God, AIDS, Africa & HOPE

Reflections / Gedanken

07/16/2016 • 3:12 pm Comments Off on World Aids Conference 2016

World Aids Conference 2016

“What do you expect from the World Aids Conference 2016?” is one of the common questions asked in the last week. Well, what does one expect from a conference with more than 15000 participants in a country which was hit the most from the pandemic. Insights into new developments? I guess the most important factor for me is being able to get an overview first hand what is going on the world of HIV and AIDS around the globe. It is indeed the direct contact with activists and researchers where I learn the most  – while listening to their experience and insights – and which makes the trip to Durban worth time and effort. Communication, exchange, but also the feeling not to be alone in the fight against the pandemic leaves on with the resolve of continuing the work one is doing locally.

Durban 2016 is so different from the previous World Aids Conference held in Durban in 2000. At that time it was despair, hopelessness and the ignorance of politics which ruled the situation in South Africa. It was the time when HOPE Cape Town was born out of the need to stop the dying of children and parents. So Durban 2016 is also about achievements, about the millions on treatment, the figure of new mother-to-child transmission slowly going towards zero and the great feeling, that we from HOPE Cape Town have been part of this unbelievable journey of hope and frustration, often changing first place in the matter of an eye-blink.

There is still so much to do – the transmission rate in South Africa is still scary high, other countries also register more new infections and a vaccine seems to be still far away. There are still millions of South Africans dealing with stigma and discrimination on various levels. There is still so much stigma attached, so much fear and anxiety when it comes to dealing with HIV and Aids. We are definitely not there where we want to be, and the next 10 years will be crucial in the attempt to make a new generation of zero new infections a reality. Given the moment state of affair in South Africa, all the service delivery protests, corruption, political ignorance and the still wounded society there is more than a question mark to put behind the question: Will we achieve a victory?  HIV is more than a medical syndrome, it has to do with poverty, with hunger, with despair, with job creation, with investments, with intact families, with proper sex education, with the end of religious bias towards moral questions – and obviously when looking at it globally the amount of resources will depend on how governments want to spend their money. Looking at madness of violence and terrorism, racism and war it seems that HIV will continue to have only a backseat. And this might compromise the achievements reached till today.

Filed under: HIV and AIDS, HIV Prevention, HIV Treatment, HOPE Cape Town Association, HOPE Cape Town Association & Trust, HOPE Cape Town Association & Trust, HOPE Cape Town Trust, Medical and Research, Politics and Society, Reflection, South Africa, , , , , , , , , , , , , , , ,

12/11/2015 • 8:54 am Comments Off on Moral responsibilities to disclose your HIV status?

Moral responsibilities to disclose your HIV status?

Moral responsibilities to disclose your HIV status to partners aren’t so clear-cut

By Bridget Haire
Bridget Haire is a lecturer in ethics, HIV prevention at UNSW Australia.
This article was originally published on The Conversation. Read the original article.

Sexual ethics is an area prone to strongly felt moral intuitions. We saw this play out in the good, bad and sometimes ugly commentary following Charlie Sheen’s public disclosure of his HIV status. But just how much disclosure is it reasonable to expect from a sex partner, particularly if that relationship isn’t a serious and committed one?
Common morality
There is a “common morality” precept that for sex to be truly consensual, sexual partners need to disclose certain facts to their intended partner. This includes information about sexually transmissible infections, and whether the person is in a committed (supposedly) exclusive relationship such as a marriage. Identity is also relevant. It’s generally considered wrong (and often a crime) to have sexual relations with someone by means of deception such as impersonation.
Withholding material facts or deceiving a sexual partner deprives a partner of making an informed choice about whether or not to engage in sex, given the particular social and health contexts that apply. If consent to sex was dependent on an intentional deception, it was coerced rather than freely given. This “common morality” precept is also upheld from a sexual rights perspective. This decrees that every person has the right to freedom and to protection from harm, such as those harms that accrue from coerced sex.
But there are exceptions
These principles appear fairly straightforward but can become vexed when there is risk for the person disclosing, or it’s unclear whether the facts themselves require disclosure. Consider instances where transgendered people may seek to “pass” as their non-birth gender to a sexual partner. Under the sexual rights framework, all people have a right to non-discrimination and to enjoy fundamental rights and freedoms on an equal basis to others. These fundamental freedoms include the right to sexual pleasure. If the intended sexual partner of a trans person is not accepting of transgender concepts and is entrenched in gender binaries, he or she may react to disclosure by rejection or even violence. Arguably then, it may be reasonable not to disclose transgender status given that it could involve serious risk, foreclose the possibility of sexual pleasure and expose the disclosing person to discriminatory hostility.
From the condom code to negotiated safety
When HIV first erupted in the 1980s, gay communities emphasised condoms as a universal precaution, rather than relying on the disclosure of HIV status, which was not always known.
The condom code of the 1980s was also a community-building strategy that recognised the importance of sex for gay men who had fought to have laws criminalising gay sex removed. The stigma and discrimination that had been associated with homosexuality transformed into gay liberation and pride. The condom code emphasised mutual protection rather than a division along the lines of HIV status. This avoided some of the perils of HIV stigma at a time when connection and support were of critical importance in order to care for the sick. As the epidemic matured and treatment options developed from marginally effective drugs with difficult side effects to the highly effective and well-tolerated combination therapies used today, prevention responses also evolved. From the early 1990s, gay men in couples began to make strategic use of HIV testing to determine whether or not they needed to use condoms with each other. This strategy, dubbed “negotiated safety”, was one of several ways to reduce HIV risk that involved testing. Now, HIV treatment can reduce one’s viral load to undetectable levels and reduce HIV transmission to partners. This has raised questions about whether people with undetectable viral loads can consider themselves uninfectious, and whether they are legally or morally compelled to disclose their status to partners. Interestingly, some public health laws such as the New South Wales Public Health Act require disclosure. But taking “reasonable precautions” against transmitting the infection is cited as a defence. Whether or not such “precautions” may include maintaining an undetectable viral load, as distinct from using a condom, has not been tested.
Disclosing HIV status
At the moral level, does a person with HIV have a duty to disclose her or his status to a sex partner? That depends. While sex is a physically intimate act, sexual relationships have different levels of depth and intensity, ranging from the most seriously committed to the casual and transient. Duties to sexual partners must therefore sit on a gradient. Within the most trusting and committed relationships, non-disclosure of a serious infection such as HIV would undermine the intimacy of the partnership. In casual sex situations, however, HIV disclosure may not be morally required (though in many Australian states it remains legally required), so long as some form of safe sex is practised. Some communities have long recognised that using a condom could discharge the responsibility to disclose. Arguably, maintaining an undetectable viral load could also be seen as adequate, particularly if combined with further risk-reduction measures such as strategic positioning (adopting the receptive role during unprotected sex). With the many and varied relationships that fall somewhere between the two poles, degrees of trust need to be negotiated, and not assumed. All people have duties to their sexual partners regardless of their HIV status and all people have a responsibility to be moral actors in a sexual community. Stigmatising and rejecting sexual partners on the basis of an HIV status needs to be recognised as a moral wrong that works against creating a culture where HIV can be discussed freely and without fear. The response to Charlie Sheen’s announcement of his HIV status demonstrates we have a long way to go before banishing the discriminatory and offensive reactions to HIV-positive people. It’s time to recognise the role that every sexual actor plays in creating a culture where sex is safe for all

Filed under: General, HIV and AIDS, HIV Prevention, HIV Treatment, Medical and Research, Reflection, Religion and Ethics, Society and living environment, , , , , , , , , , , , , , , , , , , , , ,

06/04/2015 • 3:57 pm Comments Off on Risk of AIDS, Serious Illness and Death Reduced by 53% with Early ART

Risk of AIDS, Serious Illness and Death Reduced by 53% with Early ART

Press Release of the National Institute of Allergy and Infectious Diseases ( US Department of Health and Human Services)

Starting Antiretroviral Treatment Early Improves Outcomes for HIV-Infected Individuals
A major international randomized clinical trial has found that HIV-infected individuals have a considerably lower risk of developing AIDS or other serious illnesses if they start taking antiretroviral drugs sooner, when their CD4+ T-cell count—a key measure of immune system health—is higher, instead of waiting until the CD4+ cell count drops to lower levels. Together with data from previous studies showing that antiretroviral treatment reduced the risk of HIV transmission to uninfected sexual partners, these findings support offering treatment to everyone with HIV.
The new finding is from the Strategic Timing of AntiRetroviral Treatment (START) study, the first large-scale randomized clinical trial to establish that earlier antiretroviral treatment benefits all HIV-infected individuals. The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, provided primary funding for the START trial. Though the study was expected to conclude at the end of 2016, an interim review of the study data by an independent data and safety monitoring board (DSMB) recommended that results be released early.
“We now have clear-cut proof that it is of significantly greater health benefit to an HIV-infected person to start antiretroviral therapy sooner rather than later,” said NIAID Director Anthony S. Fauci, M.D. “Moreover, early therapy conveys a double benefit, not only improving the health of individuals but at the same time, by lowering their viral load, reducing the risk they will transmit HIV to others. These findings have global implications for the treatment of HIV.”
“This is an important milestone in HIV research,” said Jens Lundgren, M.D., of the University of Copenhagen and one of the co-chairs of the START study. “We now have strong evidence that early treatment is beneficial to the HIV-positive person. These results support treating everyone irrespective of CD4+ T-cell count.”
The START study, which opened widely in March 2011, was conducted by the International Network for Strategic Initiatives in Global HIV Trials (INSIGHT) at 215 sites in 35 countries. The trial enrolled 4,685 HIV-infected men and women ages 18 and older, with a median age of 36. Participants had never taken antiretroviral therapy and were enrolled with CD4+ cell counts in the normal range—above 500 cells per cubic millimeter (cells/mm3). Approximately half of the study participants were randomized to initiate antiretroviral treatment immediately (early treatment), and the other half were randomized to defer treatment until their CD4+ cell count declined to 350 cells/mm3. On average, participants in the study were followed for three years.
The study measured a combination of outcomes that included serious AIDS events (such as AIDS-related cancer), serious non-AIDS events (major cardiovascular, renal and liver disease and cancer), and death. Based on data from March 2015, the DSMB found 41 instances of AIDS, serious non-AIDS events or death among those enrolled in the study’s early treatment group compared to 86 events in the deferred treatment group. The DSMB’s interim analysis found risk of developing serious illness or death was reduced by 53 percent among those in the early treatment group, compared to those in the deferred group.
Rates of serious AIDS-related events and serious non-AIDS-related events were both lower in the early treatment group than the deferred treatment group. The risk reduction was more pronounced for the AIDS-related events. Findings were consistent across geographic regions, and the benefits of early treatment were similar for participants from low- and middle-income countries and participants from high-income countries.
“The study was rigorous and the results are clear,” said INSIGHT principal investigator James D. Neaton, Ph.D., a professor of biostatistics at the University of Minnesota, Minneapolis. “The definitive findings from a randomized trial like START are likely to influence how care is delivered to millions of HIV-positive individuals around the world.” The University of Minnesota served as the trial’s regulatory sponsor and statistical and data management center.
Prior to the START trial, there was no randomized controlled trial evidence to guide initiating treatment for individuals with higher CD4+ cell counts. Previous evidence to support early treatment among HIV-positive people with CD4+ cell counts above 350 was limited to data from non-randomized trials or observational cohort studies, and on expert opinion.
START is the first large-scale randomized clinical trial to offer concrete scientific evidence to support the current U.S. HIV treatment guidelines, which recommend that all asymptomatic HIV-infected individuals take antiretrovirals, regardless of CD4+ cell count. Current World Health Organization HIV treatment guidelines recommend that HIV-infected individuals begin antiretroviral therapy when CD4+ cell counts fall to 500 cells/mm3 or less.
In light of the DSMB findings, study investigators are informing all participants of the interim results. Participants will be offered treatment if they are not already on antiretroviral therapy, and they will continue to be followed through 2016.
The HIV medicines used in the trial are approved medications donated by AbbVie, Inc., Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline/ViiV Healthcare, Janssen Scientific Affairs, LLC, and Merck Sharp & Dohme Corp.
In addition to NIAID, funding for the START trial came from other NIH entities, including the National Cancer Institute; the National Heart, Lung and Blood Institute; the National Institute of Mental Health; the National Institute of Neurological Disorders and Stroke; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; the NIH Clinical Center; and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Funding was also provided by the National Agency for Research on AIDS and Viral Hepatitis (ANRS) in France, the Federal Ministry of Education and Research in Germany, the European AIDS Treatment Network and government organizations based in Australia, Denmark, and the United Kingdom.
The Medical Research Council Clinical Trials Unit at University College London; the Copenhagen HIV Program at the Rigshospitalet, University of Copenhagen in Denmark; the Kirby Institute at the University of New South Wales in Sydney, Australia; and the Veterans Affairs Medical Center affiliated with George Washington University in Washington, D.C. coordinated the work of the 215 START sites.
For more information about the START trial, see the Questions and Answers or visit ClinicalTrials.gov using study identifier NCT00867048.
NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH…Turning Discovery Into Health ®

 

Filed under: HIV and AIDS, HIV Prevention, HIV Treatment, Medical and Research, Networking, , , , , , , , , ,

04/01/2015 • 7:52 am Comments Off on From Transgender to PrEP – good to know…

From Transgender to PrEP – good to know…

It’s time again to suggest some reading for the interested parties to get more insight in HIV and AIDS related matters:

Violence against women is not only in the USA but also in South Africa a very hot topic. The “Well-Project” has written about it and I am sure we all can learn from the extensive knowledge of these articles:
Violence against women and HIV

The CROI conferences are always a good source of new information. Here are the most important HIV research news from the 2015 conference:
6 important HIV research findings

The Body.Com is providing news and information about HIV on different levels. To download the app go here:
TheBody.com in the palm of your hand

The question of transmission between sero-different partners are often of great concern, read about the results of studies regarding gay sero-different couples:
No HIV transmission between serodifferent couples if undetectable load – preliminary results

PrEP – Pre-exposure prophylaxis (PrEP) works very well at preventing HIV transmission. Even if that is from a costing point still utopia for South African it is worth to read about it and its obstacles of perception:
How to overcome the challenges of accessing PrEP

Transgender people are having a difficult time – read about how transgender people fighting stigma and injustice:
How Transgender People fighting Stigma…

Starting early treatment gives you advantages – so get tested in times:
Starting HIV treatment early leads to better health..

Enjoy reading!

Filed under: General, HIV and AIDS, HIV Prevention, HIV Treatment, HOPE Cape Town Association & Trust, Medical and Research, Politics and Society, Reflection, Society and living environment, , , , , , , , , , , , , , , , , , , , ,

03/25/2015 • 7:02 am Comments Off on We demand a cure

We demand a cure

The HIV activist Larry Kramer from the US gave an impassioned speech calling for a cure for the virus at a Gay Men’s Health Crisis gala (23.3.2015). The 79-year-old activist said that he no longer has “any doubt that our government is content, via sins of omission or commission, to allow the extermination of my homosexual population to continue unabated,” pointing blame at the U.S. president, Congress, the National Institutes of Health, and the head of the National Institute of Allergy and Infectious Diseases, Dr. Anthony Fauci, for their inaction.

Even if this might be a bit of an overreaction, one can understand the frustration of being 34 years into the pandemic and a cure or a therapeutic vaccine seems to be far away. Knowing how much money has been gone to war and the destruction of people every year it is understandable that the plight and suffering of so many million people worldwide must cause an ongoing outcry. More so as it was the USA President Ronald Reagan who clearly missed the boat of stopping this pandemic in the early times because of his religious convictions not allowing to pay attention to the drama of gay people dying. He never acknowledged it contrary to the late Nelson Mandela, who also was silent during his tenure as president of the country. But he acknowledged at least afterwards that shying away from this topic because of his traditional upbringing was a big mistake affecting millions of South Africans.
It is true: We have achieved a lot – and for the first time a global initiative, the Global AIDS Fund, was able to coordinate the war against the pandemic on a global scale. But as time passes and medications are keeping the virus at least in the so-called developed countries at bay it seems the momentum is lost and there are only half-hearted efforts to stem the pandemic further. It seems that Ebola is now more frightening than HIV even if the numbers don’t match up at all.
I am convinced that if we don’t pay attention, HIV will come back to hunt the global village and when you have a close look at the development of multi-resistant TB it is only a question of time when this little bug called HI virus will go the same route. The human race tends to never learn that nature and creation on that level also strives for survival – and looking around and seeing all those infectious diseases and STIs we thought we have conquered and cornered: TB, polio, syphilis, Ebola… – there is still a long way to go and to underestimate a virus or bacteria has cost us dearly and will continue to do so.

Larry Kramer ended up his speech with: “We must aspire to a cure once and for all. Let’s demand a cure and a society that values people with HIV enough to pay for it. Only if we aspire to more can we demand more. Only if we demand more will we get more … The power to change history is still within our grasp. We cannot wait another 34 years. This evil still being waged against us must cease. The battle cry now must be one word: CURE. CURE. CURE.”

Filed under: General, HIV and AIDS, HIV Prevention, HIV Treatment, Medical and Research, Networking, Politics and Society, Reflection, , , , , , , , , , , , , , , , , , , , ,

Blog Categories

Follow God, AIDS, Africa & HOPE on WordPress.com

You can share this blog in many ways..

Bookmark and Share

Enter your email address to follow this blog and receive notifications of new posts by email.

Join 2,711 other subscribers

Translation – Deutsch? Française? Espanol? …

The translation button is located on each single blog page, Copy the text, click the button and paste it for instant translation:
Website Translation Widget

or for the translation of the front page:

* Click for Translation

Copyright

© Rev Fr Stefan Hippler and HIV, AIDS and HOPE.
Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Rev Fr Stefan Hippler and HIV, AIDS and HOPE with appropriate and specific direction to the original content.

This not withstanding the following applies:
Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License.