12 May 2017 VOLUME 18 ISSUE 19

Since 2002, with bipartisan support bridging political administrations, the United States’ global strategy on AIDS, started by President George W. Bush and sustained by President Barack Obama, has delivered unprecedented results...The opportunity to end AIDS is real. However, a business-as-usual approach will cost us dearly.

"We met every condition they set for us: internal controls for monitoring money, having competent personnel to implement programmes that are funded, and sealing loopholes that would jeopardise accountability, among others," said [Health Permanent Secretary] Julius Korir....Despite the denials, however, Mr Bernard Muchere, the man who blew the lid off the scam, maintained that there were massive improprieties...that had led to embezzlement of funds. The final report of the audit is yet to be made public.

Atieno, a mother of five, has sold the fish since her husband died 10 years ago leaving her to support her family. With no other income, she was left with no option but to trade sex with the fishermen for a share of their catch. Sex-for-fish, known locally as "jaboya", is common practice in Abimbo village in western Kenya's Siaya County and throughout sub-Saharan Africa....Siaya is the county with the second highest HIV prevalence in Kenya, with nearly a quarter of the population infected with the virus that causes AIDS.

“Dr. Zulu"..., a nurse mentor at Nyangana District Hospital in Namibia,...and his team developed a detailed procedure that ensures close coordination among the hospital’s nurses and health assistants, outreach clinic staff and community health workers. The system tracks HIV-positive mothers and ensures their babies are tested at 6 weeks, 9 months and 18 months.

More people are living longer lives with HIV, according to a new report in the Lancet HIV that includes data from more than 88,000 people from 18 countries. People who contracted the virus in recent years are living 10 years longer than people infected in the mid 1990s....The researchers, part of the Antiretroviral Therapy Cohort Collaboration, say that introduction of anti-HIV drugs...played a large role....As encouraging as the results are, they also reveal that for some groups of people, the gains aren’t as great.

For 40 years starting in 1932, medical workers in the segregated South withheld treatment for unsuspecting [black] men infected with [syphilis] simply so doctors could track the ravages of the horrid illness and dissect their bodies afterward. Finally exposed in 1972, the study ended and the men sued, resulting in a $9 million settlement. Twenty years ago this May, President Bill Clinton apologized for the US government, [seeming] to mark the end of this ugly episode....Except it didn't.

USAID issued a notice informing the government that funding for various health-related programmes and administrative support would be suspended until certain conditions...are met. Direct health service delivery, including life-saving treatment, prevention, outbreak or emergency response, family planning promotion and tackling HIV/Aids has not been frozen....In his first reaction, Kenya's health minister Cleopa Mailu said that the ministry is committed to "prudent financial management and accountability".

Scott Gottlieb, a physician and former deputy FDA commissioner during the George W. Bush administration, is seen as competent and knowledgeable. But critics worry about his ties to the pharmaceutical industry....Gottlieb is expected to move quickly to implement FDA mandates in the recently passed 21st Century Cures Act...and streamline the process for approving generic versions of complex, difficult-to-copy therapeutics.

The virus reprograms the stem cells, called basal cells, to produce enzymes that can destroy lung tissue....“This research is important because although antiretroviral agents have turned HIV into a chronic, rather than deadly, disease, the viral reservoirs that remain in the lungs and other tissue continue to cause serious side effects,” study author Ronald G. Crystal, MD, at New York Presbyterian/Weill Cornell Medical Center, said.

Women living with HIV had a lifetime prevalence of post-traumatic stress disorder four times the national average, according to a small study examining women from an urban HIV clinic. Overall, 43.1% of participants met diagnostic criteria for lifetime PTSD, while the national prevalence for women is estimated at 10%, reported Keemi Ereme, MPH, of Howard University College of Medicine in Washington, D.C., and colleagues.

Our recently released study provides critical evidence of the gaps in the content and delivery of existing sexuality education programmes and an opportunity for strengthening them. The study, conducted in 2015 in 78 public and private schools, found three out of four surveyed teachers reportedly teaching...a comprehensive sexuality education programme. Yet only 2% of the 2,484 sampled students said they learned about all the topics. Worse still, incomplete and sometimes inaccurate information is being taught.

As Congress moves legislation forward to repeal and replace parts of the Affordable Care Act and debates other possible changes to our nation’s health care delivery systems, a new brief assesses...proposals to alter the ACA’s Medicaid expansion and overhaul the traditional Medicaid program and the far-reaching impact on people with HIV. A related infographic explores how the ACA’s Medicaid expansion affected health care and coverage for people with HIV.

An update on philanthropic funding in the area of HIV/AIDS is the subject of the GrantWatch column in the May 2017 issue of Health Affairs....I learned of some interesting stats and projects. However, the column is just a small sampling of what is going on in HIV/AIDS philanthropy and is not meant to be comprehensive.

A decision by the NIH to limit its grant support for individual researchers has sparked concerns that the policy could discourage collaboration or divert funding from the best science....“This seems like tax reform to me: everybody agrees something needs to be done, but with any given scheme there's going to be winners and losers,” says Jonathan Karn, an HIV researcher at Case Western University.

A new contraceptive silicone ring that doubles as an anti-HIV drug dispenser could give vulnerable women in places like sub-Saharan Africa greater ability to protect themselves....Developed by the International Partnership for Microbicides, the ring is inserted into the vagina by the wearer. There, it releases dapivirine and levonorgestrel for 3 months. IPM founder Zeda Rosenberg believes women will be more likely to use the ring faithfully...because it also prevents pregnancy.

Cells productively infected with HIV-1 release virions along with extracellular vesicles (EVs) whose biogenesis, size, and physical properties resemble those of retroviruses. Here, we found that a significant number of EVs (exosomes) released by HIV-1 infected cells carry gp120 (Env), a viral protein that mediates virus attachment and fusion to target cells, and also facilitates HIV infection in various indirect ways....Thus, EVs that carry Env identified in our work seem to facilitate HIV infection and therefore may constitute a new therapeutic target for antiviral strategy.