Saturday, March 16, 2013
Case report of a
'functional' HIV cure in a child
HIV persists in child's body, but
no signs of new virus production after 12 months off treatment. Researchers in
the United States say that they have identified a case of a 'functional' HIV
cure in a child infected with HIV who began antiretroviral treatment within
days of birth. The child has now been off treatment for a year, and although
HIV DNA has been detected at very low levels in the child’s cells, the virus is
Further follow-up will be required to determine
whether this state persists, or whether viral replication resumes, but
researchers involved in the case are optimistic that what they have found
represents a functional cure – a state in which HIV remains in the body, but no
longer replicates. One functional cure in an adult has been reported previously
– the so-called 'Berlin patient'
The findings were presented at a press conference
on the opening day of the 20th Conference
on Retroviruses and Opportunistic Infections (CROI) in Atlanta,
and further details were released on Monday 4 March in a conference session on
Dr Deborah Persaud of Johns Hopkins University
School of Medicine, Baltimore, reported on the case of a child treated with
antiretroviral therapy from 30 hours after birth, almost immediately after
testing for HIV DNA and RNA on the second day of life. The child was born to a
mother with detectable viral load at the time of delivery.
The child was delivered prematurely, at 35 weeks of
gestation, and the mother underwent rapid antibody testing for HIV at the time
of delivery. She had not been in HIV care previously. The child was tested for
HIV at around 30 hours of life, and tests revealed detectable HIV DNA and HIV
RNA of just under 20,000 copies/ml. RNA tests continued to be positive up until
20 days of life, indicating that this was not an isolated false positive result
and that viral replication was taking place.
In line with recommended practice in cases where
mothers have detectable viral load at the time of delivery, the infant was
initiated on a regimen of AZT/3TC and nevirapine as prophylaxis against
infection. In cases of prophylactic treatment to prevent infection in
HIV-exposed infants, this regimen would be given for 4 weeks. In this case,
because virus was detected and the infant had confirmed HIV infection,
treatment continued until the age of 18 months (although lopinavir/ritonavir (Kaletra)
was substituted for nevirapine at day 7). At 18 months of age, the child’s
caregiver withdrew the child from treatment and the child was lost to follow-up
for nearly six months.
Viral load tests were carried out at 7, 12 and 20
days of age that showed detectable virus after the initiation of treatment,
before the virus became undetectable on a test with a lower limit of detection
of 20 copies/ml at day 29. Subsequent testing until month 26 showed that viral
load remained persistently undetectable after this point, despite the fact that
treatment was stopped after 18 months.
When the child returned to care at 23 months of age
and it became apparent that viral load was not detectable in the absence of
treatment, clinicians at the University of Mississippi Medical Center sought
advice from research groups outside the state, including Dr Katherine Luzuriaga
at the University of Massachusetts.
Collaborating laboratories at the National Institutes
of Allergy and Infectious Diseases and the University of California San Diego
carried out ultrasensitive tests to determine whether HIV had been eliminated,
or whether any traces of the virus persisted in any cell types. They found that
viral RNA of 1 copy/ml could be detected in tests carried out when the child
was two years of age and 2 copies/ml at 26 months. Co-culture of 22 million
resting CD4 cells failed to identify any replication-competent HIV at 24
However, testing at 24 and 26 months of age found a
reservoir of presumably latently infected cells: HIV DNA was detected in
peripheral blood mononuclear cells at a frequency of 37 and 4 copies per
million cells. The investigators also looked for 2-LTR circles, fragments of
unintegrated HIV DNA that might have the potential either to influence the way
in which the infected cell evades immune surveillance, or to establish a
prolonged state of latency. They found no 2-LTR circles within the cells
containing HIV DNA, suggesting that HIV is completely quiescent, and not
replicating – a functional cure of HIV infection.
Speaking at the press conference, Deborah Persaud
rejected suggestions that the case might represent an episode of successful
post-exposure prophylaxis, noting that several blood samples taken during the
first week of life had tested positive for viral RNA, indicating that infection
had already become established. However, further testing of these samples is
not possible because the samples had not been stored, their future significance
not being appreciated at the time the child was diagnosed.
Dr Persaud said that the findings represented a
“proof of concept”. Referring to the case of a Berlin man who was declared
cured of HIV infection following a bone marrow transplant from a donor with
genetically conferred resistance to HIV infection, she said: “We believe this
is our Timothy Brown moment.”
She said that trials to investigate whether a
functional cure is possible for larger numbers of infants are now in design,
and that, if successful, the challenge will be to replicate the results through
the existing platform of services for prevention of mother-to-child
Published by: Keith
Alcorn on March 03, 2013 on nam aidsmap
The man who was my abuser was a fine host, a good husband, a caring father, a respected elder whose generosity and kindness were as genuine as the fact of the abuse. These qualities were important, because they helped him conceal the abuse he carried out over a period of four years.
As a much-loved older relative, a close friend of my parents, he had unrestricted access to our house, and we visited him often. It was only at 12 that I began to feel uncomfortable. I didn’t know the term “child sexual abuse,” and had no words with which to describe my discomfort with the “games” he played — but I sensed there was something wrong about the silence that he demanded. When I was 13, I left Delhi for Calcutta, to study in that city, and left my abuser behind. But he didn’t forget, and when I came back to Delhi as a 17-year-old, he was there.
FIERCE, PROTECTIVE BARRIER
At 17, I knew now that he had no right to do this to me. When he sent poems, said that despite the four decades that separated us, we were supposed to “be together,” I broke my own silence — but only partly. I told my mother and my sister, and they formed a fierce, protective barrier between me and my abuser.
But the man who had started his abuse when I was nine was still invited to my wedding, because we were all keeping secrets, trying to protect one family member or another. (He was married, with grown children of his own.)
Years later, when my abuser was dying of old age and diabetes, I visited him. There was no space for a long conversation, but I did tell him that I would not forget, even if forgiveness was possible. The silence around the abuse festered and caused damage for years, until finally, in my thirties, the difficult, liberating process of healing began.
If this story saddens you, please think about this: my story is neither new nor rare, nor was the man who abused me a monster, or in any way out of the ordinary. According to a 2007 survey (the largest of its kind in India) conducted by the Ministry of Women and Child Welfare, over 53 per cent of Indian children have experienced some form of sexual abuse — a slightly higher percentage of boys than girls. I am only one of many.
As I learned to cope with the fallout from the childhood abuse, I made unexpected connections, found good friends, found strong mentors, found help, found my voice again and built a happier, more free life. If I bring up the abuse today, it’s to make a point about the importance of consent in the debate over gender equality in India.
Child abuse survivors are experts in two areas: we’ve taken a masterclass in the toxicity of silence and secret-keeping, and we have doctorates in our understanding of the importance of consent. It can take survivors, like rape survivors of either gender, years to reclaim a sense of ownership over their own bodies. The body is the site of so many violations, starting with the chief one: our abusers did not ask us for permission to use our bodies as they pleased. Children subjected to abuse learn one harsh lesson — their bodies are not their own.
RIGHT TO OFFER OR WITHHOLD
Over years, those of us who are fortunate enough to find counsellors and healers learn to reclaim our bodies. We learn as adults what children are supposed to know by instinct: we learn that we can be safe in our bodies, we learn to allow ourselves pleasure, to take care of ourselves, and most of all, we learn that we have the right to offer or withhold permission to other people, when they want access to our bodies, our selves.
In December 2012, a violent gang rape in Delhi took the life of a young woman and set off a raging debate over women’s freedoms and rape laws. In all the complex arguments we’ve heard in the last few months in India on rape, violence against women, we have not discussed consent as much as we need to. When we talk about rape, women’s bodies are often discussed as though they were property: how much freedom should the Indian family allow its daughters, wives, sisters, mothers?
Recently, rejecting the Verma Committee’s strong appeal that marital rape be made an offence under the law, the Standing Committee on Home said that (a) the Indian family system would be disturbed (b) there were practical difficulties and (c) marriage presumes consent.
These assumptions expose the toxicity at the heart of a certain view of the Indian family. For marriage to “presume consent,” you must assume that a woman gives up all rights to her body, to her very self, once she goes through the ceremony of marriage. You must also presume that a man is granted the legally sanctified right to access over his wife’s body, regardless of whether she finds sex unwelcome, frightening, painful, violent or simply doesn’t feel like it that day.
This diminishes both genders, in its assumption that men are little more than lustful beasts, unable to restrain their libidos, that women are passive receptacles without desires of their own, forced to submit to demands for sex regardless of what they want. This is a medieval view of marriage and sex, and it is dismaying that Parliament appears to subscribe to it.
What is missing is the key question of consent — the consent of the woman, of any person in a sexual contract. All people — children, women, men — have a right to their own bodies.
In any equal partnership, the only possible basis for sex is on the mutual understanding that consent is an active process — to be offered freely and gladly, to be withdrawn just as freely. Underlying the principle of consent is the equally strong principle of respect; respect for one’s self, as much as for one’s partner. No one should be forced to share their bodies against their will.
On an active, day-to-day basis, consent embraces the idea that any woman or man is free to say ‘yes’ or ‘no’ to a sexual encounter, inside or outside marriage, regardless of whether they are, in the ugly phrase of the courts and police stations, “habituated to sex.”
Child abuse survivors and sexual violence survivors understand instinctively that true respect includes giving all people the right to say ‘no,’ the right to choose when they will be touched, and by whom.
If it is hard for Indian society to understand why everyone should have this right, then perhaps we should start with the basics.
You own your own body. Everyone has the right to live without their bodies being violated. Everyone has the right to demand that you ask for permission before you touch their bodies.
Perhaps in time, Parliament and the government might understand this. Justice Verma Committee and thousands of women trapped in marriages where they do not have the right to refuse sex certainly do understand. (For those who believe that marriage in India is a perfect, unsullied institution, read the statistics: over 40 per cent of women in marriages have reported domestic violence. That’s reported, not experienced. In addition, we rarely discuss the experiences of men who have gone through childhood sexual abuse — currently, the percentage is slightly higher for boys than girls, but men are doubly silenced, by shame and the demands of masculinity.)
FROM VICTIM TO SURVIVOR
My own journey from victim to survivor and then to a kind of freedom, took years. Even so, I had less to deal with than many whose stories are reported in Human Rights Watch’s recent study of child sexual abuse in India — no institutionalised abuse, no caste abuse, no extreme violence. In time, I became a writer, a listener, and a collector of stories. The shared stories of survivors allowed me to let go of shame — child abuse was too common and too widespread for that. I also learned that your memories, however dark, will not kill you, or prevent you from creating a better life.
Reclamation happened slowly, sometimes painfully. I was lucky to have the support of my partner, friends and great counsellors. But that journey started with believing that I did have the right to say ‘no,’ that my body did belong to me.
The debate in India over rape laws, particularly marital rape, is about such a simple thing: acknowledging that women (and men, and children) have a right over their own bodies. Why is this being treated as though it were a dangerous or radical idea? In a country that calls itself modern, as India does, it’s time we embraced the idea of consent, in all relationships.
Even though it’s so common — more than half of all adults in my generation of Indians have experienced some form of childhood sexual abuse — few survivors speak about their experiences because of the Indian family’s insistence on silence. That silence transferred the shame of the abuser’s act on to the child, and on to the family; it is powerful and crippling, and it actively enables abuse.
The silence around marital rape is strengthened when the Indian social and legal system refuses even to acknowledge that it exists; for an abuser, and for a rapist, these silences are frighteningly empowering.
Just as children have the right to ask that their bodies remain unviolated by the people they should be able to trust, a woman has the right to say, no, she does not give her consent. Even, and perhaps especially in, a relationship as intimate as marriage.
Written by: Nilanjana S. Roy in Hindu Newspaper
Friday, March 15, 2013
Najood Ali is world's youngest divorcee at the age of 9.
Thursday, March 7, 2013
66% women experienced sexual violence: survey
Around 66 per cent of total interviewed women of a survey on violence against women said that they experienced sexual violence whereas 93 per cent said that they experienced marital rape.
The research study was conducted Rutgers World Population Foundation (WPF) in Dera Ghazi Khan, Muzaffargarh, Jacobabad, Kashmore, Jafferabad and Naseerabad to measure the prevalence of domestic violence and perception of men about the issue through Focus Group Discussions. Rutgers WPF is an international organisation working for the promotion of sexual and reproductive health and rights throughout the country. The study will be formally launched at International Women’s Day on March 8 in Quetta.
Findings of the study represents high prevalence of harmful traditional practices in the shape of early marriages, Vanni, Swara, Sang Chatti, Badal, Bazo, Watta Satta and Pait Likaei. Sixty one per cent women covered under the study were children when they got married while more than 77 per cent of the marriages were settled under some kind of customary practices. Shockingly, 63 per cent of injured women never received health care services due to accessibility and permission issues.
In line with the global theme of International Women’s Day, “A promise is a promise: Time for action to end violence against women” and on the basis of alarming research findings, Rutgers WPF demanded effective implementation of laws and legislations from responsible authorities for protection of women rights according to international set standards.
Most importantly, the Prevention of Anti-Women Practices (Criminal Law Amendment) Act 2011 should be enforced by respective governments to reduce the prevalence of customary practices. Child Marriages Restraint Act 1929 needs to be implemented after incorporating required amendments in all provinces to protect young girls from early age marriages which in turn lead to different forms of domestic violence.
Effective steps are also required to implement Convention on Elimination of Discrimination against Women (CEDAW) with true letter and spirit ensuring elimination of discrimination against women at all levels.
Published by : The News on March 7, 2103
Published by: Express Tribune on March 25,2012
Rutgers WPF has conducted research study on prevalence of gender based domestic violence and to measure the perception of men about the issue. The study was conducted in districts of Kashmore, Naseerabad, Muzaffargarh, Jafferabad, Dear Ghazi Khan and Jacobabad.
More details follow the link:
More details follow the link: