Antifungal Drug Shows Promise Fighting HIV in the Lab

The topical antifungal agent Ciclopirox eradicates HIV by promoting infected cells to effectively commit suicide, and it does not lead to viral rebound after the therapy is stopped, according to U.S. News and World Report. Reporting their findings in PLOS ONE, researchers studied how, in a laboratory setting, Ciclopirox affected HIV-infected H9 cells and peripheral blood mononuclear cells infected with clinical HIV isolates.

One of the reasons HIV manages to endure in the body even in the face of antiretroviral (ARV) therapy is because the virus blocks cells’ natural mechanism for instigating their own demise in the event they are damaged or infected. The scientists found that Ciclopirox fought the virus by inhibiting the expression of certain HIV genes and also interfering with the cells’ mitochondria, undoing HIV’s inhibition of the suicide mechanism.

Uninfected cells were not affected by the treatment. Also, once Ciclopirox was terminated, the virus did not rebound as it would after stopping ordinary ARVs.

Because Ciclopirox is already approved by the Food and Drug Administration as an antifungal, the process of moving into human trials for an HIV-fighting capacity should be much more efficient. There is a possibility the drug may prove useful as a topical application to reduce the risk of sexual transmission of the virus.

Newly Found HIV Replication Pathway May Lead to New Drugs

The discovery of a new HIV replication route may eventually lead to advancements in antiretroviral (ARV) therapy and attempts to eradicate the virus. Publishing their findings in the Journal of Virology, researchers investigated the phenomenon that more than 90 percent of HIV fails to integrate its DNA into human cells, leaving unintegrated viral DNA in the cell. (Integration is a key component of the HIV lifecycle; integrase inhibitors attack the virus at this juncture.) In the past, researchers have assumed that these stranded viruses could not copy themselves.

But as the scientists discovered, some of this unintegrated virus is able to skip the integration process and still reproduce itself, producing new viruses that can in turn infect other cells.

“Although this is not the virus’s main method for replicating, having this option available can help HIV survive,” the study’s lead researcher, David N. Levy, PhD, associate professor of basic science and craniofacial biology at the New York University College of Dentistry, said in a release. “These new findings suggest one mechanism by which HIV may be surviving in the face of antiviral drugs, and suggests new avenues for research into eliminating infection.”

Levy’s team also discovered that these unintegrated viruses can survive in human cells for weeks, providing themselves a kind of cover against ARVs and other natural immune responses.

HIV-Positive Airman in Kansas Gets Military High Court Appeal

The highest court for the U.S. armed forces has agreed to hear the appeal of a Kansas airman convicted of assault for exposing multiple sex partners to HIV at swinger parties in Wichita, his attorney said Friday.

David Gutierrez was a sergeant serving at McConnell Air Force base in Kansas when he was sentenced in 2011 to eight years in prison and stripped of his rank in an aggravated assault case. Prosecutors told the trial judge that a stiff sentence would send a message that the military values the integrity of its service members, saying Gutierrez played Russian roulette with his sexual partners' lives.

The defense on appeal has won a rare opportunity to present before the U.S. Court of Appeals for the Armed Forces an argument that his attorney says could set a far-reaching precedent across the military.

"It will set the table for the entire military services as to what kind of evidence is necessary to find that someone can cause grievous bodily injury after testing positive for HIV," said Kevin McDermott, one of his defense attorneys.

In addition to the HIV issue, the military appeals court agreed Tuesday to decide whether the evidence was sufficient to find Gutierrez committed adultery. The defense contends Gutierrez can't be guilty of adultery because his wife participated with her husband in the "swinger's lifestyle."

The appeals court, essentially the military equivalent of the U.S. Supreme Court, takes fewer than 5 percent of petitions submitted to it, McDermott said.

A military judge in Wichita found Gutierrez guilty in January 2011 on seven of eight counts of aggravated assault and of 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 of eight counts of adultery.

Prosecutors did not immediately respond to an email Friday seeking comment.

The Air Force Court of Criminal Appeals affirmed the conviction in March 2013, and the defense appealed to the U.S. Court of Appeals for the Armed Forces.

In its petition, the defense argued that the evidence was not sufficient to prove Gutierrez was HIV positive. The test used has since been recalled by the Food and Drug Administration because it was susceptible to false reactions.

His attorneys also said that even if Gutierrez had HIV, his medical records showed his viral load was so low during that time that he had a "zero chance" of infecting anyone through oral sex and a 1 in 10,000 to 1 in 100,000 chance of infecting a partner through unprotected intercourse.

"If the court agrees with us and determines David was not infected to the point that he could have caused grievous bodily injury to others, this would gut substantially 90 percent of the case against David," McDermott said.

The case has not yet been set for oral arguments and no decision is expected until the summer of 2014.

NYC Requires Families of People With HIV on Support to Work

The city’s agency assisting low-income people with HIV and AIDS is looking for help in paying for its clients’ ­costs of living — from the family members and other people who live with them.

This month, the city HIV/AIDS Services Administration (HASA) issued a rule requiring all household members living with people receiving benefits from the agency to sign up to participate in a work program. The city projects the move will save about $3 million in the coming year.

In July 2013, more than 30,000 New Yorkers living with HIV or AIDS were receiving HASA benefits. Those with families were entitled to extra benefits, such as increased rental assistance or more food stamps. In all, 11,400 household members get such aid. VOCAL-NY, an advocacy group that works with people with HIV/AIDS, estimates that between 10 to 20 percent of these are of working age and were not required to participate in any work program — until now.

If someone living in the household refuses to work or participate in a training program, an HIV/AIDS client may see cuts in his or her aid. But those who work for pay can expect to be penalized too: As noted in a City Council analysis earlier this year, when the family member is already working, “cases will be re-calculated to reflect the additional income.” Benefits, such as rental assistance, could be decreased as a result. HASA clients currently get between $300 and $1,500 a month in rent subsidies.

In addition, some people with HIV/AIDS may no longer be entitled to what the agency calls “intensive case management,” which often includes home care and mental health and substance abuse treatment.

A spokesperson for HRA indicated the administration is  bringing its HIV/AIDS Services program in compliance with longstanding state rules, and that it would be in each family’s best interest to encourage adult members capable of working to do so.

Terri Smith-Caronia, a Housing Works’ vice president, said that the new rule could damage relationships among family members whose benefits are cut. “They are cash- strapped, looking for nickels and dimes,” she said. “The only way to save money is to kick people out. You keep your savings by disrupting households.”

“Our issue is the punitive aspect of the policy,” said Jason Walker, a VOCAL-NY community organizer and coordinator of the New York HIV/AIDS Housing Advocacy Network. “A HASA client would be penalized because of what someone else [in the household] may or may not be doing.”

In March, Human Resources Administration (HRA) Commissioner Robert Doar said that HASA, a division of HRA, would be reaching out soon to clients whose children are now adults and require them, when appropriate, to take part in the agency’s employment programs.

In July, City Council Speaker Christine Quinn and Annabel Palma, chair of the Council’s general welfare committee, expressed concern that the new rule might result in “improper reductions” of benefits.

While the council asked HASA to explain how clients will be assessed and how exemptions will be determined, the agency hasn’t offered any clarification. Palma’s office said it would wait to see how the rule is affecting HASA clients before taking further action.

Affected household members will be given the opportunity to present evidence of barriers to employment such as physical or mental health issues, according to HRA. The evidence will then be evaluated according to state guidelines on a case-by-case basis.

HIV and Hepatitis a Fear on Olympia Playgrounds

An alarming number of hypodermic needles and drug paraphernalia showing up in Olympia playgrounds and parks have parents concerned. A poke puts their children at risk for HIV or Hepatitis.

“It’s a horrible risk you shouldn’t have to face when you ride a bike or play in the playground,” said Jessica Archer, a parent.

One of Archer’s young sons recently had a close call while riding his bike.

“He crashed and he was just a couple inches from a dirty needle, a couple inches,” she said.

Area pediatricians are seeing an increased number of patients saying they were poked by syringes.

“Used needles in a park often mean drug use so there’s blood, there’s all sorts of concerns of a needle poke,” said Dr. Sara Murdoch of Pediatrics Olympia.

Dr. Murdoch has seen a spike in incidents the last few months, including two patients in one day who both tested negative for HIV and Hepatitis. While there’s a low chance of infection, Dr. Murdoch says the ordeal is agonizing for parents.

“The exposure, the waiting and the not knowing,” said Dr. Murdoch.

“Our community is being put at risk by people right now and it’s not ok,” said Archer.

Complaints at places like Bigelow Park have promoted action by the city. Park Rangers have upped patrols and have started a tracking system.

Since Mid-August, 207 hypodermic needles and 107 drug paraphernalia items have been picked up from outdoor areas and safely discarded.

City park officials have also formed a partnership with Olympia Police called the “Downtown Response Team” to fight the problem.

“It could be anyone’s kid and we shouldn’t have to be on high alert for syringes, we just shouldn’t,” said Archer.

An AIDS Cure in Two Years? Prostratin Could Make It Possible

Scientists researching a cure for HIV have projected that a cure could be available in 18 to 24 months. The researchers were working on two natural compounds––prostatin and bryostatin––that they reproduced in the laboratory for medical purposes. Prostratin comes from the bark of the Samoan mamala tree. Paul Cox, an ethnobotanist and director of the Institute of Ethnomedicine in Wyoming, heard of the bark from a Samoan healer. Paul Wender, a chemist from California’s Stanford University, found in experiments with prostratin that it flushed out the virus from cells where it was hiding. Drugs are able to kill the virus when it is in the open, but not when it is hiding in cells. When patients stopped taking their medication, the virus resurfaced and quickly multiplied. 

Wender was able to recreate the drug and design new variants and has made it 100 times more powerful than that obtained from the tree. The AIDS Research Alliance (ARA), a Los Angeles nonprofit dedicated to finding a cure for AIDS, is developing prostratin. Dr. Stephen Brown, medical director of ARA, stated that the organization was two thirds of the way through necessary experiments before the drug would be ready for market. Researchers had performed initial tests on animals and now were conducting tests on blood from AIDS patients who had been on immunosuppressive therapy. Bryostatin, a compound that comes from a sea creature called bryozoa, also has healing qualities. It was discovered by Robert Pettit, a University of Arizona chemistry professor. Wender created bryostatin variants 1,000 times more powerful at flushing HIV from cells than prostratin. However, additional work is necessary before it could be considered a successful drug candidate. The National Institutes of Health is helping to fund Wender’s research. The study was presented before the 246th American Chemical Society National Meeting, September 8–12, in Indianapolis, Ind.

Maine Confronts Aging Population with HIV/AIDS

The US Senate Aging Committee heard testimony on September 18, the sixth annual National HIV/AIDS and Aging Awareness Day, from five witnesses testifying about the challenges facing aging HIV-infected people. Witnesses noted that states with large aging HIV-infected populations experienced greater impact than other states. According to Kenneth Miller, executive director of Maine’s Down East AIDS Network, older HIV-infected people who lived in rural areas faced complicated health issues, including lack of access to medical care and mental health treatment.

Miller stated that older, rural patients also isolated themselves because of stigma against those who were gay and had HIV. Other difficulties specific to rural HIV-infected people included transportation to physician’s appointments and lack of access to social support networks. Miller recommended ways to improve the system of care, including awareness and outreach. He advised that this population was vulnerable to depression and might not have access to mental health screening and care.

Although treatment advances had extended life expectancy for HIV patients, Sen. Susan Collins (R-Maine) cautioned older Americans not to stereotype HIV as a young person’s disease. Older Americans also were vulnerable to HIV and should “exercise the same kind of care” if they were engaging in high-risk behaviors.

Meeting NoVa Health Needs: Northern Virginia's Gay Men's Health Collaborative Building a Brand That's Part Health Resource, Part Social Club

Gay Men's Health Collaborative (GMHC) hoped to become a driving force in providing resources and services to Northern Virginia’s lesbian, gay, bisexual, and transgender (LGBT) community, thus filling the void left by the closure this summer of another organization that once provided those services. Based in Inova Fairfax Hospital in Falls Church, Va., GMHC provides intervention and prevention services as well as hosting and supporting social opportunities. According to James Leslie, an HIV-health educator and gay men's health coordinator at Inova Fairfax Hospital, social opportunities for LGBT people outside of bars was sparse, especially for gay, bisexual, and transgender (GBT) men, whose rates of HIV infection were high.

GMHC’s dual approach would facilitate programs that focused on HIV prevention and health as well as building self-esteem and support their mental and emotional well-being. It will hold bi-weekly HIV and STD testing on the second and fourth Tuesdays of the month at several Northern Virginia locations. Social events, meant to provide GBT men an opportunity to make friends and build support systems, would focus on no-alcohol activities, including bowling, movie and game nights, and a visit to a local waterpark. "We want to have a space for people outside the city that's not a bar," said Leslie.

A grant from the Virginia Department of Health and private donations will fund GMHC's activities; Leslie hoped the Department of Health would renew the grant as long as he could show the need for such prevention and support services.

Costs Spike for 2nd- and 3rd-Line ARVs and Late Treatment

The National AIDS Treatment Advocacy Project has reported on the increase in cost to treat HIV-infected individuals on second- and third-line antretrovirals (ARVs). Researchers calculated costs after reviewing data from 2007 to 2011 in the MarketScan Commercial Claims and Encounters Database and from the MarketScan Lab Database, which covered 2007 to 2010. The researchers followed 9,931 individuals in the first group, whose treatment moved from first- to third-line therapy, and 486 individuals on ARVs in the second group who provided data on CD4 counts.

The researchers adjusted for factors such as AIDS diagnosis, sex, age, region of the country, and type of health insurance. Results showed that the average cost for total care of HIV-infected individuals on first-line therapy was $28,861, cost for second-line therapy was $35,805, and for third-line, $40,804. Also, the average cost to treat a patient who started treatment with more than 350 CD4 cells was $2,526 per month. Treatment for individuals who started with 100–350 CD4 cells was $2,378 per month, and for individuals with fewer than 100 CD4 cells, the price increased to $4,860 per month.

The full report, “Burden of Illness in a US Commercially Insured HIV Population: Treatment Patterns and Costs,” was presented at the 53rd ICAAC Interscience Conference on Antimicrobial Agents and Chemotherapy, September 10–13, 2013, Denver. Abstract H–662.

Kenya Sees Drop in HIV Prevalence

Preliminary Kenya AIDS Indicator Survey (KAIS) results showed that Kenya’s overall HIV prevalence dropped from 7.2 percent in 2007 to 5.6 percent in 2012. Peter Cherutich, head of prevention for Kenya’s National AIDS and Sexually Transmitted Infections Control Program, attributed the prevalence decrease to more HIV-infected people receiving antiretroviral therapy (ART). Early ART could reduce heterosexual HIV transmission by as much as 96 percent, according to recent studies.

Officials feared that these gains would not be sustainable unless Kenya reduced its reliance on donor funding. At present, more than 70 percent of HIV-infected Kenyans with a CD4 count of 350 or lower were on ART. The HIV virus was undetectable for 80 percent of those, which meant there was low risk of transmitting the virus.

Allan Ragi, executive director of the Kenya AIDS NGO Consortium, attributed Kenya’s progress to the fact that government, donors, civil society, and HIV-infected people had worked together at all levels to put in place effective policies, messages, and interventions. Other HIV prevention efforts included mother-to-child prevention, medical male circumcision, and counseling and testing programs.

KAIS reported that approximately 1.2 million Kenyans had HIV, and HIV prevalence varied by gender and region. Overall prevalence among women was 6.9 percent, compared to 4.4 percent overall prevalence among men and 0.9 percent overall prevalence among children. The survey indicated “substantial” drops in the Coast, Nairobi, and Rift Valley regions, but recorded an overall prevalence increase in Nyanza region from 14.9 percent prevalence in 2007 to 15.1 percent in 2012. 

Can't Hardly Wait: Federally Funded Abstinence-Only Education Finds its Way to New Mexico

The New Mexico Department of Health (DOH) and New Mexico State University (NMSU) quietly began to accept federal funding for abstinence-only education programs in fall 2012, six years after DOH rejected a federal grant for abstinence-only education in public schools. According to DOH Spokesperson Kenny Vigil, the state had accepted more than $470,000 in federal abstinence-only funds, to which the state added in-kind contributions of more than $350,000. Vigil stated that the funding offered New Mexico another sex education option. New Mexico reported the highest teen pregnancy rate and highest chlamydia and gonorrhea rates in the country, and DOH stated that 30 percent of students under 15 reported they had had sex.

According to the Sexuality Information and Education Council of the United States (SIECUS), DOH used the money to fund a community-based curriculum called “Sex Can Wait” in Chavez, Cibola, Curry, Doña Ana, Eddy, Lea, and Luna counties. SIECUS advocated for comprehensive sex education for teens and tracked abstinence-only federal dollars. However, Vigil stated that DOH had piloted the “Sex Can Wait” program, developed in 1994 by Dr. Michael Young, and would offer the curriculum in Curry County middle school after-school programs.

The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics both opposed abstinence-only education, and a 2007 US Department of Health and Human Services study confirmed that students who took abstinence-only courses were likely to have their first sex at the same age and to have as many partners as students who did not receive abstinence-based sex education. Critics noted that abstinence-based education failed to teach teens about birth control and contraception.

Santa Fe Public Schools refused abstinence-only funding and partnered with Planned Parenthood to provide comprehensive sex education for public school students in grades 7–9.

$5M Funding for Project Aimed at Eliminating HIV/AIDS

British Columbia Center of Excellence in HIV/AIDS (BC-CfE) at St. Paul’s Hospital in Vancouver, Canada, has received $5 million in funding for a project to develop an improved HIV drug-resistance test, real-time drug resistance surveillance, and better ways of personalizing HIV treatment.

The new individualized test, which is based on DNA sequencing technology, can detect drug-resistant strains. Also, using the patient’s DNA, two types of tests—viral and human genomic—will enable doctors to determine the best antiretroviral drugs to reduce the virus in the patient’s blood and minimize adverse reactions, thus preventing non-adherence.

The researchers also will develop a new early warning system to monitor and map drug resistance and indicate geographic or population “hotspots” where resistance is highest and transmission risk greatest.

The test at the BC-CfE labs will be available for all Canadian HIV patients through their doctors, and the researchers plan to share the technology with labs globally.

Genome BC, Genome Canada, Genome Quebec, the Canadian Institutes of Health Research, ViiV Health care and the St. Paul’s Hospital Foundation are funding the project.

Newport News Has Highest HIV/AIDS Rate in Region

The Emory University AIDSVu study reported that the 23607 ZIP code in Newport News, Va., had the highest concentration of HIV/AIDS diagnoses in the region. AIDSVu ranked the Virginia Beach-Norfolk-Newport News metropolitan statistical area (MSA) 20th among 103 US metropolitan areas. Emory University Professor of Epidemiology Patrick Sullivan explained that the AIDSVu study aimed to identify areas with greatest need for early HIV diagnosis and treatment interventions. HIV incidence in the city of Newport News was 538 per 100,000 people, and more than 500 of Newport News HIV cases occurred in ZIP code 23607. This could be due to the fact that the Newport News City Jail was located there.

Dr. Nzinga Teule-Hekima, director of the Peninsula Health District, stated that public health officials were aware of the high concentration of HIV/AIDS cases. Incidence of all STDs and chronic diseases such as high blood pressure and diabetes also were disproportionately high in the neighborhoods because residents lacked access to medical care.

According to Virginia Department of Health HIV Surveillance Assistant Director Celestine Buyu, AIDSVu made state-reported HIV/AIDS data more accessible to communities. AIDSVu compiled health department data to break down incidence by city, county, gender, race, and age, and to provide corresponding data on poverty and education levels. Sullivan noted that only 75 percent of 23607 ZIP code residents had a high school diploma or the equivalent. Rates within the ZIP code also varied widely by race and gender, with higher HIV incidence among blacks and among men having sex with men.

AIDSVu began collecting state-level data in 2010, expanded to include three cities in 2011, and analyzed incidence at the census tract level in 2012. In 2013, the study included MSAs and began to produce HIV/AIDS rate and numbers.

HIV/AIDS incidence by ZIP code was available at http://www.AIDSVu.org.

Innovative Cambodia Method Could Curb TB Cases

CDC and Harvard School of Public Health infection control experts shared a World Health Organization (WHO)-approved TB prevention model with workshop attendees at Sion Hospital in Mumbai, India. The experts also analyzed the impact of Sion Hospital’s ventilation system design on TB transmission within the hospital.

Dr. Sujata Baweja, head of Sion Hospital’s microbiology department, stated that the WHO TB prevention model designated “cough officers” to “fast-track” patients who entered the hospital with a cough. The cough officers asked the patient how long the cough had lasted, and then requested that the patient take a TB sputum test (away from other patients) that would give immediate results. Patients with positive sputum test results moved immediately to a separate area where they would not interact with other patients and spread TB.

Cambodia, which recorded 1,500 TB cases per 100,000 people in 2002, reduced the number of new TB infections dramatically using this screening method. The number of new TB cases dropped by 45 percent in 2012 after Cambodian hospitals implemented the model.

The US experts presented the infection control workshop to address recent increases in TB incidence and mortality among nurses, physicians, and class IV hospital workers in Mumbai hospitals. A 24-year-old Sion Hospital medical intern and a 21-year-old Nair Hospital nursing student recently died from TB. Thirteen Sion staff members and nine Nair Hospital staff members also were receiving TB treatment. State-run JJ Hospital had eight staff members in TB treatment.

NJ Lawmakers Want Loophole Closed in Cases Involving Failure to Disclose HIV Infection

New Jersey state lawmakers introduced a bill that would permit authorities to obtain medical records of persons accused of not disclosing their HIV status to sexual partners. The measure was prompted by the recent acquittal of a retired police captain who did not tell his female sexual partners that he was HIV-positive; an appeals court cited current state law that barred prosecutors from obtaining his medical records.

“Failing to inform a sexual partner of this type of personal information can result in life-changing and deadly results and is akin to the most serious of assaults,” said Sen. Kip Bateman (R-16th District). “In order to allow for the appropriate prosecution of this appalling crime—and to send a message to others that this selfish and dangerous behavior won’t be tolerated—we must give the court the ability to consider information critical to the case like a suspect’s medical history.”

The bill, co-sponsored by Bateman, Assembly Member Jack Ciattarelli (R-16th District), and Assembly Member Donna Simon (R-16th District), would allow a court order to release medical records for a person charged with a third-degree crime of not disclosing his/her HIV-positive status to sexual partners. Current law prohibits access to medical records unless the offender is charged with a first-degree crime as well. “The legal system will never ever be perfectly perfect,” Ciattarelli said. But he added that it was the policymaker’s job to perfect laws as much as possible “and ensure that justice is served.”

AIDS Task Force to Hold Annual Dinner Dance Fundraiser

The AIDS Task Force in Fort Wayne, Ind., will hold its 25th annual Gay and Lesbian Dinner Dance at the Grand Wayne Center on October 5, starting at 7:30 p.m.

The task force has priced dinner dance tickets at $50 and $100 for VIP tickets, which will include admittance to the mayor’s reception. Guests must purchase either dinner or VIP tickets in advance by calling (260) 744–1144. Tickets for only the dance are $10 in advance or $15 at the door.

The event will include a tapas-style dinner, a live DJ, and performances by Doug Strahm. Proceeds from the event will benefit AIDS Task Force programs and operations.

The organization is Indiana’s oldest AIDS service organization and serves 11 counties in northeast Indiana with care coordination services, prevention education, and HIV testing.

School Official: Kids Kicked out Because of HIV “Risk” to Others

The Disability Rights Center of Arkansas reported that the Pea Ridge School District has notified the foster parents of three school-aged siblings that the students could not attend school until the foster parents provided documentation that they were HIV-negative. Tom Masseau, the center’s executive director, stated that denying the children the right to attend school was illegal because of the Health Insurance Portability and Accountability Act and the Americans with Disabilities Act. Two of the siblings had disabilities, according to the Disability Rights Center.

The students’ dismissal occurred after Pea Ridge School District officials discovered during a summer review of student records that one of the siblings and their mother were HIV-infected. School officials informed the foster parents on Monday, September 16, that the children could not attend school until they proved they did not have HIV. The children returned to school on Tuesday, but were not allowed to attend class or participate in extracurricular activities.

Superintendent Rick Neal confirmed that the district had denied the students access and requested their HIV test results to “formulate a safe and appropriate educational plan” for the siblings. The school district had not sent out official district-wide notification to parents.

47 Public Hospital Staffers, 7 Doctors Catch TB in Mumbai

Brihanmumbai Municipal Corporation (BMC) reported that approximately 54 healthcare providers from Mumbai’s public hospitals were receiving TB treatment under India’s Revised National TB Control Programme. A “miniscule” number of these TB-infected healthcare workers had multidrug-resistant TB (MDR TB), according to BMC officials. Most of the TB diagnoses occurred among Grade IV staffers who did not have patient contact, or among nursing and Bachelor of Medicine, Bachelor of Surgery (MBBS) students. However, seven TB patients were doctors in post-graduate training in tertiary hospitals. Mumbai reported more than 30,000 TB cases annually.

Although veteran healthcare providers asserted that TB was the “commonest” occupational hazard, recent MDR TB deaths have drawn fresh attention to the disease. A Sion Hospital MBBS student died of MDR TB in June 2013, and 13 other Sion healthcare workers currently were receiving TB treatment. A Nair Hospital nursing student also died of MDR TB in June, and a nursing college hostel has reported three TB cases among 400 students in 2013. Mumbai TB Officer Dr. Minni Khetarpal attributed TB incidence among nursing students primarily to nutrition, work stress, and climatic conditions. Dr. Sujata Baweja, head of Sion Hospital’s microbiology department, noted that some patients who arrived with TB left the hospital with drug-resistant TB.

CDC and Harvard School of Public Health infection control experts recently arrived in Mumbai to consult with BMC architects, engineers, and specialists. According to CDC Expert Paul Jensen, ventilation control issues, including design, operation, and sustainability, could assist with infection control.

New Alaska Condom Campaign Pushes Limits to Get People Talking

In an effort to address some of the highest STD rates in the nation, Alaska lawmakers have introduced a new STD prevention program that would emphasize the importance of using condoms to protect against disease. The program also would provide access to free STD test kits in the hopes that more people would identify their infection and seek treatment. According to State HIV/STD Program Manager Susan Jones, untreated STDs could cause long-term health effects such as miscarriage, babies born with infections, and complicated infections in both men and women.

The 3-year, $360,000 campaign, funded by the state legislature, is Alaska’s attempt to “get control” of its high rate of incidence and would target the two groups most at risk: teens under 17 and young adults between the ages of 18 and 24. Jones added that some infected residents refused to identify all their sexual partners or to inform their partners of their risk of infection, the consequence of such behavior motivated state health officials to change philosophies on STD prevention strategies.

The new strategy, according to Jones, was to embrace “unique” approaches, includes using humor as a means to encourage condom use and open dialogue about safe sex. "We are hoping that this campaign will put some of the responsibility on the folks that are sexually active and they will try to protect themselves and their partners by using condoms," Jones said.

Free condoms and STD kits can be ordered online at http://www.iknowmine.org.

PrEP Adherence Curbs HIV Transmission in Straight Couples

A study of HIV-negative heterosexuals who followed instructions for pre-exposure prophylaxis (PrEP) therapy indicated that PrEP was successful in preventing HIV. The researchers studied 1,147 HIV-negative individuals in long-term stable heterosexual relationships (average length of relationship was 8.5 years) with HIV-infected partners. Participants were from three Ugandan sites of the Partners PrEP study, which provided them with either Viread (tenofovir) or Truvada (tenofovir/emtricitabine). The group had six months of follow up left in the trial, had a median age of 34 years, and was 53 percent male.

Researchers tracked PrEP adherence by electronic pill bottle monitoring and unannounced home visits to count pills. Participants received counseling if adherence dropped below 80 percent.

Study participants had exceptional adherence levels, with an average of 99 percent for in-home pill counts and 97 percent for electronic monitoring. Of 404 individuals who received placebo, 14 were infected with HIV whereas of the 750 individuals who received PrEP, none was infected.

Researchers concluded that PreP could be very effective in preventing HIV transmission when recipients maintained their daily dosing schedule.

The full report, “Adherence to Antiretroviral Prophylaxis for HIV Prevention: A Substudy Cohort Within a Clinical Trial of Serodiscordant Couples in East Africa,” was published in the journal PLOS Medicine (2013;doi/10.1371/journal.pmed.1001511).