The standard blood screening test for HIV infection is the ELISA (enzyme linked immuno assay) or EIA (enzyme immuno assay). ELISA extremely good screening test with a sensitivity of more than 99.5%. EIA is an extremely sensitive test, but it is not optimal with regard to specificity. This is true and a problem in low-risk individuals, like volunteer blood donors, of whom only 10% of EIA positive individuals are subsequently confirmed to have HIV infection (by confirmatory test i.e. Western blot). Among the factors associated with false positive EIA tests are antibodies to class II antigens, auto antibodies, hepatic disease, recent influenza vaccination, and acute viral infections. Because of low specificity, anyone suspected of having HIV infection based upon a positive or inconclusive EIA (intermediate or partially reactive) result must have the result confirmed with a more specific test like the Western blot.

Most of the diagnostic laboratories use a commercial EIA kit that contains antigens from both HIV-1 and HIV-2 and can detect both the types of HIV infection. These are continuously updated and they use both natural and recombinant antigens. EIA tests are generally scored as positive (highly reactive), negative (non reactive), or indeterminate (partially reactive). The latest EIA (fourth generation) can detect antibodies to HIV with detection of the p24 antigen of HIV.

Western blot is the most commonly used confirmatory test. In a patient with a positive or indeterminate EIA and a negative Western blot, one can conclude with certainty that the EIA reactivity was a false positive. Western blot demonstrating antibodies to products of all three of the major genes of HIV (gag, pol, and env) is conclusive evidence of infection with HIV. Multiple HIV antigens of different, well characterized molecular weights elicit the production of specific antibodies. All of the HIV antigens can be separated on the basis of molecular weight, and antibodies to each component can be detected as discrete bands on the Western blot. If no band appears it can conclusively conclude that the test is negative.

U.S. Food & Drug Administration (FDA) in 1993 have established criteria for a positive Western blot test, which state that result is considered positive if antibodies exist to two of the three HIV proteins: p24, gp41, and gp120/160. By these criteria about 10% of the blood donors tested positive by EIA only are positive for HIV. Western blot patterns of reactivity that do not fall into the positive or negative categories are considered "indeterminate."

When the Western blot results are indeterminate, the following tests can help in the diagnosis of HIV infection. (1) HIV RNA by PCR (polymerase chain reaction), this test make use of PCR amplification of cDNA generated from viral RNA. (2) HIV RNA by bDNA, this is done by measuring the levels of particle associated HIV RNA in a nucleic acid capture assay employing signal amplification. (3) HIV RNA by NucliSens, this is done by isothermic nucleic acid amplification with internal controls. (4) Immune complex dissociated p24 antigen capture assay, this test is done by measuring the levels of HIV-1 core protein in an EIA based format following dissociation of antigen-antibody complexes by weak acid treatment. The last test is very cheap in compare to the other three.

For the same amount of sleeping around,, you now have a greater risk of getting infected with HIV if you use a condom every single time you have sex in Swaziland than you do if you never use a condom at all in China.

That is from the excellent and frequently illuminating The Wisdom of Whores: Bureaucrats, brothels and the business of AIDS by Elizabeth Pisani. The book is an treasure in its explanation of statistical methods, data collection, and the politics of HIV/AIDS prevention. Pisani provides a first-hand account of the work that goes into developing HIV/AIDS statistics, how these statistics are used to attack attention to the international movement to combat the spread of HIV, and a blunt analysis of the global failures in HIV prevention.

Chapter 3 should be mandatory reading for anyone doing field research in a developing country.

My one complaint the book is that Pisani's argument regarding poverty reduction and HIV prevention is a bit muddled. At some opints she argues that poverty-targeted programs are inefficeint policy for HIV reduction. At other points, she makes the argument that income inequality between men and women in Africa tends to increase the spread of HIV. Pisani's focus is on the vector that spread HIV, namely sex and needles, but the causes of risky sex and drug use must certainly be tied to economic reasons.

Nevertheless, in a retort of the poverty argument, Pisani does provide one of her numerous memorable lines:

The World Bank believes poverty and gender inequality spread AIDS. I believe sex and drug injection spread AIDS. The very best rational, utility-maximizing calculations tend to get displaced by erections and addiction.

Many reports have suggested )MHC (major histocompatibility complex) genes and other host factors may influence the pathogenesis and course of HIV disease. These genes may influence clinical course like slow or rapid rates of progression from HIV to AIDS. Many mechanisms have been postulated whereby MHC encoded molecules may predispose an individual rapid progression or to nonprogression to AIDS. These proposed mechanisms include the ability to present certain immunodominant HIV T helper or CTL epitopes, leading to a comparatively protective immune response against HIV and hence to a slower rate of disease progression.

Certain rare MHC class I and class II alleles facilitate rapid recognition of HIV infected cells from the infecting partner in primary HIV infection and promote rejection of these cells by alloreactive responses. MHC class I or class II alleles may predispose an individual to an immunopathogenic response against virus in certain tissues. In the same way common MHC alleles can lead to less effective removal of HIV infected cells. It has been demonstrated that allele sharing at HLA-B loci is associated with increased risk of transmission of HIV infection between heterosexual Zambian couples. It has also been clearly demonstrated that HLA (human leukocyte antigen) heterozygosity for class I loci (A, B, and C) is associated with a delayed onset of AIDS among HIV-infected individuals, whereas homozygosity for these loci was associated with a more rapid progression to AIDS and death. It is the fact that the HLA class I alleles B 35 and Cw 04 were consistently associated with rapid development of AIDS.

A recent finding of genetic association with HIV disease progression has highlighted the role for NK (natural killer) cells in HIV disease.

The following host genetic factors influence risk of transmission and rates of disease progression from HIV to AIDS:

Disease transmission:

Increased risk:

A2, B21, B35, Cw4, allele sharing between HIV donor and recipient (HLA I).

DRB105, DRB106, DRB113 (HLA classII).

Reduced risk:

A2/A6802 super type, A11, B18, B52, B57, B58, C2.

Disease transmission:

Rapid transmission:

A23, A24, A26, A28, A29, A31, B7 super type, B08, B14, B21, B22, B25, B35, B37, B38, B53, B44, B49, C4, C7, C8, C16, homozygosity for class I alleles (HLA I).

DRB101, DRB103, DRB105, DRB111 (HLA II).

Slow transmission:

A10, A19, A30, A32, B14, B16, B17, B18, B27, B39, B51, B57, B58, C8, heterozygosity for class I alleles (HLA I).

DRB103, DRB113 (HLA II).

Long Term Survivors & Non Progressors

It is important to distinguish between the terms long term survivor and long term non progressor. The prognosis for HIV infected individuals who have easy access to health care and ARV therapy has improved greatly. The median time from primary HIV infection to the development of AIDS in untreated individuals in the industrialized world is about 10 years and it has been extended greatly by availability of ARV therapy. Long term non progressors are by definition long term survivors; but, the reverse is not always true. Individuals were considered to be long term survivors if they remained alive for 10 to 15 years after initial infection. But at present, individuals are considered to be long survivors if they remain alive for more than 20 years after initial infection. In such individuals the disease has progressed, and they have significant immunodeficiency. Some of these individuals have CD4+ T cell counts that have decreased to less than or equal to 200 cells per micro liter, but have remained stable at that level for years. The mechanisms of this stabilization are not clear but may be due to the beneficial effects of ARV therapy and prophylaxis against opportunistic infections.

Long term non progression or long term survival of HIV patients may be due to genetic factors (to some extent). In a report, a blood donor in Australia who was HIV infected and a group of seven individuals were infected by that blood donor remained free of HIV related disease and maintained normal and stable CD4+ T cell counts for several years after infection. Sequence analysis of viruses isolated from that donor and recipients revealed similar deletions in the nef gene and the region of overlap of nef and the U3 region of the HIV LTR (long terminal repeat).

Capital witnesses Pride walk, but 68 Pages of anguish gets no hearing

Paromita-Chakrabarti

Posted online: Friday , July 04, 2008 at 11:54:39
Updated: Friday , July 04, 2008 at 11:54:39

New Delhi, July 3 Director Sridhar Rangayan’s award-winning movie on HIV-affected gays finds no hall for screening On June 29, as Delhi’s saw its first Rainbow Pride March, Sridhar Rangayan was busy trying to organise shows for his latest film, 68 Pages.

Like his previous two films, 68 Pages deals with issues close to Rangayan’s heart — lives of MSMs (men who have sex with men) who have been infected with HIV.

“But for all the hullabaloo about increased awareness about gays, educated urban heterosexuals are still scared to show empathy. There is no aggressive homophobia, but no support either,” shrugs the 45-year-old human rights activist.

Rangayan has reasons to believe so.

His film, which won the Silver Remi at the Houston World Fest earlier this year, is yet to be released in India as no mainstream distributor has come forward to screen it.

“When I made the film, I tried my best to stick to the narrative mode, so the audience could connect with it even if the subject was unfamiliar. But when I met the distributors, I realised it did not matter. They all refused to screen it on ground that a film on homosexuality which talks about AIDS, is not going to bring them any audience,” he says.

In Delhi alone, Rangayan had got in touch with all major multiplex owners, but the experience, he says, has left him rather sceptical.

“The PVR authorities did not respond for the longest time. Finally, when I sent them a rather curt mail, they replied that it did not quite fit even their corporate social responsibility profile.”

68 Pages deals with the lives of five HIV positive individuals — a trans-sexual bar dancer, a gay couple, a sex worker and a drug user — each grappling to come to terms with their own lives.

The story is a narrative from the personal diary of a counsellor who worked with them.

But instead of a bleak, oblique narrative, Rangayan has focussed on the idea of hope and redemption.

He drew his inspiration from the first woman counsellor who worked at his NGO, Humsafar Trust, in Mumbai, one of India’s first organisations to work with sexual minorities. Humsafar Trust is also the co-producer of the film.

The IIT Mumbai alumnus, who has worked with directors like Kalpana Lajmi, Sai Paranjape among others, is now distributing the film via the NGO route.

Humsafar Trust and their associates have come forward to hold a 12-city promotion tour, which includes Mumbai, Baroda, Nagpur, Indore, Chennai, Kolkata and Bangalore.

“We are going to show at auditoriums and hold discussion sessions afterwards, so there is a dialogue. That’s the only way to clear misconceptions,” he says.

In Delhi, Rangayan has found support in Gargi Sen’s Magic Lantern Foundation, an NGO which distributes non-commercial films.

A screening will be held on July 10 at the India International Centre. Naz Foundation, an NGO as well as Kriti, a city-based film club, too are organising screening. Rangayan is also planning to bring out DVDs of the movie.

All these, the director, says, are a small step towards their ultimate goal.

“It’s not just Article 377 which needs amendment. There’s still a long way to go before people’s mindset about alternative sexuality changes,” he says.

I love the fact that this number, given to Mandela as a prisoner on Robben Island by the Apartheid Government, is now being used for the global awareness and fight against HIV/AIDS. 

HIV/AIDS is well documented and written about, however to actually see it ravage a person whom you know brings it home to the importance of campaigns like these.

A new initiative has just been launched to ensure ongoing funding for the 46664 campaign, it's a bangle made from precious metals.  What I really like about it is that it also going to uplift those who are already infected with HIV/AIDS.  They will be able to earn a weekly income by being employed to manufacture these bangles.

The website itself will be able to explain everything in better detail than I can so check it out at www.46664.com/bangle.

I am a little dissapointed that as the bangle is only produced in precious metals, like Platinum, Gold and Silver, it may only be affordable to those of a higher financial bracket and therefore it can become an 'elitest' fashion accessory .  My only wish is that they brought out a 'stainless steel' bangle that would be more affordable and available to more people, especially in South Africa with a weaker Rand. 

I suppose it is the money that counts.

From male Rekha imitators to gay executives, director Sridhar Rangayan has depicted a range of homosexual exeperiences in his films. 68 Pages is his third movie after Gulabi Aaina, about drag queens, and Yours Emotionally!, about a gay affair   British tourist and an Indian male. Rangayan's new feature, 68 Pages, is about the lives of five HIV-positive individuals as told by counselor (Mouli Ganguly). The stories are of corporate employee Nishit (Zafar Karachiwala), prostitute Payal (Jayati Bhatia), transsexual bar dancer Umrao (Uday Sonawane), gay researcher Kiran (Joy Sengupta) and municipal sweeper Nathu (Abhay Kulkarni). The storytelling style is as basic as the aesthetics, but some episodes are moving, especially those of Umrao and Payal. 68 Pages is scheduled to be screened on June 26 at a city multiplex. A DVD release is also planned.

• INTRODUCTION
• DEFENDING THE INDEFENSIBLE
• IN HIS OWN WORDS: JACOB ZUMA ON MBEKI AND HIV/AIDS
• THE OPEN OPPORTUNITY SOCIETY FOR ALL: LEADERSHIP

INTRODUCTION

Welcome to the third issue of ‘The Real ANC Today’ and the third in our series on ANC President Jacob Zuma, in which we have undertaken to examine Zuma’s public record on a number of key issues, in an attempt to better understand his political philosophy and what exactly it is that a Jacob Zuma presidency might entail for South Africa. (It also represents part of a broader DA initiative in this regard.)

To date we have looked at Jacob Zuma’s public record on Zimbabwe and Zuma’s views on religion and politics, both of which suggest a man at odds with the democratic ideals enshrined in our Constitution and complicit in some of the ANC’s worst policy decisions. HIV/Aids is no exception. Today, the two key failings that define President Mbeki’s tenure are his approach to Zimbabwe, on the one hand, and his disastrous attitude towards HIV/Aids, on the other. As is now well know, the consequences of the former have been dire and, while government has managed to turn the tide somewhat in the fight against HIV/Aids - in spite of Mbeki - he, together with the Minister of Health, managed to dramatically undermine and retard that fight. We are still living with the consequences.

As the Deputy President, Zuma played a number of key roles in the fight against HIV/Aids. Obviously, in his capacity as Deputy President, he would have been expected to provide leadership and direction when the President strayed, but he also served as the head of the South African National Aids Council and, yet, despite occupying these two key leadership positions, as with Zimbabwe, he consistently defended the President and his actions and, thus, is complicit in one of the biggest policy blunders committed to date by the ANC government.

Finally, by way of introduction, we have introduced a new section to this newsletter, which follows at the end - the DA’s alternative. In it, we will each week try to identify the principle which underlies our analysis, how it has been distorted or corrupted and how the DA believes that principle should be correctly applied to our politics and, more particularly, how it reflects our vision of an Open Opportunity Society for All.

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DEFENDING THE INDEFENSIBLE

If anything, South African politics is defined by crisis. Consider the following current events, for example: Judge Hlophe and the Constitutional Court; the Ginwala commission’s inquiry into Vusi Pikoli’s fitness for office; the disbanding of the Scorpions; the vote of no confidence in the SABC board; Eskom; Zimbabwe; and the ongoing battle between the President of the ANC and the President of the country. Every day, almost every newspaper is faced with an impossible choice - which story to run as its front page headline, such is the breakneck speed at which all of these critical issues are developing and new issues unfolding.

Nor is this situation a new one. Indeed, for some time now, South Africa’s current affairs have been defined by crisis and, most of the time, the blame can be squarely laid at the feet of the ANC government.

Inevitably, this has an effect on the way in which ordinary South Africans understand politics. On the one hand, the impression is created that things are badly managed as a general rule, and an attitude in which the abnormal is assumed to be normal and crisis to be part and parcel of everyday life tends to prevail.

On the other hand, because of the sheer quantity of crises, it becomes hard to keep track of what has happened in the past, we have come to live in a vacuum, in which whatever is happening ‘now’ simply displaces some other crisis that has slipped off the radar, so to speak.

The consequences of this are fairly profound. For one thing, we tend to overlook past discrepancies, if only because they seem to pale in comparison to the current unfolding drama. But also because there is simply too much bad news and it would require constant, vigilant monitoring to keep a mental record of it all.

Thus, when Jessie Duarte is appointed the ANC’s new spokesperson, we tend to forget that she was embroiled in a corruption scandal in the late 1990s; when Minister Marthinus van Schalkwyk makes a speech about the environment, we tend to forget that he deceived most of his supporters in 2004, by taking their vote and promptly merging with the ANC; and, when President Mbeki stands up and congratulates the Springboks on winning the world cup, we tend to forget that, just a few years earlier, he said we should sacrifice winning in order to transform.

But the past holds within it a number of important lessons, and people’s positions on, and attitudes to, past events not only helps us place their current behaviour in a broader context, but also tells us much about their personality and their likelihood to go one way or the other, when faced with a similar predicament today.

Jacob Zuma’s attitude to HIV/Aids is a good example. For many people, Zuma’s attitude to HIV/Aids is defined by his most recent blunder on this issue - his testimony during his rape trial, where he suggested that taking a shower after having unprotected sex was a good way to minimise the risk of contracting the HI virus, a statement met with outrage, disbelief and derision.

But there is another element to Zuma’s track record on HIV/Aids, one which has received far less public scrutiny and, yet, one which is just as significant: when President Mbeki first began to slip into Aids denialism - in 2000 - and as his warped and distorted views increasing began to undermine South Africa’s fight against HIV, Jacob Zuma repeatedly and consistently defended the President.

In doing so, he demonstrated poor leadership and an inability (or unwillingness) to counter or even criticise the President’s position. The result is that Jacob Zuma is complicit in one of the biggest policy disasters to define post apartheid South Africa. At the same time, his decision to defend President Mbeki is an indicator of a poor moral compass. Zuma prides himself on his loyalty to the ANC, but blind loyalty can quite easily prevent one from making the correct choice when the party itself loses direction.

The collection of quotes below this article sets out Zuma’s defence of Mbeki’s Aids denialism in some detail, and there is no need to repeat them here; suffice to make one point: they do not constitute a blurred or ambiguous defence, they are categorical, clear and explicit.

When Mbeki’s views were being criticised, Zuma defended Mbeki’s stature as “towering”; when asked whether Mbeki’s views were doing any damage, he said “there is absolutely no damage”; and when he was asked to intervene, to dissuade Mbeki from his views, Zuma emphatically stated, “he absolutely does not need any persuasion”. These are not the words of someone unsure about his position, or his defence. For Zuma, there never was a problem. Mbeki never inflicted any damage and his views were entirely justified.

Any crisis has a number of key points in its lifespan: its creation, its development and its conclusion. How a person reacts to each one of these stages tells you much about their ability to identify, counteract and solve that crisis. The appropriate response to all three stages is important; but it is their reaction to the first that tells you about their values and principles, for their initial position will determine their later response and, if they deny or fail to identify a crisis when it first manifests, they will never be able to respond properly or indeed to solve it.

When Mbeki first challenged the view that HIV causes Aids, the crisis that would define South Africa’s Aids response for the next seven years first manifested. Zuma failed to identify properly what was happening and, even when that crisis was clearly well set and developing at an exponential rate, he still defended the President and the party, subverting democratic ideals to the will of one man with a profoundly damaging thesis on a key challenge facing South Africa.

The same argument could be made about Zuma’s attitude and response to the situation in Zimbabwe, as we have set out in a previous edition of this newsletter, and both tell us as much about his ability to provide proper leadership as they do about his ability to identify a crisis properly.

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IN HIS OWN WORDS: JACOB ZUMA ON MBEKI AND HIV/AIDS

2000: On individual responsibility and the fight against HIV/Aids, in 2000:

“I believe that until a cure for this disease is found, no amount of intervention by government will succeed until people of their own accord heed the call for changing behaviour to save themselves.” (HANSARD; [17 May 2000]; Column 1673.)

2000: On what Mbeki’s views on Aids have done for his stature:

“All I know is that the President of this country, since his election, has grown in stature in the world. He is the leading President on the continent, and is invited by all international organisations to come and put the views of the country and of the continent.”

“In our view, our President today is towering. He is, in fact, at the level of presidents in the developed countries. He has brought innovation in the debates that have taken place.”

“…as a result of [President Mbeki’s] activities internationally South Africa, which is what it was before 1994, has gained 100% recognition. Indeed, he has attracted investments to this country, because he has been recognised as a serious thinking President and head of state who knows exactly what he is doing.” (HANSARD; [4 October 2000]; Columns 3724 – 3726.)

2000: On whether Mbeki’s views have affected the ANC government’s credibility:

“…I am not aware of South Africa losing credibility.” (HANSARD; [4 October 2000]; Column 3726.)

2000: On whether Mbeki’s views have done any damage:

“I do not know what damage the President has caused. What I know is that the President asked specific questions which were aimed at getting information from those who know, particularly scientists, so that Government could take informed positions as it works out its policies to deal with this matter.”

“Instead of getting answers, there has been the kind of excitement which I do not know where it came from, which the hon member calls a damage (sic). I do not know what has to be repaired because the answers had not come. The President went further, when there was this excitement, invited the experts, internationally, who came and met in this country and posed the questions to the real people who deal with the business. They are working on it, in order to help answer the questions that our President has asked.”

“I do not know what damage one is causing by asking questions. I do not understand why people would say there has been a damage (sic) that needs to be repaired. There is absolutely no damage.” (HANSARD; [1 November 2000]; Columns 4328 – 4329.)

2002: On why government was taking so long to comply with the July 2002 Constitutional Court order to provide Nevirapine:

“I cannot indicate, right here, how long this will take but we are doing everything we can to encourage people, because people have different views and we do not want to exclude those views from what one will finally come up with as a final decision in moving forward. This is what we are waiting for.” (HANSARD; [13 November 2002]; Column 5039.)

2003: On whether he will act to dissuade Mbeki from his views on Aids

“President Mbeki does not need any persuasion…he absolutely does not need any persuasion.” (HANSARD; [13 November 2003]; Column 4351.)

2006: On individual responsibility and the fight against HIV/Aids, in 2006:

“It [a shower]... would minimise the risk of contracting the disease.” (SAPA; [5 April 2006]; “A person just can’t trespass on your bed”.)

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THE OPEN OPPORTUNITY SOCIETY FOR ALL

In an Open Opportunity Society for All, strong political leadership is necessary for good governance. And by strong, one means principled, consistent leadership that makes decisions in accordance with a particular vision.

Obviously, as far as the DA is concerned, that vision is of an Open Opportunity Society for All, a society where an individual’s well-being is not subjugated to the will of the ruling party, but the very purpose behind any policy decision or position. It is also a vision consistent with the values enshrined in the constitution.

But perhaps the biggest difference is that both the leaders and the members of an Open Opportunity Society for All are required to take individual responsibility for their decisions, if only because a failure to do so would mean their removal from office.

The consequences of this, in practical terms, are twofold: On the one hand, in an Open Opportunity Society for All, no one would be prevented from living out their life to its full potential by not having access to life-saving drugs; and, on the other hand, any leader who acted to prevent this or contrary to the ideals embodied by South Africa's constitution would be held to account.

Ideally, those elected to office would be directly accountable to the people they represented and not shielded by an amorphous party. For the possibility of a change in power and, indeed, a change in office bearer, is one of the surest safeguards against unaccountable behaviour.

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The pool of cells that are in the post integration state of latency is established early during the course of primary HIV infection. Despite the suppression of plasma viremia to less than 50 copies of HIV RNA per milliliter by effective combinations of several ARV drugs administered over several years, this pool of latently infected cells persists. They can give rise to replication competent virus and maintain infection. Latest modeling studies suggest that, if the suppression is maintained for long duration it will take 7 to 70 years to eliminate the pool of latently infected virus completely. Other point to remember is this pool of latently infected cells is replenished if there is slight fault in maintaining the suppression. Attempts have been made to eliminate HIV in the latent viral reservoir using agents that stimulate resting CD4+ T cells during the course of antiretroviral therapy; but, such attempts have been unsuccessful.

With more sophisticated techniques for measuring extremely low levels of virus replication, it is clear that virus replication continually occurs at very low levels in a substantial proportion of individuals whose viral load is undetectable by the standard assays of plasma viremia. That is why though very small pool of resting, latently infected cells exists at any given point in time, this pool is continuously activated and replenished.

Reservoirs of HIV infected cells can exist in a number of sites including the lymphoid tissue, peripheral blood, and the CNS and also in other unidentified locations. This persistent reservoir of infected cells at various stages of latency and low levels of persistent virus replication are major obstacles to the goal of eradication of virus from infected individuals, despite very good clinical outcomes from ARV therapy employed for treatment if HIV disease.

Except long-term non progressors, the level of CD4+ T cells in the blood decreases progressively in HIV infected individuals. This decline may be gradual or abrupt. During this decline most of the patients are asymptomatic, and are often described as being in a state of clinical latency. This is different from microbiologic latency, because some level of virus replication invariably occurs during the period of clinical latency. Progression of disease although slow in many cases, is generally relentless during this period of clinical latency. Even in rare patients who have less than 50 copies of HIV RNA per milliliter in the absence of therapy, there is always some degree of ongoing virus replication.

93–99% of the circulating viruses originate from recently infected, CD4+ T cells that have high turn over and that about 1% to 7% of circulating virus originated from longer lived cells, likely monocytes or macrophages. A very small number of circulating virus originates from the pool of latently infected cells or reservoirs.

The half-life of a circulating virion is about 30–60 minutes and that of productively infected cells is 1 day. Thus it is assumed that extremely large amounts of virus (about 10¹⁰–10¹¹ virions) are produced and cleared from the circulation every day. The minimal duration of the HIV-1 replication cycle in vivo is approximately 2 days. Lymphoid tissue is the main site of HIV replication and the main source of plasma viremia.

Viral set point which is the level of steady state of viremia. Viral set point is important prognostic factor for the progression of HIV disease. Those who have a low set point 1 year progress to AIDS much more slowly than individuals whose set point is very high at that time.

Among human viral infections HIV infection is unique. Strong cellular and humoral (by antibodies) immune responses are mounted following primary infection. But, once infection is established the virus succeeds in escaping immune mediated clearance by the body. Paradoxically it seems to thrive on immune activation, and is never eliminated completely from the body. Instead of getting cleared from circulation a chronic infection develops that persists with varying degrees of continual virus replication and multiplication in the untreated patient for an average of10 years before the patient becomes clinically ill and develop AIDS. Chronic, persistent infection is the hallmark of HIV disease.

Latest studies using highly sensitive molecular techniques have demonstrated that even in patients in whom plasma viremia is suppressed to below 50 copies of HIV RNA/ml by ARV (antiretroviral or anti HIV) therapy, there is a continual low level of virus replication in the body.

Unlike many deadly viral infections HIV infection very rarely kills the host during primary infection. With very few exceptions, in other human viral infections if the host survives, the virus is completely cleared from the body and a state of immunity against subsequent infection develops and the individual is protected from that particular viral infection in the future.

Evasion of Immune System by HIV:

HIV has the ability to evade elimination and control by the immune system of the host body. There are a number of mechanisms by which the HIV evades the immune system. Main among these is the establishment of a sustained level of replication along with the generation of viral diversity via mutation and recombination that provide a mean to evade control and elimination by the immune system. The selection of mutants that escape control by CD8+ cytolytic T lymphocytes (CTLs) is very critical to the propagation and progression of HIV infection. The high rate of virus replication and the continual mutation of virus contribute to the inability of neutralizing antibody to contain the virus present in an individual at any given time. Molecular analysis of clones of CD8+ CTLs demonstrated that they are no longer detectable after their initial burst of expansion. It is thought that the initially expanded clones may have been deleted or rendered dysfunctional owing to the overwhelming immune activation.

The principal targets of neutralizing antibodies (humoral response) against HIV are the envelope proteins gp120 and gp41. HIV employs three mechanisms to evade neutralizing responses: extensive glycosylation of the envelope, hypervariability in the primary sequence of the envelope, and conformational masking of neutralizing epitopes.

HIV preferentially infects activated CD4+ T cells including HIV-specific CD4+ T cells. CD4+ T cell help is essential for the integrity of antigen specific immune responses, both humoral and cell mediated. So this loss of viral-specific helper T cell responses has profound negative consequences for the immunologic control of HIV replication. This loss occurs early in the course of infection, and animal studies indicate that 40–70% of all memory CD4+ T cells in the GALT are eliminated during acute infection. Another means of escape of HIV-infected cells from elimination by CD8+ CTLs is the sequestration of infected cells in immunologically privileged sites such as the central nervous system (CNS).

The escape of HIV from elimination during primary infection allows the formation of a pool of latently infected cells that cannot be eliminated by virus specific CTLs. Thus, despite a potent immune response and the marked down regulation of virus replication following primary HIV infection, HIV succeeds in establishing a state of chronic infection.

]]> http://koww.wordpress.com/?p=528 Fri, 04 Jul 2008 08:58:41 +0000 koww http://koww.wordpress.com/?p=528 Du bist positiv?

Na und? Was hat sich geändert? Du bist immer noch der Mensch, der du vorher warst. Du bist immer noch ein Mensch. Ein Mensch, der genauso ein Recht auf Liebe hat, wie jeder andere auch. Ein Mensch, der es wert ist, geliebt zu werden. Einfach ein Mensch.

Das Einzige, was sich geändert hat ist, dass du dich beim Sex mit Mitteln schützen musst, die jeder von uns verwenden sollte.
Was ist anders an dir?

Der Zeitpunkt deines Todes ist für dich genausowenig absehbar, wie für jeden anderen auch. Morgen? Nächste Woche? Nächstes Jahr, oder vielleicht auch erst in 10 oder 20 Jahren.
Also, was ist anders?

Dein Äußeres verändert sich mit der Einnahme von Medikamenten?
Bist du deshalb nicht mehr der oben beschriebene Mensch?

Also hilf mir und sag mir, was anders ist!

The article discusses how gender-based violence, discrimination, and poverty increase women's risks for contracting HIV/AIDS.  While some of the opinions expressed in the article may be rather extreme, the author provides a lot of useful information about the widely-recognized problem of HIV/AIDS rates among women.

It also provides plenty of evidence (which could be added to heaps upon heaps of other evidence!) to contradict anyone who might claim that people only get HIV/AIDS through their own foolish or immoral behavior.  As this article demonstrates, in some parts of the world, one of the main risk factors for contracting HIV/AIDS is being a faithful wife.

Read the article here, or click below for some excerpts.

Excerpts from "What is a Woman Worth? The Global Story is the Feminization of a Pandemic":

Consider these statistics: The latest reports from the UNAIDS (Dec. 2007) show 33.2 million people are living with HIV throughout the world. Sub-Saharan Africa has more than two-thirds (22.6 million) of the total number of HIV infections. Sixty-two per cent (14 million) of those infected are women and adolescent girls. Seventy-five per cent of all HIV-positive women in the world are African. [...]

Many forms of violence against African women contribute to, and worsen, the devastation of women and girls from the HIV/AIDS virus. Women and girls are often ill informed about sexual and reproductive matters and are more likely than men and boys to be uneducated and illiterate. Physiologically, women are two to four times more likely than men to become infected with HIV, but they lack social power to insist on safer sex or to reject sexual advances.

Gender-based violence and harmful traditional practices are some of the major risks for contracting the HIV virus. These include sexual violence, marital rape, domestic violence, early child marriage of young girls to older men, forced marriage, wife inheritance, widow cleansing, polygamy, and female genital mutilation.

Poverty forces many women into subsistence sex work or transactional relationships that preclude negotiating condom use. For economic reasons, women are often unable to leave a relationship, even if they know that their partner has been infected or exposed to HIV. [...]

To reverse the spread of AIDS, women must have greater control of their decisions, bodies and lives—as well as their governments and public policies.

In 2004, UNAIDS launched the Global Coalition on Women and AIDS, a worldwide alliance of civil society groups, governments, UN organizations and networks of women living with HIV/AIDS. The coalition’s platform calls for education, literacy, and economic rights for women; equal access to antiretroviral treatment; access to sexual and reproductive health services; changes in harmful gender stereotypes; and zero tolerance for gender-based violence.

Three-quarters of all new HIV infections are sexually transmitted between men and women. The behaviors of men are critical to prevention efforts in Africa.  They hold overwhelming power in decisions about sexual matters, including whether to have sex or to use condoms.  In many societies, women are expected to know little about such matters and those who raise the issue of condom use risk accusations of being unfaithful or promiscuous.

While mortality rates among people living with HIV/AIDS increases after five years, "possibly because people are less likely to adhere to antiretroviral regimens or are less able to tolerate side effects from the drugs," the increased risk is relatively small (e.g. 5% after ten years, for some age groups).

These results highlight the incredible importance of antiretroviral medications: "Before 1996, when antiretroviral cocktails were not widely available, the increased death risk for newly diagnosed HIV-positive people ranged from nearly 8% to 20%, depending on a person's age."

I love poking around the website of Books & Culture: A Christian Review, and an article by Healther D. Curtis called "All Shall Be Well" recently caught my eye.  It's a review of a book called Healing in the History of Christianity, by Amanda Porterfield.  Apparently the book argues that health and healing (physical and otherwise) has been a major theme in Christian spirituality through the course of its existence.

This struck me as really interesting in terms of Christian AIDS advocacy.  Many Christians (including myself) are motivated to care about AIDS (and other health and social justice issues) because of our faith - because we believe that God created and loves every human being, and has called us to serve others.  Through the centuries, countless men, women, and children have been introduced to the love of Christ through Christians who have cared for the sick.

Anyway, I doubt many people are likely to be as interested in this article and book as I am - that would be the history major in me - but for anyone who is, check it out.  (And if this topic doesn't appeal to you, well, Books & Culture has tons of other great stuff.)

Bush's speech focuses on initiatives aimed at supporting developing nations.  He said he will urge the other G8 leaders to fulfill aid committments made at previous meetings, and discussed antiretroviral treatment (calling once again for Congress to re-authorize PEPFAR), the need for more health workers, and strategies for fighting hunger.  He also mentioned climate change and (suprise!) "the struggle against violent extremists."

It's good to see that Bush wants global health, poverty, and development to rank high on the G8 agenda.  Groups like the ONE Campaign have worked very hard in recent years to make these issues a major part of the G8 discussions.  Hopefully the leaders at the Summit will take these problems seriously, and not get sidetracked by contentious debates or pet foreign policy arguments.  (This has been known to happen in the past.)

Here's an article from the Kaiser Network that discusses what Bush said, stressing his PEPFAR mention.  You can read Bush's whole speech here, or click below for excerpts.

Excerpts from Bush's speech:

          At recent summits, G8 countries have made pledges to help developing nations address challenges, from health care to education, to corruption. Now we need to show the world that the G8 can be accountable for its promises and deliver results. As I said the other day, we need people who not only make promises, but write checks, for the sake of human rights and human dignity, and for the sake of peace.
          Accountability is really important when it comes to our work on the continent of Africa. In 2005, G8 leaders promised to double development assistance to Africa by 2010. America is on track to meet our commitments. And in Japan, I'll urge other leaders to fulfill their commitments, as well.
          We must also fulfill our commitments in the battle against HIV/AIDS and malaria. I've asked Congress to reauthorize and expand the Emergency Plan for AIDS Relief, doubling our funding for this vital effort. It's very important that Congress reauthorize this plan. [...]

          It's important that over the next five years that we support antiretroviral treatment for approximately 2.5 million people, that we prevent 12 million new AIDS infections, and that we care for 12 million people also affected by HIV/AIDS -- including 5 million orphans and vulnerable children. Last year, the G8 agreed to meet those commitments; they agreed to match. They also agreed to help us reduce malaria in affected countries by half. And I just -- I hope that these countries understand the great promise and hope that comes when we help alleviate this suffering. And so one of my really important agenda items is going to -- is going to rally our partners to make commitments and meet commitments.
          We'll also discuss additional steps to confront some other challenges, such as the need to train health care workers in G8 partner countries in Africa. It's one thing to say we're going to help people with their -- deal with disease, but a lot of these countries need workers that are capable of helping, of reaching out to people in need. We should set a goal to treat at least 75 percent of the people with neglected tropical diseases in the most affected countries. We've got to work to confront higher food prices. [...]

          On the food issue, I've announced that the United States would make available nearly $1 billion in new resources to bolster global food security. Once again I'll be going to the G8 and talking about the great compassion and concern of the American people in addressing problems.
          At Toyako I'll also ask leaders of the G8 to make other important strategic moves to alleviate hunger, such as increasing the shipments of food, fertilizers and seeds to countries in need. It's one thing to talk about the problem; this is a practical way to help countries deal with the lack of food.

According to yesterday's article from the Kaiser Network,

Former Pennsylvania Sens. Rick Santorum (R) and Harris Wofford (D), who competed in a "bitter and high-profile" Senate race in the 1990s, are joining together to serve as state co-chairs of ONE Vote '08 -- which aims to bring attention to issues of extreme poverty and global disease, including HIV/AIDS, during the presidential campaign -- the Philadelphia Inquirer reports. The group [...] is co-chaired nationally by former Senate Majority Leaders Bill Frist (R-Tenn.) and Tom Daschle (D-S.D.).

According to the same article,

Both presumptive presidential candidates Barack Obama (D-Ill.) and John McCain (R-Ariz.) have already agreed to continue the Bush administration's efforts to fight HIV/AIDS and malaria in low-income countries and to visit Africa during a first term, but Wofford said that does not eliminate the need for continued political pressure. Wofford said, "When there is common ground between the candidates on a good issue like this, it's very important that it not be relegated to the periphery just because it's not controversial."

One of the things I really like about this is that it's so committed to its non-partisan status.  Heaven knows, it can only be good for American politics to focus on big issues everyone agrees we need to tackle.

Product RED is planning to launch a digital music service.  For monthly fee of $5, each month users will get 2 songs (mp3 format), one from a well-known musician and the other from an up-and-coming artist, and one surprise item.  According to reports, this would all be "exclusive content."  Half the money earned will go to the Global Fund; half will go to the musicians and their record companies.

According to this article from the Kaiser Network, "U2, Bob Dylan, Elvis Costello, Elton John, Emmylou Harris and Death Cab for Cutie" are among the artists already signed up to participate.

Product RED (co-founded by Bono, a famous musician himself) is an initiative that teams up with popular brands and products like Gap and iPod to donate money to the Global Fund to Fight AIDS, Tuberculosis and Malaria.  When consumers buy designated RED products, the company donates a percentage of the purchase price to the Global Fund.

According to the Kaiser Network article:

Some critics of RED have said it does not direct enough of the profits from its products to HIV/AIDS relief in comparison to the amount of money companies spend promoting their RED products. The organization's approach is to find businesses that can finance HIV/AIDS treatment in a sustainable way, and a subscription music service that generates steady revenue would fit that approach, according to the Times (Levine, New York Times, 6/30).

To find out more about Product RED, check out its website and blog.

 Evolution A gradual process in which something changes into a different and more complex or better form. See Synonyms at development. The process of developing. Gradual development.

Perhaps evolution does exist, but perhaps its definition, especially in this case, is flawed. What, exactly, is more complex or better with seemingly unbeneficial mutations? Lighter skin, straighter hair, different color eyes, and different color hair—how are any of these things more complex or in a “better” form other than the myth of European features being aesthetically appealing more so than African features.

18th century anthropologist Christoph Meiners, who first defined the term, characterized the "Caucasian" as having the characteristics of "lightness", "beauty" and being "handsome" with the "ancient Germans" having the "whitest, most blooming and most delicate skin" because they were the most racially pure Caucasians.

18th century anthropologist Johann Blumenbach, the second person to define the term, considered Caucasians to be the top of "racial hierarchy" he organized where,

 "the white color holds the first place, such as it is that most Europeans. The redness of cheeks in this variety is almost peculiar to it: at all events it is but seldom seen in the rest." and described Caucasians as, "Color white, Cheeks rosy; hair brown or chestnut-colored; head subglobular; face oval, straight, its parts moderately defined, forehead smooth, nose narrow, slightly hooked, mouth small. The primary teeth placed perpendicularly to each jaw: the lips (especially the lower one) moderately open, the chin full and rounded."

Further definition of evolution: Change in the genetic composition of a population during successive generations, as a result of natural selection acting on the genetic variation among individuals, and resulting in the development of new species.

Of course, Europeans are not a different species, considering the fact they have the least genetic diversity which makes them much more susceptible to harmful mutations only invalidates this definition more. Moreover, all humans share more than 90% of their DNA with each other, so the genetic variation that does exist is very minute to their genetic commonality, with people of African decent having the most genetic diversity.

Natural selection is the process by which favorable heritable traits become more common in successive generations of a population of reproducing organisms, and unfavorable heritable traits become less common, due to differential reproduction of genotypes. Natural selection acts on the phenotype, or the observable characteristics of an organism, such that individuals with favorable phenotypes are more likely to survive and reproduce than those with less favorable phenotypes.

Favorable by whose standards--defiantly not mother natures.

 More than this, what happened to the extinction aspect of evolution in this case, if everyone else ultimately evolved from Africans, why is the African populations not dwindling on the point of extinction? Just how much time is required, it’s been about 100,000 years. In 2007, the population of Africa was 965 million, while Europe has 731 million. Of course not everyone in Europe is of European decent and the same can be said for Africa, however, most are actually of the origin of the continents –give or take a few.

Those who try to argue about AIDS playing out the role of natural selection on the African population (which is by the way, very unintelligent) —you’d have to say that Europeans and people of other races are not able to contract the virus—and everyone knows that they are just as capable as anyone else of contracting AIDS. If they were somehow evolved, as a “better developed breed”, so to speak, they’d have immunity to this OR somehow adapted in some way. I just wanted to address the stupidity before it came.

Why would one think, and be justified in thinking, that AIDS, or HIV is a man-made disease? Two very simply reasons..maybe three--besides the ones listed on the above mentioned site.

1. The fact that this virus has two strains in such a short amount of time, and it just sprouted up all of a sudden, out seemingly no where. Monkeys were discovered to have the virus parallel to the time it began to spread in the (African) human population. As many experiments that monkeys and apes have been subjected to since the breaking age of science, it is highly unlikely that scientist, all of sudden found out those animals had HIV--at least they would have noted a decline in the population much earlier than the time it took to spread in the human population.
2. The way the virus works, turning the immune system against itself, is unnatural…in its entirety. There is no other disease or virus known to do this.
3. There are occurrences of two women from China who were exposed to the HIV virus AND actually showed immunity to it.
4. Magic Johnson is alive and well (almost 20 years) and it is pubically known that he has/had HIV/AIDs.

Fishy stuff, huh? Everyone's life is affected and at risk by AIDS. Start asking questions, seeking information, and demandig answers---real answers. I've noticed how many people just take whatever the media/government feeds---much like "jumping of a cliff because someone simply told you to jump". 

Other Helpful links: http://rense.com/general67/viru.htm  http://www.whatreallyhappened.com/AIDS3.html         http://www.aliveandwell.org/

This isn't the place to go into detail about Zimbabwean politics - even assuming I was capable of doing so, which I'm not.  Basically, long-time president Robert Mugabe won another term in office in a run-off election preceded by so much political violence and intimidation, his opponent dropped out of the race just days before the voting date.  His government now stands on very shaky ground, as the rest of the world tries to decide what to do.  To learn more, I strongly recommend the BBC News Special Report, Zimbabwe in Crisis.

Zimbabwe's political problems exacerbate the problem of the HIV/AIDS epidemic in that area in several ways.  I've gathered several articles that at least touch on the subject.

John Yearwood's article from the Miami Herald (which I also mention in this post) features a Zimbabwean AIDS activist who talks about the problems caused by his country's political atmosphere.

In the run-up to the more recent election, NGOs were banned from working in the country on June 13.  Although about 400 HIV/AIDS organizations were exempted from the rule, this detail was often overlooked on the ground.  Political violence, especially in rural areas, made it almost impossible for many NGOs to get to the people they care for.  This July 1 article from IRIN/PlusNews and this June 21 article from the Zimbabwe Standard (one of Zimbabwe's few independent press outlets) discuss this situaton.

Meanwhile, Zimbabwe's women have faced the danger of rape as a political weapon as groups of Mugabe supporters have terrorized political opponents.  A man quoted in this article described the situation this way:

"Every woman who is still young is being raped by these brutes who threaten to destroy homesteads if women do not give in to their demands. We men, know it's happening even though women don't talk about it. We know they are desperate to spare their husbands and families victimisation. We are going to be raising children that are not ours, but AIDS is the real threat in the community now."

A BBC article reports a matter-of-fact attitude about rape and sexual abuse among some of Mugabe's supporters.  According to the author, the responses he encountered

glossed over the dangers of sexually transmitted diseases, especially HIV/Aids which has wreaked havoc in Zimbabwe. 

Life expectancy has plunged to 37 years from 60 years in 1990, largely due to the HIV/Aids pandemic.

(Here's a brand new blog post from womensphere that talks about violence against women in Zimbabwe.)

The situation in Zimbabwe brings the warning in a recent Red Cross report (World Disaster Report 2008) into sharp relief:

"ignoring HIV/AIDS as a disaster exposes people to unnecessary risks. According to the report, relief workers should do more to prevent unsafe blood donations, protect women and children from rape and minimize disruptions in HIV treatment. In addition, low-cost measures and better planning should be implemented to minimize the risk of spreading the disease in a disaster zone (AP/International Herald Tribune, 6/26). The report also called on governments and humanitarian agencies to pay more attention to HIV/AIDS in their response to armed conflicts, as well as the growing rate of transmission among vulnerable groups, including injection drug users, commercial sex workers and men who have sex with men (Evans, Reuters, 6/25).

(Quote is from this article. For more on the Red Cross Report, see this post from June 30.)

Approximately 50–70% of individuals with HIV infection experience an acute clinical syndrome in about 3–6 weeks after primary infection. This is Acute HIV Syndrome. Clinical manifestations vary from individual to individual to a great extent. It is suggested that symptomatic seroconversion leading to the seeking of medical attention indicates an increased risk for an accelerated course of disease. There is no correlation between the level of the initial burst of viremia in acute HIV infection and the subsequent course of disease.

The clinical manifestations (general) are fever (long duration of more than one month), diarrhea (long duration of more than one month), weight loss (more than 10%). Pharyngitis, anorexia, nausea, vomiting are also some of the clinical manifestations. Lethargy, malaise, arthralgias (joint pain), myalgias (muscle pain), headache, retroorbital pain (pain behind the eyes), lymphadinopathy are also not uncommon symptoms. There are also neurological symptoms like meningitis, peripheral neuropathy (pathology of peripheral nerves), myelopathy (pathology of covering of nerves) and encephalitis. Skin manifestations like cutaneous ulceration of skin, maculopapular rashes are seen. All the above manifestations occur along with the burst of viremia.

It has been reported that many of the symptoms of the acute HIV syndrome (fever, pharyngitis, skin rash, and myalgia) occur less frequently in those infected by injection drug use than those infected by sexual contact. The manifestations are typical of an acute viral infection. Symptoms typically persist for one week to several weeks and gradually subside as immune response to HIV develops and the levels of plasma viremia decrease. Opportunistic infections have been reported during this stage of infection, due to immunodeficiency that results from reduced numbers of CD4+ T cells and also from the dysfunction of CD4+ T cells. The number of total lymphocytes and T cell subsets (CD4+T and CD8+T) are initially reduced and inversion of the CD4+/CD8+ T cells take place during Acute HIV Syndrome due to increase of CD8+T cells.

Lymphadenopathy occurs in approximately 70% of individuals with primary HIV infection. Most of the patients recover spontaneously from this and many are left with only a mildly depressed CD4+ T cell count that remains stable for a variable period of time before beginning its progressive decline.

Approximately 10% of patients manifest a fulminant (severe) course of immunologic and clinical deterioration after primary infection, even after the disappearance of initial symptoms. But in most of the patients, primary infection with or without the acute syndrome is followed by a prolonged period of clinical latency. A small percentage of HIV infected individuals treated with ARV drugs during acute infection may revert to a negative EIA test as long as they remain on therapy. But reseroconversion takes place very rapidly when ARV is withdrawn.

1.  This article from IRIN/PlusNews tells the story of Khuda Mutchato, a Zimbabwean woman who "has to regularly cross a chain of mountains into Mozambique to improve her chances of survival." 

2.  This article from the Rwanda News Agency reports that many Rwandan HIV/AIDS patients have to travel long distances within the country to reach ARV distribution sites.  One of these people is a very ill 45-year-old woman named Daphroza, who has to walk for one whole day to get a 15-day supply of ARVs.

Click the links above to access the articles, or keep reading this post for more summary.

(1.)  According to IRIN/PlusNews, in Zimbabwe "only about 100,000 of the estimated 321,000 people in need of ARVs are receiving them through the public health sector."  It is estimated that over 100 Zimbabweans in need of AIDS medication are surreptitiously picking up their ARVs in Mozambique, where "about 100,000 HIV-positive patients are currently getting free ARV treatment."  (In a bit of unqualified good news, this number is up from only 7,000 in 2005.)

Health officials in Manica - the region of Mozambique that Mutchato and others are travelling to - say that although the influx of patients is a strain on already limited resources, they are committed to providing treatment to the Zimbabweans who come to them for help.

(2.)  Daphroza is one of "up to 73 HIV positive patients" in "varying conditions" who have to walk a distance that would take two hours by car "to have their bi-monthly dose of ARVs."  According to Dr. Jules Mugabo, the leader of a "government and donor funded agency" in charge of ARV distribution, health officials are well aware of the problems rural Rwandans have in getting their medicine, but they are already doing all they can to extend accessibility with the resources they have.

According to the article, over 53,000 Rwandans - including 5,000 children - currently on ARV treatment.  This is up from a mere 800 or so who were on ARVs between 1999 and 2003.  According to Dr. Mugabo, medical infrastructure has expanded rapidly to facilitate this massive growth ("from just four main provincial hospitals in 1999 to about 143 health centers currently"), but "limited resources [...] do not permit the expansion of the program to the 'door steps of all the patients'. "  He is optimistic that within "the next two to three years [...]  patients should be having their doses from meters away."  But as the author of the article points out, that may be too late for people like Daphroza.

In looking at these stories, I'm struck by the irony of the situations.  In a sense, these are problems created by successes.  The number of people able to take ARVs has exploded in both Mozambique and Rwanda.  Now health workers are facing the logistical difficulties of actually getting the medicine to all these people.  If you think about it, it makes perfect sense.  Nonetheless, it's clearly a very serious problem.  I suppose it illustrates the need for cooperation among people working on various aspects of AIDS work, and even various aspects of providing treatment.  I'm thinking that people like Dr. Mugabo could use our prayers as they try to keep up with these sorts of rapid developments.

About 2,400 cases of HIV have been registered in Yemen, but research suggests that "for every reported case, 20 to 30 go unreported."  (If accurate, this would put the actual number of cases somewhere between 48,000 and 72,000.)

The proposed law is aimed at reducing stigma and discrimination against people living with HIV/AIDS.  According to Abdul-Bari Dughaish, the leader of the group preparing the law, noted that "HIV-positive people risked being fired from their jobs and their children dismissed from school, because contracting the virus was sometimes viewed as a punishment from God."  (The overwhelming majority of Yemen's population is Muslim.)

The proposed law would:

• Prohibit "discrimination against HIV-positive people seeking accommodation and services"
• Prohibit employers from dismissing workers based on HIV status
• Prohibit the exclusion of HIV+ children from schools
• Provide free medical, psychological, and social care for HIV patients
• Provide access to legal help for "those whose rights had been violated"
• Make medicines and equipment used in HIV/AIDS efforts "free of taxes and customs duties"
• "[C]ommit the Ministry of Health to educating people about HIV and how to prevent it, and to adding information about HIV and AIDS to Yemen's school curriculum"
• Provide for "a government fund to be established to support HIV-positive people and their families"
• Provide for "the state to seek assistance from the private sector and international donors to accomplish all the goals set out in the proposed legislation"

In [...] sub-Saharan Africa, there have been some victories in the battle against the disease. Many point to Uganda and Senegal among a handful of countries that have made progress.

But activists and international AIDS organizations continue to criticize many governments for failing to devote the needed time and energy to preventing their populations from contracting HIV and treating those infected with the disease. [...]

Some African leaders are beginning to get the message. At the recent UNAIDS High-Level Meeting in New York, several presidents pledged to move more aggressively to fight the disease in their countries.

The article mentions President Faure Gnassingbé of Togo as an example of a concerned leader.  In contrast, it notes that in Zimbabwe "a long-running political feud between President Robert Mugabe and the opposition has been a barrier to better care for those suffering with HIV and AIDS."