CNS

What did we miss while treating HIV?

Dr BB Rewari, NACO

Bobby Ramakant - CNS
Expanding access to antiretroviral therapy (ART) and HIV care services have helped people living with HIV (PLHIV) to survive and lead a better quality of life, but closing our eyes to other non-HIV healthcare needs can also reverse health benefits. “PLHIV on ART are at an elevated risk of cardiovascular diseases [CVDs],” said Nazisa Hejazi, from the University of Kebangsaan, Malaysia. “PLHIVs often have traditional NCD risk factors such as taking high fat intake, smoking, physical inactivity among others. We also know that ART medications affect the liver, potentially leading to metabolic disorders”

Citizen News Service - CNS
Civil society networks, United Nations agencies and other partners in Asia and the Pacific are urging a rapid increase of voluntary confidential community-based HIV testing and counselling for key populations at higher risk in the region – including men who have sex with men, transgender people, sex workers and people who use drugs – to help ensure more people in need are able to access life-saving antiretroviral treatment.

Sumita Thapar - CNS
Oral substitution therapy (OST) saves lives, improves quality of life, and helps people who use drugs to lead functional lives, advocates say. It is like “insulin for a diabetic,” argues Dr M Suresh Kumar, a psychiatrist from Chennai, India, who has worked on substance use disorder for over 30 years. Beneficiaries of OST agree that it turns drug use into a chronic condition, which can be managed with medical and psychosocial help. “By taking care of withdrawal, it saves them from doing ‘desperate’ things.”

Ishdeep Kohli - CNS
In line with the UNAIDS campaign to achieve the 'Three Zeroes' -- Zero new infections, Zero new deaths and Zero discrimination, the Community Programme Committee for ICAAP11 came up with the 'Community Three Zeroes' -- Zero funding, Zero political will and Zero legal reform.

Bobby Ramakant - CNS
“One of the positive developments since the 10th ICAAP (held in Busan, South Korea in 2011) is that national governments have put more money into HIV/AIDS programmes - be it India, Indonesia or China. It is the national governments’ input and acceptance of the responsibility to finance the domestic HIV programme that has become more of a reality now than it ever was. Money from external donors for financing HIV programmes has dropped significantly so this positive change of upping domestic funding is important. We can of course argue that the money is not enough and we need more investment in HIV programmes” said Dr NM Samuel, President, of AIDS Society of Asia and the Pacific (ASAP) and former Professor of Experimental Medicine, Dr MGR Medical University. “The negative aspect since last ICAAP is that we have to put more money as current investment in HIV programmes is not enough.”

11th ICAAP official daily conference newspaper (English and Thai: November 2013): During the 11th International Congress on AIDS in Asia and the Pacific (ICAAP), held in Bangkok, Inis Communication partnered with Citizen News Service (CNS) to produce a daily on-site newspaper covering sessions and issues around the event. Eleven experienced health reporters from India, Vietnam, Philippines, and Myanmar were deployed for on-site reporting throughout the conference, with a team of three from Inis providing editing, graphic design and coordination support. Issue 1, Issue 2, Issue 3, Issue 4

Intellectual property and decriminalization: Don't have to wait for laws to be changed

Anand Grover is a lawyer from India who is known for his legal activism in Indian law relating to HIV. He is a co-founder member of the Lawyers Collective and has been UN Special Rapporteur on the Right to Health since 2008. He spoke with the ICAAP11 Insight team as the 11th International Congress on AIDS in Asia and the Pacific (11th ICAAP) got underway, stressing two points that are likely to feature in discussions this week.

Le Nguyen - CNS
A female Interpol officer–wannabe and a former male sex worker. They hug and admire each other for their sharing and their strength. Just one of many inspiring moments from the youth preconference that took two days before the opening of 11th International Congress on AIDS in Asia and the Pacific (11th ICAAP).

Craig Knowles and Ani Lamont
Asia and the Pacific faces enormous challenges if it is to arrest rapidly rising rates of HIV infection among men who have sex with men (MSM), APCOM's 'Foreplay – the final push towards the Three Zeros' event heard at 11th International Congress on AIDS in Asia and the Pacific (11th ICAAP). The numbers of new infections among MSM continue to rise, despite treatments having been available for almost two decades.

Swapna Majumdar - CNS
Despite a 26% overall reduction in new HIV infections in Asia and the Pacific since 2001, the epidemic still outpaces regional responses. According to a new UNAIDS report on HIV in Asia and the Pacific, the rate of new infections remains the issue of most concern. According to the report, the fastest-growing epidemics in the region are among men who have sex with men (MSM). HIV levels are particularly high in this key population, with between 15% and 25% MSM living with HIV, largely in major cities.

Le Nguyen - CNS
Halong Bay, one of Vietnam's UNESCO-recognized Natural Heritage, located in northern Quang Ninh province, about 120 km east of Vietnamese capital Hanoi, is full of colors: deep blue skies, turquoise ocean, white wakes behind the faster boats, brown fishing craft roaming the bay. The green of the islands blends with the colors of skin, eyes and hair of tourists from all over the world. All these bright colours create such a dazzling picture that impresses so many visitors.

Le Nguyen - CNS
Statistics by the HIV/AIDS Prevention Department of the Ministry of Health (MOH) of Vietnam shows that currently there are about 170,000 drug users in the listed record of the country. Vietnam is urging more methadone treatment for people who use drugs nationwide as it is seen as an effective method in helping prevent HIV/AIDS, according to the MOH.

Swapna Majumdar – CNS
"Why wouldn't you want to share my chocolate?" What would be your answer if a young five year old girl infected with the Human Immunodeficiency Virus (HIV) asks this innocent question? The Indian government Department of AIDS Control (DAC) is hoping that thought provoking questions like this on HIV and AIDS printed on tickets to the popular annual international trade fair held from14 to 30 November in New Delhi will give visitors something more than just entry to the exhibition.

Chhatra Karki, Nepal
(First published in Kapan Online, Kathmandu, Nepal on 13 November 2013)
It is believed that tuberculosis (TB) is no more a death causing disease and few months of medical treatment can cure the disease. But, the Multidrug Resistant (MDR)-TB has become a major challenge all over the world. MDR-TB is a type of disease which resist to the drugs ‘Rifampicin’ and ‘Isoniazid’. As the MDR-TB resists the drugs, its treatment has turned expensive. As per the experts, It takes a more than two years of treatment to cure the disease.

Lwin Lwin Thant, Myanmar
Had it not been for community volunteers, a person co-infected with TB and HIV would not have been able to get proper care in Myanmar. When the thin and faded seventy years old mother asked, "Mg Swe…..How are you feeling today?". Mg Swe, lying in bed and writhing with pain, answered "I am alright, A May (Mum)." Mg Swe is a 46 years old, single man who has only one leg. He joined the army in 1985 out of despondency due to his parents’ divorce. Four years later, when there was the sea-island battle with Kayin People in Tanitaryee Division, he lost his left leg in that war.

Lwin Lwin Thant, Myanmar
[Lwin Lwin interviewed a person living with HIV, drug-resistant TB and Hepatitis B Virus in Myanmar. She is presenting the story as was told to her below]
“Ma Mya!.. Ma Mya!.. Ma Mya!” I heard my name being called out loud and impatiently from the street while I was busy with housekeeping for my family. Worried, I rushed out of my house and found a nurse from the township medical clinic waiting for me.

World Pneumonia Day is observed on 12 November every year since 2009 to bring awareness to this leading killer of children below 5 years of age. An editorial in this month’s International Journal of Tuberculosis and Lung Disease (IJTLD) highlights that pneumonia is a lung disease that affects not only children but people of all ages. Authors Dr Stephen Graham of The Union and Prof Guy B Marks, IJTLD Editor-in-Chief for Lung Disease, write that “pneumonia has been an important cause of death for centuries”.

Carolyn Kavita Tauro, India
It was a casual sit-in with some of my friends back home when one of them who is a mother of a three-year old boy said to me, “Hey tell me! As soon as I get to know that one of my son’s friends is ill, I already give him some antibiotics so that he doesn’t get ill… is this ok”? By the time she had asked me the question, she had realized that maybe it was not ok for her to do it, but like most people she did not know why. Another young mother quickly adds, “But anyway the doctor give so many medicines nowadays”.

Alice Tembe, Swaziland
It is common labour practice that sick leave is fourteen days with full pay, followed by another fourteen days of half pay and thereafter, it is unpaid leave. This made practical sense about a decade if not more years ago. With the rising toll of TB, industries lose on average an estimated thirty days to six months of paid sick leave a year, when one staff member gets infected with TB. The productivity time lost is becoming even greater, with MDR-TB. In the interest and respect of human rights, most industries are failing to control and manage productivity in the face of this dreaded disease.

The air around us has been riddled with so much of dirt that it is increasingly becoming unfit for consumption. And yet we cannot survive if we do not breathe. The theme of the 44th Union World Conference on Lung Health organised by the International Union Against Tuberculosis and Lung Disease (The Union) held recently in Paris was very apt - 'Shared air, safe air?'

India has the world's third-largest population of people living with HIV (PLHIV) - 2.4 million. However, it has been able to make significant progress in recent years by thinking out of the box. This has led to a decline of 50% in the number of new infections over the past decade. For a country that UNAIDS once feared could eventually house the largest number of persons living with HIV, this is a big feat.

A young scientist was awarded the third prize at Falling Walls Labs 2013 for her research aimed to reduce mortality and complication rate in surgical procedures to treat cardiovascular diseases (CVDs). According to the World Health Organization (WHO), CVDs are the number one cause of death globally (30% of all global deaths are attributed to CVDs). "Of these deaths, an estimated 7.3 million were due to coronary heart disease and 6.2 million were due to stroke" said Dr Rishi Sethi, Associate Professor, Department of Cardiology, King George's Medical University.

Okeoghene Oghenekaro, Nigeria
(First published in News Agency of Nigeria (NAN), on 30th October 2013)
The 2013 WHO Global Tuberculosis Report says an estimated 450,000 people develop Multi-Drug Resistant to Tuberculosis (MDR-TB). MDR-TB is a form of TB that is resistant to at least two drugs known as ``rifamoicin’’ and ``isonaizid’’, which are the two most powerful first line treatment of tuberculosis. The report however said that globally 170,000 died from the disease in 2012.

At the close of the 44th Union World Conference on Lung Health, held in Paris, the International Union Against Tuberculosis and Lung Disease (The Union) announced that it has received US $48 million in new funds for TB control in some of the world’s hardest-hit countries and to continue critical areas of operational research. The Global Fund pumped in US $40.05 million for the Union’s TB control activities in India (Project Axshya) and Myanmar (PICTS); while the USAID renewed funding of US $8.30 million for the TREAT TB initiative of the Union. The two together amount to a funding of US $48 million.

L-R: Dr Swarup Sarkar, Dr Santhosh Matthew,
Ganesh Ramakrishnan, Lov Verma,
Dr M Suresh, Dr Sundararaman, Taufik Bakkali

Sumita Thapar - CNS
Learnings from Project ORCHID's pioneering work on harm reduction in northeast India shows that scale up is possible even in resource poor and conflict ridden settings. A national dissemination workshop organized by Project ORCHID in Delhi saw sharing and discussion on best practices on harm reduction: reducing HIV risk among injecting drug users (IDUs).

Shobha Shukla - CNS
(Based on an exclusive interview given to CNS by Dr Mao Tan Eang, NTP Manager, Cambodia, during the 44th Union World Conference on Lung Health)
Cambodia, with a population of 15 million, is one of the 22 high TB burden countries. It has implemented two national TB prevalence surveys, during the last 10 years—one in 2002 and the other in 2011.The repeat survey provided robust evidence of a decline in TB burden in Cambodia, following DOTS (Directly Observed Treatment Short course) expansion in 2002. Results indicate a 45% reduction in the prevalence of bacteriologically-confirmed cases over a period of only 9 years since the first survey conducted in 2002. This amounts to an annual decrease of over 4.5% which is quite remarkable as compared to the global average of 2%.

Shobha Shukla - CNS
(As told by her to CNS during the 44th Union World Conference on Lung Health held in Paris)
My name is Xolelwa Joni and I am 26 years old. I come from Cape Town in South Africa. After finishing my secondary school education I did a course in information technology. In my family I have my 85 years old father, my 63 year old mother, my 32 years old elder sister, a younger 11 year old brother and my twin sister from whom I contracted MDR-TB. All of us live together in a two roomed house.

The International Union Against Tuberculosis and Lung Disease (The Union) issued a position statement at the 44th Union World Conference on Lung Health in Paris, warning about the potential health impact of e-cigarettes (ECs) and electronic nicotine delivery systems (ENDS). The statement which was developed by a panel of health experts, based upon a comprehensive review of all the available scientific evidence on the use of ECs and ENDS, calls for urgent regulation of these products.

There is evidence of an important association between diabetes mellitus (DM) and tuberculosis (TB). DM increases the risk of active tuberculosis by a factor of 2 to 3. Also people with TB, who have diabetes, have been found to have worse TB treatment outcomes. The WHO - The Union (The International Union Against Tuberculosis and Lung Disease) Framework for Collaborative Activities recommends bilateral screening for TB and Diabetes -- screening for active tuberculosis in patients with diabetes and for diabetes in patients with TB in order to make earlier diagnoses, which in turn may lead to better treatment outcomes and control of both diseases.

Shobha Shukla - CNS
According to the World Health Organization’s Global Tuberculosis Report 2013, India has the highest incidence of TB in the world, with 2.2 million new TB cases annually which amount to 18% of the global TB burden and 66% of that in South East Asia. India also has 31% of the global total of missed cases of 3 million. In addition, out of the 22 high-burden countries, India saw the greatest increase in multidrug-resistant (MDR-TB) between 2011 and 2012. There were an estimated 64000 cases of MDR-TB in 2012, over 25% (16588) of which were diagnosed with the disease and 14143 were put on treatment.

There is no doubt that investment and thrust for more effective new diagnostic and treatment tools for tuberculosis (TB) must go up but alongside it is equally imperative to optimally use existing technologies. "Innovation has the ability to change the world. Innovative approaches lead us to concrete outcomes as opposed to knowledge for knowledge sake. We need new ways of doing things. It is trying to solve a problem as opposed to generate new knowledge [by doing research]" said Dr Mel Spigelman, President and CEO of Global Alliance of TB Drug Development (TB Alliance) at the 44th Union World Conference on Lung Health. "We do not optimally use all the resources we have currently."

World Pneumonia Day: 12 November 2013
Pneumonia is the single largest cause of death in children worldwide. Every year, it kills an estimated 1.2 million children under the age of five years, accounting for 18% of all deaths of children under five years old worldwide. Pneumonia affects children and families everywhere, but is most prevalent in South Asia and sub-Saharan Africa. Dr Stephen M Graham of International Union Against Tuberculosis and Lung Disease (The Union) said at the 44th Union World Conference on Lung Health in Paris that children can be protected from pneumonia – it can be prevented with simple interventions, and treated with low-cost, low-tech medication and care. An alarming number of deaths due to childhood pneumonia continue to take place in countries such as India and China.

Shobha Shukla - CNS
While the number of people detected with MDR-TB increased to 94,000 globally in 2012 (by more than 40%) this amounts to less than 20% of those actually estimated to have MDR-TB. Even amongst the lucky few who did get diagnosed, almost 17, 000 of them could not be put on treatment for a variety of reasons: lack of political commitment, inadequate financing, bottlenecks in uninterrupted drug supply, human resource shortage - to name a few. Failure to test and treat all those with MDR-TB not only has grave consequences for those affected but also poses serious public health risks.