United Nations Secretary-General Ban Ki-moon on Thursday said that many large pharmaceutical companies -- including Abbott Labs, Boehringer Ingelheim, GlaxoSmithKline and Pfizer -- plan to increase their efforts to develop HIV/AIDS drugs and diagnostics for impoverished regions, Reuters reports. The companies have promised to invest more in prevention efforts -- including vaccine development and pre- and post-exposure prophylactics -- Ban said in a statement after he met with senior pharmaceutical executives from 17 companies and other U.N. officials. "We noted that despite the gains, the epidemic continues to outstrip our best efforts," Ban said, adding, "Only one-third of those who need antiretroviral treatment in low- and middle-income countries are getting it. Each day, for every two people who are placed on antiretroviral treatment, five more are infected. Collectively, we still have more work to do."

The companies also agreed to work toward adapting medicines and treatment for "resource-limited settings to be used safely in children, adolescents, adults and pregnant women," according to Ban. He added that the drug companies and the United Nations jointly agreed that increasing access to vaccines and medicines is "essential in scaling up prevention and treatment efforts" (Charbonneau, Reuters, 10/9).

As HIV spreads beyond high-risk groups into China's general population, drug-resistant strains of the virus also are appearing in parts of the country, Chen Zhiwei of the AIDS Institute in Hong Kong said recently, Reuters reports. According to Chen, the two trends are "alarming" and people living with HIV in China could face treatment obstacles because relatively few antiretroviral drugs are available in the country. "All these drug-resistant mutations are in China now, they are emerging in Chinese patients," he said, adding, "The major worry is whether the drug-resistant virus will spread. We are studying whether that is happening, but that will be the case if you don't provide proper treatment. If drug-resistant virus (strains) spread in China, we don't have enough selection of (drugs) that are made available."

According to Reuters, about seven of the more than 20 different antiretrovirals are available in China, meaning that HIV-positive people might be left with limited options if they develop resistance to certain drugs. In addition, treatment adherence can be low in rural parts of China because of a lack of knowledge among patients, low access to health care and inadequate numbers of health care workers to explain the importance of adherence.

Chen's comments follow a study published last week in the journal Nature that found how HIV cases are increasing among women and men who have sex with men in the country. "The virus is moving into the general population," Chen said, adding, "Signs are prevalent among women and" in mother-to-child transmission. Chen also said if "there is no good prevention, transmissions will suddenly explode." According to Chen, China's open southern border is a concern, and an HIV strain recorded in Yunnan province also has been detected in Thailand and Myanmar. He added that this could be explained by women working as commercial sex workers in other countries and returning to China. In addition, travelers crossing China's southern border could be contributing to the situation, Chen said (Ee Lyn, Reuters, 10/10).

Although Asian migrant women working in Arab countries generate significant economic benefits for both their home and host countries, many of them are at risk of HIV because of the unsafe conditions under which they migrate and live, according to a panel of experts organized by the United Nations Development Programme Regional Center in Colombo, Sri Lanka, The Hindu reports. According to the panelists -- which included senior government officials and representatives of civil society in Lebanon, the Philippines and Sri Lanka; representatives of key diplomatic missions in Sri Lanka; U.N. officials; and migrant welfare organizations -- it is critical that the HIV vulnerabilities of this demographic are addressed so that the economic gains of both home and host countries, as well as the health and rights of migrant women, are protected.

Ajay Chhibber, assistant secretary-general and director of UNDP's Regional Bureau for Asia and the Pacific, said that women account for 43% of the 54 million people who at any given time are on the move within Asia and to destinations outside the region. "Women often migrate under unsafe conditions, live under very difficult circumstances, and can be targets of sexual exploitation and violence," Chhibber said, adding, "With little or no access to health services and social protection, these factors can make them highly vulnerable to HIV." He said that an increasing number of migrant workers from Asia who have contracted HIV in various host countries in recent years have been deported, which causes economic loss for the workers and their families. According to Chhibber, "There is a need for strategic national, regional and international action to ensure safe movement and access to HIV programs for migrants and mobile populations." In addition, Chhibber said that addressing the HIV vulnerabilities of migrants is key to achieving universal access to treatment and the U.N. Millennium Development Goals' aim of halting and reversing the spread of HIV/AIDS by 2015.

UNDP Releases Summary of HIV Vulnerabilities Among Migrant Women
During the round table, an executive summary of a UNDP study -- titled "HIV Vulnerabilities Faced by Women Migrants: From Asia to the Arab States" -- also was released. According to Caitlin Wiesen, UNDP's HIV/AIDS regional program coordinator and practice leader, although migrant women are among the most vulnerable to HIV, it is important to emphasize the fact that the conditions under which people migrate -- such as being separated from families and social support systems -- rather than the actual act of migration are what make women vulnerable to contracting the virus. Wiesen said, "Women, particularly domestic workers, are among the most vulnerable. They experience basic rights violations, in terms of pay and conditions of work. Many respondents reported physical violence, verbal and sexual abuse."

Malu Marin -- study coordinator and director of the nongovernmental organization ACHIEVE, which works for migrants' welfare in the Philippines -- said that restricting the movement of female migrants would force migration underground and increase women's risk of exploitation and HIV transmission. Marin added that in some cases, domestic workers are tested for HIV without consent and counseling and are deported if they are found to be HIV-positive. "This needs to change in favor of a migrant-friendly testing policy," Marin said.

According to The Hindu, the study recommends dialogue and coordination between ministries of health, labor, foreign affairs and social welfare in both countries of origin and destination to reduce vulnerabilities of HIV, as well as facilitation of multi-country negotiations between origin and host countries. The Hindu reports that the study examines HIV-susceptibility among female migrants from Bangladesh, Pakistan, the Philippines and Sri Lanka to Bahrain, Lebanon and the United Arab Emirates and explores ways to address their HIV risks without compromising their right to movement and livelihood. The study was based on research comprising more than 500 interviews over nine months using focus group discussions and key informant interviews with migrant workers; senior officials of the ministries of health, labor and foreign bureaus of employment; embassy officials; service providers; and recruitment agencies in both origin and host countries (The Hindu, 10/9).

The executive summary of the study is available online.

Thirty-five percent of the 2,000 to 2,500 new HIV infections in Spain last year occurred among immigrants, Daniel Zulaika, president of the AIDS Interdisciplinary Society of Spain, said Wednesday at the XI National Congress on AIDS in Cordoba, Spain's El Pais reports. A focus of the conference, which will continue through Friday, is the increasing number of HIV/AIDS cases among the country's immigrant population (El Pais, 10/9).

According to Zulaika, the percentage of new HIV/AIDS infections among immigrants -- who make up 10% of Spain's 45 million inhabitants -- is much higher than it was in 2002 when immigrants accounted for 5% of new HIV/AIDS infections. The group is vulnerable to the disease because they often have low incomes and come from different cultures, which create barriers to obtaining medical care, Zulaika said.

In terms of transmission modes, Zulaika said that there is no difference between how immigrants and Spaniards contract HIV, adding that the increase in new cases among immigrants paralleled the growth in the country's foreign-born population. According to Zulaika, 50% of new HIV/AIDS cases in 2007 were transmitted through heterosexual relations, while 25% were transmitted through male-to-male sexual relations and 12% were the result of injection drug use.

The conference is being attended by nearly 1,000 HIV/AIDS experts -- including physicians, nurses, members of nongovernmental organizations, public health officials -- as well as some HIV-positive individuals. Zulaika said that in order to fight the disease, there should be efforts to adapt treatment within the health care system, especially in the area of sexually transmitted infections, adding that campaigns should be created to target the spread of HIV/AIDS among immigrants (EFE News Service, 10/8).

Alhaja Roli Daniju, executive director of the nongovernmental organization Ajegunle Community Project, recently called on Nigerian government officials and other stakeholders to help reduce poverty in the country by empowering people living with HIV/AIDS, This Day/AllAfrica.com reports. Daniju spoke in the capital of Lagos at the organization's one-day program, which was supported by the Global Fund for Women and called "Positive Living and Income Generation." It aimed to address the stigma surrounding women living with HIV/AIDS in Nigeria, as well as to create awareness among HIV-positive women about how to manage the virus on their own.

According to Daniju, people living with HIV/AIDS are "part and parcel of the society. They are just victims of circumstances but notwithstanding what an HIV-negative person can do, they can also do even better, because they have a vision, mission and are full of hope for a greater future." ACP is "keen on showing love and concern to positive living women in society" because of the HIV/AIDS-related stigma they face, Daniju said, adding that poverty in the country could be alleviated or eliminated by empowering these women (Olojo, This Day/AllAfrica.com, 10/8).

Although Uganda had many achievements to celebrate on the anniversary of its independence on Wednesday, the country must "focus on independence on the individual level," especially among women affected by HIV/AIDS in the country, Milly Nattimba of the Makerere University School of Public Health writes in a New Vision opinion piece. When looking at "the real situation on the ground in this area and what more needs to be done," women account for more than half of the almost one million HIV/AIDS cases in the country, Nattimba writes, adding that women are most affected by the disease because of their "inherent dependence on men and the subsequent vulnerability."

According to Nattimba, women have no inheritance rights in Uganda, and they are discriminated against in regard to education and economic opportunities. She adds that as a result, they become more dependent on men. According to Nattimba, "the majority of women, especially in Third World countries, do not control their sexuality." Women cannot control when they have sex or how many children they have, leaving them at an increased risk of HIV because they "cannot negotiate safe sex" and "they cannot say no to sex even when they are sure their partner is having sexual relations elsewhere," Nattimba writes. She adds that although many women receive HIV tests in Uganda, "they are afraid to share the results with their husbands" because of "extreme" repercussions. "This affects their adherence to treatment," Nattimba writes, adding that there is a "culture of silence" surrounding HIV among married couples. "A truly independent nation is a result of the good health of its people, especially the women on whose shoulders most of the production in this country rests," Nattimba concludes (Nattimba, New Vision, 10/8).

Luc Montagnier and Francoise Barre-Sinoussi, two French scientists who jointly were awarded half of the Nobel Prize for medicine earlier this week, spoke with French President Nicolas Sarkozy on Wednesday about the effect that the world financial crisis could have on global funding for HIV/AIDS, the AP/Hartford Courant reports. Both scientists voiced their concerns that international HIV/AIDS funding and research could decrease because of the recent global financial crisis. Montagnier also questioned whether assistance from the Global Fund To Fight AIDS, Tuberculosis and Malaria for medicines in places such as Africa could continue in light of the financial situation, according to the AP/Courant (AP/Hartford Courant, 10/8).

In related news, Montagnier on Tuesday discussed the development of a therapeutic rather than preventive HIV/AIDS vaccine, London's Daily Telegraph reports. Montagnier said that if financial backing is available, the results of a therapeutic vaccine as a possible treatment, which would prevent the virus from progressing in a person already living with HIV, could be published in three to four years. "I think it will be possible with a therapeutic vaccine rather than preventative vaccinations," Montagnier said, adding, "We would give it only to people who are already infected" (Alleyne, Daily Telegraph, 10/7).

On Wednesday, Montagnier also praised Robert Gallo of the Institute of Human Virology at the University of Maryland and French scientist Jean-Claude Chermann, Agence France-Presse reports. Montagnier said that Gallo and Chermann also deserved to be recognized by the Nobel Prize, adding, "One can feel regret that Dr. Chermann and Dr. Gallo weren't on the list" (Agence France-Presse, 10/8).

Editorials
Two newspapers recently published editorials about the 2008 Nobel Prize in medicine. Summaries appear below.

• Baltimore Sun: In science, "great things often are accomplished through the collective effort of many individuals," a Sun editorial says, adding that the discovery of HIV in 1983 was "such an achievement." Barre-Sinoussi and Montagnier were awarded the Nobel Prize in medicine for "that breakthrough," the editorial says, adding, "But because of a technicality in the rules governing the award of the prize," Gallo "did not share in the accolades." Nobel Prize "rules are narrowly tailored to reward only those who initially discover scientific principles or phenomena rather than those who put such knowledge to practical use," according to the editorial. It adds that although Gallo was not the "first to identify the virus, it was he who made the crucial connection between HIV and AIDS that allowed scientists to begin developing drugs and vaccines to combat the epidemic's spread." The editorial says that "millions more lives would have been lost before the pandemic was checked" if "not for [Gallo's] pathbreaking research." It concludes, "That work more than qualified him for recognition as a giant as well" (Baltimore Sun, 10/8).
  
  
• Philadelphia Inquirer: "Congratulations to the three scientists awarded the Nobel Prize in medicine" -- Barre-Sinoussi, Montagnier and Harald zur Hausen, who discovered the human papillomavirus -- "for their work in discovering viruses behind two deadly illnesses," an Inquirer editorial says. About 25 million people have died from AIDS-related causes since the virus that causes it was discovered, and 33 million people are living with HIV worldwide, the editorial says, adding that about 250,000 women die annually from cervical cancer, which is caused by HPV. According to the editorial, after being awarded the Nobel Prize, Montagnier said that the "fight" against HIV/AIDS "is not finished." It concludes, "But both discoveries have helped combat two devastating diseases" (Philadelphia Inquirer, 10/9).
  

India's Tamil Nadu State AIDS Control Society is launching a campaign that will focus on providing a comprehensive package of HIV/AIDS services to private maternity hospitals in the state in an effort to match services provided at government-run maternity hospitals, The Hindu reports. Such services include counseling, treatment, the prevention of mother-to-child transmission and managing HIV/TB coinfection. A "key requirement" of the program is "to make counseling an integral feature of HIV testing," according to Supriya Sahu, project director of TANSACS.

Private maternity hospitals account for about 38% of the more than 1.1 million deliveries recorded annually in Tamil Nadu, while state-run maternity hospitals account for about 60% of deliveries, according to The Hindu. Under the campaign, TANSACS will provide participating hospitals with training, assistance in developing HIV/AIDS treatment capacity, rapid test kits and informational resources. Participating hospitals will be required to implement the package of services and report to TANSACS. In addition, hospitals will be encouraged to participate in the program under an incentive-based component that provides accreditation. As part of an effort to map private maternity hospitals in the state that conduct at least 50 deliveries monthly, TANSACS has measured 1,400 hospitals against specific parameters, such as quality of basic services, pre-test HIV counseling, services offered when a pregnant woman tests positive and interventions to prevent MTCT (Varma, The Hindu, 10/8).

Health officials in Papua New Guinea's capital of Port Moresby on Wednesday launched a national HIV/AIDS research agenda for 2008 to 2013, the Papua New Guinea Post-Courier reports. According to speakers at the agenda's launch, the research plan, as well as the establishment of a research unit in the National AIDS Council Secretariat earlier this month, will bolster the fight against HIV/AIDS in the country.

The agenda establishes a plan and guidelines for HIV/AIDS and sexually transmitted infection research conducted in Papua New Guinea. Its priorities include: increasing knowledge about the main factors behind HIV transmission in Papua New Guinea; improving understanding of the conditions faced by people affected by the disease; examining the efficacy and appropriateness of the country's response to the disease; and evaluating the economic and social impacts of HIV/AIDS.

At the launch, Governor-General Paulias Matane said that the research agenda comes at a time when Papua New Guinea needs to bolster its response to HIV/AIDS. Health Secretary Clement Malau said that the agenda will help guide the country's response to HIV/AIDS in a direction that can help improve people's lives. Jamie Maxtone-Graham, chair for the Special Parliamentary Committee on HIV/AIDS, said that although leadership is a key factor in curbing the spread of HIV, leaders in Papua New Guinea have not done enough to address the disease (Gerawa, Post-Courier, 10/9).

As the disbursement of funding to 3,000 HIV/AIDS community-based organizations in Malawi is being shifted from international nongovernmental organizations to local government authorities, known as district assemblies, a number of groups are expressing concern about the ability of some assemblies to distribute the money, IRIN/PlusNews reports.

Bizwick Mwale, the country's National AIDS Commission executive director, said that the international NGOs, called umbrella bodies, were contracted in 2003 to disperse HIV/AIDS funding from donors and the government until the district assemblies had developed the capacity to take over the task. Mwale said, "We did an assessment after 18 months and found there was still a gap (in capacity), so we extended the contract to umbrellas for another two years, with the view that by that time (the district assemblies) would be ready." Although some responsibilities already have been transferred to the district assemblies, Ishmael Nkosi, a policy and advocacy officer at the Malawi Network of AIDS Service Organisations, said, "Our membership is worried because the process involved will be lengthy, and there are some reports that when a CBO (community-based organization) comes up with a proposal, (the district assemblies) demand a certain percentage from this amount," adding, "There are also concerns that there will be a lot of nepotism in the approving of funds."

The distribution of funding from international donors to local organizations also has proven to be a long and often problematic process, according to IRIN/PlusNews. McBride Nkhalamba -- an HIV/AIDS coordinator at the international NGO ActionAid, which served as one of NAC's umbrella bodies until 18 months ago -- said disbursements from NAC often were late or inconsistent. Groups also experienced delays or the cancellation of grants because they lacked the skills or training to adequately account for funds received in the previous quarter. Nkhalamba said, "An organization has to account through a very vigorous system, and some of the demands are discriminatory, because if you're dealing with a local organization there's only so much you can expect." He added that often so much time passes between when an organization writes a proposal and when it receives the funds that situations on the ground have changed.

According to Mwale, organizations should be prepared for some disruption in the disbursement of grants while district assemblies take over for the umbrella bodies (IRIN/PlusNews, 10/7).

The University of Buffalo's School of Pharmacy and Pharmaceutical Sciences on Tuesday announced that it has received a seven-year, $7.6 million grant from NIH's National Institute of Allergy and Infectious Diseases for HIV/AIDS research worldwide, Business First of Buffalo reports. The funding will be used to establish clinical pharmacology quality assurance programs and laboratories at the university's Pharmacotherapy Research Center and at the Translational Pharmacology Core in the New York State Center of Excellence in Bioinformatics and Life Sciences.

The grant money also will support in-country laboratory specialist training in areas with high HIV/AIDS burdens worldwide, as well as allow researchers to analyze HIV/AIDS clinical trials. The program will train as many as 200 clinical researchers annually and offer clinical audits and other services. Bruce Holm, University of Buffalo senior vice provost and executive director of the Center of Excellence, said the funding is "just the beginning" for many potential projects, adding, "Over the next year to year and a half, we will launch even more of these programs" (Drury, Business First of Buffalo, 10/7).

Although one focus of the fight against HIV/AIDS worldwide is on increasing antiretroviral drug access and conducting clinical trials, such trials need to be carried out in countries with the highest HIV/AIDS burdens worldwide, the Buffalo News reports. However, many countries highly affected by HIV/AIDS do not have adequate facilities or trained specialists, according to the News. To address the issue, the Buffalo program will provide training in pharmacology to researchers who conduct trials on experimental antiretrovirals. The program also will conduct on-site audits, provide HIV/AIDS information and establish a centralized Web site to provide global access to research data. "We are excited about this opportunity to use our expertise and facilities to help fight the global AIDS epidemic," Gene Morse, professor and associate dean for clinical and translational research, said (Rey, Buffalo News, 10/7).

Despite research showing circumcision can reduce a man's risk of HIV during heterosexual intercourse, a study published Wednesday in the Journal of the American Medical Association found that the procedure offers little protection against the virus for men who have sex with men, AFP/Yahoo! News reports. According to the study, there was minimal difference in HIV infections between those MSM who were circumcised and those who were not (AFP/Yahoo! News, 10/7).

For the study, researchers at CDC, led by Gregorio Millett, reviewed 15 previous studies on circumcision that included 53,567 MSM from Australia, Great Britain, Canada, India, the Netherlands, Peru, Taiwan and the U.S. Circumcised MSM were 14% less likely to be HIV-positive than those who were not, a rate that was not statistically significant, according to the researchers. Millett said, "You can't necessarily say with confidence that we're seeing a true effect there," adding, "Overall, we're not finding a protective effect associated with circumcision" for MSM (Dunham, Reuters, 10/7).

However, when examining studies carried out before the introduction of highly active antiretroviral therapy in 1996, the researchers found evidence that circumcision in the past had a protective effect for MSM, BBC News reports. The researchers said one explanation for the reduced effectiveness of circumcision among MSM following the introduction of HAART is that the efficacy of drugs diminished the perceived need to practice safer sex to avoid contracting HIV. In addition, the study noted that HAART might help reduce the risk of HIV transmission to a level that circumcision does not provide further benefits. The researchers also said that there may have been a smaller proportion of men in the pre-HAART trials who engaged primarily in receptive anal sex, which carries the greatest risk of HIV among MSM (BBC News, 10/7).

CDC's Peter Kilmarx, who was not involved in the study, said the agency is set to release a draft of formal recommendations on circumcision early next year. Although Millett said circumcision cannot be recommended as a strategy for HIV prevention among MSM in the U.S., he added that there are signs the procedure could protect certain MSM depending on sexual practices. For example, Millett said that studies in Australia and Peru have shown that men who engaged only in insertive anal sex and were not being penetrated by male sex partners experienced a greater level of protection from circumcision (Reuters, 10/7). However, Millett said, "Even if we find that insertive men are protected, that might be such a small proportion that we wouldn't get the effect on the overall population that we'd like. As it stands now, circumcision is unlikely to have the same kind of benefit [in the U.S.] that it's projected to have in Africa" (Lauerman, Bloomberg, 10/7).

According to the authors, more research might be needed to determine the amount of protection provided by circumcision for insertive MSM (AFP/Yahoo! News, 10/7). "These studies weren't designed to answer this question in the first place, and it's possible that they're too varied to show an effect," Millet said, adding, "The idea makes sense, but there just aren't enough data out there right now to show whether there's a benefit" (Bloomberg, 10/7). In a related editorial also published in JAMA, a team of peer reviewers from Vanderbilt University wrote that "circumcision would likely be insufficiently efficient to be universally effective in reducing HIV and will have to be combined with other prevention modalities to have a substantial and sustained prevention effect" (AFP/Yahoo! News, 10/7).


The study is available online. The related editorial also is available online.

Vietnam on Monday announced the launch of a nationwide initiative, called "Every Citizen is Involved in HIV/AIDS Control and Prevention Activities at Community Level," to curb the spread of the disease in the country, the Vietnam News Agency reports. The program will be implemented by the Ministry of Health, the Ministry of Culture, Sports and Tourism and the Vietnamese Fatherland Front Control Committee and will run through 2012. Health Minister Nguyen Quoc Trieu said the initiative's goals are to raise awareness of prevention and control methods. He added that the program aims to encourage and create opportunities for families with HIV-positive members, commercial sex workers and injection drug users to become involved in prevention and control activities. Nguyen Thanh Long, head of the Department of HIV/AIDS Control at the health ministry, said that many people in remote, rural areas of Vietnam are unaware of HIV prevention methods (Vietnam News Agency, 10/6).

UNESCO plans to launch a network of HIV-positive teachers in Zimbabwe to help the group access no-cost antiretroviral drugs and other services, Zimbabwe's The Herald reports. Bekezela Mapanda -- UNESCO program assistant for education and HIV/AIDS -- said that the network aims to provide assistance to teachers, who often are poorly paid, to manage the rising price of drugs and other services. "We all know their salaries are very poor," Mapanda said, adding, "They cannot afford all the procedures needed before one is put on antiretroviral treatment; worse still, the drugs are required monthly." Teachers in Zimbabwe earn an average of 12,000 Zimbabwean dollars, or about $78, monthly, and antiretrovirals cost an average of $225,000 Zimbabwean dollars -- or about $1,460 -- monthly. The cost of antiretrovirals can fluctuate daily, The Herald reports.

According to Mapanda, teachers have "dominated cross-border trade business to raise extra income, causing them to engage in risky behavior, exposing them to risks of contracting HIV." She added that the network will allow teachers to access no-cost antiretrovirals, take part in national HIV/AIDS programs, and review workplace initiatives and policies. The UNESCO program follows recent comments from HIV-positive teachers in the country about their inability to access antiretrovirals from the government's program, as well as the high costs of the drugs at private pharmacies. According to some HIV-positive teachers who attended World Teachers' Day events in the capital of Harare last week, Zimbabwe's National AIDS Council should consider them when allocating budgetary assistance as it does for the armed forces. "I am lucky to be accessing free drugs, but my fear is that my health is deteriorating because of lack of a balanced diet and overworking catering for my family," teacher and HIV/AIDS advocate Joana Kasirori said. She also called on teachers to undergo voluntary HIV/AIDS testing and counseling and develop a network of HIV-positive teachers. Zimbabwe Teachers' Association President Tendai Chikowore said that teachers affected by HIV/AIDS feel most of the effects of inflation and other economic issues. "The situation is worse for our colleagues living with HIV and AIDS owing to prohibitive medical costs versus the teachers' meager salaries," she said (The Herald, 10/7).

At a recent workshop held by Women, Media and Change, Afua Ansre, national coordinator of the United Nations Development Fund for Women in Ghana, said that obstacles to HIV/AIDS prevention -- including a lack of access to information, education and health care -- are compounded by a deficit of sex-specific data on monitoring systems, Ghana's Public Agenda reports. Ansre also said that women should be provided with education about the disease, particularly for the prevention of mother-to-child transmission. She added that governments, nongovernmental organizations and individuals must work together "to implement structured programs to prevent the spread" of HIV/AIDS.

According to the Public Agenda, the workshop aimed to provide female members of the media with the skills to effectively report about women living with HIV/AIDS and give them relevant information about HIV/AIDS prevention among at-risk groups, particularly women and girls. Charity Binka, a WOMEC facilitator, said that the specific objectives of the workshop were to train female journalists on the gender and rights aspects of HIV/AIDS reporting and supply them with the opportunity to collect first-hand information on the challenges of living with the disease. She added that workshop organizers hope to create a network of peers reporting on HIV/AIDS in Ghana.

Oliver Commey of the Korle Bu Teaching Hospital said that women's biology, their economic status, forced marriages and unstable environments such as conflict are some factors that contribute to women being at risk of contracting HIV. Commey added that issues such as marriage, stigma, disclosure, and access to treatment and care are important to address among women living with HIV/AIDS. According to Commey, media should be responsible for advocating for those without power. He added, "You need to gather, analyze and disseminate accurate information on HIV. This should be continuous to keep authorities on their toes" (Amankwah, Public Agenda, 10/6).

An increasing number of men from tribes in Uganda and other parts of East Africa that traditionally do not practice circumcision have undergone the procedure, prompting the government to begin developing a plan to promote male circumcision as a method of curbing the spread of HIV, AFP/Mail & Guardian reports. Alex Opio of the country's Ministry of Health said that male circumcision has "overwhelming support in the country" and that the ministry hopes to begin the program by targeting adolescent males, circumcising them before they become sexually active. Kihumuro Apuuli, head of the Uganda AIDS Commission, said the government decided to go forward with the program despite some concerns surrounding male circumcision and HIV/AIDS because "if you get an intervention that can contribute to the reduction of infections, you have to support it." He also said the government does not plan to advocate methods of circumcision already practiced by some tribes because the "ceremonies associated with that ritual are not safe. Using the same knife on different people. Having sex before the wounds heal. We are talking about safe circumcision." Geofrey Natubu -- vice chair of the Bududa District, where male circumcisions already are practiced -- said he would like to see more tribes embrace the procedure. "If it is true that is one of the preventive measures against HIV/AIDS, then it is better for us all to take it, irrespective of the way through which you do it. You can do it the way you want," he said. Natubu said that the community about 10 years ago recognized the threat of HIV/AIDS and began using one knife per circumcision (Simon, AFP/Mail & Guardian, 10/7).

China "had made substantial progress in checking the spread of HIV but there is still a long way to go," UNAIDS Executive Director Peter Piot writes in a China Daily opinion piece. Although more than 34,000 people in China now have access to antiretroviral drugs -- compared with 5,000 in 2003 -- "we cannot slow down in our vigilance," Piot writes, adding, "Whereas substantial progress has been achieved in this country, the number of people receiving HIV drugs is still less than half the number who require them." In addition, the "epidemic continues to run ahead of the response: for every two people who start taking antiretroviral drugs, another five become newly infected with HIV," according to Piot.

Many HIV cases occur "in situations that are illegal or outside of mainstream society," Piot writes, adding, "These give rise to apparent contradictions between respect for the law and protecting the health of people who inject drugs or are sex workers, between sexuality and morality, between needs of public security and public health, drug control and safe injections." To "confront AIDS is to confront contradictions in society," according to Piot, who adds, "On closer investigation, however, most of these contradictions prove to be false contradictions. A scientifically based AIDS response can solve them for the greater well-being of more people."

These issues make HIV/AIDS "such a complex problem to deal with," Piot writes, adding, "Complex problems require complex solutions. They also respond best to collective approaches." According to Piot, working "with community groups, for example, can greatly increase the impact -- and effectiveness -- of AIDS strategies." He adds, "In fact, given that most infections are happening in situations outside the mainstream norm, it is often very difficult for government alone to reach those who need to be reached." China has "solid policies in place and has made significant progress in the fight against AIDS," Piot writes, concluding, "It is time now to use the tremendous array of resources at its disposal to build on that progress and to tackle new, tough challenges like harm reduction and increasing civil society involvement" (Piot, China Daily, 10/8).

Musician Annie Lennox on Monday in Dublin, Ireland, at a two-day forum on HIV/AIDS and children worldwide said that governments should meet aid pledges to support developing countries over the long-term, the Irish Times reports. Lennox said that governments are "notoriously bad at keeping their promises" but that "we must not walk away from the issues. Governments come and go, but poverty remains." She also said that the Irish government is doing a "fantastic" job addressing such issues and that citizens should do more to help people in need and development workers. "Anybody who has a laptop has a tool to connect," Lennox said, adding, "It's so powerful and it's international. We can really use the facilities that we have. We use them for social networking and really we can use them for advocacy and change" (O'Brien, Irish Times, 10/7). She also said that she would like to see "really long lasting social and political change" (Irish Examiner, 10/7).

The event at which Lennox spoke, called Together for Children, was part of the Fourth Global Partners Forum on Children Affected by HIV and AIDS. The forum aims to secure government commitments to promote health, education and welfare standards for children living with HIV/AIDS worldwide, the PA/Virgin Media reports. More than 1,000 children contract HIV daily, and 15 million children have lost one or both parents to AIDS-related causes. Lennox said that her personal commitment to the cause is not "going to go away," adding that she has witnessed poverty and that "[w]e, on one side of the globe, have so much benefit and, on the other hand, when you actually witness [poverty] and look at the circumstances that people live in, it's almost beyond comprehension" (PA/Virgin Media, 10/6).

Also speaking at the conference, Irish Prime Minister Brian Cowen said the country's commitment to the "poorest and most vulnerable" people worldwide will continue, despite the current global economy, the Times reports. Cowen called Ireland's record on the United Nations Millennium Development Goals "impressive," adding that 900 million Euros -- or about $1.2 billion -- will be spent this year on international aid. UNICEF Executive Director Ann Veneman at the forum said, "Even though there has been progress in the global fight against HIV and AIDS, last year some 370,000 children were newly diagnosed with HIV. The rate of HIV infection among children is unacceptable and needs to be addressed by the global community as a matter of urgency." The forum is organized by Irish Aid and UNICEF. About 200 people from 42 countries are attending the forum and likely will issue a joint declaration on HIV/AIDS (Irish Times, 10/7).

Recent statistics from Fiji's Health Ministry on Sexually Transmitted Infections are a cause for concern, and the high rate of STIs among people ages 20 to 29 put them at an increased risk for contracting HIV/AIDS, Fiji's Director of Public Health Josaia Samuela said recently, the Fiji Times reports. Statistics gathered over the past eight years by the ministry show that gonorrhea and syphilis are the most frequently reported STIs in the country, which Samuela said "highlights the underlying concern of unsafe sexual behavior among young people" and the "same high-risk behavior for the transmission of HIV." He also said that "sex is serious business" and that "[a]nyone, especially young people, who participates does so at their risk, in view of the sad consequences of infection from so many STIs including HIV, pelvic inflammatory disease and infertility."

According to the Times, the 1,024 treated gonorrhea cases in 2007 were the highest Fiji had seen in five years and an increase compared with the 416 treated cases in 2006. Statistics also show an increase in the number of treated syphilis cases from 2006 to 2007, with 567 and 940 cases, respectively. Last year, the ministry recorded 1,338 gonorrhea and 1,123 syphilis cases, rates that Samuela called "very high" for Fiji. "The most affected are in the productive times of their lives, could be studying in tertiary institutions or earning money through employment," Samuela said, adding that the issue of sexual behavior is "very complex." Sexual behavior becomes an economic and social issue "in terms of treatment, follow-up of partners or contacts for treatment and care," all of which "involve costs, resources, testing equipment and facilities, drugs for treatment," Samuela said (Sakiasi, Fiji Times, 10/6).

The Gaya Dewata Foundation -- a group focused on HIV/AIDS and sexually transmitted infection education, support and treatment in Bali -- recently called for increased STI testing among male sex workers who have sex with both men and women, the Jakarta Post/Asia News Network reports. Although an HIV/AIDS and STI outreach program launched in 2006 by the foundation has reached as many as 360 male sex workers, foundation representatives said the increasing number of men in this particular group could contribute to the spread of HIV and other STIs. The group said that the high risk of HIV among this particular group of sex workers largely is because they switch between male and female partners and are very mobile, the Post/Asia News Network reports.

The number of male sex workers who switch between male and female partners is increasing, and the foundation has focused its support services on serving this particular group. According to the foundation's director Vivi, the decrease in the number of STIs recorded among male sex workers visiting foundation clinics is a result of "intensive support, such as education and free medication." Bali has recorded 2,208 HIV/AIDS cases, 133 of which occur among men who have sex with men, according to the Bali Commission for AIDS Handling (De Suryani, Jakarta Post/Asia News Network, 10/4).