From: matthew@ooc.uva.nl (Matthew Lewis)
Subject: Conference Newspaper -Tuesday, 21 July - part 1
Note: non-commercial reproduction.
Archive-Number: 5748
Organization: Center for Innovation and Cooperative Technology, University of Amsterdam
Date: 21 Jul 92 20:06:46 GMT

Hello all,

Here is the Conference Newspaper, Tuesday 21 July.  This paper 
comes to you courtesy of HIVNET, an organization based in the 
Netherlands which has set up a network of BBS systems for the 
spreading of information about HIV and AIDS.  It is made possible 
by the kind permission of the Aids Congress Foundation.

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Variety: the key to HIV control  
by Janis Kelly

The HIV/AIDS epidemic is changing direction, the virus is 
changing its coat and human social systems are not changing fast 
enough, according to speakers in yesterday's plenary session on 
Longitudinal Trends in the Epidemic.  
Dr Michael Merson, director of the WHO's Global Programme on 
AIDS, said: "Yesterday, the HIV pandemic was concentrated in 
cities and towns. Today, the virus is following roads and navigable 
rivers deeper and deeper into the countryside." He added that HIV 
incidence in Asia is skyrocketing and that, without adequate 
prevention programmes, the number of new infections in Asia will 
overtake that in Africa some time during this decade.  

Sharing
He called for human rights, replication of effective prevention 
programmes and greater sharing of resources between developed 
and developing nations. He said: "Now that the developing 
countries have mustered their courage and pledged their 
commitment to fighting AIDS, it would be a cruel irony if the world 
did not match this effort with the funding needed."
A great deal of effort has already been invested in studying the 
variability of HIV. Dr Gerald Myers, of Los Alamos National 
Laboratories in the US, described a wider spectrum of HIV genetic 
diversity than had been originally observed. There are at least five 
major subtype lineages of HIV-1, and each subtype changes about 
1% of its genes each year.  

'Swarm'
Myers said that an HIV-infected individual soon becomes host to "a 
swarm of distinguishable variants"differing from each other by about 
5%. He raised the possibility that infection by one subtype of HIV 
may actually prevent infection by another subtype. No one has ever 
been found who is infected with more than one subtype (not to be 
confused with variants of subtypes). It might be possible to harness 
this apparent inhibition, protecting people against lethal subtypes 
by inoculation with a less deadly one. Myers said this theory might 
lead to a prophylactic vaccine but doubted that the world was "quite 
ready"to risk using an infectious agent, even a defective virus, to 
protect against AIDS.
At the moment, the only strategy for protection is change in 
behaviour. Questioning how we could achieve this, Dr Anke 
Ehrhardt of Columbia University, New York, said we should try to 
learn as much about human sexual variety as we know about viral 
variety. Ehrhardt said that public health and moralistic attitudes 
continue to come into conflict: "The moralising position may range 
from labelling sexual behaviour outside of heterosexual marriage as 
sinful, in which case disease prevention becomes secondary to 
moral principles, to the extreme position that if the sinner does 
not change his or her sexual behaviour, he or she may be doomed 
and deserve to die."
There is growing evidence that properly designed AIDS prevention 
programmes do cause change in people's sexual behaviour, said      
Dr V. Chandra Mouli of the         All India Institute of Medical 
Sciences. He cited a WHO study of 15 projects in 13 countries 
which found that safer sex practices are being adopted by ever-
growing numbers of military recruits in Rwanda, truck drivers in 
Tanzania, sex workers in Zimbabwe and other groups in risky 
situations.

Burden
However, in the developing world, the burden of caring for people 
with HIV and AIDS still falls largely on the extended family network 
and Mouli says that "the strands of this safety net have become 
increasingly frayed". Care of children orphaned by AIDS has passed 
to a generation of elderly grandparents. 
Mouli says: "Extended family networks and social support systems 
are beginning to falter because they are overwhelmed by the 
endless demands made on them"and warns that entire 
communities face "destitution and even disintegration"without 
outside help. 

**********************************************************
Vaccine toxicity is low
by William Check

A candidate vaccine containing HIV envelope protein has produced 
promising results in a pilot study on humans. Delegates at the 
session on prophylactic HIV vaccines heard that the candidate 
vaccine, which contains a recombinant version of gp120 from the 
IIIB strain of HIV, could stimulate antibody responses and cell-
mediated immunity. 
Tests in chimpanzees had already shown that the candidate vaccine 
could protect the animals against viral challenge. Two years after 
the challenge, there was still no sign of infection.
For the tests in humans, Dr Mary Lou Clements of Johns Hopkins 
University, along with other researchers, immunised 25 healthy 
HIV-negative volunteers at low risk of HIV infection at 0, 1 and 8 
months, with either 100 or 300 mcg of the vaccine in alum or with 
alum placebo. The trial was double-blind.
Clements said the candidate vaccine was tolerated well. All 
volunteers receiving the active preparation had specific antibody 
responses. The higher dose was more potent. At two weeks after 
the third immunization, the anti-rgp120 titer was 4.0 for the 
higher dose and 3.4 for the lower dose. 
Blocking antibody against the V3 hypervariable loop of the peptide 
and blocking antibody against CD4 was present in 90% and 100% of 
those receiving the 300 mcg dose, respectively. Nine of 10 had 
neutralising antibody, with a mean titer of 1:58, "the highest we've 
seen with a IIIB envelope vaccine,"Clements says. 
A lymphoproliferative response to rgp120 was present in nine of 10 
subjects receiving the higher dose. Two people tested more than 
six months after the second booster retained this response.
Some researchers have suggested that cytotoxicity may be more 
important than neutralising antibody for protection against HIV.
"Cytotoxic cells may restrict virus replication after infection, but 
they don't correlate with prevention of infection,"Clements says. 

**********************************************************
Liz Taylor: Scientists unite!
By Simon Rozendaal

Amfar, the American Foundation for AIDS Research, is to give 
almost US$300,000 for AIDS work in Argentina. Elizabeth Taylor, 
the founding chairman of Amfar, announced at a press conference 
yesterday that the money would be shared between six prevention 
projects aimed at the gay community, drug users, young women and 
HIV-positive people and their families.
Taylor reinforced her commitment to the battle against AIDS. She 
said: "I am tired and I am grieving. 

Tired of having to convince the world out there, over and over 
again, that AIDS is a universal threat to all mankind". 
She appealed to scientists: "Here and now we are all fellow 
travellers on the road to defeat AIDS. From the lab bench to the 
bedside, from the icy north to the deep south, we are all part of the 
world community that does want to stop AIDS now."
Miss Taylor urged women to take the risk of HIV seriously. "It can 
be contracted vaginally, it does not have to be anal sex", she said.

**********************************************************

Fight to get condoms and syringes into prisons
By Simon Rozendaal

Many prisons carry out mandatory HIV-testing and in some there is 
systematic segregation of prisoners infected with HIV, delegates at 
a session on Sex and Drugs in Prisons heard yesterday. In most 
prisons there is no distribution of condoms and there are neither 
clean syringes nor bleach for cleaning them, making it difficult or 
impossible for prisoners in most countries who need to protect 
themselves against HIV and AIDS to do so. 
Ted Hammett, from the consulting company Abt Associates in 
Cambridge, Massachusetts, said most prisons therefore do not 
comply with the WHO's recommendations published in 1987. He 
said mandatory HIV-testing took place in 17 out of 51 American 
prisons and 5 out of 27 European prisons. The same survey showed 
that five out of seven Australian prisons segregate HIV-positive 
prisoners. 
Condom distribution is a particular problem, delegates heard. Only 
two out of 51 US prisons distributed condoms. In Europe, the 
situation is slightly better. Out of 27 European prisons, 16 
complied with the WHO's recommendations on condoms. Several 
speakers at the session said that prison authorities and politicians 
in many countries are reluctant to hand out condoms. Sex among 
inmates is officially forbidden.
Oscar Simooya from the University of Zimbabwe presented a study 
in five Zambian prisons with a seroprevalence rate of 16%. There 
was no policy to hand out condoms, Simooya said. "The prisoners 
do not want it themselves. It is a difficult problem for us."
Mercedes Diez from the Spanish penitentiary authorities told 
delegates that it is possible to distribute condoms in prisons 
without creating significant problems. In Spain, which has a high 
rate of seroprevalence in prisons (about 55% in Madrid), condoms 
are handed out in every prison. The inmates receive the condoms 
along with toiletry items at entry. "They do not have to ask for 
them", Diez said. She could not make any estimate of the extent to 
which prisoners use condoms, however.
HIV/AIDS is causing huge problems in prisons. Especially in 
countries like Spain and Italy, where a large proportion of drug 
users are infected, the level of seroprevalence in prisons is high. All 
over the world, prevalence in prison is higher than outside.
In the USA alone, almost 7,000 inmates have AIDS. In the New 
York prisons, an epidemic of TB related to HIV is raging. Stephen 
Machon, a member of ACT UP, said that in the last quarter of 1991, 
13 prisoners died in New York jails because of TB. The mortality 
rate from AIDS in prisons is more than ten times higher than the 
New York average, Machon said.
The session was the first at an international AIDS conference to 
address the issue of sex and drugs in prison. Speakers as well as 
audience applauded the initiative. Hammett said: "It is an issue that 
concerns the whole of society, because most prisoners return to 
society after completing their sentences."

Behind bars: many prisons fail to supply inmates with condoms or 
syringes to prevent the spread of HIV

Photo: R. Podorni/TASS

**********************************************************
Sex workers face harsh penalties
by Cindy Patton

Sex workers who are illegal aliens in Thailand face deportation and 
sometimes death, according to a prostitute's pressure group there. 
Chantaiwipa Apisukh, of EMPOWER (Education Means Protection of 
Women Employed in Recreation), an organisation based in 
Bangkok, Thailand, said that earlier this year about 20 women who 
were deported to Burma and tested HIV positive on their return 
were killed by lethal injection.

Concern
Apisukh, who met with Asian campaigners at Saturday's satellite 
meeting of some 250 sex workers and community organizers,  said 
sex workers in Thailand, where the sex industry is focussed on sex 
tourism, are now highly organised to campaign for their rights. But 
she is concerned that sex workers will not be properly informed 
about the benefits and harms of participating in the HIV vaccine 
trials planned for Thailand.
"These women are very poor and marginal. If they join the trial it 
isn't really of benefit to themselves, but to the next generation. 
Some may die sooner as a result of the trials.  We want 
compensation for them and a guarantee that they will receive 
treatment."
Marie-Helene Mottin-Sylla, who directs a project that supports sex 
workers in Dakkar, Senegal, said that the organizing work among 
Western prostitutes has been important, but may not be easily 
applied in Africa: "It is important to learn strategies. We need a 
global solution, but we also need to develop local ways."

Traditional life
Because sex work in Africa is not related to tourism or large 
businesses, prevention strategies used in countries like Thailand 
may not work as well in Africa, said Mottin-Sylla. "Except for a very 
few resorts, in the cities, it is largely local prostitution. Traditional 
life is hard on women, both in terms of economic conditions and in 
terms of patriarchal relations. More and more women want to leave 
the smaller towns and countryside to go to the big world of modern 
life, where they have no other economic or social means of 
survival."
Swaminathan Sundararaman, of the AIDS Research Foundation of 
India (ARFI) in Madras, who has conducted studies to determine 
STD transmission patterns between clients and sex workers from a 
variety of different settings, said that in India, sex work is stratified 
by class. "Street workers see migrant labourers who either have 
wives at home, or are single."
But in the mid-1980s, the researchers saw a new pattern of sex 
work in which middle-class women sell sex from their homes five 
or six times a month, said Sundararman. "With the failing economy, 
middle class families can't pay their bills. These are older women 
whose clients are men of the same class. It's very discreet, like a 
relative coming to visit."
Diana Alan, consultant to the National Transsexual and HIV Needs 
Analysis funded by the Australian government said she has 
identified transexuals as a subset of sex workers with specific 
needs.

'Worthless'
She said that young people who do not conform to gender 
expectations of their cultures are likely to be thrown out of their 
homes. They become "educationally disad-vantaged and believe they 
are unwanted, unemployable and worthless. They leave home and 
school, enter into sex work early and stay there,"Alan said. In her 
study, 40% of transexuals had engaged in drug injection and 80% 
had at some time been involved in sex work. Alan notes that 
transexuals are not covered by any discrimination laws or included 
in existing prevention strategies: they are considered neither 
women nor homosexuals. "Transexuals in the Third World are 
treated even worse than women,"Alan said.

Magic bullet
Priscilla Alexander, who directs a project on prostitutes at WHO's 
Global Programme on AIDS, applauded the inclusion at the 
conference of more front-line organizers from sex work projects.
"The main problem is that people are still  looking for a magic 
bullet,"said Alexander. "The most essential part of prevention is 
community identity. People have to believe that their own lives are 
valuable. The best way to do this is to organize people and work 
with them to help them realize that they are valuable and 
worthwhile."

(end of part 1 of 4)
-- 
Matthew Lewis, University of Amsterdam		Grote Bickersstraat 72
+31-20-52 51 220				1013 KS  Amsterdam
Internet: matthew@ooc.uva.nl			The Netherlands
Newsgroups: sci.med.aids