Kaiser Daily HIV/AIDS Report-Mon, 27 Aug 2001
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*'Joint Ownership' Patent Agreement Reached for African HIV Vaccine
*Most HIV-Positive Ugandan Mothers Prefer to Breastfeed Than Use
Formula
*Annan to Meet with Major Drug Company Executives to 'Assess
Progress' on Cheaper AIDS Drug Offers
*Nigeria and South Africa Launch Toll-Free AIDS Hotlines
*'Joint Ownership' Patent Agreement Reached for African HIV Vaccine
*South African Anti-HIV/AIDS Campaign 'Misguided,' Should Model
Uganda's Broad Focus on Changing Behaviors, Op-Ed Says
*Male Circumcision 'Ideal' Preventive Measure?
Global Challenges
'Joint Ownership' Patent Agreement Reached for African HIV Vaccine
The University of Nairobi, the International AIDS Vaccine Initiative
and Great Britain's Medical Research Council signed a three-year
agreement last week giving all three "joint ownership" over the pat-
ent of an HIV/AIDS vaccine "specifically designed for an African
strain of the disease," the AP/South Florida Sun-Sentinel reports.
The agreement removes "one of the hurdles" to testing the vaccine, as
Kenyan trials started "several months later than expected, partly be-
cause of wrangling over ownership and patent rights." The three or-
ganizations began work on a "double vaccine" in 1998, "basing much of
their research" on Nairobi prostitutes who "appear to be immune" to
HIV. One part of the "simple DNA vaccine ... delivers the genetic in-
formation on HIV," while the second, "known as MVA, is a vaccine that
delivers the same genetic information but uses a weakened smallpox
virus to carry it to the cells."
Testing Progress
According to Gilbert Carnathan, project manager at IAVI, which is
funding the research, the DNA vaccine is in its first phase of human
testing in both Kenyans and Britons. He said that tests of the MVA
vaccine are now underway in England and will begin in Kenya in Sep-
tember or October, adding that trials combining the components are
expected to begin later this year in Britain and in Kenya early next
year. "[S]afety tests" will be conducted on the vaccines to determine
if they have any toxic effects. As soon as the combined vaccine "has
proven safe," it will be used to see "if it actually wards off AIDS."
Seth Berkley, president of the vaccine initiative, said that tests so
far have "not only been safe, but also generated surprisingly good
immune results." Carnathan said that Berkley will sign an agreement
tomorrow with the Uganda Vaccine Research Institute to allow for
testing of an oral version of the double vaccine there (England,
AP/South Florida Sun-Sentinel, 8/24).
Most HIV-Positive Ugandan Mothers Prefer to Breast feed Than Use For-
mula
Most HIV-positive Ugandan mothers would rather breast feed their in-
fants than use free infant formula, "despite knowing the ris[k]" of
HIV transmission through breast feeding, according to an article pub-
lished in the Aug. 25 issue of the Lancet. Francis Mmiro, chair of
the technical committee for the prevention of vertical HIV transmis-
sion in Uganda, said that 61% of the HIV-positive mothers who at-
tended antenatal clinics at the National Referral Hospital in Uganda
"opted for breast feeding," even though doctors have told the women
that HIV can be transmitted through breast feeding. Saul Onyango, the
medical officer in charge of prevention of vertical transmission in
the country, added that in some parts of Uganda, up to 80% of HIV-
positive women choose to breast feed. Onyango said that the women's
decision to breast feed is "understandable" because many women in the
country lack the necessary supplies to prepare infant formula. Milly
Katana, a member of the National Guidance and Empowerment Network for
People Living with HIV/AIDS, added that Ugandan women are "generally
expected" to breastfeed their infants and may fear the "social
stigma" that comes with choosing not to do so. Katana added that some
women "hope" that they will not pass HIV to their children through
breast feeding. Mmiro said that HIV-positive women who choose to
breast feed are advised by physicians to do so for three to six months
and then alternate between formula and breast feeding (Wendo, Lancet,
8/25).
Drug Access
Annan to Meet with Major Drug Company Executives to 'Assess Progress'
on Cheaper AIDS Drug Offers
U.N. Secretary-General Kofi Annan said on Friday that he will meet
this fall with leaders from the six largest pharmaceutical firms to
"assess progress on their pledge" to offer antiretroviral drugs at
lower prices to the world's poorest countries, Agence France-Presse
reports. Annan told AFP, "We met in April and that's when we agreed"
to make the drugs available to citizens in the least developed na-
tions. He added, "I will be seeing them again in October ... and then
we will review where we are. The process has begun already." Annan's
remarks come amid a "heated battle" between governments of developing
countries and drug giants over pricing and distribution of AIDS
drugs. On Thursday, Brazil announced that it would begin to manufac-
ture a generic version of Roche's Viracept after halting price nego-
tiations with the drug maker (Agence France-Presse, 8/24).
Media & Society
Nigeria and South Africa Launch Toll-Free AIDS Hotlines
South Africa and Nigeria have launched toll-free hotlines aimed at
giving callers "the latest and most accurate information" on
HIV/AIDS, Reuters Health reports. Nigeria launched its hotline on
Tuesday, while South Africa's hotline, launched on July 30, is an up-
dated version of the nation's existing AIDS Helpline. South Africa's
24-hour hotline, which maintains a 68-member staff speaking 11 lan-
guages, has the capacity to field up to 200,000 calls per month but
currently receives only about 20,000 calls each month. AIDS Helpline
Manager Pamilla Mudhray said that approximately 84% of the hotline
calls are placed by individuals ages 15 to 29, with 60% of the calls
coming from males. Most callers ask about methods of HIV transmis-
sion, how to use condoms and where to obtain HIV testing. Iwalola
Akin-Jimoh, executive secretary of the Nigerian hotline, said that
most callers to Nigeria's phone line are older than 24, although the
hotline "targets younger adults." South Africa's phone line was de-
veloped by the South African government, the Johns Hopkins University
Center for Communication Programs and the local NGO LifeLine. Nige-
ria's hotline was created by the Lagos State HIV/AIDS Foundation,
JHU/CCP and the local Youth Empowerment Foundation (Reuters Health,
8/22).
OPINION
South African Anti-HIV/AIDS Campaign 'Misguided,' Should Model
Uganda's Broad Focus on Changing Behaviors, Op-Ed Says
A South African advertising campaign encouraging safe sex is ineffec-
tive because it is vague and focuses on the individual, and should be
replaced with direct and more society-based messages similar to those
utilized in Uganda, Daniel Halperin and Brian Williams write in a
Washington Post op-ed. Halperin, a faculty member at the University
of California-San Francisco's Center for AIDS Prevention Studies and
a visiting scientist at South Africa's Medical Research Council, and
Williams, a South African public health researcher currently working
for the World Health Organization, write that two years ago, South
Africa's "loveLife" public education initiative was launched with
about $100 million in funding mainly from the Kaiser Family Founda-
tion, the Bill and Melinda Gates Foundation and the South African
government. While the campaign's creators defend it as promoting
"frank communication" and the "ability to make better choices" among
young people, Halperin and William state that the campaign's messages
are "confusingly vague" and "misguided" -- and that many South Afri-
cans are "outraged by the misallocation of precious public and pri-
vate resources, especially when many community-based organizations
are struggling to survive." The authors interviewed "several hundred"
young people throughout South Africa, and found that while most were
"obviously ... concerned, even obsessed" about the AIDS pandemic,
"few ... showed any clear interest" in the loveLife initiative. One
ad, for instance, which bears the words, "Score" and "Red Card" with
check-off boxes next to them, elicited much talk about soccer rules
before its intended reference to the dangers of obtaining HIV through
unprotected sex was noticed. Williams and Halperin add that even
though condoms "offer the best protection against" HIV and "most of
loveLife's target population are not using condoms," loveLife's media
campaign does not "explicitly mentio[n]" condoms.
The Ugandan Model
On the other hand, Uganda has employed a successful anti-HIV/AIDS
campaign based on a "much broader" initiative that "emphasis[zes] a
radical shift in community norms of sexual behavior, in contrast to
loveLife's focus on changing individuals' decision-making capabili-
ties," Williams and Halperin write. They state that Uganda has used
strategies to encourage people to "delay sex," limit their number of
sexual partners and increase condom use through a "broad mobilization
of civic, religious and other grass-roots communities, combined with
clear and committed political leadership aimed at changing fundamen-
tal patterns of sexual behavior." The success in Uganda, where the
rate of pregnant women with HIV decreased from 21% in 1991 to less
than 10% in 1998, demonstrates that "prevention policies can work,"
Halperin and William write.
Male Circumcision 'Ideal' Preventive Measure?
Halperin and Williams state that other "under-explored, potentially
effective" HIV prevention techniques are "emerging," and one of the
"more promising" is the promotion of male circumcision. More than 35
studies in the past two decades "have found that removal of the un-
usually vulnerable foreskin tissue reduces the risk of heterosexual
HIV infection -- the most common form of transmission in Africa -- by
a half or more." According to an estimate published in the Lancet
last year, the procedure could have prevented eight million adult HIV
infections in 15 African and Asian countries. Once abandoned by many
African cultures, circumcision is gaining renewed interest on the
continent, the authors write, more so for the belief that it is
"cleaner" and enhances sex than for any HIV-prevention purposes. Male
circumcision, "performed under clinical conditions," could "turn out
be an ideal intervention," as it is a "onetime procedure for perma-
nently reducing HIV/STD risk" and also is thought to make condom use
easier. Noting that "billions of dollars" will flow into Africa in
the coming years through the U.N.'s Global AIDS and Health Fund,
Halperin and Williams write that "it is worth thinking hard about
just how such sums will be spent" (Halperin/Williams, Washington
Post, 8/26).
The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org,
a free service of The Henry J. Kaiser Family Foundation, by National
Journal Group Inc. , 2001 by National Journal Group Inc. and Kaiser
Family Foundation. All rights reserved.
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