Roundup: Science Based Approach to HIV/AIDS Returns to South Africa

Brady Swenson

Science-based approach to HIV prevention returns to South Africa; Indian authors tell real stories of HIV epidemic in India; New cream could help women quietly protect themselves against HIV; Catholic university orders NPR station to stop accepting underwriting from Planned Parenthood; A mother's final look at life.

Science Based Approach to HIV/AIDS Returns to South Africa

South Africa’s new Health Minister, Barbara Hogan, said on Monday at the International AIDS Vaccine Conference 2008 in Cape Town that Thabo Mbeki’s
government wasted time in fighting HIV/AIDS and vowed to step up
efforts after years of controversy
when her predecessor advocated
beetroot and garlic as treatment.  South Africa, which has one of the world’s heaviest HIV caseloads,
has been accused by activists of dragging its feet in dealing with the
disease which kills an estimated 1,000 people every day.  No longer: 

At the opening of the International AIDS Vaccine Conference 2008 in
Cape Town the new Minister of Health, Barbara Hogan, repeatedly
stressed the importance of scientific, "evidence-based responses" to
stop HIV.

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Hogan said to the South African government and people about the
vaccine conference: "There can’t be any other more important meeting at
this time."

Vice-Chancellor of the University of KwaZulu-Natal,
Professor Malegapuru Makgoba, won applause from the delegates when he
welcomed the new attitude to HIV science by the ministers.

"We (can say) confidently that HIV causes Aids without threats. It is liberating."

In striking contrast to the previous health minister,
Hogan acknowledged that South Africa had "lost ground" to the epidemic
and that Aids was killing young South Africans.

She said the government was committed "to scale-up
mother-to-child prevention programmes" and stated that HIV and TB were
the primary health challenges in South Africa.

"We know that HIV causes AIDS," said Hogan, a point that former president Thabo Mbeki publicly contested.

"… It was imperative to get ahead of the curve of this epidemic
ten years ago. We all, for various reasons, have lost ground. We also wasted time despite having one of the best plans to cope
with the epidemic," Hogan said, adding South Africa must now show more
urgency in implementing a national program launched last year to
fight HIV/AIDS.

Mbeki drew sharp criticism shortly after coming to power in 1999
when he questioned accepted AIDS science and failed to make
life-prolonging anti-retroviral drugs (ARVs) widely available.
Tshabalala-Msimang has been lampooned by leading scientists and
activists for recommending garlic and beetroot as treatments.


Famous Indian Authors Tell Real Stories of HIV and Sex Worker Suffering

Time Magazine today reviewed a new book, AIDS Sutra: Untold Stories From India, in which acclaimed Indian authors, like Salman Rushdie, Siddhartha Deb and William Dalrymple, travel around the country and memorialize the accounts of those who suffer most from the HIV pandemic:

With its diversity of perspectives and voices, this collection provides
a uniquely intimate glimpse into a disease that is either sterilized by
statistics or ignored altogether. Each story reveals a government and
culture that, like so many other nations, still denies the HIV’s
impact. Yet even with its pages filled with so much injustice and pain,
the book also contains its fair share of triumphant moments. An
HIV-positive doctor who fought for his constitutional right to marry a
"negative" woman — and won; a group of HIV-positive children who found
a home when no one else would take them, a sex worker who braves police
corruption and abuse to spread condoms to her colleagues. As one women
explained: "I know I am HIV positive, but it is only a condition, not a
curse. I have the right to live a normal life."


Researchers Work on Cream that Can Stop HIV Transmission

Despite the long road microbicide research has traveled with little success hope remains that this method of defense against the spread of HIV will eventually arrive at success.  Dr. James Hildreth and his team at the Center for AIDS Health Disparities Research at Meharry Medical College are developing a cream that could potentially block the transmission of HIV during sex.  The cream is designed with women in mind, especially women in Africa who "have no way of protecting themselves from HIV transmission, as well as
black women in the United States who are disproportionately affected by
the disease." 

The vaginal cream, described as a "chemical condom," relies on a
sugar found in toothpaste and mouthwash to remove cholesterol the HIV
virus needs to spread. The cream is odorless and is designed to be
undetectable to a woman’s sexual partner.

"In many parts of the
world, women are not in the position to negotiate how sex is
practiced," including the use of condoms, Hildreth said. "We have been
trying to formulate something transparent to the act of having sex.
Women might be able to use it without getting permission or even
letting the men know they are using it."

Earlier this summer,
Hildreth traveled to Lusaka, Zambia, to see how women and men reacted
to the feel and the smell of the cream. About 1.1 million Zambians, 17
percent of the adult population, were living with HIV in 2005,
according to the United Nations.

Researchers expected men to reject the cream, but most accepted it.



Catholic University Forces NPR Station to Refuse Funding From Planned Parenthood

(Via Feministe) Former Catholic Duquense University student Michelle Pilicki writes at that her alma mater asked its NPR affiliate station WDUQ to "refuse underwriting from Planned Parenthood."  Planned Parenthood was running the following underwriter statements on the air at WDUQ:

Support for DUQ comes from Planned Parenthood, offering healthcare
services to men, including screenings for cancer and STDs. Planned
Parenthood: Their mission is prevention.

Support for DUQ comes from Planned Parenthood, providing comprehensive
sexuality education, including lessons on abstinence. Planned
Parenthood: Their mission is prevention.

Support for DUQ comes from Planned Parenthood, whose community
educators empower teens to make good choices by teaching self-esteem.
Planned Parenthood: Their mission is prevention.

Support for DUQ comes from Planned Parenthood, offering cancer
screenings for women and men. Planned Parenthood: Their mission is

Of course, Planned Parenthood’s main business is education, screening for potential disease and dispensing subsidized birth control.  Despite the fact that all of the underwriter statements were focused only on these generally accepted and certainly much needed social services the university asked the NPR affiliate to refuse money from the organization. 

Pilecki goes on to argue for the evidence-based middle ground where more and more common-sense people are meeting on this issue:

Even more to the point, undercutting the efforts of Planned Parenthood is more likely to increase, not decrease the demand for abortion. Serendipitously, today’s New York Times reported
on a worldwide study of abortion rates, quoting Dr. Paul Van Look,
director of the World Health Organization’s department of reproductive
health and research:

We now have a global picture of induced abortion in the
world, covering both countries where it is legal and countries where
laws are very restrictive. What we see is that the law does not
influence a woman’s decision to have an abortion. If there’s an
unplanned pregnancy, it does not matter if the law is restrictive or

The study, published in Lancet (you can read the 13-page pdf here),
says the data also suggest that the best way to reduce abortion rates
was not to make abortion illegal but to make contraception more widely
available. The highest rates of abortion are in countries that outlaw
abortion; not surprisingly, these are also the places with the highest
rates of maternal death from abortion complications. The lowest
abortion rates? In Western Europe, where abortion is not only legal,
but contraception is also available as part of citizens’ universal
health coverage.



A Mother’s Final Look at Life

In case you missed it, a special report in the Washington Post this past Sunday told the story of Fatmata Jollah who died at 18 while giving birth in Sierra Leone, which has the highest rate of maternal mortality in the world.  Fatmata’s story provides a human face to the startling numbers of maternal deaths:

More than 500,000 women a year — about one every minute — die in
childbirth across the globe, almost exclusively in the developing
world, and almost always from causes preventable with basic medical
care. The planet’s worst rates are in this startlingly poor nation on
West Africa’s Atlantic coast, where a decade of civil war that ended in
2002 deepened chronic deprivation.

According to the United Nations,
a woman’s chance of dying in childbirth in the United States is 1 in
4,800. In Ireland, which has the best rate in the world, it is 1 in
48,000. In Sierra Leone, it is 1 in 8.

Maternal mortality rarely gets attention from international donors,
who are far more focused on global health threats such as malaria,
tuberculosis and HIV-AIDS. "Maternal death is an almost invisible
death," said Thoraya A. Obaid, executive director of the U.N.
Population Fund.

Amie recently wrote a great post taking a close look at the maternal health crisis our world faces that includes some scientifically accepted ways to start to reduce that number and achieve the fifth Millennium Development Goal, to reduce maternal deaths, including improved access to family planning services, prenatal care and maternal education.  


News Sexual Health

People With HIV Will Soon Have Access to Life Insurance

Martha Kempner

Major insurance provider Prudential announced on World AIDS Day, December 1, that it would offer ten- and 15-year convertible term policies to HIV-positive people who meet certain health qualifications.

Those living with HIV will be able to purchase a standard life insurance policy for the first time. Prudential Financial, Inc. announced on World AIDS Day, December 1, that it would offer ten- and 15-year convertible term policies to HIV-positive people who meet certain health qualifications.

Insurance industry and public health officials see this as further evidence that HIV is now viewed as a manageable chronic illness.

People living with HIV can’t legally be excluded from their employer’s group life insurance policies, but such plans tend to have small payouts, such as one year of salary. Policies that pay more have been mostly unavailable to those who are HIV-positive. Some companies claimed to offer such policies if individuals could meet other strict health requirements, such as adherence to antiretroviral drug protocols and undetectable viral loads, but insurance agents said that even clients who met these standards often were rejected.

Life insurance policies help people provide for family members left behind, but this peace of mind is not the only thing individuals living with HIV are lacking by being denied such policies. People are required to have life insurance in order to adopt children or undertake certain business transactions.

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Bill Grant, co-founder of ÆQUALIS, a financial services company serving people living with HIV, explained to Kaiser Health News that he realized how limiting the lack of life insurance was when his HIV-positive brother could not finish a business deal they were trying to do together because he could not get the required life insurance.

Grant channeled his frustration into starting ÆQUALIS. The company was able to collect and analyze enough data to plot new mortality curves that convinced Prudential to offer ten- and 15-year term life insurance to those with HIV.

“There’s been just enough history to project long enough into the future to get started on this path,” Grant explained.

Many with HIV are leading long lives. A 2013 study found that a person in the United States or Canada diagnosed with HIV at 20 years old, who starts drug therapy right away, can be expected to live another 50 years. Mike McFarland, vice president of underwriting for Prudential Individual Life Insurance explained in a statement: “With advances in the successful treatment of people with HIV, we are now able to offer this population the opportunity to apply for life insurance—a milestone we see as a significant step in the right direction.”

The company has health requirements for people living with HIV, like it does for other populations. It is looking for people to be at least a year out from their HIV diagnosis and six months into a drug regimen. It will require certain blood cell counts, though those have not yet been reported. Anyone with an “AIDS-defining condition” will be disqualified, as will those who acquired the virus through a blood transfusion or intravenous drug use.

The company says such restrictions are similar to what they look for with other chronic diseases, such as heart disease.

This acknowledgement that HIV can be a manageable chronic illness is a big step for a disease that was once considered a death sentence, Scott Schoettes, HIV Project director at Lambda Legal, told Kaiser Health News.

“Finally, an insurance company has realized that this is the right thing to do and that it is profitable from a business perspective to offer this product to people living with HIV,” Schoettes said. “Now that there is one company out there doing this, it will encourage others to do the same when they see that there is money to be made in this market.”

News Sexual Health

Company Doesn’t Keep Promise to Lower Price of Drug Used By AIDS Patients

Martha Kempner

Pharmaceutical company Turing did not quite follow through on its promise of a "modest" price drop for a drug to treat an infection that can be life-threatening in those with HIV or AIDS. Competitors have decided to offer a $1 alternative.

Turing, a small pharmaceutical company, was caught in a swirl of negative publicity this fall when the New York Times announced that Turing had raised by almost 5,000 percent the price of an old drug used to treat an infection that can be life-threatening in those with HIV or AIDS or with otherwise compromised immune systems. The company’s founder and CEO promised at least a “modest” reduction in price, but did not quite follow through, announcing a discounting scheme instead.

Now, two companies in the pharmaceutical industry have declared that they will work together to provide an alternative drug for just $1 dollar a pill.

Turing spent $55 million dollars this summer for the right to produce and distribute Daraprim, a drug approved by the Food and Drug Administration (FDA) in 1952 to treat toxoplasmosis, as Rewire reported. This parasitic infection can come from eating undercooked meat or unwashed fruits and vegetables, or from cleaning out the litter box of an infected cat.

The parasite is common and most people never get symptoms, but it can be very dangerous to pregnant women and those with compromised immune systems, such as the elderly, infants, certain cancer patients, and people with HIV or AIDS.

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When Turing acquired Daraprim, it cost either $13.50 or $18 per pill (Turing’s CEO disputed reports that used the lower number). Regardless, the price hike—to $750 per pill—was alarming to patients and providers. A standard, two-week course of the medication went from costing $1,130 to $63,000. Some patients with compromised immune systems need to take Daraprim daily.

For them, the increase meant the drug would cost $634,500 per year.

Turing’s CEO, Martin Shkreli, defended the price increase, saying that his company needed to raise the price to continue making the drug and that it would funnel some profits into researching newer, better drugs to fight toxoplasmosis. But experts questioned why that was necessary as Daraprim still worked just fine.

In a late September interview, Shkreli said his company would lower the price of the drug but did not say by how much. He later said that the public could expect an announcement of modest decrease in price by the end of December.

What was ultimately announced, however, was somewhat different. Instead of lowering the list price, the company created a program to provide the pills to hospital at a 50 percent discount and promised to make smaller bottles so hospitals could afford to keep it in stock. Turing also promised to provide free sample starter packs to “ensure physicians treating patients in the community have free and immediate access to start therapy in emergency situations.”

The company vowed to participate in programs that make drugs more affordable to low-income people who benefit from Medicaid, the Section 340B program, and Patient Services, Inc. Turing said it would provide the drug free of charge to qualified patients with demonstrated income at or below 500 percent of the federal poverty level.

In its press release, the company tried to explain why it made these changes rather than a simple price reduction: “Drug pricing is one of the most complex parts of the healthcare industry. A drug’s list price is not the primary factor in determining patient affordability and access. A reduction in Daraprim’s list price would not translate into a benefit for patients.”

All of this, however, may become irrelevant because two companies have jumped in to provide an alternative. Drug maker Imprimis Pharmaceuticals has said it will create a compound of two drugs it already makes—pyrimethamine and leucovorin—that together can treat toxoplasmosis. Express Scripts, the largest pharmacy benefits management company in the country, has said that it will offer this compound to its patients for $1 per pill.

The companies have also announced an educational campaign to ensure that providers are aware of this low-cost alternative.

“We are pleased to partner with Express Scripts to take positive action to counterbalance companies like Turing and others in order to address the growing drug pricing crisis in America,” Mark Baum, the CEO of Imprimis, said in a statement.

In the meantime, Shkreli has been called to appear in front of Senate subcommittee on December 9 for a hearing on drug pricing. He told Business Insider, however, that he was unlikely to participate and pointed out that the committee doesn’t have subpoena power: “When my lawyers tell me I absolutely have to go, I’ll go,” he said.


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