Obama to roll out 'turning point' AIDS strategy

HAART truth: Life with AIDS drugs
Paris (AFP) July 13, 2010 - HIV may be dismissed by some as a treatable disease, but as middle-aged Frenchman Jean-Luc Romero can attest, living with antiretroviral drugs means a daily battle with queasiness. Side effects are an often-overlooked downside of highly active antiretroviral therapy (HAART), the drugs that have turned HIV from a death sentence to a manageable illness. If the media chirpily dub HAART a drug "cocktail", HAART is definitely not a fun experience, Romero said. The powerful drugs can have toxic side effects and, unless a cure for AIDS is found some day, have to be taken for the rest of one's life.

"They are like tiny bombs which prevent the AIDS virus from replicating, but also they destroy a host of other things," the 51-year-old councillor for the Paris region said an interview. In his long litany of woes, Romero suffers from aching muscles, acute diarrhoea and lipodystrophy, a notorious HAART-related condition in which fat can accumulate on the belly or as a "buffalo hump" on the back of the neck, yet disappear from the face, leaving a patient looking sunken-eyed. He is haunted especially by exhaustion, a never-ending feeling of being unwell and of "premature ageing", that his body and a mind have become old before their time. "I don't know what it's like to sleep for more than three hours in one go," said Romero. "Even when I come back from holiday, I can't say, 'I feel really relaxed.'"

Life for Romero is dictated by the pill box. He takes six HAART tablets a day, four tablets for diabetes -- another HAART risk -- and throughout the day takes quantities of medication for the diarrhoea. Even so, Romero, as president of an association gathering local officials in the fight against AIDS, is the first to praise HAART as a lifesaver. In 1987, at the age of 27, he learned that he had the human immunodeficiency virus (HIV). At that time, such news heralded a long, painful and inevitable descent towards death. The only medication was AZT, which had "horrifying" side effects and had to be taken every four hours.

"We lived from day to day. There was no point planning beyond that. We saw people dying all around us, and we would say, 'That will be us one day.' We didn't think about the future, because the present was all we had. I remember thinking, 'I won't live beyond 30'." All that changed in 1996, when HAART became available -- in rich countries at least, for it would take another decade for the lifeline to be cast to poorer nations in Africa. Today, millions of people are not only kept alive by HAART but able to hold down jobs, have a social life or a family. The drug regimen, initially a punishing 27 pills a day, has been hugely simplified -- some take a single pill a day -- and some of its side effects, including lipodystrophy, are not as bad as before.

In the light of this success, experts at the six-day International AIDS Conference opening in Vienna on Sunday will debate whether treatment guidelines should be overhauled, so that HAART is given to patients when their infection is at a lower threshold. Reducing mortality will have to be balanced against side effects. If HIV has been reduced in the public's mind to the status of a chronic illness, many people have still not placed it on the same footing as routine conditions such as cancer or heart disease, said Romero. In France, shame, stigma and discrimination, especially in employment, are deeply rooted, he said. "At the time when I found out I was infected, there was compassion. Today, the notion of blame is even stronger," said Romero. Living with HIV "is something that you never get used to", he said. "For nearly 25 years I have had to live in the consciousness of death, and that has forced me to squeeze every single drop out of life."

by Staff Writers
Washington (AFP) July 13, 2010
President Barack Obama will Tuesday declare that America's battle against AIDS is at a "crossroads" and roll out a plan to cut new infections and improve care for those with the disease.

Thirty years after the human immunodeficiency virus (HIV) burst to global attention, the first-ever National HIV/AIDS Strategy will demand action from federal, state and tribal governments and medical and scientific communities.

It envisages cutting the annual number of new domestic infections by 25 percent over five years, and aims to increase the number of people living with HIV, who actually know their status to 90 percent.

The strategy, previewed by the White House on Monday, will say in a vision statement that "the United States will become a place where new HIV infections are rare."

Those who are infected, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or economic level, will get "unfettered access to high-quality, life-extending care, free from stigma and discrimination."

The HIV/AIDS epidemic in the United States has claimed nearly 600,000 lives, though has faded from the headlines in recent years, as new life-extending anti-retroviral drug therapies have emerged.

But around 56,000 people still become infected with HIV every year.

There are currently 1.1 million Americans living with HIV, according to US government figures.

Health and Human Services Secretary Kathleen Sebelius, speaking several hours before Obama was due to address a reception of HIV/AIDS workers, said the new strategy represented a turning point for US government policy.

"Either we could chose to get used to HIV and AIDS and accept that it was a permanent feature of US society ... or we could chose to double down and refocus our efforts," she said.

"We refuse to accept a stalemate -- to dig in and just hold the disease at bay."

The new Obama strategy has three goals: to reduce the number of new infections; to increase access to care for those with HIV; and to reduce HIV-related health disparities.

"Our country is at a crossroads. Right now we are experiencing a domestic epidemic that demands a renewed commitment, increased public attention and leadership," Obama said in the preamble to the new national strategy.

Obama said in the strategy that countless Americans had devoted their lives to fighting HIV/AIDS and that successful prevention efforts had averted more than 350,000 new infections in the United States.

"This moment represents an opportunity for our nation. Now is the time to build on and refocus our existing efforts to deliver better results for the American people."

The new strategy recognizes the tight fiscal straitjacket under which the administration is operating, after the worst financial crisis in decades.

It does not lay out an increase on the current 19 billion dollars a year the government spends to fight HIV/AIDS within the United States.

Rather, the strategy states that better results should be possible to achieve within existing funding levels and says the case for additional investments where they are required should be highlighted.

The new strategy, laying out the philosophical grounding for the fight against AIDS, will be accompanied by a Federal Implementation Strategy.

The plan is designed to intensify HIV prevention efforts in most at risk communities, including gay and bisexual men, African-American men and women, the Latino community, addicts and drug users.

It also envisages improving the education of all Americans about HIV/AIDS and how to prevent the spread of the disease.

The administration also plans to use the new Obama health care reform plan passed this year as a platform for expanding treatment of HIV/AIDS for the most vulnerable communities.

Obama announced in October that his administration would end a ban on people with HIV/AIDS traveling to the United States, which rights groups had branded discriminatory and harmful.

The measure came into force in January.

The United States has also contributed tens of billions of dollars for HIV/AIDS relief around the world, with the President's Plan for Emergency AIDS Relief (PEPFAR) -- one of the most lauded legacy achievements of former president George W. Bush.

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