HIV AIDS

London, Aids testing by saliva in 20 minutes

2009-05-22T04:49:00.000-07:00

A simple stick to find out if you have the AIDS virus in only twenty minutes from a sample of saliva. In London to test for HIV is now easier. The test, already in use in the United States, was approved by the National Health Service (NHS) and London is the first city in Britain to offer this service. Can be done in less than half an hour without doing blood tests.

With a special toothbrush, in fact, take a sample of saliva and indicators that are reported on the buffer if the body has developed antibodies against HIV. Since March last year 200 people have already done this test and the local health care company hopes that will come to 250 patients a month, hoping to start distributing the buffers also on the premises.

"It is important - said Merle Symonds, head of the department for diseases of the sexual NHS in London - that HIV will take time before it becomes ill. Really hope that the saliva tests could encourage many people to discover if they have contracted the virus. Before we know the better. " In health care, the company is the fact that many British people do not know they are sick with AIDS. Only in 2007 in Great Britain there were more than 7700 new cases of AIDS, the highest number among the countries of Western Europe. Of these only 41% were gay men, while most were heterosexuals who have contracted HIV while they were abroad.

Kit for monitoring HIV

2009-05-21T20:26:00.000-07:00

Three research centers in London, along with some private companies will have access to a loan of 2 million pounds for the development of a kit that nanotechnology will enable people living with HIV to monitor their health conditions At Home with a device similar to that used by diabetics to measure your glucose.

Through a puncture on the finger and the analysis of the drop of blood that comes out, little mechanical sensors will be able to measure levels of the HIV virus, sending the results in seconds on the screen.

This will make it possible for patients seek medical attention as soon as the viral load exceeds the limits of alert.

Rachel McKendry at University College London and the London Center for Nanotechnology, which coordinates research, explained that the sensors of the array type, are covered with substances that attach themselves to HIV and other protein markers of the progression of the disease.

Depending on the amount of virus protein and detected, the sensors are moving, giving the measure of the levels present in the body.

Anna Maria Goretti, advisor and researcher at the Royal Free Hospital, said "If the patient has forgotten to take medication or have an emergency situation, it is an immediate and easy way to find out" in this way Patients "will be able to follow their health with the kit and go to the doctor only when necessary."

The kit will support the medical staff in the developing world, where tools are needed fast and inexpensive to monitor HIV patients.

Obviously the kit cannot replace the doctor, but certainly reduces the dependency of the patient to the doctor, as already happens for those who are sick from diabetes.

AIDS: an explanation of heart attacks related to antiretroviral drugs

2009-05-18T07:45:00.000-07:00

Ireland - Researchers from several universities and hospitals in Dublin have discovered why some patients with AIDS treated with antiretroviral drugs had a higher risk of heart attack.

An international study in 2008 identified a higher risk of heart attacks in patients treated with antiretroviral drugs against AIDS. Scientists have developed a test to measure the activity of platelets in the blood. These are necessary for the proper clotting of blood, their dysfunction can cause clots in the arteries that can lead to heart attack.

Clinical trials have been conducted with patients suffering from AIDS using the new test. The results show a significant increase in platelet reactivity in patients taking certain antiretroviral drugs.

For Dr. Mallon, "These results significantly affect the management of patients with AIDS and [will] have implications for treatment. These results provide valuable information to assist in finding cures and secure long term against HIV. "

Socioeconomic status and HIV / AIDS in Tanzania

2009-05-18T00:25:00.000-07:00

Objective: To examine the relationship between different dimensions of socio-economic status and HIV seroprevalence in Tanzania.

Methods: In a large nationally representative sample of 7515 adults having sex, from the 2003-04 survey on indicators of HIV / AIDS in Tanzania, we analyzed the relationship between various measures of socioeconomic status and seroprevalence HIV, from logistic regression models burdened.

Results: In adjusted models, people enjoying better living standards have introduced a higher odds ratio (OR: odds ratios) indicating HIV (men: OR 2.38, 95% CI 1.17-4.82; among women: OR 3.74, 95% CI 2.16-6.49). The job was differentially associated with HIV infection in men and women, women have presented an OR higher seropositivity (OR 1.54, 95% CI 1.02-2.38), while unemployed men have a risk of HIV higher (OR 3.49, 95% CI 1.43-8.58). No significant association was seen between the increase of educational level and HIV seroprevalence among men (P = 0.83) or women (P = 0.87).

Conclusion: Contrary to the prevailing perception that individuals with low socioeconomic status tend to be more vulnerable to HIV infection, we found a positive association between living standards and HIV infection. Strategies to reduce HIV infection should be aware of complex social heterogeneity in models of HIV infection.

Significant reduction in the field of HIV / AIDS according to a male circumcision intervention in sub-Saharan Africa

2009-05-18T00:24:00.001-07:00

Background: Observations that reduced the prevalence of HIV among adults in sub-Saharan Africa correlated with levels of male circumcision (MC), have suggested that male circumcision could serve as a preventive measure against HIV infection. The exact benefits of this intervention are uncertain. Moreover, if male circumcision is not feasible on the entire male population, to which groups to contact?

Methods: A mathematical model simulated observed levels of HIV prevalence in the entire range of current levels of circumcision. Male circumcision increased since 2007, was incorporated into the model then used to simulate HIV prevalence in 2020.

Results: A full coverage for male circumcision (MC) can reduce HIV prevalence from 12 to 6% for an average population country in sub-Saharan Africa in 2020. This reduction is scaled proportionally when lower levels of male circumcision is completed. These benefits are mostly obtained by circumcision of men between 20 and 30 years (prevalence of adults is reduced from 12 to 10%) and those with a more dangerous (8 to 6.9%). For a total negation of these benefits, at least 40% of circumcised men to increase remarkably dangerous behavior.

Conclusions: Male circumcision (MC) provides an effective intervention in sub-Saharan Africa to reduce HIV prevalence. It is most effective when applied to men at risk between 20 and 30 years with diminishing returns in relation to a wider male population.

Treating HIV earlier to reduce the risk of death

2009-05-18T00:20:00.000-07:00

A new North American study shows that starting antiretroviral treatment earlier may reduce the risk of death to 94 percent.

Montreal - Treat as soon as possible: a general rule of common sense for most diseases ... except for HIV / AIDS that does that at a certain threshold of loss of immune cells called CD4 +. The results of a North American study which the team of Dr. Marina Klein of the Research Institute of the MUHC, goes against the consensus. They show that the risk of death among HIV-positive patients decreases from 69% to 94% if treatment is started earlier than the official recommendations.

The study, published recently in The New England Journal of Medicine, could have considerable influence on medical practices.

Dealing earlier reduces the risk of death

More specifically: the risk of death decreases by 94% for patients starting their HIV treatment when their rate of CD4 + cells is greater than 500 cells per milliliter, compared to those who start when it is below 500. More patients starting treatment when their rate of CD4 + cells is between 350 and 500 cells per milliliter see their risk of death reduced by 69% compared to those that begin with a rate below 350.

"The official guidelines recommend starting anti-HIV treatment when the rate of CD4 + cells is less than 350 cells per milliliter. This rate was calculated from data relating to older drugs and causing more side effects than current treatments, "says Dr. Klein. "The current therapies produce fewer side effects, are better tolerated and more effective. It is therefore safe to start treating patients sooner. "

This is the first study of this magnitude to measure the risk of death according to the progress of infection at the time of starting treatment. Data were drawn from several databases in North America, including Dr. Klein managed the Montreal Chest Institute. Overall, the researchers analyzed data from 17,517 patients between 1996 and 2005.

Disease in general

"We found that HIV treatment could also reduce the incidence of diseases unrelated to AIDS, such as cardiovascular disease, liver disease, or cancer. This partly explains why earlier treatment reduces the risk of death, "said Dr. Klein. "We do not know precisely the mechanisms behind this observation, but two hypotheses are plausible. First, the drugs would support the immune system more effectively by acting sooner on the other hand they would prevent HIV from replicating, thereby reducing inflammation. "

Despite official recommendations, current practice tends to suggest patients start treatment much earlier after the detection of the virus. This study could help to strengthen this trend, and possibly to develop formal guidelines.

Early Initiation Of Antiretroviral Therapy Improves HIV Survival Rates, Study Says

2009-05-02T10:00:00.001-07:00

The New York Times on Thursday examined a study that found asymptomatic HIV-positive people who delayed antiretroviral treatment until their disease reached an advanced stage faced higher mortality rates than those who initiated treatment earlier. According to the Times, current national guidelines recommend starting HIV-positive people on antiretroviral treatment when CD4+ T cell counts fall below 350; however, the recent study suggests that initiating treatment earlier could reduce the risk of death. The study, as well as a related editorial, appeared online in the New England Journal of Medicine earlier this month and both will appear in the April 30 edition of the journal. In addition, a separate study published online earlier this month in the journal Lancet developed similar conclusions about the benefits of earlier antiretroviral therapy initiation, the Times reports.

For the NEJM study, researchers led by Mari Kitahata, director of clinical epidemiology at the Center for AIDS and Sexually Transmitted Infections at the University of Washington, tracked survival rates for 17,517 asymptomatic HIV-positive people in the U.S. and Canada who received care from 1996 to 2005 and who had never previously taken antiretroviral therapy. For their first analysis, the researchers examined a group of 8,362 patients, 2,084 of whom started therapy when CD4+ counts were between 351 and 500. They also examined 6,278 participants with similar CD4+ counts who delayed therapy until their counts declined below 350. According to the study, the patients who delayed treatment had a 69% higher risk of death compared with those who initiated treatment earlier. For the researchers' second analysis, they examined 9,155 HIV-positive people with CD4+ counts of more than 500. Of those, 2,220 started therapy within six months, while 6,935 delayed therapy. Among those who postponed treatment, 3,881 experienced a decline in CD4+ levels and 539 started antiretroviral treatment within six months of having a CD4+ count of 500 or less. In addition, the researchers found that those who deferred therapy had a 94% greater mortality risk than those who initiated treatment earlier.

According to Kitahata, the study examined "one of the most important questions in the last decade: what the optimal timing is for starting therapy." She added that the recent research "provides evidence that patients would live longer if antiretroviral treatment was begun when their CD4+ count was above 500." According to the Times, the study is "not the final word on the matter" (Rabin, New York Times, 4/30).

Use Of Certain Antibiotics In Topical Cream Could Prevent HIV Transmission, Study Says

2009-04-30T08:06:00.001-07:00

A class of antibiotics known as aminoglycosides could be used to make a topical cream that would trigger production of a protein in humans to prevent HIV transmission, according to a study published Tuesday in PLoS Biology, the Orlando Sentinel reports.

For the study, researchers led by Alexander Cole of the University of Central Florida used the antibiotics to trigger a dormant human gene to produce a protein called retrocyclins that resists HIV transmission. The researchers applied the antibiotics to vaginal tissues and cervical cells and found that it stimulated the tissues and cells to produce retrocyclins. Cole said there is a "good chance the aminoglycosides antibiotics will be used in a topical cream as a way to prevent the transmission of HIV from men to women." He noted that more research, including human trials, is necessary to determine the safety and efficacy of a potential cream.

Cole said the discovery that aminoglycosides can trigger cells to produce retrocyclins is a "promising find," adding that the researchers "will be moving forward with this -- full steam ahead." Phalguni Gupta, a scientist at the University of Pittsburgh who specializes in infectious diseases, said the research is "very hopeful," adding that the use of aminoglycosides in a cream or gel would be an "important part of the arsenal in the fight against" HIV/AIDS (Quintero, Orlando Sentinnel, 4/28).

Kaiser Family Foundation Releases Survey About HIV/AIDS In U.S.

2009-04-30T08:04:00.000-07:00

"2009 Survey of Americans on HIV/AIDS," Kaiser Family Foundation: The new survey found that in the U.S., the sense of urgency about HIV/AIDS as a national health issue has decreased significantly and that residents' concerns about the disease as a personal risk also has declined, even among some high-risk groups. According to the survey, the percentage of people in the U.S. who named HIV/AIDS as the most urgent health problem facing the country decreased from 44% in 1995 to 17% in 2006 and 6% currently. It also found that although blacks and Hispanics have HIV rates seven and three times higher than whites, respectively, and are more likely to see HIV/AIDS as a pressing issue, fewer say that it is a "more urgent" problem now than in 2006. According to the survey, the percentage of people ages 18 to 29 who say that they are personally very concerned about contracting HIV decreased from 30% in 1997 to 17% currently. In addition, it found that 53% of non-elderly adults say that they have been tested for HIV.

Half of the U.S. public thinks that the federal government is allocating too little on domestic HIV/AIDS issues, and the survey also found signs that HIV/AIDS might carry less stigma than in the past (Kaiser Family Foundation release, 4/28).

Glaxo, Pfizer to Merge HIV-Drug Units in New Company

2009-04-16T05:00:00.000-07:00

GlaxoSmithKline Plc and Pfizer Inc. plan to combine their HIV-drug units into a new company that will control almost 20 percent of the market for treating the deadly virus.

London-based Glaxo will hold 85 percent of the joint venture and Pfizer the remainder, the drugmakers said in a statement today. The new company will wield more clout than either Glaxo or New York-based Pfizer alone, the statement said.

One of Glaxo’s best-selling HIV medicines, Combivir, will lose patent protection in 2012 and Pfizer, which agreed to buy U.S. rival Wyeth this year, may look to exit the market for HIV medicines in the future, said Navid Malik, an analyst at Matrix Corporate Capital in London.

“Glaxo is looking to consolidate its franchise through this tie-up with Pfizer, who are probably looking to exit HIV,” Malik said.

Glaxo’s HIV drugs had 2008 sales of about 1.51 billion pounds ($2.25 billion), or 6.2 percent of its revenue, led by Combivir and Epzicom. The company’s shares fell 8 pence, or 0.8 percent, to 1,016 pence as of 11:34 a.m. in London. The stock has dropped 21 percent this year.

The venture is a “good signal” of how Glaxo seeks to combine expertise going forward, spokesman Stephen Rea said in an interview. He declined to provide financial details for the venture.

‘Speed and Efficiency’

Dominique Limet is the chief executive officer designate of the new company, Glaxo said in a filing to the U.S. Securities and Exchange Commission. Limet, a trained physician, is a senior vice president at Glaxo.

The new company will have 17 molecules at its disposal to develop in fixed-dose combinations as possible new HIV treatments. It will contract research services directly from Glaxo and Pfizer to develop these medicines.

“With the strength of the companies’ current products, as well as the complementary fit of Pfizer’s pipeline and Glaxo’s global distribution capabilities, the new company is well positioned to bring new and improved medicines to patients with more speed and efficiency,” Pfizer Chief Executive Officer Jeff Kindler said in the statement.

An estimated 33 million people were living with HIV last year, according to UNAIDS, which coordinates the United Nations’ response to the disease. About 4 million were taking AIDS drugs.

Bush's AIDS Treatment Program Saved 1.2 Million Lives In Africa.

2009-04-07T06:12:00.000-07:00

According to a new recount, PEPFAR, President Bush's AIDS action plan abridged the total number of AID/HIV deaths by 1.2 million from 2004 to 2007. PEPFAR (President's Emergency Plan for AIDS Relief) embattled Africa's most injured countries.

PEPFAR was launched by President Bush in 2003. Experts from the Stanford University, control by Eran Bendavid, express in a tale published in the Annals of Internal Medicine that the syllabus reduced AIDS deaths by about 10.5% per year in the most injured African countries. They added that PEPFAR did not avert new infections or moderate overall prevalence of AIDS.

PEPFAR focused largely on treating people who have AIDS, and to a lesser area on prevention programs, with sexual abstinence. It was the prime track American unrelated aid plan ever.

In an interview with Bloomberg, Bendavid, a fellow in infectious diseases and vigor statement, said that the remedy has worked. He added that prevention desires to be in the head over the next five days.
According to PEPFAR, through to September 30th, 2008:

58.3 million people were reached through village programs to avoid sexual transmission with the ABC slant
2.2 billion condoms were complete
16 million pregnancies were helped to try to thwart mother-to-baby HIV transmission, antiretroviral prophylaxis was administered to almost 1.2 million pregnant women found to be HIV-decisive, allowing nearly 240,000 infants to be born HIV-released
2.1 million people were supported with life-economy cure
The reveal of children receiving PEPFAR action rose from 3% in 2004 to 8% in 2008
Supported problem for more that 10.1 million people precious by HIV/AIDS, of whom over 4 million were children
HIV counseling and testing was supported for almost 57 million people
Supported TB (tuberculosis) action for nearly 400,000 HIV-infected people
Partnered with 2,667 organizations, 86% of them confined
Supported 3.7 million teaching and retraining encounters with wellbeing attention workforce

Funding HIV/AIDS, TB, Malaria 'Smart Investment,' U.N. Secretary General Ban Says

2009-04-02T10:30:00.000-07:00

Funding programs aimed at fighting HIV/AIDS, tuberculosis and malaria is a "smart investment," United Nations Secretary General Ban Ki-moon said Monday in a video message to a meeting in Cacares, Spain, to call on donors to fund United Nations-supported efforts against the three diseases, Xinhuanet reports.

Ban said the Global Fund To Fight AIDS, Tuberculosis and Malaria will need $4 billion to meet its 2010 targets. He called on donors to increase spending, adding, "I say to you that spending on AIDS, TB and malaria is a smart investment. It is a true recovery package." Ban also called on the international community to honor commitments made at the 2005 Group of Eight Industrial Nations summit in Gleneagles, Scotland.

According to Ban, the Global Fund has committed more than $10 billion to programs in 140 countries since 2001. Global Fund programs have helped delay progression to AIDS in two million HIV-positive people, detect and treat 4.6 million TB cases, distribute 70 million insecticide-treated nets and administer 74 million malaria treatments, Ban said. He said that the Global Fund has "been a success" and has "saved millions of lives," adding, "It is important that we replenish it" (Xinhuanet, 3/30). Ban added that TB efforts cost $16 billion annually in the lowest-income communities worldwide but that containing the disease would cost $4.2 billion annually. In addition, Africa spends $12 billion annually on malaria, but $3.4 billion would fund malaria prevention and treatment annually (UN News Service, 3/30).

Health Officials In Canadian Province Develop Communications Strategy To Address Increase In HIV Cases

2009-04-02T08:02:00.000-07:00

Health experts are developing plans to increase HIV/AIDS awareness in the Canadian province of Saskatchewan in response to the virus' rising incidence in the province, Moira McKinnon, Saskatchewan's chief medical health officer, said recently, the Regina Leader-Post reports.

McKinnon said a committee recently created to address the province's HIV incidence has "met with a number of stakeholders and devised a plan" and also has developed several additional steps that can be taken to curb the spread of the virus, including increased HIV testing. "We've still got a lot of work to do in looking at the challenges from different points of view," McKinnon said, noting that both the federal and provincial governments and various other partners are involved in the process. According to the Leader-Post, Saskatchewan recorded 174 new cases of HIV in 2008, an increase from the 124 new cases recorded in 2007. About 60% of the new cases in 2008 were associated with injection drug use.

McKinnon said a communications plan that targets specific groups, especially young women, is important to address HIV in the long term. McKinnon said, "We need to work out what we're saying to people. We want to keep it positive: Get tested, get on treatment. Those kind of messages." The plans for how those messages will be conveyed to the public still are under development and additional funding and advocates on the ground will be needed, she noted. The partners in the communications plan "know that there are resource implications, so we'll be sitting down and getting final detail on that in the next week or so," McKinnon said. Don McMorris, Saskatchewan's health minister, said that the government "is supporting aggressive measures to respond to this important public health issue, in addition to the current programs and services already funded" (Hall, Regina Leader-Post, 3/28).

Transmission Of Drug-Resistant HIV-1

2009-04-01T09:46:00.001-07:00

Drug-resistant forms of HIV can be spread between individuals who have not received anti-retroviral treatment, according to Professor Deenan Pillay from University College, London and the Health Protection Agency, speaking at the Society for General Microbiology meeting at Harrogate.

Anti-retroviral therapy is a major advance in the treatment of HIV and there are currently over 25 drugs available. It is known that the virus can mutate, reducing its susceptibility to treatment, and that these resistant viruses can be transmitted between individuals. Professor Pillay found that drug resistant viruses could also circulate between individuals who have not received antiretroviral drugs treatments.

"Our findings show that assuming that drug resistant HIV was only passed on from individuals receiving drug treatment may mean the number and size of the reservoirs of drug resistant virus in the United Kingdom has been underestimated," said Pillay, "Our results indicate that although the incidence of drug resistance has been declining, this might not continue - which could have implications for planning and management of treatment programmes".

Source:
Dianne Stilwell
Society for General Microbiology

Potential New HIV Drug May Help Patients Not Responding To Treatment

2009-04-01T09:17:00.000-07:00

A potential treatment for HIV may one day help people who are not responding to Anti-Retroviral Therapy, suggests new research published tomorrow in The Journal of Immunology. Scientists looking at monkeys with the simian form of HIV were able to reduce the virus levels in the blood to undetectable levels, by treating the monkeys with a molecule called D-1mT alongside antiretroviral therapy (ART).

Simian Immunodeficiency Virus (SIV) is very similar to Human Immunodeficiency Virus (HIV) and it is used to study the condition in animal models. In both HIV and SIV, the level of virus in the blood, or 'viral load', is important because when the viral load is high, the disease progresses and it depletes the patient's immune system. This eventually leads to the onset of Acquired Immune Deficiency Syndrome (AIDS), where the patient cannot fight infections which would be innocuous in healthy individuals.

Currently, the 'gold standard' treatment for HIV is Highly Active Anti-Retroviral Therapy (HAART), a cocktail of drugs that reduces the viral load by stopping the virus from replicating. HAART can increase the life expectancy of an HIV-positive patient substantially if it works well. However, the treatment is not effective for around one in ten patients, partly because some develop resistance to the drugs used in HAART. The researchers, from Imperial College London, the National Cancer Institute, Bethesda, and Innsbruck Medical University, hope their study could ultimately lead to a new treatment that will help HAART to work more effectively in these people.

In the new study, researchers gave daily doses of a modified amino acid called D-1mT to 11 rhesus macaques infected with SIV. All of the macaques had been treated with ART for at least four months. Eight of the macaques had higher viral loads (reaching up to 100,000 copies of the virus per millilitre of blood), because they were not responding completely to the treatment. However, three had undetectable viral loads (fewer than 50 copies of the virus per millilitre of blood), because ART was working well.

The researchers took blood samples at six and 13 days. After six days, only three of the macaques had detectable SIV levels and after 13 days the virus could only be found in two of them, at very low levels (below 1,000 copies of the virus per millilitre of blood). The researchers repeated the research in eight macaques that were not being treated with ART but this time they found no change in viral load over 13 days.

Dr Adriano Boasso from Imperial College London said: "HIV can have a devastating effect on people's lives but with advances in Anti-Retroviral Therapy it is becoming a more chronic, manageable disease. Unfortunately, treatment does not work for everyone - some people develop resistance to the drugs and when that happens, we start to run out of options for treating them and delaying the onset of AIDS.

"Our early findings suggest that D-1mT could be used alongside antiretroviral therapy to stop the virus from replicating. The disease can only progress if the virus is replicating, so if we can slow replication down we can reduce the impact of the disease on the patient's life. We still need to figure out how D-1mT is working, then we can think about developing this as a potential treatment for HIV," added Dr Boasso.

The results of the new study surprised the researchers because D-1mT did not appear to work in the way they had expected. They had believed it might reactivate the immune system, because D-1mT is able to block an enzyme called IDO, which HIV and SIV use to hold the immune system back. In healthy people, IDO prevents the immune system from attacking the body. HIV and SIV hijack the machinery that makes IDO and use it to stop the immune system from attacking them.

In the new study, the researchers could find no evidence that D-1mT reactivated the immune response against SIV, although they do not exclude this possibility. They are now keen to carry out further research to explore how D-1mT is working.

"The effect D-1mT seemed to have on viral load was really encouraging but it was a surprise to us - we didn't expect D-1mT to work only in macaques that were already being treated with ART. It seems that D-1mT synergises with ART and we would really like to find out how this works," said Dr Boasso.

In healthy people, the IDO enzyme controls allergic reactions and autoimmune diseases and it also stops the foetus from being rejected in pregnancy. As D-1mT blocks IDO, the researchers say that its effects may need to be tested in SIV-infected macaques over a longer time, to determine if taking the drug could increase the risk of these conditions.

D-1mT is currently in Phase I clinical trials to test its safety and potential efficacy as a treatment for cancer, which should indicate whether the drug is suitable for treating human patients. The researchers hope that if D-1mT proves safe in the initial trials for cancer and shows further promise for treating HIV, trials for using D-1mT as a treatment for HIV could begin as early as 5 years from now.

1.7M People Visit Webpage Urging Gov. Schwarzenegger To Save California AIDS Care Plan

2009-03-31T05:38:00.000-07:00

More than 1.7 million people have visited a multi-media webpage urging California Governor Arnold Schwarzenegger to 'Have a Heart' and save 'Positive Healthcare,' a California primary care case management health care plan caring for low income people living with AIDS. The webpage (http://ga1.org/campaign/ahf_gov_haveaheart) is a part of an ambitious ongoing public awareness campaign spearheaded by AIDS Healthcare Foundation (AHF), the operator of the Positive Healthcare program, intended to persuade the Governor and State health officials to halt the forced closure of the respected money-saving AIDS care plan. Without intervention from the Governor or other officials, Positive Healthcare will be forced to cease operating after this Tuesday, March 31st.

"This lifesaving program, which has been serving low-income Californians living with HIV/AIDS for fifteen years, has saved countless lives and saved the state millions of dollars in health care costs-nearly $7.5 million in the past five years alone," said Michael Weinstein, President of AIDS Healthcare Foundation. "Unless Governor Schwarzenegger and state officials act quickly, this program is in danger of ending on March 31st-leaving some of the state's poorest and most vulnerable citizens without proper access to the health care they desperately need."

Since first learning of the threat to Positive Healthcare's existence in mid-December, AHF has been spearheading a multi-pronged campaign to save the AIDS care plan. This public awareness effort has included lobbying visits to state legislators' offices by Positive Healthcare patients and nurse case managers; the filing of a lawsuit in mid-February in the Superior Court of the State of California, County of Los Angeles (case #BS 119149) to legally halt the forced closure of the plan; and an innovative grassroots media and web-based awareness campaign intended to alert the public-at-large to this short-sighted and punitive bureaucratic move by state health officials. Visitors to the webpage can send an e-letter to the Governor asking him to save Positive Healthcare as well as view news stories and general information on the issue. Yesterday, AHF posted a video parody of Governor Schwarzenegger that plays off an image from his film star days as "The Terminator." The 60 second parody will also start airing as a paid TV commercial on select television stations in Sacramento and Los Angeles.

Illinois County Reports Increased Demand For STI Testing

2009-03-30T11:41:00.001-07:00

Health Officials in Kane County, Ill., are reporting an increased demand for sexually transmitted infection tests, and the county likely will have to allocate an additional $55,000 to meet the demand, the Chicago Daily Herald reports. Paul Kuehnert, Kane County Health Department executive director, said that the increase in testing is positive because it helps to address the impact of STIs such as HIV/AIDS, chlamydia, gonorrhea and syphilis. He added that the increased demand and related costs likely will make the county evaluate how it performs STI testing. "Not everybody really needs to be screened medically," Kuehnert said.

The Kane County Board's Public Health Committee was scheduled to vote on increased funding for the Greater Elgin Family Care Center and the Open Door Clinic in Elgin and Aurora to meet the increased demand for STI testing. However, not enough board members attended the vote to legally hold the meeting, and the board is scheduled to consider the issue again on Friday.

Although the number of clients seeking STI tests at the Elgin Family Care Center is almost the same as last year, the Open Door clinics have reported an almost threefold increase in testing demand. According to Kuehnert, the increase might not indicate a dramatic increase in the number of STI cases. However, he added that figures from January and February for certain STIs have increased slightly compared with the same time period last year. Health officials recorded 279 chlamydia cases in January and February, about 60 more than the same time period in 2008. Fifty gonorrhea cases have been reported, an increase of nine compared with last year. STI cases overall have remained flat compared with 2008 figures, according to the Herald (Fuller, Chicago Daily Herald, 3/25).

Stigma, Discrimination Deterring HIV Testing Among Some High-Risk Populations In Indonesia, Foundation Says

2009-03-30T11:40:00.001-07:00

Stigma and discrimination aimed at transgendered people and men who have sex with men in Indonesia are significant factors in deterring the groups from receiving HIV tests, the country's Inter Medika Foundation said Tuesday, the Jakarta Globe reports. Harry Prabowo, director of the foundation, said that members of these high-risk communities should be motivated to seek voluntary counseling and testing, especially those who practice unsafe sex. He added that motivation should come from members of the community, as well as family and friends. VCT is offered at clinics run by the government and nongovernmental organizations, the Globe reports.

The Indonesian government has set aside 21 billion rupiah, or about $1.79 million, in the 2009 budget for National AIDS Commission programs. The government also expects to receive $2.18 million from international donors. Subagio MS, intergovernmental body director at the Ministry of Communication and Information Technology, said that the ministry is collaborating with the media, NGOs, local authorities, communities and religious leaders to increase HIV prevention efforts. He said the ministry is "[p]roviding education and public dialogue" about HIV/AIDS, as well as distributing information to communities. "Awareness of the problem and the willingness to be tested will help change society's attitudes," he said (Osman, Jakarta Globe, 3/24).

Boston Globe Examines Center That Provides Services To Children Living With HIV, Other Conditions

2009-03-28T22:46:00.001-07:00

The Boston Globe on Thursday examined the SPARK Center, which opened in 1988 as a residential program for children living with HIV. The center in 1992 moved from Boston City Hospital to the grounds of the old Boston Chronic Disease Hospital and later switched from residential to day care. It provides educational, medical and mental health services for HIV-positive children, many of whom had lost one or both parents to AIDS-related causes.

According to the Globe, the center a few years ago changed its name to SPARK, which reflected the "medical reality" that fewer infants are contracting HIV. The center now provides services to children with other conditions such as metabolic issues, serious asthma, neurological disorders, diabetes and cerebral palsy. According to the Globe, center employees are seeing a new group of teenagers contracting HIV through sex and drug use. SPARK Director Martha Vibbert said that there can be problems with teenagers adhering to their treatment regimens because there still is a stigma surrounding the virus. "The older kids have fallen off the radar screen because they're no longer babies," she said, adding that many have been with the program since they were children.

The Globe reports that budget cuts related to the economic downturn might force the center next fall to reduce enrollment and hours. Vibbert said that she is determined to keep the program running (English, Boston Globe, 3/26).

Education Sector Faces Severe Impact From HIV/AIDS, Ugandan Official Says

2009-03-28T20:19:00.000-07:00

A senior official at Uganda's Ministry of Education said recently that the impact of HIV/AIDS on the country's education sector would be severe if measures are not taken to address the situation, Uganda's Daily Monitor reports. Yusuf Nsubuga, director for basic and secondary education said, "If the effects of HIV/AIDS are not addressed, know that your brothers, your sisters, your children in school are going to be affected." He said the education sector is "experiencing low morale of the workers because when people get sick and cannot perform as expected," then "the morale of both learners and educators is affected." Nsubuga also said that overwhelming stigma and discrimination against people living with HIV/AIDS indicates an underlying problem in the education sector, although no studies have been done to determine the prevalence of the virus among those in the sector.

Nsubuga's comments were made one week ahead of the launch of the Supporting Public Sector Workplace To Expand Action and Response program, which is funded by the World Vision and USAID. The program is expected to be extended to the ministries of Local Government and Internal Affairs (Kirunda/Mashoo, Daily Monitor, 3/25).

Kenyan Government To Launch Yearlong National HIV/AIDS Strategy

2009-03-27T11:08:00.001-07:00

The Kenyan government will launch a national strategic plan that aims to provide affordable and accessible services to all HIV/AIDS patients, Kenya's Capital News reports. The plan -- which will run from 2009 to 2010 -- is "on course" to meet a July launch deadline, according to Special Programs Minister Naomi Shaaban. "An HIV/AIDS-free society is our vision. The new strategic plan will aim to achieve universal access for quality integrated services," she said.

The new policy will focus on prevention services and will "reduce HIV-related illnesses," Shaaban said. It also aims to provide cost-effective services related to prevention, treatment, care and support. Shaaban said that the plan will include community-based programs to support universal access. National AIDS Control Council Director Alloys Orago said that increased government funding for HIV programs is needed "so that we do not depend so much on donor support." He called on the public to take advantage of voluntary counseling and testing centers, adding that these centers will "ensure that 80% of Kenyans will have known their status, which will be good for planning." He continued, "Those who are positive will be put on treatment and this will reduce the number of orphans," which stands at about 2.4 million (Ndong'a, Capital News, 3/25).

Transfer Of HIV Between T Cells Captured On Video

2009-03-27T08:45:00.000-07:00

A team of researchers at Mount Sinai School of Medicine and the UC Davis Center for Biophotonics Science and Technology have for the first time captured on video the transfer of human immunodeficiency virus (HIV) from infected to uninfected T cells through structures called virological synapses. The breakthrough study, which could lead to new methods to block the transmission of HIV, will be published in the March 27 edition of Science.

"Most prior studies of HIV dissemination have focused on free roaming viruses, but this study shows us how direct T cell-to-T cell contact could in fact be the predominant mode of dissemination within the body," said Dr. Benjamin Chen, Assistant Professor of Medicine, Infectious Diseases, Mount Sinai School of Medicine.

"Direct T cell-to-T cell transfer through virological synapses is a highly efficient avenue of HIV infection. Our recent experiments show that the viral structural protein moves with surprising speed in infected cells and that the cell machinery actively participates in the transport of virus between T cells. This suggests there are many targets for interfering with the process," said Dr. Chen.

In order to make the HIV virus visible to track on video from cell to cell, researchers at Mount Sinai created a molecular clone of infectious HIV that contains green fluorescent jellyfish protein. With the team at UC Davis, they then used quantitative, high-speed 3D video microscopy to record both viral particle formation and transmission of the virus between T cells.

The resulting images and videos show that, once an infected cell adheres to a healthy cell, the HIV proteins which appear bright green in the study migrate within minutes to the contact site. At that point, large packets of virus are simultaneously released by the infected cell and internalized by the recipient cell. This efficient mode of transfer is a distinct pathway from the cell-free infection that has been the focus of most prior HIV studies, and reveals another mechanism by which the virus evades immune responses that can neutralize free virus particles within the body.

"We found that the transfer of HIV is highly coordinated between T cells, and that the transfer is rapid and massive," said Dr. Chen. "Future efforts to block HIV transmission may be designed to specifically exploit and block this cell-to-cell mode of infection."

ImQuest Presentations At Keystone Symposium Focus On Advancements In Their Therapeutic And Microbicide Development Programs

2009-03-26T10:06:00.000-07:00

ImQuest Life Sciences presented their latest biological results supporting the continued development of their small molecule pyrimidinedione inhibitors of HIV-1 at the Prevention of meeting being held in Keystone, Colorado. The presentations highlighted new data supporting the selection of lead second generation therapeutic agents with an increased barrier to the selection of drug resistant virus strains in treated patients, as well as preclinical studies supporting the development of the pyrimidinedione IQP-0528 as a topical microbicide candidate for human clinical trials. The pyrimidinediones are highly potent inhibitors of HIV, exhibiting a dual mechanism of action which includes targeting virus entry and reverse transcription, a highly positive safety profile, and enhanced sensitivity against multi-drug resistant viruses isolated from patients. ImQuest recently submitted an Investigational New Drug Application to the FDA to initiate Phase 1 human clinical trials with the pyrimidinedione IQP-0410.

Robert W. Buckheit, Jr., Ph.D. (Executive Vice President and Chief Scientific Officer) presented the results of studies which demonstrate the ability of various analogs of IQP-0410 to more effectively suppress the replication of viruses which are resistant to the action of other NNRTIs used in the clinic. ImQuest, in collaboration with their drug development partner Samjin Pharmaceutical Co. Ltd of Seoul, Korea, have recently engaged in an effort to develop more active pyrimidinediones possessing this higher genetic barrier to resistance. Karen M. Watson, M.S. (Director, Topical Microbicide Research & Development) reported on results of preclinical efficacy evaluations of a series of pyrimidinediones, resulting in the selection of IQP-0528 as ImQuest's lead compound to prevent the sexual transmission of HIV worldwide. The studies included ImQuest co-authors Tracy Hartman, M.S., Lu Yang, M.D. and Christa E. Buckheit, as well as collaborators Patrick Kiser, Ph.D., Alamelu Mahalingham and Todd Johnson of The University of Utah.

"These results highlight the significant potential of the pyrimidinediones as highly potent therapeutic and preventative agents and provide additional rationale for their expedited development," said Dr. Buckheit. "We appreciate the continued support of these development programs by the National Institutes of Health (NIAID) and the International Partnership for Microbicides, as well as our close partnership with the chemistry team at Samjin."

ImQuest Life Sciences, a privately held U.S. company located in Frederick, Maryland specializes in the preclinical and clinical development of novel compounds for the treatment of infectious disease and cancer. ImQuest BioSciences, also located in Frederick, Maryland, is a leading provider of anti-infective and anti-cancer drug and vaccine development services to the biotechnology and pharmaceutical industry.

Czech Patient Group Calls For Mandatory HIV Testing Among Health Professionals

2009-03-26T10:05:00.000-07:00

The Czech Patients' Association recently called for mandatory HIV testing among all health workers in the country, the CTK/Prague Daily Monitor reports. Both the Czech Health Ministry and the Czech Doctors' Chamber oppose compulsory testing for doctors and other health professionals. President of the Czech Doctors' Chamber, Milan Kubek, said the proposal for mandatory testing is "outrageous," adding, "It is impossible to demand that medical personnel undergo testing on the mandatory basis." Kubek also said that mandatory testing could be discriminatory. Deputy Health Minister Marek Snajdr said the ministry is not planning to implement mandatory testing, citing one of the reasons as the high cost of testing all 200,000 doctors and nurses registered in the country. The proposal comes after an Albanian dentist was detained by the Czech police for violating an order to halt his practice after he was found to be HIV-positive, according to the CTK/Prague Daily Monitor (CTK/Prague Daily Monitor, 3/23).

Health Official Releases HIV, STI Data For Maryland County

2009-03-26T09:52:00.000-07:00

Prince George's County in Maryland has the second-highest rate of reported HIV/AIDS cases statewide, County Health Officer Donald Shell announced on Tuesday, the Washington Post reports. The county also has the second-highest rate of sexually transmitted infections, Shell said, adding that only Baltimore is higher in both categories.

Prince George's County reported 5,240 HIV/AIDS cases in 2007, the most recent year for which data are available, according to Shell. He added that the county's proximity to Washington, D.C. -- which recently reported an HIV/AIDS prevalence of 3% -- has affected Prince George's. "There is no border line," he said, adding, "Our proximity puts us at greater risk." In addition, many county residents do not have access to health care -- about 151,000 do not have health coverage, and about 102,000 are on Medicaid, Shell said.

According to Shell, the county also has seen a "resurgence" in syphilis cases. In 1998, the county reported 6.6 cases per 100,000 people, compared with 11.2 cases per 100,000 people in 2007. Although Shell reported rates for several STIs, the department did not provide data to support the claim that the county has Maryland's second-highest rate overall, the Post reports.

According to Shell, the rates of HIV/AIDS and other STIs in Prince George's County can be attributed in part to a lack of safer-sex practices, particularly during heterosexual intercourse. Shell said that he has been surprised by the response he receives from college students. "They don't care about condom usage or about their partners," he said, adding, "There is a blatant disregard that anything is going to happen to them" (Wiggins, Washington Post, 3/25).

Global HIV-Related TB Deaths Higher Than Previously Thought

2009-03-25T07:10:00.000-07:00

A new report from the World Health Organization shows that while the total number of new TB cases worldwide remained stable in 2007, and the proportion of people becoming ill with TB continued to fall, the proportion of TB deaths that are HIV related is now thought to be 25 per cent, which is twice as many as previously estimated.

The World Health Organization (WHO) 2009 Global TB Control Report was released on 24 March, to coincide with World TB Day and a gathering of 1,500 delegates attending the 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil.

The new report shows that in 2007, there were 1.37 million estimated new TB cases among HIV-infected people and 456,000 deaths worldwide. These figures reflect an improvement in the quality of the data, which is thought to be more representative and available from more countries than ever before.

The report also reveals that one out of every four TB deaths is HIV-related, twice the previous estimate. This is a grave concern not just for for affected individuals but also for public health because HIV speeds up the progress of TB, and drug resistant strains of TB are on the rise.

Dr Margaret Chan, Director-General of WHO said:

"These findings point to an urgent need to find, prevent and treat tuberculosis in people living with HIV and to test for HIV in all patients with TB in order to provide prevention, treatment and care."

"Countries can only do that through stronger collaborative programmes and stronger health systems that address both diseases," she added.

The sudden rise in HIV-related TB is likely to be because there has also been a sharp rise in HIV testing among people receiving treatment for TB. African nations show the sharpest rises; in 2004 only 4 per cent of TB patients in Africa were being tested for HIV, in 2007 that figure went up to 37 per cent, with some countries testing for HIV at rates of over 75 per cent of TB patients.

Once a person whose immune system is wrecked by HIV catches TB, they will most likely die within 6 months, Richard Chaisson, director of the Johns Hopkins Center for Tuberculosis Research, told the Washington Post.

"The problem in Africa is HIV patients are not being diagnosed early enough. They die and they die quickly," said Chaisson.

People with TB can easily be checked for HIV, this only involves taking a saliva test, but it is much harder to check people with HIV for TB, which involves taking a sample of phlegm, and then an X-ray.

Michel Sidibe, Executive Director of UNAIDS, said:

"We have to stop people living with HIV from dying of tuberculosis."

"Universal access to HIV prevention, treatment, care and support must include TB prevention, diagnosis and treatment. When HIV and TB services are combined, they save lives," he added.

The report shows that increased testing for HIV among TB patients has led to more people receiving treatment although much fewer than actually need it. In 2007, 300,000 TB patients with HIV started on treatments: two thirds of them on co-trimoxazole treatment to prevent opportunistic infections, and one third on antiretrovirals.

The report shows that of the 9.27 million estimated new cases of TB in 2007, half of them were in India, China, Indonesia, Nigeria and South Africa, and about 57 per cent of the affected individuals are receiving treatment, which involves taking a mixture of different drugs for about six months.

Fighting TB/HIV co-infection and drug resistant TB is one of the greatest challenges we face, said the report. In 2007, of the 500,000 people estimated to have multidrug resistant TB (MDR-TB), less than 1 per cent of them were on treatments that were in line with WHO standards.

Meeting 2009 milestones in the current financial climate is another challenge, and the report mentions increasing concerns about shortage of funds.

To meet the Stop TB Partnership's Global Plan to Stop TB, the funding shortfall from the 94 countries that carry 93 per cent of the world's TB burden has gone up to around 1.5 billion US dollars.

The Global Plan aims to cut TB cases and deaths to half the 1990 level by 2015: but this will only happen with full funding, warns the report.

Dr Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said:

"We have made remarkable progress against both TB and HIV in the last few years."

"But, TB still kills more people with HIV than any other disease," he added, warning that "the financial crisis must not derail the implementation of the Global Plan to Stop TB."

"Now is the time to scale-up financing for effective interventions for the prevention, treatment and care of TB worldwide," urged Kazatchkine.

There is another gathering in Beijing next week to address funding, when health ministers and leaders attend a meeting held by WHO, the Ministry of Health of the People's Republic of China and the Bill & Melinda Gates Foundation.

Study Shows High Rates Of Treatment Interruption For HIV Infected Inmates Released From USA's Largest Prison System

2009-03-24T10:48:00.002-07:00

A study supported by the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health, shows high rates of treatment interruption for HIV infected inmates being released from the Texas state prison system, leaving them at heightened risk for poorer health outcomes and an increased risk of transmission of the virus to others. The study was published in the Journal of the American Medical Association on February 25th, 2009.

The study, led by researchers at the University of Texas, followed all 2115 HIV infected inmates who left the Texas State Department of Criminal Justice prison system between January 2004 and December 2007 and were receiving antiretroviral therapy (ART) at the time of their release. Researchers found that only 5% of these inmates filled a prescription for their ART medication soon enough to avoid a treatment interruption; only 18% filled a prescription within 30 days of their release; and only 30% did so within 60 days.

Research shows that even a small number of ART interruptions can lead to more devastating health outcomes, including an increased risk of premature death and HIV opportunistic infections, such as tuberculosis and Hepatitis C. Treatment interruption in combination with resumption of high risk-behaviors may also increase risk for creating reservoirs of drug resistant HIV in the general community. Moreover, because higher viral load predicts greater infectiousness, those who discontinue ART may be more likely to infect their sexual contacts.

Approximately half of all prisoners in the U.S. have substance abuse problems which contribute to HIV risk behaviors. HIV infected inmates leaving prison face immediate social and economic challenges as well as obstacles to good health care. As a result, the state of Texas has made efforts to encourage these inmates to continue treatment. Upon release, HIV infected inmates are given a ten day supply of the ART medications with instructions on how to fill out the necessary forms to receive additional medication at a minimal or no cost from state-supported programs, as well as a copy of their most recent lab work and a list of clinicians in their area that provide HIV care.

About half of the inmates across 110 prison sites (55%) were also given more formal counseling about how to continue to receive treatment. The study showed that inmates who received the more structured assistance were more likely to refill their prescriptions. In addition, researchers found that inmates released on parole requiring periodic contact with the system were more likely to fill their prescriptions than were those with a standard, unsupervised release. Researchers note that similar support strategies could have broad public health applications across U.S. criminal justice systems.

U.S., South African Scientists Launch $60M HIV/TB Research Initiative

2009-03-24T10:48:00.001-07:00

Scientists from the U.S. Howard Hughes Medical Institute and South Africa's University of KwaZulu Natal on Wednesday announced the launch of a $60 million, 10-year initiative to establish a new research facility to examine the associations between HIV and tuberculosis, the Boston Globe reports. According to the Globe, HHMI will finance the project. About $20 million of the funding will be directed toward establishing a research institute on the Durban campus of UKZN's Nelson Mandela Medical School, which will include two floors of high-level biosafety laboratories. The center will use the additional $40 million for research, training and related programs over a 10-year period (Smith, Boston Globe, 3/20). Thomas Cech, HHMI president, said the partnership "reflects a shared view that direct and substantial investment in basic, clinical and translational research in the heart of the pandemics of HIV and TB will yield significant discoveries that will alleviate the human suffering caused by these diseases." According to South Africa's Business Day, HHMI and UKZN have formed a recruitment committee to jointly appoint a permanent director for the center (Blaine, Business Day, 3/20).

According to the Globe, scientists involved with the project will study the increasing incidence of HIV/TB coinfection and examine outbreaks of extensively drug-resistant TB among HIV-positive people. Salim Abdool Karim, director of the Center for the AIDS Program of Research in South Africa, said the researchers also will study the causes of recurrent TB and the spread of TB among HIV-positive people in health center waiting rooms. In addition, the scientists will study the challenges of diagnosing TB among HIV-positive people and analyze genetic factors that could contribute to drug resistance. Researchers also will study HIV immunology and examine the role HIV plays in the development of aggressive TB. According to the Globe, the project also aims to integrate patient treatment at three hospitals in the province and provide training for researchers and clinical staff (Boston Globe, 3/20).

Bruce Walker, infectious disease specialist and director of the Ragon Institute said, "One of the most exciting parts of this whole project is the ability to conduct research at the heart of these two epidemics." He added that the HIV/TB research will "really be focused on the local problems that need to be solved." Thumbi Ndung'u, associate professor at UKZN, added that the institute will provide a "tremendous opportunity" for African researchers (De Capua, VOA News, 3/19). According to Ndung'u, the new center "will make it possible for African scientists to be trained on the African continent, to engage with the communities, which is key to beating the HIV and TB epidemics" (AFP/Google.com, 3/19). Walker said the institute also aims to integrate HIV and TB services "both at the clinical level and at the research level, so that we have under the same roof people that are trying to deal with this co-epidemic." He added that although the research primarily will focus on HIV and TB, it could have "wide-ranging implications" for improving other aspects of public health in South Africa (VOA News, 3/19).

Christian Science Monitor Examines Effect Of Economy On U.S. Foreign Aid Targets

2009-03-24T10:47:00.001-07:00

The Christian Science Monitor on Monday examined how the Obama administration is "hinting that the economic downturn means the president is unlikely to reach his goal of doubling foreign aid by the end of his four-year term." Doubling foreign aid to $50 billion annually by 2012 and a pledge to reform the way the U.S. works with the rest of the world were key elements of Obama's presidential campaign, the Monitor reports. The situation is raising concerns about the possible effects on development and global health efforts, as well as the perception of the U.S. oversees, according to the Monitor. The U.S. in recent years has increased funding for efforts to address HIV/AIDS, tuberculosis, malaria and other diseases, but some "worry that the upward trend may now be reversed," the Monitor reports.

Some development experts point out that President Obama's fiscal year 2010 budget includes an almost 10% increase in foreign aid. However, the White House Office of Management and Budget has been discussing "extending out" the target of doubling foreign aid, likely into what some hope will be Obama's second term. Steve Radelet of the Center for Global Development said that although the development community reacted "pretty positively" to Obama's budget, there is "still a wait-and-see attitude."

In addition, some in the development community have said that the current economic crisis is the time to reform the U.S. foreign aid system to make it more current and efficient. However, "questions remain about whether Congress will go for what the president is proposing and where any additional money will be spent," according to the Monitor.

Congress recently approved $900 million for the Global Fund To Fight AIDS, Tuberculosis and Malaria -- the highest annual U.S. contribution since the Global Fund launched. Global Fund officials still say that they plan to monitor the 2010 U.S. contribution for any signals about donations. "We are all aware of the severity of the global economic crisis and the strain it is putting on budgets and economies," Christoph Benn of the Global Fund said. He added that he remains hopeful because when Obama, Vice President Biden and Secretary of State Hillary Rodham Clinton were senators, they all signed letters supporting increases to the Global Fund (LaFranchi, Christian Science Monitor, 3/23).

Kansas House Committee Approves Bill That Would Require HIV Testing Among Pregnant Women

2009-03-24T10:46:00.000-07:00

The Kansas House Committee on Health and Human Services last week approved a bill (S.B. 147) that would require doctors to test pregnant women and some infants for HIV, the Kansas Health Institute News reports. Committee chair Rep. Brenda Landwehr (R) said that there were "some questions" about the bill "raised early on, but they've been answered." Landwehr previously asked for clarification about whether the bill could lead to HIV-positive infants being denied health insurance because of a "pre-existing condition." Supporters of the bill, including the Kansas Department of Health and Environment, told committee members that the benefits of preventing mother-to-child HIV transmission outweighed concerns about health insurance. The bill passed in the Senate earlier this month and now goes to the full House for consideration (Ranney, Kansas Health Institute News, 3/19).

According to the Kansas Health Institute News, the bill would require that doctors test women in the first trimester of pregnancy for HIV, with those testing negative but at a high-risk for HIV being tested again in the third trimester. The bill also would allow pregnant women to opt out of testing. In addition, infants born to women who have not been tested or who are unaware of their HIV status would be tested under the bill. According to KDHE data, about 4,400 pregnant women in the state do not receive HIV tests each year. William Lyons, director of the HIV/AIDS program within KDHE's Division of Disease Control and Prevention, told the committee that 89% of pregnant women are being tested for HIV in Kansas, meaning that 11% are not. He noted that the cost of a course of medication to prevent MTCT costs "about $17," while the cost of caring for an HIV-positive child often exceeds $250,000 (Ranney, Kansas Health Institute News, 3/18).

New Zealand Reports Record Number Of HIV Diagnoses

2009-03-24T10:44:00.000-07:00

New Zealand reported 184 HIV diagnoses last year, the highest on record, according to recently released statistics from University of Otago's AIDS Epidemiology Group, the NZPA/New Zealand Herald reports. The previous record high was 183 diagnoses in 2005. According to the epidemiology group, 152 people contracted the virus through sexual contact, including 91 men who have sex with men, and 39 men and 22 women who were exposed through heterosexual contact. Two cases involved injection drug use, and another two cases involved blood transfusions that occurred overseas. According to the statistics, four infants contracted HIV through mother-to-child transmission. In addition, the statistics indicate that 43 people received AIDS diagnoses. According to the report, safer-sex practices, HIV testing, and the prevention and treatment of other sexually transmitted infections should be emphasized to reduce the spread of HIV. In addition, it said that prevention efforts should focus on minority groups (NZPA/New Zealand Herald, 3/20).

Houston Chronicle Examines Local Church's Efforts To Increase HIV Testing

2009-03-23T10:16:00.000-07:00

The Houston Chronicle on Wednesday examined efforts by pastors at the predominantly black St. John's Church in Houston to encourage people to receive HIV tests. St. John's offers HIV testing, among other services, through the non-for-profit Bread of Life. Amber David, a counselor at the church, serves as an advocate for testing, urging congregants to be screened during monthly "Get Tested" Sundays. St. John's Pastor, Rudy Rasmus, began an HIV campaign among congregants 15 years ago, after "too many funeral service requests for young people who died" from AIDS-related causes, he said.

Rasmus says the church serves as an effective forum for reaching the black community because it is historically the center of the community. According to Houston health department data, blacks account for more than half of all new HIV cases in Harris County, and black teenagers represent most new cases among all adolescents. St. Johns' Bread of Life tested 700 people in 2008 (George, Houston Chronicle, 3/18).

Report On HIV/AIDS In Washington, D.C., Raising Concerns Among Health Officials In South Carolina

2009-03-23T07:31:00.000-07:00

A recent report finding that HIV/AIDS prevalence in Washington, D.C., has reached 3% is "raising alarm bells" in South Carolina's Lowcountry region, the Charleston Post and Courier reports. Although South Carolina's prevalence has not reached the same level as the district's, it is "still one of the riskiest states in the nation for unprotected sex," according to the Post and Courier. "We've made a lot of progress, but we can't be complacent," Tony Price, the HIV prevention program manager at the Department of Health and Environmental Control, said. Virginia King, director of Lowcountry AIDS Services, said that the district report should serve as a warning for South Carolina. "It could become more of a problem here if people don't start to pay attention to what they do," she said.

According to the Post and Courier, blacks are at an increased risk of contracting HIV/AIDS. In South Carolina, blacks comprise 29% of the population but account for 73% of HIV cases, according to the health department. The health department also reports that men who have sex with men, particularly black MSM, are at an increased risk, as well as injection drug users and women, who are increasingly affected through heterosexual intercourse. According to the health department, the percentage of HIV-positive blacks in South Carolina has decreased over the past 10 years, which health workers attribute to increased HIV/AIDS education and testing efforts (Munday, Charleston Post and Courier, 3/18).

Education Slowing AIDS In Sub-Saharan Africa

2009-03-23T06:19:00.000-07:00

Increased schooling across sub-Saharan Africa may be lowering new HIV infections among younger adults, according to sociologists, suggesting a shift in a decades-long trend where formal education is considered an AIDS risk factor.

While education in general has a positive impact on global public health, when it comes to HIV and AIDS in sub-Saharan Africa, education has had a completely opposite effect.

During the early stages of the HIV pandemic in the region, the disease passed unnoticed amidst the onslaught of other infections. When scientists took a closer look at the deadly new disease, they found that more often males with a higher than average education were contracting the disease.

"Before the 1990s, in the impoverished regions of sub-Saharan Africa, even modest amounts of education afforded males higher income, more leisure time, and, for some males, greater access to commercial sex workers," explained David Baker, professor of education and sociology at Penn State and lead author of the study. "HIV-infected higher-status males then spread the infection to both educated and uneducated women, which moved the disease into the general population."

Baker and his Penn State colleagues John Collins and Juan Leon, both graduate students, believe that information about AIDS that was already percolating in wealthier countries did not get to sub-Saharan Africa until the mid 1990s. AIDS was seen as a homosexual, urban disease and either neglect or active misinformation campaigns in some African countries ensured that the preventative effects of education never took root. But among younger people in the region, formal education is emerging as a major preventative factor against new infections. They report their findings in the current issue of the UNESCO journal Prospects.

"There needs to be a very clear message, both to the donor community and to governments in sub-Saharan Africa, that expanding quality primary schools has to be a topmost priority," said Collins, co-author of the study. "It will not only have economic benefits, but also health benefits."

To find what has happened recently to the link between formal education and HIV infections, the researchers analyzed data from surveys previously undertaken in 11 countries across the region between 2003 and 2005. They specifically looked at males ages 15 to 24, 25 to 34, and older than 35.

Survey participants were tested for HIV infection and interviewed about their education, social status, and sexual behavior.

The researchers argued that because the youngest members of the oldest group -- the 35 and older -- became sexually mature in the late 1980s, when there was little or no information about AIDS, higher education would show as a risk factor instead of a social vaccine.

Statistical analyses of the data suggest that in all 11 countries formal education had no effect on HIV infections in the oldest group, probably because many older adults, educated and uneducated have already been exposed to the virus and many have died. However, having some schooling did reduce the risk of HIV infections in the youngest group by up to 34 percent in Guinea, Malawi, Senegal, Cameroon, Ghana, and Kenya.

"At 24 years, the oldest member of this young group reached sexual maturity in the mid 1990s, when there was already widespread knowledge that HIV and AIDS could be contracted through unprotected sex and intravenous drug use," explained Baker.

The researchers hypothesize that, reasoning skills gained in school by younger adults play a preventative role against HIV in sub-Saharan Africa.

"More educated people have the cognitive tools to make better sense out of facts presented to them," explained Baker. "We have shown that when there is sufficient information, and no misinformation, people with education adopt healthy strategies to avoid infections."

The Penn State researchers caution that while a large number of deaths in the early stages of the HIV pandemic could mask the true effects of education in the oldest group, the findings hold key policy implications for turning education into a social vaccine against HIV in sub-Saharan Africa.

According to Baker, AIDS is a complicated disease and it can only be tackled effectively by providing people with an everyday, accurate working theory of how the disease is transmitted. "We are telling the governments that increased literacy is an explicit prevention strategy against HIV because it will help stop pandemics," he said.

The Penn State researcher also asks non-governmental organizations to reevaluate their educational programs.

"The kind of information being supplied by NGOs is scandalous because it is so simplistic and minimalist, particularly for low-educated people, that they are not going to figure this disease out in time to prevent their own infection," Baker added.

Genomic 'fossils' In Lemurs Shed Light On The Origin And Evolution Of HIV And Other Primate Lentiviruses

2009-03-22T09:54:00.000-07:00

A retrovirus related to HIV became stably integrated into the genome of several lemurs around 4.2 million years ago, according to research led by Dr. Cédric Feschotte at the University of Texas, Arlington. Published March 20 in the open-access journal PLoS Genetics, the analysis of prosimian immunodeficiency virus (pSIV) offers new insights into the evolution of lentiviruses.

During replication, retroviruses integrate within the chromosomes of their host cells. If germ cells are infected, the integrated viral DNA can be transmitted from parent to offspring and may eventually become assimilated as part of the genetic material of the host species. This 'endogenization' process has occurred repeatedly during evolution, and has involved diverse retroviruses, giving rise to a sizeable portion of the genome of many vertebrate species - for example, ~8% of the human genome. Until now, the process was believed to be extremely rare for lentiviruses, an evolutionarily elusive group of retroviruses that infect diverse mammals, including humans (in the form of human immunodeficiency virus ).

Based on 'fossil' sequences collected from different lemur species, the researchers computationally reconstructed an apparently intact and complete DNA sequence for the ancestral prosimian lentivirus. The discovery that two different species of lemurs endemic to Madagascar suffered, independently and quasi-simultaneously, multiple germline infections of pSIV provides evidence that lentiviruses have repeatedly infiltrated the germline of prosimian species.

These findings should allow future functional analysis of the extinct virus and advance our understanding of the biology of lentiviruses, including HIV. In addition, the characterization of this ancient lentivirus in lemurs raises the possibility that HIV-like retroviruses are still circulating today in the mammalian fauna of Madagascar.

Officials Launch HIV Testing Campaign In Washington, D.C.

2009-03-20T23:35:00.000-07:00

Mayor Adrian Fenty and top health officials in Washington, D.C., on Monday announced a new initiative aimed at increasing HIV testing in the city, the Washington Post reports. The testing campaign follows a report that found an HIV/AIDS prevalence of 3% in the district.

According to Shannon Hader, director of the city's HIV/AIDS Administration, the report marks the start of a new effort to address the disease in the district, the Post reports. "I am very hopeful, because I really believe that our citizens and our neighbors can take this information and use it to protect their lives."

Cornell Jones, executive director of the community development group Miracle Hands, said that the district is not adequately helping people who work with ex-offenders, a group with one of the highest HIV/AIDS burdens. "Right now, the agencies in the forefront of this battle are being attacked with a lack of funding," Jones said. According to the Post, Miracle Hands runs an HIV/AIDS prevention program within the D.C. Department of Corrections. HIV/AIDS Administration spokesperson Michael Kharfen said that the agency plans to hire someone to address issues among prisoners and parolees.

According to Miracle Hands Deputy Director Danette Williams, one of the group's most urgent needs is housing for HIV-positive people. "We have a revolving door," she said adding, "They go from emergency housing to supportive housing, and then they are back on the streets because services are fragmented. There is not enough continuity" (Harris, Washington Post, 3/19).

Vietnam To Include Input From HIV-Positive People For New Prevention Project

2009-03-20T23:34:00.000-07:00

An institute in Vietnam is formulating a new HIV/AIDS prevention project that will include input from people living with the disease, the Vietnamese News Agency reports. The project will implement an approach based on human rights, gender equality and the participation of multiple sectors, according to the Vietnamese News Agency.

The National Ho Chi Minh Politics-Administration Institute partnered with the Vietnam Health Policy Initiative and Community Health College of Boston to organize a workshop that included training sessions on HIV/AIDS prevention and capacity building for provincial and city leaders. Organizers hope that the workshop will influence policymakers and HIV/AIDS program developers in the country and improve implementation. In addition, the institute held an open forum for people living with HIV/AIDS to share information and experiences with each other and the community. Meanwhile, a project funded by the Ford Foundation recently launched a Web site dedicated to prevention and communication among people living with HIV/AIDS and their involvement in programs to address the disease (Vietnamese News Agency, 3/17).

Reproductive Health Group In Cambodia Reports Increase In HIV Testing Among Women

2009-03-20T23:23:00.000-07:00

A report released on Monday by the Reproductive Health Association of Cambodia found that 40,587 women in the country underwent HIV tests in 2008 -- up from 38,660 who were tested in 2007 -- the Phnom Penh Post reports. Blood tests are offered at no-cost at state and referral hospitals across Cambodia, the Post reports. RHAC said the increase in testing was in part because of an increase in reproductive health awareness campaigns.

Mean Chivoan -- director of the National Centre for HIV and AIDS, Dermatology and STD -- said that the government has distributed information about HIV/AIDS tests since 2001, giving information to community groups and garment factories. He said that the government will continue to promote tests among women -- particularly pregnant women -- because it believes such efforts are "important." Cheat Khemara, senior labor official at the Garment Manufacturers Association of Cambodia, said the increase in testing among women is a reflection of a partnership between community groups and garment factories -- where about 300,000 Cambodian women are employed. He called on "all factories to help provide health facilities and services" at no-cost to employees and to "provide care to employees who have HIV/AIDS so that they have the mental strength to continue their work." Chea Mony, president of the Free Trade Union of Cambodia, reported that most garment factory workers are required to have a health check at the Labor Health Centre. He added, "Usually, women who work for factories do not understand the importance of having blood tests. They only go if they are helped or guided by NGO workers."

Chak Chenda, clinic manager at RHAC, said that the group is planning to publish a "guide book and leaflets on reproductive health to be distributed in communities and also organize a peer group education program" to bring trained volunteers to discuss reproductive health in communities (Leakhana, Phnom Penh Post, 3/18).

Waking Up Dormant HIV

2009-03-18T08:34:00.000-07:00

HAART (highly active anti-retroviral therapy) has emerged as an extremely effective HIV treatment that keeps virus levels almost undetectable; however, HAART can never truly eradicate the virus as some HIV always remains dormant in cells. But, a chemical called suberoylanilide hydroxamic acid (SAHA), recently approved as a leukemia drug, has now been shown to 'turn on' latent HIV, making it an attractive candidate to weed out the hidden virus that HAART misses.

Matija Peterlin at UCSF and colleagues had previously identified another chemical called HMBA that could activate latent HIV, but the risk of several toxic side effects made HMBA clinically non-viable. However, the chemically similar SAHA had received FDA approval, making it a potentially safer alternate.

So, the researchers examined whether SAHA had any effect on HIV latency. They found that SAHA could indeed stimulate latent HIV to begin replicating, which exposes the infected cell to HAART drugs. SAHA could activate HIV in both laboratory cells as well as from blood samples taken from HIV patients on antiretroviral therapy. Importantly, this successful activation was achieved using clinical doses of SAHA, suggesting toxicity will not be a problem.

HIV/AIDS In US Capital Exceeds UN Epidemic Threshold

2009-03-18T08:32:00.000-07:00

The health department of the government of Washington DC, the capital city of the United States, has issued a report that says 3 per cent of its residents over the age of 12 are infected with HIV/AIDS, a figure that most likely places DC above the threshold that the United Nations defines as an epidemic (1 per cent of the whole population of a specific geographic area).

The report, titled "District of Columbia HIV/AIDS Epidemiology Update 2008", is an update to the 2007 annual report on HIV/AIDS; before that there hadn't been one for over five years. The 2007 report was the first to publish statistics on HIV and described the District of Columbia (the formal way to refer to Washington, DC) as being in the middle of a "modern HIV/AIDS epidemic", modern because of its size and complexity.

The 2008 Update, released earlier this month but dated February 2009, reaffirms the depth and diversity of the epidemic and gives a snapshot of how severely it is affecting the people of DC, according to its preface. It is also the first report to cover the behaviour of heterosexual DC residents.

The report suggests that black men and people aged between 40 and 49 are the ones most affected by the HIV/AIDS epidemic in DC.

Among its major findings, the Update reports that studies of behaviour show that between one third and one half of residents may be unaware of their infection, and this suggests that the true infection rate is most likely to be higher than the 3 per cent of over-12s given in the official figures which are based on diagnosed and reported cases.

Across age groups, the current infection rates given in the report break down as follows:

0.1 per cent of 13 to 19 year olds.
1.1 per cent of 20 - 29 year olds.
3.4 per cent of 30 - 39 year olds.
7.2 per cent of 40 - 49 year olds.
5.2 per cent of 50 - 59 year olds.
1.3 per cent of those aged 60 and over.

Broken down by race and sex, the infection rate of HIV/AIDS in DC is:

0.2 per cent of white females.
0.7 per cent of Hispanic females.
2.6 per cent of black females.
2.6 per cent of white males.
3.0 per cent of Hispanic males.
6.5 per cent of black males.

As with all reports of this type, these figures are based on diagnosed reported cases compared to census data on the numbers of people in the various groups of the population. They do not take account for example, of whether some groups of a population are more likely to report symptoms and undergo diagnosis than others.

On a geographic basis, the report found high rates of HIV in nearly every neighbourhood of DC, and suggests that the reported figures are actually an understimate since 20 per cent of the cases reported don't have sufficient information to attribute to a specific ward.

The report does not give figures for what it describes as vulnerable groups, such as heterosexuals living in areas of high HIV/AIDS infection and high poverty, or men who have sex with men, or injected drug users. It mentions plans to have these in the next issue once smaller studies targeted at these specific groups are complete.

The Whitman-Walker clinic is one of Washington's biggest HIV centers. Their chief medical officer told the BBC that he thinks the real figure is much higher than the 3 per cent given in the report.

"When they've tested large groups of the District population it looks like the prevalence is actually about 5 per cent," said Dr Raymond Martins.

Martins said the apparent recent increase in these figures could be because Washington has a new director responsible for HIV/AIDS administration, and this has led to a "large push" in getting people tested and they are discovering a lot of people that didn't know they were infected.

Washington DC Mayor Adrian Fenty wrote in a letter at the front of the report that the city's government is following a three point plan to tackle the HIV/AIDS epidemic: Promote, Prevent, Protect. This includes increasing publicly supported testing, providing free condoms and needle exchanges to stem the spread, taking better care of the people who are already infected and reducing the number of babies born with HIV.

Antibodies Present In Long-Term HIV Survivors Could Contribute To Vaccine Development, Study Says

2009-03-18T08:31:00.001-07:00

HIV-positive people who do not develop AIDS and do not require antiretroviral medication could provide insight for new strategies in vaccine development, according to a study published Sunday in the journal Nature, London's Independent reports. Michel Nussenzweig -- head of Rockefeller University's Laboratory of Molecular Immunology and author of the study -- said his research aimed to harness natural mechanisms to target HIV rather than use synthetically produced antibodies, some of which have failed in earlier HIV vaccine trials.

For the study, Rockefeller University researchers examined antibodies present in the blood of six long-term HIV survivors who appeared to have a degree of natural immunity to the virus (Connor, Independent, 3/16). The researchers isolated 433 antibodies from the patients, all of which targeted HIV's protective outer coating, or "envelope." The researchers then cloned the antibodies and observed which elements of the envelope each antibody targeted and how effectively it neutralized HIV. During the research, Johannes Scheid, a doctoral student at Rockefeller University, identified a new structure on the HIV envelope that scientists previously had not recognized as an antibody target. Although the researchers determined that each antibody individually had a weak effect on HIV, they also found that the antibodies as a group effectively targeted the virus (PA/Google.com, 3/15). In addition, the researchers determined that a prototype vaccine developed from several of the antibodies can prevent the growth of HIV in human cells in a test tube.

Nussenzweig said the study identified "many different antibodies that individually have limited neutralizing ability but together are quite powerful." According to Nussenzweig, only about one in every 1,000 HIV-positive people produces the neutralizing antibodies. He said the research attempts a new approach to HIV vaccine development by "copying what exists in nature and that we know can work because of the long-term survivors." He added, "Instead of inventing something that doesn't exist, it's trying to copy something that does exist." Nussenzweig said the study's results "should make people think about what an effective vaccine should look like." According to the Independent, the researchers next plan to conduct further trials of vaccine candidates on laboratory animals and human volunteers.

The Independent also profiled Kai Brothers, a San Francisco man who has been living with HIV for 28 years without developing AIDS or requiring antiretroviral medications. The Independent reports that Brothers, who did not participate in the new study, might be one of "a few -- perhaps as few as one in 5,000" -- HIV-positive people who have natural immunity to the virus. Brothers said he has participated in HIV research for 10 years, adding, "I feel dedicated to giving back something because of my good fortune" (Independent, 3/16).

Hair Samples Can Be Used To Measure Effectiveness Of Antiretrovirals, Researchers Say

2009-03-18T08:29:00.000-07:00

Hair strands might help determine the effectiveness of antiretroviral drugs for HIV-positive people, researchers from the University of California-San Francisco said recently, VOA News reports. Monica Gandhi of the university and colleagues have found that antiretroviral levels in hair samples strongly correlate with HIV levels in patients. They also found that the hair samples can indicate which medications are being used well and which are not, as well as if patients are taking adequate doses. According to VOA News, because hair grows at a specific rate -- about one centimeter monthly -- these tests can provide an average reading of how well drug therapy is working. "We collect a small sample of hair from the back of their head, and by small I mean 10 to 15 strands," Gandhi said, adding, "So we collect after about a month of therapy a small thatch of hair from the back of your head and then grind it up and measure the antiretroviral [levels] in that hair. And that gives us an idea after you start a new regimen whether you have enough in your system."

According to Gandhi, asking patients themselves for information about their drug regiments can have inherent issues. "We often ask the patient what is their adherence to their medication," she said, adding that physicians ask, "How much are they taking of their medication when we're trying to predict why they're not doing well. And self-reported adherence has its own set of limitations. There's, you know, bias in how people present their level of adherence and there's literally just memory problems in people not remembering how much they're taking." In addition, blood samples to test antiretroviral levels can present problems, according to Gandhi. "The problem there was everyone's blood levels of drugs varies day by day," she said, adding, "So depending on what I ate for breakfast that morning or if I smoked that morning or if I took another medication that interfered, the levels are sort of going to be up and down every day."

Although some hairs are useful for testing, others are not, according to Gandhi. "We have tested it on all types of hair, African hair," she said, adding, "We actually have some projects in Uganda with African hair. It works on fine hair. It works on gray hair. One thing is that people ask can we use pubic hair for these measurements. And we don't' think that those are going to be useful because hair in those areas grow to a certain length and then they stop. ... But you really want to measure hair that's sort of growing continuously and that's really scalp hair."

VOA News reports that the test has been called easy, painless, bloodless and free of biohazards. Although hair clipping can be conducted in rural areas in developing countries, a costly machine at a central laboratory still is needed for analysis (DeCapua, VOA News, 3/13).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

The Spread Of HIV/AIDS Denials And Misinformation Examined In New Book

2009-03-18T08:04:00.000-07:00

Since the discovery of HIV and the ensuing AIDS epidemic, a frightening group of people has spread destructive misinformation - and outright denials - about the virus. Seth Kalichman, editor of the journal AIDS and Behavior, debunks these dangerous myths in the new book Denying AIDS, published by Springer. Denying AIDS captures the contradictions inherent in AIDS denialism and exposes the scientific and sociopolitical forces involved in AIDS denial.

Kalichman writes about the organized, extensive forms of denial, the junk science, faulty logic, conspiracy theories, and larger forces of homophobia and racism that fuel this misinformation and pose a real threat to understanding AIDS. Denying AIDS traces the origins of AIDS denialists from the early days of the outbreak and examines the psychology and politics of the current denial movement. Topics covered include:

Why AIDS denialism endures, and why science must understand it.
Pioneer virus researcher Peter Duesberg's role in AIDS denialism.
Flawed immunological, virological, and pharmacological pseudoscience studies that are central to texts of denialism.
The social conservative agenda and the politics of AIDS denial, from the courts to the White House.
The impact of HIV misinformation on public health in South Africa.
Fighting fiction with reality: anti-denialism and the scientific community.

Kalichman has dedicated his research to preventing the spread of HIV/AIDS and caring for those affected by the HIV epidemic. His research has focused on the southern United States and South Africa. His work has been continuously and exclusively funded by the National Institutes of Health since 1992. He was previously on the faculties of Loyola University of Chicago, Georgia State University, and the Medical College of Wisconsin where he worked under the direction of Jeffrey A. Kelly to help establish the Center for AIDS Intervention Research (CAIR). He is currently the director of the Southeast HIV and AIDS Research and Evaluation (SHARE) Project, a research program within the AIDS Survival Project in Atlanta, Georgia. Professor Kalichman serves on NIH grant review panels, has over 200 peer-reviewed journal articles, and has authored and edited five books in the area of HIV/AIDS prevention and care services, including Positive Prevention, published by Springer. He is also the current editor of the bimonthly journal AIDS and Behavior. Professor Kalichman was the recipient of the 1997 Early Career Award in Health Psychology from the American Psychological Association and the 2005 Distinguished Scientist Award from the Society for Behavioral Medicine.

New Technology Opens Gateway To Studying HIV-specific Neutralizing Antibodies

2009-03-17T09:09:00.001-07:00

Many scientists believe a vaccine that prevents HIV infection will need to stimulate the body to make neutralizing antibodies, infection-fighting proteins that prevent HIV from entering immune cells. Previous research has shown that some individuals who control HIV infection without medication naturally produce antibodies able to neutralize diverse strains of HIV. Until now, however, scientists were hampered in studying the way effective HIV-neutralizing antibodies arise during natural HIV infection because scientists lacked the tools to obtain more than a few HIV-specific antibodies from any given individual.

A new research endeavor has assembled a group of state-of-the-art techniques for the first time to study the phenomenon of natural antibody-mediated HIV neutralization. The project demonstrates how this system can isolate dozens of HIV-specific antibodies from a single HIV-infected individual, something never accomplished before. Applied prospectively to a large group of HIV-infected individuals, the system will enable scientists to identify and define the diverse set of neutralizing antibodies that arise during natural HIV infection, information that may prove important in vaccine development.

John R. Mascola, M.D., Richard T. Wyatt, Ph.D., and Mark Connors, M.D., all of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, participated in the research, which NIAID co-funded. Michel C. Nussenzweig, M.D., Ph.D., of The Rockefeller University led the team of 22 co-investigators in this collaboration.

The process begins with collecting memory B cells, which produce antibodies, from HIV-infected individuals previously screened for strong neutralizing antibody responses. These B cells are incubated with a specially flagged protein from the outer shell of an HIV virus particle. The HIV-specific memory B cells bind to the flagged protein, enabling researchers to identify these cells, isolate and store them. Then, for each of the HIV-specific memory B cells, a pioneering technique expresses the genes that code for HIV-specific antibodies. Finally, assays help scientists determine which of these antibodies can effectively neutralize HIV.

Research Suggests Scientists Should Follow The Body's Lead To Prevent HIV From Taking Root

2009-03-17T09:08:00.001-07:00

For 25 years, researchers have tried and failed to develop an HIV vaccine, primarily by focusing on a small number of engineered "super antibodies" to fend off the virus before it takes hold. So far, these magic bullet antibodies have proved impossible to produce in people. Now, in research published March 15 online by Nature, scientists at The Rockefeller University have laid out a new approach. They have identified a diverse team of antibodies in "slow-progressing" HIV patients whose coordinated pack hunting knocks down the virus just as well as their super-antibody cousins fighting solo.

By showcasing the dynamic, natural immune response in these exceptional patients, the research, led by Michel C. Nussenzweig, Sherman Fairchild Professor and head of the Laboratory of Molecular Immunology, suggests that an effective HIV vaccine may come from a shotgun approach using of a wide range of natural antibodies rather than an engineered magic bullet.

"We wanted to try something different, so we tried to reproduce what's in the patient. And what's in the patient is many different antibodies that individually have limited neutralizing abilities but together are quite powerful," says Nussenzweig, who also is a Howard Hughes Medical Institute investigator. "This should make people think about what an effective vaccine should look like."

HIV strains mutate rapidly, making them especially wily adversaries of the immune system. But one element is shared almost universally among the diverging strains - a protein on the envelope of the virus called gp140 that HIV needs to infect immune cells. Prior research has shown that four randomly engineered antibodies that block the activity of that protein prevent the virus from infecting immune cells in culture, but all attempts to coax the human body into producing those four have failed.

So Johannes Scheid, a visiting student in Nussenzweig's lab who is now a doctoral candidate, turned his attention to the antibodies produced by six people infected with HIV whose immune systems put up an exceptionally strong fight. The patients represent the roughly 10 to 20 percent of HIV patients who are able to control the virus and are very slow to progress to disease. Their immune systems' memory B cells produce high levels of antivirus antibodies, but until now, researchers have known little about the antibodies or how effective they are.

With help from Rockefeller's Center for Clinical and Translational Science and Rockefeller scientists David D. Ho and Jeffrey V. Ravetch, Scheid and colleagues isolated 433 antibodies from these individuals' blood serum that specifically targeted the envelope protein - the chink in HIV's protean armor. He cloned the antibodies and produced them in bulk, mapped which part of the envelope protein each targeted, and gauged how effective each was in neutralizing the virus. In the process, he identified a new structure within the envelope protein - called the gp120 core - that had never been recognized as a potential target for antibodies. "It's the first time that anyone has defined what is really happening in the B cell response in these patients," says Scheid.

Scheid's work shows that it's common for these antibodies to have neutralizing activity, says Nussenzweig. But each antibody alone has limited ability to fight the virus. "Individually, they're not as strong as the Famous Four," says Nussenzweig, referring to the high-profile super antibodies on which several vaccine attempts have been based. But in high concentrations, a combination of the sets of antibodies cloned from the individual patients seemed to act as teams to knock down the virus in cell culture as well as any single antibody studied to date. These natural antibodies were also able to recognize a range of HIV strains, indicating that their diversity may be an advantage over a single super antibody that focuses on only one part of the virus, which can mutate. The findings suggest that research into vaccines that mimic this natural antibody response could pay off.

In HIV-Infected Individuals Combination Therapy Restores T Cell Numbers

2009-03-17T08:50:00.000-07:00

White blood cells known as CD4+ T cells are the main target of HIV. The virus hijacks these cells and replicates within them, which ultimately destroys the cell. This depletion of the T cell population represents a major blow to the immune system and puts HIV-infected individuals at increased risk of opportunistic infections. Treatment of HIV-infected individuals with a cocktail of drugs called combination antiretroviral therapy (c-ART) is able to restore the T cell population and help fight HIV infection, however not all patients respond to this therapy. The growth factor interleukin-7 (IL-7) is known to stimulate T cell production and survival, suggesting that IL-7 may help restore the T cell population during HIV infection.

In a new study published in the JCI, Yves Levy and colleagues at the University of Paris undertook a clinical trial to evaluate the safety and efficacy of repeated IL-7 therapy over a 16-day period in 13 c-ART-treated, HIV-infected patients that possessed low T cell counts despite successful suppression of virus levels with c-ART. In these individuals, IL-7 was well tolerated and boosted the number of CD4+ and CD8+ T cells, which were able to mount an immune response against HIV. These effects were observed for 48 weeks. The data suggest that HIV-infected patients may benefit from intermittent therapy with IL-7 in combination with c-ART.

Life expectancy in developing countries could increase to 69 years by 2050 if the global health community sustains progress in controlling HIV/AIDS an

2009-03-16T10:38:00.000-07:00

New research led by a US team suggests that vaccines developed from a group of antibodies that occur naturally in the bodies of "slow progressing" HIV patients might be a better way to knock out the virus than focusing on a small number of engineered "super antibodies".

The study was led by Michel C Nussenzweig, Sherman Fairchild Professor and head of the Laboratory of Molecular Immunology at the The Rockefeller University in New York and is published in the 15 March advanced online issue of Nature.

For the last 25 years, scientists have tried to develop a "magic bullet" HIV vaccine that rely on a small number of engineered "super antibodies" to stop the virus taking hold.

Nussenzweig, who is also a Howard Hughes Medical Institute investigator, and colleagues showed that patients infected with HIV in whom the virus progresses much more slowly, have a diverse group of antibodies produced naturally in dynamic response to the infection, that behave like a co-ordinated hunting pack to knock down the virus more effectively than their super antibody cousins fighting on their own.

They suggest that a "shotgun" approach, based on these naturally produced antibodies, might be a better way to develop an effective HIV vaccine than trying to engineer a super antibody "magic bullet".

As Nussenzweig explained, looking for a different approach, they tried to reproduce what happens in the patient:

"What's in the patient is many different antibodies that individually have limited neutralizing abilities but together are quite powerful," he said, adding that "this should make people think about what an effective vaccine should look like."

HIV's primary survival advantage is the ability of virus strains to mutate rapidly and thus stay one step ahead of the immune system and vaccine developers.

However, all HIV strains share one feature, they have a surface glycoprotein called gp140 that helps them to infect host cells. Earlier studies have shown there are four engineered antibodies that can stop the virus infecting human cells by blocking the action of gp140 in culture, but so far attempts to get the human body to produce these antibodies have failed.

In about 10 to 20 per cent of people infected with HIV, the virus progresses very slowly to disease because the memory B cells in their immune system produce high levels of antibodies specific to the virus. But nobody knows much about these antibodies and how effective they are.

Lead author Johannes Scheid, who was a visiting student in Nussenzweig's lab and is now a doctoral candidate, started examining naturally produced antibodies in six HIV infected patients whose immune systems appeared to be putting up a strong fight against the virus.

With the help of David D Ho and Jeffrey V Ravetch from the Rockefeller Center for Clinical and Translational Science, Scheid and colleagues took blood from these patients and isolated 433 antibodies that targeted gp140.

The researchers then mass-produced these 433 antibodies by cloning them, and then mapped which part of the gp140 protein each one attacked and how effective it was against the virus.

As a result, they found a new structure within the gp140 protein that is a potential new target for the antibodies. They called this new structure the "gp120 core", because it is in the same region as the CD4-binding site of another envelope glycoprotein gp120.

"It's the first time that anyone has defined what is really happening in the B cell response in these patients," said Scheid.

Nussenzweig said that what Sheid and colleagues did was find that each of the 433 antibodies had some way of attacking HIV, but each on its own did not do enough to knock it out.

Individually, these antibodies are not as strong as the four engineered super-antibodies, which Nussenzweig described as the "Famous Four" that vaccine developers are using.

But in high concentrations, and used as a group, the cloned antibodies appeared to act as a team, and just as able to knock out HIV in cell cultures as any single antibody studied to date, said Nussenzweig.

The natural antibodies alos recognized a range of HIV strains, suggesting another reason why used as a group, they may be more effective than a single super-antibody that only recognizes one part of a virus with a high rate of mutation.

The researchers believe their findings make a strong case for investigating potential vaccines that mimic the body's natural immune system response to HIV.

Continued HIV/AIDS Progress Could Lead To Increased Life Expectancy, Population Among Developing Countries, U.N. Report Says

2009-03-16T10:37:00.000-07:00

Life expectancy in developing countries could increase to 69 years by 2050 if the global health community sustains progress in controlling HIV/AIDS and other infectious diseases, according to a report released Wednesday by the United Nations Population Division, Montreal's Gazette reports (Edwards, Gazette, 3/12).

For the report, titled "2008 Revision of the U.N.'s World Population Prospects," the United Nations compiled findings from recent census reports and population surveys around the world (Lederer, AP/Los Angeles Times, 3/11). According to the report, successes in reducing child mortality played a significant role in increasing projected life expectancy. Although the emergence of HIV/AIDS threatened to offset these gains in recent decades, global efforts to control the disease have begun to achieve success, the Gazette reports. The report found that developing nations that had rapidly advancing economies before the current economic downturn are expected to experience an increase in life expectancy from 67 years in 2009 to 75 years in 2050. In addition, the life expectancy in industrialized countries currently is 77 years and is expected to rise to 83 years over the next four decades, the report said (Gazette, 3/12).

The report estimated that the world's population will increase to seven billion by 2012 and nine billion by 2050, with developing countries in Asia and Africa fueling the majority of the increase. According to the United Nations, the population projections will depend on the success of efforts to prevent the spread of HIV and provide antiretroviral medications to people living with the disease. Hania Zlotnik, director of the U.N. Population Division, said the "good news" is that new data indicate that the "HIV/AIDS epidemic is not as bad as had been expected." The United Nations also said the projected population figures depend on a decline in family size from an average of 2.56 children per woman to 2.02 children per woman.

The report also projected that population growth will occur primarily in the most populous countries over the next four decades, with nine countries accounting for half of the estimated increase. According to the report, India will account for the largest proportion of population growth, followed by Pakistan, Nigeria, Ethiopia, the U.S., Congo, Tanzania, China and Bangladesh. In addition, the report estimated that the fastest population growth will occur among the 49 least-developed nations, which are predicted to double in population from 840 million in 2009 to 1.7 billion in 2050 (AP/Los Angeles Times, 3/11).

Selected tables from the U.N. report are available online (.pdf). A database of the findings also is available online.

Haiti Making Progress Against HIV/AIDS, Challenges Remain, Opinion Piece Says

2009-03-16T09:59:00.000-07:00

There is "some good news" in the fight against HIV in the Americas, Cesar Chelala -- an international public health consultant -- writes in a Miami Herald opinion piece, adding that "most surprisingly, it's coming from Haiti, one of the countries hardest hit by the epidemic." Chelala writes that United Nations data show that about 2.2% of Haiti's population -- or 120,000 people -- are living with HIV/AIDS and that AIDS-related deaths in the country have decreased in recent years. This compares with an HIV/AIDS prevalence of 6.1% in 2001, according to Chelala. Haiti's progress has been "particularly significant for a country where 60% of the population lives below the poverty line of $2 per day," he writes, adding, "Only four of every 10 Haitians have access to potable water, and there is one doctor for every 10,000 inhabitants." However, the "scenario is optimistic," Chelala writes, noting that the percentage of HIV-positive test results among pregnant women has decreased by 50% over the past 10 years.

The progress in fighting HIV/AIDS in Haiti is "due in large part to the work of people like" Jean Pape -- a Haitian doctor who focuses on HIV/AIDS and founded GHESKIO -- and Paul Farmer of Partners in Health, Chelala writes. PIH, along with its HIV Equity Initiative, are "dedicated to preventing and treating AIDS in the context of primary care; improving care for tuberculosis; optimizing treatment for sexually transmitted infections; and emphasizing women's health," Chelala writes. More than 400 workers have been trained to administer no-cost antiretroviral drugs within the community, and more than 1,500 HIV-positive people are receiving treatment, he writes.

According to Chelala, "many challenges remain," and a majority of Haitians "still lack sufficient sex education, for example." He adds that only 15% of women and 28% of men between ages 15 and 24 know HIV prevention methods, and both boys and girls are becoming sexually active at earlier ages. In addition, Chelala notes that prevalence and incidence rates have been declining more slowly in rural areas than in urban areas.

Chelala concludes that the "advances in fighting the epidemic in Haiti show that although much remains to be done to achieve better results, a committed leadership, good planning, parallel attention to prevention and care, and community involvement can successfully control this terrible epidemic, even under the worst of circumstances" (Chelala, Miami Herald, 3/12).

An abstract of Chelala's report -- "AIDS: A Modern Epidemic" -- is available online.

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

Nigerian Scientists Establish T Cell Baseline Standards For Country

2009-03-13T12:05:00.000-07:00

Nigerian scientists, led by Dauda Oladepo of the National Institute for Pharmaceutical Research and Development, recently established CD4+ T cell baseline standards in the country, the Vanguard/AllAfrica.com reports. According to Oladepo, the country previously did not have a national T cell baseline count for enrolling HIV-positive people in antiretroviral treatment. He said that "it is imperative to determine local baseline CD4 count and also provide national data for reference values in Nigeria."

According to Oladepo, the Ministry of Health's national HIV/AIDS and sexually transmitted infection control program began funding for T cell research in Nigeria in 2006 with support from the Global Fund To Fight AIDS, Tuberculosis and Malaria. Health Minister Babatunde Oshotimehin praised the scientists' efforts and called for a renewed commitment to HIV/AIDS efforts in the country among organizations and stakeholders. He also recommended that the results of the research be used as a basis for clinical practice guidelines in Nigeria (Amalu, Vanguard/AllAfrica.com, 3/10).

Germany To Provide $31.7M To Philippines For HIV/AIDS, Malaria, TB Efforts

2009-03-13T12:04:00.000-07:00

Germany's government has offered to provide 25 million euros, or about $31.7 million, to the Philippines in the form of a debt exchange to support health programs related to the United Nations Millennium Development Goals, including efforts to control HIV/AIDS, malaria and tuberculosis, the Philippine Daily Inquirer reports.

Ralph Recto, director-general of the Philippines' National Economic and Development Authority, said the debt servicing program will allow the Philippines to use unpaid debt to fund health projects rather than to repay certain loans, according to information from Germany's Federal Ministry for Economic Cooperation and Development. Recto said NEDA appreciates Germany's proposal and will await an indication of which projects the debt exchange will cover. According to NEDA, UNICEF also recently announced that it will extend until 2011 its Sixth Country Program for Children promoting child welfare in the Philippines. UNICEF plans to sign an agreement with NEDA to provide $11.54 million for various projects, the Daily Inquirer reports (Domingo, Philippine Daily Inquirer, 3/11).

Progress Toward AIDS Vaccine

2009-03-13T10:32:00.000-07:00

Rutgers AIDS researchers Gail Ferstandig Arnold and Eddy Arnold may have turned a corner in their search for a HIV vaccine. In a paper just published in the Journal of Virology, the husband and wife duo and their colleagues report on their research progress.

With the support of the National Institutes of Health, the Arnolds and their team have been able to take a piece of HIV that is involved with helping the virus enter cells, put it on the surface of a common cold virus, and then immunize animals with it. They found that the animals made antibodies that can stop an unusually diverse set of HIV isolates or varieties.

Some researchers have previously been able to elicit effective antibodies, but usually only against a very limited number of HIV types. With HIV's known propensity to mutate, antibodies developed against one local strain may not recognize and combat mutant varieties elsewhere. These geographic varieties with different mutations constitute one of the great challenges to finding a broad spectrum vaccine capable of protecting against the vast array of HIV varieties.

The approach taken by the Arnolds and their colleagues has been to identify a part of the AIDS virus that is crucial to its viability - something the virus needs in order to complete its life cycle - and then target this Achilles heel.

"The part that we targeted plays a role in the ability of HIV to enter cells, and is common to most HIV varieties," Gail Ferstandig Arnold said. "That is a mechanism that would not be easy for the virus to reinvent on the fly, so it turns out to be a really helpful target."

The Arnolds are both members of the Center for Advanced Biotechnology and Medicine, a joint center of Rutgers, The State University of New Jersey, and the University of Medicine and Dentistry of New Jersey. Also, Gail Ferstandig Arnold is a research professor and Eddy Arnold is a professor, both in Rutgers' Department of Chemistry and Chemical Biology.

While most vaccines are actually made from the pathogen itself, employing weakened or inactivated organisms to stimulate antibody production, HIV is just too dangerous to use as the basis for a vaccine vehicle. What the Arnolds have done is to use the relatively innocuous cold-causing rhinovirus and attach the target portion of the HIV. This must be done in a way that maintains the HIV part's shape so that when the immune system sees it, it will actually mount an immune response as it would to the real HIV.

"The idea is to trick the immune system into thinking it is acting upon HIV before the virus shows actually shows up on the scene," said Eddy Arnold.

To actually accomplish this is a big problem in engineering. The goal was to take a small piece of the HIV out of its native context, put it in a completely different system (rhinovirus), and have it look the same and act the same. Eddy Arnold likens this to taking the Rocky Mountains, putting them on India and having them look exactly right.

Using recombinant engineering, the research team developed a method to systematically test millions of varied presentations of the HIV segment with the rhinovirus. They tried millions of different variations on how to graft (or splice) one onto the other, creating what are called combinatorial libraries.

"It's like the lottery," Eddy Arnold commented. "The more tickets you buy the better chance you have of winning."

"The really exciting part is that we were able to find viruses that could elicit antibodies against a huge variety of isolates of HIV. That is an immense step and a very important step," said Gail Ferstandig Arnold.

"However, we need to be careful to not overstate things because the quantity of response is not huge, but it is significant," added Eddy Arnold. "This is actually the first demonstration of this particular Achilles heel being presented in way to generate a relevant immune response. It is probably not potent enough by itself to be the vaccine or a vaccine, but it is a proof of principle that what we are trying to do is a very sound idea."

Specialists Are Highly Satisfied With The Safety And Efficacy Of Atripla And Isentress In The Treatment Of HIV Patients

2009-03-12T06:27:00.000-07:00

Decision Resources, one of the world's leading research and advisory firms for pharmaceutical and healthcare issues, finds that surveyed infectious disease specialists identify a therapy's effect on the ability to achieve viral load suppression in treatment-naive patients as the attribute that most influences their prescribing decisions in HIV. Surveyed specialists indicate they are highly satisfied with Gilead/Bristol Myers Squibb's Atripla and Merck's Isentress in this attribute.

The new report entitled HIV: Opportunity lies for Drug Developers in Integrase Inhibitors and Next Generation CCR5 Antagonists finds that a novel drug in the CCR5 antagonist class that is dosed once daily and achieves maximum physician expectations would earn an 18 percent patient share in HIV in the United States and a 30 percent patient share in Europe, according to surveyed U.S. and European infectious disease specialists.

In 2008, Decision Resources' proprietary clinical gold standard for HIV was Merck's Isentress/Gilead's Truvada. Based on expert opinion, Isentress/Truvada will retain clinical gold standard status through 2017, owing to its balance of efficacy, novel mechanisms of action and safety. Although some therapies in development for HIV hold promise, most have efficacy, safety and tolerability, and/or delivery features that interviewed thought leaders believe are inferior when compared with Isentress/Truvada.

"Experts we surveyed rated Isentress plus Truvada as one of the safest antiretroviral regimens available," said Decision Resources Analyst Jose Avalos, Ph.D. "Furthermore, interviewed specialists believe Isentress' novel mechanism of action provides advantages in highly treatment experienced patients."

About the Report

HIV: Opportunity lies for Drug Developers in Integrase Inhibitors and Next Generation CCR5 Antagonists is a DecisionBase 2009 report. DecisionBase 2009 is a decision-support tool that provides in-depth analysis of unmet need, physician expectations of new therapies and commercial dynamics to help pharmaceutical companies optimize their investments in drug development.

The report can be purchased by contacting Decision Resources. Members of the media may request an interview with an analyst.

Men, Women Should Share Responsibility For HIV/AIDS Prevention, Treatment, Malaysian Official Says

2009-03-10T11:10:00.000-07:00

Men and women should share equal responsibility for preventing HIV/AIDS and providing treatment to people living with the diseases, Ng Yen Yen -- Malaysian minister for women, family and community development -- said last week at the 53rd Session of the U.N. Commission on the Status of Women, Bernama Daily Malaysian News reports. According to Ng, the percentage of new HIV/AIDS cases in Malaysia that occur among women has increased from 1.2% in 1990 to 16.4% in 2007. In addition, most HIV-positive women in the country contract the virus from their husbands, Ng said.

According to Ng, it is "important that both men and women take equal responsibility in preventing the spread of HIV among women." She added that "it is crucial that in the intersection of care-giving and HIV/AIDS, women are given the utmost support" because the "role of care-giving in many societies often falls upon women." Ng said that it is important to increase HIV/AIDS awareness among men in Malaysia so that they can become "involved in shouldering their responsibility in care-giving" for people living with HIV (Bernama Daily Malaysian News, 3/5). In addition, men and women should share equal responsibility for promoting safer sex, she said.

According to Ng, gender stereotypes pose significant challenges to equal responsibility and the advancement of women. She added that policymakers often encounter difficulty discussing stereotypes and implementing initiatives to address the issue. Ng said that "chipping away long-held biases and ways of thinking require strenuous efforts. But the outcome is worthwhile and the international community should not shirk from this" (Malaysia National News/Bernama, 3/4). Ng added that gender equality also can contribute to Malaysia's development at both the family level and the wider community and political levels. According to Ng, the Malaysian government "places the utmost importance on gender equality and Malaysian women have made significant progress in various fields, such as in the education, health and economic sectors" (Bernama Daily Malaysian News, 3/5).

Religious Leaders In Tajikistan Join HIV/AIDS Campaign

2009-03-10T11:09:00.000-07:00

Religious leaders in Tajikistan have joined a campaign that aims to address HIV/AIDS in the country, Radio Free Europe reports. According to Mullah Abdurahim Imam, who heads a mosque in the city of Dushanbe, the religious leaders are working with an HIV/AIDS center and international groups to improve their understanding of the disease and promote healthy lifestyles. In addition, the government, the United Nations office in Dushanbe and HIV/AIDS experts have organized seminars and roundtables for mullahs and imams. Muslim clerics during Friday services also have called on returning migrant workers to be tested for HIV and avoid risky behaviors. They also have promoted tolerance toward people living with HIV/AIDS, Radio Free Europe reports.

Manizha Haitova of an HIV/AIDS center in Dushanbe said that because mullahs are one of the most influential segments of society in Tajikistan, they should become more involved in efforts to fight the disease. Tajikistan has officially recorded 1,400 HIV/AIDS cases, but some experts say that the real number of cases is higher (Radio Free Europe, 3/5)

HIV/AIDS Outreach Efforts In Atlanta, Buffalo, N.Y., Target Black Community

2009-03-10T11:07:00.000-07:00

The following summarizes two recent events that seek to raise HIV/AIDS awareness in the black community.

Atlanta: The African-American Outreach Initiative will hold its 10th annual conference on HIV/AIDS in Atlanta March 15, the Atlanta Journal-Constitution reports. AIDS is the leading cause of death among black women ages 24 to 34 and the second leading cause of death among black men ages 35 to 44. The two-day conference will seek to identify people who are HIV-positive and encourage them to seek care, Michael Banner, chair of the planning committee, said. According to Banner, the conference attracts between 500 and 600 people who are HIV-positive. Banner said the conference "gives people who are HIV-positive a safe place to come and get information and see role models who are living with HIV but not living in the shadows" (Bonds Staples, Atlanta Journal-Constitution, 3/8).
Buffalo, N.Y.: The Buffalo division of the National Black Leadership Commission on AIDS on Saturday as part of an effort to commemorate "Black Church Week of Prayer for the Healing of AIDS" sponsored a series of HIV/AIDS prevention workshops at a local church, the Buffalo News reports. The highest rates of new HIV infections are among black men who have sex with men and heterosexual women, Donna Chapman, the Buffalo coordinator of NBLCA, said. "The purpose of (the commission) is to mobilize the indigenous, African-American leadership in whatever city we go to help them make an intelligent and meaningful response to the HIV pandemic," Chapman said. The workshops were aimed at "demystifying issues surrounding the disease while also allowing participants to deal with the issue from a faith perspective," the News reports. The commission also held a breakfast for local pastors and their wives as part of its outreach mission targeting black religious leaders (McNeil, Buffalo News, 3/7).

San Francisco Chronicle Examines Call For Collaborative Effort To Eradicate HIV/AIDS

2009-03-09T10:26:00.000-07:00

The San Francisco Chronicle on Friday examined a recent challenge issued by HIV/AIDS advocates, scientists and the pharmaceutical industry to reduce HIV-positive people's dependency on antiretroviral drugs and ultimately eradicate the disease from the body. For their call to action, several scientists on Friday published a review paper in the journal Science titled, "The Challenge of Finding a Cure for HIV Infection." According to the Chronicle, the authors aim to "find a path that would free every" HIV-positive person worldwide from the virus and "from lifelong dependence on the drugs that can hold the virus at bay, but are far too costly" for developing countries.

The authors dedicated the paper to Martin Delaney, founder and former director of San Francisco's Project Inform, who died in January. Before he died, Delaney had worked with scientists to develop plans for the coordinated research initiative, which they are calling a "collaboratory." The authors of the paper include Warner Greene of the University of California-San Francisco's Gladstone Institute of Virology and Immunology; Daria Hazuda of Merck; David Margolis of the University of North Carolina; Douglas Richman of the University of California-San Diego; and Roger Pomerantz of Johnson & Johnson.

Although highly active antiretroviral therapy has achieved success in delaying the progression of HIV, the treatments are "overwhelmingly expensive" and many developing nations cannot afford the cost of the drugs, the Chronicle reports. According to the United Nations, more than 33 million people are living with HIV worldwide, but only four million currently receive HAART, of which one million are in the U.S. HAART also does not fully eliminate HIV from the body, meaning that people need to take the drugs indefinitely. According to the Chronicle, the scientists' "ultimate goal is to find ways to purge those latent virus particles" from HIV-positive people and "thereby forestall permanent dependence on those overwhelmingly expensive drugs." By eradicating all latent viruses in the cells of HIV-positive people, the researchers hope that the "immune systems of those who are infected would be empowered to cope with any few virus particles that remain without ever requiring more antiretroviral drug therapy," the Chronicle reports. Greene said that the "big question is how do we turn against a silent virus when we can't kill it until it expresses itself?" He added that the effort "calls for a fundamentally different approach to cure the HIV infection, and it's an extremely tough goal that may not even succeed."

Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, said he will strongly support the collaborative research effort. "Finding a cure for HIV infection may be a pie-in-the-sky idea, but it would mean you could stop taking drug therapy and the virus wouldn't bounce back," he said. Fauci said he had discussed this idea with Delaney, adding that it "may never succeed, but it's surely worth trying." According to Fauci, the HIV/AIDS budget for NIAID and other institutes within NIH is currently about $2.9 billion, and it already is funding some of the new approaches sought by the researchers (Perlman, San Francisco Chronicle, 3/6).

Tools For More Accurate Dosage Of Drugs Against HIV/AIDS And Malaria

2009-03-09T10:25:00.000-07:00

A doctoral thesis presented at the Sahlgrenska Academy, University of Gothenburg, Sweden, shows that it is possible to describe and quantify the relationships between dose, concentration and effectiveness of several drugs against HIV/AIDS and malaria. The method may allow improved treatment and fewer undesired effects for patients with these diseases.

Registered pharmacist Daniel Röshammar has in his thesis studied the optimal use of certain pharmaceutical substances that are used to combat HIV/AIDS and malaria. He has analysed, among other things, data from 121 healthy volunteers from Uganda using a mathematical model known as a pharmacometric model. The study showed that both sex and genetic differences between individuals influence the way in which the body metabolises efavirenz, which is part of some anti-HIV/AIDS drugs. Other studies have focussed on 74 people from Zimbabwe with HIV/AIDS, and showed that a reduction in the daily dose of efavirenz from 600 mg to 400 mg can reduce the risk of undesired effects in those affected who have a genetically conditioned poorer ability to catabolise the substance.

"Many HIV/AIDS patients are treated with efavirenz, and they should be genetically tested using a blood test before deciding on a dose. This is particularly important in Africa, where the fraction of patients with a poorer catabolic ability is greater than it is elsewhere", says Daniel Röshammar.

Repeated measurements of the drug concentrations and virus levels in 239 previously untreated Scandinavian patients with HIV/AIDS allowed a similar model to be used in order to study the antiretroviral effects of anti-HIV/AIDS drugs. Calculations showed that treatment in which efavirenz was combined with other pharmaceutical substances was more effective than two other frequently used combination treatments.

"It may be possible in the future to use the model to predict when the treatment will lose its effectiveness for an individual patient, and explain why", says Daniel Röshammar.

Further work involved using a model to describe how the catabolism of the anti-malarial drug artemisinin increases and the concentration of the drug decreases when patients take this drug. When artemisinin was given to 97 patients in Vietnam without other drugs, approximately 37% of them were affected by recrudescent malaria. The model showed that this could not be explained solely by low drug concentrations. Another anti-malarial drug, piperaquine, may be a suitable partner for artemisinin in the treatment of malaria. An investigation of 12 Vietnamese study subjects, however, allowed scientists to estimate that the levels of piperaquine that remain in the body are too low to be effective, and this increases the risk that the malaria parasite will develop resistance.

"Research shows that pharmacometric models can be adapted to patient data in order to understand the relationships between drug concentration, effectiveness and the progress of disease, while at the same time taking into consideration differences between patients such as, for example, weight, age, sex, genetic factors, other diseases and other drugs. We expect that these tools will be important in the fight against HIV/AIDS and malaria", says Daniel Röshammar.

Source: Ulrika Lundin
University of Gothenburg

Study Reports HIV Prevalence Among Vancouver Sex Workers, IDUs, MSM

2009-03-09T10:24:00.002-07:00

A recent study conducted by the British Columbia Centre for Excellence in HIV/AIDS found that 26% of Vancouver's up to 520 female commercial sex workers and 17% of the city's injection drug users are HIV-positive, the Vancouver Sun reports. The overall prevalence of the virus in Vancouver is about 1.21% -- six times the national average -- and the HIV prevalence among the city's estimated 20,000 men who have sex with men, including male sex workers, is estimated at 15%, the Sun reports. The study -- published in the Harm Reduction Journal -- is the first in Canada to estimate the per capita prevalence of HIV for high-risk groups. Researchers used software from the United Nations and the World Health Organization, in addition to 2006 Statistics Canada data and other sources such as population surveys, according to the Sun.

Study author Julio Montaner, president of the International AIDS Society and head of the division of HIV/AIDS at the University of British Columbia, said that drugs and sexual activity are the "preferred routes" for HIV transmission. According to Montaner, sex workers often are paid more for unprotected sex with clients. He added that it is difficult to know HIV/AIDS prevalence rates among the clients of female sex workers. Montaner said that researchers "don't have any way of accessing the [clients] to ask them those questions," adding that if clients are seen in clinics, "it's not like they volunteer" that they contracted HIV through unprotected sex with a sex worker. "They would be more likely to report that they got it through having casual sex, or with multiple partners," he said.

Montaner added, "We always knew we had a significant problem, because of factors like our benign climate causing people to drift here, being a port city, and having so much poverty and so many homeless people on the Downtown Eastside." He also said that there "should be public advisories everywhere" about the new data. Patricia Daly, chief medical health officer for Vancouver Coastal Health, said she had not read the report yet and could not say if a targeted public health campaign for those involved in the commercial sex industry is required. She said that commercial sex work is a "high-risk activity for all kinds of infections and, therefore, you need to practice safe sex." She added, "Our message has always been that you should assume sex trade workers are HIV-positive."

Some HIV/AIDS experts have suggested that the provincial government "seek out and treat" the people living with HIV who are not on medications, Montaner said. The Sun reports that an estimated 13,000 British Columbia residents are HIV-positive but that less than one-third are taking HIV medications. "We need an outreach program that brings treatment to the people, to make it more accessible," Montaner said, adding that if the number of people taking medications were around 7,500, the number of annual new HIV cases would be reduced by 300 to 400. The current system puts off treatment until the immune system cells deplete to a certain level, thus reducing the program's cost and delaying potential side effects of the medication, the Sun reports.

A strategy Montaner's group proposed would provide highly active antiretroviral therapy to HIV-positive people in the early stages of the virus so the chances of spreading it are diminished. Montaner said the government, health minister and premier "have been very supportive about this kind of progressive approach," but the current economic downturn has placed the approach in "a waiting mode" (Fayerman, Vancouver Sun, 3/5).

Men should be more active in caring for people living with HIV so women have a chance to participate in public life, Asha-Rose Migiro, United Nations

2009-03-09T10:24:00.001-07:00

Bishops from the Evangelical Lutheran Church in America on Thursday publicly took HIV tests in an effort to raise awareness about the virus among their congregations, the Chicago Tribune reports. "We in the U.S. tend to think of this as a global pandemic unrelated to people in the U.S.," ECLA Presiding Bishop Mark Hanson, who also serves as president of the Lutheran World Federation, said, adding, "For me, as a married heterosexual man to be tested is a reminder that all communities are affected, if not infected." According to Hanson, the bishops were following the lead of religious leaders in Africa, many of whom for years have called on their congregations to receive HIV tests and agreed to be screened publicly for the virus.

According to the Tribune, although many churches have "long worked to eradicate poverty-related pandemics" and diseases such as malaria, they have been "slow to address" HIV/AIDS, which is "haunted by a moral stigma" because it can be sexually transmitted. Hanson said that the church should take steps to embrace people living with the disease. Bishop Wayne Miller of the Metropolitan Chicago Synod said that taking an HIV test is his way of being closer with the Central Diocese of the Evangelical Lutheran Church in Southern Africa -- Chicago's companion synod. Miller added that he hopes his actions will send a signal to his congregations that they should be proud and not ashamed to be screened for the virus. "There's still so much shame and secrecy, people end up hiding from the treatment and care they need," he said.

ELCA's chief legislative authority during its biennial assembly in August is expected to approve a new national church HIV/AIDS strategy (Brachear, Chicago Tribune, 3/6).

U.N. Official Calls For Strengthening Men's Rolls In HIV/AIDS Caregiving

2009-03-09T09:26:00.000-07:00

Men should be more active in caring for people living with HIV so women have a chance to participate in public life, Asha-Rose Migiro, United Nations deputy secretary-general, said earlier this week at the 53rd session of the U.N. Commission on the Status of Women, IRIN/PlusNews reports. Migiro said, "We must address the significant responsibilities faced by women and girls during home-based care in the context of HIV and AIDS and find ways to strengthen the role of men" (IRIN/PlusNews, 3/4). She said that the inequality in HIV/AIDS caregiving "is unjust and a serious form of discrimination, even a form of violence" against women. Migiro said that women are restricted in public life, employment and education, while men are held back from being more active in their families' lives. "Families, communities and society as a whole suffer the consequences," she said (U.N. News Service, 3/2).

Migiro called for the creation of "innovative ways to eliminate gender stereotypes about the roles of women and men -- beginning at an early age in homes, schools and communities -- and engaging leaders in all walks of life." She said that measures to encourage shared responsibility should include closing the pay gap between men and women, increasing flexibility in working arrangements, and putting better leave provisions in place for both men and women (IRIN/PlusNews, 3/4). Migiro said, "Ensuring that caregivers have the means to do their work effectively has a cost that society must be ready to meet. We must provide adequate resources to empower women and girls who are dedicating their time to looking after people living with HIV" (U.N. News Service, 3/2).

New Stanford List Of HIV Mutations Vital To Tracking AIDS Epidemic

2009-03-08T09:48:00.000-07:00

In a collaborative study with the World Health Organization and seven other laboratories, researchers at the Stanford University School of Medicine have compiled a list of 93 common mutations of the AIDS virus associated with drug resistance that will be used to track future resistance trends throughout the world.

The researchers analyzed data from about 15,220 patients across the globe to develop an updated and accurate list of the most common, resistance-related mutations of the virus. The list will be published March 6 in the online journal PLoS-One.

"The epidemic is changing, especially as new drugs are being developed," said Robert Shafer, MD, associate professor of infectious diseases and geographic medicine at Stanford and the senior author of the paper. "To effectively track the spread of drug resistance, particularly transmitted drug resistance, you need a sensitive and specific list that's considered standard and is adopted by all the surveillance studies."

The list is important, he said, as it helps countries gauge the effectiveness of their HIV medication programs. But assembling such a list can be a challenge, particularly with a virus that has so many resistance-related variants. On the one hand, if the list is too liberally defined, then HIV drug funders and providers may believe resistance is more widespread than is actually the case.

"That will cause problems in countries. They may be concerned about whether their drugs will work," Shafer said.

On the other hand, if the list is too restrictive, there is a risk of underestimating the actual extent of resistance, he said.

"So there is a real challenge to using the right number of mutations," Shafer said.

In 2007, Shafer and his colleagues published a similar list of 80 HIV mutations that has since served as the basis for global AIDS surveillance work. However, with the scale-up of antiretroviral drug programs in the last two years and the introduction of new medications, resistance patterns have changed. So there was a need for a newly updated reference, he said.

The data used in the study was derived from a publicly available, searchable database that Shafer and his colleagues began at Stanford in 1998. Known as the Stanford HIV RT and Protease Sequence Database, it includes information on the two key proteins targeted by HIV drugs: reverse transcriptase and protease. More recently, the researchers have begun gathering resistance data on integrase inhibitors, the latest class of antiretroviral drugs to be introduced. However, this data was not included in the study, as these drugs are not yet in wide use, particularly in developing countries.

To compile the latest list, the researchers added data from other laboratories in Europe, Canada and the United States to include more than 15,000 sequences from untreated individuals, double the number available in 2007. To ensure geographic diversity, information was included for eight different subtypes of the virus, as these vary from one region of the world to another.

The researchers scoured the data to ensure they included only those mutations that were clearly recognized as causing or contributing to resistance. They excluded polymorphisms, or variants of the virus that can arise naturally, as well as drug-related mutations that occur rarely.

The result was that 16 new mutations were added to the 2007 list, while three were dropped. Shafer said it was reassuring to find minimal changes were needed.

"It shows the first list was quite good," he said.

Shafer's Stanford colleagues in the study are Mark Kiuchi, Tommy Liu, Soo-Yon Rhee and Jonathan Schapiro, MD. The research was funded by the National Institutes of Health.

The Stanford database can be found at: http://hivdb.stanford.edu.

Stanford University Medical Center integrates research, medical education and patient care at its three institutions - Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children's Hospital at Stanford. For more information, please visit the Web site of the medical center's Office of Communication & Public Affairs at http://mednews.stanford.edu.

Researchers' New Goal: Drug-Free Remission For HIV Infection

2009-03-07T08:47:00.000-08:00

A group including leading academic and industry scientists has issued a challenge to researchers in the field of HIV/AIDS: find a way to effectively purge latent HIV infection and eliminate the need for chronic, suppressive therapy to control this disease. "The Challenge of a Cure for HIV Infection," published in the March 6 issue of Science, calls for a coordinated initiative involving academia, industry, patient advocates and government to accelerate the search for a cure.

Highly active antiretroviral therapy (HAART) for the chronic suppression of HIV replication has been the major accomplishment in HIV/AIDS medicine, a therapy now being used by more than four million people around the world to keep the latent HIV virus in check, according to lead author Douglas Richman, Professor of Pathology and Medicine at the University of California San Diego and the Florence Seeley Riford Chair in AIDS Research. He is Director of the Center for AIDS Research at UC San Diego and staff physician at the VA San Diego Healthcare System.

While HAART therapy has allowed many patients to assume a relatively healthy life, unencumbered by symptoms or side effects of the once-daily treatment, HAART is no panacea, according to the authors which include David M. Margolis of the University of North Carolina, Chapel Hill, Warner C. Greene of the Gladstone Institute of Virology and Immunology and UC San Francisco, Daria Hazuda of Merck and Co., Roger Pomerantz, of Tibotec Pharmaceuticals Inc. and Johnson & Johnson Corporation and the late Martin Delaney of "Project Inform."

The team states that combination therapy for HIV infection represents a triumph for modern medicine. However, they add that HAART's success is limited by its cost, the requirements of lifelong adherence required to contain persistent HIV infection - meaning that interruption of treatment can result in a rapid rebound of replicating HIV virus - and the unknown effects of such long-term treatment. There is already growing concern about increased rates of heart disease, diabetes, liver disease and many forms of cancer in aging HIV-infected patients on treatment, according to the paper.

"If we could purge the latent reservoir of HIV infection, we could withdraw chronic suppressive therapy - with great potential impact on cost, toxicity, convenience and transmission," Richman said, adding that the scientific challenges to achieving this goal are substantial but "considering the payoff, the effort is well worth it."

The goal of HIV therapeutics, they propose, should be a drug-free remission. Such a goal requires understanding of the persistence of HIV infection or low-level viremia - the presence of the virus in the bloodstream. Persistent infection is maintained in reservoirs like latently infected lymphocytes or macrophage cells of the immune system. There may be other, as yet unrecognized, reservoirs as well. As multiple mechanisms may contribute to maintenance of this viral latency, combination approaches would likely be required to eradicate infection. Such therapeutic approaches would also affect host cell function, says Richman, so global immune activation must be avoided.

The scientists agree that a major clinical and ethical challenge will be how to safely test future drug development in humans since current antiretroviral therapy is so effective and relatively safe. However, such studies would be required in order to cure HIV. The difficulty of developing a preventive vaccine or microbicide for HIV puts even great pressure on other methods in order to contain the ongoing pandemic of HIV.

"Without a vaccine, we are left with the substantial financial burden of lifelong treatment for tens of millions of people," said Richman. "Acknowledging and addressing the challenges outlined in this paper is the first step toward progress."

"Success - if achieved - will not occur quickly," Richman added. "But, bear in mind, the dramatic success of combination antiretroviral therapy which has transformed HIV/AIDS in the developed world and is beginning to impact the developing world required 15 years of substantial effort."

Microbicide Containing Natural Compound Provides Protection In Monkeys Against Simian Version Of HIV, Study Says

2009-03-06T09:35:00.000-08:00

An experimental microbicide containing a naturally occurring compound provides protection in monkeys against the simian version of HIV by diminishing immune responses to the virus, according to a study published Wednesday in the journal Nature, the Los Angeles Times reports. HIV typically spreads in the body by entering CD4+ T cells, which the immune system sends out to attack the virus after exposure. The compound -- called glycerol monolaurate, or GML -- works by inhibiting immune signals that dispatch the T cells to attack the infection. It is those T cells that HIV infects and uses to proliferate throughout the body (Engel, Los Angeles Times, 3/5). GML occurs naturally in the human body and already is approved for use as an antimicrobial and anti-inflammatory ingredient in cosmetics and toiletries, as well as an emulsifier in foods. In addition, each dose of GML used in the study costs less than one cent. According to the researchers, the study's findings have promising implications for the development of effective microbicides to prevent HIV (AFP/Google.com, 3/4).

For the study -- led by Ashley Haase, head of the microbiology department at the University of Minnesota Medical School, and microbiologist Patrick Schlievert -- researchers administered the GML gel vaginally to five rhesus monkeys and then repeatedly exposed them to the simian version of HIV, or SIV. After two weeks, all of the five monkeys tested negative for the virus. However, four out of five monkeys that did not receive the GML gel contracted SIV. According to the researchers, five months after the experiment, they learned that one of the monkeys treated with GML tested positive for the virus. The researchers said they are unsure how this monkey contracted SIV, but they suggested that a small amount of the virus might have spread in the body undetected or the monkey might have been exposed to SIV after the study ended (Lerner, Minneapolis Star Tribune , 3/4).

Haase said the current research is "a relatively preliminary study but worth sharing because it establishes a novel approach." The researchers added that a mathematical model suggests that even if the microbicide were 60% effective and used 20% of the time, it still could prevent about 2.3 million HIV cases over a three-year period. According to the study authors, researchers will need to conduct further animal studies to determine whether the microbicide should be administered over a longer period of time to provide long-term protection against the virus (Los Angeles Times, 3/5). Further study also will be needed to demonstrate whether GML prevents HIV transmission among humans, they added. The researchers said they plan to undertake a larger study with monkeys, followed by a study with female volunteers. In addition, the University of Minnesota has applied for patents for the new compound combining GML with a personal lubricant, which currently is not available commercially. According to Schlievert, the ultimate goal will be to develop a gel that can be used for both men and women (Minneapolis Star Tribune, 3/4).

According to the study authors, the research "represents a highly encouraging new lead in the search for an effective microbicide to prevent HIV transmission that meets the criteria of safety, affordability and efficacy" (Fox, Reuters, 3/4). Haase said that although the research "sounds counter-intuitive, halting the body's natural defense system might actually prevent transmission and rapid spread of the infection" (AFP/Google.com, 3/4). Charlene Dezzutti, laboratory network director of the Microbicides Trial Network at the University of Pittsburgh, said the research illustrates "a new approach to thinking about microbicides." She added that she believes scientists "definitely" could develop an effective microbicide before developing an HIV/AIDS vaccine. "It's just a matter of getting all the right pieces together," she said (Lauerman, Bloomberg, 3/4). Rowena Johnston, vice president of research for the Foundation for AIDS Research, said that if further studies confirm these results, "then this is really a fabulous new finding." She said that although future microbicide research could encounter setbacks, the study is "absolutely a great beginning to a research project."

According to Schlievert, women could apply the GML microbicide "an hour or so before they had sex" to protect against HIV transmission. In addition, the gel might provide protection against other sexually transmitted infections, such as chlamydia, he said (Minneapolis Star Tribune, 3/4). According to AFP/Google.com, Schlievert first identified the microbicidal properties of GML when studying the use of the compound in preventing toxic shock syndrome associated with tampons. He said research repeatedly has found that the compound is safe and has no effect on beneficial vaginal bacteria (AFP/Google.com, 3/4). Lorraine Teel, executive director of the Minnesota AIDS Project, said the gel could provide women with a way to prevent disease transmission in areas of the world where many people do not use condoms because of cultural or other pressures. The research has "absolutely enormous implications" for women worldwide, she said (Minneapolis Star Tribune, 3/4). Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, said an effective microbicide would "empower women to protect themselves in a sexual situation in which they may not have complete control" (Los Angeles Times, 3/5).

HIV/AIDS Advocates In Thailand Urge Government To Maintain Compulsory License Program

2009-03-06T09:22:00.000-08:00

HIV/AIDS advocates in Thailand plan to meet with officials to urge the government not to restrict its compulsory license program, which allows people in the country to access low-cost, generic versions of drugs such as antiretroviral medications, AFP/Google.com reports. The program suspends patent protections for brand-name drugs to treat HIV/AIDS, cancer and heart disease, thus allowing low-cost, generic medications into the market.

According to the HIV/AIDS advocates, Thailand's Ministry of Commerce recently sent a letter to public health officials requesting that they suspend issuing compulsory licenses because the program is posing obstacles for free trade talks with the U.S. The letter said Thailand "should not implement additional compulsory licensing" in order to encourage the U.S. to remove Thailand from its "piracy watch list," the advocates said. Alongkorn Polabutr, Thailand's deputy commerce minister, plans to visit the U.S. later this month to engage in renewed trade discussions, AFP/Google.com reports. Nimit Tienudom, director of Thailand's AIDS Access Foundation, said he will meet with the minister before his departure. "We are totally opposed to the idea that Thailand should not do more compulsory licensing," Nimit said, adding that the program "benefits Thai people as a whole."

Panitan Wattanayagorn, a spokesperson for Thailand's government, said officials have no intentions of halting the compulsory license program. "Thailand reaffirms that it has implemented compulsory licensing in line with international practice to allow Thai people access to drugs," Panitan said. He added that Abhisit Vejjajiva, Thailand's prime minister, has asked U.S. business representatives to "send signals to the U.S. administration not to cite the compulsory licensing case to deprive Thailand of trade status or affect our country" (AFP/Google.com, 3/4).

New HIV Cases Reach Record High In Hong Kong, Officials Say

2009-03-06T09:19:00.000-08:00

Hong Kong in 2008 recorded 435 new HIV cases, the highest number of annual new cases since record-keeping began in 1984 and a 5% increase from the 414 cases reported in 2007, Hong Kong's The Standard reports. Wong Ka-hing, a consultant for the Center for Health Protection, said the primary mode of HIV transmission continues to be sexual contact, with 145 cases occurring among men who have sex with men and 131 cases through heterosexual contact. "One thing to note is that in many countries, [MSM] sexual transmission is on the rise," Wong said, adding that this could be because of the difficulty reaching out to the MSM population.

The Standard reports that records show 40 of the 435 new cases involved injection drug use and that three occurred through blood or blood product transfusions. People with a "history of unsafe sex" should be tested for HIV and should use condoms "for safer sex to reduce the risk of contracting HIV," Wong said. According to The Standard, a total of 780 women and 3,267 men have been diagnosed with HIV since 1984 (Wong, The Standard, 3/4).

Loretta Wong Wai-kwan of the advocacy group AIDS Concern said the government "should be stronger in its leadership and boldly invest more in Hong Kong people's health." She said, "More work should be done right now as the effects will take a few years to materialize" (Ng, South China Morning Post, 3/4). Wong Wai-kwan said that condom use among MSM and the general population still is low. She added that despite regular use by 60% of the MSM community, some people are "willing to take the risk if condoms are not in their immediate reach." Wong Wai-kwan urged non-governmental organizations to increase HIV/AIDS prevention services, adding that it will not be "easy." She said it will "require more funds from the government to make the services stable and sustainable." In addition, Wong Wai-kwan said that the increasing number of new cases in 2008 could be because more people took HIV tests last year (China Daily, 3/4).

Video Game Aims To Teach Young People In Kenya About HIV/AIDS Prevention

2009-03-06T09:17:00.000-08:00

A video game in Kenya -- called Pamoja Mtaani and launched through a partnership between Warner Bros. Entertainment and the President's Emergency Plan for AIDS Relief -- is teaching young people in the capital of Nairobi about HIV/AIDS risks and prevention strategies, VOA News reports. The game, which was developed and distributed by the private entertainment company Virtual Heroes, simulates real-life situations in which characters find themselves at risk of contracting HIV. The situations are made to represent realistic settings in the city. In order to advance to the next level of the game, players are required to make the best decisions to solve problems their characters face.

During the game, teenagers are given information about HIV/AIDS prevention, with the target age group being teens ages 15 to 19. Brad Wilson of Virtual Heroes said that during the game, each character initially engages in high-risk behavior and then interacts with other characters to "learn that these behaviors they are doing are actually risky" and have "ramifications." He added that the characters "realistically" change from the beginning of the game to the end and that the developers "are hoping that a lot of that is going to sink in to the youth." While developing the game, the company consulted with teens in Nairobi to determine what is important to them and what ideas they had for the game. PEPFAR officials now plan to offer the game in more sites in Nairobi and other parts of Kenya (VOA News, 3/3).

Antigua HIV/AIDS Program Manager Announces Plans For Education Campaign

2009-03-06T09:15:00.000-08:00

Delcora Williams, Antigua's deputy program manager for the AIDS secretariat, on Tuesday announced that the secretariat is waiting for approval from the Board of Education to begin a new HIV/AIDS education and awareness campaign, the Antigua Sun reports. Williams said the campaign includes establishing booths outside schools throughout the island to provide students with information on HIV/AIDS, including prevention information. Williams said, "We want to get the message out ... especially to the 15 to 19 age group where you find a lot of HIV cases." She noted that the earlier health officials can inform people about HIV/AIDS, the better chances people have of practicing safer behaviors. According to Williams, the secretariat also plans to provide rapid HIV screening at the office of the AIDS secretariat and at clinics throughout the island. Williams said that the secretariat also plans to increase HIV/AIDS outreach programs and extend these programs to rural areas to inform people about the disease and encourage them to be tested (Jagdeo, Antigua Sun, 3/4).

Texas Bill To Make HIV Screening Part Of Routine Care Would Help Efforts To Curb Virus, Editorial Says

2009-03-06T04:33:00.000-08:00

"More than two years after" CDC "recommended routine HIV screening, two state lawmakers" in Texas have proposed a bill to align the state with the federal recommendations, a Lubbock Avalanche-Journal editorial says. It adds that between 2003 and 2007, "more than one-fourth of Texans with HIV were diagnosed late in the course of the disease and were diagnosed with AIDS within a month." According to Ed Sherwood, chair of the Texas Medical Association Committee on Infectious Diseases, making HIV tests a part of routine care "would help avoid situations where patients assume they couldn't be infected and decide not to get tested," the editorial says. In addition, if the legislation "passes, it will be a model for other states," according to bill sponsor Sen. Rodney Ellis (D), the editorial says, adding, "California and Illinois are the only other states to pass HIV screening legislation, but not as comprehensive."

The state "already has legislation requiring inmates in Texas prisons to be tested for HIV when they enter and leave the system," according to the editorial. It adds that state law "also requires doctors to offer HIV screening at checkups for pregnant" women. The editorial concludes that the bill is a "good idea ... as long as people can opt out" (Lubbock Avalanche-Journal, 3/4).

Drug Policies Could Condemn Millions To HIV

2009-03-05T05:02:00.000-08:00

As governments meet next week in Vienna (11-12 March 2009) to set international drug policy for the next 10 years the International HIV/AIDS Alliance is concerned that HIV prevention strategies are being seriously undermined by conflicting policy approaches.

"We are very concerned. There is an opportunity here to tackle HIV rates amongst injecting drug users but because of a conflict in policy public health is being put at risk.

"UNAIDS advocates for harm reduction strategies such as needle exchange schemes to prevent the spread of HIV. But some governments are blocking a more progressive approach and the UN Office on Drugs and Crime (UNODC) despite endorsing harm reduction does not actively support it, claiming it perpetuates drug use," said Susie McLean, senior advisor on HIV and drug policy at the Alliance.

"This fundamental split in the policy approach is hampering efforts to contain the spread of HIV. All the available evidence points to the fact that harm reduction strategies do not increase drug use."

In 2008 around 3 million of the nearly 16 million people who inject drugs were estimated to be HIV positive. Inadequate policy frameworks are the main reason that HIV prevention programmes still fail to reach most injecting drug users.

The Alliance supports some unique HIV prevention programmes around the world including Ukraine, India and Cambodia that have former and current drug users at the heart of tackling HIV amongst their community.

Harm reduction strategies such as providing clean needles and/or substitution therapies can reduce rates of HIV infection. Governments like the UK that introduced needle exchanges in the 1980s have seen the epidemic among drug users remain low. The UK Government is a champion of harm reduction in Europe and with the USA.

Ishwar Haobam is from SASO, an organisation in Manipur, India, working with the Alliance. SASO is made up of drug users and ex-drug users who are providing HIV prevention services, home detox services and support for women and young people vulnerable to HIV.

"Manipur has one of the highest HIV prevalence rates in India. Among injecting drug users the rate went from zero to a peak of almost 80% by 1997. Putting HIV prevention efforts in place we saw the rate drop to around 20% (2006)," explains Ishwar.

"Harm reduction groups from India to USA are harassed by the police at needle exchange sites and drug users are arrested attempting to access clean syringes. This simply makes users more likely to share needles. We need an environment that ensures that harm reduction strategies are not compromised and people can receive all the support they need to prevent themselves from contracting HIV and passing it to others," he said.

Notes

- HIV rates are just 1.1% in England and Wales among injecting drug users. In the USA where the federal government has not supported harm reduction approaches there is an estimated rate of 16%.

- 33 million people worldwide are estimated to be living with HIV.

- The International HIV/AIDS Alliance (the Alliance) is a global partnership of nationally-based organisations working to support communities to reduce the spread of HIV and meet the challenge of AIDS.

Managing HIV/AIDS And Predicting Treatment Success Via Hair Samples

2009-03-05T04:57:00.000-08:00

UCSF researchers have found that examining levels of antiretroviral drugs in hair samples taken from HIV patients on therapy strongly predicts treatment success.

The findings, published in the February 20 issue of AIDS, note that the levels of antiretrovirals found in the hair of patients on treatment correlated strongly with levels of HIV virus circulating in patients' blood.

"High levels of antiretrovirals in hair correlated with success in HIV viral suppression in treatment and did so better than any of the other variables usually considered to predict response," said the study's primary investigator, Monica Gandhi, MD MPH, assistant professor of medicine at UCSF's Positive Health Program at San Francisco General Hospital.

Typically, clinicians rely on either self-report by patients, pill counts or expensive medication dispensing devices to monitor how well patients are taking their pills as directed. These methods are highly patient dependent and have not been good predictors of treatment success.

Clinicians can draw blood and then measure plasma levels of medications, but since a single plasma level represents medication exposure only hours prior to the blood draw, this method has also not been a good predictor of viral suppression, according to Gandhi. Single drug levels can vary day-by-day for a single patient and may reflect improved pill-taking by patients just before clinic visits, she said.

Hair, which grows at a rate of about a centimeter a month, gives a reading of drug levels that reflects the rate of pill consumption sustained by patients over weeks, not days. Assessing an average level of drug exposure over time may be more predictive of treatment response than the "snapshot" of exposure provided by a single plasma level of medication, Gandhi said.

"Hair sampling for antiretroviral levels could become a new standard to look at how much drug a patient is getting - an equivalent in HIV clinical care of measuring hemoglobin A1C, the method used in diabetes to monitor average blood glucose levels," said study co-investigator, Ruth M. Greenblatt, MD, UCSF professor of clinical pharmacy and principal investigator of the Women's Interagency HIV study.

Researchers took 10 strands of hair from patients on HIV therapy from the back of the head. They cut the hair sample close to the scalp underneath the top layer of hair, marked the part farthest from the scalp with tape and wrapped the strands in aluminum foil. The sample was then stored at room temperature in a plastic bag until it was analyzed.

"This is a painless, bloodless, biohazard-free, method of collecting a stable specimen from HIV patients that may allow for the monitoring of levels of antiretroviral drugs absorbed over time and the prediction of treatment success," said Gandhi. "Our next step is to test this method in resource-limited settings where blood collection and viral load monitoring may be expensive and difficult. Not only could this method help in measuring pill-taking, but its strong correlation with viral suppression could allow its use as an inexpensive, non-invasive method of monitoring treatment success in particularly challenging settings."

Researchers from this group are also collaborating with public health researchers in testing hair to monitor pill-taking in clinical trials of single or dual antiretrovirals in high risk, HIV negative individuals to prevent infection with HIV (pre-exposure prophylaxis, known as PrEP, trials).

The 224 patients in this study were drawn from the Women's Interagency HIV study, an ongoing multi-center, prospective study of HIV-infected and at risk uninfected women established in 1994.

"Women taking antiretroviral medications may have more adverse events than men taking these regimens. The safety trials of these medications were conducted in trials consisting largely of men, and the highest tolerable amount of drug in order to successfully suppress HIV is usually recommended. One foreseeable use of this technique may be to fine-tune the amount of drug prescribed. We could measure drug levels in hair, find the level correlating with viral suppression, and then reduce the amount of drug prescribed if it was at a point exceeding the level needed for viral control, hopefully reducing toxicities," said Gandhi.

HIV Rates Surprisingly High In The Over 50s

2009-03-04T10:33:00.000-08:00

A new report suggests that HIV infection and prevalence rates are surprisingly high among older people, who seem to have been completely ignored by research and surveillance, perhaps because we don't assume they are at risk. However this also means that many cases of HIV among the over 50s go undiagnosed. The authors said more research is needed to identify the risk factors for HIV infection among older people.

These are the conclusions of scientists working for and on behalf of the World Health Organization (WHO) whose findings were published in the Bulletin of the World Health Organization earlier this week.

There is little data on how many people over the age of 50 are infected with HIV (ie prevalence), as this age group is rarely included in health surveys.

Data on HIV incidence rates among older people is also scarce (incidence is new cases per year whereas prevalence is how many people have a disease).

While developing countries have limited case reporting systems, the authors wrote that as far as identifying HIV rates in older people, industrialized countries aren't much better. However, what data there is suggests incidence of HIV in older people is rising, mostly from information gathered in the US.

To start shining some light in this rather dark corner of our public health awareness, the authors calculated incidence and prevalence of HIV among older people using what information they could get hold of.

For example, using the UNAIDS estimate of HIV cases and population numbers by country, they found a consistent pattern: HIV prevalence in people aged 50 and over was between 25 and 33 per cent of that among people aged 15 to 49.

The authors wrote that after some debate, most of them decided this was a surprising finding.

Figures from Africa show that in many regions, a second peak of HIV incidence appears in the older age group.

When the authors looked in the literature for explanations of how older people become infected with HIV they found only one small study.

We know very little about the sexual habits of older people in the developing world. There is some evidence that many older people throughout the world are sexually active, although interest and frequency of vaginal intercourse does wane with age, wrote the authors.

Much research shows that older people are less likely to practise safe sex compared to younger age groups, and there is some evidence from industrialized countries that use of erectile dysfunction drugs is linked to risky sexual behaviour, and there have been debates about whether men who are HIV-positive should be given these drugs.

If the scant data is to be believed, and the main cause of HIV infection in older people is sex, but they are not having intercourse as frequently, then this suggests older people are more vulnerable to the virus: their chance of becoming infected each time they have sex is much higher than for their younger couterparts.

One biological reason could be that the wall of the vagina gets thinner as women get older, making it easier for the virus to get into the bloodstream.

However, the authors emphasized that while sexual activity was probably the most likely way, more research was needed to find out the relative risks of the different ways older people acquire HIV.

There is however, a consistent failure among health professionals to consider HIV as a cause of illness among older patients, said the researchers.

Older people diagnosed with HIV progress to AIDS much faster, and this could be partly because of age but also because they are not diagnosed as early as their younger counterparts, who are also more likely to be screened for the virus.

The authors concluded that:

"HIV prevalence and incidence in the over-50-year-olds seem surprisingly high and the risk factors are totally unexplored."

"Understanding the epidemiology of HIV infection in older individuals can lead to interventions to make these years safer and more enjoyable," they added.

Miami Herald Examines Efforts To Improve HIV/AIDS Knowledge Among Young People

2009-03-04T10:32:00.000-08:00

The Miami Herald on Monday examined efforts to improve HIV/AIDS knowledge among young people and combat the stigma associated with the disease. According to the Herald, the effectiveness of modern antiretroviral drugs has created the perception among some young people that HIV/AIDS is not a fatal condition. Charles Martin, director of the South Beach AIDS Project, said, "In the '80s, you'd see people losing weight and becoming gaunt. People called [HIV/AIDS] a death sentence." However, young people today who "haven't seen the devastation begin to look at AIDS as a manageable condition," Martin said.

According to Martin, some young people decide not to use condoms because they "just get tired of all the precautions." He continued, "They think they've missed the intimacy. They say, 'I don't want that barrier anymore.'" In addition, some young people continue to have misperceptions about HIV risk factors, according to Martin. He said, "We still have to overcome the idea that HIV is linked only to the gay community. It's especially true in the black community. They think they will never get it if they're not gay."

Damaries Cruz, an HIV/AIDS educator with the Miami-Dade Health Department, is working with local journalism students at Florida International University to produce a four-part series of Web-based episodes called "The Stigma Stops With Me." The aim is to combat HIV/AIDS stigma and misperceptions among young people. Cruz also is part of the Spanish language "SOY..." ("I AM...") campaign launched last year by Univision and the Kaiser Family Foundation, which uses personal stories of Hispanics living with HIV/AIDS and their loved ones to reach out to the Hispanic community. Leilani Laureano, a FIU student, said that HIV/AIDS is taboo in the Hispanic community, where many people believe that only men who have sex with men, commercial sex workers and injection drug users have HIV.

According to the Herald, Florida in 2007 reported 6,235 new HIV cases and 1,747 AIDS-related deaths. According to the Florida Department of Health, Fort Lauderdale ranked third for new HIV cases in U.S. urban areas in 2007, with Miami ranking fourth and Palm Beach ranking 11th (Tasker, Miami Herald, 3/2).

AFP/MSN.com Examines Hospice For HIV-Positive People In Thailand

2009-03-04T10:31:00.000-08:00

The Wat Phra Baht Nam Phu temple, a hospice for people living with HIV/AIDS in Thailand, has provided care to more than 10,000 HIV-positive people out of the estimated 610,000 people living with the virus in the country, the AFP/MSN.com reports. People often come to the temple anonymously and without notice, according to AFP/MSN.com. The hospice was founded 17 years ago as a place to care for HIV/AIDS patients, many of whom face discrimination because of the high amount of stigma surrounding the disease. People can access some medical services, and the temple's principles are "steeped in its Buddhist faith," AFP/MSN.com reports.

One Indian nurse and one Cambodian doctor -- who is not permitted to prescribe medicines -- care for 120 residents and 300 non-resident patients. In emergency cases, patients are sent to a nearby hospital to receive antiretroviral treatment. The temple's clinic workers attempted to hire more doctors by appealing to nearby hospitals and the health department, but they had no applicants. Ching Thangsing, the nurse who works at the clinic, said, "I think [doctors] are afraid of HIV, they don't want to work with HIV-positive patients." The temple aims to combat the stigma surrounding the disease by welcoming school groups to its museums and monuments, as well as to a shrine that contains the ashes of 10,000 former residents. Japanese volunteer Katsumi Suzuki said, "This is a very unique place. It crosses the area between Buddhism and medicine" (Truscott, AFP/MSN.com, 2/28).

HIV/AIDS Posing Risks To Economy, Social Development In South Asia, Report Says

2009-03-04T10:30:00.001-08:00

Countries in South Asia face serious economic and social development risks from HIV/AIDS, according to a World Bank report released Friday, the Times of India reports. The report, titled "HIV and AIDS in South Asia: An Economic Development Risk," said that even if the overall prevalence of the disease is low, there still could be high and rising prevalence among vulnerable groups, such as commercial sex workers and their clients, and injection drug users and their partners (Times of India, 2/28). The report said, "Without increasing prevention interventions among those at highest risk, these concentrated epidemics can further escalate." Sadiq Ahmed, the World Bank's acting chief economist, said the report's analysis "shows that failure to contain the epidemic at low levels may have serious economic consequences."

According to Asia Pulse/Individual.com, the report also said that access to HIV/AIDS prevention and treatment is linked with socioeconomic factors -- such as gender, education and wealth -- and that people's ability to cope with the financial impact of HIV/AIDS differs significantly. For example, the report says that HIV-positive widows face a disproportionate economic impact because of their HIV-positive and low socioeconomic status.

In addition, failure to contain the epidemic in South Asia could result in high costs related to treatment, the report said, adding that access to effective treatment is "vitally important to mitigate the health and economic impacts" of HIV/AIDS. The medical costs of treatment can put a significant portion of the HIV-positive population at risk of poverty, "especially in a region where most health services are paid for out of pocket," Asia Pulse/Individual.com reports. The report said that, with the exception of Sri Lanka, 75% or more of health expenditures in South Asia are financed privately and very little are paid for by third-parties like insurance companies.

According to the report, although the effect of HIV/AIDS on countries' overall level of economic activity is small, the impact of direct welfare costs because of increased mortality and lower life expectancy are more considerable. In addition, the economic impact of HIV/AIDS on individual households is substantial, the report found. For example, a household survey in India found that 36% of HIV-positive people who were able to retain employment still reported an average income loss of about 9% (Asia Pulse/Individual.com, 3/2).

Mariam Claeson, the World Bank's HIV/AIDS coordinator for South Asia, said that there "cannot be any room for complacency," even in countries with low HIV/AIDS prevalence rates. Claeson said that although the impact of HIV/AIDS "on economic growth is small in South Asia, the welfare cost on households is by no means negligible." She added that HIV/AIDS also has an "enormous disproportionate impact on vulnerable and often marginalized people at highest risk of infection, and on poor households with less access to information, preventive services and treatment" (Times of India, 2/28).

'Sesame Street' Program In Nigeria Aims To Spread HIV/AIDS Awareness Messages To Children

2009-03-04T08:59:00.000-08:00

The television show "Sesame Street" is launching a program in Nigeria -- called "The Adventures of Kami and Big Bird" -- that aims to teach children about HIV/AIDS, the Sunday Tasmanian reports. Supported by funding from the United States, the program will include original videos and workbooks. Kami -- a character from the South African version of the show, called Takalani Sesame -- is HIV-positive and also is an AIDS orphan. She aims to teach children how to deal with loss and grief using a child-friendly approach. The show is expected to reach 30,000 children in Nigeria, many of whom are orphans or vulnerable children. Educational consultant Ayobisi Osuntusa said that there are about 240,000 HIV cases reported among children in Nigeria. He added, "Education about this disease and how to prevent it needs to begin in early childhood, and who better to construct groundwork for the future than the organization that set the gold standard for educational programming?" (Sunday Tasmanian, 3/1).

Cholesterol Medications Can Work Well Among Certain HIV Patients At Risk For Cardiovascular Disease, Findings Of Largest Study To Date

2009-03-03T08:52:00.000-08:00

A new study in the online issue of Annals of Internal Medicine has found that cholesterol medications can work well among certain HIV patients at risk for cardiovascular disease.

Though HIV patients are at higher risk for cardiovascular disease in part due to lipid abnormalities that can occur with the use of certain antiretroviral therapies, researchers now have evidence that cholesterol medications work very well in this population.

"This should be encouraging for patients and their providers," said the study's lead author Michael Silverberg, PhD, MPH, a research scientist with the Kaiser Permanente Division of Research in Oakland. CA. He explained that HIV Patients getting cholesterol-lowering treatments such as statins get slightly less benefit on cholesterol levels from the treatment as patients without HIV infection, but it is still a clinically significant benefit and side effects from the drugs occurred in very few patients.

In addition, say the researchers, the use of fibrates in combination with NNRTIs (a class of antiretroviral drugs) may be a good choice to manage triglyceride levels in HIV patients. Triglycerides are another fat in that blood that contributes to inflammation of the pancreas and may contribute to coronary disease, they explain.

The study, which appears in the March 3, 2009 online issue of the Annals of Internal Medicine, is the largest to date to compare the effectiveness and side effects of drugs to treat cholesterol problems in patients with and without HIV infection.

"The good news is lipid lowering therapy in HIV patients works, not quite as well as it does in patients without HIV, but close," explained Silverberg. Given the challenges for treating high cholesterol in HIV patients and the more aggressive target lipid goals for all patients, optimizing lifestyle factors like obesity and hypertension are also important factors to monitor for those with HIV infection, he added.

Researchers studied 829 patients with HIV infection and 6941 patients without HIV infection in the Kaiser Permanente health system that started cholesterol treatment during 1996 to 2005. The researchers compared changes in levels of low-density lipoprotein (LDL) cholesterol (bad cholesterol) and triglycerides (another fat in the blood) after the start of cholesterol treatment in patients with and without HIV infection. They also looked at liver and muscle-related side effects of cholesterol treatments and whether the cholesterol changes in patient with HIV infection were related to the types of HIV treatments patients were taking. Among patients taking statins, LDL levels declined only 3% less for HIV patients; however, among patients taking gemfibrozil, triglyceride levels declined 15% less for HIV patients. HIV patients taking both NNRTIs and gemfibrozil had identical triglyceride declines compared with those without HIV infection. Side effects of cholesterol treatments occurred in very few patients, but patients with HIV infection did have more changes in liver and muscle enzyme levels than patients without HIV infection.

Lancet Editorial Examines China's Response To HIV/AIDS

2009-03-03T08:50:00.000-08:00

Although the response to HIV/AIDS in China has evolved from "denial and inertia to pragmatic prevention and treatment programs," there still are "massive challenges" to addressing the disease in the country, a Lancet editorial says. Chinese health officials recently reported that in 2008, HIV/AIDS was the country's "leading killer among infectious diseases for the first time," the editorial says. It adds that although "[u]nder-reporting means that accurate figures on the country's epidemic are hard to come by," UNAIDS estimates that around 700,000 people are living with HIV in the country.

China has "committed resources and energy to tackle the epidemic, which deserve praise," according to the editorial. A nationwide program launched in 2003 provides no-cost testing; no-cost counseling and antiretroviral treatment for rural residents; no-cost medication for all HIV-positive pregnant women; no-cost education for AIDS orphans; and care for impoverished people living with the disease, the editorial says. In addition, the government recently launched awareness and safer-sex campaigns focusing on the heterosexual transmission of HIV -- which has become the main mode of transmission in the country -- according to the editorial. However, "the size of the country and its population and the decentralized system of government make universal access to testing, treatment and prevention, and the communication of public health messages, extremely difficult," the editorial says. It notes that additional challenges in communicating the risks of HIV/AIDS include "[c]ultural sensitivities to discussing sex and the stigma attached to homosexuality," as well as human rights, which remain "a problem." The editorial concludes that the "success of China's HIV control efforts will depend on how the country's response continues to evolve to meet these challenges" (Lancet, 2/28).

Indonesia Creates Budget Forum To Address HIV/AIDS Spending Issues

2009-03-03T08:48:00.000-08:00

The Indonesian government has established a Forum of HIV/AIDS Control Planning and Budgeting to address the country's issues with providing adequate funding for the disease, Arum Atmawikarta, director of health and public nutrition at the Office of the State Minister for National Development Planning, announced recently, Asia Pulse/Individual.com reports. The country has funded 41% of the 1.5 trillion Indonesian rupiah -- or about $125.5 trillion -- needed to address HIV/AIDS in the country through national and regional budget allocations. An additional 40% of HIV/AIDS funding has been provided by foreign donors, but such funding is not continuous, according to the state minister's office. The remaining 19% has not been met because of limited funding, Asia Pulse/Individual.com reports.

Atmawikarta said that officials hope the "forum would be able to overcome the fund constraint so that the HIV epidemic in the country could be immediately curbed." She said that the "mechanism of work of the forum will be adapted to the cycle of planning and budgeting process at national and regional levels," adding that the forum aims to optimize HIV/AIDS efforts. Atmawikarta said the number of HIV/AIDS cases in Indonesia is increasing annually (Asia Pulse/Individual.com, 2/26).

New Monkey Model For HIV

2009-03-03T08:41:00.000-08:00

By altering just one gene in HIV-1, scientists have succeeded in infecting pig-tailed macaque monkeys with a human version of the virus that has until now been impossible to study directly in animals. The new strain of HIV has already been used to demonstrate one method for preventing infection and, with a little tweaking, could be a valuable model for vetting vaccine candidates.

A team of researchers led by Paul Bieniasz and Theodora Hatziioannou at The Rockefeller University showed that two pig-tailed macaques, given a common antiretroviral treatment one week before and one week after being exposed to the newly engineered HIV, had no signs of infection. "We're not saying we can save the world with antiretroviral pills. But this model will allow us to start studying the best way to administer prophylaxis and do other experiments on preventing HIV-1 infection that could not be easily done on humans," says Bieniasz, head of the Aaron Diamond AIDS Research Center Laboratory of Retrovirology at Rockefeller and a Howard Hughes Medical Institute investigator.

The findings, published in the Proceedings of the National Academy of Sciences, show that the engineered virus injected into a pig-tailed macaque initially spreads almost as ferociously as it does in people and the virus remains detectable for at least six months. But it does not make the monkeys sick. Rather, it behaves as it is thought to behave in a group of HIV-positive people whose exceptional immune systems are generally able to keep the virus in check. These fortunate few are called long-term nonprogressors.

The animal model grew out of years of research into the molecular cloak-and-dagger fight between HIV and the cells of the host it infects. In particular, Bieniasz, who is also a scientist at the Aaron Diamond AIDS Research Center, Hatziioannou and colleagues have studied two groups of rapidly evolving genes, APOBEC3 and TRIM5, which produce unusual classes of defensive proteins with distinctive capabilities to fight retroviruses such as HIV. These genes, shared by humans and their simian forebears, have evolved mutations specific to each species' unique history of retroviral battles. In most simians, the APOBEC3 and TRIM5 proteins actually kill HIV on sight, making it impossible for researchers to study the virus in an animal model. Instead, they have studied HIV's cousin, simian immunodeficiency virus (SIV), which causes an AIDS-like disease in certain monkey species. But SIV shares only about half of its amino acid sequence with HIV, making it a very imperfect substitute for testing anti-HIV drugs and vaccines. Several labs have engineered hybrids called SHIVs - SIVs that contain pieces of HIV DNA - but these have problematic differences, too.

Now, Bieniasz and Hatziioannou, working with Vineet KewalRamani and Jeffrey Lifson at the National Cancer Institute in Maryland, have developed a strain they call simian-tropic HIV-1 (stHIV-1), which shares about 95 percent of its genome with the human version. It differs only in the one HIV-1 gene that fails to deal with the pig-tailed macaques' APOBEC3 defenses. (The scientists did not need to overcome their TRIM5 defenses because macaque TRIM5 proteins are extremely unusual and not effective against HIV). The new research marks a major advancement of experiments the Bieniasz and Hatziioannou team published in 2006 that showed that HIV engineered to hide from both the APOBEC3 and TRIM5 proteins in rhesus macaques could grow in their cells, at least in a test tube. But that strain's growth was poor, and it failed to take root in the actual animals.

The new virus, stHIV-1, spreads almost as quickly after injection as HIV-1 initially does in humans and it persists for several months, after which it is controlled. Bieniasz and colleagues showed that that control is in part thanks to a specific class of immune system T cells that if blocked, allow a resurgence of the virus. The team demonstrated the use of the model by showing that a commonly used antiretroviral drug combination taken briefly before and after an injection of two million infectious units of stHIV-1 effectively protected the monkeys from the virus.

Though the work is an important advance, for stHIV-1 to be useful for testing vaccines, the scientists must modify the protein envelope that surrounds the virus so that it targets the same set of immune cells in monkeys as it does in humans. In addition, says Hatziioannou, an assistant professor at ADARC, they want the infection to run its full course and cause disease, to make it as faithful to HIV-1 as possible. "This model, even as is, should be useful for studying pre- or postexposure treatments," she says. "But to have a really authentic model, we need to make it pathogenic, to make it hotter."

Obama Names Director For Office Of National AIDS Policy

2009-03-02T09:21:00.000-08:00

President Obama on Thursday named Jeffrey Crowley -- a senior research scholar at Georgetown University's Health Policy Institute and former deputy executive director for programs at the National Association of People with AIDS -- as the director of the Office of National AIDS Policy, the Washington Post's "Cast of Characters" reports. As director, Crowley will be responsible for coordinating the federal government's efforts in curbing the spread of HIV through education programs, in addition to coordinating treatment efforts for people living with the virus. He also will serve on the president's Domestic Policy Council and help guide the Obama Administration's disability policies. Obama said, "Crowley brings the experience and expertise that will help our nation address the ongoing HIV/AIDS crisis and help my administration develop policies that will serve Americans with disabilities" (Stein, "Cast of Characters," Washington Post, 2/26).

During his time at NAPWA, Crowley helped implement major initiatives, including National HIV Testing Day and the Ryan White National Youth Conference. Crowley has expertise in Medicaid policy, including Medicaid prescription drug policies, and Medicare policy. He also has experience in consumer education and training. Crowley has spent the last fourteen years in efforts to improve access to health and social services for people living with HIV/AIDS, people with physical and mental disabilities, low-income individuals and other groups (Rhee, "Political Intelligence," Boston Globe, 2/26). Rep. Barbara Lee (D-Calif.) -- chair of the Congressional Black Caucus -- welcomed Crowley's appointment and said, "We need a national AIDS strategy to better coordinate and guide our response to this devastating disease" (AP/Google.com, 2/26).

VOA News Profiles HIV/AIDS Counselor Who Works In Washington, D.C.

2009-03-02T09:20:00.000-08:00

VOA News on Wednesday profiled Pernell Williams, an HIV/AIDS counselor in Washington, D.C., who provides HIV testing and counseling at the Whitman-Walker Clinic's Max Robinson Center. The D.C. Department of Health reports that 80% of HIV/AIDS cases in the city occur among blacks. Williams provides help to people who test positive by guiding them to other HIV services in the clinic and the community. In addition, he provides counseling on HIV prevention and risk reduction.

Williams said that in parts of the district, few people are aware of their HIV status. He said, "My passion as part of my job is to get as many people to be tested as possible," adding that many people, particularly minorities, "do not even believe they could have [HIV] because they still think it is just a gay, white men's disease, and it could not be further from the truth." Williams said that it is his goal to help people living with the disease to live more productive lives, although overcoming the stigma remains difficult. Williams added that HIV/AIDS is a "serious illness, but it is not a death sentence" and that many HIV-positive people are living longer. He advises clinic visitors on the best ways to reach others in the community and uses a two-part approach that combines counseling and group therapy for HIV-positive people. Williams said, "If we can change things here, if we can make a difference on this corner, in this ward, in this city, then the reverberations can help the entire country," adding, "And in fact, we can help rid the world of HIV and AIDS" (Maroney, VOA News, 2/25).

Fighting HIV/AIDS In The Lab And On The Phone With Cutting-Edge AmfAR Grants

2009-03-02T09:19:00.000-08:00

Most parents of teenage children have experienced frustration at their sons' and daughters' obsession with text messaging. But what if this ubiquitous technology could be used to save lives? At the University of Dar es Salaam in the East African nation of Tanzania, a country where few have landlines but most own a cell phone, that is precisely what Dr. Joyce Nyoni is trying to do.

amfAR, The Foundation for AIDS Research, has announced that it will fund three projects, including the work of Dr. Nyoni, that are harnessing social networking technologies to prevent the spread of HIV infection. Dr. Nyoni will recruit a small number of men who have sex with men (MSM), who in turn will recruit other MSM, to receive and send regular text messages containing HIV/AIDS information. At the end of her study, Dr. Nyoni will assess the changes in knowledge and behavior that she hopes will result from the program. In addition to searching for novel ways to prevent HIV infection, at the other end of the research spectrum amfAR announced the award of six new grants for innovative biomedical research studies aimed at advancing the treatment and cure of HIV/AIDS.

On the 200th anniversary of Charles Darwin's birth, it is fitting perhaps that one of the grantees will use our deepening understanding of evolution to identify new targets for anti-HIV drugs. Dr. Sara Sawyer of the University of Texas at Austin will base her study on the Red Queen hypothesis, which suggests that organisms must continue to evolve just to keep up with the other organisms that surround them. Arguing that mutations in cell proteins that compromise HIV's ability to grow will be favored over time, Dr. Sawyer hopes to identify those that show the greatest promise as drug targets.

A third group of awards is allocated specifically to younger scientists who often have the greatest difficulty finding support for their work but who represent the long-term viability of AIDS research. Four of these Mathilde Krim Biomedical Research Fellowships were awarded for a total of close to $500,000. Only in its second year, the Krim Fellowships have already yielded spectacular results. In January alone, three Krim Fellows authored papers in leading scientific journals describing novel strategies for vaccine development, drug design, and prevention of heterosexual transmission of HIV. The new Fellowship recipients will examine viral latency and new targets for microbicide and anti-HIV drug development.

"HIV does not slow down in a recession," said Dr. Rowena Johnston, amfAR's vice president and director of research. "In fact it's more important than ever to fund projects with the potential to help those who are hit hardest in times like these. These new awards focus on the fundamental needs of the field of HIV/AIDS research: new prevention technologies, new treatments, recruitment of young researchers, and progress towards a cure."

Obama's FY 2010 Budget Emphasizes Commitment To PEPFAR, Increases Resources For Domestic HIV/AIDS Prevention, Treatment

2009-03-02T09:18:00.000-08:00

President Obama on Thursday released his $3.55 trillion budget proposal for fiscal year 2010, the San Francisco Chronicle reports. According to the Chronicle, the proposal emphasizes the commitment to the President's Emergency Plan for AIDS Relief and other global health programs (Coile, San Francisco Chronicle, 2/27).

According to the New York Times, the $51.7 billion allocated in the budget for the State Department and foreign assistance is "purposely vague" because the administration is working to "figure out its overseas spending priorities during an economic crisis at home," some experts said. Obama's proposal for the department and foreign assistance is an almost 10% increase over the FY 2009 budget of $47.2 billion, which the White House says places the U.S. "on a path to double foreign assistance," although the budget does not provide a timeframe. The Times reports that the Obama administration might be "rethinking" some international issues, such as global health. According to Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies, this could include PEPFAR. According to Morrison, he expects the Obama administration will continue to provide antiretroviral drugs to those already receiving them from the U.S. "on ethical and moral grounds." However, he added that Obama might shift funding to other infectious diseases, such as malaria and tuberculosis, or other health issues such as family planning or clean water. Morrison added that promoting foreign aid in the U.S. could be difficult because of the current economic situation. "There's going to have to be a strong case made," he said, adding that "these investments have concrete, verifiable impacts on people's lives" (Gay Stolberg, New York Times, 2/27).

The AP/Google.com reports that Obama's budget proposal pledges to increase resources to domestic HIV/AIDS prevention and treatment, although a specific amount was not included (AP/Google.com, 2/26). The budget also notes the increased resources for domestic HIV/AIDS efforts will have a particular focus on underserved populations (FY 2010 budget, 2/26).

FDA Halts Reviews Of Pending Ranbaxy Applications, Cites Fraudulent Lab Tests

2009-03-02T09:17:00.000-08:00

FDA on Wednesday halted its review of all pending applications from India's Ranbaxy Laboratories, citing fraudulent laboratory tests dating back to 2006, the Washington Post reports. This is the second sanction against Ranbaxy in six months -- officials in September 2008 blocked the company from importing some drugs made at its plants in Dewas and Paonta Sahib (Layton, Washington Post, 2/26). Ranbaxy manufactures generic antiretroviral drugs used in the U.S. and in the President's Emergency Plan for AIDS Relief, as well as other generic drugs (Kaiser Daily HIV/AIDS Report, 9/17/08).

According to the Post, FDA investigators said the current problems concern the company's plant in Paonta Sahib, which has produced 25 FDA-approved drugs. Most of those drugs are not believed to be carried in U.S. pharmacies, and FDA is not seeking a recall on the medications because regulators do not believe the drugs post a health risk. The affected drugs include medications for high cholesterol and an antihistamine, but FDA would not provide a specific list, the Post reports. Deborah Autor, director of compliance at FDA, said there is "no concern about the safety or efficacy of Ranbaxy's drugs on the U.S. market." However, federal officials said they were concerned enough by their investigation into the plant that they decided to stop approvals of any new or pending applications for Ranbaxy's drugs. If Ranbaxy improves its manufacturing process the agency will resume approvals, Autor said. Douglas Throckmorton, deputy director of FDA's Center for Drug Evaluation and Research, said patients using the drugs should not stop their treatment (Washington Post, 2/26).

According to the Newark Star-Ledger, FDA said the company did not properly test the shelf-life and other safety measures of its drugs and then lied about the results. Ranbaxy said in a statement that it will "continue to cooperate with" FDA and that "[n]o effort or action will be spared to protect key (new drug applications) from Paonta Sahib" (Todd, Newark Star-Ledger, 2/26).

BMS Pulls AIDS Diarrhea Ad Campaign, Says AHF

2009-03-02T09:11:00.000-08:00

Drug giant Bristol-Myers Squibb (BMS) appears to have pulled a controversial print advertising campaign focusing on diarrhea in HIV/AIDS patients that critics say was designed to mislead and frighten patients in an attempt to recruit them away from other manufacturers' HIV/AIDS drugs to BMS' own similar medications. BMS' move comes on the heels of the publication of a parody of the ad criticizing Bristol-Myers Squibb's AIDS drug advertising tactics that was created by AIDS Healthcare Foundation (AHF) (http://www.aidshealth.org), the largest non-profit HIV/AIDS organization in the US. AHF's parody has been published in some of the same media outlets where BMS' original AIDS diarrhea ad campaign ran.

The original BMS ad features a full page image of a toilet piled high with magazines with the ominous headline, "Living with HIV doesn't mean you have to live here." The BMS ad also encourages patients to "Ask your doctor if there are HIV medications with a low risk of diarrhea."

In its parody, AHF lampoons BMS' misleading and fear-based patient recruitment advertisement that has been running in targeted gay and AIDS-related press outlets nationwide. AHF's parody uses the original BMS ad as a template with a 'black box' warning superimposed over the top right corner of the ad with a clear notation that the parody is, "A public service announcement from AIDS Healthcare Foundation." AHF's public service announcement plays off the BMS ad's diarrhea-themed headline by adding the blunt sub-headline, "We don't give a crap how you live as long as you buy our drug!"

"Bristol-Myers Squibb's ad is a blatant attempt to scare and mislead patients and interfere in the doctor/patient relationship in an attempt to intimidate patients into switching to BMS' own HIV/AIDS drugs," said Michael Weinstein, President of AIDS Healthcare Foundation. "AHF opposes such deceptive so-called 'help-seeking' advertising tactics and we will continue to educate HIV/AIDS patients to the manipulative, fear-based patient recruitment tactics that BMS is using."

"This BMS ad campaign injects confusion and profit motives into medical decisions that should be made based solely on one's medical needs and through conversations and collaboration between health care providers and their patients," said Homayoon Khanlou, MD, Chief of Medicine/US for AIDS Healthcare Foundation.

"We tweaked and spoofed the BMS ad so that it became a thought-provoking parody exposing the scare tactics used by BMS," added AHF's Weinstein. "We are glad that BMS has pulled its ad and hope our parody also serves as a catalyst to raise awareness about other questionable advertising tactics the drug industry employs to increase its profit margins."

To view an image of AIDS Healthcare Foundation's parody ad spoofing BMS, please visit: http://www.aidshealth.org

About AHF

AIDS Healthcare Foundation (AHF) is the nation's largest non-profit HIV/AIDS organization. AHF currently provides medical care and/or services to more than 96,000 individuals in 21 countries worldwide in the US, Africa, Latin America/Caribbean and Asia.

HIV Adapts To 'Escape' Immune Response

2009-03-01T09:27:00.001-08:00

The human immunodeficiency virus (HIV) adapts so well to the body's defense system that any successful AIDS vaccine must keep pace with the ever-changing immunological profile of the virus, according to researchers at the University of Alabama at Birmingham (UAB) and the University of Oxford in England.

A new study better describes HIV's ability to adapt by spelling out at least 14 different "escape mutations" that help keep the virus alive after it interacts genetically with immunity molecules that normally attack HIV.

The researchers analyzed genetic data from more than 2,800 HIV-infected patients on five continents. The findings are published online in the journal Nature.

"Key genetic regions of HIV introduced into individuals of different ancestry in different places have been evolving to a greater or lesser degree according to inherited factors controlling immune response," said Richard Kaslow, M.D., a professor in the UAB School of Public Health and a co-author of the study. "If HIV adapts differently in genetically distinct hosts, the challenge ahead in vaccine design is formidable," he said.

The researchers looked at different DNA variations of HIV in conjunction with different forms of human leukocyte antigen (HLA), a group of molecules that orchestrate immune response. Normally HLA molecules present fragments of HIV proteins on the surface of infected cells to the immune system, acting as a signal for HIV destruction.

The Nature study shows just how efficiently the virus evolves escape mutations that help infected cells avoid destruction, Kaslow said. HLA genes themselves vary considerably across populations, most likely due to many biological and environmental factors that researchers are just beginning to understand.

The future of vaccine exploration will need to address the escape mutation capacity and identify new drug targets that work against an ever-changing HIV immunology landscape, said Philip Goulder, M.D., a professor of immunology at the University of Oxford and the study's senior author.

The study was a partnership between researchers at UAB; the University of Oxford; Kumamoto University in Japan; the James Martin 21st Century School in Oxford, England; Royal Perth Hospital and Murdoch University in Western Australia; Massachusetts General Hospital in Boston; Emory University in Atlanta; the International Medical Center of Japan in Tokyo; Germans Trias i Pujol University Hospital in Badalona, Spain; the University of West Indies in Bridgetown, Barbados; the Botswana-Harvard School of Public Health AIDS Initiative in Gaborone, Botswana; the Imperial College in London; the University of KwaZulu-Natal in Durban, South Africa; the British Columbia Centre for Excellence in HIV/AIDS in Vancouver, Canada; the Howard Hughes Medical Institute in Chevy Chase, MD.

Funding came from the U.S. National Institutes of Health, the Wellcome Trust, the U.K. Medical Research Council, the U.K. National Institutes for Health Research Biomedical Research Centre Programme and the Mark and Lisa Schwartz Foundation.

Is HIV Testing During Labor Feasible?

2009-03-01T09:26:00.001-08:00

Cameroon is a sub-Saharan African country with high HIV rates yet many pregnant women do not know their HIV status. Research published in the open access journal BMC Pregnancy and Childbirth has shown that HIV testing during labour is a suitable way of improving detection rates and may help mothers and their infants receive appropriate antiretroviral treatment.

Eugene Kongnyuy of the Liverpool School of Tropical Medicine and his collaborators from the University of Yaounde I, Cameroon, investigated the acceptability of rapid HIV testing among 2413 women of unknown HIV status at four hospitals in the capital city, Yaounde. They found that 88.3% of the women were willing to accept HIV testing during labour. Furthermore, their study revealed a higher rate of HIV infection among women screened during labour (10.1%) than was previously estimated in a national health survey (6.8%) which, according to the authors, highlights the importance of HIV testing during labour.

About 3.2 million infants and young children worldwide are infected with HIV and in most cases the infection is a consequence of mother-to-child transmission (MTCT). Rapid HIV testing during labour or delivery represents the last opportunity for treatment before delivery to reduce MTCT. While this investigation has shown that HIV testing in the delivery room is feasible, it is nevertheless a challenging task especially in resource-constraint settings. The authors recommend "an opt-out approach for HIV testing during labour in Cameroon (i.e. women are informed that HIV testing will be routine during labour if HIV status is unknown but each person may decline to be tested). Such an approach will decrease the proportion of women who give birth with unknown HIV status and increase the number of mother-infant pairs who receive appropriate treatment for preventing MTCT of HIV".

The team propose that cost-effectiveness of HIV counselling and testing during labour is evaluated before the approach is implemented nationwide.

Diversity In Mental Health HIV/AIDS Research Critical, Says Commentary

2009-02-27T20:24:00.000-08:00

In a lead commentary for this special supplement to the Journal, the authors argue the importance of ensuring racial and ethnic diversity in HIV/AIDS research. The supplement focuses on the recent epidemiological trends associated with HIV infection in diverse populations. It also addresses the need for mentoring programs to study these disparities and to include the underrepresented work force within these mentoring programs. The authors stress the need to diversify the scientific work force, not just on the premise of fairness and equity, but also to ensure full participation by all Americans.

"Diversity in the research work force promotes research that is sensitive to and inclusive of the needs and concerns of underrepresented racial/ethnic groups," said the commentary's authors. "The evidence is quite clear: underrepresented racial/ethnic groups have relatively unmet needs for HIV care compared with less disadvantaged groups," they say. "There is a need for improvement in the research agenda so that promising practices and solutions can be identified, and the needs and concerns of underrepresented groups satisfactorily met."

[From: "The Case for Diversity in Research on Mental Health and HIV/AIDS" David M. Stoff, PhD, National Institute of Mental Health, Bethesda, Md].

The American Journal of Public Health is the monthly Journal of the American Public Health Association (APHA), the oldest and most diverse organization of public health professionals in the world. APHA is a leading publisher of books and periodicals promoting sound scientific standards, action programs and public policy to enhance health.

Perceived Racism Not A Barrier To HIV Testing For N.C. Blacks

2009-02-27T20:20:00.000-08:00

African-Americans who perceive racism whether subtle or overt might be more likely to accept readily available HIV testing, according to a study conducted in a county public health STD clinic in North Carolina. Although one might expect awareness of racism to be a barrier, it seemed to have the opposite effect.

"We were investigating the extent to which [study participants] believe that most blacks still experience racism," said lead study author Chandra Ford, Ph.D. "We wanted to understand whether they thought it was still prevalent, and if so whether this was a barrier to obtaining CDC-recommended HIV testing as has been hypothesized."

Ford is an assistant professor in the department of community health sciences at the UCLA School of Public Health. The clinic-based, multilevel study included 373 blacks seeking sexually transmitted disease diagnoses or screening. The study appears in the April supplement of the American Journal of Public Health.

Ford said that only about 6 percent of participants did not perceive everyday forms of racism (such as being followed by white clerks or security guards while shopping). Of interest, individuals who perceived racism were more likely to undergo HIV testing, even when controlling for other factors such as perceived risk of HIV infection.

"This study highlights the importance of moving away from a 'business as usual' approach to investigating health behaviors and treatment seeking behaviors," said Craig Demmer, Ed.D. "Health inequalities connected to race and racism are well established, but our constant preoccupation with looking to race as the definitive explanation or cause for a multitude of health behaviors and attitudes, including HIV/AIDS, is shortsighted."

Demmer, a professor in the department of health sciences at Lehman College at CUNY, said the findings serve as an important reminder "to look at the whole person and not make assumptions as to why a category of people feel and behave the way they do."

"Awareness of racism in the environment is not inherently a barrier to HIV testing," Ford said, "so it need not be something to avoid discussing." In fact, the greatest barrier might be that two-thirds of study participants believed they had a very low or no risk for HIV infection, despite seeking STD testing and despite 40 percent having symptoms.

Demmer noted that the study made no mention of sexual orientation and said that it is also important to look at how racism intersects with homophobia when it comes to attitudes to testing and treatment. "We need to be open to exploring factors associated with race, but also those that may extend beyond race to explain why some people may be more inclined to get tested for HIV than others," he said.

Effective Mentoring Critical To HIV/AIDS Research Efforts

2009-02-27T20:18:00.000-08:00

An innovative mentoring program at the UCSF-Gladstone Institute for Virology and Immunology Center for AIDS Research is providing vital support for the development of the next generation of HIV/AIDS researchers and clinician scientists.

Described in an article published in the American Journal for Public Health February 26 in the First Look section of the AJPH website, the program focuses on overcoming challenges faced by early-career investigators through several novel mechanisms.

"One key innovation adopted in our program is 'trans' mentoring. In this model, a mentee is paired with a mentor from a research discipline different from the mentee's. For instance, a mentee working in basic science is paired with a mentor who is doing either clinical or behavioral research. One advantage is to lessen potential conflicts of interest between mentee and mentor. Additionally, an important benefit in that it strongly encourages multidisciplinary research," said the article's co-author James S. Kahn, MD, UCSF professor of clinical medicine and co-director of the UCSF-GIVI CFAR's mentoring program.

One of the goals of the CFAR mentoring program is to support and create pathways for multidisciplinary HIV research. The three broad categories that mentors and mentees are divided into are basic research, clinical or translational research, and population or behavioral research.

Another significant innovation in the CFAR program lies in considering the role of the mentor.

"In the past, senior investigators mentored junior researchers without really considering what was necessary for successful mentoring. Our concept is that mentoring is a teachable skill. We focus on and help develop the specific skill set needed by a mentor to best assist an early-career investigator," said Kahn.

Open mentoring is an innovation that the CFAR mentoring program uses to support its goal of retaining early-career investigators and optimizing their productivity. Open mentoring is a strategy that provides mentoring to persons desiring mentoring and is contrasted with elite mentoring in which mentoring is provided to those investigators who have achieved early success.

"Deciding to reserve mentoring for the top strata of early-career researchers does not broaden the pool of investigators. By making mentoring open to any investigator doing HIV research, we find that we are providing career support to a more diverse group of individuals from a more diverse set of research disciplines," said the article's co-author, Ruth M. Greenblatt, MD, UCSF professor of clinical medicine and co-director of the CFAR mentoring program.

The authors note other goals of the mentoring program, including retaining early-career investigators and optimizing their productivity and assisting them with transitions as their careers progress.

"The National Institutes of Health is limiting grant resubmissions due to funding constraints. Our mentors assist in optimizing grant submissions and ensuring mentees have a strong career strategy with appropriate expectations. Moreover, mentoring can be extremely helpful in assisting early-career investigators with the complicated but essential balancing of personal time with career advancement," said Greenblatt.

Greenblatt observed that the NIH has placed particular emphasis on the challenges faced by clinician scientists and noted that the country risks losing an entire generation of these essential investigators.

"We hear similar concerns from clinician scientists. They mention lack of access to funding, lack of caring for them as individuals and lack of a collegial atmosphere. Our mentoring serves as an intervention to specifically address these problems," said Greenblatt.

Young People In Parts Of Costa Rica Have Limited Knowledge Of HIV/AIDS, Practice Unsafe Sex, Report Says

2009-02-27T20:16:00.000-08:00

Young people in Costa Rica's coastal cities of Limon and Puntarenas have limited knowledge of HIV/AIDS transmission and prevention methods, and many practice unsafe sexual behaviors, according to a report released Tuesday, Xinhua News Agency reports. Costa Rica released the report during an event launching an agreement between the government and UNICEF to implement a joint HIV/AIDS program targeting young people in the two cities.

For the study, researchers surveyed 800 young people between ages 13 and 18 in both cities. According to the report's findings, 52.5% of young people in Limon and 43.3% of young people in Puntarenas correctly identified HIV transmission routes. In addition, 26.5% of teenagers in Limon and 34.5% in Puntarenas correctly identified methods to prevent HIV transmission. A United Nations target calls for at least a 90% HIV prevention knowledge level by 2010, according to Xinhua News Agency.

The study also found that many young people in these cities practice unsafe sexual behaviors. About 59% of young people in Limon and 51.6% of young people in Puntarenas reported having sex before age 16, and 6.8% in Limon and 24.6% in Puntarenas reported beginning sexual activity at age 13. In addition, 27.7% of young people in Limon and 18.9% of young people in Puntarenas report using condoms during sex, the report said.

According to Marco Fournier, coordinator of the study, the report's findings are "worrying," because "there is a very low knowledge level and the teenagers barely have 40% of the information they need" to prevent HIV and other risks associated with unsafe sex. He added, "The problem is not the frequency the youngsters have sexual relations, but the conditions in which they have them -- with little knowledge, without condoms, one-off relations and with people older than they are." Fournier said he also is concerned about reports that 14% of young people in Puntarenas have had sexual relations against their will. According to Fournier, the study demonstrates the need for significant changes in Costa Rica's sex education programs (Xinhua News Agency, 2/24).

Illinois Law Requiring Officials To Report Identities Of HIV-Positive Students Could Be Amended

2009-02-27T20:15:00.000-08:00

A lawmaker in Illinois has proposed a bill (H.B. 0154) to amend a current statute that requires state or local health officials to report the names of HIV-positive students to school principals, the Daily Journal reports. The standing law also allows principals to reveal to school nurses the identity of HIV-positive students, as well as to reveal to teachers that there is an HIV-positive student in their class but not the identity of the student. State Rep. LaShawn Ford (D), the bill's sponsor, said the standing law has created privacy issues for the families of HIV-positive students. Parental consent is required for a person to review a student's health records, according to Annette Tyler, a registered nurse at Kankakee Junior High School.

The Illinois House rejected a similar bill to revoke the standing law in 2008. Rep. Shane Cultra (R), who voted against the 2008 bill, said the current law is acceptable if principals use discretion when reporting students' health information. However, Wendy Kelly, executive director of AIDS Project Quad Cities, said that the law could discourage testing if people are uncertain about where their health information will be disseminated. She said that young people must continue to use education and testing to address the stigma associated with HIV/AIDS, adding, "There's still a stigma, but the adolescents are more open about it than the adults. They can actually tell you more about how HIV is transmitted." According to state Department of Health data, there are 500 HIV cases reported among people younger than age 19, with 164 cases of AIDS reported among the same age group.

Kimberly Lisanby-Barber, principal of the Lincoln School in Spring Valley, said that principals must perform a balancing act between confidentiality and public safety. Illinois is one of five states requiring disclosure of a student's HIV-positive status to school officials under the 1987 law that is under debate. Sheila Grogan -- a regional president for the Illinois Association of School Nurses for DuPage, Will and Kankakee counties -- said a requirement that compels school officials to know how to prevent the spread of HIV makes the 1987 law outdated. She said, "Overall, people are more aware now about communicable diseases. Risk factors are much more well-known and understanding of AIDS itself has grown." Federal law requires all school workers to annually review steps for the handling and disposal of fluids, according to the Journal (Lee, Daily Journal, 2/24).

NPR Profiles Two Kenyan Brothers' Efforts To Provide Health Services In Home Village

2009-02-27T20:14:00.000-08:00

NPR's "News and Notes" on Tuesday profiled two brothers, originally from a village in western Kenya, who returned to the village after attending medical school at Dartmouth College to build and operate a local health clinic to provide services such as HIV/AIDS, tuberculosis and malaria treatment. Milton Ochieng said that after seeing "the difficulties in people accessing health care" in their village while growing up and having both parents die from AIDS-related causes, he returned with his brother to open a clinic that provides "public health interventions," including vaccinations and child immunizations. He reported that the clinic has seen more than 30,000 patients, 85% of whom have been treated at no cost. He said that the government plans to partner with the clinic to bolster community outreach efforts, adding, "We are hoping to break ground on the maternity wing and an HIV wing so that we can provide more comprehensive care to the community."

According to Fred Ochieng, curbing the spread of HIV in Kenya will require "interventions on different levels." He added that the clinic has used soccer, which has a large following in the country, to provide HIV/AIDS education through tournaments to "bring people together to talk about ways to raise HIV awareness" and "answer the questions that the young people do have about HIV." Fred Ochieng said that he is excited about the "potential" of President Obama's plans to support HIV/AIDS efforts in Africa. He added that there has been a "feminization of HIV/AIDS" and that support is needed for agriculture, sanitation and health care delivery (Cox, "News and Notes", NPR, 2/24).

WHO Approves Heat-Stable, Generic Version Of Abbott's Kaletra

2009-02-27T20:13:00.000-08:00

The pharmaceutical company Mylan on Wednesday announced that the World Health Organization has approved its heat-stable, generic version of Abbott Laboratories' antiretroviral drug Kaletra, the AP/MSNBC reports. According to the company, the drug was approved under WHO's prequalification program. Kaletra is sold under the name Aluvia in developing countries, and the generic version combines lopinavir and ritonavir. India-based generic drug firm Matrix Laboratories will manufacture to drug (AP/MSNBC, 2/25). According to a Mylan statement, the approval allows the company to market 200 mg and 50 mg doses of the drug in most countries outside the U.S. and Europe (Bondre, Reuters India, 2/26). Because the drug is designed to be heat-stable and low-cost, it is more practical for distribution in countries with warm climates, according to the AP/MSNBC (AP/MSNBC, 2/25).

Vietnamese Program Aims To Involve Society In HIV Prevention Efforts

2009-02-27T20:11:00.000-08:00

A new Web site aimed at providing HIV-positive people with a forum to share information with each other and the community launched last week in Vietnam as part of a project that aims to increase society's overall involvement in the country's fight against HIV/AIDS, the VNA/TMCNet reports. Khuat Thi Hai Oanh, a project officer, said people typically focus on prevention and safety regarding HIV-negative people when discussing prevention, adding that they do not appreciate the role HIV-positive people can play in such efforts. She also said that social workers in the field of HIV prevention have said that people living with the virus are usually the object of intervention, rather than the subjects of change.

According to VNA/TMCNet, experiences in countries like Thailand and Cambodia have indicated that people living with HIV/AIDS who play an active role in prevention efforts are crucial to success. In Vietnam, there have been clubs and networks geared toward helping people living with HIV/AIDS lead healthy lives and prevent the spread of the disease. The project that designed the Web site was launched in July 2007 and is dedicated to preventing the spread of HIV/AIDS through communication and information, as well as calling for the involvement of society as a whole -- particularly those living with HIV. The project is funded through a partnership between the Ford Foundation, the Institute for Social Development Studies and the "For a Bright Future" network.

Ministry of Health data indicate that HIV cases have been reported in all 63 of Vietnam's provinces and cities throughout the country and that 84% of people living with HIV/AIDS are between ages 20 and 39 (VNA/TMCNet, 2/24).

What is Infertility ?

2008-11-04T09:30:00.000-08:00

Infertility primarily refers to the biological inability of a man or a woman to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term. There are many biological causes of infertility, some which may be bypassed with medical intervention.

Is infertility just a woman's problem?

No, infertility is not always a woman's problem. In only about one-third of cases is infertility due to the woman (female factors). In another one third of cases, infertility is due to the man (male factors). The remaining cases are caused by a mixture of male and female factors or by unknown factors.

What causes infertility in men?

Infertility in men is most often caused by: (i) problems making sperm -- producing too few sperm or none at all (ii) problems with the sperm's ability to reach the egg and fertilize it -- abnormal sperm shape or structure prevent it from moving correctly (iii) Sometimes a man is born with the problems that affect his sperm. (iv) Other times problems start later in life due to illness or injury

What increases a man's risk of infertility?

The number and quality of a man's sperm can be affected by his overall health and lifestyle. Some things that may reduce sperm number and/or quality include: (i) alcohol/drugs (ii) environmental toxins such as pesticide (iii) smoking cigarettes (iv) a history of mumps (v) certain medications (vi) radiation treatment due to cancer.

What causes infertility in women?

Infertility in women may occur due to (i)Problems in ovulation (ii) blocked fallopian tubes (iii) physical problems with the uterus (iv) lumps in the uterus referred to as uterine fibroids.

What things increase a woman's risk of infertility?

Many things can affect a woman's ability to have a baby. These include: (i) Increasing age (ii) Stress (iii) Poor diet (iv) Being overweight or underweight (v)smoking (vi) Alcohol (vii) sexually transmitted diseases (viii)Health problems that cause hormonal changes.

How does a sexually transmitted disease cause infertility ?

The bacteria responsible for causing a sexually transmitted infection may gain access above the cervix to the uterus and tubes, the inside surfaces of the fallopian tubes are denuded of their skin. An abscess may be formed inside. Even when it gets resolved by treatments with antibiotics, the denuded inside of the tube may cause sticking together of the walls of the tube so that there is a blockage of the tube(s) later to sperm and eggs. For normal pregnancy, the sperm and the egg meet in the tube where fertilization takes place.

How does age affect a woman's ability to have children?

Aging decreases a woman's chances of having a baby in the following ways: (i) The ability of a woman's ovaries to release eggs ready for fertilization declines with age. (ii) As a woman ages she is more likely to have health problems that can interfere with fertility. (iii) her risk of having a miscarriage increases.

How long should women try to get pregnant before calling their doctors?

(i) Most healthy women under the age of 30 shouldn't worry about infertility unless they've been trying to get pregnant for at least a year. (ii) Women in their 30s who've been trying to get pregnant for six months should speak to their doctors as soon as possible. A woman's chances of having a baby decrease rapidly every year after the age of 30. So getting a complete and timely fertility evaluation is especially important.

How is a man tested for an infertility problem?

For a man, doctors usually begin by testing his semen. They look at the number, shape, and movement of the sperm. Sometimes doctors also suggest testing the level of a man's hormones.

How is a woman tested for an infertility problem?

As a part of evaluating infertility in a woman, doctors may perform the following tests: (i) Check for ovulation by means of blood tests and ultrasound of the ovaries. (ii) Hysterosalpingography: This is an X –ray technique to check for functioning of the fallopian tubes (iii) Laparoscopy: This is a surgical technique by means of which doctors use a tool known as laparoscope to see inside the abdomen. Using the laparoscope, doctors check the ovaries, fallopian tubes, and uterus for disease and physical problems.

How do doctors treat infertility?

Infertility can be treated with medicine, surgery, artificial insemination or assisted reproductive technology. Many times these treatments are combined. Doctors recommend specific treatments for infertility based on: (i) test results (ii) how long the couple has been trying to get pregnant (iii) age of both the man and woman (iv) the overall health of the partners (v) preference of the partners.

How successful are these infertility treatment modalities?

About two-thirds of couples who are treated for infertility are able to have a baby.

How do doctors often treat infertility in men?

Doctors often treat infertility in men in the following ways: (i) Sexual problems: If the man is impotent or has problems with premature ejaculation, doctors can help him address these issues. Behavioral therapy and/or medicines can be used in these cases. (ii) Too few sperm: If the man produces too few sperm, sometimes surgery can correct this problem. Antibiotics can also be used to clear up infections affecting sperm count.

How do doctors often treat infertility in women?

Doctors often treat infertility in women in the following ways: (i) Various fertility medicines are often used to treat women with ovulation problems (ii) Doctors also use surgery to treat some causes of infertility. Problems with a woman's ovaries, fallopian tubes, or uterus can sometimes be corrected with surgery.

What is Artificial Insemination?

In this procedure, the woman is injected with specially prepared sperm. Artificial insemination is often used to treat (i) in case the male partner is infertile.(ii) women who have problems with their cervical mucus (iii) couples with unexplained infertility

What is assisted reproductive technology (ART)?

Assisted reproductive technology (ART) is a term that describes several different methods used to help infertile couples. ART involves removing eggs from a woman's body, mixing them with sperm in the laboratory and putting the embryos back into a woman's body. ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who can not produce eggs. Also, donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease that can be passed on to the baby.

How often is assisted reproductive technology (ART) successful?

The average success rate has been seen to be 37 % for women less than 35 years of age. With rising age, the success rate tends to decline. Apart from age, success rates vary and depend on many factors. Some things that affect the success rate of ART include: (i) reason for infertility (ii) type of ART (iii) if the egg is fresh or frozen (iv) if the embryo is fresh or frozen

What are the different types of assisted reproductive technology (ART)?

Common methods of ART include: (i) In vitro fertilization (IVF) (ii) Zygote intrafallopian transfer (ZIFT) (iii) Gamete intrafallopian transfer (GIFT) (iv) Intracytoplasmic sperm injection (ICSI)

What is In vitro fertilization (IVF)?

IVF means fertilization outside of the body. IVF is the most effective ART. It is often used when a woman's fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man's sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the woman's uterus.

What is Zygote intrafallopian transfer (ZIFT) ?

ZIFT is similar to IVF. Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus.

What is Gamete intrafallopian transfer (GIFT)?

Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the woman's fallopian tube. So fertilization occurs in the woman's body.

What is Intracytoplasmic sperm injection (ICSI)?

In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or fallopian tube. ICSI is often used for couples in which there are serious problems with the sperm. Sometimes it is also used for older couples or for those with failed IVF attempts.

What is AIDS? What causes AIDS?

2008-11-04T07:09:00.000-08:00

AIDS stands for Acquired Immune Deficiency Syndrome.. AIDS is a medical condition caused by a deadly virus called HIV. People develop AIDS because HIV has damaged their natural defences against disease.

HIV (Human Immunodeficiency Virus)

HIV is a virus. Viruses infect the cells that make up the human body and replicate (make new copies of themselves) within those cells. A virus can also damage human cells, which is one of the things that can make a person ill.

HIV can be passed from one person to another. Someone can become infected with HIV through contact with the bodily fluids of someone who already has HIV.

HIV stands for the 'Human Immunodeficiency Virus'. Someone who is diagnosed as infected with HIV is said to be 'HIV+' or 'HIV positive'.

An HIV-positive person receives an AIDS diagnosis after developing one of the CDC-defined AIDS indicator illnesses. An HIV-positive person can also receive an AIDS diagnosis on the basis of certain blood tests (CD4 counts) and may not have experienced any serious illnesses. A positive HIV test does not mean that a person has AIDS. A diagnosis of AIDS is made by a physician according to the CDC AIDS Case Definition.

Over time, infection with HIV (Human Immunodeficiency Virus) can weaken the immune system to the point that the system has difficulty fighting off certain infections. These types of infections are known as opportunistic infections. Many of the infections that cause problems or that can be life-threatening for people with AIDS are usually controlled by a healthy immune system. The immune system of a person with AIDS has weakened to the point that medical intervention may be necessary to prevent or treat serious illness.