January 2008

[HIVMA officials criticize President Bush’s proposed rule regarding visitors with HIV]
[World Bank launches grant contest for unique programs to fight HIV/AIDS stigma and discrimination in South Asia]
[Government of Madagascar recognized for aggressive fight for HIV/AIDS prevention]
[German researchers link protein in semen with increased HIV transmissibility]
[HIV subtype E, most common in Thailand, may be more deadly than other strains]

HIVMA officials criticize President Bush’s proposed rule regarding visitors with HIV

The Bush administration’s proposed rule for waivers to allow some people with HIV to visit the United States is even more restrictive, burdensome and arbitrary than the rule it is intended to replace, according to a statement by the HIV Medicine Association.

The proposed rule does not address a flaw in the U.S. policy barring people with HIV from entering the United States, said officials from the HIV Medicine Association (HIVMA).

“The law denying entry to people with HIV has no basis in science or public health and should be replaced,” said Arlene Bardeguez, MD, MPH, chair of HIVMA and professor of obstetrics and gynecology at the University of Medicine and Dentistry of New Jersey.

Since 1990, people with HIV have been barred from entering the United States despite the fact that HIV infection is manageable and is not transmitted through contact. Individual exceptions for short visits may be granted on case-by-case basis, but only through an unscientific waiver process.

President George W. Bush promised to revisit the waiver process last year. The only appropriate remedy would be to repeal the law, according to HIVMA officials. Under the proposed rule, people with HIV are required to not impose on people who have other chronic medical conditions such as heart disease, diabetes or cancer. In their home countries, visitors applying for waivers must demonstrate to their consulars that their HIV infection is under control, that they will not require medical attention, and that they have supplies for medicine for the duration of their visit. They also must have sufficient financial assets to cover any medical expenses during their visit.

A consular is responsible for determining the state of an applicant’s disease.

“I find it inexplicable that the United States can on one hand exercise such strong leadership in HIV science and care around the world and on the other hand display such intolerance toward people with HIV who want to visit the country,” said Michael S. Saag, fMD, HIVMA vice chair and director fof the Center for AIDS research at the University of Alabama at Birmingham.

The proposed law creates obstacles for people with HIV who want to visit the United States by requiring documentation on the status of their HIV infection and requiring a financial status in which people with HIV have enough resources for medical insurance and medications for the duration of their visits. Visitors with HIV may also be denied the possibility of extension of their visa and applications for U.S. residency.

“The proposed rule adds barriers to the already burdensome and stigmatizing process for people living with HIV seeking to enter the United States,” Bardeguez said. “There is no public health rationale for excluding people with HIV from this country.”

World Bank launches grant contest for unique programs to fight HIV/AIDS stigma and discrimination in South Asia

The World Bank, with the United Nations and private sectors, launched a competitive development marketplace initiative, “Tackling HIV and AIDS Stigma and Discrimination: From Insights to Action,” in late November.

The initiative is intended to identify and fund innovative approaches to reduce stigma and discrimination associated with HIV and AIDS in South Asia, including Afghanistan, Bangladesh, Bhutan, India, Nepal, Sri Lanka and Pakistan.

The Development Marketplace is reaching out to communities across South Asia seeking proposals for local, small-scale projects with the potential for expansion and replication.

Winners will be selected by an international jury of World Bank officials and independent HIV and AIDS experts at an event May 15, 2008 in Mumbai, India.

“Stigma and discrimination seriously undermines efforts to fight HIV and AIDS,” said Praful Patel, World Bank vice president for South Asia. “It also marginalizes people at risk and living with the disease contributing further to their social isolation and rejection.”

The competition will offer unique opportunities to channel small grants directly to community organizations and non-government organizations for new approaches to help erase HIV/AIDS-associated stigma, Patel said.

“Many of the people most at risk for HIV around the world deal with stigma on a regular basis, posing challenges to achieving universal access to HIV prevention, treatment, care and support,” said Peter Piot, MD, UNAIDS executive director. “It is encouraging to see innovative steps being taken toward addressing these issues in South Asia, where stigma and discrimination remain serious problems.”

The South Asia Regional Development Marketplace is open to all groups with unique ideas. The maximum award is $40,000 per proposal.

Government of Madagascar recognized for aggressive fight for HIV/AIDS prevention

Madagascar’s response to HIV/AIDS has been one of the most aggressive in Africa and could serve as a model for transmission prevention and public health initiatives.

Although prevalence of HIV in Madagascar is estimated at less than 1%, an influx of foreign workers and a high rate of other sexually transmitted infections had led the country to implement aggressive HIV prevention campaigns.

The country’s campaign is a “personal initiative” of Madagascan President Marc Ravalomanana, Fanjaniania Rajoelisolo, head of the national AIDS office of Madagascar, told the Associated Press. The president negotiates with international donors for HIV prevention and provides detailed accounting to all contributors.

“Donors see exactly where their money is going and are willing to contribute more,” Rajoelisolo said.

As part of the aggressive campaign, the government opened more than 100 testing clinics, increased condom access and supports teacher training on HIV prevention education. The government also enacted the first law in Africa that imposes fines for discriminating against people with HIV. In addition, the government plans to distribute 400,000 HIV test kits by the end of 2007 and to provide 90% of people with HIV with antiretroviral drugs within five years.

German researchers link protein in semen with increased HIV transmissibility

A common protein in semen may potentially increase the infectious potential of HIV by 100,000-fold, according to data published in Cell.

The study was conducted by researchers at the University of Ulm in Germany who analyzed semen for potential proteins for blocking transmission of HIV-1. Researchers found prostatic acidic phosphatase, a protein produced in the prostate, could enhance HIV transmission.

In laboratory experiments, 1,000 to 100,000 HIV particles are necessary to infect human cells, but as few as three HIV particles can infect human cells when prostatic acidic phosphatase is present.

Researchers are investigating the role of amyloids and the transmission of pathogenesis.

“It is a surprising finding, but I would be cautious about how important this is going to be,” Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Disease, told the Associated Press. He added that the study is impressive, but that the findings are a long way from a practical solution for HIV transmission risk reduction.

HIV subtype E, most common in Thailand, may be more deadly than other strains

People with HIV in Thailand die significantly sooner than those with HIV living in other parts of the world, according to researchers.

Data from two studies led by researchers at Johns Hopkins Bloomberg School of Public Health associate shorter survival times in people with HIV subtype E, the most common subtype in Thailand. The findings of both studies were published in AIDS.

In the first study, data were collected on men (n=228) for 14 years beginning in 1991. All participants were serving in the Thai military and were HIV negative when they enrolled. Participants were tested every six months to determine time of HIV acquisition. Diagnoses of HIV infection were made before antiretroviral drug therapy was available.

The Thai men were compared with a group of men with HIV in North America and Europe who were enrolled in another study.

The median time for death associated with HIV infection in Thai men was 7.8 years compared with 11 years in HIV-positive men living in North America and Europe.

Survival rates among Thai men were also lower than those estimated in similar studies of people living in low and middle income countries, including sub-Saharan Africa, where subtypes A, C, D and G circulate. The shorter survival time after HIV infection in people in Africa with HIV subtype D was similar to rates in Thai men.

“We were surprised to learn that the young military recruits from Thailand appeared to develop AIDS more quickly and had shorter survival after their HIV infection than persons in Africa who were carefully followed,” said Ram Rangsin, assistant professor of Community and Military Medicine at Pharmaongkutklao College of Medicine in Bangkok. “Fortunately, the men who had survived are now receiving treatment with effective antiretroviral drugs and are doing well.”

In a second study, researchers followed a group of men who donated blood and their wives from 1992-2007. All participants were determined to have acquired HIV less than two years prior to study enrollment.

Median survival rates from infection to death was 7.8 years in men and 9.6 years in women, lower than the 11-year median survival rate reported for HIV-positive men in developed countries.

“The fact that both young military conscripts and blood donors and their wives in Thailand had similarly shortened survival compared with persons in the United States and Africa, except those with subtype D viruses, suggests that viral subtype D and E may be more virulent than other viral subtypes,” said Kenrad E. Nelson, MD, professor in the Epidemiology and International Health at the Bloomberg School. “If we could understand better the virulence characteristics of these viruses, we might learn something more about why those with HIV infection progress to AIDS, usually many years after they are infected.”

—Compiled by Kirsten H. Ellis