Ask the UN and you’ll get the staggering sum of $10 billion.   A year . The annual per capita cost of treating infected Africans, where much of the UN money goes, is around $1,100. One of the major problems facing HIV/AIDS advocates is their inability to lower this number. An estimated $600 is spent on anti-retroviral drugs, while the remaining $500 is spent on other AIDS associated conditions. Even $10 billion wouldn’t cover treatment for the more than 20 million Africans with HIV/AIDS. A considerable portion of the proposed UN budget is directed not towards treatment but towards prevention. A major problem is that no one can seem to agree on the actual cost. Although the UN has held firm to their estimate, other groups have presented vastly different figures. The World Health Organization has presented four different scenarios which vary wildly in both the projected outcome and cost. To merely maintain the current status quo, WHO estimates more than $400 billion will need to be spent over the next 20 years. To significantly reduce annual new HIV infections, WHO’s figure is more than $700 billion. Unfortunately such different figures can sometimes complicate funding by making it hard for donors to decide how much to give. Ask someone who is living with HIV/AIDS and you’ll get a number that’s a lot smaller. The average AIDS patient in America takes a combination of drugs that add up to around  $14,000 a year . Much of this cost in the US is defrayed by private insurance, government insurance or sometimes through   AIDS drug assistance programs (ADAPs) . These programs are meant to provide access to drugs for low income individuals. Currently 89% of people enrolled in ADAPs make less than 300% of the federal poverty level. However recently the economic conditions have forced many states to scale back their support of these programs. States have either closed enrollment entirely, or narrowed eligibility-forcing people to drop out. Currently the nationwide waiting list is at an all time high of  3,586 people . Ask the companies that manufacture these lifesaving drugs and you’ll be back to huge figures. One of the newest drugs to enter the market, Fuzeon , is produced by the giant Swiss company, Roche. Roche maintains that Fuzeon’s price (nearly $20,000 a year, or three times the next most expensive drug) is due to the $600 million cost of development. The average drug begins to turn a profit in 16 years, but  analysts estimate  that Fuzeon’s pricing, and anticipated demand, could mean profits for Roche in as little as three years. Ask an economist and you’ll get a couple different figures. By 1995 more than  $75 billion  had been spent on AIDS. Since then, spending has increased most years, with an average of $10 billion more being spent every year. But money spent directly on AIDS does not even begin to cover the true cost. In addition, economists have tried to measure the costs related to lost productivity, wages, and premature death, due to the disease. Figures vary, but some think that indirect costs account for nearly 80 percent of the total cost of AIDS. Worst case scenario guesses estimate that AIDS robs the world of 1.4% of gross domestic product, or the equivalent of wiping out the economy of   Australia . A government study in Uganda found that some companies are hiring and training two employees for a single job in the hope that one will stay healthy. The UN estimates that since 1981 AIDS has reduced Africa’s overall labor force by 25%. Sick days and absenteeism due to AIDS related illness have further reduced productivity in the countries hit hardest by AIDS. Ultimately the cost of HIV/AIDS is extraordinarily difficult to measure. The disease affects so many people worldwide that it would be impossible to assess the impact that it has had on everyone. However it is obvious that unless something drastic changes, the costs will continue to grow until they become unbearable.

Ask the UN and you’ll get the staggering sum of $10 billion. <a href="http://www.time.com/time/magazine/article/0,9171,1000261,00.html" rel="nofollow" target="_blank"> A year </a>. The annual per capita cost of treating infected Africans, where much of the UN money goes, is around $1,100. One of the major problems facing HIV/AIDS advocates is their inability to lower this number. An estimated $600 is spent on anti-retroviral drugs, while the remaining $500 is spent on other AIDS associated conditions. Even $10 billion wouldn’t cover treatment for the more than 20 million Africans with HIV/AIDS. A considerable portion of the proposed UN budget is directed not towards treatment but towards prevention. A major problem is that no one can seem to agree on the actual cost. Although the UN has held firm to their estimate, other groups have presented vastly different figures. The World Health Organization has presented four different scenarios which vary wildly in both the projected outcome and cost. To merely maintain the current status quo, WHO estimates more than $400 billion will need to be spent over the next 20 years. To significantly reduce annual new HIV infections, WHO’s figure is more than $700 billion. Unfortunately such different figures can sometimes complicate funding by making it hard for donors to decide how much to give. Ask someone who is living with HIV/AIDS and you’ll get a number that’s a lot smaller. The average AIDS patient in America takes a combination of drugs that add up to around <a href="http://www.videojug.com/expertanswer/hiv-treatment-basics/how-much-does-hiv-medication-cost" rel="nofollow" target="_blank"> $14,000 a year </a>. Much of this cost in the US is defrayed by private insurance, government insurance or sometimes through <a href="http://www.videojug.com/interview/aids-drug-assistance-program#what-is-the-aids-drug-assistance-program-or-adap" rel="nofollow" target="_blank"> AIDS drug assistance programs (ADAPs) </a>. These programs are meant to provide access to drugs for low income individuals. Currently 89% of people enrolled in ADAPs make less than 300% of the federal poverty level. However recently the economic conditions have forced many states to scale back their support of these programs. States have either closed enrollment entirely, or narrowed eligibility-forcing people to drop out. Currently the nationwide waiting list is at an all time high of <a href="http://www.adapadvocacyassociation.org/" rel="nofollow" target="_blank"> 3,586 people </a>. <a href="http://2.bp.blogspot.com/_HPCf_WV1x2U/TMcj4wRFUvI/AAAAAAAAAJI/JL2vEjB-OO4/s1600/01aidsdrug_graphic-popup.gif" rel="nofollow" target="_blank"></a> Ask the companies that manufacture these lifesaving drugs and you’ll be back to huge figures. One of the newest drugs to enter the market, <a href="http://www.fuzeon.com/consumer/how_does_fuzeon_work.aspx" rel="nofollow" target="_blank">Fuzeon </a>, is produced by the giant Swiss company, Roche. Roche maintains that Fuzeon’s price (nearly $20,000 a year, or three times the next most expensive drug) is due to the $600 million cost of development. The average drug begins to turn a profit in 16 years, but <a href="http://www.cbsnews.com/stories/2003/03/13/health/main543887.shtml" rel="nofollow" target="_blank"> analysts estimate </a> that Fuzeon’s pricing, and anticipated demand, could mean profits for Roche in as little as three years. Ask an economist and you’ll get a couple different figures. By 1995 more than <a href="http://www.aegis.org/news/lt/1995/LT951003.html" rel="nofollow" target="_blank"> $75 billion </a> had been spent on AIDS. Since then, spending has increased most years, with an average of $10 billion more being spent every year. But money spent directly on AIDS does not even begin to cover the true cost. In addition, economists have tried to measure the costs related to lost productivity, wages, and premature death, due to the disease. Figures vary, but some think that indirect costs account for nearly 80 percent of the total cost of AIDS. Worst case scenario guesses estimate that AIDS robs the world of 1.4% of gross domestic product, or the equivalent of wiping out the economy of <a> Australia </a>. <a href="http://1.bp.blogspot.com/_HPCf_WV1x2U/TMcitLunV7I/AAAAAAAAAJA/OOZzTKI5ddw/s1600/WJ060706_India.gif" rel="nofollow" target="_blank"></a> A government study in Uganda found that some companies are hiring and training two employees for a single job in the hope that one will stay healthy. The UN estimates that since 1981 AIDS has reduced Africa’s overall labor force by 25%. Sick days and absenteeism due to AIDS related illness have further reduced productivity in the countries hit hardest by AIDS. Ultimately the cost of HIV/AIDS is extraordinarily difficult to measure. The disease affects so many people worldwide that it would be impossible to assess the impact that it has had on everyone. However it is obvious that unless something drastic changes, the costs will continue to grow until they become unbearable.

What does HIV/AIDS cost? The answer to this question depends a lot on whom you ask.

Africa. The seed of the world. One of the most beautiful and most scintillating places on earth. From the deserts of the Sahara and the rainforests of the Congo to the bright and bustling metropolis of Cape Town, life is rich everywhere. Yet amidst all this beauty and splendor, a deadly scourge threatens the people of this continent. AIDS.Sub-Saharan Africa is more heavily affected by HIV/AIDS than is any other region in the world. Somewhere around 22.4 million people in the region are currently living with HIV. This makes up a whopping two-thirds of the global number of HIV-infected individuals. Whereas in other areas of the world the disease affects only certain groups, here, HIV/AIDS affects everyone. This affliction picks apart whole extended families one by one. Schools are gradually emptied over time as students are orphaned. Healthcare and economic development have all taken a hard hit because of the impact of HIV/AIDS on the African peoples. Organizations simply don’t have the funds to support or expand prevention, treatment and care efforts and for this reason, it is likely that the death count will continue to rise. Life expectancy has been drastically reduced across the continent, falling to as low as 31 years in some of the worst afflicted areas. HIV/AIDS is present everywhere we look. It is an unavoidable aspect of everyday life.The following dialogue includes excerpts from various interviews. I spoke with a group of college students who lived for six months in South Africa and Zambia, another student who lived 2 years in Nigeria, and a field biologist currently doing research in Cameroon. Their testimonies will enhance the picture of daily life in African countries afflicted with HIV/AIDS.Take the country of Cameroon, for example. As of 2008, the population in Cameroon neared 19 million. Of that, about 600,000 are living with HIV/AIDS. More than half of that is made up of women 15 years and older. While prevalence here is much lower than other countries, HIV/AIDS remains a chief concern. When asked about general knowledge about the disease, most agreed that the “information is very available to middle and upper class citizens, but not necessarily to the lower class citizens and those that are at highest risk.”  There is a large focus on prevention here, and the country is littered with billboards promoting abstinence, safer sex practices and condom use. Public Service Announcement in Cameroon“Sex can wait…my future comes first.”South Africa is a key example of a country, of a government that has failed its people. Until very recently, the government took no part in the fight against AIDS. Thabo Mbeki, president from 1999 to 2008 refused to believe that HIV causes AIDS and that condoms can prevent infection. This leadership has fueled outlandish beliefs such as that condoms cause AIDS, or that white people are pushing condoms laced with AIDS to wipe out Africans. When asked about the role of the government in the fight against AIDS, one student said, “The president is not very influential considering he stated that he took a shower after having had sex with someone infected with AIDS, and therefore he would not contract the disease.” Here, she is referring to the current president, Jacob Zuma, who publicly stated that showering after sex with an HIV-positive woman would reduce his risk of being infected. A fellow student added, “NGOs are much more active. They have done a much better job fighting AIDS through their provision of important information and items such as condoms and antiretrovirals.” Incumbent President of South Africa, Jacob Zuma The picture of life here has changed drastically since AIDS exploded on the scene. While treatment and prevention are improving in some areas, the governments of more conservative countries, such as South Africa, need to step up and face this issue with full force so that HIV/AIDS is no longer a shadow looming over the lives of everyone.Facts and figures were obtained from AVERT International HIV and AIDS charity, the Global Health Council, USAID, and Elizabeth Pisani’s The Wisdom of Whores.I would like to recognize Albert Noah-Messomo, an African native of the Beti people in the rainforest of Cameroon. His traditional African-style music was featured during this Podcast. I would like to thank Kurt Kristensen, Sara Levintow, Nikki Pagano, and Rebecca McQuade for their contributions to this Podcast.

Africa. The seed of the world. One of the most beautiful and most scintillating places on earth. From the deserts of the Sahara and the rainforests of the Congo to the bright and bustling metropolis of Cape Town, life is rich everywhere. Yet amidst all this beauty and splendor, a deadly scourge threatens the people of this continent. AIDS. Sub-Saharan Africa is more heavily affected by HIV/AIDS than is any other region in the world. Somewhere around 22.4 million people in the region are currently living with HIV. This makes up a whopping two-thirds of the global number of HIV-infected individuals. Whereas in other areas of the world the disease affects only certain groups, here, HIV/AIDS affects everyone. This affliction picks apart whole extended families one by one. Schools are gradually emptied over time as students are orphaned. Healthcare and economic development have all taken a hard hit because of the impact of HIV/AIDS on the African peoples. Organizations simply don’t have the funds to support or expand prevention, treatment and care efforts and for this reason, it is likely that the death count will continue to rise. Life expectancy has been drastically reduced across the continent, <a href="http://www.avert.org/aids-impact-africa.htm" rel="nofollow" target="_blank">falling to as low as 31 years</a> in some of the worst afflicted areas. HIV/AIDS is present everywhere we look. It is an unavoidable aspect of everyday life. The following dialogue includes excerpts from various interviews. I spoke with a group of college students who lived for six months in South Africa and Zambia, another student who lived 2 years in Nigeria, and a field biologist currently doing research in Cameroon. Their testimonies will enhance the picture of daily life in African countries afflicted with HIV/AIDS. Take the country of Cameroon, for example. As of 2008, the population in Cameroon neared 19 million. Of that, about 600,000 are living with HIV/AIDS. More than half of that is made up of women 15 years and older. While prevalence here is much lower than other countries, HIV/AIDS remains a chief concern. When asked about general knowledge about the disease, most agreed that the “information is very available to middle and upper class citizens, but not necessarily to the lower class citizens and those that are at highest risk.” There is a large focus on prevention here, and the country is littered with billboards promoting abstinence, safer sex practices and condom use. <a href="http://4.bp.blogspot.com/_HPCf_WV1x2U/TL3si4iJh-I/AAAAAAAAAIo/CWws6iV-0QM/s1600/Carcelen_Fig1.jpg" rel="nofollow" target="_blank"></a> Public Service Announcement in Cameroon “Sex can wait…my future comes first.” South Africa is a key example of a country, of a government that has failed its people. Until very recently, the government took no part in the fight against AIDS. Thabo Mbeki, president from 1999 to 2008 <a href="http://news.bbc.co.uk/2/hi/africa/934435.stm" rel="nofollow" target="_blank">refused to believe</a> that HIV causes AIDS and that condoms can prevent infection. This leadership has fueled outlandish beliefs such as that condoms cause AIDS, or that white people are pushing condoms laced with AIDS to wipe out Africans. When asked about the role of the government in the fight against AIDS, one student said, “The president is not very influential considering he stated that he took a shower after having had sex with someone infected with AIDS, and therefore he would not contract the disease.” Here, she is referring to the current president, Jacob Zuma, who publicly stated that <a href="http://news.bbc.co.uk/2/hi/africa/4879822.stm" rel="nofollow" target="_blank">showering after sex</a> with an HIV-positive woman would reduce his risk of being infected. A fellow student added, “NGOs are much more active. They have done a much better job fighting AIDS through their provision of important information and items such as condoms and antiretrovirals.” <a href="http://3.bp.blogspot.com/_HPCf_WV1x2U/TL3s0i_9vtI/AAAAAAAAAIw/s2NLwA640AA/s1600/Carcelen_Fig2.jpg" rel="nofollow" target="_blank"></a> Incumbent President of South Africa, Jacob Zuma The picture of life here has changed drastically since AIDS exploded on the scene. While treatment and prevention are improving in some areas, the governments of more conservative countries, such as South Africa, need to step up and face this issue with full force so that HIV/AIDS is no longer a shadow looming over the lives of everyone. Facts and figures were obtained from <a href="http://www.avert.org" rel="nofollow" target="_blank">AVERT</a> International HIV and AIDS charity, the <a href="http://www.globalhealth.org" rel="nofollow" target="_blank">Global Health Council</a>, <a href="http://www.usaid.gov" rel="nofollow" target="_blank">USAID</a>, and Elizabeth Pisani’s <a href="http://www.wisdomofwhores.com" rel="nofollow" target="_blank">The Wisdom of Whores</a>. I would like to recognize Albert Noah-Messomo, an African native of the Beti people in the rainforest of Cameroon. His traditional African-style music was featured during this Podcast. I would like to thank Kurt Kristensen, Sara Levintow, Nikki Pagano, and Rebecca McQuade for their contributions to this Podcast.

A Picture of Life with HIV in Africa

“By 2015, let us end the transmission of HIV from mother to child. This is not a dream: we can do it.”Carla Bruni-Sarkozy,The Global Fund AmbassadorWith that simple statement from Ms. Bruni-Sarkozy as its guiding principle, the Global Fund to Fight AIDS, Tuberculosis, and Malaria has launched Born HIV Free. The goal of this new initiative is straightforward – stop the mother-to-child transmission of HIV. As Ms. Bruni-Sarkozy notes, this goal is achievable. We have at our disposal the means of protecting our children from infection.When an HIV+ woman becomes pregnant and gives birth, the virus can be transmitted to the infant during gestation, during delivery, or through subsequent breast-feeding. These types of transmission collectively are referred to as mother-to-child transmission. The terms vertical transmission and perinatal transmission also may be used. We now know that relatively simple and relatively cheat antiviral regimens can dramatically reduce the rate of mother-to-child transmission. In a 1999 study, Dr. Mary Lou Lindegren and colleagues noted that rates of perinatal transmission dropped significantly in concert with zidovudine (AZT) treatment for the mothers. With the development of better drug regimens, these drops in transmission rates have continued. According to the CDC, an estimated 1,650 HIV-infected infants were born in the US in 1991. In 2004, that number had dropped to less than 200. This success, however, has not been mirrored in developing countries. The causes of this disparity are several-fold. The most important factors affecting the continued problem of mother-to-child transmission of HIV in developing countries include access to treatment and access to testing. In recent years, antiretroviral drugs have become more available throughout the developing world, thanks, in large part, to the influx of money from sources such as the United States PEPFAR program and the United Nation’s Global Fund. Additionally, other groups, most notably the Clinton Foundation, have fought hard to make these drugs more affordable. But we need to do more. Too many HIV+ women still do not have access to the necessary treatments.In addition to making drugs more available, we also must work diligently to increase the levels of testing. Treatment to prevent perinatal transmission requires that women know their HIV status.To find out more about the Born HIV Free campaign, please visit their website at http://www.bornhivfree.org. Let’s join Ms. Bruni-Sarkozy in ending the transmission of HIV from mother to child.

“By 2015, let us end the transmission of HIV from mother to child. This is not a dream: we can do it.” Carla Bruni-Sarkozy, The Global Fund Ambassador With that simple statement from Ms. Bruni-Sarkozy as its guiding principle, the Global Fund to Fight AIDS, Tuberculosis, and Malaria has launched Born HIV Free. The goal of this new initiative is straightforward – stop the mother-to-child transmission of HIV. As Ms. Bruni-Sarkozy notes, this goal is achievable. We have at our disposal the means of protecting our children from infection. When an HIV+ woman becomes pregnant and gives birth, the virus can be transmitted to the infant during gestation, during delivery, or through subsequent breast-feeding. These types of transmission collectively are referred to as mother-to-child transmission. The terms vertical transmission and perinatal transmission also may be used. We now know that relatively simple and relatively cheat antiviral regimens can dramatically reduce the rate of mother-to-child transmission. In a 1999 study, Dr. Mary Lou Lindegren and colleagues noted that rates of perinatal transmission dropped significantly in concert with zidovudine (AZT) treatment for the mothers. With the development of better drug regimens, these drops in transmission rates have continued. According to the CDC, an estimated 1,650 HIV-infected infants were born in the US in 1991. In 2004, that number had dropped to less than 200. This success, however, has not been mirrored in developing countries. The causes of this disparity are several-fold. The most important factors affecting the continued problem of mother-to-child transmission of HIV in developing countries include access to treatment and access to testing. In recent years, antiretroviral drugs have become more available throughout the developing world, thanks, in large part, to the influx of money from sources such as the United States PEPFAR program and the United Nation’s Global Fund. Additionally, other groups, most notably the Clinton Foundation, have fought hard to make these drugs more affordable. But we need to do more. Too many HIV+ women still do not have access to the necessary treatments. In addition to making drugs more available, we also must work diligently to increase the levels of testing. Treatment to prevent perinatal transmission requires that women know their HIV status. To find out more about the Born HIV Free campaign, please visit their website at <a href="http://www.bornhivfree.org" rel="nofollow" target="_blank">http://www.bornhivfree.org</a>. Let’s join Ms. Bruni-Sarkozy in ending the transmission of HIV from mother to child.

Born HIV Free campaign to end mother-to-child-transmission

I'm Paige Bates and this is The AIDS PandemicThe RV144 study was a phase III HIV vaccine trial conducted by the US Army and Thai government over seven years on 16,402 volunteers—all HIV negative men and women between the ages of 18 and 30 in parts of Thailand.  For ethical reasons, all participants were taught HIV prevention behaviors, given condoms, and promised lifelong antiretroviral treatment if they contracted HIV.  Half of the volunteers were given a prime-boost vaccine regimen and half received placebo vaccinations.  The prime-boost approach utilizes Sanofi Pasteur’s ALVAC-HIV vaccine as a prime and AIDSVAX (originally made by Genentech) as a boost.  ALVAC-HIV is comprised of a canarypox virus with three HIV genes grafted onto it.  AIDSVAX contains a recombinant gp120 protein found on the surface of HIV.  These vaccinations were combined because one was designed to create antibodies and the other to alert white blood cells.  These vaccinations were focused on the two strains of HIV commonly found in Thailand, but it is unclear whether this regimen would have any benefit elsewhere in the world.  The participants were regularly tested for HIV for three years following the completion of the vaccine regimen.  In September, the companies and agencies which implemented and funded the trial announced in a press release and interviews that new HIV infections were observed in 74 of the 8,198 people who received the placebo, but in only 51 of the 8,187 given the vaccine.  They claimed that this was a statistically significant 31.2% reduction in infection.  However, the vaccine did not reduce levels of HIV activity in those who became infected and did not appear to produce any neutralizing antibodies.Source: Wall Street Journal, September 25, 2009In the 1980s, top officials embarrassed themselves by predicting an HIV vaccine in five years.  Reminiscent of these overly optimistic declarations, the backers of the RV144 trial claimed that “we now have evidence that a safe and effective HIV vaccine is possible.”  In the first wave of press subsequent to the initial press release and interviews, many reputable news sources, such as the San Francisco Chronicle, New York Times, NPR radio and BBC news, suggested that these results were highly encouraging, and some even went so far as to suggest that this regimen might be the forerunner or basis for a usable vaccine in the near future.  The LA Times suggested that these findings would “energize and redirect” the HIV vaccine field.  Many articles quoted Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Disease which largely funded the $100 million dollar study, as saying “I don’t want to use a word like breakthrough, but I don’t think that there’s any doubt that this is a very important result.”  The Wall Street Journal suggested that this finding could be the second “big game changer in AIDS research since the mid 1990’s” with the advent of drug cocktails.  Many articles later qualified with the cautionary statement that much more research is necessary before the vaccine could be available to the public. Phrases urging the public to be “cautious” but “hopeful” and describing the results as “modest” yet “encouraging” rang throughout the media and press releases.However, only days later, the LA Times wrote “By Thursday afternoon, the initial wave of euphoria had given way to the recognition that many vexing questions will have to be answered before researchers can produce a vaccine that will reliably shield people from HIV.”  Experts predicted that it would require two to three years of research to unravel how and why the vaccine regimen worked, and then an additional five to ten years to produce a vaccine that was ready to test in people.  The fact that this still overly optimistic statement was a step back from the “initial euphoria” shows the extent of the preliminary sensationalism.  The media reported that the researchers would now compare the blood of those who were vaccinated and resisted infection, and those who did not in order to determine whether the regimen stimulated antibodies or other protective molecules against HIV infection.  In an article entitled “If AIDS went the way of smallpox,” a New York Times reporter recognized many problems with the initial reports including that many headlines in the first 24 hours after the press release read “One Third Protected,” while in reality the margin of success was “razor thin.”  In addition, even the experts overseeing the trial could not explain why blending two failed vaccines suddenly resulted in “working” vaccine. Finally, this article recognized the financial difficulties surrounding a regimen that requires six shots over the span of months resulting in minimal protection.  While this might be practical in rich countries, AIDS generally burdens the poorest nations in this world.  Only one article mentioned that some researchers were suggesting that the apparent reduction in infections might be a statistical fluke due to the small number of HIV infections observed.  Throughout all articles, there were minimal reminders to keep vigilance about prevention, testing, and the necessity to utilize current retroviral care.Source: Wall Street Journal, October 12, 2009In 2004, there was so much skepticism about this trial that 22 top AIDS researchers published an editorial in Science magazine suggesting it was a waste of money.  Five years later, the organizations which conducted the trial announced in a press release that there has been significant protection, before making the scientific data available to peer review.  When the full details of the study were released on October 20th at a meeting in Paris, the statistic frailty of the study was revealed.  The vaccine was not shown to protect people at the highest risk of HIV infection.  As The Washington Post noted on October 21st, when the results are analyzed using alternate methods, the protection is no longer statistically significant.  For example, when only the people who received all six injections are counted, the trend towards protection is no longer significant.  This raises many questions.  What are the societal implications of the press surrounding this vaccine?  If this vaccine doesn’t have much, if any, effect, what is the societal consequence of the data being overstated?  The possibility of a public backlash against vaccination efforts wouldn’t be too hard to imagine.  In fact, Gregg Gonsalves, an AIDS activist, remarked that, “When this was rolled out a couple of weeks ago, it was terribly hyped by the investigators.  Some people think that you have to dangle the slimmest morsels of hope in front of the general public in order to keep them interested in an AIDS vaccine.  But I think that damages the credibility of the effort.”  The extent to which these results might represent a breakthrough can only be determined after the mechanism behind the possible conferred immunity is discovered.  As Gonsalves points out, the over-exaggeration of the success in the media will likely hurt the results of the study if they prove to be less remarkable than originally stated.  Furthermore, this study raises a general question about scientific results: is it appropriate to have news press releases before data is available for full review by scientific peers?While this trial may not have been the scientific breakthrough that it was praised as, at the very least, this tremendous study is an example of international and interagency collaboration in conducting a large-scale vaccine trial, including the Thai and US governments, private companies such as Sanofi Pasteur, and non-profit organizations such as Global Solutions for Infectious Diseases (GSID).  In this regard, it provides incredible hope for HIV vaccine efforts in the future.For more information, please see these articles.US Military Research Program in ThailandBBC news coverage of RV144 The Wall Street Journal: Data Call ito Question HIV Study Results

I'm Paige Bates and this is The AIDS Pandemic The RV144 study was a phase III HIV vaccine trial conducted by the US Army and Thai government over seven years on 16,402 volunteers—all HIV negative men and women between the ages of 18 and 30 in parts of Thailand. For ethical reasons, all participants were taught HIV prevention behaviors, given condoms, and promised lifelong antiretroviral treatment if they contracted HIV. Half of the volunteers were given a prime-boost vaccine regimen and half received placebo vaccinations. The prime-boost approach utilizes Sanofi Pasteur’s ALVAC-HIV vaccine as a prime and AIDSVAX (originally made by Genentech) as a boost. ALVAC-HIV is comprised of a canarypox virus with three HIV genes grafted onto it. AIDSVAX contains a recombinant gp120 protein found on the surface of HIV. These vaccinations were combined because one was designed to create antibodies and the other to alert white blood cells. These vaccinations were focused on the two strains of HIV commonly found in Thailand, but it is unclear whether this regimen would have any benefit elsewhere in the world. The participants were regularly tested for HIV for three years following the completion of the vaccine regimen. In September, the companies and agencies which implemented and funded the trial announced in a press release and interviews that new HIV infections were observed in 74 of the 8,198 people who received the placebo, but in only 51 of the 8,187 given the vaccine. They claimed that this was a statistically significant 31.2% reduction in infection. However, the vaccine did not reduce levels of HIV activity in those who became infected and did not appear to produce any neutralizing antibodies. <a href="http://4.bp.blogspot.com/_HPCf_WV1x2U/SvssFe3xAkI/AAAAAAAAAIA/Bbhq1e0Id_s/s1600-h/AIDS_Pandemic_81A.jpg" rel="nofollow" target="_blank"></a> <blockquote>Source: Wall Street Journal, September 25, 2009</blockquote>In the 1980s, top officials embarrassed themselves by predicting an HIV vaccine in five years. Reminiscent of these overly optimistic declarations, the backers of the RV144 trial claimed that “we now have evidence that a safe and effective HIV vaccine is possible.” In the first wave of press subsequent to the initial press release and interviews, many reputable news sources, such as the San Francisco Chronicle, New York Times, NPR radio and BBC news, suggested that these results were highly encouraging, and some even went so far as to suggest that this regimen might be the forerunner or basis for a usable vaccine in the near future. The LA Times suggested that these findings would “energize and redirect” the HIV vaccine field. Many articles quoted Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Disease which largely funded the $100 million dollar study, as saying “I don’t want to use a word like breakthrough, but I don’t think that there’s any doubt that this is a very important result.” The Wall Street Journal suggested that this finding could be the second “big game changer in AIDS research since the mid 1990’s” with the advent of drug cocktails. Many articles later qualified with the cautionary statement that much more research is necessary before the vaccine could be available to the public. Phrases urging the public to be “cautious” but “hopeful” and describing the results as “modest” yet “encouraging” rang throughout the media and press releases. However, only days later, the LA Times wrote “By Thursday afternoon, the initial wave of euphoria had given way to the recognition that many vexing questions will have to be answered before researchers can produce a vaccine that will reliably shield people from HIV.” Experts predicted that it would require two to three years of research to unravel how and why the vaccine regimen worked, and then an additional five to ten years to produce a vaccine that was ready to test in people. The fact that this still overly optimistic statement was a step back from the “initial euphoria” shows the extent of the preliminary sensationalism. The media reported that the researchers would now compare the blood of those who were vaccinated and resisted infection, and those who did not in order to determine whether the regimen stimulated antibodies or other protective molecules against HIV infection. In an article entitled “If AIDS went the way of smallpox,” a New York Times reporter recognized many problems with the initial reports including that many headlines in the first 24 hours after the press release read “One Third Protected,” while in reality the margin of success was “razor thin.” In addition, even the experts overseeing the trial could not explain why blending two failed vaccines suddenly resulted in “working” vaccine. Finally, this article recognized the financial difficulties surrounding a regimen that requires six shots over the span of months resulting in minimal protection. While this might be practical in rich countries, AIDS generally burdens the poorest nations in this world. Only one article mentioned that some researchers were suggesting that the apparent reduction in infections might be a statistical fluke due to the small number of HIV infections observed. Throughout all articles, there were minimal reminders to keep vigilance about prevention, testing, and the necessity to utilize current retroviral care. <a href="http://4.bp.blogspot.com/_HPCf_WV1x2U/SvssS_H3ufI/AAAAAAAAAII/V9UFn9klbyM/s1600-h/AIDS_Pandemic_81B.jpg" rel="nofollow" target="_blank"></a> <blockquote>Source: Wall Street Journal, October 12, 2009</blockquote>In 2004, there was so much skepticism about this trial that 22 top AIDS researchers published an editorial in Science magazine suggesting it was a waste of money. Five years later, the organizations which conducted the trial announced in a press release that there has been significant protection, before making the scientific data available to peer review. When the full details of the study were released on October 20th at a meeting in Paris, the statistic frailty of the study was revealed. The vaccine was not shown to protect people at the highest risk of HIV infection. As The Washington Post noted on October 21st, when the results are analyzed using alternate methods, the protection is no longer statistically significant. For example, when only the people who received all six injections are counted, the trend towards protection is no longer significant. This raises many questions. What are the societal implications of the press surrounding this vaccine? If this vaccine doesn’t have much, if any, effect, what is the societal consequence of the data being overstated? The possibility of a public backlash against vaccination efforts wouldn’t be too hard to imagine. In fact, Gregg Gonsalves, an AIDS activist, remarked that, “When this was rolled out a couple of weeks ago, it was terribly hyped by the investigators. Some people think that you have to dangle the slimmest morsels of hope in front of the general public in order to keep them interested in an AIDS vaccine. But I think that damages the credibility of the effort.” The extent to which these results might represent a breakthrough can only be determined after the mechanism behind the possible conferred immunity is discovered. As Gonsalves points out, the over-exaggeration of the success in the media will likely hurt the results of the study if they prove to be less remarkable than originally stated. Furthermore, this study raises a general question about scientific results: is it appropriate to have news press releases before data is available for full review by scientific peers? While this trial may not have been the scientific breakthrough that it was praised as, at the very least, this tremendous study is an example of international and interagency collaboration in conducting a large-scale vaccine trial, including the Thai and US governments, private companies such as Sanofi Pasteur, and non-profit organizations such as Global Solutions for Infectious Diseases (GSID). In this regard, it provides incredible hope for HIV vaccine efforts in the future. For more information, please see these articles. <a href="http://www.hivresearch.org/global-efforts/thailand.html" rel="nofollow" target="_blank">US Military Research Program in Thailand</a> <a href="http://news.bbc.co.uk/2/hi/8272113.stm" rel="nofollow" target="_blank">BBC news coverage of RV144</a> <a href="http://online.wsj.com/article/SB125511780864976689.html" rel="nofollow" target="_blank"> The Wall Street Journal: Data Call ito Question HIV Study Results</a>

The Search for an HIV vaccine

Hi, I’m Justin Eusebio.While tuberculosis is one of the world’s oldest surviving plagues and HIV-1 infection is one of medicine’s newest challenges, there is an undeniable relationship between HIV/AIDS and tuberculosis.  Independently, Mycobacteria tuberculosis and HIV are formidable pathogens but in concert, the prospects for controlling either epidemic are jeopardized.  TB-HIV coinfection and interaction complicate all aspects of each disease: pathogenesis, epidemiology, clinical presentation, diagnosis, treatment, prevention, and even social and economic issues. Not only are individuals more likely to undergo tuberculosis infection if living with HIV, depending on their geographic location, people living with HIV infection are 6-50 times more likely to develop active TB than people living without HIV.  Thus, with one-third of the world’s population at least latently infected with Mycobacteria tuberculosis, the current pace of new HIV-1 infections threatens public health on a wide scale.Tuberculosis infection is believed to have the greatest potential among other common opportunistic infections to increase viral load and to accelerate HIV-1 disease progression.  This is in part due to the chronic nature of active TB disease, the marked increase in tumor necrosis factor-alpha (TNF-α) expression for macrophage activation, and intensified antigen presentation causing the recruitment of CD4 T lymphocytes to the site of TB infection. Manoff and others demonstrated that active tuberculosis is associated with increased viral load in HIV-1 infected patients.  Also, TB-HIV coinfected persons have a significantly higher HIV RNA load than persons without opportunistic infections and similar CD4 cell counts.Figure 1. Schematic hypothetical individual’s of risk of TB infection compared to CD4 cell count.  From: Havlir, Diane V., Haileyesus Getahun, and Ian Sanne.  “Opportunities and Challenges for HIV Care in Overlapping HIV and TB Epidemics.”  Journal of the American Medical Association 300.4 (2008): 423-430.Researchers from Case Western Reserve University demonstrated that not only do TB-HIV co-infected patients have significantly higher viral loads than those without TB, the timing of infection by M. tuberculosis affects HIV-1 disease progression.  In fact, these researchers showed that TB had its strongest impact on HIV-1 viral load when patients are least immunodeficient.  Furthermore, from the same study, more than 25% of TB-HIV coinfected patients developed TB when their CD4 cell counts were at least 500 cells/µl.  Thus TB infection is unique because it can occur at any CD4 cell count level.Perhaps the most problematic tuberculosis-induced effect contributing to HIV-1 disease progression is its apparent impact on HIV-1 evolution.  While reverse transcriptase, a polymerase without proofreading capabilities, provides an effective mechanism for genetic diversity, M. tuberculosis infection increases HIV-1 heterogeneity through compartmentalization. In a cohort of patients matched by their CD4 cell counts, dually infected TB-HIV patients were found to have greater systemic, or more general, HIV-1 heterogeneity and more frequent occurrences of distinct HIV-1 quasispecies than HIV-1 patients without TB infection.  A population of diverse quasispecies increases the viral capacity to evolve and adapt to the host immunological response.  Furthermore, upon examination of the lung sites of M. tuberculosis infection of TB-HIV coinfected patients, Collins and others found greater genetic HIV-1 heterogeneity and distinct quasispecies in the pleural space compared to blood samples.  While phylogenetically distinct HIV-1 subpopulations have been shown to develop in other organs or tracts in humans (i.e. kidneys, brain, urogenital tract and blood), compartmentalization of HIV-1 occurs most significantly and is more defined in the lungs of co-infected TB-HIV patients.  Therefore, the lungs, induced by active tuberculosis disease, function as a reservoir for genetically diverse HIV-1.In addition to accelerating the disease progression of one another, their collision has highlighted underlying public health and human rights failures.  Africa, although only home to 10% of the world’s population, is the major site of intersection between the two epidemics with an astounding 75% of the world’s TB-HIV coinfections.Figure 2. The disproportionate incidence of HIV and HIV-TB coinfection in Africa in 2000.  Each person indicates 5% of the global population.  The African population is shaded red while blue represents the rest of the world.From: Corbett, Elizabeth L, Barbara Marston, Gavin J. Churchyard, and Keven M. De Cock.  “Tuberculosis in Sub-Saharan Africa: Opportunities, Challenges, and Change in the Era of Antiretroviral Treatment.”  Lancet 367 (2006): 926-937. Thus, novel TB diagnostic tests are needed in HIV-endemic regions because HIV infection reduces the sensitivity of current diagnostic methods such as direct smear sputum microscopy.  In terms of treatment, high pill burden and toxicity often discourage adherence among many coinfected patients.  Furthermore, rifampicin, a common antibiotic component of tuberculosis chemotherapy disrupts antiretroviral treatment by accelerating the metabolism of both protease inhibitors and nonnucleoside reverse transcriptase inhibitors (NNRTs).  Finally, if antiretroviral treatment of coinfected patients is started too soon after treatment for TB, a rapid recovery of CD4 T cell levels may induce an overwhelming inflammatory response against previously hidden opportunistic infections resulting immune reconstitution inflammatory syndrome (IRIS).The connection between the biology of the two diseases is clear and complications are numerous.  Thus, experts in HIV and experts in TB should respond accordingly and move towards greater collaboration and shared research.Until next, this is Justin Eusebio.For more information:Bartlett, John G. “Tuberculosis and HIV Infection: Partners in Human Tragedy.”  Journal of Infectious Diseases 196 (2007): S124-5.Collins, Kalonji R., Miguel E. Quioñones-Mateu, Mianda Wu, Henry Luzze, John L. Johnson, Christina Hirsch, Zahra Toossi, and Eric J. Arts.  “Human Immunodeficiency Virus Type 1 (HIV-1) Quasispecies at the Sites of Mycobacterium tuberculosis Infection Contribute to Systemic HIV-1 Heterogeneity.”  Journal of Virology 76.4 (2002): 1697-1706.Collins, Kalonji R., Miguel E. Quioñones-Mateu, Zhara Toossi, and Eric J. Arts.  “Impact of Tuberculosis on HIV-1 Replication, Diversity and Disease Progression.”  AIDS Review 4 (2002): 165-176.Kalonji Collins et. al, “Greater diversity of HIV-1 quasispecies in HIV-infected individuals with active tuberculosis.” Journal of Acquired Immune Deficiency Syndrome 24, 408-417.Friedland, Gerald, Gavin J. Churchyard, and Edward Nardell.  “Tuberculosis and HIV Coinfection: Current State of Knowledge and Research Priorities.”  Journal of Infectious Diseases 196 (2007): S1-3.Manoff, SB, H Farzadegan, A Muñoz, JA Astemborski, D Vlahov, RT Rizzo, L Solomon, and NM Graham.  “The Effect of Latent Mycobacterium tuberculosis infection on Human Immunodeficiency Virus (HIV) Disease Progression and HIV RNA Load Among Injecting Drug Users.”  The Journal of Infectious Diseases 174.2 (1996): 299-308.Nunn, Paul, Alasdair Reid, Kevin De Cock.  “Tuberculosis and HIV Infection: The Global Setting.”  The Journal of Infectious Diseases 196 (2007): S5-14.Vignuzzi, Marco, Jeffrey K. Stone, Jamie J. Arnold, Craig E. Cameron, and Raul Andino.  “Quasispecies Diversity Determines Pathogenesis through Cooperative Interactions within a Viral Population.”  Nature 439.7074 (2006): 344-348.

Hi, I’m Justin Eusebio. While tuberculosis is one of the world’s oldest surviving plagues and HIV-1 infection is one of medicine’s newest challenges, there is an undeniable relationship between HIV/AIDS and tuberculosis. Independently, Mycobacteria tuberculosis and HIV are formidable pathogens but in concert, the prospects for controlling either epidemic are jeopardized. TB-HIV coinfection and interaction complicate all aspects of each disease: pathogenesis, epidemiology, clinical presentation, diagnosis, treatment, prevention, and even social and economic issues. Not only are individuals more likely to undergo tuberculosis infection if living with HIV, depending on their geographic location, people living with HIV infection are 6-50 times more likely to develop active TB than people living without HIV. Thus, with one-third of the world’s population at least latently infected with Mycobacteria tuberculosis, the <a href="http://www.avert.org/worldstats.htm" rel="nofollow" target="_blank">current pace of new HIV-1 infections</a> threatens public health on a wide scale. Tuberculosis infection is believed to have the greatest potential among other common opportunistic infections to increase viral load and to accelerate HIV-1 disease progression. This is in part due to the chronic nature of active TB disease, the marked increase in tumor necrosis factor-alpha (TNF-α) expression for macrophage activation, and intensified antigen presentation causing the recruitment of CD4 T lymphocytes to the site of TB infection. Manoff and others demonstrated that active tuberculosis is associated with increased viral load in HIV-1 infected patients. Also, TB-HIV coinfected persons have a significantly higher HIV RNA load than persons without opportunistic infections and similar CD4 cell counts. <a href="http://1.bp.blogspot.com/_HPCf_WV1x2U/StogKRijCSI/AAAAAAAAAHw/Y5Cne_qXgyw/s1600-h/AIDS_Pandemic_80A.jpg" rel="nofollow" target="_blank"></a> <blockquote>Figure 1. Schematic hypothetical individual’s of risk of TB infection compared to CD4 cell count. From: Havlir, Diane V., Haileyesus Getahun, and Ian Sanne. “Opportunities and Challenges for HIV Care in Overlapping HIV and TB Epidemics.” Journal of the American Medical Association 300.4 (2008): 423-430.</blockquote>Researchers from Case Western Reserve University demonstrated that not only do TB-HIV co-infected patients have significantly higher viral loads than those without TB, the timing of infection by M. tuberculosis affects HIV-1 disease progression. In fact, these researchers showed that TB had its strongest impact on HIV-1 viral load when patients are least immunodeficient. Furthermore, from the same study, more than 25% of TB-HIV coinfected patients developed TB when their CD4 cell counts were at least 500 cells/µl. Thus TB infection is unique because it can occur at any CD4 cell count level. Perhaps the most problematic tuberculosis-induced effect contributing to HIV-1 disease progression is its apparent impact on HIV-1 evolution. While reverse transcriptase, a polymerase without proofreading capabilities, provides an effective mechanism for genetic diversity, M. tuberculosis infection increases HIV-1 heterogeneity through compartmentalization. In a cohort of patients matched by their CD4 cell counts, dually infected TB-HIV patients were found to have greater systemic, or more general, HIV-1 heterogeneity and more frequent occurrences of distinct <a>HIV-1 quasispecies</a> than HIV-1 patients without TB infection. A population of diverse quasispecies increases the viral capacity to evolve and adapt to the host immunological response. Furthermore, upon examination of the lung sites of M. tuberculosis infection of TB-HIV coinfected patients, Collins and others found greater genetic HIV-1 heterogeneity and distinct quasispecies in the pleural space compared to blood samples. While phylogenetically distinct HIV-1 subpopulations have been shown to develop in other organs or tracts in humans (i.e. kidneys, brain, urogenital tract and blood), compartmentalization of HIV-1 occurs most significantly and is more defined in the lungs of co-infected TB-HIV patients. Therefore, the lungs, induced by active tuberculosis disease, function as a reservoir for genetically diverse HIV-1. In addition to accelerating the disease progression of one another, their collision has highlighted underlying public health and human rights failures. Africa, although only home to 10% of the world’s population, is the major site of intersection between the two epidemics with an astounding 75% of the world’s TB-HIV coinfections. <a href="http://3.bp.blogspot.com/_HPCf_WV1x2U/Stoglhx4avI/AAAAAAAAAH4/i1JpJt8Niqg/s1600-h/AIDS_Pandemic_80B.jpg" rel="nofollow" target="_blank"></a> <blockquote>Figure 2. The disproportionate incidence of HIV and HIV-TB coinfection in Africa in 2000. Each person indicates 5% of the global population. The African population is shaded red while blue represents the rest of the world. From: Corbett, Elizabeth L, Barbara Marston, Gavin J. Churchyard, and Keven M. De Cock. “Tuberculosis in Sub-Saharan Africa: Opportunities, Challenges, and Change in the Era of Antiretroviral Treatment.” Lancet 367 (2006): 926-937.</blockquote> Thus, novel TB diagnostic tests are needed in HIV-endemic regions because HIV infection reduces the sensitivity of current diagnostic methods such as direct smear sputum microscopy. In terms of treatment, high pill burden and toxicity often discourage adherence among many coinfected patients. Furthermore, rifampicin, a common antibiotic component of tuberculosis chemotherapy disrupts antiretroviral treatment by accelerating the metabolism of both protease inhibitors and nonnucleoside reverse transcriptase inhibitors (NNRTs). Finally, if antiretroviral treatment of coinfected patients is started too soon after treatment for TB, a rapid recovery of CD4 T cell levels may induce an overwhelming inflammatory response against previously hidden opportunistic infections resulting <a>immune reconstitution inflammatory syndrome (IRIS)</a>. The connection between the biology of the two diseases is clear and complications are numerous. Thus, experts in HIV and experts in TB should respond accordingly and move towards greater collaboration and shared research. Until next, this is Justin Eusebio. For more information: Bartlett, John G. “Tuberculosis and HIV Infection: Partners in Human Tragedy.” Journal of Infectious Diseases 196 (2007): S124-5. Collins, Kalonji R., Miguel E. Quioñones-Mateu, Mianda Wu, Henry Luzze, John L. Johnson, Christina Hirsch, Zahra Toossi, and Eric J. Arts. “Human Immunodeficiency Virus Type 1 (HIV-1) Quasispecies at the Sites of Mycobacterium tuberculosis Infection Contribute to Systemic HIV-1 Heterogeneity.” Journal of Virology 76.4 (2002): 1697-1706. Collins, Kalonji R., Miguel E. Quioñones-Mateu, Zhara Toossi, and Eric J. Arts. “Impact of Tuberculosis on HIV-1 Replication, Diversity and Disease Progression.” AIDS Review 4 (2002): 165-176. Kalonji Collins et. al, “Greater diversity of HIV-1 quasispecies in HIV-infected individuals with active tuberculosis.” Journal of Acquired Immune Deficiency Syndrome 24, 408-417. Friedland, Gerald, Gavin J. Churchyard, and Edward Nardell. “Tuberculosis and HIV Coinfection: Current State of Knowledge and Research Priorities.” Journal of Infectious Diseases 196 (2007): S1-3. Manoff, SB, H Farzadegan, A Muñoz, JA Astemborski, D Vlahov, RT Rizzo, L Solomon, and NM Graham. “The Effect of Latent Mycobacterium tuberculosis infection on Human Immunodeficiency Virus (HIV) Disease Progression and HIV RNA Load Among Injecting Drug Users.” The Journal of Infectious Diseases 174.2 (1996): 299-308. Nunn, Paul, Alasdair Reid, Kevin De Cock. “Tuberculosis and HIV Infection: The Global Setting.” The Journal of Infectious Diseases 196 (2007): S5-14. Vignuzzi, Marco, Jeffrey K. Stone, Jamie J. Arnold, Craig E. Cameron, and Raul Andino. “Quasispecies Diversity Determines Pathogenesis through Cooperative Interactions within a Viral Population.” Nature 439.7074 (2006): 344-348.

Intersecting Epidemics: HIV/AIDS and Tuberculosis

Welcome to this installment of the AIDS Pandemic, a podcast hosted by Dave Wessner of the Department of Biology at Davidson College. I am Sarah Bertram. This past summer, I traveled to Mwandi, Zambia through a Davidson biology and pre-medical program. Mwandi is a predominantly Lozi village of about 7,000 people and the catchment area totals about 25,000 people. We spent 5 weeks in Africa, 3 of which were spent working in the Mwandi Mission Hospital, the Mwandi AIDS clinic, the Orphans and Vulnerable Children’s center, and the Mother and Child Health Center. We all went with a research topic to study that was based on some aspect of Mwandian life. I looked at Mwandi’s Prevention of Mother to Child Transmission of HIV, otherwise known as the PMTCT program, and its effectiveness over the past three years. Here, I will talk about my findings.     About out of every five pregnant women in Zambia is infected with HIV and without any prevention or treatment interventions, more than 300,000 babies would contract HIV from their mothers each year. Starting in 1999, many Zambian mission and government hospitals started PMTCT programs. The Mwandi PMTCT program was launched in 2005 by an American Pediatrician in conjunction with the Mwandi missionary who was going to serve as the leader of the program. The procedure for PMTCT at the Mwandi Mission Hospital is as follows: 1) discuss the PMTCT program and HIV/AIDS information during group antenatal care visits, 2) offer private pre-test counseling, 3) test the mother for HIV and CD4 counts and give her the results, and 4) offer post-test counseling and discuss further treatment and a re-test in three months. According to the hospital staff in Mwandi, HIV testing of any pregnant mother is required by law in Zambia.  If a woman tests positive, she is evaluated at the Pastoral Care Center for AIDS treatment. If she is considered a WHO stage IV or has multiple symptoms for WHO stage III, HAART treatment is usually started unless the woman chooses to undergo short-course treatment instead. Many of the HIV positive mothers choose to undergo HAART treatment because of its documented increased ability to treat HIV/AIDS symptoms and to lower the viral load by decreasing viral replication. The Mwandi hospital staff is good about giving options to the positive mothers and explaining each option and its risks and benefits. Due to the staff’s willingness to counsel and inform the HIV positive pregnant mothers of treatment options, a majority of these women decide to take part in a course of HIV/AIDS treatment in order to help themselves and to prevent the transmission of HIV to their babies.  Although record-keeping is sparse and sometimes hard to find and evaluate, some records for the PMTCT program proved helpful in evaluating the program’s success over the years. From March of 2005 to September of 2007 (before HIV testing was mandatory), 1,205 women attended an antenatal care appointment to sign up for the PMTCT program and of these 1,205 women, only 35 women or about 3% refused the HIV test. Of the 1,170 women who agreed to be tested, 24.4% tested positive for HIV. This statistic is quite high, but reflects the belief that about 1/3 to ¼ of Mwandi’s population is infected with HIV. Because the PMTCT program was in place, the HIV positive women were able to learn their status, get treatment, and prevent (for the most part) the transmission of HIV to their babies during pregnancy, delivery, and breastfeeding.  Mwandi’s PMTCT program has changed drug regimens in order to stay current with the most effective treatments. Originally, the program was based on a single dose of nevirapine given to the mother during delivery and to the baby right after birth. In April of 2006, the PMTCT program switched to a dual therapy involving both nevirapine and AZT for both mothers and babies. Starting in November of 2007, Mwandi updated its treatment regimen to the most current and effective triple therapy drug treatment. This drug therapy involves a mixture of AZT, 3TC, and NVP for the mother and baby. This new therapy has proven to be very effective and the PMTCT program workers approximate that transmission from mother-to-child rates have decreased to less than 10% and possibly even as low as 6% or 7%.  Possibly the most enticing aspect of the PMTCT program for pregnant women is the free formula feeding program provided to HIV-negative babies of HIV-positive mothers. Breastfeeding is the most common type of mother-to-child HIV transmission, so by providing free formula for those babies who test negative (after 6 weeks of age), the worry of transmission by breastfeeding can be alleviated. Currently there are over 100 babies receiving infant formula and most, but not all, are HIV-negative babies of HIV-positive mothers who participated in the PMTCT program. The program has never resulted in a case of child dysentery, a common negative outcome of formula feeding programs, which is often a result of incorrectly boiled water used to make the formula. This clean record is a result of the care and attention put forth into teaching the mothers how to correctly make the formula and clean the bottles.  Compared to many other Sub-Saharan African PMTCT programs, Mwandi’s program is doing a very good job of keeping the program advancing, as far as the number of women being treated and the updates to newer forms of drug therapies. The program could however still make larger strides in incorporating more women from far out in the catchment area and by possibly providing more rural village outreaches for the sole purpose of PMTCT.

Welcome to this installment of the AIDS Pandemic, a podcast hosted by <a href="http://www.bio.davidson.edu/people/dawessner" rel="nofollow" target="_blank">Dave Wessner</a> of the Department of Biology at Davidson College. I am Sarah Bertram. This past summer, I traveled to <a href="http://mwandi-mission.awardspace.com/Areainfo.html" rel="nofollow" target="_blank">Mwandi, Zambia</a> through a Davidson biology and pre-medical program. Mwandi is a predominantly Lozi village of about 7,000 people and the catchment area totals about 25,000 people. We spent 5 weeks in Africa, 3 of which were spent working in the <a href="http://mwandi-mission.awardspace.com/Hospital.html" rel="nofollow" target="_blank">Mwandi Mission Hospital</a>, the Mwandi AIDS clinic, the <a href="http://mwandi-mission.awardspace.com/OVC.html" rel="nofollow" target="_blank">Orphans and Vulnerable Children’s center</a>, and the Mother and Child Health Center. We all went with a research topic to study that was based on some aspect of Mwandian life. I looked at Mwandi’s Prevention of Mother to Child Transmission of HIV, otherwise known as the PMTCT program, and its effectiveness over the past three years. Here, I will talk about my findings. <a href="http://4.bp.blogspot.com/_HPCf_WV1x2U/SsY_vakGcmI/AAAAAAAAAHg/6uy-a2OtT-s/s1600-h/AIDS_Pandemic_79A.png" rel="nofollow" target="_blank"></a> About out of every five pregnant women in Zambia is infected with HIV and without any prevention or treatment interventions, more than 300,000 babies would contract HIV from their mothers each year. Starting in 1999, many Zambian mission and government hospitals started PMTCT programs. The Mwandi PMTCT program was launched in 2005 by an American Pediatrician in conjunction with the Mwandi missionary who was going to serve as the leader of the program. The procedure for PMTCT at the Mwandi Mission Hospital is as follows: 1) discuss the PMTCT program and HIV/AIDS information during group antenatal care visits, 2) offer private pre-test counseling, 3) test the mother for HIV and CD4 counts and give her the results, and 4) offer post-test counseling and discuss further treatment and a re-test in three months. According to the hospital staff in Mwandi, HIV testing of any pregnant mother is required by law in Zambia. If a woman tests positive, she is evaluated at the Pastoral Care Center for AIDS treatment. If she is considered a WHO stage IV or has multiple symptoms for<a href="http://www.avert.org/stages-hiv-aids.htm" rel="nofollow" target="_blank"> WHO stage III</a>, HAART treatment is usually started unless the woman chooses to undergo short-course treatment instead. Many of the HIV positive mothers choose to undergo HAART treatment because of its documented increased ability to treat HIV/AIDS symptoms and to lower the viral load by decreasing viral replication. The Mwandi hospital staff is good about giving options to the positive mothers and explaining each option and its risks and benefits. Due to the staff’s willingness to counsel and inform the HIV positive pregnant mothers of treatment options, a majority of these women decide to take part in a course of HIV/AIDS treatment in order to help themselves and to prevent the transmission of HIV to their babies. Although record-keeping is sparse and sometimes hard to find and evaluate, some records for the PMTCT program proved helpful in evaluating the program’s success over the years. From March of 2005 to September of 2007 (before HIV testing was mandatory), 1,205 women attended an antenatal care appointment to sign up for the PMTCT program and of these 1,205 women, only 35 women or about 3% refused the HIV test. Of the 1,170 women who agreed to be tested, 24.4% tested positive for HIV. This statistic is quite high, but reflects the belief that about 1/3 to ¼ of Mwandi’s population is infected with HIV. Because the PMTCT program was in place, the HIV positive women were able to learn their status, get treatment, and prevent (for the most part) the transmission of HIV to their babies during pregnancy, delivery, and breastfeeding. <a href="http://2.bp.blogspot.com/_HPCf_WV1x2U/SsY_-tGjrKI/AAAAAAAAAHo/lMLdxC-KgoQ/s1600-h/AIDS_Pandemic_79B.png" rel="nofollow" target="_blank"></a> Mwandi’s PMTCT program has changed drug regimens in order to stay current with the most effective treatments. Originally, the program was based on a single dose of nevirapine given to the mother during delivery and to the baby right after birth. In April of 2006, the PMTCT program switched to a dual therapy involving both nevirapine and AZT for both mothers and babies. Starting in November of 2007, Mwandi updated its treatment regimen to the most current and effective triple therapy drug treatment. This drug therapy involves a mixture of AZT, 3TC, and NVP for the mother and baby. This new therapy has proven to be very effective and the PMTCT program workers approximate that transmission from mother-to-child rates have decreased to less than 10% and possibly even as low as 6% or 7%. Possibly the most enticing aspect of the PMTCT program for pregnant women is the free formula feeding program provided to HIV-negative babies of HIV-positive mothers. Breastfeeding is the most common type of mother-to-child HIV transmission, so by providing free formula for those babies who test negative (after 6 weeks of age), the worry of transmission by breastfeeding can be alleviated. Currently there are over 100 babies receiving infant formula and most, but not all, are HIV-negative babies of HIV-positive mothers who participated in the PMTCT program. The program has never resulted in a case of child dysentery, a common negative outcome of formula feeding programs, which is often a result of incorrectly boiled water used to make the formula. This clean record is a result of the care and attention put forth into teaching the mothers how to correctly make the formula and clean the bottles. Compared to many other Sub-Saharan African PMTCT programs, Mwandi’s program is doing a very good job of keeping the program advancing, as far as the number of women being treated and the updates to newer forms of drug therapies. The program could however still make larger strides in incorporating more women from far out in the catchment area and by possibly providing more rural village outreaches for the sole purpose of PMTCT.

Preventing Mother to Child Transmission of HIV in Mwandi, Zambia- A Success

Momentum for the alternate HIV/AIDS explanation started in 1987 when Dr. Peter Duesberg, a professor of Molecular and Cell Biology at the University of California at Berkeley and initial demonstrator that the influenza virus has a segmented genome, published a paper claiming that HIV cannot be the cause of AIDS.   Four years later, a number of scientists formed “The Group for the Scientific Reappraisal of the HIV/AIDS Hypothesis” which later established itself as an official non-profit organization. Within another four years, 32 scientists with advanced medical degrees published a statement in Science asking for the reconsideration of the current HIV/AIDS theory.  Since this publishing, over 2,100 people have signed this statement. Should institutions acknowledge any concerns from this small, not-too-silent minority or are their claims completely unsubstantiated?  I’m Colby Uptegraft from Dr. Dave Wessner’s Biology of HIV/AIDS class at Davidson College, and while AIDS dissidents have many claims, I will present their arguments regarding HIV testing.  HIV critics rest a substantial amount of their theory on the problems with HIV tests. Currently, there are three main types of tests—antibody tests, antigen tests, and PCR tests.  Dissidents primarily scrutinize the antibody tests. HIV antibody tests begin with an enzyme-linked immunosorbent assay (ELISA).  A second test confirms a positive ELISA.  These secondary tests include Western blot assays, indirect immunoflorescence assays, line immunoassays, or a second ELISA.  When used in combination, these tests are 99.9% accurate in detecting HIV antibodies.According to Rebecca Culshaw, author of Science Sold Out: Does HIV Really Cause AIDS?, the flaws in antibody tests originate in the proteins initially used to define reactivity on ELISA and Western blots.  Before HIV had been isolated, scientists stimulated cell cultures from AIDS patients with mitogens to produce more proteins.  Researchers found 30 of these proteins to have densities characteristic of retroviruses and selected the 10 that most commonly reacted in blood from AIDS and pre-AIDS patients to be from HIV alone.  Do you see the circular logic?  Researchers assumed HIV caused AIDS and automatically attributed the 10 most common reactive proteins to HIV.  Positive test results may have a high correlation to developing AIDS, but according to Culshaw, they do not mean HIV is the cause.  HIV supporters ascribe her claims to outdated data. Robert Geraldo, a medical doctor working at the Cornell University hospital, added suspicion to these tests when he discovered that everyone reacts positive on the ELISA test for HIV.  Lab technicians typically use a 1:400 dilution of HIV-suspected serum samples for these tests.   Many antibody tests for other viruses such as hepatitis A and B, rubella, and syphilis use undiluted samples, and the ones that use dilutions such as the Epstein-Barr virus, use dilutions an order of magnitude less.  When Geraldo tested 100 undiluted samples, including his own blood, they all produced positive ELISA results.  When diluted 1:400, all specimens produced negative results.  He claims his results indicate that we all have antibodies to HIV or at least ones that will cross-react with ELISA tests.  AIDSTruth.org presents the counter argument.  One cannot compare antibody tests for other viruses to the HIV test.  All antibodies are unique and require different dilutions to eliminate false-positives resulting from non-specific binding.   The second HIV test detects antigens, substances that trigger generation of antibodies in organisms.  The most common HIV antigen that provokes an immune response is the protein p24.  According to Culshaw again, the dissidents assert that many AIDS patients do not have detectable levels of p24 and that many people without HIV infection produce positive p24 results.  However, the HIV hypothesis acknowledges the disappearance of p24 in the bloodstream as AIDS progresses, and states lab technicians can use the p24 antigen test in conjunction with other antigen or antibody tests to increase its accuracy.   The third and final family of HIV tests uses PCR to amplify minute levels of RNA or DNA to quantities sufficient for detection. However, Kary Mullis, the inventor of PCR technology, proclaims, “Quantitative PCR is an oxymoron” and believes PCR is not applicable to HIV detection.  PCR is too efficient in that it will amplify any DNA in a sample, whether it represents contamination or belongs to HIV.  Therefore, scientists cannot use PCR to ascertain HIV infection status or viral load, the number of DNA or RNA copies per milliliter of blood.  Even with these dissenting claims, the FDA approved these tests for monitoring the health of people with HIV and high statistical correlations exists between these tests and the onset and severity of AIDS. While believing in Bigfoot or that the Holocaust never happened provides entertainment to some, the conspiracies cannot sustain actual scientific inquiry.  The theory that HIV does not cause AIDS is not any different.  AIDS dissidents cling to small individual details and pull them out of context with the vast majority of HIV evidence and research.  In the case of HIV tests, critics ignore the use of multiple tests to predict HIV status and the combined accuracy of these tests in predicting the onset of AIDS and the causative nature of HIV. They instead focus upon the individual use of each test and make the illogical assertion that the unknowns in each are additive and cannot be used to support each other.   If you believe the United States never landed on the moon, then consider the arguments of the AIDS dissidents.  If you like reality, then stick with the traditional explanation.

Momentum for the alternate HIV/AIDS explanation started in 1987 when <a href="http://www.duesberg.com" rel="nofollow" target="_blank">Dr. Peter Duesberg</a>, a professor of Molecular and Cell Biology at the University of California at Berkeley and initial demonstrator that the influenza virus has a segmented genome, published a paper claiming that HIV cannot be the cause of AIDS. Four years later, a number of scientists formed “The Group for the Scientific Reappraisal of the HIV/AIDS Hypothesis” which later established itself as an official non-profit organization. Within another four years, 32 scientists with advanced medical degrees published <a href="http://rethinkingaids.com/Content/AboutRA/tabid/59/Default.aspx" rel="nofollow" target="_blank">a statement in Science</a> asking for the reconsideration of the current HIV/AIDS theory. Since this publishing, over 2,100 people have signed this statement. Should institutions acknowledge any concerns from this small, not-too-silent minority or are their claims completely unsubstantiated? I’m Colby Uptegraft from <a href="http://www.bio.davidson.edu/people/dawessner" rel="nofollow" target="_blank">Dr. Dave Wessner’s</a> Biology of HIV/AIDS class at Davidson College, and while AIDS dissidents have many claims, I will present their arguments regarding HIV testing. <a href="http://2.bp.blogspot.com/_HPCf_WV1x2U/Sa7y-NfBbzI/AAAAAAAAAG4/nHc3qwxXMxM/s1600-h/Science+sold+out.jpg" rel="nofollow" target="_blank"></a> HIV critics rest a substantial amount of their theory on the problems with HIV tests. Currently, there are <a href="http://www.avert.org/testing.htm" rel="nofollow" target="_blank">three main types of tests</a>—antibody tests, antigen tests, and PCR tests. Dissidents primarily scrutinize the antibody tests. HIV antibody tests begin with an enzyme-linked immunosorbent assay (ELISA). A second test confirms a positive ELISA. These secondary tests include Western blot assays, indirect immunoflorescence assays, line immunoassays, or a second ELISA. When used in combination, these tests are 99.9% accurate in detecting HIV antibodies. According to Rebecca Culshaw, author of Science Sold Out: Does HIV Really Cause AIDS?, the flaws in antibody tests originate in the proteins initially used to define reactivity on ELISA and Western blots. Before HIV had been isolated, scientists stimulated cell cultures from AIDS patients with mitogens to produce more proteins. Researchers found 30 of these proteins to have densities characteristic of retroviruses and selected the 10 that most commonly reacted in blood from AIDS and pre-AIDS patients to be from HIV alone. Do you see the circular logic? Researchers assumed HIV caused AIDS and automatically attributed the 10 most common reactive proteins to HIV. Positive test results may have a high correlation to developing AIDS, but according to Culshaw, they do not mean HIV is the cause. HIV supporters ascribe her claims to outdated data. Robert Geraldo, a medical doctor working at the Cornell University hospital, added suspicion to these tests when he discovered that <a href="http://www.robertogiraldo.com/eng/papers/EveryoneTestsPositive.html" rel="nofollow" target="_blank">everyone reacts positive</a> on the ELISA test for HIV. Lab technicians typically use a 1:400 dilution of HIV-suspected serum samples for these tests. Many antibody tests for other viruses such as hepatitis A and B, rubella, and syphilis use undiluted samples, and the ones that use dilutions such as the Epstein-Barr virus, use dilutions an order of magnitude less. When Geraldo tested 100 undiluted samples, including his own blood, they all produced positive ELISA results. When diluted 1:400, all specimens produced negative results. He claims his results indicate that we all have antibodies to HIV or at least ones that will cross-react with ELISA tests. <a href="http://www.aidstruth.org/new/denialism/denialists/giraldo-immunoassays" rel="nofollow" target="_blank">AIDSTruth.org</a> presents the counter argument. One cannot compare antibody tests for other viruses to the HIV test. All antibodies are unique and require different dilutions to eliminate false-positives resulting from non-specific binding. <a href="http://4.bp.blogspot.com/_HPCf_WV1x2U/Sa7zI74c--I/AAAAAAAAAHA/axk1jGq7JH8/s1600-h/Sandwich+ELISA.jpg" rel="nofollow" target="_blank"></a> The second HIV test detects antigens, substances that trigger generation of antibodies in organisms. The most common HIV antigen that provokes an immune response is the protein p24. According to Culshaw again, the dissidents assert that many AIDS patients do not have detectable levels of p24 and that many people without HIV infection produce positive p24 results. However, the HIV hypothesis acknowledges the disappearance of p24 in the bloodstream as AIDS progresses, and states lab technicians can use the p24 antigen test in conjunction with other antigen or antibody tests to increase its accuracy. The third and final family of HIV tests uses PCR to amplify minute levels of RNA or DNA to quantities sufficient for detection. However, <a href="http://www.karymullis.com" rel="nofollow" target="_blank">Kary Mullis</a>, the inventor of PCR technology, proclaims, “Quantitative PCR is an oxymoron” and believes <a href="http://www.virusmyth.com/aids/hiv/chjtests5.htm" rel="nofollow" target="_blank">PCR is not applicable</a> to HIV detection. PCR is too efficient in that it will amplify any DNA in a sample, whether it represents contamination or belongs to HIV. Therefore, scientists cannot use PCR to ascertain HIV infection status or viral load, the number of DNA or RNA copies per milliliter of blood. Even with these dissenting claims, the FDA approved these tests for monitoring the health of people with HIV and high statistical correlations exists between these tests and the onset and severity of AIDS. While believing in Bigfoot or that the Holocaust never happened provides entertainment to some, the conspiracies cannot sustain actual scientific inquiry. The theory that HIV does not cause AIDS is not any different. AIDS dissidents cling to small individual details and pull them out of context with the vast majority of HIV evidence and research. In the case of HIV tests, critics ignore the use of multiple tests to predict HIV status and the combined accuracy of these tests in predicting the onset of AIDS and the causative nature of HIV. They instead focus upon the individual use of each test and make the illogical assertion that the unknowns in each are additive and cannot be used to support each other. If you believe the United States never landed on the moon, then consider the arguments of the AIDS dissidents. If you like reality, then stick with the traditional explanation.

The Dissidents' Views of HIV Tests

More than twenty-five million people have died from AIDS since it was first recognized in 1981, making it one of the most destructive epidemics in history. It is undeniable however, that sub-Saharan Africa is the hardest hit and most affected area in the world. Of the global 2.9 million AIDS related deaths in 2007, 72% occurred in this area. AIDS has devastated the social and economic framework of societies in sub-Saharan Africa by mostly infecting people in the age group of 15-49, while 63% of the 40 million people living with HIV/AIDS today live in Sub-Saharan Africa. What is also startling is that, of the 2.9 million people who died from AIDS in 2007 one in seven was children. HIV/AIDS also has many indirect effects. Children of HIV positive parents compose the largest group of secondary sufferers. Africa is home to 95% of the world’s 13 million children orphaned as a result of AIDS. It is estimated that by 2010 a third of African children will be orphaned. Caring for these orphans has become a severe humanitarian disaster. With the rapidly increasing numbers it is difficult to care and provide for all of these children. However, the potential for these children to form a large group of dysfunctional adults, which could further destabilize societies already weakened by AIDS, has increased the urgency of finding an effective solution to the crisis. The response to the problem has been unsustainable given the number of children that need aide. In Zimbabwe, fewer than 4,000 orphans out of an estimated 800,000 are accommodated in the country’s 45 registered institutions. As an entire generation is being devastated by HIV/AIDS, major secondary effects are occurring on the children watching it all unfold. These impacts arise in a number of overlapping ways, including, economic consequences, changes in position of caregiver, education, nutrition, long term psychological effects, and even the likelihood of infection. What overarches all of these is how children psychologically process and respond to the stresses HIV/AIDS adds to their lives. It is important to focus on the psychological impact on a child who is forced to drop out of school, who must care for themselves and younger siblings, and face losing a parent or family member. These psychological effects are what lead children to destructive or with drawn behaviors that could make them more likely to become infected. If an attempt is made to better understand what these children are experiencing, it may be possible to reach them on a level that would help encourage them to protect themselves from the dangers of HIV/AIDS. A child’s age effects not only how they respond to and understand AIDS as a disease but in what ways they are most affected. Pre-school aged children show the primary effects on growth and health in relation to losing a caregiver. School-aged children show more effects related to loss of education and therefore the development of a vulnerability to internalization and anti-social behaviors. It appears in several studies that children over the age of ten years are most vulnerable to becoming orphaned, but are a group neither specifically targeted by many current programs nor institutions that house affected children. In these cases family, community, or school based intervention is essential.  The loss of a parent or loved one generally speaking is associated with psychological conditions including anxiety, rumination, depression, social isolation, survivor’s guilt and low self esteem. Mel Freeman, former director of Mental Health and Substance abuse in the South African Department of Health, states that children after losing a parent will have difficulties with modeling, boundary setting and development of value systems necessary for moral development; as well as the support, caring and discipline needed for emotional stability. If children have problems figuring out how to set boundaries and develop moral standards then it is likely they will also be at a higher risk for HIV infection. This secondary impact of HIV/AIDS is a catastrophic one because it will cause a whole new generation to be at an even higher risk and only further the HIV/AIDS epidemic. Orphaned children have an increased incidence of internalized psychological problems, and 34% of AIDS related orphans have contemplated suicide within the year after their parent or parents’ death.     In response to preventing the majority of psychological disorders and their related effects, the main goal is to postpone the death of a parent. When extending the life of the parents, you increase his or her chance to complete school and possess the proper mechanism to establish a sound value system. Nearly one half of children who lose a parent to HIV/AIDS drop out of school. This is a secondary impact that can be reduced by attempting to supply more infected people with ARV treatment that is both successful and easily attainable. It will both extend their life span and improve the quality of life for their children.

More than twenty-five million people have died from AIDS since it was first recognized in 1981, making it one of the most destructive epidemics in history. It is undeniable however, that sub-Saharan Africa is the hardest hit and most affected area in the world. Of the global 2.9 million AIDS related deaths in 2007, 72% occurred in this area. AIDS has devastated the social and economic framework of societies in sub-Saharan Africa by mostly infecting people in the age group of 15-49, while 63% of the 40 million people living with HIV/AIDS today live in Sub-Saharan Africa. What is also startling is that, of the 2.9 million people who died from <a href="http://www.unaids.org/en/" rel="nofollow" target="_blank">AIDS</a> in 2007 one in seven was children. HIV/AIDS also has many indirect effects. Children of HIV positive parents compose the largest group of secondary sufferers. Africa is home to 95% of the world’s 13 million children orphaned as a result of AIDS. It is estimated that by 2010 a third of African children will be orphaned. Caring for these orphans has become a severe humanitarian disaster. With the rapidly increasing numbers it is difficult to care and provide for all of these children. However, the potential for these children to form a large group of dysfunctional adults, which could further destabilize societies already weakened by AIDS, has increased the urgency of finding an effective solution to the crisis. The response to the problem has been unsustainable given the number of children that need aide. In <a href="http://www.bmj.com/cgi/content/full/324/7331/185" rel="nofollow" target="_blank">Zimbabwe</a>, fewer than 4,000 orphans out of an estimated 800,000 are accommodated in the country’s 45 registered institutions. As an entire generation is being devastated by HIV/AIDS, major secondary effects are occurring on the children watching it all unfold. These impacts arise in a number of overlapping ways, including, economic consequences, changes in position of caregiver, education, nutrition, long term psychological effects, and even the likelihood of infection. What overarches all of these is how children psychologically process and respond to the stresses HIV/AIDS adds to their lives. It is important to focus on the psychological impact on a child who is forced to drop out of school, who must care for themselves and younger siblings, and face losing a parent or family member. These psychological effects are what lead children to destructive or with drawn behaviors that could make them more likely to become infected. If an attempt is made to better understand what these children are experiencing, it may be possible to reach them on a level that would help encourage them to protect themselves from the dangers of HIV/AIDS. A child’s age effects not only how they respond to and understand AIDS as a disease but in what ways they are most affected. Pre-school aged children show the primary effects on growth and health in relation to losing a caregiver. School-aged children show more effects related to loss of education and therefore the development of a vulnerability to internalization and anti-social <a href="http://www.issafrica.org/Monographs/No109/Chap2.htm" rel="nofollow" target="_blank">behaviors</a>. It appears in several studies that children over the age of ten years are most vulnerable to becoming orphaned, but are a group neither specifically targeted by many current programs nor institutions that house affected children. In these cases family, community, or school based intervention is essential. The loss of a parent or loved one generally speaking is associated with psychological conditions including anxiety, rumination, depression, social isolation, survivor’s guilt and low self esteem. Mel Freeman, former director of Mental Health and Substance abuse in the South African Department of Health, states that children after losing a parent will have difficulties with modeling, boundary setting and development of value systems necessary for moral development; as well as the support, caring and discipline needed for emotional stability. If children have problems figuring out how to set boundaries and develop moral standards then it is likely they will also be at a higher risk for HIV infection. This secondary impact of HIV/AIDS is a catastrophic one because it will cause a whole new generation to be at an even higher risk and only further the HIV/AIDS epidemic. Orphaned children have an increased incidence of internalized psychological problems, and <a href="http://www.ncbi.nlm.nih.gov/pubmed/12061364" rel="nofollow" target="_blank">34% of AIDS related orphans have contemplated suicide</a> within the year after their parent or parents’ death. <a href="http://4.bp.blogspot.com/_HPCf_WV1x2U/SZ2I54ltI2I/AAAAAAAAAGk/nkg2Y6hgwEs/s1600-h/AIDS_Pandemic_77B.jpg" rel="nofollow" target="_blank"></a> In response to preventing the majority of psychological disorders and their related effects, the main goal is to postpone the death of a parent. When extending the life of the parents, you increase his or her chance to complete school and possess the proper mechanism to establish a sound value system. Nearly one half of children who lose a parent to HIV/AIDS drop out of school. This is a secondary impact that can be reduced by attempting to supply more infected people with ARV treatment that is both successful and easily attainable. It will both extend their life span and improve the quality of life for their children.

HIV/AIDS Orphans in Sub-Saharan Africa

Welcome to this installment of The AIDS pandemic, a podcast hosted by Dr. David Wessner from the Department of Biology at Davidson College. I’m Middleton Chang. Since 1987, the United States Department of Health and Human Services has imposed a travel ban on HIV-infected individuals, under the premise that HIV falls into their list of “dangerous and contagious” diseases which present a public health risk. The law specifically prohibited foreigners from immigrating or obtaining a travel visa to the United States. Activists had long decried the ban for several reasons, until this past summer. On July 30, 2008, President Bush signed into law a five-year, $48 billion bill to fight AIDS, malaria and tuberculosis around the world as well as lift the ban on HIV positive travelers. Yet the ban has still not actually been lifted. HIV/AIDS activists, at first praising the current administration are becoming impatient for an actual removal of the ban.HIV/AIDS activists originally declared the ban to be unnecessary and unfair. The ban was not codified into law however until 1993 during the Clinton Administration, much to the chagrin of activists. This legislation made HIV the only specific medical condition mentioned as grounds for inadmissibility to the United States. Activists argue that the ban was just another in a long string on US inconsistencies on HIV/AIDS policy. Helene Gayle, president of CARE, stated that the ban was not consistent with the international leadership role the United States has taken with PEPFAR (President’s Emergency Plan for AIDS relief). Experts at the International AIDS conference this past fall were full of praise for the new legislation lifting the travel ban. However, little has been done to actually lift the ban. In order to do so, the Department of Health and Human Services must write a new rule, submit it for public comment, and finalize it. The Bush Administration has moved with the speed of a rolling stone gathering moss on this issue. Last week 58 house Democrats submitted a letter to President Bush urging “swift action” on the issue.Due to the ban, no major AIDS conference has been held on US soil since 1993 as no activists or researchers infected with the virus may enter the country without embarking on a complicated waiver process. In 1991, 40,000 Haitian political refugees fled to the United States. Of these refugees, 158 were detained in Guantanamo Bay, Cuba due to the ban. For nearly twenty months, Guantanamo Bay hosted these 158 political refugees, due to either being HIV-positive, or a relative of one of the positive refugees. A court order was needed to force the Clinton Administration to close down the razor-wire encircled refugee camp setup in 1991 by the Bush Administration. Despite the fact President Bush has signed the bill mandating removal of the ban into law, HIV remains on the list of “dangerous and contagious” diseases that may prevent entry into the United States. Recently, the Department of Homeland Security released a revised and “streamlined” process for obtaining a waiver, making it easier to obtain the necessary paperwork. However, the Department of Heath and Human Services has still not removed HIV from the list of medical conditions which are grounds for exclusion from entering the United States.A study conducted in 2006 showed that of 1113 HIV positive survey respondents. 349 (31%) had traveled to the United States. Of those 349 that had traveled to the US, only 14.3% traveled with the mandatory waiver to obtain a travel visa. Many simply did not disclose their status. This study not only shows the inefficacy of the travel ban, but shows the harm presented to HIV positive individuals who desire to visit the United States. The study showed that patients on anti-retroviral therapy (212 patients) were more likely to go off their medication, increasing their chances of developing drug-resistant HIV strains or developing AIDS. The study concluded that people do so “with insufficient planning and advice.”Only about a dozen countries around the world maintain a travel ban on people living with HIV. These countries are: Iraq, China, Saudi Arabia, Libya, Sudan, Qatar, Brunei, Oman, Moldova, Russia, Armenia, and South Korea. Should the United States still include itself amongst these countries in discriminating against people living with HIV?Thanks for listening, until next time I’m Middleton Chang.For more information:Mahto  M, Ponnusamy  K, Schuhwerk  M, Richens  J, Lambert  N, Wilkins  E, Churchill  DR, Miller  RF, Behrens  RH.  “Knowledge, attitudes and health outcomes in HIV-infected travellers to the USA”. HIV Medicine  2006; 7: 201–204."Give me your tired, your poor,Your huddled masses yearning to breathe free,The wretched refuse of your teeming shore.Send these, the homeless, tempest-tost to me,I lift my lamp beside the golden door!"-An excerpt from The New Colossus, which hangs within the Statue’s Pedestal.

Welcome to this installment of The AIDS pandemic, a podcast hosted by <a href="http://www.bio.davidson.edu/people/dawessner" rel="nofollow" target="_blank">Dr. David Wessner</a> from the Department of Biology at Davidson College. I’m Middleton Chang. Since 1987, the United States <a href="http://www.hhs.gov" rel="nofollow" target="_blank">Department of Health and Human Services</a> has imposed a travel ban on HIV-infected individuals, under the premise that HIV falls into their list of “dangerous and contagious” diseases which present a public health risk. The law specifically prohibited foreigners from immigrating or obtaining a travel visa to the United States. Activists had long decried the ban for several reasons, until this past summer. On July 30, 2008, President Bush signed into law a five-year, $48 billion bill to fight AIDS, malaria and tuberculosis around the world as well as lift the ban on HIV positive travelers. Yet the ban has still not actually been lifted. HIV/AIDS activists, at first praising the current administration are becoming impatient for an actual removal of the ban. HIV/AIDS activists originally declared the ban to be unnecessary and unfair. The ban was not codified into law however until 1993 during the Clinton Administration, much to the chagrin of activists. This legislation made HIV the only specific medical condition mentioned as grounds for inadmissibility to the United States. Activists argue that the ban was just another in a long string on US inconsistencies on HIV/AIDS policy. Helene Gayle, president of <a href="http://www.care.org" rel="nofollow" target="_blank">CARE</a>, stated that the ban was not consistent with the international leadership role the United States has taken with PEPFAR (President’s Emergency Plan for AIDS relief). Experts at the International AIDS conference this past fall were full of praise for the new legislation lifting the travel ban. However, little has been done to actually lift the ban. In order to do so, the Department of Health and Human Services must write a new rule, submit it for public comment, and finalize it. The Bush Administration has moved with the speed of a rolling stone gathering moss on this issue. Last week 58 house Democrats submitted a letter to President Bush urging “swift action” on the issue. Due to the ban, no major AIDS conference has been held on US soil since 1993 as no activists or researchers infected with the virus may enter the country without embarking on a complicated waiver process. In 1991, 40,000 Haitian political refugees fled to the United States. Of these refugees, 158 were detained in Guantanamo Bay, Cuba due to the ban. For nearly twenty months, Guantanamo Bay hosted these 158 political refugees, due to either being HIV-positive, or a relative of one of the positive refugees. A court order was needed to force the Clinton Administration to close down the razor-wire encircled refugee camp setup in 1991 by the Bush Administration. Despite the fact President Bush has signed the bill mandating removal of the ban into law, HIV remains on the list of “dangerous and contagious” diseases that may prevent entry into the United States. Recently, the Department of Homeland Security released a revised and “streamlined” process for obtaining a <a href="http://www.dhs.gov/xnews/releases/pr_1222705590290.shtm" rel="nofollow" target="_blank">waiver</a>, making it easier to obtain the necessary paperwork. However, the Department of Heath and Human Services has still not removed HIV from the list of medical conditions which are grounds for exclusion from entering the United States. A study conducted in 2006 showed that of 1113 HIV positive survey respondents. 349 (31%) had traveled to the United States. Of those 349 that had traveled to the US, only 14.3% traveled with the mandatory waiver to obtain a travel visa. Many simply did not disclose their status. This study not only shows the inefficacy of the travel ban, but shows the harm presented to HIV positive individuals who desire to visit the United States. The study showed that patients on anti-retroviral therapy (212 patients) were more likely to go off their medication, increasing their chances of developing drug-resistant HIV strains or developing AIDS. The study concluded that people do so “with insufficient planning and advice.” Only about a dozen countries around the world maintain a travel ban on people living with HIV. These countries are: Iraq, China, Saudi Arabia, Libya, Sudan, Qatar, Brunei, Oman, Moldova, Russia, Armenia, and South Korea. Should the United States still include itself amongst these countries in discriminating against people living with HIV? Thanks for listening, until next time I’m Middleton Chang. For more information: <a href="http://www3.interscience.wiley.com/cgi-bin/fulltext/118567701/HTMLSTART" rel="nofollow" target="_blank">Mahto M, Ponnusamy K, Schuhwerk M, Richens J, Lambert N, Wilkins E, Churchill DR, Miller RF, Behrens RH. “Knowledge, attitudes and health outcomes in HIV-infected travellers to the USA”. HIV Medicine 2006; 7: 201–204.</a> <a href="http://1.bp.blogspot.com/_HPCf_WV1x2U/SZGwrph3gZI/AAAAAAAAAGU/T_genNRHieU/s1600-h/AIDS_Pandemic_76.jpg" rel="nofollow" target="_blank"></a> <blockquote>"Give me your tired, your poor, Your huddled masses yearning to breathe free, The wretched refuse of your teeming shore. Send these, the homeless, tempest-tost to me, I lift my lamp beside the golden door!" -An excerpt from The New Colossus, which hangs within the Statue’s Pedestal.</blockquote>

US Travel Ban on HIV-infected Individuals

Ryan White

I'm Utsha Khatri. The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, was the first piece of comprehensive AIDS legislation created to provide funding for people living with AIDS (PWAs) to access care and treatment.  Ryan White was a young, Caucasian hemophiliac who contracted HIV through a blood transfusion. He was diagnosed with AIDS at age thirteen and died six years later. Prior to the media’s coverage of the Ryan White story, it was widely held that HIV/AIDS only affected marginalized sectors of society namely homosexuals, intravenous drug users, and racial minorities. However, because of the widespread media attention given to the Ryan White story, the American people soon realized that this was not the case and that it could potentially infect anyone. When Ryan White’s story was put on the media agenda in 1985, it changed the meaning of HIV/AIDS for the media, the public and policymakers. Political scientist Mark Donavan explains that this shift in public consciousness allowed policy-makers to formulate an AIDS policy that would deliver benefits to what were considered “deserving” target populations. When people with AIDS were considered to be social deviants and dependents, policy-makers could not defend the use of tax dollars to provide care and treatment to these populations. However, when Americans realized that the HIV/AIDS epidemic started affecting “innocent victims” (whose infection was not caused by their behavior), policy-makers were able to create programs to provide benefits to a “deserving” population.  For this reason, Ryan White CARE Act bills passed both houses with overwhelming bipartisan support in 1990.Donavan emphasizes that during the drafting of the legislation, lawmakers attempted to, “downplay the receipt of benefits of gays while emphasizing the benefits granted to positively constructed populations, most notably children,”  During floor debates lawmakers told moving stories of people with AIDS to win over support for the bill. Of the 19 stories told on the Senate floor, only one story was that of a homosexual. Lawmakers needed to justify the act by ensuring each other and the public that the recipients of the benefits did in fact deserve it. Donavan describes the final version of the bill emphasized women and children as the “victims” of the epidemic and deemphasized the extent to which benefits would be delivered to negatively constructed groups. The bill did nonetheless provide benefits to populations with negative social constructions as well; however, to the public, the policy was directed towards helping populations with positive social constructions. The Ryan White CARE Act was first passed in 1990 as Congress’ attempt to financially assist many urban public hospitals that had not been compensated for care they provided to AIDS patients. It was reauthorized in 1996, 2000 and most recently in 2006. The reauthorization in 2006 changed the acceptable use of Ryan White funds. The amendments emphasized providing funding to urban areas with the highest prevalence of AIDS, encouraged outreach and testing and required that 75% of funding be spent on “core medical services.” Core medical services include services such medications, outpatient and ambulatory medical services, mental health services, substance abuse services, hospice care, early intervention services and home health care. Ryan White funds are also used for support services, including transportation, respite care, outreach and language services. The Ryan White program presents the third largest source of federal funding for HIV/AIDS care, after Medicaid and Medicare. Currently, it provides about $2.2 billion a year to fund over 2,500 organizations and provides some level of care to about 500,000 people living with HIV/AIDS. Unlike Medicaid and Medicare, it is not a health insurance program. It is a series of flexible grants given to cities, states, and other public and private nonprofit organizations to develop and operate systems that deliver health and support services to uninsured or underinsured individuals affected by HIV/AIDS. Though the CARE Act was originally designed to fill the gaps in financing care, it has now grown into a major source of funding essential to the operation of HIV/AIDS programs across the country. The reauthorization in 2006 extended the program for an additional three years. After September 30, 2009 further legislative action will be needed to provide continued federal funding. It is important to recognize that the program by itself is not capable of improving access to HIV/AIDS care and treatment for the majority of the infected population. The CARE Act is a discretionary grant program that receives annual appropriations from Congress. Services are provided only as long as the finite funds last. Therefore, it is not able to meet the rising demands in services due to the growing number of people living with HIV/AIDS.  Furthermore, CARE Act programs vary from region to region due to the flexibility given to organizations in formulating programs and services. The programs therefore do not provide a single, unified policy solution to a national problem. Rebecca Haag, Executive Director of the AIDS Action Council, while expressing appreciation for the 2006 reauthorization, stressed the need of more funding. As Haag described, “…this bill alone is not sufficient to ensure that life saving drugs and medical treatment is available to all who are infected. Appropriations have fallen far short over the last several years while the epidemic is growing with 40,000 new infections every year.”

I'm Utsha Khatri. The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, was the first piece of comprehensive AIDS legislation created to provide funding for people living with AIDS (PWAs) to access care and treatment. Ryan White was a young, Caucasian hemophiliac who contracted HIV through a blood transfusion. He was diagnosed with AIDS at age thirteen and died six years later. Prior to the media’s coverage of the Ryan White story, it was widely held that HIV/AIDS only affected marginalized sectors of society namely homosexuals, intravenous drug users, and racial minorities. However, because of the widespread media attention given to the Ryan White story, the American people soon realized that this was not the case and that it could potentially infect anyone. When Ryan White’s story was put on the media agenda in 1985, it changed the meaning of HIV/AIDS for the media, the public and policymakers. Political scientist Mark Donavan explains that this shift in public consciousness allowed policy-makers to formulate an AIDS policy that would deliver benefits to what were considered “deserving” target populations. When people with AIDS were considered to be social deviants and dependents, policy-makers could not defend the use of tax dollars to provide care and treatment to these populations. However, when Americans realized that the HIV/AIDS epidemic started affecting “innocent victims” (whose infection was not caused by their behavior), policy-makers were able to create programs to provide benefits to a “deserving” population. For this reason, Ryan White CARE Act bills passed both houses with overwhelming bipartisan support in 1990. Donavan emphasizes that during the drafting of the legislation, lawmakers attempted to, “downplay the receipt of benefits of gays while emphasizing the benefits granted to positively constructed populations, most notably children,” During floor debates lawmakers told moving stories of people with AIDS to win over support for the bill. Of the 19 stories told on the Senate floor, only one story was that of a homosexual. Lawmakers needed to justify the act by ensuring each other and the public that the recipients of the benefits did in fact deserve it. Donavan describes the final version of the bill emphasized women and children as the “victims” of the epidemic and deemphasized the extent to which benefits would be delivered to negatively constructed groups. The bill did nonetheless provide benefits to populations with negative social constructions as well; however, to the public, the policy was directed towards helping populations with positive social constructions. The Ryan White CARE Act was first passed in 1990 as Congress’ attempt to financially assist many urban public hospitals that had not been compensated for care they provided to AIDS patients. It was reauthorized in 1996, 2000 and most recently in 2006. The reauthorization in 2006 changed the acceptable use of Ryan White funds. The amendments emphasized providing funding to urban areas with the highest prevalence of AIDS, encouraged outreach and testing and required that 75% of funding be spent on “core medical services.” Core medical services include services such medications, outpatient and ambulatory medical services, mental health services, substance abuse services, hospice care, early intervention services and home health care. Ryan White funds are also used for support services, including transportation, respite care, outreach and language services. The Ryan White program presents the third largest source of federal funding for HIV/AIDS care, after Medicaid and Medicare. Currently, it provides about $2.2 billion a year to fund over 2,500 organizations and provides some level of care to about 500,000 people living with HIV/AIDS. Unlike Medicaid and Medicare, it is not a health insurance program. It is a series of flexible grants given to cities, states, and other public and private nonprofit organizations to develop and operate systems that deliver health and support services to uninsured or underinsured individuals affected by HIV/AIDS. Though the CARE Act was originally designed to fill the gaps in financing care, it has now grown into a major source of funding essential to the operation of HIV/AIDS programs across the country. The reauthorization in 2006 extended the program for an additional three years. After September 30, 2009 further legislative action will be needed to provide continued federal funding. It is important to recognize that the program by itself is not capable of improving access to HIV/AIDS care and treatment for the majority of the infected population. The CARE Act is a discretionary grant program that receives annual appropriations from Congress. Services are provided only as long as the finite funds last. Therefore, it is not able to meet the rising demands in services due to the growing number of people living with HIV/AIDS. Furthermore, CARE Act programs vary from region to region due to the flexibility given to organizations in formulating programs and services. The programs therefore do not provide a single, unified policy solution to a national problem. Rebecca Haag, Executive Director of the AIDS Action Council, while expressing appreciation for the 2006 reauthorization, stressed the need of more funding. As Haag described, “…this bill alone is not sufficient to ensure that life saving drugs and medical treatment is available to all who are infected. Appropriations have fallen far short over the last several years while the epidemic is growing with 40,000 new infections every year.”

Ryan White CARE Act

In this podcast, students of Davidson College and I will explore the biology of HIV/AIDS, its history, and review the latest scientific advances related to this pandemic.

It all began with a 1994 study that showed antiretrovirals given to HIV-positive pregnant women before and during childbirth – as well as to the child upon delivery – reduced the risk of mother-to-child HIV transmission by 50%.  Next were the post-exposure prophylaxis guidelines issued by the Center for Disease Control and Prevention in 1998, recommending an antiretroviral regimen for healthcare workers after unintended HIV exposure.  Then, 2006 brought exciting data gleaned from a study of monkeys who remained uninfected after repeated exposure to a HIV-like virus as a result of taking the antiretroviral drugs tenofovir and emtrictabine.  These studies raised the question: Can drugs prevent HIV? After recent unimpressive results in vaccine and microbicide tests, scientists’ leading hope for stopping HIV infection before it starts seeks to answer that question with pre-exposure prophylaxis, or PrEP. By the middle of next year, close to 15,000 individuals will be enrolled in PrEP trials. That’s more people than all HIV vaccine and microbicide trials combined.  In the PrEP approach, an oral antiretroviral agent (specifically, Viread or Truvada) is taken daily to prevent HIV infection.  In theory, this method inhibits HIV replication and permanent infection from the moment the virus enters the body.  If proven safe and effective, PrEP could significantly reduce the risk of HIV infection for high-risk individuals all over the world.  It would be particularly advantageous for individuals in serodiscordant relationships as well as those unable to negotiate other proven protective measures such as condom use.  Perhaps most importantly, PrEP would represent the first female-initiated intervention method. Currently, three studies conducted by the CDC are underway to test the safety and effectiveness of PrEP.  In Thailand, injection drug users are using once-daily Viread.  In Botswana, young heterosexual men and women are taking once daily Truvada, and in the US, once-daily Viread is being tested among men who have sex with men.  PrEP is quickly becoming a reality.  Over the course of 7 years, the CDC will spend an estimated $53 million researching PrEP.  Most importantly, the CDC has recently urged public health leaders to begin planning for PrEP implementation.  The time has come to discuss the optimal use and delivery of PrEP if found effective.  PrEP raises particularly challenging questions that need attention now.  How will we ensure that individuals use PrEP in concert with other proven preventative strategies?  Some people may refuse to use condoms if they learn that their partner is taking PrEP and, theoretically, protected from HIV transmission.  No single strategy will likely be 100% effective against HIV infection, and reducing transmission will require integration of all biomedical and behavioral methods.  How will healthcare providers ensure that PrEP is used before exposure, and not after infection, to prevent drug-resistant HIV?  Who exactly would be prescribed PrEP?  Would people be required to prove that they are at "high risk," and if so, will that lead to their being stigmatized?  What will happen if an individual disregards instructions for daily use and takes the pill before a night on the town?  Will this ineffective so-called “disco dosing” become rampant?  Already, rumors are emerging of new drug cocktails of Truvada, Viread, Viagra and Ecstasy that are being sold in gay dance clubs.Clearly, this new strategy will not be a panacea for the difficult issues involved in the HIV pandemic, including stigma, the sexuality of young people, drug use, homophobia and the sex industry.  PrEP may one day be an important response to AIDS, but that response will never be equitable nor ultimately successful unless we begin planning for it now.I’m Charlotte Steelman.  Thanks for listening.

It all began with a <a href="http://content.nejm.org/cgi/content/full/331/18/1173" rel="nofollow" target="_blank">1994 study</a> that showed antiretrovirals given to HIV-positive pregnant women before and during childbirth – as well as to the child upon delivery – reduced the risk of mother-to-child HIV transmission by 50%. Next were the <a href="http://wonder.cdc.gov/wonder/prevguid/m0052722/m0052722.asp" rel="nofollow" target="_blank">post-exposure prophylaxis guidelines</a> issued by the Center for Disease Control and Prevention in 1998, recommending an antiretroviral regimen for healthcare workers after unintended HIV exposure. Then, 2006 brought exciting data gleaned from a study of monkeys who remained uninfected after repeated exposure to a HIV-like virus as a result of taking the antiretroviral drugs tenofovir and emtrictabine. These studies raised the question: Can drugs prevent HIV? After recent unimpressive results in vaccine and microbicide tests, scientists’ leading hope for stopping HIV infection before it starts seeks to answer that question with pre-exposure prophylaxis, or PrEP. By the middle of next year, close to 15,000 individuals will be enrolled in PrEP trials. That’s more people than all HIV vaccine and microbicide trials combined. In the PrEP approach, an oral antiretroviral agent (specifically, Viread or Truvada) is taken daily to prevent HIV infection. In theory, this method inhibits HIV replication and permanent infection from the moment the virus enters the body. If proven safe and effective, PrEP could significantly reduce the risk of HIV infection for high-risk individuals all over the world. It would be particularly advantageous for individuals in serodiscordant relationships as well as those unable to negotiate other proven protective measures such as condom use. Perhaps most importantly, PrEP would represent the first female-initiated intervention method. Currently, <a href="http://www.cdc.gov/hiv/resources/qa/TrialDesign.htm#TD1" rel="nofollow" target="_blank">three studies conducted by the CDC</a> are underway to test the safety and effectiveness of PrEP. In Thailand, injection drug users are using once-daily Viread. In Botswana, young heterosexual men and women are taking once daily Truvada, and in the US, once-daily Viread is being tested among men who have sex with men. PrEP is quickly becoming a reality. Over the course of 7 years, the CDC will spend an estimated $53 million researching PrEP. Most importantly, the CDC has recently urged public health leaders to begin planning for PrEP implementation. The time has come to discuss the optimal use and delivery of PrEP if found effective. PrEP raises particularly challenging questions that need attention now. How will we ensure that individuals use PrEP in concert with other proven preventative strategies? Some people may refuse to use condoms if they learn that their partner is taking PrEP and, theoretically, protected from HIV transmission. No single strategy will likely be 100% effective against HIV infection, and reducing transmission will require integration of all biomedical and behavioral methods. How will healthcare providers ensure that PrEP is used before exposure, and not after infection, to prevent drug-resistant HIV? Who exactly would be prescribed PrEP? Would people be required to prove that they are at "high risk," and if so, will that lead to their being stigmatized? What will happen if an individual disregards instructions for daily use and takes the pill before a night on the town? Will this ineffective so-called “disco dosing” become rampant? Already, rumors are emerging of new drug cocktails of Truvada, Viread, Viagra and Ecstasy that are being sold in gay dance clubs. Clearly, this new strategy will not be a panacea for the difficult issues involved in the HIV pandemic, including stigma, the sexuality of young people, drug use, homophobia and the sex industry. PrEP may one day be an important response to AIDS, but that response will never be equitable nor ultimately successful unless we begin planning for it now. I’m Charlotte Steelman. Thanks for listening.

Time to Prepare for “PrEP”

72% of the 5.5 million South Africans who are HIV-positive are in need of antiretroviral (ARV) drug treatment.  In leading the movement against ARV drugs, recently removed South African President Thabo Mbeki denied millions of his people HIV treatment.  He believes that the AIDS pandemic was created by Western pharmaceutical companies to take advantage of Africans and maximize their profits.  Mbeki also sides with dissident scientists in denying that the HIV virus causes AIDS and in 2003 he was quoted as saying, “Personally, I don’t know anybody who has died of AIDS” and when asked if he knew anyone infected with HIV he responded, “I really, honestly don’t”.  Mbeki’s views opposing antiretroviral drugs were echoed by his Health Minister, Manto Tshabalala-Msimang, more commonly known as “Dr. Garlic”, who promotes garlic, olive oil, beetroot, and African potatoes as a cure for AIDS.  Because the South African government has been reluctant to supply its people with antiretroviral drugs, HIV/AIDS activist groups, such at the Treatment Action Campaign (TAC), have been instrumental in the push to allow the distribution of these drugs.  It was not until 2004 that the South African government, pressured by HIV/AIDS activist groups, finally began to provide ARVs for its people.  It also took a Constitutional Court battle and much lobbying from the TAC to compel the Health Department to allow the administration of AZT and nevirapine to HIV-positive pregnant women to prevent mother-to-child transmission of the virus.  However, the recent resignation of Mbeki as President of South Africa and the September 25th appointment of the ruling African National Congress (ANC) deputy head Kgaleme Motlanthe as interim president, give HIV/AIDS activists hope for change.  His first day in office, Motlanthe demoted “Dr. Garlic” to a less important Cabinet position and appointed Barbara Hogan, a senior ANC member of Parliament, as Minister of Health and Dr. Molefi Sefularo as Deputy Minister of Health.  The TAC applauded Motlanthe’s change in administration and issued a statement in support of the new appointees.  The TAC credits Hogan as being “one of the few Members of Parliament to speak out against AIDS denialism and to offer support to the TAC” and cites Dr. Sefularo as supporting “ARV rollout and the implementation of the Prevention of Mother to Child Transmission” at Health of North West Province.  Hogan has already promised to “champion the issue” of the government increasing spending on providing ARVs to HIV-positive individuals.  In an interview just hours before being sworn into office, Hogan was quoted as saying, “I would thoroughly endorse the roll-out of anti-retrovirals and any way that we can accelerate that, the better”.    Looking ahead to the next president’s administration, in the most recent edition of the ANC newsletter Jacob Zuma, current ANC President the expected future South African President, is quoted as wanting “more action with regards to the reduction of HIV infections…widespread HIV prevention, treatment and support programmes”.  Yet, Zuma’s infamous statement during his 2006 rape trial that he showered after intercourse with a HIV-positive woman to minimize the risk of becoming infected lingers in the back of my mind.  I question that how such change can be implemented when South African government officials still need to be educated about how HIV is transmitted and how to reduce their risk of infection.

72% of the 5.5 million South Africans who are HIV-positive are in need of antiretroviral (ARV) drug treatment. In leading the movement against ARV drugs, recently removed South African President Thabo Mbeki denied millions of his people HIV treatment. He believes that the AIDS pandemic was created by Western pharmaceutical companies to take advantage of Africans and maximize their profits. <a href="http://news.bbc.co.uk/2/hi/africa/3143850.stm" rel="nofollow" target="_blank">Mbeki</a> also sides with dissident scientists in denying that the HIV virus causes AIDS and in 2003 he was quoted as saying, “Personally, I don’t know anybody who has died of AIDS” and when asked if he knew anyone infected with HIV he responded, “I really, honestly don’t”. Mbeki’s views opposing antiretroviral drugs were echoed by his Health Minister, Manto Tshabalala-Msimang, more commonly known as “Dr. Garlic”, who promotes garlic, olive oil, beetroot, and African potatoes as a cure for AIDS. Because the South African government has been reluctant to supply its people with antiretroviral drugs, HIV/AIDS activist groups, such at the <a href="http://www.tac.org.za/community/" rel="nofollow" target="_blank">Treatment Action Campaign (TAC)</a>, have been instrumental in the push to allow the distribution of these drugs. It was not until 2004 that the South African government, pressured by HIV/AIDS activist groups, finally began to provide ARVs for its people. It also took a Constitutional Court battle and much lobbying from the TAC to compel the Health Department to allow the administration of AZT and nevirapine to HIV-positive pregnant women to prevent mother-to-child transmission of the virus. However, the recent resignation of Mbeki as President of South Africa and the September 25th appointment of the ruling African National Congress (ANC) deputy head Kgaleme Motlanthe as interim president, give HIV/AIDS activists hope for change. His first day in office, Motlanthe demoted “Dr. Garlic” to a less important Cabinet position and appointed Barbara Hogan, a senior ANC member of Parliament, as Minister of Health and Dr. Molefi Sefularo as Deputy Minister of Health. The TAC applauded Motlanthe’s change in administration and issued a <a href="http://www.tac.org.za/community/node/2414" rel="nofollow" target="_blank">statement</a> in support of the new appointees. The TAC credits Hogan as being “one of the few Members of Parliament to speak out against AIDS denialism and to offer support to the TAC” and cites Dr. Sefularo as supporting “ARV rollout and the implementation of the Prevention of Mother to Child Transmission” at Health of North West Province. Hogan has already promised to “champion the issue” of the government increasing spending on providing ARVs to HIV-positive individuals. In <a href="http://www.news24.com/News24/QA/0,,2-2377_2400124,00.html" rel="nofollow" target="_blank">an interview</a> just hours before being sworn into office, Hogan was quoted as saying, “I would thoroughly endorse the roll-out of anti-retrovirals and any way that we can accelerate that, the better”. Looking ahead to the next president’s administration, in the most recent edition of the <a href="http://www.anc.org.za/ancdocs/anctoday/2008/at39.htm" rel="nofollow" target="_blank">ANC newsletter</a> Jacob Zuma, current ANC President the expected future South African President, is quoted as wanting “more action with regards to the reduction of HIV infections…widespread HIV prevention, treatment and support programmes”. Yet, Zuma’s infamous statement during his 2006 rape trial that he showered after intercourse with a HIV-positive woman to minimize the risk of becoming infected lingers in the back of my mind. I question that how such change can be implemented when South African government officials still need to be educated about how HIV is transmitted and how to reduce their risk of infection.

New Leadership in South Africa brings hope for AIDS Reform

Today is the 20th annual World AIDS Day, a day set aside to remember those who have died of HIV/AIDS and those who are living with HIV/AIDS. It’s also a day to remind ourselves that we all are affected by this disease. Today, many of us are wearing red ribbon pins. Many of us have placed red ribbon photos on social networking sites. Many of us will be attending HIV/AIDS breakfasts or seminars. Many of us are blogging about HIV/AIDS.Do any of these events really matter? Roughly 35 million people worldwide are infected. 14,000 people become newly infected every day. Will wearing a red ribbon or attending a breakfast change that? Sometimes, the pessimist in me says no. But then I look around at the various activities going on and think differently. Never underestimate the power of small actions. Never underestimate the power of one.At Davidson College, groups of students are making a difference. For several years now, the members of Warner Hall, a women’s eating house at Davidson, have hosted the Red and Black Ball, a charity event for HIV/AIDS. This year, the proceeds will benefit Metrolina AIDS Project in Charlotte and ThyatiraHospital in Mwandi. The members of Warner Hall also help Metrolina AIDS Project in other ways. Recently, I joined them on a Saturday morning to make condom packets – small bags containing condoms and information about getting tested for HIV – to be distributed at local bars and clubs.Students at Davidson College make condom packets for Metrolina AIDS ProjectThis effort, though, is not solely an extracurricular activity. In a mutually beneficial partnership, the students in my Biology course on HIV/AIDS cooperate with Warner Hall on some of these projects. Together, we have sponsored screenings of movies like 3 Needles, volunteered at a local HIV/AIDS benefit triathlon, collected toys for the annual Metrolina AIDS Project holiday party, and organized speakers and symposia. Academic and extracurricular activities are wonderfully joined.Volunteers getting ready for their assignments at a triathlon to benefit Metrolina AIDS ProjectNone of these events, individually or even in total, will end the AIDS Pandemic. But each and every one of these events does make a difference. Maybe one person will receive a condom packet and, as a result, not become infected. Maybe the money sent to Mwandi will help provide care for a child in need. Maybe one person who listens to a seminar will enter a career of public service. Maybe all of us will be a little more aware.Today, I’m wearing my red ribbon. Today, I’m blogging about HIV/AIDS. Today, I’m attending an HIV/AIDS breakfast. Today, in some small way, some almost imperceptible way, I’m making a difference. We all can make a difference. Never underestimate the power of one.      

Today is the 20th annual World AIDS Day, a day set aside to remember those who have died of HIV/AIDS and those who are living with HIV/AIDS. It’s also a day to remind ourselves that we all are affected by this disease. Today, many of us are wearing red ribbon pins. Many of us have placed red ribbon photos on social networking sites. Many of us will be attending HIV/AIDS breakfasts or seminars. Many of us are blogging about HIV/AIDS. Do any of these events really matter? Roughly 35 million people worldwide are infected. 14,000 people become newly infected every day. Will wearing a red ribbon or attending a breakfast change that? Sometimes, the pessimist in me says no. But then I look around at the various activities going on and think differently. Never underestimate the power of small actions. Never underestimate the power of one. At <a href="http://www.davidson.edu" rel="nofollow" target="_blank">Davidson College</a>, groups of students are making a difference. For several years now, the members of Warner Hall, a women’s eating house at Davidson, have hosted the Red and Black Ball, a charity event for HIV/AIDS. This year, the proceeds will benefit <a href="http://www.metrolinaaidsproject.org" rel="nofollow" target="_blank">Metrolina AIDS Project</a> in Charlotte and Thyatira Hospital in Mwandi. The members of Warner Hall also help Metrolina AIDS Project in other ways. Recently, I joined them on a Saturday morning to make condom packets – small bags containing condoms and information about getting tested for HIV – to be distributed at local bars and clubs. <a href="http://1.bp.blogspot.com/_HPCf_WV1x2U/STQUk6BD7TI/AAAAAAAAAF0/7pDG_FCGD_k/s1600-h/IMG_0271.JPG" rel="nofollow" target="_blank"></a> <blockquote>Students at Davidson College make condom packets for Metrolina AIDS Project</blockquote>This effort, though, is not solely an extracurricular activity. In a mutually beneficial partnership, the students in my <a href="http://www.bio.davidson.edu/people/dawessner/361HIV/Syllabus.html" rel="nofollow" target="_blank">Biology course on HIV/AIDS</a> cooperate with Warner Hall on some of these projects. Together, we have sponsored screenings of movies like 3 Needles, volunteered at a local HIV/AIDS benefit triathlon, collected toys for the annual Metrolina AIDS Project holiday party, and organized speakers and symposia. Academic and extracurricular activities are wonderfully joined. <a href="http://2.bp.blogspot.com/_HPCf_WV1x2U/STQU9NybouI/AAAAAAAAAF8/JhS-kdSiAc0/s1600-h/IMG_0109.JPG" rel="nofollow" target="_blank"></a> <blockquote>Volunteers getting ready for their assignments at a triathlon to benefit Metrolina AIDS Project</blockquote>None of these events, individually or even in total, will end the AIDS Pandemic. But each and every one of these events does make a difference. Maybe one person will receive a condom packet and, as a result, not become infected. Maybe the money sent to Mwandi will help provide care for a child in need. Maybe one person who listens to a seminar will enter a career of public service. Maybe all of us will be a little more aware. Today, I’m wearing my red ribbon. Today, I’m blogging about HIV/AIDS. Today, I’m attending an HIV/AIDS breakfast. Today, in some small way, some almost imperceptible way, I’m making a difference. We all can make a difference. Never underestimate the power of one. <a href="http://feeds.feedburner.com/~ff/TheAidsPandemic?a=QQO0Rn0N__I:X81aSiJN1rw:yIl2AUoC8zA" rel="nofollow" target="_blank"></a> <a href="http://feeds.feedburner.com/~ff/TheAidsPandemic?a=QQO0Rn0N__I:X81aSiJN1rw:63t7Ie-LG7Y" rel="nofollow" target="_blank"></a> <a href="http://feeds.feedburner.com/~ff/TheAidsPandemic?a=QQO0Rn0N__I:X81aSiJN1rw:dnMXMwOfBR0" rel="nofollow" target="_blank"></a> <a href="http://feeds.feedburner.com/~ff/TheAidsPandemic?a=QQO0Rn0N__I:X81aSiJN1rw:F7zBnMyn0Lo" rel="nofollow" target="_blank"></a> <a href="http://feeds.feedburner.com/~ff/TheAidsPandemic?a=QQO0Rn0N__I:X81aSiJN1rw:V_sGLiPBpWU" rel="nofollow" target="_blank"></a> <a href="http://feeds.feedburner.com/~ff/TheAidsPandemic?a=QQO0Rn0N__I:X81aSiJN1rw:qj6IDK7rITs" rel="nofollow" target="_blank"></a>

World AIDS Day – The Power of One

In a recent episode of the television show South Park, one of the main characters is infected with HIV.  In an attempt to find a cure, he must continually deal with the public opinion that AIDS is no longer a threatening condition.  He is told that his disease is “a disease of the 80s and 90s” and even that he is “retro” for being infected with HIV.  But has this retrovirus truly become retro to Americans?  If we take South Park as a social barometer, then it seems that the disease has been marginalized in the public eye.  Public interest on the Internet regarding AIDS is declining as well.  A recent government blog about Google search hits for the terms “HIV” or “AIDS” shows a declining trend over the past four years.  Each year, fewer people searched for the terms “HIV” or “AIDS” on December 1st (World AIDS day) than the previous year.  Why has the US public marginalized this disease, which twenty years ago was the terror of the nation?Searches for “AIDS” and “HIV” have decreased for four years running now.  Have Americans stopped caring about this disease?  Photo courtesy of Google, Inc.A simple reason may be that the media sensationalism of the disease has settled down.  As people become accustomed to news, it ceases to be news, no matter how horrible the reality of the situation may be.  The early media coverage of the AIDS epidemic focused on the fact that the disease seemed to infect only gay men.  Some even believed that AIDS was the punishment for the lifestyles of gay men, and AIDS became known as the “gay cancer” by many after its initial discovery.  In this way, AIDS aided U.S. society in demonizing the gay population in the early 1980s.  AIDS was deemed a gay problem, and the rest of society could forget about it.  Ryan White’s struggle against the disease helped dispel some of these myths, but many fallacies have persisted regardless, even to the present day.  Many choose to ignore the AIDS epidemic, as they believe that they will not come in contact with the disease if they are not homosexual. AIDS may also be ignored because its prevalence in the U.S. is perceived to be decreasing.  In South Park, the public seems surprised when the main character is newly infected with AIDS.  In many regions of the U.S., taboo prevents open discussion about AIDS, and if people aren’t hearing about a problem, they tend to imagine that it is going away.  In reality, 56,000 new cases of AIDS are diagnosed in the U.S. every year.  This figure only represents the number of cases detected; the true occurrence is likely higher.  Why does the public believe, then, that AIDS is on the decline?The apparent decrease of infection rate is caused by the fact that infected individuals generally live longer and healthier lives than they would have in the 80s, when the average lifespan following diagnosis was approximately three months.  This fact is largely due to the success of many drugs in delaying the onset of AIDS after exposure to HIV.  AIDS advocates are victims of their own success, then, as the myth has arisen that AIDS will no longer kill infected individuals.  This belief is wrong; AIDS is a lethal disease.  Drugs do a great deal these days to slow its progress, but HIV has the uncanny ability to develop resistance to these drugs and overwhelm the body’s immune system, which invariably leads to death.One additional aspect of fading public interest in AIDS, sadly enough, may be the lack of infection of a public figure. The movie star Rock Hudson was a famous AIDS victim in his time, and his death helped shock the nation into action against HIV.  Rock Hudson is relatively unknown by today’s youth, who grew up after the passing of the star.  These days, when most people think of celebrities with AIDS, Magic Johnson is the first name that pops to mind.  This former basketball superstar retired after being diagnosed with HIV and began working towards a cure for the deadly virus.  Indeed, in the South Park episode, the character with AIDS must travel to find Magic Johnson who may have the cure for AIDS.  Magic Johnson faded from public view when his basketball career ended.  The fact that no Hollywood star or public figure of great significance has recently been diagnosed with AIDS means that the disease is no longer the vogue disease it once was.Rock Hudson (left) and Magic Johnson (right) are two of the most famous AIDS patients.  Neither are well-known by much of today’s younger generation.  Photos courtesy of Wikipedia.As is typical for the satirical style of South Park, the characters discover that the cure for AIDS is to inject large quantities of cash directly into the bloodstream.  While there is no real cure for AIDS, the biting commentary of this cartoon is telling.  Wealthy AIDS patients, like Magic Johnson, often live the longest and healthiest lives following their infection.  Many AIDS patients do not have access to the resources that Magic Johnson enjoys, and are therefore much more susceptible to the disease.  The average cost of a year’s supply of antiretroviral drugs is between $10,000 and $15,000, which means that those living near the poverty line with AIDS must devote an enormous portion of their income to their drug regimen.  Some of the hardest hit regions of the world with regards to AIDS are also the poorest.  Sub-Saharan Africa is among the worst regions, with up to 30% infection rates in the population.  The disease is therefore easier to ignore for U.S. citizens, who are more likely to be wealthy enough to afford treatment.South Park offers one final shot at society, stating, “Americans have forgotten that AIDS is a serious disease.”  Decreasing public interest in the AIDS epidemic is apparent, which is unfortunate both for affected individuals and the general public alike.  AIDS continues to rage as a fearsome epidemic, and the number of infected individuals continues to grow.  Society needs to wake up again and face the reality that AIDS is still here, and is still a terrible disease.

In a recent episode of the television show <a href="http://www.southparkstudios.com/episodes/163542" rel="nofollow" target="_blank">South Park</a>, one of the main characters is infected with HIV. In an attempt to find a cure, he must continually deal with the public opinion that AIDS is no longer a threatening condition. He is told that his disease is “a disease of the 80s and 90s” and even that he is “retro” for being infected with HIV. But has this retrovirus truly become retro to Americans? If we take South Park as a social barometer, then it seems that the disease has been marginalized in the public eye. Public interest on the Internet regarding AIDS is declining as well. A <a href="http://blog.aids.gov/2008/09/a-picture-is-wo.html" rel="nofollow" target="_blank">recent government blog</a> about Google search hits for the terms “HIV” or “AIDS” shows a declining trend over the past four years. Each year, fewer people searched for the terms “HIV” or “AIDS” on December 1st (World AIDS day) than the previous year. Why has the US public marginalized this disease, which twenty years ago was the terror of the nation? <a href="http://3.bp.blogspot.com/_HPCf_WV1x2U/SRmd-LjT4BI/AAAAAAAAAEY/RZRrrhISvMw/s1600-h/Google+AIDS+Searches.jpg" rel="nofollow" target="_blank"></a> <blockquote>Searches for “AIDS” and “HIV” have decreased for four years running now. Have Americans stopped caring about this disease? Photo courtesy of Google, Inc.</blockquote>A simple reason may be that the media sensationalism of the disease has settled down. As people become accustomed to news, it ceases to be news, no matter how horrible the reality of the situation may be. The early media coverage of the AIDS epidemic focused on the fact that the disease seemed to infect only gay men. Some even believed that AIDS was the punishment for the lifestyles of gay men, and AIDS became known as the “gay cancer” by many after its initial discovery. In this way, AIDS aided U.S. society in demonizing the gay population in the early 1980s. AIDS was deemed a gay problem, and the rest of society could forget about it. <a href="http://query.nytimes.com/gst/fullpage.html?res=9C0CE1DB123AF93AA35757C0A966958260" rel="nofollow" target="_blank">Ryan White’s</a> struggle against the disease helped dispel some of these myths, but many fallacies have persisted regardless, even to the present day. Many choose to ignore the AIDS epidemic, as they believe that they will not come in contact with the disease if they are not homosexual. AIDS may also be ignored because its prevalence in the U.S. is perceived to be decreasing. In South Park, the public seems surprised when the main character is newly infected with AIDS. In many regions of the U.S., taboo prevents open discussion about AIDS, and if people aren’t hearing about a problem, they tend to imagine that it is going away. In reality, 56,000 new cases of AIDS are diagnosed in the U.S. <a href="http://www.avert.org/america.htm" rel="nofollow" target="_blank">every year</a>. This figure only represents the number of cases detected; the true occurrence is likely higher. Why does the public believe, then, that AIDS is on the decline? The apparent decrease of infection rate is caused by the fact that infected individuals generally live longer and healthier lives than they would have in the 80s, when the average lifespan following diagnosis was approximately three months. This fact is largely due to the success of many drugs in delaying the onset of AIDS after exposure to HIV. AIDS advocates are victims of their own success, then, as the myth has arisen that AIDS will no longer kill infected individuals. This belief is wrong; AIDS is a <a href="http://www.avert.org/statsum.htm" rel="nofollow" target="_blank">lethal disease</a>. Drugs do a great deal these days to slow its progress, but HIV has the uncanny ability to develop resistance to these drugs and overwhelm the body’s immune system, which invariably leads to death. One additional aspect of fading public interest in AIDS, sadly enough, may be the lack of infection of a public figure. The movie star Rock Hudson was a famous AIDS victim in his time, and his death helped shock the nation into action against HIV. Rock Hudson is relatively unknown by today’s youth, who grew up after the passing of the star. These days, when most people think of celebrities with AIDS, Magic Johnson is the first name that pops to mind. This former basketball superstar retired after being diagnosed with HIV and began working towards a cure for the deadly virus. Indeed, in the South Park episode, the character with AIDS must travel to find Magic Johnson who may have the cure for AIDS. Magic Johnson faded from public view when his basketball career ended. The fact that no Hollywood star or public figure of great significance has recently been diagnosed with AIDS means that the disease is no longer the vogue disease it once was. <a href="http://1.bp.blogspot.com/_HPCf_WV1x2U/SRmoVaUU26I/AAAAAAAAAEg/hrir7SkZG0w/s1600-h/Rock+Hudson.jpg" rel="nofollow" target="_blank"></a><a href="http://4.bp.blogspot.com/_HPCf_WV1x2U/SRmtGWdHh7I/AAAAAAAAAEo/gIt5cMsxY78/s1600-h/Magic+Johnson.jpg" rel="nofollow" target="_blank"></a> <blockquote>Rock Hudson (left) and Magic Johnson (right) are two of the most famous AIDS patients. Neither are well-known by much of today’s younger generation. Photos courtesy of Wikipedia.</blockquote>As is typical for the satirical style of South Park, the characters discover that the cure for AIDS is to inject large quantities of cash directly into the bloodstream. While there is no real cure for AIDS, the biting commentary of this cartoon is telling. Wealthy AIDS patients, like Magic Johnson, often live the longest and healthiest lives following their infection. Many AIDS patients do not have access to the resources that Magic Johnson enjoys, and are therefore much more susceptible to the disease. The average cost of a year’s supply of antiretroviral drugs is between <a href="http://www.avert.org/generic.htm" rel="nofollow" target="_blank">$10,000 and $15,000</a>, which means that those living near the poverty line with AIDS must devote an enormous portion of their income to their drug regimen. Some of the hardest hit regions of the world with regards to AIDS are also the poorest. Sub-Saharan Africa is among the worst regions, with up to 30% infection rates in the population. The disease is therefore easier to ignore for U.S. citizens, who are more likely to be wealthy enough to afford treatment. South Park offers one final shot at society, stating, “Americans have forgotten that AIDS is a serious disease.” Decreasing public interest in the AIDS epidemic is apparent, which is unfortunate both for affected individuals and the general public alike. AIDS continues to rage as a fearsome epidemic, and the number of infected individuals <a href="http://www.avert.org/worldstats.htm" rel="nofollow" target="_blank">continues to grow</a>. Society needs to wake up again and face the reality that AIDS is still here, and is still a terrible disease.

The reality of HIV/AIDS: It hasn't gone away

Welcome to this installment of The AIDS Pandemic, a podcast hosted by Dr. David Wessner from the Department of Biology at Davidson College. I’m Kara Earle.Since the diagnosis of the first case of HIV in 1982, infection rates in South Africa have skyrocketed. It is currently estimated that one in five South Africans, or approximately 5.7 million people, are living with HIV. In addition, there are nearly 1,000 AIDS-related deaths occurring daily. Many AIDS experts around the world blame the South African government for their lack of appropriate response to this nationwide epidemic. Until 2003, South Africans using the public health system could only receive treatment for the opportunistic infections acquired as a result of being HIV positive, but not the antiretroviral drugs that fight the virus itself. As a result of slow government action, the HIV prevalence rate among pregnant women in South Africa increased from 0.8% in 1990 to 29.1% in 2006.Since the end of Apartheid in 1993, South Africa has been governed by a popularly elected President. Beginning in April 1994, the African National Congress, or ANC, has consistently won a majority of votes to become the governing party, with the President of the ANC serving as President of South Africa. Thabo Mbeki was elected following Nelson Mandela in June 1999, and was forced to resign by the ANC September 24th, 2008, a mere 6 months before the end of his second term in office. With the election of Jacob Zuma as ANC President in December 2007, it is likely that when new national elections are held in April of 2009, the ANC will again be the victorious party and Zuma the new South African president. Until then, the South African Parliament has chosen Kgalema Motlanthe to lead the country.                        Kgalema Motlanthe As Deputy President under Nelson Mandela, Mbeki initially acknowledged widely-held views about the spread of HIV/AIDS in South Africa. However, shortly after his election to the presidency, Mbeki increasingly cited poverty, not HIV, as the primary cause of AIDS. He began to side with dissident scientists and did not believe antiretroviral drugs could help in the treatment of AIDS; rather, he believed the commonly used drugs were toxic. His beliefs were shared by the South African Minister of Health, Dr. Manto Tshabalala-Msimang, who advocated good general nutrition and a combination of lemon juice, garlic, and alcohol as treatment for HIV/AIDS. In 2001, the South African government, independent of President Mbeki, declared that AIDS is in fact caused by HIV and shortly thereafter the High Court ordered the government to make antiretroviral drugs available publicly. Even so, it is estimated that only 28% of South Africans who need treatment for HIV/AIDS are actually receiving the drugs.President Mbeki was forced to resign due to allegations that he had interfered in a corruption case against ANC President Jacob Zuma. Since taking office September 25, 2008, President Motlanthe has replaced Health Minister Tshabalala-Msimang with Barbara Hogan, an advocate for the treatment of HIV/AIDS. In combination with increased awareness and involvement by the government in recent years, this change is seen as a step in the right direction for the HIV epidemic in South Africa. However, the expected next President, Jacob Zuma, arrives with a considerable amount of controversy. In addition to the recent corruption case brought against him, Zuma was tried in 2006 for raping an HIV positive family friend. He was acquitted of the charges by explaining that the victim was wearing a short skirt and sitting provocatively. He also told the court that he reduced the risk of HIV infection by showering afterwards. Despite these previous comments, he seems to address the HIV/AIDS epidemic in a reasonable manner.It is impossible to know what changes the next six months will bring in South Africa as a result of the sudden change in government. In recent years, the country has shown a desire to take on the HIV epidemic through both prevention and treatment methods, regardless of the beliefs held by its President. It is widely believed that a country with as much wealth as South Africa should be able to provide antiretroviral drugs to all who need them, and not merely the 28% who are currently receiving them. In order to slow this epidemic, the incoming administration will need to devote significant time and funding to the development of prevention and treatment programs throughout South Africa.I’m Kara Earle, thanks for listening.

Welcome to this installment of The AIDS Pandemic, a podcast hosted by Dr. David Wessner from the Department of Biology at Davidson College. I’m Kara Earle. Since the diagnosis of the first case of HIV in 1982, infection rates in <a href="http://www.avert.org/aidssouthafrica.htm" rel="nofollow" target="_blank">South Africa</a> have skyrocketed. It is currently estimated that one in five South Africans, or approximately 5.7 million people, are living with HIV. In addition, there are nearly 1,000 AIDS-related deaths occurring daily. Many AIDS experts around the world blame the South African government for their lack of appropriate response to this nationwide epidemic. Until 2003, South Africans using the public health system could only receive treatment for the opportunistic infections acquired as a result of being HIV positive, but not the antiretroviral drugs that fight the virus itself. As a result of slow government action, the HIV prevalence rate among pregnant women in South Africa increased from 0.8% in 1990 to 29.1% in 2006. Since the end of Apartheid in 1993, South Africa has been governed by a popularly elected President. Beginning in April 1994, the <a href="http://www.anc.org.za" rel="nofollow" target="_blank">African National Congress</a>, or ANC, has consistently won a majority of votes to become the governing party, with the President of the ANC serving as President of South Africa. Thabo Mbeki was elected following Nelson Mandela in June 1999, and was forced to resign by the ANC September 24th, 2008, a mere 6 months before the end of his second term in office. With the election of <a href="http://www.anc.org.za/show.php?doc=ancdocs/history/zuma/index.html&amp;title=Zuma+Page" rel="nofollow" target="_blank">Jacob Zuma</a> as ANC President in December 2007, it is likely that when new national elections are held in April of 2009, the ANC will again be the victorious party and Zuma the new South African president. Until then, the South African Parliament has chosen <a href="http://www.thepresidency.gov.za" rel="nofollow" target="_blank">Kgalema Motlanthe</a> to lead the country. <a href="http://2.bp.blogspot.com/_HPCf_WV1x2U/SQXVMmm4h1I/AAAAAAAAAEQ/pgYysiVJ6C8/s1600-h/AIDS_Pandemic_69.jpg" rel="nofollow" target="_blank"></a> Kgalema Motlanthe As Deputy President under Nelson Mandela, Mbeki initially acknowledged widely-held views about the spread of HIV/AIDS in South Africa. However, shortly after his election to the presidency, Mbeki increasingly cited poverty, not HIV, as the primary cause of AIDS. He began to side with dissident scientists and did not believe antiretroviral drugs could help in the treatment of AIDS; rather, he believed the commonly used drugs were toxic. His beliefs were shared by the South African Minister of Health, Dr. Manto Tshabalala-Msimang, who advocated good general nutrition and a combination of lemon juice, garlic, and alcohol as treatment for HIV/AIDS. In 2001, the South African government, independent of President Mbeki, declared that AIDS is in fact caused by HIV and shortly thereafter the High Court ordered the government to make antiretroviral drugs available publicly. Even so, it is estimated that only 28% of South Africans who need treatment for HIV/AIDS are actually receiving the drugs. President Mbeki was forced to resign due to allegations that he had interfered in a corruption case against ANC President Jacob Zuma. Since taking office September 25, 2008, President Motlanthe has replaced Health Minister Tshabalala-Msimang with Barbara Hogan, an advocate for the treatment of HIV/AIDS. In combination with increased awareness and involvement by the government in recent years, this change is seen as a step in the right direction for the HIV epidemic in South Africa. However, the expected next President, Jacob Zuma, arrives with a considerable amount of controversy. In addition to the recent corruption case brought against him, Zuma was tried in 2006 for raping an HIV positive family friend. He was acquitted of the charges by explaining that the victim was wearing a short skirt and sitting provocatively. He also told the court that he reduced the risk of HIV infection by showering afterwards. Despite these previous comments, he seems to address the HIV/AIDS epidemic in a reasonable manner. It is impossible to know what changes the next six months will bring in South Africa as a result of the sudden change in government. In recent years, the country has shown a desire to take on the HIV epidemic through both prevention and treatment methods, regardless of the beliefs held by its President. It is widely believed that a country with as much wealth as South Africa should be able to provide antiretroviral drugs to all who need them, and not merely the 28% who are currently receiving them. In order to slow this epidemic, the incoming administration will need to devote significant time and funding to the development of prevention and treatment programs throughout South Africa. I’m Kara Earle, thanks for listening.

HIV/AIDS in South Africa: Past, Present, and Future

The AIDS Pandemic

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