• HIV Prevention Efforts in Five African Countries Not Reaching At-Risk Groups, Report Says
  National HIV prevention strategies in at least five African countries are not reaching the groups most at risk of infection, according to a report from UNAIDS and the World Bank conducted in conjunction with the national HIV/AIDS authorities of Kenya, Lesotho, Mozambique, Swaziland and Uganda, IRIN/PlusNews reports. The study was conducted between 2007 and 2008 to determine how and where most HIV cases were occurring in each country. It also aimed to examine whether prevention programs and spending aligned with those findings. According to the report, most prevention initiatives are not based on evidence of the behaviors that spread HIV in the five surveyed countries. For example, most new infections in Lesotho occur because of concurrent sexual partnerships, both before and after marriage. However, the country does not have any prevention strategies aimed at concurrent partnerships, or couples who are married or in long-term relationships. In addition, the report found that in Mozambique, an estimated 19% of new HIV infections were spread through commercial sex work, 3% from injection drug use and 5% among men who have sex with men. According to the report, few programs in the country target sex workers, while none are tailored to IDUs or MSM. According to the report, spending on HIV prevention often is low in the surveyed countries. Lesotho spends 13% of its national HIV/AIDS budget on prevention, while Uganda spends 34%. Director of the World Bank's Global HIV/AIDS Unit Debrework Zewdie said that the economic downturn makes it important to maximize the impact of HIV prevention investments. "These syntheses use the growing amounts of data and information available to better understand each country's epidemic and response and identify how prevention might be more effective," she said. The report includes recommendations on how the surveyed countries can better implement evidence-based prevention efforts. It said that Lesotho should revise its prevention messages to address multiple concurrent partnerships and integrate the subject into future initiatives. In addition, Mozambique should focus condom promotion on groups such as sex workers, the report said. According to IRIN/PlusNews, the five-country program aims to enhance capacity to ensure that the countries can conduct similar studies in the future (IRIN/PlusNews, 5/27). The report is available online.
• Report Estimates Significant Impact of Widespread Circumcision Effort in Botswana
  Botswana's campaign to circumcise about 500,000 men by 2012 will prevent nearly 70,000 new HIV cases by 2025, according to a report published Thursday in the Journal of the International AIDS Society, AFP/Yahoo! News reports. The government's national campaign aims to circumcise 460,000 men over the next five years, and the country has begun airing television and radio advertisements to encourage men to be circumcised at local clinics. "Scaling up safe male circumcision has the potential to reduce the impact of HIV/AIDS in Botswana significantly," according to the study. The report puts the estimated cost of the circumcision campaign at about $47 million. A UNAIDS report estimates that the HIV prevalence among pregnant women in Botswana was 43% in 2003, the year that antiretroviral drug access was introduced in the country (AFP/Yahoo! News, 5/28). An abstract of the study is available online.
• Thai HIV/AIDS Advocates Urge Increased Treatment Access for IDUs
  The Thai AIDS Treatment Action Group recently called on the country to launch a comprehensive harm reduction program for injection drug users in an effort to help curb the spread of HIV, Thailand's The Nation reports. According to the group, many IDUs are unable to access drug treatment and substation therapy because of the stigma surrounding drug use in the country. Karyn Kaplan, director of development and policy for the group, said, "Health care workers have denied many injecting drug users access to an antiviral drug and the use of methadone." Public Health Minister Witthaya Kaewparadai recently announced that the country's harm reduction programs have helped to curb the spread of HIV among IDUs, adding that local substitution programs have reduced the number of HIV-positive IDUs and that the country needs increased support from UNAIDS for such efforts. TTAG called for the government to provide prevention and treatment options, such as substitution therapy and needle-exchange programs. The Nation reports that methadone treatment is offered at hospitals across the country as part of the national health care scheme, but many health care workers refuse to administer treatment. In addition, government treatment is offered for 45 days. Kaplan said that the government should revise its policy regarding treatment access for IDUs, as a majority of IDUs are incarcerated and living with HIV or hepatitis-C without treatment access. She called on the government to "implement the international standards of medical treatment for [IDUs], without discrimination and human rights violations" (The Nation, 5/27).
• Legislation Needed To Boost HIV/AIDS Efforts in Solomon Islands, Health Official Says
  Isaac Muliloa -- national coordinator of the HIV and sexually transmitted infections unit at the Solomon Islands' Ministry of Health -- recently said that a lack of national HIV/AIDS laws is hindering efforts to address the disease, the Solomon Times reports. Recent World Health Organization estimates said that the number of HIV cases in the Solomon Islands could reach 350 by 2010. Muliloa said that legislation is needed to address continued discrimination against HIV-positive employees in the workplace. He added that the HIV/AIDS and STI unit is relatively new in the health ministry, as is the Solomon Islands' National AIDS Council. According to Muliloa, officials are continuing to work toward implementing policies. The Times reports that the Solomon Islands does not have laws in place criminalizing the intentional transmission of HIV (Solomon Times, 5/27).
• Researchers Plan To Target Immune Cells Responsible for Eluding Antiretroviral Treatment
  Certain human immune cells known as macrophages are composed of hybrid HIV strains that elude treatment and antiretroviral drugs, according to a new study by researchers from the University of Florida and other institutions, the Gainesville Sun reports. For the study, researchers examined tissue from HIV-positive people and discovered that as much as half of the macrophages present were hybrids, made from genetic material from several HIV viruses that when combined formed new HIV strains. Marco Salemi -- assistant professor of pathology, immunology and laboratory medicine at the University of Florida's College of Medicine -- said that macrophages likely make HIV more aggressive over time, adding, "If we want to eradicate HIV, we need to find a way to actually target the virus specifically infecting the macrophages." According to the Sun, current research and treatment target T-cells, and although antiretrovirals are effective at blocking infection from new cells and lowering viral loads, they are unable to reduce the viral level in an HIV-positive person to zero. The Sun notes that macrophages can be targeted by HIV multiple times, and once they are infected, they can live for months, unlike T-cells. The team of researchers, led by Michael McGrath of the University of California - San Francisco, is developing macrophage-targeting drugs through a grant from the National Institute of Mental Health, the Sun reports (Chun, Gainesville Sun, 5/28).

Reprinted with permission from kaisernetwork.org. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2006 Advisory Board Company and Kaiser Family Foundation. All rights reserved.