To reduce spread of HIV/AIDS, IFRC calls for more focus on IDU programs

Ahead of World AIDS Day, the International Federation of the Red Cross on Friday released a report (.pdf) calling for governments around the world to do more to help stop the spread of HIV/AIDS among populations of injecting drug users (IDUs), the Associated Press reports (Heilprin, 11/25).

"The United Nations estimates that approximately 15.9 million people living in 148 countries regularly inject drugs," and "[w]orldwide, an estimated three million injecting drug users are now living with HIV," according to the report.

Among the regions of the world with the highest rates of HIV/AIDS among IDUs, the report states: "Five countries in particular (China, Malaysia, Russia, Ukraine, and Vietnam) are characterized as 'mega-epidemics' in terms of people who inject drugs. Taken together, these countries account for an estimated 2 [million] to 4 million cases of HIV infection and constitute the largest concentration of injecting drug users living with HIV worldwide. … In Eastern Europe and Central Asia the situation is particularly worrisome. Injecting drug users account for more than 60 percent of all HIV infections in Belarus, Georgia, Iran, Kazakhstan, Kyrgyzstan, Moldova, Russia, Ukraine, Tajikistan and Uzbekistan" (December 2010).

"The Red Cross calls the increasing rate of HIV infection among drug users who use needles 'a public health emergency' and recommends more governments provide health services such as substitute drug therapy and clean needle and syringe exchanges," the AP continues. "It says studies consistently show that needle exchanges can lower transmission rates by as much as 42 percent," the news service adds.

"The IFRC is focusing on injecting drug users because a growing body of evidence shows that failing to reach them with hard reduction programs not only jeopardizes their own health, but also the safety of the public at large," IFRC President Tadateru Konoe said, according to the AP (11/25).

PBS NewsHour Examines PrEP, ARV Costs

In related news, PBS NewsHour examines the results of the Pre-Exposure Prophylaxis Initiative, or iPrEx trial, which found a daily dose of oral antiretroviral (ARV) Truvada taken by men who have sex with men (MSM) reduced the risk of contracting HIV by an average of 44 percent and by more than 70 percent when the drug regimen is followed closely. Reporter Ray Suarez interviews Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), and Chris Collins, the vice president of amfAR, the Foundation for AIDS Research, on what the next steps in using an antiretroviral to prevent the spread of HIV/AIDS might look like.

On the topic of the oral antiretroviral in addition to condom use and counseling, Collins said, "It's very important to recognize that what the people in the study got was a package of interventions … And as we move forward and take the next step between the demonstration projects to see how we can use PrEP in the field, we've got to keep that in mind, providing people with other behavioral interventions that we know work is going to be a critical part of making this work."

Fauci, on the topic of using antiretrovirals for prevention as opposed to treatment, said, "[I]f, in fact, after the demonstration projects and the analysis of the data and the discussion of whether or not this would be a feasible thing to actually recommend or make as part of the guidelines, if you look globally, people are going to ask the question: how can you be giving a drug to prevent infection in an individual who might be getting infected with HIV when we don't even have the resources to treat people who are already infected? … And those kind of cost-benefit analysis are going to have to be done country to country because the situations will be very different in one country versus another, in the developing world versus the developed world."

The guests also weigh in on the cost associated with the therapy, the groups who might benefit most from such therapy and the necessary steps that will need to be taken before any recommendations on the drug are made (11/25).

In a separate PBS NewsHour piece, Correspondent Spencer Michels examines the costs associated with ARVs and increasing efforts among pharmaceutical companies to make such drugs more affordable in developing countries. According to the news service, "[e]stimates are that 14 million people in the world today - mostly in poor countries - need antiretroviral drugs, and that number will increase to 55 million in 20 years."

The piece focuses on the company Gilead Sciences, the maker of Truvada as well as other ARVs, who has "a global access program, an innovative tiered pricing scheme that sells drugs at full price in developed countries, 70 percent to 90 percent less in middle-income countries like Brazil, and at no profit in the poorest nations. ... In addition to selling its own drugs at cost, Gilead has also begun to license its formulas to Indian generic drug firms, which then sell the drugs for an even lower price, around $84 per patient per year," according to the news service.

The piece details the costs associated with the development of new ARVs - expenses the pharmaceutical companies look to recover in product sales - and the trend for global pharmaceutical firms to reduce prices on drugs in developing countries.

"Today, with more drug companies making ARVs available cheaply, there's a new hitch: those drugs can eventually become less effective as patients develop resistance," Michels explains, noting that there will likely be increasing pressure on pharmaceutical companies to reduce their prices on the more expensive second- and third-line therapies. The piece includes interviews with representatives from Gilead Sciences, a physician and HIV/AIDS advocates (11/25).