Health
Mistakes in handling HIV/AIDS pandemic could hinder monkeypox response, advocates say – CBC News
Top health officials say they are trying to limit the spread of the monkeypox virus while also preventing stigma against those most affected — particularly gay, bisexual and other men who have sex with men — but their messaging may be a part of the problem, according to some advocates.
More than 21,000 people, in over 70 countries, have contracted the virus, which causes painful sores and blisters among other symptoms. An estimated 98 per cent of confirmed cases are in men who have sex with men.
This week, the head of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, warned stigma “can be as dangerous as any virus and can fuel the outbreak.” At the same time, he urged men who have sex with men to reduce their number of sexual partners or to reconsider having new sexual partners “for the moment.”
The Public Health Agency of Canada (PHAC), which has reported at least 745 cases since the first two cases were detected in late May, also urged men who have sex with men to limit sexual partners, especially casual acquaintances.
“I think when we try to tell people ‘Stop doing this. Stop doing that,’ it doesn’t really work,” Devan Nambiar of the Gay Men’s Sexual Health Alliance in Toronto told CBC News. “It hasn’t worked in any infection.”
It is important to make people aware of the risk factors so they can make informed decisions, and to be compassionate and concise in the messaging, he said, but not to stigmatise people for their sexual activity and behaviour – something gay men, in particular, have endured since the early years of the HIV/AIDS pandemic when the illness was widely considered a “gay disease.”
Lessons learned from that era have been applied to public health care today, but there are criticisms that history is repeating itself with the handling of the monkeypox outbreak.
Some advocates attending the International AIDS Conference (AIDS 2022) in Montreal from July 29 – Aug. 2 say health officials need to prevent the perception that a viral threat, like HIV/AIDS or monkeypox, only affects one portion of the population.
“[We] lived that with the HIV epidemic. We certainly saw that with COVID-19. Let’s not do it with monkeypox, right?” said Linda-Gail Bekker, deputy director of the Desmond Tutu HIV Centre at the University of Cape Town’s Institute of Infectious Disease and Molecular Medicine in South Africa and a past president of the International AIDS Society, which organized the AIDS 2022 gathering.
Engagement key to combating health threats
The conference returns to Montreal for the first time since 1989, a time when access was limited to drugs that could prolong the lives of people infected with HIV. The majority of those dying from AIDS at that time were gay, bisexual and other men who have sex with men, transgender women, as well as injection drug users.
As monkeypox cases spread worldwide, overwhelmingly among men who have sex with men, there is growing concern that public health messages targeting that community have missed the mark.
The monkeypox virus, however, is not a sexually transmitted infection like HIV, the virus that causes AIDS; it’s transmitted through close personal contact with someone who is infected, but also through direct contact with materials that have touched the bodily fluids or sores of an infected person, such as bed sheets or clothing.
Bekker believes that without proper communication and engagement with affected groups — whether it concerns HIV/AIDS or monkeypox — there is a risk of discrimination that may lead to people not seeking or being able to access the services they need.
Gay men take health into their own hands
Nambiar, who will also be attending the AIDS 2022 conference which begins Friday, said gay and bisexual men have long been their own health-care advocates, having to “figure a lot of things out for ourselves” because of “indifference” to the LGBTQ community.
“We have led the work in many things actually, in terms of getting self checks, taking [on] advocacy, taking autonomy in terms of our well-being, fighting for our rights,” he told CBC News.
With monkeypox, he said, gay and bisexual men have been speaking up loudly since early on, calling for paid leave so they can properly quarantine, and to demand access to testing and vaccines.
He said it’s an individual decision to get vaccinated to protect against monkeypox, something about 27,000 eligible people have done so far in Canada, according to PHAC.
Some public health authorities have set up pop-up vaccination clinics at locations frequented by men who have sex with men, including gay bars, bathhouses and cruising areas. The response to monkeypox has been “pretty decent” in Canada, Nambiar said, though he can’t say the same for other countries.
In the U.S., which now has the highest number of recorded cases of monkeypox, the response to the outbreak has been criticized. One AIDS advocate compared the U.S. government’s initial response to monkeypox to their handling of the COVID-19 pandemic, when the country led the world in deaths and less than 70 per cent of the population is fully vaccinated.
The Current20:50Dr. Anthony Fauci on the lessons learned from COVID-19, HIV/AIDS and monkeypox
We talk to Dr. Anthony Fauci about the COVID-19 pandemic, the lessons he learned from the fight against HIV/AIDS, and what the world needs to do to get rising monkeypox cases under control.
HIV/AIDS overshadowed by converging threats
As fears grow over monkeypox, and with COVID-19 case numbers again rising, health professionals gathering in Montreal worry about whether the world will be able to meet the UN’s 2030 target to end HIV/AIDS as a global health concern.
There were an estimated 38.4 million people living with HIV/AIDS globally in 2021, with approximately 1.5 million new HIV infections last year. The United Nations said that is a million cases higher than global targets and a sign of “faltering progress.”
This week, at the launch of a new UNAIDS report titled In Danger, UNAIDS Executive Director Winnie Byanyima warned “the response to the AIDS pandemic has been derailed by global crises,” including the war in Ukraine and international economic instability.
“The actions needed to end AIDS are also key for overcoming other pandemics,” she said.
Over the four days of the AIDS 2022 conference, there will be a push to “counter apathy” in combating HIV/AIDS globally and a call “to re-engage and follow the science.”
“Some of this is going on the offensive,” said Bekker, noting there is an additional challenge with the polarization around science that has emerged in the COVID-19 pandemic.
Nambiar said some of that apathy towards HIV/AIDS comes from being “inundated with viruses,” with the mutated variants and subvariants of COVID-19, and now monkeypox.
But he said one of the important lessons that has been learned over the years, that certainly applies today, is that a successful response to a public health emergency requires cooperation between governments, public health workers and community organizations. That didn’t happen immediately with HIV/AIDS, but he sees it developing now in response to monkeypox.
Though there have been remarkable achievements in the last four decades to prevent the transmission of HIV and allow people to live with the infections as a chronic illness, Bekker wants to remind people that doesn’t mean the HIV/AIDS pandemic is over.
“I would say we’ve got the hardest mile to come,” she told CBC News. “We really do need to gird our loins, pull ourselves together as a community and say, ‘What can we do to reach that last mile?'”
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Early this year, Equatorial Guinea and Tanzania reported outbreaks of Marburg virus disease (MVD), the first-ever outbreak of the disease in these countries. As the countries respond to the outbreaks through contact tracing and restricting movement across affected regions, the World Health Organization (WHO) estimated the risk of spread of the disease as “very high” across both countries.
The Marburg virus was first identified in 1967 during outbreaks in Germany and Serbia and is known to cause severe and fatal viral haemorrhagic fevers in humans.
The virus is closely related to another deadly virus, Ebola and is rated as a high-risk pathogen by the WHO. Marburg virus is transmitted to humans through contact with infected animals such as fruit bats, and further human-to-human transmission can occur through direct contact with the bodily fluids of an infected patient or contaminated surfaces resulting in outbreaks.
Since its initial detection in 1967, several outbreaks of Marburg virus have been detected between 1975 and 2023, with African countries being the most affected and often with high fatality rates up to 90%, depending on the early access to quality care.
In recent years, and for the first time, isolated cases have been reported in Guinea and Ghana in 2021 and 2022, respectively.
New outbreaks
An outbreak of unknown haemorrhagic fever linked to a funeral ceremony was reported from Equatorial Guinea on February 7, 2023, which was later confirmed as Marburg virus on February 13 by the WHO. A month later, Tanzania reported an outbreak of MVD on March 21, after the detection of eight suspected cases, five of which were fatal. The genome sequence of a Marburg virus from Equatorial Guinea was quickly made available in public domain by researchers. The sequence shows high similarity with Marburg virus genomes previously found in fruit bats, suggesting a potential zoonotic origin.
Is there a concern?
There are no approved vaccines, antivirals or monoclonal antibodies for Marburg virus yet and supportive care to manage symptoms and prevent complications forms the mainstay. However, the WHO aims to accelerate trials of some investigational vaccines. Case detection through contact tracing, molecular diagnosis and quarantine is central to managing the spread of the disease.
While the two outbreaks have triggered a rapid res- ponse to control the spread, the outbreak in Equatorial Guinea has spread to multiple provinces and has even crept into a populous city, Bata. Equatorial Guinea has, so far, reported a total of 35 con- firmed cases and 27 deaths. The large geographic spread of the infection in the country and the unidentified epidemi- ological links between many of the reported cases suggest a wider range of transmission of the virus.
The large geographic spread of the infection in the country and the unidentified epidemiological links between many of the reported cases suggest a wider range of transmission of the virus.
Surveillance
As the affected countries continue to make efforts to contain the disease and another country, Burundi, investigates a suspected outbreak of viral haemorrhagic fever, surveillance of emerging viral diseases is crucial to help early detection, monitoring the circulation and evolution, and develop effective diagnostics, prevention and control measures.
It is only natural that the concept of One Health is increasingly taking centre-stage.
(The authors are researchers at the CSIR Institute of Genomics and Integrative Biology, New Delhi. All opinions expressed are personal)
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A new Canadian study of 4.8 million people says a daily alcoholic drink isn’t likely to send anyone to an early grave, nor will it offer any of the health benefits touted by previous studies, even if it is organic red wine.
Low and moderate drinkers have similar mortality rates to those who abstain entirely, researchers from the Canadian Institute for Substance Use Research explain. On the other hand, women who enjoy more than one standard drink per day are at least 20 per cent likely to die prematurely.
“In this updated systematic review and meta-analysis, daily low or moderate alcohol intake was not significantly associated with all-cause mortality risk,” the study’s authors write, “while increased risk was evident at higher consumption levels, starting at lower levels for women than men.”
Published Friday in the medical journal JAMA Open Network, the study comes on the heels of a report by the Canadian Centre on Substance Use and Addiction (CCSA) that said Canadians should have no more than two alcoholic drinks per week in order to minimize the health risks associated with alcohol.
Lead researcher Dr. Jinhui Zhao and his co-authors wanted to better understand the link between alcohol and all-cause death, including theories advanced by previous studies that a small amount of alcohol can provide health benefits, and that “moderate drinkers” live longer and are less likely to die from heart disease than non-drinkers.
They reviewed 107 studies from between 1980 and 2021 involving 4.8 million people and found that consuming more than one standard drink per day raised the risk of premature death significantly, especially for women.
In Canada, a standard drink is defined as a 341-ml bottle of five per cent alcohol beer or cider, a 142-ml glass of 12 per cent alcohol wine or a 43-ml shot glass of 40 per cent alcohol spirits. Each standard drink contains 13.45 grams of pure alcohol.
“There was a significantly increased risk of all-cause mortality among female drinkers who drank 25 or more grams per day and among male drinkers who drank 45 or more grams per day,” the authors wrote. “Low-volume alcohol drinking was not associated with protection against death from all causes.”
When they looked at previous studies that suggest people who drink a little are less likely to die early or from heart disease than people who don’t drink at all, they found the evidence was skewed by systematic bias.
“For example, light and moderate drinkers are systematically healthier than current abstainers on a range of health indicators unlikely to be associated with alcohol use, (like) dental hygiene, exercise routines, diet, weight (and) income,” they wrote.
Meanwhile, abstainers may be statistically more likely to experience poorer health, since many have had to stop – or never started drinking in the first place – for health reasons. They also found most of the studies they reviewed overrepresented older white men in their data, failing to account for the experiences of women, racialized people and people from diverse socioeconomic backgrounds.
When Zhao and his colleagues adjusted the data to account for these variables, they couldn’t find any evidence that drinking a low or moderate amount of alcohol had any kind of positive effect on life expectancy or heart health.
“Our meta-analysis… found no significant protective associations of occasional or moderate drinking with all-cause mortality, and an increased risk of all-cause mortality for drinkers who drank 25 g or more,” the authors conclude.
“Future longitudinal studies in this field should attempt to minimize lifetime selection biases by not including former and occasional drinkers in the reference group, and by using younger cohorts more representative of drinkers in the general population at baseline.”
If you or someone you know is struggling with addiction or mental health matters, the following resources may be available to you:
- Hope for Wellness Helpline for Indigenous Peoples (English, French, Cree, Ojibway and Inuktitut): 1-855-242-3310
- Wellness Together Canada: 1-866-585-0445
- Drug Rehab Services: 1-877-254-3348
- SMART Recovery: meetings.smartrecovery.org/meetings/
- Families for Addiction Recovery: 1-855-377-6677
- Kids Help Phone: 1-800-668-6868
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Game creators at the University of Alberta (U of A) teamed up with their Japanese counterparts in hopes to get more people exercising and having fun in a virtual reality game called Slice Saber.
The U of A said in a recent news release that they’re looking at things like what it sounds like when someone slices through a watermelon with a lightsabre. And after it’s been sliced, what are the physics of the watermelon cut up?
The game is one of many available on Virtual Gym, an exercise platform still in development, where gamers of all ages can slip into a virtual reality headset and try climbing mountains, a wide range of stretching, balloon popping, shooting arrows, or yes, even slicing through fruit that is flying at you in real-time.
The game’s co-creator and computing science professor Eleni Stroulia shared Virtual Gym with counterparts at the Ritsumeikan University, which according to the Ritsumeikan Center for Game Studies website, is the only academic organization in Japan that offers the field of game studies.
“Our Japanese colleagues proposed to make Virtual Gym more enjoyable and motivating for younger adults, which is particularly relevant during the COVID-19 pandemic, where people can be stuck at home,” said Stroulia in the news release.
It’s not just sound that the team is looking to experiment with, either; they’re looking at visual effects as well as haptics, or touch effects, in the game.
Virtual Gym is being developed by a U of A computing science research team led by Stroulia and Victor Fernandez, a post-doctoral fellow in the computing science department. While it is designed to entice people to exercise, it’s also collecting game-play data which evaluates how the player is performing. It then tailors the game to their capabilities.
“In our case, we’re working with seniors who may not be able to go out to exercise, to give them an opportunity to maintain the flexibility, balance and level of activity that is good for avoiding frailty,” Stroulia said.
There is no date yet for when the platform will be released to the public.
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