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July 15, 2004

In This Update:
  • From the Editor
  • Webcasts From Bangkok
  • HIV Treatment
  • HIV Transmission
  • U.S. HIV/AIDS Policy & Activism
  • HIV-Related Health Problems & Quality of Life
  • HIV/AIDS Outside the U.S.

    The XV International AIDS Conference is winding down in Bangkok, Thailand, and news from the massive gathering is coming in fast and furious. This week's update includes highlights from the first few days of the conference. With more than 8,500 abstracts presented on a range of topics -- from basic science to epidemiology, from prevention to social and economic issues -- we can only hope to cover a miniscule number.

    Though much of the scientific material presented at AIDS 2004 was published or presented at conferences earlier this year, there is some news worth noting. Stop in at The Body's AIDS 2004 home page for the most recent news and research to come out of the conference, or to watch Webcasts of key conference sessions and speeches from major world figures!

    For another take on the happenings at AIDS 2004, read through Health & Development Networks' daily online newspaper, which provides on-the-scene coverage of the conference along with analysis and commentary. Click on the following links to download the newspapers for July 12, July 13 or July 14.

    - Bonnie Goldman, Editorial Director, The Body


    Each of the following links will take you to Webcasts from the XV International AIDS Conference provided by Click here for a complete rundown of video highlights from the conference.

    Watch AIDS 2004's Opening Ceremony
    International AIDS Society President Joep Lange, Prime Minister of Thailand Thaksin Shinawatra and United Nations Secretary-General Kofi Annan addressed conference delegates during the opening ceremony on July 11. The ceremony also featured a candlelight memorial hosted by Miss Universe 2004 Jennifer Hawkins and a selection of songs sung by Thai children and children from one of East Africa's largest orphanages.

    Click here to read a transcript of Kofi Annan's opening ceremony speech.

    Need for Female Leaders in the Global AIDS Fight Has Never Been Greater
    It's no surprise that the number of women with HIV is growing so quickly throughout the world. Many women -- not only those in developing countries, but here in the United States and other developed nations as well -- lack the power to negotiate safer sex, say no to sex entirely, or even to demand monogamy from their husbands. In this important conference session, a panel of experts discusses why female leaders are needed now, more than ever before, to fight the worsening AIDS epidemic among women.

    ABC vs. CNN: The Battle of the HIV Prevention Plans (Not TV Networks)
    Although it was meant to be a debate between two different HIV prevention strategies, there was plenty of agreement between supporters of the "ABC" (abstain, be faithful, use condoms) and "CNN" (condoms, clean needles and negotiating skills) approaches in this July 12 conference session. As expected, however, the participants disagreed on how much emphasis should be placed on each prevention method.

    AIDS Funding Increases -- But Are the Donors Still Too Selfish?
    Donations to the international fight against AIDS topped $6 billion in 2003, more than four times what donors gave just three years before. Yet the number of new HIV infections continues to rise while millions of people go without access to treatment. Why isn't the increasing cash flow having an impact? Much of the problem lies with the donors themselves, according to speakers at this session. Conflicting priorities and redundant efforts make many AIDS assistance programs inefficient at best and harmful at worst.

    Comparing HIV Treatment Programs: India, South Africa and Thailand
    Many developing countries are considering whether or to what degree they should expand public financing for antiretroviral therapy. What better way than by looking at the efforts already made by others? In this symposium, speakers discussed the nuts and bolts of three national treatment programs -- in India, South Africa and Thailand -- and examined ways in which they could be replicated in other countries.



    The Body Pro's JournalView: A Close-Up Look at the Latest HIV Research
    Looking to stay informed about the latest, greatest HIV-related research to be published in major medical journals? The Body Pro, The Body's sister site for healthcare professionals, publishes a monthly recap of newly released study data, along with thought-provoking analysis from a top HIV physician! Visit The Body Pro now to check out June 2004's JournalView, written by David Wohl, M.D. This month, Dr. Wohl focuses on the newest findings regarding HIV drug resistance.

    Older People With HIV May Respond Differently to Treatment
    Does a person's age affect how well HAART works? Recent studies say no, but there is also evidence that older people's immune systems may react differently than those of younger people once HAART begins to suppress their viral loads.

    Benefits of T-20 Persist for At Least Two Years
    Enfuvirtide (T-20, Fuzeon), the first drug to receive approval in the fusion inhibitor class, demonstrates continued success in treatment-experienced people through 96 weeks. Cal Cohen, M.D., reports from AIDS 2004.

    HAART Can Still Work Well, Even After Late HIV Diagnosis
    Despite being diagnosed with HIV late (when their CD4 counts were already below 50), HIV-positive people who survived opportunistic infections responded well to HAART, both virologically and immunologically. Thanes Vanig, M.D., reports from AIDS 2004.

    "Intermittent Drug Switching": A New Treatment Strategy?
    A German proof-of-concept study examined intermittent antiretroviral switching, in which a person with multi-drug resistance is shifted from one single-class regimen (e.g., only protease inhibitors) to another as resistance redevelops. The strategy appeared to be safe through 48 weeks, with no reduction in CD4 count seen; however, there was no sustained significant reduction in viral load. As Mark Holodniy, M.D., reports from AIDS 2004, the clinical benefits of this unique strategy are still unknown.

    Integrase Inhibitor Suppresses Viral Load in Early Clinical Trial
    L-870812 is the Star Wars-like name for an experimental HIV integrase inhibitor, a new type of drug that attempts to prevent HIV from entering a person's immune cells. In a recent study conducted on monkeys, L-870812
    significantly reduced viral load levels while preserving CD4 cell counts, provided the monkeys have been very recently infected.



    HIV Prevalence Among U.S. Women Rising Faster Than Rest of World
    The proportion of women making up the total number of HIV cases in the United States is increasing faster than in any other country, according to a new report from the United Nations. Despite the sharp rise, however, women still comprise only a quarter of the total number of people living with HIV in the United States, a much lower proportion than the 48% figure for women worldwide. The rise is part of the "feminization" of the epidemic throughout the world, the report says.

    Syphilis Up Sharply Among Gay California Men, But HIV Hasn't Climbed With It -- Yet
    Even though syphilis infection is rapidly spreading among men who have sex with men (MSM) in San Francisco and Los Angeles, researchers haven't yet found a sign that HIV cases are rising as well. In part, this is because at least half of the MSM who were newly infected with syphilis already had HIV, the researchers said -- but they warn that if this trend of unsafe sex continues, it will almost certainly result in a jump in new HIV cases.

    Ugandan President Stirs Controversy for Downplaying Use of Condoms to Prevent HIV
    Attendees at the XV International AIDS Conference were deeply divided over Ugandan President Yoweri Museveni's comments on July 12 that condoms were less effective for HIV prevention than campaigns that promote abstinence and faithful relationships. "The principle of condoms is not the ultimate solution," Museveni told a conference plenary session. "In some cultures sexual intercourse is so elaborate that condoms are a hindrance."

    New York City: One in 14 Middle-Aged Black Men Have HIV
    African-American men between the ages of 40 and 54 living in New York City are almost three times as likely as other city residents to have HIV, according to a report released at the XV International AIDS Conference by the city's Department of Health and Mental Hygiene. One of every 14 middle-age black men in New York are HIV infected, the report says; in the borough of Manhattan, the rate is one in seven.

    HIV Vaccine Research Funding Is Far Below Needed Level, Report Says
    With the search for an effective AIDS vaccine still years from bearing fruit, spending on the effort needs to be doubled in order to broaden research efforts, since researchers might have to "go back to the drawing board" if the current approach fails, according to a report released by the International AIDS Vaccine Initiative at the XV International AIDS Conference. More than 30 vaccines are currently in clinical trials, the report says, but virtually all are in the early stages of development. Annual spending on vaccine research stands at about $650 million -- less than 1% of the total spending on all HIV/AIDS product development.



    Review of Government-Funded HIV Treatment Programs
    Medicare; Medicaid; the Ryan White CARE Act. How do these three programs differ in the financial assistance they provide for low-income people with HIV in the United States? Social worker Mary Lynn Hemphill explains the basics of each service in this helpful overview.

    Need help navigating the maze of different benefits available for HIV-positive people in the United States? Use The Body’s online listing of U.S. AIDS organizations.

    Government Subcommittee Votes to Freeze Most Ryan White Funding
    With the exception of a $35 million increase for AIDS Drug Assistance Programs (ADAPs), a U.S. House of Representatives budget subcommittee has recommended holding all programs under the Ryan White CARE Act at last year's funding levels -- something it has done every year since President George W. Bush took office, despite the growing number of Americans in need of HIV treatment and care. The subcommittee did, however, recommend a $7 million increase for HIV prevention initiatives from the Centers for Disease Control and Prevention, an additional $600 million for global AIDS relief and $3.3 million in added funding for the Minority AIDS Initiative.



    HIV Positive and Reaching the Big 5-0
    Fifty-two-year-old Paul Muller never expected he'd still be around after more than two decades of living with HIV. And while he's grateful to have been given this unplanned opportunity to grow old, it's also brought a new set of issues to deal with -- both mental and physical. "I am looking forward to having a more productive life, being able to deal with the other concerns that come with aging," he explains. "Though at times I wonder -- why am I still here after 24 years with HIV while so many family members and friends have died?"

    Research Still Sketchy on Menopause in HIV-Positive Women
    Exceedingly little is known about the impact of menopause on HIV disease in women, and vice versa. Although much research remains to be done in this area, new data presented at the XV International AIDS Conference may help healthcare providers better understand the prevalence of symptoms such as nausea, weakness and insomnia in HIV-infected menopausal women. Lisa Hirschhorn, M.D., reports.

    Long-Term Stress Can Harm Immune System, Especially for HIVers
    It's long been known that being under stress for long periods of time makes people less able to fight off infections. But this is even more true for those with damaged immune systems from HIV or other diseases, according to the results of a massive review of hundreds of clinical studies. Brief periods of stress, on the other hand, were found to actually be beneficial to the body's natural immunity to illness. (Web highlight from



    HIV Treatment Access Protesters Make Their Presence Felt at AIDS 2004
    About 1,000 Thai and international protesters on July 11 held a rally outside the XV International AIDS Conference in Bangkok, Thailand, to call for increased access to antiretroviral drugs and an end to ongoing free-trade negotiations between Thailand and the United States, which the advocates say will only serve to protect U.S. patents on antiretrovirals. About 20 advocates for injection drug users also heckled Thai Prime Minister Thaksin Shinawatra during a speech, and an exhibition booth run by GlaxoSmithKline was reportedly "besieged" by protesters accusing the pharmaceutical company of failing to provide antiretrovirals to HIV-infected South Africans.

    France Accuses U.S. of "Blackmailing" Developing Countries Into Ditching Generics
    French President Jacques Chirac has joined a growing chorus of critics denouncing efforts by the United States to force poor countries -- Thailand among them -- to give up their rights to develop inexpensive generic drugs in exchange for potentially lucrative
    free-trade agreements. The tactic is "tantamount to blackmail," Chirac said. (Web highlight from the Associated Press)

    WHO Report Says 3 by 5 Initiative Is Behind Schedule, but Still Achievable
    Although the objective of the World Health Organization's 3 by 5 Initiative -- treating 3 million HIV-positive people with antiretrovirals by 2005 -- is behind schedule, it is still possible, according to the initiative's first progress report, released on July 10. The report estimates that 440,000 people currently are receiving treatment under the program, about 12% shy of the WHO's target for July 2004.

    U.S. Global AIDS Initiative Gets Off to a Rocky Start
    President Bush's global AIDS initiative often bears a striking resemblance to an elephant tiptoeing through a flower garden. Despite lofty goals and high hopes, many of the 15 countries who are beneficiaries of the President's Emergency Plan for AIDS Relief have been angered by the arrogance and unilateralism with which the United States has acted. To the initiative's credit, in some cases, U.S. officials have adapted to the needs of individual countries, and anti-HIV programs there have begun to flourish as a result. In others, there remains a tremendous amount of work to be done just to get programs off the ground. (Web highlight from The New York Times; free registration required)

    Why the Meds Should Wait: An African AIDS Advocate Speaks Out
    AIDS advocate and former African resident Colin Webb argues that we should not be trying to deliver life-daving HIV meds to Africa before the continent has a health infrastructure in place that can effectively give them to the people who need them. "This obsession with the supply of medicines does not begin to tackle the realities of the health-care crisis that engulfs much of the underdeveloped world," he writes.

    Worldwide, Nearly as Many Women Have HIV as Men
    The percentage of HIVers who are adult women has increased from 35% in 1985 to 48% in 2003, according to a report from the United Nations Development Fund for Women. Sixty percent of HIV-infected 15- to 24-year-olds worldwide are women, the report adds, pointing to a range of factors -- most of which revolve around a complete lack of female empowerment in many countries -- as the cause of the increase.

    "I Don't Want Others to Die Like My Wife"
    Dr. Leonard Okello heads the Ugandan branch of ActionAid, an AIDS advocacy group, and is leading the agency's team at the XV International Aids Conference. He is also an AIDS widower who has had to raise his three daughters alone since his wife's death. (Web highlight from BBC News)

    Photo of the AIDS Quilt in Thailand
    One of several panels of an AIDS quilt making an appearance at the XV International AIDS Conference in Bangkok, Thailand. This photo, along with many others taken of the people, places and events surrounding this conference, will be available at The Body next week in a special AIDS 2004 photo journal.
    Image from the July 2004 Visual AIDS Web Gallery
    "Diary: One Day," 1997;
    Joe De Hoyos
    Visit the July 2004 Visual AIDS Web Gallery to view this month's new collection of art by HIV-positive artists.