ctvnews.ca

Thein Aung has been trained not to show weakness, but he’s convinced no soldier is strong enough for this.

He clenches his jaw and pauses, trying to will his chin to stop quivering and his eyes not to blink. But he’s like a mountain that is crumbling. His shoulders shake, then collapse inward, and he suddenly seems small in the denim Wrangler shirt that’s rolled up to his elbows and hanging loosely off his skinny arms. Big tears drip from his reddened eyes, and he looks away, ashamed.

As he sits outside a crowded clinic on the outskirts of Myanmar’s biggest city, he knows his body is struggling to fight HIV, tuberculosis and diabetes – but he can’t help wishing he was sicker.

Although Aung is ill enough to qualify for HIV treatment in other poor countries, there’s simply not enough pills to go around in Myanmar. Only the sickest of the sick are lucky enough to go home with a supply of lifesaving medicine here. The others soon learn their fate is ultimately decided by the number of infection-fighting cells found inside the blood samples they give every three months.

The World Health Organization recommends treatment start when this all-important CD4 count drops to 350.

In Myanmar, it must fall below 150.

—-

Antiretroviral therapy, in the past considered a miracle only available to HIV patients in the West, is no longer scarce in many of the poorest parts of the world. Pills are cheaper and easier to access, and HIV is not the same killer that once left thousands of orphaned children in sub-Saharan Africa.

But Myanmar, otherwise known as Burma, remains a special case. Kept in the dark for so many decades by its reclusive ruling junta, this country of 60 million did not reap the same international aid as other needy nations. Heavy economic sanctions levied by countries such as the United States, along with virtually nonexistent government health funding, left an empty hole for medicine and services. Today, Myanmar ranks among the world’s hardest places to get HIV care, and health experts warn it will take years to prop up a broken health system hobbled by decades of neglect.

“Burma is like the work that I did in Africa in the’90s. It’s 15, 20 years out of date,” says Dr. Chris Beyrer, an HIV expert at Johns Hopkins University who has worked in Myanmar for years. “If you actually tried to treat AIDS, you’d have to say that everybody with every other condition is going to die unless there are more resources.”

Of the estimated 240,000 people living with HIV, half are going without treatment. And some 18,000 people die from the disease every year, according to UNAIDS.

The problem worsened last year after the Global Fund to Fight AIDS, Tuberculosis and Malaria canceled a round of funding due to a lack of international donations. The money was expected to provide HIV drugs for 46,500 people.

But as Myanmar wows the world with its reforms, the U.S. and other nations are easing sanctions. The Global Fund recently urged Myanmar to apply for more assistance that would make up the shortfall and open the door for HIV drugs to reach more than 75 percent of those in need by the end of 2015. It would also fight tuberculosis, a major killer of HIV patients. TB in Myanmar is at nearly triple the global rate as multi-drug resistant forms of the disease surge.

The aid group Doctors Without Borders has tried to take up the slack by providing more than half the HIV drugs being distributed. But every day, physicians at its 23 clinics must make agonizing decisions to turn away patients like Aung, who are desperately ill but still do not qualify for medicine because their CD4 counts are too high.

“It’s very difficult to see those kind of situations,” says Kyaw Naing Htun, a young doctor with a K-pop hairstyle and seemingly endless energy, who manages the organization’s busy clinic in Insein. He says about 100 patients who should be on drugs are turned away every month in Yangon alone. “It takes a lot more resources when they come back sicker. It’s a lose-lose game.”

—-

Aung first learned about the virus living inside him in April. He had dropped weight and wasn’t sleeping well, but figured it was the TB and diabetes running him down.

When the test came back positive for HIV, he was shocked and scared: How? Why?

“I wanted to commit suicide when I found out the results,” he says softly, looking away. “What upset me most was my wife. She says I shouldn’t die now because we have children.”

The questions swarmed and consumed him, followed by a flood of worry and guilt that he had possibly infected his spouse. Then the bigger concern: What’s next?

Unlike many living in a country closed off to the world for the past half century of military rule, Aung, an Army staff sergeant, had some firsthand knowledge about HIV.

He had watched the disease rot one soldier from the inside out, punishing him with a cruel death. But he also saw another get on treatment and live a normal life, despite the military kicking him out.

With the images of those two men locked in his head, Aung decided to fight to save himself and ultimately his family. No one but his wife could know, or he would lose his job and their home on the military base because of the deep fear and discrimination surrounding the disease. Drugs were his only chance to keep the secret.

“If I get the medicine, and I can stay in this life longer, I will serve the country more and my family will not be broken,” he says. “My family is invaluable.”

At the clinic in Insein, an area of Yangon better known for a notorious prison, Aung, who is using another name to protect his identity, waited nervously for the results of his first blood test.

CD4 count: 460. Low enough for drugs in the U.S., but well above the 150 cutoff in Myanmar. He was given TB meds and told to come back in three months.

—-

Many of the 200 people crammed into the two small buildings of an HIV center just outside Yangon are simply waiting to die.

Beloved opposition leader Aung San Suu Kyi visited patients there in November 2010, just days after being freed from house arrest, appealing to the world for more medicine. She also spoke passionately in July about the stigma of HIV via a video link to the International AIDS conference in Washington, saying, “Our people need to understand what HIV really is. We need to understand this is not something that we need to be afraid of.”

There are no doctors or nurses stationed at the hospice supported by Suu Kyi’s National League for Democracy party, forcing patients to care for each other. One man hangs a drip bag on a plastic string from the ceiling over an emaciated body. Other caregivers – many of whom are also infected – wave paper fans beside their loved ones for hours, providing the only relief they can offer.

Infected children whose parents have already passed away play barefoot in the stuffy, crowded rooms. Bodies, some nothing more than breathing corpses, are stacked side by side on bamboo slats above dirt floors.

Another room is packed with 20 women stretched out on straw mats crisscrossing the wooden floor. A young mother sobs in one corner as she breast-feeds a 7-day-old baby girl. She did not take HIV drugs until late in her pregnancy, and now must wait up to 18 months to know for sure whether her only child is infected.

“The funding is limited for the enormous number of patients,” says newly elected parliament member Phyu Phyu Thin, who founded the center in 2002 and was jailed by the former government for her HIV work. “Waiting to get the medicine under the limits is too risky for many patients because they can only get it when their health is deteriorating.”

—-

Aung looks the part of a soldier with his shaved head and wiry build. He spent the first decade of his 27 years in the military fighting in domestic ethnic wars, away from his wife and two children.

It’s this past life that devours him each night when sleep refuses to come. He served as a medic then, and regularly came into contact with the blood of wounded soldiers. He also had sex with other women. The question that haunts him most is, which one is to blame? He’ll never know.

He takes sleeping pills every night to be released from these thoughts. But relief does not come, as chills and night sweats drench his body and the constant urge to urinate keeps him running to the toilet.

He’s lost 10 pounds in the past month, dropping from 130 pounds to 120. His cheeks are starting to sink, and his eyes look hollow. His strength is also fading, and he can no longer lead grueling daily runs with the trainees. He uses his TB as an excuse, but he fears his superiors will not be fooled much longer.

“I try to hide it as much as I can, but some people have started rumors about me, so I try not to face them directly,” he says. “I want to be strong like the other people. I’m trying, but now my body cannot follow my mind.”

His wife refuses to be tested until Aung gets on the drugs. She worries if she comes back positive, her guilt-ravaged husband will kill himself.

“She doesn’t want me to be depressed,” he says. “If she is positive, I will be very, very depressed.”

The disease has forced him to rethink who he is. He’s killed people in combat, cheated on his wife and witnessed many horrors in his lifetime. But he wants a chance to make up for his wrongs.

As a Buddhist, he believes his disease is a punishment for misdeeds in a previous life. He vows to be a better man by helping others and giving what little he has to charity.

He says sicker patients deserve treatment first. Still, as he sits waiting for his second blood test, he can’t help wishing his immune system was weak enough to help him reach the magic number.

But when the doctor reads his results, he knows he will leave empty-handed again.

CD4 count: 289. Still too high.

His only choice is to try again in three months, hoping he’ll be sick enough then.

Times Republican
They were the headline-grabbing diseases of several years ago that don’t seem to get talked about much these days.

The diseases, HIV and AIDS, have seemingly been put on the back burner, but cases continue to be added in Iowa.

Statewide there are nearly 200 new diagnoses of HIV/AIDS each year and males account for 84 percent of the new diagnoses, according to the Iowa Department of Public Health. The total number of Iowans reported to be living with HIV/AIDS was 1,828 as of Dec. 31, 2010.

In Marshall County, there were 26 people living with HIV/AIDS at the end of 2010, according to a report by the IDPH. That rate equates to 64 per 100,000 people, which is slightly above the state average of 60 per 100,000 people.

Both Tama and Grundy counties have less than four cases. Any number less than that is not revealed to protect the identity of those who have the disease. Hardin County had six reported people living with HIV/AIDS at the end of 2010.

Randy Mayer, chief of the Bureau of HIV, STD and Hepatitis with the Iowa Department of Public Health, said the disease has become more manageable medically, which has kept it out of the headlines.

“We know a lot more about it and have treatment to manage it,” Mayer said.

The challenge for health leaders are those cases which do not get tested and go unreported. Mayer could not estimate how many people in Iowa have HIV/AIDS and are not reported in the IDPH numbers.

“That’s something that we really can’t measure,” Mayer said. “The estimates nationally are about 21 percent of people who are positive have not been diagnosed.”

As a result of the disease being more manageable, deaths have decreased through the years statewide as five people died as a result of HIV/AIDS in 2010. The peak year for Iowa deaths of the last 12 years was in 2000, when 28 people died from the disease in the state.

Ghana is on the verge of manufacturing anti-retroviral drugs for the treatment of HIV/AIDS locally. This is because three traditional herbal medicines submitted to Noguchi Memorial Institute for Medical Research, are beginning to show results of efficacy for the treatment of HIV/AIDS, a source close to the health sector has told the Times.

The three drugs were among 20 others submitted to the Institute by local plant medicine producers, to determine their efficacy against the AIDS virus.
A clinical test of the products is currently test of the products is currently ongoing to determine their antioxidant and other toxicological properties.

“When successful, it will be Ghana’s response to managing the HIV/AIDS pandemic,” the source said.

The drugs, according to the source, had the potential of reducing the viral loads in HIV-positive patients and could be best used as anti-retroviral therapy (ART).

The National AIDS and STI Prevention and Control Programme (NACP) bulletin of 2011, indicated that an estimated 267,069 people were living with HIV and AIDS in the country, but only about 40,575 people were receiving anti-retroviral therapy.

The source was confident that with the new development, the country stood the chance to make up for the shortfall of anti-retroviral drugs needed to treat HIV/AIDS and better the physical well-being of people living with AIDS.

Explaining issues further, the source said the positive results being shown by the herbal medicines were the results of attention being given to traditional herbal medicine practice by successive government since 1991.

It said presently, the Mampong Centre for Scientific Research into Herbal Medicines had approved 34 of scientifically evaluated herbal medicines, while the Food and Drugs Board (FDB), had also approved about 300 of similar products.

“Though some of the medicines have been approved by the various regulatory bodies, they are still under continuous evaluation to forestall any sub-standard and fake products on the market.”

The source said the Ministry of Health, through the Ghana Health Services had selected 86 of such products to be dispensed in 17 hospitals across the country.

“The measure is aimed at integrating traditional herbal medicine as part of the health service delivery system in the country.”

It said well-performing products, would be patented as a means of safeguarding the intellectual property of the sector.

Meanwhile, the Noguchi memorial Institute for Medical Research, has confirmed in its 30th Anniversary Journal that systematic research on Ghanaian medical plants has indentified six anti-HIV plants’.

Scientist at the Institute have been researching into Ghanaian traditional medicine comprising largely plant medicines.

The Institute which works closely with the Traditional and Alternative Medicine Directorate at the Ministry of Health has also been working constantly with a number of local plant medicine producers to train them on quality measures to improve their products.

Source: Ghanaian Times

Timesofindia.com

About 750 HIV patients requiring advanced treatment in the state are forced to go without life-saving second-line anti-retroviral therapy (ART) drugs which are in short supply.

Hospitals, which are supposed to hand them out free, say they don’t have adequate stocks of these medicines. Officials of the National AIDS Control Organization (NACO), the country’s nodal agency for prevention and control of HIV/AIDS, said the sudden increase in the number of patients receiving second-line of treatment has caused the countrywide shortage of these drugs. Healthcare experts and NGOs fear this would increase the number of patients dropping out of the drug regimen, causing more cases of drug resistance.

ART is a combination of highly advanced drugs meant to fight HIV infection and increase life expectancy of HIV-AIDS patients. If the first-line of treatment is not adequate to bring down the viral load, patients are given the second-line of drugs. Both these regimens are provided free of cost by NACO.

Patients advised to take higher dosage of pediatric drugs

In Tamil Nadu, only two ART centres provide second line of drugs. They are located in Tambaram in Chennai and in Salem city. At least 150 patients from Salem, Krishnagiri, Erode, Namakkal, Karur, Ooty and Coimbatore visit the Salem centre to collect a month’s dosage.

For the past one month, patients have been asked to take higher dosage of pediatric drugs or purchase them from the retail market. Second-line ART regimen consists of tenofovir, lamivudin, atazanavir and ritonovir. But ART centre managers say that the NACO has not supplied them with ritonovir. Krishnagiri-based G Karunanidhi, member of Tamilnadu Networking People with HIV/AIDS, is among those prescribed the second line ART medicine. He visits the ART centre every month to collect his monthly quota of drugs.

On July 18, the centre gave him medicines for only four days though his usual dosage is for a month. “They asked me to come back to Salem after four days to collect the remaining drugs. I went back on July 25 and I was told they had not received the stock,” he said. P Nagaraj of Salem Network of PLWHA wasn’t as lucky. He was asked to take the pediatric ART drugs. “They told me that I could take double the child’s dose.

I avoided it as I feared side effects,” he said. Experts say the drugs may not produce the desired effect unless they are taken at the right time and dosage. Dr Sentha Krishnan, who is in charge of Salem ART centre, said there were no stocks of ritonovir tablets. “We have not received supply of the drugs from NACO since mid-July. We ask patients to take a combination of lopinavir-ritonovir tablets. It has no side effects.

NACO has told us the stocks will be replenished in a few days,” she said. NACO’s regional co-ordinator SThennarasu said the situation was the same all over the country. NACO’s national programme officer (ART) BB Rewari confirmed that the number of persons taking second line ART has increased. “We have added five more centres to give the second line of ART drugs. We are doing our best to give everyone the medicines. Instead of buying from international companies, we are now planning to go in for local pharmaceutical companies,” he said.

Thenews.com

PARIS: Heterosexuals who take daily AIDS drugs reduce the risk of being infected by the human immunodeficiency virus (HIV) by nearly two-thirds, ground-breaking studies said on Wednesday.

Campaigners hailed what they described as a powerful new weapon in the three-decade war against AIDS.

“This is a major scientific breakthrough which reconfirms the essential role that antiretroviral medicine has to play in the AIDS response,” Michel Sidibe, executive director of the UN agency UNAIDS said.

“These studies could help us to reach the tipping point in the HIV epidemic.”

A trial called Partners PrEP, conducted by the University of Washington, followed 4,758 “sero-discordant” heterosexual couples — in which one person had HIV and the other was uninfected — in Kenya and Uganda.

The uninfected partner received either a dummy pill or a tablet containing either the HIV drug tenofovir or a combination of tenofovir and emtricitabine.

In the group receiving tenofovir, there were 62 percent fewer infections compared with the placebo group.

In the tenofovir/emtricitabine group, there were 73 percent fewer infections over counterparts taking the placebo.

The results were so remarkable that safety monitors recommended the probe be stopped early, for to continue it would have been unethical.

The second trial, conducted by the US Centers for Disease Control and Prevention (CDC), followed 1,219 uninfected men and women in Botswana who received either placebo or the tenofovir/emtricitabine combination.

Those who received the antiretroviral pill reduced the risk of HIV infection by 63 percent compared with the placebo group.

They are the first trials to show that so-called pre-exposure prophylaxis, or PrEP, can work among heterosexuals.

Last November a study, conducted among sero-discordant homosexual men, found a reduction of 44 percent in risk among uninfected partners who took HIV drugs.

In contrast, a smaller-scale trial, whose preliminary results were published earlier this year, found that PrEP did not protect heterosexual women.

In May, a big study conducted among sero-discordant heterosexual couples in Africa showed early use of drugs by the infected partner slashed the risk of transmitting HIV to the other partner by 96 percent.

Put together, these trials add massively to the argument that the world’s AIDS pandemic can be slowed by wider distribution of antiretrovirals, said activists.

“These results are tremendously exciting and confirm that we are at pivotal period,” said Mitchell Warren, executive director of US advocacy group AVAC.

“Now is the time to include ARV-based prevention in national plans, applications to the Global Fund to Fight AIDS, Tuberculosis and Malaria and donor priorities.

“(…) We need ambitious pilot and demonstration projects to guide programmatic design, along with national and international guidance on how best to use ARVs (antiretrovirals) as lifesaving prevention tools,” he said.

The International AIDS Society, which is hosting a major conference in Rome from Sunday, said data from the two trials was “compelling” and “adds to the cascade of evidence.”

But it also highlighted the looming debate about using drugs designed for treatment in the role of prevention.

Antiretrovirals are the famous “cocktail” of drugs, first introduced in 1996, that helped turn the tide against AIDS.

They suppress HIV in the body but do not eradicate it completely.

As a result, they reduce the risk of infection through contact with body fluids, although they are not a cure and taking them can carry inflict toxic side effects.

In addition, there is a potentially hefty financial cost if the pills are taken daily for prevention, although the price has fallen to as little as 25 US cents per tablet.

The “treatment as prevention” strategy has risen alongside male circumcision as new options in the global HIV/AIDS pandemic, which has claimed around 30 million lives over the past three decades.

More than 33 million people are living with the AIDS virus, according to estimates for 2009 released last year by UNAIDS. (AFP)