OraSure HIV Test Inches Closer to FDA Approval

The Food and Drug Administration is in the final stages of reviewing a proposed over-the-counter version of the rapid HIV test available in hospitals and clinics, test-maker OraSure Technologies said recently.

To gain approval, OraSure will at a minimum have to prove that consumers untrained in lab testing can correctly use the OraQuick Rapid HIV test. The final review includes an assessment of such unsupervised self-testing. OraSure said it expects the trial "will continue well into 2011." "We are extremely pleased to have approval to begin the final phase of studies to support our efforts to obtain FDA approval for an over-the-counter offering of our OraQuick HIV test," said Douglas A. Michels, the company's president and CEO.

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!

Silicon Valley AIDS Center to Close

Despite fundraising efforts, a loss of corporate sponsorship is shuttering the Silicon Valley AIDS Leadership Center. SVALC, the only organization in Santa Clara County focused exclusively on fighting HIV/AIDS, will close its doors by year's end, said James Lee, the center's chairperson.

According to Lee, the $100,000 to $200,000 in corporate philanthropy SVALC once enjoyed has vanished due to the recession. A food festival, a popular AIDS walk, banquets, and other fundraising efforts could not overcome the loss, he said. "It turns out none of our efforts turned up enough money," Lee noted.

Faced with the prospect of falling into debt, SVALC's board of directors decided to liquidate all assets and distribute those funds to local AIDS agencies.

"I'm really saddened to see them close. We worked with them for many, many years," said Dr. Martin Fenstersheib, the county's health director.

Vida Kanthak, director of HIV education and training for the Community Health Partnership, one of 10 agencies that received support from SVALC this year, said the center's grants, though modest, helped offset funding cuts from the county at a critical time. "It's definitely a loss," she said.

Worse than the loss of funding is the loss of an agency that got people "to pay attention to this problem," said Kanthak.

Marianne Gallagher, a retired nurse who recently joined SVALC's board, helped stage the center's first AIDS walk at Stanford University. "The loss of the walk is the saddest part," she said. "It's an institution in Silicon Valley."

Lee said the board hopes one of the agencies SVALC has supported will keep the annual walk going.

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!

HIV+ Women Need Annual Cervical Cytology: ACOG Guidelines

The American College of Obstetricians and Gynecologists recently issued guidelines for the routine gynecological care of HIV-positive women. "Most of the women living with HIV today in the US are in their prime reproductive years," noted Dr. Hal C. Lawrence, vice president of practice activities for ACOG.

All women ages 19 to 64 should receive routine HIV screening, the report recommended. While there is no consensus on how often repeat screening should be offered, the guidelines suggested at least annual testing for women at elevated risk, including injection drug users, those whose partners are injection drug users or HIV-positive, and those have had an STD in the previous year.

The guidelines recommend aggressive treatment of STDs, which increase the risk of HIV transmission. CDC recommends annual testing for curable STDs, ACOG noted. HIV-positive women should have cervical screening twice during the first year after HIV diagnosis and annual screening thereafter.

HIV-positive women are at increased risk of bacterial vaginosis and yeast infections, and treatment may take longer than average, the guidelines note. Women with recurrent yeast infections may need long-term medication to forestall future yeast infections, they said.

Condoms, which are recommended for all sexually active HIV-positive persons, plus another method of birth control are recommended to prevent unintended pregnancy among HIV-positive women of child-bearing age. Oral contraceptives are safe for women with HIV, but combined oral contraceptives generally are not recommended for women taking certain antiretroviral therapy, as the medications can interfere with each other. ACOG notes that IUDs can be a good birth control option for HIV-positive women.

Strategies are available for HIV-positive women who wish to become pregnant to avoid the risk of vertical transmission. They include reducing the virus to undetectable levels before delivery, not breastfeeding, and administering the infant prophylactic antiretrovirals.

HIV-positive women tend to go through menopause about three to four years before other women, according to the guidelines. In the absence of detailed research, the guidelines suggest standard interventions to address the bone loss often seen in menopausal women: increasing physical activity, stopping smoking, and taking vitamin D and calcium supplements.

The full report "Practice Bulletin No. 117: Gynecologic Care for Women with Human Immunodeficiency Virus," was published in Obstetrics & Gynecology (2010;116(6):1492-1509).

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!

Delaying Treatment for HIV Can Become Costly

The higher costs of starting HIV treatment when the disease is well advanced can persist for years, report researchers from Johns Hopkins University.

Among 8,348 study patients in nine HIV clinics around the country, the stage of the disease when treatment began had a dramatic impact on costs. Treatment costs during the first seven or eight years for "late entrants," those who began care when CD4 counts were equal to 200 cells/mm3 or below, were $27,275 to $61,615 higher than for those who entered care with a CD4 count of more than 500.

"We know that it's important clinically to get people into care early because they will stay healthier and do better over the long run," said a statement from Dr. Kelly Gebo, an associate professor of medicine in the division of infectious diseases at Hopkins' School of Medicine. "But now we know it's also more costly to the health care system for potentially decades and a serious drain on our limited health care dollars."

The researchers attributed the additional cost to the challenge of boosting CD4 counts when they have dropped to low levels. In addition, the weakened immune system of someone who has a low CD4 count is more vulnerable to other diseases.

People often delay treatment because they do not know they are infected, because they do not know how to access care or because of other issues such as addiction or mental illness, the researchers said. The patients in the study entered care between 2000 and 2006.

The full study, "The Economic Burden of Late Entry into Medical Care for Patients with HIV Infection," was published in Medical Care (2010;48(12):1071-1079).

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!

Three Big Developments Make AIDS Outlook More Hopeful

Three recent developments on the HIV/AIDS front have renewed hope among health experts and advocates. On the same day, Nov. 23, UN officials announced a dramatic drop in new HIV cases globally, the pope opened the way for condom use to prevent HIV, and study results showed that a daily AIDS treatment already on the market could help prevent new infections in gay men.

"I don't know of a day where so many pieces are beginning to align for HIV prevention and treatment, and frankly with a view to ending the epidemic. This is an incredibly opportune moment and we have to be sure we seize it," said Mitchell Warren, head of the AIDS Vaccine Advocacy Coalition, a non-profit organization dedicated to HIV prevention research.

According to the UN, new HIV cases declined almost 20 percent over the last decade and 33.3 million people worldwide are currently infected. Health officials attribute part of the drop to more widespread use of condoms. "We can say with confidence and conviction that we have broken the trajectory of the AIDS pandemic," UNAIDS chief Michel Sidibe said in Geneva.

And in a historic shift, Pope Benedict XVI said using a condom is a lesser evil than spreading HIV.

Finally, in what scientists call a true breakthrough, a three-year global study found that daily doses of Gilead Science's Truvada cut the chances of HIV infection in gay and bisexual men by 44 percent, and by 73 percent or more among men who took the medicine more consistently.

The results are "a major advance" in curbing the epidemic in gay men, said Dr. Kevin Fenton, director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. But he warned that the results may not apply to people exposed through drug use, male-female sex or other ways.

Men who have sex with men account for nearly half of the more than 1 million Americans living with HIV. Worldwide, 5 percent to 10 percent of cases involve sex between men.

"The condom is still the first line of defense," since it protects against other STDs and unwanted pregnancies, said Dr. Robert M. Grant of the Gladstone Institutes and the study leader.

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!

Teens Should Teach Adults About Safe Sex

An Indiana University study published last month in the Journal of Sexual Medicine examined the habits of almost 6,000 people ages 14 to 94. Forget the 'teens gone wild' stereotypical thinking. The statistics that give pause are unmarried adults:

*91 percent of men older than 50 do not use condoms for sex with a date or casual acquaintance.

*70 percent of men over 50 do not use condoms when having sex with someone they just met.

*Some men and women over 50 didn't use condoms even when they knew that they or their partner had an STD. By comparison, 80 percent of sexually active teen boys and 69 percent of teen girls' partners used condoms during their most recent encounters.

Researchers say this proves kids are getting the 'safe sex' message.

Why such reckless behavior among older people? According to Debra Herbenick, associate director of the Center for Sexual Health Promotion at Indiana University, Boomers didn't come of age with pervasive messages about condoms.

Public campaigns on condom use and safe sex should begin to target older folks. But Herbenick says health care providers can also play a role by asking patients about all aspects of their sexual lives.

University of Texas psychologists David Buss and Cindy Meston have conducted several studies, including 'Why Women Have Sex,' which looked at the habits of more than 1,000 women ages 18-86 from every racial group. With women over 30 expressing a greater desire for sex, Buss noted it's possible that the onus for increased condom use, as with birth control in the past, may fall disproportionately to women.

As hard as I've preached to my 18-year-old son Brandon about behavior, condoms, abstinence, and the stigmas associated with STDs, it's a tad awkward these days as he somewhat jokingly returns the advice to his post-divorce mom. Turnabout is fair play, especially when adults aren't taking their own advice.

The author is a freelance writer in Dallas.

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!

New York HIV/AIDS Agency Seeks Clients for Nutrition Program

The only thing missing in Hudson Valley's largest HIV food program is enough HIV-positive clients.

Together Our Unity Can Heal, an agency in Congers, N.Y., serves about 85 of the estimated 785 HIV-positive Rockland County residents, said TOUCH Executive Director Robert Maher. "I think the majority of people who aren't using the program don't know about it," Maher said.

TOUCH raises about $40,000 annually to cover its costs, and recently received a $1.25 million federal grant to continue the program. To be eligible, a person must be HIV-positive and meet twice per year with a nutritionist. There is no income eligibility limit.

TOUCH has revamped its menu over the years to respond to the longer lifespan and changing nutritional needs of HIV-positive clients. Recognizing the growing problem of diabetes, heart disease, and obesity among clients, the food program has abandoned high-calorie foodstuffs in favor of fresh fruit, vegetables, and whole grains.

Each week, clients receive a seven-day supply of food, plus a $60 gift card for perishable items such as milk. To ensure the clients make healthy choices with the gift card, they submit receipts to TOUCH.

"This is truly helping improve people's eating habits," Maher said. "We all know how difficult it is to eat better and we recognize how expensive it is to eat better."

TOUCH hopes to offer clients cooking classes to help them prepare nutritious, good-tasting meals. Germonds Presbyterian Church in New City has donated use of its kitchen; TOUCH is looking for a volunteer to run the classes, Maher said. For more information, telephone 845-268-8023.

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!

HIV Inmate Deprived of Care, Suit Says: ACLU Says Case Reflects Pattern of Failure at City Jails

An HIV-positive inmate received substandard care at a St. Louis jail, including 17 days without his medication, charges a suit filed on his behalf by the American Civil Liberties Union of Eastern Missouri.

The man, known in court documents as John Doe, is in his late 40s. He was arrested in March 2010 and released this month. Prison officials knew of his condition, and the physician who had treated him successfully before incarceration faxed to the jail details about his medication regimen, the suit says.

The suit named as defendants the city, vendor Correctional Medical Services, jail superintendent Eugene Stubblefield, and Drs. Brenda Mallard and Susan Singer of CMS. The current case is indicative of a pattern of poor care at St. Louis' Justice Center downtown and the Medium Security Institution on Hall Street, the suit says.

"It's inexcusable, and it's serious," ACLU Legal Director Tony Rothert said.

A spokesperson for the city rejected the premise of the suit. "Contrary to the claims of the ACLU, the records of the inmate in question reflect that he received adequate medical care consistent with his constitutional rights," Deputy City Counselor Nancy Kistler said.

In a 2009 report, the ACLU charged the jails with inmate abuse, providing inadequate medical attention, falsification of reports, and unsanitary conditions.

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!

Truvada Cuts HIV Risk Significantly in San Francisco Study

Taking two HIV drugs once-daily provided high-risk but HIV-negative participants an average 44 percent protection against HIV infection in a trailblazing new study.

The clinical trial followed 2,499 HIV-negative men who have sex with men (MSM) and transgender women who have sex with men in six countries, including a study site in San Francisco. Participants were randomly assigned to receive a combination of two antiretroviral drugs, emtricitabine plus tenofovir disoproxil fumarate (FTC-TDF), to be taken orally once a day, or a once-daily placebo. FTC and TDF in combination are marketed as Truvada.

At a median follow-up of 1.2 years (maximum 2.8 years), 100 subjects subsequently became infected, including 64 in the placebo group and 36 in the FTC-TDF group. Taking FTC-TDF as pre-exposure prophylaxis (PrEP) provided trial participants an average of 44 percent additional protection against HIV infection (95 percent confidence interval, 15 percent-63 percent; P=0.005). Among those with an adherence rate to FTC-TDF of 90 percent or more, HIV risk was reduced by roughly 73 percent (95 percent confidence interval 41 percent-88 percent).

"It will only work if people use it consistently, and the real challenge is how do you use it consistently," said study leader Dr. Robert Grant, a University of California-San Francisco professor and researcher with the Gladstone Institute for Virology and Immunology. "Condoms are still our first line of defense, but this could potentially be a very good backup."

Researchers are not recommending PrEP be immediately used to prevent HIV. For one thing, PrEP was only proven effective among MSM and transgender women who have sex with men, not heterosexuals or IV drug users.

Cost presents another issue: Truvada sells for $750 to $1,000 a month in the United States. A generic version available overseas costs about 40 cents a day.

Public health officials and representatives from Bay Area HIV/AIDS groups were meeting Tuesday morning to discuss how the trial results could affect local prevention efforts. CDC will be developing interim guidance, and urges individuals and their doctors to await those guidelines for the appropriate use of PrEP. For more information, visit http://www.cdc.gov/nchhstp/newsroom/iPrExMediaStatement.html.

The study, "Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with Men," was published in the New England Journal of Medicine (2010; doi:10.1056/NEJMoa1011205).

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!

UN Sees Global AIDS Epidemic Starting to Turn

Global HIV incidence fell 19 percent between 1999 and 2009, and the decline exceeded 25 percent in 33 countries, including 22 in sub-Saharan Africa, UNAIDS said in its annual AIDS Epidemic Update. At least 56 countries either have stabilized or significantly reduced HIV incidence, UNAIDS reported.

An estimated 33.3 million people worldwide have HIV, the agency said. In 2009, 5.2 million people with HIV in poorer countries were receiving treatment, or 36 percent of the 15 million developing-world citizens in need of antiretroviral therapy. An additional 1.2 million people began ARVs last year. However, for every person starting antiretroviral therapy, two people were newly infected with HIV.

"Just a few years ago, there were five new infections for every two people starting treatment," said Michel Sidibe, executive director of UNAIDS. "We are closing the gap between prevention and treatment."

The result was fewer AIDS-related deaths last year, about 1.3 million in sub-Saharan Africa, where 1.8 million people became newly infected with HIV. In addition, a trend analysis shows an overall decline in the percentage of people with more than one sexual partner in the last year in sub-Saharan Africa.

Last year, 370,000 mother-to-child HIV transmissions occurred, down 24 percent from five years ago, UNAIDS said. Rapid expansion of mother-to-child HIV prevention programs has been hindered by inadequate access to ante- and post-natal services, reported the agency.

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!

National Institute of Mental Health Multisite Eban HIV/STD Prevention Intervention for African-American HIV Serodiscordant Couples

Noting that rates of new HIV infections are seven times higher for African Americans than for white persons, the researchers undertook to determine whether couple-level efforts may be a promising intervention strategy.

A cluster randomized controlled trial (Eban) was conducted in four US cities - New York, Atlanta, Philadelphia, and Los Angeles - to determine if a behavioral intervention can reduce HIV/STD risk behaviors among HIV serodiscordant African-American couples. Eligibility requirements included both partners being at least 18 years old, being aware of each other's serostatus, and having had unprotected intercourse in the previous 90 days. In all, 1,070 participants were enrolled. Their mean age was 43; 40 percent of the males were HIV-positive.

The couples were randomized into one of two interventions: the couple-focused Eban HIV/STD risk reduction intervention, or attention-matched individual-focused health promotion comparison. The study's primary outcomes were the promotion of condom-protected intercourse acts and cumulative incidence of STDs (chlamydia, gonorrhea or trichomonas). Data were collected before and after the intervention, and at six and 12 months.

Data were analyzed for 260 couples in the intervention group and 275 in the comparison group. At 12-month follow-up, 81.9 percent were retained. Generalized estimating equation analyses found the proportion of condom-protected intercourse acts was greater among intervention group couples (0.77) than among the comparison group (0.47; risk ratio, 1.24; 95 percent confidence interval 1.09 to 1.41, P=.006) after adjustment for baseline criterion measure.

The adjusted percentage of couples consistently using condoms was higher in the intervention group (63 percent) than in the comparison group (48 percent, RR, 1.45; 95 percent CI, 1.24 to 1.70, P<.001) The adjusted mean number of (log) unprotected intercourse acts was lower in the intervention group than in the comparison group (mean difference, -1.52, 95 percent CI, -2.07 to -0.98; P<.001).

"The overall HIV seroconversion at the 12-month follow-up was five (two in the intervention group, three in the comparison group) of 535 individuals, which translates to 935 per 100,000 population," the authors noted.

"The findings draw attention to an effective intervention strategy that may be scaled up to curb the magnitude and continued spread of HIV and other STDs," the authors concluded. "Future studies must explore the generalizability of the findings to couples irrespective of serostatus and in settings where individuals and couples are not aware of their risks for HIV transmission but whose relationships can be supported as they learn to minimize the risks for themselves and each other. Moreover, the approach of engaging couples should be tested elsewhere in the United States and in other parts of the world, including sub-Saharan Africa, where sex-based power imbalances make it especially difficult for women in couples to reduce their risk of heterosexual exposure to HIV and other STDs."

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!

Sex Law that Raises Age of Consent to 16 Not Protecting Youth Most at Risk: Study

In a bid to prevent the sexual exploitation of adolescents by adults, Canada in 2008 raised the minimum age for legal consent to sexual relations from 14 to 16. However, 14- and 15-year-olds are much more likely to have sex with other youths within three years of their own ages - well inside the law's five-year "close-in-age" exception. Children under 13, on the other hand, are at greatest risk of exploitation by adults, a new study shows.

The analysis was based on the 2008 British Columbia Adolescent Health Survey, which polled more than 29,000 students in grades seven through 12.

"The change in law isn't going to change anything for them," as Canadians under 13 years old were already protected, said Elizabeth Saewyc, a professor of nursing and adolescent medicine at the University of British Columbia. Just 2 percent to 3 percent of teens ages 14-15 at sexual debut had partners who were 20 years old or more. Among those who had sex at age 12 and younger, 39 percent had partners age 20 or older.

"We're not seeing huge numbers of 14-year-olds, compared to 16-year-olds, having sex with adults," Saewyc said. "The kids who are much more vulnerable to having sex with adults are 13, 12, and even younger. So that's clearly an issue."

The proportion of youth surveyed who reported having had sex before age 14 declined, from about 37 percent in 1992 to 19 percent in 2008, Saewyc said. Condom use rose among the sexually active.

The government could have protected youth more by raising awareness about the existing laws and better enforcing them, said Saewyc.

The study by Saewyc and colleagues was accepted for publication in volume 19 of the Canadian Journal of Human Sexuality (2010;19).

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!

Russian HIV Patients Seen as 'Lab Rats' Amid Drug Shortage

Russian HIV/AIDS treatment centers in 44 regions have had to use substitute drugs due to bureaucratic delays in the procurement and distribution of antiretrovirals, advocates say. The Health and Social Development Ministry recently took over these tasks from another state agency, and it was late initiating a tender for ARV suppliers, said Vadim Pokrovsky, head of the federal AIDS Center. It also may have been unfamiliar with the procurement process, he added.

Some patients have filed lawsuits to remain on standard regimens rather than take the substitute drugs. One such patient, "Irina," a 28-year-old computer programmer, said it took her a month to adjust to her initial treatment regimen.

"The first two weeks I felt so nauseous I could not get out of bed," said Irina, who spoke on condition of anonymity. She fears that angering authorities could get her cut off from ARVs, which she gets from a Moscow treatment center. The center replaced the usual ARV regimen with another, less preferable drug, stavudine, which can cause lipodystrophy.

In Irina's case, which she is appealing, the city's Izmailovsky district court ruled that doctors have the right to use alternate treatment if necessary, said Ilnur Sharapov, her attorney. The Moscow City Court upheld the ruling on Oct. 26, though it violates treatment rules stating that changes be made to the regimen only if it is ineffective or causes unbearable side effects. Sharapov likened the ruling to treating AIDS patients as lab rats.

The Moscow AIDS center said the change was to improve treatment, not respond to a shortage.

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!

Aid Group Trains Swaziland Laymen to Fight AIDS

Swaziland, with the world's highest HIV prevalence, is training lay people and nurses to assume sophisticated health care roles in its fight against the virus.

"It's a necessary policy in order to reach the number of people in the region given the shortage of human resources in the public sector," said Catherine Tomlinson, senior researcher at Treatment Action Campaign, a Cape Town, South Africa, advocacy group for people with HIV.

The initiative, begun in 2007 by Doctors Without Borders (DWB), trains lay people to fulfill responsibilities usually given to nurses. In turn, nurses step up to take on tasks normally assumed by doctors.

The shift to lay people and nurses has lessened the need for Swaziland's HIV patients to travel long distances for care. In Shiselweni - the country's poorest, most remote region, and home to the largest number of HIV patients - community health workers in 21 facilities counsel patients and administer tests for the virus.

The push for decentralization has been replicated in two parts of South Africa, with lay people producing outcomes similar to those of doctors, Tomlinson said.

The kingdom of Swaziland, tucked between South Africa and Mozambique, has an adult HIV prevalence of 26.1 percent. According to DWB, HIV has lowered Swaziland's average life expectancy in the last 20 years from 60 to 31.

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!

Pope Says Some Condom Use 'First Step' of Morality

In the limited context of preventing the onward transmission of HIV, condom use could be a first step toward embracing a different, moral sense of sexuality, Pope Benedict XVI said in a book to be released Tuesday. Benedict made the statement over the course of a six-day interview with German journalist Peter Seewald. The pope's remarks about condoms form just a section of the book by Seewald and Benedict, titled "Light of the World: The Pope, the Church and the Signs of the Times."

Seewald asked whether it is not "madness" for the Vatican to prohibit condom use by populations at risk for HIV.

"There may be a basis in the case of some individuals, as perhaps when a male prostitute uses a condom, where this can be a first step in the direction of a moralization, the first assumption of responsibility," Benedict replied in the English translation. The Italian excerpt in Vatican City's L'Osservatore Romano's translation is "female prostitute," and the interview was in German. The discrepancy was not immediately resolved.

The church "of course does not regard it as a real or moral solution, but in this or that case, there can be nonetheless in the intention of reducing the risk of infection, a first step in a movement toward a different way, a more human way, of living sexuality," Benedict said.

However, abstinence and marital fidelity are the only sure way to prevent HIV, Benedict reiterated. In another section of the book, he reaffirms the 1968 encyclical "Humanae Vitea," in which Pope Paul VI explicates the church's opposition to artificial contraception. Benedict repeated the church's endorsement of the rhythm method, in which married couples refrain from sex on days when the wife is likely to be fertile.

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!

Massachusetts Inmates Sue over New Rules on HIV Medication: HIV Patients Now Must Wait in Line

The process for distributing HIV medication in Massachusetts prisons is designed to save the state money by discouraging adherence with therapy regimens, charges a suit expected to be filed today in US District Court in Boston.

The prison system and its medical provider, UMass Correctional Health, "can and have erected barriers to access in order to discourage adherence," says the suit by five HIV-positive prisoners. HIV-positive inmates constitute 2 percent to 3 percent of the prison population, while antiretrovirals account for 20 percent of state spending on medications.

Until February 2009, HIV pharmaceuticals were among the drugs in the prison system's Keep On Person program, in which inmates store and take prescription medications in their cells. At that time, HIV medications were removed from the program and made available only in a medication line, requiring HIV-positive patients queue up at least once and perhaps several times per day.

"The removal of HIV medications from the Keep on Person program is callous and extremely shortsighted, as patients who refuse or are unable to go to the med line, or who miss doses because of the chronic defects in the med line process, will become more sick," says the suit.

In response to a similar suit last year, lawyers for UMass said such changes in fact are made to increase compliance. For example, medical staff can ensure HIV-positive patients take their medication during a face-to-face encounter in the medication line.

The change was "by no means fueled by discriminatory intentions," the previous suit stated.

Massachusetts' previous HIV care regime included a case manager and allowed prisoners to hold a 30-day supply of antiretrovirals in a locked container in their cells, said Joel H. Thompson, a staff attorney for Prisoner's Legal Services, the Boston advocacy organization representing the plaintiffs.

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!

Prevalence of HIV Testing and High-Risk Human Immunodeficiency Virus Behavior Among 18- to 22-Year-Old Students and Nonstudents

The current study characterizes HIV testing and high-risk behavior among 2,007 nationally representative adults ages 18-22. Conducted between March 2002 and February 2003, Cycle 6 of the National Survey of Family Growth involved students and nonstudents. Data were analyzed using univariate and multivariate methods.

The estimated proportion who ever tested for HIV, excluding during blood donation, was 34.2 percent (95 percent confidence interval [CI]: 31.6 percent-36.8 percent). Testing was less frequent among students than nonstudents after adjusting for age, gender, race/ethnicity, and marital status (adjusted odds ratios [AOR]: 0.54; 95 percent CI: 0.40-0.73). The estimated proportion of individuals who had been screened for HIV in the previous year was 18.1 percent (95 percent CI: 16.1 percent-20.1 percent), with no difference by student status (AOR: 0.76; 95 percent CI: 0.55-1.05).

The estimated proportion reporting any high-risk HIV behavior was 37.5 percent (95 percent CI: 34.4 percent-40.5 percent). Of these, just 28.3 percent reported testing for HIV in the previous year (95 percent CI: 24.5 percent-32.0 percent), with no difference observed by student status (AOR: 0.91; 95 percent CI: 0.62-1.35).

"More than one-third of this young adult population reported high-risk HIV behavior," the study authors concluded. "Of these, less than one-third was tested for HIV during the year before the study. These results indicate that enhanced HIV testing and prevention efforts are needed for students and nonstudents, and that HIV testing in this age group should be monitored over time."

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!

Driving to Better Healthcare

Auto manufacturer Mercedes-Benz SA has stepped up and solidified its long-standing support of HIV prevention efforts among truckers.

"We, like other people in the South Africa transport industry, are very concerned that the once-stable complement of 7,000 truck drivers is now under threat due to the impact of poor health and a shortened life span on the workforce," said Kobus van Zyl, vice president of Mercedes-Benz's commercial vehicle unit. "The effects of HIV/AIDS can be seen in the constant search to replace drivers lost through high absenteeism, disability or death," van Zyl said.

Mercedes-Benz announced a formal partnership with the South African Business Coalition and the trucker-specific HIV prevention outreach Trucking Wellness, which was set up in 1999 as Trucking Against AIDS. The high-profile announcement coincided with October's designation as Transport Month.

Mercedes-Benz last year made a sizable donation to Trucking Wellness' effort to expand targeted HIV prevention initiatives around the country. As part of its work, Trucking Wellness converts panel vans into mobile clinics that offer STD treatment as well as prevention education. In addition, it has helped establish 20 comprehensive wellness centers along trucking routes in all nine South African provinces.

It is estimated that the wellness center personnel have distributed almost 11 million condoms since 2000. More than 141,000 people have received treatment at the centers, about 48,000 of them for STDs. The center's education services have reached almost 390,000 people.

With HIV prevalence in South Africa estimated at 5 million, the business community has an obligation to step in and help contain the epidemic, said Thando Khaile, senior project manager of the South African Business Coalition on 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!

US Funds Circumcision to Fight AIDS in Zimbabwe

Since May 2009, Zimbabwe has campaigned to circumcise more than 1 million men in a bid to fight HIV transmission. The program, which the United States supported with $6.6 million in its first year, has circumcised 12,000 men already. The procedure has been shown to reduce the risk of female-to-male HIV infection by 60 percent, noted Dr. Bill Jansen, a senior advisor with the US Agency for International Development (USAID).

The United States has pledged further assistance as the circumcision program expands. The United States is the biggest contributor to modern AIDS clinics in Zimbabwe, which have tested and counseled more than 2 million people. An additional $50 million US pledge made this month will go toward broader Zimbabwean AIDS programs, including AIDS treatment.

At a clinic in western Harare, nurses recently unpacked some of the 60,000 one-time circumcision kits provided by USAID. The packs contain forceps, disposable scalpels, needles, and gauze. The nurses gave a local anesthetic to Tineyi Marokwe, 32, as the surgeon, Shame Dendere, surgically removed Marokwe's foreskin in about 10 minutes.

Clinic workers told Marokwe that as the anesthetic wore off, he could expect to feel some minor pain, and that he should abstain from sex for six weeks for the wound to heal. He was asked to come back three times for follow-up treatment.

"I was worried, but when I came here I learned this could save my life," said Marokwe, "I'm going to tell all of my friends."

The US subsidizes most of the cost of the procedures, which are provided free to patients. Donors also include the International Population Services group and other health care charities.

If 1.2 million Zimbabwean men were circumcised by 2017, an estimated 750,000 HIV infections could be prevented, said Jansen. Organizers hope that someday the program will provide infant male circumcision.

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!

Food Security, HIV/AIDS Treatment Closely Linked

Africa's struggle to contain HIV must include strategies to ensure that its people have enough to eat, said experts who met recently in Cape Town, South Africa, to discuss food security.

The early years of the HIV epidemic claimed farmers in the already-marginal, agriculture-based economies of Africa, noted Stuart Gillespie, director of a non-governmental organization (NGO) promoting food security. Today, successful antiretroviral therapy still can be compromised from the lack of adequate nutrition.

Food crises "can impact treatment, the ability of people to remain on drugs when they're too hungry, when they cannot afford to buy food to meet the increased appetite they have [when] on the drugs," said Gillespie, director of the Regional Network on AIDS, Livelihoods and Food Security, an NGO with hubs in southern African countries.

When people on treatment are unable to find adequate nutrition - and antiretroviral therapy demands about 30 percent more calories than usual - their condition can quickly deteriorate, Gillespie said.

"If people are stopping drugs because they are too hungry to take the drugs without feeling completely sick, if they're stopping the drugs and compliance levels drop below 90 percent, we're in a situation where the virus becomes resistant to the drugs. And therefore, we need second-line therapies or third-line therapies, which are going to be a lot more expensive and even more difficult to resource in the current climate of austerity," Gillespie said.

Civil servants with responsibility for disseminating agricultural expertise to African farmers also were felled by the epidemic, Gillespie noted.

"During a five-year period between 2002 and 2007 in both Malawi and Zambia, one in eight agricultural extension workers had actually died of HIV," he said. "Farmers were therefore not able to avail themselves to new technologies."

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!

Grown-Up, but Still Irresponsible

50-something singles are singled out in a new study from Indiana University (IU) for their casual sexual behavior and less-than-diligent use of condoms.

Among men over 50, 23 percent said their most recent sexual connection was with a "friend" or "new acquaintance." The comparable number among women was 13 percent, said IU's National Survey of Sexual Health and Behavior.

Single people over 50 may be less likely than middle-age peers to want to "complicate" their lives with committed sexual relationships, suggested Dr. Pepper Schwartz, a sociology professor at the University of Washington in Seattle. Sex after 50 is "warm, it's nice, they care about each other, but no one is under the illusion this is grand love," said Schwartz, who advises the study's sponsor, Trojan condom manufacturer Church & Dwight.

Condom use during the most recent sexual contact reached only 25 percent among those 50-plus respondents who were single, had a new sex partner or had more than one partner in the last year. Almost 40 percent said they had never been tested for HIV, and a significant number were unaware of their partners' sexual history.

Experts suggest several reasons for the relatively infrequent use of condoms among older adults:
*Older singles, particularly those who have spent their lives in committed relationships, consider HIV/AIDS a concern of younger people.
*Sexual activity among older singles is not a priority of the public health establishment.
*Older adults lack anyone comparable to a parent figure who would urge them to stay safe.
*Older men may be concerned that condoms can cause erectile dysfunction.
*Senior adults who have not used condoms for decades may be reluctant to resume doing so, said Dr. Debby Herbenick, an investigator on the 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!

Standing in the Need

"As one of the most respected and powerful voices in the African-American community, the black church cannot continue to be missing in action in fighting the disproportionate impact of AIDS and HIV among blacks.

"That's why it's heartening to learn that black clergy members in and around Philadelphia are breaking their silence and joining a bold national movement to address a disease that is devastating black families, especially in Philadelphia. .

"The local campaign has been spearheaded by Amy Nunn, a social science researcher at Brown University School of Medicine, who has been in Philadelphia for months focusing on prevention strategies involving the church.

"Already, more than 100 houses of worship in the city, from Baptist to Muslim, have agreed to raise the issue in the coming weeks. At least 30 churches will host HIV testing on site.

"In addition to putting messages on donated billboards urging testing, the pastors will speak from the pulpit and initiate public conversations about a topic that has been taboo in the black church.

"This unconventional and provocative approach is needed, given the staggering statistics. More churches should join the program to increase awareness of a disease that too many have written off as a gay problem. Many heterosexuals are infected.

"Black clergy in Washington, Atlanta, Detroit, Tampa, and Chicago have also heeded the call. They are becoming advocates for an infected population frequently shunned by their churches.

"The clergy deserve credit for striving to overcome their own fears and long-held misconceptions about the disease. . Some pastors are finding ways to incorporate a message about HIV/AIDS into their sermons, often using stories of Jesus healing the afflicted. .

"Such straight talk about HIV/AIDS has been a long time coming. Now, people need to listen.

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!

Philadelphia Clergy Increase AIDS Awareness

Clergy in Philadelphia's African-American congregations are deploying their resources over the next several weeks in an all-out HIV prevention campaign.

The citywide effort involves more than 100 houses of worship, 30 of which have pledged to host HIV testing on site. In addition, clergy are delivering HIV prevention messages in their sermons and church bulletins.

"We are in crisis here in Philadelphia," the Rev. Leslie Callahan told congregants at a recent service at St. Paul's Baptist Church in Spring Garden. "It's not just a disease of gay, white men."

Callahan stressed that 20 percent of HIV-positive Philadelphians are unaware they have the disease. "And if they don't know it, surely their partners don't know it."

Congregants after the service were sobered and inspired by Callahan's message.

"We have to work this out as a church and a community," said member Lisa Miller. "Like she said, we can do that just by getting tested."

Member Doris Whitehead saw HIV/AIDS as an important issue for the church to embrace. "It was so important to let everybody know we need to be taking care of each other. That's where our strength is."

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!

Comparison of Two HIV Postexposure Prophylaxis Regimens Among Men Who Have Sex with Men in Amsterdam: Adverse Effects Do Not Influence Compliance

The current study's authors compared two HIV postexposure prophylaxis (PEP) regimens for safety, outcome, and follow-up among men who have sex with men (MSM) in Amsterdam.

From 2000, all MSM beginning HIV PEP have been followed in one location. The PEP regimen was zidovudine or lamivudine and nelfinavir (regimen 1) until 2005. Thereafter, PEP consisted of zidovudine or lamivudine and atazanavir (regimen 2). From 2000 to 2007, patient data including side effects and alanine aminotransferase (ALT) were systematically recorded and compared by regimen.

PEP was prescribed 309 times to MSM, and 261 MSM were followed up. Of the 261 MSM, 237 (91 percent) completed the 28-day course of PEP. Fewer patients experienced diarrhea on regimen 2 than regimen 1, though the completion rate was the same - 98 of 110 (89 percent) for regimen 2, and 139 of 151 (92 percent) for regimen 1.

Just one patient with severely elevated ALT was advised to stop PEP; he also had serious illness. MSM over age 30 and MSM whose partners were known to be HIV-positive completed PEP significantly more often than MSM under 30 and MSM with sex partners of unknown serostatus. Of PEP completers, five seroconverted despite good adherence. None of the five were resistant to the PEP regimen used.

"No difference in adherence was found between the two regimens, even though fewer adverse events were reported on regimen 2," the study authors reported. "ALT need not be routinely tested to monitor adverse effects. The five seroconversions were not likely caused by PEP failure, but rather ongoing HIV exposures."

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!

Clicks Eases State HIV/AIDS Load

South Africa's campaign to test 15 million residents for HIV by June 2011 is getting help from a retail pharmaceutical chain eager to illustrate it can provide primary care to state-funded patients.

Pharmacy chain Clicks said it has administered 20,000 HIV tests since the program began in April. Sixty percent were to state-funded patients, whom Clicks has committed to test for free, and the rest were private patients, who pay a nominal fee. During the first three months of the year, Clicks tested fewer than 10,000 people, none of them state patients.

"Clicks pharmacies have a role to play in providing primary health services conveniently and accessibly. This is a perfect example of how we can help," said Dan Zinner, head of Clicks' new business development.

Government health workers are referring patients to Clicks, where, Zinner said, the testing process is more private and convenient than in a state facility.

"Independent and retail pharmacies provide a safe environment where you can pick up some lipstick, shampoo, and an HIV test," Zinner said.

Results are reported to the health department. About 5 percent of those tested so far are HIV-positive, Zinner said.

South Africa's testing campaign also offers screening for tuberculosis, diabetes, high blood pressure, and anemia.

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!

Press Conference, Rally Planned to Address Georgia's AIDS Drug Waiting List

Georgia's AIDS Drug Assistance Program instituted a waiting list for new clients on July 1. As of Nov. 11, the list included 672 residents, according to the National Alliance of State and Territorial AIDS Directors. Georgia's ADAP waiting list is second only to Florida's, with 2,043 individuals.

A rally in Atlanta on World AIDS Day, Dec. 1, is planned to spotlight the growing number of HIV-positive Georgians who have been wait-listed for help accessing lifesaving drugs.

ADAP serves about 5,500 Georgians, according to AIDS activists, providing assistance to low- and moderate-income persons without insurance or Medicaid coverage for some 60 HIV-related medications.

Georgia's ADAP maintained a waiting list from 1997 to 2002; at its peak, it included 1,600 patients.

"It shocks me we do have a list again, and how fast the numbers have grown, and there is not the same sense of urgency," said Jeff Graham, executive director of Georgia Equality and a longtime AIDS activist. "I really had hoped to not see another waiting list."

At the rally, activists plan to deliver to governor-elect Nathan Deal postcards asking for sufficient funding to eliminate the ADAP waiting list. A press conference is scheduled for 1 p.m. to 2 p.m. inside the north wing of the Capitol.

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!

Egrifta Gets FDA Approval for HIV-Associated Lipodystrophy

Egrifta (tesamorelin) has been approved for the treatment of HIV-associated lipodystrophy, according to a November 10 announcement from the U.S. Food and Drug Administration (FDA). The drug, requiring once-daily injections, was approved to reduce visceral adipose tissue (VAT)— deep belly fat surrounding the liver, stomach and other abdominal organs—in people living with HIV experiencing lipodystrophy, a side effect of antiretroviral (ARV) therapy.

Egrifta was developed by Theratechnologies, a company based in Montreal. It is a synthetic growth hormone release factor that acts on pituitary cells in the brain to stimulate growth hormone production, which has been shown to reduce VAT in people with lipodystrophy.

Injecting Egrifta is a multiple-step process. Vials containing a dry version of the active drug must first be mixed, or reconstituted, with sterile water packed with the product. The mixed liquid is then drawn up into a hypodermic needle and injected directly under the skin of the stomach area. One of the FDA’s post-marketing requirements is the development of a single-vial drug that does away with the need for reconstitution.

Theratechnologies tested the drug in two Phase III clinical trials involving 816 HIV-positive adult men and women with lipodystrophy and excess abdominal fat. Of these, 543 patients received Egrifta during a 26-week, placebo-controlled period. In both studies, patients treated with Egrifta experienced greater reductions in VAT—about 15 to 17 percent—as measured by CT scan, compared with patients receiving placebo. Some patients reported improvements in their self-image.

Once Egrifta therapy is discontinued, VAT returns. As a result, Egrifta therapy will need to be continued indefinitely in order to mantain reductions in abdominal fat.

The presence of excess VAT associated with this condition may contribute to other health problems, such as cardiovascular disease, as well as affect a patient’s quality of life. Whether Egrifta decreases the risk of cardiovascular disease or improves adherence to ARV therapy has not been studied. In the absence of these data, careful consideration should be given to whether Egrifta treatment should be continued in people living with HIV who do not show a clear efficacy response, notably a reduction in VAT measured by waist circumference or CT scan.

The most commonly reported side effects in the Phase III studies included joint pain (arthralgia), skin redness and rash at the injection site (erythema and pruritus), stomach pain, swelling and muscle pain (myalgia). Worsening blood sugar control occurred more often in patients treated with Egrifta than with placebo.

Egrifta will be marketed in the United States by EMD Serono, a company based in Rockland, Massachusetts. The drug is expected to be available in January 2011; distribution of the drug will be tightly regulated, with all prescriptions being processed through an EMD Serono-designated service and fulfilled by select mail-order pharmacies. To learn more about the prescription process, people living with HIV and their health care providers are encouraged to call the Axis center at: 877-714-2947.


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!

Kidney Transplants Found Safe in HIV Patients

HIV-infected patients who received kidney transplantation had high patient and organ survival rates at both the first and third year after the surgery, a new study shows.

An increasing number of people with HIV have end-stage renal disease (ESRD), despite the efficacy of highly active antiretroviral therapy in reducing HIV-related kidney disease, noted the study's lead author from the University of California-San Francisco, Dr. Peter Stock, and colleagues. "In the United States and Europe, nearly 1 percent of patients with ESRD are infected with HIV, and HIV-associated nephropathy is the third most common cause of ESRD among blacks in the United States who are between 20 and 64 years of age," they wrote.

In the non-randomized trial, the researchers studied the safety and efficacy of renal transplantation in 150 HIV-positive recipients from 19 US medical centers. Patient survival rates were 94.6 percent one year after transplantation and 88.2 percent after three years. Organ survival rates were 90.4 percent and 73.7 percent at years one and three.

"A multivariate proportional-hazards analysis showed that the risk of graft loss was increased among patients treated for rejection (hazard ratio [HR], 2.8; 95 percent confidence interval [CI], 1.2-6.6; P=0.02) and those receiving antithymocyte globulin induction therapy (HR, 2.5; 95 percent CI, 1.1-5.6; P=0.03); living-donor transplants were protective (HR, 0.2; 95 percent CI, 0.04-0.8; P=0.02)," the study found.

"The rates of patient survival and graft survival at three years were generally between the reported rates in the national database for older kidney transplant recipients (=65 years of age) and for all kidney transplant recipients," the authors reported.

Rejection rates were about two to three times higher than usual, indicating the need for better immunotherapy, wrote Stock and colleagues. "It's not that dramatic and we've been able to reverse them," Stock said. "But we know that each rejection episode takes a little bit of life out of the kidney. So instead of lasting 20 years, it might last 15 years. That's why it's very important to figure that out."

The study, "Outcomes of Kidney Transplantation in HIV-Infected Recipients," was published in the New England Journal of Medicine (2010;363:2004-2014).

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!

Almost 30 Percent of South African Pregnant Women Have HIV

An estimated 29.4 percent of pregnant women in South Africa last year were HIV-positive, a figure that has been stable for the past four years, Health Minister Aaron Motsoaledi told the National Consultative Health Forum on Thursday.

"The HIV epidemic poses one of the greatest health and developmental challenges," Motsoaledi said. "In this country particularly, the epidemic is threatening the reversal of post-apartheid developmental gains."

The new data are derived from the latest National Antenatal Sentinel HIV and Syphilis Prevalence survey, which in October 2009 surveyed 33,841 pregnant women from 1,457 antenatal clinics. HIV prevalence among pregnant women ages 15 to 24, who comprised almost half the survey population, was 21.7 percent. The only age group that showed increasing infection was 30- to 34-year-olds, among whom prevalence was 41.5 percent.

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!

Bone Loss More Common in HIV

People with HIV are at a greater risk of bone disease, a new study shows, though it is unclear why. Nonetheless, the findings emphasize the need to apply strategies that prevent bone demineralization and to closely monitor bone mass density in this population, said Dr. Anna Bonjoch of the Lluita Contra la SIDA Foundation in Barcelona, Spain.

In the study, Bonjoch evaluated 671 patients who previously had at least one dual-energy X-ray absorptiometry scan. Twenty-three percent had osteoporosis, the brittle bone disease that can raise the risk of fractures, and another 48 percent had osteopenia, abnormally low bone mass that can progress to osteoporosis.

Half the study participants were 42 or younger. Among 105 patients with two or more scans and at least five years of follow-up, 47 percent showed progressive bone demineralization (18 percent to osteopenia and 29 percent to osteoporosis).

"Factors associated with bone loss and progression were age (odds ratio [OR] 1.07; 95 percent confidence interval [CI] 1.05-1.08; P<0.0001), male sex (OR 2.23; 95 percent CI 1.77-2.8; P<0.0001), low body mass index (OR 1.14; 95 percent CI 1.11-1.17; P<0.0001), time on protease inhibitor (OR 1.18; 95 percent CI 1.12-1.24; P<0.0001), time on tenofovir (OR 1.08; 95 percent CI 1.03-1.14; P<0.0019), and current use of protease inhibitors (OR 1.64; 95 percent CI 1.35-2.04; P<0.0001)," Bonjoch reported.

The risk factors comport with previous studies, though the rate of bone loss is significantly higher, said Dr. Todd Brown of Johns Hopkins University, who was not affiliated with the study. Though patients with bone loss may simply have been more likely to get the scans, Brown said, "The percentage of patients with osteoporosis with HIV infection is probably higher than you would expect in an HIV-negative population."

The study, "High Prevalence and Progression to Low Bone Mineral Density in HIV-Infected Patients: A Longitudinal Cohort Study," was published in AIDS (2010;24(18):2827-2833).

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!

China AIDS Group Says It Is Forced to Shut Down

A Chinese group focusing on rural AIDS and orphans shut down Thursday due to mounting pressure from the Beijing tax bureau, advocates said. Beijing Loving Source (BLS) was founded by jailed AIDS activist Hu Jia; its closure follows stepped-up government pressure against and harassment of other organizations dealing with controversial matters.

Earlier this year, AIDS activist Wan Yanhai fled to the United States after receiving numerous police threats. In March, the government decided to regulate overseas donations to private aid groups. Government leaders are struggling with rapidly increasing grass-roots groups, concerned they may evolve toward political activity during China's economic transition.

BLS worked with the UN and Oxfam on HIV awareness and rural patient care. Hu's wife, Zeng Jinyan, announced the group's closing in a Thursday posting on her website.

Zeng noted "profound lessons" when tax authorities in 2009 levied a 1.4 million yuan (US $206,000) fine against a legal-aid group that assisted with politically sensitive cases. Though the Beijing tax bureau does not usually target organizations as small as BLS, it is pressing for a detailed audit, Zeng said.

Zeng said she hopes volunteers continue the group's work. "Without the help of volunteers, at least more than 100 AIDS orphans could be living on the streets," Zeng wrote.

Hu is now serving a 3.5-year prison sentence on charges of sedition related to his activism.

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!

Law Banning Discrimination on HIV Fails in China Court

Chinese authorities have rejected a 22-year-old college graduate's claim that he was unfairly denied a teaching job because he is HIV-positive. The man will appeal, his lawyers said.

In his ruling, the judge said regulations barring HIV-positive civil servants take precedence over a four-year-old law that states "no institution or individual shall discriminate against people living with HIV, AIDS patients and their relatives." The law was promulgated by the State Council, the Chinese government's chief administrative body.

"I'm heartbroken," said the man who brought the suit, identified in court papers by the alias "Xiao Wu." The decision defied logic, the man's lawyer said. "It's an example of how the legal system enhances and expands discrimination against people who are HIV-positive," Li Fangping said.

Xiao had passed written tests and an employment interview, but the local education bureau in the eastern city of Anqing rejected his application when a mandatory blood test revealed his HIV status.

AIDS activists had championed Xiao's cause, hoping for a precedent-setting positive outcome in the case. Inspired by Xiao, another HIV-positive college graduate has filed a similar case in Sichuan Province.

Now, advocates are concerned that Friday's court decision could have a chilling effect on the rights of HIV-positive citizens.

"This is bad news given that it was the first time an HIV-positive person dared to stand up for his rights," said activist Yu Fangqiang. His organization, Beijing Yirenping, provided Xiao with no-cost legal representation. "The entire HIV community had high hopes, but now the door appears to be shutting for people who want to use the courts to fight discrimination."

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!

Study: Girls Take More Chances During First Sex

Teenage girls are 30 percent more likely than teenage boys to engage in their first sexual encounter without contraception, according to research presented at the annual meeting of the American Public Health Association (APHA).

Because 80 percent of contraception used at first sex is condoms, the use of birth control largely depends upon boys, noted Laura Lindberg, senior research associate at the Guttmacher Institute.

In her APHA poster session, doctoral student Nicole Weller said that whether teens had received some form of sex education, or what type they received, had no bearing on whether they used contraception during their first sexual encounter. The types of sex education were categorized as abstinence-only, information about birth control methods, and information about STDs.

The data from the National Survey on Family Growth described 5,012 boys and girls ages 11 to 19 who reported any sexual activity. Among all respondents, the average age of first sex was 16. Weller reported that African Americans were 40 percent more likely than whites to have unprotected first sex.

Upcoming research will examine whether girls are more likely to forego contraception if they are in a relationship. "My hypothesis is that relationship status will override sexual education. I love my boyfriend. I trust my boyfriend. I'm not worrying about getting an STD from him," she said.

The research was conducted at the Arizona State Interdisciplinary Research Center, which is funded by a grant from the National Center on Minority Health and Health Disparities.

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!

Gonorrhea and Chlamydia Testing Rates of HIV-Infected Men: Low Despite Guidelines

Noting that gonorrhea (GC) and chlamydia (CT) screening for HIV-infected men "may decrease HIV transmission and reduce the incidence of pelvic inflammatory disease in female partners," the study authors determined GC/CT testing rates in a clinical HIV cohort before and after 2003, when CDC issued guidelines for GC/CT screening.

First GC/CT testing episodes were identified for all men enrolling in a Baltimore HIV clinic from 1999 to 2007. Clinical and demographic factors associated with being tested and with having a positive result were assessed using multivariate Cox and logistic regression.

Of 1,110 male participants, the rate of GC/CT testing upon clinic enrollment increased from 4.0 percent prior to 2003 to 16.5 afterwards, while the rate of ever being tested increased from 34.2 percent to 49.1 percent (p<0.001 for both comparisons). Among men with same-sex contact, extragenital sites were included for 10 percent of first testing episodes. Among the 342 men ever tested, 5.2 percent had positive results for their first test. Predictors of testing included enrollment after 2003, younger age, frequent visits, and black race. Positive test result predictors included CD4 count =200 cells/mm3 and younger age.

"GC/CT testing rates among men increased substantially after the 2003 guidelines but remain low," the authors concluded. "Disseminating existing evidence for GC/CT screening and promoting operational interventions to facilitate it are warranted."

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!

Oral Sex Often a Prelude to Intercourse for Teens

Students who engage in oral sex within the first two years of high school are much more likely than those who do not to report having vaginal intercourse by the end of 11th grade, a new study suggests. The study involved surveying 627 ninth-grade students in two northern California high schools every six months between 2002 and 2005.

Among students reporting oral sex by their ninth-grade year, just 9 percent had abstained from vaginal sex through 11th grade, reported Dr. Bonnie L. Halpern-Felsher of the University of California-San Francisco and Dr. Anna V. Song of UC-Merced. The overwhelming majority experienced oral sex before vaginal sex, with most of those transitioning to the latter doing so within six months.

Students "who initiated oral sex at the end of the ninth grade had a 50 percent chance of initiating vaginal sex by the end of the 11th grade," reported the authors. "In comparison, adolescents who delayed until the end of 11th grade had a 16 percent chance of initiating vaginal sex by the end of 11th grade."

In addition, students reporting sexual activity before ninth grade or after 10th grade had a lower chance of intercourse by the final survey than those initiating oral sex in ninth or 10th grade. Of those who abstained from oral sex through 11th grade, 80 percent had also avoided vaginal sex.

"In a past publication, we showed that adolescents perceived that oral sex was more acceptable and more prevalent compared to intercourse, and that adolescents believe that oral sex carries less risk of health consequences - sexually transmitted infections, HIV, and pregnancy - as well as social and emotional consequences than does vaginal sex," Halpern-Felsher wrote.

"These findings highlight the need for health care providers, health educators, and parents to include discussions of oral sex within a comprehensive sexual education curriculum," Halpern-Felsher said.

The study, "Predictive Relationships Between Adolescent Oral and Vaginal Sex," was published in Archives of Pediatrics & Adolescent Medicine (doi:10.1001/archpediatrics.2010.214).

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!

Text Messaging Joins Africa's War on AIDS

A new study led by Richard Lester of the British Columbia Center for Disease Control in Vancouver finds that using text messages to remind HIV patients to take their medicines can boost adherence.

Under the "WelTel Kenya1" study, Lester and colleagues recruited 538 HIV patients receiving antiretroviral treatment in Kenya. Participants received either a weekly SMS (short-message service) text on their mobile phone or standard care. The text recipients typically received messages like "Mambo?", which is Kiswahili for "How are you?" They were instructed to respond within 48 hours, replying either "Sawa" ("fine") or "Shida" ("problem"). Those who did not respond within the timeframe or who said they had a problem were then contacted by a nurse.

Compared to the control group, the number of patients in the SMS group who achieved 100 percent adherence was 12 percent higher. The SMS group also was 9 percent more likely to achieve HIV viral suppression below detectable levels compared to the control group.

Just 3.3 percent of the texts required a follow-up. That meant one nurse could potentially manage 1,000 patients by SMS and expect to make follow-up calls to just 33 patients per week.

SMS systems are cost-effective since no additional equipment is required. Each text costs around five US cents, and the messages were sent out in computerized batches, rather than individually.

Lester and colleagues suggested the approach could work well in low-income countries hard-hit by AIDS where cell phone use is common.

The study, "Effects of a Mobile Phone Short Message Service on Antiretroviral Treatment Adherence in Kenya (WelTel Kenya1): Randomized Trial," was published early online in The Lancet (doi:10.1016/S0140-6736(10)61997-6).

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!