"Responding to the Challenge of STIs and AIDS"

"It is bad enough that people are dying of AIDS, but no one should die of ignorance"- Elizabeth Taylor –American Actress

According to the latest figures published on November 21st 2006, by UNAIDS/WHO AIDS Epidemic Update, an estimated 39.5 million people are living with HIV. There were 4.3 million new infections in 2006 with 2.8 million (65%) of these occurring in sub-Saharan Africa and important increases in Eastern Europe, and Central Asia, where there are some indications that infection rates have risen by 50% since 2004. In 2006, 2.9 million people died of AIDS-related illnesses.

An estimated 8.6 million (6.0 million-13.0 million) people were living with HIV in Asia in 2006, including 960,000 (640,000- 2.5 million) who became newly infected in the past year. Approximately 630,000 (430,000- 900,000) died from AIDS-related illnesses in 2006. The number of people receiving antiretroviral therapy has increased more than threefold since 2003, and reached an estimated 235,000 (180,000- 290,000) by June 2006. This represents about 16% of the total number of people in need of antiretroviral treatment in Asia, according to the UNAIDS/WHO AIDS Epidemic Update December 2006.Only Thailand has succeeded in providing treatment to at least to 50% of people needing it according to UNAIDS/WHO 2006.

"Poverty and war are the biggest factors for HIV/AIDS in the developing countries. If a country is poorer or facing a war situation, it is inevitable that HIV/AIDS spread faster in this country than other countries. Poverty and war lead the developing countries to be more vulnerable" says Dr. Veerakathy Harindra FRCP, FRCP (Glasg) Clinical Director, Department of Genito Urinary Medicine, St. Mary's Hospital, Portsmouth, United Kingdom.

He delivered speeches on "Responding to the Challenge of STIs and AIDS", and "Advances in HIV prevention" at the annual scientific session of the College of Venerologists of Sri Lanka in October 2006.

The following are the excerpts of an interview with Dr. Veerakathy Harindra FRCP, FRCP (Glasg) Clinical Director, Department of Genito Urinary Medicine, St. Mary's Hospital, Portsmouth, United Kingdom:

Q: How do you compare the HIV/AIDS situation now with twenty five years ago?

A: Twenty five years into the global HIV/AIDS epidemic HIV infection rates are alarmingly high. The rate of new HIV infections continues to climb every year, with an estimated 4.9 million people having been infected during 2004. There is no "magic bullet" for HIV prevention. None of the new prevention methods currently being tested is likely to be 100% effective and all will need to be used in combination with existing approaches. Greater access to existing HIV prevention tools could avert half of the new infections projected to occur over the next decade.

A wide range of HIV prevention approaches are available. Behaviour therapy, condom use, voluntary HIV testing and treatment of sexually transmitted infections are proven methods of HIV prevention. A number of promising HIV prevention approaches are in late stage clinical trials.

Male circumcision:
Countries with higher rates of male circumcision have lower rates of HIV infection. The first randomised trial in South Africa showed that circumcised men were 60% less likely to become infected with HIV compared to uncircumcised men. Removal of HIV target cells from the foreskin, keratinisation of skin surface and reduction of STIs are the key factors associated with this reduction. Further 3 trials are on going in Kenya and Uganda.

Microbicides:
Microbicide is a chemical product applied in the vagina to prevent HIV. Anal application is also been studied. Currently five first generation vaginal microbicide candidates are in late stage clinical trials. They act as a physical barrier, maintain vagina flora, and prevent STIs (Sexually Transmitted Infection). In addition a number of second generation microbicide candidates including Tenofovir containing microbicide are in earlier stages of research.

Cervical barrier:
cervical barriers such as diaphragms may help protect women from HIV and others STIs Sexually Transmitted Infection). An efficacy trail of the diaphragm for HIV prevention is nearing completion in south Africa and Zimbabwe.

Herpes suppression:
Genital herpes simplex infection increases the risk of HIV acquisition as well as risk of transmission to others significantly. Trials are being conducted in Africa and the US to test the efficacy of suppression of herpes with acyclovir to lower HIV risk.

Pre-exposure prophylaxis with antiretrovirals: Efficacy trials in the use of Tenofovir and Truvada are being conducted in Botswana, Thailand and Peru. This approach has being successfully used in the prevention of mother to child transmission of HIV. A significant disadvantage to this approach could be the development of drug resistance.

HIV Vaccine:
The aim of the vaccine is to induce either neutralising antibody or T cell response or both. But for more than 25 years scientists have struggled to develop an HIV vaccine. Genetic diversity of HIV, infecting cells of the immune system, spreading from cell to cell and integration of the viral genome have been the key stumbling block in the development of a effective HIV vaccine. Currently 30 HIV vaccine candidates are in clinical trials.

These promising new HIV prevention approaches have the potential to dramatically reduce the burden of HIV/AIDS around the world. Women account for more than half the HIV population globally. They often do not have the social or economic power to refuse sex. Many of these new development provide women with HIV prevention methods that they could initiate.

Q: Why women are more vulnerable than men?

A: Women are biologically vulnerable to HIV than men. Women are increasingly at risk of HIV globally. 10%-20% of the virus is transmitted from person to person. Women are powerless in the developing countries due to socio economic status of their families.

About 40 million people in the world are infected with the Human Immunodeficiency Virus (HIV).More than 16,000 new infections occur,

Approximately 24 million people have died from Acquired ImmunoDeficiency Syndrome (AIDS). About 90% are due to sexual contact, highlighting the need for prevention of HIV transmission.

A recent study conducted by the London school of Hygiene & tropical Medicine estimated that a microbicide that reduced the risk of infection by 40% & that was used by 30% of women at risk in low-income countries – would avert more than 2 million HIV infections a year & save $ 1-billion annually in health care cost.

"Empowering women to protect themselves seems so elemental, and yet when I hear people pontificating against AIDS and acting as if we can do everything through abstinence, I think they don't know what most women are up against in too many parts of the world today." - Bill Clinton, Former President of United States of America, and the head of Clinton Foundation, which provide technical and financial assistance to developing countries to stop the spread of HIV/AIDS around the world.

Q: What more should be done in the developing countries to prevent HIV/AIDS?

A: The developing countries need to have a better infrastructure for heath care. HIV/AIDS is the biggest problem in Africa and India. HIV/AIDS is a growing problem in China .

The majority of the doctors in Thailand, and in India are being trained in HIV/AIDS. They have better knowledge about HIV/AIDS compared to twenty five years ago. People Living With HIV/AIDS (PLWHAs) are treated with love and care in Thailand.

The doctors in Sri Lanka are also undergoing training on HIV/AIDS. Awareness on HIV/AIDS is being created among the various sections of the society in Sri Lanka. It's a positive start to make towards the prevention of HIV/AIDS in Sri Lanka.