21st September, 2010
Countries in Sub-Saharan Africa are leading a global decline in new HIV infections, theÂ UN has said. UNAids said 22 countries in the worldâ€™s worst affected region had seen aÂ drop in new cases of more than 25%. The fall was because of greater awareness and betterÂ use of preventative measures, it said.
But UNAids also noted that cases of HIV were increasing in Eastern Europe and CentralÂ Asia, and among gay men in developed countries.
Michel Sidibe, UNAids executive director, said the world was making â€œreal progressâ€Â towards achieving the sixth Millennium Development Goal (MDG6) of halting and reversingÂ the spread of HIV/Aids by 2015.
â€œFor the first time change is happening at the heart of the epidemic. In places where HIVÂ was stealing away dreams, we now have hope,â€ he said. UNAids says there are now 5.2Â million people worldwide receiving treatment for HIV/Aids, which has helped to ensureÂ that 200,000 fewer people died from the virus in 2008 than in 2004.
The agency said young people â€œare leading the prevention revolution by choosing to haveÂ sex later, having fewer multiple partners and using condoms, resulting in significantlyÂ fewer new HIV infections in many countries highly affected by Aidsâ€.
The use of male condoms has also doubled in the past five years, while the report notesÂ that â€œtradition is giving space to pragmatismâ€ in many communities as they embrace maleÂ circumcision, which research shows has the potential to reduce HIV infections among menÂ by nearly 60%.
China, where cases are largely concentrated within high-risk groups, was praised for itsÂ efforts to increase preventative measures for drug users. UNAids said South Africa hadÂ also rapidly increased â€œefforts to achieve universal access to HIV prevention, treatment,Â care and supportâ€.
But there was a warning that â€œchallenges remainâ€ in the global fight against HIV/Aids,Â including expanding epidemics in Eastern Europe and Central Asia, and resurgence in newÂ 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 wasÂ a $10bn (Â£6.4bn) shortfall in 2009.
It said those countries most severely affected by HIV/Aids could not handle the crisisÂ with their own resources alone.
â€œAt this turning point flat-lining or reductions in investments will set-back the AidsÂ response and threaten the worldâ€™s ability to reach MDG 6,â€ said Mr Sidibe.
â€œInvesting for Aids is a shared responsibility – between development partners andÂ national governments.â€
Meanwhile, a vaginal gel has significantly cut the rate of women contracting HIV fromÂ infected partners in an experiment in South Africa, researchers said.
They said the gel, containing Aids drug tenofovir, cut infection rates among 889 women byÂ 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 beenÂ 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-SaharanÂ 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 moreÂ 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 inÂ South Africa in August to discuss the next steps with the product.
The results of the three-year study, which was completed by the Centre for the AidsÂ Programme of Research in South Africa (Caprisa), have been presented at an internationalÂ 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 infectionÂ 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 thisÂ is not an option for many women around the world who find it difficult to insist that aÂ man take the necessary precautions.
As a result, women have become particularly vulnerable to infection in recent years andÂ in Sub-Saharan Africa, where the Aids pandemic is most severe, they make up nearly 60% ofÂ those who are infected with the virus.
To compound the problem, science has shown that women are biologically more at risk ofÂ infection than men.
An effective gel would finally give women the chance to do something to protectÂ themselves from infection – to take control of their own sexual health.
However, several earlier trials have produced disappointing results, and even the resultsÂ of the latest trial – impressive though they are – underline that a gel is far from aÂ 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 worldâ€™sÂ poorest countries, where it is needed the most, it could help to transform many lives forÂ the better.
The gel was found to be both safe and acceptable when used once in the 12 hours beforeÂ 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 thatÂ the 889 women involved in the trial, conducted in the coastal city of Durban and a remoteÂ rural village, had largely used the gel as directed.
They were also given condoms and advice about sexually transmitted diseases, and testedÂ for HIV once a month. After 30 months, 98 women became infected with HIV – 38 in theÂ group that got tenofovir in the gel and 60 in the group that got placebos.
â€œWe showed a 39% lower incidence of HIV in the tenofovir group,â€ Dr Karim said.Â Tenofovir, he added, lowered the risk of infection by 50% at 12 months but then theÂ 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 andÂ gel cost â€œjust penniesâ€.
â€œBoy, have we been doing the happy dance,â€ Dr Karim, from the University of KwaZulu-NatalÂ in Durban, said.
â€œItâ€™s the first time weâ€™ve ever seen any microbicide give a positive result that youÂ could say was statistically significant,â€ said Dr Anthony Fauci, director of the NationalÂ Institute of Allergy and Infectious Diseases.
The researchers say women who used the gel also showed a significant reduction in genitalÂ herpes, a common sexually transmitted infection, which itself increases the risk of HIVÂ infection.
The UNâ€™s HIV/Aids agency noted that nearly 20 years of research had gone intoÂ microbicides that can be controlled by a woman, independent of her partner.
â€œWe are giving hope to women,â€ said Mr Michel Sidibe, executive director of UNAids.
â€œFor the first time we have seen results for a woman-initiated and controlled HIVÂ prevention option.â€
A microbicide, he said, would be a â€œpowerful option for the prevention revolution andÂ help us break the trajectory of the Aids epidemicâ€.
Dr Margaret Chan, director-general of the World Health Organization, welcomed Caprisaâ€™sÂ findings.
â€œWe look forward in seeing these results confirmed,â€ she said.
â€œOnce they have been shown to be safe and effective, WHO will work with countries andÂ partners to accelerate access to these products.â€
â€¢Culled from bbc.co.uk