This week’s edition of HATIP highlights all the aidsmap.com reports from the 2006 Implementers meeting of the President’s Emergency Plan for AIDS Relief, which was held in Durban, South Africa, in June.

PEPFAR is funded by the US government and implemented by a vast network of partner organisations working in 15 focus countries.

The 2006 Implementer’s Meeting provided an invaluable opportunity to learn about the vast range of activities now taking place thanks to PEPFAR funding, and to share lessons being learnt about programme implementation in some of the world’s poorest and worst-affected countries.

PEPFAR - an overview of HIV prevention research from the 2006 Implementers Meeting

While PEPFAR has been subjected to a great deal of (sometimes histrionic) criticism because of its ring-fencing of some of its funding to Abstinence and Being Faithful-only HIV prevention programmes, the complete picture of PEPFAR-supported prevention work is far more complex.

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Cultural obstacles to abstinence and being faithful present challenges for PEPFAR HIV programmes

Certain cultural factors in resource limited settings pose significant challenges to prevention efforts and must be addressed to make it possible for people (especially, the youth) to adopt behaviours such as abstinence, being faithful, and correct and consistent condom use (ABC) according to several presentations at the 2006 PEPFAR’s Implementer’s Meeting held mid-June in Durban, South Africa.

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ABC prevention successes claimed in Nigeria, Kenya

Some PEPFAR funded ABC prevention projects are having an effect on behaviour according to presentations at the PEPFAR’s 2006 Implementers meeting, with reports of delayed sexual debut in Nigeria and reduction in the number of sex partners in East Africa. Although it is too soon to assess the impact of these interventions on HIV transmission, data were presented from other countries, in particular Kenya, demonstrating that these behavioural changes do correlate with lower HIV prevalence rates.

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PEPFAR: Greater wealth and not poverty associated with higher HIV prevalence in Africa, according to survey

Contrary to widespread belief, HIV is not disproportionately more common among the poor in Africa, according to a study by Dr. Vinod Mishra at the 2006 PEPFAR Implementers meeting held in Durban in mid-June. In fact, if anything, the reverse was true across several sub-Saharan African countries: “Even with all other factors controlled, in most countries, the weathier adults remain at least as likely as the poor to be HIV-infected, if not more,” said Dr. Mishra.

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PEPFAR: Epidemiologist presents a scientific rationale for focusing on Abstinence & Being Faithful in sub-Saharan Africa

“The high prevalence HIV epidemic in sub-Saharan Africa is characterised by close-knit sexual networks that allow the propagation of the virus to large numbers of individuals” said epidemiologist David Stanton, who believes that Abstinence, Being Faithful and Condoms-based (ABC) interventions, but especially the A & B parts, are the means to disrupt these networks. Stanton, who serves as the Chief of the Division of Technical Research in the Office of HIV/AIDS at USAID, made a scientific case in support of PEPFAR’s emphasis on A & B, at the 2006 Implementers meeting in Durban last month.

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PEPFAR: PMTCT improving but services only reaching small percentage of women in need

The past few years have seen improvements in the treatment options for the prevention of mother-to-child transmission (PMTCT), according Dr Dorothy Mbori-Ngacha, who is the Chief of the PMTCT Section of the US Centers for Disease Control in Kenya. But despite the expansion of programmes under PEPFAR, PMTCT services are reaching less than 10% of HIV-infected women in most countries.

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PEPFAR: Unexpected and unwanted pregnancies in women on ART highlights family planning gap

A number of antitroviral treatment (ART) programmes supported by the US have observed a large number of unexpected pregnancies in women on ART, according to reports made at the 2006 PEPFAR Implementers meeting held in June in Durban, South Africa. According to one report, the results were disastrous for some women on ART in Uganda, who did not want any more children. As a result, teams have concluded that PEPFAR may need to invest more in supporting family planning services in these countries.

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PEPFAR: Early weaning to avoid mother-to-child transmission of HIV could endanger infant’s health

Early weaning to prevent mother-to-child transmission (PMTCT) of HIV can pose considerable challenges in resource-limited settings — and could put HIV-exposed infant’s health in serious jeopardy —according to reports presented at the 2006 PEPFAR Implementers meeting in Durban this June.

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Zimbabwe observes a reduction in HIV prevalence, but why?

In 2005, a substantial reduction in national HIV prevalence during the previous year was observed in Zimbabwe. This has been heralded by some as evidence that HIV prevention efforts, particularly strategies based upon Abstinence, Be Faithful and use Condoms (ABC), are having an impact.

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PEPFAR: HIV prevention for injection drug users in Africa a growing issue

While sexual transmission is the leading driver behind the spread of HIV, it has been estimated that globally, injection drug use accounts for at least 10% of new infections globally. In some countries injection drug users (IDUs) are at the centre of the epidemic. Preventing the spread of HIV in this (and from this) marginalised population will be necessary to reverse the epidemic in Eastern Europe and southeast Asia.

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PEPFAR project reports reduction in the number of partners among Zambian truck drivers

Prevention work among truck drivers in Africa appear to be leading to reductions in sexual risk taking behaviour according to one presentation at the 2006 HIV/AIDS Implementers Meeting of the President’s Emergency Plan for AIDS Relief held from June 12-15 in Durban, South Africa.

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Is PEPFAR competing or cooperating in treatment scale-up?

Given the political climate in which the PEPFAR Implementers meeting and the UN High Level meeting took place, it would be only natural for some working in the respective funding organisations to become a bit competitive — and yet publicly at least both appear to be striving for closer cooperation.

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Casting the first stone: the US Christian right’s war on the Global Fund

When he first announced PEPFAR, President Bush pledged to allocate $1 billion dollars to the Global Fund over the next five years, and recent PEPFAR promotional materials proudly announce that the US Congress has seen fit to increase that funding to an aggregate closer to $2 billion dollars. Earlier this year politicians from both parties in Congress sponsored an amendment to the Global AIDS Bill that would boost next year’s US donation to $866 million.

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PEPFAR and Global Fund both highly effective, but is the funding sustainable?

At the 2006 Annual Implementers’ Meeting of the US President’s Emergency Plan for AIDS Relief (PEPFAR), last week in Durban, South Africa, the “implementers” (the teams working on the ground in PEPFAR’s focus countries) reported success after success and gave numerous examples of just how rapidly effective smart and strategic investments in AIDS care and treatment can be. In a little over two years since disbursements began, PEPFAR has supported antiretroviral treatment (ART) for hundreds of thousands and care for literally millions of people infected or affected by HIV in resource-constrained settings.

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Fat loss beginning to trigger treatment changes in South African patients

Fat loss caused by the d4T (stavudine) component of triple antiretroviral therapy is beginning to trigger treatment changes among people receiving HIV treatment in South Africa, doctors from Durban’s McCord Hospital reported at last week’s 2006 Implementers Meeting of the President’s Emergency Plan for AIDS Relief in Durban, South Africa.

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Rapid antibody tests can diagnose HIV infection in infants almost as well as DNA PCR, South African study shows

The use of two separate rapid antibody tests can accurately diagnose HIV infection in infants as early as four months after birth, and in a study of 67 infants with a median age of eleven months, this method diagnosed HIV infection with 95-97% accuracy, South African researchers reported last week at the 2006 Implementers Conference of the US President’s Emergency Plan for AIDS Relief in Durban, South Africa.

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Cost of ARVs makes up less than one third of treatment cost in South African study

The cost of antiretroviral drugs (ARVs) amounts to only one third of the costs incurred in treating HIV-positive people with antiretroviral therapy in South Africa, researchers reported last week at the 2006 Implementers Meeting of the President’s Emergency Plan for AIDS Relief in Durban, South Africa.

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High discordance rates among Ugandan ART clients require new prevention approaches

High rates of discordant HIV status between people receiving antiretroviral therapy in Uganda and their partners have been reported in two studies presented on Tuesday at the 2006 Implementers Conference of the US President’s Emergency Plan for AIDS Relief in Durban, South Africa.

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Fees for HIV treatment increase risk of death in developing countries

People with HIV who have to pay fees for treatment in resource-limited settings are significantly more likely to die during the first year of follow-up than people who receive free treatment, according to findings from an international cohort study presented on Monday at the 2006 implementers` meeting of the US President’s Emergency Plan for AIDS Relief in Durban, South Africa.

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Risky sexual behaviour remains low after two years of ART in Uganda

People receiving antiretroviral therapy in rural Uganda continue to have lower levels of risky sexual behaviour and a vastly reduced risk of HIV transmission after two years on treatment, US researchers from the Centers for Disease Control (CDC) reported on Tuesday at the 2006 Implementers meeting of the US President’s Emergency Plan for AIDS Relief in Durban, South Africa.

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