All in the mind... How HIV attacks the brain

New research by a group of scientists from the University of California and the University of Pittsburgh, has uncovered worrying evidence that HIV is causing brain damage in many infected individuals, including those on antiretroviral therapy.

The study, lead by the British scientist, Dr Paul Thompson, used advanced three-dimensional MRI scans to map the brains of 26 people with HIV and 14 people without.  They found that in some regions, the brains of the HIV+ people were 10 – 15% less dense than those of the negative participants.  This 'thinning' was mainly found in primary sensory, motor and premotor cortices - the areas that control movement, language and feeling - and was more noticeable in those with higher CD4 counts (a marker of a more advanced stage of disease).

It has long been known that HIV can cause cognitive impairment and neurological problems, and AIDS-related dementia is a well-documented condition.  However, it was hoped that the advent of antiretroviral therapy (ART) would significantly reduce the number of people affected by such conditions.  What the research shows is that ART actually has very little effect on preventing HIV damage in the brain, as most drugs are not potent enough to cross the protective barrier of blood that surrounds it. 

“The brain provides a sanctuary for HIV where most drugs cannot follow.” said Dr Thompson, “Even though antiretroviral drugs rescue the immune system, AIDS is still stalking the brain…  This was the most terrifying aspect of our findings.”

Up to 40% of people with HIV suffer from neurological symptoms at some point during the course of their illness.  For some, these symptoms may be mild and manageable, for others they may cause dementia and ultimately death.  It is hoped that the researcher’s findings will lead to larger-scale studies of neurology in HIV+ people, and to routine brain scans to identify those that could potentially be helped by neuroprotective therapies.
 

 BBC.co.uk & The Daily Telegraph (p.9), 11/10/05

Free ARV program finally gets underway

The government of Ethiopia has announced that it has finalised arrangements for the provision of free antiretroviral drugs (ARVs) to all its citizens with AIDS.

The ministry of Health has for sometime been providing free treatment to those on very low incomes, but only a few thousand out of the estimated 1.5 million living with HIV in Ethiopia have been eligible.

Under the new scheme, supported by UNAIDS, ARVs will be available to anyone who meets the criteria (low CD4 count or serious illness) for no charge, provided they can reach one of the 100 health centres around the country that will be distributing them.

Around 9,000 people are already receiving ARV therapy from 60 centres in Ethiopia, a total which the government hopes will increase dramatically as the scheme expands over the coming months.

IOL, 05/10/05

Sharp rise in German HIV cases

 (Reuters AlertNet, 05/10/05)

Uganda to build new ARV plant

Uganda has announced it is to build a new pharmaceuticals factory in the capital, Kampala, to manufacture antiretroviral AIDS treatments and anti-malarial formulations for the Ugandan people.

The plant will be built by the Ugandan-based firm Quality Chemicals Ltd with the assistance of Cipla, an Indian pharmaceutical company.  Cipla have been producing generic (or ‘copy’) versions of major brand-named drugs for over 20 years.

The factory will cost an estimated $15 million to build, but it is hoped that this initial outlay will quickly be offset by the money saved on importing antiretrovirals from overseas. It is also hoped that the drugs produced can be exported to neighbouring nations, including Kenya, Tanzania and Rwanda.

More localised ARV manufacturing has been identified as key in the scaling up of antiretroviral distribution in areas of high prevalence and low income.  It not only makes the drugs cheaper and more readily available (thus allowing more people to be treated), it also creates jobs and boosts both the local and national economy.

More about generic drug manufacture can be found on our TRIPS and Generics page.

 Xinhuanet, 05/10/05

Cheaper version of Female Condom to be launched

The Female Health Company, makers of the Femidom® condom for women, have announced that they are to launch a second-generation version condom aimed specifically at women in developing countries.

As well as effectively protecting against pregnancy, the female condom can also help to prevent the transmission of most STIs, including HIV.  It is currently the only method of female-controlled contraception available on the market to do so.

Unfortunately, the Femidom® (or FC1) is at present priced at a level unaffordable to many outside of the developed world.  The new version, FC2, which is made from the synthetic material nitrile (rather than more expensive polyurethane used for the FC1), looks and performs very similarly to the original, but will be offered at a significantly lower price to any developing country wishing to buy in bulk.  

Initial models based on studies conducted in South Africa and Brazil have suggested that even low level of uptake could save more than 2,000 people from becoming infected with HIV and would subsequently save around $1.4 million in health care costs.  In large volumes, it is estimated that FC2 could be sold for just 22 cents per unit.  Similar volumes of FC1 would be priced at around 72 cents per unit, due to much higher manufacturing costs.

Women are three times more likely to be infected with HIV, but often get little say over whether their partners use a condom or not.  The female condom allows women to have a superior degree of control over their sexual health and it is hoped that greater and more widespread uptake will eventually result in a perceptible drop in the levels of HIV infection in areas where it is used.

 (PR Newswire, 30/09/05)

PEPFAR supply chain contract awarded

The US government has finally awarded the contract to manage its international AIDS supply chain, which will handle hundreds of millions of dollars worth of HIV/AIDS-related products.

The supply chain is a critical part of the President's Emergency Plan for AIDS Relief (PEPFAR) initiative, which is a $15 billion, five-year scheme to fight HIV and AIDS worldwide. Through PEPFAR, the US aims to provide treatment to 2 million people in its fifteen "focus countries" by the end of Federal Year 2008.

The winning consortium is called The Partnership for Supply Chain Management (PSCM). It is a non-profit organisation established by the JSI Research and Training Institute and Management Sciences for Health. The consortium contains thirteen other organisations, including three from South Africa.

The contract funds up to $77 million over the first three years in system operating expenses and technical assistance, and the drugs and supplies handled by the system could total up to $500 million over the same period.

The US Agency for International Development says the supply chain will "provide one-stop shopping for programs to obtain important HIV/AIDS-related products" including drugs, HIV test kits and laboratory supplies.

AVERT.org has more about PEPFAR.

 (USAID press release, 27/09/2005)

Putin promises 20-fold increase in Russia's AIDS budget

Next year Russia will allocate at least 20 times more money to fight HIV and AIDS than it did in 2005. Russian President Vladimir Putin announced this increase during a state television and radio interview, in which he also called AIDS in Russia a "serious problem".

President Putin said that current spending was only around 150 million rubles ($5 million) per year.

"That's practically nothing for Russia on the scale of things. Next year, funding will be increased 20- to 30-fold. Up to 3 billion rubles [$105 million] will be appropriated for the purpose, keeping in mind that all those in need of medications, however expensive, should have them."

According to UNAIDS/WHO estimates, Russia had 860,000 adults and children living with HIV at the end of 2003. In comparison, the United States has around one million living with HIV, but its total population is more than twice as large, so the prevalence rate is much lower. Domestic spending for HIV/AIDS in the US is around $17.5 billion per year.

The President's announcement will surely be welcomed by the United Nations and other organisations working to combat AIDS in Russia, who have in the past criticised authorities for downplaying the problem. But the funds may still not be sufficient to provide treatment for all those in need.

UNAIDS/WHO estimates that 94,000 people urgently required treatment for HIV in June of this year, but fewer than 6,500 were actually receiving the drugs.

AVERT.org has more about HIV and AIDS in Russia and Eastern Europe.

 (Bloomberg.com, 27/09/2005 & Novosti, 27/09/2005)

UN warns AIDS funding is 'Not Enough'.

 Steven Lewis, the UN’s special envoy for HIV & AIDS in Africa, has warned that the pledges made by leaders at the G8 summit in July will not be enough to tackle the AIDS epidemic in an effective manner.

The G8 leaders pledged a collective sum of $50 billion per year in extra development aid at the meeting, with an extra $25 billion of this going to Africa by 2010.  It also vowed to provide antiretroviral treatment for all those in need of it by 2010.

However, in his latest statement, Lewis warned that, “these figures will not bring universal access to treatment,” and suggested that annual HIV & AIDS funding will need to rise to $22 billion a year by 2008 to get anywhere near the target.  Spending for this year currently stands at around $8.3 billion.

This is not the first time that agreements made by the G8 leaders have been called into question.  Just a few weeks after leaders promised to relieve the debt of 18 of the world’s poorest countries, a number of European countries tried to alter the terms of the International Monetary Fund deal, putting the process in serious jeopardy.  The Global Fund to fight AIDS, TB & Malaria, which a number of leaders promised to replenish in full at the summit, only received half of the $7.1 billion it needs to continue its work this year.  And campaigners have also questioned the large sums of ‘extra’ money put forward for aid, much of which is believed to be money that had already been allocated for international development in national budgets.

AVERT.org has more about funding the fight against AIDS.

 (FT.com, 27/09/05)

Patent expires on antiretroviral AZT

 AZT, the first ever antiretroviral drug to effectively combat HIV, has finally reached the end of its patent protection period, over 20 years after it was first discovered to be effective against HIV.

The end of patent protection is good news for the millions of HIV+ people in developing countries, as it means any pharmaceutical company can produce the drug legally and cheaply, without having to pay royalties to the patent owner, GlaxoSmithKline.  However, as AZT (which also goes under the names zidovudine and Retrovir®) has to be taken in combination with several other antiretrovirals to be effective, the end of its patent is likely to offer only modest benefits to those in resource-poor areas.

A number of antiretroviral drugs, including AZT, are already produced in generic form for sale to developing countries.  However the legal processes involved in obtaining a licence for a patent-protected drug are lengthy, and mean many countries are reluctant to invest in generic production.   

AZT was first approved for use as an anti-AIDS therapy in 1987, and until the mid-1990s, it remained the only drug capable of fighting HIV.  Many patients suffered unpleasant side effects on taking it, and most became resistant to its effects within a year to eighteen months.  However, with the advent the multi-drug combination therapies to reduce resistance, its popularity grew again, and it remains a common component in many people's HIV treatment regimens even today.

Though AZT does not cure AIDS, its development marked a small but significant victory against the disease, and encouraged scientists to believe that treatments for HIV were more than just a theoretical possibility.


More about AZT and other HIV drugs can be found in our history and treatment sections.

 (The News & Observer, 18/09/05)

China begins massive condom drive

The Chinese government has announced a new initiative to distribute free condoms across the country in an effort to prevent the spread of HIV & AIDS.

305 million condoms will be purchased from the Chinese condom manufacturer, Gaobang Latex Products, and distributed to disease control centres around the country.  They will then pass on the condoms to hotels, bars, clubs and other places of entertainment to be handed out to members of the public.

“If people could get a condom as conveniently and naturally as buying a Chinese cabbage,” said Tao Ran of the China Youth HIV/AIDS Prevention and Care fund, “the AIDS prevention function carried out by condoms could finally imbue people’s lives and change their bias (against condoms).”

Thirty percent of China’s 840 000 people living with HIV & AIDS were infected through unsafe sex, a figure that appears to be growing steadily.

AVERT.org has more about AIDS in China

 (IOL.co.za, 14/09/05)

HIV+ survivors of Hurricane Katrina face drug shortage

Thousands of HIV positive people in New Orleans and the surrounding area are facing dangerous interruptions to their treatment regimes after their homes and HIV support centres were destroyed by Hurricane Katrina.

Around 8,000 people with HIV and AIDS are believed to have been displaced by the hurricane and subsequent flooding, many of whom have now running low on essential antiretrovirals.  If anti-AIDS treatment is interrupted for too long, a person can rapidly become ill, and their virus can mutate into a form that is resistant to the drugs.  

Some HIV & AIDS centres have managed to find temporary homes outside of the disaster zone, but making people aware of these new locations can be difficult.  Posters have been put up on a billboard at the Huston Astrodome, but for those evacuated to more remote areas, help can be difficult to come by.  One ten-clinic family programme said it took eight days before even their first clinic could reopen, and many staff had to resort to driving around door-to-door to get medications out to the people that needed them.

In a country with no universal public health system, money is also proving a problem - the floodwaters washed away many people’s jobs and their medical insurance along with them.  However, one of the area’s biggest HIV & AIDS services – the NO/AIDS Task Force – has insisted that lack of funds will not stop people getting the drugs they need.  “We treat them first, worry about the money later,” said one representative.  

The AIDS Alliance Emergency Fund has now stepped in to providing some funding, and a number of major pharmaceutical companies have offered to provide free medications to those affected.  A toll-free telephone helpline for both HIV+ patients and medical staff has also been set up on 1-866-887-2842. 

However, it may be weeks, even months before the full range of HIV support services are re-established in New Orleans.  Until then, service providers predict it will be a major struggle to keep people on uninterrupted treatment programmes, and fear that the after effects of the hurricane may continue to take lives long after the floodwaters have disappeared.

AVERT.org has more about HIV & the USA

 (The Miami Herald, 12/09/05)

Zimbabwe claims AIDS rate is falling despite warnings of a rise

 (BBC.co.uk, 12/09/05 & People's Daily Online, 10/09/05)

Global Fund donations fall short of need

 (BBC.co.uk, 07/09/05)

Anti-rape condom may help prevent attacks & HIV

 A South African inventor has developed a female condom that she hopes may cut the number of rapes committed in the country, as well as protecting women from HIV and pregnancy.  South Africa has one of the highest rates of sexual assault in the world, with around 50,000 rapes reported every year.

The specially designed condom, known as the “Rapex”, is worn internally, much like a regular female condom, and contains several shafts of sharp angled barbs that hook onto the rapist’s penis, causing considerable pain.  Once attached, the condom can only be removed at a hospital, which the inventor hopes will enable rapists to be clearly identified.

The Rapex has the added benefit of protecting the victim against HIV, pregnancy and other sexually transmitted infections, and the distracting pain and confusion it causes should, in theory, allow the women extra time to escape her attacker.  However, some women’s rape-crisis groups have raised concerns that the pain will simply enrage an attacker and cause further violence against the women.  They also question the likelihood of women wearing the device constantly ‘just in case’.   Many women know their attackers and are unlikely to expect to be raped, while some suffer long-term abuse from a family member, and may not have the psychological strength to use the device.

However, Sonette Ehlers, the inventor, is adamant that if the Rapex prevents just one rape, or stops one woman becoming infected with HIV, she will consider it a success.  It may even make rapists think twice about their actions in the future.  “This is not about vengeance,” she said, “but the deed, that is what I hate.

The “rapex” is due to go into production next year.

 (Reuters, 31/08/05)

U.N. Summit crisis deepens as U.S. call for omission of MDGs

 When the United Nations holds its annual summit in New York next month, it will mark the 60th anniversary of the organisation’s foundation.  However, any planned celebrations may have to be put on hold unless U.N. officials can find a way to avert a crisis that some say is threatening the very existence of the U.N. as a influential and effective global power.

At the centre of the crisis is a forty-page document due to be ratified by 175 world leaders attending the U.N. summit on the 14-16 September.  The paper is designed to identify the key issues that the body will focus on in the future, and set out ways in which they will be addressed.  It will also reform how the U.N. is managed and the internal structures of the organisation.  The latest draft of this document has however created deep divisions between many nations, most notably on issues of terrorism, global warming, international development and human rights.

Much of the problem lies in a list that was submitted by the United States, the U.N.’s biggest financial supporter, just three weeks before the summit is due to start.  Written by John Bolton, the controversial new U.S. ambassador to the U.N., it suggests over 500 changes to the current draft.  Among the most contentious of these is the omission of all specific references to the Millennium Development Goals (MDGs), a set of high-profile targets conceived by the U.N. in 2000, which aim to reduce global poverty, inequality and climate change and reverse the spread of HIV and AIDS by 2015.  Instead, the U.S. wants more general references to “internationally developed development goals”.

Bolton has argued that the deletion of references to the MDGs would avoid any specific and potentially controversial commitments being made on achieving them. The U.N. however insists that firm commitments are paramount if any progress on international development is to be made.  “Any effort to eliminate the MDGs from the Summit outcome would be a step back to the global fight against poverty and for the billions living in poverty,” a spokeswoman for the U.N. said.

One of the key stumbling blocks for America is the U.N. call for wealthy countries to spend 0.7% of their gross national product on international aid. Despite being the richest nation in the world, the U.S is almost bottom of the list for the amount it gives according to national income.  In 2002, it donated just 0.07% of its GNP to charitable causes and international development (10% of the amount suggested by the U.N.) and appears to have little interest in increasing this figure.

The United States is not the only country to object to the proposals in the document, with Russia and the Nonaligned Movement of Developing Nations also raising concerns about the wording, and a number of nations asking that more is included about role that capitalist nations play in inciting terrorism.  

Current reports suggest the U.N. Secretary General, Kofi Annan, has cut short his holiday in Africa to join crisis talks, but with just two weeks to go, it is unclear how much progress can realistically be made, or what it will mean for U.N. funding if U.S. demands are not met.

AVERT.org has more about the Millennium Development Goals

 (Reuters, 31/08/05 & Washington Post, 23 - 30/08/05)

US "extreme policies" accused of damaging Uganda's AIDS programme

A senior UN figure has accused the United States of endangering Uganda’s previously successful AIDS prevention programme by encouraging "abstinence only" and by exacerbating a national condom shortage.

Uganda is of special significance to AIDS policy makers because it experienced a drop in HIV rates not seen anywhere else in Africa. Between the early 1990s and 2001, HIV prevalence in Uganda fell from around 15% to 5%, and credit was given to President Museveni for leading wide-ranging prevention campaigns.

But AIDS advocacy groups say that Uganda's progress is being threatened by a shift away from a balanced HIV prevention policy, coupled with a national shortage of condoms. And the finger of blame is being pointed at America and its international AIDS programme, known as PEPFAR. According to Jodi Jacobson, Executive Director of the Center for Health and Gender Equity, "there has been  a dangerous and profound shift in US donor policy from comprehensive prevention, education and provision of condoms to focus on abstinence only".

Stephen Lewis, the UN Special Envoy for HIV/AIDS in Africa, has now added his voice to the debate: "there is no question that the condom crisis in Uganda is being driven and exacerbated by PEPFAR and by the extreme policies that the administration in the United States is now pursuing".

Mr Lewis also said that PEPFAR's emphasis on abstinence above condom distribution is a "distortion of the preventive apparatus and is resulting in great damage and undoubtedly will cause significant numbers of infections which should never have occurred". PEPFAR believes in promoting condoms to those whom it sees as being at highest risk of HIV infection, such as sex workers and truck drivers, while everyone else is encouraged to abstain from sex or to remain faithful to one long-term partner.

Critics say the US-backed policy offers no protection to those who are unable to abstain, or to those whose partners are not as faithful as themselves. They also say there is a massive condom shortage in Uganda.

Last year the Ugandan government issued a nationwide recall of the condoms distributed free in health clinics, due to concerns about their quality. Although tests showed there was nothing at all wrong with the condoms, the government says that public confidence in the brand has been badly dented, so they will not redistribute them. This is said to have contributed to a severe scarcity of condoms, and new taxes have helped to make the remaining stocks too expensive for many people to afford. An American NGO has even offered one million condoms to Uganda's Ministry of Health to help alleviate the problem.

"The crisis in Uganda has been created by the actions - and inactions - of the government of Uganda and the Bush administration, the primary donor for HIV/AIDS programmes in Uganda, and a major force in undermining effective HIV prevention programmes throughout sub-Saharan Africa and Central America," said Mr Jacobson.

However Uganda's coordinator of condom procurement at the Ministry of Health has denied there is any shortage of condoms, and said that new stocks will be distributed soon. She also said the government was committed to promoting all three parts of the "ABC" strategy: Abstinence, Faithfulness and Condoms.

AVERT.org has more about AIDS in Uganda, about PEPFAR, and about the ABC of HIV prevention.

 (New York Times, 30/08/05; Associated Press, 30/08/05; Guardian, 29/08/05)

Tuberculosis is an African emergency

African health ministers meeting in Mozambique have declared tuberculosis (TB) an emergency in the African region. The ministers, representing 46 countries, made the announcement at a meeting of the World Health Organisation (WHO) Regional Committee for Africa.

The WHO spelt out why this action was needed: “The declaration was made in response to an epidemic that has quadrupled the annual number of TB cases in 18 African countries since 1990 and continues to rise across the continent, killing more than half a million people every year.”

The continuing rise in African TB cases is mainly due to the spread of HIV, which weakens the immune system and makes people much more likely to develop the active, contagious form of the disease. TB is a leading cause of death among HIV positive people, accounting for up to a third of all AIDS deaths worldwide.

It is hoped that the emergency declaration will lead to rich nations committing more money to fight TB and AIDS in sub-Saharan Africa, where more than 25 million people are living with HIV. The declaration is part of a wider WHO programme that calls for $2.2 billion in new funding to control African TB in 2006-07.

AVERT.org has more about HIV and tuberculosis.

(Reuters, 26/08/05)

U.S. withholds funding for abstinence-only group.

The Bush administration has announced it is to suspend a federal grant for the pro-abstinence education group, the Silver Ring Thing, because it appears to be using taxpayers’ money to further its religious ideals.

The decision has caused some surprise among many sex education groups, who had until now had presumed that the President’s own endorsement and support of Christian-based abstinence-until-marriage education meant that the government would turn a blind eye to groups incorporating overt religious teachings in their work.

Three months ago the American Civil Liberties Union filed a lawsuit against the US Department of Health and Human Services, claiming that the Bush Administration was illegally using tax dollars to promote Christianity.  Under current US law, groups can mention religion in their promotion of more responsible sexual practices, but they cannot use federally funded programmes to promote any one religion.  Clearly wary of the issues raised by the ACLU lawsuit, the HSS has now told the Silver Ring Thing, one of the biggest abstinence-until-marriage groups in the US, that it will have to submit a “corrective plan of action” if it is to receive the $75,000 grant it is hoping for.

The organisation, which describes itself as ‘faith-based’, insists that their religious activities are kept quite separate from their abstinence programme, which asks young people to take a pledge of chastity in return for a silver ring.  However, their virginity oath must be taken “before God Almighty”, the ring is inscribed with a passage from the bible reminding the wearer to “keep clear of sexual sin”, and most meetings are held in churches, which has led some, including the US government, to cast doubt on the group’s true motivations.

Abstinence-only education has been heralded by many as the best AIDS prevention measure available in the US, but statistics on HIV rates among young people have as yet failed to show that the programmes are having any impact.

(Washington Post, 24/08/05)

Global Fund suspends Ugandan AIDS, TB & Malaria Grants

 The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) has suspended all grants to Uganda following concerns about possible corruption within the Ugandan Health Ministry, according to a letter leaked to the UK’s Financial Times newspaper.

All grants issued by the Fund are carefully monitored by a Local Fund Agent (LFA) within the country to ensure that the money is being used for its intended purpose.  However, according to the letter seen by the FT, a routine investigation carried out by Uganda’s LFA (the business services firm PwC), found evidence of “serious mismanagement” of funds.  Around $280,000 is believed to have been siphoned off by someone in the Ministry after the American dollar grants were converted into Ugandan Shillings using false exchange rates.  Around $45 million has been spent on AIDS, TB and Malaria related projects in Uganda so far.

The Fund have not yet specified exactly who they believe is responsible for the discrepancies, but have made suggestions that it is either a partner or someone within the Health Ministry’s special Programme Management Unit (PMU) which was set up specifically to administer Global Fund grants back in 2003.  They have now asked for the Ugandan government to reorganise its mechanism for receiving and disbursing grants so that the PMU is excluded.

News of the suspension comes just one day after The Global Fund issued a press release stating that their programmes had exceeded targets set for 2005.  Seven out of eight of the Fund’s key goals on AIDS, TB and Malaria were surpassed, with the greatest achievement being among children orphaned by AIDS.  66% more orphans than expected are now receiving care and support thanks to GFATM money.  “It is extremely gratifying to see that our grant portfolio is doing well – even better than expected,” said the chair of the Fund, Dr Carol Jacobs, “It indicates that the Global Fund’s financing structure, which lets countries design and implement their own programs and which rewards good performance, works even in countries that traditionally are not able to use external financing well.”

However, as keen to reward good behaviour as the Fund may be, the Ugandan situation and the GFATM’s recent withdrawal from Burma, suggest that officials have no qualms about punishing bad behaviour in equal measure.  The suspension of funding may be extremely serious for the people of Uganda, but the GFATM has always maintained that in the long term, fraud and financial mismanagement are far more damaging to the economy and health of a nation.  Avoidance of corruption through transparency has therefore always been key in all Global Fund activities and all Principal Recipients are warned that irregularities will be met with suspension and possibly cancellation of funding.  

With the third voluntary replenishment conference for donors due to be held in London next month, the Global Fund has everything to play for if it wants to secure the funding it needs to continue its work.  However, ironically, it may not be the stories of AIDS orphan support networks or exceeded AIDS treatment targets that ultimately persuade the large donor nations to part with their cash, but the simple fact that the Global Fund can and will uncover and combat corruption.  In an age when mistrust in the leaders and governments of developing nations is fuelling cynicism and apathy, this guarantee could provide a vital boost in aid donation worldwide, and ensure that this aid actually reaches the people that need it most. 

AVERT.org has more about the Global Fund and Uganda

 (Financial Times, 24/08/05 & GFATM Press Release, 23/08/05)

Swaziland ends chastity rite so King can marry

Young girls in Swaziland are to be released early from a five-year chastity pledge imposed by King Mswati III in 2001 to prevent the spread of HIV.

The "umchwasho" is an ancient rite that requires all girls under the age of eighteen to wear a woollen tassel as a symbolic badge of virginity. Any man who attempts to embark on sexual relations with a girl wearing a tassel is fined one cow, or around 1,300 Swazi emalangeni.

The king himself was fined in 2001 after choosing a seventeen-year-old as his ninth wife. Initially he tried to insist that the ban only applied for casual sex, not marriage, but a 300-women strong protest at his palace forced him to hand over the required cow, which the protesters then roasted and ate in celebration.

The Umchwasho was reintroduced by the King in an effort to tackle the country's enormous AIDS epidemic. Nearly 40% of Swazis are HIV positive, giving the country the highest prevalence rate in the world. However, many have criticised the rite, saying it is ineffective, out-dated, sexist, and bankrupts parents who have 'promiscuous' sons.

The King has given these objections as reasons for ending the ban one year early, but many suspect that his true motive is the annual 'Reed Dance' at the end of August. Up to 20,000 bare-breasted young girls will dance before him at the event, after which he is expected to choose his fourteenth wife. 

 (Associated Press, 22/08/05)