a Metropolitan AIDS Research Communiqué - aidsinfo@metropolitan.co.za
The views and opinions expressed in this publication do not necessarily reflect those of Metropolitan. As always, we encourage responses on any of the issues covered.
Drugs and alcohol are two of the most destructive substances to a person living with HIV and AIDS. Countless articles have been documented of their debilitating effects on the immune system. Our feature this month is based upon a study performed at UCLA on the relationship between cocaine addiction, HIV infection and AIDS.
While the number of cocaine addicts in South Africa is significantly lower than in the US or Europe, there are substances used here that cause as much damage and play their part in the HIV and AIDS epidemics.
The struggle for the empowerment of women continues. This has been the theme of many of the articles featured in AIDSToday over the past three years. It is clear that addressing issues relating to gender remains a silver bullet in the fight against HIV and AIDS. The news, therefore, that microbicides will not be available until 2007 is disheartening. Do women have to wait that long for the one safer sex method that could truly empower them as sexual partners? Read about the gels, jellies and mousses that could mean the difference between life and death for many women.
The HIV/AIDS epidemic has become a significant part of our reality here in southern Africa. But lest we forget that this epidemic is a worldwide phenomenon, read our ‘In the eye of the storm’ feature that profiles a young woman in Thailand who has a similar story to tell as many of the women in South Africa. And just like many people living positively with HIV in southern Africa, she refuses to be defeated by HIV and AIDS.
Email: nsamuels@metropolitan.co.za
Tel: 021 - 940 6717
By Maggie Fox, Health and Science Correspondent, Reuters NewMedia, February 2002
WASHINGTON - Cocaine not only makes people act recklessly - having unsafe sex that can lead to HIV infection - it can also give the virus a kick-start, scientists reported this month. Tests in mice show that cocaine helps the virus spread faster in the body, killing off more immune cells and reproducing 200 times faster than usual.
"Cocaine not only influences risky behaviours, it also has a direct and profound effect on the AIDS virus," Dr. Gayle Baldwin, an AIDS researcher at the University of California Los Angeles who led the study, said in a statement.
The spread of the virus and its effects on immune cells known as CD4 T-cells are directly related to how sick a person becomes with HIV infection. Baldwin knew that people who use drugs are more likely to become infected with HIV and she knew this was also the case specifically with cocaine, which is not usually injected-the usual route of HIV infection for drug users.
"There were some studies done quite some time ago that suggested a correlation between cocaine use and the progression of disease in HIV-positive individuals," Baldwin said in a telephone interview. She also knew that cocaine can affect the immune system.
Writing in the online edition of the Journal of Infectious Diseases, Baldwin said she and colleagues tested specially bred mice that are infected with the human AIDS virus. Half the mice got daily injections of liquid cocaine and half got salt water. They tested the mice 10 days later.
"We saw a 200-fold increase in AIDS viral load in the blood of the animals injected with cocaine compared to those that received the placebo," Baldwin said. "In only two weeks, the drug radically stimulated the production and spread of HIV."
Viral load is a measure of how much virus is circulating in the blood.
Baldwin's team also looked to see how many CD4 cells had been killed.
"The cocaine increased HIV's efficiency so dramatically that it nearly wiped out the CD4 T-cells. We found nine times fewer CD4 T-cells in the cocaine-treated mice than in the animals that received the placebo," Baldwin said.
"This means that the cocaine produced a spectacular double outcome," she added. "Not only did the drug double the number of HIV-infected cells, it produced a nine-fold plunge in the number of T-cells that fight off the virus."
The cocaine could be working on many levels, Baldwin said. It could be increasing the number of molecular doorways, called receptors, that HIV uses to get into the cells it infects. Cocaine may cause cells to sprout more CCR5 and CXCR4 receptors, both of which are used by HIV, she said. It may also increase the levels of cytokines, chemical messengers, such as TGF-beta and IL-10, which also affect HIV.
A revved-up immune system only helps HIV, which is so insidious and difficult to fight because it thrives on and destroys the very cells sent to attack it. Baldwin said her work could be important, because recent studies show that younger people are returning to risky sexual behavior, such as not using condoms, because they are losing their fear of AIDS.
"Cocaine is still a very bad problem in populations at risk," she said. She said it is not clear whether taking cocaine might make a person more likely to contract HIV from an infected sex partner or a contaminated needle.
Copyright © 2002 - Reuters, Ltd
A woman-focused method to prevent HIV/AIDS and other sexually transmitted infections can be available by 2007, according to a series of reports by the Rockefeller Foundation-funded Initiative on Microbicides.
"We
have the science and the road map, now we need the political will to fund this
effort," said Geeta Rao Gupta, President of the International Center for
Research on Women (ICRW), one of several groups participating in the Initiative.
Microbicides are substances that can kill, inactivate or block the HIV virus, and a range of viral and bacterial agents that cause other sexually transmitted infections. Microbicides would provide a unique advantage to a woman-she can control their use. A woman can apply them vaginally or rectally to protect herself and her partner. Current techniques to prevent HIV exposure -condom use, monogamy, reducing the number of partners, and treatment of other sexually transmitted diseases - often are not feasible or available for women. Many women face cultural barriers that prevent them from requiring their partners to use condoms, as well as cultural and economic barriers to securing other types of protection and treatment. Meanwhile, nearly six of every 10 new HIV infections occur in women.
The Initiative brought together experts in scientific research, product development, public health, economics and advocacy, to help bring to market this critical health technology that women worldwide are demanding as they cope with staggering levels of HIV/AIDS infection. The results are five fact-based studies that detail:
"The development of a safe, effective microbicide would represent the most significant advance in women's reproductive health since the Pill. There are only a handful of problems in the world where lack of money is the true barrier to progress. This is one of them," said Lori Heise, Director of the Global Campaign for Microbicides, also a participant.
The groups released scientific and public health impact findings at a briefing on February 12, at the National Press Club in Washington, DC. According to the findings, immediate development of microbicides can provide the best response to this reality. Over 100 organizations worldwide have joined forces in a global campaign designed to build support for increased investment in women-controlled methods of HIV prevention. For the most part, microbicides have been developed by independent researchers and small bio-tech firms, as the initial return on investment is not attractive to larger medical device or pharmaceutical R&D companies.
Eleven microbicide candidate products have shown sufficient promise to be approved for human testing in clinical trials. (Dozens more await further laboratory testing) Three are slated to begin Phase 3 clinical trials in 2002. Phase 3 trials involve large scale studies in the field with volunteers to test for product safety and effectiveness. Depending on trial outcomes and adequate funding it is likely that one or more of these products could come to market by 2007.
"Microbicide development has made great progress against great odds and is ready to take a major leap forward," said Polly Harrison, Director of the Alliance for Microbicide Development. "Now what we need is the kind of steady, well-directed investment that can make the most of that opportunity." "Microbicides will offer a better chance of survival for women, especially poor women in developing countries, who are disproportionately at risk of contracting HIV/AIDS," said Dr. George Brown, Associate Director of the Rockefeller Foundation's Health Equity Program. "Yet the very future of these women-and the children they may bear-depends on our political will, and our urgent and wise investment today."
Copyright GENDER-AIDS 2002, email: gender-aids@healthdev.net
By Chayanit Poonyarat, Inter Press Service - February 15, 2002
BANGKOK - "If someone could tell you how many days you have left before leaving this world, would you really want to know?" asked Kaew, a Thai woman in her twenties who is busy making every moment of her life count. Kaew found out she was HIV-positive when she received, a year ago, the results of the blood test she took to satisfy the job-application requirements of a company.
"I
was shocked and felt under an enormous amount of pressure," Kaew, who is a
masteral degree holder, recalled in her popular book, 'The Critical Second: AIDS
Diary'. "What I did was to keep checking the result paper every half an
hour, hoping it would be different. At that very moment, I wanted to die."
There are some 984,000 people living with HIV in Thailand, a country that has been seriously affected by the pandemic but in recent years has managed to cut new infection rates. As in other parts of the world, young people are bearing the brunt of the pandemic - Thai government figures say 27.5 percent of HIV/AIDS cases are among people aged 25 to 29 years.
"The only friend I had then was the Internet," wrote Kaew, who does not reveal her full name. "I could talk to anybody without feeling discrimination. I was sure HIV/AIDS cannot be spread through the computer."
A year later, Kaew is very much around-and doing much better than even she had expected. Since she started writing something short materials in a webboard - a diary as she calls it - Kaew has become popular among many people, both HIV-positive and those who are not. In fact, her readers range from high school students and housewives to photographers and doctors.
In the process, Kaew's work has helped give a human - and young - face to HIV/AIDS. Her reaching out in public also underlines the message that people with HIV/AIDS can live productive lives much like any other young person, despite the stigma they have to deal with.
Kaew says she herself is surprised by the feedback she gets from her book and the website. "Friends of mine have sent me e-mail with notes saying 'read this story and you will feel sorry for this girl,' she explained. "When I read it, what they had sent me turned out to be extracts from my own diary. I was sort of shocked the first few times."
The eighth edition of her book 'The Critical Second' is due to be released this month. "Reading the book, I feel sorry but at the same time very fond of her," said 23 year-old employee Thitiporn Sukitpattanakun. "Her story encourages both people with HIV/AIDS and without."
But the popularity of her diary and the openness with which Kaew speaks about living with HIV has also drawn doubts from some. "It seems to me more like a made-up story," said 34 year-old employee Rasri Samipakdi.
He said the story would not encourage many HIV-positive persons in Thailand, as Kaew is from a middle-class family where she has much support and can afford expensive treatment. This is unlike most people with HIV/AIDS in Thailand who are very poor and usually abandoned by their families, he added.
Though some anti-virus medicines are recently produced in Thailand, many of them cost around 15,000 baht (344 U.S. dollars) a month, way above what the average employee can afford.
"I do not think HIV-positive persons should take the treatments mentioned in the book too seriously, as they surely need more details and each case should be handled differently," said Thitiporn. Kaew also says some messages on the website have been insensitive. Some people have posted messages saying mean things like "when are you gonna die?", for instance.
Because of discrimination against people with HIV/AIDS, Kaew says, "Society these days is much scarier than AIDS. People do not want to eat with or talk to us."
Indeed, Thitiporn admits, "Though I have learned more about HIV/AIDS, it
is not easy to imagine touching and sharing meals with them."
People living with HIV/AIDS also find themselves shunned by companies.
Rasri, head of the personnel department of a company, said that although it is not said in the law, companies usually require employees to turn in their physical examination results including blood tests-as a requirement to get a work contract.
Kaew added that people with HIV/AIDS also have to deal with negative perceptions, that "people strongly believe that HIV-positive persons are bad and promiscuous. That is not always true." For instance, Kaew said, she and her boyfriend - from whom she says she got HIV - did not have much of a nightlife, (neither were they) into drinking or smoking. "He is a very nice man," Kaew said of her boyfriend, the first and only man she has dated.
"I want every HIV-affected person to believe we are as much human as others so we should not dispirited," said Kaew. "And for those who are not affected, please understand that HIV-affected are people like you, and are spending their lives not very different than yours. They might be sitting next to you. Please do not detest them."
In the eye of the storm is a segment of AIDSToday dedicated to the success stories that come to light as individuals, communities and companies continue to grapple with the challenge AIDS presents. If you would like your success story or that of another individual or organisation to be published, contact the editor via email: aidsinfo@metropolitan.co.za.
For a complimentary copy contact Gillian Núr Samuels on 021 - 940 6717.
This e-newsletter was created by Red Stone Design
Email - ggroenewald@metropolitan.co.za,
Cell - 083 680 8682