HIV’s Spread Declines in Africa —UN
THE number of young people infected with HIV in Africa is falling in 16 of the 25 countries hardest hit by the virus, according to a new report by a U.N. agency. The number of young people infected with HIV dropped by at least 25 percent in a dozen countries, the U.N. AIDS report said. In Kenya, for instance, the infection rate among people aged 15 to 24 fell from about 14 percent in 2000 to 5.4 percent in urban areas.
The drop in HIV rates coincided with a change in sexual behavior, like having fewer sexual partners or increased condom use, UNAIDS said. But the agency could not say the drop was because of recent U.N. policies, which mainly have focused on buying AIDS drugs rather than preventing infections.
Prevention will remain a key investment for the Bill & Melinda Gates Foundation, its co-leader, Microsoft Corp. founder Bill Gates, said Tuesday. He spoke in a conference call with reporters to preview comments he’ll make at next week’s International AIDS Conference in Vienna.
Gates repeatedly cited circumcision to reduce the spread of HIV as an area the foundation had “got out in front of” and would continue to support. Economic woes have limited how much money countries can spend on AIDS, so more must be done to trim administrative costs and make delivering treatment as efficient as possible, Gates said.
“We’ve hit some limits and we’re going to have to get as much as we can out of the funding that exists,” he said.
The Seattle-based foundation has given more than $2.2 billion to fight HIV around the world, plus $650 million to support the Global Fund to Fight AIDS, tuberculosis, and malaria. The UNAIDS research provides further evidence the AIDS outbreak peaked more than a decade ago and that the disease is on the decline. In a report last year, the agency said the number of people infected with HIV had remained unchanged — at about 33 million — for the last two years.
The new report is based on population surveys and mathematical modeling, and comes with a significant margin of error.
Some experts said the new focus on prevention was too little, too late.
“Thanks to the U.N.’s strategic blunder, many more people are now infected than would have otherwise been the case had they focused on prevention much earlier,” said Philip Stevens, a health policy expert at International Policy Network, a London-based think tank. UNAIDS also called for more money to combat the epidemic.
In 2008, the world spent more than $15 billion on AIDS, with about half of that coming from the United States. In its report, UNAIDS said that “what’s been good for the AIDS response has been good for global health in general.”
But a study published last month found there was little correlation between U.S. money spent on AIDS and improvements in other health areas across Africa.
UNAIDS urged countries to invest more in their own HIV programs. It noted South Africa and Nigeria, two of Africa’s wealthiest countries, receive the most money from international donors.
Stevens said that while some recent AIDS investments — like putting more people on drugs — have clearly saved lives, it also has distorted health spending. Despite only causing 4 percent of deaths, AIDS gets about 20 cents of every public health dollar.
“The same amount of money that we spend on AIDS could save many, many more lives more cheaply by vaccinating children or distributing cheap treatments for diarrhea,” he said.
“Aid agencies have a responsibility to ensure they save the most lives possible with the amount of money they have available,” he said. “Spending the lion’s share on HIV clearly does not do that.”
Gel Cuts HIV Transmission Rate
A new topical gel has shown promise in helping to protect women from HIV infection, according to a study being presented at the International AIDS Conference in Vienna, Austria.
The gel contains the antiretroviral drug tenofovir, which keeps the virus from multiplying.
An effective vaginal microbicide such as this could be a major new tool in the HIV toolbox.
“Women represent the majority of new HIV infections globally, and urgently need methods they can control to protect themselves from infection,” said Dr. Kevin Fenton, director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, part of the Centers for Disease Control.
The two-and-a-half-year-old CAPRISA trial followed nearly 900 HIV-negative, sexually active South African women between ages 18 and 40 to determine how safe and effective tenofovir gel was in preventing HIV infection.
Researchers found the gel overall reduced infection by 50 percent after a year and 39 percent after 30 months. In women who used the drug consistently infection was reduced 54 percent. The gel was used up to 12 hours before and within 12 hours of sexual intercourse. The study found the gel also reduced the risk of genital herpes by 51 percent.
This is the first completed study on an antiretroviral microbicide. In the double-blind, randomized control trial, half the women got tenofovir gel and half got a placebo. Information from this trial could help researchers develop more antiretroviral-based microbicide drugs in the future.
Antiretrovirals can prevent retroviruses like HIV from reproducing and damaging the immune system.
A separate study presented at the conference found that a microbicide that is 40 to 50 percent effective could prevent nearly 300,000 to 600,000 new infections in a 10-year period.
Tenofovir is marketed by Gilead Sciences under the trade name Viread. It belongs to a class of drugs called reverse transcriptase inhibitors. They don’t kill the virus but they slow down its growth, which ultimately slows the progression of the disease.
The therapy is not yet ready for widespread use, but the finding is a giant step forward in the use of microbicides, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health.
Mushrooms kill 400 in China
Every year during the height of the rainy season, villagers of all ages in a corner of southwestern China would suddenly die of cardiac arrest.
No one knew what caused Yunnan Sudden Death Syndrome, blamed for an estimated 400 deaths in the past three decades.
After a five-year study, an elite investigative unit from China’s Center for Disease Control and Prevention believes it has pinpointed the cause: an innocuous-looking mushroom known as Little White.
The search for the culprit took investigators to remote villages spread over the rural highlands of Yunnan province, said Robert Fontaine, an epidemiologist with the U.S. Centers for Disease Control and Prevention.
There was “this very obvious clustering of deaths in villages in very short periods of time in the summer,” said Fontaine, who helped in the investigation. “It appears that there was something a little different going on.”
Local health officials had noted the deaths for years. In 2004, they appealed to Beijing for assistance. The government gave the task to the China Field Epidemiology Training Program, a unit of medical investigators at China’s CDC assigned some of the country’s toughest health mysteries.
The medical teams encountered obstacles. Many villagers communicated in their own dialect. Villages were scattered in often remote areas. Rapid burials made it difficult to conduct autopsies. Torrential rain and mudslides hampered travel.
But that first year, investigators were able to narrow the list of possibilities: most victims had drunk surface water, they had emotional stress and they ate mushrooms.
The investigators zeroed in on mushrooms, because the deaths were closely aligned with the harvesting season. More than 90 percent of the deaths occurred in July or August. By the end of 2005, investigators began issuing warnings to some villages to avoid eating unfamiliar mushrooms.
That was a difficult order to follow. Yunnan province is legendary for its wide variety of wild mushrooms, many of which are exported at high prices. Entire families go out to hunt for them during the summer months.
By 2008, investigators had discovered a relatively unknown mushroom in a number of homes where people had died. The mushroom is not usually sold in the markets, because it’s too small.
“We repeatedly found it at all these sites,” Fontaine said.
A public information campaign to warn against eating the mushrooms has dramatically reduced the number of deaths. Only a handful have been reported in the last couple of years, and none so far this year.
However, the mystery has not yet been definitively solved. Testing found the mushroom contained some toxins, though not enough to be deadly. Chinese scientists need to isolate the toxin and test whether it triggers cardiac arrests.
Researchers have hypothesized that there is a second agent. Many of the victims showed high levels of barium, a heavy metal in the soil that seeps into mushrooms.
“There is a lot of work left to do,” Fontaine said. “We really need additional lab investigations.”
Problems with poisonous mushrooms are common throughout Asia, said Diderik De Vleeschauwer, a spokesman for the U.N. Food and Agriculture Organization regional office in Thailand.
“Normally we expect people to have knowledge of what they can and can’t eat. One would think there is indigenous knowledge available about what they can forage,” he said. “But these are accidents that can happen.”

Rolake Odetoyinbo, HIV-positive, celebrating robust existence