From: matthew@ooc.uva.nl (Matthew Lewis)
Subject: Conference newspaper - Thursday 23 July - part 2
Note: non-commercial reproduction.
Archive-Number: 5774
Organization: Center for Innovation and Cooperative Technology, University of Amsterdam
Date: 24 Jul 92 12:46:46 GMT

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

Two Thai subtypes identified

Further insights into the mysterious ways of HIV subtypes have 
come from Dr Chin-Yih Ou and Dr Bruce Weniger of the Centers for 
Disease Control HIV/AIDS collaboration project in Bangkok.  Ou 
reported that two viral subtypes have been found in Thailand. One 
type is in patients likely to have contracted HIV via sexual 
transmission, while the other is confined largely to intravenous 
drug users.  None of the Thai patients had contracted HIV through 
blood transfusion.  As in related data presented previously by Dr 
Gerald Myers, no one has been found to be infected with both 
subtypes.
The subtype found in female prostitutes, their male clients and the 
pregnant wives of those clients closely resembles the HIV subtype 
most prominent in Africa, including strains Uganda 455, Zaire Z6, 
NDK and MAL.
The subtype found in drug users is essentially the same as that 
found in the North American and European strains LAI and ADA.  
The Thai data show a 22% genetic divergence between the two 
subtypes, indicating that HIV-1 was introduced twice into Thailand 
and that the current subtypes did not evolve from a common 
precursor virus after initial introduction into the country, Ou said.  
He added: "We do not fully understand the reasons for this 
segregation.  It could be that there is little high-risk contact 
between intravenous drug users and prostitutes and that the HIV 
epidemics are quite separate between these groups."  Other 
theories are that there may be biological differences in how easily 
the two subtypes can be transmitted, or that infection with one 
viral subtype may block infection with another.

The Thai programme researchers are currently trying to determine 
whether the subtypes differ in pathogenicity.  They are running 
cohort studies, in prostitutes, young men and pregnant women, and 
they are now going back to determine the viral subtypes in each of 
these patients. This work should reveal some useful information 
about the relation of HIV subtypes to the progression of the disease. 

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

No sex day?

Elizabeth Ngugi, of the University of Nairobi, yesterday suggested 
that there should be a "World No Sex Day", linked to World AIDS 
Day, to highlight women's power to say no. Women must be the 
focus of analysis, Ngugi said yesterday at a session on prevention 
programmes for women. Some participants were concerned that 
recent moves to educate heterosexual men would result in a shift of 
funds and programmes away from women.
"Women must be placed at the centre of analysis, and men 
considered part of their world," Ngugi said. "We must have real 
partnerships between men and women."

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

Duesberg's objections answered

By William Check
A study designed to rebut the arguments of the virologist Peter 
Duesberg has confirmed that the development of AIDS is related to 
becoming seropositive for HIV and is not related to the use of 
psychoactive drugs, use of nitrate inhalants or anal intercourse. 
Keven Craib, of the Vancouver Lymphadenopathy-AIDS Study Group, 
which conducted the study, said the data prove convincingly that 
HIV causes AIDS. 
Peter Duesberg, a virologist at the University of California, Berkeley, 
has proposed that certain types of behaviour, including use of 
psychoactive drugs and "chronic promiscuous male homosexuality", 
leads to AIDS. To address these assertions, Craib looked at the 
incidence of AIDS in men in the Vancouver cohort, in relation to 
whether they were seropositive and what types of sexual behaviour 
they practised.
At entry, 237 men were seropositive; another 128 seroconverted 
and 350 remain seronegative.
 None of the 136 cases of AIDS defined during follow-up occurred 
in persistently seronegative men. In uninfected men, the number of 
CD4 cells remained stable; decreases in CD4 counts were seen only 
after seroconversion. 
Risky behaviours cannot explain this difference, Craib said. 
Psychoactive drugs (cocaine, LSD, heroin or amphetamines) were 
used by 56% of persistently seronegative men.
About 25% of the seronegative group reported receptive anal 
intercourse with casual partners. 
Co-factors play a very important role in determining the rate of 
clinical progression of HIV disease, Craib said. But "it is a disservice 
and a hindrance to public health for scientists to claim that HIV is 
harmless."  

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

Minicourses a huge success

Conference organisers were sur-pised by the turnout at last night's 
minicourses, said Dr Jonathan Silin, a consultant with the Harvard 
AIDS Institute who has co-ordinated the sessions. The minicourses 
have run over three consecutive evenings. Over 2,500 - nearly one 
in four - of those attending the conference stayed late to attend one 
of the 11 courses, which ranged from issues in sex work and 
management of opportunistic infections to methods of surveillance 
and prediction.

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

University supplies ddC  

By Simon Rozendaal
The University of Ghent in Belgium has become an important 
supplier of the antiviral drug ddC. The university is making the 
tablets on contract with Fight for Life, a private medical clinic in 
Amsterdam. This clinic exports ddC, not yet registered in most 
countries, to Spain, Germany, France and Belgium. 
Earlier this year, when ddC was not available in the US, Fight for 
Life was the only organisation given permission by the US Food and 
Drug Administration to export ddC to the US.
Hoffmann LaRoche is the main producer of ddC and therefore 
responsible for seeking official registration. Studies of ddC have 
been taking place since 1986 but so far, only a few countries have 
granted registration. They include Austria (since March 1992, for 
monotherapy) and the US (since June 1992, in combination with 
zidovudine). 
Fight for Life has been able to purchase ddC from the Belgian 
university because of a loophole in the law. Before substances are 
registered, people are allowed to conduct trials with them. Fight 
for Life has three doctors (one employed, two volunteers) who 
conduct the trials, in which about 200 patients take part. The 
participants have to pay for the drug themselves. Fight for Life 
charges about 40% of the official price.  
The Dutch Fight for Life organisation is affiliated to the American 
service organisation with the same name. The Dutch clinic was 
founded in 1990 and has specialised in new drugs which have not 
yet been registered. A trial with kemron (alpha interferon) and 
levamisol has been completed.  The clinic is currently conducting 
trials with ddC and compound Q (trichosanthin). Fight for Life 
imports compound Q, a protein extracted from the Chinese 
cucumber, from the Shanghai Institute of Organic Chemistry and 
has it checked for purity and sterility by the Department of 
Biochemistry of the University of Amsterdam. Preparations are also 
being made for trials with PMEA (phosphonylmethoxyethyl), 
peptide T and passive immunotherapy (infusions of antibodies 
purified from the blood of healthy seropositive people).

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

Call to tackle sex workers' clients 

By Cindy Patton
One way to reduce the risk of HIV transmission to sex workers is to 
direct educational programmes at their clients. But how do you find 
their clients?
Researchers in India and the Netherlands have been tackling this 
question. In Madras, India, one approach has been to contact men 
through their place of work. 
Dr Swaminathan Sundararaman of the AIDS Research Foundation in 
Madras, which sponsors several HIV education programmes related 
to sex work, says planners have been slow to direct programmes at 
clients because of social prejudices which cast sex workers as the 
"imminent threat" while their clients fade quietly into the 
background. 
The AIDS Research Foundation developed programmes for men at 
workplaces after extensive studies to determine what class of men 
are likely to hire the most economically disadvantaged sex workers. 
These studies found that men tend to visit prostitutes of the same 
social class as themselves.  
The foundation's studies also showed that working class sex 
workers and clients find it difficult to obtain condoms, not only 
because they are expensive but also because people are afraid to buy 
them in their own neighbourhood. Building on earlier programmes 
which used sex workers to persuade clients to attend STD clinics, 
the foundation is now considering employing sex workers to sell 
condoms to clients.
In the Netherlands, the Men and Prostitution Foundation, an 
organisation formed by clients of sex workers in 1986, has also 
been working with clients to promote safer sex. Gerrit Bloemen, a 
co-founder of the group, said: "We need to get lust out of the 
gutter." 
Bloemen said that the negative associations of prostitution affect 
clients, too. According to a recent Dutch study, he said, there is 
good reason to believe that "the more positive clients feel about 
their relation to prostitution, the more likely they are to protect 
against STDs."
Bloemen said men have a variety of "social and individual" motives 
for hiring sex workers. 
These could include the search for variety, in order to satisfy their 
curiousity or because they want to show off their masculinity. 
Different prevention strategies need to be directed at each of these 
motivating factors.

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

A plethora of alternatives

The vast majority of people with AIDS and HIV are taking 
alternative therapies, delegates heard at a minicourse on Tuesday. 
Kaiya Montaocean from the Center of Natural and Traditional 
Medicines in the USA thought the figure was as high as 90%.
People in developingcountries take alternative therapies because 
they cannot afford expensive drugs and because such therapies 
often fit with their cultures. 
Leonardo Ortega, a native Venezuelan doctor living in Washington 
DC, asked people in Latin and South America what alternative 
therapies they were using. 
The list included acupuncture, massage, folk healing, shamanism 
and spiritism. He said the spirit of a doctor from Ecuador was 
believed to have cured two HIV-infected people. 
The use of herbal therapies is also common. Among the herbs being 
eaten for the treatment of HIV/AIDS in Latin America are garlic, 
coneflower (Angustifolia) and several less well-known ones. In many 
developingcountries, traditional approaches are illegal and those 
who practice them are wanted by the authorities, Ortega said. In 
the developed world, many HIV-positive people also believe in 
alternative therapies, speakers said. Tanne de Goei from ACT UP 
Amsterdam said one study had concluded that as many as 40% of 
Dutch HIV-positive people follow non-official therapies like eating 
extra vitamins, garlic or ginseng or having ozone treatment. 
David Baker, an HIV-positive nurse from the US, listed today's 
favourite alternative drugs. The antivirals included compound Q, 
NAC (N-acetylcysteine), vitamin C and Chinese herbs and the 
immunomodulators included DNCB (dinitrochlorobenzene), 
glycyrrhizin (liquorice root extract), iscador (mistletoe extract) and 
cimetidine (an official drug used to treat stomach ulcers). 

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

Secrets of long-term survivors

By Simon Rozendaal
Half of all the HIV-positive people with access to health care will be 
free of symptoms for 10 years or more. At a Round Table session on 
Tuesday on long-term survivors, Frits van Griensven from the 
Municipal Health Service in Amsterdam said that 50% of the gay 
men in the combined cohorts in New York, San Francisco and 
Amsterdam have yet to develop AIDS 10 years after they first 
became HIV-positive. These three cohort studies represent the 
biggest longitudinal studies in the world on HIV-positive people. 
There is no single explanation why some HIV-positive people are 
'long-term survivors' and some are not, those taking part in the 
dicussion agreed. An important factor seems to be good access to 
health care. There are no precise figures but the phenomenon of 
the 'long-term survivor' seems to be very rare in Africa. 
An analysis of 562 men with well-defined dates of seroconversion 
from the San Francisco cohort suggests that fewer than 1% will 
develop AIDS within two years of seroconversion, Susan 
Buchbinder, from the AIDS Office in San Francisco, said. More than 
one in 10 will have AIDS within five years, more than one in two 
within 10 years and more than two out of three within 13 years. 
Aldyn McKean from ACT UP New York presented himself as one of 
the long term survivors. 
He knows that he was HIV-positive by 1980 and thinks he became 
infected in the late 1970s. Since 1983, he has had a low but stable 
CD4-count of 160. McKean said there are many more long-term 
survivors in the files of general practioners. He called for more 
comprehensive studies. 

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

Why African Governments Fail to Act:
Disorganisation, Denial and Debt

In the second decade of the AIDS epidemic, the slowness of many 
African governments to react to this problem can be traced to three 
issues: denial, disorganisation, and debt.
Denial
Like individuals, governments think AIDS will not affect them, 
despite the fact that other people or countries in similar 
circumstances are affected. Due to the long latent period of the 
virus, this problem is especially severe in countries where the 
prevalence is lower. Although governments in subSaharan Africa are 
aware of what is happening in Uganda, for example, imagining that 
their own country is the next in line is difficult.
Many countries do not have a policy on AIDS and have not included 
AIDS in national plans. Very few African heads of state have talked 
openly about AIDS to their populations. Only in June of this year, 
did the African heads of states include AIDS on a meeting agenda.
Like individuals, governments return to reality when the epidemic 
hits home. Many of us can remember the speech to a previous AIDS 
conference by President Kaunda of Zambia, who had lost a son to 
the disease.
Disorganisation
Many factors within a country can "paralyse" a government. The 
very fact that AIDS concerns human sexuality is a difficult issue to 
deal with at every level.
Underlying social, economic, and political questions have to be 
addressed, and these governments are not ready to answer them. If 
the government of a country tries to deal with prostitution, it must 
first deal with the economic issues, find other jobs for the 
prostitutes, find jobs for migrant workers so they are not separated 
from their families, solve the problem of street children, and 
change the subordinate position of women in society, which is one 
of the factors forcing women into prostitution. Few African 
countries have either the organization or the funds to do these 
things.
In most countries in sub-Saharan Africa, AIDS control programmes 
are under the Ministries of Health. These are not powerful 
ministries, and they have more problems than other departments 
because of the huge health and nutrition problems in these areas. A 
programme manager from such a ministry has little influence on 
higher-ranking officials.
That was why some countries like Uganda and Thailand placed 
their AIDS control programmes directly under the Prime Minister's 
office, which gives the programme the crucial position of dealing 
with the relevant ministries. However, these actions were taken 
only when the epidemic had reached very high proportions. What 
one would like to see is the low-prevalence countries doing the 
same, before it is too late.
Debt
I cannot think of a single African country that could attempt all of 
the things which are needed. Most are paying 40% or more of their 
income out to repay debts. The governments of developed and 
developing countries must come together to solve this problem.

(article continued in part 3)
-- 
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