|Sexually Transmitted Diseases (STD) Prevention: New Challenges, New Approaches (AIDSCAP/FHI - USAID, 1996, 47 p.)|
Behavior Change Lowers HIV/STD Risk
Research from behavioral studies indicates that reducing high-risk sexual practices can sharply curtail the spread of AIDS, reported The Lancet in its March 16 issue.
A program requiring the use of condoms in San Francisco's gay sex clubs resulted in a near-perfect protected sex rate, according to Dr. Thomas Coates of the Center for AIDS Prevention Studies at the University of California, San Francisco. In a lecture at the National Institutes of Health, Coates also noted a dramatic reduction in STD rates in prevention programs in India and Thailand that taught condom negotiation skills to commercial sex workers.
Acknowledging that research on sexual behaviors is often hindered by political opposition to funding studies on sexuality, Coates nonetheless emphasized that we're talking about things we didn't talk about 15 years ago.
Lower Fertility Among HIV-positive Women
HIV-positive women have a significantly lower pregnancy rate compared to HIV-negative women with no known exposure to STDs, according to one of the first studies investigating the links between fertility and seroprevalence in developing countries. The findings are important not only for projecting the demographic impact of AIDS, but also in estimating the number of orphans and HIV-infected infants and the future demand for treatment to prevent mother-child transmission.
In a March presentation in Washington, D.C., Dr. Ronald Gray of Johns Hopkins University described his research, based on a cohort of 5,000 women in the Rakai District of Uganda, 1,200 of whom were HIV-positive. The research found a 48 percent reduction in fertility in women infected with both HIV and other STDs.
Gray said that HIV-positive women experienced an increase of spontaneous abortions during pregnancy, but was not certain whether reduced pregnancy rates were due to fewer conceptions among HIV-positive women or possible biological damage from HIV and other STDs. He cited a study from Tanzania associating a higher risk of infertility resulting from HIV and another study reporting higher stillbirth rates in HIV-infected women.
Early HIV Complications in African Women
Researchers have discovered that pneumococcal disease may be among the earliest serious complications in HIV-infected women in sub-Saharan Africa, based on results of a study reported in the March 16 issue of The Lancet.
Dr. Charles F. Gilks and colleagues from the Center for Tropical Medicine at Oxford University followed a cohort of 719 female sex workers in Nairobi, Kenya, 587 of whom were infected with HIV. Among those who were seropositive, 79 had pneumococcal disease, compared to one in the HIV-negative group. The researchers were surprised to find that pneumococcal disease, not tuberculosis, was both the earliest and most common serious complication among the HIV-infected women in the study.
The researchers stressed that pneumococcal disease, which among this study's cohort included bacterial pneumonia, sinusitis and occult bacteraemia, is relatively treatable with antibiotics.
New AIDS Drugs Approved
Two new drugs for individuals infected with HIV have been approved for use by the U.S. Food and Drug Administration (FDA). Both are classified as protease inhibitors, which suppress HIV activity to improve the immune system's effectiveness.
Abbott Laboratories' Norvir, generically known as ritonavir, will be used for treatment of late-stage AIDS patients and for other HIV-infected individuals on a limited basis. During clinical trails, Merck & Co.'s Crixivan (indinavir) caused HIV to fall below detectable levels in more than 90 percent of the patients using the drug in combination with AZT and 3TC (lamivudine). Saquinavir, another protease inhibitor, has already received FDA approval and is on the market.
Both manufacturers announced immediate start-up of production and distribution of their respective products. Because of concern voiced by AIDS activists that drug prices are too high, Merck plans to sell Crixivan at a discount (U.S.$12 per day, about 30 percent lower than comparable drugs), and will also provide it free to patients who cannot afford it, or help patients find reimbursement.
Vancouver Conference: Unity in Diversity
One Hope, One World is the theme for the XI International Conference on AIDS, to be held in Vancouver, Canada, July 7-12,1996.
The planners announced four principles-excellence, practicality, sustainability and solidarity-to serve as focal points for priorities and decision making throughout the conference. Workshops, presentations and panels have been organized into four distinct tracks: basic science, clinical science, epidemiology and public health, and social research, policy and action.
The conference theme reflects the organizers' belief that it is only through the interchange of ideas and experiences among people from diverse disciplines and cultures that solutions to AIDS can be found.
For more information on the conference, contact the Conference Secretariat, IXth International Conference on AIDS, P.O. Box 48740, 595 Burrard Street, Vancouver, BC Canada V7X 1T8. Telephone: 800-780-AIDS (Canada/U.S.) or (604) 878-9995 (worldwide); fax: (604) 668-3242; Internet: firstname.lastname@example.org; or World Wide Web site: http://unixg.ubc.ca:780/~aids11/aids96.html.
Among the wide variety of conference satellite activities will be a two-day symposium, The Status and Trends of the Global HIV/AIDS Pandemic, cosponsored by AIDSCAP, the Frans-Xavier Bagnoud Center for Health and Human Rights of the Harvard School of Public Health and UNAIDS. For more information on the July 6-7 gathering, contact Deborah Murray at AIDSCAP at (703)516-9779 by telephone or (703)516-9781 by fax.