среда, 19 октября 2011 г.

Russia offers aid to help neighbours fight HIV

Россия предлагает соседним странам помощь в борьбе с ВИЧ

("The Financial Times", Великобритания) Эндрю Джек (Andrew Jack)

Москва – Россия планирует усилить свою роль в международной борьбе с инфекционными заболеваниями в Восточной Европе и Центральной Азии, что многими экспертами воспринимается как самая свежая попытка Кремля укрепить свое политическое влияние в странах бывшего Советского Союза.

Стремление предполагает выделение дополнительных средств для того, чтобы приостановить распространение ВИЧ в регионе, где он имеет самые высокие показатели в мире по скорости распространения – уровень инфекций здесь вырос в три раза за последние десять лет, охватив 1,4 миллиона человек.

Однако вызывает опасения тот факт, что Россия может распространить на своих соседей свою ограничивающую политику в области предотвращения распространения ВИЧ.

На форуме, посвященном борьбе с особо опасными заболеваниями, который прошел в Москве на прошлой неделе, экономический советник президента Дмитрия Медведева Аркадий Дворкович пообещал выделить деньги для нового международного агентства, которое будет заниматься программами по борьбе с ВИЧ и туберкулезом.

Обещание может стать новым политическим обязательством и источником ресурсов для усиления профилактических и лечебных программ в то время, когда экономический кризис угрожает правительственному финансированию программ по инфекционным заболеваниям.

Но некоторые наблюдатели опасаются, что увеличившееся финансирование позволит России выставлять свои условия при создании программ по ВИЧ в соседних странах. Это увеличивает опасения, что Россия будет экспортировать свой жесткий подход в отношении наркоманов, который сводит на нет усилия по замедлению распространения эпидемии.

Во время форума Геннадий Онищенко, глава Роспотребнадзора и главный санитарный врач России, еще раз подчеркнул нежелание правительства предоставлять таблетки метадона тем, кто колется героином.

Подобная терапия замены считается Объединенной программой ООН по ВИЧ/СПИДу и другими авторитетными институтам ключевой в борьбе с распространением ВИЧ через зараженные шприцы среди наркоманов - главной группе в зоне риска в России и странах ближнего зарубежья.

В России терапия считается незаконной, но успешно используется в других странах, например, в Таджикистане, Армении и Киргизии.

Министр иностранных дел Сергей Лавров заявил, что профилактика ВИЧ среди наркоманов должна начаться с того, что силы коалиции должны наносить авиаудары по плантациям опиумного мака в Афганистане с тем, чтобы сократить поставки героина.

Отчет Всемирного банка показал, что лишь 11% средств, направленных на борьбу с ВИЧ в регионе, тратятся на наркоманов и другие группы, где инфекция распространяется быстрее всего.

Исполнительный директор ЮНЭЙДС Мишель Сидибе (Michel Sidibé) заявил: «У меня четкое ощущение, что Россия хочет играть лидирующую роль в регионе. Люди опасаются, что будет меньше  спонсорских денег. Но могло бы быть и хуже, если Россия не изменит своей политики в области замены и программы обмена шприцев».

Участники московской конференции также выразили обеспокоенность тем, что российские усилия по оказанию помощи могут сопровождаться попытками поощрения использования произведенных на внутреннем рынке наркотиков и методов диагностики, что увеличит расходы на профилактику и лечение.

В России уже крайне высокая стоимость лечения, примерно 2,5 тысячи долларов на человека ежегодно, в сравнении с 560 долларами, которые тратятся в странах с доходом населения выше среднего, согласно Глобальному фонду по борьбе со СПИДом, туберкулезом и малярией.

Один из участников конференции заявил: «Российская идея помощи базируется на моделях, которые на Западе использовали в 60-х и 70-х годах. Ясно лишь то, что Россия хочет усилить свое влияние на территории бывшего Советского Союза».

Другие отметили символичную значимость того, что Россия провела данную конференцию, так как это символизирует свежую политическую волю в вопросе профилактики ВИЧ. В стране значительно усилило программы по борьбе с болезнью за последние несколько лет.

Оригинал публикации: Russia offers aid to help neighbours fight HIV

среда, 12 октября 2011 г.

I want it

Determinants of mortality in naval units during the 1918—19 influenza pandemic

Summary
In 1918, two waves of epidemic influenza arose with very different clinical phenotypes. During the first wave, infection rates were high but mortality was low. During the second wave, high numbers of deaths occurred and mortality differed 30—100 times among seemingly similar groups of affected adults, but the reason for this variation is unclear. In 1918, the crews of most warships and some island populations were affected by influenza during both waves of infection and had no or very few deaths during the second wave. However, some warships and island populations were not affected during the first wave of infection and had high mortality during the second wave. These findings suggest that infection during the first wave protected against death, but not infection, during the second wave. If so, the two waves of infection were probably caused by antigenically distinct influenza viruses—not by one virus that suddenly increased in pathogenicity between the first and second waves. These findings are relevant to modern concerns that the 2009 influenza A H1N1 virus could suddenly increase in lethality.

HIV life expectancy rises in UK, study finds

Life expectancy for people with HIV in the UK has increased by 15 years in the past decade, thanks to modern drugs and earlier treatment, a study suggests.
Health authorities should consider more widespread testing for HIV, given the benefits of early treatment, UK researchers report.
The Terrence Higgins Trust says people at risk should get tested now.
Figures suggest more than 80,000 UK are living with HIV, and about 25% are unaware they have the infection.
A team led by Dr Margaret May, of the University of Bristol, looked at the life expectancy of the average 20-year-old starting treatment with anti-retroviral drugs between 1996-1999 and 2006-2008.
During that time average life expectancy increased from 30 to almost 46 years, according to the data, reported in the BMJ.
A woman with HIV could expect to live a decade longer than a man with HIV, perhaps because women are tested for HIV during pregnancy and are likely to start treatment earlier, the study found.
Co-author Dr Mark Gompels, of North Bristol NHS trust, said: "These results are very reassuring news for current patients and will be used to counsel those recently found to be HIV-positive."
Chief executive Sir Nick Partridge said: "It also demonstrates why it's so much better to know if you have HIV. Late diagnosis and late treatment mean an earlier grave, so if you've been at risk for HIV, get tested now.
"Of course, it's not just length of life that's important, but quality of life too, and having HIV can still severely damage your life's chances.
"While so much has changed 30 years on from the start of the epidemic, condoms continue to be the best way to protect yourself and your partner from HIV in the first place."
Source: Helen Briggs, BBC News website, 12 October 2011

and more

вторник, 11 октября 2011 г.

HIV/AIDS prevention initiative averts 100,000 infections in India

Evaluation study of Avahan prevention program shows promising effects for future efforts and highlights the need for building program evaluations into public health interventions. October 10, 2011 – An ambitious, large-scale HIV/AIDS public health program prevented an estimated 100,000 new infections over five years in the parts of India hardest hit by the AIDS epidemic, indicating that HIV prevention programs that target high-risk groups can reduce HIV rates in the broader population. This is according to a new analysis by the Public Health Foundation of India (PHFI) and the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in collaboration with colleagues at the Ministry of Health and Family Welfare in India.
In three of six states where the Avahan program was implemented, the study found significant reductions in HIV infections, but in the smaller northeastern states, the program appeared to have little or no significant impact. The researchers say the lack of success in some parts of India shows the need to carefully plan programs and to include an ongoing evaluation of the program’s effectiveness from the beginning. The study, “Assessment of population-level effect of Avahan, an HIV-prevention initiative in India,” is published in The Lancet. “The impact of HIV prevention on high-risk groups such as sex workers and injection drug users has been shown before, but this study shows the broad impact that HIV prevention can have on overall incidence of HIV,” says Dr. Marie Ng, the study’s lead author, who is a former IHME Post-Graduate Fellow and now an Assistant Professor at the University of Hong Kong. “Even though it will take several more years to truly assess the effectiveness of Avahan, we can say that this initial assessment is encouraging.” India has an estimated 2.4 million people with HIV, making it one of the largest infected populations in the world. Launched in 2003, Avahan targeted the states with the highest HIV rates at the time: four large states in south India — Andhra Pradesh, Karnataka, Maharashtra, and Tamil Nadu—and two small states in the northeast—Manipur and Nagaland. Together, the states had a total population of 300 million.
Avahan focused on high-risk groups, such as sex workers and their clients, men who have sex with men, and injecting drug users. The program included peer outreach for safe-sex counseling, treatment for sexually transmitted infections, distribution of free condoms, needle and syringe exchanges, and community advocacy activities. Previous research showed that Avahan has successfully scaled up these interventions. Research also found a subsequent decline in HIV rates among sex workers in some parts of Karnataka, but no previous study has measured the effect of the program on the general population.
This study shows that Avahan had a significant beneficial effect on HIV prevalence in Andhra Pradesh, Karnataka, and Maharashtra, borderline significant effect in Tamil Nadu, and no significant effect in Manipur and Nagaland. Because of Avahan, between 2003 and 2008 the HIV prevalence in the general population fell at the highest by 12.7% in Karnataka and at the lowest by 2.4% in Maharashtra.
The study estimates the cost for each infection averted to be about $2,500, making the program cost-effective compared to the amount of care required to treat a patient with AIDS over his or her lifetime. The first phase of Avahan, from 2003 to 2008, was funded by $258 million from the Bill & Melinda Gates Foundation, which also provides funding to PHFI and IHME. The foundation has continued to fund Avahan while it is being transitioned to control by the Indian government.
“There has been a lull in HIV prevention funding in recent years, with funding shifting to treatment, largely because of increasing evidence on the success of antiretroviral therapies,” says Dr. Lalit Dandona, the study’s senior author, Distinguished Research Professor at PHFI in New Delhi, and Professor of Global Health at IHME. “This study suggests that prevention programs that invest in good planning and management can be effective on a large scale and therefore deserve a balanced infusion of funds.”
Under ideal conditions, a prospective evaluation of the impact of Avahan in the general population would have been rolled out simultaneously with the program, the authors note. This would have allowed researchers to more effectively compare populations that were not covered by Avahan efforts to populations that were covered.
“It’s always hard to thoroughly evaluate a program after the fact,” says Dr. Emmanuela Gakidou, Associate Professor of Global Health at IHME and one of the paper’s co-authors. “Our hope is that as the program is expanded or applied in other countries, the evaluation piece will be built into it from day one. If we don’t know how exactly these programs are working, we won’t know how to maximize their impact.”
The Public Health Foundation of India (PHFI) was launched by the Prime Minister of India in 2006 as a response to redress the limited institutional capacity in India to strengthen training, research, and policy development in public health. It is a public-private partnership that has collaboratively evolved through consultations with multiple constituencies including Indian and international academia, state and central governments, multilateral and bilateral agencies, and civil society groups. PHFI is establishing a network of Indian Institutes of Public Health across the country. The governing board of PHFI includes leading experts in public health and policy internationally and from India.
The Institute for Health Metrics and Evaluation (IHME) is an independent global health research center at the University of Washington that provides rigorous and comparable measurement of the world's most important health problems and evaluates the strategies used to address them. IHME makes this information freely available so that policymakers have the evidence they need to make informed decisions about how to allocate resources to best improve population health.
Media contacts PHFI in New Delhi: Ms. Vijayluxmi Bose Tel: +91 11 4604 6000; Mobile: +91 98114 15443 vbose@phfi.org IHME in Seattle: Mr. William Heisel Tel: +1-206-897-2886; Mobile: +1-206-612-0739 wheisel@uw.edu

среда, 5 октября 2011 г.

вторник, 4 октября 2011 г.

HIV in India

a BMJ paper

OBJECTIVE: To determine the rates of death and infection from HIV in India.
DESIGN: Nationally representative survey of deaths.
SETTING: 1.1 million homes in India. Population 123,000 deaths at all ages from 2001 to 2003.
MAIN OUTCOME MEASURES: HIV mortality and infection.
RESULTS: HIV accounted for 8.1% (99% confidence interval 5.0% to 11.2%) of all deaths among adults aged 25-34 years. In this age group, about 40% of deaths from HIV were due to AIDS, 26% were due to tuberculosis, and the rest were attributable to other causes. Nationally, HIV infection accounted for about 100,000 (59,000 to 140,000) deaths or 3.2% (1.9% to 4.6%) of all deaths among people aged 15-59 years. Deaths from HIV were concentrated in the states and districts with higher HIV prevalence and in men. The mortality results imply an HIV prevalence at age 15-49 years of 0.26% (0.13% to 0.39%) in 2004, comparable to results from a 2005/6 household survey that tested for HIV (0.28%). Collectively, these data suggest that India had about 1.4-1.6 million HIV infected adults aged 15-49 years in 2004-6, about 40% lower than the official estimate of 2.3 million for 2006. All cause mortality increased in men aged 25-34 years between 1997 and 2002 in the states with higher HIV prevalence but declined after that. HIV prevalence in young pregnant women, a proxy measure of incidence in the general population, fell between 2000 and 2007. Thus, HIV mortality and prevalence may have fallen further since our study.
CONCLUSION: HIV attributable death and infection in India is substantial, although it is lower than previously estimated.

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