January 2013– The atlas provides sound scientific information on the connections between weather and climate and major health challenges. These range from diseases of poverty to emergencies arising from extreme weather events and disease outbreaks.

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Geneva/Nairobi, 19 January 2013–International effort to address mercury—a notorious heavy metal with significant  health and environmental effects—was today delivered a significant boost with governments agreeing to a global, legally-binding treaty to prevent emissions and releases.

The Minamata Convention on Mercury—named after a city in Japan where serious health damage occurred as a result of mercury pollution in the mid-20^th Century—provides controls and reductions across a range of products, processes and industries where mercury is used, released or emitted.

These range from medical equipment such as thermometers and energy-saving light bulbs to the mining, cement and coal-fired power sectors.

The treaty, which has been four years in negotiation and which will be open for signature at a special meeting in Japan in October, also addresses the direct mining of mercury, export and import of the metal and safe storage of waste mercury.

Pinpointing populations at risk, boosting medical care and better training of health care professionals in identifying and treating mercury-related effects will also form part of the new agreement.

Mercury and its various compounds have a range of serious health impacts including brain and neurological damage especially among the young.

Others include kidney damage and damage to the digestive system. Victims can suffer memory loss and language impairment alongside many other well documented problems.

Initial funding to fast track action until the new treaty comes into force in the expected three to five years’ time has been pledged by Japan, Norway and Switzerland.

Support for developing countries is also expected from the Global Environment Facility and a programme once the convention is operational.

Achim Steiner, UN Under-Secretary General and Executive Director of the UN Environment Programme (UNEP) which convened the negotiations among over 140 member states in Geneva, said at the close:” After complex and often all night sessions here in Geneva, nations have today laid the foundations for a global response to a pollutant whose notoriety has been recognized for well over a century.”  

“Everyone in the world stands to benefit from the decisions taken this week in Geneva– in particular the workers and families of small-scale gold miners, the peoples of the Arctic and this generation of mothers and babies and the generations to come. I look forward to swift ratification of the Minamata Convention so that it comes into force as soon as possible,” he said.

Fernando Lugris, the Uruguayan chair of the negotiations, said : “ Today in the early hours of 19 January 2013 we have closed a chapter on a journey that has taken four years of often intense but ultimately successful negotiations and opened a new chapter towards a sustainable future. This has been done in the name of vulnerable populations everywhere and represents an opportunity for a healthier and more sustainable century for all peoples”.

Ambassador Franz Perrez of the Federal Ministry for the Environment, Switzerland said:”Switzerland, which initiated with Norway the negotiations for a mercury convention, is very pleased about this impressive success. It will help us to protect human health and the environment all over the world and is a proof that multilateralism can work when political will exists.”

“This treaty will not bring immediate reductions of mercury emissions. It will need to be improved and strengthened, to make all fish safe to eat,” said David Lennett from the Natural Resources Defense Council representing the Zero Mercury Working Group a global coalition of environmental NGOs “Still, the treaty will phase out mercury in many products and we welcome it as a starting point.”
 
The decision to launch negotiations was taken by environment ministers at the 2009 session of the UNEP Governing Council and the final and fifth negotiation took place this week in Geneva.

The scope of the new treaty which puts in controls and also reduction measures in respect to mercury is as follows.

Products

Governments have agreed on a range of mercury containing products whose production, export and import will be banned by 2020.

These include:-

·        Batteries, except for ‘button cell’ batteries used in implantable medical devices

·        Switches and relays

·        Certain types of compact fluorescent lamps (CFLs)

·        Mercury in cold cathode fluorescent lamps and external electrode fluorescent lamps

·        Soaps and cosmetics

Certain kinds of non-electronic medical devices such as thermometers and blood pressure devices are also included for phase-out by 2020.

Governments approved exceptions for some large measuring devices where currently there are no mercury-free alternatives.

·        Vaccines where mercury is used as a preservative have been excluded from the treaty as have products used in religious or traditional activities

·        Delegates agreed to a phase-down of the use of dental fillings using mercury amalgam.

Artisanal and Small-Scale Gold Mining

The booming price of gold in recent years has triggered a significant growth in small-scale mining where mercury is used to separate gold from the ore-bearing rock.

Emissions and releases from such operations and from coal-fired power stations represent the biggest source of mercury pollution world-wide.

Workers and their families involved in small-scale gold mining are exposed to mercury pollution in several ways including through inhalation during the smelting.

Mercury is also being released into river systems from these small-scale operations where it can contaminate fish, the food chain and people downstream.

·        Governments agreed that the treaty will require countries to draw up strategies to reduce the amount of mercury used by small-scale miners

·        Nations with artisanal and small-scale gold mining operations will draw up national plans within three years of the treaty entering into force to reduce and if possible eliminate the use of mercury in such operations

·        Public awareness campaigns and support for mercury-free alternatives will also be part of the plans

From Power Stations to Cement Factories

The new treaty will control mercury emissions and releases from various large industrial facilities ranging from coal-fired power stations and industrial boilers to certain kinds of smelters handling for example zinc and gold.

Waste incineration and cement clinker facilities are also on the list.

Nations agreed to install the Best Available Technologies on new power plants and facilities with plans to be drawn up to bring emissions down from existing ones.

The negotiations were initially looking to set thresholds on the size of plants or level of emissions to be controlled. But it was decided this week to defer this until the first meeting of the treaty after it comes into force.

Notes to Editors

Background to the fifth session of the Intergovernmental Negotiating Committee to prepare a global legally binding instrument on mercury (INC5) http://unep.org/hazardoussubstances/Mercury/Negotiations/INC5/tabid/3471/Default.aspx

Global Mercury Assessment 2013 http://www.unep.org/publications/contents/pub_details_search.asp?ID=6282

Time to Act

http://www.unep.org/publications/contents/pub_details_search.asp?ID=6281

 For More Information Please Contact Nick Nuttall, UNEP Spokesperson on Tel: +254 733632755 or when travelling +41 79 596 5737

Mercury Treaty: Last Chance to Address Health Effects
In Final Talks, Western Governments Should Agree to Include Prevention, Treatment

(Geneva, January 10, 2013) – A proposed international treaty to address the damaging effects of mercury should include specific provisions to protect the health of children and other vulnerable populations, Human Rights Watch said today. Governments are to meet in Geneva beginning January 13, 2013, for a fifth and final round of talks for the treaty. Mercury is a toxic metal that attacks the central nervous system and is particularly harmful to children.

So far, the draft treaty has been focused on the environment and neglected the important role that the health sector has to play in addressing the problems caused by mercury, Human Rights Watch said. Western governments have resisted including stronger health provisions.

“Delegates to the mercury treaty negotiations should seize this last chance and draft effective health strategies to prevent and treat mercury poisoning,” said Juliane Kippenberg, senior researcher at Human Rights Watch. “Millions of people around the globe are exposed to mercury on a daily basis, in artisanal mining and elsewhere. There is a dire need for stronger prevention and treatment of mercury poisoning.”

Human Rights Watch research has documented how small-scale gold miners use mercury to extract gold from the ore, and risk mercury poisoning as a result. At least 13 million people work as artisanal gold miners globally, including many children. Few are aware of the harm mercury can cause.

In Mali, Human Rights Watch interviewed children as young as 11 about their daily work with mercury. In Papua New Guinea, a doctor told Human Rights Watch researchers about the impact of mercury on small-scale gold miners: “We have dozens of cases of mercury poisoning. ….They stare blankly at the wall. You cannot talk to them, they are not conversant, nothing. They are like zombies. And we have several cases that did not recover.”

Many health systems are ill-equipped to address mercury poisoning. During a Human Rights Watch investigation in Tanzania, a medical officer in a mining area expressed concern that health workers were “failing to diagnose” people suffering from mercury poisoning because they lack training.

A proposal by Latin American governments for a stand-alone article on health in the mercury treaty was a positive move, Human Rights Watch said. The article should require more public health information, research, surveillance, testing, treatment, and capacity-building of health systems to respond to mercury exposure. In a submission to governments, Human Rights Watch proposed specific language for a health article.

Human Rights Watch welcomed the fact that the current treaty article on small-scale gold mining requires parties to undertake public health activities for artisanal mining communities, but said this is not sufficient to address the problem. Mercury is used in a variety of areas, and as a result affects many different populations. Among other things, it is used in the production of chlorine, of poly vinyl chloride (PVC), a type of plastic, and of batteries, and in dental medicine. Burning fossil fuels, primarily coal, also significantly contributes to mercury emissions.

At the last round of negotiations, in July 2012, Western governments – in particular Canada, the United States, and European Union members – rejected including a stand-alone article on health, contending that treaty is primarily about the environment.

They indicated that including health strategies might interfere with the health sector and drive up the cost of the treaty’s implementation. They also said that current references to health strategies in the draft text were sufficient. Their stance caused a heated debate with Latin American and African governments, whose representatives wanted a stronger health article.

“The position of the United States, Canada, and the European Union has been disappointing,” Kippenberg said. “Wealthier countries should recognize that environmental and health strategies on mercury go hand in hand, and provide financial support for both.”

The treaty is scheduled to be adopted toward the end of 2013 as the “Minamata Convention” in Japan. In the 1950s, the city of Minamata in Japan was the scene of one of the worst mercury poisoning disasters in history, in which more than 1,700 people died and many more suffered lifelong disease and disability. Japan has remained in the background, though, in the debate over including health strategies in the treaty.

“Today, Japan has a chance to say, ‘Never again,’” Kippenberg said. “It should take a lesson from Minamata and actively press to include health strategies in the mercury treaty.”

Around the world, environmental degradation – including contamination from mercury – has resulted in the denial of rights, including the right to health, Human Rights Watch said. Governments should recognize international human rights law in the preamble to the treaty and integrate human rights into environmental law.

Mercury poisoning can cause a wide range of health problems. Mercury can attack the cardiovascular system, the kidneys, the gastrointestinal tract, the immune system, and the lungs. Symptoms of exposure include tremors, twitching, vision impairment, headaches, and memory and concentration loss. Higher levels of mercury exposure may result in kidney failure, respiratory failure, and death.

Mercury is particularly harmful to unborn babies and infants, and can be transmitted during pregnancy and through breast milk. It can cause irreversible damage to a child’s development. Researchers have described mercury poisoning as an “invisible epidemic.”

For more Human Rights Watch reporting on the dangers of mercury, please visit:
http://www.hrw.org/dangers-of-mercury

To read the Human Rights Watch report on the dangers of mercury in Mali, please visit:
http://www.hrw.org/reports/2011/12/06/poisonous-mix
To read the Human Rights Watch report on the dangers of mercury in Papua New Guinea, please visit:
http://www.hrw.org/reports/2011/02/01/gold-s-costly-dividend

For more information, please contact:
In Geneva, Juliane Kippenberg (English, French, German): +41-77-472-9194 (mobile); or kippenj@hrw.org
In New York, Joseph Amon (English): +1-917-519-8930 (mobile); or amonj@hrw.org

DURBAN, South Africa, October 22, 2012 – Ahead of the official draw for the 2013 Orange Africa Cup of Nations (AFCON), African football stars and heads of state have joined United Against Malaria (UAM), pledging to distribute life-saving malaria prevention and treatment messages throughout the tournament. Football icons including Didier Drogba, Samuel Eto’o and Steven Pienaar, along with African Leaders Malaria Alliance (ALMA) heads of state including President Ellen Johnson Sirleaf of Liberia, President Jakaya Kikwete of Tanzania, President Blaise Compaoré of Burkina Faso, President Alassane Ouattara of Cote d’Ivoire and President Yoweri Museveni of Uganda, will lend their voices to the cause, appearing in television spots, billboards and educational materials that will be distributed across Africa.

“Across the continent, football dominates the hearts and minds of children and parents alike. But, so does malaria – the cause of 174 million illnesses and nearly 600,000 deaths in Africa alone every year,” said Samuel Eto’o, Cameroonian national team player and UAM champion. “We have united to utilize the power of football to fight malaria and we hope our fans will join us.”

Although preventable and treatable, malaria kills a child in Africa every 60 seconds and costs the continent an estimated minimum of US $12 billion in lost productivity and healthcare costs each year.

“I have been a victim of malaria and have witnessed first-hand the devastating effects it can have on individuals and families,” said Didier Drogba, Côte d’Ivoire national team captain and UAM champion. “We need malaria out of the game. Using the popularity of football to increase awareness of prevention and treatment methods will go a long way in the fight to show malaria the red card.”

By leveraging the popularity and excitement surrounding Africa’s signature tournament, the Confederation of African Football (CAF) and UAM are partnering to disseminate life-saving malaria messages through television and radio spots, in-stadium branding and local outreach to policy-makers and millions of fans across the continent.

“Malaria affects nearly everyone on the continent of Africa, including footballers and government leaders. With all eyes on the tournament and its participants, CAF and UAM are committed to utilizing this platform to communicate important messaging to end deaths from this devastating disease,” said Mr. Hicham El Amrani, secretary general of CAF.

Activities kicked off during tournament qualifying matches as President of Liberia Ellen Johnson Sirleaf surprised football fans at the friendly game between Liberia and Ghana to cheer on her national team and congratulate them for their efforts to fight malaria. “When we all fight malaria together, we build a stronger nations and save lives,” said President Ellen Johnson Sirleaf of Liberia. “As a football fan myself, I understand the game’s power and popularity. We have the tools to win against malaria and I urge others to join us in the fight.”

In Nigeria, Malawi, Benin, Ghana, Uganda, Tanzania and other countries, malaria messages will be shared using football players, favorite teams and sports programs. Research has shown that audiences retain and act on these messages more often when delivered by their football heroes. In those countries, billboards, sports journals, tournament programs will complement the PSAs on air to ensure the UAM campaign messages reach every household. In Cote d’Ivoire, images of Drogba and his teammates Kolo Toure, Gervinho and Salomon Kalou attract readers to malaria educational materials, and create excitement about ridding this West African country of the burden of malaria. The UAM campaign has broken language barriers by having PSAs recorded by football stars in over 18 African languages since the campaign was launched in 2009.

“I am honored to be a champion for this cause,” said Steven Pienaar, UAM champion and former South African captain. “It is unacceptable that malaria kills one child in Africa every minute. We can take such simple steps to prevent and treat this disease. United we can beat malaria.”

About Malaria

Malaria is a disease caused by parasites that are transmitted to humans through the bite of an infected mosquito. If left untreated, the infection in its most severe forms can lead to coma and death. Although malaria is preventable and treatable, it continues to kill a child every 60 seconds and 655,000 people globally each year. More than 90 percent of these deaths occur in Africa, and the majority of them are children under the age of five. Furthermore, malaria contributes to the cycle of poverty and limits economic development.

About United Against Malaria

United Against Malaria (UAM) is a partnership of football teams and heroes, celebrities, health and advocacy organizations, governments, corporations, and individuals who have united to win the fight against malaria. Our goal is to galvanize partners throughout the world to reach the international target of reducing deaths worldwide. To learn more about UAM, please visit www.UnitedAgainstMalaria.org and follow us on Facebook and Twitter.

About Orange Africa Cup of Nations

The Orange Africa Cup of Nations is the continent’s premiere football championship, organized biannually by the Confederation of African Football (CAF). The 2013 tournament, hosted in conjunction with the Local Organizing Committee (LOC) of the South African Football Association (SAFA) will take place from January 19 to February 10 and be followed by millions of fans in Africa and around the world. For more information, please visit www.Cafonline.com.

About ALMA

ALMA is a 46-member alliance of African heads of state and government working to end malaria. For more information, please visit www.alma2015.org.

###

Media Contacts:

UAM – Anna McCartney-Melstad: amccartn@jhsph.edu +27 743 674636

CAF – Mahmoud Garga: garga@cafonline.com +20 238 371000 ext. 116

Kigali, Rwanda/Washington D.C

Iron deficiency is widely prevalent in Sub-Saharan Africa. During childhood and adolescence, it lowers resistance to disease and impairs learning capacity.  It reduces the ability of adults for physical labor. Severe anemia increases the risk of women dying in childbirth.

In Rwanda, anemia, which is used as an indicator of iron deficiency, afflicts almost one out of five non-pregnant women and 40% of children under?five in Rwanda. Children and women will be the main beneficiaries of these new bean varieties, which could provide up to 30% of their daily iron needs.

“Beans are the ‘meat’ and even the ‘bread’ of the Rwandan countryside. A meal without beans in Rwanda is like a meal without food.” explains Lister Katsvairo, HarvestPlus Country Manager.

The new iron-rich bean varieties were bred by the Rwanda Agriculture Board (RAB) and the International Center for Tropical Agriculture (CIAT) using conventional breeding methods. Farmers who evaluated these beans during field trials liked them because they were high yielding and resistant to major diseases and pests. The beans are also highly marketable due to their large seed size and their preferred colors, including red and white that are sought for in local and urban markets. “Demand for these varieties has already started, and we have produced enough seed quantities to sell to farmers at an affordable price for the next cropping season.” said Katsvairo.

By September, HarvestPlus and its partners will distribute more than 200 tons of iron-rich climbing and bush bean varieties via agrodealers and local markets to about 75,000 farming households. Farmers will be able to grow these new beans to feed their families. They can also harvest and share seeds with others in their community amplifying the nutritional benefits. By the end of 2013, more than half a million household members are expected to be eating iron-rich beans.

This development and delivery of iron-rich beans is being funded by HarvestPlus. Partners include RAB, CIAT, other Rwanda Government agencies and local partners.

HarvestPlus (www.harvestplus.org) leads a global effort to breed and disseminate staple food crops that are rich in vitamins and minerals to improve nutrition and public health. Using a process called biofortification, higher amounts of vitamins and minerals are directly bred into foods such as bean, cassava, sweet potato, rice, maize, pearl millet, and wheat. HarvestPlus is part of the CGIAR Research Program on Agriculture for Improved Nutrition and Health. It is coordinated by CIAT and the International Food Policy Research Institute (IFPRI).

Media contacts

Lister Katsvairo, Rwanda Country Manager, HarvestPlus, listerkatsvairo@yahoo.com, Tel:             +250 784 057 448
Louis Butare, HarvestPlus Rwanda Bean Project Leader, RAB, butare.lewis@gmail.com, Tel:             +250 788 523 075
Yassir Islam, Communications Head, HarvestPlus, y.islam@cgiar.org, Tel:             +1 202 862-5602

In the fight against malaria, it took years of consistent medical results on insecticide-treated bed nets to gain the World Health Organization’s (WHO) recommendation in 2007. Governments will generally not implement an intervention without the WHO stamp of approval.

“After the evidence was collected, it took another decade for effective use of this intervention,” said Fred Binka, dean of the school of public health at the University of Ghana and former board member of WHO’s Roll Back Malaria Initiative.

“The problem was, who was to drive this evidence forward, when was it enough, and how do you move to policy?” Poor communication between researchers could also lead to confusion, difficulty and stalled policy recommendations, Binka noted.

But they are learning how to get approval in less time. After six years of experiments, talks began between WHO and researchers testing seasonal malaria chemoprevention (SMC) in areas of sub-Saharan Africa where the disease is endemic. The WHO recommendation came in March 2012, just one year after the final trial results were published.

About eight out of every 10 healthy children living in endemic areas who are given four doses of anti-malarial drugs during high-transmission periods do not contract malaria. SMC treatment was previously called intermittent preventative treatment against malaria in children.

To speed the approval process, researchers consulted with WHO policy-makers while trials were still in the planning stages, SMC trial coordinator Diadier Diallo told IRIN.

Similarly, scientists working on a malaria vaccine are optimistic that they will receive a WHO recommendation soon after trial results are reported in 2014. The RTS,S vaccine encourages the production of antibodies and T-cells – part of the immune system – which weaken the malaria parasite and reduce its ability to reproduce in the liver.

“All evidence points towards a potential licence for the RTS,S vaccine in 2014 or 2015, with implementation in 2015,” said Brian Greenwood, a professor at the London School of Hygiene & Tropical Medicine (LSHTM) and head of the Malaria Capacity Development Consortium, which is hosted by the university to boost malaria research strength in Africa.

Photo: The Global Fund/John Rae

Tried and true, though not tested

When tests are completed, RTS,S will have cost its makers an estimated $220 million since 2007.

Parachute approach

Not all methods to control malaria, among other diseases, have taken the “gold standard” approach of scientific trials, said Immo Kleinschmidt, a researcher in the Tropical Epidemiology Group at LSHTM. Rather, common sense and communities have often promoted their use.

“It’s been proposed to adopt a ‘parachute approach’ to evidence-based trials, based on the simple observation that parachutes have never been evaluated through trials yet we don’t doubt their effectiveness,” said Kleinschmidt.

In this approach communities become testing grounds, where – like parachutes – if malaria control methods are properly functioning and effectively used, they will reduce infection and/or the risk of it.

For instance, in 2006 WHO used mostly historical data rather than findings from large trials to promote indoor residual spraying. But such instances are the exception. Community studies alone rarely provide the needed assurance to roll out new malaria interventions, said Kleinschmidt, who agreed that large experiments are always the ideal, but said tests may not work out as planned.

“We should strive to produce evidence of the highest quality, but often we have to resort to designs that don’t necessarily meet the standard, because the real world is inevitably more messy than the ivory tower.”

Source: IrinNews

By Regina McEnery and Richard Jefferys

As the global campaign against AIDS enters its fourth decade, the development of a broadly preventive HIV vaccine remains among its most vexing challenges.

In his opening remarks at the 19th Conference on Retroviruses and Opportunistic Infections (CROI), held March 5-8 in Seattle, Tufts University virologist John Coffin, the scientific organizer of the event, noted that the failure of previous vaccine candidates had convinced many scientists that antibodies capable of preventing HIV infection could not be elicited through vaccination.

But the 31.2% efficacy demonstrated in the RV144 vaccine trial in Thailand—which, though modest, provided the first evidence of vaccine-induced protection from HIV—has helped lift the gloom from such speculations. Volunteers in that trial who received the prime-boost vaccine combination developed low titers of gp120-binding antibodies that subsequent analyses revealed are correlated with the risk of HIV infection. Separately, a dramatic expansion in the number of broadly neutralizing antibodies (bNAbs) against HIV isolated from volunteers, and the data describing their mechanisms of action, have renewed optimism about the prospects of this vaccine strategy.

“We’re now thinking much more seriously about developing vaccines that might be based on eliciting specific antibodies,” Coffin told the international gathering of more than 4,200 HIV researchers and clinicians.

Reflecting this shift in strategy, CROI organizers selected pioneering antibody researcher Dennis Burton, professor of immunology and microbial science and director of IAVI’s Neutralizing Antibody Center (NAC) at The Scripps Research Institute in La Jolla, California, to kick off the conference. Burton observed that the recent discovery of more than two dozen potent bNAbs by his lab and others, and the elucidation of some of their structural targets on HIV’s Envelope glycoprotein, have revealed weaknesses that can be exploited for both drug and vaccine development. “The tools are all there,” said Burton. “It remains to be seen if immunogen design can take advantage of all these tools.”

But antibodies were far from the only item on CROI’s four-day agenda. The conference also highlighted investigations of the structure of HIV’s Envelope trimer and updates on the continuing analysis of samples collected in the RV144 trial. Other talks of particular interest covered new findings on how a subset of T cells influences antibody development, the evolutionary pathways of HIV and SIV, and the results of several recent studies on ARV-based prevention, which dominated the conference and provoked more than a few animated discussions.

Freezing the fidgety trimer

All known bNAbs against HIV target functional Envelope trimers that—rather sparsely—adorn the viral surface. Many researchers believe that obtaining the detailed molecular structure of this protein complex would bring us much closer to the design of vaccines that induce sterilizing immunity to HIV, the ultimate goal of the AIDS vaccine field.

But that objective is easier defined than attained. The spike—composed of three identical pairs of the extracellular gp120 and transmembrane gp41 proteins—is highly unstable and structurally dynamic. While a structure of the HIV Envelope glycoprotein gp120 bound to CD4 was obtained more than a decade ago through X-ray crystallography (Nature 393, 648, 1998), scientists haven’t yet obtained a high-resolution structure of the unliganded trimer.

In a riveting plenary talk describing his use of cryo-electron microscopy (cryo-EM) to probe the trimer’s structure, Joseph Sodroski, professor of microbiology and immunology at the Dana-Farber Cancer Institute, Harvard Medical School, compared the Envelope protein in its unliganded state to a mousetrap that has been set but not sprung. Once it binds its receptors on the surface of the T cell, the trap is sprung. At that point its gp120 and gp41 components each assumes a “preferred, lower energy” conformation. “The difference in energy between starting and final conformation,” Sodroski explained, “is used to drive the fusion of viral and target cell membranes, and complete the cell entry process.”

But the only low-resolution images available are of the unliganded HIV Envelope trimer and a brief subsequent state, assumed just before viral entry, known as the prehairpin intermediate. Sodroski said the main problem is that researchers haven’t yet been able to generate crystals of the functional Envelope protein that are amenable to X-ray crystallography. The resolutions achieved using electron tomography, meanwhile, are too low to reveal the details essential to protein engineering.

So Sodroski’s lab turned about three years ago to single-particle analysis of the HIV trimer using cryo-EM. This approach, said Sodroski, permits near atomic-level resolution of molecular structures, allowing researchers to generate reconstructions of molecular assemblies that resist crystallization.

Sodroski and colleagues first expressed the Envelope glycoproteins obtained from a primary HIV-1 strain in JR-FL cells, and then fragmented their membranes (which carried the intact trimer) with detergent to release the soluble proteins. They then purified and froze the molecules, spread them out in thin layers and obtained multiple micrographs of the particles from a variety of angles. To improve the resolution and reduce background noise, they averaged images of particles in similar orientations taken from multiple angles. They then aggregated the results to generate a structure of the trimer.

Sodroski said close to a million single-particle images were used to create the 3D image of the Envelope trimer at nearly atomic-level resolution. The resulting single-particle cryo-EM structure agreed with a structure of the native Envelope protein trimer constructed by cryo-electron tomography in the laboratory of Sriram Subramaniam, chief of the Biophysics Section in the Division of Cell Biology at the US National Cancer Institute (seeThe Beauty Behind the Beasts, IAVI Report, Nov.-Dec. 2009).

A striking architectural feature of the HIV Envelope trimer in its unliganded state, Sodroski said, is the “doughnut hole” at its center. This conformation, he noted, is distinctly different from the densely packed structure that emerges at the end stage of the viral entry process. The images obtained from cryo-EM show that the gp41 protein is kept from its more energetically favorable conformation by the inner domain of gp120, which acts like a clamp holding the membrane-distal domains of the former far apart. Sodroski pointed out that the unliganded gp120 protein also has an open structure. The only parts of that molecule that interact with each other are the trimer association domains—the V1, V2 and V3 loops.

Sodroski said that the architecture of the unliganded HIV Envelope glycoprotein suggests that broadly neutralizing antibodies must not only recognize conserved epitopes, but approach them from appropriate angles as well. He noted that more detailed reconstructions of the trimer structure could aid the design of immunogens that can elicit similar antibodies.

Of sieves and the sifting of samples

The continuing correlates analysis of samples collected in the RV144 trial provided some grist for discussion as well. Paul Edlefsen, a biostatistician at the Public Health Sciences and Vaccine and Infectious Disease Division of the Fred Hutchinson Cancer Research Center in Seattle, added a little texture to the primary analysis of RV144 samples. That analysis suggested that the presence of non-neutralizing IgG antibodies that bind to the V1/V2 loops of HIV Env correlated with a 43% reduction in HIV infection risk in vaccine recipients (see A Bangkok Surprise, IAVI Report, Sep.-Oct. 2011).

Last year, his team, in collaboration with teams from the US Military HIV Research Program (MHRP) and the University of Washington, presented an analysis of breakthrough viruses—those that emerge in individuals who are not protected by vaccination— from 110 infected recipients across the vaccine and placebo arms of the RV144 trial. Their analysis compared nearly 1,000 amino acid sequences from the envelope proteins of Clade E HIV-1, the dominant subtype contained in the AIDSVAX B/E gp120 boost, from 50 vaccinees and 71 placebo recipients in the trial. These studies, led by MHRP virologists Morgane Rolland and Sodsai Tovanabutra and University of Washington virologist Jim Mullins, found viral escape (known to vaccinologists as a “sieve effect”) to be associated with the V2 and C1 region of the Envelope protein.

This is of particular interest because C1 corresponds to a common antibody-dependent cellular cytoxicity (ADCC) epitope, and ADCC is thought to have played a role in the protection induced by the RV144 regimen. The sieve effect appeared to be associated with a region between amino acids 69-95 in the C1 region. They identified two amino acid positions that appear to help determine whether a given clade E HIV variant escaped the nominal protection afforded by the RV144 vaccine regimen. The amino acids at positions 169 and 181 that correlated with such escape correspond to the crown of the V2 loop and the third amino acid of the ?4ß7 binding motif, respectively (see A Bangkok Surprise, IAVI Report, Sep.-Oct. 2011).

Edlefsen shared this year the results of a linear peptide microarray assay—developed by Duke University scientist David Montefiori—that his laboratory used to conduct its secondary correlates analysis of RV144 samples. The assay was designed to detect binding of antibody inÊthe vaccinees’ sera to linear epitopes representing all clades of HIV-1. This showed that people who have antibodies binding to the crown of the V2 loop were less likely to become infected, confirming results of the primary correlates analysis. The detection of IgG binding to linear peptides, he argued, strengthens the relevance of V2 antibody responses observed in the initial correlates studies.

Other findings have similarly boosted the starring role of the V2 loop in RV144. Edlefsen discussed, for example, two novel human monoclonal antibodies (mAbs), CH58 and CH59, retrieved from blood samples collected from a vaccine recipient after the fourth vaccination in the RV144 regimen. The mAbs—cloned by the lab of Duke University scientist Barton Haynes, who led the scientific steering committee that oversaw the search for RV144 correlates—are only weak neutralizers of HIV, unlike the PG9 bNAb, which they resemble. They do, however, bind the crown of the V2 loop implicated by sieve analysis. Interestingly, a substitution of the amino acid alanine at position 169 of the V2 loop abrogates this binding, but a similar substitution at position 181 does not. Exactly why that may be remains unclear.

T Follicular Helper Cells in Action

In the red germinal center (stained for cytidine deaminase, a marker for germinal center B cells), T follicular helper cells (stained green for CD3) can be seen interacting with B cells. An outer ring of re-circulating follicular B cells (stained blue for IgD), known as follicular B-cell mantles, surround the germinal center. Other T-cell zones are stained green as well. Image courtesy of Shimpei Kawamoto and Carola Vinuesa.

HIV and the elusive follicular helper

Immunologists have long been aware that CD4+ T cells—which are T-helper cells—play a vital role in the antibody response. One of those roles is the delivery of signals that drive the maturation and selection of B cells that generate increasingly potent antibodies. This process, called affinity maturation, is critical to the evolution of bNAbs to HIV.

But only in the last decade has it become clear that there exists a specialized subset of CD4+ T cells that is dedicated to such maturation. Carola Vinuesa, Humoral Immunity & Autoimmunity Group Leader at the John Curtin School of Medical Research, Australian National University in Canberra, spoke to the CROI audience about this subset—T follicular helper (Tfh) cells. Part of the reason Tfh cells eluded identification for so long is that they hang around in the B-cell follicles of lymph nodes and tend to be poorly represented in the circulating population of immune cells.

Vinuesa explained that the discovery of Tfh was facilitated by the identification of the chemokine receptor CXCR5 in the mid-1990s (Cell 87, 1037, 1996). This receptor was shown to be required for lymphocyte migration into lymph node follicles and the formation of germinal centers, where B-cell proliferation and affinity maturation of antibodies occur. Subsequent work by several research groups revealed that high levels of CXCR5 expression defined a subset of CD4+ T cells that home in on lymph node follicles and provide help to B cells (J. Exp. Med. 192, 1545, 2000,J. Exp. Med. 192, 1553, 2000).

The elevation of these Tfh cells to the rank of an independent subset was initially boosted by data revealing that their gene expression patterns are distinct from that of better-known Th1, Th2 and T-regulatory groups of the CD4+ T-cell clan (J. Immunol.173, 68, 2004). It was subsequently cemented by the identification of the Bcl-6 gene as the master regulator of their differentiation (Immunity 31, 457, 2009). If any doubt lingered about the legitimacy of the promotion, it was dispelled by the finding that, in addition to CXCR5, Tfh cells are distinguished by the expression of high levels of the PD-1 molecule and that they primarily secrete the cytokine IL-21.

Vinuesa highlighted two types of interactions that occur between Tfh and B cells: a brief dalliance at the border of the lymph node follicle and germinal center that leads to the generation of short-lived antibody-producing plasma cells and promotes class-switching of antibodies—from the IgM class to mature IgG, IgA or IgE classes—and longer, secondary liaisons in the germinal center that facilitate affinity maturation and the development of long-lived memory B cells. The secondary interface is crucial to the induction of lasting memory responses by vaccines, but Vinuesa noted that research into the impact of different vaccine approaches on Tfh cell and Tfh/B cell interactions is still in its infancy. The finding that bNAbs are characterized by extensive somatic hypermutation—the genetic changes in B cells that occur during affinity maturation (see Vaccines to Antibodies: Grow Up!,IAVI Report, July-Aug. 2010)—suggests that a better understanding of Tfh cells could contribute significantly to HIV vaccine development.

There followed other intriguing presentations on Tfh cells. Madelene Lindqvist, a postdoctoral researcher in the laboratory of Ragon Institute immunologist Hendrik Streeck, presented the first data on Tfh cells ever collected from individuals with chronic HIV infection. Her study involved 16 individuals with untreated infections (a median CD4+ T-cell count of 444 and a viral load of 35,000 copies/ml), 10 on antiretroviral therapy (median CD4+ T-cell count of 573 and viral load of 49 copies/ml) and seven HIV-uninfected controls. Lindqvist first demonstrated that Tfh cells with the profile outlined by Vinuesa (displaying CXCR5 and PD-1, expressing Bcl-6 and producing IL-21) were present in lymph node samples from participants at a frequency that was 100-fold higher than that measured in peripheral blood.

Comparing the different study cohorts, Lindqvist found that Tfh cells were significantly expanded in untreated HIV infection compared to controls. Gag-specific Tfh cells were found to be a component of this expansion, as the magnitude of such responses was two-fold higher in untreated vs. treated infection. Tfh responses to gp120 were also measured, but were around five times lower than those to Gag. Additional analyses revealed correlations between Tfh expansion and the B-cell dysregulation that has been described in progressive HIV infection (Nat. Rev. Immunol. 9, 235, 2009). Specifically, increased Tfh numbers in untreated HIV infection correlated with an increase in plasma cells and loss of memory B cells in lymph nodes, along with the hypersecretion of IgG antibodies (hypergammaglobulinemia). Lindqvist noted that B-cell dysregulation in HIV had been thought to be a consequence of compromised CD4+ T-cell help. Her data indicate, however, that it is driven by an abnormal expansion of Tfh cells.

Learning from the living

Researchers are learning more about what drives protective immune responses to HIV-like retroviruses by studying, in nonhuman primates, the effects of live attenuated vaccines (LAVs) made from weakened strains of simian immunodeficiency virus (SIV). Such experimental vaccines provide macaques with the most robust protection obtained against SIV. Although preventive LAVs against HIV are generally considered too risky for use in humans, the field has placed a high priority on understanding why precisely they work so well in experimental models and applying that information to improve the design of HIV vaccines.

Yoshinori Fukazawa, a postdoctoral researcher at the Oregon Health & Science University’s Vaccine and Gene Therapy Institute, presented new data at CROI that described the strongest correlates of LAV protection obtained so far.Fukazawa’s experiment evaluated five different LAVs with six macaques in each vaccine group and six unimmunized controls. Challenge was performed intravenously with SIVmac239 at week 50 after LAV inoculation. The extent of protection achieved was diverse, with only SIVmac239?nef and SIVmac239?3 offering complete protection, which Fukazawa primarily defined as no—or only transient—replication of the challenge virus, and no depletion of mucosal CD4+ T cells.

Eleven different immunological parameters were assessed as potential correlates of immunity, including ADCC, neutralizing antibodies and SIV-specific T-cell responses (both CD4+ and CD8+) in blood, lymph nodes and lung. Highly significant correlations with protection were only observed for SIV-specific CD4+ and CD8+ T-cell responses measured by intracellular cytokine staining (ICS) in the lymph nodes (p=0.0036 and p=0.0070, respectively), after Bonferroni corrected for multiple comparisons. The T cells displayed an effector memory phenotype. Using an assay designed to measure the ability of SIV-specific CD8+ T cells to suppress viral replication in autologous infected CD4+ T cells, Fukazawa also found differences between protected and non-protected animals. But these were only statistically significant for SIV-specific CD8+ T cells sampled from lymph nodes, not from blood.

The subject of Tfh cells cropped up again in Fukazawa’s talk, when he produced evidence suggesting that LAVs preferentially replicate in that population. Furthermore, the amount of LAV RNA in lymph nodes correlated significantly with the magnitude of the SIV-specific CD4+ and CD8+ T-cell responses at the site. Fukazawa concluded that ongoing LAV replication is probably essential to maintaining protective effector memory T-cell responses in lymph nodes. This suggests that persistent vaccine vectors will in all likelihood be required to induce and maintain this type of immunity in humans.

Molecular warfare

Researchers continue to study HIV’s ancestral tree to better understand the emergence of viral defense mechanisms. The tussle between viruses and hostile host environments leads to an “evolutionary arms race” that has shaped the evolution of HIV.

It has, for one thing, spurred the selection of several HIV-1 proteins to counteract the effects of defensive host cell proteins—restriction factors—that curtail viral replication. The latest restriction factor identified is a cellular protein named SAMHD1, which limits the ability of HIV-1 to replicate in dendritic cells (DCs) and monocytes by depleting the nucleotide components the virus needs to assemble new virions (Nat. Immunol. 13, 223, 2012). Some members of the lentivirus family to which HIV belongs possess a protein, Vpx, which has the ability to degrade SAMHD1, allowing these viruses—including HIV-2 and its simian virus precursors—to infect dendritic cells and monocytes.

Olivier Fregoso, a postdoctoral fellow in the laboratory of Michael Emerman at the Fred Hutchinson Cancer Research Center in Seattle, described his efforts to ascertain whether the ability to degrade SAMHD1 is a function that HIV-1 has lost, or one that its viral relatives have gained. The question is not merely academic: understanding the emergence of adaptations can shed light on hidden vulnerabilities that emerge at various points in the viral life cycle.

Fregoso showed that the ability to degrade SAMHD1 was acquired initially by Vpr in a lineage of lentiviruses distinct from the one out of which HIV-1 evolved. The Vpr protein in this lineage subsequently evolved into Vpx, a protein specializing in the degradation of SAMHD1. HIV-1, it would appear, has not evolved to avoid infecting DCs and monocytes, as was suggested when SAMHD1 was first identified. Rather, Fregoso’s group believes that HIV-1’s greater pathogenicity compared to HIV-2 could be related to its inability to infect these cell types (Cell Host Microbe 11, 194, 2012).

Two restriction factors were discovered prior to SAMHD1. One was APOBEC3G, a cellular protein with antiretroviral activity that is degraded by the HIV-1 protein Vif, the other, tetherin, which limits viral replication by tethering virions to the cell and preventing their dissemination. Tetherin is counteracted by the HIV-1 protein Vpu. APOBEC3G, meanwhile, belongs to a family of APOBEC3 proteins (designated A, B C, DE, F, G and H). Emerman showed evidence that the selection of a version of APOBEC3DE with increased antiviral activity occurred in response to a virus that infected chimpanzees around 2.5 million years ago (J. Virol.85, 11361, 2011). The human version lacks similar activity because the virus-driven change occurred after the evolutionary branches of humans and chimpanzees diverged.

Tetherin, too, provides a striking example of the impact of viral adaptation. In chimpanzee SIV (SIVcpz), the precursor to HIV-1, the antiviral effect of tetherin is blocked by the Nef protein. But the specific site on tetherin that SIVcpz Nef binds doesn’t exist in the human version of the protein. HIV-1 group M, the strain primarily responsible for the worldwide pandemic, overcame this obstacle by adapting and deploying the Vpu protein to subvert tetherin. The far rarer HIV-1 group O did not; and in group N viruses the anti-tetherin activity of Vpu is far less consistent. HIV-1 group M’s arms race against tetherin has, in a sense, helped shape human history (J. Virol. 84, 7124, 2010).

Sticking to PrEP

As it did last year, and the year before, ARV-based prevention dominated discussion at CROI. In particular, attendees sought to mine the implications of fresh data from a number of pre-exposure prophylaxis (PrEP) studies that suggest PrEP may be significantly less feasible in some high-risk populations than had been hoped.

“The reality doesn’t necessarily match the vision,” said Jared Baeten, a University of Washington associate professor of global health and a co-investigator in the Partners PrEP study, which found high efficacy in serodiscordant couples. “We have four completed PrEP trials that demonstrate efficacy, but we have two trials in women with high incidence where the entire study or individual arms have demonstrated futility.”

One of them was FEM-PrEP, which enrolled nearly 2,000 high-risk heterosexual women from Kenya, South Africa, and Tanzania. The study was discontinued in March, 2011, after a data safety monitoring board determined it was unlikely to establish whether or not daily oral administration of Truvada—a combination of the ARVs tenofovir (TDF) and emtricitabine (FTC)—is effective in reducing HIV acquisition (see Vaccine Briefs, IAVI Report, Mar.-Apr. 2011).

Lut Van Damme, the trial’s principal investigator, presented a final analysis of the trial data that suggests inadequate adherence to the prescribed drug regimen may have undermined the trial, which tallied 33 infections in its Truvada arm and 35 in its placebo arm. Analyses of the blood plasma collected during the trial from the 33 women in the Truvada arm who acquired HIV and about 99 matched uninfected controls found detectable levels of TDF in fewer than half of the samples. Notably, this contrasted with the 86% adherence rate suggested by the weekly pill counts—the number of pills dispensed minus those returned—as well as the claims of 95% of the volunteers who said they had taken the drug diligently. Van Damme noted that these data raise questions about the value of pill counts in measuring adherence, not to mention what became of the pills that were neither taken nor returned.

Van Damme also reported that there were 74 pregnancies (11%) in the Truvada group compared to 51 (7.5%) in the placebo arm of the study, which means that women in the Truvada group spent more time off PrEP because it had to be stopped due to safety concerns. Van Damme noted that pregnancy rates in the trial were highest among oral contraceptive users, which, she suggested, reflected a “problem with daily pill taking.”

Follow-up studies of the Partners PrEP trial underscore the importance of adherence as well. That study, which enrolled 4,758 heterosexual serodiscordant couples in Kenya and Uganda, revealed in 2011 that a daily dose of TDF reduced the risk of HIV infection by 62%, and a similar regimen of Truvada cut that risk by as much as 73% in the study population. Recent findings presented by Deborah Donnell, principal investigator of the HIV Prevention Trials Network and a statistician in the Partners PrEP study, indicate that individuals who remained HIV uninfected in the TDF and Truvada arms had detectable levels of the drug on 83% and 81% of their study visits, respectively. Drug levels were much lower in the 29 participants in both arms of the trial who acquired HIV. Only about a third of them had detectable levels of TDF when investigators first identified HIV antibodies in their blood plasma. “Even in visits prior to seroconversion, these people were not taking their drug as often as those who did not seroconvert,” Donnell said.

Yet adherence does not always predict PrEP efficacy. In her sub-analysis, Donnell noted that nine of the HIV-infected participants who had been assigned to either the TDF or Truvada arms did have detectable levels of TDF. Eight of them had drug levels that were consistently high or detectable throughout the follow-up—an indication the drug was being taken faithfully. “Of course, we don’t know what the level of the drug was at the time they got HIV infected,” said Donnell.

Baeten said that while adherence is arguably the primary determinant of PrEP efficacy, there are important hypotheses to consider about how biologic factors may diminish protection. He said pharmacokinetic studies have found that oral TDF achieves 10-fold or higher concentrations in rectal tissue compared to vaginal tissue, suggesting that PrEP may be more sensitive to non-adherence in women whose primary risk exposure is through vaginal sex, compared with men who have sex with men. He said sexually transmitted infections, genital inflammation and other factors that might increase the risk of HIV acquisition among high-risk heterosexual women could be interacting with PrEP to decrease its efficacy. “Research needs to assess whether this hypothesis can be supported,” he said.

Richard Jefferys is Coordinator, Michael Palm Basic Science, Vaccines & Prevention Project at the Treatment Action Group.

Study Addresses Long-standing Debate about Funding Imbalances for Global Diseases

Deerfield, Ill. (May 2, 2012) — While the battle against HIV/AIDS attracts more donor funding globally than all other diseases combined, it has not diverted attention from fighting unrelated afflictions — such as malaria, measles and malnutrition — and may be improving health services overall in targeted countries, according to a study on Rwanda published today in the May 2012 edition of the American Journal of Tropical Medicine and Hygiene.

A six-year investigation of health clinics in Rwanda by researchers at Brandeis University infuses fresh evidence into a long-standing debate about whether the intensive focus on HIV/AIDS, which in 2010 alone killed 1.8 million people, is undermining other health services, particularly in African countries that are at the epicenter of the pandemic. For example, between 2002 and 2006, one-third of funds from wealthy countries earmarked for health and population programs abroad were committed to fighting HIV/AIDS.

“We found that when health clinics in Rwanda expanded AIDS services, these efforts had no adverse effects on other types of health care,” said Donald S. Shepard, PhD, a professor at Brandeis’ Schneider Institute for Health Policy and the study’s lead author. “There is even evidence that clinics that have received funding for HIV/AIDS services provide better care for all patients, including superior prevention services, than do clinics without AIDS programs.”

Shepard and his colleagues note that their study differs from past efforts to analyze the issue because their investigation focused on the actual performance of health centers rather than on “inputs” such as overall spending on facilities or staff. For example, for the Rwanda study, the researchers collected data on the number of vaccines administered, visits for child growth monitoring, and non-HIV/AIDS hospitalizations. 

They concluded that “for most indicators examined, there were neither prominent diversions nor enhancement effects” after AIDS services were inaugurated in the health centers. However, there was evidence that the health centers that offered AIDS services provided better preventive care than those that did not, including superior delivery of childhood vaccinations. 

For several years advocates for childhood immunization, tuberculosis control and those seeking a general improvement in health services in poor countries have expressed concern that HIV/AIDS prevention and care activities are crowding out other deserving public health programs. Meanwhile, on the opposite side are advocates who argue that the sharp increase in HIV/AIDS funding is a rising tide that lifts all boats, bringing improvements in such areas as laboratories, disease surveillance, human resources, and information systems that generate broad benefits across the health care system.

The authors noted that this study was designed to answer concerns, such as in the Bulletin of the World Health Organization in 2006 aboutHIV funding “crowding out resources,” for the many other health issues in the world’s poorest people. The debate has become more heated since 2008 when the economic crisis squeezed public spending in industrialized countries, thus intensifying competition for international aid among a number of worthy causes.

Shepard and his colleagues, including researchers from the public policy consulting firm Abt Associates, explored the issue by comparing the state of treatment and prevention services at 25 rural health centers in Rwanda that launched comprehensive HIV/AIDS interventions between 2002 and 2006 to 25 centers that did not engage in these activities.

They noted that Rwanda is a particularly good location to consider the impact of HIV/AIDS funding on health services because the country has received a substantial investment from international donors to address the disease, and its experience has been used to support both sides of the debate regarding the impact of AIDS spending.  In 1996, the HIV infection rate in Rwanda was 6.9 percent among the rural population; the latest data show a 2.3 percent prevalence of disease in rural populations and 95 percent coverage of anti-retroviral treatment.

“Rwanda’s progress against HIV/AIDS has not come at the expense of addressing other health needs,” Shepard added. “While the differences between the health centers was not large, we did find indications that the AIDS funding may be having spill-over effect in terms of improving overall quality of care,” Shepard said. For example, Shepard and his colleagues speculate that by simultaneously providing AIDS services along with a variety of other family health care interventions, the clinics that offer AIDS treatment may have more encounters with children who would otherwise miss their vaccinations.

The researchers were not able to measure other ways in which the AIDS funding could have benefited health services overall by, for example, streamlining drug procurement or improving information systems. They also acknowledge that the central finding—that the AIDS funding did not have a negative effect on non-AIDS health services—could be attributed to the fact that Rwanda has done an exceptional job of integrating AIDS services into the national health system.

However, they note that the experience in Rwanda adds to a growing body of evidence from several countries that AIDS-related funding is not adversely affecting non-AIDS services. For example, a study from Ethiopia found that while the increase in AIDS funding might have encouraged health professionals from the public sector to take positions with non-governmental organizations, mortality rates nationwide nonetheless dropped, immunization rates increased, and pre-natal care improved.

“What is at the heart of this research is that the science community is unified by its commitment to improved health for all,” said James W. Kazura, MD, President of the American Society of Tropical Medicine and Hygiene, which publishes the journal, and Director of the Center for Global Health and Diseases at Case Western Reserve University. “To reach that goal, evaluating the effectiveness of all our disease control efforts will help policymakers to make appropriate, evidence-based decisions.”

For more information click this link: http://www.ajtmh.org/content/86/5/902.full  ]]> http://afejnews.org/?feed=rss2&p=770 0 http://afejnews.org/?p=749 http://afejnews.org/?p=749#comments Fri, 27 Apr 2012 10:36:15 +0000 daud http://afejnews.org/?p=749 By Andualem Sisay, Rakai, Uganda

Sitting on an old mattress in front of a small house in Kimukunda village in the Rakai District of southernUganda, Teddy Nakawoeisi, 60, is waiting for her grandchildren to bring home something for supper. Between the ages of 4 and 8 years, they are at a nearby farm — working as daily labourers.

The house she now shares with her five grandchildren and one daughter was built for her by community members after she lost another daughter and the father of three of the children a few years ago. They died from what she calls “a strange disease.” Two other children were dumped on her by a drug-addicted son who is now inKampala, the capital.

While waiting for the children, Ms. Nakawoeisi is busy attending to her daughter, who has been in bed for a long time because of the same strange disease. “I didn’t mean to be cruel to the children,” she says in Luganda, the local language, in explaining their farm work. “But as you can see, I am weak and have to take care of her at home.”

Here in Rakai, whereUganda’s first AIDS case was reported in the early 1980s, it is common to see children engaged in intensive labour activities. The children seem to have no other option to sustain themselves and their elderly family members.

According to the Ugandan Bureau of Statistics (UBOS), in 2006 there were about 1.8 million children involved in child labour. According to UBOS and the International Labour Organization (ILO), these children primarily work in agriculture, fishing, transport, mining, construction, the urban informal sector, domestic service and commercial sex exploitation.

Nowhere to turn

In Rakai District, children who lost their parents to AIDS or who struck out on their own for other reasons are mostly engaged in farming. They often load heavy bunches ofmatookes (green bananas) on trucks for the export market or work on farms, as do Ms. Nakawoeisi’s grandchildren.

“A child who does not go to school has no future,” says Alex Bagarukayo, acting labour officer in Rakai District. Meanwhile, grandparents who used to rely on their children for their daily needs now have nowhere to turn except their grandchildren.

According to an ILO-sponsored report by Bill Rau, “HIV/AIDS and Child Labour,” the pandemic has been one of several major factors contributing to child labour since the mid-1990s, based on research inSouth Africa,Tanzania,ZambiaandZimbabwe. And HIV/AIDS and child labour will likely remain closely linked during the first decades of this century.

Supporting communities

To break such links, research has shown, interventions are needed to help these orphans and their close relatives, with the goal of keeping the children in school, protecting their legal and human rights and meeting their emotional needs.

Several non-governmental organizations (NGOs) inUgandaare working with community groups to reduce the reliance of families on their children and to save the children from the likely negative impact of child labour on their development.

Since 2010, some 8,100 children have been taken out of child labour — or prevented from getting involved in the first place — in three districts (Rakai, Wakiso and Mbale), according to Rural Development Media and Communications, one of the partnering organizations.

“I can say that we have achieved significant change for the better,” says Kalamagi Yakub, a programme officer for the Rakai Counselors’ Association, another NGO engaged in the programme. Among other things, the association provides children with school uniforms and exercise books, introduces income-generating projects for households and educates local leaders and the community about the harmfulness of child labour exploitation.

According to Jackie Banya, a senior programme officer with the ILO’sUgandaoffice, such interventions have strengthened communities’ ability to address the needs of its vulnerable members. They also have “enhanced local government’s capacity for combating child labour,” he says, by helping them to raise awareness, provide training and enforce laws against child labour.

Sustainability

The ILO programme inUgandais just a pilot project, with no plans at this point for replicating it. However, Mr. Banya says, as with any pilot project, the “best achievements will be shared with key stakeholders. It is our hope that the government will take the lead in replicating it in other districts of the country.”

Many agree that for a country likeUganda— which had 1.7 million AIDS orphans in 2010 — such small-scale interventions fall well short of the needs.

To sustain activities to abolish child labour and to support the families of the victims of AIDS, the government “has to fund the non-governmental organizations that are working with the community,” argues Timothy Mbaziira, chairperson of theLocalCouncilIIISub-county. He notes that so far the NGOs and the local communities have been funding such activities out of their own pockets.

There is still a long way to go to fully support Ms. Nakawoeisi and other weak grandparents, get all child labourers back to school and rescueUganda’s many other “collateral victims” of AIDS.

AfricaRenewal www.un.org/africarenewal