Gay Couples Need HIV Prevention, Says Study

Couples should be included in HIV prevention campaigns that have traditionally targeted only single gay and bisexual men, according to new research.

The study examined sexual agreements among 566 gay male couples from the San Francisco Bay Area. These agreements consisted of decisions the couples made about whether they allowed sex with outside partners and the kinds of sexual behaviors they engaged in together.

Roughly equal proportions were in monogamous (45 percent) or open (47 percent) relationships. However, 8 percent had "discrepant agreements," in which the partners reported different understandings of whether their relationship was monogamous or open.

The major motivations for agreements among most couples included strengthening or improving the relationship by building trust, promoting honesty, and fostering the primacy of the coupled partners. Except among concordant HIV-negative partners, HIV/STD prevention was not usually listed among the top motivators.

"We found that gay couples are interested in building healthy, satisfying, and loving relationships," said lead author Colleen Hoff, a San Francisco State University professor and director of its Center for Research on Gender and Sexuality. "These desires, when nurtured, can lead to strong relationships. Yet the reality is that a broken sexual agreement, or one that isn't clear to either partner, can make both partners vulnerable to HIV."

Given efforts by many researchers to tie disease prevention to sexual agreements, it is critical to understand the primary motivations couples have in establishing them, noted Hoff and colleagues. In the study, most couples cited relationship dynamics rather than risk reduction for their mutual understandings. Prevention messages should urge couples to discuss their agreements on an ongoing basis, the authors suggested.

The full study, "Relationship Characteristics and Motivations Behind Agreements Among Gay Male Couples: Differences by Agreement Type and Couple Serostatus," was published in AIDS Care (2010;22(7):827-835).

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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Prevention Is Weakest Link in AIDS Fight

Many Latin American countries have enacted laws and policies to provide youth with sexual health education and services; implementation, however, has been spotty.

At the 2008 International AIDS Conference in Mexico City, Latin American and Caribbean ministers pledged to boost by 75 percent the number of schools that offer comprehensive sex education. Their declaration also promised an increase of 50 percent in the number of youths with access to sexual health services.

Under Mexico's conservative National Action Party, the Public Health Secretariat has provided adolescents with a book about contraceptive methods. Leftist-led Mexico City will provide classes on sexuality and gender education during the 2010-11 school year. Other states have been slower to take action, said Alexis Sorel of the Mexico-based Sexuality and Democracy Network.

Brazil's health and education ministries have taken a leading role in structuring a national policy of school-based sex education, including information about STDs and discrimination against homosexuals, said Juan Carlos Raxach, project advisor of the Brazilian Interdisciplinary Association on AIDS (ABIA).

"But in practice it is difficult to ensure all of the schools take on this commitment," Raxach said. While this is slowly changing, schools are adopting ABIA-produced sex education materials, he added. Outside of school, adolescents receive little sex education and do not identify with the few messages that target them, he said.

In Chile, the change in national government in March has delayed enactment of a law establishing secondary school sex education. However, more than 5,000 teachers and professors have been trained. The subject also has been incorporated into curricula, but "that doesn't necessarily translate into action in the schools," said Leonardo Arenas, coordinator of Arcis University's Sexual Education Program. Access to sex education can depend on the political ideology of the mayor, since schools are municipally controlled, he 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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New Jersey Says AIDS Patients Won't Lose Coverage

On Thursday, New Jersey Gov. Chris Christie's administration announced that nearly 1,000 residents who are to be cut from the AIDS Drug Assistance Program (ADAP) on Aug. 1 will still be able to access treatment through a temporary program.

Under Christie's budget, tighter income restrictions for ADAP clients were enacted in order to save an estimated $7.4 million. ADAP lowered the income ceiling for clients to $32,490, or 300 percent of the poverty level for an individual, from the previous 500 percent individual cap of $54,150.

Unexpectedly, state officials learned "several weeks after the budget was adopted" that New Jersey will receive an additional $5 million in pharmaceutical company rebates, said Poonam Alaigh, commissioner of the Department of Health and Senior Services (DHSS).

With the rebate and additional federal funds, New Jersey will be able to extend treatment coverage to ADAP clients who make between 300 percent and 500 percent of the federal poverty level. DHSS can enroll these patients in a new program called the Temporary AIDS Supplemental Rebate and Federal Relief Program. New enrollments also will be permitted, said Donna Leusner, a spokesperson for the department.

AIDS advocates said they welcome the administration's about-face, while urging the state to make a longer-term commitment and cover drugs not directly related to AIDS.

"This was the compromise that we were looking for to begin with, so nobody had to go without their HIV meds," said David Condoluci, a physician who heads Garden State Infectious Diseases Associates in Voorhees. For several weeks, staff members were scrambling to help some of its 1,600 patients who were expected to lose coverage, he said.

Long term, the future of state-supported AIDS coverage is still undetermined, as "the department's budget process is year to year," said Leusner.

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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Governor Paterson Signs into Law Landmark HIV Testing Legislation!

New York, New York, July 30, 2010 – The Friends of AIDS Foundation recognizes the leadership of the Honorable Governor David Paterson, Senator Thomas K. Duane and Assemblyman Dick Gottfried in achieving a tremendous public health victory for New York communities with the new HIV testing law.

The new legislation (S08227/A11487) will institute significant advances in making HIV testing routine, such as:

* Requiring the offering of an HIV test in all public (Article 28) and private health care settings thereby establishing the offer of an HIV test as the standard of care;

* Extending required offering of HIV screening to individuals ages 13-64 years old;

* Requiring that informed consent be obtained prior to performing an HIV test;

* Facilitating routine testing by permitting flexibility in how informed consent is documented where rapid technology is used;

* Providing durable consent where written consent is part of the general consent to medical care with an opt-out for HIV testing. Durable unless patient changes providers or revokes the consent;

* Requiring that when an HIV test is positive, with the patients’ consent, the person ordering the test must provide or arrange for follow-up medical care.

New York is the epicenter of this disease in the United States and each year, more than 1000 New York City residents (3 per day), are diagnosed concurrently with HIV and AIDS. Many of these individuals are late testers who have been infected for 10 years or longer, and have intersected numerous times with the health care system without being offered an HIV test. These late testers receive an AIDS diagnosis when it may be too late to fully benefit from life-extending treatments. Until this week, New York was one of only three states to have legislation in place that would hinder routine HIV testing. This new law will go into effect a few weeks after President Obama’s unveiling of the new HIV/AIDS National Strategy that focuses on prevention, HIV testing and connecting those in need of care to appropriate services.

The Friends of AIDS Foundation applauds Governor Paterson, all Senators and Assembly members who supported this legislation and thanks Senator Duane and Assemblyman Gottfried for their dedication to improving the health and well being of all New Yorkers.

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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AIDS Program at Capacity

Georgia has closed its AIDS Drug Assistance Program to new enrollees. A projected 125 patients will be added to the ADAP waiting list each month, and the tally could reach 1,300 by year's end without additional funding, according to state health officials.

The program, which receives $12 million in state funding and $33 million in federal money, needs another $11 million to meet additional demand, the Georgia Department of Community Health reports. Georgia's high unemployment rates have prompted more patients to seek out ADAP, with enrollment up 17 percent in the past year, officials said. With 5,700 enrollees, ADAP is now at capacity.

"Our funding has not decreased in Georgia, but because of the economic situation, many people have lost insurance," said Dr. Anil Mangla, director of infectious disease for the state Division of Public Health.

"It's an immediate impact," said Lola Thomas, executive director of the AIDS Alliance of Northwest Georgia in Cartersville. "The numbers continue to increase of people needing assistance through the program."

Current ADAP enrollees will not lose their benefits, provided they regularly pick up their medications and requalify every six months, according to advocates.

Mangla said pharmaceutical firms have agreed to provide assistance to HIV/AIDS patients placed on the waiting list. Individuals should apply to the program to receive a denial letter, which can then be used to apply for drug company assistance.

The Obama administration recently announced $25 million for states with ADAP waiting lists, which numbered 13 as of July 23, according to the National Association of State & Territorial AIDS Directors. Georgia officials hope some of the relief money will help them re-open enrollment but have no estimate as to when that might happen, said Mangla.

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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Lawmakers Debate Whether to Extend, Expand, End Syringe Sales

Over-the-counter syringe sales without a prescription will become illegal in California at the end of the year unless the Legislature takes action. The pilot program, signed into law by Gov. Arnold Schwarzenegger in 2004, gives counties or cities, and then pharmacies within those municipalities, the option to participate.

The state Department of Public Health recently released an evaluation, which had been due by Jan. 15, on the current law. That report found needle sharing is lower in areas that opted into the program. It documented no evidence of a rise in drug use or crime; accidental needle-sticks among first responders remain rare; and there has been no increase in improperly discarded syringes.

However, the current two-step, opt-in process for allowing legal syringe sales - first by municipality, then by pharmacy - limits the program's benefits and creates confusion over what is legal where, the report said.

Assembly member Wes Chesbro (D-Arcata) is sponsoring a measure (AB 1701) that would extend the existing law for eight years, continuing the program as is. AB 1701 passed the Assembly by a 49-27 vote this spring and now is pending before the Senate Appropriations Committee.

SB 1029, by Sen. Leland Yee (D-San Francisco), would permanently allow all state pharmacists to sell syringes and give adults the right to possess up to 30 without a prescription. That bill passed the Senate on May 28 and is now before the Assembly Appropriations Committee.

Opinion on both bills has been divided mostly along party lines, with Democrats in favor and Republicans opposed. Republicans are concerned that Yee's bill would replace local control with a top-down, one-size-fits-all approach and that it does not specify how often a person could buy 30 syringes.

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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Concerns over Cost of New HIV/AIDS Treatment Regime

Malawi's adoption of updated HIV treatment guidelines has some AIDS advocates worried the costlier regimen will hamper patients' access to therapy. Malawi provides free antiretroviral (ARV) drugs to about 250,000 of the 1 million Malawians who have HIV. Twelve percent of Malawians are HIV-positive, and 65 percent live on less than $1 a day, according to the UN.

"At the moment, not all people who require treatment are getting it," said George Kampango of the Malawi Network of People Living with HIV/AIDS (MANET+). "Government is failing to provide free treatment for many poor people and children including orphans who need it most."

"Malawi is changing the treatment in line with World Health Organization [WHO] guidelines which are urging countries to phase-out the current first line of treatment, which is blamed for increased side-effects," said Dr. Mary Shawa, the nation's principal secretary for HIV/AIDS.

The government has been providing the first-line course of stavudine, lamivudine, and nevirapine for about $33 per patient each month. In comparison, the new WHO-endorsed ARV regimen will cost $100. [PNU editor's note: The WHO recommendations were summarized in the July 19 edition of PNU.]

"The new drugs are even much more expensive, and we fear that government will struggle even more to make them available even to those people who are already accessing treatment free of charge," Kampango said. "Poor children are likely to be penalized from accessing the drugs because they are not usually a priority for treatment."

WHO's guidelines also recommend initiating ARVs for patients with a CD4 count of 350 cells/mm3 or less, instead of the previous guidance of 200 cells or less. Kampango said this, too, could overtax treatment efforts.

Malawi's government has increased its HIV budget for 2010-11, including $75 million for the National AIDS Commission for fiscal 2010, said Ken Kandodo, Malawi's finance minister.

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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Haitians with AIDS Hit by Broken Promises of Aid

Haiti's HIV-positive population is proving especially hard-hit by the international community's slower-than-expected earthquake recovery effort, activists said at the 18th International AIDS Conference in Vienna.

"It's very difficult for grassroots organizations to operate since the quake. We simply don't have the means to do so," said Liony Acclus, head of a Haitian coalition of HIV-related organizations called PHAP+.

Six months after the Jan. 12 disaster, an international pledge of $500 million was only 20 percent fulfilled, the World Bank said. About 90 percent of funding for HIV in Haiti comes from foreign sources, Acclus said.

Aid workers note that before the earthquake, health services constituted a rare bright spot in Haitian development efforts. HIV prevalence in Haiti declined from 6.2 percent in 1993 to 2.2 percent in the middle of the current decade, noted Dr. Jonathan Quick, director of Management Sciences for Health (MSH), a US-based non-governmental organization (NGO).

"What we hear about Haiti is always very negative, but before the earthquake, good things were happening there, in the health sector particularly," Quick said.

Free care for people with HIV, testing, and preliminary treatment are still available, said Edner Boucicaut, head of the NGO Housing Works. However, Haiti cannot provide access to second-line drugs for those whose HIV strain is resistant to initial treatment, he said. Even before the quake, 43,000 HIV-positive persons were not getting the care they needed, he said.

In a joint statement, MSH and other NGOs called for strengthening the Haitian health sector overall as the most effective way to "sustain HIV/AIDS prevention, care and treatment over the long term."

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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Study Links Homophobia, HIV

In countries that already have high HIV prevalence, ongoing brutal antigay attacks, vigilantism, and stigma may be fueling a surge of infections, according to a new study. The research broke ground by offering the first HIV prevalence estimates for men who have sex with men (MSM) in countries that traditionally have tracked only heterosexual HIV/AIDS.

"Kenya, Malawi, Zambia - nations with stunningly high infection rates among the general population - are now seeing double those rates among men who have sex with men," said Chris Beyrer, director of Johns Hopkins Center for Public Health and Human Rights. Beyrer presented the World Bank-supported study at the Global Forum on MSM and HIV in Vienna ahead of the 18th International AIDS Conference.

A group of gay HIV educators was recently beaten, doused with kerosene, and nearly burned alive in Kenya, where the study found that up to 15 percent of MSM have HIV. In comparison, Kenya's general prevalence is 6 percent.

In Malawi, 21 percent of MSM have HIV, compared with 11 percent of the general population. In Zambia, one-third of MSM have HIV, while the country's general prevalence is 15 percent.

"Due to stigma, a significant number of these countries simply fail to track HIV among their MSM," said George Ayala, the Global Forum's executive officer. "Equally troubling is that such stigma can completely derail lifesaving programming that MSM desperately need: HIV-related services, prevention work, outreach, and even epidemiological studies that would help us understand the full scope of this crisis."

"If you or your friends are viciously beaten because you're a sexual minority, then HIV risk is probably not your first concern," said Ayala.

Solving the problem involves a sharpened focus on the human rights of MSM and expanded prevention and treatment efforts targeting them, Beyrer said.

"We must improve outreach, interventions, and access to care for MSM in these countries," Beyrer said. "The argument that gay and bisexual men are a trivial sideshow in the global fight against AIDS is wrong."

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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University of North Carolina Awarded $1.7 Million to Curb the Spread of HIV in State

With a $1.7 million CDC grant, North Carolina researchers will evaluate new HIV testing technology to track the spread of the virus during the initial weeks of infection.

Researchers from the UNC Institute for Global Health & Infectious Diseases will use fourth-generation tests to identify HIV infection before the development of antibodies, a period of up to 12 weeks. In this stage, called acute HIV infection (AHI), the virus replicates rapidly and the possibility of transmission is high.

"We believe that a significant proportion of HIV transmission by the sexual route is driven by AHI," said Peter Leone, MD, MPH, co-principal investigator and UNC professor of medicine. "Identifying individuals with AHI could have a significant positive impact on the spread of the virus."

The investigators hope the results of the tests will point to social networks where there is a high risk for HIV transmission. The researchers will use the networks themselves, Internet-based notifications, and text messaging to disseminate prevention information and partner notifications.

"The anonymity of the Internet can limit the ability to perform partner notification by traditional means," said Lisa Hightow-Weidman, MD, MPH, assistant professor of medicine at UNC and a co-principal investigator.

Other sites funded for this four-year study are the San Francisco Department of Public Health and the New York City Department of Health and Mental Hygiene.

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 Can Be Deadly Even Before CD4 Counts Fall, Researchers Say

Compared to the general population, persons with HIV infection have a higher risk of premature death even before their immune system deteriorates to the point at which doctors have traditionally begun antiretroviral treatment (ART), a new study shows. The analysis is based on data for 40,830 patients ages 20 to 59 in 23 countries in the European Union and North America.

The pooled cohort observational study provides further evidence that ART should begin earlier, rather than delaying it until the immune system has deteriorated significantly. A CD4 count of 200 cells/microliter or lower increases the chance of infections and AIDS-related illnesses. Yet in the developing world, treatment has generally begun only when the count falls to 200. UNAIDS recently adopted a strategy of initiating ARVs when CD4 counts reach 350 or lower.

The study focused on ART-naïve HIV patients with at least one CD4 count greater than 350. Adjusting for other mortality risks, untreated heterosexual patients were nearly three times as likely to die prematurely as uninfected peers. Injection drug users were more than nine times as likely to die, and those with unknown/other risk factors were 4.5 times as likely to die. For men who have sex with men, the risk was 30 percent greater.

Compared with CD4 counts of 350-499 cells per microliter, the death rate was lower in patients with counts of 500-699 cells per microliter (adjusted rate ratio 0.77, 95 percent confidence interval 0.61-0.95) and counts of 700 cells per microliter or greater (0.66, 0.52-0.85), the researchers reported.

"The increase in risk was substantial in injecting drug users and the heterosexual group, but was small in men who have sex with men," the authors said. "This finding suggests that much of the raised risk in the former two risk groups probably results from confounding by socioeconomic and lifestyle factors rather than being an effect of HIV infection itself. The magnitude of the raised risk in the [MSM] group is more likely to reflect the effect of HIV itself."

The full study, "Death Rates in HIV-Positive Antiretroviral-Naïve Patients with CD4 Count Greater than 350 Cells per µL in Europe and North America: A Pooled Cohort Observational Study," was published in the Lancet (2010;doi:10.1016/S0140-6736(10)60932-4).

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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Antiretroviral Treatment of Adult HIV Infection: 2010 Recommendations of the International AIDS Society - USA Panel

"Successful antiretroviral therapy (ART) is associated with dramatic decreases in AIDS-defining conditions and their associated mortality," the authors wrote in introducing their updated treatment recommendations.

Since the 2008 guidelines were published, new data have emerged regarding the consequences of untreated HIV infection and the expansion of treatment options for ART-naïve and -experienced patients, observed the panel.

"Uncontrolled HIV replication and immune activation lead to a chronic inflammatory state, resulting in end-organ damage and comorbid conditions not previously thought to be associated with HIV infection," the authors wrote. "Several studies have shown that the lifespan of those with HIV infection still falls short of that of the general population, even at higher CD4 cell counts. This life span decrease is related to serious, non-AIDS events attributed to chronic immune activation and the potentially permanent immune damage associated with prolonged immune depletion."

"Patient readiness for treatment should be confirmed before initiation of antiretroviral treatment," the panel said. "Therapy is recommended for asymptomatic patients with a CD4 cell count less than or equal to 500/microliter, for all symptomatic patients, and those with specific conditions and comorbidities. Therapy should be considered for asymptomatic patients with CD4 cell count above 500/microliter.

"Components of the initial and subsequent regimens must be individualized, particularly in the context of concurrent conditions," wrote the authors, who presented these considerations in an accompanying table. "Patients receiving antiretroviral treatment should be monitored regularly; treatment failure should be detected and managed early, with the goal of therapy, even in heavily pretreated patients, being HIV-1 RNA suppression below commercially available assay quantification limits," the panel advised.

The full recommendations are available online via open access; visit http://jama.ama-assn.org/cgi/content/full/304/3/321.

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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Health Watchdogs Sound Alarm over TB/HIV Deaths

The scourge of co-infection with HIV and TB is the target of a health care initiative launched at the 18th International AIDS Conference in Vienna.

UNAIDS and the public-private Stop TB partnership joined forces in a campaign to cut the annual number of deaths from HIV/TB to 200,000 by 2015, half the number reported in 2004.

"Every three minutes a person living with HIV has his or her life cut off prematurely by TB," said Jorge Sampaio, UN Secretary-General Ban Ki-moon's special envoy on tuberculosis. "This is completely unacceptable. TB is a preventable and curable disease."

While acknowledging that reaching the goal would require billions of dollars annually, conference speakers focused on low-cost strategies that have been shown to cut HIV/TB mortality. "There is a package of activities that, if properly implemented by countries, will work," said Stop TB Executive Secretary Marcos Espinal.

Health care facilities and laboratories should be designed to handle both HIV and TB. To help identify and treat TB as early as possible, health care workers should ask HIV-positive patients whether they have had any recent coughing episodes.

In addition, French and US researchers reported trial results that suggest changes in the typical treatment schedule for patients co-infected with HIV and TB.

In a Cambodian trial of seriously ill HIV patients newly infected with TB, researchers compared the standard approach, starting TB treatment and then waiting eight weeks to initiate antiretroviral therapy (ART), with an experimental approach of waiting only two weeks to introduce HIV treatment. The team recorded 59 deaths among the 332 patients who started ART at two weeks, compared to 90 deaths among the 329 patients who started ART at eight weeks (death rates of 18 percent and 27 percent, respectively).

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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Main Outcomes from World AIDS Forum

Strong scientific evidence presented at the 18th International AIDS Conference (IAC) in Vienna showed clear progress is possible in fighting HIV/AIDS, though economic woes have made the resource gap wider.

Researchers presented results from a trial of a tenofovir-based vaginal microbicide gel showing it reduced HIV infection among heterosexual female users by 39 percent over 2.5 years. The protection was greater for highly adherent users. The gel is expected to undergo expanded trials to further assess its efficacy. Some experts doubted whether 39 percent was enough to justify taking the gel to the public.

After increasing for six consecutive years, AIDS funding for developing countries slackened in 2009 amid the global recession, UNAIDS reported. In 2009, the funding gap was $7.7 billion, and the unmet need in 2010 is $11.3 billion. Some advocates are calling for a micro-tax on financial transactions to meet the growing treatment tab.

For the health of those living with HIV, treatment should be initiated at a CD4 count of 350 cells/mm3, regardless of the presence or absence of clinical symptoms, the World Health Organization announced at the conference. Earlier access to antiretroviral therapy benefits HIV patients in reduced morbidity and mortality, several recent studies show. Expanded ARV access also reduces HIV incidence in society at large, according to research by International AIDS Society President Dr. Julio Montaner and British Columbia Center for Excellence in HIV/AIDS colleagues.

For years, experts have avoided using the term "eradicate" with respect to HIV, largely because the virus rebounds once treatment stops. Nobel laureate and HIV co-discoverer Francoise Barre-Sinoussi returned to the question of whether viral "reservoirs" can indeed someday be flushed out to eradicate HIV from the body.

The aging of the HIV-positive population was also discussed. Both the virus and ARVs are linked with myriad health effects. Many older patients are now facing cancer, diabetes, heart, liver, and kidney diseases without adequate savings or social support, experts said.

The IAC, which ended July 23, will next be held in Washington, D.C., in 2012.

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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More HIV Patients Lose State Support in Ohio

The Ohio Department of Health is finalizing details of a plan that will tie eligibility for the state AIDS Drug Assistance Plan to a patient's CD4 cell count. The DOH plan is a response to a projected ADAP deficit stemming largely from increased demand for help, state officials said.

The plan would limit ADAP enrollment either to patients with CD4 counts of 500 cells/mm3 and below, or to those whose counts have dropped below 200 cells/mm3 at any point, said Jay Carey, a management analyst for the Ryan White program, which is administered by the Ohio Department of Health (DOH). Carey expects the change will occur next month, after which an additional 500 clients would be cut from ADAP.

Earlier this month, 250 clients were dropped from ADAP after the state restricted eligibility to those earning 300 percent of the federal poverty level or less - about $32,000 for a single person. Previously, the bar had been at 500 percent. DOH also implemented a waiting list and stopped paying for non-emergency dental care and prescriptions not directly related to HIV/AIDS.

In addition, the state will place spending caps in its next contract with CVS, the drug store chain that provides the ADAP drugs, said Jen House, a DOH spokesperson.

ADAP was anticipating a deficit of $3.9 million three months into the fiscal year and $16.4 million by next spring. Ohio now has 19 patients on the ADAP waiting list, and 30 more have applied.

"I'm not going to sit here and tell you that more cuts down the road are not a possibility," Carey said. That may depend in part on any federal assistance to Ohio's ADAP in the next month, he added. Case workers have been scrambling to provide alternative sources of assistance.

Nationally, 2,158 people with HIV/AIDS were on state ADAP waiting lists as of July 22, according to the National Alliance of State and Territorial AIDS Directors. The average cost of HIV drugs per ADAP client is about $12,000, and it is much higher for those outside of ADAP, said Ann Lefert, NASTAD's associate director of government relations.

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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Research from London School of Hygiene & Tropical Medicine Provides New Data about HIV/AIDS

A report, 'Child mortality in rural Malawi: HIV closes the survival gap between the socio-economic strata,' is newly published data in Plos One. According to recent research from London, the United Kingdom, "As HIV-related deaths increase in a population the usual association between low socioeconomic status and child mortality may change, particularly as death rates from other causes decline. METHODS/PRINCIPAL FINDINGS: As part of a demographic surveillance system in northern Malawi in 2002-6, covering a population of 32,000, information was collected on socio-economic status of the households."

"Deaths were classified as HIV/AIDS-related or not by verbal autopsy. Poisson regression models were used to assess the association of socio-economic indicators with all-cause mortality, AIDS-mortality and non-AIDS mortality among children. There were 195 deaths in infants, 109 in children aged 1-4 years, and 38 in children aged 5-15. All-cause child mortality in infants and 1-4 year olds was similar in households with higher and lower socio-economic status. In infants 13% of deaths were attributed to AIDS, and there were no clear trends with socio-economic status for AIDS or non-AIDS causes. For 1-4 year olds 27% of deaths were attributed to AIDS. AIDS mortality was higher among those with better built houses, and lowest in those with income from farming and fishing, whereas non-AIDS mortality was higher in those with worse built houses, lowest in those with income from employment, and decreased with increasing household assets. In this population, since HIV infection amon! g adults was initially more common among the less poor, childhood mortality patterns have changed," wrote A. Jahn and colleagues, London School of Hygiene & Tropical Medicine.

The researchers concluded: "The usual gap in survival between the poor and the less poor has been lost, but because the less poor have been disproportionately affected by HIV, rather than because of relative improvement in the survival of the poorest."

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 Prevention Planning Council Seeking New Members

The membership committee of the San Francisco HIV Prevention Planning Council is currently conducting its membership recruitment campaign.

For 2010, the committee is seeking members representing the following categories: gay males or men who have sex with men (MSM); people living with HIV; Asian and Pacific Islanders; Native Americans; injection drug users; MSM IDUs; and people under age 25. Persons with experience or expertise (either lived or professional) in one or more of the following areas are encouraged to apply: biomedical interventions; behavioral interventions; collaborations within other health fields or disease prevention activities; research, data, analysis and/or evaluation; hepatitis C; epidemiology; and the faith community.

Minimum requirements for membership are that individuals must live or work in San Francisco and can commit up to 10 hours a month to HPPC business. The application deadline is Aug. 12. For more information, visit http://sfhiv.org/community.php or telephone Betty Chan Lew at 415-554-9494.

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/AIDS Funding Restored in San Francisco Budget

The $6.5 billion budget approved by the San Francisco Board of Supervisors on July 20allocates more than $1 million to restore funding that benefits people with HIV/AIDS and youths.

The budget includes full funding of $560,000 in rent subsidies for persons with HIV/AIDS, Supervisor Bevan Dufty said, as well as $500,000 for core services related to youths.

Mission Bay resident Arye Bender, whose monthly rent is subsidized through the program, talked about the link between housing and treatment adherence. "A large part of that discipline is having stable, clean housing," he said.

"We are so thrilled at the leadership provided by the Board of Supervisors in making this happen," said San Francisco LGBT Community Center Executive Director Rebecca Rolfe. "It certainly looked for a long time like services not just for LGBT youth, but the entire city, were going to be drastically reduced." Specific concerns included meal programs for youths and links to employment services.

Dufty recognized the public testimony of many San Francisco youths during the budgeting process. "We want these young people to feel empowered," he said.

Supervisors are scheduled to take a final vote to adopt the budget during the week of July 26.

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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L.A. County Trails in Needle Exchange

Los Angeles County pharmacies distributed fewer than 5,000 syringes in 2007 under a state program designed to stem the spread of blood-borne diseases. In comparison, San Francisco's pharmacies, though far fewer in number, sold nearly 14,000 syringes, according to a new study by California State University-Dominguez Hills (CSU-DH).

The five-year pilot program, whose goal is to remove barriers to clean needle access, began in 2005. Statewide, 650 pharmacies in 15 counties and four cities have registered with local governments, a program requirement, and can sell up to 10 syringes with no questions asked. The California Department of Public Health funded the CSU-DH research.

In 2007, CSU-DH researchers surveyed pharmacies in San Francisco County and in selected areas of Los Angeles County, regardless of whether they had registered for the program. A total of 67 San Francisco pharmacies and 171 in selected regions of Los Angeles were polled.

Among the surveyed drug stores, just 28 percent of Los Angeles pharmacies had signed up for the program, compared to 76 percent in San Francisco. Of all pharmacies in L.A. County, just 17 percent have registered to take part.

"What surprised me the most was that pharmacists [in San Francisco] were more open to speaking with us, to give us time, than those in Los Angeles," said Chaka Dodson, a CSU-DH graduate student who helped oversee the study. L.A. County pharmacies "were very uneasy, and seemed pretty suspicious."

Almost half of Los Angeles pharmacies surveyed said they did not sell syringes out of fear of being robbed or harmed by drug users, Dodson said. They also were more likely to turn away suspected drug users and less likely to provide information on proper needle disposal, disease prevention, and drug treatment.

The study, "Pharmacy Participation in Non-Prescription Syringe Sales in Los Angeles and San Francisco Counties, 2007," was published in the Journal of Urban Health (2010;87(4):543-552).

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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Sex Now Chief Cause of Ukraine's AIDS Epidemic

The most common mode of transmission in Ukraine's devastating HIV epidemic has shifted from injection drug use to heterosexual sex.

In 2009, 43 percent of reported HIV cases were believed to have been the result of heterosexual contact. Transmission by injection drug use accounted for another 35 percent, health authorities say.

The two modes of transmission are interconnected. A typical scenario involves a male injection drug user who does not know his HIV status giving the virus to a woman who likely does not know her partner uses IV drugs.

"Two-thirds of cases of sexual transmission are liked to intravenous drug use," said Tetyana Deshko of the International HIV/AIDS Alliance Ukrainian branch.

In 2009, HIV prevalence among Ukraine's adult population was 1.11 percent, among the highest in Europe, according to a national report prepared by the Ukrainian Ministry of Health for UNAIDS. In January of this year, 101,182 adults with HIV/AIDS were under medical observation in specialized facilities. The government estimates 360,000 residents age 15 and older are HIV-infected.

Some regions of the country report an HIV infection rate among pregnant women above 1 percent, said Svitlana Antonyak, a national HIV clinic official.
Controlling the epidemic in Ukraine is complicated by the prevailing public perception that using a condom indicates lack of trust in one's partner, Deshko said. In addition, many Ukrainians believe that HIV affects only "disadvantaged groups," Deshko said.

The increasing use of antiretroviral therapy, introduced into Ukraine only six years ago, cut the morality associated with AIDS last year for the first time. An estimated 7,500 people who need such drugs are going without, officials say.

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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Prisons Emerge as Hotspots for AIDS Pandemic

A toolkit to help governments prevent and treat HIV among prisoners was rolled out by the UN Office on Drugs and Crime during the 18th International AIDS Conference in Vienna. "Health care in prisons should be at least equivalent to that in the community," UNODC stated.

HIV is far more prevalent among the world's 30 million penitentiary inmates than in the general population, UNODC said. The virus is spreading through sex between inmates, injecting drug use, and tattooing. Overcrowding, corruption and limited access to condoms and HIV care exacerbate the problem, scientists told conference attendees.

The situation in African prisons is particularly dire. Zambia has no HIV screening and just 14 health care workers for the 15,300 prisoners in its 86 jails, said Katherine Todrys, who conducted a study of six Zambian jails for Human Rights Watch. The US State Department estimates that in 2008, the proportion of Zambian prisoners who were HIV-positive was 27 percent, twice that of the country's non-incarcerated population.

Nigeria forbids the distribution of condoms among its prison population, reported Emika Chima of the Society of Family Health. "It is prohibited because if you do that you're encouraging sodomy, that's the stance," he said. "In Nigeria, officially, same-sex practices don't exist."

Nevertheless, the Open Society Institute reported that efforts to extend HIV prevention and treatment to inmates can be very successful. A needle-exchange and methadone program introduced by Moldova in the late 1990s now reaches 75 percent of inmates, OSI said.

US research suggests that care for HIV-positive injecting drug users is more effective when begun before a prisoner is released. Methadone programs initiated behind bars also were more effective than post-release referrals to such programs, research indicates.

"This isn't just about prisoners," said Brown University researcher Samuel Dickman, who conducted the study. "This is about communities prisoners return to."

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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Obama Pledges to Up AIDS Fight Despite Tough Times

The United States remains committed to fighting AIDS abroad and to redoubling efforts through the US Global Health Initiative, President Barack Obama pledged in a video-link address at the conclusion of the 18th International AIDS Conference in Vienna. Obama's speech followed criticism from some advocates at the conference that his administration has failed to capitalize on momentum in tackling HIV/AIDS internationally.

In the address, the president acknowledged that the US fiscal environment is a challenge in the wake of the global recession. However, Obama said his administration is focusing on comprehensive, sustainable, and effective approaches to handling HIV/AIDS.

Obama's $63 billion Global Health Initiative will address a range of diseases and focus on developing better health systems in poor nations. Nevertheless, some activists say the initiative will take funding away from HIV/AIDS programs including the Global Fund to Fight AIDS, TB and Malaria. The head of the Global Fund has said he worries about the prospect of securing the $20 billion needed to cover projects over the next three years.

A UNAIDS report released at the conference showed support from the wealthiest nations leveled out in 2009. That year, the G-8 wealthy nations, the European Commission and other government donors provided $7.6 billion for AIDS in developing nations, down from $7.7 billion in 2008, UNAIDS said.

Secretary of State Hillary Clinton, appearing on the video with Obama, said access to HIV/AIDS prevention, treatment and care should be "a universal, shared responsibility."

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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New HIV Cases Return to Levels Seen in Early 1980s; Shift Sees Fewer Homosexual Patients

Canada's HIV epidemic "is changing, and so must our response," according to Dr. Steffanie Strathdee, associate dean of Global Health Services in the department of medicine at the University of California-San Diego.

"The downward trend [in new HIV infections] in Canada started reversing itself in 2001." Canada saw approximately 3,300 new HIV diagnoses in 2008, according to data from the Public Health Agency of Canada. Among the new cases, 36 percent were heterosexuals, and 44 percent were men who have sex with men. Increasingly, Strathdee said, new diagnoses are turning up among IV drug users, immigrants and aboriginals. Strathdee, who holds dual Canada-US citizenship, made her remarks Thursday at the 18th International AIDS Conference in Vienna.

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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Program Modifies Behavior in Some HIV-Mixed Couples

Black HIV-discordant couples participating in an HIV/STD risk-reduction intervention program demonstrated lower rates of risky behavior, according to a new study by researchers at the National Institute of Mental Health.

Willo Pequegnat and colleagues conducted a cluster-randomized trial of couples taking the "Eban" intervention program. Of the 535 discordant couples enrolled, 260 took part in Eban, which included eight weekly two-hour sessions led by trained African-American facilitators. The remaining 275 couples participated in a similarly structured general health-promotion program targeting individual - not couple-focused - health and behaviors linked to heart disease, hypertension, and certain cancers. The main behavioral outcome was couple's reported use of condoms, while the primary biological outcome was cumulative incidence of STDs.

The baseline average proportion of condom-protected intercourse for each group was 44 percent. At the end of one year, Eban participants reported significant increases in condom use and more consistent condom use. After adjustment for baseline measure, the rate was 77 percent in the Eban group compared with 47 percent in the control group. The adjusted percentage of couples consistently using condoms was 63 percent in the intervention group and 48 percent in the control group.

However, cumulative STD incidence between the groups did not differ at the end of 12-month follow-up. This could be because the intervention did not affect the rate of concurrent partners, the researchers noted.

Two HIV-negative partners in the intervention group seroconverted compared with three in the control group, a total of five seroconversions among the 535 couples, translating to 935 infections per 100,000 population. This observed seroconversion rate is "substantially larger" than the annual HIV incidence estimate overall for blacks (approximately 83.8 per 100,000), suggesting that HIV-negative members of such couples are at very high risk, the researchers warned.

The study, "National Institute of Mental Health Multisite Eban HIV/STD Prevention Intervention for African-American HIV Serodiscordant Couples: A Cluster Randomized Trial," was published early online in the Archives of Internal Medicine (2010;doi:10.1001/archinternmed/2010/261.

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AIDS: Activists Lobby for 'Robin Hood' Levy

Now is the time to push for a micro-tax on all financial transactions to fund HIV prevention and care throughout the world, activists said this week at the 18th International AIDS Conference in Vienna.

The so-called "Robin Hood" tax of 0.005 percent would generate $33 billion annually worldwide, said Khalil Elouardighi of Coalition PLUS, an assembly of HIV advocacy groups.

"It acts like an invisible micro-withdrawal. Knowing that 97 percent of transactions are of a speculative nature, there will be no consequence on the real economy," noted Philippe Douste-Blazy, UN undersecretary-general for innovative financing for development.

One challenge is to ensure that receipts from such a tax are funneled to HIV/AIDS and not diverted to other needs, said Douste-Blazy, a former French foreign minister.

Douste-Blazy also serves as chair of UNITAID, a World Health Organization enterprise dedicated to expanding treatment for HIV, tuberculosis, and malaria. France and 11 other countries have implemented a UNITAID funding mechanism in which a small tax on airline tickets helps to pay for treatment of HIV-positive pregnant women.

Countries adopting a micro-tax assessment would not be immune from existing donor obligations, said Christoph Benn of the Global Fund to fight AIDS, TB and Malaria.

"We are not taking away any pressure from governments to provide additional resources from their development budgets: that is a given, that is our first request, that they increase their contributions," Benn said.

Activists feel this is the right time to advocate for the tax, given the upcoming Millennium Development Goals meeting in September and a G-20 gathering in November.

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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Aging With HIV: The Hidden Side of the World's AIDS Crisis

For the first time, the world is about to encounter a sizable cohort of HIV-positive persons age 60 and older.

"There have always been older people with HIV, but what is new is the numbers. That will require new public health thinking compared to the past," said Gottfried Hirnschall, director of HIV/AIDS for the World Health Organization.

The first significant cohort to survive decades on HIV therapy is found in western nations, where antiretroviral therapy (ART) was introduced in 1996. In the 33 US states with long-term name-based HIV reporting, those 50 and older in 2005 accounted for 24 percent of the HIV-positive population, up from 17 percent in 2001. The shift is expected to appear next in sub-Saharan Africa, which began to access ART around 2005.

Older HIV-positive survivors are notable not only for their numbers. In a survey by Great Britain's Terrence Higgins Trust, HIV-positive respondents over 50 were more likely than their HIV-negative peers to be unemployed. In addition, many HIV-positive respondents had not anticipated a long life, and had banked only modest savings.

Living into old age with HIV infection and ART also is associated with greater likelihood of an array of illnesses: hypertension; diabetes; lipodystrophy; metabolic disorders; osteoporosis; heart, liver, and kidney disease; and cancer.

"In the future, we are going to see patients living decades, and we are going to have to figure out ways of getting them to a healthy old age," said Margaret Hofffman Terry of the American Academy of HIV Medicine, who presented a profile of aging and HIV at the 18th International AIDS Conference this week in Vienna.

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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Call to End War on Drugs Falls on Distracted Ears

Drafted by a team of international experts, the official declaration of the 18th International AIDS Conference (IAC) calls for drug policy reform to remove barriers to HIV prevention, treatment, and care. Outside sub-Saharan Africa, almost one-third of all HIV infections stem from injection drug use.

"The criminalization of illicit drug users is fueling the HIV epidemic and has resulted in overwhelmingly negative health and social consequences," the declaration states. "A full policy reorientation is needed."

This marks the second-ever IAC declaration. Its first, the 2000 Durban Declaration, reaffirmed that HIV causes AIDS in response to the AIDS denialist policies of South Africa's government at that time.

The Vienna declaration proposes that drug users not be arrested but offered science-based treatment programs that have been clinically proven. It also calls on governments to "abolish ineffective compulsory treatment centers," which violate human rights.

Arresting drug users drives them away from HIV prevention and care services "and into environments where the risk of infectious disease transmission (e.g., HIV, hepatitis C and B, and tuberculosis) and other harms is increased," the declaration says.

IAC also calls on governments and international organizations to endorse and scale-up funding for comprehensive interventions. Such efforts include offering injecting drug users' access to sterile syringes, methadone, and HIV/AIDS treatment for those infected.

"In some areas where HIV is spreading most rapidly, such as Eastern Europe and Central Asia, HIV prevalence can be as high as 70 percent among people who inject drugs, and in some areas more than 80 percent of all HIV cases are among this group," according to the statement.

Only two governments responded to the declaration: Canada rejected it, and the Democratic Republic of Georgia embraced it. Reports that global AIDS funding is ebbing due to the recession largely overclouded the declaration.

For more information: http://www.viennadeclaration.com.

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Is There a Cure for AIDS? Forum Lifts a Taboo

Connecting at the 18th International AIDS Conference this week in Vienna are about 200 researchers who want to resurrect the search for a definitive AIDS cure. Convened by 2008 Nobel laureate Francoise Barre-Sinoussi, attendees are mapping out a research agenda and establishing methods to coordinate their efforts.

"It's the single biggest hurdle we have to get over," said Kevin Frost, CEO of the American Foundation for AIDS Research (amfAR). Frost said "cure" is a word rarely used by AIDS researchers, who are both mindful of the virus' extraordinary ability to survive and wary of stoking unrealistic expectations.

One likely research objective is learning how to attack the tiny, latent reservoirs of infection that persist even when antiretroviral therapy has reduced HIV to undetectable levels.

"We have to build a strategy for understanding what the reservoir comprises, its relationship with the immune system, whether there is a genetic predisposition to it and whether there are new drugs that can tackle it," said Jean-Francois Delfraissy, director of France's National Agency for AIDS Research.

Scientists are investigating one reservoir, an immune system component known as resting memory T cells. A person with HIV has about 1 million infected resting memory T cells, dormant and invisible to the immune system. One possible line of attack is to animate these cells so that they start shedding HIV. Once the resting memory T cells betray their existence and location, so the reasoning goes, they can be found and destroyed.

Other possible reservoirs are located in the brain, the genital area, the gastrointestinal tract, blood stem cells, and macrophage cells.

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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Advocates Decry New Jersey Changes in AIDS, HIV Assistance

AIDS advocates say a new income cap for the state AIDS Drug Assistance Program (ADAP) will force patients to choose between buying their medicines and paying other bills, unless they quit work in order to qualify under the new limit.

The income cap goes into effect Aug. 1 and is expected to save the state roughly $7.4 million. Previously, a person earning less than $54,150 was ADAP-eligible. Next month, allowable income drops to $32,490, disqualifying 967 of the 7,645 people enrolled at the end of 2009. Department of Health and Senior Services (DHSS) spokesperson Dawn Thomas said the change puts New Jersey's income limit on par with those in 25 other states.

However, the budget signed by Gov. Chris Christie last month increased appropriations for ADAP more than 75 percent, from $9.8 million to $17.2 million. The decision to limit access to ADAP even as its budget rises is "going to be very difficult, politically, to explain," said Beth Crutsinger-Perry, an associate director with the National Alliance of State and Territorial AIDS Directors.

DHSS officials say the tighter enrollment criteria anticipate higher drug costs and 200-300 new low-income applicants next year.

Limiting ADAP access via income eligibility is the last cost-saving measure a senior official at the Hyacinth AIDS Foundation would have recommended. Cutting funds for case management or trimming from the list of covered drugs would have been preferable, said Axel Torres Marrero. Without assistance, HIV/AIDS medications can cost patients $22,000 annually. HIV drugs require "100 percent adherence," he said.

The cost of assistance is far cheaper than the expense of emergency room visits or long hospital stays if an HIV/AIDS patient goes off medication, said Dr. David Condoluci of Garden State Infectious Disease Associates in Voorhees.

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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HOPWA Receives $5 Million Increase from FY2010 Level

The Senate Transportation, Housing, and Urban Development (T-HUD) Appropriations Subcommittee marked up its Fiscal Year (FY) 2011 spending bill on Wednesday. The HOPWA program was appropriated $340 million, a $5 million increase from FY 2010 levels and equal to the President's FY 2011 budget request.

"The Senate is always tougher in appropriations however it is encouraging that public housing and homeless assistance programs will receive increased funding across the board, " said NAHC Executive Director Nancy Bernstine.

You can view the Appropriations Summary at: http://www.appropriations.senate.gov/news.cfm?method=news.view&id=a99f2a12-649b-4fa4-bc43-f58303b4e142.

Please note that HOPWA is listed on page 3.

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Lowering the Risk of Secondary HIV Transmission: Insights from HIV-Positive Youth and Health Care Providers

"Both perinatally and behaviorally infected HIV-positive youth engage in sexually risky behaviors, and a better understanding of the perceptions of these youth and of health care providers regarding disclosure of HIV status and risk reduction would aid in the development of behavioral interventions for such youth," according to the authors of the current study.

In spring 2007, in-depth, semi-structured interviews were conducted with some 20 HIV-positive inner-city youths (ages 13-24) and 15 health care providers who work with HIV-infected youths. The youths were recruited at an HIV clinic, AIDS clinics, and an AIDS service organization; they had received care from participating providers. A detailed contextual and thematic analysis was conducted using interview transcriptions.

Of the 20 youths, 18 had disclosed their HIV status to another person at least once; 11 reported being sexually active, and three of these had been perinatally infected. Qualitative analysis revealed four disclosure-related sub-themes: stigma and emotions, trust issues, reasons for disclosing, and strategies for addressing disclosure. Five sub-themes were identified related to sexual risk reduction: dating challenges, attitudes concerning condom use, self-efficacy in negotiating condom use, pregnancy attitudes, and sexual risk reduction strategies. Providers reported that risk reduction counseling with HIV-positive youths could be enhanced via access to more engaging and interactive educational tools within the clinical setting.

"HIV-positive youth experience multiple challenges regarding disclosure and sexual risk reduction, and health care providers need innovative tools that can be used in clinic settings to improve adolescents' skills in reducing risky sexual behavior," 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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Study Finds MTV AIDS Project Changes HIV Attitudes

Young people in Africa and the Caribbean report positive shifts in knowledge and attitudes after watching MTV dramas that address HIV, said researchers at the 18th International AIDS Conference this week in Vienna.

The MTV music channel project is backed by the UN and tackles the risks of unsafe sex, multiple partners, and injecting drugs. The programming also provides information on testing, treatment and overcoming HIV-related stigma.

"The results have shown a really positive change in terms of attitudes, knowledge, and the sense among young people that they understand the risks and can take action to address them," said Susan Kasedde, a UNICEF HIV prevention specialist.

Part of the MTV project is a television series called "Shuga" that depicts "the reckless sex lives and loves of young Kenyans and their partners." It was first aired in Kenya in November 2009.

An evaluation by Johns Hopkins' researchers indicated that the program was seen by 64 percent of Nairobi residents ages 16-24. More than 80 percent of those who watched the program said it altered their views on multiple concurrent partners, HIV testing, and HIV-related stigma.

"These results make us determined and completely committed to continuing our campaigns globally," said Bill Roedy, CEO of MTV Networks International.

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 Eager to See Speedy Roll-Out of AIDS Gel

South Africa's health minister on Tuesday said he is very pleased with a study showing that a tenofovir-based vaginal microbicide is partially effective in preventing heterosexual women from HIV infection.

"We are very interested in it," Aaron Motsoaledi said when asked whether South Africa's government will move ahead to endorse the gel before it has been licensed. "We believe in an evidence-based approach and if scientists say this thing is going to work, then we will definitely be looking at it. So far, evidence is showing that it is very promising."

The gel reduced HIV incidence by 39 percent over 2.5 years, and by 54 percent among women with greater than 80 percent adherence to the regimen, scientists told the 18th International AIDS Conference in Vienna.

The director of the World Health Organization, Dr. Margaret Chan, said she would work to deploy the gel if it continues to prove safe and effective in future studies. Researchers already are planning a trial involving 5,000 women in South Africa, Malawi, Uganda and Zimbabwe. The South African trial was smaller, with 889 women.

Countries with the greatest need should be free to move forward and use new HIV/AIDS drug formulations without waiting for US Food and Drug Administration (FDA) approval, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

"Judgments will have to be made by individual nations based on their need for such an approach as to how they will use the [trial] data to utilize the product," Fauci said. "And I don't necessarily think that there has to be a direct link between something that is approved by the FDA and something that [the President's Emergency Plan for AIDS Relief] will pay for."

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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AIDS: Fewer Than 10 Percent of Drug Users Get Help

A small fraction of the world's HIV-positive injection drug users (IDUs) get the assistance they need to keep themselves healthy and avoid spreading the virus to others, according to reports presented this week at the 18th International AIDS Conference in Vienna.

Among the world's estimated 16 million IDUs, some 3 million to 6.6 million are believed to be HIV-positive. This week in the Lancet, Louisa Degenhardt - of the National Drug and Alcohol Research Center at the University of New South Wales, Australia - and colleagues said criminalization of drug use and marginalization of users increases the risk they will transfer the virus to others. The most common methods of transmission are sharing needles and turning to prostitution to pay for a drug habit.

Of IDUs worldwide:
*5 percent have access to an established needle-exchange program; *8 percent have access to programs that provide substitutes for heroin and other opiates.

In addition, of HIV-positive IDUs, only 4 percent have access to antiretroviral therapy, which can reduce their risk of transmission by 90 percent. These three interventions together have been shown to cut the prevalence of HIV among IDUs by more than half.

UNAIDS last year recommended that 19 percent of HIV prevention funding be directed toward IDUs, but this population was the target of only about 1 percent of prevention allocations.

More than two-thirds of the region's 1.5 million HIV patients reside in Russia. Russia and Ukraine together account for 90 percent of the region's HIV cases.

Dengenhardt's study is one of a series of articles on HIV and drug use published online this week in the Lancet.

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/AIDS Patients' Health Care Options Thin

Since June 1, the state AIDS Drug Assistance Program (ADAP) for low-income patients has turned away 177 qualified applicants, canceled several provider contracts, and slashed funding to community clinics, all in a bid to plug an $11.7 million budget shortfall, according to DeAnn Gruber, interim administrative director of Louisiana's HIV/AIDS Program.

However, these reductions total only $4 million to $5 million. If officials cannot find additional funding for ADAP or manage further cuts to the program, which is estimated to cost $31.4 million through March 2011, they could be forced to eliminate it altogether by next spring, the state Office of Public Health said.

Louisiana's ADAP has been hard-hit in recent years by a confluence of factors, including a 15 percent increase in new HIV patients in the state since 2008. New Orleans ranks third behind Miami and Baton Rouge in new AIDS cases and eighth in the proportion of residents living with AIDS, advocates say.

Poverty is a key reason for the region's high HIV/AIDS rates, triggering other social problems such as lack of education, poor access to health care, and high prevalence of other STDs that can increase the risk of contracting HIV.

In 2009, more than 3,500 residents relied upon ADAP in Louisiana, where 56 percent of residents have incomes below 300 percent of the federal poverty level, and 19 percent are uninsured.

The state is encouraging would-be ADAP applicants to apply to pharmaceutical patient-assistance programs. Ryan White case managers and AIDS service organizations' staff have stepped in to help patients with the application process, which can take about two weeks. Alana Moore of the NO/AIDS Task Force said she has yet to see an eligible person turned away by a drug company.

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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