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Majority Of HIV-Positive Pregnant Women In Developing World Lack Access To PMTCT Services, Report Says
Two-thirds of HIV-positive pregnant women in the developing world do not have access to treatment to prevent mother-to-child HIV transmission, which could lead to 370,000 new HIV cases annually among infants, according to a study released Thursday by the International Treatment Preparedness Coalition, Bloomberg reports (Chase, Bloomberg, 5/21). Of the 1.5 million HIV-positive pregnant women each year in the developing world, about one-third receive any kind of drug therapy at all, the report said, adding that most of the treatment is inadequate and fails to prevent MTCT. According to the report, eight years after world governments pledged to cut the number HIV cases among infants in half by 2010, only about 8% of pregnant women in developing countries are receiving the complete triple-dose combination therapy widely used in wealthy nations (York, Globe and Mail, 5/22). The report cited poor government and donor coordination, as well as funding gaps, as the main reasons many women do not obtain the treatment, Stephen Lewis, founder of AIDS-Free World and a co-author of the report, said (Bloomberg, 5/21). According to the report, there is a "shocking lack of consistency and coordination" between governments and agencies, and about 18% of pregnant women worldwide were offered HIV tests in 2007. In addition, there is an acute shortage of prevention and counseling services for women, the report said. It added that one of the largest issues is a lack of counseling on infant feeding, as most women are not properly counseled and advice sometimes can lead to a bias toward using formula over breastfeeding. Lewis also criticized United Nations health agencies for claims that an increasing number of pregnant women in developing countries are gaining treatment access. He added that the large majority of such women do not have access to the complete triple-dose treatment. "It makes the access a simple mockery," Lewis said.The report found that in 61 countries -- such as Cameroon, Ethiopia, India and Nigeria -- more than three-quarters of HIV-positive pregnant women do not receive any drug treatment for PMTCT. It said that the world is tolerating a "shameful example of double standards" because MTCT has been virtually eliminated in wealthy nations, where most HIV-positive pregnant women have access to the complete drug regimen (Globe and Mail, 5/22).According to Bloomberg, most HIV-positive pregnant women who do have access to prevention services in developing countries receive nevirapine for PMTCT, which is 40% effective at reducing transmission. Nevirapine can so lead to drug-resistant strains of HIV from developing, Bloomberg reports. Boehringer Ingelheim, which manufactures nevirapine, provides the drug at no-cost to pregnant HIV-positive women in developing countries, according to Bloomberg. According to CDC, the availability of PMTCT services in the U.S. has reduced the number of HIV cases in infants by more than 90%.Officials from UNAIDS, the World Health Organization and 20 international groups are expected to meet this week in Nairobi, Kenya, to launch a campaign aimed at improving access to PMTCT services, UNAIDS Executive Director Michel Sidibe said. Gregg Gonsalves, head of ITPC, said, "For millions of women, maternal and child health is about HIV/AIDS and we have failed them" (Bloomberg, 5/21). He added, "Our failure to prevent HIV transmission to babies is truly a failure to prevent disease progression in women living with HIV. If we treat mothers properly, if we treat women properly for their own health, we would have few or no HIV infections in babies" (VOA News, 5/21). Sidibe said, "There has been some progress" in PMTCT services, but added, "Overall coverage is still very low for this proven, inexpensive and effective intervention." Sidibe said that UNAIDS "agree[s] with the report that the combination of stigma, fragmented health services, inadequate knowledge within the community and insufficient political leadership are root causes of low coverage" (Bloomberg, 5/21). UNAIDS also has called for the
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Diagnostics

Agent Orange Exposure May Increase Risk Of Heart Disease And Parkinson's Disease

A new report from the Institute of Medicine finds suggestive but limited evidence that exposure to Agent Orange and other herbicides used during the Vietnam War is associated with an increased chance of developing ischemic heart disease and Parkinson"s disease for Vietnam veterans. The report is the latest in a congressionally mandated series by the IOM that every two years reviews the evidence about the health effects of these herbicides and a type of dioxin -- TCDD -- that contaminated some of the defoliants. A finding of "limited or suggestive evidence of an association" means that the evidence indicates there could be a link between exposure to a chemical and increased risk for a particular health effect, though conflicting results from studies, problems with how the studies were conducted, or other confounding factors limit the certainty of the evidence. Until now, the cumulative evidence had been inadequate to draw conclusions about whether these two conditions may be associated with veterans" exposures to herbicides or TCDD. Ischemic heart disease -- a condition characterized by reduced blood supply to the heart, which can lead to heart attack and stroke -- is the foremost cause of death among people in industrialized countries. Major risk factors include buildup of cholesterol in the arteries, age, smoking, high blood pressure, and diabetes. The committee that wrote the report reviewed several studies investigating TCDD exposure and heart disease, many of which showed that higher TCDD exposure correlated with greater incidence of disease. The studies had weaknesses; for instance, it is difficult to adjust entirely for the impact of smoking, age, weight, and other common risk factors. But based on the preponderance of the evidence as well as biologic data beginning to show how TCDD can cause this toxic effect, the committee concluded that the evidence suggests that veterans exposed to defoliants contaminated with TCDD during the war may face a higher risk for developing ischemic heart disease. The committee"s conclusion that there may be a relationship between Parkinson"s disease and Agent Orange exposure stems from its review of 16 studies that looked at herbicide exposures among people with Parkinson"s disease or Parkinson"s-like symptoms. The finding was bolstered by several studies that have identified exposure to certain compounds similar to those in the herbicides used in the war as potential risk factors for the development of Parkinson"s. The committee"s review was hampered by the lack of studies investigating the occurrence of Parkinson"s disease in Vietnam veterans specifically and the lack of animal studies testing the chemical components of Agent Orange for their potential to cause Parkinson"s-like symptoms. The report strongly recommends that studies examining the relationship between Parkinson"s incidence and exposures in the veteran population be performed. Parkinson"s disease affects approximately 1 percent of people over age 60 -- some 5 million people worldwide. In response to a request for clarification by the U.S. Department of Veterans Affairs, the committee also affirmed that hairy cell leukemia is in the same category as chronic lymphocytic leukemia (CLL) and lymphomas. Previous reviews in the series found sufficient evidence to state that there is an association between herbicide exposure and increased risk for CLL and lymphomas. The report presents scientific data only and does not suggest or intend to imply policy decisions that the U.S. Department of Veterans Affairs might make. Also, the findings relate to exposures and outcomes in broad populations; researchers" abilities to pinpoint the health risks faced by any individual veteran are hindered by inadequate information about military personnel"s exposure levels during service in Vietnam. U.S. forces sprayed Agent Orange and other defoliants over parts of southern Vietnam and surrounding areas from 1962 to 1970. Most large-scale sprayings were conducted from airplanes and helicopters, but herbicides were also dispersed from boats and ground vehicles and by soldiers wearing back-mounted equipment. The report series is sponsored by the U.S. Department of Veterans Affairs. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. Christine Stencel National Academy of Sciences


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