal access by 2010' goal would be deemed too ambitious, and would be ignored.

Other important HIV & AIDS declarations included a guarantee to fully replenish the Global Fund to Fight AIDS, TB and Malaria this year and a commitment to continue exploring the possibilities for an African-based 'International Centre for Genetic Engineering and Biotechnology' that will research vaccines and cures for major diseases affecting the continent. Promises were also made to work with African partners to improve healthcare systems and implement the UN's '3 Ones' principles (One agreed HIV/AIDS Action Framework, One National AIDS Coordinating Authority and One agreed country-level Monitoring and Evaluation System) in all African nations.

The problems of climate change remain largely unresolved, and the promises made on Africa are of course only promises (as Tony Blair himself said, "We do not, simply by this communiqué, make poverty history.") But, rather refreshingly, it would seem that in terms of Africa at least, the weary pessimism that filled so many column inches in the run up to the G8 has largely been unjustified. Poverty may not yet have been made history, but history has probably been made.

  (BBC.co.uk, 09/07/05 and Gleneagles Communique)

Mandela calls for condom use as SA HIV infections rise

The former South African president, Nelson Mandela, has called for people to use condoms more consistently, and to wait until they are older before having sex in an effort to stop the spread of HIV.

"AIDS has spread because people have so many partners." he said while speaking at a Nelson Mandela Foundation press conference to introduce four new ambassadors to his 46664 HIV/AIDS awareness campaign. "People should use condoms and try to resist being with a partner until about 18 or 19 years old."

His statement came on the same day that new statistics were released suggesting between 6.29 and 6.57 million South Africans had been infected with HIV by the end of 2004. This represents over 13% of the population.

The new figures are taken from surveillance carried out in antenatal clinics by the country's health department. The method has been criticised in the past for exaggerating figures as it bases estimates on a select group (i.e. pregnant women) that are arguably more likely to have come into contact with HIV than other sectors of the population. The Department of Health however maintain that it is a far more accurate representation of the true levels of infection than the recent estimate of 4.5 million infections given by the government agency, Statistics South Africa.

Regardless of the true numbers infected however, the message from Mandela was clear: "No matter how beautiful your partner is - be it man or woman - a disease is a disease… People should use condoms… A lot of religions don't like the fact that we encourage the use of contraception, but that is the only way."

To find out more about HIV in South Africa, please visit our statistics and AIDS in SA pages. 

  (SABC News, 11/07/05 & The Guardian, 11/07/05)

UNAIDS confirms support for needle exchange

After weeks of tense debate, UNAIDS has finally released its new policy report on HIV prevention, and to the delight of many AIDS organisations, has come down firmly in favour of harm reduction strategies.

Harm reduction among injecting drug users (IDUs) is considered essential in preventing the spread of HIV and AIDS. Strategies such as needle exchange (whereby IDUs can exchange used needles for sterile ones) and supervised injecting rooms can have a major impact on reducing HIV transmission. However, they are controversial, and some countries such as the USA, object to their use, claiming that any strategy that accepts or 'aids' drug use will only cause a proliferation of the practice in the long term.

The USA has long been lobbying UNAIDS (and a number of other UN Agencies, including the Office on Drugs and Crime) to drop its support of harm reduction, and there were fears that the threat of reduced funding and support from America would force UNAIDS to capitulate. However, after vocal support from a number of high profile political figures (including the UK's International Development Minister, Gareth Thomas) officials at UNAIDS' recent board meeting in Geneva agreed to renew its pro harm reduction policy.

According the report, the organisation hope to reduce HIV prevalence amongst IDUs "by developing a comprehensive, integrated and effective system of measures that consists of the full range of treatment options, (notably drug substitution treatment) and the implementation of harm reduction measures (through, among others, peer outreach to injecting drug users, and sterile needle and syringe programmes).

The message about the importance of harm reduction got a further boost this week after Iran, one of the most religious and staunchly conservative countries in the Middle East, dropped its zero tolerance policy on heroin use, and replaced it with a comprehensive programme of needle exchange and methadone substitution. It is hoped the government's actions will not only slow the rapid rise in HIV amongst the ever growing number of IDUs in the country, but set an important example for other Middle Eastern nations to follow. 

More information about harm reduction and injecting drug use can be found on the International Harm Reduction Association's website

  (The Guardian, 28/06/05 & UNAIDS policy report, July 2005)

Botswana disputes US treatment claims

Frequently hailed as having the most comprehensive HIV and AIDS programme in Africa, the government of Botswana is naturally proud of its efforts to combat the disease. It was therefore somewhat dismayed to hear President's Bush's PEPFAR officials declaring back in January that 32,839 Batswana had been put onto ARV treatment thanks to US government funding. According to most HIV & AIDS workers in the country, such a figure is a total distortion of the facts; the overwhelming majority, if not all HIV+ people on treatment in Botswana are receiving drugs as a result of government investment and a partnership scheme known as ACHAP.

PEPFAR treatment 'successes' have been controversial ever since the programme was first introduced in 2002. Official guidance states that any treatment scheme that has received 'significant support' from the US government should be included in treatment numbers. However just what constitutes 'significant support' is unclear. In the annual PEPFAR report released in March, the Bush administration stated that it was anything involving general 'system strengthening'. Such a category is so broad, that virtually any US activity in the country could be classed as having helped to get people on ARVs, even if there is no real link apparent. The head of the Botswana PEPFAR scheme, Peter H. Kilmarx, admitted that even something as minor as the editing of a government official's speech could be construed as system strengthening, but he added that although the system could potentially be abused, nobody had ever done so.

The Botswana government is not solely responsible for the high numbers of people on treatment in the country: their far-reaching and ambitious plans have received support from a variety of foundations and charities, most notably through a public/private partnership known as ACHAP (The African Comprehensive HIV/AIDS Partnership). This partnership between the government, the Bill and Melinda Gates Foundation and the pharmaceutical company Merck has been vital in Botswana's success. The Gates Foundation has helped to build a number of clinics and treatment centres, Merck has donated a substantial amount of ARV drugs, and the government has been responsible for the co-ordination and funding of everything else.

PEPFAR on the other hand spent just $2.5 million dollars on "treatment" in Botswana last year (about one-twentieth of the amount invested by the government) and most of this is believed to have been spent on monitoring the existing government programme and training new doctors. None was actually used to buy drugs or set up treatment centres. Yet despite this, and the anger surrounding the remarkably high January figures, officials decided to cause further outcry in May by trying to increase their PEPFAR-funded treatment statistics to 41,444 - a figure that included every single person on treatment in the country. Even for PEPFAR this was apparently stretching things too far however, and in the latest update (see "Bush announces PEPFAR treatment plan success" below), numbers had been toned down to just 20,000. Nobody has any idea how PEPFAR came up with the new lower figure, but many suspect it was decided upon arbitrarily to appease AIDS groups and the Botswana government.

For the thousands of Batswana receiving drugs, the source of their treatment is of relatively little consequence - a dose of ARVs paid for by the government is after all the same as a dose paid for by PEPFAR. But as a matter of national pride, many do feel anger over the US's apparent attempt to steal their glory. At a time when so few positive stories seem to be coming out of Africa, they want their government to be recognised as a success in its own right, something they say can never happen if the US persist in unjustifiably portraying themselves as Botswana's saviours.

AVERT.org has more on both PEPFAR and Botswana

  (The Washington Post, 01/07/05)