An estimated 50 million women in Asia are at risk of becoming infected with HIV from their intimate partners. Evidence from many Asian countries indicates that these women are either married or in long-term relationships with men who engage in high-risk sexual behaviours. These findings are published in a new report by UNAIDS, its Cosponsors and civil society partners entitled HIV Transmission in Intimate Partner Relationships in Asia, being released today at the 9th International Congress on AIDS in Asia and the Pacific in Bali.

The HIV epidemics in Asia vary between countries in the region, but are fuelled by unprotected paid sex, the sharing of contaminated injecting equipment by injecting drug users, and unprotected sex among men who have sex with men. Men who buy sex constitute the largest infected population group - and most of them are either married or will get married. This puts a significant number of women, often perceived as 'low-risk' because they only have sex with their husbands or long-term partners, at risk of HIV infection.

It is estimated that more than 90% of the 1.7 million women living with HIV in Asia became infected from their husbands or partners while in long-term relationships. By 2008, women constituted 35% of all adult HIV infections in Asia, up from 17% in 1990.

"HIV prevention programmes focused on the female partners of men with high-risk behaviours still have not found a place in national HIV plans and priorities in Asian countries" said Dr Prasada Rao, Director, UNAIDS Regional Support Team Asia and the Pacific, speaking at the launch of the report. "Integration of reproductive health programmes with AIDS programmes and the delivery of joint services to rural and semi-urban women are the key to reducing HIV transmission among intimate partners."

In Cambodia, India and Thailand, the largest number of new HIV infections occur among married women. In Indonesia, where HIV was initially concentrated among drug users, the virus is now spreading quickly into sex work networks, including long-term partners and sex workers. Research from several Asian countries indicates that between 15% and 65% of women experience physical and/or sexual violence in intimate partner relationships, placing them at increased risk of HIV infection. According to studies in Bangladesh, India and Nepal, women exposed to intimate partner violence from husbands infected with HIV through unprotected sex with multiple partners were seven times more likely to acquire HIV compared to women not exposed to violence and whose husband did not have sex with multiple partners.

The strong patriarchal culture in Asian countries severely limits a woman's ability to negotiate sex in intimate partner relationships, according to the report. While there is a societal toleration of extramarital sex and multiple partners for men, women are generally expected to refrain sex until marriage and remain monogamous thereafter.

"Discrimination and violence against women and girls, endemic to our social fabric, are both the cause and consequence of AIDS," said Dr Jean D'Cunha, Regional Director, UNIFEM South Asia. "Striking at the root of gender inequalities and striving to transform male behaviours are key to effectively addressing the pandemic."

The report also indicates that the female partners of migrant workers have been shown to be at increased risk of HIV infection when the latter return from working in countries with high HIV prevalence. A study in Viet Nam showed that married migrant workers reported having commercial sex partners and low condom use.

To prevent HIV transmission among intimate partner relationships, the report outlines four key recommendations:

1. HIV prevention interventions must be scaled-up for men who have sex with men, injecting drug users, and clients of female sex workers and should emphasize the importance of protecting their regular female partners.
2. Structural interventions should be initiated to address the needs of vulnerable women and their male sexual partners. This includes expanding reproductive health programmes to include services for male sexual health.
3. HIV prevention interventions among mobile populations and migrants must be scaled-up and include components to protect intimate partners.
4. Operational research must be conducted to obtain a better understanding of the dynamics of HIV transmission among intimate partners.

"The work that has been started around prevention of HIV transmission in intimate partner relationships is incredibly important because it means a new way of doing our work," said Vince Crisostomo, Regional Coordinator, Seven Sisters (Coalition of Asia Pacific Regional Networks on HIV/AIDS). "The ultimate goal is the empowerment of women and it shows that the responsibility is on both sides."

With news doing the rounds about some international companies being ready with H1N1 vaccines, India has asked these companies to involve it in their clinical trials. "About 10 days ago we had written to all four international companies that are preparing the vaccines to test the efficacy of the vaccine on our population," VM Katoch, director general of the Indian Council of Medical Research (ICMR), said. "We have also told them to keep us informed so we can move ahead with procuring the vaccines. We are expecting a reply early next week."

Dr Katoch added, however, that rushing to get the vaccines, without following procedure, may lead to serious public health issues. "A serious side effect of the influenza vaccine is paralysis. We cannot allow people to become crippled by merely trying to procure the vaccines in a hurry. They will also be tested in India only after a certification by the Drug Controller General of India (DGCI) and subsequently procured in bulk or allowed in the open market," Dr Katoch said.

While health ministry officials said it was not possible to immunise the entire population of India, minister Ghulam Nabi Azad said the first batch of vaccines will be procured for doctors and paramedical staff who are in direct touch with H1N1 patients."We will procure the first batch of vaccines only for them at whatever cost," Azad said.

Meanwhile, the three Indian companies working to produce the vaccine have completed their first phase of animal trials. The vaccines produced by them are expected to be available by January.

Polycystic ovary syndrome, a common condition among women, can be relieved by the use of acupuncture and exercise. This has been shown by a recent study at the Sahlgrenska Academy, University of Gothenburg, Sweden.

Nearly 10% of women of reproductive age have polycystic ovary syndrome (PCOS). The syndrome expresses itself as a large number of small immature cysts on the ovaries that cause a disturbance in the production of hormones and an increase in the secretion of the male sex hormone. This means that many women with the condition do not ovulate normally, and the syndrome may lead to infertility. The women run an increased risk of becoming obese, developing type 2 diabetes, or developing cardio-vascular disease.

"We do not know for certain what causes the condition, despite it being so common. We have seen that women with the syndrome often have high activity in that part of the nervous system that we cannot consciously control, known as the "sympathetic nervous system". We believe that this may be an important underlying factor in the syndrome", says Elisabet Stener-Victorin, who has led the research at the Sahlgrenska Academy.

During the study, one group of women with polycystic ovary syndrome received acupuncture regularly for four months. They received a type of acupuncture known as "electro-acupuncture", in which the needles are stimulated with a weak low-frequency electric current, similar to that developed during muscular work. A second group of women were provided with heart rate monitors and instructed to exercise at least three times a week. A control group was informed about the importance of exercise and a healthy diet, but was given no other specific instructions.

The study showed that activity in the sympathetic nervous system was lower in the women who received acupuncture and in those who took regular exercise than it was in the control group. The acupuncture treatment brought further benefits.

"Those who received acupuncture found that their menstruation became more normal. We could also see that their levels of testosterone became significantly lower, and this is an important observation, since elevated testosterone levels are closely connected with the increased activity in the sympathetic nervous system of women", says Elisabet Stener-Victorin

While the first batch of swine flu vaccine goes to Britain and countries such as the US have already booked to receive it, India has not taken any action to even place an order.

Despite the swine flu toll reaching 90, Indian health authorities have failed to move fast enough although it may not have its indigenous vaccine ready before May 2010.

While huge quantities - 195 million and 90 million doses respectively are going to the US and UK - India is still miles from getting vaccines because the government has not entered into any pre-booking contracts with Novartis, GlaxoSmithKline or any other domestic manufacturers.
The first batch of H1N1 vaccine rolled out from Baxter Inc labs on Friday for Britain.

China has 20-odd companies racing to make the vaccine, with Sinovac Biotech perhaps being the first company worldwide to complete clinical trials for swine flu vaccine.

The World Health Organization (WHO) said recently that countries in the northern hemisphere had ordered more than a billion doses, sparking warnings of shortages.

Developing a vaccine is the only way to protect people from the disease, which may become severe with the onset of winter and the dire possibility of the H1N1 virus mutating.

UK scientists have discovered a new route to a potential cure for breast cancer, one that focuses on how the cancer manipulates genetic pathways to spread through the body, rather than on how tumors develop in the first place. They are already working on a new drug to switch off the cancer's effect on the pathways and say it could be ready in a couple of years, but experts suggest this could be rather optimistic.

The landmark study was the work Dr Justin Stebbing of Imperial College London (ICL) and other colleagues from ICL and also from the Howard Hughes Medical Institute, Cold Spring Harbor Laboratory in New York, USA. They have written a paper on it in the 24 August online before print issue of the Proceedings of the National Academy of Sciences, PNAS.

Stebbing, who is senior lecturer and consultant medical oncologist at ICL was reported by the Daily Express as telling the media that the new discovery was a "step on the way" to a potential cure for breast cancer.

"It helps us understand the way breast cancer cells grow and divide and if we understand this then we understand how to stop it," said Stebbing.

Breast cancer is the most common cancer of women in the western world, in Britain alone it kills 12,000 women a year.

In most cases the cancer depends on estrogen to fuel tumor growth, and current treatments focus on inhibiting the activity of the estrogen receptor. These treatments, for example tamoxifen, have been very successful at reducing deaths from breast cancer.

"The estrogen receptor is incredibly important in breast cancer," said Stebbing.

"Most of the treatments around treating breast cancer are blocking it or inhibiting the oestrogen but despite that about half of all women relapse," he added.

Many patients relapse because they eventually become resistant to hormone therapies.

Cancer is essentially a process where cell growth gets out of control. One of the ways that healthy cells stop growth getting out of control is via microRNA molecules that use genetic pathways to control various cellular processes in the body, such as making proteins.

As Stebbing explained:

"The way to cure breast cancer or any cancer is by fundamental biological understanding of what turns cells on and off, stopping the way tumours grow."

Stebbing and colleagues' breakthrough has been to discover how cancer cells switch off the microRNA molecules that control cell division to unleash the growth and proliferation of malignant cells.

"We can use these microRNAs as a new treatment and make them do what current drugs don't do," said Stebbing.

He said they had found a new microRNA pathway that the estrogen receptor activates. In normal cells estrogen encourages the production of microRNAs, but then as more of them are produced, they switch off estrogen activity, and this keeps cell division under control. Stebbing described this as a "perfect circle".

"But in breast cancer cells, production of the molecules is turned off," said Stebbing, and this is how the control over cell division is then lost and the malignant cells proliferate.

So their aim is to produce a drug that restores the "perfect circle" by stopping the deactivation of the microRNAs.

"If we know how to stop it then we can cure it. This only applies in oestrogen positive breast cancer but this could save millions of lives," said Stebbing.

Experts welcomed the discovery but had reservations about a drug being available soon.