Africa: Daily HIV/Aids Report

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Kaisernetwork.org (Washington, DC)

18 May 2007
Posted to the web 18 May 2007


Global Challenges

Gates Foundation Gives Glaser Foundation $9.7M for Research on Pediatric HIV Vaccines; Research To Focus on Breast-Feeding Infants


[May 18, 2007]

The Bill & Melinda Gates Foundation has awarded the Elizabeth Glaser Pediatric AIDS Foundation a five-year, $9.7 million grant to research and develop experimental HIV vaccines aimed at children, Glaser Foundation President and CEO Pamela Barnes announced Friday on HIV Vaccine Awareness Day, the AP/Houston Chronicle reports. The research will focus on preventing mother-to-child transmission of the virus through breastmilk, according to the Glaser Foundation. The grant will fund eight research studies and up to three pediatric clinical trials of HIV vaccines previously tested among adults. Barnes said nearly 14% of all new HIV cases worldwide occur among infants who contract the virus from their mothers, most of whom rapidly develop AIDS because they lack treatment access (Gordon Blankinship, AP/Houston Chronicle, 5/18). The preclinical research studies will examine issues related to HIV transmission through breastmilk and pediatric immunity.

Researchers have found that an effective vaccine, provided shortly after birth, would not only protect an infant from contracting HIV while breast-feeding but also could offer long-term or even life-long immunity from the virus, according to the Glaser Foundation. The protective vaccine then would allow HIV-positive mothers to safely breast-feed for an extended period of time, providing infants in resource-poor settings with nutritional and basic health benefits. \"We are profoundly grateful to the Gates Foundation for recognizing the special needs of children in the fight against AIDS,\" Barnes said, adding, \"Children have been virtually absent from HIV vaccine research despite having the most to gain from such a discovery.\" According to Barnes, it is \"absolutely vital that we start to include children in HIV vaccine research, or we may miss important discoveries that only pediatric research could reveal.\"

According to the Glaser Foundation, to date there have been two HIV vaccine trials aimed at preventing mother-to-child HIV transmission, either during childbirth or through breast-feeding (Glaser Foundation release, 5/18). The Glaser Foundation has helped pay for 41 studies related to pediatric HIV/AIDS research since 1988. According to the AP/Chronicle, the Gates Foundation grant nearly equals all the funds the Glaser Foundation spent on HIV/AIDS research from 1988 and 2007 (AP/Houston Chronicle, 5/18).

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Sex Education Bans Hinder India's Efforts To Curb Spread of HIV, NACO Official Says

[May 18, 2007]

Banning sex education in Indian schools hinders the country's efforts to fight the spread of HIV, National AIDS Control Organisation Director-General Sujatha Rao said on Wednesday, Reuters reports (Zaheer, Reuters, 5/17). Recent attempts by the Indian government to promote sex education in schools have caused a debate between some educators who say that sex education will reduce the spread of HIV and opponents who say it will corrupt young people. India's government wants the country's 29 states and seven federally administered regions to fight the spread of HIV by promoting knowledge about safer-sex practices.

The governments of Gujarat, Madhya Pradesh and Maharashtra have banned sex education in public schools, saying that the education modules are too explicit and that some photographs are too graphic. The southern states of Karnataka and Kerala also are considering bans (Kaiser Daily HIV/AIDS Report, 5/15). According to Reuters, Chhattisgarh also will not implement a sex education curriculum.

\"There will be a huge negative impact if you don't provide sex education, given the vulnerability of young people\" to HIV/AIDS, Rao said in a speech to members of parliament. Her comments come one day before NACO plans to present to the Cabinet its HIV/AIDS prevention plan that requests about $2 billion in government funding through 2012, Reuters reports. India has recorded 165,000 AIDS cases, about 50,000 of which occur among people ages 15 to 29. \"Some people are in denial that young people experiment with sex,\" Rao said, adding, \"They need to get real.\" NACO's HIV/AIDS plan will focus on prevention and increasing the number of people with access to first-line antiretroviral drugs (Reuters, 5/17).

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Public Health & Education

HIV Screening in Hospital EDs Might Be More Cost Effective Than Other Screening Methods, Study Finds

[May 18, 2007]

Conducting routine HIV tests in hospital emergency departments was shown to be cost effective and \"welcomed\" by many patients, according to a study conducted by researchers at the George Washington University School of Medicine and Health Sciences, HealthDay News/Washington Post reports. For the study, Jeremy Brown, research director at GWU's emergency medicine department, and colleagues offered rapid HIV tests to 4,000 ED patients, 2,500 of whom agreed to be tested. The study found that 1% of the patients who agreed to be tested, or 26 people, had preliminary positive results for HIV.

According to HealthDay News/Post, the Washington, D.C., Department of Health provided the rapid screening kits at no cost, and the researchers administered the tests and analyzed the data. Brown said that the approach would not be feasible in the long term but added that the study's findings suggest some models for ongoing HIV testing programs in EDs. The cost per preliminary positive result was about $1,700, and the cost per confirmed HIV case was about $4,900 -- lower than other early detection methods -- such as the nucleic acid amplification testing method, which costs $17,000 per case -- Brown said. \"Washington, D.C., has one of the highest AIDS case prevalence rates in the United States, and our results suggest that ED HIV screening in this high prevalence area is well accepted by patients,\" Brown added. The study was scheduled to be released Thursday in Chicago at the annual meeting of the Society for Academic Emergency Medicine, HealthDay News/Post reports (HealthDay News/Washington Post, 5/16).

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Opinion

Experimental HIV Vaccines Likely Will Offer Limited Immunity, Might Delay Onset of AIDS, Commentary Says

[May 18, 2007]

Many of the most promising experimental HIV vaccines in development will offer only limited immunity against the virus but might delay the onset of AIDS, Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, and Margaret Johnston of NIAID write in a New England Journal of Medicine commentary, AFP/Yahoo! News reports. The commentary was published ahead of HIV Vaccine Awareness Day, which is May 18.

Although the first generation of HIV vaccines likely will not prevent HIV infection, they might protect HIV-positive people's immune systems from the \"worst ravages\" of the disease and delay the onset of AIDS, according to AFP/Yahoo! News. The vaccines also are potential tools for public health authorities trying to contain the HIV/AIDS pandemic because vaccines can potentially reduce viral loads in HIV-positive people, therefore reducing their ability to transmit the virus to others (Daly, AFP/Yahoo! News, 5/16).

According to studies of HIV in humans and animal models, experimental vaccines that induce strong responses from CD4+ T cells \"in the absence of broadly neutralizing antibodies may prove beneficial even if infection is not completely prevented,\" Fauci and Johnston write. They add that the vaccines might \"prevent the early and massive destruction of memory CD4+ T cells that help control infection and prolong disease-free survival.\" In addition, \"secondary transmission may also be reduced if the vaccine helps to control viral replication,\" the authors write (Johnston/Fauci, NEJM, 5/17).

According to Fauci and Johnston, some animal studies indicate peak viral loads were reduced by a factor of 10 in primates that were inoculated with these types of vaccines and then infected with the simian counterpart of HIV. The inoculations also \"dramatically\" slowed the progression of the disease in many animals, the authors write. They add that although it is not clear when the first vaccines will be available, Phase I and II clinical trials are \"well into their execution\" and large \"numbers of people are being vaccinated.\" While these new vaccines likely will offer only limited immunity, there is \"optimism that even a less-than-perfect vaccine could benefit both individual recipients and the at-risk community,\" Fauci and Johnston write (AFP/Yahoo! News, 5/16).

The commentary is available online.

The San Francisco Chronicle on Friday also ran an opinion piece by Fauci and Johnston on experimental HIV vaccines. The opinion piece is available online.

Newspapers Respond to HIV Vaccine Awareness Day

Two newspapers recently published opinion pieces to mark HIV Vaccine Awareness Day. Summaries appear below.

Patricia Thomas, Atlanta Journal-Constitution: Former President Clinton 10 years ago \"challenged America to develop a vaccine to prevent AIDS within the next decade,\" and \"thousands of people will come together\" on HIV Vaccine Awareness Day to \"see how far we've progressed toward a vaccine that is effective and safe,\" Thomas -- Knight Chair in Health and Medical Journalism at the University of Georgia's Grady College of Journalism and Mass Communication -- writes in a Journal-Constitution opinion piece. According to Thomas, \"Only a preventive vaccine can halt the spread of AIDS, and only large clinical trials can determine which of the candidates in the pipeline will work\" (Thomas, Atlanta Journal-Constitution, 5/18).

Omu Anzala and Walter Jaoko, Kenya's Nation: HIV Vaccine Awareness Day is a \"day to renew our commitment to the discovery of technologies to halt HIV/AIDS\" and \"is an appropriate time for us to rededicate ourselves to the cause\" of ending AIDS, Anzala and Jaoko, both of the University of Nairobi's Department of Medical Microbiology, write in a Nation opinion piece. \"Although an effective, accessible AIDS vaccine continues to elude us, we can be proud of the leadership role Kenya has played in supporting AIDS vaccine research and development,\" Anzala and Jaoko write. \"The search for an AIDS vaccine is a long and difficult process that requires time and single-minded persistence,\" the authors write, adding that it also requires \"[l]ong-term political support and commitment, financing, education and global cooperation\" (Anzala/Jaoko, Nation, 5/17).

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