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- Path: sparky!uunet!stanford.edu!ames!elroy.jpl.nasa.gov!ucla-cs!usenet
- From: matthew@ooc.uva.nl (Matthew Lewis)
- Subject: Conference newspaper - Thursday 23 July - part 2
- Message-ID: <1992Jul24.142704.23463@cs.ucla.edu>
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- Archive-Number: 5774
- Organization: Center for Innovation and Cooperative Technology, University of Amsterdam
- Date: 24 Jul 92 12:46:46 GMT
- Approved: phil@wubios.wustl.edu
- Lines: 316
-
- ****************
-
- Two Thai subtypes identified
-
- Further insights into the mysterious ways of HIV subtypes have
- come from Dr Chin-Yih Ou and Dr Bruce Weniger of the Centers for
- Disease Control HIV/AIDS collaboration project in Bangkok. Ou
- reported that two viral subtypes have been found in Thailand. One
- type is in patients likely to have contracted HIV via sexual
- transmission, while the other is confined largely to intravenous
- drug users. None of the Thai patients had contracted HIV through
- blood transfusion. As in related data presented previously by Dr
- Gerald Myers, no one has been found to be infected with both
- subtypes.
- The subtype found in female prostitutes, their male clients and the
- pregnant wives of those clients closely resembles the HIV subtype
- most prominent in Africa, including strains Uganda 455, Zaire Z6,
- NDK and MAL.
- The subtype found in drug users is essentially the same as that
- found in the North American and European strains LAI and ADA.
- The Thai data show a 22% genetic divergence between the two
- subtypes, indicating that HIV-1 was introduced twice into Thailand
- and that the current subtypes did not evolve from a common
- precursor virus after initial introduction into the country, Ou said.
- He added: "We do not fully understand the reasons for this
- segregation. It could be that there is little high-risk contact
- between intravenous drug users and prostitutes and that the HIV
- epidemics are quite separate between these groups." Other
- theories are that there may be biological differences in how easily
- the two subtypes can be transmitted, or that infection with one
- viral subtype may block infection with another.
-
- The Thai programme researchers are currently trying to determine
- whether the subtypes differ in pathogenicity. They are running
- cohort studies, in prostitutes, young men and pregnant women, and
- they are now going back to determine the viral subtypes in each of
- these patients. This work should reveal some useful information
- about the relation of HIV subtypes to the progression of the disease.
-
- ***************
-
- No sex day?
-
- Elizabeth Ngugi, of the University of Nairobi, yesterday suggested
- that there should be a "World No Sex Day", linked to World AIDS
- Day, to highlight women's power to say no. Women must be the
- focus of analysis, Ngugi said yesterday at a session on prevention
- programmes for women. Some participants were concerned that
- recent moves to educate heterosexual men would result in a shift of
- funds and programmes away from women.
- "Women must be placed at the centre of analysis, and men
- considered part of their world," Ngugi said. "We must have real
- partnerships between men and women."
-
- ***************
-
- Duesberg's objections answered
-
- By William Check
- A study designed to rebut the arguments of the virologist Peter
- Duesberg has confirmed that the development of AIDS is related to
- becoming seropositive for HIV and is not related to the use of
- psychoactive drugs, use of nitrate inhalants or anal intercourse.
- Keven Craib, of the Vancouver Lymphadenopathy-AIDS Study Group,
- which conducted the study, said the data prove convincingly that
- HIV causes AIDS.
- Peter Duesberg, a virologist at the University of California, Berkeley,
- has proposed that certain types of behaviour, including use of
- psychoactive drugs and "chronic promiscuous male homosexuality",
- leads to AIDS. To address these assertions, Craib looked at the
- incidence of AIDS in men in the Vancouver cohort, in relation to
- whether they were seropositive and what types of sexual behaviour
- they practised.
- At entry, 237 men were seropositive; another 128 seroconverted
- and 350 remain seronegative.
- None of the 136 cases of AIDS defined during follow-up occurred
- in persistently seronegative men. In uninfected men, the number of
- CD4 cells remained stable; decreases in CD4 counts were seen only
- after seroconversion.
- Risky behaviours cannot explain this difference, Craib said.
- Psychoactive drugs (cocaine, LSD, heroin or amphetamines) were
- used by 56% of persistently seronegative men.
- About 25% of the seronegative group reported receptive anal
- intercourse with casual partners.
- Co-factors play a very important role in determining the rate of
- clinical progression of HIV disease, Craib said. But "it is a disservice
- and a hindrance to public health for scientists to claim that HIV is
- harmless."
-
- ****************
-
- Minicourses a huge success
-
- Conference organisers were sur-pised by the turnout at last night's
- minicourses, said Dr Jonathan Silin, a consultant with the Harvard
- AIDS Institute who has co-ordinated the sessions. The minicourses
- have run over three consecutive evenings. Over 2,500 - nearly one
- in four - of those attending the conference stayed late to attend one
- of the 11 courses, which ranged from issues in sex work and
- management of opportunistic infections to methods of surveillance
- and prediction.
-
- *****************
-
- University supplies ddC
-
- By Simon Rozendaal
- The University of Ghent in Belgium has become an important
- supplier of the antiviral drug ddC. The university is making the
- tablets on contract with Fight for Life, a private medical clinic in
- Amsterdam. This clinic exports ddC, not yet registered in most
- countries, to Spain, Germany, France and Belgium.
- Earlier this year, when ddC was not available in the US, Fight for
- Life was the only organisation given permission by the US Food and
- Drug Administration to export ddC to the US.
- Hoffmann LaRoche is the main producer of ddC and therefore
- responsible for seeking official registration. Studies of ddC have
- been taking place since 1986 but so far, only a few countries have
- granted registration. They include Austria (since March 1992, for
- monotherapy) and the US (since June 1992, in combination with
- zidovudine).
- Fight for Life has been able to purchase ddC from the Belgian
- university because of a loophole in the law. Before substances are
- registered, people are allowed to conduct trials with them. Fight
- for Life has three doctors (one employed, two volunteers) who
- conduct the trials, in which about 200 patients take part. The
- participants have to pay for the drug themselves. Fight for Life
- charges about 40% of the official price.
- The Dutch Fight for Life organisation is affiliated to the American
- service organisation with the same name. The Dutch clinic was
- founded in 1990 and has specialised in new drugs which have not
- yet been registered. A trial with kemron (alpha interferon) and
- levamisol has been completed. The clinic is currently conducting
- trials with ddC and compound Q (trichosanthin). Fight for Life
- imports compound Q, a protein extracted from the Chinese
- cucumber, from the Shanghai Institute of Organic Chemistry and
- has it checked for purity and sterility by the Department of
- Biochemistry of the University of Amsterdam. Preparations are also
- being made for trials with PMEA (phosphonylmethoxyethyl),
- peptide T and passive immunotherapy (infusions of antibodies
- purified from the blood of healthy seropositive people).
-
- *****************
-
- Call to tackle sex workers' clients
-
- By Cindy Patton
- One way to reduce the risk of HIV transmission to sex workers is to
- direct educational programmes at their clients. But how do you find
- their clients?
- Researchers in India and the Netherlands have been tackling this
- question. In Madras, India, one approach has been to contact men
- through their place of work.
- Dr Swaminathan Sundararaman of the AIDS Research Foundation in
- Madras, which sponsors several HIV education programmes related
- to sex work, says planners have been slow to direct programmes at
- clients because of social prejudices which cast sex workers as the
- "imminent threat" while their clients fade quietly into the
- background.
- The AIDS Research Foundation developed programmes for men at
- workplaces after extensive studies to determine what class of men
- are likely to hire the most economically disadvantaged sex workers.
- These studies found that men tend to visit prostitutes of the same
- social class as themselves.
- The foundation's studies also showed that working class sex
- workers and clients find it difficult to obtain condoms, not only
- because they are expensive but also because people are afraid to buy
- them in their own neighbourhood. Building on earlier programmes
- which used sex workers to persuade clients to attend STD clinics,
- the foundation is now considering employing sex workers to sell
- condoms to clients.
- In the Netherlands, the Men and Prostitution Foundation, an
- organisation formed by clients of sex workers in 1986, has also
- been working with clients to promote safer sex. Gerrit Bloemen, a
- co-founder of the group, said: "We need to get lust out of the
- gutter."
- Bloemen said that the negative associations of prostitution affect
- clients, too. According to a recent Dutch study, he said, there is
- good reason to believe that "the more positive clients feel about
- their relation to prostitution, the more likely they are to protect
- against STDs."
- Bloemen said men have a variety of "social and individual" motives
- for hiring sex workers.
- These could include the search for variety, in order to satisfy their
- curiousity or because they want to show off their masculinity.
- Different prevention strategies need to be directed at each of these
- motivating factors.
-
- ***************
-
- A plethora of alternatives
-
- The vast majority of people with AIDS and HIV are taking
- alternative therapies, delegates heard at a minicourse on Tuesday.
- Kaiya Montaocean from the Center of Natural and Traditional
- Medicines in the USA thought the figure was as high as 90%.
- People in developingcountries take alternative therapies because
- they cannot afford expensive drugs and because such therapies
- often fit with their cultures.
- Leonardo Ortega, a native Venezuelan doctor living in Washington
- DC, asked people in Latin and South America what alternative
- therapies they were using.
- The list included acupuncture, massage, folk healing, shamanism
- and spiritism. He said the spirit of a doctor from Ecuador was
- believed to have cured two HIV-infected people.
- The use of herbal therapies is also common. Among the herbs being
- eaten for the treatment of HIV/AIDS in Latin America are garlic,
- coneflower (Angustifolia) and several less well-known ones. In many
- developingcountries, traditional approaches are illegal and those
- who practice them are wanted by the authorities, Ortega said. In
- the developed world, many HIV-positive people also believe in
- alternative therapies, speakers said. Tanne de Goei from ACT UP
- Amsterdam said one study had concluded that as many as 40% of
- Dutch HIV-positive people follow non-official therapies like eating
- extra vitamins, garlic or ginseng or having ozone treatment.
- David Baker, an HIV-positive nurse from the US, listed today's
- favourite alternative drugs. The antivirals included compound Q,
- NAC (N-acetylcysteine), vitamin C and Chinese herbs and the
- immunomodulators included DNCB (dinitrochlorobenzene),
- glycyrrhizin (liquorice root extract), iscador (mistletoe extract) and
- cimetidine (an official drug used to treat stomach ulcers).
-
- ***************
-
- Secrets of long-term survivors
-
- By Simon Rozendaal
- Half of all the HIV-positive people with access to health care will be
- free of symptoms for 10 years or more. At a Round Table session on
- Tuesday on long-term survivors, Frits van Griensven from the
- Municipal Health Service in Amsterdam said that 50% of the gay
- men in the combined cohorts in New York, San Francisco and
- Amsterdam have yet to develop AIDS 10 years after they first
- became HIV-positive. These three cohort studies represent the
- biggest longitudinal studies in the world on HIV-positive people.
- There is no single explanation why some HIV-positive people are
- 'long-term survivors' and some are not, those taking part in the
- dicussion agreed. An important factor seems to be good access to
- health care. There are no precise figures but the phenomenon of
- the 'long-term survivor' seems to be very rare in Africa.
- An analysis of 562 men with well-defined dates of seroconversion
- from the San Francisco cohort suggests that fewer than 1% will
- develop AIDS within two years of seroconversion, Susan
- Buchbinder, from the AIDS Office in San Francisco, said. More than
- one in 10 will have AIDS within five years, more than one in two
- within 10 years and more than two out of three within 13 years.
- Aldyn McKean from ACT UP New York presented himself as one of
- the long term survivors.
- He knows that he was HIV-positive by 1980 and thinks he became
- infected in the late 1970s. Since 1983, he has had a low but stable
- CD4-count of 160. McKean said there are many more long-term
- survivors in the files of general practioners. He called for more
- comprehensive studies.
-
- ***************
-
- Why African Governments Fail to Act:
- Disorganisation, Denial and Debt
-
- In the second decade of the AIDS epidemic, the slowness of many
- African governments to react to this problem can be traced to three
- issues: denial, disorganisation, and debt.
- Denial
- Like individuals, governments think AIDS will not affect them,
- despite the fact that other people or countries in similar
- circumstances are affected. Due to the long latent period of the
- virus, this problem is especially severe in countries where the
- prevalence is lower. Although governments in subSaharan Africa are
- aware of what is happening in Uganda, for example, imagining that
- their own country is the next in line is difficult.
- Many countries do not have a policy on AIDS and have not included
- AIDS in national plans. Very few African heads of state have talked
- openly about AIDS to their populations. Only in June of this year,
- did the African heads of states include AIDS on a meeting agenda.
- Like individuals, governments return to reality when the epidemic
- hits home. Many of us can remember the speech to a previous AIDS
- conference by President Kaunda of Zambia, who had lost a son to
- the disease.
- Disorganisation
- Many factors within a country can "paralyse" a government. The
- very fact that AIDS concerns human sexuality is a difficult issue to
- deal with at every level.
- Underlying social, economic, and political questions have to be
- addressed, and these governments are not ready to answer them. If
- the government of a country tries to deal with prostitution, it must
- first deal with the economic issues, find other jobs for the
- prostitutes, find jobs for migrant workers so they are not separated
- from their families, solve the problem of street children, and
- change the subordinate position of women in society, which is one
- of the factors forcing women into prostitution. Few African
- countries have either the organization or the funds to do these
- things.
- In most countries in sub-Saharan Africa, AIDS control programmes
- are under the Ministries of Health. These are not powerful
- ministries, and they have more problems than other departments
- because of the huge health and nutrition problems in these areas. A
- programme manager from such a ministry has little influence on
- higher-ranking officials.
- That was why some countries like Uganda and Thailand placed
- their AIDS control programmes directly under the Prime Minister's
- office, which gives the programme the crucial position of dealing
- with the relevant ministries. However, these actions were taken
- only when the epidemic had reached very high proportions. What
- one would like to see is the low-prevalence countries doing the
- same, before it is too late.
- Debt
- I cannot think of a single African country that could attempt all of
- the things which are needed. Most are paying 40% or more of their
- income out to repay debts. The governments of developed and
- developing countries must come together to solve this problem.
-
- (article continued in part 3)
- --
- Matthew Lewis, University of Amsterdam Grote Bickersstraat 72
- +31-20-52 51 220 1013 KS Amsterdam
- Internet: matthew@ooc.uva.nl The Netherlands
-