Author Archives: B Merritt

Punitive Laws Undermine HIV Prevention Efforts

Some 34 million people globally are living with HIV.  Since 1981, when the first cases of what we came to know as AIDS were diagnosed in the United States, more than 60 million people have been infected and more than 30 million have died from AIDS-related causes.  The most recent data indicate that more than two million people a year are newly infected worldwide, the vast majority of these in the resource poor countries of the South, especially those of sub-Saharan Africa.  In Western and Central Europe there are some one million people living with HIV, of which approximately 100,000 are in the UK (with a quarter of these unaware of their HIV positive status).

It is a tragic indication of the impact that HIV and AIDS have had on our planet in the past thirty years that these morbidity, mortality and new infection figures represent something of an improvement.  The rate of new infections has fallen by almost a fifth since 1999 and appears to be levelling out; one-third of the 15 million people living with HIV in low- and middle-income countries have access to treatment.  Consequently, the number of deaths is falling, and the number of people living with HIV is stabilising.  To this extent the global AIDS response has been a success, and for this we should acknowledge not only the financial resources countries and individuals have made available, but the invaluable contribution of scientists, healthcare workers, academics, civil society organisations, international bodies such as UNAIDS and the World Health Organization and – most importantly of all – people living with, and affected by, HIV.  Without the concerted effort and dedication of all these actors and activists the individual, social and economic impact of the virus would be even more catastrophic than it has been.

Ruins-1000x55-logo-6Central to the success of these efforts has been the recognition that our response to HIV and AIDS must be informed by human rights principles, including the fundamental right to non-discrimination and the right to the highest attainable standard of physical and mental health.  HIV impacts disproportionately on those who are stigmatised, marginalised or who lack economic or social capital (men who have sex with men, women and girls, sex workers, migrants and displaced people, injecting drug users).  Prevention efforts, and access to treatment and care, will only be successful if those most at risk of infection, or already living with HIV, are given – and experience – the respect and support to which they are entitled as of right, without judgement.

Despite this, governments across the world persist in introducing, implementing and enforcing punitive and coercive laws which reinforce stigma and popular misconceptions.  One of the most egregious examples of this in recent years was the introduction by Greece’s Minister of Health of a law which resulted in the detention and forcible HIV testing of hundreds of women in Athens alleged to have been sex workers.   Those who tested HIV positive were charged with a range of serious offences (most of which were subsequently dropped or reduced), detained in inhumane conditions and had their photographs published in the national media.  The law that permitted this was unnecessary, disproportionate. and resulted in a gross violation of the right to respect for private life.  Introduced immediately before the hotly contested and contentious Greek elections of May 2012, many commentators suggested that the measure was a cynical gesture that played to populist sentiment in times of austerity.  It was condemned by national groups and activists, and by international organisations and health experts and was repealed in May 2013.  In July, however, it was reinstated – with the support of the Greek Centre for Disease Control, and to the dismay of those who thought reason had triumphed over prejudice.   The President of the International AIDS Society, Françoise Barré-Sinoussi (a co-discoverer of HIV), speaking at the Society’s conference in Kuala Lumpur this summer expressed her clear disappointment:

“As President of the IAS I strongly condemn this move and urge the Greek Government to rethink its position. HIV infections are already increasing in Greece due to the economic crisis and a mandatory policy of detainment and testing will only fuel the epidemic there.”

As yet, however, there seems to be no rethinking, and new infections in Greece increase at a rate significantly higher than elsewhere in the EU.

RUINS-poster-EN-web1Ruins, a documentary by Zoe Mavroudi about the Greek law and its impact on the women who were rounded up in 2012, had its UK première at Birkbeck on Friday 18th October, supported by the Birkbeck Gender & Sexuality (BiGS).  In it, Mavroudi shows the way in which economic austerity, fear and ignorance combined to produce a toxic cocktail which not only blighted the lives of individuals but has done serious harm to HIV prevention work in her country.  It is an important and timely reminder of the work that still needs to be done in combating HIV-related prejudice, and of the profoundly negative impact that punitive laws can have in the field of public health.

 

Professor Matthew Weait

Matthew Weait is Professor of Law and Policy at Birkbeck and Pro-Vice-Master (Academic Partnerships).  He has been a consultant to UNAIDS and the WHO and was a member of the Technical Advisory Group of the Global Commission on HIV and the Law (UNDP).  He co-founded the River House Law Clinic, which provides free legal advice to people living with HIV, and which is supported by student volunteers from the School of Law.  An article on this theme, “Unsafe law: Health, rights and the legal response to HIV”, based on his inaugural lecture, will be published in the International Journal of Law in Context in December 2013.

Experiences of Court

Researchers Jessica Jacobson, Gillian Hunter and Amy Kirby from the Institute for Criminal Policy Research (ICPR), School of Law at Birkbeck discuss their recently completed study about the experiences of victims, witnesses and defendants at the Crown Court. Follow them: @ICPRtweet 

exp_of_court

Our study was funded by the Economic and Social Research Council. We wanted to understand what it is like to appear in court as victim, witness or defendant and what factors determine whether proceedings are seen as fair and legitimate by the participants.

We conducted fieldwork at two Crown Courts and our findings were gathered primarily through interviews with victims, defendants and witnesses, supplemented by observations of trials and sentencing hearings and interviews with court staff, judges and barristers. By these means, we assessed victims’, defendants’ and witnesses’ comprehension of court proceedings, how fair they perceived the proceedings to be, how respectfully they felt they were treated by the courts, and the significance they accorded to proceedings.

Legitimacy of the court

We tend to think of the court as a place where ‘what really happened’ is established. In fact, court proceedings are a highly ritualised process of managing conflict between alleged wrongdoers and those allegedly wronged, in which the ‘truth’ often remains unknown and unknowable.

Attending court can be terrifying, humiliating, upsetting or frustrating; and many aspects of the process can be difficult to understand. Proceedings are often characterised by an intermingling of incongruous elements and a degree of chaos. And yet, the vast majority of witnesses, victims and defendants conform with the expectations and social rules of the process. This reluctant conformity seems to reflect an implicit belief in the legitimacy of proceedings. Verdicts or sentences thought to be unfair can undermine, but tend not to erase, the perceived legitimacy of the court process.

Our work with Victim Support

The criminal justice system depends on cooperation of victims and witnesses to report crime, and to give evidence in court. How they are treated is likely to affect their confidence and trust in the system.

We describe victims’ and witnesses’ experiences of court in a report, published in July in collaboration with national victims’ charity, Victim Support. It shows the effectiveness of much existing provision for victims and witnesses in helping them feel valued and supported. This includes separate waiting areas, away from the defendant, court familiarisation visits and the Witness Service, whose staff and volunteers help explain procedures and accompany witnesses to the courtroom. Overall, witnesses reported being treated respectfully but they found aspects of the court process frustrating, confusing and distressing.

Distress and anxiety

Most were anxious about coming face-to-face with the defendant or the possibility of reprisals for giving evidence. Despite this, they tended to come to court voluntarily, citing their motivation as sense of duty to protect others from becoming victims or to secure justice for themselves or for others.

Chance encounters with defendants did occur in the entrance to the court, in the smoking areas and the canteen, and were reported as one of the most distressing aspects of the witness experience.

Waiting

Waiting characterised much of the experience: lengthy waits for the case to come to court, then while at court to give evidence and sometimes for the sentence to be delivered. Witnesses were often given little warning to attend court or, conversely, late notice that a trial had been postponed; and they were not always told of the reasons for delays.

Understanding

Some did not understand the role of prosecution barrister, and thought he or she was acting on their behalf. This coupled with limited or no contact with the prosecution barrister heightened witnesses’ feelings of marginalisation and a sense that the defendant was getting a better deal.

Most nerves were reserved for cross-examination; the formal or legal language often posed difficulties and witnesses were appreciative of judges’ interventions to ensure they understood a barrister’s questioning or to prevent hostile or aggressive questioning.

Having your ‘day in court’

There was frustration about how their testimony or their story about what happened was inhibited by rules about admissibility of evidence or by the particular focus of the prosecution case.

What needs improving?

Respectful treatment makes the difficulties of coming to court more manageable, and helps reduce any sense of marginalisation. However, there is scope for support to be enhanced; for witnesses to be better informed about court processes, and to have their voices heard more clearly.

Fostering collaborations between the UK and India – the way ahead for TB drug discovery research

This post was contributed by Arundhati Maitra, Associate Research Fellow at Birkbeck

Tuberculosis (TB) has re-emerged as a serious public health threat worldwide because of an alarming increase in the mortality rates due to drug resistant Mycobacterium tuberculosis strains and a deadly liaison between HIV and M. tuberculosis infection. There is an urgent need for identifying and validating new therapeutic leads to facilitate the development of novel anti-TB drug treatment.

An important element in intracellular survival and consequent pathogenesis of M. tuberculosis is its distinctive cell wall, of which peptidoglycan is a major structural, functional and regulatory component. The cytoplasmic steps of the biosynthesis of peptidoglycan are catalysed by a series of ATP-dependent ligases and they play a pivotal role by utilising ATP while incorporating specific amino acids sequentially to the C-terminus of the stem peptide; steps critical for cell wall cross-linking. They share a similar reaction mechanism and are essential for the growth of M. tuberculosis. As the reactions catalysed by these enzymes provide key precursors for the cell wall biogenesis and recycling, they are therefore considered as excellent therapeutic targets at the different physiological stages of the TB pathogen.

On a recent trip to India, Dr Sanjib Bhakta, Director of Mycobacteria Research Laboratory (MRL) part of the Institute of Structural and Molecular Biology, Birkbeck, University of London and UCL, visited a number of universities, specialised research institutes, organisations and schools to shed light on the world-class research being carried out at MRL researchers in the field of tuberculosis  drug discovery and to discuss new research and educational initiatives with India.

Dr Bhakta speaks to the Department of Molecular Biology and Biotechnology, Tezpur University (India)

Dr Bhakta speaks to the Department of Molecular Biology and Biotechnology, Tezpur University (India)

Dr Bhakta was invited by the erstwhile Vice-Chancellor of Dibrugarh University, Assam, India Professor Alak K. Buragohain, to engage in an interactive session with the research students of the Department of Molecular Biology and Biotechnology (MBBT), Tezpur University as well as the senior professors of the Department of Pharmaceutical Sciences, Dibrugarh University. A number of intense interactive sessions, held between July 23 – 25 2013 at the university departments was attended by the department’s students and faculty members and also by those in the Department of Chemical Sciences and Food Engineering and Technology. Dr Bhakta spoke about ‘Tackling drug resistance and persistence in Mycobacterium tuberculosis: integrative inter-disciplinary approaches in novel therapeutic intervention’, in the course of which he discussed whole cell assay techniques developed exclusively in his laboratory to evaluate potential anti-infective molecules. Highlighting some of the current work being carried out in his laboratory Dr Bhakta spoke about understanding ligand-protein interaction to unveil the mechanism of action of anti-mycobacterial compounds. He laid special emphasis on the need for an inter-disciplinary approach to fight TB and leprosy. A meeting with Professor Mihir Kanti Chaudhuri, Vice Chancellor, Tezpur University and other senior professors culminated in a proposal to forge collaborations between Birkbeck and Tezpur University, Assam, India. Any collective work between these two universities will benefit from the availability of potential anti-tubercular agents of plant origin harboured in the highly bio-diverse forests of Assam and the technical expertise of Dr Bhakta in testing the effectiveness of these agents in a wet lab setting.

Another invited seminar and one-to-one research meeting at which Dr Bhakta spoke was at the National Institute for Research in Tuberculosis, Chennai (India). Collaboration between NIRT and MRL is not new, as a materials transfer agreement already exists between the two world leading institutions. A memorandum of understanding currently being drafted will expectedly consolidate the existing relations.

Guest of Honour at the IDF Grants and Awards Function, Chennai (India)

Guest of Honour at the IDF Grants and Awards Function, Chennai (India)

A combination of social responsibilities, university outreach activities and common academic interests led Dr Bhakta to engage with the Indian Development Foundation (IDF). Established in 2005, the IDF is a non-government organisation with a three-fold goal to cater to education, development and health in the rural parts of India. Having been monumental in the elimination of leprosy in India, the organisation has moved its focus to tuberculosis. IDF hosted its Annual Grants Release Function on August 7, 2013 at Bharatiya Vidya Bhavan, Mylapore, Chennai at which Dr Bhakta was invited as a Guest of Honour to recognise the efforts of IDF and emphasise the need for continued support to such organisations. The annual feature is conducted to share resources with leprosy/TB projects and recognise schools in the region for their participation in social work and raising awareness of the cause. It was well attended this year with five-hundred audience members and renowned speakers on the panel including Mr. B.S. Raghavan (former Policy Advisor to the UN) and Dr A.R.K. Pillai (Founder President of IDF) and Mr. J. Ravichandran (CEO, German Leprosy and TB Relief Association) to name a few. The event was covered by Indian national television and print media units.

In an effort to stir the minds of tomorrow’s researchers, Dr Bhakta also accepted the opportunity to deliver a motivational talk at Maharishi School to a group of 50 A-level equivalent students, addressing their queries and encouraging them to embark on the life of a research scientist.

Alpha-1 Antitrypsin Deficiency – research update

Now almost a year into a two-year project, Dr Bibek Gooptu, from the Institute for Structural and Molecular Biology (ISMB) at Birkbeck and UCL, and his team are researching new treatments for the condition Alpha-1 Antitrypsin Deficiency and helping to advance our understanding of the mechanisms behind the condition.

The protein Alpha-1 Antitrypsin is created in the liver and then carried in the blood to the lungs, where it protects lung tissue. In people with Alpha-1 Antitrypsin Deficiency, a mutant gene within the liver cells causes the Antitrypsin protein to adopt a different structure, and individual protein molecules link together in chains, known as polymers. The liver is not able to secrete these polymers and so they remain stuck inside liver cells, damaging them. It also means that not enough Antitrypsin reaches the lungs from the bloodstream. People with Antitrypsin Deficiency are likely to suffer both from liver disease (e.g. cirrhosis or cancer of the liver) and, if they are smokers, they are likely to develop emphysema at a much younger age than someone without Antitrypsin Deficiency – probably in their 30s or 40s.

Promising compounds

Dr Gooptu and the project team (Gooptu group and collaborators at Birkbeck, UCL and Cambridge) have been studying compounds which will bind to the Antitrypsin protein in such a way that it is prevented from forming polymers. Because they have previously solved the molecular structure of the Antitrypsin in atomic detail they have identified three possible drug binding sites to target with new treatments. They have confirmed that small molecules (drug building blocks) predicted to target these sites in computer simulations bind the protein when tested experimentally in solution. The team are currently finalising computer simulations identifying a set of 750 compounds with similar binding characteristics to these ‘hits’. They will use these to test run the technology they are developing to assess the effects of many molecules at a time, not just on the protein in a test tube (which they do using a technique called mass spectrometry) but also at the site where the disease starts: in cells.

Example of a compound (cyan) successfully binding one of the target sites (surface features shown in grey) in Alpha-1 Antitrypsin (molecular structure shown as coloured ribbons) in computer simulation.

Example of a compound (cyan) successfully binding one of the target sites (surface features shown in grey) in Alpha-1 Antitrypsin (molecular structure shown as coloured ribbons) in computer simulation.

Testing in mammalian cells

Although a compound may bind to a protein in a solution, to be a successful drug the compound has to be able to enter the cell effectively. Once inside it must bind effectively in conditions that may be quite different. To see whether the compounds which bound successfully in solution can bind in the same way in cells like liver cells the team are testing them in cells known as CHO cells.  These are simple mammalian cells that grow well in a nutrient broth (cell culture) and behave like liver cells in terms of how they deal with normal Antitrypsin (secreting it efficiently) and disease mutant forms (accumulating polymers within the cell). It is already possible to check these cells for beneficial effects of drug-like compounds by checking whether the amount of secreted Antitrypsin goes up and/or the polymer levels go down. However at early stages of drug development the effects of the compounds may be more subtle, so Dr Gooptu and his post-doctoral researcher, Dr Nyon, are working with the Thalassinos group at UCL to identify more sensitive markers. For this they are working out the molecular signatures of health and disease in the part of the cell where proteins are prepared for secretion and where Antitrypsin polymers form and get stuck. These signatures are the levels of different proteins found within this area, known as the endoplasmic reticulum or ER for short. Not only is this useful for the current project, the signatures may themselves provide clues for other treatment options in the future.

Other proteins can aggravate or lessen disease

As well as the Antitrypsin protein there are hundreds of other proteins present in the ER. The amounts in which these proteins are present change depending on whether the cell is healthy or unhealthy. Some drop to undetectable levels while some new proteins are only found in one or other situation. Dr Gooptu compares this to looking at a street from an aerial view. In one view there are people in the street, with music and bunting. This is a street party and the equivalent to the ER of a healthy cell. In another view of the same street there might again be people in the street, but this time you also observe flames, fire engines and hoses. This is an emergency situation and the equivalent of the ER in an unhealthy cell. However, it is necessary to establish whether the people (proteins) in the second scene are causing the disease (arsonists) or fighting it (fire fighters). This will allow comparison of desirable with harmful responses to promising compounds and identify other proteins that might themselves be useful targets for future drug treatments.

Understanding how compounds are binding

Once they have identified the best compounds from the original set of 750 that bind Antitrypsin both in free solution and within cells, a technique known as Nuclear Magnetic Resonance (NMR) spectroscopy will be used to look very closely at the binding process and discover exactly how it takes place.

Binding of the Antitrypsin protein (grey ribbon representation) to a prototype drug molecule can be followed by NMR looking at changes seen when the interaction occurs around the structure at many individual points (spheres). In this case the colour coding shows many areas that change a lot (blue), whilst a few areas are stable (white)

 

Binding of the Antitrypsin protein (grey ribbon representation) to a prototype drug molecule can be followed by NMR looking at changes seen when the interaction occurs around the structure at many individual points (spheres). In this case the colour coding shows many areas that change a lot (blue), whilst a few areas are stable (white)

 

 

Using this technique the team can identify the characteristics of the protein:compound interaction. Armed with this information they can return to a library of thousands of compounds and identify further potential binders for testing and develop compounds which will bind in the most effective way.

Improving understanding of Alpha-1 Antitrypsin deficiency and the disease mechanisms

The approach taken by Dr Gooptu has developed existing methods and combined them in a new way. Usually drug companies will blind-test thousands of compounds in solution. Using the computational modelling before the in-solution testing meant that the team could identify a smaller number of compounds which were more likely to give positive results. The more detailed NMR spectroscopy studies are then targeted on a small number of compounds that show the most promise both in solution and in cells. This approach also has the additional advantage that while identifying compounds that bind Antitrypsin it also reveals more about how the genetic mutation causes disease in terms of harmful changes in proteins and cell responses.

Next steps

Having carefully developed the individual computational, mass spectrometry, cell biology and NMR techniques over the last year, in the next 12 months the project team will put them together and see how well they work in a pipeline for assessing the 750 test compounds. If this works well the pipeline could then be boosted to screen far greater numbers of compounds in future. However above the molecular scale, the project has already paved the way for bigger drug discovery projects in Alpha-1 Antitrypsin deficiency. Through his work, and the forum of research meetings convened by the US patient charity that funds the project (the Alpha-1 Foundation), Dr Gooptu has established contact with other groups working on a range of other approaches to identify new treatments. He is now collaborating with these groups and the Foundation to develop larger screens in which hit molecules can be rapidly identified from cell screening. The hits will then be studied in parallel by his group in Birkbeck and US research groups with complementary expertise to establish how they work and so how they can be further improved as efficiently as possible.

Dr Bibek Gooptu has been working on Antitrypsin Deficiency at Birkbeck since 2006. He is also a practising Consultant in Respiratory Medicine.  His research is supported by the Alpha-1 Foundation, the Medical Research Council and the Wellcome Trust.