South Africa makes progress in HIV, AIDS fight

JOHANNESBURG (AP) — In the early '90s when South Africa's Themba Lethu clinic could only treat HIV/AIDS patients for opportunistic diseases, many would come in on wheelchairs and keep coming to the health center until they died. Two decades later the clinic is the biggest anti-retroviral, or ARV, treatment center in the country and sees between 600 to 800 patients a day from all over southern Africa. Those who are brought in on wheelchairs, sometimes on the brink of death, get the crucial drugs and often become healthy and are walking within weeks. "The ARVs are called the 'Lazarus drug' because people rise up and walk," said Sue Roberts who has been a nurse at the clinic , run by Right to Care in Johannesburg's Helen Joseph Hospital, since it opened its doors in 1992. She said they recently treated a woman who was pushed in a wheelchair for 3 kilometers (1.8 miles) to avoid a taxi fare and who was so sick it was touch and go. Two weeks later, the woman walked to the clinic, Roberts said. Such stories of hope and progress are readily available on World AIDS Day 2012 in sub-Saharan Africa where deaths from AIDS-related causes have declined by 32 percent from 1.8 million in 2005 to 1.2 million in 2011, according to the latest UNAIDS report. As people around the world celebrate a reduction in the rate of HIV infections, the growth of the clinic, which was one of only a few to open its doors 20 years ago, reflects how changes in treatment and attitude toward HIV and AIDS have moved South Africa forward. The nation, which has the most people living with HIV in the world at 5.6 million, still faces stigma and high rates of infection. "You have no idea what a beautiful time we're living in right now," said one of the doctors at the clinic, Dr. Kay Mahomed, over the chatter of a crowd of patients outside her door. President Jacob Zuma's government decided to give the best care, including TB screening and care at the clinic, and not to look at the cost, she said. South Africa has increased the numbers treated for HIV by 75 percent in the last two years, UNAIDS said, and new HIV infections have fallen by more than 50,000 in those two years. South Africa has also increased its domestic expenditure on AIDS to $1.6 billion, the highest by any low-and middle-income country, the group said. Themba Lethu clinic, with funding from the government, the United States Agency for International Development and the United States President's Emergency Plan for AIDS Relief, is now among some 2,500 anti-retroviral therapy facilities in the country that treat approximately 1.9 million people. "Now, you can't not get better. It's just one of these win-win situations. You test, you treat and you get better, end of story," Mahomed said. But it hasn't always been that way. In the 1990s South Africa's problem was compounded by years of misinformation by President Thabo Mbeki, who questioned the link between HIV and AIDS, and his health minister, Manto Tshabalala-Msimang, who promoted a "treatment" of beets and garlic. Christinah Motsoahae first found out she was HIV positive in 1996, and said she felt nothing could be done about it. "I didn't understand it at that time because I was only 24, and I said, 'What the hell is that?'" she said. Sixteen years after her first diagnosis, she is now on anti-retroviral drugs and her life has turned around. She says the clinic has been instrumental. To handle the flow of patients, they're electronically checked in at reception, several nursing stations with partitions are set up to check vital signs and a new machine even helps dispense medicine to the pharmacists. "My status has changed my life, I have learned to accept people the way they are. I have learned not to be judgmental. And I have learned that it is God's purpose that I have this," the 40-year-old said. She works with a support group of "positive ladies" in her hometown near Krugersdorp. She travels to the clinic as often as needed and her optimism shines through her gold eye shadow and wide smile. "I love the way I'm living now." Motsoahae credits Nelson Mandela's family for inspiring her to face up to her status. The anti-apartheid icon galvanized the AIDS community in 2005 when he publicly acknowledged his son died of AIDS. Motsoahae is among about a hundred people waiting in a room to see one of about 10 doctors or to collect medications. A woman there rises up, slings her baby behind her back in a green fleece blanket, and tries to leave by zigzagging through the intercrossing legs of those seated. None of Motsoahae's children was born with HIV. The number of children newly infected with HIV has declined significantly. In six countries in sub-Saharan Africa — South Africa, Burundi, Kenya, Namibia, Togo and Zambia —the number of children with HIV declined by 40 to 59 percent between 2009 and 2011, the UNAIDS report said. But the situation remains dire for those over the age of 15, who make up the 5.3 million of those infected in South Africa. Fear and denial lend to the high prevalence of HIV for that age group in South Africa, said the clinic's Kay Mahomed. About 3.5 million South Africans still are not getting therapy, and many wait too long to come in to clinics or don't stay on the drugs, said Dr. Dave Spencer, who works at the clinic . "People are still afraid of a stigma related to HIV," he said, adding that education and communication are key to controlling the disease. Themba Lethu clinic reaches out to the younger generation with a teen program. Tshepo Hoato, 21, who helps run the program found out he was HIV positive after his mother died in 2000. He said he has been helped by the program in which teens meet one day a month. "What I've seen is a lot people around our ages, some commit suicide as soon as they find out they are HIV. That's a very hard stage for them so we came up with this program to help one another," he said. "We tell them our stories so they can understand and progress and see that no, man, it's not the end of the world."

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Clinton Unveils PEPFAR Blueprint in Honor of World AIDS Day

U.S. Secretary of State Hillary Clinton unveiled the nation's new initiative to eradicate HIV and AIDS on Thursday. Dubbed the "President's Emergency Plan for AIDS Relief (PEPFAR) Blueprint: Creating an AIDS-free Generation," the initiative is focused on improving both preventative measures and treatment options. Clinton presented PEPFAR during a special news conference in the Benjamin Franklin Room at the State Department. Clinton's announcement was meant to coincide with World AIDS Day, which is Dec. 1. World AIDS Day was established in 1988 in order to shed light on the disease, its causes, and its prevention and treatment, as well as to push for comprehensive government intervention and research. The theme of this year's World AIDS Day is a continuation of last year's "Getting to Zero." Here is some of the key information that emerged from Clinton's PEPFAR announcement. * The State Department had announced Clinton's intention to present the plan in a press release issued on Tuesday. * The press conference, which was streamed live by the State Department, featured opening remarks by Florence Ngobeni-Allen, who is the ambassador for the Elizabeth Glaser Pediatric AIDS Foundation, as well as remarks by Ambassador Eric P. Goosby, who is the U.S. Global AIDS Coordinator. * Clinton reportedly had requested that the PEPFAR blueprint be drawn up after her visit to South Africa this past summer. * As noted by The Hill, The PEPFAR Blueprint establishes several priorities in the nation's fight against AIDS, particularly mother-to-child transmission of HIV, increased access to condoms, and more HIV testing, among other factors. * Clinton said in her remarks on Thursday that while "HIV may well be with us into the future," AIDS itself "need not be." * She outlined what she referred to as two "broad goals" of the PEPFAR Blueprint and the nation's fight against AIDS -- to be able to fight new HIV infection rates to the point where globally more people are treated for an existing infection than are newly-diagnosed, and for the U.S. "to deliver" on its promises to continue to help lead the fight against the disease. * Clinton also said that the nation's fight against AIDS would place more of its global focus on women and girls, as they are at a higher risk of infection due to "gender inequity and violence." * According to the U.N. News Centre, the U.N. also has plans to mark World AIDS Day. U.N. Secretary-General Ban Ki-Moon reportedly plans to call for more focused initiatives and an ongoing global commitment "to get to zero."

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Hormone disorder and the Pill tied to blood clots

NEW YORK (Reuters Health) - Women who have a hormone disorder called polycystic ovary syndrome (PCOS) and who take the birth control pill have twice the risk of blood clots than do other women on the Pill, according to a new study. "For many women with PCOS, (the risks) will be small," said Dr. Christopher McCartney, an associate professor at the University of Virginia School of Medicine in Charlottesville, who was not involved in the new work. "For some women, they might be high enough to say we really shouldn't use the Pill, such as for women over 35 who smoke." The three to five percent of women in the U.S. with PCOS have a hormone imbalance, which can lead to irregular periods, extra hair growth and higher risks for being overweight and developing hypertension and diabetes. They are often treated with oral contraceptives, many of whose labels already include warnings about blood clots. A blood clot, also called venous thromboembolism, can be deadly if it spreads to the lungs, although none of the cases of blood clots in the study were fatal. Because women with PCOS already tend to have more heart disease risk factors, researchers wanted to see if the Pill adds any additional risk. They used medical and pharmacy information from a large health insurance database, including 43,500 women with PCOS. On average, over the course of a particular year, about 24 out of every 10,000 women with PCOS taking the Pill were diagnosed with a blood clot, compared to about 11 out of every 10,000 women without the disorder using the contraceptive. "Am I particularly surprised by the findings? No," said Dr. Shahla Nader-Eftekhari, a professor at the University of Texas Medical School at Houston, who treats women with PCOS but was not involved in the current study. OBESITY PLAYING A ROLE? The study, published in the Canadian Medical Association Journal, could not say for sure why women with PCOS are more likely to have a blood clot. McCartney said he suspects that obesity has something to do with it. At the beginning of the study in 2001 the percent of women with and without PCOS who were obese was the same - about 13 percent - but by the end of the study in 2009, 33 percent of women with PCOS and 21 percent of women without the disorder were obese. "I really think that could be something that's contributing to the risk," McCartney told Reuters Health. "Weight not only contributes to the risks associated with the Pill, it also contributes to some of the symptoms of PCOS and some of the metabolic problems associated with PCOS," he added. McCartney pointed out that the risk of developing a blood clot, even among women with PCOS, is still considered small, and shouldn't necessarily discourage women from taking the Pill. Steven Bird, the lead author of the study and an epidemiologist with the U.S. Food and Drug Administration, said that the importance of the findings is to raise awareness among women and their doctors that there is an increased risk for them if they take the Pill. "Although the risk is small, prescribers should consider the increased risk for blood clots in women with PCOS who are prescribed contraceptive therapy," Bird told Reuters Health by email. McCartney agreed, and added that it's also a good reminder for doctors of women with PCOS to discuss the importance of maintaining a healthy weight.

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HPV tied to throat cancers: study

NEW YORK (Reuters Health) - A sexually transmitted infection usually thought of in connection to cervical cancer is also tied to a five times greater risk of cancer of the vocal chords or voice box, a new report suggests. Combining the results of 55 studies from the past two decades, Chinese researchers found 28 percent of people with laryngeal cancers had cancerous tissue that tested positive for human papillomavirus (HPV). But that rate varied widely by study, from no throat cancer patients with HPV to 79 percent with the infection. "We're finding that HPV appears to be linked to a number of squamous cell carcinomas of the head, neck and throat," said Dr. William Mendenhall, a radiation oncologist from the University of Florida in Gainesville who didn't participate in the analysis. However, he told Reuters Health, "I think the risk of HPV on laryngeal cancer is probably relatively low. Most of the patients we see currently that come in with laryngeal cancer have a strong history of cigarette smoking, also heavy drinking." Along with tobacco and alcohol, having a poor diet and exposure to certain chemicals can increase a person's risk of laryngeal and other head and neck cancers. The American Cancer Society estimates 12,360 people will be diagnosed with laryngeal cancer in the United States in 2012 and that there will be 3,650 deaths from the disease. Along with their larger review, researchers led by Dr. Xiangwei Li, from the Chinese Academy of Medical Sciences and Peking University Medical College in Beijing, analyzed 12 studies that compared cancerous and non-cancerous tissues from a total of 638 patients. They found the cancerous throat tissue had 5.4 times the odds of testing positive for HPV infection, compared to non-cancerous tissue. The analysis was published last week in the Journal of Infectious Diseases. Mendenhall said that of all head and neck cancers, HPV seems to play the biggest role not in laryngeal cancer, but in cancer of the tonsils and back of the tongue. However, he added, "the exposure is probably decades earlier. Someone who develops a base of tongue cancer when they're 50, they probably were exposed to the virus years before, in their teens or 20s." At least half of sexually-active people get HPV at some point in their lives, according to the Centers for Disease Control and Prevention (CDC), but the virus is usually cleared by the immune system. Only some of the 40-plus HPV strains have been tied to cancer. Based on the current findings, it's difficult to know how many of the laryngeal cancers in the original studies were actually caused by the virus, researchers said. But Mendenhall said extending HPV vaccination to boys and young men, as the CDC has recommended, "will hopefully reduce at least some of these HPV-related cancers." (This story corrects to say "squamous" instead of "squalors" in paragraph 4 from story filed on Nov. 30)

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Uncircumcised boys and men may face more UTIs

NEW YORK (Reuters Health) - Infections of the kidney, bladder and urethra happen in uncircumcised baby boys at ten times the rate of circumcised boys, and over a lifetime uncircumcised men are four times more likely to experience one, according to a new analysis of past research. Urinary tract infections (UTIs) are most common in boys' first year of life, and circumcision was already known to make a difference in their risk, but how much and whether that carried through to adulthood was unclear, Australian researchers say. They found that circumcision "provides considerable protection and over the lifespan makes about a three- to four-fold difference by our prediction, which is quite striking in public health terms," lead study author Brian Morris, professor of molecular medical science at the Sydney Medical School, University of Sydney, told Reuters Health. Morris and a colleague examined 22 studies published between 1987 and 2012 that included a total of 407,902 males across the globe, a quarter of whom were uncircumcised. Breaking down the results by age, they calculated that the likelihood of a UTI between birth and one year of age is 9.9 times higher in uncircumcised boys compared to circumcised boys. Between ages 1 and 16, uncircumcised boys are at 6.6 times higher risk, and after age 16 their risk is 3.4 times that of uncircumcised men. Based on those findings, the researchers projected that doctors could prevent one UTI with every four circumcisions, "which is astronomical," Morris said. The younger the infant, the more serious a UTI can be, the researchers note in their report, which is published in the Journal of Urology. Side effects of a UTI in infants can include kidney scarring, fever, pain and blood infections. Health experts have mostly framed circumcision as a public health preventive measure focused on HIV and other sexually transmitted diseases. In August, the American Academy of Pediatrics for the first time stated that the health benefits of circumcision outweigh the risks, but added that the decision to circumcise a child remains with parents. The U.S. Centers for Disease Control and Prevention is currently evaluating the potential health impact of circumcision, according to a spokeswoman, but any recommendations that come of that will also be voluntary, she said. The estimated health benefit Morris and his colleague found was several times larger than what was projected in two previous studies, which suggested 111 or 195 circumcisions would be needed to prevent one case of UTI in the first year of life. One expert questioned the new findings based on the methods Morris' team used. Zbys Fedorowicz, director of the Bahrain branch of the UK Cochrane Centre, a non-profit organization that evaluates medical studies, said that the 22-study analysis combined different types of studies and the researchers failed to assess their quality. "It doesn't mean to say that these guys are necessarily wrong, it's just that we don't know because the methodological approach that they used isn't thorough enough, it's not transparent, it's not reproducible and it's not clear," Fedorowicz said. In November, Fedorowicz and colleagues published a report concluding that no existing study that examined the risk of urinary tract infections and circumcision was of high enough quality for any recommendation. Dr. Robert Van Howe, clinical professor of pediatrics at the Michigan State University College of Human Medicine and vocal critic of circumcision, also found the new study problematic. Van Howe said that diagnostic criteria for urinary tract infections differ between researchers and that the cost/ benefit analysis of circumcision as a preventive tool for infections doesn't add up. At $200 each circumcision, preventing one urinary tract infection would cost $40,000, "which you can treat with an $18 antibiotic; it's overkill," Van Howe said. "You would think we have long lists for dialysis in men because they're not circumcised, but it just isn't a problem, it's fear mongering," Van Howe told Reuters Health. A middle ground might be to let boys decide for themselves at age 14 or 16 to become circumcised, Van Howe suggested. "You can leave this choice up to the person who has to live with the consequences," Van Howe said. Morris maintains that the study sends "a really strong signal for advocacy of circumcision as a public health intervention in reducing these various - and in many cases very serious - conditions over the lifetime."

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