Abuse of hiv/aids-relief funds in mozambique
Reﬂ ection and Reaction
of such variants in vivo might aﬀ ect sensitivity to other 4 Nagot N, Ouedraogo A, Foulongne V, et al. Reduction of HIV-1 RNA levels with
therapy to suppress herpes simplex virus. N Engl J Med
reverse transcriptase inhibitors used at present. Although 5 Zuckerman RA, Lucchetti A, Whittington WL, et al. Herpes simplex virus the evidence for HIV-1 reverse transcriptase evolution
(HSV) suppression with valacyclovir reduces rectal and blood plasma HIV-1 levels in HIV-1/HSV-2-seropositive men: a randomized, double-
in people treated with aciclovir in vivo has never been
blind, placebo-controlled crossover trial. J Infect Dis
reported, this possibility should be addressed.
Watson-Jones D, Weiss HA, Rusizoka M, et al. Eﬀ ect of herpes simplex suppression on incidence of HIV among women in Tanzania. N Engl J Med
We are convinced that, in view of the new data on
aciclovir suppression of HIV reverse transcriptase, new 7
Celum C, Wald A, Hughes J, et al. Eﬀ ect of aciclovir on HIV-1 acquisition in herpes simplex virus 2 seropositive women and men who have sex with
studies and new targeted clinical trials are needed to
men: a randomised, double-blind, placebo-controlled trial. Lancet
understand these newly discovered features of the 8 Lisco A, Vanpouille C. HSV-2 suppression and the incidence of HIV. interaction between HSV and HIV, and of the herpes-
N Engl J Med
Cohen J. AIDS research: promising prevention interventions perform
suppressive drugs in patients infected with HIV-1. Also,
poorly in trials. Science
acknowledgment of the necessity for such trials is a 10 Hudson
Eﬀ ect of aciclovir on HIV-1 acquisition in HSV-2-positive
rare point upon which both of the teams engaged in 11 Lisco A, Vanpouille C, Tchesnokov EP, et al. Acyclovir is activated into a this discussion in The Lancet Infectious Diseases
HIV-1 reverse transcriptase inhibitor in herpesvirus-infected human
tissues. Cell Host Microbe
12 McMahon MA, Siliciano JD, Lai J, et al. The antiherpetic drug acyclovir
*Andrea Lisco, Christophe Vanpouille, Leonid Margolis
inhibits HIV replication and selects the V75I reverse transcriptase
multidrug resistance mutation. J Biol Chem
Eunice Kennedy Shriver National Institute Of Child and Human
13 Amini H, Javan M, Gazerani P, Ghaﬀ ari A, Ahmadiani A. Lack of
Development, Program in Physical Biology, National Institutes of
bioequivalence between two aciclovir tablets in healthy subjects. Clin Drug Investig
14 Weller S, Blum MR, Doucette M, et al. Pharmacokinetics of the acyclovir
pro-drug valaciclovir after escalating single- and multiple-dose
We declare that we have no conﬂ icts of interest.
administration to normal volunteers. Clin Pharmacol Ther
Van de Perre P, Segondy M, Foulongne V, et al. Herpes simplex virus and
15 Gupta R, Wald A, Krantz E, et al. Valacyclovir and acyclovir for suppression
HIV-1: deciphering viral synergy. Lancet Infect Dis
of shedding of herpes simplex virus in the genital tract. J Infect Dis
Cheng RG, Nixon DF. Herpes simplex virus and HIV-1: deciphering viral
synergy. Lancet Infect Dis
16 Tchesnokov EP, Obikhod A, Massud I et al. Mechanisms associated with
Barbour JD, Sauer MM, Sharp ER, et al. HIV-1/HSV-2 co-infected adults in early
HIV-1 resistance to acyclovir by the V75I mutation in reverse
HIV-1 infection have elevated CD4+ T cell counts. PLoS ONE
transcriptase. J Biol Chem
Abuse of HIV/AIDS-relief funds in Mozambique
Before medical school I spent 3 years as a Peace Corps
The investment of over US$2284 million into
volunteer in Mozambique. A beautiful country ﬁ lled with Mozambique in 2008 alone—by the US President’s potential, Mozambique is at present in the epicentre of Emergency Plan for AIDS Relief—increased the inﬂ uence the AIDS epidemic. It also faces endemic AIDS-related of NGOs, the gatekeepers for much of that money. One corruption.
result has been an exponential increase in the number
Mozambique was one of the last African nations of people on antiretroviral drugs and an increase in HIV-
to win independence from colonialism. In 1975, prevention programmes. There is more money available the Portuguese ﬂ ed the country, and a new socialist for HIV/AIDS than can reasonably be spent, especially government took control. Peace was brief, because given Mozambique’s poor infrastructure and large Mozambique plunged into two decades of civil war geographical area. Unfortunately, one side-eﬀ ect has characterised by child soldiers, rape, and other human
been an associated increase in corruption.
rights violations.1 During and immediately after the
To give a recent example, many NGOs oﬀ er support
war, there was a steadily increasing presence of aid programmes for people living with HIV/AIDS.5 By organisations in the country. These non-governmental
distributing food, goods, and extra income, they help
organisations (NGOs) ﬁ lled a gap left by the young those with AIDS to live healthy, normal lives. However, government and had widespread inﬂ uence across ﬁ nancial and material incentives are very attractive in a the country.2 Although NGOs have worked hard to society as poor as Mozambique. One unintended result is improve lives, lack of oversight has led to substantial the identity theft of HIV-positive status. The current price opportunities for corruption.3
for a forged HIV test result is 200 meticais (about $8).
www.thelancet.com/infection Vol 9 September 2009
Reﬂ ection and Reaction
cult—government intentioned prevention programmes. However, abuse of
salaries are frequently paid months late while hospital HIV/AIDS money has become widespread in Mozambique, workers struggle to make ends meet. According to a detracting from the overall public health eﬀ ort.
report on corruption in Mozambique by the US embassy
Although the detrimental eﬀ ects of low-level
in Maputo, “major corruption and mismanagement corruption are not enough to seriously derail the problems in the public health system stand as obstacles to HIV/AIDS eﬀ ort in Mozambique, the situation is a continued improvement in health care delivery”.6
cause for concern. For example, suspect data and
The price for falsiﬁ ed health documents can be quickly subsequently inaccurate project evaluations make
recouped—one programme in northern Mozambique resource allocation, as well as monitoring and oﬀ ers goats, worth $20–30 each, to HIV-positive people. evaluation, diﬃ
The drive to fake one’s own HIV-positive status is even innocuous corruption will set the stage for large-scale stronger for government employees, who are eligible for
systemic corruption is also a concern. Possible solutions
a substantial salary increase for testing positive.
might include stronger monitoring and auditing by
A second area of widespread corruption involves HIV donors and stricter controls on project monitoring
prevention. Prevention activities necessarily occur in and evaluations. A requirement for individuals to take remote villages, where they are diﬃ
cult to monitor. antiretroviral drugs to qualify for wage increases or
A growing trend in Mozambique has been to request material incentives might help reduce the number of grants for rural education programmes (such as taking people with a falsiﬁ ed HIV status. In the end, careful a theatre group to a rural primary school). However, and creative resource management will be needed to because of a lack of monitoring—almost a technical maximise aid eﬃ
impossibility in a country as vast and as lacking in infrastructure as Mozambique—it is common practice Paul Johnson
to pocket the money and falsify reports of having done Michigan State University College of Human Medicine, East Lansing, prevention work.
Not only is aid money misspent, but the data collected I declare that I have no conﬂ icts of interest. I would like to thank Jane Turner for
on the number of people reached by prevention support during the writing of this article. programmes are inaccurate. The process of monitoring 1
Lautze S, Leaning J, Raven-Roberts A, Kent R, Mazurana D. Assistance,
and evaluation is confounded by false data and
protection, and governance networks in complex emergencies. Lancet
an inaccurate picture of the progress in HIV/AIDS 2 Finnegan,
CA: University of California Press, 1993.
prevention results. NGOs have outreach targets and 3 Hanlon, J. Do donors promote corruption?: the case of Mozambique. require statistics to report to donors, so there is little
Third World Q
PEPFAR. FY2008 country proﬁ le: Mozambique. http://www.pepfar.gov/press/countries/proﬁ les/116237.htm (accessed March 6, 2009).
Money remains available because the total funds 5
PEPFAR. FY 2007 Mozambique partners. http://www.pepfar.gov/partners/103020.htm (accessed March 6, 2009).
available outpace the amount being spent. There have 6 USAID. Corruption assessment: Mozambique. Washington, DC: United States been many beneﬁ ts from the inﬂ ux of money for
Agency for International Development, 2005. http://maputo.usembassy.gov/uploads/images/pdf/q3naBGGSYz8BsCXguSD5Pw/Final_Report-Mozambique__
HIV/AIDS into Mozambique. Over 460 0007 people that
Corruption_Assessment-without_internal_rec.pdf (accessed March 6, 2009).
are HIV-positive have beneﬁ ted from support and care, 7
PEPFAR. Mozambique FY 2007 Country Operational Plan (COP). http://www.
pepfar.gov/about/82448.htm (accessed March 6, 2009).
and many times that beneﬁ t from well run and well
The potential emergence of leptospirosis in Sri Lanka
Leptospirosis became a notiﬁ able disease in Sri Lanka in a substantial increase in reported cases to 35·7 per 100 000 1991. The number of cases every year reported by clinicians
during 2008.1 Documented increases occurred in at least
to the Sri Lanka Epidemiology Unit of the Ministry nine districts (Colombo, Gampaha, Kaluthara, Kandy, Galle, of Health in the decade leading up to 2007 remained Matara, Kurunegala, Kegalle, and Matale), representing a around 1000–2000 cases, with an incidence in 2007 of large area of west, south, and central Sri Lanka (ﬁ gure). The 11·0 per 100 000 population (ﬁ gure). This was followed by
case fatality rate for reported cases was 2·8%.
www.thelancet.com/infection Vol 9 September 2009
Boissons énergisantes, ou « Energy drinks » Quelques réflexions de l’Équipe santé du Service d’aide et d’Univers santé La question du sponsoring de cercles, de groupements étudiants ou d’évènements par les producteurs d’ « Energy drinks » est complexe. En effet, il ne s’agit pas d’une problématique aussi claire que celle du sponsoring par les alcooliers
Treatments for Minor Discomforts Colds, Congestion, Cough, Mucinex DM, Coricidin D, Neo-Synephrine Nose Drops (not nose spray), and Seasonal Allergies: Saline drops, Tylenol Cold/ Sinus/ Allergy, Sudafed, Robitussin (plain) PE, Dimetapp Extentabs, Dimetapp Elixir, Chlor-Trimeton 4mg, Plain Benadryl, Claritin, Actifed, Non-medicated cough drops. Sore Throat: Chloraseptic Spray, Cepa