Challenging parental consent laws to increase young people’s access to vital HIV services

http://www.unaids.org/en/resources/presscentre/featurestories/2014/july/20140723youth/

There remain serious challenges in reaching the world’s adolescents with HIV, sexual and reproductive health and harm reduction services. The situation is especially worrying given that this is the only age group in which AIDS-related deaths are increasing, and AIDS-related deaths are the number two contributor to global adolescent mortality.

A session at the International AIDS Conference in Melbourne, Australia, on 23 July explored one of the key barriers preventing young people from accessing interventions: the need for parental consent before they are allowed to benefit from services such as HIV counselling and testing and needle–syringe programmes. The session heard that in sub-Saharan Africa, for example, at least 33 countries had age-based or other specific criteria for consenting to HIV testing and counselling.

While acknowledging that parents, guardians and the state have an obligation to protect young people from harm, participants discussed adolescents’ evolving capacity to independently consent to accessing potentially life-saving programmes. Daniel McCartney, of the International Planned Parenthood Federation and a member of the pact for social transformation, a coalition of 26 youth-led organizations, supported by UNAIDS, presented the findings of a global online youth survey on parental consent laws and requirements at the session.

It was found in the survey that 72% of respondents said laws requiring parental consent were not a good way of involving their parents in decision-making about their sexual and reproductive health and harm reduction. Thirty-eight per cent said that they have not always been able to access relevant services without restrictions when they needed them, a situation that left them feeling discriminated against and disempowered.

Participants agreed to use the results of the survey to advocate for countries to review their policies on age-related legal, regulatory and social barriers to specific health services and to strive to ensure that young people feel empowered and in charge of their own sexual health and well-being.

Quotes

"Young people need harm reduction services. But parental consent remains a major barrier to access needle–syringe programmes for young people."

Anita Krug, Youth RISE

"My parents accepted my sexual orientation and my HIV status, but many young people are not that lucky."

Gautam Yadav, Youth Voices Count

"The journey to the end of the AIDS epidemic is a journey to inclusion and social justice."

Luiz Loures, UNAIDS Deputy Executive Director

"In order to facilitate access to services we need a better understanding of what are the barriers that exist in order to remove them."

Aram Barra, Espolea

UNAIDS Strategy 2011-2015

http://www.unaids.org/en/aboutunaids/unaidsstrategygoalsby2015/

The UNAIDS strategy aims to advance global progress in achieving country set targets for universal access to HIV prevention, treatment, care and support and to halt and reverse the spread of HIV and contribute to the achievement of the Millennium Development goals by 2015.

Adopted by the Programme Coordinating Board in December 2010, the strategy works to position the HIV response in the new global environment. The AIDS response is a long term investment and the intent of the strategy is to revolutionize HIV prevention, catalyse the next phase of treatment, care and support, and advance human rights and gender equality.

UNAIDS strategy goals by 2015:

• Sexual transmission of HIV reduced by half, including among young people, men who have sex with men and transmission in the context of sex work
• Vertical transmission of HIV eliminated, and AIDS-related maternal mortality reduced by half
• All new HIV infections prevented among people who use drugs
• Universal access to antiretroviral therapy for people living with HIV who are eligible for treatment
• TB deaths among people living with HIV reduced by half
• People living with HIV and households affected by HIV are addressed in all national social protection strategies and have access to essential care and support
• Countries with punitive laws and practices around HIV transmission, sex work, drug use or homosexuality that block effective responses reduced by half
• HIV-related restrictions on entry, stay and residence eliminated in half of the countries that have such restrictions
• HIV-specific needs of women and girls are addressed in at least half of all national HIV responses
• Zero tolerance for gender-based violence

The UNAIDS strategy is a roadmap for the Joint Programme with concrete goals marking milestones on the path to achieving UNAIDS’ vision of “Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths.”

The strategy will be underpinned by a new Unified budget and accountability framework. The framework will operationalize the strategy, mobilize and allocate resources for its implementation, measure progress and report on results.

Ending the AIDS epidemic: a new target for HIV treatment

http://www.unaids.org/en/resources/presscentre/featurestories/2014/july/20140720treatment/

At a high-level political session on the opening day of the 20th International AIDS Conference, UNAIDS Executive Director Michel Sidibé called for a new set of treatment targets by 2020. These include that 90% of all people living with HIV know their HIV status, 90% of all people with diagnosed HIV infection receive HIV treatment and 90% of all people receiving HIV treatment have durable viral suppression.

These new targets will reflect a new paradigm for HIV treatment: targets for each stage of the treatment continuum, rather than a single number of people who initiate treatment; recognition not only of the life-saving therapeutic benefits of HIV treatment, but also its prevention potential; and a commitment to leave no one behind in the push to link all people living with HIV to treatment services.

Participants in the session included Mr Sidibé; the United States Global AIDS Coordinator, Deborah Birx; the Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Mark Dybul; the Executive Director of the Global Network of People Living with HIV, Suzette Moses-Burton; the Minister of Health, South Africa, Aaron Motsoaledi; and the Vice-Minister of Health and Surveillance, Brazil, Jarbas Barbosa.

They reviewed progress made in scaling up HIV treatment and explored issues surrounding the new treatment targets, such as how they can be integrated into the post-2015 development agenda and how the necessary treatment scale-up might be financed. It was recognized that new business models and partnerships are required to achieve the goal of accelerated treatment delivery for all people in need.

Civil society activists made a statement at the beginning of the meeting demanding the target of complete suppression of HIV for all people living with HIV by 2020.

Quotes

"The potential of HIV treatment needs to be leveraged to save peoples’ lives and stop this epidemic."

Michel Sidibé, UNAIDS Executive Director

"If we focus where the infections are happening by geography and population we can get to control the epidemic."

Mark Dybul, Executive Director, Global Fund to Fight AIDS, Tuberculosis and Malaria

"It is unacceptable that millions of people don’t have access to diagnostics and HIV treatment."

Jarbas Barbosa, Vice-Minister of Health and Surveillance, Brazil

"The closer we get to communities, the better the outcomes. Subnational data would allow us to use the dollars in the most effective way."

Deborah Birx, United States Global AIDS Coordinator

"The retargeting discussions should not be limited by financial and funding possibilities: we should start from real demands from the ground. The question is not how can we do it. The question is—how can we not?" 

Aaron Motsoaledi, Minister of Health, South Africa

The red ribbon

http://www.worldaidsday.org/the-red-ribbon.php

30 years after the first cases of HIV – the red ribbon is the universal symbol of awareness and support for those living with HIV. The red ribbon was the first ever ribbon symbol, inspiring later versions such as the pink ribbon for breast cancer awareness.

Where did the idea come from?

In 1991 – a decade after the emergence of HIV – a group of 12 artists gathered to discuss a new project for Visual Aids; a New York arts organisation that raises awareness of HIV. They were photographers, painters, film makers and costume designers, and they sat around in the shared gallery space in New York's East Village.

After a short brainstorm they had come up with a simple idea that later became one of the most recognised symbols of the decade - the red ribbon, worn to signify awareness and support for people living with HIV.

Why did we need a symbol?

When the artists sat down to work on this project, their aim was to get people talking about HIV. This was during a time where HIV was highly stigmatised and people living with HIV were suffering behind closed doors, some too scared to even tell their loved ones they were living with the virus. The artists wanted to create a visual expression of compassion for people living with, and affected by, HIV.

The artists were inspired by the yellow ribbons tied on trees to denote support for the US military fighting in the Gulf War. Pink and the rainbow colours were rejected because they were too closely associated with the gay community, and they wanted to convey that HIV went beyond the gay community and was relevant to everyone.

Red was chosen as it is bold and visible – symbolising passion, a heart and love. The shape was chosen simply because it was easy to make and replicate – anyone can make one by just cutting out a piece of ribbon, looping it around your finger and pinning it on.

How did the red ribbon become so well known?

In the early days, the artists made the ribbons themselves and distributing them around the New York art scene and dropped them off at theatres. Initially there was a text that went with it, to explain why they were being worn, but eventually this was dropped as its symbolism no longer needed an explanation.

Within weeks of the red ribbon idea being born, world-famous actors starting wearing the red ribbon to high-profile award ceremonies such as the Oscars and talking about why it was important. The media also cottoned on, and within a short space of time the red ribbon symbol became universally recognised.

At the Freddie Mercury Tribute Concert held at London's Wembley Stadium on Easter Sunday 1992, more than 100,000 red ribbons were distributed among the audience, with performers such as George Michael wearing one. The Red Ribbon continues to be a powerful force in the efforts to increase public awareness of HIV.

CDC Releases Guidelines About Medications to Prevent HIV Infection

http://newsatjama.jama.com/2014/05/16/cdc-releases-guidelines-about-medications-to-prevent-hiv-infection/
BY JILL JIN, MD, MPH


The CDC has released its first set of comprehensive guidelines for preexposure prophylaxis (taking a daily pill that contains 2 anti-HIV drugs) for the prevention of HIV infection in high-risk individuals. Image: Gilead.

Physicians should consider prescribing antiretroviral medication to individuals who are not infected with HIV but are at high risk of infection, according to a new set of comprehensiveguidelines released this week by the US Centers for Disease Control and Prevention (CDC).

This approach, called preexposure prophylaxis, involves individuals who are not infected with HIV taking daily antiretroviral (anti-HIV) medications to prevent infection. Numerous clinical studies have shown this approach to dramatically reduce the chance of HIV infection in certain high-risk groups, such as men who have sex with men, people who are HIV negative but are in an ongoing relationship with a partner who is HIV positive, and people who use injection drugs.

In July 2012, the US Food and Drug Administration approved daily tenofovir/emtricitabine (Truvada), a pill that combines 2 anti-HIV medications, for preexposure prophylaxis in the United States. Now, the CDC has released recommendations to advise clinicians on which individuals may be considered candidates for this treatment. These include:

• Individuals who are in an ongoing relationship with a partner known to be infected with HIV
• Gay or bisexual men who have had sex without a condom or have been diagnosed with a sexually transmitted infection within the past 6 months
• Heterosexual men or women who have a high number of sexual partners, do not regularly use condoms, or have partners known to be at risk for HIV
• People who use injection drugs
• Commercial sex workers

Individuals taking Truvada to prevent HIV infection should be tested every 3 months to make sure they do not have HIV because Truvada alone is not the ideal treatment for known HIV infection. And importantly, preexposure prophylaxis should not take the place of other HIV prevention strategies, such as condom use, HIV counseling, and screening and treatment for other sexually transmitted diseases.

Researchers are studying the use of preexposure prophylaxis for adolescents and pregnant women, because evidence for its safety and effectiveness in these groups is much more limited. Current recommendations suggest that offering preexposure prophylaxis to these groups should be considered on an individual basis, with careful weighing of the risks and benefits.

The CDC also has information on the use of postexposure prophylaxis, which involves taking 4 weeks of antiretroviral therapy to prevent HIV infection after an event during which HIV exposure may have occurred, such as an accidental needlestick injury in a health care worker.

Soy Sauce Molecule Could Treat HIV—Better

http://www.newser.com/story/186484/soy-sauce-molecule-could-treat-hiv-better.html
Kate Seamons

(NEWSER) – Picture the soy sauce bottle on most sushi restaurant tables, yep, the one with the red or green top. Those omnipresent bottles are the product of the Yamasa Corporation, which started manufacturing the soy sauce in 1645. But the most fascinating part of the Japan company's history is a thoroughly recent one: Virologists have confirmed that Yamasa's scientists did indeed make a discovery involving a molecule related to flavor enhancers contained in soy sauce—and HIV. Vocativ reports that Yamasa in 1988 established a division of food scientists who were tasked with carrying out research on how the immune system responds to a variety of chemicals in food; in 2001, they announced a big find: that the molecule, EFdA, could possibly be used in treatment of HIV.

That's because EFdA, along with eight HIV drugs on the market, belongs to a family of compounds that help prevent HIV replication, explains the University of Missouri, whose virologists researched Yamasa's findings and this week confirmed them. But the issue with some of those drugs—the researchers single out the commonly used Tenofovir—is that patients develop resistance to them and then need to step up to a more powerful drug. But as Missouri researcher Stefan Sarafianos found, EFdA "is less likely to cause resistance" because it's activated more readily and doesn't break down in the liver and kidneys as rapidly as similar drugs. His lab has discovered it "works 10 times better than on wild-type HIV that hasn’t become Tenofovir resistant" and it works even better—70 times better—on HIV that has grown resistant to Tenofovir. Sarafianos has teamed up with Merck to test potential new drugs.

Study Gives Hope of Altering Genes to Repel H.I.V.

http://www.nytimes.com/2014/03/06/health/study-gives-hope-of-altering-genes-to-repel-hiv.html
By DENISE GRADY


Jay Johnson of Philadelphia took part in research involving gene editing, which zeros in on a particular gene and disables it. CreditJessica Kourkounis for The New York Times

The idea of genetically altering people’s cells to make them resist the virus that causes AIDS may seem like a pipe dream, but a new report suggests it can be done.

The research involves the first use in humans of “gene editing,” a treatment that zeros in on a particular gene and disables it.

In 12 people infected with H.I.V., scientists used the technique to get rid of a protein on the patients’ immune cells that the virus must latch onto to invade the cells. Cells were removed from the patients, treated and then dripped back into their bloodstreams through an intravenous line.

In theory, if enough cells could be engineered to repel the virus, patients might no longer need antiviral drugs, and might in effect be cured.

In theory, if enough cells could be engineered to repel the virus, patients might no longer need antiviral drugs, and might in effect be cured.

The experiment was a pilot study, meant to test safety, not efficacy. It found that immune cells could be altered, and that doing so did not harm patients. The gene editing also seemed to help fight the infection in some cases, but the findings are preliminary and researchers cautioned that widespread use of the technique is a long way off.

“It’s a great strategy,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, who was not involved in the research. “It’s exciting, interesting, elegant science. But a lot of ‘ifs’ need to be addressed before you can say ‘Wow, this could really work.’ ”

Dr. Fauci also questioned whether patients would want this relatively complex treatment when many people can keep the infection under control with just one to a few pills a day.

An article about the study is being published on Wednesday in The New England Journal of Medicine, by researchers from the University of Pennsylvania, the Albert Einstein College of Medicine in New York and Sangamo BioSciences, a company in Richmond, Calif., that makes the gene-editing product.

The study has its roots in something that scientists discovered in the 1990s: A small percentage of people are resistant to H.I.V. thanks to a lucky mutation that causes their immune cells to lack CCR5, a protein that gives the virus a foothold. In people with one copy of the mutated gene, the infection progresses more slowly than in those who have normal CCR5. People who have inherited two copies of the mutated gene, one from each parent, are highly resistant to H.I.V. and may never become infected despite repeated exposure.

One man, known as “the Berlin patient,” was apparently cured of AIDS after he developed leukemia and had bone-marrow transplants in 2007 and 2008. As luck would have it, his bone-marrow donor had two copies of the mutated gene for CCR5. His immune system rebounded, the virus disappeared and he was able to stop taking antiviral drugs. But bone-marrow transplants are too arduous, risky and expensive to be used as a treatment for H.I.V.

Dr. Carl June, the senior author of the study and an expert in AIDS and cancer at the University of Pennsylvania, said gene editing may offer another way to achieve the same result.

He said the approach was worth considering because many patients dislike the antiviral drugs and experience side effects, and because lifelong treatment can cost $1 million in the United States. Gene editing could be cheaper, he said.

One scientific advance had a big role in making researchers consider even trying to engineer H.I.V. resistance: the development of a powerful molecular tool, zinc-finger nucleases, enzymes that can cut DNA at specific sites. When the cell tries to repair such a cut, it often makes mistakes, disabling that particular gene.

At first, he doubted that the technology would ever be useful for humans, but he began trying it out in mice, and was surprised by how well it worked.

“It’s incredible,” Dr. June said. “This tool can target any gene you desire.”

He and his team began testing the technique in people with H.I.V. in 2009. The 12 patients were given infusions of about 10 billion of their own CD4 T-cells, which had been treated to disable the CCR5 gene. The technique disabled the gene in 11 percent to 28 percent of the treated cells.

Six of the patients then stopped taking antiviral drugs. In most, their H.I.V. levels went up and their immune cells diminished. But the modified immune cells declined significantly less than the patients’ untreated cells, suggesting that the gene editing was protective. The altered cells persisted, at least for a while. On average, half were still present after 48 weeks.

Jay Johnson, 53, who lives in Philadelphia, took part in the study and was treated in 2010. He was the only patient who had an adverse reaction: a brief bout with fever, chills and joint and back pain.

For three months, he went off antiviral drugs. Initially, his virus levels were undetectable, but they began to rise, and he went back on the drugs.

A few months ago, doctors told him that he still had some of the altered cells, Mr. Johnson said, adding that he hopes the cells will keep multiplying, take over and eventually leave him virus free. He would gladly go through the treatment again, he said.

“If this works, it will be just such an overwhelming joy to say that I’m H.I.V. negative,” he said.

As the studies move ahead, Dr. June said, researchers will be trying to find ways to increase the proportion of edited cells and to make them persist in the body. It remains to be seen whether the treatment can be made practical for large numbers of patients. Because the test patients have received a treatment that alters their DNA, the Food and Drug Administration requires 15 years of follow-up to check for adverse effects. One concern is that the treatment could disable the wrong genes, though no evidence of that has been seen so far.

A version of this article appears in print on March 6, 2014, on page A4 of the New York edition with the headline: Study Gives Hope of Altering Genes to Repel H.I.V.

Baby who was born with HIV believed to be cured after doctors treated her immediately following her birth

http://www.dailymail.co.uk/news/article-2573966/Doctors-hope-cure-2nd-baby-born-HIV.html
ASSOCIATED PRESS

A second baby born with the AIDS virus may have had her infection put into remission and possibly cured by very early treatment — in this instance, four hours after birth.

Doctors revealed the case Wednesday at an AIDS conference in Boston. The girl was born in suburban Los Angeles last April, a month after researchers announced the first case from Mississippi.

That case was a medical first that led doctors worldwide to rethink how fast and hard to treat infants born with HIV. The California doctors followed that example.

The Mississippi baby is now 3 1/2 and seems HIV-free despite no treatment for about two years. The Los Angeles baby is still getting AIDS medicines, so the status of her infection is not as clear.

A host of sophisticated tests at multiple times suggest the LA baby has completely cleared the virus, said Dr. Deborah Persaud, a Johns Hopkins University physician who led the testing. The baby's signs are different from what doctors see in patients whose infections are merely suppressed by successful treatment, she said.

"We don't know if the baby is in remission ... but it looks like that," said Dr. Yvonne Bryson, an infectious disease specialist at Mattel Children's Hospital UCLA who consulted on the girl's care.

Doctors are cautious about suggesting she has been cured, "but that's obviously our hope," Bryson said.

Most HIV-infected moms in the U.S. get AIDS medicines during pregnancy, which greatly cuts the chances they will pass the virus to their babies. The Mississippi baby's mom received no prenatal care and her HIV was discovered during labor. 

So doctors knew that infant was at high risk and started her on treatment 30 hours after birth, even before tests could determine whether she was infected.

The LA baby was born at Miller Children's Hospital Long Beach, and "we knew this mother from a previous pregnancy" and that she was not taking her HIV medicines, said Dr. Audra Deveikis, a pediatric infectious disease specialist at the hospital.

The mom was given AIDS drugs during labor to try to prevent transmission of the virus, and Deveikis started the baby on them a few hours after birth. Tests later confirmed she had been infected, but does not appear to be now, nearly a year later.

The baby is continuing treatment, is in foster care "and looking very healthy," Bryson said.

The Mississippi girl was treated until she was 18 months old, when doctors lost contact with her. Ten months later when she returned, they could find no sign of infection even though the mom had stopped giving her AIDS medicines.

Bryson is one of the leaders of a federally funded study just getting underway to see if very early treatment can cure HIV infection. About 60 babies in the U.S. and other countries will get very aggressive treatment that will be discontinued if tests over a long time, possibly two years, suggest no active infection.

"These kids obviously will be followed very, very closely" for signs of the virus, Persaud said.

She described the Los Angeles case at the Conference on Retroviruses and Opportunistic Infections.

Provocative new ad aimed at promoting safe sex tells people to 'Come Together' to fight Aids

http://www.independent.co.uk/news/uk/home-news/provocative-new-ad-aimed-at-promoting-safe-sex-tells-people-to-come-together-to-fight-aids-9111689.html
ROB WILLIAMS



Mattress springs creak and bounce while all manner of combinations of couples and threesomes - old, young and in the middle - writhe, squeak, squeal and groan to the sound of a sultry tango.

No, it's not yet another risqué advert for perfume, sexy underwear or online dating services but is, in fact, a refreshing attempt by an international charity to put the issue of HIV/Aids and safe sex back at the forefront of people's minds.

The advert, which has been released exclusively to The Independent ahead of its 'for-one-night-only' terrestrial screening on Channel 4 tomorrow night, has been created in a bid to highlight the continued importance of addressing the HIV epidemic - an issue which the International HIV/AIDS Alliance believes has fallen off the public agenda in recent years.

The 60-second television spot, has been described as one of the most provocative ads to be screened on British television, has already started tongues wagging amongst industry experts, and looks set to get pulses racing as well when its shown at 11.45pm and 12.05am on Friday night - the only terrestrial showing it will receive.

The aim of the raunchy advert is not to shock, however, Awo Ablo, Director of External Relations at the International HIV/AIDS Alliance explains: "It's arresting. Our motivation for the advert comes from something that we've known for a couple of years now. Our polling says that people, internationally, don't care about HIV/Aids."

"We hope the advert educates in a way that it is joyful and expresses what we feel safe sex: that it is something to be enjoyed and something that helps save lives."

The tongue-in-cheek ad is a world away from the terrifying 'don't die of ignorance' slots of the 1980s. "We should remember that the majority of young people weren't alive when those shocking adverts appeared," Ablo says. "At the time we not only saw those adverts but we also saw people going from being healthy to being emaciated walking skeletons."

"Our aim now is to unite people in fighting against this disease and we acknowledge that most young people haven't seen those frightening adverts and have a different experience of HIV/Aids."

The advertisement for the charity directs viewers to visit the 'Come Together' campaign website which encourages people to pledge money and support Aids-related causes.

The advert has already caught the attention of industry experts including Jo Hodges, who is Head of the Advertising Faculty at London College of Communication: "Historically the advertising campaigns surrounding AIDS only appeared to target the gay community."

"However, the Come Together ad shows couples of every sexual orientation enjoying sex from every angle and in turn produces what I think is one of the most provocative ads I have ever seen."

"This is a welcome and urgently needed departure that doesn't feel reproachful. Instead it is an open celebration of the joys of safer sex that targets people of all different ages, sexual orientations/preferences and genders."

The International HIV/AIDS Alliance, which carries out educational and medical work in around 40 countries across the world, has never before screened an advert, something that has changed because the polls the organisation were doing were consistently showing that the subject was not on the public agenda.

"People think its generally gone away globally," says Awo Ablo.

"That is partly a good thing, because people have heard the good stories that people can lead a healthy life with good care. But the real frustration is that there's still a massive problem."