TB is the deadliest disease

 The latest report by the Global Fund to Fight AIDS, Tuberculosis and Malaria shows both progress and challenges in the fight against epidemics, said Peter Sands, Executive Director of the Global Fund. Indicators confirm that if funding is insufficient, the three diseases could return to the forefront of global health. The number of HIV infections has dropped and continues to decline, albeit too slowly.  Malaria cases are on the rise again.  And tuberculosis remains the deadliest of the three pathologies.

Sept 14, 2018

Ebola Attacked Congo Again. But Now Congo Seems to Be Winning

The New York Times and local media in the DRC have upbeat news about the Ebola response there. New cases are dropping sharply, vaccination is going well and schools are about to open. But it is too soon to declare victory, experts say.

The month-old Ebola outbreak in the Democratic Republic of Congo, which emerged unexpectedly in a dangerous region and quickly soared to over 100 cases, now appears to be fading.

Only a handful of new cases appear each week, and the region's two treatment centers, full until recently, now have fewer than 30 patients in their 78 beds.

More than 3,500 contacts of known cases are being followed, more than 4,000 doses of vaccine have been given and officials feel hopeful enough to allow schools in the area — North Kivu Province, on the eastern border with Uganda — to open as usual on Monday.

However, it is far too early to relax, health experts warn.

Over the next few days (mid-September), many contacts will come out of their 21-day surveillance periods, and then health personnel will know to what extent they managed to break the transmission chain.

sept 6 2018

People with HIV twice as likely to develop heart disease than those without the virus

British researchers reviewed studies from 153 countries and found that HIV-associated heart disease has more than tripled in the past 20 years, as more people with HIV live longer.

A study published in the journal Circulation shows that more than two-thirds of HIV-associated heart disease occurs in sub-Saharan Africa and Asia Pacific regions. More than 35 million people worldwide have HIV, and that number is on the rise. It's believed that HIV may cause inflammation of the blood vessels, which puts stress on the cardiovascular system.

It's also thought that HIV may contribute to heart disease by increasing fat levels in the blood and affecting the body's ability to regulate sugar levels, the researchers said.

See more on News24 of the global public health implications of this study.

august 20, 2018

HIV vaccine science is a story for the long haul. And an important one, with trial results expected in 2020 and 2021. Check out our bullet point list of must-knows about HIV vaccines in our new story entitled "What is the HIV vaccine story now?"

August 17, 2018

Tough times for medical teams in new DRC Ebola outbreak

The Ebola vaccine is to be used again in the latest disease outbreak in DRC.

Good news: better surveillance means faster detection of outbreaks; the vaccine is highly effective. Bad news: war and conflict will be a massive challenge for medical teams. Wishing them the best!

Roughly a week after celebrating the defeat of an Ebola outbreak in Équateur province, the DRC has four new confirmed cases of the disease 2500 kilometers across the country in North Kivu province. The DRC Ministry of Public Health says there is no indication of a link between the outbreaks and the decision to use the vaccine again was "common sense" due to the remaining doses in stock and the approval for the vaccine's continued study by scientific and ethical committees. The Équateur “trial” of the vaccine had no control group and cannot conclude whether it contributed to the end of that outbreak, but preliminary results show that none of the 3300 vaccinated people became infected.

Peter Salama, head of the World Health Organization’s Health Emergencies Programme in Geneva, Switzerland, and the lead official during the agency’s response to the just-ended outbreak said a vaccine campaign still faces several hurdles. Salama stressed that North Kivu province is a conflict zone and vaccination teams may have to travel with armed escorts. Contacts of cases, the primary people to receive the vaccine, now are known to be in 10 different locations, he said, further complicating attempts to reach them. “It’s going to be a very, very complex operation,” Salama said. “On the scale of degree of difficulty, trying to extinguish an outbreak of a deadly, high-threat pathogen in a war zone reaches the top of any of our scales.”

August 6, 2018

Good news, but stigma still hampers the HIV response: UNAIDS report

When thousands of delegates gather in Amsterdam for AIDS2018, the 22nd International AIDS Conference, they will hear about promising developments in science, but the decades-old story of reducing stigma remains one of the most important.

Men with same-sex sexual partners are 28 times more likely to contract HIV than their heterosexual counterparts despite a radical reduction in new infections among gay men in Western countries, according to a UN report.

The overall annual number of new HIV infections dropped from a high of 3.4 million in 1996 to 1.8 million last year, according to UNAIDS, which coordinates the organisation’s global response to HIV/Aids.

Yet gay men and men who have sex with men remained most at risk of contracting HIV, along with female sex workers, drug users and transgender women.

Reuters reports that in North America, western Europe and Australia, the roll-out of pre-exposure prophylaxis (PrEP) – an oral prophylactic – has seen transmission rates drop dramatically among gay men.

“What we should be doing is ensuring that anyone who is at high risk of acquiring HIV – and that includes anyone who is homosexually active – has the ability to access PrEP,” Matthew Hodson, executive director of NAM, a British HIV/Aids information charity says. In many cases, sexual minorities are turned away from services or they don’t visit health facilities in the first place, for fear of stigma and negative attitudes from those who are supposed to help them.

Stigma and discrimination against sexual minorities remain barriers to wider health and sex education, with transgender women 13 times more at risk of acquiring HIV than adults aged between 15 and 49.

“Human rights are universal — no one is excluded, not sex workers, gay men and other men who have sex with men, people who inject drugs, transgender people, prisoners or migrants,” said Michel Sidibe, executive director of UNAIDS.

“Bad laws that criminalise HIV transmission, sex work, personal drug use and sexual orientation or hinder access to services must go, and go now.”

july 19, 2018

PrEP for teenagers – what doctors say

A study suggests most physicians would be willing to prescribe PrEP to teens, but the doctors themselves need to be educated on its use. Pre-exposure prophylaxis (PrEP), a daily antiretroviral pill, can lower the risk of getting HIV from sex by up to 90%, according to the U.S. Center for Disease Control and Prevention.

Reuters reports on a study that surveyed 162 U.S. doctors who worked with adolescents and young adults. While 93% of the clinicians had heard of PrEP, only 35% had prescribed it.

In the survey, more than half of the respondents said they had only treated a few teens and young adults with HIV. Just 15% of the clinicians reported treating many HIV-positive youth.

The results suggest that some providers may still need to be educated about PrEP and made aware that it’s now approved for use in teens, said Matthew Beymer, a researcher at the University of California, Los Angeles, David Geffen School of Medicine, and at the Los Angeles LGBT Center.

“I think the take-home message is that PrEP works well whether you are an adolescent (and over 77 pounds) or an adult provided you take your medication every day,” Beymer, who wasn’t involved in the study, said.  “Teens should consider taking PrEP if they either have an indication for PrEP or feel that taking PrEP would reduce their concerns about contracting HIV.”

June 26, 2018

New Drug Helps Patients Beat Drug Resistant TB

News from the 5th South African Tuberculosis Conference in Durban is that a new drug could change the fate of people with extensively drug-resistant TB (XDR-TB).

Health-e News reports that the death rate for XDR-TB patients fell to 27% after the introduction of the blockbuster anti-TB drug bedaquiline. Before the introduction of this drug, about half of XDR-TB patients would die.

“DR-TB comes in two forms. Multi-drug resistant TB (MDR-TB) is resistant to two of the most common anti-TB drugs and XDR-TB is resistant to four – leaving very few drugs available. DR-TB treatment has traditionally equated to taking a cocktail of old and toxic drugs for about two years. The side-effects of this treatment are often debilitating, for example deafness, but even if patients take all their pills religiously they have a very slim chance of being cured.

In 2013, South Africa made “a bold and innovative move” to introduce a brand-new drug into the TB programme, according to Dr Francesca Conradie, a DR-TB expert from the Southern African HIV Clinicians Society.

It was bold, she said, because bedaquiline’s manufacturer Janssen Pharmaceuticals had not completed the usually-required years of rigorous safety and efficacy testing. Early trials had shown promising results but health experts had safety concerns.

But because, with so few effective drugs available, patients were dying, the Department of Health made the decision to introduce it to a small number of patients as part of a compassionate access programme. In 2014, access was rapidly scaled up and now two thirds of people receiving bedaquiline are in South Africa.

“The reason other countries with DR-TB epidemics haven’t introduced bedaquiline in the same way we have simply comes down to a lack of political commitment,” said Conradie. “The South African government has put their money where mouth is and the result is we have much fewer people dying of DR-TB.”


June 18, 2018

Recent article published in the New York Times:

"It Saves Lives. It Can Save Money. So Why Aren't We Spending More on Public Health?"

Funding for health campaigns is surprisingly low when you consider they’re often so valuable that they pay for themselves.

Not only have many public health interventions in the United States been hugely successful, but they’ve also saved more money than they’ve cost.

And yet Americans spend relatively little money in that domain and far more on medical care that returns less value for its costs. Instead of continually complaining about how much is being spent on health care with little to show for it, maybe we should direct more of that money to public health.

Think of it this way: Americans can expect to live into their late 70s, on average, in large part because of public health investments. From 1900 to 1999, life expectancy at birth increased from 47 years to 77 years. Although much of that was because of significant improvement in the care of babies and children, experts believe that 25 of the 30 years gained can be attributed to public health advances.

Read the full article here: https://www.nytimes.com/2018/05/28/upshot/it-saves-lives-it-can-save-money-so-why-arent-we-spending-more-on-public-health.html


june 5, 2018

South Sudan’s quiet victims of war: With HIV, without help

South Sudan’s five-year civil war is quietly creating another kind of victim: those prevented from getting life-saving antiretroviral medicine. Experts say the number of affected people could be in the hundreds of thousands, reports AP News.

Currently just 13 percent of the estimated 200,000 South Sudanese living with HIV are being treated, according to UNAIDS. That compares to 42 percent of people in neighbouring Congo, another impoverished country that has long faced instability. Although South Sudan’s 2.7 percent HIV prevalence isn’t notably high for sub-Saharan Africa when compared to countries like Swaziland, whose prevalence is at 27 percent according to UNAIDS, concerns are rising that the civil war has made accurate tracking of the disease impossible. Local aid groups think the country’s HIV prevalence is likely higher, citing a recent increase in people testing positive due to widespread transactional sex by women trying to support themselves and families and mass rape by armed men, especially in the capital, Juba.

At the same time, the conflict has sent millions fleeing while sexual violence rises as a weapon of war, according to human rights groups.

“The army are the ones raping. They’re the ones with the guns,” said Evelyn Letio, director of the National Empowerment of Positive Women United, a local group supporting women with HIV. Both sides in the civil war have been accused of abuses including rape.

28-year old Juba resident, Marlene Freet, says the worsening economy caused by the civil war makes it hard to find the food she needs to take with her HIV medication.

Sometimes she eats only once a day, she says.

May 29, 2018