WHO New HIV Treatment Recommendations

WHO Issues New HIV recommendations to Improve Health, Reduce Infections and save lives
By Saira Stewart & Olivia Lawe-Davis
On the eve of World AIDS Day, WHO is releasing new recommendations on treatment, prevention and infant feeding in the context of HIV, based on the latest scientific evidence.
WHO now recommends earlier initiation of antiretroviral therapy (ART) for adults and adolescents, the delivery of more patient-friendly antiretroviral drugs (ARVs), and prolonged use of ARVs to reduce the risk of mother-to-child transmission of HIV. For the first time, WHO recommends that HIV-positive mothers or their infants take ARVs while breastfeeding to prevent HIV transmission.
"These new recommendations are based on the most up to date, available data," said Dr Hiroki Nakatani, Assistant Director General for HIV/AIDS, TB, Malaria and Neglected Tropical Diseases at the World Health Organization. "Their widespread adoption will enable many more people in high-burden areas to live longer and healthier lives."
An estimated 33.4 million people are living with HIV/AIDS, and there are some 2.7 million new infections each year. Globally, HIV/AIDS is the leading cause of mortality among women of reproductive age.
New treatment recommendations
In 2006, WHO recommended that all patients start ART when their CD4 count (a measure of immune system strength) falls to 200 cells/mm3 or lower, at which point they typically show symptoms of HIV disease. Since then, studies and trials have clearly demonstrated that starting ART earlier reduces rates of death and disease. WHO is now recommending that ART be initiated at a higher CD4 threshold of 350 cells/mm3 for all HIV-positive patients, including pregnant women, regardless of symptoms.
WHO also recommends that countries phase out the use of Stavudine, or d4T, because of its long-term, irreversible side-effects. Stavudine is still widely used in first-line therapy in developing countries due to its low cost and widespread availability. Zidovudine (AZT) or Tenofovir (TDF) are recommended as less toxic and equally effective alternatives.
The 2009 recommendations outline an expanded role for laboratory monitoring to improve the quality of HIV treatment and care. They recommend greater access to CD4 testing and the use of viral load monitoring when necessary. However, access to ART must not be denied if these monitoring tests are not available.
Preventing mother-to-child transmission and improving child survival
In 2006, WHO recommended that ARVs be provided to HIV-positive pregnant women in the third trimester (beginning at 28 weeks) to prevent mother-to-child transmission of HIV. At the time, there was insufficient evidence on the protective effect of ARVs during breastfeeding. Since then, several clinical trials have shown the efficacy of ARVs in preventing transmission to the infant while breastfeeding. The 2009 recommendations promote the use of ARVs earlier in pregnancy, starting at 14 weeks and continuing through the end of the breastfeeding period.
WHO now recommends that breastfeeding continue until the infant is 12 months of age, provided the HIV-positive mother or baby is taking ARVs during that period. This will reduce the risk of HIV transmission and improve the infant's chance of survival.
"In the new recommendations, we are sending a clear message that breastfeeding is a good option for every baby, even those with HIV-positive mothers, when they have access to ARVs," said Daisy Mafubelu, WHO's Assistant Director General for Family and Community Health.
National health authorities are encouraged by WHO to identify the most appropriate infant feeding practice (either breastfeeding with ARVs or the use of infant formula) for their communities. The selected practice should then be promoted as the single standard of care.
Benefits and challenges
An earlier start to antiretroviral treatment boosts the immune system and reduces the risks of HIV-related death and disease. It also lowers the risk of HIV and TB transmission.
The new prevention of mother to child transmission (PMTCT) recommendations have the potential to reduce mother-to-child HIV transmission risk to 5% or lower. Combined with improved infant feeding practices, the recommendations can help to improve child survival.
The main challenge lies in increasing the availability of treatment in resource-limited countries. The expansion of ART and PMTCT services is currently hindered by weak infrastructure, limited human and financial resources, and poor integration of HIV-specific interventions within broader maternal and child health services.
The recommendations, if adopted, will result in a greater number of people needing treatment. The associated costs of earlier treatment may be offset by decreased hospital costs, increased productivity due to fewer sick days, fewer children orphaned by AIDS and a drop in HIV infections.
Another challenge lies in encouraging more people to receive voluntary HIV testing and counselling before they have symptoms. Currently, many HIV-positive people are waiting too long to seek treatment, usually when their CD4 count falls below 200 cells/mm3. However, the benefits of earlier treatment may also encourage more people to undergo HIV testing and counselling and learn their HIV status.
WHO, in collaboration with key partners, will provide technical support to countries to adapt, adopt and implement the revised guidelines. Implemented at a wide scale, WHO's new recommendations will improve the health of people living with HIV, reduce the number of new HIV infections and save lives.
30 November 2009 -
For more information please contact:
Saira Stewart
Telephone: +41 22 791 2511
E-mail: stewarts@who.int
Olivia Lawe-Davis
Telephone: +41 22 791 1209
Mobile: +41 794 755 545

COGESID Bonamikano Celebre La SMAM 2009

Par Priscille Mouto,
La Presidente de COGESID Bonamikano
Depuis de longues années, il est d’usage de célébrer au Cameroun, avec le reste du monde, la semaine mondiale de l’allaitement maternel, allant du 1 au 7 août. Le ministère de la santé publique, conjointement avec d’autres acteurs de santé, organisations internationaux et nationaux, à l’instar de l’OMS, l’UNICEF, WABA, IBFAN, et quelques ONG à caractère humanitaire et sanitaire  ont pris l’initiative de relever le pourcentage de l’allaitement maternel au Cameroun, celui-ci étant actuellement de 24 % , contre 95 % en Europe.
L’ONG COGESID BONAMIKANO, catégorie d’organe suscité, a une fois de plus a mené des activités de promotion de l’allaitement maternel en cette année 2009.
Après avoir participé aux réunions préparatoires de la SMAM au Ministère de la Santé Publique à Yaoundé, vint le jour du lancement des activités par le Ministre de la Santé. Publique, Andre Mama Fouda a Obala. Contrairement aux années précédentes où le lancement avait été fait à Yaoundé, il a eu lieu, cette fois-ci, à Obala, afin d’imprégner cette localité dans la mouvance de l’allaitement maternel. La date du lancement ayant été retardée de trois jours, nous a contraint à mener les activités hors de la periode fixée generalement entre le 1 au 7 aout.
La logique des grandes puissances étant de s’unir pour être efficace, nous de Douala avons saisi la leçon et travaillé ensemble et non de façon isolée. C’est ainsi que nous fîmes des tours dans nos différents quartiers pour transmettre le propos du Ministre de la Santé et l’importance qu’il accorde à ce sujet. Toutefois, nous avons prodigué tout le conseil de l’allaitement maternel, et abordé le thème de cette année, à savoir : L’allaitement maternel, une réponse vitale en situation d’urgence ! Etes-vous prêt ?
Plus d’une centaine de personnes étaient réunies à COGESID BONAMIKANO le 11 aout dont 60 mères et bébés, les femmes enceintes, ainsi que des hommes et femmes curieux de savoir ce qui se passait dans le centre d’écoute de COGESID. Ce jour nous avons eu la présence de la presse privée, représentée par madame NSEUMI Florine Léa, journaliste à la Nouvelle Expression, assistée de deux partenaires européen d’Allemagne et Suède. Le 14 août 2009, Nouvelle Expression sort un article sous le thème  de la causerie éducative en titre: « BONABERI- ALLAITE SES BEBES ;
Pendant la causerie éducative, il y a eu un jeu de questions-réponses pour évaluer si le message est passé, et apporter des réponses aux préoccupations des uns et des autres. C’est dans ce cadre que les savons et les tricots ont été distribués aux participants de la séance.
Les sandwichs ont été également à tous les participants, tandis qu’une collation a été donnée à tous les collaborateurs et facilitateurs.
Quelques semaines après, une émission télévisé est organise en table ronde à la chaîne de télévision STV2, sur le bien fait de l’allaitement maternel. L’émission féminine « TOI et MOI », dont la présentatrice Solange KIKI,est celle qui nous a sollicité pendant deux samedi durant pour parler de ce sujet combien important. Deux heures sont consacre pour l’edition interactive avec les spectateurs en Europe aussi.
Le samedi 29 août 2009, il y avait quatre (4) femmes sur le plateau, la Présentatrice Solange KIKI , Madame TOUAYON Jinet, médecin généraliste, madame DIOUEDI Agnès, vice-présidente COGESID BONAMIKANO, et Priscille MOUTO, la présidente COGESID BONAMIKANO. Nous avons parlé du lait maternel, de sa composition, de ses bienfaits pour le bébé et la mère, des tabous qui empêchent les mères de pratiquer l’allaitement maternel ; des allégations mensongères n’ayant aucun fondement scientifique. En outre, nous avons démontré que le lait artificiel possède beaucoup d’inconvénients et ne peut être comparé au lait maternel, comme l’a si bien dit le Ministre de la Santé Publique au jour du lancement de la SMAM à Obala : « Aucune technologie humaine ne saurait égalé ou remplacer ce que dieu a Créer ».Par conséquent, toutes les mères doivent allaiter leurs bébés dès la première heure de leur naissances, pendant 6 mois de façon exclusive, puis avec complément nutritionnel jusqu’à 24 mois et plus.
Notre thème avait suscité beaucoup d’intérêts, la preuve, les appels fusaient de toute part : France, Centrafrique, Guinée Equatoriale, et Douala, pour ne citer que ceux-là. Certains posaient des questions, d’autres apportaient leurs contributions en faveur de l’allaitement maternel .Nous avons reçu une téléspectatrice africaine appelant de France disant que l’allaitement maternel n’était que l’apanage des femmes africaine à cause de la pauvreté. Elle a reçu des éléments de réponse non seulement de nous, mais aussi d’autres téléspectateurs. Ne pouvant clôturer le débat à cause des questions envoyées par sms, la présentatrice a reconduit le débat pour le 05/septembre 2009.
Ce samedi, nous avons été accompagnées du Président de la FECABPA , M. James ACHANYI FONTEM ; Il était question de répondre aux 62 questions envoyés précédemment. Nous n’avons pas certes épuisé toutes ces questions, mais l’essentiel a été dit ; c’est ainsi que nous avons quitté le plateau, ayant le sentiment que le message est passé, les hommes et les femmes ont été sensibilisés, éduqués informés et satisfaits. Nous attendons les jours à venir, le changement de comportements.

Teen Pregnancy Prevention

2009 Teen Pregnancy Prevention Conference
By Donald Roberts
The New York Teen Pregnancy Network upholds the international agreements to protect lives: including the Unborn and the protection of teenage mum and Prevention of Teenage Pregnancy. The most important of which is the 1998 Convention on the Rights to live. The convention recognizes a range of rights related to human protection, and calls upon countries to honor their obligations to uphold these rights.
The Convention is the most widely ratified human rights treaty in the world. To make further progress on these commitments, The New York Teen Pregnancy Network invites, Youth organizations, Socio-Cultural Organizations, Community Based Organizations, Educators, Scholars, Researchers, Health Organizations, Professionals, Business Organizations, Decision makers in the public and private sector, Representatives of Governmental and Non-Governmental organizations (NGO'S), Religious organizations, Human Right Organizations & Women Groups "2009 Teen Pregnancy Prevention Conference".
Date: 30th June - 4th July 2009
Venue: Herencia Hotel Eastrop Way, Basingstoke, Hants, RG21 4QD Hampshire, London, United Kingdom.
Theme: "2009 Teen Pregnancy Prevention Conference"
This conference will bring together an almost 800 representatives of NGO's/CBO's and numerous number of interested individual participants from all over the world. The conference will be conducted on participatory bases with satellite plenary and simultaneous sessions followed by general and small group discussions.
SPONSORSHIP: The conference receives financial support from Bank HSBC Bank London, the United Nations Health Commission and Ford Foundation USA. This sponsorship covers the following:
1. Return airplane travel ticket for selected delegates from their home country to venue of event in London (United Kingdom) and back to their home country.
(2) Medical insurance cover for delegates throughout the entire conference duration.
The New York Teen Pregnancy Network will not assume responsibility of any other cost, other than those listed above. Participants will bear responsibility for their own accommodation cost
NOMINATION AND SELECTION OF PARTICIPANTS: Intending participants are requested to nominate between two (2) to five (5) active members to participate, age bracket between 21 years and above. In order to foster gender balance, we would appreciate if your delegation includes one or two female participant(s).
REGISTRATION/INQUIRIES:
For purpose of registration to participate in this Conferences, contact: donaldrobert@email.com
The program will include:
* Gain insights from top experts from around the country;
* Discover successful strategies, interventions, and initiatives
* Learn the latest facts and statistics, and about helpful resources.
* Capacity and skills-building sessions
* Exchange ideas with professionals who share your goals.
* Presentations by our sponsors and donors
In addition to the main program, the meeting will also host book launches, artistic and cultural activities and, as with all NY Teen Pregnancy’s events, plenty of space and opportunity for informal networking and alliance-building.
All sessions will have interpretation into English and French.
Meet the organisers in London to assert a new change for a stronger society. Contact ntpnetwork@gmail.com for more details.

Infant Feeding National Code Analysis

National Implementation of the International Code of Marketing of Breastmilk Substitutes in Cameroon
Title of Decree : Decree N° 2005 /5168/ PM of 01 December 2005 regulating the marketing of substitutes of breastmilk
Analysis and comments by ICDC
By virtue of Article 20, Decree No. 2005/5168/PM of 1 December 2005 (the 2005 Decree) supercedes the Inter-ministerial Decree No 040 on the Control of Marketing of Breastmilk Substitutes of 1993 (the 1993 Decree). The 2005 Decree retains the overall format and sequence of the 1993 Decree but the parts on enforcement and sanctions are missing from the new Decree. This is worrisome.
This analysis evaluates the 2005 Decree by comparing it with the 1993 Decree and the International Code of Marketing of Breastmilk Substitutes (the Code). It also highlights the changes made to a few substantive provisions and explains why they are positive or negative developments.
A. Scope and Terminology of the Decree
The scope of the 2005 Decree is wider than both the 1993 Decree and the Code, covering as it does, additional products such as dummies and pacifiers. The definition section in Article 2 of the 2005 Decree is longer compared to the 1993 Decree and departs substantially from Code definitions.
There is a concerted effort to incorporate the global recommendation of exclusive breastfeeding for 6 months into the various definitions under Article 2 of the 2005 Decree.
The 2005 Decree also raises the upper age limit for infants from 12 months in the 1993 Decree to 30 months in Article 2(d). By extending the upper age limit of “infant”, Cameroon is able to protect a bigger category of babies. This means that toddler milks which hitherto are not included in the scope of the Code are now covered by the 2005 Decree. Though innovative, Article 2(d) does set the country apart from international health and trade standards which refer to babies older than 12 to 36 months as “young children.” Since many products covered by the Decree are imported, the question here is whether there are difficulties in aligning international trade practices to the requirements of the Decree. Other countries will benefit from Cameroon’s experience and feedback would be welcome in this respect.
On a less positive note, the presence of two overlapping terms “designated product” and “breastmilk substitute” gives rise to ambiguity.
“Breastmilk substitute” is defined under in Article 2(a) as “any solid or liquid food sold, used or presented in any other way as partial or total replacement of breast milk...”
“Designated product” is defined under Article 2(j) as “a milk for infants (infant formula, first age milk) or any other product sold as food for infants, follow-up or 2nd age milk, feeding bottles, teats, dummies …..”.
Due to the global controversy surrounding the interpretation of “breastmilk substitute”, ICDC coined the term “designated product” and advocated for its use at the national level. The latter term is meant to replace and subsume the former; not to be used interchangeably or as mutually exclusive concepts the way it is done in the 2005 Decree.
ICDC advocates for the use of the term “designated product” to enable countries to list products by their commercial names so there is no uncertainty on the scope of a law. This is a useful mechanism which enables countries to analyse current marketing practices and extend above the minimum standard set in 1981 by the International Code. It is indeed necessary to cover more products so that a wider group of infants and young children are protected from commercial influence today.
Unfortunately, these objectives are not fully realised by amendments in the 2005 decree. Reiterating the position in 1993, Article 1(3) of the 2005 Decree expressly excludes complementary foods (from 6 months) and circumscribes the potential of Article 2(j). This exclusion cuts out a whole range of products which would otherwise be included if reliance were to be placed solely on the interpretation of “designated product” or “breastmilk substitute”.
B. Prohibitions
Like the 1993 Decree, the 2005 Decree maintains a unique anti-dumping clause not found elsewhere. This is an excellent provision.
In relation to the Code, the 2005 Decree repeats the lacuna of the 1993 Decree by leaving out prohibitions relating to promotion in shops, gifts to parents and contact by marketing personnel. Focussing just on advertising and not the wider aspects of promotion is a very narrow approach to overcome the mischief of unethical marketing which undermines breastfeeding.
Article 11 uses the term “breastmilk substitute”. To be consistent with other provisions in the 2005 Decree, it should be replaced by “designated product”.
Typo errors are found in Articles 4 and 7 which respectively reads “Any form of advertising of teats designated products...”and “...or par for costs of attendance of health professionals...”.
C. Labelling, Information and Education
In an improvement over the 1993 Decree, Article 15 of the 2005 Decree disallows manufacturers and distributors from participating in public information and education campaigns on breastfeeding without prior authorisation of the Ministry of the Public Health. This positive development will restrict the possibility of manufacturers and distributors promoting their products under the guise of information and education.
In regressive mode, the labelling provisions in the 2005 Decree are less comprehensive than both the Code and article 13 of the 1993 Decree. Unless there are other laws which govern this area, the following are missing –
i) Ban on use of pictures or text which may idealise the use of infant formula;
ii) A statement that the product should only be used on the advice of a health worker as to the need for its use and the proper method of use; and
iii) Instructions for appropriate preparation and warning against health hazards of inappropriate preparation.
D. Enforcement
Enforcement and penalty provisions in the 1993 Decree are omitted from the 2005 Decree. Unless there are other regulations or laws in Cameroon covering this area, this omission is a major concern and could render the 2005 Decree ineffective.
Conclusion
The improvements made in the 2005 Decree vis-à-vis scope, age range and information do not outweigh the emasculation of vital parts of the 1993 Decree, to wit, the parts of labelling, enforcement and sanctions. The opportunity to fill existing lacunas on promotion seems to have been missed. Should the occasion arise for another review of the Cameroon Decree, ICDC suggests the following:
a) a recast of the term “designated product” to cover all breastmilk substitutes including complementary foods marketed as suitable for use below 6 months;
b) more comprehensive labelling provisions for the different categories of designated products;
c) new prohibitions on promotion at the retail level and practices such as gifts and contact with mothers; and
d) a reinstatement of enforcement and penalty provisions.
ICDC’s Model Law is a useful precedent for the drafting of relevant provisions. The Model Law is available upon request from ICDC.
Yeong Joo Kean
Legal Advisor
IBFAN-ICDC Penang
Malaysia

COGESID ADVOCATES FOR INFANT

COGESID ADVOCATES FOR INFANT & YOUNG CHILD PROTECTION
The Gender, AIDS & Development Council (COGESID) Baobab – Bonamikano organised an advocacy campaign for infant and young child protection during the working visit of Professor Donna Taliaferro and Dr. Neal Rosenburg to Cameroon on the 10th March 2009. Receiving the guests, the chairlady of COGESID, Mrs. Priscille Mouto, express gratitude and thanks for the acceptance of their invitation to visit their counselling and health care centre in the native village of Bonamikano.
In the brief presentation of COGESID, Mrs. Priscille Mouto, told Pr. Donna Taliaferro and Dr. Neal Rosenburg that the gender council stands for « Comité, Genre, SIDA et Développement » and it represents a summary of the area of activities of the association, which groups men and women to fight against the spread of HIV/AIDS while promoting gender and development within the poverty alleviation Millennium Development Goals.
The association has existed since 2003 and like all newly created organisations, it has got its ups and downs due to the lack of sustainable funding, while problems to be addressed increase on daily basis.
Mrs. Mouto told her guests that at the start of the organisation, the former coordinator of the technical group for the control of AIDS in the littoral, Dr. Rodolphe Mbangué approved the first subvention, which was a seedgrant for their installation and sensitisation of the populations of Bonamikano on HIV prevention during educative talks.
It was during the educative talks and exchanges that the identification of HIV orphans started in the Douala native community of Bonamikano. She acknowledges that working for orphans and vulnerable children is not an easy task, especially as the subject of HIV/AIDS is still surrounded by taboos and the systematic refusal of some individuals of the existence of AIDS.
With different strategies of sensitisation, it has been observed that there is a relative change in the behaviour of the most vulnerable groups, which remain the adolescents and young persons.
This is measured by the number of persons who now accept to do the voluntary test for HIV. At the COGESID counselling centre, the nurses convince all persons, men, women and youths who are received for health care reason to do the HIV test. Generally, when the rapid test turns out to be positive, the patient is referred to the District Hospital in Bonssama, for confirmation of the results before any prescriptions.
This is how the COGESID centre in Bonamikano works in partnership with the District Hospital of Bonassama in the area of HIV prevention and other diseases. It is shocking to witness the great number of orphans in Bonamikano in need of adequate nutrition, clothing, recreational possibilities and assistance to continue their education. The strategy of COGESID is to integrate these children in families for prevention of stigmatisation, though this often increases the care load, especially as other children in the families are also in need.
With the presence of Pr. Donna Taliaferro and Dr. Neal Rosenburg from the Washington Univeristy at St. Louis, USA, COGESID launched an appeal for aid in dignostic materials and primary essential medication, IT appliances to equip their centre with materials for collection of data, and support for capaciting the staff on infant and young child feeding.
As a humanitarian organisation, COGESID works in partnership to support communities in health care delivery, the promotion of well being through the creation of micro-income generating activities and participation in infant and young child nutrition campaigns and sensitisation on the immunisation of children. All help that would assistance in the expansion of the work of COGESID will be welcome. For more on COGESID partnerships, click on http://cameroonlink.blogspot.com or write to camlink99@gmail.com cogesidmbappe@yahoo.com