Newsdesk
AIDS epidemic still not under control On World AIDS Day 2005, the United Nations (UN) announced that almost 5 million people in the world were newly infected by HIV in 2005—the highest jump since the first reported case in 1981. The 4·9 million new infections were fuelled by the epidemic’s continuing rampage in sub-Saharan Africa and a spike in the former Soviet Union, eastern Europe, central Asia, and east Asia, the UNAIDS body said in its annual report. 2 days later, the Joint United Nations Programme on HIV/AIDS, the WHO, and the United Nations Population Fund endorsed another announcement by the European Union to intensify HIV pre-
Irwin Fediriansyah/AP/Empics
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Campaigners out in full force
vention efforts to get ahead of the epidemic. “The problem”, says Adamson Muula (Department of Community Health, University of Malawi) “is prevention means many things to many people”. This can be a good thing if we deal with the HIV problem from different angles but it can also result in all of us trying to pull in different directions, he says. Education is certainly important and must continue, but Muula warns that targeting is vital. “When teaching about virus transmission, we need to go beyond politically correct thinking. Anal sex between a male and a heterosexual female certainly happens in Africa but it is rarely spoken of; this must change”, he says. There is also a need to recognise that homosexuality happens, even though societies are intolerant of it and even though it is regarded as illegal in some countries. The UN report says that 70% of Indian sex workers either did not know what a condom was or how to use one. “Condoms are not a simple answer at all: in Africa, the church says that sexual abstinence is the ideal standard and has problems with the message that condoms are for all”, adds Muula. Janet Seeley of the University of East Anglia
(UK), who has studied HIV transmission in remote Ugandan fishing communities, also says that supplies of condoms or the ability of women to ensure condom use by partners may be limited. “Inequitable gender relations are a major hurdle for the prevention of the spread of HIV in many places”, she says. Money for projects is important but success does not depend only on large donations of cash. “It is important that local communities in India and Africa and elsewhere have ownership of the idea of HIV prevention or antiviral treatment”, comments Sunil Shaunak (Imperial College, London, UK). Local compliance is critically dependent on trust between the community and local health workers—outside health professionals often risk mistrust as they do not take the time to understand subtle cultural differences, he says. “If local communities accept the need for HIV prevention methods and treatment, they will be stimulated to find ways to pay for it locally so that it can continue when external funding runs out”, stresses Shaunak, but he warns that “this will not happen overnight; HIV prevention is a very long-term goal”.
Kathryn Senior
To vaccinate or not to vaccinate? See Newsdesk page 15
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As China embarks on an ambitious campaign to vaccinate all of its 14 billion poultry and Vietnam struggles to finish vaccinating its 170 million domestic birds, the debate about the value and safety of poultry vaccination is raging in veterinary and human influenza circles. China’s plans to vaccinate its poultry were criticised by some American poultry health officials who pointed out in the New York Times in November that using poor infection control procedures when vaccinating may increase, rather than prevent, the spread of H5N1 avian influenza
among poultry in China. They cite outbreaks of Newcastle disease in the early 1970s in the USA that were worsened by poor practices among poultry vaccinators as cause for concern. In China, where an army of “extension workers”—many of them volunteers—have been mobilised to tackle the Herculean task of vaccinating every one of their estimated 14 billion poultry—chickens, geese, and ducks—there are many instances of poor infection control. Vaccinators use bare hands and wear no protective clothing, do not wash
their hands between vaccinations, use the same equipment from one farm to the next, and do not disinfect vehicles and equipment when moving between farms. Along with poor practice, demand for vaccination has long outstripped supply, despite China strengthening production of vaccine by their nine domestic vaccine producers. The Ministry of Agriculture estimates production has reached 100 million doses per day. However, local officials charged with vaccinating all poultry in their district complain they are not being given adequate supplies to get the job done, http://infection.thelancet.com Vol 6 January 2006