The Friends of AIDS Foundation Community Journal: August 2012

Wednesday, August 29, 2012

Mugabe Says Census Will Reveal AIDS Toll on Zimbabwe

Zimbabwe recently launched its national census to measure the extent of HIV/AIDS in the population, a survey undertaken once a decade.

The 2002 census found that HIV/AIDS had slowed Zimbabwe’s rate of population growth, said President Robert Mugabe. About 13 percent of the population has HIV, but new infections dropped 50 percent between 1997 and 2007, according to a study last year. Officials are encouraging male circumcision to help prevent HIV.

The census will cost about $40 million, including $12.6 million from donors, the finance ministry said.

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

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County Jail to Expand HIV Testing; Inmates Can Opt Out

In late June, opt-out HIV testing was expanded to male inmates entering Cook County Jail, a process in place for female inmates since April 2011. Health officials plan to adopt a similar program for state prisons soon, hoping to increase the number of people who know their HIV status.

The program requires inmates to sign a form refusing to take the test during intake; otherwise, they will be tested. Undiagnosed inmates who leave prisons might infect their partners in the community, said experts.

“It’s a window of opportunity for reaching them for education purposes,” said Cajetan Luna, executive director of the Center for Health Justice. “Once people get out in the community, it’s much harder to do that work.”

According to CDC, each year one in seven people with HIV pass through a correctional facility. Inmates are more than twice as likely to have HIV as people in the general population, particularly inmates who used to engage in injecting drug use, sex work, and other risk behaviors.

Experts attribute misunderstandings about HIV and how it is transmitted for inmate reluctance to test, and fear of unwanted attention dissuades some from seeking treatment. “I try to give them plausible reasons on why they are seeing me other than they got it,” said Dr. Chad Zawitz, director of infectious disease for Cook County Jail.

Compared to the previous year, the number of female inmates getting tested has about tripled since the opt-out program began, Zawitz said.

In the state prison system, opt-out testing will be paid for with part of a $7 million grant awarded two years ago to University of Illinois-Chicago researchers, who are also working to find and diagnose more HIV infections within inmate social networks.

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Healthful Food Could Be Key in Treatment: HIV/AIDS

HIV patients who have inadequate access to nutritious food are more likely to face hospitalizations and emergency room (ER) visits than those who have enough to eat, according to a recent study. In San Francisco, 56 percent of HIV-positive patients who were homeless or living in substandard housing also were food insecure, defined as regularly unable to obtain enough healthy food.

The 347 food-insecure HIV patients studied had about twice the ER visits or hospitalizations over a given three-month period compared with food-secure patients, University of California—San Francisco (UCSF) researchers found. Food insecurity had a greater association with trips to the hospital than homelessness, drug abuse, depression, and just about any other poverty-associated measure.

Earlier studies in the United States and elsewhere have found food insecurity associated with missed doctors’ appointments, less suppression of HIV, and greater mortality risk.

“I feel like, if we can give antiretroviral medications, why shouldn’t we also be able to write a prescription for food?” said one study author, Dr. Margot Kushel, an associate professor in the UCSF Division of Internal Medicine at San Francisco General Hospital.

More research is needed, such as studying whether food-insecure patients have better health outcomes with more to eat, Kushel and colleagues said.

Only a fifth of participants in the UCSF study took advantage of federal food assistance programs over a one-year period, the study authors noted. They suggested either helping patients sign up for programs or lowering the bar for assistance in order to lessen food insecurity. About 72 percent of participants received some form of food aid.

The study, “Food Insecurity Is Associated with Greater Acute Care Utilization Among HIV-Infected Homeless and Marginally Housed Individuals in San Francisco,” was published ahead of the print version of the Journal of General Internal Medicine (2012;doi:10.1007/s11606-012-2176-4).

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AIDS Projects Receive Grant Extensions

US and South African government officials recently agreed to terms detailing how the US President’s Emergency Plan for AIDS Relief program will draw down its South African support and shift funds from service delivery to technical assistance. Now, the Department of Health has secured grant extensions for some PEPFAR-assisted projects, giving their managing organizations enough time to make alternative plans so that no patients are affected.

Since 2003, the United States has been South Africa’s largest HIV/AIDS donor, contributing $3.2 billion. By 2017, annual US grants to South Africa will decline to $250 million from the current fiscal year’s $484 million.

Some nongovernmental organizations will see their five-year PEPFAR grants end with the closing of the US fiscal year next month, prompting the urgent need to secure funding to continue their HIV/AIDS services.

Yogan Pillay, the health department’s deputy director-general for strategic health programs, said grant extensions have been arranged for NGOs until January. “The immediate [priority] is to ensure no patient is worse off than they were under PEPFAR,” said Pillay.

“PEPFAR funding will not decline significantly immediately, but in three to five years,” said Mark Blecher, the Treasury’s director for social services. “So changes to the funding of specific NGOs now are probably more due to specific business cases that may have or have not been approved by PEPFAR, based on its own internal funding policy.”

Both US and South African officials have promised that the shift in priorities will be carefully managed to protect patients. “This is a five-year timeframe [and] provides enough time to work together to make sure there is no break in services,” said James Maloney, deputy PEPFAR coordinator for South Africa.

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California Counties Step Up Tattoo Shop Inspections

New state legislation that became effective in July requires tattoo and piercing shops to register and pass safety tests. Assembly member Fiona Ma (D-San Francisco) said she authored the bill to protect people from hepatitis C and other blood-borne diseases.

“I wanted to do something about this to ensure diseases would not be shared through needles,” Ma said.

The legislation allows counties to charge fees, which will fund the annual inspections. “It’s the intent of this law to protect the client and the artist,” said Anne Frey, an environmental specialist in Sacramento County, which charges practitioners $142 a year. A green “pass” placard can be placed in the shop’s window after a positive inspection. County officials say there are more than 175 sites, but just 47 have been inspected.

Underground artists operating out of their homes are the problem, said some shop owners.

“If they don’t go after people who are working out of their house and not compliant, what is the point?” asked Dave O’Connor, owner of Sacramento Tattoo. O’Connor and others said the best practitioners are trained on blood-borne pathogens and did 90 percent of what is required by the law.

Nonetheless, the new rules prompted changes at local shops, including new sinks with touch-free faucets, new cleaning regimens, and updated paperwork.

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Georgia Wait Over on HIV/AIDS List

Thanks to $8.4 million in federal emergency funding, Georgia has eliminated its waiting list for the state AIDS Drug Assistance Program (ADAP).

The wait list was initiated just over two years ago and at one point was the largest among states with lists. Demand for ADAP was largely prompted by the economic downturn in which people lost their jobs and health insurance. Concurrently, the Georgia Department of Public Health (GDPH) boosted HIV testing initiatives statewide.

“The reduction of our wait list to zero is a remarkable accomplishment, especially considering where we were in 2011,” Brenda Fitzgerald, Georgia’s public health commissioner, said Friday.

The federal funds also allowed state officials to move more than 350 ADAP patients to an insurance pool for people with pre-existing conditions established under the Affordable Care Act, creating more spots for those low-income patients in need. “Eliminating the waiting list required extraordinary work and ingenuity,” noted Patrick O’Neal, director of health protection for GDPH.

Jeff Graham, executive director of the LGBT advocacy group Georgia Equality, commended state and federal officials for their efforts in addressing ADAP wait lists. However, he worries about the long-term viability of the program. Noting that he has seen three waiting lists come and go since moving to Georgia more than two decades ago, “I really hope it doesn’t come back for a fourth time.”

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Pine Bluff Notebook: Forum to Address AIDS-Fight Ideas

The Arkansas HIV/AIDS Minority Task Force and Future Builders will host a public forum this week on testing and tackling HIV/AIDS disparities among minority groups.

Task force members will discuss legislation to create an opt-out HIV testing program - the Arkansas State Healthcare Access Research Project.

The forum will be held 6-8 p.m. Thursday in the John Brown Watson Library at the University of Arkansas-Pine Bluff. A reception starts at 5 p.m.

For more information, telephone Bruce Lockett at 501-319-2012.

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A Pill that Treats and Tells

Sensors small enough to be placed in patients’ medications are being tested as a means to provide digital feedback about patient adherence to drug-taking regimens. This new technology will be pilot tested in China for treating TB.

About the size of a salt grain, the sensor is activated when it gets wet from stomach juices, completing a circuit that generates a tiny voltage. The sensor has no battery or antenna. Digital data from the sensor, recorded by a skin patch worn on the torso, can be sent to a phone or computer. The data can then be viewed on a computer network by patients, caregivers, and physicians. The technology, devised by Redwood City, Calif.-based Proteus Digital Health Inc., was approved last month by the Food and Drug Administration.

“Overall, people only take their medications half of the time ... adherence is a really big issue across all treatments,” said Eric Topol, chief academic officer of Scripps Health, a nonprofit medical service provider.

Proteus has partnered with the Bill & Melinda Gates Foundation and China’s Center for Disease Control to test the technology for TB treatment. With the help of a $560,000 Gates Foundation grant, Proteus will test the sensors in Chinese TB patients. Treatment for TB can have unpleasant side effects, leading some patients to drop out of treatment and place others at risk.

Health experts question whether patients will accept the monitoring system. “People may not want to wear the patch and have the medications because they might feel like big brother is watching,” Topol conceded.

“The point of this technology is not to say you are being a bad patient. The point is to have accurate data,” said George Savage, Proteus’ chief medical officer and co-founder.

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Rapid HIV Tests Weighed Up as Infection Rate Rises

Victoria may become the first state in Australia to adopt rapid HIV tests due to increasing HIV infection rates in the region.

Last year, 280 HIV cases were diagnosed in Victoria, up from 233 the year before. Most infections were in men who have sex with men (MSM), with the majority in their 20s and 30s. Twenty females also tested positive, including a teenage girl.

According to Dr. Rosemary Lester, Victoria’s Chief Health Officer, although increased testing may be partly responsible for the sharp increase in HIV, many men also are still having unprotected, casual sex. “A lot of them see it as a chronic manageable disease and something which isn’t to be feared the way it was 20 years ago when most people died of HIV infection,” she said.

The government is looking at rapid HIV tests to see if they would improve testing rates, said Lester. Currently in Australia, testing involves a full blood test, rather than a finger prick, and a wait of several days before getting a result. Rapid tests could also be used in community settings, making them more accessible.

Surveys show about a third of MSM are not getting tested every six months to a year, as recommended, said Dr. Mark Stoove, the head of HIV research at the Burnet Institute. More research is needed to see if the rapid tests would work in different settings locally, such as sex venues, he said. “I’m a strong advocate for community-based testing, but how that model evolves, we need to examine carefully.”

Matt Dixon, the executive director of the Victorian AIDS Council, said he does not believe men are being complacent about HIV, but thought a trial of rapid testing would help prevent more infections.

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FDA Approves Once-a-Day Pill for HIV

Gilead Science’s once-a-day HIV treatment that combines four HIV drugs into one tablet has been approved by the Food and Drug Administration. Gilead says Stribild, previously known as Quad, will cost about $28,500 a year.

Stribild is the third once-a-day HIV treatment Gilead has brought to market, after Atripla in 2006 and Complera in 2011. Stribild does not represent a significant leap medically compared to the others. In clinical trials that led to its approval, Stribild was shown to be roughly equivalent to Atripla and to another combination, though without some of Atripla’s psychiatric side effects. Approximately 88 percent-90 percent of patients who took Stribild had undetectable HIV in their blood after 48 weeks, compared to 84 percent taking Atripla and 87 percent taking a combination of Gilead’s Truvada, Bristol-Myers Squibb (BMS)’s Reyataz, and Abbott’s Norvir.

Stribild is composed of emtricitabine and tenofovir, which are also found in Atripla and Complera, as well as elvitegravir and cobicistat - neither of which has been approved for use independently. What could differentiate Stribild commercially is that Gilead owns all the ingredients, whereas Atripla includes a BMS drug and Complera contains a drug from Johnson & Johnson - meaning Gilead must split profits from those drugs.

Michael Weinstein, president of the AIDS Healthcare Foundation, which treats more than 100,000 HIV/AIDS patients worldwide, called Gilead’s pricing of Stribild “shockingly irresponsible.” “It’s just unsustainable at these levels,” he said.

Gilead spokesperson Erin Rau said price “reflects a reasonable return on our product development investment.” The company plans to provide discounts to state AIDS Drug Assistance Programs, and offer programs to help privately insured patients with Stribild’s cost, she said. Further, Gilead has granted certain Indian generic drug manufacturers rights to produce Stribild for distribution in poor countries.

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Tuesday, August 28, 2012

Brazil Company Recalls 620,000 Condoms

Brazilian condom manufacturer Olla recently recalled 620,000 condoms due to a potential defect in quality control.

“The recall is a preventive measure since a possible lapse in quality has been identified that could make the product unfit for use,” Olla said in a statement. The five different lots involved are lubricated condoms distributed in promotional packs of eight for the price of six, said Olla, which recalled the products in response to an uptick in consumer complaints.

The condoms should not be used but kept in the packaging, said Olla. Customers can contact the service department to return the condoms for a free replacement, the company said.

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Bristol-Myers Ends Hepatitis C Drug Development

Concerns over patient safety have prompted New York-based Bristol-Myers Squibb Co. to discontinue a mid-stage study of its hepatitis C treatment BMS-986094.

Nine patients in the trial were hospitalized, including one who died of heart failure. Two patients remain under hospital care, the drug maker said. “The decision to halt development of BMS-986094 has been guided by our overriding interest in protecting patients,” said Elliot Sigal, its chief scientific officer.

Though BMS said it has not yet determined exactly what caused the patients to become ill, heart and kidney toxicity are likely a key factor. BMS pledged it would continue to look into the matter. Meanwhile, the Food and Drug Administration has placed BMS-986094 on a clinical hold, and FDA and the drug maker are monitoring the study patients.

BMS-986094 was one of two key experimental hepatitis C treatments in BMS’ portfolio. The other, the compound daclatasvir, has begun late-stage testing. BMS acquired BMS-986094 along with other potential treatments as part of its acquisition of drug developer Inhibitex Inc. earlier this year.

FDA has focused more on experimental drugs’ cardiovascular risks since Merck & Co.’s agency-approved painkiller Vioxx was found to double the risk of heart attack or stroke.

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Circumcision Pluses Outweigh Risks: Pediatricians

According to a new policy statement by the American Academy of Pediatrics (AAP), the medical benefits of circumcision outweigh its small risks, and the procedure should be covered by health insurers.

Monday’s statement moves the country’s most influential pediatricians group closer to an endorsement, though AAP says the decision should be up to parents. “It’s not a verdict from on high,” said policy co-author Dr. Andrew Freedman, a pediatric urologist in Los Angeles.

AAP’s previous stance was that the potential medical benefits did not sufficiently warrant recommending routine circumcision for newborn males. However, recent research showing circumcision reduces the chances of HIV and other STD infections, urinary tract infections, and penile cancer prompted the group to update their 13-year-old policy.

“The benefits of newborn male circumcision justify access to this procedure for those families who choose it,” the AAP’s new policy states. Pain relief stronger than a sugar-coated pacifier - preferably an injection to numb the area - is essential, AAP notes.

Coverage for the procedure, which CDC estimates costs $200-$600 nationwide, varies among insurers. In 18 states, Medicaid programs no longer fund circumcision. While US rates have declined over the years, about half of baby boys nationwide undergo circumcision each year. The US rate is markedly higher than those of other developed nations, though rates vary by region and are higher in areas where it is a cultural or religious tradition. A recent study projected that declining rates could amount to more than $4 billion in US health care costs in coming years due to increased infections and illness.

The American Congress of Obstetricians and Gynecologists participated in the research review that led to AAP’s new policy and has endorsed it. CDC also participated in the review and will consider the academy’s update in preparing its own recommendations, an agency spokesperson said.

To view the AAP policy statement, visit http://pediatrics.aappublications.org/content/early/2012/08/22/peds.2012-1989.

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HIV Educator Helps Women Learn from Her Mistake

For the last five years, Precious Jackson has worked with the Los Angeles-based Center for Health Justice to educate women whose male partners are in prison or have a history of incarceration on how to protect themselves from HIV. The program, called Project HOME, or Healthy Options Means Empowerment, also teaches women how to become peer educators.

Jackson said she found out she was HIV-positive in 1998 after then-boyfriend, who was incarcerated, notified her he was infected. Over the last three years, Jackson has helped 307 women through the program, many of whom are African-American like herself and at high risk for HIV.

According to Jackson, self-esteem is a key tool in HIV prevention. “If a woman is not emotionally balanced, then she would find herself making unhealthy choices which will increase her risk for acquiring HIV,” she said.

Prisons and jails can be described as a revolving door between the criminal justice system and the community, according to UCLA Professor William Cunningham, and resuming relationships is a high priority for those released. “High-risk sexual activity along with substance use is a volatile combination that increases the risk of transmission to the community.”

Jackson encourages women to ask their incarcerated partners to get tested and mail the results home, or get tested with them post-release. She added that a woman should “feel disrespected” if a man does not use a condom.

Jackson also speaks about HIV at black churches and runs her church’s annual health fair, which includes an HIV testing van. “The more we have people talking about HIV, whether it’s in the church house or on the street, the better it will become normalized,” she said.

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Churches Work to Promote HIV/AIDS Education

To combat HIV/AIDS stigma in African-American churches, black pastors are educating their congregations using a new 61-page NAACP activity manual and an intervention program called “TIPS: Taking It to the Pews.”

In Alabama, TIPS is operated through the Alabama Council on Substance Abuse under its “Turning Point” project, funded through the Minority AIDS Initiative. “Turning Point came about because there was an increase of new HIV cases in Montgomery County and Alabama,” said Kwatasian Hunt, its project manager. Eleven churches have presented the TIPS program to their congregations; Hunt said about one in three churches offered the programming accepts it.

A target population is African-American women and their sexual partners. In 2009, black women accounted for 30 percent of new HIV infections among blacks - more than 15 times the rate for white women, according to CDC.

Some of the behaviors associated with HIV/AIDS make it difficult to bring up such a “taboo subject” in Southern churches, said Marxavian Jones with Montgomery AIDS Outreach.

The Rev. Benjamin Jones of St. James Missionary Baptist Church said his congregation has come to accept discussing HIV, although “it was a little shock to some of the older members” that their pastor would broach the subject.

Pastor Tony Peoples of Love Center Church has a younger congregation, so he uses modern technology to convey AIDS education, including statistics in texts. As a result of TIPS, many of the congregants have had HIV tests. “Many of them just didn’t know HIV was that prevalent,” Peoples said.

Shavon Arline-Bradley, NAACP’s director of health programs, helped oversee the manual’s creation. “People look at us as just civil rights, and what they’re missing is that health is one of the most pressing civil rights issues of our time,” she said.

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'Quad' Stribild Combo Tablet Approved by FDA

Stribild, the once-daily four-in-one fixed-dose combination (FDC) tablet formerly known as the “Quad,” has been approved for people living with HIV initiating antiretroviral (ARV) therapy for the first time, according to announcements by Gilead Sciences and the U.S. Food and Drug Administration released on Monday, August 27.

The tablet contains two new antiretrovirals—the integrase inhibitor elvitegravir and the novel pharmacokinetics enhancer cobicistat (needed to boost blood levels of elvitegravir)—as well as the nucleotide/nucleoside analog pair Truvada (tenofovir and emtrictabine).

The approval of Stribild is supported by 48-week data from two Phase III clinical trials (Studies 102 and 103) in which the single-tablet regimen was found comparable to Atripla and Norvir (ritonavir)-boosted Reyataz plus Truvada.

Like labels of many other ARVs, Stribild’s package insert carries a Boxed Warning alerting people living with HIV and their health care providers that the drug can cause a build up of lactic acid in the blood and severe liver problems, both of which can be fatal. The Boxed Warning also states that Stribild is not approved to treat chronic hepatitis B virus infection.

Common side effects observed in clinical trials include nausea and diarrhea. Serious side effects include new or worsening kidney problems, decreased bone mineral density, fat redistribution and changes in the immune system (immune reconstitution syndrome).

Stribild’s label gives advice to health care providers on how to monitor patients for kidney or bone side effects.

Stribild's per-patient annual wholesale acquisition cost (WAC) is $28,500, according to a Gilead spokesperson. The per-patient WAC for Atripla (efavirenz plus tenofovir and emtricitabine), Gilead’s current leading once-daily FDC tablet, is $21,000.

A patient assistance program—Gilead’s U.S. Advancing Access initiative—will provide assistance to people living with HIV who do not have insurance or who need financial assistance to pay for their ARVs, including Stribild. Patients may contact Advancing Access at 1-800-226-2056 between 9:00 AM and 8:00 PM (Eastern Time) to see if they are eligible for the program.

For people living with HIV who have private insurance, Gilead’s co-pay program provides assistance with out-of-pocket expenses for Gilead’s HIV medications, including Stribild, starting at the first dollar. Additionally, Gilead is working closely with the ADAP Crisis Task Force, as the company has done for each of its other HIV medications, to provide discounts to state AIDS Drug Assistance Programs (ADAPs) that will help ensure access to Stribild for people living with HIV who receive medications through these programs.

Applications for marketing approval of Stribild are pending in Australia, Canada and the European Union.

In the developing world, Gilead has granted multiple Indian manufacturing partners and the Medicines Patent Pool the right to develop generic versions of Stribild and distribute them to 100 developing countries. These agreements include a complete technology transfer of the manufacturing process for the single tablet regimen.

Source: POZ

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Monday, August 27, 2012

Nonsurgical Circumcision Device Will Be Tested to Help Curb AIDS

Researchers will study a bloodless circumcision device for adult males in at least nine African nations next year, according to reports.

A large study already has established that the device, PrePex, is safer than conventional circumcision surgery. The US Food and Drug Administration approved PrePex in January, and the World Health Organization’s approval is expected soon. The new research will evaluate its acceptability to men in each of the study nations and whether there are any regulatory challenges, according to Dr. Jason B. Reed, a technical adviser to the US President’s Emergency Plan for AIDS Relief (PEPFAR).

To slow the spread of HIV on the continent, health authorities hope to circumcise 20 million men in Africa by 2015.

No surgeon is required to perform circumcision using PrePex. Working together, two nurses slide a grooved ring inside the patient’s foreskin, then guide a rubber band to compress the skin into the groove. A week later, the dead skin falls off or can be clipped off painlessly, said PrePex CEO Tzameret Fuerst.

PEPFAR will pay for 2,500 men to be circumcised with PrePex in Lesotho, Malawi, South Africa, Tanzania, and Uganda.

Similar studies in Kenya, Mozambique, South Africa, Zambia, and Zimbabwe - funded by the Bill & Melinda Gates Foundation - also will test the Shang Ring, a circumcision device that requires some surgery and an anesthetic injection.

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AIDS Pill's Price Draws Criticism

Some lawmakers and AIDS advocates are worried about the potentially high price of a once-daily AIDS treatment that US regulators are expected to approve soon. The price for Gilead Sciences Inc.’s Quad will not be established until it gains Food and Drug Administration approval; however, analysts have estimated the price will be $27,000-$34,000 per patient annually. In the spring, an FDA advisory panel recommended approval, and the agency’s official decision is anticipated Monday.

Last week, 20 California lawmakers urged the state Department of Public Health to use its leverage to obtain lower prices for antiretroviral therapies for poor patients. Earlier this month, 14 congressional Democrats wrote to Gilead’s CEO, voicing concern about Quad possibly being too costly.

Gilead worked out a freeze on Quad’s price through 2013 for state AIDS Drugs Assistance Programs. Even so, some people fear its cost could still prove too much for public treatment and private insurance programs.

“Gilead now has a significant amount of market share, so people are particularly focused on the way in which this is priced,” said Dana Van Gorder, executive director of San Francisco-based Project Inform, an advocacy organization. “We’re definitely hopeful this is never priced as high as has been rumored.”

Quad could cost 38 percent more than Gilead’s Atripla, the members of Congress noted. In clinical trials, Quad proved slightly more effective than Atripla, which wholesales for $21,000 per patient annually. For ADAPs, Atripla costs about $10,000 per patient yearly.

Gilead officials would not discuss pricing ahead of FDA’s decision. However, spokesperson Erin Rau pledged in an e-mail that the company is “committed to ensuring patients can access the therapies we develop.” Gilead offers in-house co-pay and patient-assistance programs, and other charitable efforts to expand access, Rau said.

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Call for S.A. Jail Needle-Exchange Program

Families and Friends for Drug Law Reform is calling on South Australia to follow the example of the Australian Capital Territory and introduce a prison-based needle-exchange program.

FFDLR’s SA representative, Sandra Kanck, said the National Hepatitis C Strategy has recommended that state governments identify opportunities to trial NEPs in prison, and “The ACT has taken up the opportunity, while SA has buried its head in the sand.” She said that the SA Department of Correctional Services had rejected such a move, citing “the old myth” that an NEP would endanger prison staff. “FFDLR challenges Correctional Services to come up with proof of that claim - they will not be able to because there is no such proof,” she said. “It’s a reality that prisoners get hold of drugs in our prison system and, because of the sharing of needles, hepatitis C is also shared.”

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Clovis Unified's Sex Ed Course Under Fire

A lawsuit filed Tuesday on behalf of parents contends that Clovis Unified School District’s ninth-grade sex education curriculum fails to meet California Department of Education (DOE) guidelines. The textbook used is not on the state-approved list, and supplementary materials are outdated and do not comply with the state law on comprehensive sexual health education, said the American Civil Liberties Union. In the lawsuit, ACLU of Northern California also represents the regional chapter of the American Academy of Pediatrics and the Gay-Straight Alliance Network.

The course’s content and procedures for students to participate all are in compliance with state law, the district said. The suit is “a question of differing interpretations of the depth and breadth of a school district’s obligation to cover detailed sexual content in its family life materials,” said Kelly Avants, a district spokesperson. It “does not accurately describe existing procedures and practices in Clovis Unified related to parent notification,” Avants said.

The course offers biased and inaccurate information, said Phyllida Burlingame, ACLU’s reproductive justice policy director. “Schools should teach teens about building healthy relationships, the benefits of delaying sexual activity, and accurate information about condoms,” Burlingame said. The textbook, “Lifetime Health,” instead emphasizes abstinence until marriage, she said.

DOE approves textbooks from kindergarten through eighth grade, not for high schools, said Tina Jung, a DOE spokesperson. Jung would not comment on Clovis Unified course content or the suit. Avants said the district is permitted to tailor course content to meet the community’s needs.

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HIV Self-Test Raises Questions

The OraQuick rapid HIV test soon will be available over-the-counter, and health professionals are discussing its potential impact.

Joan Duggan, a physician at the University of Toledo Medical Center, said, “This test is a two-edged sword. It’s a great thing to have available, but we have to be careful. There’s a huge potential for misuse.” She added, however, “If we want to end this epidemic, people need to know their HIV status and use the appropriate measures to stop transmission.” According to CDC, about one in five infected people do not realize they have HIV.

Jerry Kerr, HIV prevention coordinator for the Lucas County Department of Health, explained that some people do not want to talk about the risks they have been taking or “don’t want it written down anywhere they even went for an HIV test.” Although health privacy laws protect patients, some people fear that insurance companies or employers could obtain their test results.

Tyler Andrew TerMeer, director of the Ohio AIDS Coalition, imagines that sex workers would prefer the privacy of an in-home test. He added that others may “worry their partner would find out and become violent if they walked into a clinic.”

Duggan and others are concerned that those using OraQuick at home will not understand the “window period” when the body, although infected, has not made enough HIV antibodies to produce a positive test result.

TerMeer added, “The challenge is we don’t have any mechanism in place for knowing they’ve tested positive and getting them into early care and treatment.”

Kerr thinks more people will seek help at free test sites once they see the test retailing for up to $60. “It’s going to create more awareness about HIV, and that’s always a good thing,” he said.

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Infections Among Homeless Could Fuel Wider Epidemics - Study

A study published online recently found that homeless people have dramatically higher rates of TB, HIV, and hepatitis C virus (HCV) infection, which could lead to community epidemics.

“Infections in homeless people can lead to community infections and are associated with malnutrition, long periods of homelessness, and high use of medical services,” said Seena Fazel, who led the study and is a senior research fellow in clinical science at the University of Oxford.

Estimates place the homeless population at 650,000 people in the United States, 380,000 in Britain, and 100 million worldwide.

Fazel and his team analyzed more than 40 research papers on HIV, HCV, and TB among homeless people from 1984 to 2012. Among the US homeless population, TB rates were at least 46 times higher than in the general population. Rates also were elevated for HCV (more than four times higher) and HIV (one to 20 times higher). Among Britain’s homeless residents, TB rates were 34 times those of the general population, and HCV was almost 50 times higher. HIV rates for the homeless in Britain were not available.

Similar patterns were found in most other countries where data were available, including France, India, Sweden, Ireland, and Brazil.

In addition to the three diseases that were the study’s focus, the researchers noted that the homeless also have high rates of hepatitis A and B, diphtheria, foot problems, and skin infections.

Fazel said his findings suggest that focusing on the homeless as a group at very high risk for infectious diseases “could have pronounced effects on public health.”

“Prevalence of Tuberculosis, Hepatitis C Virus and HIV in Homeless People: A Systematic Review and Meta-Analysis,” was published in the Lancet Infectious Diseases (2012;doi:10.1016/S1473-3099(12)70177-9).

TOGETHER WE REMAIN STRONG!

New Jersey Syringe Program Might Get Expansion

A bill to establish permanent statewide needle-exchange programs (NEPs) awaits review in the New Jersey Assembly Health and Senior Services Committee. The state launched syringe access sites in 2006 as a pilot program under the Blood-Borne Disease Reduction Act. Currently Newark, Camden, Jersey City, Trenton, and Paterson host programs.

A report by the New Jersey Department of Health and Senior Services says the pilot program has helped curb the number of used needles in circulation. Data from 2007-09 indicated that 4,482 participants were enrolled, and 998 were receiving drug treatment.

The Newark NEP has served 2,8000 unique clients since its inception, according to Brian McGovern, executive director of the North Jersey Community Research Initiative. He said the state would benefit from making NEPs available beyond urban areas.

Roseanne Scotti, New Jersey director for the Drug Policy Alliance, said it makes “good moral and good financial sense” for the state to further fund the existing programs and make them permanent. The bill being proposed appropriates $95,000 toward this effort.

The bill is controversial, however, and most of Warren and Hunterdon counties’ senators voted against it last month. “I think it sends the wrong message to society,” Sen. Michael Doherty (R-Warren/Hunterdon) said. “On the one hand, you’re saying, ‘Drugs are bad,’ then providing needles to facilitate drug use.” Although the programs offer other services, Doherty said there are other, better means for drug users to seek treatment.

In January, Gov. Chris Christie signed a bill that allows pharmacies to sell up to 10 hypodermic syringes without a prescription to people older than 18.

TOGETHER WE REMAIN STRONG!

US Health Panel Likely to Make HIV Tests Routine

The US Preventive Services Task Force could soon recommend that HIV testing become routine in medical settings, according to health officials close to the panel, speaking on condition of anonymity. Under the 2010 federal health reform law, health insurers must fully cover preventive services that USPSTF recommends. The recommendation is expected to be open for public comment before the year ends.

“It still will take culture change for medical providers, but this will be a tremendous leap,” said Michael Kharfen, chief of community outreach with the District of Columbia’s Department of Health.

USPSTF weighed issues around HIV testing in 2005 but did not recommend widespread screening, leaving it up to physicians. Since then, however, studies have shown that early HIV treatment improves patients’ health and life expectancy, and it cuts the risk of transmission by 96 percent.

“We did not find that evidence at that time compelling enough to say that we were confident that more people would benefit than the people who had HIV detected,” said Dr. Michael LeFevre, USPSTF’s co-chair. “Obviously that was seven years ago,” and the new data will be taken into consideration, he said.

In 2006, CDC recommended that everyone ages 13-64 be tested for HIV at least once.

Expanding HIV testing to the general population would cost $27 billion over a 20-year period, one Stanford University study estimated. One-time universal testing followed by annual testing in high-prevalence areas could prevent an estimated 212,000 infections. Adding HIV testing to routine blood work would cost $1.50 per patient.

TOGETHER WE REMAIN STRONG!

Wednesday, August 22, 2012

New Name, Location for 9th AIDS Walk

The fundraiser formerly called AIDS Walk St. Petersburg will take place on Sept. 8 under a new name: AIDS Walk Tampa Bay.

The name change reflects an acknowledgement of “all of the areas that we serve,” said William Harper, executive director of the AIDS Service Association of Pinellas. Also, the walk’s location has shifted from North Shore Park to Vinoy Park, and participants will be treated to more entertainment along the route. ASAP has set a goal of $125,000 for the event.

To learn more or sign up, visit: www.AIDSWalkTampaBay.org.

TOGETHER WE REMAIN STRONG!

Sixth Annual HIV/AIDS Action Summit to Feature Project Runway Winner Mondo Guerra

Experts and activists will come together on Sept. 12 at City of Hope for the sixth annual HIV/AIDS Action Summit. Organized by the medical center and Assembly member Anthony Portantino (D-Pasadena), this year’s meeting will feature “Project Runway All-Stars” winner and HIV awareness spokesperson Mondo Guerra.

“The San Gabriel Valley HIV/AIDS Action Summit raises awareness about HIV and AIDS and efforts to prevent new infections and keep HIV-positive patients healthy,” Portantino said in a statement. “This year we are especially pleased to have Mondo Guerra talk about getting young people involved in the fight against AIDS.”

Dr. Alexandra Levine, City of Hope’s chief medical officer and former research chair for the President’s Advisory Council on HIV/AIDS, will speak at the conference.

The summit will take place from 9 a.m. to 12:30 p.m. at City of Hope’s Cooper Auditorium, 1500 E. Duarte Rd. in Duarte. The public is invited.

TOGETHER WE REMAIN STRONG!

New HIV/AIDS Clinic Fills Void in Fort Worth

The AIDS Healthcare Foundation (AHF) opened its new Magic Johnson Healthcare Center at the Fort Worth AIDS Outreach Center (AOC) on Aug. 13 and began client intake the next day. The Los Angeles-based nonprofit operates clinics in four states and Washington, D.C., as well as 26 other countries.

AHF Regional Director Adam Ouderkirk said the organization’s goal is to provide AIDS care where services are lacking, not to compete with existing agencies.

AOC Executive Director Allan Gould said the two organizations found they had similar philosophies. “We’re working hand-in-hand,” he said. “We offer services they don’t offer, and they fulfill a need we’ve had for some time.” He said the new clinic fills a void for some of the clients of AIDS Services of Rural Texas, which closed last summer. According to Gould, the clinic will benefit those in rural settings who are uncomfortable discussing HIV with doctors who have limited HIV experience. “We hope to relieve an overburdened and stressed-out system,” Gould added.

In conjunction with the clinic’s opening, AHF’s “Condom Nation” 18-wheeler completed its 40-city, 25-state tour in Fort Worth. The specially equipped big-rig tested 4,400 people, gave away 10 million condoms and provided safer-sex information, in conjunction with local partners.

AHF is close to opening another area clinic - at Medical City in North Dallas, according to Ouderkirk. He also is talking to groups in Austin and San Antonio, where he said there is a growing need for services.

TOGETHER WE REMAIN STRONG!

Free Clinic Stressing HIV Testing: Opt-Out Strategy on Consent-to-Treat Form May Boost Identifications

Starting in late September, the Free Medical Clinic of Greater Cleveland will begin opt-out HIV testing for all patients. In 2006, CDC recommended all health care providers offer opt-out testing for patients ages 13-64 and all pregnant women.

In Cuyahoga County, 4,519 people are living with HIV/AIDS, according to the Cleveland Health Department. The Free Clinic has seen a steady rate of 20-30 people testing HIV-positive each year since 2006, according to HIV Outreach Manager Kalia Johnson. Last year the clinic diagnosed 23 people; all except one were black men who have sex with men and were ages 15-21. “If we test 200 people, we can count on about four of those people being positive,” said Johnson.

Adriana Whelan, the clinic nurse practitioner, said, “If we do opt-out testing, in addition to clinical testing, which includes going out to high-risk communities, we may increase numbers for the clinic overall.” The clinic will continue offering pre- and post-test counseling services.

Whelan said the Free Clinic will use the treatment-as-prevention approach. This method places patients on antiretroviral treatment as soon as they are diagnosed to reduce their viral loads and the risk of transmitting HIV.

The Free Clinic will continue its educational efforts targeting at-risk populations. “One thing I don’t want to get lost is the prevention piece of it,” said Johnson. “It’s one thing to test someone; it’s another thing to educate them.”

TOGETHER WE REMAIN STRONG!

Concern Rising over HIV Among Utah's African Immigrants

Utah’s Refugee Services Office (RSO) is one of several organizations encouraging African community groups to hold HIV/AIDS education events in a bid to address fear and confusion on the part of many immigrants.

According to community members, rumors abound about people transmitting HIV to others or refusing treatment. “The community is very worried now. It’s really spreading,” said Joseph Nahas, an immigrant from Sierra Leone who works at RSO overseeing grants for refugee groups.

But whether HIV actually is increasing among Utah’s African community is not clear. Newly analyzed data of state HIV diagnoses between 2007 and 2011 show roughly two-thirds of blacks with HIV were foreign-born, though this represented only 30 cases. Matt Mietchen, an epidemiologist with the Utah Department of Health (UDH), said, “If they’re getting here and are already infected, are we getting them the services they need? If they’re getting it here, why and what can we do?”

“If we did some more systematic testing, we would maybe find out it really isn’t a problem,” said Heather Bush, HIV education specialist for UDH. She hopes to see the data broken out further, as some others states have done, to clarify whether HIV actually is a growing problem in Utah’s African community. This knowledge would be key to accessing resources to target this population, she said.

Because HIV prevalence is so much lower in the United States than in Africa, a particular challenge is informing new arrivals that the virus exists here. “There’s the perception that there’s no HIV in the US anymore,” said Margaret Korto, a senior program analyst with the federal Office of Minority Health Resource Center, which is involved in the National African HIV/AIDS Initiative.

TOGETHER WE REMAIN STRONG!

Nurse-Centered HIV Care as Effective as Doctor's Care

A new study carried out in South Africa suggests that nurse-centered care of patients with HIV can be as effective as doctor-provided care, and it offers some particular benefits.

Researchers from the University of East Anglia (UEA) in the United Kingdom and the University of Cape Town in South Africa coordinated with other universities on the project — a two-year randomized controlled trial involving 15,000 patients in Free State, South Africa.

The study marked the first time scientists have investigated doctor-to-nurse task-shifting on such a large scale. The results indicated a number of benefits for patients in nurse-centered care. These included significantly improved TB detection, increased white blood-cell counts, weight gain and better treatment compliance. In addition: When nurses, rather than doctors, administered antiretrovirals, survival rates were not negatively affected.

“Our findings show that with very little extra training and support, nurses can deliver HIV care that is just as safe and effective as that provided by doctors,” said Professor Max Bachmann, joint lead author, of UEA’s Norwich Medical School.

The study, “Task Shifting of Antiretroviral Treatment from Doctors to Primary-Care Nurses in South Africa (STRETCH): A Pragmatic, Parallel, Cluster-Randomized Trial,” was published online in the Lancet (2012;doi:10.1016/S01040-6736(12)60730-2).

TOGETHER WE REMAIN STRONG!

Health Reform Could Improve AIDS Treatment in Kentucky, Advocate Says

At a two-day HIV/AIDS conference recently in Lexington, an AIDS advocate pushed for better communication about health care reform among health care providers, advocates and the state.

According to Amy Killelea, senior manager for health care access at the National Alliance of State and Territorial AIDS Directors, now is the time for advocates to let state legislators and the Kentucky office of Health Care Reform know what they need as part of health care reform.

Kentucky is one of 16 states in the process of creating health care exchanges to provide new insurance options. Killelea said it is important to make sure, for example, that antiretrovirals are covered at a reasonable cost under the benefits plan. Health reform offers the promise that many of the roughly 8,000 Kentuckians with HIV/AIDS will have health insurance for the first time, replacing “a patchwork system with many, many holes and gaps,” Killelea added.

The conference theme was “Turning the Tide Together.” According to Sigga Jagne, manager of the HIV/AIDS branch in the Kentucky Department of Public Health, these words matter. She said that even though the number of HIV/AIDS patients in Kentucky is relatively small, prevention and early testing are vital.

Jagne pointed out that people may have outdated perceptions regarding who is affected. While male-to-male sexual contact accounts for about 65 percent of total current cases in the state, the number of women infected — chiefly through heterosexual exposure — continues to grow.

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!

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Wednesday, August 29, 2012

Mugabe Says Census Will Reveal AIDS Toll on Zimbabwe

County Jail to Expand HIV Testing; Inmates Can Opt Out

Healthful Food Could Be Key in Treatment: HIV/AIDS

AIDS Projects Receive Grant Extensions

California Counties Step Up Tattoo Shop Inspections

Georgia Wait Over on HIV/AIDS List

Pine Bluff Notebook: Forum to Address AIDS-Fight Ideas

A Pill that Treats and Tells

Rapid HIV Tests Weighed Up as Infection Rate Rises

FDA Approves Once-a-Day Pill for HIV

Tuesday, August 28, 2012

Brazil Company Recalls 620,000 Condoms

Bristol-Myers Ends Hepatitis C Drug Development

Circumcision Pluses Outweigh Risks: Pediatricians

HIV Educator Helps Women Learn from Her Mistake

Churches Work to Promote HIV/AIDS Education

'Quad' Stribild Combo Tablet Approved by FDA

Monday, August 27, 2012

Nonsurgical Circumcision Device Will Be Tested to Help Curb AIDS

AIDS Pill's Price Draws Criticism

Call for S.A. Jail Needle-Exchange Program

Clovis Unified's Sex Ed Course Under Fire

HIV Self-Test Raises Questions

Infections Among Homeless Could Fuel Wider Epidemics - Study

New Jersey Syringe Program Might Get Expansion

US Health Panel Likely to Make HIV Tests Routine

Wednesday, August 22, 2012

New Name, Location for 9th AIDS Walk

Sixth Annual HIV/AIDS Action Summit to Feature Project Runway Winner Mondo Guerra

New HIV/AIDS Clinic Fills Void in Fort Worth

Free Clinic Stressing HIV Testing: Opt-Out Strategy on Consent-to-Treat Form May Boost Identifications

Concern Rising over HIV Among Utah's African Immigrants

Nurse-Centered HIV Care as Effective as Doctor's Care

Health Reform Could Improve AIDS Treatment in Kentucky, Advocate Says

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