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HIV/AIDS

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on 8 January 2013

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Transcript of HIV/AIDS

Ethics of Research a virus that which destroys the
immune system's helper T cells,
the loss of which causes AIDS. Currently in the News -AIDS detected in California and New York
-detected first in gay men
-AIDS is being detected in several more countries
-'AID' abbreviation created, & several safe sex homosexual organizations
-1/3 of 3000 AIDS individuals die
-doctors confident AIDS is infectious
-scientists identify HIV as the cause of AIDS
-HIV tests mandated from now on, on Blood supplies
-more than 38000 AIDS cases in 85 countries
-AZT is the fist drug approved for AIDS, countries now raise awareness
-American Govt conducts a national AIDS education campaign priya,mehreen,ranjana,dipankar,prince,jeevan,sneha HIV/AIDS 1980's -Global Fund established which was highly beneficial to all countries
-AIDS treatment program is established in Botswana
-AIDS drugs becomes more affordable for developing countries
- HIV vaccine seen to be infective
-Circumcision is shown to reduce HIV infection among heterosexual men.
-28% of people in developing countries who need treatment for HIV are receiving it.-Annual global spending on AIDS in low- and middle-income countries is $8.9 billion.
-It is estimated that $14.9 billion would be needed for a truly effective response.
-Around 33 million people are living with HIV, according to revised estimates.-Another major HIV vaccine trial is halted after preliminary results show no benefit.
-President Obama announces the removal of the travel ban that prevents HIV-positive people from entering the US.-4 million people in developing and transitional countries are receiving treatment for HIV; 9.5 million are still in immediate need of treatment.
-United States, South Korea, China and Namibia lift their travel bans for people living with HIV.-The CAPRISA 004 microbicide trial is hailed a success after results show the gel reduced the risk of HIV infection by 40%.
-Results from the HPTN 052 trial show that early initiation of antiretroviral treatment reduces the risk of HIV transmission by 96% among discordant couples
-FDA approval of Complera, the second all-in-one fixed dose combination tablet, expands the treatment options available for people living with HIV. -approx. 800,000 people living with HIV worldwide
-AZT shown no to be beneficial to those in the early stages of HIV infection
-However, AZT is seen to reduce mother-to-child transmission of HIV
-Joint United Nations Programme on AIDS (UNAIDS) established
-Combination antiretrovial treatment shown to be highly effective towards HIV
-developed countries pursue this method
-AIDS spending in low & middle income countries is 300,000$
-AIDS deaths decline in developed countries
-AIDS treatments and drugs limited to people in developing countries 1990's 2000's In the beginning, within the 1950's-1970's -HIV (the virus that causes AIDS) probably transfers to humans in Africa between 1884-1924
-HIV entes US, however doctors still remain ignorant to the growing epidemic History of HIV/AIDS Therefore throughout HISTORY Economic Difficulties New infections are occurring everyday leading in a decrease of population worldwide.
Due to the economic defeat in third world countries their focus on HIV/AIDS deprives their development of resources.
A new form of action proposed would be a wide skill HIV/AID patent buy out.
Larger countries like the United States would buy from pharmaceutical companies the patent rights to any FDA-approved drug that effectively treats HIV/AIDS.
Companies would receive one billion dollars for each patent. This would total to approximately $12-13 Billion up front. The government would then gain the right to produce this medication.
Medication would now be available at cost NGO's specializing in HIV/AIDS treatment.
This would create an equivalent distribution of them globally.
Many experts agree that it is impossible for third world nations to develop so long as their limited resources are drawn to HIV/AIDS.
In an attempt to keep up with these astronomical costs associated with treatment and prevention, these countries continue to take out loans.
The World Bank provides these countries with loans at the highest interest rates and restrictive repayment conditions of these loans hasten countries' decent into poverty.
By decreasing the financial burden of HIV/AIDS of these third world countries such as Africa, we give the freedom to put their resources to development.
This eventually would lead to more stable international markets and efficient, responsible trade.
UNAIDS Global Report of 2012, sub-Saharan AFRICA is home to 68% of people living with HIV worldwide and 72% of global AIDS death.
22.5 million people living with HIV on the continent, more than half are woman, and growing number are children.
Although great strides have been made to provide treatment in recent years, only 30% of those who needed are receiving anti retro viral drugs and the number of orphan numbers continues to rise. African countries have themselves taken on the financial responsibility for prevention, treatment, care and support, accounting for 52% of resources for the HIV response. Prevention Do not participate in unprotected sexual intercourse. The only form of sexual intercourse that does not carry a risk of HIV infection is in a mutually monogamous partnership in which both members are uninfected.
Do not reuse needles or syringes. These may carry and transmit HIV, putting intravenous drug users at risk of infection. Individuals who administer medications subcutaneously or intravenously should always use a new, sterile needle with each injection.
Talk to your partner about past and present sexual history. Ask if they have been tested recently and about the results. Do not have sex with anyone who refuses to disclose this information.
Ask any new sexual partner if he or she has participated in intravenous drug use in the past.
Encourage your partner to be tested. If he or she has not recently been tested, ask your partner to do so before having sex.
Seek treatment if you think you have been exposed to other STDs, such as gonorrhea, syphilis, or chlamydia. Infection with these diseases can increase your risk of contracting HIV.
Do not use intravenous drugs that are not prescribed by your physician. Illicit intravenous drug use can increase your risk of infection with HIV and make you more likely to participate in risky sexual behavior. If you inject drugs, follow these precautions:
Never use dirty needles or syringes.
Avoid all contact with another person's blood.
Get tested for HIV yearly.
Vaccinate yourself against hepatitis A and hepatitis B.
Do not abuse alcohol or recreational drugs. Losing full mental control can lead to dangerous situations or poor decision-making, increasing the likelihood of participating in unprotected intercourse or other activities that carry a high risk of HIV infection.
Practice abstinence or safe sex. If you or your partner is infected with HIV, it is essential to use a latex condom and a lubricant (to prevent condom tears) during intercourse of any kind.
Only engage in unprotected sex if you are in a mutually monogamous relationship in which both you and your partner are uninfected by HIV or any other STD.
If you are infected, you must always notify a new sexual partner of your status before intercourse so that he or she can decide whether to continue involvement with you or take appropriate precautions to prevent infection.
Do not assume that someone who is asymptomatic does not have HIV. People can have HIV for many years before developing AIDS, and any infected person can transmit the virus.
Get tested if you become pregnant. HIV infection can be transmitted from mother to child. Some medications may reduce the risk of transmission, so testing and treatment is essential. Clinical Trials SAV001-H
-Attempts to develop a successful vaccine for HIV failed in 2003, 2007 and 2009.
-No commercialized vaccine has been successfully developed yet, although currently there are more than thirty HIV vaccines being tested throughout the world using human trials according to the International AIDS Vaccine Initiative. SAV001-H is the only Canadian-developed one and shows promising results.
-Developed by researchers at Western University’s Schulich School of Medicine and Dentistry by Dr. Chil-Yong Kang and his team
-Funded by Sumagen Canada, company created in 2008 to aid the vaccine development.
-It is the first and only preventative HIV vaccine based on a genetically modified killed whole-virus. This virus is used to activate immune response and is the same strategy that is used in the development of vaccines for influenza, polio, rabies and hepatitis A.
-The United States Food and Drug Administration approved human clinical trials on the vaccine. The process involved using white blood cells and the melittin protein from honeybees to aid in cultivating the vaccine.
-According to Dr. Kang, the researchers conducted 230 different tests, some involving primates, in order to assure that the vaccine is safe enough for human use. Phase 1
-Designed to see whether or not the vaccine is safe or not for humans.
-Starting this March, the testing of SAV001-H began. 24 HIV-positive volunteers, males and females aged between 18 and 50 years, at two Los Angeles clinics participated.
-18 people received the vaccine, while six people were given a placebo.
-Expected Results: two or threefold increase in the level of HIV-1 antibodies
-Actual Results: no adverse effects and level of HIV-1 antibodies increased significantly, one individual showed a 32-fold increase and another a 10-fold increase Next Steps
-Phase 2 includes the testing of the vaccine on 600 HIV-negative volunteers who are at a high risk of infection. This will allow researchers to measure the immune response and is expected to take approximately one year.
-Phase 3 entails the testing of the vaccine on 6,000 HIV-negative men and women at high risk of infection. This will determine whether or not the vaccine is successful or not.
-Testing to take place in Canada, the United States and in other European countries.
-If vaccine shows promising results, it could be available on the market possibly in five years. Scientists and doctors, governments, citizens all work together to develop effective treatments for HIV/AIDS, which was only done after several attempts, as knowledge about the disease was developed as years passed. Developed economical strategies through funding by The Global Fund, in order for developed countries to attain treatments as well as developing countries showed a struggle to allow for a wide range of their citizens to be able to attain the drugs.However over the years Companies and Organizations , indivuals have created the assistance needed for HIV/AIDS patients several methods of prevention developed as years passed, ex. HIV screenings on blood supplies, educational campaigns, UNAIDS-Number of individuals who had HIV/AIDS rapidly increased to millions - several methods of prevention developed as years passed, ex. HIV screenings on blood supplies, educational campaigns, UNAIDS Treatment and Medications Over the past years, several drugs have become available to fight HIV
A combination of at least three drugs is needed to supress the virus’ replication and to also boost the immune system.
The system of virus suppression is called Highly Active Antiretroviral Therapy (HAART). These regimens have substantially reduced HIV-related complications and death.
Reverse transcriptase inhibitors inhibit the ability of the virus to make copies of itself. Some examples are:
Nucleoside reverse transcriptase inhibitors (NRTIs)
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
There are two regimens that combine two NRTIs and one NNRTI in a pill. This pill is taken by the affected person once a day. The regimens are called Atripla and Complera.
Other types of antiretroviral drugs are protease inhibitors (PIs), which interrupt virus replication at a later stage than reverse transcriptase inhibitors, and fusion and entry inhibitors, which are drugs that prevent HIV from entering human cells.
Also, there are integrase inhibitors which prevent HIV genes from being spliced into a human cell’s DNA.
However, there is a negative aspect to using such drugs, and this includes severe side effects such as decreased levels of red and white blood cells, inflammation of the pancreas, liver toxicity, rash, gastrointestinal problems, elevated cholesterol levels, diabetes, abnormal body-fat distribution, and painful nerve damage.
In the case of pregnant women who are HIV-positive, HAART therapy reduces the risk of HIV transmission to the fetus, however, some drugs are harmful to the baby. First Person 'Cured' of HIV Timothy Brown (a.k.a "the Berlin patient") is the first person who was tested HIV-positive and is the only person believed to be cured of the disease.
Brown was HIV positive when he developed leukemia. He chose to have a bone marrow transplant in 2007.
His doctors searched for a donor that had a rare genetic mutation that disabled a receptor known as CCR5, which HIV needs to gain entry into immune cells.
Then, Brown had two transplants that not only cured his leukemia but also cured his HIV by replacing his HIV-susceptible immune system with one that could fight the disease.
However, bone marrow transplants like the one Brown received are not suitable for widespread use, as finding a donor is very difficult and the procedure itself ends in death 20% of the time. Two general approaches are an elimination cure, which would rid the body of all HIV infected cells, and a functional cure, which would engineer a patient's own immune system to resist and fight HIV.
Even after the discovery of a cure, it could take years for it to be useful for practical use, such as in low and middle income countries, where there are 97% of the people with HIV.
Dr. Jay Levy, who codiscovered the AIDS virus in 1983, says that finding a cure is like “the four-minute mile — what we need to do is just show it’s possible... there’s enough creativity out there to find a way of having it applied in all parts of the world.” Some participants will without a doubt become naturally infected with HIV, but it is the job of the medical community to provide care—but to what extent? Some say that the services that are available to the country in which the trials are occurring should be provided Others say that the best treatment in existence is in order (lifelong supply of antiretroviral drugs ARVs currently 31 in existence to help prolong life and slow or stop the growth of the virus) In 2006, the cost of highly antiretroviral treatment (HAART) was $300 per patient per year however only 39 of the 160 countries whose data was available illustrated health expenditures over $730; 85/160 showed under $300 Treatment of HIV comes with more than just medication, it requires skilled personnel to monitor the patients Developing countries lack infrastructure to carry this out However, according to Seth Berkley, “no country in Africa, and few countries elsewhere in the developing world, can afford Western levels of treatment” Once a research trial is finished, researchers often leave patients to return to their own homes and the patients are then left to be or not to be treated by unknown entities
Another major issue raised is the fact that trials held in developed countries such as the United States would require infected patients to be treated with the best available care, however trials conducted on people in places such as Africa or India does not hold the same promise

Scientist Kathy Shapiro and ethicist Solomon Benatar agree that richer countries who sponsor poorer countries obviously have more resources and thus,
they are morally obligated to provide improvements in the medical care of these less fortunate nations

They even extend this to not only the well-being of patients, but to the overall health of the country Another view advocates the fact that if a patient is required to be provided with the best care on the planet, there would be no need for research to begin with Scientists should only focus on achieving the best outcome; clear line between research and treatment “medical treatment outside the confines of the trial is beyond their scope of duty” There are costs to providing care and if care was provided extensively, there would no longer be sufficient funds to conduct future experiments o Community support is also needed for clinical trials

o Countries who need to focus on developing their own medical systems find it a hindrance, inconvenience and burden o There are also reasons for which people do not join the trials

-Fear of side effects
-Contracting HIV
-No insurance
-Distrust of medical companies and their governments Should women participate in trials? they must in order to conduct fair and valid trials. Difficult in some areas as some women do not have the liberty to decide for themselves in terms of their participation Women may face discrimination if their families find out they have contracted HIV (whether it be genuine or just the result of a trial)—may also have an effect on future pregnancies

Some trials also recommend the use of contraception and this is seen as the promotion of promiscuity; bringing up a whole new side of ethical responsibilities Bibliography -"Ethical Dimensions of HIV/AIDS." HIV InSite Gateway to HIV and AIDS Knowledge. http://hivinsite.ucsf.edu/InSite?page=kb-08-01-05#S4X (accessed December 5, 2012).

-"VaccineEthics.org: Logistical and Ethical Considerations in HIV Vaccine Clinical Trials." VaccineEthics.org - The Ethical Challenges of Vaccines. http://www.vaccineethics.org/issue_briefs/HIV_clinical_trials.php (accessed December 7, 2012).

-"HIV & AIDS Information from AVERT.org." HIV & AIDS Information from AVERT.org. http://www.avert.org (accessed December 22, 2012

-"UC Atlas: AIDS/HIV Economic Impact." UC Atlas of Global Inequality. http://ucatlas.ucsc.edu/health/aids/econ_imp.php (accessed December 28, 2012).

"Centers for Disease Control and Prevention." Centers for Disease Control and Prevention. http://www.cdc.gov (accessed January 2, 2013).

-"Antiretroviral drugs used in the treatment of HIV infection." U S Food and Drug Administration Home Page. http://www.fda.gov/ForConsumers/ByAudience/ForPatientAdvocates/HIVandAIDSActivities/ucm118915.htm (accessed January 2, 2013).

-"HIV/AIDS Drug Information | AIDSinfo." Page Not Found | AIDSinfo. http://aidsinfo.nih.gov/drugs/ (accessed December 29, 2012).

-"Home - Population Reference Bureau." Home - Population Reference Bureau. http://www.prb.org/ (accessed January 3, 2013).

"UNAIDS -Targets and commitments." http://www.unaids.org/en/ourwork/managementandgovernance/partnershipsdepartment/ (accessed January 2, 2013)

"International HIV/AIDS Alliance - Where We Work." http://www.aidsallianceimpact.org/where-we-work
(accessed January 2, 2013)

-Teotonio I. 2012. Canadian-developed HIV vaccine shows promising results, no adverse effects, say developers.. The Toronto Star [Internet]. [cited 2012 Dec 29]. Available from: http://www.thestar.com/living/health/article/1283425--canadian-developed-hiv-vaccine-shows-promising-results-no-adverse-effects-say-developers International Mindedness: The World’s Resolution to a Global Issue
UNITED NATIONS: UNAIDS 2011 Political Declaration: Targets and Elimination Commitments Reduce sexual transmission of HIV by 50% by 2015.
Reduce transmission of HIV among people who inject drugs by 50% by 2015. Eliminate new HIV infections among children by 2015 and substantially reduce AIDS-related maternal deaths. Reach 15 million people living with HIV with lifesaving antiretroviral treatment by 2015. Reduce tuberculosis deaths in people living with HIV by 50 per cent by 2015. Close the global AIDS resource gap by 2015 and reach annual global investment of US$22-24 billion in low- and middle-income countries. Eliminate gender inequalities and gender-based abuse and violence and increase the capacity of women and girls to protect themselves from HIV. Global Community put pressure on the Commonwealth and its institutions to make legal reforms for a better response to HIV.

United Nations General Assembly on 29 September 2012 and agreed to adopt in full the outstanding recommendations of the Eminent Persons Group (EPG). AIDS ALLIANCE
NGO THE ALLIANCE IS A NETWORK OF
NATIONALLY-BASED, INDEPENDENT
LINKING ORGANISATIONS
WORKING IN OVER 40 COUNTRIES TO ADVANCE HUMAN RIGHTS BY ADDRESSING THE NEEDS OF VULNERABLE PEOPLES Result- Success
Number of people reached with information, education and communication materials and/or activities (IEC): 3,660,516
Number of people reached directly through services: (excluding IEC)
2,763,262
Number of condoms distributed:
50,734,531
Organisations supported financially:
1,488
Number of decision makers of leaders reached through advocacy:
11,826
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