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1514AIDS in Africa

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  • Bell, Elizabeth
    Jul 11, 2000
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      "Preventing Infections With Today's Tools"
      Science (www.sciencemag.org) (06/23/00) Vol. 288, No. 5474, P.
      2161; Cohen, Jon
      Without an AIDS vaccine, Africa must rely on other HIV prevention
      methods. Frank Plummer of the University of Manitoba's research
      program in Kenya recommends six interventions, including bottle
      feeding babies and male circumcision. However, implementing
      these behaviors and educating the public is difficult, and has
      been slow. Plummer's team has worked with sex workers in Nairobi
      to show that intervention can help the most at-risk groups. A
      1991 study by Plummer and colleagues found that peer education,
      HIV testing, counseling, and sexually transmitted disease (STD)
      treatments can prevent up to 10,000 new HIV cases a year.
      Stephen Moses and Plummer also discovered that male circumcision
      lowers the risk of HIV, but cultural differences keeps many from
      choosing the option. Two conflicting studies address the
      relationship between sexually transmitted diseases and the risk
      of HIV. A 1995 study from Tanzania found that people treated for
      STDs had fewer HIV infections. However, a Ugandan study found no
      relationship between STD treatment and HIV rates. Scientists
      agree that treating STDs is necessary for good health, but more
      active preventions are needed to stop HIV.

      "Africa Boosts AIDS Vaccine R&D"
      Science (www.sciencemag.org) (06/23/00) Vol. 288, No. 5474, P.
      2165; Cohen, Jon
      In Hlabisa, in the Kwazulu-Natal Province of Africa, almost 40
      percent of pregnant women have HIV; just 10 years ago, none
      tested positive. Hlabisa has become a prime spot to test HIV
      vaccines, including those in development by the International
      AIDS Vaccine Initiative (IAVI), led by Seth Berkley. IAVI has
      granted $4.5 million for the next three years to test vaccines in
      South Africa, Kenya, and Uganda. Ethical standards require that
      testing these vaccines is conducted with volunteers who
      understand the risks and how to avoid infection. This is
      difficult in a poorly educated land that has low-income citizens.
      Guidelines for AIDS vaccine tests mandate that testers not take
      advantage of vulnerable populations. The Council for
      International Organizations of Medical Sciences (CIOMS) calls for
      "equitable distribution" of a successful vaccine at an affordable
      price. Peggy Johnston of the NIH's AIDS vaccine program believes
      these requirements will not be enough to allow community access
      to a vaccine. Researchers have not yet found a perfect vaccine,
      but even a 60 percent effective vaccine will save twice as many
      lives if created today rather than in a few years. A study of
      sex workers outside Nairobi, Kenya, has led to some startling
      results. They show that certain prostitutes who are repeatedly
      exposed to HIV have no sign of infection. A woman named Agnes
      Monifa has sex up to 10 times a day and remains uninfected,
      perhaps due to her white blood cells' power. Discouraging news
      came near the end of the trial when 10 of the 80 uninfected sex
      workers contracted HIV after stopping sexual behavior. This
      means that natural immunity may be caused by repeated stimulation
      from HIV, a difficult behavior to copy in a vaccine. A vaccine
      is needed to treat strains other than subtype B, which is common
      in Europe and the United States. Seth Berkley knows that a
      vaccine would be embraced by the people of Hlabisa if only one
      can reach final testing phases.


      "AIDS in Africa Is Reshaping Whole Populations, Study Says"
      USA Today (www.usatoday.com) (07/11/00) P. 1A; Sternberg, Steve
      A new report from the U.S. Census Bureau indicates that the AIDS
      epidemic will significantly affect life expectancy in Africa over
      the coming years. By the year 2010, study author Karen Stanecki
      concluded, life expectancy will be 29 in Botswana, 30 in
      Swaziland, and 33 in Namibia and Zimbabwe. Life expectancy would
      have been about 70 without AIDS. Stanecki also noted there would
      negative population growth in Botswana, South Africa, and
      Zimbabwe, versus 2 percent to 3 percent population growth in each
      of those nations without AIDS. The study suggested that AIDS
      will affect entire populations, take the lives of whole
      communities, and could spur the migration of many men to seek
      available women. The Centers for Disease Control and
      Prevention's Kevin DeCock stated that the AIDS epidemic is
      "Africa's worst social catastrophe since slavery."

      "Circumcision Debated in Control of AIDS"
      Washington Post (www.washingtonpost.com) (07/11/00) P. A17;
      Brown, David
      Research presented at the 13th International AIDS Conference
      in Durban, South Africa, on Monday discussed the relationship
      between male circumcision and HIV infection. Several studies
      have shown that uncircumcised men are two to eight times more
      likely to be infected with HIV than circumcised men. Daniel T.
      Halperin, an AIDS researcher at the University of California at
      San Francisco, noted that even if the low numbers in those
      studies are correct, almost 50 percent of the infections in men
      in some high-prevalence nations could be "attributable" to not
      being circumcised. However, data from a study of men in the
      Rakai District of Uganda suggests that such conclusions can be
      complicated. A total of 17 percent of the men in Rakai are
      circumcised, with a 99 percent rate among Muslims and a 4 percent
      rate among non-Muslims. While the overall infection rate among
      circumcised men is about half that of the uncircumcised men, in
      the subgroup of circumcised non-Muslims, there is little effect
      on risk. The results indicate that religion could be a
      protective factor, perhaps because Muslim men may have fewer
      casual sex partners since they can have more than one wife, or
      because religious instruction emphasizes frequent washing, which
      could reduce viral transmission.

      "Vaccine Targeting HIV in Africa to Begin Human Tests This
      Wall Street Journal (www.wsj.com) (07/11/00) P. B1; Waldholz,
      Researchers are expected to announce today details of HIV
      vaccine trials set to begin later this summer. First, 18 healthy
      volunteers in Britain will be used to test the safety of the
      vaccine and to determine whether it can generate the kind of
      immune system response that has helped to protect a small group
      of Kenyan women from HIV infection. The vaccine, developed by
      researchers from Oxford University and the University of Nairobi
      with funding from the International AIDS Vaccine Initiative, is
      designed to fight an HIV strain that is common in Africa.
      According to the researchers, the vaccine is made up of genetic
      material that prompted a T-cell response in animal tests and
      which is attached to a weakened version of an animal virus; it
      also includes a gene removed from HIV that is thought to generate
      a killer T-cell response.

      "Cheap Antibiotics Seen Helping HIV Patients"
      Reuters (www.reuters.com) (07/11/00); Fox, Maggie
      Researchers from the Centers for Disease Control and Prevention
      have concluded that inexpensive antibiotics may be useful in
      preventing HIV-infected individuals in Africa from developing
      AIDS, even if access to potent antiretroviral therapy is limited.
      Led by Dr. Mark Dworkin, the researchers tested the antibiotic
      trimethoprim-sulphamethoxazole--which is used in the United
      States to preventing Pneumocystis carinii pneumonia (PCP)--and
      found that it was effective against a number of diseases. The
      researchers noted that while the cheap drug did not affect
      viruses and could not control HIV, it was effective against
      several opportunistic infections that affect HIV patients. The
      drug, sold under the names of Bactrim and Septra, lowered the
      risk of PCP by 40 percent, of toxoplasmosis by 30 percent, and of
      salmonella by 60 percent.

      "Africa Reacts Coolly to German AIDS Drug Offer"
      Reuters (www.reuters.com) (07/08/00); Sithole, Emelia
      Boehringer Ingelheim's announcement that it would provide
      its Viramune AIDS drug at no charge for five years was met with
      wariness from Southern Africa Development Community health
      ministers, who are worried about the terms of the agreement since
      they were not consulted on the offer. Based on data from a study
      published in the medical journal The Lancet, up to 110,000 HIV
      infections of newborns caused by mother-to-child transmission
      could be prevented in the next five years if all pregnant women
      in South Africa alone received treatment. The international
      medical charity Medecins Sans Frontieres noted that while
      manufacturers are likely to make such announcements at the world
      AIDS conference, more action is required. Other concerns remain,
      including the fact that the drug has not yet been approved in
      South Africa, although results of a study of the drug in South
      Africa and Uganda are slated for release at the Durban
      conference, and the fact that benefits of the drug become negated
      if the infected mother breast-feeds the infant, a common practice
      in South Africa.

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