World AIDS Day: A Look At The Gains And Challenges In The Fight Against HIV

A woman adjusts a red ribbon, symbol of the fight against AIDS, during a demonstration on World AIDS Day in Spain on Dec. 1, 2014. (Alvaro Barrientos/AP)

A woman adjusts a red ribbon, symbol of the fight against AIDS, during a demonstration on World AIDS Day in Spain on Dec. 1, 2014. (Alvaro Barrientos/AP)

From ribbons to lights on buildings, you may have seen a lot of red Monday — it’s the symbolic color for World AIDS Day (Dec. 1), which raises awareness about HIV.

The day began in 1988, some years after the AIDS epidemic was first identified in the early ’80s. As the world marks the day with events and vigils, here is a look at the current state of HIV:

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10 Ways The Birds And The Bees Have Changed

(Courtesy Candlewick Press)

(Courtesy Candlewick Press)

Way back in 1988, children’s book author Robie H. Harris was sitting in a New York editor’s office batting around ideas for possible books. The editor proposed that she write a book about AIDS for elementary school children; she counter-proposed an all-encompassing look at “almost every single question that kids might have” about anything related to sex.

She rattled off a list of topics, and the rest is history: “It’s Perfectly Normal” is just out in its 20th-anniversary edition, with more than a million copies already in print. The mix of text by Harris and illustrations by Michael Emberley do indeed seem to cover all the sexual topics pubescent kids wonder about, from masturbation to menstruation to orientation to contraception.

“Of course,” Harris says, “over the years, I’ve added more topics as the times have changed, as information has changed, and as kids coming into puberty and adolescence have changed in some ways.”

What might those topics be? And what do they say about how kids’ worlds have changed over the last 20 years? Herewith, 10 significant changes in the book and what Harris says about them:

1. The Infosphere:
“There can be a lot of inappropriate, weird, confusing, uncomfortable, creepy, scary or even dangerous websites that you can end up on when looking for information.”

The biggest change in kids’ lives over the last 20 years, Harris says, is how they get their information. “With the explosion of information happening everywhere, kids are bombarded by sexual images, sexual words, words in songs. And then there’s the Internet: Kids can go on the Internet and find responsible information, and they can also go on the Internet and find information that is not accurate and sometimes absolutely dishonest.“

“And so the biggest change is the need to help kids know how to understand the information you get, and how do you get help with it? That’s when you go to a trusted adult. There’s just much more information to sort through for kids, and that’s why the biggest expansion in the book is the Internet chapter.”

And just a note on porn: Harris says every mental health expert she consulted says youngsters should stay away from it. (The book is for age 10 and up.) So “It’s one of the few judgments I put into the book, because I think it has to do with the health and wellbeing of our kids.”

2. Gender
“Gender is another word for whether a person is male or female. Gender is also about the thoughts and feelings a person has about being a female or being a male.”

Author Robie H. Harris (Courtesy Candlewick Press)

Author Robie H. Harris (Courtesy Candlewick Press)

That’s the broader definition of gender in the opening chapter, and the new edition also includes an explanation of “transgender” and “LGBT.” Harris acknowledges that the section on transgender youth “should have been in the book earlier, but it’s in there now.”

The section also includes a discussion of some people’s disrespect for gay and transgender people, and says it generally stems from ignorance. “I can’t write without a point of view,” Harris says. And her litmus tests has always been, “Is this what I would say to my own children?”

3. Long-acting birth control
The IUD, the implant and Depo-Provera are the most effective kinds of birth control.

The ranking of the most effective birth control methods is new, Harris says. It reflects a strong consensus among medical authorities that those long-acting methods are appropriate for teens who become sexually active — and desirable because they’re by far the most effective: they require no further action by the user — no daily pill, no pause for diaphragm insertion. Continue reading

Boston Doc At AIDS Conference Reports Shock, Grief For Colleagues

A pro-Russian fighter inspects the site of a crashed Malaysia Airlines passenger plane near the village of Hrabove, Ukraine, eastern Ukraine Friday, July 18, 2014. (AP Photo/Dmitry Lovetsky)

A pro-Russian fighter inspects the site of a crashed Malaysia Airlines passenger plane near the village of Hrabove, Ukraine, eastern Ukraine Friday, July 18, 2014. (AP Photo/Dmitry Lovetsky)

Veronica Thomas
CommonHealth Intern

The 20th International AIDS Conference began Sunday in Melbourne, Australia, as attendees mourned the loss of colleagues in last week’s plane crash in Ukraine. Yesterday, the International AIDS Society released a statement confirming that at least six delegates traveling to the conference were onboard the Malaysian Airlines flight.

Dr. Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center and a professor at Harvard Medical School who is attending the conference, said the attendees are reeling in disbelief.

“The mood is somber, people are in shock,” he told WBUR’s Kassandra Sundt. “And it’s certainly not the type of discussions that people were planning to have here.”

Despite the tragedy, he said there was no discussion of canceling the conference, which is scheduled to continue through Friday.

‘A lot of people’s lives are saved because of his work.’

“There are clearly statements of sorrow and condolences and moments of silence throughout the scientific sessions, throughout the conference dinners, and privately,” he says. “But from the start everyone acknowledged that it would be the desire of all those who died tragically in this plane crash to have the work go on.”

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Mourning The AIDS Researchers Killed In Ukraine Plane Crash

A pro-Russian fighter inspects the site of a crashed Malaysia Airlines passenger plane near the village of Hrabove, Ukraine, eastern Ukraine Friday, July 18, 2014. (AP Photo/Dmitry Lovetsky)

A pro-Russian fighter inspects the site of a crashed Malaysia Airlines passenger plane near the village of Hrabove, Ukraine, eastern Ukraine Friday, July 18, 2014. (AP Photo/Dmitry Lovetsky)

With an estimated 100 HIV/AIDS researchers believed to have been on the Malaysian Airlines flight that went down in Ukraine, the official mourning has begun and will surely grow as names and details emerge. This just in from James Friedman, executive director of the American Academy of HIV Medicine:

It is with heavy heart we learn many of those that perished in the crash of Malaysia Airlines Flight 17 were leading HIV/AIDS researchers traveling to the International AIDS Conference scheduled to begin on Sunday in Australia. While all names have not yet been released, the passing of Dr. Joep Lange, a leading HIV/AIDS researcher, has been confirmed.

It is due to their continued dedication to HIV/AIDS patients worldwide that they were making this journey. Not only did this tragedy take the lives of these researchers, but also robbed the world of their future discoveries and contributions to the HIV/AIDS patients they served.

The HIV/AIDS community mourns the loss of these talented and compassionate researchers and HIV care providers. Our condolences to the families of all those affected by the Malaysia Airlines Flight 17 tragedy.

The New York Times profiles Dr. Lange here, and the Australian Broadcasting Corporation reports that Canadian HIV researcher Trevor Stratton said the crash was a huge loss to the AIDS research world.

“What if the cure for AIDS was on that plane? Really? We don’t know,” he said.

“There were some really prominent researchers that have been doing this for a very long time and we’re getting close to vaccines and people are talking about cures and the end of AIDS.

One Baby Appears Cured Of HIV, Now For The Rest

“In science,” Dr. Katherine Luzuriaga says in the UMass Medical School video above, “one case is nice, but being able to replicate that and understand what happened is our goal.”

Dr. Luzuriaga describes efforts to expand the treatment of the “Mississippi baby” to others with HIV, but let’s just take a moment to celebrate this HIV/AIDS milestone, one reported previously but now detailed in the latest New England Journal of Medicine. The baby born with HIV, now three years old, has now gone 18 months without treatment and still shows no sign of HIV rebound.

It appears, Dr. Luzuriaga says above, that “very early and vigorous treatment of HIV infection can make a difference…We may be altering the what we call “reservoirs” that the virus sets up, and it is those reservoirs that are the barriers to cure.”

HIV particles, yellow, infect an immune cell, blue. (NIAID_Flickr)

HIV particles, yellow, infect an immune cell, blue. (NIAID_Flickr)

NPR’s Richard Knox reports on the case: A Toddler Remains HIV-Free, Raising Hopes For Babies Worldwide. He begins:

A 3-year-old girl born in Mississippi with HIV acquired from her mother during pregnancy remains free of detectable virus at least 18 months after she stopped taking antiviral pills.

New results on this child, published online by the New England Journal of Medicine, appear to green-light a study in the advanced planning stages in which researchers around the world will try to replicate her successful treatment in other infected newborns.

And it means that the Mississippi girl still can be considered possibly or even probably cured of HIV infection — only the second person in the world with that lucky distinction. The first is Timothy Ray Brown, a 47-year-old American man apparently cured by a bone marrow transplant he received in Berlin a half-dozen years ago.

This new report addresses many of the questions raised earlier this year when disclosure of the Mississippi child’s case was called a possible game-changer in the long search for an HIV cure.

And he concludes: Continue reading

AIDS Overview: Optimism, Money, And Persistent U.S. Infection Rate

Harvard School of Public Health Professor Richard Marlink addressing Harvard University President Drew Faust and others in 2009, when Faust visited the Botswana-Harvard AIDS Initiative for HIV Research and Education, which Marlink helped found. (Justin Ide/Harvard University News Office)

By Karen Weintraub
Guest contributor

For the first time in 22 years, the world’s biggest AIDS conference is being held in the United States.

The 19th International AIDS Conference, under way since Sunday in Washington, DC, comes at a time when doctors are feeling optimistic about their battle against AIDS. The rate of new infections is falling 5 percent per year (though the new infection rate isn’t dropping in the United States); research has shown that the same anti-retroviral drugs that keep people with HIV alive longer also protect against transmission; and 8 million people worldwide are now being treated with life-saving drugs.

Harvard School of Public Health Professor Richard Marlink was at the conference this week and helped write an essay that led off a special section in the Journal of Acquired Immune Deficiency Syndromes laying out what needs to happen to realize the dream of a world without AIDS. We spoke with him about where we stand in the global fight against AIDS.

Overall, what is the mood of the conference?

The feeling is one of optimism. We have new biomedical tools in our armamentarium that show a lot of promise in prevention, in addition to the continued scale-up of treatment in poor countries in Africa and elsewhere that show the dramatic effect of being treated.

What’s behind that optimism, what progress is being made?

There’s excitement about new prevention findings, treatment contributing to prevention – if you’re on treatment you don’t transmit the virus readily at all to your partner. If you’re circumcised  you’re less likely to get infected. Behavioral and condom use interventions continue, but it’s hard to measure their effectiveness. There’s new hope in women-controlled prevention methods, such as microbicides or ring implants that can be used once a month or once every three months. That is an exciting area because it puts things more into a woman’s control, which is needed.

Why does it seem like AIDS is getting better everywhere but in the US? Continue reading

Commentary: What I Learned Far Away From Public Health School

Kayla Laserson, director of the Kenya Medical Research Institute/CDC Field Research Station. (Evelyn Hockstain/PATH)

By Kayla Laserson, Ph.D.
Guest Contributor

KISUMU, Kenya — When I was an undergraduate student in Boston some 25 years ago, I didn’t know what I would do in my life.

A roommate at Harvard-Radcliffe College suggested that I work with a cardiologist in Colombia, and I said, “Sure, why not?” It didn’t last long, but the kind doctor helped me find work in the maternity ward and emergency room of a provincial hospital. That experience opened lots of doors and eventually led to a master’s degree in public health at Harvard, and later, three years in the Amazon jungle studying malaria among the Yanomami tribe for my doctorate.

The beginning of my career is very similar to many others who have been inspired by teachers and students in colleges and universities everywhere. All of us seized an opportunity and got hooked.

What hooked us — and what is hooking so many young university students today — is not only the adventurous life of living in the Amazon or on the shores of Lake Victoria here in Kisumu, but the chance to make a difference in the lives of hundreds of millions of people whose health has been neglected for too long.

Traditionally, pharmaceutical companies and biotech firms don’t invest in research for diseases affecting mostly impoverished people. It’s not a mystery: there isn’t a market to support such investment. But something is stirring, striving to end this period of neglect. The U.S. Government’s support for global health research and development, along with new partnerships between the private and public sectors, is creating a rich pipeline for new drugs, vaccines, and diagnostic tools. Continue reading

Big Decline In HIV/AIDS Deaths Among Black New Yorkers

Getting an HIV/AIDS test

Good news on HIV/AIDS from the New York City Department of Health:

The Health Department today announced that new HIV data shows a 41% drop in deaths among black persons living with HIV/AIDS between 2001 and 2010. Despite this progress, black New Yorkers – representing 25% of the New York City population – disproportionately accounted for almost half of all new HIV diagnoses (48%) in 2010, a proportion that has remained almost unchanged for the past 5 years. Blacks were, however, more likely than all other racial/ethnic groups in the City to have had an HIV test in the past 12 months. To commemorate the 12th annual National Black HIV/AIDS Awareness Day today, the Health Department reminds all New Yorkers who do not know their HIV status to get tested for HIV, take the necessary precautions to stay negative and protect their partners, and get into treatment if you are positive. Continue reading

Paul Farmer On Why The Global Fund Shouldn’t Die

Dr. Paul Farmer’s speciality, among others, is his clarity when articulating a moral imperative.

Here he is on the opinion page of yesterday’s New York Times making the case to keep The Global Fund for Aids, Tuberculosis and Malaria (which has itself been injured recently by financial troubles of various kinds) alive.

Farmer, of course, is a Harvard infectious disease doctor and a cofounder of Partners In Health, the global health nonprofit, which has received support from The Global Fund in several countries. Farmer cites four reasons why The Fund matters, including its spillover benefits to other health and development areas, and its substantive investments in local health systems. Continue reading