Use light to highlight rights this World AIDS Day

[Pic :UN Secretary-General Ban Ki-Moon speaking at the "Light for Rights" event during the World AIDS Day celebrations in New York City in 2009.]

The first Light for Rights: Keep the light on HIV and human rights event was held on 1 December 2009 in New York. The United Nations Secretary-General Ban Ki-moon joined leaders in the AIDS response and entertainment stars to commemorate World AIDS at the City’s historic Washington Square Park Memorial Arch.

Lights on the arch and other landmarks around the city were turned off to remember family and friends lost to AIDS, and to represent how stigma, discrimination, fear and shame can drive people living with HIV into darkness. Then, the lights were re-lit to show how shining a human rights light on HIV can help people living with HIV emerge from the shadows, to seek the information, treatment, care and support.

Light for Rights was inspired by Night without Light, a project organized by Visual AIDS in the early 1990s in which the skylines of New York and San Francisco were darkened, by turning off the architectural illumination on key landmarks, as a symbolic reflection for the lives lost due to HIV.

The Light for Rights campaign compliments the theme for this year’s World AIDS Day: human rights and universal access. This year, it encourages 100 cities around the world to dim the lights on public landmarks to remember the devastating affect AIDS has had, and to turn the lights back on to illuminate the fundamental human rights shared by all but often denied people living with HIV.

“The Light for Rights campaign sends a message of hope to the world,” said Michel Sidibé, Executive Director of UNAIDS. “The power of light can convey the message that human rights are essential to the AIDS response.”

(Courtesy : http://unaidstoday.org/?p=1450)
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Building Bridges, Dismantling Walls

From Seth Berkley



The development of a vaccine to prevent HIV infection is one of the most daunting scientific challenges of our time. Yet, for all its complexity, this field of research seeks to answer a relatively simple question: how do you get the immune system to detect and disable HIV before it has a chance to insert itself into the human genome and establish an intractable infection? Most vaccines against viruses, such as those that prevent measles and polio, do so by teaching the immune system's B cells to generate neutralizing antibodies - exquisitely targeted protein missiles that bind to invading pathogens and tag them for destruction. HIV, however, is no ordinary adversary. It has evolved multiple strategies to flummox the immune response. Not least among these is a nearly unparalleled mutability that has vexed vaccine designers for the better part of three decades.

Any vaccine devised to seriously curb the AIDS pandemic will, at a minimum, have to protect against those HIV subtypes that predominate in developing countries, where some 90 percent of new infections occur. It should also thwart multiple variants of those viruses. This poses extraordinary scientific and logistical challenges. But it also has significant implications for the policies that guide and shape AIDS vaccine research and development. First, it requires that candidate HIV vaccines be tested in developing countries, which entails the establishment of the requisite human resources and technical capacity in such places. Second, in light of the unique scientific challenges of AIDS vaccine development, funders and policymakers need to find ways to encourage innovation and the application of hitherto untapped technologies to solve the toughest problems in the field. Finally, global efforts to develop AIDS vaccines would benefit from greater participation from the private sector. The market disincentives and risks - most prominently high failure rates and opportunity costs - inherent to HIV vaccine development have traditionally discouraged industrial participation. But appropriate incentives and funding policies could do much to change that.

This is especially true today. Following the failure of two AIDS vaccine candidates over the past decade, some commentators had begun to suspect that AIDS vaccine researchers might be tilting at windmills. But significant breakthroughs in the past year have countered such doubts. Late last year, a clinical trial in Thailand demonstrated - for the first time ever in humans - that a vaccine can prevent HIV infection (though this particular vaccine candidate provided only modest protection). A few weeks prior to that, researchers at the International AIDS Vaccine Initiative (IAVI) and in the Neutralizing Antibody Consortium (NAC) it oversees reported in the journal Science that a highly collaborative effort involving some 1,800 HIV-positive volunteers in eleven countries on four continents had resulted in the isolation, from a single African volunteer, of a pair of novel antibodies capable of neutralizing a wide spectrum of HIV variants. The two broadly neutralizing antibodies (bNAbs) - PG9 and PG16 - were found to be exceptionally potent neutralizers of HIV. This discovery was closely followed by the isolation of equally potent bNAbs by the Vaccine Research Center (VRC) of the U.S. National Institutes of Health, and several others from IAVI's antibody project.

Why should these findings matter? In short, because they clear a path to solving one of the most pressing problems of AIDS vaccine development - the elicitation of sufficiently potent antibodies against many of the subtypes of HIV in circulation.

Most of the experimental AIDS vaccines that have been put into clinical trials in recent years have been devised to primarily harness cell-mediated immunity (CMI). This is the branch of the immune response that depends on the recruitment of specialized soldiers known as T lymphocytes to detect and destroy cells already infected by HIV. But most researchers believe that an effective vaccine will also need to activate a neutralizing antibody response. In this view, the ideal vaccine would first deploy antibodies to prevent HIV from infiltrating cells, and would then mobilize the CMI response to mop up any viruses that slip past that biologic barrier. One of the major difficulties with this strategy has been in designing immunogens - the active ingredients of vaccines - that can teach B cells to produce broadly and potently neutralizing antibodies.

Researchers have long known that some HIV positive people produce just such antibodies. And animal experiments suggest that these bNAbs, if elicited by a vaccine, would block HIV from establishing an infection in the first place. This is why researchers had exhaustively studied four particularly versatile - though not especially potent - bNAbs that were isolated more than a decade ago. But it was clear that more such antibodies were sorely needed to inform vaccine design.

Antibodies attach with exquisite precision to unique folds and surfaces on large molecules. These shapes are known as epitopes. The careful study of purified bNAbs, and the epitopes they target, is the first step to devising strategies to elicit similar antibodies via vaccination. One approach to the neutralizing antibody problem - known as reverse vaccinology, the driving objective of the NAC - is to study these shapes in atomic detail, recreate them in the lab (or at least find similar structures) and use the synthetic epitopes as immunogens. Of course, the more such antibodies researchers have to scrutinize, the more likely they are to find an epitope that can be replicated to make a broadly effective vaccine.

NAC researchers have found that the newly discovered bNAbs, PG9 and PG16, have several potentially valuable traits. They latch on to a relatively unchanging patch on its endlessly mutable spike - a roughly toadstool-shaped scrum of proteins on its surface that HIV uses to invade its target cells. This epitope may prove an Achilles heel on HIV, given that it appears to be relatively accessible compared to the target sites of previously isolated bNAbs. This means scientists might have an easier time devising immunogens to elicit similar antibodies. Finally, the antibodies are notable for their potency. This is of great practical significance because candidate HIV vaccines have historically failed to elicit vigorous antibody responses, and the more potent an antibody the less of it is needed to block infection.

Beyond the elegance of the science, IAVI's antibody project provides a lesson in how well-conceived policies can drive the development of drugs and vaccines that may have questionable market prospects but are of critical significance to global health. For one thing, it confirms the value of cultivating biomedical research capacity in developing countries and working in partnership with local scientists and institutions to conduct vaccine trials and HIV research. A network of clinical research centers IAVI supports in five southern African countries played an indispensible role in the antibody project. The network, along with a half-dozen other research centers worldwide, provided the NAC with well-characterized cohorts of HIV positive volunteers who could be studied for the project. And it allowed IAVI to cast a wide net in the antibody hunt: there's no guarantee that a single, small cohort of volunteers would have yielded even a single antibody of interest.

The IAVI-supported clinical trials network continues to contribute to the antibody project, especially through cohorts participating in Protocol C, an IAVI study of HIV positive volunteers that tracks how the virus and the immune response to it evolve from the earliest phases of infection. Thanks in part to their access to these cohorts, IAVI researchers recently received a major grant from the NIH to explore why it is that only some HIV-positive people make potent bNAbs.

The antibody project also illustrates how practices that promote partnerships with the private sector can advance science in the public interest. The detection and isolation of bNAbs were accomplished through close collaboration between IAVI and affiliated scientists and researchers at two biotech companies - Monogram Biosciences in San Francisco, and Theraclone Sciences in Seattle. The former adapted its existing screening technology to evaluate hundreds of blood serum samples for their ability to neutralize a panel of HIV variants selected by IAVI researchers.

Theraclone, one of four laboratories charged with isolating antibodies from IAVI's blood samples, was the first to succeed, successfully isolating PG9 and PG16. It was the recipient of a grant from the Innovation Fund, which IAVI supports in partnership with the Bill & Melinda Gates Foundation to underwrite the novel application of existing technologies to AIDS vaccine development. Until it became involved in the antibody project, the company had applied its technology primarily to discover drugs for autoimmune disorders. By participating in the project, it got to showcase the versatility and power of its technology, which is just the sort of thing a start-up needs to generate new streams of revenue. In fact, Theraclone's success with PG9 and PG16 helped it win new business from a Japanese drug company.

IAVI continues to work with Theraclone and Monogram to isolate new bNAbs from several other serum samples collected in the antibody project, and has engaged other biotechs in vaccine design through the Innovation Fund. Other policy approaches that might draw more private sector participation in AIDS vaccine development include the fashioning of better incentives, advance market commitments and even public sector support to lessen the financial risk of tackling such a formidable problem.

Finally, policies that support long-term rather than project-by-project financing for research would benefit AIDS vaccine design. The NAC, for example, funds labs that have a long track record of success and a demonstrated ability to innovate. This not only gives researchers the time they need to pursue the painstaking business of designing vaccines. It also frees them to adapt their strategies to respond to advances in the swiftly evolving fields of HIV pathogenesis and immunology. It is noteworthy that the NAC and the VRC, which takes a similar approach to funding, have both made several significant contributions to AIDS vaccine design. By providing a measure of financial and professional security, such policies also create a space for young HIV researchers to hone their skills in vaccine-related research, and ready the best of them for future scientific leadership.

Thanks to the recent renaissance in R&D, the outlook for an AIDS vaccine is more promising today than ever. The progress was achieved in laboratories and in clinical testing centers, but was made possible by policies and practices, beyond the domain of pure science, that encourage collaboration, capacity-building, innovation and private-sector engagement. Those practices must be extended and expanded if we are to reach the goal of making an AIDS vaccine a reality.


Dr. Seth Berkley is president, CEO and founder of the International AIDS Vaccine Initiative.

(Courtesy : http://www.globalhealthmagazine.com/cover_stories/dismantling_walls)
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Being young and HIV-positive in Manipur

Senjenbam Noinoisana died recently. He was just 18 years old. Brutally murdered on April 7, 2010, his death was the culmination of all the discrimination he had faced in his short life.

Being young is not easy. Being HIV-positive and young in Imphal, state capital of Manipur, is perhaps as difficult as it can get. Allegedly killed for his property, Noinoisana was the HIV-positive child of AIDS-affected parents who died leaving him in the custody of his paternal aunt and uncle who mistreated him to the point of even denying him his ART (antiretroviral therapy) medicines.

Noinoisana’s case is common enough in Manipur which has the dubious distinction of having the largest HIV-positive population in the country. Children and young people bear the brunt of the AIDS epidemic, which is further compounded by insurgency issues in the state.

The condition of children in Manipur is, in many ways, representative of HIV-positive children and young people all across India.

The Global Fund to Fight AIDS recently declared that a large percentage of AIDS patients in India were not receiving timely treatment, and that this would soon pose a huge challenge as the country attempts to fight the virus. For the rising number of children affected by HIV/AIDS in the state, ART and the right to a life free of stigma and discrimination is imperative.

A number of reasons including the fact that they are too young to understand the disease and that they are usually left to fend for themselves hinder access to care and ART. While adult and mother-to-child transmission is highlighted, affected children and their unique problems receive very little attention in Manipur. The rising numbers are testimony to the fact that the response to HIV and children must take into consideration all three aspects of children living with, vulnerable to, and affected by HIV/AIDS.

Youth at risk

The Convention on the Rights of the Child stipulates four guiding principles of survival, development and protection, non-discrimination and the best interests of the child, and participation as key principles in protecting and treating children with AIDS. Young people in Manipur deal with the same issues of discrimination that HIV-positive youth in other parts of India face. And some more. CRY’s (Child Rights and You) Jhilam Roychowdhury, who has worked on HIV in Maharashtra and Manipur, says: “Yes, I’d definitely agree. This was the first time I had heard of a child actually getting murdered because of his HIV-positive status! In Manipur, you’ll find small hamlets on the outskirts of villages where HIV-positive mothers and their children, who have been thrown out of their homes by relatives, try to eke out a living. We are creating a new group of ‘untouchables’, all because of the ignorance surrounding AIDS and the scarcity of medicines.”

Yet, children don’t ignore the reality of HIV/AIDS. After 14-year-old Bijay’s (name changed) father died of AIDS complications, he and his mother were unceremoniously thrown out of their home by relatives, with all their rights to home and property illegally revoked. His relatives got away with this because the boy and his mother were not aware of the legal recourse they could take. Also, the advancing disease was the main concern at this stage. Since he is a teenager, Bijay is able to go to hospital on his own, and is very particular about continuing his ART course. The family subsists on a stipend paid to his mother by another project. “My father’s family only allowed my elder sister to stay with them as she is not positive,” he says matter-of-factly.

Bijay’s views back up what Dr Priscilla Akwara, Unicef statistics expert, has to say. Recently awarded the IAS/CCABA Prize for Excellence in Research Related to the Needs of Children Affected by AIDS, at the XVIII International AIDS Conference in Vienna, Akwara and her team believe that not just HIV-positive children but children living in families of affected people must be considered vulnerable. Her research clearly states: “If an adult falls ill or dies, for instance, the child may have to leave school and work to support the family. Meals may not be available regularly, and the child’s access to healthcare may be limited. That’s why children who are orphaned or living with a chronically ill adult are frequently considered vulnerable.”

AIDS and child rights

Ashim Ghosh, who has been working with children’s rights in Manipur for the last two years, explains: “Three thousand children are HIV-positive in Manipur. Since public services like government-supported healthcare, the public distribution system, and anganwadis are almost non-functional in Manipur, children who are HIV-positive are practically left to fend for themselves, often with mothers who are infected as well. Without ART, survival is difficult. And ART is not easily forthcoming as there are exactly two hospitals offering the course. The one in the capital, Imphal, gets crowded because people from all across the state go there.”

Besides the scarcity of hospitals, practical factors like distance also play an important role. CRY volunteers working with HIV-positive children point out: “Patients have to travel up to 40 km, in a place where public transport is non-existent, to the central hospital. An added problem is that since these children are living in poverty, their diet during the therapy is not adequate.”

Take the case of 11-year-old Martina who lives with her HIV-positive mother. She contracted measles and had to be taken to a hospital in Imphal, some distance away. After the initial treatment and medicines, the doctors referred her to the isolation ward of a neighbouring hospital. When Martina and her mother reached that hospital, they discovered that the isolation ward had been converted into staff quarters. Martina is back home now, even though her condition demands hospitalisation. As a result, she cannot access her ART course either.

Understanding ART

Access to ART isn’t the only issue. Very often young children don’t understand why they have to take so many medicines. An important factor that is overlooked is counselling. Counsellors from the Wide Angle Social Development Organisation say: “Many don’t understand that even children have to know why they are being medicated when their friends don’t have to be. Children do not agree to take ART easily, even though they have to take orally administered drugs not injections. The benefits of counselling can’t be overlooked just because they are young. In fact, they need it the most.”

Activists and volunteers in Manipur believe that community-based support groups could play an important role in helping deal with such issues. “We call them mutual support groups, or safe spaces where HIV-positive community members can talk about and trace solutions to their specific problems,” explains Ghosh.

Roychowdhury seconds this view. She says: “We explain to the grown-up children who have the ability and the capacity to understand. They are told that HIV is a manageable disease and that the ART medicines are used to battle the HIV infection. We first talk to the parents and then we try to convince the children by saying that the medicines are like vitamins which are good for health and very necessary for them.”

Although organisations like the Kripa Foundation, based in Imphal, Manipur, are pitching in to enrol more young people in ART programmes, much more needs to be done. For, as the Kerala Children Advocacy Group (KCAG), affiliated to the Kerala Positive Women Network (KPWN+), findings have shown, children are willing to take their prescribed medicines but are often put off by the attitudes of caregivers administrating the doses.

Articulating needs

One strategy that seems to help combat the situation is CRY’s children’s collectives.

“Both positive children and those not affected are in the same group processes designed to erase discrimination among peers. It is a space for interaction using the ‘play way’ method; it later helps them disclose their status to their peers,” Roychowdhury explains.

In a state battling insurgency, the government often shifts focus to defence areas to the extent that vulnerable populations have little options to escape risk. A 2003 briefing paper from the World Bank estimated that India had the largest number of AIDS orphans in the world. It predicted that this “number is expected to more than double in five years, and the proportion of orphaned children will remain exceptionally high until 2020 or 2030”.

Ghosh warns that this might just come true, and says: “State authorities must invest in public facilities, infrastructure, and rights-related services such as primary healthcare, provision of ART for children, and schooling. This approach needs to be prioritised above the military approach to problem-solving in Manipur.”

Till informed awareness translates to proactive action, making treatment options cheaper and more readily available, cases like Senjenbam Noinoisana’s won’t remain rare.

(Paromita Pain is a senior reporter and sub-editor with The Hindu and its feature supplements Young World and NXg)

Infochange News & Features, October 2010
(Courtesy : http://infochangeindia.org/kids/news_38.php)

Race Against Time: Activists call for more research on aging and HIV

From David Evans

With the ranks of HIV-positive people older than 50 growing rapidly, AIDS activists with the Coalition for HIV and Aging Research and Policy Advocacy (CHARPA) are demanding that the National Institutes of Health (NIH) devote more attention and resources to the issue of aging and HIV. Will the NIH respond, and will it respond in time?

Think of old age. Chances are that various forms of disease and disability come to mind. Brittle bones, the relentless exchange of muscle for fat, weak hearts, and forgetfulness—while all of these conditions are unpleasant and unwelcome when they strike, they are almost expected by the time people reach their 70s or 80s. What if, however, these health issues begin to happen during a person’s 40s and 50s? That’s exactly what researchers fear is occurring in people with HIV—and we don’t fully understand why.

Is It Aging or Something Else?

The data emerging from recent scientific conferences paint a troubling picture—they increasingly suggest that diseases common among the elderly are now occurring at a much earlier age in people with HIV. Rates of heart disease, bone loss, cancer and cognitive decline are many times higher in HIV-positive people in their 40s and early 50s, compared with HIV-negative people of the same age. In addition, several immunological alterations characteristic of HIV infection, notably declines in the immune system's ability to mount effective responses to disease-causing pathogens, are similar to immunosenscence: gradual deterioration of the immune function brought on by aging.

Is this accelerated aging or something else? There are believers that it is, and there are skeptics.

While no one disputes there’s a lot more disease and disability occurring in people with HIV than their HIV-negative peers, the skeptics are cautious about calling this accelerated aging. Rather, they argue that what looks like aging is a combination of other factors, including: immune system dysfunction, a higher prevalence of cancer-causing viruses, increased rates of smoking and drug use, toxic effects of some older antiretroviral (ARV) drugs, and constant inflammation due to the presence of the virus. Take away these factors, the skeptics suggest, and a person could probably live a next-to-normal lifespan.

While the believers agree whole heartedly that these factors greatly contribute to the conditions plaguing an aging population of people with HIV, they also insist that many of the diseases are occurring in people who never smoked, or never took the more toxic HIV drugs, or didn’t wait too long to start ARV therapy.

Jeff Taylor, a longtime HIV activist from Palm Springs, California, is a believer. He thinks that some type of accelerated aging is occurring, and he’s not pleased at the way that some scientists are approaching the problem. “My response to those arguments is, ‘If it looks like a duck and it quacks like a duck, chances are it is a duck,’” he says. “That’s got to be your best assumption, and you start there, and then disprove it if you can.”

Proving the Point

That’s exactly how Taylor and a group of activists he belongs to—called the Coalition for HIV and Aging Research and Policy Advocacy (CHARPA)—are hoping that the National Institutes of Health (NIH) will begin to approach the problem: Assume that aging itself plays a role, and then set out to better understand, and then disprove the theory.

The consequences of not following this approach could be serious indeed. The Centers for Disease Control and Prevention (CDC) estimates that more than half of all people with HIV will be older than 50 by 2015. This, activists say, makes them feel like they’re in a race against time.

Jules Levin of the National AIDS Treatment Advocacy Project is another CHARPA member who took an early interest in the topic. He experienced an HIV-related bone fracture three years ago and began haranguing researchers about the subject at that time. Levin thinks we are woefully unprepared for an aging population.

Levin and Taylor began pushing researchers more than a decade ago to quickly respond to the body fat distribution problems that were starting to show up in people with HIV. Taylor feels that researchers turned their attention too slowly toward the condition, ultimately dubbed lipodystrophy. By the time we figured out what did and didn’t cause it—we’re still not entirely clear why people are accumulating such large amounts of fat in their guts—tens of thousands of people had developed the condition.

Taylor laments that there’s still no approved drug to treat fat accumulation and the only one near approval, Egrifta (tesamorelin), is “lackluster.”

“But at least with lipodystrophy there’s now a kind of a checklist of what these things are,” he reflects. Not so with aging.

These concerns led Lei Chou of the Treatment Action Group (TAG) and two other members of CHARPA to hand-deliver a letter to Anthony Fauci, MD, the director of the National Institute of Allergy and Infectious Diseases (NIAID)—the institute at the NIH responsible for the bulk of HIV research dollars—at a NIAID council meeting September 20. The letter begs NIAID and other NIH institutes to boost both the priority and funding of aging-related HIV research.

“Right now [NIAID is] just paying lip service to HIV and aging by given it an ‘awareness day,’” claims Chou, referring to a September 9 press release from the institute dedicating September 18, 2010, National HIV/AIDS and Aging Awareness Day.

In essence, the letter from CHARPA calls on the NIH to take several actions. First, CHARPA would like the NIH to create a new funding mechanism in the 2012 budget that sets aside discrete money to study aging and HIV.

Second, CHARPA asked the NIH to issue a Request for Information and Ideas (RFI) on aging and HIV to the research community and to set up a special review panel that has expertise across all relevant disciplines in order to streamline the grant making process.

Third, CHARPA wants the community to have a prominent role in the research prioritization and review process.

Finally, CHARPA would like the NIH to establish a new cohort study that includes enough older people with HIV and enough HIV-negative people—who are similar in demographics and other key factors to the HIV-positive participants—to answer the most fundamental questions about HIV and aging.

This last point is particularly vital. It is perhaps one of the only ways to determine whether accelerated aging is part of the problems that researchers are beginning to document—and that many people with HIV are suffering through.

If research fails to illuminate how much various factors are contributing to the increased rates of diseases and disorders in people with HIV, the prospects aren’t good for the people Taylor knows.

“I live in Palm Springs,” he says, “which is kind of the epicenter of aging gay men who have survived long enough to tell the tale.” When asked to explain the ailments some people are already suffering from, he says, “It’s everything, the whole gamut: cancer, heart disease…the whole lipodystrophy spectrum…and neurocognitive decline.” This last item, he asserts, “that’s what terrifies the average aging person with HIV more than anything. Nobody wants to lose their mind.”

A Step in the Right Direction?

“NIAID’s research priorities are tightly focused on prevention, a vaccine and the cure,” Chou says. “Of course we want all of these things, but the medical complications and comorbidites of people living and aging with HIV seem to have been put on a back burner.”

Levin agrees: “They did not notice it. It got past them. They were preoccupied with everything else.”

Levin hears regularly from researchers who are interested in doing work on aging and HIV but who say the NIH turns down their requests for funds. When he asked “a top government official” about the accusations, he recalls, the response he got was, “Oh these researchers, they complain about everything. They just want their studies funded.”

A spokesperson for the Office of AIDS Research (OAR), which coordinates the HIV research programs across the different NIH institutes, insists that the OAR has actually been focused on the issue for quite some time and that NIH funding has already begun to bear fruit, including a large cohort study out of the Veterans Administration.

What’s more, the spokesperson said NIAID is currently working on a letter responding to CHARPA’s concerns, and that OAR would be glad to meet with the community at any time.

This echoes the experience of Sharon Maxwell, an activist from Kansas City who attended the NIAID council meeting along with Chou. “After we gave the letter to [Anthony] Fauci and Carl Dieffenbach [the director of the Division of AIDS at NIAID], Carl came back and said, ‘You all have some very good points in this. I do want to have a meeting with you,’” Maxwell recounted.

“From the time that we handed him the letter it was only 15 or 20 minutes before he was back saying, ‘Yes, let’s have a meeting,’” she continues. “I was very pleased with that.”

When asked what he would consider to be a sign of progress, Chou says, "I think one early indication that they are taking this seriously would be demonstrated by the research network recompetition process that'll end by Feb. 2011. The new network leadership must include experts outside of virology, and be composed of researchers from other…disciplines as well as more emphasis on immunology. That would be a good indication.”

The OAR representative pointed out that the office has sponsored two meetings dedicated to the topic in the past year, and further stated that, “We are in the midst of the development of the fiscal year 2012 budget, and OAR plans to set aside funds to stimulate additional research in this area.”

What Comes Next?

CHARPA was born at the HIV Research Catalyst Forum, a conference held in April 2010 to rebuild and reinspire an activist community focused on HIV research advocacy. The conference was supported by funding from OAR and the pharmaceutical industry and cosponsored by TAG and other advocacy groups.

Though CHARPA has no official leaders and belongs to no specific agency, TAG has continued to sponsor the group’s activities and has dedicated the time and energy of its staff, including Chou. He hopes that the letter to NIAID, and the research it could inspire, will be just a first step in addressing the needs of an aging population of people with HIV.

In addition to the letter to NIAID, and plans for how to get the most out of a meeting with the staff of NIAID and OAR, CHARPA also intends to work on other areas, such as disease prevention and care guidelines. It will also explore how Ryan White programs and health care reform will affect the aging HIV population and whether or not safety nets will be there as people’s needs for ancillary care grow.

The group currently has more than 50 members across the United States. “I’ve been very encouraged by the community response to CHARPA so far, and I think there is a lot of interest and motivation out there,” Chou says.

Maxwell’s motivation for joining CHARPA was two-fold. While she’s been involved in HIV research advocacy for years, it’s also personal.

She was diagnosed with HIV in 1994 and had just 40 CD4 cells at the time of her diagnosis. She says she’s been remarkably stable ever since. At 63 years old, however, she is beginning to experience the effects of age and HIV. “The frailty, the weakness in the legs, the lipid disorders…all of that is starting to show up now.”

Bob Munk, an HIV-positive activist from Santa Fe, says he’s not a “sky is falling” type of activist, but the issue has particular urgency for him. While he’s deeply grateful for the extended years that ARVs have given him, he insists that quality of life is equally important—and something that research has not yet conquered. “I have osteoporosis. I have CNS symptoms. And routinely those get kind of shrugged off as, ‘Well you’re aging,’” he complains.

“Yeah right!” he responds. “I’m almost 60, and I deserve better.”

*David Evans is a member of CHARPA. CHARPA is a coalition of activists and people living with HIV that has formed to: 1.) expedite research about the intersection of aging, inflammation and HIV; 2.) ensure that the community has a voice in developing an aging and HIV research agenda; and 3.) advocate for policies that improve clinical care and social safety nets for older people with HIV. Members meet via monthly conference calls to share information and develop advocacy strategies. CHARPA is not affiliated with any other group.

(Courtesy : http://www.aidsmeds.com/articles/hiv_charpa_aging_2042_19208.shtml)
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Here’s the Pub, Church and Field for Public Sex

[Pic by Andrew Testa: A mat used by people having sex in a field adjacent to the lay-by on the A31 next to the village of Puttenham. ]

By SARAH LYALL

PUTTENHAM, England — There was the man they called “Bob the Builder,” who wore only a hard hat. There was the naked sunbather who remarked, “Nice day for it, isn’t it?” to a woman taking a walk. And there was the moment, Jules Perkins said, when the dizzying array of sexual forces that have somehow descended on her blameless Surrey village came together all at once, like a scene from a one-size-fits-all X-rated film.

“There were two blokes sitting side by side, watching a man and a woman having sex,” Ms. Perkins said, describing what happened as she strolled with her dog on the hill between her house and the Hog’s Back ridge. “Nearby, there were two men sunbathing together, wearing nothing but tight little white underpants.”

Later, she found a pink vibrator in the bushes.

“I gave it to the police,” she said. “They said, ‘What should we do with it?’ I said, ‘Put it in Lost Property.’ ”

Puttenham, about an hour’s drive from London, has fewer than 2,500 residents and is famous for its ancient church; its friendly pub, the Good Intent; and its proud inclusion in both the Domesday Book — an 11th-century survey of English lands — and “Brave New World.”

Unhappily for many people here, it is also famous for being featured on lists of good places to go “dogging” — that is, to have sex in public, sometimes with partners you have just met online, so that others can watch. So popular is the woodsy field below the ridge as a spot for gay sex (mostly during the day) and heterosexual sex (mostly at night) that the police have designated it a “public sex environment.”

Public sex is a popular — and quasi-legal — activity in Britain, according to the authorities and to the large number of Web sites that promote it. (It is treated as a crime only if someone witnesses it, is offended and is willing to make a formal complaint.) And the police tend to tread lightly in public sex environments, in part because of the bitter legacy of the time when gay sex was illegal and closeted men having anonymous sex in places like public bathrooms were routinely arrested and humiliated.

Enthusiasts’ Web sites alert practitioners to known dogging locations — more than 100 in Surrey alone — and offer handy etiquette tips for the confused or overly excited.

“Only join in or move closer if you are asked,” advises one site, Swinging Heaven, which says it has more than one million registered members.

Richard Byrne, a senior lecturer in countryside management at Harper Adams University College in Shropshire, said that modern technology has made dogging much more convenient than it used to be, thanks to search engines, Facebook groups and people tweeting about their experiences. “And of course, everybody’s got mobiles,” he said.

Swinging Heaven says that the practice began in Britain in the 1970s, and that the term comes from the phenomenon of voyeurs “doggedly” following people having sex. Others say that practitioners claim to be “walking the dog” when they are, in fact, going out to meet naked strangers in fields.

Britons are a tolerant bunch, and most probably would not care who watched whom doing what in whatever configuration, as long as they all went somewhere else. Why, Puttenham residents wonder, do they have to do it 400 yards from the village nursery school?”

“We have nothing against gays or whoever it is up there,” said Lydia Paterson, who lives here. “It’s just the principle of, ‘What on earth is going on?’ ”

A stroll through the field the other day unearthed no doggers (it was raining) but revealed much evidence of their existence. Debris — used condoms, things made of rubber, pages torn from pornographic magazines, snack wrappers, discarded tea cups — littered the area. The paths were dotted with black mats that people had conveniently left behind for the next time.

Residents have been pressing the authorities to do something, arguing that the government should simply close the rest stop that provides access to the offending field, just off the busy A31 road. That way, people hoping to have sex would have nowhere to park.

But local government officials refused, saying closing it would unfairly penalize motorists who genuinely wanted just to rest and would deprive the owner of the Hog’s Back cafe, also at the rest stop, of his livelihood.

Alternative suggestions, discussed at a recent meeting of the Surrey County Council Cabinet, included deploying rangers to patrol the site on horseback; encouraging hikers to roust doggers with actual dogs; and filling the field with potentially bad-tempered bulls.
“It was like, ‘Are you taking this seriously?’ ” Ms. Paterson said. “One cabinet member said, ‘If you close this site, there could be an increase in suicides because these people have nowhere else to go.’ ”

Some older residents sympathize with the council. “Honestly, it’s been going on for so many years,” said Jennifer Debenham, 71, a customer at the Good Intent.

Referring to a nearby village, an elderly man at the bar piped up, “At Wisley, there are two sites, one for males and one for heteros.”

Mrs. Debenham said, “I think we should just let them get on with it.”

The man added, “If you want to find out more, just put ‘dogging’ into your search engine.”

Meanwhile, frazzled residents trade tales of woe: The half-dressed men who materialize from the shrubbery and theatrically pretend to be foraging for nuts and berries. The Internet reviews (“One site listed us as the No. 2 dogging site in Europe,” Ms. Perkins said wearily). The occasion when an unsuspecting motorist went for a bathroom break in the bushes, only to be surrounded by a crowd of eager men.

“It was the quickest pee he’d ever done in his life,” Ms. Paterson said.

The council has agreed to institute an “active management plan” that might include cutting down some shrubbery and putting in security patrols. And the police recently put up a sign warning people not to engage in “activities of an unacceptable nature.”

“There was a lot of debate over the wording for that sign,” Ms. Paterson said. “I guess they didn’t want to say, ‘Don’t have sex.’ ”

(Courtesy : http://www.nytimes.com/2010/10/08/world/europe/08puttenham.html?_r=2&pagewanted=2&hp)
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Prop 19 Analysis: Will Marijuana Legalization Increase Use?

( Pic : More than Munchies

These THC-infused baked goods can be purchased at a cannabis dispensary in Colorado Springs. )

As California moves toward the legalization of marijuana — next month, voters will decide on Proposition 19, the Regulate, Control and Tax Cannabis Act of 2010 — a key question remains: could the new law produce a whole generation of stoners? Opponents of legalization say, yes, fearing it will lead to a massive increase in pot smoking among youth. But some supporters suggest the opposite: legalizing cannabis could de-glamorize it and ultimately prompt reductions in toking. Who's right?

That question is surprisingly hard to answer, but two recent research reports offer some potentially useful insight. The first, a Rand Corporation report that led to related testimony before the California legislature on Sept. 21, discusses the effects of price changes and taxation on consumption of drugs. (More on Time.com: What's in Your Marijuana? Some Pot Doesn't Rot Your Memory)

A newer report, released Thursday, comes from the new scientist-led International Centre for Science in Drug Policy (ICSDP). It takes a historical look at how U.S. drug policy has affected use, and suggests how to regulate drugs effectively.

One thing the ICSDP report makes clear is that current U.S. drug policy has no effect on marijuana prices or use. While spending on federal drug law enforcement has increased 1,200% and marijuana arrests have risen 150% since 1981, the rate of marijuana use nationwide has bounced around, with no relationship to these efforts.

"No scientific evidence demonstrates an association between the amount of money governments spend on drug law enforcement and rates of drug use," says Dr. Evan Wood, a professor of medicine at the University of British Columbia, founder of ICSDP and lead author of the report. "And some nations like the U.S., which spend the most have among the highest rates of drug use." (More on Time.com: 30 Years Since 'Jimmy's World': The Media and Drugs)

Meanwhile, according to national surveys, high school students continue to report that marijuana is universally available, purity has increased and prices have fallen.

The Rand report forecasts how legalization and taxation of marijuana could affect its market price and overall use in California. Although the public tends to view drug users, and addicts in particular, as too irrational and irresponsible to base their behavior on drug prices, research debunks these notions. Studies on legal drugs, such as alcohol and tobacco, for example, show that taxing them and raising prices can often be quite effective in lowering consumption — even among the heaviest users. "After legalization, we expect a large price drop. That's the biggest take away message from this report," says Beau Kilmer, co-director of the Rand Drug Policy Research Center and lead author of the report. "We expect the price [of marijuana] to drop at least 80%. There are a couple of other figures out there, ours falls in the middle and you can quibble about the details but there's a general agreement that the price will drop."

The trick is to determining how high to set the tax — the price has to be high enough to minimize consumption, but low enough to avoid creating a black market. Kilmer says that the current price for an ounce of good sinsemilla (a type of highly potent marijuana) ranges from $250 to $400. "If that drops down to $50 to $60 an ounce, it would require a really large tax to get [the price back up to that level]. But if the tax is set too high, [we] worry about tax evasion," he says. (More on Time.com: Is Drug Use Really on the Rise?)

Experts disagree on how much tax evasion occurs under California's tobacco tax regime, with smokers ordering cigarettes by mail to avoid state taxes, for instance. Some put the figure at 1% to 4%, but the agency that administers the state's tobacco taxes has said that the rate is more like 15%. Either way, the majority of cigarette taxes do seem to be paid rather than evaded.

Kilmer notes, however, that if Prop 19 passes, each local jurisdiction can set its own tax rate, which could prompt a "race to the bottom," as localities compete for a piece of the pie. "Regardless of how you feel about Prop 19, how to stop a race to the bottom is going to be important for everyone. No one wins if we end up with a really low tax rate on a really low price," Kilmer says. To prevent that, he suggests that the state government could withhold certain types of funding to localities that set marijuana taxes under a certain limit.

But let's say the price of marijuana does end up dropping precipitously. What effect might that have on consumption? Neither report can answer that. "Ultimately, we don't come up with a conclusion at all on a consumption increase," Kilmer says, explaining that many factors other than price can affect use.

The highest rates of marijuana use reported in the U.S. were in the late 1970s and early '80s, despite harsh drug laws. At the time 60% of high school seniors reported trying marijuana at least once; by comparison, the rate in 2009 was 42%. And what became of Generation X? The kids seem to have turned out all right.

Other countries that have decriminalized or quasi-legalized marijuana — such as Portugal and Holland — also have not seen social disasters because of their drug laws. In fact, they have benefited from reduced enforcement costs and increased access to addiction treatment.

One study did find that rates of marijuana use among Dutch youth increased when "coffee shops" — cafes where selling and smoking of marijuana are permitted — were proliferating and being widely marketed. But, overall, even those elevated rates of use were no higher than U.S. rates under marijuana prohibition. "It wasn't the decriminalization, it was commercialization that could have caused this," says Kilmer.

Advertising and commercialization may end up being cause for concern in the U.S. as well, given that medical marijuana ads already seem to be sustaining some newspapers. But, then again, even if Prop 19 passes, marijuana wouldn't be completely legal — it would still be prohibited under federal drug laws, which could put pressure on the Obama Administration to enforce them (though this Wall Street Journal article suggests that supporting legalization measures could be a boon for Democrats — putting similar measures on other states' ballots could draw out some key voters on Election Day).

Many questions remain about what will happen if Proposition 19 passes, but the only result I can unequivocally predict is that drug policy debates will finally become less theoretical — and much more interesting.


Read more: http://healthland.time.com/2010/10/07/prop-19-analysis-will-marijuana-legalization-increase%C2%A0use/#ixzz11iqHcrGs

(Courtesy : http://healthland.time.com/2010/10/07/prop-19-analysis-will-marijuana-legalization-increase%C2%A0use/)
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Parents adopting more open attitude to alcohol, drugs and sex

British parents are increasingly relaxed about their children drinking alcohol from as young as 10 years old, taking drugs and having sex, according to research released today .

One-third of parents – rising to half of those in London – said they were happy for their children to experiment with cannabis. A similar proportion admitted they were relaxed about all drug-taking, regarding it as an inevitable part of growing up.

One-quarter of Londoners admitted they allowed their children to drink at home from the age of 10, whereas in Northern Ireland 15 was the average age.

The study of more than 3,000 parents across Britain also revealed that most are happy for their child to start having the occasional alcoholic drink at home from the age of 13.

"Sex, alcohol and even drugs are no longer no-go areas for children as far as parents are concerned," said Frank Furedi, professor of sociology at the University of Kent. "The old-fashioned parent is fast becoming a cultural minority as mums and dads do their best to give their kids the freedoms they did not have. Families have become surprisingly open-minded about allowing their children to experiment and find their own way in life.

"Parents understand that society has changed and that it is not the end of the world if their teenager experiments with alcohol or has sex," he added.

Parents were also liberal about homosexuality, with two-thirds saying they would have no problem if their child was gay.

Mothers showed themselves as being far more relaxed, with 76% saying they would be untroubled if their child was gay, – 55% – admitted they would feel uncomfortable if their child was homosexual.

There were also marked difference between mothers and fathers when it came to children drinking alcohol in the survey, commissioned to mark the DVD release of Modern Family.

Fathers are far more relaxed than mothers about drinking, with 17% of men happy with their child drinking at home from the age of 10 compared to just 6% of women. Fathers were also more liberal when it came to drug taking, with 38% seeing it as part of growing up compared to 24% of mothers.

(Courtesy : http://www.guardian.co.uk/lifeandstyle/2010/oct/05/parents-open-alcohol-drugs-sex)
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UNAIDS welcomes first voluntary license to the Medicines Patent Pool by the National Institutes of Health of United States

30 September, 2010

US National Institutes of Health, Medicines Patent Pool and UNITAID announce landmark license agreement for the new Medicines Patent Pool

GENEVA, 30 September 2010––The Joint United Nations Programme on HIV/AIDS (UNAIDS) welcomes the announcement made today by the National Institutes of Health (NIH) that they will be sharing patents with the Medicines Patent Pool. This is the first time that a patent-holder has shared intellectual property on antiretroviral medicines with the newly established Medicines Patent Pool.

“This announcement by the NIH underscores the tremendous potential of the Medicines Patent Pool to help increase access to more affordable, newer and better medicines for people living with HIV,” said Mr Michel Sidibé, UNAIDS Executive Director. “I commend the NIH and urge all public and private partners, in particular pharmaceutical companies and research institutions, to follow suit and collaborate with the Medicines Patent Pool to increase access to HIV treatment.”

The Medicines Patent Pool was set up in July 2008 by the global health financing mechanism UNITAID, to increase access to newer antiretroviral medicines by creating a pool of patents and intelligence on antiretroviral production donated by medicine producers.

The Medicines Patent Pool aims to increase access to treatment by promoting price reductions of existing antiretrovirals, stimulating the production of newer first- and second-line drugs and by increasing the number of generic producers of these medicines.

In low- and middle-income countries, around 15 million people are in need of treatment but only five million currently have access. This announcement will help advance Treatment 2.0, a radically simplified treatment platform which includes producing better drugs with better resistance thresholds and less side effects; easier HIV testing, simpler monitoring technologies; and more community empowerment.

(Courtesy : http://unaidstoday.org/?p=1202)
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Afghan opium production halves in 2010, according to UNODC annual survey

30 September - Afghanistan's opium production halved in 2010 but soaring prices may encourage farmers to go back to opium cultivation, warned UNODC in its 2010 Afghan Opium Survey released today.

"This is good news but there is no room for false optimism; the market may again become lucrative for poppy-crop growers so we have to monitor the situation closely," said Yury Fedotov, Executive Director of UNODC.
Cultivation stable

Afghanistan, which has long been the producer of about 90 percent of the world's opium, produced an estimated 3,600 tonnes of opium this year. The bulk of cultivation continued to take place in the restive southern and western provinces of the country.

"These regions are dominated by insurgency and organized crime networks. This underscores the link between opium poppy cultivation and insecurity in Afghanistan, a trend we have observed since 2007," said Mr. Fedotov.

Although cultivation remained stable at 123,000 hectares (ha), falling output was largely due to a plant disease hitting the major poppy-crop growing provinces of Hilmand and Kandahar particularly hard. As a result of the damage, yield fell 48 per cent to 29.2 kilograms per hectare, from 56.1 kilograms per hectare compared with the previous year.
Production down, prices up

Afghanistan, which has long produced about 90 percent of the world's opium, produced an estimated 3,600 tonnes of opium this year. In the short run, the decline in opium production has pushed prices up. Now that opium is again commanding high prices, the gross income for farmers per hectare has increased by 36 per cent to US$ 4,900.

Shrinking supplies have driven the average farm-gate price of dry opium to $169 a kilo, a 164 per cent increase over last year when the price was $64 a kilo.

"We will have to monitor price trends for several months to gain a true indication of how the opium market will be affected by the drop in production this year", said Mr. Fedotov.

Compounding the problem was the low price of wheat, an important alternative crop. "We are concerned that in combination with the high price of opium, a low wheat price may also drive farmers back to opium cultivation" said Mr. Fedotov.
Bright spots

The good news was that the 20 provinces that were poppy-free in 2009 remained poppy-free this year. And opium cultivation in Hilmand province - the source of 53 per cent of Afghanistan's opium - was stable or declined slightly.
Development and security

Mr. Fedotov called for a comprehensive strategy to rein in the Afghan opium threat, including by strengthening the rule of law and security, and spurring development efforts. "Corruption and drug trafficking feed upon each other and undermine any development effort in Afghanistan. We must continue to encourage the Afghan government to crack down on corruption.

The first priority was to curb demand. "We must not forget the consumer side of opium's deadly equation. Unless we reduce the demand for opium and heroin, our interventions against supply will not be effective. As long as demand drives this market, there will always be another farmer to replace one we convince to stop cultivating, and another trafficker to replace one we catch."

(Courtesy : http://www.unodc.org/unodc/en/frontpage/2010/September/afghan-opium-production-halves-in-2010-according-to-unodc-annual-survey.html)
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