Doctors Get Guidelines for Medicine to Block HIV

CDC on Thursday published interim guidelines for providers facing questions about the use of the HIV drugs tenofovir and emtricitabine (TDF/FTC) to prevent sexually acquired HIV infection. In an international trial, TDF/FTC taken orally each day with an adherence rate of at least 90 percent was associated with a 73 percent reduction in risk of HIV infection among men who have sex with men. The MSM in both the treatment and control groups received preventive services, including counseling, condoms, and STD treatment if needed.

While CDC and other US Public Health Service agencies are developing guidelines on the use of TDF/FTC pre-exposure prophylaxis (PrEP), concerns exist about unsafe and potentially less effective PrEP practices that could develop during the interim, CDC said. The agency specifically cited intermittent dosing just before or after sex as a concern. In the trial, MSM who adhered to daily TDF/FTC at less than 90 percent had only a 21 percent reduction in HIV risk, a sharp decline in efficacy.

"PrEP has the potential to contribute to effective and safe HIV prevention for MSM if (1) it is targeted to MSM at high risk for HIV acquisition; (2) it is delivered as part of a comprehensive set of prevention services, including risk-reduction and PrEP medication adherence counseling, ready access to condoms, and diagnosis and treatment of [STDs]; and (3) it is accompanied by monitoring of HIV status, side effects, adherence and risk behaviors at regular intervals," CDC said.

MSM at high risk include those who are not taking other effective risk-reduction measures, such as using condoms; those who have frequent partner changes or concurrent partners in high HIV prevalence settings; and MSM whose sex partners are HIV-positive or of unknown serostatus.

In the San Francisco Bay Area, public health officials could begin a PrEP pilot this summer for men who meet CDC guidelines. The trial would determine how best to deliver PrEP and ensure adherence and condom use.

MSM inquiring about PrEP should first be tested for HIV and other STDs at the outset, CDC noted.

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!

Schools Advocate STD Testing

Health officials are recommending a high school-based STD prevention intervention in the Manchester area that would include free screenings. The board of education was briefed on the program and was hearing a presentation at its Monday meeting in Lincoln Center.

"We have been very concerned about the numbers [of STD cases] in the young population," said Maryann Cherniak Lexius, Manchester's health director. The town recorded 250 chlamydia cases in 2009, up from 199 diagnoses in 2005, and Cherniak Lexius said her office is focused on how to stop local STD increases.

Tenth-graders last spring participated in a pilot program presented in collaboration with the state Department of Health's STD Control Program. The one-period lesson included graphic slides and the message of abstinence "as the only true prevention," Cherniak Lexius said. Parents can elect not to have their child participate in the session.

Manchester health officials want to continue the pilot program and begin providing confidential, non-invasive testing in Manchester High School as well as other local high schools. Testing in the school nurse's office would be during specific periods, and walk-in testing would be available with a state health professional. Under state law, parental consent is not needed for the screenings, Cherniak Lexius said.

"As health educators and health promoters, anything we can do to remove barriers for students to access health care is wise," said Suzanne Valade, Manchester's coordinator of school health services.

Town health officials would like to offer the program to all local high school students, said Cherniak Lexius.

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!

Rare HIV Transmission Changed Transplant Practice

On Nov. 13, 2007, the media widely published the news that several HIV transmissions had resulted after donated organs were transplanted from a deceased high-risk donor. Though this was the first such transmission in 20 years, it prompted an "exaggerated" response by some US transplant surgeons, a new study suggests.

CDC-defined high-risk organ donors (HRDs) include those who, in the past five years, have engaged in specific risk behaviors: men having sex with men, drug injecting, and sex work.

Between January and April 2008, researchers surveyed 422 working US transplant surgeons about their attitudes and practices following the 2007 transmission event.

Among respondents, 31.6 percent said they had changed their practice, including 41.7 percent who had decreased use of HRDs and 34.5 percent who emphasized the risks during informed consent counseling. Just 16.7 percent increased their use of nucleic acid testing (NAT), and 6 percent adopted a formal policy. Fear of being sued or hospital pressure was associated with more than a two-fold higher odds of changing practice, with medical risks of HIV associated with an 8.29-fold odds of decreasing HRD use.

"The risk of death while waiting for an organ transplant is far higher for many patients than is the risk associated with these organs," said study leader Dr. Dorry Segev of the Johns Hopkins University School of Medicine.

In 2009, 14,600 people donated organs, and about 6,700 people died waiting for such a donation. More than 72,000 Americans are on a waiting list for organs.

The 2007 transmission case involved donated organs from a man who had sex with men. Standard antibody tests for hepatitis C and HIV came back negative, and his organs were transplanted into four recipients, who later turned up infected with both viruses. NAT, which can detect more recent HIV infections than antibody tests, is now used at the organ procurement center that distributed the organs in the 2007 case.

The study, "Provider Response to a Rare but Highly Publicized Transmission of HIV Through Solid Organ Transplantation," was published in the Archives of Surgery (2011;146(1):41-45).

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 Drug Shortage in Jamaica - Medication Being Rationed

The shortage of some antiretrovirals has resulted in their being distributed in one-week rations instead of the customary monthly dosage - or sometimes, not at all. The drugs in short supply are lopinavir and ritonavir (Aluvia) and emtricitabine and tenofovir (Truvada).

According to Tony Hron, program development manager at Jamaica AIDS Support for Life, the organization's clients have complained since last November that they were unable to get the drugs at some public pharmacies. "These drugs require 90 to 95 percent adherence," said Hron, further noting that noncompliance will result in a rebound of the virus.

Dr. Kevin Harvey, head of the National HIV/STI program, admitted that lopinavir has been rationed due to inclement weather in the United States and Europe, which grounded flights and delayed arrival of the drugs from India in November and December. Rationing was instituted to prevent patients from running out entirely, Harvey explained.

According to Harvey, a shipment has since come in and will be distributed soon. "The stock is still not up to where it should be, but we are hoping another supply will come in February, and so by the end of February everyone should be able to get their full supply," said Harvey.

An anonymous member of the Jamaica Network of Seropositives noted that the intermittent shortage has been more severe since the beginning of January. Some members cannot afford weekly bus fare to collect the rations, and it is difficult to have prescriptions filled in other parishes not as badly affected, he said.

Adherence could be improved, Hron said, if patients with a history of compliance were given two months' supply at a time.

The current situation also raises the question of whether Jamaica is prepared to locally distribute lifesaving drugs in the wake of a natural disaster, he added.

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


TOGETHER WE REMAIN STRONG!

Taking the Co-pay Out of Staying Healthy

More than 100,000 lives could be saved annually by increasing the use of just five preventive medical services - aspirin to prevent heart disease, smoking cessation assistance, screenings for breast and colorectal cancers, and flu shots - according to a 2007 study by the Partnership for Prevention. Yet a 2003 New England Journal of Medicine report said Americans get only half the preventive services recommended by their physicians.

The Patient Protection and Affordable Care Act is attempting to eliminate cost as a barrier to getting these services. Insurance providers will no longer be able to charge a co-pay, deductible or co-insurance for preventive services.

The rule currently applies to those covered by Medicare and Medicaid, and group or individual health plans established since Sept. 23, 2010. Private plans created before then will have to comply if they make "significant" changes that reduce benefits or increase costs - such as major adjustments in co-pays, provider networks or drug benefits. "This tries to rebalance a system that has been largely focused on acute care instead of being healthy," said Dr. Roland Goertz, president of the American Academy of Family Physicians.

Patients may still have to pay for preventive services if they visit doctors outside their networks, bundle covered and uncovered services within the same visit, or go against the guidelines concerning the frequency, method or setting for receiving preventive services. However, the US Department of Health and Human Services estimates that 88 million Americans will have access to free preventive services by 2013.

A comprehensive list of recommendations - which pertain to topics including diabetes, cholesterol, hepatitis, HIV, cervical screenings, mammograms, and genetic screenings for newborns - is available at: http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm.

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!

CDC Issues Interim Guidance to Providers About PrEP

The Centers for Disease Control and Prevention (CDC) has published an interim guidance for health care providers regarding pre-exposure prophylaxis (PrEP) for high-risk individuals. The guidance comes on the heels of data released late last year, concluding that daily use of Truvada (tenofovir and emtricitabine) among HIV-negative men who have sex with men (MSM) reduced new HIV infections by about 44 percent.

That data, from the iPrEx study, which took place predominantly in Peru, Ecuador and Brazil among HIV-negative MSM and transgender women who have sex with men, generated tremendous press coverage. Aside from the modest level of protection found overall, the study also revealed that in people who reported taking Truvada at least 90 percent of the time, the reduction in infections was 73 percent.

In the interim guidance, published January 27 in the Morbidity and Mortality Weekly Report (MMWR), the CDC warns, however, that there are important caveats to the study results—limitations that many community members pointed out when the data were first published.

These include the fact that less than 10 percent of the participants resided in the United States. This means we don’t yet know whether or to what extent PrEP will work in the high-risk populations in this country. Moreover, adherence rates were poor in the study, and drug-level testing in a subset of people suggested that self-reported adherence—combined with pill counts and pharmacy records—was a poor indicator of actual adherence. Other concerns include the long-term safety and efficacy of PrEP and the fact that we don’t know how people’s sexual behavior will change when they use PrEP in real-world settings.

More detailed guidelines from the CDC and the Public Health Service (PHS) are in the works and expected to be released in the coming months. Given the fear that providers are already beginning to prescribe Truvada for PrEP—a drug that is readily available by a prescription at any pharmacy—the CDC has rushed to provide an interim guidance for those providers.

Before providers prescribe PrEP, the CDC is recommending that they conduct a thorough assessment of a person’s HIV risk behaviors and that they document ongoing high-risk activity. An HIV test (a more sensitive test to determine a recent infection may be used in those with symptoms) and tests for sexual transmitted infections (STIs) are recommended. So too are tests for kidney function—the tenofovir in Truvada is associated with kidney toxicity—and hepatitis B virus (HBV) infection, given that Truvada is also active against HBV and must be used cautiously.

Providers are cautioned to prescribe no more than a 90-day supply of PrEP and to offer extensive HIV risk-reduction counseling, adherence counseling and condoms.

Follow-up is recommended every two to three months to test again for HIV. Further assessments are also recommended at this time for adherence and continued HIV risk behavior, and to provide ongoing support and counseling for these. Kidney function testing is again recommended three months after a person first starts PrEP and yearly thereafter. Tests for common STIs are also recommended every six months, even if a person has no symptoms.

The CDC also recommends that before people discontinue PrEP—whether because of safety concerns, a positive HIV test result, or a person requests to stop treatment—their providers should link them to HIV care (if a person has become infected) or ongoing HIV risk-reduction counseling and support. For people who have HBV, their providers should also discuss whether to continue treatment as a means to control HBV infection.

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!

UNAIDS, IOM Seek to Improve HIV Services for Migrants

Joint United Nations Programme on HIV/AIDS (UNAIDS) and the International Organization for Migration (IOM) today signed a new cooperation agreement to overcome HIV-related challenges faced by many migrants.

The agreement seeks to integrate human rights and the needs of migrants and mobile populations into national and regional HIV responses and ensure universal access to HIV prevention, treatment, care and support.

“Healthy migrants contribute significantly to achieving healthy economies,” said Michel Sidibé, Executive Director of UNAIDS. “States and other actors in the AIDS response have a fundamental duty to ensure the safety and well-being of migrants—this must include access to HIV services.”

Under the new agreement, IOM and UNAIDS will also focus on enhancing social protection for migrants affected by HIV; stopping violence against migrant women and girls and removing punitive laws, policies, practices, stigma and discrimination related to HIV and population mobility that block effective responses to AIDS.

"Government and civil society are becoming increasingly concerned about the potential vulnerability of migrants to HIV infection. By strengthening our partnership and pooling our respective expertise on HIV and migrants, our two organizations can address this critical issue more effectively," said IOM Director General William Lacy Swing.

In addition UNAIDS and IOM will work on strengthening technical support to help governments, regional institutions and civil society reduce vulnerability to HIV among mobile and migrant populations. The two organizations will also continue cooperation on research to deepen the understanding of HIV and population mobility.

IOM and UNAIDS have a long-standing partnership, formalized in a 1999 Cooperation Framework which was updated in 2002. This is now replaced by today’s new agreement. IOM’s HIV and population mobility programme not only complements the work of UNAIDS globally, but the Organization is also part of the UN Joint Team on HIV/AIDS at the country level.

UNAIDS is committed to improving access to HIV services for migrants and has included mobility in its Strategy 2011-2015 which states that HIV responses must create space to involve marginalized and disempowered people, such as migrants.

HIV projects are a significant part of IOM’s work, comprising the second largest area of migrant health projects implemented after health assessments. They are part of IOM’s broader efforts to ensure migrant access to health services regardless of migration status, throughout the migration process.

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 Lipo Drug Egrifta Now Available; Financial Assistance Programs Open

Egrifta (tesamorelin), the lipodystrophy treatment approved by the U.S. Food and Drug Administration (FDA) late last year, is now officially available to people living with HIV and their health care providers, according to announcements from EMD Serono. To expedite prescriptions and reimbursement, the company also described various services—including patient assistance and co-pay programs—now open to HIV-positive patients who need the drug.
Egrifta was approved by the U.S. Food and Drug Administration (FDA) on November 10, 2010. 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 and experiencing lipodystrophy, a side effect of antiretroviral (ARV) therapy.

Egrifta was developed by Theratechnologies, a company based in Montreal, but is to be sold in the U.S. by Rockland, Massachusetts-based EMD Serono. 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.

The company 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.

The wholesale acquisition cost (WAP) of Egrifta—the pre-retail price charged by EMD Serono—is $23,900 annually, or $1,964 for a 30-day supply.

Prescriptions for Egrifta will need to be processed through the AXIS Center, a centralized group of prescription specialists contracted by EMD Serono. In addition to prescription processing, the AXIS Center offers in-home or in-office injection training to every new patient through a national network of injection trainers, along with educational kits and 24-hour support. The AXIS Center will also facilitate important financial assistance options, including EMD Serono’s patient assistance and co-pay assistance programs.

For commercially insured patients with a prescription drug benefit that covers Egrifta, the co-pay assistance program covers up to $2,400 of patients’ out-of-pocket cost over a 12-month period. This can offset up to $200 of their co-pay or coinsurance for up to 12 uses before December 31, 2012, but not more than once every 21 days.

Patients may not use the co-pay assistance program if they receive drug benefits from state or federal health care initiatives (including Medicare or Medicaid). This program is not valid in the Commonwealth of Massachusetts.

EMD Serono’s patient assistance program (PAP) provides free Egrifta for eligible patients who are uninsured or underinsured. Patients must meet other eligibility requirements, including a household income that does not exceed 600 percent of the Federal Poverty Level (FPL), which for one person is currently $10,830. Patients must also have a diagnosis of lipodystrophy and be a resident of the United States.

The PAP, which is being coordinated by the AXIS Center, will provide free Egrifta for one year, and patients will need to reapply if they want to continue receiving the drug.

To start the process, licensed health care providers must fax a Statement of Medical Necessity (SMN)—a detailed prescription—and completed patient authorization form to the AXIS Center at 866-823-9554. SMNs will be provided by the EMD Serono sales team or can be requested by calling the AXIS Center at 877-714-AXIS.

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-Positive Surgeon in Ireland Settles Suit Against Hospital

A surgeon who contracted HIV from a patient in 1997 has settled his High Court action for damages.

At a previous hearing the man, who cannot be identified, said he was diagnosed with HIV in 1997 after a flu-like illness. He said his 'life stopped' the day he was diagnosed.

For the three months prior to the diagnosis, he had operated on more than 100 patients and could not be specific about when he was infected. He said he knew he had sustained numerous needle stick injuries and said 'unfortunately one of them got me'.

The orthopaedic surgeon said he had to use screws, saws and chisels and there was a risk of contamination with blood from wounds.

The High Court was told the action against the hospital and the Attorney General was settled and could be struck out. No details of the settlement were disclosed.
The surgeon had claimed the defendants had failed to implement patient testing for HIV on 'economic grounds'.

He also claimed there was a failure to adopt risk management, infection control policies and training and educational programmes.

The defendants denied the claims. A statement was read in court on behalf of the hospital, which said it wished to make clear that it never intended to suggest that HIV had been acquired otherwise than in an occupational setting.

The man was forced to stop working as a surgeon after his diagnosis and has suffered from depression along with the physical symptoms of HIV. He has to undergo combination therapy for life for his condition.

He and his wife were extremely distressed and depressed about the future and feared for the prospect of having children.

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!

Approval of Gilead and Tibotec’s New Combo HIV Pill Hits Snag

Gilead Sciences announced January 25 that the U.S. Food and Drug Administration (FDA) has refused to accept the company’s New Drug Application (NDA) supporting the approval of a new three-in-one HIV drug that combines Tibotec’s rilpivirine (TMC278) with Gilead’s Truvada (tenofovir plus emtricitabine).

The company expects to be in a position to resubmit the NDA by the end of March, once it is ready to provide additional information requested by the FDA. The agency is interested in the chemistry and manufacturing of the three-in-one drug, notably its methodology of establishing acceptable levels of an impurity related to emtricitabine that was found while testing the combination tablet.

Gilead’s chief scientific officer, Norbert Bischofberger, told Bloomberg news that FDA’s refusal to accept the filling will actually help ensure that the drug will still receive a priority six-month review.

“I am confident that this will result in only a minor delay in bringing this important new treatment to patients,” said John Martin, Gilead’s chief executive officer.

While Gilead is responsible for manufacturing the combination pill and getting its FDA approval, Tibotec—a subsidiary of Johnson & Johnson—remains responsible for manufacturing rilpivirine as a stand-alone drug. Gilead’s reported manufacturing problem has affected the FDA review only of the combination pill.

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!

Hep C Treatment Telaprevir Gets Fast-Tracked FDA Review

Vertex Pharmaceuticals announced on January 20 that the U.S. Food and Drug Administration (FDA) has agreed to expedite its approval review of the experimental hepatitis C protease inhibitor telaprevir. The agency has until May 23—six months from the original New Drug Application (NDA) filing date of November 23—to complete its review.

Vertex also announced the completion of a New Drug Submission (NDS) to the Therapeutic Product Directorate (TPD) of Health Canada seeking approval for telaprevir in Canada, where it was also granted Priority Review.

The U.S. NDA and Canadian NDS are supported by results from three Phase III studies evaluating the protease inhibitor in people chronically infected with genotype 1 hepatitis C virus (HCV) who were new to treatment as well as those who were treated before but did not achieve a sustained virologic response (SVR, or viral cure).

All Phase III studies, in which telaprevir was started immediately in combination with standard HCV treatment (pegylated interferon plus ribavirin) for the first 12 weeks of treatment, met their primary objectives.

In people with hepatitis C who were new to treatment, up to 75 percent achieved an SVR with telaprevir-based combination therapy, compared with 44 percent of people who received pegylated interferon and ribavirin alone. What’s more, a majority of patients treated with telaprevir in the treatment-naive studies (ADVANCE and ILLUMINATE) were eligible to reduce their treatment time by half—from 48 to 24 weeks.

Among those who had not achieved an SVR with an earlier course of treatment, SVRs were significantly more likely to be documented upon retreatment with the addition of telaprevir, compared with those retreated with pegylated interferon and ribavirin alone.

Standard review in the United States takes about 10 months. Priority Review shortens the review time to six months. And in Canada, where standard review can take at least 18 months, Priority Review results in an approval decision from TPD within six to nine months.

Vertex is developing telaprevir in collaboration with Tibotec Pharmaceuticals and Mitsubishi Tanabe Pharma. Vertex has rights to commercialize telaprevir in North America, and Tibotec has rights in Europe, South America, Australia, the Middle East and certain other countries. Mitsubishi Tanabe Pharma has rights to commercialize telaprevir in Japan and certain Far East countries.

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!

Discovery About HIV Could Lead to New Prevention and Treatment Approaches

Researchers have discovered how HIV is able to reproduce within a type of immune cell called a macrophage and how it evades many of the most common antiretroviral (ARV) therapies. This new finding was published December 10 in The Journal of Biological Chemistry and detailed in a release from the University of Rochester in New York.

Macrophages serve as one of the first lines of defense against viruses, bacteria and other microbes. The Greek term macrophage translates into English as “big eater,” which describes their function—to engulf an infectious organism and then present small bits of it to other immune cells. This helps provoke a strong response against the invaders. HIV, however, is able to hijack macrophages and use them to infect other cells.

Baek Kim, PhD, from the University of Rochester, has been studying macrophages for more than 15 years in hopes of understanding fully how HIV is able to hijack the molecular machinery of macrophages and turn it to the advantage of the virus. Now, he and other researchers at the University of Rochester and Emory University in Atlanta, report that they’ve figured it out.

It turns out that HIV is able to utilize more than one type of molecular “tool” in order to reproduce inside cells. It is widely known that HIV commonly uses a molecule called deoxynucleoside triphosphate (dNTP) to build strings of HIV DNA that turn most other immune cells into virus factories. This molecule, however, is in short supply inside macrophages. For this reason, HIV’s ability to replicate inside macrophages has remained somewhat of a mystery. What Baek and his team discovered, however is that HIV can turn to another type of molecule, called ribonucleoside triphosphate (rNTP), when dNTP has been knocked out.

“The virus would normally just use dNTP, but it’s simply not available in great quantities in the macrophage. So HIV begins to use rNTP, which is quite similar from a chemical perspective. This is a surprise,” Kim said. “The virus just wants to finish replicating, and it will utilize any resource it can to do so.”

The findings will need to be confirmed by further research, and it will take some time to determine whether they can be applied to treat or prevent new infections. However, one of Kim’s partners in this research, Raymond Schinazi, PhD, from Emory says this finding could have significant implications for both HIV treatment and prevention.

Many ARVs target the molecule dNTP. Kim’s finding that the virus can also use rNTP means that such drugs may not effectively target macrophages and shut down viral reproduction there. Since macrophages are the first cells that HIV encounters, current ARVs might not be able to effectively block infection. Likewise, once a person is infected, the macrophages that line the gut and inhabit lymph nodes might also be resistant to the effects of typical ARVs.

“This significant breakthrough was unappreciated prior to our paper. We are now exploiting new [ARV] drugs jointly based on this novel approach that are essentially not toxic and that can be used to treat and prevent HIV infections,” Schinazi 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.


TOGETHER WE REMAIN STRONG!

Study: Sex, Race and Location May Influence HIV Outcomes

Despite comparatively favorable clinical parameters at enrollment, women with HIV developed worse outcomes than men in a 1997-2007 study of a primarily North American cohort of recently and acutely infected patients. The study was based on 2,277 HIV seroconverters, including 124 women, enrolled in the Acute Infection and Early Disease Research Program.

Among the study findings:
*Initially, women averaged .40 log10 fewer copies/mL of HIV-1 RNA (P<.001) and 66 more CD4+ T cells/µL (P=.006) than men, after controlling for age and race.
*Nonwhite men and women were less likely to initiate antiretroviral therapy (ART) at any time than white men (P<.005).
*Patients in the US South were less likely to initiate ART compared with those in other regions (P=.047).
*Women were 2.17-fold more likely than men to experience at least one HIV/AIDS-related illness (P<.001), and nonwhite women were most likely compared to all others (P<.035), adjusting for IV drug use and ART.
*Eight years after diagnosis, 78 percent of nonwhite and 37 percent of white patients in the South had reported at least one HIV/AIDS-related illness, compared with 24 percent of whites and 17 percent of nonwhites from other regions (P<.001).

"To me that's just incredible," said lead author Dr. Amie Meditz of the University of Colorado-Denver. "We have to figure out why this group had poor outcomes, and we have to develop strategies on how to fix this."

"Despite striking advances in the treatment of HIV-infection, this study points out that there are other factors that are beyond the sphere of science, medicine, and the health care system that can substantially impact the health outcome of HIV-infected individuals," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which funded the study. "Paramount among these is the influence of socioeconomic factors that often determine access to health care as well as contribute in a negative way to a lifestyle detrimental to optimal health outcomes in the acquisition and treatment of a number of diseases, including HIV infection."

The full study, "Sex, Race, and Geographic Region Influence Clinical Outcomes Following Primary HIV-1 Infection," was published in the Journal of Infectious Diseases (2011;203(4):442-451).

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!

GOP Lawmaker Wants to End HIV Prevention Funding

State Rep. Dave Agema (R-Grandville) has proposed diverting funding away from HIV prevention and related health initiatives toward upkeep and expansion projects at the state's airports.

The Michigan Health Fund Initiative is funded by the state Department of Community Health (DCH) under a law that directs a small percentage of sales tax revenues to the program. Through distributions to public and private agencies, MHFI supports HIV prevention, testing, and care programs; STD contact tracing services; research on effective health promotion campaigns; and laboratory services for the Detroit Health Department. It also provides prevention programming for chronic conditions such as diabetes and heart disease.

According to Agema, the services funded by MHFI are also paid for by DCH's budget. "This is almost like double-dipping," he said.

Agema also questions the initiative's management of funds. MHFI's approximately $9 million budget, $5.7 million is spent on administrative costs.

Agema, a former airline pilot, wants to shift the money to the Michigan Aeronautics Fund, which would pay for runway and building maintenance and airport expansions to accommodate more cargo freight. The state will receive $9.50 in federal funds for every $1 spent it spends on airports, he noted. "There's not a better job creator," he added.

AIDS advocates question the wisdom of Agema's proposal.
"HIV, [STD] and pregnancy prevention fall into an area of community health that is already grossly underfunded even while the need for such prevention programs fails to diminish," said Emily Dievendorf, policy director of Equality Michigan. The state has 14,371 HIV/AIDS cases.

"It's too early in the budget priority setting process to make a decision/determination and we haven't yet seen any of the specifics of this bill," said Geralyn Lasher, spokesperson for Gov. Rick Snyder (R).

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!

Australia Clean-Needle Program Keeping HIV at Bay

The early, widespread use of needle and syringe programs (NSPs) in Australia has managed to keep down HIV prevalence among injection drug users, a new study suggests. To prevent an HIV epidemic among IDUs, Australia began setting up NSPs in 1986. In Australia's NSPs, IDUs do not have to turn in used sharps in return for sterile injecting supplies.

Researchers evaluated data for 22,478 individual clients attending NSPs from 1995 to 2009, a mean response rate of 44 percent per year (range 38 percent to 60 percent). Among these, 85 percent identified as heterosexual, 10 percent bisexual, and 5 percent homosexual. Of the 21,248 for whom serology was available, 230 (1.1 percent) tested HIV antibody positive.

"Variables independently associated with antibody seropositivity were homosexual or bisexual identity; male sex; older age at first injection; and survey participation between 1995 and 1997 rather than later periods," reported Libby Topp, of Australia's National Center in HIV Epidemiology and Clinical Research, and colleagues.

"There has never been a significant, generalized outbreak of HIV among people who inject drugs in this country," Topp said. The 1 percent rate mirrors that seen in studies of Australian IDUs generally, not just NSP clients, said Topp.

HIV prevalence among US IDUs is an estimated 16 percent, and among Russian IDUs it is 37 percent. In 2009, the United States overturned a ban on the use of federal funds for NSPs. Injection drug use was the infection route for 19 percent of the 1.1 million US residents living with HIV in 2006, according to CDC.

The study, "Fifteen Years of HIV Surveillance Among People Who Inject Drugs: The Australian Needle and Syringe Program Survey 1995-2009," was published in AIDS (2010; doi:10.1097/QAD.0b013e32834412cc).

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


TOGETHER WE REMAIN STRONG!

AIDS Drug Assistance Program Activists Schedule 'Crisis' Summit to Find Solutions for Budget Hole

The AIDS Drug Assistance Program Advocacy Association (AAA)will host "ADAPs in Crisis: Preparing for 2011" Jan. 29-30 in Fort Lauderdale, Fla. Discussion topics will include securing additional federal appropriations, programmatic reforms, available private resources, and other remedies to move beyond waiting lists and improve access to care for all people living with HIV/AIDS.

Using funds from the federal Ryan White program, ADAPs in all 50 states provide HIV-positive low-income Americans with medications. However, ADAP budgets are being strained by a range of factors including the recession, funding cuts, higher numbers of patients resulting from expanded testing efforts, and federal guidelines recommending earlier initiation of drug therapy. Also, thanks to the efficacy of treatment, patients are surviving longer and thus remaining longer on the ADAP rolls.

Florida, according to the National Alliance of State and Territorial AIDS Directors, has the nation's largest waiting list: 2,879 patients as of Jan. 21. "The pharmaceutical companies have made their drug assistance programs available, but we don't know how many people on the waiting lists are being covered this way," said AAA+ CEO Brandon Macsata

According to the New York Times, drug assistance is the largest component of the federal Ryan White program. And while demand has spiked, federal support rose barely 2 percent this year. Drug companies have increased their contributions by half, to nearly $500 million, but state appropriations have fallen 34 percent, according to state AIDS directors.

For summit fee, registration, and scholarship information visit
http://www.adapadvocacyassociation.org/pdf/2011_aaa_Conference_Emergency-ADAP-Summit-flyer_01-05-11.pdf

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


TOGETHER WE REMAIN STRONG!

test

HIV-Positive Airman Sentenced to 8 Years

McCONNELL AIR FORCE BASE, Kan. — An Air Force noncommissioned officer convicted of exposing multiple sex partners to HIV at swinger parties was sentenced Wednesday to eight years in military prison and will be dishonorably discharged after serving his time.

The court-martial’s judge earlier found Tech. Sgt. David Gutierrez guilty on seven of eight counts of aggravated assault and violating his commander’s order to notify partners about his HIV status and use condoms. The judge also convicted Gutierrez of indecent acts for having sex in front of others and eight counts of adultery.

The judge, Lt. Col. William Muldoon, delivered the sentence after a brief hearing, during which Gutierrez had begged between sobs not to be discharged so he could keep the military medical benefits he will now lose. Gutierrez also will be busted in rank to airman basic while serving out his military confinement.

Before he was sentenced, Gutierrez told Muldoon that he was willing to spend more time in jail rather than lose the medical benefits he needs.

“The possibility of a future without assistance does scare me — scares me to the core,” he tearfully said. “The cost of medicine is very expensive and I don’t know if I can afford it.”

Gutierrez, 43, apologized to the court, the Air Force, his family and his sexual partners. He said he thanks God every day none of his partners contracted the disease and asked the judge to have mercy on him so he can live to see his two children graduate from college and get married.

Prosecutors had argued Gutierrez played Russian roulette with his sexual partners’ lives.

“The accused was not thinking about how his victims would pay for their medications,” Capt. Sam Kidd said.

Defense attorneys asked for imprisonment in the “single digits” and pleaded with the judge not to impose the punitive discharge that would strip his benefits.

“He is looking at his own mortality as he looks down the road,” said defense attorney Maj. James Dorman.

Dr. Donna Sweet testified Wednesday that the cost of HIV medication typically runs between $1,700 and $1,800 a month, and HIV-infected patients on average spend between $28,000 and $30,000 annually for their medical care.

Without medical care, infected patients usually die within 10 years, she said. But with proper care and mediation, a 20-year-old person who contracts HIV can easily expect to live to age 70.

A Wichita woman who said she has lived a swinger lifestyle for six years returned to the stand during Gutierrez’s sentencing hearing to give a victim impact statement, saying she found out from news reports about the case that she had been exposed to HIV.

“I started crying,” she said. “I was kind of mortified.”

Another woman who testified against Gutierrez during the court martial sat in the gallery during the sentencing phase and wiped tears from her eyes as he said he was sorry he betrayed the friendships he had with his partners.

“I hope they understand I never intended to hurt them, and I sincerely ask for their forgiveness,” Gutierrez said.

The Associated Press is not naming the airman’s sexual partners because they are alleged victims of sexual crimes.

Several people who participated in swinger and partner-swapping events with Gutierrez and his wife testified this week that they never would have had sex with him had he told them he was HIV-positive.

Gutierrez repeatedly denied that he was infected, and he was encouraged by his wife to carry on with swinger events, several witnesses testified during the airman’s court-martial at the base near Wichita.

Gutierrez originally was charged with 10 counts of aggravated assault and with violating his squadron commander’s order to notify partners about his HIV status and use condoms. The judge granted a prosecution request Wednesday to drop two of the assault charges and one of the adultery charges.

Gutierrez told the judge his first priority will be to heal the damage the case has caused his children.

“I know the future I have in front of me and I know it will be hard,” he said. “All one has to do is Google my name and my life is before them.”

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!

Chechnya Says Couples Must Be HIV-Negative to Marry

Any couples planning to marry in Muslim Chechnya must prove they are not infected with HIV, the region's spiritual leaders declared this week.

"Any potential bride or groom is obliged to receive a medical certificate proving they are HIV-negative," according to a statement by the Chechen mufti, or professional jurist who interprets Muslim law. An imam can only approve of a marriage once that certificate is obtained. "Only an official representative from the republic's clergymen has that right," the statement added.

The order follows a demand last year that all eateries cease operations during the holy month of Ramadan and the call for armed men to harass women who do not wear headscarves. The mufti's requirements carry no legal weight but are generally followed because he is a respected spiritual leader.

However, activists and some residents in the volatile region are outraged by the new requirement. "This is, of course, not within Russian law," said Minkail Ezhiev, a human rights activist and founder of the Chechen Civil Society Forum. "We wish human rights were taken into account here."

Russia is in the midst of a serious heroin crisis, which could lead to an explosion of HIV/AIDS cases. The UN estimates at least 1 million Russians are HIV-positive, though Chechnya has been largely spared by the epidemic.

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!

Brown's Budget Would Hit People with HIV

Gov. Jerry Brown's proposed budget for fiscal 2011-12 could increase clients' share of costs in the state AIDS Drug Assistance Program. Proposed ADAP funding for the period is $518.5 million - $163.8 million of it from the state's general fund.

Under Brown's proposal, ADAP would increase clients' out-of-pocket costs up to a maximum of 5 percent of gross income. "It can stop [people] from picking up their medications," said Anne Donnelly, director of health care policy at Project Inform, noting the move would save the state an estimated $16.8 million in general fund net savings.

The California Department of Public Health is evaluating "the fiscal impact of different options including co-pays and a monthly premium system," said Matt Conens, the agency's spokesperson.

"One of the largest drivers of ADAP's annual cost increases is the continuous increases in drug pricing," Conens said. Federal law enables ADAP "to bill manufacturers for rebates when ADAP pays any part of a prescription, including co-pays and co-insurance," he said. "Without the ability to collect these full manufacturer rebates, ADAP will no longer be viable. Thus it is critical that we maintain these clients in ADAP."

Brown's proposal would also require co-payments in Medi-Cal, saving an estimated $294.4 million. Prescriptions would be limited to six per month, excluding life-saving drugs, saving $11.1 million.

"We know this is going to be difficult and painful across the board, but certainly I and our LGBT legislative caucus will be very vigilant" in supporting ADAP and HIV/AIDS issues, said state Sen. Mark Leno (D-San Francisco), chair of the Senate budget and fiscal review committee. "We need to have pharmaceutical companies, for example, provide appropriate rebates to the state for ADAP," 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.


TOGETHER WE REMAIN STRONG!

HIV-Positive Virginia Man Sentenced to 50 Years in Prison

A Madison Heights man was sentenced to 50 years in prison on Wednesday for having sex with a 14-year-old girl and knowingly infecting her with HIV.

Carlos Rose, 41, pleaded guilty in November to 11 felony counts, including two counts of producing child pornography, three counts of carnal knowledge of a child, three counts of indecent liberties and three counts of infected sexual battery.

The victim, now 15, testified during the sentencing hearing before Amherst Circuit Judge Michael Gamble, as did her mother.

“Ever since I found out that he gave me HIV, I was devastated,” she said. “I thought it was the end of my life. I thought no one would love me. What he did just ruined my mind.”

The teenager found out she was positive on her 15th birthday, her mother testified.

The girl acknowledged under questioning by Rose’s attorney, Leigh Drewry, that she initiated contact with Rose on Facebook, lied about her age and consented. She said she was 16; he said he was 19.

“Who’s the adult here?” said Commonwealth’s Attorney Stephanie Maddox. “He is the adult, he is the responsible one … I don’t think Mr. Rose has taken responsibility.”

Drewry called for a sentence of just more than six years to no more than 14 years, comparing the girl’s injury to chronic leukemia and acknowledging that Rose “will be marked with today’s equivalent of a scarlet letter.”

Rose, shackled at the ankles and wearing an orange jump suit, hung his head as Gamble pronounced the sentence of 135 years, with all but 50 years suspended –– which included the maximum five years each for two counts of sexual infected battery.

Maddox said afterward she was pleased with the sentence.

The family spoke briefly after the sentencing, with victim-witness advocates from Amherst and Bedford counties present. Rose faces sentencing in March in Bedford County on similar charges.

“The court and what they’ve done, we’re well pleased,” the victim’s father said. “What we want to do now is move on and live our lives as God intended.”

Said the victim’s mother, “The streets will be safer with one less predator,” and credited the family’s faith. “That’s the only reason we were able to get through this.”

Maddox said Rose had known he was HIV positive since 2007. Maddox said during his November plea hearing that Rose often took the girl back to the house he shared with his mother for their sexual encounters.

Rose was arrested after the girl’s parents reported him to Bedford City police in early June.

Investigators also found Rose had photographed and recorded video of the encounters.

In exchange for his pleas of guilty, Maddox said, Rose was not charged under provisions of Virginia law that provide for a 15-year mandatory-minimum sentence for second or subsequent offenses of child pornography production.

Rose pleaded guilty Dec. 16 in Bedford County Circuit Court to one count each of carnal knowledge of a child and soliciting to produce child pornography. He pleaded no contest to infected sexual battery. His sentencing there is set for March 1.

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!

Stroke Rates Increasing in People With HIV

The rate of stroke diagnoses increased significantly between 1997 and 2006 in people living with HIV, while simultaneously falling in HIV-negative people, according to a study published online January 19 in the journal Neurology and reported by the Los Angeles Times.

Researchers have been reporting for years that cardiovascular disease (CVD) rates are on the rise in people with HIV, looking mostly at the number of heart attacks and clogged arteries in various cohorts. Less is known about the rate of stroke, which is another major form of CVD. It occurs when there is an interruption of the blood supply to any part of the brain. It can cause disability and, in many cases, death.

To explore this matter, Bruce Ovbiagele, MD—from the University of California at San Diego—and Avindra Nath, MD—from Johns Hopkins University in Baltimore—examined the medical records of HIV-positive and HIV-negative individuals from a national database of hospitalized patients who were treated for stroke between 1997 and 2006.

Ovbiagele and Nath found that while the risk of stroke in HIV-negative study participants had fallen by 7 percent over that time period, the risk had actually increased by 60 percent in people with HIV. Moreover, the researchers found that the higher stroke risk was from an increase in ischemic strokes—those caused by blood clots in the brain—rather than strokes caused by ruptured arteries (hemorrhagic stroke).

The authors concede that some of the increased risk might be tied to the fact that more people with HIV are simply living into old age, when strokes become more prevalent. They also point out, however, that the age at which HIV-positive patients experienced a stroke—the majority of whom were in their 50s—remained largely the same over the course of the study, and that this more likely points to both HIV and antiretroviral treatment as causes.

As the LA Times story concluded, “The researchers cautioned HIV physicians to be particularly alert to symptoms that might indicate that a patient is at above-normal risk for a stroke…[but that] the absolute risk of stroke was still very low, less than 0.2 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!

HIV-Positive Airman in Kansas Faces 53 Years in Prison

A lawyer for an Air Force officer accused of having unprotected sex with multiple partners without telling them he’s HIV positive told a military judge Tuesday that recent scientific research shows such action doesn’t amount to aggravated assault.

The opening statement by one of Tech. Sgt. David Gutierrez’s military lawyers offered a first glimpse at the strategy the defense will employ. Court-martial proceedings are being held at McConnell Air Force Base, where Gutierrez is stationed and assigned to the 22nd Maintenance Operations Squadron. He has been under arrest at the base since Aug. 9.

Gutierrez is charged with 10 counts of aggravated assault — one count for each sexual partner — and with violating his squadron commander’s order to notify his sexual partners about his HIV status and to use condoms. He also has been charged with multiple indecent acts for having sex in front of others. He also was charged with nine counts of adultery.

Gutierrez pleaded not guilty to all charges in a case being heard before military judge Lt. Col. William Muldoon. The judge rejected a defense attorney’s request at the start of the proceedings to dismiss aggravated assault charges as unconstitutional because similar case law on aggravated assault in effect says his client can’t ever have sex again.

Capt. Sam Kidd, who is prosecuting the case, contended the government has a legitimate, if not compelling interest, to protect the community from service members spreading a life-threatening disease. He said in his opening statement that Gutierrez engaged in unprotected sex despite being counseled about the risks and ordered by his commander to inform sexual partners of his HIV status.

A Topeka woman testified Tuesday that she had unprotected sex with the airman during a toga party, at a camping trip and at his house.

She said Gutierrez’s wife participated in the swinger lifestyle.

“She was talking about opening a bed-and-breakfast for swingers,” she said. “She was all for it.”

The woman said she asked Gutierrez if he had any sexually transmitted diseases and he assured her he “was clean.” She said she would not have had sex with him had she known he had HIV.

“I watched a brother die of AIDS,” she said. “It wouldn’t have happened.”

Two other women, one from Stillwater, Okla., and another from Wichita, also testified about their sexual encounters with Gutierrez. They also said he didn’t tell them he was HIV positive and that they wouldn’t have had sex with him had they known. None of the women tested positive for HIV.

His commander, Maj. Christopher Hague, testified Tuesday that he gave Gutierrez a written order in October 2009 requiring him to use condoms and to notify his sexual partners of his HIV status before engaging in sex.

Special Agent Richard Toth of the Air Force Office of Special Investigations at McConnell testified that military authorities found out about Gutierrez’s sexual activities through numerous interviews with his wife.

Under military law, Gutierrez could face more than 53 years in prison if convicted on all charges. Other penalties include a dishonorable discharge, forfeiture of pay and reduction in rank.

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!

Lansing Area AIDS Network Grows, Evolves with the Times

Within the last 25 years, the Lansing Area AIDS Network grew from a small planning group convened at El Azteco restaurant into a non-profit with 11 full-time employees, a bimonthly food pantry, and an $825,000 budget. LAAN now helps more than 300 local people living with HIV/AIDS. Low-income clients also receive assistance with medical co-pays, bus passes, and other services.

"Back in 1985 or '86, it's sad to say most AIDS organizations were really helping people at the end of their life," said LAAN Executive Director Jacob Distel. "The major shift we've had is switching from an agency that basically helps people prepare to die to helping people live with the disease."

LAAN has assisted more than 1,000 people since it was founded. Distel notes that number continues to grow, with 43 more people helped last year than the previous year. Likewise, the number of HIV/AIDS cases in Ingham County has steadily increased. Two years ago, the county recorded 414 cases of HIV/AIDS, and now that number is 441, according to Vennishia Smith, Ingham County Health Department HIV/STD prevention coordinator.

"We've always had a high prevalence rate," said Smith. "Right now we are tied with Kent County for the second-highest prevalence rate [in the state]." Smith credits the increase to a greater willingness to be tested for HIV using a rapid test that provides results in 20 minutes versus a previous wait time of up to two weeks.

Unfortunately, the percentage of infected teens is also rising. Distel fears the results of a funding gap for prevention: "When prevention dollars go down, what's going to follow is higher instance rates," 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.


TOGETHER WE REMAIN STRONG!

HIV Results by Phone: Can We Predict Who Will Test HIV-Negative?

To study a requirement that all patients return to the health care setting to learn their HIV test results, the researchers described the number of HIV cases detected at Sydney Sexual Health Center among persons who disclosed no known risk factors before testing.

All HIV tests between January 2004 and January 2007 - together with the patient's gender, sex partners' gender, and test results - were identified through the clinic database. For each person who tested positive, the team reviewed pro forma medical records for sex partners' gender, condom use, sexual contact with a person from a country with high HIV prevalence, and injecting drug use.

A total of 13,290 HIV tests were performed during the three-year period. Among men who have sex with men, 55 (0.88 percent) of 6,194 tests were positive. Among women and heterosexual men, four (0.06 percent) of 7,096 tests were positive, and all four of these patients reported known risks for HIV infection before testing.

"Clients with no recognized risk factors for HIV are unlikely to test positive at our Australian sexual health clinic," the authors concluded. "Providing the option for low-risk people to obtain their results other than face-to-face has advantages for both the clinic in terms of service provision and the clients in terms of time and the proportion who receive their result."

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!

Inadequate Fight Against Drugs Hampers Russia's Ability to Curb HIV

Maxim, a graying 33-year-old Russian heroin addict with telltale scarred arms, circles a Moscow pharmacy known to sell prescription drugs illicitly. Another man with quarter-sized holes gouged into his body from injection-related infections declined to give his name, fearing arrest if he sought treatment for his addiction.

These men personify a Russian HIV epidemic that has raged since the Soviet collapse 20 years ago. According to UNAIDS, Russia reported 60,000 new cases of HIV in 2009, an 8 percent increase from 2008. More than 60 percent of those infections are attributed to drug injection, while many others are related to sex with intravenous drug users (IDUs).

Officials estimate that more than 1 million people in Russia are IDUs, often sharing tainted needles and infecting one another. In 2011, the government plans to double spending on HIV drugs to $600 million and expand prevention programs focusing on youths, said Galina G. Chistyakova, a Health Ministry official who helps oversee the country's HIV/AIDS policies.

Although the government has increased efforts to fight HIV/AIDS, sex education and preventive programs such as needle exchange and drug substitution therapy have been denounced by top medical and political officials, as well as by the Russian Orthodox Church. According to the Federal Drug Control Service, 90 percent of Russian addicts use Afghan heroin, which officials blame on a US inability to eradicate production of heroin in Afghanistan.

Lev Zohrabyan, Europe and Central Asia adviser for UNAIDS, identified IDUs and sex workers as groups to focus funds on to effect change but noted that Russia's budget for the next two years makes no provisions for prevention work among them.

"I've been researching the problem of HIV infection for 25 years," said Dr. Vadim V. Pokrovsky, head of Russia's Federal AIDS Center, "and I must say the situation has become significantly worse."

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!

Funding Gap Threatens Florida AIDS Drug Help

Florida's AIDS Drug Assistance Program could run out of money by mid-February, ADAP officials say. The program for low-income HIV/AIDS patients has a $14.5 million funding gap that could last until April 1, when $100 million in federal funding arrives.

"We're running out of money, and we're trying to help the patients through this six-week gap," Tom Liberti, chief of the HIV/AIDS Bureau of the state Department of Health, said Wednesday.

Liberti said he is "99 percent of the way" toward working out an agreement with drug companies to supply medicines in the interim. "We're exploring all our options," he said.

Florida's ADAP provides treatment to 10,600 patients, 3,000 of them in Miami-Dade and Broward counties. On Friday, the Miami-Dade HIV/AIDS Partnership, which advises the county, will hold an emergency meeting to determine whether to conserve resources by limiting the number of nonessential drugs, such as vitamins and aspirin, that ADAP supplies.

"At present, no patients are doing without AIDS drugs," said Dan Wall, director of the Miami-Dade Office of Grants Coordination. The situation after mid-February, however, is another story.

Liberti said state Sen. Joe Negron (R-Stuart) and other lawmakers are trying to persuade the Florida Legislature to provide more support for ADAP. In 2009, the Legislature cut state funding for ADAP by $1 million to $10.5 million. 2010 saw no additional funding appropriated for the program.

ADAP has grown by 25 percent since 2008, in part due to the poor economy. The program initiated a waiting list last June that has grown to include 2,800 people, said Liberti.

Friday's meeting will be held at the Behavioral Science Research building, 2121 Ponce de Leon Blvd., Coral Gables. The public is invited; for more information, telephone 305-443-2000.

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!

WHO Over-Extended, Not Performing Well Enough

The head of the World Health Organization told its executive board Monday that WHO needs to scale back its operations and concentrate on areas where it can make the most impact.

"We are not functioning at the level of top performance that is increasingly needed, and expected," said WHO Director-General Margaret Chan. "This organization is over-extended. We are constantly asked to do more and more. This has a limit. We are there."

In addition to fighting disease, improving primary health care, promoting vaccination and responding to disasters, WHO has taken on the global tobacco industry and monitors leading food, alcohol, and agri-business companies. Though it has had success in areas such as battling tropical diseases, "this is not the case in all the areas covered by our last program of work," said Chan.

The board is reviewing a proposed program budget of $4.54 billion for 2010-11 - a figure that was cut from $5.84 billion in the wake of the global financial crisis. WHO's program budget in 2008-09 was $4.23 billion.

Given the "serious funding shortfalls" facing WHO and other health financiers such as the Global Fund to Fight AIDS, TB and Malaria and the vaccine coalition GAVI, it is critical to avoid duplication of efforts, Chan said.

"The level of WHO engagement should not be governed by the size of a health problem. Instead, it should be governed by the extent to which WHO can have an impact on the problem. Others may be positioned to do a better job," said Chan. "In some areas, our engagement should be that of a watchdog."

"WHO needs to change at the administrative, budgetary, and programmatic levels," Chan noted, calling on its 193 member states to help shape the overhaul.

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!

Waiting List for AIDS Drug Assistance Grows

State health officials reported last week that 337 patients are on a waiting list for enrollment in South Carolina's AIDS Drug Assistance Program.

The program currently serves about 2,000 residents a month. If funding remains level, that same number of individuals - 2,000 - are projected to be on the waiting list by June 2012, said Anand Nagarajan, director of the state ADAP.

Recent years have seen double-digit increases in enrollment as more patients have been diagnosed; funding, however, has increased only modestly. Current figures from the state Department of Health and Environmental Control show the federal government gave about $17 million to South Carolina's ADAP, while the state itself contributed $1.8 million.

The S.C. HIV/AIDS Care Crisis Task Force was meeting in Columbia on Tuesday to discuss the situation; for more information, telephone Elizabeth McLendon at 803-254-6644, ext. 110. Across the country, 5,387 people were on ADAP waiting lists as of Jan. 13, according to the National Alliance of State and Territorial AIDS Directors.

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!

Teen STD Rate Soars on Salt Lake City's West Side

In west Salt Lake City, the chlamydia rate among youths far exceeds the national average. Glendale and Rose Park have the highest rates of chlamydia diagnoses, and the highest birth rates, among Utah teens. Glendale's STD rate is 32 times higher than Provo's, the lowest in the state, Department of Health data show.

"We have such a problem out here on the west side," said Amanda Thorderson, a Rose Park mother and member of the Salt Lake City school board. "Every parent should know what the rate of infection is in Salt Lake City and how that infection is growing every year. Parents have no idea."

Where rates of poverty, violence, and substance abuse are higher than average, teens are more likely to have sex at an early age, according to a 2007 review of 400 US studies on teen sexual activity. Some of the most ethnically diverse Salt Lake City ZIP codes have the highest rates of chlamydia.

Most Utah chlamydia diagnoses are made among whites. Nonetheless, the infection rate among Latinos is three times the rate among whites, and black residents have five times the infection rate of whites.

Heather Bush, an STD prevention specialist for the state Department of Health, said she feels most at ease providing instruction to youths in detention, as public schools are virtually off-limits. The correctional centers' population is disproportionately minority, and Bush also can reach west side youths there.

While her message is abstinence-based, Bush lets the kids know that having fewer sex partners and using protection also are smart choices. "I'm trying to empower them to make their own decisions," she 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.


TOGETHER WE REMAIN STRONG!

Reducing Drug Use, Human Immunodeficiency Virus Risk, and Recidivism Among Young Men Leaving Jail: Evaluation of the REAL MEN Re-Entry Program

The Returning Educated African-American and Latino Men to Enriched Neighborhoods (REAL MEN) intervention is designed to reduce drug use, risky sexual behavior, and criminal activity among males ages 16-18 leaving New York City jails. The current study assessed the impact of this multifaceted approach.

A total of 552 participants were recruited in city jails and randomly assigned to receive either an intensive 30-hour jail/community-based intervention or a single jail-based discharge planning session. In addition, all the men were referred to optional services at a community-based organization (CBO). One year after release from jail, 397 (72 percent) completed a follow-up interview. REAL MEN's impact on drug use, risky sexual behavior, criminal justice involvement, and school/work involvement post-release was evaluated using logistic and ordinary least squares regression.

The results showed assignment to REAL MEN and, independently, use of CBO services, significantly reduced the odds of substance dependence (odds ratio=.52, p=.05; OR=.41, p=.05, respectively) one year post-release. Participants assigned to the intervention spent 29 fewer days in jail compared with those in the control group (p=.05). Compared to non-CBO visitors, those who visited the CBO were more likely to have attended school or found work in the year after release (OR=2.02, p=.01).

"Jail and community services reduced drug dependence one year after release and the number of days spent in jail after the index arrest," the researchers concluded. "While these findings suggest that multifaceted interventions can improve outcomes for young men leaving jail, rates of drug use, risky sexual behavior, and recidivism remained high for all participants after release from jail, suggesting the need for additional policy and programmatic interventions."

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!

Lumpy Body Fat Compounds Stigma of AIDS

For Argentine HIV/AIDS patients, lipodystrophy is a visual sign of an already stigmatized disease. The redistribution of body fat, a common side effect of antiretroviral drugs (ARVs), is generally played down by health professionals but can be one of the most pressing concerns of people living with HIV/AIDS.

"I was one of those doctors who would say, when patients mentioned the issue of lipodystrophy, that it was a lesser evil, and at least they were alive," said Dr. Mercedes Bisgarra, who heads a pioneering primary care AIDS program in Tres de Febrero, a district on the outskirts of Buenos Aires. "But they would respond, 'yes, but I don't want to live like this.'"

Lipodystrophy is marked by loss of fat in the face, arms, legs, and buttocks. Fatty tissue can concentrate between the shoulder blades, a condition known as a "buffalo hump," and in the breasts and abdomen for both genders. Women may experience narrowing of the hips. The condition also can affect HIV-positive adolescents and children.

"When members of our network meet, we see that most of us are suffering from clear signs of the problem," said Marcela Alsina of the Buenos Aires Network of People Living with HIV. The issue has not yet been addressed sufficiently at the regional level, she said.

To raise awareness, the network staged a December photo exhibit with the Foundation for Studies and Research on Women in the Buenos Aires provincial Senate in La Plata. The photos showed the effects of lipodystrophy and featured personal accounts of people on ARVs. "I learned to live with the virus, now I have to learn how to live with the body that the pills have given me," said one patient.

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!