Latest news with #AIDS
Reuters
7 hours ago
- Health
- Reuters
Insight: Trump aid cuts deal a blow to HIV prevention in Africa
June 20 (Reuters) - Emmanuel Cherem, a 25-year-old gay man in Nigeria, tested positive for HIV two months after U.S. President Donald Trump's administration cut access for at-risk groups like gay men and injecting drug users to medication that prevents infection. Cherem admits he should have been more careful about practicing safe sex but had become accustomed to using the U.S.-supplied pharmaceutical. The drug - known as Pre-Exposure Prophylaxis, or PrEP - is typically taken daily as a tablet and can reduce the risk of contracting HIV through sex by 99%. "I blame myself... Taking care of myself is my first duty as a person," Cherem said at his gym in Awka, the capital of Nigeria's southeastern state of Anambra. "I equally blame the Trump administration because, you know, these things were available, and then, without prior notice, these things were cut off." Trump ordered a 90-day pause on foreign aid after taking office in January and halted grants by the U.S. Agency for International Development (USAID). The agency was responsible for implementing the bulk of the assistance under the President's Emergency Plan for AIDS Relief (PEPFAR), the world's leading HIV/AIDS initiative. Sub-Saharan Africa remains the epicenter of the AIDS pandemic. Trump's cuts have restricted the availability of drugs that millions of Africans have taken to prevent infection - particularly vulnerable communities such as gay men and sex workers - as aid groups and public health systems in Africa strove to roll back the disease. The number of initiations, or people who have taken at least one dose of the drug, rose in Africa from fewer than 700 in 2016 to more than 6 million by late 2024, according to PrEPWatch, opens new tab, a global tracker. More than 90% of new initiations last year were financed by PEPFAR, using cheap generic versions of the drug. Sub-Saharan Africa had 390,000 AIDS-related deaths in 2023, or 62% of the global total, according to UNAIDS, the United Nations AIDS agency. However, progress has been made: that death toll was down by 56% from 2010, according to the World Health Organization. Now, some of those who've lost access to the preventative medication because of U.S. cutbacks are already testing positive, according to 10 patients, health officials and activists. Restrictions on PrEP have coincided with dwindling supplies of more widely used HIV prevention tools like condoms and lubricants "because of the US funding cuts", according to a UNAIDS fact sheet, opens new tab from May. The combination is creating what nine activists and three medical experts described as a major threat to prevention across the continent. "I just see this as incredibly short-sighted because we were on a winning path," said Linda-Gail Bekker, an HIV expert at the University of Cape Town. She said that many African governments did not have the resources to spend on PrEP drugs on top of treatment for HIV infections, risking a worsening of the pandemic. "It's as predictable as if you take your eye off a smouldering bushfire and the wind is blowing: a bushfire will come back." Trump has said that the United States pays disproportionately for foreign aid and he wants other countries to shoulder more of the burden, as he seeks to reduce U.S. government spending across the board. The U.S. disbursed $65 billion in foreign assistance last year, nearly half of it via USAID, according to government data, opens new tab. "It's a question of who has primary responsibility for the health needs of citizens of other countries, and it's their own governments," said Max Primorac, a former senior USAID official who is now senior research fellow at The Heritage Foundation's Margaret Thatcher Center for Freedom. "We all know, and this is a bipartisan issue, that aid dependency doesn't help these people - that the best solution is for these countries to be able to take over the responsibility of these programs." UNAIDS says the permanent discontinuation of PEPFAR-supported prevention and treatment programs could lead to an additional 2,300 new HIV cases globally per day. There were 3,500 new cases per day in 2023. Reuters spoke to 23 health workers, PrEP users and activists, nearly all of whom said that the increase in HIV infections since the funding cuts was impossible to quantify because many organisations working with vulnerable populations have been defunded. A State Department waiver issued on February 1 allowed some PEPFAR activities to restart, but only covered HIV prevention for mother-to-child transmission. That means PEPFAR-financed PrEP is no longer available for gay and bisexual men, sex workers and injecting drug users who are especially exposed to the virus. Many African governments had specifically targeted these groups in their PrEP programs. A spokesperson for the State Department, which oversees USAID and the PEPFAR program, told Reuters it "continues to support lifesaving HIV testing, care and treatment, and prevention of mother to child transmission services approved by the Secretary of State." "All other PEPFAR-funded services are being reviewed for assessment of programmatic efficiencies and consistency with United States foreign policy," the spokesperson said. The spokesperson did not directly respond to a question about why the waiver had excluded vulnerable groups from PrEP distribution. In East and Southern Africa, the sub-region that accounts for more than half of all people living with HIV, the U.S. had been funding nearly 45% of HIV prevention programming, UNAIDS said in March, opens new tab. Some countries like Malawi, Zimbabwe and Mozambique were almost entirely dependent on PEPFAR for their HIV prevention programs, the agency said. In some wealthier nations, like South Africa and Kenya, PEPFAR represented less than 25% of spending on HIV prevention. Russell Vought, the director of the U.S. Office of Management and Budget, told a Congressional committee on June 4 that, due to high U.S. debt levels, Africa needed to shoulder more of the burden in fighting AIDS. Asked specifically about restrictions on HIV prevention programs, Vought said: "We believe that many of these nonprofits are not geared toward the viewpoints of the administration." His office did not respond to a request for further details. Reuters spoke to four PrEP users in Nigeria, all gay or bisexual men, who have tested positive for HIV since January when they stopped being able to obtain more pills, after practicing unsafe sex. Hearty Empowerment and Rights (HER) Initiative, a community-based organisation in southeastern Nigeria, worked with other groups that provide HIV/AIDS services to confirm the men's diagnosis and help secure treatment for them, said executive director Festus Alex Chinaza. In Asaba, the capital of Nigeria's Delta state, Echezona, a 30-year-old gay man who took PrEP pills daily for more than three years, is struggling to come to terms with his HIV-positive test result, which he received in early May. He regrets that he had unprotected sex. "I just pray and wish that Trump actually changes his policy and everything comes back to normal so that the spread and transmission of the virus would be reduced," said Echezona, who asked to be identified only by his first name for fear of stigma. Like the other three men, he described being told by staff at community-based clinics that PrEP was only available to pregnant and lactating women, in line with the Trump administration guidelines. Nigeria has an adult HIV prevalence rate of 1.3% and an estimated 2 million people living with HIV, the fourth-highest total globally, according to UNAIDS. But for so-called key populations, the rates are much higher: 25% for men who have sex with men, according to a survey completed in 2021. The Nigerian health ministry did not respond to a request for comment on the effects of the Trump administration's cuts to HIV prevention services. South Africa – which has an estimated 7.7 million people living with HIV, according to UNAIDS, the highest number in the world - pays for its own PrEP pills. But some clinics where so-called key populations obtained them relied on PEPFAR grants and have been forced to close in recent months. PrEP is also available for free at public health centers, but gay men and sex workers often avoid such facilities, fearing discrimination and harassment, nine activists said. Francois Venter, executive director of the Ezintsha medical research center at the University of the Witwatersrand in Johannesburg, said PrEP distribution from public sector clinics in the city had shown almost no increase since the Trump cuts. Foster Mohale, spokesperson for South Africa's health ministry, said the ministry was "not aware" of reports that key populations were avoiding health facilities due to stigma. "We have sensitized health officials across the country to create (a) conducive environment for all healthcare seekers/clients to access the service without feeling judged or discriminated against," he said.
Scoop
10 hours ago
- Health
- Scoop
Legalising Key Population Led Health Services In Thailand Is A Gamechanger
Article – CNS 'Key population led health services (KPLHS) is a bottom-up approach in providing healthcare. It speaks to the needs and willingness of the community which will increase the value of the effort as compared to some thing being given to them passively (top-down … Legalising key population or community-led health services has been a gamechanger in Thailand to protect most-at-risk people from getting infected with HIV, as well as to take evidence-based standard care to the people living with HIV in a person-centred manner so that they can lead normal healthy lives, said Dr Praphan Phanuphak, a legend who has played a defining role in shaping Thailand's HIV response since the first few AIDS cases got diagnosed in the land of smiles in 1985. Key populations are groups of people who are disproportionately affected by HIV (which may include men who have sex with men, transgender women and sex workers, among others). Dr Praphan Phanuphak is a distinguished Professor Emeritus of the Faculty of Medicine, Chulalongkorn University in Bangkok, Thailand. In February 1985, Professor Praphan diagnosed Thailand's first three cases of HIV/AIDS and has been involved in clinical care as well as in HIV prevention and treatment research since then. Together with late Professors Joep Lange and David Cooper, Prof Praphan co-founded HIV-NAT (the HIV Netherlands, Australia, Thailand Research Collaboration), Asia's first HIV clinical trials centre in Bangkok in 1996. Prof Praphan served as the Director of the Thai Red Cross AIDS Research Centre for 31 years (1989-2020) and is currently the Senior Research and Policy Advocacy Advisor of the Institute of HIV Research and Innovation (IHRI) in Bangkok as well as the Advisor of HIV-NAT. Dr Phanuphak was speaking with CNS (Citizen News Service) around 10th Asia Pacific AIDS and Co-Infections Conference (APACC 2025), 2nd Asia Pacific Conference on Point-of-Care Diagnostics for Infectious Diseases (POC 2025) and 13th International AIDS Society Conference on HIV Science (IAS 2025). When people lead, change happens Sterling examples of high impact key population or community-led health service deliver models come from Thailand. HIV key populations continue to play a major role in delivering Pre-Exposure Prophylaxis (PrEP for HIV prevention) to those who are at a heightened risk of HIV acquisition. Thailand has the largest PrEP rollout in Asia Pacific region, 80% of people using PrEP in Thailand receive it from a clinic led and staffed by members of the community that it serves. Key population led health services mean that community thinks, demands and does the work and manages the programmes, for the benefit of their own community members (and the country). This model has proven to help accelerate community-led responses towards ending AIDS with government's support, said Dr Praphan Phanuphak. 'Therefore, it is a collaborative effort with equal responsibility and equal importance [between key populations or communities and the government]. One has to respect the other. It is not that the NGOs are snatching the work or the territory of the government,' he said. 'Key population led health services (KPLHS) is a bottom-up approach in providing healthcare. It speaks to the needs and willingness of the community which will increase the value of the effort as compared to some thing being given to them passively (top-down approach). It fills the gaps that government cannot do and it is acceptable by the community they serve,' emphasised Dr Praphan Phanuphak. However, there could be some misunderstanding from the government side in some instances. For example, some may opine that 'government is getting blamed for not doing enough good work because of which NGOs are trying to compete with them'. Truth is that KPLHS or community-led models are only helping complement government's work. 'One has to show the evidence that KPLHS (key population led health services) can actually provide quality services to the populations that conventional healthcare providers cannot. Key population led health services will lead to ending AIDS and other sustainable health goals beyond HIV, such as mental health and NCDs, i.e., KPLHS is in accordance with government policy,' said Dr Phanuphak. He added: 'KPLHS or key population or community led health services is one arm of the holistic healthcare approach. They need to collaborate with the main stream public healthcare systems. Once the government accepts these facts, legal and financial supports will follow. However, key population led health services may be more expensive than conventional healthcare since the personnels and office facilities are not provided by the government. Therefore, they need enough financial support to ensure sustainability of the programme.' 95-95-95 HIV targets for 2025 Dr Praphan firmly believes that the 95-95-95 HIV goals can be achieved. We have science-based tools to deliver on these goals, he said. 95-95-95 goals refer to ensuring 95% of people living with HIV know their HIV positive status, 95% of them are receiving lifesaving antiretroviral therapy, and 95% of those on treatment are virally suppressed. According to the World Health Organization (WHO), there is ZERO RISK of any further HIV transmission from a person living with HIV whose viral load remains undetectable. That is why it is referred to as Undetectable Equals Untransmittable or #UequalsU. Dr Praphan Phanuphak stresses upon 'finding people with HIV early in all sub-groups of the population.' He calls for focussing on HIV key populations as well as general population too. 'General population is the group currently being left behind since we have rightly focussed on key populations now – but if we are to end AIDS by 2030, we need to reach out to everyone. Each individual – from general population or key population – should have at least one HIV test in their life – earlier the better (and repeat test as appropriate),' he said. 'Pre-Exposure Prophylaxis (PrEP) can prevent up to 99.9% HIV acquisition': Dr Praphan Phanuphak Pre-Exposure Prophylaxis (PrEP) is a medicine taken by those without HIV to reduce the risk of getting infected with the virus. 'PrEP can prevent up to 99.9% of HIV acquisition. One needs to scale up access to PrEP widely and rapidly. Once HIV cannot spread further and individual-at-risk cannot acquire new HIV infection with PrEP use, AIDS can be ended,' said Dr Praphan Phanuphak. Treatment is also prevention because when people with HIV are on treatment and their viral load is undetectable, then there is zero risk of any further HIV transmission. Thailand government rolls out PrEP under its universal health coverage since 2019 onwards. A majority of PrEP is being provided through key population led health services in Thailand. Eliminate legal and structural barriers Dr Praphan calls for eliminating all legal and structural barriers including stigma and discrimination that block access to existing HIV and other health and social support services – especially for HIV key populations. He not only calls for strong and sustained national political commitment which is essential to end AIDS by 2030 but also for accountability of political leaders if we fail to deliver on the promise to end AIDS by 2030. He acknowledges that USA President Trump's current policy decisions have severed research funding and development financing for a range of programmes including HIV in the Global South. 'This could pose to be a big obstacle for ending AIDS in many developing countries,' said Dr Phanuphak. Lot of progress towards ending AIDS but challenges remain Thailand has seen alarmingly high HIV rates in certain sub-national areas or key populations in late 1980s and early 1990s. But a strong community-led response to prevent HIV has turned the tide since then and brought down HIV rates significantly. Thailand today champions a HIV response which parallels only a few other nations in the Global South. And Thailand is on track to deliver on HIV goals for 2025 too. '100% condom use campaign to prevent HIV infection from commercial sex was a game changer. Establishment of HIV-NAT (the HIV Netherlands Australia Thailand Research Collaboration), the first HIV clinical trials centre in Asia to provide free up-to-date HIV treatment through clinical trials in 1996, was another major step forward,' said Dr Praphan Phanuphak. Helping children born to HIV positive parents are HIV free When world's first therapy was rolled out in the rich nations in 1994 to reduce the risk of vertical transmission of HIV (from mother to child), Thailand soon began its rollout two years later (1996 onwards). Zidovudine was the first available antiretroviral agent for reducing mother-to-child HIV transmission in 1994. 'Princess Soamsawali prevention of mother to child transmission of HIV (PMTCT) project was another gamechanger to provide up-to-date PMTCT drugs to all pregnant women in Thailand, free of charge, from 1996 to 2010,' said Dr Praphan Phanuphak. Thailand government took over and provided science-based triple antiretroviral therapy from 2010 to all HIV infected pregnant women so that no child is born of HIV. In 2016, Thailand became the first country in Asian region to eliminate mother to child transmission of HIV as well as syphilis. Another gamechanger which helped Thailand progress towards ending AIDS is generic manufacturing of lifesaving antiretroviral medicines from 2006 onwards. Thailand is a leading manufacturer of generic medicines in the region and also procures lifesaving medicines from other nations including India. Test and treat policy was rolled out in Thailand, a year before the WHO recommendation came in A year before the WHO recommendation came for 'Test and Treat' policy, Thailand had begun its rollout. WHO 'Test and Treat' policy meant that anyone diagnosed with HIV, regardless of their CD4 count or stage of infection, should be offered and immediately linked to lifesaving antiretroviral therapy. Strong scientific evidence showed that this approach maximises the benefits of early treatment for individual health and to prevent further transmission of the virus. What could have gone better in HIV response Dr Praphan Phanuphak reflects and shares that although 'Test and Treat' and PrEP was rolled out by Thailand but it has not been implemented to its full scale. To some extent, it lacks a sense of urgency, and frequent changes of policy makers also impacted the rollout. Flashback to 1980s: When first HIV cases were diagnosed in Thailand by Dr Praphan Phanuphak 'I was accidentally involved in HIV/AIDS arena. I am not an infectious disease doctor, but an allergist and clinical immunologist trained in USA. The first patient, an American gay man living in Thailand, was referred to me at King Chulalongkorn Hospital in October 1984 to investigate the cause of his recurrent muco-cutaneous infection. Immunologic investigations revealed that his T-helper cell numbers and T-cell functions were moderately low, but no diagnosis was made. In February 1985 the patient was admitted into the hospital with confirmed diagnosis of Pneumocystis carinii pneumonia (PCP) and his T-cell numbers and functions were further deteriorated. With the diagnosis of PCP and severe T-cell defect, AIDS was diagnosed at that time,' shared Dr Praphan Phanuphak. He added: 'During the same month, a Thai male sex worker was referred to Chulalongkorn Hospital because of multi-organ cryptococcal infection. His T-cell numbers and T-cell functions were also severely impaired. AIDS was diagnosed in this second patient since he had sexual contact with a foreign man who had sex with men. The girlfriend of this patient was asymptomatic but had generalised lymphadenopathy, Her T-cell numbers and functions were moderately impaired. This patient was counted as the third case. Sera collected from these 3 patients were tested for HIV in May 1985 when the anti-HIV test kit was available in Thailand. All were HIV-positive. These are the first 3 HIV/AIDS cases diagnosed in Thailand, all in February 1985. With the availability of anti-HIV test in Thailand, more and more patients were diagnosed. This accidentally drove me deeper and deeper into the HIV field, coupled with the fact that there were not very many infectious disease doctors in the early days who were willing to see HIV patients.' Dr Phanuphak's lifetime contribution and continuing guidance to shaping HIV responses in Thailand and worldwide is commendable. We hope community-led responses would steer the global AIDS response towards getting on track to end AIDS by 2030. Shobha Shukla – CNS (Citizen News Service) (Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media) and Chairperson of Global AMR Media Alliance (GAMA received AMR One Health Emerging Leaders and Outstanding Talents Award 2024). She also coordinates SHE & Rights initiative (Sexual health with equity & rights)
Scoop
15 hours ago
- Health
- Scoop
Legalising Key Population Led Health Services In Thailand Is A Gamechanger
Legalising key population or community-led health services has been a gamechanger in Thailand to protect most-at-risk people from getting infected with HIV, as well as to take evidence-based standard care to the people living with HIV in a person-centred manner so that they can lead normal healthy lives, said Dr Praphan Phanuphak, a legend who has played a defining role in shaping Thailand's HIV response since the first few AIDS cases got diagnosed in the land of smiles in 1985. Key populations are groups of people who are disproportionately affected by HIV (which may include men who have sex with men, transgender women and sex workers, among others). Dr Praphan Phanuphak is a distinguished Professor Emeritus of the Faculty of Medicine, Chulalongkorn University in Bangkok, Thailand. In February 1985, Professor Praphan diagnosed Thailand's first three cases of HIV/AIDS and has been involved in clinical care as well as in HIV prevention and treatment research since then. Together with late Professors Joep Lange and David Cooper, Prof Praphan co-founded HIV-NAT (the HIV Netherlands, Australia, Thailand Research Collaboration), Asia's first HIV clinical trials centre in Bangkok in 1996. Prof Praphan served as the Director of the Thai Red Cross AIDS Research Centre for 31 years (1989-2020) and is currently the Senior Research and Policy Advocacy Advisor of the Institute of HIV Research and Innovation (IHRI) in Bangkok as well as the Advisor of HIV-NAT. Dr Phanuphak was speaking with CNS (Citizen News Service) around 10th Asia Pacific AIDS and Co-Infections Conference (APACC 2025), 2nd Asia Pacific Conference on Point-of-Care Diagnostics for Infectious Diseases (POC 2025) and 13th International AIDS Society Conference on HIV Science (IAS 2025). When people lead, change happens Sterling examples of high impact key population or community-led health service deliver models come from Thailand. HIV key populations continue to play a major role in delivering Pre-Exposure Prophylaxis (PrEP for HIV prevention) to those who are at a heightened risk of HIV acquisition. Thailand has the largest PrEP rollout in Asia Pacific region, 80% of people using PrEP in Thailand receive it from a clinic led and staffed by members of the community that it serves. Key population led health services mean that community thinks, demands and does the work and manages the programmes, for the benefit of their own community members (and the country). This model has proven to help accelerate community-led responses towards ending AIDS with government's support, said Dr Praphan Phanuphak. "Therefore, it is a collaborative effort with equal responsibility and equal importance [between key populations or communities and the government]. One has to respect the other. It is not that the NGOs are snatching the work or the territory of the government," he said. "Key population led health services (KPLHS) is a bottom-up approach in providing healthcare. It speaks to the needs and willingness of the community which will increase the value of the effort as compared to some thing being given to them passively (top-down approach). It fills the gaps that government cannot do and it is acceptable by the community they serve," emphasised Dr Praphan Phanuphak. However, there could be some misunderstanding from the government side in some instances. For example, some may opine that 'government is getting blamed for not doing enough good work because of which NGOs are trying to compete with them'. Truth is that KPLHS or community-led models are only helping complement government's work. "One has to show the evidence that KPLHS (key population led health services) can actually provide quality services to the populations that conventional healthcare providers cannot. Key population led health services will lead to ending AIDS and other sustainable health goals beyond HIV, such as mental health and NCDs, i.e., KPLHS is in accordance with government policy," said Dr Phanuphak. He added: "KPLHS or key population or community led health services is one arm of the holistic healthcare approach. They need to collaborate with the main stream public healthcare systems. Once the government accepts these facts, legal and financial supports will follow. However, key population led health services may be more expensive than conventional healthcare since the personnels and office facilities are not provided by the government. Therefore, they need enough financial support to ensure sustainability of the programme." 95-95-95 HIV targets for 2025 Dr Praphan firmly believes that the 95-95-95 HIV goals can be achieved. We have science-based tools to deliver on these goals, he said. 95-95-95 goals refer to ensuring 95% of people living with HIV know their HIV positive status, 95% of them are receiving lifesaving antiretroviral therapy, and 95% of those on treatment are virally suppressed. According to the World Health Organization (WHO), there is ZERO RISK of any further HIV transmission from a person living with HIV whose viral load remains undetectable. That is why it is referred to as Undetectable Equals Untransmittable or #UequalsU. Dr Praphan Phanuphak stresses upon "finding people with HIV early in all sub-groups of the population." He calls for focussing on HIV key populations as well as general population too. "General population is the group currently being left behind since we have rightly focussed on key populations now - but if we are to end AIDS by 2030, we need to reach out to everyone. Each individual - from general population or key population - should have at least one HIV test in their life - earlier the better (and repeat test as appropriate)," he said. "Pre-Exposure Prophylaxis (PrEP) can prevent up to 99.9% HIV acquisition": Dr Praphan Phanuphak Pre-Exposure Prophylaxis (PrEP) is a medicine taken by those without HIV to reduce the risk of getting infected with the virus. "PrEP can prevent up to 99.9% of HIV acquisition. One needs to scale up access to PrEP widely and rapidly. Once HIV cannot spread further and individual-at-risk cannot acquire new HIV infection with PrEP use, AIDS can be ended," said Dr Praphan Phanuphak. Treatment is also prevention because when people with HIV are on treatment and their viral load is undetectable, then there is zero risk of any further HIV transmission. Thailand government rolls out PrEP under its universal health coverage since 2019 onwards. A majority of PrEP is being provided through key population led health services in Thailand. Eliminate legal and structural barriers Dr Praphan calls for eliminating all legal and structural barriers including stigma and discrimination that block access to existing HIV and other health and social support services - especially for HIV key populations. He not only calls for strong and sustained national political commitment which is essential to end AIDS by 2030 but also for accountability of political leaders if we fail to deliver on the promise to end AIDS by 2030. He acknowledges that USA President Trump's current policy decisions have severed research funding and development financing for a range of programmes including HIV in the Global South. "This could pose to be a big obstacle for ending AIDS in many developing countries," said Dr Phanuphak. Lot of progress towards ending AIDS but challenges remain Thailand has seen alarmingly high HIV rates in certain sub-national areas or key populations in late 1980s and early 1990s. But a strong community-led response to prevent HIV has turned the tide since then and brought down HIV rates significantly. Thailand today champions a HIV response which parallels only a few other nations in the Global South. And Thailand is on track to deliver on HIV goals for 2025 too. "100% condom use campaign to prevent HIV infection from commercial sex was a game changer. Establishment of HIV-NAT (the HIV Netherlands Australia Thailand Research Collaboration), the first HIV clinical trials centre in Asia to provide free up-to-date HIV treatment through clinical trials in 1996, was another major step forward," said Dr Praphan Phanuphak. Helping children born to HIV positive parents are HIV free When world's first therapy was rolled out in the rich nations in 1994 to reduce the risk of vertical transmission of HIV (from mother to child), Thailand soon began its rollout two years later (1996 onwards). Zidovudine was the first available antiretroviral agent for reducing mother-to-child HIV transmission in 1994. "Princess Soamsawali prevention of mother to child transmission of HIV (PMTCT) project was another gamechanger to provide up-to-date PMTCT drugs to all pregnant women in Thailand, free of charge, from 1996 to 2010," said Dr Praphan Phanuphak. Thailand government took over and provided science-based triple antiretroviral therapy from 2010 to all HIV infected pregnant women so that no child is born of HIV. In 2016, Thailand became the first country in Asian region to eliminate mother to child transmission of HIV as well as syphilis. Another gamechanger which helped Thailand progress towards ending AIDS is generic manufacturing of lifesaving antiretroviral medicines from 2006 onwards. Thailand is a leading manufacturer of generic medicines in the region and also procures lifesaving medicines from other nations including India. Test and treat policy was rolled out in Thailand, a year before the WHO recommendation came in A year before the WHO recommendation came for "Test and Treat" policy, Thailand had begun its rollout. WHO "Test and Treat" policy meant that anyone diagnosed with HIV, regardless of their CD4 count or stage of infection, should be offered and immediately linked to lifesaving antiretroviral therapy. Strong scientific evidence showed that this approach maximises the benefits of early treatment for individual health and to prevent further transmission of the virus. What could have gone better in HIV response Dr Praphan Phanuphak reflects and shares that although "Test and Treat" and PrEP was rolled out by Thailand but it has not been implemented to its full scale. To some extent, it lacks a sense of urgency, and frequent changes of policy makers also impacted the rollout. Flashback to 1980s: When first HIV cases were diagnosed in Thailand by Dr Praphan Phanuphak "I was accidentally involved in HIV/AIDS arena. I am not an infectious disease doctor, but an allergist and clinical immunologist trained in USA. The first patient, an American gay man living in Thailand, was referred to me at King Chulalongkorn Hospital in October 1984 to investigate the cause of his recurrent muco-cutaneous infection. Immunologic investigations revealed that his T-helper cell numbers and T-cell functions were moderately low, but no diagnosis was made. In February 1985 the patient was admitted into the hospital with confirmed diagnosis of Pneumocystis carinii pneumonia (PCP) and his T-cell numbers and functions were further deteriorated. With the diagnosis of PCP and severe T-cell defect, AIDS was diagnosed at that time," shared Dr Praphan Phanuphak. He added: "During the same month, a Thai male sex worker was referred to Chulalongkorn Hospital because of multi-organ cryptococcal infection. His T-cell numbers and T-cell functions were also severely impaired. AIDS was diagnosed in this second patient since he had sexual contact with a foreign man who had sex with men. The girlfriend of this patient was asymptomatic but had generalised lymphadenopathy, Her T-cell numbers and functions were moderately impaired. This patient was counted as the third case. Sera collected from these 3 patients were tested for HIV in May 1985 when the anti-HIV test kit was available in Thailand. All were HIV-positive. These are the first 3 HIV/AIDS cases diagnosed in Thailand, all in February 1985. With the availability of anti-HIV test in Thailand, more and more patients were diagnosed. This accidentally drove me deeper and deeper into the HIV field, coupled with the fact that there were not very many infectious disease doctors in the early days who were willing to see HIV patients." Dr Phanuphak's lifetime contribution and continuing guidance to shaping HIV responses in Thailand and worldwide is commendable. We hope community-led responses would steer the global AIDS response towards getting on track to end AIDS by 2030. Shobha Shukla – CNS (Citizen News Service) (Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media) and Chairperson of Global AMR Media Alliance (GAMA received AMR One Health Emerging Leaders and Outstanding Talents Award 2024). She also coordinates SHE & Rights initiative (Sexual health with equity & rights)
Time of India
a day ago
- Health
- Time of India
US FDA approves Gilead's twice-yearly injection for HIV prevention
By Deena Beasley and Julie Steenhuysen Los Angeles: The U.S. Food and Drug Administration on Wednesday approved Gilead Sciences lenacapavir , a twice-yearly injection, for preventing HIV infection in adults and adolescents at high risk of contracting the deadly virus. Investors and AIDS activists had been eagerly awaiting the regulatory decision for the drug seen as convenient enough to help end the 44-year-old HIV epidemic. It will be sold under the brand name Yeztugo in the U.S. at a list price of $28,218 a year. Lenacapavir, part of a class of drugs known as capsid inhibitors, proved nearly 100% effective at preventing HIV in large trials last year, raising new hope of interrupting transmission of the virus that infects 1.3 million people a year. Yeztugo "will only be as effective as it is accessible and affordable," Kevin Robert Frost, CEO of the Foundation for AIDS Research, said in a statement, calling on Gilead and the U.S. government to make sure people who want lenacapavir can get it. Gilead said it is working to secure health insurer coverage. It said it will provide co-pay assistance for eligible insured people, and the drug may be available free of charge for some under its program for the uninsured. Medications to prevent HIV, known as pre-exposure prophylaxis, or PrEP, are widely available. But most are daily pills, including low-cost generic versions of Gilead's older drug Truvada, that require strict adherence to be effective. Gilead said Yeztugo is priced in line with other branded drugs. "This is a milestone moment," said Gilead Chief Executive Daniel O'Day of the approval. "We believe that lenacapavir is the most important tool we have yet to bend the arc of the epidemic and move this epidemic into the history books," O'Day said. Availability of a twice-yearly HIV prevention tool is "a huge advance," that could help change the course of the epidemic, Dr. Raphael Landovitz, director of the UCLA Center for Clinical AIDS Research & Education, said in an email. But he said the product's high launch price "is almost certainly going to complicate payor coverage and access." Gilead has plans for a rapid launch in the United States as well as a wider rollout of the drug in collaboration with global partners. Gilead's chief commercial officer, Johanna Mercier, said the company's "end game" is to normalize PrEP usage, both in the United States and other countries, including low-income African nations where the virus is most prevalent. Citi Research analyst Geoff Meacham said he expects Yeztugo's launch to be slow and steady, reaching annual sales of $2.8 billion by 2030. Mercier said she expects around 75% of U.S. insurers, including government health plans, will cover lenacapavir for PrEP within about six months, with the number rising to 90% within 12 months of launch. The drug is currently sold as a treatment in the U.S. under the brand name Sunlenca for patients with advanced disease that has become resistant to other drugs. PEPFAR CUTS In December, the President's Emergency Plan for AIDS Relief (PEPFAR) under then-President Joe Biden signed an agreement with the Global Fund to Fight AIDS, Tuberculosis and Malaria to provide the treatment to as many as 2 million people for three years if it won U.S. regulatory approval for prevention. That would allow for unprecedented early access to a state-of-the-art treatment, as six generic drugmakers that have licensed the product from Gilead gear up for production of low-cost versions in 120 resource-limited countries. AIDS activists have viewed the drug as a way to significantly slow the epidemic, but cuts to PEPFAR by the Trump administration have raised concerns about the U.S. government's commitment to the rollout. O'Day acknowledged that the changes have been "challenging," but said the company has continued to have discussions with both the Global Fund and PEPFAR. "I believe that there will be sources of funding for this, and that these organizations will prioritize this type of prevention," he said.
IOL News
a day ago
- Health
- IOL News
Health challenges facing youth demand urgent action
Free condom distribution remains inconsistent across the province, leaving young people at risk of HIV/AIDS and other Sexually Transmitted Infections (STIs). The health challenges facing our youth require immediate attention, especially regarding resources for sexual health and accessibility to medical care, including mental health support. Free condom distribution remains inconsistent across the province, leaving young people at risk of HIV/AIDS and other Sexually Transmitted Infections (STIs). This gap undermines efforts to promote safe sex among youth. Moreover, access to medication and surgical care is severely constrained. Chronic conditions like diabetes require consistent medication, yet public facilities frequently face shortages. Surgical backlogs in Gauteng's hospitals delay critical procedures, prolonging suffering. This shortage leaves many young people facing mental health issues without sufficient support, which increases the risks of substance abuse and, ultimately, suicide. The Gauteng Department of Health must ensure that condoms are distributed effectively across the province, particularly in underserved areas. This initiative should be backed by a thorough sex education campaign. Additionally, to tackle challenges like medication shortages, surgical delays, and the mental health crisis, the department needs to ensure increased funding, recruit more healthcare professionals, and expand health facilities. Madeleine Hicklin MPL, DA Gauteng Spokesperson for Health
