Drug Interactions Common, Frequently Unrecognized by Doctors

Not only are significant drug-drug interactions common among people living with IV taking antiretroviral (ARV) therapy, but they are frequently overlooked by health care providers. These important findings were reported by a team of Liverpool researchers in the May 15 issue of Clinical Infectious Diseases.

“Unrecognized drug-drug interactions are one of the most common reasons for medication error with HIV drugs among the most therapeutically risky,” writes John Evans-Jones of the Royal Liverpool and Broadgreen University Hospitals NHS Trust and his colleagues. Failing to recognize these interactions, the authors point out, can result in blood concentrations of some drugs to fall below the levels needed to remain therapeutically active or to become elevated to the point where serious side effects are a risk.

Although previous studies have suggested that the risk of clinically significant drug interactions (CSDIs) is common, no study has assessed the extent to which these interactions are recognized and managed by health care providers.

Evans-Jones’s group asked HIV-treating physicians at the Royal Liverpool University Hospital to complete structured questionnaires. For each patient—a total of 159 were included in the study—the health care providers were told to record all prescription and over-the-counter medications being taken by the patient, along with any known recreational/illicit drugs. From there, the participating physicians were asked to identify potential CSDIs in the list of medications being used by each patient and to note any dosing changes to compensate for the interactions.

A total of 86 CSDIs were documented, occurring in 43 (27 percent) of the patients enrolled. Not surprisingly, patients using a protease inhibitor—a class of ARVs known for their many drug-drug interactions—faced the greatest risk of a CSDI.
Among the drugs most frequently involved in drug interactions including ARVs, antidepressants, antibiotics, statins (for cholesterol management) and recreational/illicit drugs.

Only 31 (36 percent) of the 86 CSDIs were correctly identified by physicians. There was a broad range of CSDIs observed, including interactions between antiretrovirals and with other classes of drugs, notably antidepressants, antibiotics, cholesterol-lowering statins, and recreational/illicit drugs.

“Poor physician recognition of CSDIs is not confined to HIV treatment and is also seen with other commonly prescribed medications,” Evans-Jones and his fellow authors write. “Nevertheless, the consequences of failure to recognize or to manage HIV CSDIs may be considerable, because over one quarter of CSDIs in our study had the potential to lower antiretroviral concentrations. Moreover, patients with CSDIs may present with ill‐defined symptoms or unexplained laboratory abnormalities.”

To better manage CSDIs—considered by the researchers to be “to a large extent unavoidable”—Evans-Jones and his colleagues argue that better medication recording is essential. “Computerized systems can support electronic prescribing; however, a systematic review of such systems showed that 55 to 91.2 percent of drug interaction alerts are ignored by physicians, probably because of ‘alert fatigue.’ Until such systems can be made more usable, we recommend that physicians are vigilant to the risks of CSDIs, use available drug information resources, and that the pharmacy department aid in identification of CSDIs and regularly audit prescribing practice.”

Concerned about possible drug interactions among the prescription medications, over-the-counter drugs and complementary therapies you're using? Search our comprehensive Check My Meds database for drug-drug and food-drug interactions and print out a report to share with your health care provider.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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25 Years of HIV Testing in Australia

This month marks a quarter-century since Australia began offering the HIV antibody test. During those 25 years, an estimated 40 percent of adults have undergone the test at least once. A 2008 study found that 80 percent of gay men in Australia had been tested at least once, and one-third said they retested every six months. With some 900,000 HIV tests conducted annually, the screening is one of the nation's most common medical tests. "The good thing in Australia is we've always had free and anonymous testing," said Levinia Crooks, CEO of the Australian Society for HIV Medicine. "When people are tested, if they find out they have HIV, the response overwhelmingly is concern about who they might have given it to and concern not to give it to anyone else." Australia continues to diagnose about 1,000 new HIV patients each year and has logged a total of 30,000 cases.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Syphilis Can Help Spread HIV; New Campaign Designed to Raise Public Awareness

Houston and Harris County health officials are launching a new educational campaign aimed at making area residents aware of the connection between syphilis and HIV/AIDS.

Harris County reported a decline in new syphilis cases in the last two years. Even so, 2009's 317 cases represent a 359 percent increase since 1999, the first year after the county stopped receiving a CDC syphilis prevention grant. Houston recorded the nation's second-highest number of syphilis cases in 2007 (443), dropping to eighth in 2009.

"Harris County hasn't seen so much syphilis in 60 years," said Dr. Robert Andrade, an infectious-disease specialist at Baylor College of Medicine and Thomas Street Health Center.

On Friday, public health experts conducted a symposium for health care providers in Acres Homes - a center for syphilis activity in the county. Forty percent of Houston's syphilis cases are co-infected with HIV, with African Americans accounting for a majority of these patients. Syphilis can increase HIV transmission fivefold, said Michael Ross, a professor of public health at the University of Texas Health Science Center at Houston.

Ross said a big factor in the city's syphilis epidemic of the last decade is gay men using the Internet to find sex partners. "HIV-positive men will hook up with other HIV-positive men and HIV-negative men will hook up with other HIV-negative men, both groups thinking that they're safe. But they don't realize they're often spreading syphilis or other STDs," said Ross, a symposium speaker.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Sexual Values and Risky Sexual Behaviors Among Latino Youths

The authors introduced the current study by noting that while understanding the sexual values of Latino youths is vital to informing efforts to prevent HIV transmission, few studies have explored associations between culturally based sexual values and behaviors in this population.

In San Francisco from 2003 to 2006, 839 sexually active Latinos ages 16-22 were interviewed. To examine associations between sexual values and behaviors, multiple regression and multinomial logistic regression analyses were conducted, while adjusting for language (as a proxy for acculturation) and other covariates.

The importance attached to female virginity was found to be negatively associated with females' number of sexual partners in their lifetime (odds ratio, 0.8) and in the past year (0.9); it was positively associated with women's nonuse of condoms, rather than consistent use, during the first month of their current relationships (1.8).

For males, the importance of satisfying sexual needs increased with the numbers of lifetime and recent sex partners, and with inconsistent condom use during the first month of their relationships (1.4, 1.1 and 1.9, respectively). Being comfortable with sexual communication was positively associated with inconsistent use or nonuse of condoms in the last month of both men's and women's current relationships (2.0-2.2). Among female participants, considering satisfaction of sexual needs to be important was associated with more sex partners only for those who attached little value to female virginity.

"It is important to integrate themes of virginity and sexual desire into intervention curricula so youth can better understand how these sexual norms influence their developing sexual identities and behaviors," the authors concluded.


The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Global Fund Faces 'Challenge' to Find Cash

The Global Fund to Fight AIDS, TB and Malaria needs $13 billion to $20 billion during 2011-13 to support its grants to programs in developing nations. On Monday, however, its executive director acknowledged that the current financial crisis creates "a very difficult context" in which to secure donors' contributions. "The challenge is the resources," Michel Kazatchkine said ahead of the agency's board meeting in Geneva.

Kazatchkine said he will spend most of his time until the pledging conference in October trying to secure support from donors. He is working especially to find financial support from Gulf nations and member states of the Organization of the Islamic Conference. UN Secretary-General Ban Ki-moon will chair the pledge meeting in New York.

For the 2008-10 period, the Global Fund provided $9.7 billon to worthy programs to prevent the three targeted diseases. "We were $3 billion short; the Global Fund could not respond to all the quality demands we have received," Kazatchkine said.

With Ethiopia in the lead, some states are lobbying to expand the Global Fund's mission to include all UN health-related Millennium Development goals.

"I don't think in a year of difficult replenishment it is the right time to broaden the mandate of the Global Fund," said Kazatchkine. One major supporter of the fund, the Bill & Melinda Gates Foundation, is also "strongly opposed" to an expansion, he added.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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China Lifts Travel Ban Against People with HIV

China has lifted its two-decade-old ban prohibiting entry by people with HIV/AIDS. The State Council said the government passed amendments on April 19 that revise the Border Quarantine Law as well as China's Law on Control of the Entry and Exit of Aliens. The move also scraps entry restrictions for foreigners with other STDs.

The ban was instituted during a time of "limited knowledge" about HIV, according to a statement on the State Council's Web site. China's move follows similar decisions by the United States and South Korea in January to eliminate travel restrictions for HIV-positive visitors.

Entry restrictions remain for people with infectious TB, those with "serious" mental illnesses, and "infectious diseases likely to cause significant harm to public health," the State Council said.

The lifting of the HIV travel ban comes just before the Shanghai World Expo opens on May 1. The State Council said the ban proved inconvenient when China hosted international events. It also said the government realized such restrictions did little in terms of preventing and controlling the spread of HIV and other STDs.

UN Secretary-General Ban Ki-moon praised China's decision and called on other countries that still ban HIV-positive visitors to rethink their laws. "Punitive policies and practices only hamper the global AIDS response," he said.

Last month, China denied a visa to Robert Dessaix, an HIV-positive writer hoping to participate in a literary tour. That move prompted a group of almost 100 prominent authors, including Nobel laureate J.M. Coetzee and Booker Prize winner Thomas Keneally, to sign a petition condemning China and demanding that officials apologize to Dessaix.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Suburbs Trail D.C. in Fighting AIDS, Study Says

Thousands of HIV/AIDS patients in Washington-area suburbs in Maryland and Virginia lack medical and support services, says a report released Tuesday, and poor coordination among jurisdictions is in part to blame. Of the region's 17,000-plus AIDS patients, 46 percent live in the suburbs, while 54 percent live in the District of Columbia. An additional 13,000 area residents are HIV-positive.

The Washington AIDS Partnership, an initiative of the Washington Regional Association of Grantmakers and Kaiser Permanente, commissioned the study. The region assessed included Montgomery, Prince George's, Arlington, Fairfax, Loudoun, and Prince William counties and the cities of Alexandria, Fairfax, Falls Church, and Manassas.

The report recommends that state and local governments support routine and voluntary opt-out HIV testing in health care settings and offer patients rapid oral swab HIV screening in emergency departments. The suburbs need to improve school-based sex education, and Virginia and Maryland should assess HIV/AIDS in the suburbs more frequently, the report says.

While Maryland and Virginia perform federally mandated HIV/AIDS studies every five years, the Washington suburbs' relative infrequency of assessments make it hard to determine the scope of any problems there, according to the report.

"We do look at regional data on a regular basis," said Elaine Martin, Virginia's HIV prevention director. "The entire state gets less [federal] funding than the District of Columbia. I don't think they have an unfair level of funding. Their positive rate is much higher than Virginia's. But in some cases, Virginia is underfunded."

The director of Maryland's Department of Health and Mental Hygiene, Heather Hauck, also cited low federal funding.

"We're not giving grades, like a report card," said Channing Wickham, the partnership's executive director. "We were able to provide a blueprint for action. We are interested in funding next steps."

To access the report, visit http://washingtonaidspartnership.org/PDF/ProfilesProject.pdf.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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No One Can Ask Me "Why Do You Take that Stuff?" Men's Experiences of Antiretroviral Treatment in South Africa

The current study examines how gender influenced the health behaviors, health care experiences, and narratives of HIV-positive men initiating antiretroviral treatment in South Africa.

In a rural health district in KwaZulu-Natal, eight men enrolled in a public HIV treatment program underwent observation and in-depth, semi-structured interviews. Family members and program staff also were interviewed.

"The study found that men's narratives and experiences of antiretroviral therapy (ART) were complex," the authors wrote. "Descriptions of control and coping juxtaposed with low self-esteem and guilt." While increased optimism about the future was noted following treatment-related health improvements, these feelings "were readily undermined by men's concerns about being unable to meet strongly gendered expectations in relation to family and work."

Alcohol use/abuse - by the men themselves, or family members - was an important issue affecting disclosure, uptake, and adherence. "Given messages discouraging alcohol use during treatment, men reported self-imposed delays to enrollment while they tried to stop or reduce alcohol use, although none had sought advice or professional help in doing so." In addition, the men "felt very threatened by alcohol abuse by family members fearing accidental disclose, insults and violence." The men held strong views regarding appropriate and professional behavior by program staff, especially relating to confidentiality.

"As ART programs in Africa become established and evolve, we not only need to identify barriers to men's access and adherence but monitor their health and treatment experiences," the authors concluded. "These findings suggest that the issue of alcohol and ART warrants further investigation. Additional training for primary health care providers and counselors on health promotion with men may be useful."

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Drug Users Must Be Helped to Halt AIDS Spread

A lack of harm reduction services in eastern Europe and central Asia threatens to make the regions stand out as exceptions to the global decline in new HIV infections, the head of UNAIDS said Friday. Harm reduction interventions include providing injection drug users (IDUs) with access to sterile syringes, methadone substitution treatment and condoms.

"HIV infection has slowed down globally, but it is expanding in this region of eastern Europe and central Asia," Michel Sidibe said ahead of a harm reduction conference Sunday in Liverpool, England. "We're not seeing anything like this in any other region of the world."

Nonetheless, some governments are wary of supporting harm reduction initiatives for fear of being seen as condoning drug use. Drug users often are shut out from health and social service programs.

"What is unacceptable is knowing there is this multitude of epidemics among drug users, we have, on average, each drug user getting less than two clean needles a month, and only about 4 percent of those living with HIV getting treatment," Sidibe said.

A 2002 study of 103 cities in 24 countries found the HIV infection rate fell almost 19 percent per year on average where syringe access programs were available, compared with 8.1 percent per year where no SAPs existed, Sidibe said. "But people are scared and there is a lack of proper understanding of harm reduction."

Sidibe said Russia would save money and prevent new HIV infections if it started protecting IDUs rather than punishing them. In Russia, the heroin substitute methadone is illegal. In the Ukraine, preventing HIV infection in an IDU would cost less than $100, whereas it costs $825 annually to treat HIV/AIDS, he said.

"Our goals will be reached only if we persuade all governments and authorities that harm reduction is more effective than punishment," Sidibe said.


The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Cutting AIDS Funds Risks 'Death Sentence': Report

The global economic downturn is having a significant impact on worldwide efforts to combat HIV/AIDS, according to a new report by the International Treatment Preparedness Coalition.

The update, "Rationing Funds, Risking Lives: World Backtracks on HIV Treatment," provides an on-the-ground assessment of programs in India, Kenya, Latvia, Malawi, Swaziland, and Venezuela. It finds patients are being turned away from treatment, and HIV drug supplies are running low because of government budget cuts and flatlined funding from key donors.

The Global Fund to Fight AIDS, TB and Malaria needs $20 billion over the next three years to help meet health-related UN Millennium Development Goals. But G-8 nations and other donors are warning that raising even $13 billion will be difficult. "If this trend continues, the result will be suffering and death for millions of people around the world currently living with HIV and the millions more who will be newly infected this year and the years to come," says the report.

President Barack Obama is using the economic crisis to justify level funding for the President's Emergency Plan for AIDS Relief, rather than providing year-on-year increases as was the case previously, the report alleges. The impact of this already is evident, with new patients being turned away from PEPFAR-funded programs in Africa.

In India, access to HIV drugs is severely restricted due to eligibility criteria for the government's program and high cost in the private sector. In Latvia, the government is imposing limits on the number of patients who can access free HIV treatment.

"For the first time since 2004, some HIV-positive men and women who are in need of life-saving antiretroviral treatment are being turned away because of funding cuts," Peter Mugyenyi, head of Uganda's Joint Clinical Research Center, wrote in a foreword to the report.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Zuma Breaks Taboo in Launching South African HIV Tests

The president of the nation hit hardest by AIDS revealed on Sunday the results of his own HIV test.

"After careful consideration, I have decided to share my test results with South Africans," Jacob Zuma told thousands of people who attended an AIDS awareness event at Natalspruit Hospital east of Johannesburg. "My April results, like the three previous ones, registered a negative outcome for [HIV]."

Zuma cautioned, however, that his action should not be used to pressure anyone else to reveal his or her own serostatus. "Anyone's HIV status is private and confidential," he said. "Disclosure is an individual decision. We must respect the decisions of those who choose to keep their status confidential, whether positive or negative."

Zuma's dramatic announcement was yet another break with the policies of his predecessor, Thabo Mbeki. In addition to denying the link between HIV and AIDS, Mbeki delayed for years the broad distribution of antiretrovirals to South Africans with HIV. Zuma already had unveiled plans to treat HIV-positive pregnant women earlier to head off transmission to their babies, and he had decreed that all infected infants would receive treatment at public facilities.

Zuma's personal life has been a topic of controversy. He has three wives and recently fathered a baby out of wedlock. In 2006 when he was charged with raping an HIV-positive woman, Zuma was derided for saying he had showered after the encounter to prevent becoming infected. The charges were eventually dismissed. His aggressive response to the AIDS epidemic, however, has been welcomed across the continent.


The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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South Africa Redoubles Efforts Against AIDS

Hoping to reverse the effects of years of denial and delay, South Africa has launched an ambitious new initiative to prevent and treat HIV/AIDS. "It's the first time one country has scaled up so quickly, to so many people," said UNAIDS chief Michel Sidibe.

Among the highlights of the new outreach:

*In the past month, the government has enabled 519 health centers to dispense AIDS medications, more than the combined total in all the years since 2004, when the government first began providing antiretrovirals (ARVs).

*The government has trained hundreds of nurses to prescribe HIV drugs; they will, in turn, train thousands more so that each of the nation's 4,333 public clinics can provide the medicines. This is seen as a crucial step, given the country's shortage of physicians.

*The South African Finance Ministry has budgeted an extra $1 billion to put one million more people on treatment in the coming years - roughly doubling the current caseload.

*Thanks to kits provided by the government, hundreds of private pharmacies will offer free HIV testing during the next year. More than 2,000 retired health care professionals have volunteered to assist with the testing drive.

*The Clinton Foundation, which has helped other African nations negotiate steep discounts for AIDS drugs, is now advising Health Minister Dr. Aaron Motsoaledi. He recently told Parliament that despite opposition from local drug makers, "We must be able to purchase ARVs at the lowest prices, as we are the largest consumers" of the medications.

*Motsoaledi said the nation also is keen to slow new infections, now occurring at a rate of 1,500 a day, through stepped-up condom distribution and other interventions. A drive is underway to circumcise 2.5 million men in KwaZulu Natal, the province hit hardest by HIV. President Jacob Zuma said the procedure, which the World Health Organization says can reduce the risk of female-to-male HIV transmission by more than half, will be offered across the country by next year.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Condoms in Jails: A Controversial Intervention

San Francisco's jail houses the only condom machine inside a detention facility in California, through a program started in 1989 in response to the HIV/AIDS epidemic. In 2001, Los Angeles County became the second county to provide a condom distribution program behind bars. Since then, no other county in the state has followed suit.

According to health officials, the HIV rate among incarcerated persons is almost seven times higher than among the general population. San Francisco Sheriff Michael Hennessey said he believes those charged with operating jails have an obligation to educate inmates about the disease, and distributing condoms is an effective way of doing so. However, the idea remains controversial.

Cpt. Dan Pena of the San Diego County Sheriff's Department, who oversees seven jails and nearly 5,200 inmates, said his department has no plans to give inmates access to condoms. "Primarily the reason for that is sexually activity in jails or prisons is illegal; it's actually a felony," he said. "And because of that, we would not want to send a mixed message to the inmate population that knowing this is a crime, here's a condom."

Until there is evidence that condom distribution reduces HIV rates in jails, San Diego County will continue its approach of providing HIV education and strict supervision of inmates, said Pena.

San Francisco County officials say evaluation of their program has found it did not increase sexual activity; there were no reports of smuggling using condoms; and inmates reported less high-risk activity.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Researchers at University of California, Releases New Data on HIV/AIDS Prevention

A new study, 'Behavior change following diagnosis with acute/early HIV infection-a move to serosorting with other HIV-infected individuals. The NIMH Multisite Acute HIV Infection Study: III,' is now available. "Risk reductions behaviors are especially important during acute/early HIV infection, a period of high transmission risk. We examined how sexual behaviors changed following diagnosis of acute/early HIV infection," scientists in the United States report.

"Twenty-eight individuals completed structured surveys and in-depth interviews shortly after learning of their infection and 2 months later. Quantitative analyses revealed significant changes after diagnosis, including reductions in total partners and decreases in the proportion of unprotected sex acts occurring with uninfected partners (serosorting). Qualitative findings indicated that these changes were motivated by concerns about infecting others. However, participants were less successful at increasing the frequency with which they used condoms," wrote W.T. Steward and colleagues, University of California, Center for AIDS Prevention Studies.

The researchers concluded: "These results suggest that the initial diagnosis with HIV may constitute an important component of interventions to promote risk reduction during the acute/early stages of the disease."

Steward and colleagues published their study in AIDS and Behavior (Behavior change following diagnosis with acute/early HIV infection-a move to serosorting with other HIV-infected individuals. The NIMH Multisite Acute HIV Infection Study: III. AIDS and Behavior, 2009;13(6):1054-60).

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Women Need to Take Lead in Safe Sex

"In 1993, the Food and Drug Administration gave its stamp of approval to a then-novel item: the female condom. At the time, AIDS awareness was growing. NBA star Magic Johnson had announced he was HIV-positive less than two years earlier. But the virus was still greatly feared and misunderstood. Condom use was urged as a matter of dire public health, and so women would finally protect themselves if their partner chose not to.

"Yet according to the Center for Health and Gender Equity, in 2007 about 11 billion male condoms were circulated worldwide compared with 26 million female ones. Cost used to be an issue, but it is no longer: The $4 female condom has been replaced by the 82-cent one.

"Though women have, indeed, come a long way, when it comes to sexual equality, we apparently still have a long way to go. But perhaps change is on the way.

"I live in Washington, D.C., and if I walk into a participating beauty salon, convenience store or high school, the FC2 female condom (FDA-approved last year) is available free of charge. Washington's campaign to protect women is being promoted through a $500,000 grant from the nonprofit MAC AIDS Fund.

"Washington has been ravaged by HIV/AIDS, with the highest rate in the country: Over 3 percent of adults are infected, according to a 2009 epidemiology report. Over a quarter of those are believed to be women. Chicago has launched a female condom awareness campaign, too, and hopefully other cities will follow. The statistics point to the urgency.

"The female condom is only one tool in helping women help themselves, but it's a critical one. It's high time that women have the opportunity to love their men while loving themselves just as much."

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Dallas County Retains State's Worst HIV Rate

Dallas County continues to have highest HIV rate in Texas, with 36 new cases per 100,000 residents in 2008. Though the rate declined from 37.5 cases per 100,000 in 2007, it is higher than Harris County's infection rate of 32.5 per 100,000 in 2008.

"This is not new. This is not sudden. What's important is that this trend has been recognized," said Dr. Wendy Chung, Dallas County's chief epidemiologist for reportable diseases.

The county recorded 859 new HIV cases in 2008 for a total caseload of 13,500 residents with HIV or AIDS. That compares with 1,288 cases in Harris County, which includes Houston, for a total of 18,751, according to the Houston Department of Health and Human Services.

"The HIV epidemic in Dallas County is reaching crisis levels in terms of our city's health status, economics, and quality of life," said Raeline Nobles, executive director of the nonprofit AIDS Arms Inc.

Zachary Thompson, executive director of Dallas County Health and Human Services, said the county has been working with AIDS service organizations to try and lower the HIV rate. "It's why we wanted to begin distributing condoms in Dallas County," he said. County commissioners in 2008 lifted a 13-year ban on condom distribution.

Dallas County released the 2008 figures the same day the Texas Department of State Health Services published its 2008 annual HIV/AIDS report, which showed a steady increase in the number of Texans living with HIV/AIDS. A total of 63,019 state residents were known to be living with the disease by the end of 2008, an increase of 42 percent in seven years, that report found.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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Pilot of Non-Invasive (Oral Fluid) Testing for HIV Within a Community Setting

In a community setting of men who have sex with men (MSM), the current study sought to determine the level of undiagnosed HIV infection and to identify any associated sexual risk factors.

In sex-on-premises venues and gay bars within the inner city of Brisbane, the researchers recruited 427 MSM. In a smaller regional center, Toowoomba, 37 additional MSM were recruited. The Orasure system was used to test oral fluids for HIV antibodies. In addition to submitting an oral fluid specimen, each participant was invited to complete a brief behavior questionnaire. The confirmed serology results were linked to reported sexual behaviors, testing patterns, and HIV status.

Thirty-three of the 464 MSM surveyed identified as HIV-positive, and all were reactive by Orasure assay. Eight men who said they were HIV-negative or did not know their HIV status had confirmed Orasure reactive results, meaning that 1.9 percent of the "non-HIV-positive" men were unaware they were positive. In all, 19.5 percent of the confirmed HIV-positive men were unaware of their actual serostatus.

"A significant minority of HIV-positive MSM are currently unaware of their positive serostatus," the authors concluded. "However, an analysis of their risk behavior does not seem to indicate any significant difference to those who are HIV-negative. Interestingly, 86 percent of those who were unaware they were HIV-positive identified that they had been tested in the previous six months, and all of them claimed to have been tested in the previous two years."

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


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HIV Vaccine is Hopeful

HIV is a "clever virus" that has managed to elude scientists' efforts to develop a vaccine against it, but recent advances have given researchers hope, according to Dr. Alan Bernstein, executive director of the Global HIV Vaccine Enterprise.

"This is a very exciting time in the field," Bernstein said in an interview in Johannesburg. "A vaccine is possible, and we have the scientific tools now to turn that possibility into a reality."

Bernstein cited the first successful testing of an HIV vaccine candidate in a large study in Thailand. In addition, he said, there has been recent progress in determining whether people with HIV produce antibodies that could lead to a vaccine guarding against several HIV strains.

Though HIV vaccine research has turned a corner after several disappointments, an effective vaccine is still many years away, Bernstein said.

An HIV vaccine would especially be important for Africa, home to most of the world's cases. A vaccine, unlike expensive daily AIDS medicine regimens, could be administered every few years, said Bernstein. A vaccine "is the most effective public health measure we've come up with," he said.

A new report summarizing the findings presented at a 2009 vaccine research conference notes that the HIV vaccine hunt is "steadily moving ahead." Already, the effort has informed the development of other vaccines and treatments for other diseases.

The report, "Progress Towards Development of an HIV Vaccine: Report of the 2009 AIDS Vaccine Conference," was published in The Lancet Infectious Diseases (2010;10(5):305-316).

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


Together We Remain Strong!

Tell the Obama Administration – Stop the Rape of Prisoners Now!

On March 10, 2010, the Department of Justice opened a 60-day public comment period on national standards addressing sexual abuse in detention. Released last June by a bipartisan federal commission, these common-sense measures have the potential to help end sexual abuse in detention. But the standards are opposed by some powerful corrections leaders. These officials argue that it is too expensive to stop prisoner rape, and they seem to have a great deal of influence over the Department of Justice.

Prisoner rape devastates more than 100,000 women, men, and children each year - including people who are living with or at risk of HIV infection. But you can make a difference by speaking out against sexual assault behind bars.

HOW YOU CAN HELP:

1. Send an email by May 10, 2010 to Attorney General Eric Holder at: AskDOJ@usdoj.gov.

Sample Letter

Dear Attorney General Holder,

I am writing to express my support for the standards developed by the National Prison Rape Elimination Commission. I urge you to codify them without undue delay. Sexual abuse in detention is devastating, physically and emotionally. When its victims are released, as almost all inmates are eventually, they carry their trauma and health problems with them, back to their communities.

As Congress recognized when it unanimously passed the Prison Rape Elimination Act of 2003, sexual abuse in detention is also preventable. The standards under review have the potential to become the most important tool so far in the effort to end this terrible abuse. But every day that we don't have these measures in place, hundreds of men, women, and children will be raped behind bars -- even though we know how to keep them safe.

No matter how big or how small, all corrections facilities must institute basic policies and practices to keep inmates safe. The final standards should include a broad definition of prisoner rape. Whatever form sexual abuse takes, it is always wrong; unchecked harassment frequently leads to more serious abuse. And I caution against letting cost be an excuse for weakening the standards. Morally, we must end the rape of those we detain; fiscally, it is a sound investment of tax dollars to do so, as it will save corrections agencies millions of dollars in litigation and medical costs.

I encourage you to defer to the expertise relied upon by the Commission in its exhaustive research and review process, and not to duplicate its efforts. If the standards are not implemented swiftly and fully, we will have missed a historic opportunity to address one of this nation's most urgent human rights crises.

I ask that you enter these comments into the public record for Docket No. OAG-131.

Sincerely,

[Your name]


2. Help us to spread the word by passing this information on to everyone you know.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


Together We Remain Strong!

Elton John's Letter to Ryan White, 20 Years After His Death From AIDS

Twenty years ago this month, you died of AIDS. I would gladly give my fame and fortune if only I could have one more conversation with you, the friend who changed my life as well as the lives of millions living with HIV. Instead, I have written you this letter.

Dear Ryan,

I remember so well when we first met. A young boy with a terrible disease, you were the epitome of grace. You never blamed anyone for the illness that ravaged your body or the torment and stigma you endured.

When students, parents and teachers in your community shunned you, threatened you and expelled you from school, you responded not with words of hate but with understanding beyond your years. You said they were simply afraid of what they did not know.

When the media heralded you as an "innocent victim" because you had contracted AIDS through a blood transfusion, you rejected that label and stood in solidarity with thousands of HIV-positive women and men. You reminded America that all victims of AIDS are innocent.

When you became a celebrity, you embraced the opportunity to educate the nation about the AIDS epidemic, even though your only wish was to live an ordinary life.

Ryan, I wish you could know how much the world has changed since 1990, and how much you changed it.

Young boys and girls with HIV attend school and take medicine that allows them to lead normal lives. Children in America are seldom born with the virus, and they no longer contract it through transfusions. The insults and injustices you suffered are not tolerated by society.

Most important, Ryan, you inspired awareness, which helped lead to lifesaving treatments. In 1990, four months after you died, Congress passed the Ryan White Care Act, which now provides more than $2 billion each year for AIDS medicine and treatment for half a million Americans. Today, countless people with HIV live long, productive lives.

It breaks my heart that you are not one of them. You were 18 when you died, and you would be 38 this year, if only the current treatments existed when you were sick. I think about this every day, because America needs your message of compassion as never before.

Ryan, when you were alive, your story sparked a national conversation about AIDS. But despite all the progress in the past 20 years, the dialogue has waned. I know you would be trying to revive it if you were here today, when the epidemic continues to strike nearly every demographic group, with more than 50,000 new infections in the United States each year. I know you would be loudly calling for the National HIV/AIDS Strategy that was promised by President Obama but has not yet been delivered. I know you would reach out to young people. I know you would work tirelessly to help everyone suffering from HIV, including those who live on the margins of society.

It would sadden you that today, in certain parts of the United States, some poor people with AIDS are still placed on waiting lists to receive treatment. It would anger you that your government is still not doing enough to help vulnerable people with HIV and populations that are at high risk of contracting the virus, including sexually active teenagers. It would upset you that AIDS is a leading cause of death among African Americans.

It would frustrate you that even though hundreds of thousands of HIV-positive Americans are receiving treatment in your name, more than 200,000 don't know their HIV-positive status, largely because a lingering stigma surrounding the disease prevents them from being tested. It would disappoint you that many teenagers do not have access to science-based HIV-prevention programs in school, at a time when half of new infections are believed to be among people under 25.

I miss you so very much, Ryan. I was by your side when you died at Riley Hospital. You've been with me every day since. You inspired me to change my life and carry on your work. Because of you, I'm still in the struggle against AIDS, 20 years later. I pledge to not rest until we achieve the compassion for which you so bravely and beautifully fought.

Your friend,

Elton

Your Input Needed on HIV-Related Health Disparities Recommendations

As many of you know, several consultations have been convened to gather community input on the President's priorities for a National HIV/AIDS Strategy. Earlier this year, a group of individuals gathered to discuss how best to achieve the President's goal of reducing HIV-related health disparities. Based on that meeting, several key themes and recommendations emerged. A work group from the consultation has drafted this document for submission to the White House Office of National AIDS Policy (ONAP) outlining key community recommendations to reduce HIV-related health disparities.

We want your input and comments! Please review the draft recommendations and submit feedback via email no later than Monday, May 3, 2010. The work group will consider comments and circulate a final version for endorsements via nationalaidsstrategy.org by May 7.

The HIV-related Health Disparites Recommendations draft can be viewed at: http://www.friendsofaids.org/files/NHASDisparitiesDraft4-25.pdf. Please submit your feedback to: info@friendsofaids.org.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


Together We Remain Strong!

Morphine Might Protect Brain Against HIV Dementia

An active compound in morphine—and thus heroin as well—might protect against HIV-related dementia, according to a study announced by researchers at Georgetown University Medical Center in Washington, DC. The study was presented last week at the 2010 meeting of the Society on NeuroImmune Pharmacology in Manhattan Beach, California.

“Needless to say we were very surprised at the findings,” said Italo Mocchetti, PhD, a lead author of the study. “We started with the opposite hypothesis—that heroin was going to destroy neurons in the brain and lead to HIV dementia.”

The reason Mocchetti’s team initially eyed morphine as a potential brain-damaging drug is because many HIV-positive injection drug users develop cognitive problems.

To explore this, Mocchetti and his colleagues looked at the brains of rats exposed to both morphine and HIV. Much to the researchers’ surprise, morphine actually inhibited certain toxic properties of an HIV protein called gp120, which plays a prominent role in the infection of immune cells.

Apparently, morphine protects the brain by prompting brain cells known as astrocytes to produce a protein called CCL5. “It is known to be important in blood, but we didn’t know it is secreted in the brain,” Mocchetti said. “Our hypothesis is that it is in the brain to prevent neurons from dying.”

CCL5 blocks a second protein, called CCR5, which sits on the surface of immune cells, and which HIV uses to enter and infect those cells. Mocchetti and his colleagues think that by blocking that second protein, brain cells are protected from infection and damage.

Mocchetti explained that in hindsight, there is evidence for morphine’s protective effect. Though many heroin users develop cognitive problems, he pointed out, a subset in other studies who became infected with HIV by sharing needles and equipment appeared to have lower rates of dementia than expected.

“We believe that morphine may be neuroprotective in a subset of people infected with HIV,” Mocchetti said.“That is not to say that people should use heroin to protect themselves—that makes no medical sense at all—but our findings give us ideas about designing drugs that could be of benefit.”

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


Together We Remain Strong!

ACTION ALERT - Tell Your Representatives to Co-Sponsor The Global Sexual and Reproductive Health Act of 2010

Recently, Representative Yvette Clarke (D-11th NY) introduced a groundbreaking piece of legislation that would fundamentally transform U.S. foreign assistance policy regarding sexual and reproductive health.

The Global Sexual and Reproductive Health Act of 2010 (H.R. 5121) changes the way the U.S. does business abroad by calling for comprehensive sexual and reproductive health programs and a continuum of care that is responsive to the range of sexual and reproductive needs of young people and adults.

Since youth comprise nearly half of the world's population, the reproductive and sexual health of these young people will affect the health and well being of this planet for decades.

H.R. 5121 includes a section specifically focused on the provision and promotion of sexual and reproductive health care for youth, including comprehensive sexuality education and youth involvement in program design and delivery.

We need your help to ensure that Congress understands the importance of promoting comprehensive sexual and reproductive health services around the globe.

HOW YOU CAN HELP:

1. E-mail your House Representative and tell him/her to contact Congressman Pascrell's office and sign on to the letter which urges the Appropriations Committee to adequately fund domestic HIV/AIDS programs.

Follow this link to find your Representative:
http://www.congress.org/congressorg/directory/congdir.tt

Alternatively, you can call toll-free to voice your support: 1.800.828.0498. When you reach the Capitol Switchboard, ask to be connected to your House Representative. If you have trouble getting through with the toll-free number, you can use the regular switchboard number: 1.202.224.3121.

Sample Letter:

Dear [Your Representative],

I am writing to ask you to co-sponsor H.R. 5121, introduced by Rep. Yvette Clarke. This legislation, The Global Sexual and Reproductive Health Act of 2010, would bring U.S. foreign assistance policy in line with accepted standards of health and well-being for women, men, children, and youth across the globe. The legislation would support activities that constitute a comprehensive sexual and reproductive health program, including voluntary family planning, education and outreach, reduction of unsafe abortions, STI and HIV prevention, integration of services, training for health professionals, abandonment of harmful traditional practices, and provision of sexual and reproductive health services during emergencies.

The Global Sexual and Reproductive Health Act of 2010 has the potential to save hundreds of thousands of lives each year. Pregnancy and childbirth complications are the leading cause of death for women aged 15 to 19 in low- and middle-income countries. Furthermore, more than half of all people living with HIV/AIDS are women of childbearing age and 45 percent of all new HIV infections in the world occur among youth aged 15 to 24.

As the largest donor in the area of sexual and reproductive health, the United States has a unique role to play in averting unnecessary deaths and unintended pregnancies while promoting healthy sexual and reproductive health. As a signatory to several human rights instruments, the U.S. also has a legal obligation to ensure that its commitments are upheld. One such commitment is meeting the Millennium Development Goals (MDGs), agreed to by 192 UN member states, including the United States. Ensuring that young people have the sexual and reproductive health information and services that they need to make healthy decisions is crucial to meeting the MDGs of eradicating poverty, achieving universal education, promoting gender equality, reducing child mortality, improving maternal health, combating HIV/AIDS, and ensuring environmental stability.

I urge you to co-sponsor H.R. 5121 to ensure that the United States meets its international obligations and aligns its policies and programs with human rights standards.

Sincerely,
[Your Name]


2. Please forward this information to everyone you know.

In the coming months, The Friends of AIDS Foundation will be working hard to bring the Global Sexual and Reproductive Health Act of 2010 to national attention — and to build support in Congress for its passage. Thank you for taking action!

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


Together We Remain Strong!

Needle Exchange Advocates Say HIV Rates in Canadian Prisons Outstrip the World

Advocacy groups say high rates of HIV and hepatitis C among Canadian inmates point to the need for the government to implement needle-exchange programs (NEPs) in federal prisons.

A 2007 Correctional Service Canada survey found an estimated 4.6 percent of prisoners reported having HIV/AIDS, more than two times the 1.6 percent from an earlier survey. CSC also found the estimated rate of hepatitis C among federal prisons was 31 percent, 39 times greater than that found in the general population. Incarcerated women, particularly Aboriginal women, are also disproportionately infected with HIV and hepatitis C, the survey showed.

According to the Canadian HIV/AIDS Legal Network's Sandra Ka Hon Chu, roughly half of prisoners surveyed reported sharing used needles or syringes to inject drugs. HIV specialist Dr. Peter Ford, a former professor at Queen's University, said it is not uncommon for used needles to be shared among 30 or 40 inmates.

Ka Hon Chu said countries that have adopted prison-based NEPs report mostly positive results. In addition to no increase in the use of drugs or injection drugs, "There is actually a decrease in syringes and needles and increasing referrals to drug addiction treatment programs," she said.

However, a CSC spokesperson said the agency "is not considering the introduction of prison-based [NEPs]." "The government has a zero-tolerance for drugs in our institutions. Providing needles for illicit drug use runs counter to that policy. Illicit drugs in federal prisons compromise the safety and security of correctional staff as well as our communities," said Christelle Chartrand.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


Together We Remain Strong!

AIDS Infections Climb, so Pueblo Program Opens Its Doors

Pueblo is responding to a rise in local HIV infection rates by improving access to testing, education and treatment.

Free, confidential HIV testing is available on a walk-in basis through the Early Intervention Program at Pueblo Community Health Center (PCHC). Anna Lee Beck, program coordinator, said too many individuals are not getting tested for the virus as part of their regular annual check-ups. Anyone who is sexually active should routinely get tested, she said.

"In the United States, 1.1 million people are living with HIV/AIDS. Approximately one in five of those people are unaware they are HIV-positive and are spreading the virus at an alarming rate. It can take up to 10 years for a person to experience symptoms of HIV, so the only way to know if someone is infected is to get tested," said Beck. "Treatment options are available, and [PCHC] directly provides care for people infected by HIV and AIDS."

Thanks to grant funding, PCHC provides primary and comprehensive care to 252 HIV patients - 197 men and 55 women - from 17 Southern Colorado counties; about 70 percent of patients are from Pueblo. According to Beck, the program sees an average of eight to 12 new patients a year.

People with HIV/AIDS must "take ownership of their disease and take care of it through medical care and lifestyle," said Beck. "We help them do that. But we can only do that with people who know they have the disease."

PCHC offers no-cost rapid HIV testing at its Park Hill Clinic, 1302 E. Fifth St.; Colorado Avenue Clinic, 300 Colorado Ave.; and Avondale Clinic, 328 Avondale Blvd. For more information, telephone Beck at 719-543-8718, ext. 725, or e-mail her at abeck@pueblochc.org.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


Together We Remain Strong!

San Francisco Health Officials Advise Early Treatment for People with HIV

A meeting to discuss San Francisco's new HIV treatment policy drew a capacity crowd at San Francisco General Hospital (SFGH)'s Carr Auditorium on April 13. City health officials want all people diagnosed with HIV offered treatment immediately, rather than later.

"Based on accumulated data, we believe all HIV-infected persons should be treated with antiretroviral therapy unless there is a strong reason not to," said Dr. Mitch Katz, city Department of Public Health director.

"We now know that from the start HIV is causing damage to more than just the immune system," said Dr. Diane Havlir, chief of the University of California-San Francisco (UCSF)'s Division of AIDS at SFGH. "The virus is causing damage to multiple organs - including the heart, liver, kidneys, and probably the brain - even when a person has high CD4s and feels fine."

In a December report, 55 percent of experts convened by the US Department of Health and Human Services "strongly" recommended initiation of antiretroviral therapy when CD4 cell counts are 350 to 500 cells/cubic millimeter. Forty-five percent supported this specific guideline "moderately." In addition, 50 percent of panel members moderately recommended treatment initiation at CD4 counts above 500, with 50 percent viewing this as "optional."

SFGH began recommending earlier treatment after discussions among staff providers in January, said Medical Director Dr. Brad Hare. The new policy applies equally to other city facilities, said Katz.

"We've never debated about whether we think low-income people are entitled to the same advances as everyone else," Katz said. "There's one standard of care, whether you're on the hill at [UCSF] Parnassus, at Kaiser or here at SFGH."

"We encourage people not to use lack of funding to avoid doing what is right, but to stand with us and advocate for more," said Dana Van Gorder, Project Inform's executive director.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


Together We Remain Strong!

Behavioral Changes Associated with Testing HIV-Positive Among Sexually Transmitted Infection Clinic Patients in Cape Town, South Africa

Toward the goal of informing HIV and sexually transmitted infection prevention programs, the researchers set out to examine behavioral risks and behavioral changes associated with testing HIV-positive among a population of STI clinic patients.

The subjects of the cohort study were 29 STI patients who seroconverted from HIV-negative to HIV-positive during one year of observation, along with 77 STI patients who consistently tested HIV-negative. At baseline and at one year, computerized behavioral interviews were collected, and STI clinic charts were abstracted over the same one-year period.

"The STI patients who reported genital bleeding during sexual activity at baseline were significantly more likely to test HIV-positive," the authors reported. "Reductions in number of sexual partners and rates of unprotected intercourse occurred for all STI clinic patients regardless of whether they tested HIV-positive."

"Although risk reductions occurred, 5 percent of HIV-negative STI clinic patients subsequently tested HIV-positive over one year. Behavioral risk-reduction interventions are urgently needed for male and female STI clinic patients," the researchers concluded.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


Together We Remain Strong!

Report: HIV Risk Behavior Before and After HIV Counseling and Testing in Jail

A report, 'HIV risk behavior before and after HIV counseling and testing in jail: a pilot study,' is newly published data in Journal of Acquired Immune Deficiency Syndromes. According to a study from the United States, "Jail incarceration represents an opportunity to deliver HIV counseling and testing (C&T) services to persons at increased risk of infection. However, jails can be chaotic with rapid turnover of detainees."

"We conducted a pilot study to investigate the feasibility of comparing the effect of different approaches to HIV C&T in jail on subsequent HIV risk behaviors among persons testing HIV negative. Consecutive cohorts of newly incarcerated jail detainees were recruited with 132 subjects completing standard HIV C&T as per jail protocol and 132 subjects completing rapid testing with an individualized counseling session. Risk behavior was assessed and compared at baseline and 6 weeks after jail release. Among the 264 male participants, preincarceration substance use and sexual risk were common. The follow-up visit was completed by 59% of eligible participants. There were no differences in postrelease HIV risk behavior between the 2 arms but there was an overall decrease in risk behavior after jail release for the cohort. In addition, all participants in the rapid arm received rapid HIV test results compared with participants receiving 28% of conventional test results. Jail incarc! eration represents an important public health opportunity to deliver HIV C&T. This study demonstrated (1) feasibility in delivering rapid HIV testing combined with individualized counseling to jail detainees, (2) improved test result delivery rates, and (3) success with evaluating risk behaviors during the transition from jail to the community," wrote C.G. Beckwith and colleagues, Brown University.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


Together We Remain Strong!

Redefining The Standard of HIV Health Care

Reprint of an article by Anthony Bongiorno, President & Founder of The Friends of AIDS Foundation, on August 17, 2009.

As a Professional who has worked with hundreds of individuals living with HIV, I know well that starting treatment for HIV is ultimately a personal decision. Every infected person, upon diagnosis, should have the opportunity to discuss the pros and cons of treatment and when to begin treatment with his or her medical provider. It should always be the patient’s choice when to initiate treatment and what treatment to initiate under the direction of a medical provider.

I also recognize that there is still not much known about the long term side effects of treatments and that legitimate fears remain. Despite this, I believe it is time for the medical community and the government to do more to promote the benefits of early treatment of HIV, both as a means of keeping people healthy and reducing the spread of the virus. In many cities, outdated definitions of HIV, and thus the standard of care used to treat it, mean that poor and chronically ill people are actually cut off from supportive services that are every bit as critical to their health as their medications.

There are many studies that indicate the start of treatment when a person’s cells fall to 350 or below. Even above that number, HIV seems to have an impact on the immune system and the chance for the onset of other diseases and complications exists. For that reason, many HIV positive people may choose and should have the right to choose treatment as soon as they learn of their infection. The Friends of AIDS Foundation strongly opposes any standard of care that denies treatment or sets a “one size fits all” protocol in regard to treatment.

Early treatment has a significant impact not just on health but also prevention efforts. First, it is apparent that treatment dramatically lowers the amount of virus in a person’s body, thereby making the virus significantly more difficult to transmit. The more positive people who have access to treatment, the less the virus will likely be transmitted. Thus, simply making treatment more widely available will have a major impact on the spread of HIV. It is apparent that these benefits should be recognized and incorporated into health and prevention efforts.

Many cities and programs to one degree or another tie HIV services to health status in relation to standards of care for treatment. The reality is that for low-income people living with HIV, and particularly for people with multiple co-morbidities such as homelessness, chronic chemical dependence and mental illness, basic supports are essential for their well-being whether or not they are on treatment.

If a person chooses treatment before reaching the current threshold of 350 T- cells or lower, that person may never achieve the threshold that would allow him or her to receive these supports. Thus, the current system provides a disincentive for people who would like to enter treatment before their T-cell count falls below 350.

There is strong evidence that housing and ancillary services are essential for the maintenance of the health of a person living with HIV, whether or not a person is ready for treatment. Treatment definitions and services need to be decoupled. But as long as they are coupled, it is imperative to recognize the changing recommendations regarding treatment.

Although HIV medications have saved many lives, the medications are not perfect and no one has a total understanding of their effects, especially because it can take years for problems to surface; that fact only underscores how important it is for people to be well informed about their treatment options. However, it is clear that we are not taking full advantage of one of our best weapons to treat and eradicate this epidemic.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals by protecting their well being and will continue to work to urge the government to address the flaws in AIDS service and effect meaningful change. Recognizing that none of us is as strong as all of us, I urge others in the community to do the same. Together We Remain Strong!

###

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


Together We Remain Strong!

Supporting the START Study

The Treatment Action Group (TAG), based in New York City, requests endorsements for the START Study by April 30. The following is taken from a TAG release.“We are requesting individual and organizational endorsements in support of a statement from the INSIGHT (International Network for Strategic Initiatives in Global HIV Trials) Community Advisory Board, one of six HIV clinical trials networks funded by the National Institutes of Health.

“As you may know, the U.S. HIV Treatment Guidelines Panel recently changed its recommendation for when to start HIV treatment, raising it from 350 to 500 CD4 cells. This change was not without controversy, since there is no conclusive evidence that starting treatment earlier is better. A large-scale randomized control trial that could clearly provide this evidence—called START (Strategic Timing of Antiretroviral Treatment)—is still in its critical pilot phase.

“As the result of this new treatment recommendation, there are now concerns that INSIGHT Network’s ability to enroll the expected 4,000 volunteers for START might be jeopardized. What’s more, as we face longer waiting lists for AIDS Drug Assistance Programs and the call for treating everyone who test positive, we need the critical answers that can be provided by the START trial more than ever, or we risk putting people on treatment prematurely, with unknown long-term side effects and the risk of drug resistance in life-long therapy.

“We believe that the priority for HIV-positive people is to have accurate, reliable data on both the risks and benefits of earlier treatment in order to base any decision for when to start treatment. We fully support this study and invite you to endorse the importance of this research.

To read the statement and to lend your support for this important study, please go to: http://www.hivresearchcatalystforum.org/endorse-start-study.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


Together We Remain Strong!

AN OPEN LETTER TO PHARMACEUTICAL COMPANIES

The Fair Pricing Coalition (FPC) issued the following open letter on April 15.

The Fair Pricing Coalition, in conjunction with individuals and organizations of the HIV community, call upon the manufacturers of HIV antiretrovirals and other medications used by people living with HIV/AIDS to provide immediate relief to AIDS Drug Assistance Programs (ADAPs) and to work in partnership with HIV advocates to ensure that additional federal and state funding also flows to ADAPs.

The ADAP crisis is rapidly expanding. These critical safety net programs are at the center of a perfect storm brought on by the economic meltdown, federal and state budget shortfalls, and continuing escalation of drug prices.

The number of new people who rely on ADAPs for their medications each month grew an unprecedented 80% from June 2008 to June 2009. States with waiting lists have grown from 3 to 10 in one year, and clients on those lists increased by 58% in the last quarter alone. Numerous additional states are being forced to plan for imminent implementation of waiting lists, formulary reductions and eligibility cuts.

To meet the needs of over 166,000 individuals living with HIV and receiving ADAP services, and tens of thousands more whose lives will depend on ADAP access in years to come, ADAPs, state and federal governments, and industry partners must all work together to solve this crisis.

The Fair Pricing Coalition and the HIV community are currently addressing budget issues with federal and state officials and are calling on pharmaceutical manufacturers to provide a financial bridge for ADAPs, particularly until the healthcare reform law is fully implemented.

ADAP survival requires that drug manufacturers hold ADAPs harmless against rising drug prices. We call upon manufacturers of HIV antiretroviral and other related drug manufacturers to implement a multi-year cost protection and rebate enhancement program for ADAPs which will allow all increased revenues to go toward eliminating waiting lists, providing medications to new clients, and maintaining formularies.

Although manufacturers provide Patient Assistance Programs (PAPs) for individuals without government or private health insurance coverage, the confusing patchwork of eligibility and recertification criteria creates barriers to access. We call upon the companies to create a standardized PAP application and to provide automatic PAP enrollment to individuals on any state's ADAP waiting list who have already been certified ADAP-eligible by that state.

Industry must work diligently and in good faith with the ADAP Crisis Task Force during the May 2010 meetings to forge agreements that assure full access to life-saving medications for all people living with HIV/AIDS.

The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


Together We Remain Strong!

Research Reveals How HIV Infects During Sex, May Lead to Better Prevention

Researchers have uncovered the mechanism HIV uses to get past a tight barrier of cells in the female genital tract—and thus cause HIV infection—according to a release by McMaster University in Canada. The study, which could help scientists develop a more effective microbicide or vaccine to prevent HIV, was published April 8 in the online journal PLoS Pathogens.

Up to 90 percent of all HIV infections worldwide are caused by sexual contact. Specifically, to enter the body during intercourse, HIV must get through the epithelium, a lining of tightly meshed cells covering mucosal tissue in the female genital tract and the rectum.

Until now, however, researchers have not understood how HIV gets past these cells. Some have theorized that many infections might be due to small tears in the mucosal lining, while others have suggested that inflammation of immune cells just beneath epithelial cells could cause the epithelium to become permeable.

To explore this further, Charu Kaushic, PhD, from McMaster University in Hamilton, Ontario and her colleagues exposed vaginal and intestinal cells to HIV. According to her group’s research, a protein on HIV’s surface can cause epithelial cells to break. When this happens, the cells become hyperactive and releases destructive inflammatory proteins.

These inflammatory proteins, Kaushic’s group shows, can then neutralize the small electrically charged proteins that keep epithelial cells packed snuggly together, like mortar between bricks. “What it does is make the electrical barrier resistance of epithelial cells decrease. By doing that, the virus can cross the barrier,” Kaushic explained.

Though Kaushic and her colleagues conducted their experiments with vaginal epithelial cells, it is possible that the same mechanism takes place in the rectum. Researchers will have to pursue both lines of research as they move toward developing a microbicide or vaccine that prevents infection at the mucosal level.

“This is a significant step forward in defining where prevention strategies, such as microbicides and vaccine, need to focus,” Kaushic concluded. “Instead of trying to stop HIV from infecting the target cells underneath the epithelium, we need to think about ways to stop the virus from attaching to epithelial cells themselves.”

The Friends of AIDS Foundation is dedicated to leading efforts to combat this disease and create an impact on policy making that will help change the future course of this pandemic. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.


TOGETHER WE REMAIN STRONG!