11 JUNE 2010, VOLUME 11, ISSUE 20

The young Congolese woman was fetching water from a well when the gang surrounded her, threw her to the ground and brutally raped her at gunpoint. But her troubles were only beginning: months later she found that she was infected with HIV. The deadly virus that causes AIDS, contracted through unprotected sex, is a double tragedy for women, and for their children who are left motherless or entirely alone. But Tuesday in Washington the announcement of a clinical trial for a new microbicide vaginal ring offered hope for the millions of women who are vulnerable to the most deadly sexually transmitted disease. "Women in Africa lack the power to negotiate safe sex," said Elizabeth Mataka, the UN special envoy for AIDS in Africa, speaking at the Women Deliver conference. "They need something that nobody knows they are using, and nobody needs to agree on."

The stakes are high: Some 682,000 women die each year from HIV-related causes, many as result of sexual activity over which they had no control. AIDS is the leading global cause of death for women of reproductive age. The microbicide ring, developed by the non-profit International Partnership for Microbicides, could be a game-changer, by giving women invisible protection against the virus through slow and controlled release of drugs into the vagina over extended periods of time.

With maternal and reproductive health as a global priority, a three-day conference, Women Deliver 2010, has kicked off in Washington DC under the theme "Invest in women. It pays." The event's main focus is to highlight that the Millennium Development Goals (MDG) will not be achieved without investing in women and that there is just enough time, if the world commits funding now, to achieve the MDG's fifth goal of improving maternal health. UNAIDS Executive Director Michel Sidibe and newly appointed UNAIDS Goodwill Ambassador Annie Lennox gave the welcome address and opening plenary on the first day of the conference. "If we integrate HIV into maternal health programmes, we can make huge progress on almost every global development goal. We can stop mothers from dying of HIV and dramatically reduce maternal mortality. Let's join together," said Mr Sidibe. Ms Lennox, who spoke on the topic Women Need a World that Delivers added, "I believe that the AIDS response is an excellent entry-point to better invest in women and girls at all levels, and to advance women's sexual and reproductive rights. We need to empower women and girls so that they can better protect themselves and take control of their own sexual and reproductive health."

Calling on world health leaders to do more to prevent deaths of mothers and their newborn babies, Melinda Gates said today the Gates Foundation is pledging $1.5 billion over the next five years for family planning, maternal and child health and nutrition in developing countries. It's the second largest donation in the foundation's history, after a $10 billion pledge over 10 years for vaccine development and delivery made in January, and indicates a new direction for the foundation, which has focused on diseases such as malaria and HIV/AIDS. The foundation announced today initial grants of $94 million in India and $60 million in Ethiopia. Among the grants for India, Seattle-based PATH received $24.3 million to demonstrate a model for health services that will save lives of newborns and reduce illness and death of mothers. Gates challenged the idea that "large numbers of maternal and child deaths are inevitable, or even acceptable, in poor countries."

"It is not that the world doesn't know how to save the 350,000 mothers and 3 million newborns who die every year," she said, speaking at a women's health conference in Washington D.C. "It is that we haven't tried hard enough." Gates said she would make the health of women and children her personal priority as co-chair of the world's largest charitable foundation. The foundation will alter its model from one focused on specialized diseases to a more integrated approach.

A non-profit that develops drugs against HIV/AIDS said Tuesday it is launching the first study in Africa of a groundbreaking device to fight AIDS: a vaginal ring with a difference. Where most vaginal rings deliver contraceptive hormones, the one developed by the International Partnership for Microbicides (IPM) discreetly releases antiretrovirals to women who use it.

IPM will launch double-blind randomized, placebo-controlled studies of the ring containing 25 milligrams of the new antiretroviral drug dapivirine at research centers in southern and eastern Africa, where the AIDS epidemic is hitting hardest. Recent data released by the World Health Organization (WHO) show HIV/AIDS is the leading cause of death globally in women 15 to 44 years old. In Africa, HIV/AIDS is the single most important cause of disease for a wider range of women, aged 15-59.

For the trials of IPM's vaginal ring, some 280 healthy, sexually-active, HIV-negative women will be given either the dapivirine ring or a placebo ring, which they will have to replace every month during the three-month study. They will also be given condoms and counseling on how to prevent AIDS. The studies will measure the acceptability of the vaginal ring and whether the women can and will correctly use the once-monthly product. "You have to make sure that a product is acceptable before you test its efficacy, because if people don't like the product, what's the point?" Pamela Norick, a spokeswoman for IPM, told AFP at the Women Deliver health conference in Washington. Women are already being enrolled for several studies of the ring in South Africa, and IPM has "been working in many other countries in eastern and southern Africa where we are waiting for regulatory approval before we begin studies there," Zeda Rosenberg, CEO of IPM, told AFP.

UN Secretary General Ban Ki-moon on Monday called on world governments to work with the United Nations to improve women's and children's health by the UN-set target date of 2015. "I am here today with a clear message: if we act now, and act together, we can deliver for women," Ban said in the keynote speech to open the Women Deliver conference on health. "We must fight for women's health with all our resources, all the time. When we work together, we succeed," Ban said, unveiling an action plan that would unite the United Nations and world governments in an effort to "deliver for mothers and children."

A consortium of AIDS organizations has given the South African government three months to deliver on promises to integrate TB and HIV services. A local AIDS lobby group, the Treatment Action Campaign (TAC), international medical charity Medicines Sans Frontiers (MSF), and the AIDS and Rights Alliance for Southern Africa (ARASA), a regional partnership of non-governmental organisations, were among civil society groups that issued the deadline at the South African TB Conference in the port city of Durban. MSF spokesperson Lesley Odendal called the three-month deadline "generous" because TB and HIV care should have been integrated by 1 April 2010, according to newly adopted national antiretroviral (ARV) treatment guidelines, but the Department of Health has yet to issue an implementation plan. "Patients are still going to different sites, and healthcare workers still have not been trained on new guidelines," said TAC Deputy Secretary General Lihle Dlamini. "One patient who has both diseases should be seen by one healthcare worker with one file." Dlamini noted that integrating TB and HIV care would lead to earlier diagnosis of TB, especially strains of the disease occurring outside the lungs, which are common in co-infected patients. It would also help health workers become more familiar with the potentially severe interactions between antiretroviral (ARV) and TB drugs.

This week's issue of The Lancet covers a range of global issues on maternal, newborn, and child health. On June 7-9, Washington, DC, USA, will host the Women Deliver and Countdown to 2015 joint conference, which will build on the current momentum behind achieving Millennium Development Goals (MDGs) 4 and 5 (improving child, maternal, and sexual and reproductive health). Although the links between the health-related MDGs (which include MDG 6, to combat HIV/AIDS, malaria, and other diseases) is increasingly being realised, one glaring omission from the conversation on how the targets will be met in 2015 is the essential contribution of MDG 3 -- to promote gender equity and empower women.

Solving the predicaments facing women is a crucial development objective. But it is also a neglected instrument for health. Women and girls make up 60% of the world's poorest people and two-thirds of the world's illiterate people. Yet, with education and empowerment, they can lead healthy lives, lift themselves and their families out of poverty and disease, usually marry later, and have fewer and healthier children who are more likely to attend school themselves. The MDG 3 target was to eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015. The indicators for MDG 3 are: ratios of girls to boys in primary, secondary, and tertiary education; share of women in wage employment in the non-agricultural sector; and proportion of seats held by women in national parliament.

Researchers have started testing the safety of a vaginal ring containing an antiretroviral drug in South Africa in the hope that it has the potential to prevent HIV infection in women. The clinical trial, known as IPM 015 will test the safety and acceptability of the dapivirine-containing vaginal ring -- which is successfully used in Europe as a delivery method for hormonal therapy and birth control. Announcing the commencement of the trial at the Women Deliver conference in Washington DC yesterday (TUES), CEO of the International Partnership for Microbicides (IPM) Zeda Rosenberg said the vaginal ring could be well suited to deliver HIV prevention drugs for women in developing countries.

The vaginal ring used in IPM 015 is made of flexible silicone, is durable and would be easy to distribute -- making it well suited for use in developing countries. Each ring slowly releases 25 mg of the ARV drug dapivirine over the course of 28 days, potentially providing sustained protection against HIV. The vaginal rings used in this study and can be easily self-inserted. The women participating in the study will use a ring for 4 weeks at a time (plus or minus 4 days), at which point it will be replaced with a new ring, over the course of three months. Participants will be asked to complete a total of 6 visits to the research centre, including a follow-up visit 4 weeks after the last ring is removed.

The vaginal ring containing dapivirine has already been shown to be safe as tested in four prior IPM clinical trials among women in Europe, with another trial ongoing. If IPM 015 further confirms the safety and acceptability of the product among women in Africa, a Phase III program to test the ability of dapivirine rings to prevent HIV infection is scheduled to begin in Africa in 2011, with results due in 2015.

Perhaps tellingly, the Fifth International Conference on HIV Treatment Adherence conference in Miami this week was not bursting with evaluations of adherence interventions which conclusively demonstrated that a given intervention was effective in a specific population. Indeed, when Mahnaz Charania of the Centers for Disease Control and Prevention (CDC) outlined the methodology of the CDC's efficacy review of adherence interventions, she indicated that in the draft results, there were only eight interventions considered to have "promising evidence" of efficacy. They found none with "best evidence" of efficacy. (The CDC only considered studies conducted in the United States). Charania gave only limited details, but did indicate that two of the eight involved specific ways of delivering antiretroviral therapy (via a methadone clinic or mobile van), while the other six were educational or behavioural interventions. Common features of the latter were that they were all delivered by a nurse or primary healthcare provider, all had a cognitive-behavioural component (for example addressing barriers), several featured a nominated support partner and half included problem solving.

In 2007, the United Nations Joint Programme on HIV/AIDS (UNAIDS) concluded that "Global HIV incidence likely peaked in the late 1990s", due to "natural trends in the epidemic as well as the result of prevention programmes". The slow decline in new infections together with a recent rise in antiretroviral therapies (ARTs) halted the rise in the estimated number of AIDS deaths at about 2.2 million per year -- equivalent to 4% of all global deaths. Among adults 15 to 49, the proportion currently infected with HIV (HIV prevalence) plateaued at just under 1% before declining to 0.8% worldwide. These trends raise the question of how global health funding should be rebalanced between AIDS treatment and HIV prevention, as well as other health-care investments.

African women are no strangers to overcoming adversity. Every day across Tanzania, women perform small miracles, working long hours or traveling great distances to provide for their families. Increasingly, they are starting small businesses and running for office -- while at the same time tending homes and raising children.

But when it comes to staying healthy, the odds are stacked against women. Biology and gender inequality make women, especially mothers, more vulnerable to disease and death. In some parts of sub-Saharan Africa, one in every 22 women still dies during pregnancy or childbirth as compared to one in every 4,800 women in the United States and only one in every 47,600 in Ireland. It is unconscionable that being born female increases a woman's risk for disease and premature death. Women have too few choices about their health and too few options that would give them the chance for a safe and healthy life. That is why we applaud the growing attention being paid to the health of women and mothers around the world.

Just this week, 3,500 world leaders, advocates and health experts, including First Lady Mama Salma Kikwete, are gathering at the Women Deliver conference in Washington D.C. to keep up the pressure to improve the lives of women and girls worldwide.

It took 105 years for researchers to develop a vaccine against the deadly typhoid disease and 89 to get one against polio. This is what Mitchell Warren, the executive director of the AIDS Vaccine Advocacy Coalition (AVAC) often tells anxious prevention advocates seeking answers to why it has taken so long to come up with an HIV vaccine. He has always been an optimist in the face of adversity. "For years now researchers and scientists have been working hard to develop an HIV vaccine but this is a very involving process, it takes years of hard work, disappointments and starting all over again but we will eventually get there," Warren told journalists at the just-ended International Microbicides Conference in Pittsburgh, US. "When you look at other diseases and the time between discovery of microbiologic cause of that disease and development of the vaccine you can see that a vaccine cannot be developed overnight otherwise you will have a product on the market that will do more harm than good for people. "There are numerous checks and balances, we all have to be patient but while scientists and researchers develop a vaccine those living with HIV must be given the right care and treatment."

Researchers exploring possibilities of a prevention method that will help protect women from HIV infection are hopeful that the first clinical trials assessing the effectiveness of an Antiretroviral (ARV)-based microbicide gel running in a number of countries including Zimbabwe will yield positive results. For years, researchers have been trying to develop a microbicide gel that women can use before engaging in sex which would help protect them from HIV infection, against a background of high infection rates among women in southern Africa.

Women account for at least 60% of the total HIV infections in the region and researchers are keen to remove the burden of the disease from them by developing a prevention method they themselves can control. The development of a female-controlled prevention method comes at a time of increasing concerns that women lack the power to influence their partners to use protection such as condoms leading to higher infection rates.

But this time researchers say they are optimistic about the outcome of the clinical trials now taking place in Zimbabwe and South Africa because it is the first time that an ARV-based microbicide is being tested.  ARVs have already been shown to prolong the lives of those taking them by reducing the viral load. Zimbabwe is currently conducting a number of studies but researchers are looking forward to the outcome of the Vaginal and Oral Interventions to Control the Epidemic (Voice), a major HIV prevention trial.

Dr. Peter Mugyenyi discusses how far Uganda has come in the fight against HIV/AIDS.

More than 800 men have been circumcised in KwaZulu-Natal to help combat HIV infections, said premier Zweli Mkhize on Tuesday. "So far 800 males have been circumcised as of the end of April. We are very happy with the programme," said Mkhize. He said the provincial government had set a target of circumcising 47,055 newborn boys and 186,703 males during the 2010/11 financial year. The KwaZulu-Natal government recently mobilised traditional leaders in the province to rally behind King Goodwill Zwelithini's call for young men to undergo medical circumcision to help prevent new infections. Strong evidence from clinical trials in Orange Farm in Gauteng, Kenya, and Uganda had demonstrated that circumcised males had close to 60 percent less chance of acquiring HIV during sexual intercourse than uncircumcised men.

Recent years have seen an unprecedented surge of global attention to maternal, newborn, and child health (MNCH). However, despite repeated commitments and calls for action, no major, specific new funding has been directed at the MNCH continuum of care during the past 12-18 months. A UN event in September, 2009 resulted in strong rhetorical and -- it seemed -- financial commitments. But of the US$5.3 billion nominally pledged at that event, almost none was specifically for MNCH programmes; rather, it was promised broadly to commodities, health-system strengthening, and vaccines.¹ These pledges, if fulfilled, will improve maternal and child health outcomes by strengthening overall health services, but will not necessarily generate new funds for essential MNCH interventions, including: family planning; skilled care during and after pregnancy and childbirth; safe abortion, when legal; immediate postnatal care for mother and newborn child; and improved child nutrition and management of childhood illnesses.

Will this situation change? Will key policy makers respond to calls for greater resources to realise the targets for the health Millennium Development Goals (MDGs) 4 (improve maternal health), 5 (reduce child mortality), and 6 (combat HIV/AIDS, malaria, and other diseases)? That remains to be seen. But an extraordinary combination of initiatives and opportunities in the coming months could prompt revolutionary funding changes and concrete actions by donors, countries, and other contributors.

A complex mix of issues drives drug-resistant tuberculosis (TB) patients to default on medication, not least of which are alcohol and money, according to new research presented by Medicines Sans Frontiers (MSF), the international medical charity, at the South African TB Conference in the east-coast city of Durban. When 22 percent of drug-resistant TB patients defaulted on treatment at one of MSF's clinics in the Cape Town township of Khayelitsha, despite access to services such as counselling and treatment support groups, TB councillors reviewed patient records to find out why.

Busisiwe Beko, a counsellor and former drug-resistant TB patient, found that household instability - often caused by a household member's alcohol abuse - circular migration to and from the neighbouring Eastern Cape Province, and financial pressures, were among the primary factors derailing treatment. Treating drug-resistant TB - including multidrug-resistant TB (MDR-TB) and extremely drug-resistant TB (XDR-TB) - can take up to 24 months and comes with a battery of injections, pills, and adverse reactions that leave many unable to work, even when they are no longer infectious.

Women in sub-Saharan Africa bear a significant burden in the HIV epidemic: two-thirds of those living with HIV/AIDS live in the region, and an estimated 60% of those infected are women. Evidence is building that the reproductive health needs of many HIV-infected women are unmet, one result of which is high rates of unintended pregnancy. Though largely preventable, mother-to-child transmission of HIV and maternal death increase when women do not have adequate access to reproductive health services. 

One potential way to better meet the full range of health needs for women who are HIV-positive or who are at risk of infection is to offer family planning and HIV services in one facility. For many HIV-positive women, contraceptive access is limited because they are required to visit two different clinics, which requires additional resources in time and travel.

A growing number of stakeholders are advocating for integrated services; however, little evidence exists to confirm that this model is effective, feasible, and acceptable to women. Ibis Reproductive Health has collaborated with the University of California, San Francisco (UCSF) and the Kenya Medical Research Institute since 2007 on a pilot project focused on answering such questions about integrating family planning and HIV services. So far, the research team has completed an assessment of the barriers to providing integrated services, interviews with clinic staff, and surveys of the family planning knowledge, attitudes, and practices of clients at HIV clinics, as well as their interest in obtaining family planning services at an HIV clinic. The team is now building on that work with a new phase of the project that will evaluate a model for offering family planning services at HIV care and treatment facilities and for training staff at 18 clinics in Nyanza Province, Kenya.

For decades public health professionals and researchers have been battling HIV and studying the links between mother-to-child transmission (MTCT) and ways to empower females to practise safe sex due to the prevalence of male-to-female transmission. Strides have been made but the rate of treatment is dwarfed by transmission, 2:5 according to Microbicide Trial Network's (MTN) analysis of 2007 data from UNAIDS and the US Center for Disease Control (CDC), meaning that for every five people who are infected, two receive treatment. "In sub-Saharan Africa women aged 15 to 24 are the highest risk group. Globally, women account for half of all HIV infections, and in sub-Saharan Africa, women comprise 60 percent of all infected adults," and in "southern Africa women aged 15 to 24 are at least three times more likely than their male peers to be infected with HIV." Rings, tablets and films are now in development and testing to empower women to take control of their own health by offering new therapeutic drug delivery and more discreet, longer lasting options than microbicide gels.

Britain has this week fundamentally changed the way we support the world's poorest. There won't be any less money -- in fact, there'll be more. But we are taking a new approach to the way that money is spent, and how spending is monitored. It's time to bring greater transparency and accountability to overseas aid.

To start with, we are going to publish online details of every international development programme, letting people see where aid money should be going. Over time we also want that information to get to the very communities who depend on the funding, so they can blow the whistle if it doesn't get through. Too much aid is too often misplaced, and too much lost to corruption. So we're creating an independent aid watchdog to make sure development projects pass the most crucial test: how many lives were saved or improved?

Making sure that every pound counts means being realistic and practical about what aid can achieve. Without being hard-hearted, we have to be hard-headed. We should ask: "What are the things that aid can best deliver and that make a real long-term difference?" That's why we've focused on things like anti-malaria bednets and vaccinations for children. It's obvious that without a healthy young population a country can never grow prosperous; it's just as obvious that we should look after women, for they hold the key to development.

On taking over as [South African] minister of health a year ago, Aaron Motsoaledi declared himself "shocked" by the state of the public health-care system. Media horror stories about dirty and overcrowded hospitals, long waiting times, lack of medicines and a shortage of medical staff were largely true, he admitted: "I don't think it will be an exaggeration to say that some of our hospitals are death traps."

Money is not the main reason. The government is pumping over 100 billion rand into the system this year, which amounts to 12% of its budget and 3.7% of GDP -- not massive, but more than most provincial governments (who are responsible for health care) know how to spend. The main problem is once again an acute shortage of qualified staff. Many thousands of public-sector doctors, nurses and other medical practitioners have left the country, fed up with the poor pay and appalling conditions. Others have gone into the rapidly expanding private sector. A study in 2007 found that one-third of public medical posts were unfilled. In some hospitals the vacancy rate for nurses is as high as 60%. The public sector now has just one doctor for every 4,570 inhabitants, against one for every 600 in private medicine. For specialists the disparity is even greater.

The number of new HIV infections is worrying and all efforts to reverse the trend should be put in place, [Uganda] President Museveni has said. Mr Museveni was on Monday speaking at a parliamentary event to award 12 individuals who have contributed to the fight against HIV/Aids in their communities. HIV prevalence rate declined from 25 per cent in the early 1990s to five per cent in 2000 but has crept higher to between six and seven per cent. He said part of the rise in new infections can be attributed to a lot of emphasis being put on condom use by the youth instead of emphasising abstinence. He noted that stressing the use of condoms as the main strategy in the fight against HIV/Aids was dangerous for the youth.

One of South Africa's most eminent HIV scientists has been accused of causing "preventable deaths" during a clinical trial he conducted on people co-infected with HIV and TB. Reaction to the trial, published this year in the New England Journal of Medicine, has split the South African HIV/AIDS community with a number of HIV clinicians criticising the study design.

But Professor Salim Abdool Karim, Pro Vice-Chancellor at the University of KwaZulu-Natal, says that it is easy to judge his trial with the benefit of hindsight. "But when the trial was designed, there were no clear guidelines about whether TB and HIV could be treated together, mainly because of concerns about how patients would tolerate the drugs, how the drugs would interact and concerns about 'Immune Reconstitution Syndrome [a resurgence of latent infections]," said Abdool Karim.

Between 2005 and 2008, Abdool Karim and colleagues conducted a trial on 642 patients on TB treatment to establish when they should start antiretroviral treatment. The trial, "Starting ARV therapy at three points in TB therapy" (SAPiT), divided patients into three groups. The first two groups started ARVs while on TB treatment, while the third group only started ARVs once they had completed their six-month TB treatment.

Aids vaccine researchers are frustrated by the high pregnancy rates among women participating in clinical trials. Now they want abstinence scrapped as a family planning method in future Aids vaccine clinical studies. Writing of their frustrations in the current issue of the East African Medical Journal, a team of local researchers led by Prof Walter Jaoko of the University of Nairobi says that for them to succeed in their research, female participants in Aids vaccine trials must agree to use effective contraceptives. The period within which they must stay pregnancy-free is specified as the effects of the vaccine on the unborn child are not known.

The Kenya Aids Vaccine Initiative (Kavi) researchers tell of one study where 39 participants were enrolled for trials. The women received family planning counselling and were offered a choice of contraceptive methods at no cost. But four women conceived during the study. "All four had opted for abstinence, but said they were coerced by their partners into unprotected sex," says the study. The researchers say that sexual abstinence should no longer be an option.  Explaining why abstinence has been an option, Kavi programme director Omu Anzala says at the early stages of the study, they select women with the lowest or zero risk of contracting HIV. "At Phase I of the trials, we are testing mainly two things -- the vaccine's safety and whether it elicits any immune response and therefore need participants at very low risk of HIV infection," Prof Anzala said in an interview on Tuesday.

See study published in East African Medical Journal, "Pregnancy rates among female participants in phase 1 and phase 2A AIDS vaccine clinical trials in Kenya"

Katitia Pitts stands before a small group of people at a health centre in Washington and waves a female condom in the air. "It squeaks, ... but it protects," she says. The condoms, which have been on the market for years, have finally been discovered by health officials in Washington, DC, where 3 per cent of the residents are HIV positive -- a rate higher than that in some developing countries. The city is the first in the country to begin a large-scale offensive using female condoms as a weapon. Half a million condoms are being distributed to women by health officials like Pitts. "If your partner doesn't want to protect you, you can protect yourselves," she tells her audience at the Christian CATAADA House (Calvary's Alternative to Alcohol and Drug Abuse House) in the impoverished south-eastern quadrant of the US capital.

Giggles ripple through the sparsely furnished, neon-lit classroom as Pitts lays a rubber model of the lower part of a female body on a table to demonstrate how to use the condom -- an 18-centimetre-long plastic tube, equipped with rings on both ends. The inner, sealed ring is put in the vagina. "Put the ring in place and pull the condom through the vagina," Pitts explains. "It has the advantage of being notably less noisy than the previous models," she says with a laugh. "If you use it one year and sleep with a positive partner, you decrease your infection chance by 90 per cent," she adds.

Slathered in face paint, toting samba drums and waving national flags, the world's most ardent soccer fans are streaming into South Africa for the 2010 World Cup. And they're being met by a host of reminders not to forget the tournament's most essential accessory: a condom. South Africa has the world's highest incidence of HIV/AIDS, with 5.7 million of its 49.1 million residents afflicted, roughly 12 percent of the population. In some regions, one in five adults is HIV-positive. The nation's health advocates have long eyed the advent of the world's biggest sporting event as an opportunity to draw global attention to the crisis, stress the importance of HIV testing and promote safe-sex practices -- not just among the 300,000 visitors who aren't necessarily known for prudent behavior amid their soccer-crazed and often alcohol-fueled euphoria, but among their own residents, as well.

But as Friday's kickoff approaches, those at the forefront of the campaign say FIFA, soccer's world governing body, has been half-hearted in linking South Africa's most pressing health issue to its grandest event -- a charge FIFA officials deny. "What I hoped I would see at the World Cup would be very visible messaging," said Mark Heywood, deputy chairman of the South African National AIDS Council. "Obviously you don't want to drown out the World Cup; you don't have to spoil the party. None of us is suggesting that you have to have explicit safe-sex advertising on television being beamed around the globe. We're simply suggesting: 'Know your HIV status. Practice safe sex.' "

Heywood's comments followed a three-day duel of news releases that started Saturday, when a consortium of 10 South African HIV/AIDS groups accused FIFA of blocking plans to distribute condoms and health information outside its 10 World Cup venues and at officially designated "Fan Parks," where supporters will gather to watch matches on giant screens.

See related articles: "South Africa: Straight talk with FIFA's Social Responsibility head" posted 10 June on IRIN/PlusNews; "FIFA to spread HIV educational message at World Cup" posted 5 June on Reuters; "South Africa: World Cup HIV prevention plans fall short" posted 4 June on IRIN/PlusNews; and "AIDS groups slam FIFA for blocking condoms at World Cup" published 3 June by Agence France-Presse.

In the three decades since the HIV/AIDS epidemic began, nearly 60 million people worldwide have been infected with HIV and more than 25 million have died of HIV-related causes. Every day, at least 7,400 people become newly HIV-infected. Despite progress in providing treatment to people who need it, these efforts cannot keep up with the number of new HIV infections. For every two individuals with HIV who begin taking antiretroviral therapy to manage the virus, five additional people become newly infected. This is why USAID continues to support the quest for a safe vaccine that could effectively prevent HIV infection -- a search that is commemorated on May 18, HIV Vaccine Awareness Day.

Since 2001, USAID has contributed $134 million to try to discover an HIV vaccine through a major partnership with the International AIDS Vaccine Initiative. In addition, several universities, biotechnology and pharmaceutical companies, and other U.S. government agencies are working to find a vaccine. The first study to test an experimental HIV vaccine in humans was conducted in 1987, and some question why a safe and effective vaccine is not yet available. "Vaccines have always been our best weapon against some of our worst diseases, including polio and smallpox. But what people seem to forget all too easily is that it often took 50 years or more to discover and develop those vaccines," said Margaret McCluskey, senior technical advisor for HIV vaccine research in the Office of HIV/AIDS, part of USAID's Bureau for Global Health. "From each clinical trial, we learn valuable lessons that serve to better design the next clinical trial until ultimately we find a vaccine that works."

Complicating the search for a vaccine has been HIV's tricky biological properties. Unlike other viruses, HIV has the ability to hide in an infected person's cells while also rapidly mutating, escaping, and evolving. And because the virus ravages critical immune system cells designed to fight infection, most people are unable to clear the infection naturally.

Background In 2008, the IAS-USA published the revised guidelines for the use of HAART in adults substantially increasing the number of individuals eligible for HAART. The epidemic in British Columbia (BC) is mainly among men who have sex with men and those with injection drug use. Here, we explored the potential impact of different HAART coverage scenarios, based on the new guidelines, on the HIV-related incidence, morbidity and mortality in BC, Canada.

Methodology We built a mathematical transmission model to investigate different HAART coverage scenarios (50%, 60%, 75% and 100%) of those medically eligible to receive HAART under the 2008 IAS guidelines. All new scenarios were compared to the current coverage in BC under the 2006 IAS guidelines (i.e. baseline scenario). In BC, it is estimated that 25-30% of individuals are unaware of their status. Costs were drug-related and reported in Canadian dollars. HIV-related morbidity and mortality were estimated based on the disability-adjusted life years (DALY) methodology.

Principal Findings Currently, there are 4379 individuals on HAART under the IAS 2006 guidelines and 6781 individuals who qualify for treatment based on the new guidelines. Within 5 years, increasing HAART coverage decreased yearly new infections by at least 44.8%. In the 50% scenario, in 5 years, DALY decreased by 53% corresponding to 4155 averted DALYs, and in 25 years it decreased by 66% corresponding to 5837 averted DALYs. The effect was even stronger if the 75% scenario was chosen instead. Compared to the 100% expansion scenario, we observed an excess in annual direct treatment expenditures at the end of 5 years of approximately 1 million dollars in the 75% scenario, and of approximately 2 million dollars in the 50% scenario.

Conclusions/Significance The individual and public health benefits of these new guidelines are immense. The results show that by increasing the number of individuals on HAART save lives, it is cost averting, and it positively impacts society by decreasing the number of new HIV infections. Thus, public health community should consider incremental gains when considering guidelines and policy.

Eliciting a broadly neutralizing polyclonal antibody response against HIV-1 remains a major challenge. One approach to vaccine development is prevention of HIV-1 entry into cells by blocking the fusion of viral and cell membranes. More specifically, our goal is to elicit neutralizing antibodies that target a transient viral entry intermediate (the prehairpin intermediate) formed by the HIV-1 gp41 protein. Because this intermediate is transient, a stable mimetic is required to elicit an immune response. Previously, a series of engineered peptides was used to select a mAb (denoted D5) that binds to the surface of the gp41 prehairpin intermediate, as demonstrated by x-ray crystallographic studies. D5 inhibits the replication of HIV-1 clinical isolates, providing proof-of-principle for this vaccine approach. Here, we describe a series of peptide mimetics of the gp41 prehairpin intermediate designed to permit a systematic analysis of the immune response generated in animals. To improve the chances of detecting weak neutralizing polyclonal responses, two strategies were employed in the initial screening: use of a neutralization-hypersensitive virus and concentration of the IgG fraction from immunized animal sera. This allowed incremental improvements through iterative cycles of design, which led to vaccine candidates capable of generating a polyclonal antibody response, detectable in unfractionated sera, that neutralize tier 1 HIV-1 and simian HIV primary isolates in vitro. Our findings serve as a starting point for the design of more potent immunogens to elicit a broadly neutralizing response against the gp41 prehairpin intermediate.

The sensitivity and specificity of 3 rapid HIV antibody tests were assessed at 5 clinical trial sites in Africa and 1 site in the United States using a minimum of 100 HIV antibody positive samples and 100 HIV antibody negative samples at each site. The overall sensitivity and specificity for the OraSure OraQuick, Abbott Determine, and Trinity Unigold tests were 99.3%, 99.8%, and 98.5%, respectively, and 99.3%, 99.4%, and 99.5%, respectively. There were no instances at any site in which false-negative or false-positive results were obtained for the same sample on more than 1 rapid test kit. The results of this study provide assurance that for these diverse sites in Africa, the accuracy of these kits is quite good. Given the excellent accuracy, relatively fast turnaround time, and minimal infrastructure required, these rapid tests for HIV antibody provide a very attractive and accurate testing format.

Clinical trials routinely exclude expectant mothers. This is unethical and unscientific, and regulators must mandate change, says Francoise Baylis, in the second of three related pieces on gender bias in biomedicine. International ethical guidelines drawn up by the Council for International Organizations of Medical Sciences¹ clearly stipulate that pregnant women are eligible to participate in biomedical research. Yet they are routinely excluded from the vast majority of clinical trials of drugs, vaccines, nutraceuticals, natural health products and medical devices because of the harm the intervention might do to the developing fetus.

Background The ability of specific behaviour-change interventions to reduce HIV infection in young people remains questionable. Since January 1999, an adolescent sexual and reproductive health (SRH) intervention has been implemented in ten randomly chosen intervention communities in rural Tanzania, within a community randomised trial (see below; NCT00248469). The intervention consisted of teacher-led, peer-assisted in-school education, youth-friendly health services, community activities, and youth condom promotion and distribution. Process evaluation in 1999-2002 showed high intervention quality and coverage. A 2001/2 intervention impact evaluation showed no impact on the primary outcomes of HIV seroincidence and herpes simplex virus type 2 (HSV-2) seroprevalence but found substantial improvements in SRH knowledge, reported attitudes, and some reported sexual behaviours. It was postulated that the impact on "upstream" knowledge, attitude, and reported behaviour outcomes seen at the 3-year follow-up would, in the longer term, lead to a reduction in HIV and HSV-2 infection rates and other biological outcomes. A further impact evaluation survey in 2007/8 (~9 years post-intervention) tested this hypothesis.

Methods and Findings This is a cross-sectional survey (June 2007 through July 2008) of 13,814 young people aged 15-30 y who had attended trial schools during the first phase of the MEMA kwa Vijana intervention trial (1999-2002). Prevalences of the primary outcomes HIV and HSV-2 were 1.8% and 25.9% in males and 4.0% and 41.4% in females, respectively. The intervention did not significantly reduce risk of HIV (males adjusted prevalence ratio [aPR] 0.91, 95%CI 0.50-1.65; females aPR 1.07, 95%CI 0.68-1.67) or HSV-2 (males aPR 0.94, 95%CI 0.77-1.15; females aPR 0.96, 95%CI 0.87-1.06). The intervention was associated with a reduction in the proportion of males reporting more than four sexual partners in their lifetime (aPR 0.87, 95%CI 0.78-0.97) and an increase in reported condom use at last sex with a non-regular partner among females (aPR 1.34, 95%CI 1.07-1.69). There was a clear and consistent beneficial impact on knowledge, but no significant impact on reported attitudes to sexual risk, reported pregnancies, or other reported sexual behaviours. The study population was likely to have been, on average, at lower risk of HIV and other sexually transmitted infections compared to other rural populations, as only youth who had reached year five of primary school were eligible.

Conclusions SRH knowledge can be improved and retained long-term, but this intervention had only a limited effect on reported behaviour and no significant effect on HIV/STI prevalence. Youth interventions integrated within intensive, community-wide risk reduction programmes may be more successful and should be evaluated.

See related article also published in PLoS Medicine, "Where to for sexual health education for adolescents in sub-Saharan Africa?"

Background The Brazilian response towards AIDS epidemic is well known, but the absence of a systematic review of vulnerable populations - men who have sex with men (MSM), female sex workers (FSW), and drug users (DU) remains a main gap in the available literature. Our goal was to conduct a systematic review and meta-analysis of studies assessing HIV prevalence among MSM, FSW and DU, calculating a combined pooled prevalence and summarizing factors associated the pooled prevalence for each group.

Method Nine electronic databases (MEDLINE via PubMed, EMBASE, Cochrane CENTRAL, AIDSLINE, AMED, CINAHL, TOXNET, SciELO, and ISI-Web of Science) were searched for peer-reviewed papers published in English, French, Spanish or Portuguese, from 1999 to 2009. To be included in the review, studies had to measure HIV prevalence and/or incidence as the primary outcome among at least one specific population under analysis.

Results The studies targeting the three populations analyzed mostly young participants aged 30 years or less. Among FSW, eight studies were selected (3,625 participants), consistently identifying higher condom use with sexual clients than with occasional and stable partners. The combined HIV prevalence for FSW was 6.2 (95% CI: 4.4-8.3). Ten studies targeting MSM were identified (6,475 participants). Unprotected anal intercourse was commonly reported on those studies, but with great variability according to the nature of the relationship - stable vs. occasional sex partners - and sexual practice - receptive vs. insertive anal sex. Pooled HIV prevalence for MSM was 13.6 (95% CI: 8.2-20.2). Twenty nine studies targeting DU were identified (13,063 participants). Those studies consistently identified injection drug use and syringe/needle sharing as key predictors of HIV-infection, as well as engagement in sex work and male-to-male sex. The combined HIV prevalence across studies targeting DU was 23.1 (95% CI: 16.7-30.2).

Conclusions FSW, MSM and DU from Brazil have a much risk of acquiring HIV infection compared to the general population, among which HIV prevalence has been relatively low (~0.6%). Those vulnerable populations should be targeted by focused prevention strategies that provide accurate information, counseling and testing, as well as concrete means to foster behavior change (e.g. access to condoms, drug abuse treatment, and clean syringes in the case of active injecting drug users), tailored to gender and culture-specific needs. Programs that provide these services need to be implemented on public health services throughout the country, in order to decrease the vulnerability of those populations to HIV infection.

Background. Human immunodeficiency virus (HIV) replication and immune activation may increase inflammation and coagulation biomarkers. Limited data exist comparing such biomarkers in persons with and without HIV infection.

Methods. For persons 45-76 years of age, levels of high-sensitivity C-reactive protein (hsCRP), interleukin (IL)-6, D-dimer, and cystatin C were compared in 494 HIV-infected individuals in the Strategies for Management of Anti-Retroviral Therapy (SMART) study and 5386 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) study. For persons 33-44 years of age, hsCRP and IL-6 levels were compared in 287 participants in the SMART study and 3231 participants in the Coronary Artery Development in Young Adults (CARDIA) study.

Results. hsCRP and IL-6 levels were 55% (P<.001) and 62% (P<.001) higher among HIV-infected participants than among CARDIA study participants. Compared with levels noted in MESA study participants, hsCRP, IL-6, D-dimer, and cystatin C levels were 50%, 152%, 94%, and 27% higher, respectively (P<.001, for each), among HIV-infected participants. HIV-infected participants receiving antiretroviral therapy who had HIV RNA levels <400 copies/mL had levels higher (by 21% to 60%) (P<.001) than those in the general population, for all biomarkers.

Conclusions. hsCRP, IL-6, D-dimer, and cystatin C levels are elevated in persons with HIV infection and remain so even after HIV RNA levels are suppressed with antiretroviral therapy. Additional research is needed on the pathophysiology of HIV-induced activation of inflammatory and coagulation pathways, to guide potential interventions.

The two top causes of death in women of reproductive age globally are HIV/AIDS and complications related to pregnancy and childbearing, which account for 19% and 15% of all deaths in women aged 15-44 years, respectively. The growing burden of HIV infection in young sexually active women and the maternal health problems that they face have been described as two intersecting epidemics. In settings with a high HIV burden and high maternal mortality ratios, especially in sub-Saharan Africa, many HIV ...

Background Voluntary contraceptive use by HIV-positive women currently prevents more HIV-positive births, at a lower cost, than anti-retroviral drug (ARV) regimens. Despite this evidence, most prevention of mother-to-child transmission (PMTCT) programs focus solely on providing ARV prophylaxis to pregnant women and rarely include the prevention of unintended pregnancies among HIV-positive women.

Methodology/Principal Findings To strengthen support for family planning as HIV prevention, we systematically identified key individuals in the field of international HIV/AIDS -- those who could potentially influence the issue -- and sought to determine their perceptions of barriers to and facilitators for implementing this PMTCT strategy. We used a criteria-based approach to determine which HIV/AIDS stakeholders have the most significant impact on HIV/AIDS research, programs, funding and policy and stratified purposive sampling to conduct interviews with a subset of these individuals. The interview findings pointed to obstacles to strengthening linkages between family planning and HIV/AIDS, including the need for: resources to integrate family planning and HIV services, infrastructure or capacity to provide integrated services at the facility level, national leadership and coordination, and targeted advocacy to key decision-makers.

Conclusions/Significance The individuals we identified as having regional or international influence in the field of HIV/AIDS have the ability to leverage an increasingly conducive funding environment and a growing evidence base to address the policy, programmatic and operational challenges to integrating family planning with HIV/AIDS. Fostering greater support for implementing contraception for HIV prevention will require the dedication, collaboration and coordination of many such actors. Our findings can inform a targeted advocacy campaign.

Objective To determine the hypothetical cost-effectiveness of vaginal microbicides preventing male to female HIV transmission.

Methods A mathematical epidemiological and cost-effectiveness model using data from South Africa and the USA was used. The prospective 1-year-long intervention targeted a general population of women in a city of 1 000 000 inhabitants in two very different epidemiological settings, South Africa with a male HIV prevalence of 18.80% and the USA with a male HIV prevalence of 0.72%. The base case scenario assumes a microbicide effective at 55%, used in 30% of sexual episodes at a retail price for the public sector in South Africa of US$0.51 per use and in the USA of US$2.23 per use.

Results In South Africa, over 1 year, the intervention would prevent 1908 infections, save US$6712 per infection averted as compared with antiretroviral treatment. In the USA, it would be more costly: over 1 year, the intervention would prevent 21 infections, amounting to a net cost per infection averted of US$405 077. However, in the setting of Washington DC, with a higher HIV prevalence, the same intervention would prevent 93 infections and save US$91 176 per infection averted. Sensitivity analyses were conducted and even a microbicide with a low effectiveness of 30% would still save healthcare costs in South Africa.

Conclusions A microbicide intervention is likely to be very cost-effective in a country undergoing a high-level generalised epidemic such as South Africa, but is unlikely to be cost-effective in a developed country presenting epidemiological features similar to the USA unless the male HIV prevalence exceeds 2.4%.

The recent announcement that a prime-boost combination of two HIV vaccine candidates had a partial protective efficacy of around 31% in phase III clinical trials in Thailand is encouraging, but for the foreseeable future the prevention of HIV acquisition will continue to require a multifactorial response. In resource-poor countries where heterosexual transmission is the dominant mode of infection, the promotion of evidence-based behavioural and biomedical prevention strategies that effectively reach vulnerable individuals most at risk of HIV and sexually transmitted infections are paramount. Female sex workers (FSWs) and their clients may represent a significant source of new HIV infections, particularly in the early stages of the epidemic. Although 100% condom usage is the gold standard for HIV and STI risk reduction for FSWs and their clients, condoms are not always available, nor are they always used, due to women's limited ability to negotiate safer sexual practices in commercial or transactional relationships.

Commentary Adaptive clinical trials, in which aspects such as medical endpoints and sample sizes can be modified midtrial, are catching on in the pharmaceutical industry to make drug development both faster and cheaper. But as the industry stakes out shortcuts, many researchers are concerned that they might also shortcut the integrity of clinical trials.

AVAC is pleased to announce the call for applications for the 2010-2011 AVAC HIV Prevention Research Advocacy Fellowship Program. The submission deadline for the Advocacy Fellowship applications is Monday, 19 July 2010. Visit http://www.avac.org/ht/d/sp/i/305/pid/305 to download application materials. 
 
The AVAC HIV Prevention Research Advocacy Fellowship (http://www.avac.org/ht/d/sp/i/305/pid/305) provides support to emerging and mid-career advocates in developing countries to design and implement advocacy projects focused on biomedical HIV prevention research activities in their countries and communities. The Advocacy Fellowship is primarily focused on countries where biomedical prevention research is planned or ongoing. Advocacy Fellows carry out their projects while based at host organisations that are active partners in the Fellowship process. 

Unite for Sight's must-attend, thought-leading conference convenes leaders, changemakers, and participants from all fields of global health, international development, and social entrepreneurship. The conference convenes 2,200 people from all 50 states and from 50 countries. Conference registration is now open. 

Interested in presenting at the conference? We have two types of presentation opportunities:
Call for Abstracts: Do you have an abstract for oral or poster presentation? Submit your abstract for presentation. The first abstract deadline is 15 August 2010. Complete details are on the conference website.

Call for Social Enterprise Pitches: Do you have an innovative idea or a new program in development? Submit your idea for presentation. Social enterprise pitches are accepted on a rolling application deadline, and the first quality pitches will be accepted for oral presentation. When the social enterprise pitch spots are filled to capacity, applications will no longer be accepted. See social enterprise pitch instructions on the conference website.

Deadline: 14 July 2010
amfAR, The Foundation for AIDS Research is pleased to announce new funding for projects that address HIV/AIDS among men who have sex with men (MSM) in the Latin America region. Grassroots organizations in low and middle income countries of the Latin America region are encouraged to submit relevant proposals. Funds for this round of awards are made available through the generous support of the Elton John AIDS Foundation. Each organization may apply for an award of up to $20,000 USD to support project-related costs for up to 12 months.  Only one application may be submitted per organization. Proposals for general operating support will not be considered. Approximately $130,000 is available for this round of awards in Latin America; amfAR anticipates funding from six to eight proposals. Funding recommendations will be announced in October 2010. Organizations that are approved for awards can expect to receive funds to begin activities as early as November 2010. For more information, visit amfAR's website.

It's been lube mania post-Microbicides 2010, where we heard a lot of interesting new data about the safety of sexual lubricants. Since, there has been a ton of media. Click here for a sample of the coverage, both good and hyperbolic.

So, what does it all mean? Please join IRMA and AVAC for a global teleconference to help make sense of it all with the folks who presented these new data, Charlene Dezzutti (University of Pittsburgh), Pamina Gorbach (UCLA) and from the Population Council, Othell Begay and Jose Romero. The call will be moderated by IRMA's Secretary and Resident Lube Expert, Marc-Andre LeBlanc.

Date: Wed, 16 June 2010
Time: 03:00 PM EDT
Duration: 1 hour 30 minutes
Host(s): Jim Pickett and Alanna Costelloe-Kuehn

PowerPoint slides will be available on the IRMA website  in advance of the call. We'll record the entire discussion, which will be posted on the same page post-call.

Program Announcement (PA) Number: PA-10-212
Opening Date:  August 7, 2010
AIDS Application Due Date(s): Standard dates apply, please see http://grants1.nih.gov/grants/funding/submissionschedule.htm#AIDS.

Purpose: This Funding Opportunity Announcement (FOA) issued by the National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), solicits grant applications from institutions/organizations that propose to develop improved HIV incidence assays with increased specificity and reliability for distinguishing incident from chronic HIV infections.
Mechanism of Support: This FOA will utilize the R01 grant award mechanism.
Funds Available and Anticipated Number of Awards: Because the nature and scope of the proposed research will vary from application to application, it is anticipated that the size and duration of each award will also vary. The total amount awarded and the number of awards will depend upon the quality, duration, and costs of the applications received.
Budget and Project Period: Because the nature and scope of the proposed research will vary from application to application, it is anticipated that the size and duration of each award will also vary.  The total amount awarded and the number of awards will depend upon the quality, duration, and costs of the applications received. A project duration of up to 5 years may be requested.

Editor's Note: NIAID concepts represent early planning stages for initiatives: program announcements, requests for applications, and solicitations.  Approval of a concept by NIAID's Advisory Council does not guarantee that it will become an initiative. NIAID makes that decision based on scientific and programmatic priorities and the availability of funds. However, concepts do indicate possible initiatives and/or suggest ideas for investigator-initiated applications. 

NIH/PEPFAR Collaboration for Implementation Science
Contact: Melanie Bacon <https://ned.nih.gov/search/ViewDetails.aspx?NIHID=0011772314>
Description: The NIH/PEPFAR Collaboration for Implementation Science (CIS) will support research focused on the multiple challenges encountered by programs established in resource-limited countries in their attempt to deploy effective prevention, treatment, and integrated interventions against HIV/AIDS, TB, malaria, and other GHI infectious disease priorities in the context of the HIV epidemic. Studies must reflect the needs and priorities of the countries and regions in which they are to be conducted and produce results that are quantifiable and applicable to diverse circumstances and geographic areas. Multidisciplinary research activities will address existing programs and methods for integrating services related to HIV with primary care and specialty care for co-morbidities.

Beyond HAART: Innovative Therapies to Control HIV
Contact: Sandra Bridges <https://ned.nih.gov/search/ViewDetails.aspx?NIHID=0010153710>
Description: This initiative will support multi-project applications for the development of innovative therapeutic approaches to improve on current HIV treatment methodologies that require lifetime commitment to combination drug therapy. Approaches of interest include gene therapy, therapeutic vaccines, cell therapies (embryonic stem cells, hematopoietic stem cell, and mature lymphocytes), antibodies, cytokines, RNAi, and inhibitors of signaling pathways. Programs will perform basic research on the chosen approach, as well as translational activities including test-of-concept human or animal studies.  

Systems Approach to Immunity and Inflammation
Contact: Lynda Chiodetti <https://ned.nih.gov/search/ViewDetails.aspx?NIHID=0010050738>
Description: This systems biology initiative will be a large scale collaborative program that requires multi-disciplinary teams of investigators with expertise in immunology, mouse genetics, genomics, proteomics, infectious diseases, and bioinformatics to better understand the innate and adaptive immune response to bacteria and viruses, as well as the regulatory mechanisms that orchestrate host innate and adaptive immune responses to infection.

Tropical Medicine Research Centers
Contact: Malla Rao <https://ned.nih.gov/search/ViewDetails.aspx?NIHID=0010084026>
Description: The scope of research to be supported under this initiative addresses neglected tropical diseases (NTDs) as defined in a 2006 article by Peter Hotez, et al [see: Hotez PJ, Molyneux DH, Fenwick A, Ottesen E, Sachs SE, et al. (2006) Incorporating a rapid-impact package for neglected tropical diseases with programs for HIV/AIDS, tuberculosis, and malaria. PLoS Med 3(5): e102]. NTDs are caused by a wide range of organisms and can be transmitted by a variety of vectors (mosquitoes, sandflies, black flies, tsetse flies, triatomine insects, and snails) as well as contaminated water and soil. Research may be focused on a single pathogen or multiple pathogens causing NTDs, and multi-disciplinary research will be encouraged. Research areas include but are not limited to identification of biomarkers, development and evaluation of diagnostics, vector management strategies, and study of co-infections (excluding HIV). The TMRCs support clinical and field site development and characterization of the pathogen, vector, and human populations that will ultimately be required to evaluate tools and interventions directed against NTDs. Funds will be awarded directly to foreign institutions in endemic areas.

International Clinical Sciences Services
Contact: Richard Hartmann <https://ned.nih.gov/search/ViewDetails.aspx?NIHID=0010163310>
Description: This program will provide support in the following areas: protocol development and design; case report form development and validation; development and implementation of data management systems; development and implementation of statistical analysis plans; training on international harmonization guidelines, clinical research, laboratory safety, and good clinical and laboratory practices; site assessment and study monitoring; other site development activities; coordination of research team conference calls and meetings; and meetings and workshops.

NIAID International Research in Infectious Diseases and AIDS
Contact: Polly Sager <https://ned.nih.gov/search/ViewDetails.aspx?NIHID=0010046241>
Description: This initiative will support small grants in eligible (resource constrained) foreign countries for infectious diseases research among investigators and institutions at international sites where NIAID has significant investment in research and/or infrastructure. Research should focus on infectious diseases, including AIDS, that is of particular interest to the local country. Collaborative projects involving investigators and institutions from international sites and the U.S. are particularly encouraged.

An Integrated Approach to Understanding Host-Pathogen Interactions
Contact: Roshawn Simpson <https://ned.nih.gov/search/ViewDetails.aspx?NIHID=0011313522>
Description: Under this initiative, multidisciplinary teams will focus on investigating metabolic, regulatory, signaling, and other biological pathways generated by pathogen-host molecular interactions to help explain and predict clinical manifestations of infectious diseases, host responses, disease progression, and outcomes. These studies will focus on persistent or recurrent infections with well-defined, highly specific phenotypes. Strategies for the Protection of Pregnant Women and Infants

Against Infectious Diseases
Contact: Chris Beisel <https://ned.nih.gov/search/ViewDetails.aspx?NIHID=0010063695>
Description: This initiative will support high-impact, pathogen-focused research, ranging from basic to translational, directed toward understanding and preventing infectious diseases for which there is a disproportionate risk to pregnant women and/or their infants. The ultimate goal of this initiative is to develop safe and effective prophylactic and therapeutic strategies for mitigating morbidity and mortality due to infectious diseases in these vulnerable populations.

A recent report by the World Health Organization (WHO), HIV/AIDS Programme Highlights 2008-09, outlines major accomplishments of the agency in collaboration with countries and partners in promoting interventions to accelerate the progress towards universal access to HIV prevention, treatment, care and support services. For the first time, WHO, UNICEF and UNAIDS jointly collected data from national programmes worldwide. Despite funding gaps and implementation challenges, measurable progress was seen in the 2008-2009 biennium. While much work remains, the HIV/AIDS Programme Highlights shows that progress can be achieved, even in the most difficult environments.

Read the full report in English and French.