Botswana’s Ministry of Health is launching a project that aims to circumcise nearly 500,000 men over the next five years in an effort to prevent the spread of HIV, the uk/news/worldnews/africaandindianocean/botswana/5292646/Botswana-to-circumcise-half-a-million-men-in-Aids-fight.html” target=”_new”>AFP/Daily Telegraph reports. Janet Mwambona, a public health specialist who is leading the project, said that officials decided to launch the program following a series of studies that showed circumcision can reduce a man’s risk of HIV. “For the public health benefits of the preventive effect of circumcision to be realized, the Ministry of Health is supposed to cover 80% of eligible males in Botswana,” Mwambona said, adding that hospitals nationwide are scheduling and performing the procedure.

According to the AFP/Telegraph, about 50 health care providers, including 27 physicians, have been trained to perform surgical circumcisions. In addition, the campaign includes television and radio advertisements that encourage men to visit clinics to undergo a safe circumcision surgery (AFP/Daily Telegraph, 5/8).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

An international multi-center clinical trial has found that acyclovir, a drug widely used to safely and effectively suppress herpes simplex virus-2 (HSV-2), the most common cause of genital herpes, does not reduce the risk of HIV transmission when taken by people affected by both HSV-2 and HIV.

Five preliminary studies had showed that it is possible to decrease the amount of HIV in the blood and genital tract when patients are treated with acyclovir for HSV-2, but these studies did not measure whether this meant that acyclovir reduced transmission of HIV. Researchers conducted the trial to find out if the drug would reduce the likelihood of HIV being transmitted from a person infected with both HIV and HSV?2 during sexual intercourse.

In the primary analysis of the Partners in Prevention Transmission Study, researchers determined that there were 41 infections in the acyclovir arm and 43 in the placebo arm, not a significant difference. Acyclover-suppressive treatment reduced the frequency of genital ulcers by 73 percent and the average amount of HIV in the blood (by 0.25 log10copies/milliliter, a reduction of 40 percent), compared to the placebo arm. Although the twice daily use of acyclovir did slow progression of HIV by 17 percent, an effect that was statistically significant, it did not reduce the risk of HIV transmission.

“This study is the first clinical trial to test whether suppressing HSV?2 infection could reduce rates of HIV transmission and HIV disease progression,” said Kenneth H. Fife, M.D., Ph.D., a professor of medicine in the Indiana University School of Medicine, Division of Infectious Diseases and a study co-author. “Because HSV-2 appears to be a major factor in fueling the HIV epidemic, we must better understand this relationship in countries where HIV infection is rampant.”

The study took place at 14 sites in seven countries in eastern and southern African,

including Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia. It began in November 2004 and ended with follow?up of participants in October 2008. The IU School of Medicine’s participation was through the IU-Kenya Partnership program, a program created by the IU and Moi University medical schools. This study was the first large controlled clinical trial to be conducted through the IU-Kenya Partnership.

The Partners in Prevention HSV/HIV Transmission Study was funded by the Bill & Melinda Gates Foundation and led by the University of Washington in Seattle. The study was conducted among 3,408 African couples, in which one partner had HIV and the other did not. In all the couples, the partner who had HIV also had HSV?2 infection. The IU-Kenya Partnership site in Eldoret enrolled 262 couples.

All participants received standard HIV prevention services, which included being supplied with condoms, treated for other sexually transmitted infections, and provided care for HIV infection. All participants received extensive counseling, both individually and as a couple, throughout the study period, on how to reduce the risk of HIV infection.

“The Partners in Prevention Study is a direct assessment of the impact of herpes
suppression in HIV transmission,” explained Dr. Connie Celum, the leader of the study and a University of Washington professor of Global Health and Medicine in the Division of Allergy and Infectious Diseases.

“A clinical trial of genital herpes suppression in HIV discordant couples is the most direct way to see if we can make a person less infectious and less likely to transmit HIV to his or her partner,” said Dr. Celum.

The study was double-blinded, randomized and placebo-controlled, meaning that both participants and the care providers did not know which treatment the participants were receiving.

“The study did find that acyclovir significantly reduced genital ulcers due to HSV?2 and modestly reduced HIV levels in the blood, consistent with what the preliminary studies of HSV?2 suppressive treatment had shown. However, it appears that these effects were not sufficient to reduce the risk of HIV transmission,” Celum said.

View the Partners in Prevention HSV/HIV Transmission Study Backgrounder here.

View HIV/Herpes FAQ here.

Source
IU School of Medicine

View drug information on Acyclovir Capsules.

asp?idnews=46748″ target=”_new”>Inter Press Service on Thursday examined how an increasing number of women living with HIV/AIDS in the Caribbean face stigma, discrimination and gender-based violence that is linked to the spread of the disease. UNAIDS reports that women overall now account for half of the population living with HIV in the Caribbean, compared with 30% in 1999. Women ages 15 to 24 account for 62% of the entire HIV-positive population in the Caribbean.

The Dominican Republic and Haiti, which make up the island of Hispaniola, have some of the highest HIV/AIDS rates in the region, according to UNAIDS. Women account for 51% of the 60,000 HIV-positive people in the Dominican Republic, while they account for 60% of the 120,000 HIV-positive people in Haiti. Myrna Flores Chian — head of the gender rights program of Profamilia, a nongovernmental organization involved in reproductive rights efforts in the Dominican Republic — said, “There are physiological factors that put women and girls at greater risk of infection in unprotected sexual relations.” She added that “the feminization of AIDS is due above all to social discrimination, gender inequality and lack of empowerment for women.” Flores Chian said that gender violence and women’s inability to negotiate condom use with partners or other conditions is directly linked to the spread of HIV.

A recent study by Development Connections, the United Nations Development Fund for Women and the World Health Organization found that 25% of women surveyed in the Dominican Republic in 2007 said they became sexually active before age 15 and 75% before age 19. Wendy Alba, a researcher involved in the study, said that additional studies in the Dominican Republic found that women who had experienced gender violence were nearly four times more likely to have a sexually transmitted infection than women who had not been abused.

Inter Press Service reports that HIV-positive women often risk abuse or abandonment if they reveal their status and that they often face challenges accessing needed services. Sara Iglesias, head of the HIV and violence against women project at the Colectiva Mujer y Salud, said Haitian women in the Dominican Republic often engage in “high-risk sexual behavior linked to their status as illegals, their poverty, and the discrimination and linguistic and cultural barriers they face.” The project aims to train commercial sex workers, police officials, prosecutors and health ministry workers about HIV and violence against women, according to Iglesias.

Inter Press Service reports that more than 30 nongovernmental organizations, government groups and U.N. agencies have created a committee to implement a five-year strategic plan to reduce gender violence and curb the spread of HIV in the Dominican Republic. Alba said the plan will launch at the end of the year and “will take into account the needs of Dominican and Haitian women in the areas affected the most by HIV and violence against women in the country” (Vilardo, Inter Press Service, 5/7).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.