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HIV This Week Issue #88
Source: | Author:hkb980dd | Published time: 2011-03-30 | 454 Views | Share:

HIV This Week: what scientific journals said (Issue 88)

Welcome to the 88th issue of HIV This Week ! In this issue, we cover the following topics:

1. Gender

  • Fathers’ involvement makes a difference: decreased infant HIV infection and decreased infant mortality in vertical transmission programmes
  • The interplay of male circumcision, gender disparities, and condom use


2. Plasma donation and HIV

  • The story of the geographic spread of HIV infection and survival estimates among former plasma donors in rural central China


3. Paediatric treatment

  • Five year survival for infants and children starting antiretroviral therapy in Thailand 

4. Pre-Exposure Prophylaxis (PrEP) costeffectiveness

  • PrEP, antiretroviral therapy, male circumcision: what, for whom, where, and how fast? 

5. Sex work

  • Criminalisation, legalisation, decriminalisation in Pert, Melbourne, and Sydney: comparing the health promotion effects


6. Epidemiology

  • High HIV incidence among women in Zimbabwe in the first 9 months after childbirth: a vulnerable period 

7. Preventing mother-to-child (vertical) transmission

  • Prong 3 alone cannot achieve virtual elimination: why we need to create demand for and provide contraceptive services 

8. Resources, impact, and development

  • What are the relationships among reduced antiretroviral drug prices, increased foreign aid, and treatment coverage in Africa? 

9. Injecting drug use

  • Russian injectors: a home-grown population with potential to contribute to future labour shortages
  • The role of pre-filled syringes and contaminated drug preparation equipment in 16 Ukrainian cities 

10. Long-term non-progressors

  • Agent or host or both: what makes 2-5% of people living with HIV keep the virus in check without treatment? 

11. Co-morbidity: tuberculosis

  • Lower early mortality in workers starting isoniazid preventive therapy and antiretroviral therapy


12. HIV prevention

  • Unprotected sex among Swiss people living with HIV after the 2008 Swiss statement 

13. Economics

  • Late presentation at diagnosis has economic consequences for the health care system, let alone yourself 

14. Antiretroviral therapy for prevention

  • Use of antiretroviral drugs to prevent HIV acquisition and transmission: what we know, what we are waiting to learn 

15. HIV service integration

  • What is ‘pre-antiretroviral therapy defaulting’ along the continuum of care in Cape Town?  

16. Research challenges: HIV-exposed seronegative people

  • What can different cohorts of HIV-exposed uninfected people tell us about protection? 

17. Serodiscordant couples

  • The emphasis on concurrency and male sexual behaviour must not undermine strategies to increase couple counselling and testing


Cate Hankins

Derek Christie

Tania Lemay

Sylvia Béké-Wilson

Chief Scientific Adviser to UNAIDS

Research officer

Research consultant

Assistant



To find out how you can access a majority of scientific journals free of charge, please see the last page of this issue or check the HIV This Week website clicking here. If you are reading this through the kindness of a friend and would like to subscribe to receive HIV This Week pdf issues by email, you can sign up on the website or send an email to hivthisweek[at]unaids.org. We want to be as helpful to you as we can, so please let us know what your interests are and what you think of HIV This Week by sending a comment to hivthisweek[at]unaids.org or by posting one on the HIV This Week weblog. If you would like to recommend an article for inclusion, please contact HIV This Week here.

Don’t forget that you can find a wealth of information on the HIV epidemic and responses to it at www.unaids.org.



 

2. Plasma donation and HIV

 

HIV-infected former plasma donors in rural central China: from infection to survival outcomes, 1985-2008

Dou Z, Chen RY, Wang Z, Ji G, Peng G, Qiao X, Fu J, Meng X, Bulterys M, Ma Y, Zhao Y, Wang N, Zhang F.PLoS One. 2010 Oct 29; 5(10):e13737.

The HIV epidemic among former plasma donors in rural central China in the early-mid 1990s is likely the largest known HIV-infected cohort in the world related to commercial plasma donation but has never been fully described. The objectives of this study are to estimate the timing and geographic spread of HIV infection in this cohort and to demonstrate the impact of antiretroviral therapy on survival outcomes. HIVinfected former plasma donors were identified using the national HIV epidemiology and treatment databases. Locations of subjects were mapped. Dates of infection and survival were estimated using the midpoint date between initial-final plasma donation dates from 1985-2008 among those with plasma donation windows ≤2 years. Among 37084 former plasma donors in the two databases, 36110 were included. 95% were located in focal areas of Henanprovince and adjacent areas of surrounding provinces. Midpoint year between initial-final plasma donation dates was 1994 among former plasma donors with known donation dates. Median survival from infection to AIDS was 11.8 years and, among those not treated, 1.6 years from AIDS to death. Among those on treatment, 71% were still alive after five years. Using Cox proportional hazard modelling, untreated AIDS patients were 4.9 times (95% confidence

interval 4.6-5.2) more likely to die than those on treatment. The epidemic of HIV-infected former plasma donors in China was not widespread throughout China but rather was centred in Henan Province and the adjacent areas of surrounding provinces. Even in these areas, infections were concentrated in focal locations. Overall, HIV infections in this cohort peaked in 1994, with median survival of 13.4 years from infection to death among those not treated. Among AIDS patients on treatment, 71% were still alive after five years.

For abstract access click here: http://www.ncbi.nlm.nih.gov/pubmed/21060835



Editors’ note: These survival figures are biased upwards because many people had likely died by 2004 when mass HIV screening identified tens of thousands of former plasma donors with HIV infection across central China. Commercial plasma collection had already been stopped for many years (1996). The full story from 1990 to 2004 remains to be told but the Chinese government responded to the 2004 screening results by setting up a free treatment programme for former plasma donors that eventually scaled up to the national level. Why did these primarily poor male farmers come to commercial plasma donation stations in UNAIDS_CSA-RO_HIVthisweek_88_110129 the first place? Plasma donation involved giving blood and receiving pooled blood cells back from bloodtype matched donors. The payment they got in return supplemented meagre farming incomes while the blood cell transfusion back, combined with drinking fluids to replace the plasma, meant that the farmer felt strong for work. Why were commercial plasma donation centres set up in rural Henanprovince and

surrounding areas? Risk factors for blood-transmitted infections such as hepatitis B and HIV were low – there was almost no injecting drug use or sex work in these communities. Donations were screened for hepatitis B which can be transmitted perinatally but not for HIV. The Chinese plasma donor HIV epidemic demonstrates graphically what happens if strict blood-borne pathogen precautions are not followed – beyond the donors, many spouses and children also became infected with HIV.


 5. Sex work

The decriminalization of prostitution is associated with better coverage of health promotion programmes for sex workers

Harcourt C, O'Connor J, Egger S, Fairley CK, Wand H, Chen MY, Marshall L, Kaldor JM, Donovan B. Aust N Z J Public Health. 2010 Oct;34(5):482-6.


In order to assess whether the law has an impact on the delivery of health promotion services to sex workers, Harcourt and colleagues compared health promotion programmes in three Australian cities with different prostitution laws. The cities were Melbourne (brothels legalized if licensed, unlicensed brothels criminalized), Perth (criminalization of all forms of sex work) and Sydney (sex work largely decriminalized, without licensing). The authors interviewed key informants and gave questionnaires to representative samples of female sex workers in urban brothels. Despite the different laws, each city had a thriving and diverse sex industry and a government-funded sex worker health promotion programme with shopfront, phone, online, and outreach facilities. The Sydney programme was the only one run by a community-based organisation and the only programme employing multi-lingual staff with evening outreach to all brothels. The Melbourne programme did not service the unlicensed sector, while the Perth programme accessed the minority of brothels by invitation only. More Sydney workers reported a sexual health centre as a source of safer sex training and information (Sydney 52% v Melbourne 33% and Perth 35%; p<0.001). Sex workers in Melbourne's licensed brothels were the most likely to have access to free condoms (Melbourne 88%, Sydney 39%, Perth 12%; p<0.001). The legal context appeared to affect the conduct of health promotion programmes targeting the sex industry. Brothel licensing and police-controlled illegal brothels can result in the unlicensed sector being isolated from peer education and support.


For abstract access click here: http://www.ncbi.nlm.nih.gov/pubmed/21040176



Editors’ note: The complex debate about criminalisation, legalisation, or decriminalisation of the world’s oldest profession can be informed by this description of effects of each option in real settings. A diversified sex industry was active in each of the cities of Melbourne, Sydney, and Perth, with men buying sexual services (brothel, escort, and private call girl sex) at roughly the same rate. The decriminalised industry in Sydney was associated with the best access to brothels, in part because Sydney had the most resources to devote to health promotion and channelled them through a community-based organisation. Melbourne, with legal brothels licensed, had the highest brothel occupational health and safety levels while Perth, where all sex work is criminalised, had the lowest. Each jurisdiction had sexual health clinics but the Perth and Melbourne sex worker programmes hosted them, reducing funds available for education, outreach, and hiring personnel with Asian-language skills. A striking finding of this analysis is the need to create or update (in the case of Melbourne) on-line health promotion services for sex workers. Sex workers increasingly use the internet and texting to organise their work and make client contacts – if web platforms exist they participate actively in updating ‘bad trick’ lists to alert others, increasing safety, enhancing social solidarity, and supporting safer sex norms.





For full PDF access to this issue: HIV This Week (Issue #88, Jan 29, 2011)