The other day a friend of mine sent me this link to an somewhat somber article in the UK's Independent, which wondered if we should stop looking for an AIDS vaccine, following the failed Merck trial of a few months ago.

The article polled 35 British and American AIDS researchers and found that, in general, they were markedly less optimistic about the short-term prospects of finding an HIV vaccine than they were five years ago. The Independent published the results of their poll one month after a US government-sponsored summit on HIV vaccine research, about which our very own Roxanne Khamsi wrote in the new issue of Nature Medicine.

I don't know that one has to be so pessimistic. In fact, it seems that the meeting was very helpful in pointing to the limitations of the existing animal models as predictive of efficacy in humans, something that, sadly, is the rule rather than the exception when it comes down to creating models of human disease. In the context of the Merck trial, this past December we wrote this editorial, in which we indeed agreed that the field faces serious problems, but tried to conclude on an optimistic note pointing to the fact that the development of the polio, measles and hepatitis B vaccines took 47, 42 and 16 years, respectively.

Sure, the failed trial was a setback and one must take a hard look at the direction in which the AIDS vaccine field is going (in fact, very soon we'll publish a Perspective on this topic), but this is hardly enough of a reason to call it a day. Paraphrasing Mark Twain, I'd say that rumors of this field's death are being greatly exaggerated.

Bust of Mark Twain. (Image by wallyg)

Posted by Juan Carlos Lopez at 10:07 AM | Permalink | Comments (3)

My colleague Clare Thomas pointed me to this fascinating report in SciDev.net.

A Nigerian doctor is suing the Nigerian Academy of Science after challenging his claims that he has produced an effective HIV vaccine from the blood of infected patients. What struck us the most was the fact that Jerimiah Abalaka, the doctor in question, cites an article he published in the journal Vaccine as evidence of his claims' legitimacy.

Why did Vaccine publish this paper? At the time of its publication, Ray Spier, editor of the journal, wrote an editorial saying that Abalaka's study was not published a peer-reviewed research paper, but as a report. He then goes to great lengths to try to justify his decision to publish the paper and concludes by stating that "desperate situations call for desperate measures".

This statement seems absurd to me. If the paper wasn’t peer reviewed, what is the true value of the data? I wish I could tell you how many charlatans send us papers every month, reporting cures for all kinds of diseases (including HIV, of course), and how quickly we reject them without further ado. How supremely irresponsible of Vaccine to publish something of such potential importance without peer review! Has science been served by the decision? The only thing that has come out of it is undue support for a man who is now in a stronger position to put the lives of thousands of people at risk.

Posted by Juan Carlos Lopez at 11:31 AM | Permalink | Comments (1)

According to the Chinese press, hair ties at the markets in Dongguan are going for a song—about three cents for a bag of ten. But these bands aren’t made out of rubber; they’re recycled condoms.

The practice of recycling condoms as hair-ware is admittedly disgusting, but does it pose public health hazard? At least one person, a dermatologist at the Guangzhou Hospital of Armed Police, identified only as “Dong” seems to think so. “People could be infected with AIDS, warts or other diseases if they hold the rubber bands or strings in their mouths while weaving their hair into plaits or buns,” Dong said.

Dong may or may not be a real person. I had no luck finding the Guangzhou Hospital of Armed Police on the internet. But his misconceptions about HIV are not unique. Even in the US, some people still believe that you can “catch” AIDS by kissing or sharing a soda with an individual who has HIV.

Even my boyfriend, a science writer, was suspicious. He (mis)remembered reading that health officials had actually tested the condoms and found them teeming with harmful pathogens.

By now the story (urban legend?) has wound its way through the blogosphere and wormed its way into several reputable news sources. Repetition without critique, I’m afraid, can only lend Dong’s comments credibility.

Another setback for the fight against HIV ignorance.

Posted on behalf of Cassandra Willyard, Nature Medicine's news intern.

Posted by Juan Carlos Lopez at 01:42 PM | Permalink | Comments (5)

A rather and confusing and counter-intuitive report came out earlier this week, when scientists announced that uncircumcised men who wash their penis after sex are increasing their risk of AIDS.

This is of course contrary to all common sense. Washing after sex, and hygeine generally, is always presented as the way to avoid sexually transmitted infections. So it's not clear why the longer the men waited to wash after sex, the lower their risk of HIV infections became.

Unfortunately, the scientists didn't ask the men how exactly they washed, according to the New York Times, which reported the story on Tuesday. This could be important because the soaps used in Africa are more irritating than the ones in the US, for example, and could be contributing to the bizarre observation. The researchers say it's also possible that vaginal secretions, which are acidic, may be harming the virus. The latter seems unlikely to me — surely if vaginal secretions offered some protection, women would not now be the brunt of the epidemic?

In any case, resolving this seemingly contradictory study is important so public health workers can spread the right message about cleanliness — and not unwittingly put men even more at risk.

Posted by Apoorva Mandavilli at 02:29 PM | Permalink | Comments (0)

Talk about chipping away at human rights: lawmakers in Papua, an Indonesian province, want to implant microchips in HIV-positive people.

Yep, you read right. Apparently, the government is fed up with its inability to control the country's AIDS epidemic so the parliament's health committee came up with this scheme to track those who are infected and stop them from transmitting the virus to others. Oh, and they're also calling for mandatory testing of the general population — about 2.4% of whom are believed to be HIV-positive.

Fortunately, saner heads prevailed and the bill was turned down, but no doubt the parliamentarians will come up with more boneheaded schemes.

At one point, they also apparently dicussed tattooing those infected. What would the tattoos say, I wonder? Something along the lines of: "I live in a fascist state"?

Posted by Apoorva Mandavilli at 05:26 PM | Permalink | Comments (5)

South African president Thabo Mbeki, famous for questioning the link between HIV and AIDS, has dismissed Nozizwe Madlala-Routledge, the health minister who seemed to be making a real difference to the country's fight against AIDS.

Madlala-Routledge had replaced previous health minister Manto Tshabalala-Msimang — often called simply "Manto" — who likes to offer beetroot, lemon juice and garlic as remedies for AIDS. After that particular brand of denialism, Madlala-Routledge's tenure was particularly welcome, as I wrote last November.

After her arrival, South Africa announced a comprehensive prevention program and openly acknowledged the gravity of its epidemic. Only a few days ago, the government announced that for the first time in years, its HIV prevalence had fallen — albeit not by much.

It's a shame that the president has so quickly undone the small progress the country had made. No more beetroot and garlic, please!

Posted by Apoorva Mandavilli at 05:10 PM | Permalink | Comments (0)

Last week's Nature carried a fascinating review of two new books that take an unsparingly critical look at the world's response to the AIDS epidemic.

The first, James Chin's The AIDS Pandemic: The Collision of Epidemiology with Political Correctness, argues that flawed mathematical models have exaggerated the scale of the epidemic. Chin's idea, which as we've reported has been gaining traction, is that tracking infection rates in pregnant women falsely inflates the numbers. Chin goes on to say that UNAIDS continues to support the bigger numbers because, among other things, it helps bring in donor money. That I can believe.

India was one of the first places where the numbers are lower than predicted by the mathematical models, but I'm not sure I agree with Chin that India's epidemic won't be as grave as the UN predicts it will be. Just last week, the government reported an alarming increase in prevalence in two Indian states. Based on my experience reporting on AIDS in India I think the numbers are likely to be much higher, not lower, than the ones we see reported.

The second book, Helen Epstein's The Invisible Cure: AIDS in Africa, argues that indigenous efforts, particularly in reducing the average number of sexual partners, and not UNAIDS-sponsored methods, have been the most effective in curbing the AIDS epidemic in Africa.

The review is worth reading in its entirety, not least because it's written by Stephen Lewis and his colleague Paula Donovan. Lewis, who was until December the UN special envoy for AIDS in Africa, is one of the most charismatic and genuine men I've ever met. When I interviewed him last year for a profile, his eyes repeatedly welled up when he talked about AIDS in Africa. I suspect he also has a lot to say about the UN, where he was not particularly popular because of his outspoken views. Now there's a book I'm dying to read.

Posted by Apoorva Mandavilli at 04:54 PM | Permalink | Comments (0)

It’s always frightening when matters of science are settled in a court of law. And a relief when reason prevails.

Last week, an Australian judge declared that yes, HIV does exist and that it causes AIDS.

The criminal case was filed against a HIV-positive man, Andre Chad Parenzee, for knowingly exposing his sexual partners to the virus. In his defense, he maintained that “the existence of HIV has not been proven” and that “there is no scientific evidence that AIDS is caused by a unique infectious agent.”

The case dragged on for months and although it wasn't covered much outside the US, did create waves in Australia. Robert Gallo, who established the link between HIV and AIDS in 1984, appeared (by videolink) for the prosecution and was grilled by the defense about his research and his notorious squabble with French virologist Luc Montagnier. AIDS denialism has its supporters even among scientists and the dissident Perth Group, led by two Australian doctors, appeared as "expert witnesses" for the defense.

Parenzee had been convicted on three counts of endangering lives and had appealed. Justice John Sulan said last week that the Perth Group witnesses lacked credibility and threw out the appeal.

The two doctors continue to be employed by the Royal Perth Hospital, although AIDS Truth, a loosely banded group of scientists and activists, and other are calling for their dismissal. As I've written here before, AIDS denialism has serious consequences in some parts of the world and is not simply an academic debate. It's time Australian scientists joined these activists in making sure science prevails.

Posted by Apoorva Mandavilli at 06:08 PM | Permalink | Comments (3)

When I went to the HIV vaccine meeting in Whistler last month, I heard some rather disturbing tales of people upset at the NIH. Some of the behind the scenes complaining I wrote about here. The rest became a news story about conflicts between HIV scientists and the NIH that runs in our May issue.

Before I wrote it, some scientists privately asked me not to write it, saying it would only stir up more trouble in the field. Others assumed--wrongly--that the story would be based on the complaints of only a few disgruntled researchers. But in fact, the discontentment is widespread, and CHAVI, the NIH's HIV vaccine project, is perhaps unfairly bearing the brunt.

Even those who have little to do with HIV vaccines seem to be aware of the swirling bitterness. It’s understandable that CHAVI is stirring up resentment when established scientists are having to downsize their labs and young researchers are giving up on science, says Paul Bieniasz, who works at the Aaron Diamond AIDS Research Center in New York.

Bieniasz serves as chair of an NIH study section on AIDS molecular and cellular biology, so he has seen first hand the effect of the tightening budget on the peer review process. Like many others I quoted when CHAVI was first launched, he doesn't believe sinking $350 million into one project is the way to solve the vaccine challenge. But unlike most of the people I tried to speak to for the most recent article, he was willing to go on the record.

"What if they’re (CHAVI is) wrong?” he says. “People have to speak out, we shouldn’t be living in an environment of fear.”

So... how about it? Here's your chance to break out of the environment of fear...

Posted by Apoorva Mandavilli at 04:29 PM | Permalink | Comments (3)

I realize that my previous blog entry makes it sound as if HIV researchers are a complaining and bitter bunch. Far from it. They do complain, but they are also one of the friendliest and most unpretentious group of researchers anywhere. They can go from discussing how quickly HIV can wipe out the immune system to the latest in footwear and eyewear in a flash.

Last night was the finale of the HIV meeting — and may I just say, these scientists also know how to party.

Earlier in the week, bigwig HIV researcher Bruce Walker hosted his annual keystone bash. Here are a few things that should tell you it was a great party: there was much spilled drink; people sang Happy Birthday to Philip Goulder at midnight (it really was his birthday); everyone with a camera or cellphone snapped incriminating pictures of everyone else; one noted scientist was so falling down drunk that he really did fall down and had to be escorted home; and the police came — twice.

Last night's was almost a repeat performance, but the police didn't make an appearance — not that I know of anyway. In between their drunken revelry, these scientists also managed to put on one of the most interesting conferences I've ever been to. As per keystone rules, I can't really write about the specifics, but among the topics I found most interesting were those that delved into why sooty mangabey monkeys infected with SIV, the monkey version of HIV, never progress to a disease like AIDS and on elite controllers, a group of people who, despite being infected with HIV for more than a decade, have undetectable levels of the virus in their blood.

Figuring out what protects the monkeys or the elite controllers could be the key to a good vaccine. And this week's talks made me feel optimistic that at some point in my lifetime, even if not in the next 15 or 20 years, we'll know the answer.

Posted by Apoorva Mandavilli at 11:28 AM | Permalink | Comments (0)

Straight from the TB meeting last week, I've been at a HIV keystone meeting all week that has two parallel tracks — one focusing on the molecular aspects of the disease and the other on strategies for making a vaccine.

The big question on everyone's lips is, why is no one from the biggest HIV vaccine project here?

In 2005, NIH created CHAVI, a $350 million behemoth led by a small group of scientists. With that kind of money at stake, particularly at a time when funding is tight, many scientists were understandably outraged — so much so that it seemed like it might split the field into bitter, warring factions.

This meeting tells me that sadly, it already has.

Last year, we reported researchers' fears that CHAVI was cutting into individual grants. Two years into CHAVI almost no one, including some people at the NIH, has anything good to say about it. The project has already taken up about $70 million, and judging by CHAVI leader Bart Haynes' presentation yesterday, doesn't have much that's new to show for it. Haynes says most of the first year went toward setting up collaborations and infrastructure — and that may be true. But why isn't his team here to share what they're doing with the rest of the field? Even Haynes flew in just for his talk and flew back the same night, which didn't really give people much time to interact with him or ask questions.

The coffee breaks are rife with rumors that even though four fabulous teams applied for the CHAVI grant, the NIH had decided months before who they would give the grant to — and that the decision was entirely political. People are also saying that any project grant that competes with CHAVI's domain automatically gets rejected.

This being a particularly gossipy community, there's little proof of any of this — grants may be getting rejected simply because these are tough times, for example — but it almost doesn't matter whether it's true. The point is, many of the scientists here are feeling betrayed by the NIH's decision to fund CHAVI and worse, afraid of what they see as its favoritism.

This cannot be good for the field. Far as I can see, if the NIH doesn’t soon make an effort to be more open — and more inclusive — about what CHAVI is doing, this important field will split into the CHAVits and the CHAV-nots.

Posted by Apoorva Mandavilli at 04:28 PM | Permalink | Comments (1)

By now, there's mountains of depressing evidence that in the Bush administration, ideology always trumps science.

Nowhere does this seem more cruelly short-sighted than in the administration's approach to AIDS. I've written here before about the government's insistence that any groups that receive federal funds have to formally oppose prostitution.

Here's one more disheartening report: after a year-long investigation, the Center for Public Integrity, a nonprofit based in Washington DC, has found that PEPFAR, the administration's $15 billion AIDS initiative, "has not worked out the way it was envisioned."

One of PEPFAR's most criticized aspects is the ABC approach for prevention: abstinence, be faithful and condoms. Neither abstinence nor being faithful is much of an option for a married woman whose husband is unfaithful, but let's not get bogged down by practical details.

The center's Consortium of Investigative Journalists filed two dozen Freedom of Information Act requests, FOIA lawsuits against the State Department, the U.S. Agency for International Development and the Department of Health and Human Services. After more than 100 interviews, examination of thousands of pages of documents and reporting on the ground in affected countries, they say that:

In fact, the actual prevention practices stress the "AB" messages — abstinence until marriage and being faithful to one partner. The "C" has moved to a small c, and the use of condoms is lumped into the category of "other preventions" that includes prevention of mother-to-child transmission, blood safety, safe medical injections and control of intravenous drug use.

It's nice to see that tomorrow, this ambitious project, dubbed "Divine intervention", is set to win the first prize in online and trade journals category from the Association of Health Care Journalists.

On another positive note, I mentioned before that Brazil had turned down money from the US rather than meet the ideological demands. Looks like even within this country, there's some rebellion afoot.

On March 5, Wisconsin turned down about $600,000 in federal "abstinence-only-before-marriage" funds because the money would have prevented programs from teaching kids about contraception or sexually transmitted diseases. California, Maine, New Jersey and Pennsylvania have also turned down the funds and another dozen are set to do the same, according to Madison's The Capital Times

Posted by Apoorva Mandavilli at 03:40 PM | Permalink | Comments (3)

My New Yorker mag arrived Monday with an article about a topic that's all too familiar to us, here at Nature Medicine. Science reporter Michael Specter wrote about AIDS denialists — or dissenters as they like to call themselves — who say either that HIV does not cause AIDS or that antiretroviral drugs do more harm than good, and that most scientists are in the pockets of the pharmaceutical industry. That last bit may be debatable, but to us and to everyone we consider credible, there's no doubt that HIV causes AIDS or that antiretroviral drugs are safe.

I'm happy the New Yorker gave this urgent and deeply troubling issue some much-needed attention, but I'm a bit disappointed with its tepid tone. If you get through the whole article — and I suppose many of the magazine's readers do — you come away with the feeling that the denialists are certainly wrong. But the first few pages give so much space to Peter Duesberg, the most famous denialist, and to the potential benefits of South Africa's traditional medicines that you might almost be tempted to think these people have a fair point. After all, who among us hasn't thought that scientists can be too harsh on those who don't agree with the reigning hypothesis or that they don't pay enough attention to traditional therapies?

But this is not your average scientific disagreement. There is NO question that HIV causes AIDS and to follow the "he said-she said" school of journalism in this case, strikes me as tame and... well, I'll leave it there. I hope the New Yorker piece goes some way to repairing the damage caused last year by an article in Harper's by dissenter Celia Farber.

For our part, we've covered the resurgence of denialists and the activities, in particular, of one Matthias Rath, who markets multivitamins as a cure for AIDS. Scientists and AIDS activists have sued the South African government and Rath for conducting trials of the so-called vitamin cures.

These denialists like to distort scientists' own statements to support their theories and have even misappropriated sentences from one of our scientific reports, which we explicitly countered in an editorial last year after the Harper's piece appeared. And we hope more of the mainstream press steps up to cover this issue.

Update: We have decided not to accept any more comments on this post, as the discussion between the two camps is not productive. We don't want this blog to perpetuate a discussion that has already received too much attention

Posted by Apoorva Mandavilli at 05:26 PM | Permalink | Comments (14)

Can the US government compel non-governmental organziations (NGOs) to condemn prostitution?

Yes, if those NGOs want to qualify for government funds. That's the upshot of a ruling on Tuesday by a federal appeals court.

Since 2003, the US has required that to qualify for funds from the $15 billion PEPFAR program for AIDS, nonprofit groups abroad have to explicitly oppose prostitution and sex trafficking.

NGOs say that taking an explicit antiprostitution stance would make it harder for them to work with sex workers, one of the highest risk groups for HIV infection. In 2005, Brazil refused $40 million from the US rather than comply with the requriements.

Even within the US, the law has been controversial and has gone through a long process of rulings and counter-rulings.

In 2005, after the law expanded to include US groups, DKT International, a Washington D.C-based organization, sued the government, arguing that the law violated its free speech rights.

Last year, a lower court agreed and ruled that the law is unconstitutional. But on Tuesday, US Circuit Judge A Raymond Randolph reversed that ruling, saying that the US Congress has authorized the Bush administration to fund these groups "on such terms and conditions as the President may determine."

What do you think? Are these acceptable strings?

Posted by Apoorva Mandavilli at 04:05 PM | Permalink | Comments (4)

As I've written before, circumcision is gaining currency as an effective means of preventing HIV. Data published in last week's Lancet suggests that circumcision cuts the risk of HIV infection by up to 65%, more even than the previous estimates.

The World Health Organization is hosting a conference in early March to make recommendations on implementing circumcision for preventing AIDS. But judging from comments here and elsewhere, it's going to be a tough sell.

Experts have warned that unsafe circumcision can endanger lives. A new study, published in the March issue of the Annals of Epidemiology, adds that in some African countries, circumcised boys are two to three times more likely to be infected with HIV. This may be because circumcision is often done with unsterilized equipment and can pass on infected blood from one child to another.

Posted by Apoorva Mandavilli at 02:57 PM | Permalink | Comments (0)

The prominent Chinese AIDS activist Gao Yaojie, whom I blogged about previously, left Beijing yesterday to receive an award in Washington DC for her work exposing blood-selling schemes that infected tens of thousands. Chinese authorities had released her from house arrest, suggesting that they respond to international media coverage and diplomatic pressure.

But what about AIDS activists who are not so internationally famous? How are they faring? To find out, I called up Nicholas Bequelin, a Hong-Kong based researcher at Human Rights Watch, which in 2003 published a report on human rights and AIDS in China.

“Essentially all the independent HIV aids activists in China operate under fairly difficult conditions,” says Bequelin, “We still see the harassment of individuals and grassroots activists.”

NGOs (nongovernmental organizations) in China have few legal protections from authorities wary of initiatives operating outside of the government framework. That’s not the most effective way to fight a virus that at current rates of transmission could infect 10 million people in China by 2010, according to estimates by the United Nations.

“I think international experience shows clearly that NGOs are the most effective groups to deal with high risk populations—sex workers, injection drug users, gay men, truck drivers—to reach them you need to have organizations that are grass roots,” says Bequelin.

As an example, consider the strong link between AIDS activism and the gay rights movement in the United States. Yet in China, the government only decriminalized homosexuality ten years ago and only six years ago removed it from a state list of mental disorders. In many parts of the country, people with HIV/AIDS are still stigmatized.

Over the last several years, China has improved its approach to AIDS treatment and prevention, for instance, increasing spending and applying for funds from the Global Fund to Fight Aids, Tuberculosis and Malaria. Yet the country still has a long way to go.

The 2003 report from Human Rights watch extensively documents the harassment and surveillance of groups that combat HIV/AIDS. Much of that is still going on, says Beqeuelin, who provided two examples:

1. Wan Yanhai, the director China’s leading AIDS NGO, Aizhixing, was reportedly coerced into canceling a conference on HIV-AIDS and human rights. The conference, “Blood Safety, AIDS and Legal Human Rights” was to have taken place in Beijing in November, 2006. But Yanhai called off the conference after being detained by Beijing security personnel for two days.

2. In Tianjin, police harassment has curtailed advocacy and awareness projects in clubs and other places where gay people meet. In July 2006, the police arrested clients at a male bath house and confiscated all the condoms supplied by Tianjin’s Family Planning Association, according to reports from Aizhixing. A month later police again raided the club. “Everything has disappeared in the city,” says Bequelin, “There are no activities in terms of prevention and awareness for gay men.”

Even Yaojie has said she is wary of being too outspoken during her trip to the United States.

The 1980's AIDS activist slogan "Silence=Death" was powerful for a reason- this is a virus that thrives on silence.

*****
By some estimates, a billion people watched the Academy awards last Sunday—and surprisingly that could provide a boost to efforts to publicize the fate of individuals infected with HIV through tainted blood in China. The documentary “The Blood of Yingzhou District" won the award for best documentary short subject. The film, produced by the China AIDS Media Project follows the life of a child orphaned by the blood scandal. The film will be playing in mid-March here in DC and I’ll be blogging about it later.

Posted by Charlotte Schubert at 11:15 AM | Permalink | Comments (0)

My graduate advisor, like many scientists, was not known for his touchy-feely approach to mentorship. But he did occasionally dispense nuggets of advice in the form of a joke. He came out with this one—perhaps told in many laboratories—in response to my frustration at getting equivocal results from experiments that I thought were obvious:

A man who had lost some change on the street at night was frustrated because he could not seem to retrieve it. His friend, wanting to help, asked, “Why do you keep looking in this one place?” The man replied, “Because that is where the light is shining.”

How many scientists keep looking where the light is shining? What do they miss when they fail to explore what’s in the darkness?

I can think of no better example of people searching little-known areas—and striking gold—than one featured in our February issue by Erika Check. In her story “Gut Warfare,” Check describes how, after difficult experiments, HIV researchers have come to view immune cells in the gut as key to the pathogenesis of the virus.

Just a few years ago almost all HIV researchers focused their studies on immune cells in the blood, but the topic of HIV in the gut is now all the buzz at HIV meetings. The findings have the potential to change how HIV is treated and have already shifted the emphasis in vaccine development to mucosal surfaces.

When I first covered this advance as the news and views editor in 2004, I was struck by the fact that some of the earliest evidence for it emerged in the 1990s including a 1998 study in Science. Why did it take so many years for the subject to become the next hot thing in HIV research? Why did so many HIV scientists seem to ignore the early clues?

I don’t know the answer. But in all fairness, the advance required extremely challenging experiments—gut biopsies taken from individuals shortly after HIV infection.

I’ve heard researchers in many fields complain about mindsets that impede progress and restrict grant funding for fresh ideas. Does too much competition make people jump on the same fashionable but obvious project, pummeling each other in the light? I’m not sure what it is, but I do know that as a graduate student, I had a strong practical interest in getting published and getting out of school.

What are some of the untapped areas in your field? Have you seen certain ideas, perhaps easier ones, prevail for long periods of time—while truer answers languished in some hard-to-find dark crevice?

Posted by Charlotte Schubert at 10:08 AM | Permalink | Comments (0)

China may be eager to claim a top spot in the international scientific community, but before it can move forward, it must first face up to its past.

Just last week, it seems that government authorities prevented a prominent AIDS activist, Gao Yaojie, from traveling from her apartment in Zhengzhou to Beijing for a visa to attend an awards ceremony in the United States. She is slated to be honored this March by the Vital Voices Global Partnership, a nonprofit group with Hillary Clinton on its board.

Yaojie is well-known for uncovering the unsafe blood donation practices in Henan province in the 1990s that ultimately infected more than tens of thousands of individuals with HIV. In state-run facilities, blood from multiple donors was mixed together before being infused back into the donors' bloodstream—a practice that continued for years as Henan officials attempted to cover it up .

For her tireless effort to expose the scandal, Yaojie, a 79-year-old physician, endured government harassment and surveillance. According to some reports, the current effort to keep her quiet stems from a wish to avoid embarrassing Li Keqiang, the former governor and party chief of Henan, who is rumored to be in line for the presidency.

No official seems to have been punished for his role in the plasma trade, according to reporting by the Economist. Victims of the scandal have been promised drugs and reparations by the government, but it’s also unclear how that effort is progressing.

China recently lifted some of its restrictions on foreign reporters, in advance of the Olympic Games. Hopefully some will be able to use the opportunity to dig deeper into the legacy of this government-sanctioned and silenced disaster.

Posted by Charlotte Schubert at 08:43 AM | Permalink | Comments (0)

When I worked at Fred Hutchinson Cancer Research Center in Seattle I was struck by the chemicals researchers routinely tossed away—often down the drain. It seemed paradoxical that the attempt to understand cancer involved the manufacture of some nasty carcinogens.

Of course, in the big scheme of things the amount of chemicals used in cancer research is small. And almost any positive endeavor has its shades of grey.

Take the Bill and Melinda Gates Foundation. Its role in public health has been extraordinary—but as a report in the Los Angeles Times reveals, the financial arm of the foundation invests in companies that spew some pretty toxic stuff, and may otherwise undermine the mission of the foundation.

These investments include oil companies that pollute regions of Africa where the foundation operates and a health care company embroiled in lawsuits for allegedly unnecessary surgeries. The Times claims that at least 41% of the foundation’s assets, or $8.7 billion, are in companies that “countered the foundation’s charitable goals or socially concerned philosophy.

Unlike some other philanthropies, such as the Ford Foundation, the Gates Foundation has apparently set up a firewall between its investment and granting arms—to try to keep the fund as flush as possible.

It may be easy to quibble with some of the standards used by the LA Times to criticize the Gates Foundation. Nonetheless, with an endowment boosted by Warren Buffett to more than $60 billion, it seems that the foundation could wield its substantial investment power in ways more in keeping with its public health mission.

Posted by Charlotte Schubert at 05:33 PM | Permalink | Comments (1)

Liquid condom? Sounds kinky, but it could actually be a clever and much-needed health tool. Scientists have come up with a condom that forms a gel-like coating in the acidic vagina. When it comes into contact with the alkaline pH of semen, it turns into liquid, releasing an antiviral drug against HIV.

This particular product, described in December's Journal of Pharmaceutical Sciences, is still years from clinical use, but the Chinese are one step ahead. They've got something called the "Nanometer-silver Cryptomorphic Condom" -- a real mood-killer, that name -- which is a spray foam that forms a thin membrane in the vagina.

For the skeptical, there are also several products in the pipeline that would replace condoms. Called microbicides, they're gels or creams that women could use to protect themselves from HIV, in most cases without the knowledge of their partner. There are 16 of these in trials and results on 5 of them are expected next year.

It's becoming increasingly obvious that to fight AIDS, we'll have to come up with ways to protect women -- particularly those who don't have much choice about using condoms, whether it is because they are sex workers at the mercy of a john, or housewives at the whim of their husbands. The more options we can give them to protect themselves, the better.

Posted by Apoorva Mandavilli at 04:46 PM | Permalink | Comments (3)

Did you hear this, men? Losing a little bit of your skin could cut your risk -- and perhaps ours -- of getting AIDS. The NIH reported yesterday that circumcision halves the risk of HIV infection. This is such good news that the agency decided to stop two trials early so they could offer circumcision even to men in the control arm.

The result isn't entirely a surprise. A previous study had pegged the protection at 60% and ever since then, some experts -- especially in Africa -- have been clamoring for circumcision to be implemented.

And rightly so. In many parts of the world where AIDS is a problem, circumcision could save millions of lives.

But is it really so simple as all that?

For instance, in India, where I'm from, whether a man is circumcised is not an idle preference -- it's a matter of cultural and religious identity. As war movies have brutally shown, in a conflict between Hindu and Muslim, Jew and non-Jew, that is sometimes the only way to distinguish friend and foe.

It's not going to be easy to convince these groups to give up their beliefs. Here's hoping they understand that in the war against AIDS too, that little piece of skin could mean the difference between life and death.

Posted by Apoorva Mandavilli at 05:56 PM | Permalink | Comments (9)