Ebola crisis: Vaccine ‘too late’ for outbreak
GSK is one of several companies trying to fast-track a vaccine to prevent the spread of Ebola in West Africa.
But Dr Ripley Ballou, head of GSK's Ebola vaccine research, said full data on its safety and efficacy would not be ready until late 2015.
The World Health Organization (WHO) says more than 9,000 people have been infected and more than 4,500 have died.
Health workers are struggling to contain the spread of the virus, which is mostly affecting people in Liberia, Guinea and Sierra Leone.
The WHO has warned there could soon be 10,000 new cases a week.
Leading experts who have previously tackled Ebola believe the only way to contain the outbreak is with a vaccine.
Prof Peter Piot, director of the London School of Hygiene and Tropical Medicine, first discovered Ebola in 1976. He is worried that the outbreak could last well into next year.
"Then only a vaccine can stop it, but we still have to prove that this vaccine protects, we don't know that for sure," he said
There are several vaccine trials under way. The Public Health Agency in Canada has started human testing, and a Russian project is planning to do the same.
At GSK's vaccine research laboratories outside Brussels, they are trying to compress trials that would normally take up to 10 years into just 12 months.
They have already given the vaccine to volunteers taking part in the trial in Africa, the US – where they are working alongside the National Institute of Health – and the UK.
Volunteer Nick Owen was injected two weeks ago at the centre for Vaccinology and Tropical Medicine in Oxford and will have regular check-ups for the next six months.
He said he had not hesitated to take part.
"It's a horrific disease, it's unimaginable what people are going through and it seemed like a really small sacrifice to make," he said.
In the next phase of the trial, the company hopes it will have 20,000 doses ready to be tested by health workers early next year.
When the outbreak was first declared in March, GSK had discussions with the World Health Organization about accelerating the development of the Ebola vaccine, Dr Ballou said. But they had decided, together, not to.
"No-one anticipated we would need a vaccine," said Dr Ballou. "And so both internally and, I think at the WHO, we felt the best approach was to watch very closely".
Seven months on, with the virus out of control, he now concedes: "I think in retrospect we should have pulled that trigger earlier.
"But, you know, it is what it is and we are working very closely with WHO.
"There shouldn't be any finger pointing around this."
Dr Ballou said it would now take some time to assess all of the data to establish the correct dosage and for how long the vaccine was effective. He said that could not be done in time for this latest epidemic.
"At the same time we have to be able to manufacture the vaccine at doses that would be consistent with general use, and that's going to take well into 2016 to be able to do that," he added.
"I don't think this can be seen as the primary answer to this particular outbreak," he said, but the trials under way could help in the future.
"If it does work then to be able to be prepared so that we don't have to go through this again in five years, or whenever the next epidemic is going to break out."
Even if GSK's vaccine does not work, other Ebola vaccines being developed by researchers in Canada and Japan could provide hope for future outbreaks.
By Simon Cox
17 October 2014
We Can’t Have a Post-2015 Agenda Without SRHR
In 2000, the creators of the Millennium Development Goals (MDGs) completely overlooked sexual and reproductive health and rights (SRHR), a mistake that, if repeated, would cripple the dreams of millions of young girls and women for years and generations to come.
Access to SRHR enables individuals to choose whether, when, and with whom to engage in sexual activity; to choose whether and when to have children; and to access the information and means to do so. To some, these rights may be considered an everyday reality. However, that is not the case for millions of young people in the world – particularly girls and women.
On Tuesday night, I had the fantastic opportunity to listen to some of the foremost global leaders speak on behalf of ensuring access to sexual and reproductive health and rights in the post-2015 agenda. The benefits of ensuring SRHR are society wide and inevitably translate into improved education, economic growth, health, gender equality, and even environment.
“At my high school, you would be expelled if found with a condom.” – Samuel Kissi, former President, Curious Minds Ghana
When girls are healthy and their rights are fulfilled, they have the opportunity to attend school, learn life skills, and grow into empowered young women. Wherever girls’ SRHR are ignored, major educational barriers follow. Child marriage and early pregnancy are major contributors to school dropout rates. In South Asia and Sub-Saharan Africa, girls are married before age 18 at an alarming 50 percent and 40 percent respectively. And in Sub-Saharan Africa, where 90 percent of adolescent pregnancies occur in marriage, it is safe to assume that not all those sexual acts were consensual and not all those pregnancies were planned.
“Initially I used to oppose family planning, but now I fully support. I support it because my wife has more time to work and earn money.” – The Honorable Dr. Tedros Adhanom Ghebreyesus, Minster of Foreign Affairs for the Federal Democratic Republic of Ethiopia, sharing the story of an Ethiopian man’s changed opinion regarding the importance of SRHR
Protecting SRHR not only saves lives and empowers people, but it also leads to significant economic gains for individuals and for the community as a whole. As previously stated, ensuring SRHR helps to decrease school dropout rates and, as a result, leads to a more productive and healthy workforce as each additional year of schooling for girls increases their employment opportunities and future earnings by nearly 10 percent.
Broader Health Agenda
“We cannot eliminate new HIV infections without providing SRHR services to women so they can make informed decisions to protect themselves and their children in the future. Yes, we will end the AIDS epidemic, but first we need to respect the dignity and the equality of women and young girls.” – Dr. Luiz Loures, Deputy Executive Director, UNAIDS
Access to SRHR guarantees quality family planning services, counseling and health information. These services are critical, particularly because women are often victims of gender-based violence and sexual assault and thereby face greater risks for sexually transmitted diseases like HIV/AIDS. Failing to secure and uphold SRHR dooms women and girls with an increased risk of unsafe, non-consensual sex and maternal mortality.
“How can you control your life if you cannot control your fertility?” – Helen Clark, UNDP Administrator
When a woman can easily plan her family, she is more equipped to participate in the economy alongside her male colleagues. When the sexual rights of a woman or girl are fulfilled, she will experience decreased rates of sexual violence and enjoy a healthy relationship with a respectful partner. When a woman or girl does not fall victim to child marriage and early pregnancy, she can stay in school and achieve anything she puts her mind to.
“The woman continues to bring life, to bring up the next generation, to stand before you and say, ‘I am ready to embrace my rights and to deliver a better planet to humanity.’” – Joy Phumaphi, former Minister of Health, Botswana; Chair, Global Leaders Council for Reproductive Health
A 2012 study found that community water and sanitation projects designed and run by women are more sustainable and effective than those that are not. Similarly, women produce 60 to 80 percent of food in developing countries and, with the economic and educational gains that coincide with secured SRHR, a woman is better equipped to effectively manage her land.
The post-2015 Sustainable Development Goals will not happen without SRHR being addressed. So far, the world has failed to recognize that SRHR are equally as fundamental to global development as finance and trade. We can no longer afford to view SRHR as a taboo or promiscuous topic. When 90% of first births in low-income countries are to girls under 18; when the leading cause of death among adolescent girls aged 15 to 19 is pregnancy and childbirth; when two-thirds of new HIV infections in sub-Saharan Africa are among adolescent girls; and when 200 million women want to use family planning methods but lack access, the young girls and women of the world do not have a promiscuity problem – they have a human rights problem.
By Elisabeth Epstein
25 September 2014
Experts demand strong, public, SA government support for proposed ECHO trial
The South African HIV Prevention Research Advocacy Expert Group & partners are writing to request strong, public, SA government support for the proposed ECHO trial which we understand to be in jeopardy of cancellation.
26th September 2014: World Contraception Day
SOLIDARITY STATEMENT TO :
Minister Aaron Motsoaledi, Minister of Health, South Africa
Prof. Glenda Gray, President – Medical Research Council of South Africa
Dr. F. Abdullah, Chief Executive Officer, South African National AIDS Council
The South African HIV Prevention Research Advocacy Expert Group & partners are writing to request strong, public, SA government support for the proposed ECHO trial which we understand to be in jeopardy of cancellation—a development that would be a blow to SA AIDS and reproductive health programming on the status of the Evidence for Contraceptive Options & HIV Outcome (ECHO) Trial. We strongly believe that the ECHO trial could be one of the most important reproductive health and HIV trials of this decade and further strengthen South Africa’s position on the global stage as a leader in generating scientific evidence that has meaningful impact on improving the lives and wellbeing of all its citizens, especially women via informed, innovative programming.
The ECHO Trial has the potential to provide high quality, evidence based answers to questions about whether three specific contraceptive options (Depo Provera, the Jadelle implant and the copper intrauterine device) might increase women’s risk of HIV acquisition. These questions are of utmost relevance to South Africa. Excluding condoms, injectable contraceptives make up nearly 75% of the contraceptive methods dispensed in South Africa. Within this, the majority of women are receiving Depo. Modeling studies designed to gauge the impact on HIV infections in a scenario where Depo does increase risk, show that the highest burden of new infections attributable to this method is in South Africa.
The RSA’s new contraceptive policy stresses an increase in the range of options offered to women, and a shift away from Depo based on the current uncertainty regarding its impact on HIV risk. These are key steps and we believe they should proceed with urgency. However, there are no data on the other hormonal methods, such as the implant, that are being introduced today. ECHO will provide an answer for multiple methods—not just Depo—laying the basis for sound public health policy and clear communication.
We seek to engage with you on ways in which we may see the full funding of the trial to ensure that it takes place. At present, there is a funding shortfall. Unless additional funds are committed, the trial may not take place We welcome South Africa’s current financial commitment to the trial and ask that you consider increasing this amount as well as making a strong, public statement that this research is a priority for our country and the region.
We the undersigned therefore stand in solidarity with the women of South Africa, one of the Sub Saharan countries with the widest use of depot medroxyprogesterone acetate (DMPA) in encouraging our Department of Health, the Medical Research Council, and the South African National AIDS Council to ensure that the ECHO trial is fully funded – as a national imperative, especially as a country whose response to and recent leadership in the national response to HIV is world renowned.
As we move forward to urgently explore ways to mobilise South African’s en masse to express their support for this trial to be fully funded, and trial recommendations urgently acted upon, we wish to categorically state that our expectation is that our Government in partnership with the Medical Research Council fill the funding gap that is needed to get the ECHO trial underway, not only as a public health imperative, but as an urgent human rights issue.
Media Contact: Tian Johnson , +27 73 4324069 , email@example.com
The SA HIV Prevention Research Advocacy Expert Group has been established to provide senior level advocates and programme leaders a platform to: enhance their individual capacity relating to all aspects of HIV Prevention Research, build the capacity of key individuals in their organization and circles of influence including policy makers, donors and strategic partners on issues of HIV Prevention Research, accelerate the pace and level of public discourse around HIV Prevention Research Advocacy as it pertains to existing as well as potential technologies in their conceptualization, development, trial, piloting, procurement, distribution & marketing stages, serve as a point of entry and access to the HIV Prevention Research Science communities for advocates.
The SA HIV Prevention Research Advocacy Expert Group is:
Dr. Ntlotleng Mabena – Centre for HIV & AIDS Prevention Studies
Ntando Yola – Desmond Tutu HIV Foundation
Sisonke Msimang – Graca Machel Trust
Phillipa Tucker – AIDS Accountability International
Dr. Johanna Kehler – AIDS Legal Network
Tian Johnson – Sonke Gender Justice
Ebola death toll reaches 2,288, says World Health Organization
The Ebola outbreak in West Africa has killed 2,288 people, with half of them dying in the last three weeks, the World Health Organization (WHO) says.
It said that 47% of the deaths and 49% of the total 4,269 cases had come in the 21 days leading up to 6 September.
The health agency warned that thousands more cases could occur in Liberia, which has had the most fatalities.
The outbreak, which was first reported in Guinea in March this year, has also spread to Sierra Leone and Nigeria.
In Nigeria, eight people have died out of 21 cases, while one case of Ebola has been confirmed in Senegal, the WHO said in its latest update.
On Monday, the agency called on organisations combating the outbreak in Liberia to scale up efforts to control the outbreak "three-to-four fold".
Ebola spreads between humans by direct contact with infected blood, bodily fluids or organs, or indirectly through contact with contaminated environments.
However, the WHO says conventional means of controlling the outbreak, which include avoiding close physical contact with those infected and wearing personal protective equipment, were not working well in Liberia.
The reason for this remains unclear; however, experts say it could be linked to burial practices, which can include touching the body and eating a meal near it.
There are also not enough beds to treat Ebola patients, particularly in the capital Monrovia, with many people told to go back home, where they may spread the virus.
Sophie-Jane Madden, of aid agency Medecins Sans Frontieres, told the BBC that health workers at the largest treatment centre in Monrovia were completely overwhelmed: "Our teams are every day turning away people who are desperately seeking healthcare."
Meanwhile, the US says it will help the African Union mobilise 100 African health workers to the region and contribute an additional $10m (£6.2m) in funds to deal with the outbreak.
The announcement comes as a fourth US aid worker infected with the deadly virus was transported to a hospital in Atlanta for treatment.
The identity of the aid worker has not yet been revealed.
Two other aid workers who were treated at the same hospital have since recovered from an Ebola infection.
Separately on Tuesday, the UN's envoy in Liberia said at least 80 Liberian health workers had died from Ebola, according to the Associated Press.
Karin Landgren described the outbreak as a "latter-day plague" that was growing exponentially. She added that health workers were operating without proper protective equipment, training or pay, in comments to the UN Security Council.
By BBC News Africa
9 September 2014
Ebola outbreak in DRC: same virus, but different
New cases of Ebola in the Democratic Republic of the Congo are raising fears that the virus will spread further across Africa. Yet the variety found in Central Africa might be of a different kind.
The Ebola River is a small stream running through the forests of the Equateur province in the northwest of the Democratic Republic of the Congo. It is in this region that the deadly disease was first recognized by Belgian scientists, who named the worm-looking virus after the river in 1976. Now, the virus has once again returned to the Equateur province with two confirmed cases of people who died from Ebola.
"In this region especially, the Ebola virus is circulating and has caused some smaller and larger outbreaks in the past", says Dr. Schmidt-Chanasit, head of the viral diagnostic unit at Hamburg's Bernhard-Nocht-Institute. "So this outbreak, most probably, is not associated with the outbreak in West Africa."
Almost 1,500 people have died so far in Liberia, Sierra Leone, Guinea and Nigeria in what has become the deadliest outbreak of Ebola in history. Yet the virus that has now caused an outbreak in the Democratic Republic of the Congo differs substantially from the one in Western Africa.
"Case fatality rate is much lower when we compare this to West Africa – it's around 20 percent," says Schmidt-Chansit. "So it might be possible that this is a different strain of the Ebola virus that is less pathogenic."
Some Ebola strains are even harmless for humans and will only cause disease in monkeys. The so-called Reston virus is such a mutation of Ebola. It has been found in China and the Philippines. The current strain that is wreaking havoc across West Africa, on the other hand, has a case fatality rate of up to 90 percent.
Confidence in Kinshasa
It might take another one or two days until laboratories have identified the exact strain of the virus that caused the two deaths in the Equateur province in northern Congo. The newest outbreak of Ebola would be the seventh recorded so far for the Democratic Republic of the Congo.
It is the country's history of Ebola outbreaks that makes Felix Kabange Numbi, health minister of the Democratic Republic of the Congo, confident.
"The experience we have gathered during the last six Ebola outbreaks will be helping us contain this disease now," he said in a televised speech on Sunday.
Numbi announced a multitude of measures to counter the outbreak, listing protective equipment for all medical personnel as a top priority. Moreover, he said his government would make sure "all burials are securely done for those confirmed cases, but also those unexplained deaths in the communities."
Experts needed at home
A country plagued by ongoing armed conflicts and a continual fight over natural resources, the Democratic Republic of Congo might be a place where one would suspect the disease to spread quickly – ever more so since it is a country the size of Western Europe with little developed infrastructure, be it roads of hospitals.
Yet this might not be fueling the disease, says Schmidt-Chanasit. Authorities have already imposed quarantine around the affected area in Jera in the Équateur province. "They are very well prepared. They know how to isolate the patients."
He adds that the outbreak occurred in a remote region, "So there is no chance that this outbreak will come into a capital like Kinshasa, because it is hundreds of kilometers away."
Just last week, Health Minister Numbi announced plans to send experts from Kinshasa to West Africa in order to help quell the Ebola epidemic there.
Now, it looks as if the Democratic Republic of the Congo will first have to deal with its own outbreak of the disease.
By Peter Hille
The silent crisis: Mental health in Africa
Steadily approaching the title of the second highest cause of disability in the world, mental health disorders are an international health concern that is gaining considerable attention.(2) Of the global burden of disease, 14% is attributed to neuropsychiatric disorders, indicating a 2% growth since the year 2000.(3) It is believed that the figure will have increased by another percent by 2020.(4) According to the Mental Health and Poverty Project, one in five individuals will suffer from a diagnosable mental disorder in their lifetime.(5) Among the adults who suffer from these disorders, 75% are found to have developed them in their youth.(6) In fact, sufferers of persistent mental disorders in adulthood tend to be those whose condition first arose between the ages of 12 and 24.(7)
The 2011 World Health Organisation (WHO) Mental Health Atlas reveals that 110 of its 184 member states have an identifiable mental health policy.(8) Of the 45 African member states surveyed, 19 reported to have mental health policies in place.(9) This paper discusses current deficits in mental health services in Africa, as well as the challenges faced by mental health patients and practising mental health professionals on the continent. The paper also illuminates strides made by groups in various parts of the continent in improving service provision to affected populations.
To describe the current accessibility of mental health services in the majority of African countries as deficient would be an understatement. The psychiatrist-to-patient ratio in Africa is less than 1 to 100,000,(10) and it is reported that 70% of African countries allocate less than 1% of the total health budget to mental health.(11) Liberia is a case in point. A 2008 report compiled by the WHO states that there are only 0.06 mental health professionals per 100,000 people in Liberia,(12) where, the S. Grant Mental Health Hospital is the sole inpatient facility for those suffering from mental disorders. A study conducted by the American Medical Association found that 44% of Liberian adults exhibit symptoms indicative of post-traumatic stress disorder (PTSD).(13) The likelihood that these individuals are receiving treatment is very low, when taking into account the scarcity of mental health facilities in that country. The Liberia National Mental Health Policy found that of those living in low income areas that need mental health services, only 15% actually receive treatment.(14)
Similarly, in Ghana only 1.17% of those who are suffering from mental health problems have received the required treatment.(15) There are only three major psychiatric hospitals in that country, all of them located in the southern region. Furthermore, there is only one psychiatrist allocated to 1.5 million people. With such limited accessibility, many mental health sufferers seek treatment from traditional and faith healers.(16)
Compared with the West African countries mentioned, the situation in East Africa is similarly dire. There is an evident shortage of mental health professionals in public practice. In 2001, Tanzania recorded 10 active psychiatrists catering to a population of 30 million. Of the 10, four work at Muhimbili, a teaching hospital, where patients with serious mental health disorders are referred.(17) Kenya is regarded as comparatively better prepared to cater for those suffering from mental health disorders, with 47 practising psychiatrists in the private and public sectors. Twenty-two physicians exclusively provide services in Nairobi, while the remaining 22 practise in other parts of the country.(18) Mathari Hospital, located in Nairobi, is the national referral and teaching hospital for mental health patients. Its 750-bed facility is divided into two wings, a civil wing for stable patients and a maximum security unit for those suffering from severe mental problems.(19) Middle and upper class citizens have the option of seeking services from psychiatrists in private practice.
Risk factors in the African context
Mental health issues among African populations are instigated by an assortment of factors. The financial standing of populations in many African countries may be predisposing them to mental health problems. Various studies state that individuals of a lower socio-economic status are twice as likely to suffer from common mental health disorders, as compared to the wealthy.(20). Furthermore, populations in East African countries such as Somalia, Ethiopia, Sudan, Rwanda and the Democratic Republic of Congo (DRC) have encountered armed conflicts and natural disasters in varying degrees. This has resulted into the displacement of more than 1.5 million individuals from the East African region.(21) A consequence of these hardships may be the emergence of mental disorders. The WHO estimates that 50% of refugees have mental health problems ranging from post-traumatic stress disorder to chronic mental illness.(22) The rise in the numbers of individuals who present with mental health problems places an even greater burden on an already under-resourced healthcare service in Africa.(23)
Mental health stigma
In many African countries, communities are often not empathetic towards mental health patients. The mentally ill face discrimination, social ostracism and the violation of basic human rights, all due to an on-going stigma associated with mental health problems. Ironically, some of these violations occur in institutions where people with ill mental health seek treatment. Mental health facilities have been found with unhygienic and inhumane living conditions, such as the use of caged beds with netting or metal bars to restrain patients.(24) There are documented cases of individuals having been tied to trees and logs far from their communities for elongated periods of time without adequate food or shelter.(25) A study performed in Uganda revealed that the term ‘depression’ is not culturally acceptable amongst the population, suggesting that mental health issues are not acknowledged or considered a legitimate affliction.(26) In another study conducted in Nigeria, participants generally responded with fear, avoidance and anger to those who were observed to have a mental illness. The stigma linked to mental illness in that country can be attributed to a variety of factors, including lack of education, fear, religious reasoning and general prejudice.(27) When surveyed on their thoughts on the causes of mental illness, over a third of Nigerian respondents (34.3%) cited drug misuse, including alcohol, marijuana and street drugs as the main cause. Divine wrath and the will of God were seen as the second most prevalent reason (18.8%), followed by witchcraft/spiritual possession (11.7%). Very few cited genetics, family relationships or socioeconomic status as possible triggers.(28)
Challenges faced in improving services
There are many barriers faced by African mental health workers in their efforts to improve and increase the availability of services in their regions. As mentioned earlier, the lack of funds allocated by most African governments to the mental health field poses a problem in expanding services so as to adequately meet demand. Furthermore, difficulties such as finding adequate transportation and medication are general obstacles for health workers attempting to reach rural dwellers.(29)
Limited research in mental healthcare has also been cited as a major concern. A study spear-headed by the United States National Institute of Mental Health and the Global Alliance for Chronic Disease found that one of the biggest barriers in mental healthcare is the lack of global collaboration in the conduction of research.(30) Research is essential for determining general needs when treating mental health disorders, as well as for creating and monitoring cost-effective interventions.(31) A WHO mapping project on research capacity for mental health in low and middle income countries indicates that epidemiological studies focusing on burden and risk factors, health systems research, as well as social science, were regarded as most desirable by researchers and other mental health stakeholders.(32)
Despite the many shortcomings in their field, mental health professionals are resilient in their efforts to serve and challenge the status quo. For example, the Ministry of Health and Social Welfare in Liberia is working towards increasing access to mental health services throughout the country. The Ministry has partnered with organisations such as the Carter Center and Doctors of the World, with the intention being to establish wellness centres in each of Liberia’s 15 counties.(33) The Carter Center is also currently training 150 mental health clinicians in Liberia. Staffed with trained mental health workers, these organisations will offer treatment to mentally ill individuals in the affected communities. In the event of a case requiring knowledge beyond the expertise of clinicians at the centre, referrals will be made to specialists located in Monrovia.(34) Dr Meiko Dolo, the Director of the Mental Health Department in Liberia, is confident that these plans will come to fruition. A recently released draft of Liberia’s national budget for 2013 depicts, for the first time ever, provisions made for mental health.(35)
Following its 11-year civil war, Sierra Leone, established a child-solider rehabilitation project, providing counselling and other support to children living with war trauma.(36) In the DRC, women facing gender-based violence can now go to ‘listening houses’ where they can talk through their trauma in a secure setting.(37) In addition, the University of Cape Town in South Africa completed a project on mental health and policy, whose goal was to expand mental health research in Africa, evaluate existing mental health policies in Uganda, South Africa, Zambia and Ghana, as well as develop new ones.(38)
Though not as notorious as HIV/AIDS, tuberculosis and malaria, mental health is a global issue that is in need of more attention than it is currently being given. In 2003, 450 million people worldwide were estimated by the WHO to have some type of mental health issue.(39) Eleven years later, it is likely that this number has increased. The WHO also reports that expenditure on mental health is less than US$ 0.25 annually per person in low income countries.(40) Currently, Africa has the lowest rate of mental health outpatient facilities, at 0.06 per 100,000 people.(41) Given the steady rise in the number of mental health sufferers, African countries need to optimise the delivery of mental health care services and take steps towards making this crisis silent no longer.
By Modupeola Dovi
Malaysia Airlines Flight 17: A tragic loss for AIDS advocacy, research
AIDS researchers and advocates are used to dealing with death, they say, but that hasn't made the last 48 hours any easier.
An estimated 12,000 scientists, medical workers, advocates and policymakers are traveling to the 20th International AIDS Conference in Melbourne, Australia — a “mega event” for their field — amid the grim news that dozens of their colleagues, including a top researcher, were killed in the downing of Malaysia Airlines Flight 17 over Ukraine.
The loss is certain to cast a shadow over the conference, members of the community said, calling the blow immeasurable and tragic.
“It's like a train has gone off the track,” said Terri Ford, chief of global advocacy and policy for the AIDS Healthcare Foundation, who arrived in Melbourne on Thursday. “It's hard to absorb what has happened.”
Confirmation of the names of the dead rolled in slowly, but by Friday, the conference attendees knew they had lost at least one superstar.
Joep Lange, a former president of the International AIDS Society and a professor of infectious diseases at the University of Amsterdam whose leadership spanned the history of the epidemic, was confirmed among the dead.
In addition to Lange, a colleague, Jacqueline van Tongeren of the Amsterdam Institute for Global Health and Development, was confirmed among those who perished; as was Glenn Thomas, 49, a spokesman for the World Health Organization. Both were headed to the AIDS conference.
The International AIDS Society late Friday confirmed the names of three more colleagues who were aboard Flight 17: Pim de Kuijer of Stop AIDS Now, and Lucie van Mens and Maria Adriana de Schutter, both of AIDS Action Europe.
Investigators were still sorting through lists to identify all 298 passengers and crew members who died when the Boeing 777 was shot down Thursday over eastern Ukraine en route from Amsterdam to Malaysia. The U.S. has said it appears pro-Russia Ukrainian separatists were responsible.
More than half of the victims were identified as Dutch, and one had dual American-Dutch citizenship.
They came from 10 countries and included scientists, amateur athletes, tourists and passengers heading home.
President Obama on Friday identified the only known American citizen on the downed plane as Quinn Lucas Schansman, who also had Dutch citizenship. Another passenger with American connections, Karlijn Keijzer, 25, of Amsterdam, was a doctoral student in chemistry at Indiana University and an avid rower.
Obama singled out the AIDS group as a special loss.
“On board Malaysian Airlines Flight MH17, there were apparently nearly 100 researchers and advocates traveling to an international conference in Australia dedicated to combating AIDS/HIV,” he said.
“These were men and women who had dedicated their own lives to saving the lives of others, and they were taken from us in a senseless act of violence.”
“In this world today, we shouldn't forget that in the midst of conflict and killing, there are people like these — people who are focused on what can be built rather than what can be destroyed; people who are focused on how they can help people that they've never met; people who define themselves not by what makes them different from other people but by the humanity that we hold in common,” Obama said. “It's important for us to lift them up and to affirm their lives. And it's time for us to heed their example.”
AIDS researchers and advocates echoed his sentiments, calling the impact on their field “unquantifiable” and the loss of Lange particularly so.
Lange was best known for participating in work in the 1990s that helped discover the effect of combination therapy, the uses of multiple drugs to suppress HIV, which causes AIDS.
Today, millions of people around the world take a variety of antiretroviral medications in such drug cocktails to help keep the virus at bay.
Before such therapies were available, “AIDS was a death sentence,” said Thomas Coates, an expert on HIV prevention who directs the UCLA Center for World Health.
More recently, Lange's work had focused on improving access to HIV medication to disadvantaged populations around the world.
“His loss is more than just a summary of his efforts and his papers,” said Columbia University professor of medicine Scott Hammer, an advisor to several of Lange's projects. “He was not shy about speaking truth to power. He spoke softly and carried a lot of moral heft. He was equally compassionate, and driven for his mission.”
Hammer and other scientists said, however, that until it becomes clear who else was on the plane, it would be hard to assess the incident's broader impacts.
“It's hard to know what it means for the field,” said Dr. H. Clifford Lane, deputy director for clinical research and special projects for the National Institutes of Health's National Institute of Allergy and Infectious Diseases. “But typically at these meetings, we try to have the senior leaders and the leaders of the next generation. If some of the members of that next generation were on that plane, it's extraordinarily devastating.”
He added that he believed the tragedy would inspire remaining researchers, health workers and advocates to reexamine their goals, “remember what they've lost, and do their best to honor [colleagues’] memories.”
AIDS researchers and advocates who knew Lange said they remained anxious, awaiting further word on other colleagues who might have been on the flight.
Harvard School of Public Health professor Richard Marlink said he had spoken by phone with associates who were in Melbourne for the conference. They reported that “everyone is shocked and saddened, and the air is quiet, and small memorial signs are starting to appear,” he said.
Times staff writers Christine Mai-Duc and Maya Srikrishnan contributed to this report.
By Eryn Brown, Michael Muskal
Health experts call for integrated approach to HIV and TB in Zimbabwe
Zimbabwe is facing challenges in eliminating tuberculosis (TB) say health experts, who are calling for much greater integration of HIV and TB programmes within the healthcare system.
Tremendous progress has been made in minimising the spread of HIV while TB programming is weak in comparison, according to Michael Bartos, UNAIDS country director for Zimbabwe.
Strengthening coordination systems
Bartos told a recent workshop for Zimbabwean civil society organisations that there was an urgent need to strengthen coordinating systems across HIV, TB and malaria. The workshop was run by AIDS Accountability International in partnership with Southern Africa AIDS Trust and Zimbabwe AIDS network.
“We need, as civil society, to enhance HIV mobilisation to support TB. There is weak mobilisation of communities where it matters. The issue of resources also needs to be addressed if we are to succeed in eliminating the spread of TB,” Bartos said.
Civil society priorities
At the workshop, representatives from various HIV groups created a priorities charter as an ‘advocacy road map’ for the Global Fund to fight AIDS, TB and malaria. The top priority was the need for a coordinating mechanism for HIV and TB, according to Dr Gemma Oberth, senior researcher at AIDS Accountability International.
“This is because HIV coordinating structures are disproportionately strong, compared with TB civil society networks,” Dr Oberth said.
Some of the priorities identified include prevention, treatment, advocacy, care and support, mitigation and stigma reduction.
Increase in new TB cases
Zimbabwe is ranked 17 among the 22 countries in the world worst affected by TB, according to a research project commissioned by the World Health Organisation.
Victoria James, director of New Dimension Consulting, which carried out the research, said: “The estimated incidence of new TB cases was 633 per 100,000 in 2010 compared to 97 per 100,000 in 1990, reflecting a growing trend. Seventy-five per cent of adult TB cases are reported to be HIV co-infected, while HIV testing in TB is 97 per cent. The treatment rate is very low and civil society needs to focus more on playing a role to address the issues.”
She also highlighted some concerns involving new TB diagnoses, which are reported to have increased from 35,340 in 2013 to 38,725 in 2012.
Lack of resources
According to Dr Charles Sandy, deputy director of AIDS and TB programmes at the Ministry of Health and Child Care, TB is managed through the routine health system. The government is faced with the challenge of a lack of resources, although it collaborates with local and international partners.
“We are dependent on the health delivery system for success of the TB programme. Although we have made some progress in trying to address TB, we are facing challenges of a demotivated health workforce and lack of optimum work performance,” Dr Sandy said.
He added that community awareness in addressing TB was low and more resources were needed to address the challenges. Sandy said the government worked with civil society organisations through the Country Coordinating Mechanism and invited them to make suggestions on how they could be more involved.
Image: Emmanuel Gasa, a young HIV/AIDS activist working within the civil society and attending workshop, Zimbabwe
© Wallace Mawire
By Wallace Mawire
7 May 2014
Discrimination without Distinction of Any Kind?
Snapshot of African civil society demands versus Addis Ababa Declaration
This paper is a snapshot comparative analysis of the Civil Society African Common Position on International Conference on Population and Development (ICPD) and the official Addis Ababa Declaration. It provides a brief examination of the differences and similarities between these two documents, which were both produced during the African ICPD review process. It also seeks to examine where the Addis Declaration fell short of CSO demands and then whether country positions on human rights commitments such as the Maputo Protocol affected their position on the Addis Declaration. This paper seeks to provide a snapshot of some of the obvious gaps in human, sexual and LGBT rights and accountability between what civil society demanded and what the Addis outcome provided. Discrimination without distinction of any kind Munyati and Tucker