AFRO-NETS> Kaiser Daily HIV/AIDS Report - Tue, 14 Aug 2001

[Cecilia Snyder <csnyder@ccmc.org>]

Kaiser Daily HIV/AIDS Report - Tue, 14 Aug 2001
-----------------------------------------------


*Outreach Program Cuts HIV Infection Rate in Sex Workers
*South African Health Official Says Antiretroviral Drugs Too Costly
  to Provide
* Clinical Trials to Begin on HIV Vaccine That Uses Horse Virus
* Molecular Discovery to Aid Vaccine Research

GLOBAL CHALLENGES

Outreach Program Cuts HIV Infection Rate in Sex Workers

An outreach program targeting sex workers in Abidjan, Ivory Coast,
has reduced the rate of new HIV infections in a group of the city's
sex workers by more than two-thirds, Reuters Health reports. Research
conducted during the mid-1990s found that approximately 80% of the
city's female sex workers were HIV-positive. In 1994, researchers en-
rolled 542 HIV-negative female sex workers in Abidjan in the study.
The women received confidential gynecologic screening and treatment,
free condoms and counseling on the prevention of HIV and other STDs.
The scientists tracked the HIV status of the study participants every
six months from 1994 to 1997 and found that new HIV infection rates
among the workers fell by 60% during that period, compared with in-
fection rates prior to the program. The researchers also found that
infection rates for chlamydia, gonorrhea and trichomoniasis "tumbled"
during the study's time span. In addition, condom use among study
participants increased during the study. By the end of the study, 82%
of participants said they "consistently" used condoms during sexual
intercourse, compared with 40% at the beginning of the study. The
study authors conclude that because "female sex workers and their
clients are a driving force of the HIV epidemic in many countries
throughout the world," other nations should "consider adopting simi-
lar types of educational health care programs to protect women and
stem the tide of AIDS" (Reuters Health, 8/10).

DRUG ACCESS

South African Health Official Says Antiretroviral Drugs Too Costly to
Provide

South African Health Director-General Ayanda Ntsaluba said in a BBC
television interview that antiretroviral drugs were still too expen-
sive for the government to purchase and distribute to HIV-positive
citizens, stating that "scarce resources" had shaped the government's
policy on the drugs, Reuters/Contra Costa Times reports. "There are
many painful choices we are making in this country. There are many
things we would like to do which we are unable," Ntsaluba explained,
adding, "Antiretrovirals are effective under specific conditions but
you also know that like many things in life there are many things we
would wish to do in this health system in South Africa which we are
not doing. There are many things we are not doing precisely because
we don't have the necessary resources." Although several multina-
tional drug firms have offered South Africa and other African nations
price discounts on AIDS medications, Pretoria "has been reluctant to
accept these offers, questioning the sustainability of the price of-
fers and the ability of the health system to dispense the drugs,"
Reuters/Contra Costa Times says. The country has the highest number
of HIV-positive people in the world, with one in nine infected with
the virus, and the government spends about $10 million annually to
fight AIDS. The Treatment Action Campaign, South Africa's leading
AIDS activist group, is expected to take the government to court for
denying zidovudine to HIV-positive pregnant women to reduce the risk
of viral transmission to their infants (Reuters/Contra Costa Times,
8/13).

SCIENCE & MEDICINE

Clinical Trials to Begin on HIV Vaccine That Uses Horse Virus

American and South African researchers are preparing for the first
human trials of an HIV vaccine derived from HIV subtype C, the "most
common" HIV strain in southern Africa, and Venezuelan Equine Encepha-
litis, a mosquito-borne virus that affects horses, the London Inde-
pendent reports. Carolyn Williamson, a virologist from the University
of Cape Town, explained that the "coat" of VEE, which is found in
North and South America, is being used to deliver the HIV vaccine.
"[A]s [the HIV in the vaccine] doesn't have all the ingredients to
replicate itself, it is rendered not infectious," she said. However,
"[o]nce delivered, the machinery is in place to churn out volumes of
HIV protein needed to get an immune response, which in turn will
hopefully protect against infection," she added. The final plans for
the initial stage of human testing are "in place" and candidates who
are "free of HIV, not likely to contract it and in good health" are
being sought for the randomized double-blind study, which is sched-
uled to begin in March. The trial will contain a placebo arm (Clarke,
London Independent, 8/13).

Molecular Discovery to Aid Vaccine Research

In other vaccine development news, the "discovery" of the structure
of IgG1 b12, an antibody that attaches to the HIV protein gp120 and
"neutralizes" the virus, could assist vaccine researchers in develop-
ing a new approach to fighting HIV, Reuters Health reports. Research-
ers explained in the Aug. 10 issue of Science that b12 is shaped like
a "Y" or a "T," and that one of the "finger-like" extensions fits
into the gp120 molecule, "effectively block[ing] other portions of
the virus surface that are needed to cause infection." The research-
ers said vaccine and drug developers can use this information to de-
sign drugs that also fit into the gp120 "glove" to fight infection.
Knowing the design will also aid in developing vaccines that "enable
the body's virus-fighting antibodies to recognize this critical re-
gion of the HIV surface," they added. "(Our hope is) that the vaccine
design community would utilize this structural information to produce
an effective vaccine," Dr. Ian Wilson of the Scripps Research Insti-
tute in La Jolla, Calif., said (Boggs, Reuters Health, 8/10).

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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