Sub-Sahara Africa Leads Global Decline In New HIV Cases

Countries in Sub-Saharan Africa are leading a global decline in new HIV infections, the  UN has said. UNAids said 22 countries in the world’s worst affected region had seen a  drop in new cases of more than 25%. The fall was because of greater awareness and better  use of preventative measures, it said.

But UNAids also noted that cases of HIV were increasing in Eastern Europe and Central  Asia, and among gay men in developed countries.

Michel Sidibe, UNAids executive director, said the world was making “real progress”  towards achieving the sixth Millennium Development Goal (MDG6) of halting and reversing  the spread of HIV/Aids by 2015.

“For the first time change is happening at the heart of the epidemic. In places where HIV  was stealing away dreams, we now have hope,” he said. UNAids says there are now 5.2  million people worldwide receiving treatment for HIV/Aids, which has helped to ensure  that 200,000 fewer people died from the virus in 2008 than in 2004.

The agency said young people “are leading the prevention revolution by choosing to have  sex later, having fewer multiple partners and using condoms, resulting in significantly  fewer new HIV infections in many countries highly affected by Aids”.

The use of male condoms has also doubled in the past five years, while the report notes  that “tradition is giving space to pragmatism” in many communities as they embrace male  circumcision, which research shows has the potential to reduce HIV infections among men  by nearly 60%.

China, where cases are largely concentrated within high-risk groups, was praised for its  efforts to increase preventative measures for drug users. UNAids said South Africa had  also rapidly increased “efforts to achieve universal access to HIV prevention, treatment,  care and support”.

But there was a warning that “challenges remain” in the global fight against HIV/Aids,  including expanding epidemics in Eastern Europe and Central Asia, and resurgence in new  infections in wealthier nations among men who have sex with men.

The UN also called for greater investment in HIV/Aids prevention, warning that there was  a $10bn (£6.4bn) shortfall in 2009.

It said those countries most severely affected by HIV/Aids could not handle the crisis  with their own resources alone.

“At this turning point flat-lining or reductions in investments will set-back the Aids  response and threaten the world’s ability to reach MDG 6,” said Mr Sidibe.

“Investing for Aids is a shared responsibility – between development partners and  national governments.”

Meanwhile, a vaginal gel has significantly cut the rate of women contracting HIV from  infected partners in an experiment in South Africa, researchers said.

They said the gel, containing Aids drug tenofovir, cut infection rates among 889 women by  50% after one year of use, and by 39% after two and a half years.

If the results are confirmed it would be the first time that a microbicidal gel has been  shown to be effective.

Such a gel could be a defence for women whose partners refuse to wear condoms.

New ways of curbing the spread of HIV are badly needed, particularly in sub-Saharan  Africa, where nearly 60% of those infected with the virus are women.

Many women are often forced to take part in unsafe sex, and are biologically more  vulnerable to HIV infection than men, making a gel they apply an attractive option.

Welcoming the results, UN agencies said they would convene an expert consultation in  South Africa in August to discuss the next steps with the product.

‘Just pennies’

The results of the three-year study, which was completed by the Centre for the Aids  Programme of Research in South Africa (Caprisa), have been presented at an international  aids conference in Vienna and were published by the US magazine Science.

An easy-to-use microbicidal gel proven to significantly reduce the risk of HIV infection  would be a very important breakthrough in the fight to control the spread of HIV/Aids.

The best way to minimise the risk of infection during sex is to use a condom – but this  is not an option for many women around the world who find it difficult to insist that a  man take the necessary precautions.

As a result, women have become particularly vulnerable to infection in recent years and  in Sub-Saharan Africa, where the Aids pandemic is most severe, they make up nearly 60% of  those who are infected with the virus.

To compound the problem, science has shown that women are biologically more at risk of  infection than men.

An effective gel would finally give women the chance to do something to protect  themselves from infection – to take control of their own sexual health.

However, several earlier trials have produced disappointing results, and even the results  of the latest trial – impressive though they are – underline that a gel is far from a  fail-safe form of protection.

The latest results also need to be replicated in a much bigger trial.

But provided a gel could be made widely accessible to women in some of the world’s  poorest countries, where it is needed the most, it could help to transform many lives for  the better.

The gel was found to be both safe and acceptable when used once in the 12 hours before  sex and once in the 12 hours after sex by women aged 18 to 40 years.

Salim Abdool Karim, one of the two leading co-researchers, told reporters in Vienna that  the 889 women involved in the trial, conducted in the coastal city of Durban and a remote  rural village, had largely used the gel as directed.

They were also given condoms and advice about sexually transmitted diseases, and tested  for HIV once a month. After 30 months, 98 women became infected with HIV – 38 in the  group that got tenofovir in the gel and 60 in the group that got placebos.

“We showed a 39% lower incidence of HIV in the tenofovir group,” Dr Karim said.  Tenofovir, he added, lowered the risk of infection by 50% at 12 months but then the  efficacy declined.

Women who used the gel more consistently were much less likely to be infected, he said.

He added that he did not know how much each dose would cost but said the applicators and  gel cost “just pennies”.

“Boy, have we been doing the happy dance,” Dr Karim, from the University of KwaZulu-Natal  in Durban, said.

“It’s the first time we’ve ever seen any microbicide give a positive result that you  could say was statistically significant,” said Dr Anthony Fauci, director of the National  Institute of Allergy and Infectious Diseases.

The researchers say women who used the gel also showed a significant reduction in genital  herpes, a common sexually transmitted infection, which itself increases the risk of HIV  infection.

The UN’s HIV/Aids agency noted that nearly 20 years of research had gone into  microbicides that can be controlled by a woman, independent of her partner.

“We are giving hope to women,” said Mr Michel Sidibe, executive director of UNAids.

“For the first time we have seen results for a woman-initiated and controlled HIV  prevention option.”

A microbicide, he said, would be a “powerful option for the prevention revolution and  help us break the trajectory of the Aids epidemic”.

Dr Margaret Chan, director-general of the World Health Organization, welcomed Caprisa’s  findings.

“We look forward in seeing these results confirmed,” she said.

“Once they have been shown to be safe and effective, WHO will work with countries and  partners to accelerate access to these products.”

•Culled from bbc.co.uk